Purpose: Renal tumors account for approximately 7% of all childhood cancers. These include Wilms tumor (WT), clear cell sarcoma of the kidney (CCSK), malignant rhabdoid tumor of the kidney (MRTK), renal cell carcinoma (RCC), congenital mesoblastic nephroma (CMN) and other rare tumors. We investigated the epidemiology of pediatric renal tumors in Korea. Materials and Methods: From January 2001 to December 2015, data of pediatric patients (0–18 years) newly-diagnosed with renal tumors at 26 hospitals were retrospectively analyzed. Results: Among 439 patients (male, 240), the most common tumor was WT (n=342, 77.9%), followed by RCC (n=36, 8.2%), CCSK (n=24, 5.5%), MRTK (n=16, 3.6%), CMN (n=12, 2.7%), and others (n=9, 2.1%). Median age at diagnosis was 27.1 months (range 0-225.5) and median follow-up duration was 88.5 months (range 0-211.6). Overall, 32 patients died, of whom 17, 11, 1, and 3 died of relapse, progressive disease, second malignant neoplasm, and treatment-related mortality. Five-year overall survival and event free survival were 97.2% and 84.8% in WT, 90.6% and 82.1% in RCC, 81.1% and 63.6% in CCSK, 60.3% and 56.2% in MRTK, and 100% and 91.7% in CMN, respectively (p < 0.001). Conclusion The pediatric renal tumor types in Korea are similar to those previously reported in other countries. WT accounted for a large proportion and survival was excellent. Non-Wilms renal tumors included a variety of tumors and showed inferior outcome, especially MRTK. Further efforts are necessary to optimize the treatment and analyze the genetic characteristics of pediatric renal tumors in Korea.

Purpose: Loss of heterozygosity (LOH) at chromosomes 1p and 16q is a poor prognostic factor infavorable histology Wilms tumor (FHWT). This study investigated the prevalence of LOH at1p and 16q and evaluated its prognostic value in Korean children with FHWT. Materials and Methods: We analyzed 101 FHWT patients who were diagnosed between 1996 and 2016 in KoreanSociety of Pediatric Hematology Oncology Group hospitals. Using paraffin-embedded kidneytissue samples sent from each center, we reviewed LOH at 1p and 16q in each patient andassessed the prognostic value of LOH status for clinical parameters affecting event-freesurvival (EFS). Results: Of the 101 patients, 12 (11.9%) experienced recurrence; the 3-year EFS was 87.6%. LOHat 1p or 16q was detected in 19 patients (18.8%), with five having LOH at both 1q and 16q.The frequency of LOH at 1p was higher among younger patients (p=0.049), but there wasno difference in LOH prevalence according to tumor stage. In the multivariate analysis, LOHat 16q was a significant negative prognostic factor affecting EFS (3-year EFS, 73.7% vs.91.1%; hazard ratio, 3.95; p=0.037), whereas LOH at 1p was not (p=0.786). Conclusion LOH at 16q was a significant negative prognostic factor affecting outcome in Korean pediatricFHWT patients. Due to the small sample size of this study, large-scale multicenter trialsare warranted to investigate the prognostic value of LOH at 1p and 16q in Korean childrenwith FHWT.

Background: Hodgkin's lymphoma (HL) constitutes 10%–20% of all malignant lymphomas and has a high cure rate (5-year survival, around 90%). Recently, interest has increased concerning preventing secondary complications (secondary cancer, endocrine disorders) in long-term survivors. We aimed to study the epidemiologic features and therapeutic outcomes of HL in children, adolescents, and young adults in Korea. Methods: We performed a multicenter, retrospective study of 224 patients aged < 25 years diagnosed with HL at 22 participating institutes in Korea from January 2007 to August 2016. Results: A higher percentage of males was diagnosed at a younger age. Nodular sclerosis histopathological HL subtype was most common, followed by mixed cellularity subtype.Eighty-one (36.2%), 101 (45.1%), and 42 (18.8%) patients were classified into low, intermediate, and high-risk groups, respectively. Doxorubicin, bleomycin, vinblastine, dacarbazine was the most common protocol (n = 102, 45.5%). Event-free survival rate was 86.0% ± 2.4%, while five-year overall survival (OS) rate was 96.1% ± 1.4%: 98.7% ± 1.3%, 97.7% ± 1.6%, and 86.5% ± 5.6% in the low, intermediate, and high-risk groups, respectively (P = 0.021). Five-year OS was worse in patients with B-symptoms, stage IV disease, highrisk, splenic involvement, extra-nodal lymphoma, and elevated lactate dehydrogenase level.In multivariate analysis, B-symptoms and extra-nodal involvement were prognostic factors for poor OS. Late complications of endocrine disorders and secondary malignancy were observed in 17 and 6 patients, respectively. Conclusion This is the first study on the epidemiology and treatment outcomes of HL in children, adolescents, and young adults in Korea. Future prospective studies are indicated to develop therapies that minimize treatment toxicity while maximizing cure rates in children, adolescents, and young adults with HL.

BACKGROUND AND OBJECTIVES: There are limited data regarding the clinical efficacy of the proximal optimization technique (POT) in the treatment of coronary bifurcation lesions. We investigated the influence of POT on the clinical outcomes of patients with coronary bifurcation lesions. METHODS: We enrolled a total of 1,191 patients with a bifurcation lesion with a side branch (SB) diameter ≥2.5 mm treated with a drug-eluting stent from 18 centers between January 2003 and December 2009. The primary outcome was major adverse cardiac events (MACEs: cardiac death, myocardial infarction or target lesion revascularization [TLR]). We performed one-to-many (1:N) propensity score matching with non-fixed matching ratio. RESULTS: POT was performed in 252 patients. During follow-up (median 37 months), the incidence of MACE was lower in the POT group than it was in the non-POT group (adjusted hazard ratio, 0.43; 95% confidence interval [CI], 0.24–0.79; p=0.006). After propensity score matching, these were 0.34; 95% CI, 0.17–0.69; p=0.003 for MACE and 0.37; 95% CI, 0.17–0.78; p=0.01 for TLR. The use of POT was associated with significantly lower TLR in patients treated without kissing ballooning, but was not in those who underwent kissing ballooning (p for interaction=0.03). CONCLUSIONS: In coronary bifurcation lesions with a large SB, POT may be beneficial to improve long-term clinical outcome, particularly in patients treated without kissing ballooning during the procedure. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01642992
Coronary Artery Disease ; Death ; Drug-Eluting Stents ; Follow-Up Studies ; Humans ; Incidence ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Propensity Score ; Treatment Outcome

BACKGROUND AND OBJECTIVES: There are limited data regarding the clinical efficacy of the proximal optimization technique (POT) in the treatment of coronary bifurcation lesions. We investigated the influence of POT on the clinical outcomes of patients with coronary bifurcation lesions. METHODS: We enrolled a total of 1,191 patients with a bifurcation lesion with a side branch (SB) diameter ≥2.5 mm treated with a drug-eluting stent from 18 centers between January 2003 and December 2009. The primary outcome was major adverse cardiac events (MACEs: cardiac death, myocardial infarction or target lesion revascularization [TLR]). We performed one-to-many (1:N) propensity score matching with non-fixed matching ratio. RESULTS: POT was performed in 252 patients. During follow-up (median 37 months), the incidence of MACE was lower in the POT group than it was in the non-POT group (adjusted hazard ratio, 0.43; 95% confidence interval [CI], 0.24–0.79; p=0.006). After propensity score matching, these were 0.34; 95% CI, 0.17–0.69; p=0.003 for MACE and 0.37; 95% CI, 0.17–0.78; p=0.01 for TLR. The use of POT was associated with significantly lower TLR in patients treated without kissing ballooning, but was not in those who underwent kissing ballooning (p for interaction=0.03). CONCLUSIONS In coronary bifurcation lesions with a large SB, POT may be beneficial to improve long-term clinical outcome, particularly in patients treated without kissing ballooning during the procedure.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01642992

BACKGROUND/AIMS: Gallbladder polyps (GBP) are a common clinical finding and may possess malignant potential. We conducted this study to determine whether visceral obesity is a risk factor for GBP. METHODS: We retrospectively reviewed records of subjects who received both ultrasonography and computed tomography with measurements of the areas of visceral adipose tissue and total adipose tissue (TAT) on the same day as health checkups. RESULTS: Ninety-three of 1,615 subjects (5.8%) had GBP and were compared with 186 age- and sex-matched controls. VAT (odds ratio [OR], 2.941; 95% confidence interval [CI], 1.325 to 6.529; p=0.008 for the highest quartile vs the lowest quartile) and TAT (OR, 3.568; 95% CI, 1.625 to 7.833; p=0.002 for the highest quartile vs the lowest quartile) were independent risk factors together with hypertension (OR, 2.512; 95% CI, 1.381 to 4.569; p=0.003), diabetes mellitus (OR, 2.942; 95% CI, 1.061 to 8.158; p=0.038), hepatitis B virus positivity (OR, 3.548; 95% CI, 1.295 to 9.716; p=0.014), and a higher level of total cholesterol (OR, 2.232; 95% CI, 1.043 to 4.778; p=0.039 for <200 mg/dL vs > or =240 mg/dL). Body mass index and waist circumference were not meaningful variables. CONCLUSIONS: Visceral obesity measured by VAT and TAT was associated with GBP irrespective of body mass index or waist circumference.
Adipose Tissue/ultrasonography ; Adult ; Case-Control Studies ; Cholesterol/blood ; Diabetes Complications ; Female ; Gallbladder Diseases/blood/epidemiology/*etiology ; Hepatitis B/complications ; Humans ; Hypertension/complications ; Intra-Abdominal Fat/ultrasonography ; Male ; Middle Aged ; Obesity, Abdominal/blood/*complications/ultrasonography ; Odds Ratio ; Polyps/blood/epidemiology/*etiology ; Prevalence ; Retrospective Studies ; Risk Factors

With recent progress in treatment modalities, mortality from upper gastrointestinal (UGI) bleeding has decreased appreciably. The aim of this study was to establish how UGI bleeds are managed in Korean patients with cirrhosis and to evaluate treatment outcomes. A total of 479 episodes of acute UGI bleeding in 464 patients with cirrhosis were included during a six-month period at nine tertiary medical centers. Treatment outcomes were assessed by failure to control bleeding, rebleeding and mortality. The source of bleeding was esophagogastric varices in 77.7% of patients, nonvariceal lesions in 15.9%, and undefined in 6.5%. For control of bleeding, endoscopic and pharmacologic treatments were used in 74.7% and 81.9% of patients, respectively. Variceal ligation was a major technique for endoscopic treatment (90%), and terlipressin and somatostatin were the main pharmacologic agents used (96.4%). Initial hemostasis was achieved in 86.8% of cases, but rebleeding occurred in 3.8% and 16.8% of cases within five days and six weeks of hemorrhage, respectively. Five-day and six-week mortality were 11.3% and 25.9%, respectively. Survival of patients with variceal bleeding seems to be remarkably improved than previous reports, which may suggest the advances in hemostatic methods for control of variceal hemorrhage..
Adult ; Aged ; Cohort Studies ; Female ; Gastrointestinal Hemorrhage/mortality/*therapy ; Hemostatic Techniques ; Humans ; Infection/epidemiology ; Liver Cirrhosis/*complications ; Lysine Vasopressin/analogs & derivatives/therapeutic use ; Male ; Middle Aged ; Treatment Outcome

BACKGROUND: A pulmonary tuberculoma is one of the most common causes of a solitary pulmonary lesion. Treating a tuberculoma is still controversial and there are few reports on antituberculosis chemotherapy. In this study, the clinical findings and changes in the size of tuberculomas on a radiograph after completing antiuberculosis chemotherapy was investigated. METHODS: The medical records, an chest radiographs of 18 pulmonary tuberculoma patients who were admitted to the Gachon medical school, Ghil medical center between April 1998 and August 2001, were reviewed. The symptomatic changes were recorded and the size of the tuberculomasl following treatment were compared. To compare the size, the long distance of each tuberculoma on the chest radiographs were measured and the additional radiological findings of calcification, satellite nodules and cavities were investigated. RESULTS: Fifteen patients were men and 3 were women. The median age was 46(24-74). Among these 18 patients, 14 patients had clinical symptoms. The other 4 patients were diagnosed incidentally as during a routine chest radiograph. The mean size of the tuberculomas on the initial plain chest film was 4.3+/-2.3cm(range : 1.7-10cm)and after 6 months treatment, it had decreased to 1.68+/-2.00cm(range : 1.5-6.5cm)(P<0.05). At least 6 months of antituberculosis chemotherapy resulted in the findings of a tuberculoma with a disappearance in 9, a decreased size in 4, and no change in 5 on the chest radiograph. Calcifications were found in 3 patients on the initial chest film and the chest CT and all calcified tuberculomas had disappeared after treatment. CONCLUSIONS: A lthough a pulmonary tuberculoma can remain as an inactive lesion for a long time, if it is confirmed by pathological or bacteriological methods, antituberculosis chemotherapy will be beneficial despite the presence of calcification.
Drug Therapy ; Female ; Humans ; Male ; Medical Records ; Radiography, Thoracic ; Schools, Medical ; Thorax ; Tomography, X-Ray Computed ; Tuberculoma*

BACKGROUND: There have been several studies showing that angiotensin II and the angiotensin convertingenzyme (ACE) contribute to the activation of fibroblast including the pulmonary fibrosis, and apoptosis of the al veolar epithelium in idiopathic intersititial pneumonia. This study was performed to identify the relationship between the serum angiotensin II. ACE and the pulmonary function test (PFT), the dyspnea score, and the cell fraction of the bronchoalveolar lavage fluid (BALF). METHODS: Twenty three patients with idiopathic interstitial pneumonia from March, 1999 to October, 2001 at Gachon medical school were enrolled in this study. They were divided into IPF(UIP) (16) and NSIP (7) group. Twelve of the idiopathic interstitial pneumonia patients (UIP : 5, NSIP: 7) were diagnosed by an open lung biopsy, 11 of IPF patients were diagnosed by the American Thoracic Society (ATS) diagnostic criteria. The PFT values, dyspnea score, serum ACE and angiotensin II were measured, and a bronchoscopy was performed to obtain the BALF. RESULTS: Of all the patients, 7 were in the normal range and 14 showed an increase in the serum level of angiotensin II. In terms of the serum ACE level, 14 patients had an increased level. The DLCO% of the angiotensin II. increased group was significantly lower than the not-increased group (p=0.021). Other factors did not correlate with the serum ACE or the angiotensin II increased group and not-increased group. CONCLUSION: These results suggest that an increased angiotensinII serum level may be associated with in crease in the of alveolar capillary block in the progression of pulmonary fibrosis in idiopathic interstitial pneumonia.
Angiotensin II* ; Angiotensins* ; Apoptosis ; Biomarkers* ; Biopsy ; Bronchoalveolar Lavage Fluid ; Bronchoscopy ; Capillaries ; Dyspnea ; Epithelium ; Fibroblasts ; Fibrosis ; Humans ; Idiopathic Interstitial Pneumonias* ; Lung ; Peptidyl-Dipeptidase A* ; Pneumonia ; Pulmonary Fibrosis ; Reference Values ; Respiratory Function Tests ; Schools, Medical