No abstract available.
Insulin Resistance* ; Insulin*

OBJECTIVE: To identify the thickness of gastrocnemius muscles (GCM) in normal children and children with spastic cerebral palsy using ultrasonography and to determine the influencing factors in order to increase the accuracy of intramuscular injection of botulinum toxin A. METHOD: Fifty-six children with spastic cerebral palsy (Group A) with no fixed contractures or operation history were involved in this study and they were compared with normal children (Group B). Children lay prone and one examiner measured the thickness of medial and lateral GCM using ultrasonography. Relationship between GCM thickness and clinical variables (age, height, weight, body mass index (BMI), calf circumference, Gross Motor Function Classification System (GMFCS) level, spasticity, number of botulinum toxin injections) were determined with Pearson's correlation. RESULTS: The thickness of medial and lateral GCM were 78.06+/-14.66 mm, 66.90+/-12.23 mm respectively, in Group A, and 103.44+/-12.04 mm, 79.95+/-9.76 mm respectively, in Group B. Medial GCM were thicker than lateral GCM in both groups. The age, height, weight, BMI, calf circumference and the thickness of GCM were higher in Group B. In group A, weight, BMI, calf circumference showed positive correlations with the thickness of medial GCM and GMFCS showed negative correlation with the thickness of medial GCM. CONCLUSION: To increase the accuracy of intramuscular injection of botulinum toxin A, we should keep in mind that the thickness of GCM may be influenced by several factors. Further controlled study including larger group is needed.
Body Weight ; Botulinum Toxins ; Cerebral Palsy ; Child ; Contracture ; Humans ; Injections, Intramuscular ; Muscle Spasticity ; Muscle, Skeletal ; Muscles

OBJECTIVES: The aim of this study is to investigate the relationship of suicide risk with early-life stress (ELS) and resilience in patients with major depressive disorder (MDD). METHODS: The participants were 60 patients with MDD and 29 healthy volunteers. Each subject was assessed concerning ELS, resilience factors, suicide ideation, and depressive symptom severity using self-report questionnaires. Mann-Whitney test and stepwise multiple linear regression analyses were performed. RESULTS: Emotional abuse, physical abuse, neglect, and exposure to inter-parental violence were higher in the patient group than in the control group. Resilience factors were significantly lower in the patient group. In multiple regression analyses, final regression model including physical abuse, neglect, and self-regulation factor was significant explaining 45.6% variance of suicide ideation score. CONCLUSION: We found that ELS experiences, particularly exposure to inter-parental violence, might be a significant risk factor for development of depression. In particular, experiences of physical abuse and neglect might increase the risk of suicide in depression but resilience may play a protective role in development of depression and prevention of suicide in depressive patients.
Depression ; Depressive Disorder, Major* ; Healthy Volunteers ; Humans ; Linear Models ; Surveys and Questionnaires ; Risk Factors ; Stress, Psychological* ; Suicide* ; Violence

Endometriosis is an enigmatic disease of menstruating females affecting the reproductive life. We report herein a case of perineal endometriosis in a 33-year-old woman. The patient presented two rounded, thickened plaques bilaterally on the perineum for about four year. The plaque on the right side was located mainly at the episiotomy scar. Histologic examination showed confirmative feature of glandular structures embedded in the cellular stroma and predecidual changes of late secretory phase of endometrium. Radical operation of total hysterectomy with bilateral oophorectomy and partial excision of perineal lesions were performed. There was complete resolution with no relapse by the 6-month follow-up. This is of a very rare occurrence and three cases have been reported in the Korean literatures up to date.
Adult ; Cicatrix ; Endometriosis* ; Endometrium ; Episiotomy ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Ovariectomy ; Perineum ; Recurrence

PURPOSE: We analyzed the association of lymph node ratio (LNR) wth locoregional control (LRC) in breast cancer patients with ≥10 involved axillary lymph nodes who underwent multimodality treatment. METHODS: We retrospectively analyzed 234 breast cancer patients with ≥10 involved axillary lymph nodes between 2000 and 2011. All patients received adjuvant chemotherapy and radiotherapy (RT) after radical surgery. The cutoff value of LNR was obtained using receiver operating characteristic curve analysis. The majority of patients (87.2%) received chemotherapeutic regimen including taxane. RT consisted of tangential fields to the chest wall or intact breast, delivered at a median dose of 50 Gy, and a single anterior port to the supraclavicular lymph node area, delivered at a median dose of 50 Gy. For patients who underwent breast-conserving surgery, an electron boost with a total dose of 9 to 15 Gy was delivered to the tumor bed. RESULTS: Within a median follow-up period of 73.5 months (range, 11-183 months), locoregional recurrence (LRR) occurred in 30 patients (12.8%) and the 5-year LRC rate was 88.8%. After multivariate analysis, LNR ≥0.7 was the only independent factor significantly associated with LRC (hazard ratio, 2.06; 95% confidence interval, 0.99-4.29; p=0.05). CONCLUSION: An aggressive multimodal treatment approach showed favorable locoregional outcome in patients with ≥10 involved axillary lymph nodes. However, patients with a high LNR ≥0.7 still had an increased risk for LRR, even in the setting of current local treatments.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Combined Modality Therapy ; Follow-Up Studies ; Humans ; Lymph Nodes* ; Mastectomy, Segmental ; Multivariate Analysis ; Radiotherapy ; Recurrence* ; Retrospective Studies ; Risk Factors* ; ROC Curve ; Thoracic Wall

BACKGROUND: Recently, missense mutation of the B3-adrenergic receptor gene has been shown to be associated with early onset of type 2 diabetes, abdominal obesity and an increased capacity to gain weight. This study was performed to investigate the effects of Trp64Arg mutation in the B3-adrenergic receptor gene on body fat distribution and weight loss in obese subjects. METHODS: Determination of the B3-adrenergic receptor gene mutation with restriction enzyme digestion method, anthropometry, various biochemical studies, including oral glucose tolerance test were performed in 99 obese and 35 control subjects. Body fat distributions were also evaluated by computerized tomography before and after weight-reduction program. RESULTS: I) There were no differences in the frequencies of Trp64Arg mutation in the B3-adrenergic receptor gene between obese and control subjects (15.2 vs 12.9 %). 2) The obese subjects with Trp64Arg mutation had higher waist to hip circumference ratio(WHR) (0.93 +/- 0.05 vs 0.87 +/- 0.04, p<0.001), visceral fat area (115.0 +/- 25.9 vs 86.4 +/- 41.4 cm, p=0.01), but decreased plasma free fatty acid (618.0 +/- 163.1 vs 817.5 +/- 248.2 pEq/L, p=0.001), and triglyceride level (118.7 +/- 36.2 vs 158.4 +/- 105.8 mg/dL, p=0.015) than those without mutation. 3) The obese subjects with Trp64Arg mutation had smaller decreases in weight (-3.4 vs -5.1 kg, p<0.001), body fat content (-2.1 vs -3.8 %, p<0.001), WHR (-0.01 vs -0.03, p=0.025), and abdominal fat masses (total, subcutaneous, and visceral fat) after weight-reduction program than those without mutation. CONCLUSION: Trp64Arg mutation in the B3-adrenergic receptor gene might be one of genetic loci contributing to central obesity and a predictor of difficulty in losing weight in obese subjects.
Abdominal Fat ; Adipose Tissue* ; Anthropometry ; Body Fat Distribution* ; Digestion ; Genetic Loci ; Glucose Tolerance Test ; Hip ; Intra-Abdominal Fat ; Mutation, Missense ; Obesity ; Obesity, Abdominal ; Plasma ; Triglycerides ; Weight Loss*

The purpose of this study is to identify a group of mild head injury patients having lesions on computerized tomography(CT) and to investigate the risk factors affecting the abnormal findings on CT scan. The study was limited to patients 16 years of age and older with a initial Glasgow Coma Scale(GCS) scores of at least 13 at the time of admission. Of a total of 243 patients studied, 156(64.2%) had abnormal CT findings. 49 patients(20.2%) required neurosurgical intervention(craniotomies for hematoma in 33, hematoma in 1 and subdural hygroma in 3). Four patients(2.4%) died of their cranial injury and three died of extracranial causes. The incidence of CT abnormalities for each GCS score was 86.7% in GCS of 13, 68.6% in GCS of 14, and 58.6% in GCS of 5. The factors affecting GCS scores at the time of admission were the presence of loss of consciousness and posttraumatic amnesia. The factors affecting abnormal CT scans were the presence of posttraumatic amnesia and skull fracture. A new lesion of extension of the initial finding on follow-up CT scans was found in 9.3% of 75 patients who underwent follow-up CT scans. Even though routine CT scans for mild head injury patients are not always necessary, these result suggest that all patients admitted to hospital after mild head injury should undergo CT scanning to enable early detection of an intracranial lesion.
Amnesia ; Coma ; Craniocerebral Trauma* ; Follow-Up Studies ; Glasgow Coma Scale ; Head* ; Hematoma ; Humans ; Incidence ; Risk Factors ; Skull Fractures ; Subdural Effusion ; Tomography, X-Ray Computed* ; Unconsciousness

PURPOSE: To evaluate the response and survival rate after three-dimensional conformal radiation therapy (3D-CRT) of patients with a solitary sternal relapse of breast cancer. MATERIALS AND METHODS: Seventeen patients between May 1996 and June 2005 were evaluated with the salvage 3D-CRT treatment of a solitary sternal relapse of breast cancer. The treatment fields included the gross tumor volume with 2 cm margins. The total radiation dose was 35.0~61.5 Gy (biologic effective dose of 43.7 ~76.9 Gy(10) using an alpha/beta ratio of 10 Gy), with a daily dose of 1.8~3.0 Gy. The tumor response was evaluated by the change in maximum tumor size via follow up CT scans 1~3 months after the completion of treatment. RESULTS: An objective tumor response was achieved in all patients, with a complete response in 5 patients and a partial response in 12 patients. The 5-year overall survival rate was 51.9% (median survival time: 27 months), and the most important factor affecting overall survival was the disease-free interval (interval from primary surgery of breast cancer to the development of sternal metastasis): The 5-year overall survival rate was 61.8% for patients with a disease-free interval > or =12 months and 0.0% for patients with disease-free interval <12 months (p=0.03). CONCLUSION: The response to 3D-CRT was good in patients with solitary sternal relapse of breast cancer. Particularly, patients with long disease-free interval from primary surgery survived significantly longer than patients with short disease-free interval from primary surgery.
Breast ; Breast Neoplasms ; Follow-Up Studies ; Humans ; Recurrence ; Survival Rate ; Tumor Burden

We describe two cases of post-radiation sarcoma after breast cancer treatment. The first patient was a 61-year-old woman who underwent partial mastectomy of the right breast and adjuvant whole breast irradiation 7 years previously. Subsequently, a rapidly growing mass from the anterior arc of the right fifth rib was incidentally detected on an abdomino-pelvic computed tomography scan. The second patient was a 70-year-old woman who received neoadjuvant chemotherapy and a partial mastectomy of the left breast 9 years ago. Adjuvant irradiation was delivered to the whole breast and supraclavicular region. Subsequently, an approximate 8 cm mass developed in the left axillary area. Both patients received wide excision of the tumor with negative resection margins. The pathological diagnoses were osteosarcoma and undifferentiated pleomorphic sarcoma, respectively. Although post-radiation sarcomas are rare complications with a poor prognosis, enhanced awareness and early detection by clinicians are essential to improve outcomes via curative surgical resection.
Aged ; Breast ; Breast Neoplasms ; Female ; Humans ; Mastectomy, Segmental ; Middle Aged ; Neoplasms, Radiation-Induced ; Osteosarcoma ; Prognosis ; Ribs ; Sarcoma

PURPOSE: We wished to evaluate the prevalence and clinical features of axillary web syndrome (AWS) after sentinel node biopsy (SNB) and axillary lymph node dissection (ALND) during the conservative treatment of early breast cancer. METHODS: From March to November 2003, a total of 110 consecutive patients with clinical T1-T2 breast cancer underwent breast conserving surgery, with ALND being performed in 98 patients or SNB being performed in 12 patients. The diagnostic criterion for AWS was the presence of palpable and visible cords of tissue in the axilla upon maximal shoulder abduction. The extent of AWS was evaluated by inspection and by palpation of the axilla and the arm. RESULTS: Ten of 110 patients (9%) developed AWS. The AWS typically presented in the first several weeks after surgery and it resolved within 1 month of onset for all the patients. AWS was encountered for 3 patients (25%) among the patients who had SNB and for 7 patients (8%) among the ALND group, which is not statistically significant. Typically, the syndrome was self-limiting, and it resolved without any specific treatment. CONCLUSION: AWS is a significant cause of morbidity in the early postoperative period for 9% of the patients after axillary surgery. A more limited axillary surgery might help reduce the incidence and severity of the AWS.
Arm ; Axilla ; Biopsy* ; Breast Neoplasms* ; Breast* ; Humans ; Incidence ; Lymph Node Excision* ; Lymph Nodes* ; Mastectomy, Segmental ; Palpation ; Postoperative Period ; Prevalence ; Shoulder