PURPOSE: The aim of this study was to investigate the effect of perinatal risk factors on brain maturation and the relationship of brain maturation and neurodevelopmental outcomes with brain maturation scoring system in brain MRI. METHODS: ELBWI infants born at the Seoul National University Children's Hospital from January 2006 to December 2010 were included. A retrospective analysis was performed with their medical record and brain MR images acquired at near full term. We read brain MRI and measured maturity with total maturation score (TMS). TMS is a previously developed anatomic scoring system to assess brain maturity. The total maturation score was used to evaluate the four parameters of maturity: (1) myelination, (2) cortical infolding, (3) involution of glial cell migration bands, and (4) presence of germinal matrix tissue. RESULTS: Images from 124 infants were evaluated. Their mean gestational age at birth was 27.1+/-2.1 weeks, and mean birth weight was 781.5+/-143.9 g. The mean TMS was 10.8+/-2.0. TMS was significantly related to the postmenstrual age (PMA) of the infant, increasing with advancing postmenstrual age (P<0.001). TMS showed no significance with neurodevelopmental delay, and with brain injury, respectively. CONCLUSION: TMS was developed for evaluating brain maturation in conventional brain MRI. The results of this study suggest that TMS was not useful for predicting neurodevelopmental delay, but further studies are needed to make standard score for each PMA and to re-evaluate the relationship between brain maturation and neurodevelopmental delay.
Birth Weight ; Brain ; Gestational Age ; Humans ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Medical Records ; Myelin Sheath ; Neuroglia ; Parturition ; Premature Birth ; Retrospective Studies ; Risk Factors

No abstract available.
Toll-Like Receptors*

No abstract available.

No abstract available.

PURPOSE: To determine the patterns of evaluation and treatment in the patient with early breast cancer treated with conservative surgery and radiotherapy and to improve the radiotherapy techiniques, nationwide survey was performed. MATERIALS AND METHODS: A web-based database system for Korean Patterns of Care Study (PCS) for 6 common cancers was developed. Two hundreds sixty-one randomly selected records of eligible patients treated between 1998~999 from 15 hospitals were reviewed. RESULTS: The patients ages ranged from 24 to 85 years(median 45 years). Infiltrating ductal carcinoma was most common histologic type (88.9%) followed by medullary carcinoma (4.2%) and infiltrating lobular carcinoma (1.5%). Pathologic T stage by AJCC was T1 in 59.7% of the casses, T2 in 29.5% of the cases, Tis in 8.8% of the cases. Axillary lymph node dissection was performed in 91.2% of the cases and 69.7% were node negative. AJCC stage was 0 in 8.8% of the cases, stage I in 44.9% of the cases, stage IIa in 33.3% of the cases, and stage IIb in 8.4% of the cases. Estrogen and progesteron receptors were evaluated in 71.6%, and 70.9% of the patients, respectively. Surgical methods of breast-conserving surgery was excision/lumpectomy in 37.2%, wide excision in 11.5%, quadrantectomy in 23% and partial mastectomy in 27.5% of the cases. A pathologically confirmed negative margin was obtained in 90.8% of the cases. Pathological margin was involved with tumor in 10 patients and margin was close (less than 2 mm) in 10 patients. All the patients except one recieved more than 90% of the planned radiotherapy dose. Radiotherapy volume was breast only in 88% of the cases, breast+supraclavicular fossa (SCL) in 5% of the cases, and breast+SCL+posterior axillary boost in 4.2% of the cases. Only one patient received isolated internal mammary lymph node irradiation. Used radiation beam was Co-60 in 8 cases, 4 MV X-ray in 115 cases, 6 MV X-ray in 125 cases, and 10 MV X-ray in 11 cases. The radiation dose to the whole breast was 45~9.4 Gy (median 50.4) and boost dose was 8~20 Gy (median 10 Gy). The total radiation dose delivered was 50.4~70.4 Gy (median 60.4 Gy). CONCLUSION: There was no major deviation from current standard in the patterns of evaluation and treatment for the patients with early breast cancer treated with breast conservation method. Some varieties were identified in boost irradiation dose. Separate analysis for the datails of radiotherapy planning will be followed and the outcome of treatment is needed to evaluate the process.
Breast Neoplasms ; Breast* ; Carcinoma, Ductal ; Carcinoma, Lobular ; Carcinoma, Medullary ; Estrogens ; Humans ; Korea* ; Lymph Node Excision ; Lymph Nodes ; Mastectomy, Segmental* ; Radiotherapy

BACKGROUND AND PURPOSE: Involvement of supraclavicular lymph nodes (SCL) is considered distant metastasis for thoracic esophageal carcinoma in AJCC staging system revised in 1997. We investigated significance of SCL involvement compared to other regional lymph node involvement. MATERIALS AND METHODS: Two-hundred eighty-nine patients with unresectable esophageal carcinoma were treated with radiation therapy from June of 1979 through December 1992. Of these patients, 25 were identified having SCL involvement. Survival rate and relapse patterns were compared with that of mediastinal and perigastric lymph node positive patients to evaluate prognostic significance of SCL involvement. RESULTS: Median survival for patients with SCL involvement was 7 months and 2- and 5-year overall survival rates were 12.0% and 4.0% respectably. Corresponding features for regional node positive patients were 9 month, 17.0% and 3.8%. There was no significant difference between two groups. There was also no difference in patterns of recurrence. CONCLUSION: Results of this analysis showed that SCL involvement should be staged as nodal disease in contrast to present classification of metastatic disease.
Classification ; Esophageal Neoplasms ; Humans ; Lymph Nodes* ; Neoplasm Metastasis ; Recurrence ; Survival Rate

PURPOSE: To understand the morphologic and molecular changes in carcinogen-induced breast tissues, DMBA (10-dimethy1-1,2 benzanthracene) was administrated in Sprague- Dawley female rats. MATERIALS AND METHODS: At 50 days of age, all experimental rats were given 20 mg DMBA by gastric intubation. Until the seventh week after DMBA administration, six rats were sacrificed every week, thereafter all tumors found during 20 weeks were removed every week. The morphologic changes were evaluated in routinely processed sections stained with H-E and with anti-smooth muscle actin antibody. Mutation of Ha-ras codons 12 and 61 was examined by ARMS (amplification refractory mutation system) method in frozen tissues. RESULTS: The epithelial cell proliferation of terminal end buds began 2 weeks after DMBA treatment and progressed to the 6th week, resulting in microscopic malignant tumor in one of the 7th weeks rats. The tumors were developed in 43 of 62 rats (69.4%); 8 benign lesions in 4 rats and 72 malignant tumors in 39 rats. Mutations in the 12th and 61th codon of Ha-ras gene were respectively found in 29.7% and 2.7% of preneoplastic breasts, 25% in benign lesions, 2.6% and 31.6% of malignant tumors. CONCLUSION: DMBA treatment in rats induced epithelial proliferation, then benign and malignant tumors through Ha-ras gene mutation, especially in codon 61 leading to cancer.
9,10-Dimethyl-1,2-benzanthracene* ; Actins ; Animals ; Arm ; Breast ; Codon ; Epithelial Cells ; Female ; Genes, ras ; Humans ; Intubation ; Rats*

BACKGROUND: Many ophthalmic procedures can be performed using a retrobulbar regional anesthetic technique. However, retrobulbar block is painful and most of patients express anxiety about the procedure. In addition, several life-threatening complications may occur. We compared the effects of midazolam and midazolam-ketamine as a sedative during retrobulbar block in cataract surgery. METHODS: Thirty patients undergoing cataract surgery were randomly allocated into two groups, group I (n=15) was received midazolam and group II (n=15), midazolam-ketamine. Mean arterial pressure (MAP), heart rate (HR), and peripheral oxygen saturation (SpO2) were compared before administration of drugs and 1, 2, 3, 4, 5, 10, 20, and 30 min after administration of drugs. Patients' movement requiring restraint were also checked. In the recovery room, postoperative nausea and vomiting, recall, delirium and/or hallucinations, and ocular complications were recorded. RESULTS: There were no significant differences in MAP and SpO2 between groups but heart rates were significantly increased at 1, 2, 3, 4, and 5 min than baseline in group II. Movement score was significantly lower in Group II than in Group I during the block (p<0.05). Recall during performance of the nerve block occured more often in Group I than in Group II (p<0.05). CONCLUSION: Low-dose midazolam-ketamine sedation sequence was superior to a midazolam technique regarding patients' movement and recall.
Anxiety ; Arterial Pressure ; Cataract* ; Delirium ; Hallucinations ; Heart Rate ; Humans ; Midazolam* ; Nerve Block ; Oxygen ; Postoperative Nausea and Vomiting ; Recovery Room

BACKGROUND: Cardiogenic shock is the most common cause of in-hospital mortality after acute myocardial infarction. Despite improvement in coronary care, the in-hospital mortality rate of cardiogenic shock is very high in conventional conservative therapy. Recently, it was suggested that coronary angioplasty may reduce the mortality associated with cardiogenic shock. METHOD: Thirteen consecutive patients with cardiogenic shock who underwent coronary angioplasty were studied. Shock was not induced by mechanical complications, arrhythmia, hypovolemia and other reversible cause. We collected and analyzed the clinical, hemodynamic survivor groups. RESULTS: Of 13 patients, 11 had successful reperfusion of the infarct-related coronary artery and 2 had unsuccessful reperfusion. Of 11 patients with successful angioplasty, 8 survived at the time of hospital discharge. All patents with unsuccessful angioplasty died in the hospital. Therefore overall hospital survival rate was 62% and the rate increased to 73% in patients with successful reperfusion. Survivor and non-survivor groups in clinical, hemodynamic and angiographic variables were similar except systolic blood pressure and the presence of successful reperfusion. CONCLUSION: In patients with cardiogenic shock, the patency of infarct-related coronary artery was strongly associated with in-hospital mortality. This findings support aggressive interventional strategy in patient with cardiogenic shock complicating acute myocardial infarction.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Arrhythmias, Cardiac ; Blood Pressure ; Coronary Vessels ; Hemodynamics ; Hospital Mortality ; Humans ; Hypovolemia ; Mortality ; Myocardial Infarction* ; Reperfusion ; Shock ; Shock, Cardiogenic* ; Survival Rate ; Survivors

BACKGROUND: Cardiogenic shock is the most common cause of in-hospital mortality after acute myocardial infarction. Despite improvement in coronary care, the in-hospital mortality rate of cardiogenic shock is very high in conventional conservative therapy. Recently, it was suggested that coronary angioplasty may reduce the mortality associated with cardiogenic shock. METHOD: Thirteen consecutive patients with cardiogenic shock who underwent coronary angioplasty were studied. Shock was not induced by mechanical complications, arrhythmia, hypovolemia and other reversible cause. We collected and analyzed the clinical, hemodynamic survivor groups. RESULTS: Of 13 patients, 11 had successful reperfusion of the infarct-related coronary artery and 2 had unsuccessful reperfusion. Of 11 patients with successful angioplasty, 8 survived at the time of hospital discharge. All patents with unsuccessful angioplasty died in the hospital. Therefore overall hospital survival rate was 62% and the rate increased to 73% in patients with successful reperfusion. Survivor and non-survivor groups in clinical, hemodynamic and angiographic variables were similar except systolic blood pressure and the presence of successful reperfusion. CONCLUSION: In patients with cardiogenic shock, the patency of infarct-related coronary artery was strongly associated with in-hospital mortality. This findings support aggressive interventional strategy in patient with cardiogenic shock complicating acute myocardial infarction.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Arrhythmias, Cardiac ; Blood Pressure ; Coronary Vessels ; Hemodynamics ; Hospital Mortality ; Humans ; Hypovolemia ; Mortality ; Myocardial Infarction* ; Reperfusion ; Shock ; Shock, Cardiogenic* ; Survival Rate ; Survivors