PURPOSE: Non-alcoholic fatty liver disease (NAFLD) has been recognized as an important childhood liver disease, especially where the prevalence of childhood obesity is increasing. The purpose of this study is to clarify the usefulness of elevated serum aminotransferase activities and their ratio for predicting the presence of fatty liver and its severity in obese children. METHODS: Forty-four children (M/F 29/15, age 4 to 16 years) with obesity (weight excess>20%) were analyzed retrospectively with medical records based on degree of obesity, bioelectrical impedence, serum aminotransferase activities, lipid profiles and ultrasonography. RESULTS: 1) Ultrasonography was carried out in 34 cases. Elevated serum ALT was found in 89.7% (26/29) of the patients diagnosed as fatty liver by ultrasonography and decreased AST/ALT ratio (<1) was found in 96.6% (28/29). There was a strong correlation between elevated serum ALT (>45 IU/L) or decreased AST/ALT ratio (<1) and the fatty liver in obese children (p<0.05). 2) There was no significant correlation between the serum ALT or AST/ALT ratio and the degree of fatty liver (p>0.05). 3) There was a significant correlation between total cholesterol, triglyceride and fatty liver (p<0.05). CONCLUSION: Serum ALT activity and AST/ALT ratio were useful to predict the presence of fatty liver diagnosed by ultrasonography in obese children, whereas they were not useful to predict the degree of fatty liver. Therefore, to prevent fatty liver progressing to advanced liver disease, it is necessary to manage and monitor the obese children continuously, especially those who have predicting factors of fatty liver.
Child* ; Cholesterol ; Fatty Liver* ; Humans ; Liver Diseases ; Medical Records ; Obesity ; Pediatric Obesity ; Prevalence ; Retrospective Studies ; Triglycerides ; Ultrasonography

PURPOSE: To evaluate the difference in radiologic features of rhabdoid tumor of the kidney (RTK) in children according to the location of the tumor within the kidney. MATERIALS AND METHODS: We retrospectively reviewed the radiologic findings of pathologically confirmed RTK in seven children (5 boys and 2 girls; age range, 6 months to 4 years 8 months; median, 18 months). All subjects underwent abdominal CT. We analyzed tumor location, size, and margin; renal hilar involvement, subcapsular hematoma, calcification, necrosis, and lymphadenopathy. RTK was classified according to the location of the tumor within the kidney: A tumor that mainly located in the central portion of the kidney with or without peripheral extension was described as type I, while one located at the periphery was type II. Imaging findings between the two types were compared. RESULTS: Tumor size varied from 3 cm to 12 cm. Tumor outlines were ill-defined in four cases but relatively well-defined in three. Four tumors (57 %) were type I. Hilar involvement was found in all four and a small subcapsular hematoma in one. Three tumors (43%) were type II, and in all three, large crescent-shaped subcapsular hematomas were found. CONCLUSION: Centrally located RTK showed hilar involvement with a small subcapsular hematoma, while in cases of peripherally located RTK, a large subcapsular hematoma was present. These findings may be helpful for the differential diagnosis of other pediatric renal tumors.
Child* ; Diagnosis, Differential ; Female ; Hematoma ; Humans ; Kidney* ; Lymphatic Diseases ; Necrosis ; Retrospective Studies ; Rhabdoid Tumor* ; Tomography, X-Ray Computed

PURPOSE: To evaluate the difference in radiologic features of rhabdoid tumor of the kidney (RTK) in children according to the location of the tumor within the kidney. MATERIALS AND METHODS: We retrospectively reviewed the radiologic findings of pathologically confirmed RTK in seven children (5 boys and 2 girls; age range, 6 months to 4 years 8 months; median, 18 months). All subjects underwent abdominal CT. We analyzed tumor location, size, and margin; renal hilar involvement, subcapsular hematoma, calcification, necrosis, and lymphadenopathy. RTK was classified according to the location of the tumor within the kidney: A tumor that mainly located in the central portion of the kidney with or without peripheral extension was described as type I, while one located at the periphery was type II. Imaging findings between the two types were compared. RESULTS: Tumor size varied from 3 cm to 12 cm. Tumor outlines were ill-defined in four cases but relatively well-defined in three. Four tumors (57 %) were type I. Hilar involvement was found in all four and a small subcapsular hematoma in one. Three tumors (43%) were type II, and in all three, large crescent-shaped subcapsular hematomas were found. CONCLUSION: Centrally located RTK showed hilar involvement with a small subcapsular hematoma, while in cases of peripherally located RTK, a large subcapsular hematoma was present. These findings may be helpful for the differential diagnosis of other pediatric renal tumors.
Child* ; Diagnosis, Differential ; Female ; Hematoma ; Humans ; Kidney* ; Lymphatic Diseases ; Necrosis ; Retrospective Studies ; Rhabdoid Tumor* ; Tomography, X-Ray Computed

BACKGROUND/AIMS: We compared the recurrence of hepatocellular carcinoma (HCC) and the survival of patients who received radiofrequency ablation (RFA) after transarterial chemoembolization (TACE) with patients treated with TACE or RFA alone. METHODS: This study included 201 patients with HCC, who were consecutively enrolled at Seoul St. Mary's Hospital between December 2004 and February 2010. Inclusion criteria were a single HCC < or = 5.0 cm or up to three HCCs < or = 3.0 cm. We used a propensity score model to compare HCC patients (n = 87) who received RFA after TACE (TACE + RFA) with those who received TACE (n = 71) or RFA alone (n = 43). RESULTS: The median follow-up period was 33.3 months (range, 6.8 to 80.9). The TACE + RFA group showed significantly lower local recurrence than the RFA or TACE groups (hazard ratio [HR], 0.309; 95% confidence interval [CI], 0.130 to 0.736; p = 0.008; and HR, 0.352; 95% CI, 0.158 to 0.787; p = 0.011, respectively). The overall survival was significantly better in the TACE + RFA group compared to the RFA group (HR, 0.422; 95% CI, 0.185 to 0.964; p = 0.041). However, the survival benefit was not different between the TACE + RFA and TACE groups (p = 0.124). Subgroup analysis showed that among patients with a tumor size < 3 cm, the TACE + RFA group had significantly better long-term survival than those in the TACE or RFA groups (p = 0.017, p = 0.004, respectively). CONCLUSIONS: TACE + RFA combination treatment showed favorable local recurrence and better overall survival rates in early-stage HCC patients. Patients with tumors < 3 cm are likely to benefit more from TACE + RFA combination treatment. Additional studies are needed for the selection of suitable HCC patients for TACE + RFA treatment.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/mortality/pathology/*therapy ; *Catheter Ablation/adverse effects/mortality ; *Chemoembolization, Therapeutic/adverse effects/mortality ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Female ; Humans ; Kaplan-Meier Estimate ; Liver Neoplasms/mortality/pathology/*therapy ; Male ; Middle Aged ; *Neoadjuvant Therapy/adverse effects/mortality ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Patient Selection ; Proportional Hazards Models ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome ; Tumor Burden ; Young Adult

This report describes a 26-year-old man of Takayasu's arteritis complicated with acute myocardial infarction due to the occlusion of proximal left anterior descending artery and renovascular hypertension which was improved spontaneously without obstruction of stenotic renal artery. Coronary artery involvement and myocardial ischemic symptom in Takayasu's arteritis is uncommon and only about 10 case of acute myocardial infarction were reported. But most cases were diagnosed by autopsy after death. In this case, acute myocardial infarction developed during follow up after diagnosis of Takayasu's aortitis and coronary artery involvement was confirmed by coronary angingraphy. Hypertension is found in 40-70% of the cases. In our case hypertension was complicated and thought to be renovascular origin. It was refractory to medication including captopril. During follow up blood pressure was normalized spontaneously after wide fluctuations for 3 times. Now he is normotensive without medication. It is thought to give a new insight to the mechanism and treatment of renovascular hypertension.
Adult ; Aortitis ; Arteries ; Autopsy ; Blood Pressure ; Captopril ; Coronary Vessels ; Diagnosis ; Follow-Up Studies ; Humans ; Hypertension ; Hypertension, Renovascular* ; Myocardial Infarction* ; Renal Artery ; Takayasu Arteritis*

Nimesulide, highly selective cyclooxygenase inhibitor-2, is a newly developed, non-steroidal anti-inflammatory drug (NSAID) with low toxicity in gastrointestinal tract. But recently, seven cases of nimesulide-induced hepatitis of which types were hepatocellular, hepatocanalicular, and mixed damage were reported. Our case of nimesulide-induced hepatic damage was mixed cholestatic and hepatotoxic hypersensititvity reaction, and her story was as follows. A 70-year female patient's first hepatic event happened in Jaunuary, 1998 after taking nimesulide 200mg daily for 50 days from November 1997, but it was cleared. She was admitted to our unit because of jaundice, edema and ascites in May, 1998 after retrial of nimesulide 150 mg daily for 50 days. Biochemical determinations showed increase of AST (181 IU/L), ALT (110 IU/L), bilirubin (20.3 mg/dL) and albumin (2.3 g/dL). Prothrombin time was also prolonged upto 2.51 INR. But neither viral markers such as anti-HCV, HBsAg, anti-HBc IgM, anti-HAV IgM, anti-CMV, anti-EBV IgG and IgM nor other immunologic markers such as ANA, SMA, and AMA were positive. Ultrasonography showed diffuse hyperechogenicity in liver and mild splenomegaly but no dilatation in biliary tract. Liver biopsy showed portal to portal bridging necrosis with severe hepatocytic cholestasis. Her liver function returned to normal after discontinuation of nimesulide. At 8 months after beginning treatment, she complained of recurrent epistaxis and abdominal distension. At this time, her liver biopsy showed cirrhosis. In conclusion, we considered that this case was nimesulide-induced Liver cirrhosis.
Abdominal Abscess ; Ascites ; Biliary Tract ; Bilirubin ; Biomarkers ; Biopsy ; Catheterization ; Cholestasis ; Dilatation ; Drainage ; Edema ; Epistaxis ; Female ; Fibrosis ; Gastrointestinal Tract ; Hepatitis A Antibodies ; Hepatitis B Surface Antigens ; Hepatitis* ; Humans ; Immunoglobulin G ; Immunoglobulin M ; International Normalized Ratio ; Jaundice ; Liver ; Liver Cirrhosis ; Necrosis ; Prostaglandin-Endoperoxide Synthases ; Prothrombin Time ; Splenomegaly ; Ultrasonography

Background : Mucin phenotypic markers and CDX2 are widely expressed in gastric carcinomas, however, recent studies have produced conflicting results regarding whether the expression patterns of these markers have clinicopathologic significance. Methods : We examined samples from 217 gastric carcinoma patients immunohistochemically to determine if the expression of mucin phenotypic markers and CDX2 was correlated with postoperative survival and other clinicopathologic factors. Results : All tumors were phenotypically classified as gastric (type G, 81 cases), gastric and intestinal mixed (type GI, 55 cases), intestinal (type I, 43 cases), or unclassified (type U, 38 cases). The occurrence of type G and GI tumors was positively correlated with tumor progression whereas that of type U tumors was negatively correlated with tumor progression. CDX2 expression was correlated with type I tumors. Tumors that expressed MUC5AC or MUC6 had a better prognosis than those that did not. When the relationship between phenotype and prognosis was considered, type GI had the best prognosis, followed by type G, then type U. Conclusions : The mucin phenotypic markers may be useful for predicting tumor progression and survival in patients with gastric carcinomas. Additionally, CDX2 may play an important role in gastric carcinogenesis of type I tumors.
Carcinogenesis ; Humans ; Mucins* ; Phenotype* ; Prognosis ; Stomach Neoplasms

Malignant melanoma of the genital tract is a rare disease that is usually diagnosed by chance. When a definite diagnosis is delayed, the prognosis is very poor without standardized treatment. Herein, we describe a 40-year-old patient who presented with a history of bloody vaginal discharge for 7 months. Gynecological examination showed an exophytic, hard and pigmented cervical mass involving the upper vagina. The patient was diagnosed with cervical melanoma after a punch biopsy and underwent a radical hysterectomy, upper vaginectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy. After surgeries, the patient underwent 2-cycles of adjuvant immunotherapy with pembrolizumab, but died within 8 months. In this report, treatment with pembrolizumab after radical surgery was not effective for this patient who had a primary cervical melanoma that metastasized to bone and lung tissue. We do not know why pembrolizumab was ineffective for this patient, but there are several possible explanations; further research is needed.
Adult ; Antibodies, Monoclonal, Humanized ; Biopsy ; Cervix Uteri* ; Diagnosis ; Female ; Gynecological Examination ; Humans ; Hysterectomy ; Immunotherapy ; Lung ; Lymph Node Excision ; Melanoma* ; Prognosis ; Rare Diseases ; Uterine Cervical Neoplasms ; Vagina ; Vaginal Discharge

Purpose: We investigated the impact of four types of antihypertensive medications, angiotensinreceptor blockers (ARBs), beta blockers (BBs; both selective and non-selective), calciumchannel blockers (CCBs), and thiazide diuretics (TDs) on survival outcomes in epithelial ovariancancer (EOC). Materials and Methods: A single-institutional retrospective chart review of 878 patients with EOC was performed.Survival was compared according to use of the four antihypertensive medications duringprimary treatment. Propensity score matching (ratio 1:3) was performed to control possibleassociated covariates, such as age, International Federation of Gynecology and Obstetricsstage, residual status after primary debulking surgery, and co-morbidity. Results: Among 878 patients, 56 patients (6.4%) were ARB users, 62 (7.1%) were BB users, 107(12.2%) were CCBs users and 32 (3.6%) used TDs. Median progression-free survival (PFS)for ARB, BB, and CCB users was 37.8, 27.2, and 23.6 months compared with 33.6 monthsfor non-users. ARB was associated with 35% decreased risk of disease progression (hazardratio [HR], 0.65; 95% confidence interval [CI], 0.42 to 0.99; p=0.046) in multivariate analysis.After propensity score matching, median PFS for ARB users was 37.8 months and ARBuse remained to be associated with lower recurrence rate in univariate (p=0.035) and multivariateanalysis (HR, 0.60; 95% CI, 0.39 to 0.93; p=0.022). Conclusion In this study, ARBs use during primary treatment is associated with lower recurrence in EOCpatients. However, CCBs, BBs, and TDs did not show beneficial impact.

BACKGROUND: Discontinuation of antiepileptic drug (AED) is valuable in patients of epilepsy who have been seizure free for a considerable time. However, there are few established methods to successfully stop AED. The purpose of study was to find the prognostic factors and the method of desirable AED withdrawal. METHODS: Seventy-eight patients who were seizure free for more than 18 months were enrolled in this retrospective study. The patients were followed for more than 2 years after starting withdrawal, or until seizure recurrence within 2 years. To clarify the prognostic factors affecting the seizure recurrence related to the withdrawal, statistical analyses were done about AED types, EEG before withdrawal, sex, age, onset age of seizure, febrile convulsion, family history, brain CT/MRI, trauma history, loss of consciousness history, seizure nature, and duration of seizure free. Furthermore, survival analysis between groups over the duration of withdrawal period and AED decrement rate was done to elucidate the most successful methods of AED withdrawal. RESULTS: Fifty-seven patients (73%) experienced seizure recurrence after starting withdrawal within 2 years. Over 12 months of withdrawal duration (p=0.037) and under 20 percent per month of the decrement rate of carbamazepine (p=0.019) were related to reduce the seizure recurrence. These were also confirmed via survival curve analysis. CONCLUSIONS: This study is a new attempt to apply reduction rate in withdrawal. AED withdrawal duration and decrement rate are important factor to prognostic factors of desirable AED withdrawal and minimize the recurrence after withdrawal.
Age of Onset ; Anticonvulsants ; Brain ; Carbamazepine ; Electroencephalography ; Epilepsy ; Humans ; Recurrence ; Retrospective Studies ; Seizures ; Seizures, Febrile ; Unconsciousness