Tracheal tumors are uncommon comprising less than 0.1% of all malignancies. Metastatic tracheal tumors, especially form the extrathoracic sites, are exceedingly rare. Ovarian cancer tends to metastasize to the serous cavities and the lymph nodes. One large autopsy study reported tracheal involvement in 1% of patients who had died from ovarian cancer. Other studies have not mentioned tracheal involvement at all. Since the main symptoms of cough, hemoptysis, or wheezing are nonspecific, patients may be initially treated for other conditions including asthma or bronchitis. Here we describe a metastatic tracheal tumor from an overain carcinoma that was initally treated for bronchial asthma.
Asthma ; Autopsy ; Bronchitis ; Cough ; Hemoptysis ; Humans ; Lymph Nodes ; Ovarian Neoplasms ; Respiratory Sounds

No abstract available.
Anemia* ; Erythropoietin* ; Humans* ; Infant, Newborn ; Infant, Premature*

No abstract available.
Bone Marrow* ; Necrosis* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma*

To study the clinical characteristics and treatment results of childhood soft tissue sarcoma, the retrospective study was performed on 67 patients with soft tissue sarcoma, experienced at the Department of Pediatrics, Seoul National University Hospital from January, 1982 to July, 1990. The median age of 67 soft tissue sarcoma patients was 4 years 5 months and age distribution showed that 0-4 year age group was most common (55.2%). The sex ratio of male to female was 1.2:1. There were 3 cancers among relatives of soft tissue sarcoma patients, including one cancer among first-degree relatives. As for pathological classification, rhabdomyosarcoma (67.1%) was the most common childhood soft tissue sarcoma, followed by malignant Schwannoma (8.9%), extraskeletal Ewing's sarcoma (6.0%), infantile fibrosarcoma (4.5%), malignant fibrous histiocytoma (3.0%), malignant hemangiopericytoma (3.0%), and there were 1 case each of angiosarcoma, leiomyosarcoma, synovial sarcoma, malignant mesenchymoma and mesenchymal chondrosarcoma. The median age of 45 rhabdomyosarcoma patients was 3 years 8 months and age distribution showed that 0-4 year age group was most common (64.5%). Twenty three patients were male and 22 were female. The histologic subtype of rhabdomyosarcoma was embryonal type in 38 patients (84.5%), alveolar type in 5 patients (11.1%) and unclassified type in 2 patients (4.4%). As for primary site of soft tissue sarcomas, the most frequent site was the head and neck region (32.8%) including parameningeal region (13.4%) and orbit (6.0%), followed by extremities (20.9%), trunk (19.4%), retroperitoneum and pelvis (11.9%), urogenital region (7.5%), perineum and perianal region (4.5%) and other region (3.0%). As for primary site of 45 rhabdomyosarcoma cases, the most frequent site was also the head and neck region (37.8%). The most common initial symptom of soft tissue sarcoma patients was mass (68.7%). As for Intergroup Rhabdomyosarcoma Study clinical grouping system of 67 soft tissue sarcoma patients, clinical group III (58.2%) was most common, followed by clinical group II(20.9%), IV (14.9%) and I (6.0%). Of 10 cases of clinical group IV with distant metastasis, lung (8 cases) was the most common metastaic region and other metastatic regions were bone, kidney, liver and bone marrow. As for IRS clinical grouping system of 45 rhabdomyosarcoma patients, clinical group III was most common (68.9%). Of 6 cases of clinical group IV, lung (5 cases) was also the most common metastatic region, followed by kidney and liver. From 1982 to 1985, chemotherapy was done with pulse VAC or pulse VAdrC-VAC regimen based on IRS-I and IRS-II. From 1986, patients in clinical group I and II received vincristine and actinomycin-D for 1 year and patients in clinical group III, IV and II with alveolar histologic subtype(unfavorable histologic group) received vincristine, actinomycin-D, adriamycin, cyclophosphamide and cisplatinum based on IRS-III. Radiation therapy was administered to patients in clinical group II, III and IV. Of 67 cases of soft tissue sarcoma, 54 case were eligible for treatment analysis. The 3 year disease free survival (DFS) of all 54 cases was 54.1%, 3 year DFS of clinical group I and II was 83.9%,3 year DFS of clinical group III and IV before 1986 was 35.7% and after 1986 was 48.2%. Of 45 cases of rhabdomyosarcoma, 41 cases were eligible for treatment analysis. The 3 year DFS of all 41 cases was 49.1%,3 year DFS of clinical group I and II was 87.5%,3 year DFS of clinical group III and IV before 1986 was 27.2% and after 1986 was 45.0%. Patients in clinical group I and II who had no gross residual tumor after primary surgical excision had best prognosis with 3 year DFS approximating 90% with only 2 drugs regimen, significantly better than patients in clinical group III and IV with 3 year DFS below 50% even after intensifying chemotherapy since year 1986. This analysis suggests that total surgical removal is very important for improving prognosis and should be undertaken where possible in all patients without distant metastasis. Treatment results also showed that after year 1986 with intensification of chemotherapy, 3 year DFS of clinical group III and IV as well as early toxic deaths increased, and after lowering doses of chemotherapeutic agents of regimen 35 of IRS-III, treatment results improved much. Therfore to improve prognosis of patients with gross residual tumor after surgical excision of biopsy and patients with distant metastasis at diagnosis, intensified multiagent chemcherapeutic regimen with adequate dose modification should be done to lower early toxic deaths.
Age Distribution ; Biopsy ; Bone Marrow ; Chondrosarcoma, Mesenchymal ; Classification ; Cyclophosphamide ; Diagnosis ; Disease-Free Survival ; Doxorubicin ; Drug Therapy ; Extremities ; Female ; Fibrosarcoma ; Head ; Hemangiopericytoma ; Hemangiosarcoma ; Histiocytoma, Malignant Fibrous ; Humans ; Kidney ; Leiomyosarcoma ; Liver ; Lung ; Male ; Mesenchymoma ; Neck ; Neoplasm Metastasis ; Neoplasm, Residual ; Neurilemmoma ; Orbit ; Pediatrics ; Pelvis ; Perineum ; Prognosis ; Retrospective Studies ; Rhabdomyosarcoma ; Sarcoma* ; Sarcoma, Ewing ; Sarcoma, Synovial ; Seoul ; Sex Ratio ; Survival Rate ; Vincristine

We report 2 cases of pediatric DNTs which presented with intractable seizures and no other associated neurologic abnormalities. They showed typical appearance of DNTs on neuroimaging and histopathology. Most patients with DNT can be cured by surgical treatment with exellent outcome and do not need ratio- or chemotheraphy. This study indicates that it is quite important to consider DNTs as one of differential diagnoses in patients with intractable seizures especially when they present only with seizures without other neurologic symptoms.
Child* ; Diagnosis, Differential ; Humans ; Neoplasms, Neuroepithelial* ; Neuroimaging ; Neurologic Manifestations ; Seizures*

Background: Oral frailty is defined as the functional decline of the oral function due to aging, and it is associated with frailty andchronic disease. Most of the frailty intervention is for adults aged 65 years and older. However, early intervention for preventive disorder is most important. The objective of this study was to identify the age at which oral frailty surpass the “normal” range. Methods: This cross-sectional study included 719 adults (aged 30∼89 years) residing in Gangwon province in May 2023. Risk of oral frailty was assessed using criteria from The Korean Academy of Geriatric Dentistry including oral function such as swallowing and mastication, and frailty. Frailty was assessed using the Kihon Checklist. To determine when oral frailty surpass the “normal” status, statistical analysis including chi-squared tests and multiple logistic regression analysis were performed using R (ver. 4.3.1). Results: There were 388 (54.0%) individuals who had a “normal” status risk of oral frailty. The risk of oral frailty was higher in the 50∼54 age group compared to the 30∼34 age group (odds ratio [OR] 0.50, 95% confidence interval [CI] 0.28∼0.91), after adjusting for gender, education, income, occupation, and frailty (OR 0.46, 95% CI 0.22∼0.94). This means that from 50∼54 years old, regardless of gender, education, income, occupation, or frailty condition, there is a distinction from the “normal” status. Conclusion We found that intervention for oral frailty is needed starting from age 50 years. This is the stage where earlyindications of oral frailty become apparent. Early intervention for oral frailty can lead to a decrease in the prevalence of diseases and medical expenditure. Therefore, early intervention in middle-aged adults of oral frailty is necessary to improve the quality of life related to oral health.

No abstract available.

There are numerous agents with potential toxic effects on the lung. In particular, cytotoxic drugs constitute the largest and most imprtant group of agents associated with lung toxicity. Bleomycin is commonly used, either alone or in combination with other chemotherapeutic agents, in the treatment of squamous cell carcinoma(head and neck, esophagus, and genitourinary tract), lymphoma, and germ cell tumor. One of the therapeutic advantages of bleomycin is its minimal bone marrow toxicity. However, pulmonary toxicity is one of the most serous adverse side effect. Classically, pulmonary toxicity manifests as a diffuse interstitial process or less commonly as a hypersensitivity reaction. This pulmonary toxicity is generally considered to be dose related and can progress to a fatal fibrosis. It is also possible that bronchiolitis obliterans organizing pneumonia(BOOP) is another manifestation of bleomycin induced toxicity. Bleomycin induced BOOP is less common and has a favorable response to steriod therapy. Here we present a case that demonstrates a BOOP, secondary to a relatively small cumulative dose of bleomycin(225mg/??, may be reversible.
Bleomycin* ; Bone Marrow ; Bronchiolitis Obliterans* ; Bronchiolitis* ; Cryptogenic Organizing Pneumonia ; Esophagus ; Fibrosis ; Hypersensitivity ; Lung ; Lymphoma ; Neck ; Neoplasms, Germ Cell and Embryonal ; Pneumonia*

BACKGROUND: Fresh gas flow (FGF) influences the speeds of induction and emergence. In general, emergence protocol involves a stepwise decrease in the vaporizer setting at fixed FGF, which causes anesthetic overuse and contaminates operating rooms. This study was designed to compare the decreasing patterns of sevoflurane concentration among groups with a similar course but with different FGFs. METHODS: One hundred patients scheduled for elective operation were randomly allocated to 3 groups (FGF 1 L/min, FGF 2 L/min, FGF 4 L/min). After induction with thiopental sodium 5 mg/kg and rocuronium 0.9 mg/kg or vecuronium 0.1 mg/kg for tracheal intubation, anesthesia was maintained at 1.5% of end-tidal sevoflurane concentration at an inflow of 4 L/min (N2O 2 L/min and O2 2 L/min). Ten minutes prior to the estimated operation end point, we changed FGF and vaporizer settings to the following 3 different emergence protocols: changing inflow in the FGF 1 L/min group (N2O 0.5 L/min and O2 0.5 L/min) with turning vaporizer off, changing inflow in the FGF 2 L/min group (N2O 1 L/min and O2 1 L/min) with a two-step decrease in the vaporizer setting (1.0 vol% for first 5 minutes then with the vaporizer off), and maintaining the inflow in the FGF 4 L/min group with a three-step decrease in the vaporizer setting (1.0 vol% for first 5 minutes and 0.6 vol% for next 5 minutes then with the vaporizer off). In each group, inspiratory and end-tidal sevoflurane concentrations were recorded every minute for 16 minutes, while end-tidal CO2, mean arterial pressure, heart rate, and inspired oxygen fraction were recorded every two minutes for 16 minutes. RESULTS: End-tidal concentrations of sevoflurane were similar in the 3 groups at the 6th, and 7th minutes and continuously increasing differences in sevoflurane concentrations from the 11th to 16th minute were observed in the FGF 1 L/min and FGF 2 L/min groups versus the FGF 4 L/min group. The concentration curves for the FGF 1 L/min group showed a smoother decreasing pattern than those of the other groups. CONCLUSIONS: The use of low FGF without vaporizer during emergence reduces sevoflurane washout within anesthetic machines and the exhausting of anesthetics into operating rooms, and also offers an easier means of controlling anesthetic depth.
Anesthesia* ; Anesthetics ; Arterial Pressure ; Fibroblast Growth Factor 2 ; Heart Rate ; Humans ; Intubation ; Nebulizers and Vaporizers ; Operating Rooms ; Oxygen ; Thiopental ; Vecuronium Bromide

PURPOSE: Renal scar or reflux nephropathy, known as a major cause of end-stage renal failure and hypertension in children and young adults, is frequently detected in pediatric urinary tract infection(UTI) patients at their first infections. So early and accurate diagnosis, and follow up of renal scar are very important. We performed this study to recognize the importance of radiologic examinations for detection of renal scar and vesicoureteral reflux(VUR) in pediatric UTI patients at their first attacks, and to compare the accuracy and usefulness of DMSA renal scan with renal ultrasonography and IVP in early detection and follow up of renal scar. We also wanted to find the association of renal scar with VUR detected by VCUG, and increased C-reactive protein(CRP) level. METHODS: We studied on 41 pediatric UTI patients without past medical history of UTI, who were admitted to the Department of Pediatics, Kangbuk Samsung Hospital from May 1993 to August 1995. On admission a blood sample was taken for the determination of CRP. Renal ultrasonography and DMSA renal scan were performed within five days after admission. Eight weeks later, with repeated studies of renal ultrasonography and DMSA renal scan, IVP and VCUG were also performed for all patients. RESULTS: 1) The incidence of UTI was most prevalent in infancy grou(56%). The ratio of male to female patients was 4.8:1 under the age of one year, and 1:2 over the age of one year. 2) At admission, 21 of 41 patients(51%) showed renal scars in the DMSA renal scans. At follow up of DMSA renal scans, 8 weaks later, 7 of 21 initially abnormal cases(33%) became normal while 14 cases(67%) continued to show renal scars. Twenty initially normal cases continued to show normal DMSA renal scans at follow up. 3) Renal ultrasonography showed 10 abnormal cases among 41 cases(24%) at admission, and 7 abnormal cases(17%) at follow up. IVP showed 13 abnormal cases among 41 cases(32%). 4) For detection of renal scar, sensitivity and specificity of DMSA renal scan were 95% and 100%, sensitivity and specificity of renal ultrasonography were 45% and 90%, and sensitivity and specificity of IVP were 59% and 100% retrospectively. 5) VCUG showed reflux in 13 patients among 41 patients(32%). Among 20 patients with normal DMSA renal scan, only two patients(10%) showed VUR in VCUG, and they were classified as grade I and II VUR by International Reflux Study Committee classifications. Among 21 patients with abnormal by DMSA renal scan, 11 patients(52%) showed VUR in VCUG, of whom 9 patients were classified as severe reflux above grade III. 6) The mean CRP level in the patients with normal DMSA renal scan was 9.6mg/L, significantly lower than mean CRP level of patients with abnormal DMSA renal scan which was 60.57mg/L(p<0.01). CONCLUSIONS: For early detection of renal scars and reflux nephropathy, appropriate radiologic investigations including DMSA renal scan and VCUG should be done to all pediatric UTI patients at their first attacks. DMSA renal scan seemed to be better radiologic method than renal ultrasonography and IVP in early detection of renal scar and have association with VUR. We also found that blood CRP level is easy and useful test for early suspection of upper UTI.
C-Reactive Protein* ; Child ; Cicatrix ; Classification ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Hypertension ; Incidence ; Kidney Failure, Chronic ; Male ; Retrospective Studies ; Sensitivity and Specificity ; Succimer* ; Ultrasonography ; Urinary Tract Infections* ; Urinary Tract* ; Young Adult