PURPOSE: This study was designed to evaluate the effectiveness of postoperative radiotherapy for patients with low-grade astrocytomas and to define an optimal radiotherapeutic regimen and prognostic factors. MATERIALS AND METHODS: A total of 69 patients with low-grade astrocytomas underwent surgery and postoperative radiotherapy immediately following surgery at our institution between October 1989 and September 2006. The median patient age was 36 years. Forty-one patients were 40 years or younger and 28 patients were 41 years or older. Fourteen patients underwent a biopsy alone and the remaining 55 patients underwent a subtotal resection. Thirty-nine patients had a Karnofsky performance status of less than 80% and 30 patients had a Karnofsky performance status greater than 80%. Two patients were treated with whole brain irradiation followed by a coned down boost field to the localized area. The remaining 67 patients were treated with a localized field with an appropriate margin. Most of the patients received a dose of 50~55 Gy and majority of the patients were treated with a dose of 54 Gy. RESULTS: The overall 5-year and 7-year survival rates for all of the 69 patients were 49% and 44%, respectively. Corresponding disease free survival rates were 45% and 40%, respectively. Patients who underwent a subtotal resection showed better survival than patients who underwent a biopsy alone. The overall 5-year survival rates for patients who underwent a subtotal resection and patients who underwent a biopsy alone were 57% and 38%, respectively (p<0.05). Forty-one patients who were 40 years or younger showed a better overall 5-year survival rate as compared with 28 patients who were 41 years or older (56% versus 40%, p<0.05). The overall 5-year survival rates for 30 patients with a Karnofsky performance status greater than 80% and 39 patients with a Karnofsky performance status less than 80% were 51% and 47%, respectively. This finding was not statistically significant. Although one patient was not able to complete the treatment because of neurological deterioration, there were no significant treatment related toxicities. CONCLUSION: Postoperative radiotherapy following surgery is a safe and effective treatment for patients with low-grade astrocytomas. The extent of surgery and age were noted as significant prognostic factors in this study. However, further effective treatment might be necessary in the future to improve long-term survival rates.
Astrocytoma ; Biopsy ; Brain ; Disease-Free Survival ; Humans ; Karnofsky Performance Status ; Survival Rate

OBJECTIVES: The purpose of this study is to evaluate the effect of geriatric depression in activities of daily living for self maintenance (ADL) and instrumental activities of daily living (IADL) under control for effect of cognitive impairment which can be originated by other reasons. METHODS: The author had interviews with 100 old peoples using various scales (KGDS, MMSE-K, Karnofsky Performance Status Scale, ADL, IADL, QOL questionnaire, HDRS). This study also attempts to compare three groups (depression group, recovered group, normal control group) in their functional status. RESULTS: 1) Self-maintenance skills are more affected by physical states than by depressive symptoms. But the effect of depression is more prominent in instrumental activities of daily living. 2) Korean Geriatric Depression Scale (KGDS) correlated well with activities of daily living for self maintenance (ADL) and instrumental activities of daily living (IADL), but Hamilton Depression Rating Scale (HDRS) did not show significant correlation. This reflects that KGDS is a more specific measure for geriatric depression patients. When the effect of physical illness state was eliminated, partial correlation between KGDS and ADL/IADL showed no significant association. This means that the patient's physical functioning status is very important in functional level of geriatric patient. 3) When the patient is recovered from geriatric depression through appropriate treatment, patient's functional level showed no significant differences with normal control. CONCLUSION: This article emphasizes the importance of appropriate treatment for geriatric depression. After the effect of cognitive function was controlled, geriatric depression itself showed significant functional impairment. This functional deficit can threaten the patient's independence and self-respect. So appropriate treatment for depression in geriatrics is indispensable for enhancing quality of life in old people.
Activities of Daily Living ; Depression* ; Geriatrics ; Humans ; Karnofsky Performance Status ; Quality of Life ; Surveys and Questionnaires ; Weights and Measures

PURPOSE: To find the more effective treatment methods that improving thesurvival of patients with glioblastoma multiforme(GBM), we analyze the prognostic factors and the outcome of therapy in patients with GBM. METHODS AND MATERIALS: One hundred twenty-one patients with a diagnosis of GBM treated at Severance Hospital between 1973 and 1993 were analyzed for survival with respect to patients characteristics, that is, duration of symptom, age, and Karnofsky performance status, as well as treatment related variables such as extent of surgery and radiotherapy. RESULTS: The median survival time(MST) and 2-year overall survival rate (OSR) of the patients with GBM were 13 months and 20.8%, respectively. Duration of symptom, age, Karnofsky performance status(KPS), radiotherapy, and extent of surgical resection were associated with improved survival in a univariate analysis. Patients whose duration of symptom was longer than 3 months, had the 2-year OSR of 47.2%(p=0.0082), who were younger than age 50, 32.9%(p=0.0003). In patients with a KPS of 80 or higher, the 2 year OSR was 36.9%(p=0.0422). Patients undergoing radiotherapy had the 2-year OSR of 22.9%(p=0.030), and surgical resection of 23.3%(p<0.000). A cox regression model confirmed a significant correlation of duration of symptom, age, radiotherapy,and extent of surgical resection with survival, excluding KPS(p=0.8823). The 2-year OSR were 22.3% and 19.4%, combined with chemotherapy or without, respectively(p=0.06028). The duration of symptom of 3 months or shorter. 50 years of age or older, and undergoing stereotactic biopsy only were considered as risk factors. then patients without any risk factors had the MST of 29 months and 2-year OSR of 53.9% compared to 4 months and 0% for patients who had all 3 risk factors. Most of all treatment failure occurred in the primary tumor site(86.4%) CONCLUSION: The duration of symptom, age, radiotherapy, and extent of surgical resection were a prognostically significant independent variables. To get a better survival, it seems to be reasonable that the study design which improves the local control rates is warranted.
Biopsy ; Diagnosis ; Drug Therapy ; Glioblastoma* ; Humans ; Karnofsky Performance Status ; Radiotherapy ; Risk Factors ; Survival Rate ; Treatment Failure

OBJECTIVE: To document surgical mortality and morbidity for the treatment of unruptured intracranial aneurysms, and to identify optimal treatment modalities, the authors reviewed and analyzed the surgical results. METHODS: The authors reviewed 49 cases of unruptured intracranial aneurysm without a previous history of subarachnoid hemorrhage from March 1984 through December 2003. Unruptured intracranial aneurysms were categorized as asymptomatic and symptomatic, and operative results were assessed using the Karnofsky scale at 3 months postoperatively. Outcomes were defined as 'excellent' for a Karnofsky scale score of 100, 'good' for a score of 80~90, 'fair' for 50~70, 'poor' for 10~40, or as 'death'. Excellent and good results were defined as a 'favorable' outcome and others as 'unfavorable' outcome. RESULTS: Of the 49 study subjects, 45 had a favorable outcome and 4 an unfavorable outcome. Surgical mortality was 6.1% and surgical morbidity was 2.0% for all subjects. And the symptomatic group had more complications. CONCLUSION: There were no significant relationships between aneurysmal size, location, and preoperative symptoms with surgical results. And we believe that the reasons for morbidity and mortality are attributable to strokes, thus more attention should be paid to peri- and post-operative patients care with a focus on strokes prevention in the symptomatic group.
Aneurysm ; Humans ; Intracranial Aneurysm* ; Karnofsky Performance Status ; Mortality ; Stroke ; Subarachnoid Hemorrhage

PURPOSE: This study aimed to explore changes in symptom distress and functional status in gynecologic cancer patients during the entire treatment cycles of chemotherapy. METHODS: A prospective and longitudinal study with repeated measures was designed. Symptom Distress Scale and Karnofsky Performance Status Index were included in a daily log developed for self-administration. A total of 39 patients with a mean age of 48.4 years participated. RESULTS: The levels of symptom distress and functional status changed significantly over the six cycles. Symptom distress kept increasing until its peak at the fourth cycle, while the functional status scored lowest at the first cycle, then it improved as the cycle repeated. In each cycle, symptom distress was marked higher during the first 6 days accompanying poor functional status. However, both changes did not recover completely until the end of each cycle. CONCLUSION: Nursing assessment and intervention need to be provided based on these changing patterns to help cancer patients cope and adjust successfully during the long treatment period. Further studies are needed to examine the impact of the major symptoms on psychological responses, quality of life, and outcomes of the cancer treatments.
Drug Therapy* ; Humans ; Karnofsky Performance Status ; Longitudinal Studies* ; Nursing Assessment ; Prospective Studies ; Quality of Life

OBJECTIVETo observe the effect of long-term application of Shengmai Capsule (SMC) on recovery of patients after myocardial infarction.

METHODSA total of 120 myocardial infarction patients were: assigned into two groups. Changes of angina pectoris, electrocardiogram (ECG), living capacity and heart function in patients were observed after 6-month treatment.

RESULTSThe total effective rate in alleviating angina: pectoris was 90.0% and that in improving ECG figure was 93.3% in the treatment group, both were significantly higher than those in the control group, 73.4% and 70.0% respectively (P<0.05). The Karnofsky Performance Status scores of heart function were increased and the Activity of Daily Living scores in living capacity decreased in both groups, but the improvements were better in the treatment group (P<0.01 and P<0.05). The parameters of cardiac function, including cardiac output, stroke volume, cardiac index and ejection fraction, were increased in both groups, but the increments in the treatment group were more significant (P<0.01 or P<0.05).

CONCLUSIONLong-term application of SMC could effectively prevent and treat angina pectoris, improve the living capacity and accelerate the recovery of heart function in patients after myocardial infarction.

Robot-assisted gait training (RAGT) is beneficial in effectively implementing repetitive, high-intensity gait training. Several studies have been conducted in different fields of RAGT; however, only a few have explored such training practices in patients with brain tumors. We conducted RAGT in 3 patients with primary brain tumors. They were treated with 30 minutes of Morning Walk® training, followed by 1 hour of conventional physiotherapy, 5 times a week for 3 weeks. At the end of RAGT, the outcomes revealed improved scores in all 3 patients on several assessments, such as the 10-meter walk test, Modified Barthel Index, Rivermead Mobility Index, Berg Balance Scale, and Karnofsky Performance Status Scale. However, the level of fatigue (Brief Fatigue Index) increased in all the patients. RAGT accompanied with conventional physiotherapy is beneficial for gait speed, mobility, and functional ambulation, but the level of fatigue is deteriorated at the same time in patients with brain tumors. The time, intensity, and protocol of RAGT accompanied with conventional physiotherapy need to be tailored to the level of fatigue expressed by patients with brain tumors to improving gait disturbances effectively.
Brain Neoplasms* ; Brain* ; Fatigue ; Gait* ; Humans ; Karnofsky Performance Status ; Rehabilitation ; Walking

Objectives : Depression is a common psychiatric disorder in cancer patients. The Brief Edinburgh Depression Scale(BEDS), which is an abbreviated version of the Edinburgh Depression Scale, may serve as a useful tool in screening for the depression in patients with the medical illnesses. This report investigated the reliability and validity of the Korean Version of the BEDS(K-BEDS) for the depression in cancer patients. METHODS : One-hundred cancer patients were enrolled in this study. All subjects completed the K-BEDS, the Hospital Anxiety Depression Scale(HADS), and the Karnofsky Performance Status Scale(KPSS). Reliability, validity and Receiver Operating Characteristic(ROC) curve analysis measures were assessed. RESULTS : The K-BEDS showed good internal consistency(Cronbach alpha=0.77) and test-retest reliability(0.94, p<0.001). All item-total correlations were above 0.3. Also, it revealed moderate correlation with the depression subscale of the HADS(r=0.617), but no correlation with the KPSS. Exploratory factor analysis produced only one factor, accounting for 47.1% of the total variance. The most valid cutoff value to screen for depression was a total score of 5 on the K-BEDS, which showed sensitivity of 62.5% and specificity of 86.4% with a positive predictive value of 4.60 and a negative predictive value of 0.43. CONCLUSION : The present findings suggested that the K-BEDS would have good psychometric properties to screen for the depression in cancer patients.
Accounting ; Anxiety ; Depression ; Humans ; Karnofsky Performance Status ; Mass Screening ; Psychometrics ; Reproducibility of Results ; Sensitivity and Specificity

PURPOSE: The purpose of this study was to identify the patterns of activities of daily living (ADL) functional status and to examine the relationships between sense of coherence (SOC), depression, and uncertainty in gynecologic cancer patients who were receiving chemotherapy. METHOD: A prospective, longitudinal design with repeated measures was utilized. Women reported depression, SOC, and uncertainty at the beginning of the first cycle of chemotherapy, and they recorded ADL functional status everyday for two consecutive treatment cycles. the The instruments used were the Karnofsky Performance Status Index, Orientation to Life Questionnaire, Beck Depression Inventory, and Mishel Uncertainty in Illness Scale-Adult Form. RESULT: Data from 42 women showed that the ADL functional status during the second cycle was better than that of the first cycle with significant improvement each week. However, it did not completely recover to the baseline level even three weeks after the treatment ended in both cycles. SOC was correlated with depression (r=-.64, p< .001) and uncertainty (r=-.62, p< .001). Uncertainty was related to depression (r=.66, p< .001) and to functional status during the second cycle (r=-.45, p< .05), while the scores of the functional status during the two cycles were not related. CONCLUSION: Changing patterns and level of functional status during the treatment phase would be useful information for cancer patients to prepare coping strategies for positive health outcomes.
Activities of Daily Living ; Depression ; Drug Therapy* ; Female ; Humans ; Karnofsky Performance Status ; Prospective Studies ; Surveys and Questionnaires ; Sense of Coherence ; Uncertainty

BACKGROUND/AIMS: Acute hemorrhagic rectal ulcers (AHRUs) are rare and have not been thoroughly studied. This study aimed to assess the clinical and endoscopic characteristics of AHRUs and to determine the risk factors for rebleeding after the initial management. METHODS: Thirty patients who underwent colonoscopy within 48 hours of the onset of hematochezia were consecutively enrolled between January 2004 and December 2007. The patients were divided into a rebleeding group and a non-rebleeding group according to presence of recurrent bleeding after initial management. We analyzed the clinical features, including the underlying disorder, the Karnofsky performance status (PS), the use of anticoagulant or antiplatelet agents, the endoscopic findings, and the methods used for hemostasis. RESULTS: All of the patients were elderly, in a bedridden status, and all had experienced the sudden onset of massive, fresh rectal bleeding without pain. The characteristics of the lesions on colonoscopy included solitary or multiple rectal ulcers, or Dieulafoy lesions located in the distal rectum. There were no differences between the two groups based on mean age, gender, use of anticoagulant or antiplatelet agents, PS, methods of hemostasis, and clinical outcomes. The PT (INR) and endoscopic findings (Dieulafoy types), however, differed significantly between the two groups (p=0.024 and p=0.013, respectively). CONCLUSIONS: When massive hematochezia occurs in bedridden patients with severe comorbid illnesses, AHRUs should be considered in the differential diagnosis. It is advisable to be vigilant for rebleeding in patients with prolongation of the PT (INR) and Dieulafoy-type ulcers on colonoscopy.
Aged ; Colonoscopy ; Diagnosis, Differential ; Gastrointestinal Hemorrhage ; Hemorrhage ; Hemostasis ; Humans ; Karnofsky Performance Status ; Platelet Aggregation Inhibitors ; Rectum ; Risk Factors ; Ulcer