Cases of acute myocardial infarction (AMI) that occur during pregnancy or postpartum are rarely reported. Ergot derivatives are known to induce the spasmodic contraction of coronary arteries. Administration of ergot derivatives can cause AMI, even in normal healthy people. In several reported cases, ergot derivatives triggered severe AMI during the postpartum period. Here, we report the case of a forty-year-old woman who was successfully impregnated by artificial fertilization and died after treatment with ergot derivatives. The autopsy revealed AMI with severe coronary atherosclerosis. This is the first case that reports aggravation of pre-existent severe coronary atherosclerosis after postpartum infusion of ergot derivtives.
Pregnancy ; *Postpartum Period ; Myocardial Infarction/*chemically induced/diagnosis/pathology ; Maternal Age ; Humans ; Female ; Ergot Alkaloids/*adverse effects ; Coronary Arteriosclerosis/chemically induced/diagnosis/pathology ; Adult

BACKGROUND: Fibroadenoma (FA) and phyllodes tumor (PT) are stromal tumors of breast and are histologically similar. There are no established differences in tumorigenesis and oncogene expression among them. Ras homolog enriched in brain (RHEB) plays an important role in cell growth and cell-cycle control, histone deacetylase 1 (HDAC1) is an important factor in breast tumor progression and prognosis, and WEE1 homolog (WEE1) functions as a tumor suppressor. No studies on the expressional differences of these proteins in FA and PT have been reported to date. METHODS: The expression of these proteins in FA, PT, and normal breast was compared. We used 102 cases of FA and 25 cases of benign PT. RESULTS: In epithelial cells, the expression of RHEB, HDAC1, and WEE1 was lowest in PT, higher in FA, and most enhanced in normal breast. In addition, the expression of RHEB and HDAC1 was higher in the stromal cells of PT than in FA and normal breast. CONCLUSIONS: Both epithelial and stromal cells of FA and PT express these proteins, which indicates that epithelial cells play an important role in the development of stromal tumors. In addition, the expressional differences of these proteins may be associated with the tumorigenesis of breast stromal tumors.
Brain ; Breast ; Breast Neoplasms ; Cell Transformation, Neoplastic ; Epithelial Cells ; Fibroadenoma ; Histone Deacetylase 1 ; Oncogenes ; Phyllodes Tumor ; Prognosis ; Proteins ; Stromal Cells

BACKGROUND: Histone deacetylase 1 (HDAC1) is associated with the expression and function of estrogen receptors and the proliferation of tumor cells, and has been considered a very important factor in breast tumor progression and prognosis. Several studies have reported an association between HDAC1 expression and poorer prognosis in cancers including breast cancer, with a few exceptions. However, because of the dearth of studies on HDAC1 expression in breast cancer, its significance for breast cancer prognosis has not been well defined. Therefore, we examined HDAC1 expression in invasive ductal carcinoma (IDC), the most common breast cancer, and investigated its potential prognostic significance. METHODS: We used 203 IDC tissue samples. Immunohistochemical stains for HDAC1 and real-time polymerase chain reaction for HDAC1 mRNA were performed and the results were compared to generally well-established prognostic factors in breast cancer and patient survival rates. RESULTS: HDAC1 expression was significantly reduced in proportion to higher histologic grade, higher nuclear pleomorphism score, and higher mitotic counts, and with lower estrogen receptor expression. Furthermore, it was significantly associated with the survival rate. CONCLUSIONS: HDAC1 expression is a good prognostic indicator in IDC.
Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Carcinoma, Ductal, Breast ; Coloring Agents ; Estrogens ; Histone Deacetylase 1 ; Humans ; Prognosis ; Real-Time Polymerase Chain Reaction ; Receptors, Estrogen ; RNA, Messenger

BACKGROUND: The role of the anaphase-promoting complex (APC) is to promote the degradation of mitotic cyclins and other substrates involved in sister chromatid adhesions. The APC appears to be responsible for the degradation of cyclin B and may have a potential role in the loss of control concerning cell proliferation in mammalian cells. However, a direct link between the defects in the APC components and oncogenesis has not been estabilished. This study investigates the relationship between APC expression and variable prognostic factors in invasive ductal carcinoma of the breast. METHODS: We evaluated 108 cases of invasive ductal carcinoma surgically resected from January, 1996 to May, 2000 at Wonju Christian Hospital, Wonju College of Medicine, Yonsei University. Immunohistochemical stains for APC, estrogen receptor, and Ki-67 were done in paraffin sections using the avidin-biotin complex method. The results were compared with clinical and pathologic parameters and flow cytometric DNA analysis factors. RESULTS: Forty cases (37.0%) showed immunopositive reactions for APC. The APC positivity in histologic grades 1, 2, and 3 were 28 cases (84.4%), 33 cases (60.0%), and 7 cases (35.0%), respectively (p=0.0011). The APC expressions in cases with the number of mitosis of less than 10, 10-19, and more than 20 per 10 high power fields, were noted in 37 cases (75.5%), 26 cases (63.4%), and 5 cases (27.8%), respectively (p=0.0016). The mean value of the Ki-67 labeling index was 221.7 in the APC-positive group and 317.9 in the APC-negative group (p= 0.0091). DNA flow cytometric analysis revealed higher APC expressions in cases with diploid patterns (p=0.0095). The APC expression rate increased significantly with decreasing histologic grade, with decreasing mitotic activity, in cases with a low Ki-67 labeling index, and those in the diploid group (p<0.05). The APC expression was not statistically correlated with clinical stage, tumor size, and estrogen receptor status. CONCLUSIONS: These findings suggest that positive APC expression may be considered as a good prognostic factor of invasive ductal carcinoma, and loss of APC expression may be related with the progression of breast cancer.
Breast Neoplasms ; Breast* ; Carcinogenesis ; Carcinoma, Ductal* ; Cell Proliferation ; Chromatids ; Coloring Agents ; Cyclin B ; Cyclins ; Diploidy ; DNA ; Estrogens ; Gangwon-do ; Humans ; Mitosis ; Paraffin ; Siblings

BACKGROUND: Lyme disease, an infection caused by Borrelia(B.) burgdorferi, has been reported in many countries. But in Korea, only 5 cases of serologically diagnosed lyme disease have been reported. Because several strains of B. burgdorferi were isolated from Ixodes ticks which were captured in Kangwon and Chungbuk province, there might be more cases of serologically undiagnosed lyme diseases presenting with erythema migrans. OBJECTIVE: To understand the clinical patterns and laboratory findings of erythema migrans in Korea. METHODS: A clinical survey was retrospectively performed on 9 patients with erythema migrans which occurred after tick bites. RESULTS: Among 9 patients with erythema migrans, 3 patients were male and 6 patients were female. The onset age of erythema migrans ranged from 26 to 71 years old (mean, 51.3 years old). The mean duration of erythema migrans after tick bite was 26.4 days and the diameter of the lesion ranged from 6 to 34 cm (mean, 18.3 cm). All cases developed from May to September and systemic symptoms such as fatigue, fever and/or chills, myalgia, palpitation, headache, arthralgia and dyspnea were present at the time of hospital visits of 3 patients. Clinically, 3 patterns of erythema migrans were seen; typical target pattern, homogenous and erythematous plaque pattern, and linear solitary plaque pattern with central postinflammatory pigmentation. Only 2 of the 7 patients (28.6%) were seropositive for IgM and IgG antibody titers by enzyme-linked immunosorbent assay in consecutive serologic tests. PCR for Borrelia DNA in paraffin-embedded tissue showed full negativity in 6 patients with erythema migrans. CONCLUSION: Although lyme disease is not endemic in Korea, some patients with erythema migrans might be undiagnosed as lyme disease serologically with erythema migrans. To take into consideration false negative serelogic results in early erythema migrans, early oral tetracycline therapy should be included through clinical and historical diagnosis.
Age of Onset ; Arthralgia ; Bites and Stings ; Borrelia ; Chills ; DNA ; Dyspnea ; Enzyme-Linked Immunosorbent Assay ; Erythema ; Fatigue ; Female ; Fever ; Glossitis, Benign Migratory ; Headache ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Ixodes ; Korea ; Lyme Disease ; Male ; Pigmentation ; Polymerase Chain Reaction ; Retrospective Studies ; Serologic Tests ; Tetracycline ; Ticks

Multicystic dysplastic kidney (MCDK) is a relatively common developmental anomaly in infants and children and has a good prognosis. In contrast, a malignant rhabdoid tumor of the kidney (MRTK) is one of the most lethal neoplasms of early life. However, the presentation of such a lethal tumor combined with multicystic dysplasia has not been reported to date. In this report, we describe a case of MRTK in a 5-yr-old girl who also had multicystic dysplasia. She was previously diagnosed with MCDK at birth due to a huge palpable mass on the right side of the abdomen. The right kidney was extensively replaced by numerous grossly dilated, variable-sized cysts. Microscopically, the tumor cells show a diffusely infiltrative growth pattern, which revealed large non-cohesive, round-to-polygonal tumor cells with vesicular nuclei. Some tumor cells had eccentric nuclei and large, round, eosinophilic cytoplasmic inclusions. There were metanephrons present, with the central ureteric bud and peripheral branches surrounded by condensing mesenchyma, immature glomeruli, and metaplastic cartilage in the adjacent parenchyma. To our knowledge, this is the first combined case of the two aforementioned diseases and this case may, in fact, suggest a new disease entity.
Child, Preschool ; Diagnosis, Differential ; Female ; Humans ; Kidney Neoplasms/*complications/*diagnosis ; Multicystic Dysplastic Kidney/*complications/*diagnosis ; Prognosis ; Rhabdoid Tumor/*complications/*diagnosis

BACKGROUND :Although clinicopathologic differences have been described between Epstein-Barr virus (EBV)-positive and negative gastric adenocarcinomas, the pathogenetic basis for these differences remains unclear. In this study, efforts were made to confirm that expression of EBV-latent membrane protein (LMP1) and immunohistochemical characteristics of EBVpositive gastric adenocarcinomas. METHODS: We investigated genomic deletion, and RNA & protein expression of the EBV-LMP1, as well as immunohistochemical protein expression of transforming growth factor (TGF)-beta1, TGF-bata RII, p21, p16, E2F1, thymidylate synthase, and NF-kappaB in relation to EBV positive gastric adenocarcinoma. RESULTS: A total of 38 Epstein-Barr Virus Encoded RNA-positive and 80 negative gastric carcinomas were examined. A 30 bp DNA deletion in the EBV-LMP1 gene, initiating at codon 342, was detected in 94.4% of EBVpositive cases. By RT-PCR and western blotting, EBV-LMP1 mRNA and protein expressions were absent in all cases, re-gardless of DNA deletion. No significant differences in TGF-bata1, TGF-betaRII, p21, NF-kappaB, E2F1, or thymidylate synthase expression were identified. However, the decreased expression of p16 was found in 84.2% of EBV-positive carcinomas, relative to only 57.5% of EBV-negative tumors (p=0.024). CONCLUSION: EBV-LMP1 DNA deletion, mRNA and protein losses are highly prevalent in EBV-positive gastric adenocarcinoma among Korean patients, along with decreased p16 expression.
Adenocarcinoma* ; Blotting, Western ; Codon ; DNA ; Herpesvirus 4, Human* ; Humans ; Membrane Proteins* ; Membranes* ; NF-kappa B* ; RNA ; RNA, Messenger ; Stomach Neoplasms ; Thymidylate Synthase* ; Transforming Growth Factors*

A 48-year-old divorced woman was found dead, lying in her room. A scarf was wound two times around her neck, which was tightened like a tourniquet. Self- strangulation by ligature is very rare and such cases emphasize the need for an accurate medicolegal evaluation of the circumstances, a thorough postmortem examination, and methodical inspection of the scene, particularly when postmortem decomposition is present. This case showed decomposition and was initially treated by the police as endogenous cardiac death. However the detailed examination of the scene photograph and of the deceased person, along with the investigation of the circumstances leading to the death, produced the verdict of suicide in this case. As we know, distinction between murder and suicide may be impossible by an examination of the body alone, and therefore the authors emphasize that close collaboration between the investigative and medicolegal fields is essential in order to gain a full understanding of this unusual case.
Autopsy ; Cooperative Behavior ; Death ; Deception ; Divorce ; Female ; Homicide ; Humans ; Ligation ; Middle Aged ; Neck ; Police ; Suicide ; Tourniquets ; Wounds and Injuries

The authors experienced a case of traumatic infarction of cerebellum and brain stem. The victim was 48-year-old woman and died after violence including head trauma. On admission, being unconscious, clinical diagnosis was cerebellar infarction of unknown cause. Autopsy showed severe subscalp hemorrhage and avulsion, cerebral edema, infarction of cerebellum and brain stem, and we also noted cervical spine fracture(C4) and Rt. vertebral artery occlusion by thrombus and dissection. There was no signs of trauma on the surface of the neck. We will describe the autopsy findings and clinical course of death.
Autopsy ; Brain Edema ; Brain Stem ; Cerebellum ; Craniocerebral Trauma ; Diagnosis ; Female ; Hemorrhage ; Humans ; Infarction* ; Middle Aged ; Neck ; Spine* ; Thrombosis ; Vertebral Artery* ; Violence

A pulmonary thromboembolism usually results from deep vein thrombosis as a serious and fatal complication. It is well known that several risk factors are predisposed to these thrombotic events, causing sudden death. Recently, new variant forms of pulmonary thromboembolism, termed as "economy class syndrome or e-thrombosis" were reported in association with sitting for long time in aircraft seat or at computer. The authors experienced a case of death developed after prolonged gambling at casino in 46-year-old man and concluded that the cause of death was fatal pulmonary thromboembolism due to deep vein thrombosis, associated with prolonged sitting. Therefore, the author thought that this case may be contribute to another possible risk factor of life-threatening pulmonary thromboembolism and highlights the importance of predicting deep vein thrombosis after prolonged gambling in sitting position at casino in the similar mechanism of aforementioned reported cases.
Aircraft ; Autopsy* ; Cause of Death ; Death, Sudden ; Gambling* ; Humans ; Middle Aged ; Pulmonary Embolism* ; Risk Factors ; Venous Thrombosis