BACKGROUND/AIMS: Information regarding the efficacy of early infliximab treatment in pediatric patients with Crohn's disease (CD) is limited. We aimed to evaluate the impact of early combined immunosuppression on linear growth in pediatric patients with CD by performing step-up comparisons. METHODS: This retrospective study included pediatric patients with moderate-to-severe CD, who received a combination therapy with infliximab and azathioprine for at least 3 years and sustained corticosteroid-free remission without loss of response. The z-scores of the growth indicators obtained at the time of diagnosis and annually for 3 years thereafter were compared between the two groups. RESULTS: The early combined immunosuppression group displayed significantly increased linear growth 3 years after diagnosis (p=0.026). A significant difference was also observed in the linear growth 3 years after diagnosis between subgroups of Tanner stages 1–2 (p=0.016). CONCLUSIONS: The early introduction of biologics should be considered to improve linear growth in pediatric patients with CD.
Azathioprine ; Biological Products ; Crohn Disease* ; Diagnosis ; Humans ; Immunosuppression ; Infliximab* ; Retrospective Studies

OBJECTIVE: The purpose of the study was to review the current status of intra-arterial (IA) thrombolysis in Korea by conducting a retrospective analysis of the data from multiple domestic centers. MATERIALS AND METHODS: The radiologists at each participating institution were asked to fill out case report forms on all patients who had undergone IA recanalization due to acute anterior circulation ischemia. These forms included clinical, imaging and procedure-related information. A central reader analyzed the CT/MR and angiographic results. The rates of successful recanalization, hemorrhagic transformation and functional outcome were obtained. The univariate analyses were performed together with the multivariate analysis. RESULTS: We analyzed the data from 163 patients, and they had been treated at seven institutes. The initial imaging modalities were CT for 46 patients (28%), MR for 63 (39%), and both for 54 (33%). Various mechanical treatment methods were applied together in 50% of the patients. Radiologically significant hemorrhage was noted in 20/155 patients (13%). We found various factors that influenced the recanalization rate and the occurrence of significant hemorrhagic transformations. The favorable outcome rate, reported as modified Rankin Scale < or = 2, was 40%, and the mortality rate was 11%. The factors that predicted a poor functional outcome were old age (p = 0.01), initially severe neurological symptoms (p < 0.0001), MR findings of a wide distribution of lesions (p = 0.001), involvement of the basal ganglia (p = 0.01), performance of procedures after working hours (p = 0.01), failure of recanalization (p = 0.003), contrast extravasation after the procedure (p = 0.007) and significant hemorrhagic transformation (p = 0.002). The subsequent multivariate analysis failed to show any statistically significant variable. CONCLUSION: There was a trend toward increased dependency on MR imaging during the initial evaluation and increased usage of combined pharmacologic/mechanical thrombolysis. The imaging and clinical outcome results of this study were comparable to those of the previous major thrombolytic trials.
Acute Disease ; Cerebral Angiography ; Cerebral Infarction/diagnosis/*drug therapy ; Female ; Fibrinolytic Agents/*administration & dosage ; Humans ; Injections, Intra-Arterial ; Logistic Models ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Thrombolytic Therapy/*methods/standards ; Tomography, X-Ray Computed ; Treatment Outcome

PURPOSE: Amylin secretion is increased parallel to insulin in obese subjects. Despite their marked obesity, a state of relative hypoinsulinemia occurs in children with Prader-Willi syndrome (PWS). Based on the hypothesis that amylin levels may be relatively low in PWS children, contributing to their excessive appetite, we studied amylin levels after oral glucose loading in children with PWS and overweight controls. MATERIALS AND METHODS: Plasma levels of amylin, glucagon, insulin, and glucose were measured at 0, 30, 60, 90, and 120 min after a glucose challenge in children with PWS (n = 18) and overweight controls (n = 25); the relationships among the variables were investigated in these two groups. RESULTS: Amylin levels were significantly correlated with insulin during fasting and during the oral glucose tolerance test in both groups. Amylin levels between 0 and 60 min after glucose loading were statistically different between the two groups. They were lower in children with PWS than in the controls between 0 and 30 min after glucose loading. CONCLUSION: The relatively low levels of amylin, compared to those in overweight controls, during the early phase of glucose loading in patients with PWS, may contribute, in part, to the excessive appetite of PWS patients as compared to the overweight controls.
Adolescent ; Blood Glucose/analysis ; Child ; Female ; Glucagon/blood ; Glucose/*pharmacology ; Glucose Tolerance Test ; Humans ; Insulin/blood ; Islet Amyloid Polypeptide/*blood/physiology ; Male ; Obesity/blood/physiopathology ; Prader-Willi Syndrome/blood/*physiopathology

PURPOSE: Household endotoxin exposure in allergy and asthma has been gaining attention for its dual potential to exacerbate these conditions in individuals with established disease and to abrogate atopy before disease onset. The aim of this work was to analyze associations between current exposure to bacterial endotoxin in house dust and allergic sensitization in adults with asthma. METHODS: From the homes of 52 adults with asthma and 28 normal controls, house dust endotoxin (detected with a Limulus Amebocyte Lysate QCL-1000) and house dust mite allergens (Der f 1 and Der p 1) were quantified. Allergen sensitization was measured by skin prick test. RESULTS: The endotoxin levels from mattresses were lower in the home of adults with asthma than in that of normal controls. The endotoxin levels from mattresses detected in the home of adults with asthma were positively correlated with Der p 1 levels and wheal size to housedust mite allergens on skin prick tests. Furthermore, the endotoxin levels in living room floor dust were positively correlated with Der f 1 levels, but didn't relate with wheal size to house dust mite allergens. CONCLUSION: Our results indicate that current exposure to house dust endotoxin might be positively associated with allergic sensitization in adults with asthma.
Adult ; Allergens ; Asthma ; Beds ; Dust* ; Family Characteristics ; Horseshoe Crabs ; Humans ; Hypersensitivity ; Pyroglyphidae ; Skin ; Social Conditions*

We report herein a case of subclavian steal syndrome due to occlusive disease in multiple branches of the aortic arch, which was successfully treated by axilloaxillary bypass and subclavian stent insertion. The hemodynamic changes were evaluated using duplex sonography and transcranial Doppler before and after each procedure. The waveform and parameters of blood flow revealed an objective improvement in cerebral perfusion. These findings correlated well with clinical outcome. Neurosonologic evaluation can provide objective evidence for improved hemodynamic status after treatment.
Aorta, Thoracic ; Hemodynamics ; Perfusion ; Stents ; Subclavian Steal Syndrome

BACKGROUND: This nationwide survey was undertaken to characterize the general pathological features of colorectal cancer in Korea, and especially to elucidate the geographical characteristics by means of their anatomical distribution. METHODS: We analysed 1,676 colorectal cancers (from 1,602 patients) surgically resected in 1998 at 15 institutions from nine geographical sites in Korea. RESULTS: The topographic incidence of colorectal cancer in seven out of the total nine geographical sites, was the highest in the rectum (32-54%); and those from Wonju and Cheongju were in the sigmoid colon (28% for both). The right colon cancer incidence was 42% in Wonju and 36% in Cheongju, while it was 17-22% in the other areas. The cecal cancer incidences in Wonju and in Taegu were 7% and 8%, respectively, but 0-4% in the other areas. As for histology, moderately differentiated adenocarcinoma was the most frequent (46-84%), except for in Wonju and Chonju, where the most predominant type was well differentiated (63% and 52%, respectively). CONCLUSION: The incidence of right colon cancer was higher in Wonju and Cheongju, than in the other geographical sites. The cecal predilection was prominent in Taegu and Wonju. The Elucidation of geographical differences in degree of differentiation for tubular adenocarcinoma seems to require further cumulative study with strict guidelines.
Adenocarcinoma ; Cecal Neoplasms ; Chungcheongbuk-do ; Colon, Sigmoid ; Colonic Neoplasms ; Colorectal Neoplasms* ; Daegu ; Gangwon-do ; Humans ; Incidence ; Jeollabuk-do ; Korea ; Pathology ; Rectum

PURPOSE: Thymus and activation-regulated chemokine (TARC) is responsible for the trafficking of Th2 lymphocytes into sites of allergic inflammation. We tested whether TARC is a useful marker for childhood atopic dermatitis (AD) and we evaluated age-related differences in the level of TARC. METHODS: Serum TARC level, serum total IgE level, total eosinophil count and specific IgE level were measured in 401 children. They were characterized as having IgE-mediated atopic dermatitis (n=157), non-IgE mediated atopic dermatitis (n=107), or as healthy control subjects (n=137). RESULTS: TARC levels in AD significantly were higher than those in healthy control subjects. (152.9+/-11.6 vs 56.7+/-5.2 pg/mL, P< 0.05) Serum TARC levels significantly correlated with disease severity (SCORAD index) both in children with IgE mediated AD (r=0.670, P< 0.05) and children with non-IgE mediated AD. (r=0.605, P< 0.05) Serum TARC levels in control subjects decreased in accordance with age. (r=-0.201, P< 0.05) CONCLUSION: Serum TARC might be a useful marker for disease severity both in children with IgE mediated AD and children with non-IgE mediated AD. Serum TARC levels in control subjects decreased in accordance with ages.
Chemokine CCL17* ; Child* ; Dermatitis, Atopic* ; Eosinophils ; Humans ; Immunoglobulin E ; Inflammation ; Lymphocytes ; Thymus Gland*

BACKGROUND: There is confusion in the diagnosis and biological behaviors of gastroenteropancreatic neuroendocrine tumors (GEP-NETs), because of independently proposed nomenclatures and classifications. A standardized form of pathology report is required for the proper management of patients. METHODS: We discussed the proper pathological evaluation of GEP-NET at the consensus conference of the subcommittee meeting for the Gastrointestinal Pathology Study Group of the Korean Society of Pathologists. We then verified the prognostic significance of pathological parameters from our previous nationwide collection of pathological data from 28 hospitals in Korea to determine the essential data set for a pathology report. RESULTS: Histological classification, grading (mitosis and/or Ki-67 labeling index), T staging (extent, size), lymph node metastasis, and lymphovascular and perineural invasion were significant prognostic factors and essential for the pathology report of GEP-NET, while immunostaining such as synaptophysin and chromogranin may be optional. Furthermore, the staging system, either that of the 2010 American Joint Cancer Committee (AJCC) or the European Neuroendocrine Tumor Society (ENETS), should be specified, especially for pancreatic neuroendocrine neoplasms. CONCLUSIONS: A standardized pathology report is crucial for the proper management and prediction of prognosis of patients with GEP-NET.
Consensus ; Digestive System ; Humans ; Joints ; Korea ; Lymph Nodes ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Prognosis ; Synaptophysin

The first edition of the ‘Standardized Pathology Report for Colorectal Cancer,’ which was developed by the Gastrointestinal Pathology Study Group (GIP) of the Korean Society of Pathologists, was published 13 years ago. Meanwhile, there have been many changes in the pathologic diagnosis of colorectal cancer (CRC), pathologic findings included in the pathology report, and immunohistochemical and molecular pathology required for the diagnosis and treatment of colorectal cancer. In order to reflect these changes, we (GIP) decided to make the second edition of the report. The purpose of this standardized pathology report is to provide a practical protocol for Korean pathologists, which could help diagnose and treat CRC patients. This report consists of “standard data elements” and “conditional data elements.” Basic pathologic findings and parts necessary for prognostication of CRC patients are classified as “standard data elements,” while other prognostic factors and factors related to adjuvant therapy are classified as “conditional data elements” so that each institution could select the contents according to the characteristics of the institution. The Korean version is also provided separately so that Korean pathologists can easily understand and use this report. We hope that this report will be helpful in the daily practice of CRC diagnosis.

PURPOSE: In 2010, the World Health Organization categorized L-cell type neuroendocrine tumors (NETs) as tumors of uncertain malignancy, while all others were classified as malignant. However, the diagnostic necessity of L-cell immunophenotyping is unclear, as are tumor stage and grade that may guide diagnosis and management. To clarify the predictive markers of rectal neuroendocrine neoplasms (NENs), 5- and 10-year overall survival (OS) was analyzed by pathological parameters including L-cell phenotype. MATERIALS AND METHODS: A total of 2,385 rectal NENs were analyzed from our previous multicenter study and a subset of 170 rectal NENs was immunophenotyped. RESULTS: In univariate survival analysis, tumor grade (p < 0.0001), extent (p < 0.0001), size (p < 0.0001), lymph node metastasis (p=0.0063), and L-cell phenotype (p < 0.0001) showed significant correlation with the prognosis of rectal NENs; however, none of these markers achieved independent significance in multivariate analysis. The 10-year OS of tumors of NET grade 1, < 10 mm, the mucosa/submucosa was 97.58%, 99.47%, and 99.03%, respectively. L-Cell marker, glucagon II (GLP-1&2), with a cut off score of > 10, is useful in defining L-Cell type. In this study, an L-cell immunophenotype was found in 83.5% of all rectal NENs and most, but not all L-cell type tumors were NET G1, small (< 10 mm) and confined to the mucosa/submucosa. CONCLUSION: From these results, the biological behavior of rectal NENs does not appear to be determined by L-cell type alone but instead by a combination of pathological parameters.
Diagnosis ; Glucagon ; Immunohistochemistry ; Immunophenotyping ; International Classification of Diseases ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Neuroendocrine Tumors* ; Phenotype ; Prognosis ; Rectal Neoplasms ; World Health Organization