In Vitro Study of Nonspecific Cellular Immunity in Rheumatoid Arthritis

Nonspecific immune parameters such as natural killer(NK) activity, antibody-dependent cellular cytotoxicity(ADCC), production of leukocyte migration inhibitory factor(LlF) and levels of immune complex(IC) were assessed in 47 patients with rheumatoid arthritis (RA) 20 with degenerative arthritis (DA) and 40 healthy controls. Peripheral blood (PB) as well as synovial fluid (SF) were collected from both RA and DA patients before treatment. Mononuclear cell suspensions and sera were prepared and submitted for the in vitro tests; 4-hr chromium-release assays using human K562 and mouse L1210 cells as targets for NK and ADCC assays respectively, 2-step agarose assay for LIF and platelet aggregation test for IC. Results revealed that 1) LIF activity of PB lymphocytes (PBL) from both RA and DA patients showed a significant (P < 0.05) decrease as compared with that from healthy controls. 2) PB-NK activity from RA patients showed an insignificant decrease as compared with that from DA or healthy controls. However, mononuclear cells isolated from SF (SFL) of RA patients exhibited significantly(P < 0.02) lower NK activity than PBL from the same patients. 3) In ADCC assays with PBL no significant differencies were observed among the 3 groups. 4) Higher titers of IC were detected in both PB and SF from RA patients than DA, and a negative correlation was found between serum IC levels and PB-NK activity. These data are discussed in light of previous reports, and a hypothesis regarding a decreased nonspecific cell-mediated immunity in conjunction with an increased humoral immune response, particularly in local sites, is proposed as one of the mechanisms underlying the pathogenesis of RA.

A Clinical Study on Fracture of Shaft of Forearm Bones / 대한정형외과학회잡지

To achieve full pronation and supination after fracture, many authors have pointed out the importance of the length of the bones, the absence of the angulatory deformity and rotational deformity, maintenance of the interosseous space and the curves of the radius, especially the lateral bowing of the radius. Over the years many methods of open reduction and internal fixation or the closed method have been advocated and comparisons have been made between the groups treated by the conservative method and open reduction and internal fixation. The authors have reviewed 108 cases of the fracture of the shaft af the forearm bones from 1 January 1971 to 31 March 1979 which were treated in Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine. The following results were obtalned from analysis of the cases studies. 1. There was no difference between the conservative treatment group and the open reduction and internal fixation group for fractures of the radius or ulna alone in fracture heallng time, but there was delay in fracture healing time in the open reduction and internal fixation group compared to the conservative treatment group for fractures of both forearm bones. 2. Satisfactory functional results were shown in the open reduction and internal fixation group rather than in the conservative treatment group. 3. Angulatory deformities were shown in 47.2% of the conservative treatment group and 14.8% of the open reduction and internal fixatlon group. 4. In selected cases, an Evan's tuberosity view was taken and rotational deformities were shown in 30.0% of the conservative treatment group and in 8.8% of the open reduction and internal fixation group. 5. There was no difference between the conservative treatment group and the open reduction and internal fixatlon group in non-union rate and delayed union rate.

Discectomy and Anterior Interbody Fusion for Spondylogenic and Discogenic Back Pain / 대한정형외과학회잡지

A study of the effectivity and reliability of discectomy and anterior interbody fusion with autogenous iliac bone graft for spondylogenic and discogenic back pain and/or radiating pain has been done on 48 patients who had been hospitalized at Severance Hospital between January 1976 to June 1978. To the preoperative symptoms and signs such as the presence of back pain, sciatica, muscle atrophy, sensory change, motor change, spinal motion, deep tendon reflex, S.L.R., knee-chest compression test and Patricks test were checked, and after the operation, the same symptoms and signs were checked as to how they were improved or not. The age range of patients was 17 to 64 years and 40% of them were in the 3rd decade. Before the operation, for the confirmation of the origion of the back pain, we did perform dynamograms for instability and myelograms for root compression and spinal stenosis. The approach to the lesion was mainly retroperitoneal with anterior approach. Bony union after the operation was decided by a plane roentgenogram or clinical signs, and a dynamogram in some cases. The following results were obtained from analysis of the cases studied. 1. Eighty percent of the cases showed improved back pain in postoperative 3rd day and 83% showed improved sciatica in 6 months after the operation. 2. During the operation, the operative dislcogram could be done to verify the level of the lesion and the disc degeneration, disc protrusion, bony spur, narrowing of the joint space and instability during the operation could be confirmed in direct vision, so we could perform the operation for the accurate lesion. 3. Rather than the posterior approach, the anterior approach could allow all the remnants of the disc to be removed thoroughly. 4. In anterior interbody fusion, the strut of iliac bone was firmly impacted with two blocks, so its stability could be maintained, and patient could be mobilized earlier. 5. Clinical union of bone grafts was obtained in between 3 to 6 months and 96% of the cases showed bony union in 9 months. In 14 cases of two level fusions, the bony union was delayed compared to the one level fusion. 6. After the operation, the patient could return with the brace on to the office only within three months. The brace was taken off after the bony union was verified by plane roentgenogram and dynamogram.

Congenital Dislocation of the Knee / 대한정형외과학회잡지

This is a report of three cases of congenital dislocation of the knee with the chief complaint of extension contracture knee, seen at the Severance Hospital Department of Orthopedic Surgery from January 1975 to the present time(April, 1978). In the first case, the dislocated knee was associated with congenital dislocation of the hip and congenital club foot. Family history revealed that the elder brother of the patient had died of complications of premature birth. The second case appeared to be an isolated congenital dislocation of the knee, without associated anomalies or relevent history in the family. In the third case, the dislocated knee was associated with adducted thumbs and genu valgum, as well as congenital dislocation of the hip and congenital club foot, although family history was irrelevant. In all the cases roentgenographic examinations revealed in the lateral view that the tibia was displaced anteriorly in relationship to the femur. Two cases were treated by four or five successive corrective castings, each lasting one week to ten days. It is contemplated that the third case will also be treated by a simillar corrective cast immobilization. Following this course of treatment, each of the two dislocated knees was completely reduced and the original limitation of flexion improved. Experience with these two cases suggests that good results may be obtained with conservative treatment in congenital dislocation of the knee. A brief review of the literature is submitted.