[Arthroscopy of the elbow joint]. / Artroskopie loketního kloubu.

PURPOSE OF THE STUDY: The authors evaluate a group of patients who underwent elbow arthroscopy in the period between August 2001 and August 2003. They pay attention to indications, the technique used, surgical diagnoses, postoperative outcomes and complications. MATERIAL: We performed 28 elbow arthroscopies in 26 patients; two patients were operated on both elbow joints. The group comprised 20 men and 6 women between 14 to 73 years, with an average of 44 years. The average follow-up was 18 months (range, 4-28 months). METHODS: We usually operated on patients in a prone position under general anesthesia, with the use of a tourniquet. We used the following approaches: anterolateral and anteromedial, posterolateral (also termed direct lateral approach), posterocentral and upper posterolateral. To evaluate the outcome we used the modified Morrey system for the elbow joint after surgery. We assessed pain and the ability to manage daily activities, joint mobility and the presence of complications. RESULTS: Of 28 elbows, 21 had excellent outcomes and seven were satisfactory; no poor outcome was recorded. Most of the patients were satisfied with the postoperative result (25 out of 28 arthroscopies; 89%). An improvement by 20 degrees and more was achieved in the range of motion in 14 out of 21 patients (67%). No infection or serious injury to nerves or blood vessels was recorded. DISCUSSION: In elbow arthroscopy, the proximal modifications of anteromedial and anterolateral approaches proved to be more convenient, permitting better manipulation with instruments. The removal of intra-articular bodies was one of the first indications for arthroscopy. Good postoperative outcomes, similar to those reported in the literature, stimulated us to employ elbow arthroscopy also in other indications. With the use of a gentle technique, good results can be achieved in some acute injuries or post-traumatic conditions in which, however, arthroscopy requires greater skills. The same experience has been reported by other authors. We recorded no serious neurovascular complications; these are described to occur at a frequency of 0 to 15%. CONCLUSIONS: Taking all risks into consideration, elbow arthroscopy is beneficial for patients and is a contribution to elbow surgery. Our results suggest that elbow arthroscopy is the method of choice for not only removal of the intra-articular bodies, but also treatment of moderate arthritis not responding to conservative therapy for 3 to 6 months at least. Elbow arthroscopy may be benefical to co-operation with the rheumatologist and in traumatic conditions. As in arthroscopy for other joint, it has the advantage of a much shorter postoperative morbidity than in open procedures.

Isolation and characterization of an immunogenic fragment of heat shock protein 60 from Trichophyton mentagrophytes.

Heat shock protein 60 (hsp60) were isolated from several fungal, protozoal and many bacterial pathogens and successfully used for protective vaccination in some infection models. This work focuses on the isolation of recombinant hsp60 from the dermatophyte, Trichophyton mentagrophytes as a potentially protective antigen in trichophytosis. With the help of a previously tested set of degenerated primers, it was used reverse transcriptase polymerase chain reaction (RT-PCR) for isolation of partial cDNA of the hsp60 T. mentagrophytes (labelled hsp60-TM814), which was cloned into cloning vector. The sequencing of hsp60-TM814 cDNA and global alignment confirmed homology of the hsp60-TM814 with other members of the hsp60 family. Hsp60-TM814 cDNA corresponds to the region encoding the immunoprotective fragment of the hsp60 from Histoplasma capsulatum, used successfully in mouse model of histoplasmosis. A recombinant fragment (r-hsp60-TM664), 220 amino acids in length, was prepared in a prokaryote expression system, and its identity confirmed by mass spectroscopy. High immunogenicity of r-hsp60-TM664 was proven after subcutaneous immunization of mice. Immunized mouse sera recognized r-hsp60-TM664 on Western blots as well as hsp60 from mouse liver lysate and lysate of Candida albicans.

Stress proteins: nomenclature, division and functions.

The heat shock response, characterized by increased expression of heat shock proteins (Hsps) is induced by exposure of cells and tissues to extreme conditions that cause acute or chronic stress. Hsps function as molecular chaperones in regulating cellular homeostasis and promoting survival. If the stress is too severe, a signal that leads to programmed cell death, apoptosis, is activated, thereby providing a finely tuned balance between survival and death. In addition to extracellular stimuli, several nonstressfull conditions induce Hsps during normal cellular growth and development. The enhanced heat shock gene expression in response to various stimuli is regulated by heat shock transcription factors.

Multiple forms of the serine protease Alp of Aspergillus fumigatus.

Alkaline proteases were produced by a virulent strain of Aspergillus fumigatus during growth on media containing glucose and proteins or peptides. After isoelectric focusing, six bands of proteolytic activity were detected with synthetic substrates after blotting on nitrocellulose membranes. The main protease (pI = 8.6) corresponded to the known subtilisin-like protease Alp of A. fumigatus and five minor components had lower isoelectric points (8.1 to 5.2). All proteases were produced on different media and in various phases of growth with only small quantitative variations. They also had identical pH optima, were denatured above 45 degrees C and stabilized by Ca2+ ions, were affected by the inhibitors of serine proteases only and had nearly identical substrate specificity against 13 synthetic substrates. On gel chromatography the three most acidic components had higher molecular weights than the main enzyme Alp. It remains to be determined if the enzymes under study arise through posttranslational processing of the main protease or are true isoenzymes, products of a gene family.

Comparison of chitin content in the apical and distal parts of fungal hyphae in Basidiobolus ranarum, Neurospora crassa and Coprinus sterquilinus.

Primary cell wall is synthesized in the growth zone of hyphal apex in fungi and rigidified during maturation along the newly formed hypha. Cross-linking of cell-wall components and self-assembly of individual polysaccharide chains into microfibrils are supposed to be involved in the rigidification process. We determined the relative chitin content in the cell wall of hyphal tips and distal walls of three fungal species and demonstrated a general increase in relative chitin content in mature cell walls. Thus, this increase can be supposed to raise cell-wall rigidity as the principal role of chitin in the determination of cell-wall rigidity is beyond doubt.

Development of the primer set for the detection of the hsp60 gene in Trichophyton mentagrophytes cDNA.

Three sequences of hsp60 from Saccharomyces cerevisiae, Schizosaccharomyces pombe and Histoplasma capsulatum were compared. Local multiple alignment of these sequences allowed the selection of two oligonucleotides suitable as primers for the polymerase chain reaction. This primer set was used for the amplification of a part of the hsp60 gene from cDNA of Trichophyton mentagrophytes and S. cerevisiae. Similar fragments detected in both PCR's imply the possible future use of the developed primer set for the detection of the hsp60 gene in other fungal species.

Heat shock proteins in immune reactions.

The review concerns heat shock proteins and their significance in immune reactions. It focuses on problems of physiological and pathological interactions in etiology and duration of autoimmune diseases and infection processes, especially fungal infections. New trends are described in exploitation of heat shock proteins for preparation of specific protective vaccines.

Electrophoretic patterns of Trichophyton mentagrophytes mutants with changed growth rate at different cultivation temperatures.

Five mutants of Trichophyton mentagrophytes with changed optimum cultivation temperature and the wild strain were used in this study. The growth rates, the keratinolytic activities and the 1-D electrophoretic patterns of these mutants were examined repeatedly. The differences among the individual mutants and the wild strain can be useful for a better understanding of the participating individual proteins for thermotolerance of this fungus.

Detection of antigens in mycelial and in arthroconidial phases of Trichophyton mentagrophytes.

Protein pattern changes were investigated in the filamentous fungus Trichophyton mentagrophytes during the morphological transition induced by increased temperature and higher CO2 partial pressure in cultivation atmosphere. The differences between the mycelial and the arthroconidial phase were characterized by SDS-PAGE and by immunodetection with mouse polyclonal antibodies. The components found by Western blotting in mycelia were 88, 86, 32, 29, 19.5, 18.5 kDa, in arthroconidia 108, 92, 88, 66, 56, 41, 39, 19.5 kDa. The results suggest the participation of some heat shock associated proteins of T. mentagrophytes in host immune response against mycotic infection.

Chitin assay in aspergillus fumigatus.

Our study is an attempt to make the determination of chitin possible for large amount of samples with high sensitivity and reproducibility. These requirements are fulfilled if using acid hydrolysis to release glucosamine from chitin, evaporating the solution to remove hydrochloric acid, dissolving it in distilled water to obtain optimal concentration and assaying it fluorimetrically. The described method was used for determination of chitin in spores of Aspergillus fumigatus.

Effect of the fluorescent brightener Rylux BSU on the cell wall chitin content in Basidiobolus ranarum.

In Basidiobolus ranarum an artificial cell dimorphism was found if cultivated in presence of Rylux BSU previously. We have found an increase of glucosamine content in purified cell walls of Basidiobolus ranarum grown in presence of Rylux BSU in SGA. The relative increase in glucosamine content did correspond with the increase of Rylux BSU present in SGA. The results are discussed with the conclusion that not only the chitin synthesis but also the mechanisms of polarized growth are influenced if Basidiobolus ranarum is cultivated in presence of Rylux BSU.