PURPOSE: To evaluate the clinical and radiographical results of triple osteotomy as a treatment for adult hallux valgus with highly increased distal metatarsal articular ankle (DMAA). MATERIALS AND METHODS: From October 2003 to April 2005, we retrospectively reviewed 7 hallux valgus patients (3 cases: moderate, 4 cases: severe) treated with triple osteotomy and followed-up for more than 1 year after operation. The mean follow up was 15.1 months. The hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA) and the length of 1:2 metatarsal bone were measured. Proximal chevron osteotomy and distal biplanar chevron osteotomy were done in 1st metatarsal bone. Akin osteotomy was added to the base of the proximal phalanx. The clinical result was assessed using the AOFAS Hallux score, tenderness on the medial eminence, ROM of 1st metatarsophalangeal joint, calluses and patient satisfaction. RESULTS: The mean HVA and IMA was improved from 37.5 degrees and 13.4 degrees to 10.5 degrees and 6.2 degrees respectively. The mean DMAA was corrected from 34.2 degrees to 11.2 degrees and mean shortening of 1st metatarsal was 2.4 mm (0.9-5.8 mm). The mean AOFAS hallux score was improved from 66.4 to 92.5 and VAS score (pain on the medial eminence) from 4.3 points to 0.4 points. Metatarsalgia disappeared in all cases and there was no complications such as necrosis of the metatarsal head. CONCLUSION: Triple osteotomy for adult hallux valgus with a highly increased DMAA is effective and should be considered as a part of the treatment armamentarium.
Adult* ; Ankle ; Bony Callus ; Follow-Up Studies ; Hallux Valgus* ; Hallux* ; Head ; Humans ; Metatarsal Bones* ; Metatarsalgia ; Metatarsophalangeal Joint ; Necrosis ; Osteotomy* ; Patient Satisfaction ; Retrospective Studies

PURPOSE: Recently, there has been increasing interest in total ankle arthroplasty as an alternative to ankle arthrodesis. This study examined the short-term results of total ankle arthroplasty using an Agility prosthesis. MATERIALS AND METHODS: This study reviewed the results of 11 patients who underwent total ankle arthroplasty using the Agility prosthesis between May, 2003 and May, 2004. With a postoperative follow-up period of 2 years, 10 patients (10 ankles) were available for review at the time of the follow-up. The clinical evaluation included the ankle range of motion, the personal type of preferred shoe, walking pain (VAS score) and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score. In addition, the patients were asked whether they were satisfied with the outcome and if they would choose to undergo the same procedure again. The radiologic evaluation included the loosening of the prosthesis, osteolysis and syndesmosis union. The anterior surgical approach was used. The syndesmosis area was fixed using 2 cannulated screws inserted percutaneously in 9 cases and a plate in 1 case. RESULTS: The patients consisted of two men and eight women. The average age was 51.8 years (range 41 to 67) with an average follow-up of 30.3 (range 24 to 36) months. The mean preoperative and postoperative AOFAS ankle scores were 38.2 and 73.8, respectively, demonstrating significant improvement. The mean preoperative and final follow-up walking pain was 8.9 and 2.8, respectively. The ankle range of motion was decreased slightly at the final follow-up. Five patients required a cane to walk. Radiographic analysis showed no prosthesis failure, even though osteolysis occurred around the prosthesis in all cases. Only one case showed further progression. Union in the syndesmosis area occurred within 6 months in 5 cases and delayed union was observed in 3 cases, and nonunion was observed in 2 cases. Sensory loss in the area innervated by the deep peroneal nerve and a fracture in the lateral malleolus was encountered in one case, but this recovered with conservative treatment. Subtalar joint arthritis was noted in one case. CONCLUSION: Agility total ankle arthroplasty results in a favorable outcome at the short-term follow-up. However, total ankle arthroplasty is associated with radiographic complications including syndesmosis nonunion and osteolysis. Only syndesmosis nonunion was associated with the clinical results. Therefore, long-term follow-up is considered to be necessary to demonstrate osteolysis and loosening with their clinical association.
Animals ; Ankle ; Arthritis ; Arthrodesis ; Arthroplasty ; Canes ; Female ; Follow-Up Studies ; Foot ; Humans ; Male ; Osteolysis ; Peroneal Nerve ; Prostheses and Implants ; Prosthesis Failure ; Range of Motion, Articular ; Shoes ; Subtalar Joint ; Walking

PURPOSE: Monoclonal antibodies (mAb) specific for CD45RB as a potent tolerogenic target can prolong allograft survival in several animal models. The mechanisms of CD45RB mAb-mediated tolerance are largely unknown. Therefore, the present studies were performed to determine the immunomodulatory effects of CD45RB mAb on T cells in early or late time after allogenic skin transplantation. METHODS: Skin grafts and bone marrows from BALB/c donor mice were transplanted on C57BL/6 recipient mice and Busulfan was administerd. Group 1 was composed of anti-CD154 mAb administerd mice, group 2 was composed of anti-CD154 and anti-CD45RBB mAb administerd mice, and group 3 consisted of anti-CD154 mAb and CTLA4-Ig administerd mice. The proportion of splenic CD4+ and CD8+ T cell and range of CD45RB was observed by flow cytometry. Cytokines secreted by CD4+ T cell were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: CD45RB mAb in combination with CD154 mAb enhanced graft survival in allogenic skin transplantation model where CD45RB mAb specific for CD45RB, which was proven mainly expressed by CD8+ T cells, had inhibitory effects on the proportion of splenocyte-derived CD8+ and CD4+CD45RB(high) T cells in early or late time posttransplant. CONCLUSION: The combined therapy showed decreases in the proliferation of CD8+ T cells in vivo and allospecific responses of IFN-gamma-producing cells. Such immunomodulatory effects may be associated with the tolerogenic ability of CD45RB mAb in allogenic skin transplantation.
Abatacept ; Allografts ; Animals ; Antibodies, Monoclonal ; Bone Marrow ; Busulfan ; Cytokines* ; Enzyme-Linked Immunosorbent Assay ; Flow Cytometry ; Graft Survival ; Humans ; Immune Tolerance* ; Lymphocytes* ; Mice* ; Models, Animal ; Skin ; Skin Transplantation ; T-Lymphocytes ; Tissue Donors ; Transplants

Pneumatosis intestinalis is an uncommon disorder characterized by an accumulation of gas in the bowel wall. We described three cases undertaking liver transplantation. The patients developed diarrhea in three cases and high fever in two. An abdominal X-ray and computed tomography scan demonstrated extensive pneumatosis intestinalis in the colon with pneumoperitoneum mimicking hollow organ perforation. However, the patients had no abdominal symptoms and there was no evidence of peritonitis. The infection work-up was negative except one case with cytomegalovirus antigenemia. After one week of conservative management including bowel rest and antibiotic therapy, their pneumoperitoneum resolved spontaneously without any complication. Pneumatosis intestinalis should be considered as a differential diagnosis after adult liver transplantation with patients suffering from watery diarrhea and fever. Pneumoperitoneum, air-density in mesentery and retroperitoneum in patients with pneumatosis intestinalis without signs of peritonitis improved with conservative management, which included bowel rest and antibiotic therapy.
Adult ; Colon ; Cytomegalovirus ; Diagnosis, Differential ; Diarrhea ; Fever ; Humans ; Liver ; Liver Transplantation ; Mesentery ; Mortuary Practice ; Peritonitis ; Pneumoperitoneum ; Stress, Psychological

PURPOSE: Recently, the methods for reconstructing the acromion joint focused on an anatomical reconstruction. However, the reports of the anatomical method of the coraco-clavicle ligament have given different descriptions. This paper reports an anatomical study of the coraco-clavicle ligament in Koreans. MATERIALS AND METHODS: One hundred and two coraco-clavicle ligaments distracted from 6 fresh cadavers and 96 drug-administered cadavers were analyzed and calibrated. A quantitative analysis of the shape and location of the attachment site of the coracoid process and clavicle was performed, and the clinical and radiological applications were examined considering the calibrating variables. RESULTS: The conoid and trapezoid ligaments were thick and wide when measured in the middle part, and the average length up to the attachment site of the coracoid process was 11.3+/-3.6mm in men and 9.5+/-2.2mm in women. The average length of the clavicle was 158.5+/-55.7mm in men and 146.6+/-50.9mm in women. The length between the middle of the trapezoid tubercle or conoid tubercle and the lateral edge of the clavicle was 21.7+/-3.2mm and 42.8+/-3.4mm respectfully in men and 20.9+/-1.8mm and 39.9+/-3.3 respectfully in women, respectively. The angles of the conoid ligament and trapezoid ligament from the anteroposterior and lateral aspects were measured to be 25+/-8degrees and 19+/-3degrees respectfully in men and 28+/-5degrees and 17+/-3degrees degree respectfully in women. CONCLUSION: A more delicate reconstruction of the coraco-clavicle ligament is believed to be possible with regard to the mean distance from the clavicle to the conoid and trapezoid ligaments and the anticipation of a relationship between these ligaments.
Acromion ; Cadaver ; Clavicle ; Female ; Humans ; Joints ; Ligaments ; Male

Background: Patients with skin barrier dysfunction often coincides with pruritus, creating a ‘vicious cycle’ of dry skin and itching. Recently, Cynanchum atratum (CA) extract and its constituents have demonstrated effects on atopic dermatitis both in vivo and in vitro. Objective: This study aimed to assess the safety and efficacy of a moisturizer infused with CA extract in enhancing epidermal barrier function and reducing pruritus. Methods: A total 36 participants with skin barrier dysfunction with pruritus (mean age: 46.22±12.48 years) applied the CA-containing moisturizer topically twice daily for up to 4 weeks. Treatment efficacy was assessed by the investigator using the erythema scaling induration fissuring (ESIF) scale, transepidermal water loss (TEWL), skin hydration, visual analogue scale (VAS) for pruritus, and overall patient satisfaction assessed via questionnaire. Results: The CA-containing moisturizer demonstrated favorable tolerability, and yielded significant pruritus relief as evidenced by VAS scores after 2 and 4 weeks of application (p＜0.05). Significant decreases in TEWL (p＜0.05) and skin hydration (p＜0.05) were observed after 2 and 4 weeks, indicating enhanced skin barrier function. Moreover, significant relief from pruritus and reductions in ESIF were observed at 2 and 4 weeks of application (p ＜0.05), aligning with the high levels of patient satisfaction was high. Conclusion The CA-infused moisturizer emerged as a safe and effective intervention for restoring skin barrier function and providing itch relief.

Intraportal islet transplantation (IPIT) may potentially cure Type 1 diabetes mellitus; however, graft failure in the early post-transplantation period presents a major obstacle. In this study, we tested the ability of nicotinamide to prevent early islet destruction in a syngeneic mouse model. Mice (C57BL/6) with chemically-induced diabetes received intraportal transplants of syngeneic islet tissue in various doses. Islets were cultured for 24 h in medium with or without 10 mM nicotinamide supplementation. Following IPIT, islet function was confirmed by an intraperitoneal glucose tolerance test (IPGTT) and hepatectomy. The effects of nicotinamide were evaluated by blood glucose concentration, serum monocyte chemoattractant protein-1 (MCP-1) concentration, and immunohistology at 3 h and 24 h after IPIT. Among the various islet doses, an infusion of 300 syngeneic islets treated with nicotinamide exhibited the greatest differences in glucose tolerance between recipients of treated and untreated (i.e., control) islets. One day after 300 islet equivalent (IEQ) transplantation, islets treated with nicotinamide were better granulated than the untreated islets (P = 0.01), and the recipients displayed a slight decrease in serum MCP-1 concentration, as compared to controls. After 15 days, recipients of nicotinamide-pretreated islets showed higher levels of graft function (as measured by IPGTT) than controls. The pretreatment also prolonged graft survival (> 100 days) and function; these were confirmed by partial hepatectomy, which led to the recurrence of diabetes. Pretreatment of islet grafts with nicotinamide may prevent their deterioration on the early period following IPIT in a syngeneic mouse model.
Animals ; Blood Glucose/metabolism ; Chemokine CCL2/blood ; Diabetes Mellitus, Experimental/blood/*therapy ; Diabetes Mellitus, Type 1/blood/*therapy ; Glucose Tolerance Test ; Graft Rejection ; Graft Survival/drug effects ; Insulin-Secreting Cells/metabolism ; *Islets of Langerhans Transplantation ; Mice ; Niacinamide/adverse effects/*pharmacology ; Time Factors ; Transplantation, Homologous ; Vitamin B Complex/adverse effects/*pharmacology

PURPOSE: Many researchers have tried to develop animal models that mimic the human immune system, e.g. a humanized mouse model, to improve the engraftment of hematopoietic stem cells and develop human immune cells in an animal model. This study evaluated the feasibility of the cultured human umbilical cord blood (hUCB)-derived CD34(+) cells for cell expansion, in Rag2(-/-)gamma(c)(-/-) mice, and establish co-transplantation with human fetal thymus/liver tissue (Thy/Liv) under the kidney capsule. METHODS: Co-transplantation of hUCB-derived CD34(+) cells with Thy/Liv was performed. The hUCB-derived CD34(+) cells were prepared by freshly thawing (G1) and culturing for 7 days with two types of cytokine combinations (G2, G3). The CD45(+) cell populations were measured at 6, 8, 10 and 16 weeks in the peripheral blood. The splenocytes were cultured with mitogenic stimuli (PHA -L or IL-2) at 20 weeks post- transplantation, and the proliferation of human immune cells was evaluated. RESULTS: There were no significant differences in the human CD45(+) cell populations at 6, 8, 10 and 16 weeks post-transplantation between the groups. In the cultured splenocytes at 20 weeks post-transplant with PHA-L or IL-2, there was remarkable expansion of CD3(+) cells in the three groups. Although no CD19(+) cells were detected in the spleen, human Ig G was detected in the sera of these mice. CONCLUSION: The cultured and expanded hUCB-derived cells with cytokine combinations might be a feasible cell source in humanized mouse modeling. In addition, human immune cells can be reconstituted from the co-transplantation of Thy/Liv and cultured hUCB-derived CD34(+) cells.
Animals ; Fetal Blood ; Hematopoietic Stem Cells ; Humans ; Hydrazines ; Immune System ; Interleukin-2 ; Kidney ; Mice ; Models, Animal ; Phytohemagglutinins ; Spleen ; Transplants ; Umbilical Cord

PURPOSE: The clinical outcome is favorable for the treatment of unstable femoral intertrochanteric fractures using both dynamic hip screw (DHS) and trochanter stabilizing plate (TSP) in elderly patients. However, there are sometimes complications related to excessive sliding. Therefore, the aim of this study was to evaluate the value of additional fixation of greater trochanter using wires and screw in the unstable femoral intertrochanteric fractures with a greater trochanter fracture. MATERIALS AND METHODS: From March 2004 through December 2005, thirty-seven patients, who were more than sixty-five years of age and were diagnosed with osteoporosis, were treated with DHS and TSP in unstable femoral intertrochanteric fractures with a follow-up of more than 6 months (mean duration, 13.5 months). The patients were divided into two groups. One group (group A: 20 patients) was treated with DHS and TSP only, whereas the other (group B: 17 patients) was treated with DHS and TSP augmented by a wire and screw. The average age was 80.9 (range 68 to 89) and 83.2 years (range 72 to 91) in groups A and B, respectively. All the patients in both groups were assessed radiographically immediately after surgery and at the last follow-up. The level of sliding of the lag screw and displacement of the greater trochanter were evaluated statistically. RESULTS: Bony union was achieved in all cases except for two cases in group A. At the last follow-up, the average of lag screw sliding in groups A and B was 8.96+/-5.98mm and 4.80+/-3.68, respectively, showing a statistical difference (P value<0.05). The average greater trochnateric displacement in groups A and B was 2.06+/-2.86mm and 0.99+/-1.41mm, respectively, showing no statistical significance (P value>0.05). CONCLUSION: Unstable femoral intertrochanteric fractures can be treated successfully using a hip screw and TSP alone. However, the addition of wires and screws in the greater trochanter can prevent excessive sliding that occurs after displacing the greater trochanteric fragments out of the plate in the presence of a greater trochanteric fracture line or severe bone defect in the lateral aspect.
Aged ; Femur* ; Follow-Up Studies ; Hip ; Hip Fractures* ; Humans ; Osteoporosis