The author carried out an experimentation to clarify a possible pathogenesis of renal papillary necrosis induced by an univisceral Shwartzman reaction. The experimental animals were healthy white rabbits in weighing between 1.7 kg and 3.0 kg. Under the condition of ureterostomy, animals were pretreated with 0.5 cc of 50% ethyl alcohol and followed by administration of 0.2 ~ 1.5 mg endotoxin (E. coli 026 : B6, bacto lipopolysaccharide B. Difco, U.S.A.) as preparation in the renal pelvis. And then sacrificed at 10 minutes, 30 minutes, 1 hour, 2 hours, 6 hours and 24 hours after intravenous injection of 0.2 mg or 0.6 mg endotoxin through the ear veins, subjection to examine light and electron microscopically. The obtained results were summarized as follows: Papillary necrosis was developed in 88% among 18 cases excluding 6 cases died before sacrification. There were two types of necrosis, namely papillary and medullary type, but the former and combined forms of both types were the most common findings. Initial main target site of injury in renal papilla induced by endotoxiin was the endothelium of vasa recta and then followed by the Henle's loop, interstitial cell and collecting tubule respectively. Vascular injuries such as swelling and detachment of endothelium were observed since 10 minutes after endotoxin injection. Henle's loop showed stratification of basement membrane without consistent features with time lapses and initially observed fatty vaculoes at 1 hour after endotoxin injection were more eminent in 24 hours group. Main changes of interstitial cells were decrease of lipid droplets while increase of fatty vacuoles; the latter were initially observed in 1 hour group and more eminent in 24 hours group. Collecting tubule showed many fatty vacuoles especially in 24 hours group. It is thought that emergence of fatty vacuoles seems to be a kind of immature lipid droplets to compensate the increased demand of PC release due to continuous ischemic condition. In conclusion, it is thought that ischemic injury due to the vascular changes is pathogenic mechanism producing renal papillary necrosis. Endotoxin induced univisceral Shwartzman reaction in the kidney may be a good experimental model in studying renal papillary necrosis.
Rabbits ; Animals

The author studied 11-cases of adenocarcinoma of the stomach confirmed by gastrofiberscopic biopsy before in order to differentiate between differentiated and undifferentiated adenocarcinoma by scanning electron microscope. Light and transmission electron microscopie examination were done, too. Seven of them are differentiated accompanied by severe intestinal metaplasia and four of them are undifferentiated with rearly focal intestinal metaplasia. Two of the undifferentiated cases shows focal tubular differentiation on the superficial region of the mucosa. Microvilli on the free border are long, regular on the differentiated type but in state of variable loss of microvilli under the transmission electron microscope. Number and density of the mucous granules are variable. Scanning electron microscopic examination shows prominent disorganization of the folds, cellular pleomorphism and pleomorphic microvilli are suggestive of early marker of neoplastic transformation. The size of them are 0.6 micrometer and 1.2 micrometer on the differentiated type respectively. Disorganization of the folds is an important differential point between differentiated and undifferentiated type on the lower power examination. Development of folds, furrow, and hemispheric colliculi are more porminent on the differentiated adenocarcinoma. Presence of striated border, partial or complete loss of microvilli and intestinal metaplasia on the undifferentiated and differentiated adenocarcinomas are consisent with origin from common precursor cells.
Adenocarcinoma ; Biopsy

No abstract available.
Colon* ; Dilatation* ; Humans ; Infant, Newborn*

A papillary adeno-carcinoma of the renal pelvis is very rare tumor and mostly diagnosed by histopathologic findings. A 10-years-old female was admitted to Fatima Hospital with Rt. flank pain and intermittent gross hematuria.Herein, we report a case of papillary adeno-carcinoma of the renal pelvis.
Adenocarcinoma ; Female ; Flank Pain ; Humans ; Kidney Pelvis*

A corticocancellous core was removed from both femurs and tibias in 5 skeletally immature pigs. The cavity was treated with 5%, 25% phenol cautery, cryosurgery, and normal saline irrigation (control). The animals were sacrified after 7days. The extent of the bone necrosis was assessed by gross examination, simple radiography, MRI evaluation and histological examination with tissue mapping. After cryosurgery, the extent of necrosis was most profound in the depth of 2.0-9.0mm beyond the cavity wall. The effect of 25%-phenol was next to cryosurgery, with a depth of 1.0-3.0mm of necrosis. 5%-phenol made necrosis with the depth of 1.0-2.5mm. Very mild degree of necrosis with the width of 0.5-1.0mm was found along the cavity wall even in control group. On MRI, signal change was well visualized on T2 weighted coronal section and it was quite coincided with the extent of bone necrosis proved by histological tissue mapping to all cases. When the epiphyseal plate was open or very close to the cavity, curettage itself, 5%- and 25%-phenol cautery and cryosurgery all produced mild ischemic necrosis along the provisional calcification zone of physeal plate. These findings suggest that cryosurgery made more profound necrosis beyond cavity than phenol cautery and MRI is very sensitive and specific to find osteonecrosis along the cavity wall after phenol cautery or cryosurgery. When epiphyseal plate is open or very close to the cavity, phenol cautery, or cryosurgery, or even curettage itself could produce an ischemic necrosis to the physeal plate itself.
Animals ; Cautery* ; Cryosurgery* ; Curettage ; Femur* ; Growth Plate ; Magnetic Resonance Imaging ; Necrosis* ; Osteonecrosis ; Phenol* ; Radiography ; Swine ; Tibia*

We report a rare case of spindle cell/pleomorphic lipoma of the oropharynx. A 45-year-old woman presented with a 9-month history of a lump in 2001. A well demarcated polypoid, rubbery mass was found in the left vallecula and was surgically removed. The mass was diagnosed as a spindle cell lipoma. She revisited with the same complaint in 2008. Examination revealed another polypoid mass at the left aryepiglottic fold, near the previous excision site. The excised mass histologically consisted of mature fat cells, numerous bizarre giant cells, and bland spindle cells, features of a typical pleomorphic lipoma. This is the first case of recurrent oropharyngeal spindle cell/pleomorphic lipoma, showing histologic changes during the recurrence. Complete removal and follow-up are necessary for the treatment of this uncommon neoplasm.
Adipocytes ; Female ; Follow-Up Studies ; Giant Cells ; Humans ; Lipoma ; Middle Aged ; Oropharynx ; Recurrence

Desmoplastic infantile astrocytoma is a huge cystic tumor, typically occurring in the cerebral hemispheres of infants. The authors report a 4-month-old baby presented with increased head circumference, bulging fontanel, and the setting-sun sign. Magnetic resonance imaging revealed a round mass with huge cystic component in the right cerebral hemisphere. Microsurgical gross total resection of the tumor was performed and pathological examination of the specimen showed features of desmoplastic infantile astrocytoma. The postoperative course was complicated by subdural hygroma which was managed by the placement of subduroperitoneal shunt. Although desmoplastic infantile astrocytomas are rare, it must be distinguished from other hemispheric tumors in infancy or childhood because of good prognosis.
Astrocytoma* ; Cerebrum ; Head ; Humans ; Infant ; Magnetic Resonance Imaging ; Prognosis ; Subdural Effusion

The Ewing's sarcoma comprises approximately less than 10 percent of malignant bone tumors and 5 percent of allbone tumors, occures in almost all bones of the body, and presents a widely divergent roentgenographicmanifestations. The tarsal bones are involved only 2 percent in the Ewing's sarcoma. Two cases experienced byauthors and ten cases published in literatures of Ewing's sarcoma of the tarsal bone were analizedretrospectively. The result were as follows; 1. Of tarsal bones, the calcaneus was 7 cases, the talus 4 cases,cuneiform 1 case. 2. Female was affected more commonly than male, the ratio being 4 to 1 in the tarsal bones. 3.About sixty percent of total case in the tarsal bones had evidence of diffuse sclerotic pattern. All the cases ofthe talus had evidence of diffuse sclerotic pattern. 4. The diseases to be considered in differential diagnosisare as follows: avascular necrosis, tuberculous osteomyelitis, osteosarcoma, and pyogenic osteomyelitis. 5. Thediffuse sclerosis radiographically showed a close relation with dead bone resulting from avascular necrosis due totumor infiltration histologically. Periosteal reactive new bone and osteoid deposition on the dead bone were alsocorrelated with diffuse sclerosis. 6. Because it is difficult to differentiate sclerotic lesions in the tarsalbones by radiographic methods alone, all such lesions should be subject to biopsy as early as possible.
Biopsy ; Calcaneus ; Female ; Humans ; Male ; Necrosis ; Osteomyelitis ; Osteosarcoma ; Sarcoma, Ewing ; Sclerosis ; Talus ; Tarsal Bones

Although fibromas are the most common renal medullary tumor identified at autopsy. their small sized and benign course make clinical detection extremely difficult. Only 9 clinical cases of renal medullary fibromas have been reported. Many fibromas of the renal medulla, previously considered as bamahomas. seemed to be composed of tumerous transformation of renomedullary interstitial calls Herein we report on a patient with huge renal medullary fibroma treated by right radical nephrectomy.
Autopsy ; Brain Stem Neoplasms ; Fibroma ; Humans ; Nephrectomy

PURPOSE: The effect of corticosteroid on severe pneumonia caused by 2009 pandemic influenza (H1N1) A virus is controversial. This study was aimed to present the effects of early, short-term corticosteroid treatment for severe pneumonia with this virus infection. METHODS: A retrospective analysis was performed on severe pneumonia patients (37 patients) who had severe respiratory distress at presentation requiring oxygen therapy and received intravenous methylprednisolone (MP, 8-10 mg/kg, divided in 4 doses/day for 2-3 days) with oseltamivir. The clinical and laboratory characteristics of the patients were evaluated through the medical records and chest radiographic findings. RESULTS: The mean age and male-to-female ratio of the patients were 6.5+/-2.9 years of age, and 3.4:1 (male 29 patients), respectively. The 5-9 aged group was predominant among the age groups (25 patients, 67.6%). Duration of fever prior to admission was 1.4+/-0.6 days and dyspnea developed within 24 h after beginning of respiratory symptoms in all patients. All patients were previously healthy and received oseltamivir within 48 h. Thirteen patients (35.1%) developed dyspnea during oseltamivir treatment. Following MP infusion, all 37 patients including 13 progressive pneumonia patients during oseltamivir treatment showed an immediate halt in the progression of pneumonic infiltration with rapid clinical improvement. There were no side-effects following steroid use. CONCLUSION: For severe pneumonia patients, early corticosteroid treatment halted clinical exacerbation, and possibly prevented progression to acute respiratory distress syndrome. Further controlled clinical studies are needed for the role of corticosteroids and antivirals on severely affected patients with influenza virus infections.
Adrenal Cortex Hormones ; Aged ; Antiviral Agents ; Child ; Dyspnea ; Fever ; Humans ; Influenza, Human ; Medical Records ; Methylprednisolone ; Orthomyxoviridae ; Oseltamivir ; Oxygen ; Pandemics ; Pneumonia ; Respiratory Distress Syndrome, Adult ; Retrospective Studies ; Thorax ; Viruses