When chemical agents penetrate the placenta, it is potentially hazardous to the embryo because the embryonic stage is known to be extremely sensitive to various toxic agents. It has been reported that exposure to some chemical agents during pregnancy resulted in the induction of malformation or cancer in the offspring of experimental animals (Larsen, 1947; Klein, 1952; DiPaolo, 1964; Druckrey et al. 1966; Mohr et al, 1966; DiPaolo and Elis, 1967; Spatz and Laqueus, 1967; Alexandrov, 1968; Fujii and Nishimura, 1969; Rice, 1969; Bulay and Wattenberg, 1970; Currie, 1970; Vesselinovitch et al, 1971; Swenberg et al, 1972; Nomura et al, 1973). Fraser and Fainstat (1954) and Kalter (1954) found that administration of cortisone to pregnant female mice induced the appearance of cleft palates in the offspring. The frequency with which this deformity appears was observed to depend on: I) the genotype of the treated animal (strain differences), 2) the dose of the chemical administered, 3) the time during the gestation period when the animal was treated. A single intraperitoneal injection of 5-fluorouracil at 10, 11, 12 or 13 days after copulation in mice also produced abnormalities to the feet, deft palate and deformities of the tail in a large proportion of fetuses (Dagg, 1960). Urethan has been considered to be a highly teratogenic and carcinogenic agent in experimental animals (Nishimura and Kuginuki, 1958: Nomura and Okamoto, 1972). However, they stated that accurate timing of urethan toxicity and accurate calculation of urethan dosage actually reaching the embryo make it possible to analyze the sensitivity of the developing mouse embryo to mortality, growth inhibition, malformation and neoplasm. Nomura and Okamoto (1972) reported that when pregnant mice were exposed to urethan on various days of gestation (day 5 to 19) by a single injection malformations and neoplasms were induced in their offspring. It is frequently implied that an abnormal phenotype is due to the aberration in the genotype, but it is not possible to prove the specitic causal relation. Though, the frequent association between a variety of chromosomal abnormalities solves the problem of how the genotypic and phenotypic are interreiated (Schultz, 1965). 5-bromodeoxyuridine (BUdR) and dimethylnitrosamine (DMN) induce chromosome aberrations in Chinese hamster cells cultured human lymphocytes and mouse cells in vivo (Somers and Hus, 1962; Kato, 1968; Matsuoka et al, 1979; Hahn and Kim, 1979). BUdR is a thymidine analog incorporated into only the DNA of proliferating cells and its mutagenic action is well understood (Freese, 1963). DMN is a potent carcinogen which induces tumors of the liver, lung, and kidney in rats (Magee and Bames, 1959). This agent has no teratogenic effect in rats when given in doses of different concentrations for different periods of time and by several routes of administeration during all stages of embryogeny (Alexandrov, 1967). The experiments reported in this study were undertaken to investigate the possibility that treatment of ICR inbred pregnant mice with BUdR and DMN might shows deformities or abnormalities in their offspring and also to determine whether chemical exposure during fetus will effect at 32 weeks after birth with second exposure to DMN by cytogenetical means. In this study, estrus ICR females were mated and 32 mice which had been diagnosed as pregnant were used. BUdR at the rate of 70, 100 and 150mg/kg of body weight was injected intraperitoneally at 6, 7, 8 days and 9, 11, 13 days of gestation, and DMN at the rate of 10, 20 and 30 mg/kg of body weight was injected at 8, 10, 12 days and 14, 15, 16 days of gestation, The offspring were examined macroscopicaily at time of birth for malformations. All animals were killed at 32 weeks of age and examined for liver abnormalities. The liver were cultured and treated with 1, 5 and 10 ug/ml of DMN for 18 hours. The frequencies of chromosome aberrations and sister chromatid exchanges (SCE) were analyzed. The results are summarized as follows: 1. The litter size was reduced on treated animals. 2. Among the 279 progeny from 36 BUdR treated mothers, malformations were seen in a total of 10 progeny and the group treated at the 9 to 13 gestation days stage had the most. 3. Of the 155 progeny from 24 mothers injected with DMN, none had any visible deformity. However. 37.5% of the group were found to have liver nodules after 32 weeks treated at the 8 to 12 gestation day stage. 4. Repetitive treatment with DMN of the liver culture of the previously BUdR and DMN treated progeny, showed increased chromosome aberrations and SCE frequencies. In conclusion since the exposure of the mother of BUdR and DMN during pregnancy leads to increased chromosomal abnormalities of the cultured liver cells of progeny when treated with DMN a second time, it is necessary to keep in mind that genetic damage may be occure to the progeny by exposing the mother during pregnancy.
Animals ; Body Weight ; Bromodeoxyuridine ; Chromosome Aberrations ; Cleft Palate ; Congenital Abnormalities ; Copulation ; Cortisone ; Cricetinae ; Cricetulus ; Cytogenetics ; Dimethylnitrosamine ; DNA ; Embryonic Structures ; Estrus ; Female ; Fetus ; Fluorouracil ; Foot ; Genotype ; Humans ; Injections, Intraperitoneal ; Kidney ; Litter Size ; Liver ; Lung ; Lymphocytes ; Mice ; Mortality ; Mothers ; Mutagens ; Palate ; Parturition ; Phenotype ; Placenta ; Pregnancy ; Rats ; Sister Chromatid Exchange ; Tail ; Thymidine ; Urethane

A Malignant Schwannoma is a relatively rare primary nerve sheath tumor arises from Sehwann cells of the peripheral nerves. This tumor is frequently associated with von Recklinghausens disease. A high percentage of patients experience local recurrence even after radical surgical excision, and eventual pulmonary metastases via the intraneural and hematogenous routes. The treatment of choice is radical excision or amputation. Results of treatment with radiation and chemotherapy have been disappointing. The authors have experienced two cases of Malignant Schwannoma, one of which was located in the median nerve of the palm, the other in the ulnar nerve of the arm, but neither were associated with von Recklinghausens disease.
Amputation ; Arm ; Drug Therapy ; Humans ; Median Nerve ; Neoplasm Metastasis ; Neurilemmoma ; Neurofibromatosis 1 ; Peripheral Nerves ; Recurrence ; Ulnar Nerve

Lowe et al. have described a disease characterized by organic aciduria, decreased renal ammonia production, hydrophthalmos, and mental retardation, this disease is now called as Lowe's syndrome or oculo-cerebro-renal syndrome which manifests growth plates, metabolic acidosis, and characteristic eye changes, including bilateral cataract, glaucoma and nystagmus. It is a congenital hereditary affectation. Most of the patients with this syndrome are male sex. We report a new case of Lowe's syndrome in a 5-year old girl.
Acidosis ; Ammonia ; Cataract ; Child ; Female ; Glaucoma ; Growth Plate ; Humans ; Hydrophthalmos ; Intellectual Disability ; Male

Cervical spine injuries are increasing recently due to increasing traffic accidents. Many patients have been treated with cervical laminectomy but stabilization of the cervical spine has been neglected as a part of the treatment. 30 patients with cervical spine injuries who were admitted to our hospital from January 1, 1973 to December 31, 1978 were evaluated. The following observations were made: 1. The ratio between male and female was 2:1 and the majority(43%) were found in the 4th decades. 2. The common causes of cervical spine injuries were traffic accident(40%) and falls(33.3%). The most common site of the lesion was the 5th and 6th cervical spine level (33.3%). 3. Among 30 cases, 10 cases(33.3%) had complete paralysis, 12 cases(40%) incomplete paralysis, 6 cases (20%) had nerve root injury and no neurological change is 2 cases. 4. The mechanisms of cervical injuries were classified morphologically and flexion-rotation injuries (55.5%) were the most common. 5. We evaluated the results of treatment neurological & radiographically. In complete paralysis, there was no neurological improvement and cervical kyphosis increased after laminectomy. In incomplete paralysis and nerve root injury, anterior fusion showed slight neurological recovery but mild cevical kyphosis and displacement of the graft were observed. In posterior fusion or cast immobilization, we had a satisfactory result with a high fusion rate and normal cervical curvature. 6. lt is impossible to compare anterior interbody fusion with posterior fusion for neurological recovery. For early mobilization and rehabilitation, we emphasize early stabilization by anterior or posterior fusion according to the mechanism of injury.
Accidents, Traffic ; Clinical Study ; Early Ambulation ; Female ; Humans ; Immobilization ; Kyphosis ; Laminectomy ; Male ; Paralysis ; Rehabilitation ; Spine ; Transplants

The function of the knee joint is determined by the anatomical integrity of ligamentous structures, however the ligaments and soft tissues which support by the knee joint are too weak to tolerate forceful stresses. The knee joint is one of the most susceptible joints to ligamentous injury. Recently, the incidence of ligamentous injuries of the knee increased because of rise in traffic accidents and participation in sports. For good results, it is very important to make an early diagnosis and to give prompt management. The authors reviewed 67 cases of ligamentous injuries in patients who were admitted and managed at the Department of Orthopaedic Surgery of Presbyterian Medical Center from March of 1976 to December of 1982. The results of the clinical study are as follows: 1. The prevalent age group is the 3rd through 5th decades, and more frequent in males (8. 6 times). 2. The traffic accident is the most common cause of injury (80. 6%) and many ligamentous injuries were associated with fracture (53. 2%). 3. The most common ruptured individual ligament was the medial collateral ligament. The isolated ligamentous rupture of anterior and posterior cruciate ligament was 3 cases each, but most of the cruciate ligaments were combined with other ligament injury. 4. The rupture sites of the individual ligaments were found to be the following: (a) The medial collateral ligament was ruptured most frequently in the mid-substance (45. 2%), with the deep layer ruptured at the femoral attachment and the superficial layer in the mid-substance; (b) The lateral collateral ligament torn at the fibular attachment (62. 5%); (c) The anterior cruciate ligament torn at the femoral and tibial (47. 6%, respectively); (d) The posterior cruciate ligament torn at the femoral attachment (40. 0%). 5. It is significant if the difference between the normal knee and the injured knee on the stress film is more than 10 or 10mm. 6. Excellent and good results were obtained in 95.2% by non-surgical management and in 93.0% by surgical management. 7. Early surgical repairs, made within 2 weeks after injury, gave much better results than late repairs.
Accidents, Traffic ; Anterior Cruciate Ligament ; Clinical Study ; Collateral Ligaments ; Early Diagnosis ; Humans ; Incidence ; Joints ; Knee Joint ; Knee ; Lateral Ligament, Ankle ; Ligaments ; Male ; Posterior Cruciate Ligament ; Protestantism ; Rupture ; Sports

Beurgers disease is a specific, recurrent, segmental, inflammatory, obliterative vascular disease involving principally the medium sized arteries and veins of the extremities. The disease was originally described by Leo Beurger in 1908. The results in treatment were not satisfactory in spite of many interaction and experiencies in treatment. So the present study is clinical analysis of 136 cases of Beurgers disease, who were treated at the Department of Orthopaedic Surgery and General Surgery, Presbyterian Medical Center, for the past 12 years, from 1971 to 1982. The results obtained are as follows: Sex distribution was predominent in male(97.1%) and peak incidence in the fourth decade. One hundred twenty eight cases had smoked over 10 years and sixty percent had more than one operation previously because of the same disease. The most common symptom was pain in the extrimities, necrosis, skin color change and coldness were in that order of frequency. The lower extremities were more commonly involved. The most common site of obstruction at the arteriogram was the popliteal artery. Among the surgery cases, 20 of the sympathetomized patients had followed-up, and the long term result showed improvement in 17 cases and all the results of the vascular surgery were poor.
Arteries ; Clinical Study ; Extremities ; Humans ; Incidence ; Lower Extremity ; Necrosis ; Popliteal Artery ; Protestantism ; Sex Distribution ; Skin Pigmentation ; Smoke ; Thromboangiitis Obliterans ; Vascular Diseases ; Veins

Spondylolisthesis has been become of considerable causative disease for low back pain in orthopedic field recently. Twenty-seven patients with spondylolisthesis, who were taken operation during a 7-year period from Jan. 1978 to Dec. 1984 at Department of Orthopedic Surgery of Presbyterian Medical Center, were studied and analized on clinical and radiological aspects and the results of obtained were as follows: 1. The averake age was 41.7 years with a range of 20 to 63 years, and the incidence was more common in female than male in all types. 2. By Wiltse's classification, isthmic type was most common and 19 patients were included and level of spondylolisthesis was common at fourth lumbar vertebra in degenerative type and fifth lumbar vertebra in isthmic type. 3. By Meyerding's grading, 14 patients (52%) were Grade 1, which was most common and the slipping measured by Taillard's method was most common with a range 10% to 19%, which included 13 patients (48%) and average slipping was 21.4%. 4. Meschan's angle was ranged from 5° to 19° with an average of 13.3°. 5. Myelogram was done in 13 patients and 9 of them showed positive findings. 6. Spina bifida was most common developmental abnormal finding and 11 patients (41%) were included. 7. Posterolateral fusion was done in 24 patients and anterior interbody fusion was done in 3 patients. 8. 24 patients who had taken posterolateral fusion were permitted to ambulate early at 2 weeks with Norton-Brown back brace. 9. After over a year follow-up, 23(85%) of 27 patients had satisfactory result. 10. After follow-up, 21(88%) of 24 patients who had taken posterolateral fusion had successful fusion.
Braces ; Classification ; Clinical Study ; Female ; Follow-Up Studies ; Humans ; Incidence ; Low Back Pain ; Male ; Methods ; Orthopedics ; Protestantism ; Spinal Dysraphism ; Spine ; Spondylolisthesis

The epidural injection of corticosteroid reduces the inflammatory process of the neural structure and its neighbor structures. Morphine, also injected epidurally, has been reported to alleviate severe pain with the short-acting property. In attempt to prolong the effectiveness of pain relief, we have studied the effect of the epidural injection of the morphine and steroid frorg May 1987 to Oct. 1987, and compared with the effect of the epidural injection of the steroid and local anesthetics from Jan. 1986 to Oct. 1987. In this study, we obtained following results; 1. The major causative diseases were herniated necleus pulposus in 34 cases(48.5%), spinal stenosis in 16 cases(22.9%) and spondylolisthesis in 9 cases(12.9%). 2. In morphine-injected group, 100% of acute group and 92.3% of chronic group was improved. In non-morphine injected group, there was no significant difference between the acute and chroinc groups. 3. The effect of epidural morphine and steroid was as follows; Complete relief 14 cases (63.6%), marked improvement 5 cases(22.7%), moderate improvement 2 cases(9.2%) and no relief 1 case(4.6%). The overall improvement was resulted in 21 cases(95.4%). 4. The effect of epidural steroid and local anesthetics was as follows; Complete relief 10 cases(20.8%), marked improvement 14 cases(29.2%), moderate improvement 12 cases(25%~ and no relief 12 cases(25%). The overall improvement was resulted in 36 cases(75%). 5. The average duration of pain relief was 2.5 months in morphine injected group and 1.3 months in non-morphine injected group. 6. The side effects associated with opiate, such as generalized pruritus, nausea, vomiting and urinary retention were reported in 16 cases(72.7%), but responded readily to Naloxone injection and subsided within 24 hours. It is considered that epidural injection of morphine and steroid prolong the effect and duration of pain relief for low back pain and sciatica when compared with the epidural injection of steroid and local anesthetics.
Anesthetics, Local ; Injections, Epidural ; Low Back Pain ; Morphine ; Naloxone ; Nausea ; Pruritus ; Sciatica ; Spinal Stenosis ; Spondylolisthesis ; Urinary Retention ; Vomiting

The results of arthroscopic synovectomy of the knee joints were reviewd in 23 joints of 21 patients hetween May 1992 and June 1996. The results were as follows: 1. Pain, tenderness, swelling, ROM of synovitis syrnpknns were much nsiproved postoperatively. 2. The degrees of articular cartilage damage were closely related to posto-perative functional recovery. 3. Preoperative and postoperative ESR changes were not ditferent signihcantly, 4. Recurrence rate was 17%, 4 cases. Of them, 2 cases were rheumatoid arthritis, 1 case was pigmented villonodular synovitis, I case was nonspecipic synovitis 5. Complicatior of arthrosc:opic synovectomy was nol found. We concluded that arthroscopic synovectoiny was very useful method of early diagnosis and treatment of synovial memhrane diseases.
Arthritis, Rheumatoid ; Arthroscopy ; Cartilage, Articular ; Early Diagnosis ; Humans ; Joints ; Knee Joint* ; Knee* ; Recurrence ; Synovitis ; Synovitis, Pigmented Villonodular

Fifty-nine knees with a specific diagnosis of mediopatella plica syndrom; under arthroscopy were treated by arthroscopic resection. The patients were se1ected for arthroscopy only if the symptoms had continued after a course of physical therapy and medication for at least three weeks. Seven patients were lost in follow up period. Fifty-two knees were reviewed after mean period of 21.5 monl;hs (range 12 to 37). The results were graded as excelient (61.5%), good (25%), poor (9.6%) and failure (3.9%). Majority of the patients ratect their result as excellent or good. We concluded that with the meticulous resection of the pathologic plica with arthroscopy, good result can he expected with resumption of athletic activities and no or mild pain in knee joint.
Arthroscopy ; Diagnosis ; Follow-Up Studies ; Humans ; Knee Joint* ; Knee* ; Sports