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Purpose@#In retinal endothelial cells, homocysteine (Hcy) activates matrix metalloproteinase (MMP)-9, which results in apoptosis. This study investigated these effects of Hcy in human trabecular meshwork cells (HTMC). @*Methods@#HTMC cultures using 5 mM low or 20 mM high glucose (HG)-containing media were exposed to 100 μM Hcy for 3 days. Cell viability was assessed with the MTT (3-[4, 5-dimethylthiazol-2-yl]-2, 5-diphenyltetrazolium bromide) assay. The MMP-9 and tissue inhibitor of MMP (TIMP)-1 levels were measured by western blotting and the degree of apoptosis was analyzed with flow cytometry using Annexin-propidium iodide double staining. @*Results@#Exposure to Hcy in HG decreased cell viability compared to HG alone (p = 0.036). Compared to HG alone, co-exposure to Hcy with HG decreased the TIMP-1 levels, albeit not significantly (p = 0.094), and did not affect the MMP-9 levels (p = 0.413). In addition, co-exposure to Hcy with HG produced no difference in the degree of apoptosis compared to HG alone (p = 0.437). @*Conclusions@#Unlike in retinal endothelial cells, Hcy did not affect the activities of TIMP-1, MMP-9, or the degrees of apoptosis significantly in HTMC. Thus, the effects Hcy may be limited in HTMC.
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Purpose@#We report a patient with bilateral dural arteriovenous fistulae (DAVF) who initially presented with unilateral, isolated trochlear nerve palsy; and later with contralateral, oculomotor nerve palsy.Case summary: A 72-year-old male without any underlying disease or a trauma history visited with sudden vertical diplopia in both eyes that had developed 5 days prior. Brain magnetic resonance imaging (MRI) performed before his first visit was unremarkable. The eye movement test revealed hyperdeviation and limitation of downgaze in the left eye; we thus suspected unilateral, ischemic trochlear nerve palsy and this was indeed observed. However, the diplopia did not improve and limitations of the upper, medial gaze of the right eye developed after 3 months. Follow-up examinations (orbital computed tomography, brain MRI, and cerebral angiography) revealed bilateral DAVF running from the left to the right. He underwent gamma-knife radiosurgery; then the eye movement limitations and diplopia improved. @*Conclusions@#Diplopia manifesting as paralysis in an elderly patient may be caused by DAVF; the diplopia may not always be the common ischemic paralytic strabismus. DAVF should be considered during differential diagnosis and further radiological examinations may be needed.
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Purpose@#To investigate the effects of prostaglandin E2 agonist omidenepag (OMD) on the expression of matrix metalloproteinase (MMP) in human trabecular meshwork (TM) cells. @*Methods@#Primarily cultured human TM cells were exposed to 0, 1, 10, or 40 µmol/L OMD for 3 days. The permeability through the TM cell monolayer was assessed using carboxyfluorescein. Expressions of messenger ribonucleic acid and protein levels of MMP-1, MMP-3, and MMP-9 were measured by reverse transcription polymerase chain reaction and Western blotting, respectively. Also, the permeability, expression of messenger ribonucleic acid, and protein levels of MMPs were measured after exposure to 1 µmol/L latanoprost free acid (LAT). @*Results@#OMD and LAT did not affect the cellular survival (all p > 0.05). Each concentration of OMD and LAT did not affect the permeability of carboxyfluorescein significantly (all p > 0.05). LAT increased the level of MMP-1 protein but did not increase the levels of MMP-3 and MMP-9 proteins. Each concentration of OMD did not affect the levels of MMP-1, MMP-3, and MMP9 proteins (all p > 0.05) @*Conclusions@#In TM cells, prostaglandin E2 agonist OMD did not increase the permeability through the TM cell monolayer, and the protein levels of MMPs. These suggest that the direct effect on the trabecular outflow by OMD may be limited.
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Purpose@#To investigate the effect of a prostaglandin (PG) analogue with or without preservative benzalkonium chloride (BAK) on corneal sensitivity. @*Methods@#Central corneal sensitivity was measured prospectively with a Cochet–Bonnet esthesiometer in patients with normal tension glaucoma (NTG) or primary open angle glaucoma (POAG) before and 1 and 3 months after treatment. All patients began treatment with PG monotherapy with or without BAK preservative. @*Results@#The study enrolled 84 patients: 52 NTG and 32 POAG. The treatment was PG with BAK preservative in 45 eyes and without BAK preservative in 39 eyes. Without BAK, the mean corneal sensitivity was 58.22 ± 3.56, 57.77 ± 4.59, and 56.33 ± 5.47 mm before and after 1 and 3 months, respectively; with BAK the mean corneal sensitivity was 58.20 ± 4.51, 56.31 ± 6.22, and 55.52 ± 6.23 mm. Corneal sensitivity was reduced significantly in patients using PG with the preservative BAK after 3 months (p = 0.033). Co-administration of artificial tears did not affect this reduction in corneal sensitivity. @*Conclusions@#PG with the preservative BAK reduced corneal sensitivity and artificial tears did not improve this reduction. Reduced corneal sensitivity and accompanying side effects should be considered in the long-term use of PG with the preservative BAK.
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Coblation devices are now widely used in arthroscopic surgery and they show a very low incidence of intraoperative complications. We experienced a case where the tip of the wand separated and migrated into the posterior knee compartment in an arthrofibrotic knee. The free wand tip was identified and then extricated from the popliteal hiatus of the knee with using C-arm fluoroscopic control. To the best of our knowledge, this is the first report of its kind involving coblation wands. We describe this complication to show that the use of coblation devices can lead to unexpected problems and it is imperative to inspect all instruments before and after each surgical use.
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Humanos , Masculino , Persona de Mediana Edad , Artroscopía/efectos adversos , Ablación por Catéter/efectos adversos , Falla de Equipo , Complicaciones Intraoperatorias , Articulación de la Rodilla/cirugíaRESUMEN
Sternoclavicular septic arthritis is a rare condition and it is usually related to predisposing conditions like intravenous drug abuse, diabetic mellitus, trauma and so on. A delayed diagnosis of this disease may cause severe complications like mediastinitis and chest wall abscess. Computed tomography or magnetic resonance imaging is needed to evaluate the complications. If the above complications are present, then joint resection should be considered. We report here on a case of a 52-year-old man who was diagnosed with primary sternoclavicular septic arthritis and he had no predisposing conditions. The pathogen on the aspiration-culture was S. aureus and it was susceptible to cefminox. The patient was cured with administering only antibiotic therapy for 6 weeks; intravenous cefminox therapy for 4 weeks followed by oral cefminox therapy for 2 weeks.
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Humanos , Persona de Mediana Edad , Absceso , Artritis Infecciosa , Cefamicinas , Diagnóstico Tardío , Articulaciones , Imagen por Resonancia Magnética , Mediastinitis , Articulación Esternoclavicular , Abuso de Sustancias por Vía Intravenosa , Pared TorácicaRESUMEN
No abstract available.
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No abstract available.
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Recently posterior stabilization with various instrumentation and fusion has been used for fractures of the thoracolumbar spine involving anterior and middle columns. However, these methods are sometimes inadequate to gain anatomical reduction and complete decompression especially in burst fractures. So anterior decompression and interbody fusion were frequently added as a second operation. Biomechanically a rigid anterior spinal instrument such as kaneda device can provide enough anterior decompression through partial or total corpectomy and adequate correction of kyphosis as an one stage operation. We have experienced 27 cases of Kaneda instrumentation via anterior approach for thoracolumbar fracture, most of them were burst fractures, from Jan. 1989 to June 1990. Of there 27 cases, 12 were followed up at least 1 year and reviewed. The results were as followed: l. Anterior spinal approach using Kaneda instrumentation provided sufficient anterior neural decompression and adequate correction of kyphotic deformity. It eliminates the second posterior procedure in most cases and enhances early solid union. Simultaneously, it allows early mobilization of patient with an application of brace. 2. Post-operative courses were eventful in most cases except a case of pathological fracture. 3. This procedure seemed to be one of the most suitable method for the treatment of burst fractures of the thoracolumber region. 4. Complications by Kaneda device itself were not developed in the early evaluation stage. However, on longer follow-up study over 1 year revealed some complications including 2 cases of screw breakage and one lateral wedging deformity.
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Humanos , Tirantes , Anomalías Congénitas , Descompresión , Ambulación Precoz , Estudios de Seguimiento , Fracturas Espontáneas , Cifosis , Métodos , Columna VertebralRESUMEN
18 humerus fractures in multiple injured patients were treated by closed intramedullary Ender nailing from June 1987 to June 1988. Follow-up over 3 months were obtained for 11 patients(11 fractures) and results were as follows : 1. Male was 10 in 11 cases and age was widely distributed to that of active life. 2. Trauma was the main cause of injury. 3. Ender nails were inserted through retrograde of entry in 6 cases and antegrade in 5 cases. 4. Coaptation splint was removed at postop. 3rd day and active joint exercise was started. 5. The average time of initial callus formation was post injury 19.2 days and that of solid periosteal callus bridge formation was post injury 7.5 weeks. 6. Early joint exercise, early mobilization of patient, ease of general care, small amount of blood loss, etc. were thought to be the adventages of closed Ender intramedullary nailing for humerus fractures especially in multiple injured patients.
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Humanos , Masculino , Callo Óseo , Ambulación Precoz , Estudios de Seguimiento , Fijación Intramedular de Fracturas , Húmero , Articulaciones , Férulas (Fijadores)RESUMEN
In the surgical trestment of unstable Iumbar spinal disorders, various methods of instrumentstion have been used for stabilization of spine, correction of deformity and reduction of fracture, despite of their technical demands. This paper reports the results of 30 patients of Cotrel-Dubousset instrumentation and posterolateral fusion for the lumbar spinal disorders associated with instability. The results obtained were as follows:l. Of the 30 cases, males were 15 cases(50%), females were 15 cases(50%) and average age of the patients was 42 yesrs ranging from 16 to 65 years. 2. Types of the disorders were spondylolisthesis in 16, failed back syndrome in 6, spondylolysis in 2, spinal canal stenosis in 2, scoliosis associated with degenerative spondylitis in 2, and burst fracture in 2 cases. 3. Among the 28 cases, 11 cases were excellent and 14 cases were good in Steffee's criteria (2 cases of burst fractures were excluded). 4. In spondylolisthesis, the average percentage of slippage was changed from 20% preoperatively to 5% postoperatively and 5.2% at the final follow-up. The initial correction rate was 75% and the loss of correction was not significant in follow-up study. 5. The patients with neurological claudication were permitted ambulation from postoperative 3rd day. In the final follow-up, the 8 patients(80%) could walk for more than 1 hour without pain. 6. The complications were relatively few(3 cases of hematoma, 2 cases of marginal sloughing of skin with superficial infection and one case of transient dysuria). In this study, this method seemed to be superior to others for the treatment of lumbar spinal disorders associated with instability especially degenerative spinal disorders in the respect of stability. Simultaneously, it provides immediate postoperative rehabilitation without rigid external support.
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Femenino , Humanos , Masculino , Anomalías Congénitas , Constricción Patológica , Estudios de Seguimiento , Hematoma , Métodos , Rehabilitación , Escoliosis , Piel , Canal Medular , Columna Vertebral , Espondilitis , Espondilolistesis , Espondilólisis , CaminataRESUMEN
Intraosseous neurogenic tumors are rare and have been reported most commonly in the mandible, possibly because of the long course of the mental nerve within this bone. They have also been reported very rarely in a vertebra. We experienced a case of intraosseous neurilemmoma arising from the body of the first lumbar vertebra, which resulted in paraplegia. The tumor was removed completely through anterior and posterior approaches by staged operation. Postoperative course was uneventful and paraplegia was recovered within three months postoperatively.
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Mandíbula , Neurilemoma , Paraplejía , Columna VertebralRESUMEN
Chronic osteomyelitis with protracted clinical course and pretibial skin loss imposes on every orthopaedic surgeon as one of the most difficult problems to deal with. All the conservative treatment hitherto reported have left much to be revised and they often accompany, to the despair of both surgeon and patient, recurrence of the lesion. The authors have had the opportunity of treating such four cases, in which the extensive removal of sclerotic bone as well as soft tissue adjacent to the focus was done, and lo cover the defect thus produced, the soleus muscle transferred anteriorly, followed by skin graft. It proves to have been successful and the rationale to meet the wider clinical applicability of this procedure is described.