Effect of sildenafil citrate on interleukin-1beta-induced nitric oxide synthesis and iNOS expression in SW982 cells

The purpose of this study was to identify the effect of sildenafil citrate on IL-1 beta induced nitric oxide (NO) synthesis and iNOS expression in human synovial sarcoma SW982 cells. IL-1 beta stimulated the cells to generate NO in both dose- and time-dependent manners. The IL-1 beta -induced NO synthesis was inhibited by guanylate cyclase (GC) inhibitor, LY83583. When the cells were treated with 8-bromo-cGMP, a hydrolyzable analog of cGMP, NO synthesis was increased upto 5-fold without IL-1 beta treatment suggesting that cGMP is an essential component for increasing the NO synthesis. Synoviocytes and chondrocytes contain strong cGMP phosphodiesterase (PDE) activity, which has biochemical features of PDE5. When SW982 cells were pretreated with sildenafil citrate (Viagra), a PDE5 specific inhibitor, sildenafil citrate significantly inhibited IL-1 beta -induced NO synthesis and iNOS expressions. From this result, we noticed that PDE5 activity is required for IL-1 beta -induced NO synthesis and iNOS expressions in human synovial sarcoma cells, and sildenafil citrate may be able to suppress an inflammatory reaction of synovium through inhibition of NO synthesis and iNOS expression by cytokines.

The Wear Pattern of Articular Cartilage of Medial Tibial Plateau with or without Functional ACL in Patients with Degenerative Osteoarthritis of the Knee / 대한정형외과학회잡지

PURPOSE: This study examined the wear pattern of the articular cartilage of the medial tibial plateau with or without a functional ACL in patients with degenerative osteoarthritis of the knee. MATERIALS AND METHODS: Between July 2003 and May 2004, 71 cases (52 patients) of total knee arthroplasty due to degenerative osteoarthritis of the knee were enrolled in this study. The intraoperative evaluations such as a test for the functional status of the ACL and the wear pattern of medial tibial plateau were performed, and the associations with the physical examinations such as, range of motion (ROM), Lachman test and pivot shift test, and tibio-femoral angle (TFA), were analyzed. RESULTS: There were 43 cases with a functional ACL, and the wear pattern of the medial tibial plateau was differentiated as anteromedial and central in 8 cases (18.6%), central in 30 cases (69.8%), and central and posteromedial in 5 cases (11.6%). There were 28 cases with a non- functional ACL and the wear pattern of the medial tibial plateau was differentiated as anteromedial and central in 1 case (3.6%), central in 2 cases (7.2%), and central and posteromedial in 25 cases (89.2%). In the group with the non-functional ACL, the most prevalent wear pattern was central and posteromedial (p<0.001). CONCLUSION: In patients with degenerative osteoarthritis of the knee without a functional ACL, the wear pattern of the articular cartilage of the medial tibial plateau was more posteromedially than patients with a functional ACL.

The Effect of Tourniquet on Patellofemoral tracking during Total Knee Arthroplasty

PURPOSE: To evaluate the effect of the tourniquet on intraoperative patellar tracking and to determine how this may influence the decision to perform lateral release during primary total knee arthroplasty (TKA). MATERIALS AND METHODS: From Jan. 1998 to Feb. 1999, 126 TKAs in which patellar tracking was assesed with tourniquet inflated were chosen as a control group. From May 1999 to June 2000, a total of 221 consecutive TKAs in which patellar tracking was assessed before and after tourniquet release were selected as a study group and were placed into 1 of 3 groups: Group I (49 out of 221) were knees that tracked properly both before and after tourniquet release. Group II (150 out of 221) were knees that maltracked with the tourniquet inflated and subsequently corrected with the tourniquet deflated. Group III (22 out of 221) were knees that maltracked both before and after tourniquet release, therefore required a lateral release. The lateral release rate, patella tilt and displacement were compared among groups. RESULTS: In control group, the lateral release rate was 65.9%(83/126). The patella tilit and displacemen were 2.65+/-0.78 degree and 3.51+/-1.68 mm respectively. In study group, the lateral release rate was 10.0%(22/221). The patella tilit and displacement were 0.76+/-0.85degree and 2.96+/-1.96 mm in study group. CONCLUSION: Tourniquet application alters intraoperative patellar tracking during TKA. When contemplating lateral retinacular release, tourniquet release and reevaluation of patellar tracking should be considered.

Intravenous Gamma-globulin Retreatment in Kawasaki Disease

PURPOSE: This study was designed to determine the outcome and safety of intravenous gamma-globulin(IVGG) retreatment in Kawasaki disease. METHODS: A clinical observation of the therapeutic effects, laboratory findings and echocardiograms was carried out on 72 patients with Kawasaki disease in Kosin University Hospital from 1991 to 1999. 27 patients were treated with 1g/kg/day IVGG for 2 days, 45 patients were treated with 2 g/kg for 10hours. The clinical indication for retreatment was fever. Persistent fever was defined as a temperature> or =38.3degrees C persisting beyond 48hrs after the completion of the infusion. Recrudescent fever was defined as a temperature> or =38.3degrees C for 48hrs after the completion of the infusion, followed by a temperatureup. CONCLUSION: We concluded that the IVGG retreatment of Kwasaki disease may improve the clinical course and coronary artery outcome.

Segond fracture of the lateral tibial condyle (lateral capsular sign ): three cases report

No abstract available.

Clinical Studies on Congenital Heart Diseases

The clinical studies were performen on 304 patients with heart disease who had been received corrective heart surgery at Kosin Medical Center from July, 1984 to December, 1991. The results were as follows: 1) Out of 304 patients, 162 cases (53.3%) were male and 142 cases (46.7%) were female and sex ratio was 1.15:1. 35 cases (11.5%) had clinical cyanosis and 269 cases (88.5%) had no evidence of cyanosis. 2) As age distribution of patients, under 2 years, 3~5 years, 6~10 years, 11~15 years, 16~18 years consist of 22.0%, 26.0%, 29.0%, 16.1% and 6.9%, respectively. 3) As disease distribution, out 304 patients, ventricular septal defect (57.9% of all) was the most common disease, and then atrial septal defect (13.2%), tetralogy of Fallot (11.2%), patent ductus arteriosus (9.9%) and pulmonic stenosis (5.3%), in their order. 4) As sex distribution of each disease, ventricular septal defect, atrial septal defect and tetralogy of Fallot were more common in male and patent ductus arteriosus and pulmonic stenosis were more common in female. 5) The most frequent cardiac anomaly associated with ventricular septal defect and atrial septal defect was pulmonic stenosis. In the case of subarterial ventricular septal defect, aortic insufficiency was associated in 13.3%. 6) Respiratory problems (11.3%), tricuspid regurgitation (9.5%), arrhythmia (6.2%) and congestive heart failure (5.8%) were the major complications after surgery. 7) Case fatality reat was 4.4%. Mortality rate in ventricular septal defect, tetralogy of Fallot and tricuspid atresia were 1.7%, 20.6% and 100%, respectively, Majority (75.0%) of expired patients were died within 24 hours after sugery and the cause of death was hypoxia due to low cardiac output syndrome.

Total Knee Replacement Arthroplasty Without Patellar Resurfacing / 대한정형외과학회잡지

We analysed the results of total knee replacement arthroplasty without patellar resurfacing in 20 patients(28 knees) retrospectively. The patella was not resurfaced when it maintained relatively healthy cartilage in osteoarthritis or the patella was too thin to be replaced in rheumatoid arthritis. The diagnoses were osteoarthritis in 11 and rheumatoid arthritis in 17 cases. The follow up period was 30.3 months in average(12-70 months). A lateral retinacular release was performed in 22 knees(78.6%). The mean knee society score improved from 45.4 preoperatively to 84.1 postoperatively and the functional score improved from 21.4 preoperatively to 63.3 postoperatively. The modified Kujala score was 43.2 points in osteoarthritis and 43.6 points in rheumatoid arthritis. We conclude the total knee replacement arthroplasty without patellar resurfacing shows good results, without high risk of postoperative peripatellar complication.

Thumb Reconstruction with a Free Neurovascular Wrap / 대한정형외과학회잡지

On the length, strength, free lateral motion, and perfect mobility of the thumb, depends the power of the human hand. The thumb is called pollex because of its strength and that strength is necessary to the power of the hand being equal to that of all the fingers."So stated Sir Chales Bell in the fourth Bridgewater Treatise, first published in 1833. Morrison and O'Brien advocated reconstruction of the thumb with a free wrap around flap from the big toe to recreate a stable, sensate and functional digit including the nail in 1980. From March, 1982 to July, 1988, Twelve thumb reconstructions were performed using the wrap around procedure at Hanyang University Hospital;12 successful thumb reconstructions were reviewed at an average of 16 months after surgery. There were several complications;these included skin necrosis(4), malunion(1), resorption of the bone graft(7). We considered that cosmesis and function were good;pinch grip averaged 68% of normal, sensibility returned in all patients as assessed by two-point discrimination(average 9.5mm). Over all the results are as follows. 1. The wrap around technic provides a good method of reconstruction. 2. The wrap around technic is one stage operation and can be used in the level of metacarpal amputation. 3. The surgeon should be familiar with microsurgical technic.

Press-Fit Condylar Total Knee Arthroplasty / 대한정형외과학회잡지

The goal of total knee replacement is to relieve pain, to stabilize joint movement and to correct deformity. It is indicated for patients with rheumatoid arthritis, osteoarthritis and severe post-traumatic arthritis. The author analyzed 71 patients(106 cases), who received the PFC type of total knee replacement from August 1992 and the results were as follows; 1. Among the 71 patients, male was 8 patients and female was 63 patients whose average age was 56 years and average follow up period was 24 months, ranged from 8 months to 3 years 8 months. 2. Rheumatoid arthritis was the most common cause with 31 patients(56 cases) followed by osteoarthritis with 39 patients(49 cases). There was also one patient(1 case) that showed bony union of the knee due to old tuberculosis. The average duration of the illness was 12 years and the average weight of the patients was 57.7kg. 3. Flexion contracture decreased from an average of 21 degrees to 5 degrees after the operation. The range of motion increased from an average of 92 degrees before the operation to 117 degrees afterwards in cases of rheumatoid arthritis and decreased slightly from 108 degrees to 106 degrees in cases of osteoarthritis. 4. The tibiofemoral angle was corrected from an average 1.5 degrees varus before the operation to an average 6.7 degrees valgus after operation. Eighty seven percent of patients with rheumatoid arthritis showed valgus deformity and seventy eight percent of degenerative osteoarthritis patients showed varus deformity preoperatively. 5. Radiographically, the joint line position shifted an average 2.3mm in rheumatoid arthritis and an average 0.3mm in osteoarthritis. The component position, the femoral flexion was an average 89.6 degrees in the anteroposterior view, an average 87 degrees in the lateral view. 6. The thickness of the patella measured in the operating room of 61 cases was an average 21mm and after resection of patella, the remaining bone measured an average of 13.6mm. 7. To achieve soft tissue balance, 29 patients(33 cases) underwent medial stripping and 23 patients(30 cases) had patella lateral release. 8. The Insall Knee Rating Score was used to evaluate the results. The results were 69 cases excellent, 33 cases good, 3 fair and 1 poor. Ninety two percent of the patients had good or excellent results in average 24 months follow-up. 9. The complications consisted of one case of delayed deep infection, one case of patellar subluxation and one case of supracondylar fracture of the femur.

Clinical Study on Hand in juries / 대한정형외과학회잡지

Hand injuries in the industries have been steadily increasing in this country in recent years. All structures are damaged when a hand is caught in punch presses, gears or under falling objects. Irreversible loss of blood supply to the part is only real indication for primary amputation. Statistical observations were carried out on 240 patients of hand injuries who were treated at the Deparement of Orthopedic Surgery, College of Medicine, Hanyang University from May, 1972 to April, 1977 and following results were obtained. 1. The peak incidence was in the age group from 11 to 20 years in 83 cases(38.4%) and of the 226 patients, 204(85.0%) were male and 36(15.0%) were female. 2. In general, the incidence of hand injuries per year was annually increased and was much more occurred on April than other months of year. 3. The injured ratio of both hands was almost equal and main causes of hand injury were industrial accident (72.1%), traffic accident(12.9%) and electric accident(6.3%). 4 Most of hand injured patients(81.7%) arrived at our hospital within 6 hours after accidents 5. Of 240 injuries, 78(32.5%) were crushing injury with open comminuted fracture, 39(16.2%) were open fracture and 30(12.5%) were closed fracture. 6. Of injured fingers, 126(51.2%) were mondigit and the remained were polydigits. 7. The most frequency of monodigit injury was index finger(32.5%) and of polydigits injury was middle finger(28.2%) 8. In mondigit amputation, index finger were generally amputated at metacarpo-phalangeal joint and middle finger at proximal phalangeal level. 9. Of 457 injuries with facture, 213(46.6%) were treated by debridement and primary suture, and 94 (20.6%) by debridement and open reduction with Kirschner wire fixation. 10. Of 240 patients, 46 cases(19.2%) were infected and the main causative organisms were pseudomonas aeruginosa (41.3%), Staphylococcus aureus(17.3%) and Alkaligenus fecalis(10.9%).

A Clinical Study of Congenital Dislocation of the Hip / 대한정형외과학회잡지

The congenital dislocation of the hip is one of the most common congenital disease of the infants. The diagnosis and treatment of comgemital dislocation of the hip has been developcd since Lorenz published the methods of the closed reduction and immobilization in 1895. By replacing the displaced femoral head in the acetabular socket in early time, the normal development of acetabulum and femoral head were expected. So the early diagnosis and treatment were very important for good results. The authors studied 19 cases of 18 patients of congenital dislocation of the hip at the Department of Orthopedic Surgery of Hanyang University Hospital from June, 1972 to June, 1977. As results of this study, the following concolusion were result reached: 1. The proponderance of girl to boy was 13: 5. 2. The ratio of left side to right was 12:7. 3. The chief complaints were shortening of lower extremity, limitation of hip motion(esp. abduction) below 1 year old age and limping in over 1 year old age. 4. The associated congenital anomaly was abserved in a case of internal tibial torsion and metatarsus varus deformity. 5. In birth history, there was 1 case of breech presentation. 6. The acetabular index was much decreased in involved hip than the sound hip in treatment. 7. The arthrogram was valuable to detect any obstacles of closed reduction. 8. In 16 cases of 15 patients, 13 cases were treated by closed reduction, 1 case was open reduction, 1 case was derotation osteotomy, 1 case was varus and derotation osteotomy. 9. The results of treatment was Excellent:8 Good:8.

Comparative Study of Therapeutic Effect of Intravenous Gammaglobulin according to Administration Modality in Kawasaki Disease

PURPOSE: This study was designed for investigation of the differences in clinical manifestation, laboratory findings, effectiveness of treatment between intravenous gammaglobulin (IVGG) 400mg/kg/day for 5days (A) and 1g/kg/day for 2days (B) group in Kawasaki disease. METHODS: A clinical observation and comparison of therapeutic effects were carried out on 11 patients (group A) and 30 patients (group B) of Kawasaki disease who were admitted to Kosin University Hospital from January 1993 to April 1996. RESULTS: 1) There were no significant difference in ages, sex ratios, durations of fever before treatment, and laboratory findings between two groups. 2) The duration of fever after onset of treatment were different significantly (group A, 2.63 1.06; group B, 1.26 0.63; p<0.01) The total duration of fever were different significantly (group A, 10 3.43; group B, 7.66 2.01; p<0.05) 3) In 2D-Echocardiography, coronary artery aneurysm were more frequent in group A (27.3%) than in group B (3.3%), it was significant difference (p<0.05) 4) The follow-up echocardiogram, 2 months later of IVGG administration, the result were as follows: i) Among 2 cases of mild coronary artery aneurysm, one was disappeared and the other was not followed. ii) 2 cases of giant coronary artery aneurysm were not improved. iii) All cases of coronary artery dilatation and pericardial effusion were disappered. ) Among 6 cases of moderate degree mitral and tricuspid regurgitation, 5 cases were improved and other 1 case was improved from grade 3/4 to grade 2/4. CONCLUSIONS: We concluded that early combination therapy with high dose IVGG (1g/kg/day for 2days) is more effective than IVGG (400mg/kg/day for 5days) for prevention of coronary artery aneurysm development and for treatment of acute inflammation in Kawasaki disease.

Multiple Carpometacarpal Dislocations: A Report of 2 Cases / 대한정형외과학회잡지

Carpometacarpal dislocations occur in less thsn 1% of osseous hand injuries. Sine Dec. 1987, two cases of multiple carpometacarpal dislocations were treated at Hanyang University Hospital. All of these were successfully treated by closed reduction and percutaneous pinning with K-wires. Follow-up periods were 6 months and 5 months respectively. All patients were asymptomstic, but one patient had occasional discomfort and diminished grip strength.

Vascularized Osteocutaneous Fibular Transfer / 대한정형외과학회잡지

Only several stages of conventional operation have been able to treat the open fracture of the limb with extensive bone and soft tissue loss. So we, authors, reviewed 25 cases of vascularized osteocutaneous fibulat transfer which were performed to the extensive bone defect of the limb and associated soft tissue injury(from May 13, 1982 to September 30, 1988). In 25 cases, one case was a chronic osteomyelitis combined pseudocarcinomatous epithelial hyperplasia of surrounding soft tissue, the other(24 cases) were the open comminuted fractures with the extensive bone and soft tissue loss of the limbs. The average size of the skin flap was 12.33 × 5.83cm, the average length of vascularized fibula was 16.5cm in length. The complications were fractures of grafted fibula, partial necrosis of both ends of the skin flap and uncontrolled infection of proximal end of grafted fibula. During postoperative period, the patency of the anastomoses were monitored by observing the color of the skin of buoy skin flap. The average amounts hypertrophied fibula at 12 months after operation were 20.6cm. And the following remarkable result were obtained. 1. With the uncontrolled bone infection, the vascularized osteocutaneous fibular transfer was able to be performed. 2. During the follow up period, the grafted fibula had been hypertrophied. 3. In roentgenogram, as compared with conventional bone graft, grafted bone was not resorbed and early united. 4. In adult, free fibula can be obtained and grafted as 23cm as long and the skin flap with fibula can be obtained and grafted as 21 × 7cm as large in or experience. 5. In the vascularized osteocutaneous fibula transfer, the patency of anastomoses was monitored indirectly by confirming skin flap. 6. The fractured fibula was united early by cast immobilization, and it was hypertrophied at the fracture site. 7. The vascularized osteocutaneous fibula transfer is also useful in application of the other long bones.

Total Knee Replacement Arthroplasty In Varus Deformity

Vnrus deformity is a common finding in patients who are candidates for toial knee replacement arthropiasty. To obtain excellent clinical results and to maintain well-aligned and stable prosthetic components in patients who have such a deformity, adequate ligament balancing as well as accurate cone.ction of bony alignment is required. But many technical problems are encountered. Especially the bony defect on the medial aspect of the tibia after adequate bone cutting and ligament imbalance with laxity in the lateral side and contracture in the medial side. Total knee replacement arthroplasty with 43 patients(56 cases) to be mcre than 10 degrees of varus of tibio-femoral angle was done by a single surgeon and reviewed retrospectively. The diagnosis was osteoarthritis in 46 cases, rheumatoid arthritis in 9 cases. The average follow up period was average 33 months(l-7 years). Preoperative varus deformity of average 13.5 degree., was corrected to valgus 6.69 degrees at last follow-up. Postoperative range of motion was 122.5 degree. And the mean knee society score improved from 24.8 to 87.2 postoperatively and the function score improved from 23.6 to 83.9 postoperatively. At self-assements, 88.2% of the patients was very satisfied or somewhat satisfied. Total knee replacement ;u1hroplasty in the patients with vaus deformity is effective procedure to corri.ct deformity and improve clini- c;1 and functional status, but long-term follow up period is required for changing alignment.

Treatment of tuberculous arthritis of the knee: arthroscopic synovectomy

No abstract available.

Treatment of chronic isolated rupture of anterior cruciate ligament

No abstract available.

Arthroscopic synovectomy of the knee

No abstract available.

Double Outlet of Right Ventricle in Criss-Cross Heart: Surgical Experience of One Case / 대한흉부외과학회지

Criss-cross heart which is a cardiac malformation caused by abnormal rotation of the ventricles early in embryonic development, is rare but a double outlet of right ventricle in criss-cross heart is very rare. We experienced a case of criss-cross heart which is situs solitus, concordant atrioventricular connection and double outlet of right ventricle with remote ventricular septal defect of perimembranous inlet type. A 4-years old female was diagnosed as a double outlet of right ventricle in criss-cross heart after echocardiography, cardiac catheterization and cardiac angiography. The surgical correction was a intraventricular reconstruction of left ventricular outflow with 3/4 circle of 20 mm Hemashield vascular graft from the ventricular septal defect to the aorta. The patient had a temporary atrioventricular block but was recovered uneventfully, and a postoperative echocardiogram showed no left ventricular outflow obstruction, no intracardiac shunt.

Total Knee Replacement Arthroplasty in Severe Flexion Contracuture / 대한정형외과학회잡지

The flexion contracture of knee was developed in long-standing knee joint arthritis like degenerative osteoarthritis and rheumatoid arthritis. One of the objectives in total knee replacement arthro-plasty (TKA) is to correct flexion deformity which is the frequent consequence of rheumatoid arthritis (RA) and osteoarthritis (OA). We defined the severe flexion contracture as above 30degrees deformity of knee joint. A review of 337 primary TKA was carried out between August 1989 and March 1995. We found that such deformity was present in 106 Knees (31.5%) of knees before the operation. We analysed the changing pattern and amount of improvement in flexion contracture with 70 knees, which we can follow up over 1 year (average 28.9 months). We corrected flexion contracture deformity only 62.7% in RA (29.2degrees out of 46.5degrees) and 85% in OA (30.4degrees out of 36.8degrees ). So the remaining flexion contracture immediate after TKA is 17.3degrees in RA and 6.4degrees in OA. After the operation, we educate the patient and care person to perform the knee joint stretching by intermittent gentle passive extension exercise for residual flexion contracture. In RA, the remaining flexion contracture immediate after TKA would be improved in follow-up period. At 1 year after TKA, the degree of flexion contracture was not significantly different between in RA ( 7.4degrees) and OA ( 5.0degrees) (independent t-test, P>0.05). The angle of further flexion of knee joint was not increased after TKA compare to preoperative angle, but the range of motion of knee joint was increased, so the increased range of motion was influenced only by the corrected flexion contracture degree. The American Knee Society Knee and Function scores were improved after the TKA (P<0.05). So we recommand that in RA, there is no need to correct the severe flexion contracture completely and it is permissible to remained residual flexion contracture within 1/3 of initial deformity, but in OA, correct the flexion contracture deformity completely during TKA procedure as possible.