For lesions like intracranial aneurysms which are located near highly vascularized regions, adequate dissection becomes almost impossible unless local blood flow can be reduced. Deliberate hypotension, purposefully lowering the arterial pressure to a level at which bleeding is no longer a problem, facilitates surgery, allows performance of a better dissection, and shortens the length of the procedure. Currently, the most useful method for induced hypotensive anesthesia is the use of chemical drugs, such as trimethaphan, nitroprusside and halothane. Induced hypotension with halothane has been reported to be a relatively safe and useful method by Murtagh (1960) and Schettini, et al (1967). Halothane has the effect of depression of myocardial contractility, central autonomic inhibition, ganglionic blocking action and suppression of the peripheral actions of norepinephrine and direct vasodilation on the vessel wall. The advantage of halothane is the reduction of mean arterial pressure slowly (1-3 mm Hg/min) and it has a transient effect on EKG, little effect on brain cortical function and appropriate oxygen supply to brain tissue. The halothane induced hypotension in 100 cases of intracranial aneurysm surgery, which were performed at Severance Hospital of the Yonsei University College of Medicine from .1972 to 1977, was investigated clinically. The results of our study were as follows: 1) The locations of intracranial aneurysm in order were the anterior cerebral artery (37 cases), internal carotid artery (35 cases), middle cerebral artery (23 cases) and posterior cerebral artey (2 cases). Three cases of multiple cerebral aneurysm were found in our study. 2) In the hypotensive phase, the mean systolic and diastolic pressures were 73. 45 mmHg+/- 0. 86, 54. 95 mmHg+/- 0. 86 and the mean duration was 34. 74 min+/- l. 60. 3) The blood pressure control by halothane was comparatively easy and there was no cliaical evidence of direct injury to the brain, heart, kidney and liver due to halothane induced hypotension. 4) The mortality rate in the 100 cases of the intracranial aneurysm was 16 percent. From the above observation it may be concluded that the technique of deliberate hypotension induced by halothane anesthesia is a useful method in the surgery of intracranial aneurysm.
Anesthesia ; Anterior Cerebral Artery ; Arterial Pressure ; Blood Pressure ; Brain ; Carotid Artery, Internal ; Depression ; Electrocardiography ; Ganglion Cysts ; Halothane* ; Heart ; Hemorrhage ; Hypotension* ; Intracranial Aneurysm* ; Kidney ; Liver ; Middle Cerebral Artery ; Mortality ; Nitroprusside ; Norepinephrine ; Oxygen ; Trimethaphan ; Vasodilation

PURPOSE: In the present study, the surgical outcome and postoperative exodrift pattern between bilateral lateral rectus recession (BLR) and unilateral lateral rectus recession (ULR) in intermittent exotropia of 20 prism diopters (PDs) were compared. METHODS: In this retrospective study, 5.0 mm BLR or 8.5 mm ULR was performed on 82 patients for the treatment of intermittent exotropia of 20 PDs with a follow-up period of 2 years. The main outcome measures were postoperative 1-week, 1-month, 6-month, 1-year and 2-year exodeviation angles with their patterns and success rates. A surgical success was considered an alignment within 10 PDs and sensory success was defined at 100 seconds of arc. RESULTS: The mean deviation angles at postoperative 1 week were 4.7 ± 5.1 PD esodeviation in the BLR group (44 patients) and 1.2 ± 4.2 PD esodeviation in the ULR group (38 patients). The BLR group was significantly more overcorrected than the ULR group (p = 0.001), but postoperative exodrift occurred in the BLR group at 1 week, 1 month, 6 months, 1 year, and 2 years. In the ULR group, the postoperative exodrift occurred at 1 week, 1 month, and 6 months which was followed by stabilized alignment. Surgical success rate at the postoperative 2-year follow-up was 75.0% in the BLR group and 81.6% in ULR group (p = 0.717). CONCLUSIONS: ULR showed less overcorrection and early exodrift up to only 6 months, resulting in stabilization of the alignment afterwards; surgical success rate at the final 2-year follow-up was similar to BLR.
Esotropia ; Exotropia* ; Follow-Up Studies ; Humans ; Outcome Assessment (Health Care) ; Retrospective Studies

PURPOSE: To evaluate and report the clinical result of the intramedullary fixation by threaded Kirschner wire in the clavicle shaft fracture. MATERIALS AND METHODS: From May 2000 to April 2004, twenty patients who had the fracture of the shaft of the clavicle were treated by the intramedullary fixation with threaded Kirschner wire. Thirteen patients were followed up and the clinical and radiological results were analyzed. RESULTS: All of the cases had satisfactory fracture union but there were four cases of skin irritation signs by the tip of threaded Kirschner wire. In one case, the Kirschner wire was bent at the fracture site with malunion. According to the clinical scoring system of Kang et al, eight cases were excellent and five cases were good. CONCLUSION: Authors think that intramedullary fixation with threaded Kirschner wire in the fracture of the shaft of the clavicle is one of a good operative method because of small operative incision, easy operative method, satisfactory fracture union and easy removability of the implant.
Clavicle* ; Humans ; Skin

PURPOSE: There have been conflicting reports on vascular response to Panax ginseng. The conflicting reports may be due to difference of ingredient of Panax ginseng. The aim of the present study was to investigate the effect of saponin, the main ingredient of Panax ginseng, on the vascular contractility. METHODS: The rabbit aortic rings were cut and mounted on the force transducer to record an isometric tension on polygraph. To elucidate the mechanism of saponin effect on vascular smooth muscle, the contractility of the vascular smooth muscle were measured under varying experimental condition. RESULTS: 1) When the aortic rings were precontracted with norepinephrine, saponin caused biphasic(initial relaxation-sustained contraction) dose-response in the endothelium dependent manner. But saponin had no effect on the resting tension. 2) When EDRF inhibitors such as methylene blue(10(-5)M), hemoglobin(10(-5)M), N-omega-nitro-L-arginine(100microM) were added to precontracted ring with norepinephrine, the initial relaxation caused by 2mg% saponin was inhibited. 3) When Ca(2+)-channel blocker, nifedipine(5x10(-7)M), was added to precontracted rings with norepinephrine, the sustsined contraction by saponin was inhibited. 4) When hemoglobin(10(-5)M) was added to precontracted rings with norepinephrine, the contractility by norepinephrine was increased and this effect was further augmented by 2mg% saponin. CONCLUSIONS: From the above results, it may be concluded that saponin stimulated the release of both an endothelium-dependent relaxing factor and endothelium-dependent contracting factor.
Endothelium ; Endothelium-Dependent Relaxing Factors ; Muscle, Smooth, Vascular ; Norepinephrine ; Panax ; Relaxation ; Saponins* ; Transducers

The aim of this study was to evaluate neurotoxicity of Nitric oxide(NO) on cornea after excimer laser photorefractive keratectomy(PRK). PRK was performed on rabbit eyes. According to the time table, tear samples were collected with microcapillary tubes and corneal sensitivity was measured with a Cochet-Bonnet esthesiometer. No generation in the tear fluid was analyzed. To demonstrate NO Synthase(NOS), immunohistochemical localization was performed on frozen sections from rat eyeball tissue. Western blot analysis was used for detection of peroxynitrite, powerful oxidant of NO. NO generation was increased and reached to a maximum value(0.69+/-0.22micrometer/microgram) after 96 hours of PRK, as compared with in normal subjects(Mean: 0.30+/-0.08micrometer/microgram) and was not increased in the treated group with topical application of Ng-nitro-L-arginine methyl ester(L-NAME), a competitive inhibitor of constitutive NOS(cNOS) and inducible NOS(iNOS). Corneal sensitivity decreased below pretreatment levers after three postoperative days, but it was not observed in the L-NAME applied group. We have confirmed that a very strong iNOS and BNOS immunoreactivity was present in corneal keratocytes. Western blot analysis identifed the bands of nitrotyro-sine-proteins suggesting in vivo peroxynitrite toxicity. Our results suggested that NO generated from the enzyme after PRK decreased corneal sensitivity by damaging corneal sensory nerve through the NO and iths oxidant peroxitrite. Therefore topical application of a NOS inhibitor may be effective in maintaining corneal sensitivity.
Animals ; Blotting, Western ; Cornea ; Corneal Keratocytes ; Frozen Sections ; Lasers, Excimer* ; NG-Nitroarginine Methyl Ester ; Nitric Oxide ; Nitroarginine ; Peroxynitrous Acid ; Photorefractive Keratectomy* ; Rats

To evaluate the expression of vascular endothelial growth factor (VEGF) in pterygia and seek the reciprocal relationships between VEGF and nitric oxide (NO) in development of pterygia. Conjunctiva sampled during conjunc-tival transplantation of pterygial operation and pterygia were used in this study. OCT compound-fixed-cryopreserved tissues consisted normal conjunctiva and pterygia were used to study the expression of VEGF and iNOS with immunohistochemistry. For confirmation of NOS activity, NADPH-diaphorase staining was done. ELISA for detection of VEGF amounts was performed. The expression of VEGF and iNOS were revealed in the epithelium of pterygia, although there were not expressed in the epithelium of normal conjunctiva. The epithelium of pterygia was stained with NADPH-diaphorase. The results of ELISA showed the higher amount of VEGF inpterygia compared with conjunctiva. These findings suggest that VEGF and NO play an important role in fibrovascular development of pterygia.s
Conjunctiva ; Enzyme-Linked Immunosorbent Assay ; Epithelium ; Immunohistochemistry ; Nitric Oxide ; Vascular Endothelial Growth Factor A*

PURPOSE: To evaluate the results and efficacy of the subtalar distraction arthrodesis on patients with complications due to malunion after intra-articular calcaneal fracture. MATERIALS AND METHODS: From October 2001 to September 2004, we operated on 10 patients (14 cases). There were 9 male patients and one female; their mean age was 41 years old. Ten cases among them were operated initially. The mean period between initial injury and arthrodesis was 18 months. The mean follow up period was 16 months. During the operation, we used extensile lateral approach and arthrodesis was performed using tricortical bone block and cannulated screws. The ankle-hindfoot scale was used for clinical evaluation. In radiologic analysis, plain X-ray and CT of the both feet were examined for union and various parameters. RESULTS: Thriteen cases achieved radiologic bone union. The mean ankle-hindfoot scale (maximum: 94 points) increased from 52.4 points preoperatively to points 77.2 at the final follow-up. The radiologic analysis of the pre and postoperative standing lateral radiograph showed mean increase of 6.9 mm in talo-calcaneal height, 5.2 degrees in talocalcaneal angle, 4.3 degrees in talar declination angle and average decrease of 4.5 degrees in talo-first metatarsal angle. CONCLUSION: The short term result of the subtalar distraction arthrodesis using tricortical bone block was promising, but longer follow-up will be needed.
Adult ; Arthrodesis* ; Female ; Follow-Up Studies ; Foot ; Humans ; Male ; Metatarsal Bones

BACKGROUND AND OBJECTIVES: Recent studies have demonstrated overexpression of cyclooxygenase-2 (COX-2) in various cancers including head and neck cancers. COX-2, an inducible enzyme which catalyzes the formation of prostaglandins from arachidonic acid, is expressed in some cancers. We investigated the anti-tumor effect of selective COX-2 inhibitor, Meloxicam, on the human oral cavity squamous cell carcinoma xenografted in nude mice. MATERIALS AND METHOD: We inoculated the oral cavity cancer cell (KB cell) line subcutaneously into 30 athymic mice which were divided into 3 groups 1 week after inoculation. One group received no treatment whereas two other groups received selective COX-2 inhibitor, Meloxicam, 10mg/kg and 40mg/kg three times weekly for 3 weeks. We studied mean tumor volume, apoptotic index (TUNEL) and proliferative index (Ki 67) in the control and treated groups. RESULTS: Meloxicam induced apoptosis, suppressed cell proliferation with significant difference (p<0.01), and suppressed the xenografted tumor growth with significant difference (p<0.05) in the Meloxicam treated group. All tumor expressed COX-2. CONCLUSION: This result suggested that the selective COX-2 inhibitors suppressed the growth of human oral cavity squamous carcinoma and a further study will be needed for determination of the pharmacologic pathway and efficacy of selective COX-2 inhibitor for head and neck cancers.
Humans ; Mice ; Animals

Purpose: This study reports the clinical results of the tenodesis of long head of the Biceps brachii tendon with bioabsorbable interference screw by minimal open procedure. Materials and Methods: Ten cases of 10 patients (7 male, 3 female) were included in this study. The average age was 45.8 years old and the average period from the symptom onset to operation was 13.7 months. Average preoperative ASES score was 38.5. The causes of injury was; sports activities in 4 patients, unknown in 4 patients, industrial accident in 1 patient and traffic accident in 1 patient. The average follow up period was 12.1 months. Tenodesis with bioabsorbable interference screw by minimal open precedure was performed in all cases. Results: The ASES score improved to 87.5 at last follow up period and 6 cases had full range of motion of the shoulder. 4 cases had mild limited range of motion of the shoulder without any problem in normal daily activity. Conclusion: It was assumed that tenodesis of long head of the biceps brachii tendon with bioabsorbable interference screw by minimal open precedure was one of the good methods with good clinical results.
Accidents, Occupational ; Accidents, Traffic ; Follow-Up Studies ; Head* ; Humans ; Male ; Range of Motion, Articular ; Shoulder ; Sports ; Tendons* ; Tenodesis*

Purpose: This study reports the clinical results of the arthroscopic repair of type II SLAP lesion with bio-knotless anchor. Materials and Methods: 25 cases of 25 patients (20 male, 5 female) were included in this study. The average age was 44.5 years old. Preoperative ASES score was average 44. Arthroscopic SLAP repair with 1 or 2 bio-knotless anchors were performed in all cases. The average follow up period was 15 months. Results: The ASES score improved to average 92.7 at last follow up period and 23 cases had full range of motion of the shoulder. 2 case had mild limited range of motion of the shoulder without any problem in normal activity. Conclusion: Arthroscopic repair with bio-knotless anchor in type II SLAP lesion is one of the good methods because of the good clinical results.
Follow-Up Studies ; Humans ; Male ; Range of Motion, Articular ; Shoulder