PURPOSE : Developmental screening tests are in widespread use, but few reliable and valid tests are available. One of the oldest and best known developmental screening test was recently restandardized and revised as Denver II. Because the Denver II was published without evidence of its accuracy in developmental screening, we evaluate its accuracy in chidren with developmental delay to see whether it can be used on Korean children. METHODS : The Denver II was translated and was administered to 244 children attending the child development clinic in Kangnam St. Mary's Hospital to evaluated motor delay(Group I, n=68), language delay(Group II, n=84) or other problem(Group III, n=92). RESULTS : 1) The ratio of male to female and the mean age of the subject were 2.4:1 and 25.1 months overall, 1.6:1 and 11.8 months in Group I, 4.6:1 and 35.6 months in Group II, and 1.3:1 and 25.4 months in Group III. 2) The distribution of results(abnormal, normal and questionable) were 76%, 13% and 10% in Group I, 76%, 10% and 14% in Group II, and 38%, 53% and 9% in Group III. 3) The neurologic problems were determined 75%(cerebral palsy, central hypotonia, infantile spasm, myopathy etc.) in Group I, 74%(mental retardation, developmental language disorder, epilepsy, cerebral palsy etc.) Group II and 39%(mental retardation, epilepsy, cerebral palsy etc.) in Group III. 4) The sensitivity and the specificity of Denver II were 0.88 and 0.41 in Group 1, 0.90 and 0.27 in Group II, 0.81 and 0.77 in Group III, and 0.85 and 0.59 overall. CONCLUSION: Although the Denver II in identifying children at risk for developmental delay has a excellent sensitivity, it has a poor specificity, especially in identifying children at risk for language delay. These results demonstrate that the Denver fail to reliably identify children in need of developmental delay evaluation. So the Denver II should be standardized and modified to be used on Korean children with developmental delay.
Cerebral Palsy ; Child ; Child Development ; Epilepsy ; Female ; Humans ; Infant ; Infant, Newborn ; Language Development Disorders ; Male ; Mass Screening* ; Muscle Hypotonia ; Muscular Diseases ; Paralysis ; Sensitivity and Specificity ; Spasms, Infantile

Radon, the primary constituent of natural radiation, is the second leading environmental cause of lung cancer after smoking. To confirm a relationship between indoor radon exposure and lung cancer, estimating cumulative levels of exposure to indoor radon for an individual or population is necessary. This study sought to develop a model for estimate indoor radon concentrations in Korea. Especially, our model and method may have wider application to other residences, not to specific site, and can be used in situations where actual measurements for input variables are lacking. In order to develop a model, indoor radon concentrations were measured at 196 ground floor residences using passive alpha-track detectors between January and April 2016. The arithmetic mean (AM) and geometric mean (GM) means of indoor radon concentrations were 117.86±72.03 and 95.13±2.02 Bq/m³, respectively. Questionnaires were administered to assess the characteristics of each residence, the environment around the measuring equipment, and lifestyles of the residents. Also, national data on indoor radon concentrations at 7643 detached houses for 2011-2014 were reviewed to determine radon concentrations in the soil, and meteorological data on temperature and wind speed were utilized to approximate ventilation rates. The estimated ventilation rates and radon exhalation rates from the soil varied from 0.18 to 0.98/hr (AM, 0.59±0.17/hr) and 326.33 to 1392.77 Bq/m²/hr (AM, 777.45±257.39; GM, 735.67±1.40 Bq/m²/hr), respectively. With these results, the developed model was applied to estimate indoor radon concentrations for 157 residences (80% of all 196 residences), which were randomly sampled. The results were in better agreement for Gyeonggi and Seoul than for other regions of Korea. Overall, the actual and estimated radon concentrations were in better agreement, except for a few low-concentration residences.
Background Radiation ; Exhalation ; Gyeonggi-do ; Korea ; Life Style ; Lung Neoplasms ; Methods ; Models, Theoretical ; Radon* ; Seoul ; Smoke ; Smoking ; Soil ; Ventilation ; Wind

Radon, the primary constituent of natural radiation, is the second leading environmental cause of lung cancer after smoking. To confirm a relationship between indoor radon exposure and lung cancer, estimating cumulative levels of exposure to indoor radon for an individual or population is necessary. This study sought to develop a model for estimate indoor radon concentrations in Korea. Especially, our model and method may have wider application to other residences, not to specific site, and can be used in situations where actual measurements for input variables are lacking. In order to develop a model, indoor radon concentrations were measured at 196 ground floor residences using passive alpha-track detectors between January and April 2016. The arithmetic mean (AM) and geometric mean (GM) means of indoor radon concentrations were 117.86±72.03 and 95.13±2.02 Bq/m³, respectively. Questionnaires were administered to assess the characteristics of each residence, the environment around the measuring equipment, and lifestyles of the residents. Also, national data on indoor radon concentrations at 7643 detached houses for 2011-2014 were reviewed to determine radon concentrations in the soil, and meteorological data on temperature and wind speed were utilized to approximate ventilation rates. The estimated ventilation rates and radon exhalation rates from the soil varied from 0.18 to 0.98/hr (AM, 0.59±0.17/hr) and 326.33 to 1392.77 Bq/m²/hr (AM, 777.45±257.39; GM, 735.67±1.40 Bq/m²/hr), respectively. With these results, the developed model was applied to estimate indoor radon concentrations for 157 residences (80% of all 196 residences), which were randomly sampled. The results were in better agreement for Gyeonggi and Seoul than for other regions of Korea. Overall, the actual and estimated radon concentrations were in better agreement, except for a few low-concentration residences.
Background Radiation ; Exhalation ; Gyeonggi-do ; Korea ; Life Style ; Lung Neoplasms ; Methods ; Models, Theoretical ; Radon ; Seoul ; Smoke ; Smoking ; Soil ; Ventilation ; Wind

PURPOSE: During the childhood, Mantoux test is very popular for detecting tuberculous infection and also useful for evaluating the immunity against tuberculosis after BCG vaccination. But the response and conversion rate is affected by the age of vaccination, the quality of vaccine, the duration after vaccination and the frequency of the test. Recently percutaneous multipuncture technique of BCG vaccination was introduced and used because of local side effect and technical problem of intradermal BCG vaccination, however there is only a study of conversion rate and side effect at 3month after multipuncture BCG vaccination. We performed this study to evaluate of the difference of the Mantoux reaction and conversion rate according to duration (3month, 9month and 15month) after vaccination, gestational age, sex, and feeding type. METHODS: 174 neonates (155 of full term infants, 19 of preterm infants) who were born Kangnam St. Mary's Hospital were given multipuncture BCG vaccination within 4weeks after birth between July, 1995 and June 1997. All subjects was performed Mantoux test using 5TU PPD (NIH, Korea) at 3month, 9month and 15month. Injecting BCG and interpretating the result of the Mantoux test was done by the same person. RESULTS: 1) The positive rates of Mantoux test which was done 3month , 9month and 15month after vaccination were 38.7%, 58.1%, 71.6% in the full term infant group and 31.6%, 31.6%, 47.4% in the preterm infant group. 2) The size of induration in Mantoux test, which was done 3month, 9month and 15month after vaccination were 7.3 mm, 9.4 mm, and 10.6 mm in the full term infant group and 5.6 mm, 7.7 mm, 9.2 mm in the preterm infant group. The size of induration was significantly lower in the preterm infant group as compared with that of the full term infant group 9month after vaccination. 3) The positive conversion rate, less than 5 mm to more than 10 mm, was 6.3% (3 infants of 48 infants who were negative Mantoux test 3month became positive 9month) and 26.3% (5 infants of 19 infants who were negative 9month became positive 15month) in the full term infant group, and 33.3% (one infant of 5 infants who were negative 9month became positive 15month). 4) There is no difference in conversion rate of Mantoux test according to the sex, feeding type in both groups5) Complication rate for multipuncture is 3.2%, which is leaded by local ulceration and fever in the full term infant group, and 5.3%, which is only fever in the preterm infant group. CONCLUSION: In those result the size of induration and conversion rate is increased as the duration after vaccination, then their smaller size in the preterm group 9month after vaccination maybe due to immunological immaturity of preterm group.
Fever ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Mycobacterium bovis* ; Parturition ; Tuberculosis ; Ulcer ; Vaccination*

The bcl-2 proto-oncogene was first described as a result of the chromosomal translocation t(14:18) seen in a large number of follicular B-cell lines. Bcl-2 is so far unique a proto-oncogene in that it codes for an inner mitochondrial membrane protein. This protein regulates the programmed cell death called apoptosis. This study was designed to investigate expression of bcl-2 protein in 81 human breast cancer by using immunohistochemical staining with the monoclonal antibody of bcl-2 protein. Also this factor was compared with established clinicopathological prognostic factors and hormone receptors. The bcl-2 protein expression was positive in 38(47%) cases and was negative in 43(53%) cases. There was significant correlation between bcl-2 protein expression and histologic grade(p=0.014). Positive expression of bcl-2 protein was correlated with positive estrogen(p=0.051) and progesterone(p=0.059) receptors, but this correlation was not significant. Bcl-2 expression failed to show its prognostic role for overall(p=0.115) and disease free(p=0.214) survival. In conclusion, the bcl-2 protein is often expressed in half of breast cancer, and its expression is associated with histologic grade and hormone receptor status, but the overall and disease free survival of breast cancer patient do not appear to be influenced by bcl-2 protein expression.
Apoptosis ; B-Lymphocytes ; Breast Neoplasms* ; Breast* ; Cell Death ; Disease-Free Survival ; Humans ; Mitochondrial Membranes ; Proto-Oncogenes ; Translocation, Genetic

BACKGROUND: While sleeping, humans frequently change their position; this is done to avoid direct and excessive pressure on the body surface, and is considered to be very important for the prevention of pressure sores. A patient who is under general anesthesia, however, cannot perform this reflex movement; maintaining the same position during an entire operation causes concentrated pressure on specific body surfaces, and this may result in complications such as allopecia, back pain, pressure sores and peripheral nerve damage. Because little is known about the relationship between surgical position and pressure on the body surface, position is in most clinical situations decided on the basis of experience and informed guesswork. In order to qualitatively and quantitatively determine weight-bearing areas, pressure on the body surface of patients was evaluated under general anesthesia. METHOD: Ten patients scheduled for elective surgery were selected for this study. They were all aged over 20 and ASA class 1. A mattress equipped with a force sensing resistor was placed on the operating table and used to determine pressure on the body surface. Pressure was measured before and after anesthesia was induced in the supine, lateral and prone position. The signal generated by this mattress was processed using an analogue-digital (AD) converter, then displayed as pressure distribution on a computer screen. Pressure points were compared qualitatively, and for quantitative measurement were digitally expressed. 'Pressure' here is mean pressure at each point calculated among ten patients. RESULTS: In the supine position, pressure was concentrated on the shoulder and sacral areas. Pressure distribution in these areas was 29.8% (shoulder) and 26.0% (sacral area) before anesthesia was induced, and 20.3% (shoulder) and 25.8% (sacral area) after induction. In the lateral position, the shoulder and trochanteric areas were identified as the main weight-bearing areas; pressure distribution was 11.2% and 8.1% before induction, and 21.6% and 15.3% after induction, respectively. In the prone position, the chest and abdomen were the main weight-bearing areas. Pressure distribution in the chest area was 30.8% before induction and 24.4% after. Operating table tilt in each surgical position also produced marked changes in pressure distribution. CONCLUSIONS: In each surgical position, weight-bearing areas were qualitatively and quantitatively determined before and after anesthesia.
Abdomen ; Anesthesia ; Anesthesia, General* ; Back Pain ; Femur ; Human Body* ; Humans* ; Operating Tables ; Peripheral Nerves ; Pressure Ulcer ; Prone Position ; Reflex ; Shoulder ; Supine Position ; Thorax ; Weight-Bearing

BACKGROUND/AIMS: In the management of choledocholithiasis, T-tube drainage was the most common treatment modality after common bile duct (CBD) exploration. However, the T-tube drainage has several problems and risk of complications such as abdominal discomfort, long duration of drainage, or bile leakage. We evaluated the effectiveness of primary closure of CBD after choledochotomy and the possibility of substitution for T-tube drainage. METHODS: Seventy six patients with choledocholithiasis who had undergone CBD exploration were enrolled in this study from January 1999 to March 2001. 20 patients among them had undergone primary closure of CBD with preoperative endoscopic nasobiliary drainage (ENBD) or percutaneous transhepatic biliary drainage (PTBD) in situ after exploration (primary closure group), 56 patients had undergone T-tube drainage (T-tube group). We compared the clinical characteristics and outcome between two groups. RESULTS: There was no difference in postoperative complication (19.6% vs. 20%), the mean amount of biliary drainage (326 ml/day vs. 320 ml/day) and the duration of hospitalization (11.6 day vs. 9.2 days) between the both groups. The duration of biliary drainage was significantly longer in the T-tube group (45.3 days) than in the primary closure group (9.2 days; p<0.01). The rate of remnant stone was higher in the T-tube group (32.1%) than the primary closure group (20%), there was not statistically significant. CONCLUSION: The primary closure of CBD with the preoperative biliary drainage was relatively safe and resulted in no difference of clinical outcome. Furthermore, this method induced going back early to normal life. These result suggest that the primary closure of CBD may be a feasible technique after choledochotomy when the patients are selected by specialized indications.
Bile ; Choledocholithiasis ; Common Bile Duct* ; Drainage* ; Hospitalization ; Humans ; Postoperative Complications

Enteroviruses are the most common agents of myocarditis and have been implicates in the pathogenesis of dilated cardiopmyopathy. There are still discrepancies in the association of enterovirus and myocardial disease, partially due to lack of data on detection of virus antigen or viral culture in the tissue. For the treatment of fulminant myocarditis, aggressive hemodynamic support is warranted because of its excellent long-term prognosis. This 16 year-old girl was admitted because of anterior chest pain for a day. She had flu-like symptoms such as fever, sore throat and cough at 2 weeks ago. Electrocardiogram showed sinus tachycardia and ST segment elevations in lead II, III, aVF and V1-V4. Troponin T was positive and creatinine phosphokinase was elevated (1323 IU/L) at emergency room. On emergency echocardiogram, inferior wall motion was decreased and the ejection fraction (EF) was 70%. Coronary angiogram showed no thrombus and no significant stenosis in coronary artery, and spasm was not induced with ergonovine. Conventional treatment for congestive heart failure with digoxin (0.25 mg daily) and furosemide (20 mg t.i.d) was started under the impression of myocarditis. On the first hospital day, pulmonary edema and signs of shock were developed. The whole left ventricular(LV) wall motion were markedly decreased and EF was less than 20% on echocardiogram. Despite of intra-aortic balloon pump (IABP) for 4 hours, shock and pulmonary edema was progressed. Mechanical circulatory support was started with left ventricular assist device (LVAD, Bio-pump, Medtronic Bio-Medicus, USA). At the time of operation, central venous pressure was 24cmH20, systolic blood pressure was 75mmHg, left atrium(LA) and LV was dilated and the whole wall of LV showed almost akinesia , and LA appendage was biopsied. After 126 hours of LVAD, LV wall motion was restored and EF was 79% on echocardiogram. LVAD was removed 10 days after operation and she was discharged on 23 days of hospitalization without any heart failure symptoms. Immunohistochemistry of LA showed enteroviral VP1 capsid protein (primary antibody; NoVo Castra Laboratory, UK) over the entire LA wall. Her serum neutralized coxsackievirus B3 (CVB3, H3 variant of Woodruff strain) in neutralization test using horse anti-CVB3 (Nancy strain) antibody (ATCC, V030-501-560) as a positive control. The titer of neutralization Ab in her serum of 21 days increased more than 4 times than that of 2 days.
Adolescent ; Blood Pressure ; Capsid Proteins ; Cardiomyopathies ; Central Venous Pressure ; Chest Pain ; Constriction, Pathologic ; Coronary Vessels ; Cough ; Creatinine ; Digoxin ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Enterovirus ; Ergonovine ; Female ; Fever ; Furosemide ; Heart Failure ; Heart-Assist Devices* ; Hemodynamics ; Horses ; Hospitalization ; Humans ; Immunohistochemistry ; Myocarditis* ; Neutralization Tests ; Pharyngitis ; Prognosis ; Pulmonary Edema ; Shock ; Spasm ; Tachycardia, Sinus ; Thrombosis ; Troponin T

PURPOSE: Tc-99m labeled diethylenetriaminepentaacetic acid (DTPA) -coupled galactosylated human serum albumin (GSA) is a currently used imaging agent for asialoglycoprotein receptor (ASGPR) of the liver, but, it has several shortcomings. Recently a new ASGPR imaging agent, (99m) Tc-lactosylated human serum albumin (LSA), with simple labeling procedure, high labeling efficiency, high stability was developed. In order to assess the feasibility of the (99m) Tc-LSA as a ASGPR imaging radiopharmaceuticals, we performed biodistribution study of the tracer in liver injured mice model and the results were compared with histolgic data. MATERIALS AND METHODS: To induce hepatic damage in ICR mice, diethylnitrosamine (DEN) (60 mg/kg/week X 5 time, low dose or 180 mg/kg/week X 2 times, high dose) and thioacetamide (TAA) (50 mg/kg X 1 time) were administrated intraperitoneally. Degree of liver damage was evaluated by tissue hematoxilin-eosin stain, and expression of asialoglycoprotein receptor (ASGPR) was assessed by immunohistochemistry using ASGPR antibody. (99m) Tc-LSA was intravenously administrated via tail vein in DEN or TAA treated mice, and biodistribution study of the tracer was also performed. RESULTS: DEN treated mice showed ballooning of hepatocyte and inflammatory cell infiltration in low dose group and severe hapatocyte necrosis in high dose group, and low dose group showed higher ASGPR staining than control mice in immunohistochemical staining. TAA treated mice showed severe hepatic necrosis. (99m) Tc-LSA Biodistribution study showed that mice with hepatic necrosis induced by high dose DEN or TAA revealed higher blood activity and lower liver activity than control mice, due to slow clearance of the tracer by the liver. The degree of liver uptake was inversely correlated with the degree of histologic liver damage. But low dose DEN treated mice with mild hepatic injury showed normal blood clearance and hepatic activity, partly due to overexpression of ASGPR in mice with mild degree hepatic injury. CONCLUSION: Liver uptake of (99m) Tc-LSA was inversely correlated with degree of histologic hepatic injury in DEN and TAA treated mice. These results support that (99m) Tc-LSA can be used to evaluate the liver status in liver disease patients.
Animals ; Asialoglycoprotein Receptor ; Diethylnitrosamine* ; Hepatocytes ; Humans ; Immunohistochemistry ; Liver Diseases ; Liver* ; Mice* ; Mice, Inbred ICR ; Necrosis ; Radiopharmaceuticals ; Serum Albumin* ; Thioacetamide* ; Veins

Hereditary factor VII deficiency is a rare disorder transmitted by autosomal recessive pattern and its clinical feature is extremely variable. Recently we have experienced a case who was performed herniorrhaphy without any cryoprecipitate or fresh frozen plasma replacement therapy. A 21-year-old patient who had undergone intermittent nasal bleeding was noted for prolonged prothrombin time(INR of 1.5). The level of the factor VII of the patient was decreased at 22% of the normal activity. His parents had normal level of factor VII activity. Both his sister and brother had decreased level of factor VII at 41% and 24% respectively. Herniorrhaphy was performed without factor replacement therapy and there was no visible postoperative bleeding. We report here a case of factor VII deficiency performed an operation successfully without any replacement therapy.
Epistaxis ; Factor VII Deficiency* ; Factor VII* ; Hemorrhage ; Herniorrhaphy ; Humans ; Parents ; Plasma ; Prothrombin ; Siblings ; Young Adult