Heterotopic bone formation is a very rare event in the gastrointestinal tract including in the appendix. Here we report three cases of heterotopic ossification in appendiceal mucinous neoplasms, one occurring in an appendiceal mucinous cystadenoma, another in a low-grade appendiceal mucinous neoplasm, and the third occurring in an appendiceal mucinous adenocarcinoma. The clinicopathologic characteristics of these three present cases and two previously reported cases are discussed in detail. The mechanism of heterotopic ossification in appendiceal mucinous neoplasm is still unclear, but mucin extravasation and subsequent calcification may be predisposing events.

No abstract available.
Adult ; Biopsy ; Cholecystitis/diagnostic imaging/*etiology/therapy ; Churg-Strauss Syndrome/*complications/diagnosis/drug therapy ; Diagnosis, Differential ; Female ; Gallstones/diagnostic imaging/*etiology/therapy ; Glucocorticoids/therapeutic use ; Humans ; Lymphadenopathy/diagnostic imaging/*etiology/therapy ; Magnetic Resonance Imaging ; Mediastinum ; Methylprednisolone/therapeutic use ; Predictive Value of Tests ; Tomography, X-Ray Computed ; Treatment Outcome

PURPOSE: Acute renal failure remains a potentially devastating clinical problem. This study aimed to examine whether the expression of TGF-beta-induced gene product, betaig-h3, is altered in ischemia- reperfusion (I/R) injury and urinary excretion of betaig-h3 is changed in I/R injury. METHODS: I/R injury was performed by clamping both renal arteries. Daily urine output, serum creatinine and urinary TGF-beta and betaig-h3 were measured after I/R injury. Also, the renal expression of betaig-h3 by western blotting and immunohistochemistry were investigated. In the second step, urinary betaig-h3 was measured at 4, 10, 16, and 24 hours after I/R injury to investigate whether it could be used as an early and sensitive marker for detecting I/R injury. RESULTS: Urinary betaig-h3 was significantly elevated at 24 hours and maintained higher than the controls until 2 days after I/R injury. In contrast, western blotting did not reveal any changes of betaig-h3 expression. Immunohistochemistry showed that labeling of betaig-h3 was seen at the basement membranes of proximal tubule cells mainly located at the medullary ray (S3 segment) in both groups. Following I/R injury, the labeling was also seen in the basement membrane of injured or regenerated proximal tubular epithelial cells. Within 24 hours, urinary betaig-h3 was significantly increased at 4 hours after I/R injury. Importantly, the urinary appearance of betaig-h3 preceded that of N-acetyl-beta-D-glucosaminidase. CONCLUSION: These results suggest that endogenous renal betaig-h3 may serve to promote tissue regeneration in I/R injury and urinary betaig-h3 could be used as an early and sensitive marker demonstrating I/R injury.
Acetylglucosaminidase ; Acute Kidney Injury* ; Basement Membrane ; Blotting, Western ; Constriction ; Creatinine ; Epithelial Cells ; Immunohistochemistry ; Regeneration ; Renal Artery ; Reperfusion ; Reperfusion Injury ; Transforming Growth Factor beta

C4d deposition in peritubular capillaries in renal allograft biopsies is a significant marker for diagnosis of antibody-mediated rejection. However, it is unclear whether C4d deposition could be derived from BK virus infection. We present a case of BK virus nephropathy with strong C4d deposition 10 months after kidney transplantation. The diagnosis of BK virus nephropathy was missed out, whereas strong C4d deposition was noted in the first biopsy and therefore anti-rejection therapy was started. The deterioration of renal function led to a evaluate the possibility of BK virus nephropathy with second graft biopsy and further studies of BK virus replication status. Second graft biopsy revealed BK virus nephropathy without rejection. Finally, discontinuation of immunosuppressants and addition of anti-viral therapy for BK virus resulted in recovery of renal function, despite development of pancytopenia and subsequent fungal infection after leflunomide therapy. As in this case, initial focal pathologic changes from BK virus nephropathy could be overlooked by light microscopy. In addition, even though C4d positivity in peritubular capillaries is a good marker for diagnosis of antibody-mediated rejection, the meticulous examinations of the localization of C4d is needed, considering BK virus activates complement pathways and therefore leads to deposition of C4d mainly in tubular basement membrane. Based on our case of BK virus nephropathy with strong C4d deposition, we suggest that C4d deposition could be derived from BK virus nephropathy and therefore, it should be differentiated from acute antibody- mediated rejection in a renal allograft recipient.
Basement Membrane ; Biopsy ; BK Virus ; Capillaries ; Complement C4b ; Complement System Proteins ; Immunosuppression ; Immunosuppressive Agents ; Isoxazoles ; Kidney Transplantation ; Light ; Microscopy ; Pancytopenia ; Peptide Fragments ; Rejection (Psychology) ; Transplantation, Homologous ; Transplants

A 50-year-old female was admitted to Pusan National University Hospital with complaints of fatigue and sweating. Echocardiography showed a small patent ductus arteriosus (PDA) and highly mobile vegetations on the aortic valve. Emergency operation was performed due to the high risk of embolization and severe aortic regurgitation. When the pulmonary artery opened, we found unexpected fresh vegetation. The tissue of the PDA was fragile and infected. We successfully removed the infected tissue, closed the PDA with a patch, and replaced the aortic valve with a mechanical prosthesis.
Adult* ; Aortic Valve Insufficiency ; Aortic Valve* ; Busan ; Ductus Arteriosus, Patent* ; Echocardiography ; Emergencies ; Endocarditis* ; Fatigue ; Female ; Humans ; Middle Aged ; Prostheses and Implants ; Pulmonary Artery ; Sweat ; Sweating

BACKGROUND/AIMS: Encapsulating peritoneal sclerosis (EPS) is an often-fatal complication of long-term peritoneal dialysis (PD). We here report the clinical features of EPS in Korean PD patients from a single university center. METHODS: The data were collected retrospectively from 606 PD patients at Kyungpook National University Hospital, between August 2001 and August 2011. The diagnosis of EPS was based on clinical signs and symptoms, and confirmed by radiological findings. RESULTS: Eight patients (1.3%, four males) were diagnosed with EPS. The mean age of the patients was 48.5 years (range, 33 to 65). The mean duration of PD was 111.8 months (range, 23 to 186). All patients except for one had three or more episodes of peritonitis. Seven patients were diagnosed with EPS after stopping PD, and only one stayed on PD after initial diagnosis and treatment. Total parenteral nutrition and corticosteroids, in addition to tamoxifen therapy, were used to treat most of the patients, and one patient underwent surgery (adhesiolysis). The overall mortality rate was 50%. CONCLUSIONS: EPS is a serious, life-threatening complication in patients on long-term PD. To reduce the incidence and mortality rate of EPS, careful monitoring and early diagnosis is needed.
Adrenal Cortex Hormones/therapeutic use ; Adult ; Aged ; Female ; *Hospitals, University ; Humans ; Male ; Middle Aged ; Parenteral Nutrition, Total ; Peritoneal Dialysis/*adverse effects/mortality ; *Peritoneal Fibrosis/diagnosis/etiology/mortality/therapy ; *Peritonitis/diagnosis/etiology/mortality/therapy ; Republic of Korea ; Retrospective Studies ; Tamoxifen/therapeutic use ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome

BACKGROUND/AIMS: Traumatic aortic injury (TAI) is rarely seen clinically, but is highly fatal. In determining how to treat TAI, there are many factors to consider, due to the complexity of concomitant injuries. The Society of Vascular Surgery recommends that thoracic endovascular aortic repair (TEVAR) should be preferentially performed over open surgical repair. We evaluated the efficacy of TEVAR based on our experiences in TAI treatment. METHODS: Between July 2008 and August 2011, we conducted a retrospective analysis of the patients who underwent TEVAR following TAI and analyzed factors including TAI type and sites, time from injury to repair, Injury Severity Score, and complications. Seven patients with multiple injuries underwent TEVAR in the acute setting. Follow-up was accomplished regularly by computed tomographic angiography (CTA). RESULTS: Type III aortic injury, rib fractures, and hemothorax were found in all patients. TEVAR was successfully performed. Completion angiography demonstrated complete exclusion of pseudoaneurysm without endoleakage, and perfusion of aortic arch vessels was maintained. There was no in-hospital mortality or evidence of spinal cord ischemia. The average follow-up duration was 30.4 +/- 23.9 months, and regular CTA revealed good durability of the stent-graft without late complications such as endoleakage, stent migration, or pseudoaneurysm formation. CONCLUSIONS: Through this study, we were able to identify good mid-term results of TEVAR in our hospital. TEVAR is thought to be a good modality with which to treat acute traumatic aortic injury, especially given the consideration of bleeding risk in trauma patients with multiple injuries.
Aneurysm, False ; Angiography ; Aorta, Thoracic ; Aortic Aneurysm, Thoracic ; Endovascular Procedures ; Follow-Up Studies ; Hemorrhage ; Hemothorax ; Hospital Mortality ; Humans ; Injury Severity Score ; Multiple Trauma ; Perfusion ; Retrospective Studies ; Rib Fractures ; Spinal Cord Ischemia ; Stents ; Thoracic Injuries

We present a case of a false-positive anti-myeloperoxidase (MPO) antibody result on an ELISA in a patient with anti-thyroid microsomal antibody (TMA)-positive hypothyroidism. A 41-year-old woman presented with dyspnea on exertion. The initial evaluation revealed pericardial effusion associated with hypothyroidism. In addition, microscopic hematuria with normal renal function and positive cytoplasmic anti-neutrophil cytoplasmic antibodies (c-ANCA) on immunofluorescent assay were found. In further evaluation, elevated anti-TMA and MPO antibodies by ELISA. While no definite signs of vasculitis were present, the clinical state improved with thyroid hormone replacement and diuretics. Anti-MPO antibody was still positive in the follow-up tests, and microscopic hematuria persisted. On the basis of previous reports that thyroid peroxidase and MPO molecules contain cross-reactive epitopes that are exposed in denaturated molecules, we suggest that in a patient with anti-TMA-positive hypothyroidism, anti-MPO antibody might also be positive on ELISA without clinical signs of vasculitis.
Adult ; Antibodies ; Antibodies, Antineutrophil Cytoplasmic ; Cytoplasm ; Diuretics ; Dyspnea ; Enzyme-Linked Immunosorbent Assay ; Epitopes ; Female ; Follow-Up Studies ; Hematuria ; Humans ; Hypothyroidism ; Iodide Peroxidase ; Pericardial Effusion ; Thyroid Gland ; Vasculitis

PURPOSE: TGF-beta-induced epithelial-mesenchymal transition (EMT) is associated with peritoneal fibrosis during PD. We conducted this study to evaluate the effect of BMP-7 adenoviral gene transfer on the functional and structural changes of peritoneum and whether it is associated with peritoneal EMT using an animal PD model. METHODS: Forty Sprague-Dawley rats were divided into five groups; Control (C, n=8), Dialysis (D, n= 8), Rest (R, n=8), BMP-7 (B, n=8) and LacZ (L, n=8) group. Peritoneal function was assessed on baseline, 3rd, 6th, 8th weeks after PD. Immunohistochemistry for TGF-beta, VEGF, laminin and aquaporin-1 was performed in addition to morphometric analysis of peritoneum. Immunofluorescence staining with western blotting for alpha-SMA and E-cadherin, as markers of EMT, was performed. RESULTS: The thickness of submesothelial matrix was highest in D and significantly decreased in B compared to D, R and L. D/D0 glucose at 8 weeks was significantly increased in B and L compared to that of at 6 weeks, but there were no significant differences among R, B and L at 8 weeks. TGF-beta1 and VEGF expression was observed in submesothelial matrix in D and decreased in R, B and L. Peritoneal fibrosis and functional deterioration of peritoneal membrane were associated with EMT, which was partially reversed in R, B and L. CONCLUSIONS: BMP-7 gene transfer to peritoneum was not associated with the additive therapeutic effect on peritoneal function compared to the peritoneal rest, although it improved morphologic changes of peritoneum.
Animals ; Blotting, Western ; Bone Morphogenetic Protein 7 ; Cadherins ; Dialysis ; Epithelial-Mesenchymal Transition ; Fluorescent Antibody Technique ; Genetic Therapy ; Glucose ; Immunohistochemistry ; Laminin ; Membranes ; Models, Animal ; Peritoneal Dialysis ; Peritoneal Fibrosis ; Peritoneum ; Rats, Sprague-Dawley ; Transforming Growth Factor beta ; Transforming Growth Factor beta1 ; Vascular Endothelial Growth Factor A

This report present the result of the national survey of pediatric surgeons' preferences on diagnosis and treatment of Hirschsprung's disease(HD) carried out in 1993. The questionnaires were sent to twenty-seven members of the Korean Association of Pediatric Surgeons (KAPS) working in twenty-four institutions. The questionnaires were designed to determine the individual surgeon's preference for the methods of diagnosis and treatment of the disease. Twenty-three pediatric surgeons from twenty institutions returned completed forms. The total number of patients diagnosed with HD in 1992 was 190 in this group. The estimated incidence of HD was 1/3,900. The most important symptom was delayed meconium passing and the most preferred diagnostic procedure was barium study. Anorectal manometric examination was carried out by 13 pediatric surgeons and 19 confirmed the diagnosis before operation by rectal biopsy, 12 with full-thickness biopsy and 7 with suction. Frozen section biopsy during operation was done by 22 surgeons. Eight surgeons did one stage operation if the age of the patient is suitable. Definitive operation was usually done at the age of 6 to 11 months. The most preferred operation was Duhamel procedure done by 19. Enterocolitis was the most serious complication of HD. Most of patients had normal continence within 6 to 12 months after operation. The follow-up period was less than 6 years in 16 surgeons. The results were presented at the 9th annual meeting of KAPS in June of 1993. This is the first national survey of HD and it can provide guidelines of diagnosis and treatment of Hirschprung's disease even though it is not a detailed study of patient data.
Barium ; Biopsy ; Diagnosis ; Enterocolitis ; Follow-Up Studies ; Frozen Sections ; Hirschsprung Disease ; Humans ; Incidence ; Korea ; Meconium ; Suction ; Surgeons