Morphologic reactions of regional lymphnode to inoculation of various vaccines(typhoid, BCG and smallpox)

의학과/박사[한글] Hartsock 및 Bellanti(1966)는 원숭이 및 가토에 여려가지 백신들을 접종하여 임파절변화를 관찰한바 천연두 백신 접종후 제 8일 내지 10일에 영역임파절에 많은 망상형 임파아구를 함유한 미만성 증식을 보고하였다. 그후 Hartsock(1968)는 사람에서 백신 접종후 발생된 임파염을 소급 연구한 결과 비교적 특징적인 조직학적 소견을 볼 수 있으며 Hartsock 및 Bellanti(1966)의 실험적인 백신 임파절 중식소견과 유사한 조직 소견을 관찰할 수 있다고 보고하였다. Mehrotra(1978)는 가토에 vaccinia 바이러스를 접종한 결과 접종후 제 3일 및 5일에 철저한 망상임파구의 증식을 볼 수 있었고 세포질은 pyronin 양성반응을 나타내며 접종후 제 21일에도 증대될 임파여포를 볼 수 있었다고 하였다. 그러나 실험적으로 혈청단백이나 합성된 polypeptide로 인한 임파구 반응에 대해서는 비교적 잘 알려져 있으나 백신에 대한 반응에 대해서는 아직 그 연구가 미흡하다. 임파구중 T-세포를 규명하는 방법은 양(羊)의 적혈구를 이용한 로젯(rosett)형성, 세포독성(cytotoxicity), phrtohemagglutinin에 대한 임파구변형 및 주사 전자현미경적 방법등 여려가지가 있으나 조직분포 상태를 알기 위해서는 효소화학적 방법 특히 acid phosphatase염색이 좋으며 이는 T-세포에 비교적 선택적인 반응을 나타낸다고 한다(Tamaoki and Essner, 1967; Catovsky et al. 1974; Wehinger and Mobius, 1976). 백신에는 주로 humoral immunity를 자극하여 혈청내 항체를 만들어 개체의 감염을 예방하거나 cell-mediated immunity를 자극하여 특이한 T-세포를 활성화 혹은 이들의 산물을 통해 면역을 유도하는 듯한 백신들이 있다(Friedman, 1978). 본 연구는 주로 tumoral immunity를 나타내는 typhoid백신과 cell-mediated immunity를 나타내는 BCG백신 및 바이러스 백신인 smallpox 백신을 백서에 접종하여 영역 임파절 소견을 기간별로 비교관찰하고 T-세포의 변동을 보기 위해 acid phosphatase 염색을 시행하여 각종 백신접종에 대한 영역임파절 반응을 연구하였다. 실험동물은 180gm내외의 백서 104마리를 대조군, typhoid 백신접종군, BCG 백신 접종군 및 smallpox 백신접종군으로 나누었다. 증류수를 주사한 대조군은 주사후 제 2일, 7일, 15일 및 45일에 각 2마리씩 도살하였고 실험군인 typhoid백신, BCG백신 및 smallpox백신 접종군은 접종후 제 2일, 4일, 7일, 10일, 15일, 20일, 30일 및 45일에 각 4마리씩 도살하였다. 경부임파절을 도살즉시 채취하여 일부는 냉동절편을 만들어 acid phosphatase염색을 시행하였으며 10% 포르마린에 고정한 나머지 조직은 hematoxylin-eosin염색 및 methrl-green pyronin염색을 시행하였고 planimeter를 이용하여 임파절의 피질 유피 띤수질의 각영역을 계측하떴으며 임파절의 형태학적 변화, pyronin 반응 및 acid phosphatase반응을 관찰하여 다음과 같은 성적을 얻었다. 1. 대조군은 수질이 임파절 영역의 대부분을 차지하였고 피질 여포내 배중심 및 유피질 발달이 경미하였다. 배중심은 대형임파구, 수질대는 형질세포들로 대부분 이루어졌고 acid phosphatase는 배송심내 탐식세포와 유피질에서 경도의 양성반응을 보였다. 2. Typhoid백신 접종군은 접종후 제 7일부터 퍼질면적이 증대되기 시작하여 접종후 제15일에 최고도에 달하였다가 그후 감소되어 접종후 제45일에는 대조군과 유사한 면적을 보였다. 피질면적의 증대는 여포 및 배중심 발달에 의해 이루어졌다. 한편 수질내 형질세포의 증식은 접종후 제 2일부터 증가되어 접종후 제10일 및 15일에 고도의 증식을 보였다가 이후에는 감소되었다. Acid phosphatase는 유피질에 다소 증가된 양성반응을. 3. BCG백신 접종군은 피질면적 증대가 typhoid 및 smallpox백신 접종군에 비해 경하였으나 유피질 증대는 이들보다 철저하게 증대되어 가장 뚜렷하였으며 접종후 제 2일부터 증가되어 제15일 및 20일에 최고도에 달하였고 제45일에도 유피질 증대가 지속되었다. 또한 유피질에서 acid phosphatase양성반응이 typhoid백신 접종군 보다 현저히 증가하였다. 4. Smallpox백신 접종군은 피질면적 증대가 typhoid 백신 접종군 정도로 증가되었다가 원상으로 늦게 회복되었으며 유피질증대는 BCG백신 접종군보다는 경하였으나 typhoid 백 신 접종군보다는 심하였고 BCG백신 접종군과 마찬가지로 제45일에도 유피질 증대가 지속되었다. Acid phosphatase는 유피질에서 BCG백신 접종군과 같이 typheid백신 접종군에 비해 강한 양성반응을 보였다. 이상의 성적을 종합하여 보면 typhoid백신 접종군은 주로 humoral immunity에 관여되는 피질및 수질 종식을 가져왔고 BCG백신 접종군은 주로 cell-mediated immunity에 관여하는 유피질 증대를 일으켰으며 smallpox백신 접종군은 피질 및 유피질 중식을 같이 초래하여 humoral immunity 및 cell-mediated immunity를 동시에 유발하는 것으로 사료되었다. [영문] There are vaccines that stimulate the humoral immune system preferentially and presumably protect an individual from infection by inducing serum antibody. This can either neutralize products derived from the microorganism, such as a toxin, or prevent attachments and/or infection of vital organs and tissues by the pathogen. Other vaccines, however, appear to induce immunity by stimulating cell-mediated responses, such as activation of specific T-Iymphocytes and their products, such as Iymphokines (Friedman,1978). Although it is widely accepted that vaccines prepared from attenuated microorganiams are often much more efficacious than vaccines of nonviable or inactivated microorganism, the underlying mechanisms are obscure. In addition to theme facts Hartsock (1968) has analysed crises of patients having histologic changes in enlarged Iymphnodes from the patients from smallpox or with other vaccines, including tetanus, typhoid, diphtheria, pertussis, influenza, and Salk vaccines. These reactive histologic findings were also studied in experimental animals, but ther? are only a few reports describing the sequence of changes after inoculation of vaccines(Harteock and Bellanti, 1976, Mehrotra, 1978). For the identification of of T-Iymphocytes, enzyme histochemical stainings were carried out such as acid phosphatase, acid α-naphthrlacetate esterase, etc(Tamaoki and Eagner, 1969,Catovsky et at., 1974, Wehinger and Mobiua, 1976). This study was performed to investigate differences of morphologic changes in the regional Iymphnode after inoculations of typhoid vaccine, which is considered as stimulating humoral immunity preferentially, BCG vaccine which might induce cell-mediated immunity, and smallpox vaccine, a type of virus vaccines. Enzyme histochemical staining of acid phosphatase was also carried out for identification and response of T-Iymphocytes after inoculation of the above mentioned vaccines. A total of 104 rate, each weighing 180gm, were used and divided into 4 groups. The first group was control group injected with saline. The second, third, and fourth groups were vaccinated with typhoid, BCG and smallpox vaccines, respectively. Animals were sacrificed with ether anesthesia at the 2nd, 7th, 15th, and 45th days in the control group, and at the 2nd, 4th, 7th, 10th, 15th, 20th, 30th, and 45th days after inoculation in the vaccination groups of typhoid, BCG, and smallpox. Lymphnodes from the neck were obtained, Stainings of the routine hematoxylin-eosin, methyl-green pyronin, and acid phosptatase for identification of T-Iymphocytes were made and examined. For the measurement of areas of the cortex, paracortex and medulla in the Iymphnode, a planimeter was used and it measured these areas through the mapping of Iymphnodes by a microprojector. The results are summarized as follows: 1. In the control group injected with saline, the area of the moat regional Iymphnodes was medulla of which the cords contained pyroninophilic plasma cells. The cortex of the Iymphnodes contained Iymphoid follicles with indistinct germinal centers. There was no significant change in these features in the period of days after saline inoculation. 2. In the typhoid vaccination group, at the 2nd day after vaccination, in the area of the cortex the regional Iymphnodes began to increase in size and reached an extreme degree of enlargement, due to the increased six and numbers of the germinal centers with Iymphoid follicles at the 10th and 15th days after vaocination. The size of the cortex had decreased to become similar to the cortex in the control group at the 45th day after vaccination. The proliferation of the plasma cells was prominent in the medulla at the 7th and 10th days after vaccination. 3. With BCG vaccination the Iymphnodes showed especially increased area of paracortex, unlike typhoid vaccination group. The increased area of paracortex persisted to the 45th day after vaccination. The enlargement of the paracortex was due to proliferation of the lymphocytes, which were intensely Pyroninophilic. 4. Smallpox vaccination induced follicular hyperplasia in the regional Iymphnodes, acoempanied by enlargement of the pararcotex. Although the paracortex enlargement was not as much as that with the BCG vaccination, the enlargement of the paracortex was remarkable compared with paracortex of the Iymphnodes in the typhoid vaccination, and the enlargement persisted until the 45th day after vaccination with smallpox vaccine. 5. Acid phosphatase staining for identification of T-lymphocytes revealed a positive reaction in the paracortex of the lymphnodes, while the germinal centers were negative except for positivity of macrophages. Increased positive reaction of acid phosphatase was observed in 7te paracortex both of the BCG and smallpox vaccination groups, but not so much in the typhoid Vaccination group. In conclusion, typhoid vaccination mainly brought the morphologic changes of increased of the cortex with plasma cell proliferation of medulla in the regional lymphnodes, related to the humoral immunity. However the BCG vaccination caused enlargement of paracortex of lymphnodes with increased population of T-lymphocytes concerned with cell-mediated immunity. By the inoculation of smallpox vaccine, a type of virus vaccine, enlargement of cortex with follicular hyperplasia and hypertrophy of germinal centers was demonstrated as well as enlargement of paracortex with T-lymphocytes proliferation. These were repressentative of both humoral and cell-mediated immunity as morphologic alterations in regional lymphnode.restrictio

Clinical and histopathological studies on tumors of the small and large intestine among Koreans

의학과/석사[한글] Clinical and Histopathological Studies on Tumor of the Small and Large Intestine among koreans Woon Sup Han Department of Medical Science The Graduate School Yonsei University (Directed by Prof. Dong Sik Kim, M.D. Prof. Yoo Book Lee, M.D.) The tumors of the small and large intestine have been investigated by many workers in both clinical and pathological aspects. It is of interest that although the small bowel tumors in the small bowel are rare (Botsford and Seibel, 1947; small bowel, malignancy is more common than benign tumor, and the former consist of adenocarcinoma, lymphosarcoma, carcinoids, etc. The carcinoma of the large intestine is the most frequent malignant tumor throughout the gastrointestinal tract in the U.S.A. But the incidence of this tumor was preceded by the carcinoma of the stomach in Korea (Lee et al., 1965; Kim, et al.,1967). The incidence of carcinoma of the colon and rectum in the Asian and African counties is less high than that of the Europe and America (Burkitt, 1971). Carcinoma of the large bowel occures mostly in the 5th and 6th decade of life. In the right colon carcinoma grows as fungating mass, while the distal colon shows "napkin-ring" configuration. The prognosis of a patient with cancer of the large bowel is dependent upon the spread may occur though the lymphatics, by direct extension and by the blood stream. Dukes (1932) devided his cases of carcinoma of the rectum into three groups: Type A; Limited to the rectal wall without nodal involvement Type B; Penetrating through bowel wall into adjacent tissue without nodal involvement. Type C; Penetrating through bowel with nodal involvement. This classification by Dukes has been adopted as a useful prognostic guide in dealing with carcinoma of the large bowel, and its modifications were also reported. The polypoid lesions of the large bowel can be identified to be adenomatous polyp, villous adenoma, etc. The adenomatous polyp is almost always benign, the incidence of malignant being less than 1 per cent. Villous adenoma is premalignant, the incidence of malignancy varying from 5 to 50 per cent, depending upon the series quoted. But some investigators suggested that these two lesions were growth variants of the same tumor (Hellwig, 1963; Hertz, et al.,; Ross and Ferrara). There are several reports on carcinoma of the colon and rectum in Korea, which based on clinical and statistical aspects. The present study is attempt to compare with reports of other countries, and extend to tumors of the small bowel as well as those of the large intestine. Materials and Methode The materials used in this study consist of 408 surgically resected or biopaied tissue from tumors of the large and small bowel for 12 years from 1960 to 1971. At first gross examination was made to observe size, location and growing characteristic of tumors. Regional lymphnodes were dissected and obtained as possibile as we could. All specimens were fixed in 10% formalin. For histological examinations, paraffin embeded blocks were cut in 6micron thickness and sections were stained by routine hematoxylineosin method. Histopathological studies on the cases available for microscopic examination are preformed as follows: 1. histopathological grading of carcinoma of the large bowel according to the Broders grade (1925) except the mucoid carcinoma was made; 2. The grades were comared with metastasis to regional lymphnodes of carcinoma of the large intestine and also with venous or lymphatic invasion by carcinoma of the large bowel.; 3. The carcinoma of the large bowel were classified as the Dukes' classification and staings by Smith's method were also made, and then they were made a comparison in relation to each grade of carcinoma. ; 4. The influences of size of carcinoma of the colon and rectum on metastasis to the regional lymphnodes; 5. The influences of the growing pattern of the tumor margin, infiltrating or pushing, on metastasis to the regional lymphnodes; 6. The tumors of the small bowel devided into benign and malignanttumors with location of the tumor. At the duodenum carcinomas arising from the ampullar of Vater were included in this study.; 7. The benign tumors of the large bowel also were classified in histopathological findings and associated malignant change was considered in the polyp. For the all cases which clinical redords were available, sex, age, chief complaints, duration of symptom and value of the serum hemoglobin were reviewed. The duration of recurcent carcinoma, of the large bowel was studied in relation to the staging in which readmissions for the treatment of 5-F.U. were not included. Result and Summary Clinical and histopathological studies were made on 408 surgically removed cases of tumors of the small and large intestine, that were submitted to the Department of Pathology, Yonsei University College of Medicine, during the period of 12 years from 1960 to 1971. 1. Among 41 cases of tumors of the small intestine, 37 cases were malignant tumors and the ratio of malignancy and benignancy was 9.5:1. Peutz-Jeghens syndrome was found in benign tumors of the small bowel. 2. The malignant tumors of the small intestine consisted of 11 cases of adenocarcinoma, 16 cases of lymphoma, 2 cases of carcinoid, 1 case of undifferentiated carcinoma and 7 cases of metastation malignant tumors. 3. The lymphoma occured at the ileum in total 10 cases. The carcinoids throughout the large and small intestine had its origin in extraappendiceal areas, and it showed difference from the reports of the foreign countries. 4. the ratio of the benign tumors mdfd malignant tumors in the large intestine was 1:4.8. And also the ratio of the malignant tumors of the large bowel and those of the small bowel was 8.3:1. 5. The adenomatous polyps occupid 85.9% of the benign tumors of the large intestine and 93.7% of them occured at the rectum. The 34 cases of the benign polypoid lesions of the large intestine were less that 1.5 cm of is diameter. 6. The malignant tumors of the large intestine were 4.3% of the total malignancy of surgical specimens or the same period. 7. Carcinoma of the large intestine showed different clinical symptoms according to the location. 8. The size of carcinoma of the large bowel had no much influence on the metastasis of the regional lymphnodes. 9. The grade of carcinoma of the large intestine had much effects on the venous or lymphatic invasion by carcinoma and also metastasis of the regional lymphnodes. 10. Stage 0was not identified in the cases examined and the higher the stage of carcinoma of the large intestine was, the higher the grade was. 11. The characteristics of local spread of carcinoma, infiltrating margin or pushing margin, gave much effects on the metastasis to the regional lymphnodes. 12. The tendency was seen that the recurrent period in less advanced stage of carcinoma was a little short, compared with more advanced stage. In conclusion based on above findings it can be stated that it is important to observe venous or lymphatic invasion by carcinoma, metastasis of the regional lymphnodes and to make stage of the carcinoma of the large bowel showed relatively advanced stage, and among the tumors of the small intestine the carcinoid had different location from that reported at foreign countries. [영문] The tumors of the small and large intestine have been investigated by many workers in both clinical and pathological aspects. It is of interest that although the small bowel tumors in the small bowel are rare (Botsford and Seibel, 1947; small bowel, malignancy is more common than benign tumor, and the former consist of adenocarcinoma, lymphosarcoma, carcinoids, etc. The carcinoma of the large intestine is the most frequent malignant tumor throughout the gastrointestinal tract in the U.S.A. But the incidence of this tumor was preceded by the carcinoma of the stomach in Korea (Lee et al., 1965; Kim, et al.,1967). The incidence of carcinoma of the colon and rectum in the Asian and African counties is less high than that of the Europe and America (Burkitt, 1971). Carcinoma of the large bowel occures mostly in the 5th and 6th decade of life. In the right colon carcinoma grows as fungating mass, while the distal colon shows "napkin-ring" configuration. The prognosis of a patient with cancer of the large bowel is dependent upon the spread may occur though the lymphatics, by direct extension and by the blood stream. Dukes (1932) devided his cases of carcinoma of the rectum into three groups: Type A; Limited to the rectal wall without nodal involvement Type B; Penetrating through bowel wall into adjacent tissue without nodal involvement. Type C; Penetrating through bowel with nodal involvement. This classification by Dukes has been adopted as a useful prognostic guide in dealing with carcinoma of the large bowel, and its modifications were also reported. The polypoid lesions of the large bowel can be identified to be adenomatous polyp, villous adenoma, etc. The adenomatous polyp is almost always benign, the incidence of malignant being less than 1 per cent. Villous adenoma is premalignant, the incidence of malignancy varying from 5 to 50 per cent, depending upon the series quoted. But some investigators suggested that these two lesions were growth variants of the same tumor (Hellwig, 1963; Hertz, et al.,; Ross and Ferrara). There are several reports on carcinoma of the colon and rectum in Korea, which based on clinical and statistical aspects. The present study is attempt to compare with reports of other countries, and extend to tumors of the small bowel as well as those of the large intestine. Materials and Methode The materials used in this study consist of 408 surgically resected or biopaied tissue from tumors of the large and small bowel for 12 years from 1960 to 1971. At first gross examination was made to observe size, location and growing characteristic of tumors. Regional lymphnodes were dissected and obtained as possibile as we could. All specimens were fixed in 10% formalin. For histological examinations, paraffin embeded blocks were cut in 6micron thickness and sections were stained by routine hematoxylineosin method. Histopathological studies on the cases available for microscopic examination are preformed as follows: 1. histopathological grading of carcinoma of the large bowel according to the Broders grade (1925) except the mucoid carcinoma was made; 2. The grades were comared with metastasis to regional lymphnodes of carcinoma of the large intestine and also with venous or lymphatic invasion by carcinoma of the large bowel.; 3. The carcinoma of the large bowel were classified as the Dukes' classification and staings by Smith's method were also made, and then they were made a comparison in relation to each grade of carcinoma. ; 4. The influences of size of carcinoma of the colon and rectum on metastasis to the regional lymphnodes; 5. The influences of the growing pattern of the tumor margin, infiltrating or pushing, on metastasis to the regional lymphnodes; 6. The tumors of the small bowel devided into benign and malignanttumors with location of the tumor. At the duodenum carcinomas arising from the ampullar of Vater were included in this study.; 7. The benign tumors of the large bowel also were classified in histopathological findings and associated malignant change was considered in the polyp. For the all cases which clinical redords were available, sex, age, chief complaints, duration of symptom and value of the serum hemoglobin were reviewed. The duration of recurcent carcinoma, of the large bowel was studied in relation to the staging in which readmissions for the treatment of 5-F.U. were not included. Result and Summary Clinical and histopathological studies were made on 408 surgically removed cases of tumors of the small and large intestine, that were submitted to the Department of Pathology, Yonsei University College of Medicine, during the period of 12 years from 1960 to 1971. 1. Among 41 cases of tumors of the small intestine, 37 cases were malignant tumors and the ratio of malignancy and benignancy was 9.5:1. Peutz-Jeghens syndrome was found in benign tumors of the small bowel. 2. The malignant tumors of the small intestine consisted of 11 cases of adenocarcinoma, 16 cases of lymphoma, 2 cases of carcinoid, 1 case of undifferentiated carcinoma and 7 cases of metastation malignant tumors. 3. The lymphoma occured at the ileum in total 10 cases. The carcinoids throughout the large and small intestine had its origin in extraappendiceal areas, and it showed difference from the reports of the foreign countries. 4. the ratio of the benign tumors mdfd malignant tumors in the large intestine was 1:4.8. And also the ratio of the malignant tumors of the large bowel and those of the small bowel was 8.3:1. 5. The adenomatous polyps occupid 85.9% of the benign tumors of the large intestine and 93.7% of them occured at the rectum. The 34 cases of the benign polypoid lesions of the large intestine were less that 1.5 cm of is diameter. 6. The malignant tumors of the large intestine were 4.3% of the total malignancy of surgical specimens or the same period. 7. Carcinoma of the large intestine showed different clinical symptoms according to the location. 8. The size of carcinoma of the large bowel had no much influence on the metastasis of the regional lymphnodes. 9. The grade of carcinoma of the large intestine had much effects on the venous or lymphatic invasion by carcinoma and also metastasis of the regional lymphnodes. 10. Stage 0was not identified in the cases examined and the higher the stage of carcinoma of the large intestine was, the higher the grade was. 11. The characteristics of local spread of carcinoma, infiltrating margin or pushing margin, gave much effects on the metastasis to the regional lymphnodes. 12. The tendency was seen that the recurrent period in less advanced stage of carcinoma was a little short, compared with more advanced stage. In conclusion based on above findings it can be stated that it is important to observe venous or lymphatic invasion by carcinoma, metastasis of the regional lymphnodes and to make stage of the carcinoma of the large bowel showed relatively advanced stage, and among the tumors of the small intestine the carcinoid had different location from that reported at foreign countries.restrictio

Diagnostic algorithm for papillary urothelial tumors in the urinary bladder

Papillary urothelial neoplasms with deceptively bland cytology cannot be easily classified. We aimed to design a new algorithm that could differentiate between these neoplasms based on a scoring system. We proposed a new scoring system that enables to reproducibly diagnose non-invasive papillary urothelial tumors. In this system, each lesion was given individual scores from 0 to 3 for mitosis and cellular thickness, from 0 to 2 for cellular atypia, and an additional score for papillary fusion. These scores were combined to form a summed score allowing the tumors to be ranked as follows: 0-1 = UP, 2-4 = low malignant potential (LMP), 5-7 = low-grade transitional cell carcinoma (TCC), and 8-9 = high-grade TCC. In addition to the scoring system, ancillary studies of MIB and p53 indexes with CK20 expression pattern analyses were compared together with clinical parameters. The MIB index was strongly correlated with disease progression. Four of the 22 LMP patients (18.2%) had late recurrences, two of these four (9.1%) had progression to low-grade carcinoma. The MIB index for LMP patients was strongly associated with recurrence (recurrence vs. non-recurrence, 16.5 vs. 8.1, p<0.001). The proposed scoring system could enhance the reproducibility to distinguish papillary urothelial neoplasms. © 2008 Springer-Verlag

Minimally differentiated acute myelogenous leukemia presented with multiple cervical lymphadenopathy

Lymphadenopathy is a relatively uncommon finding of minimally differentiated acute myelogenous leukemia(AML-M0). We experienced a case of AML-M0 in a 57-year-dd man initially presented with multiple cervical lymphadenopathy. Bone marrow aspiration revealed myeloblasts, which were negative for myeloperoxidase, Sudan black B, Periodic acid-Schiff, non-specific esterase and double esterase reaction. In cell surface marker studies, CD13, CD14, CD33, CD34, CD45 and HLA-DR were present. CT scan of neck demonstrated multiple lymphadenopathy at both internal jugular chains, spinal accessary chains and submandibular area. He died about two weeks after diagnosis without specific treatment

Pericarditis due to Tsutsugamushi disease

Tsutsugamushi Disease is an acute febrile illness caused by Rickettsia tsutsugamushi, which enters into the human bloodstream through the bite of leptotrombidium, It is characterized by eschar, fever and cutaneous rash. Pericardial effusion in Tsutsugamushi Disease is not a common manifestation, although a high rate of effusion was reported in autopsy in those who had died of the disease. Here, we report a case of Tsutsugamushi pericarditis documented by indirect immunofluorescent test of pericardial fluid, and give a brief review of the literature

Expression of epidermal growth factor receptor in cervical tissue and serum in patients with cervical neoplasia

Objective. We hypothesized that there may be a relationship between epidermal growth factor receptor (EGFR) expression in cervical tissue and serum in patients with cervical neoplasia. Materials and Methods. The expression of EGFR was measured in cervical tissues from 23 cervical intraepithelial neoplasia patients and 16 cervical carcinoma patients using immunohistochemical staining and the level of serum EGFR extracellular domain was measured in serum from 17 cervical intraepithelial neoplasia patients and 14 cervical carcinoma patients using enzyme-linked immunosorbent assay. Results. The expression of EGFR was significantly increased as normal cervical tissue progressed to cervical intraepithelial neoplasia then to cervical carcinoma (p = .009). The mean level of serum EGFR according to the intensity of immunohistochemical staining in negative, weakly positive, positive, and strongly positive staining was 19.36 ± 3.12 fmol/mL, 20.99 ± 3.59 fmol/mL, 29.08 ± 16.86 fmol/mL, and 24.34 ± 10.35 fmol/mL, respectively (p = .450). Conclusions. We believe that the level of serum EGFR may have a similar role as tumor markers such as the EGFR expression in cervical neoplastic tissue

Renal cell carcinoma in South Korea: A multicenter study

The incidence of renal cell carcinoma (RCC) in South Korea is steadily becoming similar to that in Western countries. This study summarizes the results of a 3-year multicenter survey of RCC in South Korea, conducted by the Korean Genitourinary Pathology Study Group. A total of 795 cases of RCC were collected from 20 institutes between 1995 and 1997, including 686 clear cell RCCs (86.3%), 58 papillary RCCS (7.30%), 49 chromphobe RCCs (6.16%), and 2 collecting duct RCCs (0.25%). At least 5 years of follow-up was available for 627 clear cell, 54 papillary, and 49 chromophobe RCCs. All subtypes presented most frequently with stage T3aN0M0 at the time of operation, and papillary RCCs demonstrated more frequent lymph node metastasis. Overall survival was not significantly related to the histological subtype (clear cell vs papillary, P = 0.8651; clear cell vs chromophobe, P = 0.0584; papillary vs chromophobe, P = 0.0743). For clear cell RCCs, statistically significant associations were found between overall survival and sex (P = 0.0153), multiplicity (P = 0.0461), necrosis (P = 0.0191), age, sarcomatoid change, TNM stage, nuclear grade, and modality of treatment (all P <0.0001). Overall survival was significantly associated with tumor size (P = 0.0307), nuclear grade (P = 0.0235), multiplicity, sarcomatoid change, and TNM stage (all P <0.0001) for papillary RCCs and with the presence of sarcomatoid change (P = 0.0281), nuclear grade (P = 0.0015), treatment modality (P = 0.0328), and TNM stage (P <0.0001) for chromophobe RCCs. Age (P = 0.0125), nodal stage (P = 0.0010), and treatment modality (P = 0.0001) were significant independent prognostic indicators for clear cell RCC on multivariate analysis. This is the first multicenter study of RCC in South Korea, demonstrating the general patterns and prognostic factors of Korean RCCs. © 2004 Elsevier Inc. All rights reserved

Detection of transforming growth factor-α in the serum of gastric carcinoma patients

Transforming growth factor-α (TGF-α) is a ligand for epidermal growth factor receptor (EGFR) and it is overexpressed in various malignancies including lung, esophageal, colorectal, ovarian and gastric carcinomas. In patients with gastric carcinoma, its overexpression may be associated with advanced stage or poor prognosis. We have recently demonstrated that the mean serum level for EGFR in gastric carcinoma patients was significantly elevated compared with that of healthy controls. Using the enzyme-linked immunosorbent assay, the levels of TGF-α were determined in serum from 40 patients with gastric carcinoma (5 patients with stage I, 2 stage II, 4 stage III, and 29 stage IV patients) and 33 healthy controls. The mean serum level for TGF-α in the gastric carcinoma patients was significantly elevated as compared with that of healthy controls (104 ± 235 vs. 22 ± 16 pg/ ml; p = 0.03). Eleven patients with gastric carcinoma (27.5%) showed elevated serum TGF-α levels above the cutoff value of 54 pg/ml (defined as 2 standard deviations above the mean of the control group). No significant association was noted between the positivity of TGF-α and clinicopathologic characteristics including gender, age and stage. However, poorly differentiated adenocarcinoma showed a higher positivity of serum TGF-α (43.8%) compared with other histologic types, which was marginally significant (p = 0.06). These results suggest that serum TGF-α could be useful as a tumor marker of gastric carcinoma for predicting prognosis and follow-up after surgery in patients whose initial serum TGF-α levels are elevated

Effects of estrogen on nitric oxide synthase and histological composition in the rabbit clitoris and vagina

We investigated the functional and histological changes after oophorectomy in the rabbit clitoris and vagina to determine the mechanism responsible for the development of arousal disorder in postmenopausal women. Twenty mature female New Zealand white rabbits were randomly divided into three groups: control; oophorectomy; and estrogen replacement after oophorectomy. We compared the nitric oxide synthase (NOS) activity and the degree of expression of neuronal (nNOS) and endothelial NOS (eNOS) using biochemical and Western blot analysis in clitoral and vaginal tissues. Histological change of smooth muscle and collagen contents in those tissues were also compared using Masson's trichrome staining. NOS activity and the expression of nNOS and eNOS were significantly increased in the oophorectomized group while there was a decrease to the level of the control group in the estrogen replacement group. Histological examination showed that oophorectomy induced a significant increase in collagen and decrease in muscle content in both clitoris and vagina, while the ratio of smooth muscle content was increased significantly after the estrogen replacement. Our results clearly demonstrate that estrogen deficiency induces compensatory NOS production which may be related to decreases in muscle to collagen ratio in female rabbit genital organs

The use of an in vitro adenosine triphosphate-based chemotherapy response assay to predict chemotherapeutic response in breast cancer

The adenosine triphosphate-based chemotherapy response assay (ATP-CRA) has the advantages of standardization, evaluability, reproducibility, and accuracy, and can be performed on relatively small numbers of tumor cells. A total of 43 patients were enrolled in the present study, and chemosensitivity tests were successfully performed in 40 (93.0%) of these patients. Twenty of the 40 received neoadjuvant chemotherapy or chemotherapy for metastatic breast cancer. The chemotherapy regimens used were doxorubicin plus docetaxel (n=9, 45.0%) or doxorubicin plus paclitaxel (n=11, 55.0%). Mean cell death rate, as determined by ATP-CRA, was lower in non-responders than in responders to therapy (P=0.012). Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for ATP-CRA were 78.6%, 100%, 100%, 66.7%, and 85.0%, respectively. Diagnostic accuracy achieved by immunohistochemistry using estrogen receptor or progesterone receptor was lower than that achieved using ATP-CRA. Expression of p53, erb-B2, Ki67, Bcl-2, Bcl-xL, and annexin I was not significantly associated with response to chemotherapy. Our results show that ATP-CRA has high specificity and positive predictive value for predicting response to chemotherapy. © 2007 Elsevier Ltd. All rights reserved