Botulinum Toxin Treatment on Upper Limb Function in School Age Children With Bilateral Spastic Cerebral Palsy: One Year Follow-up

OBJECTIVE: To prospectively investigate the long-term effects of botulinum toxin treatment on the upper limb function and performance of school age children with spastic bilateral cerebral palsy, who have limitations in performing activities of daily living and school activities, due to spasticity of the upper extremities. METHODS: Botulinum type A toxin (BoNT-A) was injected into 24 spastic upper limbs of 15 children. We used a Modified Ashworth Scale and a Modified Tardieu Scale for the evaluation of upper limb spasticity, and Quality of Upper Extremity Skills Test (QUEST), Canadian Occupational Performance Measure (COPM), and Test of Visual-Motor Skills-Revised (TVMS-R) for the evaluation of upper limb function and performance. RESULTS: Upper limb spasticity continuously decreased until the end of the one-year follow-up. Upper limb function on QUEST and COPM showed the best performance at 3 months and deteriorated slightly, but still showed a significantly better performance at 9 and 12 months than at pre-injection. In more functional nine subjects who could perform TVMS-R, the performance enhancement effects remained constant after 12 months, suggesting that the reduced spasticity led to the learning effect acquired by the repeated use of the affected upper limb. CONCLUSION: For school age children with bilateral spastic cerebral palsy whose upper limb functions are important, BoNT-A injections seem to be of help in the performance of school activities and activities of daily living.

Deformities of Spine and Lower Extremities in Teenagers with Cerebral Palsy

OBJECTIVE: To investigate the state of musculoskeletal deformities in spine and lower extremities in teenagers with cerebral palsy. METHOD: 79 teenagers with cerebral palsy attending special schools were examined for deformities of the spine and the lower extremities with physical examinations and radiographic studies. RESULTS: The number of cases with scoliosis was 47 (59.5%) and the mean of Cobb's angle was 21.7 degrees. There were 42 joints (26.6%) of hip subluxation and 10 joints (6.3%) of hip dislocation out of 158 hip joints. The mean of migration percentage was 53.6%. 30 participants (38.0%) had pelvic obliquity. The coxa valga appeared in 147 hip joints (93.0%), with the mean of femur neck-shaft angle was 156.0 degrees. It had a casual link with migration percentage (p<0.001). 131 knee joints (82.9%) had the increased popliteal angle and 113 knees (71.5%) had patella alta. 72 cases (91.1%) had equinus feet, and 49 cases (62.0%) had planovalgus feet deformities on radiographic studies. As the score of Gross motor function measure (GMFM) was decreased, the migration percentage (p<0.01), the Cobb's angle (p<0.01), the popliteal angle increased (p<0.001) and femur neck- shaft angle (p<0.05). CONCLUSION: Teenagers with cerebral palsy are highly risk to develop musculoskeletal deformities in their spine and the lower extremities. Therefore, a close medical inspection should be paid on this group.

Clinical Effectiveness of Restriction Fragment Mass Polymorphism Assay for Human Papillomavirus Genotyping / 임상검사와정도관리

BACKGROUND: Human papillomavirus (HPV) infection is the main cause of cervical cancer and with the advent of genotype specific vaccines, there is increased need for accurate, broad-spectrum and high-throughput methods for HPV genotyping. A MALDI-TOF mass spectrometry (MS)-based restriction fragment mass polymorphism (RFMP) assay has proven to accurately and reliably genotype a wide variety of HPV. METHODS: We evaluated the clinical utility of the RFMP assay in HPV genotyping by testing a total of 2,689 specimens taken from liquid-based cytology, which was composed of normal cytology, atypical squamous cells of undetermined significance (ASCUS), low grade squamous intraepithelial lesion (LSIL), high grade squamous intraepithelial lesion (HSIL) and invasive squamous cervical cancer (SCC). RESULTS: Overall HPV positive rate of total specimens was 32.5% and the high-risk positivity was 16.4%. The HPV positive rates were increased as increasing severity level of cervical lesion. Predominant high-risk HPV genotypes were found as following order; 52 (18.6%), 16 (13.7%), 18 (3.8%), 58 (3.4%), 56 (2.6%) and 31 (2.5%). The high-risk HPV positivities according to cytologic diagnosis were 10.7% (238/2229), 31.7% (76/240), 50.0% (88/176), 86.0% (37/43), 100% (1/1) in normal, ASCUS, LSIL, HSIL and SCC subgroups, respectively. The concordance rate and Kappa value between sequencing and RFMP assays were 96.6% and 0.932 (95%CI: 0.908-0.956). CONCLUSIONS: The RFMP HPV genotyping assays showed high concordance with sequencing. The assay is simple, and can accurately detect and identify HPV genotypes in samples with various levels of cytological lesions. The results demonstrated that RFMP assay should be clinically suitable for HPV genotyping in laboratories.

Long-term Effects of Day Hospital Program in Stroke Rehabilitation

OBJECTIVE: Comprehensive poststroke rehabilitation includes continuum of care after discharge from hospital. Day hospital is a milieu-oriented outpatient rehabilitation program that offers continuous rehabilitation service to promote psychosocial adaptation and quality of life. This study is to evaluate long-term effects of day hospital program in stroke patients. METHOD: Forty-eight stroke patients who received day hospital program for 2 or more months after inpatient rehabilitation program and 42 control stroke patients, who received only inpatient rehabilitation program, responded telephone interview for the study. Outcome measurement included the Korean Activities of Daily Living (K-ADL), the Korean Instrumental Activities of Daily Living (K- IADL) and the Medical Outcome Study 8-item Short Form Survey (SF-8). RESULTS: There was no difference in many item scores of K-ADL between day hospital group and control group, but the item scores of dressing, washing face and hands were significantly higher in control group. Among the item scores of K-IADL, except managing money, most item scores of K-IADL were no significant difference between day hospital group and control group. All item scores of SF-8 were significantly higher in day hospital group than control group. CONCLUSION: Day hospital is an effective rehabilitation program to enhance health-related quality of life for stroke patients.

Utilization Status of Public Health and Medical Rehabilitation Services by the Persons with Disabilities in Community

OBJECTIVE: To survey the utilization status of public health and medical rehabilitation services by the persons with disabilities in community. METHOD: The subjects were 118 patients who were admitted to National Rehabilitation Center from January 1998 to December 2001 and agreed with home-visit. The subjects were assessed of disability level with functional scales, utilization rate of public health and medical rehabilitation services, utilization facilities, and service contents. RESULTS: The subjects included 78 pesons with stroke, 20 persons with spinal cord injury, 9 pesons with traumatic brain injury, and 11 persons with other diseases. Only 28.0% of the low-functional group used public health and medical rehabilitation services, showing a low utilization rate than the high-functional group (43.2%). 17 out of 24 persons who used rehabilitation clinics were in the low-functional group and 9 out of 13 persons who used welfare agency were in the high-functional group (p=0.012). In two groups, most frequent utilization out of the service contents was the exercise therapy. CONCLUSION: The utilization rate of public health and medical rehabilitation services in communities was 32.8%. It is necessary to supply the persons with disabilities in community with the rehabilitation service for the continuum of rehabilitation.

Shoulder Subluxation and Risk of Complex Regional Pain Syndrome after Stroke

OBJECTIVE: To evaluate the frequency of complex regional pain syndrome (CRPS) and to determine the risk of CRPS after stroke according to the degree of shoulder subluxation by quantitative radiographic analysis. METHOD: Sixty-four stroke patients (40 male; 24 female, mean age: 59.2 10.4) were included in the study. All subjects underwent a clinical examination that included spasticity and Brunnstrom stage; and a radiologic examination. The diagnosis of CRPS was based on clinical criteria and three-phase scintigraphies. The degree of shoulder subluxation was assessed by the distance between inferomedial point of acromion and the center of humeral head and glenoid fossa. RESULTS: CRPS after stroke occurred in 34 patients (53%). There were significant differences in Brunnstrom stage and shoulder subluxation between the CRPS groups and the non CRPS groups. Among radiographic measurements, vertical distance ratio (involved/uninvolved) and oblique distance ratio indicated a strong correlation with CRPS (p<0.01). Among clinical variables and radiographic measurements, oblique ratio was the most valuable determinant of the risk for CRPS. CONCLUSION: Shoulder subluxation shows a significant correlation with CRPS after stroke. We suggest oblique ratio as a useful measurement of shoulder subluxation to estimate the risk of CRPS.

Pure Epithelioid Malignant Schwanoma: A case report

The pure epithelioid malignant schwanoma is a rare form of malignant schwanoma and differs from the ordinary epithelioid malignant schwanoma because of the absence of a spindle cell component. We present a case of purely epithelioid malignant schwanoma arising in the parapharyngeal area from vagus nerve without difinite evidence of von Recklinghausen's disease. The patient was a 28-year-old man with palpable right neck mass and swallowing difficulty during 2 years. The mass was an ovoid encapsulated tumor and measured 5x3x3 cm in dimension. The cut surface showed brownish tan homogeneous nodular appearance with partly myxoid area. Microscopically the tumor showed nodular pattern composed of epitheliod cells which were arranged in both tight clusters and stringy cords. The cells were ovoid in shape and had vesicular nuclei with single prominent eosinophilic nucleolei and sometimes abundant intracytoplasmic mucin. Mitoses were infrequent. Ultrastructural study showed rudimentary cell junction and degenerated cytoplasmic organelles including scattered mitochondriae, short segments of rough endoplasmic reticulum and lipid droplets. There were no definite basement membrane and melanosome. Immunohistochemical study showed the cells being positive for S100 protein, neuron specific enolase and myelin basic protein and negative for cytokeratin.