BACKGROUND: Cerebrospinal fluid (CSF) examination can be used to verify the presence of primary malignancies as well as cases of central nervous system (CNS) metastasis. Because of its importance, there have been several studies concerning the sensitivity of CSF cytology. To determine the practical use and reproducibility of diagnoses based on CSF cytology, we evaluated this test by analyzing cytology results from consecutive CSF samples. METHODS: Between July 2010 and June 2013, 385 CSF cytology samples from 42 patients were collected. The samples were gathered using a ventricular catheter and reservoir. CSF cytology of all patients was examined more than two times with immunocytochemistry for cytokeratin. RESULTS: Primary neoplastic sites and histologic types of patients' metastatic cancer were diverse. The overall sensitivity for detecting malignancy was 41.3%. Even within short-term intervals, diagnoses frequently changed. CONCLUSIONS: Our results were inconsistent, with low sensitivity, when compared to the results of previous studies. However, CSF evaluation can still provide valuable diagnostic and prognostic information because adjuvant treatments are now routinely performed in patients with CNS metastasis. Negative CSF cytology results should not be ignored, and continuous CSF follow-up is essential for following the clinical course of patients with metastatic cancer involving the CNS.
Catheters ; Central Nervous System ; Cerebrospinal Fluid* ; Diagnosis ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Keratins ; Neoplasm Metastasis

Lingual metastasis is defined as the metastasis of malignant tumors to the tongue from another primary organ cancer. Primary lung cancer which had metastasized to the tongue was reported in 0.2–1.6% of these cases. The base of the tongue is the most frequent site of lingual metastasis due to its rich vascular supply and relative lack of mobility compared with other areas of the tongue. The aim of this article is to report a benign appearing lingual metastasis to the tip of the tongue as the first sign of metastasis from squamous cell carcinoma of the lung. Clinical presentation of lingual metastasis resembled a hyperplastic or reactive lesion, such as a pyogenic granuloma or submucosal mass. In cases where there was a single metastatic focus, a surgical excision was recommended as a palliative measure for pain control, the prevention of infection or bleeding, and the maintenance of an acceptable oral function.
Carcinoma, Squamous Cell ; Granuloma, Pyogenic ; Hemorrhage ; Lung Neoplasms* ; Lung* ; Neoplasm Metastasis* ; Tongue*

Objective: This study examined the carry-over contamination of Salmonella species through the entire slaughtering process in South Korea. Methods: From 2018 to 2019, 1,097 samples were collected from the nine slaughterhouses distributed nationwide. One hundred and seventeen isolates of Salmonella species were identified using the invA gene-specific polymerase chain reaction, as described previously. The serotype, phylogeny, and antimicrobial resistance of isolates were examined. Results: Among the 117 isolates, 93 were serotyped into Salmonella Mbandaka (n = 36 isolates, 30.8%), Salmonella Thompson (n = 33, 28.2%), and Salmonella Infantis (n = 24, 20.5%). Interestingly, allelic profiling showed that all S. Mbandaka isolates belonged to the lineage of the sequence type (ST) 413, whereas all S. Thompson isolates were ST292. Moreover, almost all S. Thompson isolates (97.0%, 32/33 isolates) belonging to ST292 were multidrug-resistant and possessed the major virulence genes whose products are required for full virulence. Both serotypes were distributed widely throughout the slaughtering process. Pulsed-field gel electrophoretic analysis demonstrated that seven S. Infantis showed 100% identities in their phylogenetic relatedness, indicating that they were sequentially transmitted along the slaughtering processes. Conclusions and Relevance: This study provides more evidence of the carry-over transmission of Salmonella species during the slaughtering processes. ST292 S. Thompson is a potential pathogenic clone of Salmonella species possibly associated with foodborne outbreaks in South Korea.

OBJECTIVE: To describe computed tomography (CT) features of metastatic gallbladder (GB) tumors (MGTs) from various primary tumors and to determine whether there are differential imaging features of MGTs according to different primary tumors. MATERIALS AND METHODS: Twenty-one patients who had pathologically confirmed MGTs and underwent CT were retrospectively enrolled. Clinical findings including presenting symptoms, type of surgery, and interval between primary and metastatic tumors were recorded. Histologic features of primary tumor and MGTs including depth of invasion were also reviewed. Imaging findings were analyzed for the location and morphology of MGTs, pattern and degree of enhancement, depth of invasion, presence of intact overlying mucosa, and concordance between imaging features of primary and metastatic tumors. Significant differences between the histologies of MGTs and imaging features were determined. RESULTS: The most common primary tumor metastasized to the GB was gastric cancer (n = 8), followed by renal cell carcinoma (n = 4) and hepatocellular carcinoma (n = 3). All MGTs (n = 21) manifested as infiltrative wall thickenings (n = 15) or as polypoid lesions (n = 6) on CT, similar to the features of primary GB cancers. There were significant differences in the morphology of MGTs, enhancement pattern, enhancement degree, and depth of invasion according to the histology of primary tumors (p < 0.05). Metastatic adenocarcinomas of the GB manifested as infiltrative and persistently enhancing wall thickenings, while non-adenocarcinomatous metastases usually manifested as polypoid lesions with early wash-in and wash-out. CONCLUSION: Although CT findings of MGTs are similar to those of primary GB cancer, they are significantly different between the various histologies of primary tumors.
Adenocarcinoma/pathology/radiography/secondary ; Adult ; Aged ; Carcinoma, Hepatocellular/pathology/radiography/secondary ; Carcinoma, Renal Cell/pathology/radiography/secondary ; Carcinoma, Squamous Cell/pathology/radiography/secondary ; Diagnosis, Differential ; Female ; Gallbladder Neoplasms/pathology/*radiography/*secondary ; Humans ; Kidney Neoplasms/pathology ; Liver Neoplasms/pathology ; Male ; Melanoma/pathology/radiography/secondary ; Middle Aged ; Neoplasm Invasiveness/radiography ; Retrospective Studies ; Stomach Neoplasms/pathology ; *Tomography, X-Ray Computed

Hemophagocytic lymphohistiocytosis (HLH) is a rare but fatal complication after solid organ transplantation. Acquired forms of HLH are described in association with severe sepsis, autoimmune disorders, malignancy, immune-compromised states, infections, and solid organ transplantation. We experienced a case of hemophagocytic lymphohistiocytosis after bilateral lung transplantation. Leukopenia, thrombocytopenia, and hyperbilirubinemia were noted and became aggravated 50 days after transplantation. Diagnosis of HLH was based on clinical and laboratory findings of splenomegaly, cytopenia, elevated ferritin, elevated interleukin-2 receptor, and hemophagocytosis in bone marrow. Other features such as elevated bilirubin, lactate dehydrogenase, and D-dimer which can be present in HLH were also noted. The patient was immediately treated with etoposide and dexamethasone. Despite aggressive therapy, the patient deteriorated and died. Awareness of the diagnostic criteria of HLH after lung transplantation is important for clinicians.
Bilirubin ; Bone Marrow ; Dexamethasone ; Diagnosis ; Etoposide ; Ferritins ; Humans ; Hyperbilirubinemia ; Interleukin-2 ; L-Lactate Dehydrogenase ; Leukopenia ; Lung Transplantation* ; Lymphohistiocytosis, Hemophagocytic* ; Organ Transplantation ; Sepsis ; Splenomegaly ; Thrombocytopenia ; Transplants

Mauriac's syndrome was described in the 1920s, as a triad of poorly controlled insulin dependent diabetes mellitus, profound growth retardation, and hepatomgaly. Following the wide availability of insulin and intensification of diabetic control, this entity has become quite rare. A 9-year-old female child was transferred to pediatric OPD of SNUCH because of hyperglycemia, short stature, and visual disturbance. Five years prior to admission, she was diagnosed as diabetes mellitus at hospital due to polyuria, enuresis and polydipsia. However, she had been managed with irregular insulin injection and 1u of NPH once a day because of poor economic state and poor diabetic education. Two years ago, her mother noticed she had grown little and she had complainted poor vision. Since 1 year prior to admission, abdominal pain, vomiting, and diarrhea were developed twice, but subsided spontaneously without specific medication. On physical examination at admission, her height was 102 cm(< 3 percentile) and her weight was 16 kg(3-10 percentile). She was short and obese. The liver was 3FB palpable below the right subcostal margin. Limitation of motion of MP and PIP joints of left middle finger and right fourth finger were observed. On ophthalmologic examination, the cataracts were observed on both eyes and diabetic retinopathy was absent. Diabetic nephropathy was confirmed by kidney biopsy due to proteinuria. The bone age was delayed as 6-year. She was consistent with Mauriac's syndrome. During admission, she and her mother recieved diabetic education, and she was managed by strict diabetic control with human insulin. 4 months after, at discharge, her growth accelerations of height and weight were observed. Limited joint mobility and cataract were improved. Proteinuria disappeared after persantin and captopril medications.
Abdominal Pain ; Acceleration ; Biopsy ; Captopril ; Cataract ; Child ; Diabetes Mellitus ; Diabetic Nephropathies ; Diabetic Retinopathy ; Diarrhea ; Dipyridamole ; Education ; Enuresis ; Female ; Fingers ; Humans ; Hyperglycemia ; Insulin ; Joints ; Kidney ; Liver ; Mothers ; Physical Examination ; Polydipsia ; Polyuria ; Proteinuria ; Vomiting

Mixtures of local anesthetics can combine the hest features of both components. The authors assayed the cardiac toxicity of local anesthetic mixtures given intravenously to rabbits. Arrhythmia was appeared at 200-150 beats/min. of pulse rate and tendency of arrhythmia in bupivacaine was increased about 16-17 times more than that of lidocaine. Mean arterial blood pressure before the study was about 92 mmHg, but it was down to about 53-74 mmHg after arrhythmia appeared. Lethal doae of bupivacaine was one-seventh that of lidocaine during infusion. None of the mixtures were more lethal than their parent components; bupivacaine containing mixtures were significantly less lethal than the bupivacaine alone. The toxicity of local anesthetic mixtures was essentially additive not synergistic.
Anesthetics, Local ; Arrhythmias, Cardiac ; Arterial Pressure ; Bupivacaine* ; Heart Rate ; Humans ; Lidocaine* ; Parents ; Rabbits*

Mixtures of local anesthetics can combine the hest features of both components. The authors assayed the cardiac toxicity of local anesthetic mixtures given intravenously to rabbits. Arrhythmia was appeared at 200-150 beats/min. of pulse rate and tendency of arrhythmia in bupivacaine was increased about 16-17 times more than that of lidocaine. Mean arterial blood pressure before the study was about 92 mmHg, but it was down to about 53-74 mmHg after arrhythmia appeared. Lethal doae of bupivacaine was one-seventh that of lidocaine during infusion. None of the mixtures were more lethal than their parent components; bupivacaine containing mixtures were significantly less lethal than the bupivacaine alone. The toxicity of local anesthetic mixtures was essentially additive not synergistic.
Anesthetics, Local ; Arrhythmias, Cardiac ; Arterial Pressure ; Bupivacaine* ; Heart Rate ; Humans ; Lidocaine* ; Parents ; Rabbits*

Post-transplant lymphoproliferative disorder (PTLD) is a spectrum of clinically and morphologically heterogeneous lymphoid proliferations of various clonal compositions that are observed after hematopoietic stem cell transplantation (HSCT) or solid organ transplantation. The majority of PTLD cases are associated with Epstein-Barr virus (EBV) infection, while overt peripheral blood (PB) or bone marrow (BM) involvement in PTLD is uncommon in early lesions. We report a 38-year-old woman with EBV-related PTLD, with BM and PB involvement, who presented with peripheral lymphocytosis as an early lesion 1 month after haploidentical HSCT for Philadelphia chromosome-positive acute lymphoblastic leukemia was performed during first complete remission. Although PB or BM involvement of PTLD after HSCT is uncommon in early lesions, peripheral lymphocytosis can be an initial presenting manifestation of PTLD, as in this case.
Adult ; Bone Marrow ; Epstein-Barr Virus Infections ; Female ; Hematopoietic Stem Cell Transplantation ; Herpesvirus 4, Human ; Humans ; Lymphocytes* ; Lymphocytosis ; Lymphoproliferative Disorders ; Organ Transplantation ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Transplantation ; Transplants

BACKGROUND: The alkaline single cell gel electrophoresis comet assay was applied to study the genotoxic properties of enflurane on the human peripheral blood lymphocytes (PBL) of cancer patients before and during anesthesia as compared to an non-cancer control group. Method: The cancer group consisted of 24 patients (aged 15-77 years), while the control group consisted of 14 trauma individuals (aged 20-81 years). After anesthesia induction (thiopental 4 mg/kg and vecuronium 0.1 mg/kg), it was maintained by enflurane inhalation; 1-2 minimal alveolar concentration in oxygen - nitrous oxide mixture. Venous blood samples were obtained before the induction of anesthesia, and after 60 and 120 min of anesthesia. The comet assay detects DNA damage, such as strand breaks and alkaline labile sites induced directly by genotoxic agents, and DNA degradation due to cell death. Fifty cells from each sample were examined and Olive tail moments (OTM) were calculated using Komet 4TM software. RESULTS: OTM values were no different between controls and patients before anesthesia. However, the OTMs of blood sampled from cancer patients at 60 (7.97 +/- 1.83) and 120 min (7.86 +/- 2.05), and from trauma patients at 120 min (8.04 +/- 1.32) of anesthesia were significantly increased. CONCLUSIONS: In immunocompromised cancer patients, we suggest the existence of a higher risk of an association DNA damage and enflurane exposure.
Anesthesia ; Cell Death ; Comet Assay ; DNA ; DNA Damage ; Electrophoresis* ; Enflurane* ; Humans* ; Inhalation ; Lymphocytes* ; Nitrous Oxide ; Olea ; Oxygen ; Vecuronium Bromide