BACKGROUND/AIMS: Since patients with human papillomavirus (HPV)-associated head and neck squamous cell carcinoma (HNSCC) have favorable outcomes after treatment, treatment de-escalation for these patients is being actively investigated. However, not all HPV-positive HNSCCs are curable, and some patients have a poor prognosis. The purpose of this study was to identify poor prognostic factors in patients with HPV-positive HNSCC. METHODS: Patients who received a diagnosis of HNSCC and tested positive for HPV from 2000 to 2015 at a single hospital site (n = 152) were included in this retrospective analysis. HPV typing was conducted using the HPV DNA chip assay or liquid bead microarray system. Expression of p16 in the tumors was assessed by immunohistochemistry. To determine candidate factors associated with overall survival (OS), univariate and multivariable Cox regression analyses were performed. RESULTS: A total of 152 patients with HPV-positive HNSCC were included in this study; 82.2% were male, 43.4% were current or former smokers, and 84.2% had oropharyngeal cancer. By univariate analysis, old age, performance status ≥ 1, non-oropharyngeal location, advanced T classification (T3–4), and HPV genotype 18 were significantly associated with poor OS. By multivariable analysis, performance status ≥ 1 and non-oropharyngeal location were independently associated with shorter OS (hazard ratio [HR], 4.36, p = 0.015; HR, 11.83, p = 0.002, respectively). Furthermore, HPV genotype 18 positivity was also an independent poor prognostic factor of OS (HR, 10.87, p < 0.001). CONCLUSIONS Non-oropharyngeal cancer, poor performance status, and HPV genotype 18 were independent poor prognostic factors in patients with HPV-positive HNSCC. Patients with these risk factors might not be candidates for de-escalation treatment.

PURPOSE: To identify the correlation between nasal eosinophilia and aeroallergen sensitization in children and adolescents. METHODS: This is a retrospective study of patients below 18 years of age who had a history of rhinitis that lasted more than 2 weeks or had been repeated more than once a year, received nasal eosinophil examinations, and had serum specific IgE to aeroallergens measured at an Allergy Clinic in a single tertiary teaching hospital in Seoul, Korea. The percentage of nasal eosinophils was calculated by the number of eosinophils per total leukocytes in a high-power field of 1,000×. Data was analyzed to determine the association between nasal eosinophilia and 18 aeroallergens. RESULTS: Of the 245 patients included, 156 (63.7%) were male and the mean age (±standard deviation) was 7.9 years (±3.8). In total, 175 patients (71.4%) were sensitized to at least 1 of the 18 aeroallergens tested, and sensitization to house dust mite was most common. In addition, 118 (48.2%) and 69 patients (28.2%) had nasal eosinophilia of at least 1% and 5%, respectively. There were no significant correlations between serum total IgE or age and the percentage of nasal eosinophils. However, the percentage of nasal eosinophils in the group sensitized to any aeroallergens was significantly increased compared to the nonsensitized group (P=0.002). The percentage of nasal eosinophils was significantly higher in patients who were sensitized to Birch-Alder Mix, oak white, Bermuda grass, orchard grass, timothy grass, sweet vernal grass, rye, mugwort, short ragweed, Alternaria alternata, cats, dogs or Dermatophagoides farinae compared to those nonsensitized. CONCLUSION: Nasal eosinophilia was significantly associated with sensitization to aeroallergens.
Adolescent* ; Alternaria ; Ambrosia ; Animals ; Artemisia ; Cats ; Child* ; Cynodon ; Dactylis ; Dermatophagoides farinae ; Dogs ; Eosinophilia* ; Eosinophils ; Hospitals, Teaching ; Humans ; Hypersensitivity ; Immunoglobulin E ; Korea ; Leukocytes ; Lolium ; Male ; Phleum ; Pyroglyphidae ; Retrospective Studies ; Rhinitis* ; Seoul

PURPOSE: This study aimed to evaluate the diagnostic value of radiologic findings in children with suspected foreign body aspiration. METHODS: A retrospective medical chart review was done on 32 children with suspected foreign bodies in terms of age, sex, symptoms, signs, bronchographic findings, and type and location of foreign bodies. The diagnostic value of radiography was analyzed: 29 with chest anteroposterior (AP) or posteroanterior (PA) view, 23 with chest lateral decubitus view, 27 with chest computed tomography (CT), 29 with chest AP, PA or chest lateral decubitus view, and 25 with bronchoscopy. RESULTS: As a measure for detecting foreign body aspiration, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of radiologic findings were: chest AP or PA view, 50%, 100%, 100%, 29.4%, and 58.6%, respectively; chest lateral decubitus view, 57.9%, 50.0%, 84.6%, 20.0%, and 56.5%, respectively; chest AP, PA or chest lateral decubitus view, 69.6%, 66.7%, 88.8%, 36.4%, and 69.0%, respectively; and chest CT, 100.0%, 85.7%, 95.2%, 100.0%, and 96.2%, respectively. CONCLUSION: There is clinical benefit to take chest radiographs to diagnose foreign body aspiration. However, based on the results of this study, it may be not necessary to take chest lateral decubitus to diagnose foreign body aspiration. If chest radiographs show unilateral hyperinflation, foreign body aspiration can be diagnosed. In cases of normal chest radiography and history of a witnessed choking episode combined with positive signs, the diagnosis of airway foreign body aspiration should be made by using chest CT.
Airway Obstruction ; Bronchoscopy ; Child* ; Diagnosis ; Foreign Bodies* ; Humans ; Radiography ; Radiography, Thoracic* ; Retrospective Studies ; Sensitivity and Specificity ; Thorax* ; Tomography, X-Ray Computed

PURPOSE: Acute lower respiratory infection (ALRI), which is frequently encountered in pediatric patients, is the leading cause of hospitalization. We aimed to identify particular cytokines that correlated with ALRI clinical characteristics. We also aimed to identify any differences in cytokines between respiratory syncytial virus (RSV)-related ALRI and non-RSV-related ALRI. METHODS: Cytokine levels were measured in the sera sampled from 103 pediatric patients diagnosed with ALRI and admitted to Seoul St. Mary's Hospital between May 2012 and April 2013. The correlations between cytokine levels and the length of hospitalization, the number of days with fever, body temperature, pulse rate, respiration rate, oxygen saturation upon admission, and duration of oxygen supplementation were analyzed. RESULTS: In children with ALRI, the level of interleukin (IL)-6, granulocyte-colony stimulating factor (G-CSF), and IL-10 were correlated with a higher body temperature on admission. In addition, the IL-8 level was correlated with pulse rate and respiration rate, and IL-1β level was related with oxygen saturation on admission. In children with RSV-related ALRI, the IL-6 was correlated the with duration of fever, and the IL-1β, IL-2, and IL-8 levels were related to pulse rate and respiration rate. In addition, the increase in interferon-gamma-inducible protein-10 (IP-10) level was correlated with a higher body temperature on admission and a longer duration of hospitalization in children with RSV-related ALRI. CONCLUSION: In children with ALRI, the levels of IL-6, IL-8, IL-1β, G-CSF, and IP-10 were correlated with its clinical features. In children with RSV-related ALRI, the IL-1β, IL-2, IL-6, IL-8, and IP-10 level was correlated with the severity of the disease.
Body Temperature ; Child* ; Cytokines* ; Fever ; Granulocyte Colony-Stimulating Factor ; Heart Rate ; Hospitalization ; Humans ; Interleukin-10 ; Interleukin-2 ; Interleukin-6 ; Interleukin-8 ; Interleukins ; Oxygen ; Respiratory Rate ; Respiratory Syncytial Viruses ; Seoul

PURPOSE: To assess the usefulness of flexible bronchoscopy in patients with suspected pulmonary tuberculosis (PTB) who have difficulty in sputum expectoration. METHODS: The subjects of this study were patients who were suspected of PTB and visited the Division of Pediatric Pulmonology at a tertiary hospital from April 2006 to March 2016. PTB suspects were determined by clinical symptoms, radiologic findings, and immunologic studies. We aimed to examine the value and safety of bronchoscopy in diagnosis and differential diagnosis of PTB in PTB-suspected patients. The diagnostic criteria for PTB were defined when Mycobacterium tuberculosis was cultured in the sputum specimen or in the bronchial washing fluid. RESULTS: A total of 19 PTB suspects were included. One patient was diagnosed with PTB by using the sputum study. However, the remaining 18 patients could not expectorate sputum or showed no evidence of Mycobacterium tuberculosis infection from the sputum study. Of the 18 patients, 15 underwent bronchoscopy. After bronchoscopy, 6 patients were diagnosed with PTB and 9 patients were diagnosed with Mycoplasma, viral, or fungal pneumonia, and tumors. For antituberculous drug resistance, there were 1 case of isoniazid (INH) resistance and 1 case of concurrent resistance to INH and prothionamide. There was no multidrug-resistant tuberculosis. None of the patients had significant complications due to bronchoscopy. CONCLUSION: Flexible bronchoscopy appears to be a definitive and safe procedure for the differential diagnosis of patients suspecting PTB in children who have difficulty expectorating sputum.
Bronchoscopy* ; Child* ; Diagnosis ; Diagnosis, Differential ; Diagnostic Imaging ; Drug Resistance ; Humans ; Isoniazid ; Mycobacterium tuberculosis ; Mycoplasma ; Pneumonia ; Prothionamide ; Pulmonary Medicine ; Sputum* ; Tertiary Care Centers ; Tuberculosis, Multidrug-Resistant ; Tuberculosis, Pulmonary*

PURPOSE: The environmental factors human rhinoviruses (HRVs) and house dust mites (HDMs) are the most common causes of acute exacerbations of asthma. The aim of this study was to compare the chemokine production induced by HRVs in airway epithelial cells with that induced by other respiratory viruses, and to investigate synergistic interactions between HRVs and HDMs on the induction of inflammatory chemokines in vitro. METHODS: A549 human airway epithelial cells were infected with either rhinovirus serotype 7, respiratory syncytial virus (RSV)-A2 strain, or adenovirus serotype 3 and analyzed for interleukin (IL)-8 and regulated on activation, normal T-cell expressed and secreted (RANTES) release and mRNA expression. Additionally, activation of nuclear factor (NF)-kappaB and activator protein (AP)-1 were evaluated. The release of IL-8 and RANTES was also measured in cells stimulated simultaneously with a virus and the HDM allergen, Der f1. RESULTS: HRV caused greater IL-8 and RANTES release and mRNA expression compared with either RSV or adenovirus. NF-kappaB and AP-1 were activated in these processes. Cells incubated with a virus and Der f1 showed an increased IL-8 release. However, compared with cells incubated with virus alone as the stimulator, only HRV with Der f1 showed a statistically significant increase. CONCLUSIONS: IL-8 and RANTES were induced to a greater extent by HRV compared with other viruses, and only HRV with Der f1 acted synergistically to induce bronchial epithelial IL-8 release. These findings may correspond with the fact that rhinoviruses are identified more frequently than other viruses in cases of acute exacerbation of asthma.
Adenoviridae ; Antigens, Dermatophagoides ; Arthropod Proteins ; Asthma ; Chemokine CCL5 ; Chemokines ; Cysteine Endopeptidases ; Epithelial Cells ; Humans ; Interleukin-8 ; Interleukins ; NF-kappa B ; Pyroglyphidae ; Respiratory Syncytial Viruses ; Rhinovirus ; RNA, Messenger ; Sprains and Strains ; T-Lymphocytes ; Transcription Factor AP-1 ; Viruses

Inguinal hernia is the most common disease treated by the pediatric surgeon. There are several controversial aspects of management 1)the optimal timing of surgical repair, especially for preterm babies, 2)contralateral groin exploration during repair of a clinically unilateral hernia, 3)use of laparoscope in contralateral groin exploration, 4)timing of surgical repair of cord hydrocele, 5)perioperative pain control, 6)perioperative management of anemia. In this survey, we attempted to determine the approach of members of KAPS to these aspects of hernia treatment. A questionnaire by e-mail or FAX was sent to all members. The content of the questionnaire were adapted from the "American Academy of Pediatrics (AAP) Section on Surgery hernia survey revisited (J Pediatr Surg 40, 1009-1014, 2005)". For full-term male baby, most surgeons (85.7 %) perform an elective operation as soon as diagnosis was made. For reducible hernia found in ex-preterm infants already discharged from the neonatal intensive care unit (NICU), 76.2 % of surgeons performed an elective repair under general anesthesia (85.8 %). 42.9 % of the surgeons performed the repair just before discharge. For same-day surgery for the ex-premature baby, the opinion was evenly divided. For an inguinal hernia with a contralateral undescended testis in a preterm baby, 61.9 % of surgeons choose to 'wait and see' until 12 month of age. The most important consideration in deciding the timing of surgery of inguinal hernia in preterm baby was the existence of bronchopulmonary dysplasia (82.4 %), episode of apnea/bradycardia on home monitoring (70.6 %). Most surgeons do not explore the contralateral groin during unilateral hernia repair. Laparoscope has not been tried. Most surgeons do not give perioperative analgesics or blood transfusion.
Analgesics ; Anemia ; Anesthesia, General ; Blood Transfusion ; Bronchopulmonary Dysplasia ; Child* ; Cryptorchidism ; Diagnosis ; Electronic Mail ; Groin ; Hernia ; Hernia, Inguinal* ; Herniorrhaphy ; Humans ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Korea* ; Laparoscopes ; Male ; Pediatrics ; Surveys and Questionnaires

OBJECTIVE: To identify risk factors for maternal morbidity in eclamptic woman. METHODS: A retrospective analysis was performed on the record of eclamptic woman during from August 1989 to February 2002. Univariate analysis was used to determine which of the independent variables were significantly different between two groups (antepartum vs postpartum). RESULTS: The incidence of eclampsia was 1 in 1,795 deliveries and the maternal mortality rate was 4.3%. Maternal complications associated with eclampsia were abruptio placentae (13.0%), pulmonary edema (26.1%), acute renal failure (39.1%), HELLP syndrome (30.4%), disseminated intravascular coagulopathy (8.7%), neurologic sequelae (8.7%), maternal death (4.3%). One patient died from disseminated intra- vascular coagulopathy, sepsis, and multiorgan failure after postpartum eclampsia. Women with antepartum eclampsia had higher incidence of acute renal failure (44.4% vs 20%) and HELLP syndrome (33.3% vs 20%) than did in women with postpartum eclampsia. Conversely, women with postpartum eclampsia had higher incidence of disseminated intravascular coagulopathy (6.7% vs 20%) and neurologic sequelae (6.7% vs 20%). CONCLUSION: Early detection and management of preeclampsia can prevent the eclampsia and maternal mortality and morbidity.
Abruptio Placentae ; Acute Kidney Injury ; Eclampsia ; Female ; HELLP Syndrome ; Humans ; Incidence ; Maternal Death ; Maternal Mortality ; Postpartum Period ; Pre-Eclampsia ; Pregnancy ; Pulmonary Edema ; Retrospective Studies ; Risk Factors* ; Sepsis

OBJECTIVE: The purpose of this study was to evaluate the efficiency of transvaginal ultrasonography for detection of fetal anomalies in first trimester. METHODS: This cohort included pregnant women between 9~14 weeks of gestation from April 2000 to April 2002 at department of Obstetrics and Gynecology, Sanggye Paik hospital, Inje university. Besides ACOG (1993) criteria, we scan nuchal translucency, FHR, cranium, abdominal wall and nuchal lesion using transvaginal sonography. If the anatomical survey was normal, the women underwent routine 18~24 weeks anomaly scans. RESULTS: 20 fetuses were identified as having 21 anomalies. Central nervous system anomaly (38%: 8/21) was the most frequent type of malformation. The other detected anomalies were isolated disorders of the lymphatic system 28% (6/21: two cystic hygromas and four nuchal edema), cystic hygroma associated with hydrops 14% (3/21), abdominal wall defects 14% (3/21), skeletal dysplasia 5% (1/21). Of the 20 fetuses that was diagnosed, 14 patients had elective first-trimester abortion, two had spontaneous fetal deaths, four were delivered at term. CONCLUSION: Besides offering the possibility of early termination, first trimester sonography has the advantage of identifying a transient sonographic sign, nuchal edema, which can be used as a marker in screening for fetal chromosomal abnormalities.
Abdominal Wall ; Central Nervous System ; Chromosome Aberrations ; Cohort Studies ; Edema ; Female ; Fetal Death ; Fetus ; Gynecology ; Humans ; Lymphangioma, Cystic ; Lymphatic System ; Mass Screening ; Nuchal Translucency Measurement ; Obstetrics ; Pregnancy ; Pregnancy Trimester, First* ; Pregnant Women ; Skull ; Ultrasonography

OBJECTIVES: To examine the effects of the oligohydramnios on perinatal outcome and latency period in patients with preterm premature rupture of membranes. METHODS: We performed a retrospective analysis of 98 singleton pregnancies complicated by preterm premature rupture of membranes, with delivery between 26 and 35 weeks' gestation. Amniotic fluid index was determined using transabdominal ultrasound at admission. All medical records of mothers and neonates were reviewed. Oligohydramnios was defined as amniotic fluid index less or equal to 5.0 cm and latency period was defined as time interval from membrane rupture to delivery. Chi-spuare test, Fisher's exact test, Student-t test, Mann-Whitney U test were used for statistical analysis. RESULTS: 1) Of the 98 patients, 59 patients(60%) were oligohydramnios group(AFI< or =5.0) and 39 patients(40%) were non-oligohydramnios group(AFI>5.0). Both groups were similar with respect to selected dermographics, gestational age at rupture of the membranes, chorioamnionitis, 1 min Apgar score and 5 min Apgar score. Patients with oligohydramnios demonstrated a lower gestatoinal age at birth and lower birth weight. There were no statistically significant correlations in neonatal morbidity and perinatal mortality between both groups. 2) For comparing latency period, we excluded deliveries of Cesarean section or induction. Comparing the remained group(25 patients), median of latency period in oligohydramnios group were 41.5 hours and median of latency period in non-oligohydramnios group were 44 hours. There were no statistically significant correlations in oligohydramnios and latency period. CONCLUSION: There were no significant effects of the oligohydramnios on poor perinatal outcome and latency period in patients with preterm premature rupture of membranes
Amniotic Fluid ; Apgar Score ; Birth Weight ; Cesarean Section ; Chorioamnionitis ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Latency Period (Psychology)* ; Medical Records ; Membranes* ; Mothers ; Oligohydramnios* ; Parturition ; Perinatal Mortality ; Pregnancy ; Retrospective Studies ; Rupture* ; Ultrasonography