Protein Expression Profile of Synovial Fibroblasts in Experimental Post-traumatic Arthritis

OBJECTIVE: To evaluate and compare protein expression profiles of synovial fibroblasts using proteome analysis in swine knee injuries with joint instability, during early post-traumatic arthritis (PTA) development. METHOD: Experimental PTA was induced by transection of the anterior cruciate ligament (ACL) in swine left knee joints. After sacrifice at 8 weeks, cartilage and synovium obtained from both knee joints were prepared for histopathologic examination. Cultured synovial fibroblasts were processed for 2-dimensional electrophoresis and mass spectrometric analysis. Histopathologic examination showed overt arthritic changes that supported the development of early PTA. RESULTS: Proteome analyses led to the identification of more than 1,500 protein spots and of 11 differently expressed protein spots. Of those, six proteins were down-regulated (cytoskeletal beta actin, cofilin-1, destrin, Rho GDP dissociation inhibitor alpha, and unnamed protein product), and five proteins were up-regulated (alpha-B crystallin, smooth muscle protein 22-alpha, and cytoskeletal beta actin) in ACL-transected synovial fibroblasts. That is, proteins related to cellular organization and signal transduction are down-regulated, and those related to cell rescue, defence, and stress are up-regulated. CONCLUSION: These results may suggest that joint instability contributes to the development of PTA and is one of the major etiologic factors of PTA. In addition, this suggests that the proteome analysis of synovial fibroblasts is a useful approach in examining a joint after an injury and can be used to understand the pathogenesis of PTA.

Comparison between the Effect of Local Steroid Injection and Prolotherapy on Iliac Crest Pain Syndrome

OBJECTIVE: To evaluate the therapeutic effect of local steroid injection and prolotherapy on the iliac crest pain syndrome (ICPS) in patients with nonspecific low back pain. METHOD: 44 patients with ICPS were chosen randomly. The treatment groups were divided into two. The first group received a mixture of triamcinolone and lidocaine. The second received with a mixture of dextrose and lidocaine. The patients in each group were injected once a week over 4 weeks. The effectiveness of treatment was evaluated by a visual analogue scale (VAS), a pressure threshold and patient's life activities with modified Oswestry questionnaire before injection, 30 minutes, 1 week, 4 weeks and 3 months later after injection respectively. RESULTS: VAS, pressure threshold and patient's life activities of two groups were all improved at 30 minutes, 1 week, 1 month and 3 months after injection compared with those of pre-injection, and there was no significant difference between groups. CONCLUSION: The low back pain on ICPS can be significantly improved by local steroid injection and prolotherapy equally. Therefore, patients with risk of steroid injection could be treated by prolotherapy.

The Effects of the Local Steroid Injection in the Patients with Medial Superior Cluneal Nerve Entrapment

OBJECTIVE: The aim of this study was to evaluate the efficacy of the local steroid injection in the patients with medial superior cluneal nerve entrapment. METHOD: The participants were 20 (13 men, 7 women) patients with medial superior cluneal nerve entrapment diagnosed by Maigne's criteria (unilateral buttock pain, tender point at iliac crest, and relieved pain by nerve block). All patients were injected with 1% lidocaine 1.75 ml and triamcinolone 10 mg at maximal tender point which was 7~8 cm away from spinous process horizontally on the iliac crest. The visual analogue scale (VAS) and the modified Oswestry questionnaire (MOQ) were checked at before, 2 weeks and 4 weeks after injection. And the VAS was checked 10 min after injection to determine the accuracy of injections. RESULTS: The mean VAS scores of before injection, 10 min, 2 weeks, and 4 weeks after injection were 7.7, 2.8, 4.0, and 4.0 respectively. The mean MOQ of before injection, 2 weeks, 4 weeks after injection were 35.7, 23.8, and 23.8 respectively. Both VAS and MOQ were significantly different in before injection, 2 weeks and 4 weeks after injection (p<0.05). CONCLUSION: The local steroid injection is an effective treatment of medial superior cluneal nerve entrapment.

Effects of L4-5 Transforaminal Epidural Steroid Injection in L5 Radiculopathy

OBJECTIVE: The aim of this study was to compare the therapeutic and functional values between the L5-S1 transforaminal epidural steroid injection (TFESI) and L4-5 TFESI in patients with L5 radiculopathy. METHOD: Among 30 patients with unilateral herniated nucleus pulposus (HNP) and L5 radiculopathy, 15 patients received L5-S1 TFESI and 15 patients received L4-5 TFESI. All patients were checked visual analogue scale (VAS) and functional score before injection, after 1 day, 2 weeks and 4 weeks. RESULTS: The VAS of before injection, after 1 day, 2 weeks and 4 weeks were 6.6, 4.0, 3.0, and 2.8 in L5-S1 TFESI, 6.2, 3.9, 2.7, and 2.6 in L4-5 TFESI, respectively. The functional score of before injection, after 1 day, 2 weeks and 4 weeks were 1.8, 2.3, 2.6, and 3.0 in L5-S1 TFESI, 1.6, 2.2, 2.5, and 2.8 in L4-5 TFESI, respectively. There was no statistical difference between the groups (p>0.05). CONCLUSION: This study suggested that either L5-S1 TFESI or L4-5 TFESI could be a valuable treatment of L5 radicular pain.

The Effect of Intra-articular Hyaluronic Acid in Facet Syndrome of the Lumbar Spine

OBJECTIVE: To evaluate the efficacy of intra-articular hyaluronic acid injection and to compare this with the efficacy of steroid injection for the treatment of facet syndrome of the lumbar spine. METHOD: Sixty-eight patients with facet syndrome of the lumbar spine were assigned two groups at random to receive an intra-articular injection into the facet joint. One group received a intra-articular injection of the facet joint three times at 1 week apart with a mixture of hyaluronic acid 0.6~0.7 ml and 1% lidocaine 0.2 ml. The other group received a intra-articular injection of the facet joint one time with a mixture of triamcinolone 10 mg and 1% lidocaine 0.5~1 ml. The effectiveness of treatment was assessed with the visual analogue scale (VAS), and the patient's life activities were assessed with the modified Oswestry questionnaire. RESULTS: The VAS and the patient's life activity of the two groups all showed improvement at 1 week, 1 month and 3 months after injection, but there was no significant difference in the VAS scores and the patient's life activity scores between the two groups. CONCLUSION: The intra-articular injection of hyaluronic acid would be a good treatment method for facet syndrome of the lumbar spine.

Immediate Effects of Patella Taping in Individuals with Knee Osteoarthritis

OBJECTIVE: To evaluate the effects of patella taping on pain and disability in symptomatic knee osteoarthritis (OA). METHOD: Using a within-subjects study design, 54 patients were tested under three conditions in random order: untaped, wearing therapeutic knee tape and wearing control knee tape. Outcome measure was pain as measured by visual analogue scale and disability as measured by walking speed, timed up and go test, and step test. RESULTS: The therapeutic tape significantly reduced pain, when compared with the control and untaped conditions (p0.05). A significant association between change of pain in stairs and lateral patellofemoral joint space was evident (r=0.503, p<0.05). CONCLUSION: Therapeutic knee tape is a simple, inexpensive strategy that increases the treatment options for therapists and patients in the conservative management of knee OA.

The Prevalence of Behavioral Risk Factors and Lifestyle Changes after Stroke

OBJECTIVE: Stroke is a major cause of mortality throughout the world and several studies have reported survival experience following stroke in different populations. This study estimates the prevalence of behavioral risk factor after stroke and explores lifestyle changes. METHOD: The subjects were 529 patients, who were admitted at the Kyung Hee Medical Center from January 2000 to February 2001. Data collection was done through chart reviews, telephone interviews, and mail. Main measures included smoking status, alcohol use, and obesity. Chisquare test and multiple logistic regression were used to determine sociodemographic differences in these measures. RESULTS: At 1 year after stroke, 11.2% of patients still smoked, 31.4% of patients were obese, and 13% drank excessively. Younger patients and patients with high blood pressure were more likely to smoke. Younger patients were more likely to drink excessively. Women, patients with diabetes, and those living in the metropolitan areas were more likely to be obese. CONCLUSION: Different behavioral risk factors were associated with specific sociodemographic groups within the stroke population. After stroke, high-risk groups should continue to be targeted to prevent stroke recurrence.

The Clinical Features of the Postinfarction Seizure

OBJECTIVE: We reviewed the clinical features of the patients with postinfarction seizure to evaluate the high risk factors of postinfarction seizure. METHOD: We retrospectively studied 81 patients with post infarction seizures to determine the clinical features (onset, type of seizure, etc.) with their clinical recordings, electroencephalographic (EEG), and computed tomographic (CT) or magnetic resonance imaging (MRI) findings. RESULTS: Patients comprised 49 men and 32 women with their ages ranged from 31 to 87 (mean 64.7) years. After cerebral infarction, 31 patients experienced seizures within 2 weeks and 50 patients more than 2 weeks. Generalized tonic-clonic and simple partial seizures were the most common type of seizure. 40 patients showed focal slowing on EEG. The most common location of the cerebral infarction was cortical area and frequently involved lobes were frontal and temporal lobes. The recurrent seizure was not associated with seizure onset duration, seizure type, EEG finding, or location of infarction. The size of cerebral infarction was significantly associated with recurrent seizure but not associated with first-attack seizure. CONCLUSION: This results would be helpful for prevention and treatment of postinfarction seizures.

Limited Joint Motion in Type II Diabetic Patients; Association with Diabetic Complications and Related Disease

OBJECTIVE: This research aimed to evaluate the relationship of limited joint motion (LJM) and shoulder adhesive capsulitis with diabetic complications and related diseases in type II diabetic patients. METHOD: A cross sectional study in 155 type II diabetic patients was done. The presence of LJM and shoulder adhesive capsulitis was sought. The diseases closely related to diabetes were recorded. The patients were assessed for retinopathy, nephropathy, and neuropathy. RESULTS: The prevalence of LJM and shoulder adhesive capsulitis in type II diabetic patients was 32.3% and 29.7%, respectively. Development of LJM and shoulder adhesive capsulitis was correlated with age and duration of diabetes. Higher blood HbA1c level was noticed in mild and moderate degree of LJM. The prevalence of shoulder adhesive capsulitis was shown association with LJM. The prevalence of LJM was associated with a history of myocardial infarction and chronic diabetic complications. The prevalence of shoulder adhesive capsulitis was associated with retinopathy, carpal tunnel syndrome, and autonomic neuropathy. CONCLUSION: According to the results, around 30% of type II DM patients could have hand LJM and should adhesive capsulitis, which suggested more attention and effort to prevent the LJM and shoulder adhesive capsulitis were needed.

The Effect of the Prolotherapy on the Injured Achilles Tendon in a Rat Model

OBJECTIVE: The purpose of this study was to evaluate the effects of the prolotherapy on the healing of the tendon tissue and the proliferation of fibroblasts in the injured Achilles tendons. METHOD: The tendons of twenty eight Sprague-Dawley rats were transected at 2 mm above the calcaneal insertion in the right Achilles tendon and sutured. Then they were allocated randomly into two groups: prolotherapy group and control group. We injected 20% dextrose 0.1 ml on injured tendon area of prolotherapy group immediately after transection. After 2 and 4 weeks, the diameters of tendons were measured on both the injured and uninjured tendon. The number of fibroblasts and the ratio of fibroblast to fibrocyte on the injured tendon tissues were measured by the image analyzer. RESULTS: The diameters of the injured tendons of the prolotherapy group were not significantly different with that of the control group. However, the number of fibroblasts and the ratio of fibroblast to fibrocyte in the prolotherapy group showed significantly larger and more increased than the control group (p<0.05). CONCLUSION: This result showed the additional regeneration effect of the prolotherapy on the healing of the injured tendon tissue. Therefore, the prolotherapy would be an effective treatment on the tendon injury.

The Characteristics of the Clinical Improvement and the Electrodiagnostic Study in Facial Nerve Palsy

OBJECTIVE: The purpose of this study was to observe the characteristics of the clinical improvement and the electrodiagnostic study in non-traumatic facial nerve palsy. METHOD: The clinical observation and the electrodiagnostic study were done in 57 of 266 patients who were treated at the Kyunghee Medical Center from December 2000 to July 2001. The initial study was done at 2 weeks from the onset time, and the follow-up study was done at 3 months later. The blink reflex, nerve conduction study and needle EMG were done, and made a statistical comparison between the initial and follow-up study. RESULTS: The clinical improvement and the change of the electrodiagnostic study between the initial and follow-up study were remarkable in the patients with expected to be good and fair prognosis. In the electrodiagnosis study, there were no statistical correlations on the % degeneration of the CMAP amplitude in the patients with expected to be poor prognosis. CONCLUSION: Although the ideal electrodiagnostic study does not yet exist, the best method of evaluating the facial nerve is side-to-side evoked amplitude comparison, and not only the initial study but also the follow-up, this method would be very useful.

The Relationship between the Lower Lumbar Disc Herniation and the Morphology of the Iliolumbar Ligaments Using Magnetic Resonance Imaging

OBJECTIVE: This research aimed to define the relationship between the lower lumbar disc herniation and the morphology of the iliolumbar ligaments using magnetic resonance imaging. METHOD: 24 male and 36 female patients were classified into two groups according to their disc herniation grade- those in whom the L5-S1 disc was less herniated than L4-5 disc, those in whom the L5-S1 disc was more herniated than the L4-L5 disc on magnetic resonance images. The lengths of iliolumbar ligaments were measured on T1- weighted coronal images. The angles of iliolumbar ligaments were measured on T1-weighted axial images. RESULTS: The length of iliolumbar ligament was not different between L4-L5 disc herniation and L5-S1 disc herniation. The degree of iliolumbar ligament angle difference (asymmetry of direction) at L5-S1 disc herniation was more deviated in paracentral disc herniation compared with central disc herniation. CONCLUSION: The morphology of the iliolumbar ligament, especially its asymmetry of direction, may be a factor influencing the development of disc herniation at L5-S1.

Effects of Local Corticosteroid Injection and Weight Bearing on Injured Achilles Tendon in a Rat Model

OBJECTIVE: To evaluate the effects of local triamcinolone (TAC) injection and weight bearing on healing process of the injured Achilles tendon. METHOD: The right Achilles tendons in 54 rats, Sprague-Dawley (about 200 g), were each sutured after transection and allocated into three groups according to the amount of the local injection of TAC (none, 0.25 mg, and 1.25 mg respectively), and subsequently each group divided into three subgroups by the type of weight bearing {normal weight bearing (NWB), treadmill exercise (7-8 m/min, 10 min/day) from day 7 for 7 days, and hind limb immobilization respectively}. On 15th day rats were sacrificed, and then diameters of both injured and uninjured tendon, numbers of fibroblasts on injured tissues and he percentage of matured fibroblasts by microscopy were evaluated. RESULTS: The diameter of the hypertrophied neotendon in groups injected with TAC 1.25 mg was significantly decreased, but not in the others. There were no differences in numbers of fibroblast. As the amount of TAC increased in groups done with NWB and treadmill exercise, the percentages of matured fibroblasts significantly decreased. CONCLUSION: The local TAC injection on acute tendon injuries had deleterious effects on healing process of tendon, and follow-up study about the types of weight bearing is needed.

Dose-Related Effects of Steroid on the Experimental Arthritis in Rabbits

OBJECTIVE: To investigate dose-related effects of repeated intraarticular steroid injection on the experimental arthritis. METHOD: Twenty-four adult male rabbits received Zymosan A into their right knee joint for experimental arthritis. After a week, they were injected with 2 mg (group I; n=9), 10 mg (group II; n=7) or 20 mg (group III; n=8) triamcinolone acetonide into their right knee weekly interval for 4 weeks. We measured weekly changes of the weight and the mediolateral diameter of both knees for the calculation of edema index. 99mTechnetium pertechnate (99mTc) uptake measurement were performed before the first steroid injection and a week after the final steroid injection. All rabbits were sacrificed and histologic examinations of their proximal tibia were performed. RESULTS: A progressive weight loss and changes of edema index were evident for all rabbits (p0.05). In the histological findings, fibrillation-frayings and fissures of the surface were similar in all rabbits, but loss of nuclear stains and cyst formations were increased prominently in group III than group I (p<0.05). CONCLUSION: Low-dose repeated steroid intraarticular injections are safe and effective treatment in arthritis though no definite evidence of chondroprotection, and high-dose steroid injections accelerate degeneration of the arthritic cartilage.

Spinocerebellar Ataxia Type 3 Confirmed by Genomic Molecular Analysis: A case report

Dominantly inherited spinocerebellar ataxias (SCAs) are a group of the heterogenous neurodegenerative diseases that are characterized by chronic progressive cerebellar ataxia associated with various combinations of other neurological signs. Clinical classification is difficult because of the phenotypic overlap. With the evolution of molecular genetics, the loci and mutations for many of the ataxias have been identified, allowing more definitive molecular classification. We experienced 42 years-old man who presented with progressive both lower leg weakness, dysarthria, ataxia, ophthalmoplegia, and nystagmus. The family history was remarkably suspicious. We could not observe the upper extremity weakness, definite evidences of peripheral neuropathy and myopathy in electrodiagnosis. No abnormal findings in blood chemistry and brain MRI. We performed polymerase chain reaction (PCR) and polyacrylamide gel electrophoresis (PAGE) analysis, found that his gene contained expanded CAG repeats (CAG repeat number was 72). Although no effective treatment exists for most the ataxic syndromes, the accurate diagnosis and the genetic counseling are often important to the patient's family for prognostication.

Skin Lesion after Repeated Fluoroscopically Guided Procedures: A Case Report

The radiation exposure has multiple complication of various organs. Especially, the Food and Drug Administration has recently issued a bulletin warning of the risks of acute skin injury occurring during fluoroscopically guided procedures. Physicians need information about typical radiation doses during fluoroscopically guided various procedures and estimates of entrance skin dose must be monitored using thermoluminescent dosimetry, film badge dosimetry, pocket dosimetry and on-line computer system. Current National Council on Radiation Protection and Measurements recommended are that yearly total body dose should not exceed 50 mSv (5 rem) and that life time dose measured in millisieverts should not exceed one's age in years multiplied by 10. Types of skin injury are erythema, alopecia, dry desquamation, invasive fibrosis, dermal atropy, telangiectasia, moist desquamation, skin necrosis and secondary ulcer. Also, long-term exposure caused skin cancer. We experienced personally pigmentation on the finger nail and the hand after repeated fluoroscopically guided procedures. Thus, we report this case for giving warning to the physiatrist by the complications due to frequent exposure during procedures.

The Effects of Facet Joint Injection in Osteoporotic Spinal Compression Fractures

OBJECTIVE: To evaluate the effects of facet joint injection in the conservative management of osteoporotic spinal compression fractures METHOD: Among 27 patients with osteoporotic spinal compression fractures which were confirmed by plain radiography and bone densitometry (dual energy x-ray absorptiometry), 9 patients were control group and 18 patients received facet joint injection treatment. Facet joint injection of thoracolumbar spine was done under fluoroscopic guide with 1% lidocaine 1 ml and triamcinolone 10 mg at each joint above and below the level of compression fracture at both side. Main outcome measures were visual analog scale (VAS), spinal movement (modified Schober's and lateral bending test), and physical activity from bed-ridden state (grade I) to outdoor activity without pain (grade V). The treatment outcomes were assessed before injection, 2 weeks and 4 weeks after injection. RESULTS: There were significant decrease in VAS at 2 weeks and 4 weeks after injection in the study group (p<0.05). Physical activity was significantly improved at post injection 2 weeks and 4 weeks (p<0.05). There were no significant differences between the two groups in spinal movement. CONCLUSION: These results suggest that facet joint injection of thoracolumbar spine is useful method in the conservative management of painful osteoporotic compression fractures.

Correlation between Bone Mineral Density and Interverterbral Disc Degeneration

OBJECTIVE: To examine the correlation between bone mineral density and intervertebral disc degeneration through retrospective study. METHOD: Bone mineral density (BMD) and Magnetic resonance (MR) image of lumbar spine from 61 postmenopausal women were assessed to examine the correlation between bone mineral density and intervertebral disc degeneration. We determined BMD of lumbar spine using the dual energy X-ray absorptiometry (DEXA). And we evaluated signal intensity of intervertebral disc, disc height and disc herniation at each lumbar disc level using the MR image. The correlation between BMD (mean value of 2nd, 3rd and 4th lumbar spine BMD) and the sum of grading scores of intervertebral disc degeneration was assessed in all the patients. RESULTS: There was a positive correlation between BMD of lumbar spine and the sum of grading scores of intervertebral disc degeneration (r=0.415, p value=0.00087). CONCLUSION: Bone mineral density has an inverse correlation to intervertebral disc degeneration and which is important when considering degenerative spinal disease and osteoporosis.

Effects of Translaminar Approach and Transforaminal Approach in Lumbar Epidural Steroid Injection

OBJECTIVE: The goal of this study was to compare the therapeutic and the functional value between translaminar approach and transforaminal approach of epidural steroid injection in patient with refractory radicular pain. METHOD: Among 31 patients with unilateral herniated nucleus pulposus (HNP) which was confirmed by physical examination and magnetic resonance imaging (MRI), 17 patients received a transforaminal approach and 14 patients received a translaminar approach. All patients were evaluated by independent observer and were checked by visual analogue scale (VAS), functional score before and 1 day, 2 weeks and 4 weeks after injection. RESULTS: The VAS of transforaminal approach was significantly lower than that of translaminar approach after 2 weeks and after 4 weeks (p<0.05), although there were no statistical difference before and 1 day after injection. The functional score of transforaminal approach was significantly higher than that of translaminar approach after 4 weeks (p<0.05), although there were no statistical difference before and 1 day, 2 weeks after injection. The translaminar approach needs more frequent injection (p<0.05). CONCLUSION: This study suggests that both translaminar approach and transforaminal approach could be valuable to the initial management of refractory radicular pain, but the duration of therapeutic effects was relatively short in translaminar approach. Transforaminal approach will be the promising treatment of refractory radicular pain, because it has better therapeutic efficacy, safety and longer duration of therapeutic effects than translaminar approach.

Comparison of Catecholamine Levels in Hemiplegic Patients with and without Reflex Sympathetic Dystrophy

OBJECTIVE: To determine whether the cause of sympathetic dysfunction is due to increased regional sympathetic outflow or receptor supersensitivity to circulating catecholamines in the pathogenesis of reflex sympathetic dystrophy in hemiplegia. METHOD: Ten hemiplegic patients with reflex sympathetic dystrophy were instructed to refrain from smoking or using caffeine and alcohol, and medications that influence catecholamine metabolism were witheld for 24 hours before blood sampling. Patients with cardiovascular disease, diabetes or abnormal liver and renal function tests were excluded from the study. Patients with a history of sympathectomy were also excluded. Ten hemiplegic patients without reflex sympathetic dystrophy served as the control group. Both groups of patients rested in supine position in a quiet room for 30 minutes. A needle with heparin cap was inserted into the dorsal venous arches of the affected hand and patients rested for another 20 minutes, after which blood was drawn through the heparin cap. The blood samples were assayed using high-performance liquid chromatography (HPLC) and norepinephrine and epinephrine were detected electrochemically. 24 hour urine was collected during rest and vanillylmandelic acid (VMA) and metanephrine were also detected using HPLC. RESULTS: The mean plasma norepinephrine levels were 1.05 0.24 ng/ml and 0.47 0.06 ng/ml in RSD affected and unaffected groups respectively, and the plasma norepinephrine level was significantly higher in the patient group with reflex sympathetic dystrophy (p<0.05). The plasma epinephrine and 24-hour urine VMA and metanephrine levels were not significantly different in two groups. CONCLUSION: These results may support a hypothesis of increased regional sympathetic outflow in the pathogenesis of reflex sympathetic dystrophy in hemiplegia.