Factors Associated with Depressive Symptom in Chronic Obstructive Pulmonary Disease Based on the Third (2005) and Fourth (2008) Korea National Health and Nutritional Examination Survey (KNHANES III, IV) / 가정의학회지

BACKGROUND: Depressive symptoms accompanied by chronic obstructive pulmonary disease (COPD) can be influenced by socioeconomic status, associated chronic diseases and the current smoking status. This study was conducted to assess factors that are associated with depressive symptoms accompanied by COPD, using the data obtained from the Korea National Health and Nutritional Survey (KNHANES) conducted in 2005 and 2008. METHODS: From the third (2005) and the fourth (2008) KNHANES, 407 (0.9%) with physician-diagnosed COPD were selected. Of the 407 subjects, only 180 (0.4%) who reported having depressive symptoms were included in this study. The associations of depressive symptoms with socioeconomic status, associated chronic diseases and smoking status were investigated. RESULTS: Of the total 180 subjects, 45 (25%) had depressive symptoms. There were 102 males (55%) and 78 females (45%) with a slight predilection for males. In multivariate analysis, significant predictors of depressive symptoms were dependent activities of daily living (odds ratio [OR], 2.42; 95% confidence interval [CI], 2.06 to 2.84) and association with number of chronic diseases (OR of one, two, and three, 1.40, 1.72, 2.60; 95% CI of one, two, and three, 1.20 to 1.63,1.41 to 2.10,1.99 to 3.39). CONCLUSION: This study provides the basis for managing COPD patients in a clinical setting by understanding the number and characteristics of COPD patients with depressive symptoms. The results of this study suggest that primary physicians should manage COPD patients with consideration of risk factors for depressive symptom.

A Case of Primary Hepatic B-cell Lymphoma of Mucosa-associated Lymphoid Tissue (MALT)-Type

Mucosa-associated lymphoid tissue (MALT) lymphoma is a low grade B cell lymphoma that, occurs in numerous sites including the stomach, ocular adnexa, thyroid, lung and breast; however, primary hepatic lymphoma is extremely rare. Only about 20 cases have been reported world wide. We recently experienced a case of primary hepatic B-cell lymphoma of the MALT type in a 63-year old female patient. She presented with abdominal pain. The CT, ultrasonogram and PET-CT showed a hepatic nodular mass. A biopsy specimen of the liver revealed MALT lymphoma. There was no evidence of the lymphoma in the extrahepatic lesion. She received segmentectomy of liver and was then treated with CVP (cyclophosphamide, vincristine and prednisolone) chemotherapy. She has been followed up for 6 months since the therapy, and she remains asymptomatic.

pH-mediated Regulation of Pacemaker Activity in Cultured Interstitial Cells of Cajal

Interstitial cells of Cajal (ICCs) are pacemakers in gastrointestinal tracts, regulating rhythmicity by activating nonselective cation channels (NSCCs). In the present study, we investigated the general characteristics and pH-mediated regulation of pacemaker activity in cultured interstitial cells of Cajal. Under voltage clamp mode and at the holding potential of -60 mV, the I-V relationships and difference current showed that there was no reversal potential and voltage-independent inward current. Also, when the holding potentials were changed from +20 mV to -80 mV with intervals of 20 mV, there was little difference in inward current. In pacemaker activity, the resting membrane potential (RMP) was depolarized (In pH 5.5, 23+/-1.5 mV depolarized) and the amplitude was decreased by a decrease of the extracellular pH. However, in case of increase of extracellular pH, the RMP was slightly hyperpolarized and the amplitude was decreased a little. The melastatin type transient receptor potential (TRPM) channel 7 has been suggested to be required for intestinal pacemaking activity. TRPM7 produced large outward currents and small inward currents by voltage ramps, ranging from +100 to -100 mV from a holding potential of -60 mV. The inward current of TRPM7 was dramatically increased by a decrease in the extracellular pH. At pH 4.0, the average inward current amplitude measured at -100 mV was increased by about 7 fold, compared with the current amplitude at pH 7.4. Changes in the outward current (measured at +100 mV) were much smaller than those of the inward current. These results indicate that the resting membrane potential of pacemaking activity might be depolarized by external acidic pH through TRPM7 that is required for intestinal pacemaking activity.

A Case of Mantle Cell Lymphoma Presenting as Multiple Lymphomatous Polyposis Involving Skeletal Muscles / 대한소화기내시경학회지

Multiple lymphomatous polyposis (MLP) is an uncommon type of primary non-Hodgkin's gastrointestinal B cell-lymphoma characterized by the presence of multiple lymphomatous polyps along the gastrointestinal tract. Unlike MALT-lymphoma, MLP has a strong tendency for histologically monomorphic character, extra-digestive localization, rare lymphoepithelial lesion and poor prognosis. The malignant cells of MLP share morphological, immunohistologic and cytogenetic similarities with cells of node-based mantle cell lymphoma. We report a case of mantle cell lymphoma presenting with MLP involving various segments of the gastrointestinal tract, skeletal muscles of the right thigh and bone marrow observed in a 71-year-old woman who complained of lower abdominal pain and a palpable right thigh mass.

A case of relapsed renal plasmacytoma after complete remission of multiple myeloma / 대한내과학회지

Extramedullary plasmacytoma is a rare presentation of plasma cell dyscrasia. Most such tumors arise on the upper aerodigestive tract and renal plasmacytoma is very rare. The patient was 44 years old female presented with a 3 month-history of palpable mass in the right flank. There was a past history of complete remission after a chemotherapy for multiple myeloma (6 cycles of VAD chemotherapy) for the two years following the first diagnosis. After surgical resection, histologic and immunofluorescence studies of resected specimens revealed that the renal parenchyma was destroyed by sheets of mature plasma cells producing monoclonal protein (IgG-lambda) and by deposits of amorphous eosinophilic substance stained with anti-lambda antisera. Treatment with chemotherapy of Hyper-CVAD and local irradiation was done. The patient has been disease-free for 3 months after treatment. We report a case of relapsed renal plasmacytoma after complete remission of multiple myeloma.

A Case of Cavernous Hemangioma of the Pyriform Sinus / 대한이비인후과학회지

Approximately 60% of all hemangiomas occur in the head and neck region, but hypopharyngeal hemangiomas are very rare. The diagnoses were classified depending on histopathologic findings into cavernous hemangioma, capillary hemangioma and mixed hemangioma. The treatments are sclero theraphy, surgical excision, vascular ligation, cryotheraphy, electrical cautery, ND Yag laser excision, and CO2 laser excision. We have experienced a case of hemangioma in the medial wall of the left pyriform sinus. In our case, we removed it "en bloc" without difficulty with the endoscopic CO2 laser. The histologic diagnosis was a cavernous hemangioma with no evidence of malignancy. One year after surgery, there was no evidence of residual tumors or recurrence. We report this case of cavernous hemangioma in the hypopharynx.

Molecular Diagnosis of Recurrent Thyroid Cancer by Reverse Transcription-Polymerase Chain Reaction of Thyroglobulin Messenger Ribonucleic Acid in Peripheral Blood / 대한내분비학회지

BACKGROUND: Differentiated thyroid cancer is the most common endocrine malignancy. Despite advances in the treatment of thyroid cancer, disease recurrence and metastasis may occur in as many as 20% of patients, and so continues to pose major problems in its clinical management. Serum thyroglobulin (Tg) measurements, by immunoassay, are used to detect residual or recurrent thyroid cancer following thyroid ablation. However, the usefulness of immunoassay is limited by both the requirement for thyroid hormone withdrawal, to attain optimal test sensitivity, and interference by the antithyroglobulin antibody (Anti-Tg Ab). Recent studies have reported the clinical usefulness of reverse transcription-polymerase chain reaction (RT-PCR) detection of Tg mRNA in the peripheral blood of patients with differentiated thyroid carcinomas. We performed this study to evaluate the usefulness RT-PCR of Tg mRNA in peripheral blood of patients with thyroid carcinoma following a total thyroidectomy and radioiodine ablation therapy. METHODS: Forty cases that underwent a total thyroidectomy and radioiodine ablation therapy were included in this study. Of the 40 patients, 35 were papillary carcinomas and 5 were follicular carcinomas. Ten normal control subjects were also studied. Tg mRNA was extracted. Then RT-PCR, and nested RT-PCR, were run with specific Tg primers. Concurrently, DNA sequencing of the isolates was carried out to prove the isolates were identical to the nucleotide sequence of the Tg. RESULTS: The Tg was detected in 4 of 19 patients, with either a residual thyroid bed, or metastasis, on a 131I whole body scan and in 1 of 21 patients with a negative radioiodine scan. Surprisingly, the Tg mRNA was detected in all the patients and normal controls. CONCLUSION: From our results we can not recommend Tg mRNA, detected by RT-PCR in peripheral blood, as a tumor marker superior to that of the Tg serum level. We consider an intensive re-evaluation of the method is required before considering its clinical applications.

Fine Needle Aspiration Cytology of Malignant Myoepithelioma of the Salivary Gland: A Case Report / 대한세포병리학회지

Malignant myoepithelioma (myoepithelial carcinoma), is a very rare malignant epithelial neoplasm accounting for less than 1% of all salivary gland tumors and has an intermediate malignant potential. We report a case of malignant myoepithelioma arising in the left parotid gland in a 54-year-old man, which was difficult to differentiate from pleomorphic adenoma and other malignant salivary gland neoplasms. Fine needle aspiration cytology of the parotid gland showed cellular smear, composed of overlapped sheets and clusters or individually scattered tumor cells without any acinic or ductal structures. The tumor cells were rather uniform, with distinct cell borders and moderate amount of cytoplasm. The eccentrically located nuclei were oval to round and pleomorphic and showed prominent nucleoli. A few clear cells were noted in the cellular aggregates. Metachromatic matrix was seen between individual tumor cells in a lacelike fashion, resembling pleomorphic adenoma. According to the immunohistochemical staining, we recognized that the component cells are myoepithelial in nature, showing reactivity for the S-100 protein, vimentin, and actin.

Myxoglobulosis of the Appendix

Myxoglobulosis is a rare morphologic variant of appendiceal mucocele. We reported herein a case of myxoglobulosis in a 50-year-old man who presented with an appendiceal mass following a several months symptomatic course. Double contrast barium study showed filling defect in cecum. Computed tomograph showed well defined tubular, cystic lesion with slight wall enhancement at the appendiceal area. Laparotomy disclosed a distended appendix, measuring 12.0 4.0 cm, without perforation containing white to pale yellowish globules, reminiscent of parasitic eggs. Microscopically globules are composed of centers of inflamed granulation tissue and amorphous granular necrotic debris, surrounded by rings of inspissated mucous shells. The wall shows devoid of a lining epithelium. We performed ileocecectomy.

Expression of the MAGE-1, -2, -3, -4, -5, and -10 Genes in Thyroid Cancers / 대한내분비학회지

BACKGROUND: MAGE(melanoma antigen gene) has been named as cancer/testis specific antigens since its expression is only detected in the testis or cancer cells. Because of its relatively specific expression in cancer cells, it has been considered as a marker for the early diagnosis of several cancers, or as an appropriate target for a specific immunotherapy mediated by cytotoxic T lymphocytes. Therefore, there have been many reports concerning the expression of MAGE genes in various types of malignant tumors, although only a few reports in human thyroid neoplasms. The purpose of this study was to determine whether the MAGE-1, -2, -3, -4, -5, and -10 genes expressed in different histological types of thyroid tumors and to elucidate the clinical usefulness of MAGE genes on the diagnosis of thyroid tumors. METHODS: Thirty-eight patients who had undergone thyroidectomy at Kosin Medical Center between January and August, 1999 were included in the study. Of the 38 patients enrolled, 26 exhibited papillary carcinoma, 3 papillary carcinoma with lymph node metastasis, 1 follicular carcinoma, 1 medullary carcinoma, 5 nodular hyperplasia, 1 adenomatous goiter, and 1 follicular carcinoma. In the twelve normal control thyroid tissues, total cellular mRNA was extracted from 31 cancer tissues and 7 benign tissues, RT-PCR was run in 35 cycles, with specific primers of the subtypes of MAGE genes. With probes confirmed by DNA sequencing, the isolates were reevaluated by Southern blot hybridization. RESULTS: In the 26 papillary carcinomas, MAGE-1,-2,-3,-4,-5 and -10 genes were expressed in 88.5%, 92.3%, 3.8%, 26.9%, 26.9%, and 0% by RT-PCR respectively. In the three papillary carcinomas with regional lymph node metastasis, MAGE-1, -2 and -5 genes expressed in two of the three, and MAGE-4 in one of the three cases. In the one medullary carcinoma, the MAGE-1,-2,-4, and MAGE-5 genes were expressed, and in the one case of follicular carcinoma, only the MAGE-2 gene was expressed. In contrast, none of the 7 benign tumors and 12 normal control tissues expressed any of these MAGE genes. The sensitivity of MAGE-1,-2,-3,-4,-5 and -10 genes in thyroid tumors was 83.8%, 90.3%, 3%, 29.0%, 32.3%, and 0%, respectively and the specificity was 100%. CONCLUSION: These results demonstrate that MAGE genes were expressed in the malignant thyroid tumors but not in the benign tumors and normal tissues. Among the MAGE gene families, MAGE-1 and -2 genes were more sensitive than MAGE-3, 4,-5 and -10 genes. However, in order to demonstrate if the MAGE genes could be used for the diagnosis of follicular carcinoma and distant metastasis in thyroid tumors, further study is required.

Expression of c-fos, p53, Transforming Growth Factor-beta1 and Glial Fibrillary Acidic Protein in Hippocampus Following Transient Forebrain Ischemia in Mongolian Gerbil

BACKGROUND: Recent studies have shown that delayed neuronal death is closely associated with early gene (c-fos or c-jun)-related apoptosis in addition to hypoxia-induced energy deficiency in the hippocampus. METHODS: To elucidate the role of c-fos, p53, TGF-1 and glial fibrillary acidic protein (GFAP) and their interactions, cellular expression with immunohistochemistry was examined during the time period of 10-minute hypoxia with variable reperfusion intervals in the mongolian gerbil hippocampus. RESULTS: Hippocampal CA1 shows progressive and delayed neuronal damage beginning from the 24-hour reperfusion, while CA2-3 reveals non-progressive, eosinophilic inclusion body within the neuron throughout the time period. CA1 neurons show short-term expressions of c-fos prior to significant cellular damage. However, CA2-3 neurons show persistent expressions by 3-day reperfusion. In both CA1 and CA2-3, p53 is expressed for the short-term period of the early time points. However, its intensity and duration are much less in CA2-3 than in CA1. While TGF-1 is transiently expressed at 24-hour reperfusion in CA1, its expression in CA2-3 is persistent in late time points. Early expression of GFAP is observed in the pyramidal layer of CA1 prior to neuronal damage and progressively increased in the late time points. CONCLUSION: These results suggest that c-fos and TGF-1 may play a role in neuronal viability in the early- and late time points. Astrocytes may also be responsible for the active protective mechanism to neuronal death, as well as reactive gliosis. The hypoxia-induced neuronal damage is, in part, a p53-dependent process in the CA1 neurons.

RECONSTRUCTION OF THE SOFT TISSUE DEFECT OF PELVIS AND GROIN AREA USING RECTUS ABDOMINIS AND GRACILIS MUSCLE FLAP

No abstract available.

HYPOPHARYNGO-ESOPHAGEAL RECONSTRUCTION WITH FREE FLAPS

No abstract available.

Expression of p53, c-myc, Transforming Growth Factor-alpha and -beta in Human Epithelial Ovarian Tumors

The author examined expression of tumor-related antigens, such as p53 tumor supressor protein, c-myc, TGF-alpha, and TGF-beta proteins in 75 cases of surgically resected epithelial ovarian tumors. Peroxidase immunohistochemistry was used to determine the frequency of expression, the relationship among expression of these antigens and histopathological spectrums, and clinical stage, and their potential prognostic significance. The results are summarized as follows. A positive correlation was found between expression of p53(P=0.02), c-myc(P=0.03), and TGF-alpha(P=0.001) and histological degrees of malignancy(benign, borderline, or malignant) in epithelial ovarian tumors. A significant correlation was found between expression of p53 and histological degrees of malignancy in serous ovarian tumors(P=0.003) and mucinous tumors (P=0.049). A significant correlation was also found between expression of c-myc and the histological grade of serous carcinomas(P=0.02). A correlation between expression of these antigenic proteins and clinical stage of epithelial ovarian tumors was not demonstrated. Expression of p53 and c-myc was closely correlated with expression of TGF-alpha irrespective of the histological degrees of malignancy and type of epithelial ovarian tumors(0.4 < or = K < or = 0.7). The results of this study support the ideas that expression of c-myc and TGF-alpha might be a useful prognostic indicator in human ovarian carcinomas, and expression of p53 could be another indicator of prognosis, as the expression of p53 is characteristic in that the expression is mostly seen in invasive ovarian carcinomas.

Clinical Pathology, Catholic University Medical CollegeSynovial Sarcoma Manifested as a Subcutaneous Nodule of Lip: A case report

Synovial sarcoma is one of the most common malignant soft tissue tumors in paraarticular regions. However, it is very rare to occur without any apparent relationship to synovial or articular structures. We report a case of synovial sarcoma manifested as a subcutaneous nodule in the upper lip. A 12-year-old boy complained of a palpable tender mass in the upper lip for several months. Under the impression of a benign soft tissue neoplasm, surgical excision was done. The mass, 1.5 cm in maximum diameter, was easily separated from surrounding tissues. Microscopically, this tumor showed a characteristic biphasic pattern of synovial sarcoma. On immunohistochemical and ultrastructural studies, the tumor cells showed evidence of epithelial differentiation. There was no evidence of joint-related, primary lesions or metastatic foci. This report describes a case of synovial sarcoma arising in very unusual location and size for histologically typical synovial sarcoma.

Epithelioid Hemangioendothelioma of Liver: A case report

Epithelioid hemangioendothelioma of liver is a very rare tumor of vascular origin, the most peculiar feature of which is that it is composed of endothelial cells closely resembling epithelial cells. We present a primary epithelioid hemangioendothelioma of liver in a 40-year-old male. This tumor was composed of an ill-defined yellowish white, 7 x 4cm sized, firm, solid mass and small satellite nodules in the right lobe of liver. Microscopically, two types of tumor cells-dendritic and epithelioid-were identified. The neoplastic cells infiltrated into sinusoids and intrahepatic veins. The background of tumor showed marked sclerotic change and focal proliferation of bile ductules. Confirmation of the endothelial origin of these cells was provided by positive immunoperoxidase staining for factor VIII-related antigen, and by electron mi-croscopic demonstration of Weibel-Palade body. This is the first case of epithelioid heman- gioendothelioma of liver documented in Korea. We report this case in view of its scarcity and distinctive morphologic features that allow differentiation from sclerosing carcinoma and angiosarcoma.