Advances in wrist arthroscopic surgery in Indonesia

Since the 1990s,new insights in wrist arthroscopy have led to the introduction of numerous treatment methods.Consequently,therapeutic procedures are no longer limited to resection as more specialized repair and functional reconstruc-tion methods,involving tissue replacement and essential structural augmentation,have been shown to be beneficial.This article discusses the most prevalent rea-sons and uses for wrist arthroscopy,with an emphasis on Indonesia’s most recent and major advances in reconstructive arthroscopic surgery.Joint debridement,synovectomy,ganglionectomy,capsular release,and osteotomies are frequent resection operations.Ligament repair and arthroscopy-aided reduction and fixation for fractures and nonunion are all examples of reconstructive surgery.

Effects of Sympathetic Denervation and Dexamethasone on Pial Microvascular Pressure in Acute Hypoxic Rabbits

To determine the effects of sympathetic denervation and dexamethasone on the individualcerebral vascular pressure profile during hypoxia, the authors measured the pial microvascular pres-sure in 24 anesthetized rabbits with a servo-null system. At a simulated altitude of 4000 meters, inthe intact group, the mean pressure in pial arterioles of 50-70 μm in diameter decreased markedly.The ratio of pressure drop between the upstream and downstream of the arteriole measured in-creased markedly, and the blood flow in the internal carotid artery was nearly doubled of the nor-mal. The pial arteriolar pressures of both the denervated and dexamethasone groups were significantlyhigher than that of the intact group, but were not different from their prehypoxic values. The ratioof pressure drop between the upstream and downstream of the denervated and dexamethasonegroups remained unchanged, and much lower than that of the intact group, These results lead tothe following conclusions: (1) Sympathetic nerves and dexamethasone exert no effect on thelongitudinal distribution of cerebro-vascular pressure in rabbits during normoxia, normocapnia andnormotension.(2) During hypoxia, pressure drop increases in the upstream arteries and/or decreasesin the downstream vessels of the microvascular pressure measured site (arterioles 50- 70 μm in diame-ter) partly due to the activation of the sympathetic nerve. (3) Dexamethasone can prevent theredistribution of cerebrovascular pressure induced by hypoxia, which can partly explained the ac-tion of dexamethasone in preventing high altitude sickness.

Role of the Peripheral Sympathetic Innervations in Controlling Cerebral Blood Flow after the Transection of Bilateral Superior Cervical Sympathetic Ganglia Two Weeks Later

Background: Cerebral blood vessels are mainly supplied by sympathetic nerves arising from the superior cervical ganglia and cerebral blood volume may be influenced by bilateral superior cervical ganglionectomy (SCG). Various stages of cerebral blood volume changes depended on the time following bilateral excision of SCG. In this study, we emphasize the subacute effect (two weeks) on the local cerebral blood flow (LCBF). Material and Methods: Sprague-Dawley rats weighing 250 ~ 400 gm (n = 20) were selected into two groups. Under the ambient temperature 20oC, the first group animals (n = 10) received sham operation and the other group animals (n = 10) underwent bilateral SCG. The LCBF and O2 delivery of 14 brain struc-tures were measured for each animal by the use of 14C-iodoantipyrine technique two weeks after the opera-tion. Results: The average of LCBF was decreased from 150 ml/100 gm/min to 129 ml/100 gm/min after bi-lateral SCG. Only the LCBF at basal ganglia was increased from 108 ml/min/100 g in the sham-operated group to 118 ml/min/100g in the SCG group. A mean of 14% reduction of LCBF was estimated. In 14 brain structures, the delivery amount of O2 was all decreased, except in basal ganglia. However, these changes of LCBF and the delivery amount of O2 at these 14 brain structures did not reach the significant differences. Conclusions: The present results show that chronic effect (two weeks) of bilateral SCG on LCBF was not only in a decrease of the LCBF, but also a decrease of local cerebral O2 delivery. However, the changes didn’t show the significant differences.