Localized constriction and torsion of the umbilical cord are rare cord abnormalities. The seg- mental absence of Whartion's jelly in the involved area of the cord is believed to be an etiologic factor of the constriction and subsequent torsion. In the past, constriction and torsion were thought to occur after the death of the fetus as a result of maceration. However, recently it has been suggested that the torsion of the constricted area might cause fetal death. We report an autopsy case of a localized constriction and torsion of the umbilical cord in a stillborn baby. The baby was delivered to a 27-year-old primiparous woman after 28 weeks gestation. The fetus was of 24 gestational weeks in size and weight. And the placenta weight was 259 gm. A grossly macerated fetus showed a cystic hygroma in the posterior neck. There were two areas of constriction in the umbilical cord, one at the squamoamniotic junction and the other, 15 cm from the fetal end. Torsions were noted in both constricted areas, more severe than in the mid portion of the cord. Microscopically, the Whartion's jelly was deficient and partly replaced by fibrosis in the constricted areas. It is believed that these two areas of constrictions and torsion are causally related to the intrauterine fetal death in this case.
Female ; Humans

Pheochromocytoma is originated from chromaffin cell of sympathetic nervous system and associated with other disease, such as neurofibromatosis, duodenal carcinoid, medullary thyroid cancer and parathyroid adenoma. Especially, pheochromocytoma is developed more than 50% in neurofibromatosis associated with hypertension. In such cases, several clinical features documented as more frequent bilateral phochromocytoma, more associated with other neuroendocrine tumors and thus more poor prognosis. We can observe the sustained hypertension despite of surgical resection of tumors in pheochromocytoma cases. One of the possible reason of post operative sustained hypertension is the pheochromocytoma originated from minor organ of Zukerkandl that was not resected during operation. Untreated or delayed treated cases with pheochromocytoma were often expired by complication of hypertension such as cerebrovascular hemorrhage, myocardial infarction, etc. Thus, in neurofibromatosis with hypertension, screening of pheochromocytorna is very important for the early detection of tumor and more favorable prognosis. Recently, We experienced a case of neurofibromatosis associated with bilateral pheochromocy-toma expired by cerebral hemorrhage during operation, so we report the case with literature review.
Carcinoid Tumor ; Cerebral Hemorrhage ; Chromaffin Cells ; Hemorrhage ; Hypertension ; Mass Screening ; Myocardial Infarction ; Neuroendocrine Tumors ; Neurofibromatoses* ; Parathyroid Neoplasms ; Pheochromocytoma* ; Prognosis ; Sympathetic Nervous System ; Thyroid Neoplasms

Although there have been many reports about the importance of the spleen's role in hepatic fibrogenesis, the exact mechanism is still uncertain. The author designed this study to evaluate splenic function on hepatic fibrogenesis. The degree of hepatic fibrosis and the population of splenocyte subsets were studied in the experimental animal model with fibrosis produced by injecting normal swine serum intra-peritoneally into Sprague-Dawley rats. The animals were divided into three groups; group A was subjected to injection of swine serum only, group B swine serum and complete Freund's adjuvant and group C swine serum and cyclosporin A. The experimental hepatic fibrogenesis by swine serum was augumented by coinjection with the adjuvant and inhibited by cyclosporin A. The study of the splenocyte subset revealed increased percentages of spienic B cell and CD4+ cell and a decreased percentage of CD8+ cell, and these changes of splenocyte subset were also augumented by the adjuvant and inhibited by cyclosporin A. The percent of monocytes was not significantly altered, although a tendancy of early decrease by the adjuvant was noted.
Rats ; Animals

Sarcomatoid renal cell carcinoma is an uncommon tumor that has to be distinguished from renal carcinosarcoma. We have described three cases of sarcomatoid renal cell carcinoma showing different clinical and light microscopic features. An ultrastructural study of the tumor cells from the sarcomatoid area revealed frequent desmosomal junction, confirming the epithelial nature of the neoplasm. All three cases showed an aggressive clinical course and tended to invade adjacent organs or tissues. We believe that an histological and immunohistochemical examination in conjunction with an electron microscopic examination are necessary to diagnose sarcomatoid renal cell carcinoma.
Carcinoma, Renal Cell* ; Carcinosarcoma* ; Desmosomes ; Microscopy, Electron

E-cadherin (ECD) is a Ca++ -dependent adhesion molecule which plays a major role in the maintenance of intercellular adhesion in epithelial tissues. The expression pattern of ECD in 77 surgically resected gastric adenocarcinomas was examined by immunohistochemistry, using a rat monoclonal antibody raised against murine E-cadherin (DECAM-1). ECD was strongly expressed uniformly at cell to cell borders in normal gastric epithelium without exception. But, various staining patterns were observed in the cancer tissues. The frequency of tumors with preserved ECD expression (Pre-type) and reduced ECD expression (Rd-type) was 44% and 56%, respectively. Using Lauren's classification, the high frequency of the Pre-type expression in adenocarcinoma of the intestinal type was significantly higher than that in adenocarcinoma of the diffuse type (p<0.05). But, no significant correlation between the ECD expression and the gross type, invasion depth, growth pattern or metastasis was observed. These results suggest that ECD might play a key role in the morphogenesis of gastric adenocarcinoma.
Adenocarcinoma* ; Animals ; Cadherins* ; Classification ; Epithelium ; Immunohistochemistry ; Morphogenesis ; Neoplasm Metastasis ; Rats

The congenital renal cystic disease encompasses a complex group of pathologic and clinical entities. We retrospectively reviewed 42 cases of congenital renal cystic lesions classified into four Potter types in a series of 2,063 consecutive autopsies from 1981 to 1996. According to our study based on morphologic, clinical, genetic features and associated anomalies, type I and III are relatively compatible with Potter's original definition. However, it was reasonable that type II and IV are classified to the same group because of: 1) very similar histologic findings representing dysplastic kidney, 2) many associated anomalies, 3) no evidence of inheritance, and 4) presence of a combined type. Syndrome associated cysts, such as Meckel-Gruber syndrome, were also separately classified. If the dysplastic evidence was insufficient for diagnosis to the dysplastic kidney in type II and IV, then these cases would be better classified into a cystic disease associated with congenital hydronephrosis. We propose a classification of the congenital cystic disease of the kidney to be: 1) dysplastic kidney, 2) cystic disease associated with congenital hydronephrosis, 3) polycystic kidney, and 4) syndromic cystic disease.
Autopsy ; Classification* ; Diagnosis ; Hydronephrosis ; Kidney* ; Polycystic Kidney Diseases ; Retrospective Studies ; Wills

BACKGROUND: Cleaning and disinfection of fiberoptic bronchoscope requires careful attention, especially to mycobacterium species because the contamination of mycobacteria could raise confusion on diagnosis. Recently, we detected contamination of Wydex(R) solution used in bronchoscope washer with Mycobacterium chelonae. In this study, we evaluated the mycobactericidal effect of 12 kinds of disinfectants for M. chelonae. METHOD: To evaluate the bactericidal effect of Wydex(R) 2%, Cidex(R) 2.25%, Cidex(R) 3%, Bacteriokiller (BK) disinfectant, Perasafe(R), HICLO-S(R), Lamicine(R), ethanol, Instrusept(R), Virkon(R), Betadine(R), and Vipon(R) against M. chelonae, culture was performed after exposure of two M. chelonae strains (ATCC 35749, the type strain and the strain isolated from contaminated Wydex(R) solution) to each disinfectant solution. The growth of organism was examined for up to 8 weeks. RESULTS: Growth of M. chelonae (reference strain of ATCC 35749 and isolated strain) was observed after a week incubation for Wydex(R) 2%, Cidex(R) (2.25%, 3%) and control. For BK disinfectant and Perasafe(R), they grew after 2-3 weeks, and 3-4 weeks, respectively. For HICLO-S(R) and Lamicine(R), only the contaminated strain grew after two and three weeks, respectively. For ethanol, Virkon(R), Betadine(R), Vipon(R), and Instrusept(R) , growth was not observed from either strain. CONCLUSIONS: On the basis of these results, Instrusept(R), virkon(R), ethanol, Betadine(R), and Vipon(R) were effective for the disinfection of M. chelonae. Especially, Instrusept(R) was thought to be useful as a disinfectant for bronchoscopes because it has advantages including non-corrosiveness, chemical stability, and non-irritativeness. And additional washing with ethanol might be effective. The finding that strain isolated from contaminated bronchoscopes was more resistant to disinfectants than reference strain suggested that the more resistant strains are selected throughout the improper disinfection.
Bronchoscopes ; Diagnosis ; Disinfectants* ; Disinfection ; Ethanol ; Mycobacterium chelonae* ; Mycobacterium*

Neurofibromatosis, first clearly described by von Recklinghausen in 1882, is a dominantly inherited mesodermal and ectodermal dysplasia with a broad spectrum of clinical findings. Most common is the classical neurofibromatosis, which has three major features: (1) multiple neural tumors dispersed anywhere on or in the body; (2) numerous pigmented skin lesions, some of which are "cafe au lait" spots; and (3) pigmented iris hamartomas also called Lisch nodules. Other lesions sometimes seen in patients with von Recklinghausen's disease include congenital malformations of various types, vascular lesions, neurilemoma meningioma and other intracranial neoplasms, pheochromocytoma, medullary carcinoma of thyroid gland, neuroblastoma, ganglioneuroma and Wilms' tumor. Approximately 10% of the patients with neurofibromatosis have the gastrointestinal tract tumors as neurofibroma, ganglioneuroma and leiomyoma. Some of them show evidence of malignancy. Increased activity of the protein "nerve growth factor" in the sera of the patients with disseminated neurofibromatosis has been reported. We would like to report here two cases of von Recklinghausen's neurofibromatosis with involvement of the gastrointestinal tract.
Hamartoma ; Meningioma

No abstract available.
Female ; Hydatidiform Mole* ; Pregnancy

For the purpose to define the clinical usefulness of fasting serum total bile acid, the authors carried out to measure the serum total bile acid in 18 cases of acute hepatitis, 10 cases of chronic active hepatitis, 21 cases of liver cirrhosis, 7 cases of hepatocellular carcinoma and 35 cases of adult healthy control. Diagnosis were confirmed histopathologically in all the patients. Blood samples were obtained usually in the morning before meals from th anterior cubital vein of all the patients and adult healthy control in Pusan National University Hospital during the periods from January to August, 1984. Total bile acid was measured fluorome cally by means of an enzymatic technique. The results obtained were as follows: 1) The mean value of serum total bile acid in adult healthy subject in fasting was 2.6+/-2.3 umol/L. 2) The mean values of serum total bile acid were significantly higher in the patients with various liver diseases, as compared with those in adult healthy subjects. 3) In acute hepatitis and chronic active hepatitis, the percentages of abnormal values were significantly higher or tended to be higher in total bile acid, as compared with those in total bilirubin, ALP, LDH and GGT activity and tended to be lower in total bile acid, as compared with those in AST and ALT activity. 4) In liver cirrhosis and hepatocellular carcinoma, the percentages of abnormal values of total bile acid were significantly higher in the patients with above 100IU/L of AST activity, compared with those in the patients with 50~100IU/L of AST activity. 5) Total bile acid showed a significant correlation with total bilirubin and ALP in acute hepatitis, with total bilirubin in chronic active hepatitis and hepatocellular carcinoma, and with ALP in liver cirrhosis. On the basis of the results obtained, it was suggested the measurement of serum total bile acid is clinically a highly sensitive, useful test in diagnosis of various liver diseases.
Adult ; Male ; Female ; Humans ; Carcinoma, Hepatocellular