BACKGROUND: In infective endocarditis, the recent introduction of transesophageal echocardiography(TEE) improved diagnostic sensitivity and detection of complications. Although the detection rate of vegetations is above 90% by TEE, the prognostic significance of these lesions remains unclear. The purpose of this study was to investigate prognostic factors for systemic embolism and death in infective emdocarditis by the analysis of transesophageal echocardiographic findings. METHODS: Transthoracic echocardiography(TTE0 and TEE were performed in 56 patients with active left-sided infective endocarditis during admission. If a vegetation was present, the size, mobility and consistency of vegetation were analyzed and paravalvular complications were assessed by TEE. Systemic emboli and in-hospital death dude to infective endocarditis were correlated to clinical and echocardiographic findings. RESULTS: 1) Echocardiographic evaluation revealed vegetations(53 patients), abscess(13 patients) and left ventricular dysfunction(13 patients). Systemic embolic events occured in twenty patients(36%) and death occured in thirteen patients(23%). 2) The size, mobility or consistency of vegetation was all foung not to be significant predictor of systemic embolism. But the incidence of embolism is significantly higher in patients who revealed increased vegetation size on follow-up echocardiogram. 3) The incidence of death was significantly higher in patients with left ventricular dysfunction or abscess on echocardiography. Although the mobility or consistency of vegetation was not related to mortality, the mortality was higher significantly in patients with larger vegetations. CONCLUSION: Our data suggest that left ventricular dysfunction, abscess and large vegetation are risk factors for higher mortality and increased vegetation size on follow-up echocardiography is risk factor for systemic embolism. Because TEE is more useful than TTE in evaluating of vegetation and paravalvular complications, TEE should be performed early in all patients with active left-sided infective endocarditis.
Abscess ; Echocardiography ; Echocardiography, Transesophageal* ; Embolism ; Endocarditis* ; Follow-Up Studies ; Humans ; Incidence ; Mortality ; Prognosis ; Risk Factors ; Ventricular Dysfunction, Left

Spontaneous submucosal dissection of the esophagus (SDE) is a rare disease, in which spontaneous submucosal spot bleeding or intramural hematoma leads to the tearing of the layers between submucosa and muscle of the esophageal wall without any definitive cause, and the pathogenesis of SDE has not been well documented yet. Typical symptoms of SDE are chest pain, hematemesis, dysphagia, and odynophagia. The laboratory tests are usually normal and symptoms could be mild and ambiguous, so the diagnosis of SDE is conducted with endoscopy or esophagogram in most cases. The prognosis of SDE is usually very good with just conservative cares such as fasting and fluid therapy Esophageal perforation complicated by SDE is very rare because symptoms od SDE usually bring the patients to hospital before perforation. Recently, we experienced a case of a 54 year-old male showing the endoscopic findings of SDE and complicated mediastinal abscess probably following esophageal perforation. The patient had social history of chronic heavy alcoholic ingestion and had symptoms of substernal pain, dysphagia, and odynophagia. The patient recovered after partial esophagectomy, abscess drainage and antibiotic therapy.
Abscess* ; Alcoholics ; Chest Pain ; Deglutition Disorders ; Diagnosis ; Drainage ; Eating ; Endoscopy ; Esophageal Perforation ; Esophagectomy ; Esophagus* ; Fasting ; Fluid Therapy ; Hematemesis ; Hematoma ; Hemorrhage ; Humans ; Male ; Middle Aged ; Prognosis ; Rare Diseases

BACKGROUND: Wilms tumor is the most common renal tumor in children. The aim of this study was to assess the effect of preoperative chemotherapy after needle biopsy on outcome of Wilms tumor and suggest an optimal treatment scheme on Wilms tumor.METHODS: We reviewed the medical records of 52 patients who were diagnosed with Wilms tumor from 1995 to 2010. Before 2000, primary nephrectomy was usually done. After 2000, preoperative chemotherapy was usually done.RESULTS: Preoperative chemotherapy was given to 39 cases while primary nephrectomy was done in 13 cases. Five year survival rate and five year event-free survival rate were 96.2+/-2.7% and 87.9+/-4.7%, respectively. Tumor spillage occurred more frequently in primary nephrectomy group than in preoperative chemotherapy after needle biopsy group (P=0.014). There was no significant difference in survival between the two groups (P=0.599).CONCLUSION: Preoperative chemotherapy after needle biopsy improved diagnostic accuracy and decreased tumor spillage while strengthened chemotherapy intensity. Further studies are needed to optimize chemotherapy intensity.
Biopsy, Fine-Needle ; Biopsy, Needle ; Child ; Disease-Free Survival ; Humans ; Medical Records ; Nephrectomy ; Survival Rate ; Wilms Tumor

No abstract available.
Heart Transplantation*

BACKGROUND: Rapid and accurate diagnosis is essential for successful management of acute aortic dissection. As transesophageal echocardiography(TEE) provides excellent imaging of thoracic aorta conveniently, TEE is widely indicated as a effective diagnostic method of aortic disease. To evaluate clinical usefulness of TEE in patients with suspected aortic dissection, we assessed diagnostic accuracy and feasibility of TEE. METHODS: Ninety-one consecutive patients with clinically suspected aortic dissection were examined by TEE, computerized tomography(CT), magnetic resonance imagion(MRI) and aortic angiography between August 1991 and September 1994. The diagnosis was confirmend by these techniques and surgery. RESULTS: 1) We diagnosed 27 proximal aortic dissection, 22 distal aortic dissection, 8 aortic intramural hematioma, 12 thoracic aortic aneurysm, 2 penetration ulcer, 1 necrotizing aortitis, 1 traumatioc aortic rupture and 18 normal findings in 91 study patients. 2) The sensitivity and specificity of TEE for aortic dissection were 98% and 97%, respecitively. The sensitivity and specificity of TEE to detect ascending aorta involvement were 94% and 100%. 3) CT was chosen in 62 cases as primary diagnostic method of aortic dissection, whereas TEE was performed in 21 cases. TEE was chosen as confirmative diagnostic method following CT in 45 cases, in one-third of whom TEE played a great role in diagnosis or decision of treatment modality. CONCLUSION: As TEE is and accurate and practical method in diagnosis of aortic dissection, TEE may be suggested as primary diagnostic method in suspected aortic dissection. TEE was also useful as confirmative diagnostic method complemention CT.
Angiography ; Aorta ; Aorta, Thoracic ; Aortic Aneurysm, Thoracic ; Aortic Diseases ; Aortic Rupture ; Aortitis ; Complement System Proteins ; Diagnosis* ; Echocardiography, Transesophageal* ; Humans ; Sensitivity and Specificity ; Ulcer

PURPOSE: The purpose of this study is to investigate the clinical significance of tyrosine hydroxylase (TH) expression in peripheral blood (PB) at diagnosis in patients with neuroblastoma. MATERIALS AND METHODS: TH mRNA expression in PB was measured by reverse transcription quantitative real-time polymerase chain reaction in 210 patients who were newly diagnosed with neuroblastoma from July 2005 to June 2015 and the clinical significance of TH expression in PB at diagnosis was evaluated. RESULTS: TH expression was positive in 60 patients (28.6%). Fifty of 60 TH-positive patients had metastatic tumors and the remaining 10 had localized tumors. TH expression was associated with high-risk features (i.e., advanced stage, older age, unfavorable pathology, and MYCN amplification) at diagnosis. Among TH-positive patients, higher TH expression level was observed in high-risk patients than in low- or intermediate-risk patients (p=0.035). The probability of 5-year progression-free survival (PFS) was lower in TH-positive patients than in TH-negative patients (63.8±6.9% vs. 94.7±2.1%, p < 0.001). In analysis confined to high-risk patients, the 5-year probability of PFS remained lower in TH-positive patients (55.7±8.2% vs. 89.6±5.8%, p < 0.001). Among TH-positive patients, a higher expression level of TH was associated with a worse outcome. In multivariate analyses, positive TH expression in PB at diagnosis was an independent poor prognostic factor for PFS. CONCLUSION: The treatment intensity should be tailored according to TH expression in PB at diagnosis.
Diagnosis* ; Disease-Free Survival ; Humans ; Multivariate Analysis ; Neuroblastoma* ; Pathology ; Polymerase Chain Reaction ; Real-Time Polymerase Chain Reaction ; Reverse Transcription ; RNA, Messenger* ; Tyrosine 3-Monooxygenase* ; Tyrosine*

BACKGROUND: Intracranial germ cell tumors are higher in the East Asia such as Korea and Japan than any other Western countries. By analyzing common clinical features of intracranial germ cell tumors in children, we will prevent from misdiagnosing and delaying in the establishment of diagnosis. Furthermore, we can choose appropriate therapeutic plans to improve patient's prognosis.METHODS: We retrospectively reviewed the medical records of 68 patients to investigate and analyze clinical characteristics of intracranial germ cell tumors in children.RESULTS: The average age of 68 patients was 14.8 years old, and the male to female ratio in all patients was 3:1. The most common symptom presented by 30 patients was headache regarded as a nonspecific symptom in brain tumors. Sixty four patients were diagnosed by histologic method called biopsy and most of them were come out into germinoma. Thirty five patients were included in low-risk group and 30 patients were in high-risk group. Intracranial germ cell tumors in this study were most commonly located in the pineal gland.CONCLUSION: There are a variety of types in intracranial germ cell tumors, and they have been accurately diagnosed by radiologic, histologic methods and elevated tumor markers. We concluded that it is necessary for early diagnosis to evaluate exhaustively in patients suspected of brain tumors.
Biopsy ; Brain Neoplasms ; Child ; Early Diagnosis ; Far East ; Female ; Germ Cells ; Germinoma ; Headache ; Humans ; Japan ; Korea ; Male ; Medical Records ; Neoplasms, Germ Cell and Embryonal ; Retrospective Studies ; Biomarkers, Tumor

BACKGROUND: To avoid the adverse effects of cardiopulmonary bypass and to overcome late vein graft failure, we routinely performed off-pump total arterial coronary revascularization. MATERIAL AND METHOD: From July 2000 to August 2001, 104 consecutive patients underwent first elective off-pump total arterial coronary revascularization. Both internal mammary, radial and gastroepiploic arteries were used. Sequential and composite grafts were used to achieve complete revascularization. Perioperative adverse events and postoperative angiograms were analyzed. RESULT: A total of 252 arterial conduits were used with an average of 2.47 grafts per patient. A total of 326 distal anastomosis were performed with a mean of 3.13 distal anastomosis per patient. Cross over to on-pump occurred in seven patients (6.7%). Of these 4 were due to unstable hemodynamics during lateral or posterior wall stabilization as a result of cardiomegaly and 3 were due to uncontrolled bleeding during dissection of diffusely dimunitive deeply placed intramyocardial coronary arteries. There were no opeartive deaths. Two cases of perioperative myocardial infarction and transient neurologic complications occurred, respectively. Of the 312 distal anastomoses, 308 (98.7%) were compatible with Fitz-Gibbon A or B patency grading. CONCLUSION: Off-pump total arterial coronary revascularization was technically feasible in most elective cases with satisfactory early results. However, on-pump coronary bypass surgery should be considered in difficult circumstances, such as cardiomegaly or unfavorable anatomy of the target coronary artery.
Cardiomegaly ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Vessels ; Gastroepiploic Artery ; Hemodynamics ; Hemorrhage ; Humans ; Myocardial Infarction ; Transplants ; Veins

Multiple RBC transfusions inevitably lead to a state of iron overload before and after high-dose chemotherapy and autologous stem cell transplantation (HDCT/autoSCT). Nonetheless, iron status during post-SCT follow-up remains unknown. Therefore, we investigated post-SCT ferritin levels, factors contributing to its sustained levels, and organ functions affected by iron overload in 49 children with high-risk neuroblastoma who underwent tandem HDCT/autoSCT. Although serum ferritin levels gradually decreased during post-SCT follow-up, 47.7% of the patients maintained ferritin levels above 1,000 ng/mL at 1 yr after the second HDCT/autoSCT. These patients had higher serum creatinine (0.62 vs 0.47 mg/mL, P = 0.007) than their counterparts (< 1,000 ng/mL). Post-SCT transfusion amount corresponded to increased ferritin levels at 1 yr after the second HDCT/autoSCT (P < 0.001). A lower CD34+ cell count was associated with a greater need of RBC transfusion, which in turn led to a higher serum ferritin level at 1 yr after HDCT/autoSCT. The number of CD34+ cells transplanted was an independent factor for ferritin levels at 1 yr after the second HDCT/autoSCT (P = 0.019). Consequently, CD34+ cells should be transplanted as many as possible to prevent the sustained iron overload after tandem HDCT/autoSCT and consequent adverse effects.
Antigens, CD34/metabolism ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Benzoic Acids/therapeutic use ; Blood Transfusion/*adverse effects ; Child ; Child, Preschool ; Creatinine/blood ; Ferritins/blood ; Follow-Up Studies ; Humans ; Infant ; Iron Chelating Agents/therapeutic use ; Iron Overload/*etiology ; Neuroblastoma/drug therapy/*therapy ; Retrospective Studies ; Risk Factors ; *Stem Cell Transplantation ; Transplantation, Autologous ; Triazoles/therapeutic use

Multiple RBC transfusions inevitably lead to a state of iron overload before and after high-dose chemotherapy and autologous stem cell transplantation (HDCT/autoSCT). Nonetheless, iron status during post-SCT follow-up remains unknown. Therefore, we investigated post-SCT ferritin levels, factors contributing to its sustained levels, and organ functions affected by iron overload in 49 children with high-risk neuroblastoma who underwent tandem HDCT/autoSCT. Although serum ferritin levels gradually decreased during post-SCT follow-up, 47.7% of the patients maintained ferritin levels above 1,000 ng/mL at 1 yr after the second HDCT/autoSCT. These patients had higher serum creatinine (0.62 vs 0.47 mg/mL, P = 0.007) than their counterparts (< 1,000 ng/mL). Post-SCT transfusion amount corresponded to increased ferritin levels at 1 yr after the second HDCT/autoSCT (P < 0.001). A lower CD34+ cell count was associated with a greater need of RBC transfusion, which in turn led to a higher serum ferritin level at 1 yr after HDCT/autoSCT. The number of CD34+ cells transplanted was an independent factor for ferritin levels at 1 yr after the second HDCT/autoSCT (P = 0.019). Consequently, CD34+ cells should be transplanted as many as possible to prevent the sustained iron overload after tandem HDCT/autoSCT and consequent adverse effects.
Antigens, CD34/metabolism ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Benzoic Acids/therapeutic use ; Blood Transfusion/*adverse effects ; Child ; Child, Preschool ; Creatinine/blood ; Ferritins/blood ; Follow-Up Studies ; Humans ; Infant ; Iron Chelating Agents/therapeutic use ; Iron Overload/*etiology ; Neuroblastoma/drug therapy/*therapy ; Retrospective Studies ; Risk Factors ; *Stem Cell Transplantation ; Transplantation, Autologous ; Triazoles/therapeutic use