Pulmonary blastoma is a family of tumors in which the glands or mesenchyme composing the neoplasm are primitive or embryonic in appearance. There are three subtypes, which include well differentiated fetal adenocarcinoma (pulmonary endodermal tumor), biphasic pulmonary blastoma, and cystic and pleuropulmonary blastomas in children. Among them, biphasic pulmonary blastoma is a primary malignancy of the lung originating from multipotential pulmonary blastema including both the malignant fetal epithelial and mesenchymal components. These make up 0.25 to 0.5 percent of all primary malignant lung tumors. This tumor is usually symptomatic and appears as a large, solitary peripheral mass, with a tendency to favor the upper lobe. Here we report a case where small sized asymptomatic peripheral lung mass was diagnosed as a biphasic pulmonary blastoma, prior to the operation, A subsequent percutaneous needle biopsy was performed, which revealed features of a large cell neuroendocirne tumor. In addition, a review of the relevant literature is provided.
Adenocarcinoma ; Biopsy, Needle ; Child ; Endoderm ; Humans ; Lung ; Mesoderm ; Pulmonary Blastoma*

Primary lymphoma of bone, first described by Parker and Jackson in 1939, is derived from bone marrow reticuloendothelial systems. It is uncommon neoplasm representing only 5% of all extranodal non-Hodgkin's lymphoma. Primary bone non-Hodgkin's lymphoma is characterized by initial symptoms of bone pain with associated single or multiple radiological bone lesions, with or without local soft tissue swelling, pathologic fractures,or regional/distant metastasis. Isolated bone marrow non-Hodgkin's lymphoma is rare, and determining the diagnosis difficult. The common features are fever, abnormal liver function, pancytopenia, polyserositis, neurologic symptoms, opportunistic infections, and a short, fatal course. Treatment includes surgery, radiotherapy, and chemotherapy depending on multiple factors, including histopathologic type of tumor, stage of disease, location of the lesion, and extent of osseous involvement. Five year survival rate is above 80%, when treated by combined radiation & chemotherapy. We experienced a patient who admitted to our department of Internal Medicine. She had mutiple bone pain, general weakness and diagnosed as primary lymphoma of the bone with severe pancytopenia. Her presentation, treatment, and clinical progress were discussed.
Bone Marrow ; Diagnosis ; Drug Therapy ; Fever ; Humans ; Internal Medicine ; Liver ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Mononuclear Phagocyte System ; Neoplasm Metastasis ; Neurologic Manifestations ; Opportunistic Infections ; Pancytopenia* ; Radiotherapy ; Survival Rate

BACKGROUND: The cyclin D1 gene is one of the most frequently amplified chromosomal regions(11ql3) in human carcinomas. In laryngeal and head and neck carcinomas, its overexpression has been shown to be associated with advanced local invasion and presence of lymph node metastases. Cyclin D1 may therefore play a key role in cell growth regulation and tumorigenesis. Lung cancer is a worldwide problem and in many contries it is the most lethal malignancy. As relapse is frequent after resection of early stage non-small cell lung cancer, there is an urgent need to define prognostic factors. PURPOSE: This study was undertaken to evaluate the prognostic value of the cyclin D1, that is one the G1 cyclins which control cell cycle progression by allowing G1 to S phase transition, on the patients in radically resected non-small cell lung cancer. METHOD: Total Si cases of formalin-fixed paraffin-embedded blocks from resected primary non-small cell 11mg cancer from January 1., 1983 to July 31, 1995 at Hanyang University Hospital were available for both clinical follow-up and immunohistochemical staining using monoclonal antibodies for cyclin D1. RESULTS: The histologic classification of the tumor was based on WHO criteria, and the specimens included 45 squamous cell carcinomas, 25 adenocarcinomas and 11 large cell carcinomas. Cyclin D1 overexpression was noted in 26 cases of 81 cases tested (30.9%). Cyclin D1 expression was not significantly associated with cell types of the tumor, pathological staging and the size of the tumor. But cyclin D1 overexpression was significantly correlated with positive lymph node metastasis(p=0.035). The mean survival duration was 22.76+/-3.50 months in cyclin D1 positive group and 45.38 +/- 5.64 months in cyclin D1 negative group. There was a nearly significant difference in overall survival Between cyclin D1 positive and negative groups(p=0.0515) in radically resected non-small cell lung cancer. CONCLUISON: Based on this study, cyclin D1 overexpressiom appears at important poor prognostic indicator in non-small cell lung cancer and may have diagnostic and prognostic importance in the treatment of resectable non-small cell lung cancer.
Adenocarcinoma ; Antibodies, Monoclonal ; Carcinogenesis ; Carcinoma, Large Cell ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Cell Cycle ; Classification ; Cyclin D1* ; Cyclins* ; Follow-Up Studies ; Genes, bcl-1 ; Head ; Humans ; Lung Neoplasms ; Lymph Nodes ; Neck ; Neoplasm Metastasis ; Recurrence ; S Phase

Anomalous right coronary artery arising from the left sinus of Valsalva is rare, but not protected from ather-osclerotic disease. Major factor determining successful angioplasty is the selection of the appropriate guiding catheter to provide optimal coaxial backup support. We report the first case of successful transradial stenting of an anomalous right coronary artery originating from the left sinus of Valsalva.
Angioplasty ; Catheters ; Coronary Vessels* ; Sinus of Valsalva* ; Stents*

BACKGROUND: A new technique resecting the hepatic parenchyma without inflow occlusion using a Cavitron Ultrasonic Surgical Aspirator (CUSA(R) ) reduces intraoperative blood loss and perioperative morbidity. This study was designed to identify the incidence and severity of venous air embolism (VAE) using transesophaseal echocardiography (TEE) in hepatic resection using CUSA(R) . METHODS: Forty patients undergoing hepatic resection using CUSA(R) of ASA class 1 and 2 were selected. After insertion of an epidural catheter for postoperative analgesia, all patients were anesthetized with sevoflurane in 50% air/O2. After the induction of anesthesia, A TEE probe was inserted into the esophagus. Blood pressure, heart rate, central venous pressure, end tidal CO2, and arterial carbon dioxide tension were recorded after induction, and during and after hepatic resection. During hepatic resection, an anesthesiologist evaluated the degree of VAE by transesophageal echocardiography in the 4-chamber view. RESULTS: The mean time of using CUSA(R) was 65.3 +/- 24.4 minutes. Of 40 patients, 9 had VAE grade I, 14 grade II, 14 grade III, and 3 grade IV. However, no significant difference was observed in hemodynamics or PaCO2 after induction, or during or after hepatic resection. The mean amount of blood loss was 887.0 ml +/- 598.8 ml and the mean transfused amount was 123.1 +/- 351.3 ml. CONCLUSIONS: All patients showed air embolism during hepatic resection with CUSA(R) . Serious complications associated with air embolism would occur in patients with an undiagnosed intracardiac right to left shunt. Therefore, meticulous monitoring by transesophageal echocardiography might be recommended in hepatic resection with CUSA(R) .
Analgesia ; Anesthesia ; Blood Pressure ; Carbon Dioxide ; Catheters ; Central Venous Pressure ; Echocardiography* ; Echocardiography, Transesophageal ; Embolism, Air* ; Esophagus ; Heart Rate ; Hemodynamics ; Humans ; Incidence* ; Ultrasonics*

Osteomyelitis of the symphysis pubis is rare and it has signs and symptoms similar to those of osteitis pubis: distal anterior thigh pain, spasm of the adductor and rectus abdominis muscle and waddling gait. Unlike ostetitis pubis, the clinical course of osteomyelitis is progressive, with increasing bone destruction and widening of the symphysis on plain radiographs, and is curable by surgical treatment. We report a case of osteomyelitis of the symphysis pubis diagnosed by MRI and treated by debridement and curettage with appropriate antibiotics.
Anti-Bacterial Agents ; Curettage ; Debridement ; Gait ; Magnetic Resonance Imaging ; Osteitis ; Osteomyelitis* ; Rectus Abdominis ; Spasm ; Thigh

PURPOSE: This study was to observe whether the apoptotic function of tumor-infiltrating lymphocytes (TIL) is induced in human gastric epithelial dysplasia and gastric adenocarcinoma according to the role of FasL expression. MATENRIALS AND METHODS: A total of 56 gastric epithelial dysplasia and gastric adenocarcinoma patients were enrolled in this study: 9 cases of gastric epithelial dysplasia, 18 cases of early gastric carcinomas (EGC) and 29 cases of advanced gastric carcinomas (AGC). Immunohistochemical staining was performed for FasL and CD45, and the terminal deoxynucleotidyl transferase mediated dUTP nick end labelling (TUNEL) method was used to detect cell death in tumor-infiltrating lymphocytes. RESULTS: 1) Positive reactions of FasL to neoplastic cells were 88.9% (8/9) in gastric epithelial dysplasia, 83.3% (15/18) in EGC, and 75.9% (22/29) in AGC. 2) Expression of TIL was decreased in the FasL positive region and was increased in the FasL negative region, and significant expression of TIL was observed in the AGC group (P=0.001). 3) Expression of apoptotic TIL was very similar to the FasL expression, and 100% expression was observed in gastric epithelial dysplasia group. 4) Expression of apoptotic TIL was increased in the FasL positive region and decreased in the FasL negative region, and significant apoptotic expression was observed in the gastric epithelial dysplasia and EGC groups (P=0.0420, P=0.0263, respectively). CONCLUSION: These results suggest that FasL is a prevalent mediator of immune privilege in epithelial dysplasia and cancer of the stomach.
Adenocarcinoma* ; Apoptosis* ; Cell Death ; DNA Nucleotidylexotransferase ; Humans ; Lymphocytes, Tumor-Infiltrating ; Stomach Neoplasms

BACKGROUND/AIMS: Resection of the esophagus for malignant disease or a benign stenosis, has a choice not only of palliative surgery, but also of replacement of the esophagus with a transposed stomach, jejunum, or colon. The first-line method is replacement with a tubulized stomach. The purpose of this study was to investigate the association of esophageal motor dysfunction and gastric emptying time with symptoms after esophagectomy. METHODS: We performed the esophageal manometry and gastric emptying time after esophagectomy for esophageal cancer in 12 patients and for benign esophageal disease in 2 patients. RESULTS: In manometric studies, a zone of high pressure in the esophago-gastric anastomosis distal to the upper esophageal sphincter was associated with symptoms after esophagectomy. The gastric emptying rate was slowed in 7 out of 14 patients, but not associated with symptoms after esophagectomy. CONCLUSIONS: Our data suggest that a high-pressure zone distal to the upper esophageal sphincter was associated with symptoms after esophagectomy in manometric study. The gastric emptying rate was not associated with postoperative symptoms.
Colon ; Constriction, Pathologic ; Esophageal Diseases ; Esophageal Neoplasms ; Esophageal Sphincter, Upper ; Esophagectomy* ; Esophagus ; Gastric Emptying* ; Humans ; Jejunum ; Manometry* ; Palliative Care ; Stomach

Behcet? disease is a recurring illness characterized by the triple symptom complex of aphthous stomatitis, genital ulceration, and uveitis. The disease is multisystemic disorder with involvement of skin, gastrointestinal tract, blood vessels, central nervous system, joints, and epididymis. Vascular involvement of Behcet? disease affects both arteries and veins and blood vessels of all sizes. Periosteal new bone formation is one feature of hypertrophic osteoarthropathy. Other features are clubbing and arthritis. Periosteal new bone formation on the bones of the lower extremities without other features of hypertrophic osteoarthropathy has been reported in patients with varicose veins, vitamin A intoxication, infantile cortical hyperostosis, tuberous sclerosis, congenital syphilis and chronic renal failure with hyperparathyroidism, and chronic venous insufficiency. However, periosteal new bone formation has not, to our knowledge, been described in patients with Behcet? disease yet although similar findings are occasionally noted in polyarteritis nodosa. We report a case of Behcet? disease complicated by leg swelling with periosteal new bone formation of right lower leg.
Arteries ; Arthritis ; Behcet Syndrome ; Blood Vessels ; Central Nervous System ; Epididymis ; Gastrointestinal Tract ; Humans ; Hyperostosis, Cortical, Congenital ; Hyperparathyroidism ; Joints ; Kidney Failure, Chronic ; Leg ; Lower Extremity ; Male ; Osteogenesis* ; Polyarteritis Nodosa ; Skin ; Stomatitis, Aphthous ; Syphilis, Congenital ; Tuberous Sclerosis ; Ulcer ; Uveitis ; Varicose Veins ; Veins ; Venous Insufficiency ; Vitamin A

PURPOSE: The H. pylori cagA gene, vacA gene and iceA gene are considered to be important virurence factors that have been implicated in the development of gastric adenocarcinoma. It was reported that the presence of IS605 elements may be responsible for rearrangements and lead to partial or total deletions of the cag pathogenicity island (PAI) and the virulence of cag PAI may be changed. However, different results regarding the association between these virulence factors and clinical disease have been reported from different geographic regions. This study evaluated the relationship between H. pylori virulence factors such as cagA, vacA, iceA, IS605 and gastric adenocarcinoma. MATERIALS AND METHODS: H. pylori isolates were obtained from 54 infected patients (24 cases of gastric adenocarcinoma, 30 cases of control). H. pylori isolates were identified by PCR with ureC gene and 16S rRNA. PCR was performed to examine cagA, vacA, iceA and IS605 genotypes. RESULTS: Significant difference was found in the negative rates of cagA between gastric adenocarcinoma group and control (62.5% vs. 33.3% P=0.033). No significant difference was found in the prevalence of iceA, vacA between gastric adenocar cinoma and control. The genotype of cagA+ vacA s1-m1 iceA1 was predominant in H. pylori isolates irrespective of the clinical outcome. IS605 in PAI was not found in gastric adenocarcinoma gruop and control. The positive rates of IS605 in genome were 33.3% in gastric adenocarcinoma group and 36.7% in control (P>0.05). In gastric carcinoma, the positive rate of cagA+/IS605- was lower than in control (12.5% vs. 40.0%, P=0.025) and the positive rate of cagA-/IS605- was higher than in control (54.2% vs. 23.3%, P=0.02). CONCLUSION: H. pylori virulence factors had not related significantly with gastric adenocarcinoma. Further study is needed to examine the specificity of H. pylori strains.
Adenocarcinoma* ; Genome ; Genomic Islands ; Genotype ; Helicobacter pylori* ; Helicobacter* ; Humans ; Polymerase Chain Reaction ; Prevalence ; Sensitivity and Specificity ; Virulence Factors ; Virulence*