Exploring the Intra Entrepreneurship-Employee Engagement-Creativity Linkage and the Diverse Effects of Gender and Marital Status

This research examines which of the sub-dimensions of intra entrepreneurship (innovativeness, pro-activeness, risk-taking), and corporate social responsibility (CSR) support affects employee engagement (organizational and job engagement), which leads to employee creativity. The study uses survey data from SME employees in South Korea and applies the Structural Equation Modeling (SEM)-Artificial Neural Network (ANN) approach, to find that innovativeness and CSR support affect creativity through mediating roles of organizational engagement and job engagement, where job engagement plays a mediating role in the relationship between organizational engagement and creativity. The study also examines how employee gender and marital status effects the relative importance of intra entrepreneurship, organizational engagement, and job engagement on creativity. Findings of ANN analysis evaluates the effects per group (male-unmarried, male-married, female-unmarried, female-married) and shows how the importance of organizational engagement, job engagement, CSR support and innovativeness differ for each group. Contribution to theory and practice are discussed.

P979Persistent atrial fibrillation terminated within the left atrium without recurrence at follow-up demonstrates a gradual intracardiac organization during stepwise ablation

Introduction

We previously reported that patients (pts) with recurrence (Rec) after stepwise catheter ablation (step-CA) of persistent atrial fibrillation (pAF) exhibit high bi-atrial intracardiac dominant frequencies (DF) values before ablation, indicative of a severe bi-atrial electro-anatomical remodeling.

Purpose

Herein, we hypothesized that a gradual decrease in DF values during step-CA is associated with pAF termination and maintenance of sinus rhythm (SR) on the long term.

Method

In 40 consecutive pts (61±8 yo, sustained AF duration 19±11 months), pulmonary vein isolation (PVI) and left atrium (LA) ablation were performed until pAF termination or cardioversion. 10-sec intracardiac electrograms (EGMs) epochs were recorded before ablation (BL), during PVI and during complex fractionated atrial electrograms (CFAEs) and linear ablation (post_PVI) in the right atrial (RAA) and left atrial (LAA) appendages and in the coronary sinus (CS). DF was defined as the highest peak within the [3–15] Hz EGM spectrum. Rec was defined as any atrial arrhythmia lasting >30 sec during follow-up (FU).

Results

pAF was terminated within the LA in 70% (28/40, LT) of the pts, while 30% (12/40, NLT) were not. After a mean FU of 34±14 months, all NLT pts had a Rec, while LT pts presented a Rec in 71% (20/28, LT_rec) and remained in SR in 29% (8/28, LT_norec). Figure 1 shows: 1) a gradient in DF values measured in the LAA (panel A), RAA (panel B) and CS (panel C) with the highest values in NLT pts (red), intermediate values in LT_rec pts (yellow) and lowest DF values in LT_norec pts (green); 2) all three groups displayed a gradual intracardiac organization during LA ablation as shown by decreasing DF values (p<0.05, BL vs post_PVI), but the LT_norec pts (green) exhibited the highest relative changes in DF from BL (p<0.05, LT_norec vs NLT, Δ range: −5.31 to −9.69%).

Figure 1. Effect of ablation on DF

Conclusion

Low DF values before ablation and gradual intracardiac organization until pAF termination are associated with maintenance of SR on the long term.

Functional Recovery after the Transplantation of Neurally Differentiated Mesenchymal Stem Cells Derived from Bone Marrow in a Rat Model of Spinal Cord Injury

This study was designed to investigate functional recovery after the transplantation of mesenchymal stem cells (MSCs) or neurally differentiated MSCs (NMSCs) derived from bone marrow in a rat model of spinal cord injury (SCI). Sprague-Dawley rats were subjected to incomplete SCI using an NYU impactor to create a free drop contusion at the T9 level. The SCI rats were then classified into three groups; MSCs, NMSCs, and phosphate-buffered saline (PBS)-treated groups. The cells or PBS were administrated 1 week after SCI. Basso-Beattie-Bresnahan (BBB) locomotor rating scores were measured at 1-week intervals for 9 weeks. Somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) were also recorded 8 weeks after transplantation. While transplantation of MSCs led to a clear tendency of motor recovery, NMSC-treated rats had significantly improved BBB scores and showed significantly shortened initial latency, N1 latency, and P1 latency of the SSEPs compared to PBS controls. In addition, 5-bromo-2-deoxyuridine (BrdU)-prelabeled MSCs costained for BrdU and glial fibrillary acidic protein (GFAP) or myelin basic protein (MBP) were found rostrally and caudally 5 mm each from the epicenter of the necrotic cavity 4 weeks after transplantation. These results suggest that neurally differentiated cells might be an effective therapeutic source for functional recovery after SCI.

Posterior Deltoid-to-Triceps Tendon Transfer for Elbow Extension in a Tetraplegia Patient: A Case Report

In tetraplegia patients, activities of daily living are highly dependent on the remaining upper limb functions. In other countries, upper limb reconstruction surgery to improve function has been applied to diverse cases, but few cases have been reported in Korea. The current authors experienced a case of posterior deltoid-to-triceps tendon transfer and rehabilitation in a complete spinal cord injury with a C6 neurologic level, and we introduce the case—a 36-year-old man—with a literature review. The patient's muscle strength in C5 C6 muscles were normal, but C7 muscles were trace, and the Spinal Cord Independence Measure III (SCIM III) score was 24. The tendon of the posterior deltoid was transferred to the triceps brachii muscle, and then the patient received comprehensive rehabilitative treatment. His C7 muscle strength in the right upper extremity was enhanced from trace to fair, and his SCIM III score improved to 29.

Gland-preserving surgery for pleomorphic adenoma in the submandibular gland

BACKGROUND

Removal of tumours arising in the submandibular gland (SMG) usually involves excision of the entire gland. This prospective study evaluated the efficacy of gland-preserving surgery in patients with benign SMG tumours.

METHODS

Twenty consecutive patients with pleomorphic adenomas in the SMG underwent local excision of tumours with limited tumour-free margins and preservation of the remnant glandular tissues. All patients had salivary scintigraphy before and 6 months after surgery, with ultrasonography 2 years after operation. Complications, operating time, salivary function and rates of tumour recurrence were evaluated.

RESULTS

The mean operating time was 28 min, and no patient had neurological complications. After surgery, the function of the affected gland was equal to that of the unaffected gland. All patients had symmetrical facial contours without defects in the operated submandibular triangle. None of the patients had evidence of tumour recurrence on ultrasonographic examination and regular clinical examination at a median of 36 months after surgery.

CONCLUSION

Gland-preserving surgery in patients with benign SMG tumours preserves salivation, and reduces surgical morbidity and operating time, with good cosmesis but without compromising local control.

Randomized clinical trial comparing partial parotidectomy versus superficial or total parotidectomy

Background

In recent decades the treatment of benign parotid tumours has shifted from superficial or total parotidectomy to partial parotidectomy. This study examined whether current surgical techniques improved functional outcomes after surgery for benign parotid tumours.

Methods

One hundred and one patients were assigned randomly to conventional (49 patients) or function-preserving (52) surgery. The latter consisted of modified facelift incision, greater auricular nerve preservation, partial parotidectomy and coverage with parotid fascia.

Results

The mean duration of operation was 0·7 h shorter and the overall complication rate significantly lower in the functional surgery group. In this group, more patients were satisfied with their scars and facial contours, the auricular nerve sensory recovery rate was high, and transient facial paralysis and Frey's syndrome were infrequent (12 and 6 per cent respectively). Stimulated salivary flow on the operated side decreased to 71·9 per cent after function-preserving surgery compared with 20·7 per cent after conventional operation. There was no tumour recurrence in either group during a mean follow-up of 48 months.

Conclusion

Compared with conventional procedures, function-preserving surgery for benign parotid tumours improved cosmetic, sensory and salivary functions, and reduced the duration of surgery and operative morbidity.

Virtual Environment Training System for Rehabilitation of Stroke Patients with Unilateral Neglect: Crossing the Virtual Street

In this paper, we propose a system for training of stroke patients with unilateral neglect by using technology of virtual reality (VR). The proposed system is designed to compensate for unilateral neglect. This system contains the calibration of unilateral neglect and the training of this disease. The calibration procedure is implemented by aligning the virtual object at a subjective middle line. The training procedure is implemented by completing the missions that are used to keep the virtual avatar safe during crossing the street in a virtual environment. The results of this study show that the proposed system is effective to train unilateral neglect. The left to right ratio scores extracted from this system gradually decrease as the sessions of training are repeated. To validate the VR system parameters, the parameters are analyzed by correlation with those of traditional unilateral neglect assessment methods (such as the line bisection test and the cancellation test).

Diffusion-tensor magnetic resonance imaging in children with language impairment

We evaluated the integrity of the white matter tract using diffusion-tensor magnetic resonance imaging in children with language impairments who exhibited a structurally normal brain on conventional magnetic resonance imaging, and compared it with age-matched normal children. After generating fractional anisotropy and color-coded vector maps, fractional anisotropy values of the major white matter tracts were measured in six locations and compared between the two groups. Compared with the normal control group, the fractional anisotropy values of children with language impairments showed a statistically significant reduction in the genu of the corpus callosum, which is rarely revealed on conventional magnetic resonance images. Our results suggest that delayed maturation of the white matter plays a partial role in the pathophysiological mechanisms of language impairments.

Effect of the intravesical resiniferatoxin instillation evaluated by the ice provocative urodynamic study

STUDY DESIGN

Prospective urodynamic investigation before and after intravesical resiniferatoxin instillation treatment.

OBJECTIVE

To evaluate the effectiveness of intravesical resiniferatoxin instillation for the treatment of neurogenic detrusor overactivity (NDO), using conventional and ice provocative urodynamic studies to monitor the activity of the unmyelinated C-fiber.

SETTING

Spinal Cord Injury Unit, Yonsei Rehabilitation Hospital, Seoul, Korea.

METHODS

A measure of 100 ml of resiniferatoxin solution, at a concentration of 100 nM diluted in 10% ethanol, was intravesically instilled into the bladder of 15 spinal cord injury patients with NDO. Conventional and ice provocative urodynamic studies were performed to evaluate the change in the involuntary detrusor activity, reflex volume, maximal bladder capacity, compliance, maximal detrusor pressure and reflex volume ratio 7 days before and 30 days after the instillation.

RESULTS

Before the intravesical resiniferatoxin instillation, all patients exhibited NDO in both the conventional and ice provocative urodynamic studies, with a mean reflex volume ratio of 0.45+/-0.22. There was no significant change in the maximal bladder capacity, compliance and maximal detrusor pressure at the follow-up urodynamic study, but the reflex volume ratio was significantly increased (P<0.05) after the intravesical resiniferatoxin instillation. Among the 15 patients, three (20%) showed complete and nine (60%) partial suppression of the unmyelinated C-fiber activities.

CONCLUSION

Intravesical resiniferatoxin instillation was partially controlled by the unmyelinated C-fiber activities, which were estimated by an ice provocative urodynamic study. Therefore, further studies on the optimal dosage and accurate indications for resiniferatoxin instillation are required.

Relationship between inspiratory muscle strength and cough capacity in cervical spinal cord injured patients

STUDY DESIGN

Prospective single centre study.

OBJECTIVES

Pulmonary rehabilitation focuses on improving the expiratory muscle function in order to increase the reduced cough capacity in patients with cervical spinal cord injuries (SCI). However, an improvement in the inspiratory function is also important for coughing effectively. Therefore, this study was to examine the significance of the inspiratory muscle strength on the cough capacity in the patients with a cervical SCI.

SETTING

SCI unit, Yonsei Rehabilitation Hospital, Seoul, Korea.

METHODS

The vital capacity (VC), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) were measured. Moreover, the unassisted peak cough flow (PCF) and assisted PCF under three conditions were evaluated.

RESULTS

All three assisted cough methods showed a significantly higher value than the unassisted method (P < 0.001). The VC correlated with the voluntary cough capacity and the MIP (R = 0.749) correlated more significantly with the VC than the MEP (R = 0.438) (P < 0.01). The MIP showed a higher correlation with both the unassisted PCF and all three assisted PCFs than the MEP (P < 0.001).

CONCLUSIONS

The management of the inspiratory muscle strength should be considered in the pulmonary rehabilitation at cervical SCI patients.

Neurologic recovery according to early magnetic resonance imaging findings in traumatic cervical spinal cord injuries

The aim of this study was to determine the usefulness of early magnetic resonance imaging findings in predicting neurologic recovery at or below the injured level in traumatic cervical spinal cord injuries. Thirty patients with traumatic cervical spinal cord injuries were included. All of the patients received a magnetic resonance imaging and a neurologic examination in the emergency room, within 7 days of injury and at 6 months following the injury. To quantify neurologic recovery below the injured level, we modified clinical scales, particularly the motor ratio and the sensory ratio. We used the neurologic level to quantify recovery around the injured level. We assessed neurologic recovery according to MRI patterns and lesion extents. The pure hemorrhagic MRI pattern was not observed. In edematous and mixed types, the improvement of neurologic levels was not significantly different. The motor ratio and sensory ratio improved significantly more in edematous type patients than in mixed type patients. Based on MRI lesion extent, the improvement of neurologic levels was not significantly different, and motor ratio and sensory ratio improved significantly more in those with one or two segments involved than in those with more than two segments involved. In conclusion, early MRI pattern and lesion extent after traumatic cervical spinal cord injury may provide important information to help predict neurologic recovery, especially below the injured level.

Over-expression of S100B protein in children with cerebral palsy or delayed development

S100B protein plays a role in promoting the maturation of a variety of neurons in many different CNS regions. Behavioral dysfunction in S100B over-expressed transgenic mice and the chronic elevation of S100B in Down's syndrome and in schizophrenia suggest that S100B over-expression is related to abnormal brain function. Therefore, we believed that the over-expression of S100B protein might be implicated in developmental brain dysfunction. The purpose of this study was to evaluate the serum S100B protein levels in patients with developmental brain dysfunction, such as cerebral palsy and delayed development, and to determine the clinical relevance of serum S100B protein in these patients. The mean values of serum S100B protein were significantly increased in both conditions. Patients with cerebral palsy had a S100B protein level of 3455.8 +/- 5004.6 ng/L and those with delayed development of 2557.0 +/- 2321.0 ng/L, compared with a normal control level of 583.8 +/- 483.0 ng/L (P < 0.05). The over-expression of S100B (defined as the normal mean plus three standard deviations) was found in 47.1% of the total patient group (delayed development (47.5%) and cerebral palsy (47.0%)). The frequency of over-expression was not significantly related to clinical diagnosis, disease severity or to brain MRI findings. However, patients who had periventricular leukomalacia by brain MRI showed a wide range and very high levels of S100B exceeding 10,000 ng/L in some cases. These findings suggest that the pathogenesis implied by the over-expression of S100B protein during brain development may play a role in developmental brain dysfunction.

Verrucous carcinoma of the foot from chronic pressure ulcer

STUDY DESIGN

This is a case report with literature review.

OBJECTIVE

To describe a case of verrucous carcinoma, a rare histopathologic type, complicating a chronic pressure ulcer of duration less than 3 years.

SETTING

The department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, USA.

METHOD

A 24-year-old African-American male with long-standing incomplete paraplegia visited the wound clinic due to a pressure ulcer that had lasted for more than 1 year on the medial side of the right foot. Despite conservative management for almost 2 years after the initial visit, the ulcer is suspected to have undergone malignant transformation. Histological study led to the diagnosis of verrucous carcinoma that necessitated transtibial amputation on the right foot.

RESULT

The carcinoma developed within 3 years, which was a relatively short time period for a pressure ulcer to have undergone malignant transformation. The diagnosis of verrucous carcinoma has never been reported as carcinoma complicating a pressure ulcer. No evidence of local recurrence or distant metastasis was seen in postoperative 10 months.

CONCLUSION

The possibility of malignant transformation should be kept in mind in cases of pressure ulcers that are unresponsive to treatment or that show morphological changes suspected to be cancerous. Furthermore, early detection and intervention increases the probability for successful outcome.

The cerebrovascular response to traditional acupuncture after stroke

Acupuncture is useful in treating the nausea and vomiting related to chemotherapy, adult postoperative surgery pain and postoperative dental pain. We obtained single-photon emission computed tomography (SPECT) brain perfusion images of six patients with middle cerebral artery occlusion obtained before and after acupuncture and compared the changes in regional cerebral blood flow (rCBF) to those in normal control. Images were obtained before and after acupuncture at six traditional acupoints (LI 4, 10, 11, 15 and 16 and TE5) in the affected arm. The baseline image was subtracted from the postacupuncture image, to produce a subtraction image displaying only voxels with values >2 SD from the mean and those voxels were coregistered to the baseline SPECT or T2-weighted MRI. Similar images were obtained before and after acupuncture of eight normal volunteers. Statistical parametric mapping with a threshold of P =0.001 and a corrected P of 0.05 was performed for group comparison between postacupuncture and baseline SPECT. Focally increased CBF was seen in all patients especially in the hypoperfused zone surrounding the ischaemic lesion, the ipsilateral or contralateral sensorimotor area, or both. Normal subjects showed increased rCBF mainly in the parahippocampal gyrus, premotor area, frontal and temporal areas bilaterally and ipsilateral globus pallidus. Acupuncture stimulation after stroke patients appears to activate perilesional or use-dependent reorganised sites and might be a way of looking at brain reorganisation.

Selective posterior rhizotomy for lower extremity spasticity: how much and which of the posterior rootlets should be cut?

BACKGROUND

It is well known that selective posterior rhizotomy is effective for relieving spasticity associated with cerebral palsy. However, there is significant variation between surgeons in terms of how much and which of the posterior rootlets should be cut for the improvement of ambulatory function without causing adverse effects.

METHODS

The study population was composed of 200 CP patients who underwent SPR more than 1 year before this study. The children were divided into 4 groups (Group A had their L1-S2 roots cut, Group B had the L2-S2 roots cut, Group C had the L2-S1 roots cut, and Group D had the L2-S1 roots and the unilateral S2 root cut). We assessed lower limb spasticity, passive range of motion, ambulatory function, and gait pattern in each group.

RESULTS

Inclusion of L1 and S2 in the lesioning process of SPR was more effective at relieving spasticity in terms of hip adduction and ankle dorsiflexion respectively and improving ambulatory function (p < 0.01). Although lesioning of S2 carried a greater risk of urinary dysfunction, resection of less than 50% of S2 significantly improved ambulatory function without urinary complications (p < 0.01). Unilateral lesioning of S2 was an alternative option in selected cases with different amounts of spasticity in the ankles for the same purpose.

CONCLUSIONS

We propose that L1 and S2 roots should be included in the lesioning process of SPR for effective improvement of gross motor function, but that resection of these roots should be less than 50% to prevent complications.

Advanced hypopharyngeal carcinoma treatment results according to treatment modalities

BACKGROUND

The purpose of this retrospective study is to compare the treatment results of locally advanced hypopharyngeal carcinoma according to treatment modalities.

METHODS

Seventy-three patients with locally advanced hypopharyngeal carcinoma treated at the Department of Therapeutic Radiology, Seoul National University Hospital, between August 1979 and July 1997 were retrospectively analyzed. Twenty-three patients were treated with radiotherapy (RT) alone, 18 patients were treated with surgery and postoperative RT, and 32 patients were treated with neoadjuvant chemotherapy (CTx) and RT. Median follow-up period was 28 months.

RESULTS

The overall 5-year survival rates were 15.7% for the RT alone group, 46.8% for surgery and postoperative RT group, and 43.0% for neoadjuvant CTx and RT group. The 5-year disease-free survival rates were 13.9%, 47.4%, and 30.7%, respectively. Surgery and postoperative RT or neoadjuvant CTx and RT showed superiority over RT alone in terms of both overall survival and disease-free survival rates. No significant differences were found in overall and disease-free survival rates between the surgery and postoperative RT group and neoadjuvant CTx and RT group (p =.15, p =.13). In the neoadjuvant CTx and RT group, 12 patients (38%) retained their larynx more than 5 years.

CONCLUSION

Neoadjuvant CTx and RT is an effective strategy to achieve organ preservation without compromising the survival of patients with locally advanced hypopharyngeal carcinoma.

Selective posterior rhizotomy in children with cerebral palsy: a 10-year experience

We reviewed our 10-year experience of selective posterior rhizotomy (SPR), with an emphasis on surgical outcome concentrated on improvements in functional ability and adverse effects. We had performed SPR in 208 patients between 1990 and 1999. All patients showed an overall improvement (over 95%) in spasticity, passive range of motion, and gait pattern. Preoperative ambulatory functional level and age were very important predictive factors for further improvements in postoperative functional ability. Compared with the younger children, the older ones lacked a full range of motion preoperatively, and they continued to lack a full range of motion postoperatively, despite the decrease in tone achieved by SPR. Most postoperative complications such as hypotonia, urinary retention, spinal deformities, and sensory changes were temporary and not functionally important. We conclude that SPR is an effective method of alleviating spasticity and provides lasting functional benefits at acceptable complication levels in spastic children with cerebral palsy.

The effect of electrical stimulation on the trunk control in young children with spastic diplegic cerebral palsy

This study was designed to determine the effectiveness of electrical stimulation over the trunk in improving sitting balance in young children with spastic diplegic cerebral palsy who displayed poor trunk control. The subjects ranged in age from 8 to 16 months and were randomly assigned to two groups. Both group had physical therapy for 6 weeks. Electrical stimulation (ES) group had additional electrical stimulation over the abdomen and posterior back muscles. Radiographic studies were carried out on the whole spine while they were sitting before and after treatment. Kyphotic angle, Cobb's angle and lumbo-sacral angle were measured. Additionally, sitting score-Gross Motor Function Measure (GMFM) was also evaluated. There was no difference of these values at initial evaluation between the two groups. Following 6 weeks of intensive therapy, the changes of kyphotic angle and sitting score-GMFM were significantly higher in ES group statistically when compared with those of the control group. The Cobb's angle following treatment was improved in ES group, but not statistically compared with that of control group. This study suggests that electrical stimulation over the trunk become a beneficial therapeutic technique in improving the sitting posture and trunk control in young children with spastic diplegic cerebral palsy.

The effect of early therapeutic electrical stimulation on bone mineral density in the paralyzed limbs of the rabbit

The purpose of this animal experiment was to evaluate the changes of bone mineral density in paralyzed limbs, and to assess the effects of electrically stimulating muscle contraction upon bone mineral density (BMD) in paralyzed limbs during the four week period immediately following spinal cord injury (SCI). Ten rabbits were used for the study, spinal cords were totally transected at the T11 spine level. The paralyzed quadriceps femoris of one limb was contracted by electrical stimulation for 60-minutes daily, while the other side was not stimulated as a control. The BMD of each lower limb was measured by Dual Photon Absorptiometry before and four weeks after acute SCI. BMD of both limbs decreased in all rabbits four weeks after SCI. The decrease in BMD for stimulated and non-stimulated limbs was 6.130 +/- 3.212% and 9.098 +/- 3.831%, respectively during the four-week period after SCI. The BMD of stimulated limbs decreased significantly less than that of the non-stimulated limbs. Electrically induced muscular contraction reduced bone mineral loss in the paralyzed limb during the early stage of SCI in the rabbit.

Comparison of anterior and posterior walkers with respect to gait parameters and energy expenditure of children with spastic diplegic cerebral palsy

The purpose of this study was to compare gait pattern and energy consumption in children with spastic diplegic cerebral palsy, when using anterior and posterior walkers, and to determine which walker should be recommended as a walking aid for these children. Ten spastic diplegic cerebral palsied children, of average age 9 years, were enrolled in this study. Before assessment, they had all received a practice period of 1-month to familiarize themselves with both types of walker. Gait characteristics were evaluated by computer-based kinematic gait analysis using Vicon 370 Motion Analysis, and energy expenditure was determined by KBI-C while they were using the walkers. The oxygen consumption rate was significantly lower whilst using the posterior walker, as was the oxygen cost. Walking velocity and cadence on gait analysis showed no significant difference between the walker types. However, step length, single support time and double support time were significantly different for the two walkers. Flexion angles of the trunk, hip and knee were lower using a posterior walker. Gait analysis data and oxygen consumption measurements indicated that the posterior walker has more advantages in terms of upright positioning and energy conservation than the anterior walker.

Cloning of Japanese flounder Paralichthys olivaceus CD3 cDNA and gene, and analysis of its expression

Two distinct CD3 homologue cDNAs, CD3-1 and CD3-2, were isolated from a Japanese flounder leukocyte cDNA library. CD3-1 consisted of 961 bp encoding 178 amino acid residues, and CD3-2 consisted of 927 bp encoding 182 amino acid residues. The two deduced amino acid sequences had an identity of 95.1%, and neither had N-linked glycosylation sites. The identities between the Japanese flounder CD3s and previously reported CD3s (CD3 epsilon, CD3 gamma, or CD3 delta) of Xenopus laevis, chicken, and various mammals were approximately 25%. The Japanese flounder CD3s had an extracellular domain, a CXXCXE motif, and an immunoreceptor tyrosine-based activation motif (ITAM), each of which are important characteristics of CD3 chains. Furthermore, the positions of four cysteine residues in the extracellular domain were preserved in both of the Japanese flounder CD3s. A phylogenetic tree based on the amino acid sequences confirmed that the Japanese flounder CD3s are closer to CD3 epsilon than to CD3 gamma and CD3 delta. However, the gene structure of Japanese flounder CD3 is identical to the chicken and Xenopus CD3 gamma/delta genes and the mammalian CD3 delta gene. Southern blot hybridization and the DNA sequence of the CD3 gene of homocloned Japanese flounder indicated that the CD3 gene exists as a single copy. Southern blot hybridization also showed the presence of a polymorphic variant of Japanese flounder CD3. An RT-PCR analysis detected Japanese flounder CD3 mRNA in several organs that contained lymphocytes. The proportion of CD3-positive cells in the peripheral blood leukocytes was 34.9%.

Perirolandic hypoperfusion on single-photon emission computed tomography in term infants with perinatal asphyxia: comparison with MRI and clinical findings

We describe the findings on single-photon emission computed tomography (SPECT) in patients with perinatal asphyxia at term, with perirolandic cortico-subcortical changes on MRI, and to correlate them with clinical features. SPECT of 7 patients was obtained after injection of 185-370 MBq of Tc-99m-ECD (ethyl cysteinate dimer). The patients had spastic quadriplegia (7/7) with perinatal asphyxia (6/7) at term (7/7). The results were correlated with the MRI findings. Hypoperfusion of the perirolandic cortex was clearly seen on SPECT in all patients, even in two with subtle changes on MRI. SPECT demonstrated a more extensive area of involvement than MRI, notably in the cerebellum (in 4), the thalamus (in 7) and basal ganglia (in 5), where MRI failed to show any abnormalities.

Serum immunoreactivity to S-100 in children with cerebral palsy and delayed development and in their healthy parents

The passive immunization of pregnant female rats to S-100 protein often leads to ultra-structural abnormalities in the brain glial structures of the offspring of these rats and induces signs of delayed development in the fetal brain. Additionally passive immunization of pregnant animals with certain antigens induces permanent Ag-specific changes in the immune response of their offspring. The purpose of this study was to investigate serum immunoreactiviy (SIR) to S-100 in cerebral-palsied and developmentally-delayed children as well as in their healthy parents and to evaluate its significance related to radiologic findings of brain MRI and single photon emission computed tomography (SPECT). The subjects were children with cerebral palsy and delayed development that had abnormal findings on brain MRI or Brain SPECT. SIR to S-100 protein was measured by ELISA method in the patients, their healthy parents, 20 normal adult controls and 22 normally developed children. The SIR to S-100 protein was significantly higher in the cerebral-palsied and developmentally-delayed children when compared to that of the normal control group children. Increased SIRs were detected in healthy mothers but not in their fathers. There was no difference of SIR between the cerebral-palsied and developmentally-delayed children or any significant difference of SIRs according to the findings of the brain MRI or to developmental quotients. But, the SIRs to S-100 protein were higher in the group of more abnormal findings on brain SPECT.

Nasal cycle in patients with septal deviation: evaluation by acoustic rhinometry

The nasal cycle in patients with septal deviation was studied by acoustic rhinometric techniques. This study included 24 patients with anteriorly located septal deviations (mean age = 23.5), and 26 normal controls (mean age = 24.7). Data of MCA (minimum cross-sectional area) and NV (nasal volume), collected in 20-minute intervals, were plotted for each subject during 8 hours. Twenty of 24 patients (83%) with septal deviation and 20 of 26 normal subjects (77%) showed at least one complete cycle. Duration of the nasal cycle, which ranged from 100 minutes to 400 minutes, had no statistical difference between the septal deviation group (mean duration of 216 minutes) and the normal control group (mean duration of 227 minutes). The degrees of variation of MCA and NV, defined as Degree of Variation of MCA (%) = 100 (MCAmax - MCAmin)/MCAmax, Degree of Variation of NV (%) = 100 (NVmax - NVmin)/NVmax, which represent the percent change of MCA and NV throughout the study, showed no difference between the wide side and the narrow side, or between the septal deviation group and the normal control group. These findings suggest that the nasal cycle is relatively independent of peripheral anatomic factors for its generation. However, the amplitude of changes of MCA was greater in the wide side, and the sum of both MCAs tended to fluctuate in accordance with the fluctuation of MCA of the wide side. Thus, the nasal cycle seemed to be affected by septal deviation.

Effects of leukotrienes and prostaglandins on cochlear blood flow in the chinchilla

Prostaglandins (PGs) such as PGE2 and PGI2 are vasodilators, and leukotrienes (LTs) such as LTB4 and LTC4 are vasoconstrictors. Our previous studies have shown that salicylate ototoxicity is associated with decreased levels of PGs and increased levels of LTs. We hypothesized that vasodilating PGs increase cochlear blood flow and vasoconstricting LTs decrease cochlear blood flow. PGE2, Iloprost (a PGI2 analog), LTB4, and LTC4 were applied to the round window membranes of chinchillas and cochlear blood flow was measured with a laser Doppler flowmeter. PGE2 increased cochlear blood flow, while LTC4 decreased cochlear blood flow. This findings show that vasodilating PGs may have therapeutic implications for sensorineural hearing loss and/or vertigo by increasing cochlear blood flow. Vasoconstricting LTs may cause hearing loss by decreasing cochlear blood flow.

Identification of genes in a KG- phenotype of Lactococcus garvieae, a fish pathogenic bacterium, whose proteins react with antiKG- rabbit serum

Five different clones (SA1B05, SA1B10, SA2F01, SA8A11 and SA9H10) were isolated from the gene library of the Lactococcus garvieae SA8201 (KG-) strain by immunological screening using rabbit serum against L. garvieae (KG-) phenotype cells. A Western blot analysis indicated that the molecular sizes of immunologically detected proteins of SA1B05, SA1B10, SA2F01, SA8A11 and SA9H10, which were fused with LacZ protein, were 25, 30, 28, 26 and 13 kDa, respectively. The amino acid sequences of the immunologically detected proteins of SA1B05, SA1B10, SA2F01 and SA8A11 were homologous to a processing protease of Bacillus subtilis (36.6%), dihydropteroate synthase of Escherichia coli (34.6%), trigger factor of B. subtilis (45.8%) and N-acetylglucosamine-6-phosphate deacetylase of Vibrio furnissii (37.1%), respectively. There was no significant homologous sequence of SA9H10 in DDBJ/EMBL/GenBank and SwissProt. We cloned and sequenced a longer DNA fragment (SA9H10L) of SA9H10 from the gene library. The predicted amino acid sequence of this clone was weak homology to M protein of Streptococcus pyogenes (22.7%). Five genes were specifically expressed in the KG- phenotype strains. However, SA8A11 and SA9H10 was expressed in the mutated strain SA8201-TTC, whose serological phenotype was changed from KG- to KG+ by 2,3,5-triphenyltetrazolium chloride.

Neoadjuvant chemotherapy and radiation therapy compared with radiation therapy alone in advanced nasopharyngeal carcinoma

PURPOSE

To analyze the impact of neoadjuvant chemotherapy on the treatment of locoregionally advanced nasopharyngeal carcinoma and to assess the outcomes of patients receiving such treatment.

METHODS AND MATERIALS

We analyzed 137 previously untreated and histologically confirmed advanced stage nasopharyngeal carcinoma patients treated with either radiation therapy only or combined radiation therapy and chemotherapy at the Seoul National University Hospital between 1984 and 1996. The stage distribution was as follows: AJCC Stage III-21, Stage IV-61 in the radiation therapy group (RT group); AJCC Stage III-1, Stage IV-54 in neoadjuvant chemotherapy and radiation therapy group (CT/RT group). The median follow-up for surviving patients was 48 months.

RESULTS

The 5-year overall survival (OS) rates were 71% for the CT/RT group and 59% for the RT group (p = 0.04). The 5-year actuarial disease-free survival (DFS) rates were 63% for the CT/RT group and 52% for the RT group (p = 0.04). Distant metastasis (DM) incidence was significantly lower in the CT/RT group. The 5-year freedom from distant metastasis rates were 84% for the CT/RT group and 66% for the RT group (p = 0.01). The incidence of locoregional failures was also lower in the CT/RT group, although this difference did not reach statistical significance (69% vs. 56%, p = 0.09)

CONCLUSION

While not providing conclusive evidence, historical evidence from this institution suggests that neoadjuvant chemotherapy significantly improves both overall and the disease-free survival of patients with advanced stage nasopharyngeal carcinoma.

Survival improvement with combined radio-chemotherapy in the primary central nervous system lymphomas

The benefits of radio-chemotherapy in HIV-negative primary central nervous system (CNS) lymphomas were analyzed in 40 patients, who received radiotherapy to the brain or craniospinal axis with the total dose of 4460-5940 cGy to the primary tumor. Radiotherapy was followed by systemic chemotherapy, mainly with the cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) regimen, in 16 of the patients. Follow-up ranged from four to 95 months with a median of 15 months. The relapse rate was 72.5%, and 83% of the relapses occurred within the radiation field. Median survival was 19 months and the two-year survival rate was 41%. Survival was significantly influenced by treatment method and radiation dose when measured by univariate analysis; median survival and the two-year survival rate was 29 months and 63% after radio-chemotherapy, while 13.5 month and 29% after radiotherapy alone (p= 0.027), and 22 months and 49% with doses of 50 Gy or more, but 12.5 months and 13% with doses less than 50 Gy (p=0.009). However, statistical significance was lost in multivariate analysis. These results might suggest the short-term efficacy of radio-chemotherapy, however, cautious observation is needed to confirm long-term effects.

Prospective evaluation of perinatal risk factors for cerebral palsy and delayed development in high risk infants

Prematurity, intrauterine infection and perinatal brain injury have been reported to be significant risk factors of cerebral palsy (CP). We examined the perinatal predictors of cerebral palsy and delayed development (DD) in 184 high risk infants. Thirty-five infants were diagnosed as cerebral palsy and delayed development at 12 months corrected age. Antenatal, intrapartum, and neonatal factors were prospectively evaluated in 2 groups of high risk infants compared with controls; Group A (n = 79), infants weighing less than 2,000 g; Group B (n = 43), infants weighing 2,000 g or more. In univariate analysis, there were no significant antenatal and intrapartum factors associated with cerebral palsy and delayed development in either group. We found that significant postnatal risk factors of CP in group A included sepsis (p = 0.008), BPD (bronchopulmonary dysplasia) (p = 0.028), IVH (intraventricular hemorrhage) (p = 0.042), ventriculomegaly (VM) (p = 0.001) and a longer duration of mechanical ventilation (p = 0.001); while in group B, sepsis (p = 0.047) and neonatal seizure (p = 0.027) were significant risk factors. In multivariate analysis, sepsis in group B was a moderate risk factor of CP (OR (odds ratio) 1.47; 95% CI (confidence interval) 1.02-2.13). In conclusion, neonatal sepsis may contribute to the development of cerebral palsy and delayed development. We suggest that high risk infants who have sepsis should be carefully followed for cerebral palsy and delayed development. The prevention of cerebral palsy may be feasible by decreasing neonatal risk factors such as sepsis during the neonatal period.

Rehabilitation of a triple amputee including a hip disarticulation

A multiple amputee more severe than a triple amputee is uncommon. There have been no reports on the rehabilitation outcome of a triple amputee, including hip disarticulation and transtibial amputation. The authors report the rehabilitation of a patient with left hip disarticulation, right trans-tibial amputation, and left trans-humeral amputation due to a train accident. He has successfully completed the rehabilitation programme and has become independent in prosthetic ambulation, activities of daily living, and driving.

Correlation of brain CT findings and developmental outcome in patients with spastic cerebral palsy

Brain computed tomography (CT) is a useful tool for evaluating the pathologic findings in the brains of children with neurologic abnormalities. Brain CT investigation and the Münchner Funtionelle Entwicklungs Diagnostik (MFED) developmental assessment was performed in 88 patients with spastic cerebral palsy. The incidence of abnormal brain CT findings in patients with spastic cerebral palsy was 69.3%. The group with pathologic CT findings had a greater possibility of having developmental delay than the group with normal CT findings (p < 0.05). However, there was no significant relationship between the specific MFED categories and the types of brain CT abnormalities. Pathological CT findings could offer important prognostic information indicating a higher risk concerning the grade of developmental delay.

Technetium-99m-ECD brain SPECT in cerebral palsy: comparison with MRI

Hypoxic brain injury is one of the major causes of cerebral palsy. Therefore, this study was performed to evaluate cerebral perfusion impairments in these patients using 99mTc-ECD brain SPECT.

METHODS

Fifty-one patients (31 boys, 20 girls; age range 6 mo to 6 yr, 11 mo) with clinical manifestations of cerebral palsy underwent brain SPECT after intravenous injection of 99mTc-ECD. The clinical subtypes of cerebral palsy were spastic diplegia (n = 35), spastic quadriplegia (n = 11), spastic hemiparesis (n = 2), choreoathetoid (n = 2) and mixed (n = 1). Transaxial, coronal and sagittal images obtained with a brain-dedicated annular crystal gamma camera were qualitatively analyzed and compared with the findings of magnetic resonance imaging (MRI).

RESULTS

In SPECT, thalamic hypoperfusion was seen in all patients except one (98%), followed by hypoperfusion in the temporal lobe (52.9%, n = 27), basal ganglia (41.2%, n = 21), cerebellum (39.2%, n = 20) and extratemporal cortices (21.6%, n = 11). However, MR imaging demonstrated thalamic abnormality in seven (13.7%), basal ganglia in two (3.9%), extratemporal cortical defect in five (9.8%) and cerebellar atrophy in one (1.9%). Instead, white matter changes such as periventricular leukomalacia or ischemia (56.9%, n = 25) and thinning of corpus callosum (49%, n = 25) were the major findings.

CONCLUSION

Brain SPECT is useful in the diagnosis of cerebral palsy and is more sensitive in the detection of cortical, subcortical nuclei and cerebellar abnormalities. MRI is superior in the detection of white matter changes.

Postembryonic development of leucokinin-like immunoreactive neurons in the moth Spodoptera litura

Antiserum to leucokinin I, a neuropeptide originally isolated from the cockroach Leucophaea maderae, was used for immunocytochemical labeling of neurons in the brain and ventral ganglia of the moth Spodoptera litura during postembryonic development. In the ventral ganglia, leucokinin-like immunoreactivity begins to occur in the abdominal ganglion A3 to A7 of first instar larva. One to two weakly labeled pairs of bilateral LK-LI cell bodies are located in the subesophageal ganglion of fourth to sixth instar larvae and in the abdominal ganglia A1 to A7 of second to sixth instar larvae. The abdominal ganglion A1 of fourth to sixth instar larvae and A8 of sixth instar larva each contain one weakly labeled pair of median LK-LI cell bodies. Two strongly labeled pairs of bilateral LK-LI neurons are found in A3 to A7 of third to sixth instar larvae. Abdominal ganglia A1 to A8 of prepupa, pupa and adult contain one to three weakly labeled pairs of bilateral LK-LI neurons. Two strongly labeled pairs of bilateral LK-LI neurons in each of the abdominal ganglia of larva, prepupa, pupa and adult send axons to the neuropil, and then each axon bifurcates into two axonal branches. Theses axonal branches from two bundles. From each of the two pairs of neurons an axon exits through the posterior ventral nerve (N2) which runs to the transverse nerve of the next posterior segment. In larval brains, 2-16 pairs of bilateral LK-LI cell bodies can be found together with LK-LI processes in the central neuropil. The larval brains show large changes in the number of LK-LI neurons throughout postembryonic development. The number of LK-LI cell bodies are reduced in number from sixth instar larval brain. Therefore, prepupal, pupal and adult brains contain a smaller number of LK-LI cell bodies. Two pairs of LK-LI median neurosecretory cells located immediately beside the pars intercerebralis in larval brains increase to three pairs in the 7-day-old pupal brain. In the adult, however, LK-LI median neurosecretory cells decrease to one pair.

Plasmacytoma of the gastrointestinal tract in Korea: higher incidence than in Japan and Epstein-Barr virus association

As a result of a systematic review of non-Hodgkin's lymphoma of the gastrointestinal tract (GI) at the Yonsei University, Seoul, Korea and the Osaka University, Osaka, Japan, we found an extramedullary plasmacytoma in 5 of a total of 78 cases (6.4%) in Korea and 1 of 136 cases (0.7%) in Osaka, which represents an approximately 9-fold difference in frequency. The presence of the Epstein-Barr virus (EBV) genome was examined in paraffin-embedded specimens from the 5 cases with GI plasmacytoma from Korea together with 17 patients collected by a nationwide study in Japan. There were no clinical findings suggestive of the presence of immunodeficiency in these Korean and Japanese patients. There were no prominent differences in the age distribution or sex ratio between the patients of the two countries. Histologically, the proliferation of mature plasma cells was almost monomorphous with occasional bi- or multinucleated forms. The immunohistochemistry revealed a restricted cytoplasmic expression of immunoglobulin light chain, kappa type in 8 cases and lambda type in 14. A polymerase chain reaction of preserved DNA from 4 Korean and 16 Japanese patients found that only 2, both Korean, were positive for EBV of subtype A. The difference in the frequency of EBV positivity between Korean and Japanese cases was significant (p < 0.05). In situ hybridization revealed positive signals in the nucleus of the tumor cells. IHC revealed that the tumor cells in these two cases were positive for latent membrane protein-1 and EB nuclear antigen-2, showing latent infection of EBV. These findings suggest a close association of EBV and Korean GI plasmacytoma, and might partly explain the remarkable number of cases in this country.

Neoadjuvant chemotherapy and radiotherapy for the treatment of advanced hypopharyngeal carcinoma

PURPOSE

To evaluate the efficacy of the neoadjuvant chemotherapy and radiation therapy in treatment of patients with advanced hypopharyngeal cancer, which is notorious for its poor prognosis and severe surgical morbidity with functional deficits.

MATERIALS AND METHODS

Medical records of 62 patients with squamous cell carcinoma of the hypopharynx, Stage III or IV (AJCC, 1992), were retrospectively reviewed.

RESULTS

Neoadjuvant chemotherapy showed an overall response rate of 87% and a complete remission (CR) rate was 67% following chemotherapy and radiation therapy. The patients who did not show CR after chemotherapy had a high likelihood of treatment failure, even though they achieved CR following subsequent radiotherapy. Thirteen of 30 patients were able to preserve their larynges for more than 3 years by chemotherapy and radiation.

CONCLUSION

This approach appeared to be as effective as radical surgery with postoperative radiation therapy without comprising survival. To improve the cure rates, we need to develop better strategies to increase CR rates with chemotherapy and determine the best treatment option for patients who are partially or nonresponsive to chemotherapy.

Transection and occlusion of lateral semicircular canal in guinea pigs

Audiologic and histopathologic examinations were made after occlusion of the lateral semicircular canal in eight guinea pigs. The lateral semicircular canal was drilled out, and then the canal lumens were plugged with muscle pieces. After a serial recording of auditory brain stem responses for 2 months, histologic specimens of the temporal bones were prepared in the lateral semicircular canal plane. One animal developed profound hearing loss due to suppurative labyrinthitis. The other seven animals showed no significant threshold elevation during this period. Histopathologic examination revealed that the bone defect on the lateral canal was replaced with newly formed bone; the perilymphatic and endolymphatic spaces maintained their compartmentalization; and the membranous endolymphatic canal healed to form complete blind ducts. These findings suggest that proper management of the injured semicircular canal is important for maintenance of postoperative hearing.

Anatomy and magnetic resonance imaging of the posterolateral structures of the knee

The purpose of the present study was to provide detailed information of the morphological and radiological characteristics of the posterolateral structures of the knee. Muscles and ligaments of the posterolateral part of the knee were studied by dissections of 50 adult cadaver knees and by Magnetic Resonance Imaging (MRI) before and after dissections for comparisons. Diverse morphological characteristics of the arcuate ligament were found. The fabellofibular ligament was present in 42.1% of the knees dissected, whereas the popliteofibular ligament was found in 37.5%. A ligamentous structure, which could be called the posterior tibial ligament, was found in 31.6% of the cases that originated from the lateral part of the capsule proximally and inserted distally on the mid portion of the proximal tibia. By comparing the cross sections and the dissections of the cadaver knees, the popliteus muscle, the arcuate ligament, the fibular collateral ligament, the popliteofibular ligament, and the fabellofibular ligament could be identified in MRI. Comprehensive understanding of the posterolateral anatomy of the knee and improved identification of the structures in MRI will help clinicians to make a more accurate and noninvasive diagnosis of posterolateral instability.

Prospective study of microvascular decompression in hemifacial spasm

OBJECTIVES

Although, in most cases, the symptoms of hemifacial spasm (HFS) disappear immediately after microvascular decompression (MVD), in some cases, they disappear more gradually. The objectives of this study were to observe the time course and the rate of the delayed resolution and to attempt to explain the phenomenon through long-term follow-up of HFS after MVD.

METHODS

Two hundred and sixty-one patients with HFS who underwent MVD were followed up to observe clinical changes. Two hundred and twenty-six of the 261 patients were followed up for a duration of 6 months to 2 years, from 1985 to 1995.

RESULTS

After the 1st week of the surgery, 61.1% of the patients were rated as having achieved excellent results. When the patients were followed up for more than 6 months, however, the rate improved to 82.7%. The clinical results of HFS after MVD improved significantly with time (P < 0.05). Delayed resolution of HFS was observed in 37.4% of the patients who experienced complete resolution; it was the most important factor for clinical improvement during the follow-up period. Abnormal muscle response immediately after MVD in the operating room was also positively correlated with resolution during the follow-up period (correlation coefficient = 0.3099, P < 0.05).

CONCLUSIONS

In conclusion, the clinical picture of HFS after MVD improves with time, and abnormal muscle response can be used as a prognostic indicator for the resolution of HFS during the follow-up period.

Enhancement of radiation effect by Ginkgo biloba extract in C3H mouse fibrosarcoma

BACKGROUND AND PURPOSE

Ginkgo biloba leaf extract (GBE) is known to increase peripheral blood circulation. The hypothesis that GBE may be able to enhance radiosensitivity of tumor by improving tumor blood flow and thus decreasing hypoxic fraction was tested.

MATERIALS AND METHODS

Fibrosarcoma (FSaII) growing in C3H mouse leg muscle was used as a tumor model. GBE was given i.p. 1 h before irradiation with or without priming dose given 1 day earlier. Effect on tumor and normal tissue radiation reaction was investigated.

RESULTS

Tumor growth delay by radiation was more elongated after two doses (1-day interval) of GBE than after a single dose. Radiation dose for 3-day tumor growth delay was decreased from 12.45 (10.97-13.93) Gy to 6.06 (3.89-8.22) Gy by two doses of GBE [enhancement ratio = 2.06 (1.32-2.79)]. Hypoxic cell fraction was 10.6% (6.3-18.2%) for control, 7.2% (3.8-14.0%) after a single dose (P = 0.18) and 2.7% (1.5-5.0%) after two doses (P < 0.001). Radiation effect on normal tissue, estimated by acute skin reaction and jejunal crypt assay, was not affected by GBE.

CONCLUSION

Ginkgo biloba extract enhances radiation effect on tumor without increasing acute normal tissue radiation damage in this model system probably by increasing tumor blood flow and further investigation for this possible radiosensitizer is needed.

Statistical analysis of amputations and trends in Korea

Epidemiological research on amputees is being continued extensively world wide, but there are different epidemiologic reports from country to country. This study undertakes an epidemiologic report of the medical records of amputees in Korea which has developed very rapidly, when compared with other countries. This study included 4258 amputees who either had an amputation and/or received prosthetic training at Yonsei University College of Medicine, Severance Hospital from January 1970 to June 1994. The most common cause of amputation was trauma (66.7%), and the second most common cause was peripheral vascular disease. While amputations due to infection or trauma were the most common in the 1950's, amputations due to peripheral vascular disease have gradually increased until they now make up 23.5% of all amputations in the 1990's. Lower limb amputation, more common than upper limb amputation, accounted for 68.7% of all amputation. Multiple amputation accounted for 9.3% of all amputations, and the occurrence rate of multiple amputation was relatively higher in cases of burn injuries, train accidents, frostbite, and Buerger's disease than in cases brought about by other causes. The various amputation causes change according to the circumstances of the times, as can be seen in this study.

Efficacy of hydrocolloid occlusive dressing technique in decubitus ulcer treatment: a comparative study

The efficacy of hydrocolloid occlusive dressing technique was compared with that of the conventional wet-to-dry gauze dressing technique in decubitus ulcer of stage I and II. Forty-four patients were randomly divided into two treatment groups and each received treatment according to the two different protocols. As a result, 80.8% of the hydrocolloid occlusive dressing group (group 1) and 77.8% of the conventional wet-to-dry gauze dressing group (group 2) healed completely with no statistically significant difference between the two groups. However, the time required for complete healing was shorter in group 1 with 18.9 days compared to 24.3 days in group 2. Ulcer healing speed was also slightly faster in group 1 with 9.1 mm2/day compared to 7.9 mm2/day for group 2. Average treatment time spent by a medical staff member was significantly shorter in group 1 with 20.4 minutes/day compared to 2017 minutes/day in group 2. The hospital cost of the ulcer treatment was higher in group 2 compared to group 1 even without taking into consideration the medical personnel's labor cost. These results indicate that the hydrocolloid occlusive dressing technique offers less time consuming and less expensive method of treatment compared to the conventional technique in stage I and II decubitus ulcers.

Intraoperative monitoring of microvascular decompression in hemifacial spasm

The significance of intraoperative electrophysiologic monitoring during microvascular decompression was evaluated prospectively in 261 patients with the hemifacial spasm from 1985 to 1995. The patients were divided into a monitored group and a non-monitored group. Identification of the offending vessels was facilitated by the monitoring during the surgical procedure and the complication rate of the monitored group was significantly lower than that of the non-monitored group (p < 0.05). In addition, the abnormal muscle response continued to improve during the follow-up period, thus the electrophysiological status of the hemifacial spasm after the microvascular decompression improved significantly with time (p < 0.05). In conclusion, intraoperative monitoring is useful for identifying the exact offender among multiple vessels, and lowering the complication rate of the microvascular decompression for the hemifacial spasm.

Computer-aided design optimization with the use of a fast dose model for linear-accelerator-based stereotactic radiosurgery

In order to efficiently plan non-spherical radiosurgical targets we have used computer-aided design optimization techniques with a fast dose model. A study of the spatial dose distribution for single or multiple non-coplanar arcs was carried out using a 18 cm diameter spherical head model. The dose distribution generated from the 3D dose computation algorithm can be represented by a simple analytic form. Two analytic dose models were developed to represent the dose for preset multiple non-coplanar arcs or a single arc: spherical and cylindrical. The spherical and cylindrical dose models compute dose quickly for each isocentre and single arc. Our approach then utilizes a computer-aided design optimization (CAD) with the use of two fast approximate dose models to determine the positions of isocentres and arcs. The implementation of CAD with fast dose models was demonstrated. While the fast dose models are only approximations of the true dose distribution, it is shown that this approximate model is sufficient to optimize isocentric position, collimator size and arc positions with CAD.

Prognostic factors of patients with thymoma

OBJECTIVES

To analyze the prognostic factors influencing the survival of patients with thymoma, clinical characteristics, treatment modalities and survival of patients were evaluated. The efficacy of chemotherapy was also determined.

METHODS

Retrospective study was done on one hundred patients whose diagnosis was confirmed pathologically at Seoul National University Hospital from 1981 to 1994. The staging was carried out according to the Masaoka system. Survival rate was calculated by the Kaplan-Meier method and prognostic factors were analyzed by a multivariate analysis (Weibull model).

RESULTS

The stage of 100 patients was as follows: Stage I-50, II-6, III-27, IV A-10, IV B-7. The overall survival rates at 5 and 10 years after diagnosis were 73.1% and 58.7%, respectively. The 5-year survival differences, according to various prognostic factors, were as follows: 1) Stage: I-92.8%, II-100%, III-71.6%, IVA-25.9% and IVB-32.9% (p = 0.0029). 2) Age: < 60 years-79.5% and > or = 60 years-41.5% (p = 0.0489). 3) Extent of resection: Total patients: complete resection-87.6% and incomplete resection-50.5% (p > 0.05) Stage III: complete resection-66.7% and incomplete resection-75.5% (p > 0.05) 4) Myasthenia gravis: present-71.6% and absent-74.9% (p > 0.05) Seventeen patients were treated with a combination chemotherapy of Cyclophosphamide, Adriamycin and cisplatin(CAP). Two complete responses and seven partial responses (overall response rate of 53%) were observed with a median response duration of fourteen months. Combination chemotherapy with CAP was effective.

CONCLUSIONS

Stage and age were the independent prognostic factors in patients with thymoma. However, the presence of myasthenia gravis or the extent of resection in stage III patients was not associated with the survival time.

Radiotherapy of intracranial germinomas

Between 1980 and 1992, 32 patients with intracranial germinomas were treated with radiation. All patients were confirmed histopathologically prior to treatment. Of the 32 intracranial germinomas reviewed, 14 were located in the suprasellar region, 12 in the basal ganglia and thalamus, four in the pineal, and two in both the pineal and suprasellar regions. Three patients had subarachnoid seeding. Craniospinal irradiation was undertaken for 29 patients. The median dose of 54 Gy was delivered to the tumor bed, 36 Gy to the whole brain and 24 Gy to the spinal axis. Five and 10-year survival rates were 96.9 and 96.9%, respectively. Local control was achieved in all patients except one who died of persistent tumor after 2 months following radiotherapy. No intracranial recurrence or spinal metastasis were found. Tumor site did not relate to the prognosis. One patient developed severe intellectual deterioration, three patients had vertebral growth impairment. The present study confirms the excellent result with radiotherapy alone for patients with germinomas.

Transferrin receptor expression of the hyperplastic lesions of hepatocyte in experimental hepatocarcinogenesis

Transferrin receptor (TR) performs the major function of binding and internalizing its specific iron-loaded ligand, transferrin, and its expression is closely linked to the proliferation status of the cell. This study was undertaken to elucidate TR expression in the hyperplastic lesion of hepatocyte in chemically induced hepatic carcinogenesis. The resistant hepatocyte model was chosen for a rat model of carcinogenesis and Sprague-Dawley rats were divided into the following groups: the control groups of normal diet and iron-rich diet with or without hydroxyquinoline and the groups of carcinogen alone and carcinogen plus iron-rich diet with or without administration of hydroxyquinoline. Microscopic changes in the liver, expression of transferrin receptor and glucose-6-phosphatase were studied. The hepatocyte of the control group showed both cytoplasmic and membranous expression of TR. The liver of rats fed on high iron diet accumulated iron and the expression of TR was down regulated by intrahepatic iron accumulation. In the carcinogen administered group the resistant hepatocyte of hyperplastic lesion revealed strong membranous expression of TR and failed to accumulate iron in spite of high iron diet but in contrast the surrounding non-resistant hepatocyte expressed TR in both the membrane and cytoplasm and stored iron when fed on high iron diet. The strong membranous expression of TR is one of the characteristics of the resistant hepatocyte of hyperplastic lesion and it seems to be related to the inability to accumulate iron in spite of a high iron diet.

Comparison of sympathetic skin response and digital infrared thermographic imaging in peripheral neuropathy

It is well known that the SSR (sympathetic skin response) is to evaluate the function of sudomotor activity and Digital infrared thermal imaging (DITI) is to evaluate the function of vasomotor activity of the sympathetic nerve. To assess the sympathetic nerve impairment in the patients with peripheral neuropathy, the SSRs and DITIs were tested in 35 cases. Twenty-four (68.6%) patients were abnormal on SSR test and twenty-nine (82.9%) patients were abnormal on DITI test. In the relationship between DITI and SSR, 19 (54.3%) cases were abnormal and 1 case was normal finding in both of these two tests. And the remaining 25 (42.9%) patients were abnormal on only either one of both tests. Frequency of abnormal SSR and DITI findings were correlated with severity of axonal involvement in peripheral nerve lesion. The results of this study revealed DITI to be more sensitive test in assessing sympathetic dysfunction in peripheral neuropathy than the SSR. However DITI has very limited values in the patients with symmetrically involved peripheral neuropathy because thermal asymmetry is considered as abnormal on DITI. Therefore, in assessing the function of sympathetic nerve in peripheral neuropathy, combined tests of SSR and DITI are useful.