Purpose: The purpose of this study was to compare the concurrent validity and test-retest reliability of ‘KPIMT Torticollis Protractor’, a smart phone and I-pad application for convenient range of motion measurement, and ‘Image J’, an analysis software with high reliability and validity, according to head tilt and active cervical rotation angle. This was done to determine the clinical utility of ‘KPIMT Torticollis Protractor’. Methods: Head tilt and active cervical spine rotation angles of 40 children with congenital muscular torticollis were measured using Image J and KPIMT Torticollis Protractor, respectively. The level of concurrent validity and inter-rater and intra-rater reliability between the two measurement methods were analyzed. Results: For forty participants, the concurrent validity between Image J and KPIMT Torticollis Protractor showed very high validity with ICC of ICC 0.977 (0.995-0.999), 0.994 (0.994-0.998), CVME% 0.71-0.72%, SEM% 0.31-0.34%, MDC% 0.86-0.94%. The test-retest intra-rater reliability showed very high reliability ICC 0.911 (0.911-0.966), CVME% 0.71%, SEM% 0.34-0.36%, MDC% 0.81-0.94%. The test-retest inter-rater showed very high reliability ICC 0.936 (0.933-0.957), CVME% 0.70%, SEM% 0.34-0.35%, MDC% 0.81-0.83%. Conclusion The KPIMT Torticollis Protractor, a smart phone and IPD application, is a highly reliable and valid device for angle measurement in children with congenital myotonia and can be easily used in clinical practice.

BACKGROUND: Physicians should try to achieve an optimal cure rate with their initial Helicobacter pylori (H. pylori) eradication therapy. Most physicians tend to use the same combination of drugs. There have been several reports that H. pylori infection in patients with peptic ulcer disease (PUD) is more likely to be cured than that in patients with non-ulcer dyspepsia (NUD). However, there is no report in Korea about that issue. The aim of this study was to evaluate the difference of eradication rates of H. pylori between patients with PUD and patients with NUD in Korea. METHODS: 297 patients who underwent upper gastrointestinal endoscopy, treated with seven-day triple therapy (proton pump inhibitor+amoxicillin+clarithromycin), and then performed follow-up urea breath test were reviewed retrospectively. RESULTS: 237 of 297 patients were PUD (98 gastric ulcers, 167 duodenal ulcers, 28 both ulcers), and 60 of 297 patients were NUD. The eradication rates were 85.7% (95% CI 80.6~89.6%) and 73.3% (95% CI 61.0~82.9%), respectively. The eradication rate of NUD group was lower than that of PUD group (p=0.032). CONCLUSIONS: Seven-day triple therapy showed lower eradication rate in patients with NUD than patients with PUD. Therefore, extention of treatment duration or use of more potent regimen may be needed for eradication of H. pylori in patients with NUD.
Breath Tests ; Duodenal Ulcer ; Dyspepsia* ; Endoscopy, Gastrointestinal ; Follow-Up Studies ; Helicobacter pylori* ; Helicobacter* ; Humans ; Korea ; Peptic Ulcer* ; Retrospective Studies ; Stomach Ulcer ; Urea

Lipomyelomeningocele is the most common malformation leading to spinal cord tethering. Nonetheless, these lesion continues to pose a challenge in patient management. The purpose of this study was to identify the clinical feature, candidate for surgical repair, and outcome of lipomyelomeningocele in young children and adults. We studied the magnetic resonance images and/or lumbar myelo-CT of lipomyelomeningocele performed between January 1987 and September 1995 at our institutions and reviewed the pertinent medical records and radiologic stuies to detemine clinical feature, surgical candidate, and outcomes of these patients. Of the 14 cases(11 female and 3 males) studied, the most common factor that caused these patients to seek help was the cosmetic effect of the mass on their back, followed by urinary incontinence, and weakness of lower extremities. The patients' age ranged from 2 months to 21 years(mean, 5.0 years). All the patients underwent immediate surgical management that consisted of removal of lipoma, untethering of the cord, and complete dural sac repair. Follow up for these patients ranged from 6 to 82 months(median, 54 mo). None of the patients that underwent surgical correction before the emergence of neurological deficit had ever developed neurological deficits or uninary incontinence at the time of surgery, improved significantly. In conclusion, early detection and prophylactic surgery is imperative to prevent permanent neurological deficits and urinary dysfunction.
Adult ; Child ; Female ; Follow-Up Studies ; Humans ; Lipoma ; Lower Extremity ; Medical Records ; Spinal Cord ; Urinary Incontinence

BACKGROUND: A pulmonary tuberculoma is one of the most common causes of a solitary pulmonary lesion. Treating a tuberculoma is still controversial and there are few reports on antituberculosis chemotherapy. In this study, the clinical findings and changes in the size of tuberculomas on a radiograph after completing antiuberculosis chemotherapy was investigated. METHODS: The medical records, an chest radiographs of 18 pulmonary tuberculoma patients who were admitted to the Gachon medical school, Ghil medical center between April 1998 and August 2001, were reviewed. The symptomatic changes were recorded and the size of the tuberculomasl following treatment were compared. To compare the size, the long distance of each tuberculoma on the chest radiographs were measured and the additional radiological findings of calcification, satellite nodules and cavities were investigated. RESULTS: Fifteen patients were men and 3 were women. The median age was 46(24-74). Among these 18 patients, 14 patients had clinical symptoms. The other 4 patients were diagnosed incidentally as during a routine chest radiograph. The mean size of the tuberculomas on the initial plain chest film was 4.3+/-2.3cm(range : 1.7-10cm)and after 6 months treatment, it had decreased to 1.68+/-2.00cm(range : 1.5-6.5cm)(P<0.05). At least 6 months of antituberculosis chemotherapy resulted in the findings of a tuberculoma with a disappearance in 9, a decreased size in 4, and no change in 5 on the chest radiograph. Calcifications were found in 3 patients on the initial chest film and the chest CT and all calcified tuberculomas had disappeared after treatment. CONCLUSIONS: A lthough a pulmonary tuberculoma can remain as an inactive lesion for a long time, if it is confirmed by pathological or bacteriological methods, antituberculosis chemotherapy will be beneficial despite the presence of calcification.
Drug Therapy ; Female ; Humans ; Male ; Medical Records ; Radiography, Thoracic ; Schools, Medical ; Thorax ; Tomography, X-Ray Computed ; Tuberculoma*

When hydrocephalus develops, excessive cerebrospinal fluid accumulation usually occurs within the ventricular system, leading to a ventriculomegaly caused by increased intracranial pressure. Shunt malfunction, a common complication after a shunt operation, usually occurs, together with recurring ventricular dilatation. The authors report a case of shunt malfunction which manifested as a porencephalic cyst along the proximal catheter. The cyst subsided after the replacement of the shunt system, and this led to the patient's clinical improvement. We postulate that although the region around a catheter is an unusual site for cerebrospinal fluid collection, this finding should be considered as a shunt obstruction. The possible mechanism of reversible porencephaly is discussed and the literature is briefly reviewed.
Catheters ; Cerebrospinal Fluid ; Dilatation ; Hydrocephalus ; Intracranial Pressure

This study evaluated clinical and radiographic results after open reduction and lag-screw fixation of mandibular condyle fractures. PATIENTS AND Methods : 26 patients had been treated by lag-screw fixation for madibular condyle fracures via submandibular approach and follow up for over 6 months. The lag-screw used in this study was designed by Eckelt. Radiographically, resorption of the condyle head found in 4 cases (15%) and minimal displacement of the condyle head was found in 3 cases (12%). Post-operative infection were not found in all cases. Clinically, All patiens had a stable occlusion and normal mouth opening (over 40mm). TMD problems with crepitus or some discomfort encountered in 4 patients but tolerable to the patients. CONCLUSION: Lag screw fixation can be a good option especially high level condylar fractures, however this procedure must be used in cautiously because of slipping of the fragments and possible to resorption of the fragments.
Follow-Up Studies ; Head ; Humans ; Mandible* ; Mandibular Condyle ; Mouth

Many hemodialysis patients suffer from constipation. The increased incidence of constipation in long-term dialysis patients is based mainly on self-reported data. So, we conducted a survey on 10 hemodialysis patents with constipation by using total and segmental colonic transit time of radio-opaque markers. Segmental colonic transit times were calculated separately for 3 segments of the colon (right, left, and rectosigmoid) and total transit time, which was the sum of all 3 segment times. On results, colonic transit time was significantly prolonged in hemodialysis patient than in healthy control (42.2+/-20.11 versus 10.57+/-12.8 hour; p<0.0001). Increased colonic transit times in the right and especially rectosigmoid segments, but not the left segment, contributed to the prolongation in total colonic transit time. In conclusion, we suggest that colonic transit time measurement is helpful to tailor therapy because it helps us determine the prolonged segment of the colon in hemodialysis patients with constipation.
Colon* ; Constipation* ; Dialysis ; Humans ; Incidence ; Renal Dialysis*

PURPOSE: Endoscopic thyroidectomy has become a widely used operative method due to the recent advances in the operative technique and instruments and its cosmetic superiority. The aim of this study is to evaluate the technical feasibility and potential role of endoscopic thyroidectomy. METHODS: Between December 1999 and December 2006, 300 patients with benign thyroid disease or thyroid cancer were treated by gasless endoscopic thyroidectomy with using the anterior chest wall approach at Uijongbu St. Mary's Hospital. We analyzed that clinicopathological features, the operative time, the operative method and the complications. RESULTS: There were 261 cases of benign disease and 39 cases of malignant tumor. We generally performed lobectomy for benign thyroid disease. For malignant tumor, we performed 14 lobectomies, 6 total (or near total) thyroidectomies, 17 total (or near total) thyroidectomies with central lymph node dissection and 2 total (or near total) thyroidectomies with lateral lymph node dissection. The most frequent pathology in benign disease was nodular hyperplasia, and in malignant disease it was papillary carcinoma. The mean operative time was 122.2 minutes. For the patients with thyroid cancer, the mean operative time for thyroid cancer surgery without lymph node dissection (20 cases) and thyroid cancer surgery with lymph node dissection (19 cases) was 144 and 177 minutes, respectively. There were 34 cases of complication (11.33%) with 11 cases of transient hoarseness, 9 cases of transient hypocalcemia and 1 case of permanent hypocalcemia. CONCLUSION: Endoscopic thyroidectomy is a safe and technically feasible alternative to conventional thyroidectomy in patients with benign disease. In patients with thyroid cancer, we suggest that that endoscopic thyroidectomy can be a good alternative to conventional thyroid surgery in highly selected cases. Larger series and longer follow-up evaluation are necessary to confirm our findings.
Carcinoma, Papillary ; Cosmetics ; Hoarseness ; Humans ; Hyperplasia ; Hypocalcemia ; Lymph Node Excision ; Operative Time ; Thoracic Wall ; Thyroid Diseases ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

BACKGROUND: LKB1(STK11) is a serine/threonine kinase that functions as a tumor growth suppressor. The functions of LKB1 in lung cancer are not completely understood. This study evaluated the relationship between LKB1 protein expression and the clinicopathological features in lung cancer tissues. METHODS: The expression of LKB1 was studied in paraffin-embedded tumor blocks, which were obtained from 77 patients who had undergone surgery at Wonkwang University Hospital. The expression of the LKB1 protein was considered positive if the staining intensity in the tumor tissue adjacent to the normal airway epithelium was >30%. RESULTS: The LKB1 expression was positive in 31 (40%) of samples. Loss of LKB1 expression was significantly associated with being male, smoking history, and squamous cell carcinoma. In the peripheral sites, the loss of LKB1 expression was strongly associated with a smoking history. A loss of LKB1 expression was more frequently associated with progression according to TNM staging, particularly more than T2, N progression. CONCLUSION: There was a significant relationship between the loss of the LKB1 protein and gender, smoking history, and histological type in primary lung cancer. Although LKB1 expression was not found to be a significant prognostic factor, further studies with a larger cohort of patient's lung cancer tissue samples will be needed to confirm this.
Carcinoma, Squamous Cell ; Cohort Studies ; Epithelium ; Humans ; Lung ; Lung Neoplasms ; Male ; Neoplasm Staging ; Phosphotransferases ; Smoke ; Smoking

PURPOSE: The methylation of tumor suppressor genes has been implicated in the development of breast cancer. However, the role of methylation in the progression of cancer is still unclear. In this study, the methylation stati of nine tumor suppressor genes (p14, p16, DAPK, E-cadherin, RASSF1 alpha, TWIST, RAR beta, HIN-1, cyclin D2) in normal, benign, DCIS and invasive cancer tissues were examined, and the methylation patterns in DCIS and hypermethylated genes investigated to see if a change in the methylation status would lead to the development of cancer and progression to an invasive tumor. METHODS: A total of 96 patients, who underwent surgery between March 2003 and March 2005, were retrospectively studied. DNA was extracted from tumor tissues, and the samples examined for aberrant hypermethylation using methylation-specific PCR (MSP). RESULTS: The total number of methylated genes in each tissue type (normal tissues; 2.97+/-1.74, benign tumors; 4.36+/-1.42, DCIS; 5.73+/-1.35, invasive cancers; 5.42+/-2.05) increased with tumor progression (P<0.001). In benign tumors, HIN-1 (83%) was the most frequently methylated gene, but in DCIS, p14 (100%), RASSF (100%) and TWIST (91%) were frequently methylated. In invasive cancer, RAR beta (60%) and p16 (37%) were frequently methylated compared to the other tissue types. In a multivariate study, TWIST was commonly hypermethylated in DCIS and invasive cancer; whereas, RAR beta and p14 were frequently independently hypermethylated in invasive cancers. CONCLUSION: Methylation induced gene silencing appears to affect multiple genes in breast tissues, which increases with cancer progression. TWIST was hypermethylated in both DCIS and invasive cancers; therefore, it was concluded that methylation of the TWIST promoter may be an early event in the development of breast cancer. The hypermethylations of RAR beta and p16 are useful marker for the progression of a DCIS lesion to invasive cancer. The methylation patterns of tumor suppressor genes in DCIS were similar to those found in invasive cancer, but also showed intermediate levels of methylation between benign tumors and invasive cancers.
Breast Neoplasms ; Breast* ; Cadherins ; Carcinoma, Intraductal, Noninfiltrating* ; Cyclins ; DNA ; Gene Silencing ; Genes, Tumor Suppressor* ; Humans ; Methylation* ; Polymerase Chain Reaction ; Retrospective Studies