A three year old girl with a left renal teratoid Wilms tumor is reported. The tumor was located both inside and outside the kidney parenchyme, to form a well encapsulated mass containing two lobulated solid and cystic masses. The tumor consists predominantly of otherwise typical Wilms tumor irregularly mixed with teratoid tissue elements such as intestinal tract, mucous glands with argentaffin cells, goblet cells and transitional epithelium. These heterologous elements were regarded as diverse epithelial differentiation of totipotent cells in certain nephrogenetic period, and this tumor was considered to be hest called "teratoid Wilms tumor".

Atresia of larynx is a rare fatal anomaly that should bring an immediate medical attention for proper managenent. We reported a case who died in neonatal period because of respiratory difficulty. His first problem was difficulty of inserting tracheal tube through the larynx. It was of interest in this case that he was presented with generalized edema and also massive lung edema. The lung was characterized by total absence of squamous and amniotic debris in the alveolar spaces and massive inflation of the alveoli by clear fluid that was thought to be amniotic fouid produced by the lung per se. Because there was no connection between oral cavity and the lungs, there would be no way the amniotic fluid outside the fetus. The laryngeal atresia was of infraglottic type and was complete with dispalced cricoid cartilage. Associated anomalies were left persistent supperior vena cava, perimembranous ventricular septal defect, spina bifida and focal cerebellar heterotopia.
Infant, Newborn ; Humans

In contrast to the nodular renal blastema which is defined by nests of primitive metanephric cells after 36 weeks of gestation, the nephroblastomatosis is characterized by neoplastic proliferation of the primitive cells. This lesion is presumed to be closely related to the development of Wilms' tumor. We report a case of bilateral nephroblastomatosis associated with Wilms' tumor in a child. This 4 1/2 year-old girl was admitted because of a 10 cm-sized round mass in the right kidney, and smaller nodules in the left kidney and the lung. After three cycles of chemotherapy and subsequent disappearance of the nodules in the left kidney and lung, she underwent a right nephrectomy and a wedge resection of the left kidney. A round Wilms' tumor mass was seen in the lower pole of the right kidney. Remaining right renal cortex showed multiple, slightly depressed gray-white nodules associated with multiple samll cysts. They were comprised of multifocal subcapsular nests of primitive nephrogenic cells with focal tubular or glomerular differentiation. They resembled fetal renal tissue. In the left kidney, similar nests of primitive cells were also noted. These lesions were interpreted as multifocal perilobar type of nephroblastomatosis.
Child ; Male ; Female ; Humans

PURPOSE: We wanted to determine the incidence and characteristics of failing graft after implantation of autologous reversed vein grafts. METHOD: From Sep. 2003 to Dec. 2005, 84 leg bypasses using autologous reversed vein grafts were performed for chronic leg ischemia in 75 patients. After the operations, duplex ultrasonography (DUS) and measurement of the ankle brachial index (ABI) were performed every 3 months for the purpose of examining the graft patency. The criteria for a failing graft was a peak systolic velocity (PSV) of the stenotic lesion >300 cm/s, or a PSV distal to the occlusive lesion <40 cm/s, but with sustained patency of the vein graft. We investigated the timing of detection, the site of the causative lesion, and the clinical symptoms of the failing grafts. For the treatment of failing grafts, surgeries (vein patch, graft extension, or inflow artery reconstruction) were performed in 4 legs. The Kaplan Meier method was used for calculating the rate of graft patency. RESULT: Nine failing grafts were detected by DUS in 8 patients. The sites of causative lesions were the inflow artery (2), the proximal anastomosis (6), and the distal anastomosis (1). Seven of the 9 patients with failing grafts were asymptomatic, 1 patient had claudication and another patient suffered from resting pain of the involved leg. The assisted graft primary patency rates at 1 and 2 years after operations were 86% and 53%, respectively. CONCLUSION: Nine cases of failing grafts were detected during surveillance with duplex ultrasonography after implantation of autologous reversed vein grafts.
Ankle Brachial Index ; Arteries ; Diagnosis* ; Humans ; Incidence ; Ischemia ; Leg ; Lower Extremity* ; Transplants* ; Ultrasonography ; Veins

BACKGROUND: Eosinophilic pustular folliculitis (EPF) is characterized by erythematous patches of follicular papules and pustules that mainly involve the face. Although various treatments have been attempted for EPF, including systemic and topical steroids, dapsone and indomethacin, there is no consensus on the first choice for treatment. OBJECTIVE: The purpose of this study was to evaluate the clinical efficacy and safety of naproxen treatment for EPF patients. METHODS: We retrospectively reviewed the clinical records of 16 biopsy-proven EPF patients who were treated with naproxen. Initial dose of oral naproxen was 500 mg to 1,000 mg. Therapeutic effects were evaluated by 3 grades: NR (no response), PR (partial remission, >50% improvement), CR (complete remission). RESULTS: Of the 16 EPF patients, 11 patients (69%) showed either complete remission (50%) or partial remission (19%). The median time to response for good responders (CR+PR) was 1.5 weeks. Two patients (13%) had mild gastrointestinal side effects, such as indigestion, but the symptoms disappeared soon after use of a gastrointestinal protectant. CONCLUSION: Oral naproxen may be an effective and safe treatment modality for EPF.
Consensus ; Dapsone ; Dyspepsia ; Eosinophilia ; Eosinophils ; Folliculitis ; Humans ; Indomethacin ; Naproxen ; Retrospective Studies ; Skin Diseases, Vesiculobullous ; Steroids

Hemobilia caused by pancreatic disease is very rare. The most common cause is a splenic artery pseudoaneurysm caused by acute and chronic inflammation of the pancreas. We experienced a case regarding as hemobilia as a complication of chronic relapsing pancreatitis in a 14 year-old boy. He was admitted with chief complaints of abdominal pain and hematemesis. Two years prior to admission, intermittent attacks of abdominal pain and vomiting began to develop. Recently he suffered a weight loss of 7.8kg due to poor oral intake but regain his usual weight after management by one month of total parenteral nutrition. On the day of admission abrupt onset of abdominal pain and massive hematermesis brought him to the emergency room of our hospital, and the area of active bleeding was on the 2 nd portion of duodenum proven by endoscopic examination. Bleeding control was failed with conservative management including blood transfusion, so whipple's operation was done on the 4 th day of admission. Ffter then bleeding was controlled, but he died of sepsis and cerebral infartion on the 20 th postoperative day.
Abdominal Pain ; Adolescent ; Aneurysm, False ; Blood Transfusion ; Duodenum ; Emergency Service, Hospital ; Hematemesis ; Hemobilia* ; Hemorrhage ; Humans ; Inflammation ; Male ; Pancreas ; Pancreatic Diseases ; Pancreatitis ; Pancreatitis, Chronic* ; Parenteral Nutrition, Total ; Sepsis ; Splenic Artery ; Vomiting ; Weight Loss

The intrahepatic calculi are prevalent in east Asia and are regarded as malignant disease because diagnosis and treatment are difficult and complication and mortality are high. This study is a retrospective clinical review of 58 cases of patient with intrahepatic calculi in the Department of Surgery, Chungnam National University Hospital from July 1994 through June 1999. The incidence of intrahepatic calculi was 8.8% of total hepatobiliary calculi. The ratio of male to female was 1:2.4. The peak incidence was noted at the 6th decade (32.7%) and mean age was 52.1 years. About the site of stones, left intrahepatic duct (48.3%)was more prevalent than right intrahepatic duct (17.2%). 42 cases(72%) of the intrahepatic calculi were associated with GB stone(8%), CBD stone(45%) or both(19%). As to surgical method, choledochotomy with T-tube drainage was performed in 34 cases(59%), choledochoduodenostomy was in 3 cases(5%) and hepatic resection in 21 cases(36%). Among them choledochotomy with T-tube drainage was the most frequently performed procedure. The remnant stones are most commonly founded after choledochotomy and T-tube drainage (80%) followed after choledochoduodenostomy(33%) and after hepatic resection(24%). But, major postoperative complications such as bile leakage and intra-abdominal abscess are more frequent in casea of hepatic resection. So we suggest that agressive treatment modality such as hepatic resection is more reasonable than drainage procedure in the management of intrahepatic duct stone by the experienced expert.
Abdominal Abscess ; Bile ; Calculi* ; Choledochostomy ; Chungcheongnam-do ; Diagnosis ; Drainage ; Far East ; Female ; Humans ; Incidence ; Male ; Mortality ; Postoperative Complications ; Retrospective Studies

In order to obtain novel genes for craniofacial development of human, molecular cloning and sequencing were performed and followed by in situ hybridization in tissue sections. Subtracted cDNA library of craniofacial tissue from 8 weeks old human embryo was made by the subtraction with cDNA of RHEK cells. A total of 231 clones were obtained and their partial sequence data disclosed that 214 clones were nonredundant in Genebank search. We have done in situ hybridization screening on the craniofacial sections of a 10 weeks old human fetus, and found significant positive reaction in 30 clones. Depending on the cell type of similar developmental origin, the positive reactions could be divided into four groups: first group showed an intense positive reaction in neural tube, ganglion, and a part of peripheral nerve tissue, second group relatively diffuse positive reaction in neural tube, cartilage, epithelium, and muscle, third group localized positive reaction in nerve, and muscle, and fourth group positive reaction in almost all kinds of cells of craniofacial tissues. Although every clone showed different expression patterns in the craniofacial development, some of them showed intense mRNA expressions in the characteristic cell type. Because this study also aimed to test a screening methods to find out novel genes related to craniofacial development by the subtracted cDNA library and in situ hybridization, the intense positive reaction of a certain clone by in situ hybridization may indicate its role in the developmental processes. We presumed that 30 clones selected in this study are possibly important new genes for the development of human craniofacial structure.
Cartilage ; Clone Cells ; Cloning, Molecular* ; DNA, Complementary ; Embryonic Structures* ; Epithelium ; Fetus ; Ganglion Cysts ; Gene Library ; Humans* ; In Situ Hybridization ; Mass Screening ; Neural Tube ; Peripheral Nerves ; RNA, Messenger

No abstract available.
Hodgkin Disease*

PURPOSE: This report outlines the incidence and the clinical features of patients with a neuroendocrine (NE) neoplasm of the colon and rectum and describes, in detail, their histologic and immunohistochemical findings. Also, we attempted to determine the impact of several clinical variables, including tumor stage, tumor location, NE pattern, and cellular subtype on survival. METHOD: Of 690 colorectal cancers operated on from April 1990 to November 1998 at Chungnam National University Hospital, 41 cases were originally diagnosed as poorly differentiated adenocarcinoms on the basis of conventional light microscopy. Paraffin blocks from the aforementioned cases were retrieved, and sections were im munostained with antibodies to human chromogranin A, neuron specific enolase, and synaptophysin. RESULTS: Of the 690 cases of colorectal caner, 35 cases (5.1%) of NE neoplasm were identified retrospectively: 28 males and 7 females. About 90% of the tumors were located at the cecum and the rectosigmoid. Pathologic stages were as follows: modified Dukes stage B2, 6; stage C1, 8; stage D1, 12; and stage D2, 9. The most common metastatic site at the time of diagnosis was the liver (8/9). Four NE patterns were identified: pure NE (n=4), and predominantly NE (n=8), equal NE and exocrine (n=4), and predominantly exocrine (n=19). Two cellular subtypes were identified: well-differentiated (n=3) and intermediate (n=32) cells. Survival statistically correlated with stage (p=0.03), but not with age, sex, tumor location, NE pattern, or cellular subtype. CONCLUSION: This study suggests that NE neoplasms of the colon and rectum are more frequent than previously believed. Since a NE neoplasm is believed to be an extremely biologically aggressive tumor, recognition of a NE neoplasm is very important because of its evident clinical and therapeutic implications.
Antibodies ; Cecum ; Chromogranin A ; Chungcheongnam-do ; Colon* ; Colorectal Neoplasms ; Diagnosis ; Female ; Humans ; Immunohistochemistry ; Incidence ; Liver ; Male ; Microscopy ; Paraffin ; Phosphopyruvate Hydratase ; Rectum* ; Retrospective Studies ; Synaptophysin