Thyroid hormones have a direct or indirect effect upon longitudinal bone growth and maturation. Deficient levels of thyroid hormone during the growth period are reflected in the skeleton by reduced proliferaion and maturation of chondrocytes, slowed endochondral ossification and delayed epiphyseal closure, Murray (1977) reported symmetrical malformation from multiple centers of ossification within large epiphyses, especially those of the femoral and humeral heads, gives a false impression of fragmentation of these structures. Occasionally a coxa vara deformity may develop. The apparent fragmentation of the capital epiphyses, due in reality to multicentric ossification, might suggest bilateral Partbes diseas, but it would be excessively unusual to find aymmetrical and equal development of Perthes disease of each hip Even though this condition is bilateral in 10 per cent of the cases, the changes are almost always consecutive rather than concurrent, so that symmetrical involvement is highly unusal. Teplick (1976) has shown in the adult, hypothyroid bone abnormalities are less common, These include coxa vara with flattened femoral head. Monroe (1935) reported arthritic changes of the character of the osteoarthritis are common among patients developing myxedema during adult life, Thomas (1933) and Cushing (1937) reported that articular changes occur in about a third of the hypertrophic osteo-arthropathy cases and consist of a synovitis which may progress to actual erosion of the articular surface and analylosis. (continued...)
Adult ; Bone Development ; Cartilage, Articular ; Chondrocytes ; Congenital Abnormalities ; Coxa Vara ; Epiphyses ; Head ; Hip ; Humans ; Humeral Head ; Hypothyroidism ; Legg-Calve-Perthes Disease ; Myxedema ; Osteoarthritis ; Skeleton ; Synovitis ; Thyroid Gland ; Thyroid Hormones

It has been shown that by applying microsurgical techniques to ensure adequate circulation and innervation it is now feasible for free whole muscle grafts to be used as a restoring lost motor power that cannot be reconstructed by simpler means such as tendon transfer. The causes of lost motor power have been direct trauma to the foream, producing loss of musculature secondary to Volkmanns ischemic paralysis, electrical burns or peripheral nerve injury. However, the status of graft in this condition is not yet clear. The purpose of this investigation was to evaluate the morphology of microsurgically grafted muscle by light microscopic and electron microscopic studies and the function of the muscle by the application of electromyography. Sixteen mogrel dogs were divided into two groups. In group I the cranial part of the sartorius muscle was transferred heterotopically, and in group II the cranial part of the sartorius muscle was transferred orthotopically. The results were summerized as follows; 1. The successful rate of grafted muscles using microsurgical technique was 82%. 2. The transplanted muscles could return almost to normal histologically, histochemically and electromyographically. 3. The evidence of the functional recovery of the successfully transplanted muscle may point the way to clinical application of this procedure.
Animals ; Burns ; Dogs ; Electromyography ; Muscles ; Paralysis ; Peripheral Nerve Injuries ; Tendon Transfer ; Transplantation ; Transplants

The purpose of this investigation was to establish that epiphyses could survive and grow when preserving the endosteal and periosteal blood supply in free vascularized long bone including epiphysis grafts. These were compared to nonvascularized free bone transfers and normal controls. Sixteen mongrel puppies 4 months old, were used and were sacrificed 6 months later. Group I (Heterotopic radius transfers): On 8 puppies bilateral, heterotopic radius transfers were performed by exchanging the proximal 8 cm of the radius from one foreleg to the opposite one. In one foreleg the palmar interosseus artery and a concomitant vein were anastomosed to the recipient site vessels after bone fixation, while in the other one vessels were not anastomosed. Group II (Orthotopic radius transfers): On 8 animals in one foreleg, the proximal 8 cm of the radius was excised and replaced to the original site with vascular anastomoses. In opposite foreleg, radiopaque metal marker was inserted in the shaft Scm distal to the radial head for radiological investigation of growth which served as normal controls. All animals were followed with serial scanograms immediately, 2 weeks and 4 weeks postoperatively, and then monthly for 6 months after surgery. Brachial arteriograms were made 4 months after operation. Results: In Group I and II, X-ray showed solid bony unions at the osteotomy sites. In all 16 instances of vascularized bone grafts, the anastomosed vessels were patent on arteriograms performed 4 months postoperatively. The proximal radial epiphyses closed by 2 weeks to 1 month in nonvascularized heterotopic grafts. In vascularized heterotopic and orthotopic grafts, the proximal radial epiphyses closed at 5 months. In normal controls, the epiphyses closed at 6 months. In the vascularized heterotopic grafts, the longitudinal growth of grafted bones averaged 1.5 cm (12% increase to the initial entire radii). In the vascularized orthotopic grafts, the longitudinal growth averaged 1.6cm(13% increase). In the nonvascularized heterotopic grafts, the growth averaged 0.3cm(3% increase) and in the normal controls the growth averaged 2.4 cm (21 % increase). There were statistically significant differences in the final growth between the normal controls and the vascularized orthotopic grafts(p<0.025) or the vascularized heterotopic grafts(p<0.010), and between the nonvascularized grafts and the vascularized orthotopic grafts (p<0.005) or the vascularized heterotopic grafts (p<0.010). No significant differences were found between the vascularized orthotopic and heterotopic transfers (p>0.500). The growth in the vascularized grafts was 65% of normal radial growth.
Animals ; Arteries ; Epiphyses ; Head ; Osteotomy ; Radius ; Transplants ; Veins

Poliomyelitis was first described in medical literature in 1789 by Underwood, an English physician. In 1909, Landsteiner and Popper confirmed the etiology of the poliomyelitis from a virus. Thereafter with clinical application of Salk and Sabin vaccinations, and marked improvements in control of poliomyelitis, the incidence of this disease has markedly decreased in developed nations. In Korea, Miyoshi was the first to report an epidemic of poliomyelitis in Dae Goo in 1939. Statistical analysis is presented of 752 cases of the late effects of the poliomyelitis who were admitted to Orthopedic Department of the Severance Hospital during the ten year period from Jan. 1961 to Dec. 1971. Results of this study are as follows: 1. The incidence in males was greater than in females (males 59.3%, females 40.7%). 2. 95.3% of the 752 cases were found to occur under the age of four years, and highest peak by age occurred between 12 and 24 months (38.7%) 3. The peak duration of deformities was from 3 years to 5 years (29.1%) 4. Difference between the incidences of the city and of the rural areas was not determined. There was no difference between the age distribution of the onset in Seoul, in the medium-sized cities and in rural areas. 5. Paralytic poliomyelitis was observed even in vaccinated children 2.5% of total cases after one injection of Salk vaccine, 1.6% after two injections of Salk vaccine, and 1.3% after three injections of Salk vaccine, and 0.2% followed a combination of Salk and Sabin vaccination. 6. Deformity of the upper extremity was only 1.2% of that of the total body. But deformity of the lower extremity was 93.9% of the total. There was no difference between the deformities in both sides. In deformities of the lower extremities, deformities of the foot were most common (29.3% of the total), those of the knee 21.3%, those of the hip 10.9%, those of the toes 8.6% and those of the legs were 8.0% Deformities of the spines were 4.4% and those of the pelvis were 0.5%. In individual deformities, discrepancy in leg length was most common (15.8% of the total), equinovalgus 7.9%, external tibial torsion 7.7%, claw toe 6.8%, equnovarus 6.2%, knock knee 5.6% and combination of flexion, abduction and external rotation of the hip was 5.4%. 7. The locations of the paralyses were found to be 90.7% in the lower extremities, 7.6% in the upper extremities, 1.5% in the trunk and 0.2% in the neck. In involvement of the upper extremities, the most frequent were in the Triceps brachii (0.5% of involvements of the total body muscles), Deltoideus (0.5%) & Biceps brachii (0.4%). In the involvement of the lower extremity, Tibialis anterior was found to be the most frequent (6.1% of invelvements of the total body muscles), Iliopsoas 6.1%, Quadriceps 6.1% and Tibialis posterior was 6.0%. Generally, the muscles of the upper extremity were more frequently affected in mild involvement than in severe involvement except that the Opponens pollicis was slightly more frequently affected in severe involvement than in mild involvement. However the muscles of the lower extremities were slightly more frequently affected in severe involvement than in mild involvement. Especially the Tibialis anterior, Quadriceps, Tibialis posterior, and hip adductors were more frequently affected in severe involvement than in mild involvement. Generally in the muscles of the upper and lower extremities, the proximal muscles were involved more frequently than that of the distal. There was no difference between the frequencies of the invelvements of right and left sides. 8. Taking associated paralysis into account it was shown that certain muscles that receive nerve supply from the same segment were paralysis or weakened together. Tibialis anterior and Tibialis posterior, Quadriceps and hip adductors, Quadriceps and hip flexors were the most numerous combinations of the associated paralysis. 9. Looking at spinal segment innervation in relation to miId affection of muscles, the highest incidence was found in the first lumbar segment. In segment incidence of severe paralysis the highest incidence was found in the second and third lumbar segments.
Age Distribution ; Child ; Congenital Abnormalities ; Daegu ; Developed Countries ; Female ; Foot ; Genu Valgum ; Hammer Toe Syndrome ; Hip ; Humans ; Incidence ; Knee ; Korea ; Leg ; Lower Extremity ; Male ; Muscles ; Neck ; Orthopedics ; Paralysis ; Pelvis ; Poliomyelitis ; Poliovirus Vaccine, Inactivated ; Seoul ; Spine ; Statistics as Topic ; Toes ; Upper Extremity ; Vaccination

Free vascularized fibula is often used in orthopaedic reconstructive surgery because the fibula is a straight cortical bone, long enough, and has a long vascular pedicle. But morbidity is occurred at the donor site which may cause problems at the ankle in children. We reviewed 10 causes who had free vascularized fibula transfer at the Department of Orthopaedic Surgery, Yonsei University College of Medicine from January 1984 to June 1989. This study is attempted to evaluat the effects of fibular defect on the ankle in children and the results of treatment. Free vascularized fibula transfer was done in 5 cases due to ossifying fibroma, 3 cases due to nonunion of fracture and 2 cases due to congenital pseudoarthrosis. The average valgus deformity was 3 degrees in 2 cases in which distal tibiofibular fixation was done with one screw and 6 degrees in 8 cases in in which distal tibiofibular fixation was not done. Three cases had severe valgus deformity and secondary operation was done. The attended type of operation was distal tibiofibular fusion in 3 cases. The valgus deformity was changed after distal tibiofibular fusion from 4 degrees to 3 degrees in 3 cases. The size of fibular defect did not effect on the degree of valgus deformity of the ankle. In conclusion, fibular defect can cause valgus deformity of the ankle in children and early distal tibiofibular fusion is recommended to prevent valgus deformity of the ankle in growing child who as defect on fibular.
Ankle ; Child ; Congenital Abnormalities ; Fibroma, Ossifying ; Fibula ; Humans ; Pseudarthrosis ; Tissue Donors

OBJECTIVES: To induce osteogenesis of cultured mesenchymal stem cells(MSCs) isolated from rat bone marrow in vitro and in vivo. METHODS: Bone marrow cells were isolated from Spraugue-Dawley rats and seeded in culture medium. MSCs were isolated from bone marrow cells and cultured. For in vitro induction of osteogenesis, MSCs were cultured in osteogenic medium. After 2 weeks, evaluation of osteogenesis was performed with alkaline phosphatase(ALP) activity, ALP immunochemical stain, von-Kossa stain for mineral deposition, and Northern blot analysis for osteocalcin m-RNA. For in vivo induction of osteogenesis, MSCs were seeded on Collagraft strips. The Collagraft strips seeded with MSCs were grafted in the subcutaneous tissue of the back of immunocompromised rats. Grafted Collagraft strips were harvested 3, 6, 9, 12 weeks after graft and stained with H-e ad toluidine blue-O stai. RESULTS: In vitro assay ALP activity was 121.27 p-nitrophenol nmol/106cell in osteogenesis induced MSCs and 75.53 p-nitrophenaol nmol/106cell in control groups. Osteogenesis induced MSCs were stongly stained by ALP immunochemical stain. Von Kossa stain showed black mineral deposition. There were strong bands in Northern blot analysis for osteocalcin m-RNA. H-E stain showed penetratin of cellular component into the pores of Collagraft strip in all specimen and showed formation of osteoid from 6 weeks after graft. Toluidine blue-O stain showed blue staining cartilagious component from 3 weeks after grafting. CONCLUSION: We could induce osteogenesis from mesenchymal stem cells in vitro and in vivo. Based on the results of this study, bone graft might be able to replaced by a new method in the near future.
Animals ; Blotting, Northern ; Bone Marrow Cells ; Bone Marrow* ; Mesenchymal Stromal Cells* ; Osteocalcin ; Osteogenesis* ; Rats* ; Subcutaneous Tissue ; Transplants

OBJECTIVE: Our purpose was to evaluate whether maternal body mass index measured before pregnancy are associated with an increased risk of cesarean delivery. METHODS: Maternal weight and height were prospectively collected on 819 women who delivered between 37 weeks and 42 weeks in the College of Medicine, Catholic University of Taegu-Hyosung. Statistical analysis was done using Chi-square tests, prepregnancy maternal weight and height were used to calculate the body mass index, and its contribution to the risk of cesarean delivery was determined. Women with congenital anomaly and pregestational diabetes were exclude from analysis. RESULTS: The analysis of risk factors for cesarean delivery in the 819 women revealed a decreased risk of cesarean delivery with maternal age < or =20 years and multiparity; increased risk of cesarean delivery was noted with maternal age >30 years. Increase in prepregnancy maternal body mass index and total weight gain were significantly associated with increase in the odds of cesarean delivery. CONCLUSION: The risk of cesarean delivery is associated with incremental changes in maternal weight and body mass index before pregnancy after adjustment for potential confounding factors. Prepregnancy counseling about optimizing maternal weight and monitoring weight gain during pregnancy to decrease the risk of cesarean delivery are supported by this study.
Body Mass Index* ; Counseling ; Female ; Humans ; Maternal Age ; Parity ; Pregnancy ; Prospective Studies ; Risk Factors ; Weight Gain

BACKGROUND: Eosinophils are suggested to play a deleterious role in the inflammatory disease of the respiratory mucosa by releasing granule substances such as major basic prorein and eosinophil cationic protein. To investigate the contribution of eosinophils in the pathogenesis of nasal polyps and the mechanism of their accumulation and activation, we observed the eosinophil inhllration and expression of endotjelial and epithelial cell adhesion molecules in the nasal polyp tissues. MATERIALS AND METHODS: Polyp and inferior turbinate mueosal specimens (polyp group) taken out of 20 patients and 10 inferior turbinate mucosa specimens of non-allergic and non-infectious controls (control group) were immunohistochemically stained using EG1, EG2, and mAb for the ICAM-1, VCAM-1 and E-seleetin. The number of EG1 (+) and EG2 (+) cells within lmm2 of tissue and the expression of ICAM-1, VCAM-1 and E-seleetin on the vessels (% of total vessel) and epithelial eelis (area x intensity) were compared among three groups. RESULTS:The inferior turbinate mucosae of nasal polyp patients .were infiltrated by signifieantly higher number of eosinophils (EG1:17, EG2:16/mm2) compared with those of controls (EGi:0, EG2:0/mm2) (p<0.05), and the polyp tissue revealed much more eosinophils (EG1: 213, EG2:154/mm2) than inferior turbinates of same patients and those of controls (p<0.001). ICAM-1 expression in the vessels was frequenly observed both in polyps and in the turbinate mucosae with significant difference (median:85% vs. 67%, p<0.05), and ICAM-1 expression in the epithelial ceils was significantly different between the polyp and turbinate groups (median:9 vs. 2.5, p<0. 01). VCAM-1 was moderately expressed on the vessels of both polyps and turbinate mucosac (median:37%, 14%, respectively) and their expressions were significantly different (p<0.01). E-selectin expression was moderate to low both in the polyps and in the turbinate mucosae (median:18%, 10% respectively) and their expressions were not significantly different (p>0.05). CONCLUSION: Most of the eosinophils infiltrated into nasal tissue as well as nasal polyps were activated forms and they were significantly increased in the nasal polyps compared to the inferior turbinate mueosae of the same patients and control subjects. Significantly increased expression of ICAM-1 and VCAM-1 on the vessels and increased epithelial ICAM-1 expression in the nasal polyps indicate that interactions of eosinophils with ICAM-1 and VCAM-1 participate in the pathogenesis of nasal polyps.
E-Selectin ; Eosinophil Cationic Protein ; Eosinophils* ; Epithelial Cells ; Humans ; Intercellular Adhesion Molecule-1 ; Mucous Membrane ; Nasal Polyps* ; Polyps ; Respiratory Mucosa ; Turbinates ; Vascular Cell Adhesion Molecule-1

The R-R interval analyzer was developed to measure the autonomic nervous system function using microcomputer. The system based on 8 bit microcomputer including bandpass filter, R-wave detector and clock generator in order to obtain the mean value, standard deviation, total time, CV value, maximum value and minimum value in the specific view point of R-R interval variation. The pattern of R-R interval change after resting, voluntary standing and deep breathing can be analyzed in normal subjects and diabetics with autonomic nervous dysfunction. The amplitude of the R-R interval variation showed sensitive pattern for normal subjects at resting, standing and deep breathing. On the contrary, the periodicities of amplitude for abnormal subjects with autonomic nervous dysfunction showed dull pattern. It was suggested that R-R interval analyzer is a good detection method for dysfunction of autonomic nervous system.
Autonomic Nervous System ; Methods ; Microcomputers* ; Periodicity ; Respiration

We aimed to investigate the effect of in vitro allergen challenge on activation of eosinophils and expression of intercellular adhesion molecule-1(ICAM-1) in the epithelial and endothelial cells of the nasal mucosa of allergic rhinitics. MATERIALS AND METHODS: Inferior turbinate mucosal specimens which were obtained from 16 perennial allergic rhinitics and sensitized to D. farinae during conchotomy operations were used. Each mucosal specimen was divided into six pieces. The first two pieces were used as basic control group without culture, the second two pieces as culture-control group which was cultured with diluent only, and the last two pieces as antigen-challenge group cultured with D. farinae solution for 24 hours. Specimens were immunohistochemically stained using monoclonal antibody against eosinophil cationic protein(EG1 for all eosinophils and EG2 for activated forms) and ICAM-1. RESULTS: Average counts of EG1 cells and EG2+ cells within 1 mm of lamina propria of nasal mucosa were 14 and 11 respectively in the basic control group, 17 and 19 in culture control group, and 16 and 16 in the antigen-challenge group. ICAM-1 expression on vessels was observed more than half of t,he vessels in the nasal mucosa and there was no significant difference between groups, however, its expression on the epithelial cells was most prominent in the antigen-challenge group (2.1 in basic control group, 3.3 in culture control group, and 6.2 in antigen-challenge group). CONCLUSION: Most of the eosinophils infiltrating into the nasal mucosae out of vessels in allergic rhinitics are activated forms. Significant up-regulation of epithelial ICAM-1 expression by antigen-challenge suggests that ICAM-1 contributes to the transmigration of eosinophils from the subepithelial tissue into the epithelial cell layer and then finally into the nasal secretion.
Endothelial Cells ; Eosinophils* ; Epithelial Cells ; Intercellular Adhesion Molecule-1* ; Mucous Membrane ; Nasal Mucosa* ; Turbinates ; Up-Regulation