The effectiveness of alternate flexion and extension splint(splint group) in restoring the range of motion(ROM) following total knee arthroplasty(TKA) was evaluated, comparing with the continuous passive motion(CPM) group. One hundred and twenty knees of 87 patients(21–80 years old:12 males & 75 females) who were followed for 2.7 years(ranging from 1.2 to 5.3 years) were involved in this study. The ROM of following groups were compared each other and the results were analyzed statistically with Wilcoxon rank sum test and the differences between each prosthesis were compared with Kruskal-Wallis test. 1) Splint(51 knees, 42.5%) v.s CPM group(69 knees, 57.5%) 2) RA(43 knees, 35.8%) v.s. OA(77 knees, 64.2%) 3) Various types of prosthesis(PSCK, PCA, Tricon-M, M/G, Oxford Knee, PFC) The results were as follws:1. The ROM of splint group(average 132.2°, ranging from 85–145°) was significantly greater than that of CPM group(average 110.5°, ranging from 50–140°)(p<0.01). 2. The ROM of osteoarthritic knees(average 122.2°) was slightly greater than that of rheumatoid knees(average 115.8°) without statistical significance(p) 0.05). 3. There was statistically significant difference between ROM of the various types of implant(p < 0.01). However this difference seemed due to different methods of rehabilitation rather than different types of prosthesis. From this result it is suggested that the alternate flexion and extension splint following TKA is a useful method in restoring ROM, comparing to gradual ROM exercise with CPM.
Arthroplasty, Replacement, Knee ; Humans ; Knee ; Male ; Methods ; Passive Cutaneous Anaphylaxis ; Prostheses and Implants ; Rehabilitation ; Splints

Cartilage is one of the most commonly manipulated tissue in esthetic and reconstructive surgery. Cartilage has an important role in longitudinal bone growth. Anabolic hormones and locally produced peptide growth factors are known to influence this process Matrix composition changes through proliferation, maturation, and differentiation of chondrocytes, and endochondral ossification thereafter. Defined cartilage matrix is synthesized during the maturation of chondrocytes where the major change is the increment of type II collagen. Variable sulfated mucololysaccharides and hyaluronic acid are also synthesized during this maturation. IGF-I(insulin like growth factor-I), so called somatomedin C, is a prominent growth factor in serum. IGF-I is known to be involved in long growth. IGF-I is affected by pituitary growth hormone. There are few studies done on IGF-I effect in cartilage matrix formation and possible changes of collagen subtypes. This experiment was designed to see the IGF-I effect on the colagen synthesis of cultured chondrocytes. Optimal concentration of IGF-I for the experiment was determined using H3-thymidine incorporation into DNA. The IGF-I effect on collagen synthesis was studied using H3-proline. The IGF-I effect on the synthesis of subtypes of collagen was studied using SDS-PAGE and immunocytochemical staining. Chondrocytes were isolated from the ears of New Zealand white rabbit and cultured in 2 X 10(5) cells/300 microgram density. IGF-I increased DNA synthesis, and optimal concentration of IGF-I was determined by dose-relationship curve as 10ng/ml. Collagen synthesis was increased by IGF-I. Type II collagen was increased on SDS-PAGE with IGF-I and this gel electrophoresis showed type X collagen, also. The increase in type II collagen was confirmed with immunocytochemical staining, the reaction becoming stronger with the addition of IGF-I. Type I collagen was not changed with IGF-I on immunocytochemistry. We conclude that IGE-I is an important modulator influencing not only proliferation and maturation but also terminal different-iation of chondrocytes.
Bone Development ; Cartilage ; Chondrocytes* ; Collagen Type I ; Collagen Type II ; Collagen Type X ; Collagen* ; DNA ; Ear ; Electrophoresis ; Electrophoresis, Polyacrylamide Gel ; Growth Hormone ; Hyaluronic Acid ; Immunohistochemistry ; Insulin-Like Growth Factor I* ; Intercellular Signaling Peptides and Proteins ; New Zealand

No abstract available.
Empyema* ; Humans* ; Urokinase-Type Plasminogen Activator*

BACKGROUND: Pediatric tonsillectomy may be associated with a high incidence of emergence agitation. The aim of this study was to determine the appropriate dose of remifentanil continuously administered in the postanesthetic care unit (PACU) to reduce the incidence of emergence agitation and side effects after total intravenous anesthesia (TIVA). METHODS: Sixty children aged from 4 to 12 years undergoing tonsillectomy were randomly assigned to 3 groups. Anesthesia was induced with 1.5 mg/kg of propofol, 1microg/kg of remifentanil and was maintained with continuous infusion of propofol 100microg/kg/min, remifentanil 0.25microg/kg/min. At the end of surgery, each group received 0.025 (group 1), 0.05 (group 2), or 0.1 (group 3)microg/kg/min of remifentanil, respectively and the infusion was discontinued at 10 min before PACU discharge. Duration of anesthesia and emergence time were evaluated at the operating room. Agitation score, the time of stay in PACU and postoperative side effects were evaluated at the PACU. RESULTS: The emergence time and the time of stay in PACU were prolonged in the group 3 compared to the other groups (P < 0.05). The Group 2 and 3 had lower agitation score in comparison with that of the group 1 in the PACU (P < 0.05). CONCLUSIONS: For reducing emergence agitation after TIVA, we recommend infusion dose of remifentanil 0.05microg/kg/min.
Anesthesia ; Anesthesia, Intravenous* ; Child ; Dihydroergotamine* ; Humans ; Incidence ; Operating Rooms ; Propofol ; Tonsillectomy*

PURPOSE: To report a case of delayed idiopathic macular hole closure after vitrectomy, internal limiting membrane peeling, and gas tamponade. CASE SUMMARY: A 69-year-old female complained of visual disturbance in her left eye. At presentation, her visual acuity was 20/100 in the left eye. Fundus examination and optical coherence tomography revealed a full-thickness macular hole 489 microm in diameter as well as posterior vitreous detachment. Hence, vitrectomy, concurrent cataract surgery, internal limiting membrane peeling and gas tamponade were performed. One month postoperatively, the hole remained unclosed, although decreased in size to 378 microm. At 2 months, cystoid macular edema developed and postoperatively the hole diameter decreased gradually to 311 microm, 252 microm and 156 microm at 2, 3, and 5 months, respectively. Finally, the hole was closed upon the resolution of macular edema at 9 months. However, the visual acuity of 20/100 remained unchanged. CONCLUSIONS: Delayed closure of holes which may be related to cystoid macular edema, can develop after macular hole surgery.
Aged ; Cataract ; Female ; Humans ; Macular Edema ; Membranes* ; Retinal Perforations* ; Tomography, Optical Coherence ; Visual Acuity ; Vitrectomy* ; Vitreous Detachment

Whereas mesangial and epithelial cells from glomeruli are commonly grown in vitro, there has been major difficulties in developing homogenous cultures of human glomerular endothelial cells. This study defines the conditions for the reproducible isolation and growth of homogenous monolayers of human glomerular endothelial cells based on the method of Green DF et al published in 1992. Using the selective media and the sieving method, fibronectin was required as a surface matrix after adequate collagenase treatment, and endothelial cell growth factor and heparin was needed for the continuous growth of endothelial cells. The endothelial cell growth factor was isolated from the bovine hypothalamic extracts. Glomerular capillary endothelial cells exhibited a cobblestone morphology at confluence and stained homogenously with von Willebrand factor(factor VIII). The cytokeratin and the actin were not stained. This study might be helpful for in vitro study to know the biological characteristics of human glomerular endothelial cells under the predetermined condition.
Actins ; Cell Culture Techniques ; Collagenases ; Endothelial Cells* ; Epithelial Cells ; Fibronectins ; Heparin ; Humans* ; Keratins ; Population Characteristics

The administration of erythropoietin for renal failure patients is frequently associated with a mild-to-marked rise in arterial blood pressure. The erythropoietin-induced hypertension has been variably attributed to the rise in erythrocyte concentration and/or a direct or indirect pressor action of erythropoietin on vascular smooth muscle. Especially erythropoietin-induced hypertension may be mediated by increased production of the potent vasoactive peptide endothelin. This study was designed to determine the effect of erythropoietin to the production of endothelin in human glomerular endothelial cells and human umbilical vein endothelial cells. ELISA method was used to measure the endothelin- 1, after 4 X 10(4) endothelial cells were grown to confluency on 24-well plates, in which erythropoietin 25u/ml was incubated for 24 hours. The results showed that the endothelin production in human glomerular endothelial cells was insignificant (116.0+/-14.0%, P>0.05, mean+/-S.E., n=5, each n means the mean of duplicate experiments), but the endothelin production in human umbilical endothelial cells was increased after 25u/ml erythropoietin treatment(126.5+/-15.2%, P<0.05, mean+/-S.E., n=4). In glomerular endothelial cells, TGF-beta(0.5ng/ml) increased the production of endothelin(218.8+/-57.2%, P<0.01, mean+/-S.E., n=5), also it looks like that TNF-alpha and thrombin might increase the production of endothelin according to the concentration. In conclusion, the responsiveness of endothelial cells to erythropoietin may be different according to the cell type, and glomerular endothelial cells could increase the production of endothelin, if appropriate stimuli were given.
Arterial Pressure ; Endothelial Cells* ; Endothelins* ; Enzyme-Linked Immunosorbent Assay ; Erythrocytes ; Erythropoietin* ; Human Umbilical Vein Endothelial Cells ; Humans* ; Hypertension ; Muscle, Smooth, Vascular ; Renal Insufficiency ; Thrombin ; Transforming Growth Factor beta ; Tumor Necrosis Factor-alpha

Cyclosporine(CsA) is a modulator of the immune system used therapeutically to prevent organ transplant rejection. However, it is nephrotoxic and causes thrombotic phenomena after renal and bone marrow transplantation. CsA nephrotoxicity in vivo is associated with elevated levels of von Willebrand factor(vWf), which is a multimeric plasm glycoprotein secreted by endothelial cells and platelets. CsA is not soluble in water and the intravenous form given to patients is dissolved in a vehicle called cremophor EL. The vehicle has been implicated in anaphylatic reactions and associated with the release of histamine in vivo. We hypothesized that CsA or cremophor might affect the release of vWf from human glomerular endothelial cells. vWf was measured in culture supernant using ELISA kit after speed vaccum for 3 hour. The expression of vWf in cultured human glomerular endothelial cells was relatively low compared to human plasm in vivo. CsA alone did not increase vWf release(100%, 99.9+/-0.7%, 99.1+/-2.9%, 106+/-21.5%, CsA 0, 0.1, 1, 10microM mean S.E., n=2), but cremophor EL increased vWf release (100%, 104.0+/-8.6%, 117.6+/-9.5%, 121.3+/-12.2%, mean+/-S.E., n=3). These results were same as the results of experiments under thrombin(1IU/ml) and histamine(10(-4)M). The increased expression of vWf in human glomerular endothelial cells in response to CsA seems to be related to cremophor, the solvent, rather than CsA itself in vitro culture experiments.
Bone Marrow Transplantation ; Cyclosporine ; Endothelial Cells* ; Enzyme-Linked Immunosorbent Assay ; Glycoproteins ; Histamine ; Humans* ; Immune System ; Transplants ; von Willebrand Factor*

BACKGROUND: Liver cirrhosis is characterized by fibrous scarring and hepatocellular regeneration. Matrix metalloproteinases (MMPs) comprise a family of zinc-dependent enzymes that degrade the extracellular matrix (ECM) components. This study examined whether or not gene delivery of human MMP-3 can attenuate established liver cirrhosis in a rat. METHODS: Rat liver cirrhosis was induced by an intraperitoneal injection of dimethylnitrosamine (DMN) three times a week for 8 weeks. The rats were infected once with either a recombinant adenovirus, AdMMP3.GFP, or a control adenovirus, Ad.GFP, into a portal vein and followed up for 3 weeks. In the rat liver tissues, the collagen content, histopathology and immunohistochemical staining were measured. RESULTS: Liver fibrosis in the DMN induced cirrhotic rat was attenuated along with a diminished hydroxyproline content and increased dried liver weight after the gene delivery of AdMMP3.GFP. In addition, the number of activated hepatic stellate cells was lower whereas the proliferation of hepatocytes, which was confirmed by immunohistochemical staining using anti-proliferating cell nuclear antigen (PCNA) antibody, was observed in the AdMMP3.GFP infected rats, suggesting that human MMP-3 stimulated hepatocyte proliferation. CONCLUSIONS: These results suggest that the gene transfer of human MMP-3 in the liver attenuates established fibrosis and induces hepatocyte proliferation. Therefore, gene therapy using MMP-3 in liver cirrhosis might be a promising therapeutic option in the future.
Adenoviridae* ; Animals ; Cicatrix ; Collagen ; Dimethylnitrosamine ; Extracellular Matrix ; Fibrosis ; Genetic Therapy* ; Hepatic Stellate Cells ; Hepatocytes ; Humans ; Hydroxyproline ; Injections, Intraperitoneal ; Liver Cirrhosis* ; Liver* ; Matrix Metalloproteinases ; Models, Animal* ; Portal Vein ; Rats* ; Regeneration

A 57-year-old man who was diagnosed with Wernicke-Korsakoff syndrome showed severe impairment of cognitive function and a craving for alcohol, even after sufficient supplementation with thiamine. After completing 10 sessions of 10 Hz repetitive transcranial magnetic stimulation (rTMS) at 100% of the resting motor threshold over the left dorsolateral prefrontal cortex, dramatic improvement in cognitive function and a reduction in craving for alcohol were noted. This is the first case report of the efficacy of a high-frequency rTMS in the treatment of Wernicke-Korsakoff syndrome.
Cognition ; Craving ; Humans ; Korsakoff Syndrome* ; Middle Aged ; Prefrontal Cortex ; Thiamine ; Transcranial Magnetic Stimulation*