A total of 362 bile samples from 104 patients with evidence of biliary tract obstruction were submitted for diagnostic cytology from January, 1989 to April, 1991. The patients were classified based on the obstructive cause, and the cytologic results were reviewed. 298 of the specimens were from patients with intrabiliary malignant stricture, and 17 were from patients with extrabiliary malignant compression or benign biliary obstruction. Bile cytology was positive for carcinoma in 42 samples from patients with intrabiliary malignant stricture, and the diagnostic sensitivity was 14%. There were no false positive cases. We concluded that the cause of low sensitivity was degenerative change of cell due to prolonged sampling time. What is noteworthy was the high prevalence of Clonorchis sinensis eggs, being detected in 25 patients with intrabiliary malignancy, supporting the association between clonorchiasis and biliary tree malignancy.
Bile ; Biliary Tract ; Clonorchiasis ; Clonorchis sinensis ; Constriction, Pathologic ; Eggs ; Humans ; Nephrotic Syndrome* ; Ovum ; Prevalence

Histopathologic studies for Helicobacter pylori (H. pylori)-associated chronic gastritis have been mostly undertaken with endoscopic biopsy specimens, often leading to an inappropriate evaluation of the gastric mucosal alterations. The purpose of this paper was designed to investigate the actual prevalence of lymphoid follicle formation by H. pylori infection using the resected stomachs. A total of 16 fresh gastrectomy specimens bearing gastric carcinoma were examined under the quick and gentle procedure, with which H. pylori was detected in 12 cases (75%) and lymphoid follicles in 14 cases (87.5%), while the detection rate of H. pylori remained 56.3% in the control group which comprised the same 16 resected stomachs and were examined by routine tissue preparation procedure without any special care. There was a significant correlation between the presence of H. pylori and lymphoid follicle formation (p=0.05), but no correlation was found between the grades of H. pylori and lymphoid follicles. The topographical distribution of H. pylori or lymphoid follicles in antrum and body gave no statistical difference. Similarly, there was no correlation between H. pylori infection and intestinal metaplasia, activity of chronic gastritis or histologic types of accompanying adenocarcinoma. We conclude that studies of the gastric mucosal change by H. pylori infection using the gastrectomy specimens provide a useful information for analysis of lymphoid follicle formation which is a consistent morphological characteristic of H. pylori infection.
Adenocarcinoma ; Biopsy ; Gastrectomy* ; Gastritis ; Helicobacter pylori* ; Helicobacter* ; Metaplasia ; Prevalence ; Stomach

Cytomegalovirus (CMV) infection is an uncommon association with idiopathic inflammatory bowel disease (IBD) often leading to a variety of serious complications. A total of 41 resected cases of IBD were examined to elucidate the pathologic features of intestinal CMV infection which was assessed by histologic examination and confirmed by immunohistochemistry with CMV antibody. Six cases were positve for CMV antibody; five cases in 19 ulcerative colitis (UC, 26.3%) and one case in 22 Crohn's disease (CD, 4.5%). Of 7 cases of the steroid-treated UC group, five cases were superinfected with CMV (71.4%) but none in 12 cases of the steroid-untreated UC group. All of the five CMV-positive cases in UC showed deep ulceration and transmural inflammation, while none of 10 UC cases without above features were CMV positive. Fibrinoid necrosis and thrombi were found in 83.3% of the CMV infected group, while none in the CMV-negative group of UC cases (p=0.01). We conclude that IBD, particularly UC, is susceptible to the CMV infection when steroid hormone is administered, and that deep colonic ulceration, transmural inflammation and fibrinoid necrosis of vasculature may suggest superinfection of CMV in UC patients. It seems that deep colonic ulceration may be the consequence of an ischemic change following vascular luminal occlusion or vasculitis by CMV infection.
Colitis, Ulcerative ; Colon ; Crohn Disease ; Cytomegalovirus Infections* ; Cytomegalovirus* ; Humans ; Immunohistochemistry ; Inflammation ; Inflammatory Bowel Diseases* ; Necrosis ; Phenobarbital ; Superinfection ; Ulcer ; Vasculitis

PURPOSE: To compare the antimicrobial effects of various kinds of multi-purpose solutions, study effective ways of washing contact lens (CLs), and suggest the most effective lens care system using P. aeruginosa-contaminated CLs. METHODS: Each disposable soft CL was incubated in 0.1 ml of diluted solution of P. aeruginosa standardstrain (10(8)CFU / mm(3)) and 0.9 ml tryptic soy broth in cell culture wells for 24 hours. In the first experimental group, to find the most antimicrobial solution, 40 CLs contaminated by P. aeruginosa were divided into four subgroups washed with four different kinds of multi-purpose solutions. Ten CLs were used in each subgroup and in the control group; Ten CLs contaminated by P. aeruginosa were washed with phosphate buffered saline (PBS) instead of cleaning solution. In the second experiment groups to find the most effective way of washing, using only Renu Multiplus multi-purpose solutionR we compared the antimicrobial effect of four different ways of washing including 30 seconds rubbing, 30 minutes soaking, 4 hours soaking, 30 seconds rubbing and 4 hours soaking. RESULTS: There was no significant difference of antimicrobial effect between four kinds of multi-purpose solutions. All methods have a significant antimicrobial effect over control group (P<0.001) and the most effective method of washing CLs was 4 hours soaking. CONCLUSIONS: we should advise all the soft CL users that they should have their CLs soaked over 4 hours everyday after wearing it.
Cell Culture Techniques ; Contact Lens Solutions* ; Contact Lenses, Hydrophilic ; Pseudomonas aeruginosa

A 9-year-old boy of B blood group with end-stage renal disease due to IgA nephropathy received group O kidney transplantation from his father. On day 9, he developed intravascular hemolysis, and anti-B autoantibody formation was confirmed. We diagnosed as immune hemolytic anemia due to passenger lymphocyte from donor, and cyclosporine withdrawl was done. Anemia resolved spontaneously, but on day 18, graft dysfunction developed, and graft biopsy revealed acute allograft rejection. Although hemolysis due to autoantibody is very rare and often mild, and the role of hemoglobinuria on acute rejection in this case is not certain, we recommend consideration of aggressive management on severe hemolysis after minor mismatched kidney transplantation.
Allografts ; Anemia ; Anemia, Hemolytic ; Biopsy ; Child ; Cyclosporine ; Fathers ; Glomerulonephritis, IGA ; Hemoglobinuria ; Hemolysis* ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Lymphocytes ; Male ; Tissue Donors ; Transplants

PURPOSE: The urinary mass screening program in school aged population has been performed since 1981, but the consensus on the follow-up schedule and the management of isolated proteinuria has not been reached yet. The aim of this study was to investigate the cause of isolated proteinuria and to propose a guideline for the treatment and follow-up afterwards. Methods: The medical records of 114 cases of isolated proteinuria detected through the analysis of urinary mass screening and evaluated at the pediatric outpatient clinic of Asan Medical Center from January 1990 to July 2001 have been reviewed. RESULTS: The classification of isolated proteinuria was as follows. Transient proteinuria 32%, orthostatic proteinuria 65%, persistent proteinuria 3%. In orthostatic proteinuria group, daytime and nighttime proteinuria were 319.2+/-89.1 mg/dL and 56.5+/-6.1 mg/dL. In persistent proteinuria group, daytime and nighttime proteinuria were 1140+/-40.5 mg/dL and 289+/-8 mg/dL. After 30 month follow-up, 2 cases of persistent proteinuria were needed renal biopsy and 1 case revealed focal segmental glomerular sclerosis. In all cases, serum creatinine, albumin and complements levels were normal. In the orthostatic proteinuria group, no significant renal diseases were detected. CONCLUSION: Since most of the isolated proteinuria detected through the school urinary mass screening were orthostatic proteinuria or transient proteinuria, initially aggressive diagnostic method such as renal biopsy is not needed and regular follow-up with quantitation of proteinuria is warranted.
Ambulatory Care Facilities ; Appointments and Schedules ; Biopsy ; Chungcheongnam-do ; Classification ; Complement System Proteins ; Consensus ; Creatinine ; Follow-Up Studies ; Humans ; Mass Screening* ; Medical Records ; Proteinuria* ; Sclerosis

PURPOSE: Streptococcus pneumoniae is a major pathogen in both adults and children, causing significant morbidity and mortality. In patients with nephrotic syndrome, Streptococcus pneumoniae is a major cause of spontaneous peritonitis, and the increasing incidence of penicillin-resistance strain facilitates the development of effective vaccine. The limitation of current pneumococcal polysaccharide vaccine prompted development of polysaccharide-protein conjugate vaccine. METHODS: We reviewed the medical record of total 225 steroid responsive nephrotic patients to ascertain the effectiveness of 23-valent pneumococcal polysaccharide vaccine. RESULTS: Twenty-eight patients have developed peritonitis during the courses, and 7 of those have recurrent peritonitis. Fifty-five patients were vaccinated and followed-up for 1-108 months (mean 38.5 months), and during the follow-up period, pneumococcus related peritonitis was not detected. Vaccine-related relapse of nephrotic syndrome was absent. CONCLUSION: In spite of the non-consensus about the efficacy of PPV23, clinically it benefits, and until the clinical trial of PCV7 is completed, PPV23 will be recommended.
Adult ; Child ; Follow-Up Studies ; Humans ; Incidence ; Medical Records ; Mortality ; Nephrotic Syndrome* ; Peritonitis ; Pneumococcal Vaccines* ; Recurrence ; Streptococcus pneumoniae

Tubulointerstitial nephritis and uveitis (TINU) is a rare syndrome of unknown etiology involving the kidney and the eye. This is the first case report of TINU in Korea. The diagnosis of TINU was confirmed in a 15-year-old girl on the basis of pathologically proven tubulointerstital nephritis and bilateral uveitis. Although the renal symptoms disappeared spontaneously, uveitis showed only partial response to topical steroid treatment and persisted for more than 11 months. TINU should be included in the differential diagnosis of tubulointerstitial nephritis of unknown etiology.
Adolescent ; Diagnosis ; Diagnosis, Differential ; Female ; Humans ; Kidney ; Korea ; Nephritis ; Nephritis, Interstitial* ; Uveitis*

Ketogenic diet is a high-fat, low carbohydrate, low protein diet used in treatment of pediatric epilepsy since the 1920s. Currently it is used primarily to treat refractory childhood epilepsy. Few serious complications caused by ketogenic diet have been reported. Short-term complications include dehydration, hypoglycemia, vomiting, diarrhea, and refusal to eat. Long-term complications include kidney stones, recurrent infections, metabolic derangement, hypercholesterolemia, irritability, lethargy, and refusal to eat. We experienced 3 cases of infantile spasm patients, whose refractory seizures were controlled with ketogenic diet, but various urinary abnormalities developed.
Dehydration ; Diarrhea ; Diet, Protein-Restricted ; Disulfiram ; Epilepsy ; Humans ; Hypercholesterolemia ; Hypoglycemia ; Infant ; Infant, Newborn ; Ketogenic Diet* ; Kidney Calculi ; Lethargy ; Seizures ; Spasms, Infantile ; Vomiting

Ki-1 positive anaplastic large cell lymphoma is a newly described high-grade lymphoma and is defined by histopathological and immunologic criteria. We experienced a case of systemically involving Ki-1 positive anaplastic large cell lymphoma in a 44 year- old female which initially manifested as pleural effusion. Abdominopelvic CT scan showed the evidence of marked lymphadenopathy in retroperitoneal and both external and inguinal lymph nodes. On cytologic examination of pleural fluid, tumor cells revealed pleomorphic large isolated cells with prominent nucleoli and abundant cytoplasms. The nuclei were large with irregular profiles including some deep invaginations. Also, occasional multilobed/ multinucleated and binucleated nuclei were seen. Immunohistochemical examination was performed to differentiate from the undifferentiated adenocarcinoma, Hodgkin's disease, non-Hodgkin's lymphoma and malignant histiocytosis. The neoplastic cells were positive for leukocyte common antigen, CD3, CD30(Ki-1) but negative for cytokeratin, epithelial membrane antigen, and CD15. A histologic diagnosis of Ki-1 positive anaplastic lymphoma was made by biopsies of the inguinal lymph node, polypoid lesions of the stomach and cecum.
Adenocarcinoma ; Amyloid ; Antigens, CD45 ; Biopsy ; Cecum ; Child* ; Cytoplasm ; Diagnosis ; Female ; Histiocytic Sarcoma ; Hodgkin Disease ; Humans ; Keratins ; Lymph Nodes ; Lymphatic Diseases ; Lymphoma ; Lymphoma, Large-Cell, Anaplastic ; Lymphoma, Non-Hodgkin ; Mucin-1 ; Multiple Myeloma ; Pleural Effusion ; Stomach ; Tomography, X-Ray Computed