We investigated the role of the tumor suppressor genes in the germ cell tumor. Immunohistochemistry (IHC) and polymerase chain reaction-single strand conformational polymorphism (PCR-SSCP) for p53 mutation were done in 46 cases of the germ cell tumor with paraffin embedded tissue. The immunohistochemical staining for Rb protein was also performed in the same specimens. The following results were obtained. The overexpression of the p53 protein was detected in 7 of 46 cases (15%). p53 mutation by PCR-SSCP was detected in 1 of 46 cases (2.2%). Expression of Rb protein was negative in 19 cases (41%). These results suggest that p53 mutation does not play an important role in the initiation and progression of germ cell tumors.
Genes, Tumor Suppressor ; Germ Cells* ; Immunohistochemistry ; Neoplasms, Germ Cell and Embryonal* ; Paraffin ; Retinoblastoma Protein*

No abstract available.
Autopsy* ; Endocarditis* ; Thromboembolism

Primary testicular carcinoid tumor, occupying 0.23% of testicular neoplasm, is a rare and indolent neoplasm with the potential for distant metastasis. We present two cases of primary pure carcinoid tumor of the testis. Both patients were 36 years old. Physical examination revealed testicular mass with and without tenderness. The preoperative serum levels of beta-human chorionic gonadotropin and alpha-fetoprotein were normal and neither patient had carcinoid syndrome. The tumors measured 7.5x6x4 cm and 5.5x5x4 cm in size. Histologically, immunohistochemically and ultrastructurally, the tumors showed typical features of the carcinoid tumor. Case 1 showed extensive tumor necrosis and vascular invasion. DNA flow cytometric analysis showed aneuploidy with DNA index of 1.47 and S+G2M of 14.0% in case 1 and tetraploidy with DNA index of 1.96 and S+G2M of 22.1% in case 2. Both patients have been well without any signs of metastasis after operation for 24 months in case 1 and for 16 months in case 2.
Adult ; Carcinoid Tumor/pathology ; Carcinoid Tumor/metabolism ; Carcinoid Tumor/genetics* ; Case Report ; DNA, Neoplasm/analysis* ; Flow Cytometry/methods* ; Human ; Immunohistochemistry ; Male ; Testicular Neoplasms/pathology ; Testicular Neoplasms/metabolism ; Testicular Neoplasms/genetics*

We experienced a case of eisenmenger syndrome treated by simple surgical intervention. Eisenmenger syndrome refers to patients with congenital heart defects who have a systemic level of pulmonary arterial pressure and high pulmonary vascular resistance, with right-to-left or bidirectional shunting. Because a progressive rise in pulmonary vascular resistance may be better tolerated with an intracardiac communication, surgical repair in such patients may shorthen their life. But, urgent surgical intervention should be undertaken to reverse process if the pulmonary vascular disease is of recent origin. Patients who respond to vasoilator therapy, such as oxygen, are subjected to surgery. We reported a case of PDA with eisenmenger syndrome whose pulmonary vascular resistance fall following vasodilator, 100% oxygen, and closure of defect during cardiac catheterization, preoperatively, and who may faborable after simple surgical repair.
Arterial Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Ductus Arteriosus, Patent* ; Eisenmenger Complex* ; Heart Defects, Congenital ; Humans ; Ligation* ; Oxygen ; Vascular Diseases ; Vascular Resistance

Thymic adenocarcinoma is extremely rare. Although its histologic features have been occasionally reported, a lack of description of the cytologic features has hampered the prompt and accurate diagnosis of this condition. Herein, we describe the cytologic findings and histology of four aspiration cytology specimens of thymic adenocarcinoma. The specimens were obtained from primary tumors, metastatic lymph nodes, and pericardial effusions. All four specimens showed three-dimensional glandular clusters with a loss of polarity and nuclear overlapping. One specimen had extensive extracellular mucinous material. Three specimens contained tumor cells with intracytoplasmic vacuoles. While the specimen with extracellular mucin showed relatively mild cytologic atypia, other specimens exhibited more atypical cytologic changes: irregular nuclear membranes, a coarse chromatin pattern, and prominent nucleoli. The cytologic features were correlated with the histologic features in each case of enteric type thymic adenocarcinoma. The differential diagnosis included other thymic carcinomas, yolk sac tumors, and metastatic adenocarcinoma from the lung or colorectum.
Adenocarcinoma* ; Biopsy, Fine-Needle* ; Chromatin ; Diagnosis ; Diagnosis, Differential ; Endodermal Sinus Tumor ; Lung ; Lymph Nodes ; Mediastinum ; Mucins ; Nuclear Envelope ; Pericardial Effusion ; Thymoma ; Thymus Gland ; Vacuoles

BACKGROUND: The ProSeal laryngeal mask airway (PLMA) is a new laryngeal mask device with a larger cuff and a drainage tube. This study was designed to assess the usefulness and the safety of the PLMA in a laparoscopic cholecystectomy. METHODS: Forty patients undergoing a laparoscopic cholecystectomy were randomly allocated to two groups; an endotracheal tube (ETT) group or a PLMA group. Anesthesia was induced with intravenous fentanyl and propofol and maintained with TCI-propofol. Blood pressure, heart rate, peak inspiratory pressure, peripheral O2 saturation (SpO2), end-tidal CO2 tension (PETCO2) and PaCO2 was measured during the operation. The incidence of gastric content regurgitation and gross pulmonary aspiration were evaluated. Postoperatively, SpO2, the visual analogue scale (VAS) of pain, nausea and vomiting (PONV), and sore throat were evaluated at 30 minutes intervals in post-anesthetic care unit (PACU) and at night. RESULTS: There were no significant differences in intraoperative PIP, SpO2, PETCO2, postoperative SpO2, VAS scores, PONV, and sore throat between the two groups. Gross pulmonary aspiration was not found in either group, but minimal gastric regurgitation occurred in 2 cases of the ETT group and 1 case of the PLMA group. CONCLUSIONS: We concluded that there were no differences in patient safety and adequate ventilation for a laparoscopic cholecystectomy between the ETT group and PLMA group. Moreover, there were no increases in blood pressure and heart rate in PLMA group during insertion/intubation.
Anesthesia ; Blood Pressure ; Cholecystectomy, Laparoscopic* ; Drainage ; Fentanyl ; Heart Rate ; Humans ; Incidence ; Laryngeal Masks* ; Laryngopharyngeal Reflux ; Nausea ; Patient Safety ; Pharyngitis ; Postoperative Nausea and Vomiting ; Propofol ; Ventilation ; Vomiting

Inflammatory and ischemic bowel disease commonly involve a longer segment than a maligant lesion. The characteristic findings of inflammatory bowel disease are mucosal nodular hypertrophy and luminal narrowing. It has recently been reported, however, that the features of mucinous adenocarcinoma are similar to those of inflammatory bowel disease with long segmental involvement. After a brief review of the literature, we describe two cases of mucinous adenocarcinoma of the ascending colon associated with inflammatory disease. Because of long segmental involvement of the ascending colon, mucosal nodular hypertrophy and luminal narrowing, one of these was thought to be multiple villous adenoma with colitis, but was confirmed as mucinous adnocarcinoma. The other case, thought to be tuberculous enterocolitis, was comfirmed as tuberculous enterocolitis associated with mucinous adenocarcinoma.
Adenocarcinoma, Mucinous* ; Adenoma, Villous ; Colitis ; Colon, Ascending* ; Enterocolitis ; Hypertrophy ; Inflammatory Bowel Diseases ; Mucins* ; Phenobarbital

An 18-year-old man suffered heat stroke after continuous working for 26 hours on his first day in an aluminium utensil plant in August 1998. His job was to put a pressed aluminium utensil on the conveyer before the process of spray painting. The ranges of temperature and relative humidity measured at the local weather-station during the patient' s working period were 23.6-30.2 degrees C, 49-87 % respectively. On arrival the patient was comatose and suffered generalized seizure three times. His rectal temperature was 41.2 degrees C . blood pressure was 90/60 mmHg, pulse was 148 beats/minute and respiratory rate was 28 times/minute. The serum level of AST was 421 IU/L. ALT was 205 IU/L, LDH was 1,160 IU/L. myoglobin was higher than 500 ng/mL. OK was higher than 2,000 IU/L. He recovered consciousness 7th day of admission and discharged after 2 months but cerebellar dysarthria was remained. The patient felt himself several prodromal symptoms of heat stroke and he showed awkward behavior considered to be drowsiness, but the patient and his co-workers neglected them. This case report shows that heat stroke can be occurred in a condition that ambient temperature, humidity, and working load are not extreme. A thorough health education and management concerned with guidelines on salt and water intake, detection of early symptoms of heat-related illness, prompt body cooling and rapid transportation to a hospital is necessary.
Adolescent ; Blood Pressure ; Coma ; Consciousness ; Drinking ; Dysarthria ; Health Education ; Heat Stroke* ; Hot Temperature* ; Humans ; Humidity ; Myoglobin ; Paint ; Paintings ; Plants* ; Prodromal Symptoms ; Respiratory Rate ; Seizures ; Sleep Stages ; Transportation

Angiofibromas commonly arise in the nasopharynx in adolescent male patients. The individual's history and clinical findings can make primarily the preliminary diagnosis of nasopharyngeal angiofibroma. Primary extranasopharyngeal angiofibromas are very rare, and clinical characteristics do not confirm to that of nasopharyngeal angiofibroma. Therefore, they can present diagnostic challenges. We present a case of extranasopharyngeal angiofibroma arsing from the ethmoid sinus of a 72-year-old man who had been followed up for recurrent epistaxis and nasal stuffiness.The tumor was successfully removed by endoscopic resection and histopathologic examination confirmed the diagnosis. In a 3 year follow up, the patient is free from relapse.
Adolescent ; Aged* ; Angiofibroma* ; Diagnosis ; Epistaxis ; Ethmoid Sinus* ; Follow-Up Studies ; Humans ; Male ; Nasopharynx ; Recurrence

A 50-year-old male visited the outpatient clinic and complained of fever, poor oral intake, and weight loss. A chest X-ray demonstrated streaky and fibrotic lesions in both lungs, and chest CT revealed multifocal peribronchial patchy ground-glass opacities with septated cystic lesions in both lungs. Cell counts in the bronchoalveolar lavage fluid revealed lymphocyte-dominant leukocytosis, and further analysis of lymphocyte subsets showed a predominance of cytotoxic T cells and few T helper cells. Video-assisted wedge resection of the left upper lobe was performed, and the histologic examination was indicative of a Pneumocystis jirovecii infection. Trimethoprim-sulfamethoxazole (TMP-SMX) was orally administered for 3 weeks; however, the patient complained of cough, and the pneumonia was aggravated in the follow-up chest X-ray and chest CT. Molecular studies demonstrated mutations at codons 55 and 57 of the dihydropteroate synthase (DHPS) gene, which is associated with the resistance to TMP-SMX. Clindamycin-primaquine was subsequently administered for 3 weeks replacing the TMP-SMX. A follow-up chest X-ray showed that the pneumonia was resolving, and the cough was also alleviated. A positive result of HIV immunoassay and elevated titer of HCV RNA indicated HIV infection as an underlying condition. This case highlights the importance of careful monitoring of patients with P. jirovecii pneumonia (PCP) during the course of treatment, and the molecular study of DHPS mutations. Additionally, altering the anti-PCP drug utilized as treatment must be considered when infection with drug-resistant P. jirovecii is suspected. To the best of our knowledge, this is the first case of TMP-SMX-resistant PCP described in Korea.
Anti-Bacterial Agents/*administration & dosage ; Drug Resistance, Bacterial ; Humans ; Lung/microbiology/radiography ; Male ; Middle Aged ; Pneumocystis jirovecii/*drug effects/genetics/isolation & purification/physiology ; Pneumonia/*drug therapy/immunology/microbiology/radiography ; Sulfamethoxazole/*administration & dosage ; Trimethoprim/*administration & dosage