PURPOSE: Our examination was designed to determine the diagnostic properties of the cutoff point for the prediction of bacteremia in febrile children less than 3 years of age. Cutoff point is the value that simultaneously maximizes both sensitivity and specificity. METHODS: We conducted a retrospective study of febrile children, less than 3 years of age, who clinically have no identifiable source of fever. Peripheral blood leukocyte count(WBC), absolute neutrophil count(ANC), erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) were measured at the same time. All patients received blood culture, urine culture and/or CSF culture. Bacterial infection was defined as single pathogen isolated from the CSF or blood or a urinary tract infection (UTI). Patients were dichotomized into two groups: those with bacterial infection and no bacterial infection. We analyzed the characteristics of the children in the two groups. RESULTS: Seventy-one patients(44 males; 27 females) were enrolled in the study. Twenty patients (28%) had a serious bacterial infection(twelve urinary tract infection, five bacteremia, three meningitis) and fifty-one(72%) had no serious bacterial infection. WBC, ESR and CRP were significantly different between the two groups(P<0.05). The cutoff point of WBC, ESR and CRP were 20,000/mm3, 30 mm/hr and 3.0 mg/dL, respectively. The sensitivity and specificity of each cutoff point were WBC(75%, 75%), ESR(79%, 68%) and CRP(83%, 77%), respectively. CONCLUSION: These data show the ability of predictors to identify febrile children less than 3 years of age with bacterial infection. Febrile children who reach the cutoff point must be treated intensively and those who do not reach the cutoff point can be carefully managed without administering antimicrobial agents.
Anti-Infective Agents ; Bacteremia ; Bacterial Infections* ; Blood Sedimentation ; Child* ; Fever ; Humans ; Leukocytes ; Male ; Neutrophils ; Retrospective Studies ; Sensitivity and Specificity ; Urinary Tract Infections

PURPOSE: Intracranial germinoma is the most radiocurable tumor of the primary intracranial neoplasm. But, the optimum radiation dose and target volume remain controversial. In this retrospective study, we analysed the spreading pattern at presentation and the pattern of the failure and survival of intracranial germinoma. MATERIALS AND METHODS: From 1989 to 1996, 23 patients were treated for intracranial germinoma at Department of Radiation Oncology. Twenty-one patients were treated at their initial presentation and 2 patients were treated for recurrent disease. Six patients had multiple tumor masses on MRI and 7 patients had ventricular seeding on MRI. The examination of cerebrospinal fluid cytology was done in 15 patients and 3 out of 15 patients had positive cerebrospinal cytology. In tumor marker study of alpha-FP and beta-hCG, 6 patients had mildly elevated beta-hCG in serum or cerebrospinal fluid. Twenty-one patients were treated with whole craniospinal axis irradiation and 2 patients were given whole ventricular radiation therapy. The total dose was ranged between 4500cGy and 5600cGy to primary tumor site (median 5580 cGy). Dose to the entire ventricular system ranged from 1980cGy to 3960 cGy (median 2700cGy) and dose to the spinal axis ranged from 2160cGy to 3900cGy (median 2700cGy). RESULTS: Of 23 patients, 21 patients are alive without evidence of disease for median 4 years follow-up. One patient who had markedly elevated alpha-FP and beta-hCG suffered from persistent disease after radiation therapy and received 2 cycles of chemotherapy. She died 9 months after chemotherapy. One patient who developed ventricular seeding after gamma-knife was treated with whole craniospinal irradiation, he died after 1 year due to probably brain necrosis. The hematologic toxicity of 3 or 4 grade were seen in 7 patients, and patient's endocrinologic dysfunction was not deteriorated after radiation therapy. One patient had been treated with growth hormone replacement due to short stature. CONCLUSIONS: This retrospective study has confirmed the excellent result of radiation therapy in intracranial germinoma. The complication rate during or after radiation therapy is considered within acceptable range. It is necessary to further investigate the optimal dose and treatment volume of radiation therapy. The role of chemotherapy in the treatment of intracranial germinoma should be further investigated.
Axis, Cervical Vertebra ; Brain ; Brain Neoplasms ; Cerebrospinal Fluid ; Craniospinal Irradiation ; Drug Therapy ; Follow-Up Studies ; Germinoma* ; Growth Hormone ; Humans ; Magnetic Resonance Imaging ; Necrosis ; Radiation Oncology ; Retrospective Studies

PURPOSE: The purpose of this study was to identify chemotherapy induced peripheral neuropathy, quality of life of patients with gynecologic cancer. METHODS: This was a cross-sectional survey design. We collected 130 patients with gynecologic cancer. They complete a self reported questionnaire including items related neuropathy and quality of life (FACT-GOG/Ntx subscale, FACT-G scale). RESULTS: The neuropathy score was 14.3+/-7.9. The quality of life score was 64.8+/-16.4. The neuropathy induced significant difference according to diabetic status, difficulties in performing household chores and willing to discontinuity of chemotherapy. And duration of cancer diagnosis, neuropathy, number of total chemo agent associated with quality of life. There was a negative correlation between number of total chemo agent and quality of life. Neuropathy independently affected quality of life. CONCLUSION: Chemotherapy induced peripheral neuropathy of patients with gynecologic cancer adversely affected women's quality of life and activities of daily living. To improve patient's quality of life, it is important that accurate assess and appropriately manage neuropathy in patients with gynecologic cancer.
Activities of Daily Living ; Cross-Sectional Studies ; Diagnosis ; Drug Therapy ; Family Characteristics ; Female ; Genital Neoplasms, Female ; Humans ; Peripheral Nervous System Diseases* ; Quality of Life* ; Surveys and Questionnaires ; Self Report

PURPOSE: Low molecular weight heparin (LMWH) is safe and effective in the treatment of acute coronary syndrome (ACS) and venous thromboembolism. Compared with unfractionated heparin (UFH), it is known to have less bleeding tendency in the general population. However, it is not certain whether bleeding complications are decreased by LMWH in patients with renal failure. We postulated that the use of LMWH may lead to increase in bleeding tendency in patients with renal dysfunction. METHODS: We conducted a retrospective study in 486 hospitalized patients who were diagnosed as cerebral infarction or ACS, and treated with enoxaparin or nadroparin from January 2008 to December 2009. Bleeding complications were compared in 3 groups according to estimated glomerular filtration rate (GFR> or =60, 30-59, and <30 mL/min/1.73m2). Age, hypertension (HTN), diabetes mellitus (DM), smoking and usage of antithrombotics were examined and the relationship of these variables with bleeding tendency was analyzed. RESULTS: Compared with group I, the frequency of total bleeding complications increased in patients with group II (p=0.002) and III (p=0.005) regardless of adequate dose reduction. Multiple logistic regression analysis after adjustment for age, HTN, DM, and usage of antithrombotics revealed that decreased GFR groups [odds ratio (OR) of group II was 5.79 (95% confidence interval (CI), 1.23-29.97; p=0.042), OR of group III 5.92 (95% CI, 1.22-27.61; p=0.029)] and DM [OR of DM 7.88 (95% CI; 1.46-46.32, p=0.026)] were two independent factors which affect major bleeding. CONCLUSION: These findings suggest that renal insufficiency, even if it is mild, could affect major bleeding complications in the use of LMWH.
Acute Coronary Syndrome ; Cerebral Infarction ; Diabetes Mellitus ; Enoxaparin ; Glomerular Filtration Rate ; Hemorrhage ; Heparin ; Heparin, Low-Molecular-Weight ; Humans ; Hypertension ; Logistic Models ; Nadroparin ; Renal Insufficiency ; Retrospective Studies ; Smoke ; Smoking ; Venous Thromboembolism

PURPOSE: This is a retrospective study to evaluate the results of radiation therapy and prognostic factors influencing the results in nasopharyngeal carcinoma. MATERIALS AND METHODS: From October 1989 to May 1996, 56 patients were treated for nasopharyngeal carcinoma at Department of Radiation Oncology. According to stage, patients were distributed as follows: stage I (2), II (13), III (11), IV (30). Twenty-eight patients were treated with radiation therapy only, 7 patients were treated with neoadjuvant chemotherapy followed by radiation therapy. Twenty-one patients were treated with radiation therapy and weekly CDDP. After external beam radiotherapy of 60Gy, 46 patients received boost dose with intracavitary radiation and 9 patients with 3D conformal therapy. One patient received boost dose with 2 dimensional photon beam therapy. The tumor dose ranged from 69.4Gy to 86.2Gy with median dose of 74.4Gy. The follow-up period ranged from 5 months to 92 months with a median of 34 months. RESULTS: Forty-seven patients achieved complete response and 8 patients showed partial response. One patient showed minimal response. Patterns of failure were as follows : locoregional recurrence (8) and distant metastasis (18). Among these patients, 2 patients failed locoregionally and distantly. The sites of distant metastasis were bone (8), lung (8) and liver (4). Five years survival rate was 67.2% and 5 years disease-free survival rate was 53.6%. KPS (P=0.005) and response of radiation therapy (P=0.0001) were significant prognostic factors for overall survival. KPS (P=0.02) and response of radiation therapy (P=0.005) were significant prognostic factors for disease-free survival. CONCLUSION: This retrospective study showed that distant metastasis was the predominant pattern of relapse in nasopharyngeal cancer. Neoadjuvantchemotherapy or weekly CDDP did not influence the distant metastasis-free survival. For advanced T stage, 3D conformal therapy provided an improved dose coverage compared to ICR. But further follow-up was needed in patients with 3D conformal therapy to assess the efficacy of this therapy. Development of techniques of radiation therapy to improve locoregional control and of more effective systemic chemotherapy regimen are needed.
Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Liver ; Lung ; Nasopharyngeal Neoplasms ; Neoplasm Metastasis ; Radiation Oncology ; Radiotherapy ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: This prospective study has been conducted to assess the value of three dimensional conformal radiation therapy (3DCRT) for lung cancer and to determine its potential advantage over current treatment approaches. Specific aim of this study were to 1) find the most ideal 3DCRT technique 2) establish the maximum tolerance dose that can be delivered with 3DCRT and 3) identify patients at risk for development of radiation pneumonitis. MATERIALS AND METHODS: Beginning in Nov. 1994, 95 patients with inoperable non-small cell lung cancer (stage I; 4, stage II; 1, stage IIIa; 14, stage IIIb; 76) were entered onto this 3D conformal trial. Areas of known disease and elective nodal areas were initially treated to 45 Gy and then using 3DCRT technique 65 to 70 Gy of total dose were delivered to the gross disease. Sixty nine patients received 65 Gy of total dose and 26 received 70 Gy. Seventy eight patients (82.1%) also received concurrent MVP chemotherapy. 3DCRT plans were compared with 2D plans to assess the adequacy of dose delivery to target volume, dose volume histograms for normal tissue, and normal tissue complication probabilities (NTCP). RESULTS: Most of plans (78/95) were composed of non-coplanar multiple (4-8) fields. Coplanar segmented conformal therapy was used in 17 pateints, choosing the proper gantry angle which minimize normal lung exposure in each segment. 3DCRT gave the full dose to nearly 100% of the gross disease target volume in all patients. The mean NTCP for ipsilateral lung with 3DCRT (range ; 0.17-0.43) was 68% of the mean NTCP with 2D treatment planning (range ; 0.27-0.66). DVH analysis for heart showed that irradiated volume of heart could be significantly reduced by non-coplanar 3D approach especially in the case of left lower lobe lesion. Of 95 patients evaluable for response, 75 (79%), showed major response including 25 (26%) with complete responses and 50 (53%) with partial responses. One and two year overall survivals of stage lll patients were 62.6% and 35.2% respectively. Twenty percent (19/95) of patients had pneumonitis ; Eight patients had grade 1 pneumonitis and 11 other patients had grade 2. Comparison of the average of NTCP for lung showed a significant difference between patients with and without radiation pneumonitis. Average NTCP for patients without complication was 62% of those with complications. CONCLUSIONS: This study showed that non-coplanar multiple fields (4-8) may be one of the ideal plans for 3DCRT for lung cancer. It also suggested that 3DCRT may provide superior delivery of high dose radiation with reduced risk to normal tissue and that NTCP can be used as a guideline for the dose escalation.
Carcinoma, Non-Small-Cell Lung* ; Drug Therapy ; Heart ; Humans ; Lung ; Lung Neoplasms ; Pneumonia ; Prospective Studies ; Radiation Pneumonitis

Klinefelter syndrome is the most common chromosomal abnormality, with a 47, XXY karyotype and typical clinical findings of infertility, hypogonadism, reduced body hair, gynecomastia, tall stature, and incresed gonadotropins and decreased testosterone levels. In addition to this classic description, several other diseases have been discribed in Klinefelter syndrome such as unilateral renal aplasia, autoimmune disease, diabetes mellitus, sexual precoxity, renal cell carcinoma, intravesical ureterocele, and osteoporosis. The incidence is 1 in 400-1,000 of the population and urological abnormalities are not common. However a case of Klinefelter syndrome associated with multicystic dysplastic kidney has not been not reported up to date. Therefore, we describe a 1- day-year old baby boy who presented with Klinefelter syndrome with unilateral multicystic kidney dysplastic disease, plus with a brief review of the literature.
Autoimmune Diseases ; Carcinoma, Renal Cell ; Chromosome Aberrations ; Diabetes Mellitus ; Gonadotropins ; Gynecomastia ; Hair ; Humans ; Hypogonadism ; Incidence ; Infant, Newborn* ; Infertility ; Karyotype ; Klinefelter Syndrome* ; Male ; Multicystic Dysplastic Kidney* ; Osteoporosis ; Testosterone ; Ureterocele

PURPOSE: To evaluate efficacy and complication of stereotactic radiosurgery using stereotactic body frame. METHODS AND MATERIALS: From December 1997 to June 1999, 11 patients with primary and metastatic tumors were treated with stereotactic radiosurgery using stereotactic body frame(Precision Therapy(TM)). Three patients were treated with primary hepatoma and seven with metastatic tumor from liver, lung, breast, trachea and one with arteriovenous malformation on neck. We used vacuum pillow for immobilization and made skin marker on sternum and tibia area with chest marker and leg marker. Diaphragm control was used for reducing movement by respiration. CT-simulation and treatment planning were performed. Set-up error was checked by CT-Simulator before each treatment. Dose were calculated on the 80~90% isodose of isocenter dose and given consecutive 3 fractions for total dose of 30 Gy (10 Gy/fraction). RESULTS: Median follow-up was 12 months. One patient (9%) showed complete response and four patients (36%) showed partial response and others showed stable disease. Planning target volumes (PTV) ranged from 3 to 111 cc (mean 18.4 cc). Set-up error was within 5 mm in all directions (X, Y, Z axis). There was no complication in all patients. CONCLUSION: In primary and metastatic tumors, stereotactic radiosurgery using stereotactic body frame is very safe, accurate and effective treatment modality.
Arteriovenous Malformations ; Breast ; Carcinoma, Hepatocellular ; Diaphragm ; Follow-Up Studies ; Humans ; Immobilization ; Leg ; Liver ; Lung ; Neck ; Radiosurgery* ; Respiration ; Skin ; Sternum ; Thorax ; Tibia ; Trachea ; Vacuum

PURPOSE: This study examined the immunological activity and optimized the mixture conditions of Sargassum horneri (S. horneri) extracts in vitro and in vivo models.METHODS: S. horneri was extracted using three different methods: hot water extraction (HWE), 50% ethanol extraction (EE), and supercritical fluid extraction (SFE). Splenocyte proliferation and cytokine production (Interleukin-2 and Interferon-γ) were measured using a WST-1 assay and enzyme-linked immunosorbent assay, respectively. The levels of nitric oxide and T cell activation production were measured using a Griess assay and flow cytometry, respectively. The natural killer (NK) cell activity was determined using an EZ-LDH kit.RESULTS: Among the three different types of extracts, HWE showed the highest levels of splenocyte proliferation and cytokine production in vitro. In the animal model, three different types of extracts were administrated for 14 days (once/day) at 50 and 100 mg/kg body weight. HWE and SFE showed a high level of splenocyte proliferation and cytokine production in the with and without mitogen-treated groups, whereas EE administration did not induce the splenocyte activation. When RAW264.7 macrophage cells were treated with different mixtures (HWE with 5, 10, 15, 20% of SFE) to determine the optimal mixture ratio of HWE and SFE, the levels of nitric oxide and cytokine production increased strongly in the HWE with 5% and 10% of SFE containing group. In the animal model, HWE with 5% and 10% of SFE mixture administration increased the levels of splenocyte proliferation, cytokine production, and activated CD4⁺ cell population significantly, with the highest level observed in the HWE with 5% of SFE group. Moreover, the NK cell activity was increased significantly in the HWE with 5% of SFE mixture-treated group compared to the control group.CONCLUSION: The optimal mixture condition of S. horneri with immune-enhancing activity is the HWE with 5% of SFE mixture. These results confirmed that the extracts of S. horneri and its mixtures are potential candidate materials for immune enhancement.
Body Weight ; Chromatography, Supercritical Fluid ; Enzyme-Linked Immunosorbent Assay ; Ethanol ; Flow Cytometry ; In Vitro Techniques ; Killer Cells, Natural ; Macrophages ; Models, Animal ; Nitric Oxide ; Sargassum ; Water

Colon tumors develop more frequently in male than in female. Nuclear factor erythroid 2-related factor 2 (Nrf2) plays differential roles in the stage of tumorigenesis. The purpose of this study was to investigate the role of Nrf2 on colitis-associated tumorigenesis using Nrf2 knockout (KO) female mice. Azoxymethane (AOM) and dextran sulfate sodium (DSS)-treated wild-type (WT) and Nrf2 KO female mice were sacrificed at week 2 and 16 after AOM injection. Severity of colitis, tumor incidence, and levels of inflammatory mediators were evaluated in AOM/DSS-treated WT and Nrf2 KO mice. Furthermore, qRT-PCR, Western blot abnalysis, and ELISA were performed in colon tissues. At week 2, AOM/DSS-induced colon tissue damages were significantly greater in Nrf2 KO than in WT mice. At week 16, tumor numbers (> 2 mm size) were significantly lower in both the proximal and distal colon in Nrf2 KO compared to WT. The overall incidences of adenoma/cancer of the proximal colon and submucosal invasive cancer of the distal colon were reduced by Nrf2 KO. The mRNA and protein expression levels of NF-κB-related mediators (i.e., iNOS and COX-2) and Nrf2-related antioxidants (i.e., heme oxygenase-1 and glutamate-cysteine ligase catalytic subunit) were significantly lower in the Nrf2 KO than in WT mice. Interestingly, the protein level of 15-hydroxyprostaglandin dehydrogenase (15-PGDH) was higher in AOM/DSS-treated Nrf2 KO than in WT mice. Our results support the oncogenic effect of Nrf2 in the later stage of carcinogenesis and upregulation of tumor suppressor 15-PGDH might contribute to the repression of colitis-associated tumorigenesis in Nrf2 KO female mice.