BACKGROUND: Intracranial germ cell tumors are higher in the East Asia such as Korea and Japan than any other Western countries. By analyzing common clinical features of intracranial germ cell tumors in children, we will prevent from misdiagnosing and delaying in the establishment of diagnosis. Furthermore, we can choose appropriate therapeutic plans to improve patient's prognosis.METHODS: We retrospectively reviewed the medical records of 68 patients to investigate and analyze clinical characteristics of intracranial germ cell tumors in children.RESULTS: The average age of 68 patients was 14.8 years old, and the male to female ratio in all patients was 3:1. The most common symptom presented by 30 patients was headache regarded as a nonspecific symptom in brain tumors. Sixty four patients were diagnosed by histologic method called biopsy and most of them were come out into germinoma. Thirty five patients were included in low-risk group and 30 patients were in high-risk group. Intracranial germ cell tumors in this study were most commonly located in the pineal gland.CONCLUSION: There are a variety of types in intracranial germ cell tumors, and they have been accurately diagnosed by radiologic, histologic methods and elevated tumor markers. We concluded that it is necessary for early diagnosis to evaluate exhaustively in patients suspected of brain tumors.
Biopsy ; Brain Neoplasms ; Child ; Early Diagnosis ; Far East ; Female ; Germ Cells ; Germinoma ; Headache ; Humans ; Japan ; Korea ; Male ; Medical Records ; Neoplasms, Germ Cell and Embryonal ; Retrospective Studies ; Biomarkers, Tumor

PURPOSE: It is very important to compare the particle size and total output from inhalation devices for standardization of bronchial provocation test. METHODS: Total output (mass output, salt output) from 4 nebulizer/compressor combination (LC plus/Pari-boy, Long life/Pari-boy, Pulmoaid/Pulmoaid, DeVilbiss/DeVilbiss) which were charged with 2 mL of 0.9% normal saline was measured. Aerosol particle size was measured directly using laser diffraction by Marvern Master Sizer and by evaluating Mass median aerodynamic diameter (MMAD). RESULTS: The LC plus nebulizer had the highest output rate and delivered the largest particles. The Maximal output rates of the 3 nebulizer/compressor combination was half that LC plus /Pari-boy combination. CONCLUSION: The results suggest that it might be different in mass output and particle size by inhalation devices. These differences can influence to the results of bronchial provocation test such as FEV1. We emphasizes that it is necessary to standardize the total output and particle size from each inhalation devices to perform and interpretate the results of bronchial provocation test.
Bronchial Provocation Tests* ; Inhalation* ; Nebulizers and Vaporizers* ; Particle Size*

OBJECTIVE: Cytomegalovirus(CMV) is the most common cause of congenital infection with diverse clinical features according to the age of hosts. This study was done to evaluate clinical manifestations and complications in congenital CMV infection. METHODS: Between October 2000 and September 2001, 10 cases of congenital CMV infection were diagnosed by urine culture within 2 weeks after birth. Demographic data, clinical and laboratory findings were collected from maternal and newborn hospital records. RESULTS: There were 7 males and 3 females. Average gestational age was 38+0 weeks(34+2-41+1), average birth weight was 2462+/-598.2g(1670-3360) and 5 cases were small for gestational age. Average head circumference was 31.9+/-1.8cm(29-34.3). There were 4 cases of microcephaly, 6 cases of petechiae, 3 cases of leukocytopenia, 6 cases of thrombocytopenia. There was no case showing hepatomegaly, hepatic dysfunction, or pathologic jaundice. 4 cases showed physiologic jaundice. IgM level was elevated in 5 out of 9 cases. Polymerase chain reaction(PCR) was positive in 7 cases. All cases showed germinal matrix hemorrhage and septated cysts on cranial ultrasonography. 1 case showed cerebral calcification. 1 case showed bilateral sensorineural hearing loss on brainstem auditory evoked potentials(BAEP). There was no case showing chorioretinitis on fundoscopy. CONCLUSION: There were diverse clinical manifestations in CMV infection in neonates. All cases showed germinal matrix hemorrhage and septated cysts. When we find these findings, we should consider the possibility of CMV infection. One patient developed bilateral sensorineural hearing loss, so its early detection and follow-up might be necessary.
Birth Weight ; Brain Stem ; Chorioretinitis ; Cytomegalovirus Infections* ; Cytomegalovirus* ; Female ; Gestational Age ; Head ; Hearing Loss, Sensorineural ; Hemorrhage ; Hepatomegaly ; Hospital Records ; Humans ; Immunoglobulin M ; Infant, Newborn* ; Jaundice ; Leukopenia ; Male ; Microcephaly ; Parturition ; Purpura ; Thrombocytopenia ; Ultrasonography

We report a case of renin-secreting juxtaglomerular cell tumor which developed in a hypertensive 47-yr-old Korean man. Presumptive clinical diagnosis was made before surgery based on the high level of plasma renin and the radiologic evidence of renal mass. Grossly, a round, bulging, well-encapsulated mass of 3x3 cm was located in the mid-portion of the right kidney. On microscopic examination, the tumor was composed of ovoid to polyhedral cells with bland nuclei, indistinct nucleoli and light eosinophilic cytoplasm. The immunostaining for renin showed strong positivity in the cytoplasm of tumor cells. The characteristic rhomboid shaped renin protogranules were observed in ultrastructural analysis.
Human ; Hypertension, Renal/*etiology/pathology ; Juxtaglomerular Apparatus/*pathology ; Kidney Neoplasms/*complications/*pathology/secretion ; Male ; Middle Age ; Renin/blood/secretion

OBJECTIVE: To define whether lactase-deficient subjects are intolerable to even a pack of milk(200ml) and whether milk intolerance in the patients with IBD is only due to lactose malabsorption, we performed this study. METHODS: We evaluated 32 healthy adults and 12 patients with active stage of inflammatory bowel disease(IBD) who had not received antibiotics therapy within the previous 3 weeks. Thirty-two healthy adults underwent H2-breath test with 200, 400, 600 and 800ml of milk at 1st, 2nd, 3rd and 4th day of study, respectively. We measured their end-expiratory hydrogen concentrations and asked them to record the gastrointestinal symptoms. Twelve patients with IBD were tested only with 200ml of milk. Lactose malabsorption was defined as the increase of 20ppm over basal H2 concentration and lactose intolerance as having two or more of the following symptoms; abdominal pain, diarrhea, borborygmus and flatus. RESULTS: The prevalence of lactase deficiency was 72%(23 of 32 subjects) at 800ml of milk(lactose 40g). Among the lactase-deficient subjects, lactose intolerance at 200ml of milk(lactose 10g) was noticed only in 13%(3 of 23 subjects). In the patients with active stage of IBD, the frequency of milk intolerance at 200ml of milk was 50%(6 of 12 subjects), which was higher than in the healthy adults(9%). But the prevalence of lactose malabsorber in the patients with IBD at 200ml of milk(17%) was not higher than in the healthy adults(16%). CONCLUSION: Most of lactase-deficient subjects(87%) can ingest one pack of milk without lactose intolerance. The increased prevalence of lactose intolerance in the patients with IBD at 200ml of milk is not originated from lactose malabsorption, but probably from incomplete colonic compensation salvage.
Abdominal Pain ; Adult ; Anti-Bacterial Agents ; Colon ; Compensation and Redress ; Diarrhea ; Drinking* ; Flatulence ; Humans ; Hydrogen ; Inflammatory Bowel Diseases* ; Lactase* ; Lactose Intolerance* ; Lactose* ; Milk* ; Prevalence

A 44-year-old man treated with azathioprine, cyclosporine and prednisolone for 7.5 years after allogeneic renal transplantation was admitted because of exertional dyspnea, fatigue and pancytopenia which were found 3 months ago. He had been on hemodialysis for renal failure of unknown cause for 8 months before the renal transplantation. Bone marrow examination showed hypercellularity, erythroid hyperplasia and 7% of myeloblast, consistent with the diagnosis of myelodysplastic syndrome. Cytogenetic study showed chromosomal abnormalities:deletion of chromosome 5, monosomy 7, trisomy 8, monosomy 14 and deletion of chromosome 17. Immunosuppressive agents were discontinued and he was treated with transfusion, G-CSF, and combination chemotherapy including topotecan and Ara-C. Graft kidney function was normal before and after the treatment, but the clinical course was fatal because of leukemic transformation and eventually sepsis. Although therapy induced myelodysplastic syndrome was rare in renal allograft recipients, thorough evaluations including bone marrow biopsy and cytogenetic study are recommended in patients with anemia of unknown etiology.
Adult ; Allografts ; Anemia ; Azathioprine ; Biopsy ; Bone Marrow ; Bone Marrow Examination ; Chromosome Aberrations ; Chromosomes, Human, Pair 17 ; Chromosomes, Human, Pair 5 ; Cyclosporine ; Cytarabine ; Cytogenetics ; Diagnosis ; Drug Therapy, Combination ; Dyspnea ; Fatigue ; Granulocyte Colony-Stimulating Factor ; Granulocyte Precursor Cells ; Humans ; Hyperplasia ; Immunosuppressive Agents ; Kidney ; Kidney Transplantation ; Monosomy ; Myelodysplastic Syndromes* ; Pancytopenia ; Prednisolone ; Renal Dialysis ; Renal Insufficiency ; Sepsis ; Topotecan ; Transplantation* ; Transplants ; Trisomy

It is now generalized to perform cardiac surgery in the patients with end-stage renal disease. The growing number of patients with chronic renal failure wake us up to the need to prepare for proper management. There are not only the prevalence of coronary artery disease, but also a great amount of valve dysfunction exist in this group. Peritoneal dialysis may be one of the obstacles for cardiopulmonary bypass but it is not a great hindrance in cardiac surgery with careful preparation and well organized perioperative care. The author has performed mitral valve replacement in a 33-year-old anuric female patient with chronic renal failure and severe mitral insufficiency. Preoperatively, the patient was kept in adequate fluid and electrolyte balance using peritoneal dialysis. Peritoneal dialysis continued and regulated according to the laboratory data in this patient during and after the surgery. She recovered well showing an uneventful course and was discharged on postoperative 1 th day.
Adult ; Cardiopulmonary Bypass ; Coronary Artery Disease ; Dialysis ; Female ; Humans ; Kidney Failure, Chronic* ; Mitral Valve ; Mitral Valve Insufficiency ; Perioperative Care ; Peritoneal Dialysis ; Prevalence ; Thoracic Surgery ; Water-Electrolyte Balance

BACKGROUND: These days, lung volume reduction surgery (LVRS) is used as an alternative or a bridge operation to lung transplantation in treating patients with severe emphysema. The procedure can be used in patients with pulmonary nodules combined with severe emphysema. We report the results of 21 months follow up after lung volume reduction surgery in 7 cases including 2 cases of concurrent resection of pulmonary nodules. MATERIAL AND METHOD: Seven patients with emphysema, including 2 cases of preoperatively suspected lung cancer were operated with LVRS technique between July 1996 and June 1997. RESULT: Postoperative mortality was observed in a case of squamous cell carcinoma in LUL with brain metastasis, detected at postoperative 13months. Average of 21months(19-25months) follow up was done for other cases without specific events. CONCLUSION: LVRS is a useful operation in the treatment of patients with severe emphysema, but further evaluation should be done about the long term results and precise criteria for patient selection. Simultaneous LVRS and tumor resection could be done in patients with emphysema with marginal reserve in the hope of maximizing postoperative lung functions.
Brain ; Carcinoma, Squamous Cell ; Emphysema* ; Follow-Up Studies ; Hope ; Humans ; Lung Neoplasms ; Lung Transplantation ; Lung* ; Mortality ; Neoplasm Metastasis ; Patient Selection ; Pneumonectomy*

It would be possible to manage the intestinal anastomotic failure with intraluminal stenting, but its reports are very rare. We experienced a effective and dramatic improvement of esophago-jejunal anastomotic leak in a esophageal and gastric double cancer patient with intraluminal stenting. The intraluminal stenting was tried at the 28th postoperative day and the anastomotic leak and inflammatory signs were disappeared about 3 weeks later. Postoperative 11th months now, the stent was moved about 1 cm downward but not changed further, and he enjoys regular diet without any problems. And we think the stenting would be helful with some limitations in the intestinal anastomotic leak patient.
Anastomotic Leak ; Diet ; Esophageal Neoplasms ; Fistula ; Humans ; Stents*

MATERIAL AND METHOD: Esophageal reconstruction by the hypopharyngointestinal anastomosis was done in 7 patients of corrosive upper esophageal stricture at St. Mary's Hospital from August 1995 to January 1997. RESULT: There were one male and six female patients ranging from 20 to 63 years of age. The causative agents were acid in 6 patients and alkali in 1 patient. The esophageal reconstruction was made by hypopharyngcolojejunostomy in 4 patients and hypopharyngocologastrostomy in 3 patients. There were no operative mortalities. One patient developed anastomotic stenosis but others were free from dysphagia. All gained 4 kg to 13 kg of body weight during the follow-up period. CONCLUSION: In this experience right colon and terminal ileum including ileocecal valve was revealed as a good substitute for the esophagus and the esophageal reconstruction by hypopharyngocologastro (jejuno)stomy seems to be a satisfactory method with acceptable morbidity and mortality in corrosive upper esophageal stricture patient.
Alkalies ; Body Weight ; Colon ; Constriction, Pathologic ; Deglutition Disorders ; Esophageal Stenosis* ; Esophagus ; Female ; Follow-Up Studies ; Humans ; Ileocecal Valve ; Ileum ; Male ; Mortality