Oxidative stress plays various roles in the development and progression of IgA nephropathy, while bilirubin is known as a potent antioxidant. We therefore hypothesized that serum bilirubin would be associated with renal prognosis in IgA nephropathy. The study subjects comprised 1,458 adult patients with primary IgA nephropathy in Korea. We grouped patients according to the following quartile levels of bilirubin: <0.4 mg/dL (Q1), 0.4-0.5 mg/dL (Q2), 0.6-0.7 mg/dL (Q3), and >0.8 mg/dL (Q4). The outcome data were obtained from the Korean Registry of end-stage renal disease (ESRD). Eighty patients (5.5%) contracted ESRD during a mean follow-up period of 44.9 months. The ESRD incidences were 10.7% in Q1, 8.2% in Q2, 2.8% in Q3, and 2.8% in Q4 (p<0.001). The relative risk of ESRD compared to that in Q1 was 0.307 (95% confidence interval [CI], 0.126-0.751) in Q3 and 0.315 (95% CI, 0.130-0.765) in Q4. The differences of ESRD incidence were greater in subgroups of males and of patients aged 35 yr or more, with serum albumin 4.0 g/dL or more, with normotension, with eGFR 60 mL/min/1.73 m2 or more, and with proteinuria less then 3+ by dipstick test. In conclusion, higher bilirubin level was negatively associated with ESRD incidence in IgA nephropathy.
Adult ; Bilirubin/*blood ; Disease Progression ; Female ; Glomerular Filtration Rate ; Glomerulonephritis, IGA/*blood/complications ; Humans ; Hypertension/complications ; Incidence ; Kidney Failure, Chronic/*blood/complications ; Male ; Middle Aged ; Risk ; Risk Factors ; Treatment Outcome

PURPOSE: To investigate the feasibility and accuracy of Proton Resonance Frequency (PRF) shift based magnetic resonance (MR) temperature mapping utilizing the selfdeveloped center array-sequencing phase unwrapping (PU) method for non-invasive temperature monitoring. MATERIALS AND METHODS: The computer simulation was done on the PU algorithm for performance evaluation before further application to MR thermometry. The MR experiments were conducted in two approaches namely PU experiment, and temperature mapping experiment based on the PU technique with all the image postprocessing implemented in MATLAB. A 1.5T MR scanner employing a knee coil with T2* GRE (Gradient Recalled Echo) pulse sequence were used throughout the experiments. Various subjects such as water phantom, orange, and agarose gel phantom were used for the assessment of the self-developed PU algorithm. The MR temperature mapping experiment was initially attempted on the agarose gel phantom only with the application of a custom-made thermoregulating water pump as the heating source. Heat was generated to the phantom via hot water circulation whilst temperature variation was observed with T-type thermocouple. The PU program was implemented on the reconstructed wrapped phase images prior to map the temperature distribution of subjects. As the temperature change is directly proportional to the phase difference map, the absolute temperature could be estimated from the summation of the computed temperature difference with the measured ambient temperature of subjects. RESULTS: The PU technique successfully recovered and removed the phase wrapping artifacts on MR phase images with various subjects by producing a smooth and continuous phase map thus producing a more reliable temperature map. CONCLUSION: This work presented a rapid, and robust self-developed center arraysequencing PU algorithm feasible for the application of MR temperature mapping according to the PRF phase shift property.
Artifacts ; Citrus sinensis ; Computer Simulation ; Heating ; Hot Temperature ; Knee ; Magnetic Resonance Spectroscopy ; Protons ; Sepharose ; Thermography ; Thermometry ; Water

PURPOSE: E-cadherin (ECD) plays a pivotal role in integrating the normal tissue architecture and the suppression of cancer invasion, including stomach cancer. The epidemiology of stomach cancers is noticeably different according to the site of the index tumor, even though the stomach cancers all have similar gross shapes. In this study, the relation between the expression of ECD, along with the clinicopathologic parameters and recurrence or survival, were investigated for patients with gastric adenocarcinoma according to the tumor location. METHODS: We examined formalin-fixed, paraffin-embedded archival tissues from 50 surgically resectable gastric adenocarcinomas, which were grouped by the index tumor site as follows: distal (antrum) versus proximal (mid and upper body). To elucidate the correlation between the ECD expression and the site of the stomach cancer with the other clinicopathologic factors, we examined the ECD tissue status via performing immunohistochemistry. To compare the rates of recurrence and survival among subgroups, the patients were followed up for an average of 42 months. RESULTS: Among the 50 tumors examined, 28 (56%) tumors showed various degrees of a ECD expression. The gender, age, size, depth of invasion, lymph node metastasis, stage, lymphatic invasion and vascular invasion were not related with the ECD expression. The Lauren classification was cor-related with the ECD expression in the mid and upper body stomach cancer, but not in the antral stomach cancer (P=0.042). The expression of ECD was not related with the survival rate (P=0.223). There was no significant difference in the recurrence rate between the subgroups with and without an abnormal expression of ECD (P=0.588). CONCLUSION: For the mid and upper body stomach cancer, the expression of E-cadherin correlated with the diffuse type of cancer, according to the Lauren classification, but not with the survival rate.
Adenocarcinoma ; Cadherins* ; Classification* ; Epidemiology ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Recurrence ; Stomach Neoplasms* ; Stomach* ; Survival Rate

Rhabdoid tumor has been considered to be a rare subtype of Wilm's tumor with Rhabdomyoma features. Since rhabdoid tumor that developed in the kidney was described for the first time in 1989, it has been reported in the gastrointestinal tract, although this is rare. The appropriate treatment is radical resection, and the effect of adjuvant chemotherapy has not yet been reported on. The outcome of extra-renal rhabdoid tumor is different from renal rhabdoid tumor and the former shows a poor prognosis. Among extra-renal rhabdoid tumors, undifferentiated gastric adenocarcinoma with rhabdoid features is very rare and its prognosis is poor. A 63 years old male patient underwent total gastrectomy for a tumor that developed in the greater curvature of the gastric body and this was diagnosed as undifferentiated gastric adenocarcinoma with rhabdoid features, according to the histopathology. We experienced an undifferentiated gastric adenocarcinoma with rhabdoid features that was diagnosed by immunohistochemical staining and we report here on this case.
Adenocarcinoma* ; Chemotherapy, Adjuvant ; Gastrectomy ; Gastrointestinal Tract ; Humans ; Kidney ; Male ; Middle Aged ; Prognosis ; Rhabdoid Tumor ; Rhabdomyoma ; Stomach Neoplasms ; Stomach* ; Wilms Tumor

PURPOSE: The purpose of our study was to compare the outcomes of patients who had undergone a conventional open adrenalectomy (OA) with those who had undergone a laparoscopic adrenalectomy (LA). METHODS: We retrospectively reviewed 66 patients who underwent an adrenalectomy between 1990 and 2005. The study group was comprised of 41 laparoscopic cases with 25 open adrenalectomy cases comprising the control group. The parameters studied included the operating times, transfusion volumes, time to resumption of a soft diet, total frequency of analgesics, time to return to free ambulation and length of hospital stay in both the OA and LA groups. RESULTS: No mortality was observed in either the OA or LA groups. The operating times were, on average, 203.1+/-64.5 and 158.2+/-76.4 minutes in the OA and LA group, respectively (P=0.011). 10 cases in the OA group needed a transfusion (average: 438.52+/-687.57 ml), but two cases including one require conversion to a celiotomy, due to a right renal vein injury, needed a transfusion (average: 23.41+/-110.63 ml)(P=0.004). The patients of the OA and LA groups began soft diets on the 4.8+/-1.1 (3~7 days) and 2.7+/-1.5 postoperative days (1~8 days), respectively (P=0.004). Total frequencies of analgesics were 9.5+/-6.5 and 4.4+/-4.7 in the OA and LA groups, respectively (P=0.001). The times needed to return to free ambulation were 7.6+/-3.8 and 4.3+/-2.3 days in the OA and LA groups, respectively (P= 0.000). Postoperative hospital stays were 16.3+/-7.5 and 7.3+/-2.3 days in the OA and LA groups, respectively (P=0.000). CONCLUSION: An LA appears to be a safe and effective approach for patients with various adrenal pathologies and large sized adrenal lesions. We expect the indications for an LA may be extended to large adrenal tumors as well as primary or metastatic malignant adrenal lesions if the oncologic principles are obeyed.
Adrenal Gland Neoplasms ; Adrenalectomy* ; Analgesics ; Diet ; Humans ; Laparoscopy ; Length of Stay ; Mortality ; Pathology ; Renal Veins ; Retrospective Studies ; Walking

PURPOSE: Tumor downstaging from preoperative chemoradiation has been associated with an increased probability of a sphincter-saving procedure and with improved local control and survival rate. We observed the effect and the prognostic value of pathologic tumor downstaging, including complete pathologic response to preoperative concurrent chemoradiation, resectability, sphincter-saving rate, disease- free survival, and overall survival in locally advanced rectal cancer patients. METHODS: From January 2000 to December 2003, we recruited a total 78 patients with computed tomography stages II and III rectal cancer which was treated by using preoperative concurrent chemoradiation; all patients had a radical resection with total mesorectal excision. Surgical resection was performed 6 to 8 weeks after completing the radiation therapy. The average follow up was 25.40+/-13.64 months. RESULTS: The number of patients according to CT stage before preoperative chemoradiation was 39 (II) and 39 (III). Tumor downstaging occurred in 51 (65.4%) patients, including 11 (14.1%) patients who had a complete pathologic response. Tumor size, radiation dose, and clinical stage were associated with tumor downstaging in the univariate analysis. None of the clinical or pathologic variables was associated with a complete pathologic response. The overall resectibality was 100%. The number of sphincter-saving procedures were 61 (78.2%). Recurrence occurred in 17 (21.8%) patients: local recurrence in 4 (5.1%) and distant metastasis in 13 (16.7%). None of the patients with a complete pathologic response recurred. Recurrences were 3 (17.6%)/7 (22.6%)/7 (36.8%) for pathologic stages I/II/III. Recurrence was more common among younger patients (P <0.05). Patients in the complete pathologic response group had more favorable disease-free survival compared with other group (yp stage I, II, III) (P=0.026). CONCLUSION: Preoperative concurrent chemoradiation for locally advanced rectal cancer seems to afford some potential advantages: high tumor response, resectability, and feasible sphincter preservation, and even a complete pathologic response. A complete pathologic response to preoperative chemoradiation is associated with an improved disease-free survival.
Disease-Free Survival ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Rectal Neoplasms* ; Recurrence ; Survival Rate

Ectopic paragonimiasis is found in many organs, such as the mesentery, liver, spleen, peritoneum, omentum and central nervous system. However, thyroid gland involvement is quite rare. A 55 year old woman was admitted to our hospital on account of a painless anterior neck mass. A ultrasonographic examination showed ill-defined, hypoechoic nodule with calcification in the right lobe of the thyroid gland. A right lobectomy was performed after a fine needle aspiration biopsy showed there were no malignant cells histologically. The histological diagnosis was a foreign body granuloma with multiple ova of Paragonimus in the thyroid gland. Postoperatively, the immunoserologic test for Paragonimus westermani was positive it. A diagnosis of this rare clinical entity before a surgical excision and histopathology examination is unlikely. Therefore an ectopic paragonimiasis of the thyoid gland should be considered when making a differential diagnosis of thyroid masses. We present a case of ectopic paragonimiasis, which presented as a thyroid nodule with a review of the relevant literatures.
Biopsy ; Biopsy, Fine-Needle ; Central Nervous System ; Diagnosis ; Diagnosis, Differential ; Female ; Granuloma, Foreign-Body ; Humans ; Liver ; Mesentery ; Middle Aged ; Neck ; Omentum ; Ovum ; Paragonimiasis* ; Paragonimus ; Paragonimus westermani ; Peritoneum ; Spleen ; Thyroid Gland* ; Thyroid Nodule*

PURPOSE: We investigated the impacts of the methylation states of the P16 and the hMLH1 genes on pathogenesis and genetic expression of stomach cancer and their relationships with Helicobater pylori infection, and with other clinico-pathologic factors. MATERIAL AND METHODS: In our study, to detect protein expression and methylation status of the P16 and the hMLH1 genes in 100 advanced gastric adenocarcinomas, used immunohistochemical staining and methylation-specific PCR (MSP) and direct automatic genetic sequencing analysis. RESULTS: Methylation of the P16 gene was observed in 19 out of 100 cases (19%) and in the 18 of those cases (94.7%) loss of protein expression was seen. We were sble to show that loss of P16 gene expression was related to methylation of the P16 gene (kappa coefficient=0.317, P=0.0011). Methylation of the hMLH1 gene was observed in 27 cases (27%), and in 24 cases of those 27 cases (88.8%), loss of protein expression was seen, which suggested that loss of protein expression in the hMLH1 gene is related to methylation of hMLH1 gene (kappa coefficient=0.675, P<0.0001). Also methylation of the hMLH1 gene was related to age, size of the mass, and Lauren's classification. CONCLUSION: We found that methylation of DNA plays an important role in inactivation of the P16 and the hMLH1 genes. The methylation of the hMLH1 genes is significantly related to age, size of the mass, and Lauren's classification.
Adenocarcinoma ; Classification ; DNA ; Genes, p16 ; Methylation* ; Polymerase Chain Reaction ; Stomach Neoplasms

PURPOSE: Gastric cancer is believed to be a disease of the elderly, and rarely occurs in young patients. The aim of this study was to analyze the clinicopathological and prognostic factors related to young gastric cancer patients. METHODS: A total of 877 patients with gastric cancer from 1995 to 2004 in a secondary referral center in Suwon City were enrolled in this study. The clinicopathological features of the young (aged<40 years) gastric cancer patients were compared with those of the older (aged > or =40 years) patients. The overall survival was the main outcome measure. The survival curves were constructed using the Kaplan-Meier method, Univariate analysis was performed using the log-rank test, and multivariate analysis was performed using with Cox regression. A P value<0.05 was considered significant. RESULTS: Of the 877 patients, 65(7.4%) were in the young age group. The mean age of this group was 34.9 years (range, 19~39 years). The male-to-female ratio of the patients younger than 40 was 1.24/1; whereas the ratio was 2.07/1 in those older than 40. 7.7 percent of the patients had a family history of gastric cancer. A significantly higher percentage of young patients had a poorly differentiated histology than the older patients (P=0.0001). Twenty-three patients (38.9%) were stage III or IV disease, whereas 36 patients (61.0%) presented with stage I or II disease. A resection with a curative intent was undertaken in 53 patients (81.5%), and a resection with a palliative intent was performed in 12 patients (18.4%). With a mean follow-up of 39 months, the disease-specific 5-year survival rates were similar to those observed in the older group of patients. The variables with a significant impact on survival were a curative resection, a lymph node metastasis, lymphatic invasion, peritoneal metastasis, and adjuvant chemotherapy. CONCLUSION: There were no significant differences in the clinicopathological characteristics and clinical outcome of a gastric adenocarcinoma between the younger and older patients. The important prognostic factors were curability, lymph node metastasis, lymphatic invasion, peritoneal metastasis, and adjuvant chemotherapy.
Adenocarcinoma ; Aged ; Chemotherapy, Adjuvant ; Follow-Up Studies ; Gyeonggi-do ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Multivariate Analysis ; Neoplasm Metastasis ; Outcome Assessment (Health Care) ; Secondary Care Centers ; Stomach Neoplasms* ; Survival Rate

A malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma in adults. About 70% of tumors arise from the soft tissue of the extremities with only 12~14% of the tumors occur in the retroperitoneum. The clinical characteristics of this tumor consist of an abdominal mass, tendency for local recurrence, paraneoplastic syndrome and a poor prognosis. A 51-year-old woman was admitted to St. Vincent's Hospital with complaining of fever and an abdominal mass. Ultrasound and computed tomography revealed a huge, heterogenous mass in the lesser sac area. The patient underwent an extensive mass resection with a histologic examination revealing a MFH which was positive for alpha1- antitrypsin. We report a case of MFH presenting in the lesser sac with a review of the literatures.
Adult ; Extremities ; Female ; Fever ; Histiocytoma, Malignant Fibrous* ; Humans ; Middle Aged ; Paraneoplastic Syndromes ; Peritoneal Cavity* ; Prognosis ; Recurrence ; Sarcoma ; Ultrasonography