No abstract available.
Cytomegalovirus* ; DNA* ; Glomerulonephritis* ; Polymerase Chain Reaction*

PURPOSE: Leptin is a hormone, encoded by ob gene in adipocytes and regulates food intake and energy expenditure. The serum concentration of leptin is known to be proportional to the amount of body fat but the regulation of leptin for growth and development in childhood is not clear. The purpose of this study is to evaluate the correlation of serum leptin levels to gender, pubertal development and sex steroid in children. METHODS: Serum leptin levels were measured by RIA in 145 Korean children of both sexes, age 8-16yr, and were compared according to body mass index, gender and pubertal stage. The correlations of leptin with testosterone and estradiol were also analized. RESULTS: A positive relationship was observed for leptin levels with body mass index(in male:r=0.63, P<0.001, in female:r=0.80, P<0.001). The mean leptin level of girls was higher than that of boys(7.50+/-.83ng/mL vs 4.11+/-.72ng/mL, P<0.05) in lean children but there was no significant difference in obese group. An analysis according to the pubertal development showed an increase of leptin level in girls while leptin decreased in boys at overt puberty. Serum leptin levels of boys in puberty correlated inversely with testosterone(r=-0.52, P<0.001) but leptin of girls did not have significant correlation with estradiol. CONCLUSION: Serum leptin level increases in girls and decreases in boys as the pubertal development proceeds. The relationships between leptin level and pubertal developement show gender difference and it might be explained in part by suppressive effects of androgen in male.
Adipocytes ; Adipose Tissue ; Adolescent ; Body Mass Index ; Child* ; Eating ; Energy Metabolism ; Estradiol ; Female ; Growth and Development ; Humans ; Leptin* ; Male ; Puberty ; Testosterone

Neonatal sepsis is a major contributing factor for increased mortality and morbidity in the newbron and its successful outcome depends on early detection and prompt institution of an effective antimic robial therapy. Accurate diagnosis of the neonatal septicemia, however, is quite difficult because its early signs and symptoms are rather subtle. This study was conducted in an attempt to search for useful early markers for the clinical entity A total of 224 newborns, over a 17 month pcriod (1/90 5/91), who were evaluated for probable neonatal sepsis were analysed. The laboratory parameters that showed highest correlation with bacteriologically proves sopsis were as follows: Total WBC counts (<5,000/mm), Band/Total ncutrophils(>0.2), elevated ESR(>15mm/hr), CRP(>6ng/ml). Of the 224 study subjects, 41 had two or more parameters of which 12 subjects had positive blood cultures(positive predictive value:29%), only 4 of the 183 newborns who had less than 2 parameters had positive blood cultures(false negative:2%). It is concluded that the presence of two or more of the above parameters can be used as a strong indicator for neonatal sepsis and its sensitivity is 75% while specificity is 86%.
Diagnosis ; Early Diagnosis* ; Humans ; Infant, Newborn ; Mortality ; Sensitivity and Specificity ; Sepsis*

PURPOSE: To evaluate the association between multidrug resistance (MDR) gene and prognosis of acute lymphoblastic leukemia (ALL), several parameters were compared according to the expression status of MDR associated P-glycoprotein. METHODS: 40 bone marrow samples from 36 children of acute lymphoblastic leukemia were analyzed with immunohistochemical stain by C219 monoclonal antibody. RESULTS: 1) The expression of MDR associated P-glycoprotein was positive in 47% at the time of initial diagnosis & 66.7% at relapse. 2) There are no stastical difference between two groups in complete remission rate, relapse rate, mean 2 years survival rate. 3) Event free survival duration was 11.3 months (+/-8.5 months) in P-glycoprotein positive group, while 20 months (+/-7.3months) in P-glycoprotein negative group (P<0.05). 4) There are no stastical difference between two groups in the mean age, sex ratio, initial WBC and immunophenotype of subjects. CONCLUSION: These results suggested the possibility of adopting MDR associated P-glycoprotein in the design of therapeutic regimen and prognostification of childhood acute lymphoblastic leukemia. However, a prospective, randomized study incorporating a larger population should precede before a firm conclusion of significance would draw regarding the prognostic and the therapeutic implication of P-glycoprotein in childhood acute lymphoblastic leukemia.
Bone Marrow ; Child* ; Diagnosis ; Disease-Free Survival ; Drug Resistance, Multiple* ; Humans ; P-Glycoprotein* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Prognosis ; Prospective Studies ; Recurrence ; Sex Ratio ; Survival Rate

PURPOSE: The laparoscopic adrenalectomy (LA) has become the preferred procedure for adrenal tumors since it has many advantages; a more rapid and comfortable recovery, shorted hospitalization, and fewer complications. The purpose of this study was to report the initial 4 years experiences of LA and describe the unusual findings encountered during the operations. METHODS: From February 1997 to November 2000, a total of 20 LA were performed. Several techniques of LA have been described already. We prefer the transabdominal approach in the lateral decubitus position using 3 or 4 trocars. RESULTS: 20 patients had all unilateral tumor. The pathological findings were 11 aldosteronomas, 6 Cushing adenomas, 2 pheochromocytomas and 1 cortical carcinoma. 18 cases of 20 patients were successfully operated by laparoscopic procedure and 2 cases were converted to open adrenalectomy. The reasons of conversion were sudden cardiac arrest due to unknown origin and intraoperative bleeding due to periadrenal massive fat. During the laparoscopic operation, 2 patients showed abnormal EKG findings. The pathologies of those patients were non-catecholamine-secreting cortical adenomas. After operation, they have been completely normal in EKG. The average operating time for the complete laparoscopic adrenalectomies was 186 minutes in the first 9 cases and 132 minutes in the next 9 cases. The first oral intake was started within 24 hours in all cases. There was no postoperative complication and no operative morbidity or mortality. The average hospital stay was 6.2 days in the first 9 cases and 4.2 days in the next 9 cases. CONCLUSION: The LA is relatively fast and safe method and is accepted as the preferred procedure for the adrenal tumors but it should be well prepared perioperatively. Surgeons and anesthesiologists should be aware of those possible cardiovascular complications and of the problems inherent in the manipulation of the adrenal gland during LA.
Adenoma ; Adrenal Glands ; Adrenalectomy* ; Death, Sudden, Cardiac ; Electrocardiography ; Hemorrhage ; Hospitalization ; Humans ; Length of Stay ; Methods ; Mortality ; Pathology ; Pheochromocytoma ; Postoperative Complications ; Surgeons ; Surgical Instruments

BACKGROUND: Pancreaticoduodenectomy is well established in the armamentarium of the surgeon treating periampullary carcinoma and benign lesion. With refinement of operative technique and more enlighting management during the postoperative period, the morbidity and mortality of this procedure have reduced significantly. Leakage of the pancreaticojejunal anastomosis has been a major complication after this procedure, frequently reported in an incidence of 5 percent to 15 percent. Therefore, authors retrospectivly reviewed about clinical experience of duct-to-mucosa anastomosis and PTBD in pancreaticoduodenectomy. OBJECTS & METHODS: The authors retrospectively reviewed the medical records of 93 patients who had undergone a pancreaticoduodenectomy with the duct-to-mucosa method between 1994 and 2000 by one surgeon. RESULTS: The male-to female ratio was 2.1:1(63:30) and mean age was 57 years old(range from 26 to 77). Thirty patients(32.6%) of 93 patients were distal common bile duct cancer, 22 patients(24%) were pancreatic head cancer, 21 patients(23%) were Ampulla of Vater cancer, 5 patients(5.4%) were chronic pancreatitis, 3 patient(3.3%) were duodenal cancer. The operative morbidity was 35.8%, and there was three perioperative mortality(3.2%). The mean operative time was 8.8 hours. A pancreatic fistula was diagnosed in 6 of the 93 patients(6.5%) and surgical intervention was done in 1 of the 6 patients. A PTBD for preoperatively biliary drainage was done 64 cases and complication related PTBD was 3 cases(4.7%, hemobilia). CONCLUSIONS: Even if this anastomotic technique requires a little more time and attention by the surgeon, we experienced that the low incidence of pancreatico-jejunal anastomosis related complication represents a validation of the method, and a motivation to adapt this anastomotic technique. But, this method is not absolute because surgeon's preference is most important factor in operation.
Ampulla of Vater ; Common Bile Duct ; Drainage ; Duodenal Neoplasms ; Female ; Head and Neck Neoplasms ; Humans ; Incidence ; Medical Records ; Mortality ; Motivation ; Operative Time ; Pancreatic Fistula ; Pancreaticoduodenectomy ; Pancreaticojejunostomy* ; Pancreatitis, Chronic ; Postoperative Period ; Retrospective Studies

PURPOSE: Cystic lesions of the liver are highly variable in respect to appearance and therapeutic approach. However, without cystectomy and hepatic resection, the patient is at risk for recurrent enlargement, infection, or progression of an unrecognized malignant neoplasm. The goal of this study was to discern the safest and most effective method, with special emphasis on a suitable therapeutic technique for various cystic lesions of the liver. METHODS: We reviwed the cystectomy and hepatic resection and outcome of patients with hepatic cysts from November, 1987 to April, 2000 at the Hanyang University Hospital. A retrospective study of 19 patients with various cystic lesions of the liver was performed. RESULTS: There were 8 simple cysts, 2 polycystic liver disease, 2 biliary cystadenoma, 4 biliary cystadenocarcinoma, 2 hydatid cysts, and 1 traumatic cyst. In examining the 6 cystectomies, 13 hepatic resections. (4 right lobectomies, 4 left lobectomies, 5 minor hepatic resections), there were no postoperative deaths in this series. Four patients (21.1%) developed operative complications. During the mean follow- up time of 78.2 months, symptomatic relief was complete and permanent in all of patients except the 1 biliary cystadenocarcinoma 1 of the 4 patients with biliary cystadenocarcinoma died of tumor recurrence (5.3%) approximately 27 months after hepatic resection. CONCLUSION: Cystectomy and hepatic resection is a more curative treatment for cystic lesions of the liver than other treatments. We recommend complete cystectomy and hepatic resection as the preferred therapy, particularly when the cyst is large, a malignancy cannot be ruled out, and a proper diagnosis is not confirmed.
Cystadenocarcinoma ; Cystadenoma ; Cystectomy* ; Diagnosis ; Echinococcosis ; Humans ; Liver Diseases ; Liver* ; Recurrence ; Retrospective Studies

The authors present 2 cases of malignant pituitary adenoma. One case has remote metastases to the right frontal lobe, and the other case has invasion into the adjacent temporal lobe and malignant features histologically. Malignant pituitary adenoma constitute less than 1% of the large reported series of pituitary adenoma, which defined as (1) it burst its capsule to invade the adjacent nervous structures or bone, (2) it shows malignant features histologically, such as frequent mitoses, anaplasia with hyperchromatic pleomorphic cells, loss of alveolar arrangement, and (3) presence of distant metastases.
Anaplasia ; Frontal Lobe ; Mitosis ; Neoplasm Metastasis ; Pituitary Neoplasms* ; Temporal Lobe

A primary hepatic sarcoma is a rare tumor, that most frequently arises from hepatic connective tissue or vascular channels, and is usually located in the intrahepatic area. Pedunculated, or bulging, lesions have also been reported. We encountered a pedunculated primary hepatic leiomyosarcoma occurring in a 61-year-old woman. A giant exophytic hepatic mass measuring 15x10cm in size, was located in the left lateral segment of the liver, which was compressing the stomach. A left lateral segmentectomy was performed. Microscopically, the tumor was composed of spindle cells reactive to muscle specific actin. The mitotic figures were 5/10 high power fields indicating the tumor was malignant. No other primary sites were recognized from clinical studies.
Actins ; Connective Tissue ; Female ; Humans ; Leiomyosarcoma* ; Liver ; Mastectomy, Segmental ; Middle Aged ; Sarcoma ; Stomach

Angiomyolipoma is a benign renal tumor composed of thick- walled blood vessels, smooth muscle cells, and adipose tissue. Despite the aggressive biological and histological features associated with angiomyolipoma, the lack of distant metastasis led us to conclude that angiomyolipoma is a benign neoplasm. Epithelioid angiomyolipoma is a recently described variant type of angiomyolipoma of the kidney. Diagnosis is usually made by histological method and immunohistochemical staining with HMB-45. Several reports suggested the presence of malignant epithelioid angiomyolipomas showing multiple metastases and local aggressiveness. We report a case of epithelioid angiomyolipoma with multiple metastases. Local recurrence and liver, bone and lung metastases developed 11 months after radical nephrectomy. Right hepatectomy and wedge resection of left lobe of the liver with radiation therapy were done.
Adipose Tissue ; Angiomyolipoma* ; Blood Vessels ; Diagnosis ; Hepatectomy ; Kidney ; Liver ; Lung ; Myocytes, Smooth Muscle ; Neoplasm Metastasis* ; Nephrectomy ; Recurrence