Nerve regeneration of vascularized rat limb allograft and functional recovery of long-term graft survivals treated by short course of FK 506 or cyclosporine.
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Animals↗
Biomedical subjects
Y Ikuta
Publications and source records attributed to Y Ikuta.
A case of steroid-induced osteonecrosis of femoral condyle treated surgically.
The clinical course and the established treatment for steroid-induced osteonecrosis of the femoral condyle have not been clarified yet, mainly because of the limited number of reports. Conservative treatment for steroid-induced osteonecrosis of the femoral condyle has been advocated, because the underlying disease tends to be serious and multiple joints are usually involved. Conservative treatment usually is continued until osteonecrosis becomes extensive and osteoarthritis has progressed enough to justify total knee arthroplasty. Reported here is a case of steroid-induced osteonecrosis of the lateral femoral condyle that, according to preliminary results, was treated successfully with a vascularized bone and periosteal graft.
Adolescent↗
[Bupivacaine-fentanyl continuous infusion is superior to morphine bolus injection in postoperative epidural analgesia].
We compared bolus injection of morphine 51 +/- 9 micrograms.kg-1 (M-S group) with 48 h-continuous infusion of bupivacaine and fentanyl mixture (BF-C group) for postoperative epidural analgesia in 100 patients who had undergone upper abdominal laparotomy. The epidural analgesia was started about 60 min before completion of surgery. The mixed solution, consisting of bupivacaine 48 ml (240 mg), fentanyl 24 ml (1.2 mg) and 0.9% saline (24 ml), was administered at a rate of 2 ml.h-1 by using a 100 ml balloon infuser. Analgesic effects (determined by visual analogue scale, verbal pain scores at rest and with movement, additional requests of other analgesics), comfort and side effects of the epidural analgesia were examined. The evaluation based on postoperative analgesia and comfortable feeling rated higher in the BF-C group compared with the M-S group (P < 0.01 to of 0.05). There were fewer requests for other postoperative analgesics in the BF-C group (P < 0.01 to 0.05). There was no significant difference in side effects between the two groups. The plasma fentanyl concentration in the BF-C group (n = 5) was maintained almost constant for the period from 24 to 49 hours after the start of infusion and was approximately 1.6 ng.ml-1. We conclude that continuous infusion of bupivacaine (2.5 mg.ml-1) and fentanyl (12.5 micrograms.ml-1) at a rate of 2 ml.h-1 is superior to bolus injection of morphine for postoperative analgesia.
Adolescent↗
[Preoperative plasmapheresis for lung cancer with multiple myeloma].
A 66-old-male admitted to our hospital was diagnosed multiple myeloma (IgA kappa type, Durie & Salmon stage IIIA) and squamous cell lung cancer (c-T2N0M0 stage I). The function of platelets was within a normal range (11.7 x 10(4)/mm3 and the bleeding time of two minutes), but the function of coagulation was reduced (prothrombin time, 13.1 seconds; activating prothrombin time, 45.1 seconds; and antithrombin III, 65%). The hyperviscosity syndrome was anticipated because of high IgA M protein (6,551 mg/dl). Plasmapheresis with 800 ml of fresh frozen plasma was performed before the left lower pulmonary lobectomy and R1 lymph node dissection. Then the function of coagulation was improved (prothrombin time, 12.6 seconds; activating prothrombin time, 31.3 seconds; and antithrombin III, 75%). IgA M protein was also decreased to 4,696 mg/dl. Postoperative bleeding necessitated a second thoracotomy. The cause of postoperative bleeding was the ablasion of the pleural adhesion due to tuberculous pleuritis as well as bleeding tendency of multiple myeloma. The plasmapheresis performed in this case did not fully improve the bleeding tendency. Cases of cancer complicated with multiple myeloma have been increasing and if an operation is needed, plasmapheresis should be considered. The indication and the extent of hematologic restoration to be achieved should be further investigated.
Aged↗
Flap reconstruction in the upper limb.
The introduction of the free flap and the regional fasciocutaneous flap has added to the methods of skin defect coverage in the upper limb and avoids the disadvantages of conventional flaps. This paper describes the features and indications of regional axial pattern flaps and free flaps for upper limb skin defects. They can be categorised into flaps in the ipsilateral upper limb and flaps from out of the upper limb. Flaps in the upper limb include the lateral arm flap, the radial forearm flap, the posterior interosseous artery flap, the dorsal metacarpal artery flap, and the digital artery flap. Flaps from out of the upper limb comprise the latissimus dorsi myocutaneous flap, the scapular flap, the groin flap and the hemipulp flap. Criteria for flap selection include the patient's age and health, the condition of the skin defects, the location and size of the defects and damage of the deep structure, the patient's cosmetic demand, the surgeon's technical skill and the facilities in the operating room.
Amputation, Traumatic↗
Serum type III procollagen peptide, type IV collagen 7S domain, central triple-helix of type IV collagen and tissue inhibitor of metalloproteinases in patients with chronic viral liver disease: relationship to liver histology.
To assess the clinical value of serum biochemical markers, the aminoterminal peptide of type III procollagen, type IV collagen 7S domain, the central triple-helix of type IV collagen and tissue inhibitor of metalloproteinases, as a marker of hepatic fibrosis, we measured these four serum markers in 132 patients with chronic viral liver disease and compared these serum markers with liver histological findings. Serum levels of these markers increased closely with the progress of liver disease, and the abnormal percentages of type III procollagen peptide, type IV collagen 7S domain, central triple-helix of type IV collagen and tissue inhibitor of metalloproteinases in patients with cirrhosis were 97%, 95%, 83% and 48%, respectively. These four serum markers strongly correlated with the histological degree of periportal with or without bridging hepatocellular necrosis and of liver fibrosis and correlated weakly with the degree of intralobular degeneration and focal necrosis and the degree of portal inflammation. The correlation coefficients of serum type IV collagen 7S domain with periportal with or without bridging hepatocellular necrosis and with liver fibrosis were the highest among these four serum markers, suggesting that serum type IV collagen 7S domain is the most valuable diagnostic marker to assess the degree of liver fibrosis in chronic viral liver disease. When we assessed the ability of each serum marker to detect cirrhosis with a receiver operating curve, the best test was type IV collagen 7S domain, and the second best was type III procollagen peptide.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Experimental challenge for the treatment of Duchenne muscular dystrophy using a vascularized free muscle graft.
Following free vascularized normal muscle graft in mice, a study was made to determine whether dystrophin expression is possible in dystrophin-deficient muscles. In this study, dystrophic C57BL/10 ScSn-mdx mice were used as recipients and normal C57BL/10 ScSn mice as donors. A free vascularized quadriceps muscle 8.0 x 6.0 x 6.0 mm in size was orthotopically transplanted into a muscle defect produced in the recipient mouse. The diameter of the sutured vessels was about 0.4 mm. Transplantation was successful in 7 of 20 mice. At 12 weeks after the transplantation, the grafted muscle was examined by immunocytochemical stain using anti-dystrophin antibody. This study showed that dystrophin was expressed in the transplanted muscle but not in the adjacent recipient quadriceps muscle, suggesting that grafted donor cells with dystrophin failed to migrate into dystrophic muscle cells and fuse together. However, since the grafted normal skeletal muscle successfully survived and normal dystrophin was expressed in almost all the grafted muscle fibers, the possibility was suggested that the function of muscular dystrophy muscle can be compensated by complete replacement with a larger muscle.
Animals↗
Nerve regeneration in predegenerated basal lamina graft: the effect of duration of predegeneration on axonal extension.
We used predegenerated acellular grafts to bridge proximal and distal stumps of transected nerves and studied how the duration of predegeneration might affect axonal regeneration. Predegenerated acellular grafts were prepared by transecting the tibial nerve of donor rats and, after a period of degeneration, freeze-thawing a 40-mm long segment of the distal stump. Five degeneration periods were used: 0 days (for fresh grafts), 3 days, 1 week, 4 weeks, and 8 weeks. Fresh cellular grafts not treated with freeze-thawing were also used for comparison. Each graft was then transplanted to an isogeneic recipient rat, in which it was used to bridge the proximal stump of the transected left tibial nerve and the distal stump of the transected right tibial nerve. Six weeks were allowed for the regeneration of axons in all grafts. The regeneration was then assessed by studying transverse sections of the grafts, to determine the maximum length that the axons had regenerated, and the packing density of axons (percentage of sampled areas occupied by axons). The results show that axons had grown to the maximum length in the 4-week predegenerated grafts, and had the highest packing density in the 1-week predegenerated grafts. Regeneration in the fresh acellular (0-day predegenerated) and 8-week predegenerated grafts, especially the latter, was poor. We examine the results with reference to time-dependent events of Wallerian degeneration and propose that there are beneficial effects of multiple factors on the grafts during the first 4 weeks of predegeneration, causing a slow but significant improvement in their capability to support axonal growth. The subsequent rapid deterioration of such capability may be related to structural changes in the extracellular scaffold.
Animals↗
Optimal attachment site for reconstruction of the ulnar collateral ligament. A cadaver study.
To determine the isometric points for ulnar collateral ligament (UCL) reconstruction, we performed a kinematic study of 15 cadaver elbows. The margins of the anterior and posterior oblique ligaments of the UCL were measured. Five humeral and three ulnar attachment sites were also selected and grouped in pairs for measurement. The distances from the proximal center of the trochlea to three ulnar points were recorded. Measurements were obtained for pairs of attachment sites for flexion of 0 degree, 30 degrees, 60 degrees, 90 degrees, and 120 degrees. We found that the anterior margin of the anterior oblique ligament (AOL) tended to lengthen as flexion increased from 0 degree to 60 degrees, and to shorten as flexion exceeded 60 degrees. The posterior margin tended to lengthen with flexion up to 120 degrees. It therefore appears that the AOL consists of functionally different components that remain taut throughout flexion. In all experiments, the location of the humeral attachment site affected the lengths through 120 degrees of flexion. At flexion of 0 degree-120 degrees, isometricity was observed in the approximate center of the trochlea, apparently the optimal attachment site. We conclude that conventional ligament reconstruction methods that locate the attachment site in the AOL origin provide inadequately for the isometricity observed in the natural anatomy.
Adult↗
The diagnostic value of MRI in traumatic brachial plexus injury.
Findings in 34 patients with traumatic brachial plexus injury documented by surgical exploration and intra-operative somatosensory-evoked potentials were correlated with findings on myelography and magnetic resonance imaging (MRI) to determine whether MRI can identify nerve root avulsion. The coronal and sagittal planes were not able to demonstrate avulsion of the individual nerve roots. The axial and axial oblique planes did provide useful information to determine which nerve root was avulsed in the upper plexus, although it was difficult to clearly delineate the lower cervical rootlets. The accuracy of MRI was 73% for C5 and 64% for C6 and that of myelography 63% for C5 and 64% for C6. Thus, the diagnostic accuracy of MRI for upper nerve roots was slightly superior to myelography. Although its primary diagnostic value is limited to the upper nerve roots whose avulsion is relatively difficult to diagnose by myelography, MRI can provide useful guidance in the waiting period prior to surgical exploration after brachial plexus injury.
Adolescent↗
Ipsilateral osteochondral grafting for finger joint repair.
A method for reconstructing articular osteochondral defects of the joint surfaces of the fingers is described. An osteochondral graft was harvested from the distal or proximal side of the second or third carpometacarpal joint of the ipsilateral hand. The graft was subsequently transplanted to the site of the defect in the proximal or distal interphalangeal joint. Ten cases with a follow-up period of more than 2 years were reviewed. The mean angular deformity decreased from 33 degrees to 4 degrees, and the mean active range of motion increased from 22 degrees to 38 degrees. Plain x-ray films revealed good joint congruity, and no donor site morbidity was appreciated. This treatment approach may be particularly useful in children.
Adult↗
Meniscal repair enhanced by an interpositional free synovial autograft: an experimental study in rabbits.
This report describes the methods and effectiveness of interpositional free synovial autografts (IPFSAs) in promoting the healing of lesions in the avascular portion of the knee joint meniscus in rabbits. Thirty-four specimens were divided into two groups: 17 in the study group and 17 in the control group. The medial meniscus of the left knee joint was excised in each rabbit, and an artificial longitudinal tear was created in the avascular zone of the meniscus. In the study group, an IPFSA was sewn into the tear with a single horizontal suture. In the control group, the tear was repaired without synovium in the same manner. The menisci were then implanted into the right knee joint in the respective animals. At intervals the animals were killed, and the menisci were examined grossly and microscopically. Three menisci were eliminated because they had become attached to the synovial wall. In the study group, the lesion completely healed by 4 weeks, except for one. The menisci in the control group never completely healed, particularly at the deeper levels of the lesion. At 8-16 weeks, autolysis of the specimens made microscopic examination difficult and unreliable in both groups. Based on these results, it has been concluded that an IPFSA can promote the healing process in the avascular zone of a torn meniscus in rabbits and that systemic vascularity to the synovium or the meniscus is not essential for healing to occur.
Animals↗
The diagnostic value and limitation of magnetic resonance imaging on chondral lesions in the knee joint.
Chondral lesions of the knee joint, which have been detected via arthrotomy or arthroscopy, were examined prospectively and retrospectively through a review of previously obtained magnetic resonance images (MRIs). The study group was composed of 34 men and 29 women whose average age was 24.6 years. Of these 63 patients, there were 72 articular cartilage lesions in 65 knees. On retrospective analysis, the sensitivity of MRI, which was defined as a true positive reading for softening, fragmentation, erosion, and/or a full-thickness loss of cartilage, was 14.3%, 57.3%, 75.0%, and 100%, respectively. Although the sensitivity to early changes of chondral lesions was low, indicating the limitation of MRI at the present stage, it has been demonstrated that MRI can delineate intracartilaginous changes associated with softening and thickening of cartilage that cannot be detected even with arthroscopy. Therefore, it may be worthwhile to perform an MRI as well as arthroscopy to clarify the pathogenesis of internal derangement of the knee.
Adult↗
Brachial plexus palsy secondary to stress fracture of the first rib: case report.
An extremely rare case of brachial plexus palsy from a stress fracture of the first rib is reported. The palsy was caused by pressure exerted by excessive callus formation following nonunion. Conservative treatment was unsuccessful, but surgical decompression led to complete resolution of symptoms.
Adolescent↗
Arteriographic study of the arterial supply of the foot in one hundred cadaver feet.
The arterial supply of 100 human cadaver feet (87 cadavers) was investigated by stereoscopic arteriography and was compared phylogenetically to that of the macaque foot. The deep plantar arch was always well developed and complete, whereas the superficial plantar arch was usually slender and incomplete. The first proximal perforating artery arising from the dorsalis pedis artery formed the main component of the deep plantar arch in 82% of the feet. The second proximal perforating artery arising from the dorsal rete contributed to the deep plantar arch in 43% of the feet, and formed most of the arch in one foot. The dorsal rete was classified into four groups of variants based on the arterial source of the second dorsal metatarsal artery. These were the arcuate artery (25%), distal lateral tarsal artery (12%), proximal lateral tarsal artery (6%), and nondorsal rete (57%) variants. In the first intermetatarsal space, the dorsal and plantar metatarsal arteries shared a common trunk in 54% of the feet, but this did not occur in the other intermetatarsal spaces. The second dorsal metatarsal artery arose from the dorsal rete in 43% of the feet, and this artery was quite large, sometimes being the largest of all the dorsal and plantar metatarsal arteries. Variations of the arterial supply found in humans sometimes resembled the typical pattern found in the macaque.
Adult↗
Further experimental evidence of selective nerve regeneration in aortic Y-chambers.
To explain the discrepancy between Weiss and Taylor's results and our recent findings about axonal growth patterns in a fresh aortic chamber, we examined whether regenerating axons show preferential growth toward a nerve piece in an aortic Y-chamber. In our previous studies, we could not reproduce their results, which showed that regenerating nerve fibres from the proximal stump of a severed peripheral nerve grew randomly in the two channels with and without a nerve segment; our results showed preferential regeneration toward a nerve segment channel. In the present study, we retraced the steps of Weiss and Taylor using white rats, the longitudinal section of the specimen, and silver staining. Despite using the same methods we were still unable to show that the growth pattern was random, but we did find preferential axonal growth into the nerve segment channel of a fresh aortic Y-chamber. The evidence of selective nerve regeneration was unequivocal and we cannot support the findings of Weiss and Taylor reported in 1944.
Animals↗
Experimental studies of vascularized joint allografts in rats.
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Animals↗