Three-Dimensional Analysis of the Morphological Features in the Femur of Atypical Fracture and Practical Implications of Intramedullary Nailing

Purpose@#This study analyzed the morphological features of the contralateral femur without an atypical fracture by constructing a three-dimensional model with an actual size medullary canal. @*Materials and Methods@#Lateral and anterior bowing of the shaft were measured for 21 models, and the shape of the medullary canal was analyzed. To eliminate the projection error, the anteroposterior (AP) femur was rotated internally to the extent that the centerline of the head and neck, which is the ideal position of cephalomedullary nail screw, was neutral, and the lateral femur matched the medial and lateral condyle exactly. @*Results@#The lateral bowing and anterior bowing was an average of 5.5° (range, 2.8°-10.7°; standard deviation [SD], 2.4°) and 13.1° (range, 6.2°-21.4°; SD, 3.2°), respectively. In the area where lateral bowing increased, the lateral cortex became thicker, and the medullary canal was straightened. On the lateral femur, the anterior angle was increased significantly, and the diameter of curvature averaged 1,370.2 mm (range, 896-1,996 mm; SD, 249.5 mm). @*Conclusion@#Even if the anterolateral bowing increases in the atypical femur, the medullary canal tends to be straightened in the AP direction. So, it might be considered as a reference to the modification of an intramedullary nail to increase the conformity.

Emm Typing of Invasive Infections Caused by Streptococcus dysgalactiae / 대한내과학회지

Recently, invasive infections with the human pathogen Streptococcus dysgalactiae subspeciesequisimilis (SDSE) have increased around the globe. Typing of the emm gene of SDSE, which encodes a virulence factor (M protein), has provided important information. Here, we report two cases of invasive SDSE infection that presented with endocarditis and bacteremia, and their emm gene types.

Emm Typing of Invasive Infections Caused by Streptococcus dysgalactiae / 대한내과학회지

Recently, invasive infections with the human pathogen Streptococcus dysgalactiae subspeciesequisimilis (SDSE) have increased around the globe. Typing of the emm gene of SDSE, which encodes a virulence factor (M protein), has provided important information. Here, we report two cases of invasive SDSE infection that presented with endocarditis and bacteremia, and their emm gene types.

A novel Na+-dependent transporter and NHE3 mediate H+ efflux in the luminal membrane of the pancreatic duct: regulation by cAMP

No abstract available.

Effect of cytokines and bFGF on the osteoclast differentiation induced by 1 alpha,25-(OH)2D3 in primary murine bone marrow cultures

Bone is a complex tissue in which resorption and formation continue throughout life. The bone tissue contains various types of cells, of which the bone forming osteoblasts and bone resorbing osteoclasts are mainly responsible for bone remodeling. Periodontal disease represents example of abnormal bone remodeling. Osteoclasts are multinucleated cells present only in bone. It is believed that osteoclast progenitors are hematopoietic origin, and they are recruited from hematopoietic tissues such as bone marrow and circulating blood to bone. Cells present in the osteoclast microenvironment include marrow stromal cells, osteoblasts, macrophages, T-lymphocytes, and marrow cells. These cells produce cytokines that can affect osteoclast formation. In vitro model systems using bone marrow cultures have demonstrated that IL-1 beta, IL-3, TNF-alpha, bFGF can stimulate the formation of osteoclasts. In contrast, IL-4 inhibits osteoclast formation. Knowledge of cytokines and bFGF that affect osteoclast formation and their capacity to modulate the bone-resorbing process should provide critical insights into normal calcium homeostasis and disorders of bone turnover such as periodontal disease, osteoporosis and Paget's disease.

Effects of small molecular antioxidants on cerulein-induced acute pancreatitis in rat

It has been suggested that oxygen free radicals are involved in the initiation process of acute pancreatitis, although its pathogenesis is not clear. This study evaluates the roles of oxygen radicals and the effects of small molecular antioxidants (rebamipide, N-acetyl-cysteine, allopurinol, beta-carotene) on the development of cerulein-induced acute pancreatitis. Acute edematous pancreatitis was induced by the intravenous infusion of cerulein at supramaximal dose of 10 mug/kg/hour for 3.5 hours. The effects of antioxidants, rebamipide (100 mg/kg, i.p.), N-acetyl-cysteine (200 mg/kg, i.v.), allopurinol (20 mg/kg/hour), beta-carotene (50 mg/kg, i.p.), were examined. Cerulein administration resulted in a significant increase in serum amylase activity and pancreatic malondialdehyde (MDA), but not glutathione peroxidase (GSHpx). The glutathione (GSH) content in pancreatic tissue decreased dramatically. Pretreatment of N-acetyl-cysteine significantly decreased the cerulein-induced hyperamylasemia and maintained GSH content in pancreas, but MDA was slightly decreased. In addition, N-acetyl-cysteine ameliorated histological damage. Allopurinol and beta-carotene attenuated cerulein-induced hyperamylasemia, but histologically there was no difference from control. These results indicate that oxygen free radicals play an important role in the initiation of experimental acute pancreatitis. N-acetyl-cysteine is an effective antioxidant that ameliorates the cerulein-induced acute pancreatitis, and the possible therapeutic application of antioxidants against acute pancreatitis needs a further evaluation.

Appearance of the Tracer Substance in the Spinal Cord following injection into or around the Coeliac Plexus / 대한마취과학회지

The present study was undertaken in an attempt to explore the spinal cord after injection of a tracer substanee into the coe1iac plexus. We studied two groups of rabbits weighing 2.0 to 2.3 kg ; a normal control group and the experimental group. The animals were anesthetized with 20 % urethane 7 ml/kg body weight intraperitoneally. To make an injectable mixture of the tracer substance, 0.5 gm of ferric oxide (Iron sesquioxide) was mixed with 2 ml of lactated Ringer's solution just prior to injection. In normal control group (N=3), animals were killed after anesthetization by shedding blood and the segment of vertebrae from the 6th thoracic to 11th thoracic were removed and fixed in 10% formalin solution. The experimental group was subdivided into a subgroup of perineurial injection of the tracer mixture to the bilateral coeliac ganglia (the perineurial injection subgroup, N=5), a subgroup of intraneural injection of tracer mixture to the bilateral coeliac ganglia (the coeliac ganglion subgroup, N=5) and a subgroup of intraneural injection of the tracer mixture to the bilateral superior mesenteric ganglia (the superior mesenteric ganglion subgroup, N=3). In the perineurial injection subgroup, the bilateral coeliac ganglia were exposed under surgical microscope and 1 ml of the tracer mixture was injected bilaterally exterior to the perineurial connective tissue of coeliac ganglion. After the injection, the abdominal wall was closed and animals were then allowed to rest in the lateral position for 2 hours. In the coeliac ganglion subgroup and the superior mesenteric ganglion subgroup 0.6 to 0.7 ml of the tracer mixture was injected bilateraUy into the coeliac ganglia or the superior mesenteric ganglia. After the injection, the aMominal wall of the animals were closed and then allowed to rest in the lateral position for 90 minutes. At the end of experiment, animals of the experimental group were killed by shedding blood and the segment of vertebrae from the 6th thoracic to 11th thoracic were removed and fixed in 10% formalin solution. Following decalcification in 50% formic acid, histological study was performed with hematoxilin-eosin(H-E) stain or iron stain in transverse sections and sagittal plane of specimen which was obtained in one animal of the coeliac ganglion group. The results were as follows ; 1. In the perineurial injection subgroup, moderate density of the tracer substance was diffused into the dura mater. There was minimally infiltrated tracer in the area of lateral side of the formatio reticularis and the perivascular space of the white matter and pia mater. 2. In the coelic ganglion subgroup many tracer were diffused into the perineurial epithelial space of unmyelinated fibers and around the Schwann's sheath of fibers in the ventral and dorsal roots. The white matter was infiltrated uniformly with the tracer substance. there was evidence of diffusion of the tracer substance through the glia limitans of the white matter in the transversely or sagittally sectioned slides. 3. The superior mesenteric ganglion was tightly encased with the connective tissue capsule, thus we experienced moderate resistance to injection of the tracer mixture. There was most extensive diffusion of the tracer substance in the ventral and dorsal roots, dorsal horns of the gray matter, the area of the lateral side of the formatio reticularis and the remaining whole area of the white matter. And the tracer substance was infiltrated around the peripherally situated cells of gray matter. Our observation demonstrate that the tightly encased ganglion like the superior mesenteric ganglion is the candidate for paralysis when a neurolytic agent was injected intraneura1ly. In discussion we indicated the existance of small ganglion on the wall of upper abdominal aorta which is prone to produce paraplegia of the distal extremities in case of neurolytic coeliac plexus block.

Role of phosphoaminoacid phosphatase in the process of calcification and remodeling of rat bone / 대한정형외과학회잡지

No abstract available.

Effect of Magnesium on Serum Potassoum Concentration and Arrhythmia in Hyperkalemia / 대한마취과학회지

The effects of magnesium sulfate treatment on the serum level of blood potassium which was induced by continuous infusion of KCl solution were evaluated in rabbits anesthetized with urethane. Pretreatment group were prepared with intravenously injection of 30 mg/kg of magnesium dissolved in 5 ml normal saline for 10 rninutes. Control group were administered 5 ml normal saline only. After these pretreatments, KCl (3 mEq/kg/hr) was infused continuously until the appearance of lethal arrhythmia in both groups. Venous blood samples were withdrawn without any treatment, immediately after pretreatment, and 50 minutes after the start of KC1 infusion for determination of serum potassium and magnesium level in both groups. In addition, electrocardiograms were monitored continuously throughout the experiment in both groups; The results were as follows: 1) Serum magnesium level were increased significantly in magnesium treated group, but potassium level showed no statistical difference in both groups. However, in magnesium treated group serum potassium level showed less elevation at 50 minutes after infusion of KCl compaired to control group. 2) P wave amplitude, QRS interval and T wave amplitude showed no difference in both groups before and after magnesium pretreatment. However, 30 minutes after continuous infusion of KCl solution, findings of hyperkalemia appeared to be significant in control group but no change in magnesium treated group. Although hyperkalemic findings were developed 50 minutes after KCl infusion in both groups, those in magnesium treated group were observed to a lesser extent. 3) Time span, from start of KCl infusion to the onset of lethal arrhythmia were measured up to 98+/-30.3 minutes in magnesium treated group and 70+/-20.5 minutes in control group. These results suggest that pretreatment with magnesium in hyperkalemic animals retarded the elevation of serum potassium concentration, attenuated the changes of electrocardiographic findings, and delayed the onset time of lethal arrhythmia.

The Effect of Disodium Etidronate on Phosphatase Activity in Experimental bone Formation of Rats / 대한정형외과학회잡지

The bone formation of periarticular connective tissue after head injury and total hip arthroplasty is included in the category of heterotopic ossification. Induction of a new bone formation in the soft tissue is related to various materials such as bone morphogenic protein. The alkaline phosphatase and acid phosphatase act as important factors in the formation and absorption of the bone. The acid phospatase has the important function of acting as the control with specific activity of phosphatase in vivo. Cholecalciferol induces absorption of the calcium in the alimentary tract and bone resorption and increment of bone calcification, whereas disodium etidronate inhibits the deposition and dissolution of calcium salt and formation of heterotopic bone. This paper reports on the relationship of alkaline phosphatase and various phosphoaminoacid phosphatase which affect the cellular differentiation and remodelling in the heterotopic ossification, with the effect of cholecalciferol and disodium etidronate on the heterotopic bone induction in rats. The following results were obtained: 1. The contents of the calcium in the implanted bone matrix increased markedly from two to five weeks. There was no changes in the calcium content by cholecalciferol or in the administration of small doses of disodium etidronate (5mg/kg). However, in the administration of large dose of disodium etidronate (25mg/kg), calcium mobilization was totally suppressed for the whole period of the experiment. 2. The protein content in the implanted bone matrix did not much change for the whole period of the experiment and the administratinn of cholecalciferol or disodium etidronate also had no effect on the protein content. 3. The activities of alkaline phosphatase in the implanted bone matrix peaked at two weeks in control or cholecalciferol group, whereas disodium etidronate admninstration caused the highest activity in the third week. 4. The activity of acid phosphatase in the implanted bone matrix increased in first and third weeks by cholecalciferol treatment. Disoidum etidronate inhibited the activity of the acid phosphatase in the first, fourth & sixth weeks of implantation. 5. The activity of phosphoserine phosphatase increased due to cholecalciferol treatment, but was significantly inhibited by disodium etidronate (25mg/kg) treatment. 6. The activity of phosphothreonine phosphatase in the implanted bone matrix slightly increased due to cholecalciferol treatment, whereas the activity decreased significantly for the whole period of the experiment by disodium etidronate (25mg/kg) treatment. 7. The activity of phosphotyrosine phosphatase in the implanted bone matrix was not change much for the whole period of the experiment and the administration of cholecalciferol or disodium etidronate had no effect on the activity of phosphotyrosine phosphatase. In conclusion, the disodium etidronate (25mg/kg) almost completely inhibited the molilization of calcium and the activities of acid phosphatase, phosphoserine and phosphothreonine phosphatases. Therefore, it can be suggested that the above phosphatases are closely related to the action mechanism of disodium etidronate.

Use of Epidural Anesthesia in Congenital Diaphragmatie Hernia / 대한마취과학회지

A case of a congenital diaphragmatic hernia was operated upon at our hospital employing a combination of light general anesthesia and epidural block, with effective results and post-operative analgesia. Cases with congenital anomalies, prematurity and neonatal respiratory distress syndrome(RDS) are at great risk during general anesthesia. To insure a good ariway and to prevent aspiration of stomach contents, tracheal intubation was done and light general anesthesia(N2-O2) administered. Unver this state candal block was done. By this method, good abdominal relaxation was obtained and the amount of inhalation anesthetics could be reduced. The author believe that in this group of patients, epidural block in combination with light general anesthesia is a good and safe method of administering anesthesia.

A Report on the Effect of Nitroglycerin in Ischemic Patient during Cardiopulmonary Resuscitation / 대한마취과학회지

The incidence of myocardial ischemia and silent myocardial infarction are higer in diabetic than in nondiabetic patients. We had a case of a disbetic, myocardial ischemic female patient, 54years old, who had cardiac arrest during an emergency surgery. The patient was admitted via emergency room with the diagnosis of rupture of basilar artery aneurysm. During the dissection for the exposure of the artery. The aneurysm ruptured. causing massive hemorrhage. At this time, cardiac arrest was revealed at the monitoring EKG, cardiopulmonary resuscitation with DC shock were performed to reverse venticular fibriliation but the EKG monitor showed T wave inversion and sinus tachycardia in several leads. And the blood pressure was hardly audible with systolic of about 50mmHg. So nitroglycerin 0.05mg, intravenous bolus injection was given twice and the systolic went up to 110mmHg with a diastolic of 80mmHg. So the operation proceeded and finished. The patient was sent to the ICU. On the third postoperative day, the patient again had cardiac arrest but this time could not be resuscitated. We experienced the dramatic effect of nitroglycerin on this ischemic patient during cardio pulmonary resuscitation and we would like to share this experience with our colleagues.

Electromechsnical Dissociation during Exsanguinating Hemorrhage on Rabbits / 대한마취과학회지

Cardiac electromechanical dissociation is a cause of cardiac arrest and this is characterized by regularly recurring QRS complexes and T waves- P waves may even be present. without an obtainable blood pressure and pulse. Such findings in man are almost invariably associated with a fatal outcome although one can observe this phenomenon in potentially treatable disorders. Recognition of these disorders on the basis of certain clinical and electrocardiographic findings may be of clinical importance. This experimental study on rabbits was performed to observe electromechanical dissociation (E.M.D.) and to recognize its clinical importance, in exsanguinating hemorrhage with the cutting of the right femoral artery. The results were as follows: 1) The incidence of E.M.D. was 100 percent. 2) In the all cases except two cardiac rhythm showed sinus rhythm but in two cases it was difficult to distinguish it from nodal rhythm. 3) Heart rate at the time of E.M.D showed a significant increase of 13,8 percent as compared with the control. 4) The voltage of the P wave and QRS complex at the time of E.M.D. showed a significant decreases of the former, 34.7%, and the latter, 30%, as compared with the control. and the QRS complex at the time of E.M.D showed severe axis deviation. 5) In seven cases in all, the voltage of the T wave at the time of E.M.D, showed a significant decrease of 61. 3 percent (one case showed T wave inversion) and the others showed. conversely a significant increase of 271 percent. 6) Regarding change of interval, the QRS interval showed no changes and P-R and Q-T intervals showed shortening of 14, 7% and 2.4%. 7) We consider that devices for heart sound, pulse or blood pressure monitoring should be: combined with ECG monitoring.

The Effects of Propanidid-Ketamine Anesthesia on Cardiovascular and Respiratory Systems of Rabbits / 대한마취과학회지

There is a definite need for safe and potent intravenously administered anesthetics of .short duration which combine analgesic and sleep-producing effects without significant cardiovascular and respiratory depression. There are many intravenous drugs to choose from and there have been many types of balanced anesthesia, but no one is satisfactory yet. This experimental study was carried out to seek the possibility of some improved features of cardiovascular and respiratory systems, with the combination of propanidid and ketamine, using rabbits as experimental animals. The following results were obtained. 1) Propanidid is freely miscible with ketamine without significant change of pH, colour or any sediment, so it seems that the effects of both drugs may be preserved well. 2) The propanidid-ketamine mixture group shows that ketamine compensates for the depressive effect of propanidid on blood pressure and pulse rate. 3) The propanidid-ketamine mixture group shows that ketamine compensates for the respiratory depression of propanidid to some extent and propanidid alleviates increased muscle tone by ketamine. Taking together the present results, ketamine compensates well the for depressive effects of propanidid on the cardiovascular and respiratory systems. Thus propanidid-ketamine mixture seems to be a suitable anesthetic.

Analysis of Interdepartmental Consultation (2) / 대한마취과학회지

This is an analysis of 75 cases of written interdepartmental consultations submitted to our department during January 1973 to December 1973. In all, 67 cases were surgical, 8 cases were non-surgical and, of which, 66 cases were for elective cases and 6 cases were for emergency cases, including 5 non-operative cases, and post-operative consultations were 3 cases. Among the 67 surgical cases, 4 cases of surgery were postponed according to our advice. The analysis was as follows; 1 Age; 58.6% were over 40 years old, which included 25.3% over 60 pears old. 2. Sex; male was 49.3% and female was 50.7%. 3. The consultation rate was 2.9% (consultation cases 75; total operation cases 2583). The number of monthly consultations was 7 cases on average. 4. The highest number of departmental consulations were requested from general surgery (42.7%), then from orthopedic department (30.7%), from internal medicine (8.0%), and from eye department (8.0%) respectively. 5. In pre-operative diagnosis of the consultations, around 45 diseases were encountered. 6. The problems of the consultations were varied in 153 subjects; 30.1% of the consulted problems were cardiovascular origins, including hypertension (8.5%), severe anemia (7.1%), and ECG abnormalities (5.9%). 23.5% of the consulted problems were respiratory dysfunction and 21.6% of the problems were endocrinological and metabolic disorders. 7. 3.9% of the problems were therapeutic pain control and/or block. Pain clinics were recently started in our country, in this regards, a joint clinic staff may help to operate the pain clinic efficiently. 8. There were 67 pre-operative surgical consultations (95.5%) and 3 post-operative consulations (4.5%). 9. Through this study, anesthesiologists are requested to have a much broad medical and surgical knowledge to keep their high standard of the speciality.