Surgical Treatment for Massive Rotator Cuff Tears / 대한정형외과학회잡지

PURPOSE: To compare the results in patients with a complete repair, partial repair, and subacromial decompression and debridement of a massive rotator cuff tear. MATERIALS AND METHODS: Twenty-eight cases, who underwent surgery for massive rotator cuff tears with a minimum follow-up of 2 years, were reviewed. Group A with a complete repair comprised of 16 cases, group B with partial repair comprised of 5, and group C with only debridement comprised of 7. The results were assessed using the UCLA shoulder rating scale. RESULTS: The pain scores improved from 2.4 preoperatively to 8.5 points postoperatively in group A, 2.2 to 8.2 in group B, and 2.4 to 8 in group C. The active forward flexion improved from 86degrees to 149degrees in group A, 82degrees to 140degrees in group B, and 91degrees to 121degrees in group C. Overall, 13 cases (81%) from group A, 4 cases (80%) from group B, and 4 cases (57%) from group C had satisfactory results. CONCLUSION: The patients, who failed to achieve a repair, and received debridement or subacromial decompression instead demonstrated pain relief with poor restoration of their function. However, there was a favorable outcome in the patients with a partial repair because the complete repair could not be done. In conclusion, where possible, it is better to repair massive rotator cuff tears surgically.

Irreducible Ankle Fractures by Locked Posterior Malleolar Fragment: Case Report / 대한족부족관절학회지

Irreducible fracture dislocation of the ankle associated with comminuted displaced fracture of posterior malleolus is rare. Locked posterior malleolar fragments interfere with reduction of fibula or talus in ankle fractures. Prompt recognition and appropriate surgical approaches are necessary to achieve anatomical reduction of the ankle fractures.

Cell-type specific regulation of thrombospondin-1 expression and its promoter activity by regulatory agents

Thrombospondin-1 (TSP-1), a multifunctional protein that is able to function as a negative regulator of solid tumor progression and angiogenesis, is normally present at a very low level but rapidly elevated in pathological tissues. To understand the cellular regulation of TSP-1 expression, the mode of it's expression in Hep3B, SK-HEP-1, and porcine aortic endothelial (PAE) cells was examined in the presence of all-trans retinoic acid (ATRA), interleukin-6 (IL-6), interferon-gamma (IFN-gamma), or phorbol 12-myristate 13-acetate (PMA). ATRA or IL-6 induced a dose-dependent increase of TSP-1 protein and mRNA levels in PAE cells, while they negatively regulated TSP-1 expression in the Hep3B and SK-HEP-1 cells. In contrast, PMA showed just the opposite effects on the TSP-1 expression in the same cells. IFN-gamma had little effect on TSP-1 level in Hep3B and PAE cells. The TSP-1 expression in SK-HEP-1 cells by these agents showed a close resemblance to that of liver cells rather than that of the endothelial cell line. Possible TSP-1 promoter-mediated responses by ATRA, IL-6, IFN-gamma, or PMA in Hep3B and PAE cells examined with luciferase activity of TSP-LUC reporter plasmid showed that levels of TSP-1 promoter activity were lower than that of the expressed TSP-1 protein and mRNA levels. Transfection of c-Jun and/or RARalpha expression vectors into Hep3B and PAE cells resulted in the enhanced TSP-1 promoter activity as well as the increments of of its protein and mRNA level. These results suggest that regulatory agents-induced TSP-1 expression may be attributed to mRNA stability and/or translational activation in concert with transcriptional activation and TSP-1 expression may be independently controlled via each signal pathway stimulated by PMA or ATRA.