Coxiella burnetii(C. burneii)was first recognized as the agent of Q fever in 1937. Q fever is an acute self-limited febrile illness. However, it manifests with several clinical symptoms depending upon the organs that are involved. The association of C. burnetii with human neoplasia has been rarely reported. We prospectively studied the 55 patients with fever of unknown origin, pneumonia, hepatosplenomegaly, lymphadenopathy, leukemia, lymphoma, and immunodeficiency and 14 persons who contacted the Q fever patients. The patient's sera were tested for antibodies specific for C. burnetii, using indirct fluorescent antibody techniques (IFA). 1) We serologically confirmed 23 C. burnetii infection. The 23 children with Q fever ranged in age from 0 to 15 years, with mean age of 4 years 11 months. Seventeen were boys and 6 were girls. 2) Characteristic symptoms and signs were fever (9/12 cases), rash (8/14 cases), hepatosplenomegaly (8/8 cases)and lymphadenopathy (14/27 cases). Five cases among 14 asymptomatic cases who contacted Q fever patients showed positive IFA test. One suffered from irregular uterine contraction, 4 weeks after contact with a Q fever patient. 3) There were no history of exposure to domestic animal carriers or contaminated dust, or drinking raw milk except one family. Three attending doctors and her father infected by a patient with Q fever. These suggested the person to person transmission of Q fever in a family and house staffs infected by a patient of Q fever. 4) Q fever (9 cases), acute lymphoblastic leukemia (2 cases), acute myelomonocytic leukemia (1 case), hairy cell leukemia (1case), Kawasaki disease (4 cases) and congenital dyserythropoietic anemia (1 case) showed positive IFA test. 5) Of 9 cases who suffered from lnly Q fever, 7 cases were confirmed hairy cell formation in their peripheral blood. One case was diagnosed as hairy cell leukemia after bone marrow study. Of 7 cases who showed hairy cells, all had hepatomegaly, 6 cases had lymphedenopathy and 5 cases showed splenomegaly. All except 1 case who was not followed cured after treatment. 6) We treated Q fever patients with rifampin and/or ciprofloxacin, and/or tetracyclin (over 8 year-old of age)for 2-4 weeks. One 25 month-old patient with hairy cell leukemia was treated with rifampin, ciprofloxacin and tetracyclin for 4 weeks, and rifampin for 8 months. A pregnant patient was administered with rifampin, and treated with rifampin and ciprofloxacin after delivery. We gave rifampin in one nweborn baby. In conclusion, we suggest that Q fever should be considered in the differential diagnosis of patients with FUO, hepatosplenomegaly and/or immunodeficiency.
Anemia, Dyserythropoietic, Congenital ; Animals, Domestic ; Antibodies ; Bone Marrow ; Child ; Child, Preschool ; Ciprofloxacin ; Coxiella burnetii* ; Coxiella* ; Diagnosis, Differential ; Drinking ; Dust ; Exanthema ; Fathers ; Female ; Fever ; Fever of Unknown Origin ; Fluorescent Antibody Technique ; Hepatomegaly ; Humans ; Internship and Residency ; Leukemia ; Leukemia, Hairy Cell ; Leukemia, Myelomonocytic, Acute ; Lymphatic Diseases ; Lymphoma ; Milk ; Mucocutaneous Lymph Node Syndrome ; Pneumonia ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prospective Studies ; Q Fever* ; Rifampin ; Splenomegaly ; Uterine Contraction

No abstract available.
Apgar Score ; Humans* ; Umbilical Cord*

Nocardia species are aerobic, gram-positive, acid-fast, filamentous branching bacilli. Nocardia is a localized or disseminated infection which may involve all tisuses and is produced by members of the genus Nocardia, principally N. asteroides. Other species, notably N. brasiliensis and N. caviae have been implicated, but N. asteroides appears to be the overwhelming predominant pathogen. Nocardial infections are usually opportunistic in the compromised host, at least 15% of the infections occurred in patients without a definable predisposing condition. Recently, we experienced an autopsy case of systemic nocardiosis. The patients was fiffty-three days old female infant, who had suffered from productive cough, dyspnea and fever. The patient was treated under the impression of the miliary tuberculosis, but she died at 34th hosital day. The postmortem examination reveals multiple tan gray colored abscess involving both lungs, both kidneys, and thymus. Microscopically, lung, kidney and thymus reveal multiple abscess, which are composed of necrotic tissue debris admixed with infiltrates of neutrophils, and they are surrounded by fibrosis, ad acute and chronic inflammatory cells. By histologic, microbiologic and biochemical studies, N. asteroides is identified in the lesion of the lung, kidney, thymus, and bronchial washing specimen.
Infant ; Male ; Female ; Humans

No abstract available.
Agaricales* ; Anemia, Aplastic* ; Humans

The spindle and epithelioid cell nevus, is known also as Spitz's nevus or benign juvenile melanoma. The histologic picture of the lesion often closely resembles that of a malignant melanoma, but spindle and epithelioid cell nevus hehaves benignly. Criteria for accurate histological diagnosis of this nevus now exist. However, a difficult lesion occasionally brings one to the worrisome situation even now. We experienced four cases (three children and one adult) of spindle and epithelioid cell neveus with nodular or macular skin lesions. In children (7/F, 9/F, 4/M), all of the lesion show a solitary pinkish red or light brown nodular firm masses, 0.7 cm to 1.0 cm in greatest dimension, which are located at the left posterior thigh, posterior neck and right anterior neck region, respectively. In adult (36/F), the lesion shows a light brown, erythematous macule, 0.8 cm in greatest diameter, in the skin of the back. Microscopically, both spindle and epithelioid cells are found in all the four cases, but epithelioid cells predominate in children and spindle cells predominate in adult.
Child ; Adult ; Male ; Female ; Humans

No abstract available.
Leukemia, Monocytic, Acute* ; P-Glycoprotein*

Hysterosalpingography and Hysteroscopy have been used for the detection of intraute-rine pathology such as polyps, submucous myomas, intrauterine adhesion and endometrial hyperplasia or cancer. Recently the ultrasound has also been utilized for the detection of uterine pathology. Therefore the purpose of this study was to evaluate the diagnostic efficacy of SonoHysterography in detection of intrauterine pathology compared with HSG and Hysteroscopy. 32 patients underwent Sono-Hysterography and Hysteroscopy for the evaluation of the uterine pathology from september 1995 to January 1996. Nine of 32 patients had infertility problem and HSG performed prior to Sono-Hysterography and Hysteroscopy. The results are as follows : 1. The patients' ages ranged from 20 to 50 years(median 37.9). 2. All 9 patients with infertility who had positive HSG findings in uterine cavity showed the intrauterine pathology in Sono-Hysterography as well as Hysteroscopy. The detail findings are as follows :septated uterus(n=2), intrauterine adhesion :IUA(n=3), endometrial polyp(n=3), and IUA combined endmetrial hyperplasia(n=1). 3. Twenty two of 23 patients with abnormal uterine bleeding showed the intrauterne pathology and one patient had negative finding in Sono-Hysterography. However, Hysteroscopy revealed positive intrauterine pathology in 22 patients who had abnormal uterine bleeding. One patients who had positive finding in Sono-Hysterograply showed negative by Hysterography. In contrast, one patient who had negative finding in Sono-Hysterography had positive uterine pathology with polyp in Hysteroscopy. The histologic pathology in all 23 patients reported endometrial polyp(n=12), placental polyp(n=2), submucous myoma(n=1), endometrial hyperplasia(n=5), endometrial cancer(n=1), normal endometrial finding(n=2). 4. Sono-Hysterography, therefore, has a sensitivity and positive predictive value of 96.6%, 93.5% respectively. Our study showed a positive Sono-Hysterography is very predictive of the intrauterine pathology. Sono-Hysterography is safe, quick and minimal invasive procedure. So it is an invaluable technique in the evaluation of uterine cavity.
Endometrial Hyperplasia ; Female ; Humans ; Hysterosalpingography ; Hysteroscopy* ; Infertility ; Myoma ; Pathology* ; Polyps ; Ultrasonography ; Uterine Hemorrhage

No abstract available.
Endometrial Neoplasms* ; Female

Leriche syndrome is a chronic disorder mostly in male and is a specific symptom complex due to thrombotic obliteration of the aortic bifurcation as result of an atherosclerotic change. The symptoms include 1) extreme liability to fatigue of both lower limbs; 2) symmetric atrophy of both lower limbs; 3) pallor of the legs and feets; 4) inability to maintain stable erection. There are several methods for surgical management of this disorder; 1) thromboendarterectomy with or without sympathectomy; 2) aortoiliac bypass graft; 3) aortofemoral bypass graft. Here we report a case of Leriche syndrome which was successfully managed with aortobifemoral bypass graft with Dacron and reviewed literatures on it briefly.
Atrophy ; Endarterectomy ; Fatigue ; Foot ; Humans ; Leg ; Leriche Syndrome* ; Lower Extremity ; Male ; Pallor ; Polyethylene Terephthalates ; Sympathectomy ; Transplants

Renal cell carcinoma, intimately associated with a sarcomatous component, is a rare malignant renal tumor. There is disagreement whether these represent true sarcomas or are sarcomatoid metaplasia. Therefore, this sarcomatous component is at times still a troublesome problem for pathologists. In March, 1986, we experienced a case of renal cell carcinoma associated with rhabdomyosarcomatous component in 47 year-old woman who had a rapidly enlarged, palpable abdominal mass. Grossly, a spherical renal cell carcinoma, 17x14x10 cm, in upper and middle portions of the right kidney showed extension through the renal capsule into the perirenal fat. Area of myxoid change was evident in the reanl cell carcinoma, with extensive hemorrhagic necrosis. Microscopically, in the myxoid area, there was malignant spindle cell proliferation in which many rhabdomyoblasts showing distinct cross striation could be demonstrated. This rhabdomyosarcomatous component intermixed with renal cell carcinoma of clear cell type could be also identified in the focal area.
Female ; Humans