Dedifferentiated chordoma is a rare pathologic entity presenting an additional sarcomatous component in otherwise classical chordoma. It has been also emphasized that this neoplasm is classified as a distinct entity because of its different clinical settings and aggressive behavior. Dedifferentiation is a peculiar phenomenon but its histogenesis has remained controversial. A 50-yera-old man developed a huge tumor mass in the retrorectal, presacral area, featured with two histological components. The one was a typical chordoma accounted for approximately 60% of the mass and the other was made up of highly cellular, plemorphic, undifferentiated tumor cells, reminiscent partly to the cells of plemorphic malignant fibrous histiocytoma. Ultrastructural features and immunoreactivity against cytokeratin, S-100 protein and alpha-1-antichymotrypsin in both portions support that histologically different components of this neoplasm derive from the same origin. To our knowledge, this is the first case of dedifferentiated chordoma in Korea.
Male ; Humans

The use of the interlocking intramedullary nails expand the possibilities for treatment of femoral shaft fractures, as illustrated by consistent and satisfactory clinical results. However, the technique is relatively complex compared to conventional nails and frequently poses technical problems. A retrospective review was undertaken of twenty-eight patients with femoral shaft fractures which had technical problems after undergoing the closed reduction and internal fixation with interlocking intramedullary nail procedure. We studied the types of the problems. Their causes, the frequency of problems with various kinds of nails, and discussed solutions of the problems. There were 21 additional comminutions and intraop erative splinterings, 8 angular deformities, 3 malpositioned nails, 3 loosened distal locked screws, 2 brocken drill bits, and 1 femoral neck fracture. Bone-union was attained in all cases (28 patients), but the period of treatment to attain bone-union was protracted to an average of 6.8 (5-12) months. In 3 cases, the knee joint range of motion was of limited flexion, 70 to 90 degrees, but in all other cases full range of motion was realized. 7 cases required 2 or more operations. The hospitalization period was for an average of 3.6 months. In conclusion, the importance of careful preoperative planning and experienced surgical technique cannot be overemphasized because we could see no significant difference in the occurence of technical problems in several kinds of the nail.
Congenital Abnormalities ; Femoral Neck Fractures ; Fracture Fixation, Intramedullary ; Hospitalization ; Humans ; Knee Joint ; Range of Motion, Articular ; Retrospective Studies

PURPOSE: Diffuse panbronchiolitis(DPB) is a chronic inflammatory airway disease of unknown causes mainly affecting the respiratory bronchioles and the more proximal bronchi. Findings on chest radiographs and high-resolution CT(HRCT) are well known and Akira classified HRCT findings of DPB into four types. Purpose of this study is to evaluate the relationship between findings of HRCT and PFT. METHODS AND MATERIALS: We retrospectively analyzed the chest radiographs and HRCT images of eleven patients with DPB and compared CT classification with pulmonary function test. RESULTS: Chest radiographs usually showed small nodular opacities throughout the both middle and lower lungs. The HRCT findings of DPB were centrilobularly distributed small nodular densities, branching linear densities contiguous with small round densities, dilated and thickened peripheral and central airways including bronchioles. More than one CT type by Akira's classification, usually two or three types, were found in nine patients. There was good correlation between CT types and FEV1%(p<0.05), CT types and FEV1/FVC (p<0.05) respectively. CONCLUSION: HRCT seems to be more useful for diagnosis and disease progression of DPB as compared with the chest radiographs or clinical stage such as pulmonary function test.
Bronchi ; Bronchioles ; Classification ; Diagnosis ; Disease Progression ; Humans ; Lung ; Radiography, Thoracic ; Respiratory Function Tests* ; Retrospective Studies

In the figure 3, designation of severity of bronchopulmonary dysplasia (BPD) was misprinted. Open bars (white) represent severe BPD, not mild BPD. Closed bars (Black) represent mild BPD, not severe BPD. Gray bars in the middle represent moderate BPD without change.

Several observation suggest that the antimelanocyte autoantibodies could play a role in melanocyte destruction. Some experiments indicate that melanocyte antibodies from patients with vitiligo can kill melanocyte in vitro. In these experiments, we demonstrated that vitiligo patient's sera containing antimelanocyte antibodies can lyse cultured human melanocytes by complement activation. Melanocyte cytotoxicity was measured using the ethidium bromide/ acridine orange viability assay. Significant melanocyte cytotoxicity was seen in sera from patients with both active and inactive vitiligo(p<0.01). Melanocyte cytotoxicity measured with complement-mediated cytotoxicity decreased after systemic steroid treatment(p<0.05) ; however melanocyte cytotoxicity showed no significant change with systemic PUVA therapy.
Acridine Orange ; Antibodies ; Autoantibodies* ; Complement Activation ; Ethidium ; Humans ; Melanocytes ; PUVA Therapy ; Vitiligo*

We analysed 8 cases of gastrointestinal cytomegalovirus(CMV) infection including one autopsy, three surgically resected and four endoscopic biopsy cases. Involved sites were colon in four,stomach in three and small intestine in one. Three of them were associated with immu-nosuppressed condition but others had no clinical evidence of immune deficiency. Multiple aphthous mucosal ulceration was a common presentation, but one revealed a mucosal ulcer with segmental narrowing and thickening of wall. Microscopically, six showed cytomegalic inclusions in endothelial cells and fibroblasts, one in mucosal epithelial cells and the remaining one in both endothelial cells and mucosal epithelial cells. Immunohistochemical staining using monoclonal antibody against CMV confirmed postive result in seven cases. Serum IgM anti-CMV antibody was elevated in one case. We conclude that gastrointestinal CMV infection is currently not a rare condition and frequently associated with non-immunosuppressed condition, and thus a thorough histologic examination is required especially in the gastrointestinal ulcerative lesion. Once cytomegalic inclusion is suspected, immunohistochemical identification of CMV seems essential for specific diagnosis.
Biopsy

The infantile polycystic kidney disease is rare fetal urinary tract anomaly. It is inherited with an autosomal recessive pattern and recurrence rate is 25%. The gene locus is on chromosome 6p. The pathogenesis of infantile polycystic kidney is the primary defect of the collecting ducts. The ultrasonographic finding of infantile polycystic kidney is oligohydramnios, bilaterally symmetrical enlarged kidneys with maintenance of their reinform shape. The differential diagnosis with adult polycystic kidney disease is important. The massive enlargement of the kidneys is rarely seen in adult polycystic kidney disease and the examination of the parents and other members of the family is helpful to confirm the adult polycystic kidney disease. If there is severe renal involvements, stillbirth or neonatal death secondary to pulmonary hypoplasia would be developed. If it were diagnosed before viability, termination of pregnancy is recommended. In a fetus at risk, diagnosed after viability, pregnancy termination is also recommended since this condition is uniformly fatal. We present a case of infantile polycystic kidney.
Diagnosis, Differential ; Female ; Fetus ; Humans ; Kidney ; Oligohydramnios ; Parents ; Polycystic Kidney Diseases* ; Polycystic Kidney, Autosomal Dominant ; Pregnancy ; Recurrence ; Stillbirth ; Urinary Tract

The authors performed this preliminary study to investigate the effect of softening E.C.T. and propofol was compared to pentothal for induction of anaesthesia for E.C.T on seizure duration. The results were follows ' 1) E.C.T. was performed in 60 psychiatric inpatients who were admitted during the study period. Of them 51.7% were diagnosed as schizophrenia, 21.6% as major depressive disorder, 16.7% as bipolar I disorder, manic and 10% of others. 2) Mean number of E.C.T. was 12.2 times a patient. 3) The most common target symptoms were persecutory delusion in schizophrenia, psychomotor retardation or agitation in major depressive disorder, and violent aggressive behavior in bipolar I disorder, manic. 4) Pre-ECT medication usually used were atropine 0.0093mg kg(-1), pentothal 2.76mg kg(-1) or propofol 1.42mg kg(-1). 5) The duration of seizure, as measured clinically, was reduced with propofol(20.5 sec) in comparison with pentothal(35.7 sec)(p<0.001). This suggest the possibility that additional treatment may be needed for the same clinical effect in psychiatric illness when propofol is used as the induction agent.
Atropine ; Bipolar Disorder ; Delusions ; Depressive Disorder, Major ; Dihydroergotamine ; Electroconvulsive Therapy ; Humans ; Inpatients ; Propofol* ; Schizophrenia ; Seizures* ; Thiopental*

It is essential to estimate the liver size in the diagnosis of liver disease. Many approaches have beenattempted in the evaluation of liver size such as measurement of length, area and volume. Among these, area andvolume measurements are accurate but complicated. So various linear measurements including Pfahler's method havebeen commonly used. But to our knowledge, there was no report about linear diameter of liver in Korean adualts. Asingeneral, larger patients are likely to have larger liver than smaller ones, it seems to be more ideal toevaluate the liver size using relative ratio rather than absolute linear diameters. The main objectives of ourinvestigation were to determine the various diameters of normal and enlarged liver and the criteria ofhepatomegaly in Korean adults using absolute and relative ments. Our cases consisted of 95 clinically normalsubjects and 51 patients suffering from liver disease and diagnosed to have hepatomegaly on abdominal palpationand simple abdomen in the Dept. of Radiology, St, Mary Hospital during the period of 6 months since Jan. 1981. Wemeasured the liver size using 3 linear diameters. And as the reference measurement, the distance from the rightmargin of the liver to the left margin of spleen was also measured. We called this “abdominal transversediameter”(ATD). The results were as follows; 1. The diameters of liver were 13.4±1.6cm, 18.4±2.4cm, 19.2±2.6cmin normal group and 18.8±3.1cm, 23.5±3.0cm, 24.2±3.2cm in hepatomegaly group using midline verticaldiameter(MIVD), maximum vertical diameter (MAVD) and diagonal diameter(DD), respectively. The difference betweentwo groups were statistically very significant in every method(p<0.01). 2. The 99% tolerance limits of liverdiameters were 13.0-13.8cm, 17.8-19.0cm, 18.5-19.9cm in normal and DD, respectively. The midpoints between theupper limit of normal group and the lower limit spectively. These points are warranted to suggest criterias ofhepatomegaly. 3. There were statistical significant difference in the ratio of each diameter to ATD between normaland hepatomegaly group (p<0.01). We called this“hepato-abdominal ratio”. The “hepato-abdominal in hepatomegalygroup using MIVD, MAVD and DD, respectively. 4. The 99% tolerance limits of “hepato-abdominal ratio” were0.43-0.45, 0.59-0.63, 0.62-0.64 in normal group and 0.60-0.62, 0.75-0.77, 0.77-0.79 in hepatomegaly group usingMAVD, MAVD and DD, respectively. The midpoints between the upper limit of normal group and the lower limit ofhepatomegaly group were 0.52, 0.69, 0.70 using MIVD, MAVD and DD, respectively. These points are alsowarranted tosuggest criterias of hepatomegaly.
Abdomen ; Adult ; Diagnosis ; Hepatomegaly ; Humans ; Liver Diseases ; Liver ; Methods ; Spleen

The association of gastric tubular adenoma and adenocarcinoma is already well known. Then, are those two pathologic lesions merely incidentally coexisting or does the one evolve to the other? That is a longstanding controversy. Nowadays, as is the case with the colonic tubular adenoma, the hypothesis that gastric tubular adenoma may be a precancerous lesion is generally accepted. However the direct evidences are rare. We report a clear case proving the potential of direct malignant transformation of gastric tubular adenorna through the 9-year close endoscopic follow-up. The developed cancer is well differentiated, surrounded with background tubular adenoma and limited to the submucosal layer.
Adenocarcinoma ; Adenoma* ; Colon ; Follow-Up Studies*