With advance of diagnostic imaging technics, the detection rate of small hepatocellular carcinoma (HCC) has become much increased, but the questions whether the growth pattern and histologic nature of the HCC keep maintain the original gross and microscopic features with its advancement of tumor size remain still unclear. We reviewed 39 surgically resected hepatocellular carcinomas(HCCs) with a tumor size less than or equal to 3 cm in diameter(s-HCC), and their gross and microscopic features were compared with the HCCs bigger than 3 cm (i-HCC, 199 cases). Single nodular type(SN) was the most common gross type(60%) in s-HCCs, and was followed by single nodular type with perinodular extension(SNPE; 15.4%), multinodular-discrete type(10.3%) and multinodular-confluent type(5.1%). These figures contrasted to SNPE(42.2%) and SN(20.6%) in the i-HCCs. Of the 39 s-HCCs, 25 cases(64.1%) were encapsulated, and 14 cases(36%) demonstrated intratumoral fibrous septations, being contrasted to the i-HCCs in which fibrous septa formation was mord prominent but complete capsule formation was found only in 40.2% of the larger ones. Microscopically, the trabecular type was the most frequent one(53.9%), and increased with their size while the compact type transformed into trabecular one. Thirty three cases(84.6%) were associated with macronodular cirrhosis. Seropositivity for HBsAg was found in 26 cases(66.6%), and high serum alpha-fetoprotein level over 500 IU/L was found in 15 s-HCC cases(38.4%), while 53.3% in i-HCC. The above results suggest that HCCs change their pathologic features by increase of their size, and a comparison of the details with regard to the possible mechanisms involved is discussed.
Carcinoma, Hepatocellular

In Korea chronic liver diseases are the important medical issues because of their high incidence, poor prognosis and no available therapeutic resume. It is believed that the etiologic agent of most of chronic liver diseases in Korea is hepatitis B virus. To find out the incidence of positivity and to understand the autoantibodies in some of the chronic liver diseases in Korea, anti-smooth muscle antibody and anti-nuclear antibody tests were performed on 43 patient serum with chronic active hepatitis, 13 patient serum with chronic persistant hepatitis and 20 patient serum with liver cirrhosis, who diagnosed by liver biopsies. The results of the study are summarized as follows: 1) The positivity of anti-smooth muscle antibody in chronic active hepatitis was 93.0%, that in chronic persistant hepatitis 60.0% and that in liver cirrhosis 80.0%. 2) The positivity of anti-nuclear antibody in chronic active hepatitis was 18.6%, that in chronic persistant hepatitis 15.4%, that in liver cirrhosis 5.0%. 3) The test efficiency of anti-smooth muscle antibody to differentiate chronic active hepatitis from chronic persistant hepatitis and liver cirrhosis was 48.7%. The above results suggest that the antismooth muscle antibody may be related to the "necrosis of liver cells", and further studies are needed to fine out any relationship between the autoantibody and the disturbance of immune regulatory function if there is, as this study suggested.
Incidence

No abstract available.
Cadmium*

Fifty three surgically resected gallbladders(49 cases of chronic cholecystitis with or without cholelithiasis, 4 cases of incidentally resected gallbladders) and 14 autopsy cases were subjected to the histotopographic analysis to identify the nature and distribution of metaplastic mucosal changes, and to determine the possible histogenesis of these mucosal lesions and diagnostic implication as a parameter of chronic cholecystitis. 1) Antral type glands were demonstrated in 47(88.7%), goblet cells in 19(35.8%) and surface epithelial changes in 27(50.9%) of total surgical specimens, indicating the benign metaplastic changes of the gallbladder mucosa toward the gastric or intestinal type. 2) Topographic distribution illustrated the extension of antral type gland to the middle and upper one third portions of the gallbladder mucosa in 37 cases, each. Goblet cells in the middle and upper one third of the mucosa were demonstrable in 13 cases(68%) an 8 cases(42%), respectively. 3) Average age by degree of extension was 50.0 years in Grade O-I, 50.1 years in Grade II and 56.4 years in Grade III. 4) Among 53 surgically resected gallbladders, gallstone was found in 31 cases, in which was a significant correlation between the distribution of metaplastic changes by degree of extent and cholelithiasis. 5) There was no statistical significance between incidence of metaplastic changes of the gallbladder and degree of inflammatory reaction by means of chronic and/or acute inflammatory cell infiltration and Rokitansky-Aschoff sinus formation. 6) Only two out of fourteen autopsy cases demonstrated focal and spotty presence of goblect cells. It is of authors assumption that the lining epithelium of the gallbladder undergos various types of metaplastic changes in the diseased conditions, in which cholelithiasis is included as one of preceding factor. And also, the diagnostic implication of epithelial metaplasia as an expression of chronic cholecystitis is discussed.
Incidence

A 55-year-old woman suffered from upper abdominal pain for two months and remained refractile against the anti-ulcer regimen. The palliative gastrectomy specimen revealed multiple shallow ulcerations on the thickened mucosal folds mainly in the antrum and body along the greater curvature where multiple, whitish nodules were found in the submucosa. Microscopically, individual submucosal nodules clearly corresponded to the necrotizing granulomatous vasculitis which were featured with diffuse fibrinoid necrosis of arterial walls accompanying granuloma formation and heavy infiltration of neutrophils, eosinophils, histiocytes and giant cells. Similar vasculitic lesions involved venules and arterioles. There were scattered vasculitic changes in the liver biopsy specimens and omentum. There were no clinical presentations or serological support of systemic involvement including systemic lupus erythematosus, Henoch-Schoenlein purpura, cryoglobulinemia or Churg-Strauss granulomatous vasculitis. We conclude that this is a hitherto undescribed primary necrotizing granulomatous vasculitis predominantly involving the stomach.
Abdominal Pain ; Arterioles ; Biopsy ; Cryoglobulinemia ; Eosinophils ; Female ; Gastrectomy ; Giant Cells ; Granuloma ; Histiocytes ; Humans ; Liver ; Lupus Erythematosus, Systemic ; Middle Aged ; Necrosis ; Neutrophils ; Omentum ; Purpura, Schoenlein-Henoch ; Stomach* ; Ulcer ; Vasculitis* ; Venules

Morphological effects of degranulation upon me-senteric mast cells of albino rats (SPrague-Dawley strain) by means of lipid administration were studied. An evident degranulation of metachromatic granules from mesenteric tissue mast cells was observed in more than half of experimental rats which were intraperitoneally given 10cc of stearic monoglyceride suspension in warm Tyrode solution (5Omg. of stearic monoglyceride in 10cc of Tyrode solution). A fairly light degranulation of metachro-matic granules from mesenteric mast cells was also displayed by the rats fed ad libitum with butter for 6 hours after being deprived of food for 24 hours.
Animals ; Cytoplasmic Granules/*drug effects ; Lipids/*pharmacology ; Mast Cells/*drug effects ; Mesentery/cytology ; Rats

To determine the perinatal mortality and morbidity of fetuses with absent end-diastolic velocities (AEDV) of the umbilical artery in severe pre-eclampsia and eclampsia, the outcome of 5 fetuses with AEDV was compared with that of 35 fetuses with positive end-diastolic velocities (PEDV). The study population comprised 38 cases of severe pre-eclampsia and 2 cases of eclampsia with structurally normal singletons, who had had umbilical artery Doppler velocimetry weekly from admission to delivery. The Doppler velocimetry result was not used for the clinical management. Perinatal death and neonatal morbidity from both groups were further examined in gestational age category to control the influence of preterm births. The incidence of AEDV of the umbilical artery Doppler velocimetry in severe pre-eclampsia and eclampsia was 12.5% (5/40). The AEDV group had a significantly higher incidence than the PEDV group in terms of ceasarean section due to fetal distress (60% : 17%), Apgar score < 7 at 5 minutes (60% : 14%), perinatal death (25% : 0%) and assisted mechanical ventilation (67% : 9%) both at 32-36 weeks. Time intervals from the detection of AEDV to delivery of live neonates varied from the day to 15 days. In conclusion, AEDV in the umbilical artery might be of clinical value in routine surveillance of pregnancies complicated by severe pre-eclampsia and eclampsia, and predict hypoxic fetal condition which needs operative interventions before or during labor and mechanical ventilation after birth.
Apgar Score ; Cesarean Section ; Dystocia ; Eclampsia* ; Female ; Fetal Distress ; Fetus ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Maternal Death ; Mortality ; Parturition ; Parturition* ; Perinatal Mortality ; Pre-Eclampsia* ; Pregnancy ; Premature Birth ; Respiration, Artificial ; Rheology ; Trial of Labor ; Umbilical Arteries* ; Uterine Rupture

The authors reviewed 50 patients of congenital dislocation of the hip who had surgical treatment at the Department of Orthopedic Surgery, Seoul National University Children's Hospital from October, 1985 to August, 1993. We investigated the contributing factors to coxa magna after surgical treatment and it's relationship to the avascular necrosis of femoral head, and observed the influnce of coxa magna on the development of the hip joint. Coxa magna was defined as a femoral head with the greatest diameter 15% greater than the opposite side. To assess the development of the acetabulum in the hips with coxa magna, radiographical horizontal and vertical parameters were measured preoperatively, and at postoperative 1 year, 2 year, and 3 year or more. Twenty-one of fifty hips had coxa manga. The incidence of coxa magna increased in patients who had open reduction at younger age(average 30 months), compared to older age(average 44 months). Neither femoral osteotomy nor pelvic osteotomy increased statistically the incidence of coxa magna. Avascular necrosis of femoral head did not necessarily resulted in coxa magna. There were not statistically significant differences in the coverage ratios of femoral head by the acetabulum between coxa magna positive and negative groups, because lateral acetabular growth accompanied in accordance with enlargement of femoral head in the majority of cases with coxa magna. Open reduction alone caused concomitant vertical overgrowth of ipsilateral hemi-pelvis with resultant pelvic tilt and leg length inequality(IHD>5mm, upto 2cm) in 6 of 10 cases. The patients, who had coxa magna with good radiological results by Severin's classification, underwent open reduction at younger age and had lesser enlargement of the femoral head, compared to those with fair or poor results.
Acetabulum ; Classification ; Dislocations ; Head ; Hip Joint ; Hip ; Humans ; Incidence ; Leg ; Necrosis ; Orthopedics ; Osteotomy ; Seoul

No abstract available.
Gestational Sac* ; Ultrasonography*

Extracorporeal membrane oxygenation(ECMO) is to be recommended when hypoxemia and hepercarbia are refractory to conventional treatments. Neonatal venoarterial(VA) ECMO in the USA is recognized as a therapeutic modality to neonatal respiratory failure and extracorporeal carbon dioxide removal(ECCO2R) in Europe is used for adult respiratory distress syndrome. The partial bypass using the membrane oxygenator aims at lung rest while relieving the hard ventilatory setting on the diseased lung. ECCO2R adopts low-flow venovenous(VV) bapss. VV bypass provides gas exchange without cardiac support. Venous drainage and perfusion catheters are placed in the right atrium or vena cavae via the femoral or internal jugular veins. Compared to VA bypass, the consequences of embolizations are potentially fewer and no major artery is sacrificed in ECCO2R. Highly oxygenated blood flows into pulmonary circulation which may relieve pulmonary hypertension. To evaluate the effectiveness of ECCO2R, we developed an experimental model on 7 mongrel dogs. Under general anesthesia with i. v. pentobarbital, two thin-walled polyurethane tubes in the external jugular vein and the femoral vein were connected with the extracorporeal circuit. Without ventilating the oxygenator duting VV bypass, control hemodynamic and blood gas values under conventional mechanical ventilation(CMV) were obtained. We proceeded to oxygen insufflation(OI), and extra- corporeal CO2 removal (ECCO2R) in that order. Oxygen was delivered at 300ml/min to the animal lung for OI and ECCO2R and was added at 21/min to the oxygenator only for ECCO2R. Hemodynamic parameteres did not vary among CMV, OI and ECCO2R. Arterial PH in CMV was 7.35+/-0.07 and was decreased to 7.19+/-0.05 in OI due to the increase of PaCO (70+/-3 mmHg). PaO2 was remained constant through the experiment. Mixed venous PH in CMV was 7.31+/-0.05 and was decreased to 7.15+/-0.08 in OI, Blood gas analysis values were same between CMV and ECCO2R. Carbon dioxide removal through the lung (V(L)CO2) were 47+/-3 ml/min in CMV, 9+/-3 ml/min in OI and 8+/-2 ml/min in ECCO2R. The amount of carbon dioxide removed via the oxygenator (VoCO2) was 38+/-5 ml/min in ECCO2R. The total amount of CO2 removal (VCO2) between CMV and ECCO2R was same statistically. The bypass flowrate at the lowest E(T)CO2 (end-tidal CO2) was 60+/-9 ml/min, resulting in 35+/-4% of bypass ratio. It can be concluded that ECCO2R can alleviate hypercapnea using a low flow VV bypass and may be used as an altermative of mechanical ventilator in the setting of acute respiratory failure.
Anesthesia, General ; Animals ; Anoxia ; Arteries ; Blood Gas Analysis ; Carbon Dioxide* ; Carbon* ; Catheters ; Dogs ; Drainage ; Europe ; Extracorporeal Membrane Oxygenation ; Femoral Vein ; Heart Atria ; Hemodynamics ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary ; Jugular Veins ; Lung ; Membranes ; Models, Theoretical ; Oxygen ; Oxygenators ; Oxygenators, Membrane ; Pentobarbital ; Perfusion ; Polyurethanes ; Pulmonary Circulation ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Ventilators, Mechanical