Risk Factors for Developing Upper Limb Lymphedema following Breast Cancer Surgery

OBJECTIVE: To identify the risk factors for secondary lymphedema after breast cancer surgery. Lymphedema, a sequelae of breast cancer therapy, changes functional abilities and may affect a patient's psychosocial adjustment and overall quality of life. It is generally underreported and undertreated. METHOD: Six hundred two patients who had undergone breast cancer surgery between January 2000 and December 2005 were examined. The circumferences of the upper extremities were measured and lymphedema was defined as difference of greater than 2cm between the affected and normal arms. The effects of age, body mass index, diabetes, hypertension, side of tumor, sugery method, radiotherapy, chemotherapy, TNM stage, involvement of axillary lymph nodes, menopausal state and laboratory findings on the development lymphedema were investigated and analyzed by t-test, chi-square test and multiple logistic regression analysis. RESULTS: 121 out of 602 patients had lymphedema. Those patients with lymphedema had a higher body mass index. Univariate analysis indicated an increased occurrence of lymphedema due to those with body mass index, radiotherapy, T2 stage, N3 stage and axillary lymph node invasion. Multivariate analysis revealed that body mass index and radiotherapy were independently associated factors for lymphedema after breast cancer surgery. CONCLUSION: The patients who had radiotherapy or BMI greater than 25 must be considered as potential candidates to have lymphedema after breast cancer surgery. Therefore, these patients should be informed during the follow-up period about this morbidity, the preventive measure, and the treatment.

Musculoskeletal Pain in Young Kendo Player

OBJECTIVE: To investigate the distribution of pain and associated factors and to understand treatment and prevention of Kendo related pain. METHOD: Ninety three Kendo players were given an account of questionnaire. Age, career, class, weekly practice time, daily warm-up exercise, daily cool-down exercise, pain existence, distribution of pain, diagnosis of pain origin, method of pain control, period of most pain and injury occurrence were investigated and analyzed. RESULTS: The mean age was 29.3 years and mean career was 25.8 months. Sixty-four out of ninty-three Kendo players had musculoskeletal pain. Foot was the most common area of pain complaints (25%), which were followed by wrist (17.2%), ankle and heel (15.4%), knee (14.1%) in order of prevalence. Univariate analysis indicated increased occurrence of pain was correlated with age, career, class and warm-up exercise. As the causes of pain, tennis elbow, herniated lumbar disk, plantar fascitis and torsion of ankle were common. CONCLUSION: Musculoskeletal pain related to Kendo was found highly frequent and involved in whole body. Foot, ankle and heel were the most common area of pain and the cause of pain was various.

Causative Organisms and Antimicrobial Susceptibility of Urinary Tract Infection of Spinal Cord Injured Patients / 감염과화학요법

BACKGROUND: To provide useful information on the choice of adequate drugs in the treatment of urinary tract infection (UTI) in spinal cord injury patients. MATERIALS AND METHODS: The subjects were 34 spinal cord injured patients who were registered in Busan Spinal Cord Disabled Person Society and 111 patients with spinal cord injury who were admitted in 4 university hospitals in Busan between January 2004 and December 2005. We collected the patient's urine in July 2006 and performed comprehensive chart reviews of these patients. We studied the incidence of UTI, commonly cultured organisms, antimicrobial sensitivities, voiding methods and follow-up. RESULTS: The incidence of UTI was 48.3% of 145 patients. The most common causative organism of UTI was Escherichia coli (27.1%), followed by Pseudomonas aeruginosa (22.9%) and Klebsiella pneumoniae (8.3%). Antimicrobial sensitivities of imipenem, amikacin and ceftazidime to Escherichia coli were respectively 100%, 92.3%, 80.8%. The sensitivities of Pseudomonas to the same agents were 63.6%, 31.8 %, 45.5% respectively. Ciprofloxacin showed decreased sensitivities of 38.5%, 31.8% respectively for Escherichia coli and Pseudomonas aeruginosa. CONCLUSION: Our results implied decreasing susceptibility of ciprofloxacin, so it can be recommended to restrict the use of ciprofloxacin as a primary empirical antibiotic for UTI of spinal cord injured patients. Causative organisms of UTI are becoming more diverse. Also the incidence and antimicrobial sensitivities are changing as well. Therefore continuous observation with the appropriate treatment is needed.

Causative Organisms and Antimicrobial Susceptibility of Urinary Tract Infection of Spinal Cord Injured Patients / 감염과화학요법

BACKGROUND: To provide useful information on the choice of adequate drugs in the treatment of urinary tract infection (UTI) in spinal cord injury patients. MATERIALS AND METHODS: The subjects were 34 spinal cord injured patients who were registered in Busan Spinal Cord Disabled Person Society and 111 patients with spinal cord injury who were admitted in 4 university hospitals in Busan between January 2004 and December 2005. We collected the patient's urine in July 2006 and performed comprehensive chart reviews of these patients. We studied the incidence of UTI, commonly cultured organisms, antimicrobial sensitivities, voiding methods and follow-up. RESULTS: The incidence of UTI was 48.3% of 145 patients. The most common causative organism of UTI was Escherichia coli (27.1%), followed by Pseudomonas aeruginosa (22.9%) and Klebsiella pneumoniae (8.3%). Antimicrobial sensitivities of imipenem, amikacin and ceftazidime to Escherichia coli were respectively 100%, 92.3%, 80.8%. The sensitivities of Pseudomonas to the same agents were 63.6%, 31.8 %, 45.5% respectively. Ciprofloxacin showed decreased sensitivities of 38.5%, 31.8% respectively for Escherichia coli and Pseudomonas aeruginosa. CONCLUSION: Our results implied decreasing susceptibility of ciprofloxacin, so it can be recommended to restrict the use of ciprofloxacin as a primary empirical antibiotic for UTI of spinal cord injured patients. Causative organisms of UTI are becoming more diverse. Also the incidence and antimicrobial sensitivities are changing as well. Therefore continuous observation with the appropriate treatment is needed.