The distinction between cholangiocarcinoma (CC) and metastatic colonic adenocarcinoma of the liver (MCA) is often difficult, particularly in needle biopsy and fine-needle aspiration specimens, if histologic features alone are used. To examine the differences in the expressions of the cytokeratin (CK) 7 and 20 in the CCs and MCAs, we performed immunohistochemical studies on surgically resected 19 CCs and 23 MCAs. We used monoclonal antibodies against CK 7 and CK 20, and applied microwave antigen retrieval technique on formalin-fixed, paraffin-embedded tissue. We interpreted diffuse cytoplasmic reactivity found in > or =5% of tumor cells as positive. CCs showed CK 7+/CK 20- immunophenotype in 63%, CK 7+/CK 20+ in 32%, CK 7-/CK 20+ in 5%, and CK 7-/CK 20- in 0%. MCAs exhibited CK 7-/CK 20+ immunophenotype in 87%, CK 7+/CK 20+ in 9%, CK 7-/CK 20- in 4%, and CK 7+/CK 20- in 0%. CK 20-reactive cells in CCs were frequently columnar in shape (p<0.05). In conclusion, the CK 7/CK 20 immunophenotype was useful in the differentiation of CCs from MCAs: the CK 7+/CK 20- immunophenotype strongly suggested CCs, whereas the CK 7-/CK 20+ immunophenotype strongly suggested MCAs.
Adenocarcinoma* ; Antibodies, Monoclonal ; Biopsy, Fine-Needle ; Biopsy, Needle ; Cholangiocarcinoma* ; Colon* ; Cytoplasm ; Keratin-20 ; Keratin-7 ; Keratins* ; Liver* ; Microwaves

The authors presented a case of gastroschisis with a pedunculated gallbladder embedded in hepatic tissue. The patient was born after fullterm gestation. Due to extensive abdominal wall defect, she succumbed 3 days after birth. There was a pedunculated mass measuring 2.5x1.5x1.5 cm between the liver and distended stomach without any attachment to the liver. The pedicle of the mass was connected to the common bile duct. Cut surface revealed that the mass was an accessory hepatic lobe encircling the gallbladder. The histologic feature of both accessory liver and gallbladder was markedly altered probably due to vascular obstruction. We could find only a single similar case in literlature. That case was associated with Beckwith syndrome and ours was associated with large atrial spetal defect, large patent ductus arteriosus, accessory spleen as well as gastroschisis. The common feature of abdominal wall defect might be a predisposing factor.

The incidence of spinal tuberculosis has been decreased because of the development of anti-tuberculosis drugs, the use of radical surgical procedures and the improvement in the nations general hygiene. The anterior fusion is the most frequently used surgical measure in the treatment of spinal tuberculosis. One-hundred-eighty cases of spinal tuberculosis were treated by surgery during the 5 years from 1976 to 1980 at Presbyterian Medical Center with the following results: 1. The age distribution showed the peak incidence to be in the third decade. 2. The predilection site was the lumbar area and the percentage was 43.3. 3. In 17.2% of the cases, anti-tuberculosis drug was ingested before surgery. 4. Paraplegia was present in 16.1% of spinal tuberculosis. 5. In paraplegia, most of the location of the involved bodies was in the thoracic and the thoracolumbar vertebrae and the percentage was 79.3. 6. In paraplegia, complete recovery was 82.8%, and incomplete recovery was 10.3%. 7. In 90% of the patients, anterior fusion was done and the union rate was 91%. 8. Kyphosis was the most common in late complication.
Age Distribution ; Clinical Study ; Humans ; Hygiene ; Incidence ; Kyphosis ; Paraplegia ; Protestantism ; Spine ; Tuberculosis, Spinal

Metastatic malignant tumors involving the spine cause destruction of vertebral body, kyphosis and neural deficit. Irradiation relieves the pain and decreases the tumor mass, but sometimes the spine is progressively destroyed and becomes unstable. Traeatment of metastatic tumor involving the spine is difficult. Replacement of the vertebral body with bone cement and high dosage of radiation therapy was recommended by Harrington. The advantages are excision of the tumor mass, firm immobilization and enough irradiation not to recur. Two cases of metastatic carcinoma involving cervical spine were treated by anterior decompression, bone cement fixation and irradiation. One case died seventeen days after surgery due to severe pleural effusion. Another case was treated with irradiation (6,000 rads) after surgery and the pain was relieved. The spine is stable one year after surgery. There is no local recurrence.
Decompression ; Immobilization ; Kyphosis ; Pleural Effusion ; Recurrence ; Spine

Aneurysms located on the proximal(A1) segment of the anterior cerebral artery are known for their rarity. In this study, eight patients, all with aneurysms arising from the proximal(A1) segment of the anterior cerebral artery, were selected from 625 patients who underwent surgical treatment under the diagnosis of cerebral aneurysm. Each cases were reviewed as an attempt to investigate the demographic and clinical features of these patients. The incidence of A1 aneurysm was 1.3%. Multiple aneurysms occurred in one(12.5%) out of the 8 cases and the bleeding was from the A1 aneurysm. The mean age of the eight patients was 56.8 years: there were six women and two men. The aneurysms were classified according to the mode of origin of the aneurysm in relation to the A1 segment: in 4 of the 8 cases, the aneurysms were found to be originated from the junction of the A1 segment and a perforating artery: in which the remaining 4 cases, they are from the A1 segment directly. Computerized tomography(CT) of these aneurysms revealed subarachnoid hemorrhage extending to the surprasellar and sylvian cisterns similar to that of the posterior communicating artery aneurysm or the internal carotid artery bifurcation aneurysm. Bleeding which extends to the interhemispheric cisterns or septum pellucidum, while frequently occurrs during the rupture of anterior communicating artery aneurysm, are rare in these cases. Because there are many differences between the findings in author's series and these in the literature, coordinated studies are necessary to define the demographic and clinical features of A1 aneurysm in Korea.
Aneurysm* ; Angiography ; Anterior Cerebral Artery* ; Arteries ; Carotid Artery, Internal ; Diagnosis ; Female ; Hemorrhage ; Humans ; Incidence ; Intracranial Aneurysm ; Korea ; Male ; Rupture ; Septum Pellucidum ; Subarachnoid Hemorrhage

Five volunteers received patch tests with 5% sodium lauryl sulfate (SIS) in solutions of differing pH. The irritant effect was monitored by visual scoring as well as by a laser Doppler vlelocimeter, evaporimeter, cutometer, and colorimeter. The non-invasive methods used in this study with the exception of the cutometer were effective in the evaluation of skin irritation. No significant differences in the skin responses to SIS in different pH solutions were found either clinically or by the non-invasive methods used for quantification. It was concluded that the pH of SIS is not a major factor in the degree of skin irritation produced by SIS.
Hydrogen-Ion Concentration* ; Patch Tests ; Skin ; Sodium Dodecyl Sulfate* ; Sodium* ; Volunteers

PURPOSE: Epstein-Barr virus(EBV) exists in the human population in two genetic forms, usually referred to as type 1 and type 2 which have been defined on the basis of sequence divergence in the EBNA-2 and EBNA-3 family genes. In this study, we were intended to investigate whether the subtypes of EBV in malignant lymphoma in Korea were associated with specific disease entities and geographical distribution. MATERIALS AND METHODS: Biopsy samples obtained from 18 Korean patients with malignant lymphoma including Hodgkin's disease(3 cases), B cell lymphoma(1 case), and NK/T cell lymphoma(14 cases) were analyzed to determine the subtype of EBV infected therein. DNA was extracted from formalin-fixed, paraffin-embeded tissues by ordinary method and specific viral sequences were sought using the polymerase chain reaction(PCR) and Southern blot hybridization assay. Oligonucleotide primers used for examination of EBV strain type were derived from the EBNA-3B and EBNA-3C coding regions. As a control, four cases of reactive hyperplasia were analyzed. RESULTS: The two of four reactive hyperplasia cases were associated with type 1 and the rest of two cases with both types. Among the 18 cases with malignant lymphoma, thirteen cases(72%) had type 1, one(6%) had type 2, and four(22%) had dual infections with both types. In case of NK/T cell lymphoma(14 cases) occupying 78% of 18 biopsy samples, 86%(12 cases) were associated with type 1, 7%(1 case) with type 2, and 7%(1 case) with both types. In case of Hodgkin's disease, all of three cases had both types. B cell lymphoma taking only one case of twenty two cases was determined as type 1. CONCLUSION: These observations indicated that type 1 EBV was predominant in Korean patients with malignant lymphoma, especially NK/T cell lymphoma and showed high frequency of dual viral infections(22%) in Hodgkin's disease as well as in reactive hyperplasia.
Biopsy ; Blotting, Southern ; Clinical Coding ; DNA ; DNA Primers ; Genotype ; Herpesvirus 4, Human ; Hodgkin Disease ; Humans ; Hyperplasia ; Korea* ; Lymphoma* ; Lymphoma, B-Cell

BACKGROUND: Serious pulmonary complications after lung surgery increase morbidity and mortality in perioperative period. Ketamine hydrochloride produces strong analgesic effect in spite of the psychomimetic effects. Intravenous anesthesia with ketamine was performed in lung surgery of patients with decreased pulmonary function and compared with inhalation anesthesia with enflurane. METHODS: Sixty patients, scheduled for elective lung surgery, were randomly assigned to two groups. Patients received either enflurane (Group 1, n=30) or ketamine (Group 2, n=30) as main anesthetic drug. Blood pressure and heart rate were compared in preinduction, postinduction, postintubation, postincision, intraoperative period (30 minutes, 60 minutes) and recovery room between groups, and in each group. Arterial blood gas analysis was compared in preoperative period, intraoperative period and recovery room between groups. Postoperative psychological complications evaluated in group 2. RESULTS: Blood pressure and heart rate were significantly different in postinduction, postintubation and recovery room between groups. PaO2 in group 2 was higher than in group 1 during intraoperative period and recovery room. Postoperative psychological complications occured in 4 patients (13%) in group 2. CONCLUSIONS: Ketamine affords advantage over enflurane anesthesia in terms of PaO2 during intraoperative period and recovery room in lung surgery of patients with decreased pulmonary function.
Anesthesia ; Anesthesia, Inhalation* ; Anesthesia, Intravenous* ; Blood Gas Analysis ; Blood Pressure ; Enflurane* ; Heart Rate ; Humans ; Inhalation* ; Intraoperative Period ; Ketamine* ; Lung* ; Mortality ; Perioperative Period ; Preoperative Period ; Recovery Room

No abstract available.
Acyclovir* ; Necrosis*

No abstract available.
Hepatitis A Antibodies* ; Hepatitis* ; Immunoglobulin M*