We report two cases of ectopic epididymal ducts and efferent ductules in the testicular appendices (TAs) of adult men with normally descended testes. In both cases, a sessile TA was incidentally found at the upper pole of the right testis during the scrotal hydrocelectomy. Microscopically, a few closely arranged tubules were detected within the TA. In the first case, the tubules were lined with a pseudostratified columnar epithelium with numerous, long microvilli, and were surrounded by a smooth muscle coat. In contrast, in the second case, the tubules had a wavy luminal surface, because ciliated columnar cells alternated with groups of cuboidal cells. In both cases, strong CD10 immunoreactivity was observed in the luminal border of the lining epithelium. Surgical pathologists should be aware of the presence of both ectopic epididymal ducts and efferent ductules that can occur in TAs, in order to avoid misinterpretation as transected, functional reproductive structures.
Adult ; Choristoma ; Epididymis ; Epithelium ; Female ; Humans ; Male ; Microvilli ; Muscle, Smooth ; Parovarian Cyst ; Phenobarbital ; Testis ; Wolffian Ducts

Inflammatory myofibroblastic tumor (IMT) of the biliary tree is extremely rare and is generally a benign condition, though malignant change is possible. Making a differential diagnosis between this lesion and other malignant conditions is very difficult on preoperative imaging studies. Hence, the final diagnosis of IMT may be made during or after operation depending on the pathologic examination. We treated a 63-year-old woman who received right hepatectomy with caudate lobectomy under the suspicion of hilar cholangiocarcinoma. Frozen biopsy during the operation showed carcinoma in situ and there were stromal cells in the bile duct's resection margins. The postoperative hospital course was uneventful except for minor bile leakage. At postoperative month 4, she developed jaundice, ascites and pleural effusion. Computed tomography images showed a mass-like lesion in the porta hepatis with portal vein thrombosis and a right chest wall mass. Excisional biopsy was done and the pathology report was malignant spindle cell tumor suggestive of an aggressive form of IMT. Her condition rapidly deteriorated regardless of the best supportive care and she expired at postoperative month 5. Further investigation is necessary to clarify the reasons for recurrence and infiltration of this disease.
Ascites ; Bile ; Bile Ducts ; Biliary Tract ; Biopsy ; Carcinoma in Situ ; Cholangiocarcinoma ; Diagnosis, Differential ; Female ; Hepatectomy ; Humans ; Jaundice ; Middle Aged ; Myofibroblasts ; Pleural Effusion ; Portal Vein ; Recurrence ; Stromal Cells ; Thoracic Wall ; Thrombosis

The herniated lumbar intervertebral disc, a common affliction in man, had been diagnosed with myelogram and treated with laminectomy. Recently, the application of CT scan and chemonucleolysis markedly changed the mode of management in lumbar disc diseases. High resolution CT scan of lumbar spine became the most popular diagnostic tool to detect herniations of lumbar discs and discolysis with chymopapain an alternative to surgery in a large number of patients. We performed CT scan and discography in 131 discs of 100 patients prior to chemonucleolysis and there were too many ruptured discs not found on CT scan but discography. Of the 5 patients who failed in chemonucleolysis severe dye leakage was seen in 4 cases. Extradural leakage of contrast medium was not a contraindication to the injection of chymopapain. However, when this occured the precaution was taken of injecting more quantity of chymopapain slowly. This report presents our experience with lumbar discography and comparative analysis of CT scan and discography. We think discography is very important diagnostic tool to detect rupture of discs prior to chemonucleolysis and may aid our gradually increasing understanding of the pathophysiology of the disc diseases.
Chymopapain ; Humans ; Intervertebral Disc ; Intervertebral Disc Chemolysis ; Laminectomy ; Rupture ; Spine ; Tomography, X-Ray Computed*

The authors treatment 35 patients with ossification of the posterior longitudinal ligament(OPLL). Sixteen of these patients had surgery during the past 3 years between 1983 and 1985. In this paper wer present a radiological and clinical analysis of these cases with a literature review. We also discuss a clinical system of grading, different types of radiological patterns, the indications of surgical treatment and the choice of operative methods. 1) The ages of the patients ranged from 31 to 79 with a mean of 55.4 years. 57.1% of the patients were in the sixth decade. The male to female ration was 28:7. 2) The cases were graded on the bases of symptoms. Grade I, no symptoms or mild neck pain, 1 case(2.9%) ; Grade II only radiculopathy, 14 cases(40.0%) ; Grade III, mild myelopathy but able to walk, 11 cases(31.4%) ; Grade IV, severe myelopathy and unable to walk alone, 7 cases(20.0%) ; Grade V, complete paralysis of one or more extremities, 2 cases(5.7%). 3) Lateral tomogram and CT scan were most useful for assesment of OPLL. 4) The pattern of OPLL was divided into a continuous type(25.7%), a multiple segmented type(31.4%), a single segmented type(20.0%), and a mixed type(22.9%). 5) In cases of a clinical grading of more than III, surgery must be considered In grade II, surgery is indicative if conservative management failed to improve the clinical symptoms. 6) Extensive total laminectomies and foraminotomies were found to be advisable in cases of OPLL involving more than two vertebrae. 7) The modified Smith-Robinson approach showed the best surgical results in cases of single segmented OPLL.
Equidae ; Extremities ; Female ; Foraminotomy ; Humans ; Laminectomy ; Longitudinal Ligaments* ; Male ; Neck Pain ; Paralysis ; Radiculopathy ; Spinal Cord Diseases ; Spine ; Spondylosis ; Tomography, X-Ray Computed

Erythema nodosum (EN) is a painful skin disease characterized by erythematous tender nodules located predominantly over the extensor aspects of the legs. Various etiological factors, including infection, drug administration, and systemic illness have been implicated as causes of EN. Mycoplasma pneumoniae is one of rare infectious agents to cause EN in children. We report a case of a 7-year-old boy with context of respiratory illness and skin lesions with arthralgia. From stepwise approaches, IgM antibody against M. pneumoniae was positive with titers of 12.18, consistent with respiratory infection of M. pneumoniae and histopathology showed findings of septal and lobular inflammation without vasculitis consistent with EN. In addition, we reviewed the pathogenesis of this disease based on our case and the previous reports.
Arthralgia ; Child ; Erythema Nodosum* ; Erythema* ; Humans ; Hypersensitivity, Delayed ; Immunoglobulin M ; Inflammation ; Leg ; Male ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pneumonia ; Pneumonia, Mycoplasma* ; Skin ; Skin Diseases ; Vasculitis

We report the first case of an angiomyomatous hamartoma (AH) of the popliteal lymph nodes (LNs) occurring in association with diffuse pigmented villonodular synovitis (PVNS) of the knee. AH is a rare benign vascular disease with a predisposition for the LNs of the inguinal region. Twenty-five cases of AH have been reported to date; however, the precise pathogenesis is still undetermined. In the present case, an open synovectomy revealed two of three popliteal LNs in close proximity to the extra-articular component of diffuse PVNS. These LNs demonstrated irregularly distributed thick-walled blood vessels in the hilum. These vessels extended into the medulla and cortex and were associated with haphazardly arranged smooth muscle cells in the sclerotic stroma. These findings are compatible with an AH. Our observations raise the possibility that AH of the popliteal LNs may represent an abnormal proliferative reaction against the inflammatory process caused by PVNS of the knee.
Angiomyoma ; Blood Vessels ; Hamartoma ; Knee ; Lymph Nodes ; Myocytes, Smooth Muscle ; Synovitis, Pigmented Villonodular ; Vascular Diseases

Recently, motor evoked potential(MEP) using cortical surface of transcranial stimulation have been used to monitor the integrity of motor pathways and map motor cortex in human and animal. The primary concept using motor evoked potentials(MEPs) for test of motor pathways was based on the assumtion that pyramidal neurons in the motor cortex are activated by electrical stimulation applied on the cerebral cortex and synchronized compound action potentials are conducted mainly along the corticospinal tracts in the spinal cord. However, the origins and the descending pathways of these MEPs in small animals may be different from those of potentials evoked by intracortical microstimulation because of current spread. Our previous study revealed that the origns of the MEPs in rats differed from those previously believed and may be reticular nuclei. To further clarify those results and localize the intraspinal pathways conduction MEPs, consecutive vertical and/or horizontal sections of the spinal cord were performed at T9 cord level in twelve rats. MEPs were recorded at T2/3 and L2/3 before and after each section and sequential alterations of MEPs were observed. In six rats, the stimulation was alternated between the right and left cortex and the lateralities of conduction pathways were compared. All six cases showed no differences of MEPs and pattern of wave abolition after each section between right and left brain stimulation. The alteration of MEPs after each consecutive section was categorized by analyzing latency shift, amplitude change, and disappearance of waves. We divided a cross section of T9 spinal cord into forty-six squares. If one of the categorized changes occurrd after cutting an area, the appropriate score was given for the area since more change of waves meant more significant contribution of the cut area to conduction of MEPs. The score of twelev rats were summed in each forty-six spots and map showing the distribution of MEPs was constructed. The map revealed that MEPs were conducted along the wide area of ventral and lateral funiculus of the spinal cord but mainly along the medial portion of the ventral funiculus of the spinal cord but mainly along the medial portion of the ventral funiculus and ventral portion of the larteral funiculus through which reticulospinal and vestibulospinal tracts pass. No conduction of MEPs along the corticospinal tracts was confirmed. This finding supports the result of our previous study. However, this extrapyramidal MEP conducted along ventral spinal cord in addition to somatosensory evoked potential(SSEP) which is conducted along posterior funiculus can be useful to monitor the integrity of the whole spinal cord. Moreover, the extrapyramidal MEP can be more useful than pyramidal MEP in rats because the reticular formation plays a more important role in motor function and pyramidal tract is located in posterior funiculus.
Action Potentials ; Animals ; Brain ; Cerebral Cortex ; Efferent Pathways ; Electric Stimulation ; Evoked Potentials, Motor* ; Extrapyramidal Tracts ; Humans ; Motor Cortex ; Neurons ; Pyramidal Tracts ; Rats* ; Reticular Formation ; Spinal Cord

Motor evoked potential(MEP) produced by cortical surface or transcranial stimulation has evolved as a new clinical and experimental tool to monitor the integrity of motor pathways and to map motor cortex. Clinical assessment of motor system using MEP has further advanced with recent development of the magnetic stimulator. The primary concept using MEPs for test of motor pathways was based on the assumption that pyramidal neurons in the motor cortex are activated by electrical stimulation applied on the cerebral cortex and synchronized compound action potentials are conducted mainly along the corticospinal tracts in the spinal cord. However,recent studies indicated that the origins of the Meps in non primates may differ from those previously believed. In order to use MEPs as a clinical or experimental tool, it is essential to clarify the origin of MEPs. Therefore, goals of this study were : (1) to investigate the origin of MEPs, and (2) to design the most reliable but simple method to evoke and monitor MEPs. In a total of fifteen rats, MEPs were produced by cortex to cortex stimulation and were monitored using a pair of epidural electrodes. Using varying stimulus intensities, the amplitudes and latencies of MEPs were statistically analyzed. The latencies and amplitudes of the MEPs in these animals showed surprisingly large standard deviations, which were partially resulted in these animals showed surprisingly large standard deviations, which were partially resulted from convergence of neighboring waves during high stimulation intensities. Wave forms of MEPs were also varied greatly depending on the position of recording electordes. At low stimulus intensities, most consisten MEPs were obtained when the stimulating electrodes were placed on the hard palate and the temporal muscle, not on the motor cortex. This observation indicates that the primary source of MEPs is not the motor cortex in the rat. When the potentials generated by direct stimulation of motor cortex and those generated by reticular nuclei were monitored epidurally in the same preparation using the same electrodes, these potentials generated by different sources actually identical in their latencies and wave forms. However, the threshold stimulus intensities evoking these potentials were quite different in the two metholds. The threshold was much lower to evoke potentails by reticular nuclei stimulation. It suggests that MEPs are geneated by the reticular nuclei or brain structure located in the brain stem. The observation that the motor cortex play no major roles in generating MEPs was confirmed by sequential sections of neural axis from the motor cortex to brain stem in three rats. All these findings suggested that neither direct motor cortex stimulation not transcranial stimulation did evoke MEPs originating from the motor cortex in rat. These stimulating methods activate reticular nuclei by stimulus current spread to the brain stem. Since the reticular formation plays an important role in motor function in rats, MEP originated from reticular nucleus can be an important testing of the motor function in rats. Moreover, transcranial stimulation of the brain is technically easy. This technique producing MEPs originated from reticular nucleus can be useful to monitor the integrity of motor pathways.
Action Potentials ; Animals ; Axis, Cervical Vertebra ; Brain ; Brain Stem ; Cerebral Cortex ; Efferent Pathways ; Electric Stimulation ; Electrodes ; Evoked Potentials, Motor* ; Extrapyramidal Tracts ; Motor Cortex ; Neurons ; Palate, Hard ; Primates ; Pyramidal Tracts ; Rats* ; Reticular Formation ; Spinal Cord ; Temporal Muscle

The purpose of the present study was to define the normal range of plasma concentration of angiotensin I-converting enzyme(ACE), N-acetyl-b-D-glucosaminidase(NAG), inactive and active renin, and atrial natriuretic peptide(ANP) in normal Korean adult male in terms of aging. Both plasma ACE activity and NAG concentration were measured by spectrofluorometry, and the plasma renin activity and ANP concentration were measured using radioimmunoassay. The ACE was 67.7+-3.6 nM His-Leu/min/ml and did not change in terms of age. The plasma NAG activity tended to decrease. Both plasma active and inactive renin activities were 2.1+-0.2 and 3.0+-0.3 ngAI/ml/h and tended to decrease in terms of aging. The percentage of inactive renin to total renin was 57.2+-2.9% at age 21-30 and also tended to decrease in terms of aging. Plasma ANP concentration at age 22 was 59.6+-2.9 pg/ml.
Adult ; Aging ; Angiotensins ; Atrial Natriuretic Factor ; Humans ; Male ; Plasma ; Radioimmunoassay ; Reference Values ; Renin ; Spectrometry, Fluorescence

To evaluate the association between ACE gene I/D polymorphism and ecNOS gene a/b polymorphism in IgA nephropathy, 158 IgA nephropathy patients and 121 control subjects were examined. In genotype distribution of the ACE gene I/D polymorphism, there was no significant difference in genotype distribution between controls and IgA nephropathy patients. We also examined the association between ACE genotype and clinical characteristics in the patients with IgA nephropathy. The incidence of hypertension in patients with DD genotype was higher than that of other genotypes. There were no significant association between I/D polymorphism distribution and chronic renal failure, nephrotic range proteinuria, and glomerular sclerosis in IgA nephropathy. In genotype distribution of ecNOS gene a/b polymorphism, there was no significant difference between IgA nephropathy patients and controls. There was no significant difference in frequency of chronic renal failure, hypertension, nephrotic range proteinuria and glomerular sclerosis among ecNOS genotypes. In addition, we failed to detect any significant association between the ACE and ecNOS gene-polymorphis ms and the decline of renal function in IgA nephropathy. A further study with larger number of patient population would be necessary.
Angiotensins* ; Genotype ; Glomerulonephritis, IGA* ; Humans ; Hypertension ; Immunoglobulin A* ; Incidence ; Kidney Failure, Chronic ; Nitric Oxide Synthase Type III* ; Peptidyl-Dipeptidase A* ; Proteinuria ; Sclerosis