Preliminary Report of Validity for the Infant Comprehensive Evaluation for Neurodevelopmental Delay, a Newly Developed Inventory for Children Aged 12 to 71 Months

Objectives@#Early detection of developmental issues in infants and necessary intervention are important. To identify the comorbid conditions, a comprehensive evaluation is required. The study’s objectives were to 1) generate scale items by identifying and eliciting concepts relevant to young children (12–71 months) with developmental delays, 2) develop a comprehensive screening tool for developmental delay and comorbid conditions, and 3) assess the tool’s validity and cut-off. @*Methods@#Multidisciplinary experts devised the “Infant Comprehensive Evaluation for Neurodevelopmental Delay (ICEND),” an assessment method that comes in two versions depending on the age of the child: 12–36 months and 37–71 months, through monthly seminars and focused group interviews. The ICEND is composed of three parts: risk factors, resilience factors, and clinical scales. In parts 1 and 2, there were 41 caretakers responded to the questionnaires. Part 3 involved clinicians evaluating ten subscales using 98 and 114 questionnaires for younger and older versions, respectively. The Child Behavior Checklist, Strengths and Difficulties Questionnaire, Infant-Toddler Social Emotional Assessment, and Korean Developmental Screening Test for Infants and Children were employed to analyze concurrent validity with the ICEND. The analyses were performed on both typical and high-risk infants to identify concurrent validity, reliability, and cut-off scores. @*Results@#A total of 296 people participated in the study, with 57 of them being high-risk (19.2%). The Cronbach’s alpha was positive (0.533–0.928). In the majority of domains, the ICEND demonstrated a fair discriminatory ability, with a sensitivity of 0.5–0.7 and specificity 0.7–0.9. @*Conclusion@#The ICEND is reliable and valid, indicating its potential as an auxiliary tool for assessing neurodevelopmental delay and comorbid conditions in children aged 12–36 months and 37–71 months.

Validity and Reliability of the Behavior Development Screening for Toddlers-Questionnaire/Parents(BeDevel-Q/P): A Korean Autism Screening Instrument for Infants aged 24–35 Months

Objective@#This study tested the validity and reliability of the Behavior Development Screening for Toddlers-Questionnaire-Parents (BeDevel-Q/P), a new autism spectrum disorder (ASD) screening instrument being developed in South Korea. The parents of 24–35-month-old infants were recruited to complete the questionnaire. @*Methods@#The participants were 791 infants aged 24–35 months. There were 623 typically developing infants, 88 infants with ASD, and 80 developmentally delayed infants. For test-retest, the participants were surveyed every 1–4 weeks. Participants were recruited nationwide. Subjects’ parents completed the BeDevel-Q/P and concurrent validity questionnaires. The data were used for statistical analysis. @*Results@#A total of 24 items consisting of 16 items from factor 1 (F1), 6 items from factor 2 (F2), and 2 items from factor 3 (F3), were selected for the final BeDevel-Q/P items. @*Conclusion@#The factors of the screening instrument developed in this study were analyzed, and three factors were extracted, confirming the theoretical foundation of the BeDevel-Q for the parents of 24–35-month-old infants.

Reliability and Validity of the Korean Version of the Infant-Toddler Social and Emotional Assessment

OBJECTIVE: This article examined the psychometric properties of the Korean version of the Infant-Toddler Social and Emotional Assessment (K-ITSEA). METHODS: Translation and back-translation of the K-ITSEA were conducted after obtaining a permission. Two thousand two hundred thirty six Korean community infants (1,199 boys and 1,037 girls) between the ages of 12 and 36 months (M=34.23, SD=3.80) and 90 clinical infant samples (60 boys and 30 girls) between the ages of 12 and 36 months (M=26.84, SD=6.24) participated in the present study. RESULTS: Confirmatory factor analyses supported the Internalizing, Externalizing, Dysregulation, and Competence domains as well as the 17 individual scales that comprise the K-ITSEA. Young children's sex and age differences emerged for some problem and most competence scales. All domains showed adequate intrascale reliability and test-retest reliability. Scale intracorrelation analyses and associations between the K-ITSEA and Korean version of PSI, Korean version of CBCL1.5-5 supported the validity of the assessment. Comparisons of the K-ITSEA scores for the Autism Spectrum Disorder, Psychiatric Disorders and Matched control groups supported the discriminant validity of the K-ITSEA. CONCLUSION: This preliminary results indicate that the K-ITSEA would be a useful assessment for detecting the early childhood's behavior problems and competences in Korean population.

Analysis of periodontal data using mixed effects models

A fundamental problem in analyzing complex multilevel-structured periodontal data is the violation of independency among the observations, which is an assumption in traditional statistical models (e.g., analysis of variance and ordinary least squares regression). In many cases, aggregation (i.e., mean or sum scores) has been employed to overcome this problem. However, the aggregation approach still exhibits certain limitations, such as a loss of power and detailed information, no cross-level relationship analysis, and the potential for creating an ecological fallacy. In order to handle multilevel-structured data appropriately, mixed effects models have been introduced and employed in dental research using periodontal data. The use of mixed effects models might account for the potential bias due to the violation of the independency assumption as well as provide accurate estimates.

Hemorheology and Microvascular Disorders

The present review presents basic concepts of blood rheology related to vascular diseases. Blood flow in large arteries is dominated by inertial forces exhibited at high flow velocities, while viscous forces (i.e., blood rheology) play an almost negligible role. When high flow velocity is compromised by sudden deceleration as at a bifurcation, endothelial cell dysfunction can occur along the outer wall of the bifurcation, initiating inflammatory gene expression and, through mechanotransduction, the cascade of events associated with atherosclerosis. In sharp contrast, the flow of blood in microvessels is dominated by viscous shear forces since the inertial forces are negligible due to low flow velocities. Shear stress is a critical parameter in microvascular flow, and a force-balance approach is proposed for determining microvascular shear stress, accounting for the low Reynolds numbers and the dominance of viscous forces over inertial forces. Accordingly, when the attractive forces between erythrocytes (represented by the yield stress of blood) are greater than the shear force produced by microvascular flow, tissue perfusion itself cannot be sustained, leading to capillary loss. The yield stress parameter is presented as a diagnostic candidate for future clinical research, specifically, as a fluid dynamic biomarker for microvascular disorders. The relation between the yield stress and diastolic blood viscosity (DBV) is described using the Casson model for viscosity, from which one may be able determine thresholds of DBV where the risk of microvascular disorders is high.

Clinical Outcome after Surgical Treatment of the Central Disc Herniation / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study OBJECTIVE: We wanted to to assess the clinical features of central disc herniation and the differences in the clinical outcome between discectomy and fusion. Summary of the literature REVIEW: Central disc herniation appears to have poorer results than does posterolateral herniation in the literature. In most reports, persistent back pain was often found after discectomy and it may be related to the anatomical characteristics of the posterior longitudinal ligament in the lower lumbar region. MATERIALS AND METHOD: Central disc herniation was defined as a herniated mass that occupied more than 50% of the spinal canal and the maximal deviation of the apex was within 2 mm from the midline. 27 patients were operated on with using these criteria and they were subdivided by the operation methods. Laminotomy and discectomy was done in 20 patients. Posterior lumbar interbody fusions were performed on the other 7 patients with significant back pain. We compared the neurological improvement and the clinical outcomes. RESULTS: Preoperative back pain was significantly more frequent in the PLIF group. The other clinical features were significantly improved in the both groups, but the differences were not statistically significant. Satisfactory clinical outcomes were obtained in 70 percent of the discectomy group and in 100 percent of the PLIF group, respectively, but this was not significantly different. CONCLUSION: The presence of significant back pain was considered as an indication for performing fusion in our series. The clinical outcome of central disc herniation after PLIF was slightly better than that of discectomy in spite of the preoperative back pain in the PLIF group, but the difference was not statistically significant.

Rosai-Dorfman Disease Occurred in Epidural Space of the Thoracic Spinal Canal / 대한척추외과학회지

Rosai-Dorfman disease is a rare, non-neoplastic lymphoproliferative disorder that is characterized by its specific histological features. However, it is uncommon for it to involve the thoracic spinal cord as a site of extranodal disease. A 36 year-old man developed progressive paraparesis 2 weeks prior to admission. On an MRI study, the spinal cord was compressed at the T4 and T5 levels posteriorly by an epidural mass. A decompressive laminectomy and removal of the mass were performed and Rosai-Dorfman disease was confirmed histologically. After the operation, additional high-dose radiotherapy was performed. The motor weakness and hypesthesia in the lower extremities resolved completely and there was no evidence of recurrence at the final follow-up examination.

A Minimum Follow-up Study of 10 years After Pedicle Screw Fixation and Fusion for Degenerative Lumbar Diseases / 대한척추외과학회지

STUDY DESIGN: A retrospective study was conducted. OBJECTIVES: To evaluate the long-term clinical results and radiological changes of lumbar spinal fusions with pedicle screw fixation for degenerative lumbar disease. SUMMARY OF LITERATURE REVIEW: Pedicle screw fixation of the lumbar spine is a widely used procedure, but there is little longterm follow-up information on the results of the technique. MATERIALS AND METHODS: Patients, who underwent surgery for degenerative lumbar diseases, from May 1988 through December 1994, were included. Those patients who received surgery for tumors, infections, traumas, and deformities were excluded, as were those who received long-level fusions . The clinical results were evaluated with Kim's criteria. Radiologically, changes in lumbar lordosis and disc height were measured, and calcification in the disc spaces was evaluated. RESULTS: One hundred-thirty-six patients matched the study criteria. Of these, 13 had died, and there were 123 available for the study. Clinical follow-up was completed in 58 patients. There were 36 women and 22 men. The average age at the time of surgery was 52.7 years. The average follow-up was 148 months. Forty-four patients had satisfactory results at the final follow-up. Repeat surgery was necessary in 7 patients: 6 of them on a single segment and 4 with a posterior lumbar interbody fusion. A final radiologic analysis was completed in 44 patients. Lumbar lordosis was reduced from 43 degrees to 33 degrees. The lordotic angle of the fusion segments was reduced from 22 degrees to 13 degrees. The relative heights of the discs were markedly reduced at L3-4 and L4-5, from 40% to 30% and from 37% to 27%, respectively. Calcification of the disc space was observed in 37 segments out of a total of 58 that were treated with posterolateral fusions. CONCLUSION: The clinically satisfactory result rate was similar to that of the 5-year follow-up reported in a previous study by the author. Repeat operations were necessary if disc herniation or stenosis developed in the adjacent vertebral segments. Patients who were treated with a single-level PLIF demonstrated a higher repeat operation rate. Lordotic angles and disc space heights were reduced significantly during the follow-up period. Many disc spaces (64%) involved in posterolateral fusions had calcific deposits, which meant that spontaneous disc space fusion would occur over time, even though the disc space was not fused at the time of surgery.

Gorham's Disease Misdiagnosed as a Simple Compression Fracture in the Thoracic Spine: A Case Report / 대한척추외과학회지

Gorham's disease is a rare condition of unknown etiology that is characterized by progressive osteolysis. A 48 year-old woman had a burst fracture at T10, which was treated by pedicle screw instrumentation at another hospital. She was transferred due to progressive paraparesis, which was not observed initially. An MRI demonstrated severe cord compression at the T10 level. Under the assumption that the patient had a highly vascular metastatic tumor, an anterior decompression with instrumentation was performed. However, neurologic symptoms and bone destruction worsened after six weeks postoperatively. A repeat decompression was performed through the posterior route and long-level pedicle screw instrumentation was applied. After the second operation, Gorham's disease was confirmed histologically. Care must be taken not to overlook a pathologic fracture caused by a spinal tumor as a simple fracture, especially an osteoporotic one.

Cauda Equina Syndrome After Percutaneous Endoscopic Discectomy At L5-S1: A case Report / 대한척추외과학회지

The Cauda Equina syndrome after spine surgery is a relatively uncommon condition, but it is a serious complication that needs emergency treatment. A 35-year-old woman was transferred to our hospital and she presented with decreased perianal sensation and rectal tone after percutaneous endoscopic discectomy. Magnetic resonance image showed that the dura sac was compressed by herniated disc material at L5-S1. After performing emergency open discectomy for the cauda eguina syndrome, the patient's neurologic symptoms were completely resolved at 12 months follow-up. There has been no previous report on Cauda Equina syndrome after percutaneous endoscopic discectomy, and so we report here on one case.

Anterior Decompression and Instrumentation in the Patients with Neurologically Compromised Vertebral Body Collapse After Osteoporotic Compression Fracture / 대한척추외과학회지

STUDY DESIGN: A retrospective study OBJECTIVES: To evaluate the clinical and radiological results of anterior decompression and instrumentation for delayed vertebral body collapse in neurologically compromised osteoporotic compression fractures. LITERATURE REVIEW SUMMARY: Indications for an operation in delayed vertebral body collapse, following osteoporotic compression fractures, are intractable pain, progressive kyphosis and neurological deficits. The options for an operation are anterior, posterior and combined anterior and posterior approaches. Posterior surgery may need some degree of destruction of intact posterior elements. Combined anterior and posterior surgery increases the morbidity and mortality due to increased operative time and blood loss. Therefore, a one stage anterior surgery is a reasonable choice. MATERIALS AND METHODS: Between June 1989 and May 2003, seven cases of delayed vertebral body collapse, with neurological deficit, were treated using anterior decompression and anterior Kaneda instrumentation. All the cases were female, with a mean age of 67, ranging from 57 to 77 years. The average follow up period was 3.4, ranging from 1 to 13 years. One patient had a history of steroid medication. The operation time, intraoperative blood loss and bone mineral density were retrospectively reviewed. The changes in the kyphotic angle, preoperatively, postoperatively and on the last follow-up plain lateral radiograph were measured. The clinical results were evaluated based on a modified Frankel grading and visual analogue scale RESULTS: The average kyphotic angles preoperatively, postoperatively and at the last follow up were 29 degrees(25~47 degrees), 14 degrees(6~20 degrees) and 19 degrees(10~27 degrees), respectively. In all cases, the preoperative neurological deficits were improved by more than one degree in the Frankel grading at the final follow up. The mean operation time, blood loss and mean bone mineral density were 3.2 hours, 1514ml and T: -3.51, respectively. The values from the visual analogue scale preoperatively and at the last follow up were 7.0 and 0.5, respectively. CONCLUSIONS: Anterior decompression and instrumentation provides effective neurological decompression and stabilization of the spine by supporting the deficient anterior column in delayed vertebral body collapse.

Anterior Decompression and Instrumentation in the Patients with Neurologically Compromised Vertebral Body Collapse After Osteoporotic Compression Fracture / 대한척추외과학회지

STUDY DESIGN: A retrospective study OBJECTIVES: To evaluate the clinical and radiological results of anterior decompression and instrumentation for delayed vertebral body collapse in neurologically compromised osteoporotic compression fractures. LITERATURE REVIEW SUMMARY: Indications for an operation in delayed vertebral body collapse, following osteoporotic compression fractures, are intractable pain, progressive kyphosis and neurological deficits. The options for an operation are anterior, posterior and combined anterior and posterior approaches. Posterior surgery may need some degree of destruction of intact posterior elements. Combined anterior and posterior surgery increases the morbidity and mortality due to increased operative time and blood loss. Therefore, a one stage anterior surgery is a reasonable choice. MATERIALS AND METHODS: Between June 1989 and May 2003, seven cases of delayed vertebral body collapse, with neurological deficit, were treated using anterior decompression and anterior Kaneda instrumentation. All the cases were female, with a mean age of 67, ranging from 57 to 77 years. The average follow up period was 3.4, ranging from 1 to 13 years. One patient had a history of steroid medication. The operation time, intraoperative blood loss and bone mineral density were retrospectively reviewed. The changes in the kyphotic angle, preoperatively, postoperatively and on the last follow-up plain lateral radiograph were measured. The clinical results were evaluated based on a modified Frankel grading and visual analogue scale RESULTS: The average kyphotic angles preoperatively, postoperatively and at the last follow up were 29 degrees(25~47 degrees), 14 degrees(6~20 degrees) and 19 degrees(10~27 degrees), respectively. In all cases, the preoperative neurological deficits were improved by more than one degree in the Frankel grading at the final follow up. The mean operation time, blood loss and mean bone mineral density were 3.2 hours, 1514ml and T: -3.51, respectively. The values from the visual analogue scale preoperatively and at the last follow up were 7.0 and 0.5, respectively. CONCLUSIONS: Anterior decompression and instrumentation provides effective neurological decompression and stabilization of the spine by supporting the deficient anterior column in delayed vertebral body collapse.

Incidental Dural Tear during Posterior Surgery of Degenerative Lumbar Disease / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVE: To analyze the clinical features and prognosis of intraoperative incidental durotomy during posterior surgery for degenerative lumbar disease. In addition, we tried to evaluate clinical outcome and safety of skillful neglect of pin point dural tear. SUMMARY OF LITERATURE REVIEW : Incidental durotomy is one of the most common complications during the operation of degenerative lumbar disease. It may cause signs and symptoms of cerebrospinal fluid leakage and complications such as meningitis, wound infection, pseudomeningocele and fistula. From the literature review, primary repair is mandatory even in the case of pin point dural tear. MATERIALS AND METHODS: Seven hundred fifty-five patients with degenerative lumbar disease, who were operated posteriorly from Jan. 1990 to Feb. 2002, were reviewed retrospectively. Primary operations were 378 cases of laminectomy without instrumentation and 377 cases of decompression and instrumented fusion. Of these patients, 44 (6 percent) sustained an incidental dural tear. We analyzed the mechanisms of dural tear, intraoperative treatment, postoperative management and clinical outcome. RESULTS: Eight cases (2.1%) of dural tears occurred during discectomy, 36 (9.5%) during instrumentation and fusion, and 12 (20%) during revision surgery. Dural tears were treated intraoperatively by primary repair in 20 cases, by fascial graft in 2 and without repair (skillful neglect) in 22. There were no cases of persistent cerebrospinal fluid leakage or fistula formation, and the symptoms of cerebrospinal fluid leakage were transient. Of 36 patients followed for more than one year, 82% had good or excellent result. CONCLUSION: Incidental durotomy occurred in 5.8 percent of lower back surgery patients, and more frequently in revision surgery. Very small dural tears did not have significant influence on the clinical outcome, whether they were repaired or not. Skillful neglect of pin point dural tear may be a reasonable treatment option.

Safety and Efficacy of Metalic Implants in the Treatments of Tuberculous Spondylitis / 대한척추외과학회지

STUDY DESIGN: A retrospective study OBJECTIVE: To analyze the safety and effectiveness of treatments using metallic implants in the tuberculous spondylitis. SUMMARY OF LITERATURE REVIEW: Residual kyphosis and loss of correction remain the major problems following surgery for tuberculous spondylitis. Several authors have used metallic implants for the prevention of these complications. However, the safety of metallic implants use in tuberculous spine infections are still controversial. MATERIALS AND METHODS: Seventeen patients, who underwent surgery, and were stabilized by the use of a metallic implant for tuberculous spondylitis, and followed up for more than 1 year were included in this study. All patients were treated with combined anterior fusion (with or without mesh) and/or posterior pedicle screw instrumentation. The patients were followed up with serial plain radiographs, laboratory inflammatory parameters and neurological recovery. RESULTS: The overall correction of the kyphotic deformity was initially 8.5 degrees, and loss of correction occurred at 5.8 degrees. Although some loss of correction occurred, even after the use of a metallic implant, clinically significant kyphotic deformity was effectively prevented. There were no cases of persistent infection or failure to control infection when the metallic implantation was combined with an anterior radical debridement and chemotherapy. The erythrocyte sedimentation rate and C-reactive protein were eventually normalized in all patients. The preoperative neurological deficits were: incomplete paralysis in 9 cases and radiculopathy in 4. At the final follow-up, 11 cases had completely recovered, partial residual neurological deficits remaining in 2. CONCLUSIONS: The use of instrumentation with metallic implants, in tubercuous spondylitis of the spine, provided immediate stability, and did not prohibit the control of infection when combined with radical debridement and anti-tuberculous chemotherapy.

Pyogenic Arthritis and Paraspinal Abscess Following Facet Joint Steroid Injection: A Case Report / 대한척추외과학회지

STUDY DESIGN: A case report and literature review. OBJECTIVES: To discuss pyogenic infections of the facet joints and paraspinal intramuscular abscess that developed after a steroid injection into the facet joint of the lower back. MATERIAL AND METHODS: A 39-year-old man who received a steroid injection to the facet joint, 3 weeks prior to admission, experienced increasing lower back pain and a high fever. RESULTS: Plain radiographs of the lumbar spine showed osteolytic erosion of the articular process at the L3-4 facet joint. On a CT scan, the destructed facet joint was connected to a paraspinal intramuscular abscess. MR images also showed a paraspinal intramuscular abscess on multiplane views. In the operative field, the paraspinal abscess, which extended from 2nd to 5th lumbar vertebrae, was found on the right side, with the L3-4 facet destructed and directly connected to the abscess. Some chalky material, considered to be steroid crystals, was found at the L3-4 facet joint. Drainage, debridement and irrigation were performed. Staphylococcus aureus was isolated from the culture. After surgery, intravenous antibiotics were administered, and the patients' symptoms quickly resolved. CONCLUSIONS: A posterior facet joint injection has its own risks of developing a pyogenic infection of the facet joint. Pyogenic facet joint infections may progress to a paraspinal intramuscular abscess. Surgical drainage is mandatory in cases resistant to antibiotic treatment, with evidence of pus formation on imaging studies.