The authors presented a case of gastroschisis with a pedunculated gallbladder embedded in hepatic tissue. The patient was born after fullterm gestation. Due to extensive abdominal wall defect, she succumbed 3 days after birth. There was a pedunculated mass measuring 2.5x1.5x1.5 cm between the liver and distended stomach without any attachment to the liver. The pedicle of the mass was connected to the common bile duct. Cut surface revealed that the mass was an accessory hepatic lobe encircling the gallbladder. The histologic feature of both accessory liver and gallbladder was markedly altered probably due to vascular obstruction. We could find only a single similar case in literlature. That case was associated with Beckwith syndrome and ours was associated with large atrial spetal defect, large patent ductus arteriosus, accessory spleen as well as gastroschisis. The common feature of abdominal wall defect might be a predisposing factor.

To evaluate the differentiation status of smooth muscle in gastric stromal tumors which were negative for S-100 protein, immunohistochemistry using desmin, actin, myosin and vimentin was performed in 14 cases of gastric smooth muscle tumors. Ultrastructural Examination was also performed. For comparison a case of leiomyoma of the esophagus, a case of the sigmoid colon, 10 cases of the uterus were also examined. The results obtained were as follows. All gastric smooth muscle tumors showed vimentin-positivity. Six of 14 gastric smooth muscle tumors, (5 of 8 leiomyoma and 1 of 4 leiomyosarcoma) showed positivity for desmin, actin, and myosin(42.9%). All esophageal, colonic, and uterine leiomyomas showed diffuse positive reaction for desmin, actin, and myosin. Vimentin positivity was also noted in leiomyoma of the colon and uterus. Ultrastructurally, a few cells in the gastric stromal tumors had scattered microfilaments with dense bodies, subplasmalemmal dense plaques, and micropinocytic vesicles. However, most of the tumor cells did not have any of the ultrastructural features of smooth muscle differentiation. Leiomyomas of the esophagus and uterus showed many cytoplasmic microfilaments with dense bodies. These results suggest that most of the benign and malignant tumor cells of gastric stromal tumors have features of the undifferentiated cells, immunohistochemically as well as ultrastructurally, although a few cells have. It is speculated that most gastric stromal tumors may have lost their smooth muscle differentiation.

Computed body tomography has become useful in the diagnosis of pancreatic disease. It was found to be are liable, often specific, and noninvasive method for detecting pancreatitis and extra-pancreatic extension of the pathology. Of eight hundred and seventy-two cases studied for abdominal pathology with EMI-CT 5005 whole body scanner form Oct. 1977 to August 1980, 21 cases were confirmed to be pancreatitis clinically or operatively. The authors reviewed the CT findings of the above cases and the results were as follows; 1. Among twenty-one cases, the acute pancreatitis was 12 cases and the chronic pancreatitis was 9 cases. The sex ratio as 17 males to females. 2. In acute pancreatitis, diffuse enlargement of pancreas (11/12), focal enlargement (1/12), loss of peripancreatic fat plane (9/12), thickening of anterior of pararenal fascia (6/12), and smooth margin ofpancreas (5/12) were observed. 3. In chronic pancreatitis, parenchymal atrophy (7/9), normal size (2/9), loss of peripancreatic fat plane (3/9), thickening of anterior pararenal fascia (1/9), calcification (1/9), smooth margin (2/9), and serrated margin (6/9) were observed. 4. The complications were associated with 7 cases of acute pancreatitis and 1 case of chronic pancreatitis; pseudocyst (6), abscess (2), and fat necrosis (3), The sites of the pseudocyst were lesser sac (2), anterior pararenal space (2), posterior pararenal space (1), subhepatic region (1), greater omentum (1), and intrapancreatic region (2). All of them were associated with acute pancreatitis except one in chronic pancreatitis.
Abscess ; Atrophy ; Diagnosis ; Fascia ; Fat Necrosis ; Female ; Humans ; Male ; Methods ; Omentum ; Pancreas ; Pancreatic Diseases ; Pancreatitis ; Pancreatitis, Chronic ; Pathology ; Peritoneal Cavity ; Sex Ratio

Pituitary stalk interruption syndrome (PSIS) involves the occurrence of a thin or absent pituitary stalk, hypoplasia of the adenohypophysis, and ectopic neurohypophysis. Diagnosis is confirmed using magnetic resonance imaging. Patients with PSIS have a variable degree of pituitary hormone deficiency and a wide spectrum of clinical manifestations. The clinical course of the disease in our patient is similar to that of a syndrome of inappropriate antidiuretic hormone secretion. This is thought to be caused by failure in the suppression of vasopressin secretion due to hypocortisolism. To the best of our knowledge, there is no case report of a patient with PSIS presenting with hyponatremia as the first symptom in Korean children. Herein, we report a patient with PSIS presenting severe recurrent hyponatremia as the first symptom, during adolescence and explain the pathophysiology of hyponatremia with secondary adrenal insufficiency.
Adolescent ; Adrenal Insufficiency* ; Child ; Delayed Diagnosis* ; Diagnosis ; Humans ; Hyponatremia* ; Hypopituitarism ; Inappropriate ADH Syndrome ; Magnetic Resonance Imaging ; Pituitary Gland* ; Pituitary Gland, Anterior ; Pituitary Gland, Posterior ; Vasopressins

Gastrointestinal cytomegalovirus(CMV) infection in adults is observed as a part of a generalized or localized infection in patients who are immunocompromized. We report a case of CMV infection of the small intestine. The patient is a 34 year-old woman who has complained of palpable purpura in the lower extremities and buttocks, and arthralgia of large joints. The skin biopsy showed fibrinoid necrosis and neutrophils with leukocytoclasis, which findings are compatible with hypersensitivity angiitis. The patient received steroid and cyclophosphamide. During the follow-up period, generalized edema and bloody stool were detected. Resected specimen of small bowel has multiple aphthous ulcer. Microscopically, cytomegalic cells are observed along the endothelial cells and mesenchymal cells. In situ hybridization using DNA probes against CMV revealed positive staining in the cytomegalic inclusions in vascular endothelial and mesenchymal cells.
Adult ; Male ; Female ; Humans ; Biopsy

Leiomyoblastoma is uncommon and has been known as a neoplasm of smooth muscle origin. However, with recent pragress in immunohistochemical staining techniques, many clinicopathological discrepancies have been pointed out about the origin of leiomyoblastoma. We present here a case of gastric leiomyoblastoma did not expressed desmin and neuron specific enolase, and was thought to be of unknown derivation.
Desmin ; Leiomyoma, Epithelioid* ; Muscle, Smooth ; Phosphopyruvate Hydratase

Leiomyoblastoma is uncommon and has been known as a neoplasm of smooth muscle origin. However, with recent pragress in immunohistochemical staining techniques, many clinicopathological discrepancies have been pointed out about the origin of leiomyoblastoma. We present here a case of gastric leiomyoblastoma did not expressed desmin and neuron specific enolase, and was thought to be of unknown derivation.
Desmin ; Leiomyoma, Epithelioid* ; Muscle, Smooth ; Phosphopyruvate Hydratase

Macrophage colony-stimulating factor (M-CSF) is known as one of the factors essential for osteoclast development. In the present study, we examined effects of M-CSF on the apoptotic pathway of osteoclast precursors and their underlying molecular mechanisms. Osteoclast precursors underwent apoptosis in the absence of M-CSF, even in the presence of receptor activator of NF-kB ligand (RANKL). Active caspase-3 and -9 were detected in the osteoclast precursors and treatments of precursors with their specific inhibitors (Z- DEVD-FMK and Z-LEHD-FMK) decreased the apoptosis. M-CSF decreased apoptosis in a dose-dependent manner with decreasing in active caspases-3 and -9 levels and up-regulating Bcl-XL. Those effects of M-CSF on inhibiting apoptosis of osteoclasts precursor by regulating anti-apoptotic signals was more effective when combined with RANKL. These results demonstrate that M-CSF acts as a survival factor for the osteoclast precursors. Furthermore, it is believed that the apoptosis of osteoclast precursors may be involved in the activation of caspase-9 and that M-CSF may promote their survival through Bcl-XL-induced inhibition of caspase-9 activation.
Animals ; Apoptosis/drug effects/physiology ; Carrier Proteins/pharmacology ; Caspases/antagonists & inhibitors/drug effects/metabolism ; Cell Survival/drug effects ; Cells, Cultured ; Cysteine Proteinase Inhibitors/pharmacology ; Enzyme Activation/drug effects ; Female ; Macrophage Colony-Stimulating Factor/*pharmacology ; Membrane Glycoproteins/pharmacology ; Mice ; Mice, Inbred ICR ; Oligopeptides/pharmacology ; Osteoclasts/*cytology/drug effects ; Proto-Oncogene Proteins c-bcl-2/drug effects/*metabolism ; Stem Cells/cytology/*drug effects ; Up-Regulation

39 patients with tibial shaft fracture had treated by open reduction and internal fixation with AO DCP and screws applying on the medial surface of the tibia, at the Department of Orthopedic Surgery, Ulsan Dongkang Hospital, from January, 1983 to December, 1985. A clinical study was done on all the 39 cases with the follow-up check over 1 year. In general, because the lateral surface of the tibia is well covered by rich soft tissue, it is popularized to apply the plate on the lateral aspect of the tibia. In our department, we applied the plate on the medial aspect of the tibia, which resulted in mimi-zing soft tissue injuries and, by inserting the screws perpendicular to the surface of the bone, increased stability of the fixation; and therefore resulted in relatively short operation time, relatively low incidences of infection and non-union; but there had been some drawbacks such as focal skin necrosis, hematoma, adhesion after fixatives removal, and cosmetic disfiguring. But there were no problems during the follow up periods. So, this is a recommandable procedure of internal fixation with the plate for the tibial shaft fractures.
Clinical Study ; Fixatives ; Follow-Up Studies ; Hematoma ; Humans ; Incidence ; Necrosis ; Orthopedics ; Skin ; Soft Tissue Injuries ; Tibia ; Ulsan

We report the sonographic features of an intracystic papillary carcinoma of the breast presenting as recurrent hemorrhagic cysts following trauma. A 56-year-old woman presented with palpable breast masses after a traumatic event; sonography showed multiple, well-defined, hemorrhagic cysts. Hemorrhagic fluid was evacuated by fine needle aspiration with no residual lesions. Cytology was negative for malignancy. Five months later, the mass reappeared; sonography demonstrated multiple cysts with solid nodules. US-guided core biopsy and surgery revealed invasive papillary carcinoma. We suggest close follow-up of cystic masses, even with negative cytology, and performance of surgical excisional biopsy in cases of rapid refilling after aspiration.
Ultrasonography, Mammary/methods ; Recurrence ; Middle Aged ; Mammography/methods ; Lymphatic Metastasis ; Humans ; Hemorrhage/*diagnosis/ultrasonography ; Female ; Diagnosis, Differential ; Cysts/*diagnosis/ultrasonography ; Carcinoma, Papillary/*diagnosis/ultrasonography ; Breast Neoplasms/*diagnosis/ultrasonography