No abstract available.
Fosinopril* ; Humans ; Hypertension*

Collagen is the major component of scar tissue. Considerable progress of fibroblast growth kinetics and of collagen synthesis has been achieved in the past decade. We have been interested in fibroblasts activities as they are expressed by cells cultured in collagen substrate. This study is to examine the effects of collagen substrate and peptide growth factors In culture medium on DNA and protein synthesis of human dermal fibroblasts. Collagen, interleukin-1(IL-1) and transforming growth factor-beta(TGF-beta) were added to fibroblast culture media according to the designed experiment model and DNA and protein synthesis were measured by [3H]-thymidine, [3H]-leucine, and [3H]-proline incorporation method. The morphological features of fibroblasts were observed by light microscope. The results were as follows ; 1) There were significant decreases of DNA and protein synthesis of cultured fibroblasts in the presence of collagen substrate compared with those in Control groups(p<0.01). 2) DNA and protein synthesis were decreased as dose dependant manner of collagen density in culture media. 3) Morphological features of fibroblasts became less stellate and flat, more spindle-like in the presence of collagen. 4) In responsiveness to IL-1, collagen non-treated groups responded to IL-1 but collagen treated groups were unresponsive to IL-1 (P<0.05). 5) Cells In collagen non-treated groups responded to TGF-beta as dose-related manner(P<0.01). Collagen treated groups desponded to TGF-beta but did not show TGF-beta dose-dependant relationship. In Conclusion, collagen substrate in the culture medium could lower the DNA and protein synthesis of fibroblasts. Cells in collagen substrate were unresponsive or less responsive to peptide growth factors than those in non-collagen substrate.
Cicatrix ; Collagen* ; Culture Media ; DNA* ; Fibroblasts* ; Humans ; Intercellular Signaling Peptides and Proteins ; Interleukin-1 ; Kinetics ; Transforming Growth Factor beta

Fractures of the tibial plateau involve a major weight-bearing joint, Thus, to achieve good joint function one must strive to achieve joint congruity, axial alignment, stability, and a satisfactory range of motion. Present operative treatment of tibial plateau fractures utilizes the principles of anatomical reduction, elevation of the plateau en masse, bone grafting of the defect in the metaphysis, stable internal fixation and early joint motion. Authors reviewed the 45 tibial plateau fractures operatively treated at Dong-Kang Hospital from Jan. 1983 to Dec. 1988 and analyzed the possible factors that could influence the results. Factors that may adversely affect the results were 1) old female. 2) Hohl Type VI, 3) delayed operation, 4) inadequate reduction, 5) no bone graft, 6) meniscectomy, 7) cruciate ligament injury, and 8) delayed exercise.
Bone Transplantation ; Female ; Humans ; Joints ; Ligaments ; Range of Motion, Articular ; Transplants ; Weight-Bearing

Treatment for the femoral shaft fractures in adolescents is somewhat controversial. These fractures have been treated nonoperatively, but adolescents tolerate prolonged immobilization less well than younger children and conservative treatment in this age group may result in more complicationssuch as malunion, shortening and angular deformities more often than those in the younger age group. Recently there has been a tendency to choose the operative method rather than traditional traction and casting technique for femoral shaft fractures in elderly children and adolescent The purpose of this study is to find better treatment for the femoral shaft fractures in adolescents. Fifty six femoral shaft fractures in 56 patients aged 10 to 14 years old were treated with traction followed by casting, open reduction and internal fixation with plate, closed intramedullary nailing, or external fixation using A-0 external fixator, and evaluated respectively for at least 1 year. External fixation may be benefit to patients with concomittant injuries and result in psychological settle down, early mobilization out of bed, short hospital stay, save of cost,and early return to daily living activities without any disadvantages such as malunion, leg length discrepancy or awareness of growing arrest in spite of negligible pin tract infection. Result of this study suggests that external fixation for the femoral shaft fractures may be an one of the attractive treatment option in adolescents.
Activities of Daily Living ; Adolescent* ; Aged ; Child ; Congenital Abnormalities ; Early Ambulation ; External Fixators ; Fracture Fixation, Intramedullary ; Humans ; Immobilization ; Leg ; Length of Stay ; Traction

Intermittent positive pressure ventilation is used as a respiratory support for acute respiratroy failure. Adult respiratory distress syndrome(ARDS) revealed mortality rate of 70% as yet. Hypoxemia is foremost problem in ARDS. Though various ventilatory support is tried on ARDS, extracorporeal membrane oxygenation(ECMO) is to be recommended when hypoxemia and hypercarbia are refractory to conventional treatments. Neonatal venoarterial (VA) ECMO in USA is recognized as a therapeutic modality for neonatal respiratory failure and extracorporeal carhon dioxide removal(ECCO2R) in Europe is used for adult respiratory distress syndome. The partial bypass using the membrane oxygenator aims at lung rest while relieving the hard ventilatory setting on the diseased lung. VA ECMO can provide circulatory support as well but the right internal jugular vein and the right common carotid artery are ligated for the cannulation of draiaage and perfusion catheters. Recent follow up study shows that VA ECMO may not be completely free from neurologic complications such as embolism in the systemic circulation and ill effects due to the reduction of blood supply to the immature lungs. ECCO2R adopts low-flow venovenous(VV) bypass. It has been reported to be valuable for treatment of neonatal respiratory failure. VV bypass provides gas exchange but no cardiac support. Venous drainage and perfusion catheters are placed in the right atrium or vena cavae via the femoral or internal jugular veins. Compared to VA bypass, the consequences of embolizations are potentially fewer, no major artery is sacrificed. Highly oxygenated blood flows into pulmonary eirculatiom which may relieve pulmonary artery hypertension. Total respiratory support may be obtained by VV bypass, VV bypass requires approximately 20-50% more flow for total respiratory sopport due to recirculation of oxygenated blood. Recently VV bypass is chosen for neonatal resyiratoty failure in USA. They alliveate the entry criteria for ECMO using the parameter of oxygenation index(OI). VV ECCO2R using to-and-fro system is tried also for neonatal respiratory failure in Europe. A double lumen tube was developed to reduce the number of veins to be cannulated during VV bypass. It is constructed with the outer drainage cannula( 14 Fr.) and the inner perfusion cannula( 8 Fr.) whose opening is placed on the left side of outer cannula. If perfusion opening is placed on the right atrium facing the right ventricle, the venous blood can be drained from both superior and inferior vena cavae through several drainage opening. To evaluate the effectiveness of ECCO2R with a double lumen tube, we developed an experimental model of acute respiratory failure on 8 mongrel dogs. Under general anesthesia with i.v, pentobarbital, a double lumen tube was introduced via the right internal jugular vein and it was connected with the extracorporeal circuit. Without ventilating the oxygenator during VV bypass, respiratory failure was induced by hypoventilation. After obtaining control hemodynamic and blood gas values under hypoventilation, we proceed to apneic oxygenation(AO), extracorporeal CO2 removal(ECCO2R) and controlled mechanical ventilation(CMV) in that order. Arterial pH in control was 7.180.09(meanSD), and it was increased to 7.33+/-0.08 and 7.28+/-0.08 in ECCO2R and CMV, respectively. PaCO2 in control was 69+/-9mmHg and it was decreased to 41+/-4mmHg and 47+/-7mmHg in ECCO R and CMV respectively. PaCO2 in control was 62+/-15 mmHg and it was increased in AO, ECCO2R and CMV. Mixed venous blood gas analysis showed the same result as arterial blood gas analysis. There was no difference between ECCO2R and CMV. The bypass flow enough to remove CO2 was 30-50% of cardiac output. It is concluded that ECCO2R using a double lumen tube was effective to control the carbon dioxide tension in arterial blood, and a double lumen tube may permit the simplicity of an operation and patient care as well as minimizing the bleeding during extracorporeal respiratory support.
Adult ; Anesthesia, General ; Animals ; Anoxia ; Arteries ; Blood Gas Analysis ; Carbon Dioxide* ; Carbon* ; Cardiac Output ; Carotid Artery, Common ; Catheterization ; Catheters ; Dogs ; Drainage ; Embolism ; Europe ; Extracorporeal Membrane Oxygenation ; Heart Atria ; Heart Ventricles ; Hemodynamics ; Hemorrhage ; Humans ; Hydrogen-Ion Concentration ; Hypertension ; Hypoventilation ; Intermittent Positive-Pressure Ventilation ; Jugular Veins ; Lung ; Membranes ; Models, Theoretical ; Mortality ; Oxygen ; Oxygenators ; Oxygenators, Membrane ; Patient Care ; Pentobarbital ; Perfusion ; Pulmonary Artery ; Respiratory Insufficiency ; Veins ; Vena Cava, Inferior

BACKGROUND: It is invasive and accompanies various risks to insert pulmonary artery catheter in order to measure mixed venous oxygen saturation (SvO2) that is associated with patients clinical course and prognosis. If there is relationship between central venous oxygen saturation (ScvO2) and mixed venous oxygen saturation, we can use the central venous oxygen saturation instead of mixed venous oxygen saturation to monitor and treat patients. METHODS: We inserted the Swan-Ganz catheter in 20 patients (male 8, female l2) scheduled for undergoing open heart surgery and accomplished the blood gas analysis of the radial arterial blood, central venous blood and mixed venous blood during postoperative respiratory care in intensive care unit at F1O2 1.0, 0.6 and 0.4 in order. RESULTS: There was no significant difference between central venous blood and mixed venous blood in respect to pH, PCO2, PO2. except the mixed venous blood pH at F1O2 0.6 that is greater than the central venous blood pH at F1O2 0.6. Central venous oxygen saturation and mixed venous saturation were not significantly different and showed the following close relationship: SvO2(%)=15.41+0.80XScvO2 (R=0.88, p<0.05). In respect to the difference according to the variation of F1O2, the SO2 and PO2 at F1O2. 1.0 were higher than the SO2 and PO2 at F1O2 0.6 and 0.4, but the differnce between F1O2 0.6 and 0.4 was not significant. CONCLUSIONS: We might conclude that central venous oxygen saturation might be replaced for the mixed venous oxygen saturation in respiratory care after open heart surgery in adults.
Adult ; Blood Gas Analysis ; Catheters ; Female ; Humans ; Hydrogen-Ion Concentration ; Intensive Care Units ; Intermittent Positive-Pressure Breathing ; Oxygen* ; Prognosis ; Pulmonary Artery ; Respiration, Artificial* ; Thoracic Surgery ; Ventilation

To evaluate historical trend, if any, anesthetic experiences of 23,385 in total performed at the Seoul National University Hospital from Jan. 1965 through Sept, 1972 were analyzed statistically according to age, sex, anesthetic agents and methods. The results are as follows: 1) General anesthesia has been used with increasing frequencies inversely to local anesthesia. 2) More than half the total cases were for the patients in the second or third decade of there ages. 3) The use of halothane has been steadily increasing ever since its introduction into clinical anesthesia in its country. 4) Thiopental has mainly been used for intravenous induction, and succinylcholine for facilitating endotracheal intubation. 5) In almost all cases semiclosed circle absorption system has been employed, and non-rebreathing system has recently been used with increasing favor for pediatric anesthesia.
Absorption ; Anesthesia ; Anesthesia, General ; Anesthesia, Local ; Anesthetics ; Halothane ; Humans ; Intubation, Intratracheal ; Seoul ; Succinylcholine ; Thiopental

It is essential for the safe conduction of anesthsia to monitor the depth of anesthesia during aperation. However no one method has been confirmed to be objective and accurate as yet. Hecently lower esophageal contractility (LEC) has emerged as a means of mesuring anesthetic depth. To evaluate the usefulness as an index of anesthetic depth, the author compared the cardio- vascular signs (blood pressure, heart rate), EMG, EEG, plasma epinephrine and norepinephrine concentrations and LEC, until now known to be relevent to the anesthetic depth, at varing conditions of of no anesthesia, under anesthesia and after stimulation. The subjects were 30 ASA class 1 surgical patients, aged from 20 to 49, who had no specific past midical history and no recent medications. Patients were given thiopental sodium 4 mg/kg and vecuronium 0.1 mg/kg for induction and intubation and respiration controlled with 100% oxygen, then baseline measurements were taken (control) and compard the values of under enflurane anesthesia with 1 minimum alveolar concentration (MAC), 1.7%, (anesthesia) and after surgical stimulation (stimulation) with each other. The results were as follows ; 1) EEG, response rate and frequency of spontaneous LEC, amplitude of provoked LEC, LEC index of under enflurane anesthesia and after stimulation revealed significant differences compared with control but no significant differences between under anesthesia and after stimulation values. 2) Systolic, diastolic, mean blood pressure revelaled significant differences among control, under anesthesia and after stimulation values. 3) Heart rate, EMG, plasma epinephrine and norepinephrine concentrations, amplitude of spontaneous LEC revealed no significant differences among control, under anesthesia and after stimulation values. According to the above results, compared to the control value, EEG, and LEC reflected anesthetic depth under 1 MAC enflurane anesthesia but were meaningless in the evaluation of surgical stimulation. Blood pressure change which revealed significant differences among three values could be judged to be useful as an index of anesthetic depth most commonly applicable in practice.
Anesthesia* ; Blood Pressure ; Electroencephalography ; Enflurane* ; Epinephrine ; Heart ; Heart Rate ; Humans ; Intubation ; Norepinephrine ; Oxygen ; Plasma ; Respiration ; Thiopental ; Vecuronium Bromide

It is essential for the safe conduction of anesthsia to monitor the depth of anesthesia during aperation. However no one method has been confirmed to be objective and accurate as yet. Hecently lower esophageal contractility (LEC) has emerged as a means of mesuring anesthetic depth. To evaluate the usefulness as an index of anesthetic depth, the author compared the cardio- vascular signs (blood pressure, heart rate), EMG, EEG, plasma epinephrine and norepinephrine concentrations and LEC, until now known to be relevent to the anesthetic depth, at varing conditions of of no anesthesia, under anesthesia and after stimulation. The subjects were 30 ASA class 1 surgical patients, aged from 20 to 49, who had no specific past midical history and no recent medications. Patients were given thiopental sodium 4 mg/kg and vecuronium 0.1 mg/kg for induction and intubation and respiration controlled with 100% oxygen, then baseline measurements were taken (control) and compard the values of under enflurane anesthesia with 1 minimum alveolar concentration (MAC), 1.7%, (anesthesia) and after surgical stimulation (stimulation) with each other. The results were as follows ; 1) EEG, response rate and frequency of spontaneous LEC, amplitude of provoked LEC, LEC index of under enflurane anesthesia and after stimulation revealed significant differences compared with control but no significant differences between under anesthesia and after stimulation values. 2) Systolic, diastolic, mean blood pressure revelaled significant differences among control, under anesthesia and after stimulation values. 3) Heart rate, EMG, plasma epinephrine and norepinephrine concentrations, amplitude of spontaneous LEC revealed no significant differences among control, under anesthesia and after stimulation values. According to the above results, compared to the control value, EEG, and LEC reflected anesthetic depth under 1 MAC enflurane anesthesia but were meaningless in the evaluation of surgical stimulation. Blood pressure change which revealed significant differences among three values could be judged to be useful as an index of anesthetic depth most commonly applicable in practice.
Anesthesia* ; Blood Pressure ; Electroencephalography ; Enflurane* ; Epinephrine ; Heart ; Heart Rate ; Humans ; Intubation ; Norepinephrine ; Oxygen ; Plasma ; Respiration ; Thiopental ; Vecuronium Bromide

The AO internal fixation system(the Fixateur Interne) is effective in reducing and stablizing a variety of unstable thoracolumbar fracture patterns. It is relatively effective in decompressing the canal of retropulsed bony fragments associated with burst fracture. Sixty-Two patients with unstable thoracolumbar spine fractures were treated with the AO internal fixator. They were followed for an average of 21 months(range 15-29 months). A compartive radiographic analysis of kyphosis and vertebral height was made using pre-operative, post-operative and follow-up radiogram. Changes in neural canal compromise were measured in 18 cases of burst fractures. Failure of instrumentation occured in 9 cases which were carefully analyzed. Recently, we've constructed the system of which the Schanz screws would be directed divergently in sagittal plane in the hope that the load to the screws might be reduced, thus the failure rate.
Follow-Up Studies ; Hope ; Humans ; Internal Fixators ; Kyphosis ; Neural Tube ; Spine