• Childhood Kidney Diseases
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• v.1 no.1
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• pp.17-23
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• 1997

After the first description of IgA nephropathy by Berger in 1968, the prognosis of this disease was considered favourable. However recent studies have revealed that IgA nephropathy result in end stage renal desease in 25-30% by 20 years. Heavy proteinuria, hypertension, histological high class are regarded as poor prognostic factors. In 1996, Yagame et al reported the new histopathologic grading with a strong correlation between the grading, heavy proteinuria, high s-Cr level and renal survival. The aims of this study are to determine whether the pathological grading and other clinical parameters could contribute to predicting the outcome of this disease eventhough pediatric patients. Seventy nine patients (59 males, 20 females) with IgA nephropathy were examined. Patients were 2.08-15.17 years of age ($9.85{\pm}2.83$). The mean follow-up duration were $27{\pm}28$ months. Six of seventy nine patients progressed to chronic renal failure during the follow-up periods. High 24h urinary protein excretion at diagnosis were significantly higher in chronic renal failure patients (p<0.05). Hypertension at diagnosis were the significant associated factors in progression of chronic renal failure (p<0.05). Histological changes of IgA nephropathy in light microscopy were classified into five classes by WHO classification, four grades in Yagame's gradings. Among the seventy nine patients, 24 were as class 1, 30 as class 2, 23 as class 3; 4 as class 4, 0 as class 5 by WHO classification. 23 were classified grade 1, 31 as grade 2, 24 as grade 3, 1 as grade 4 by Yagame's grading. Among six patients who progressed to chronic renal failure, 1 clssified as class 1, 1 as class 2, 3 as class 3, 1 as class 4, 0 as class 5 by WHO Classification. 1 patients were classified as grade 1, 1 as grade 2, 3 as grade 3, 1 as grade 4 by Yagame's grading. (p>0.05) In conclusion, hypertension and heavy proteinuria at initial presentation were significantly associated with progression of chronic renal failure. The classification of WHO & Yagame's grading has no significant association with the progression of chronic renal failure in pediatric patients.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.8 no.2
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• pp.213-221
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• 2005

Purpose: Hemophagocytic syndrome (HPS) is characterized by persistent high fever, hepatosplenomegaly, cytopenias, hypertriglyceridemia, and/or hypofibrinogenemia. Hepatic manifestations including overt hepatic failure and fulminant hepatitis are common in HPS. Liver transplantation (LT) should be considered in a case of fulminant hepatitis by other than HPS, but LT is contraindicated and complete cure is possible by chemotherapy in HPS. Therefore, we conducted this study to define the characteristics of HPS presenting as severe acute hepatitis. Methods: Among the total of 23 patients diagnosed as HPS by bone marrow examination between 1994 and 2005 in Asan Medical Center, 11 cases presented as severe acute hepatitis were enrolled in this study. We analyzed the clinical features, laboratory findings and outcome retrospectively. Results: Seven (64%) of the 11 children with HPS and hepatitis were referred to pediatric gastroenterologist at first. The mean age of onset was 50 months. There was no case with family history of primary HPS. Epstein-Barr virus was positive in 4, and herpes Simplex virus was positive simultaneously in 1 case. As the presenting symptoms and signs, fever was present in 10, hepatosplenomagaly was noted in all and jaundice in 10. Anemia was observed in 10, thrombocytopenia in 10, leukopenia in 8, hypertriglyceridemia in 9, hypofibrinogenemia in 8 and hyperferritinemia in 7 cases, respectively. Nine children received chemotherapy including etopside. The overall mortality rate was 72% (8/11). Conclusion: HPS, which needs chemotherapy, should be considered as a cause of severe acute hepatitis especially when accompanied with prolonged high fever and cytopenias.

• Radiation Oncology Journal
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• v.15 no.3
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• pp.187-195
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• 1997

Purpose : To analyze the involvement of apoptosis regulatory genes p53, $p21^{wart/cip1}$ bax and bcl-2 in induction of apoptosis by radiation in murine tumors. Materials and methods : The radiation-sensitive ovarian carcinoma OCa-1, and the radiation-resistant hepatocarcinorna HCa-I were used. Tumors, 8 mm in diameter, were irradiated with 25 Gy and at various times after irradiation, ranging from 1 to 48 h, were analyzed histologically for apoptosis and by western blot for alterations in the expression of these genes. The p53 status of the tumors were determined by the polymerase chain reaction-single strand conformation polymorphism assay. Results : Both tumors were positive for wild-type p53. Radiation inducesd apoptosis in OCa-1 but not in HCa-1. Apoptosis developed rapidly, peaked at 2 h after irradiation and returned to almost the background level at 48 h In OCa-1 radiation upregulated the expression of p53, $p21^{wart/cip1}$. and the bcl-2/bax ratio was decreased. In HCa-1 radiation increased the expression of both p53 and $p21^{wart/cip1}$, although the increase of the latter was small The bcl-2/bax ratio was greatly increased. In general the observed changes occurred within a few hours after irradiation, and either preceded or coincided with development of apoptosis Conclusions : The development of apoptosis required upregulation of both p53 and $p21^{wart/cip1}$ as well as a decrease in bcl-2/bax ratio. In contrast, an increase in bcl-2/bax ratio Prevented apoptosis in the presence of upregulated p53 and $p21^{wart/cip1}$ . These findings indentified the involvement of multiple oncogenes in apoptosis regulation in vivo and demonstrate the complexity that may be associated with the use of a single oncogene assessment for Predicting the outcome of cancer therapy with cytotoxic agents.

• Radiation Oncology Journal
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• v.28 no.3
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• pp.117-124
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• 2010

Purpose: To analyze the postoperative radiotherapy results and prognostic factors in patients with WHO grade 3 and 4 gliomas. Materials and Methods: A total of 99 patients with malignant gliomas who underwent postoperative radiotherapy between 1988 and 2007 were enrolled in this study. Total resections, subtotal resections ($\geq$50%), partial resections (<50%), and biopsies were performed in 16, 38, 22, and 23 patients, respectively. In total there were 32, 63 and 4 WHO grade 3, 4, and unspecified high grade gliomas, respectively. The biologically equivalent dose was in the range of 18.6 to $83.3\;Gy_{10}$ (median dose, $72.2\;Gy_{10}$). We retrospectively analyzed survival rate, patterns of failure, prognostic factors, and adverse effects. Results: The median follow-up time was 11 months and there were 54 patients (54.5%) with local failure. The one and 2-year survival rates were 56.6% and 29.3%, respectively, and the median survival duration was 13 months. The one and 2-year progression-free survival rates (PFS) were 31.3% and 18.2%, respectively, and the median PFS was 7 months. The prognostic factors for overall survival were age (p=0.0001), surgical extents (subtotal resection, p=0.023; partial resection, p=0.009; biopsy only, p=0.002), and enhancement of tumor in postoperative imaging study (p=0.049). The factors affecting PFS were age (p=0.036), tumor enhancement of the postoperative imaging study (p=0.006). There were 3 patients with grade 3 and 4 side effects during and after radiotherapy. Conclusions: In addition to age and surgical extents, tumor enhancement of the postoperative imaging study was included in the prognostic factors. The most common relapse patterns were local failures and hence, additional studies are needed to improve local control rates.

• Radiation Oncology Journal
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• v.28 no.3
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• pp.133-140
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• 2010

Purpose: We retrospectively investigated the effect of irradiation using helical tomotherapy in recurrent pelvic tumors that underwent prior irradiation. Materials and Methods: Fourteen patients with recurrent pelvic tumors consisting of rectal cancer (57.1%), cervical cancer (35.7%) and cancer with an unknown origin (7.1%) were treated with tomotherapy. At the time of irradiation, median tumor size was 3.5 cm and 7 patients complained of pain originating from a recurrent tumor. The median radiation dose delivered to the gross tumor volume, clinical target volume, and planning target volume was 50 Gy, 47.8 Gy and 45 Gy, respectively and delivered at 5 fractions per week over the course of 4 to 5 weeks. Treatment response and duration of local disease control were evaluated using the Response Evaluation Criteria in Solid Tumors (ver. 1.0) and the Kaplan-Meyer method. Treatment-related toxicities were assessed through Common Terminology Criteria for Adverse Events (ver. 3.0). Results: The median follow-up time was 17.3 months, while the response rate was 64.3%. Symptomatic improvement appeared in 6 patients (85.7%). The median duration time of local disease control was 25.8 months. The rates of local failure, distant failure, and synchronous local and distant failure were 57.1%, 21.4%, and 7.1%, respectively. Acute toxicities were limited in grade I or II toxicities, except for one patient. No treatment related death or late toxicity was observed. Conclusion: Helical tomotherapy could be suggested as a feasible palliative option in recurrent pelvic tumors with prior radiotherapy. However, to increase treatment effect and overcome the limitation of this outcome, a large clinical study should be performed.

• The Journal of Korean Society for School & Community Health Education
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• v.5
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• pp.71-84
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• 2004

The sexual discourse has been frequent, but the subjects of it have been limited to the young, and the sex of women and that of the old people, until now, have been overlooked. According to the data in 2,000 of the Korea Statistic Service, the older-than-sixty-five-year people consist of 37.4% men and 62.6% women. Of them, the older-than-seventy-year people consist of 33.8% men and 55.2% women. The data show the fact that as the age of the old people is higher, the number of old women is enlarging. Paying attention to the above-mentioned tendency, this study conducted a survey about the aspects of the sexual consciousness of old women. The purpose of study was focused, through the survey, on discovering the ways of old women's recognization about their sexual desire, and on presenting basic data to developing the programs which could solve the problems derived from the discovery. That is to say, the purpose of it was to prevent the sexual desire's distortion and suppression of old women, if they had any, and to present basic data to developing the programs which could convert their recognization of sex. The objects of the survey were the sample group of 301 people inhabiting in Hwaseong City, Seongnam City, Yongin City, and Suwon City, chosen out of 375,298 old women of 614,316 older-than-sixty-five-year people in Kyeonggi Province (Kyeonggi Province homepage, 2002). The data were collected by the questionnairers' interviews in the fields of old men's resting house, churches, temples, old men's niversities and so like, from September 19th to September 31th in 2003. The questionnairers as volunteers were taught the prior education, being prepared for the survey about old women's sexual consciousness. The contents of education were composed of the understanding of old women, the ways of questionnairing, and the items of questionnaire. The outcomes of the survey are following; First, concerning general items, the old women of the sample group answered that they felt greatly the difficulties of health(36.5%), economy(12.0%), and loneliness(11.3%) in turn. The 48.2% of them answered that they were healthy, but the 62.3% answered that they were suffering various illnesses. The 24.4% answered they were economically rich, and the 23.9% answered they were working. The 53.5% were living alone due to divorce or death. The 71.1% had been living for more than ten years. The 83.1% believed in their own religion. Second, the 43.8% of the sample group admitted the necessity of a heterosexual friend and sexuality The 39.0% felt sexual desire, and the 33.9% were experiencing sexuality. As the obstructing factors in performing sexuality, the objects of sample group pointed out shamefulness or morality(28.7%), anxiety that such deeds might afflict their health or the problem of health itself(20.2%), weakening of sexual potency(16.9%). This outcome shows that they have ambiguous notions about their sexual alienation and manner. Third, the 33.7% of the sample group admitted sexual education and sexual counsel, and of those that admitted them, the 85.2% said that they would take part in sexual education if it were held. It shows that the demand of sexual education and sexual counsel need be fulfilled. Therefore, through this study, the following two important suggestions can be drawn: First, systematic sexual education programs should be developed, considering old people's developing steps containing their rights of health and sex. Also those should be educated through kindergartens, primary, middle and higher education institutions. Second, sexual education and sexual counsel on prospective old people and present old people should be performed.

• Journal of Chest Surgery
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• v.38 no.5 s.250
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• pp.357-365
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• 2005

Background: Patients with mitral regurgitation (MR) in the setting of coronary artery disease have a dismal long-term prognosis whether treated medically or surgically. Moreover, the optimal management of moderate ischemic MR at the time of coronary artery bypass grafting (CABG) remains the subjects of controversy. Thus, the present retrospective study was undertaken to determine whether mitral valve surgery for moderate ischemic MR at the time of CABG would be preferable to CABG alone in terms of clinical outcome. Material and Method: Between January 1997 and December 2003, 34 patients with moderate (Gr 3/4) ischemic MR underwent CABG alone (Group I, n=23) or CABG plus mitral valve surgery (Group II, n=11). Operative mortality, long-term survival and echocardiographic parameters were used to evaluate the efficacy of mitral valve surgery in patients with moderate ischemic MR. The mean follow-up durations of each group were $69.3\pm4.3$ months and $53.1\pm4.9$ months respectively. Result: There was no hospital mortality in both groups. There was one case of late mortality in Group I. The mean number of bypass graft was similar ($3.8\pm1.2\;vs\;3.7\pm1.3$ respectively). Cardiopulmonary bypass time was longer in group II (p=0.014). In group II, all of the patients received mitral annuloplasty using ring. On immediate postoperative echo-cardiogram, mitral regurgitation was reduced more in group II (p=0.002). Echocardiogram performed at last follow-up state showed no difference except the grade of MR between the two groups. Actuarial survival of both groups at 5 years was similar ($95.5\%\;vs\;100\%$, p=0.48). Conclusion: This study shows that in selected patients with moderate ischemic MR, CABG without mitral valve surgery might be sufficient. However, patients with low EF and NYHA functional class pre-operatively had tendency of significant residual MR, so mitral valve surgery should be necessary in these patients, and moreover, MR severity and left ventricle volume decreased more in mitral valve surgery group. Therefore, more large-scale studies are necessary to determine these effects on the ventricular function and long-term survival.

• Journal of Chest Surgery
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• v.39 no.6 s.263
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• pp.449-455
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• 2006

Background: Female sex was known to be a risk factor for mortality after coronary bypass grafting (CABG), and women showed higher in-hospital mortality than men. Material and Method: Between 1992 and 1996, 147 consecutive patients (98 men and 49 women) undergoing CABG were included in the study. Most patients had undergone CABG with left internal thoracic artery and saphenous vein under cardiopulmonary bypass. We examined the influence of gender on survival after CABG and looked for risk factors for survival. Result: There was no in-hospital mortality in women, but 3 death (3.0%) in men. During the mean follow-up period of $138.5{\pm}23.0$ months, mortality was lower in women than in men (20.4% vs 44.9%, p=0.004), and the most common cause of death in women was chronic renal failure (40%). Survival in women at 1, 5, 10, and f4 years was 100%, $98.0{\pm}2.0%,\;81.2{\pm}5.6%,\;and\;78.4{\pm}6.1%$, respectively, which was better than in men (p=0.004). Although preoperative left ventricular ejection fraction was higher in women than in men, this did not affect early and long-term survival difference between two sexes (p=0.15). Risk factor for long-term survival in women was diabetes (p=0.033) and in men number of diseased coronary artery (p=0.006). Conclusion: Long-term survival after CABG was better in women than men. Risk factor for long-term survival in women was morbid disease rather than cardiac disease.

• Journal of Chest Surgery
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• v.35 no.5
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• pp.356-364
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• 2002

Background: This study was undertaken to investigate the outcome of composite graft aortic root replacement using coronary button reimplantation technique for the treatment of aneurysms of the ascending aorta involving the aortic root. Material and Method: Between April 1995 and September 2001, 54 patients having aortic root replacement with a composite valve graft using direct coronary button reimplantation were reviewed retrospectively. Left ventricular dysfunction was present in 14 patients(25.9%), aortic regurgitation in 48(89%), and Marfan's syndrome in 17(31.5%). The indications for operation were annuloaortic ectasia in 29 patients(53.7%), aortic dissection in 11(20.4%), aneurysms of the ascending aorta involving aortic root in 12(22.2%), and aortitis in 2(3.7%). Six patients(11.1%) had previous cardiac or ascending aortic operations. Concomitant procedures were arch replacement in 21 patients(38.9%), coronary artery bypass graft in 7(13%), mitral valve repair or replacement in 4(7.4%), and others in 6. The mean time of circulatory arrest, total bypass, and aortic crossclamp were 18 $\pm$ 9 minutes, 177 $\pm$ 42 minutes, and 127 $\pm$ 31 minutes, respectively. Result: There was 1 early death(1.9%). Mean follow-up was 24.6$\pm$ 19.5 months. There were two late deaths(3.8%) including one death due to the traumatic cerebral hemorrhage. The Kaplan-Meier survival rate was 98.0 $\pm$ 2.0% and 93.1 $\pm$ 5.1% at 1 and 6 years, respectively. Two patients required reoperation owing to a false aneurysm at the root anastomosis site and a malfunction of prosthetic aortic valve(3.8%). Staged operation for dissection of the remaining thoracoabdominal aorta was performed in 1 patient. The freedom rate from reoperation was 97.8 $\pm$ 2.0% and 65.3 $\pm$ 26.7% at 1 and 6 years, respectively.

• Journal of Chest Surgery
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• v.37 no.10
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• pp.827-832
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• 2004

Background: The significance of MIDCAB is emerging topics recently as OPCAB is going to be universalized, and long-term outcome of bypass graft surgery was proved to be more excellent than balloon dilation or stent insertion. We report our MIDCAB results in 73 patients in the last three years. Material and Method: Retrospective analysis of medical records was done from November 1, 2000 through November 31, 2003. There were 47 males and 26 females ranging in age from 31 years to 79 years (average $61.3\pm9.8$ years). Observation periods after operative procedures were 10 to 1238 days (average $763\pm319.8$ days). Left longitudinal parasternal incision as a standard procedure was done to approach the heart after dissection of the left internal thoracic artery by partial or total resection of 3rd to 5th ribs. Result: Of those patients, 46 patients were transferred to ICU after extubation at operation room and 58 patients were extubated within 3 hours after operation. Average ICU staying periods was $26.8\pm11.5$ hours. Follow-up angiography during admission was done in 36 patients and showed 100% patency. Only one patient died on the 10$^{th}$ post operative day because of sudden CVA. Complications included wound problems in 4 patients, and constructing pericardial window using thoracoscopy due to continuous pericardial effusion in 1. Permanent pacemaker was inserted in one patient owing to sick sinus syndrome. In one patient with recurrence of angina 8 months after operation, stenosis at anastomic site was found and improved with balloon dilatation. Conclusion: We were satisfied with our results of MIDCAB in single and multi-vessel coronary artery disease. These results have made the cardiologists tried to operate positively and we expect widening operative indications including hybrid revascularization.