This is to report a case of collision tumor of the urinary bladder, which was composed of papillary transitional cell carcinoma(PTCC) and osteosarcoma. Grossly the tumor was located at left antero-lateral wall and was a fungating, gray yellow, bony hard mass with papillary configuration of the luminal surface. Histologically the tumor was composed of PTCC confined to the mucosa and sarcomatous component not intermixed with the overlying PTCC. The sarcomatous area had features of classic osteosarcoma with anaplastic tumor cells and haphazardly arranged osteoid matrix, and was positive for osteonectin but entirely negative for cytokeratin or epithelial membrane antigen. Ultrastructural study demonstrated the tumor cells to be osteoblast which had rich rERs and a few lipid vesicles in plump cytoplasm without any evidence of epithelial ongin. The case is thought to be an example of collision tumor because there was no evidence of transition between PTCC and osteosarcoma.

Tumor angiogenesis(TA) refers to the growth of new vessels toward and within a tumor. TA is necessary both at the beginning and at the end of the metastatic cascade of events. Recently, experimental evidence suggests that the growth of a tumor beyond a certain size requires angiogenesis. To investigate how tumor angiogenesis correlates with metastases in breast carcinoma, the microvessels were counted (per 200 / field) in the most active areas of neovas-cularization by two investigators. The microvessels within breast carcinoma were highlighted by in imunohistochemical staining for factor VIII-related antigen. Microvessel count(MVC) in node-positive carcinoma(59.66=35) was significantly higher than in node-negative carcinoma(44.76=17)(p=0.009). MVC was also statistically correlated with tumor size and stage, but not with histologic grading, DNA ploidy, or hormonal receptors(estro-gen and progesterone). MVC in invasive breast carcinoma may be one of many prognostic predictors of node-positive breast carcinoma. Assessment of tumor angiogenesis may therefore be valuable in selecting patients with early breast carcinoma for aggressive therapy.
Neoplasm Metastasis

Transforming growth factor-beta (TGF-beta) plays an important role in hepatic fibrogenesis. It is thought to inhibit regeneration of the hepatocytes. The aim of this present study was to clarify the correlation of TGF-beta, collagen type III (PIIINP) and the regenerating activity of hepatocytes, and the effect of prostaglandin E2 (PgE2) on them in acute liver injury. Two hundred and sixteen male Sprague-Dawley rats, weighing 200g on average, were divided into six experimental groups and two control groups; group I-CCl4 only administration, group II-partial hepatectomy(PH) only, group III-PH following CCl4 administration, group IV-olive oil only administration, group V-sham operation, group VI-CCl4 administration with pretreatment of PgE2, group VII- PH with pretreatment of PgE2, and group VIII- PH following CCl4 administration with pretreatment of PgE2. Five rats were sacrificed at 12, 24, 36, 48, 96 and 168 hours after the administration of CCl4 or PH in each experimental group. The liver was tested with immunohistochemical stain for proliferating cell nuclear antigen (PCNA) and in situ hybridization for TGF-beta. Radioimmunoassay for serum PIIINP was also performed. The results were as follows: TGF-beta was expressed mainly in the perisinusoidal cells and periportal mesenchymal cells. The TGF-beta positive cells were most numerous in the combined group of CCl4 plus PH. TGF-beta expression tended to have an inverse relation, with the PCNA index in all experimental groups. The PCNA index was highest in the CCl4 only group and lowest in the combined group of CCl4 plus PH. The PH only group showed a peak PCNA index at 48 hours. In the CCl4 only group and the combined group of CCl4 plus PH, serum PIIINP appeared to increase at 12 hours or more after the expression of hepatic TGF-beta. Pretreatment of PgE2 revealed that TGF-beta precipitously disappeared at 48-96 hours after insult. PgE2 influenced the vanishing period, not the emerging time of TGF-beta and had a remarkable effect on the amount of TGF-beta especially in the PH following CCl4 administration group, which resulted in significant accentuation of PCNA indices. In conclusion, PH of the prior injured liver induces a marked increase of TGF-beta followed by a significant suppression of regeneration of the remaining liver, and PgE2 overtly suppresses the expression of TGF-beta.
Male ; Humans ; Rats ; Animals

Polypoid prolapse of mucosal folds can occur at various sites and in various conditions predominantly associated with strain during defecation. There are two well known types of mucosal prolapse syndrome(MPS), the inflammatory cloacogenic polyp(ICP) and the mucosal redundant polyp associated with diverticular disease(N4RPD). ICP is a mucosal prolapse of the anorectal junction and MRPD is a proximal analogue involving the sigmoid colon. We experienced two cases of eroded polypoid hyperplasia(EPH) of the rectosigmoid colon which manifested as a huge gyriform mass simulating the gross features of gastrointestinal lymphomas or other malignant tumors. The EPH consisted of confluent polypoid mucosal folds with rolled-up submucosa to form stalk, The polypoid lesion represented hyperplastic epithelium, erosion of the mucosal surface and congestive vascular ectasia of lamina propria and submucosa. To explain the whole morphologic features, the initial phenomenon should be the mucosal prolapse. Vascular stretching with ischemic erosion of the mucosal surface and compensatory epithelial hyperplasia ensue as the result. The ominous endoscopic and gross features of EPH should be kept in mind to avoid erroneous radical surgery.

To evaluate the efficacy of Alka-Seltzer Effervescent, a commercially available non-particulate antacid(mixture of sodium and potassium bicarbonate and citric acid), a clinical and in vitro titration study was designed. Two tablets of antacid dissolved in 30 ml of water was administered 5-30 minutes before the induction of general anesthesia in a group of patients undergoing Cesarean section. The volume and pH of gastric contents in each patient were under the critical level(vol<25ml, pH> 2.5) and no patient was at risk of aspiration in contrast with the control group which showed 48 % of patients were at risk when no antacid was administered(p<0.00l). In vitro titration study revealed that Alka-Seltzer Effervescent buffered 12-60 times the volume of HCI solution with a pH between 1.0-2.0 to above a pH of 2.5. Preoperative administration of Alka-Seltzer Effervescent at least 5 minutes before the induction of anesthesia can effectively increase the pH of gastic contents without increasing the volume significantly and thereby each patient undergoing Cesarean section will be safe from risk of aspiration.
Anesthesia ; Anesthesia, General ; Cesarean Section ; Female ; Humans ; Hydrogen-Ion Concentration ; Potassium ; Pregnancy ; Sodium ; Tablets ; Water

PURPOSE: We investigated the role of myocardial perfusion SPECT in prediction of ventricular dilatation and the role of revascularization including thrombolytic therapy and PTCA in prevention of ventricular dilatation after an acute myocardial infarction (AMI). MATERIALS AND METHODS: We performed dipyridamole stress, 4 hour redistribution, and 24 hour reinjection Tl-201 SPECT in 16 patients with AMI two to nine days after attack. Perfusion and wall motion abnormalities were quantified by perfusion index (PI) and wall motion index (WMI). Left ventricular ejection fraction (LVEF), WMI and ventricular volume were measured within 1 week of AMI and after average of 6 months. According to serial changes of left ventricular end-diastolic volume (LVEDV), patients were divided into two groups. We compared WMI, PI and LVEF between the two groups. Relationships among degree of volume, stress-rest PI, WMI, CKMB, Q wave, LVEF and revascularization were analysed using multivariate analysis. RESULTS: Only initial rest perfusion index was significantly different between the two groups (p<0.05). While initial LVEF, stress PI, CKMB, trial of revascularization procedure, presence of Q wave and WMI were not significantly different between the two groups. Eight of 16 patients (50%) showed LV dilatation on follow-up echocardiography. Three of 3 patients (100%) who did not undergo revascualrization procedure documented LV dilatation. And only 5 (38%) of the remaining 13 patients who underwent revascularization revealed LV dilatation. There was no difference in infarct location between the two groups. By multivariate linear regression analysis in patients only undergoing revascularization, rest perfusion index was the only significant factor. CONCLUSION: Myocardial perfusion SPECT performed prior to revascularization was useful in prediction of LV dilatation after an AMI. Rest perfusion index on myocardial perfusion plays as a significant predictor of left ventricular dilatation after AMI. And revascularization appears to be a valuable procedure in alleviating LV dilatation after AMI with or without viable myocardium in a limited number of patients studied retrospectively.
Dilatation ; Dipyridamole ; Echocardiography ; Follow-Up Studies ; Humans ; Linear Models ; Multivariate Analysis ; Myocardial Infarction* ; Myocardium ; Perfusion* ; Retrospective Studies ; Stroke Volume ; Thrombolytic Therapy ; Tomography, Emission-Computed, Single-Photon* ; Ventricular Remodeling*

One of the most common symptoms in gynecologic disorders is an abnormal utirine bleeding, of which dysfuncyional uterine bleeding (DUB) is frequently encountered. DUB is defined as an endocrinologic imbalance of the axis of hypothalamus-pituitary-ovary-endometrium without organic diseases such as a neoplasm, and inflammation, a pregnancy, a trauma, Although the correct diagnosis of DUB depends on various assessements such as a menstrual cycle, basal body temperature, endocrine assay, vaginal cytology and endometrial histology, in many circumstances pathologist have only the endometrial histology with trivial clinical information to make a diagnosis. Therefore, the present study was aimed at assessing the pattern of the endometrium as precisely as possible. The histologic pattern was classified according to the Handrickson and kempson classification (1980). The authors also attempted to correlate the non-neoplastic metaplasia with the endometrial histology. The material consisted of 447 cases of endometrial curettage specimens diagnosed clinically as DUB during recent 4 years. The histologic examination was carried out through the routine formalin fixed-paraffin embedding method, followed by hematoxylin-eosin staining in routine and other special staining as required. The following results were obtained; 1) The pattern of the endometrium in DUB was predominently the proliferative type (239 cases, 65.55%). Of these 293 cases, 144 were of the abnormal proliferatrive phase, and particulary most were the disordered proliferative phase. The remaining 154 cases (34.45%) were found to have secretory endometrium, of which 50 cases belonged to the abnormal secretory type. Most of the cases shewing abnormal secretory patterns appeared dyssynchronous or underdeveloped. 2) Of the 361 patients with DUB for whom the clinical records were available, 197 (54.57%) were non-ovulatory and 118 (32.69%) were ovulatory. 3) Non-neoplasic metaplasia was found in 87 cases, of which ciliiated and papillary types were most common. The endometrium was of the proliferative phase in 73.56% of the cases with metaplasia, and the disordered proliferative pattern showed a particular correlation with the metaplasia (44 cases). 4) Among 63 postmenopausal DUB patients, 52 (82.53%) appeared to have the proliferative endometrium, and in particular 23 (36.51%) had the disordered proliferative endometrium.
Pregnancy ; Female ; Humans

The glomus coccygeum is a glomus body located close to the tip of the coccyx. Because of its large size and multiple anastomotic channels, it mimics glomus tumor. It is very unfamiliar to the pathologits. We describe a case of glomus coccygeum incidentally found associated with coccygeal dimple from 5-month-old infant.
Infant ; Male ; Female ; Humans

Cholesteatoma in the kidney and ureter are accumulations of waxy, gray flakes of keratin materials, secondary to squamous metaplasia of the transitional epithelium. Herein, we describe a case of cholesteatoma in the renal pelvis of a 69-year-old woman, and give a brief review of the literature. In the upper pole of the left kidney was a 6 cm cystic lesion filled with a thick, flaky, grayish, comified material. Microscopically, the cystic area showed calyceal and pelvic structures being replaced by keratinizing stratified squamous epithelium. The surrounding renal parenchyma was atrophic with features of chronic pyelonephritis.
Female ; Humans

The chronic osteomyeltis of the adult long bones has different problems from the acute osteomyelitis and osteomyelitis of the children. The ischemic scar tissues and infected bones of the chronic csteomyelitis in the adult are resistant to the antibiotic therapy and their healing mechanisms are delayed. The chronic osteomyelitis has no single effective method of treatment since every case reveals different conditions and the treatment should be individualized case by case. 87 cases of chronic osteomyelitis of the adult long bones were studied in the department of orthcpaedic surgery, Fatima Hospital for 7 years during the years between 1973 to 1979. The cases were 65 male and 22 female having ages 35 years in average and the duration of the osteomyelitis was 14 years and 4 months in average ranging from 3 months to 50 years. The cau ative organisms were mostly staphylococcus but Gram (−) bacilli were found in 28% and the adjacent joint problems were found in 38% The cases were analysed in 5 different groups according to x-ray findings as follows; I. Group with sequestrum: 23 cases having sequestra with varying degree of bone sclerosis and destruction. Most cases had draining sinus but the soft tissue involvement was not severe. II. Sclerotic group: 32 cases having significant bone sclerosis with minimal destructicn if any. The soft tissue involvement and scarring were severe but involvement of the bone marrow was not significant. The duration of osteomyelitis was longest having recurrent episodes of the painful swelling in most cases. III. Destructive group: 17 cases with significant bone destruction with varying degree cf sclerosis. The involvement of the bone marrow was significant and soft tissue involvement was not marked The duration of osteomyelitis was short mostly. IV. Group with skin problem: 9 cases having scar problems overlying tibia. V. Group with complication: There were 2 pathologic fractures of the femurs, 3 quamous cell carcinomas on the lower legs and a severe deformity of a leg. Treatment was mostly surgical including 4 amputations. The surgical method was focused on saucerization of the bone and extensive excision of the infected soft tissues and the scar tissues. 23 cases having small or no dead cavity after mobilization and suture of the adjacent healthy soft tissue closed primarily. Otherwise the cavity was packed open for econdary healing in other 23 cases including several cases having big cavity which was unable to close the skin. The cases having big cavity were prepared for continueus irrigation in 14 caes which were able to closed skin. The transposition of muscles to fill the dead cavity was performed in 4 cases that had big cavity and was unable to close skin. The results were healing in 10 weeks in 54% and after 10 weeks in 38% and 8% failed to heal with the first trials. The recurrence of the ostecmyelitis was found in 9 cases among the 42 cases followed for I year and 3 months in average mostly in group II and in cases of primary closure and open packing.
Adult ; Amputation ; Bone Marrow ; Child ; Cicatrix ; Clinical Study ; Congenital Abnormalities ; Female ; Femur ; Fractures, Spontaneous ; Humans ; Joints ; Leg ; Male ; Methods ; Muscles ; Osteomyelitis ; Recurrence ; Sclerosis ; Skin ; Staphylococcus ; Sutures ; Tibia