PURPOSE: Hip adductor spasticity has a great impact on developing hip displacement in children with cerebral palsy (CP). Obturator nerve (ON) block is less invasive intervention rather than soft tissue surgery for reduction of hip adductor spasticity. The aim of this study is to investigate the effect of ON block on hip lateralization in low functioning children with spastic CP. MATERIALS AND METHODS: The study was performed by retrospective investigation of the clinical and radiographic follow-up data of low functioning children [gross motor function classification system (GMFCS) level III to V] with spastic cerebral palsy whose hip was subluxated. Migration percentage (MP) was measured on hip radiographs and its annual change was calculated. In intervention group, ON block was done with 50% ethyl alcohol under the guidance of electrical stimulation. RESULTS: The data of 49 legs of 25 children for intervention group and the data of 41 legs of 23 children for nonintervention group were collected. In intervention group, the MP were significantly reduced at 1st follow-up and the MPs at 2nd and last follow-up did not show significant differences from initial MP. Whereas in nonintervention group, the MPs at 1st, 2nd and last follow-up were all significantly increased compared to initial MPs. CONCLUSION: ON block with ethyl alcohol is useful as an early effective procedure against progressive hip displacement in these children with spastic CP.
Cerebral Palsy/*drug therapy ; Child ; Child, Preschool ; Ethanol/therapeutic use ; Female ; Humans ; Male ; Muscle Spasticity/drug therapy ; Nerve Block/*methods ; Obturator Nerve/*drug effects ; Retrospective Studies

OBJECTIVE: To determine reliability and clinical use of two methods of migration index (MI) in CP patients with or without hip dysplasia. METHOD: The materials included radiographs of 200 hips of children with cerebral palsy. Conventional anteroposterior radiographs of the pelvis were taken with the child in the supine position with standardized methods. Two rehabilitation doctors measured the migration index using two methods. In the classic method, the lateral margin of the acetabular roof was used as a landmark and in the modified method the lateral margin of the sourcil was used as a landmark. Each rater measured the migration index at three separate times with a time interval of at least one week. Intraclass correlation (ICC) was used to test the inter- and intra-rater reliability. RESULTS: MI shows excellent intra-rater reliability in both the classic and modified methods, but the inter-rater reliability was higher in the classic method than in the modified method. When categorized according to the sourcil classification, inter-rater reliability was higher in the normal sourcil type and lower in the dysplastic sourcil types. CONCLUSION: Generally, the classic method showed higher reliability than the modified method, even though the reliability of the MI measurement was relatively high with both methods.
Cerebral Palsy ; Child ; Hip ; Hip Joint ; Humans ; Pelvis ; Supine Position

Isodicentric chromosome 15 [idic(15)] is a rare chromosomal abnormality that occurs due to inverted duplication of chromosome 15q. It is associated with many clinical findings such as early central hypotonia, developmental delay, cognitive dysfunction, autism spectrum disorders, and seizure. Delayed development is a common problem referred to pediatric rehabilitation clinics. A 9-month-old boy with delayed development was referred to our clinic for assessment and treatment. On chromosomal analysis, he was diagnosed as idic(15) syndrome with 47,XY,+idic(15)(q12) on karyotyping. Herein we describe his clinical manifestations and provide a brief review of the related literature.
Aneuploidy ; Child ; Autism Spectrum Disorder ; Chromosome Aberrations ; Chromosomes, Human, Pair 15 ; Developmental Disabilities ; Karyotyping ; Muscle Hypotonia ; Seizures

PURPOSE: The objective of this study was to describe hand function in relation with gross motor function and subtype of spastic cerebral palsy and to investigate the relationships among gross motor function, bimanual performance, unimanual capacity and upper limb functional measures in children with spastic cerebral palsy (CP). MATERIALS AND METHODS: We collected upper extremity data of 140 children with spastic CP. The Gross Motor Functional Classification System (GMFCS) was used to assess gross motor function, Manual Ability Classification System (MACS) for bimanual performance, and Modified House Functional Classification (MHC) for the best capacity of each hand. Upper limb functions were evaluated by using the Upper Limb Physician's Rating Scale and Upper Extremity Rating Scale. RESULTS: There was a good correlation between GMFCS and MACS in children with bilateral CP, but the correlation was not strong in children with unilateral CP. No significant difference between GMFCS and MACS was found in children with bilateral CP, but children with unilateral CP scored higher on GMFCS than on MACS. A strong correlation was observed between MACS and MHC in children with bilateral CP, but not in children with unilateral CP. The upper limb functional measures in each hand were highly related with MACS and MHC in bilateral CP, but not in unilateral CP. CONCLUSION: Gross motor function, bimanual performance and the best capacity of each hand are closely related with each other in children with bilateral CP, but not in children with unilateral CP.
Cerebral Palsy/classification/*physiopathology ; Child ; Child, Preschool ; Disability Evaluation ; Hand/*physiopathology ; Humans ; *Motor Skills ; Upper Extremity/physiopathology

OBJECTIVE: To investigate the frequency of tarsal tunnel syndrome (TTS) in the diabetic neuropathy patients. METHOD: Electrodiagnostic study was performed to diagnose diabetic neuropathy and tarsal tunnel syndrome (TTS) in 56 patients (male 25, female 31) with diabetes mellitus. The frequency of combined TTS in diabetic neuropathy patients was calculated. RESULTS: Out of 56 diabetic patients, 52 patients were diagnosed as diabetic peripheral neuropathy. The frequency of concomitant TTS was 22 cases in 52 diabetic patients with diabetic neuropathy. CONCLUSION: In diabetic neuropathy group, the frequency of TTS was higher than general population.
Diabetes Mellitus ; Diabetic Neuropathies ; Female ; Humans ; Peripheral Nervous System Diseases ; Tarsal Tunnel Syndrome

OBJECTIVE: To evaluate the diagnostic value of pudendal nerve terminal motor latency (PNTML) and the relationship with manometric profiles in patients with fecal incontinence. METHOD: A total of 29 patients with fecal incontinence who visited colorectal clinic were recruited. The PNTMLs of 29 patients were compared with those of normal controls (2.03+/-0.39) using one-sample t test. Patients were classified into three groups according to pudendal nerve latency; Group I (normal latency, n=8), group II (unilaterally delayed latency, n=9), group III (bilaterally delayed latency, n=12) and compared with manometric parameters (mean maximal resting pressure, mean maximal squeezing pressure, 1st sense volume, urge sense volume, maximal tolerance volume). RESULTS: The PNTML is 3.83+/-2.19 in right side, 4.57+/-2.19 in left side which are significantly delayed in patients with fecal incontinence compare to that of normal controls, 2.03+/-0.39. (p=0.031 in Rt., p=0.000 in Lt.) Among group I~III, there were no statistically significant differences in the values of mean maximal resting pressure, mean maximal squeezing pressure, 1st sense volume, urge sense volume and maximal tolerance volume. There was no correlation between the PNTML and any of manometric parameters. CONCLUSION: The PNTML is valuable in diagnosing patients with fecal incontinence. It is suggested that combined assessments are necessary to identify the cause of fecal incontinence.
Fecal Incontinence ; Humans ; Manometry ; Pudendal Nerve

OBJECTIVE: To investigate the reliability of inspection-based classification of sagittal gait patterns in children with bilateral spastic cerebral palsy (CP). METHOD: Video clip recordings of gait patterns and sagittal kinematic data obtained by a computerized motion analysis system from 91 patients with bilateral spastic CP were reviewed. The abnormal gait patterns were classified into 4 groups using the method described by Rodda et al. Visual observation-based classification (visual classification) was compared with classification by 3D analysis-based methods (3D classification). The reliabilities of visual classifications made by an experienced physician and a trainee physician were analyzed. RESULTS: The consistency of inspection-based gait classification using kinematic data analysis was demonstrated by an experienced physician (Kappa coefficient (k)=0.67, p<0.001). However, the consistency was low for the trainee physician (k=0.37, p<0.001). Group III (apparent equinus) was commonly confused with group IV (crouch gait) by the trainee physician, resulting in lower agreement for those two evaluation groups than for other patterns. Video observation showed low reliability in comparisons made between the experienced and the trainee physician (k=0.37, p<0.001). CONCLUSION: There was substantial agreement of gait classification between video observation and kinematic data analysis by the experienced physician, but not by the trainee physician. Low reliability was also demonstrated for inspection-based gait classification.
Cerebral Palsy ; Child ; Gait ; Humans ; Muscle Spasticity ; Statistics as Topic

BACKGROUND: In an era of medical cost containment, cost-effectiveness has become a major focus in healthcare. The effect of a new policy on the use of low fresh gas flow during maintenance of general anesthesia with volatile anesthetics was evaluated. METHODS: The numbers and duration of general anesthesia cases using sevoflurane 5 weeks prior to and 15 weeks after policy implementation were retrieved from the electronic medical records database. The number of sevoflurane bottles consumed was also assessed. The anesthesia hours per bottle of sevoflurane were compared before and after policy implementation. RESULTS: The number of anesthesia hours performed per bottle of sevoflurane increased by 38.3%. The effect varied over time and tended to fade with time. CONCLUSIONS: The implementation of a low fresh gas flow rate policy effectively reduces the amount of sevoflurane consumed for the same duration of anesthesia.
Anesthesia ; Anesthesia, General ; Anesthetics ; Cost Control ; Delivery of Health Care ; Electronic Health Records ; Methyl Ethers

BACKGROUND: Social interests and the prevalence of skin disease have increased rapidly along with social development and improvement of life quality. Information on skin diseases and aesthetics are available through the internet and mass media. However, there have been few studies on the value of this information and the treatment-seeking behavior of patients. OBJECTIVE: To evaluate the recognition of skin health and diseases in patients who visit dermatology clinics and to improve the role of dermatologists in the process. METHODS: From March, 2008, to April, 2008, 1901 patients were asked to complete a questionnaire in 62 dermatologic hospitals. The questions covered: purposes of visiting the clinic; duration of skin disease; treatment-seeking behavior; recognition of the prescribed medicine; compliance and common sense about representative skin problems. RESULTS: Patients visited the dermatologic clinic because of skin disease for 67.39% of patients, esthetic treatment in 22.88% of patients, and both in 9.73% of patients. For visits to a dermatology clinic for skin problems, 61.28% of patients visited a clinic but 38.72% did not. Most (81.38%) patients followed the doctor's prescription. Most negative responses to prescribed medicine were due to the internet and mass media or wrong information from pharmacists (52.24%). Moreover, patients who learned about skin diseases and prescription medicines through the internet usually lacked compliance and common sense regarding their skin problems. CONCLUSION: The internet can provide good information about healthy skin and skin diseases, but we have to consider its disadvantages of exaggeration and misbelief. The effects of this tool have been overstated and excessively publicized in comparison to actual established clinical results. Use of the internet may delay diagnosis and decrease compliance. Consequently, dermatologists have to provide correct information to minimize the disadvantages of internet information. Patients who have abnormal skin problems should visit dermatologic clinics to be evaluated and treated appropriately.
Compliance ; Dermatology ; Esthetics ; Humans ; Internet ; Mass Media ; Outpatients ; Pharmacists ; Prescriptions ; Prevalence ; Quality of Life ; Skin ; Skin Diseases ; Social Change ; Surveys and Questionnaires

BACKGROUND: With the development of medical science and technology, the proportion of the aged in the population has significantly increased. For the same reasons, concerns regarding skin aging and skin diseases in the geriatric population has increased. OBJECTIVE: To evaluate the recognition of skin health and disease in the elderly. METHODS: On April 2009, 190 elderly persons were asked to complete a questionnaire in 5 senior welfare centers in the city of in Korea. The questions included: satisfaction with the subject's own skin; treatment-seeking behavior; knowledge and common sense about representative skin problems; efforts taken to achieve healthy skin. RESULTS: Among the elderly, 44.74% were dissatisfied with their own skin. The most complained about skin diseases in the elderly were pruritus and xerosis. Also, interest in esthetic problems such as wrinkles and pigmentation was high. On the question of whether they visit a dermatologic clinic when they develop skin problems, 40.53% of subjects said that they visited the dermatologic clinic. However, this means that 59.47% did not visit a dermatologic clinic. A somewhat unexpected finding was that knowledge of skin diseases and esthetic problems were plentiful in the geriatric population. Among the elderly, 81.05% did something to achieve skin health such as using a moisturizer or sunscreen. CONCLUSION: The present study contributes to our understanding of the recognition of dermatologic problems in the geriatric populations. Dermatologists and society should pay more attention to the provision of correct information and appropriate treatments for skin diseases in the elderly.
Aged ; Humans ; Korea ; Pigmentation ; Pruritus ; Skin ; Skin Aging ; Skin Diseases ; Surveys and Questionnaires