The Electron Microscopic Study on the Development of Knee Joint in Rat / 대한해부학회지

These study was designed to observe the appearance and the characteristics of apoptotic cells during the development of knee joint in rat. The fetus were collected on the 16th, 17th, 18th, 19th, and 20th day of pregnancy. In this study, TUNEL staining, electron microscopic investigation and immunocytochemical gold labeling techniques were used. In the immuno-cytochemical gold labeling techniques, primary antibodies were used, which were to be polyclonal rabbit anti-mouse/ rat Bax, polyclonal rabbit anti-tissue transglutaminase C, and polyclonal goat anti-cpp32p20. The samples were observed under JEOL 1200 EX-II transmission electron microscope. The results were as follows. 1. In a 16-day-old fetus, between femur and tibia cartilages, mesenchymal cells were observed. Mesenchymal cells had marginated heterochromatin and dilated rough endoplasmic reticulum. 2. In a 17-day-old fetus, the knee joint clefts were first formed. In the primordial cruciate ligaments between the cartilages, capillaries were scattered. The apoptotic cells, which had fragmented and condensed nucleus, showed in the synovium. And necrotic cells, which had nuclear chromatin margination, perinuclear cisternae, and dilated rough endoplasmic reticulum, also were observed in the joint cleft surface. 3. From the 18-day-old fetus, phagocytic synovial cells and secretory synovial cells could be confirmed. The apoptotic cells were not seen. 4. In a 17-day-old fetus, a few cells were positive for TUNEL reaction in the joint cleft region. 5. In a 17-day-old fetus, Bax were marked on the mitochondria, endoplasmic reticulum of apoptotic cells. Also, it was marked at the phagocytosed apoptotic bodies in the neighboring cells. 6. In a 17-day-old fetus, the tissue Transglutaminase C were marked in the perinuclear region, vacuoles, cell membrane and extracellular matrix of the apoptotic cells. Also, it was marked at the phagocytosed apoptotic bodies in the neighboring cells. 7. In a 17-days-old fetus, CPP32 labeling were marked in the cytoplasm of the apoptotic cells. Practically, it was distributed between the phagocytosed apoptotic bodies and the neighboring cells. On the basis of above findings, it is obvious that the joint cleft are first formed in a 17-day-old fetus, a few cells are to be TUNEL positive signals, and the apoptotic cells contain Bax, tissue Transglutaminase C, and CPP32. Therefore the apoptotic cells and the necrotic cells are appeared in the 17-day-old fetus, and these cells are concerned with joint cleft formation.

Expression of Oncoprotein in Rheumatoid Synovium / 대한류마티스학회지

OBJECTIVE: The synovium in rheumatoid arthritis(RA) is characterized by an increase in the thickness of lining layer and infiltration of cells into the sublining area. Histomorphologic studies of RA have indicated that initial destruction is more closely related to the presence of transformed appearing proliferating synovial cells than to the presence of subsynovial or periarticular inflammation. Based on the fact that synovial lining cells have some properties of transformed appearing cells, we examined the expressions of Fos, Jun and Myc oncoproteins in the synovial tissue from patients with rheumatoid arthritis and osteoarthritis. METHODS: Synovial tissues from 15 patients with RA and 15 with osteoarthritis(OA) were studied by the immunohistochemical staining technique. Nine of 15 RA specimen were from arthroscopic synovectomy and the other 6 were from total knee replacement arthroplasty. RESULT: In all specimen studied, Myc and Fos were expressed in the synovial lining cells and Myc, Fos and Jun were expressed in the sublining cells, including lymphocytes, other inflammatory cells and blood vessels. Lymphocytes in the diffuse infiltrates showed increased expression of three oncoproteins compared to lymphocytes in the nodular aggregates. When oncoprotein expressions in RA were compared to OA, Fos and Myc expressions in the synovial lining cell layer were significantly higher in RA than in OA and Jun, Fos and Myc expressions in inflammatory cells were significantly higher in RA than in OA. The expressions of Fos and Myc were significantly correlated with the degree of synovial hypercellularity. In RA, the expressions of all three oncoproteins were increased in synovectomy group than joint replacement group. CONCLUSION: We observe that there are increased expressions of Myc, Fos and Jun in RA synovium than OA. These changes are more prominent in synovectomy group than joint replacement group, which suggest the differential expression of oncoproteins according to disease progression.

Analysis of the Sagittal Alignment of Normal Spines / 대한정형외과학회잡지

PURPOSE: This study was undertaken to increase the knowledge of the intra- and extra-spinal alignments and to help recovery of sagittal alignment in operation by measuring the normal values of the spinal alignment in relation to hip axis as well as those of the thoracic, thoracolumbar junction, lumbar and lumbosacral junction of sagittal alignment and their correlation. MATERIALS AND METHODS: Whole spine standing lateral radiographs were taken in young 100 adults without spinal abnormalities clinically and radiographically. Intraspinal alignment was measured with angles of thoracic kyphosis, lumbar lordosis, maximum thoracic kyphosis, maximum lumbar lordosis, angle of the thoracolumbar junction, sacral inclination, segmental angles and disc angles respectively with special emphasis on lumbar lordosis. Extraspinal alignment was measured with sacropelvic angle, spinopelvic balance and spinal balance in relation to hip axis. Correlations among these parameters were analyzed. RESULTS: Lumbar lordosis and thoracic kyphosis were measured -49 degree(-22 - -79 degree) and 32 degree(6 degree-56 degree), respectively. Slight amount of kyphosis in thoracolumbar junctional area was considered normal. Lumbar lordosis had significant correlation with thoracic kyphosis and sacral inclination. However, there was no correlation between thoracic kyphosis and sacral inclination. Lowest two lumbar segments comprised 71% of total lordosis. Lumbar lordosis usually started at L1-2 and gradually increased at each level caudally to the sacrum. Sacropelvic angle, spinopevlic balance and spinal balance were measured -11 degree(-6 degree - 24 degree), -4 cm (-10 - 2 cm), and -2 cm (-7 - 4 cm) respectively with C7 positioned posterior to hip axis mostly. CONCLUSIONS: There was a wide range of normal sagittal alignment of the thoracic and lumbar spines, and normal values of these alignments were not easily defined. Therefore, normal patterns of sagittal curvature and sagittal balance should be more emphasized.

Clinical Results of Open versus Endoscopic Carpal Tunnel Release / 대한정형외과학회잡지

Open carpal tunnel release has been the standard method of sumical treatment of carpal tunnel syndrome. Recently endoscopic carpal tunnel release has been introduced and is heing used by many authors. The advantages of this new technique are less postoperative pain, rapid restoration of power and rapid return-to-work. However many considerate authors, in spite of these advantages. insist that the inevitahle risk of neurovascular injury during the endoscopic procedure should not he underestimated. The purpose of our study is to compare the clinical results of endoscopic carpal tunnel release with those of open release. 20 open carpal tunnel releases in 16 patients and 15 endoscopic carpal tunnel reieases (single-portal technique) in 11 patients were performed hy the first author. Preoperative conditions of both groups are not different. Authors compared the clinical results between the two groups with some parameters. The overall clinical results were not different significantly hetween two groups. Rapid return-to-work(36 days in endoscopic group versus 60 days in open group) and less postoperative scar and pillar pain in endoscopic group were demonstrated. However, the major complication of one median nerve injury in endoscopic group seemed to overweigh these some benefits. We suggest that the standard operative technique for carpal tunnel syndrome should be open carpal tunnel release and more considerations should be takcn in choosing endoscopic method because of its inherent risk.

Intravertebral Vacuum Phenomenon / 대한정형외과학회잡지

There are several reports on the intervertebral vacuum phenomenon since Maldague s report in 1978. This disease is, however, considered as uncommon and miscellaneous entity. We performed retrospective review of 27 collapsed vertebral bodies of 21 osteoporotic patients to define the clinical, radiological and pathological characteristics of intravertebral vacuum phenomenon. Simple radiographs and MRIs were reviewed and the pathological findings from 6 specimens were matched with MRI. Intravertebral air shadows were shown in all cases either on A-P or lateral view, more definite on extension lateral views. Basically, it was considered as a burst fracture with loss of anterior and middle column height. The extent of collapse could be classified as complete or incomplete and the shape of spinal canal intrusion as bulging or local beak type. 12 cases of MRI findings were classified in to three types by T1, T2 and gadolinium enhancement patterns. The extent of spinal canal intrusion was less then 50% in all cases but neurolgic deficits were examined in 10 cases. Pathologically, necrotic trabeculae with fibrous granulation tissue was mixed with reactive new bone and callus formation in some area. This phenomenon is considered not so uncommon, which can be noticed easily in lateral flexion/extension view. Basically, this is a burst fracture with nonunion from ischemic necrosis and neurologic status should be carefully obserued.

Serial Change of the Bone Density in Distraction Osteogenesis in Long Bone Lengthening in Lower Extremity - by the Pixel Value in PACS / 대한정형외과학회잡지

We investigate the serial change of the bone density of the lengthening sites in distraction osteogenesis in long bone lengthening of the lower extremity by measuring the pixel value of the PACS(Picture Archiving Communication System). The purpose of this study was to find the clinical implication of the pixel value in PACS in the distraction osteogenesis. The number of the distraction sites were 22 in tibia and 16 in femur. The average distraction length was 4.5cm ranged between 2.1cm and 7.0cm in femur, 4.1cm ranged hetween 1.9cm and 6.8cm in tibia. When the image were sent to the PACS workstations, they were directly interfaced to the workstation without any processing. The absolute and the relati ve pixel values of cortical bones of the original and the lengthening sites repr sented in workstation of PACS were obtained by average value measuring 3 times by 3 different persons. The average absoiute pixel value of the original cortical bone near distraction site was not significantly changed, maintaining 575+/-6 in femur, and 570+/-7 in tibia. The absolute pixel vaIues in AP and lateral view were not significantly changed until 6 week/cm, but rapidly increased after 7 week/cm hoth in the tibia and the femur. The relative pixel value of the lengthening sites were more than 95% in three of the four cortices at the time of the removal of the external fixators. in conclusion, the pixel value of the PACS can be a rapid, simple and easy method for detection of the change of the bone density in distraction osteogenesis.

Clinical Implications of Pixel Values in PACS ( Picture Archiving and Communications System ) : A comparison with Dual energy X-ray Absorptiometry / 대한정형외과학회잡지

PACS (Picture Archiving and Communications System) is a computer-based image storage and retrieval system that can store, recall and display medical images rapidly on high resolution workstations. The image acquisition system consists of direct digital interface to computed radiography (CR) system. We reviewed X-rays of 84 patients who had both studies of Dual energy X-ray Absorptiometry (DXA) and AP, lateral views of lumbar vertebrae between January and December of 1995. We tried to verify the clinical implication of pixel values on PACS for DXA by comparing pixel values and bone mineral density (BMD) of the 2nd, 3rd and 4th lumbar vertebrae. They were all female between 44 and 72 years old, average age of 59. Bone mineral density (BMD), represented in DXA of a total of 252 vertebrae were mostly in the range of between 0.228 (22%) and 1.318 (121%). Pixel values of the AP and lateral views of the 2nd, 3rd and 4th vertebrae in the PACS workstation were closely correlated to bone mineral density (p=0.0001). The values of the DXA (bone mineral density and T score) get comparatively lower as the pixel values get smaller. In conclusion, the pixel value on PACS interfaced to CR could be utilized as an easy, speedy and economical tool for screening of osteoporosis.

Pathological Findings of the Femoral Head in Avasular Necrosis after Failed Core - Decompression Surgery / 대한정형외과학회잡지

Core decompression is still widely used in avascular necrosis of the femoral head but the results are unpredictable and the indications are not settled yet. The reparative process of the decompressed femoral head is poorly understood. Seven cases in 5 patients were undertaken THRA following failed decompression and these were studied for the radiological and pathological changes of the core tracts. The lesions of failed cases were involved more than 1/3 of femoral head on MRI and all cases were stage II A or B. The extent of the necrotic area in MRI was enlarged with crack, sclerosis and sometimes gas collection. Depression of the subchondral plates were also observed. Capillary ingrowth or neovascularization was not found at all and there were only fibrosis, inflammatory response and foreign body reactions.

Metabolic Activities of Benign Musculoskeletal Tumors Using 2- F - 18 - Fluoro -2 - deoxy - D - glucose ( FDG ) Positron Emission Tomogrphy ( PET ) ( preliminary report ) / 대한정형외과학회잡지

Positron emission tomography (PET) with 2-[F-18]-Fluoro-2-deoxy-D-glucose (FDG) was performed in ninteen patients who had benign musculoskeletal tumors in order to determine if there was a relationship between histologic grade of tumor and FDG uptake of tumor. These patients had been evaluated previously with computed tomography (CT) or magnetic resonance (MR) imaging or both. The diagnoses were confirmed with incisional or excisional biopsy or by radiographic follow-up. Generally high-grade tumors had significantly greater uptake of FDG than low-grade lesions . Benign lesions such as giant cell tumor, fibrous dysplasia, and osteofibrous dysplasia showed significant elevation of SUV (Standardized Uptake Value) above 4.0. On the contrary. The current studies suggest the utility of FDG-PET imaging as an adjunct to CT or MR imaging in the evaluation of benign tumors. And results of PET suggest benign tumors with high SUV are histologically active lesion and tend to be locally aggressive.

The Reliability and Accuracy of Perdriolle's Method on Measurement of Spinal Axial Rotation / 대한정형외과학회잡지

The purpose of this study is to determine how accuratively and reliably the Perdriollo s method can measure vertebral rotaton according to the level of vertebra and true axial rotation. Standard AP radiographs were taken using 10 dry human vertebra (two set of T3, T6, T9, T12, L3) with 5degrees increments in axial rotation, ranging from 0degrees to 50degrees. In order to evaluate the reliability of Perdriolle s method, three observers measured each radiograph twice, and intet-and intraobserver variance were estimated. The accuracy of Perdriolle's method was analyzed by total error analysis, root mean square error (RMSE) and Deviation of differences. 372 errors were made in the 660 measurement and 88.9% of all measurements were within +/- 5degrees of true rotation angle. There were no signigicant difference in the intraobserver measurement at each level whereas interobserver measurements were significantly different only at T3 level. The measurement was also the least accurate at T3 (RMSE=6.2292). We concluded that Perdriolle's method using torsion meter is an accurate and reliable one to measure the vertebral rotation with less accuracy and reliability in high thoracic level.