Purpose: Renal tumors account for approximately 7% of all childhood cancers. These include Wilms tumor (WT), clear cell sarcoma of the kidney (CCSK), malignant rhabdoid tumor of the kidney (MRTK), renal cell carcinoma (RCC), congenital mesoblastic nephroma (CMN) and other rare tumors. We investigated the epidemiology of pediatric renal tumors in Korea. Materials and Methods: From January 2001 to December 2015, data of pediatric patients (0–18 years) newly-diagnosed with renal tumors at 26 hospitals were retrospectively analyzed. Results: Among 439 patients (male, 240), the most common tumor was WT (n=342, 77.9%), followed by RCC (n=36, 8.2%), CCSK (n=24, 5.5%), MRTK (n=16, 3.6%), CMN (n=12, 2.7%), and others (n=9, 2.1%). Median age at diagnosis was 27.1 months (range 0-225.5) and median follow-up duration was 88.5 months (range 0-211.6). Overall, 32 patients died, of whom 17, 11, 1, and 3 died of relapse, progressive disease, second malignant neoplasm, and treatment-related mortality. Five-year overall survival and event free survival were 97.2% and 84.8% in WT, 90.6% and 82.1% in RCC, 81.1% and 63.6% in CCSK, 60.3% and 56.2% in MRTK, and 100% and 91.7% in CMN, respectively (p < 0.001). Conclusion The pediatric renal tumor types in Korea are similar to those previously reported in other countries. WT accounted for a large proportion and survival was excellent. Non-Wilms renal tumors included a variety of tumors and showed inferior outcome, especially MRTK. Further efforts are necessary to optimize the treatment and analyze the genetic characteristics of pediatric renal tumors in Korea.

PURPOSE: Dexrazoxane has been used as an effective cardioprotector against anthracycline cardiotoxicity. This study intended to analyze cardioprotective efficacy and secondary malignancy development, and elucidate risk factors for secondary malignancies in dexrazoxane-treated pediatric patients. MATERIALS AND METHODS: Data was collected from 15 hospitals in Korea. Patients who received any anthracyclines, and completed treatment without stem cell transplantation were included. For efficacy evaluation, the incidence of cardiac events and cardiac event-free survival rates were compared. Data about risk factors of secondary malignancies were collected. RESULTS: Data of total 1,453 cases were analyzed; dexrazoxane with every anthracyclines group (D group, 1,035 patients) and no dexrazoxane group (non-D group, 418 patients). Incidence of the reported cardiac events was not statistically different between two groups; however, the cardiac event-free survival rate of patients with more than 400 mg/m2 of anthracyclines was significantly higher in D group (91.2% vs. 80.1%, p=0.04). The 6-year cumulative incidence of secondary malignancy was not different between both groups after considering follow-up duration difference (non-D, 0.52%±0.37%; D, 0.60%±0.28%; p=0.55). The most influential risk factor for secondary malignancy was the duration of anthracycline administration according to multivariate analysis. CONCLUSION: Dexrazoxane had an efficacy in lowering cardiac event-free survival rates in patients with higher cumulative anthracyclines. As a result of multivariate analysis for assessing risk factors of secondary malignancy, the occurrence of secondary malignancy was not related to dexrazoxane administration.
Anthracyclines ; Cardiotoxicity ; Dexrazoxane ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Multivariate Analysis ; Neoplasms, Second Primary ; Risk Factors* ; Stem Cell Transplantation

BACKGROUND: The aims of this study were to investigate the parameters of thromboelastography (TEG) for evaluating coagulopathy and to reveal an association with disease severity and/or transfusion requirement in patients with chronic liver disease (CLD) in a clinical laboratory setting. METHODS: We enrolled two groups of adult patients with cirrhotic (N=123) and non-cirrhotic liver disease (N=52), as well as 84 healthy controls. Reaction time (R), kinetic time (K), α-angle (α), maximal amplitude (MA), and coagulation index (CI) were measured with kaolin-activated citrated blood with the TEG 5000 system (Haemonetics Corporation, USA). Platelet count, prothrombin time international normalized ratio (PT INR), albumin, bilirubin, and creatinine were simultaneously measured. The CLD severity was calculated by using the Child-Pugh (C-P) and Model for End-stage Liver Disease (MELD) scores. Transfusion history was also reviewed. RESULTS: All TEG parameters, PT INR, and platelet count in the cirrhotic group showed significant differences from those in other groups. At least one or more abnormal TEG parameters were identified in 17.3% and 44.7% of patients in the non-cirrhotic and cirrhotic group, respectively. Patients with cirrhotic disease had hypocoagulability. A weak correlation between R and PT INR (r=0.173) was noted. The TEG parameters could not predict CLD severity using the C-P and MELD scores. Patients with normal TEG parameters did not receive transfusion. CONCLUSIONS: Clinical application of TEG measurements in CLD can be informative for investigating coagulopathy or predicting the risk of bleeding. Further studies are warranted.
Adult ; Bilirubin ; Creatinine ; Hemorrhage ; Humans ; International Normalized Ratio ; Liver Diseases* ; Liver* ; Platelet Count ; Prothrombin Time ; Reaction Time ; Thrombelastography

No abstract available.
Carcinoma, Squamous Cell* ; Epithelial Cells*

PURPOSE: There are gaps between the treatment guideline and clinical practice of osteoporosis showing low compliance. Although attitude and knowledge of prescriber have been known to be associated with the low compliance in real clinical practice, no study has assessed the knowledge of prescriber regarding osteoporosis in accordance to the level of medical institution. We compared the knowledge on osteoporosis of general practitioners with that of practitioners in a tertiary referral hospital. MATERIALS AND METHODS: In May 2012, 40 general practitioners and 40 practitioners in a tertiary referral hospital were evaluated using a modified Facts on Osteoporosis Quiz. RESULTS: The level of knowledge of general practitioners was similar with that of practitioners in a tertiary referral hospital (p=0.386). And, both groups were lack of knowledge of effect of physical exercise. CONCLUSION: The level of knowledge on osteoporosis was not associated with the level of medical institute, and the effect of physical exercise should be stressed in an educational program on osteoporosis for practitioners.
Adult ; Attitude of Health Personnel ; Exercise ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Middle Aged ; *Osteoporosis ; Questionnaires

Although many studies have assessed mortality and morbidity of conservative treatment after hip fracture in elderly patients, the mortality of conservative treatment done because of economic burden is unclear. Among 451 patients diagnosed with displaced hip fracture during 3 yr, 28 patients (Group I) were enrolled as conservative treatment. Fifty-six patients matched in age, gender, ASA score, and diagnosis (Group II) who had undergone surgical treatment were used as the control group. The causal factors of non-operative treatment and mortality rate and functional recovery were evaluated according to the causal factors of patients with surgical procedure. Ten patients (36%) in Group I involved medical problems and 18 (64%) by economic burdens. The cumulative mortality rate over 3, 6, 12, and 24 months was 54%, 61%, 64%, and 82% in Group I and 9%, 11%, 14%, and 21% in Group II, respectively. At the latest follow-up, all five patients in Group I displayed a nonfunctional ambulatory state, whereas only seven of 44 patients in Group II were in a nonfunctional ambulatory state. Non-surgical treatment following hip fracture that is done because of the economic burden is associated with substantially high mortality and serious functional loss.
Age Factors ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Hip Fractures/diagnosis/mortality/*surgery ; Humans ; Kaplan-Meier Estimate ; Male ; Prognosis ; Recovery of Function ; Severity of Illness Index ; Sex Factors ; Socioeconomic Factors

Aortic intramural hematoma (IMH) is classically defined as a variation of aortic dissection where blood collects within the aortic media without the presence of an intimal flap. Ascending IMH is known to have worse clinical outcomes than IMH of the descending aorta or aortic arch. Therefore, some patients with higher risk of disease progression require surgical corrections. However, the indications and the benefits of surgical management of ascending IMH, compared with medical treatment only, have not yet been established. We present two cases of IMH in the ascending aorta that presented with cardiac tamponade; patients were treated differently according to risk factors.
Aorta ; Aorta, Thoracic ; Cardiac Tamponade ; Disease Progression ; Hematoma ; Humans ; Risk Factors

PURPOSE: The purpose of this study was to evaluate whether the symptoms of migraine and car sickness coexist or not. In addition, we tried to elucidate whether the car sickness can be a clinical indicator of diagnosing migraine in children. METHODS: A total of 166 children and adolescents who had newly diagnosed migraine and followed up for more than 2 years after the termination of treatment were involved in the study. The co-morbidity or co-existence of symptoms between two conditions in the clinical course was investigated. RESULTS: Sixty three of 124 who had car sickness as well as migraine recovered from migraine. Among these 63 patients, the car sickness disappeared in 44 (69.8%), decreased in 7 (11.1%) and persisted in 12 (19.0%). On the other hand, 23 of those 124 migraineurs continued to have migraine. In these patients, car sickness disappeared in 4 (17.4%), decreased in 5 (21.7%) and persisted in 14 (60.9%). The freedom or alleviation of car sickness is more common in children free from migraine than in children with persistent migraine (P<0.001). CONCLUSION: The results suggest that migraine is closely related to car sickness in children and the clinical course of migraine generally overlaps those of car sickness. We therefore believe that car sickness can be a clinical indicator in the diagnosis of migraine.
Adolescent ; Child ; Freedom ; Hand ; Humans ; Migraine Disorders ; Motion Sickness

PURPOSE: The purpose of this study was to evaluate the clinical course and prognosis of migraines in childhood and adolescence, and the influence of preventive therapy on them. METHODS: We recruited 110 children and adolescents with migraines who had been newly diagnosed and treated. Treatment was composed of observation after consultation, acute symptomatic treatment, and preventive therapy. We prescribed topiramate for preventive therapy. The recipients of preventive therapy were those patients who complained of disturbance in daily life due to severe headache. The clinical course was evaluated on the basis of changes in the frequency of migraine attack and was divided into three groups: complete recovery, partial recovery, and non-recovery. The prognosis of migraine was classified into those free from migraine attack, decreased, and persistant. RESULTS: Forty-six (41.8%) of 110 patients completely recovered, and 70 (63.6%) were free from migraine attack. In those suffering from migraines without aura, 38.3% of the patients completely recovered and 59.6% were free from migraine attack. Regarding migraines with aura, 58.5% of the patients completely recovered and 70.7% were free from migraine attack. With respect to cases of probable migraine, 18.2% completely recovered and 59.6% were free from migraine attack. In those receiving preventive treatment, 80.0% of all patients completely recovered and 85.0% were free from migraine. According to migraine type, 66.7% of patients with migraine without aura completely recovered and 80% were free from migraine. In those with migraine and aura, 88.8% of patients completely recovered and 88.8% were free from migraine attack. CONCLUSION: It was estimated that the clinical course and prognosis of migraine patients who were treated by pediatric neurologists were generally good. The clinical course was better in the preventive therapy group. In particular, the effect of preventive treatment and prognosis were optimal in patients with migraine with aura.
Adolescent ; Child ; Epilepsy ; Fructose ; Headache ; Humans ; Migraine Disorders ; Migraine with Aura ; Migraine without Aura ; Prognosis ; Stress, Psychological

Hypoglossal nerve palsy (HNP) is an uncommon neurological abnormality that can provoke characteristic clinical signs, including unilateral atrophy of the tongue musculature. We present the case of a healthy 11-year-old Korean male who was admitted to the outpatient department of our institution with acute onset dysarthria, tongue fasciculations, and right-sided tongue weakness upon awakening. His evaluation included a virology work-up, neck magnetic resonance imaging (MRI), brain MRI, and otorhinolaryngological physical examination; all tests were normal and showed no evidence of inflammation. Fifteen days after the onset of symptoms, the patient recovered completely. Herein, we report a case of idiopathic isolated HNP in a Korean male.
Atrophy ; Brain ; Child ; Dysarthria ; Fasciculation ; Humans ; Hypoglossal Nerve ; Hypoglossal Nerve Diseases ; Inflammation ; Magnetic Resonance Imaging ; Male ; Neck ; Outpatients ; Paralysis ; Tongue