The formation, maintenance, and regeneration of bone is a complex precess involving the interactions of many cellular elements with systemic and local regulators. TGF-β is one of growth factors that play an important role in the formation and remodeling of bone. In vitro studies have suggested that TGF-β regulates chondrogenesis and possibly osteogenesis by affecting replication, gene expression, and structural protein synthesis in bone formation. We investigated the effect of TGF-β1 upon fracture callus formation and maturation in mature rate. Closed femoral shaft fracture was made consistently by three point stress technique after percutaneous intramedullary nailing. TGF-β1 was injected subperiosteally at the fracture site daily for 2 weeks. We examined the effect of TGF-β1 on the fracture healing process with the radiographic, densitometric, histologic, and immunohistochemical methods. The following results were obtained. 1. Radiographic examination demonstrated that TGF-β1 injection group appeared to have more abundant callus formation and earlier callus maturation as compared to the control group. 2. Bone densitometric examination revealed that TGF-β1 injection group had higher bone mineral density and content that the control group. 3. Thermographic examination revealed that TGF-β1 injection group had higher local temperature at the injection area than the control group. 4. Histologic examination suggested that TGF-β1 stimulates and accelerates fracture callus formation and endochondral bone formation. 5. Immunohistochemical examination revealed that chondrocytes at the fracture site in the TGF-β1 injection group seemed to produce type I collagen.
Bone Density ; Bony Callus ; Chondrocytes ; Chondrogenesis ; Collagen Type I ; Fracture Fixation, Intramedullary ; Fracture Healing ; Gene Expression ; In Vitro Techniques ; Intercellular Signaling Peptides and Proteins ; Osteogenesis ; Regeneration

No abstract available.
Spine* ; Spondylitis, Ankylosing* ; Tabes Dorsalis*

STUDY DESIGN: An experimental study. OBJECTIVES: To define the phases of chronic spinal cord injury by researching the changes in gene expression. SUMMARY OF LITERATURE REVIEW: The exact time of conversion from acute stage to chronic stage in spinal cord injury is unknown. MATERIALS AND METHODS: We used 18 month-old Beagle dogs as study subjects. Under spinal cord monitoring, we underwent laminectomy on thoracic vertebra 10 and 11, and induced cord injury by a weight-drop injury method. Dogs in each group with spinal cord injury and group without spinal cord injury on POD 1, 7, 30, and 90. The motor functions were evaluated using the Tarlov scale. Tissues were prepared from 0.5cm up and down from the 10th thoracic level. Additional cephalic and caudal lesions from the injured site were prepared. We have checked the differentially expressed gene(DEG). RESULTS: The mean Tarlov value was 0.67 which indicated a significant cord injury. 4 DEG (GP3, 9, 25, 34) were detected among 40 primers after screening, the detection percentage of which was 10. In the tissues of study subjects with spinal injury, DEG was found at the injury site and cephalic lesion. DEG expressed GP3, GP9 and GP34 started expression on day 30, and GP25 was expressed on day 90. CONCLUSIONS: According to the changes in gene expression, the day 30 would be considered as the date of conversion from acute to chronic phase of cord injury. Inhibiting secondary inflammatory change and apoptosis following spinal cord injury until this period would maximize the effect of chronic phase therapy such as cell-transplantation.
Animals ; Apoptosis ; Dogs ; Gene Expression ; Laminectomy ; Mass Screening ; Spinal Cord ; Spinal Cord Injuries ; Spinal Injuries ; Spine

PURPOSE: Bone graft is essential for successful spinal fusion. So, we clinically assessed the effect of uniting grafted autologous bone. MATERIALS AND METHODS: Retrospective analysis is performed on 46 patients who had grade I or II, one segmental, degenerative spondyloiisthesis according to Meyerding classification and treated operatively by posterolateral fusion with posterior decompression and autologous iliac bone graft from January 1991 to June 1996. We got the data from simple anteroposterior, lateral, flexion- extension X-ray film at preoperative, postoperative and last follow-up period, and from clinical results at last OPD follow-up according to Kirkaldy-Willis criteria. We compared the union of grafted autologous bone with clinical results using X2-test. We also compared preoperative spinal instability, with/without instrumentation and intraoperative reduction with the union of grafted autologous bane and clinical results. RESULTS: There was high significant correlation (P=0.000) between the union of grafted autologous bone and clinical results statistically, CONCLUSIONS: This results suggest that the union of grafted autologous bone was an important factor in determing clinical results.
Classification ; Decompression ; Follow-Up Studies ; Humans ; Retrospective Studies ; Spinal Fusion ; Spondylolisthesis* ; Transplants* ; X-Ray Film

The clinical entity of Dysplasia Epiphyseal Multiplex was first descrihed by Fairbank in 1935, characterized by the disturbance of endochondral ossification in hoth epiphyseal centers and regions of physeal growth. It manifests itself radiologically as late appearance and mottling of the ossification centers and clinically as short stature, stubby digits and painful stiffness of multiple joints. It is typically transmitted as an autosomal dominant trait though recessive forms have been described. The spine is normal apart from a mild increased lumbar lordosis. Many patients are referred to an orthopaedic surgeon for bilateral Perthes disease, as was one of the authors cases. This Paper reports four cases of multiple epiphyseal dysplasia which affected one family.
Animals ; Hip ; Humans ; Joints ; Knee ; Legg-Calve-Perthes Disease ; Lordosis ; Osteochondrodysplasias* ; Spine

PURPOSE: To compare the usefulness of double-dose contrast-enhanced CT (DDCE-CT) and conventional contrast-enhanced CT (CCE-CT) in the detection of metastatic brain lesions. MATERIALS AND METHODS: Sixteen patients with brain metastases were evaluated with both CCE-CT and thinslice DDCE-CT. For CCE-CT, an initial injection of 100 ml contrast medium was given, and DDCE-CT with both 10-mm and 5-mm thickness was performed after the addition of an extra 100 ml of contrast medium. The numbers of metastatic lesions detected by CCE-CT and by DDCE-CT were compared, as were the findings of contrast-enhanced MRI (CE-MRI) and thin-slice DDCE-CT in seven patients who underwent both these procedures. RESULTS: Fourteen metastatic brain lesions were detected by CCE-CT, 22 by 10-mm-thickness DDCE-CT, and 36 by 5-mm thickness DDCE-CT. Thus, almost 2.6 times more lesions were detected by thin-slice DDCE-CT than by CCE-CT. Metastatic lesions were detected by 10-mm-thickness DDCE-CT in 16 patients and by CCECT in seven; in five, edema only was detected, while in four there were no detectable metastases. CCE-CT detected four lesions of less than 5 mm in diameter, while 10-mm-thickness DDCE-CT and 5-mm-thickness DDCE-CT detected seven and 18 lesions, respectively. Eleven lesions were detected by thin-slice DDCE-CT and 17 by CE-MRI in the seven patients who underwent both CE-MRI and DDCE-CT. The lesions detected only by CE-MRI were less than 5 mm in diameter and were discovered in the cerebellum or inferior temporal lobe. CONCLUSION: Thin-slice DDCE-CT was superior to CCE-CT in detecting metastatic brain lesions.
Brain* ; Cerebellum ; Edema ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis* ; Temporal Lobe ; Tomography, X-Ray Computed*

High tibial osteotomy has been widely accepted as a method of treatments for middle-aged varus osteoarthritides with uncompartmental involvements. There have been several reports regarding the managements of fibula and their complications during the valgization procedure of tibia. They are, for example, osteotomy of fibular diaphysis or neck and excision of fibular head. Each level of fibular management is often complicated by nonunison, peroneal nerve palsy and lateral instability respectively. We have reviewed 20 cases of cases of high tibial osteotomy using proximal tibiofibular arthrolysis performed between March 1987 and February 1993. This method has proved excellent exposure of upper lateral tibia for the wedge removal, internal fixation and relief of the tethering effect of fibula. There was no peroneal nerve palsy relate to this degenerative change of the proximal tibiofibular was 3.4mm(range 1-11mm) and there was neither degenerative change of the proximal tibiofibular joint nor varus instability. In conclusion the arthrolysis of proximal tibiofibular joint can be highly recommended in high tibial osteotomy.
Diaphyses ; Fibula ; Head ; Joints ; Methods ; Neck ; Osteoarthritis ; Osteotomy ; Paralysis ; Peroneal Nerve ; Tibia

PURPOSE: To evaluate the effectiveness of a blocking screw in intramedullary nailing at the tibia proximal shaft fracture. MATERIALS AND METHODS: 63 tibia proximal shaft fractures from January 2000 to December 2002 treated with only intramedullary nailing were referred to as group I, and 8 fractures from January 2003 to December 2003 treated with both intramedullary nailing and the blocking screw were referred to as group II. Retrospective studies were done for group I and II. The incidence of nonunion and the postoperative angular alignments were compared. Malalignment was defined as an angle of 5 degrees anteroposteriorly or mediolaterally. RESULTS: There were 7 nonunion (11%) in group I in compare with none in group II. There were 21 angular malalignments (33%) in group I and 1 in group II (12%) and most of them had valgus deformity or anterior anglulation. No complications were directly due to the use of the Blocking screw. CONCLUSION: The technique of the blocking screw used to be one of the option for proximal tibial nailing at tibial proximal shaft fracture helps to overcome angular malalignments of bones.
Congenital Abnormalities ; Fracture Fixation, Intramedullary ; Incidence ; Retrospective Studies ; Tibia ; Tibial Fractures*

Inflammatory pseudotumors are tumor-like benign lesions of uncertain pathogenesis and have most commonly been reported in the lungs. In the pancreas they are rare. We describe a case of inflammatory pseudotumor of the pancreas which was seen to be isoattenuating at non-contrast CT, and as a well-defined nodule with homogeneous enhancement in the pancreatic tail at contrast-enhanced CT. After a preoperative diagnosis of islet cell tumor, partial pancreatectomy of the pancreatic tail, with splenectomy, was performed. The gross specimen was a yellowish-white, solid mass and the lesion was histopathologically confirmed as inflammatory pseudotumor with an extensive area of sparse cellular fibrosis and collagen deposition.
Adenoma, Islet Cell ; Collagen ; Diagnosis ; Fibrosis ; Granuloma, Plasma Cell* ; Lung ; Pancreas* ; Pancreatectomy ; Splenectomy ; Tomography, X-Ray Computed

Limited data are available on inappropriate shocks in Korean patients implanted with an implantable cardioverter-defibrillator (ICD). We investigated the impact of inappropriate shocks on clinical outcomes. This retrospective, single-center study included 148 patients treated between October 1999 and June 2011. The primary outcome was a composite event of all-cause mortality or hospitalization for any cardiac reason. The median follow-up duration was 29 months (interquartile range: 8 to 53). One or more inappropriate shocks occurred in 34 (23.0%) patients. A history of atrial fibrillation was the only independent predictor of inappropriate shock (hazard ratio [HR]: 4.16, 95% confidence interval [CI]: 1.89-9.15, P < 0.001). Atrial fibrillation was the most common cause of inappropriate shock (67.7%), followed by supraventricular tachycardia (23.5%), and abnormal sensing (8.8%). A composite event of all-cause mortality or hospitalizations for any cardiac reason during follow-up was not significantly different between patients with or without inappropriate shock (inappropriate shock vs no inappropriate shock: 35.3% vs 35.4%, adjusted HR: 1.06, 95% CI: 0.49-2.29, P = 0.877). Inappropriate shocks do not affect clinical outcomes in patients implanted with an ICD, although the incidence of inappropriate shocks is high.
Adult ; Aged ; Atrial Fibrillation/complications ; Defibrillators, Implantable/*adverse effects ; Equipment Failure ; Female ; Hospitalization ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; *Predictive Value of Tests ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Shock/*etiology/mortality ; Tachycardia, Supraventricular/complications