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

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

Radial nerve paralysis associated with humeral shaft fracture is the most common peripheral nerve lesion complicating fractures. The mechanism of injury, treatment, and prognosis of radial nerve paralysis associated with fracture of the humerus vary considerably, depending on when the nerve injury occured with respect to the humeral fracture and its subsequent treatment. A clinical study was performed on 243 patients with fractures of the humeral shaft. Especially fourty two cases of radial nerve paralysis associated with fracture of the humerus were analyzed at Department of Orthopedic Surgery, Yonsei University College of Medicine from January 1965 to December 1982. The results were summarized as follows: l. Among 243 humerus shaft fractures, the ratio of male to female was 2: 1. The common cause of radial nerve paralysis associated with humerus fracture were due to traffic accident and industrial machine injury. The closed fracture was 205 cases(84.4%) and the most common type of fracture was comminuted fracture(52.6%) 2. Among 243 humerus shaft fractures, 42 cases(17.3%) complicated the radial nerve paralysis. The radial nerve paralysis was the most vulnerable to injury at the distal third of the humerus, especially when there was open or comminuted fracture. The incidence of primary radial nerve paralysis was 8%(34 cases), and 19#g(8 cases) in secondary radial nerve paralysis. 3. Among 42 radial nerve paralysis associatd with humerus fractures, 15 cases were treated by conservative method. And 27 cases were treated by surgical exploration. By surgical exploration the practical cause of radial nerve paralysis were found: 13 cases negative, 5 cases contusion, 3 cases stretching. The recovery sign of radial nerve paralysis was noted from 2 weeks after treatment. Spontaneous neurological recovery was not noted beyond 6 months after treatment. Thirty two patients were available for follow up study. The overall recovery rate of radial nerve paralysis was 81.3. The practical causes of patient with no recovery of nerve function were cross section of nerve, severe stretching or entrapment of radial nerve between the sites of fracture. From a consideration of these series, it was concluded that satisfactory result was obtained from conservative management in humerus shaft fracture associated with radial nerve paralysis. Indication of early surgical exploration of radial nerve paralysis associated with humeral fractures are open fractures requiring debridement, spiral or oblique fractures with marked displacement, and progressive nerve paralysis.
Accidents, Traffic ; Clinical Study ; Contusions ; Debridement ; Female ; Follow-Up Studies ; Fractures, Closed ; Fractures, Comminuted ; Fractures, Open ; Humans ; Humeral Fractures ; Humerus ; Incidence ; Male ; Methods ; Orthopedics ; Paralysis ; Peripheral Nerves ; Prognosis ; Radial Nerve

Long term follow-up study was done on 38 cases of anterior fusion for spinal tuberculosis especially about effect of buttress graft. The average follow-up period was 16 months. 14 cases of effective buttress group were appeared' to achieve more rapid bony union and prevent further kyphosis or lateral wedging of the involved vertebral body than inadequate buttress group of 7 cases.
Follow-Up Studies ; Kyphosis ; Spine ; Transplants ; Tuberculosis ; Tuberculosis, Spinal

Peripheral nerve injury occurs mostly in company with tendon and muscle injuries, fractures, or dislocations. Because of the disabilities and socioeconomic loss caused by such injuries, much attention must be paid to the initial treatment, and later to the reconstruction and rehabilitation. At department of Orthopedic Surgery, Seoul National University Hospital, 336 patients of nerve lesion were treated from Jan, 1980 to Dec, 1988. Among them 128 patients were nerve compression syndrome (carpal tunnel 52 patients, cubital tunnel 40 patients, thoracic outlet 16 patients, others 20 patients), and 50 patients were brachial plexus injury, and 168 cases were peripheral nerve injury. 50 patients of the peripheral nerve injury were treated with reconstruction and 118 patients were treatred with neurorrhaphy, nerve graft, and neurolysis. Of the 118 patients, 94 patients were followed up for more than one year, and the results of neurorrhaphy, nerve graft and neurolysis were analyzed. In 46 patients (73.0%) of the patients treated with neurorrhaphy, 7 patients (58.3%) with nerve graft, and 15 patients (78.9%) with neurolysis, good or excellent results were obtained.
Brachial Plexus ; Dislocations ; Humans ; Nerve Compression Syndromes ; Orthopedics ; Peripheral Nerve Injuries ; Peripheral Nerves ; Rehabilitation ; Seoul ; Tendons ; Transplants

We have used BALB/c mice as an animal model for the study of anaphylactic hypersensitivity to the house dust mite. For the sensitization, BALB/c mice were injected with a single dose of extracts of Oermatophagoides farinae (D. pa) or Dermatophagoides pteronyssinus (D. pt) mixed with adjuvants (aluminum hydroxide and Bordetella pertussis) intraperitonealy. On days of 15, 30, and 60 after the sensitization, the mice received a challenge dose of the same allergen intravenously to induce anaphylactic shock. The hypersensitivity reactions were scored by anaphylactic shock. And various immunological parameters, including cytokines and immunoglobulin isotypes, were studied in relation with the shock. A high level of anaphylactic shock was produced in the mice by both of the allergens, D, fa and D, pt, at 15 and 30 days after sensitization. In vitro Ag specific proliferative reponses of spleen cells from D. pt treated mice (D. pt mice) was six times higher than those from O. fa treated mice (O. fa mice). Regardless the differences in antigens, the production of IFN-r by spleen cells from D. pt mice or O. fa mice was equally high at 15 days after sensitization. However, the ability to produce IFN-r by the spleen cells from D, pt mice was three times higher compared to that from D. fa mice. The production of IL-4 by the spleen cells was enhanced slightly but not significant in both groups. In studies of the allergen-specific immunoglobulin isotypes in the sera of the mice, the level of IgE in both groups was enhanced slightly but not significant. In contrast, the level of IgG subtypes were increased in both groups. When the levels of IgG were compared by subtypes, the level of IgG1 increased significantly on day 15 when the anaphylactic shock score was maximized in both groups. Increase in IgG2a level at the day was not significant, instead, asignificant increase in IgG2 levels was observed on day 60 after sensitization when the anaphylaxis was almost discontinued. Although a higher level of IgG3 was examined on day 15 and 30 in D. pt mice and on day 60 in D, fa mice, anaphylaxis was not appeared to be associated with the levels of IgG3 in this study. The IgG1, rather than IgE, was assumed to the major factor involved in the anaphylactic response observed in this experiment. In conclusion, BALB/c mice would be an animal model for the study of anaphylactic hypersensitivity to D. fa or D, pt., which might be an essential tool for the future development of immuno-therapeutic agents.
Mice ; Animals

The authors made an attempt to classify the supracondylar extension-valgus fracture according to the direction and location of the fracture line based on the radiographic manifestation. This new classification helps to dictate the model of treatment, possible sequence of reduction and the causes of deformity of the elbow after treatment. During the last 12 years of this study, 200 supracondylar fractures of the humerus were treated in the Kyung Hee University Hospital. Of the cases 82 were extension-valgus fractures. The results were as follows: 1. The supracondylar extension-valgus fracture were classified into 5 types: Type I: fish-tail fracture (14 cases) Type II : obtuse fish-tail fracture (27 cases) Type III: oblique fracture (16 cases) Type IV: oblique fracture with comminution of lateral column (14 cases) Type V: Transverse fracture (11 cases) 2. The displacement of the distal fragment in the fish-tail fracture is severe but it can be reduced easily by manipulation. Once reduction has been obtained, the fracture is stable and maintained by a long arm cast with acute flexion of the elbow alone. There is no need of percutaneous pinning. Among 14 cases of type I fracture there was no cubitus varus deformity. 3. The line of the obtuse fish-tail fracture lies distal to fish-tail fracture. This is unstable so it is necessary to percutaneous pinning. 4. The oblique fracture is produced by the hyperextension of the elbow and degrees of the obliquity of the fracture line were 12 to 20 degrees (Av. 14 degrees). The valgus angles in opposit elbows were 9 to 25 degrees (Av. 16 degrees). The forearm must be pulled into valgus position during the reduction of the fracture. 5. Type IV fracture occures under 4 years old, and more commonly in girls. This is unstable, so it is necessary to percutaneous pinning.
Arm ; Child ; Classification ; Congenital Abnormalities ; Elbow ; Female ; Forearm ; Humans ; Humerus

Generalized granuloma annulare is manifested by numerous, symrnetrical, shiny, normal-skin colored, discrete or confluent, papular eruption on the sunexposed areas, mostly in females of past middle age. Up to date, a variety of therapeutic approaches have been tried with inconsistent results. Recently several agents have been reported to be inconsistent results. Recently several agents have reported to be effective in the treatment of genealizecl granuloma annulare. Of these, dapsone has been used with favorable respones. The fact dapsone can inhibit the lysosomal enzyme release and the mononuclear cell-rnediated rnyeloperoxidase cytotaxicity would account for its effect in granuloma annulare even in part. We observed a case of generalized granulare in a 49-year old man, who had had numerous normal-skin colored or faintly violaceous, flattopped papular eruption on the sun-exposed areas for 3 years. He was treated successfully with dapsone 100mg a day for about 22 months.
Dapsone* ; Female ; Granuloma Annulare ; Humans ; Middle Aged

Responses of mouse lymphocytes to the soybean paste fermented by Korean traditional fashion was examined to clarify its effects in cytokine production in vitro. A fraction of the soybean paste (KFSP-100) was prepared by precipitation with ammonium sulfate and by filtration through ultrafiltration membrane. KFSP-100 were added into cultures of fresh mouse splenic cells in vitro. KFSP-100 significantly enhanced the amount of IL-6 and TNF-a produced by macrophages and IL-6 and IFN-r produced by lymphocytes. Production of IL-12 by macrophages was not much affected by KFSP-100 treatments. The most noticeable finding was the fact that lymphocytes treated with KFSP-100 proliferated to an exceeding numbers (more than 10 times to the control) in 72 hours. The KFSP-100-induced proliferative response was specific to B cells since almost all of the KFSP-100-induced cells in the cultures of splenic cells were B cells. Furthermore, such a proliferative responses were equally observed only in cultures of purified B cells but not in cultures of T cells. In thermostability test, the biologically active components of the KFSP-100 is assumed to be either linear protein or glycoprotein. KFSP-100 did not induce agglutination of lymphocytes demonstrated by lectins in the same cells. These observations suggest that KFSP-100 may be a novel mitogen for B lymphocytes. The component (s) responsible for the B cell proliferation in KFSP-100 might be a factor gained by natural fermentation. None of the fractions of not fermented soybean paste prepared by the same methods demonstrate the same effect.
Agglutination ; Ammonium Sulfate ; Animals ; B-Lymphocytes ; Cell Proliferation ; Fermentation ; Filtration ; Glycoproteins ; Immunologic Factors* ; Interleukin-12 ; Interleukin-6 ; Lectins ; Lymphocytes ; Macrophages ; Membranes ; Mice ; Soybeans* ; T-Lymphocytes ; Ultrafiltration

BACKGROUND: This study aimed to evaluate the abilities of transcranial magnetic stimulations(TMS) and electrical stimulations(ES) in predicting clinical recovery in patients with Bell's palsy and to contribute to the understanding of the relations observed between the clinical and electrophysiological time courses of the disease. METHOD: We serially studied 22 patients(9 males, mean age 42) with Bell's palsy. Facial nerve function was graded according to the House-Brackmann grading system. RESULTS: A side-to-side comparison(amplitude ratio) of the amplitude of evoked responses between the initial and follow up studies showed a significant change except for the TMS on the stylomastoid foramen. With the TMS over the parieto-occipital area, the absence of a compound muscle action potential(CMAP) was observed in 19 patients during the early course of the disease. The reappearance(n=14) of evoked muscle potentials after an initial absence was observed in 14 patients with satisfactory recoveries at the last follow-up study. The amplitude ratio of ES and TMS during the early course of the disease correlated with the clinical outcome. CONCLUSIONS: Our findings indicate that TMS and ES can provide an early prediction for the outcome of the palsy. The presence of CMAP at the acute phase or the reappearance of CMAP after an initial absence with TMS suggests a rather good prognosis. Both TMS and ES were found to be useful methods for the assessment of facial palsy and as early predictors for the outcome in patients with Bell's palsy. Serial neurophysiologic studies were also important for evaluation of the prognosis of facial palsy.
Bell Palsy* ; Electric Stimulation ; Facial Nerve ; Facial Paralysis ; Follow-Up Studies ; Humans ; Male ; Paralysis ; Prognosis* ; Transcranial Magnetic Stimulation