A case of Toxic epidermal necrolysis in 19 th years old man is presented. This patient has been suffering from erythematous patches and bullae over entire body including vesicles, erosions, and fissures on both lips since 2 days ago after taking some drugs (analgetics, aspirin, chloramphenicol, sulfisoxazole, erythromycine.) for treatment of tonsillitis. Furthermore, it is very difficult for us to say why the disease has occured. Toxic Epidermal Necrolysis (TEN) by talking drugs or Staphylococcal Scalded Skin Syndrpme (4S) by staphylococcus aurues because staphylococcus aureus was found on bacteriai culture from his throat swab. He was treated with corticosteroid, antibiotics and fluids for 20 days with good result. Literature was briefly reviewed.
Anti-Bacterial Agents ; Aspirin ; Chloramphenicol ; Humans ; Lip ; Palatine Tonsil ; Pharynx ; Skin ; Staphylococcus ; Staphylococcus aureus ; Stevens-Johnson Syndrome* ; Sulfisoxazole ; Tonsillitis

Malignant mixed mullerian tumor (MMMT) is an unusual tumor composed of malignant epithelial and nonepithelial components in the same lesion and is subdivided into homologous and heterologous types. Epidemiologically, these tumors are associated with prior pelvic irradiation, functioning ovarian lesions, exogenous estrogen therapy and rarely endometriosis. We experienced a case of uterine MMMT which arose from adenomyosis in a 47-year-old woman who had no specific past medical history. The posterior uterine corpus showed a 3.5x3.0x2.0 cm sized, relatively well defined tumor mass within the background of the adenomyosis. The tumor was composed of well differentiated endometrial adenocarcinoma and sarcomatous stroma with foci of rhabdomyosarcomatous differentiation confirmed by immunohistochemical and electron microscopic studies. Through the immunohistochemical study, both the epithelial and nonepithelial components were positive for cytokeratin and it suggested that the sarcomatous area originated from metaplasia of the adenocarcinoma component. From the overall findings, it is regarded as an uterine heterologous MMMT which arose from adenomyosis.
Adenocarcinoma ; Adenomyosis* ; Endometriosis ; Estrogens ; Female ; Humans ; Keratins ; Metaplasia ; Middle Aged ; Rhabdomyosarcoma ; Uterus*

Adult Wilms' tumor, unlike that of childhood, is a rare disease. Microscopically, the tumor is fundamentally characterized by triplastic embryonal renal tumor composed of variable amounts of metanephric blastema and its epithelial and stromal derivatives but rarely a small group of tumors composed virtually entirely of differentiated epithelial derivatives, the abundance of tubular structures. These monomorphous epithelial type of Wilms' tumor tended to have an early onset and benign course. Grossly, classic Wilms' tumor is a solid tumor, but very rarely shows cystic change and may lead to misinterpretation as a polycystic kidney or multicystic nephroma. Here, we reports a case of primary renal tumor, grossly very similar to a multicystic kidney but histologically represent a tubular monomorphous epithelial variant of Wilms' tumor occured in 63 year old male adult.
Child ; Adult ; Male ; Female ; Humans

We present a case of localized mucosal hyperplasia of the stomach. The resected stomach contained four large, short stalked polyps, three of which were located in the anterior wall of body and the other in the posterior wall. In addition, numerous small sessile polyps were also scattered in the anterior and posterior fundic walls. Microscopically, the abnormally thick mucosa, carrying with it the muscularis mucosae and a thin core of loose fibrous tissue comprised the polyps by intraluminal infolding of widening of mucosal area. Abundant vasculature of the rugal pattern was prominent in the submucosa. The above findings suggest that the histogenesis of the polyps is related to both hyperplastic thickening and widening of mucosal areas in rugal pattern in the background of inverted distribution pattern of intestinal metaplasia.

No abstract available.
Humans ; Pregnancy* ; Ultrasonography*

The nucleolus of human cell is a morphologically well recognizable nuclear organelle and the argyrophilic NORs (AgNORs) are nucleic acid-argyrophilic nonhistone protein complex in the nucleoli and the silver staining allows their identification and enumeration at the light microscopic level. The AgNOR counts are in parallel with mitotic activity and vary in different phase of cell cycle. It has been reported that human cells have one AgNOR during interphase and S-phase. However, the correlation between the number of AgNORs and S-phase markers is still controversial and they have never been studied simultaneously. In this study, AgNOR and PCNA were stained simultaneously to find out the relationship of AgNOR counts with cell cycle (S-phase) in human palatine tonsil, gastric carcinoma, liver and brain tissues. S-phase cells (PCNA-positive) were found predominantly in lymphoid follicles in palatine tonsil but gastric carcinoma showed diffuse immunoreactivity for PCNA. The AgNOR counts varied according to the type and locus of tissue. More than one AgNOR were identified in S-phase cells and some of hepatocytes and neurons in the brain which were not in S-phase contained two or more AgNORs. The above results suggest that the number of AgNOR is a characteristic feature of each type of cells and can be more than one even in S-phase.
Brain ; Cell Cycle ; Hepatocytes ; Humans* ; Interphase ; Liver ; Neurons ; Organelles ; Palatine Tonsil ; Proliferating Cell Nuclear Antigen ; Silver Staining

Obstructive colitis is an ulceroinflammatory lesion of the large intestine at a distance proximal to the obstructing or potentially obstructing lesion of any etiology. It has been suggested that a rise in the intraluminal pressure related to the obstruction results in a fall in the intramural blood flow with subsequent ischemic necrosis. We examined 7 cases of surgically resected obstructive colitis associated with distal constrictive adenocarcinoma of the large intestine. Two cases of the obstructive colitis were radiologically suspected prior to surgery either as a separate tumor mass or diverticulosis, and another case was suggested to be a tumor seeding by colonoscopy. Grossly, five cases presented with single or multiple, shallow, well-demarcated ulcerative lesions, and the remaining two were featured with a segmental ulcerative lesion the with pseudopolypoid area. The ulceroinflammatory lesions were separated from the distal obstructive carcinoma by a skipped zone of relatively normal mucosa measuring 4-43 cm. The proximal colon to the obstructive lesions were obviously dilated except in one case. Microscopically, mucosa and submucosa were replaced by granulation tissue, and showed inflammatory cell infiltration and fibrin exudates. Muscle coat often accompanied ischemic contraction. Fissuring was noted in one case. The recognition of these lesions prior to or during surgery is stressed based on the morphological features corresponding to an ischemic change in the proximal mucosa to the primary obstructive lesion.
Adenocarcinoma

The correlation of metaplasia to dysplasia and carcinoma in the gallbladder has attracted the attention of many investigators. We mapped and examined a total of 263 cholecystectomized gallbladders to analyze the mucosal changes in the carcinogenesis of the gallbladder. Stones were present in 59.7%, hyperplasia in 28.5%, metaplasia in 55.5% (gastric 37.6%, intestinal 17.9%), dysplasia in 17.1% (low grade 9.1%, high grade 8%) and carcinoma in 7.6%. Metaplasia was more frequently identified in the stone-positive group (62.4%) than in the stone-negative group (45.3%) (P<0.05). Especially, the incidence of intestinal metaplasia was significantly higher in the stone-positive group. Dysplasia and carcinoma were more frequent in the metaplasia-positive group (dysplasia 26.7%, carcinoma 11%) than in the metaplasia-negative group (dysplasia 5.1%, carcinoma 3.4%) (P<0.05). Their incidences were significantly higher in the intestinal metaplasia than in the gastric metaplasia. Forty four percent of the dysplasia-positive cases were associated with carcinoma in the adjacent mucosa but carcinoma was absent in the dysplasia-negative cases. Hyperplasia did not reveal any significant correlation with metaplasia, dysplasia and carcinoma. These results suggest that gallstone is causally related to the metaplasia in the gallbladder and the metaplasia-dysplasia- carcinoma sequence exists in the gallbladder.
Adenocarcinoma* ; Carcinogenesis ; Gallbladder* ; Gallstones ; Humans ; Hyperplasia* ; Incidence ; Metaplasia* ; Mucous Membrane ; Research Personnel

No abstract available.
Female ; Fetal Heart* ; Heart Rate, Fetal* ; Pregnancy ; Telemetry*

To analyse the clinical characteristics of children with atrial flutter(AF1), we reviewed(the medical records of the children who had been admitted and diagnosed as AF1 or 12 leads surface ECG during the period between February, 1986 and Octobe, 1990. The onset age of 25 children was evenly distributed between gestational period and upto 14 years of age. The sex ratio between boys and girls was 11:14. The cardiac abnormalities were detected in 21 children(dilated cardiomyopathy in 3, congenital heart defect in 18). In 4 children, AF1 occured in apparently normal heart. In 9 children, AF1 developed without relation to cardiac surgery(4 in normal heart, 3 in dilated cardiomyopathy, 2 in preoperative CHD). AF1 developed in 9 children within 30 days postoperatively(group A) and in 7, after 30 days postoperatively(group B). In group A, various types of operation were done. In 2 of them, AF1 persisted beyond the immediate postoperative period and 1 died of cardiac decompensation 3 months postoperatively. In group B, operative procedures before AF1 were Senning operation in 2, Fontan operation in 2, operation for tetralogy of Fallot, ventricular septal defect with severe tricuspid regurgitation, endocardial cushion defect in 1 each. Five children in group B( except 1 Senning operation and 1 Fontan operation) had significant residual atrioventricular regurgitation. The associated rhythm disturbance besides AF1 could be determined in 23 children. The sinus node dysfunction was associated in 8 ; the supraventricular dysrhythmia in 10; the ventricular dysrhythmia in 6; the atrioventricular conduction disturbance in 3, and no other associated rhythm disturbance in 6. The efficacy of various methods in conversion of AF1 to sinus rhythm were 57.1%(4/7) with DC cardioversion, 38.5%(5/13) with digoxin and other antiarrhythmic drug(amiodarone, beta blocker, quinidine, verapamil, flecainide), 25%(5/20) with pacing in esophagus or endocardium. The follow-up evaluation was possible in 24 children. Eight children were dead : 5 due to chronic decompensation, 2 due to sudden cardiac arrest, and 1 due to sepsis. Of the 16 alive children, 14 had recovered the normal sinus rhythm and the other 2 had persistent AF1. Twelve children without AF1 and 1 with persistent AF1 were on medication, Although there were none cardiac death in children without persistent AF1, 7 out of 9 children with persistent AF1 were dead. Of the 7 children with significant atrioventricular regurgitation, corrective procedures were done in 4. There were no death in these 4 children, despite of 2 cardiac death out of 3 children on whom corrective procedure were not done. In conclusion, the atrioventricular regurgitation was a significant factor in relation to the occurrence and persistence of AF1 and the prognosis was bad in children with persistent AF1. It is recommended to trat the children with AF1 associated with atrioventricular regurgitation promptly and more aggressively.
Age of Onset ; Atrial Flutter* ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Child* ; Death ; Death, Sudden, Cardiac ; Digoxin ; Electric Countershock ; Electrocardiography ; Endocardial Cushion Defects ; Endocardium ; Esophagus ; Female ; Follow-Up Studies ; Fontan Procedure ; Heart ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular ; Humans ; Medical Records ; Postoperative Period ; Prognosis ; Quinidine ; Sepsis ; Sex Ratio ; Sick Sinus Syndrome ; Surgical Procedures, Operative ; Tetralogy of Fallot ; Tricuspid Valve Insufficiency ; Verapamil