Hepatoma is one of the most common malignant disease among cancers that occur in Korea. Recently, according ta developing imaging diagnostic technology and non surgical treatment the hepatoma is easily detected in early diagnosis and appropriate treatment. From this point of view, the histologic pattern of hepatoma is markedly important. This is the first reported case of sclerosing hepatocellular carcinoma, which is characterized by intense fibrosis, in which the tubular neoplastic structures are embedded. The incidence of sclerosing hepatocellular carcinoma is very rare. Therefore the rare histologic pattern of hepatoma might be introduced by many studies and reports. We recently experienced a case of sclerosing hepatocellular carcinoma.
Carcinoma, Hepatocellular ; Early Diagnosis ; Fibrosis ; Incidence ; Korea

OBJECTIVES: This study was carried out to survey the prevalence of Helicobacter pylori infection and the incidence of vacuolating toxin producing H. pylori. A further aim of this study was to evaluate the quantitative assay for cell vacuolation on the basis of the rapid uptake of neutral red dye by vaculoes of the cells. METHODS: We studied the gastric biopsy specimens of patients with 154 cases of gastritis, 74 cases of gastric ulcer, and 167 cases of gastric cancer and in 44 cases of healthy persons. One of the biopsy specimen was placed into a CLOtest plate for rapid urease test and the other one of the biopsy spcimen was inoculated on Brain Heart Infusion blood agar for culture. The culture supernatant of isolated H. pylori was serially diluted with BHI broth. After 24 hour incubation of cultured RK-13 cells treated with the culture supernatant of H. pylori, cytoplasmic vacuolation of the cells were observed microscopically. RESULTS: The positivity of urease test and the rate of isolation of H. pylori from urease positive gastric biopsy materials were 34.1% and 93.3% in healthy person, 55.8% and 70.9% in gastritis, 60.8% and 71.1% in gastric ulcer, and 56.3% and 96.8% in gastric cancer. The isolation rate of H. pylori from patients between 20 and 39 years old was 16.8%, for patients between 40 and 59 years old it was 51.9%, and for patients above 60 years old it was 31.2%. The isolation rate of the vacuolating toxin producing H. pylori from gastric biopsy specimens was 66.7% in a healthy person, 76.6% in gastritis, 79.4% in gastric ulcer, and 80% in gastric cancer. CONCLUSIONS: The isolation rate of H. pylori from the patients with gastric diseases is higher than the rate of H. pylori from healthy persons, but the isolation rate of the vacuolating toxin producing H. pylori is not different between the patients with gastric diseases and healthy persons. The titers of vacuolating toxin produced by some H. pylori isolated from the patients with gastric diseases are higher than those from healthy persons.
Adult ; Agar ; Biopsy ; Brain ; Cytoplasm ; Gastritis ; Heart ; Helicobacter pylori* ; Helicobacter* ; Humans ; Incidence* ; Middle Aged ; Neutral Red ; Prevalence ; Stomach Diseases* ; Stomach Neoplasms ; Stomach Ulcer ; Urease

OBJECTIVES: Septic shock is characterized by the circulatory failure including vasodilation, hyporeactivity to vasoconstrictor agents and organ ischemia in association with multiple organ failure and increased platelet aggregation and blood coagulation. In the present study, we investigated the preventive effects of N-nitro-L-arginine methyl ester (L-NAME, 30mg/kg, i.p.), a non-selective nitric oxide synthase (NOS) inhibitor, S-methylisothiourea sulfate (SMT, 5mg/kg, i.p.) and pentoxifylline (PTX,10mg/kg, i.p.) on the multiple organ dysfunction in a rat model of circulatory shock induced by bacterial endotoxin (E. coli lipopolysaccharide: LPS) and discussed the mechanism underlying the development of multiple organ failure. METHODS: The effect of each other N-nitro-L-arginine methyl ester(L-NAME, 30 mg/kg, i.p.), a non-selective nitric oxide synthase(NOS) inhibitor, S-methyli-sothiourea sulfate(SMT, 5mg/kg, i.p.) and pentoxifylline (PTX, 10mg/kg, i.p.) were comparatively evaluated following inducing circulatory shock by means of infusion of bacterial endotoxin to the rat model. RESULTS: 1) The systemic mean arterial blood pressure decreased by 48.7mmHg and vascular hyporeactivity to noradrenaline injection(1 g/kg, i.v.) upon intravenous administration of LPS. 2) Endotoxemia for 6hours resulted in little change in the numbers of white blood cells and neutrophils but a significant reduction in the numbers of platelets. The variables were not affected by the inhibitors. 3) Endotoxemia for 6hours caused a significant increase in serum nitric oxide level (P<0.01) which was inhibited by SMT, but not by L-NAME and PTX. 4) Upon injection of LPS, serum creatinine(0.65+/-0.08mg/dl) and urea(28.7+/-5.9mg/dl) were significantly elevated to 0.92+/-0.12 (P<0.05) and 54.3+/-2.1mg/dl (P< 0.01). These elevated levels were significantly attenuated by PTX but not by L-NAME and SMT. 5) Endotoxemia for 6 hours resulted in a significant increases in serum ALT(988.8+/-28.2 IU/L, P<0.01) and AST levels(1470.5+/-396.5 IU/L, P<0.01) from basal levels of ALT(67.8+/- 11.7IU/L) and AST(170.3+/-14.8IU/L). These increased activities were significantly attenuated by PTX, but not by L-NAME and SMT. The level of LDH(1279.8+/-156.2IU/L) was significantly increased by LPS treatment to 2932.0+/-519.9IU/L (P<0.05), which was inhibited by PTX. 6) Upon LPS treatment, the myeloperoxidase activity in the lung homogenate was significantly increased by LPS treatment (P<0.05), whereas that in the liver showed less change. The increased activity was reduced by PTX (P<0.05), but not by L-NAME and SMT. 7) The level of serum malondialdehyde, an index of lipid peroxidation by oxygen free radicals, was little influenced by LPS. CONCLUSION: Based on these results, it is summarized that PTX characteristically inhibited the development of multiple ogran dysfunction in a murine model of endotoxemia. Thus, it is concluded that the formation of TNF and increased activity of neutrophils may importantly contribute to the development of LPS-induced endotoxemia.
Administration, Intravenous ; Animals ; Arterial Pressure ; Blood Coagulation ; Endotoxemia ; Free Radicals ; Ischemia ; Leukocytes ; Lipid Peroxidation ; Liver ; Lung ; Malondialdehyde ; Models, Animal ; Multiple Organ Failure ; Neutrophils ; NG-Nitroarginine Methyl Ester ; Nitric Oxide ; Nitric Oxide Synthase ; Norepinephrine ; Oxygen ; Pentoxifylline* ; Peroxidase ; Platelet Aggregation ; Rats* ; Shock ; Shock, Septic ; Vasoconstrictor Agents ; Vasodilation

Advanced or complete atrioventricular (AV) block is frequently regarded as a cause of informed syncopal attacks even though escape rhythm is maintained. Torsades de pointes (TdP) may be a significant complication of AV block associated with QT prolongation. Maintaining ventricular rate over 70 beats/min is known to be important to normalize QT interval and to reduce the possibility of bradycardia-related TdP recurrence after pacemaker implantation. We report one case of syncopal attacks associated with TdP in a 70 year old female patient with advanced AV block and prolonged QT interval. She was referred to evaluate palpitation and syncope. Advanced AV block and QT interval prolongation were seen with electrocardiography, but junctional escape rhythm was maintained. Syncopal attacks occurred during temporary pacemaker insertion. Multiple episodes of nonsustained polymorphic ventricular tachycardia and TdP related to syncopal attacks were demonstrated by 24-hour Holter monitoring. A permanent pacemaker was implanted and ventricular rate was set over 70 beats/min resulting in no recurrence of TdP and syncope.
Atrioventricular Block* ; Electrocardiography ; Electrocardiography, Ambulatory ; Female ; Humans ; Recurrence ; Syncope* ; Tachycardia, Ventricular ; Torsades de Pointes* ; United Nations

The prognosis of lung cancer is very poor. Patients with lung cancer have usually no symptom in early stage or some mild cough, sputum. When patient feel weight loss or dyspnea, majority of patients with lung cancer are advanced stage and inoperable. The growth rate of lung cancer is different according to cell type of tumor and related to prognosis. Generally, tumor. doubling time (TDT) of lung cancer has been known that small cell lung cancer is about 65 days, squamous cell carcinoma is about 90 days, and adenocarcinoma is about 185 days. There has been rarely reported of lung cancer with very fast or very slow growth. The prognosis of a slow growing lung cancer is relatively good but rapidly growing cancer is not. We report a very rare case that surgicallytreated early stage non-small cell lung cancer (adenocarcinoma) with 4-year- TDT without invasion or distant metastasis
Adenocarcinoma* ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Cough ; Dyspnea ; Humans ; Lung Neoplasms ; Lung* ; Neoplasm Metastasis ; Prognosis ; Small Cell Lung Carcinoma ; Sputum ; Weight Loss

A 38-year-old woman presented with facial edema with neck vein engorgement for about 45 days. Chest roentgenography showed bulging soft tissue opacities in the right superoanterior mediastinum and a lobulated intraluminal mass was noted in the superior vena cava on the venacavogram. The superior vena cava was incised and the tumor located from the junction of the superior vena cava and internal jugular vein to the right atrial inlet was excised. Grossly, the tumor was myxoid or gelatinous in appearance. A combination of microscopic and immunohistochemical features showed myxoid leiomyosarcoma arising from the wall of the superior vena cava.
Adult ; Bays ; Edema ; Female ; Gelatin ; Humans ; Jugular Veins ; Leiomyosarcoma* ; Mediastinum ; Neck ; Radiography ; Superior Vena Cava Syndrome* ; Thorax ; Veins ; Vena Cava, Superior*

Gas-forming pyogenic liver abscess is an uncommon, life-threatening, necrotizing infection that is usually found in poorly-controlled diabetic patients. Herein, we report a case of gas-forming liver abscess caused by Klebsiella pneumoniae, as proven by aspirated pus culture, in a 70-year old woman with diabetes mellitus. The patient was successfully managed with broadspectrum antibiotics and transhepatic percutaneous drainage and was discharged after 3 weeks of hospitalization. In conclusion, strict control of diabetes mellitus is the most important factor in the prevention of gas-forming pyogenic liver abscess.
Aged ; Anti-Bacterial Agents ; Diabetes Mellitus ; Drainage ; Female ; Hospitalization ; Humans ; Klebsiella pneumoniae ; Liver Abscess ; Liver Abscess, Pyogenic* ; Suppuration

BACKGROUND: The purpose of this study was to examine the causes and pathologic process of chronic non-productive cough as an isolated symptom with a normal spirometry and chest radiograph by investigating clinicopathologic findings. METHOD: We studied 25 adults with chronic non-productive cough over a 3-week period with a normal chest radiograph and pulmonary function tests without any other symptoms. Clinical assessment, cough score, chest and sinus radiograph, pulmonary function tests, methacholine challenge, allergic skin prick test, and bronchoscopy for bronchial biopsies were performed. Subjects were then treated with prednesolone 20 to 30 mg/day for 1 to 2 weeks. RESULTS: The experimental group was divided into two subgroups - those infiltrated with eosinophils, and those infiltrated with lymphocytes depending on eosinophil and lymphocyte counts, both of which were respectively higher than those of the control group. Eosinophils infiltrated group had mean numbers of eosinophil of 89.8 cells/mm(2) while control group's mean was 0.4 cells/mm(2)(P=0.005). Lymphocyte infiltrated group was 4 patients whose mean was 84.3 cells/mm(2) with 28.4 cells/mm(2) of control group(P=0.026). In addition, the mean thickeness of the basement membrane of experimental group was 14.20+/-5.20microM in contrast of control group whose mean was 3.50+/-1.37microM(P=0.001). With the methacholine challenge test, 7 of the 21 eosinophil infiltrated subjects were diagnosed with cough asthma; the other 14 with eosinophilic bronchitis. Three subjects with eosinophilic bronchitis were atopic positive(21.4%) with the skin prick test. In the lymphocyte dominant group, all four subjects were diagnosed with lymphocytic bronchitis. Cough score was improved after steroid treatment in 22 of 25 subjects in the experimental group (88.0%). CONCLUSION: These results suggest chronic non-productive cough as an isolated symptom with a normal spirometry and chest radiograph was associated with airway inflammation by eosinophil and lymphocyte infiltration. The causes for chronic non-productive cough were eosinophilic bronchitis, cough variant asthma, and lymphocytic bronchitis(written in frequency). They further suggest that therapeutic treatment with steroids can provide effective symptomatic relief.
Adult ; Asthma ; Basement Membrane ; Biopsy* ; Bronchitis ; Bronchoscopy ; Cough* ; Eosinophils ; Humans ; Inflammation ; Lymphocyte Count ; Lymphocytes ; Methacholine Chloride ; Radiography, Thoracic ; Respiratory Function Tests ; Skin ; Spirometry ; Steroids ; Thorax

Fat embolism syndrome is a rare but serious complication occurring most of the time in patients with long bone fractures. And it occasionally occurs when patient had underlying disease. For example, pancreatitis, diabetes mellitus, alcoholic liver disease and connective tissue disease can be risk factors. The 44-year old woman visited to the Korea university hospital because of sudden dry cough, blood tinged sputum, and exertional dyspnea. We found petechiae on her anterior chest wall. Chest X-ray and CT showed patchy opacities and multifocal ground-glass opacities in both lung fields. Open lung biopsy demonstrated diffuse pulmonary hemorrhage and intravascular macrovesicular fat bubbles. After conservative management, her symptoms and radiologic findings were significantly improved. We report a case of fat embolism syndrome without any known risk factors.
Adult ; Biopsy ; Connective Tissue Diseases ; Cough ; Diabetes Mellitus ; Dyspnea ; Embolism ; Embolism, Fat* ; Female ; Fractures, Bone ; Hemorrhage* ; Humans ; Korea ; Liver Diseases, Alcoholic ; Lung ; Pancreatitis ; Purpura ; Risk Factors ; Sputum ; Thoracic Wall ; Thorax ; Tolnaftate

BACKGROUND: Diffuse panbronchiolitis(DPB) is a chronic inflammatory lung disease that presents as coughing, copious sputum, exertional dyspnea, which progresses to bronchiectasis. The pathogenesis of bronchiectasis is controlled by inflammatory mediators, which are closely related to mucus hypersecretion, goblet cell dysplasia. In recent studies, the epidermal growth factor receptor(EGFR) system was reported to be associated with this process. It was hypothesized that a relationship exists between goblet cell dysplasia, EGFR expression, and inflammatory mediators produced by neutrophil. METHOD: Alcian blue/periodic acid -Schiff(AB/PAS) stain, MUC5AC, EGFR, CD16 immunohistochemical stain were examined to investigate a role for the EGFR system in a mucus hypersecretion in DPB using the lung biopsy specimens from 13 DPB patients and 6 controls. RESULTS: In the DPB group, the AB/PAS- and MUC5AC-stained areas were 8.31+/-3.36%, 11.46+/-4.68%, respectively. In the control group, the AB/PAS- and MUC5AC-stained areas were 50.5+/-5.77%, 53.3%+/-6.67%, which was significantly larger than in the DPB group (each comparison, p<0.05). The percentage of EGFR expression was 9.54+/-4.95% in the DPB group, but zero in of the control group. The extent of neutrophilic infiltration was 71.92+/-3.71/5HPF in the DPB group and 45.0+/-5.73/5HPF in the control group, which was statistically significant(p=0.002). CONCLUSION: The EGFR system is highly related to goblet cell dysplasia, mucus hypersecretion and neutrophilic inflammation in DPB.
Biopsy ; Bronchiectasis ; Cough ; Dyspnea ; Epidermal Growth Factor* ; Goblet Cells* ; Humans ; Inflammation ; Lung ; Lung Diseases ; Mucus ; Neutrophils ; Receptor, Epidermal Growth Factor* ; Sputum