Malignant rhabdoid tumor (MRT) is a rare and highly aggressive neoplasm of infancy and childhood. Although it was originally described and most frequently reported in the kidney, it may occur in various extra-renal sites such as the liver, thymus, and soft tissue. In the last decade primary central nervous system (CNS) MRTs have been reported in both the supra- and infratentorial compartments. Patients with CNS MRT were generally below the age of two and reports in adults are extremely rare. This is a case of primary cerebellar MRT in a 24-year-old woman, who had presented with intermittent headache, vocal cord palsy, and cerebellar dysfunctions such as abnormal finger to nose test and tandem gait. By magnetic resonance imaging scan, a well-enhancing solid mass was demonstrated at the posterior fossa filling the 4th ventricle, which extended into the medulla and cervical cord via the foramen of Magendie. Histologically, the monotonous polygonal tumor cells were arranged in diffuse sheet with occasional hemorrhagic necrosis. The nuclei were vesicular and eccentrically located due to eosinophilic, PAS-positive, intracytoplasmic inclusions with prominent nucleoli. They were diffusely or focally immunoreactive for vimentin, neurofilament, cytokeratin, GFAP, synaptophysin, and smooth muscle actin, while epithelial membrane antigen and desmin were negative. Ultrastructurally, the polyhedral tumor cells were densely packed with primitive intercellular junctions. Scanty fibrillar intermediate filaments were intermingled with cellular organelles. Postoperatively, craniospinal irradiation and systemic chemotherapy have been done and she has been free of tumor recurrence during the 13 months' follow-up periods.
Actins ; Adult* ; Central Nervous System ; Cerebellar Diseases ; Cerebellum* ; Craniospinal Irradiation ; Desmin ; Drug Therapy ; Eosinophils ; Female ; Fingers ; Follow-Up Studies ; Gait ; Headache ; Humans ; Intercellular Junctions ; Intermediate Filaments ; Keratins ; Kidney ; Liver ; Magnetic Resonance Imaging ; Mucin-1 ; Muscle, Smooth ; Necrosis ; Nose ; Organelles ; Recurrence ; Rhabdoid Tumor* ; Synaptophysin ; Thymus Gland ; Vimentin ; Vocal Cord Paralysis ; Young Adult

No abstract available.
Abortion, Spontaneous* ; Chorion* ; Chorionic Villi* ; Female ; Humans ; In Situ Hybridization ; Pregnancy

A clinico-pathologic study with an immunohistochemical examination for c-erbB-2 expression in 54 cases of ductal carcinoma in situ and 16 cases of Paget's disease of the breast was performed. c-erbB-2 oncoprotein overexpression was observed in 45% (24/54) and 88% (14/16) of ductal carcinoma in situ and Paget's disease, respectively. The overexpression of c-erbB-2 oncoprotein was significantly correlated with the nuclear grade of tumors and inversely with the status of the estrogen receptor. c-erbB-2 was positive in 4 out of 5 patients with metastasis to axillary lymph nodes and 3 out of 4 patients who died of the disease. Prognostic significance of c-erbB-2 oncoprotein in ductal carcinoma in situ was highly suggested. The expression of c-erbB-2 oncoprotein in Paget's disease was well correlated with coexisting infiltrating or in situ ductal carcinoma. The high positive rate of c-erbB-2 oncoprotein in ductal carcinoma with Paget's disease could be understood with a recent hypothesis that c-erbB-2 oncoprotein is involved in promotion of cell motility and the spread of carcinoma cells.
Neoplasm Metastasis

Clinical observation was done on 302 cases of cerebrovascular accidents admitted at Sung-Sim hospital, Chung-Ang University from January, 1968 to August, 1976. 1) Of 302 cases of cerebrovascular accidents, the incidence of cerebral hemorrhage was 28.8, cerebral thrombosis 47,7 Subarachnoid hemorrhage 20.2% and cerebral embolism 3.3%. 2) The peak age incidence was in the fifth decade in cerebral hemorrhage, subarachnoid hemorrhage, whereas in cerebral thrombosis, it was in the sixth decade. 3) The most frequent predisposing factor in cerebral hemorrhage and subarachnoid hemorrhage were physical activity and emotional stress, whereas in thrombosis and embolism, it was rest. 4) Among disease preceding the onset of cerebrovascular accidents, hypertension were presented 65.4% in cerebral hemorrhage, 63.6% in cerebral thrombosis, 56.6% in subarachnoid hemorrhage and valvular heart disease was presented 40.0% in cerebral embolism. 5) Serum cholesterol level over 200mg% was seen in 33.0% of cerebrovascular accidents. 6) Leukocytosis was seen 58.6% of cerebrovascular accidents which was predominantly found in the hemorrhagic group. 7) The pressure of cerebrospinal fluid was elevated in 61.7% of cerebrovascular accidents, predominantliny the hemorrhagic group. 8) The peak duration of admission was present in 51.7% of cerebrovascular accidents within 7 days and mortality rate during hospitalization was 38.0% in cerebral hemorrhage, 10.4% in cerebral thrombosis and 27.8% in subarachnoid hemorrhage. 9)The mortality rate during hospitalization was 35.3% in all cerebrlavascular accidents within 24 hours.
Causality ; Cerebral Hemorrhage ; Cerebrospinal Fluid ; Cholesterol ; Embolism and Thrombosis ; Heart Valve Diseases ; Hospitalization ; Hypertension ; Incidence ; Intracranial Embolism ; Intracranial Thrombosis ; Leukocytosis ; Mortality ; Motor Activity ; Stress, Psychological ; Stroke ; Subarachnoid Hemorrhage

No abstract available.

Forty-five cases of histiocytic necrotizing lymphadenitis (HNL) or Kikuchi-Fujimoto disease were reviewed clinico-pathologically and studied for Epstein-Barr virus (EBV) and hepatitis B virus (HBV) by in situ hybridization to assess their causative role. Histologically, the lymph nodes typically showed relatively well defined paracortical lesions composed of large atypical mononuclear cells, histiocytes, and karyorrhectic nuclear debris. Mild to moderate degree of coagulation type necrosis was present in 24 cases. Clinical features did not vary greatly from previously described female preponderance, young age onset, subacute cervical lymphadenopathy, and frequent leukopenia, except for a few cases with recurrent disease over 8-9 years. Serologic tests revealed EBV IgG antibody in one case, HBV surface antibody in 11 cases and HBV surface antigen in 2 cases. In situ hybridization was performed on 41 cases using internal repeat 1 fragment DNA and EBV-coded small RNA (EBER-1) for EBV, and pan-HBV DNA probe for HBV detection, and showed that all cases were negative for EBV or HBV genome. Our results suggest EBV or HBV may not have causative role in the pathogenesis of HNL.
Adolescent ; Adult ; Aged ; Child ; DNA, Viral/analysis ; Female ; Hepatitis B Virus/genetics/*isolation & purification ; Herpesvirus 4, Human/genetics/*isolation & purification ; Histiocytes/pathology/*virology ; Human ; In Situ Hybridization ; Lymphadenitis/pathology/*virology ; Male ; Middle Age

Thirty-six adult patients who received caudal anesthesia for perianal surgery were rando-mly agsigned to two grgups. Of these, 15 patients ingroup 1 were given 1.5 and 2% plain lidocaine in 18 and 7 ml doses, repectively. Twenty-one patients in group 2 were given lidooaine carbonated with 5% NaHCO3 0.1 ml per 1 ml-lidocaine in the same volume and concentration as in group 1. The time of onset of analgesia for the pin prick and scratch tests was significantly more rapid in group 2(2.04+/-0.63 and 4,69+/-1.12 min for the pin prick and scratch tests, respecti-vely-) than those in group 1(5.00+/-1.70 and 9.48+/-5.40 min for the pin prick and scratch test, respectively). However, the duration of anesthesia in both groups was not significantly different (111.80 +/-40.24 and 105.95+/-45.04 min in group 1 and 2, respectively). The mean pH of the 1.5 and 2% agents used in group 1 was 5.289+/-0.206 and 5.257+/-0.193, respectively, while the mean PH of the 1.5 and 2% carbonated lidocaine used in group 2 was 7.004+/-0.079 and 7.023+/-0.288, reapectively. The results iridicate that pH-adjusted lidocaine for caudal anesthesia has a more rapid onset than plain lidocaine hut that there is no difference in the length of duration of its effect.
Adult ; Analgesia ; Anesthesia ; Anesthesia, Caudal* ; Carbon* ; Humans ; Hydrogen-Ion Concentration ; Lidocaine*

No abstract available.
Blood Platelets* ; Cardiopulmonary Bypass*

Massive blood transfusion may be defined as the acute administration of blood more than one and a half times the patient's estimated blood volume. When stored whole blood is infused, complications such as coagulation defect, volume overload, acid base disturbance and pulmonary complications will develop. Massive transfusion has been associated with the development of adult respiratory distress syndrome(ARDS) in man, and both humoral factor and microemboli have been proposed as the injurious agent in the transfused blood. WE experiecned the patient who had suffered from acute respiratory failure after the transfusion of massive amount of whole blood and managed him effectively with ventilatory support with positive end expiratory pressure under the monitoring of cardiopulmonary function via the Swan-Ganz Catheter at ICU.
Adult ; Blood Transfusion* ; Blood Volume ; Catheters ; Humans ; Positive-Pressure Respiration ; Respiratory Insufficiency

No abstract available.
Fistula*