Cholelithiasis is defined as the presence of stones within the lumen of the gallbladder or in the extrahepatic biliary tree. Cholecystitis, secondary to gallstones, is a common surgical disorder in Korea. Detailed microscopic descriptions, particularly the ultrastructural changes, of these diseases were not available. The goal of this study was to identify the ultrastructural alterations of gallbladder epithelium in cholecystitis with and without a stone, according to the degree of severity of inflammation, and the nature of the stone. The gallbladders of the control group, and cholecystitis cases without stone and with stone were fixed and examined with routine stain, special stain, immunohistochemical stain and trans-mission electron microscopy. The number and the volume density of the mucin containing secretary granules were not significantly increased in the calculous cholecystitis cases compared with those of the acalculous cholecystitis cases. Major findings were that the calculous cholecystitis cases showed a markedly reduced total lysosome area and volume density of the lysosome compared with those of the acalculous chole-cystitis cases. The differences between the mucin secretary granules and lysosomes, according to the degree of severity of cholecystitis and the natures of gallstones, were statistically not significant.
Humans

The aims of this study were to assess the role of p53 overexpression in colorectal tumorigenesis and the association with clinicopathological features. The immunohistochemical results were semiquantitatively assessed. Expression of aberrant p53, tumor-suppressor gene product, was studied immunohistochemically using a monoclonal antibody in 11 nonneoplastic polyps, 19 tubular adenomas, 9 villous adenomas, and 48 colorectal carcinomas. Five out of 11 nonneoplastic polyps, 14 out of 19 tubular adenomas and one out of 9 villous adenomas expressed p53 protein. Seven out of 24 colorectal carcinomas without lymph node metastasis and 14 out of 24 colorectal carcinomas with lymph node metastsis expressed p53 protein. The case of more than 75% positivity of p53 in colorectal carcinoma with lymph node metastasis was seven out of 24, but that in lymph node negative group was two out of 24. In the colorectal carcinoma with lymph node metastasis group; metastatic intranodal neoplastic cells were expressed positively for p53 in 10 out of 14 cases and zero out of 10 cases in group of positive and negative expression of primary lesions, respectively. p53 protein expression was not significantly correlated with variable clinicopathologic features such as age, sex, tumor location, tumor size, differentiation and Dukes' stage. It is suggested that p53 protein overexpression could be a early event in pathogenesis of colon cancer but is not involved in progression of villous adenoma to adenocarcinoma. p53 overexpression seems to be involved in metastatic ability of colorectal carcinomas.
Adenoma ; Neoplasm Metastasis ; Cell Transformation, Neoplastic

Small round cell tumors such as neuroblastoma, rhabdomyosarcoma, Ewing's tumor, malignant lymphoma and small cell carcinoma are often confused clinically and histologically. To clarify the similarites and differences and to get more information on the histogenesis among the small round cell tumors, we examined histological, immunohistochemical and ultrastructural features of ten cases of neuroblastomas, twenty Ewing's tumors, ten embryonal rhabdomyosarcomas and twelve small cell carcinomas in children and young adults. Antibodies against desmin, vimentin, cytokeratin, neuron-specific enolase, synaptophysin, neurofilament, S-100 protein, chromogranin and HBA 71 were used in biotin streptavidin procedures. The results of the immunohistochemical and electron microscopical examinations yielded virtually identical findings in each group as followings. 1) Among the twenty cases of Ewing's tumors, eighteen cases were positive in staining for HBA-71. The staining for HBA-71 was negative in neuroblastoma, embryonal rhabdomyosarcoma and small cell carcinoma. 2) Neuroblastomas had marked interdigitating cytoplasmic processes containing many microtubules and dense-core secretory granules, however, they were sparse and rare in Ewing's tumor. 3) Embryonal rhabdomyosarcoma showed actin-myosin bundles. According to differentiation, well differentiated rhabdomyosarcoma exhibited Z-band materials and external lamina. 4) Neuroblastoma showed ultrastructural evidence of a neuronal differentiation, but neuronal differentration is a sparse and rare in Ewing's tumor. This ultrastructural feature strengthens the hypothesis that Ewing's tumor is derived not only from an undifferentiated neuroectodermal stem cell but from primitive cell of neuroectodermal origin.
Antibodies ; Biotin ; Carcinoma, Small Cell ; Child ; Cytoplasm ; Desmin ; Humans ; Immunohistochemistry ; Keratins ; Lymphoma ; Microtubules ; Neural Plate ; Neuroblastoma ; Neurons ; Phosphopyruvate Hydratase ; Rhabdomyosarcoma ; Rhabdomyosarcoma, Embryonal ; S100 Proteins ; Sarcoma, Ewing ; Secretory Vesicles ; Stem Cells ; Streptavidin ; Synaptophysin ; Vimentin ; Young Adult

Lipid cell tumors of the ovary are among the rarest of the functional ovarian neoplasms. Recently, authors experienced a case of lipid cell tumor of the left ovary in a 19 year old female, who presented with amenorrhea and hirsutism for 4 years. Grossly, the ovary was well encapsulated, and measured 6.5x6x4.5 cm. Cut surface show homogenous yellowish bulging neoplastic tissue and peritheral displaced normal ovarian tissue. Microscopically, neoplastic cells were composed of rounded and polyhedral cells, arranged in nests seperated by rich vascular networks. On the basis of the author's findings and the evidence available in the literature, we determined this case as ovarian lipid cell tumor.
Female ; Humans

A 55 year old male complain right shoulder pain and right upper quadrant pain about three months. He was a heavy alcoholism. Highly selective angiography, CT scan and operation findings suggest primary malignant neoplasm of the liver. Right hepatic lobectomy and partial diaphragmectomy was done under impression of heaptocellular carcinoma. The specimen measured 15x11x9 cm and disclose relatively hard and nodular mass devoid of cirrhotic changes. Cut surface show unilobar large mass measuring 11x8x6 cm and bearing brightly yellow discoloration and multifocal hemorrhagic necrosis. Histological characteristics were diffuse proliferation of large neoplastic cells with ample cytoplasm, containing granular materials, erythrophagocytosis, neutrophagocytosis and hemosiderin pigments. Atypical and bizarre mitosis and multinucleated giant cells bearing abundant erythro and neutrophagocytosis were frequently seen. The large or vesicular nuclei were irregular, with occasional deep indentations and revealed sharply defined nuclear membrane, coarse chromatin and conspicious nucleoli. Ultrastructurally the cytoplasm of neoplasltic cells had lysosomal granule, phagolysosome, phagocytized material and residual bodies. Immunohistochemical stains for alpha 1-antitrypsin, alpha 1-antichymotrypsin, vimentin and lysozyme showed positive reactions, but, alpha fetoprotein, cytokeratin, S-100 protein, factor VIII, complement 3 receptor and carcinoembryonic antigen were negative. Alpha-naphtyl acetate esterase activity in paraffin embedded tissue ribbon showed negative reaction. These findings show compatible with primary malignant lymphoma, true histiocytic type, (histiocytic sarcoma, Kupffer cell carcinoma) of the liver.
Male ; Humans

This study was performed to fine out the possible causes of primary infertility in female and to provide some diagnostic and therapeutic modalities. A total of 104 cases of endometrium in primary infertility was obtained from the pathology files of Chosun University Hospital and Kwang-ju Christian Hospital during the period of 5 years and 10 months from January, 1984 to October, 1989. The endometrial biopsies were taken on the first of menstruation and classified according to Noyes, Hertig and Rock's criteria. Histologic findings which were compatible with their normal menstrual cycle (premenstrual of late secretory phase and bleeding phase) were noted in 52 cases (50%). Abnormal 52 cases (50%) revealed deficient secretory phase in 36 case (34.6%), proliferative phase in 5 cases (4.8%), irregular proliferation and chronic nonspecific endometritis in 4 cases (3.8%), respectively, endometrial hyperplasia in 3 cases (2.9%), tuberculous endometritis in 2 cases (1.9%), and asynchronous cycle in 1 case (1%). Among the case of dissociated delay was 21 cases (20.2%) and coordinated delay was 15 cases (14.4%). Therefore, deficient secretory phase with dissociate delay was most common abnormal endometrial finding in cases of female primary infertility. The peak age distribution of the female primary infertility in this study revealed 73 cases (63.8%) in patients between the age of 25 and 29. This finding indicated that there was no significant relationship between the age distributions and the endometrial histopathologic findings.
Female ; Humans ; Biopsy

Liposarcoma of the male breast is rare. In English literature, nearly 90 tumors of this type can be found, but the majority of citation is female without detail descriptions of gross or microscopic features. Recently, we experienced a case with pleomorphic liposarcoma of the breast. This 62-year-old male patient presented with tumorous mass of right breast for 3 months ago. He underwent radical mastectomy under the impression of breast cancer. Received specimen was a breast and attached nodular bulging mass. The serial section reveal a relatively defined nodular mass consists of yellowish and glistened bulging tumorous lesion, measuring 5x4.5x5cm. Microscopically, there were multiple pleomorphic giant cells composed of plump esoinophilic or microvesiculated cytoplasm and bizarre nuclei with prominent nucleoli. These cells were positive staining for oil-red O. Ultrastructurally, variable sized numerous fatty vacuoles in the cytoplasm were seen.
Female ; Male ; Humans ; Breast Neoplasms

Proliferations of the endometrial glands form a continuum from focal glandular crowding through simple hyperplasia, complex hyperplasia and atypical hyperplasia to frank adenocarcinoma. But objective criteria to distinguish these proliferative endometrial lesions are not clear-cut and terminology is confusing. The p53 protein is a nuclear phosphoprotein that can regulate cell proliferation and suppress tumor growth. Mutation in the p53 gene have been reported in a variety of human tumors, and in selected malignancies overexpression of p53 has been associated with poor prognosis. In this study we examined a series of endometrial proliferative lesion, including hyperplasia, adenocarcinoma, and adenomyosis to determine whether or not p53 is overexpressed in these lesions. In the result, p53 immunoreactivity was observed in 3 of 17 (17.6%) simple hyperplasia, one of 6 (16.6%) complex hyperplasia, none of 3 (O%) atypical hyperplasia, 6 of 13 (46.1%) adenocarcinoma and none of 10 (O%) adenomyosis. In conclusion, p53 mutation seems to play a role in oncogenesis of endometrial adenocarcinoma in early phase but there was no significant relationship between p53 overexpression and histologic grade of adenocarcinoma.
Adenocarcinoma* ; Adenomyosis ; Carcinogenesis ; Cell Proliferation ; Crowding ; Endometrial Hyperplasia* ; Female ; Genes, p53 ; Humans ; Hyperplasia ; Prognosis

OBJECTIVES: This study aimed to evaluate the clinical efficacy of individual cognitive behavioral therapy (CBT) for Patients with Primary or Secondary Insomnia. METHODS: Participants were recruited from a primary care sleep clinic from January 2008 to June 2009. The study sample included 64 outpatients with primary insomnia (n=30) and secondary insomnia (n=34) according to the criteria of DSM-IV. Participants completed sleep diaries, Dysfunctional Beliefs and Attitudes about Sleep Scale-16 (DBAS), State-Trait Anxiety Inventory (STAI) before CBT and shortly after completion of CBT. CBT was provided in 7 weekly, 40-50-minute individual therapy sessions. RESULTS: Both groups of patients with primary and secondary insomnia showed significant improvement in the DBAS and sleep parameters including sleep onset latency, total sleep time, and sleep efficiency. Repeated-measures ANOVA of the DBAS and sleep parameters showed no significant group-by-time interactions between patients with primary and secondary insomnia, suggesting the efficacy of CBT for patients with secondary insomnia was equivalent to that of CBT for patients with primary insomnia. CONCLUSION: This study suggests that CBT is effective for the management of primary and secondary insomnia in a primary care setting.
Anxiety ; Cognitive Therapy ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Outpatients ; Primary Health Care ; Sleep Initiation and Maintenance Disorders

BACKGROUND: Many physicians hesitate to discuss do-not-resuscitate (DNR) orders with patients or family members in critical situations. In the intensive care unit (ICU), delayed DNR decisions could cause unintentional cardiopulmonary resuscitation, patient distress, and substantial cost. We investigated whether the timing of DNR designation affects patient outcome in the medical ICU. METHODS: We enrolled retrospective patients with written DNR orders in a medical ICU (13 bed) from June 1, 2014 to May 31, 2015. The patients were divided into two groups: early DNR patients for whom DNR orders were implemented within 48 h of ICU admission, and late DNR patients for whom DNR orders were implemented more than 48 h after ICU admission. RESULTS: Herein, 354 patients were admitted to the medical ICU and among them, 80 (22.6%) patients had requested DNR orders. Of these patients, 37 (46.3%) had designated DNR orders within 48 hours of ICU admission and 43 (53.7%) patients had designated DNR orders more than 48 hours after ICU admission. Compared with early DNR patients, late DNR patients tended to withhold or withdraw life-sustaining management (18.9% vs. 37.2%, p = 0.072). DNR consent forms were signed by family members instead of the patients. Septic shock was the most common cause of medical ICU admission in both the early and late DNR patients (54.1% vs. 37.2%, p = 0.131). There was no difference in in-hospital mortality (83.8% vs. 81.4%, p = 0.779). Late DNR patients had longer ICU stays than early DNR patients (7.4 ± 8.1 vs. 19.7 ± 19.2, p < 0.001). CONCLUSIONS: Clinical outcomes are not influenced by the time of DNR designation in the medical ICU. The late DNR group is associated with a longer length of ICU stay and a tendency of withholding or withdrawing life-sustaining treatment. However, further studies are needed to clarify the guideline for end-of-life care in critically ill patients.
Advance Directives ; Cardiopulmonary Resuscitation ; Consent Forms ; Critical Illness* ; Hospital Mortality ; Humans ; Intensive Care Units ; Resuscitation Orders* ; Retrospective Studies ; Shock, Septic