The number of end-stage renal disease (ESRD) patients is progressively growing with more than 60,000 ESRD patients on renal replacement therapy in Korea. The mortality risk in ESRD patients is approximately 10 to 20-fold higher compared to the general population, which is mainly attributed to prevalent cardiovascular disease in these patients. However, the risk factors for cardiovascular disease in ESRD patients are different from the general population, and useful biomarkers for predicting cardiovascular mortality are not completely defined. The nationwide multicenter Clinical Research Center (CRC) for ESRD program was initiated in Korea not only to elucidate the incidence and prevalence of cardiovascular disease in ESRD patients but also to identify potential risk factors including various biomarkers for cardiovascular disease. A prospective cohort of 864 incident hemodialysis patients, from 34 dialysis centers of the CRC for ESRD in Korea, was followed up for 36 months, and the clinical outcome of these patients was reviewed. This article presents the recent data from the CRC for ESRD program, and, in addition, brief reviews on key risk factors and potential biomarkers for cardiovascular disease in ESRD patients.
Biomarkers ; Cardiovascular Diseases ; Cohort Studies ; Dialysis ; Humans ; Incidence ; Kidney Failure, Chronic ; Korea ; Prevalence ; Prospective Studies ; Renal Dialysis ; Renal Replacement Therapy ; Risk Factors

Hematemesis is not infrequent occurences in the neonatal period. Physician's first task is to determine whether this blood is maternal in origin or whether the infant is bleeding internally. Fetal blood indicates one of a variety of lesions and its source may be difficult to determine. The causes are esophagitis, peptic ulcer of the stomach or duodernum, hemorrhagic disease and pulmonary hemorrhage etc. We have experienced a case of massive hematemesis that occured in a 1 day of life. we conducted 24 hour pH monitoring, upper gastrointestinal barium series, and endoscopy with biopsy. this case showed esophagitis due to gastroesohageal reflux and errosive gastritis by above procedures. If there is hematemesis during the neonatal period, the esophagitis and gastritis should be considered.
Barium ; Biopsy ; Endoscopy ; Esophagitis ; Esophagitis, Peptic* ; Fetal Blood ; Gastritis* ; Hematemesis* ; Hemorrhage ; Humans ; Hydrogen-Ion Concentration ; Infant ; Stomach ; Ulcer

The purpose of this study was to investigate pregnancy, abortion and delivery rates among Korean teenagers. The subjects of this study were 11,433 teenagers aged 13-19 year in Seoul, Pusan, Taegu, Kwangju, Insheon, Taejeon and Ansan, Korea. Data were collected from Feb. 1994 to May 1995, 16 months, by schoolnurses or the researchers. The results showed pregnancy rate was 7.2 per 1,000 teenagers, the abortion rate was 4.3 per 1,000 teenagers, and delivery rate was 1.2 per 1,000 teenagers. In the pregnancy experience, the main factors related to teenage pregnancy were love or marriage engagement. In the abortion experience, 53.9% of teenagers had more than two abortion experiences, 38.1% midtrimester abortion, 22% complications after abortion. In the delivery experience, 64.3% of teenagers delivered with no prenatal care and 42.9% had a delay in realizing they were pregnant. Fifty percent were delivered by non-professionals in non-medical institutions.
Abortion, Induced ; Adolescent* ; Birth Rate ; Busan ; Daegu ; Daejeon ; Female ; Gwangju ; Gyeonggi-do ; Humans ; Korea ; Love ; Marriage ; Pregnancy in Adolescence ; Pregnancy Rate ; Pregnancy Trimester, Second ; Pregnancy* ; Prenatal Care ; Seoul

BACKGROUND: The purpose of this study was to assess the efficacy of three chemotherapeutic agents both new and old, on a human neuroblastoma xenograft, designated TNB9, according to the standard Battelle Columbus Laboratories protocol. Cytogenetic and phenotypic analyses showed that TNB9 was one of the most malignant strains among human neuroblastoma xenografts. METHODS: When the estimated TNB9 tumor weight reached 100 to 200 mg, 28 nu/nu BALB/c tumor- bearing mice were randomly divided into 4 groups. One of three drugs was administered intraperitoneally in a total of three doses at four-day intervals to the mice in each experimental group while the control group received injections of normal saline. The doses of these agents at each injection were equivalent to one-third of the LD50. The results were evaluated on the basis of the maximum inhibition rate and also by the degree of tumor regression. RESULTS: Maximum inhibition rates were as follows: mitomycin C, 95.6%; irinotecan (CPT-11), 72.5%; paclitaxel, 46.4%. Mitomycin C was graded as having effects, representing tumor regression. Irinotecan was also effective against TNB9, and none of the irinotecan treated mice lost weight, suggesting minimal toxicity. CONCLUSIONS: Assessment of the chemotherapeutic sensitivity in vivo showed that irinotecan, mitomycin C were active agents whereas paclitaxel had minimal or marginal activity in the treatment of neuroblastoma.
Animals ; Cytogenetics ; Heterografts ; Humans ; Lethal Dose 50 ; Mice ; Mice, Nude ; Mitomycin* ; Neuroblastoma* ; Paclitaxel* ; Tumor Burden

It is uncommon that two phenotypically different lymphomas develop in the same person, and especially in the skin. Composite lymphoma is defined as two distinctly demarcated types of non-Hodgkin's lymphoma (NHL) or its association with Hodgkin's lymphoma (HL) within a single organ or tissue. Discordant lymphoma is defined as two types of NHL or the association of HL with NHL at different anatomic sites in the same person. Sequential lymphoma and simultaneous lymphoma are defined as two different types of lymphoma that occur in the same person at different times and at the same times, respectively. We herein report on two cases of sequential composite lymphomas that were limited to the skin. A 57-year-old woman who had had been diagnosed with HL at the face had been treated with chemotherapy for 1.5 years. 6 months later, the patient revisited the dermatologic clinic of our hospital for a one-month history of erythematous nodules on her chest and upper extremities. Punch biopsy was performed and the pathologic diagnosis was mantle cell lymphoma. She refused further treatment. A 68-year old woman, who had been diagnosed as having extranodal marginal zone B cell lymphoma, had been treated with chemotherapy and radiation therapy for one year. After one year, she revisited dermatologic clinic of our hospital for a several-month history of erythematous nodules on her extremities. Punch biopsy from the lesion was performed and the pathologic diagnosis was cutaneous diffuse large B cell lymphoma, the leg type. She was scheduled for chemotherapy (rituximab with cyclophosphamide, adriamycin, vincristine and prednisolone (R-CHOP)). To the best of our knowledge, our cases are the first such cases in the Korean dermatologic literature.
Biopsy ; Composite Lymphoma ; Cyclophosphamide ; Doxorubicin ; Extremities ; Female ; Hodgkin Disease ; Humans ; Leg ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, B-Cell, Marginal Zone ; Lymphoma, Mantle-Cell ; Lymphoma, Non-Hodgkin ; Middle Aged ; Prednisolone ; Skin ; Thorax ; Upper Extremity ; Vincristine

Ascending aortic injury after blunt chest trauma is an emergency condition that requires urgent diagnosis and treatment. The authors report the case of a patient with traumatic ascending aortic injury who received ascending aorta replacement under cardiopulmonary bypass after failure of primary repair.

Patients with traumatic aortic rupture rarely reach the hospital alive. Even among those who arrive at the hospital alive, traumatic aortic rupture after high-speed motor vehicle accidents leads to a high in-hospital mortality rate and is associated with other major injuries. Here, we report a rare case of descending midthoracic aortic rupture with blunt diaphragmatic rupture. Successful management with emergency laparotomy after an immediate endovascular procedure resulted in a favorable prognosis in this case.

Meconium obstruction (MO) in neonates arises from highly viscid meconium and the poor motility of the premature gut. Recently the incidence of the MO in neonates has been increasing, but, the diagnosis and treatment of this disease have not yet been clarified. Between March 2004 and April 2010, 24 neonates were treated for MO at Severance Children's Hospital. Their clinical characteristics and treatment were reviewed retrospectively. Twenty neonates were diagnosed with MO and 4 neonates were diagnosed with Hirschsprung's disease (HD). The mean birth weight and gestational age of the 20 neonates with MO were 1.45+/-0.90kg and 31.1+/-4.6 weeks, respectively. Thirteen neonates (65%) diagnosed with MO weighed less than 1.5kg and 10 neonates (50%) weighed less than 1kg. Half of the neonates with MO were treated by non-operative methods and the other half were treated by operative methods. Compared with the group that weighed over 1.5kg, the group that weighed less than 1.5kg were more frequently operated upon (61.5% vs. 28.5%), and contrast enemas were performed later and more frequently. Also the group that weighed less than 1.5kg had a higher mortality rate (15.4% vs. 0%). Three of the four neonates with HD were diagnosed with long-segment aganglionosis. In conclusion, MO occurred in very low birth weight neonates more often and must be differentiated from HD. Also, MO in very low birth weight neonates should be treated with special attention due to more a complicated clinical course.
Birth Weight ; Enema ; Gestational Age ; Hirschsprung Disease ; Humans ; Incidence ; Infant, Newborn ; Infant, Very Low Birth Weight ; Meconium ; Retrospective Studies

PURPOSE: In patients with diabetic end stage renal disease (ESRD), glycated albumin (GA) reflects recent glycemic control more accurately than glycated hemoglobin (HbA1c). We evaluated the relationship between GA and average blood glucose (AG) level and developed an estimating equation for translating GA values into easier-to-understand AG levels. MATERIALS AND METHODS: A total of 185 ESRD patients, including 154 diabetic and 31 non-diabetic participants, were enrolled (108 hemodialysis, 77 peritoneal dialysis). Patients were asked to perform four-point daily self-monitoring of capillary blood glucose (SMBG) at least three consecutive days each week for four weeks. Serum levels of GA, HbA1c and other biochemical parameters were checked at baseline, as well as at 4 and 8 weeks. RESULTS: Approximately 74.3+/-7.0 SMBG readings were obtained from each participant and mean AG was 169.1+/-48.2 mg/dL. The correlation coefficient between serum GA and AG levels (r=0.70, p<0.001) was higher than that of HbA1c and AG (r=0.54, p<0.001). Linear regression analysis yielded the following equation: estimated AG (eAG) (mg/dL)=4.71xGA%+73.35, and with this formula, serum GA levels could be easily translated to eAG levels. Multivariate analysis revealed significant contributions of postprandial hyperglycemia (beta=0.25, p=0.03) and serum albumin (beta=0.17, p=0.04) in determining serum GA level, independent to other clinical parameters. CONCLUSION: Compared to HbA1c, serum GA levels were better correlated with AG levels. Using the estimating equation, an average blood glucose level of 155-160 mg/dL could be matched to a GA value of 18-19% in patients with ESRD.
Adolescent ; Adult ; Aged ; Blood Glucose/*metabolism ; Female ; Humans ; Kidney Failure, Chronic/*blood/metabolism ; Male ; Middle Aged ; Prospective Studies ; Serum Albumin/*metabolism ; Young Adult

In one-stage transanal endorectal pull-through operation (TERPT) for Hirschsprung disease, preoperative evaluation by contrast enema (CE) is important tool in aspect of planning of surgical procedure as well as diagnosis. This study was to evaluate the significance of CE for identifying the extent of aganglionic bowel. A retrospective analysis was performed in 40 patients who underwent TERPT between 2003 and 2011. The authors reviewed the CE studies and their correlation with pathologic extent of aganglionosis. Total 66 contrast enemas were performed in 40 patients. Twenty patients underwent single CE, but 20 patients required multiple CEs. In single CE group, 17 had clear radiographic transition zone, but 3 had less definite transition zone. In multiple CE group, 17 patients who had equivocal finding in first or second CE had definite radiographic transition zone, but 3 patients of this group had less definite radiographic transition zones. Overall, 34 patients (85%) had clear radiographic transition zone by single or repeated CE. One (2.9%) out of 34 patients with clear radiographic transition zone had discordance between radiographic and pathologic transition zone. In contrast 4 (66.7%) out of 6 patients with equivocal radiographic transition zone had discordance between radiographic and pathologic transition zone. Observation of clear radiographic transition zone is important in preparation of TERPT, and repeated CE is helpful to reduce the discordance between radiographic and pathologic transition zone. Awareness of the possibility of discordance is also important if radiographic transitional zone is not clear.
Enema ; Hirschsprung Disease ; Humans ; Retrospective Studies