Objectives: Most developmental screening tests have been built as parent-performed questionnaires. However, they often do not guide parents on how to answer the questionnaire. This study aimed to develop easily applicable parent guidelines. Methods: We implemented the Delphi procedure with 20 panelists. The development of the initial questionnaire was based on the results of two surveys of parents and experts provided by a policy research report that investigated the item adequacy of the Korean Developmental Screening Test. Round one included 33 items comprising all possible measurements in six categories that were identified as difficult to understand or confusing. Round two merged and modified some items and included 32 items. We defined consensus as a median agreement value of one or less and convergence and stability values of 0.5 or less. The subjective usefulness of the parent guidelines was examined based on their previous test experiences. Results: Consensus was reached after the second round, reflecting the items with the highest level of accuracy in each category. Of the 167 parents who participated in the survey, 113 (67.7%) affirmed the usefulness of the guidelines, while 10 (6.0%) answered that they were not useful. Items that recommended a different scoring strategy in answering the questionnaire from their previous measurements were found to be more useful by the parents. Conclusion The parent guidelines, composed of five bullet points, drew on the consensus of the experts. Further studies are required to assess whether these guidelines improve the accuracy of screening tests in clinical settings.

Vaginal foreign bodies in children are often associated with intermittent vaginal disch-arge, vaginal bleeding and create a clinical scenario similar to that of certain cases of sex-ual abuse and isolated premature menarche. Intravaginal foreign body of especially long duration can pose a diagnostic dilemma, since a number of diagnostic modalities may fail to detect its existence. A 4-year-old girl who suffered from a bloody, malodorous vaginal discharge visited SNUH. She had had such problems for over a year and had been evaluat-ed by several gynecologists. Preoperative evaluations including ultrasound was performed and pelvis MRI strengthened the suspicion that some foreign bodies could be an etiologic factor. A vaginal inspection performed under general anesthesia with 0degrees endoscope and nasal speculum size no. 43 revealed "pen top of ink pen" lodged in her vaginal mucosa of posterior fornix area. We were allowed to remove a foreign body without trauma of genital tract by nasal forceps. We report a case of intravaginal foreign body in a 4-year-old girl with a brief review.
Anesthesia, General ; Child ; Child, Preschool* ; Endoscopes ; Female* ; Foreign Bodies* ; Humans ; Ink ; Magnetic Resonance Imaging ; Menarche ; Mucous Membrane ; Pelvis ; Surgical Instruments ; Ultrasonography ; Uterine Hemorrhage ; Vagina ; Vaginal Discharge

BACKGROUND: Segmental glomerulosclerosis without significant mesangial or endocapillary proliferation is rarely seen in IgA nephropathy (IgAN), which simulates idiopathic focal segmental glomerulosclerosis (FSGS). We recently recognized aberrant blood vessels running through the adhesion sites of sclerosed tufts and Bowman's capsule in IgAN cases with mild glomerular histologic change. METHODS: To characterize aberrant blood vessels in relation to segmental sclerosis, we retrospectively reviewed the clinical and histologic features of 51 cases of FSGS-like IgAN and compared them with 51 age and gender-matched idiopathic FSGS cases. RESULTS: In FSGS-like IgAN, aberrant blood vessel formation was observed in 15.7% of cases, 1.0% of the total glomeruli, and 7.3% of the segmentally sclerosed glomeruli, significantly more frequently than in the idiopathic FSGS cases (p = .009). Aberrant blood vessels occasionally accompanied mild cellular proliferation surrounding penetrating neovessels. Clinically, all FSGS-like IgAN cases had hematuria; however, nephrotic range proteinuria was significantly less frequent than idiopathic FSGS. CONCLUSIONS: Aberrant blood vessels in IgAN are related to glomerular capillary injury and may indicate abnormal repair processes in IgAN.
Blood Vessels* ; Bowman Capsule ; Capillaries* ; Cell Proliferation ; Glomerulonephritis, IGA* ; Glomerulosclerosis, Focal Segmental ; Hematuria ; Immunoglobulin A* ; Kidney Glomerulus ; Proteinuria ; Retrospective Studies ; Running ; Sclerosis

OBJECTIVES: To clarify the clinicopathologic features of borderline malignancy of the ovary and analyze the treatment and survival characteristics through the study of our cases. Study METHODS: 102 patients with borderline tumors of the ovary, aged from 14 to 79 years, treated between 1982 and 1999 at Seoul National University Hospital, were analyzed retrospectively for clinicopathologic features. Most informations about stage, treatment modality and prognosis were obtained by hospital record or contacting patient with telephone. RESULTS: There were 77 patients (75.5%) with stage Ia, 5 stage Ib, 11 stage Ic, 4 with stage II and 5 with stage III by the classification of FIGO. 72 patients (70.6%) were mucinous type and 28 (27.5%) were serous type, 1 endometrioid type, 1 mixed. Total abdominal hysterectomy, bilateral adnexectomy, and omentectomy were performed in 43 (42.2%) patients and fertility saving surgery in 43 patients(cystectomy in 11 patients, USO in 32 patients). Twenty two patients (21.6%) were treated with postoperative adjuvant chemotherapy. The median duration of follow up was 54.0 months (1-204 months) and 6 patients developed recurrence after several years from the primary operation. The ten-year eumulative survival rate was 92.2% and the only independent prognostic factors evaluated by Cox analysis in regards to corrected survival were the FIGO stage (p=0.0197). There was no difference in the ten-year survival rate between surgery types - conservative surgery versus full surgical staging. And there was no difference in the 10-year survival rate between treatment groups - surgery only versus surgery followed by adjuvant chemotherapy. CONCLUSIONS: FIGO stage is the only independent prognostic factor in the borderline ovarian tumors. There was no difference in the 10-year survival rate of barderline ovarian tumors between surgery alone versus surgery followed by adjuvant chemothearpy. The slow clinical course, low recurrence rate and good prognosis in our patients explained again the reason for therapeutic approach relying on surgery alone.
Chemotherapy, Adjuvant ; Classification ; Female ; Fertility ; Follow-Up Studies ; Hospital Records ; Humans ; Hysterectomy ; Mucins ; Ovary* ; Prognosis ; Recurrence ; Retrospective Studies ; Seoul ; Survival Rate ; Telephone

Tumor hypoxia, a common feature occurring in nearly all human solid tumors is a major contributing factor for failures of anticancer therapies. Because ionizing radiation depends heavily on the presence of molecular oxygen to produce cytotoxic effect, the negative impact of tumor hypoxia had long been recognized. In this review, we will highlight some of the past attempts to overcome tumor hypoxia including hypoxic radiosensitizers and hypoxia-selective cytotoxin. Although they were (still are) a very clever idea, they lacked clinical efficacy largely because of ‘reoxygenation’ phenomenon occurring in the conventional low dose hyperfractionation radiotherapy prevented proper activation of these compounds. Recent meta-analysis and imaging studies do however indicate that there may be a significant clinical benefit in lowering the locoregional failures by using these compounds. Latest technological advancement in radiotherapy has allowed to deliver high doses of radiation conformally to the tumor volume. Although this technology has brought superb clinical responses for many types of cancer, recent modeling studies have predicted that tumor hypoxia is even more serious because ‘reoxygenation’ is low thereby leaving a large portion of hypoxic tumor cells behind. Wouldn’t it be then reasonable to combine hypoxic radiosensitizers and/or hypoxia-selective cytotoxin with the latest radiotherapy? We will provide some preclinical and clinical evidence to support this idea hoping to revamp an enthusiasm for hypoxic radiosensitizers or hypoxia-selective cytotoxins as an adjunct therapy for radiotherapy.
Anoxia* ; Cytotoxins ; Hope ; Humans ; Oxygen ; Radiation, Ionizing ; Radiotherapy* ; Treatment Outcome ; Tumor Burden

OBJECTIVE: To evaluate the complication and recurrence rates in patients undergoing trocar-guided mesh implant for pelvic organ prolapse (POP) treatment. METHODS: A retrospective study was performed based on the medical records of patients who had undergone mesh implant by one surgeon from May 2006 to August 2013 at the Presbyterian Medical Center in Korea. We evaluated perioperative complications such as bladder injury, mesh exposure, urinary symptoms, infections, and chronic pelvic pain. Recurrence was defined as a POP-quantification system stage ≥II or any symptomatic prolapse. RESULTS: Sixty-seven patients were evaluated, and the mean age of patients was 65.4±7.2 years. Stage ≥III POP-quantification Ba was noted in 61 patients (91%). Intraoperative complications included three cases of bladder injury (4.5%). The mean follow-up period was 44.1±7.9 months. Postoperative complications occurred in seven women (10.5%): four cases of urinary symptoms (6%), two cases of infections (3%), and one case of chronic pelvic pain (1.5%). Mesh exposure did not occur (0%). Prolapse recurrence was reported in five patients (7.5%). CONCLUSION: Based on our operational result, the trocar-guided mesh implant seems to provide safe and effective outcomes.
Female ; Follow-Up Studies ; Humans ; Intraoperative Complications ; Korea ; Medical Records ; Pelvic Organ Prolapse* ; Pelvic Pain ; Postoperative Complications ; Prolapse ; Protestantism ; Recurrence ; Retrospective Studies ; Surgical Mesh ; Urinary Bladder

Cancer of the vulva accounts for approximately 0.5% of all gynecologic malignancies. At diagnosis, one-third of these cases is detected in an advanced stage (FIGO stages III, IV), and local extension of primary vulvar cancer may involve adjacent midline structures such as the clitoris, urethra, vagina, and anus. Initial surgical therapy of such locally advanced primary cancers may compromise the functional integrity of midline structures, necessitating ultraradical surgery including pelvic exenteration. In view of the relatively elderly age of the patients and the morbidity of this ultraradical dissection, concomitant chemoradiation therapy - that the efficacy had been proven in head and neck cancer, anal cancer has approached for patients with locally advanced vulvar cancer. We experienced a case of stage III vulvar cancer patient, who underwent concomitant chemoradiation therapy with 5-fluorouracil(FU) and cisplatin and who showed complete response. So, we report this case with brief review of the literatures.
Aged ; Anal Canal ; Anus Neoplasms ; Cisplatin ; Clitoris ; Diagnosis ; Female ; Head and Neck Neoplasms ; Humans ; Pelvic Exenteration ; Urethra ; Vagina ; Vulvar Neoplasms*

We report a case of a solitary osteochondroma as a dumbbell tumor compressing the spinal cord and its surgical strategy. The patient is a 16-year-old female with longstanding posterior neck pain and left arm abduction weakness. She was examined by plain X-ray, three-dimensional-computed tomography, magnetic resonance imaging, and vertebral angiography. The analyses indicated a calcified extradural mass compressing the cord in the C3–4 portion extending into the neural and vertebral foramen with eroded vertebral body. The tumor was successfully excised using a modified combined anterior and posterior approach. Histopathologic study of the resected material confirmed the diagnosis. The postoperative assessment was followed by clinical and radiologically therapy for 5 years after surgery. Osteochondroma arises from enchondral bone but it rarely involves the spine, especially not as s dumbbell type. In this patient, the tumor may have arisen from the neural arch and extended into the extradural and extraforaminal space over a long period. We successfully removed the dumbbell tumor with a combined anterior oblique and posterior approach. However, further observation is essential because of the possibility of recurrence and sarcomatous change.
Adolescent ; Angiography ; Arm ; Cervical Cord* ; Cytochrome P-450 CYP1A1 ; Diagnosis ; Female ; Humans ; Magnetic Resonance Imaging ; Neck Pain ; Osteochondroma* ; Recurrence ; Spinal Cord ; Spinal Cord Compression ; Spine

Anomalous systemic arterial supply to the normal basal segments with normal bronchial connection of the lung without sequestration is a rare anomaly. It was classified as a type of sequestration according to Pryce's terminology, but whether the term - one of the sequestration is appropriate or not, is controversial because of normal bronchial connection. We describe our experience with surgical treatments for anomalous arterial supply to the normal basal segments of the left lower lobe.
Lung ; Pulmonary Artery

The most frequent ectopic locations of endometriosis include, in descending order of frequency, the ovaries, uterine ligaments, the rectovaginal septum, and peritoneum covering the pelvic organs, that is, uterus, fallopian tubes, rectum, sigmoid colon, and bladder. Endometriosis at the site of episiotomy scar and abdominal scar following cesarean section are very rare conditions among the extrapelvic endometriosis. We have experienced two cases of endometriosis. One occurred from episiotomy scar and the other occurred from abdominal scar following cesarean section. The diagnosis of scar endometriosis is suggested if the symptoms are cyclic or in association with the patient's menstrual cycle. We can use ultrasonography, computerized tomography, magnetic resonance imaging to differentiate from other tumors. Surgical excision is the method of choice for diagnosis and treatment. We report the two cases with review of rare extrapelvic endometriosis.
Cesarean Section* ; Cicatrix* ; Colon, Sigmoid ; Diagnosis ; Endometriosis* ; Episiotomy* ; Fallopian Tubes ; Female ; Ligaments ; Magnetic Resonance Imaging ; Menstrual Cycle ; Ovary ; Peritoneum ; Pregnancy ; Rectum ; Ultrasonography ; Urinary Bladder ; Uterus