Although prenatal and neonatal intensive care in recent years improved survival of infants, the risk of cerebral palsy (CP) in infants with perinatal asphyxia persisted. Screening criteria for risk factors of cerebral palsy and delayed development (DD) in term infants with perinatal asphyxia are required so that early diagnosis and rehabilitation and physical therapy could decrease the neurologic complications and maximize quality of life. To identify the risk factors of CP and DD in infants with perinatal asphyxia, we undertook a case-control study of 25 infants with perinatal asphyxia (5 min Apgar score below 6). At one year follow-up, 12 infants developed CP and DD and 13 control infants showed normal development. Risk factors associated with an increased risk of CP and DD were the number of abortion (p=0. 031), history of neonatal seizure (p=0.021), hypoxic ischemic encephalopathy (p=0.046), and poor response to resuscitation immediately after birth (p=0.017). In term infants with perinatal asphyxia, the risk factors of CP and DD were increased number of abortion, history of neonatal seizure, and hypoxic ischemic encephalopathy and poor response to resuscutation. Thus infants with these risk factors should be carefully followed up after hospital discharge and further extensive and prospective study in term infants with perinatal asphyxia could elucidate possible mechanisms related to cerebral palsy and delayed development.
Apgar Score ; Asphyxia* ; Case-Control Studies ; Cerebral Palsy* ; Early Diagnosis ; Follow-Up Studies ; Humans ; Hypoxia-Ischemia, Brain ; Infant* ; Infant, Newborn ; Intensive Care, Neonatal ; Mass Screening ; Parturition ; Quality of Life ; Rehabilitation ; Resuscitation ; Risk Factors* ; Seizures

OBJECTIVE: To evaluate the effect of stretching therapy of neurogenic bladder in spinal cord injured patients. METHOD: Twelve spinal cord injured patients who had neurogeic bladder manifested with urinary incontinence resistant to oral and intravesical anticholinergic instillation treatment were selected. Oxybutynin solution was instillated via foley catheter and the catheter was clamped until incontinence occur. This was performed twice a day for 7 days. The urodynamic studies were compared before and after therapy. Total volume of daily incontinence and total volume of daily fluid intake were also monitored. RESULTS: After stretching therapy, median maximal bladder capacity increased from 190.08 to 457.17 ml (p<0.01), mean bladder compliance increased from 8.46 to 18.85 ml/cmH2O (p<0.01), mean reflex volume increased from 148.75 to 252.17 ml (p<0.05), mean maximal detrusor pressure decreased from 52.17 to 28.29 cmH2O (p<0.01), mean clinical maximal capacity increased from 277.50 to 537.50 ml (p<0.01), and mean daily incontinent volume decreased from 508.33 ml to 20.83 ml (p<0.01). No significant correlation was found between the duration since onset of injury and the urodynamic finding. CONCLUSION: This study proved that stretching therapy of bladder was an effective method in spinal cord injured patients who had neurogenic bladder with uncontrolled incontinence with conventional therapy.
Administration, Intravesical ; Catheters ; Compliance ; Humans ; Reflex ; Spinal Cord Injuries* ; Spinal Cord* ; Urinary Bladder ; Urinary Bladder, Neurogenic* ; Urinary Incontinence ; Urodynamics

OBJECTIVE: To investigate the characteristics of ramp walking. METHOD: The sagittal kinematic and temporospatial data of ramp and level walking were obtained by a motion analyzer for ten healthy young adults. RESULTS: Compared with the values of level walking, the range of motion of ankle at all degrees for up-hill walking and the ROM of hip at 20o down-hill and all degrees for up-hill walking were significantly different (p<0.05). The peak dorsiflexion of ankle at 20o of up-hill and at 20o down-hill walking increased significantly (p<0.05) and peak plantar flexion of ankle at all degrees of up-hill walking increased significantly (p<0.05). The peak flexion of knee at 20o of up-hill walking increased significantly (p<0.05) and peak extension of knee at 20o of up-hill and down-hill walking also increased significantly (p<0.05). The peak flexion angles of hip at all degrees for up and down-hill walking were significantly different (p<0.05) and peak extension angles of hip at 10o of up-hill walking increased significantly (p<0.05). The temporospatial data showed no significant difference. CONCLUSION: Ramp walking showed a different kinematic gait pattern. So, this study may be useful to evaluate the effect of gait training on the ramp and pathologic gait patterns.
Adult* ; Ankle ; Architectural Accessibility* ; Gait* ; Hip ; Humans ; Knee ; Range of Motion, Articular ; Walking* ; Young Adult

PURPOSE: To obtain the optical treatment method in patients with endometrial carcinoma(clinical stage FIGO I, II) by comparative analysis between preoperative radiotherapy(pre-op R) and postoperative radiotherapy(post-op RT). MATERIALS AND METHODS: A retrospctive review of 62 endometrial carcinoma patients referred to the Yonsei Cancer Center for radiotherapy between 1985 and 1991 was undertaken. Of 62 patients, 19 patients(Stage I; 12 patients, Stage II; 7 patients) received pre-op RT before TAH(Total Abdominal Hysterectomy) and BSO(Bilateral Salphingoophorectomy) (Group 1) and 43 patients( Stage 1; 32 patients, Stage 2; 11 patients) received post-op RT after TAH and BSO (Group 2). Pre-op irradiation was given 4-6 weeks prior to surgery and post-op RT was administered on 4-5 weeks following surgery. All patients exept 1 patient(Group2; ICR alone) received external irradiation. Seventy percent(13/19) of pre-op RT group and 54 percent(23/42) of post-op RT group received external pelvic irradiation and intracavitary radiation therapy(ICR). External radiation dose was 39.6-55Gy(median 45Gy) in 5-6week through opposed AP/PA fields or 4-field box technique treating daily, five days per week, 180cGy per fraction. ICR doses were prescreibed to point A(20-39.6 Gy, median 39Gy) in Group 1 and 0.5cm depth from vaginal surface (18-30 Gy, median 21Gy) in Group2. RESULTS: The overall 5year survival rate was 95%. No survival difference between pre-op and post-op RT group.(89.3% vs 97.7%, p>0.1) There was no survival difference by stage, grade and histology between two groups. The survival rate was not affected by presence of residual tumor of surgical specimen after pre-op RT in Group 1(p>0.1), but affected by presence of lymph node metastasis in post-op RT group(p<0.5). The complication rate of pre-op RT group was higher than post-op RT.(16% vs 5%) CONCLUSION: Post-op radiotherapy offers the advantages of accurate surgical-pathological staging and low complication rate.
Endometrial Neoplasms* ; Female ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm, Residual ; Radiotherapy* ; Survival Rate

Background: F-18 Fluorodeoxyglucose positron emission tomography (F-18 FDG PET), which can cover the body from the skull base to the thigh in one scan, is beneficial for evaluating distant metastasis. F-18 FDG PET has interested policymakers because of its relatively high cost. This study investigated the effect of the F-18 FDG PET reimbursement criteria amendment on healthcare behavior in breast cancer using an interrupted time series (ITS) analysis. Methods: We retrospectively analyzed the inpatient and outpatient data from Korea’s Health Insurance Review and Assessment Service (HIRA) from January 1, 2013 to December 31, 2018. ITS analysis was performed for the number of each medical imaging modality and the total medical imaging cost of the breast cancer patients. Results: The annual number of breast cancer patients has been increasing steadily since 2013. The trend of F-18 FDG PET increased before the reimbursement criteria was amended, but intensely decreased immediately thereafter. The chest and abdomen computed tomography scans showed a statistically significant increase immediately after the amendment and kept steadily increasing. A change in the total medical imaging cost for the breast cancer patient claimed every month showed an increasing trend before the amendment (β = 5,475, standard error [SE] = 1,992, P = 0.008) and rapid change immediately after (β = −103,317, SE = 16,152, P < 0.001). However, there was no significant change in the total medical imaging cost at the long-term follow-up (β = −912, SE = 1,981, P = 0.647). Conclusion Restriction of health insurance coverage for cancer may affect healthcare behaviors. To compensate for it, the policymakers must consider this and anticipate the impact following implementation.

PURPOSE: Although using the high energy photon beam with conventional parallel-opposed beams radio-therapy for nasopharyngeal carcinoma, radiation-induced xerostomia is a troublesome problem for patient. We conducted this study to explore a new parotid gland sparing technique in 3-D conformal radiotherap (3-D CRT) in an effort to prevent the radiation-induced xerostomia. MATERIALS AND METHODS: We performed three different planning for four clinically node-negative naso-phar yngeal cancer patients with different location of tumor(intracranial extension, nasal cavity extension, oropharyngeal extension, parapharyngeal extension), and intercompared the plans. Total prescription dos <. Was 70.2 Gy to the isocenter, For plan-A, 2-D parallel opposing fields, a conventional radiotherapy technique, were employed. For plan-B, 2-D parallel opposing fields were used up until 54 Gy an < 3 afterwards 3-D non-coplanar beams were used. For plan-C, the new technique, 54 Gy was delivered b r 3-D conformal 3-port beams (AP and both lateral ports with wedge compensator; shielding both superficial lobes of parotid glands at the AP beam using BEV) from the beginning of the treatment and early spinal cord block (at 36 Gy) was performed. And bilateral posterio r necks were treated with electron after 36 Gy. After 54 Gy, non-coplanar beams were used for cone-down plan. We intercompared dose statistic; Dmax, Dmin, Dmean, D95, D05, V95, V05, Volume receiving 46 Gy) and dose volume histograms (DVH) of tumor and normal tissues and NTCP values of parotid glands for the above three plans. RESULTS: For all patients, the new technique (plan-C) was comparable or superior to the other plans in target volume isodose distribution and dose statistics and it has more homogenous target volume, coverage. The new technique was most superior to the other plans in parotid glands sparing (volume receiving 46 Gy: 100, 9 B, 69% for each plan-A, B and C). And it showed the lowest NTCP value of parotid glands in all patients (range of NTCP; 96-100%, 79-99%, 51-72% for each plan-A, B and C). CONCLUSION: We conclude that the new technique employing 3-D conformal radiotherapy at the beginning of radiotherapy and cone down using non-coplanar beams with early spinal cord block is highly recommended to spare parotid glands for node-negative nasopharygeal cancer patients.
Humans ; Nasal Cavity ; Neck ; Parotid Gland* ; Prescriptions ; Radiotherapy* ; Radiotherapy, Conformal* ; Spinal Cord ; Xerostomia

Prematurity, intrauterine infection and perinatal brain injury have been reported to be significant risk factors of cerebral palsy (CP). We examined the perinatal predictors of cerebral palsy and delayed development (DD) in 184 high risk infants. Thirty-five infants were diagnosed as cerebral palsy and delayed development at 12 months corrected age. Antenatal, intrapartum, and neonatal factors were prospectively evaluated in 2 groups of high risk infants compared with controls; Group A (n = 79), infants weighing less than 2,000 g; Group B (n = 43), infants weighing 2,000 g or more. In univariate analysis, there were no significant antenatal and intrapartum factors associated with cerebral palsy and delayed development in either group. We found that significant postnatal risk factors of CP in group A included sepsis (p = 0.008), BPD (bronchopulmonary dysplasia) (p = 0.028), IVH (intraventricular hemorrhage) (p = 0.042), ventriculomegaly (VM) (p = 0.001) and a longer duration of mechanical ventilation (p = 0.001); while in group B, sepsis (p = 0.047) and neonatal seizure (p = 0.027) were significant risk factors. In multivariate analysis, sepsis in group B was a moderate risk factor of CP (OR (odds ratio) 1.47; 95% CI (confidence interval) 1.02-2.13). In conclusion, neonatal sepsis may contribute to the development of cerebral palsy and delayed development. We suggest that high risk infants who have sepsis should be carefully followed for cerebral palsy and delayed development. The prevention of cerebral palsy may be feasible by decreasing neonatal risk factors such as sepsis during the neonatal period.
Cerebral Palsy/etiology* ; Child Development* ; Developmental Disabilities/etiology* ; Female ; Human ; Infant ; Infant, Newborn ; Infant, Newborn, Diseases* ; Male ; Prospective Studies ; Risk Factors

PURPOSE: To assess the efficacy of high dose rate - intracavitary radiotherapy (HDR-ICR) in the radiotherapy of FIGO stage IB squamous cell carcinoma of uterine cervix and to determine the optimum dose combination xheme of external radiotherapy and ICR to achieve acceptable local control without severe complication. METHODS AND MATERIALS: One hundred and sixty two patients with FIGO stage Ib squamous cell carcinoma of uterine cervix who received definitive radiotherapy between May 1979 and December 1990 were retrospectively analyzed. All the patients received external radiotherapy combined with HDR-ICR. External dose of 40-46 Gy in 4.5-5 weeks was given to whole pelvis(median 45 Gy) and ICR dose of 30-39 Gy in 10-13 times was given to the point A. Midline shielding was done after 20-45 Gy of external radiotherapy(median 40 Gy). Summation of external dose plus ICR dose to the point A range were 64.20-95.00 Gy, and mean was 83.94 Gy. We analyzed the local control rate, survival rate, and late complication rate. RESULTS: Initial complete response rate was 99.4% for all patients. Overall 5-year survival rate was 91.1% and 5-year disease free survival rate was 90.9%. Local failure rate was 4.9% and distant failure rate was 4.3% Tumor size was the only significant prognostic factor. When tumor size greater than 3cm, 5-year survival rate was 92.6% and less than 3cm, that was 79.6%, Late complication rate was 23.5% with 18.5% of rectal complication and 4.9% of bladder complication. Mean rectal dose summation of external midline dose plus ICR rectal point dose was lower in the patients without rectal complication(74.88 Gy) than those with rectal complication (78.87 Gy). Complication rate was inceased with low rate of improvement of survival rate when summation of external midline dose plus point A or point R dose by ICR was greater than 70-75 Gy. CONCLUSION: The definitive radiation therapy using high dose rate ICR in FIGO stage IB uterine cervical cancer is effective treatment modality with good local control and survival rate without severe complication.
Carcinoma, Squamous Cell ; Cervix Uteri ; Disease-Free Survival ; Female ; Humans ; Radiotherapy ; Retrospective Studies ; Survival Rate ; Urinary Bladder ; Uterine Cervical Neoplasms*

Eccrine spiradenoma is a rare benign tumor which is differentiated into the direction of eccrine gland. Neurofibromatosis type-1 is an autosomal dominantly inherited disorder that is characterized by neurofibroma, cafe au lait spots and axillary freckles of the skin. We report a case of a 42-year-old man with a painful, solid nodule on his right arm for 4~5 months. He was diagnosed with neurofibromatosis type-1 in childhood. He has several cafe au lait spots and diffuse freckles on whole body. On microscopy, the tumor was sharply demarcated with encapsulated lobules in the dermis. The lobules consisted of two undifferentiated epithelial cells. There was hyperpigmentation of the basal cell layer in the epidermis without increase in the number of melanocyte. We herein report an unusual case of eccrine spiradenoma in neurofibromatosis type-1 patient.
Adult ; Arm ; Cafe-au-Lait Spots ; Dermis ; Eccrine Glands ; Epidermis ; Epithelial Cells ; Humans ; Hyperpigmentation ; Melanocytes ; Melanosis ; Microscopy ; Neurofibroma ; Neurofibromatoses ; Skin

BACKGROUND: Chronic irritant contact dermatitis, the common occupational dermatitis of the skin, could be caused by repetitive exposure of the skin to irritants. Adaptation of the skin to repeated influence of exogenous irritants is called the hardening. The defining characteristic of hardening phenomenon has been progressively decreasing inflammatory response with prolonged exposure to an irritant. OBJECTIVE: The purpose of this study was to evaluate the induction of hardening phenomenon by the repeated application of various concentrated sodium lauryl sulfate (SLS) solutions. METHODS: Once a day a 0.1%, 0.5%, 2% solution of SLS and distilled water were applied to the volar forearm skin in 15 healthy volunteers for 10 minutes over 3 weeks. After 3 weeks interval of rest, patch tests with 1% solution of SLS were conducted on previously irritated sites for 24 hours. We measured transepidermal water loss (TEWL) and erythema index (E-index) before irritation, during 3 weeks of repeated application. 4 days after the patches test, we measured TEWL and E-index once a day. RESULTS: During 3 weeks of irritation with repeated application of 0.1%, 0.5%, 2% SLS solution, increase of TEWL was accelerated according to concentrations of SLS. In the study of 24-h patch test with 1% SLS solution on previously irritated sites after 3 weeks interval of rest, TEWL on distilled water application site was significantly higher than other sites irritated with SLS solution on D44 and D45. The TEWL values on the site irritated with higher concentration of SLS solution were lower than those with lower concentration of SLS solution. In contrast, there were no significant differences in E-index value during 3 weeks of irritation and after 24-h patch test with 1% SLS solution. CONCLUSION: Hardening could be induced by repeated irritation with SLS solution for 3 weeks. We suggest that hardening could be induced more efficiently with the higher concentration of SLS solution than the lower concentration.
Dermatitis, Contact ; Dermatitis, Occupational ; Erythema ; Forearm ; Irritants ; Organ Preservation Solutions ; Patch Tests ; Skin ; Sodium ; Sodium Dodecyl Sulfate ; Sucrose ; Water