Although the histologic grade of astrocytic neoplasms of the brain have been used as a prognostic factor, the lack of an objective criteria is possible to create the disagreement of classification. We evaluated 25 cases of astrocytic neoplasms of brain to document the usefulness of prolifera-tive potential of tumor as a prognostic indicator and the correlation with histologic grade by Nils Ringertz. The Ringertz's classification was relatively simple in an application among the variable systems and easy to define the differentiate from grade to grade. The examined cases were com-prised of 7 astrocytomas, 9 anaplastic astrocytomas and 9 glioblastoma multif6rmes. The prolife-rative potential of tumors were measured by Ag-NORs count, PCNA labeling index and flow cytometric analysis. The mean numbers of Ag-NORs per cell and PCNA labeling index were sig-nificantly differ among each histologic grade. In addition, abnormal DNA content and high prolif-erative index were frequently identified in anaplastic astrocytoma and glioblastoma multiforme. Therefore, the Ag-NORs counts, PCNA labeling index, DNA index and proliferative index were well correlated with the histologic grade.

Nineteen astrocytic neoplasms, such as 9 cases of glioblastoma multiforme, 6 cases of anaplastic astrocytoma and 4 cases of low grade astrocytoma, were analysed in view of the relationship between histopathologic grade, nuclear pleomorphism, grade of mutant p53 gene expression and mean survival time after operation. The histopathologic classification by Ringertz and immunohistochemical stain for mutant p53 gene with the DO-7 anti-p53 oncoprotein mouse monoclonal antibody were applied, and the results obtained were as follows; 1) Among 19 cases, 18 cases were located in the supratentorium, where 13 cases(42%) were located in the left and 17 cases(55%) in the right. 2) The p53 gene expression was detected in 12(63.2%) of the cases, as revealed by positive nuclear staining. All cases of glioblastoma multiforme showed p53 gene expression, compared with two(33.3%) cases of anaplastic astrocytoma and one(25%) case of low grade astrocytoma. The frequency and degree of histopathologic grade(p=0.03). 3) The mean survival time after operation was 29.49+/-4.08 months in cases with p53-negative tumors and 12.93+/-3.14 months in cases with p53-positive tumors(p<0.05). 4) Both histopathological classification and p53 gene expression showed a significant influence on servival(p=0.02 and p=0.03, respectively). 5) The relative risk for survival time was the highest in p53 gene expression. In conclusion, p53 gene expression appears to be one of the recommendable prognosticators among astrocytic neoplasms.
Animals ; Astrocytoma ; Classification ; Genes, p53* ; Glioblastoma ; Mice ; Survival Rate

BACKGROUND: Patients survival after liver transplantation continue to improve, and renal dysfunction is not uncommon complication in the posttransplant setting and influences to prognosis. But this important complication has not been extensively evaluated in Korea. The aim of this study was to determine the incidence of renal insufficiency and to identify the risk factors associated with renal insufficiency in long-term survivor over 6 months after liver transplantation at Seoul National University Hospital. METHODS: A retrospective study was done of 62 adult (44 males, 18 females; mean age 45 years, range 16-64) patients surviving more than 6 months (mean 17 months, range 6-63) after liver transplantation in the period of November 1996 to July 2001. Renal function of patients was classified by estimated endogenous creatinine clearance using Cockcroft-Gault formula. Potential risk factors for renal insufficiency were investigated. In addition, in the cases of patient who received mycophenolate mofetil (MMF) with calcineurin inhibitors (CNI) in reduced dosages for presumed CNI-induced nephrotoxicity, the change of renal function was analyzed retrospectively. RESULTS: The underlying diseases leading to transplantation included HBV-related cirrhosis in 43, hepatoma in 11, HCV-related cirrhosis in 2, alcoholic cirrhosis in 2, Wilson's disease in 1, and biliary atresia in 1 case (s). The immunosuppressive therapy included tacrolimus in 48 cases and cyclosporine in 14 cases combined with prednisolone. In all, 26 patients among study period, received MMF. Of all patients, 8 (13%) kept normal renal function (Ccr> or = 90), 27 (43.5%) developed mild dysfunction (60< or =Ccr< 90), 27 (43.5%) developed moderate dysfunction (30< or =Ccr< 60), and none of these patients developed severe renal dysfunction (Ccr< 30). Compared with control patients (Ccr> 60), renal dysfunction patients (Ccr< 60) had a lower preoperative creatinine clearance (p=0.007) and a lower 3-month creatinine clearance (p=0.032). But there were no differences seen among groups in age, sex, immunosuppresive protocol (tacrolimus vs. cyclosporine), mean tacrolimus serum level, developement of postoperative acute renal failure (ARF), and frequency of ARF among 6 months after transplantation. There was no statistically significant (p=0.057) but some recovery of renal function in the cases of patient who received MMF with low dose CNI. CONCLUSION: Patients who are more than 6 months after liver transplantation have renal dysfunction at a high rate (87%). Patients who develop moderate renal dysfunction have a lower preoperative and 3-month creatinine clearance. For renoprotective effect of MMF with reduced dosage of CNI, long-term randomized controlled studies are warranted.
Acute Kidney Injury ; Adult* ; Biliary Atresia ; Calcineurin ; Carcinoma, Hepatocellular ; Creatinine ; Cyclosporine ; Female ; Fibrosis ; Hepatolenticular Degeneration ; Humans ; Incidence* ; Korea ; Liver Cirrhosis, Alcoholic ; Liver Transplantation* ; Liver* ; Male ; Prednisolone ; Prognosis ; Renal Insufficiency ; Retrospective Studies ; Risk Factors* ; Seoul ; Survivors ; Tacrolimus

We compared the histological diagnosis and activity between the right and left lobes in order to assess the sampling variability in HBsAg(+) chronic liver diseases. From May 1987 to September 1991, we prospectively evaluated 23 patients(male 19, female 4, mean age: 32.0+8.8)with HBsAg(-) chronic liver diseases. (continue...)
Diagnosis* ; Female ; Humans ; Laparoscopy ; Liver Diseases* ; Liver* ; Prospective Studies

A 12-years-old female admitted to the hospital with the complaint of pain on the right upper chest area which persisted about 1 month prior to admission. Cafe-au-lait spots of various size laying on a whole body and freckling on the axilla were found on physical examination. A huge mass was found on the plain chest X-ray and on chest MRI. The mass encroached thoracic spine, posterior rib, back muscles, and then into the neural canal and compressed thoracic spinal cord. On the 5th day of hospitalization, the patient complained tingling on the both legs and 2 days later, monoparesis on the right leg. Open thoracotomy and decompressive laminectomy was done to remove mass. Pathologic reports confirmed rhabdomyosarcoma, embryonal type.
Axilla ; Back Muscles ; Cafe-au-Lait Spots ; Female ; Hospitalization ; Humans ; Laminectomy ; Leg ; Magnetic Resonance Imaging ; Mediastinum* ; Neural Tube ; Paresis ; Physical Examination ; Rhabdomyosarcoma* ; Rhabdomyosarcoma, Embryonal ; Ribs ; Spinal Cord Compression* ; Spinal Cord* ; Spine ; Thoracotomy ; Thorax

Granulocytic sarcoma, a rare extramedullary solid tumor arising from early myeloid precursors, is capable of invading the meninges or the rain parenchyma. The tumor may occur during or after the onset of systemic myelogenous leukemia. On rare occasions, the tumor may evolve before the onset of systemic myelogenous leukemia. Children are affected more often than adults, but sex is not related. Although no definite target area of the brain can be demonstrated, there may be some predilection of the tumor for the posterior fossa. The authors report a case of 4-year-old-boy with granulocytic sarcoma occurring in the posterior fossa presenting with gait disturbance and torticollis. The patient was treated by surgical removal of the tumor, there by avoiding the potentially lethal complication of a posterior fassa mass. This rare case is reported together a review of the literature.
Adult ; Brain ; Cerebellum* ; Child ; Gait ; Humans ; Leukemia, Myeloid ; Meninges ; Rain ; Sarcoma, Myeloid* ; Torticollis

Parvimonas micra is a non-spore-forming anaerobic gram-positive coccus, widely distributed as normal flora in the skin, vagina and mucosa, and able to cause opportunistic infections, particularly endocarditis and brain abscess following dental manipulations. A 49-year-old woman was hospitalized due to fever and headache. She had been diagnosed with periodontitis at the beginning of fever. A brain abscess was noted in the right temporal lobe on the brain CT, and she was treated with ceftriaxone, isepamicin and metronidazole. In the next day, abscess was aspirated and drained by a surgical procedure. An organism was isolated from an anaerobic culture of the abscess aspirate, and was identified as P. micra by a commercial kit and 16S rRNA sequencing.
Abscess ; Brain ; Brain Abscess ; Ceftriaxone ; Endocarditis ; Female ; Fever ; Gentamicins ; Headache ; Humans ; Metronidazole ; Middle Aged ; Mucous Membrane ; Opportunistic Infections ; Peptostreptococcus ; Periodontitis ; Skin ; Temporal Lobe ; Vagina

We describe a case of metastatic alveolar soft part sarcoma of the brain in a 31 year old women. Alveolar soft part sarcoma is rare tumor that occurs mostly in the extremities and have a high incidence of blood born metastasis. Cerebral metastasis may be the first manifestation of the disease. The histogenesis of alveolar soft part sarcoma remains uncertain. The primary therapeutic option is aggressive surgical excision. Survival even with the development of metasrasis can be long.
Adult ; Brain ; Extremities ; Female ; Humans ; Incidence ; Neoplasm Metastasis* ; Sarcoma, Alveolar Soft Part*

In recent times, central nervous system(CNS) tuberculosis has been rare and the prevalence of the focal form, the tuberculoma, varies from 1 per 20 to 1 per 1000. CNS tuberculosis occurs as a result of hematogenous sparead from a primary focus, mostly pulmonary tuberculosis. It can be diffuse exudative leptomeningitis or a localized tuberculoma; the former is more common. We report a case of military cerebral tuberculosis in a 24-year-old female who had been having headaches for 4 months. Magnetic resonance imaging showed numerous small round Gadolinium-enhanced supratentorial and infratentorial lesions scattered throughtout the brain. Histologic examination confirmed well-defined tuberculous granulomas with central caseous necrosis in open biopsy, containing several acid-fast bacilli, the patient was treated with isoniazid, rifampin, ethambutol, pyrazinamide in combination with prednisolone.
Biopsy ; Brain ; Central Nervous System* ; Ethambutol ; Female ; Granuloma ; Headache ; Humans ; Isoniazid ; Magnetic Resonance Imaging ; Military Personnel ; Mycobacterium tuberculosis ; Necrosis ; Prednisolone ; Prevalence ; Pyrazinamide ; Rifampin ; Tuberculoma ; Tuberculosis ; Tuberculosis, Miliary* ; Tuberculosis, Pulmonary ; Young Adult

Renal lymphangiectasia is a rare cystic kidney disorder. This disorder has been termed renal lymphangioma, renal lymphangiomatosis, pararenal lymphatic cyst. We report on a 32-year-old man admitted with complaints of abdominal discomfort, in whom unilateral renal lymphangiectasia with renal vein thrombosis was diagnosed. Abdominal computed tomography revealed left perirenal fluid collection with multiloculation. Left renal vein was completely obliterated due to thrombosis and inferior vena cava (IVC) was partially obliterated. Perirenal fluid collection and renal vein thrombosis were treated initially with percutaneous drainage and anticoagulation therapy. The biochemical features of the drained fluid were compatible with lymphatic fluid. Since there was no decrease in the amount of daily drainage, left nephrectomy and IVC thrombectomy was performed on the 34th day of hospitalization. Left kidney was enlarged (15x10x18 cm, 750 g) and composed of numerous smooth, thin-walled cysts. Pathologic diagnosis was renal lymphangiectasia.
Adult ; Diagnosis ; Drainage ; Hospitalization ; Humans ; Kidney ; Kidney Diseases, Cystic ; Lymphangioma ; Lymphocele ; Nephrectomy ; Renal Veins* ; Thrombectomy ; Thrombosis* ; Vena Cava, Inferior