Peroxisome Proliferator-Activated Receptor γ Activation Promotes Adipogenesis in Human Mesenchymal Stem Cells

Purpose: In this study, we determined that the troglitazones could induce uniform adipogenesis of human mesenchymal stem cells (MSCs) within a short time in a dose- and a time-dependent manners. Materials and Methods: Human MSCs were isolated from bone marrow and cultured in basal or adipogenic medium in the presence of 0 50 μM troglitazone for 5 days. Then we performed flow cytometry, RT-PCR and western blot analysis. Results: In FACS assay, troglitazone induced adipocyte differentiation in a dose-dependent manner. At concentration of 25 μM troglitazone in adipogenic medium, over 50% of the cells differentiated into adipocytes at day 5. This was accompanied by increased mRNA levels for the adipocyte gene markers (LPL, aP2 and PPARγ) in RT-PCR. In western blot analysis, we found that ERK phosphorylation was inhibited in the early stage of adipogenesis. Conclusion: Through the addition of troglitazone as a PPAR γ agonist, we could get the uniform adipogenic differentiation within a short time. Thus, troglitazone directly regulates differentiation of human MSCs into adipocytes; induced PPAR γ expression may play a key regulatory role in this process. And we suggest a role for ERK as a regulatory switch for these differentiation pathwaysope

Diagnostic Value of Distal Radio-ulnar Joint Arthrography in TFCC Tear

Purpose: When it seems that TFCC is injured, it is known that MR arthrography is the most excellent method to confirm among examinations. However, MR arthrography has demerit by its cost for the case that is not covered by medical insurance. In this study, it is discussed about the diagnostic value of Arthrography. Materials and Methods: Between March 2003 and July 2008, fifty-nine patients are selected who have possibility of TFCC injury by clinical examination. Arthrography was examined by injection of contrast media into distal radio-ulnar joint, Pain of arthrographic procedure is compared with intravenous injection by visual analogue scale (VAS). Results: In case of the arthrography, Conservative treatment for 43 normal cases by arthrographic finding. Among them, 35 cases (81%) showed favorable improvement of the symptom and finished follow-up only by 8.7weeks. In 16 cases who showed TFCC injury in arthrography, 7 cases were done arthroscopic surgery without further-evaluation. Other 9 cases were examined with MR arthrography, these cases showed same result as in the result by arthrography Conclusion: In case of possibility of TFCC injury by clinical examination, arthrography is regarded as available diagnosis method with its economical merit and there is no problem with the pain of patients during the arthrographic procedure.ope

Internal Fixation of Mallet Fractures Using a Hook Plate

Purpose: The purpose of this study is to introduce the result of treatment for bony mallet finger using hook plate Materials and Methods: From September 2007 to Feburary 2008, 7 patients were treated with hook plate for bony mallet finger. Indications of operative treatment are fractures involving more than 30% of articular surface or those with palmar subluxation or fracture fragment displaced more than 3 mm. We used hook plate which prebend the 1.2 mm miniplate (Leibinger?). The mean follow-up period was 7 months. The clinical results were evaluated using Crawford classification. Results: According to Crawford classification, 6 cases were excellent and 1 case was good. There were marginal necrosis in one case and nail deformities in 3 cases. These complications were healed spontaneously. Conclusion: Internal fixation of mallet finger using Hook plate is a relatively easy method which can achieve anatomical reduction and firm fixation for earlier interphalangeal joint exercise.ope

The Results of Treatment for Motor Vehicle-related Crushing Injuries of Foot in Children

Purpose: The purpose of this work was to describe the results of treatment for motor vehiclerelated crushing injuries among children and adolescents under sixteen years in Korea. Materials and Methods: A retrospective analysis was conducted of data from children who were under sixteen year and injured foot by motor vehicles. Cases were documented 1) age at the time of injury, 2) injured site, 3) the area of accident, 4) the kind of vehicle, 5) associated injuries, 6) methods of treatment for soft tissue reconstruction and 7) complications. The relationships between the area of accident and associated injuries, and the kind of vehicle and associated injuries were analyzed using Chi-square test and Fisher exact test. Results: There were 97 children who were 15 year and younger. The mean age was 7.4 years, and 65% were boys. The left foot was more dominant side of injury (57%). Seasonal variation was seen with the number of injuries peaking during the summer (43%, p<0.05). Among the vehicles, 78.3% were the large vehicles (bus, truck or van). The where of accident was more frequent at an alley or less than two lanes of traffic. But, the relationships between the place of accident and associated injury or the kind of vehicles and associated injury were not statistically significant. The associated injury were fracture or dislocation (23 cases, 35.9%), injury of tendon (21 cases, 32.8%). There were amputation or disarticulation of foot in 8 cases (8.2%) and post-traumatic deformities such as flatfoot, hindfoot varus or valus deformities by tendon injury in 7 cases (7.2%). Conclusion: More than 50% of crushing or degloving injuries of child's foot by traffic accidents happened in boys between 5 to 9 years old. The associated injury was unrelated with size of vehicles or accident place at the time of accident. But, even though foot injury happened in an alley or one lane by small vehicles, child who hurt feet by car need thorough investigation about associated injury. If a surgeon keep in mind and treat child to associated injury necessarily, can minimize complication. Microsurgical reconstruction for soft tissue defect was prior to other methods.ope

The Treatment of Nonunion of the Scaphoid with a Horse-Shoe Bone Graft and Fixation with Two Screws

Purpose: Three dimensional anatomical reconstruction of an old scaphoid nonunion injury with a humpback deformity is not an easy procedure. The single interpositional bone graft technique has its limitation for accurate anatomic reconstruction. We report here on the effect of a cortical interpositional horse-shoe graft using two screws and a volar cancellous chip bone graft for the treatment of scaphoid nonunion with a humpback deformity or a miss-match fracture surface in scaphoid nonunion. Materials and Methods: We retrospectively reviewed nineteen patients who were treated for scaphoid nonunion using a cancellous chip bone graft and a cortical interpositional horse-shoe graft with 2 screws (a Herbert's screw and a mini screw). The mean follow up period was 24 months (range: 14-36 months). The mean age was 30.5 years (range: 17-52 years) and 18 patients were male and 1 patient was female. The mean period between injury and operation was 6.7 years (range: 1 to 30 years). The nonunion sites were located in the waist in 15 wrists and in the distal third in 4 wrists. The volar approach was used in 18 cases and the dorsal approach was used in 1 case. In 2 cases, one additional kirschner's wire was used due to the instability of fixation. The clinical results were assessed by the criteria of Maudesley and Chen at the last follow-up. Results: Bony union was obtained in 18 (95%) cases. The average time for union was 13 weeks. There were improvements in the scapholunate angle (from 65.2 degrees to 49.5 degrees) and the intrascaphoid angle (from 43.5 degrees to 29.6 degrees). There are 3 cases with excellent results, 10 cases with good results and 6 cases with fair results. There was one complication. In 1 case, a nonunion gap was seen at 7 months after operation, but there were no clinical symptoms. Conclusion: A cortical interpositional horse-shoe graft using two screws and a cancellous chip bone graft for treating scaphoid nonunion with a humpback deformity or a large defect seems to be an encouraging procedure for regaining the normal anatomy of the scaphoid.ope

Idiopathic Avascular Necrosis of the Capitate

Idiopathic avascular necrosis of the capitate is a very rare condition. Only 7 cases have been reported until 2002 in the literature since the lesion was originally described by Jonsson in 1942. The incidence of the injury has not been documented and no report has been issued in Korea. The author experienced one case of idiopathic capitate avascular necrosis which was treated by curettage and autoiliac bone graft.ope

Free Flap Transfer for the Reconstruction of injured Hands

Purpose: The purpose is to analyze the clinical results of a free flap transfer for the reconstruction of variously injured hands. Materials and Methods: Between March 1983 and December 2002, we reviewed retrospectively 79 patients (68 mem, 11 women) treated for soft tissue defects or functional loss of hands or forearms. There were 49 mechanical injuries, 20 traffic accidents, 6 burn scars, 2 tumorous condition, 2 bite injuries. The results were evaluated with flap survival rate and functional score using 4 grading system of Jung’s criteria. Result: Sixty four out of total 79 flaps successfully survived (81%). There were 18 wrap around flaps (out of them 17 survived, 94%), 14 parascapular flaps (11, 78%), 16 groin flaps (14, 87%), 10 dorsalis pedis flaps (7, 70%), 5 lateral arm flaps (3, 60%), 3 deltoid flaps (2, 67%), 6 gracillis flaps (4, 67%), 3 first web space flaps (2, 67%), 2 latissimus dorsi flaps (2, 100%), 2 lateral thigh flaps (2, 100%). Out of survived 64 cases, excellent or good results were obtained in 62 cases. Conclusion: Free flap transfer for the reconstruction of injured hands is very useful method for the functional and cosmetic recovery. Especially combined transfer of several tissues enables the primary reconstruction and rapid recovery.ope

Osteogenic Potential of Human Mesenchymal Stem Cells During Serial Subculture

Purpose: The purpose of this study was to evaluate the osteogenic differentiation potential of human mesenchymal stem cells during serial subculture. Materials and Methods: Human bone marrow-derived MSCs were serially subcultured and then maintained in basal or osteogenic medium for 14 days. Then we performed FAC analysis, RT-PCR, alkaline phosphatase activity and stains. Results: Human MSCs had different morphologies, immunophenotypes, and growth rates that were correlated with the length of serial subculture. The phenotype changed from small spindle-shaped cells at passage 1 into large cuboidal or flattened cells at passage 7. The osteogenic capacity of human MSCs decreased during serial subculture. Using RT-PCR, the mRNA levels of bone-specific genes, such as cbfa1/runx2 and osteocalcin, decreased with increasing passage number. Strong positive staining was observed for ALP and Alizarin reds in osteogenic medium on day 14, but declined significantly with increasing passage number. Conclusion: We have shown that osteogenic potential of human MSCs decreased during serial subculture. This result can provide the helpful information to decide the timing of human MSC transplantation during in vitro culture expansion for treatment of bone defects and so on.ope

Factors Influencing the Recurrence of a Giant Cell Tumor of the Bone

Purpose: The aim of this study was to evaluate the recurrence rates of a giant cell tumor of the bone and determine what, if any, patient factors, tumor characteristics and surgical treatments correlate with the incidence of a local recurrence. Materials and Methods: The records of fifty two cases who were diagnosed with a giant cell tumor of the bone between March 1992 and March 2001 and were could be followed up for at least 2 years were analysed retrospectively. This study reviewed the clinical characters, and the treatment method, recurrence, complication, the result of the follow-up. A Fisher's exact test was carried out to analyse the statistics. Results: Sixteen patients (31%) had a local recurrence. The average time to recurrence was 17 months. All but case one recurred within 2 years after receiving surgical treatment. There was no significant differences in the recurrence rates based on the following variables: gender, tumor location, Campanacci grade, the presence of a pathologic fracture, primary versus recurrent tumor at presentation, resection margin, the use of a bone graft, internal fixation or polymethylmethacrylate. Conclusion: The clinical characters and methods of treatment were not correlated with a local recurrence. Most recurrences of a giant cell tumor can be expected within the first two to three years. Therefore the patient needs to be followed up in that period and longer for the a late recurrence and pulmonary metastasis.ope

Intraneural Ganglion of the Peroneal Nerve - A Report of 3 Cases -

An intraneural ganglion mainly affects the common peroneal nerve but the condition is relatively rare. Ganglions arising from the joint, tendon sheath or sheath of a peripheral nerve. We report three cases of intraneural ganglion cysts in the peroneal nerve that were treated by an excision.ope