Clinical Significance of ReceptorInteracting Protein 3 and Parkin, Essential Molecules for Necroptosis, in Breast Cancer / 한국유방암학회지

Purpose@#Receptor-interacting protein 3 (RIP3) is the main initiator of necroptosis. Parkin prevents the formation of the RIP1–RIP3 complex by promoting polyubiquitination of RIP3. However, the mechanism by which necroptosis affects the clinical features of breast cancer and prognosis is not known. Here, we aimed to study the effect of necroptosis on the clinical features and prognosis of breast cancer by assessing the expression of RIP3 and Parkin. @*Methods@#Tissue microarrays (TMAs) were constructed from 257 cases of breast cancer.Immunohistochemistry was performed on 4-μm tissue sections from each TMA block. The χ2 test, Kaplan-Meier survival analysis with log-rank test, and Cox regression proportional hazard model were used for statistical analysis. @*Results@#Low RIP3 expression resulted in a large tumor size and high nuclear grade. Low RIP3 expression was correlated with human epidermal growth factor receptor 2 positivity, short overall survival (OS), and short disease-free survival (DFS). The triple negative breast cancer group with low RIP3 expression and lymph node (LN) positive group with low RIP3 expression had the shortest OS. High Parkin expression was associated with high histological grade, estrogen and/or progesterone receptor negativity, and lymphatic emboli, but was not correlated with OS and DFS. OS was correlated with LN metastasis and RIP3 loss and DFS with large tumor size, LN metastasis, and RIP3 loss. @*Conclusion@#Low RIP3 and high Parkin expression are associated with aggressive clinical features in breast cancer. RIP3, a molecular marker of necroptosis, is an independent factor associated with survival in breast cancer. Further in-depth studies are needed to investigate the role of necroptosis in breast cancer development, metastasis, and treatment in the future.

Clinical Significance of ReceptorInteracting Protein 3 and Parkin, Essential Molecules for Necroptosis, in Breast Cancer / 한국유방암학회지

Purpose@#Receptor-interacting protein 3 (RIP3) is the main initiator of necroptosis. Parkin prevents the formation of the RIP1–RIP3 complex by promoting polyubiquitination of RIP3. However, the mechanism by which necroptosis affects the clinical features of breast cancer and prognosis is not known. Here, we aimed to study the effect of necroptosis on the clinical features and prognosis of breast cancer by assessing the expression of RIP3 and Parkin. @*Methods@#Tissue microarrays (TMAs) were constructed from 257 cases of breast cancer.Immunohistochemistry was performed on 4-μm tissue sections from each TMA block. The χ2 test, Kaplan-Meier survival analysis with log-rank test, and Cox regression proportional hazard model were used for statistical analysis. @*Results@#Low RIP3 expression resulted in a large tumor size and high nuclear grade. Low RIP3 expression was correlated with human epidermal growth factor receptor 2 positivity, short overall survival (OS), and short disease-free survival (DFS). The triple negative breast cancer group with low RIP3 expression and lymph node (LN) positive group with low RIP3 expression had the shortest OS. High Parkin expression was associated with high histological grade, estrogen and/or progesterone receptor negativity, and lymphatic emboli, but was not correlated with OS and DFS. OS was correlated with LN metastasis and RIP3 loss and DFS with large tumor size, LN metastasis, and RIP3 loss. @*Conclusion@#Low RIP3 and high Parkin expression are associated with aggressive clinical features in breast cancer. RIP3, a molecular marker of necroptosis, is an independent factor associated with survival in breast cancer. Further in-depth studies are needed to investigate the role of necroptosis in breast cancer development, metastasis, and treatment in the future.

Decrease of peripheral blood lymphocyte count predicts response to neoadjuvant chemotherapy in breast cancer patients

Purpose@#Pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) holds promise as a significant prognostic factor to predict NAC response in breast cancer patients. The absolute peripheral blood lymphocyte (PBL) count has been suggested as an independent predictor of response to NAC. The current study evaluated the relationship between pCR and the change of PBL count in patients treated with NAC. @*Methods@#A total of 61 patients with histologically confirmed breast cancer treated with NAC followed by mastectomy between January 2010 and December 2019 were analyzed retrospectively. Correlational analyses confirmed a statistically significant relationship between PBL count and pCR. Following conformational correlational analyses, patients were divided into two groups according to cutoff values using the receiver operating characteristics curve and a logistic regression was conducted to determine the optimal conditions for achieving pCR. @*Results@#A total of 14 patients (22.9%) achieved pCR. Most PBL counts decreased after NAC relevant to pCR. Logistic regression analysis revealed that a small decrease of PBL was associated with pCR (P=0.028). The cutoff value of PBL decrease was 755×106/L, which was used to divide patients into high and low reduction groups. The pCR rate was 11.43% and 38.46% for the high and low reduction group, respectively (area under the curve, 0.707; 95% confidence interval, 0.556–0.858; P=0.020). The high reduction group was found to have more difficulty achieving pCR. @*Conclusion@#The decrease of PBL is significantly associated with pCR. Our data support that the decrease of PBL after NAC may be useful factors in predicting the response to NAC in breast cancer patients.

Decrease of peripheral blood lymphocyte count predicts response to neoadjuvant chemotherapy in breast cancer patients

Purpose@#Pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) holds promise as a significant prognostic factor to predict NAC response in breast cancer patients. The absolute peripheral blood lymphocyte (PBL) count has been suggested as an independent predictor of response to NAC. The current study evaluated the relationship between pCR and the change of PBL count in patients treated with NAC. @*Methods@#A total of 61 patients with histologically confirmed breast cancer treated with NAC followed by mastectomy between January 2010 and December 2019 were analyzed retrospectively. Correlational analyses confirmed a statistically significant relationship between PBL count and pCR. Following conformational correlational analyses, patients were divided into two groups according to cutoff values using the receiver operating characteristics curve and a logistic regression was conducted to determine the optimal conditions for achieving pCR. @*Results@#A total of 14 patients (22.9%) achieved pCR. Most PBL counts decreased after NAC relevant to pCR. Logistic regression analysis revealed that a small decrease of PBL was associated with pCR (P=0.028). The cutoff value of PBL decrease was 755×106/L, which was used to divide patients into high and low reduction groups. The pCR rate was 11.43% and 38.46% for the high and low reduction group, respectively (area under the curve, 0.707; 95% confidence interval, 0.556–0.858; P=0.020). The high reduction group was found to have more difficulty achieving pCR. @*Conclusion@#The decrease of PBL is significantly associated with pCR. Our data support that the decrease of PBL after NAC may be useful factors in predicting the response to NAC in breast cancer patients.

Basic Facts of Breast Cancer in Korea in 2014: The 10-Year Overall Survival Progress / 한국유방암학회지

We, the Korean Breast Cancer Society (KBCS), present the facts and the trends of breast cancer in Korea in 2014. Data on the total number of newly diagnosed patients was obtained from the Korea Central Cancer Registry database, other data were collected from the KBCS online registry database, and the overall survival data of patients were updated from Statistics Korea. A total of 21,484 female patients were newly diagnosed with breast cancer in 2014. The crude incidence rate and the age-standardized incidence rate (ASR) of breast cancer in female patients, including carcinoma in situ, were 83.4 cases and 63.9 cases per 100,000 women, respectively. The ASR showed an annual increase of 6.1% from 1999 to 2014; however, although the increase of the ASR had slowed since 2008, the incidence rate itself continuously increased. The proportion of early breast cancer increased consistently, and the pathological features changed accordingly. While breast-conserving surgery was mainly performed, the proportion of total mastectomy was slightly increased. The total number of breast reconstruction surgeries increased rapidly. The 5-year and 10-year overall survival rates for all stages of breast cancer patients were 91.2% and 84.8%, respectively. The overall survival rate of Korean patients with breast cancer was extremely high, compared with other developed countries. Thus, we consider that the clinical characteristics of breast cancer have changed over the past decade. A nationwide registry data will contribute to a better understanding of the characteristics of breast cancer in Korea.

The Basic Facts of Korean Breast Cancer in 2013: Results of a Nationwide Survey and Breast Cancer Registry Database / 한국유방암학회지

The Korean Breast Cancer Society (KBCS) has reported a nationwide breast cancer data since 1996. We present a comprehensive report on the facts and trends of breast cancer in Korea in 2013. Data on the newly diagnosed patients in the year 2013 were collected from 99 hospitals by using nationwide questionnaire survey. Clinical characteristics such as stage of cancer, histologic types, biological markers, and surgical management were obtained from the online registry database. A total of 19,316 patients were newly diagnosed with breast cancer in 2013. The crude incidence rate of female breast cancer including carcinoma in situ was 76.2 cases per 100,000 women. The median age at diagnosis was 50 years, and the proportions of postmenopausal women with breast cancer accounted for more than half of total patients. The proportion of early breast cancer increased consistently, and the pathologic features have changed accordingly. Breast-conserving surgery was performed in more cases than total mastectomy in the year. The total number of breast reconstruction surgeries markedly increased approaching 3-fold in last 11 years. According to annual percentile change of invasive cancer incidence, the incidence increased rapidly until 2010. And thereafter the increase of it became steadier. For ductal carcinoma in situ, the incidence consistently increased during the same period without any joinpoint. Analysis of nationwide registry data will contribute to defining of the trends and characteristics of breast cancer in Korea.

The Basic Facts of Korean Breast Cancer in 2012: Results from a Nationwide Survey and Breast Cancer Registry Database / 한국유방암학회지

The Korean Breast Cancer Society has constructed a nationwide breast cancer database through utilization of an online registration program. We have reported the basic facts about breast cancer in Korea in 2012, and analyzed the changing patterns in the clinical characteristics and management of breast cancer in Korea over the last 10 years. Data on patients newly diagnosed with breast cancer were collected for the year 2012 from 97 hospitals and clinics nationwide using a questionnaire survey, and from the online registry database. A total of 17,792 patients were newly diagnosed with breast cancer in 2012. The crude incidence rate of female breast cancer, including invasive cancer and in situ cancer, was 70.7 cases per 100,000 women. The median age at diagnosis was 51 years, and the proportion of postmenopausal women was higher than that of premenopausal women among those diagnosed with breast cancer. The proportion of cases of early breast cancer increased continuously, and breast-conserving surgery was performed in more cases than total mastectomy in that same year. The total number of breast reconstruction surgeries increased approximately 3-fold over last 10 years. The 5-year overall survival rate for all stages of breast cancer patients was extremely high. The clinical characteristics of breast cancer have changed in ways that resulted in high overall survival over the past 10 years in Korea, and the surgical management of the disease has changed accordingly. Analysis of nationwide registry data will contribute to a better understanding of the characteristics of breast cancer in Korea.

Erratum: The Basic Facts of Korean Breast Cancer in 2011: Results of a Nationwide Survey and Breast Cancer Registry Database / 한국유방암학회지

The funding source should be added.

BRAF mutation may predict higher necessity of postoperative radioactive iodine ablation in papillary thyroid cancer

PURPOSE: The primary aim of the present study was to analyze the association between high-risk clinicopathologic characteristics and the BRAFV600E mutation. METHODS: From March 2010 to September 2012, we performed analysis of the BRAF mutation (assessing V600E point mutation of BRAF gene, exon 15, on chromosome 7q34 by real-time polymerase chain reaction kit) from 499 papillary thyroid carcinoma (PTC) patients who underwent thyroidectomy. We analyzed the relation between the mutation and known clinicopathologic risk factors of PTC. RESULTS: BRAF mutations were found in 353 of 499 patients (70.7%). On univariate analysis, BRAF mutations were more frequently detected in patients with central lymph node metastasis (78.5% vs. 66.7%, P = 0.007) and classic PTC type (71.3% vs. 16.7%, P = 0.011). Patients with one or more aggressive pathologic feature such as lymph node metastasis, multifocality, and extrathyroidal extension showed higher BRAF mutation rate (73.5% vs. 62.3%, P = 0.022). BRAF mutation group showed more aggressive pathologic features, which is considered as higher necessity of radioactive iodine ablation (relative risk, 1.617; P = 0.035). CONCLUSION: This study found that BRAF mutation is associated with classic PTC and central lymph node metastasis and higher necessity of radioactive iodine ablation.

The Basic Facts of Korean Breast Cancer in 2011: Results of a Nationwide Survey and Breast Cancer Registry Database / 한국유방암학회지

Breast cancer is the second most frequent malignancy in Korean women, with a continuously increasing incidence. The Korean Breast Cancer Society has constructed a nationwide breast cancer database through an online registration program. The aim of the present study was to report the fundamental facts on Korean breast cancer in 2011, and to analyze the changing patterns in clinical characteristics and breast cancer management in Korea over the last 10 years. Data on newly diagnosed breast cancer patients, including the total number of cases, age, stage, and type of surgery, for the year 2011 were collected from 84 hospitals and clinics nationwide using a questionnaire survey. Additional data relating to the changing patterns of breast cancer in Korea were collected from the online breast cancer registry database and analyzed. According to nationwide survey data, a total of 16,967 patients were newly diagnosed with breast cancer in 2011. The crude incidence of female breast cancer, including invasive cancer and in situ cancer, was 67 cases per 100,000 women. Analysis of the survey and registry data gave equivalent results in terms of age distribution, stage, and type of surgery. The median age at diagnosis was 50 years, and the proportion of postmenopausal women (51.3%) was higher than that of premenopausal women (48.7%) with breast cancer. The incidence of stage 0 and stage I breast cancer increased continuously over the last 10 years (56.3% in 2011), and breast conserving surgery (65.7%) was performed more frequently than total mastectomy (33.8%). The total number of breast reconstruction surgeries increased approximately 8-fold. We conclude that the clinical characteristics of breast cancer have changed over the past 10 years in Korea, and surgical management has changed accordingly. Analysis of nationwide registry data will contribute to a better understanding of the characteristics of breast cancer in Korea.

Thrombolytic Therapy Using Urokinase for Management of Central Venous Catheter Thrombosis

PURPOSE: The management of central venous catheters (CVCs) and catheter thrombosis vary among centers, and the efficacy of the methods of management of catheter thrombosis in CVCs is rarely reported. We investigated the efficacy of bedside thrombolysis with urokinase for the management of catheter thrombosis. MATERIALS AND METHODS: We retrospectively reviewed data from patients who had undergone CVC insertion by a single surgeon in a single center between April 2012 and June 2014. We used a protocol for the management of CVCs and when catheter thrombosis was confirmed, 5,000 U urokinase was infused into the catheter. RESULTS: A total of 137 CVCs were inserted in 126 patients. The most common catheter-related complication was thrombosis (12, 8.8%) followed by infection (8, 5.8%). Nine of the 12 patients (75%) with catheter thrombosis were recanalized successfully with urokinase. The rate of CVC recanalization was higher in the peripherally inserted central catheter (PICC) group (87.5%) than the chemoport group (50%). Reintervention for catheter-related thrombosis was needed in only 2.2% of patients when thrombolytic therapy using urokinase was applied. Age <60 years (P=0.035), PICC group (P=0.037) and location of the catheter tip above the superior vena cava (P=0.044) were confirmed as independent risk factors for catheter thrombosis. CONCLUSION: Thrombolysis therapy using urokinase could successfully manage CVC thrombosis. Reintervention was rarely needed when a protocol using urokinase was applied for the management of CVC thromboses.

Right Paraesophageal Lymph Node Metastasis in Papillary Thyroid Cancer and Prophylactic Dissection: A Retrospective Study / 대한내분비외과학회지

PURPOSE: The purpose of this study is to determine the status of nodal disease, including the right paraesophageal node, in papillary thyroid carcinoma (PTC). METHODS: A total of 116 patients with PTC underwent total thyroidectomy and prophylactic central node dissection, including right paraesophageal lymph nodes (RPE LNs). Metastases to RPELNs were analyzed by site and clinicopathologic variables. Recurrence rate and post-operative complications were also evaluated by comparing the right paraesophageal lymph node dissection (RPE LND) with the non-RPE LND group. RESULTS: Central node metastases were detected in 57 (49.1%) patients; paratracheal and pre-tracheal lymph node metastases, total RPE LN metastases, and metastases only in RPE LN occurred in 50 (43.1%), 18 (15.5%), and 5 (4.3%) patients, respectively. Age, tumor size, tumor longitudinal location, extrathyroidal extension, and multicentricity were insignificant in RPE LN metastasis (P>.05). Although there was no significant statistical difference, tumors with lymphatic invasion and larger tumors (>1 cm) had more frequent RPE LN metastases. RPE LN metastases were frequent in deeply located tumors instead of superficially located tumors (P=0.015). Compared with the non-RPE LND group, the incidence of post-operative complications (transient hypocalcemia and vocal cord palsy) was not significantly different and there was no recurrence in both groups during the follow up period. CONCLUSION: The metastatic rate of the right paraesophageal lymph nodes was 15.5%; 83.3% of these were macrometastatic. Prophylactic RPE dissection compared with the non-RPE LND group, however, did not show a survival difference for 5 years.

Cancer Subtypes of Breast Carcinoma with Micropapillary and Mucinous Component Based on Immunohistochemical Profile

BACKGROUND: Micropapillary carcinoma (MPC) is known to have a worse prognosis than the other subtypes of breast cancer. Occasionally, MPC is observed in association with invasive ductal carcinoma not otherwise specified (IDC NOS), as well as mucinous carcinoma. METHODS: We examined the immunohistochemical expression of an estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) in 127 cases of surgically resected MPC or IDC NOS with MPC. Further, we classified these cases based on their immunohistochemical profile. RESULTS: Among the IDC NOS with MPC cases, 47 were luminal A (62.7%), 10 were luminal B (13.3%), and 9 were HER2 (12.0%). The MPC cases included 4 luminal A (50.0%), 2 luminal B (25.0%) and 1 HER2 (12.5%) subtypes. Of the mucinous carcinomas with MPC, 4 were grouped as luminal A (57.1%), 1 as luminal B (14.3%), and 2 as HER2 (28.6%) subtypes. However, among the mucinous carcinomas, 33 were categorized as luminal A (89.2%), 3 as luminal B (8.1%), and 1 as HER2 (2.7%) subtype, indicating a low incidence of HER2 subtype as compared to the other subtypes. CONCLUSIONS: The luminal B and HER2 subtypes were prevalent in carcinomas with MPC. This result explains the poor prognosis of breast carcinomas with an MPC pattern.

Overexpression of MMP-9 and HIF-1alpha in Breast Cancer Cells under Hypoxic Conditions / 한국유방암학회지

PURPOSE: Hypoxia, which is a loss of oxygen in tissues, is a common condition in solid tumors due to the tumor outgrowing existing vasculature. Under hypoxic conditions, hypoxia-inducible factor (HIF)-1alpha rapidly accumulates and transactivates hundreds of genes, such as matrix metalloproteinases (MMPs). MMPs contribute to invasion and metastasis of tumor cells by degrading the surrounding basement membrane and extracellular matrix barriers, which enables the easy migration and spread of cancer cells. We examined whether hypoxia increases tumor cell invasion, and whether increased invasiveness was due to HIF-1alpha and MMP-9 expression. METHODS: Transwell invasion assays were performed to demonstrate whether hypoxia enhance tumor invasion by use of MDA-MB-231 breast cancer cells. An immunofluorescence assay was used to demonstrate expression of HIF-1alpha and MMP-9 under hypoxic conditions. Luciferase and ChiP assays were performed to demonstrate that MMP-9 promoter activity was regulated by HIF-1alpha. RESULTS: HIF-1alpha was stabilized under hypoxic conditions and stimulated MMP-9 expression, which affected the tumor invasiveness of breast cancer cells. HIF-1alpha transactivated the MMP-9 promoter by forming a transcriptional unit with p300, thus increasing expression of MMP-9 transcripts. Zymography indicated that MMP-9 had more gelatinase activity under hypoxic conditions than normoxic conditions. Furthermore, the small GTPase Ras was also activated in response to hypoxia, which then aids stabilization of HIF-1alpha, and in turn upregulates MMP-9 expression. We also demonstrate that MMP-9 is upregulated concurrently with HIF-1alpha in tumor tissues from patients with breast cancer. CONCLUSION: These results suggest that HIF-1alpha promotes cell invasion through a MMP-9-dependent mechanism and that future antitumor agents could be used to target HIF-1alpha and MMP-9.

A Case of Primary Mucoepidermoid Carcinoma Arising from the Common Bile Duct / 대한소화기학회지

Mucoepidermoid carcinoma of the bile duct is an extremely rare tumor. Seventeen cases originating from intrahepatic bile duct and 2 cases from common hepatic duct have been reported in the English literature. Mucoepidermoid carcinoma arising from the common bile duct has not been previously reported. A 68 year-old man was admitted due to obstructive jaundice. Computed tomography showed a malignant tumor of the common bile duct located in the intrapancreatic segment. Filling defects of the distal common bile duct was seen on endoscopic retrograde cholangiogram. Under the impression of bile duct cancer, pylorus-preserving pancreatoduodenectomy was performed. Histologic diagnosis of the resected specimen was mucoepidermoid carcinoma of the common bile duct. After surgery, the patient received concurrent chemoradiotherapy, and planned to receive additional chemotherapy. We herein report on a first case of primary mucoepidermoid carcinoma of the common bile duct, and review the literature.

Clinical Review of Pneumatosis Intestinalis

PURPOSE: Pneumatosis intestinalis (PI) is increasingly being detected in recent years with the more frequent use of computerized tomography (CT). The present study was performed to evaluate the clinico-radiologic characteristic presentation of PI and to determine the prognostic factors for mortality. METHODS: Fifteen patients who were diagnosed with PI on CT between June 2000 and May 2010 were retrospectively reviewed. Age, sex, location of PI, presence of portal vein gas, time to diagnosis, American Society of Anesthesiologists (ASA) classification, Acute Physiology And Chronic Health Evaluation II (APACHE II), acidosis, shock, and other associated findings were analyzed for their association with outcome. RESULTS: Fifteen patients (7 males and 8 females, average age, 60.3 years) were diagnosed with PI. Mortality rate was 47% (7 patients). The mortality rate in patients with septic shock, APACHE II score (18), acidosis (pH<7.36) were all 100%, 87%, 100%, respectively (P<0.05). Age, sex, location of PI, portal vein gas, time to diagnosis, ASA classification, associated findings did not show statistical difference. CONCLUSION: Shock, APACHE II score (18) and acidosis were associated with high mortality in patients with PI. So, more intensive management and interest are recommended in patients with shock, APACHE II score (18), and acidosis due to PI.

Expression of E-cadherin in Chromophobe Renal Cell Carcinoma and Its Prognostic Implication

BACKGROUND: Chromophobe renal cell carcinoma is a category of renal cell carcinoma composed of histologically characteristic tumor cells. E-cadherin is an intercellular adhesion protein that has been correlated with tumor aggressiveness in many carcinomas, including clear cell renal cell carcinoma. However, the significance of an E-cadherin expression in chromophobe renal cell carcinoma is not known. METHODS: We evaluated the E-cadherin expression status of 65 chromophobe renal cell carcinomas by performing immunohistochemical staining with the tissue microarray method. The percentage of positively stained tumor cells was evaluated and this was then classified into two categories: a low expression where 0 to 25% of the cells are positive, and a high expression where more than 25% of the cells are positive. RESULTS: Among 65 cases, 11 cases (17%) showed a low expression, and 54 cases (83.0%) showed a high expression. The tumors with low expression were more likely to have a higher stage but this was not significant (p=0.056). On the survival analysis, a low E-cadherin expression was significantly associated with poor cancer-specific survival (p=0.005) and progression-free survival (p=0.003). CONCLUSIONS: The E-cadherin expression is a good prognostic marker for survival in patients with chromophobe renal cell carcinoma.

Early Results of Endovascular Aneurysm Repair in Abdominal Aortic Aneurysms

PURPOSE: We report early experiences on endovascular abdominal aortic aneurysm repair (EVAR). METHOD: We reviewed the results of 15 patients underwent EVAR between 2003 and 2007 in the Kyung Hee University Medical Center, retrospectively. RESULT: Mean age of patients was 71.2 years (range, 51~85 years). 14 patients (93.3%) had comorbidities. All of AAAs were infrarenal types. The mean size of AAA was 58.5 mm (38~91 mm), and the mean length, diameter, and angle of neck was 26.4 mm, 19.9 mm, and 37.7degrees, respectively. Ten patients were accompanied with iliac aneurysm. 14 were bifurcated grafts and 1 was straight tubular graft. Mean procedure time was 100.6 minutes. Mean length of hospitalization was 6.5 days (2~10 days). There was no need of transfusion or use of an intensive care unit. Fever of unknown origin occurred in 7 cases but resolved spontaneously. Device deployment was successful in 100% (primary 9 cases, assisted-primary 6 cases). There were seven endoleaks during interventions. One patient with secondary type II endoleak and suprarenal enlargement of AAA sac died from aortoenteric fistula. In one patient with perigraft abscess after EVAR, surgical drainage was performed. Decrease of AAA diameter > or =5 mm in two patients, newly developed suprarenal aortic aneurysm in one patient were detected on CT scan during mean follow-up of 11.4 months (2-29 months) and remained unchanged in other twelve cases. CONCLUSION: These early results suggest that EVAR offers considerable benefits for appropriate patients, but is thought to need more experiences and long-term outcomes.

Secondary Hyperparathyroidism Associated with End Stage Renal Disease (ESRD): A Case Report / 대한내분비외과학회지

In contrast to the intrinsic feedback inhibition defect of primary hyperparathyroidism (HPT), secondary HPT is caused by chronic extrinsic overstimulation of otherwise normal parathyroid glands. This condition is very common in patients with end stage renal disease (ESRD), and secondary HPT develops as a complex sequence of interactions. As the glomerular filtration rate falls, the renal production of 1,23- dihydroxy-vitamin D3 decreases. Moreover, this causes a reduction in intestinal calcium absorption, which creates the parathyroid hormone (PTH) secretion. This secretion increases serum calcium levels by mobilizing calcium from bones. Lastly, the PTH secretion is further stimulated by hyperphosphatemia (via a phosphorous-specific receptor) and a decrease in ionized calcium (from reduced solubility caused by hyperphosphatemia). Intact PTH levels of 500 to 1,500 pg/ml are common (normal: 10~65 pg/ml) in ESRD patients. Long-standing hyperphosphatemia contributes to the alteration of the parathyroid cells, which affect feedback inhibition, due to an increase in ionized calcium. Secondary HPT is mainly controlled by the restriction of phosphate, the inhibition of phosphorous absorption and the supplementation of calcitriol. Secondary HPT, which is unresponsive to medical treatment, it is well known that a total parathyroidectomy and autotransplantation has good results. This report documents our experience with secondary HPT, treated with a total parathyroidectomy and autotransplantation.

Survey of experience rate of allergic disease of elementary school children in a large city

BACKGROUND: Recently, the apartment complex is rapidly increasing as a new type of housing in a large city. So the purpose of the this survey is to research the experience rate of young children's allergic disease in an area of the apartment complex of a large city and to help the family medical doctor to diagnose and treat the young patients. METHODS: The experience rate of atopic dermatitis, bronchial asthma, allergic rhinitis, allergic conjunctivitis, food allergy was surveyed on June 1999 at an elementary school in a large apartment complex in Kwang ju. The survey group were 832 students attending elementary school from the second to sixth grade. Also this survey was used to elicit information about the relationship between allergic disease and factors such as age, sex, birth history, family history, and home environment. For analysis of our finding, we have been used chi square test. RESULTS: The survey shows that the experience rate of allergic disease is 40.4%. The experience rate of allergic disease was not related with sex, but the more ages the less experience rate. Allergic disease was not related with birth weight, gestational age, feeding method, use of carpet, breeding of pet, smoker in home, and the previous housing type. But experience rate of allergic disease was increased with positive family history. CONCLUSION: General facts of allergic disease in elementary school children had no differentiation between large city and the other region. The experience rate of allergic disease is 40.4%.