OBJECTIVE: To investigate the effect of epilepsy and neonatal seizure on development in children with cerebral palsy (CP) or delayed development (DD). METHOD: The subjects were 135 patients with CP or DD. Development was evaluated by Bayley Scale of Infant Development II (BSID II). Epilepsy was diagnosed on the base of clinical features, past history and electroencephalography. RESULTS: The incidence of epilepsy was 18.4% in CP, and 37.8% in DD. Spastic quadriplegia of CP has the highest incidence of epilepsy (38.4%). First seizure attack was occurred before 6 months old of age in 66.7% of CP with epilepsy and in 64.3% of DD with epilepsy. The prevailing type of epilepsy was generalized seizure in DD (57.1%), partial seizure in CP (50.0%). The group with epilepsy had lower psychomotor and mental development quotient on BSID II than the group without epilesy (p<0.05). Polytherapy was more used to control epilepsy than monotherapy. Valproate (50.0%), phenobarbital (37.5%), carbamazepine (31.3%) were commonly used drugs for controlling epilepsy. CONCLUSION: The epilpesy has a negative effect on psychomotor and mental development in the children with CP or DD.
Carbamazepine ; Cerebral Palsy* ; Child ; Child Development ; Developmental Disabilities* ; Electroencephalography ; Epilepsy* ; Humans ; Incidence ; Infant ; Phenobarbital ; Quadriplegia ; Seizures* ; Valproic Acid

OBJECTIVE: This study was performed to investigate the effect and safety of cardiac rehabilitation program in heart failure. METHOD: 36 patients who suffered from heart failure with decreased left ventricular ejection fraction less than 50% by echocardiogram were recruited for study subject. They took graded exercise test before and after cardiac rehabilitation program. Cardiac rehabilitation program was consisted of 6~8 weeks monitoring exercise according to the result of exercise test. We reviewed the all courses of the program to see the safety and compared the several results to know the effect of the program. RESULTS: During totally 696 exercise-hours with ECG monitoring, 12 abnormal hemodynamic responses were happened, but those were minor in severity. All of them were managed successfully and could complete their exercise program as their schedules. Even in heart failure patients, cardiac rehabilitation program could improve exercise capacity in terms of increased maximal oxygen consumption, maximal exercise time, and maximal myocardial oxygen demand. Submaximal myocardial oxygen demand and rate of perceived exertion were significantly decreased after cardiac rehabilitation program. CONCLUSION: In case of prudent monitoring and proper management, cardiac rehabilitation program is safe and effective to improve exercise capacity in heart failure patient.
Appointments and Schedules ; Electrocardiography ; Exercise Test ; Heart Failure* ; Heart* ; Hemodynamics ; Humans ; Oxygen ; Oxygen Consumption ; Rehabilitation* ; Stroke Volume

No abstract available.

BACKGROUND: Fosinopril is a new phosphorous containing angiotensin converting enzyme inhibitor. To assess the antihypertensive efficacy and safety of fosinopril, the clinical trial was done in patients with mild to moderate hypertension. METHODS: In 30 patients with mild to moderate essential hypertension, we administered fosinopril 10-20mg once daily for 10 weeks and checked their blood pressure every 2 weeks. RESULTS: The blood pressure decreased from 158+/-12.3/103.4+/-4.2mmHg to 139+/-7.5/88.4+/-5.9mmHg at the end of treatment(p<0.05). Heart rate did not change significantly during therapeutic period. Of 30 patients, the efficacy of fosinopril therapy disclosed 25 patients(83.7%) with normal diastolic pressure of more than 10mmHg decline of diastolic blood pressure. But two patients had no effects and three patients were not followed up. The adverse reactions due to fosinopril were reported in 3 patients(10%) with dry cough, 2 patients with palpitation(6.7%) and 1 patient with weakness(3.3%), but there were no patients who discontinued fosinopril due to adverse effect. CONCLUSION: Fosinopril has an excellent antihypertensive effect at low dosage as a first line antihypertensive agent or as a substituting agent for other antihypertensives in patients with mild to moderate essential hypertension.
Antihypertensive Agents ; Blood Pressure ; Cough ; Fosinopril* ; Heart Rate ; Humans ; Hypertension ; Peptidyl-Dipeptidase A

This study evaluated the effects of saddle height on the muscle activity and oxygen uptake during bicycling. The subjects were 20 young adult volunteers. Muscle activity and oxygen uptake were measured with the two saddle heights (maximum knee extension of 180degrees and 120degrees) and at two power outputs (70 and 100 watts, respectively.) The pedaling rate was 40 rpm. The exercise time was 1 minute and the resting time between each condition was 3 minutes. The raw electromyogram activity was measured for 1 minute and was converted to a root mean square value. Oxygen uptake was measured during exercise using the mixing chamber mode. The activities of two flexors (the medial hamstring and medial head of gastrocnemius) increased at the high saddle height and the activities of four extensors (rectus femoris, vastus medialis, vastus lateralis, and tibialis anterior) increased at the low saddle height. The oxygen uptake at the low saddle height was significantly higher than that at the high saddle height. The oxygen uptake positively correlated with the muscle activities of the knee extensors. The muscle activity and oxygen uptake were significantly affected by the postures (saddle heights) in cycle ergometer. The postures should be considered in the exercise test and prescription.
Bicycling ; Exercise Test ; Head ; Humans ; Knee ; Muscles ; Oxygen ; Posture ; Prescriptions ; Quadriceps Muscle ; Young Adult

OBJECTIVE: To investigate the correlation between magnetic resonance imaging (MRI) findings for children with cerebral palsy (CP) and the severity of their developmental disability. METHOD: MRI and M nchener Funktionelle Entwicklungs Diagnostik (MFED) were used for the evaluation of 52 children with CP. MFED quotient (MFED age/corrected age 100) was compared to the MRI findings. RESULTS: Of the 52 MRIs, no abnormalities were found in 7 cases (13%), periventricular leukomalacias (PVLs) in 37 cases (71.2%), corpus callosum abnormalities in 33 cases (63.5%), delayed myelinations in 8 cases (15.4%), congenital brain abnormalities in 6 cases (11.5%), and central sulcus abnormalities in 3 cases (5.8%). Among 27 patients who were born preterm, the major MRI finding was PVL (100%), indicative of a hypoxic brain injury. All patients with a normal MRI were born at term. There were significant correlations between the MFED quotient and the severity of PVL. The ratio of corpus callosum length/brain anteroposterior diameter was correlated with a developmental disability. CONCLUSION: MRI findings for the patients with CP are well correlated with the developmental disabilities and the timing of brain insult.
Brain ; Brain Injuries ; Cerebral Palsy* ; Child ; Corpus Callosum ; Developmental Disabilities* ; Humans ; Infant, Newborn ; Leukomalacia, Periventricular ; Magnetic Resonance Imaging ; Myelin Sheath

OBJECTIVE: The purposes of our study were to determine the effect of serial radioisotope renography on the diagnostic evaluation and therapeutic intervention of spinal cord injured patients and to determine the characteristics of renographic findings in spinal cord injured patients. METHOD: Three hundred and two spinal cord injured patients were examined with radioisotope renography using Technetium-99m mercaptoacetyltriglycine. Forty-two of 302 patients were examined in serial studies. Intravenous pyelogram, urodynamic study, 24-hour creatinine clearance, and voiding cystourethrogram were also performed. Radioisotope renography was correlated with diagnostic procedures and therapeutic interventions. Therapeutic interventions included changes in medication and bladder management. RESULTS: The renal functions in the left kidney were better than the functions in the right kidney after spinal cord injury (p<0.01). If neurogenic bladders were managed properly, renal functions improved after the shock stage of injury (p<0.05). Patients with significant improvement in their renal function underwent changes in proper medication and methods of bladder management (p<0.05). Renal function changes were correlated with the type of neurogenic bladder and maximal detrusor pressure (p<0.05). No significant renal function changes were found between the groups according to the completeness of injury and gender. CONCLUSION: Radioisotope renography is a good initial indicator to show problems that required management changes. Serial radioisotope renographic findings give valuable informations about the urinary tract in spinal cord injured patients.
Creatinine ; Humans ; Kidney ; Radioisotope Renography* ; Shock ; Spinal Cord Injuries ; Spinal Cord* ; Urinary Bladder ; Urinary Bladder, Neurogenic ; Urinary Tract ; Urodynamics

OBJECTIVE: To determine the clinical utility of ice water test for the urodynamic study in neurogenic bladder of spinal cord injured patients. METHOD: Warm water (20~30oC) urodynamic studies were performed on 66 spinal cord injured patients. Subsequently, ice water (4~8oC) urodynamic studies were performed. We determined the ice water test to be positive if the reflex volume of ice water urodynamic study is lower than the volume of the warm water urodynamic study. RESULTS: Ice water test was positive in 24 (55.8%) and negative in 19 (44.2%) of the 43 patients showing hyperreflexic detrusor activity in warm water urodynamic study. Ice water test was negative in all 23 cases showing areflexic detrusor activity. No significant difference was found between positive and negative ice water test groups for the level of injury, sex, age, extent of injury and duration since injury. If water was cool enough, positivity of ice water test was not affected by infusion rate. There was no difference between the two urodynamic studies of maximal bladder pressure and compliance. CONCLUSION: This study suggests that ice water urodynamic study is a useful method for the evaluation of hyperreflexic neurogenic bladder activated by cold specific receptors via C afferent fibers in spinal cord injured patients.
Compliance ; Humans ; Ice* ; Reflex ; Spinal Cord Injuries ; Spinal Cord* ; Urinary Bladder ; Urinary Bladder, Neurogenic* ; Urodynamics* ; Water*

OBJECTIVE: To compare the exercise capacity after cardiac rehabilitation (CR) in patients with percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery. METHOD: 27 patients who underwent PCI and 18 patients who underwent CABG surgery were included. All the subjects performed supervised exercise training for 6~8 weeks at hospital and self-exercise at community for additional 16~18 weeks. Exercise capacity was measured by symptom limited graded exercise tests at study entry and 6 months later. RESULTS: After 6 months of CR, maximal oxygen consumption (VO2max) was significantly increased, resting heart rate (HR) and submaximal rate pressure product (RPP) were significantly decreased in both groups (p<0.05). There were no significant change of maximal HR in both groups (p<0.05). Maximal RPP in CABG increased significantly (p<0.05) but did not change significantly in PCI group. Resting HR was significantly higher, VO2max was significantly lower in CABG group than PCI group at study entry (p<0.05). Resting HR was not significantly different in both groups but, VO2max was still lower in CABG group than PCI group even after 6 months of CR (p<0.05). CONCLUSION: The cardiac rehabilitation program was effective in both PCI and CABG group. Although VO2max in PCI group was higher than CABG group after 6 month CR, the range of improvement was greater in CABG group than PCI group.
Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Vessels ; Exercise Test ; Heart Rate ; Humans ; Oxygen Consumption ; Percutaneous Coronary Intervention ; Transplants

OBJECTIVE: The purpose of this study was to evaluate the clinical effectiveness of intravesical oxybutynin chloride instillation in the management of neurogenic bladder dysfunction in spinal cord injured patients. METHOD: Fifty-two spinal cord injured patients with hyperreflexic or hypertonic neurogenic bladder were treated with intravesical oxybutynin instillation therapy. The purified oxybutynin chloride was dissolved in sterile water and mixed with normal saline. This oxybutynin solution was instilled twice a day for 7 days. The urodynamic studies were compared before and after the instillation. Total volume of daily incontinence was also monitored. RESULTS: After the intravesical oxybutynin instillations, mean maximal bladder capacity increased from 212.13 to 323.81 ml (p<0.01), mean bladder compliance increased from 11.73 to 18.56 ml/cmH2O (p<0.01), mean maximal detrusor pressure decreased from 67.19 to 50.90 cmH2O (p<0.01) and mean daily amount of incontinence decreased from 735.58 to 201.73 ml (p<0.01). No significant differences were found between the groups according to the level of injury, completeness of injury, duration since onset of injury and the presence of asymptomatic bacteriuria. CONCLUSION: This study proved that intravesical instillation of oxybutynin solution is an effective method in spinal cord injured patients with hyperreflexic or hypertonic neurogenic bladder dysfunction regardless the level and completeness of injury, as well as duration since the onset of injury or the presence of asymptomatic bacteriuria.
Administration, Intravesical ; Bacteriuria ; Compliance ; Humans ; Spinal Cord Injuries ; Spinal Cord* ; Urinary Bladder ; Urinary Bladder, Neurogenic* ; Urodynamics ; Water