A pregnancy is considered postterm if it is beyond 294 days (42 complete weeks). Several investigators have demonstrated that postterm pregnancy may be accompanied by a rise in perinatal morbidity and/or mortality. Abnormalities such as meconium staining, cringenital anomalies, intrauterine growth retardation, postmaturity syndrome, fetal asphyxia have been reported in some cases of reduced amniotic fluid volume (oligohyramnios) which is commonly observed in postterm pregnancies. Amniotic fluid volume has been shown to decrease significantly as gestational age advances beyond term. Oligohydramnios has particular relevance to postterm pregnancies. Poor perinatal outcomes of oligohydramnios on postterm pregnancy have been reported by several authors. To date, however, the relationship between oligohydramnios in pastterm pregnancy and fetal outcome is debatable. The purpose of this clinical study was to evaluate the relationship between oligohydr- amnios and perinatal outcome in 64 cases of postterm pregnancies. Amniotic fluid index(AFI) values were measured semiweekly in 64 good dated, uncomplicated singleton pregnancies. AFI values were categorized into 2 groups. The group 1; patients whose final AFI value was above 5.0 cm; Group 2, patients whose AFI value fell below 5.0 cm. Adverse fetal outcome was defined by the presence of meconium staining, fetal heart rate decelerations, cesarean delivery for fetal distress, low Apgar score at 1 and 5 minutes, neonatal intensive care unit admission, and perinatal mortality. The fetal outcome was compared group 1 with group 2 and results obtained were as follows: 1. The incidence of oligohydramnios in postterm pregnancy was 54.7 %. The average diminution of amniotic fluid index was from 8.2 1.8 cm to 5.6+2.2 cm/week. 2. The incidence of meconium-staining in amniotic fluid was 40.6 % (Group 1: 20.7 %, Group 2: 57.1 %) and showed statistically significant difference between the two groups(p= 0.003). 3. The incidence of Apgar score less than 7 was 23.4% in 1 minute (Group 1: 13.8 %, Group 2: 31.4 %) and 4.7 % in 5 minutes(Group 1: 3.4%, Group 2: 5.7 %), respectively and showed no statistically significant difference between the two groups (p=0.140, p=1.000). 4. I'he incidence of cesarean delivery due to fetal distress was 12.5 % (Group 1: 6.9%, Group 2: 17.1 %) and showed no statistically significant difference between the two groups (p=0.275). 5. The incidence of admission to NICU was 12.5 % (Group 1: 6.9%, Group 2: 17.1 %) and showed no statistically significant difference between the two groups (p=0.275). Adverse fetal outcome was not uniformly observed in postterm pregnancies with oligohydramnios. Amniotic fluid index in oligohydramnios group as a single independent guide was not enough to predict fetal outcomes in postterm pregnancy without specific pathologic condition of fetus.
Amniotic Fluid* ; Apgar Score ; Asphyxia ; Deceleration ; Female ; Fetal Distress ; Fetal Growth Retardation ; Fetus ; Gestational Age ; Heart Rate, Fetal ; Humans ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal ; Meconium ; Mortality ; Oligohydramnios ; Perinatal Mortality ; Pregnancy* ; Research Personnel

Pathogenetic mechanisms of progressive glomerulosclerosis are not clear. We studied the long-term(10 weeks) effects of puromycin aminonucleoside(PAN) in Sprague-Dawley rats with or without uninephrectomy(UN). Compared to rats with PAN injections only, rats with uninephrectomy and PAN injections showed significantly higher serum levels of urea nitrogen(153 +/- 155 mg/dl vs. 16 +/- 4 mg/dl, p<0.01), ceatinine(2.96 +/- 1.21 mg/dl vs. 0.92 +/- 0.36 mg/dl, p<0.01), cholesterol(466 +/- 125 mg/dl vs. 94 +/- 27 mg/dl, p<0.01), and triglyceride(337 +/- 237 mg/dl vs. 111 +/- 36 mg/dl, p<0.05) as well as increased amounts of proteinuria(428 +/- 90 mg/day vs. 136 +/- 130 mg/day, p<0.01). Lesions of focal segmental glomerulosclerosis(FSGS) were more frequently observed in rats with UN and PAN injections than rats with PAN infections only(39.5 +/- 17.2% vs. 4.3 +/- 4.7%, p<0.01). Ultrastructural examination of the glomeruli from rats with UN and PAN injections revealed severe epithelial cell changes including foot process effacement, vaculoar change or pseudocyst formation and focal detachment of epithelial cells from the underlying basement membrane. The results suggest that chronic nephrosis induced by PAN showed functional and morphologic features similar to those of human FSGS. Cytotoxic effect of PAN on the glomerular epithelial cells may be an initiating factor for the development of FSGS. which may be aggravated by some hemodynamic changes induced by uninephrectomy.
Humans ; Rats ; Animals

There have been a few reports suggesting that the imune response to pulmonary tuberculosis provides the appropriate setting for the development of IgA nephropathy (IgAN). To define better the relation between pulmonary tuberculosis and IgAN, we evaluated the prevalence of pulmonary tuberculosis among 386 Korean patients with IgAN. Seventeen cases (4.4%) showed abnormal chest X-ray findings suggestive of pulmonary tuberculosis. Ten patients were male and seven were female. Only one case was a child. Urinary abnormalities were detected during the course of antituberculous medication in 11 patients, and after completion of chemotherapy in 2. Chest abnormalities were noted in the remaining 4 patient after IgAN had been diagnosed. Clinical diagnosis of tuberculosis was made mainly based on the chest X-ray findings, but sputum Acid-Fast Bacilli were detected in one patient and pulmonary granulomo was noted in 2. The patients presented various clinical manifestations such as gross hematuris (5 cases), nephrotic syndrome (5 cases), asymptomatic urinary abnormalities (4 cases) and pyuris (1 case) at time of biopsy. Histologic grading of the glomerular lesions was made with modified Meadow classification (1972): one had grade I lesion, 8 grade II, 5 GRADE III and 3 showed grade IV. Follow-up studies were made in 7 patients. Six showed resolution of urinary abnormalities after completion f antituberculous medication, while one pursued chronic renal failure 20 days after the onset. The above clinical and morphologic features suggest that pulmonary tuberculosis may be partly related to the occurrence of IgAN in some Korean patients.
Child ; Male ; Female ; Humans ; Follow-Up Studies

We are report on three cases of typical clinical characterstics and treatment response in neuroleptic maligant syndrome(NMS), and reviewed the literatures of NMS. NMS was first recognized as a life-threatening complication of dopamine receptor antagonists, and defined as a catatonic-like states associated with fever, obtundation, muscle rigidity, and unstable vital sign in patients taking neuroleptic agents. Concepts of NMS have changed because medications other than classic neuroleptic drugs have been implicated as triggering agents and syndromes identical to NMS have been observed in other conditions. The important neurochemical features are probably functional dopamine deficiency and ensuing hyperactivity of excitatory amino and neurotransmission in the basal ganglia and hypothalamus. Recognition of NMS and early discontinuation of neuroleptics are the most important step in its management. Supportive care includes management of hyperthermia and fluid replacement. Contraversial therapeutic measures include the application of dopamine receptor agonists, excitatory amino acid antagosists, or dantrolene. Psychiatric patients with a history on NMS and psychotic relapse necessitating antipsycotics do not commonly redevelop NMS.
Antipsychotic Agents ; Basal Ganglia ; Dantrolene ; Dopamine ; Dopamine Agonists ; Dopamine Antagonists ; Excitatory Amino Acids ; Fever ; Humans ; Hypothalamus ; Muscle Rigidity ; Neuroleptic Malignant Syndrome* ; Recurrence ; Synaptic Transmission ; Vital Signs

Transitional vertebrae include lumbarization and sacralization of lumbosacral region. The prevalence of transitional vertebra was reported as 3 to 21%. It is known that transitional vertebra is related to herniated nucleus pulposus and spinal stenosis but there is no report in English literature about the relationship of transitional vertebra to spondylolysis or spondylolytic spondylolisthesis. The purpose of this study is to evaluate the relationship of transitional vertebra to spondylolysis or spondylolytic spondylolisthesis and to find out the clinical relevance for the treatment. The cases included 182 cases of spondylolysis or spondylolytic spondylolisthesis who were treated at Severance hospital from 1987 to 1993. There were 33 cases of transitional vetebra; 12 lumbarization and 21 sacralization. And there were remaining 149 cases of control group. The degree of anterior sippage was measured by Meyerding's grading and percentage of Taillard method. As the results, the degree of average anterior slippage of L4 was 14.5% in the cases of isthmic defect in L4 and sacralization. The average slippage of L4 was 11.4% in the control group. The degree of average anterior slippage of L5 was 12.5% in the cases of isthmic defect in L5 and lumbarization, and 9.5% in the cases of isthmic defect in L5 and sacralization. The average slippage of L5 was 16.2% in the control group. In summary and conclusion, the cases with isthmic defect in L4 and sacralization showed more anterior slippage than the cases with isthmic defect in L4 without transitional vertebrae, and the cases with isthmic defect in L5 and sacralization showed less anterior slippage than the cases with isthmic defect in L5 without transitional vertebrae. It is concluded that more aggressive treatment is recommended in the cases of isthmic defect in L4 and sacralization, whereas more conservative treatment is recommended in the cases of isthmic defect in L5 and sacralization.
Lumbosacral Region ; Methods ; Prevalence ; Spinal Stenosis ; Spine ; Spondylolisthesis ; Spondylolysis

It is likely that the peroneus longus tendon acts as a structure resisting the varus force upon the first column of the foot. Our study was designed to examine the possibility that absence of the peroneus longus insertion into the first metatarsal and first cuneiform will destabilize the first metatarsal. The fresh frozen cadaveric specimens of the lower leg were obtained. There were six right feet. The specimens appeared normal visually and roentgenographically. The tibial remnant was rodded by an intramedullary rod and the sprcimen was positioned in a specially designed rig so that standing position of the foot was simulated. The tibia was then loaded with twenty pounds. To obtain reproducible radiographic landmarks radioopaque beads were implanted underneath the level of the cortex through small drill holes in the following location : First metatarsal (one bead in the head, another bead in the base). The second metatarsal (again one bead in the head, on e bean in the base). To simulate the contraction of the peroneus longus muscle a suture was placed into the proximal end of the tendon, brought through two pulleys and loaded with a five pound weight. To create a varus force on the first metatarsal a stab incision was made over the base of the first metatarsal at its medial aspect and a suture was passed through the base of the first metatarsal. The suture was guided over a pulley and loaded with ten pounds. The second metatarsal head was fixed to the bottom of the rig with a smooth Steinmann pin. At this point an AP roentgenogram was taken of the footto assure proper positioning of the foot. Thereafter, the soft tissue between the first and second toe were cut sequentially : (1) Transection of the skin of the first web space both dorsally and plantarly. (2) Transection of the adductor hallucis tendon and the intermetatarsal ligament. (3) Transection of the peroneus longus tendon at its insertion. Each step in the transaction of the soft tissues was followed by another X-ray examination. In each roentgenogram the proximal and distal beads in the first and second metatarsal were connected by a line and the angles between those lines were measured. The results were statistically analyzed with the Friedman Chi square test between each step of the ten feet. Following the first and second step angular changes are not significant. Following the final step, adding release of the tendon insertion of the peroneus longus, the angle changes from 15.95 to 20.55 degrees (difference 4.60 degrees) and this is significant (p < 0.05).
Cadaver ; Foot ; Head ; Leg ; Ligaments ; Metatarsal Bones ; Metatarsus ; Posture ; Skin ; Sutures ; Tendons ; Tibia ; Toes

One of the common cause of the acquired adult flat foot is posterior tibial tendon insufficiency whose etiology and development is different from that of congenital flat foot, and various methods, such as synovectomy, tendon transfer, calcaneal osteotomy and arthrodesis, can be used to treat the symptoms. The sliding calcaneal osteotomy has been recently introduced by Mark Myerson. The basic concept beneath this treatment is that by displacing distal part medially after a calcaneal osteotomy, the valgus strain in hindfoot can be relieved to place the joint back to the normal position. In order to find out the effect of the sliding calcaneal soteotomy on the flat foot, we measured the changes in the strain in the upper medial spring ligament complex underneath the talonavicular joint after the operation. Four right hand four left fresh frozen cadaver foot specimens, which included the distal half of the tibia were utilized. The spring ligament was isolated with its origin at the sustentaculum tali and insertion on the navicular. At the medial calcaneus the soft tissues were periostially dissected and a small incision was made over the lateral calcaneus for the purpose of visualization. For each specimen a calibrated open liquid metal strain gauge was secured at the origin and insertion of the ligament with superglue and the gauge was sutured along the length of the superomedial portion of the spring ligament complex allowing for the gauge to slide freely. A tibial rod was driven into the intramedullary canal and the foot was always placed in the neutral plantigrade position in the test fig such that the rod was vertical at all times. A initial strain measurement was obtained with only the weight of the platform (19.6N) on the tibia. Weights were added in 7 increments to a total 472 Newton and strains were recorded. Three trials were conducted. The specimens were then removed from the rig and an oblique osteotomy were conducted. A repeated measures analysis of variance showed a significant (p < 0.001) reduction in strain following the osteotomy. To conclude, the direct measurements support the concept that a calcaneal osteotomy provides an alteration which is favorable to unloading the medial arch.
Adult ; Arthrodesis ; Cadaver ; Calcaneus ; Flatfoot ; Foot ; Hand ; Humans ; Joints ; Ligaments ; Osteotomy ; Posterior Tibial Tendon Dysfunction ; Tendon Transfer ; Tibia ; Weights and Measures

Ninety two injuries of the main nerves in the upper extremity observed in 79 patients, were studied at the Department of the Orthopedic Surgery, 17th Army Hospital from May 1965 to Aug. 1968. The treatment given consisted of neurolysis in 15, neurorrhapy in 77(primary 43 and secondary 34) and tendon transplantation and transfer in 11 cases. The results for the median, ulnar and radial nerves after primary and secondary suture were analyzed with respect to the level of injury(high and lower). The results of the median nerve repair were more succesful than those of the ulnar nerve, In these two nerve injuries, the sensory recovery was better than the motor and secondary suture gave better results than primary suture. Thirteen cases failed to respond to primary or secondary nerve repair, among those tendon transfer or tendon transplantation was tried in eleven cases, from the latter approximately 25% of motor recovery could be seen.
Hospitals, Military ; Humans ; Median Nerve ; Orthopedics ; Peripheral Nerve Injuries ; Peripheral Nerves ; Radial Nerve ; Sutures ; Tendon Transfer ; Tendons ; Ulnar Nerve ; Upper Extremity

No abstract available.
Animals ; Cadmium Chloride* ; Cadmium* ; Nasal Mucosa* ; Rats*

Inflammatory pseudotumor of the liver is a rare benign tumor with microscopic finding of fibrous stroma and chronic inflammatory cell infiltration. Predominance of plasma cells, histiocytes, lymphocytes, some eosinophils and whorled pattern of fibrosis is often characteristic. Due to similar radiologic appearance of hepatocellular carcinoma, inflammatory pseudotumor of the liver was often misdiagnosed and hepatic resection is often performed before preoperative tissue diagnosis. We report a case of inflammatory pseudotumor, which was a 47-year-old woman with fever, upper aMominal pain and weight loss, diagnosed by sonoguided liver biopsy and treated with antibiotic therapy only without surgery. After two weeks of treatment, the radiologic image of the mass was almost disappeared with improvement of previous symptoms. This opportunity and the possible effectiveness of antibiotic treatment should keep in mind in the differential diagnosis of the hepatic mass with similar radiologic appearance of hepatocellular carcinoma.
Biopsy ; Carcinoma, Hepatocellular ; Diagnosis ; Diagnosis, Differential ; Eosinophils ; Female ; Fever ; Fibrosis ; Granuloma, Plasma Cell* ; Histiocytes ; Humans ; Liver* ; Lymphocytes ; Middle Aged ; Plasma Cells ; Weight Loss