The depth of wound level is as important as the level of the tendon injury itself. And the timing of the operative procedure is an important factor. As a rule, tendons injured outside of the flexor sheath yield much better results than those injured within the sheath. The nutritional supply of the flexor tendons is not completely understood. Many elaborate studies have outilned the vascular anatomy of these tendons, and not all authors are in agreement. It is now clear that synovial fluid within the sheath supplies nutrition to the tendon much as synovial fluid in a joint supports cartilage. With this in mind, the present study was designed to determine the effect of exposing tendons for varying periods of time on the viability of the tendon and sequential morphological changes. The results are as follows: 1. Twelve hours after tendon sheath removal, collagen fibrillar dissociation and irregular surface of the tendon sheath were noted on the chicken flexor tendons by electronmicroscopy. 2. Superficial tenocyte necrosis was created after 24 hours of tendon exposure. 3. At 3 days, inflammatory cell infiltration and thickening of the outer synovial layer were noted. After 7 days, fibrosis of the degenerated tendon started from the exposed surface. 4. The fibrous connective tissue and new blood vessel infiltration into the tendon were progressed after 7 days. From these morphological results, any interference with the synovial environment leads to a regressive change of the flexor tendons immediately. It is suggested that delayed primary wound covering procedure within three days an after exposed tendon injury is ideal, and it should by done at least 7 days after tendon exposure.
Blood Vessels ; Cartilage ; Chickens ; Collagen ; Connective Tissue ; Equipment and Supplies ; Fibrosis ; Joints ; Necrosis ; Surgical Procedures, Operative ; Synovial Fluid ; Tendon Injuries ; Tendons ; Wounds and Injuries

Lumbar spinal stenosis is a common category of spinal disease in which a decrease in the volume of the spinal canal results in compression of the neural elements. Its pressure symptoms are characterized by vague back-pain and chronic sciatica. The goals of surgical treatment in lumbar spinal stenosis are the relief of pain and the preservation or restoration of neurologic function. Extensive laminectomy in lumbar spinal stenosis results in postoperative instability and postoperative vertebral subluxation with pain, restricted movement, and further neural compression occurs after decompressive laminectomy. Therefore internal fixation devices have been used in these circumstances to prevent postoperative instability while the fusion being consolidated. From February 1988 to October 1988, 36 patients of lumbar spinal stenosis had undergone operations with decompressive laminectomy and segmental spinal instrumentation with transpedicular screws at the department of Orthopaedic Surgery, Yonsei University College of Medicine. In 18 patients degenerative changes in lumbar spine were the principal aetiologic factor:7 patients had spondylolisthetic spinal stenosis:ll patients had combined spinal stenosis. All patients were followed up for periods varying between twelve and ninteen months. According to Kim's criteria, the postoperative results were as follows;excellent in 17 cases(47.2% ), good in 15 cases(41.7% ) and fair in 4 cases(11.1% ). The study revealed that segmental spinal instrumentation with transpedicular screws provided a rigid fixation, early ambulation, minimal fusion and reducing of recovery period were possible. In conclusion, segmental spinal instrumentation with transpedicular screws is a good and reliable method of stabilization after extensive decompressive laminectomy.
Early Ambulation ; Humans ; Internal Fixators ; Laminectomy ; Methods ; Sciatica ; Spinal Canal ; Spinal Diseases ; Spinal Fusion ; Spinal Stenosis ; Spine

With the increasing number of the occupational accidents proportionate to the rapid development of modern culture, fractures of the hand have become one of the commonest fractures of the human body. The authors have reviewed 211 cases of injured hand in industry which were treated in the department of orthopedic surgery, InCheon Severance hospital from Jan. to Dec. in 1989. The following results were obtained; 1. The peak incidence was in the age group from 21 to 30 years in 87 cases (41.2%). Injured males outnumbered females predominantly by 92.9% vs 7.1%. 2. The hand injuries happened most commonly in the day time (from 8 oclock A.M. to 6 oclock P.M.) but there were no differences between month in the year. 3. Most of patients injured hand (73.9%) arrived at hospital within 1 hour after accidents. 4. The commonest cause of the injury was due to electric saw (21.9% ). 5. Of the 98 fracture cases left hand was more frequently involved than right hand and 64 cases monodigit and remained were polydigits. 6. 43 (32.6%) of total 132 fractured sites were index finger and 74 (56.1%) were distal phalanx. 7. The index finger was also most vulnerable to amputation (56.8% out of 44 amputation cases) and the most distal part was more vulnerable to amputation. 8. The most common method was primary closure and splint. The method of treatment was affected in part by the economic and social status of the patients. 9. In order to prevent hand injuries in industry, preventive policy should be established by improvement of working environments, machines and education.
Accidents, Occupational ; Amputation ; Education ; Female ; Fingers ; Hand Injuries ; Hand ; Human Body ; Humans ; Incheon ; Incidence ; Male ; Methods ; Orthopedics ; Splints

The present study was intended to examine the effect of sodium vanadate on contractility of vascular smooth muscle. Aortic ring preparations were made from the rabbit thoracic aorta and endothelial cells were removed from the ring. The contractility of the aortic ring was measured under various conditions. The results were summarized as follows; 1) Sodium vanadate induced contraction of vascular smooth muscle in a dose-dependent fashion. 2) The contractile effects were not blocked by treatments with adrenergic blocking agent(phentolamine) and indomethacin, indicating the direct action of the drug on vascular smooth muscle. 3) In the presence of ouabain, Na(+)-K(+)-ATPase inhibitor, sodium vanadate still increased the contractility of vascular smooth muscle. 4) Treatment with 4.4'-diisothiocyanostilbene-2.2'-disulfonic acid(DIDS) blocked completely the contractile effects of sodium vanadate. 5) In the presence of verapamil, lanthanum and ryanodine, the contractility of the vascular smooth muscle by sodium vanadate was decreased. From the above results. it was suggested that sodium vanadate acts directly on vascular smooth muscle and causes contraction. It was probably due to inhibition of Ca(++)-ATPase in plasma membrane as well as increasing the release of Ca(++) from sarcoplasmic reticulum and Ca(++) influx across the plasma membrane, but not inhibition of Na(+)-K(+)-ATPase.
Aorta, Thoracic ; Cell Membrane ; Endothelial Cells ; Indomethacin ; Lanthanum ; Muscle, Smooth, Vascular* ; Ouabain ; Ryanodine ; Sarcoplasmic Reticulum ; Sodium* ; Vanadates* ; Verapamil

Caffeine has been known to induce the contraction of rabbit aortic ring resulting from Ca2+ release from the intracellular stores. But in contrast, contraction of aortic ring induced by depolarizing agents or agonist was reported to be suppressed by caffeine. The present study was intended to examine the effect of caffeine on Ca2+ movement across the plasma membrane and actomyosin ATPase activity of vascular smooth muscle to elucidate the modes of action of caffeine on the vascular smooth muscle. Aortic ring preparation were made from the rabbit thoracic aorta and the endothelial cells were removed from the ring by gentle rubbing. The contractilty of the aortic ring was measured under varying conditions, and Ca2+ influx across the membranes of the aortic ring was measured with Ca2+ sensitive electrode with and without caffeine and the effect of caffeine on actomyosin ATPase activity were measured by modified Hartshrone's method. 45Ca wash out curves with and without caffeine were studied by Richard's method. The results were summarized as follows: 1) Caffeine inhibited the contractilty induced by norepinephrine. high K+, and histamine. but caffeine alone induced a transient contraction of vascular smooth muscle. The caffeine induced contraction was demonstrable even in the absence of external Ca2+. 2) Caffeine increased 45Ca efflux from vascular smooth muscle. 3) In the presence of propranolol, the inhibitory effect of caffeine on epinephrine induced contraction still persisted. 4) Caffeine decreased norepinephrine induced Ca2+ influx through the plasma membranes of aortic ring. 5) Caffeine decreased the actomyosin ATPase activity of vascular smooth muscle. From the above results, it is suggested that caffeine induces the contraction of vascular smooth muscle by release of Ca2+ from intracellular Ca2+ stone, but inhibits drug-induced contraction by decrease of Ca2+ influx across the plasma membranes and a decreased Ca2+ sensitivity of contractile protein in vascular smooth muscle.
Actomyosin* ; Aorta, Thoracic ; Caffeine* ; Cell Membrane ; Electrodes ; Endothelial Cells ; Epinephrine ; Histamine ; Membranes ; Muscle, Smooth, Vascular* ; Myosins* ; Norepinephrine ; Propranolol

Distal radioulnar is a part which has a rotational movement through the function of distal radioulnar joint and extensor carpi ulnaris. The injury mechanism in this area is usually a trauma largely due to traffic accidents. In general these injuries to the distal radioulnar joint are treated by a closed reduction. However, the isolated distal ulnar fracture without radial fracture, which is often called the night stick fracture, is difficult to treat by a closed reduction and a cast immobilization alone, especially if there is a displacement or fracture segment impinging soft tissue or severe comminution. Nonunion has been the frequent outcome with this method of treatment and limitation of rotation of forearm and distal radioulnar joint have occurred due to long period of immobilization or malunion. Thus, a different treatment modality such as open reduction and internal fixation and early active joint motion has arisen as a better treatment modality. In this study, 8 cases of isolated distal ulnar fracture without radial fracture have recieved the operation and the early active joint movement, if a displacement was present either at the time of injury or after the initial closed reduction. As a result, this method has enabled the patients to reduce the rate of complication of nonunion and to recover limitation of joint motion in a shorter time period.
Accidents, Traffic ; Forearm ; Humans ; Immobilization ; Joints

No abstract available.

The treatment of pain in the back and extremities remains empirical. The application of surface electrodes to the dorsal columns of the spinal cord has been used by Shealy. The rationale. for dorsal column stimulation has been the “gate control theory” of pain proposed by Melzack and Wall. Transcutaneous electrical nerve stimulation is well recognized for its effectiveness in pain relief. The authors studied 48 cases of group A (physiotherapy, medication) and compared them with 43 cases of group B(physiotherapy, medication 'and diadynamic current), in the Department of Orthopedic Surgery, Yonsei University Hospital, from April, 1983, to June, 1984. The results were as follows: 1. Significant relief of pain was noted in group B in long term follow up of acute pain in the back and extremities. 2. In long term follow-up of group B, there was more improvement than in group A, especially when there was radiating pain in the extermities with or without back pain. 3. In long term follow-up according to the causes of the pain, there was more improvement in group B than in group A in cases of herniated nucleus pulposus and low back syndrome. From a consideration of these studies, it was concluded that satisfactory results were obtained from diadynamic current treatment for the patient with pain in the back and extremities.
Acute Pain ; Back Pain ; Electrodes ; Extremities ; Follow-Up Studies ; Humans ; Orthopedics ; Spinal Cord ; Transcutaneous Electric Nerve Stimulation

Lumbar spinal stenosis may be defined as any type of narrowing of the spinal canal, nerve root canals or intervertebral foramina. It may be local, segmental or generalized and may be caused by the encroachment of bone or soft tissue. The narrowing may involve the bony canal alone or the dural sac or both. Routine conventional radiographs or sagittal tomographs cannot accurately assess the midsagittal diameters of the lumbar canal or detect encroachment on the canal by osteoarthritis articular facets. However, myelography and computed tomography provide a means for distinguishing between herniation of a disc and bony encroachment on the spinal cord. The goals of surgical treatment in lumbar spinal stenosis are the relief of pain and the preservation or restoration of neurological functi ions. The surgical strategy is based on the patients symptoms and roentgenographic findings. Eighty-two operative cases of lumbar spinal stenosis were analyzed who were admitted in the Department of Orthopedic Surgery at Yonsei University College of Medicine from January, 1979, to July, 1984. The male female ratio was 1.3:1 and 66 cases (80.5%) included in their 50's and 60's. The results of the study are as follows: 1. Clinical symptoms included aggravation of pain during back extension (28.0%); back pain with radiating pain (22.0%); paresthesia of extremities (18.3%); back pain only (13.4%); and claudication (12.2%). 2. On physical examination, the straight leg raising test showed positive results in 25.6%, motor changes occurred in 24.4%, sensory changes in 20.7%, and DTR changes in 11.0%. 3. The most frequent level of spinal stenosis, L5-Sl invertebral space, was found in 68.3%(56cases) followed by L4-L5 intervertebral space found in 61.0% (50 cases). 4. Operative findings induded 31 lesions (46.3%) identified as herniated or ruptured discs,20 lesions (29.9%) identified as thickening of lamina and ligamentum flavum, and 5 lesions (7.5%) as compression of a nerve root by scar adhesion. 5. Of the 67 patients (81.7%) operated through the posterior surgical approach, 52 cases (77.6%) were effective; and of the 15 patients operated on by the anterior surgical approach, 9 cases (60.0%) were effective. 6. When the duration of symptoms was less than 1 year and the involved level of spinal stenosis was less than 2, operative results were satisfactory. 7. When there was a degenerative type of stenosis without a herniated or ruptured disc, operative results were excellent. 8. For post operative external support, 32 cases (39.0%) wore body jacket cast and 38 cases (46.3%) wore back braces.
Back Pain ; Braces ; Cicatrix ; Clinical Study ; Constriction, Pathologic ; Dental Pulp Cavity ; Extremities ; Female ; Humans ; Ions ; Leg ; Ligamentum Flavum ; Male ; Myelography ; Orthopedics ; Osteoarthritis ; Paresthesia ; Physical Examination ; Spinal Canal ; Spinal Cord ; Spinal Stenosis