Chemical, Structural & Osteoconductive Properties of Mineralized Porcine Cancellous Bone / 대한정형외과연구학회지

PURPOSE: The purpose of this study is to determine the efficacy of bioactive hydroxyapatite obtained from the porcine cancellous bone for the treatment of bone defect and nonunion. MATERIALS AND METHODS: Porcine cancellous bones were heat-treated at 1300degrees C for 2 hours. The chemical compositions, calcium to phosphate ratio and microstructures of mineralized porcine bone were examined. For in vivo implantation, bone defects were made on the anteromedial aspects of proximal tibia in 7 beagle dogs and theses artificial bones were inserted. Plain X-ray was taken at every 2 weeks interval for radiologic evaluation. At 12 weeks, specimens were evaluated histologyically with hematoxylin and eosin stain. RESULTS: The composition and morphology of mineralized porcine cancellous bone were similar to those of heat-treated human cancellous bone. Radiographs showed union at the host bone-bone block interfaces. At 12 weeks, all uniform and substantial new bone formation were observed. CONCLUSION: This mineralization technique has several advantages such as no disease transmission, no immune reaction, excellent biocompatibility, and cost-effectiveness. Consequently, mineralized porcine cancellous bone showed an effective osteoconductivity.

Arthroscopic Treatment for Limitation of Motion of the Elbow Joint / 대한정형외과학회잡지

PURPOSE: To describe long-term clinical results and serial changes in the postoperative range of motion (ROM) after arthroscopic treatment for a limitation of motion (LOM) of the elbow. MATERIALS AND METHODS: Sixty-three patients with LOM of the elbow were treated with arthroscopic procedures. The follow-up period averaged 42.5 months. RESULTS: The total ROM was 79.3degrees C preoperatively. From the first and second week after the operation, the ROM showed a progressive increase up to six months postoperatively (mean 109.2degrees C at 3 months and mean 118.4degrees C at 6 months follow-up). Then the ROM continued to increase slowly for a total of 1 year after the operation (mean 121.5degrees C). However, after one year postoperative, the ROM showed little further increase. The ROM acquired during surgery (mean 121.9degrees C) was usually the same range achieved by patients during the rehabilitation period (mean 122.8degrees C at an average of 42.5 months follow-up). Patients with post-traumatic stiffness had more severe flexion contracture and decreased total ROM (73.1degrees C) than those with degenerative stiffness (85.7degrees C) preoperatively. But no significant difference existed in the postoperative total ROM (post-traumatic stiffness, 122.8degrees C and degenerative stiffness, 120.5degrees C). CONCLUSION: Based on our experience, 94% of the patients obtained functional ROM after arthroscopic procedures. The minimally invasive nature of elbow arthroscopy is a safe, reproducible and effective procedure for LOM of the elbow with minimal morbidity.

Plasmapheresis in Recurrent Focal Segmental Glomerulosclerosis after Renal Transplantation / 대한신장학회잡지

Focal segmental glomerulosclerosis (FSGS) in pediatric age tends to progress to end stage renal disease and to recur after renal transplantation. And recurrence of FSGS after kidney transplantation results in the graft loss in above half of cases. An unknown circulating factor in serum and immunologic dysfunction may be responsible for the recurrence. So, plasmapheresis to remove the uncertain serum factor and high dose cyclosporin A to control the immunologic system have been tried as the therapeutic regimen. We experienced 5 patients with recurrent FSGS after transplantation and tried plasmapheresis and methyl prednisolone pulse therapy with high dose cyclosporin A for them. The patients were 2 girls and 3 boys, aged between 8 and 14 years. In all cases, the kidney was donated by living related donors. Recurrence of FSGS was detected by postop. 3 days. Plasmapheresis started within 1 week after recurrence in 4 cases, and 2 months in 1 case. Early plasmapheresis brought rapid and sustained remission in 2 cases without evidence of acute rejection and short-term partial response in remaining 3 cases. In conclusion, plasmapheresis with high dose cyclosporin A resulted in a good outcome in recurrent FSGS. And starting plasmapheresis as early, prior to irreversible glomerular scarring, as possible is important for immediate and long-term prognosis in recurrent FSGS after renal transplantation.