Fifty six patients with unstable thoracolumbar bursting fractures were treated using variable internal fixation devices such as the Kaneda Anterior Fixation System(Kaneda device), the Z-Plate-ATL(TM) Anterior Fixation System(Z-Plate ATL(TM) device), the Harrington device, Cotrel-Ducousset(CD) or Compact Contrel Dubousset(CCD) device or Steffee Transpedicular System with or without decompression. Such internal fixation devices were grouped into anterior and posterior internal fixation devices and compared with each other in the aspect of the degree of neurological improvement, the changes of the vertebral height and the kyphotic angle, the duration of admission, and postoperative complications. In conclusion, the anterior internal fixation device appears to be of more benefit in the management of patients with unstable thoracolumbar bursting fracture.
Decompression ; Humans ; Internal Fixators ; Postoperative Complications

This study was designed to introduce free toe tissue transfer using infiltration method of local anesthetic agent. Four toe pulp tissues were transferred to reconstruct finger tip defect in four patients who were not suitable for general anesthesia. Two flaps taken from the lateral side of the great toe was used for reconstruction of thumb defect and two flaps from the medial side of the second toe for resurfacing of the index and fifth finger. Flap sizes were various from 2.0x2.0 cm2 to 1.6x4.0 cm2. Anesthesia was induced by infiltration of 2% lidocaine hydrochloride (with 1:100,000 epinephrine) with dilution of normal saline in same volume unit, as like as in ordinary digital block. All vessels were anastomosed within 2 cm of distance from the proximal margin of the defect. Whole operative procedures were carried out by one team. All flaps were successfully taken without complication. The average operation time was 4 hours 10 minutes. The amount of anesthetic agent used in whole operative procedures was roughly 4 mL in the toe, 8 mL in the finger, and 12 mL totally. In conclusion, free toe tissue transfer using infiltration method of local anesthetic agent would be good strategy for finger tip reconstruction in the patient not suitable for general anesthesia.
Anesthesia ; Anesthesia, General ; Fingers ; Humans ; Lidocaine ; Surgical Procedures, Operative ; Thumb ; Toes*

Non-vascularized free composite graft is one of the simple and effective reconstructive options, but its clinical use has been limited due to questionable survival rate. Early vascularization is essential for graft survival and is mainly carried out via recipient bed or repaired sites. This study was designed to investigate the effect of the lateral marginal approximations on the survival of the free composite flap using a model of skin-subcutaneous composite graft in rats. Thirty 1.5 x 1.5 cm2 sized square shape composite flaps were elevated freely and reposed in place immediately on the dorsum of five Sprague-Dawley rats, and divided into five groups of six flaps. In all groups, graft bed was isolated with silastic sheet. In the group I, all sides of flap were repaired with blockage of silastic sheet insertion. Three, two, and one sides of flap were treated with same method in the group II, III, and IV respectively. Other sides of flaps were repaired without blockage, so all sides of flap were repaired in the group V. At 14 days later, the survived rate of each flap was evaluated according to the numbers of the repair sites. Histological examination was done for the evaluation of new vessel development quantitatively. Overall survived rates were increased with the number of repaired sites, but the group V only showed increased survival rate up to more than fifty percentile of the flap size with a significant difference statistically. New vessels were also increased in proportion with the number of repaired sites, and the repair site more than two had significant effect on the increased number of new vessels. In conclusion, at least more than threefourth of flap circumference should be repaired in order to increase flap survival effectively under the condition of bed isolation.
Animals ; Graft Survival ; Rats ; Rats, Sprague-Dawley ; Survival Rate ; Transplants

OBJECTIVE: The purpose of this study was to find reliable behavioral measures for the evaluation of motor dysfunction in photothrombotic ischemia rat model. METHOD: Male Sprague-Dawley rats were trained for behavioral test including tray reaching task (TRT), single pellet reaching task (SPRT), and rotarod task (RRT) for more than 2 weeks. Photothrombotic ischemia was induced in a stereotactically held rats using Rose Bengal dye (20 mg/kg) and cold light. Rats were assigned to either control (n=10) or experimental ischemic group (n=10). Post-lesional behavioral tests were performed for 4 weeks after confirmation of lesion by magnetic resonance imaging (MRI), followed by histological examination. RESULTS: RRT showed no difference between control and experimental group. SPRT and TRT showed significant difference between control and experimental group (p<0.05). SPRT could well demonstrate the recovery of motor dysfunction after over time. CONCLUSION: SPRT could be the most reliable test to measure not only motor dysfunction but also motor recovery in unilateral motor cortex lesion of photothrombotic ischemia rat model.
Animals ; Humans ; Ischemia ; Magnetic Resonance Imaging ; Male ; Models, Animal* ; Motor Cortex ; Rats* ; Rats, Sprague-Dawley ; Rose Bengal ; Stroke* ; Thrombosis

In this study, we estimated inhomogeneity correction factor in small field. And, we evaluated accuracy of treatment planning and measurement data which applied inhomogeneity correction factor or not. We developed the Inhomogeneity Correction Phantom (ICP) for insertion of inhomogeneity materials. The inhomogeneity materials were 12 types in each different electron density. This phantom is able to adapt the EBT film and 0.125 cc ion chamber for measurement of dose distribution and point dose. We evaluated comparison of planning and measurement data using ICP. When we applied to inhomogeneity correction factor or not, the average difference was 1.63% and 10.05% in each plan and film measurement data. And, the average difference of dose distribution was 10.09% in each measurement film. And the average difference of point dose was 0.43% and 2.09% in each plan and measurement data. In conclusion, if we did not apply the inhomogeneity correction factor in small field, it shows more great difference in measurement data. The planning system using this study shows good result for correction of inhomogeneity materials. In radiosurgery using small field, we should be correct the inhomogeneity correction factor, more exactly.
Electrons ; Radiosurgery

BACKGROUND/AIMS: The treatment efficacy for advanced hepatocellular carcinoma is poor. This study examined the efficacy and toxicity of 3-dimensional conformal radiotherapy (3D-CRT) in combination with transarterial chemolipiodolization (TACL) for a huge hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). METHODS: From March 2001 to November 2004, 49 patients with advanced HCC with PVTT (size>8 cm, modified UICC stage IVa) were enrolled in this retrospective study. Twenty two patients underwent more than 2 cycles of TACL (adriamycin 50 mg/m2, cisplatin 60 mg/m2, 5-fluorouracil 200 mg/m2 every 4-6 weeks) without 3D-CRT, while 27 patients underwent consecutive TACL with 3D-CRT (40-45 Gy for 4-5 weeks) that was started one week after the 1st TACL. The response was assessed by a computed tomography (CT) and the serum alpha-fetoprotein (AFP) level at 1-2 month intervals. RESULTS: The objective response rates in the TACL group and TACL with 3D-CRT group were 18% and 48% at 3 months (P=0.051), and 10.5% and 42% at 6 months (P=0.024) respectively. The median survival time was 13 months and 13.5 months in TACL and TACL with 3D-CRT groups, respectively (P=0.502). The treatment response was better in the TACL with 3D-CRT group but there was no significant difference in survival between the two groups. Most toxicities in the two groups were mild, not exceeding grade 1 according to the WHO criteria. CONCLUSIONS: For patients with a huge HCC with PVTT, TACL with 3D-CRT achieved some meaningful clinical benefit. Prospective controlled trials will be needed to confirm the real benefit of TACL combined with 3D-CRT.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/complications/radiotherapy/*therapy ; Chemoembolization, Therapeutic/*methods ; Combined Modality Therapy ; Data Interpretation, Statistical ; Female ; Humans ; Liver Neoplasms/complications/radiotherapy/*therapy ; Male ; Middle Aged ; *Portal Vein ; Radiotherapy, Conformal/adverse effects/*methods ; Severity of Illness Index ; Survival Analysis ; Venous Thrombosis/etiology/radiotherapy/*therapy