Endometrial squamous cell carcinoma is extremely rare. In 1928 Fluhmann proposed three criteria to establish the diagnosis of endometrial squamous cell carcinoma: (1) no coexisting endometrial adenocarcinoma, (2) no connection between the endometrial tumor and the squamous epithelium of the cervix, and (3) no squamous cell carcinoma of the cervix present. More recently, the World Health Organization (WHO) updated Fluhmann's criteria by adding that the tumor must contain clear evidence of squamous differentiation, such as the presence of intercellular bridges and/or keratin. We presented a case of carcinoma in situ of endocervix and endometrial squamous cell carcinoma involving full thickness of whole endometrium with a review of literature.
Adenocarcinoma ; Carcinoma in Situ ; Carcinoma, Squamous Cell* ; Cervix Uteri ; Diagnosis ; Endometrium ; Epithelium ; Female ; World Health Organization

BACKGROUND: A pulmonary tuberculoma is one of the most common causes of a solitary pulmonary lesion. Treating a tuberculoma is still controversial and there are few reports on antituberculosis chemotherapy. In this study, the clinical findings and changes in the size of tuberculomas on a radiograph after completing antiuberculosis chemotherapy was investigated. METHODS: The medical records, an chest radiographs of 18 pulmonary tuberculoma patients who were admitted to the Gachon medical school, Ghil medical center between April 1998 and August 2001, were reviewed. The symptomatic changes were recorded and the size of the tuberculomasl following treatment were compared. To compare the size, the long distance of each tuberculoma on the chest radiographs were measured and the additional radiological findings of calcification, satellite nodules and cavities were investigated. RESULTS: Fifteen patients were men and 3 were women. The median age was 46(24-74). Among these 18 patients, 14 patients had clinical symptoms. The other 4 patients were diagnosed incidentally as during a routine chest radiograph. The mean size of the tuberculomas on the initial plain chest film was 4.3+/-2.3cm(range : 1.7-10cm)and after 6 months treatment, it had decreased to 1.68+/-2.00cm(range : 1.5-6.5cm)(P<0.05). At least 6 months of antituberculosis chemotherapy resulted in the findings of a tuberculoma with a disappearance in 9, a decreased size in 4, and no change in 5 on the chest radiograph. Calcifications were found in 3 patients on the initial chest film and the chest CT and all calcified tuberculomas had disappeared after treatment. CONCLUSIONS: A lthough a pulmonary tuberculoma can remain as an inactive lesion for a long time, if it is confirmed by pathological or bacteriological methods, antituberculosis chemotherapy will be beneficial despite the presence of calcification.
Drug Therapy ; Female ; Humans ; Male ; Medical Records ; Radiography, Thoracic ; Schools, Medical ; Thorax ; Tomography, X-Ray Computed ; Tuberculoma*

Microscopic polyangiitis is a systemic small-vessel vasculitis that is associated primarily with necrotizing glomerulonephritis and pulmonary capillaritis. A recurrent and diffuse alveolar hemorrhage due to pulmonary capi llaritis is the main clinical manifestation of lung involvement. Recently, an interstitial lung disease that mimics idiopathic pulmonary fibrosis was reported to be rarely associated with microscopic polyangiitis. Here we report two patients with microscopic polyangiitis who showed a honeycomb lung at the time of the initial diagnosis with a brief review of relevant literature.
Diagnosis ; Glomerulonephritis ; Hemorrhage ; Humans ; Idiopathic Pulmonary Fibrosis ; Lung Diseases, Interstitial ; Lung* ; Microscopic Polyangiitis* ; Vasculitis

Paraquat intoxication is a fatal problem. Most of paraquat intoxications happen through oral administration. But there is no clinical data for parenteral paraquat intoxication, so we will describe its fatal progression and clinical course. A 52-year-old male injected paraquat solution on his thigh. Initial serum level of paraquat was 42.7 microgram/mL and urgent hemoperfusion was performed and his serum level of paraquat was reduced by 5.2 microgram/mL. But the patient expired due to respiratory failure and hypoxemia. Different from oral paraquat poisoning, serum level of the drug increases rapidly in intramuscular intoxication. So the paraquat in blood rapidly accumulates in tissue, especially lung parenchyme. We removed his paraquat in blood rapidly, but could not get rid of tissue concentration, so we lost him even with lowered serum paraquat level. Through this case, it is thought that the paraquat intoxication via intramuscular injection can make up a extremely poor prognosis even with very a little amount of paraquat.
Administration, Oral ; Anoxia ; Hemoperfusion ; Humans ; Injections, Intramuscular* ; Lung ; Male ; Middle Aged ; Paraquat* ; Poisoning ; Prognosis ; Respiratory Insufficiency ; Thigh

Acquired amegakaryocytic thrombocytopenia is a relatively rare bone marrow failure disorder characterized by severe thrombocytopenia associated with a total absence or a marked reduction in the number of bone marrow megakaryocytes. We report a case of acquired amegakaryocytic thrombocytopenia. A 39-year old man admitted our hospital because of gingival bleeding and purpura on the thigh, his initial complete blood cell counts were white blood cell 5.6 103/micro liter hemoglobin 9g/dL, and platelet 1 103/micro liter On the bone marrow study, megakaryocyte was not observed and cytogenetic analysis of marrow was 46, XY, inv(9). (p11q13). Other autoimmune markers were negative. The patient received steroid therapy during 8 weeks, but there was no significant improvement and then he received immunosuppressive therapy with antithymocyte globulin and cyclosporin-A. Thereafter the platelet count increased to 80 103/micro liter, and this level continued for 10 months
Adult ; Antilymphocyte Serum ; Blood Cell Count ; Blood Platelets ; Bone Marrow ; Cytogenetic Analysis ; Hemorrhage ; Humans ; Leukocytes ; Megakaryocytes ; Platelet Count ; Purpura ; Thigh ; Thrombocytopenia*

We report the case of a 43-year-old woman with Cushing's syndrome showing bilateral adrenococortical adenomas. We performed bilateral selective adrenal vein samplings. Hypersecretion of cortisol on the left sided adrenal tumor was observed, but no evidence of cortisol hypersecretion from the adrenal tumor on the right side was observed. The left adrenal tumor was resected selectively, but the right adrenal gland was reserved. The left adrenal tumor was histologically diagnosed as a adrenal adenoma without any evidence of nodular hyperplasia. Following the resection of the left adrenal gland, no cortisol hypersecretion from the remaining adrenal tumor on the right side was observed until now, suggesting that a selective adrenalectomy of functioning adenoma may be an acceptable treatment modality.
Adenoma* ; Adrenal Glands ; Adrenalectomy ; Adrenocortical Adenoma* ; Adult ; Cushing Syndrome* ; Female ; Humans ; Hydrocortisone ; Hyperplasia ; Veins

Mucormycosis is an uncommon, frequently fatal, opportunistic fungal infection and usually occur in immunocompromised patients. Rhinocerebral and pulmonary disease are the common forms but intestinal infection is an extremely rare form of the disease. Invasive intestinal mucormycosis is usually fatal, therefore, few cases reported survival after early diagnosis and surgical resection combined with antifungal treatment. Because of high mortality after surgery, the healing of ulcers caused by intestinal mucormycosis has not previously observed in immunocompromised host. We reported a case of the intestinal mucormycosis that had been healed the ulcer and symptomatic improvement after only amphotericin B.
Amphotericin B* ; Early Diagnosis ; Immunocompromised Host ; Lung Diseases ; Mortality ; Mucormycosis* ; Ulcer*

Adrenal gland is a common site of metastatic tumors such as breast cancer, lung cancer, and colon cancer. When adrenal mass is found incidentally, adenoma is the most common among single adrenal masses. But in the case of bilateral adrenal masses, infection, bilateral metastases and hemorrhage are common. Secondary involvement of the adrenal gland is found in 25% of autopsy cases of non-Hodgkin's lymphoma. However, adrenal insufficiency is rare because it becomes apparent only when approximately 90% of adrenal cortex is destructed. We exprienced two cases of malignant lymphoma which involved the adrenal glands bilaterally. One case in which adrenal insufficiency was suspicious, was accompanied by hypovolemic shock and sepsis at the initial presentation. He died of sepsis combined with DIC even though hydrocortisone, intravenous saline infusion, and antibiotics therapy were started immediately. The other one was found incidentally, in which adrenal infiltraion was confirmed by CT scan. Hormonal level was normal and adrenal masses disappeared after chemotherapy.
Adenoma ; Adrenal Cortex ; Adrenal Glands* ; Adrenal Insufficiency ; Anti-Bacterial Agents ; Autopsy ; Breast Neoplasms ; Colonic Neoplasms ; Dacarbazine ; Drug Therapy ; Hemorrhage ; Hydrocortisone ; Lung Neoplasms ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Neoplasm Metastasis ; Sepsis ; Shock ; Tomography, X-Ray Computed

BACKGROUND: There have been several studies showing that angiotensin II and the angiotensin convertingenzyme (ACE) contribute to the activation of fibroblast including the pulmonary fibrosis, and apoptosis of the al veolar epithelium in idiopathic intersititial pneumonia. This study was performed to identify the relationship between the serum angiotensin II. ACE and the pulmonary function test (PFT), the dyspnea score, and the cell fraction of the bronchoalveolar lavage fluid (BALF). METHODS: Twenty three patients with idiopathic interstitial pneumonia from March, 1999 to October, 2001 at Gachon medical school were enrolled in this study. They were divided into IPF(UIP) (16) and NSIP (7) group. Twelve of the idiopathic interstitial pneumonia patients (UIP : 5, NSIP: 7) were diagnosed by an open lung biopsy, 11 of IPF patients were diagnosed by the American Thoracic Society (ATS) diagnostic criteria. The PFT values, dyspnea score, serum ACE and angiotensin II were measured, and a bronchoscopy was performed to obtain the BALF. RESULTS: Of all the patients, 7 were in the normal range and 14 showed an increase in the serum level of angiotensin II. In terms of the serum ACE level, 14 patients had an increased level. The DLCO% of the angiotensin II. increased group was significantly lower than the not-increased group (p=0.021). Other factors did not correlate with the serum ACE or the angiotensin II increased group and not-increased group. CONCLUSION: These results suggest that an increased angiotensinII serum level may be associated with in crease in the of alveolar capillary block in the progression of pulmonary fibrosis in idiopathic interstitial pneumonia.
Angiotensin II* ; Angiotensins* ; Apoptosis ; Biomarkers* ; Biopsy ; Bronchoalveolar Lavage Fluid ; Bronchoscopy ; Capillaries ; Dyspnea ; Epithelium ; Fibroblasts ; Fibrosis ; Humans ; Idiopathic Interstitial Pneumonias* ; Lung ; Peptidyl-Dipeptidase A* ; Pneumonia ; Pulmonary Fibrosis ; Reference Values ; Respiratory Function Tests ; Schools, Medical

PURPOSE: This study was aimed to investigate the effect of early phosphorus intake on respiratory distress in extremely low-birth-weight infants (ELBWIs) with a high incidence of hypophosphatemia. METHODS: We performed a retrospective study to target 164 ELBWIs admitted to the neonatal intensive care unit in Seoul National University Children's Hospital. Birth characteristics, nutritional intake, and electrolyte levels during the first week were investigated as predictors that would affect the clinical outcomes. The correlations among invasive ventilation at postnatal age of 2 weeks, moderate-to-severe bronchopulmonary dysplasia (BPD), and phosphorous intake were analyzed. RESULTS: Hypophosphatemia (phosphorus level <4 mg/dL) was observed in 72.0% of the subjects. The rates of invasive ventilation (P=0.001) and moderate-to-severe BPD (P=0.005) were significantly lower in the high phosphorus intake group (≥0.7 mM/kg/day) than in the low phosphorus intake group (<0.7 mM/kg/day). Phosphorus intake during the first week was a significant factor affecting invasive ventilation at 2 weeks of age (adjusted odds ratio [OR], 8.212; 95% confidence interval [CI], 2.256 to 28.896; P=0.001) and moderate-to-severe BPD (adjusted OR, 3.402; 95% CI, 1.274 to 9.084; P=0.015). CONCLUSION: Early insufficient phosphorus intake confers a significantly higher risk with invasive ventilation at 2 weeks of age and moderate-to-severe BPD. Therefore, early sufficient phosphorus supply may improve respiratory outcomes in ELBWIs.
Bronchopulmonary Dysplasia ; Humans ; Hypophosphatemia ; Incidence ; Infant, Extremely Low Birth Weight ; Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care, Neonatal ; Odds Ratio ; Parturition ; Phosphorus ; Retrospective Studies ; Seoul ; Ventilation