Since Palmer's introduction of the torn medial collateral ligament, many clinical and anatomical studies were performed. But any reconstructive procedure of the medial collateral ligament of the knee known to us, has not solved the problem completely yet. The purpose of present study is to describe a technique of reconstruction, socalled Tatsuzawa's tenodesis surgery of transposed semitendinosus tendon, and is to report the clinical results of 45 cases treated by his procedure between April 1976 and June 1981. In addition, significance of the procerdure was compared with the result of primary closure group of the torn ligament. Tatsuzawa's procedure consists of reinforcement surgery of the repaired or unrepaired torn medial collateral ligament with forwardly transposed semitendinosus. The semitendinosus tendon was brought forward to lie adjacent to deep layer of the medial collateral ligament. The transposed part of the tendon was sutured throughout its length to the medial collateral ligament and to the medial aspect of the tibia and femoral condyle. Because the direction of transposed tendon as similar to the direction of fibers of medial collateral ligament, the procedure was very simple and anatomical one, and had some functional advantages. In this series some old cases are treated only with tendon reinforcement operation without repairing the laxed torn ligament. The results of the surgery were evaluated by the Asais modification of the Feltons evaluation criteria. Results obtained were as follows: 1. In semitendinosus tenodesis with or without primary repair of the torn ligament, satisfactory results were obtained (excellent and good) in 33 cases (73.3%). But in 20 cases of the primary repair group, the satisfactory results were obtained in 11 cases (55%). More satisfactory results were obtained with the semitendinosus tendon reinforcement operation of the torn ligament than only with primary repair. 2. In 29 cases with fresh injury of the medial collateral ligament in which the primary repair together with the tendon reinforcement procedure was performed, satisfactory (excellent and good) results were obtained in 72.4% (21 cases), and in 16 untreated old cases in which only the tendon reinforcement procedure were done, satisfactory results were obtained in 75%. 3. In 5 cases having medial collateral and anterior cruciate ligaments tear, excellent results were obtained in 3. This explains that semitendinosus tendon reinforcement procedure is the key one of the reconstructive operative procedures. It is thought that the procedure is also effective for the anterior cruciate tear to provide the anterior instability.
Anterior Cruciate Ligament ; Clinical Study ; Collateral Ligaments ; Knee ; Ligaments ; Surgical Procedures, Operative ; Tears ; Tendons ; Tenodesis ; Tibia

In order to evaluate the efficacy of adenosine triphosphate (ATP) in the reduction of left ventricular afterload, we studied the hemodynamic and intrapulmonary shunt effects of intravenous ATP during ethrane-N2O anesthesia. Hemodynamic measurements and arterial and mixed venous blood gas analyses were made in ten patients before (baseline) and 10 min after. ATP infusion at 80,60,120 and 250 mcg/kg/min, respective. The results were as follows: 1) ATP produced a rapid and stable reduction in mean arterial pressure resulting from a marked decrease in systemic vascular resistance. 2) Cardiac index increased significantly by 14, 47 and 72% from baseline value after intravenous infusion of ATP at rates of 60, 120 and 250 mcg/kg/min, respectively. 3) Stroke volume index, heart rate, mean pulmonary arterial pressure, pulmonary capillary wedge pressure and central venous pressure increased significantly, whereas systemic vasular resistance and pulmonary vascular resistance decreased significantly in a dose related fashion during ATP infusion. 4) Intrapulmonary ehunt fraction increased from 5.67% to 6.73, 8.28, 9.85 and 13.38% after intra- venous infusion of ATP at rates of 30, 60, 120 and 250 mcg/kg/min, respectively. 5) Arterial oxygen tension decreased significantly after ATP infusion. These results suggest that ATP might be of value in augmentation of cardiac performance in patients with low cardiac output with high peripheral vascular resistance.
Adenosine Triphosphate* ; Adenosine* ; Anesthesia ; Arterial Pressure ; Blood Gas Analysis ; Cardiac Output, Low ; Central Venous Pressure ; Enflurane* ; Heart Rate ; Hemodynamics* ; Humans ; Infusions, Intravenous ; Lung ; Oxygen ; Pulmonary Wedge Pressure ; Stroke Volume ; Vascular Resistance

The purpose of this study was to elucidate the effects of fentanyl and morphine on the ability of epinephrine to induce arrhythmias in halothane-anesthetized dogs. Epinephrine was infused in progressively increasing doses from 0.5 ug/kg/min. Arrhythmogenic dose of epinephrine(ADE), defined as that induces 4 or more premature ventricular contractions within 15 s during 3 min iafusions of epinephrine, was determined before(control) and after pretreatment of either fentanyl(6 ug/kg i.v. plus 6 pg/kg/hr) or morphine(0.2mg/kg i.v. plus 0.2 mg/kg/hr). Blood pressure and heart rate were also measured immediately before(baseline), immediately after infusion of epinephrine. The results were as follows. l) Fentanyl and morphine increased ADE by 37%(2.19+/-0.49 to 3.00+/-0.44 ug/kg/min, p<0.01) and by 43%(2.50+/-0.60 to 3.58+/-0.93 ug/kg/min, p<0.05), respectively. 2) Percent increases in systolic blood pressure at control were similar to those after pretreatment with fentanyl or morphine in both groups, but systolic blood pressures at the time of arrhythmia after pretreatment were lower than those at control in fentanyl(p<0.05) and morphine group(NS). 3) Fentanyl and morphine decreased heart rate by 27%(127+/-8 to 93+/-6 beats/min, p<0.001) and by 13%(118+/-5 to 103+/-5 beats/min, p<0.05), respectively. These results suggest that fentanyl or morphine inhibits epinephrine induced arrhythmias during halothane-oxygen anesthesia. Thus, pretreatment of surgical patients, who were supposed to receive epinephrine during halothane anesthesia, with either fentanyl or morphine might be safe.
Anesthesia ; Anesthetics ; Animals ; Arrhythmias, Cardiac* ; Blood Pressure ; Dogs* ; Epinephrine* ; Fentanyl* ; Halothane* ; Heart ; Heart Rate ; Humans ; Morphine* ; Pharmacology ; Sympathetic Nervous System ; Ventricular Premature Complexes

BACKGROUND: Recent evidences suggest that anesthetic action within the spinal cord is important in suppressing somatic responses to painful stimuli. Intrathecal endothelin-1 (ET-1) is known to have antinociceptive effect. The purpose of this experiment was to determine whether intrathecal ET-1 may influence the minimum alveolar concentration (MAC) of isoflurane in rats and access the role of the spinal cord as the sites of anesthetic action in blocking somatic responsiveness. METHODS: In Sprague-Dawley rats fitted with an indwelling intrathecal catheter, we determined the MAC of isoflurane using a tail-clamp technique as a painful stimulus, combined with end-tidal anesthetic sampling. In experiment 1, the control MAC was determined and changes of control MAC were observed after intrathecal ET-1 (4x10-2 nmol, 4x10-3 nmol) administration. In experiment 2, we observed the effects of L or N type Ca++ channel blocker such as verapamil (50 g) or W-conotoxin (0.5 g) on the MAC after measurement of the control MAC. In experiment 3, after measurement of the control MAC, ET-1 (10-2 nmol) was administered intrathecally and the MAC was determined again. Next, intrathecal verapamil (50 g) or W-conotoxin (0.5 g) was injected. After that, the MAC was determined again. RESULTS: In experiment 1, ET-1 decreased the MAC of isoflurane and its effect was sustained over 2 hours. In experiment 2, the MAC, determined following administration of verapamil or W-conotoxin, was not different from that of the control. In experiment 3, the MAC was decreased after ET-1 administration and then increased following injection of verapamil or W-conotoxin. CONCLUSIONS: These results suggested that ET-1, in relation to calcium, might play an important role in determining the MAC of isoflurane in the spinal cord.
Animals ; Calcium ; Catheters ; Endothelin-1* ; Isoflurane* ; Rats* ; Rats, Sprague-Dawley ; Spinal Cord ; Verapamil

Although herpes zoster (HZ) is not a fatal disease, the legacy of postherpetic neuralgia (PHN) often causes prolonged and significant misery and distress. There are now several therapeutic options, but the management of PHN is not always straightforward. Herpes zoster (shingles) affects up to half of all people who live to 85 years of age and can lead to long-term morbidity. Prevention and proper treatment are important in PHN. Most cases of zoster can be managed in primary-care settings and a full understanding of the condition is essential. In this article the author presents an update on the treatment of PHN. Treatment with antidepressants, anticonvulsants, opioids, nerve block, topical creams, TENS, cryotherapy, LASER therapy may be effective when pain has sustained over a long time. Social support and psychological interventions should also be considered. Although the measures described above can benefit many patients, the management of PHN remains, in some cases, to be challenging.
Analgesics, Opioid ; Anticonvulsants ; Antidepressive Agents ; Cryotherapy ; Diagnosis* ; Herpes Zoster ; Humans ; Laser Therapy ; Nerve Block ; Neuralgia, Postherpetic* ; Transcutaneous Electric Nerve Stimulation

Many patients,especially in certain high risk groups, undergo operative procedures under regional anesthesia in belief that this approach is safer than general anesthesia. During the regional anesthesia, sedation is often provided with intravenous agents, such as diazepam even if diazepam has some dipressant effects on respiration and hemodynamics. To evaluate the effects of diazepam on spinal anesthesia, arterial oxygen tension (PaO2), arterial carbon dioxide tension (PaCO2), arterial oxygen saturation (SaO2) and mean arterial pressure (MAP) were measured at 1,3,5.10,15,20and 30min. following diazepam iv (0.2 mg/kg) under spinal anesthesia (group 2), and were compared with the changes in the control group (group 1), who received spinal anesthesia without diazepam administration. The results were as follows: 1) MAP revealed no significant decrease in the control group, and decreased significantly in the group 2 from 3 to 30 min. after diazepam iv under spinal anesthesia. 2) PaO2 did not change significantly in the control group, but PaO2 in group 2 decreased significantly at 1 and 10 min. after intravenous administration of diazepam. And the changes from 3 to 20 min. after intravenous administration of diazepom were significantly different from changes in the group 3) PaO2 increased significantly in grorp 2 from 3 min. after diazepam iv which were significantly different from the changes in the control group. 4) SaO2 decreased significantly in group 2 from 1 to 30 min. after diazepam iv which were significantly different from the changes in the control group. From the above results, diazepam administration under spinal anesthesia affects the respiratory function and hemodynamics, so oxygen inhalation technique may be needed in most cases of sedatives administration after spinal anesthesia.
Administration, Intravenous ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Spinal* ; Arterial Pressure* ; Carbon Dioxide ; Diazepam* ; Hemodynamics ; Humans ; Hypnotics and Sedatives ; Inhalation ; Oxygen ; Respiration ; Surgical Procedures, Operative

Changes in arterial blood gases and arterial pressure during laparoscopic cholecystectomy under the general anesthesia (enflurane in N2O/O2 50%) were investigated in 30 patients, who were divided into two groups according to control of minute ventilation. During surgery, minute ventilation was set 100 ml/kg in group I and 150 ml/kg in group II, and intraabdominal pressure was maintained at 15mmHg by CO2 insufflation, in both groups. Variables were measured before CO2 gas insufflation, 15 and 30 minutes after insufflation, just after exsufflation, 15 and 30 minutes after exsufflation and in recovery room. 1. PaCO2 was increased significantly during CO2 gas insufflation and just after exsufflation in both group, and degree of increase (PaCO2) was significantly greater in group I compared to group II. 2. Changes of PaO2 were not statistically significant in comparison to control value and between two groups during CO2 gas insufflation and exsufflation. 3. Blood pH in both groups were lowered significantly compared to control value during CO2 gas insufflation and exsufflation, and group II (increased minute ventilation group), represents lower risk of acidosis compared to group I. 4. Mean arterial pressure and airway pressure were significantly increased compared to control value during CO2 gas insufflation, but there was no significant difference between two groups. These results suggest that minute ventilation during laparoscopic cholecystectomy should be increased up to maintaining normal PaCO2 for prevention of hemodynamic and blood gas changes due to CO2 retention.
Acidosis ; Anesthesia, General* ; Arterial Pressure ; Cholecystectomy, Laparoscopic* ; Gases* ; Hemodynamics ; Humans ; Hydrogen-Ion Concentration ; Insufflation ; Recovery Room ; Ventilation

The purpose of this study is to compare thiopental sodium and propofol as to the effects of anesthesia induction and hemodynamic changes associated with endotracheal intubation. Forty healthy adult patients, scheduled for elective surgery under general anesthesia, were randomly assigned to receive either thiopental sodium 5 mg/kg (Group 1, n =20) or propofol 2 mg/kg (Group 2, n=20) as an induction agent. Endotracheal intubation was performed following injection of succinylcholine 1 mg/kg. Anesthesia was maintained with 1.5~2% ethrane and 50% N2O in O2. The results were as follows, 1) Both thiopental sodium and propofol revealed high incidence of pain in the site of injection (13/20, 10/20, respectively). 2) The time from the start of injection to spontaneous closing of eyes and to loss of eyelid reflex were 42 and 43 sec in group 1 and 46 and 51 sec in group 2, respectively. 3) The loss of respiratory efforts. Occured in all cases and took 65 and 59 sec, in group 1 and 2 respectively. 4) The blood pressure was more decreased in group 2 than group 1 during induction period, but there was no significant difference between two groups. Also, there was no significant difference of the heart rate between two groups. 5) The increments of systolic blood pressure and rate-pressure-product to endotrachal intubation in group 2 were less than group 1 at time of immediate and 1 minute after intubation. Also, the increments of mean arterial pressure, disastolic blood presure and heart rate were lessen in group 2 than group 1. The retum of blood pressure, heart rate and RPP to the control was fasten in group 2 than group l. In conclusion, propofol may be an alternative to thiopental sodium in patients who require endotracheal intubation without hemodynamic instability.
Adult ; Anesthesia* ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Enflurane ; Eyelids ; Heart Rate ; Hemodynamics* ; Humans ; Incidence ; Intubation ; Intubation, Intratracheal* ; Propofol* ; Reflex ; Succinylcholine ; Thiopental*

BACKGROUND: Intrathecal gabapentin is effective on nociceptive states evoked by tissue injury. In addition, gabapentin interacts synergistically with clonidine at the spinal level, suggesting that a mechanism of gabapentin may be related to spinal adrenoceptors. However, it has not been established whether this drug is associated with cholinergic receptors. The aim of this study was to examine the role of spinal adrenergic and cholinergic receptors on the antinociceptive action of intrathecal gabapentin. METHODS: Rats were implanted with lumbar intrathecal catheters. For a nociceptive test, 50nl of 5% formalin solution was injected into the hindpaw. The effect of intrathecal gabapentin, administered 10 min before the formalin injection, was assessed. Next, antagonistic effects of intrathecal prazosin, yohimbine, atropine and mecamylamine for the action of intrathecal gabapentin were evaluated. RESULTS: Formalin injection caused a biphasic incidence of flinching of the injected paw. Intrathecal gabapentin produced a dose-dependent suppression of only the phase 2 flinching response in the formalin test. Intrathecal atropine, but not prazosin, yohimbine nor mecamylamine, reversed the antinociception of intrathecal gabapentin. CONCLUSIONS: The antinociceptive effect of intrathecal gabapentin on facilitated states may be mediated through the muscarinic receptor but by neither the nicotinic receptor nor the adrenergic receptor at the spinal level.
Animals ; Atropine ; Catheters ; Cholinergic Antagonists* ; Clonidine ; Formaldehyde ; Incidence ; Mecamylamine ; Nociception ; Pain Measurement ; Prazosin ; Rats ; Receptors, Adrenergic ; Receptors, Cholinergic ; Receptors, Muscarinic ; Receptors, Nicotinic ; Spinal Cord ; Yohimbine

BACKGROUND: The effect of spinal adrenergic and cholinergic receptors on the anti-nociceptive effect of intrathecal ginsenosides was determined in a rat postoperative pain model. METHODS: Catheters were placed into the intrathecal space of male Sprague-Dawley rats. Postoperative pain was evoked by an incision to the plantar surface of a hind paw. Withdrawal thresholds was used as a nociceptive parameter and was measured with a von Frey filament. After observing the effect of intrathecal ginsenosides, an alpha-1 adrenergic receptor antagonist (prazosin), an alpha-2 adrenergic receptor antagonist (yohimbine), a muscarinic acetylcholine receptor antagonist (atropine), and a nicotinic acetylcholine receptor antagonist (mecamylamine) were given 10 min before administration of the ginsenosides to analyze the contribution of spinal adrenergic and cholinergic receptors on the antinociceptive effect of ginsenosides. RESULTS: Paw incision decreased withdrawal threshold in incised site of paw, but no change of withdrawal threshold was not seen in non-incised site. The intrathecal ginsenosides increased withdrawal threshold of the incised paw in a dose-dependent manner. Pre-treatment with both prazosin and intrathecal yohimbine antagonized the anti-nociceptive effect of the ginsenosides. However, pre-treatments with atropine or mecamylamine had any effect on the antinociceptive activity of ginsenosides. CONCLUSIONS: Intrathecal ginsenosides are effective in attenuation of postoperative pain induced in the rat model. Anti-nociceptive action of ginsenosides is partially mediated by spinal adrenergic receptors, but does not appear to be related to spinal cholinergic receptors.
Animals ; Atropine ; Catheters ; Ginsenosides ; Humans ; Male ; Mecamylamine ; Pain, Postoperative ; Prazosin ; Rats ; Rats, Sprague-Dawley ; Receptors, Adrenergic ; Receptors, Adrenergic, alpha-1 ; Receptors, Adrenergic, alpha-2 ; Receptors, Cholinergic ; Receptors, Muscarinic ; Receptors, Nicotinic ; Spinal Cord ; Yohimbine