OBJECTIVE: To investigate the value of positive lymph node ratio (LNR) in predicting the prognosis of patients with esophageal cancer. METHODS: We retrieved the data of a total of 862 patients with esophageal cancer with complete clinical pathology data archived in SEER database in 2010 to 2015. The best cutoff point of LNR was selected using X-tile software. Univariate and multivariate COX proportional hazard models were used to assess the value of LNR in predicting the prognosis of patients after propensity score matching (PSM). RESULTS: The best cut-off point of LNR determined using X-tile 3.6.1 software was 0.16. The patients with LNR < 0.16 and those with LNR≥0.16 showed significant differences in the number of positive lymph nodes, pathological type, T stage and M stage. After 1:1 propensity score matching, the two groups showed no significant difference in the clinical data or pathological parameters. Matched univariate and multivariate COX regression analyses showed that LNR, primary tumor site and M staging were all independent risk factors affecting the prognosis of patients, and among them LNR had the most significant predictive value (LNR < 0.16 LNR≥0.16: HR=1.827, 95% : 1.140-2.929; =0.000). The median survival time of patients with LNR < 0.16 was 31 months (95%: 22.556-39.444 months), as compared with 16 months (95%: 12.989-19.011) in patient with LNR≥0.16 (Log Rank χ=27.392, < 0.0001). LNR had a better accuracy than N stage for assessing the patients' prognosis with an area under the ROC curve of 0.617 (95%: 0.567-0.666), as compared with 0.515 (95%: 0.463-0.565) of N stage (=3.008, =0.0026). CONCLUSIONS LNR≥0.16 is an independent risk factor affecting the prognosis of patients with esophageal cancer and has better prognostic value than N stage.
Esophageal Neoplasms ; Humans ; Lymph Node Excision ; Lymph Node Ratio ; Lymph Nodes ; Lymphatic Metastasis ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Risk Factors

Objective: To study the impact of regional positive lymph node ratio (LNR) on prognosis of patients with gallbladder carcinoma. Methods: The clinicopathological and survival data of 53 patients with gallbladder carcinoma who underwent radical resection with regional lymph node metastasis in Ningbo University Affiliated Lihuili Hospital from May 2012 to December 2020 were collected, and receiver operating characteristic curve (ROC) was used to determine the optimal cut-off value of LNR for predicting postoperative survival status in patients with gallbladder carcinoma. According to the critical value, the patients were divided into low LNR group and high LNR group. The clinicopathological features and prognosis of the two groups were compared. Log rank test was used for univariate analysis of prognostic factors in patients with gallbladder carcinoma, and Cox proportional hazards model was used for multivariate analysis. Results: A total of 417 regional lymph nodes were dissected in 53 patients, of which 144 lymph nodes were positive, with a positive rate of 34.5%. The optimal cut-off value of LNR for predicting postoperative survival status of patients with gallbladder carcinoma was 0.33. According to this cut-off value, patients were divided into low LNR group (LNR≤0.33, 28 cases) and high LNR group (LNR>0.33, 25 cases). The recurrence rates were 64.3% (18/28) and 88.0 % (22/25) in low LNR group and high LNR group, respectively. The median recurrence-free survival (RFS) was 8 and 7 months, respectively (P=0.032). In the low LNR group, the 1-, 3-, and 5-year survival rates were 56.2%, 38.4%, and 32.0%, respectively, and the median overall survival (OS) was 16 months. In the high LNR group, the 1-, 3-, and 5-year survival rates were 37.9%, 5.4%, and 0, respectively, and the median OS was 9 months. The postoperative survival rate of patients in the low LNR group was better than that in the high LNR group (P=0.008). Univariate analysis showed that LNR was even associated with RFS and OS in patients with gallbladder carcinoma (P<0.05). Multivariate analysis showed that LNR>0.33 was an independent risk factor for postoperative RFS (HR=1.977, 95% CI: 1.045-3.740), but not for OS (HR=1.561, 95% CI: 0.685-3.553). Conclusion: On the basis of clearing a sufficient number of regional lymph nodes, patients with gallbladder carcinoma with regional LNR>0.33 are more likely to relapse after operation, but the predictive value of LNR>0.33 OS is insufficient.
Humans ; Lymph Node Ratio ; Gallbladder Neoplasms/pathology* ; Lymph Node Excision ; Lymphatic Metastasis/pathology* ; Neoplasm Staging ; Retrospective Studies ; Lymph Nodes/pathology* ; Prognosis

PURPOSE: In most patients of Kawasaki disease(KD), fever subsides within 48 hours after infusion of intravenous immunoglobulin(IVIG), but in some cases, retreatment of IVIG is needed because of prolonged fever. This study was performed to findout the factors associated with the retreatment of IVIG in KD. METHODS: Patients with KD, treated with IVIG were classified into two groups : single IVIG treatment group(defeverescence within 48 hours after starting IVIG : group B) and IVIG retreatment group(retreatment with IVIG for fever over 48 hours despite the 1st infusion of IVIG; group A). We compared the clinical symptoms, laboratory findings, clinical signs and echocardiogram findings between group A and B. RESULTS: The mean CRP level of group A was higher than that of group B(P= 0.001), and the mean cholesterol level of group A was lower than that of group B(P=0.002). In CRP level is above 10 mg/dL, odds ratio for retreatment of IVIG is higher than that of level below 10 mg/dL. As cholesterol level decreased, the odds ratio for retreatment with IVIG increased. CONCLUSION: When readministration of IVIG in KD patients for prolonged fever over 48 hours, the consideration of the initial levels of relatively low serum cholesterol and high CRP is recommended.
Cholesterol ; Fever ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Mucocutaneous Lymph Node Syndrome* ; Odds Ratio ; Retreatment*

PURPOSE: The purpose of this study is to investigate the clinical manifestations and the risk factors of recurrent Kawasaki disease(KD). METHODS: From March 1995 to June 2003, 14 children with recurrent KD in Ewha Womans University Hospital were etrospectively evaluated by reviewing their admission reports. The clinical characteristics, laboratory findings, treatment and complications of the recurrent KD group were compared to that of a control group. The control group was admitted once for KD. Also, for the patients in the recurrent KD group, the clinical characteristics, laboratory findings, treatment and com plications were compared between an initial and a second episode. RESULTS: Among the 561 children with KD, 14 cases(2.4%) were included in the recurrent KD. At the initial episode of recurrent KD group, the sex ratio was 1.3 : 1(male : female) and the mean age was 23+/-13 months. There were no differences in demographic characteristics, clinical characteristics, laboratory results, treatment and complications between the recurrent KD group and control group. The interval between two episodes in the recurrent KD group was 17.9+/-16.2 months(1-60 months). The total febrile period showed no differences between the two episodes in the recurrent KD group but the febrile period before admission was shorter in the second episode(P=0.02). The clinical characteristics, laboratory findings, treatment and coronary artery complications were not different in the two episodes of the recurrent KD group. CONCLUSION: There were no predictive clinical characteristics or laboratory findings for recurrent KD. Treatment and coronary artery complications were not different between an initial and a second episode of the recurrent KD.
Child ; Coronary Vessels ; Female ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Recurrence ; Risk Factors ; Sex Ratio

PURPOSE: Glutathione-S-transferase (GST) is a phase II metabolism enzyme and plays an important role in the detoxification of various chemicals. Recently, the genetic background of Kawasaki disease has been investigated by some researchers and significant results were documented. To demonstrate genetic background of pathogenesis of Kawasaki disease (KD), we examined the genetic polymorphism of Glutathione-S-transferase in KD patients. METHODS: Sixty-seven Korean children with Kawasaki disease and 252 Korean healthy controls were enrolled in this study. The polymorphisms of GSTM1 and GSTT1 gene were analyzed. RESULTS: The distribution of GSTM1 polymorphism between Kawasaki disease patients and controls was not significantly different [2=0.6479, P=0.4209; odds ratios (95% confidence intervals)=0.8004 (0.4651-1.3772)]. However, the distribution of GSTT1 polymorphism was significantly different between two groups [2=18.7898, P<0.0001; odds ratios (95% confidence intervals)=4.1009 (2.0950- 8.0274)]. In the combined analysis of GSTM1 and GSTT1 genes, the frequency of both null type of GSTM1/T1 genes was significantly different from both positive type of GSTM1/T1 genes [2= 8.2528, P=0.0041; odds ratios (95% confidence intervals)=4.1486 (1.4846-11.5927)]. The group of the GSTM1 positive and GSTT null type also showed significantly different from both positive type of GSTM1/T1 genes [2=17.3479, P<0.0001; odds ratios (95% confidence intervals)=6.9143 (2.5387- 18.8314)]. CONCLUSION: These results indicates that the polymorphisms of GSTT1 gene might be a susceptible factor in development of Kawasaki disease in Koreans.
Child* ; Humans ; Metabolism ; Mucocutaneous Lymph Node Syndrome* ; Odds Ratio ; Polymorphism, Genetic

PURPOSE: The recurrence of Kawasaki disease has not been considered significant and has not been reported on literatures in Korea. Authors reviewed cases with recurrent Kawasaki disease to get informations about recurrent Kawasaki disease and to know whether there is any factor, if present, that can predict recurrence. METHODS: We reviewed and analyzed the hospital records of patients with recurrent Kawasaki disease who had been admitted to Inha University Hospital from January 1986 through December 1994. RESULTS: The total number of cases with Kawasaki disease was 266 during that period in Inha University Hospital. Seven patients were diagnosed as having recurrent Kawasaki disease, but four of them fulfilled five or more items of the diagnostic criteria for Kawasaki disease. So the proportion of recurrent cases was 1.5%(4/259)(or 2.7% (7/259) ?). Sex ratio was M:F=3:1. The ages at the first episodes of illness were from 7 months to 3 years 2 months (median=24 months), and those of the second episodes were from 11 months to 6 years 3 months (median=4 years 3 months). The intervals between two episodes were from 4 months to 4 years 2 months (median=1 year 9 months). No special aspect could be found in the clinical and laboratory findings of primary cases, compared with other cases with kawasaki disease. The clinical manifestations and courses of recurred cases were not significantly different from those of primary cases, except one recurred case who developed coronary aneurysm. CONCLUSIONS: The recurrence rate of Kawasaki disease seems to be higher than 1.5%(or 2.7%) at least. The risk factors for recurrence could not be found, and there was no specific aspect in the clinical manifestations and courses of recurrent Kawasaki disease.
Coronary Aneurysm ; Hospital Records ; Humans ; Korea ; Mucocutaneous Lymph Node Syndrome* ; Recurrence ; Risk Factors ; Sex Ratio

We compared the efficacy of each modality of treatment group in reducing the frequency of coronary artery abnormalities and change of clinical courses in children with Kawasaki disease in the children of 81 cases who were admitted in pediatric department of Yeungnam University Hospital from September 1985 to August 1990. Group A (37 cases)-aspirin alone, Group B (44 cases)-intravenous gammaglobulin (400 mmg/kg/day) for 5 consecutive days, plus aspirin. We studied the frequency of echocardiographic abnormalities, the duration of fever, and changes in the total white blood cell counts, platelet counts, ESR and CRP value at 1, 2 and 3 weeks of the illness and compared the results between the two groups. The results were as follows. 1) There was no significant intergroup difference in age and sex ratio. 2)The duration of the febrile period after the initiation of the therapy was significant shorter in group B (2.5±1.2days) than in group A: (5.2±3.5 days) (p<0.01). 3) No significant difference was noticed in the WBC and platelet counts in two groups as measured at admission day, 1 and 2 weeks of the illness, however, at 3weeks of illness significant difference was noted. 4) The CRP values measured at 1,2 and 3 weeks after treatment were significantly lower in group B (2.42±1.8, 2.00±1.2, 1.16±1.0) than in group A (7.22±5.3, 5.25±3.9, 1.85±1.2) respectively (p<0.01). 5) In 2D-Echocardiogram, coronary artery dilatation was more frequent in Group A than in Group B at 6month of illness (p<0.01). In conclusion, intravenous gammaglobulin therapy was effective in the shortening of the duration of fever and in the anti-inflammatory action and somewhat effective in prevention of coronary artery aneurysm.
Aneurysm ; Aspirin* ; Child ; Coronary Vessels ; Dilatation ; Echocardiography ; Fever ; Humans ; Leukocyte Count ; Mucocutaneous Lymph Node Syndrome* ; Platelet Count ; Sex Ratio

PURPOSE: To determine the optimal time of high dose intravenous immune globulin (IVIG) treatment, we analysed the clinical characteristics and progress of a group of Kawasaki disease patients who had early treatment with IVIG. METHOD: A retrospective study was conducted of 188 patients with Kawasaki disease who were admitted to Yeungnam University Medical Center from January 2000 to December 2005. All patients were treated with a high dose IVIG and high dose aspirin for the initial acute phase treatment. The early treatment group consisted of 94 patients who received treatment before 5 days of fever, and the conventional group consisted of 94 patients who were treated on or after day 5. The patients' sex, age, laboratory findings, total duration of fever, duration of fever after initial IVIG, need for additional IVIG and coronary artery status were noted. RESULT: There were no significant differences between the two groups in sex ratio and age. No significant differences were noted in the level of WBC count, ESR, CRP, serum albumin, LDH, total duration of fever and coronary abnormality. But the value of ALT(151.8+/-17.3 vs. 81.9+/-13.4, P=0.002), duration of fever after initial IVIG (3.8+/-0.5 days vs. 2.1+/-0.2 days, P=0.003), and rate of additional IVIG (15.9% vs. 6.3%, P=0.037) were significantly higher in the early treatment group. There was no significant difference in initial dose of IVIG, but dosage of aspirin was lower in early treatment group (P=0.037). CONCLUSION: There is no evidence that early treatment of IVIG has greater efficacy in preventing cardiac sequelae than conventional treatment. In addition, early treatment is likely to result in a greater requirement for additional IVIG treatment.
Academic Medical Centers ; Aspirin ; Coronary Vessels ; Fever ; Humans ; Immunoglobulins, Intravenous* ; Mucocutaneous Lymph Node Syndrome* ; Retrospective Studies ; Serum Albumin ; Sex Ratio

PURPOSE: The study was performed to investigate the IgG subclasses in acute febrile phase of Kawasaki disease(KD) to find correlation between selective IgG4 deficiency and incidence of KD patients. METHODS: The patients group consisted of 64 cases in acute phase of KD hospitalized from Jan. 1996 to Jul. 1999, and control group consisted of age matched 36 cases who admitted without KD. The obtained sera were measured the level of total IgG, IgM, IgA and IgG subclasses(IgG1, IgG2, IgG3, IgG4) by using Enzyme Immuno Assay and Single Radial Immuno-Diffusion method. RESULTS: The sex ratio of male to female was 1.4:1.0, and febrile days before admission was 4.6+/-2.4 days. Total levels of IgG, IgM and IgA were normal range in both groups. The levels of IgG1, IgG2 and IgG3 were not specific changes but significantly decreased the level of IgG4 in patients group as compared with control group(P<0.05). CONCLUSION: Selective decreased the levels of serum IgG4 can be one of factors to increasing the incidence of KD.
Female ; Humans ; Immunoglobulin A ; Immunoglobulin G* ; Immunoglobulin M ; Incidence ; Male ; Mucocutaneous Lymph Node Syndrome* ; Reference Values ; Sex Ratio

PURPOSE: Pylorus-preserving gastrectomy (PPG), which retains pyloric ring and gastric function, has been accepted as a function-preserving procedure for early gastric cancer for the prevention of postgastrectomy syndrome. This study was compared laparoscopy-assisted pylorus-preerving gastrectomy (LAPPG) with laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction (LADGB I). MATERIALS AND METHODS: Between November 2006 and September 2007, 39 patients with early gastric cancer underwent laparoscopy-assisted gastrectomy in the Department of Surgery at Korea Cancer Center Hospital. 9 of these patients underwent LAPPG and 18 underwent LADGBI. When LAPPG was underwent, we preserved the pyloric branch, hepatic branch, and celiac branch of the vagus nerve, the infrapyloric artery, and the right gastric artery and performed D1+beta lymphadenectomy to the exclusion of suprapyloric lymph node dissection. The distal stomach was resected while retaining a 2.5~3.0 cm pyloric cuff and maintaining a 3.0~4.0 cm distal margin for the resection. RESULTS: The mean age for patients who underwent LAPPG and LADGBI were 59.9+/-9.4 year-old and 64.1+/-10.0 year-old, respectively. The sex ratio was 1.3:1.0 (male 5, female 4) in the LAPPG group and 2.6:1.0 (male 13, female 5) in the LADGBI group. Mean total number of dissected lymph nodes (28.3+/-11.9 versus 28.1+/-8.9), operation time (269.0+/-34.4 versus 236.3+/-39.6 minutes), estimated blood loss (191.1+/-85.7 versus 218.3+/-150.6 ml), time to first flatus (3.6+/-0.9 versus 3.5+/-0.8 days), time to start of diet (5.1+/-0.9 versus 5.1+/-1.7 days), and postoperative hospital stay (10.1+/-4.0 versus 9.2+/-3.0 days) were not found significant differences (P>0.05). The postoperative complications were 1 patient with gastric stasis and 1 patient with wound seroma in LAPPG group and 1 patient with left lateral segment infarct of liver in the LADGB I group. CONCLUSION: Patients treated by LAPPG showed a comparable quality of surgical operation compared with those treated by LADGBI. LAPPG has an important role in the surgical management of early gastric cancer in terms of quality of postoperative life. Randomized controlled studies should be undertaken to analyze the optimal survival and long-term outcomes of this operative procedure.
Arteries ; Diet ; Female ; Flatulence ; Gastrectomy ; Gastroparesis ; Humans ; Korea ; Length of Stay ; Liver ; Lymph Node Excision ; Lymph Nodes ; Postgastrectomy Syndromes ; Postoperative Complications ; Seroma ; Sex Ratio ; Stomach ; Stomach Neoplasms ; Vagus Nerve