BACKGROUND: The growing number of spinal cord injured individuals facing old age makes the understanding of age related limitations increasingly important. This study was to investigate the age-related differences in rehabilitation outcome according to the level of cervical spinal cord injury and each category of activity of daily living(ADL). METHODS: Subjects were 79 adults with tetraplegia all of whom were admitted in National Rehabilitation Hospital. The level of injury was classified into upper cervical(C4, C5), mid-cervical(C6), and lower cervical(C7, C8) spinal cord injury. Eight ADL categories including feeding, grooming, bathing, dressing, toileting, bed-transfer, toilet/tub transfer, and indoor mobility were assessed using the scale of Spinal Cord Independence Measure. Age related differences were examined by separating the sample into two age groups(> or =40 and <40 years) RESULTS: There was no age related difference in rehabilitation outcome in upper cervical cord injury patients. In mid-cervical cord injury level, ADL capacities differed only in the feeding and grooming activities. In lower cervical cord injury level, older patients showed lower rehabilitation outcome than younger counterparts in all ADL categories examined. CONCLUSION: Along with injury level, age should be considered when formulating rehabilitation plans and functional prognostic statements in tetraplegic patients.
Activities of Daily Living ; Adult ; Animals ; Bandages ; Baths ; Grooming ; Humans ; Quadriplegia ; Rehabilitation* ; Spinal Cord Injuries* ; Spinal Cord* ; Treatment Outcome*

PURPOSE: Recent progress in neonatal medicine increased the survival of preterm low birth weight infants. However, neurodevelopmental sequelae are ever increasing. We carried out this study to determine whether serial cranial ultrasonographic findings could predict neurodevelopmental outcome. METHODS: Four hundred and forty-one preterm low birth weight infants, who were admitted to the Neonatal Intensive Care Unit of Chonnam University Hospital from Jan. 1996 to Dec. 1998, were enrolled in this study. Infants were allocated to one of four groups, according to their ultrasonographic findings. Cases were included in group I when they showed normal ultrasound scans or their periventricular echogenicity was equal to choroid plexus(n=232); in group II, subependymal hemorrhage, intraventricular hemorrhage without ventricular dilatation(n=146); in Group III, intraventricular hemorrhage with ventricular dilatation or perivemtricular echogenicity-3 (n=48); in Group IV, bilateral cystic Periventricular leukomalacia(PVL)(n=15). In these four groups, correlation among the incidence of cerebral palsy and neurodevelopmental abnormalities, cranial ultrasonographic findings, and other perinatal parameters were evaluated by ANOVA test, chi- square test, and logistic regression analysis. RESULTS: The incidence of cerebral palsy was remarkably high in group IV(86.6%) and half of them showed a combination of other developmental abnormalities. The significant predictors of cerebral palsy were cystic PVL and duration of oxygen therapy. CONCLUSION: Cranial ultrasonographic findings could predict the development of cerebral palsy and other neurodevelopmental outcome in preterm low birth weight infants.
Cerebral Palsy ; Choroid ; Dilatation ; Hemorrhage ; Humans ; Incidence ; Infant* ; Infant, Low Birth Weight* ; Infant, Newborn ; Intensive Care, Neonatal ; Jeollanam-do ; Leukomalacia, Periventricular ; Logistic Models ; Oxygen ; Ultrasonography*

It has been demonstrated that the epidermal growth factor receptor(EGFR) gene, the normal human counterpart of the viral erb-B oncogene, is amplified and overexpressed in 40-50% of malignant astrocytomas. Although little is known about the functional status of the overexpressed protein molecule, overexpression of a growth factor receptor evenly distributed throughout a tumor would be an ideal target for monoclonal antibody or growth factor receptor targeted therapy. We undertook the immunohistochemical study of the EGFR with malignancy grade. The results were as follows 1) Expression of EGFR was deteced in 1 case(6.7%) of low grade astrocytoma, 14 cases(63.6%) of anaplastic astrocytoma and 19 cases(73.1%) of glioblastoma multiforme. It was more frequent in malignant astrocytoma that low grade astrocytoma(p<0.01). 2) The distributed proportion and staing density of EGFR-expressed tumor cells was more increased in glioblastoma multiforme than anaplastic astrocytoma. 3) Regional heterogeneity of EGFR-expressed tumor cells was recognized in cases of EGFR expressed malignant astrocytoma. These results suggest that overexpression of EGFR would be involved in malignant progression of astrocytoma, and the use of monoclonal antibody or growth factor receptor targeted therapy maybe limited due to heterogeneity of EGFR expressed tumor cells in malignant asrotcytoma.
Astrocytoma ; Epidermal Growth Factor* ; Glioblastoma ; Humans ; Oncogenes ; Population Characteristics ; Receptor, Epidermal Growth Factor*

The relapse of leukemia is usually classified as hematologic relapse and extramedullary relapse. The most common sites of clinical extramedullary relapse are the central nervous systems (CNS) and gonads. However, the relapse in the uterus is very rare. We experienced a very unusual case of uterine relapse of acute lymphoblastic leukemia (ALL) after about a 6-year remission period. This female patient returned to our hospital with a two-month history of amenorrhea. Pelvic radiology confirmed an about 7 cm sized ill-defined ovoid mass in the uterus. There was no evidence of ALL relapse in the peripheral blood or CNS. The uterine biopsy showed diffused homogenous infiltration of numerous small round cells in uterine corpus, suggesting ALL relapse. The bone marrow study revealed 100% cellularity, most of which were lymphoblasts. Our patient received the bone marrow transplantation (BMT) and achieved the second complete remission (CR). Therefore, we here report our case with a brief review of literature.
Amenorrhea ; Biopsy ; Bone Marrow ; Bone Marrow Transplantation ; Central Nervous System ; Female ; Gonads ; Humans ; Leukemia ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Recurrence* ; Uterus

Chylothorax is the most common cause of pleural effusion in the neonatal period and is defined as an effusion of lymph in the pleural cavity. We report a case of chylothorax in 8-day-old male who was admitted due to respiratory difficulty. Chest AP roentgenogram showed pleural effusion of the left lung, and milky yellow fluid was aspirated via thoracentesis. Diagnosis was confirmed by chemistry studies of pleural lipid and lipoprotein electrophoresis. Chyle obtained from pleural space was diagnosed by their high triglyceride levels and the finding of chylomicrons on lipid electrophoresis. He was treated by thoracentesis, chest tube insertion, feeding with formulas containing medium-chain triglyceride and total parenteral nutrition without oral feeding. He was discharged on the 45th hospital day in good health.
Chemistry ; Chest Tubes ; Chyle ; Chylomicrons ; Chylothorax* ; Diagnosis ; Electrophoresis ; Humans ; Infant, Newborn ; Lipoproteins ; Lung ; Male ; Parenteral Nutrition, Total ; Pleural Cavity ; Pleural Effusion ; Thorax ; Triglycerides

In microarray technology, many diverse experimental features can cause biases including RNA sources, microarray production or different platforms, diverse sample processing and various experiment protocols. These systematic effects cause a substantial obstacle in the analysis of microarray data. When such data sets derived from different experimental processes were used, the analysis result was almost inconsistent and it is not reliable. Therefore, one of the most pressing challenges in the microarray field is how to combine data that comes from two different groups. As the novel trial to integrate two data sets with batch effect, we simply applied standardization to microarray data before the significant gene selection. In the gene selection step, we used new defined measure that considers the distance between a gene and an ideal gene as well as the between-slide and within-slide variations. Also we discussed the association of biological functions and different expression patterns in selected discriminative gene set. As a result, we could confirm that batch effect was minimized by standardization and the selected genes from the standardized data included various expression pattems and the significant biological functions.
Bias (Epidemiology) ; Computational Biology ; Dataset* ; Genes, vif ; RNA

PURPOSE: It is widely known that allergic diseases progress through an allergic march. However, there have not been any recent reports in Korea on how the diseases progress. METHODS: Parents who visited one of the Pediatric Allergy Clinics of four university hospitals in Seoul with a child under the age of 6 years during the period from May 1-30, 2006 were asked to complete a questionnaire. RESULTS: A total of 229 parents answered the questionnaire about their children, of which 122 were male and 107 were female. The most common allergic disease before 2 years of age was atopic dermatitis (79%). Meanwhile, in 2- to 4-year age group, allergic rhinitis (38%) and asthma (37%) were predominant. The most common allergic disease in the 4- to 6-year age group was asthma (72%), followed by allergic rhinitis (64%). Seventy-three percent of the children had a family history of allergic disease, most often in the fathers (39%). Among patients with allergic rhinitis, 50% had experienced asthma in their earlier days and 30% had experienced atopic dermatitis. In addition, 57% of the children with asthma had suffered from atopic dermatitis. Parents believed that asthma was the most serious allergic disease. CONCLUSION: In the present study, allergic disease showed a tendency to march from atopic dermatitis to asthma and then to allergic rhinitis. Early diagnosis and treatment of atopic dermatitis is, therefore, considered important for prevention of the allergic march.
Asthma ; Child ; Dermatitis, Atopic ; Early Diagnosis ; Fathers ; Female ; Hospitals, University ; Humans ; Hypersensitivity ; Korea ; Male ; Parents ; Surveys and Questionnaires ; Rhinitis ; Rhinitis, Allergic, Perennial

The aim of our study was to evaluate intermediate-term oncologic outcomes, predictive factors for recurrence, and recurrence patterns in a multicenter series of patients treated with robot-assisted radical cystectomy (RARC) for urothelial carcinoma (UC) of the bladder. Between 2007 and 2015, 346 patients underwent RARC at multiple tertiary referral centers in Korea. Descriptive statistics were used for demographics and perioperative variables. Survival and recurrence were estimated with Kaplan-Meier analysis. Logistic regression models were used to determine predictors of recurrence. Median follow-up was 33 months (interquartile range [IQR], 7–50). The numbers of patients with organ-confined and lymph node (LN)-positive disease were 237 (68.4%) and 68 (19.7%), respectively. LN density (1–20 vs. > 20) was 13.6% and 6.1%, with a median of 17 nodes removed (IQR, 9–23). In logistic regression analysis, type of LN dissection, and pathologic tumor stage were significant predictors of cancer recurrence and death from cancer. Local, distal recurrence and secondary UC occurred in 7 (2.0%), 53 (15.3%), and 4 (1.2%) patients, respectively. The 5-year overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were 78%, 84%, and 73%, respectively. At last follow-up, RFS for extended pelvic LN dissection vs. standard pelvic LN dissection was 70% and 47% (P = 0.038). In addition, at last follow-up, LN density (0 vs. 1–20 vs. over 20) was 67%, 41%, and 29%, respectively (P < 0.001). Patients undergoing RARC in this multi-institutional cohort demonstrated intermediate-term oncologic outcomes, predictive factors for recurrence, and recurrence patterns that were not unusual.
Cohort Studies ; Cystectomy* ; Demography ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Korea* ; Logistic Models ; Lymph Nodes ; Recurrence* ; Tertiary Care Centers ; Urinary Bladder ; Urinary Bladder Neoplasms

OBJECTIVE: This study examined the effect of a maximal cervical dilatation prior to their primary cesarean birth on the time length of labor in women attempting vaginal birth after cesarean section (VBAC). METHODS: From January 2000 to Jun 2005, a total of 526 patients with VBAC were entered into the study. Patients were classified into 4 groups according to the maximal cervical dilatation on the prior cesarean birth: Group 1 (0~3 cm), Group 2 (4~7 cm), Group 3 (8~9 cm), and Group 4 (10 cm). RESULTS: An analysis of the duration of labor showed that the time length of active phase was significantly shorter in each of Group 3 (147.3+/-103.9 minutes) and 4 (155.2+/-104.2 minutes) than in Group 1 (192.9+/-126.0 minutes) or 2 (195.1+/-148.2 minutes) (p<0.05), although there was no difference with regard to the second stage between each group. These results were also sustained even among the selected 248 patients without prior use of oxytocin, vacuum delivery, or epidural anesthesia that could affect the duration of labor. CONCLUSION: The time length of active phase on VBAC is significantly shorter in women with a prior maximal cervical dilatation of > or =8 cm than those without. Study results indicate that prior cervical dilatation may affect the labor time of subsequent VBAC. The proper understanding of the association between prior cervical dilatation and labor time on a subsequent VBAC may be useful for better management or further intervention in the setting of VABC.
Anesthesia, Epidural ; Female ; Humans ; Labor Stage, First* ; Oxytocin ; Parturition ; Pregnancy ; Vacuum ; Vaginal Birth after Cesarean*

PURPOSE: Chronic blood transfusions result in excessive iron deposition leading to eventual tissue damage and impaired function of organs, such as the liver, spleen, pancreas, skin, thyroid, and heart. We evaluated the body iron status and endocrinopathy in repeatedly transfused patients with aplastic anemia (AA). METHODS: Fourteen patients with AA who were transfused with more than 10 Units of packed RBC since 1996 were evaluated. We evaluated the correlation of amount of blood transfused with status of iron stores (determined by serum iron, TIBC, ferritin and transferrin saturation) and organ damage. RESULTS: Patients received a median of 61 units (range 11~168 units) of PRC. Twelve patients (85.7%) had elevated serum ferritin levels, and 11 (78.6%) had elevated transferrin saturation. Serum ferritin (P<0.01; r=0.868), and transferrin saturation (P<0.05; r=0.569) were significantly correlated with the amount of PRC transfused, respectively. Five patients had clinically significant iron overload despite the use of deferoxamine. Organ damage caused by transfusion iron overload were skin pigmentation (N=3), hepatic (N=1) and endocrinologic abnormalities. Diabetes (N=3), hypothyroidism (N=3), and hyogonadotropic hypogonadism (N=1) were observed. No patient developed clinically significant arthropathy or cardiac disease. CONCLUSION: AA patients who received chronic blood transfusions develop iron overload which may lead to endocrinopathy. Iron status and organ dysfunction should be monitored and effective measures to prevent iron overload should be applied in patients who need chronic transfusions.
Anemia, Aplastic* ; Blood Transfusion ; Deferoxamine ; Ferritins ; Heart ; Heart Diseases ; Hemochromatosis* ; Humans ; Hypogonadism ; Hypothyroidism ; Iron ; Iron Overload ; Liver ; Pancreas ; Skin ; Skin Pigmentation ; Spleen ; Thyroid Gland ; Transferrin