Ischemia and reperfusion of skeletal muscle occurs in acute vascular occlusion and revascularization, in elective vascular surgery, in upper and lower extremity surgery by means of a tourniquet, and in free transplantation of muscle containing cutaneous flaps. During revascularization of skeletal muscle after ischemia, lipid mediators, mainly eicosanoids are released that may have a role in the pathogenesis of reperfusion injury. The exact role of eicosanoids in the imposed ischemia-reperfusion induced functional deficits in skeletal muscle is still unknown, we compared tissue edema and the changes of eicosanoids and the effects of cyclooxygenase inhibitor indomethacin in the rat right hindlimb by application of tourniquet ischemia-reperfusionn injury. After 4-hours of ischemia, reperfusion was established 4 hours by releasing tourniquet. Experimental groups comparised ischemia-reperfused animals pretreated with indomethacin 20 mg/kg. The control animals received normal saline, 4 hours of ischemia without reperfusion. To assess tissue edema, wet/dry weight ratios were determined and the concentrations of prostaglandins and thromboxane were measured by the high performance liquid chromatography with UV detector at 195 nm. Ischemia itself did not result in muscle edema and did not increase the release of cyclooxygenase metabolites, but muscle edema(52%, p<0.01), and the relase of 6-keto-PGFalpha(151%, p<0.01), thromboxane B2(98%, p<0.05), and PGE2(127%, p<0.01) were significantly increased by reperfusion. Indomethacin treatment ameliorated limb edema(35%, p<0.05 versus ischemis-reperfusion control) and decreased 6-keto-PGF1alpha(65%, p<0.05) releases. These results support view that cyclooxygenase products may play significant roles in the formation of ischemic muscle edema and suggest that nonsteroidal antiinflammatory agents and eicosanoids antagonists might be beneficial to the management of acute limb ischemia-reperfusion injury.
Animals ; Anti-Inflammatory Agents, Non-Steroidal ; Chromatography, Liquid ; Edema* ; Eicosanoids* ; Extremities ; Hindlimb ; Indomethacin ; Ischemia* ; Lower Extremity ; Muscle, Skeletal* ; Prostaglandin-Endoperoxide Synthases ; Prostaglandins ; Rats* ; Reperfusion Injury* ; Reperfusion* ; Tourniquets

No abstract available.
Alopecia* ; Hair* ; Humans ; Male* ; Tissue Expansion*

BACKGROUND: When clonidine is mixed with local anesthetics, it extends the duration of both the motor and sensory elements of spinal, epidural, axillary, peripheral nerve block. This study was designed to determine whether the addition of clonidine to 1% lidocaine would produce significant extension of anesthetic and analgesic effect after axillary brachial plexus block and to assess the incidence and severity of side effect. METHOD: Sixty patients who were scheduled for hand surgery received 1% lidocaine 40 ml (Group L), 1% lidocaine 40 ml with clonidine 75 microgram (Group C75) or 150 microgram (Group C150) during axillary plexus block. Time from the performance of the block to 1) loss of pain sensation to pinprick, 2) return of pain sensation to pinprick, 3) onset of postsurgical pain and 4) time of first analgesic medication were recorded. Blood pressure, heart rate and sedation and pain score were checked every 10 min after block. RESULTS: The onset time of anesthesia in Group C75 and Group C150 were shorter than that of Group L (p<0.05). The duration of anesthesia and analgesia and the time to first analgesics medication in Group C75 and Group C150 were longer than that of Group L (p<0.05). Group C75 and Group C150 represented higher sedation score than Group L (p<0.05). CONCLUSION: The addition of clonidine (75 microgram or 150 microgram) to 1% lidocaine significantly prolongs the duration of anesthesia and analgesia after brachial plexus block and induces some degree of sedation without significant side effects.
Analgesics ; Anesthesia and Analgesia* ; Anesthesia* ; Anesthetics, Local ; Blood Pressure ; Brachial Plexus* ; Clonidine* ; Hand ; Heart Rate ; Humans ; Incidence ; Lidocaine* ; Peripheral Nerves ; Sensation

During the microsurgery or during the postoperative period, the occurrence of the vascular spasm increases the failure rate of microvascular anastomosis,and in cases of trauma, the thrombogenic possibility is increased by the endothelial damage. The author thought that the vascular freezing of crushed vessels could improve the patency rate of microvascular anastomosis. Vascular freezing destroys most of the cells in the intima and media. There by causing degeneration of adrenergic fibers. Even though regeneration occurs after 2-3 weeks, regeneration in the smooth muscle layer is still incomplete. So vascular freezing has beneficial effects on relief of vasospasm. Fifteen Sprague-Dawley rats weighing approximately 300 g each were inflicted with crushing injury on the femoral arteries of the right side and the crushing injury with vascular freezing on the femoral arteries of the left side. The gross and histologic findings, as well as the patency rates, were observed at the postoperative 2nd, 10th, and 30th day,and the results were compared between the crushed and crush-freezing groups. The left side (crush-freezing group) showed less vasospasm and less thrombogenesis than the right side (crushed group). There were no significant differences in the patency rate between the crushed group and crush-freezing group. Vascular freezing is suggested to be effective on a potentially thrombogenic, endothelial damaged vessel as a prophylactic treatment method against vasospasm. Clinical application of vascular freezing awaits further experimentation.
Adrenergic Fibers ; Endothelium* ; Femoral Artery ; Freezing* ; Microsurgery ; Muscle, Smooth ; Postoperative Period ; Rats, Sprague-Dawley ; Regeneration ; Spasm

BACKGROUND: Propofol has been found to be an ideal anesthetic for sedation during regional anesthesia with the advantage of rapid onset of action and recovery. Infusion of propofol by target-controlled infusion (TCI) has been shown to be effective in achieving conscious sedation. The purpose of this study was to define the optimal target concentration of propofol evaluated by bispectral index (BIS) which is necessary for conscious sedation in patients to achieve a local or regional blockade. METHODS: Sixty patients scheduled to undergo local or regional anesthesia were divided into 3 groups. 10 20 min after performing local anesthesia with 2% lidocaine 10 ml (group 1), spinal anesthesia with 0.5% hyperbaric bupivacaine 12 18 mg (group 2) or brachial plexus block with 1% lidocaine 40 ml (group 3), TCI of propofol was started at a target plasma level of 1 microgram/ml and the target concentration was adjusted in steps of 0.2 microgram/ml to maintain a sedation level comparable to an Observer's Assessment of Alertness/Sedation (OAA/S) score of 3. BIS, EKG, heart rate, noninvasive arterial blood pressure, respiratory rate and SpO2 were recorded during the operation. RESULTS: Group 1 had a significantly higher mean (range) target concentration [1.8 (0.9 2.8) microgram/ml] than group 2 [0.9 (0.2 2.4) microgram/ml] and group 3 [1.0 (0.2 2.6) microgram/ml]. A target concentration of 0.9 1.8 microgram/ml of propofol produced BIS 78.2 (group 1), 73.4 (group 2) and 75.4 (group 3). CONCLUSIONS: TCI of propofol with a 0.9 1.8 microgram/ml blood concentration produces safe sedation during locoregional anesthesia without severe complications.
Anesthesia ; Anesthesia, Conduction ; Anesthesia, Local ; Anesthesia, Spinal ; Arterial Pressure ; Brachial Plexus ; Bupivacaine ; Conscious Sedation* ; Electrocardiography ; Heart Rate ; Humans ; Lidocaine ; Plasma ; Propofol* ; Respiratory Rate

The increasingly successful results of hair restoration surgery in the last years have developed the interest and the confidence of patients and it is the most frequently performed esthetic surgery among male patients. Currently, various kinds of techniques for hair restoration surgery including hair transplantation, scalp reduction, and scalp flaps are performed in our clinic. Among these, hair transplantation is the basic and the most popular procedure, which can be performed not only by itself but also in conjunction with other procedures. 123 consecutive cases of hair transplantations were peformed from Jan. 1995 to Feb. 1996 for male pattern baldness, traumatic alopecia, and female pattern baldness under out patient base. The authors introduced a new classification for male pattern baldness, which are the type M, O, C, U, M-O, and C-O after alphabet to make simple and easy for clinical application. The ancillary procedures were scalp reduction, preauricular flap, and scalp expansion. An ellipsis of hair bearing scalp taken from the occipital area was sliced into slit-, mega-, mini-, and micro-grafts. The survival rate of the grafts was over 90% with minimal complications. This hair transplantation technique enabled us to achieve a good density and more natural looking hair with avoidance of cobble stoning and apparent scar.
Alopecia* ; Cicatrix ; Classification ; Hair* ; Humans ; Male* ; Scalp ; Surgery, Plastic ; Survival Rate ; Transplants

No abstract available.

No Abstract Available.
Female ; Mammaplasty*

Scalp extension involves the continuous nonvolumetric expansion of the hair-bearing scalp, via biologic creep, using implanted surgical device consists of cutting a 5 cm wide strip of plain silastic (0.02 inch thick) from a larger 16x8 inch sheet, then gluing dacron-reinforced silastic strip (5x1 cm, 0.015 inch thich) to the distal ends. A stainless steel plate from hooks is then secured to each end of the extender. During the period from March 1996 to September 1997, 21 patients including 16 patients of male pattern baldness were treated for alopecia of the scalp using internal scalp extender in the department of plastic surgery Korea university hospital. All cases were successfully reconstructed without major complications. It not only reduces the number of scalp reductions and time necessary to totally excise bald vertex scalp, but also appears to decrease the amounts of stretch back and atrophic scarring that may accompany some reductions. Scalp extension appears to be a useful adjunctive technique in hair replacement and reconstructive surgery, and has distinct advantages over standard scalp reduction and tissue expansion techniques.
Alopecia* ; Cicatrix ; Hair* ; Humans ; Korea ; Male* ; Scalp* ; Stainless Steel ; Surgery, Plastic ; Tissue Expansion

For the pre-treatment prior to laser resurfacing, materials such as glycolic acid, tretinoin, and/or hydroquinone have been widely used. However, the optimal duration of pretreatment is still controversial. The authors chose guinea pig skin which is similar to human skin, pre-treated it with tretinoin and hydroquinone with different duration, and examined gross and histologic changes after performing laser resurfacing in an attempt to study the effect of pre-treatment period on CO2 laser resurfacing. Sixteen guinea pigs were divided into four groups, and the dorsal skin was pre-treated with 0.05% tretinoin cream and 4% hydroquinone for 4, 8, and 12 weeks respectively while groupI underwent no pre-treatment as control. During the pre-treatment period, the authors observed gross skin reactions, and also examined the number of epithelial layers, thickness changes, the extent of epithelial regeneration, and collagen tissue change within dermis layer with skin tissue samples before and after laser resurfacing. Compared to group I(control) which received no pre- treatment, pre-treatment groups showed rapid epithelial hyperplasia and increase in the number and thickness of squamous epithelial cells and granular cell layer. However, there was no statistically significant difference in epithelial regeneration and number and thickness of epithelial cell layer between the 4-weeks, 8-weeks, 12- weeks pretreated groups. Pre-treatment with tretinoin and hydroquinone prior to laser resurfacing helped epithelial regeneration after resurfacing, but as to the benefit of long-term pre-treatment more than 4 weeks was not necessary.
Animals ; Collagen ; Dermis ; Epithelial Cells ; Guinea Pigs* ; Guinea* ; Humans ; Hyperplasia ; Lasers, Gas* ; Regeneration ; Skin* ; Tretinoin