Intramuscular Myxoma of the Foot: A Case Report / 대한족부족관절학회지

Intramuscular myxoma is a rare benign myxoid tumor that is difficult to differentiate from other benign soft tissue tumors and sarcoma, and as a result, intramuscular myxoma is commonly misdiagnosed as another type of soft tissue tumor. Accordingly, awareness of the existence of this condition is a fundamental requirement for treatment decision-making. Furthermore, although intramuscular myxoma appears grossly to be well-circumscribed, it can infiltrate adjacent soft tissue microscopically. Tumor resection is the recommended treatment, but appropriate surgical margin sizes remain controversial. To the best of our knowledge, this is the first South Korean report to be issued on the treatment of intramuscular myxoma of the foot.

Analysis of Death Certificate Errors of a University Hospital Emergency Room / 대한법의학회지

This study aimed to analyze the errors and their causes in inappropriately completed death certificates, and to suggest improvement measures. The death certificate is an important medical document that proves the cause and manner of death. However, a death certificate is not as valuable as a medical document, since many death certificates are inappropriately completed and thus provide inaccurate information. We reviewed 307 death certificates issued by the Emergency Room of Chung Nam National University Hospital between January 1, 2015, and November 31, 2016, and compared their details with the cause and manner of death in the patients' medical records. Among various errors, the most common was “omission of other significant information not related to the cause of death” (184 cases). On 29 death certificates, the mechanism of death was recorded instead of the cause of death. When comparing death certificates and medical records, discrepancies in the cause and manner of death were found in 13 (4.2%) and 17 (5.5%) cases respectively. Although the contents of a death certificate may vary according to a physician's point of view, multiple errors on death certificates should be avoided, and we suggest necessary improvement measures.

Voice Change Due to Paratracheal Air Cysts

Paratracheal air cysts are a rare entity in which cystic formation occurs adjacent to the trachea. Most patients with paratracheal air cysts are asymptomatic, and the cysts are detected incidentally on chest radiograph or computed tomography (CT) scan. Most symptomatic patients complain of pulmonary symptoms or repeated respiratory infection. Rarely, the air cysts can lead to paralysis of the recurrent laryngeal nerve as a result of direct compression. We report a case of a 59-year-old male patient who presented with voice change, and the cause was identified as paratracheal air cysts on a chest CT scan. Surgical resection via video-assisted mediastinoscopy was performed, and the voice recovered immediately after the operation.

Metachronous Primary Carcinoid Tumor and Spindle Cell Carcinoma of the Lung

Spindle cell carcinoma (SpCC) of the lung is extremely rare, with an incidence of less than 0.5% among all lung malignancies. Neuroendocrine tumors are frequently associated with secondary primary malignancies. Here, we report a case of metachronous SpCC that occurred after treatment of a primary carcinoid tumor of the lung. The SpCC mass was successfully removed by lobectomy. In immunohistochemical analyses, the tissues were positive for cytokeratin 7 and vimentin.

Pulmonary Artery Angiosarcoma Confused with Acute Pulmonary Thromboembolism: Focusing on Clinical and Echocardiographic Features in the Differentiation of Two Categories

Although pulmonary artery angiosarcoma is rare, it can be misdiagnosed as pulmonary embolism because of its similar clinical and diagnostic features. The diagnosis is often delayed and the misdiagnosis brings unnecessary treatment. Because we made a wrong diagnosis of pulmonary artery angiosarcoma as an acute pulmonary embolism, we did thrombolytic therapy which could be dangerous to the patient. In this case report, we focused on the clinical and echocardiographic features of pulmonary artery angiosarcoma which can be used in differentiating the diagnosis from pulmonary embolism.

A Case of Malignant Transformation in a Congenital Cystic Adenomatoid Malformation / 대한내과학회지

Congenital cystic adenomatoid malformation (CCAM) of the lung is a rare condition with the potential for malignant transformation. Several cases that presented with malignant changes have been reported worldwide. However, no report about a malignant transformation case in a CCAM in Korea has been published. We report the first patient who had a malignant change in a CCAM. A 32-year-old female underwent a bilobectomy for a cystic lung lesion that was a type 1 CCAM associated with malignant transformation. A biopsy specimen from the resected cystic lesion showed foci of adenocarcinoma.

A Case of Atypical Adenomatous Hyperplasia of Larger Than 2 cm / 결핵및호흡기질환

Atypical adenomatous hyperplasia (AAH) has been considered to be a precursor lesion of bronchioloalveolar carcinoma (BAC) and pulmonary adenocarcinoma. It usually coexists with BAC and/or an adenocarcinoma. Chest computed tomography reveals multiple well-defined nodules with ground-glass opacity. Usually, AAH does not exceed 10 mm in size. AAH with extensive involvement on one side of the lung field or one that is larger than 2 cm has not been previously reported. We herein report a case of a 71-year-old nonsmoking female with lung AAH of larger than 2 cm.

Immunohistochemical Application to the Pathologic Diagnosis of Lung Cancer

Lung cancer is the most common cause of death from neoplasms in Korea. Since the pathologic diagnosis is very important to determine the optimal treatment protocol of the patients, not only pathologists, but also oncologists, have an interest in the diagnosis of cancer. At the present time, immunohistochemical studies do more than play a supplementary role on the biopsied or excised specimens from cancer patients. Thus, I have reviewed the general principles and applications of immunohistochemistry on the histologic diagnosis of lung cancer

Phase II Study of Induction Irinotecan + Cisplatin Chemotherapy Followed by Concurrent Irinotecan + Cisplatin Plus Twice-Daily Thoracic Radiotherapy / 결핵및호흡기질환

BACKGROUND: Irinotecan hydrochloride, a topoisomerase I inhibitor, is effective against small-cell lung cancer. Irinotecan also can act as a potential radiation sensitizer along with cisplatin. To evaluate efficacy and toxicity of irinotecan plus cisplatin (IP) with concurrent thoracic radiotherapy, we conducted a phase II study of IP followed by concurrent IP plus hyperfractionated thoracic radiotherapy in patients with previously untreated limited-stage small-cell lung cancer. METHODS: Twenty-four patients with previously untreated small-cell lung cancer were enrolled onto the study since November 2004. Irinotecan 60 mg/m2 was administered intravenously on days 1 and 8 in combination with cisplatin 60 mg/m2 on day1 every 21 days. From the first day of third cycle, twice-daily thoracic irradiation (total 45 Gy) was given. Prophylactic cranial irradiation was given to the patients who showed complete remission after concurrent chemoradiotherapy. Restaging was done after second and sixth cycle with chest CT and/or bronchosocpy. RESULTS: Up to November 2004, 19 patients were assessable. The median follow-up time was 12.5 months. A total of 99 cycles (median 5.2 cycles per patient) were administered. The actual dose intensity values were cisplatin 19.6 mg/m2/week and irinotecan 38.2 mg/m2/week. Among the 19 patients, the objective response rate was 95% (19 patients), with 9 patients (47%) having a complete response (CR). The major grade 3/4 hematological toxicities were neutropenia (35% of cycles), anemia (7% of cycles), thrombocytopenia (7% of cycles). Febrile neutropenia was 4% of cycles. The predominant grade 3/4 non-hematological toxicities was diarrhea (5% of cycles). Toxicities was not significantly different with concurrent administration of irinotecan and cisplatin with radiotherapy, except grade 3/4 radiation esophagitis (10% of patients). No treatment-related deaths were observed. The 1-year and 2-year survival rate of eligible patients was 89% (16/18) and 47% (9/18), respectively. CONCLUSION: Three-week schedule of irinotecan plus cisplatin followed by concurrent IP plus hyperfractionated thoracic radiotherapy is an effective treatment for limited disease small-cell lung cancer, with acceptable toxicity.

Phase II Study of Induction Irinotecan + Cisplatin Chemotherapy Followed by Concurrent Irinotecan + Cisplatin Plus Twice-Daily Thoracic Radiotherapy / 결핵및호흡기질환

BACKGROUND: Irinotecan hydrochloride, a topoisomerase I inhibitor, is effective against small-cell lung cancer. Irinotecan also can act as a potential radiation sensitizer along with cisplatin. To evaluate efficacy and toxicity of irinotecan plus cisplatin (IP) with concurrent thoracic radiotherapy, we conducted a phase II study of IP followed by concurrent IP plus hyperfractionated thoracic radiotherapy in patients with previously untreated limited-stage small-cell lung cancer. METHODS: Twenty-four patients with previously untreated small-cell lung cancer were enrolled onto the study since November 2004. Irinotecan 60 mg/m2 was administered intravenously on days 1 and 8 in combination with cisplatin 60 mg/m2 on day1 every 21 days. From the first day of third cycle, twice-daily thoracic irradiation (total 45 Gy) was given. Prophylactic cranial irradiation was given to the patients who showed complete remission after concurrent chemoradiotherapy. Restaging was done after second and sixth cycle with chest CT and/or bronchosocpy. RESULTS: Up to November 2004, 19 patients were assessable. The median follow-up time was 12.5 months. A total of 99 cycles (median 5.2 cycles per patient) were administered. The actual dose intensity values were cisplatin 19.6 mg/m2/week and irinotecan 38.2 mg/m2/week. Among the 19 patients, the objective response rate was 95% (19 patients), with 9 patients (47%) having a complete response (CR). The major grade 3/4 hematological toxicities were neutropenia (35% of cycles), anemia (7% of cycles), thrombocytopenia (7% of cycles). Febrile neutropenia was 4% of cycles. The predominant grade 3/4 non-hematological toxicities was diarrhea (5% of cycles). Toxicities was not significantly different with concurrent administration of irinotecan and cisplatin with radiotherapy, except grade 3/4 radiation esophagitis (10% of patients). No treatment-related deaths were observed. The 1-year and 2-year survival rate of eligible patients was 89% (16/18) and 47% (9/18), respectively. CONCLUSION: Three-week schedule of irinotecan plus cisplatin followed by concurrent IP plus hyperfractionated thoracic radiotherapy is an effective treatment for limited disease small-cell lung cancer, with acceptable toxicity.

Genistein Supplementation Inhibits Atherosclerosis with Stabilization of the Lesions in Hypercholesterolemic Rabbits

The effect of genistein on aortic atherosclerosis was studied by immunohistochemistry with RAM-11 and HHF-35 antibodies and western blotting for matrix metalloproteinase-3 (MMP-3) in New Zealand White rabbits. After provocation of atherosclerosis with hyperlipidemic diet, the rabbits were divided as hyperlipidemic diet group (HD), normal diet group (ND) and hyperlipidemic plus genistein diet group (HD+genistein) for 4 and half months. The average cross sectional area of atherosclerotic lesion was 0.269 mm2 after provocation. The lesion was progressed by continuous hyperlipidemic diet (10.06 mm2) but was increased mildly by genistein (0.997 mm2), and decreased by normal diet (0.228 mm2). The ratio of macrophages to smooth muscle cells in the lesion was not changed by genistein supplementation. The western blotting showed reduction of MMP-3 expression in HD+genistein and ND groups than HD group. The inhibition of atherogenesis by genistein was might be due to improve the endothelial dysfunction rather than direct action on macrophages and/or smooth muscle cells in the lesion, since endothelial dysfunction by lipid peroxidation was the main atherogenic factor in the hypercholesterolemicrabbits. The genistein supplementation also suggests that it helps the stabilization of the atherosclerotic lesion by inhibition of MMP-3 expression.

Correlation among Magnetic Resonance Images, Electron Microscopic Findings, Light Microscopic Findings and Clinical Symptom of the Degeneration of Lumbar Intervertebral Disc / 대한척추외과학회지

STUDY DESIGN: A retrospective study was performed in patients who had undergone any operation with removal of lumbar intervertebral disc at Chungnam National University Hospital. OBJECTIVES: To evaluate relationship among magnetic resonance image, electron microscopic findings, light microscopic findings and clinical symptoms in degenerated intervertebral disc. SUMMARY OF LITERATURE REVIEW: Degenerative changes and disc herniations in the intervertebral disc have been shown to be accompanied by changes in the water and proteoglycan content of the tissue. MATERIALS AND METHODS: Our study followed by any operation with removal of intervertebral disc was carried out on 60 patients at Chungnam National University Hospital from January 1998 to December 1999. In radiographic evaluation we used a criteria from Frymoyer. In clinical evaluation we classified clinical symptom according to scale of Kirkaldy-Willis. And we classified of electron microscopic findings into five grades according to degrees of denudation of proteoglycan from hyalunonic acid. In light microscopic findings, we classified by cell nest formation, noevascularization and amount of muccopolysaccharide. RESULTS: In radiologic evaluation there were 11 cases in grade III, 28 cases in grade IV, and 21 cases in grade V. There were no grade I, II in our study. In clinical symptom, there were 20 cases in Good, 18 cases in Fair, and 22 cases in Poor. In electron micro-scopic findings, there were 4 cases in grade 3, 35 cases in grade 4, and 21 cases in grade 5. There were no grade I, II in this study. There was a relationship between magnetic resonance image and electron microscopic findings and clinical symptom (p<0.05). CONCLUSION Our study of electron microscopic findings of degenerated intervertebral disc may be a help to understand of pathogenesis of disc prolapse.

Association of castration-dependent early induction of c-myc expression with a cell proliferation of the ventral prostate gland in rat

The protooncogene c-myc is known to be associated with both cell proliferation and apoptosis. The possible cellular affects of castration on the ventral prostate gland of rat as well as the relationship to a castration induced c-myc expression were examined. Levels of c-myc mRNA in the ventral prostate gland peaked at 6 h (early induction) and 48 h (late induction) after castration, respectively. Castration-induced DNA fragmentation was not observed at an early induction of c-myc mRNA. DNA fragmentation appeared to be testosterone-dependent. On the other hand, cellular DNA synthesis measured by [3H]thymidine uptake in the ventral prostate gland was increased to maximum at 6 h after castration. These results suggest that an early induction of c-myc mRNA in ventral prostate gland after castration is closely associated with cell proliferation of the gland.

Inhibition of expression of P-selectin by antioxidant in cholesterol-fed rats

Butylated hydroxytoluene (BHT) can inhibit experimental atherosclerosis in animals. Although the agent is an antioxidant, the exact mechanism of the reaction in atherosclerosis is still unknown. To investigate the effects of BHT on expression of P-selectin (PADGEM, GMP-140), intercellular adhesion molecule-1 (ICAM-1) and class II MHC (Ia) antigen, we proposed an experiment on rats. Male rats (n=18 per group) were fed either a normal cholesterol control diet, a normal cholesterol diet containing 0.5% BHT (BD), a high cholesterol diet containing 1.5% cholesterol and 0.1% sodium cholate (CD), or the CD diet containing 0.5% BHT (BCD). Rats were sacrificed after 3 days, and after 1, 2, 4, 10, and 17 weeks of dietary treatment. Although there was no gross or light microscopic atherosclerotic lesions, scanning electron microscopy revealed monocytic adhesion to aortic endothelium and mild endothelial injuries in CD and BCD groups. Immunohistochemically, the addition of BHT to a high cholesterol diet inhibited P-selectin expression but not in ICAM-1 and Ia antigen. These findings suggest that in rats, high cholesterol diets induce expression of ICAM-1, P-selectin and Ia antigen. In addition, the antiatherogenic effect of BHT may play a role in the inhibition of P-selectin.

Common Arterial Trunk: Report of Five Atopsied Cases

The common arterial trunk is a congenital cardiovascular malformation in which one arterial trunk gives origin to the aortic arch, pulmonary and coronary arteries. Other cardiovascular malformations are often associated, such as ventricular septal defect, aortic arch interruption, patent arterial duct and so on. During the early period of life, the persistence of the increased pulmonary arteriolar resistance results in cyanosis. As the pulmonary vascular resistance decreases, the cyanosis disappears but signs of congestive heart failure become the main problems. We report five cases of common arterial trunk that was confirmed by autopsy at Chungnam National University Hospital, Seoul National University Hospital, and Yonsei University Severance Hospital between 1983 and 1995. The ages of these patients at autopsy were 8-28 days and four of them were male. Pulmonary arteries arose as a pulmonary trunk in two cases but three cases showed two arteries arising separately from the posterior wall of the common trunk. The type of ventricular septal defect was juxtatruncal in every case. All five cases had three leaflet truncal valves but three cases showed dysplasia of the leaflets. Interruption of aortic arch was associated in two cases. The cause of death was renal failure in two cases, cardiac failure after corrective surgery in two cases, and pulmonary edema and failure in one case.

Endoscopic Review of Early Gastric Cancer / 대한소화기내시경학회지

In order to decide on appropriate treatment strategy against gastric cancer, an accurate preoperative evaluation of the depth of cancer invasion is essential. We studied 165 cases(19%) of early gastric cancer among 706 cases of gastric cancer. resected over a 6 year period. A retrospective study of early gastric cancer was done to evaluate the endoscopic accuracy and lymph node metastasis status, the following results were obtained: 1) The proportion of EGC according to macroscopic type was 68.5% of depressed type(II, III, IIa+III, IIc+III, III+IIc, IIb+IIc), 26% of elevated type(I, IIa, IIa+ IIb, IIa+IIc), 5.5% of flat type(IIb). 2) In the view of accuracy of endoscopic diagnosis, the rate of accurate diagnosis suitable for postoperative macroscopic type was 37.5%, the rate of unsuitable typed EGC was 33.3%, overestimation(diagnosed to AGC) was 20.6% and underestimation(diagnosed to benign diseases)was 8.6%. Overall accuracy of endoscopic diagnosis was 70.8%. 3) The cases confined to the mucosa were 40.6% and others were submucosal cancers(59.4%). 4) Positive lymph node metastasis was found in 1.5% of M-cancer and 18.4% of SM-cancer(overall 11.5%). 5) Node positive rate of differentiated cancer was 10.5%, undifferentiated carcinoma was 15.4%. There was no signficant difference in frequency of nodal metastasis according tumor size and macroscopic type. 6) Tumors which satisfy the following criteria may not metastasize to lymph nodes:(1) confined to the mucosa; (2) less than 2.0cm in diameter; (3) macroscopically elevated or flat; (4) histologically well or moderately differentiated.

Effect of Eicosapentaenioc acid and Butyrated hydroxyanisole on Hypercholestrolemic Diet Induced Atherogenesis in Rabbit

It has been suggested that the fish oil can reduce atherogenesis in humans and animals, and that peroxidation of lipoproteins may be a major factor causing atherosclerotic lesions. We tested these posibilities in rabbits fed an atherogenic diet by comparing the effect of a eicosapentaenoic acid(EPA: a major component of fish oil)supplement and a butyrated hydroxyanisole(BHA: antioxidant)diet supplement. Tweenty-eight young male New Zealand White rabbits were used in this study. The animals were divided by control, cholesterol fed only, cholesterol + EPA, and cholesterol + BHA groups. The experimental course lasted 12 weeks and animals were sacrificed periodically(2, 5, 8, 12weeks)for quantitative studies of aortic atherosclerosis using light and electron microscopy. Plasma cholesterol levels were determined and lipopreteins were separated periodically. The cholesterol fed only group showed an increased serum cholseterol level and atherosclerotic lesions from 5 weeks of experiments. The EPA supplement resulted in similiar serum cholesterol levels with cholesterol fed only group, but greater lesion than cholesterol fed only group. The BHA supplement resulted in higher serum cholesterol levels except VLDL-cholesterol than EPA supplement group. However, the atherosclerotic lesion was not increased. Our studies support the theory that oxidative modification of lipoproteins is important for the atherogenesis and antioxidant may have a protective effect. However, it failed to show antiatherogenesis effect of fish oil.

Endodermal Sinus Tumor of the Orbit

An endodermal sinus tumor is a malignant germ cell tumor that usually arises in the gonads, but on rare occasion occurs in extragonadal locations. Our case was that of a 3 year old girl who complained of a rapid growing orbital mass. On histologic examination it revealed the typical picture of an endodermal sinus tumor and it also disclosed a positive reaction for alphafetoprotein using an immunoperoxidase technique. An orbital exenteration was performed followed by chemotheraphy, but the patient died 5 months after the onset of the disease.