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

BACKGROUND: Germline mutations in the breast cancer-associated genes BRCA1 and BRCA2 confer susceptibility and a lifetime risk of breast. Several morphological and clinical features have been attributed to hereditary tumors. However, in sporadic breast cancer, the interrelationship between the loss of heterozygosity (LOH) of these loci and clinical features remains to be fully elucidated. METHODS: Microdissected paraffin-embedded tissue blocks of 48 cases of surgically resected breast carcinoma were investigated to identify the LOH of BRCA1 and BRCA2 using microsatellite markers. RESULTS: Of 48 cases, 22 (45.9%) exhibited LOH at BRCA1 locus while in 29 out of 48 (60.4%) cases LOH was observed for the BRCA2 region. There was no significant correlation between LOH at BRCA1/2 and the patient's age, tumor size, histologic grade or lymph node metastasis. When comparing the frequency of LOH with the expression of several prognostic factors, such as p53, c-erb B2 protein, estrogen and progesterone receptor using immunohistochemical stain, there was only correlation with LOH at BRCA2 and the progesterone receptor. CONCLUSIONS: Our results suggest that allelic deletion play a role to the development of sporadic breast cancers.
Breast Neoplasms* ; Breast* ; Estrogens ; Germ-Line Mutation ; Loss of Heterozygosity* ; Lymph Nodes ; Microsatellite Repeats ; Neoplasm Metastasis ; Paraffin* ; Receptors, Progesterone

BACKGROUND: Sevoflurane and Desflurane are new inhalation anesthetics with a low blood/gas solubility which should allow a fast induction and emergence from anesthesia. This study was designed to compare the induction and recovery characteristics of gynecologic surgical patients receiving sevoflurane, desflurane or isoflurane with nitrous oxide for the maintenance of general anesthesia. METHODS: After a standardized induction of anesthesia with fentanyl, propofol, succinylcholine and tracheal intubation, patients undergoing an elective gynecologic surgery lasting 1 - 2 hr randomly received sevoflurane (n = 23), desflurane (n = 21) or isoflurane group (n = 20). Induction, recovery time and the incidence of postoperative nausea and vomiting, and recall were compared among groups. The liver (SGOT, SGPT, ALP) and renal (BUN, serum creatinine) function were evaluated before and after the operation. RESULTS: Although anesthetic conditions were similar during the operation in the three groups, significant differences were noted in induction and recovery profiles from anesthesia. Induction time was 201 +/- 67 sec for sevoflurane, 124 +/- 66 sec for desflurane and 422 +/- 257 sec for isoflurane. The time required for the end-tidal concentration of anesthetics to decrease by 50% was 180.9 +/- 34.4 sec for sevoflurane, 168.0 +/- 160.1 sec for desflurane, and 222.9 +/- 127.5 sec for isoflurane. The time to response (eye opening following a simple command), and orientation (recall of name and date of birth), to reach 10 points of the PAR (post anesthesia recovery) score and discharge from recovery room were significantly shorter after sevoflurane and desflurane than after isoflurane. There were no significant differences in liver and kidney functions between the periods before and after the operation among the groups. The frequency of side effects such as nausea, vomiting and recall during the postoperative period was similar among the groups. CONCLUSIONS: It is concluded that a balanced anesthetic technique using sevoflurane and desflurane as the main anesthetics has certain advantages compared with isoflurane in terms of faster emergence.
Alanine Transaminase ; Anesthesia ; Anesthesia, General ; Anesthesia, Inhalation* ; Anesthetics ; Anesthetics, Inhalation ; Female ; Fentanyl ; Gynecologic Surgical Procedures ; Humans ; Incidence ; Inhalation* ; Intubation ; Isoflurane ; Kidney ; Liver ; Nausea ; Nitrous Oxide ; Postoperative Nausea and Vomiting ; Postoperative Period ; Propofol ; Recovery Room ; Solubility ; Succinylcholine ; Vomiting

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

Spinal alpha-2 adrenoceptors and cholinergic receptors are involved in the regulation of acute nociception and the facilitated processing. The aim of this study was to examine the pharmacological effect of an intrathecal alpha-2 agonist and a cholinesterase inhibitor on the facilitated pain model induced by formalin injection and to determine the nature of drug interaction using an isobolographic analysis. Both intrathecal clonidine and neostigmine dose-dependently suppressed the flinching during phase 1 and phase 2. Intrathecal pretreatment with atropine reversed the antinociceptive effects of clonidine and neostigmine in both phases. Pretreatment with intrathecal yohimbine attenuated the effect of clonidine. The antinociception of clonidine and neostigmine was not reversed by mecamylamine. Isobolographic analysis showed that intrathecal clonidine and neostigmine acted synergistically in both phase 1 and 2. Intrathecal pretreatment with atropine and yohimbine antagonized the effect of the mixture of clonidine and neostigmine in both phases, but no antagonism was observed with mecamylamine pretreatment. These data indicate that spinal clonidine and neostigmine are effective to counteract the facilitated state evoked formalin stimulus, and these two drugs interact in a synergistic fashion. In addition, the analgesic action of intrathecal clonidine is mediated by spinal muscarinic receptors as well as alpha-2 adrenoceptors.
Adrenergic alpha-Agonists/*pharmacology ; Analgesics, Non-Narcotic/*pharmacology ; Animal ; Cholinesterase Inhibitors/*pharmacology ; Clonidine/administration & dosage/*pharmacology ; Dose-Response Relationship, Drug ; Drug Synergism ; Formaldehyde ; Injections, Spinal ; Male ; Neostigmine/administration & dosage/*pharmacology ; Pain/drug therapy ; Rats ; Rats, Sprague-Dawley

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