Classic pulmonary blastoma is a variant of carcinosarcoma which is seen almost exclusively in adults. By contrast, most cases of pulmonary blastoma in children have been described as having an exclusive mesenchymal composition, which was proposed as pleuropulmonary blastoma. Recently we experienced a case of pleuropulmonary blastoma, type 1. This 27-month-old male baby was transferred to our hospital due to the left tension pneumothorax. Chest CT revealed a subpleural pulmonary cystic lesion on the left upper lung and an open cystectomy was performed. Histologically the lesion was composed of variable-sized cystic structures lined with a single layer of respiratory-type epithelium. the underlying stroma was composed of sheets of small, round to oval, primitive tumor cells. Some of them had eccentric, eosinophilic cytoplasm, suggestive of rhabdomyoblastic differentiation. These rhabdomyoblastic cells were fuchsinophilic and positive with desmin and vimentin on immunohistochemistry.
Child ; Adult ; Male ; Female ; Humans

PURPOSE: Although spinal tapping and cerebrospinal fluid analysis is essential for diagnosis of aseptic meningitis, it is equivocal that all patients with headache and vomiting should receive spinal tapping for diagnosis of meningitis during an outbreak of enteroviral meningitis in summer seasons. The purpose of this study was to find clinical indicators that may be useful for differentiation of bacterial meningitis, and also to compare the clinical course between spinal tapping group and non-spinal tapping group confirmed enteroviral infection. METHODS: We retrospectively reviewed medical record of 65 cases of reverse transcription-polymerase chain reaction(RT-PCR) proven enteroviral meningitis, and 30 cases of culture proven bacterial meningitis admitted in Chunchon Sacred Heart Hospital. We compared the difference of clinical factors between bacterial and enteroviral meningitis groups and also clinical course between spinal tapping and non-spinal tapping groups. RESULTS: Children with bacterial meningitis had younger age onset, high incidence of seizure and altered consciousness, increased C-reactive protein(CRP) levels(P<0.05), but no difference in fever degree at admission and white blood cell and platelet count, erythrocyte sedimentation rate(P>0.05). Children with spinal tapping group with enteroviral meningitis had longer hospital stay and duration of fever as compared to children in non-spinal tapping group(P<0.05), but no difference in duration of headache in both groups. CONCLUSION: We recommend children with younger age, altered consciousness, having seizure and increased CRP levels receive spinal tapping for the differentiation of bacterial meningitis during an outbreak of enteroviral meningitis, and introduction of rapid diagnostic technique may reduce unnecessary spinal tapping, hospital stay and antibiotics therapy.
Anti-Bacterial Agents ; Blood Sedimentation ; Child ; Consciousness ; Fever ; Headache ; Heart ; Humans ; Incidence ; Length of Stay ; Leukocytes ; Medical Records ; Meningitis ; Meningitis, Aseptic ; Meningitis, Bacterial ; Platelet Count ; Retrospective Studies ; Seasons ; Seizures ; Spinal Puncture ; Vomiting

Mucoceles usually occur as solitary, asymptomatic, translucent, and dome-shaped cysts containing clear viscous fluid on lower lip or oral mucosa. The authors reviewed the clinical and histopathological findings in 33 patients with mucocele and attempted to clarify the difference between the histopathologic types (retention and extravasation). The results were summarized as follows. 1. Age distribution was from 2 to 53 years and mean age was 21.4 years. Male to female ratio was 1.2:1(18 males.15 females). 2. Histopathologic type was classified. 4 cases(12.1%, mean age.17.3 years) were retention type, 19 cases(57.6%, mean age.'21.5 years) mixed type, and 10 cases(30.3 %, mean age.20.9 years) extravasation type. Among 19 mixed types, 13 cases were retention dominant and 6 cases extravasation dominant. 3. Durations from the onset to the diagnosis could be clarified in 16 cases. Those were below 1 year in 14 cases(87.5% ) and below 3 years in 16 cases all. Mean duration was 9.4 months. 4. The sites of involvement were lower lip(72.7%), tongue(24.3%), and oral mucosa(3.0%), in decreasing order of frequency. 5. The visited departments were otolaryngology(72.7%), dentistry(12.1%), plastic surgery(9,1%) and dermatology(6.1%), in decreasing order of frequency. 6. In the histopathologic observation, surface epithelium was observed in 25 cases (75.8%), cyst in 23 cases(69.7%), granlation tissue in 29 cases(87.9%), mucin in 28 cases(84.8%), surrounding salivary glands in 20 cases(60.6%) and foamy macrophages in 32 cases(97.0% ), 7. Special stains(PAS, D-PAS, and alcian blue at pH2.5 and 0.4) for the mucin were performed in 10 cases. The results were compatible with sialomucin.
Age Distribution ; Alcian Blue ; Diagnosis ; Epithelium ; Female ; Humans ; Lip ; Macrophages ; Male ; Mouth Mucosa ; Mucins ; Mucocele* ; Salivary Glands ; Sialomucins

PURPOSE:Obesity is a common complication in children who were surgically treated for craniopharyngioma. We analysed body composition, metabolic parameters and evaluated for correlation between adiponectin and metabolic parameters in children who were surgically treated for craniopharyngioma. METHODS:Sixteen patients with craniopharyngioma (9 males, 7 females) were included in this study (patient group). The data of patient group were compared to those of children who visited the clinic for normal short stature with appropriate gestational age (14 males, 4 females) (control group). Height SDS, weight SDS, BMI were calculated. Total body fat, abdominal fat distribution were measured by bioelectrical impedance analysis. Plasma levels of total cholesterol, HDL-cholesterol, triglycerides, adiponectin, and insulin were measured after overnight fasting. The degree of insulin resistance was calculated by HOMA-IR. RESULTS:Four of 16 patients were obese. and three were overweight. Patient group had higher total body fat percentage (27.5+/-6.8 vs 17.6+/-6.8, P=0.01), triglycerides (207.9+/-241.6 vs 76.7+/-30.8, P=0.001), lower HDL-cholesterol (37.5+/-14.6 vs 61.4+/-15.4, P=0.000) and adiponectin levels (7.1+/-4.2 vs 10.7+/-4.3, P=0.012). Adiponectin levels were correlated negatively with total body fat percentage (r=-0.631, P= 0.009), abdominal fat distribution (r=-0.547, P=0.03), triglycerides (r=-0.518, P=0.04), insulin (r=-0.525, P=0.037) and correlated positively with HDL-cholesterol (r=0.572, P=0.021). CONCLUSION: These results suggest that children who were surgically treated for craniopharyngioma, had tendency to develop obesity, dyslipidemia and Insulin resistance. Therefore, patients who were surgically treated, should be closely monitored to minimize the effect of metabolic syndrome on their health and well being.
Abdominal Fat ; Adiponectin ; Adipose Tissue ; Body Composition ; Child* ; Cholesterol ; Craniopharyngioma* ; Dyslipidemias ; Electric Impedance ; Fasting ; Gestational Age ; Humans ; Insulin ; Insulin Resistance ; Male ; Obesity ; Overweight ; Plasma ; Triglycerides

To define the basic sequential events of the healing process in normal fracture and evaluate the role of growth regulatory molecules and extracellular matrix components, the expression of transforming growth factor β(TGF-β), platelet-derived growth factor(PDGF), type I and II collagen, and chemistry during the healing process of an experimental fracture of tibia in 41 adult rats for 7 weeks using ABC methods. The phases of inflammation, reparation, and remodeling followed each other in sequence. The inflammatory phase was characterized by hemorrhage, edema, and infiltration of inflammatory cells on the first day. During the reparative phase, the undifferentiated mesenchyme undergoes rapid chondrogenesis, followed by endochondral ossification and supplemented by appositional bone formation. At day 3, the expression of TGF-β and PDGF was noted in the undifferentiated mesenchymal cells and from day 5, these two growth factors were detected in the osteoblasts and extracellular matrix in areas of endochondral ossification and newly formed periosteal bone. From day 3, the expression of type I collagen and osteonectin was noted in the osteoblasts and extracellular matrix in both endochondral ossification and appositional bone growth as a marker of ossification. From day 3, type III collagen was mainly expressed in the plump mesenchymal cells showing chondroid differentiation and chondroid matrix as a marker of cartilaginous reparative phase. From day 14, these growth factors and extracellular matrix components were decreased in staining intensity and at the 5th week, the histology and immunostaining pattern were similar to the mature bone.
Adult ; Animals ; Bone Development ; Chemistry ; Chondrogenesis ; Collagen Type I ; Collagen Type III ; Collagen ; Edema ; Extracellular Matrix ; Fracture Healing ; Hemorrhage ; Humans ; Inflammation ; Intercellular Signaling Peptides and Proteins ; Mesoderm ; Osteoblasts ; Osteogenesis ; Osteonectin ; Rats ; Tibia ; Transforming Growth Factors

Animals ; Ascorbic Acid ; Asian Continental Ancestry Group ; Calcium ; Cholesterol ; Diet ; Humans ; Iron ; Multivariate Analysis ; Niacin ; Pantothenic Acid ; Plants ; Riboflavin ; Selenium ; Sodium ; Vegetarians ; Vitamin D ; Vitamin K ; Vitamins ; Zinc

PURPOSE: Renal vascular clamping during a laparoscopic partial nephrectomy is a time-consuming procedure with a risk of renal ischemia. To study the feasibility of laparoscopic partial nephrectomy without renal arterial clamping, we compared the procedure with laparoscopic partial nephrectomy with vascular clamping. MATERIALS AND METHODS: Seventeen patients underwent laparoscopic partial nephrectomy without renal arterial clamping (group 1) from February 2004 to June 2008. The operative results were reviewed retrospectively and compared with those of 16 patients who underwent laparoscopic partial nephrectomy with arterial clamping (group 2). Patient characteristics did not differ significantly between the 2 groups. However, exophytic tumors were detected in 13 patients in group 1 and 3 patients in group 2 (p=0.001). Scores on the preoperative aspects and dimensions used for an anatomical (PADUA) classification were 6.9 in group 1 and 7.7 in group 2 (p=0.037). All surgeries by the transperitoneal approach were performed by a single surgeon. RESULTS: The mean operative times were 103 and 130 minutes in groups 1 and 2, respectively (p=0.312). The mean renal arterial clamping time of group 2 was 27.6 minutes (range, 20-42 minutes). The mean estimated blood loss was 327 ml in group 1 and 315 ml in group 2 (p=0.971). The mean postoperative change in the glomerular filtration rate was 20.11 ml/min/1.73 m2 in group 1 and 18.95 ml/min/1.73 m2 in group 2 (p=0.748). The mean times to postoperative initiation of ambulation and of oral intake were 1.6 and 1.7 days (p=0.486) and 1.3 and 1.6 days (p=0.811) in groups 1 and 2, respectively. The mean length of hospital stay was 7.4 and 7.9 days in groups 1 and 2, respectively (p=0.9). The mean tumor size was 2.1 cm (range, 1-7 cm) in group 1 and 3.3 cm (range, 1.5-9 cm) in group 2. CONCLUSIONS: Laparoscopic partial nephrectomy without renal arterial clamping is feasible for a localized renal tumor. However, patients should be selected carefully, such as those with an exophytic tumor.
Constriction ; Glomerular Filtration Rate ; Humans ; Ischemia ; Kidney Neoplasms ; Laparoscopy ; Length of Stay ; Nephrectomy ; Operative Time ; Retrospective Studies ; Walking

BACKGROUND: In our hospital, an abrupt increase in the resistant rate of A. baumannii to imipenem was observed. We evaluated the imipenem minimal inhibitory concentration (MIC) of an automated system that our laboratory is using, by comparing with those of other methods. METHODS: During the period from February 2002 to February 2003, the imipenem MICs of the agar dilution method, Etest(R), and the disk diffusion method, were compared for imipenem-resistant A. baumannii tested by an automated system in 46 samples at Chung-Ang University Phil-Dong Hospital. We tested for susceptibility to imipenem with the Vitek system by using the GNI card, the disk diffusion method by using the imipenem disk (BBL(TM)), and the agar dilution method. PCR testing of the isolates for carbapenemase genes (IMP-1 and VIM-2) detected in other hospitals was done using published primers and conditions. RESULTS: By the agar dilution method, 23 (50.0%) isolates were susceptible to imipenem, 14 (30.4%) isolates were intermediate, and 9 (19.6%) isolates were resistant. However, by the Etest, 8 (17.4%) were susceptible to imipenem, and 28 (60.9%) isolates were resistant. By the disk diffusion method, the susceptible isolates were 14 (30.4%) and the resistant isolates were 17 (37.0%). Quantitative agreement between the agar dilution method and the disk diffusion test gave an inverse linear correlation coefficient (r=-0.564). The results of the 13 isolates, whose results of the MIC were below 2 or above 16 in the agar dilution method, corresponded with the Etest and the disk diffusion test. The IMP-1 gene was detected in one isolate. CONCLUSIONS: It is recommended that when a gram-negative bacilli isolate including A. baumannii is characterized as resistant to imipenem by the Vitek system, an additional simple test, such as the disk diffusion assay, might be used.
Acinetobacter baumannii* ; Agar ; Diffusion ; Imipenem* ; Polymerase Chain Reaction

No abstract available.
Colon* ; Gastrointestinal Hemorrhage* ; Varicose Veins*

PURPOSE: Since the introduction of newborn screening, the detection rate of transient hypothyroidism has been increased. Therefore, we aimed to reevaluate the prevalences of congenital hypothyroidism according to etiology and to evaluate the clinical characteristics to differentiate between transient and permanent hypothyroidism before L-thyroxine withdrawal to avoid unnecessary prolonged treatment. METHODS: We retrospectively reviewed medical records of 25 male and 46 female patients diagnosed as congenital hypothyroidism by newborn screening from 1992 to 2002. We performed thyroid function test such as T3, TSH and total T4 before 1997, and free T4 from 1997. RESULTS: Since the introduction of newborn screening, the prevalences of permanent congenital and transient hypothyroidism were 53.5% and 46.5%, respectively. Thyroid dysgenesis was more common in females (males 3, females 22, P<0.05). Among 58 patients, who were not confirmed as thyroid dysgenesis at L-thyroxine therapy, the proportion of transient and permanent hypothyroidism were 32 (55.2%) and 26 (44.8%) respectively. There were no significant differences in free T4, total T4, TSH levels at initial diagnosis between transient and permanent hypothyroidism patients. Permanent hypothyroidism patients could not withdraw L-thyroxine during the first 3 years. Among 32 patients with transient hypothyroidism, 30, 23, and 17 patients continued L-thyroxine therapy at 1, 2, and 3 years of age, respectively. The mean duration of L-thyroxine therapy was 26.4+/-11.8 months. The dose of L-thyroxine had been significantly decreased since 6 months of age in the patients with transient hypothyroidism (P<0.05). The patients with thyroid aplasia received the highest dose of L-thyroxine from 6 to 36 months of age (P<0.05). Among 13 patients who were confirmed as thyroid dysgenesis at L-thyroxine therapy, 12 patients were confirmed as permanent hypothyroidism, while one patient, who was diagnosed as thyroid aplasia by thyroid scan, revealed normal thyroid gland and could be ceased thyroid hormone therapy at 3 years of age. CONCLUSION: We could not differentiate between transient and permanent hypothyroidism by free T4, total T4 and TSH levels at the initial diagnosis. We could diagnose as permanent hypothyroidism in patients with thyroid dysgenesis and with higher or appropriate L-thyroxine doses for weight to maintain euthyroid during follow-up. We therefore suggest that diagnostic test maybe done before 3 years of age in some patients who had the histories of suspecting transient hypothyroidism and significantly low L-thyroxine doses for weight.
Congenital Hypothyroidism* ; Diagnosis ; Diagnostic Tests, Routine ; Female ; Follow-Up Studies ; Humans ; Hypothyroidism* ; Infant, Newborn* ; Male ; Mass Screening* ; Medical Records ; Neonatal Screening ; Prevalence ; Retrospective Studies ; Thyroid Dysgenesis ; Thyroid Function Tests ; Thyroid Gland ; Thyroxine