PURPOSE: We evaluated the easily-assessable risk and prognostic factors of septic shock in children with neutropenic fever (NF) which developed after anticancer chemotherapy. METHODS: We retrospectively reviewed the medical records and laboratory data of 97 children who received anticancer chemotherapy at Dong-A University Hospital and had NF between March, 1993 and February, 2001. RESULTS: There were 223 episodes of NF in 97 children, of which 71 episodes (31.8%) of bacteremia and 18 episodes (8.1%) of septic shock developed. The incidence of septic shock was associated with fever duration (> 5 days, odds ratio=7.367, P=0.0159), tachycardia (odds ratio=11.857, P=0.0001), and serum bicarbonate level (<24 mEq/L, odds ratio=6.235, P=0.0378), whereas not with the underlying disease, age, sex, causative organisms, absolute neutrophil count, absolute monocyte count, absolute phagocyte count, the presence of central venous catheter, the accompanied focal infection, and the use of hematopoietic growth factor. Septic shock developed 3.2 (1~11) days after NF. The prognosis of septic shock patients was not associated with the therapeutic timing, antibiotics, fever duration, tachycardia, or serum bicarbonate level. CONCLUSION: We suggest that the fever duration, tachycardia, and serum bicarbonate level could be important risk factors of septic shock in children with NF. Although We could not reveal the prognostic factors in children with septic shock, further studies will be required.
Anti-Bacterial Agents ; Bacteremia ; Central Venous Catheters ; Child ; Drug Therapy ; Fever* ; Focal Infection ; Humans ; Incidence ; Medical Records ; Monocytes ; Neutropenia ; Neutrophils ; Phagocytes ; Prognosis ; Retrospective Studies ; Risk Factors* ; Shock, Septic* ; Tachycardia

PURPOSE: This study was carried out to survey the serum anti-PRP titers after the completion of a primary series with 3 doses of the PRP-T conjugate vaccine(ACT-HIBTM), to evaluate the necessity of booster vaccination. METHODS: One hundred twenty healthy infants who went for consultations at Moon Hwa hospital between December 1999 to May 2001 were vaccinated at two, four and six months after birth. The serum antibody levels were measured at 7-8 months and 19-20 months of age by the "Farr" type of radioimmunological method at Aventis Pasteur International in France. RESULTS: The geometric mean of Anti-PRP titers were 24.6 microgram/mL at 7-8 months and then fell to 2.10 microgram/mL at 19-20 months. Minimum Anti-PRP titer was 0.75 microgram/mL at 7-8 months, and 0.1 microgram/mL at 19-20 months. Maximum Anti- PRP titer was 99.2 microgram/mL at 7-8 months, and 9.1 microgram/mL at 19-20 months. Subjects of Anti-PRP titers more than 0.15 microgram/mL were 100% at 7-8 months, and 97.0% at 19-20 months, and subjects of Anti-PRP titers more than 1.0 microgram/mL were 98.3% at 7-8 months, and 61.6% at 19-20 months. CONCLUSION: The Anti-PRP titers at 7-8 months were very high but rapidly decreased at 19-20 months of age, so the necessity of booster vaccination could be considered in Korean children.
Child ; France ; Haemophilus influenzae* ; Haemophilus* ; Humans ; Infant ; Parturition ; Referral and Consultation ; Vaccination*

Acute necrotizing encephalopathy predominantly affects young children and infants living in Japan and Taiwan, and is characterised by acute encephalopathy with seizures and decreased level of consciousness. The Hallmark of the disease is diffuse and symmetrical CNS lesions of both thalami, brainstem tegmentum, cerebral periventricular white matter and cerebellar medula. The clinical, radiological and pathological features of this disease, a disease entity established recently, is proposed by Masashi Mizuguchi et al in 1995. The aetiology is unknown but infectious or parainfectious process seems likely. The diagnosis can be made without difficulty on the basis of the combination of a typical clinical figures and characteristic radiologic findings. There is no specific therapy or prevention. The prognosis was poor in the 1980s but has improved recently. We experienced a case of 6-month-old female infant with acute necrotizing encephalopathy and a thalamic hemorrhage. We report this case with a review of the related literatures.
Brain Stem ; Child ; Consciousness ; Diagnosis ; Female ; Hemorrhage* ; Humans ; Infant ; Japan ; Prognosis ; Seizures ; Taiwan

PURPOSE: Phyllodes tumor is a rare fibroepithelial tumor of the breast, first described by Johannes Muller in 1838. Much has been written about phyllodes tumor, but very few widely accepted conclusions about its clinical behavior, treatment modality, and prognosis have been reached. This study aims to analyze the clinical, radiological, and pathological characteristics of phyllodes tumor of the breast. METHODS: The medical records of 41 patients with phyllodes tumor who had been treated between February 1982 and August 1998 at the Department of Surgery, Seoul National University Hospital, were retrospectively reviewed for clinical, radiological and pathological findings, treatment modalities, and follow-up results. RESULTS: Of these 41 cases, there were 28 cases (68.3%) of benign tumors and 13 cases (31.7%) of malignanat tumors. All patients were females, and the mean ages of onset were 33.2 years for benign tumors and 40.8 years for malignant tumors. Most patients, 100% of benign and 92.3% of malignant, presented with a papable mass in the breast. The median duration of illness was 2 months for malignant tumors and 8 months for benign tumors. The tumor size was greater than 10 cm in diameter in 5 cases (38.5%) of malignant tumors and in 3 cases (10.7%) of benign tumors. Only 4 cases were preoperatively diagnosed as having a phyllodes tumor by using radiological and fine needle aspiration cytology. Out of the 10 malignant cases reviewed, 5 cases were confirmed as malignant, and 5 cases were confirmed as borderline phyllodes tumors. Cellularity was moderate or above in all 5 malignant and 5 borderline cases. Atypism above moderate degree was found in 4 of 5 (80%) malignant tumors, in 3 of 5 (60%) borderline tumors, and in 4 of 24 (16.7%) benign tumors. Mitotic counts in all 5 malignant cases were 5 or more per 10 high power field while those in the 5 borderline tumors were 2-5 mitoses per 10 high power field. The most commonly performed operative procedures were a simple mastectomy (50%) for malignant tumors and a simple excision (64.3%) for benign tumors. Post-operative adjuvant therapy was done for 4 cases; out of these, 1 case had been initially diagnosed as a malignant phyllodes tumor, but the diagnosis was changed to a benign phyllodes tumor upon review. Of the 27 follow-up cases, recurrences developed in 3 cases (16.7%) of benign tumors. CONCLUSION: From the above results, there were no specific clinical features for differentiating benign from malignant phyllodes tumor preoperatively; therefore, we cannot help depending on the pathologic findings. Pathologic reviews showed that among several criteria, atypism, cellularity, and mitotic count were the most definite pathologic characteristics in differentiating benign from malignant phyllodes tumor. But much more experience and long-term follow-up may be needed to define optimal treatments and to analyze the prognosis for phyllodes tumors of the breast.
Biopsy, Fine-Needle ; Breast* ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Mastectomy, Simple ; Medical Records ; Mitosis ; Phyllodes Tumor* ; Prognosis ; Recurrence ; Retrospective Studies ; Seoul ; Surgical Procedures, Operative

PURPOSE: Although papillary thyroid carcinomas are known to have a good prognosis, invasive papillary thyroid carcinomas have different outcomes. There are many studies on the prognostic factors for thyroid carcinomas, but few studies have been performed for invasive papillary thyroid carcinomas. We performed this study to investigate the prognosis and the prognostic factors for invasive papillary thyroid carcinomas. METHODS: We analyzed 184 patients with papillary thyroid carcinomas who had undergone a thyroidectomy between 1985 and 1990, especially for the clinicopathologic entity of an invasive papillary thyroid carcinoma, and made univariate and multivariate analyses for various clinical and pathological factors to evaluate whether they would be of value in estimating the prognosis in papillary thyroid carcinoma patients. RESULTS: In the univariate analysis of the 10-year disease-free survival rate of the overall cases, sex, tumor size, and lymph-node metastasis were confirmed to be significant prognostic factors. In the multivariate analysis, all of these factors were independent significant prognostic factors. Invasive papillary thyroid carcinoma patients, compared to non-invasive papillary thyroid carcinoma patients, were older and more prone to metastasis to cervical lymph nodes. In the univariate analysis of the 10-year disease-free survival rate of patients with an invasive papillary thyroid carcinoma, sex, tumor size, and lymph-node metastasis were significant prognostic factors. However, in the multivariate analysis, sex and tumor size appeared to be independent significant prognostic factors. CONCLUSION: We conclude that invasive papillary thyroid carcinomas have a the tendency to occur in elderly patients and are more prone to metastasis to cervical lymph nodes. The male sex, a tumor size more than 5 cm, and positive cervical-lymph-node metastasis present the worse prognosis. However, a randomized prospective study may be needed to better understand how to manage invasive papillary thyroid carcinomas.
Aged ; Disease-Free Survival ; Humans ; Lymph Nodes ; Male ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: There are no specific clinical and histopathologic characteristics of malignant pheochromocytoma and the optimal treatment modality has not been established yet. We analyzed the clinical and histopathologic features of malignant pheochromocytoma and treatment results. MATERIALS AND METHODS: We reviewed the clinical records of 10 patients with malignant pheochromocytoma diagnosed at Seoul National University Hospital from March 1987 to June 1998. RESULTS: Nine of 10 (90%) patients had functional tumors. The biochemical laboratory findings showed elevated 24-hour urine VMA level in nine patients available. The median size of the tumors was 11x11 cm. Six of 10 (60%) patients were initially diagnosed as malignant tumors because of direct invasions to adjacent tissues or distant metastases. On the other hand, remaining 4 patients were initially diagnosed as benign, but the distant metastases developed metachronously after resection of the primary lesion. The median duration between the initial operation and the detection of metastases was 57 months (range: 47~72 months) in these patients. The liver was the most common site of metastases (60%). With regards to the histopathological features, most of the tumors (87.5%) showed capsulation, necrosis and hemorrhage. The findings of lymphatic invasion, angio-invasion, and mitosis were found in 62.5% of the cases. All but 2 patients were initially treated with radical operation for the primary lesions. The disease recurrences or metastases occurred in 7 out of 10 patients. Of these, 4 patients were treated with chemotherapy or interferon- a after recurrences. Overall, the median survival for all patients was 82 months (range: 37~143 months). Two patients is alive and only one patient is alive without recurrence. CONCLUSION: The careful follow-up for at least 5 years and the aggressive multi-disciplinary therapy may be needed for the diagnosis and the management of malignant pheochromocytoma.
Diagnosis ; Drug Therapy ; Follow-Up Studies ; Hand ; Hemorrhage ; Humans ; Liver ; Mitosis ; Necrosis ; Neoplasm Metastasis ; Pheochromocytoma* ; Recurrence ; Seoul

No abstract available.
Child ; Choledochal Cyst ; Humans

Retroperitoneal fibrosis is a rare fibrosing reactive process, which is characterized by diffuse or localized fibroblastic proliferation and chronic lymphoplasmacytic infiltration in the retroperitoneum causing compression or obstruction of the ureters, aorta, or other vascular structures. The majority of cases are idiopathic. A 35-year old woman was transferred for further evaluation and the management of a mass in the left adrenal area. She suffered from vague abdominal pain, which was dull, non-colicky and poorly localized. She had no obstruction of the ureters or vascular structures. The preoperative diagnosis was a tumor of the left adrenal gland. A solitary retroperitoneal mass was excised, which was proven to be localized idiopathic retroperitoneal fibrosis. She was discharged on the 9th post operative day without any complications.
Abdominal Pain ; Adrenal Glands ; Aorta ; Diagnosis ; Female ; Fibroblasts ; Humans ; Retroperitoneal Fibrosis* ; Ureter

A clinical analysis was done for 141 patients with parotid tumors who had been admitted to and treated at the Department of Surgery, Seoul National University Hospital over a period of 15 years from January 1981 to December 1995. Of these 141 cases, there were 123 cases of benign tumors and 18 cases of malignant tumors. The results were as follows ; 1) Sex distribution revealed a preponderance of females with a ratio of 1.4 : 1. When only malignant tumors were considered, males were predominant with a ratio of 1.6 : 1. 2) Benign tumors were prevalent in the 3rd & the 4th decades while malignant tumors were prevalent in the 4th & the 5th decades. 3) The chief complaint was a palpable mass in all the cases and facial nerve palsy was accompanied with 22% of malignant cases. 4) The mean size of the mass was 3.5 cm in diameter. 5) The mean duration of illness was 4.9 years with a duration of 1 year being seen in 28% of the benign tumor cases and in 44% of the malignant tumor cases. 6) The most commonly performed operative procedures were a superficial lobectomy(56%) for benign tumors and a total parotidectomy(67%) for malignant cases. And 76% of all benign tumors and 89% of all malignant tumors were treated with a superficial lobectomy or a more extensive operation. 7) According to the histopathological findings, benign tumors were present in 123 cases(87%) and malignant tumors in 18 cases(13%). The most common benign tumor was pleomorphic adenoma(80%) and the most common malignant tumor was mucoepidermoid carcinoma(50%). 8) In the 5 recurrent cases, previous operations were enucleation(4 cases) and biopsy only(1 case). 9) The postoperative complications developed in 51 cases(36%), including 33 cases(23%) of facial nerve palsy and 9 cases(6%) of Frey's syndrome. Facial palsy was permanent in 7 cases(5%). 10) Of the 94 follow-up cases, recurrences developed in 6 cases(7%) of benign tumors and 6 cases (50%) of malignant tumors.
Biopsy ; Facial Nerve ; Facial Paralysis ; Female ; Follow-Up Studies ; Humans ; Male ; Paralysis ; Postoperative Complications ; Recurrence ; Seoul ; Sex Distribution ; Surgical Procedures, Operative ; Sweating, Gustatory

PURPOSE: H rthle cell neoplasm of the thyroid gland is a rare disease. The reported cases in Korea are not so many; thus, there has been a lack of common therapeutic and prognostic guidance. METHODS: The cases of 15 patients with a H rthle cell neoplasm of the thyroid gland, hospitalized at Seoul National University Hospital from Nov. 1981 to Feb. 1998, were retrospectively reviewed. RESULTS: There were 4 males and 11 females. The ages varied from 23 to 69 years old (mean: 46.3 years old). Among them, 13 had neck masses with a mean size of 3.3 cm (1.2-6.0 cm), and the mean duration of the symptom was 4 years (5 months-8 years). Of the other two, one had laryngeal discomfort for 2 months, and the other one was diagnosed through a fine needle aspiration follow-up. One of the 15 patients had hyperthyroidism whereas the others had euthyroidism. The thyroid scans for 10 of them showed cold nodules. The operations consisted of a unilateral lobectomy in 2 cases, a unilateral lobectomy and isth mectomy in 11 cases, a unilateral lobectomy, isthmectomy and contralateral partial lobectomy in 1 case, and a total thyroidectomy and neck lymph node dissection in the 1 case that was combined with a papillary carcinoma. Thirteen patients (86.7%) had a H rthle cell adenoma, and two of them (13.3%) had a H rthle cell carcinoma. The mean duration of follow-up was 33 months (range 1 month-12 years), and no recurrence or death occurred during the follow-up period. CONCLUSIONS: The incidence of H rthle cell neoplasms is higher in women and the sex ratio is 1:2.8. The incidence of H rthle cell carcinomas among H rthle cell neoplasms is 13.3% (2/15). We found no specific clinical features for differentiating a H rthle cell adenoma from a H rthle cell carcinoma and no factors for adequate operative methods and prognosis due to the rarity of the condition and the short duration of the follow-up. Because of the low incidence of H rthle cell neoplasms and our limited experience, not only co-research of centers but also pathologic research is needed.
Adenoma ; Aged ; Biopsy, Fine-Needle ; Carcinoma, Papillary ; Female ; Follow-Up Studies ; Humans ; Hyperthyroidism ; Incidence ; Korea ; Lymph Node Excision ; Male ; Neck ; Prognosis ; Rare Diseases ; Recurrence ; Retrospective Studies ; Seoul ; Sex Ratio ; Thyroid Gland* ; Thyroidectomy