It is notoriously difficult to obtain a sound bony union of large segmental bone defects secondary to trauma or following tumor resection, infected nonunion, congenital pseudarthrosis of the tibia, and avascular necrosis of the femoral head with conventional methods. Recent advances in microsurgery have made it possible to provide a continuing circulation of blood in bone grafts so as to ensure viability. With the nutrient blood supply preserved, healing of the graft to the recipient bone is facilitated without the usual replacement of the graft by creeping substitution. Thus, the grafted bone is achieved more rapid stabilization of bone fragments separated by a large defect without sacrificing viability. Thirty nine cases of the free vascularized fibular graft had been performed in the Department of Orthopedic Surgery, Kyung Hee University Hospital during the period of 3 years from October 1978 to December 1981. Of these, ll cases were congenital pseudarthrosis of the tibia, 4 cases were tuberculous spondylitis, 4 cases were infected nonunion, 7 cases were large segmental bone defects secondary to trauma, 9 cases were avascular necrosis of the femoral head and the other was one case. The results were obtained as follows: 1. The advantages of free vascularized living fibular graft are one stage procedure, resistance of torsion and angular stress, union with rapid hypertrophy of the graft, a shorter immobilization period and more rapid incorporation of the graft into the recipient area. 2. Free vascularized fibular graft can be widely used in the field of Orthopedic surgery. 3. The fibula is the bone best suited for reconstruction of a defect in a long bone. 4. In children, distal tibiofibular synostosis must be performed. 5. For prevention of clawing toe, the muscles around the bone is meticulously dissected, 6. Evaluation by selective arteriography and isotopic scanning both before and after operation may be used to assess the viability of the fibula graft.
Angiography ; Animals ; Child ; Fibula ; Head ; Hoof and Claw ; Humans ; Hypertrophy ; Immobilization ; Microsurgery ; Muscles ; Necrosis ; Orthopedics ; Pseudarthrosis ; Spondylitis ; Synostosis ; Tibia ; Toes ; Transplants

Diagnosis of a thymic carcinoid was made on transthoracic fine needle aspiration in a 36-year old woman who had an anterior mediastinal mass on chest X-ray and CT scan. The aspiration smears showed numerous anastomosing ribbons and cords of small round tumor cells. The tumor cells had slightly eccentric nuclei and some granular cytoplasm. The small and uniform nuclei of the tumor cells had finely granular chromatin and thin nuclear membrane. The cytologic diagnosis of a carcinoid was confirmed on histopathologic, immunohistochemical, and electromicroscopic examination of surgical specimen.
Adult ; Alleles* ; Biopsy, Fine-Needle ; Carcinoid Tumor ; Carotid Body ; Child* ; Chromatin ; Cytoplasm ; Diagnosis ; Female ; Humans ; Immunoglobulin A* ; Nuclear Envelope ; Paraganglioma ; Thorax ; Tomography, X-Ray Computed

Adult stem cells are multipotent and self-renewing cells that contain several functions; i) migration and homing potential: stem cells can migrate to injured and inflamed tissues. ii) differentiation potential: stem cells which migrated to injured tissues can be differentiated into multiple cell types for repairing and regenerating the tissues. iii) immunomodulatory properties: stem cells, especially mesenchymal stem cells can suppress immune system such as inflammation. All those characteristics might be useful for the treatment of the digestive tract diseases which are complex and encompass a broad spectrum of different pathogenesis. Preclinical stem cell therapy showed some promising results, especially in liver failure, pancreatitis, sepsis, and inflammatory bowel disease. If we can understand more about the mechanism of stem cell action, stem cell therapy can become a promising alternative treatment for refractory digestive disease in the near future. In this review, we summarized current preclinical experiences in diseases of the digestive tract using stem cells.
Adult Stem Cells/cytology/*transplantation ; Digestive System Diseases/*therapy ; Drug Evaluation, Preclinical ; Humans

Magnetic resonance image of INFH were correlated with histologic sections. Seventeen patients withe eighteen hips were included in this study. reoperative radiographs and MRI were taken for the patients. Three hips were in stage II, nine hips were in stage III, and remaining six were in stage IV respectively(Ficat and Alert). These hips were replaced with artificial joint and resected heads were examined. The specimens were bisected along the imaging plane, and studied histologically and matched with respective MR images of T1 and T2. Specimen MRI was performed on three femoral head immediately after femoral head removal. Necrotic portion of the femoral head in earlier stage showed higher signal intensity in T1-weighted image. Subchondral void, necrotic bone and saponified fat were responsible for low signal intensity in necrotic portion. Low signal band adjacent to the necrotic foci represented inner fibrous tissue and outer reactive sclerotic bone. Outside the fibrous band, the signal intensity diminished compared with normal fatty marrow. these findings were attributed by cellular infiltration and trabecular bony proliferation. MRI patterns were variable in various stages, but corresponded well with histologic findings.
Bone Marrow ; Head ; Hip ; Humans ; Joints ; Magnetic Resonance Imaging ; Necrosis

PURPOSE: To determine whether intracellular localization of intravenously injected infection specific MoAb can be localized in the infected cells, immunohistochemical staining was obtained in animals infected with Mycobacterium tuberculosis. MATERIALS AND METHODS: One mg of intact mouse MoAb against mwobacteria (group I, n=10) and F(ab')2 (group II, n=6) were intravenously injected to the rabbits of each groups infected with M. tuberculosis H37RV. Immunohistochemical staining using an anti-mouse antibody was obtained at the 1,3, 5, 7 and 8th days in Group I and at the 1, 2, 3rd days in group II by streptavidin biotin method. For the control study, I mg of non specific polyclonal human IgG (group III, n=10) and 100 microgram of normal rabbit IgG F(ab')2 (group IV, n=6) were injected to the rabbits and guinea pigs respectively. RESULTS: Both groups (group I & II) showed a positive Ag-Ab reaction within the cytoplasm of monocytes. A weak but positive reaction was observed intracellularly in group III, however no positive reaction in group IV. CONCLUSION: Our results suggest intracellular Ag-Ab reaction plays an important role in the localization of infection by immunoscintigraphy using a specific MoAb fragments.
Animals ; Biotin ; Cytoplasm ; Guinea Pigs ; Humans ; Immunoglobulin G ; Mice ; Monocytes ; Mycobacterium tuberculosis ; Rabbits ; Streptavidin ; Tuberculosis ; Tuberculosis, Pulmonary*

Rhabdomyosarcoma is the most common soft tissue sarcoma in childhood, representing 4 to 8% of all malignant tumors in children below 15 years old, but rhabdomyosarcoma of the paratesticular region is rare. The paratesticular rhabdomyosarcoma is a highly malignant lesion with early invasion and metastasis, which has retroperitoneal metastases in about half of the patients at time of diagnosis. However, the survival rates have been improved greatly by using multimodal therapy. We are submitting a case of paratesticular rhabdomyosarcoma with retroperitoneal lymph node metastasis with review of literatures.
Adolescent ; Child ; Diagnosis ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Rhabdomyosarcoma* ; Sarcoma ; Survival Rate ; Testis

Recently fibrin glue, a hemostatic or adhesive material has been used worldwide in surgical procedures. There have been only limited numbers of reports on anaphylaxis following the topical use of fibrin glue. Here, we experienced an anaphylactoid reaction during transsphenoidal removal of pituitary tumor after local application of fibrin glue including aprotinin. Unexpected hypotension and erythematous eruptions on whole body developed suddenly after packing of it at operation field. Treatment with aggressive volume replacement with vasoactive agents and steroids were done immediately on the diagnosis of anaphylactoid reaction and patient recovered without any complications.
Adhesives ; Anaphylaxis ; Aprotinin* ; Diagnosis ; Fibrin Tissue Adhesive* ; Fibrin* ; Humans ; Hypotension ; Pituitary Neoplasms ; Steroids

BACKGROUND: Implantation of xenogenic chromaffin cells into the spinal subarachnoid space can produce analgesia in neuropathic pain models. However, transplantation of xenogeneic chromaffin cell has a potential risk of viral or bacterial infections from animals to humans including encephalopathy due to prion transmission. The aim of this study was to investigate the possibility of developing a homogeneic source of therapeutic chromaffin cells. METHODS: Anti-allodynic effects of human chromaffin cells (HCCs) were evaluated in a neuropathic pain model in rats induced by chronic constriction injury of the sciatic nerve. HCCs encapsulated with alginate-poly-L-lysine-alginate were intrathecally implanted into rats (n = 10), while empty capsules were intrathecally implanted as a control (n = 8). Levels of norepinephrine from encapsulated HCCs before and after nicotinic stimulation were measured. We then perfomed a behavior test (cold allodynia) with acetone. In addition, to assess the potential contribution to pain reduction of opioid peptides released from the HCCs, all animals were injected with naloxone. RESULTS: The concentration of norepinephrine after nicotine stimulation was significantly increased compared to basal levels. Intrathecal implantation of encapsulated HCCs, significantly reduced cold allodynia as compared to rats receiving empty capsules (P < 0.05). Fifteen minutes after the injection of naloxone, cold allodynia significantly decreased in rats with HCCs (P < 0.05), while the degree of cold allodynia in control animals was unaltered. CONCLUSIONS: From these results, it appears that HCCs have a possibility as an analgesic source for transplants delivering pain-reducing neuroactive substances.
Acetone ; Analgesia ; Analgesics ; Animals ; Bacterial Infections ; Capsules ; Chromaffin Cells ; Cold Temperature ; Constriction ; Humans ; Hyperalgesia ; Naloxone ; Neuralgia ; Nicotine ; Norepinephrine ; Opioid Peptides ; Rats ; Sciatic Nerve ; Subarachnoid Space ; Transplants

BACKGROUND: The issue of using phenylephrine in hemorrhagic shock treatment has been controversial because it is known that phenylephrine improves the tissue perfusion by increasing arterial blood pressure but deteriorates the myocardium by increasing afterload and decreasing myocardial oxygen delivery via coronary vasoconstriction. This study was aimed to assess the effects of phenylephrine on hemodynamic variables, cardiac performance, and myocardial oxygen balance in resuscitation from hemorrhagic shock. METHODS: Twenty anesthetized dogs were randomly divided into phenylephrine group and control group. After inducing hemorrhagic shock, resuscitation was done with phenylephrine and 0.9% normal saline respectively. We measured hemodynamic indices, blood gas parameter and cardiac enzymes which indicate myocardial demage. RESULTS: In both groups, cardiac output and hemodynamic indices improved. In phenylephrine group, the systemic oxygen delivery and consumption was much higher and the myocardial oxygen extraction ratio was maintained at the lower level than the control group. In addition, the CK-MB was higher at the early phase of resuscitation and the troponin T was also higher than the control group during the whole period of resuscitation. Creatine kinase-MB increased during early resuscitation in phenylephrine group but kept decreasing after that and there's no difference between two groups. Troponin T was higher in the phenylephrine group after resuscitation. CONCLUSIONS: We concluded that phenylephrine improves myocardial oxygen balance and contractility without serious myocardial demage during resuscitation from hemorrhagic shock.
Animals ; Arterial Pressure ; Cardiac Output ; Creatine ; Dogs ; Hemodynamics ; Myocardium ; Oxygen* ; Perfusion ; Phenylephrine* ; Resuscitation* ; Shock, Hemorrhagic* ; Troponin T ; Vasoconstriction

Endotracheal obstruction may cause serious complications, including cardiovascular instability, pneumothorax, pulmonary edema and even brain death. A 21-year-old man was scheduled to undergo an open reduction for an orbital fracture. The patient had tracheostomy with an 8.0 mm tracheostomy tube 3 weeks ago and was breathing well spontaneously. When the cuff of tracheostomy tube was inflated for assisted manual ventilation and the induction of anesthesia, signs of partial endotracheal obstruction were observed, including high airway pressure, low tidal volume and high ETCO2. Large dried mucous plug was impacted in the tracheostomy tube. After removing this plug with a sterile surgical forcep, effective ventilation was recovered without complications. The case like this nearly fatal obstruction by large dried mucous plug was rarely reported, but it should be considered cautiously when a patient uses tracheostomy tube as an airway before general anesthesia.
Airway Obstruction ; Anesthesia ; Anesthesia, General ; Brain Death ; Humans ; Orbital Fractures ; Pneumothorax ; Pulmonary Edema ; Respiration ; Surgical Instruments ; Tidal Volume ; Tracheostomy ; Ventilation ; Young Adult