PURPOSE: To evaluate the modified Ender nailing technique for the treatment of femoral intertrochanteric fractures in elderly patients. MATERIALS AND METHODS: 31 cases of femoral intertrochanteric fractures treated by modified Ender nailing from May 1997 to December 2004 were included in this study. We analyzed the method of the anesthesia, amount of intraoperative blood loss, operation time, number of used nail, postoperative ability of ambulation, postoperative complication, and the time for radiological union. RESULTS: 22 cases were operated under epidural anesthesia and 9 cases under general anesthesia. The average amount of intraoperative blood loss was 55 ml and average time for operation was 37 minutes. The average number of used nails were 3.1. The postoperative ambulatory ability was clinically recovered to the preoperative ambulatory ability in 23 cases, and decreased than before in 8 cases. Postoperative complications included knee joint pain or limitation of motion of the knee joint and distal migration of the nails. The average time for radiological bone union was 17.1 weeks postoperatively. CONCLUSION: The modified Ender nailing technique is the one of the proper method in elderly femoral intertrochanteric fractures with associated medical problems. This method reduce the operation time and the amount of intraoperative blood loss.
Aged ; Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Femur* ; Hip Fractures ; Humans ; Knee Joint ; Postoperative Complications ; Walking

OBJECTIVE: Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder. Chronic anovulation, hyperandrogenism, hirsutism, obesity, infertility and polycystic ovaries (PCO) are clinical hallmarks of PCOS. PCO can be induced in prepubertal rats by daily injection of dehydroepiandrosterone (DHEA). The aims of this study is to investigate cDNA array analysis of genes expressed in the rat PCO induced by DHEA. METHODS: To induce the hyperandrogenic PCO condition, 22-day old rats were injected each day s.c. with DHEA for 15 days. Total ovarian RNA was isolated from the DHEA induced rat PCO and control, and used to prepare radiolabeled cDNA probes, which were hybridized to cDNA arrays. Some of selected genes were further analyzed by reverse transcription-polymerase chain reaction (RT-PCR) or in situ hybridization. RESULTS: Quantitative analysis identified differential expression profiles of 31 genes including leukemia inhibitor factor receptor alpha (LIFR-alpha), alpha 1A adrenergic receptor (ADRA1A), heat shock 90-kDa protein A (HSP90A) and platelet-derived growth factor receptor alpha (PDGFR-alpha) genes. RT-PCR analysis was used to validate the changes in above four gene expressions by the cDNA array. The levels of ADRA1A and LIFR-alpha gene expressions were incresed in DHEA induced rat PCO than control, but HSP90A and PDGFR-alpha gene expressions were decresed in PCO. The mRNA of ADRA1A gene was mainly localized in granulosa cells of cystic follicles. CONCLUSION: Rat hyperandrogenic PCO was induced by daily injection of DHEA for 15 days. ADRA1A, LIFR-alpha, HSP90A and PDGFR-alpha gene expressions were differentially expressed in PCO induced by DHEA. The above four genes may be involved in the mechanism of follicular growth and ovulation processes. The precise relationship between the altered gene expressions and PCO is a matter of further investigation.
Animals ; Anovulation ; Dehydroepiandrosterone* ; DNA, Complementary* ; Female ; Gene Expression ; Granulosa Cells ; Hirsutism ; Hot Temperature ; Hyperandrogenism ; In Situ Hybridization ; Infertility ; Leukemia ; Obesity ; Oligonucleotide Array Sequence Analysis* ; Ovary* ; Ovulation ; Polycystic Ovary Syndrome ; Rats* ; Receptors, Adrenergic, alpha-1 ; Receptors, Platelet-Derived Growth Factor ; RNA ; RNA, Messenger ; Shock ; Staphylococcal Protein A

PURPOSE: The most common cause of failure after Steindler flexorplasty has been known insufficient power of the transferred muscles. We develop "effective muscle index" which is calculated from the actual strength of each muscle to predict postoperative flexion power of the elbow for preventing the failure of the surgery. MATERIALS AND METHODS: We reviewed 10 patients who received Steindler flexorplasty from Aug. 1983 to Jan. 1997. We calculated "effective muscle index" with power of each transferred muscle, tension fraction2) by Brand, 1981, correction index of the magnitude of transferring muscle and correlated the "effective muscle index" with postoperative elbow flexion power. RESULTS: Excluding 4 out of total 10 patients who had grade 1 or 2 power of biceps and brachialis, "effective muscle index" has borderline significance with the postoperative flexion power of the elbow (p=0.123) . CONCLUSION: The authors concluded that the "effective muscle index" is maybe considered as a useful index for predicting the postoperative flexion power of the elbow after Steindler flexorplasty.
Elbow* ; Humans ; Muscles

BACKGROUND: Recently there have been several contradictory reports about the analgesic effects of opioids applied to peripheral tissues. To confirm the peripheral analgesic effects of opioids, this study compared the analgesic effects by observing the pain behavior in rats using the formalin test following infiltration of the commonly used opioids: morphine, meperidine and fentanyl. Furthermore, to confirm the mechanism of this analgesia, it also contrasted the differences of the analgesic effects between local infiltration and intraperitoneal injection of each opioid, and the reversal of peripheral analgesia of morphine by the administration of naloxone. METHODS: One hundred rats were divided into ten groups. The groups were a SHAM group(injection of normal saline 5 min before the formalin injection), infiltration groups(MSLO; 0.1 mL of 0.1% morphine 5 min before the formalin injection, DMLO for 1% meperidine, FTLO for 0.001% fentanyl), intraperitoneal groups(MSIP, DMIP, FTIP), reversal groups(MSLONAIP, MSLONALO) and a naloxone group(NALO). Under inhalation anesthesia, all animals were injected with an opioid according to their allocated group followed by the injection of 0.1 mL of 5% formalin in the plantar area of the hind paw. After recovery from anesthesia, all animals were observed for the number of flinches during phase 1(2~3 min, 5~6 min) and phase 2(every 1 min from 10 to 61 min) after the formalin injection. RESULTS: The flinches were significantly less in the infiltration groups(MSLO, DMLO, FTLO) than in the SHAM group(p<0.05). In addition, there were significantly different peripheral analgesia according to the type of opioid(p<0.05): morphine had a weak, prolonged but delayed onset of peripheral analgesia; meperidine had a potent, prolonged, rapid onset of analgesia but the number of flinches increased in the latter stages of the test; and fentanyl had a rapid, potent but very short duration of analgesia. Differences between peripheral and systemic analgesia were observed; the numbers of flinches in the DMLO, MSLO and FTLO groups were less than in the DMIP, MSIP and FTIP groups respectively(p<0.05). The reversals by naloxone applied locally or intraperitoneally did not increase the number of flinches in the groups of local infiltration of morphine. Furthermore, local infiltration of naloxone alone had less flinches than in the SHAM group(p<0.05). CONCLUSIONS: In this study, peripheral analgesia of opioids are readily present. Local infiltration of opioids such as morphine, meperidine and fentanyl has more potent analgesia than in systemic injection and the characteristics of these peripheral analgesia are different by the type of opioid. Moreover, these effects are not reversed by naloxone.
Analgesia ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Inhalation ; Animals ; Fentanyl* ; Formaldehyde* ; Injections, Intraperitoneal ; Meperidine* ; Morphine* ; Naloxone ; Pain Measurement* ; Rats*