PURPOSE: The most significant fact about wheezing in early infancy is that it is very common. Until recently, despite its high prevalence and hints of subsequent long- term morbidity, the natural history of early infancy wheezing has been incompletely understood. We evaluated the outcome of the patients who experienced wheezing during first year of life until 5 years of age and the prognostic factors for later development of asthma. METHODS: 72 infants less than 1 year old age who were hospitalized with wheezing-associated respiratory infection over a period of 12 months from 1994 to 1995 were included. After the first wheezing episode, the patients were followed-up prospectively until 5 years of age. The recurrent wheezing episodes were registered at 1-2, 2-4, and after 4 years of age. The frequency of wheezing episodes was assessed in relation to the later asthma at 5 years of age. Total serum IgE, the presence of atopic dermatitis, family history of allergic disease, RSV infection on first admission were investigated and compared between two groups of children who had asthma and who had no more asthma at 5 years of age. These early findings were also evaluated as risk factors for later development of asthma. RESULTS: 28(38%) of the 72 patients with bronchiolitis before 1 year old age suffered from subsequent wheezing until 5 years of age. The prevalence of atopic dermatitis(39% vs 14%, P<0.05), total serum IgE(98.5+/-3.7 IU/mL vs 13.6+/-3.5 IU/mL, P<0.001), frequency of repeated wheezing episodes(6.4+/-2.7 vs 3.4+/-2.9, P<0.001) were significantly higher in patients with later asthma than in patients with no more asthma at 5 years of age. RSV infection showed no association with the later development of asthma. CONCLUSION: The risk for later asthma is increased after bronchiolitis in early infancy. Early atopic findings and frequently repeated wheezing episodes are significant risk factors for developing asthma in later childhood.
Asthma* ; Bronchiolitis* ; Child ; Dermatitis, Atopic ; Follow-Up Studies* ; Humans ; Immunoglobulin E ; Infant* ; Natural History ; Prevalence ; Prospective Studies ; Respiratory Sounds ; Risk Factors

Cutis verticis gyrata(CVG) is a morphologic syndrome of the scalp characterized by folds and furrows resembling the surface of brain. The primary form of cutis verticis gyrata is commonly associated with a neuropsychiatric condition and a secondary form occurs as a response of inflammatory or neoplastic process. The patient was a 1-day-old girl, who had a 15x11 cm sized, convoluted mass over whole scalp. Skin biopsy from the lesion was consistent with cerebriform intradermal nevus. The baby girl was followed up as an outpatient with monitoring of the scalp lesion for 2 years and showed improvement of folds and furrows of the lesion.
Biopsy ; Brain ; Female ; Humans ; Infant, Newborn* ; Nevus, Intradermal* ; Outpatients ; Scalp ; Skin

PURPOSE: We evaluated the diagnostic implications and therapeutic efficacy of antithrombin III(AT III) in the disseminated intravascular coagulation(DIC) of premature infants. METHODS: Ninety-two premature infants diagnosed with DIC and treated with AT III from March, 2000 to May, 2003 were retrospectively reviewed. Clinical manifestations, complete blood counts, coagulation tests, and AT III levels were compared between the two groups:definite DIC if clinical signs of DIC and AT III <70% with more than two abnormal laboratory parameters were present, and suspected DIC if not more than two abnormal laboratory parameters were present. RESULTS: AT III was given for an average of 3.2 days and no side effects related to the treatment were reported. The AT III levels increased significantly more than four fold with treatment in both groups. The clinical signs and laboratory values improved significantly after treatment. CONCLUSION: AT III level is a sensitive parameter in the diagnosis of DIC in premature infants, and it is useful as a treatment modality since it improves the clinical symptoms and the laboratory parameters without significant side effects.
Antithrombin III* ; Blood Cell Count ; Dacarbazine ; Diagnosis* ; Disseminated Intravascular Coagulation* ; Humans ; Infant, Newborn ; Infant, Premature* ; Retrospective Studies

Laryngeal leukoplakia is seen in a number of pathologic settings such as keratosis without atypia(KWOA), keratosis with atypia(KWA), squamous cell carcinoma in situ(CIS) and invasive squamous cell carcinoma, and it continues to be a confusing and controversial topic for both otolaryngologist and pathologist. This is largely due to the use of ambiguous and inconsistent terminology, the lack of unanimous agreement on the definition of these terms, failure of the clinician to obtain a representative biopsy, and the subjectivity of the pathologist interpreting the biopsy. To evaluate the applicability of the expression pattern of p53 and PCNA in borderline cases of histopathologic classification, we performed a histopathologic analysis of leukoplakia to includ clinical follow-up, correlation of disease progression and degree of atypia, and expression of p53 and PCNA according to the degree of atypia. Histologically, laryngeal leukoplakia included seven cases of KWOA, fourteen cases of KWA (mild-2, moderate-8, severe-4), three cases of CIS, and one case of invasive squamous cell carcinoma. Keratosis with atypia, a moderate degree or more, showed a strong tendency to progress to invasive carcinoma(p<0.05). The degree of p53 and PCNA expression correlated with the degree of atypia(p<0.05). p53-positive cases at the initial biopsy clearly tended to recur and develop into invasive carcinoma(p<0.01).
Biopsy

Mucopolysaccharidoses (MPSs) are a group of inherited heterogenous metabolic disorders, caused by deficiency of an enzyme involved in the degradation of mucopolysaccharides, and thus deposition of mucopolysaccharides in all connective tissue. MPS type III is heparan sulphate storage disorder, especially marked central nervous system involvement. As with all the MPS disorders, this patient with MPS III presents coarse outlook features, such as macrocephaly, macroglossia, prominent mandible, short neck, and unstable atlantoaxial joints, as well as tracheal abnormality. These clinical findings give significant challenges to the anesthesiologist for adequate airway management and tracheal intubation. Recently, a number of new devices have been developed to facilitate intubation. We report an experience of facilitated tracheal intubation using video styletscope (OptiScope PM201(R), Pacific Medical, Seoul, Korea) in a 16 year old male patient with MPS III, who was undergoing inguinal hernia repair.
Airway Management ; Atlanto-Axial Joint ; Central Nervous System ; Connective Tissue ; Glycosaminoglycans ; Hernia, Inguinal ; Humans ; Intubation ; Intubation, Intratracheal ; Macrocephaly ; Macroglossia ; Male ; Mandible ; Mucopolysaccharidoses ; Neck

OBJECTIVE: The purpose of this study is to investigate the transmission route and determine the clinical characteristics of rotavirus infection in asymptomatic neonate in the nursery. METHODS: From November to December 2001, 88 term neonates in the nursery of Ewha Womans University Hospital were evaluated for the screening of rotavirus infection. Fecal specimens of neonate were tested for rotavirus by latex agglutination. The clinical characteristics were compared between the rotavirus positive and negative group and follow up was done by OPD visiting or by telephone. RESULTS: Among the 88 neonates, 17 cases(19%) were rotavirus positive result. There were no difference in sex, delivery method, gestational age, birth weight, birth place between the rotavirus positive group and negative group, but mixed feeding was more common in the rotavirus positive group (p=0.01). Only 3 neonates in the rotavirus negative group were readmitted because of diarrhea. Readmission rate and clinical symptoms were not different in the two groups during follow up. CONCLUSION: The positive rate of rotavirus in nursery is high, but most of all were asymptomatic. Routine rotavirus screening test among asymptomatic neonate seems to be unnecessary. The neonate with rotavirus have to be isolated for preventing the spreading.
Agglutination ; Birth Weight ; Diarrhea ; Female ; Follow-Up Studies ; Gestational Age ; Humans ; Infant, Newborn ; Latex ; Mass Screening ; Nurseries* ; Residence Characteristics ; Rotavirus Infections* ; Rotavirus* ; Telephone

Intrathecal baclofen (ITB) therapy has been proven to reduce severe spasticity in cerebral palsy (CP). However, few results reported the objective gait pattern change after ITB bolus injection in adult ambulatory CP. We therefore evaluated observational and kinematic gait patterns at different ITB bolus injection doses. We performed a test trial of 3-day ITB bolus injections at doses of 12.5 microg, 25 microg, and 50 microg in ambulatory CP. We evaluated modified Ashworth scale, visual analogue scale, observational gait scale, and kinematic gait analysis after ITB bolus injection. Intrathecal administration of low-dose baclofen 25 microg was successfully used not only for the treatment of spasticity but also for the treatment of gait disturbance, whereas the higher dose baclofen 50 microg induced foot drop and deteriorated gait pattern. We experienced dose-dependent changes in gait pattern confirmed by the observational and kinematic gait assessments after ITB bolus injection in adult ambulatory CP.
Adult* ; Baclofen* ; Cerebral Palsy* ; Foot ; Gait* ; Humans ; Muscle Spasticity

OBJECTIVE: To evaluate the effect of hospital-based cardiac rehabilitation (CR) on quality of life (QOL) and physical ability in patients with myocardial infarction (MI). METHODS: Patients with MI who were referred to the Cardiac Health and Rehabilitation Center 2 weeks after percutaneous coronary intervention were divided into CR and non-CR groups. The CR group performed supervised exercises 3 times a week for 2 months. QOL assessment, using the 36-item Short-Form Health Survey (SF-36) and physical ability evaluation were performed at the beginning and end of CR. RESULTS: The CR group demonstrated statistically significant improvements in physical functioning (PF), physical role functioning (RP), bodily pain (BP), general health perceptions (GH), vitality (VT), social role functioning (SF), emotional role functioning (RE), mental health (MH), physical component summary (PCS), and mental component summary (MCS). The non-CR group showed improvement in RP. Secondary outcomes, including resting heart rate (RHR), maximal oxygen consumption (VO(2max)), metabolic equivalent of task (MET), maximal exercise time (ET(max)), stage 3 Borg rating of perceived exertion (3RPE), maximal Borg rating of perceived exertion (RPEmax), and stage 3 rate pressure product (3RPP), improved in the CR group. The non-CR group showed improvements in VO(2max), MET, ET(max), and 3RPE. There were significant differences in improvements in PF, RP, BP, VT, SF, MH, MCS, RHR, VO(2max), MET, ET(max), 3RPE, and 3RPP between the two groups. CONCLUSION: Male patients with MI demonstrated improvements in QOL and physical ability following hospital-based CR; the impact on the mental component was greater than that on the physical component.
Exercise ; Health Surveys ; Heart Rate ; Home Care Services, Hospital-Based ; Humans ; Male ; Mental Health ; Metabolic Equivalent ; Myocardial Infarction* ; Oxygen Consumption ; Percutaneous Coronary Intervention ; Physical Fitness ; Quality of Life* ; Rehabilitation Centers ; Rehabilitation*

PURPOSE: Total knee replacement is one of the most painful orthopedic procedures, and effective pain relief is essential for early mobility and discharge from hospital. The aim of this study was to evaluate whether addition of single-injection femoral nerve block to epidural analgesia would provide better postoperative pain control, compared to epidural analgesia alone, after total knee replacement. MATERIALS AND METHODS: Thirty-eight patients received a single-injection femoral nerve block with 0.25% levobupivacaine (30 mL) combined with epidural analgesia (femoral nerve block group) and 40 patients received epidural analgesia alone (control group). Pain intensity and volume of patient-controlled epidural analgesia medication and rescue analgesic requirements were measured in the first 48 hours after surgery at three time periods; 0-6 hours, 6-24 hours, and 24-48 hours. Also, side effects such as nausea, vomiting, and pruritus were evaluated. RESULTS: Median visual analog scale at rest and movement was significantly lower until 48 hours in the femoral nerve block group. Patient-controlled epidural analgesia volume was significantly lower throughout the study period, however, rescue analgesia requirements were significantly lower only up to 6 hours in the femoral nerve block group. The incidences of nausea and vomiting and rescue antiemetic requirement were significantly lower in the femoral nerve block group up to 6 hours. CONCLUSION: The combination of femoral nerve block with epidural analgesia is an effective pain management regimen in patients undergoing unilateral total knee replacement.
Aged ; Analgesia, Epidural/*methods ; Analgesia, Patient-Controlled/*methods ; Anesthetics, Local/administration & dosage/therapeutic use ; Arthroplasty, Replacement, Knee/*methods ; Bupivacaine/administration & dosage/analogs & derivatives/therapeutic use ; Female ; Femoral Nerve/*drug effects ; Humans ; Injections ; Male ; Middle Aged ; Nerve Block/*methods

PURPOSE: Treatment options for patients with advanced gastric cancer remain limited. Few studies have investigated the efficacy and tolerability of the combination regimen of oxaliplatin and 5-fluorouracil with leucovorin for patients with advanced gastric cancer. The goal of this study was to examine the efficacy and toxicity of a modified FOLFOX-6 (mFOLFOX-6) regimen as a first-line chemotherapy regimen for patients with advanced gastric cancer. MATERIALS AND METHODS: From March, 2006, to December, 2007, 82 patients with advanced gastric cancer received 100 mg/m2 oxaliplatin and 100 mg/m2 leucovorin on the first day of treatment, followed by 2,400 mg/m2 of 5-fluorouracil on the first and second days of treatment every 2 weeks as a first-line treatment. RESULTS: The median age of the enrolled patients was 62 years (range; 30~75). Out of 82 patients, 34 cases (41.5%) were recurrent cases after curative resection, and the other 48 cases were unresectable or non-curative resectable cases. Their response was evaluated every 6 weeks. The overall response rate was 40.2%, with 2 (2.4%) complete response and 31 (37.8%) partial responses. The median time to progression (TTP) and overall survival (OS) time were 6.0 months (95% confidence interval [CI]: 4.69~7.31) and 13.0 months (7.99~18.0), respectively. The grade 3~4 hematologic toxicities observed included neutropenia (34.1%), thrombocytopenia (7.3%), and anemia (1.2%). The gastrointestinal toxicities observed included grade 3~4 nausea (9.8%) and vomiting (7.3%). Six patients (7.3%) experienced grade 3 neuropathy. No treatment-related deaths were recorded. CONCLUSION: The modified FOLFOX-6 regimen is effective and well tolerated as a first-line chemotherapy regimen for patients with advanced gastric cancer.
Anemia ; Antineoplastic Combined Chemotherapy Protocols ; Chemotherapy, Adjuvant ; Fluorouracil ; Humans ; Leucovorin ; Nausea ; Neutropenia ; Organoplatinum Compounds ; Retrospective Studies ; Stomach Neoplasms ; Thrombocytopenia ; Vomiting