We performed a histopathologic and immunohistochemical study of 23 cases of surgically resected large cell undifferentiated carcinoma(LCUC) of the lung. The relative incidence of LCUC was 7.6% among the total resected cases of primary lung cancer over 7 years(1987-1993). The mean age of the patients was 56 years and 21 cases were male. The mean size of the mass was 5 cm and 11 cases were located peripherally. According to the histologic features, LCUC could be divided into three groups: squamous cell carcinoma-like(6 cases), adenocarcinoma-like(13 cases), and small cell carcinoma-like(4 cases) groups. The histologic differences were related to the variations of the immunohistochemical properties, but there were no differences in prognosis among these groups. Immunoreactivity to cytokeratin(CAM 5.2) was demonstrated in 22/23(96%). Carcinoembryonic antigen was positive in 13/23(57%). Neuron specific enolase and chromogranin were positive in 11/23(48%) and 5/23(22%), respectively. Vimentin was seen in 11/23(48%). From these observations, we could subclassify them by their immunologic phenotypes; exocrine features in 6/23(26%), neuroendocrine(NE) features in 4/23(17%), both exocrine and NE phenotypes in 7/23(30%), and 6 cases(26%) showed neither phenotype. The group with NE features showed a worse prognosis(P<0.05) and immunoreactivity for vimentin was also related to a worse prognosis(P<0.05). These findings imply that the immunohistochemical properties of LCUC are closely related to the histopathologic features. The groups, subdivided by histology and immunoreactivity, showed no prognostic difference except for the NE differentiation and reaction for vimentin.
Incidence ; Lung Neoplasms

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.

Twenty-three cases of the scaphoid fracture which were treated at the Department of the Orthopaedic Surgery, Catholic University Medical College during the period of december 1978 to december 1987 were analysed. The main purpose of this study was to clarify the significant factors affecting the union rate of the scaphoid fracture. The results obtained were as follows ; 1. The great majority of 23 cases was male with mean age 31. 2. Ulnar deviated stress oblique view with msking a fist was the most reliable means for diagnosing the fracture, location of fracture and stability of wrist after scaphoid fracture. 3. Union rate was obtained from 88.8% in undisplaced fresh fracture, 85.7% in displaced fresh fracture and 71.4% in old neglected fracture. 4. The union rate and associated factors affecting the prognosis after scaphoid frscture seems to be depended on the location of fracture, the severity of initial displacement of fracture fragments, time elapsed of treatment after fracture and accompanied injuries around the ipsilateral wrist.
Humans ; Male ; Prognosis ; Wrist

Infantile esotropia is an esodeviation with onset before six months of age, characterized by a large stable angle and initial alternation with cross fixation. The natural history of infantile esotropia has not yet been verified. A 39-month-old girl presented with a history of esotropia. She was firstnoted to constantly cross her eyes at three months of age. At the age of five months, she was diagnosed by one of the authors[SHH]to have 25 prism-diopters of esotropia with a low hyperopic refractive error of 0.50D sphere. At that time, she fixed and followed with either eye. Ductions and versions were full. On three more examinations in her first year, she consistently showed 25~30 prism-diopters of esotropia. Against medical recommendation, she did not undergo any surgery. At the age of 39 months, she was found to be orthophoric at distance and at near by another author[JMH]. She could not identify flies or animals in random dot stereograms or Titmus stereograms. At the age of four years, she was still orthophoric at distance and at near. All the ophthalmologic findings remained the same. At the age of five years, she developed exophoria and DVD OS. She still could not identify flies. In conclusion, in rare cases infantile esotropia with a relatively small angle may spontaneously resolve without any treatment.
Animals ; Child, Preschool ; Diptera ; Esotropia* ; Exotropia ; Female ; Humans ; Natural History ; Refractive Errors

INTRODUCTION AND OBJECTIVES: A kidney in the growing state and the possibility of spontaneous improvement are characteristics of the pediatric ureteropelvic junction obstruction (UPJO) that make the treatment of this disease difficult. We have tried to determine the histopathologic changes of the kidneys with UPJO relating to age, differential renal function and urinary tract infection (UTI). METHODS: The total number of patients was 38 (40 kidneys). The age at the operation time was under 3 months in 9 cases (9 kidneys), 3 to 12 months in 10 cases (10 kidneys), and 1 to 18 years in 20 cases (21 kidneys). Needle biopsies from 3 different sites at the lower pole of the kidney were taken. The tissue was blindly observed for the presence of irreversible change (arteriolar thickening, glomerulosclerosis, interstitial fibrosis and periglomerular fibrosis) and reversible change (inflammatory cell infiltration) by light microscopy. Each pathological finding was graded as I, II or III, and each grade was given a numerical value. Statistical analysis was done with ANOVA. RESULTS: Although the kidneys from patients under 3 months tended to show better histopathologic findings, there was no statistically significant difference in all 5 pathologic findings regardless of patient age. 5 cases (5 kidneys) with previous percutaneous nephrostomy (PCN) were not included in any group for analysis due to possible histologic changes of the renal parenchyma. Inflammatory cell infiltration, arteriolar thickening, glomerulosclerosis and periglomerular fibrosis were statistically significant in patients with previous or present UTI (14 kidneys) compared to the patients without UTI (26 kidneys). The patients with a mean differential renal function less than 30% (7 kidneys) as measured by DTPA or DMSA renal scan showed statistically significant changes in all of the 5 histopathologic findings compared to the patients with differential renal function greater than 30% (27 kidneys). 4 cases with bilateral UPJO (6 kidneys) were excluded from comparing the differential renal function. 5 kidneys with previous PCN had statistically significant degree of glomerulosclerosis compared to others. CONCLUSIONS: Although we did not determine whether pediatric UPJO affects renal growth, it is probable that statistically significant irreversible histopathologic changes do not occur according to age. Considering histopathologic findings only, differential renal function and UTI Should be key factors in deciding the management of pediatric UPJO. In addition, PCN seems to induce more severe histopathologic changes of the kidney.
Biopsy, Needle ; Fibrosis ; Humans ; Kidney* ; Microscopy ; Nephrostomy, Percutaneous ; Pentetic Acid ; Pregnenolone Carbonitrile ; Succimer ; Urinary Tract Infections

Staphylococcus species are one of prevalent pathogens found in hospitals. Microbes that are a primary cause of nosocomial infection were isolated from a dental and medical environment it may assist the reader to explain what this is and how it differs from the 'dental health care providers and ward health care providers'. To investigate the distribution of staphylococcus species in this environment, we used vitek II to measure drug sensitivity, and further performed biochemical testing. The isolation rate of staphylococcus species from the dental and medical environment was 100% but from dental health care providers and ward health care providers were 44.4% and 33.3%, respectively. In the analyses, staphylococcus species showed resistance to diffusion of cefoxitin and oxacillin discs. These staphylococci may be sufficiently positive for the mecA gene. Our results suggest that staphylococci might be an important cause of nosocomial infection in the dental clinic.
Adenosine ; Anti-Infective Agents ; Cefoxitin ; Cross Infection ; Delivery of Health Care ; Dental Clinics ; Diffusion ; Health Personnel ; Humans ; Oxacillin ; Staphylococcus

A case of right-sided infective endocarditis in a 22-year-old male with ventricular septal defect of perimembranous type, right ventricular(RV) infundibular and pulmonic valve stenosis was reported. The vegetations were found on the mural endocardium of RV infundibulum and pulmonic valve. Streptococcus viridans was identified in 5 consecutive blood cultures, Pulmonary embolism and septic infarction in the lung was associated with systemic embolization, which was manifested by left renal infarction. The RV infundibular stenosis was due to anomalous muscle bundle at the proximal portion. Therefore, we thought that the mechanism of RV infundibular vegetation was probably due to 'Venturi effect and turbulence'. Several clinical features which were found in this case were also reviewed.
Constriction, Pathologic ; Endocarditis* ; Endocardium ; Heart Septal Defects, Ventricular ; Humans ; Infarction ; Lung ; Male ; Pulmonary Embolism ; Viridans Streptococci ; Young Adult

Cryptococcal meningitis is a relatively common central nervous system infection by Cryptococcus neoformans. Before the introduction of amphotericin B in 1956, cryptococcal infection of the central nervous system had been almost uniformly fatal. Although amphotericin B(alone or in combination with flucytosine) has been the standard therapeutic regimen, problems such as modest efficacy, nephrotoxcity, other clinically significant toxicities, and the inconvinience of intravenous dosing have led to search for a new antimycotic agents. Fluconazole is a new therapeutic agent which is effective as amphoterin B. Accumulating evidence suggests that the antifungal triazole fluconazole represent an advance in the treatment of cryptococcal meningitis, particulary in acquired immunodeficiency syndrom patients. Thus we report clinical experiences of fluconazole therapy for 5 cases of cryptococcal meningitis. Four of 5 patients are improved clinically and microbiologically, 1 of 5 patients is expired due to concomittent tuberculous infection.
Amphotericin B ; Central Nervous System ; Central Nervous System Infections ; Cryptococcus neoformans ; Fluconazole* ; HMGB1 Protein ; Humans ; Meningitis, Cryptococcal*

PURPOSE: Tacrolimus (FK506) is a new potent immunosuppressive agent which has been used as a primary immunosuppressive agent and rescue therapy for refractory rejection in kidney transplantation. In vitro, on a molecular basis, tacrolimus is 10 to 100 times more potent than cyclosporine. Complications associated with tacrolimus are similar to those seen in cyclosporine, including nephrotoxicity. An early marker of tacrolimus-induced nephropathy is tubular vacuolization, whereas long-term administration of tacrolimus is associated with striped interstitial fibrosis and arteriolar hyalinosis. However, morphological changes and pathogenesis of fibrosis in chronic tacrolimus-induced nephropathy remain poorly understood. Transforming growth factor (TGF)-beta1 has been implicated in the fibrosis of a number of chronic diseases of the kidney and other organs. This study was designed to clarify the ultrastructural changes of tacrolimus-induced nephropathy, and to evaluate the relationship between tacrolimus- induced nephropathy and expression of TGF-beta1. METHODS: Male ICR mice received tacrolimus daily at a dose of 2.5 mg/kg by intraperitoneal route for 12 weeks and sacrified 1, 4, 8, 10, and 12 weeks after the initiation of the study, respectively. The kidneys were removed, the cortex is carefully dissected from the medulla, and the tissues are processed for evaluation by light microscopy, electron microscopy, immunohistochemistry and RT-PCR for RNA analysis. RESULTS: Characteristic histological changes of tacrolimus-induced nephropathy were peritubular capillary and intraglomerular capillary congestions, vacuolizations of the tubular epithelium, pericapillary focal fibrosis, and tubular atrophy. Tacrolimus- treated kidneys had a progressive increase in the expression of TGF-beta1, especially in the glomerular and interstitial capillary endothelial cells and atrophied tubular epithelial cells. TGF-beta1 mRNA is expressed persistently in tacrolimus- treated mice for 12 weeks. CONCLUSION: It can be concluded that TGF-beta1 may be involved in the fibrogenesis in the tacrolimus-induced nephropathy.
Animals ; Atrophy ; Capillaries ; Chronic Disease ; Cyclosporine ; Endothelial Cells ; Epithelial Cells ; Epithelium ; Estrogens, Conjugated (USP) ; Fibrosis ; Humans ; Immunohistochemistry ; Kidney ; Kidney Transplantation ; Male ; Mice ; Mice, Inbred ICR ; Microscopy ; Microscopy, Electron ; RNA ; RNA, Messenger ; Tacrolimus ; Transforming Growth Factor beta1 ; Transforming Growth Factors

No abstract available.
Hemangioma, Cavernous*