Cricopharyngeal incoordination of infancy is a rare disease, characterized by difficult swallowing soon after birth. regurgitation, frequent choking and aspiration with deglutition, recurrent aspiration pneumonia, and to-and-fro movement of the contrast medium in the posterior pharynx on upper esophageal cineroentgenography. Clinical investigation was performed in the infants who were admitted due to difficult swallowing, regurgitation, and recurrent pneumonia from March 1, 1989 to June 30, 1992. The results were as follows: 1) Male to female sex ratio was great, and major symptoms such as difficult swallowing, regurgitation, choking and aspiration with deglutition, and those of pneumonia developed soon after birth in most cases. 2) The typical findings of this disease were noted on the cineroentgenography of upper esophagus in all cases and those of aspiration pneumonia in 10 cases. 3) The infants had been fed via gavage tube until they were able to swallow without difficulties before and after 6 months after birth. 4) Cricopharyngeal incoordination is a rare disease, but we suggest this disease should be considered in differential diagnosis in the infants with difficult swallowing soon after birth and recurrent episodes of aspiration pneumonia.
Airway Obstruction ; Ataxia* ; Deglutition ; Diagnosis, Differential ; Esophagus ; Female ; Humans ; Infant ; Male ; Parturition ; Pharynx ; Pneumonia ; Pneumonia, Aspiration ; Rare Diseases ; Sex Ratio

The pathologic features of acute corrosive esophago-gastritis by ingestion of "Trapunc", a common commercial drain cleansing liquid, is presented. A 37-year-old woman ingested abut 30 ml of Trapunc (3 gm NaOH/100 ml) to commit suicide and received piecemeal esophagectomy and total gastrectomy 9 days after the episode. The esophagus and stomach were extremely friable and necrotic. The most part of the stomach showed acute toxic necrotizing gastritis which was manifested by extensive greenish brown discoloration due to liquefaction necrosis of the mucosa except for a few rugae along the greater curvature. The antrum and distal body revealed severe mucosal detachment and even transmural necrosis. The tissue reaction was basically the same as those of NaOH-induced corrosive esophago-gastritis of acute stage, although it appeared to be severer probably due to sodium hypochlorite, and additive constituent of the ingested cleanser. A unique distribution pattenr of mucosal involvement is discussed.
Female ; Humans

The authors developed a computer program for use in report printing as well as data storage and retrieval system at the surgical pathology and its efficacy was evaluated at the Department of Pathology, Seoul National University Hospital. This program used IBM PC XT and was written in DBASE III plus language. The main features of the program included an automatic coding and decoding of the diagnosis, automatic searching of the previous biopsy during gross dictation, powerful word processing function and flexibility of the program. The data storage was carried out during the typewriting of the report, so that the typist's workload became markedly reduced. Two kinds of data files wer stored in the hard disk ; the temporary file contained full informations and the permanent file contained the core data only. Searching of a specific case was performed by pathology accession number, chart number, patient's name or by SNOMED code within a second. All the cases were arranged by copied to the diskette during the daily service automatically, with which data were easily restored in case of hard disk failure. The advantages of this program using a persosnal computer were discussed with comparison to those of larger computer system. Based on the experience of 8 months usage in Seoul National University, we assume that this program gives a sufficient solution to the surgical pathology service of many institutes where a large computer system with well designed software is not available yet.
Biopsy

The authors described a case of male schizophrenia who developed myoclonic jerk repeatedly and one episode of convulsive seizure during the treatment of clozapine. According to literatures and reported cases, myoclonic jerks induced in a small amount of clozapine may precede and predict the development of a convulsive seizure. Therefore clinicians have to pay attention to the development of a myoclonic jerk during the administration of clozapine. They may decrease the dosage of clozapine step by step at first in the convulsive state, and observe EEG changes of patients frequently.
Clozapine* ; Electroencephalography ; Humans ; Male ; Myoclonus ; Schizophrenia ; Seizures*

Decubitus ulcer is often seen in the skin and underlying tissue of debilitated or immobilized patients as the result of prolonged pressure and impaired circulation. It manifests chiefly as an ulcer over bony prominences, but tumefaction is an extremely unusual presentation. A 53-year old male, a paralytic of the lower extremity for 18 years, developed a recurrent decubital ulcer despite repeated surgical repair, from which a rapidly growing, large fungating mass grew within a month. The last resected mass was bosselated and measured 15x9x3 cm with a major area of cicatrix-like induration, interdigitated with skeletal muscle bundles at the central area. Microscopically, the mass was composed of an upper half of active granulation tissue layer and a deeper half of dense, poorly cellular, fibrocollagenous bundles admixed with florid proliferation of atypical fibroblasts, but the absence of mitosis and the multifocal admixture of active inflammatory process-granulation tissue formation seemed to help exclude genuine fibromatosis, nodular fasciitis or proliferative myositis. We assume that this rapidly growing pseudofibromatosis is an additional manifestation of a prolonged decubitus ulcer, possibly related to the modified reparative process of decubitus ulcer following repeated excisions, for which we propose a term of decubitoma.

No abstract available.
Hypertension, Portal*

Wilms' tumor is the most common urinary tract neoplasm and one of the most frequent solid abdominal malignant tumors of childhood, usually diagnosed between the ages of 2 and 5 years. Typically, it is manifested as an asymptomatic unilateral or upper abdominal mass. Abdimonal pain after some traumatic incident, fever, anemia, hematuria and hypertension are other patterns of presentation. In a considerable number of these patients, pulmonary metastases are present at the time of primary diagnosis. But, the initial presentation of acute pulmonary tumor emboli without surgical manipulation is very rare. We describe a sudden unexpected infantile death case diagnosed as pulmonary tumor embolism preexisting Wilms tumor. To our knowledge, this is the initial autopsy presentation of Wilms tumor with tumor embolism as sudden and unexpected death in Korea.
Anemia ; Autopsy ; Death, Sudden* ; Diagnosis ; Fever ; Hematuria ; Humans ; Hypertension ; Korea ; Neoplasm Metastasis ; Neoplastic Cells, Circulating* ; Urologic Neoplasms ; Wilms Tumor*

A total of 66 cases of thymoma(57 surgically resected cases and 9 incisional biopsy cases) were reviewed with an attempt to correlate pathomorphologic features and clinical presentations. Criteria of benign or invasive thymoma were primarily determined by operative clinical and pathologic findings. Of them, 21 cases were invasive thymomas. The mean age of patients at the time of surgery was 47 years and it occurred largely in the sixth decade. Myasthenia gravis was accompanied in 29 cases(43%). One patient died during folow-up period, and five of the remainder suffered from recurrence. Microscopically, mixed type was the most common one(33 cases), being followed by predominantly epithelial type(17 cases) and predominantly lymphocytic type(16 cases). Thirty four cases of thymomas were cortical type, 29 mixed type, and the remaining 3 medullary type. None of the histologic type were significantly correlated with tumor invasiveness, Myasthenia gravis was more frequently associated with mixed and cortical type, respectively.
Biopsy

Arthrography is an invaluable procedure in critically verifyging the concentricity of closed reduction and the optimum position of stability. And it is known to be the most accurate and certain way of demonstrating lesser degrees of incongruity. It can visualize the intrinsic obstructive fractors, such as capsular attachment, the labrum, the psoas tendon and its relationship to the joint, the pulvinar, ligamentum teres, the inferior transverse ligament, and the shape of the femoral head and acetabulum. We analyzed 20 cases of congenital dislocation of the hip in 17 patients, which had been evaluated by arthrography. The results are as follows: 1. We found the inferior approach very efficient among many kinds of arthrographic techniques. 2. Among 20 cases, 12 cases could be treated with closed reduction and 8 cases were treated by open reduction such as capsuloplasty, partial limbusectomy, and removal of space occupying lesion in acetabulum, including 2 cases of Salter's innominate osteotomy and 1 case of derotational osteotomy. 3. Among the intracapsular obstructive factors which played major role in hindering closed reduction, capsular constriction was shown in 8 case, inverted or hypertrophic limbus in 5 cases, and other space occupying lesions in 2 cases. 4. We performed combined operation including bone and soft tissue for severe extra- and intracapsular lesions and closed reduction for mild to moderate extra- and intracapsular lesions. 5. Arthrography of the hip joint was indispensable in evaluating the intracapsular osstructive lesions as well as detecting the subtle incongruent reduction.
Acetabulum ; Arthrography ; Constriction ; Dislocations ; Head ; Hip Joint ; Hip ; Humans ; Joints ; Ligaments ; Osteotomy ; Pulvinar ; Round Ligaments ; Tendons

The developing process of the hair of the fetal skin was studied. The ages of 103 human embryos and fetuses ranged from 4 to 40 gestation weeks. Ten different sites were selected, i.e., scalp, forehead, cheek, chest, abdomen, back, palm, sole, finger and toe. For the embryos 3 sites were studied, i.e., cephalic, trunk, and caudal portions. Following results were made: 1) The primitive hair germ was first noted the 10th week in the face skin as nubbins of mesenchymal cells beneath discrete foci of crowdes, elongated germinative epithelial cells. The developing hair germs and hair pegs were observes at the cephalic portion by 11 weeks. At 15 weeks the hair pegs including hair germs were noted in the trunk skin. The bulbous hair peg stage started at the 16th week in the cephalic portion and at the 18th week in the trunk. 2) Relative number of fetal hairs progressively increase up to 20 weeks of gestation but, thereafter decreased although it was different by the site of the body. 3) The diameter of fetal hair follicles increased with fetal age to the term with slight difference by the portion of body. 4) The developmental process of hair was more rapid in the cephalic portion than the trunk in views of morphologic changes of the hair structures, number and diameter of hair follicles.
Humans