Gonadal Tumors Developed from Consecutively Transplanted Spleens Bearing Gonad Implants

This study was conducted by consecutively transplanting spleens, which had gonads implanted previously. A total of 84 cases for infantile testicles and 106 cases for ovarian follicles were performed. In the case of ovarian implants, the results were determined by the total number of follicle implants. A modified spleen transplantation technique called double implantation of ovarian follicles was applied to increase the amount of the implants. In this technique, an extra spleen is implanted into the potential donor so that the ovarian follicles can be implanted to two different spleens, doubling the amount of implants. Through consecutive spleen transplantation, we observed the results beyond a typical rat's life span. In many of these cases, we found more aggressive forms of malignant tumor, seminoma and dysgerminoma. We present the results and discuss possible pathogenic mechanisms of tumor formation.

Vanishing Pancreatic Grafts

Comparison of pancreaticoduodenal transplants (PDT) and duct-ligated pancreas transplant (DLPT) were performed using syngeneic and allogeneic studies in rats. Both DLPT and PDT allogeneic grafts showed mild rejection. DLPT groups showed disorganized pathology and acini replaced by fat. Eventually, massive fibrosis was seen in the Islets of Langerhans, as well as rejection cellular infiltrates. In both PDT groups, normal histology was observed in the same period. Thus the effect of duct occlusion is highly detrimental for the grafts.

Adenoid Cystic Carcinoma of the Male Breast: A case report

A 65 year-old male patient presented with a large palpable mass beneath the areola of the right breast for 7 years. The resected breast tissue was almost totally replaced by a round large solid mass (9 6 cm) with a pink-gray to yellow firm, partly nodular cut surface. Microscopically, the tumor revealed the diagnostic biphasic cellular pattern of adenoid cystic carcinoma, which consisted of both cribriform pattern of myoepithelial cells and tubular pattern of epithelial cells. On immunohistochemistry, the tumor revealed immunoreactivities for alpha-smooth muscle actin and S-100 protein in the myoepithelial cells and for AE1/AE3 in the epithelial cells. Mitoses were scarce. Multifocal lymphatic permeation and foci of perineural invasion were also found. Underlying resection margins and overlying skin were invaded by the tumor. We diagnosed this tumor as grade II adenoid cystic carcinoma according to the system utilized for the salivary gland tumors.

Nonobstetric Surgery during Pregnancy

BACKGROUND: Nonobstertic surgery during pregnancy needs special considerations by the surgeon in relation to the maternal and the fetal outcomes. Although there are many studies about appendicitis in pregnant women, nonobstetric surgery, in general, during pregnancy has not been sufficiently analyzed. In this clinical study, we reviewed the incidences of nonobstetric surgical diseases during pregnancy and observed the maternal and the fetal outcomes of surgery, including the effects of anesthesia and antibiotics. METHODS: We retrospectively analyzed 80 patients who were pregnant at the time of operation and who had undergone operations during an 11-year period from March 1986 to April 1997 at Shinchon- and Inchon-Severance Hospital. The distributions of age, disease, and delivery history were analyzed, and the diagnostic characteristics, and the fetal and the maternal outcomes were observed with respect to anesthesia and antibiotic usage. RESULTS: The average age of the patients was 32, and 53% of the patients were over 30. The numbers of patients in the first, the second, and the third trimester were 24 (30%), 36 (45%) and 20 (25%), respectively. The most frequent surgical disease was appendicitis with 52 patients (65%). The average duration of hospitalization was 14.4 days. Twenty-two patients (27.5%) had postoperative preterm labor and were successfully managed with tocolytic agents except for one preterm delivery. The total number of preterm deliveries was 10 (12.5%), and still birth occurred in 3 cases (3.8%). The cases of still birth involved severe original diseases, such as rectal carcinomas, pancreatic carcinomas, and sepsis. Among the antibiotics that were used during surgical care, monotherapy with ampicillin was the most frequently used mode. The incidence frequencies of delivery complications according to the used antibiotics were not significantly different from each other. General endotracheal anesthesia was used in 40 cases, spinal and epidural anesthesia was inducted in 25 and 13 cases, respectively. The incidences of fetal complications according to the methods of was administering anesthesia were not significantly different. CONCLUSIONS: The maternal and the fetal risks of nonobstetric surgery during pregnancy depend on the risk of the original surgical disease of the patient. Modes of anesthesia or antibiotic usage do not increase the incidences of obstetric complications.

Tacrolimus(FK-506) Nephrotoxicity and the Effect of alpha-Tocopherol in the Rat Renal Isograft / 대한이식학회지

There have been many reports about oxygen free radical injury as a pathogenetic mechanism of CyA nephrotoxicity, but few reports have investigated the relationship between Tacrolimus(FK-506) nephrotoxicity and oxygen free radical injury. Therefore, we decided to evaluate the relationship between Tacrolimus nephrotoxicity and oxygen free radicals, to examine the protective effect of alpha-tocopherol as an antioxidant, and finally to determine the histological changes of these injuries. En bloc resection of the left kidney, left renal artery including a portion of aorta, left renal vein with vena cava, and left ureter including a portion of bladder from male Lewis rats was done, and then preserved in UW solution and stored in the refrigerator at 4oC for 24 hours. After right nephrectomy in the recipients, the harvested organs were transplanted into the right peritoneal cavity using end-to-side anastomoses of the aorta and inferior vena cava between the recipient and donor under a microscope. Also, end-to-end anastomosis of the partly-resected bladders was made between the recipient and donor. After transplantations, rats were divided into 4 groups(I~IV). 2 mg of Tacrolimus per kilogram body weight was injected intramuscularly daily into groups II and III. alpha-Tocopherol was injected intraperitoneally daily in the amount of 20 mg/kg from 2 days prior to transplantation in groups III and IV. The control group(I) received the same amount of saline. 5 or 6 rats from each group were sacrificed at 3 days, 7 days, and 14 days after transplantation, respectively. The grafted and native kidneys were removed for histopathologic examination and the measurement of malondialdehyde(MDA) using a modified TBA method(Ohkawa). Both morphologic renal tubular injury and the increase of MDA due to cold ischemia-reperfusion were highest at 3 days after transplantation, then were alleviated after 7 days. The inhibitory effect of alpha-tocopherol to renal tubular damage from cold ischemia-reperfusion began to appear after 1 week, and was distinct 2 weeks after transplantation. The degree of renal tubular damage was the most severe in Tacrolimus nephrotoxicity, and the frequency of tubulointerstitial nephritis increased with the passage of time, as compared with the ischemia-reperfusion injury(group I). With alpha-tocopherol treatment, ischemia-reperfusion injury as well as Tacrolimus nephrotoxicity was decreased or healed 2 weeks after transplantation, and the amount of MDA was markedly decreased after 1 week. In summary, Tacrolimus nephrotoxicity prolonged the duration of acute tubular necrosis and caused tubulointerstitial nephritis in the rat renal isograft model, which may be the result of aggravation of ischemia-reperfusion injury. That the renal damage due to cold ischemia-reperfusion and Tacrolimus administration was reduced by alpha- tocopherol, indicates that oxidative injury is a pathogenetic mechanism of Tacrolimus nephrotoxicity in this model.

Tacrolimus(FK-506) Nephrotoxicity and the Effect of alpha-Tocopherol in the Rat Renal Isograft / 대한이식학회지

There have been many reports about oxygen free radical injury as a pathogenetic mechanism of CyA nephrotoxicity, but few reports have investigated the relationship between Tacrolimus(FK-506) nephrotoxicity and oxygen free radical injury. Therefore, we decided to evaluate the relationship between Tacrolimus nephrotoxicity and oxygen free radicals, to examine the protective effect of alpha-tocopherol as an antioxidant, and finally to determine the histological changes of these injuries. En bloc resection of the left kidney, left renal artery including a portion of aorta, left renal vein with vena cava, and left ureter including a portion of bladder from male Lewis rats was done, and then preserved in UW solution and stored in the refrigerator at 4oC for 24 hours. After right nephrectomy in the recipients, the harvested organs were transplanted into the right peritoneal cavity using end-to-side anastomoses of the aorta and inferior vena cava between the recipient and donor under a microscope. Also, end-to-end anastomosis of the partly-resected bladders was made between the recipient and donor. After transplantations, rats were divided into 4 groups(I~IV). 2 mg of Tacrolimus per kilogram body weight was injected intramuscularly daily into groups II and III. alpha-Tocopherol was injected intraperitoneally daily in the amount of 20 mg/kg from 2 days prior to transplantation in groups III and IV. The control group(I) received the same amount of saline. 5 or 6 rats from each group were sacrificed at 3 days, 7 days, and 14 days after transplantation, respectively. The grafted and native kidneys were removed for histopathologic examination and the measurement of malondialdehyde(MDA) using a modified TBA method(Ohkawa). Both morphologic renal tubular injury and the increase of MDA due to cold ischemia-reperfusion were highest at 3 days after transplantation, then were alleviated after 7 days. The inhibitory effect of alpha-tocopherol to renal tubular damage from cold ischemia-reperfusion began to appear after 1 week, and was distinct 2 weeks after transplantation. The degree of renal tubular damage was the most severe in Tacrolimus nephrotoxicity, and the frequency of tubulointerstitial nephritis increased with the passage of time, as compared with the ischemia-reperfusion injury(group I). With alpha-tocopherol treatment, ischemia-reperfusion injury as well as Tacrolimus nephrotoxicity was decreased or healed 2 weeks after transplantation, and the amount of MDA was markedly decreased after 1 week. In summary, Tacrolimus nephrotoxicity prolonged the duration of acute tubular necrosis and caused tubulointerstitial nephritis in the rat renal isograft model, which may be the result of aggravation of ischemia-reperfusion injury. That the renal damage due to cold ischemia-reperfusion and Tacrolimus administration was reduced by alpha- tocopherol, indicates that oxidative injury is a pathogenetic mechanism of Tacrolimus nephrotoxicity in this model.

Vascular Endothelin, TGF-beta and PDGF Expression in FK506 Nephrotoxicity of Rats / 대한이식학회지

The vascular lesions in FK506 nephrotoxicity are similar to cyclosporine A, in which mediators related to vascular constriction and thickening such as endothelin, TGF-beta and PDGF may have some roles. Their expressions may be different in terms of degree and time sequence as well as overlapping ischemia, which made us to perform this experiment. Male Sprague Dawley rats received FK506 daily at a dosage of 2 mg/kg by intramuscular route for 4 weeks at maximum and were sacrificed 3 days, 1, 2 and 4 weeks after the initiation of the study, respectively. The control rats received saline. Renal ischemia was induced by occluding the left renal artery for 45 minutes and rats were sacrificed up to 2 weeks after reperfusion. Kidneys were processed for light microscopy and stained with PAS method and with antibodies against endothelin, TGF-beta and PDGF. The number of juxtaglomerular apparatus(JGA) and arterioles positive for each antibody was counted under light microscope and was expressed as mean +/- S.D per mm2 cortex. In FK506 treated rats, JGA and afferent arterioles were prominent with PAS positive granules, which was extended proximally to interlobular arteries with increased duration of FK506 treatment. With increasing duration, TGF-beta reactivity was increased in afferent arterioles. However, no such results were shown in cases of PDGF and endothelin. Renal ischemia itself increased vascular TGF-beta as well as endothelin and PDGF reactivities. Renal ischemia in FK506 treated rats further upregulated the expression of these markers in a similar distribution. However, the expression of endothelin was mostly found in endothelial cells of peritubular and glomerular capillaries. PAS staining was decreased in ischemic kidneys regardless of FK506 treatment. These results indicate that FK506 toxicity was comparable to CsA toxicity. Since expression levels of endothelin, TGF-beta and PDGF were increased in ischemic kidney, it might be helpful to prevent ischemic damage as well as to hinder secretion of these factors in order to reduce FK506 nephrotoxicity.

Primary Intestinal Lymphoma Treatment Results and prognostic Factors in 52 Cases / 대한암학회지

PURPOSE: In spite of many published reports about the primary gastrointcstinal lymphoma in Korea, the majority of them unfortunately involved a small number of patients with diverse results conceming treatment, patient survival, and prognostic factors. There also were few reports mainly focusing on primary intestinal lymphoma alone. Therefore we studied the patient-survival and prognostic factors in 52 cases of intestinal lymphomas. MATERIALS AND METHODS: We reviewed fifty two patients who received treatment due to primary intestinal lymphoma at Severance hospital, from January 1980 to June 1995. RESULTS: The intestinal lymphomas were located in descending order of frequency at the terminal ileum, i1eocecal region, right colon, and the jejunum. The most common histologic type was diffuse large cell type and the majority showed an intermediate grade of differentiation. The average survival time was 40.7 months with a 5 year survival rate of 41.4%. The overall and complete remission rate of the intestinal lymphoma were 76.2%, 64.3%, respectively. Additional chemotherapy or radiotherapy to surgery improved remission rate. The overall 5 year survival rates were 50.4%, 47.3%, 33.3%, and 25.0% in stage I, II1, II2 and III~IV, respectively. The 5 year survival rate after curative resection was 57.0% and 16.6% after incomplete resection. The significant prognostic factors were residual tumor, site of the lesion, multiplicity, and adjacent organ invasion. However, the site of the lesion alone (worst in the jejunum) was the sole independent variable on multivariate analysis. CONCLUSION: We concluded that early diagnosis and curative resection were important to improve survival rates in the primary intestinal lymphoma. More number of such cases are needed for further comparison of various treatment methods and results.

Controlled Gastrostomy & Omental Patch for a Aifficult Case in Peptic Ulcer Perforation: A case report

If peptic ulcer perforates in the presence of shock or concurrent medical disease or delay of operation, the postoperative morbidity and mortality are high. Years ago most discussion was on whether urgent definite surgery was the most effect therapy, nowadays there is a tendency to less invasive measures in risk situation. Although the simple closure or omental patching has its weak point of high frequency of symptomatic relapse, it is a simple and safe method with the advantage of having a low complication rate than other definite operations. So many surgeons frequently use this simple method in high risk situation. But in the rare instance of large perforation of prepyloric ulcer, this simple closure method is not safe to apply. The authors experienced an unusual case of large prepyloric ulcer perforation in an 80 year old female who had undergone a previous operation(choledocho-duodenostomy). Moreover she had suffered from several concurrent medical diseases and the operation was delayed. We succeeded in repairing the perforation using controlled gastrostomy and omental patching method, and present this case with a review of the literature.

Renal Ischemia/Reperfusion Injury and Cyclosporine Nephrotoxicity in the Rat Renal Isograft Model: A Pilot Study / 대한이식학회지

Renal allografts frequently suffer from ischemia/reperfusion injury, which is a major cause of delayed graft function in renal transplantation(Tx). Cyclosporine(CsA) is known to aggravate ischemic injury, which may further heighten graft dysfunction. To know the histopathologic features of renal ischemic/reperfusion injury and cyclosporoine nephrotoxicity, we performed renal Tx between Lewis rats with cold ischemia and with/without CsA. Rats were sacrificed 3, 5, 7 days, 2, 3 and 4 weeks post-Tx. Control rats received sham operation. The kidney was processed for light microscopy and stained with H-E, PAS. Furthermore, to know the distribution of thioredoxin peroxidase(TPx), a recently cloned antioxidant in this model, the kidney tissue was stained with antibodies against three subtypes of TPx; NKEF-A /PAG(TPx A), NKEF-B/TPx(TPx B) and Mer 5. Renal isografts showed acute tubular necrosis from 3 days and recovery by 7 days, which was prolonged in CsA treated rats with signs of tubular and vascular toxicity. In sham operated rats, TPx A was distributed in all tubular segments, most prominently in distal tubules(DT). TPx B was stained in DT and collecting ducts(CD) exclusively. Mer 5 was present mainly in S3 segment. Glomerular or vascular expression was not found. In isografts TPx A expression was increased in both proximal(PT) and DT, markedly in the nonnecrotic S1 segment till 1 week postTx and returned to normal pattern by 2 weeks. TPx B and Mer 5 expression were increased till 5 days postTx with stronger staining in DT than in PT. CsA sustained the tubular expression of TPx till 4 weeks postTx. In summary, TPx expression was increased in renal tubules of rat renal isografts suffering cold ischemia, and more prolonged with CsA therapy. Marked increase of TPx A expression in S1 segment of ischemic kidneys may indicate resistance against oxidant injury, especially in S1 segment.

Granular Cell Tumor of the Presacral Space: A Case Report

Granular cell tumors are rare lesions of probable Schwann cell origin and are composed of oval to fusiform cells with abundant granular eosinophilic cytoplasm. We report ultrasonography, barium enema, computed tomography and magnetic resonance imaging findings in a case of granuar cell tumor in the presacral space in a 34-year-old woman.