To study the basic pathological changes of small intestine in metagonimiasis, light- and electron microscopic studies were made, using a total of 21 cats which were experimentally infected with metacercariae of Metagonimus yokogawai. The metacercariae were obtained from naturally infected sweetfish (Plecoglossus altivelis) by digestion technique. The cats were divided in control, light-infection(10,000 metacercariae infected) and heavy-infection(50,000 metacercariae infected) groups. Cats were killed at the 5th, 10th, 15th day, and 4th, 8th and 10th week after the infection. And the small intestine was prepared for the study. Pathological studies comprised gross examination, worm distribution pattern, light microscopic examination and both transmission and scanning electron microscopic examinations. The results obtained were summarized as follows. Gross morphologic changes were the most marked during the first 2 weeks after infection. The gross abnormalities were severer in the heavily infected animals. The changes were dryness and listlessness of serosal surface due to dehydration, mushy and/or watery intestinal content, effacement of transverse nodes and enlargement of mesenteric lymph folds and Peyer's patches. After 4 weeks of infection, these changes became less marked showing a tendency to return to normal. The sectioned flukes were distributed from duodenum to proximal ileum. However, individual variation was marked in distribution. In the heavy-infection group, the locality of parasitism tended to extend more distally. The locality of M. yokogawai in the intervillous space was mostly in the lower-most portion of intervillous space, where they compressed and eroded epithelial cells probably due to mechanical damage to the structure. Very rarely the worms were found in lumen of Lierberkuehn's crypt, and reaching, in two occasions, into proprial lymphoid tissue. Light-microscopically the lesion was restricted in mucosa: Early mucosal changes were shortening, blunting, fusion, and thickening of the villi, crypt hypertrophy with consequent decrease of villus/crypt ratio, as well as stromal changes of edema, capilliary ectasia and marked inflammatory cell infiltration of lymphocytes and plasma cells. Goblet cells were markedly reduced in number as with depletion of its cytoplasmic content. In the later stages of infection, mucosa restored its normal configuration in spite of persistent parasitism of the worms. At the infection stage of 5-15 days, there was significant shortening of the microvillous height with varible destruction of glycocalyx in electron microscopic examination. With lapse of infection time, microvilli became to restore the normal pattern. With these morphological changes, it appears that diarrhea in experimental metagonimiasis would be related to the decrease of absorptive surface of the small intestine particularly in the early phase of infection. The significant changes seen in villi and microvilli might be due to massive intrusion or invasion of Metagonimus worms into the crypts, causing direct mechanical and possible host-immune response to the small bowel mucosa.
parasitology-helminth-trematoda ; metagonimiasis ; Metagonimus yokogawai ; pathology ; cat-intestine ; edema ; lymphocytes ; plasma cells ; goblet cell

Radilogy plays an important role in evaluating patients with suspected adrenal gland pathology. Morphologicdelineation of adrenal gland is especially valuable in patients with clinical and/or biochemical evidence of adisturbance in adrenal function. Many diagnostic radiologic methods are avilable for demonstrating adrenallesions. CT overcomes many of the disadvantages of these other radiologic techniques. The high degree of spatialand density resolution allows precise demonstration of the normal adrenal glands as well as detection of bothsmall and large tumors in almost all patients. So CT of adrenal gland is an excellet nonivasive screening methodand definitive imaging technique. The authers have investigated the capability of CT to image the nomral size,location and shape of both glands. Knowledge of the range of normal is useful for optimal interpretation of CTscans in patients with suspected aderenal pathology. We reviewed CT scan of 150 cases without evidence of adrenaldisease. The following results were obtained: 1. There were 90 male and 60 female patients. 2. Their ages rangedfrom 20 to 60 years. 3. On CT, both gland were shown in 135 (90.0%), the right in 143(95.3%), the left in142(94.6%). 4. In the shape of adrenal glands, most of right adrenal gland was linear or comet shaped; 68(47.6%),most of left adrenal gland was inverted-Y shaped: 103(72.6%). 5. In the length of adrenal glands, theright was2.5+-0.77cm, the left was 2.9+-0.75cm. 6. In the width of adrenal glands, the right was 3.2+-0.74cm, the left was2.7+-0.57cm. 7. In the thickness of adrenal glands, the right was 0.5+-0.14cm, the left was 0.6+-0.16cm.
Adrenal Glands ; Female ; Humans ; Male ; Mass Screening ; Pathology ; Pheniramine ; Tomography, X-Ray Computed

OBJECTIVES: To evaluate the effects of progesterone/progestin and in combination with estrogen in relaxation of rat aorta. METHODS: Eight weeks after bilateral oophorectomy, the descending aorta of Spague-Dawley rats (n=10) were quickly removed and placed in organ bath containing Krebs solution. Each aorta ring in 2-3 mm length was connected to an isometric force transducer (FT 03, Grass, USA) and the changes in tension were recorded with an AD converter system (MP 100, Biopac Inc, USA) in a personal computer. After precontraction of the rings with norepinephrine (1 umol/L) or KCl (40 mmol/L), estradiol, progesterone, medroxyprogesterone acetate (MPA), norethisterone acetate (NETA) (10-5-10-8 M/L in each) were added to each ring and they were incubated for 15 minutes. The relaxation was expressed as a percentage of the tonic contraction. RESULTS: Estrogen relax the aorta in all concentrations. The degree of relaxation was dose dependent (P<0.001). All of the progesterone, MPA, NETA relax the aorta and the effects was different according to the concentration of steroids (P<0.0001). The degree of relaxation was not different between estrogen and those of progesterone, MPA, NETA except MPA 10-8 M, NETA 10-5 M. Addition of progesterone, MPA and NETA to the estrogen showed similar vascular effects compared to those of estrogen alone. CONCLUSION: Not only estrogen but also progesterone, MPA, and NETA acutely relax aorta. Progesterone/progestin have not been found attenuate the action of estrogen in our animal in vitro study.
Animals ; Aorta ; Aorta, Thoracic ; Arteries ; Baths ; Estradiol ; Estrogens ; Female ; Medroxyprogesterone Acetate ; Microcomputers ; Norepinephrine ; Norethindrone ; Ovariectomy ; Poaceae ; Progesterone ; Rats ; Relaxation ; Steroids ; Transducers

It is easy to view the laryngeal aperature with a flexible fiberscope through a laryngeal mask airway (LMA). This is a case report that the LMA could facilitate a fiberscope-aided tracheal intubation easily. Patient was a 59 year old female who had some limitation of mouth opening due to ankylosis of bilateral temporomandibular joints. After thiopental (200 mg) and succinylcholine chloride (50 mg) were given intravenously, a number 3 sized LMA was inserted and the lungs were ventilated via the LMA. The anesthesia cirele system is then disconnected from the LMA and a fiberscope, with the proximal end jacketed with a well-lubricated, cuffless, 6-mm-ID endotracheal tube (ETT); was inserted into the trachea through the lumen of the LMA. The 6-mm-ID ETT was threaded over the fiberscope into the trachea before fiberscope was withdrawn, and a traeheal tube exchanger was inserted through the ETT after enough ventilation for a while, followed withdrawal of the LMA and ETT. Finally, we can make the 7 mm-ID ETT with cuff insert into the trachea over a tracheal tube exchanger very easily without any difficulties.
Anesthesia ; Ankylosis ; Bronchoscopes* ; Female ; Humans ; Intubation ; Intubation, Intratracheal* ; Laryngeal Masks* ; Lung ; Middle Aged ; Mouth ; Succinylcholine ; Temporomandibular Joint ; Thiopental ; Trachea ; Ventilation

No abstract available.
Humans ; Survival Rate*

Retrorectal cystic harmatoma; Tailgut cyst, is a rare congenital disease typically presented as presacral mass, and malignant change of this disease is extremely rare. Frequently, This disease is misdiagnosed or confused at initial time. So, we have a case of tailgut cyst and report the clinical symptom and the result. A 40-year-old woman has admitted at Severance hospital for the anal pain. About 6cm sized irregular cystic and solid mass in the retrorectal area involving coccygeal bone and right gluteal muscle tendon were detected in magnetic resonance image. Under the impression of malignant tailgut cyst, the patient underwent Hartmann's operation (abdomino-sacral approach) under the sacral resection (S4, 5). The pathology was adenocarcinoma (poorly differentiated) arising from a tailgut cyst involving rectal adventitia, gluteus muscle and sacral bone. For the following 4 months after the operation, The patient is doing well with no evidence of recurrence.
Adenocarcinoma* ; Adult ; Adventitia ; Female ; Humans ; Pathology ; Recurrence ; Tendons

PURPOSE: The aim of this study was to estimate the degree of difficulty in total mesorectal excisions (TMEs) for rectal cancer by using statistical methods after analysis of factors affecting the resection time and incomplete resection. METHODS: A total of 63 patients who underwent a total mesorectal excision for rectal cancer were evaluated. MRI pelvimetry data {(transverse diameter (TD), obstetric conjugate (OC), interspinous distance (ID), sacrum length (SL), sacrum depth (SD)}, tumor size (TS), T stage, and body mass index (BMI) were prospectively analyzed. A stepwise multiple regression analysis was performed to determine the operating time prediction equation by using these variables, and the differences in the mean operating time hased on gross evaluations of each specimen were analyzed. RESULTS: A stepwise multiple regression with the operating time as a dependent variable led to the following equation: Operation time (min)=35.726-2.162xTD (cm)-2.324 x OC (cm) + 2.671 x SL (cm) + 1.274 x TS (cm), with r2=0.533 and SEE=5.438. The mean operating time according to a gross evaluation of the TME specimen was 20.0 +/- 7.3 min in complete TME cases (n=42) and 27.9 +/- 7.2 min in incomplete TME cases (n=21) (P<0.001). CONCLUSIONS: MRI pelvimetry data (TD, OC, SL) and tumor size were factors affecting the operation time in TMEs for rectal cancer, and the operating time could be predicted by using the equation of the present study. Also, the mean operating time in incomplete TME cases was longer than that in complete TME cases. Thus, the degree of difficulty of an operation for rectal cancer can be predicted by using these factors.
Body Mass Index ; Humans ; Magnetic Resonance Imaging ; Pelvimetry ; Prospective Studies ; Rectal Neoplasms* ; Sacrum

PURPOSE: The management of local recurrence after curative surgery of the rectal cancer remains difficult clinical problems to surgeons. This study was performed to analyze the outcomes of patients with local pelvic recurrence according to its recurrence type. METHODS: A total 109 patients with local recurrence were evaluated. Among the 109 patients 62 were local recurrence alone and 47 were both local and systemic recurrence. The recurrence type was classified as Central, Anterior, Posterior, Lateral and Perineal recurrence according to the relation of the tumor location and either intra pelvic organ and/or fixed pelvic structure. RESULTS: Only 26 (23.9%) of the 109 patients had curative resection and the remaining 83 (76.1%) patients had palliative exploration or nonsurgical procedure. The resectability according to the recurrence type showed that the Central and Anterior type was higher than other type of recurrences (P=0.001). When the primary operation was Abdominoperineal Resection (APR) the resectability was poorer than Low Anterior Resection (LAR) (P=0.0001). When comparing the patients with local recurrence alone, the 5 year survival rate was significantly higher patients treated by curative resection than palliative or non-resection group (P=0.002). Mean follow up period was 44.2+/-30.0 months and mean recurrence time between primary operation and recurrence was 26.0+/-22.7 months. CONCLUSIONS: Resection for central type of the recurrent is potentially curative, however treatment failure was common when the recurrence invaded fixed pelvic structure. Our data suggest that local pelvic recurrence should be treated with radical resection as can as possible.
Classification* ; Follow-Up Studies ; Humans ; Prognosis* ; Rectal Neoplasms* ; Recurrence* ; Survival Rate ; Treatment Failure

PURPOSE: As the oncologic safety of coloanal anastomosis (CAA) has been proven by many other authors, the incidence of CAA following a ultra-low anterior resection has increased. The purpose of this study is to evaluate the functional outcomes and complications for patients who underwent an ultra-low anterior resection and CAA for distal rectal cancer. METHODS: 57 patients underwent CAA following an ultra-low anterior resection between July 1997 and November 2003. 44 patients, who were followed up for more than 6 month after diverting ileostomy repair were evaluated for recurrence pattern, complications, and functional outcomes. RESULTS: The median follow-up period was 32.0+/-22.8 (8~83) months. The mean age of the patients was 54.3+/-10.4 (23~74) years. The types of anastomosis were straight CAA (n=20) and J pouch CAA (n=37). The mean tumor size was 4.1+/-1.9 (2~8) cm, the mean distal resection margin was 1.3+/-0.9 (0.2~4) cm. Six months later, the anastomosis distance following diverting ileostomy repair was measured at 3.24+/-0.6 (2~4) cm from the anal verge. The complications were multiple fistulas (n=3), fistula with anal stenosis (n=1), local recurrence with anal stenosis (n=1), anal stenosis (n=7). Anal incontinence (Kirwan grade III) was noted in 14 patients, and bowel movements more than 6 times per day were observed in 16 patients. Overall recurrence occurred in 6 patients (13.6%). The 5-years survival rate was 84.4%, and the 5-year disease-free survival was 68.9%. CONCLUSIONS: Although CAA in patients with rectal cancer provides excellent long-term survival, a low risk of recurrence, in tolerable function, complications, and poor functional outcomes have been observed with CAA; therefore, the choice of this method should be considered carefully.
Colonic Pouches ; Constriction, Pathologic ; Disease-Free Survival ; Fistula ; Follow-Up Studies ; Hand* ; Humans ; Ileostomy ; Incidence ; Rectal Neoplasms* ; Recurrence ; Survival Rate

PURPOSE: Hepatic veno-occlusive disease (VOD) is a life-threatening complication occurring early after stem cell transplantation (SCT). Early diagnosis and effective treatment has not been established in severe VOD. Because there are few reports on VOD in Korean children, we evaluated the clinical characteristics of VOD following SCT in children. METHODS: We retrospectively reviewed the chart of all patients (n=116) receiving SCTs in CNUH Pediatric BMT center between May, 1991 and June, 2004. RESULTS: VOD developed in 11 patients (9.5%) (median age, 9.8 years; range, 2 to 13.9). Underlying diagnoses were ALL (n=3), severe aplastic anemia (n=3), AML (n=2), acute biphenotypic leukemia (n=1), neuroblastoma (n=1), and myelodysplastic syndrome (n=1). The median day of onset of VOD was D+9 (range, D-3 to D+19). VOD was classified as moderate in 5 and severe in 6 cases. Maximum level of serum total bilirubin was 2.9 mg/dL (range, 2.1 to 9.2) in moderate VOD and 7.3 mg/dL in severe VOD (range, 2.0 to 24.2) at D+18 (range, D-5 to D+59). We successfully treated VOD with various combinations including tPA and heparin (2/5, 40%), ursodeoxycholic acid (2/5, 40%), N-acetylcysteine (3/5, 60%), and defibrotide (1/2, 50%). All of 5 patients with moderate VOD survived at D+100 (range, 5.5+ to 66.6+ months). Five of 6 (83%) patients with severe VOD died within first 19 day from complications of VOD. CONCLUSION: This retrospective study showed that the incidence of VOD was 9.5%, and the mortality of severe VOD was still high which would necessitate early diagnosis, effective prevention and treatment.
Acetylcysteine ; Anemia, Aplastic ; Bilirubin ; Child ; Diagnosis ; Early Diagnosis ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Heparin ; Hepatic Veno-Occlusive Disease* ; Humans ; Incidence ; Leukemia, Biphenotypic, Acute ; Mortality ; Myelodysplastic Syndromes ; Neuroblastoma ; Retrospective Studies* ; Stem Cell Transplantation ; Ursodeoxycholic Acid