No abstract available.
Female ; Menstrual Cycle* ; Pregnancy Rate* ; Pregnancy*

Articular cartilage is a highly differentiated tissue, lacking a vascular supply and having only limited regenerative capability. Cut or other mechanical damage restricted to the cartilage does not repair. Experimentally and clinically, cartilage defect that penetrate the subchondral bone undergoes repair through the formation of tissue usually characterized as fibrous, fibrocartilaginous or hyaline-like cartilaginous tissue. There is little definitive informations about local or systemic factors that control the differentiation of mesenchymal cells to osteoblast, chondroblast or fibroblast. Our study was designed to evaluate the effect of transforming growth factor-beta (TGF-pl) and autogenous periosteal graft on the healing of osteochondral defect of distal femur of rabbit and also the possibility of these method to be clinically applicable to human. The experimental model used in the present study for including cartilage in rabbit was based mainly on the model used by Frukawa et al14). in rabbit. A full thickness osteochondral defect of 80 rabbit were made with 2mm diameter of drill-bit and electrically driven drill. Experimental animals were divided into four group: 1) group I, osteochondral defect only, 2) group II, osteochondral defect with infiltration of phosphate buffer solution, 3) group III, osteochondral defect with infiltration of TGF-Bl, 4) group IV, osteochondral defect with autogenous periosteal graft. The healing of the defect was assessed at 1 week, 3 weeks, 5 weeks, 12 weeks after operation by gross and histochemical examination. At 1 week, fibrinoid material in edge to edge arcade arrangement was present in group I,II,III,IV. At 3 weeks, spindle shaped undifferentiated mesenchymal cell present in the periphery of fibrinous network, but there is no appearance of mesenchymal cell in group I,II. At 5 weeks, essentially complete repopulation of the defect with progressive differentiation of cells to chondroblast, chondrocyte, osteoblast and synthesis of cartilage and matrix in their appropriate location in group III and IV were found. At 12weeks, hyaline like cartilage formation was observed in group III and IV. but early trace of degeneration of the cartilage were seen in many defect with the prevalence and intensity of the degeneration increasing at group I and 3 . Our study demonstrated in detail the repair of full-thickness defect in rabbit articular cartilage extending into cancellous bone of the marrow cavity under influence of local growth factor (TGF-pl) and autogenous periosteal graft. Excellent reconstruction of articular cartilage was observed in TGF- Bl infiltration group and autogenous periosteal graft group as early as 5 weeks after the creation of defect. Although the further study should be carried out for their clinical application, we conclude that TGF-Bl regulates the overall mechanism of matrix constituent in connective tissue and autogenous periosteal graft have a chondrogenic potential to repair major osteochondral defect. these suggest that TGF-Bl and autogenous periosteal graft may be a important pathophysiological regulator of chondro- genesis.
Animals ; Bone Marrow ; Cartilage ; Cartilage, Articular ; Chondrocytes ; Connective Tissue ; Femur ; Fibrin ; Fibroblasts ; Humans ; Hyalin ; Models, Theoretical ; Osteoblasts ; Prevalence ; Transplants*

Vascular lesions involving the upper extremities have been treated by different route of upper thoracic sympathectomy with varying success. More recently, the anatomic and physiologic interest for autonomic nervous system has been progressively mounted but the surgical attack has plateau. It may be worthy for academic interest and clinical practice to estimate and to compare with the different surgical method. This paper concerns the treatment of a case suffering from atherosclerotic occlusion whom were treated by upper thoracic sympathetic ganglionectomy through the transaxillary transpleural route. This operation seems to be simpler than other surgical methods with lower morbidity, fewer complication and satisfying results.
Autonomic Nervous System ; Ganglionectomy ; Sympathectomy* ; Upper Extremity

No abstract available.
Administration, Intravenous* ; Cervix Uteri* ; Cisplatin* ; Female ; Fluorouracil*

BACKGROUND: Differences between sexes in sensitivity to nociceptive stimuli and response to analgesics have been noted in humans and animals. Male rats are more sensitive than female rats to the antinociceptive properties of morphine. Kappa-opioid analgesia is greater in women than in men. The purpose of this study was to evaluate the difference between the sexes in postoperative analgesic responses to patient-controlled epidural analgesia (PCEA) with butorphanol or fentanyl in 0.05% bupivacaine solution. METHODS: After obtaining their consents, 30 men and 30 women, less than 60 years old, undergoing elective gastrectomy under general anesthesia were randomly allocated into four groups of 15; butorphanol-female, butorphanol-male, fentanyl-female and fentanyl-male. An epidural catheter was introduced at the T7-8 or T8-9 interspinous space before the operation. Postoperative analgesia was provided with PCEA with butorphanol 50 microgram/ml or fentanyl 5 microgram/ml in a 0.05% bupivacaine solution. When patients first required analgesics after complete recovery of consciousness from anesthesia, a bolus of 5 ml was initially administered. The PCEA device was set to deliver a bolus of 2 ml, a lockout interval of 10 min and no basal infusion. PCEA consumption, pain intensity using a 10-cm visual analog score (VAS), patient's satisfaction to PCEA and side effects were evaluated at 3, 6, 24, and 48 h after the surgery. RESULTS: Cumulative PCEA consumption with butorphanol was less in the butorphanol-female group than in the butorphanol-male group at 24 and 48 h postoperatively. VAS pain scores and patients' satisfaction to PCEA were not different between the butorphanol-female group and the butorphanol-male group. Cumulative PCEA consumption with fentanyl was less in the fentanyl-male group than in the fentanyl-female group at 6, 24 and 48 h postoperatively. VAS pain scores and patients' satisfaction to PCEA were not different between the fentanyl-female group and the fentanyl-male group. There was no differece in side effects in both butorphanol groups and in both fentanyl groups. CONCLUSION: For postoperative analgesia with PCEA, butorphanol may be better for females than males, and fentanyl may be better in males than in females.
Analgesia ; Analgesia, Epidural* ; Analgesics ; Anesthesia ; Anesthesia, General ; Animals ; Bupivacaine ; Butorphanol* ; Catheters ; Consciousness ; Female ; Fentanyl* ; Gastrectomy ; Humans ; Male ; Middle Aged ; Morphine ; Rats

Brachial plexus block has been evaluated in 192 cases of surgery of the upper extremities performed during the past 13 years and 9 months. (from Jan. 1958 to Sept. 1971) We have assessed supraclavicular and axillary brachial plexus block using 1% to 2% procaine and lidocaine adding adrenaline case by case. The dosage given was 30 ml to 40 ml in each case There were 142 males and 50 females. In 26 blocks judged unsatisfactory for surgery, we have usually substituted inhalation anesthesia and .2 cases were supplimented with intravenous thiopental sodium, 2.5%, 3 ml to 5 ml intermittently and 4 cases with intravenous thiopental sodium and meperidine. There were 4 cases of complications of supraclavicular brachial plexus block including 2 cases of pneumothorax, one of Horners syndrome only and a cardiac arrest immediately after block. There were no complications in axillary approaches. Therefore in conclusion this brachial plexus block was a simple and useful technic in surgery and treatment of the upper extremities.
Anesthesia, Inhalation ; Brachial Plexus* ; Epinephrine ; Female ; Heart Arrest ; Horner Syndrome ; Humans ; Lidocaine ; Male ; Meperidine ; Pneumothorax ; Procaine ; Thiopental ; Upper Extremity

PURPOSE: To find out whether or not the computed tomographic (CT) classification systems of the calcaneal fracture are efficient in illuminating displaced posterior facet fragment and the degree of displacement can be evaluated by analyzing serial CT images. MATERIALS AND METHODS: Seventy-seven hundred calcaneal fractures were classified by CT classification systems including Sanders classification, and the sagittal rotation angle of the posteior facet fragment was measured on the plain lateral radiograph. Among the serial axial CT images, a number of images with the cortical bone embedded in the cancellous portion were recorded and any significant relationship between each data were evaluated. RESULTS: The conventional CT classification systems are rather insufficient in illuminating the extent of sagittal rotatory displacement. However, the number of CT images in which the cortical radiodensity was observed showed a significantly related with the degree of displacement. CONCLUSION: The conventional CT classification of the calcaneal fractures is unsatisfactory in expressing the degree of sagittal rotatory displacement of the posterior facet fragment; this problem may be alleviated by observing the number of axial CT images in which cortical radiodensity was revealed within the calcaneal body.
Calcaneus ; Classification

BACKGROUND/AIMS: The retrocaval dissection, with venous collaterals, is sometimes difficult, making subsequent hemostasis less easy during orthotopic liver transplantation(OLT). We have recently applied a modified technique of vena caval preservation during OLT, and undertook this study to evaluate retrospectively its effects. METHODS: Five patients with liver cirrhosis underwent a modified OLT from March 1999 through July 2001. The procedure includes a side to side anastomosis between the IVC of the donor and the recipient without vena cava occlusion during OLT. RESULTS: This technique pemitted the avoidance of vena caval occlusion in all cases. We could performed OLT without venovenous bypass in 3 patients who tolerated the temporary portal clamping test before the recipient hepatectomy. As retrocaval dissection was not performed, hemostasis was esier during anhepatic phase. We could reduce anhepatic phase into average 60 minutes from only one caval anastomosis during OLT. CONCLUSIONS: We think this alternative technique, requiring only one caval anastomosis, can reduce the duration of the anhepatic phase and the need for venous bypass.
Constriction ; Hemostasis ; Hepatectomy ; Humans ; Liver Cirrhosis ; Liver Transplantation* ; Liver* ; Retrospective Studies ; Tissue Donors

Pulmonary sequestration is an unusual malformation consisting of isolated nonfunctioning lung segments lacking communication with functional tracheobronchial trees. Systemic blood supply is commonly from the thoracic aorta, but arteries occasionally arise from other sites. We report a rare form of pulmonary sequestration with arterial supply from the right coronary artery.
Aged ; Bronchopulmonary Sequestration/*pathology/radiography ; Coronary Angiography ; Coronary Vessel Anomalies/*pathology/radiography ; Female ; Humans

Intractable pain from advanced carcinoma of the upper abdomen is difficult to manage. On method used to control pain associated with these malignancies is to block off the splanchnic nerve. In 1919 kappis described a technique by which the splanchnic nerve of the upper abdomen could be anesthetized, using a percutaneous injection. This method has been used for the relief of upper abdominal pain due to hepatoma and cancer of the pancreas, stomach, gall bladder, bile duct, and colon. During the period from November 1968 to January 1986, this method was used in 208 cases of malignancy at Severance Hospital and clinically evaluated. Patients were retroactively grouped according to the stage of development of technique used. Twelve patients who received the treatment in the period from November 1968 to March 1977 were designated as group 1, 26 patients from April 1977 to April 1979 as group 2, and 170 from May 1979 to January 1986 as group 3. The results are as follows: 1) The number of patients receiving splanchnic nerve block has been increasing since 1977. 2) A total of 208 patients, including 133 males and 75 females, ranging in age from 18 to 84 and averaging 51. 3) The causes of pain were stomach cancer 90, pancreatic cancer 69, and miscelianeous cancer 49 cases respectively. 4) There were 57.7% who had had surgery, and 3.7% of whom had had chemotherapy before the splanchnic nerve block was done. 5) These blocks were carried out with the patient in the prone position as described by Dr. Moore. Fro group 2 and 3 C-arm image intensifier was used. In group 1, a 22 gauze 10cm long needle was inserted at the lower border of the 12th rib on each side about 7cm from the midline. The average distance from the middle was 6.60+/-0.61cm on the left side and 6.60+/-0.83cm on the right side in group 2, and 5.46+/-0.76 on the left side and 5.49+/-0.69cm on the right side in group 3. The average depth to which the needle was inserted was 8.60+/-0.52cm on the left side and 8.74+/-0.60cm on the right side in group 2, and 8.96+/-0.63cm on the left side and 9.18+/-0.57cm on the right side in group 3. 6) The points of the inserted needles were positioned in the upper quarter anteriorly. 51.8% on the left side and 54.4% on the right side of the L1 vertebra by lateral roentgenogram in group 3. The inserted needle points were located in the upper and anterolateral part, of the L1 vertebra 68.5% on the left side and 60.6% on the right side, on the anteroposterior rentgenogram in group 3. The needle tip was not advanced beyond the anterior margin of the vertebral body. 7) In some case of group 3, contrast media was injected before the block was done. It shows the spread upward along the anterior margin of the vertebral body. 8) The concentration and the average amount of drug used in each group was as follows: In group 1, 39.17+/-6.69ml of 0.5% -1% lidocaine or 0.25% bupivacaine were injected for the test block and one to three days after the test block 40.00+/-4.26ml of 50% alcohol was injected for the semipermanent block. In group 2, 13.75+/-4.48ml of 1% lidocaine were used as the test block and followed by 46.17+/-4.37ml of 50% alcohol was injected as the semipermanent block. In group 3, 15.63+/-1.19ml of 1% lidocaine for test block followed by 15.62+/-1.20ml of pure alcohol and 16.05+/-2.58ml of 50% alcohol for semipermanent block were injected. 9) The result of the test block was satisfactory in all cases. However the semipermanet block was 83.3 percent of the patients in group 1 who received relief from pain for at least 2 weeks after the block, 73.1% in group 2, and 91.8% in group 3. In these unsuccessful cases, 2 cases in group 1 were controlled by narotics but 7 cases in group 2 and 14 cases in group 3 received the same splanchnic nerve block 1 or 2 times again within 2 weeks. But in some cases it was 3 to 5 months before the 2nd block and in 1 cases even 7 years. 10) The most common complications of splanchnic nerve block were hypotensino(25.5%) occasional flushing of the face, nausea, vomiting, and chest discomfort. 11) For the patients in group 3, the supplemental block most commonly used was a continuous epidural block; it was used as a diagnostic block and to afford relief from pain before the splanchnic nervel block was done. 12) The interval between the receiving of the alcohol block and discharge was from 5 to 8 days in 61 cases(31.1%) and from 1 to 2 days in 48 cases(24.5%). From the above results, it can be concluded that the splanchnic nerver block done in the prone position with pure and 50% alcohol immediately after an effective test block with 1% lidocaine under C-arm fluoroscopic control is satisfactory and reliable. How to minimize the repeat block is still a problem to be solved.
Abdomen ; Abdominal Pain ; Bile Ducts ; Bupivacaine ; Carcinoma, Hepatocellular ; Colon ; Contrast Media ; Drug Therapy ; Female ; Flushing ; Humans ; Lidocaine ; Male ; Nausea ; Needles ; Pain, Intractable ; Pancreatic Neoplasms ; Prone Position ; Ribs ; Spine ; Splanchnic Nerves* ; Stomach ; Stomach Neoplasms ; Thorax ; Urinary Bladder ; Vomiting