OBJECTIVE: The purposes of this study were to measure the effect of Stellate ganglion block(SGB) objectively and quantitatively by the use of sympathetic skin response(SSR), and to evaluate the cumulative effects and complications of repetitive SGB and to find out optimal numbers of injection per one cycle in the patients with reflex sympathetic dystrophy(RSD). METHOD: Six patients with RSD were evaluated with a SSR test before and after the injection of 1% lidocaine 4 ml by SGB method. RESULTS: There was a significant prolongation of latencies in SSR of the lesion side of sixty mixed cases by the SGB methods and SSR tests. There were no significant changes in the latency and amplitude of SSR from the lesion side between pre- and post injection states. There was a significant decrease of amplitude in the sound side after the injection. The differences of the amplitudes between pre- and post injections were significantly higher in the lesion side than the sound side. The degree of pain of the patients with RSD was evaluated by visual analogue scale(VAS), which scored on pre and post injection state decreased from 10 to 6.5 by 5 times injections, but did not decrease by more injections. CONCLUSION: We concluded that SGB is more effective in the RSD lesion side than the sound side and the SSR is a useful test for evaluating the effect of SGB.
Humans ; Lidocaine ; Reflex Sympathetic Dystrophy* ; Reflex* ; Skin* ; Stellate Ganglion*

PURPOSE: To evaluate the characteristics of the bronchiectasis in diffuse panbronchiolitis using HRCT. MATERIALS AND METHODS: We retrospectively studied 12 HRCT scans and two bronchography of 12 patients with diffuse panbronchiolitis(DPB). According to Akira et al., DPB was classified into four types: small nodules around the end of bronchovascular branchings(CT type I), small nodules in the centrilobular area connected with small branching linear opacities(CT type II), nodules accompanied by ring-shaped or small ductal opacities connected to proximal bronchovascular bundles(CT type III), large cystic opacities accompanied by dilated proximal bronchi(CT type IV). We compared the type and the extent of bronchiectasis, CTtypes of DPB, and pulmonary function test. RESULTS: Bronchiectasis was defined in 12 cases with the tubular type predominantly involving small and medium-sized bronchi. These bronchiectasis involved the proximal bronchi of the centrilobular lesions of DPB. Among eight cases of advanced DPB(CT type III & IV) which extended to both upper lobes, seven showed tubular bronchiectasis at the same area. Cystic bronchiectasis was shown in eight cases predominantly involving right middle lobe(n=7). There was no linear correlation between the values of pulmonary function test and CTtypes of DPB. CONCLUSION: Characteristic feature of the bronchiectasis in DPB is the tubular ectasis predominantly involving the small and medium-sized bronchi. DPB with associated tubular bronchiectasis can involve whole lung field in advanced cases. HRCT is useful not only to depict the findings of DPB but also to demonstrate the extent of lesion.
Bronchi ; Bronchiectasis* ; Bronchography ; Humans ; Lung ; Respiratory Function Tests ; Retrospective Studies

Traumatic hemipelvectomy is rarely observed because very few patients have survived from the initial trauma. We describe one male child who survived from this massive trauma with a good functional outcome. The boy was 28 months old when he was accidentally struck by a truck. He had severe open trauma of the pelvis and hemorrhage of the left lower limb. Amputation of the left hemipelvis, colostomy, cystostomy and removal of the left avulsed testicle were performed. Once healing had been achieved, he was transferred to our Department of Physical Medicine and Rehabilitation and rehabilitative management was begun, including prosthetic measurement and psychologic intervention for the patient and his parents. For 13 years of long-term follow-up, his prosthesis was readjusted annually. Now he is a 16-year-old middle school student. He is functioning remarkably well with a prosthesis. The psychologic report shows that he is emotionally stable and has good scholastic performance. Although hemipelvectomy appears to be a radical procedure in children, the potential for rehabilitation in a group of children before body image has developed appears to be unexpectedly good.
Adolescence ; Case Report ; Child, Preschool ; Hemipelvectomy*/psychology ; Hemipelvectomy*/adverse effects ; Human ; Male ; Wounds and Injuries/surgery*

Dystonia is a rare syndrome of sustained muscle contractions which frequently causes twisting and repetitive movements or abnormal postures. Dopa-responsive dystonia(DRD) is a slowly progressive dystonia with childhood on set. Initial gait disturbance with toe-walking, diurnal variation of symptoms, dramatic response to levodopa treatment and concurrent signs of parkinsonism are other characteristics of DRD. We report a 22 year old woman who showed the typical characteristics of DRD and was successfully managed with medical, surgical and rehabilitational methods. Better understanding of the disease entity and its treatment options are necessary for comprehensive rehabilitational management of DRD.
Dystonia* ; Female ; Gait ; Humans ; Levodopa ; Muscle Contraction ; Parkinsonian Disorders ; Posture ; Young Adult

Collapsing glomerulopathy is recently described as the disease which causes rapidly progressive renal failure. Clinically, the disease starts with constitutional symptoms, and then nephrotic syndrome with marked proteinuria and hypertension follows. Eventually the disease rapidly progresses to the ESRD within several weeks to months. Its typical renal biopsy findings are extensive glomerular capillary collapse, visceral epithelial cell hypertrophy and hyperplasia, and variable degree of tubulointerstitial inflammation. Such findings closely resemble those of HIV associated nephropathy(HIVAN) except endothelial inclusion body in HIVAN. Here we present, for the first time in Korea, a 16 yrs-old female patient with ESRD in a normal sized kidney. Nephrotic syndrome and hypertension were also accompanied. Serologically, she had no evidence of HIV infection. Though her symptom duration was somewhat shorter than that previously reported, her renal biopsy findings were those of collapsing glomerulopathy as previously described. Her renal function did not return to normal, and now she is on regular hemodialysis, waiting for renal transplantation.
Biopsy ; Capillaries ; Epithelial Cells ; Female ; HIV ; HIV Infections ; Humans ; Hyperplasia ; Hypertension ; Hypertrophy ; Inclusion Bodies ; Inflammation ; Kidney Failure, Chronic ; Kidney Transplantation ; Kidney* ; Korea ; Nephrotic Syndrome ; Proteinuria ; Renal Dialysis ; Renal Insufficiency

OBJECTIVE: To evaluate the effects of orthostatic stress with a head-up tilt on the autonomic nervous system and to determine how a cerebral stroke influences the cardiac autonomic function, using the power spectral analysis(PSA) of heart rate variability(HRV). METHOD: We studied 11 stroke patients with a left hemiplegia and 14 patients with a right hemiplegia. Their hemispheric brain lesions were confirmed by the MRI. The ECG and respiration signals were recorded at the tilt angle of 0o and 70o for 5 minutes under the condition of frequency controlled respirtaion(0.25 Hz). Data were compared with the age- and sex-matched 12 healthy controls. RESULT: In a control group, the normalized high frequency power showed a significant decrease during the head-up tilt(p<0.05), whereas the normalized low frequency power showed a significant increase(p<0.05). But for the left and right hemiplegia groups, there were no significant changes of normalized high and low frequency power under the orthostatic stress(p>0.05). Compared with the right hemiplegia and control groups, the left hemiplegia group was associated more with a reduced low and high frequency power and showed no significant changes under the orthostatic stress. CONCLUSION: PSA of HRV can identify the reduced cardiac autonomic activity in stroke patients, with a greater reduction in the left hemiplegia group than in the right hemiplegia group, which may cause a high risk of cardiac arrhythmias and sudden death.
Arrhythmias, Cardiac ; Autonomic Nervous System ; Brain ; Death, Sudden ; Electrocardiography ; Heart Rate* ; Heart* ; Hemiplegia ; Humans ; Magnetic Resonance Imaging ; Respiration ; Stroke*

As a standard method for the measurement of post-void residual urine volume, the urethral catheterization is commonly used. However, it is frequently associated with the discomfort of the patients, urethral trauma and urinary tract infection. A noninvasive method of determining the residual urine volume could minimize unnecessary catheterizations and be useful in the management of neurogenic bladder in the patient with spinal cord injury(SCI). This study was undertaken to evaluate the accuracy of a portable ultrasound scanner for measuring bladder volumes in SCI patients undergoing bladder training and to determine the factors affecting its accuracy. Sixty patients with SCI were included in this study. Two investigators performed the ultrasound measurement of the post-void residual urine volume alternately and the same procedures were repeated. After that, the urethral catheterization was done. In comparison of the residual volume measured by two different methods, the correlation coefficient(R2) of the two different methods was 0.996 and the mean value of difference between the residual volume measured by ulltrasound and by catheterization was 21.6 ml. The accuracy of the ultrasound measurements was not affected by gender, types of the neurogenic bladder, shape of the bladder, trabeculation of the bladder and central obesity. The results indicate that the portable ultrasound scanning method is a useful non-invasive method and can be substituted for the urethral catheterization in determination of bladder volumes in patients with SCI.
Catheterization ; Catheters ; Humans ; Obesity, Abdominal ; Research Personnel ; Residual Volume ; Spinal Cord Injuries* ; Spinal Cord* ; Ultrasonography* ; Urinary Bladder ; Urinary Bladder, Neurogenic ; Urinary Catheterization ; Urinary Catheters ; Urinary Tract Infections

The powers of the low-frequency(LF) and high-frequency(HF) components characterizing heart rate variability (HRV) appear to reflect, in their reciprocal relationship, changes in the state of the sympatho-vagal balance occurring during orthostatic stress with head-up tilt. We studied 24 healthy volunteers (median age, 23.1 years) who were subjected after a rest period to a series of passive head-up tilt steps chosen from the following angles: 0 degree. 15 degrees, 30degrees, 45degrees, 70degrees, and 90degrees under the condition of frequency controlled respiration(0.25Hz) in order to get data of the Korean young adults. During head-up tilt, heart rate and normalized low frequency power(LF(N : 0.05-0.15 Hz) of HRV showed significant increase(p=0.000), but normalized high frequency power(HFN : 0.2-0.3 Hz) and total power showed progressive decrease(p=0.000, p<0.01 respectively). Male showed significantly higher LF(N and lower HFN than female at tilt table angle 0degree(p<0.01). Power spectral analysis of HRV appears to be capable of providing a noninvasive quantitatibve evaluation of graded changes in the state of the sympatho-vagal balance.
Female ; Healthy Volunteers ; Heart Rate* ; Heart* ; Humans ; Male ; Young Adult*

PURPOSE: To determine the patterns of evaluation and treatment in patients with breast cancer after mastectomy and treated with radiotherapy. A nationwide study was performed with the goal of improving radiotherapy treatment. MATERIALS AND METHODS: A web-based database system for the Korean Patterns of Care Study (PCS) for 6 common cancers was developed. Randomly selected records of 286 eligible patients treated between 1998 and 1999 from 17 hospitals were reviewed. RESULTS: The ages of the study patients ranged from 20 to 80 years (median age 44 years). The pathologic T stage by the AJCC was T1 in 9.7% of the cases, T2 in 59.2% of the cases, T3 in 25.6% of the cases, and T4 in 5.3% of the cases. For analysis of nodal involvement, N0 was 7.3%, N1 was 14%, N2 was 38.8%, and N3 was 38.5% of the cases. The AJCC stage was stage I in 0.7% of the cases, stage IIa in 3.8% of the cases, stage IIb in 9.8% of the cases, stage IIIa in 43% of the cases, stage IIIb in 2.8% of the cases, and IIIc in 38.5% of the cases. There were various sequences of chemotherapy and radiotherapy after mastectomy. Mastectomy and chemotherapy followed by radiotherapy was the most commonly performed sequence in 47% of the cases. Mastectomy, chemotherapy, and radiotherapy followed by additional chemotherapy was performed in 35% of the cases, and neoadjuvant chemoradiotherapy was performed in 12.5% of the cases. The radiotherapy volume was chest wall only in 5.6% of the cases. The volume was chest wall and supraclavicular fossa (SCL) in 20.3% of the cases; chest wall, SCL and internal mammary lymph node (IMN) in 27.6% of the cases; chest wall, SCL and posterior axillary lymph node in 25.9% of the cases; chest wall, SCL, IMN, and posterior axillary lymph node in 19.9% of the cases. Two patients received IMN only. The method of chest wall irradiation was tangential field in 57.3% of the cases and electron beam in 42% of the cases. A bolus for the chest wall was used in 54.8% of the tangential field cases and 52.5% of the electron beam cases. The radiation dose to the chest wall was 45~59.4 Gy (median 50.4 Gy), to the SCL was 45~59.4 Gy (median 50.4 Gy), and to the PAB was 4.8~38.8 Gy, (median 9 Gy) CONCLUSION: Different and various treatment methods were used for radiotherapy of the breast cancer patients after mastectomy in each hospital. Most of treatment methods varied in the irradiation of the chest wall. A separate analysis for the details of radiotherapy planning also needs to be followed and the outcome of treatment is needed in order to evaluate the different processes.
Breast Neoplasms ; Breast* ; Chemoradiotherapy ; Drug Therapy ; Humans ; Korea* ; Lymph Nodes ; Mastectomy* ; Mastectomy, Radical ; Radiotherapy ; Thoracic Wall

In this article, on page 230, Fig. 2A needs to be corrected.