This study was conducted to set up a common mechanism for varying phases of focal segmental glomerulosclerosis(FSGS) by comparing the morphological differences between human FSGS and changes in 5/6 renal ablation animal model, which has been accepted as experimental prototype for hyperfiltration theory as pathogenesis of FSGS. Both the human and the experimental rats showed very similar changes such as segmental glomerulosclerosis, vacuole formations or inclusion of small granules of podocytes, appearance of foamy cells in the capillary lumina, eosinophilic deposits along the mesangial area, and focal atrophy of tubules with associated interstitial fibrosis. The halo, frequently seen in human FSGS, is due to detachment of visceral epithelium from basement membrane, however, did not appear in the experimental rat specimen. On the other hand, the foamy cells and hyalinization were more frequently noted in the rat series and even involved the arterioles. The mesangial proliferation never appeared in the rat series occasionally found in human FSGS. In conclusion, the pathogenesis of FSGS cannot depend solely on the hyperfiltration theory of hemodynamic derangement, but has complex impairment of visceral epithelium and cells forming the constituents of basement membrane.
Animals ; Arterioles ; Atrophy ; Basement Membrane ; Biopsy ; Capillaries ; Eosinophils ; Epithelium ; Fibrosis ; Hand ; Hemodynamics ; Humans* ; Hyalin ; Models, Animal* ; Nephrectomy* ; Podocytes ; Rats* ; Vacuoles

This study was conducted to set up a common mechanism for varying phases of focal segmental glomerulosclerosis(FSGS) by comparing the morphological differences between human FSGS and changes in 5/6 renal ablation animal model, which has been accepted as experimental prototype for hyperfiltration theory as pathogenesis of FSGS. Both the human and the experimental rats showed very similar changes such as segmental glomerulosclerosis, vacuole formations or inclusion of small granules of podocytes, appearance of foamy cells in the capillary lumina, eosinophilic deposits along the mesangial area, and focal atrophy of tubules with associated interstitial fibrosis. The halo, frequently seen in human FSGS, is due to detachment of visceral epithelium from basement membrane, however, did not appear in the experimental rat specimen. On the other hand, the foamy cells and hyalinization were more frequently noted in the rat series and even involved the arterioles. The mesangial proliferation never appeared in the rat series occasionally found in human FSGS. In conclusion, the pathogenesis of FSGS cannot depend solely on the hyperfiltration theory of hemodynamic derangement, but has complex impairment of visceral epithelium and cells forming the constituents of basement membrane.
Animals ; Arterioles ; Atrophy ; Basement Membrane ; Biopsy ; Capillaries ; Eosinophils ; Epithelium ; Fibrosis ; Hand ; Hemodynamics ; Humans* ; Hyalin ; Models, Animal* ; Nephrectomy* ; Podocytes ; Rats* ; Vacuoles

Undifferentiated sarcoma of the liver is a highly malignant neoplasm that occurs almost exclusively in children. We present a case of adult undifferentiated sarcoma in a 33-year-old man. The neoplasm was typically hypovascular on hepatic angiography and a globular, cystic and mucoid mass separated from the adjacent liver by a psedocapsule was removed from the left lobe of the liver. Necrosis and hemorrhage were found. Microscopically the neoplasm consisted of myxoid and cellular areas and the basic neoplastic cells were stellate cells showing variable degree of anaplasia and pleomorphism. Eosinophilic globules were PAS-positive and immunohistochemically negative for alpha-fetoprotein. Extramedullary hematopoiesis was present and normal-appearing bile ducts and hepatic cell cords were noted.
Child ; Adult ; Male ; Female ; Humans

Potentially, some donor site complications are associated with the harvesting of autogenous tricortical iliac bone grafts for anterior spinal fusion. The purpose of this study was to evaluate the reliability of the anterior iliac crest reconstruction after harvesting autogenous iliac grafts for anterior spinal fusion. We devided into two groups : the study group were the anterior iliac crest reconstruction in 57 patients with minimal twelve months follow up period, the control group were not the anterior iliac crest reconstruction in 21 patients who could not obtain the rib from retroperitoneal approach. The average follow up was obtained at 43.3 months(12 to 72 months) in study group, at 41.6 months(12 to 60 months) in control group. The study group had a tendency to improve the donor site pain after incorporation of the rib graft and the control group tend to remain the donor site pain till late especially in the thinner group and combined disease group. In residual deformity of the donor site, the study group was superior to the control group. Residual deformity of the study group was associated with the complications such as displacement and resorption of the grafts. Cosmetic residual deformity tends to be higher in the thinner group. Radiographically all rib gragts incorporated in situ in 51 patients despite of some cases of migration(Average 11 weeks and 4 days) and clinical results did not affect by biological behavior of rib grafts on the follow up radiogram. The authors attempted anterior iliac crest reconstruction using the implants (Mennen plate in 3 patients, threaded pin in 3 patients) after large harvesting of autogenous tricortical graft in 6 patients who could not obtain the rib from retroperitoneal approach or could not fit the rib too the defect. In those cases the results were satisfactory clinically. These results suggest anterior iliac crest reconstruction can minimize painful deformity after the harvesting of autogenous tricortical iliac grafts for anterior spinal fusion.
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Ribs ; Spinal Fusion ; Tissue Donors ; Transplants

No abstract available.
Aspergillosis ; Diabetes Mellitus ; Humans ; Liver Cirrhosis ; Liver ; Lung ; Maxillary Sinus

No abstract available.

The association of gastric tubular adenoma and adenocarcinoma is already well known. Then, are those two pathologic lesions merely incidentally coexisting or does the one evolve to the other? That is a longstanding controversy. Nowadays, as is the case with the colonic tubular adenoma, the hypothesis that gastric tubular adenoma may be a precancerous lesion is generally accepted. However the direct evidences are rare. We report a clear case proving the potential of direct malignant transformation of gastric tubular adenorna through the 9-year close endoscopic follow-up. The developed cancer is well differentiated, surrounded with background tubular adenoma and limited to the submucosal layer.
Adenocarcinoma ; Adenoma* ; Colon ; Follow-Up Studies*

Forty-four ovairan tumors were immunohistochemically studied for the presence of broad-spectrum keratin, vimentin, desin, carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), and alpha 1-antitrypsin (AAT) in formalin-fixed, paraffin-embedded tissues. 1) Among the common epithelial tumors, all the serous carcinomas (4) expressed keratin and AAT, and one additionally CEA. Six mucinous carcinomas exhibited keratin-positivity in two. One endometrioid carcinoma coexpressed keratin and vimentin as well as AAT, but one clear cell carcinoma expressed only keratin. Keratin-and CEA-positivity in epithelial cell nests and vimentin-positivity in stromal cells were observed in two Brenner tumors. Two undifferentiated carcinomas showed keratin-positivity in one and focal CEA positivity in the other. 2) In sex cord-stromal tumors, four out of six granulsa cell tumors, all four thecomas and three fibromas expressed vimentin, and two granulosa cell tumors and two thecomas showed AAT-positivity. The others were negative. 3) Among germ cell tumors, four dysgerminomas showed focal vimentin-positive cells in two and diffuse staining for AAT. Seven endodermal sinus tumors expressed AAT in all. Additionally, AFP were positive in two and CEA in three out of them. One embryonal carcinoma expressed CEA, AAT and AFP. 4) In four metastatic carcinomas, three exhibited keratin-and CEA-positivity, whereas one exhibited keartin-and vimentin-positivity. All showed AAT-positivity. 5) There was no positive case for desmin among ovarian tumors.
Neoplasm Metastasis

Zonisamide was administered to 20 patients with refractory epileptic seizures. The mean duration of the administration was 6 months, and the mean dosage was 7.2 mg/kg/day. The efficacy of zonisamide was rated remarkable in 15% of the cases, improvement in 40%, and no change in 45%. The response rates of zonisamide were 62.5% for myoclonic seizures, 50% for tonic-clonic seizures, 80% for atonic seizures and 33.3% for atypical absence seizures. There was no correlation between the clinical response and dose or serum concentration of the drug. The adverse effects were observed in 35% of the cases which were drowsiness, dizziness, ataxia, nausea, and vomiting. In all cases, however, the administration of zonisamide could be continued.
Ataxia ; Child* ; Dizziness ; Epilepsy* ; Epilepsy, Absence ; Humans ; Nausea ; Seizures ; Sleep Stages ; Vomiting

The authors present a retrospective analysis of central nervous system(CNS) tuberculoma, describing the clinical manifestations, radiological findings, diagnosis, treatment, and prognosis. Between February 1984 to December 1996, 22 cases of CNS tuberculoma presenting as intracranial space occupying lesions were managed at Seoul National University Hospital. The age of patients ranged from two to 47 (mean, 28) years and the male-to-female ratio was 6 to 16. The diagnosis of CNS tuberculoma was pathologically confirmed in 18 cases, while the remaining four were diagnosed on the basis of clinical manifestations and radiological findings. The duration of follow-up ranged from 10 months to 7 years(median, 2 years). The results of treatment and prognosis were defined according to the status of patients on their final visit to the Outpatients' clinic. The symptoms of CNS tuberculoma were seizure(45% of cases), headache(36%), visual disturbance(18%), and hemiparesis(18%), and in 12 patients(55%), the presence of related pulmonary tuberculosis was noted. The most commom site of CNS tuberculoma was the frontal lobe; multiple lesions were present in five cases, and brain stem lesions in three. In 13 cases, CNS tuberculoma was seen as low signal intensity on T2 weighted magnetic resonance images(MRI). Gadolinium-enhanced T1 weighted MRI showed strong rim enhancement in ten cases and nodular enhancement in five, as well as characteristic grape-like conglomerated lesions in six cases. Surgical removal was performed in 13 cases, stereotactic biopsy in two, and biopsy via craniotomy in three. Although microbiologic study was negative in all 18 cases, diagnosis of CNS tuberculoma was possible on histological examination. After clinical or surgical diagnosis, a course of anti-tuberculosis medication was started in all patients. In 18 cases, intracranial lesions disappeared completely after anti-tuberculosis medication, and during the follow-up period, there was no evidence of recurrence. In three cases the lesions became smaller during treatment and symptoms improved. One patient died in spite of medication and decompressive surgery. Between the group of 13 patients who underwent decompressive surgery or lesionectomy via craniotomy, and the other group of nine, the outcome of treatment was not different(p=1.000, Fisher's exact test). In conclusion, the MRI findings of intracranial CNS tuberculoma are characteristic MRI findings. In cases of CNS tuberculoma, the treatment of choice is anti-tuberculous medication after histologic confirmation, though if sufficient clinical data support this diagnosis, then diagnostic and therapeutic medication without histologic confirmation is recommanded. Stereotactic biopsy is an ideal method for confirming a pathologic diagnosis of intracranial CNS tuberculoma, except in the cases in which intracranial pressure is high.
Biopsy ; Brain Stem ; Central Nervous System* ; Craniotomy ; Diagnosis ; Follow-Up Studies ; Frontal Lobe ; Humans ; Intracranial Pressure ; Magnetic Resonance Imaging ; Prognosis ; Recurrence ; Retrospective Studies ; Seoul ; Tuberculoma* ; Tuberculosis ; Tuberculosis, Pulmonary