Reactive human mesothelial cells were examined by immunocytochemical stain with intermediate fiiaments (cytokeratin [CK1, CK7, CK8, CK18, CD19], vimentin, desmin, actin), epithelial membrane antigen, carcinoembryonic antigen (CEA), MHC class II antigen (HLA-DR), LeuM-1 (CD15), alpha1-antitrypsin(ACT), alpha1-antichymotrypsin(ACMT), CD68(KP-1) and FcyRIII(CD16). The mesothelial cells were isolated from patients with liver cirrhosis and pleural effusion, and short-term cultured in RPMI 1640 media containing 10% heat inactivated fetal calf serum and 1% identical supernatant fluid of the patients transudates. The results obtained are as follows. 1. The cultured-reactive mesothelial cells were positive for the protein of cytoskeleton such as cytokeratin and vimentin, but negative for desmin and actin. The resting mesothelial cells showed positive reactions for cytokeratin, but negative for vimentin, desmin and actin. 2. The primary antibodies to the cytokeratin were strongly reactive for CK1, CK8 and CK18 but negative r CK7 and CK19 in both reactive and resting mesothelial cells. 3. Resting mesothelial cells showed negative reactions for CEA, but strong positive reactions in cultured-reactive mesothelial cells. 4. The markers for the monocytes/histiocytes(CD11b, CD14, CD16, CD68, lysozyme and alpha1-antitrypsin and alpha1-antichymotrypsin) were nonreactive in resting mesothelial cells, but lysozyme and alpha1-antitrypsin were weakly reactive in reactive and proliferative mesothelial cells. 5. MHC Class II molecule(HLA-DR antigen) was negative in both resting and reactive mesothelial cells. These results suggest that the short-term cultured, reactive mesothellal cells show a newly aberrant expression of the vimentin and carcino-embryonic antigen. The reason of the aberrant expression of the intermediate filament and oncofetal antigen in reactive and proliferative mesothellal cells should be further evaluated.
Actins ; Antibodies ; Carcinoembryonic Antigen ; Cytoskeleton ; Desmin ; Exudates and Transudates ; Follow-Up Studies* ; Histocompatibility Antigens Class II ; Hot Temperature ; Humans ; Hydronephrosis* ; Intermediate Filaments ; Keratins ; Liver Cirrhosis ; Mucin-1 ; Muramidase ; Pleural Effusion ; Salivary Glands ; Vimentin

The diagnosis of carcinoma in situ of urinary bladder is difficult in that the symptoms and cystoscopic findings are nonspecific. The cytology of urine could be helpful for diagnosis of carcinoma in situ of urinary bladder. We present a case of bladder washing cytology of carcinoma in situ. A 54-year-old man presented with dysuria for 1 year. Cystoscopic findings revealed multifocal reddish trabeculated lesions. The bladder washing cytology revealed rather uniform tumor cells which were singly scattered or forming syncytium in the clean background. The nuclei were round to oval with inconspicious nucleoli. The cystoscopic biopsy revealed typical histologic features of carcinoma in situ of urinary bladder.
Biopsy ; Biopsy, Fine-Needle ; Carcinoma in Situ ; Child* ; Diagnosis ; Dysuria ; Giant Cells ; Humans ; Kidney* ; Middle Aged ; Thymoma ; Urinary Bladder

Fine needle aspiration of the breast is an important diagnostic tool in malignant lesions, but is also useful in differentiation of inflammatory breast diseases mimicking carcinoma clinically and radiologically. Recently, the authors have experienced eight biopsy-proven cases of chronic inflammatory diseases of the breast, which consisted of 4 cases of duct ectasia, 2 cases of fat necrosis, and a case of tuberculous mastitis and granulomatous mastitis respectively, Their cytoiogic features mainly based on the components and the relative frequency of inflammatory cells were evaluated for differential diagnosis of chronic inflammatory breast diseases. The results are as follows ; 1. In cases of duct ectasia, varying amount of neutrophils, mononuclear leukocytes, histiocytes and multinucleated giant cells were intermixed with benign epithelial cell clusters. 2, Abundant fat tissue fragments were diagnostic for fat necrosis. Histiocytes and mononuclear cells were main components but not rich, and neutrophils and giant cells were infrequently observed. 3. Characteristic granulomas composed of epithelioid cells, mononuclear leukocytes and Langhans' type giant cells and lymphocytic infiltrates were conspicuous in tuberculous mastitis, and occasionally neutrophils, necrotic materials and epithelial cell clusters were found. 4. In granulomatous mastitis, epithelioid cell granulomas were also noted but numerous neutrophils and histiocytes were intermingled within or outside the granulomas.
Biopsy, Fine-Needle ; Breast ; Breast Diseases ; Child* ; Diagnosis, Differential ; Dilatation, Pathologic ; Epithelial Cells ; Epithelioid Cells ; Fat Necrosis ; Female ; Giant Cells ; Granuloma ; Granulomatous Mastitis ; Histiocytes ; Humans ; Leukocytes, Mononuclear ; Mastitis ; Mothers* ; Neutrophils ; Salivary Glands

In a six-year period(1988. 5-1994. 4), fine needle aspiration cytology(FNAC) of 322 pulmonary lesions from 296 patients were performed at Soonchunhyang University Hospital. Of these 322, malignancy was diagnosed cytologically in 139(43.2%), suspicious malignancy in 7(2.2%), negative in 164(50.8%), and insufficient material in 12(3.8%). Malignant lesions consisted of 54 cases of adenocarcinoma, 50 cases of squamous cell carcinoma, 18 cases of small cell carcinoma. They were verified by histologic examination in 70 cases. There were 2(0.6%) false positive cases due to florid bronchoalveolar hyperplasia and atypical bronchial epithelial cells associated with granulomatous lesion. The overall accuracy rate was 90%, the sensitivity 84.3% and the specificity 94.7%.
Adenocarcinoma ; Biopsy, Fine-Needle ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Child* ; Epithelial Cells ; Humans ; Hyperplasia ; Multicystic Dysplastic Kidney* ; Sensitivity and Specificity ; Tuberculosis, Pulmonary

OBJECTIVE: It is mandatory to optimaze clip placement in situ for complete clipping of cerebral aneurysm. Intraoperative microvascular doppler sonography (MDS) provides a functional and non-invasive intraoperative examination of the aneurysm proper. The present study was performed to investigate the reliability of MDS for assessing the complete aneurysm closure. METHODS: Blood flow velocities in the aneurysm sac were determined by MDS with a 20-MHz probe before and after aneurysm clipping, to confirm the obliteration of aneurysm since 1997. Complete aneurysm obliteration was confirmed by absent flow patterns in the domes of all aneurysms after clipping. RESULTS: The 1 mm microprobe was able to insonate all vessels and their major branches. The immediate adjustment of aneurysm clip placement or another clipping was done because hemorrhage after puncturing of completely clipped aneurysms on MDS developed in five patients including 3 middle cerebral artery aneurysms, 1 posterior communicating artery aneurysm, and 1 anterior communicating artery aneurysm. CONCLUSIONS: MDS is safe and cost-efficient for evaluation of aneurysm obliteration. In many cases, it can preclude the need of postoperative angiogram. However, although an intra-aneurysmal flow velocity is absent on MDS, it is necessary to puncture or cut the aneurysm sac if that is not shrunken after clipping, especially in cases of a complex aneurysm with a broad irregular base and atherosclerotic or thrombotic sac.
Aneurysm* ; Blood Flow Velocity ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Punctures

Metastatic tumors occur more frequently in the liver than in any other organ, Guided percutaneous fine-needle aspiration (FNA) of the liver is often recommended for confirmative diagnosis of the metastatic lesion, because of its simplicity, high yield, and reasonable safety. The authors studied retrospectively cytologic findings of 110 cases of metastatic tumors to the liver. The frequent primary sites were the stomach (23 cases), pancreas (19 cases), gallbladder (12 cases), and periampullary lesions (6 cases). Most of the metastases were carcinoma (106 cases). There were only 4 cases of sarcoma. The characteristic cytologic findings of FNA of meatastatic tumors were dirty background, abrupt change between hepatocytes and malignant cells, and desmoplasia. Some tumors displayed rather distinctive cytologic appearance that suggests primary sites. For example, the colonic adenocarcinoma showed tall columnar cells with a palisading arrangement, adenocarcinoma of gallbaldder showed focal squamous differentiation in some cases, and metastatic renal cell carcinoma and neuroblastoma showed also distinctive cytologic findings. Because the cytologic features of metastatic tumor are very similar to those of primary tumor, correct cytologic typing may be helpful in pursuit of an occult primary site of metastatic liver lesions, reducing extensive diagnostic investigation in poor prognostic patients.
Adenocarcinoma ; Biopsy, Fine-Needle ; Carcinoma, Renal Cell ; Colon ; Diagnosis ; Gallbladder ; Hepatocytes ; Humans ; Kidney Diseases* ; Kidney* ; Liver ; Melanoma, Amelanotic ; Neoplasm Metastasis ; Neuroblastoma ; Pancreas ; Retrospective Studies ; Sarcoma ; Stomach ; Vagina

OBJECTIVE: The ideal treatment of intracranial aneurysms is an occlusion of the neck with a clip, which preserves the parent vessels. Upward projecting anterior communicating artery(Acom) aneurysms appear to be directed both above and below the plane formed by the two A2 segments, which usually conceal the contralateral A2 takeoff. It is difficult to perform complete clipping when these lesions are tightly adherent to the A2 segment. Neurosurgeons need to focus on the safe treatment of these lesions. A variety of clipping techniques can be used depending on the aneurysm anatomy, size, and morphology. The authors recommend a safe method of clipping these lesions safely. METHODS: The authors operated on 109 patients with upward projecting Acom aneurysms over the last 16 years. Among them, 34 aneurysms were clipped using fenestrated clips through the side of the dominant A1 segment, which were closely adhered to the A2 segment. RESULT: In each case, the aneurysm and both A2 segments formed a straight line in the narrow surgical field and were not easily separated, and consequently it was difficult to handle the aneurysm behind the ipsilateral A2. After partial identification of the Acom complex, careful dissection of the posterior aspect of the ipsilateral A2 and the aneurysm dome was continued to allow mobilization of both A2 segments and the aneurysm. All aneurysms were secured successfully without any surgery related complications. CONCLUSION: The authors recommend that fenestrated clip incorporating the ipsilateral A2 segment after complete mobilization of both A2 segments and the aneurysm may be useful for definitive clipping of upward projecting Acom aneurysm which is densely adherent to the A2 segment.
Aneurysm ; Humans ; Intracranial Aneurysm* ; Neck ; Parents

BACKGROUND: Recently, the number of patients visiting pain clinics has been increasing with the augmented concerns of those patients about the management of their pain. We conducted this study in order to elucidate the characteristics of patients visiting pain clinics and to determine a method to further raise their awareness about pain treatment. METHODS: We reviewed 1, 424 new patients who visited our pain clinic from March 2003 to December 2004. We analyzed these patients according to their age and sex, treatment method before visiting the pain clinic, coexisting disease, chief complaint and pain location, resident district, route of visiting pain clinic, and degree of impairment due to pain by use of questionnaire. RESULTS: In age distribution, the largest proportion (23.5%) was in their 50's. Most patients (64.0%) had received treatment in an oriental medicine clinic before visiting the pain clinic. The most common coexisting disease was hypertension (20.3%) and low back pain was the most common chief complaint (68.3%). Most of the patients lived in Gyeonggido (87%) and most visited our pain clinic on the recommendation of other patients who had visited our pain clinic before. CONCLUSIONS: We need to guide pain patients to undergo proper treatment much earlier using patient education or a referral system. Moreover, we should be more careful in patients with diabetes mellitus, and should have greater concern in the treatment of low back pain.
Age Distribution ; Diabetes Mellitus ; Gyeonggi-do ; Humans ; Hypertension ; Low Back Pain ; Medicine, East Asian Traditional ; Pain Clinics* ; Patient Education as Topic ; Surveys and Questionnaires ; Referral and Consultation

BACKGROUND: Epidural steroid injections benefit certain patients with radicular pain, and often have only a limited duration. We compared the efficacy of hyaluronidase and triamcinolone and triamcinolone alone in patients with lumbar herniated disc disease treated with transforaminal epidural block. METHODS: Forty patients who had undergone a transforaminal epidural injection were retrospectively reviewed. The T group received triamcinolone and local anesthetics; whereas, the HT group received hyaluronidase, triamcinolone and local anesthetics. We evaluated the improvement as being good, moderate, mild or no improvement, and in those where the improvement was good or moderate, also evaluated the duration of pain relief. Data were collected from the medical records of patients or via phone calls, which were analyzed using Student t- and chi-squared tests. A value of P < 0.05 was considered significant. RESULTS: There were no significant differences in the degree of pain improvement or duration of pain relief between the two groups. CONCLUSIONS: A hyaluronidase and triamcinolone injection during transforaminal epidural block has on benefit with respect to the degree of pain improvement or its duration compared to a triamcinolone only injection.
Anesthetics, Local ; Humans ; Hyaluronoglucosaminidase* ; Injections, Epidural ; Intervertebral Disc Displacement ; Medical Records ; Retrospective Studies ; Triamcinolone*

The origins of medullary carcinoma (MTC) and papillary carcinoma (PTC) of the thyroid are embryologically different. Tumors showing concurrent medullary and papillary features are rare and they represent less than 1% of all thyroid malignancies. Hereditary MTC is an autosomal dominantly inherited disease which is genetically determined as part of the MEN 2A, MEN 2B, or variants of MEN 2A such as familial MTC. Germline mutations of the RET gene are the underlying cause of the majority of cases of hereditary medullary carcinomas. The pathogenesis of concurrent PTC with familial MTC has rarely been known. Genetic analysis of the RET oncogene has so far provided conflicting results. Here we describe a family whose sibling was affected by both PTC & MTC, and the family carried a germ-line point mutation in the RET extracellular domain that converted cysteine 634 into tryptophan (C634W).
Carcinoma ; Carcinoma, Medullary ; Carcinoma, Papillary ; Cysteine ; Factor IX ; Germ-Line Mutation ; Humans ; Multiple Endocrine Neoplasia Type 2a ; Multiple Endocrine Neoplasia Type 2b ; Oncogenes ; Point Mutation ; Siblings ; Thyroid Gland ; Thyroid Neoplasms ; Tryptophan