PURPOSE: The purpose of this study was to investigate the effects of a task-oriented upper arm exercise performed in a sitting position on either an unstable support surface or a stable support surface for children with cerebral palsy. METHODS: We prospectively evaluated 18 children with cerebral palsy. Eight subjects were randomly assigned to each of the stable and unstable support surface groups. We performed the upper arm exercise three times a week for 6 weeks. To confirm the effects of the intervention, the berg balance scale test, modified functional reaching test (MFRT), timed up and go test (TUG), and Jebsen-Taylor hand function test were conducted before and after the study. RESULTS: Significant differences were observed in MFRT and TUG between the experimental and control groups (p<0.05). In the Jebsen-Taylor hand function test, there were significant differences between the groups for the items picking up small objects, stacking checkers, lifting large light objects, and lifting large heavy objects (p<0.05), but not for writing and stimulation of feeding. Significant differences were observed between the groups in items of card turning, lifting large light objects, and lifting heavy objects. CONCLUSION: The purpose of this study was to evaluate the effectiveness of a task-oriented upper extremity exercise program for dynamic balance and hand function performed in a sitting position with either stable or unstable support by cerebral palsy patients. There were improvements in the two groups, but performing the exercise while sitting on an unstable support surface had a greater effect on dynamic balance and hand function than exercise while sitting on a stable supporting surface. The results of this study can be used to improve the daily lives of cerebral palsy patients.
Arm* ; Cerebral Palsy* ; Child ; Hand* ; Humans ; Lifting ; Prospective Studies ; Upper Extremity ; Writing

A clinical study was made on 68 cases of neonatal meningitis occuring under the age of 1 month at the department of Pediatrics at Severance Hospital, Yonsei University College of Medicine from 1st Jan. 1965 to 31th Dec. 1981. The sex ratio of male to female was 1.8:1 approximately. Neonatal predisposing factors significantly associated with neonatal meningitis were omphalitis(14 cases), skin infection (13 cases), birth injury (9 cases) and pneumonia (8 cases) etc. The most common maternal predisposing factor was difficult labor (13 cases). In 27 out of the 68 cultured CSF, the most common organisms were E. coli (29.6%), Staphylococcus coagulase(+) (22.2%) and Beta meholytic streptococcus (22.2%). Gram negative organisms were found in 12 cases (44.4%). The most common presenting symptoms were non-specific in nature -an elevated or subnormal body temperature, convulsion, poor feeding, irritability, jaundice and vomiting in that order of frequency. The presence of a poor Moro reflex, neck stiffness, unconsciousness or convulsion correlated with the high mortality rate significantly. Complications and sequelae included convulsion(11 cases), subdural effusion (8 cases), candida infection (8 cases), hydrocephalus (2 cases) and cerebral hemorrhage (2 cases) in that order of frequency. In the 68 cases, there were 29 mortalities or 42.6%.
Age Factors ; Female ; Human ; Infant, Newborn ; Male ; Meningitis/diagnosis ; Meningitis/epidemiology* ; Prognosis

The ductus arteriosus is a normal and essential structure in fetal circulation. Since the introduction of fetal echocardiography, there have been reports of ductal constriction, many of which were related to maternal use of some medications. However, there have been some reports of idiopathic ductal constriction, which usually present in later gestation. Recently we experienced a case, which initially showed an S-shaped ductus with mild narrowing at 23 weeks and 27 weeks gestation and developed severe ductal constriction at 33 weeks. Soon after birth, ductus was searched for but no ductus was found in 2-D and color images. The neonate required mechanical ventilation with supplemental oxygen for 3 days. All echocardiographic abnormalities were normalized in 7 months. We report progressive ductal constriction in an S-shaped ductus and emphasize the importance of continuous follow up extending to the third trimester and even immediately after birth.
Constriction* ; Ductus Arteriosus ; Echocardiography ; Female ; Fetus* ; Follow-Up Studies ; Humans ; Infant, Newborn ; Oxygen ; Parturition ; Pregnancy ; Pregnancy Trimester, Third ; Prenatal Diagnosis ; Respiration, Artificial ; Ultrasonography, Prenatal

The ductus arteriosus is a normal and essential structure in fetal circulation. Since the introduction of fetal echocardiography, there have been reports of ductal constriction, many of which were related to maternal use of some medications. However, there have been some reports of idiopathic ductal constriction, which usually present in later gestation. Recently we experienced a case, which initially showed an S-shaped ductus with mild narrowing at 23 weeks and 27 weeks gestation and developed severe ductal constriction at 33 weeks. Soon after birth, ductus was searched for but no ductus was found in 2-D and color images. The neonate required mechanical ventilation with supplemental oxygen for 3 days. All echocardiographic abnormalities were normalized in 7 months. We report progressive ductal constriction in an S-shaped ductus and emphasize the importance of continuous follow up extending to the third trimester and even immediately after birth.
Constriction* ; Ductus Arteriosus ; Echocardiography ; Female ; Fetus* ; Follow-Up Studies ; Humans ; Infant, Newborn ; Oxygen ; Parturition ; Pregnancy ; Pregnancy Trimester, Third ; Prenatal Diagnosis ; Respiration, Artificial ; Ultrasonography, Prenatal

Orbital lesions may be the presenting sign of a systemic disease, such as a metastatic cancer. A metastatic cancer of the orbit, which has been reported to account for 2~3% of all orbital tumor, is a malignant neoplasm that had spread by hematogenous routes to the orbit from a distant primary site. Although metastatic orbital tumors are mostly from breast, lung, prostate, rarely, they can be originated from gastrointestinal tract such as large intestine, ileum and pancreas. However, there has been no report of metastatic orbital tumor from biliary system, until now. Herein, we report a unique case of metastatic orbital tumor from the intrahepatic cholangiocarcinoma, which has been successfully controlled with systemic chemotherapy and radiotherapy.
Biliary Tract ; Breast ; Cholangiocarcinoma* ; Drug Therapy ; Gastrointestinal Tract ; Ileum ; Intestine, Large ; Lung ; Neoplasm Metastasis* ; Orbit* ; Pancreas ; Prostate ; Radiotherapy

BACKGROUND AND OBJECTIVES: During the transitional period from fetal to neonatal life, there are dramatic changes in the newborn circulation. Among these changes, the left ventricular diastolic function can be easily assessed by Doppler measurement of the mitral inflow. However, there are many physiologic and hemodynamic factors responsible for the mitral inflow. This study was designed to evaluate several parameters that represent the left ventricular function during the transitional circulation period. SUBJECTS AND METHODS: Eighteen normal full-term infants were studied by serial two-dimensional, Doppler and color flow echocardiography within 24 hours before and after birth, between 2 days and 6 days after birth and between 7 days and 30 days after birth). RESULTS: One day after birth, the mitral valve (MV) E velocity and E/A increased (37.9+/-7.5 vs. 60.3+/-9.0 and 0.8+/-0.1 vs. 1.1+/-0.1, p<0.01, respectively), but the MV A velocity, the velocity of propagation (Vp), the LV isovolumic relaxation time (IVRT), the corrected IVRT and the tissue Doppler ventricular septum e' and s' did not change. Although Vp/E and a' decreased (1.2+/-0.3 vs. 0.7+/-0.2 and 8.2+/-1.8 vs. 6.5+/-1.7, p<0.05, respectively), the E/e' and the systolic and diastolic pulmonary venous flow velocities increased after birth (6.3+/-1.9 vs. 11.6+/-2.9, and 26.1+/-6.7 vs. 64.5+/-9.6, and 20.9+/-4.1 vs. 63.5+/-17.2, p<0.05, respectively). CONCLUSION: Increased preload plays a key role for the increased MV E/A ratio after birth. Other unknown factors (and possibly including pericardial restriction) may be also responsible for left ventricular diastolic function.
Echocardiography* ; Echocardiography, Doppler, Color ; Hemodynamics ; Humans ; Infant ; Infant, Newborn ; Mitral Valve ; Parturition ; Relaxation ; Ventricular Function, Left ; Ventricular Septum

A 63-year-old female complained of transient dysarthria. MRA was conducted to evaluate this symptom, revealing distal internal carotid artery occlusion with collateral vessel development, suggesting Moyamoya disease, which had not been detected in MRA performed 5 years previously. Vascular risk factors and laboratory findings suggested no cardiac or autoimmune diseases. The diameter of stenosis of the middle cerebral artery on high-resolution MRI was 2.11 mm, and genetic evaluation revealed mutation of the gene encoding ring finger protein 213 (RNF213). High-resolution MRI and gene studies are useful for distinguishing between Moyamoya disease and atherosclerosis.
Adult* ; Atherosclerosis ; Autoimmune Diseases ; Carotid Artery, Internal ; Constriction, Pathologic ; Dysarthria ; Female ; Fingers* ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Middle Cerebral Artery ; Moyamoya Disease* ; Risk Factors

BACKGROUND: The metabolic syndrome (MS) is a cluster of risk factors of cardiovascular disease. The association between components of the MS and bone mineral density has been researched, but no prior studies have directly evaluated the association with the metabolic syndrome and bone mineral density in Korea. METHODS: We evaluated postmenopausal women who had visited a university hospital from November 2006 to October 2007. Data on their lifestyle, current medical diseases and medications were collected from medical records. Height, body weight, waist circumference and serum lipid profiles were measured. RESULTS: The prevalence of metabolic syndrome was 21.8% in this study. In adjusted analysis including age and other factors, only waist circumference had a close correlation with bone mineral density of femur and lumbar vertebral body (P < 0.05). The bone mineral density of femur and lumbar vertebral body had no correlation with the presence of metabolic syndrome. When stratified by body mass index, corrected bone mineral density revealed no significant correlation with the presence of metabolic syndrome. CONCLUSION: The bone mineral density of postmenopausal women with metabolic syndrome has highly influenced by obesity, especially by abdominal obesity.
Body Height ; Body Mass Index ; Bone Density ; Cardiovascular Diseases ; Female ; Femur ; Humans ; Life Style ; Medical Records ; Obesity ; Obesity, Abdominal ; Osteoporosis ; Prevalence ; Risk Factors ; Waist Circumference

BACKGROUND: The metabolic syndrome (MS) is a cluster of risk factors of cardiovascular disease. The association between components of the MS and bone mineral density has been researched, but no prior studies have directly evaluated the association with the metabolic syndrome and bone mineral density in Korea. METHODS: We evaluated postmenopausal women who had visited a university hospital from November 2006 to October 2007. Data on their lifestyle, current medical diseases and medications were collected from medical records. Height, body weight, waist circumference and serum lipid profiles were measured. RESULTS: The prevalence of metabolic syndrome was 21.8% in this study. In adjusted analysis including age and other factors, only waist circumference had a close correlation with bone mineral density of femur and lumbar vertebral body (P < 0.05). The bone mineral density of femur and lumbar vertebral body had no correlation with the presence of metabolic syndrome. When stratified by body mass index, corrected bone mineral density revealed no significant correlation with the presence of metabolic syndrome. CONCLUSION: The bone mineral density of postmenopausal women with metabolic syndrome has highly influenced by obesity, especially by abdominal obesity.
Body Height ; Body Mass Index ; Bone Density ; Cardiovascular Diseases ; Female ; Femur ; Humans ; Life Style ; Medical Records ; Obesity ; Obesity, Abdominal ; Osteoporosis ; Prevalence ; Risk Factors ; Waist Circumference

The optimal management of lesions located in the brainstem(BS) is problematic. As an alternative to microsurgical resection, stereotactic radiosurgery employing the Gamma unit has been used to manage BS lesions, and this can provide relatively safe and effective management. This study describes our experience with 17 patients who underwent Gamma Knife radiosurgery(GKR) for vascular lesions of the brainstem between June 1989 and May 1996. Six of these had BS arteriovenous malformations(AVMs). The minimal radiation dose to the margin of AVMs ranged from 15 to 25Gy(mean, 18.9Gy). Four of six cases were partially obliterated, and on follow-up angiography, one small AVM was seen to be completely obliterated. Twelve months after GKR, one patient experienced a temporary neurologic deficit due to the effects of radiation and another patient, who had a large AVM, showed a permanent deficit as a direct result of treatment. There have been no instances of hemorrhage after GKR and all the patients are still alive. GKR was used to manage 11 patients with angiographically occult vascular malformations (AOVMs) of the BS. The periphery of the lesions received a radiosurgical dose of between 12 and 20Gy(mean, 15.5Gy). In four patients, the lesions became smaller, but in one, an increase was seen. In the remaining six, size change was not documented. One patient's neurological deficit worsened, though that might be related not to GKR but to non-fatal post-GKR rebleeding. At seven months, one patient developed a temporary neurologic deficit in association with perilesional edema that resolved over time. Three patients experienced post-GKR rebleeding, and none died during the follow-up period. We believe that GKR is an excellent option for patients with BS AVMs: when the risks of microsurgery are deemed too high, it is a course of action which seems reasonable. GKR does not, though, appear to obliterate AOVMs as effectively as it does AVMs. To assess the long-term effectiveness of the technique on these lesions, longer follow-up intervals will, however, be required.
Angiography ; Arteriovenous Malformations ; Brain Stem* ; Edema ; Follow-Up Studies ; Hemorrhage ; Humans ; Microsurgery ; Neurologic Manifestations ; Radiosurgery* ; Vascular Malformations