Hepatocellular carcinoma (HCC) is malignant tumor frequently occurring in Koreans. There have been few reports regarding the cytologic findings of fine needle aspiration (FNA) of HCC. Most have suggested a diagnostic problem in the cytology distinguishing HCC from some benign hepatic lesions-for example, a regeneration nodule in cirrhosis and liver cell adenoma. In spite of its high frequency in Korea, no cytologic study has been reported, concerning the FNA of HCC. In an attempt to achieve cytologic criteria for the diagnosis of HCC, the authors studied retrospectively cytopathologic findings of 247 cases of HCC. These cases were confirmed either by histologic examination including lobectomy, biopsy, or cell block materiai, or, when tissue diagnosis was unavailable, by a high serum alpha-fetoprotein level (over 400 l. U.). All aspiration smears were stained by the Papanicolaou method. In each case, the smears were analyzed for cell patterns and various cytomorphology of the tumor cells. The smear background was assessed for the presence of tumor cell necrosis and inflammatory components and compared to that of metastatic carcinomas. The cell patterns were classified as trabecular, acinar, dispersed, and irregular. The cytologic parameters analyzed included the degree of nuclear atypia and the presence of mitoses, intranuclear cytoplasmic inclusions, nucleolar prominency, endotheiial lining, multinucleated giant cells, eosinophiic globules, bile, and Mallory body.Most of the FNA of HCC showed markedly cellular smears. The tumor cells were most frequently arranged in a trabecular pattern (80.3%). The irregular (12.6%), the acinar (5.5%), and the dispersed patterns (1.7%) followed in decreasing frequency. Individual hepatoma cells were larger than normal liver cells. However, they had morphologic features characteristic of the hepatic cells: the cells were round or polygonal, their cytoplasm was abundant and granular with eosinophilic or amphophilic stainability, and their nuclei were round to oval, located centrally, and tended to have prominent nucleoli. Anaplasia and pleomorphism of tumor cells were generally mild to moderate. These findings existed even in very well differentiated cases. Mitotic figures were present in about 85% of the cases. Prominent nucleoli were observed only in about half the cases. The frequency of other cytologic features was as follows: intranuclear cytoplasmic inclusion in 86.8%; endothelial lining in 56.1%: bile in 19.8%; and giant cells in 60.1%. Clear cells were often present in11.7%, Most aspiration smears of HCC displayed clean background without necrosis or inflammatory material in contrast to the dirty, necrotic background of metastatic cancers and cholangiocarcinomas. Based on the above mentioned features, it is suqqested that the cytologic critieria most important for the diagnosis of HCC include a markedly cellular smear, trabecular pattern, hepatocytoid appearance of tumor cells, endothelial lining, the presence of bile, giant cells, intranuclear cytoplasmic inclusions, and prominent nucleoli, Among these, trabecular pattern, endothelial lining, giant cells and clean smear background are points to be considered in differentiating HCC from metastatic and cholangiocellular carcinoma.
Adenoma, Liver Cell ; alpha-Fetoproteins ; Anaplasia ; Bile ; Biopsy ; Biopsy, Fine-Needle ; Carcinoma, Hepatocellular ; Child* ; Cholangiocarcinoma ; Cytoplasm ; Diagnosis ; Endothelial Cells ; Eosinophils ; Fibrosis ; Giant Cells ; Glomerulonephritis* ; Hepatocytes ; Humans ; Inclusion Bodies ; Korea ; Liver ; Mitosis ; Necrosis ; Regeneration ; Retrospective Studies

No abstract available.
Growth Hormone* ; Humans

Recurrent epistaxis is not one of rare symptoms in children, the well-known causes of which are anatomical abnormalities of nasal cavity and systemic bleeding tendency. but, in the majority of cases of recurrent epistaxis, it is usually very difficult to find out their underlying causes, so that the treatment is only symptomatic control of nasal bleeding whenever epistaxis occurs, but it usually is impossible to manage against their underlying causes as a specific therapy. The authors considered the breakdown or weakness of vascular integrity of nasal capillary vessel wall as an important factor of recurrent epistaxis, and vitamin C, which has an important role for the synthesis of collagen fiber, could influence to the vascular integrity of nasal capillary vessels. To elucidate the relation between recurrent epistaxis and the status of vitamin C in the tissue of the patients, the authors performed urinary vitamin C loading test measuring urinary excretion of vitamin C with high-performance liquid chromatography by Sirota et al in 19 cases of control group and 32 cases of patients with recurrent epistaxis, whose underlying diseases were not identified. And also the authors administered 1.0 gm/day of vitamin C orally for the treatment of recurrent epistaxis and follow-up was done over 1 year from the beginning of treatment to evaluate the treatment response. The results were as follows: 1) The hemoglobin level was significantly decreased in patient group compared with that of control group (12.4+/-0.8 vs 9.0+/-3.2 gm/dl). 2) The results of urine loading test of vitamin C, expressed as the percent excreted ratio, revealed significantly decreased in the patient group compared to that of the control group (9.1+/-6.1% vs 13.6+/-7.9%). 3) After treatment with 1.0 gm/day of vitamin C orally, follow-up was possible in 23 cases of total 32 patients. Of the 23 patients, "excellent" therapeutic response were in 16 cases (69.6%), "good" response in 5 cases (21.7%), and "no response" only in 2 cases (8.7%). The overall treatment response were in 21 cases (91.3%). In conclusion, it seems that majority of the patients with idiopathic recurrent epistaxis in the deficient state tissue vitamin C so that administration of vitamin C will be one of the effective therapy.
Ascorbic Acid* ; Capillaries ; Child* ; Chromatography, Liquid ; Collagen ; Epistaxis* ; Follow-Up Studies ; Hemorrhage ; Humans ; Nasal Cavity ; Vitamins*

No abstract available.
Femoral Neck Fractures* ; Femur Neck* ; Femur* ; Fracture Fixation, Intramedullary*

With the advancement of modern medicine, diabatic foot gangrene rather than acute metabolic complications are eneountered as serious problem. The diabetic gangrene, one of the angiopathic and neuropathic complications, is difficult in treatment because of wound infection and delayed healing. The authors reviewed a series of 47 cases in 40 patient of diabetic gangrene that treated in orthopedic department of Eulji General Hospitsl, Seoul, from January 1982 to December 1987. We summarized the obtained results as following. 1. The overall incidence of diabetic gangrene was 0.42%, and 77.5% of patients with gangrene were in over 50 year age group. 2. 72.5% of patients with gangrene were 5–14 years in duration of diabetes. 3. The most common predisposing factor was local pressure(45%), and the most common site of lesions was big toe(34%). 4. Bacterial infections were shown in 90% of cases, and the most common organism wasstaphylococcus(56%).5. Diabetic retinopathy was the most common associated complication and neuropathy, nephropsthy in order. 6. According to the Wagner's classification, grade 4 lesion was most common(47%). 7. There was no correlation between primary healing and the lowest palpable pulse. 8. The overall rate of primary healing was 57%.
Bacterial Infections ; Causality ; Classification ; Clinical Study ; Diabetic Foot ; Diabetic Retinopathy ; Foot ; Gangrene ; History, Modern 1601- ; Humans ; Incidence ; Orthopedics ; Seoul ; Wound Infection

Tibial Plateau fracture is relatively common injury which often produce major disability, and their treatment has been in controversy. Recent studies suggest that early knee motion and perhaps better surgical techniques have improved clinical end results. Protection from weight bearing and length of immobilization have varied among authors and variable treatment methods. Thirty-eight tibial plateau fractures treated at Kangnam Sacred Heart Hospital from March in 1984 to December in 1988 were analized and the followings were obtained. l. Of 38 patients, 29 patients were male and 9 female. 2. The most common associated injury was an ipsilateral fibular fracture. 3. Average duration of immobilization was 4 to 6 weeks in conservative treatment and 2 to 4 weeks in operative treatment. 4. We started partial weight bearing in 24 patients within 6 weeks and full weight bearing in 28 patients between 8 and 12 weeks, and good end results were obtained.
Clinical Study ; Female ; Heart ; Humans ; Immobilization ; Knee ; Male ; Weight-Bearing

In general, reverse shoulder arthroplasty revision is performed using the same implant for both the humerus and glenoid components. However, the authors of the present case used different implants from what was used previously for treating instability with scapular notching and glenoid aseptic loosening and report the case.

Thirty-two consecutive patients with spondylolisthesis associated with displacement in varying degrees were operated by the Steffee procedure. Slippings more than Meyerding Grade III were reduced by modified Schollner technique:destabilization of the slipped segement, local distraction with spinal elevator and completion of reduction with a cork screw force pulling backward. Autogenous bone and Pyrost were added to get solid fusion. The authors reviewed thrity-two cases of symptomatic lumbar spondylolisthesis which were operated since March in 1987 at Kangnam Sacred Heart Hospital, Hallym University and the followings were obtained. 1. There were 17 males and 15 females, and the age of the patients was 44.2 years in average ranging from 19 to 66 years. 2. The types of spondylolisthesis were isthmic defect at 19 levels in 18 cases and degenerative in 14 cases. The level of the lesion was L5-Sl in 17 cases, L4-5 in 15 cases and L2-3 in 1 cases. 3. The clinical symptoms were low back pain, radiating pain, intermittent claudication, and motorsensory deficit in order of incidence. 4. Preoperatively, the degree of slinpping was Meyerding Grade I in 18, Grade III in 12 and Grade Ill in 3 cases. The slipping was reduced to nearly anatomic position in 13 cases and Grade I in 20 cases. The average slipping measured by Taillard method was changed from 23.4% preoperatively to 5% postoperatively. 5. Clinically, the results were judged as excellent in 13(13%) cases, good in 16(50%) cases and fair in 3(9%) cases according to Kim's criteria. 6. Postoperative complications were leg pain in 3 cases and "stress transfer" in 1 cases.
Elevators and Escalators ; Female ; Heart ; Humans ; Incidence ; Intermittent Claudication ; Leg ; Low Back Pain ; Male ; Methods ; Pedicle Screws ; Postoperative Complications ; Spine ; Spondylolisthesis

OBJECTIVE: We analyzed 200 cases of prenatal amniocentesis and compared them with other reported studies. Thus we propose the necessity of metanalysis for prenatal amniocentesis. METHOD: We analyzed 200 cases that have undergone amniocentesis at Masan Samsung hospital from January 1996 to December 1997. The results of our study was compared with other reported studies of amniocentesis by indication and maternal age. The proportion of age-class and indication are compared between previous study subjects and our 200 cases. RESULTS: Triple marker abnormality was the most common indication of amniocentesis(51%) and the most common age distribution was 25-29 years (43.5%). Chromosomal aberration was diagnosed in 20 cases (10%) of which the numerical aberration was 9 cases (4.5%) and the structural aberration was 11 cases (5.5%). 5 cases (2.5%) out of ll cases of the structural aberration were normal variant. There were 7 cases (trisomy 21) of autosomal aberration and 2 cases (Turner syndrome) of sex chromosome aberration. Arnong the structural aberration, there was only one reported case of 46, t(7:10) reciprocal translocation. There were no cases of fetal death except for a little self limited preterm labor. There were no neonatal complications. In the comparison of indication and maternal age with other studies, abnormal triple test was the most common indication of amniocentesis. The number of young pregnant women under 35 years old who underwent genetic amniocentesis was increased year by year. CONCLUSION: Triple maker screening test and genetic amniocentesis become popular method of antenatal diagnosis in Korea. Now, it is the proper time to establish standard indication of prenatal amniocentesis in this country by systemic and objective statistic examination. So we address the need for metanalysis in our country as comparing with other studies.
Adult ; Age Distribution ; Amniocentesis* ; Chromosome Aberrations ; Female ; Fetal Death ; Humans ; Korea ; Mass Screening ; Maternal Age ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnant Women ; Prenatal Diagnosis ; Sex Chromosome Aberrations

Ankylosing spondylitis is a chronic inflammatory disease that characteristically involves the sacroiliac and spinal joints; less frequently other musculoskeletal articular structures, the eyes and the heart may be affected. A 49 year old male patient was admitted to our hospital to be operated upon for a periappendiceal abscess. The patient has been suffering from ankylosing spondylitis for 18 years and was unable to flex or extend his neck due to cervical and lumbosacral ankylosing spondylitis. Regional anesthesia was tried through L1-2 interspace, which was poorly defined radiologically, but neither a spinal or epidural block from both the lateral and midline were successful due to the bony resistance. Oral endotracheal intubation was performed with an #8 rubber shaped like a "hocky stick". The anesthetic problems of a patient with ankylosing spondylitis are discussed.
Abscess ; Anesthesia* ; Anesthesia, Conduction ; Heart ; Humans ; Intubation, Intratracheal ; Joints ; Male ; Middle Aged ; Neck ; Rubber ; Spondylitis, Ankylosing*