The authors reviewed surgical materials from 20 patients with carcinoma of the extrahepatic biliary system, and a correlation between macroscopic appearance of the tumors with various clinical features and histopathologic findings was made. Microscopically, the tumors were classified into four types; Four (21%) patients had polypoid tumors, six (32%) had nodular growths, five (26%) were scirrhous constricting in type, and four (21%) had diffusely infiltrating type. Histologically all the differentiation in two cases. The degree of differentiation of the tumors was classified into 3 types: 11 (55%) patients were well differentiated, 3(15%) were moderately well and 6(30%) were poorly differentiated. All polypoid tumors were well differentiated and had low stage. No correlation in the degree of differentiation of the tumor with the stage was present. No correlation in clinical symptoms, duration of symptoms, laboratory findings with morphologic findings of the tumors was noted.

Tamoxifen is a nonsteroidal triphenylethylene delivative that has been widely used in the treatment of breast cancer. tamoxifen is indicated for the adjuvant treatment of breast cancer in women following total mastectomy or segmental mastectomy, breast irradiation and chemotherapy. tamoxifen has been shown to have significant benificial effect in the treatment of breast cancer patient as hormonal therapy. However ,there is mounting evidence that tamoxifen may affect other hormon sensitive organs, including the uterus and ovaries. An increased risk of endometrial polyps, endometrial hyperplasia and adenocarcinoma has been reported in tamoxifen treated women. We have met cases of endometrial polyp and endocervical polyp which were associated with tamoxifen use, after modified radical mastectomy for infilterating ductal carcinoma of breast . So we report these cases with the brief review of literatures.
Adenocarcinoma ; Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Drug Therapy ; Endometrial Hyperplasia ; Female ; Humans ; Mastectomy, Modified Radical ; Mastectomy, Segmental ; Mastectomy, Simple ; Ovary ; Polyps* ; Tamoxifen* ; Uterus

Leri-Weill syndrome or Leri-Weill dyschondrosteosis represents a short stature syndrome that is characterized by symmetric shortening of the forearms and lower legs and a bilateral shortening and bowing of the radius with a dorsal subluxation of the distal ulna(Madelung deformity). Recent genetic analyses demonstrated that functional haploinsufficiency of SHOX(short stature homeobox-containing gene) accounts for Leri-Weill syndrome. Further studies are needed to explain phenotypic heterogeneity of SHOX defect. We experienced a case of Leri-Weill syndrome in a 11-year-old girl with short stature, who revealed typical Madelung deformity, mesomelic(middle segment) dysplasia, and a karyotype of 46,XX. In cases with dyschondrosteosis or Turner-characteristic dysmorphic skeletal features, detection of SHOX mutation is recommended.
Child ; Congenital Abnormalities ; Female ; Forearm ; Haploinsufficiency ; Humans ; Karyotype ; Leg ; Population Characteristics ; Radius

PURPOSE: To evaluate the role of CT in early detection, location, and extent of osteochondritis dissecans (OCD) of the elbow joint. MATERIALS AND METHODS: We reviewed surgically proved 27 cases of 22 patients with osteochondritis dissecans in elbow joint retrospectively. We compared simple x-ray(elbow AP & lateral) with CT on the basis of staging of OCD of talus by simple x-ray. RESULTS: The frequency of location was as follows:fourteen cases of capitellum, 5 cases of olecranon tip, 5 cases of medial epicondyle, 2 cases of trochlea, and 1 case of olecranon base. Among the 4 cases of normal finding on simple x-ray, CT showed 1 case each of stage I, II, III, and IV OCD and among the 8 cases of stage I on simple x-ray, CT showed 2 cases of stage I, 1 case of stage II, and 5 cases of stage III. Among the 3 cases of stage II on simple x-ray, CT showed 1 case of stage II and 2 cases of stage III. Among the 5 cases of stage III on simple x-ray, CT showed 1 case of stage II, 2 cases of stage III, and 2 cases of stage IV, but it was difficult to detect the presence or absence of attachment between the articular cartilage of mother bone and osteochondral fragment. CT was more accurate than simple x-ray in detection of loose body. CONCLUSION: CT might be an useful imaging modality in early diagnosis of OCD and evaluation of its anatomic location and extent in elbow joint.
Cartilage, Articular ; Early Diagnosis ; Elbow Joint* ; Elbow* ; Humans ; Mothers ; Olecranon Process ; Osteochondritis Dissecans* ; Osteochondritis* ; Retrospective Studies ; Talus

No abstract available.
Brain Stem* ; Evoked Potentials, Auditory, Brain Stem* ; Humans ; Infant*

Effects of thoracentesis on thoracic impedance and cardiac performance were studied in patients with uncomplicated unilateral tuberculous pleural effusion. The speed of the removal of the pleural effusion in thoracentesis was essentially similar to that of a generally used for therapeutic purpose in daily practice. Thoracic impedance was measured in 23 cases before, 4 and 10 minutes after thoracentesis to the amount of pleural effusion aspirated was observed. In 11 cases out of 23, the changes in cardiac performance as assessed by stroke volume, cardiac output, heart rate, heather index and ratio of pre-ejection period to left ventricular ejection time(PEP/LVET) were observed 4 minutes after 150 ml to 1,000 ml of thoracentesis. In these cases, stroke volume, cardiac output, and Heather index were determined from impedance cardiograms, and PEP/LVET from mechanocardiograms recorded simultaneously with the former. A significant increase in thoracic impedance was observed both 4 and 10 minutes after thoracentesis. There was a slight but a significant correlation between the changes in thoracic impedance and the amount of pleural fluid aspirated only 4 minutes after thoracentesis. Thoracentesis showed no consistent influence on cardiac performance as reflected to stroke volume, cardiac output, heart rate, heart index and PEP/LVET. These facts suggest that measurement of thoracic impedance may be a useful method reflecting alterations in pleural fluid volumes, particularly when it occurs in a relatively short period of time, and the effects of thoracentesis of less than one liter on the cardiac functions as determined by the above-mentioned parameters were variable.
Cardiac Output ; Electric Impedance* ; Heart ; Heart Rate ; Humans ; Pleural Effusion ; Stroke Volume

Development of the human colorectal cancer is associated with several distinct genetic abnormalities involving both dominant-acting oncogenes (K-ras, c-src) and tumor suppressor genes (APC, DCC, p53) which undergo inactivation or loss. In colorectal tumors, the common molecular alteration is localized in the 17p13 and 5q21 loci encoding the p53 and the APC gene, respectively. The identification of these genes may help the understanding of the pathogenesis of colorectal neoplasia. In order to determine whether the frequency of the genetic alterations varies with sex, age, tumor size, or site, including pathologic parameters, such as degree of differentiation, tumor stage, mucin component, lymphoid reaction, tumor invasion pattern, vein and nerve invasion, lymph node metastasis, and other parameters, such as disease-free survival, distant metastasis and patient outcome, the authors analyzed the loss of heterozygosity (LOH) of the APC and the p53 genes in paraffin-embedded specimens of 48 colorectal cancers by use of the polymerase chain reaction and restriction fragment length polymorphism. The results were as follows: the LOH affecting the APC was found in 15 out of 31 (48.4%) heterozygous patients, while the LOH of the p53 locus was observed in 11 out of 26 (42.3%) patients. Among 48 patients, the LOH at both the APC and the p53 loci was observed in five (10.4%) patient. No statistically significant associations were found between the LOH of the APC gene and the proposed parameters. The relationship between the LOH of the p53 and the histologic differentiation, lymphoid reaction was significant (P<0.05), but survival was not correlated. Statistically significant associations were found between overall survival of the colorectal cancer patients and distant metastasis, Astler-Coller stage, lymphoid reaction, invasion pattern, nerve invasion, vein invasion, lymph node metastasis, and disease free survival. The above results suggest that the LOH of the p53 genes could be involved in the progression of colorectal cancers. However, neither the LOH of the APC nor that of the p53 have significant association with survival of the colorectal cancer patients.
Colorectal Neoplasms* ; Disease-Free Survival ; Genes, APC ; Genes, p53 ; Genes, Tumor Suppressor* ; Humans ; Loss of Heterozygosity* ; Lymph Nodes ; Mucins ; Neoplasm Metastasis ; Oncogenes ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Veins

Matrix metalloproteinases are believed to play an important role in tumor invasion and metastasis. But little is known about the role of them in the gastric adenocarcinoma. We investigated the expression of matrix metalloproteinase-1,2,3 in eighty paraffin blocks of the primary gastric adenocarcinoma tissues with immunohistochemistry and analysed their correlation with lymph node metastasis and survival. MMP-1,2,3 were expressed most intensely in the fibroblasts around the tumor stroma. In our study the increased immunoreactivity of MMP-2 only showed statistically significant correlation with lymph node metastasis (P=0.0517, Odd's ratio=2.274). But MMP-1,2,3 all were correlated with survival. Type IV collagen was observed in the vascular basement membranes and tumor basement membranes and showed statistically significant correlation with lymph node metastasis (P=0.0002, Odd's ratio=0.194) and prognosis (P=0.0001). The immunoreactivity of MMP-2 and type IV collagen was inversely correlated (Kendall's Tau-b correlation = 0.37482, P=0.0001). Our results suggest that in human gastric adenocarcinoma the increased immunoreactivity of MMP-2 and the decreased immunoreactivity of type IV collagen has an important role in lymph node metastasis and prognosis. MMP-1,3 are not correlated with lymph node metastasis but correlated with survival. The mechanism responsible for the production of MMP by the host fibroblasts remains obscure and requires further investigation.
Adenocarcinoma* ; Basement Membrane ; Collagen Type IV* ; Fibroblasts ; Humans ; Immunohistochemistry ; Lymph Nodes* ; Matrix Metalloproteinases ; Neoplasm Metastasis* ; Paraffin ; Prognosis*

A case of gallbladder empyema caused by Pediococcus pentosaceus is discussed. This appears to be the first reported case of gallbladder empyema caused by this organism. The laboratory method to identify this vancomycin-resistant gram-positive cocci and antimicrobial susceptibility of this organism are described.
Cholecystitis* ; Gallbladder* ; Gram-Positive Cocci ; Pediococcus*

Duret hemorrhage is characterized by an upper brainstem hemorrhage due to increased intracranial pressure by mass effect such as subdural hematoma or a brain tumor. The anteroposterior elongation and downward displacement of the upper brainstem by transtentorial herniation results in the compression and tearing of the paramedian perforating vessels that feed the upper brainstem tegmentum. The consequent hemorrhage that involves the upper brainstem renders recovery to be almost impossible. Following a tricuspid valve replacement surgery, a 56-year-old woman developed a left fronto-temporo-parietal nontraumatic subdural hematoma resulting in transtentorial herniation of the left mesial temporal lobe. A successful surgical evacuation of the hematoma was done with clinical improvement. Two days later, she was referred to neurology with an aggravated right side weakness, dysarthria, and a newly developed extraocular movement disturbance. A brain CT and MRI showed a pontine hemorrhage. We report a case of pontine hemorrhage, a Duret hemorrhage, after the surgical evacuation of nontraumatic subdural hematoma.
Brain ; Brain Neoplasms ; Brain Stem ; Dysarthria ; Female ; Hematoma ; Hematoma, Subdural* ; Hemorrhage* ; Humans ; Intracranial Pressure ; Magnetic Resonance Imaging ; Middle Aged ; Neurology ; Temporal Lobe ; Tricuspid Valve