Platelet-derived growth factor(PDGF) is known to accelerate soft tissue fracture and periodontal bone healing, but little information is available for characterizing the healing of articualr cartilage. This study was designed to demonstrate the regeneration potential of pasteurized autogeneous osteochondral graft when PDFG was applied locally in vivo. Eighteen rabbits in two groups were used in the experiment. The free osteochondral fragment(1x1x1 cm) were taken from distal femur. The fragment were pasteurized in 65degrees C for 5 minutes. In experimental group(group II), the fragment were soaked in 0.25 mg/ml of recombinant human PDGF mixed 5 ml normal saline and reimplanted to the resected site, and followed with local administration of 0.25 mg/ml PDGF to knee joint. In control group(group I), the pasteurized fragment were reimplanted in the resected site without any treatments. The histologic characteristics of the transplanted autografts for three rabbits in each group were observed at 3, 5 and 7 weeks postoperatively. The results were as follows; Group II revealed the more favorable regeneration of articular cartilage, less arthritic changes and more mature arrangement of chondrocytes than group I. Even thought the cartilage is avascular and the regeneration capacity of pasteurized cartilage is severely limited, the regeneration of grafted articular cartilage is thought to be accellerated by increased newly formed blood vessels and soft tissues due to the diffusion of PDGF on grafted cartilage, and probably also by differentiation of mesenchymal cells in the initial stage of experiment. The results of this study suggest that local administration of PDGF could be used for the treatment of posttraumatic or degenerative arthritis and various cartilage damages.
Autografts ; Blood Vessels ; Cartilage ; Cartilage, Articular ; Chondrocytes ; Diffusion ; Femur ; Humans ; Knee Joint ; Osteoarthritis ; Platelet-Derived Growth Factor* ; Rabbits* ; Regeneration* ; Transplants*

No abstract available.
Breast* ; Glucuronidase* ; Lipase* ; Milk, Human*

During the arthroscopic surgery of the shoulder, there was extravasation of fluid into the surrounding soft tissue due to the use of pressure pump irrigator. Clinically, the shoulder region became tense and intramuscular pressure of the deltoid could be elevated. To analyze the change of the intramuscular pressure of the deltoid and the efficiency of cryotherapy in the shoulder arthroscopy with pressure pump, we studied 35 consecutive patients who underwent various arthroscopic shoulder procedures at the Dankook University Hospital. We monitored intramuscular pressure using spinal needle connected to the patient monitoring system during arthroscopic procedures and postoperative period until return to preoperative pressure level. Twenty-seven patients were fitted with a cryotherapy. device in the operating room, and 8 were not according to the patient opinions. We evaluated the effect of cryotherapy with visual analog scales and amounts of analgisics for 3 days postoperatively. The results were followed; 1. Intraoperative highest intramuscular deltoid pressure was 293mmHg (average 169+/-68mmHg, 71293mmHg). 2. Immediate postoperative deltoid pressure was average 58.3+/-28.1mmHg (24-145mmHg). 3. Average time that the pressure had returned to the preoperative level was 114.3+/-38.6 minutes (p<0.05). There were no statistically significant between two groups, 113.9+/-41.1 min in the cryotherapy group and 115.7+/-32.6 min in the non-cryotherapy group. 4. Shoulder pain was less in the cryotherapy cases until second postoperative day. In conclusion, arthroscopic surgery of the shoulder can be performed with minimal complication in spite of high intramuscular deltoid pressure. More than 60 minutes may be needed for returning to normal intramuscular deltoid pressure. Cryotherapy is eftective in the pain relief but cannot minimize swelling postoperatively.
Arthroscopy* ; Cryotherapy* ; Humans ; Monitoring, Physiologic ; Needles ; Operating Rooms ; Postoperative Period ; Shoulder Pain ; Shoulder* ; Transcutaneous Electric Nerve Stimulation ; Visual Analog Scale

PURPOSE: To identify sensory nerve endings in the human hip joint capsule and in the pseudocapsule after total hip replacement. MATERIALS AND METHODS: Ten hip joint capsules from patients undergoing bipolar hip replacement for acute femoral neck fracture, and six pseudocapsules from patients undergoing revision hip surgery for failed total hip replacement were harvested and stained in bulk using a modified gold-chloride method. Sensory nerve endings were identified using the criteria described by Freeman and Wyke. RESULTS: Three morphologically distinct types of nerve endings were identified in the normal human hip joint capsules; type I Ruffini corpuscles, type II Pacinian corpuscles and type IV free nerve endings. In contrast, no proprioceptive nerve endings (type I and II receptors) were observed in pseudocapsular tissues. A small number of type IV receptors were noted in the pseudocapsule, but these were significantly fewer in number than in normal hip capsular tissue. CONCLUSION: The pseudocapsule that forms after hip replacement surgery may protect joint stability through a mechanical check-rein effect rather than through a proprioceptive feedback mechanism.
Arthroplasty, Replacement, Hip* ; Capsules ; Feedback, Sensory ; Femoral Neck Fractures ; Hip Joint* ; Hip* ; Humans* ; Joints ; Mechanoreceptors ; Nerve Endings ; Pacinian Corpuscles ; Sensory Receptor Cells

PURPOSE: We compared the clinical and radiological outcomes of total hip arthroplasty (THR) using Summit and Bencox stems. MATERIALS AND METHODS: The patients who underwent cementless total hip arthroplasty were recruited with a satisfactory condition of a minimum three years of follow-ups after THR. Those patients were divided into two groups, those with Summit stems and those with Bencox stems. Summit stems were in 36 patients(40 hips), and Bencox stems in 36 patients(48 hips). Summit and Bencox stems had 78 months and 42.2 months as a mean follow-up, respectively. The clinical and radiological evaluations of femoral components were performed. RESULTS: There was no difference in clinical results between the two groups. Under the radiological findings, there were no osteolytic changes or loosening. Osseointegration was detected at an average of 6.4 months(3-12 months) in the Bencox stem on the distal portion of the femoral stem, and cortical hypertrophy was detected on 6 hips with a Summit stem. CONCLUSION: The clinical and radiological evaluations in both systems showed excellent outcomes at the three year follow-ups, and there was no statistical difference on the clinical and radiological results between the two groups. Thigh pain and cortical hypertrophy were not detected in the Bencox stem, and that wound would be caused by surface treatment methods of the femoral stem, and morphological differences.
Arthroplasty ; Follow-Up Studies ; Hip ; Humans ; Hypertrophy ; Osseointegration ; Osteonecrosis ; Thigh

PURPOSE: We wanted to evaluate the accuracy of the alignment of the lower extremity in 661 cases of total knee arthroplasty (TKA) with using a navigation system. MATERIALS AND METHODS: We evaluated 661 cases (431 patients) that underwent TKA using a navigation system from June 2006 to September 2008. To analyze the mechanical axis, the weight bearing full length lower extremity radiographs were taken preoperatively and the again at3 weeks after the operation. The results from a well- experienced surgeon (423 cases) were compared with those from a less-experienced surgeon (238 cases), and they both used the navigation system. RESULTS: The mean of the mechanical axis was -13.3degrees (range: -33.3degrees-10.6degrees) preoperatively, but it was corrected to -2.0degrees (range: -14.3degrees-7.5degrees) after TKA using a navigation system. There was no significant difference between the mean of, -1.8degrees (range: -13.4degrees-6.8degrees) by a well-experienced surgeon and the mean of, -2.2degrees (range: -14.3degrees-7.5degrees) by a less-experienced one. CONCLUSION: According to the radiologic results, the navigation system is beneficial for the accuracy of the mechanical axis in TKA. The navigation system helps a less-experienced surgeon increase the accuracy of the lower extremity alignment.
Arthroplasty ; Axis, Cervical Vertebra ; Knee ; Lower Extremity ; Statistics as Topic ; Weight-Bearing

Damages on the recurrent laryngeal nerve (RLN) during thyroid surgery is the most common iatrogenic cause of vocal cord paralysis. Identification of the recurrent laryngeal nerve and meticulous surgical techniques can significantly decrease the incidence of this complication. The nonrecurrent inferior laryngeal nerve is an exceedingly rare anomaly of the recurrent laryngeal nerve. The nonrecurrent inferior laryngeal nerve is associated with abnormal development of the aortic arch, where the innominate (brachiorephalic) artery is not found and the right common carotid artery rises directly from the aortic arch. The aberrant right subclavian artery can always be felt against the vertebral column behind the esophagus. Surgeons need to be aware of the positions of these arteries to avoid damaging them. We experienced a case of nonrecurrent inferior laryngeal nerve in the right side with the aberrant right subclavian artery. The patient received a total thyroidectomy with neck dissection for thyroid carcinoma with nodal metastasis. Incidentally, we also found nonrecurrent inferior laryngeal nerve, and also found an aberrant right subclavian artery by the computed tomography scan. The patient presented transient vocal cord paralysis but gained complete recovery of vocal cord mobility after one and a half month later.
Aorta, Thoracic ; Arteries ; Carotid Artery, Common ; Esophagus ; Humans ; Incidence ; Neck Dissection ; Neoplasm Metastasis ; Recurrent Laryngeal Nerve* ; Spine ; Subclavian Artery ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Vocal Cord Paralysis ; Vocal Cords

PURPOSE: We hypothesize that the presence of barium sulfate debris plays an influential role to deteriorate the balance of bone remodelling around prosthesis via cytotoxic mechanism to osteoblast. MATERIALS AND METHODS: Osteoblasts were obtained from the neonatal rat calvarium, and SiO2, TiO2 , PMMA and BaSO4 particles were prepared for the evaluation of particle induced cytotoxicity to osteoblast. Osteoblasts were grown in DMEM and then were seeded into 6 well culture plates. 1.0wt% solution of each particle was added to culture medium to generate a final concentration of 0.1wt%, and 0.005wt% of various particles in each well, respectively. The measurement of intracellular calcium was conducted using various agonists of calcium. The cell viability assay for osteoblast was performed with MTT reduction assay and the mineralization of the matrix was checked by Von Kossa staining. ELISA kit was used to quantify the level of osteocalcin in osteoblast. RESULTS: BaSO4 significantly lowered the cell viability. All particles except TiO2 increased [Ca(2+)]i transiently, and the rank of differential cytosolic [Ca(2+)]i was in order as follows; SiO2, BaSO4, and PMMA. The mineralization was significantly prohibited in SiO2 and BaSO4(0.1wt%), however the PMMA showed no definite inhibitory effect on bone mineralization. PMMA(0.1wt%) and BaSO4(0.1wt%) showed significantly inhibitory effect on osteocalcin production. CONCOUSION: In higher concentration, BaSO4 has a cytotoxic effect on osteoblast and inhibitory effect of osteocalcin production as well as mineralization of osteoblast. Also, this study has shown that the concentration of intracellular calcium is strongly influenced by exposure to BaSO4 particles in vitro. The effect of BaSO4 on osteoblast observed in this study could have implications for the role of BaSO4 particles on osteoblast function at aseptic loosening of cemented total joint arthroplasty.
Animals ; Arthroplasty ; Barium Sulfate ; Calcification, Physiologic ; Calcium ; Cell Survival ; Cytosol ; Enzyme-Linked Immunosorbent Assay ; Joints ; Osteoblasts* ; Osteocalcin ; Polymethyl Methacrylate ; Prostheses and Implants ; Rats* ; Skull

PURPOSE: It is difficult to develop a good defense system that can prevent nurses from experiencing physical and verbal violence from patients and families in intensive care units, which are closed spaces. This study aimed to identify intensive care nurses' experience of violence from patients and families and investigate their coping methods, if there are any, in a tertiary hospital in South Korea. METHODS: This study used a mixed methods design using both a survey for collecting quantitative data and individual interviews for a qualitative one. A total of 200 intensive care nurses participated in the survey, with 30 of them taking part in individual interviews. Survey data were analyzed using SPSS 21.0 program, and qualitative data were analyzed by qualitative content analysis method. RESULTS: In the survey, 99.5% of the nurses reported that they had experienced violence from the patients, and 67.5% of the nurses reported that they had experienced violence from their visitors (families or relatives). Verbal violence were reported more than physical ones. They showed moderate or severe responses to violence, scoring an average of 2.98 ± 0.63 of 5. The qualitative data were analyzed to draw four themes, eight categories, and 17 subcategories. The four themes were perception of violence, coping with violence experience, coping resources, and caring mind after violence experience. CONCLUSION: While intensive care nurses experience unpredicted violence from patients and their visitors, they fail to cope well with the experience. The safe working environment of intensive care units is expected to contribute to quality care and an improvement of expertise in nursing.
Critical Care* ; Humans ; Intensive Care Units* ; Korea* ; Methods* ; Nursing ; Tertiary Care Centers ; Violence*

BACKGROUND AND OBJECTIVES: To analyze results of treatment and prognostic factors in patients with T3 supraglottic carcinoma and to compare results of treatment in patients with T3 transglottic carcinoma with T3 pure supraglottic carcinoma. MATERIALS AND METHOD: A retrospective study was done on thirty-two patients who underwent a surgery or surgery with postoperative radiation therapy from 1990 to 2000. Neck dissection was performed in 27 patients and 24 patients received postoperative radiation therapy. RESULTS: The 3-year overall survival rate was 81.6%. The 3-year overall survival rate of T3 pure supraglottic carcinoma and T3 transglottic carcinoma were 91.7% and 73.2%, respectively (p<0.05). The univariate analysis revealed a prognostic significance for vocal cord fixation and statistical trend to age, dyspnea, clinical and pathological metastasis of cervical lymph node and postoperative radiation therapy (p<0.2). T3 transglottic carcinoma was significantly correlated with vocal cord fixation. CONCLUSION: Surgery or surgery with postoperative radiation therapy provides acceptable rates of cancer control and survival rate for patients with T3 supraglottic carcinoma. Transglottic involvement and vocal cord fixation shown by the fiberoptic laryngoscopy were significant prognostic factors. T3 transglottic cancer needs more aggressive management.
Dyspnea ; Humans ; Laryngoscopy ; Lymph Nodes ; Neck Dissection ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Survival Rate ; Vocal Cords