Purpose: Adenocarcinoma is an extremely rare malignancy in the pediatric population. Research regarding pediatric adenocarcinoma is very rare in Korea. This study aimed to investigate the clinical features of pediatric adenocarcinomas of various primary organ sites in Korea. Materials and Methods: Pediatric patients under 18 years, diagnosed with adenocarcinoma of various sites between January 1995 and December 2016, were included. We retrospectively reviewed patient and tumor characteristics and calculated survival estimates, reported as 5-year survival rate and 95% confidence interval. Results: Of 80 patients (median age, 15 years; range, 10 to 17 years), 37 (46.3%) were men, and 24 (30%) had a family history of cancer or underlying disease relevant to malignancy. The cancer locations were the colon and rectum (n=32), ovaries (n=18), stomach (n=15), lung (n=4), small bowel (n=1), and other sites (n=10). Totally, 54.8% patients (42/77) had stage 3 or 4 disease. The median follow-up period was 2.0 years (range, 0 to 20.4). The 5-year overall survival estimate for all patients, and for those with stomach, colorectal, ovarian, and other cancer sites were 57.9%±11.5%, 58.2%±25.7%, 41.5%±18.2%, 87.5%±16.2%, and 64.0%±34.4%, respectively. The 5-year survival rate differed significantly between categories of adenocarcinomas into gastrointestinal (GI) (44.7%) and non-GI adenocarcinomas (78.8%) (p=0.007). The 5-year survival rate also differed significantly according to carcinoembryonic antigen level (69.3% in < 3 ng/mL, 23.8% in > 3 ng/mL; p < 0.001). Conclusion In pediatric patients, adenocarcinomas arise from various organs and are often diagnosed at advanced stages. Large, prospective studies for their accurate clinical characteristics and prognostic factors are needed.

BACKGROUND: Sleep problems commonly occur in patients with Parkinson's disease (PD), and are associated with a lower quality of life. The aim of the current study was to translate the English version of the Scales for Outcomes in Parkinson's Disease-Sleep (SCOPA-S) into the Korean version of SCOPA-S (K-SCOPA-S), and to evaluate its reliability and validity for use by Korean-speaking patients with PD. METHODS: In total, 136 patients with PD from 27 movement disorder centres of university-affiliated hospitals in Korea were enrolled in this study. They were assessed using SCOPA, Hoehn and Yahr Scale (HYS), Unified Parkinson's Disease Rating Scale (UPDRS), Parkinson's Disease Sleep Scale 2nd version (PDSS-2), Non-motor Symptoms Scale (NMSS), Montgomery Asberg Depression Scale (MADS), 39-item Parkinson's Disease Questionnaire (PDQ39), Neurogenic Orthostatic Hypotension Questionnaire (NOHQ), and Rapid Eye Movement Sleep Behaviour Disorder Questionnaire (RBDQ). The test-retest reliability was assessed over a time interval of 10–14 days. RESULTS: The internal consistency (Cronbach's α-coefficients) of K-SCOPA-S was 0.88 for nighttime sleep (NS) and 0.75 for daytime sleepiness (DS). Test-retest reliability was 0.88 and 0.85 for the NS and DS, respectively. There was a moderate correlation between the NS sub-score and PDSS-2 total score. The NS and DS sub-scores of K-SCOPA-S were correlated with motor scale such as HYS, and non-motor scales such as UPDRS I, UPDRS II, MADS, NMSS, PDQ39, and NOHQ while the DS sub-score was with RBDQ. CONCLUSION: The K-SCOPA-S exhibited good reliability and validity for the assessment of sleep problems in the Korean patients with PD.
Depression ; Humans ; Hypotension, Orthostatic ; Korea ; Movement Disorders ; Parkinson Disease ; Quality of Life ; Reproducibility of Results ; Sleep, REM ; Weights and Measures

On ultrasonography, medullary thyroid carcinoma (MTC) shows hypoechogenicity, an irregular margin, a predominantly solid composition, and microcalcifications, similar to those observed in papillary thyroid carcinoma (PTC). MTC presenting as a cystic lesion is rare, and endoscopic thyroidectomy can be performed for benign thyroid masses and early stage PTC, however it is inappropriate for MTC regardless of cystic change. The authors report a case of cystic MTC found after endoscopic thyroid lobectomy and provide a review of the literature on this topic.
Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Ultrasonography

Cytomegalovirus (CMV) is not a rare infection and is frequently observed in immuoncompromised patients. CMV infection is usually asymptomatic in immunocompetent patients however it can be a major cause of morbidity and mortality in immunocompromised patients. The diagnosis of CMV gastric ulcer is not easy because of the absence of characteristic endoscopic features and the difficulty in the identification of infection by routine histologic examinations. We experienced a case of CMV-associated giant gastric ulcer in a patient receiving immunosuppressive therapy. She was a 45-year-old woman with dermatomyositis and had received steroid therapy to control her disease. Epigastric pain developed during therapy and upper endoscopy revealed a gastric ulcer. Despite proton pump inhibitor therapy, her epigastric pain aggravated and follow-up endoscopy revealed a huge gastric ulcer approximately 10 cm in diameter. Histologic findings showed intracellular inclusion bodies after immunostaining which confirmed CMV-associated gastric ulcer. Steroid therapy was discontinued and she received proton pump inhibitors without antiviral agents. Her symptoms improved and follow-up endoscopy revealed successful healing of the CMV-associated gastric ulcer. If an unusual gastric ulcer develops in the immunocompromised patients, CMV gastric ulcer should be suspected and examination for inclusion bodies using CMV immunostaining should be considered.
Antiviral Agents ; Cytomegalovirus ; Dermatomyositis ; Diagnosis ; Endoscopy ; Female ; Follow-Up Studies ; Glycogen Storage Disease Type VI ; Humans ; Immunocompromised Host ; Immunosuppressive Agents ; Inclusion Bodies ; Middle Aged ; Mortality ; Proton Pump Inhibitors ; Proton Pumps ; Steroids ; Stomach Ulcer*

PURPOSE: To analyze the incidence and patterns of calcification of papillary thyroid microcarcinoma (PTMC) on neck ultrasonography (NUS) and assess the clinical implications of calcification, especially for neck node metastasis. METHODS: The clinical data of 379 patients with PTMC who underwent thyroidectomy between January and December 2011 were retrospectively analyzed. PTMC lesions were classified into four subgroups according to their calcification patterns on preoperative NUS: microcalcification, macrocalcification, rim calcification, and noncalcification. The clinicopathologic characteristics were compared between the patients with and without calcification, and among the four subgroups. RESULTS: Calcifications were detected on NUS in 203 patients (53.5%) and central neck node metastasis was observed in 119 patients (31.3%). Calcification was associated with larger tumor size (0.68 cm vs. 0.54 cm), higher rate of lymph node metastasis (38.6% vs. 23.2%) and higher lymph node ratio (0.11 vs. 0.06) compared to noncalcification (All P < 0.05). In addition, the extent of calcification correlated with lesion size (0.67 cm vs. 0.69 cm vs. 0.85 cm). Further, the likelihood of lymph node metastasis also correlated with the extent of calcification in the order of non-, micro- and macrocalcification (23.3%, 36.8%, and 44.1%, respectively). The calcification rate was higher in patients with lymph node metastasis than those without it (65.5% vs.47.7%) (All P < 0.05). CONCLUSION: PTMC patients positive for calcification on NUS had a higher rate of lymph node metastasis, and a higher lymph node ratio compared to noncalcification patients. Calcification patterns should be assessed carefully in patients with PTMC by preoperative NUS.
Humans ; Incidence ; Lymph Nodes ; Neck* ; Neoplasm Metastasis ; Retrospective Studies ; Thyroid Gland* ; Thyroidectomy ; Ultrasonography*

PURPOSE: The conventional treatment for ingested foreign bodies (IFB) is removal, which is successful in most cases. However, it can be associated with severe complications, such as gastrointestinal tract perforation, and require emergency surgery. The aim of this study is to analyze clinical data relating to IFB and to develop a proper management plan to reduce the incidence of severe complications. METHODS: Between September 2001 and September 2009, 117 patients visited the emergency room complaining of IFB. Among these patients, 29 were diagnosed with bezoar and were excluded from the study. Medical data for the remaining 88 patients was reviewed retrospectively. For statistical analysis, the foreign bodies (FB) were classified into three subgroups according to their shape (round, sharp, and amorphous). RESULTS: The median age of patients with IFB was seven years, and the male-to-female ratio was 1.3:1. Many of these patients were preschool children under the age of seven who had accidentally sw allowed FB (56 cases, 63.6%). The most common symptom presented among the patients was FB sensation (18 cases, 21%). The results of subgroup analysis showed no significant relation between the shape of the FB and the treatm ent m odality. Spontaneous passage was observed in 21 cases (23.9%). Otherwise, endoscopic removal was performed successfully in 61.4% of cases, and 13 patients required emergency operations (14.8%). CONCLUSION: Early diagnosis and a prompt approach are significant in the successful treatment of IFB. Endoscopic or surgical procedures are sometimes required, particularly in cases where complications are suspected.
Bezoars ; Child, Preschool ; Early Diagnosis ; Emergencies ; Emergency Service, Hospital ; Endoscopy ; Foreign Bodies* ; Gastrointestinal Tract ; Humans ; Incidence ; Retrospective Studies ; Sensation

PURPOSE: The current study examined the validity and outcomes of three lobectomy methods for papillary thyroid carcinoma (PTC), open surgery, minimally invasive videoassisted thyroidectomy (MIVAT), and endoscopic surgery. METHODS: Between January 2006 and June 2011, 360 patients underwent lobectomy for treatment of PTC. Clinical data were collected and analyzed retrospectively. Open lobectomy, MIVAT, and endoscopic lobectomy were performed in 170 (47.2%, Group A), 81 (22.5%, Group B), and 109 patients (30.3%, Group C), respectively. Median tumor size was 0.5 cm. RESULTS: No significant differences in tumor size, lymphovascular invasion, extrathyroidal extension, and metastatic lymph node number were observed among the groups. However, the mean number of retrieved central lymph nodes was higher in the open surgery group than in the other groups (8.9, 4.9, and 5.8 in Groups A, B, and C, respectively P<0.05). Postoperative bleeding occurred in one patient each in Group A. Temporary hypoparathyroidism developed in ten, three, and three patients in Groups A, B, and C, respectively. Recurrence occurred in five cases (1.4%), however, no significant difference in short-term recurrence (median duration of follow up: 1,109 days) was observed among the three groups. CONCLUSION: The number of retrieved central lymph nodes was higher in the open surgery group. However, no differences in the incidence of complications or short-term recurrence were observed among the groups, indicating that either one of these methods can be recommended as limited surgery for PTC.
Follow-Up Studies ; Hemorrhage ; Humans ; Hypoparathyroidism ; Incidence ; Lymph Nodes ; Recurrence ; Retrospective Studies ; Surgical Procedures, Minimally Invasive ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: Several reports have examined the predictors of temporary hypoparathyroidism after total thyroidectomy; however, few have assessed the clinical predictors of early recovery from the condition. Here, we compared the clinical factors of early and late recovery groups of patients with temporary hypoparathyroidism. METHODS: The electronic medical records of 248 patients who underwent total thyroidectomy from January 2012 to July 2013 and had parathyroid hormone (PTH) levels <10 pg/mL on the first postoperative day were examined retrospectively. The early recovery group showed recovery from PTH at two weeks postoperatively and the late recovery group showed recovery from PTH at one month postoperatively. RESULTS: The early recovery group included a lower proportion of males (8.6% vs. 23.7%, P<0.01) and a higher proportion of patients with more than three parathyroid glands saved (83.8% vs. 76.8%, P<0.04). There were no significant differences in the other variables examined. CONCLUSION: The early recovery group of patients with temporary hypoparathyroidism included a lower proportion of males and a higher proportion of patients with more than three parathyroid glands saved intraoperatively. These findings can be used as clinical indicators when discharge medication is prescribed.
Electronic Health Records ; Humans ; Hypoparathyroidism* ; Male ; Parathyroid Glands ; Parathyroid Hormone ; Retrospective Studies ; Thyroidectomy*

BACKGROUND/AIMS: The purpose of this study was to investigate the expression of urokinase-type plasminogen activator (uPA), uPA receptor (uPAR), and plasminogen activator inhibitor (PAI)-1 on podocytes in immunoglobulin A (IgA) glomerulonephritis (GN). METHODS: Renal biopsy specimens from 52 IgA GN patients were deparaffinized and subjected to immunohistochemical staining for uPA, PAI-1, and uPAR. The biopsies were classified into three groups according to the expression of uPA and uPAR on podocytes: uPA, uPAR, and a negative group. The prevalences of the variables of the Oxford classification for IgA GN were compared among the groups. RESULTS: On podocytes, uPA was positive in 11 cases and uPAR was positive in 38 cases; by contrast, PAI-1 was negative in all cases. Expression of both uPA and uPAR on podocytes was less frequently accompanied by tubulointerstitial fibrosis. CONCLUSIONS: Our results suggest a possible protective effect of podocyte uPA/uPAR expression against interstitial fibrosis.
Adolescent ; Adult ; Aged ; Atrophy ; Biological Markers/analysis ; Biopsy ; Female ; Fibrosis ; Glomerulonephritis, IGA/diagnosis/*enzymology/immunology ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Plasminogen Activator Inhibitor 1/*analysis ; Podocytes/*enzymology/immunology/pathology ; Receptors, Urokinase Plasminogen Activator/*analysis ; Urokinase-Type Plasminogen Activator/*analysis ; Young Adult

PURPOSE: The postoperative scar of open thyroidectomy is one of the clinical issues in patients diagnosed with thyroid disease. The aim of this study was to analyze postoperative scars in patients who underwent thyroidectomy based on the Modified Vancouver Scar Scale and to find factors for use in predicting formation of hypertrophied scars and keloids. METHODS: Clinical data from 283 patients who underwent thyroidectomy were collected randomly and analyzed retrospectively. All postoperative scars were classified according to five categories; excellent, good, moderate, hypertrophied, and keloid, using the Modified Vancouver Scar Scale according to the assessment of pliability, height of the scar, vascularity, and pigmentation. For analysis, hypertrophied and keloid were classified as bad status and others were classified as good status. RESULTS: According to our results, 84.8% of scars were classified as good status and 15.2% of scars were classified as bad status. Forty percent of patients who were in their twenties, 17.8% of patients who were in their thirties, and 22.1% of patients who were in their forties showed bad status; 92.9% of patients who were in their fifties and 89.2% of patients who were in their sixties showed good status (P=0.003). The only statistically significant factor influencing the scar status was the weight of the thyroid (P=0.022). CONCLUSION: Postoperative scars from thyroid surgery were evaluated using the Modified Vancouver Scar Scale. Age was the most important factor in formation of hypertrophied and keloid scar and the weight of the excised thyroid also influenced the scar status. Preoperative prediction of the status of the scar might be possible considering the age and size of the thyroid gland.
Cicatrix* ; Humans ; Keloid ; Pigmentation ; Pliability ; Retrospective Studies ; Thyroid Diseases ; Thyroid Gland ; Thyroidectomy*