Available conventional pathologic diagnostic tools for lung cancer include sputum cytology, lung biopsy using bronchoscopy, and washing and brushing cytology. In addition, fine needle aspiration (FNA) cytology is now available and has become popular. In this study, an attempt was made to compare the relative sensitivity between conventional cytopathologic methods and FNA cytology, to study the clinical characteristics of lung cancer in which the diagnosis was established by FNA cytology, and to study the cellular findings and diagnostic criteria of lung cencers. Cases included in this study were selected from 105 patients who had been diagnosed an lung cancer at Yonsei University Medical Center during the 5-year period from January 1984 to December 1988. These 105 cases were reviewed with respect to medical records and pathologic slides and then the following conclusions were made. The mean age of cases was 58.5 years, and the sex ratio of males to females was 3.5:1. Tumors were mostly solitary in number and were mainly located at the periphery of the lung. The sensitivity of FNA cytology, sputum, and bronchial washing was as follows: FNA cytology was 0.93, sputum, 0.2, and bronchial washing, 0.14. The coincidence rate of cytopathologic diagnosis with histologic diagnosis was as follows: epidermoid carcinoma was 92%, adenocarcinoma 83%, undifferentiated large cell carcinoma 66%, and undifferentiated small cell carcinoma 100%. The false negativity of FNA cytology was 7%, which was mainly due to material insufficiency. For the differential diagnosis of histologic type, some brief criteria could be summarized. Differential diagnostic points of each histologic type were as follows: epidermoid carcinoma showed a large cellular group with keratinized cytoplasms and hyperchromatic and pyknotic nuclei, adenocarcinoma showed a glandular or ball-like arrangement by monotonous round cells, undifferentiated large cell carcinoma was mainly composed of irregular large cells and showed emperipolesis, and undifferentiated small cell carcinoma showed an Indian file appearance with molding by small, round hyperchromatic cells. In conclusion, FNA cytology is a more efficient, definite, and sensitive method for diagnosing lung cancer than other cytopathologic studies, so that careful selection of patients and experienced technique will improve the diagnostic accuracy of FNA cytology in diagnosing lung cancer.
Female ; Male ; Humans ; Diagnosis, Differential ; Adenocarcinoma ; Biopsy ; Lung Neoplasms

Available conventional pathologic diagnostic tools for lung cancer include sputum cytology, lung biopsy using bronchoscopy, and washing and brushing cytology. In addition, fine needle aspiration (FNA) cytology is now available and has become popular. In this study, an attempt was made to compare the relative sensitivity between conventional cytopathologic methods and FNA cytology, to study the clinical characteristics of lung cancer in which the diagnosis was established by FNA cytology, and to study the cellular findings and diagnostic criteria of lung cencers. Cases included in this study were selected from 105 patients who had been diagnosed an lung cancer at Yonsei University Medical Center during the 5-year period from January 1984 to December 1988. These 105 cases were reviewed with respect to medical records and pathologic slides and then the following conclusions were made. The mean age of cases was 58.5 years, and the sex ratio of males to females was 3.5:1. Tumors were mostly solitary in number and were mainly located at the periphery of the lung. The sensitivity of FNA cytology, sputum, and bronchial washing was as follows: FNA cytology was 0.93, sputum, 0.2, and bronchial washing, 0.14. The coincidence rate of cytopathologic diagnosis with histologic diagnosis was as follows: epidermoid carcinoma was 92%, adenocarcinoma 83%, undifferentiated large cell carcinoma 66%, and undifferentiated small cell carcinoma 100%. The false negativity of FNA cytology was 7%, which was mainly due to material insufficiency. For the differential diagnosis of histologic type, some brief criteria could be summarized. Differential diagnostic points of each histologic type were as follows: epidermoid carcinoma showed a large cellular group with keratinized cytoplasms and hyperchromatic and pyknotic nuclei, adenocarcinoma showed a glandular or ball-like arrangement by monotonous round cells, undifferentiated large cell carcinoma was mainly composed of irregular large cells and showed emperipolesis, and undifferentiated small cell carcinoma showed an Indian file appearance with molding by small, round hyperchromatic cells. In conclusion, FNA cytology is a more efficient, definite, and sensitive method for diagnosing lung cancer than other cytopathologic studies, so that careful selection of patients and experienced technique will improve the diagnostic accuracy of FNA cytology in diagnosing lung cancer.
Female ; Male ; Humans ; Diagnosis, Differential ; Adenocarcinoma ; Biopsy ; Lung Neoplasms

Recently the syndrome of mitral valve prolapse with associated auscultatory and other clinical findings has generated considerable interest. Although this syndrome was originally described as benign, more recent observations have demonstrated that the patients are subject to sudden death, life threatening arrhythmias, bacterial endocarditis or hemodynamically significant mitral regurgitation. It is therefore important to identify such patients so that appropriate antibiotic prophylaxis and antiarrhythmic therapy may be instituted. Since earlier reports of this syndrome by Barlow et al. in 1963, various names or descriptions have been applied to the condition based upon pathologic findings, on cinical investigators has stressed different aspects of the entity. Now it is well known that the syndrome is no longer a benign condition. We have recently had the opportunity to study 15 cases of mitral valve prolapse, which was confirmed by left ventricular cineangiography. Among them 9 cases had associated other cardiac anomalies, most frequently secundum type of atrial septal defect. Among 15 cases 8 were female and the ages ranged from 20 to 52. Selective cine-coronary arteriography was also performed in 2 cases who complained of severe chest pain. We discussed generally the clinical features including hemodynamic and angiocardiographic findings, and pertinent literature published until recently were reviewed.
Female ; Humans

No abstract available.
Apoptosis*

Strongyloides stercoralis is a nematodes and is prevalent in the tropical regions. In Korea, 6 cases have been reported in which the parasites were identified in feces. We report a case of hyperinfection syndrome with Strongyloides stercoralis confirmed in the tissue sections. A 52-year-old woman was admitted to the hospital because of generalized edema and weakness. She received steroid therapy for 30 years because of rheumatoid arthritis. One year ago, generalized edema and dyspnea were developed and she was diagnosed as minimal change nephrotic syndrome for which she received cyclosporin. On admission, she complained of generalized weakness and edema, multiple arthralgia and abdominal discomfort with nausea. The white-cell count was 14,600 without eosinophilia. A stool specimen was negative for occult blood, ova or parasites. Right lower quadrant abdominal pain and tenderness were developed, and the exploratory laparotomy was done under the impression of the acute appendicitis. An appendectomy with a biopsy of mesenteric lymph nodes was performed. From the 5th day after operation, the patient began to complain of the abdominal pain and constipation. Under the impression of adhesion bad formation, the laparotomy was done and disclosed that the proximal ileum was markedly dilated. On jejunotomy, a great amount of formed stool and barium was noticed in the proximal portion of small bowel. The jejunal tissue was biopsied. Grossly, the appendix was unremarkable. Microscopically, the inflammatory reaction was nearly absent, but in serosa, minute granulomas were found which contain a part of the parasite. Same feature was noted in the mesenteric lymph node. The biopsied jejunum contains numerous adult female, filariform and rhabdidiform larvae and eggs in the mucosa, submucosa and muscle wall. Their morphology was compatible with Strongyloides stercoralis. The patient died 5 days later in the state of multiple organ failure.
Adult ; Male ; Female ; Humans ; Biopsy

PURPOSE: Endothelin-1(ET-1) is a potent vasoconstrictor peptide. It has potent contractile and proliferative effects on vascular smooth muscle cells. Congenital heart diseases are often accompanied by pulmonary hypertension, and the severity of pulmonary hypertension is important in the prognosis. The aim of this study was to elucidate changes of ET-1 after pulmonary venous stenosis in a dog model, and investigate the interaction between pulmonary venous pressure and ET-1. METHODS: Plasma ET-1 levels were measured by radioimmuno-assay at the thoracic aorta, left pulmonary artery and left pulmonary vein. Pressures were also monitored at the same sites. Immunohistochemical staining of ET-1 was performed in the lung tissue. RESULTS: Increased serum ET-1 levels were noted at 1 hour after left pulmonary vein stenosis in the left pulmonary vein and aorta, and at 2 days after stenosis in the left pulmonary artery. Left pulmonary venous pressure was significantly increased at 1 hour after pulmonary vein stenosis, and systolic pulmonary artery pressure at 2 days after stenosis. Increased expression of ET-1 was noted by immunohistochemical staining at the lung tissue at 7 days after stenosis of left pulmonary vein. CONCLUSION: Increased serum ET-1 level and expression of ET-1 in immunohistochemical staining at lung tissue were noted after stenosis of pulmonary vein. Serum ET-1 level would be useful in the diagnosis and prediction of pulmonary artery hypertension. (J Korean Pediatr Soc 2000;43:769 778)
Animals ; Aorta ; Aorta, Thoracic ; Constriction, Pathologic* ; Diagnosis ; Dogs ; Endothelin-1* ; Endothelins ; Heart Diseases ; Hypertension ; Hypertension, Pulmonary ; Lung ; Muscle, Smooth, Vascular ; Plasma ; Prognosis ; Pulmonary Artery ; Pulmonary Veins ; Venous Pressure

The origin of the stromal cell of cerebellar hemangioblastoma has long been studied electron microscopically and immunohistochemically. The results and theories about the stromal cell origin are variable and plentiful. However, the exact origin of the stromal cell remains controversial. The present study is aimed to elucidate the nature of the stromal cell of cerebellar hemangioblastoma. Ten cases of hemangioblastoma in Severance Hospital were used for immunohistochemical analysis of the stromal cell. The immunohistochemical staining of GFAP, S-100 protein, NSE, alpha-l-antichymottypsin, cytokeratin, CD 68, factor VIII related antigen, and synaptophysin were performed. The results were as follows; GFAP and S-100 protein were stained mainly but weakly in bellar capillary spindle cell and cellular process. NSE was stained mainly in foam cells, and 6 cases among them revealed strong reaction. ct-l-antichymotrypsin was stained in a few foam cells of 5 cases. Cytokeratin, CD 68, factor VIII related antigen, and synaptophysin showed negative reaction. Based on these results, it is considered that the origin of the stromal cell is histiocytic or neurogenic rather than glial. The weak positivity of GFAP and S-100 protein may support the neurogeriic origin but ct-l-antichymotrypsin positivity does not support the possibility. The positivity of GAP and S-100 protein supports the phagocytic action of histiocytic cell and suggests histiocytic origin rather than neurogenic.

The accessory ovary can be defined as an extraovarian tissue that is located near the normal ovaries and is connected to the broad ligament, infundibulopelvic ligament or utero-ovarian ligament. It has very rarely been reported. The majority was found during abdominopelvic surgeries for any other purposes, because they were usually small and less than 1 cm in diameter adn gave no particular symptoms related simply to their presence. We reported a case of accessory ovary in which developed a simple cyst of a largest diameter of 12 cm, and discussed the significance of the accessory ovary in clinical and pathological aspects.
Cysts

Electrocardiography has been long an important tool in cardiac diagnosis and, with advances in electrocardiography, the accuracy of the electrocardiographic diagnosis has been greatly increased. Though the most accurate methods for quantitative diagnosis of mitral valvular disease are cardiac catheterization and ventriculography, these procedures are time consuming, expensive, and not without risk, thus, it would be helpful if routine catheterization of the heart could be avoided in patients who are potential condidates for mitral valvulotomy. This could be done if reliable electrocardiographic criteria could be found for estimating the amount of obstrcution and leak at the mitral valve. As mitral valvular dysfunction progress, changes (hypertrophy and/or dilation) in the left atrium and both ventricles are inevitable. Many authors attempted to characterize the electrocardiographic findings of such changes according to the specific lesion of the mitral valve. In addition to atrial fibrillation, characteristic P wave changes and their diagnostic significance have been reported (Macruz et al., 1958; Arevalo et al., 1963: Morris et al., 1964). The diagnostic importance of QRS voltage difference in precordial leads has been stressed in the differential diagnosis of specific lesions of mitral valvular disease (Janton et al., 1954: Bateman and January, 1955: Wierum and Glenn, 1957: Bentivoglio et al., 1958: Imperial et al., 1960). Semle and Pruitt(1960) reported that a mean QRS electrical axis of +91degrees or more degrees was the most frequent positive single index of increased total pulmonary resistance in mitral stenosis, and Fowler et al. (1955) stated that precordial lead V1 was very helpful in evaluating the degree of pulmonary hypertension. In Korea there are only a few reports on the electrocardiographic changes in mitral valvular disease and the correlation of electrocardiographic findings and hemodynamics (Oh et al., 1961: Kim, 1970: Kim, 1971). It would be evident that the various electrocardiographic findings noted in western races can't be applied to Koreans. The main objectives of this study are: 1. To determine the electrocardiographic characteristics of pure mitral valvular disease and the differentiation between the specific lesions of pure mitral stenosis, pure mitral insufficiency and combined lesions of mitral stenosis and insufficiency. 2. To know whether the characteristic electrocardiographic changes of mitral stenosis are directly related to the narrowed valve area or to the hemodynamic abnormalities secondary to obstruction. SUBJECTS AND METHODS: 139 cases of isolated mitral valvular disease were reviewed: of these 93 were cases of pure mitral stenosis, 18 were pure mitral insufficiency, and 28 were combined mitral stenosis and insufficiency. Of the total patients, 68 were male and 71 were female. The ages ranged from 10 to 54 years with an average of 35.6 years. Diagnosis was based on cardiac catheterization and supplemented by cienangiocardiography. The conventional 12 lead electrocardiogram was taken at normal sensitivity and at a paper speed of 25mm/sec. The mitral valve area was estimated according to the Gorlin's formula and cardiac output was determined by the direct Fick's principle. The electrocardiograms were analyzed with respect to: 1. Rhythm (atrial fibrillation and sinus rhythm) 2. Presence or absence of P-mitrale 3. Terminal P force in lead V1 (by the method of Morris et. al., 1964) 4. Mean QRS electrical axis in frontal plane 5. QRS voltage in percordial leads(V1S, V5R, V6R & V1S+V(5-6)R) 6. R/S ratio in lead V1 7. Conduction disturbance of right bundle branch block In patients with pure mitral stenosis the electrocardiographic findings of atrial fibrillation P-mitrale, terminal P force in lead V1 were correlated with the hemodynamic data of mean pulmonary artery pressure, mean pulmonary arterial wedge pressure and mitral valve area. An attempt was made to ascertain whether or not a quantitative correlation could be found. A patient showing electrocardiographic pattern of right bundle branch block was excluded in the evaluation of QRS voltage in lead V1 and mean QRS electrical axis in frontal plane. RESULTS AND SUMMARY: 1. P wave abnormality, which was noted in most (131/139) cases, is apparently a characteristic and most frequent electrocardiographic finding in mitral valvular disease. Of the P weve abnormalities the development of atrial fibrillation and P-mitrale were thought to be related to the duration of the illness rather than to the types of lesion or hemodynamic abnormalities secondary to valvular dysfunction. However, the terminal P force in lead V1 was thought to be related to the mean pulmonary arterial wedge pressure rather than to narrowing of the valve. 2. 15 patients showed the electrocardiographic pattern of right bundle branch block. In patients with mitral stenosis this electrocardiographic pattern was noted at almost all levels of mean pulmonary artery pressure, mean pulmonary arterial wedge pressure, mitral gradient and mitral valve area. 3. Mean QRS electrical axis and QRS voltage in precordial leads; There was no case which deviated leftward more than +30degrees even among cases with a predominant or pure mitral insufficiency. Although the difference of mean value in mean QRS electrical axis and QRS voltage in precordial leads according to the types of the lesion was significant, this difference was generally not helpful in the differential diagnosis in individual patients because of much overlapping among cases. 4. There was no definite electrocardiographic criteria to differentiate clearly the types of mitral valvular disease. However, the following aspects of electrocardiogram may be useful in differential diagnosis. a. Difference of QRS voltage in precordial leads: The volage of V1S and V1S+V(5-6)R in all patients with pure mitral insufficiency was over 1mm and 11mm respectively. That of V1S+V(5-6)R in all patients with pure mitral stenosis was below 39mm. b. R/S ratio in lead V1: There was no case showing "R wave only" in lead V1 among patients with pure or predominant mitral insufficiency. c. Mean QRS electrical axis in frontal plane: The mean QRS electrical axis of all patients with pure mitral stenosis deviated rightward more than +60degrees in all except one case. None of the patients with pure mitral insufficiency deviated rightward more than +110degrees. 5. Relationship between hemodynamics and electrocardiography in paitents with mitral stenosis: Among the hemodynamic abnormalities, mean pulmonary artery pressure showed a close relationship with the following aspects of the electrocardiogram. a. R/S ratio in lead V1:The mean value of mean pulmonary artery pressure (45.9+/-3.8mmHg) in groups showing R/S>1 was significantly elevated as compared with that (34.8+/-1.5mmHg) of groups showing R/Sdegrees1. b. Mean QRS electrical axis in frontal plane: There was a weak positive correlation (r=+0.53) between mean pulmonary artery prersure and QRS electrical axis in the frontal plane. The QRS axis of all patients with a mean pulmonary artery pressure of 41mmHg or more was +91degrees or more except for one case. c. Terminal P force in lead V1: The difference of mean value in mean pulmonary artery pressure according to the size of terminal P force in lead V1 was significant in all cases.
Atrial Fibrillation ; Axis, Cervical Vertebra ; Bundle-Branch Block ; Cardiac Catheterization ; Cardiac Catheters ; Cardiac Output ; Catheterization ; Catheters ; Continental Population Groups ; Diagnosis ; Diagnosis, Differential ; Electrocardiography* ; Female ; Heart ; Heart Atria ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Korea ; Male ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Pulmonary Artery ; Pulmonary Wedge Pressure

No abstract available.
Biopsy, Fine-Needle* ; Liver*