Effect of sildenafil citrate on interleukin-1beta-induced nitric oxide synthesis and iNOS expression in SW982 cells

The purpose of this study was to identify the effect of sildenafil citrate on IL-1 beta induced nitric oxide (NO) synthesis and iNOS expression in human synovial sarcoma SW982 cells. IL-1 beta stimulated the cells to generate NO in both dose- and time-dependent manners. The IL-1 beta -induced NO synthesis was inhibited by guanylate cyclase (GC) inhibitor, LY83583. When the cells were treated with 8-bromo-cGMP, a hydrolyzable analog of cGMP, NO synthesis was increased upto 5-fold without IL-1 beta treatment suggesting that cGMP is an essential component for increasing the NO synthesis. Synoviocytes and chondrocytes contain strong cGMP phosphodiesterase (PDE) activity, which has biochemical features of PDE5. When SW982 cells were pretreated with sildenafil citrate (Viagra), a PDE5 specific inhibitor, sildenafil citrate significantly inhibited IL-1 beta -induced NO synthesis and iNOS expressions. From this result, we noticed that PDE5 activity is required for IL-1 beta -induced NO synthesis and iNOS expressions in human synovial sarcoma cells, and sildenafil citrate may be able to suppress an inflammatory reaction of synovium through inhibition of NO synthesis and iNOS expression by cytokines.

The Wear Pattern of Articular Cartilage of Medial Tibial Plateau with or without Functional ACL in Patients with Degenerative Osteoarthritis of the Knee / 대한정형외과학회잡지

PURPOSE: This study examined the wear pattern of the articular cartilage of the medial tibial plateau with or without a functional ACL in patients with degenerative osteoarthritis of the knee. MATERIALS AND METHODS: Between July 2003 and May 2004, 71 cases (52 patients) of total knee arthroplasty due to degenerative osteoarthritis of the knee were enrolled in this study. The intraoperative evaluations such as a test for the functional status of the ACL and the wear pattern of medial tibial plateau were performed, and the associations with the physical examinations such as, range of motion (ROM), Lachman test and pivot shift test, and tibio-femoral angle (TFA), were analyzed. RESULTS: There were 43 cases with a functional ACL, and the wear pattern of the medial tibial plateau was differentiated as anteromedial and central in 8 cases (18.6%), central in 30 cases (69.8%), and central and posteromedial in 5 cases (11.6%). There were 28 cases with a non- functional ACL and the wear pattern of the medial tibial plateau was differentiated as anteromedial and central in 1 case (3.6%), central in 2 cases (7.2%), and central and posteromedial in 25 cases (89.2%). In the group with the non-functional ACL, the most prevalent wear pattern was central and posteromedial (p<0.001). CONCLUSION: In patients with degenerative osteoarthritis of the knee without a functional ACL, the wear pattern of the articular cartilage of the medial tibial plateau was more posteromedially than patients with a functional ACL.

The Effect of Tourniquet on Patellofemoral tracking during Total Knee Arthroplasty

PURPOSE: To evaluate the effect of the tourniquet on intraoperative patellar tracking and to determine how this may influence the decision to perform lateral release during primary total knee arthroplasty (TKA). MATERIALS AND METHODS: From Jan. 1998 to Feb. 1999, 126 TKAs in which patellar tracking was assesed with tourniquet inflated were chosen as a control group. From May 1999 to June 2000, a total of 221 consecutive TKAs in which patellar tracking was assessed before and after tourniquet release were selected as a study group and were placed into 1 of 3 groups: Group I (49 out of 221) were knees that tracked properly both before and after tourniquet release. Group II (150 out of 221) were knees that maltracked with the tourniquet inflated and subsequently corrected with the tourniquet deflated. Group III (22 out of 221) were knees that maltracked both before and after tourniquet release, therefore required a lateral release. The lateral release rate, patella tilt and displacement were compared among groups. RESULTS: In control group, the lateral release rate was 65.9%(83/126). The patella tilit and displacemen were 2.65+/-0.78 degree and 3.51+/-1.68 mm respectively. In study group, the lateral release rate was 10.0%(22/221). The patella tilit and displacement were 0.76+/-0.85degree and 2.96+/-1.96 mm in study group. CONCLUSION: Tourniquet application alters intraoperative patellar tracking during TKA. When contemplating lateral retinacular release, tourniquet release and reevaluation of patellar tracking should be considered.

The Results of Revision Total Knee Replacement Arthroplasty

PURPOSE: To evaluate the results of revision total knee replacement arthroplasty (TKRA) and compare those outcomes according to the reasons for the revision TKRA. MATERIALS AND METHODS: We reviewed the results of 27 revision TKRAs followed at a minimum of 2 year after revision surgery with American Knee Society clinical and radiological rating system and satis-faction survey. There were 25 females and 1 male with the average age of 65.6 years (52~77). The origi-nal diagnosis was osteoarthritis in 24 cases and rheumatoid arthritis in 3 cases in the study group. The patients were followed for 2 year to 7 years 2 months (average 2 year 11 months). The reasons for revi-sion TKRA were osteolysis and loosening in 10 knees (37%), polyethylene wear in 10 knees (37%), infection in 3 knees (11.1%), stiffness in 3 knees (11.1%) and instability in 1 knee (3.8%). RESULTS: The knee score was average 84.7 (65~100) and function score was 68 (15~100) at final fol-low-up examination. The patients expressed, 11 knees (40.7%) were as very satisfactory knee, 5 knees (18.6%) as satisfactory knee, 8 knees (29.6%) as improved knee and 3 knees (11.1%) as got no change on their knees. There was no stastistically difference on the result from the original diseases and we got a good to excellent results for the infected TKRA with 2 staged revision TKRA. Isolated exchange of the tibial polyethylene insert performed in 10 knees (29%), but there was no statistical significance in the results between isolated polyethylene exchange and revision TKRA with new prosthesis. CONCLUSION: Although we can get 59.3% of the patients' satisfaction and 81.5% of good to excellent results, the overall outcomes of revision TKRA were not as good as primary TKRA. This study clearly does not support the premise that isolated polyethylene exchange is favorable for the long-term results.

Assessment of Failure Modes in Total Knee Replacement Arthroplasty

PURPOSE: To analyze the causes of revision total knee arthroplasty and evaluate the difference in failure modes according to the revision interval after a primary total knee arthroplasty. MATERIALS AND METHODS: We retrospectively analyzed the failure mode of 60 cases assessable by clinical, radiological and operative findings according to the following intervals after primary total knee arthroplasty: under 5 years; from 5 to 10 years; and after 10 years. RESULTS: In 50% of the cases osteolysis and loosening was the cause for revision total knee arthroplasty. In comparison, tibial polyethylene insert wear occurred in 25% of the cases, infection in 13%, instability in 7%, and stiffness in 5%. The average duration from primary total knee arthroplasty to revision arthroplasty due to infection, stiffness and instability was less than 5 years. In contrast, revision arthroplasty resulting from tibial polyethylene wear, osteolysis and loosening took place after 5 years. CONCLUSION: The most common failure mode is osteolysis and loosening regardless of the revision interval. Infection and instability was common in the under-5-year period and osteolysis and loosening was common after 5 years.

Results of Total Knee Arthroplasty with NexGen(R) system (5-year follow up) / 대한정형외과학회잡지

PURPOSE: To evaluate the mid-term (over 5 years) clinical and radiologic results of NexGen(R) total knee replacement arthroplasty (TKRA)retrospectively. MATERIALS AND METHODS: Between Nov. 1996 and Jun. 1997, 57 knees in 43 patients who had been followed up for 5 years after TKRA with NexGen(R) were evaluated retrospectively for clinical and radiologic results. RESULTS: The average range of motion increased from 116degree preoperatively to 125 degrees at the last follow-up. In patients with osteoarthritis, the average preoperative knee score (59.9) and functional score (40.3) improved to 94.7 and 83.7, respectively. In rheumatoid arthritis patients, the mean knee score and functional score also improved from 55.6 and 35.9 to 88.9 and 79.9. Roentgenographic evaluation revealed a radiolucency rate of 60%. Complications were periprosthetic fractures in 2 cases and aseptic loosening in 1 case. The latter had received a reimplantation. CONCLUSION: The mid-term results of NexGen. TKRA were reliable and satisfactory in terms of improvements of; range of motion, restoration of function, and rare complications. However, long-term follow-up evaluation is necessary to monitor many cases of radiolucent line (60%) in the femoral component.

Egg positive rate of Enterobius vermicularis of primary school children in Geoje island

The status of pinworm (Enterobius vermicularis) egg positive rate of primary school children in Geoje island was investigated by using adhesive cellotape anal swap method, in September, 2002. Total egg positive rates of E. vermicularis were 9.8% (74/754) and those of male and female were 10.8% and 8.7%, respectively. Among three schools examined, Myeongsa primary school showed the highest egg positive rate (12.6%) followed by Yeoncho [9.8% (26/266)] and Geoje [9.1% (35/385)]. As for the age groups, the 2nd grade had the highest egg positive rate (15.3%), whereas the 5th grade showed the lowest egg positive rate (2.6%). The above result led us to confirm that the egg positive rates of E. vermicularis in primary school children in Geoje island were not significantly different from the those in the whole country including urban and rural areas, showing more than 10%.

Clinical and Radiological Evaluation of Detached MCL cases in Medial Release During TKA: MCL detached vs stable CR vs stable PS

PURPOSE: On performing TKA in severe varus deformity, sometimes processing medial release, we can not get well balanced knee without completely detaching the MCL in tibial attached site. In these cases, we analyzed the clinical and radiological results. MATERIALS AND METHODS: We evaluated 20 TKA patients with completely detached MCL (Group I) comparing to 20 TKA patients without MCL detached using CR type(Group II), 20 TKA patients without MCL detaches using PS type(Group III). The clinical evaluation was done by the American Knee Society evaluation system. The radiographic examination in valgus stress were done with Telos device under control of fluoroscopic guide 0 degree and 30 degree flexion. RESULTS: The mean knee score of each group was improved from 43, 45, and 41 points preoperatively to 89, 90, and 91, then mean functional score also improved from 52, 54, and 57 points preoperatively to 88, 91 and 94 points at the latest follow-up respectively. On the radiographs in valgus stress at 0 degree flexion and 30 degree flexion, the mean angle were; in group I 4.5 and 6.0 degree, in group II 3.1 and 4.2 degree, in group III 3.4 and 4.7 degree. There was no patients to complain the subjective medial instability of the knee. CONCLUSION: On performing TKA in severe varus deformity, in releasing MCL, it might be detached completely from tibial side. In this situation, this resulted in good function and there was no need to reattach the ligament and use constrained type prosthesis.

Prevalence of Lateral Discoid Meniscus / 대한정형외과학회잡지

PURPOSE: Lateral discoid meniscus is a well known disease entity with an uneventfully high incidence in Koreans and Japanese. However, the reported incidence had been obtained mainly by using arthroscopy. The purpose of this study was to determine the prevalence of discoid lateral meniscus obtained by arthroplasty, unrelated to arthroscopic surgery. MATERIALS AND METHODS: We studied the prevalence of lateral discoid meniscus in 465 cases of total knee replacement arthroplasty, after disregarding patients with any possibility of an affecting lateral meniscus. To conduct the comparison, we measured the incidence of lateral discoid meniscus in 423 arthroscopy cases, performed during study period, and in 1,364 of our arthroscopy cases. RESULTS: We found 18 discoid lateral menisci during 465 total knee replacement arthroplasties, Therefore, its prevalence of lateral discoid meniscus was 3.9%. but 38 cases (9.0%) out of 423 arthroscopy cases, and 145 cases (10.6%) out of 1,364 arthroscopy cases were diagnosed as a lateral discoid meniscus. We also founded that 50% of lateral discoid meniscus cases were bilateral. CONCLUSION: We suspect that the prevalence of lateral discoid meniscus is similar in the Korean and Western populations. However, due to different lifestyles and ethnicity, Koreans might experience in one discomfort and confront a treatment, and thus the reported prevalence of discoid lateral meniscus is higher in Koreans.

The Thickness of Patella in Korean, Measured During Total Knee Replacement Arthroplasty / 대한정형외과학회잡지

PURPOSE: To report patella thickness measurements in Korean. MATERIALS AND METHODS: Between July 1990 and December 2000, the thicknesses of the patella in 1,245 patients who underwent total knee replacement arthroplasty (TKRA) were measured in 0.5 mm increment using caliper during operation. The diagnoses of the 833 knees were degenerative osteoarthritis and 386 knees rheumatoid arthritis. The difference of the thicknesses of the patellas in the same individuals were evaluated in cases of bilateral TKRAs. The relationships between the patellar thickness and sex, body weight and height were evaluated. RESULTS: The average thickness of the patella was 21.46+/-1.59 (18-32) mm. The thickness of the patella was increased significantly in the male (p0.05). CONCLUSION: Because the thickness of the patella in Korean adult was less than that in the Caucasian, the thickness of the patella after resurfacing the patella during TKRA may be reduced unnecessarily, which may cause increased strain on the surface of the patella. This increased strain may result in the fracture of the patella consequently. In the present study, the thickness of the patella after resurfacing during TKRA was 13.9+/-0.7 mm. Considering the fact that the prevalence of patella fracture was low (0.24%) in our study, the author's method of patella resurfacing is believed to be appropriate in Koreans.

Total Knee Rephacement Arthroplasty in Rheumatoid Arthritis: Mid-term follow-up

PURPOSE: Rheumatoid arthritis patients have difficulty in rehabilitative movement postoperatively, and prosthesis fixation due to osteoporosis. We evaluate the mid-term clinical, radiographic results and patients satisfaction degree of total knee replacement arthroplasty for rheumatoid arthritis retrospectively. MATERIALS AND METHODS: Between October, 1989 and May, 1994, 125 total knee replacement arthro- plasties were performed in 83 rheumatoid arthritis patients. Of these, we can follow up 99 knees in 70 patients, who were evaluated retrospectively for at least 5 years. The average age of the patients at the operation was 48.7(23-71) years old. The average follow up period was 87(60 112) months RESULTS: The average range of motion was increased 90.7 degrees preoperatively to 113.9 degrees at the final followup examination. The radiolucency score was average 1.14(1-9) points on roentgenographic evaluation and there was one loosening of tibial component, which was performed revision arthroplasty. CONCLUSION: In patients with rheumatoid arthritis, the total knee replacement arthroplasty relieve pain and increase range of motion, restore the function, cause rare complication and good patients own satisfaction, with relatively satisfactory results.

Polyethylene Failure Following TKRA

PURPOSE: We purpose to analyze the factors related to the polyethylene failure through the 7 exchanged polyethylene. MATERIALS AND METHODS: We experienced 7 cases of polyethylene failure from Apr. 1988 to Jan. 2000. The average duration of reoperation is 5 year 2 months(1 year 8 months-8 year 11 months), age at primary operation is 62 years old(55-64 years old), weight is 65kg(56-78kg) and height is 155cm(150-162cm). The used prostheses were AGC(Biomet, Warsaw, U.S.A) in 2 patients, AMK(Depuy, Warsaw, U.S.A) in 1 patient, ,MG II(Zimmer, Warsaw, U.S.A) in 1 patient, PFC(Johnson and Johnson, Warsaw U.S.A) in 2 patients and Series 7000(Osteonics, New Jersey, U.S.A.) in 1 patient. RESULTS: The thickness of polyethylene is Smm in 6 patients and 9mm in 1 patient. All of prostheses are cruciate retaining type with relatively flat surface geometry and low-height intercondylar eminence, and the minimal thickness of each system. CONCLUSION: We consider that the thicker polyethylene should be used when feasible in order to avoid reoperation which is caused by accelerated wear of polyethylene, and early detection of polyethylene wear is important. This can be got through knee standing AP, fluroscopic evaluation with varus and valgus stress.

Measurement of Posterior Slope Angle of the Proximal Tibia by MRI and X-ray / 대한정형외과학회잡지

PURPOSE: The aim of this study was to determine the anatomic proximal tibial posterior slope angle by measuring the true posterior slope angle of the proximal tibia and the meniscal slope angle by MRI. MATERIALS AND METHODS: We measures 102 meniscal and tibial plateau slope angles, including 39 medial and 63 lateral sides. The average age of the patients was 33.3 years (8-66). We measured the meniscal slope angle form MRIs of the patients, with confirmed no pathologic abnormality of the meniscus by arthroscopy. We traced the line between the upper margins of the anterior and posterior horn of the medial and lateral menisci, and the proximal tibial plateau line. The angle between the two lines was considered as the meniscal slope angle. RESULTS: The medial meniscal slope angle between the medial meniscal slope and the medial tibial bony slope averaged 6.2 degrees (2.5-9) and 5.3 degrees (1-15) in the lateral, side, an overall average angle of 5.8 degrees. CONCLUSION: This results suggests that the proximal tibial meniscal slope is less oblique than the usually measured bony slope at about 5.8 degrees. The authors suggest the proximal tibial cutting slope with 5.8 degrees less posterior tilt than bony slope angle.

Press-Fit Condylar Total Knee Arthroplasty: 5 to 10 year Follow up Evaluation / 대한정형외과학회잡지

PURPOSE: To evaluate the mid-term clinical, radiographic results in P.F.C total knee replacement arthroplasty (TKRA) retrospectively. MATERIALS AND METHODS: Between Aug. 1989 and Jun. 1995, the status of 70 knees in 45 patients was followed retrospectively for at least 5 years, the mean being 7.9 (5-10.4) years. RESULTS: The average range of motion increased from 96 preoperatively to 118 at the lastest follow-up. In patients with rheumatoid arthritis, the average of 34 in the preoperative knee rating score and 23 in the function score improved to an average of 86 and 78, respectively. In the patient with osteoarthritis, the scores also improved from 41 and 39 to 88 and 84. Roentgenographic evaluation revealed a radiolucency rate of 36%. The total radiolucency score was 1.7. Reoperations were needed because of a deep infection that later developed in 2 cases, aseptic loosening in 2 cases and wear of polyethylene in 1 case. CONCLUSION: The mid-term results of P.F.C TKRA were reliable and good in that there was an increased range of motion, a restoration of function, relatively rare complications (5.8%) and the patients were well satisfied. However we consider that a long-term follow-up evaluation is needed in order to monitor changes in the rate of radiolucency.

Bilateral Rupture of Quadriceps Tendon: A Case Report

Bilateral rupture of quadriceps tendon is a rare but well known disease entity. It can be happened in the patient with underlying systemic disease or condition, like diabetes mellitus, hemodialysis for renal failure, long-term steroid therapy for systemic lupus erythematosus and rheumatoid arthritis etc. The surgical repair is the treatment of choice for this condition in spite of' underlying pathology. This is a report on one case of 6 months interval staged bilateral rupture of quadriceps tendons following moderate trauma.

Screw Osteolysis Total Knee Replacement Arthroplasty

PURPOSE: The purpose of this study was to evaluate the prevalence and the pattern of osteolysis around screws and the clinical results of total knee replacement arthroplasty with the fixation of tibial implant with screws. MATERIALS AND METHODS: This study group was consisted of 31 knees of 23 patients, followed up for at least 5 years were reviewed. The American Knee Society Evaluation System was used for the clinical and radiological assessment. We also analyzed pattern and prevalence of the osteolysis around the screws by the Lewis classification. RESULTS: The American Knee Society knee score and function score were improved from a mean of 30, 20 points preoperatively to 91, 88 points postoperatively. The 2l tibial trays in 31 tibial components developed non progressive radiolucent lines with average of 1.7 points radiolucent score. In the last follow-up radiographic findings of osteolysis around screw were detected in 25 screws among total 122 screws. All 25 screws showed screw related osteolysis pattern as type l(linear) and neither cystic nor cavitary change were found. CONCLUSION: We suspected that the autogenous caneellous bone graft around the peg hole, before the insertion of the screw, prevented cystic or cavitary lesion around the screws in total knee replacement arthroplasty, but more long-term follow-up is needed.

Effects of Mycoplasmal Antigens on Production of Tuansforming Growth Factor-beta1 in Human Tumor Cells

No Abstract Available.

Intravenous Gamma-globulin Retreatment in Kawasaki Disease

PURPOSE: This study was designed to determine the outcome and safety of intravenous gamma-globulin(IVGG) retreatment in Kawasaki disease. METHODS: A clinical observation of the therapeutic effects, laboratory findings and echocardiograms was carried out on 72 patients with Kawasaki disease in Kosin University Hospital from 1991 to 1999. 27 patients were treated with 1g/kg/day IVGG for 2 days, 45 patients were treated with 2 g/kg for 10hours. The clinical indication for retreatment was fever. Persistent fever was defined as a temperature> or =38.3degrees C persisting beyond 48hrs after the completion of the infusion. Recrudescent fever was defined as a temperature> or =38.3degrees C for 48hrs after the completion of the infusion, followed by a temperatureup. CONCLUSION: We concluded that the IVGG retreatment of Kwasaki disease may improve the clinical course and coronary artery outcome.

Total Knee Replacement Arthroplasty in Stiff or Ankylosed Knees / 대한정형외과학회잡지

PURPOSE: To evaluate clinical results of total knee replacement arthroplasty for stiff or ankylosed knees. MATERIALS AND METHODS: This study reviewed 31 knees of 27 patients who underwent total knee replacement arthroplasties between August 1989 and May 1998. All patients had severe limitations of motion preoperatively with a range of motion below 50 degree (33.8 in average) . The follow-up period was over 1 year (40.8 months in average) . RESULTS: The range of motion was increased to an average of 94.0 (30-135) on the final follow-up. The average knee and function scores were 77.0 (26-100) and 67.3 (0-100) on the last follow-up. Twelve patients (44.4 % of 27 patients) were able to walk with no pain and limitation of distance. CONCLUSION: Although the results were inferior to that of total knee replacement arthroplasty for preoperative flexible knees, total knee replacement arthroplasty for stiff or ankylosed knees had relatively good results with excellent pain relief and much improved range of motion. Thus, the total knee replacement arthroplasty may be a good surgical treatment for stiff or ankylosed knees.

Hybrid Total Knee Replacement Arthroplasty: minimum 5 years follow-up / 대한정형외과학회잡지

PURPOSE: Authors intend to evaluate the mid-term clinical, radiographic results and patient's satisfaction degree for hybrid total knee replacement arthroplasties (TKRA) retrospectively. MATERIALS AND METHODS: Sixty-one knees in 39 patients were followed retrospectively for at least 5 years at a mean 6.5 (5.1-9.1) years. The average age of the patients at the time of operation was 55 (29-70) years. RESULTS: The average 26.4 preoperative knee rating score and 22.5 function score were improved to average 91 and 85.9 respectively at the last follow-up. The average range of motion was increased to 100.1 preoperatively to 121.2 at the final follow-up. Roentgenographic evaluation revealed a radiolucency rate of 82% of patients at tibia and femur interface, but no radiolucent line was detected on patellar component. All of patients were satisfactory for their postoperative status subjectively. CONCLUSION: The mid-term results of hybrid TKRA was reliably good with increased range of motion, restoration of function, rare complication and patient's own satisfaction. But authors considered that more long-term follow-up evaluation must be needed because of the high rate of radiolucency.