• Clinical and Experimental Pediatrics
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• v.51 no.4
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• pp.431-434
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• 2008

A 13-year-old boy, complained of an intermittent suddenly aggravated severe abdominal pain and diarrhea, was diagnosed as a small bowel volvulus without an intestinal malrotation, due to mesenteric lymphangioma. He took abdominal ultrasonography, abdominal CT scanning, upper gastrointestinal study and got an operation. The small bowel volvulus with cystic lymphangioma was confirmed by gross and pathologic findings.

• Advances in pediatric surgery
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• v.8 no.1
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• pp.54-61
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• 2002

Hirschsprung's disease (HD) is usually diagnosed in the newborn period and early infancy. The common presentation of HD in newborns consists of a history of delayed passage of meconium within the first 48 hours of life. The differential diagnosis in newborns is one of the clinical challenges of this disorder. A number of medical conditions which cause functional obstruction of the intestines are easily excluded. Neonates with meconium ileus, meconium plug syndrome, distal ileal atresia and low imperforate anus often present in a manner similar to those with HD in the first few days of life. Abdominal radiographs may help to diagnose complete obstruction such as intestinal atresia. Microcolon on contrast enema can be shown in cases with total colonic aganglionosis, ileal atresia or meconium ileus. Suction rectal biopsy or frozen section biopsy at operation is essential for differential diagnosis in such cases. HD is also considered in any child who has a history of constipation regardless of age. Older children with functional constipation may have symptoms that resemble those of HD and contrast enema is usually diagnostic. However, children with other motility disorders generally referred to as chronic idiopathic intestinal pseudoobstruction present with very similar symptoms and radiographic findings. These disorders are classified according to their histologic characteristics.; visceral myopathy, visceral neuropathy, intestinal neuronal dysplasia (IND), hypoganglionosis, immature ganglia, internal sphincter achalasia. Therefore, the workup for motility disorders should include rectal biopsy not only to confirm the presence of ganglion cells but also evaluate the other pathologic conditions.

• Journal of Chest Surgery
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• v.25 no.11
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• pp.1292-1298
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• 1992

This investigation is designed to illustrate the clinical features '||'&'||' preoperative diagnosis, surgical role in the management of pulmonary aspergilloma, '||'&'||' compare with the previous study. We reviewed 42 cases of surgically treated pulmonary aspergillosis from Jan. 1984 to July 1992. The peak age incidence laid in the 2nd '||'&'||' 3rd decade of 25 cases[59.5%]. The 41 cases[97.6%] had a history of treatment with anti-tuberculous drugs under impression of pulmonary tuberculosis. The most common complaint was hemoptysis in 28 cases[66.7%]. The 21 cases showed so called "Air-meniscus sign" on the preoperative chest X-ray. As a preoperative diagnostic modality, the positivity was 30.0%, 57.8%, 88.5% on the fungus culture of sputum for Aspergillus, Chest CT, serum immunodiffusion test for A. fumigatus, respectively. The 37 cases[88.1%] can be diagnosed as pulmonary aspergillosis pre-operatively by any diagnostic method. The anatomical location of aspergilloma was mainly upper lobe in 17 cases[40.5%] '||'&'||' the majority of cases were managed by lobectomy. The postoperative pathologic findings showed that 18 cases[41.0%] were combined with tuberculosis '||'&'||' 15 cases[34.1%] were not combined with any other disease[Pr imary Aspergillosis]. The 6 cases showed postoperative empyema including 4 cases of bronchopleural fistula, 3 cases showed postoperative bleeding. One case was died postoperatively due to respiratory failure. In conclusion, when the patient who has longstanding history fo pulmonary tuberculosis '||'&'||' hemoptysis, must be suspected fungal super infection. The resectional surgery is the treatment of choice for symptomatic localized disease. And compare with the previous study, preop. chest CT '||'&'||' immunodiffusion test were more commonly available '||'&'||' showed high positivity.

• Journal of Chest Surgery
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• v.22 no.3
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• pp.425-435
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• 1989

The solitary pulmonary nodule is considered as a round or ovoid lesion with sharp, circumscribed borders, surrounded by normal appearing lung parenchyme on all sides, and found on a simple chest X-ray without any particular symptoms or signs. There is a wide spectrum of pathologic conditions in the solitary pulmonary nodules prove to be malignant tumors, either primary or metastatic. Most Benign granulomas and other benign conditions can also be seen as solitary nodules. The resection of solitary malignant nodules results in a surprisingly high 5-year survival rate. On the contrary, most benign nodules do not need to be resected and a period of prolonged observation and nonsurgical management is usually indicated. Therefore, the best approach to the controversial management of solitary pulmonary nodules depends on finding factors affecting the probability of malignancy. In this article, clinical records and chest roentgenographies of 60 patients operated on over the past 8 years at the Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital were reviewed. There were 15 malignant nodules and 45 benign nodules and the prevalence of malignancy was 25%. The most common pathologic entity was tuberculoma [21 cases]. The mean age was 55.5*9.6 years in the malignant group, 45.8>12.5 years in the benign group and there was a significant statistical difference between the two groups [P < 0.05]. The malignant ratio in each age group increased with advancing age. The average smoking amount was 35.6*12.9 cigarettes per day in malignant smokers, 20.9* 12.0 cigarettes per day in benign smokers, and there was a significant statistical difference between the two groups [p< 0.05]. The malignant ratio also increased with the increasing smoking amount. Comparing the appearance of the nodule on chest films, 6 calcifications and 7 cavitations were found only in benign nodules, not in malignant nodules. Therefore, calcification and cavitation can be considered as preferential findings for benignity. Previous cancer history was also a significant factor deciding the prognosis of the nodule [p< 0.05]. The average diameter on chest X-ray was 3.07*0.82 cm in malignant nodules, 3.25*1.04 cm in benign nodules and there was no significant statistical difference between the two groups [p< 0.05]. The author used Bayes theorem to develop a simple method for combining individual clinical or radiological factors of patients with solitary nodules into an overall estimate of the probability that the nodule is malignant. In conclusion, patient age, smoking amount, appearance of nodule on chest film such as calcification and cavitation, and previous cancer history were found to be strongly associated with malignancy, but size of nodule was not associated with malignancy. Since these prognostic factors have been found retrospectively, prospective controlled studies are needed to determine whether these factors have really prognostic significance.

• Journal of Gastric Cancer
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• v.19 no.2
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• pp.173-182
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• 2019

Purpose: Intraoperative peritoneal washing cytology (PWC) is used to determine treatment strategies for gastric cancer with suspected serosal invasion. However, a standard staining method for intraoperative PWC remains to be established. We evaluated the feasibility of a rapid and simple staining method using Shorr's stain for intraoperative PWC in advanced gastric cancer. Materials and Methods: Between November 2012 and December 2014, 77 patients with clinical T3 or higher gastric cancer were enrolled. The sensitivity, specificity, and concordance between the Shorr staining method and conventional Papanicolaou (Pap) staining with carcinoembryonic antigen (CEA) immunohistochemistry (IHC) were analyzed. Results: Intraoperative PWC was performed laparoscopically in 69 patients (89.6%). The average time of the procedure was 8.3 minutes, and the average amount of aspirated fluids was 83.3 mL. The average time for Shorr staining and pathologic review was 21.0 minutes. Of the 77 patients, 16 (20.7%) had positive cytology and 7 (9.1%) showed atypical findings; sensitivity and specificity were 73.6% and 98.2% for the Shorr method, and 78.9% and 98.2% for the Pap method with CEA IHC, respectively. Concordance of diagnosis between the 2 methods was observed in 90.9% of cases (weighted ${\kappa}$ statistic=0.875) and most disagreements in diagnoses occurred in atypical findings (6/7). In overall survival, there was no significant difference in C-index between the 2 methods (0.459 in Shorr method vs. 0.458 in Pap with CEA IHC method, P=0.987). Conclusions: Shorr staining could be a rapid and reliable method for intraoperative PWC in advanced gastric cancer.

• Clinical and Experimental Pediatrics
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• v.56 no.3
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• pp.116-124
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• 2013

Purpose: Tumor necrosis factor (TNF)-${\alpha}$ is thought to contribute to pulmonary hypertension. We aimed to investigate the effect of infliximab (TNF-${\alpha}$ antagonist) treatment on pathologic findings and gene expression in a monocrotaline-induced pulmonary hypertension rat model. Methods: Six-week-old male Sprague-Dawley rats were allocated to 3 groups: control (C), single subcutaneous injection of normal saline (0.1 mL/kg); monocrotaline (M), single subcutaneous injection of monocrotaline (60 mg/kg); and monocrotaline + infliximab (M+I), single subcutaneous injection of monocrotaline plus single subcutaneous injection of infliximab (5 mg/kg). The rats were sacrificed after 1, 5, 7, 14, or 28 days. We examined changes in pathology and gene expression levels of TNF-${\alpha}$, endothelin-1 (ET-1), endothelin receptor A (ERA), endothelial nitric oxide synthase (eNOS), matrix metalloproteinase (MMP) 2, and tissue inhibitor of matrix metalloproteinase (TIMP). Results: The increase in medial wall thickness of the pulmonary arteriole in the M+I group was significantly lower than that in the M group on day 7 after infliximab treatment (P<0.05). The number of intraacinar muscular arteries in the M+I group was lower than that in the M group on days 14 and 28 (P<0.05). Expression levels of TNF-${\alpha}$, ET-1, ERA, and MMP2 were significantly lower in the M+I group than in the M group on day 5, whereas eNOS and TIMP expressions were late in the M group (day 28). Conclusion: Infliximab administration induced early changes in pathological findings and expression levels of TNF-${\alpha}$, and MMP2 in a monocrotaline-induced pulmonary hypertension rat model.

• Journal of Korean Neurosurgical Society
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• v.55 no.6
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• pp.370-374
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• 2014

To present a case of cauda equina syndrome (CES) caused by chronic inflammatory demyelinating polyneuropathy (CIDP) which seemed clinically similar to Charcot-Marie-Tooth disease type1 (CMT1). CIDP is an immune-mediated polyneuropathy, either progressive or relapsing-remitting. It is a non-hereditary disorder characterized by symmetrical motor and sensory deficits. Rarely, spinal nerve roots can be involved, leading to CES by hypertrophic cauda equina. A 34-year-old man presented with low back pain, radicular pain, bilateral lower-extremity weakness, urinary incontinence, and constipation. He had had musculoskeletal deformities, such as hammertoes and pes cavus, since age 10. Lumbar spine magnetic resonance imaging showed diffuse thickening of the cauda equina. Electrophysiological testing showed increased distal latency, conduction blocks, temporal dispersion, and severe nerve conduction velocity slowing (3 m/s). We were not able to find genetic mutations at the PMP 22, MPZ, PRX, and EGR2 genes. The pathologic findings of the sural nerve biopsy revealed thinly myelinated nerve fibers with Schwann cells proliferation. We performed a decompressive laminectomy, intravenous IgG (IV-IgG) and oral steroid. At 1 week after surgery, most of his symptoms showed marked improvements except foot deformities. There was no relapse or aggravation of disease for 3 years. We diagnosed the case as an early-onset CIDP with cauda equine syndrome, whose initial clinical findings were similar to those of CMT1, and successfully managed with decompressive laminectomy, IV-IgG and oral steroid.

• Korean Journal of Clinical Laboratory Science
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• v.39 no.2
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• pp.122-127
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• 2007

This study is a report about a specific patient whose primary stomach adenocarcinoma metastasized to uterine cervix adenocarcinoma. A thirty-nine year old female patient was initially diagnosed as having metastatic adenocarcinoma in the supraclavicular lymph node. Upon further examination, she was diagnosed with stomach adenocarcinoma. 8 months later, a cervix punch biopsy was performed. The stains used for examination were H&E stain, PAS stain, Alcian blue stain, Mucicarmine stain, Papanicolaou's (Pap.) stain, and as immunohistochemical stains, cytokeratin 7 and 20 were done. In the H&E stain, the tumor cells showed prominent and eccentric nuclei, thin nuclear membrane in abundant mucous cytoplasm, and cylinder shape. In the PAS stain, intracytoplasmic mucin vacuoles were stained with pink, and in Alcian blue and Mucicarmine stains, intracytoplasmic mucin vacuoles were stained with blue and red. As in the above results, she was diagnosed with undifferentiated adenocarcinoma. As found on the cytologic smear preparation of the uterine cervix stained by Papanicolaou's stains, the background was relatively clear, the number of malignant cells was relatively low, and large and eccentric nuclei in abundant cytoplasm were observed. Upon observing the tissue preparation of the uterine cervix biopsy by H&E stain, a clear background, large and eccentric nuclei, and a signet ring cell types were observed, and the number of malignant cells were fewer than in the primary uterine cervix adenocarcinoma. The vacuoles in cytoplasm were observed. The nuclear membrane and chromatin were thick and very rough, and upon observation by cytokeratin 7 and 20 of immunohistochemical stain, the tumor cells indicated a positive rate of 70% and 20%, respectively. According to these results, also she was diagnosed with metastasized uterine cervix adenocarcinoma. In summary of the results of pathologic findings on stomach biopsy and cytologic, histopathologic, and immunohistochemical finding on uterine cervix biopsy, the adenocarcinoma of her uterine cervix could assert the adenocarcinoma of signet ring cell type that was metastasized from the primary undifferentiated adenocarcinoma in stomach.

• Tuberculosis and Respiratory Diseases
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• v.55 no.6
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• pp.631-635
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• 2003

Idiopathic interstitial pneumonia is a group of lung disease classified by clinical, radiological and pathologic findings. Steroid is described in many reports as an effective treatment for the idiopathic interstitial pneumonitis. For the treatment of steroid non-responders, immuno-suppressive or cytotoxic agents are used as second line drug of choice. We experienced a case of nonspecific interstitial pneumonitis who was treated initially with glucocorticoid and antibiotics without effects, but later did respond to cyclosporin treatment. This 63 year-old patient was admitted due to dyspnea, cough, and sputum production. He was started on glucocorticoid and antibiotics after he was diagnosed as having nonspecific interstitial pneumonitis by open lung biopsy. The initial steroid treatment was not effective, however, after cyclosprin treatment, the patient showed clinical and radiologic improvements.

• Journal of Chest Surgery
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• v.18 no.4
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• pp.872-880
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• 1985

Myasthenia gravis is a neuromuscular transmission disorder characterized by fatigue and weakness of voluntary muscles. Although the pathogenesis is known as reduction of available acetylcholine receptors at neuromuscular junctions by autoimmune attack, the thymic role in myasthenia gravis is still unclear and under investigation. But thymectomy in the management of myasthenia gravis has become increasingly important since the first successful operation with remission of symptoms in 1939 by Blalock. From January 1983 to June 1985, authors performed 17 thymectomies for patients with myasthenia gravis. Among them, 12 patients were free from thymoma [Croup A] and 5 were coupled with thymoma [Group B]. The results were as follows: 1] Sex distribution was 11 females and 6 males. Mean age of the patients was 32.2 year old. Sex and age distribution by the Group A and B are shown Table 1. 2] Clinical manifestations of ocular symptoms were seen in 5 patients [88.2%], extremity weakness in 13 patients, bulbar weakness in 12 patients and dyspnea in 6 patients. According to the Osserman`s classification, 5 patients were in group IIA, 6 in IIB and 6 in IIC. 3] Pre-operatively, all patients were positive response to the anti-cholinesterase test and 12 patients [92.3%] revealed positive findings in electromyography [EMC] which was done in 13 patients. 4] The postoperative complications were respiratory distress in 3 patients, myasthenic crisis in 2 patients and wound disruption in one patients. 5] Pathologic examination of the thymus showed hyperplasia in 10 patients [90%] and thymoma in 5 patients, of which 4 were mixed type with invasion to the adjacent tissues and one lymphocytic type without invasion. Normal thymus was noticed in only 2 patients. 6] In postoperative evaluations, among the 12 patients c free from thymoma [Group A], complete remission of symptoms was noticed in 3 patients and improvement in 7 patients. But among the 5 patients coupled with thymoma [Group B], only one patients showed improvement [Table 8]. Therefore, remission and clinical improvement were noticed in 11 patients [64.7%] of the all and complete remission was noticed in 3 patients [17.6%].