Utility of orcein stain and comparison with Masson trichrome stain in chronic intestinal pseudo-obstruction

Chronic intestinal pseudo-obstruction (CIPO) is caused by a plethora of primary and secondary causes, dominantly involving the neuromuscular tissue, interstitial cells of Cajal, or the connective tissue framework. The lack of the connective tissue framework, known as desmosis, is evaluated by Masson's trichrome (MT) or picrosirius red stains, both of which are recommended in the London classification. We evaluated the orcein stain in detecting desmosis in comparison to the MT stain. We performed both orcein and MT stains in six previously published cases of complete or partial desmosis along with six age-matched controls. Our results showed comparable results of the orcein stain as compared to the MT stain. Additional advantages of lower cost and a clearer background in orcein stain were noteworthy, whereas MT stain can be used for the detection of additional pathology. We believe that orcein stain can be used as a cheap alternative in resource-limited settings.

Triple transferencia tendinosa en la parálisis radial alta. A propósito de un caso / Triple tendinous transference in high radial paralysis. Apropos of a case

RESUMEN La parálisis del nervio radial producida por lesiones a nivel del brazo es considerada una parálisis alta, y se caracteriza por presentar la muñeca y los dedos flexionados y el pulgar en aducción con imposibilidad para la extensión de los mismos (muñeca y dedos). Todos los autores coinciden en que, para la extensión de la muñeca, el músculo de elección a transferir es el pronador redondo para el segundo radial. Sin embargo, hay diversidad de criterios sobre la utilización del palmar mayor o del cubital anterior para el extensor común de los dedos, y del palmar menor para el extensor largo del pulgar. Se presentó el caso de un paciente de 31 años de edad, con antecedente de accidente de tránsito y diagnóstico de parálisis radial alta de 18 meses de evolución, en el que se decide tratamiento quirúrgico utilizando el músculo cubital anterior después de una rehabilitación exitosa, obteniéndose excelentes resultados (AU).

ABSTRACT The radial nerve paralysis produced by lesions at the level of the arm is considered a high paralysis, and is characterized by presenting the wrist and fingers flexed and the thumb in adduction with impossibility of extending them (wrist and fingers). All consulted authors agree that, for wrist extension, the elective muscle to transfer is the round pronator for the second radial. However, there are different criteria on the use of the palmar major or anterior ulnar for the common finger extender, and the palmar minor for the long thumb extender. We presented the case of a 31-year-old patient, with a history of traffic accident and diagnosis of 18-month high radial paralysis, in which surgical treatment using the anterior ulnar muscle after a successful rehabilitation was decided, obtaining excellent results (AU).

Tumor de células gigantes de la vaina con infiltración tendinosa / Giant cell tumor of the sheath with tendinous infiltration

Se describe el caso clínico de una paciente de 58 años de edad, quien acudió a la consulta de Ortopedia y Traumatología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba porque hacía alrededor de 5 años comenzó a notar aumento progresivo de volumen en el dorso de la mano izquierda, cercano a la articulación metacarpofalángica del tercer dedo, que le dificultaba la extensión y resultaba antiestético. Mediante la ecografía se observó una imagen ecogénica, bien delimitada, que infiltraba el espesor del tendón, por lo que se realizó la exéresis del tumor. Se comprobó la infiltración de dicho tendón, el cual se resecó y se sustituyó con autoinjerto del tendón accesorio que envía el tendón del dedo anular. Los resultados de los estudios histológicos informaron que se trataba de un tumor de células gigantes de la vaina con infiltración tendinosa. Se inmovilizó durante 3 semanas y la recuperación funcional se completó a los 45 días.

The case report of a 58 years patient is described. She went to the Orthopedics and Traumatology Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba because she began to notice progressive increase of volume in the back of the left hand around 5 years ago, near the metacarpusphalangic articulation of the third finger that made its extension difficult and was unsightly. By means of the scan, a well defined echogenic image that infiltrated the thickness of the tendon was observed, reason why the exeresis of the tumor was carried out. The infiltration of this tendon was confirmed, which was dried up and substituted with self-graft of the accessory tendon that sends the ring finger tendon. The results of the histologic studies reported that it was a giant cell tumor of the sheath with tendinous infiltration. The hand was immobilized during 3 weeks and the functional recovery was completed at 45 days.

Study On Tendinous Connections Between Flexor Hallucis Longus And Flexor Digitorum Longus

Introduction: Flexor Hallucis Longus (FHL) and Flexor Digitorum Longus (FDL) are long flexors of the toes, oftenwith the interconnecting tendinous slips at various points. These interconnecting slips hold great significance inreconstruction surgeries of ankle and foot such as chronic Achilles tendon rupture, posterior tibial tendondysfunction (PTTD) and peroneal tendon rupture. In view of the above this study was aimed to find out varioustypes of connections between tendons of FHL & FDL.Materials and methods: This cross sectional study was carried out in the Department of Anatomy ACSR GovernmentMedical College, Nellore, conducted in a total of 34 lower limbs. Flexor digitorum brevis and abductor hallucismuscles were reflected distally after the removal of the skin, superficial fascia and plantar aponeurosis toexpose FHL and FDL tendons which were examined for the interconnections. Specimens with interconnectionswere photographed and documented.Result: Out of 34 samples, 17 were right sided and 17 were of left sided. Mean foot length was 22.4 ± 1.9 cm. Threetypes of connections i.e. type 1, 4 & 5 were documented at 17 (50%), 16 (47.1%) and 1 (2.9%) type 5 respectively.Type 1 tendinous connections were further classified into 3 sub types i.e. type 1A were 10 (58.8%), type 1B were5(29.4%) and type C were of 2(11.8%).Conclusion: This study finds maximum distribution of type1 interconnections followed by type 4 and sub type 1Aamong type 1. This study also reports for the first time a common origin of 1st lumbrical from distal part oftendinous slip as well as from 1st digital slip of FDL. These interconnections provide stable base and enhancedpropulsion by toes and also act as natural tenodesis

The Tendinous Slip of the Flexor Digitorum Longus for the Great Toe: An Anatomic Variation / 체질인류학회지

This report describes a variation of the tendinous slip of the flexor digitorum longus (FDL) for the great toe. In addition, compositions of the long flexor tendons for all five toes were examined. The tendons of the FDL in the foot were investigated in 66 specimens of embalmed Korean adult cadavers. The tendons of the flexor hallucis longus (FHL) and the FDL with the lumbrical muscles were cut at the calcaneus and the metatarsophalangeal joints and were removed en bloc specifically to observe the FDL and the FHL tendons of the great toe. The tendinous slip of the FDL for the great toe was found bilaterally in the foot of a 52-year-old male. Its prevalence was two of 66 specimens (3.0%). The tendinous slip of the FDL for the great toe passed forward the great toe, and it constituted the superficial portion of the long flexor tendon for the great toe. The tendon of the FHL passed forward to constitute the deep portion of the long flexor tendon for the great toe. Thus, both the tendinous slip of the FDL and the tendon of the FHL composed the long flexor tendon for the great toe. The tendinous slip of the FDL and the tendon of the FHL for the great toe were similar in thickness; thus, each tendinous slip of the FDL and the tendon of the FHL were approximately one-half of the long flexor tendon for the great toe in thickness. The present study demonstrated an anatomical variation of the interconnection between the FHL and the FDL tendons, which will be useful for various surgeries and biomechanical research.

Lesión postraumática de la válvula tricúspide / Post-traumatic injury of tricuspid valve

Resumen Se presenta el caso de un adulto con insuficiencia de la válvula tricúspide de origen traumático, debido a ruptura del músculo papilar de la valva anterior en relación a trauma de tórax cerrado, se realizó el diagnóstico mediante ecocardiografía transesofágica. La válvula se reemplazó mediante bioprótesis con resultados clínicos favorables. Este caso enfatiza la necesidad de una alta sospecha de lesión valvular por parte del clínico en los pacientes con trauma torácico cerrado. (Acta Med Colomb 2016; 41: 202-205).

Abstract The case of an adult with traumatic tricuspid valve insufficiency due to papillary muscle rupture of the anterior leaflet in relation to closed chest trauma is presented. Diagnosis was made by trans-esophageal echocardiography. The valve was replaceded by bioprosthesis with favorable clinical outcome. This case emphasizes the need for a high suspicion of valvular lesion by the clinician in patients with blunt chest trauma. (Acta Med Colomb 2016; 41: 202-205).

Sinovitis vellonodular en el dorso del pie / Villonodular synovitis in the dorsal side of the foot

Se describe el caso de un paciente de 75 años de edad atendido en la consulta de traumatología del Centro de Diagnóstico Integral con quirófano "Calilo García" en el Estado de Apure, de la República Bolivariana de Venezuela, quien desde hacía 3 años aproximadamente había sufrido un traumatismo en el dorso del pie izquierdo, por lo cual presentaba aumento de volumen, de crecimiento relativamente lento, adherido a planos profundos, no doloroso a la palpación profunda. Los estudios radiográficos del pie resultaron normales y en la ecografía de partes blandas se visualizaron imágenes de bordes mal definidos con celularidad en su interior. Se realizó la exéresis del tumor y los resultados de la biopsia confirmaron que se trataba de una sinovitis vellonodular. La evolución fue satisfactoria y el paciente se reincorporó a sus actividades habituales.

The case of a 75 years patient assisted in the Traumatology Department of "Calilo García" Center of Comprehensive Diagnosis with operating room in Apure state, Bolivarian Republic of Venezuela is described who, for 3 years approximately had suffered a traumatism in the dosal size of the left foot, reason why he presented an increase of volume, of relatively slow growth, adhered to deep planes, not painful at deep palpation. The radiographic studies of the foot were normal and in the echography of soft parts, images of not well defined borders were visualized with cellularity inside. The exeresis of the tumor was carried out and the results of the biopsy confirmed that it was a villonodular synovitis. The clinical course was satisfactory and the patient returned to his habitual activities.

Anatomical Variation of Palmaris Longus: Tendinous Origin and Fleshy Insertion.

A tendinous origin and fleshy insertion of palmaris longus muscle was observed in the left forearm during routine dissection which was performed on adult male cadaver in the department of Anatomy, Dr. Rajendra Prasad Government Medical College. It was having long tendinous origin from the medial epicondyle of the humerus and the surrounding deep fascia. It was fusiform at the lower middle of the forearm. The fleshy muscular insertion was noted to the flexor retinaculum and few muscular fibers interdigitate with flexor carpi ulnaris muscle and palmar aponeurosis. The length of tendon was 19 inches and fleshy muscular length was 11inches. Themedian nerve and ulnar nervewas covered by this fleshy insertion. This palmaris longus variation is helpful for the surgeon and the radiologist, orthopaedic, plastic surgeon during any diagnosis of the forearm because this fleshy part of muscle can compress the median nerve and ulnar nerve or it can be mistaken as a tumor or ganglion during radiological or clinical examination.

Typification the tendinous cords of the left valve complex of sheep hearts

Forty Santa Ines sheep (Ovis aries Lin.) hearts were examined with the purpose of studying the present types of chordae  tendineae in the left valve complex. The study was performed at the State University of North Fluminense Darcy Ribeiro, Morphology sector of the Agricultural Science Animal Health Center Laboratory. Hearts were initially kept in 10% formalin solution and later dissected to undergo removal and plannifcation of left atrioventricular complex. With the removal of the left atrioventricular complex began the observation and characterization of the cord. After the analysis we observed the presence of eight types of cuspidal chordae tendineae present in the left valve complex, they were classifed as type I, II, III, IV, V, VI, VII and commissural kind.

La ultrasonografía en el estudio de rodilla dolorosa / Ultrasonography in the study of painful knee

La presencia de dolor y/o tumefacción a nivel de la rodilla es un motivo de consulta frecuente, ya sea en pacientes con enfermedad reumatológica definida o en la población general. Si bien la rodilla es una región accesible para el examen clínico, la ultrasonografía se ha convertido en una herramienta de gran ayuda para el reumatólogo al momento de definir el origen del dolor y/o la tumefacción, ya que permite detectar inclusive mínimas alteraciones morfoestructurales a nivel de las distintas estructuras anatómicas de la rodilla. En la práctica clínica es importante destacar la importancia de la ultrasonografía para la detección de sinovitis y entesopatía subclínicas en las artropatías inflamatorias, así como para demostrar cambios mínimos sugestivos de artropatía degenerativa y microcristalina. Por otra parte, esta técnica es de suma utilidad en la determinación del origen de los distintos síndromes regionales dolorosos y es una herramienta eficaz como guía para el intervencionismo diagnóstico y/o terapéutico. La ultrasonografía cuenta con muchas ventajas, tales como la inocuidad, el bajo costo operativo y la posibilidad de estudiar múltiples regiones en tiempo real y dinámico; sin embargo, en la actualidad, la larga curva de aprendizaje quizás sea una de sus mayores limitaciones.

The presence of knee pain and/or swelling is an important reason of attendance in rheumatologic daily practice. Although knee is an accessible region to be evaluated by the physical examination ultrasonography has been converted in an excellent and helping tool for the rheumatologists in order to establish the origin of the knee pain and/or swelling. Ultrasonography has the ability to detect subclinical synovitis and enthesopathy in patients with inflammatory arthritis and to demonstrate minimal changes indicative of degenerative or mycrocristaline arthropathies. Moreover, ultrasonography can be useful to determinate the cause of the different pain regional syndromes and is a very good option to be used as guide for the interventional arthrocentesis. Ultrasonography has several advantages as safety, low cost and the capability to study many joints in a realtime. However, at the present the large learning curve might be one of the main limitations.

Efecto del plasma rico en plaquetas en la resistencia de un injerto tendíneo, en túnel óseo en modelo en animal / Effect of platelet-rich plasma in relation to mechanical strength of intra-tunel integration of tendon graft in animals

Introduction: Bone-tendon interface is one of the places for early failure in the ligament reconstruction surgery. In that way, osteintegration should be favored. Growth factors have been proposed to enhance tendon healing and tissue regeneration. Objective: To assess the effect of Platelet-Rich Plasma (PRP) in relation to the mechanical strength of intra-tunel integration of flexor tendon in a rabbit model. Methods: Experimental and control trial in animal model. Nine skeletally mature, New Zeland rabbits were used for this study (18 knees) performing a proximal tibia bone tunnel in one knee in which a flexor tendon graft was introduced, applying a dose of PRP in the bone tunnel. The other knee was used as control. Rabbits were sacrificed in three groups of three at de 2nd, 4th and 8th week. Biomechanical evaluation was performed, recording the force to achieve graft failure. Data analysis was done using Mann Whitney test. Results: The resistance obtained in the PRP group vs control group at 2nd week was 7.4 N vs 6.6 N (p = 0.51), at 4th week was 16 N vs 13.5 N (p = 0.27) and at 8th week was 21N vs 13.2 N (p = 0.51). Conclusion: Administration of local PRP in bone tunnels does not significantly modify mechanical strength of the graft in bone tunnel compared with controls.

Introducción: La interface tendón-hueso es uno de los sitios de falla precoz de la reconstrucción ligamentosa. Se han buscado distintas formas de aumentar la osteointegración del injerto. Existen estudios demostrando algún grado de utilidad del plasma rico en plaquetas (PRP) en relación a la cicatrización y regeneración de tejidos. Objetivo: Evaluar el efecto del plasma rico en plaquetas en la resistencia de la cicatrización intraósea de tendón flexor en un modelo de reconstrucción ligamentosa en conejos. Material y Método: Estudio experimental, controlado, en modelo animal. Nueve conejos de raza albina New Zeland, esqueléticamente maduros. Se estudiaron 9 conejos (18 rodillas), realizando un túnel óseo tibial proximal en una rodilla, donde se introdujo injerto de tendón flexor, administrándose una dosis autóloga de PRP en el túnel óseo. La otra rodilla se utilizó como control, los conejos se sacrificaron en grupos de 3 a la 2ª, 4ª y 8ª semana. Realizamos evaluación biomecánica, registrándose la fuerza necesaria para conseguir la falla del injerto. El análisis de datos se realizó mediante Test de Mann Whitney. Resultados: La resistencia obtenida en el grupo con PRP vs grupo control a la 2da semana fue 7,4 N vs 6,6 N (p = 0,51), a la 4ta semana fue 16 N vs 13,5 N (p = 0,27) y a la 8va semana fue 21 N vs 13,2 N (p = 0,51). Conclusiones: La administración local de PRP en los túneles óseos, no modifica en forma significativa la resistencia del injerto en el túnel óseo comparado con grupo control. Nivel de evidencia: II (ensayo clínico controlado no aleatorio).

Lesiones tendinosas del tobillo en resonancia magnética: análisis retrospectivo en 548 estudios / Tendinous lesions of the ankle in MRI: retrospective review in 548 exams

Objetivo: Determinar la prevalencia de las diversas lesiones tendinosas del tobillo y sus características iconográficas típicas en los pacientes sometidos a Resonancia Magnética (RM). Material y métodos: Se efectuó un análisis descriptivo, retrospectivo y de corte transversal, de 548 estudios de RM de tobillo durante un período de 18 meses (entre enero de 2006 y junio de 2007), que contabiliza el total de los exámenes obtenidos en resonadores de campo cerrado en Diagnóstico por Imágenes Adrogué y en las sedes Hospital Fiorito de Avellaneda y Fundación Científica del Sur. Resultados: Del total de exámenes (n=548), el 40.3% fueron realizados a pacientes de sexo femenino (n=221) y el 59.7% a pacientes de sexo masculino (n=327), con una edad promedio de 47.6 ± 17 años. El 60.5% de los estudios (n=331) no reveló alteraciones en ningún grupo tendinoso del tobillo, mientras que el 39.5% (n=217) demostró la presencia de algún tipo de patología tendinosa. Asimismo, 64 estudios (11.7%) revelaron alteraciones en el tendón tibial posterior; 47 (8.6%) en el tendón de Aquiles; 34 (6.2%) en el tendón peroneo lateral corto; 27 (4.9%) a nivel del tendón del flexor propio del hallux; 26 (4.7%) en el tendón peroneo lateral largo; 10 (1.8%) en el tendón flexor común de los dedos; 6 (1.1%) en el tendón tibial anterior; y 3 (0.5%) en el tendón extensor común de los dedos. Conclusiones: La RM constituye una excelente herramienta en la valoración de las diversas patologías tendinosas debido a su capacidad multiplanar y a su alto contraste tisular.

Purpose: To determine the prevalence of several tendinous lesions of the ankle, and the MR imaging features that characterize these lesions. Materials and methods: MR images in 548 exams of ankle were retrospectively reviewed. These studies were performed during a 18-months period of time in 3 MR scanners at Hospital Fiorito (Avellaneda), Diagnóstico por Imágenes Adrogué, and Fundación Científica del Sur Avellaneda. Results: The ankle MR images (n=548) were taken from 221 women, and 327 men; median age, 47.6 years. In 60.5% studies (n=331), no pathologic images were identified. Sixty four exams (11.7%) showed some kind of tendon injury in the tibialis posterior tendon, 47 (8.6%) in the Achilles tendon, 34 (6.2%) in the peroneus brevis tendon, 27 (4.9%) in the flexor hallucis longus tendon, and 26 (4.7%) in the peroneus longus tendon. Additional findings included lesions in the flexor digitorum longus tendons (n=10), in the tibialis anterior tendon (n=6), and in the extensor digitorum longus tendons (n=3). Conclusions: The high-quality soft-tissue contrast resolution, noninvasive nature, and multiplanar capabilities of the MR images make it an excellent tool for the detection and evaluation of a variety of tendon disorders in the ankle.

Cobertura fasciocutánea en trauma de mano con colgajo inguinal: presentación de un caso: Hospital Luís Vernaza, Guayaquil / Fasciocutaneous coating in hand injury with inguinal flan, case presentation: Luis Vernaza Hospital of Guayaquil

Las quemaduras son injurias frecuentes que ocasiona gran número de secuelas. La mayoría de los individuos que las padecen, no sólo se quejan de problemas físicos sino también psicológicos. La verdadera reconstrucción de la mano comienza con los procedimientos quirúrgicos que proporcionan una cubierta adecuada de piel y tejidos blandos. Históricamente los colgajos a distancia fue el primero utilizado en caso de grandes pérdidas de sustancia de la mano (colgajo abdominal, colgajo braquial e infraclavicular)3. La segunda generación de estos colgajos a distancia está representada por aquellos con pedículo axial. Shaw y Payne en 1946 describió el colgajo abdominal vascularizado por la arteria epigástrica superficial. Finalmente, McGregor y Jackson propusieron en 1972 un colgajo inguinal vascularizado por la arteria ilíaca superficial, siendo el único consagrado por el uso, no solo utilizándose como colgajo pediculado, sino como colgajo libre para los problemas de la cabeza, cuello, tronco y extremidades14,17. Al realizar un tratamiento inmediato y de mantenimiento oportuno, se disminuye de forma notable el número de problemas posteriores. Sin embargo, en la actualidad aún continúa apareciendo deformidades debido a un incorrecto tratamiento durante la fase inicial. El presente trabajo reporta el caso de un paciente de 43 años con antecedente de trauma de mano por quemadura eléctrica en región palmar derecha y exposición tendinosa más lesión de tendones flexores superficiales y profundos de 2do. 4to. y 5to. dedos.

Burns are common injuries that cause numerous after-effects. Most people suffering them complains not only of physical problems but also of psychological ones. The real rebuilding of the hand starts with the surgical procedures that supply an appropriate coating of skin and soft tissues. Historically, the remote flaps were the first used in case of large substance loss in the hand (abdominal flap, brachial flap, and infraclavicular flap). The second generation of these remote flaps is represented by those with axial pedicle. Shawn and Payne in 1946 described the inguinal flap irrigated by the superficial epigastric artery. Finally, McGregor and Jackson suggested in 1972 an inguinal flap irrigated by the superficial iliac artery and it is the only one confirmed by use, not only using it as a pediculate flap, but as a free flap for injuries in head, neck, trunk and limbs. Giving immediate treatment and timely maintenance the number of further problems is reduced in a noticeable way. Nevertheless, currently, deformities are still showing up because wrong treatments in initial stage. This paper reports the case of a 43 years old patient with a hand injury history by electric shock in the right palm and tendon exposure plus injury in his superficial an deep flex tendons of 2nd, 4th, and 5th fingers.

Analysis of clinical manifestation,misdiagnosis and prognosis in patients with tendious sheath tubercular / 中国矫形外科杂志

[Objective]To analysis the clinical manifestation and treatment of tendious sheath tubercular,probe the influencing factor of misdiagnosis and effect of treatment,in order to offer evident base for diagnosis and treatment.[Method]The material of 86 cases(from January 1994 to Jun 2005)were reviewed and statistically analyzed including sex,age,nidus region,clinical manifestation,method and effect of treatment,etc.[Result]65% of the cases were 30~49 years old.Sexual difference was not significant.Nidus region in right side was apparently higher than that in left(67%:30%).Major manifestation was edema,tenderness and mal-motion.The misdiagnosis rate and recurrent rate were 88% and 1.2%.[Conclusion]Untypical clinical symptoms and sign,non-special laboratory examinations lead to misdiagnosis.The effective treatment includes integrity excision,local and general chemotherapy,which made recurrent rate low.

Anatomical study of the third palmar interosseous muscle and its dominate nerve / 中华显微外科杂志

Objective To explore the anatomical characteristic of the third palmar interosseous mus- cle as well its dominate nerve,and to investigate the anatomical basis of difficult recovery of digitus minimus adduction.Methods Twenty aduh fresh hands without deformity and trauma were obtained.Dissect and observe the third palmar interosseous muscle and its dominate nerve and adjacent structure under surgical mi- croseope,measure the size of the third pahnar interosseous muscle and its dominate nerve,the data were pro- cessed by stastistics method.Results Among palmar interosseous muscles and its dominate nerves,the third palmar interosseous muscle and its dominate nerve is the smallest.There are conspicuous tendon bundle on the surface of the third palmar interosseous muscle partly,which have a potential compression on the third palmar interosseous muscle dominting nerve.Conclusion The third palmar interosseous muscle is the smal- lest among palmar interusseous muscles and it is the only digitus minimus adduction muscle.The sominating nerve of the third palmar interosseous muscle is small anti the tendon bundle of the third palmar interosseous muscle have a potential compression.All these can cast light on diffcult recovery of digitus minimus adduction.

Anatomical Location of the Tendinous Intersections of the Rectus Abdominis Muscle in Korean Women

PURPOSE: The transverse rectus abdominis myocutaneous(TRAM) flap has become a reliable method for autogenous breast reconstruction. However, dissection of the tendinous intersections of rectus abdominis is technically difficult. The tendinous intersection has significant vascularity within its fascial layers raising in importance of technique in elevation. If tendinous intersections are damaged during the elevation of the rectus muscle, circulation to TRAM flap can be endangered. The purpose of this study is to evaluate the number of tendinous intersections and to predict anatomical position of the tendinous intersections. METHODS: We dissected 182 consecutive TRAM flaps and measured the distance between xiphoid process and each tendinous intersection and evaluated the statistic correlation among the distance, patient's height and position of umbilicus. RESULTS: In this study, in 30.7% of patients, two tendinous intersections were observed in one rectus abdominis muscle, in 67.7% three tendinous intersections, and in 1.6% four tendinous intersections, respectively. But there was no correlation between patient's height and the distance between xiphoid process and each tendinous intersection. CONCLUSION: It still remains difficult to predict the position of tendinous intersections just by topography before the dissection. Careful and meticulous dissection of the tendinous intersections is still required.

DYNAMIC BEHAVIOR OF SEMITENDINOSUS MUSCLE DURING ISOMETRIC KNEE FLEXIONS / 体力科学

The purpose of this study was to investigate semitendinosus muscle (ST) behavior during isometric knee flexions. Healthy male subjects were directed to exert ramp isometric knee flexion up to a maximum of eight knee flexion angles (0, 15, 30, 45, 60, 75, 90, 105 degrees). Displacement of the tendinous intersection (TI) in ST was measured using ultrasonographic images. TI moved proximally 15.8±4.9mm by maximum isometric contraction at 0 degrees, and the displacement of TI was significant at over 30% ramp maximum. Maximum knee flexion torque significantly correlated to displacement of TI at every knee angle, and decreased as the flexion angle increased. These results suggested that TI moved proximally in accordance with flexion torque, and demonstrated the unique behavior of ST, that is, the proximal part concentrically contracted, whereas the distal part eccentrically contracted.

In Vivo Effect of Intra-Tendinous Thermal Shrinkage on the Rabbit Patellar Tendon / 대한정형외과학회잡지

PURPOSE: In this vivo animal study, the authors evaluated the effect of thermal shrinkage on the rabbit patellar tendon using modified approaches involving intra-tendinous thermal treatment and protective immobilization. METHODS AND MEASURES: Of 30 New Zealand white rabbit patellar tendons, Twenty-five rabbits underwent tendon immobilization by fixation of the patella to the femur after thermal shrinkage of the right-side patellar tendon. Ten rabbits of those were sacrificed at 4 weeks and the other fifteen rabbits at 8 weeks. The left-side patellar tendon of twenty-five rabbits were underwent sham-control except thermal treatment. The rate of shrinkage and maximal peak stress and linear stiffness by unit area were assessed in these twenty-five rabbits. Differences between groups were statistically analyzed. Light and transmission electron microscopy examination were evaluated in all of thirty rabbits. RESULTS: The shrinkage rate immediately after thermal treatment did not change significantly at 4 and 8 weeks. The mean maximal tensile stress and linear stiffness at 8 weeks (372.30+/-164.37 N/m2 and 214.60+/-142.52 N/mm) were significantly higher than those measured at 4 weeks (233.84+/-91.12 N/m2 and 196.70+/-72.10 N/mm, respectively) allthough those were diminished when it compared with those of sham control group. Numerous collagen fibers with medium diameters and myofibroblasts indicative of a healing process were observed on histologic examination at 8 weeks. CONCLUSION: Intra-tendinous thermal shrinkage combined with a period of protective immobilization may be one of positive concern for prevention of re-stretching phenomenon as time goes by.

An Experimental Model of Chronic Nerve Compression in the Rat / 대한정형외과학회잡지

PURPOSE: The aim of this study was to develop a model for chronic nerve compression in a rat and a model reproducing a normal anatomical narrow portion that lies in the course of the peripheral nerve. MATERIALS AND METHODS: Male Sprague-Dawley rats were used. A 5 mm tendinous band was made from the patellar tendon harvested from each rat and placed around the sciatic nerve. In order to determine the degree of compression, a series of internal diameters of the band (0.2 mm smaller than (group I), same as (group II), and 0.2 mm (group III), 0.4 mm (group IV) and 0.6 mm greater (group V) than the diameter of sciatic nerve) were used. The rats were evaluated at 1, 2, 3, 4, and 6 months after banding using an electroneurophysiologic study, a pathohistologic study, and the morphometric nerve fiber analysis. RESULTS: In groups III and IV the morphometric findings showed statistically significant compressive changes in the periphery after 3 and 4 months, respectively and revealed significant changes in both the periphery and central portion at 6 months (p<0.05). In group V, the measurements and histologic findings were almost identical to the control group at 6 and 10 months. The nerve electrophysiologic study showed significant compressive changes at 6 months in groups III and IV (p<0.05). In the group V, the measurements were similar to those of the normal control. CONCLUSION: Groups III and IV appear to be a reliably reproducible chronic nerve compression model while excluding the possibility of foreign body reactions. In addition, group V appears to be a reliable model of a normal anatomical narrow portion that lies in the course of the peripheral nerve.