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OBJECTIVE: To assess the diagnostic information provided by digital subtraction dacryocystography (DCG) and dacryoendoscopy in patients with epiphora. METHODS: Sixty-eight lacrimal systems of 34 patients with epiphora were prospectively studied. Patients were initially examined with syringing, followed by digital subtraction DCG and dacryoendoscopy to confirm the diagnosis. Obstructions in lacrimal pathways were evaluated by degree, location, and cause. The weighted kappa coefficient was used to compare the agreement between the tests. RESULTS: Of the 68 lacrimal pathways, partial or complete obstructions were identified in 56 cases (82.3%) with syringing, in 38 cases (55.9%) with DCG, and in 60 cases (88.2%) with dacryoendoscopy. DCG and dacryoendoscopy showed the same result in 42 of the 68 (61.8%) lacrimal pathways. The weighted kappa value for DCG and dacryoendoscopy was 0.60 (95% CI: 0.40–0.81). The most common sites of obstruction were the common canaliculus (36.7%) and the nasolacrimal duct (28.3%) in dacryoendoscopy. Thirty-three lacrimal pathways (48.5%) were identified to have obstructions on the same level between DCG and dacryoendoscopy. Among the 30 lacrimal pathways (44.1%) that were normal by DCG, obstruction was revealed in 22 cases by dacryoendoscopy, with 11 cases in the common canaliculus. Additional useful information on the cause of obstruction and identification of multiple obstructed sites was provided by dacryoendoscopy. CONCLUSIONS: DCG and dacryoendoscopy showed moderate agreement in detecting lacrimal pathway obstruction. Dacryoendoscopy allowed for comprehensive investigations of the lacrimal pathway and can help explain unidentified factors associated with lacrimal pathway obstruction in patients with epiphora.

Gastrointestinal stromal tumors are the most common mesenchymal neoplasm of the gastrointestinal tract. Distant metastasis of gastrotintestinal stromal tumors occurs in ∼50% of the cases and is usually found in the liver and peritoneum. We present a patient with diplopia which was due to a metastatic gastrointestinal stromal tumor of the clivus. Transsphenoidal resection of the tumor was performed and post-operative treatment with oral imatinib mesylate was done. One month after the surgery, treatment was started with imatinib and the patient's diplopia improved within 15 days. Follow-up computed tomography was taken 2 months after the initiation of oral imatinib, and the size of the main gastric mass has decreased. To our knowledge, this is an extremely rare case of gastrointestinal stromal tumor with metastasis to the clivus with diplopia as the presenting symptom. We report our clinical findings along with a review of the relevant literature.

The present study was carried out to identify the existence of voltage-dependent Ca2+- channels (P/Q-, N-, and L-type) and their distributional differences in germinal vesicle (GV) and GV breakdown (GVBD)-arrested mouse oocytes which includes GVBD to telophase I of meiosis I and matured oocytes (MII, metaphase of meiosis II) by using the immunocytochemical method and a confocal laser scanning microscope. (1) Comparison between follicular oocytes (GV) and GV-arrested oocytes after 17 hr of in vitro culture. In follicular oocytes, P/Q-, N-, L (anti-alpha(1C) anti-alpha(1D)) type Ca2+-channels showed both localized and uniform staining. In contrast, GV-arrested oocytes, after in vitro culture for 17 hr, showed no presence of Ca2+-channels in most oocytes. (2) Comparison between GVBD oocytes after culture in vitro for 3 hr and GVBD-arrested oocytes after culture in vitro for 17 hr. In GVBD oocytes, P/Q-, N-, L (anti-(1C), anti-alpha(1D))type Ca2+-channels showed both localized and uniform staining. In contrast, in GVBD-arrested oocytes, none of the three types of Ca2+-channels were identified in 72-86% of oocytes. The present study demonstrates that in most GVBD-arrested oocytes that do not mature to MII, there is no Ca2+-channel identified. Therefore, most of the GVBD-arrested oocytes seem to have defects in Ca2+-channel expression/translation. Also, distributional changes of Ca2+- channels take place depending on the maturation progress in GV oocytes and MII stage oocytes (ovulated and 17 hr cultured MII stage oocytes). In addition, we found evidence that a functional voltage-dependent Ca2+-channel (L-type) exists in mouse oocytes (ovulated and cultured MII staged oocytes by a confocal laser scanning microscope). (C) 2004 Wiley-Liss, Inc.

Inverted hyperplastic polyps (IHPs) of the colon are unusual variant of exophytic hyperplastic polyps that are characterized by epithelial displacement or inversion of the epithelium into the submucosa.1 To date, only a few cases of IHPs associated with adenoma or adenocarcinoma have been reported.2-4 However, due to the rarity of these polyps, their malignant potential is poorly understood. A 56-year-old man was referred to Uijeongbu St. Mary's Hospital due to a positive fecal occult-blood test during a routine health check-up. The patient had a medical history of surgery for intestinal perforation and hypertension. On admission, physical examination revealed no abnormal findings and all laboratory examination were within normal range. We performed colonoscopy for further evaluation. The colonoscopy showed a subpedunculated polyp with a large dimple, 20 mm in diameter, in the sigmoid colon (Fig. 1). An endoscopic mucosal resection (EMR) using the inject and cut technique was performed and the polyp was resected en bloc. The pathology examination showed an intramucosal cancer in an IHP (Fig. 2). The intramucosal cancer consisted mainly of well-differentiated adenocarcinoma (Fig. 2). Abdominal computed tomography showed no discernible malignant lesion. Follow-up colonoscopy revealed no remarkable findings 1 year after EMR. Fig. 1 Colonoscopy shows a subpeduculated polyp with a large dimple located in the sigmoid colon. Fig. 2 Microscopic image of the resected specimen showing an inverted hyperplastic polyp associated with intramucosal cancer, as indicated by the arrowhead in the low-magnified image (H&E stain, ×100). The intramucosal cancer consisted mainly ... IHPs of the colon were initially described by Sobin5 in 1985. They represent an unusual morphological variant of hyperplastic polyps that shows epithelial displacement into the submucosa.5 IHPs of the colon are most commonly sessile lesions and are predominantly located in the left colon.1 Although the pathogenesis and natural history remain unknown, IHPs are thought to result from local trauma.1 The characteristic endoscopic features of IHPs include sessile or superficial elevated lesions with a pitted surface or central depression.6-8 Because distinctive surface pattern of IHPs is similar to that of invasive carcinoma or depressed type adenoma, IHPs are difficult to diagnose endoscopically.2,6 Observation of the pit pattern using magnifying colonoscope may be useful to precisely diagnose IHPs because it has the same surface and cellular features as ordinary hyperplastic polyps.6 The current case showed atypical endoscopic findings with large depressed portion. In addition, the histology showed the presence of well-differentiated carcinoma in the depressed portion. To date, only a small number of cases associated with adenomas or adenocarcinoma have been described. Among them, three cases with an IHP were associated with adenomas,3 and one case with invasive cancer.4 For several years, hyperplastic polyps have been considered as non-neoplastic lesions without malignant potential. However, some hyperplastic polyps show molecular features similar to those of colorectal carcinomas. Several subtypes of serrated polyps, such as sessile serrated adenoma (traditional serrated adenoma), and mixed polyp, have been proposed to be the precursors of colorectal carcinomas.9 However, due to the rarity of IHPs, their malignant potential is poorly understood. IHPs of the colon are usually asymptomatic and are often detected incidentally on endoscopy.3 In some cases, the main clinical feature of IHPs of the colon is gastrointestinal bleeding or abdominal pain.2 Usually, an endoscopic biopsy is not sufficient to make an accurate diagnosis of an IHP of the colon. The final diagnosis of an IHP of the colon depends on the pathological examinations of EMR and endoscopic polypectomy specimens.8 Treatment for IHPs continues to be debated. Since IHPs have benign cellular characteristics of exophytic hyperplastic polyps, overtreatment should be avoided. However, endoscopic treatment is necessary in cases with associated adenomatous findings, due to their malignant potential.4 In the present case, endoscopic treatment was appropriate for the large hyperplastic polyp. In conclusion, we reported a rare case of early colon cancer developing in an IHP of the sigmoid colon treated with EMR. Further studies are needed to clarify the malignant potential of IHPs.

Coccidioidomycosis, a fungal infection caused by the fungus known as Coccidioides immitis, can affect many species of mammals and some reptiles. The fungus is endemic in the soil of the southwestern United States, Mexico, and parts of Central and South America. Most infections in humans are relatively mild or asymptomatic, but severe or fatal illness can also occur, especially in the elderly or immunocompromised. We report on a patient with disseminated coccidioidomycosis whose lymph nodes, skin, and especially brain were infected at diagnosis; however, the lung parenchyme was not infected. Because the brain infection could have been a fatal complication in this peculiar case, we recommended life-long fluconazole treatment for the patient. After 2 months of high doses of fluconazole, the patient's clinical signs were greatly improved with respect to fever, headache, skin lesions, and mediastinal widening on the chest X-ray. (Korean J Med 2012;82:734-738)

Oocyte-cumulus complexes and granulosa cells were harvested from small (1–2 mm), medium (3–5 mm), and large (6–12 mm) porcine antral follicles and cultured for 2 and 3 days. The effects of various doses of purified hCG and human FSH on progesterone secretion and monolayer formation were examined. After a 2-day culture period it was found that FSH was more effective in stimulation of progesterone secretion by cultured oocyte-cumulus complexes than in granulosa cells harvested from small follicles (P < 0.01), whereas hCG was more effective in stimulating progesterone secretion in granulosa cells than in oocytecumulus complexes harvested from large follicles. In contrast, after a 3-day culture period, granulosa cells secreted more progesterone compared to oocytecumulus complexes under control conditions or in the presence of hCG or FSH. After 3 days both FSH and hCG stimulated progesterone secretion by oocytecumulus complexes and granulosa cells; however, the hormone effect was greater upon granulosa cells than oocyte-cumulus complexes. After 3 days of culture in the case of both follicular cell types, there was a greater response to FSH in the case of cells harvested from small compared to large follicles. The reverse was true in the case of hCG responsiveness. Monolayer formation ability of oocyte-cumulus complexes was greater in the case of complexes harvested from small and medium than complexes harvested from large follicles. Addition of hCG to the cultures led to a dose-dependent decrease in monolayer formation by oocyte-cumulus complexes harvested from all sizes of follicles.

Porcine follicular oocytes from medium-sized follicles (3-5 mm in diameter) were cultured in modified Hank's balanced salts solution (MHBS) to which pyruvate, lactate, and glucose were added as an energy source. Bovine serum albumin (0.4%) was added as a protein source and the oocytes were cultured for 42 h at 37 degrees C in 5% CO2 in air. In this medium porcine oocytes underwent 80-90% nuclear maturation after 42 h. Oocytes were cultured in MHBS with various amounts of CaCl2 as well as in the presence of verapamil, a Ca2+ channel blocker, and the divalent cationophore A23187. It was found that the lowest concentration of Ca2+ required for oocyte maturation was around 0.0265-0.053 mM. Such a requirement for Ca2+ in the culture medium extended through metaphase II. If Ca2+ was omitted during the final 4 h of culture, the metaphase II chromosomes appeared extremely condensed or degenerated. Verapamil at a level of 0.2 mM inhibited germinal vesicle breakdown or resulted in degeneration, whereas lower concentrations did not affect oocyte maturation. In the presence of 0.02 mM verapamil, the maturation of cumulus-enclosed oocytes was not affected, whereas at the same dose of verapamil the maturation of denuded oocytes was inhibited. Less than 3.8 X 10(-7) M divalent cationophore did not inhibit oocyte maturation. Maturation was inhibited by 3.8 X 10(-7) and 3.8 X 10(-6) M divalent cationophore. In conclusion, maintenance of oocytes in a nondegenerated state also requires the constant presence of Ca2+ in the culture medium.

Administration of charcoal-treated aqueous extract of porcine corpus luteum on Days 0, 1, and 2 after mating inhibited coitus-induced ovulation in the rabbit. Inhibition of ovulation was evidenced by a significant (P < 0.01) inhibition of the coitus-induced rise in serum progesterone and lack of formation of corpora lutea. Administration of charcoal-treated heart or lung extract had no significant effect upon the formation of corpora lutea or on the coitus-induced rise in serum progesterone. Administration of the same extract 3 and 4 days after coitus-induced ovulation had no significant effect upon serum progesterone and further formation of corpora lutea. These data are consistent with the existence of an LH binding inhibitor in porcine corpus luteum extract which acts to inhibit the ovulatory response to the coitus-induced LH surge.

Rabbit follicular oocytes were cultured at 37 °C for 18–24 h in a basic salt medium containing 0.4% bovine serum albumin (BSA), carbohydrates and amino acids in various combinations. Osmolarity of the medium was maintained at 308 mOsm. The carbohydrates, pyruvate, lactate and glucose were all about equally beneficial, but not essential for rabbit oocyte maturation. Glutamine and proline, but not methionine or phenylalanine stimulated oocyte development. Glutamine stimulated more follicular oocytes to develop to prophase and metaphase II than did any of the three carbohydrates tested alone or in combination. Ammonia production after 24 h of culture was highest in media containing glutamine (15.2 μg/ml) but this was not inhibitory to maturation. Negligible amounts of ammonia were found with the other amino acids added. With 0, 0.08, 0.4, 2, 10 and 50 mM of glutamine in the basic salt medium, plus 0.4 % BSA, but without carbohydrates, 30, 73, 70, 71, 59 and 45 % of the follicular oocytes developed to the prophase or metaphase II stage. It is concluded that the optimum level of glutamine ranged from 0.08 to 2 mM and that no carbohydrate need be added to the medium for culturing oocytes when glutamine is included.

The mammalian oocyte is arrested in the dictyate state of meiosis from shortly before or at the time of birth until 1–2 days prior to ovulation. Under the influence of the preovulatory LH surge the oocyte in the large preovulatory follicle destined to ovulate undergoes maturation. The germinal vesicle breaks down and the first polar body is extruded. This first meiotic maturation must be completed in order to render the oocyte fertilizable. The physiological mechanism responsible for keeping the oocyte in the state of meiotic arrest is unknown. It is well documented that if the oocytes are removed from medium or large-sized follicles and cultured they resume meiotic maturation before they normally would in vivo. (Reviewed by Tsafriri, 1978; Channing et al., 1980; Schuetz, 1974.) Addition of a low molecular weight fraction of follicular fluid (FF1) (porcine, human, bovine) can inhibit the resumption of meiosis of cultured cumulus-enclosed porcine (Tsafriri and Channing, 1975; Tsafriri et al., 1976; and Stone et al., 1978), rat (Tsafriri et al., 1977; Pomerantz, Tsafriri, and Channing, 1979), and hamster (Gwatkin and Andersen, 1976) oocytes suggesting that a meiotic inhibitor is present in follicular fluid.

Progesterone stimulated oocytes to develop more rapidly in culture. The time-dependent effect was more pronounced on large preovulatory Graafian follicles than on small- and medium-sized follicles. Treatment with LH had no effect.

Follicular oocytes developed in a balanced salt medium containing universally labeled 14C-glutamine and bovine serum albumin, but no carbohydrates or other organic compounds. From the 14CO2 produced and 14C-TCA precipitable material isolated it is suggested that glutamine probably is utilized by oocytes and cumulus cells as a source of energy as well as for protein synthesis. The oocytes produced only about 32% as much 14CO2 as did the associated cumulus cells, but produced 27% more protein.

In order to compare the properties of isolated cumulus and granulosa cells, granulosa cells and cumulus cells surrounding oocytes were harvested from small (1-2 mm), medium (3-5 mm) and large (6-12 mm) porcine antral follicles and the number of LH/hCG receptors was measured by the binding of [125I]hCG. The ability of the cells to secrete progesterone in culture was examined in the presence and absence of hCG and LH. In 3 separate experiments of 1-h incubations at 37 degrees C using cells harvested from medium-sized follicles, granulosa cells bound 10--15-fold more iodinated hCG than an equivalent number of cumulus cells. During a 2-day culture period, cumulus cells secreted less progesterone than granulosa cells from medium- and large-sized antral follicles (p less than 0.01). The potential of both cumulus and granulosa cells to secrete progesterone in culture increased as the follicle progressed from small to large size. Also, the ability of the oocyte to mature in culture increased with antral follicle size. Concurrently the ability of cumulus-oocyte complexes to form monolayers in culture decreased as the follicle matured. Cumulus and granulosa cells harvested from small- and medium-sized follicles responded similarly to LH and hCG with a stimulation in progesterone secretion after 2-6 days in culture.