OBJECTIVES: This study was conducted in order to evaluate the effectiveness of a day-center treatment program to promote development of children with pervasive development disorder (PDD) and pervasive development disorder/mental retardation (PDD/MR). METHODS: Twenty five children (14 in the PDD group and 11 in the PDD/MR group) participated in a day-center treatment program. They had been enrolled in the whole program for 2-3 years. Their performance was evaluated according to the Preschool Language Scale (PRES), Social Maturity Scale (SMS), and Korean version of the Childhood Autism Rating Scale (CARS). They were grouped by diagnosis at the beginning of the program and the treatment effect was compared. RESULTS: Children who participated in the day-center treatment program showed a significant increase in their PRES and SMS scores and a decrease in their CARS scores. CONCLUSIONS: A day-center treatment program is effective for development of children with PDD and PDD/MR.
Autistic Disorder ; Child ; Child Development Disorders, Pervasive ; Humans

PURPOSE: To analyze clinical, radiological and pathological features as well as clinical outcome after surgical treatment of patients with secondary chondrosarcoma arising from osteochondroma(tosis). MATERIALS AND METHODS: We retrospectively reviewed clinical records, radiographs, pathologic slides of 14 patients. Nine patients were male and five were female. The mean age was 34 years. The mean follow-up period was 54 months. RESULTS: All patients had a history of previous mass since childhood or puberty. Preexisted osteochondroma was single in 3 patients and multiple in 10. Remaining 1 patient had multiple osteochondromatosis with enchondromatosis. MRI clearly provided thickness of cartilage cap, which was over 2 cm except in 2 cases. Chondrosarcoma was grade 1 in all except 1 case, which was grade 2. Wide excision was performed in 10 patients, marginal excision in 3 and amputation in 1. Twelve patients were doing very well without evidence of disease. Among 3 patients with marginal excision, 1 patient had local recurrence and 1 patient died of disease. CONCLUSION: Comprehensive understanding of clinical, radiological and pathological features of secondary chondrosarcoma is warranted for accurate diagnosis. The best result can be expected with early recognition of malignant change of osteohcondroma(tosis) and wide excision.
Amputation ; Cartilage ; Chondrosarcoma ; Enchondromatosis ; Female ; Follow-Up Studies ; Humans ; Male ; Osteochondroma ; Osteochondromatosis ; Puberty ; Recurrence ; Retrospective Studies

PURPOSE: To investigate prognostic factors influencing on local recurrence, distant metastasis and event-free survival of liposarcomas. MATERIALS AND METHODS: Fifty-two patients managed for liposarcomas since 1993 were analyzed respectively in the view of prognostic influence of patient age, tumor size, location, histologic type, histologic grade, resection type, surgical margin, chemotherapy and radiation therapy on local recurrence, distant metastasis and event-free survival. The mean follow up period was 39 months. The univariate and multivariate regression analysis were performed for statistical evaluation. RESULTS: The local recurrences occurred in 11 patients (21.2%) and distant metastasis in 4 patients (8%), Event-free survival rate at 4 year follow up was 67%. In univariate analysis, histologic grade, surgical margin, chemotherapy and radiation therapy were significant prognostic factors on local recurrence (p<0.05). However, histologic grade lost its significance in muitivariate analysis. Trunk location revealed higher rate of distant metastasis than extremity location. In univariate analysis on event-free survival. histologic grade and chemotherapy were significant factors (p<0.05). No factor remained significant in multivariate analysis. CONCLUSION: Considering selection bias, positive surgical margin was negative prognostic factor on local recurrence. Liposarcomas arisen in trunk revealed higher rate of distant metastasis. There was no independent prognostic factor on event-free survival of patients with liposarcomas.
Disease-Free Survival ; Extremities ; Follow-Up Studies ; Humans ; Liposarcoma ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Selection Bias

OBJECTIVES: Machine learning (ML) encompasses a body of statistical approaches that can detect complex interaction patterns from multi-dimensional data. ML is gradually being adopted in medical science, for example, in treatment response prediction and diagnostic classification. Cognitive impairment is a prominent feature of schizophrenia, but is not routinely used in differential diagnosis. In this study, we investigated the predictive capacity of the Wechsler Adult Intelligence Scale IV (WAIS-IV) in differentiating schizophrenia from non-psychotic illnesses using the ML methodology. The purpose of this study was to illustrate the possibility of using ML as an aid in differential diagnosis. METHODS: The WAIS-IV test data for 434 psychiatric patients were curated from archived medical records. Using the final diagnoses based on DSM-IV as the target and the WAIS-IV scores as predictor variables, predictive diagnostic models were built using 1) linear 2) non-linear/non-parametric ML algorithms. The accuracy obtained was compared to that of the baseline model built without the WAIS-IV information. RESULTS: The performances of the various ML models were compared. The accuracy of the baseline model was 71.5%, but the best non-linear model showed an accuracy of 84.6%, which was significantly higher than that of non-informative random guessing (p=0.002). Overall, the models using the non-linear algorithms showed better accuracy than the linear ones. CONCLUSION: The high performance of the developed models demonstrated the predictive capacity of the WAIS-IV and justified the application of ML in psychiatric diagnosis. However, the practical application of ML models may need refinement and larger-scale data collection.
Adult ; Classification ; Cognition Disorders ; Data Collection ; Diagnosis ; Diagnosis, Differential* ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Intelligence ; Machine Learning ; Medical Records ; Mental Disorders ; Nonlinear Dynamics ; Schizophrenia*

Hemodynamics in 60 normal, 15 simple goiter and 40 hyperthyroid subjects were determined from non-invasive Wezler's method. Hemodynamic changes in hyperthyroid patients were compared with those of normal subjects. The relationships of the cardiac output, aging,131I uptake rate and PEP/LVET to the hemodynamic changes in Hyperthyroid patients were also discussed. 1) The hemodynamics of normal subjects were same as those of simple goiter. 2) The heart rate and cardiac output were increased very significantly in hyperthyroid patients but they appeared to decrease with age. The stroke volume was increased slightly in the hyperthyroid patients, but remained unlateerd even with aging. Peripheral arterial resistance in hyperthyroid patients was decreased but appeared to increase with age. 3) As the131I uptake rate increased, the heart rate, cardiac output also increased, but PEP/LVET as an index of myocardial contractility and the peripheral arterial resistance decreased. 4) PEP/LVET as an index of myocardial contractility in hyperthyroid patients was markedly reduced. 5) The relationship of stroke volume and the rate of the heart to cardiac output in normal subjects were reasonably linear, and peripheral arterial resistance has negative relation to cardiac output. However the heart rate, though increased in most patients with thyrotoxicosis, bears no close relations to the level of cardiac output increment. The relationshop of stroke volume to cardiac output in hyperthyroid patients is reasonably linear and peripheral arterial resistance has negative correlation with the cardiac output.
Aging ; Cardiac Output ; Goiter ; Heart ; Heart Rate ; Hemodynamics* ; Humans ; Stroke Volume ; Thyrotoxicosis

The upper trunk of the brachial plexus is the most common area affected by neuralgic amyotrophy (NA), and paresis of the shoulder girdle muscle is the most prevalent manifestation. Posterior interosseous nerve palsy is a rare presentation in patients with NA. It results in dropped finger on the affected side and may be misdiagnosed as entrapment syndrome or compressive neuropathy. We report an unusual case of NA manifested as PIN palsy and suggest that knowledge of clinical NA phenotypes is crucial for early diagnosis of peripheral nerve palsies.
Brachial Plexus ; Brachial Plexus Neuritis* ; Early Diagnosis ; Fingers ; Humans ; Paralysis* ; Paresis ; Peripheral Nerves ; Phenotype ; Shoulder

Lymphocytic ascites with low serum-ascites albumin gradient (SAAG) are observed mainly in tuberculous peritonitis, peritoneal carcinomatosis, and pancreatic disease. However, pelvic inflammatory disease (PID) induced generalized peritonitis causing diffuse ascites has been rarely described. We report a 26-year old female patient, who was diagnosed as generalized peritonitis with diffuse ascites due to Chlamydia trachomatis infection. Gynecologic examination did not show the clue of PID and in the analysis of ascites, low SAAG, predominant lymphocyte count and high level of adenosine deaminase were noted. Although the best impression was tuberculous peritonitis on the base of these findings, the laparoscopic finding was consistent with PID and the PCR for C. trachomatis infection in cervical swab was positive. This case suggests that C. trachomatis peritonitis should be considered as a rare cause of low SAAG and lymphocytic ascites in sexually active women and should be intensively evaluated including laparoscopic examination.
Adult ; Anti-Bacterial Agents/therapeutic use ; Ascites/diagnosis/metabolism/therapy ; Ascitic Fluid/chemistry ; Cephalosporins/therapeutic use ; Chlamydia Infections/complications/*diagnosis/drug therapy ; Chlamydia trachomatis/genetics/*isolation & purification ; Diagnosis, Differential ; Female ; Humans ; Laparoscopy ; Peritonitis/*diagnosis/etiology/radiography ; Peritonitis, Tuberculous/diagnosis ; Serum Albumin/metabolism ; Tomography, X-Ray Computed

PURPOSE: To analyze the clinical characteristics and outcome of Langerhans' cell histiocytosis that developed in patients younger than 2 years and to compare them with those of older patients. MATERIALS AND METHODS: The chief complaint, age of onset, site and number of bone involvements, systemic organ involvement, treatment and final outcome of fourteen cases of histologically proven Langerhans' cell histiocytosis that developed in patients younger than 2 years were analyzed retrospectively and compared with the results from those of fourteen older patients. The Fisher Exact test was used for statistical analysis. RESULTS: Langerhans' cell histiocytosis that developed in patients younger than 2 years had a more advanced stage (2.5/1.1), multiple bone involvement (2.7/1.7 sites) and a higher rate of systemic organ involvement (29%/0%). It required chemotherapy more often (9/2 patients). There was also a trend of frequent relapse and a lower rate of complete healing, but this was not statistically significant. Among the 62 bone lesions, 47 were healed by simple observation or systemic chemotherapy without the need for surgical intervention. CONCLUSION: Langerhans' cell histiocytosis that developed in patients younger than 2 years showed multiple bone involvement, more systemic involvement and a high recurrence rate. It also required systemic chemotherapy more often. However most bone lesions were managed successfully without the need for surgical intervention.
Age of Onset ; Drug Therapy ; Histiocytosis* ; Humans ; Recurrence ; Retrospective Studies

PURPOSE: This study was aimed to evaluate the result of inlay cortical strut bone grafts for large cysts or cavitary bone lesions in long bones. MATERIALS AND METHODS: Seven patients with large cyst or cavitary bony lesions were managed with curettage, allogeneic inlay cortical strut and cancellous bone grafts. Additional plate and screw fixations were performed in 6 patients. There were three SBCs, two FDs with secondary ABC changes, one FD and one post-cement spacer removal state. Three of them had pathologic fractures. Progression of bone healing and mechanical support and functional result were evaluated. The mean follow-up period was 25.4 months. RESULTS: Incorporations into host bones were progressed in all, average 4.2 months in six metaphyseal regions and 5.8 months in five diaphyseal regions respectively. Full structural supports were achieved in all except one patient without any additional procedures. No allograft-related complication was developed. Mean functional score according to the MSTS criteria was 29.6 at last follow up. CONCLUSION: Inlay cortical strut graft provided additional mechanical stability and bone stock for screw purchase in large cyst or cavitary defects of long bones, which allow early mobilization and excellent functional outcome.
Bone Cysts ; Curettage ; Early Ambulation ; Follow-Up Studies ; Fractures, Spontaneous ; Humans ; Inlays ; Transplants

PURPOSE: We reviewed the clinical characteristics of skeletal Paget's disease in Korean. MATERIALS AND METHODS: We retrospectively analyzed the clinical features, the responses to treatment and complications of 11 cases of Paget's disease occurred in Korean patients. Then we compared the result obtained with those previously reported. RESULTS: Previous studies have mainly involved the axial skeleton, such as skull, spine or pelvic bone, and the pelvis was the most commonly involved site. In 7 cases, more than one site were involved. Clinical symptoms were pain around the involved sites in 5 cases and claudica-tion associated with spinal stenosis in one case. Serum alkaline phosphatase, a biochemical marker of bone formation, was elevated two to five fold in all cases. Responding to bisphosphate, the clinical symptoms subsided and the levels of alkaline phosphatase were markedly diminished or normalized. No serious complications, such as, cranial neuropathy or a congestive heart failure occurred. CONCLUSION: Compared western reports, Paget's disease of skeletal bone in Koreans showed a much lower incidence rate, milder symp-toms and fewer complications.
Alkaline Phosphatase ; Biomarkers ; Cranial Nerve Diseases ; Heart Failure ; Humans ; Incidence ; Osteogenesis ; Pelvic Bones ; Pelvis ; Retrospective Studies ; Skeleton ; Skull ; Spinal Stenosis ; Spine