No abstract available.
Biopsy, Fine-Needle* ; Sarcoma, Synovial*

Turner's syndrome results from complete or partial monosomy of the X chromosome and is characterized by hypogonadism or related other congenital anomalies in phenotypic females. In these patients, there are failure to develop normal secondary sex characteristics, amenorrhea, or short stature at puberty and the ovaries are reduced to atrophic fibrous strands devoid of ova and follicles(streak gonads). Individuals with this condition are particularly prone to the development of gonadoblastoma. For this reason, the gonads should be early removed and supplemental estrogen therapy given. We experienced a case of Turner's syndrome, 45, XO/46, XY karyotype in a 20-year-old phenotypic female complained an amenorrhea. On the exploratory laparotomy, the right gonadal mass is sevearly adhered to the adjacent organs and measures 8 x 5 x 5 cm in dimension and 75gm in weight and shows multiple foci of hemorrhage with necrosis. The left streak gonad measures 3.5 x 2 x 1.5 cm in dimension and shows multiple foci of calcification. Microscopically, the right gonadal mass reveals malignant mixed germ cell tumor, composed of endodermal sinus tumor, composed of endodermal sinus tumor with dysgerminoma and gonadoblastoma. The left streak gonad consists of mainly dense fibrous connective tissue and shows some foci of calcification associated with gonadoblastoma. On immunohistochemical and special stainings, the cytoplasm and hyalin droplets of the endodermal sinus tumor component reveal strong positivity to the a-fetoprotein and PAS. After removal of both gonads, the serum level of the a-fetoprotein is markedly down from 1742ng/ml to 2.6 ng/ml.
Female ; Humans

Metabolic acidosis (MA) is associated with increased proteolysis, increased osteoclast activity and blunted cardiac muscle response, but the effect of MA on various clinic al parameters in CAPD patients is not well known. To evaluate the effects of MA on serum albumin level and other nutritional parameters in CAPD patients, we studied 106 CAPD patients retrospectively who have had monthly biochemical measurement and urea kinetic studies every 6 months for more than 2 years. The patients were divided into three groups according to their mean total CO2 (tCO2) level of the 2-year follow-up (Group l; mean tCO2 < 22mM/L, Group ll; 22mM/L < or = mean tCO2 < 26mM/L, and Group lll; mean tCO2 > or = 26mM/L), and the clinical, biochemical, and urea kinetic data were compared among the three groups. 1)The mean age of the subjects was 46.9+/-12.2 years with a sex ratio of 1.2:1, the mean CAPD duration 28.3+/-21.8 months, mean body weight (Bwt) 59.0+/-8.9kg, %Bwt/IBW 104.1+/-11.5%, %LBM/Bwt 75.5+/-11.1% and well-nourished patients by subjective global assessment (SGA) were 65%. 2)The mean BUN, creatinine, total protein and albumin of all patients were 55.6+/-13.6mg/dL, 12.3+/-3.5mg/dL, 6.6+/-0.7g/dL and 4.0+/-0.4g/dL, respectively. In urea kinetic study, the mean NPCR, weekly Kt/ Vurea, SCCr and RRF were 0.96+/-0.16g/kg/day, 2.02+/-0.37, 63.7+/-18.4L/week/1.73m2, and 0.99+/-1.32ml/ min, respectively. 3)The mean age was significantly higher in group l (51.0+/-10.8) than those of group ll (47.0+/-12.4) and lll (42.6+/-11.4) (P<0.05). %Bwt/IBW of group l (114.4+/-15.8%) was also significantly higher than those of group ll (104.6+/-12.6%) and lll (103.5+/-13.7 %) (P<0.05), but there were no significant differences in sex ratio, CAPD duration, %LBM/Bwt, and SGA among the three groups. 4)The mean tCO2 in group l, group ll, and group lll were 20.6+/-1.2mM/L, 23.9+/-1.1mM/L, and 27.3+/-0.8mM/L, respectively. Compared to group lll, group l had significantly higher BUN (61.1+/-14.3 vs. 46.1+/-7.2mg/dL, P<0.05) and serum albumin (4.04+/-0.31 vs. 3.75+/-0.39g/dL, P<0.05), in spite of comparable dialysis dose and albumin loss into dialysate. 5)NPCR (1.02+/-0.21g/kg/day vs. 0.88+/-0.14g/kg/ day, P<0.05) and ultrafiltration volume (1.4+/-0.4 vs. 1.0+/-0.3, P<0.05) were significantly higher in group l than those of group lll. But there were no significant differences in Kt/Vurea, SCCr, RRF, and 24-hour dialysate loss of protein/albumin among the three groups. 6)No differences were observed among the three groups in the changes of body weight, %Bwt/IBW, %LBM/Bwt, BUN, albumin, NPCR, and RRF from the baseline values after the 2-year follow-up. 7)There were significant inverse correlations between the mean tCO2 level and NPCR (r=-0.33, P<0.001), %Bwt/IBW (r=-0.32, P<0.001), RRF (r=-0.29, P<0.005), and serum albumin level (r=-0.24, P<0.05). But, creatinine, %LBM/Bwt, and Kt/Vurea did not show any correlation with the mean tCO2 level. 8)Using stepwise multiple regression analysis, NPCR (beta=-0.3491, P<0.001), %Bwt/IBW (beta=-0.046, P<0.001), and ultrafiltration volume (beta=-0.0012, P< 0.005) were independent factors affecting the mean tCO2 level. In conclusion, low total CO2 level in long-term CAPD patients may reflect increased protein intake and mild to moderate degree of metabolic acidosis may not affect the nutritional status of well-dialyzed CAPD patients.
Acidosis* ; Body Weight ; Creatinine ; Dialysis ; Follow-Up Studies ; Humans ; Myocardium ; Nutritional Status ; Osteoclasts ; Peritoneal Dialysis, Continuous Ambulatory* ; Proteolysis ; Retrospective Studies ; Serum Albumin* ; Sex Ratio ; Ultrafiltration ; Urea

No abstract available.
Humans ; Hypertension* ; Perindopril*

Hypercalcemia is a common complication in CAPD patients treated with calcium-containing phosphate binders and using the standard dialysate (SCD) calcium concentration of 3.5mEq/L. We performed a retrospective study in 25 CAPD patients to determine whether a low calcium dialysate (LCD) containing 2.5mEq/L calcium would reduce the incidence of hypercalemia with adequate control of serum inorganic phosphate levels and diminish the need to use aluminum-containing phosphate binders. All patients had previously used SCD before converting to LCD. The incidence of hypercalcemia (more than 2 episodes of corrected serum calcium > or = 10.5mg/dL) tended to be lower after converting to LCDl 0.27 (0-2.76) vs. 0 (0-1.97) episodes/patient-yearl. Intact PTH level increased from 38.8 (0.1-1599.3)pg/mL to 70.6 (9.5-1540.0)pg/mL after conversion, but there was no statistical sifnificance. Serum calcium, inorganic phosphate, alkaline phosphatase and bicarbonate levels did not change after converting to LCD. We were able to reduce aluminum hydroxide dosagel 1.09 (0-10.88) vs. 0 (0-3.26)g/day/patientl and increase calcium carbonate dosage (1.95 0.92 vs. 2.98 2.14g/day/ patient) after conversion significantly (P<0.05). The frequency of peritonitis was similar in LCD and SCD period. In conclusion, low calcium dialysate is useful in diminishing aluminum-containing phosphate binder dosage and increasing calcium carbonate dosage to maintain a similar phosphate value. Its effects on renal osteodystrophy remain to be assessed.
Alkaline Phosphatase ; Aluminum Hydroxide ; Calcium Carbonate ; Calcium* ; Humans ; Hypercalcemia ; Incidence ; Kidney Failure, Chronic ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Renal Osteodystrophy ; Retrospective Studies

Menetrier's disease is a rare, characterized by the presence of large rugal folds involving part or all of the stomach. Patients with hypertrophic gastropathy often have distressing abdominal symptoms, weight loss, and edema due to gastric protem loss. A 64 year old male patient was admitted with the chief complaint of epigastric discomfort. Endoscopic, radiologic and histologic examination, revealed characteristic findings of Menetrier's disease. A case of Menetrier's disease is reported with a brief review of literature.
Edema ; Gastritis, Hypertrophic* ; Humans ; Male ; Middle Aged ; Stomach ; Weight Loss

PURPOSE: We investigated the effectiveness and safety of DA-3030 for prophylatic use in patients receiving chemotherapy for malignant disease. MATERIALS AND METHODS: Seventy cancer patients were randomized to receive chemotherapy alone (36 patients) or with DA-3030 administered (34 patients) after stratified block randomization according to chemotherapeutic regimen. DA-3030 was subcutaneously administered at the dose of 100 pg/m/day for 10 days from 24 hours after the completion of chemotherapy. RESULTS: Of the 70 enrolled patients, 62 patients were evaluable. The neutropenia (absolute neutrophil count [ANC] <1,000/mm) occurred in 9 of 32 (28.1%) of the DA-3030 group and 21 of 30 (90.0%) of the control group, giving relative risk for control group of 0.154 (95% confidence interval [CI], 0.05 to 0.45; p-0.0001). Severe neutropenia (ANC 500/mm') occurred in 4 of 32 (12.5%) of the DA-3030 group and in 20 of 30 (66.7%) of the control group (relative risk for control group of 0.316 [95% CI, 0,18 to 0.55]; p=0.0001). The mean duration of neutropenic period (+/-standard error) was 1.13+/-0.34 days in the DA-3030 group and 6.73+/-0.69 days in the control group respectively, and was significantly shorter in the DA-3030 group (p<0.0001). And, there was higher nadir ANC in the OA-3030 group than that in the control group (p=0.0001); the mean nadir ANC was 2,547+/- 343/mm and 442+/-120/mm, respectively. The DA-3030 group had significantly higher incidence of myalgia in comparison to the control group (43.8% compared with 3.3%; p=0.001). However, it was tolerable and was easily managed by conservative therapy CONCLUSION: The use of DA-3030 was effective in preventing chemotherapy-induced neutropenia.
Drug Therapy* ; Humans ; Incidence ; Myalgia ; Neutropenia* ; Neutrophils ; Random Allocation

No abstract available.
Glomerulonephritis* ; Humans ; Proteinuria*

In order to investigate the anti-proliferative effect of 3-hydroxy-3-methylglutaryl coenzyme. A reductase inhibitor, we evaluated the effects of lovastatin on DNA replication and the proliferation of rat mesangial and aortic smooth muscle cells, both of which were mesenchymal origin cells. Proliferations were determined by measuring [3H]thymidine uptake, and counting the number of cells. Growth-arrested mesangial and aortic smooth muscle cells were exposed to platelet-derived growth factor (PDGF), endothelin (ET) and angiotensin II (Ang II) to stimulate mitogenesis. All agents exhibited dose-dependent stimulation of [3H] thymidine uptake. PDGF was more potent than the others. Ang II increased [3H] thymidine uptake without demonstrable mitogenic activity. Lovastatin inhibited PDGF (10 ng/ml in mesangial cell, 25 ng/ml in smooth muscle cell)-, ET (10(-7)M)- and Ang II (10(-7)M)-induced [3H] thymidine uptake significantly in a dose-dependent manner in both cells. The increase of cell number in response to PDGF and ET treatment were also inhibited at 10 microM of lovastatin. The inhibitory effect of lovastatin was largely overcome in the presence of exogenous mevalonate at 200 microM, with 75.5% restoration from lovastatin-induced inhibition on PDGF-induced [3H] thymidine uptake in mesangial cells (77.8% in aortic smooth muscle cells). However, the addition of cholesterol did not prevent inhibition by lovastatin. In conclusion, lovastatin had an inhibitory effect on mesangial and aortic smooth muscle cell proliferation, and mevalonate was essential for DNA replication in both types of cells. Lovastatin may reduce glomerular and atherosclerotic injury through an anti-proliferative effect on mesangial and vascular smooth muscle cells, in addition to lowering circulating lipids.
Angiotensin II/pharmacology ; Animal ; Aorta/cytology/drug effects ; Cell Division/drug effects ; Cells, Cultured ; Endothelins/pharmacology ; Glomerular Mesangium/cytology/*drug effects ; Lovastatin/*pharmacology ; Male ; Muscle, Smooth, Vascular/cytology/*drug effects ; Platelet-Derived Growth Factor/pharmacology ; Rats ; Rats, Sprague-Dawley ; Support, Non-U.S. Gov't ; Thymidine/metabolism

We experienced five cases of solitary fibrous tumor; two in the pleura, two in the orbital soft tissue, and one in the lung parenchyma. Three patients were male, and the age of the patients ranged from 38 to 71 years (mean age: 53.6). Grossly, the masses were well circumscribed and had varying sizes from 2.5 to 30.0 cm. The cut surfaces were grayish-yellow firm with focal variegated hemorrhage, necrosis, cystic change, and myxoid area. Microscopically, these were characterized by a haphazard proliferation of spindle cells or polygonal cells separated by variable amounts of hyalinized collagen and showed a prominent vascular channels reminiscent of hemangiopericytoma in foci. Immunoperoxidase stains showed a strong reactivity for CD34, and were weakly positive for vimentin. Electron microscopical examination revealed features of fibroblast; spindle to round tumor cells were arranged in groups and surrounded by collagen. Nucleoli were seldom prominent. The cytoplasm contained many microfilaments and a moderate number of cisternae of rough endoplasmic reticulum.
Actin Cytoskeleton ; Collagen ; Coloring Agents ; Cytoplasm ; Endoplasmic Reticulum, Rough ; Fibroblasts ; Hemangiopericytoma ; Hemorrhage ; Humans ; Hyalin ; Lung ; Male ; Necrosis ; Orbit ; Pleura ; Solitary Fibrous Tumors* ; Vimentin