Basic science and experimental research on stem cells has increased exponentially in the last decade. Our present knowledge about stem cell biology is better than ever before. This new paradigm shift in research has been reflected in the field of orthopaedic surgery. Various experimental models have suggested a potential application of stem cells for different orthopaedic conditions, and early clinical results of stem cell use have been encouraging. These cells can be easily isolated, processed and made available for clinical use. From healing of bone defects caused by trauma, tumor or infection to cartilage defects, nerve, tendon and ligament healing, stem cell use has the potential to revolutionize orthopaedic practice. The purpose of this article is to orient a general orthopaedic surgeon towards the current use and clinical applications of stem cell based therapy in orthopaedics and to provide a complete overview of the clinical advances in this field.
Stem Cells

PURPOSE: We experienced a patient with posttraumatic duplication of the sternoclavicular joint causing a protruding deformity, whose major complaint was aesthetic. The patients history, radiologic findings, and surgical treatment are reported. METHODS: A 41-year-old bus driver complained a bony prominence at the left medial clavicle, which had developed after a fracture. The patient was annoyed by the protrusion, which was even visible, when he was wearing a pullover. A three dimensional CT scan showed that the medial head was split into two portions, of which the anterior portion was protruding. In general anesthesia the anterior portion of the medial head was excised. RESULTS: The bony prominence was corrected successfully. Follow up three dimensional CT scans showed that the anterior cortex of the clavicle had regenerated completely at the resection line one year after the operation. CONCLUSION: Surgical interventions for complications after clavicular fracture are usually carried out, only if there is a limitation of function or if it is painful. We report of a patient with posttraumatic bifurcation of the medial clavicular head, most probably caused by malunion. Upon the patient's request, the deformity causing protrusion of the medial clavicular area was successfully resected for cosmetic reasons.
Adult ; Anesthesia, General ; Clavicle* ; Congenital Abnormalities ; Follow-Up Studies ; Head* ; Humans ; Sternoclavicular Joint ; Tomography, X-Ray Computed

OBJECTIVES: Suicide is one of the most common causes of deaths in correctional institutions. This study aimed to examine the characteristics of suicide attempts and its related psycho-social factors in correctional institutions. METHODS: This study examined the characteristics of 101 suicide attempts from 2006 to 2007 in the two regional correctional headquarters. Thirty-seven male inmates (43 suicide attempts) and 40 matched controls were included in interviews and reviews of personal records. Psychiatric illnesses were examined using the Structured Clinical Interview for DSM-IV and medical outcomes of their suicide attempts with the Lethality Scale of Diagnostic Interview for Genetic Studies. RESULTS: Over a half of suicide attempts occurred in solitary cells and the most common method was hanging. Medically, 70% of the suicide attempts were more than severe. Poor social support, a lifetime history of suicide attempts, and incarceration were associated with suicide attempts. Additionally, psychiatric illnesses were more likely to increase the risk of suicide. CONCLUSION: This study implies that mental health issues and monitoring systems are important to reduce suicides in the correctional system. Regular checks and management of suicide risk and mental illness are crucial to prevent suicide in correctional institutions.
Cause of Death ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Male ; Mental Health ; Risk Factors ; Suicide

PURPOSE: This study aimed to investigate the luminal stenosis of the internal carotid artery with calcification detected on panoramic radiographs. MATERIALS AND METHODS: This study used fifty carotid arteries of 36 dental patients whose panoramic radiograph and computed tomography angiography (CTA) revealed the presence of carotid artery calcification. A neuroradiologist interpreted CTA to determine the degree of stenosis of the internal carotid arteries. The degree of stenosis was stratified in four stages; normal (no stenosis), mild stenosis (1-49%), moderate stenosis (50-69%) and severe stenosis (70-99%). RESULTS: Among the fifty carotid arteries with calcification detected on both panoramic radiography and CTA, 20carotid arteries (40%) were normal, 29 carotid arteries (18%) had mild stenosis, 1 carotid artery (2%) had moderate stenosis, and there was none with severe stenosis. CONCLUSION: Sixty percent of the carotid arteries with calcification detected on both panoramic radiography and CTA had internal luminal stenosis, and two percent had moderate stenosis. When carotid atheroma is detected on panoramic radiograph, it is possible that the dental patient has luminal stenosis of the internal carotid artery.
Angiography ; Arteries ; Carotid Arteries ; Carotid Artery, Internal ; Constriction, Pathologic ; Humans ; Phenobarbital ; Plaque, Atherosclerotic ; Radiography, Panoramic

Raynaud's syndrome causes discolorization, ischemic claudication(pain) and necrosis of the digits through insufficiency in the circulation which is induced by intermittent spasms of the digital arteries. From January, 2002 to December, 2004, 10 patients were surgically treated for Raynaud's syndrome. 9 patients were female and 1 patient was male. 2 patients showed unilateral involvement, 8 patients were operated on both hands. 6 patients had necrotic changes on the finger tips due to the disease. Ages ranged from 21 to 60 with an average of 39.1. Ischemic pain, discolorization, and cold intolerance of the digits were the common symptoms. All patients were evaluated with color doppler before the surgery. Two different procedures were applied according to the severity of the disease: Patients with decreased circulation received, what we call a limited digital sympathectomy, i.e. stripping of the adventitia of the ulnar, radial and common digital arteries. An extended procedure, radical digital sympathectomy, was performed on patients with a complete block of circulation. Stripping of the adventitia in these patients also involved the proper digital arteries. Symptoms like discolorization, ischemic pain, and cold intolerance improved immediately after the surgery. The patients did not suffer from pain even with exposure to cold weather. We conclude that digital sympathectomy could improve the symptoms in Raynaud's patients who do not respond to conservative treatment such as calcium channel blocker and other vasodilators.
Adventitia ; Arteries ; Calcium Channels ; Female ; Fingers ; Hand ; Humans ; Male ; Necrosis ; Spasm ; Sympathectomy* ; Vasodilator Agents ; Weather

PURPOSE: Recent studies have suggested that isoflavones have an inverse correlation with the risk of prostate cancer. In addition, the serum isoflavones levels are thought to be decided not only by the level of intake of isoflavones, but also by the metabolic processes or the genetic abilities required for ingestion of isoflavones. So, we conducted this study to determine the effects of dietary habits on the serum isoflavones levels. MATERIALS AND METHODS: One hundred age- and community-matched healthy men between the ages of 10 and 59 years were interviewed using a food frequency questionnaire that was developed and validated for Korean populations. The individuals' dietary habits during the previous one-year period and the foods they ingested during the previous one-week period before blood sampling were assessed. The serum concentrations of isoflavones were analyzed by the reversed-phase high performance liquid chromatography-multiple reaction ion monitoring-mass spectrometry method (HPLC-MS), (SRL Co. Tokyo, Japan). RESULTS: The genistein and daidzein levels were significantly correlated with age (p=0.026 and p=0.016, respectively), but the equol level was not (p=0.091). The foods associated with the genistein level were unmilled rice, beans, garlic and etc. The foods significantly related to the daidzein level were unmilled rice, garlic and etc. Of the foods ingested during the previous one-week period, fermented soybean soup, garlic, strawberries and mung-bean pancakes were associated with the equol level. CONCLUSIONS: The genistein and daidzein levels were associated with usual dietary habits, but the equol level was related to the short-period food consumption. Changes in dietary habit might induce significant changes in the genistein and daidzein levels.
Eating ; Equol ; Fabaceae ; Food Habits* ; Fragaria ; Garlic ; Genistein ; Humans ; Isoflavones* ; Male ; Metabolism ; Prostatic Neoplasms ; Surveys and Questionnaires ; Soybeans ; Spectrum Analysis

PURPOSE: The objective of this study was to evaluate the outcomes of using the free flap in the reconstruction of maxillary defects. METHODS: 27 consecutive cases of maxillary reconstruction with free flap were reviewed. All clinical data were analyzed, including ideal selection of flap, time of reconstruction, recurrence of cancer, postoperative complications, flap design, and follow-up results. The main operative functional items, including speech, oral diet, mastication, eye globe position and function, respiration, and aesthetic results were evaluated. RESULTS: Among the 24 patients who underwent maxillary reconstruction with the free flap, 14 patients underwent immediate reconstruction after maxillary cancer ablation, and 10 patients underwent delayed reconstruction. There occurred 1 flap loss. Recurrences of the cancer after the reconstruction happened in 2 cases. Postoperative complications were 3 cases of gravitational ptosis of the flap, 2 cases of the nasal obstruction, and 1 case of fistula formation. Out of 27 free flaps, there were 15 latissimus dorsi myocutaneous flaps, 5 radial forearm, 4 rectus abdominis myocutaneous flaps, 1 scapular flap, 2 fibula osteocutaneous flap, respectively. Flaps were designed such as 1 lobe in 9 cases, 2 lobes in 9 cases, and 3 lobes in 5 cases. Among the 14 patients who had intraoral defect or who had palatal resection surgery, 2 patients complained the inaccuracy of the pronunciation due to the ptosis of the flap. It was corrected by the reconstruction of the maxillary buttress and hung the sling to the upper direction. All of the 14 patients were able to take unrestricted diets. In 6 patients who had reconstruction of inferior orbital wall with rib bone graft, they preserved normal vision. Aesthetically, most of the patients were satisfied with the result. CONCLUSION: LD free flap is suggested in uni-maxilla defect as the 1st choice, and fibular osteocutaneous flap and calvarial bone graft to cover the larger defect in bi-maxilla defect.
Diet ; Fibula ; Fistula ; Follow-Up Studies* ; Forearm ; Free Tissue Flaps ; Humans ; Mastication ; Maxilla* ; Myocutaneous Flap ; Nasal Obstruction ; Orbit ; Postoperative Complications ; Rectus Abdominis ; Recurrence ; Respiration ; Ribs ; Superficial Back Muscles ; Transplants

The physiological roles of brain angiotensin II in mediating water deprivation-induced drinking and in regulating renal renin release were assessed in male Sprague-Dawley rats. Specific AT1 receptor antagonists, losartan and SK 1080, and antisense oligonucleotide (AS-ODN) directed to AT1 receptor mRNA were intracerebroventricularly (i.c.v.) administered in conscious unrestrained rats. When water was given 20 min after i.c.v. injection of AT1 receptor antagonists in 48-h water-deprived rats, losartan and SK 1080 produced approximatly 20% and 50% decrease in 1-h water intake, respectively. In contrast, i.c.v. treatment of the AS-ODN to AT1 receptor mRNA for 24-h did not alter 1-h water intake in 24-h water-deprived rats, but prevented the increase in overnight water intake after 24-h water-deprivation. Six-day i.c.v. treatment of AS-ODN did not alter either the basal plasma renin concentration or renal cortical levels of renin and renin mRNA. The present results suggest that endogenous brain Ang II plays an important role in thirst and water intake through AT1 receptors, but further studies are required to elucidate its regulatory role in renal renin synthesis.
Angiotensin II* ; Angiotensin Receptor Antagonists* ; Angiotensins* ; Animals ; Brain* ; Drinking* ; Humans ; Losartan ; Male ; Negotiating ; Plasma ; Rats* ; Rats, Sprague-Dawley ; Receptors, Angiotensin* ; Renin* ; RNA, Messenger ; Thirst ; Water

BACKGROUNDThe neurogenesis in retina of adult mammals is generally abolished, and this renders the retina lack of regenerative capacity. Despite this, there is a small population of nestin-positive cells in the ciliary epithelium which retains neurogenic potential. The present study aimed at investigating the effect of two drugs, corticosterone and paroxetine, on the cell proliferation of the ciliary body.

METHODSAdult Sprague-Dawley rats were given vehicle, corticosterone, paroxetine, or both corticosterone and paroxetine treatment for 14 days. Cell proliferation in the ciliary body was quantified using 5-bromo-2-deoxyuridine (BrdU) immunohistochemistry. Co-labelling of BrdU and stem cell marker was used to phenotype the BrdU immunoreactive cells.

RESULTSCorticosterone treatment suppressed while paroxetine treatment increased the cell proliferation of the ciliary body. Co-labelling with cell markers revealed that the BrdU positive cells also showed nestin expression but not glial fibrillary acidic protein (GFAP).

CONCLUSIONSThe results illustrate that proliferation of retinal progenitor cells situated in ciliary body are subjected to regulation by selective serotonin reuptake inhibitors (SSRI) and corticosteroid, which is similar to our previous findings in neurogenic regions in central nervous system (CNS). Paroxetine treatment could reverse the suppressive effect of corticosterone on ciliary body cell proliferation. This provides information for future investigation of retinal stem cell biology and potential treatment of retinal degenerative diseases.

Adrenal Glands ; drug effects ; pathology ; Animals ; Body Weight ; drug effects ; Cell Proliferation ; drug effects ; Ciliary Body ; cytology ; drug effects ; Corticosterone ; pharmacology ; Immunohistochemistry ; In Vitro Techniques ; Male ; Organ Size ; drug effects ; Paroxetine ; pharmacology ; Rats ; Rats, Sprague-Dawley

PURPOSE: This study aimed to assess the three-dimensional (3D) facial changes after orthognathic surgery by evaluating the spherical coordinates of facial lines using 3D computed tomography (CT). MATERIALS AND METHODS: A 19-year-old girl was diagnosed with class III malocclusion and facial asymmetry. Orthognathic surgery was performed after orthodontic treatment. Facial CT scans were taken before and after orthognathic surgery. The patient had a menton deviation of 12.72 mm before surgery and 0.83 mm after surgery. The spherical coordinates of four bilateral facial lines (ramal height, ramal lateral, ramal posterior and mandibular body) were estimated from CT scans before and after surgery on the deviated and opposite side. RESULTS: The spherical coordinates of all facial lines changed after orthognathic surgery. Moreover, the bilateral differences of all facial lines changed after surgery, and no bilateral differences were zero. CONCLUSION: The spherical coordinate system was useful to compare differences between the presurgical and postsurgical changes to facial lines.
Facial Asymmetry ; Female ; Humans ; Malocclusion ; Orthognathic Surgery* ; Tomography, X-Ray Computed ; Young Adult