Hepatocellular carcinoma (HCC) is malignant tumor frequently occurring in Koreans. There have been few reports regarding the cytologic findings of fine needle aspiration (FNA) of HCC. Most have suggested a diagnostic problem in the cytology distinguishing HCC from some benign hepatic lesions-for example, a regeneration nodule in cirrhosis and liver cell adenoma. In spite of its high frequency in Korea, no cytologic study has been reported, concerning the FNA of HCC. In an attempt to achieve cytologic criteria for the diagnosis of HCC, the authors studied retrospectively cytopathologic findings of 247 cases of HCC. These cases were confirmed either by histologic examination including lobectomy, biopsy, or cell block materiai, or, when tissue diagnosis was unavailable, by a high serum alpha-fetoprotein level (over 400 l. U.). All aspiration smears were stained by the Papanicolaou method. In each case, the smears were analyzed for cell patterns and various cytomorphology of the tumor cells. The smear background was assessed for the presence of tumor cell necrosis and inflammatory components and compared to that of metastatic carcinomas. The cell patterns were classified as trabecular, acinar, dispersed, and irregular. The cytologic parameters analyzed included the degree of nuclear atypia and the presence of mitoses, intranuclear cytoplasmic inclusions, nucleolar prominency, endotheiial lining, multinucleated giant cells, eosinophiic globules, bile, and Mallory body.Most of the FNA of HCC showed markedly cellular smears. The tumor cells were most frequently arranged in a trabecular pattern (80.3%). The irregular (12.6%), the acinar (5.5%), and the dispersed patterns (1.7%) followed in decreasing frequency. Individual hepatoma cells were larger than normal liver cells. However, they had morphologic features characteristic of the hepatic cells: the cells were round or polygonal, their cytoplasm was abundant and granular with eosinophilic or amphophilic stainability, and their nuclei were round to oval, located centrally, and tended to have prominent nucleoli. Anaplasia and pleomorphism of tumor cells were generally mild to moderate. These findings existed even in very well differentiated cases. Mitotic figures were present in about 85% of the cases. Prominent nucleoli were observed only in about half the cases. The frequency of other cytologic features was as follows: intranuclear cytoplasmic inclusion in 86.8%; endothelial lining in 56.1%: bile in 19.8%; and giant cells in 60.1%. Clear cells were often present in11.7%, Most aspiration smears of HCC displayed clean background without necrosis or inflammatory material in contrast to the dirty, necrotic background of metastatic cancers and cholangiocarcinomas. Based on the above mentioned features, it is suqqested that the cytologic critieria most important for the diagnosis of HCC include a markedly cellular smear, trabecular pattern, hepatocytoid appearance of tumor cells, endothelial lining, the presence of bile, giant cells, intranuclear cytoplasmic inclusions, and prominent nucleoli, Among these, trabecular pattern, endothelial lining, giant cells and clean smear background are points to be considered in differentiating HCC from metastatic and cholangiocellular carcinoma.
Adenoma, Liver Cell ; alpha-Fetoproteins ; Anaplasia ; Bile ; Biopsy ; Biopsy, Fine-Needle ; Carcinoma, Hepatocellular ; Child* ; Cholangiocarcinoma ; Cytoplasm ; Diagnosis ; Endothelial Cells ; Eosinophils ; Fibrosis ; Giant Cells ; Glomerulonephritis* ; Hepatocytes ; Humans ; Inclusion Bodies ; Korea ; Liver ; Mitosis ; Necrosis ; Regeneration ; Retrospective Studies

BACKGROUND: Allergic diseases are characterized by immediate - and late - phase reactions to various allergens by the selective activation of a subset of CD4 + T cells. In response to allergen, T cells isolated from atopic donors are biased to low levels of IFN - y and high levels of IL - 4, and vice versa by T cells from non - atopic donor. Objective : The aim of this study was to evaluate the patterns of IL - 4 and IFN - y production after Der p I stimulation and the effect on the cytokine production from T cells by budesonide, disodium cromoglycate and cyclosporin A in atopic and non - atopic individuals. MATERIAL AND METHOD: Seven Der p I specific atopic and 7 non - atopic individuals were selected. We decided the 50% inhibiting concentration of each immunomodulator by lymphocyte proliferation assay, and measured their effects on the cytokine production in vitro by intracellular IL - 4, IFN - y staining and flow cytometry. Results and CONCLUSION: There was significant difference on stimulation index ( SI ) of production of IFN - y as well as IL-4 after Der p I stimulation between atopic and non-atopic individuals ( IL - 4 ; 1.57 +/- 0.7 : 0.98 +/- 0.2, p = 0.026, IFN - r : 1.45 +/- 0.5 : 0.95 +/- 0.2, p = 0.048 ). The synthesis of IL - 4, and IFN - r were significantly inhibited after the stimulation of every immunomodulators in atopic individuals, DSCG couldnt inhibit IL - 4 and IFN - r in nonatopic individuals. There was no significant difference in the inhibiting effect of these immunomodulators in both of them.
Allergens ; Bias (Epidemiology) ; Budesonide ; Cromolyn Sodium ; Cyclosporine ; Dust* ; Flow Cytometry ; Humans ; Immunologic Factors ; Interferons* ; Interleukin-4 ; Lymphocytes ; Pyroglyphidae* ; T-Lymphocytes* ; Tissue Donors

The congenital long-QT syndrome (LQTS) is characterized by recurrent syncope, prolonged QT intervals, QT interval lability, polymorphic ventricular tachycardia, and sudden death. We report a case of congenital long QT syndrome in a 28-day-old male infant who presented with syncope, bradycardia with 2: 1 pseudo-atrioventricular block and a markedly prolonged QT inteval. One episode occured after crying and degenerated into ventricular fibrillation and terminated after cardioversion. A VVI type cardiac pacemaker was implanted. Subsequently, the infant's heart rate was over 110/min and 2: 1 AV block and any other arrhythmia were absent. The infant recovered from the accompanied pneumonia and sepsis and was discharged 47 days after adrnission. However, 13 days after discharge, the infant returned to our hospital ER with syncope. Ventricular fibrillation ceased after cardioversion. Despite medication with propranolol, ventricular tachycardia persisted. The infant expired the day after he was discharged against medical advice.
Arrhythmias, Cardiac ; Atrioventricular Block* ; Bradycardia ; Crying ; Death, Sudden ; Electric Countershock ; Heart Rate ; Hospitals ; Humans ; Infant ; Long QT Syndrome ; Male ; Pneumonia ; Propranolol ; Sepsis ; Syncope ; Tachycardia, Ventricular ; Ventricular Fibrillation

The authors investigated mortality rate of hospitalized CWP(coal workers' pneumoconiosis) patients. Date, which was composed of age, date of hospitalization, date of death, and radiological findings(profusion of small opacity, type of large opacity, tuberculosis, emphysema, pneumothorax, and cardiac abnormality), was gathered from medical charts and chest x-ray films at the time of hospitalization of CWP patients. Among 738 CWP patients, that were entered survey differently and have followed different period, 160 CWP patients were died during different observational period. Mean value of observational period was 203 weeks, and mean age at hospitalization was 51 years. Because of short observational period, mean survival time could not found. There was statistically significant difference of mortality rate between group of small opacity and that of large opacity. In group of small opacity 5 year survival rate was 0.80 and in group of large opacity that was 0.73. And 80 percentile survival time was 57 months in group of small opacity and that was 40 months in group of large opacity.
Coal* ; Emphysema ; Hospitalization* ; Humans ; Mortality ; Pneumoconiosis* ; Pneumothorax ; Survival Rate* ; Thorax ; Tuberculosis ; X-Ray Film

Morphometry of nuclei of the benign and malignant prostatic lesions was performed to study the relationship between nuclear size and shape and the prognosis of prostatic adenocarcinoma. Fifty one cases of prostatic adenocarcinoma and 13 cases of benign prostatic hyperplasia were included to evaluate area, perimeter, Dmax, Dmin, and 5 form factors of the nuclei by image analyzer (Zeiss Ibas 2000) using hematoxylin-eosin stained slides. All analytic factors of nuclear size and shape were significantly different between benign lesions and adenocarcinomas. Increased nuclear size was associated with nu- clear irregularity, presence of metastasis, advanced clinical stage, and high Gleason's grade and score of prostatic adenocarcinoma. On Kaplan-Meier method, survival was decreased with older age, no hormonal treatment, stage D, high Gleason's grade and stage as well as with larger size and irregular shape of the nuclei. In conclusion, morphometry of nuclei of the prostate can be a helpful tool to differentiate between benign and malignant lesions. Nuclear morphology is thought to be associated with prognosis of prostatic adenocarcinoma.
Adenocarcinoma ; Breast ; Fibroadenoma ; Hepatitis B e Antigens* ; Hepatitis B Surface Antigens* ; Hepatitis B* ; Hepatitis* ; Neoplasm Metastasis ; Prognosis ; Prostate ; Prostatic Hyperplasia

This article consists of a clinical analysis of 221 cases of the Pediatric Inguinal Hernia treated in General Surgery of Pusan Adventist Hospital, from January 1990 to June 1996. The results were as follows ; 1) Patients with inguinal hernia were 37.5% of total operative patients in the division of pediatric surgery 2) Males predominated over females by the ratio of 5.5:1 3) Of 221 cases, 101(54%) were on the Rt side, 80(43.1%) on the Lt side and the remainder (6.4%) on both side in case of Male. 20(58.8%) were on the Rt side, 13(38.2%) on the Lt sid and the remainder (3.0%) on both side in case of Female. 4) The chief Complaints were inguinal protrusion in 131 cases(59.3%) and scrotal enlargement in 77 cases(34.9%) 5) Peak incidence age (32 Months) & Duration of history (20.2 Months) 6) Associated diseases were found in 10 cases(4.9%) and they were cryptorchidism (1.47%), hydroclele (0.98%), Umbilical hermia (0.49%), Heart anomaly (0.49%), cleft palate (0.49%), Teratoma (0.49%), and Jejunal atresia (0.49%). Family History was denied. 7) All were indirect hernia. 8) Incarcerated cases were 6(2.7%) and the ratio of male to female was 2:1, and the location of incarcerated hernia was Rt (66.6%), and Lt (33.3%) 9) There were 70 cases of strangulation. 10) Intraperitoneal organ in hernial sac was noted in 5 cases (2.26%), and they were ovary and fallopian tube in 3 cases (1.35%), small intestine in 1 case (0.45%), cecum and appendix in 1 case (0.45%). 11) 215 (97%) of all hernia were repaired only by highligation of sac and 6(3%) were inforced with Bassini's posterior wall repair. 12) Mean postoperative hospitalization were 5.2 days. 13) Postoperative complications occured in only 2 cases : hematoma and edema 1, wound infection 1.
Appendix ; Busan ; Cecum ; Cleft Palate ; Cryptorchidism ; Edema ; Fallopian Tubes ; Female ; Heart ; Hematoma ; Hernia ; Hernia, Inguinal* ; Hospitalization ; Humans ; Incidence ; Intestinal Atresia ; Intestine, Small ; Male ; Ovary ; Postoperative Complications ; Sudden Infant Death ; Teratoma ; Wound Infection

Ultrasonographic and radiographic findings in 72 cases of pelvic masses which have been provedhistopathologically were analyzed. The results were as follows; 1. Among 72 cases, 28 cases were uterine massesand 44 cases were adnexal masses. 2. Pathologic accuracies of ultrasonographic diagnosis were 64.3% in uterinemasses, 70.5% in adnexal masses, and 68.1% in all pelvic masses. 3. Plain or IVP findings were not specific indiagnosis and showed secondary mass effects or functional disturbances. 4. Because of its high accuracy ofpathologic diagnosis and safety, ultrasonography can be regared as the most valuable and preferential study. Butin cases of cystic myomas, endometrioses, cystic missed abortions and huge masses, the accurate diagnoses weredifficult.
Abortion, Missed ; Diagnosis ; Endometriosis ; Female ; Myoma ; Pregnancy ; Ultrasonography

Spinal reflex activity that remains after insult to the spinal cord brings with it significant functional impairment. Our patient had suffered from general spasticity and hyperreflexic neurogenic bladder caused by sixth cervical cord injury. Unfortunately, the use of oral medication (baclofen) was limited by an inadequate effect. So we performed two times of subarachnoid block with 0.5% heavy bupivacaine, the patient experienced improvement in bladder and sphincter function. We concluded that subarachnoid block with 0.5% heavy bupivacaine is an effective and safe modality for spasticity control in patients who are refractory to oral medication before neurolytic block.
Bupivacaine ; Humans ; Muscle Spasticity ; Reflex ; Spinal Cord ; Urinary Bladder ; Urinary Bladder, Neurogenic*

PURPOSE: Despite plenty of evidence that the healing of skin wounds is fostered by the use of skin tape and early suture removal, the technique has not been widely practiced. In order to investigate the combined technique of early suture removal using skin tape, we compared it with conventional suture removal. METHODS: We analyzed, retrospectively, 260 patients who underwent on appendectomy during 1999 to compare the two methods on the basis of age, sex, wound infection by class and incision type, cosmetic effect, and other suture site complication, including seroma, hematoma, dehiscence, and pain. RESULTS: Out of these 260 patients, 124 had conventional suture removal while 136 had early suture removal using skin tape. In the group of early suture removal using skin tape, there were a lower incidence of seroma, hematoma, and wound infection, a shorter period of postoperative wound pain, and superior cosmetic results and patient acceptability. CONCLUSION: We have found the combined technique to have advantages that produce a lower incidence of wound complication with a superior cosmetic result and an excellent patient acceptance.
Adhesives* ; Appendectomy* ; Hematoma ; Humans ; Incidence ; Retrospective Studies ; Seroma ; Skin* ; Surgical Tape* ; Sutures* ; Wound Infection ; Wounds and Injuries

PURPOSE: Recognition of impending death is crucial not only for efficient communication with the caregiver of the patient, but also determination of the time to refer to a separate room. Current studies simply list the events 'that have already occurred' around 48 hours before the death. This study is to analyze the predictability of each event by comparing the time length from 'change' to death. METHODS: Subjects included 160 patients who passed away in a palliative care unit in Incheon. The analysis was limited to 80 patients who had medical records for the last week of their lives. We determined 9 symptoms and 8 signs, and established the standard of 'significant change' of each event before death. RESULTS: The most common symptom was increased sleeping (53.8%) and the most common sign was decreased blood pressure (BP) (87.5%). The mean time to death within 48 hours was 46.8% in the case of resting dyspnea, 13.6% in the ease of low oxygen saturation, and 36.9% in the case of decreased BP. The symptom(s) which had the highest positive predictive value (PV) for death within 48 hours was shown to be resting dyspnea (83%), whereas the combination of resting dyspnea and confusion/delirium (65%) had the highest negative PV. As for the most common signs before death within 48 hours, the positive PVs were more than 95%, and the negative PV was the highest when decreased BP and low oxygen saturation were combined. The difference in survival patterns between symptoms and signs was significant. CONCLUSION: The most reliable symptoms to predict the impending death are resting dyspnea and confusion/delirium, and decline of oxygen saturation and BP are the reliable signs to predict the event.
Blood Pressure ; Caregivers ; Dyspnea ; Humans ; Medical Records ; Oxygen ; Palliative Care ; Prognosis ; Terminally Ill