Clinical Classification of Spinal Muscular Atrophy

OBJECTIVE: To describe the classification and prognosis of the patients with spinal muscular atrophy (SMA). METHOD: The medical records of thirty one patients, who were diagnosed as SMA by electromyography or muscle biopsy from January 1987 to December 1999, were reviewed retrospectively. Classification of SMA was mainly based on age at onset and achieved milestones. RESULTS: Patients with SMA type I, II and III were 17 (54.8%), 7 (22.6%) and 3 (9.7%) respectively. Four patients were unclassifiable due to functional improvements. Two patients who were classified as SMA type I, had achieved ability to sit unaided at last follow up (at 20 months and 24 months old). Two patients who were classified as SMA type II, could walk independently at last follow up (at 34 month and 26 years old). In three of SMA type I patients, functional improvements of rolling over and head control were achieved. CONCLUSION: Classification of SMA based on age at onset and achieved milestones was helpful in prediction of prog nosis. But 12.9% of SMA patients were not classifiable due to unexpeceted functional improvement.

Relationship between Clinical Outcome and Electrophysiological Study in Spinal Bifida

OBJECTIVE: To investigate the relationship the electrodiagnostic findings with the functional outcomes in spina bifida patients and to assess usefulness of follow up electrodiagnostic study. METHOD: Initial and follow up electrodiagnostic data of 100 patients who had been diagnosed as spina bifida were obtained retrospectively. Electrophysiological diagnosis and neurological level were investigated by the findings of needle electromyography. Each patients were divided into no change, improvement and deterioration group according to follow up study. The change of urodynamic study findings and clinical findings were also investigated. The recent functional outcomes and the presence of complications were evaluated by recent outpatient record. RESULTS: 56 patients had no change, 15 patients had improvement and 29 patients had deterioration electrophysiologically. The initial electrodiagnostic findings were associated with the functional outcomes in patients with spina bifida (p<0.05). However, neurological level by electrodiagnostic findings cannot predict functional outcomes except ambulation activities. The change of electrodiagnostic findings of follow up study were related with the change of clinical findings statistically (p<0.05). CONCLUSION: Follow up electrodiagnostic study as well as initial study is necessary for the evaluation of the change of neurological states in the patients with spina bifida.

Excretory-secretory antigen is better than crude antigen for the serodiagnosis of clonorchiasis by ELISA

Although stool examination is the standard diagnostic method of clonorchiasis, serodiagnosis by ELISA using crude antigen is now widely used because of its convenience. However, ELISA diagnosis still suffers from cross-reactions, and therefore there is a need to improve the present conventional ELISA. The present study was undertaken to evaluate the diagnostic value of ELISA using excretory-secretory antigen (ESA) instead of crude antigen (CA) of Clonorchis sinensis. The diagnostic sensitivity of ELISA using excretory-secretory antigen was 92.5%, which was higher than that of ELISA using crude Clonorchis sinensis antigen (88.2%). In addition, the specificity of excretory-secretory antigen was found 93.1% while that of crude antigen was 87.8%. In summary, Clonorchis sinensis ESA was found to be a better serodiagnostic antigen than CA for ELISA.

Fluid and Calory Intake in Patients with Dysphagia

OBJECTIVE: The objective of this study is to assess whether the patients with dysphagia, who must take fluid thickener and dysphagia diet, have adequate fluid and calory intake. METHOD: Fifteen patients with dysphagia were participated in this study. In all of them, dysphagia was documented by videofluoroscopy and viscosity modification was recommended. The amount of fluid and calory intake was measured for 3 consecutive days during taking thickened fluid and dysphagia diet. serum sodium, blood urea nitrogen (BUN) and creatinine (Cr) level were measured. RESULTS: Fourteen of 15 patients with dysphagia took adequate fluid and calory. In thirteen of 14 patients, BUN/Cr ratio and serum sodium were within normal limit. In one of 14 patients, BUN/Cr ratio was elevated due to excessive protein intake. One of 15 patients with dysphagia took the fluid and calory under the standard. Her BUN/Cr ratio was 27.2. But this patient took more fluid and nutrition day after day. At 3rd day after measurement, she took adequate fluid and calory. CONCLUSION: Sufficient fluid and calory could be supplied with fluid thickener and dysphagia diet. But physician should observe carefully whether dysphagic patient consume adequate amount of fluid and calory.

The Effects of Viscosity on Oropharyngeal Phase

OBJECTIVE: The videofluoroscopic swallowing study (VFSS) has been accepted for standard method of dysphagia evaluations. But there is no research for oropharyngeal effects depending on the change of viscosity. METHOD: The 10 normal subjects without dysphagia symptom or history were participated. 4 test foods were selected according to viscosity which was measured by line spread test (LST); thick semiblended diet: LST 1 cm, Yoplait: LST 2.44 cm, tomato juice: LST 3.67 cm, 35% diluted barium: LST 4.15 cm. Each foods were swallowed 3 times during VFSS. We measured oral transit time (OTT), pharyngeal delay time (PDT), pharyngeal transit time (PTT), and cricopharyngeal opening time (CPOT) RESULTS: There was linear correlation between OTT and LST (cm)(r= 0.965, P<0.05). As the score of LST increased, PDT tended to increase linearly, but there was no statistical significance (r=0.949, P=0.509). PTT and CPOT had no significant correlation with viscosity. CONCLUSION: The viscosity affected OTT and PDT. The test foods of VFSS and dysphagia diet shoud be selected by viscosity measures.

Long-term Follow-up Astigmatic Changes in Cataract With or Without Suture

We performed an analysis of corneal astigmatism of 123 eyes with suturing(sutured group) and 56 eyes without suturing(sutureless group) after phacoemulsification and PCL implantation through 7.0 mm straight incision wound 2.0-2.5 mm from superior limbus by use of algebraic and vector methods for two years following surgery. In both groups, the amount and axis of astigmatism were continued to change for 2years(p>0.05). The amount of astigmatisms in sutureless group was less than in sutured group until 2 months postoperatively(p0.05). Astigmatic changes in sutureless group were stable and had lower against-the-rule shift than the sutured group after 6 months postoperatively(p<0.01). Surgically induced astigmatism was stabilized after 1 month postoperatively in sutured group and after 2 weeks psotoperatively in suture less group(p<0.01), and it was lower in suture less group than sutured group during the two years postoperatively.(p<0.01).

Corneal Astigmatic Changes by Temporal Incision or Oblique Incision in Sutureless Cataract Surgery

We analyzed postoperative astigmatic changes according to the location of incision in 129 eyes that sutureless cataract surgeries were performed. We followed up the astigmatic changes until six months postoperatively, and compared the results of two groups of which the one is the preoperative against-the-rule astigmatic cases with superior incisions and temporal incisions, the other is the preoperative oblique astigmatic cases with superior incisions and superotemporal incisions. In the preoperative against-the-rule astigmatic cases, postoperative astigmatic changes were shifted toward against-the-rule astigmatism(0.23 diopters) in superior incisions and toward with-the-rule astigmatism(0.20 diopters) in temporal incisions until 6 months following surgery(p0.05). Surgically induced astigmatisms were less in superotemporal incisions than superior incisions (p<0.01) and corneal astigmatisms were stabilized after one month postoperatively in both groups(p<0.05). These results demonstrated that surgically induced astigmatisms were decreased by the incision at steep axis, and in the cases of preoperative againstthe rule astigmatism, the preexisting astigmatisms were decreased by the temporal incisions.

The Evaluation of Incidence of Hyphema as Early Complication following Sutureless Cataract Surgery

Postoperative hyphema following cataract extraction surgery is not usually a serious complication and clears quickly in the most cases. Sutureless cataract surgery was reported to have less incidence of postoperative hyphema than conventional cataract surgery. We analyzed the incidence of postoperative hyphema in each group according to the depth and the length of scleral pocket incision in 500 eyes with the sutureless cataract surgery via superior incision during two years. One day after surgery, 90 cases(18.0%) had hyphema and most of them(74.4%) showed grade 1 severity. The incidence of hyphema was 23.0% in the deep incision group and only 11.9% in the superficial incision group(p<0.01). The percentage of grade 1 hyphema was 66.6% in the deep group and 92.6% in the superficial group, then severity was greatly reduced in the superficial incision group(p<0.01). The incidence of hyphema in the group of 7.0 mm in length was highest among the 6.0, 6.5, 7.0 mm groups(p<0.01), and the shorter the incision length, the milder the serverity of hyphema(p<0.01). The incidence of hyphuma was the lowest(6.2%) in the group of 6.0 mm in length and superficial incision, and it was the highest(28.5%) in the 7.0 mm in length and deep incisional group(p<0.01).