Congenital dislocation of the hip has always presented an unique problem in Orthopedic Surgery. Orthopedic surgeons have been baffled not only by the mystery of its origin, but also by its unpredictable course and the uncertainty of results of treatment. Hippocrates described this condition first with all its distinguishing characteristics, including distortion of the hip, the pathologic gait, the exaggerated lordosis. etc, His prognosis in this luxation of early childhood appeared to be unfavorable. In 1895, Lorenz established a new, decidedly conservative method of treatment. His process involved a complete separation of the two objectives to be fulfilled, namely reduction and retention. To retain this reduction he conceived the motion of fixing the hip for a specific and prolonged period in carefully chosen “primary position” of 90 flexion and 90 abduction by forcibly maintaining the head in its normal location. Ortolani, in 1935, was the first to show that a diagnosis could be establisted immediately after birth. The jerk, click or snap elicited by manipulation of the new born infants hip. Early diagnosis is still the most important aspect of congenital disiocation of the hip. Despite the emphasis on early diagnosis, a disturbingly large number of congenital dislocation of the hip remain undiagnosed until after the child has started to walk. Numerous surgical procedures and modifications have been used. The general types are: 1) Open reduction, 2) Shelf procedure, 3) Innominate osteotomy, 4) Arthroplasty, and 5) femoral osteotomy. These procedures have been useful also with the more difficult problem of residual or recurrent dislocation or subluxation aftertreatment by closed or open method. Congenital dislocation of the hip was not common in Korea like as in western countries. The reasons for this are poorly understood. But racial differences and native customs may offer a partial explanation. The author studied congenital dislocation of the hips in sex incidence, site of predilection, clinical symptoms and signs, X-ray findings, relation to the congenital anomalies and birth history, and the results of treatment. In this study, 57 cases of congenital dislocation of the hip, admitted to the orthopedic department of Severance Hospital during 7 years and 6 months since January 1963 until June 1970, were reviewed. The results of this study are as follows: 1. The annual changes of the numbers of the patients, who were first seen at Severance Hospital, were increasing. 2. The female incidence in Korea is relatively low as compared with the western countries. And the preponderance of females over males is in the ratio of ten to one in bilateral cases and two to one in unilateral cases. 3. The ratio of bilateral cases: right sides: left sides is 1:2: 2.2. 4. In these series, 15 cases of congenital anomalies or diseases in 13 patients are combined and among them, 10 patients are included in teratologic groups. And most common co-existing anomalies are club foot (7 cases). The incidence of the teratologic dislocation in Korea is relatively high as compared with the western countries. 5. The acetabualr index in affected hips showed no relationship to the age factor, but C-E angle, Y-coordinate and height are aggravated according to the increment of age. 6. Closed reduction is satisfactory under the age of 3, but after then the prognosis is poor. 7. Open reduction is recommendable after the age of 3 and under the age of 9. 8. The prognosis of treatment in bilateral cases and teratologic groups is poor.
Age Factors ; Animals ; Arthroplasty ; Child ; Diagnosis ; Dislocations ; Early Diagnosis ; Female ; Foot ; Gait ; Head ; Hip ; Humans ; Incidence ; Infant ; Korea ; Lordosis ; Male ; Methods ; Orthopedics ; Osteotomy ; Parturition ; Prognosis ; Reproductive History ; Surgeons ; Uncertainty

BACKGROUND: The epidermal permeability barrier necessary for terrestrial life resides in the intercellular spaces of the stratum corneum and is composed of lipids. OBJECTIVE: Since strrtum corneum lipid may be important for the permeability barrier, we studied the differences and effects of experimentally altered barrier function using acetone and tape-stripping technique. METHODS: The permeability barrier of hairless mouse was disrupted by tape-stripping and acetone treatment and the recovery rate was assessed by histochemical staining, electron microscopic examination and lipid analysis. RESULTS: Although the transepidermal water loss recovered completely by 48 hours in both of the acute models, acetone treated samples seem to have on over-all better recovery rate than tape-stripped samples. The return of barrier function to normal in both tape-stripped and acetone-treated skin was accompanied by a comparable return of normal nile red and ruthenium tetroxide staining. The amount of lipid in stratum corneum paralleled both the return of barrier function towards normal and the extent of prior damage to the barrier in acetone treated skin, yet, the lipid synthesis in tape-stripped skin showed a slower return of lipid content. CONCLUSION: The difference in the recovery rate of the two acute models may be due to the fact that acetone mainly extracts intercellular lipids, whereas, tape-stripping has a prolonged effect by removal of comeocyte in addition to the intercellular lipids. This shows the importance of comeocytes as well as the intercellular lipid bilayer in the recovery of normal barrier function.
Acetone* ; Animals ; Extracellular Space ; Lipid Bilayers ; Mice ; Mice, Hairless ; Permeability ; Ruthenium ; Skin ; Water

Heart failure is a recognized, although uncommon, cause of massive liver cell necrosis, the clinical consequence of which are intermingled with those of cardiac insufficiency in most case. But, hepatic coma is rerely caused by hepatic congestion only. We report the three cases with heart failure resulted in massive liver cell necrosis and fulminant hepatic failure. The manifestations of fulminant hepatic failure were hepatic encephalopathy, jaundice, marked increase of prothrombin time and serum transaminase and there were no evidences of viral hepatitis and toxic hepatitis as a cause of liver failure.
Drug-Induced Liver Injury ; Estrogens, Conjugated (USP)* ; Heart Failure* ; Hepatic Encephalopathy ; Hepatitis ; Jaundice ; Liver ; Liver Failure ; Liver Failure, Acute* ; Necrosis ; Prothrombin Time

Ventricular premature beats(VPB) are the most common cardiac arrhythmia and frequently found in apparently normal healthy persons as well as in various heart diseases. Postectopic potentiation of ventricular contraction has widely reported by electrocardiography. In this study, the authors performed comparative assessment of the left ventricular function at the preextrasystolic, extrasystolic and postextrasystolic beats by M-mode echocardiography and electrocardiography. The results obtained were as followings; 1) Among 22 patients of isolated, unifocal ventricular premature beats with fully compensatory pause, male were 6 and female 16, mean age being 47.2 years. 2) Hypertensive heart disease was the most common underlying disease of ventricular premature beats(5 patients) and the others were valvular heart diaeases(3), ischemic heart diseases(3), cardiomyopathy(2), intracerebral hemorrhagy(1), atrial septal defect of secundumtype(1), cor pulmonale(1), pericarditis(1), 1degree A-V block(1) and enteric fever(1). In 3 patients the causes were not clarified. 3) R wave amplitude was higher in the postextrasystolic beat(2.02+/-0.79cm) than preestrasystolic beat(1.86+/-0.66cm) 4) PEP/LVET ratio showed more decrease(18%) in postextrasystolic beat than that of preextrasystole. 5) Diastolic filling time of mitral valve was more reduced in the extrasystole than preextrasystole, but that of postextrasystole exceeded the preextrastystole. 6) Aortic cusps separation was more decreased in the extrasystole than preextrasystole and slightly more increased in the postextrasystole than preextrasystole. 7) LVID, LSa, ENa, DeltaEN/Deltat, LVEDV, SV and LV mass showed more decrease in extrasystole compared with those in pre-and postextrasystole, which was higher than preextrasystole. But LVESV was slightly lower in extrasystole than preextrasystole. 8) In extrasystolic beat, LVEDV, LVESV, stroke volume, and ejection fraction of ventri cular premature beat were 15.77%, 0.18%, 24.05% and 12.21% lower, respectively, than those of preextrasystole. And in the postextrasystole, LVEDV, LVESV, stroke volume and ejection fraction were 23.35%, 2.42%, 28.51% and 10.4% higher, respectively, than these of preextrasystole.
Arrhythmias, Cardiac ; Cardiac Complexes, Premature* ; Echocardiography* ; Electrocardiography ; Female ; Heart ; Heart Diseases ; Heart Septal Defects, Atrial ; Humans ; Male ; Mitral Valve ; Stroke Volume ; Ventricular Function, Left*

Holter ECG monitoring is a continuous tape recording of a patient's electrocardiogram during ordinary activities and picks up hidden abnormalities in rate, rhythm or conduction. The authors delineated the types and incidence rates of arrhythmia in 32 normal Koreans by utilizing medical personnels and patients without evident heart diseases or symptoms, or significant systemic illness. Tracings and analysis were performed using 24 hour Holter monitoring processor(SCM 240, Fukuda, japan), auto-analyser (SCM-25), casette recorder(SM 24) and chrome tape. Results are as follows: 1) Portable 24 houre Holter ECG monitoring was performed in 32 persons(age range of 21 to 35) without cardiovascular disease, as defined by normal clinical and noninvasive cardiovascular examination. 2) During exercise, maximal heart rates ranged from 125.0+/-12.1/min and minimal rates from 96.7+/-5.8/min. During normal activity period, maximal and minimal heart rates were, respectively, 95.4+/-16.2/min and 62.6+/-6.3/min. Maximal sleep rates were 90.3+/-26.6/min and minimal sleep rates 57.4+/-12.4/min. 3) P-R interval decreased as heart rate increased. Transient first degree AV block was noted in 3 subjects(9.4%) and Wenckebach type second degree AV block in 2 subjects(6.3%). 4) Sinus tachycardia and bradycardia were observed in all subjects and sinus arrhythmia was more frequently noted during waking periods. Three subjects had episodes of sinus pause with maximum duration of 3.24 seconds. 5) In 13 persons(40.6%) having supraventricular premature beats, the frequency was 50.01+/-49.36/hr and in 14 persons having(44%) ventricular premature beats the frequency 26.33+/-18.83/hr. Transient ventricular tachycardia of 3 seconds' duration was observed in one subject under the extreme stressful environment. 6) ST segment elevation over 1mm was noted in 5 subjects(15.6%), of whom one had a nocturnal chest pain and ST segment depression over 1mm in 2 subjects. T wave inversion was also found during exercise(3.1%) and during sleep(9.4%).
Arrhythmia, Sinus ; Arrhythmias, Cardiac ; Atrioventricular Block ; Bradycardia ; Cardiac Complexes, Premature ; Cardiovascular Diseases ; Chest Pain ; Depression ; Electrocardiography* ; Electrocardiography, Ambulatory ; Heart Diseases ; Heart Rate ; Humans ; Incidence ; Tachycardia, Sinus ; Tachycardia, Ventricular ; Tape Recording

The electrocardiographic and echocardiographic analysis was made on 23 patients with atrial septal defect of ostium secundum type, who were confirmed by right heart catheterization under admission at hanyang University Hospital from january 1979 to July 1981. Following results were obtained: 1) In the 23 patients, 13 were male and 10 female. Their ages ranged from 6 to 45 years, mean age being 19.9 years. 2) In 18 patients(78.3%), the QRS axis was between +90degrees and +150degrees. No significant correlations could be demonstrated between QRS axis and some hemodynamic parameters(right ventricular systolic pressure, pulmonary artery mean pressure and pulmonic to systemic flow ratio), and also, between QRS axis and the size of right ventricular dimension index. 3) Right ventricular outflow tract hypertrophy, right ventricular hypertrophy and complete right bundle branch block pattern in Lead V3R or V1were observed in 95.7% of ostium secundum defect. No significant correlations could be found between types of QRS complexes and some hemodynamic parameters(right ventricular systolic pressure, pulmonary artery mean pressure and pulmonic to systemic flow ratio), and also, between types of QRS complex and the size of right ventricular dimension index. 4) The mean amplitude of S wave in precordial Lead V6was 7.6mm. There was a definite correlation between the amplitude of S wave in Lead V6and right ventricular systolic pressure. No significant correlations could be demonstrated betwen the amplitude of s wave in Lead V6and some hemodynamic parameters(pulmonary artery mean pressure and pulmonic to systemic flow ratio), and also, the size of right ventricular dimension index. 5) Right ventricular dimension index was increased in all cases but one. A significant correlation was found between the size of right ventricular dimension index and pulmonary artery mean pressure, whereas no significant correlation could be demonstrated between the size of right ventricular dimension index and pulmonic to systemic flow ratio. 6) 95.7% of 23 patients with ostium secudum defect showed paradoxical septal motion was proved not to be associated with other congenital heart disease by cardiac catheterization. The pulmonic to systemic flow ratio in groups of septal motion type A was significantly increased than that of normal septal motion group, whereas no significantl relation between types of septal motion and the size of right ventricular dimension index was observed.
Arteries ; Axis, Cervical Vertebra ; Blood Pressure ; Bundle-Branch Block ; Cardiac Catheterization ; Cardiac Catheters ; Echocardiography* ; Electrocardiography* ; Female ; Heart Defects, Congenital ; Heart Septal Defects, Atrial* ; Hemodynamics ; Humans ; Hypertrophy ; Hypertrophy, Right Ventricular ; Male ; Pulmonary Artery

We have studied the function of lymphokines on human tonsillar B cell prolifertion and differentiation. B cells were stimulated with Staphylococcus aureus Cowanl (SAC) or anti- bead. The followings showed the results of this study. 1) In B cell activation, SAC induced B cell DNA synthesis but anti-mubead did not. SAC could activate and proliferate B cells. Minimal number of B cells were required to proliferate effectively. 2) In B cell proliferation, SAC could proliferate B cell in the abscence of lymphokines. Exogenous IL-2 or IL-4 enhanced B cell proliferation. The roles of IL-2 were very important in B cell proliferation. The effect of IL-4 on the IL-2 induced B cell proliferation was inhibitory in SAC-B cells. IL-4 could enhance the proliferation of anti-mu bead activated B cells. 3) In B cell differentiation, IL-2 was a major factor to differentiate SAC activated B cells, but IL-4 did not. IL-6 had a synergistic effect on the differentiation. The results of this study showed that the different signal transduction mechanisms were involved in B cell proliferation and differentiation. The B cell resposes to lymphokine were different, and it is depend upon antigens or mitogens.
B-Lymphocytes ; Cell Differentiation ; Cell Proliferation* ; DNA ; Humans* ; Interleukin-2 ; Interleukin-4 ; Interleukin-6 ; Lymphokines ; Mitogens ; Signal Transduction ; Staphylococcus aureus

The authors reported here a 23 years-old female patient with acute renal failure and anaphylaxis induced by rifampicin, who was suffered from exudative pericarditis. The diagnosis was made by its reproducibility with rifampicin. The pathogenesis of acute renal failure and anaphylaxis in this case was thought to be immunologic mechanism, because of elevated IgE and depressed complements. Relevant literature was also reviewed.
Acute Kidney Injury* ; Anaphylaxis* ; Complement System Proteins ; Diagnosis ; Female ; Humans ; Immunoglobulin E ; Pericarditis ; Rifampin ; Young Adult

Stratum corneum lipids, which are enriched in sphingolipids, free fatty acids, and cholesterol, are required for epidermal barrier function. When the epidermal permeability barrier is perturbed, the transepidermal water loss returns to normal by 24-48 hours in parallel with the reappearance of stratum corneum lipids, derived from secreted lamellar bodis and accelerated lipid synthesis. Recent evidence shows that topical application of individual lipids interferes with barrier recovery while complete mixtures of cholesterol, fatty acids, and ceramides facilitate recovery after barrier disrupton. Metabolic imbalances and perturbed barrier function can be either the cause or the consequences of the pathobiology of scaling disease. Many skin diseases relating cornification and dryness are indeed related to abnormality of one or several combinations of lipids. Recently the cytokines which have changed during barrier recovery seem to be important in understanding of epidermal lipid homeostasis as well as barrier recovery.
Ceramides ; Cholesterol ; Cytokines ; Fatty Acids ; Fatty Acids, Nonesterified ; Homeostasis* ; Permeability ; Skin Diseases ; Sphingolipids ; Water

No abstract available.