Necrotizing ruptured vaginal leiomyoma mimicking a malignant neoplasm

Leiomyomas are common benign uterine tumors. However, the incidence of vaginal myoma is very rare and may be confused with a variety of vaginal tumors. We report a case of 43-year-old nulligravida who presented with a protruding painful vaginal mass for 7 days. The mass had initially appeared 3 years prior, as 2 to 3 cm that had not subsequently increased. However suddenly, there was rapid severe enlargement over the course of 7 days. Physical exam revealed a monstrous shaped, black color with focal necrosis, odorous protruding vaginal mass about 7 cm in size. The vaginal mass was infected and degenerated. And vaginal wall was also destroyed by the enlarged mass. Because of the clinical features and radiologic findings, the preoperative diagnosis was a vaginal malignancy. We reported an extremely rare case of vaginal myoma that had several characteristics of malignancy, with a brief review of the literature.

The Effects of CD11c/CD18 and CD14 Blocking on Lipopolysaccharide-induced Endotoxemia

We studied the morphologic changes and the expression of cytokines of major organs by blocking CD14 and CD11c/CD18, which are known to be receptors of lipopolysaccharide (LPS), in the LPS induced endotoxemic mice. In 2 and 8 hours after initial intraperitoneal injection of 10 mg/kg of LPS into the mice, 500 microgram/kg of anti-CD14 antibody (Ab) and/or the same dosage of the anti-CD11c/CD18 Ab were administered intravenously, respectively or concomitantly. Under the light microscope, the LPS only and the LPS with the anti-CD14 Ab injected groups (group 1 and 2) showed marked acute inflammation in the organs, especially in the lung and liver, but the LPS with the anti-CD11c/CD18 Ab only or with both anti-CD14 and anti-CD11c Abs injected groups (group 3 and 4) revealed only mild acute inflammation. Under the electron microscope, there was marked inflammation in the group 1 and 2 such as marked infiltration of neutrophils, monocytes/ macrophages, lymphocytes, aggregation of platelets, and marked edematous change of endothelial cells with separation from the basement membrane. However in the group 3 and 4, there was only mild inflammation such as mild infiltration of neutrophils in the tissue or aggregation of neutrophils in the capillaries and sinusoids with mild endothelial swelling. The expressions of tumor necrosis factor-alpha (TNF-alpha) and interleukin-1alpha (IL-1alpha), detected by RT-PCR method, was remarkable in the group 2, but minimal in the group 3 and 4. We conclude that blocking the CD11c/CD18 with anti-CD11C/CD18 Ab is effective for the prohibition of biologic reactions and diminution of the inflammation induced by the LPS, even in the LPS induced endotoxemia.

A Statistical Observation on Medico-Legal Autopsy in Taegu Area during the Year of 1998 / 대한법의학회지

This is a report revealing statical cause of death brought to the department of forensic medicine, Kyungpook National University School of Medicine based on the result of autopsy. The summary of result is as follows. 1. The number of autopsy made during 1998 were 356, of these 225 cases (63.2%) were male, and 131 (36.8%) were female. 2. 30's, 40's, 20's and 50's was the order according to the number of violent death, and in case of natural death, 30's, 50's, 40's was the oder. 3. August is the period during which autopsies are made most, with December placing second, and the other months are similar. 4. In distributing deaths by cases, violent deaths were 241 cases (67.7%), natural deaths were 105 (29.5%) and unknown cases were 10 (2.8%). 5. For the violent deaths, deaths due to injury were 128 cases (53.1%), asphyxia were 63 (26.1%), intoxications were 30 (12.4%) and abnormal temperature were 19 (7.9%). According to relationship with deaths, homicide is outstanding with 101 cases (41.9%), while suicide and accidental death was the same with 62 cases (25.7%). 6. For death due to injury, death due to blunt injury were 48 cases, sharp force injury which was used most in case of homicide were 43. 7. For the asphyxia, drowning is the most 20 cases, 13 cases of which is accidental death. 8. The deaths of intoxication is the largest part of suicide, and most of intoxication were involved in agrochemical. 9. Of 105 cases of natural death, deaths due to the disease of cardiovascular system were 51 cases (48.6%), of which deaths due to myocardial infraction were 35 cases. 10. Of all autopsy, alcohol intake were checked out in 90 cases and 21 cases of medical controversy took places. 11. Of all violent deaths, the cases involved in the discord between man and woman occupied percentage of 9.6. Of these, homicides were 18 cases, with all sacrificed being females, and of 16 cases of suicide, 13 cases were female.

LAN-based Autopsy Recording System for Documentation and Statistics / 대한법의학회지

The automation in autopsy data recording, particularly in the reporting and encoding system using computers requires well designed databases. This system employed multimedia computer techniques to design a database system with application programs along with the standardized autopsy data management flow. The benefit of the present development was verified by practical application into the autopsies performed in the department of forensic medicine, Kyungpook National University. The standardized medical information of forensic autopsy data provides mutual exchange of information between the institutions and information to law enforcement agencies. Statistics on autopsy data could be used not only for medical education and research, but also as a template for policy determination concerning forensic medicine in Korea. It is necessary to standardize information between the institutions.

Essential Points for Examination of the Injuries

No abstract available.

The Effects of Intraventricular Injection of Lipopolysaccharide on the Periventricular Neural Tissue

Ventriculitis is one of the most serious complication of the ventriculoperitoneal shunt, which may cause intelligence deterioration in children. The purpose of this study is to investigate the mechanism of the neural damage in lipopolysacciride(LPS)-induced ventriculitis in rat. Ventriculitis was induced by intraventricular injection of 1mg/Kg LPS in rat. H & E and Tunel stains were done on the day 1, 2 and 14 to access the microscopic changes of the periventricular tissue and apoptosis, respectively. TNF-alpha and IL-1beta mRNA expressions were studied using RT-PCR. HRP was injected into the femoral vein and electron microscopic examinations were performed to access the BBB changes. Light microscopic examination one day after LPS injection revealed neutrophilic infiltration, which diminished on day 4, and disappeared on 14. Tunel stain revealed apoptosis on day 1 and 4. TNF-alpha and IL-1beta were expressed on day 1, and diminished progressively thereafter. HRP histochemical electron microscopic examination revealed accumulation of HRP reaction in the interstitial space around the brain parenchyma. These findings suggest the opening of the BBB and increased capillary permeability in the periventricular tissue in the LPS induced ventriculitis. This can possibly damage the periventricular neural tissue. TNF-alpha and IL-1beta seemed to play an important role in the opening of the BBB.

Cytokine Expression on Microglial Proliferation and Apoptosis in Rat Lumbar Spinal Cord Following Unilateral Sciatic Nerve Transection

This study was carried out to elucidate the cytokine mRNAs expression and morphological features according to a microglial proliferation and apoptosis in a rat lumbar spinal cord, after a right sciatic nerve transection. The control group was composed of 5 rats (Spraque-Dawley) and the experimental group was composed of 70 rats. On post operation day (pod) 1, 2, 3, 5, and 7 eight rats were sacrificed on those days. On pod 10 five rats were sacrificed as well as five rats sacrificed on post operation weeks 2, 3, 4, 5, and 6. On light microscopy, activated microglia were often found in a perineuronal position around motoneurons in the ventral gray matter and more randomly distributed throughout the neuropil in the dorsal gray matter of lumbar spinal cord. GSA I-B4-positive microglia began to increase from 1 day after transection, and reached peak at 2~3 days and it persisted at 5~7 days and decreased thereafter. TUNEL-positive microglia was not observed in control group and began to increase from 5 days after transection and increased gradually until 3 weeks and decreased thereafter. On in situ RT-PCR, the positive signal for IL-1alpha and IL-6 mRNA was found mainly in the cytoplasm of the activated microglia and astrocytes at 1 day after transection and showed stronger signal at 3 days and decreased gradually until 10 days. TNF-alpha mRNA was detected 1 day after transection and remained for 7 days and localized to activated microglia as well as probably some astrocytes. The signal intensity of IL-1alpha and IL-6 mRNA was generally stronger than TNF-alpha mRNA. On transmission electron microscopy, there were chromatin condensation with margination toward nuclear membrane and condensation of cytoplasm at 3 days after transection. Apoptotic bodies were found after 5 days and increased gradually until 3 weeks. According to the above findings, it is concluded that apoptosis appears to be one mechanism by which activated microglia are gradually eliminated and cytokine expression seems to played an active role in the microglial turnover.

Forensic Pathology of the Lung in Fetus and Infant / 대한법의학회지

Most autopsy cases of fetus or infants in Korea are deaths of prematurity or death after birth arising medical dispute. It is natural to closely examine the all organs at autopsy. Thorough investigation of the lungs of infants is important to distinguishing the live birth and stillbirth. Forensic pathologists in Korea are not frequently experienced infant autopsy. So it is necessary to review the pediatric forensic pathology. And the author summarized the forensic pathology of the lungs in fetus and infants and its significance.

Autolytic Changes of Hair, Nail, and Cornea(I): Changes by Three Weeks after Resection / 대한법의학회지

This study was carried out to determine whether the autolytic changes of the hair, nail, and cornea were useful marker to estimate the postmortem interval. The hairs and nails obained from variable aged men and corneas from rabbits were placed in variable temperatures (10 degrees, 20 degrees, 30 degrees)and humidities (50%, 75%, 100%) and periodically investigated by electrom microscopy. The results were as follows. The hairs and nails were not significantly changed to 21 days after cut in variable temperatures and humidities. The cornea showed epithelial desquamation from the first day and endothelial desquamation from the third day. However, Bowman's membrane, stroma, and endothelial changes of the cornea were irregular on case. From the above results, it is concluded that the autolytic changes of the hair, nail and cornea were not useful to estimate the posmortem interval within a few weeks.

The Morphologic Changes of the Sinusoidal Endothelial Cells in N-diethylnitrosamine Induced Cirrhotic Rat Liver

The purpose of this study is to investigate the morphologic changes of the sinusoidal endothelial cells and the associated structures of the cirrhotic rat liver induced by repeat intraperitoneal injections of N-diethylnitrosamine (DEN) (100 mg/kg/week). One day to 6 weeks later, rat livers were observed under the light, transmission and scanning electron microscopy, and immunostained with laminin antibody. Two weeks after DEN treatment, the fibrillar material in Disse's space was noted, and then a basement membrane-like structure was found at 4 weeks after treatment. Laminin was detected in perisinusoidal areas after 4 weeks. Laminin was strongly positive on the fibrous septum and in the sinusoidal wall of cirrhotic nodules after 6 weeks of treatment. The diameters and numbers of sinusoidal endothelial fenestrations did not change significantly until 2 weeks. They decreased within 4 weeks, and then the sinusoidal endothelium was poorly fenestrated at 6 weeks after DEN treatment. These results suggest that as fibrosis develops in cirrhosis, the deposit of extracellular matrix such as laminin within Disse's space is a major contributing factor in the structural alteration of sinusoidal endothelial cells, and the capillarization of the sinusoidal endothelial cells may be a contributor to impairment of the hepatic function in cirrhosis.

A Case of Tracheopathia Osteoplastica / 결핵

Tracheopathia osteoplastica is a rare disease characterized by submucosal cartilaginous or bony projections into tracheobroncheal lumen with sparing of the posterior membranous portion of tracheobroncheal tree. The cause of this disorder is unknown. In the past, a majority of the cases were discovered incidentally at autopsy. But recently, antemortem diagnosis is increasingly reported after the introduction of computed tomography and bronchoscopy. We report a case of extensive tracheopathia osteoplastica diagnosed antemortem by computed tomography, bronchoscopic examination and biopsy.

An Ultrastructral Study in the Prolapsed Intervertebral Disk

The study was carried out to investigate the ultrastructural changes of nucleus pulposus of prolapsed disc and to evaluate the characteristic histologic changes of prolapsed intervertebral disc. Histologic findings of curetted fibrocartilage from 33 discs having documented disc prolapse into spinal canal were reviewed. Light microscopically, neovascularization, splitting, myxoid degeneration, cystic change, chondrocytic cloning and granular change were observed. Among these microscopic features, splitting, myxoid degeneration and chondrocytic cloning were observed in all of the cases, and the remaining other features were noted in more than 50% of the cases. Electron microscopically, the nucleus pulposus showed a few viable notochord cells, which had abundant cytoplasmic organelles such as glycogen particles, mitochondria, rough endoplasmic reticulum and lipid droplets. Numerous cytoplasmic processes are noted. Then matrix showed fine fibrils and irregular shaped electron dense granules and fragmented collagen fibers.

Paraganglioma of Cauda Equina: A case report

The clinical and pathological features of a paraganglioma arising in the cauda equina is described and compared with previous reports. The right microscopic fetures were similar to those of paragangliomas from other sites, with a 'Zellballen' pattern of cells containing arzyrophil granules. Immunohistocytochemical stains for neurone specific enolase, S-100 protein, cytokeratin were positive, but stains for glial fibrillary acidic protein were negative. Electron microscopy showed densely staining membrane-bound granules, cilia like structures and fibros bodies in the cytoplasm. The last two features only occur in paragangliomas from this site. The pathological findings suggest that paragangliomas in this site arise from pre-existing paraganglia, possibly of the visceral autonomic group.

An Immunohistochemical Study on the Distribution of Endotoxin

This study was performed to investigate the distribution of endotoxin in various organs after intraperitoneal injection of E. coli homogenator(0111:B4, 3X10(9)cells/200g of body weight). Sprague-Dawley rats were intraperitoneally injected with E. coli homogenator and sacrificed 1 and 3 hours after injection. The lung, liver, and kidney were immunohistochemically stained with avidin-biotin complex method and observed by light and electron microscopy. On the light microscopy, granular deposits of reaction products of immunohistochemical stain were found on the cytoplasmic membrane of endothelial cells and some of parenchymal cells of all organs observed. Electron microscopic study revealed finely granular reaction products on the surface of endothelial cells and some of parenchymal cells. The pinocytotic vesicles of endothelial cells demonstrated reaction products in the early phase of experiment. The distribution of reaction products were prominent in the liver among three organs. The Kupffer cells showed the most sensitive and strongest positive reaction. The hepatocytes and endothelial cells revealed weak positive reaction 3 hours later. The alveolar macrophages of the lung were also positive from the early phase of endotoxemia, while the pneumocytes and alveolar septa demonstrated weakly positive reaction in the later phase. The capillary endothelium of the kidney revealed positive reaction from the early phase. According to above results, it is concluded that the endotoxin entered into the systemic circulation was captured in the liver and lung. And both mononuclear phagocytic system and endothelial cells could be activated or damaged by endotoxin.

Morphologic Changes of the Urinary Bladder Mucosa Induced by E. coli / 대한비뇨기과학회지

This study was carried out to investigate pathogenesis of E. coli-induced cystitis by light and electron microscopy with immunocytochemistry. A group of ICR mice was intravesically given 0.3ml of E. coli DIE 174 lysate( 1000000000/ml). Another group was given E. coli lysate after acid solution(pH 4.5) washing for 30 minutes. The urinary bladders were observed at 2 hours and 24 hours after E.coli lysate irrigation. On light microscopy, submucosal edema, congestion, and perivascular neutrophilic infiltration occurred 2 hours after E. coli lysate irrigation. The congestion and acute inflammation were more pronounced 24 hours after. In cases of acid washing and E. coli lysate irrigation, mucosal acute inflammatory infiltration with edema and congestion was marked at early stage. Necrosis of transitional cells developed with time. On immunostain for E. coli, surface of transitional cells was stained 2 hours after E. coli lysate irrigation. At 24 hours after irrigation, intercellular spaces of transitional cells were stained. In cases of acid washing and E. coli lysate irrigation, entire mucosa was stained at early stage. Electron microscopically, transitional cells revealed increase of cytoplasmic processes, enlargement of cytoplasmic vesicles, and widening of intercellular spaces. There were large amounts of various shapes of lysosomes in neutrophils and monocytes infiltrated in the mucosa in acid washing groups. According to the above results, it is concluded that E. coli lysate may easily penetrate into the bladder mucosa and that the mucosal mucopolysaccharide plays as a barrier against bacterial invasion.

Present status and problems in medicolegal investigation of sudden unexpected death / 대한법의학회지

No abstract available.

The Effects of Proteolytic Agent on the Lung Injured by Endotoxemia

The authors studied the lung injury induced by endotoxemia and the effects of proteolytic agent on the lung changed by endotoxemia. Sprague-Dawley rats were intraperitoneally administrated with a single dose of endotoxin (4 mg/kg, E. coli 025 : B6 lipopolysaccharide) or with endotoxin and gabexate mesilate (200 mg/kg), a proteolytic agent, concomitantly. Rats of each group were scarificed at 9, 18, and 27 hours after injection. Light and electron microscopic examination were done. The results obtained were summarized as follows: Light microscopic exmination revealed congested capillaries and neutrophilic infiltration in both groups. Electron microscopic findings were interstitial and alveolar neutrophilic infiltration, endothelial swelling with increased pinocytotic vesicles and cytoplasmic process formation, and interstitial edema. Decrease of osmiophilic bodies in the type II pneumocytes had appeared at 9 hours after endotoxin injection. These changes were increased in severity at 18 hours and 27 hours after endotoxin injection. In the group of concomitant treatment of gabexate mesilated and endotoxin, there was no edema at 9 hours after injection. After 18 hours welling of endothelial cell and interstitial edema had appeared. However, the severity of the edema was markedly decreased. Type II pneumocytes showed well preserved osmiophilic bodies. According to these results, it is considered that administration of gabexate mesilate can significantly redeced the lung injury induced by endotoxemia.

Pulmonary Alveolar Proteinosis: A case report

A case of pulmonary alveolar proteinosis is reported. Most of the alveolar spaces were filled with amorphous deep eosinohilic material which revealed strong positive reaction to periodic acid-Schiff staining. Electron microscopic observation of this material showed numerous lamellar bodies in the alveolar spaces and cytoplasms of alveolar macrophages. A part of them were concentric multilamellated type A lamellar bodies and the other were finger printlike type B bodies. Combined type A and type B lamellar bodies were rarely present. From the above features it is suggested that both type A and B lamellar bodies could be transformed one another and those lamellar bodies may be originated from pulmonary surfactant.

Congenital Herditary Stromal Dystrophy of the Cornea

In 1978, a nonprogressive corneal dystrophy was seperated from other causes of congenital opacification on the basis of unique clinincal findings and characteristic electronmicroscopic findings. This disorder, termed congenital hereditary stromal dystrophy, appears to the result of disordered stromal fibrogenesis. Recently, the autors have experienced 4 members of a family with typical electronmicroscopic findings of congenital heaeditary stromal dystrophy of the cornea. In this report we describe the characteristic findings of congenital hereditary stromal dystrophy.

Lysosomal Changes of Retinal Pigment Epithelium

This study was carried out to investigate diurnal changes of lysosomes includ ing ultrastructural changes of phagosomes and activity of acid phosphatase in the phagosomes and diurnal biochemical changes of cathepsin D activity of rab bits. The eyes were obtained at 0:00, 4:00, 8:00, 12:00, 16:00 and 20:00 o'clock. The number of lysosomes and phagosomes in retinal pigment epithelium(RPE) was the highest at 8:00 o'clock, thereafter decreased with time. There were three types of phagosomes; fresh phagosomes showed both negative and positive reactions, lamellar bodies positive, and dense bodies partially positive. The biochemical activity of cathepsin D was the highest at 8:00 o'clock consistent with the time of peak in phagocytic activities of RPE. According to the above results, it would be suggested that the maximum shedding of outer segments and phagocytic activity of RPE occurred on the early stage after sunlight exposure, and that the phagosomes were degraded to the lamellar bodies and dense bodies sequentially. And also activity of the cathepsin D would be increased consistent with the phagocytic activity of RPE.