To assess the effects of regional wall motion abnormalities on left ventricular function, mitral annulus(MA) motion and left ventricular posteior wall(LVPW) motion were studied by M-mode and Doppler echocardiography in 13 normal subjects and 40 mitral valve replaced(MVR) patients. In MVR patients, mitral annulus motion showed significantly delayed contraction(DC) after A2 by 3.7+/-3.0mm in amplitude and 80+/-35 msec in time(normal control; 0.1+/-0.3mm, 35+/-15msec, p<0.01 for both) and reduction in systolic % thickening of LVPW(39.7+/-23.6 VS 63.2+/-18.4%, p<0.01). MVR patients were devied into 2 group according to the amplitude of MA motion, 4mm Group I(n=13, DC> or =4mm) showed increase epicardial excursion of LVPW compared with Group II(n=27, DC<4mm)(Group I vs Group II, 11+/-3.7 vs 8.6+/-2.6 mm, p<0.05). In mechanical prosthetic valve replaced patients(n=22), time relationship between valve opening, mitral flow, peak thining rate of LVPW and valve peak excursion were studied also and the phase difference that are observed in normal subjects, were lost. We interpreted these delayed contraction of mitral annulus motion and epicardial motion increment as muscle fiber architectural abnormalities which might effect on MVR patients as a factor of left ventricular systolic and diastolic dysfunction.
Echocardiography, Doppler ; Humans ; Mitral Valve* ; Ventricular Function, Left

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

Authors analysed systolic pressure-volume-stress relations by combined echo-pressure-cineangiographic measurement in 10 normal subjects(Group I) and 37 patients with chronic valvular heart diseases. Patients with chronic valvular heart diseases were divided into 3 groups : Group II ; mitral stenosis(n=9), Group III ; mitral stenosis with aortic regurgitation(n=19). The aims of this study are to find useful left ventricular(LV) contractility indices and evaluate left ventricular contractility at various volume loading states. Studied LV contractility indices were maximal elastance of isovolumic contraction(Eiso), endsystolic pressure-volume ratio(Ees) and slope of regression line in late systolic stress-volume loop(A). Eiso was estimated using an isovolumic contraction model of Sunagawa and A was analysed in a single ejecting beat. Endsystolic volume index(ESVI), end diastolic volume index(EDVI), stress at peak pressure(Speak), cardiac index, Vmax, mean Vcf and ejection fraction were determined also. The obtained results were as follows. 1) Significant correlations were found in whole group(n=47) between Eiso and Ees(r=0.88, P<0.005), Elso and cardiac index(r=0.83, P<0.005), Ees and CI(r=<0.76, p<0.005). Further, these correlation coefficiencies were not different between any two groups of Group I, Group II, Group III, Grouop IV and whole group (p<0.05); that is Eiso or Ees had a constant significance at various loading state. 2) Significant correlation between A and cardiac index was noted in Group I+II+III(n=28, r=0.48, p<0.01), but this correlation coefficiency was significantly different from that of Group IV(n=19, r=0.08); p<0.05. 3) In Group II(patients with mitral stenosis), cardiac index* and EDVI* and stress at peak pressure** were decreased significantly(*:p<0.05, **:p<0.005). But Eiso, Ees, A and all the other idices were not decreased. These findings suggested that left ventricular contractility is not reduced in mitral stenosis. 4) In Group IV(patients with amitral regurgitation with or without aortic regurgitation), **EDVI and ESVI** were increased while Eiso**, Ees, Vmax*, mean Vcf* and cardiac index** were decreased significantly. But ejection fraction and A were not decrease. These findings suggested that ejection fraction and A may not be decreased at volume overload, despite of impaired left ventricular contractility. In summary; Eiso or Ees was evaluated as an useful contractility index which appeared not to be influenced by various volume loading state, while eiection fraction and A to be influenced. Patients with mitral stenosis as a group have reduced cardiac performance which is not due to impairment of left ventricular contractility(muscle function) but to reduced preload.
Constriction, Pathologic ; Heart Valve Diseases* ; Humans ; Mitral Valve Stenosis

Early diastolic left ventricular relaxation was determined in 20 patients by combined echopressure measurement. 7 normal control cases and 13 cases with valvular regurgitation were studied with reference to incremental delta elastance. The hemodynamic and echocardiographic data were analysed during the phase of decreasing left ventricular elastance (that is, when pressure is decreasing while volume is increasing). Starting from a fixed level of wall stress (40 kdyne/cm2), we determined Incremental Delta Elastance(ratio big up tri, Delta p/big up tri, Delta V) by a constant increase in LV volume(eg. 10 ml/M2 or 20 ml/M2). We named Incremental Delta Elastance at 10 ml/M2 and 20 ml/M2 of LV volume increase as d-E 10 and d-E 20 respectively. In valvular regurgitation, incremental delta elastances were statistically different from those of normal subjects(p<0.01). d-E10 was -1.67+/-0.69(versus -3.38+/-1.75 in normal subjects) mmHgm2/ml and d-E20 was -0.98+/-0.39(versus -1.69+/-0.84 in normal subjects) mmHgm2/ml. d-E 10 and d-E20 were compared with ejection phase indices(ejection fraction, meanVcf) in whole group(n=20). There was significant correlation between d-E and ejection fraction(d-E10 : r=-0.47, d-E20:r=-0.50) p<0.05. There was significant correlation between d-E and meanVcf(d-E10: r=0.53, d-E20: r=-0.57) p<0.05. d-E10 and d-E20 were compared with volume indices(end-diastolic volume index and end-systolic volume index) but no significant correlation was found. Because we evaluated that inotropic state or afterload would influence incremental delta elastance, further study, especially with reference to endsystolic volume index may be needed. The absolute values between d-E10 and d-E20 were different but they were simliar in property. We concluded that incremental delta elastance(d-E10 or d-E20) could be used as a useful index of early diastolic relaxation in chronic valvular regurgitation.
Echocardiography ; Hemodynamics ; Humans ; Relaxation*

A benign chondroblastoma of bone which involved the proximal end of the right tibia of a 14 year old girl was presented. Clinical symptoms, signs, roentgenographic findings, and bone biopsy led to the diagnosis. The lytic lesion of bone, which was 4cm×3cm×2.5cm in size, was curetted and autogenous bone graft was done. Most of the lesion was composed of a dark bluegray substance, which was either friable or even hemorrhagic, and the other areas were more grayish, gritty and flecked with yellowish calcified material. The postoperative course has been satisfactory, showing no recurrence for a period of 10 months after surgery.
Biopsy ; Chondroblastoma ; Diagnosis ; Female ; Humans ; Recurrence ; Tibia ; Transplants

Alveolar soft-part sarcoma has been originally described as a unique pathological entitiy by Christopherson, Foote, and Stewart in 1952, who have chosen its name because of their uncertainty in determining from which cells the tumor arose. The tumor is generally considered to be malignant and originates in soft tissue, the most commonly in the deep tissues of the extremities. The case, reporting here, illustrated several of the recognized characteristics of alveolar soft-part. sarcoma, both clinically and pathologically and is described in view of its rarity of its kind and difficulty of accurate diagnosis. The patient was a 29 year old male who has complained of a adult. fist-sized mass on posterolateral aspect of left arm for one year. Roentgenographic findings showed multiple metastatic lesions on both lung fields, left humerus, skull and cervical spine. The mass on the same site recurred after excision and hemoptysis probably due to aggravation of the metastatic lesions of the both lungs developed 4 months later. He died 8 months after surgery.
Adult ; Arm ; Diagnosis ; Extremities ; Foot ; Hemoptysis ; Humans ; Humerus ; Lung ; Male ; Sarcoma ; Sarcoma, Alveolar Soft Part ; Skull ; Spine ; Uncertainty

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

Most of cataract surgeons have made a great effort to minimize or nullify corneal 'astigmatism resulted from the incision and closure, but a completely ideal wound system still eludes us. The scleral pocket incision and continuous single knotted shoelace suture of it has been known as one of the technique for reducing postoperative astigmatism. Recently, horizontal suture closure of scleral pocket incisior has been introduced because it doesn't cause suture induced wound compression. We implanted standard PMMA intraocular lenses in the bag of 400 patients through 7mm scleral pocket incision following CCC (continuous circular capsulorhexis) and bimanual phacoemulsification. The incision was closed with either the shoelace or horizontal suture. The keratometric measurement was maded at postoperative 1 day, 1 week, 1 month, 2 month, 3 month and 6 month. In shoelace suture group, the preoperative corneal astigmatism appeared -0.14 +/- 0.15D of with the rule astigmatism (WTR); at one day postoperatively -2.75 +/- 1.61 of WTR, at 3 month 0.18 +/- 1.14D of against the rule astigmatism (ATR), 6 month 0.3 +/- 1.22D of ATR. In horizontal suture group, the preoperative corneal astigmatism appeared -0.22 +/- 1.22D of WTR; at one day postoperatively -1.05 +/- 1.28 of WTR, at 2 month 0.57 +/- 1.0 of ATR, at 6 month 0.72 +/- 1.91 of ATR. The difference between two suture methods was statistically significant (p<0.01 until 3 month, p<0.05 until 3-6 month).
Astigmatism* ; Cataract ; Humans ; Lenses, Intraocular ; Phacoemulsification ; Polymethyl Methacrylate ; Sutures* ; Wounds and Injuries

A 61-year-old male was presented with oozing crusted erythematous skin lesions on the ex-tensor site of the right forearm, the extensor site of the left forearm, left calf, right shin, and the right portion of the buttock. He was diagnosed as having multiple pagetoid Bowen's disease by H&E staining, special staining and by an electron microscopic examination. He was treated with a topical application of 5-flurouracil cream and cryosurgery. The skin lesions were mostly healed after 7 months. We herein report a case of multiple pagetoid Bowen's disease on the sun-protected area that may be caused by arsenic ingestion.
Arsenic ; Bowen's Disease* ; Buttocks ; Cryosurgery ; Eating ; Forearm ; Humans ; Male ; Middle Aged ; Skin