Objective : Scoliosis in cerebral palsy can seriously disturb the patient's daily life. To help alleviate this we developed a new original orthosis and named it the Dynamic Spinal Brace (DSB). In this study, we investigated the effectiveness of the DSB in daily life with patients and caregivers. Methods : We studied 222 cerebral palsy patients treated with the DSB. We carried out a questionnaire survey of the caregivers and measured X-ray results of the scoliosis deformities. Results: In the questionnaire, more than 80% of the patients improved in their sitting position and posture and more than 50 % of the patients improved in the transfer or ambulation assistance and meal assistance requirement by the caregivers. Higher age (over 18 years old) revealed improved muscle tonus. Breathing and muscle tonus showed improvement as scoliosis was advanced. Conclusion : DSB for scoliosis in cerebral palsy showed effectiveness in the sitting position, posture, transfer or ambulation assistance and meal assistance. DSB is also effective for muscle tonus in patients after growth maturity and breathing and muscle tonus in patients with severe scoliosis.

Objective : Recently, children with more severe disabilities are being hospitalized for inpatient rehabilitation. Therefore, it is becoming more difficult to adequately assess the effect of rehabilitation by conventional methods alone. The objective of this study is to evaluate the usefulness of the Canadian Occupational Performance Measure (COPM), which is an open-ended questionnaire that allows patients to prioritize their needs and rate their performance in different tasks of daily living as well as their satisfaction in performing them. Methods : The COPM performance and satisfaction scores of 81 patients hospitalized for over one month were measured at admission and discharge. Changes during inpatient rehabilitation were evaluated in each case. Results : The mean age at admission was 8.2 yrs. The mean length of inpatient stay was 56.2 days. The children included 31 girls and 50 boys. The distributions according to the Gross Motor Function Classification System (GMFCS) were Levels Ⅰ, Ⅱ, Ⅲ, Ⅳ, and Ⅴ in 3.7%, 8.6%, 28.4%, 32.1%, and 27.2% of patients, respectively. The mean COPM performance score and satisfaction score increased from 3.41 to 5.71 and 3.22 to 5.88 respectively with significant difference. The GMFCS level did not affect the changes in COPM scores. Conclusion : The COPM may work as a useful assessment method for relatively short-term inpatient rehabilitation children since it identifies child-unique problems that are mostly not assessed by conventional methods.

Endoscopic papillectomy (EP) for ampullary adenomas achieves cure rates ranging from 76% to 90%, and recurrence rates are as high as 33%. If remnant or recurrent lesions after prior EP are endoscopically visible and are not suspected of intraductal extension into the biliary or pancreatic duct, repeated snaring and cutting can be performed until all visible lesions are completely resected. However, endoscopic ablative therapies, particularly argon plasma coagulation, can be attempted for tiny or uncertain remnant and recurrent lesions. In addition, intraductal radiofrequency ablation has recently been attempted for residual intraductal lesions after EP at several institutions. Although still under investigation, it has shown some promise. It might be offered as an alternative to surgery, particularly in patients who are unfit for surgery or those who refuse to undergo surgery.