Association Between Blood Sugar Level, Psychological Impact, and Emotional Symptoms in Patients Newly Diagnosed with Diabetes / 임상당뇨병

As the duration of diabetes mellitus (DM) increases, the risk of complications increases and the prevalence of depression becomes higher. Most studies on depression in Korean patients with DM have focused on a point 5-10 years after diagnosis, and there has not been much data reported regarding the early stages of DM, including newly developed DM. In this study, we examined whether blood glucose levels could be associated with emotional symptoms such as depression (DS) and anxiety (AS) in patients newly diagnosed with DM. Serum glucose and HbA1c were measured in 89 patients with DM. The Impact of Event Scale (IES) was used to investigate the extent of the psychological impact of a diagnosis of DM. The IES comprises four elements: hyperarousal, intrusiveness, avoidance, and sleep problems. DS and AS were investigated using the Hospital Anxiety and Depression Scales. DS was observed in 32 patients (36%) and AS was observed in 21 patients (23.6%), indicating a higher prevalence of DS and AS than in the general population. There was an inverse correlation between HbA1c and DS (Pearson's correlation coefficient: R = -0.227; P = 0.035), but no correlation was found for AS. The four elements of the IES had significant correlations with DS and AS. Logistic regression analysis showed that sleep problems (OR = 1.437) and HbA1c (OR = 0.51) were associated with DS, but only intrusiveness (OR = 0.629) showed a correlation with AS. In patients newly diagnosed with DM, DS is associated with sleep problems and low HbA1c levels. Emotional symptoms should be considered as part of glucose control, and efforts to mitigate psychological stress during the initial period of diabetes management should be made.

Assessment of Abdominal Fat and Mid-Thigh Low-Density Muscle Areas in Patients with Schizophrenia / 대한정신약물학회지

OBJECTIVE: Patients with schizophrenia are at a higher risk for developing insulin resistance and type 2 diabetes mellitus (T2DM). However, few studies have examined abdominal fat and mid-thigh low-density muscle areas, which are known risk factors for insulin resistance and T2DM, in patients with schizophrenia. Therefore, we measured the abdominal fat and mid-thigh low-density muscle areas of schizophrenics and compared them with normal controls. METHODS: Nineteen (four men and 15 women) drug-naive or -free subjects who met the DSM IV criteria for schizophrenia and 19 age- and sex-matched controls were recruited. We measured weight, height, waist circumference, and percent body fat, and calculated the body mass index (BMI). Abdominal fat and mid-thigh low-density muscle areas were evaluated using computed tomography. RESULTS: There was no significant difference in terms of age and BMI between the two groups. The areas of abdominal fat (262.4+/-101.8 vs. 257.1+/-93.8 cm2 ; p=0.919), subcutaneous fat (182.4+/-72.8 vs. 180.5+/-75.1 cm2 ; p=0.988), visceral fat (79.9+/-47.2 vs. 76.6+/-49.3 cm2 ; p=0.872), and mid-thigh low-density muscle (15.0+/-9.9 vs. 15.4+/-5.2 cm2, p=0.373) did not differ between schizophrenics and controls. CONCLUSION: Abdominal obesity is a well-recognized risk factor for developing certain medical conditions such as insulin resistance and T2DM. We demonstrated that drug-naive or- free patients with schizophrenia do not have increased visceral fat or mid-thigh low-density muscle areas, which might have explained the higher prevalence of insulin resistance and T2DM in these patients.

Nodular Gastritis and Pathologic Findings in Children and Young Adults with Helicobacter pylori Infection

PURPOSE: The aim of this study was to investigate the pathologic characteristics of nodular gastritis in children and young adults infected with Helicobacter pylori (H. pylori). MATERIALS AND METHODS: A total of 328 patients were enrolled in this study, and the diagnosis of H. pylori infection was done with gastroduodenal endoscopy concomitant with a CLO

Association between Left Ventricular Hypertrophy (LVH) and Angiotensin Converting Enzyme (ACE) Gene Polymorphism in Diabetic Nephropathy Patients / 대한신장학회잡지

BACKGROUND: Left ventricular hypertrophy (LVH) is an important risk factor of cardiovascular disease in diabetic nephropathy patients. Renin-angiotensin system has an independent role as a neurohormonal factor in promoting cardiac growth and remodeling. Genetic and environmental factors also influence the pathogenesis of LVH. The association of LVH progression and angiotensin converting enzyme (ACE) gene polymorphism is well known, especially in ACE DD genotype. But there is some controversy between LVH and ACE gene polymorphism. So, we evaluated the prevalence and patterns of LVH and analyzed the associated factors including ACE polymorphism in diabetic nephropathy patients. METHODS: One hundred and eighty one type 2 diabetic patients with overt proteinuria were recruited in the study. ACE genotyping and echocardiogram were performed to observe the association between LVH and ACE polymorphism. RESULTS: The prevalence of LVH was 141 out of 181 (77.9%) patients (concentric, 35.9% and eccentric, 42.0%, each). Patterns of LVH, left ventricular mass (LVM), and left ventricular mass index (LVMI) showed no differences among the three genotypes. But, LVMI was higher in DD genotype group than in II group in men (171.2 vs. 144.8, p=0.028). On the other hand, in women, there were no differences of clinical and echocardiographic variables among three genotypes. LVM and LVMI were negatively correlated with hemoglobin level in all patients. CONCLUSION: The results suggest that ACE DD genotype is associated with LVH in male patients with diabetic nephropathy, but not in female patients. Determining whether or not the gender influences LVH in the diabetic nephropathy patients will require further studies.

Clinicopathologic Review of Pulmonary Silicone Embolism with Special Emphasis on the Resultant Histologic Diversity in the Lung: A Review of Five Cases

It is known that the subcutaneous injection of silicone can lead to severe pulmonary complications, followed in some patients by respiratory failure. Currently, silicone is being increasingly applied in the field of plastic surgery and, unfortunately, the illicit injection of silicone fluid by uncertified practitioners is not uncommon in Korea. We offer a critical pathologic review of 5 cases of pulmonary silicone embolism following illegal injection to the vaginal wall, four of which were fatal and came to legal autopsy. Our findings again confirm that subcutaneously injected silicone can gain access to the pulmonary vascular tree and cause pulmonary embolism. The histologic changes observed in the lung are variable and include four patterns i.e., the mere presence of silicone emboli, congestion and hemorrhage, acute pneumonitis, and diffuse alveolar damage despite the severe critical course in all cases. We were unable to find any histologic pattern that correlates well with the clinical course. Apart from producing emboli in the pulmonary vessels, subcutaneous injection of silicone can obviously cause serious pulmonary disease due to its ability to induce acute to induce acute pneumonitis and even possibly acute respiratory distress syndrome.

Medullomyoblastoma with Neuronal and Rhabdomyoblastic Differentiation

Medullomyoblastoma is a very rare central nervous system tumor and is regarded to be a variant of medulloblastoma showing a rhabdomyoblastic component. We found 32 cases of medullomyoblastoma in English literature. We recently experienced a case of a cerebellar medullomyoblastoma with neuronal differentiation in a 15-year-old girl who displayed headaches and vomiting. The tumor displayed extensive neuronal and myoblastic differentiation on microscopic and immunohistochemical examination. On ultrastructural study, the tumor obviously demonstrated rhabdomyoblastic features showing myofilaments composed of actin and myosin with well developed Z-bands.

An Impacted Distal Common Bile Duct Stone Mimicking a Tumor: An Unusual Manifestation of Gallstone Disease / 대한소화기내시경학회지

Patients with bile duct stones usually present with biliary pain, obstructive jaundice, ascending cholangitis, or pancreatitis. When endoscopic retrograde cholangiopancreatography (ERCP) is performed, bile duct stones are usually movable and thus easily detected. If a stone in the bile duct presents unusually, it may pose some diagnostic challenges. Recently, we experienced a case of an impacted distal common bile duct (CBD) stone mimicking a tumor which resulted in performing a pylorus-preserving pancreaticoduodenectomy in an asymptomatic 56-year-old man. On ERCP, an obstructing distal CBD lesion did not move even by doing brush cytology. Moreover, the result of brush cytology was positive for atypical cells. A major resective surgery performed after recovery from severe post-ERCP pancreatitis confirmed the diagnosis. Interestingly, this stone caused erosion with acute and chronic inflammation and fibrosis containing foci of mild epithelial dysplasia. We herein report an unusual manifestation of gallstone disease with a review of the literature.

A Case of Squamous Cell Carcinoma of Thymus with Negative CD5, Cytokeratin 7 and Positive Cytokeratin 13 / 결핵

The most common anterior mediastinal tumors originate from the thymus. Among them, thymic carcinomas occur as an early local invasion and wide spread metastases. However, when squamous cell carcinoma in the thymus or mediastinum is identified, an occult primary lung cancer must be excluded because the histologic types resemble those found more typically in the lung. CD5 and cytokeratin immunohistochemical staining is useful in evaluating biopsy samples from those tumors. Spuamous cell carcinoma of an unknown primary origin in the mediastinum is a rare occurrence and there are only a handful of case reports. Here we describe a case with an anterior mediastinal mass of squamous cell carcinoma with unknown primary origin. A resection of the mediastinal mass without an association with the lung was performed. Immunohistochemical stainings were positive using cytokeratin 13, and negative using CD5 and cytokeratin 7. This was followed by chemotherapy for presured thymic carcinoma.

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.

Diagnostic Usefulness of MRI for Pulmonary Hamartoma: CT, MRI and Histopathologic Correlations

PURPOSE: To determine the diagnostic usefulness of MRI in pulmonary hamartoma, and the significant MRI features other than fat or characteristic calcification, both revealed by CT. MATERIALS AND METHODS: We prospectively studied chest MR images in five patients with pulmonary hamartoma. All underwent narrow-collimated CT scanning and conventional MRI, specimen MRI was available in three cases. Pulmonary nodular size, shape and margin and the presence of intratumoral fat density, calcification and a cleft-like structure were determined. At MRI, the presence and signal intensity (SI) of the cleft-like structure, including intratumoral cystic space and SI of the main portion of the tumor, were analyzed and compared with the findings of specimen MRI, and correlated with the histopathologic findings. In three cases, the typical enhancement pattern revealed by post-contrast MRI was also evaluated. RESULTS: Narrow-collimated CT scanning revealed fat density or popcorn-shape calcification in two cases and a cleft-like structure in one. The other two cases showed neither fat nor calcification. At MRI, however, all five cases showed a cleft-like structure, which was especially evident on T2WI. The detectability of this did not vary between conventional and specimen MRI. The cleft-like structure showed varying SI on T1, and T2WI correlated to variable mesenchymal component including with respiratory epithelial cells lining the cleft. Marginal rim enhancement was noted on all three post-contrast MR images, and correlated with the relatively rich vascularity of the tumor's marginal portion. An enhanced cleft-like structure was noted in two cases. CONCLUSION: The presence of a cleft-like structure, especially prominent on T2WI and with variable SI, is a useful MR finding for the diagnosis of pulmonary hamartoma, and marginal rim enhancement is an ancillary diagnostic MR finding. In particular, MRI is a useful diagnostic tool in cases where a simple pulmonary nodule demonstrates neither fat nor calcification.

Teratoid Hepatoblastoma: Multidirectional Differentiation of Stem Cell of the Liver

Hepatoblastoma is the most common malignant hepatic neoplasm of childhood, showing a wide spectrum of epithelial and mesenchymal components. Teratoid hepatoblastoma, which reveals multiple lines of tissue differentiation such as mucinous epithelium, melanin pigment, endocrine differentiation, glial and mesenchymal components, has rarely been observed. We report a case of teratoid hepatoblastoma in a 22-month-old girl. She had been diagnosed with hepatoblastoma through percutaneous needle biopsy of the liver and treated with 10 chemotherapy cycles of epirubicin, VP-16 and cisplatin and with hepatic artery embolization. After 10 months, an extended left lobectomy was performed. Grossly, a multinodular, partly well-demarcated, solid mass (7 x 5 cm) with dense fibrosis and focal cystic change occupied almost the entire specimen. There was extensive necrosis due to preoperative treatment. Microscopically, the tumor showed multiple lines of differentiation, which was composed of embryonal, fetal hepatocytes and mesenchymal elements with numerous foci of osteoid. There were also other components showing endodermal, neural, melanocytic and endocrine differentiation. These teratoid components were considered relatively resistant to preoperative chemotherapy, in contrast to extensive necrosis of both embryonal and fetal hepatocytes. These teratoid features of hepatoblastoma are considered to be a multidirectional differentiation of the small epithelial cells or stem cells of the tumor.

Malakoplakia in a Renal Allograft: A case report / 대한이식학회지

Malakoplakia is a rare inflammatory disease which usually involves the lower urinary tracts, especially in immunocompromised patients. The characteristic feature is parenchymal infiltration by macrophages, known as von Hansemann cells, and intra- or extracytoplasmic Michaelis-Gutmann bodies. We report a case of renal malakoplakia in a renal allograft patient. Renal allograft biopsy was performed 1.5 years posttransplantation under the impression of chronic rejection. By light microscopy, inflammatory infiltrate composed of many macrophages and Michaelis-Gutmann bodies were present in the renal medulla and accompanied by moderate tubular atrophy and interstitial fibrosis. (J Korean Soc Transplant 2001;15:256-258)

Thymoma with Pseudosarcomatous Stroma

Thymoma with psuedosarcomatous stroma is a recently described, rare variant of thymomas that are characterized by having a biphasic histologic pattern which consists of both an epithelial and a spindle cell stromal component. So far only 11 cases having similar histologic findings have been reported world wide. At this time we report a case of this rare variant of thymoma which occurred in a 53-year-old Korean man. This previously healthy patient presented with coughing and an anterior mediastinal mass was then detected radiographically. Mediastinal exploration revealed a 9 x 8 x 8 cm-sized well- encapsulated, ovoid, cystic mass. Histological examination showed a biphasic neoplasm composed of anastomosing nests of epithelial cells and somewhat cellular stromal spindle cells that had advanced degenerative changes. Immunohistochemical staining using the antibodies for cytokeratins, EMA, e-cadherin, and p75NGFR showed a strong expression of these markers in the epithelial component but no expression in the spindle stromal cells. The epithelial tumor cells showed no reactivity to CD5 and L26 and a high proportion of the infiltrated lymphocytes were the cortical type that expressed CD99 and terminal deoxynucleotidyl transferase. Ultrastructural examinations revealed tonofilaments in the spindle cells. Follow up has been done for 5 years after the surgical excision and the patient has been free of disease during that period. Similar to previous reports, this patient had a benign clinical course that was unassociated with myasthenia gravis which appears to be a characteristic of this histologic variant of thymoma. However, our case also showed advanced degenerative features and we could demonstrate ultrastructural evidence of epithelial differentiation in the stromal spindle cells that were not mentioned in the previously reported cases. Based on the results of our studies, we suggest this entity is a distinct type of organotypic thymoma that shows cortical differentiation and abundant cellular stroma.

The Expression of DNA Dependent Protein Kinase Protein in Malignant Lymphoma

BACKGROUND: DNA dependent protein kinase (DNA-PK) composed of Ku70, Ku80 and DNA-PK catalytic subunit (DNA-PKcs), plays an important role in the primary repair of break points of damaged DNA and is involved in the recombination of the V, D, and J genes. Loss of DNA-PK may lead to immunodeficiency and malignant lymphomas. This hypothesis has been supported by animal study in a Ku70 knock-out mouse model. The relationship between DNA-PK and human malignant lymphoma has not yet been studied. METHODS: We examined the loss of DNA-PK proteins in 85 representative cases of different subtypes of malignant lymphoma. Immunohistochemical stains for DNA-PK subunits were performed on formalin-fixed and paraffin-embedded tissue sections. RESULTS: Lymphomas demonstrated statistically significant loss of Ku70, Ku80 and DNA-PKcs. T cell lymphomas showed more loss of DNA-PK proteins in comparison with B cell lymphomas. According to the World Health Organization (WHO) classification system, both T cell lymphomas and high-grade subtypes of B cell lymphomas demonstrated similar degree of loss of DNA-PK proteins. CONCLUSIONS: We confirmed the loss of DNA-PK proteins in malignant lymphomas through the results of our study, and the loss of these proteins seems to be more significant in high-grade lymphomas. These findings support the role of DNA-PK as a tumor suppressor gene.

Lobular carcinoma in situ in sclerosing adenosis

The initial presentation of breast malignancy as noninvasive carcinoma in an area of sclerosing adenosis is unusual. Especially, lobular carcinoma in situ in sclerosing adenosis sometimes can be a potential source of confusion with invasive lobular carcinoma. We report a case of lobular carcinoma in situ presenting in adenosis exhibiting patterns akin to invasive lobular carcinoma, thus leading to potential misdiagnosis. Overall architecture of the lesion as seen at lower power and immunohistochemistry can be useful to distinguish between sclerosing adenosis with lobular carcinoma in situ and infiltrating lobular carcinoma.

Primary carcinoma of the fallopian tube coexisting with benign cystic teratoma of the ovary

Primary carcinoma of the fallopian tube is a rare malignancy of the female genital tract and infrequently diagnosed before an operation. The majority of patients have extensive disease at the time of diagnosis. We have experienced incidentally a case of a carcinoma of the fallopian tube coexisting with a benign cystic teratoma of the ovary in a 25-year-old woman. We report this case with a brief review of literatures.

A Case of Insulinoma Combined with Pheochromocytoma / 대한내분비학회지

Multiple endocrine neoplasia (MEN) is a combination of endocrine tumor associations and consists of 3 types: 1, 2A and 2B. Herein, we report a case of insulinoma which is combined with pheochromocytoma discovered at the left adrenal gland which was treated by surgical resection. We think there is a possibility of a new type of multiple endocrine neoplasia (MEN).

A case of Primary Transitional Cell Carcinoma of Ureteral Stump Following nephreetomy for renal tuberculosis / 대한비뇨기과학회지

No abstract available.