Synchronous Roentgenographically Occult Lung Carcinoma Treated with Argon Plasma Coagulation in a Patient with Resectable Primary Lung Cancer / 결핵및호흡기질환

We treated synchronous double primary lung cancers, where one site resulted from CIS disease, with lobectomy and argon plasma coagulation (APC) in a patient who couldn't tolerate pneumonectomy, which resulted in a reduction of the extent of surgery. APC could be a reasonable alternative for CIS disease of lung in inoperable patients.

Spectrum of Axillary Disorders (Excluding Metastasis from Breast Cancer): Radiological and Pathological Correlation: A Pictorial Essay

Axillary disorders originate from an axillary lymph node, subcutaneous fat layer, accessory breast, nerve, vessel and muscle. The most common causes of a palpable axillary mass are a lymph node pathology containing a benign axillary lymphadenopathy, and malignant lymph nodes such as a metastatic lymphadenopathy from breast cancer and a malignant lymphoma. For the detection of masses in the axilla, mammography and sonography are the imaging modalities of choice. We present a spectrum of various axillary masses with correlative radiological imaging and pathological findings in this pictorial essay. Knowledge of the radiological findings of various axillary disorders is useful for a differential diagnosis and for preventing unnecessary invasive procedures.

Malignant Deciduoid Mesothelioma: A Case Report

Malignant deciduoid mesothelioma is a rare malignant neoplasm occurring in the peritoneum of young women. We report a case of malignant deciduoid mesothelioma that occurred in the omentum of a 47-year-old woman. The patient had never exposed to asbestos and had no history of cesarean section. The lesions were multiple infiltrative nodules affected the peritoneal cavity, omentum, and surface of the uterus with both ovaries. Microscopically, the nodules were composed of mesothelial cells similar to decidual cells

A case of herpes simplex virus esophagitis by primary infection in an immunocompetent patient / 대한내과학회지

Herpes simplex virus esophagitis (HSVE) is a rare disease and most of cases were reported in the immunocompromised state. In the immunocompetent individuals, HSVE was reported in only a few cases worldwidely, moreover some case of which was not a pure HSV infection but a mixed infections with other pathogens. We report a case of HSVE with 72 years-old immunocompetent male patient. He complained about vomiting, poor oral intake. We couldn't find any evidence that he was in immunocompromised state. Upper gastrointestinal endoscopy demonstrated that the esophagus mucosa was friable, having hemorrhagic tendency, and there were multiple ulcers, which was covered with whitish patch, became confluent like a map at the distal. Microscopic examinations revealed that the squamous epithelium at the ulcer margin was infiltrated with inflammatory cells and have intranuclear eosinophilic inclusion body. This case report describes of HSVE by primary infection in an immunocompetent patient without any other infection.

The Effect of Vacuum-Assisted Closure (V.A.C.) Therapy in Pressure Ulcer

OBJECTIVE: To evaluate the effect of Vacuum-Assisted Closure (V.A.C.) therapy in stage 3 or 4 pressure ulcers refractory to traditional saline wet gauze dressing. METHOD: Ten patients who had stage 3 or 4 pressure ulcers which were failed to heal with saline wet gauze dressing over 4 weeks were investigated. We treated these subjects with V.A.C. therapy. The length, width and depth of pressure ulcers were evaluated every week for 3 weeks. Soft tissue biopsy from pressure ulcer was taken before starting V.A.C. therapy and after the scheduled therapy was done. RESULTS: The sizes of length, width and depth in pressure ulcer were significantly decreased after one week of V.A.C. application. And then healthy granulation tissue was formed. The length, width and depth of the pressure ulcer were decreased of 40.2%, 42.7% and 79.8% of their original size. Soft tissue biopsy in pressure ulcers was taken in 4 cases, the number and size of capillaries were more increased and inflammatory cells were decreased. CONCLUSION: V.A.C. therapy promoted wound healing and revealed favorable histological changes in pressure ulcers refractory to traditional dressing. We suggest that V.A.C. therapy can be used for the effective management of pressure ulcer.

The Prevalence of Antimicrobial Resistance in Helicobacter pylori Isolated in Daejeon / 대한임상미생물학회지

BACKGROUND: The most commonly used regimen for the eradication of Helicobacter pylori is combination of a proton pump inhibitor, clarithromycin, and two other antibiotics, metronidazole and amoxicillin. The increase in resistance to antibiotics seems to result in a decrease in eradication efficacy for H.pylori. We investigated the prevalence of antibiotic resistance in H.pylori isolated in Daejeon area. METHODS: A total of 31 clinical isolates of H.pylori were collected from the patients who underwent upper gastrointestinal endoscopy in Keonyang University Hospital during the period from March to July 2004. Antibiotic susceptibility tests for metronidazole, amoxicillin, and clarithromycin were performed by the E test (AB Biodisk, Sweden) on an egg yolk medium containing triphenyltetrazolium. The resistance break points for amoxicillin, metronidazole, and clarithromycin were defined as 0.5 microgram/mL, 8 microgram/mL, 1 microgram/mL, respectively. RESULTS: Resistance to amoxicillin, metronidazole, and clarithromycin was detected in 7.4% (2/27), 25.8% (8/31), 3.6% (1/28), respectively. CONCLUSION: The resistance to amoxicillin and clarithromycin was uncommon in Daejeon area.

Early Onset of Minimal change Nephrotic Syndrome during Treatment with D-penicillamine in a Patient with Wilson s Disease

Wilson s disease is an autosomal recessive disorder characterized by degenerative changes in the brain, liver, and cornea. Treatment includes D-penicillamine, trientine, and zinc sulfate. D-penicillamine has been used frequently as first line therapy for Wilson s disease. However, nephrotoxicity can occur after D-penicillamine treatment. Among them membranous glomerulopathy is the most common histological abnormality but minimal change lesions have also been reported. Nephrotic syndrome is a late complication of D-penicillamine treatment but very rarely can occur within 2 months after treatment of D-penicillamine. We report the early development of minimal change nephrotic syndrome in a 3-year-old girl with Wilson s disease 3 weeks after initiation of D-penicillamine.

A Case of an Atypical Teratoid/Rhabdoid Tumor of the Cerebellum

Primary central nervous system atypical teratoid/rhabdoid tumors are rare and extremely aggressive malignancies of early childhood. These tumors are most common in infants less than 2 years of age. Diagnosis is based on distinctive light microscopic and immunohistochemical findings, coupled with a molecular genetic analysis. A histologic features of these tumors are epithelial and/or mesenchymal components in addition to rhabdoid, with or without neuroepithelial fields. The expression of the epithelial membrane antigen, vimentin, and the smooth muscle actin are characteristic of these tumors. Treatment includes surgery, chemotherapy, and radiotherapy. Prognosis is poor despite of an aggressive therapy. We report one case of an atypical teratoid/rhabdoid tumor in a young child. She is an 18 month-old-girl who presented with central type facial palsy. After extensive surgery she improved transiently but relapsed immediately. Her condition was not permitted to receive radiotherapy or chemotherapy. Thereafter, with phrenic nerve palsy, she suffered from recurrent episodes of pneumonia and respiratory difficulties. Finaly, she was expired three months after the diagnosis and treatment.

Nevus Cell Inclusions in the Lymph Node: A Report of Two Cases

Nevus cell inclusion in the lymph node is an uncommon histologic finding and usually is an incidental finding in the capsule, fibrous trabeculae, perinodal adipose tissue, and parenchyma of the axillary, inguinal, or cervical lymph nodes which are removed as part of cancer diagnostic or therapeutic procedures. The aggregated pigmented nevus cells in the lymph node resemble the cells of the cutaneous nevi. It is important to differentiate them from metastatic carcinoma or malignant melanoma. The characteristic features of nevus cell inclusions are presence of nevus cells within the capsule and supporting stroma, without presence in the marginal sinus of the lymph node, and the absence of cytological atypia or mitosis of nevus cells. We report two cases of nevus cell inclusions, in the axillary lymph nodes in a patient with breast carcinoma and in an enlarged inguinal lymph node in a patient without a malignant tumor.

Glomerular Basement Membrane Thickness in Minimal Change Disease

The thickness of the glomerular basement membrane may vary not only in glomerular disease, but also in normal persons according to age and sex. But there has been no data on the normal thickness of the basement membrane in Korea. This study was designed to determine the glomerular basement membrane thickness as a reference value according to age and sex, in 50 cases of minimal change disease obtained from patients aged 2~67 years. Measurement of glomerular basement membrane was made on electron micrograph using an image analyzer. The thickness of each case was estimated by the arithmetic and harmonic mean methods. The mean thickness of the glomerular basement membrane was 291.9 47.9 nm by harmonic mean method and 284.2 43.7 nm by arithmetic mean method. And the harmonic mean thickness of the glomerular basement membrane according to age was 249.1 32.5 nm (1~5 years), 256.6 45.3 nm (6~10 years), 279.2 57.9 nm (11~15 years), 303.2 43.8 nm (16~20 years), 335.3 37.5 nm (21~30 years), and 291.1 22.5 nm (over 30 years), respectively. There was a trend that the thickness of glomerular basement membranes increased with the age till 30 years of age. There was no significant sex-related difference. In conclusion, the mean glomerular basement membrane thickness is comparable to the data from western people and shows a trend of increasing thickness according to the age.

Small Cell Osteosarcoma Similar to Ewing's Sarcoma in Histologic Findings and MIC2 Expression: A case report

Small cell osteosarcoma is a rare form of osteosarcoma and the histological differential diagnosis from other small round cell tumors (SRCTs) is difficult. The immunohistochemical stain for MIC2 has been considered an useful diagnostic marker for Ewing's sarcoma and primitive neuroectodermal tumors but recently, other SRCTs such as malignant lymphoma and embryonal rhabdomyosarcoma also showed positive reaction. Therefore, the usefulness of MIC2 must still be proven. We experienced a case of small cell osteosarcoma of the mandible in a 25-year-old man. Histologically, the tumor consisted of small round cells that resembled those of Ewing's sarcoma. Immunohistochemically, the tumor cells expressed diffuse strong positive reaction for MIC2 gene products. However, the scanty foci of lacy osteoid material between the tumor cells seemed to be diagnostic of osteosarcoma. The histologic and immunohistochemical findings of this case suggest close relationship between small cell osteosarcoma and Ewing's sarcoma.

Miliary Tuberculosis Involving the Central Nervous System

In recent times, central nervous system(CNS) tuberculosis has been rare and the prevalence of the focal form, the tuberculoma, varies from 1 per 20 to 1 per 1000. CNS tuberculosis occurs as a result of hematogenous sparead from a primary focus, mostly pulmonary tuberculosis. It can be diffuse exudative leptomeningitis or a localized tuberculoma; the former is more common. We report a case of military cerebral tuberculosis in a 24-year-old female who had been having headaches for 4 months. Magnetic resonance imaging showed numerous small round Gadolinium-enhanced supratentorial and infratentorial lesions scattered throughtout the brain. Histologic examination confirmed well-defined tuberculous granulomas with central caseous necrosis in open biopsy, containing several acid-fast bacilli, the patient was treated with isoniazid, rifampin, ethambutol, pyrazinamide in combination with prednisolone.