PURPOSE: The aim of this study is evaluating the accuracy of preoperative magnetic resonance imaging (MRI) in patients who underwent pelvic lymph node dissection (PLND). MATERIALS AND METHODS: The medical records of 1,528 patients who underwent radical prostatectomy and PLND from 2003 to 2017 in Seoul National University Bundang Hospital were retrospectively reviewed. We evaluated the various clinicopathologic variables including preoperative MRI findings and pathologic lymph node (LN) metastasis. The prediction model for pathologic LN metastasis was assessed using univariate and multivariable logistic regression analyses and areas under receiver operating characteristic (ROC) curves. RESULTS: The mean age of our cohort was 66.4±6.7 years. Positive LN finding of preoperative MRI finding was observed in 9.4% (145 of 1,528) of patients. 5.3% (81 of 1,528) of patients had confirmed final pathologic LN metastases. Sensitivity and specificity of preoperative MRI were 30.8% and 91.7%, respectively. Multivariable analysis showed that preoperative MRI findings, clinical stage and biopsy Gleason score were independent significant predictors for pathologic LN metastasis (p < 0.001, p=0.002, and p < 0.001, respectively). Prediction model using preoperative MRI findings and National Comprehensive Control Network risk stratification showed fair accuracy using ROC analysis. CONCLUSIONS: Preoperative MRI findings for pathologic LN metastasis showed limited prediction value. A large-scale, multicenter, prospective study is needed to fully evaluate the clinical significance of preoperative MRI.
Biopsy ; Cohort Studies ; Humans ; Logistic Models ; Lymph Node Excision* ; Lymph Nodes* ; Magnetic Resonance Imaging* ; Medical Records ; Neoplasm Grading ; Neoplasm Metastasis* ; Prospective Studies ; Prostate* ; Prostatectomy ; Prostatic Neoplasms* ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Seoul

Rice is a popular food all over the world. Rice is regarded as hypoallergenic and rice hypersensitivity is not common. We experienced a case of multiple food allergy including cow's milk, egg white, buckwheat, soybean and rice. The 8 month-old boy presenting with atopic dermatitis developed recurrent wheezing later. Laboratory findings showed a high serum level of total IgE (561 kU/L), and high levels of specific IgE to rice (11.0 kU/L), egg white (13.0 kU/L), cow's milk (5.73 kU/L), buckwheat (5.45 kU/L), and soybean (25.5 kU/L) using the immune-CAP system. Foods causing allergic reaction were absolutely eliminated and substituted with hypoallergic formula milk. Thereafter, his skin lesions began to improve, and 5 months later, he was tolerable to eat rice. However, he developed recurrent wheezing at the age of 23 months. At now 4 years, he is regularly followed up without any symptoms of food allegy.
Dermatitis, Atopic ; Egg White ; Fagopyrum ; Food Hypersensitivity ; Hypersensitivity ; Immunoglobulin E ; Milk ; Respiratory Sounds ; Skin ; Soybeans

PURPOSE: To report brain metastasis of hepatocellular carcinoma presenting as homonymous hemianopia. CASE SUMMARY: A 51-year-old female with a history of hepatectomy and diagnosis of hepatocellular carcinoma (HCC) 19 months earlier was referred to our neuro-ophthalmology clinic for evaluation due to headache and decreased visual acuity over the past several months. Best visual acuity was 20/20, and the results of all other aspects of our examination were normal except Humphrey automatic perimetry, which showed complete left homonymous hemianopia. Brain magnetic resonance imaging showed a large mass in the right occipital lobe. Craniotomy and removal of tumor were performed. HCC was confirmed by histopathologic examination. CONCLUSIONS: Metastasis of hepatocellular carcinoma to the occipital lobe is extremely rare but can present as homonymous hemianopia. Therefore, clinicians should be aware of this when examining a patient with a history of HCC.
Brain ; Brain Neoplasms ; Carcinoma, Hepatocellular* ; Craniotomy ; Diagnosis ; Female ; Headache ; Hemianopsia* ; Hepatectomy ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neoplasm Metastasis* ; Occipital Lobe* ; Visual Acuity ; Visual Field Tests

BACKGROUND: Depression is considered as a risk factor for cardiovascular disease (CVD) and associated with changes in individuals' health status that might influence CVD risk. However, most studies have scrutinized this relationship on a rather narrower and specific study population. By focusing on general population of Korea, we sought to inspect the association of depression with CVD risk and cardiovascular risk factors. METHODS: The data from the first year (2016) of the 7th Korea National Health and Nutrition Examination Survey was used. Participants were classified by the Patient Health Questionnaire-9 (PHQ-9) score as such: normal group (PHQ-9 score 0–4), mild depression (MD) group (PHQ-9 score 5–9) and moderate and severe depression (MSD) group (PHQ-9 score 10–27). General linear model was used to analyze differences and the trend of mean CVD risk according to depression level. Adjusted odds ratios (AORs) were calculated by logistic regression to identify the association between depression and cardiovascular risk factors after adjusting for age. RESULTS: Mean CVD risk of MSD group was higher than that of normal group (p < 0.05). There was a tendency of CVD risk to increase as depression worsened (p < 0.01). Among men, MSD group was associated with current smoking (AOR, 2.97; 95% confidence interval [CI], 1.78–4.97), taking antihypertensive medications (AOR, 2.42; 95% CI, 1.26–4.66), increased fasting blood sugar (> 125 mg/dL; AOR, 2.37; 95% CI, 1.25–4.50) and taking diabetes medications (AOR, 3.08; 95% CI, 1.65–5.72). MD group was associated with current smoking (AOR, 1.60; 95% CI, 1.18–2.17). Among women, MSD group was associated with high body mass index (≥ 25 kg/m2; AOR, 1.61; 95% CI, 1.11–2.32), large waist circumference (≥ 85 cm; AOR, 1.63; 95% CI, 1.12–2.37), current smoking (AOR, 5.11; 95% CI, 3.07–8.52) and taking diabetes medications (AOR, 2.62; 95% CI, 1.68–4.08). MD group was associated with current smoking (AOR, 1.86; 95% CI, 1.18–2.93). CONCLUSIONS: We suggest that depression is associated with increased risk for CVD occurrence in general population of Korea.
Blood Glucose ; Body Mass Index ; Cardiovascular Diseases ; Depression ; Fasting ; Female ; Humans ; Korea ; Linear Models ; Logistic Models ; Male ; Nutrition Surveys ; Odds Ratio ; Risk Factors ; Smoke ; Smoking ; Waist Circumference

Purpose: Food sensitization to egg white (EW) peaks during early childhood, after which some children with sensitization to EW outgrow food sensitization, while others develop an increased degree of sensitization to EW. We investigated factors determining changes in EW-specific IgE in children under 2 years of age. Methods: Among children under 2 years of age with atopic dermatitis or food allergy who visited Asan Medical Center from March 2018 to September 2021, a total of 172 sensitized to EW were enrolled. Serum specific IgE to EW, ovalbumin and ovomucoid, and specific IgG4 to EW and ovomucoid were measured at 0, 6, and 12 months. An increase in EW-specific IgE was defined as an increased level of EW-specific IgE after 12 months from baseline. Multiple logistic regression analysis was performed to identify factors determining an increase in EW-specific IgE. Results: Of the 172 children, 85 had complete data on serum specific IgE and specific IgG4 during a period of 12 months. The levels of EW-specific IgE were decreased in 51 subjects (60.0%), while they were increased in 34 subjects (40.0%). Introduction of baked eggs had a protective effect against an increase in EW-specific IgE levels during a period of 12 months (adjusted odds ratio, 0.148; 95% confidence interval, 0.022–0.983). Conclusion Introduction of the baked egg can prevent an increase in EW-specific IgE during early childhood. Further studies are needed for the long-term effect of baked egg on the natural course of EW sensitization.

Abnormal inflammatory responses are closely associated with intestinal microbial dysbiosis. Oral administration of Qmatrix-diabetes-mellitus complex (QDMC), an Aloe gel-based formula, has been reported to improve inflammation in type 2 diabetic mice; however, the role of the gut microbiota in ameliorating efficacy of QDMC remains unclear. We investigated the effect of QDMC on the gut microbiota in a type 2 diabetic aged mouse model that was administered a high-fat diet. Proinflammatory (TNF-α and IL-6) and anti-inflammatory (IL-4 and IL-10) cytokine levels in the fat were normalized via oral administration of QDMC, and relative abundances of Bacteroides, Butyricimonas, Ruminococcus, and Mucispirillum were simultaneously significantly increased. The abundance of these bacteria was correlated to the expression levels of cytokines. Our findings suggest that the immunomodulatory activity of QDMC is partly mediated by the altered gut microbiota composition.

Purpose: Sixty to eighty percent of children with egg allergy are able to tolerate eggs in baked form. The purpose of this study was to evaluate the clinical usefulness and diagnostic value of measurements of IgE specific to egg white, ovalbumin, and ovomucoid for reactivity to baked egg in children with sensitivity to egg. Methods: Two hundred seventeen children with suspected egg allergy underwent open food challenges with baked egg (in the form of muffins). The outcomes of the challenges were compared to the serum concentrations of IgE specific to egg white, ovalbumin, and ovomucoid by using ImmunoCAP. Results: There were no statistically significant differences in levels of IgE specific to egg white, ovalbumin, and ovomucoid between the baked egg challenge positive and negative groups younger than 2 years (n = 163). However, significant differences were observed between the challenge positive and negative groups in 54 subjects aged 2 to 5 years (all P < 0.05). The optimal cutoff points of egg white, ovalbumin, and ovomucoid specific IgE levels among children aged 2 to 5 years were 12.40 kU A/L (sensitivity 79%, specificity 66%), 4.07 kU A/L (sensitivity 88%, specificity 58%), and 3.65 kU A/L (sensitivity 77%, specificity 62%), respectively. Conclusion The level of IgE specific to egg white and its components can predict the reactivity to baked egg in children aged 2 to 5years.

PURPOSE: Although many previous studies have attempted to identify differences between atopic asthma (AA) and non-atopic asthma (NAA), they have mainly focused on the difference of each variable of lung function and airway inflammation. The aim of this study was to evaluate relationships between lung function, bronchial hyperresponsiveness (BHR), and the exhaled nitric oxide (eNO) levels in children with AA and NAA. METHODS: One hundred and thirty six asthmatic children aged 5-15 years and 40 normal controls were recruited. Asthma cases were classified as AA (n=100) or NAA (n=36) from skin prick test results. Lung function, BHR to methacholine and adenosine-5'-monophosphate (AMP), eNO, blood eosinophils, and serum total IgE were measured. RESULTS: The AA and NAA cases shared common features including a reduced small airway function and increased BHR to methacholine. However, children with AA showed higher BHR to AMP and eNO levels than those with NAA. When the relationships among these variables in the AA and NAA cases were evaluated, the AA group showed significant relationships between lung function, BHR to AMP or methacholine and eNO levels. However, the children in the NAA group showed an association between small airway function and BHR to methacholine only. CONCLUSIONS: These findings suggest that the pathogenesis of NAA may differ from that of AA during childhood in terms of the relationship between lung function, airway inflammation and BHR.
Asthma* ; Child* ; Eosinophils ; Humans ; Immunoglobulin E ; Inflammation ; Lung* ; Methacholine Chloride ; Nitric Oxide* ; Skin

PURPOSE: Food-dependent exercise-induced anaphylaxis (FDEIA) is a specific clinical syndrome requiring both ingestion of an allergenic food and exercise to induce anaphylaxis. It may be underdiagnosed due to insufficient history taking in terms of the causes of anaphylaxis. This study aims to describe clinical characteristics and diagnostic results of FDEIA in children. METHODS: We retrospectively reviewed the medical records of patients under 18 years old who were diagnosed with FDEIA at Asan Medical Center between January 2003 and August 2014. RESULTS: Of the 170 children with anaphylaxis, 11 (6.5%) had FDEIA. The mean age at the onset of symptoms was 14.8+/-1.5 years. The causative foods were: wheat (n=4), meat (n=1), mung beans (n=1), rice (n=1), celery (n=1), cabbage (n=1), fish (n=1), and soy (n=1). The numbers of symptom development were: 7 (n=1), 6 (n=1), 3 (n=4), 2 (n=2), and 1 (n=3). The geometric mean (range of 1 standard deviation) of total serum IgE levels was 131.6 kU/L (53.5-324.2 kU/L). The skin prick test and immununoCAP were positive for causative foods in 3 of 6 patients (50.0%) and 7 of 10 patients (70.0%), respectively. The provocation test was performed in 8 of 11 patients and showed positive results except 1 patient. The interval between exercise and symptoms was 21.6+/-7.3 minutes. CONCLUSION: It is important to suspect FDEIA and take a detailed history in children with anaphylaxis. Provocation test should be considered to confirm the diagnosis. Further studies on disease course and long-term prognosis are warranted.
Anaphylaxis* ; Apium graveolens ; Brassica ; Child* ; Chungcheongnam-do ; Diagnosis ; Eating ; Fabaceae ; Humans ; Immunoglobulin E ; Meat ; Medical Records ; Prognosis ; Retrospective Studies* ; Skin ; Triticum

PURPOSE: There have been several studies on comparisons of efficacy between subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) in children with house dust mite (HDM)-sensitized allergic rhinitis (AR), without consistent results. This study was conducted to compare short-term effects between SCIT and SLIT in Korean children with HDM-sensitized AR. METHODS: Fifty-three children (mean age, 11.15+/-2.82 years) with HDM-sensitized AR and with/without asthma (SCIT group, n=33; SLIT group, n=20) were enrolled. Clinical symptom scores and skin prick test results were assessed before, and after 3, 6, and 12 months of immunotherapy. Blood tests, including eosinophils, total serum IgE, and HDM-specific IgE, and adenosine 5'-monophosphate, and methacholine bronchial challenge tests were performed before and after 12 months of immunotherapy. RESULTS: In the SCIT group, the symptom scores improved after 3 months compared to those before immunotherapy, whereas they improved after 6 months in the SLIT group. Significant decreases in skin reactivity to HDM were observed after 3 months only in the SCIT group. Decreases in total eosinophil counts and improvements in methacholine bronchial provocation tests were observed after 12 months of immunotherapy only in the SCIT group. No difference in severe adverse reactions was noted in either group. CONCLUSION: The results of this study suggest that SCIT may have more rapid effects on clinical symptoms and skin reactivity in children with AR, compared to SLIT.
Adenosine ; Asthma* ; Bronchial Provocation Tests ; Child* ; Dermatophagoides farinae ; Dermatophagoides pteronyssinus ; Dust* ; Eosinophils ; Hematologic Tests ; Humans ; Immunoglobulin E ; Immunotherapy ; Methacholine Chloride ; Pyroglyphidae ; Rhinitis* ; Skin ; Sublingual Immunotherapy*