Initial trabeculectomy with mitomycin C in eyes with uveitic glaucoma with inactive uveitis.

PURPOSE: To analyse clinical outcomes of trabeculectomy with mitomycin C (MMC) in eyes with uveitic glaucoma (UG) with inactive uveitis and compare them to those in eyes with primary open-angle glaucoma (POAG). DESIGN: Retrospective non-randomized comparative interventional case series. METHODS: A total of 53 eyes with UG and 80 eyes with POAG that received MMC trabeculectomy as an initial ocular surgery with average follow-up of 5.4 years were reviewed retrospectively. The intraocular pressure (IOP) control and persistence of filtering bleb were analysed using the Kaplan-Meier life-table method based on two definitions of successful IOP control, ie complete success (IOP

Unicompartmental knee arthroplasty for osteoarthritis of the knee: remaining postoperative flexion contracture affecting overall results.

The success rate of unicompartmental knee arthroplasty has been variable, and controversy still surrounds its use. Achieving good functional results from this surgery may require understanding surgical principles, precise operative techniques, and careful patient selection. This paper evaluates clinical results and factors influencing postoperative knee function after unicompartmental knee arthroplasty. The follow-up assessment of 109 knees that underwent unicompartmental knee arthroplasty showed that 90 of 109 knees were classified as excellent or good (82.6%) using the Hospital for Special Surgery knee scoring system. In the excellent group (54 knees), 52% of the postoperative, standing femorotibial angles converged on a range of 170 degrees to 175 degrees with a mean of 174 degrees +/- 4 degrees. The knees with residual flexion contracture after surgery showed poorer clinical results. Therefore, complete elimination of the flexion contracture during surgery is considered mandatory.

NF-kappa B and I-kappa B overexpression in articular chondrocytes with progression of type II collagen-induced arthritis in DBA/1 mouse knees.

OBJECTIVE: To investigate the roles of NF-kappa B and I-kappa B in chondrocytes in the cartilage destruction of mouse collagen-induced arthritis. METHODS: DBA/1 mice were immunized with bovine type II collagen (C II) emulsified with Freund's incomplete adjuvant. Histological abnormalities in the mouse knees were evaluated in sections stained with hematoxylin and eosin, or toluidine blue. Immunostaining using anti-NF-kappa B and anti-I-kappa B antibodies was performed to observe the expression and nuclear shift of NF-kappa B and I-kappa B in articular chondrocytes. RESULTS: Loss of metachromasia of perichondrial cartilage was found in 8 out of 10 knees of the mice at 5 weeks, and in all 10 knees at 7 weeks after C II-immunization. The mean percentage of NF-kappa B-positive chondrocytes at 3, 5 and 7 weeks and in the control was 33.6 +/- 7.6, 54.9 +/- 2.7, 75.9 +/- 1.0 and 27.9 +/- 3.8%, respectively. The mean percentage of NF-kappa B-positive nuclei was 9.1 +/- 0.7, 19.5 +/- 3.7, 47.5 +/- 3.0 and 8.6 +/- 0.1%, respectively. NF-kappa B-positive chondrocytes significantly increased from 3 to 7 weeks in a time-dependent manner (p < 0.0001). The percentage of I-kappa B-positive chondrocytes at 3, 5 and 7 weeks and in the control was 15.5 +/- 1.7, 41.1 +/- 2.5, 51.2 +/- 5.7 and 12.1 +/- 2.1%, respectively. I-kappa B-positive chondrocytes significantly increased from 3 to 5 weeks (p < 0.005). CONCLUSION: These findings suggest that nuclear shift of NF-kappa B localization causes cartilage destruction in the early stage of arthritis in DBA/1 mice immunized with C II.

Immunolocalization of carboxy-terminal type II procollagen peptide in regenerated articular cartilage of osteoarthritic knees after reduction of mechanical stress.

OBJECTIVE: The purpose of this study was to investigate the immunolocalization of carboxy-terminal type II procollagen peptide (pCOL-II-C) in the regenerated articular cartilage grown 1-2 years after reduction of mechanical stress by correction of varus deformity with high tibial osteotomy (HTO) for knees with medial compartmental osteoarthritis. DESIGN: The series included 24 knees of 16 patients with a mean age of 70 (56-79) years. Synovial fluid and tissue specimens of the regenerated articular cartilage were obtained at the time of plate removal with arthrotomy. Tissue specimens were decalcified and stained with toluidine blue, safranin O, anti-type I and type II collagen and anti-pCOL-II-C. Pineda's histological grading of articular cartilage repair and Okada's grade of immunostaining were employed to assess the regenerated articular cartilage. RESULTS: In knees with regeneration of articular cartilage, there was a positive linear correlation between the grade of immunostaining and the concentration of synovial fluid pCOL-II-C (r=0.652; P< 0.001). Similarly, a positive linear correlation was observed between the grade of immunostaining and the histological grading score (r=0.683; P< 0.001). CONCLUSIONS: The immunostaining and synovial fluid concentration of pCOL-II-C decreased in accordance with the progression of articular cartilage regeneration observed after reduction of mechanical stress by correction of deformity with HTO.

Development of Dunn osteosarcoma inoculated into subcutaneous air pouch in mice.

Dunn osteosarcoma cell growth was observed in C3H/Hej mouse subcutaneous air pouch. Inoculation with Dunn osteosarcoma cell suspension was performed by injection into air pouches of 70 mice on Day 7 after the initial injection of air. The developmental pattern of the tumor cell colonies was classified histologically into five stages. In Stage 0 (stage of no tumor cells), there were no tumor cells. In Stage 1 (focal stage), the colonies were limited to the lining-cell layers. In Stage 2, (segmental stage) the colonies protruded into the cavity of the pouch. In Stage 3 (annular stage), the total surface of the inner wall of the pouch was occupied by tumor cells. In Stage 4 (occlusive stage), the cavity of the pouch was fully occupied by tumor cells. The tumor was observed to develop to stage 1 in all mice 7 days after inoculation. The colonies were all found to be settled initially in the deeper layer of lining cells. Thus, the mouse air-pouch model is useful for direct observation of osteosarcoma cell growth.

Quantitative analysis of NF-kappaB-expression in cartilage and synovium of rat knee induced by intra-articular injection of synthetic lipid A.

OBJECTIVE: NF-kappaB expression in cartilage and synovium of rat knee after intra-articular injection of lipid A was investigated. METHODS: Inflammation was evaluated in histological sections stained with hematoxylin and eosin, toluidine blue and immunostained with monoclonal anti-NF-kappaB antibody or monoclonal anti-TNF-alpha antibody. RESULTS: Inflammatory cell infiltration into the synovium, hyperplasia of synovial lining layers, loss of metachromasia of cartilage, TNF-alpha-positive cells and NF-kappaB-positive cells in the synovium and cartilage were observed in all 26 rat knees intra-articularly injected with lipid A. The numbers of TNF-alpha-positive and NF-kappaB-positive synovial cells and chondrocytes after the injection were significantly greater than those in knees injected with triethylamine (p < 0.05). The amount of inflammatory cell infiltration into the synovium, synovial lining layers, TNF-alpha-positive synovial cells and NF-kappaB-positive synovial cells 12 h after the injection was significantly smaller than those after 1 day (p < 0.05). CONCLUSION: Intra-articular injection of lipid A induced NF-kappaB expression in cartilage and synovium. Cartilage degeneration started earlier than synovitis in this model. Quantitative analysis of NF-kappaB in cartilage might be useful to evaluate the extreme acute phase of cartilage degeneration.

Reproducibility of pulsed Doppler measurements of the maternal renal circulation in normal pregnancies and those with pregnancy-induced hypertension.

OBJECTIVE: To assess the inter- and intraobserver reproducibilities of pulsed Doppler measurements of the maternal renal circulation in normal pregnancies and those affected by pregnancy-induced hypertension. MATERIALS AND METHODS: Color and pulsed Doppler ultrasound was used to measure acceleration time and resistance index in the renal segmental and interlobar arteries. For the investigation of interobserver reproducibility, two sonographers performed measurements blindly in six normal pregnant women and 14 women with pregnancy-induced hypertension between 28 and 36 weeks' gestation. A second group of 10 patients between 30 and 35 weeks' gestation were examined by one sonographer to assess the level of intraobserver reproducibility of measurements. For each patient in this group, the flow waveform was measured three times in succession. Calculations of the intraclass correlation coefficient Ri were used to determine the level of reproducibility. RESULTS: The interobserver Ri and intraobserver Ri for acceleration time in the segmental artery were 0.95 and 0.96 and for the interlobar artery they were 0.97 and 0.98, respectively. For the resistance index, these values were 0.01 and 0.01 in the segmental artery and 0.52 and 0.29 in the interlobar artery. CONCLUSION: Both the inter- and intraobserver reproducibility of acceleration time measurements in the renal segmental and interlobar arteries were clinically acceptable but the equivalent reproducibilities of resistance index measurements were poor.

Assessment of the hepatic arterial and portal venous blood flows during pregnancy with Doppler ultrasonography.

PURPOSE: The aim of this study was to evaluate whether the dual hepatic blood supply is altered in healthy pregnant women compared with that in nonpregnant women. MATERIALS AND METHODS: Flow wave-forms in common hepatic artery and portal vein were obtained in 67 healthy pregnant women at 10-40 weeks gestation and 22 nonpregnant women by using Doppler ultrasonography. RESULTS: In the nonpregnant group, the mean (SD) hepatic arterial blood flow, portal venous blood flow, and total liver blood flow were 0.57 (0.31) L/min, 1.25 (0.46) L/min, and 1.82 (0.63) L/min, respectively. In the healthy pregnant group, the portal venous blood flow and total liver blood flow significantly increased after 28 weeks gestation. However, the hepatic arterial blood flow remained unchanged during pregnancy. There was no relationship between the hepatic arterial blood flow and the portal venous blood flow. CONCLUSION: The results demonstrated that the hepatic perfusion increased during third trimester compared to nonpregnant level. Because the hepatic arterial blood flow remained unchanged during pregnancy, major determinant of the increase in the hepatic perfusion was the portal venous return. The data suggest that the hepatic arterial and portal venous vascular territories have regulatory mechanisms that allow for independent changes during pregnancy.

Increased cellular infiltrate in inflammatory synovia of osteoarthritic knees.

OBJECTIVE: To determine the nature and origin of synovial inflammation in knees with osteoarthritis (OA). METHOD: Synovial samples were obtained from 21 medial compartmental knee OAs from 19 patients. First, using 11 medial knee synovial samples from 9 patients, a quantitative estimation of synovitis was made with both ordinary and immunohistochemical staining. Second, from the other 10 knees, tissue samples were taken from both the medial and the lateral compartments to quantify cells that infiltrated into the synovium. Medial synovium was immunostained using antibodies to anti-type II collagen, CD68, CD2, CD4, CD8, CD15, CD19, CD25, HLA-DR, CD1a and LN5. The lateral synovium was immunostained with anti-type II collagen, CD68, HLA-DR and CD4 antibody as a control. RESULT: Denatured cartilaginous detritus was found captured by synovial lining cells with a strong immunoreactivity to CD68 antibody, and whose phagocytic potential was activated. The number of anti-type II collagen-positive fragments in the medial compartment of the knee was larger than that found in the lateral compartment. Moreover, the population of CD68-positive cells in synovial tissue and HLA-DR-positive cells in the lining layer was larger in the medial compartment than in the lateral compartment. The number of CD4-positive cells (defined as helper/inducer T lymphocytes) was greater in medial synovium than in lateral synovium. CONCLUSION: Overall, this study strongly supports the concept that the synovitis observed in patients with knee OA might be induced by an immunological mechanism involving, to some extent, a macrophage/helper T cell interaction.

Upregulation of CD44 expression on bovine articular chondrocytes induced by synthetic lipid A.

Abstract The purpose of the study reported in this article was to investigate effects of synthetic lipid A on the expression of adhesion molecule CD44 on bovine articular chondrocytes. Full-thickness bovine articular cartilage was dissected from the carpometacarpal joints of 24 cows. Cartilage pieces were enzymatically digested to liberate chondrocytes. The chondrocytes were incubated in the presence of synthetic lipid A in suspension culture. Cell characteristics and binding of monoclonal antihuman CD44 antibodies were assessed with a flow cytometer. The expression of CD44 mRNA in chondrocytes was detected by reverse transcription-polymerase chain reaction (RT-PCR) technique. PCR products were quantified with a charge-coupled device image sensor. The percentage of CD44-positive chondrocytes was 42.2% ± 12.0%, 51.7% ± 6.8%, and 51.1% ± 5.0%, in the presence of lipid A at 0.25 µg/ml, 2.5 µg/ml, and 25 µg/ml, respectively, whereas it was 39.2% ± 8.9% in the absence of lipid A. In flow cytometry, two subpopulations of chondrocytes were found in each of five separate experiments, one with smaller number of forward scatter (FS) and the other with larger number of FS. The percentage of CD44-positive cells was 24.8% ± 8.5% in the subpopulation with smaller number of FS and 31.9% ± 6.4% in the subpopulation with larger number of FS at time 24 h after incubation. The bacterial component, lipid A, upregulated expression of CD44 on articular chondrocytes.

Doppler velocimetry of maternal renal circulation in pregnancy-induced hypertension.

PURPOSE: The purpose of this study was to evaluate whether the Doppler waveforms of the maternal main renal, segmental, and interlobar arteries are altered in women with pregnancy-induced hypertension (PIH) compared with healthy pregnant women. METHODS: Flow waveforms of the maternal main renal, segmental, and interlobar arteries were obtained from 42 healthy pregnant women between 24 and 41 weeks of gestation and 21 women with PIH between 28 and 40 weeks of gestation using pulsed Doppler sonography. We used spectral analysis to measure the peak systolic and end-diastolic velocities and the acceleration time. The presence or absence of the normal early systolic compliance peak-reflective-wave complex (ESP) was assessed in only the main renal artery. RESULTS: The acceleration times of the segmental and interlobar arteries were significantly prolonged in the PIH group compared with those in the healthy pregnant women. Of the 21 women with PIH, 3 showed loss of the ESP in the renal artery, but these changes were not significant. CONCLUSIONS: Decreased systolic acceleration and the absence of ESP, the hemodynamic indicators for significant proximal stenosis, suggest that severe stenosis or continuous vasospasm in the proximal arteries, such as the main renal or segmental artery, may be implicated in the pathogenesis of PIH.

[Destructed knee in patient with systemic lupus erythematosus treated with total knee arthroplasty: a case report].

We reported a case of a 61-year-old female with arthritis of right knee associated with systemic lupus erythematosus (SLE). She suffered from SLE at age 31 and felt pain around her right knee at age 60. It gradually increased despite intraarticular injections of steroid and arthroscopic synovectomy. On admission, the range of motion of her right knee was 20 to 135 degrees and remarkable gait disturbance were noted due to the pain. Radiographs of the right knee showed joint space narrowing and bone erosion. YMCK total knee arthroplasty was performed. Operation findings showed smooth and thick synovium and cartilage defect. Histological examination revealed fibrin on surface, proliferad connective tissue and newly development of vasculature. Synovium eroded both cartilage and bone. In SLE, soft tissue contructure was reported to be a main cause of joint dislocation, but there were only a few report of progressive joint destruction due to SLE. In this case, the main cause of joint destruction may be invasion synovium into cartilage and bone.

[Effective use of electrolized soft acid aqueous solution for treatment of mediastinitis following cardiac surgery].

Mediastinitis following cardiac surgery occurs infrequently, but features both high mortality and morbidity, especially in patients with an artificial graft. A 24-year-old man was admitted with a diagnosis of Williams'syndrome with supraaortic stenosis. After ascending aorta and hemiarch reconstruction, mediastinitis developed, which was treated successfully with mediastinal irrigation using electrolized soft acid aqueous solution at one liter per day for 3 days. This procedure appears to be an effective method for treatment of mediastinitis following cardiac surgery.

Treatment of the unstable distal radius fracture with external fixation and a hydroxyapatite spacer.

A prospective study was performed on 25 patients (15 women, 10 men) with unstable fractures of the distal radius selectively treated with a dynamic type of external fixation combined with a hydroxyapatite spacer. The fractures ranged from type VI to type VIII according to Frykman's classification. The patients' mean age at surgery was 49 years (range, 19-75 years). The mean follow-up period was 2.5 years, and overall outcome was assessed using Gartland and Werley's demerit point system as modified by Sarmiento. Radial inclination was 26 degrees +/- 4 degrees at the time of reduction and 26 degrees +/- 5 degrees at follow-up, palmar tilt was 9 degrees +/- 2 degrees at reduction and 8 degrees +/- 3 degrees at follow-up, and ulnar variance was 1.4 +/- 0.6 mm at reduction and 2.1 +/- 0.9 mm at follow-up. The mean range of motion at follow-up was 80 degrees +/- 10 degrees in flexion, 80 degrees +/- 10 degrees in extension, 85 degrees +/- 10 degrees in supination, and 80 degrees +/- 5 degrees in pronation. The outcome in 24 of 25 patients was evaluated as excellent. In the surgical treatment of unstable fractures of the distal radius using external fixator, the fracture reduction should be supported with bone graft or a bone substitute, and a hydroxyapatite spacer was considered to be a useful substitute for a bone graft.

Minimum ten-year follow-up clinical and radiographic results of Mark I and Mark II Lord type femoral component in total hip arthroplasty.

The purpose of this study was to evaluate the clinical and radiographic results in 103 hips in 88 patients who had cementless primary Lord type femoral component (stem), with a mean follow-up of 11.8 years (range, 10 to 16 years). The original diagnoses were: osteoarthritis in 77 hips, rheumatoid arthritis in 15, and osteonecrosis of the femoral head in 11. Clinical results were assessed using the Harris hip score. Biological fixation, stem full-fit ratio in the intramedullary canal, and bone remodeling were evaluated by X-ray findings. The average clinical hip scores were: 47.1 points preoperatively, 81.7 points at 1 year, 86.6 points at 5 years, 79.0 points at 10 years, and 76.8 points at 15 years. By setting the endpoint at the time when loosening was radiologically confirmed, the 10-year survivorship of the femoral component was 96.9%, and the 16-year survivorship was 95.9%. The full-fit ratio between the bone implant interface just after surgery showed a significant relationship to stability of the femoral component. The decrease in the hip score at 10 years was caused by aseptic loosening of the acetabular threaded cup. However, the femoral component was stable for more than 10 years after the operation. In conclusion, long-term acceptable durability can be expected with the Lord type femoral component.

Effect of acetabular cup position and orientation in cemented total hip arthroplasty.

Long-term clinical results of total hip arthroplasty for patients with developmental acetabular dysplasia of the hip have been reported, but placement of the femoral head center or cup orientation remains controversial, especially with a severe anterolateral shallow acetabulum or dislocated femoral head. Results of 41 Müller and 34 Harris Design 2 cemented total hip arthroplasties were evaluated for developmental dysplasia of the hip. The femoral head center and acetabular cup inclination angle were measured from the interteardrop line. Linear wear and wear direction were measured using the Livermore technique. The best position of the femoral head center was less than 35 mm vertically from the interteardrop line and 25 mm laterally from the teardrop. Femoral head center analysis showed that hips with the cup in a lateral and superior cup position all were revised, but a superior and medial position combined with a cup inclination angle less than 40 degrees did not require revision. Hips with a cup inclination angle more than 45 degrees had superior and lateral penetration patterns of the polyethylene. However, hips with an inclination angle less than 35 degrees and medial placement had medial head penetration patterns. With these all-polyethylene monolithic cemented cups, regardless of the femoral head diameter or cup thickness, better long-term results occurred with a cup inclination angle of 40 degrees or less and medial position of the cup.

Arthroscopic synovectomy for rheumatoid arthritis using a holmium:YAG laser.

OBJECTIVE: To determine the usefulness of the holmium:YAG laser system in arthroscopic synovectomy (ASSX) for treating rheumatoid arthritis (RA). METHODS: ASSX was performed on 15 knees (one Larsen Grade 1, 7 Grade 2, 7 Grade 3) and 8 ankles (6 Grade 2, 2 Grade 3) of 17 female patients with RA. The average age at ASSX was 50.6 years (25-70). The average followup period was 24.4 months (10-47). RESULTS: Seven out of 8 knees with grade 1 or 2 had reduced pain and swelling, as well as decreased average serum levels of C-reactive protein (CRP) (from 3.6+/-1.1 to 1.4+/-0.3 mg/dl). However, 4 out of 7 knees with grade 3 showed recurrence of pain and swelling along with persistent average serum level of CRP (from 4.3+/-1.0 to 3.8+/-1.0 mg/dl). All 8 ankles with Grade 2 or Grade 3 experienced reduced pain and swelling, while the average serum CRP levels did not change (from 3.2+/-0.9 to 2.9+/-1.0 mg/dl). CONCLUSION: The Holmium:YAG laser was useful in ASSX for treating RA knees and ankles.

Activation of HIV-1-specific immune responses to an HIV-1 vaccine constructed from a replication-defective adenovirus vector using various combinations of immunization protocols.

We constructed a recombinant replication defective adenovirus vector containing the env gene (Ad-Bal) derived from macrophage-trophic HIV-1 (HIV-1 Bal). We then immunized mice with this vector using several administration routes and protocols, and examined the immune response. When the Ad-Bal viral vector (over 1 x 10(7) pfu) was injected subcutaneously, both humoral and cell-mediated immunities were induced. However, immune response induced by the Ad-Bal vector alone was weaker than that induced by the recombinant vaccinia viral vector. We then employed the following three immunization protocols: (l) DNA vaccination followed by immunization with the Ad-Bal; (2) vaccination using the Ad-Bal vector followed by DNA vaccination; and (3) DNA vaccination followed by Ad-Bal infection and passive transfer of dendritic cells (DCs) infected with the Ad-Bal. Among the three protocols, the last gave the strongest humoral and cell-mediated immunity. These results suggest that the combination of DNA vaccination, Ad-Bal vector infection and passive transfer of Ad-Bal-infected DCs can induce strong immunity against HIV-1 Bal.

Acceleration of lung metastasis by up-regulation of CD44 expression in osteosarcoma-derived cell transplanted mice.

The effect of CD44-phenotypic expression on metastasis to the lung was studied using a spontaneous murine osteosarcoma-derived cell line, POS-1, stimulated with lipopolysaccharide (LPS). POS-1 cells were inoculated into the hind paws of 20 C3H/HeJ mice and produced a visible mass in all mice in 5 weeks, and these transplanted tumors resulted in lung metastasis in all mice. The number of metastatic foci in the lungs was 12.0+/-2.1 (mean+/-SD) with LPS-stimulated cells, which was significantly higher than that of unstimulated cells (5.8+/-1.4; N=10 for each; P<0.05). Hyaluronate (HA), a ligand of CD44, inhibited a number of lung metastases in a dose-dependent manner (0.5% HA, 3.0+/-1.1; 0.005% HA, 5.1+/-1.5; without HA, 8.6+/-1.7; N=10 for each; P<0.05, each group with HA versus the group without HA). Adhesion assay by coculturing POS-1 cells and lung microvascular endothelial cells on culture plate showed that the adhesion was significantly lower in HA treated POS-1 than those without HA (1.18+/-0.12 and 2.74+/-0.17, respectively, P<0.05). These results suggest that lung metastasis was accelerated by up-regulation of CD44.