Inhibitory effect of mangosteen peel and propolis ethanol extracts on alveolar bone loss against increased treatment amount of Porphyromonas gingivalis lipopolysaccharide in rat / 대한치과재료학회지

In previous studies, we introduced that mangosteen extract complex (MEC; ethanol extracts of Garcinia mangostana L. peel and propolis) had inhibitory effects on inflammation and alveolar bone loss in silk-ligature applied and Porphyromonas gingivalis lipopolysaccharide (LPS) induced periodontitis model in rats. This study was conducted to evaluate whether MEC had inhibitory effect of alveolar bone loss when a higher inflammatory state was induced by increasing the injection amount of P. gingivalis LPS by 20 times and increasing the treatment dose of MEC by twice the amount or maintaining MEC dose that used in the previous study. The data showed that alveolar bone loss was significantly reduced in the Lig+L+MEC 1:34 group (treated with mixture of 16 µg mangosteen peel extract powder and 544 µg propolis extract powder) and in the Lig+L+MEC 2:68 group (treated with mixture of 32 µg mangosteen peel extract powder and 1,088 µg propolis extract powder) by 24.3% and 28.9%, respectively. This result reveals that the mixture of MEC 1:34 could be useful in improving periodontal tissue health and may be able to be used as a therapeutic adjuvant for periodontitis.

Inhibitory effect of mangosteen peel and propolis ethanol extracts on alveolar bone loss against increased treatment amount of Porphyromonas gingivalis lipopolysaccharide in rat / 대한치과재료학회지

In previous studies, we introduced that mangosteen extract complex (MEC; ethanol extracts of Garcinia mangostana L. peel and propolis) had inhibitory effects on inflammation and alveolar bone loss in silk-ligature applied and Porphyromonas gingivalis lipopolysaccharide (LPS) induced periodontitis model in rats. This study was conducted to evaluate whether MEC had inhibitory effect of alveolar bone loss when a higher inflammatory state was induced by increasing the injection amount of P. gingivalis LPS by 20 times and increasing the treatment dose of MEC by twice the amount or maintaining MEC dose that used in the previous study. The data showed that alveolar bone loss was significantly reduced in the Lig+L+MEC 1:34 group (treated with mixture of 16 µg mangosteen peel extract powder and 544 µg propolis extract powder) and in the Lig+L+MEC 2:68 group (treated with mixture of 32 µg mangosteen peel extract powder and 1,088 µg propolis extract powder) by 24.3% and 28.9%, respectively. This result reveals that the mixture of MEC 1:34 could be useful in improving periodontal tissue health and may be able to be used as a therapeutic adjuvant for periodontitis.

Results of total knee arthroplasty for painless, stiff knees

Background@#Stiff knees, like completely ankylosed or arthrodesed knees, can be painless. Total knee arthroplasty (TKA) for these painless, stiff knees is technically demanding. However, it can correct the alignment and advance the range of motion to improve quality of life. So, we reviewed the preoperative and postoperative results of functional and pain scores, range of motion (ROM) and complications in painless, stiff knees treated by TKA. @*Methods@#Fifteen painless, stiff knees underwent TKA from January 1998 to January 2017. The mean follow-up period was 15.4 (2.4–22.2) years. All the knees were completely ankylosed or arthrodesed. Clinical outcome and complications were evaluated using medical record review, serial plan radiography, ROM assessment, Knee Society score (KSS), Knee Society function score (FS), and a visual analog scale for pain (VAS). @*Results@#All patients were satisfied with their operated knees. Mean KSS and FS scores were improved from 36 and 50.9 to 76.9 and 67.2, respectively (P < 0.001 and P = 0.01). The mean ROM increased from 0º preoperatively to 77.6º (15–130) at the final follow-up (P < 0.001). The mean VAS had worsened from 0 preoperatively to 0.2 postoperatively, however it was not significant (P = 0.1). Major postoperative complications were reported in five of the knees (33.3%). @*Conclusions@#The results of TKA for painless, stiff knees were satisfactory with improved ROM and quality of life. Although some patients had mild pain and complications postoperatively, they were satisfied with the result. However, our study recommends that surgeons should consider the high rate of complications in the completely ankylosed or arthrodesed knees.

Results of total knee arthroplasty for painless, stiff knees

Background@#Stiff knees, like completely ankylosed or arthrodesed knees, can be painless. Total knee arthroplasty (TKA) for these painless, stiff knees is technically demanding. However, it can correct the alignment and advance the range of motion to improve quality of life. So, we reviewed the preoperative and postoperative results of functional and pain scores, range of motion (ROM) and complications in painless, stiff knees treated by TKA. @*Methods@#Fifteen painless, stiff knees underwent TKA from January 1998 to January 2017. The mean follow-up period was 15.4 (2.4–22.2) years. All the knees were completely ankylosed or arthrodesed. Clinical outcome and complications were evaluated using medical record review, serial plan radiography, ROM assessment, Knee Society score (KSS), Knee Society function score (FS), and a visual analog scale for pain (VAS). @*Results@#All patients were satisfied with their operated knees. Mean KSS and FS scores were improved from 36 and 50.9 to 76.9 and 67.2, respectively (P < 0.001 and P = 0.01). The mean ROM increased from 0º preoperatively to 77.6º (15–130) at the final follow-up (P < 0.001). The mean VAS had worsened from 0 preoperatively to 0.2 postoperatively, however it was not significant (P = 0.1). Major postoperative complications were reported in five of the knees (33.3%). @*Conclusions@#The results of TKA for painless, stiff knees were satisfactory with improved ROM and quality of life. Although some patients had mild pain and complications postoperatively, they were satisfied with the result. However, our study recommends that surgeons should consider the high rate of complications in the completely ankylosed or arthrodesed knees.

Common Peroneal Nerve Palsy Associated with Multiple Knee Ligament Injury / 대한스포츠의학회지

Common peroneal nerve (CPN) injury associated with multiple-ligament knee injury is relatively rare. A 38-year-old male presented with left knee pain occurred during ssireum (Korean wrestling). The patient exhibited positive Lachman, grade 3 varus stress, and also positive dial testing at 30°. Sensory loss of some area of left foot and foot drop were observed. Magnetic resonance imaging showed complete anterior cruciate ligament (ACL) rupture and posterolateral corner (PLC) injury. Motor nerve conduction velocity indicated left CPN palsy. ACL and PLC reconstructions were performed 10 days after injury and nerve exploration was done simultaneously. Neurolysis and primary repair were also performed. At 26 months after injury, muscle power of the tibialis anterior and extensor hallucis longus improved to grade 3, and sensation in CPN area recovered to about 60%. There was good stability in injured knee. To the best of our knowledge, this is the first case report describing CPN palsy with multiple-ligament knee injury during ssireum.

Comparison of Revision Rates Due to Aseptic Loosening between High-Flex and Conventional Knee Prostheses

PURPOSE: The purpose was to evaluate and compare the revision rate due to aseptic loosening between a high-flex prosthesis and a conventional prosthesis. MATERIALS AND METHODS: Two thousand seventy-eight knees (1,377 patients) with at least 2 years of follow-up after total knee arthroplasty were reviewed. Two types of implants were selected (LPS-Flex and LPS, Zimmer) to compare revision and survival rates and sites of loosened prosthesis component. RESULTS: The revision rate of the LPS-Flex (4.9%) was significantly higher than that of the conventional prosthesis (0.6%) (p<0.001). The 5-, 10-, and 15-year survival rates were 98.9%, 96.2% and 92.0%, respectively, for the LPS-Flex and 99.8%, 98.5% and 93.5%, respectively, for the LPS. The survival rate of the high-flex prosthesis was significantly lower than that of the conventional prosthesis, especially in the mid-term period (range, 5 to 10 years; p=0.002). The loosening rate of the femoral component was significantly higher in the LPS-Flex prosthesis (p=0.001). CONCLUSIONS: The LPS-Flex had a higher revision rate due to aseptic loosening than the LPS prosthesis in the large population series with a long follow-up. The LPS-Flex should be used carefully considering the risk of femoral component aseptic loosening in the mid-term (range, 5 to 10 years) follow-up period after initial operation.

Fracture of the Humeral Shaft Secondary to High-Velocity Gunshot (Machine Gun) Injury: A Case Report

High-velocity gunshot injury (muzzle velocity greater than 609.6 m/s) is uncommon and primarily a military injury. Humerus shaft fracture, caused by a high-velocity gunshot, should be considered as a severe open fracture. The principles of treatment are immediate and aggressive irrigation, wide debridement, primary delayed wound closure, and broad-spectrum intravenous antibiotics. External fixation has been widely used for fracture fixation. We report a case of humerus shaft fracture secondary to high-velocity gunshot (machine gun) injury, with a literature review.

Isolated Fracture of Distal Humeral Trochlea

Isolated fracture of the distal humeral trochlea occurs while the axial load delivered to the elbow passes through the trochlear of the distal humerus. It has been rarely reported, because of those reasons. The trochlea is located deep inside of the elbow joint space and since it does not have the direct attachment with muscles or ligaments, a force is hardly transmitted directly. Also ulno-humeral joint is less influenced by compressive or shear force than radio-humeral joint. We report a case of isolated trochlear fracture with review of the literature.

The Immunomodulatory Activity of Mori folium, the Leaf of Morus alba L., in RAW 264.7 Macrophages In Vitro

BACKGROUND: Immunoregulatory elements have emerged as useful immunotherapeutic agents against cancer. In traditional medicine, Mori folium, the leaf of Morus alba L. (Moraceae), has been used for various medicinal purposes; however, the immunomodulatory effects have not been fully identified. We evaluated the immunoenhancing potential of water extract of Mori folium (WEMF) in murine RAW264.7 macrophages. METHODS: RAW264.7 cells were treated with WEMF for 24 hours and cell viability was detected by an MTT method. Nitric oxide (NO) levels in the culture supernatants were assayed using Griess reagent. The productions of prostaglandin E2 (PGE2) and immune-related cytokines was measured using ELISA detection kits. The mRNA and protein expression levels of Inducible NO synthase, COX-2, and cytokines were assayed by reverse transcription-PCR and Western blotting, respectively. The effect of WEMF on phagocytic activity was measured using a Phagocytosis Assay Kit. RESULTS: WEMF significantly stimulated the production of NO and PGE2 as immune response parameters at noncytotoxic concentrations, which was associated with the increased expression of inducible NO synthase and COX-2. The release and expression of cytokines, such as TNF-α, interleukin (IL)-1β, IL-6, and IL-10, were also significantly increased in response to treatment with WEMF. Moreover, WEMF promoted the macrophagic differentiation of RAW264.7 cells and the resulting phagocytosis activity. CONCLUSIONS: WEMF has the potential to modulate the immune function by regulating immunological parameters. Further studies are needed to identify the active compounds and to support the use of WEMF as an immune stimulant.

A Comparative Study of Subcutaneous versus Intra-Articular Indwelling Closed Suction Drainage after Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: The aim of this study was to compare the drainage amount, total blood loss, and clinical results between two different positions of suction drainage after total knee arthroplasty. MATERIALS AND METHODS: A total of 100 patients who underwent one stage bilateral total knee arthroplasty were enrolled. In experiment 1 with 50 patients, we compared the drainage amount, pain, range of motion, and complications of the leg whose suction drain was inserted into the joint cavity with those of the contralateral leg whose suction drain was inserted in subcutaneous tissue. Another 50 patients of experiment 2 had suction drainage in the joint cavity of both legs and the total blood loss (sum of drainage output, exudates, and hematoma of subcutaneous tissue and joint) was calculated and compared with that of experiment 1. RESULTS: In experiment 1, the drainage amount was less in the leg with suction drainage in subcutaneous tissue compared with the contralateral leg with suction drainage in the joint cavity (p<0.001). However, the postoperative joint pain was significantly different only on post-operative day 2 between two legs. In experiment 2, there was no significant difference in the total blood loss between the two groups. CONCLUSION: Although the drainage amount was less in the leg whose suction drain was kept in subcutaneous tissue compared with the contralateral leg whose suction drain was in the joint cavity, the total blood loss and the clinical results were not significantly different according to the position of the suction drain. Therefore, we can conclude that the subcutaneous position of the suction drain did not yield superior results.

Ulnar Artery Thrombosis in Guyon's Canal

Causes of ulnar nerve compression in Guyon's canal are various, but thrombosis of the ulnar artery due to a single trauma is rarely reported. We report a case of ulnar nerve compression caused by traumatic thrombosis of the ulnar artery in Guyon's canal. Surgical excision of the ulnar artery thrombus and end to end anastomosis resulted in complete relief of the patient's symptoms.

Large Cavernous Hemangioma of the Subscapularis Muscle: A Case Report

We report a case of intramuscular hemangioma in the subscapularis muscle and the resulting impairment of shoulder function in an adult patient. A nineteen-year-old female complained of shoulder pain and the development of a mass in the absence of previous trauma. Physical examinations, including lift-off and belly-press tests, showed abnormality. X-ray showed multiple calcifications in the front of the scapula. Magnetic resonance imaging showed a soft-tissue mass occupying almost the entire intramuscular portion of the subscapularis muscle. An arthroscopic examination excluded the possibility of a joint invasion, after which the entire mass was successfully removed by open excision. The displacement of the subscapularis by the mass was relieved after the surgery. Pathological diagnosis of the tissue confirmed a cavernous hemangioma. Both shoulder pain and function was improved after operation. There was no evidence of recurrence even at the 2-year follow-up. Rare forms of hemangioma adjacent to the shoulder joint could be successfully managed with surgical excision. Differential diagnosis, such as synovial chondromatosis, pigmented villonodular synovitis, and malignant sarcoma, should also be considered.

Large Cavernous Hemangioma of the Subscapularis Muscle: A Case Report

We report a case of intramuscular hemangioma in the subscapularis muscle and the resulting impairment of shoulder function in an adult patient. A nineteen-year-old female complained of shoulder pain and the development of a mass in the absence of previous trauma. Physical examinations, including lift-off and belly-press tests, showed abnormality. X-ray showed multiple calcifications in the front of the scapula. Magnetic resonance imaging showed a soft-tissue mass occupying almost the entire intramuscular portion of the subscapularis muscle. An arthroscopic examination excluded the possibility of a joint invasion, after which the entire mass was successfully removed by open excision. The displacement of the subscapularis by the mass was relieved after the surgery. Pathological diagnosis of the tissue confirmed a cavernous hemangioma. Both shoulder pain and function was improved after operation. There was no evidence of recurrence even at the 2-year follow-up. Rare forms of hemangioma adjacent to the shoulder joint could be successfully managed with surgical excision. Differential diagnosis, such as synovial chondromatosis, pigmented villonodular synovitis, and malignant sarcoma, should also be considered.

Anti-carcinogenic effects of non-polar components containing licochalcone A in roasted licorice root

BACKGROUND/OBJECTIVE: Licorice has been shown to possess cancer chemopreventive effects. However, glycyrrhizin, a major component in licorice, was found to interfere with steroid metabolism and cause edema and hypertension. The roasting process of licorice modifies the chemical composition and converts glycyrrhizin to glycyrrhetinic acid. The purpose of this study was to examine the anti-carcinogenic effects of the ethanol extract of roasted licorice (EERL) and to identify the active compound in EERL. MATERIALS/METHODS: Ethanol and aqueous extracts of roasted and un-roasted licorice were prepared. The active fraction was separated from the methylene chloride (MC)-soluble fraction of EERL and the structure of the purified compound was determined by nuclear magnetic resonance spectroscopy. The anti-carcinogenic effects of licorice extracts and licochalcone A was evaluated using a MTT assay, Western blot, flow cytometry, and two-stage skin carcinogenesis model. RESULTS: EERL was determined to be more potent and efficacious than the ethanol extract of un-roasted licorice in inhibiting the growth of DU145 and MLL prostate cancer cells, as well as HT-29 colon cancer cells. The aqueous extracts of un-roasted and roasted licorice showed minimal effects on cell growth. EERL potently inhibited growth of MCF-7 and MDA-MB-231 breast, B16-F10 melanoma, and A375 and A2058 skin cancer cells, whereas EERL slightly stimulated the growth of normal IEC-6 intestinal epithelial cells and CCD118SK fibroblasts. The MC-soluble fraction was more efficacious than EERL in inhibiting DU145 cell growth. Licochalcone A was isolated from the MC fraction and identified as the active compound of EERL. Both EERL and licochalcone A induced apoptosis of DU145 cells. EERL potently inhibited chemically-induced skin papilloma formation in mice. CONCLUSIONS: Non-polar compounds in EERL exert potent anti-carcinogenic effects, and that roasted rather than un-roasted licorice should be favored as a cancer preventive agent, whether being used as an additive to food or medicine preparations.

Early Results of Total Knee Arthroplasty Using a Built-in 3-Degree External Rotation Prosthesis

PURPOSE: We compared the outcomes of total knee arthroplasty (TKA) using the Genesis II prosthesis in which 3degrees of external rotation was incorporated into the femoral component and Nexgen LPS prosthesis in which the degree of external rotation was determined by the extent of intraoperative bone cutting. MATERIALS AND METHODS: Of the patients who underwent TKA for osteoarthritis between November 2006 and December 2009, 326 patients (572 knees) were included in this study. The prosthesis of choice was Genesis II in 199 knees and Nexgen LPS in 373 knees. The mean follow-up was 27 months (range, 24 to 51 months). The American Knee Society score (KSS) and function score (FS) were used for clinical assessments. The maximum flexion angle and patellar tilt were compared between the groups. RESULTS: At the final follow-up, no significant intergroup difference was observed regarding the KSS (p=0.217), FS (p=0.238), maximum flexion angle (p=0.124), and patellar tilt (p=0.156). CONCLUSIONS: There was no significant difference in the clinical outcomes and patellar tilt between the prosthesis in which 3degrees of external rotation was incorporated into the femoral component and the prosthesis in which external rotation was determined based on bone cutting.

Preoperative Prediction for Length of Patellar Tendon in Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft / 대한스포츠의학회지

Preoperative prediction of patellar tendon length is important during anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) autograft. Three methods of imaging analysis to predict patellar tendon length were compared in this study. One hundred and twenty-three patients who underwent ACL reconstruction using BPTB autograft by single surgeon during October 2002 through April 2011 were included. We measured the patellar tendon length from true and oblique lateral simple radiographs (classified according to degree of rotation) and magnetic resonance image (MRI). These values were compared with actual length measured during operation and assessed accuracy by calculating the coefficient of determination. The mean length of patellar tendon measured during operation and by true lateral and oblique lateral radiographs and MRI were 42.4+/-0.45 mm (range, 32.0-54.0 mm), 41.7+/-0.61 mm (range, 24.2-55.3 mm), 40.7+/-0.57 mm (range, 24.8-51.5 mm), and 41.7+/-0.52 mm (range, 28.7-56.0 mm), respectively. The correlation of patellar tendon length was the most strong between actual length and value from true lateral radiograph (coefficient of determination, r2=0.660) according to simple linear regression analysis. R2 values were 0.361 and 0.332 for oblique lateral radiograph and MRI compared to actual value, respectively. In conclusion, Patellar tendon length measured on true lateral radiograph was the best method to coincide with actual patellar tendon length among various preoperative prediction methods.

Long-term Results of Hybrid Total Knee Arthroplasty: Minimum 10-years Follow-up

PURPOSE: To evaluate the survival rate and long term clinical outcomes of hybrid total knee arthroplasty (TKA). MATERIALS AND METHODS: We retrospectively analyzed 113 hybrid TKAs (NexGen) in 86 patients that were followed for more than 10 years. Kaplan-Meier survival curves were generated using revision as an end point. Knee Society Score (KSS) and range of motion were evaluated for clinical assessment and plane radiographs were used to evaluate implant problems. RESULTS: At 11.2 years (range, 10 to 12.2 years) of follow-up on average, 7 knees required revision. The reason for revision was aseptic loosening in 4 knees (1 in femoral and tibial component and 3 in tibial component only) and infection in 3 knees. The survival rate was 93.8% at 12 years for all knees, and 96.5% when septic loosening was excluded. The KSS improved from 29.3 to 91.5 in the Cruciate-Retaining type (CR) and from 21.5 to 90.3 in the posterior stabilizing type (PS) at latest follow-up. The average range of motion was improved from 120.6degrees to 133.8degrees in the CR type and 119.5degrees to 135.5degrees in the PS type. CONCLUSIONS: Hybrid TKA provides good survival rates and clinical results comparable to cemented TKA.

Early Aseptic Loosening after Total Knee Replacement Using Legacy Posterior Stabilized-Flex Prosthesis / 대한정형외과학회잡지

PURPOSE: We analyzed the patterns and causative factors of early aseptic loosening after total knee arthroplasty (TKR) using a legacy posterior stabilized (LPS)-flex prosthesis. MATERIALS AND METHODS: We examined 483 cases that occurred in 311 patients who underwent TKR using LPS-flex by single surgeon between August 2001 and March 2007 and who were followed-up for at least 2 years. The loosened group included 25 cases that exhibited early aseptic loosening on radiograph, the remaining 458 cases were regarded as the control group, and analysis was performed. RESULTS: The mean loosening period was 34.7 months and femoral component loosening alone was found in 22 cases (88%). There were no statistically significant differences in age, body mass index, or pre-operative range of motion between the 2 groups, but varus deformity was more severe in the loosened group (mean 8.92degrees) than in the control group (mean 5.21degrees) (p=0.003). Protrusion of the femoral component proximally over posterior condyle of the distal femur were more prominent in the loosened group (mean 20.3%) than in the control group (mean 13.4%) (p=0.001). CONCLUSION: Early loosening after TKR using LPS-flex prosthesis developed mostly in the femoral component. Choosing a proper size for the femoral component and cutting level for the distal femur should be considered.

Carpal Alignment Evaluation Using Three-dimensional Computed Tomography

PURPOSE: The purpose of this study was to analyze carpal alignment and evaluate the interobserver reliability of the several parameters using three-dimensional computed tomography (3D-CT) in normal Koreans. MATERIALS AND METHODS: The study included 42 wrists with no history of wrist pain or abnormality by physical examination. 3D-CT scanning was performed with each patient in zero position; the arm abduction against the trunk; the elbow flexed 90degrees; the forearm in neutral position using the stabilizing device. The three observers measured the carpal alignment parameters including distal radius articular angle, radiolunate angle, radioscaphoid angle, radiocapitate angle, radio-3rd metacarpal angle, scapholunate angle, lunocapitate angle, luno-3rd metacarpal angle. RESULTS: The mean distal radius articular anglewas 12.8degrees+/-2.6degrees, the mean radiolunate angle was 0.9degrees+/-4.6degrees, the radioscaphoid angle was 54.4degrees+/-5.3degrees, the mean radiocapitate angle was 1.7degrees+/-2.1degrees, the mean radio-3rd metacarpal angle was -1.2degrees+/-2.5degrees, the mean scapholunate angle was 53.4degrees+/-7.8degrees, the mean lunocapitate angle was 0.8degrees+/-4.7degrees and the mean luno-3rd metacarpal angle was -2.1degrees+/-5.0degrees. All parameters have excellent interobserver reliability. CONCLUSION: The normal mean values and ranges of carpal alignment angles measured by using 3D-CT may be of assistance in the evaluation of carpal alignment in patients.

A Case of Arthritis due to Mycobacterium Intracellulare in a Immunocompetent Patient

Nontuberculous mycobacteria (NTM) are widely distributed in nature and are usually of low pathogenic potential. NTM rarely has been recognized as a cause of musculoskeletal infections that involve joints, bone and soft tissue in immunocompetent patients. The risk factors of its infection are local traumas caused by surgery, injury, or injection. A fifty five-year-old immunocompetent patient visted to hospital due to right wrist mass and pain. Excisional biopsy was done. Histologically granulomatous inflammation was identified and Mycobacterium intracellulare was cultured. Although very rare, NTM should be suspected at least once as a causative pathogen of chronic arthritis when the cause is uncertain.