Reliability and validity of the Korean version of the manual ability classification system for children with cerebral palsy

BACKGROUND

To investigate the inter- and intra-rater reliability of the Korean version of the Manual Ability Classification System (MACS) for children with cerebral palsy.

METHODS

After a two-step forward and one-step backward translation, the inter-rater reliability of the Korean version of the MACS was assessed separately by parents, occupational therapists and physicians. A second assessment for intra-rater reliability was performed 4 weeks later.

RESULTS

Sixty-nine children were enrolled. The intra-class correlation coefficients were 0.956 between occupational therapists and physicians, 0.927 between parents and physicians, and 0.960 between parents and occupational therapists. Intra-rater reliability ranged from 0.965 to 0.987.

CONCLUSIONS

The Korean version of the MACS is reliable and valid and is suitable for assessing manual ability in Korean children with cerebral palsy.

Upper gastrointestinal haemorrhage in the acute cardiac care setting: antiplatelets and endoscopy

Upper gastrointestinal haemorrhage (UGIH) in cardiac patients receiving antiplatelets presents a difficult management problem. The aim of this study was to describe a series of cardiac inpatients receiving antiplatelets who underwent endoscopy for an acute UGIH. Cardiac inpatients receiving antiplatelets and requiring endoscopy for UGIH over an 18-month period were followed up. Forty-one patients were studied. Most patients (25 [61%]) presented with melaena. Antiplatelets were withheld in 34 (83%) patients; predominantly in those with higher pre-endoscopy Rockall scores (median, 4; interquartile range [IQR], 3-5 versus median, 3; IQR, 2-4; P < 0.05). Positive findings were identified at endoscopy in 80%. Duodenal ulcers were the most common lesion and adrenaline the most common method of haemostasis. Median time to first endoscopy was 0 (IQR, 0-1) days. Seven (17%) patients re-bled, median Rockall score was six (IQR, 4-8). Three (7%) patients experienced procedural complications, two patients became hypoxic and one patient died. Following endoscopy, antiplatelets were restarted after a median of three (IQR, 3-5) days. On discharge, 27/28 (96%) patients continued with antiplatelet and proton-pump inhibitor therapy. Thirty-day inpatient mortality was 7% (3 patients). One patient re-bled within six months of discharge. Endoscopy helped assess the risk of re-bleeding and timing of antiplatelet re-introduction in cardiac inpatients experiencing UGIH.

National-wide data on the treatment of BPH in Korea

The healthcare system in Korea provides coverage to all the people who are residing in Korea, so the data of the Korea healthcare system are national-wide and relatively accurate. We obtained the recent 5-year data (2004-2008) on the treatment of BPH from the national health insurance system. We tried to determine the trends or changes of BPH treatments in Korea. Over 3.8 million men visited clinics and were prescribed one or more BPH medications, and more than 44 000 men underwent surgical treatment during 2004-2008. Compared with the year 2004, two times the patients were prescribed BPH medications in 2008. With respect to the surgical treatment, the number of cases was increased 1.6 times in 2006 compared with the previous years. The most commonly used surgical option was TURP before 2006, but laser therapy was carried out as much as TURP in 2006 and in the following years. The relative risk of laser therapy in the 50 s is 1.53 (95% CI is 1.47-1.59). In conclusion, our national-wide data for the Korean BPH patients show that these patients' medical treatment increased during the 5 years from 2004 to 2008. Laser treatment had increased and it might replace TURP in several years.

Uncomplicated diverticular disease is not a common cause of colonic symptoms

BACKGROUND

Colonic diverticular disease is common among older individuals whereas colonic symptoms, such as those of irritable bowel syndrome, are frequent in the general population.

AIM

To determine among patients in secondary care, if uncomplicated diverticular disease is a common cause of colonic symptoms.

METHODS

Patients aged ≥50 years attending gastroenterology out-patient clinics or scheduled for colonoscopy or barium enema in a secondary care hospital were invited to take part. Those with structural gastrointestinal diseases were excluded. Participants completed a locally validated Rome II questionnaire on colonic symptoms. Patients with diverticular disease were compared with those without.

RESULTS

Seven hundred and eighty four patients with no structural pathology other than diverticular disease or benign colonic polyps completed the study. A total of 744 patients underwent colonoscopy, 40 barium enema. Of these, 281 patients had diverticular disease. Among patients with and without diverticular disease, the frequency of abdominal pain, diarrhoea, constipation and irritable bowel syndrome were 123 (44%) and 226 (46%), 44 (16%) and 80 (17%), 38 (14%) and 80 (17%) and 66 (25%) and 119 (25%), respectively (N.S.).

CONCLUSION

Uncomplicated colonic diverticular disease is not a common cause of colonic symptoms among patients in secondary care.

Clinical and urodynamic significance of morphological differences in intravesical prostatic protrusion

Purpose

The objectives of this study were to evaluate whether morphologic differences correlated with urodynamic and clinical characteristics in patients with benign prostatic hyperplasia (BPH) with intravesical prostatic protrusion (IPP) of trilobar or bilobar adenoma.

Materials and Methods

Between January 2008 and June 2009, 72 male patients who had undergone transurethral resection (TUR) owing to BPH with IPP were included in this study. They underwent preoperative urodynamic studies, the International Prostate Symptom Score (IPSS)/quality of life (QoL), maximal flow rate (Qmax), post-voiding residual urine volume (PVR), transrectal ultrasonography (TRUS), and serum prostate-specific antigen (PSA) measurement. The patients were classified into 2 groups (the trilobar and bilobar adenoma groups) on the basis of video findings during the TUR operation.

Results

The trilobar and bilobar adenoma groups consisted of 37 patients and 35 patients, respectively. The Mean±SD IPP, prostate volume (PV), and transition zone volume of the trilobar and bilobar adenoma groups were 11.8±5.2 mm and 9.0±3.8 mm (p=0.014), 81.1±25.8 g and 59.3±22.5 g (p<0.001), and 49.6±20.6 g and 34.8±19.4 g (p=0.003), respectively. The Mean±SD PSA, bladder contractility index (BCI), and bladder outlet obstruction index (BOOI) were 4.6±2.5 ng/ml and 3.5±1.7 ng/ml (p=0.042), 119.8±33.4 and 87.7±24.4 (p<0.001), and 62.6±29.5 and 44.6±20.4 (p=0.005), respectively. There were no significant differences in IPSS/QoL, Qmax, PVR, acute urinary retention, or detrusor overactivity in the 2 groups.

Conclusions

IPP has two morphologic types of trilobar or bilobar enlargement. The PV, BOOI, and BCI were significantly smaller in the bilobar adenoma group than in the trilobar adenoma group.

Safety and efficacy of combined transrectal ultrasound-guided prostate needle biopsy and transurethral resection of the prostate

Purpose

This study was conducted to examine whether simultaneous transrectal prostate needle biopsy (TPNB) owing to an increase in prostate-specific antigen (PSA) levels is safe and effective in patients who are scheduled for transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH).

Materials and Methods

Combined TPNB and TURP was performed in a total of 42 patients aged 60 years and older who had gray-zone PSA values (4-10 ng/ml) and PSA density (PSAD) values of 0.12 and less. The frequencies of fever, sepsis, and epididymitis were assessed after surgery. The diagnostic accuracy was assessed, and the results of histologic examination were evaluated in terms of TPNB or TURP. In addition, the diagnostic accuracy was assessed according to age.

Results

Prostate cancer was diagnosed in 6 (14.3%) of the 42 patients: 2 patients were diagnosed with prostate cancer by TPNB only, 3 patients by TURP only, and 1 patient by combined TPNB and TURP. Four (25%) of the 16 patients aged under 70 years and 2 (7.8%) of the 26 patients aged 70 years and older were diagnosed with prostate cancer. Fever was observed in 9 patients (21.4%), 4 (9.5%) of whom had a fever of higher than 38℃. The fever normalized the day after surgery in all 9 patients. No septicemia was noted. There were no serious complications related to combined TPNB and TURP.

Conclusions

The results of this study suggest that combined TPNB and TURP may be safe and effective in patients who require TURP.

Comparison of desaturation and resaturation response times between transmission and reflectance pulse oximeters

BACKGROUND

In general, there is a response time between actual arterial hypoxemia and its detection by pulse oximeters. We compared the desaturation and resaturation response times between two types of pulse oximeters, transmission and reflectance pulse oximeters, to find out which oximeter has a more rapid response time.

METHODS

Thirty-three ASA 1 or 2 patients were enrolled in this study. A transmission pulse oximeter was placed on the index finger and a reflectance pulse oximeter was placed on the forehead and monitored simultaneously. After the induction of general anesthesia without pre-oxygenation, we waited until the oxygen saturation value of any of two pulse oximeters declined to 90%, and then mask ventilation was started with 100% oxygen. Oxygen saturation was recorded at an interval of 2 s during this time.

RESULTS

The desaturation response time of SpO(2) to 95% after apnea was 82.0 s (interquartile range: 67.0-98.5 s) vs. 94.0 s (interquartile range: 84.0-106.5 s) (P<0.001) and SpO(2) to 90% was 94.0 s (interquartile range: 75.5-109.5 s) vs. 100.0 s (interquartile range: 84.5-114.5 s) (P<0.001) in the reflectance and transmission oximeters, respectively. The resaturation response time from mask ventilation to 100% SpO(2) was 23.2+/-5.6 vs. 28.9+/-7.6 s (P<0.001) in the reflectance and transmission oximeters, respectively.

CONCLUSION

In clinical situations in which rapid changes in oxygen saturation are expected, we recommend the forehead reflectance pulse oximeter because it responds more quickly in detecting oxygen desaturation and resaturation compared with the transmission pulse oximeter.

A multicenter phase II study of belotecan, new camptothecin analogue, in patients with previously untreated extensive stage disease small cell lung cancer

Belotecan (Camtobell, CKD602) is a new camptothecin derivative antitumor agent that belongs to the topoisomerase inhibitors. The aim of this phase II study was to evaluate the efficacy and safety of single agent belotecan in patients with small cell lung cancer (SCLC). Patients with previously untreated extensive stage disease (ED) SCLC were entered into the study. Belotecan was given by daily intravenous infusion at 0.5mg/m(2)/day for 5 consecutive days, every 3 weeks. 62 patients were enrolled in this study. The overall response rate to chemotherapy on an intention-to-treat basis was 53.2%. The median overall survival was 10.4 months, the median time to progression 4.6 months, and the 1-year survival rate 49.9%. The most common toxicity was hematologic. Grade 3/4 neutropenia occurred in 71.0% of patients and grade 3/4 thrombocytopenia 12.9%. Non-hematologic toxicity of grade 3 or 4 was low. The results suggest that belotecan is relatively active and well tolerable as single agent in patients with ED SCLC. Further investigations with platinum or other active agents are needed.

Interface modification of the InGaN/GaN quantum wells: the strain pre-relief effect

Interface modification by inserting an ultrathin low-temperature GaN layer prior to the growth of high-temperature GaN barriers followed by an annealing process was employed to improve the properties of the InGaN/GaN quantum wells. By detailed studies and comparisons of the surface morphology, photoluminescence and the surface compositions of the InGaN/GaN quantum wells at different growth stages with and without the interface modification, we find that with the interface modification the surface morphology was significantly improved with better smoothness, and smaller and shallower pits of lower density compared with that without interface modification; further, the indium aggregation and phase separation were suppressed. The physical phenomena are attributed to the 'strain pre-relief effect' by the formation of quasi-dots (approximately 20 nm in diameter) prior to temperature ramping and growth of high-temperature GaN barriers. Furthermore, the ultrathin low-temperature GaN layers have a good protection property as confirmed by PL and XPS measurements.

An InGaN/GaN single quantum well improved by surface modification of GaN films

Surface modification of GaN films by in situ droplet homoepitaxy of thin GaN layers was employed for improvement of the surface/interface qualities characterized by atomic smoothness, low defect density and surface chemistry being close to stoichiometry. We find that, with surface modification of the GaN films the surface morphology of the subsequently grown InGaN/GaN single quantum well (SQW) was improved with less density of surface pits and indium-rich inclusions. The improvement in surface smoothness and InGaN/GaN surface/interface qualities is desirable for the growth of high-quality multiple QWs (MQWs) structures and fabrication of high-performance and reliable LEDs. PL results show that with surface modification the QW luminescence was significantly enhanced by more than 50% than that without surface modification.

Antipyretic, analgesic, and anti-inflammatory activities of the seaweed Sargassum fulvellum and Sargassum thunbergii in mice

Dichloromethane, ethanol, and boiling water extracts of the brown seaweeds Sargassum fulvellum and Sargassum thunbergii were examined for antipyretic, analgesic, and anti-inflammatory activities in mice. The activities were evaluated against yeast-induced pyrexia, tail-flick test, and phorbol myristate acetate-induced inflammation (edema, erythema, and blood flow). The dichloromethane extract (0.4 mg/ear) of Sargassum fulvellum inhibited an inflammatory symptom of mouse ear edema by 79.1%. The ethanol extract (0.4 mg/ear) of Sargassum thunbergii also inhibited edema by 72.1%. No acute toxicity was observed after p.o. administration of each extract (5 g/kg bw). These findings are consistent with various claims that these seaweeds can be used as remedies for inflammation-related symptoms.

Eicosapentaenoic acid (EPA) reduces crypt cell proliferation and increases apoptosis in normal colonic mucosa in subjects with a history of colorectal adenomas

BACKGROUND AND AIMS

Omega-3 fatty acids in fish oil exert a protective effect on the development of colorectal cancer in animal models. Patients with colorectal adenomas have been shown to have increased crypt cell proliferation and decreased apoptosis in macroscopically normal appearing colonic mucosa. We investigated whether dietary supplementation with eicosapentaenoic acid (EPA) could alter crypt cell proliferation and apoptosis in such patients.

PATIENTS/METHODS

Thirty subjects were randomised to either 3 months of highly purified EPA in free fatty acid form (2 g/day) or to no treatment. Colonic biopsies were taken at the initial colonoscopy and repeated 3 months later, and analysed for cell proliferation and apoptosis (immunohistochemistry) and mucosal fatty acid content.

RESULTS/FINDINGS

Crypt cell proliferation was significantly reduced whilst apoptosis was significantly increased after EPA supplementation. Neither crypt cell proliferation nor apoptosis were altered in the control group. EPA in the mucosa increased significantly after EPA supplementation, whereas there was no significant change in controls.

CONCLUSIONS

Dietary supplementation with EPA significantly increases levels of this fatty acid in colonic mucosa, associated with significantly reduced proliferation and increased mucosal apoptosis. Further studies are needed to assess the potential efficacy of EPA supplementation in preventing polyps in the chemoprevention of colorectal cancer.

Systematic review: does gastro-oesophageal reflux disease progress?

BACKGROUND

Gastro-oesophageal reflux disease affects approximately 20% of western populations. Barrett's oesophagus, associated with severe gastro-oesophageal reflux disease, is premalignant and regular endoscopic surveillance is generally performed. In contrast, mild gastro-oesophageal reflux disease is thought not to progress and is not generally subjected to endoscopic follow-up. Aim To investigate whether gastro-oesophageal reflux disease progresses endoscopically.

METHODS

Systematic review of the literature.

RESULTS

Well-designed prospective studies are few, diagnostic criteria were not always standardized, management strategies varied and various sources of bias could not be excluded. Whilst most patients do not progress to more severe forms of gastro-oesophageal reflux disease, and some cases actually regress, progression is seen in a small proportion of patients. Annual progression rates for non-erosive gastro-oesophageal reflux disease developing erosive oesophagitis ranged from 0% to 30%. About 1-22% of patients with mild erosive oesophagitis developed more severe inflammation annually, while 1-13% of patients with erosive oesophagitis developed Barrett's oesophagus each year.

CONCLUSION

Although most patients with gastro-oesophageal reflux disease do not progress, and some actually regress, progression does occur in a minority. Better data are required to determine whether patients with mild gastro-oesophageal reflux disease would benefit from increased surveillance with the aim of detecting more advanced disease.

Recent trends in hospital admissions and mortality rates for peptic ulcer in Scotland 1982-2002

BACKGROUND

While overall hospital admission rates for peptic ulcer declined in England in the 1990 s, they increased among the elderly, especially for complicated ulcer. However, peptic ulcer admissions fell for all age groups in the United States.

AIM

To examine time trends in the incidence of hospital admissions, mortality and operations because of peptic ulcer in Scotland from 1982 to 2002, and the use of various drugs relevant to the aetiology and treatment of peptic ulcer from 1992 to 2002.

RESULTS

There was a general decrease in admission rates, especially for younger individuals. For individuals aged above 74 years, admission rates actually increased for gastric ulcer with haemorrhage among men, and for duodenal ulcer haemorrhage between both sexes. The number of operations fell dramatically, especially for younger patients. Mortality rates generally declined. Case fatality rates were greater for women than men, and declined over the study period for gastric ulcer, but increased for duodenal ulcer. The use of low-dose aspirin, oral anticoagulants, selective serotonin reuptake inhibitors and proton-pump inhibitors increased while those of non-steroidal anti-inflammatory drugs and histamine-2 antagonists declined.

CONCLUSIONS

Admission rates for peptic ulcer generally fell for younger individuals, but increased for older people with haemorrhage.

Small intestinal cancer in England & Wales and Scotland: time trends in incidence, mortality and survival

BACKGROUND

Time trends in mortality from small intestinal cancer have not been studied for the 1990s.

OBJECTIVE

To examine secular trends in incidence of, mortality from, and survival from, small intestinal cancer in England & Wales and Scotland from 1975 to 2002, considering also histological type (incidence), subsite (incidence) and indices of social deprivation (incidence and survival).

METHODS

Data were extracted from the Scottish Cancer Registry database and the General Register Office for Scotland, and from the National Cancer Intelligence Centre at the Office for National Statistics for England & Wales.

RESULTS

Incidence rates for small intestinal cancer increased for both England & Wales and Scotland over the study period. They were highest among older individuals and generally greater for males than for females. Despite the increase in incidence rates, mortality rates from small intestinal tumours tended to remain stable over the study period, and the general trend was towards increasing survival. Indices of social deprivation were not obviously related to the incidence of small intestinal cancer and did not influence survival.

CONCLUSIONS

Incidence rates for small intestinal cancer for both England & Wales and Scotland increased in the last quarter of the 20th century, but survival rates improved and mortality rates declined.

Pancreatic cancer in England and Wales 1975-2000: patterns and trends in incidence, survival and mortality

BACKGROUND

Rates and time trends in mortality from pancreatic cancer vary considerably between countries.

AIM

To examine trends and patterns in the incidence of, and the survival and mortality from, pancreatic cancer in England and Wales from 1975 to 2000; in particular, whether incidence and survival rates are related to socio-economic deprivation.

METHODS

We calculated annual age-specific and overall age-standardized incidence and mortality rates by sex for pancreatic cancer in total, and by subsite. We also estimated survival by sex and age group and by subsite.

RESULTS

In males, the age-standardized rate fluctuated in the late 1970s, to peak at 13.0 per 100,000 in 1979, declined steadily by an average of 1.3% per year to around 10.3 per 100,000 in the mid-1990s and then levelled off. For females, the rate peaked at 8.4 per 100,000 in the late 1980s before declining and fluctuating around 7.7 per 100,000 in the late 1990s. Patterns and trends in mortality rates were closely similar to those in incidence, due to the very low survival rates: only 2-3% at 5 years from diagnosis. Survival rates improved only minimally over the period 1971-99. Incidence and mortality rates were slightly higher in both males and females living in the most deprived areas, but survival was not consistently related to socio-economic deprivation.

CONCLUSIONS

The incidence of, and mortality from, pancreatic cancer in England and Wales have fallen from peak levels observed in the 1970s and 1980s, and levelled off in the 1990s for both sexes; survival rates remain very low.

Systematic review: the influence of geography and ethnicity in irritable bowel syndrome

BACKGROUND

Irritable bowel syndrome has been said to be less common in developing countries compared with western populations. In some case series of irritable bowel syndrome from the Indian subcontinent and Africa, the female predominance typical of western patients did not occur.

AIM AND METHODS

A systematic review was performed on Medline, of community prevalence studies of irritable bowel syndrome, chronic constipation and chronic diarrhoea using standardized criteria, with special reference to the effect of geography and ethnicity, and the gender distribution in different countries.

RESULTS

There is a wide variation, depending in part on the criteria used and differences in diagnostic practices and health care utilization. No convincing evidence emerged of a difference between east and west. Most series, eastern or western showed a female predominance or no gender difference. Several US studies in communities and specific populations suggest that stool frequency is lower, and the prevalence of constipation higher, among Afro-Caribbean Americans compared with white individuals.

CONCLUSIONS

Community studies in multi-racial populations are a useful way of assessing possible ethnic differences in the frequency of irritable bowel syndrome, chronic constipation and diarrhoea, and would additionally present opportunities to relate any ethnic differences to dietary and other environmental factors.

Systematic review: geographical and ethnic differences in gastro-oesophageal reflux disease

BACKGROUND

Many observers believe that gastro-oesophageal reflux disease is more common among white individuals compared with Asians and Afro-Caribbean subjects.

AIM

To perform a systematic review regarding geographical and ethnic factors in the prevalence of reflux symptoms, endoscopic oesophagitis, hiatus hernia and Barrett's oesophagus.

RESULTS

Differences in definitions and methodology make comparison between studies difficult. Overall, however, the community prevalence of reflux symptoms, as well as the prevalence of endoscopic oesophagitis, hiatus hernia and Barrett's oesophagus among patients undergoing upper endoscopy, were lower among Asian and Afro-Caribbean subjects compared with white individuals. There may also be a north-south gradient in the prevalence of gastro-oesophageal reflux disease among western countries. Gastro-oesophageal reflux disease may be moderately common in the Middle East. There are suggestions that the prevalence of gastro-oesophageal reflux disease is increasing in the Far East.

CONCLUSIONS

More data are required, especially from Africa, South America, the Middle East, and the Indian subcontinent. Suggestions are made regarding definitions and methodology to facilitate comparison between future studies from different countries.

The role of the hiatus hernia in gastro-oesophageal reflux disease

A sliding hiatus hernia disrupts both the anatomy and physiology of the normal antireflux mechanism. It reduces lower oesophageal sphincter length and pressure, and impairs the augmenting effects of the diaphragmatic crus. It is associated with decreased oesophageal peristalsis, increases the cross-sectional area of the oesophago-gastric junction, and acts as a reservoir allowing reflux from the hernia sac into the oesophagus during swallowing. The overall effect is that of increased oesophageal acid exposure. The presence of a hiatus hernia is associated with symptoms of gastro-oesophageal reflux, increased prevalence and severity of reflux oesophagitis, as well as Barrett's oesophagus and oesophageal adenocarcinoma. The efficacy of treatment with proton pump inhibitors is reduced. Our view on the significance of the sliding hiatus hernia in gastro-oesophageal reflux disease has changed enormously in recent decades. It was initially thought that a hiatus hernia had to be present for reflux oesophagitis to occur. Subsequently, the hiatus hernia was considered an incidental finding of little consequence. We now appreciate that the hiatus hernia has major patho-physiological effects favouring gastro-oesophageal reflux and hence contributing to oesophageal mucosal injury, particularly in patients with severe gastro-oesophageal reflux disease.