Clinical Significance of Erosive or Ulcerative Lesions Isolated in Terminal Ileum

BACKGROUND/AIMS: Although terminal ileal erosive or ulcerative lesions are frequently observed on colonoscopic examination, their clinical significance are unclear. We evaluated clinical course and significance of isolated terminal ileal erosive or ulcerative lesions. METHODS: We retrospectively analyzed clinical features, number, size and histologic findings of 186 patients with isolated terminal ileal erosive or ulcerative lesions on colonoscopic examination from December 2003 to February 2012. RESULTS: The indications for colonoscopy included screening for colorectal cancer or surveillance in 122 patients (65.6%), evaluations for symptoms in 64 patients (34.4%). Of the 186 patients, 170 underwent biopsy at the terminal ileal lesions. Histologic findings were mostly non-specific chronic inflammation except two cases of Crohn's disease, one case of cytomegalovirus ileitis, and one case of intestinal tuberculosis. Forty six patients underwent follow-up colonoscopy and the mean duration was 17.8+/-14.2 months (range, 1-64 months). Of those who showed non-specific ileitis (44 patients), 35 (79.5%) showed resolution of lesions without specific treatment. In the remaining 9 (20.5%) patients, lesions were continued and two patients were diagnosed as Crohn's disease and Behcet's ileitis, respectively. There were no significant differences in the duration of follow-up, presence of symptoms, number and size of terminal ileal lesions between the patients who resolved and not resolved. CONCLUSIONS: Most isolated terminal ileal erosive or ulcerative lesions reveal non-specific histological findings and have a propensity to resolve without treatment. However, in small portions of patients, isolated terminal ileal lesions need careful attention because it is possible to be early inflammatory bowel diseases.

Clinical Features of Intestinal Tuberculosis in Recent Ten Years (2001-2010)

BACKGROUND/AIMS: Intestinal tuberculosis (ITB) evades early diagnosis due to non-specific clinical manifestations and difficulties in confirming the disease process. In the current study, we determined the diagnostic appearance and clinical manifestations of ITB in recent 10 years according to diagnostic guidelines, as proposed by the IBD Study Group of Korean Association for the Study of the Intestinal Diseases (KASID). METHODS: Fifty-six patients with ITB who were diagnosed at Seoul Paik Hospital between January 2001 and August 2010 were retrospectively reviewed. The diagnosis of ITB was defined as definite or probable in accordance with the diagnostic guidelines and the clinical features were analyzed in comparison with previous studies involving ITB in Korea. RESULTS: The mean age at the time of diagnosis was 45+/-15 years (range, 17-71 years). Definite and probable diagnoses were obtained in 29% and 71% of the patients, respectively. Twenty-three percent of the patients had synchronous active pulmonary TB and 14% of the patients had other forms of abdominal TB, such as TB mesenteric lymphadenitis or peritonitis. The most common symptoms were abdominal pain (43%), followed by diarrhea (30%), weight loss (14%). Twenty-seven percent of the patients (15 cases) were asymptomatic and diagnosed on comprehensive health care or post-operative surveillance. Only 2 patients (3.6%) underwent surgery for complications, such as intestinal obstruction and perforation. CONCLUSIONS: ITB is still prevalent in Korea; however, in the recent 10 years the symptoms of ITB have been milder than previously reported. In addition, the complication rates of ITB were remarkably decreased, suggesting that early diagnosis of ITB was increased.

A Case of Acute Fibrinous and Organizing Pneumonia / 결핵및호흡기질환

Acute fibrinous and organizing pneumonia (AFOP) is a histological pattern consisting of prominent intra-alveolar fibrin and organizing pneumonia, with out hyaline membranes or prominent eosinophilia. The clinical manifestations of AFOP resemble those of acute lung injury such as acute interstitial pneumonia (AIP). However, the classic histological patterns of AFOP differ from diffuse alveolar damage (DAD), bronchiolitis obliterans with organizing pneumonia (BOOP) or acute eosinophilic pneumonia (AEP). The characteristic intra-alveolar fibrin ball and lack of classic hyaline membrane are the predominant histological features of AFOP. Although some reports suggest that its clinical course is less catastrophic than DAD, the clinical entity that distinguishes AFOP from DAD has not been established. We present a case of pathologically demonstrated AFOP in a 79-year-old man. The radiological findings of our case were similar to those of DAD, presented with diffuse bilateral lung infiltrations. However, despite the rapid development of respiratory failure, the patient had a better response and outcome to steroid therapy than what would be expected for DAD.

Comparison of anti-gamma hemoglobin antibody and CD71 antibodies in isolation of fetal nucleated erythrocytes from maternal blood / 대한산부인과학회지

OBJECTIVE: In an attempt to further maximize the potential of genetic analysis from fetal cells isolation, fetal nucleated red blood cell (FNRBC) recovery with direct anti-gamma hemoglobin staining after density gradient and depletion was compared with three different whole blood magnetic separations (1-step and 2-step ferrofluid, 2-step Dynal beads). METHODS: In model systems such as quantitatively defined spikes of fetal into adult blood, as well as blood samples after surgical termination procedures, fetal cell yield and purity through the results of fluorescence in situ hybridization (FISH), quantitative real time polymerase chain reaction (PCR), and fluorescence-activated cell sorting (FACS) were calculated. RESULTS: The yield of total number of cells with a XY signal after FISH was the highest on direct anti-gamma hemoglobin staining. After normalizing the results of each experiment to the corresponding result from anti-gamma hemoglobin staining (1), ratio is 0.42 in 1-step ferrofluid, 0.33 in 2-step ferrofluid, and 0.76 in 2-step dynal beads. The fetal cell purity is clearly better in direct anti-gamma hemoglobin staining than those of the magnetic separations from whole blood. The median ratio is 56.3% in anti-gamma hemoglobin staining, 7.7% in 1-step ferrofluid, 6.5% in 2-step ferrofluid, and 31.4% in 2-step dynal beads. CONCLUSION: This study shows that the direct anti-gamma staining is the best fetal cell recovery system and it is very useful to isolate fetal nucleated red blood cells as a non-invasive genetic source.

Primary Signet Ring Cell Carcinoma of the Lung: A Case Report / 결핵및호흡기질환

Signet ring cell carcinoma (SRCC) of the lung is a rare variant of pulmonary adenocarcinoma. Because the majority of SRCCs seen in the lung are metastatic tumors from stomach, colon, or breast, the differentiation of primary SRCC from metastatic SRCC is important but may be problematic. Recently, immunohistochemical studies are known to be valuable in determining primary sites of SRCC. Herein, we presented a case of primary signet ring cell carcinoma of the lung in a 67-year-old man. Even though radiographic findings of our case were more suggestive of metastatic orgin of SRCC in the lung, we could finally conclude that lung was the primary site of SRCC in this case with the help of immunohistochemical studies (TTF-1 and CK7 positive and CK 20 negative) and other diagnostic work up.

The Modular Concept in the Lateral and Posterior Skull Base Approaches: Anatomico-clinical Study

OBJECTIVE: Despite advance in the surgical treatment of the skull base lesions, reaching the ventral brain stem is not familiar to us yet. No traditional complex skull base approaches have a value not only in treating complex and unusual skull base pathology but also in providing a better and safer exposure to traditional pathology. However, a more widespread use of these complex skull base approaches is predicated on a clear understanding of the topographical areas of the skull base exposed and on how these complex approaches can improve the exposure afforded by more conventional surgical routes. PATIENTS AND METHODS: The study was performed on 43 surgical dissection with 20 embalmed cadevaric heads in which the cephalic vascular system had been injected with colored silicone material. RESULTS AND CONCLUSIONS: This paper provides an visual anatomical understanding of the areas of the skull base exposed by the approaches examined using the same cues(CT and MRI) that the surgeons use in selecting an approach when confronted with a real lesion and makes them to apply to the clinical situations properly and intimately for the optimal treatment. In addition, with the modular concept, the neurosurgeon may better understand how complex skull base approaches are derived and modified from, and improve the exposure of basic, well known conventional neurosurgical approaches as building block.

Outcome of 274 Cases with Prenatal Diagnosis of Congenital Heart Disease: Multicenter Study of Korean Fetal Cardiology Study Group in 1998 / 대한주산의학회잡지

OBJECTIVE: Prenatal diagnosis of congenital heart disease(CHD) has been made by fetal echocardiography and its clinical impact on the outcome of affected cases has been reported. METHODS: A multicenter retrospective study was performed by our study group for the fetal diagnosis of CHD, confirmed postnatally or at second study and/or at autopsy and/or follow up. 274 cases out of 8 centers operating fetal echocardiography in high risk pregnancies were analyzed and their outcome was analyzed according to the presence of associated factors and with respect to the types of the CHD. RESULTS: There were 179 cases of significant CHD, 72 cases of miscellaneous CHD, 23 cases of fetal arrhythmias. Significant CHD consisted of 42 cases of ventricular septal defect(VSD), 17 cases of heterotaxia induding asplenia and polysplenia, 15 cases of complete atrioventricular septal defect(AVSD), 15 cases of coarctation of aorta, 14 cases of hypoplastic left heart syndrome(HLHS), 13 cases of tetralogy of Fallot(TOF), 11 cases of double outlet right ventricle(DORV). These 6 frequent CHDs consisted of 70.9% of significant CHD. The gestational age of the fetuses at diagnosis was 20-41 weeks(83 cases from 5 hospitals: Kangnam and Bundang CHA hospital, Ewha women's university hospital and Samsung medical center). 28.9%(24 out of 83 cases with known gestational age at diagnosis) had been diagnosed before 25 weeks of pregnancy. The most common indication of fetal echocardiography was abnormal obstetric ultrasound findings. Associated extracardiac and chromosomal anomaly was 27.9% and 11.7% respectively. The rate of termination of pregnancy(TOP)/significant CHD was 34.1%. Perinatal mortality was 39.7% induding 61 TOP, 5 fetal death in utero(FDIU), 4 neonatal death and 1 neonatal operative death. The most common factors of TOP were extracardiac and chromosomal anomaly. Five cases of d-transposition of great arteries with intact ventricular septum had been diagnosed prenatally at 3 hospitals, all of them had planned delivery and all survived arterial switch operation in the neonatal period. CONCLUSION: This study represents the impact of fetal echocardiograhpy on the outcome of CHD in Seoul and part of Kyung-Gi area in 1998. The data suggested that significant CHDs could be diagnosed accurately in most hospital But the prenatal detection rates of CHD were relatively low in several hospitil compared to the number of livebirth, probably due to inaccurate prenatal ultrasound screening.

A Case of Adrenal Neuroblastoma Presented with Late Brain Metastasis

Intracranial metastasis from primary extracranial neuroblastoma is rare and parenchymal involvement is even rarer. Its pathogenesis is uncertain and the outcomes from the previous reports during the past several decades indicate a uniformly poor. The operative findings of this case suggest that the neural crest derived tissues providing the appropriate "soil" to support CNS-metastasizing neuroblastoma. We report a case of cerebral metastatic neuroblastoma which has relapsed in adrenal gland and discuss its pathogenesis with review of the literature.

Delivery of the elderly primipara / 대한산부인과학회잡지

No abstract available.

Placetnal Findings of Septic Abortion Caused by Listeria Monocytogenes: A case report

Since human listeriosis was firstly described by Nyfeldt in 1929, Listeria monocytogenes as a cause of septic abortion has been well known. It primarily affects pregnant woman and neonates, the elderly, and persons with immune-system dysfunction due to immunosuppressive drugs, malignant tumors or AIDS. Although several large epidemic listeriosis have been reported in the English literatures, it is still an underdiagnosed and underreported cause of congenital sepsis and septic abortion, because it is not always easy to isolate the organism in culture. There are 17 cases reports of Listeria monocytogenes infection in Korea, however, most of which were described about the bascteriologically proven cases. We describe placental findings of a septic abortion caused by Listeria monocytogenes at 15 weeks gestation in a 23-year-old primigravida woman. Placental examination showed characteristic and relatively specific patterns of granulomatous microabscesses composed of necrotic nuclear debris in the center and surrounding epithelioid histocytes enmeshed in fibrin between the acutely inflamed villi. There were numerous gram positive bacilli on Brown-Brenn stain.