Solitary Rectal Ulcer Syndrome with Lesion of Polypoid Growth

Solitary rectal ulcer syndrome (SRUS) is a rare disorder characterized by rectal ulceration associated with typical histological features and disturbed defecatory behaviour from the passage of blood and mucus. While the cause of SRUS is yet unknown, the rectal prolapse and the paradoxical contraction of pelvic floor muscles have been considered the most important factors. The diagnosis is made usually on the basis of clinical symptoms, endoscopic appearance, and histology. Despite the terminology of SRUS, patients often show multiple lesions instead of just a single lesion or polypoid lesions instead of ulcerative lesions. Polypoid lesions, especially when combined with histologic findings of colitis cystica profunda, may sometimes be mis-interpreted as cancer. We report the case of one female patient with SRUS with out-growing polypoid lesion, which was misdiagnosed as invasive cancer on endoscopic biopsy.

Does HSP70 Induced by Amphetamine Prevent Renal Ischemia/Reperfusion Injury in Rat? / 대한신장학회잡지

BACKGROUND: Heat shock proteins (HSPs) induced by variable kinds of stress produce tolerance to a variety of adverse conditions. However, the protective effect of HSP on ischemia/reperfusion injury (I/R injury) of kidney in vivo remains unclear. The present study was designed to evaluate whether HSP70 induced by hyperthermic preconditioning had renoprotective effect on I/R injury of the kidney in vivo. METHODS: 82 Sprague-Dawley male rats were used. Animals in control group (n=24) were subjected to bilateral occlusion of renal pedicles for 30 or 60 minutes followed by 24-hour reperfusion. In amphetamine (Amp, n=18) and quercetin (Q, n=16) group, amphetamine sulfate, a sympathomimetic drug which can elevate the body temperature as a result of enhanced endogenous lipolysis, and quercetin, a biflavonoid which inhibit the expression of HSP, were injected 4 hours prior to renal ischemia, respectively. In quercetin-amphetamine (QAmp, n=7) group, quercetin was injected 1 hour before administration of amphetamine. AA (n=8) or QQ (n=9) group was identical to Amp or Q group except that sham operation was performed instead of ischemic insult. In all groups, animals were sacrificed prior to or 24 hours after I/R injury. HSP70 induction was confirmed by immunohistochemistry. To assess the I/R injury of kidney, BUN, Cr, histopathologic change of tubular cell and HSP70 expression were evaluated. RESULTS: In Amp group, an increase of BUN and Cr were significantly lower than other groups and less severe renal tubular injury was also observed. In addition, HSP70 was strongly expressed in Amp group, whereas HSP70 was weakly expressed in control group and not expressed in QAmp and Q group. There were no differences in the functional and histologic injuries of kidney after I/R injury between AA, QQ and control group. CONCLUSION: These data demonstrate that the renoprotective effect by amphetamine preconditioning to I/R injury is linked with the expression of HSP70.

A case of thyroid tuberculosis diagnosis by FNAB associated with miliary tuberculosis / 대한내과학회지

Thyroid tuberculosis is rare. We experienced case of a 50-year-old woman with tuberculosis of the thyroid associated with miliary tuberculosis. She complained of chronic cough and weight loss. She was clinically and biochemically euthyroid. Thyroid sonogram demonstrated 3 2 cm sized heterogenous echogenic mass on upper pole of the left lobe of thyroid with calcification. Fine needle aspiration biopsy showed epithelioid granuloma in the caseous necrosis and acid-fast bacilli. She took antituberculous agents. One month later, radiologic finding improved and thyroid mass decreased also.

A case of thyroid tuberculosis diagnosis by FNAB associated with miliary tuberculosis / 대한내과학회지

Thyroid tuberculosis is rare. We experienced case of a 50-year-old woman with tuberculosis of the thyroid associated with miliary tuberculosis. She complained of chronic cough and weight loss. She was clinically and biochemically euthyroid. Thyroid sonogram demonstrated 3 2 cm sized heterogenous echogenic mass on upper pole of the left lobe of thyroid with calcification. Fine needle aspiration biopsy showed epithelioid granuloma in the caseous necrosis and acid-fast bacilli. She took antituberculous agents. One month later, radiologic finding improved and thyroid mass decreased also.

The Effect of Surfactant Treatment for Experimental Escherichi coli Pneumonia in Rats

PURPOSE: Recently, it has been reported that the disease with secondary surfactant deficiency such as pneumonia and adult respiratory distress syndrome (ARDS) improved in arterial blood gas analysis and pulmonary mechanics by surfactant treatment. In this study, we investigated the effect of surfactant in the experimentally induced E. coli pneumonia in rats. METHODS: 0.25 mL (0.5x109) E. coli suspension was injected intratracheally to the rats. After ventilating rats for 1 minute, 0.25 mL Surfactant TA (60 mg/mL phospholipid) was administered to the study group and normal saline to the control group. In about 12 hours, pneumonia symptoms developed, and the arterial blood gas analysis was performed with the blood obtained from abdominal aorta accessed by laparotomy. And then, bronchial lavage fluid (BAL) was obtained to perform cell count with differentials and E. coli culture, and to measure protein concentrations. The lungs were fixed in formalin for histological examination to compare the degree of inflammation. RESULTS: There were no significant differences in PaO2, cell count, differential count, E. coli culture between the study group and the control group. The protein concentrations of BALs in the surfactant-treated group were significantly lower than those in the control group (277+/-164 mg/dL vs 1,030+/-410 mg/dL). The inflammatory changes were found in E. coli-infected lung tissues from both groups, but less prominent in the surfactant-treated group than in control. CONCLUSION: Surfactant treatment decreased both the protein concentration of BALs and the inflammatory changes of lung tissue in an experimental model of E. coli pneumonia in rats.

A Case of Pleomorphic Adenoma of the Nasal Septum / 대한이비인후과학회지

Pleomorphic adenoma in nasal cavity is rare and mainly occurs in the major salivary gland. We have experienced a case of a 25 years old woman complaining recurrent nasal bleeding and nasal obstruction. She showed a tumor in the left nasal cavity. We treated the nasal cavity tumor by endoscopic sinus surgery. The tumor was 4.5X3.0X2.5 cm in size and firm, parenchymatous and pale in contour. The pathologic diagnosis was pleomorphic adenoma. We report in this case of pleomorphic adenoma in the nasal septum.

Type of Intestinal Metaplasia in the Surrounding Mucosa of Gastric Carcinoma and Expression of bcl-2, p53 and c-erbB-2 Prtein in Gastric Carcinoma / 대한암학회지

PURPOSE: This study was carried out to clarify significance of types of intestinal metaplasia and roles of bcl-2, p53 and c-erbB-2 protein in the development of gastric carcinoma. MATERIALS AND METHODS: Total one hundred fifty nine cases of surgically resected stomachs with benign ulcer (n=21), dysplasia (n=18) and gastric carcinoma (n=120) were studied histologically, histochemically and immunohistochemically. RESULTS: Type III intestinal metaplasia was significantly more common in the carcinoma patients in older age group. Bcl-2 expression was found in 94.4% cases of dysplasia and 75.0% cases of carcinoma. Positivity for bcl-2 protein was significantly higher in intestinal type carcinomas than in diffuse type carcinomas (p=0.000). The expression of p53 protein showed 50.0% cases of dysplasia and 49.2% cases of carcinoma. The expression of p53 protein was significantly correlated with depth of invasion (p=0.000), regional lymph node metastasis (p=0.001), and tumor size (p=0.001). C-erbB-2 protein was only expressed in 15.0% cases of carcinoma. The expression of c-erbB-2 protein was found more often in advanced carcinomas (p=0.001) and carcinomas with regional lymph node metastasis (p=0.003). CONCLUSION: Type III intestinal metaplasia was associated with age, but not with types of gastric carcinoma. Bcl-2 protein is probably involved in dysplastic lesion of gastric carcinogenic sequence and associated with intestinal type carcinoma, and p53 protein is also involved in dysplasia. p53 protein and c-erbB-2 protein may have a role of tumor invasion and nodal metastasis as poor prognostic factors.

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.

Expression of Antigenic Surface Molecules of Pneumocystis Carinii by Immunoelectron Microscopic Examination

This study was carried out to investigate the morphologic characteristics and localization of antigenic molecules of Pneumocystis carinii in experimentally induced P. carinii pneumonia in rats. After six weeks of administration of low protein diet and dexamethasone, Sprague-Dawley rats were sacrificed to submit lungs or bronchoalveolar lavage for the study. Monoclonal (092, 900, 902, and 904) and polyclonal (SP-D) antibodies were used for immunohistochemistry and immunoelectron microscopy (ITEM and ISEM). Immunohistochemically P. carinii organisms were well identified as clusters or separated forms in the alveolar spaces being frequently attached to the alveolar walls. Immunoelectron microscopically the adherences of gold particles were observed on the surface of all stages of the P. carinii. Occasionally positive immunogold labeling was observed in the cytoplasm of the trophozoites and on the pellicle of the intracystic bodies within the cysts. The monoclonal antibodies 092, 900, 902, and 904 reacted mainly with pellicles of P. carinii, whereas SP-D labeled on the pellicles, intracystic bodies, cytoplasms of the alveolar macrophages, and free floated surfactant material in the alveolar spaces. The immunogold particles were observed more diffusely and intensely in the cysts than in the trophozoites. These results indicate that antigen is mainly localized on the pellicles, and accumulated during development from the trophozoite to the cyst stages.

Synaptic Reorganization of Dentate Mossy Fibers and Expression of Calcium Binding Proteins in Hippocampal Sclerosis of Temporal Lobe Epilepsy

This study was designed to identify expression of calcium-binding proteins and synaptic reorganizations of dentate mossy fibers in hippocampal sclerosis of human temporal lobe epilepsy. Hippocampal neuronal density was quantitively analyzed in temporal lobe epilepsy group (n=50) to investigate the degree of hippocampal sclerosis and it was compared with that of autopsy control (n=3). To verify the distribution of calcium-binding proteins in neurons of epileptic hippocampi, the parvalbumin (PV)-immunoreactive and calbindin-D28K (CB)-immunoreactive neurons were quantitively analyzed in each area of Ammon's horn by immunohistochemical stain. Also, to clarify synaptic reorganizations of the dentate mossy fibers, a part of each hippocampus was examined under light microscopy and transmission electron microscopy using Timm sulphide silver method. In epileptic hippocampi, severity of hippocampal sclerosis (HS) was graded four, which consisted of 3 cases with no HS, 6 mild HS, 12 moderate HS, and 29 severe HS. The hippocampal neuronal loss was most prominent in CA1, followed by CA4 and CA2. Expression of calcium-binding proteins was more prevalent in CA2 of all groups. The proportion of PV-immunoreactive neurons in CA1 and CA4 significantly increased in the moderate and severe HS group, whereas the proportion of CB-immunoreactive neurons did not correlated with the severity of HS. Timm granules were noted in inner molecular supragranular layer of dentate gyrus of epileptic hippocampi and they tended to increase in proportion along with the severity of hippocampal sclerosis. Transmission electron microscopy showed that supragranular Timm granules corresponded to synaptic terminals of mossy fibers. These results suggest that parvalbumin appears to have more protective effect against neuronal loss and that mossy fiber synaptic reorganization seems to play a major role in pathogenesis of hippocampal sclerosis of human temporal lobe epilepsy.

The Effect of Alpha1-blockers according to Histological Compositions in Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: Benign prostatic hyperplasia(BPH) describes a hyperplastic process of the stromal and epithelial elements of the prostate. The proliferative rates of each compartment in BPH may vary individually and the prostate is topographically not affected in a uniform way. The proposed mechanism of alphas-blockers in the treatment of BPH is the decrease of prostatic urethral resistance by relaxing the prostatic smooth muscle component present in the stroma. The purpose of this study is to search the effect of alphas-blockers according to histologic compositions in patients with BPH. MATERIALS AND METHODS: From January 1994 to June 1997, 74 patients were treated with alpha1-blockers(> or =1month) before prostatectomy. Of 74 patients, the international prostate symptom score(IPSS) was used in 62 patients to evaluate the severity of voiding difficulties. The clinical response to alpha1-blockers was based upon change in IPSS during medication period. According to histological compositions of prostatectomy specimen, the patients were classified into three groups: predominantly stromal type(20 patients), predominantly glandular type(21 patients) and mixed type(21 patients). RESULTS: There were 17 patients In response group and 45 patients in nonresponse group. The stromal type, glandular type and mixed type were composed of 52.9%, 17.7% and 29.4% respectively in response group and 24.4%, 40.1% and 35.5% respectively in nonresponse group. There was not statistical significant differences between clinical response of the alpha1-blockers and histologic compositions in patients with BPH(p>0.05). CONCLUSIONS: Although stromal type was predominant in response group and glandular type was predominant in nonresponse group, the relationship between the effects of alpha1-blockers and histologic compositions in patients with BPH was not statistically significant. Further evaluation will be necessary to assess the association between effects of alpha1-blockers and histologic difference of prostate in patients with BPH.

A Case of Interstitial Lung Disease in Ulcerative Colitis / 결핵

Extracolonic manifestations which occur in approximately 10-20% of patients with ulcerative colitis most commonly affect joints, skin, liver and eyes. In contrast, pulmonary involvement in ulcerative colitis is very rare. However, a variety of respiratory disorders has been associated with ulcerative colitis, including pulmonary vasculitis, bronchiectasis, chronic bronchitis, interstitial fibrosis, pleural effusion. Since the first observation of pulmonary involvement in ulcerative colitis by Kraft in 1976, a few cases have been reported, and probably no such case have been reported in Korea yet. Here we report an experience concerning 56 year-old man interstitial lung disease in ulcerative colitis, who was diagnosed by clinical, radiographic, endoscopic, histologic findings.

Verrucous Carcinoma of the Bladder Unassociated with Bilharzial Cystitis: A Case Report

Verrucous carcinoma that occurs only in the bladder is a very rare, well-differentiated squamous cell carcinoma. The tumor is a histologically and clinically distinctive variant of squamous cell carcinoma, and is almost exclusively associated with bilharzial infection. We report the radiologic findings of a case of verrucous carcinoma of the bladder unassociated with bilharzial infection.

Pathologic Analysis of 71 Cases of Cerebral Cortical Dysplasia

Cortical dysplasia (CD) is considered to be a malformative lesion of the neocortex which exhibits a spectrum of pathologic changes reflecting a disturbance in the process of its development. CD is recently recognized as a major cause of intractable epilepsy with non-neoplastic lesions. Mischel et al. proposed that CD can be graded mild, moderate and severe with regard to nine specific microscopic abnormalities: mild CD consists of 1) cortical laminar disorganization, 2) single heterotopic white matter neurons, 3) neurons in the cortical molecular layer, 4) persistent remnants of the subpial granular cell layer, and 5) marginal glioneuronal heterotopia; moderate CD displays 6) polymicrogyria and 7) white matter neuronal heterotopia; severe CD phows 8) neuronal cytomegaly with associated cytoskeletal abnormalities and 9) balloon cell change. We reassessed 71 cases of cortical dysplasia to elucidate the proportion and histologic features of each group, using Mischel's grading system. CD was most frequently found in the temporal lobe with 50 cases (70%). Mild CD was predominently seen and was noted in 61 cases (86%) Cortical laminar disorganization and single heterotopic white matter neurons were identified in all mild CD cases. Neurons in the cortical molecular layer, persistent subpial granular cell layer, and marginal glioneuronal heterotopia were also noted in case numbers 40, 3, and 1 of mild CD, respectively. Moderate CD was composed of 2 cases with polymicrogyria, and the remaining 8 cases had severe CD. All moderate and severe CD were associated with the various histological features of mild CD. Thirty eight cases (51%) of CD showed dual pathology, composed of both CD and hippocampal sclerosis, and 5 cases of dysembryoplastic neuroepithelial tumor also had CD. Neurofilament immunostain revealed disarray of abnormally beaded axons in CD. We believe that the grading system of CD is very important to the evaluation and classification of CD.

The Causes of Elevated Serum Prostatic Specific Antigen (PSA) Concentrations in Nonprostatic Cancer Group / 대한비뇨기과학회지

Elevations of serum PSA concentrations have been widely reported due to prostatic cancer, but other causes haute not been formally characterized or quantified. So that, we evaluated the causes of elevated serum PSA concentrations in men whose prostate biopsy showed no cancer. The effects of prostate volume, inflammation, echogenecity on ultrasound and calculi were examined in 43 men that serum PSA concentrations greater than 4.0 ng/ml with negative biopsy. These men were compared with 16 men who had suspicious rectal examinations, negative biopsy and serum PSA concentrations of 4.0 ng/ml. or less. Prostate volume (22.5%, p4.0 ng/ml) than control group ( or =0.05). In summary, prostate volume and inflammation were the most important factors contributing to increase serum PSA concentration in men that clinically undetectable prostatic cancer.

Immunocytochemical Detection of Pneumocystis Carinii in Bronchoalveolar Lavage / 대한세포병리학회지

Pneumocystis carinii is an established cause of pulmonary infections in immuno- compromised hosts. Several cytological stains, such as Papanicolaou, Gomori methenamine silver(GMS) and Diff-Quik have been used for detection of the organism, but occasionally can be laborious and, due to a degree of nonspecificity, may be misleading. We evaluated the diagnostic utility of immunocytochemical stains that recognize P. carinii in bronchoalveolar lavage from experimentally induced P. carinii pneumonia rats(n=15). In addition to routine stains for diagnosis by morphologic recognition of P. carinii on Papanicolaou, GMS and Diff-Quik stains, bronchoalveolar lavage samples were reacted with immunocytochemical stains using monoclonal antibodies(MAB) 092 and 902. In bronchoalveolar lavage P. carinii organisms were detected in 9 of 10 cases (90%) using each MAB 092 and 902, whereas GMS and Diff-Quik stains demonstrated P. carinii in 13(86%) and 11(73%) of 15 cases respectively. In lung tissue specimens(n=15) P. carinii organisms were well identified on GMS stain and immunohistochemical stains using MAB 092 and 902 in all cases. We believe that the immunocytochemical staining using MAB 092 and/or 902 is a very useful and diagnostic tool in addition to GMS and Diff-Quik stain to detect P. carinii organisms in bronchoalveolar lavage.

An Ultrastructural Study of Bleomycin-Induced Interstitial Pulmonary Fibrosis in the Rat

This study was carried out to investigate the mechanisms of interstitial pulmonary fibrosis of rats after the intratracheal administration of bleomycin. Both lungs after bleomycin injection were examined by light and electron microscopy. The results are as follows: Light microscopically, 1 or 2 weeks after bleomycin injection acute and chronic inflammatory infiltrates and edema in the interstitium and alveolar spaces were observed. Proliferation of alveolar type II pneumocytes was also found at 4 to 6 weeks after bleomycin injection, chronic inflammatory infiltrates with interstitial fibrous thickening were noted. Electron microscopically, the number of type II pneumocytes and irregular lamellar bodies were increased and blunted microvilli were noted at 2 weeks. 4 to 8 weeks, proliferation of fibroblasts with deposition of abundant collagen fibrils in the thickened interstitium revealing irregular or collapsed alveolar spaces were observed. Based on these findings, it can be concluded that bleomycin-induced interstitial pulmonary fibrosis is considered to pass from an early acute inflammation of the interstitium and alveolar spaces to an interstitial fibroblast proliferation and collagen deposition to the length of the period after injection.

Cytologic Findings of Bronchoalveolar Lavage / 대한세포병리학회지

Bronchoalveolar lavage (BAL) has emerged as a useful technique for the study of pulmonary interstitial disorders. Several types of information are provided by the evaluation of lavage fluid. Identification of cellular constituents helps to separate inflammatory process. Recently we have studied cellular constituents of BAL from three cases with histologically confirmed pulmonary sarcoidosis, idiopathic pulmonary fibrosis and hypereosinophilic syndrome. Pulmonary sarcoidosis showed a marked increase in lymphocytes, idiopathic pulmonary fibrosis revealed a predominance of neutrophils, and hypereosinophilic syndrome presented a marked increase in eosinophils in the lavage fluids.