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Objective. Using Doppler Ultrasound to observe nutrient artery waveform change in uterine fibroids and focal adenomyosis before and after oxytocin, thereby assessing the response of non-pregnant uterus to oxytocin. Methods. 30 patients (mean age 39.77 ± 4.34 years) with uterine fibroids and 15 patients (mean age 36.27 ± 4.54 years) with focal adenomyosis were observed when ready for HIFU ablation. The nutrient artery waveform with Doppler US was observed for 30 minutes and compared before and after intravenous oxytocin (0.04u/min). Results. After oxytocin, abnormal waveforms were seen in 24 uterine fibroids patients(80%),as well as in 10 focal adenomyosis patients(66.7%), including monophasic-wedged, monophasic-domed, biphasic-wedged, or tropical fish. The difference was no statistically significant between uterine fibroids and focal adenomyosis (p>0.05). Waveform change could be categorized into two types, i.e., bizarre waveform which included persistent change (19/30,6/10) and alternative change (5/30,4/10), and normal waveform which included velocity change (6/30,5/15) and no change (0/30,0/15). There was no significant difference in the waveform change between subserosal fibroids and intramural fibroids (p>0.05). We did not observe any waveform change in uterine arcuate artery and bilateral uterine artery. Conclusions. Doppler US waveform change of uterine nutrient artery was useful in evaluating the response to oxytocin in non-pregnant uterus. Oxytocin could cause myometrium contraction, resulting in nutrient artery stenosis or spasm. There was no significant difference in the waveform change between subserosal fibroids and intramural fibroids, or between fibroids and focal adenomyosis, however, uterus responded quite individually to oxytocin.

Since the end of the last century a large number of surgical techniques for limb lengthening have been proposed but none has successfully solved the complex problems associated with limb segment elongation. Optimization of the biological and mechanical conditions necessary to ensure a successful outcome requires the following: (1) minimal surgical trauma to both soft tissues and bone; (2) preservation of bone-forming tissues and their blood supply; (3) rigid fixation of the osteotomized fragments; (4) the proper rate and rhythm of distraction; (5) preservation of the locomotor function of the limb during lengthening.

In the data presented in the foregoing chapters, we have demonstrated that osteogenesis during fracture healing and regenerate formation depends upon the degree of preservation of the osteogenic elements of the bone marrow and upon the integrity of the nutrient artery and its branches. Considering the bone-forming potential of bone marrow, we thought it worthwhile to investigate the relationship between the marrow’s osteogenic potential and its hematopoietic activity. Active osteogenesis is replaced by active hematopoiesis as the function of the marrow becomes normal during the remodeling phase of new bone formation.

The nature of the extravascular extracellular space in bone may play an important role in the control of mass transport in bone. Do the cells lining bone surfaces control the fluid environment adjacent to bone surfaces so that its composition is different to perivascular fluid? This question has been discussed for some years, but experimental evidence has not been conclusive. Neuman published a series of papers concerned with blood-bone disequilibrium or blood-bone equilibrium (Neuman 1982; Neuman et al. 1979), and Talmage (1977) has also proposed disequilibrium between blood and bone. To investigate this problem, we have used techniques already used in the study of trans-capillary exchange to investigate whether transport of ions from the perivascular bone fluid can be controlled by cells lining bone surfaces.

Microsurgery opened a completely new field in bone transplantation with the free vascularized bone transfer. Oestrup and Fredrickson (1974) stressed that successful transplantation of bone is dependent on both the endosteal blood supply, i.e., the nutrient blood supply, and the periosteal blood supply. Using microsurgical techniques both blood supplies can be reestablished by anastomosing the donor vessels, artery and vein, to the recipient vessels (Berggren et al. 1982). After restoration of the blood supply the bony segment should be as well vascularized as a living bone, and therefore incorporation of the bone graft should be similar to fracture healing. Non-vascularized bone grafts will undergo complete remodeling until the periosteal and endosteal blood supply is reestablished. However, it is questionable whether, for example in free iliac crest grafts, the endosteal blood supply remains as effective as it was in the original site, since the medulla is no longer supplied by the original nutrient artery and vein.

The survival of a bone graft is a struggle, a race against impending death. It is generally accepted that the most peripheral cells of the graft are able to survive by diffusion if the recipient site is favourable and these cells exercise a conductor function. The success of all standard bone-grafting procedures is totally dependent on the slow revascularisation of the graft from the bone ends and the surrounding soft tissues, followed by slow resorption of the old bone within the existing framework and its subsequent replacement with new Haversian systems. Primary graft circulation is thought to be dependent either on the ingrowth of new vessels of host origin, i.e. revascularisation, or on anastomoses between host and pre-existing graft vessels, i.e. recirculation.