Membranous glomerulonephropathy (MGN) is the most common primary cause of the nephrotic syndrome in adults, accounting for about 20% of the cases in most series. MGN is idiopathic in the majority of cases, however approximately 25% of adults have identifiable causes (secondary MGN). To evaluate the clinical and pathologic characteristics of MGN, we reviewed the clinical data and renal biopsies from 141 cases of MGN. The mean age of the patients at biopsy was 43 years old, but patients of all age were seen (range from 3 to 76 years of age). There were 88 males and 53 females. There were 99 idiopathic MGN cases and 42 secondary MGN cases. The associated causes of secondary MGN included hepatitis B infection (18 cases), SLE (10 cases), drugs (4 cases), post-transplantation MGN (5 cases), diabetes mellitus (4 cases), syphilis (1 case) and hepatitis B infection associated with rheumatoid arthritis. The prevalence of histologic stages by Ehrenreich and Churg was as follows. Stage I was 24 cases, stage II was 72 cases, stage III was 35 cases, and stage IV was 9 cases. All patients had proteinuria. Nephrotic syndrome was observed in 39%, edema in 73%, microscopic hematuria in 49%, gross hematuria in 28%, hypertension in 13%, and the serum creatinine level above 1.5 mg/dl was in 13%. Cases with glomerulosclerosis was observed in 45 cases with an increased percentage of glomerulosclerosis in the higher grade. Immunofluorescence (IF) examination showed predominantly granular IgG (118 cases) and C3 (84 cases) stainings along the glomerular capillary wall. In idiopathic MGN, sparse mesangial IF staining was noted up to 10% of the cases. However, mesangial IF staining in SLE was observed in 33%, hepatitis B infection in 28% and diabetes mellitus in 50%. An electron microscopic examination revealed subepithelial electron dense deposits of immune complex in all cases. The prevalence of mesangial and subendothelial electron dense deposit in idiopathic MGN was present in 19% and 6%, respectively. In SLE cases, mesangial and subendothelial deposits were observed in 78% and 56%, respectively. In hepatitis B infection, mesangial and subendothelial deposits were observed in 54% and 69%, respectively. In conclusion, immune deposits in the mesangium are scanty in idiopathic MGN, and if pronounced this should increase suspicion of underlying systemic diseases, such as SLE or other infectious diseases.
Adult ; Antigen-Antibody Complex ; Arthritis, Rheumatoid ; Biopsy ; Capillaries ; Communicable Diseases ; Creatinine ; Diabetes Mellitus ; Edema ; Female ; Fluorescent Antibody Technique ; Glomerulonephritis, Membranous* ; Hematuria ; Hepatitis B ; Humans ; Hypertension ; Immunoglobulin G ; Male ; Nephrotic Syndrome ; Prevalence ; Proteinuria ; Syphilis

No abstract available.
Animals ; Embryonic Structures* ; Mice*

Mesoblastic nephroma is an important differential diagnosis of a renal mass occurring in the neonatal period or in early childhood. It is a rare monomorphous congenital renal neoplasm most commonly recognized during the first 3 months of life. With the widespread application of ultrasound imaging, many cases are recognized prior to birth. We report a case of mesoblastic nephroma detected by ultrasonograph at 36 weeks of intrauterine fetal life and removed after birth. It showed a well circumscribed, grayish white, solid mass measuring 4x3x2 cm. The tumor was predominantly a classic type with a focal cellular pattern. Immunohistochemical and electron microscopic studies were done.
Diagnosis, Differential ; Kidney ; Kidney Neoplasms ; Nephroma, Mesoblastic* ; Parturition ; Ultrasonography

Background and Objectives: We investigated the clinical validity of and correlation between the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) scores and the eustachian tube function test (ETFT) results in patients with a normal drum. Subjects and Methods: The study included 49 patients (93 ears) with unilateral or bilateral ear fullness over >3 months. All patients were administered the ETDQ-7 survey and underwent the ETFT on the same day. The receiver operating characteristic (ROC) curve and the association between the results were statistically analyzed. Results: ETDQ-7 scores were not significantly correlated with the ETFT results or with middle ear pressure. ETDQ-7 scores in patients with eustachian tube dysfunction (ETD) were significantly higher than those in patients with normal ETFT results (p=0.039) when ETD was defined as a pressure change <10 daPa on the ETFT. The area under the ROC curve was 0.631, with a sensitivity of 37.0% and specificity of 89.4%. Conclusions The ETDQ-7 has limited clinical significance in patients with ETD but a normal drum. Therefore, concomitant objective tests should be performed to diagnose patients with ETD.

Intraductal variant of peripheral cholangiocarcinoma is extremely rare. This variant shows intraductal growth and intraluminal extension without any infiltrative growth. The mode of intraductal growth is not known. The prognosis of this variant is better than that of usual cholangiocarcinoma. We report three cases, one of which is associated with Clonorchis sinensis (CS) infection. The tumors were entirely confined within the dilated peripheral tributaries of the intrahepatic bile duct. Microscopically, the tumors were well to moderately well differentiated, with a papillary or a micropapillary growth pattern. Focal clear cytoplasmic change and mucin production were noted. The tumors showed intraductal spreading without any invasion to the liver parenchyme. Mucosal hyperplasia and dysplasia were noted in the adjacent ducts. The authors assume that intraductal cholangiocarcinoma is a distinct subtype, and persistent irritation, such as, CS infection may undergo a malignant transformation through mucosal dysplasia.
Bile Ducts, Intrahepatic ; Cholangiocarcinoma* ; Clonorchis sinensis ; Cytoplasm ; Hyperplasia ; Liver* ; Mucins ; Prognosis

No abstract available.
Lung*

OBJECTIVE: To compare the clinical outcomes of intrauterine insemination (IUI) according to the catheter used. MATERIALS AND METHOD: From March 1998 to September 1998, total 95 infertile patients were included in this study. Patients were randomly allocated to TomCat group (n = 39) and Mackler group (n = 56) according to the catheter for insemination. The controlled ovarian hyperstimulation (COH) using luteal long protocol of gonadotropin releasing hormone agonist (GnRH-a) was used in all patients. Statistical analysis was performed using Student's t-test, Fisher's exact test, and x2 test as appropriate. Statistical significance was defined as p < 0.05. RESULTS: The total dose and duration of exogeneous gonadotropin required were similar between the two groups. There were also no significant differences in serum estradiol (E2) level, endometrial thickness and texture on the day of hCG administration between the two groups. However, the percentage of uterine souding due to failure of initial approach was significantly higher in TomCat group compared to Mackler group (23.1% vs. 0%, p < 0.01). The percentage of bleeding after IUI in TomCat group seemed to be higher than that in Mackler group (15.4% vs. 3.6%, p = 0.06), although there was no statistically significant difference between the two groups. There was also no significant difference in the clinical pregnancy rate per patient between the two groups. CONCLUSION: These results suggested that using Mackler catheter might be effective for IUI, especially for the patients with cervical factor infertility.
Catheters* ; Estradiol ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Hemorrhage ; Humans ; Infertility ; Insemination* ; Pregnancy Rate

Inhibin is a glycoprotein usually produced by granulosa cell of ovary and is known as regulator of FSH secretion. Inhibin is consisted of two heterodimeric subunit of a, B . There are two distinct molecular forms of the B subunit that exist (BA and BB) and when combined with an a subunit, form inhibin A, and inhibin B, respectively. Ovarian reserve describes women's reproductive potential, which usually decreased according to chronological age. Because useful markers claimed for the prediction of ovarian response during controlled ovarian hyperstimulation for IVF-ET have not been always successful, new biomarker has been investigated. The purpose of this study was to observe the changes in serum and ovarian follicular inhibin A concentration during controlled ovarian hyperstimulation for IVF-ET program and to evaluate the clinical significance of inhibin A as a prognostic marker for assisted reproductive technology outcomes. From Jan 1996 to Dec 1996, 48 patients who underwent IVF-ET were included. In each patient, the Day 3 FSH, LH, E2q were measured in the first month of cycle before commencing GnRH agonist administration, In the stimulation period after pituitary down regulation, blood samples for inhibin A were collected at the day 3, day 7, day of hCG injection, day of oocytes aspiration, and day of embryo transfer. Ovarian follicular inhibin A was collected at the day of oocyte aspiration. Inhibin A concentration was measured using test kit for inhibin A (INHIBIN-EASIA (code 40.134.00), Belgium Medgenix). The changes in serum inhibin A, E2 concentration during IVF-ET program showed increasing pattern throughout controlled ovarian hyperstimulation periods. If the cut-off value of day 3 serum inhibin A determined to 0.28 U/ml, the sensitivity and specificity were 80.0%, 75.0% respectively in predicting the number of oocytes retrieved being more than five. If the cut-off value of peak serum E determined to 1316 pg/ml, the sensitivity and specificity were 89.0%, 100.0% respectively in predicting the number of oocytes retrieved being more than five. In conclusion, measurement of serum inhibin A concentration on the day of starting stimulation (day 3) could be used as a useful marker for predicting the ovarian response in IVF-ET program.
Belgium ; Down-Regulation ; Embryo Transfer ; Female ; Glycoproteins ; Gonadotropin-Releasing Hormone ; Granulosa Cells ; Humans ; Inhibins* ; Oocyte Retrieval ; Oocytes ; Ovary ; Reproductive Techniques, Assisted ; Sensitivity and Specificity ; Serum

No abstract available.
Gestational Sac*

Inflammatory myofibroblastic tumor(IMT) or inflammatory pseudotumor is a rare, solid tumor that most often affects children. This tumor is characterized by a spindle cell proliferation admixed with a variety of inflammatory cells. Although it has disputed nosology, a distinctive fibroinflammatory and even pseudosarcomatous appearance have been well appreciated. Herein, we report a case of IMT in the posterior mediastinum in a 19-year-old girl with clinical findings. The immunohistochemical and ultrastructural studies on the tumor cells are reported, and their distinctive characteristics are discussed in details.
Cell Proliferation ; Child ; Female ; Granuloma, Plasma Cell ; Humans ; Mediastinum* ; Myofibroblasts* ; Young Adult