Hydrops fetalis (HF) is a disease characterized by generalized subcutaneous edema and cavity effusion in the fetal stage. We report here on two autopsy cases of HF that were caused by parvovirus B19 (PVB19) infection. The human PVB19 is an erythrovirus that cause diverse clinical manifestations ranging from an asymptomatic or mild presentation to more severe effects such as hydrops fetalis, and this is the only known human pathogenic parvovirus. The gestational ages of the two fetuses were 21 weeks and 23 weeks, respectively. Both fetuses were hydropic and anemic. Hepatic tissues of both fetuses demonstrated erythroblasts with eosinophilic intranuclear inclusions, the so called "lantern cells". PVB19 was confirmed by electron microscopy and immunohistochemical staining. For the diagnosis of this disease, recognition of parvovirus infection as a cause of hydrops fetalis and careful examination of red blood cells with a high-power view are required.
Anemia ; Autopsy* ; Diagnosis ; Edema* ; Eosinophils ; Erythroblasts ; Erythrocytes ; Erythrovirus ; Fetus ; Gestational Age ; Humans ; Hydrops Fetalis* ; Intranuclear Inclusion Bodies ; Microscopy, Electron ; Parvoviridae Infections ; Parvovirus*

Sweet's syndrome was originally described as an "acute febrile neutrophilic dermatosis". Sweet's syndrome presents in three clinically settings: (1) classical or idiopathic Sweet's syndrome, (2) malignancyassociated or paraneoplastic Sweet's syndrome, (3) drug-induced Sweet's syndrome. Sweet's syndrome is known to respond well to systemic corticosteroids, and mortal case associated without any other predisposing factors is hardly found. Twenty-nine year old male was transferred from local clinic with the chief complaint of recurrent thrombophlebitis which occurred 10 days ago after IV treatment of antibiotics for burn. The symptom did not get well with conventional treatment for the thrombophlebitis such as antibiotics or drainage. After several days of pyrexia, the patient died suddenly. Grossly abnormal findings including pulmonary thrombus which could explain sudden death were not found. Disseminated intravascular microthrombi was the most peculiar finding. It was prominent in small sized vein, and lung was the most severely affected. Heart and liver were also involved. Large thrombi within deep vein of the legs were also noted. Minor collections of inflammatory cells, even apart from the main lesion, were noted in skin adnexa or small vessles within aorta wall. No tumorous area was found. The disseminated intravascular coagulation, which was associated with vasculitis was thought to be the direct cause of death. Several points about the Sweet's syndrome including the unusualness of this case were discussed.
Adrenal Cortex Hormones ; Anti-Bacterial Agents ; Aorta ; Burns ; Causality ; Cause of Death ; Death, Sudden ; Disseminated Intravascular Coagulation ; Drainage ; Fever ; Heart ; Humans ; Leg ; Liver ; Lung ; Male ; Neutrophils ; Skin ; Sweet Syndrome* ; Thrombophlebitis ; Thrombosis ; Vasculitis ; Veins

Dedifferentiated chondrosarcoma is an uncommon bone tumor, defined as a tumor in which two components -a low-grade chondrosarcoma and a high-grade non-cartilaginous sarcoma-coexist with abrupt interface. We report a rare case of giant-cell rich dedifferentiated chondrosarcoma occurred in the right distal femur shaft of a 60 year-old female. The plain X-ray film showed an irregular radiolucent mass. The T2-weighted MRI revealed a heterogeneous high signal intensity. It was an irregular mass composed of bluish-white, translucent chondroid elements and yellowish solid components with extraosseous invasion. Microscopically, a low-grade chondrosarcoma and a giant-cell rich spindle cell sarcoma with areas resembling giant cell tumor were recognized with abrupt transition. Immunohistochemical staining revealed a S100 protein positivity in chondroid cells and a few spindle cells. CD68 was strongly positive in giant cells. Vimentin was positive in both components and smooth muscle actin was positive in some spindle cells. There was no cytokeratin, desmin and myogenin immunopositivity. It is important to be aware of this rare variant of dedifferentiated chondrosarcoma to avoid the misdiagnosis of more common bone tumors including giant cell tumors.
Actins ; Chondrosarcoma* ; Desmin ; Diagnostic Errors ; Female ; Femur ; Giant Cell Tumors* ; Giant Cells* ; Humans ; Immunohistochemistry ; Keratins ; Magnetic Resonance Imaging ; Middle Aged ; Muscle, Smooth ; Myogenin ; Sarcoma ; Vimentin ; X-Ray Film

Neurofibromatosis originally described by von-Recklinhausen in 1882, is often depicted as a chronic progressive hereditary disease characterized by pigmentation of the skin, cutaneus lesions, and numerous tumors developing in association with elements of both the central and peripheral nervous tissue. Mesenteric involvements in neurofibromatosis are very rare in childrens. We experienced a case of neurofibromatosis with multiple neurofibromas on mesentery in 6 years old male who presented with abdominal pain. The diagnosis was confirmed by clinical manifestations, abdominal CT, and histopathologic findings. Brief review of literatures was made.
Abdominal Pain ; Child ; Diagnosis ; Genetic Diseases, Inborn ; Humans ; Male ; Mesentery* ; Neurofibroma ; Neurofibromatoses* ; Pigmentation ; Skin ; Tomography, X-Ray Computed

Endometrial mucinous adenocarcinoma occurs in 1-9% of endometrial adenocarcinomas and adenocarcinoma with squamous differentiation in approximately 25%. We report a rare case of mucinous adenocarcinoma with squamous differentiation in a 53-year-old woman. Curetting biopsies of the endometrial lesion were taken twice after hormone replacement therapy, which lasted for four months. Because the squamous differentiation was so extensive, the initial diagnosis based on each curetting specimen was squamous papilloma. A total hysterectomy was performed and the tumor was revealed to be a mucinous adenocarcinoma with squamous differentiation. We subsequently discussed the pathogenesis and prognosis of this type of tumor.
Adenocarcinoma ; Adenocarcinoma, Mucinous* ; Biopsy ; Diagnosis ; Endometrial Neoplasms ; Female ; Hormone Replacement Therapy ; Humans ; Hysterectomy ; Middle Aged ; Mucins* ; Papilloma ; Prognosis

Hemobilia is a disease caused by injury or conditions that cause the abnormal communication between intrahepatic blood vessels and biliary tract, resulting in leakage of blood into the biliary tract. In the past, trauma had been the most common cause of hemobilia. However, with the increasing invasive procedures in the hepatobiliary tract, iatrogenic origin has become the major cause of hemobilia. Also, non-traumatic etiologies of hemobilia include vascular malformation such as aneurysm, gallstone, inflammation, biliary tumor, hepatocellular carcinoma and coagulopathy. Among these non-traumatic etiologies, choledocholithiasis is a rare cause of hemobilia. The authors have experienced two cases of hemobilia caused by choledocholithiasis, which was diagnosed by abdominal ultrasonography, abdominal CT and duodenoscopy. Both patients were treated by the endoscopic sphincterotomy and stone removal with basket.
Aneurysm ; Biliary Tract ; Blood Vessels ; Carcinoma, Hepatocellular ; Choledocholithiasis ; Common Bile Duct* ; Duodenoscopy ; Gallstones ; Hemobilia* ; Humans ; Inflammation ; Sphincterotomy, Endoscopic ; Tomography, X-Ray Computed ; Ultrasonography ; Vascular Malformations

Negative pressure pulmonary edema is an uncommon complication related to general anesthesia. Its main pathophysiology is excessive negative intrathoracic pressure that is caused by an acute upper airway obstruction. Pneumopericardium, the presence of air within the pericardial sac, is another rare condition. The common pathophysiology of pneumopericardium, except for that caused by blunt or penetrating trauma, is barotrauma-induced alveolar rupture caused by positive intrathoracic pressure. Here, we report the case of a 61-year old female patient with negative pulmonary edema and pneumopericardium after general anesthesia. She recovered after conservative management.
Airway Obstruction ; Anesthesia, General* ; Female ; Humans ; Pneumopericardium* ; Pulmonary Edema* ; Rupture

OBJECTIVE: To investigate the efficacy of ultrasonography (US)-guided injections in patients with low lumbar facet syndrome, compared with that in patients who received fluoroscopy (FS)-guided injections. METHOD: Fifty-seven subjects with facet syndrome of the lumbar spine of the L4-5 and L5-S1 levels were randomly divided into two groups to receive intraarticular injections into the facet joint. One group received FS-guided facet joint injections and the other group received US-guided facet joint injections. Treatment effectiveness was assessed using a visual analogue scale (VAS), physician's and patient's global assessment (PhyGA, PaGA), and the modified Oswestry Disability Index (MODI). All parameters were evaluated four times: before injections, and at a week, a month, and three months after injections. We also measured, in both groups, how long it took to complete the whole procedure. RESULTS: Each group showed significant improvement from the facet joint injections on the VAS, PhyGA, PaGA, and MODI (p<0.05). However at a week, a month, and three months after injections, no significant differences were observed between the groups with regard to VAS, PhyGA, PaGA, and MODI (p>0.05). Statistically significant differences in procedure time were observed between groups (FS: 248.7+/-6.5 sec; US: 263.4+/-5.9 sec; p=0.023). CONCLUSION: US-guided injections in patients with lumbar facet syndrome are as effective as FS-guided injections for pain relief and improving activities of daily living.
Activities of Daily Living ; Fluoroscopy ; Humans ; Injections, Intra-Articular ; Spine ; Treatment Outcome ; Zygapophyseal Joint

Diabetic gastroparesis is a pathologic condition of delayed gastric emptying with gastrointestinal symptoms such as nausea, early satiety and vomiting in the absence of mechanical obstruction in patients with diabetes mellitus. We report a case of diabetic gastroparesis who had diabetes mellitus for 13 years and suffered from nausea and vomiting with marked gastric dilatation of acute onset. Blood glucose level of the patient was very high and any mechanical obstruction was not found by gastroduodenal endoscopy, hypotonic duodenography, celiac angiography, electrogastrography and CT scan. Acute gastric dilatation was resolved with conservative treatment of gastric drainage, glucose control and hydration. Gastrointestinal symptoms of nausea and vomiting improved and diet was well tolerated thereafter.
Angiography ; Blood Glucose ; Diabetes Mellitus ; Diet ; Drainage ; Endoscopy ; Gastric Dilatation* ; Gastric Emptying ; Gastroparesis* ; Glucose ; Humans ; Nausea ; Tomography, X-Ray Computed ; Vomiting

BACKGROUND/AIMS: The aim of this study was to examine the incidence of proximal colon adenoma according to characteristics of distal colon adenoma. METHODS: Ninety-two colon adenoma patients who underwent total colonoscopy and endoscopic polypectomy were analyzed retrospectively. Adenoma was classified as proximal when located in proximal to splenic flexure. The advanced adenoma was defined as an adenoma larger than 10 mm or any size with a villous component or severe dysplasia. RESULTS: The incidence of proximal adenoma was increased significantly in those with old age (odds ratio (OR)=3.3), villous (OR=5.3) or dysplastic histology (OR=8.1) or the presence of advanced distal adenoma (OR=3.4). However, the incidence of advanced proximal adenoma was increased only in those with old age (OR=11.2). Nineteen in thirty-nine (48.7%) patients with proximal colon adenoma did not have distal colon adenoma. CONCLUSIONS: Various characteristics of distal colon adenoma couldn't exactly predict the presence of synchronous proximal adenoma and a greater percentage of subjects with proximal adenoma didn't have distal adenoma. So, colonoscopy could be a standard method for colon cancer screening in Korea.
Adenoma* ; Colon* ; Colon, Transverse ; Colonic Neoplasms ; Colonoscopy ; Humans ; Incidence* ; Korea ; Mass Screening ; Retrospective Studies ; Sigmoidoscopy