Outcome of patients with neuroblastoma aged less than 1 year at diagnosis / 소아과

PURPOSE: The purpose of this study was to evaluate the clinical characteristics and outcomes of patie nts with neuroblastoma aged less than 1 year. METHODS: From January 1997 to December 2007, 41 patients aged less than 1 year were diagnosed with neuroblastoma. Patients were divided into 3 risk groups according to the stage of the disease and N-myc amplification. Low-risk patients underwent surgery with (stage 2) or without (stage 1) short-term chemotherapy. Intermediate-risk patients underwent chemotherapy and surgery with or without local radiation therapy. High-risk patients underwent chemotherapy, surgery, radiation therapy, and high-dose chemotherapy/autologous stem cell rescue (HDCT/ASCR). RESULTS: While tumor relapse occurred in only 1 patient, 7 patients died of treatment-related toxicities. Causes of treatment-related death included infection during conventional chemotherapy in 5 patients and acute myocarditis during HDCT/ASCR in 2 patients. The overall 5-year survival (+/-standard error) and 5-year event-free survival (EFS) rates after diagnosis for all 41 patients were 82.8+/-5.9% and 80.0+/-6.3%, respectively, with a median follow-up of 58 (9-137) months. The 5-year EFS rates for low-risk, interme diate-risk, and high-risk patients were 100%, 68.4+/-10.8%, and 66.7+/-19.3%, respectively. CONCLUSION: Increased efforts to reduce infection-associated toxicity deaths during conventional chemotherapy are needed to further improve the survival of patients with neuroblastoma aged less than 1 year.

High-dose Chemotherapy and Autologous Stem Cell Rescue in Patients with High-risk Stage 3 Neuroblastoma: 10-Year Experience at a Single Center

High-dose chemotherapy and autologous stem cell rescue (HDCT/ASCR) was applied to improve the prognosis of patients with high-risk stage 3 neuroblastoma. From January 1997 to December 2006, 28 patients were newly diagnosed as stage 3 neuroblastoma. Nine of 11 patients with N-myc amplification and 5 of 17 patients without N-myc amplification (poor response in 2 patients, persistent residual tumor in 2 and relapse in 1) underwent single or tandem HDCT/ASCR. Patients without high-risk features received conventional treatment modalities only. While 8 of 9 patients underwent single HDCT/ASCR and the remaining one patient underwent tandem HDCT/ASCR during the early study period, all 5 patients underwent tandem HDCT/ASCR during the late period. Toxicities associated with HDCT/ASCR were tolerable and there was no treatment-related mortality. While the tumor relapsed in two of eight patients in single HDCT/ASCR group, all six patients in tandem HDCT/ASCR group remained relapse free. The 5-yr event-free survival (EFS) from diagnosis, in patients with N-myc amplification, was 71.6+/-14.0%. In addition, 12 of 14 patients who underwent HDCT/ASCR remained event free resulting in an 85.1+/-9.7% 5-yr EFS after the first HDCT/ASCR. The present study demonstrates that HDCT/ASCR may improve the survival of patients with high-risk stage 3 neuroblastoma.

ERRATUM: Outcome of patients with neuroblastoma aged less than 1 year at diagnosis / 소아과

No abstract available.

Determination of Needle Depth for Lumbar Puncture in Children Using Spine Magnetic Resonance Imaging

PURPOSE: This study was performed to find the applicable equations which determine the proper needle depth for lumbar puncture in Korean pediatric patients using spine magnetic resonance imaging(MRI). METHODS: The authors enrolled the patients who had spine MRI from August 2007 to June 2008 and were aged less than 20 years. Eighty eight patients whose height(Ht.) and weight(Wt.) were recorded within 10 days from spine MRI were recruited. The posterior dural depths and dural widths were measured on each L2-3, L3-4, and L4-5 levels of intervertebral space. By comparing the R squares, the most significant independent variables for posterior dural depth were selected, and by calculating malposition rate, the further insertion distance from posterior dural depth and the final puncture depth equation were determined. RESULTS: The proper puncture depths with the lowest malposition rate were as follows. L2-3 puncture depth (mm) = 126.5xWt./Ht. (kg/cm)+7.1 or 0.613xWt. (kg)+16.1 L3-4 puncture depth (mm) = 136.0xWt./Ht. (kg/cm)+7.6 or 0.656xWt. (kg)+17.3 L4-5 puncture depth (mm) = 138.3xWt./Ht. (kg/cm)+7.5 or 0.665xWt. (kg)+17.5 CONCLUSION: Lumbar puncture depth is best predicted using weight and height as independent variables. And the equations of each tap sites were different in constants. Using this formula, the rate of failure and complication in lumbar can be diminished, but it should be validated by further studies.

Medulloblastoma and Familial Adenomatous Polyposis in a 24-year-old Female Patient: A Case Report of Turcot Syndrome / 대한소아소화기영양학회지

Turcot syndrome is characterized by the concurrence of a primary neuroepithelial brain tumor and multiple colorectal polyposis. We report a case of a 24-year-old woman diagnosed with Turcot syndrome. At first, the patient was diagnosed as having a medulloblastoma after a tumorectomy of the 4th ventricle mass. The patient underwent radiotherapy and chemotherapy. After high-dose chemotherapy, neutropenic fever and severe mucositis developed. For an evaluation of the persistent hematochezia and diarrhea, a colonoscopy was performed. It revealed pseudomembranous colitis and multiple polyps in the entire colon. According to the family history, her father had undergone a total colectomy due to colon cancer and polyposis of the entire colon. Her brother also was found to have multiple polyps in the colon by a colonoscopy. The patient was diagnosed with Turcot syndrome.

5-12 Year Results of Femoral Revision Total Hip Arthroplasty using the Wagner Revision Stem / 대한정형외과학회잡지

PURPOSE: To analyze the results of a 5-12 year (mean, 7 years, 5 months) follow-up of femoral revision THA using the Wagner(R) stem. MATERIALS AND METHODS: Of 79 revision THA patients enrolled in the study between March 1991 and January 2000, there were 64 cases of aseptic loosening (69 hips, 44 males and 20 females) during a minimum 5-year follow-up. In addition, postoperative complications and clinical and radiographic results were evaluated. RESULTS: The Harris hip score improved from 48.6 to 91.2 points, postoperatively. There were 3 revisions due to failed stem fixation and aseptic loosening. The Kaplan-Meier survivorship analysis, with failure defined as a removal of the Wagner(R) stem, revealed a 97.1% survival at a 12-year follow-up. Besides the revisions, there were 66 hips that were hip-related symptom-free. However, there was claudication in 1 case. Radiographic findings included subsidence of the implant (5 cases, 7.5%, all less than 10 mm), calcar femorale atrophy (4 cases, 6.0%), stress shielding (4 cases, 6.0%), and heterotopic ossification (5 cases, 7.5%). Postoperative peroneal nerve palsy (2 cases) resolved completely within the following 6 months. CONCLUSION: We obtained a stable fixation and satisfactory results in the cases we studied using the Wagner(R) revision stem.

A Case of Basal Ganglia Germinoma Presenting Only with Cerebral Hemiatrophy Diagnosed by Using 11C-Methionine Positron Emission Tomography

We present a case of cerebral germinoma that occurred in the basal ganglia with progressive hemiparesis. A 10-year-old boy was referred to our hospital complaining of progressive right hemiparesis and decreased mental functions. Brain MRI showed left cerebral hemiatrophy and high signal intensity in left thalamus, basal ganglia, cerebral peduncle, and pons. However, no mass or enhancement was observed. 11C-Methionine positron emission tomography showed discernable hot uptake in the left basal ganglia and thalamus. Stereotactic biopsy, with a guide of 11C-Methionine positron emission tomography, was performed and the diagnosis of pure germ cell tumor was determined. 11C-Methionine positron emission tomography is useful for localization of a suspicious tumor in patients with cerebral hemiatrophy without overt mass or enhancing lesions in brain MRI.

Misplaced IUD / 대한산부인과학회잡지

OBJECTIVE: To study intrauterine or extrauterine misplacement of intrauterine devices in respect to their usage in diagnosis and therapy via retrospective analysis. METHODS: Data from 1993 to 2000 on a total of 32 patients from seven Catholic University branch hospitals who had been admitted to treat IUDs which had misplaced to intrauterine or extrauterine locations were analyzed for usage in a retrospective study. RESULTS: The data for intrauterine and extrauterine misplacement revealed no significant difference between from the statistical average in relation to age, parity and duration of insertion. In terms of removal method, all 15 patients with extrauterine misplacement underwent surgical extraction by open or laparascopic method under general anesthesia, but those patients with intrauterine misplacement had their device removed after cervical dilatation with a laminaria using local anesthesia. Concerning diagnosis, 81.2% of extrauterine misplacement were diagnosed using x-ray while 58% of intrauterine misplacement were diagnosed using vaginal US. The result of the Fisher's exact test showed a significant difference (p=0.043) in the rate of diagnosis for intrauterine and extrauterine misplacement of IUDs. Also, the results of multi-variable analysis performed for logistical regression analysis showed that intrauterine misplacement occurred 1.23 times more frequently than extrauterine misplacement. CONCLUSION: Further studies are required on a broader patient population, on more types of IUDs and with time variables taken into account. Despite more research, prevention of complications such as misplacement remains the most appealing situation, being influenced by such factors as technical skill of the physician inserting the IUD, appropriate duration of insertion and proper patient education.

Diallyl Disulfide from Garlic Induces Apoptosis through a Caspase Dependent Pathway in Human Breast Cancer Cell Line, MCF-7

PURPOSE: Diallyl disulfide (DADS), an organosulfur compound in garlic, has been reported to be effective in inhibiting the growth of several human tumor cell lines. The aim of this study was to determine whether DADS induced growth inhibition in MCF-7 breast cancer cell lines and to understand the molecular mechanism by which DADS acts. METHODS: MCF-7 cell lines were incubated with various concentrations of DADS for various time intervals and the cytotoxicity was determined by MTT assay. We examined the changes of intracellular proteins related to apoptosis, such as bcl-2, bax and PARP in cells treated with DADS. To study the expression level of bcl-2 and bax, which serve as modulators of apoptosis, we performed RT-PCR and western blot analysis. RESULTS: MCF-7 cells treated with DADS led to the suppression of viability and proliferation in both a time and concentration dependent manner. Microscopic observation revealed typical features of apoptosis in the DADS-treated cells, further verified in nuclear DAPI staining. Flow cytometry analysis with FITC-annexinV and propidium iodide (PI) demonstrated that the apoptotic cell population with AnnexinV /PI increased dramatically from ~0.8% to ~75% after 24h exposure to 500nM DADS in MCF-7 cells. Cellcycle analysis demonstrated that the number of apoptotic cells increased with the increasing time of the DADS treatment. Additionally, thermore, we investigated the effects of DADS on apoptosis related gene expression in MCF-7 cells. PARP cleavage was markedly increased in the DADS treated cells with time. This result indicated that DADS induced the caspase-dependent apoptotic pathway. We also found down-regulation of bcl-2, however no significant change of Bax expression was observed after DADS treatment. CONCLUSION: Taken together, these results indicate that DADS induces apoptosis by activating a caspase pathway involving the activation of Bcl-2 but not of Bax. Our findings suggest chemotherapeutic potentials of DADS in human breast cancer.

The Role of a Needle Localization Breast Biopsy for the Diagnosis of Nonpalpable Breast Cancer

PURPOSES: Efforts directed at early detection of breast cancer have resulted in an increased incidence of nonpalpable mammographic lesions that warrant excisional biopsy. The most common localization method is the needle-localization biopsy. The aims of this study were to evaluate the effectiveness and the usefulness of a needle localization biopsy in the diagnostic work-up of nonpalpable mammographic abnormalities that are suspected of being cancerous, and to determine the frequency of malignancy detection as well as the incidence of noninvasive carcinoma. METHODS: One hundred seventy eight needle-localization biopsies of nonpalpable breast lesions were performed at Samsung Medical Center from January 1995 to December 1999. A retrospective review was undertaken to assess histopathologic findings based on mammographic abnormalities, as well as pathologic staging and the treatment of breast cancer detected by needle-localization biopsy. RESULTS: Needle-localization biopsies led to the diagnosis of malignancy in 29.8% of the biopsies. Of the malignancies detected, 81.2% were in-situ carcinomas. Invasive carcinomas were less than 2 cm in size (T1) in 70% of the cases and were 2 to 5 cm (T2) in 30% of the cases; there were no evidence of lymph node metastases in 70% of the cases. Overall, 90.6% of the patients were found to be within pathologic stage 0 or stage 1. Microcalcifications only were more related with DCIS than mass density with or without microcalcifications findings. Fine linear, branching, granular, pleomorphic microcalcifications findings and ill defined, irregular, spiculated mass densities were likely to result in higher rate of malignancy. CONCLUSION: It is concluded that needle- localization breast biopsy of nonpalpable suspicious mammographic lesions is an important and effective method for the detection of early breast cancer and noninvasive carcinomas. Appropriate selection ofcases for needle localization biopsy should be made to avoid unnecessary breast biopsies and to increase the percentage of early breast cancer.

A Case of Delayed Hemolytic Transfusion Reaction Due to Anti-E(rh") / 대한내과학회지

Delayed hemolytic transfusion reaction occurs when the transfused red cells possess an antigen to which the patient has been previously sensitized. Red cells are destructed by an antibody not detected by compatibility testiing some time after the transfusion. Anti-E(rh") is the Rh antibody that found second most commonly after anti-D in Korea, but very seldom causes hemolytic disease. Recently we experienced a case of delayed hemolytic transfusion reaction due to anti-E(rh") in a 37-year-old woman. Three days after the transfusion, she showed a fall in hematocrit and elevation of indirect bilirubin and LDH accompanied by a positive indirect antiglobulin test. Anti-E(rh") was identified in the patient's serum by antibody screening and identification test.

A case of delayed hemolytic transfusion reaction due to anti-C(rh') / 대한내과학회지

No abstract available.

A Case Report of Intestinal Anisakiasis / 대한소화기내시경학회지

Anisakiasis refers to the infestation of humans by species of marine nematode larvae belonging to the subfamily Anisakiae. An acute abdominal symptom may occur after ingestion of raw marine fish containing nematode larvae of the genus Anisakis. Migration of the parasite into the wall of gtomach, small intestine or, less commomly, the colon elicits a striking eosinophilic granulomatous tissue response. A 39 year old man was visited St. Vincent Hospital because of abdominal distension and tenderness. The plain abdominal X-ray showed ileus pattern suggesting intestinal obstruction. Hence we presented a case of intestinal Anisakiasis combined with intstinal obstruction.