PURPOSE: Since the first description of multiple primary malignant neoplasms(MPNs) by Billroth, numerous studies concerning MPNs have been reported. We analyzed variable characteristics of MPNs in urologic tumor patients and try to offer useful clinical informations. MATERIALS AND METHODS: From January 1994 to September 1998, we have treated 1,230 patients who had at least one primary urologic cancer; 459 transitional cell carcinomas, 366 renal cell carcinomas, 325 prostatic cancers, 128 others. Among those patients, 99 patients(8.0%) had genitourinary multiple primary neoplasms(GU-MPNs). We reviewed the medical and pathologic records of these 99 patients with GU-MPNs. RESULTS: The incidence of MPNs was especially high in patients with renal cell carcinoma and bladder cancer than any other GU tract cancers. Renal cell carcinoma plus gastrointestinal malignancy and urothelial cancer plus cervix cancer were common combinations of MPNs in this study. Incidences of counterpart cancers were similar to the ranks of relative frequency of cancers in Korea except genitourinary cancers that were more common than the relative frequency of their own. 55 cases were synchronous and mean diagnostic interval was one month and eleven days. 36 cases of 44 metachronous MPNs developed within 5 years after the diagnosis of the first tumor. In synchronous MPNs, 29 second tumors(52.7%) were diagnosed by staging workup or during operation of the first tumor and 34 second tumors(77.3%) of metachronous MPNs were diagnosed by their own symptoms. CONCLUSIONS: Due to the improvements in the techniques for diagnosis and treatment of cancer and the prolonged average life span, occurrence of MPNs is no longer rare. Therefore importance of early diagnosis of MPNs is increasing. We recommend to keep in mind the possibility of MPNs especially in RCC and bladder cancers. We think further study is needed to delimitate the risk factors of MPNs.
Carcinoma, Renal Cell ; Carcinoma, Transitional Cell ; Diagnosis ; Early Diagnosis ; Humans ; Incidence ; Korea ; Neoplasms, Multiple Primary* ; Prostatic Neoplasms ; Risk Factors ; Urinary Bladder Neoplasms ; Urogenital Neoplasms ; Urologic Neoplasms ; Uterine Cervical Neoplasms

PURPOSE: Interfenon-gamma(IFN-gamma) has been tried to decrease fibrosis in liver cirrhosis in the human and animals. To decrease collagen content in the partially obstructed kidney, we examined collagen changes by IFN-gamma after creating partial ureteral obstruction in the rat. We applied IFN-gammato the partially obstructed kidney and examined collagen contents in the renal cortex by morphometric analysis. MATERIALS AND METHODS: In a total of 50 Sprague Dawley adult male rats(300-350gm), we created partial unilateral ureteral obstruction(PUUO). We divided rats into 5 groups(n=10 in each group): normal control, sham operation group, sham operation with IFN-gamma 4 weeks, PUUO 4 weeks, PUUO with IFN-gamma 4 weeks. IFN-gamma(LG Chemical, Korea) 100,000 IU was subcutaneously injected daily for 4 weeks from operation day 1 in the treated groups. The rats were sacrificed on the expected day and renal cortex was prepared for Masson`s trichrome special staining. With the image analyser, we calculated the relative ratio of collagen to renal cortex area randomly in each kidney. RESULTS: Relative percent of collagen content of the normal control, sham-operation, and sham-operation with IFN-gamma treated groups were 2.42+/-0.53%(n=10), 2.62+/-0.53%(n=10), and 2.22+/-0.65%(n=10), respectively. While relative percent of collagen content of PUUO group, and PUUO with IFN-gamma treated group were 12.25+/-2.41%(n=5) and 7.14+/-3.43%(n=9) respectively. There was significant difference between those of last two groups.(p<0.05, Wilcoxon-rank sum test) CONCLUSIONS: We applied interferon-gamma to the partially obstructed kidney and examined collagen contents in the kidney by morphometric analysis. From the above data, IFN-gammaseems to have a decreasing effect upon collagen content in the partially obstructed rat kidney.
Adult ; Animals ; Collagen* ; Fibrosis ; Humans ; Injections, Subcutaneous* ; Interferon-gamma* ; Kidney* ; Liver Cirrhosis ; Male ; Rats* ; Ureter* ; Ureteral Obstruction*

Primary cervical neuroblastoma is very rare disease in neonates and should be distinguished with other diseases, which cause stridor in neonate, including laryngomalacia, vocal cord paralysis, laryngeal web, laryngotracheal esophageal cleft, laryngotracheal stenosis, etc. It is characterized by cough, stridor, dysphagia, neck mass, Horner syndrome and heterochromia iridis. Survival rate is high even in the advanced cases, in which the residual mass is remained after partial resection, without further therapy. A 1-day-old girl showed severe dyspnea with inspiratory stridor after birth. At first, she was misdiagnosed as a case of laryngomalacia, but later proved to have stage I primary neuroblastoma by plain X-ray film of lateral view of the neck, flexible nasolaryngoscopy, and computerized tomography. She has been well without relapse after total resection for 1 (1/2) year. We report this case as the first case in Korea.
Constriction, Pathologic ; Cough ; Deglutition Disorders ; Dyspnea ; Female ; Horner Syndrome ; Humans ; Infant, Newborn ; Korea ; Laryngomalacia ; Neck ; Neuroblastoma* ; Parturition ; Rare Diseases ; Recurrence ; Respiratory Sounds* ; Survival Rate ; Vocal Cord Paralysis ; X-Ray Film

Salmonella-triggered reactive arthritis appears one to three weeks after the onset of salmonella infection and presents with asymmetric, usually migratory, oligo- or polyarthritis. The course is usually self-limiting and symptoms last two to six months. We experienced a 10-year-old male patient who presented to a local pediatric center with long-lasting fever and right ankle joint pain. The pain migrated to the left ankle joint, both wrists, and both knees and he was diagnosed as juvenile rheumatoid arthritis and was medicated with NSAIDs and corticosteroid. In the meantime, 20 days prior to the transfer to our hospital he was febrile with nausea and abdominal pain and the antibody titer of S. typhi O Ag by Widal test was 1 : 320, and an antibiotic therapy was followed. Soon after, the fever subsided but the migrating joint symptoms continued and he was transferred to our hospital. Widal tests were weekly checked and the antibody titers of S. typhi O Ag were 1 : 160, 1 : 320, 1 : 320, 1 : 160, 1 : 160, respectively. ESR was 55 mm/hr, CRP 9.18 mg/dl, HLA-B27 positive and his endoscopic findings of the colon showed mild lymphoid hyperplasia and mucosal nodularities in the cecum and ileocecal area. Stool cultures and duodenal juice culture for Salmonella and Shigella were all negative. He was treated with ibuprofen and bactrim and the joint symptoms were gradually mitigated. After discharge, he maintained mildly elevated CRP levels and antibody levels by Widal tests, but was free from symptoms except for several episodes of finger pains for 11 months.
Abdominal Pain ; Ankle Joint ; Anti-Inflammatory Agents, Non-Steroidal ; Arthritis ; Arthritis, Juvenile* ; Arthritis, Reactive* ; Cecum ; Child* ; Colon ; Fever ; Fingers ; HLA-B27 Antigen ; Humans ; Hyperplasia ; Ibuprofen ; Joints ; Knee ; Male ; Nausea ; Salmonella ; Salmonella Infections ; Shigella ; Trimethoprim, Sulfamethoxazole Drug Combination ; Wrist

College of Medicine, Ulsan University, Seoul, Korea The vascular rings comprise less than 1% of congenital cardiovascular malformations and can be overlooked because they are rare diseases and show nonspecific respiratory symptoms such as wheezing or airway obstruction or apnea. This case is a 2-months old infant who had been repaired patch closure due to ventricular septal defect, but failed to wean from ventilator. Chest CT showed right main stem bronchus lying between right pulmonary arery and right descending aorta, bronchoscopy showed right main bronchus was compressed by extrinsic pulsating mass which were descending aorta and Kommerell's diverticulum . After aortopexy and transfer of subclavian artery, this patient was able to be extubated and is now free of respiratory symptoms. When there is failure to weaning of ventilator and persistent bronchial obstruction and emphysema, we should have more vigorous effort to seek the cause of bronchial obstruction, using bronchoscope and chest CT.
Airway Obstruction ; Aorta, Thoracic* ; Apnea ; Bronchi ; Bronchoscopes ; Bronchoscopy ; Deception ; Diverticulum* ; Emphysema ; Heart Septal Defects, Ventricular ; Humans ; Infant ; Korea ; Rare Diseases ; Respiratory Sounds ; Seoul ; Subclavian Artery ; Tomography, X-Ray Computed ; Ulsan ; Ventilators, Mechanical ; Weaning

Several different diseases may have an associated exudative pleural effusion. In a patient with a pleural effusion of unknown origin, a possibility of intra-abdominal abscess should always be considered, especially in a patient who has the past history of abdominal surgery or procedure. We describe a 5-year-old male patient who had been operated for congenital hydrocephalus with ventriculo-peritoneal shunt insertion at 15 months old, admitted to our hospital with complaints of headache and edema of valvular area. Brain CT scan revealed shunt disconnection, and he was operated for insertion of new shunt catheter. Seven days after first operation, he presented fever, abdominal pain and distension. Abdominal ultrasonography revealed bowel adhesion and peritonitis. Staphylococcus epidermidis was isolated by aspiration of shunt valve and reservior, repeatedly. He should have had another 2 operations of peritoneal lavage and catheter change for shunt infection associated peritonitis. Eight days after the 3rd operation, he complained newly developed left shoulder, left chest pain and fever up to 39 degrees C. His chest x-ray revealed pleural effusion on the left side. Though antibiotic therapy was already being conducted, the left pleural effusion and fever aggravated. Repeated ultrasonography disclosed an occult left subphrenic abscess, explaining the fever and left pleural effusion on the radiograph. Fourth operation of abscess drainage and infected shunt removal with extraventricular drainage was done. After the operation, his fever and pleural effision were rapidly disappered, and postoperative CSF culture was negative. A review of ventriculoperitoneal shunt infection associated with subphrenic abscess and pleural effusion was discussed.
Abdominal Abscess ; Abdominal Pain ; Abscess ; Brain ; Catheters ; Chest Pain ; Child, Preschool ; Drainage ; Edema ; Fever ; Headache ; Humans ; Hydrocephalus ; Infant ; Male ; Peritoneal Lavage ; Peritonitis ; Pleural Effusion* ; Shoulder ; Staphylococcus epidermidis ; Subphrenic Abscess* ; Thorax ; Tomography, X-Ray Computed ; Ultrasonography ; Ventriculoperitoneal Shunt*

PURPOSE: A Cow's milk allergy (CMA) is one of common problems during first year of life. Though milk caused allergic problems, their parents didn't know it, and gave milk to their children. But the parents don't give milk to their children if they know it. Therefore it may cause problems of growth and development in children. The purpose of this study is to analyze those clinical features of milk allergy confirmed by oral provocation test. METHODS: We carried out the retrospective study on 21 patients who had been performed oral milk provocation test at Yonsei university children's allergic clinic. RESULTS: 9 out of 21cases (43%) showed positive milk oral provocation test. The most common clinical symptom & sign was urticaria, followed by respiratory symptoms and abdominal symptoms. The rate which past history and positive skin test corresponded to oral provocation test was very high (100%). CONCLUSION: The most valuable diagnosis of food allergy is oral provocation test. However, predictive value of allergy skin test and past history was very high in milk allergy.
Child ; Diagnosis ; Food Hypersensitivity ; Growth and Development ; Humans ; Hypersensitivity ; Milk Hypersensitivity ; Milk* ; Parents ; Retrospective Studies ; Skin Tests ; Urticaria

PURPOSE: The respiratory tract infections including pneumonia have been the major contributing factor for bronchial asthma, and are frequently involved in hospitalization due to asthma attack. We studied clinical characteristics of hospitalized cases due to asthma attack with and without pneumonic infiltrates. METHODS: Over 5 years between January 1993 and December 1997, 628 patients were hospitalized due to asthma attack. 315 of them had pneumonic infiltrates on chest X-ray (defined as pneumonia group) and 197 patients had no pneumonic infiltrates (uncomplicated group). The clinical characteristics of both groups were reviewed retrospectively. RESULTS: The age on admission and first attack in pneumonia group were significantly younger than those of uncomplicated group (P<0.05). The incidence of male was higher than that of female in both groups. The interval from attack to admission and duration of hospitalization were much longer in pneumonia group (P<0.05). The bronchial asthma attack was most frequently occurred between September and November. The atopy-perennial type was predominant in the both groups, and the incidence of non-atopy type was higher in the pneumonia group. The mild asthma attack was predominant in the pneumonia group and moderate one was predominant in the uncomplicated group. The incidence of fever and inflammatory reaction (peripheral blood WBC count, serum CRP level) were higher in the pneumonia group (P<0.05). There was no significant difference in the serum IgE level between two groups. CONCLUSION: Frequency and duration of hospitalization due to asthma attack might be lessened by prevention against respiratory tract infection.
Asthma* ; Female ; Fever ; Hospitalization ; Humans ; Immunoglobulin E ; Incidence ; Male ; Pneumonia ; Respiratory Tract Infections ; Retrospective Studies ; Thorax

PURPOSE: Many cytokines including tumor necrosis factor-alpha (TNF-alpha), IL-6, IL-1 influence the inflammatory response in acute and chronic respiratory inflammation. Tumor necrosis factor-alpha is a pleiotropic mediator of many inflammatory responses. Soluble TNF receptor acts in a antiinflammatory manner by inhibit the function of TNF. In order to investigate the role of TNF-alpha and sTNF-RI to develop the chronic airway inflammation in RDS and asthma, We measured the serum levels of TNF-alpha and sTNF-RI in the patients with respiratory distress syndrome, bronchial asthma and normal healthy controls. METHODS: Total 24 subjects (10 of RDS neonates, 6 of health newborn infants, and 8 of infantile asthma) who admitted to our pediatric department of Soonchunhyang university were enrolled to our study. The serum levels of TNF-alpha and soluble sTNF-RI were measured by EIA kit (Quantikine human TNF-alpha Immunoassay, Catalog number DTA50, and Quantikine human sTNF RI Immunoassay, Catalog Number DRT100, R&D). RESULTS: The serum levels of TNF-alpha in the patients with respiratory distress syndrome, bronchial asthma, and normal healthy controls were 4.96+/-3.32 pg/mL, 5.65+/-5.85 pg/mL, 2.95+/-2.33 pg/mL (mean+/-SD), respectively. There was no statistically significance between each group (P=0.732, P=0.367, P=0.255). The serum levels of soluble sTNF-RI in the patients with respiratory distress, bronchial asthma, and normal healthy controls were 156.1+/-166.4 pg/mL, 120.3+/-134.1 pg/mL, 33.3+/-10.7 pg/mL, respectively. There was no statistically significance between each group (P=0.469, P=0.102, P=0.326). There were significant correlation between TNF-alpha and sTNF-RI in the group of normal healthy controls (r=0.9534, P=0.0032,). But, there was no significant correlation between TNF-alpha and sTNF-RI in the group of respiratory distress syndrome (r=0.5940, P=0.0702). CONCLUSIONS: In this study, it is suggested that disturbance of the ratio of TNF-alpha to sTNF-RI play a role as a factor to persist pulmonary inflammation which lead to a development of bronchial asthma.
Asthma* ; Cytokines ; Humans ; Immunoassay ; Infant* ; Infant, Newborn ; Inflammation ; Interleukin-1 ; Interleukin-6 ; Pneumonia ; Prospective Studies* ; Receptors, Tumor Necrosis Factor* ; Tumor Necrosis Factor-alpha*

OBJECTIVE: Peritumoral edema(PTE) in meningioma occurs variably and can adversely affect the clinical course. Moreover, the etiology of PTE in meningioma is not well documented. To examine possible correlations with PTE, the authors report an investigation of the clinical parameters and the expressions of vascular endothelial growth factor(VEGF), matrix metalloproteinases(MMPs), and their inhibitors(TIMPs) in 20 meningiomas. METHODS: Tumor volume and edema volume estimation was done using Osiris software with magnetic resonance images and the edema index was calculated. The expression of VEGF, MMP, and TIMP were estimated in all 20 meningiomas by Western blotting, zymography, and laser densitometry. RESULTS: Tumor location was closely related with PTE. Meningiomas of the frontal lobe or the frontotemporal base had large PTEs, whereas those of the occipitoparietal lobe, posterior fossa or petroclivus were small. The level of VEGF expression bore no correlation with histologic malignancy and PTE extent. MMP-2 and -9 were detected in 100% of meningiomas and these levels were significantly related with PTE. TIMP-1 and -2 were detected in 19(95%) and 12(60%) of meningiomas respectively and their presence had no significant correlations statistically with PTE. CONCLUSION: Meningiomas with severe PTE expressed high levels of MMP-9 and low levels of MMP-2. The expressions of VEGF, MMP-2, MMP-9, and TIMPs in meningioma seems to be strongly related with PTE, which might be important factors of the etiology of PTE.
Blotting, Western ; Densitometry ; Edema* ; Frontal Lobe ; Meningioma* ; Tissue Inhibitor of Metalloproteinase-1 ; Tumor Burden ; Vascular Endothelial Growth Factor A