To pursue a desirable format for the pathological diagnosis of liver cirrhosis, the authors attempted to classify 369 biopsy-proven cirrhosis on the basis of etiology and made effort to find out the morphological characteristics of each category. About 735 of total cases were HBsAg seropositive postnecrotic cirrhosis. Alcholic cirrhosis ws the second most frequent type, although accounted only 6.8%. In about 15%, the etiology was not known. Excluding the congenital biliary atresia, chronic biliary obstruction appeared to be a rare cause of cirrhosis among these biopsied cases. Of the HBsAg positive postnecrotic cirrhosis, the eAg seropositive cases tended to be micronodular and to show a higher necroinflammatory activity, in contrast to eAg seronegative cases and those complicated by hepatocellular carcinoma (HCC), suggesting that the loss of eAg is followed by a decrease of the destructive activity, active regeneration of hepatocytes and finally the development of HCC. alcoholic cirrhosis was micronodular in 64% and revealed histologic evidences of alcoholic liver disease in most cases. The results indicate that etiological diagnosis can be made in most cases of cirrhosis by the morphological characteristics and the precise clinical informations, including those on the NANB virus and the inborn error of metabolism, and that the pathological diagnosis should be more comprehensive, implicating the etiology, the nodular size and the necroinflammatory activity.
Carcinoma, Hepatocellular

Forty-nine lobectomized hepatocellular carcinomas(HCC) were classified according to the gross anatomical features. Because the presence of cirrhosis in the remaining liver has a good clinico-pathological implication, cases of HCC were divided into non-cirrhotic(non-LC) and cirrhotic(LC) groups. In both groups, the tumors themselves belonged to either expanding, focal spreading, spreading or mixed type. Another special type, which has been called a "diffuse type" is added in the LC group with the name of "cirrhotomimetic type" Among 49 cases, 21 belonged to the non-LC group and 28 to the LC group. Most common was expanding type(20 cases, 40.8%), which was followed by spreading(32.7%), focal spreading(16.3%), mixed(6.1%) and cirrhotomimetic(4.1%) types. Expanding type of the LC group was the single most common type(13 cases, 26.5%). The accordance rate of gross typing was 0.94. Tumor masses of the LC group showed a greater tendency of having a fibrous capsule(60.7%) and a lobulated cut surface(82.1%), in contrast to those of the non-LC group (28.6% and 42.9% respectively). The patient's age and the HBsAg seropositivity were not different between the groups and between the types. Increased serum level of AFP was particularly frequent in the spreading type(81.3%) of both groups and in the cirrhotomimetic type(100%).
Carcinoma, Hepatocellular

No abstract available.
Prenatal Diagnosis* ; Pulmonary Atresia* ; Ventricular Septum*

Vertigo mimicking labyrinthine lesions may have resulted from ischemic insult to the inner ear or the vestibular nerve and nucleus in the AICA infarction syndrome. A 56-year-old female was admitted to the emergency room with vertigo and hearing loss in right ear. On neurological examination, she had left beating jerky torsional and horizontal nystagmus with falling and past pointing to right side. Brain magnetic resonance images showed high signal intensity in anterolateral portion of inferior pons on T2- weighted images. Severe right facial palsy of peripheral type developed 24 hours after admission. Audiometry and electronystagmography documented absent auditory and vestibular function on the affected side. We argue that vertigo of the acute infarction in AICA territory can be involved the eight and seventh nerve root entry zoon and mimic labyrinthine lesions
Audiometry ; Brain ; Ear ; Ear, Inner ; Electronystagmography ; Emergency Service, Hospital ; Facial Nerve* ; Facial Paralysis ; Female ; Hearing Loss ; Humans ; Infarction* ; Middle Aged ; Neurologic Examination ; Nystagmus, Pathologic ; Pons ; Vertigo* ; Vestibular Nerve

Left atrial myxoma is well-known mimicker of systemic vasculitis. In general, however, these patients showed some symptoms and signs of cardiovascular disease. We experienced a patient with left atrial myxoma who first presented as vasculitis without any symptoms and signs suggesting cardiovascular disorders. A 45 year-old lady showed tender skin nodules, livedo reticuiaris-like skin lesions, severe constitutional symptoms, multiple cerebral infarctions, and elevated ESR and globulin. Skin biopsy findings were thought to be consistent with polyarteritis nodosa. Echocardiography was performed as a routine test for evaluating suspected vasculitis patients and it revealed left atrial myxoma. However, we were not able to detect any auscultation abnormality, even after echocardiography, After echocardiography, we found the tumor emboli in skin biopy specimen with deeper section. This case demonstrated the importance of suspecting the possibility of left atrial myxoma when performing diagnostic work-up for vasculitis.
Auscultation ; Biopsy ; Cardiovascular Diseases ; Cerebral Infarction ; Echocardiography ; Humans ; Middle Aged ; Myxoma ; Polyarteritis Nodosa ; Skin ; Systemic Vasculitis ; Vasculitis

PURPOSE: To explore the relationship between problem-based learning (PBL) evaluations and clinical performance. METHODS: The study included 117 third-year medical students at Chonnam National University Medical School. The students' first-, second-, and third-year PBL evaluations were compared with their clinical performance examination (CPX) scores in third year. The PBL evaluations were composed of three subscales: tutors' evaluation (students' professional behavior, contribution to group process, and contribution to group content), a report, and a written examination. The CPX assessed four performance categories: history taking, physical examination, information sharing, and patient-physician interaction. RESULTS: No significant correlation was found between the first-year PBL evaluations and CPX scores; however, the second-year PBL evaluations were significantly correlated with history taking (r=0.186, p=0.044) and patient-physician interaction (r=0.213, p=0.021) of CPX. The third-year PBL evaluations were significantly correlated with physical examination (r=0.248, p=0.007), and patient-physician interaction (r=0.283, p=0.002) of CPX. Several significant correlations between the PBL evaluations subscales and CPX scores were revealed. The PBL tutors' evaluation (r=0.343, p=0.000) and report scores (r=0.210, p=0.023) were significantly correlated with patient-physician interaction of CPX. The contribution to group process of tutors' evaluation was significantly correlated with patient-physician interaction (r=0.186, p=0.045), and the contribution to group content of tutors' evaluation was significantly correlated with physical examination (r=0.187, p=0.044). CONCLUSION: We found a significant association between PBL evaluations and CPX scores.
*Clinical Competence ; *Education, Medical, Undergraduate ; *Educational Measurement ; Group Processes ; Humans ; *Problem-Based Learning ; Republic of Korea ; Schools, Medical ; *Students, Medical ; Universities

Amiodarone, an antiarrhythmic drug, may exert pulmonary toxicity in some patients but the pathogenesis is not clear. This study was carried out to investigate the pathogenetic mechanism of pulmonary injury induced by amiodarone at dose of 100 mg/kg/day given to rats by intraperitoneal injection for 3 weeks. And the preventive effects of concomitantly injected steroid (10 mg/kg/day) on amiodarone induced pulmonary injury was also studied using bronchoalveolar lavage, light microscopy and transmission electron microscopy. The results obtained were summarized as follows: Mild lymphocytosis of bronchoalveolar lavage fluid was found in all experimental groups. Intracytoplasmic lamellar body formation was found in all types of pulmonary cells and type II pneumocytes revealed the earliest abnormal lamellar body formation. The capillary endothelial cells showed cellular swelling and detachment from underlying basement membrane at early phase of experiment and the edema of alveolar wall and interstitium were noted. Interstitial fibrosis and proliferation of type II pneumocytes were noted at late phase. The lungs of steroid injected groups revealed accumulation of lamellar bodies in all types of pulmonary cells but interstitial fibrosis was not occurred. These findings support the concept that amiodarone is responsible for a drug-induced phospholipidosis and directly toxic to pulmonary endothelial and epithelial cells. And steroid may regress the progression of amiodarone induced pulmonary injury.
Rats ; Animals

No abstract available.
Carcinoma, Renal Cell* ; Caveolin 1*

This study was conducted to evaluate the effectiveness and preferences of supplementary drinks for very old subjects who are likely to be malnourished. Twenty-five elderly subjects were divided into two groups. The supplemented group(N=15) received 500mls of nutrient supplement(New Care) two times daily for 4 weeks. This resulted in a significant increase in the total calories, protein, minerals and vitamins. Nutritional status was assessed both anthropometrically and biochemically, before and after the study period. A significant improvement in mid arm circumference, triceps skinfold thickness and serum albumin were observed in the supplemented group but not in the control group. There is a possibility that most of the elderly were in an anemic state at the beginning of the study since their mean hematologic parameters were within the lower normal range while their mean serum osmolarities was slightly higher than normal,. Although mean serum hemoglobin and hematocrit were not increased significantly, th percentage of the recovery rate from anemia in the supplemented group was higher than in the control group. Total lymphocyte count also showed similar tendency. Sensory evaluation of nutritional supplementary drinks were relatively good and the elderly showed great interest in nutrient supplements. This study suggests that a nutritional status of poorly nourished elderly subjects can be improved by providing them with nutritional supplementations.
Aged* ; Anemia ; Arm ; Hematocrit ; Humans ; Lymphocyte Count ; Minerals ; Nutritional Status ; Osmolar Concentration ; Reference Values ; Serum Albumin ; Skinfold Thickness ; Vitamins

No accepted standard currently exists to classify asphyxia and define its subtypes. Sauvageau and Boghossian proposed an asphyxia classification system in 2010 that divided asphyxia into suffocation, strangulation, mechanical asphyxia, and drowning. Here, we present a modification of this classification system. We propose to classify asphyxia into four main categories: suffocation, strangulation, mechanical asphyxia, and complicated asphyxia. Suffocation includes smothering and choking as well as confined spaces, entrapment, and vitiated atmosphere. Strangulation is subdivided into hanging, ligature strangulation, manual strangulation, and other unspecified strangulation. Mechanical asphyxia includes positional and traumatic asphyxia. Finally, complicated asphyxia is defined as cases with two or more identifiable mechanisms of asphyxia. In this study, we review autopsy cases from 2012 diagnosed as asphyxia and classify them according to our proposed asphyxia classification system. In 24.7% of cases, the age range was 40-49 years, and 51.9% were men. The most common method of asphyxia was hanging (245 cases, 55.1%), followed by ligature or manual strangulation (53 cases, 11.9%). Most hangings were suicides; smothering, ligature, and manual strangulation were usually homicides. Eighteen cases were complicated asphyxia. This classification provides a simplified, unified, and useful tool to classify and understand deaths due to asphyxia.
Airway Obstruction ; Asphyxia* ; Atmosphere ; Autopsy* ; Classification* ; Confined Spaces ; Drowning ; Homicide ; Humans ; Korea* ; Ligation ; Male ; Suicide