No abstract available.
Nephrectomy*

Granuloma is a chronic inflammatory process associated with non-infectious agents or infectious diseases such as tuberculosis. It is well known that AFB staining, which has been used to determine the etiology of the granulomatous inflammation, lacks both sensitivity and specificity. Due to the slow growth rate of most pathogenic mycobacteria, culturing of organisms can take up to eight weeks. It is not uncommon for specific therapy to be delayed, or for an inappropriate treatment be given to patients without mycobacterial infections or with infections caused by atypical mycobacteria. Determination of the causative agent in Papanicolaou stained cytology specimens gives pathologists even more difficulties when only necrotic material has been aspirated from the center of the granuloma. In recent years, the use of a polymerase chain reaction for the amplification of DNA has appeared promising in terms of speed, efficiency, sensitivity, and specificity. Since a polymerase chain reaction permits the sensitive genetic analysis of small amounts of tissue, it is ideally suited to the genetic analysis of cytologic specimens. A polymerase chain reaction is easily performed on unfixed and unstained cells, however, an analysis of ethanol fixed and Papanicolaou-stained archival smears has also been described. We have recently established a method to detect Mycobacterium tuberculosis organism by a nested polymerase chain reaction with primers in the insertion sequence IS 6110, using cellular digests of ethanol-fixed and Papanicolaou-stained archival specimens aspirated from the lymph nodes, lungs, thyroid, etc. Inhibitors present in Papanicolaou stained material was removed by destaining the slides with 0.5% HCl solution for 10-30 minutes. Eight out of ten cases which have shown the epithelioid granulomas revealed a positive reaction and four out of ten cases which have shown lymphohistiocytic cells in a necrotic background without any evidence of granuloma revealed a positive reaction. This study showed that it was possible to employ a polymerase chain reaction to detect Mycobacterium tuberculosis in Papanicolaou stained archival cytology specimens.
Communicable Diseases ; DNA* ; Ethanol ; Granuloma ; Humans ; Inflammation ; Lung ; Lymph Nodes ; Mycobacterium tuberculosis* ; Mycobacterium* ; Nontuberculous Mycobacteria ; Polymerase Chain Reaction ; Sensitivity and Specificity ; Thyroid Gland ; Tuberculosis

Objective: We investigated whether circle of Willis (COW) morphology on 3D time-of-flight (TOF) MR angiography differs between young normal subjects, older normal subjects, and patients with carotid atherosclerotic plaques. Methods: One hundred seventy-seven subjects were grouped according to age into a young group (20 – 40 years; n = 91) and an older group (> 60 years; n = 86). Subjects underwent brain MR examination as part of a health check-up. Fifty-three patients with carotid atherosclerotic plaque were also included for evaluation in this study. COW morphology on 3D TOF MR angiography was analyzed in terms of completeness or incompleteness of the anterior and posterior components of the circle and completeness of the circle. Results: An incomplete pattern of anterior circulation was significantly more common in carotid atherosclerotic plaque patients (20.7%) than normal older subjects (5.5%) (p < 0.01). A complete posterior circulation pattern was more frequent in normal young subjects (46.5%) than in normal older subjects (16.5%) or the patient group (18.9%) (p < 0.01). Of patients with carotid artery stenosis, 18.9% had a bilateral incomplete connection and were significantly more likely to have an incomplete pattern than normal young (2.3%) or normal older subjects (2.2%) (p < 0.001). Conclusion: Young, healthy subjects were significantly more likely to have a complete pattern of posterior circulation than older subjects. Patients with carotid atherosclerotic plaques were significantly more likely to have incomplete anterior circulation and an incomplete circle than young, normal subjects.
Circle of Willis

PURPOSE: Prenatal sonography resulted in increased recognition of renal duplication anomalies and, therefore, earlier urological referral and evaluation. However, surgical approach in very young children is debating. We attempt to investigate clinical features and to propose the management strategies in patients with prenatally detected ureteroceles. MATERIALS AND METHODS: From 1982 to 1997, there has been 35 patients (47 units) of duplex system ureter in which both preoperative and postoperative imaging studies including DMSA renal scan were available. Among these, detailed diagnosis and treatment of prenatally detected (PreD) ureteroceles associated with duplex system (9 patients or 12 ureteroceles) were assessed compared with post-natally detected (PND) ones (26 patients or 35 ureteroceles). RESULTS: There were 2 males and 7 female patients in PreD group, whose ureteroceles presented as 6 unilateral (right 1, left 5) and 3 bilateral units. There were 3 patients (33%) presented with urinary tract infection in PreD group and 24 patients (92%) in PND group. Functional evaluation by DMSA renal scan revealed that 8 units (67%) were functioning in PreD group while 37% in PND group, which was not significantly different between two groups. Initial treatment in PreD group were performed in 11 units; transurethral ureterocele incision (TUI, 8 units), ureteroureterostomy (UUO, 1) and upper pole nephrectomy (UPNx, 2). Additional surgery was performed in 8 units, all of which were initially performed TUI. When initial functional status of the upper pole (UP) determined by renal scan were analyzed by ultimate mode of treatment, initially nonfunctioning parenchyme resulted in UPNx in 4 units and 8 functioning moiety were led to parenchyme-sparing surgery, implying TUI actually had not modified ultimate clinical course. Taken both PreD and PND together, UUO and ureteral reimplantation showed lower secondary operation rate. CONCLUSIONS: Although statistics did not fully support our clinical impression, patients with PreD ureterocele have higher proportion in preserving UP function compared with that of a PND. Our results shows direct approach to the upper pole according to the functional status is preferred.
Child ; Diagnosis ; Female ; Humans ; Male ; Nephrectomy ; Referral and Consultation ; Replantation ; Succimer ; Ultrasonography ; Ureter ; Ureterocele* ; Urinary Tract Infections

Tumarkin's otolithic crisis refers to drop attacks that are an unusual manifestation of Meniere's disease. It has been proposed that these drop attacks result from mechanical deformation of the otolithic organs related to the endolymphatic hydrops that occurs in Meniere's disease, as revealed by MRI with intratympanic gadolinium enhancement. Here we report a patient with Tumarkin's otolithic crisis in whom inner-ear MRI with intratympanic gadolinium administration during the acute attack did not reveal the presence of endolymphatic hydrops.
Endolymphatic Hydrops* ; Gadolinium ; Humans ; Magnetic Resonance Imaging* ; Meniere Disease ; Otolithic Membrane* ; Syncope

No abstract available.

Patients with cerebrovascular accidents often have abnormal electrocardiograms in the absence of known organic heart disease. In 1901 harvey Cushing has discovered sinus bradycardia in CVA patients. Burch, Myers and Abildskov were the first to report electrocardiographic abnormalities in CVA. Since then many reports have appeared in the literature. This study was done utilizing brain C-T scan to varify and localize the site of CVA, for purposes of correlation of the CVA with abnormalities of electrocardiogram. We obtained the following results. 1. Among 250 cases of CVA, 107 cases were excluded due to pre-existing cardiac disease, abnormal serum electrolyte and early death. 2. Among 143 cases, intracranial hemorrhage were 62.9% and brain infarction were 37.1%. 3. In intracranial hemorrhage, normal electrocardiographic finding were only 4.5%. Q-Tc prolongation revealed 64.5%. 4. In brain infarction, normal electrocardiographic finding was only 5.7%. Q-Tc prologation revealed 64%.
Bradycardia ; Brain ; Brain Infarction ; Electrocardiography* ; Heart Diseases ; Humans ; Intracranial Hemorrhages ; Stroke

The activation of the insulin-like growth factor-I-receptor system (IGF-IR) has recently emerged as critical events in transformation and tumorigenicity of several human tumors. In this study we investigated the expression of IGF-IR in 33 colorectal adenomas, 88 primary colorectal carcinomas, and 30 normal colonic mucosa adjacent to the carcinoma. Immunohistochemical staining (IHC) for IGF-IR was performed on paraffin embedded sections using an anti-IGF-IR rabbit polyclonal antibody. IHC stains for IGF-IR were scored using a semiquantitative scoring system. The relationship of IGF-IR staining to clinicopathologic variables and proliferating cell nuclear antigen (PCNA) staining was also analysed. The mean IHC scores for IGF-IR of normal glands, adenoma, intramucosal carcinoma, node-negative carcinoma, and node-positive carcinoma were 0.41 0.96, 0.76 1.23, 2.0 1.48, 2.83 2.0 and 5.93 1.58, respectively. These scores for each category were statistically significant except between normal glands and adenoma and between intramucosal carcinoma and node-negative carcinomas. The mean PCNA indexes of normal glands, adenoma, intramucosal carcinoma, node-negative carcinoma, and node-positive carcinoma were 2.48 2.60, 6.94 11.03, 27.21 11.42, 43.36 9.9 and 57.60 10.01, respectively. The PCNA index for each category was statistically significant except between normal and adenoma. IGF-IR scores and PCNA indexes were higher with tumor progression and also correlated each other (sr=0.65, p=0.0001). Higher IGF-IR scores and PCNA indexes were seen in tumors with advanced stage, infiltrative growth pattern, poor differentiation, nerve invasion, lymphovascular invasion, and moderate fibrosis. Our results suggest that IGF-IR plays an important role in tumorigenicity and tumor progression.
Adenoma* ; Colon ; Colorectal Neoplasms ; Coloring Agents ; Fibrosis ; Humans ; Immunohistochemistry ; Mucous Membrane ; Paraffin ; Proliferating Cell Nuclear Antigen

Actinomycosis causes a chronic suppurative infection most commonly involving the cervico-facial region, thorax, and the abdomen. Thoracic infection results from an aspiration of contaminated material from mouth or oropharynx. Actinomyces was known to have a predilection for the periphery of the lung and the endobronchial lesion is extremely rare. We report two cases of actinomycosis presenting as an endobronchial mass which arose in 53-year-old and 44-year-old women. The first case presented with cough, sputum, weight loss and had a history of pulmonary tuberculosis 24 years ago. Chest CT revealed a right lobe collapse simulating mass and suggested carcinoma. The second case presented with hemoptysis for 2 years. Chest CT revealed cystic bronchiectasis of both lungs and intracystic soft tissue mass in the anterior segment of the right upper lobe which suggested aspergilloma. The gross features of them were similar to those of aspergilloma. Characteristic sulphur granules consisting of a granular basophilic center surrounded by a radiating zone of eosinophilic, hyaline, club-shaped projection were histologically confirmed in both cases. Granulomas containing P. westermani eggs were present in the second case. Staphylococcus, true fungal organism, nocardia, and streptomyces shoud be distinguished by analysing their morphologic characteristics in the appropriate stains. Actinomycosis should be included in the differential diagnoses of an endobronchial mass.
Abdomen ; Actinomyces ; Actinomycosis* ; Adult ; Basophils ; Bronchiectasis ; Coloring Agents ; Cough ; Diagnosis, Differential ; Eggs ; Eosinophils ; Female ; Granuloma ; Hemoptysis ; Humans ; Hyalin ; Lung ; Middle Aged ; Mouth ; Nocardia ; Oropharynx ; Ovum ; Sputum ; Staphylococcus ; Streptomyces ; Thorax ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary ; Weight Loss

No abstract available.
Edema* ; Hydrops Fetalis*