Death due to Pulmonary Thromboembolism with Cerebral Venous Thrombosis / 대한법의학회지

Cerebral venous thrombosis is an uncommon cause of cerebral infarction. A 31-year-old man complained of headache, weakness, and numbness of the left leg a day before being admitted to the hospital. After admission, brain computed tomography and brain magnetic resonance imaging revealed superior sagittal sinus thrombosis with cerebral infarction in the right hemisphere. He had no significant medical history. On the fourth hospital day, he suddenly collapsed and died. Medicolegal autopsy was performed 3 days later; medical malpractice was suspected. External examination revealed a few conjunctival petechiae. Internal examination revealed thrombi in the superior sagittal sinus and superficial cortical veins. Thrombi were noted in the pulmonary trunk and both pulmonary arteries. Upon dissection of the left leg, we found thrombi in the posterior tibial vein. A microscopic examination revealed vasculitis of the same cortical veins, and we therefore assumed that vasculitis of the cortical veins gave rise to thrombosis. In typical autopsy practice, an examination of the dura mater is often overlooked, but careful examination of this region should be performed in cases of cerebral infarction in young adults, such as this one.

Evaluation of Protein Expression in Housekeeping Genes across Multiple Tissues in Rats

BACKGROUND: Housekeeping genes, which show constant protein expression patterns between different tissue types, are very important in molecular biological studies as an internal control for protein research. METHODS: The protein expression profiles of seven housekeeping genes (HPRT1, PPIA, GYS1, TBP, YWHAZ, GAPDH and ACTB) in various rat tissues (cerebrum, cerebellum, cardiac ventricle and atrium, psoas muscle, femoral muscle, liver, spleen, kidney, and aorta) were analyzed by Western blot and compared by coefficient of variation (CV). RESULTS: HPRT1 was stably expressed (CV< or =10%) in six tissues (cerebrum, cerebellum, ventricle, femoral muscle, spleen, and kidney), PPIA was stably expressed in five tissues (cerebrum, cerebellum, ventricle, spleen and kidney), YWHAZ was stably expressed in three tissues (cerebrum, cerebellum, and kidney), and GAPDH was stably expressed in four tissues (cerebrum, ventricle, psoas muscle, and kidney). In comparison, GYS1, TBP, and ACTB were found to have CV values over 10% in all tissues. Of the seven genes examined, four (HPRT1, PPIA, YWHAZ, and GAPDH) were found to be stably expressed across multiple organs, with low CV values (< or =10%). CONCLUSIONS: These results will provide fundamental information regarding internal controls for protein expression studies and can be used for analysis of postmortem protein degradation patterns in forensic medicine.

Inflammatory Myofibroblastic Tumor of the Thyroid Gland: A Brief Case Report

No abstract available.

Discrepant Causes of Death between Medical Death Certificates and Autopsy Reports (II) / 대한법의학회지

The postmortem examination certificate and death certificate provide proof of death and supply important data used to establish health statistics. However, the format of the form and the accuracy of postmortem examination and death certificates yield errors that must be corrected by comparison with postmortem studies. We reviewed 401 autopsies performed in the Department of Forensic Medicine of Chonnam National University Medical School from January 1, 2009 to December 31, 2011 and compared the reports with their postmortem examination certificates and death certificates. Of the 252 cases submitted with death certifications, 60 cases were concordant with the cause of death on the autopsy report. Eighty-nine cases had clear descriptions of the cause of death. Of these cases, 47 were from postmortem examination, 42 were from death certificates; 17 were natural deaths, 72 were unnatural. Concordance in each group was 59.6% (28/47 cases), 76.2% (32/42 cases), 41.2% (7/17 cases), and 73.6% (53/72 cases). We thus identified various types of errors in postmortem examination and death certificates. This study reveals a high rate of discrepancy between causes of death reported on death certificates and postmortem examination certificates. There are a few useful death certificate and postmortem examination certificates that can be used as a model, based on which we propose several remedies to increase the accuracy of death and postmortem examination certificates.

Intestinal obstruction caused by a duplication cyst of the cecum in a neonate / 소아과

Duplication cysts are rare congenital malformations, that may be detected anywhere along the alimentary tract, and they may communicate with the intestinal tract. Cystic duplication of the cecum is especially rare. About 80% of these cases are detected in the first 2 years of life as a result of an acute intestinal obstruction, which manifests as vomiting, recurrent abdominal pain, recurrent gastrointestinal bleeding and constipation. We report a case of intestinal obstruction secondary to a duplication cyst of the cecum in a neonate. The patient underwent surgery and was diagnosed subsequently, and is presently healthy.

The Changes of Incidence of Childhood Diabetes in Jeollabuk-do for 26 Years / 대한소아내분비학회지

PURPOSE: The purpose of this study was to know the changes and types of diabetes mellitus (DM) in children who lived in Jeollabuk-do for last 26 years. METHODS: We subdivided 26 years (January 1981-December 2006) as group 1 (January 1981-December 1993) and group 2 (January 1994-December 2006). Patients under 15 years old who had been newly diagnosed with DM in these periods in general hospitals situated in Jeollabuk-do were reviewed retrospectively about clinical conditions at the onset. RESULTS: 141 patients were enrolled; group 1 was 43 (30.5%) and group 2, 98 (69.5%). Patients number in same period increased over twice. For types of diabetes, group 1 was all type 1 diabetes and group 2 was 75.5% in type 1 diabetes, 21.4% type 2 diabetes and 3.1% clinically suspected maturity onset diabetes of the youth (cMODY). The incidence of diabetes was 0.12 patients per 100,000 under 15 years old in 1980 and increased upto 4.73 ones in 2005. The diagnosed mean age increased from 8.9 years (group 1) to 10.3 years (group 2), but type 1 diabetes had no significant difference. Diabetes occurred in girls more than boys. Two-thirds of all patients were diagnosed in the winter (December-February) and the spring (March-May). CONCLUSION: The incidence of childhood diabetes in Jeollabuk-do increased rapidly and type 2 diabetes was remarkable. We think these aspect would be not only the problem in this province but also the national one. So, we suggest that the practicing of the dynamic survey nationwide is important for the treatment and the management of childhood diabetes.

Clinical characteristics of Epstein-Barr virus infection detected by polymerase chain reaction in children less than 15 years old / 소아과

PURPOSE: Previously, Epstein-Barr virus (EBV) infection was diagnosed by serological examination; currently, many EBV antigen detection methods have been developed and applied clinically for diagnosing EBV infection. To delineate the clinical characteristics of EBV infection, clinical and laboratory findings were evaluated for patients who tested positive in EBV polymerase chain reaction (PCR). METHODS: EBV PCR was conducted in 352 patients admitted to the pediatric ward from January 2004 to December 2006, with more than 2 clinical signs such as fever (> or =37.5degrees C), exudative throat infection, lymphadenopathy, hepatitis of unknown etiology, and splenomegaly. The EBV viral gene was detected by PCR in 115 patients (32%), and the clinical characteristics of these patients were evaluated. Laboratory findings such as leukocytosis, thrombocytopenia, atypical lymphocyte, and alteration in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in peripheral blood were examined. The EBV-specific immunoglobulin M antibody (EBV-IgM Ab) was also tested. RESULTS: Most of the children were younger than 8 years (89%), and the male to female ratio was 1.3:1. Exudative throat infection and fever (> or =37.5degrees C) were observed in all patients. Cervical lymph node enlargement was seen in 36 patients (31%); leukocytosis (WBC> or =10,000/mm3), in 54 patients (47%); and atypical lymphocyte (> or =20%), in 28 patients (24%). EBV-IgM Ab was positive in 33 patients (29%). The younger patients had higher ALT levels and higher incidence of positive EBV-IgM Ab than the older patients. CONCLUSION: The cumulative number of patients diagnosed to have EBV infection by PCR increased markedly for those under 8 years. ALT was higher and EBV-IgM Ab was detected more in younger patients with EBV infection.

Treatment of Osteoporotic Vertebral Collapses of the Thoracolumbar Spine with Neurologic Deficits using Anterior Approach / 대한척추외과학회지

STUDY DESIGN: Retrospective OBJECTIVES: To evaluate the clinical and radiological results of treatment for thoracolumbar spine fractures, with neurological deficits, using an anterior approach in a senile osteoporotic spine. SUMMARY OF BACKGROUND DATA: With osteoporotic vertebral collapses, an operative treatment may be indicated for lesions that are considered unstable, especially if there is spinal canal compromise with neurological deficits. As for the treatment of these cases, a posterior approach destabilizes, and increases, the kyphotic deformity, resulting in the need for a longer fusion period. A combined anterior-posterior approach increases the morbidity. A one stage anterior decompression and anterior reconstructive stabilization is often the most reasonable operative choice. MATERIALS AND METHODS: Between January 1999 and August 2001, 12 cases of thoracolumbar osteoporotic vertebral collapse, with neurological deficits, were performed. There were 10 female and 2 male cases. The mean age for the patient was 69.3 years, ranging from 60 to 79 years. The numbers of each level of fractured vertebrae were; 2, 5, 4 and 1, in eleventh thoracic, twelfth thoracic, first lumbar and second lumbar vertebrae, respectively. All patients reported minor injury or trauma, and the average interval between injury and operation was 8.3 months, ranging from 1 to 36 months. There were 4 and 8 cases of neurological deficits in the Frankel D2 and D3 groups, respectively. The average preoperative local kyphotic angle was 23.8 degrees, ranging from 5 to 35 degrees, with a 66% loss in height, ranging from 42 to 83%). The average T score from the Bone Densitometry was -3.7 S.D, ranging from -3.2 to -4.4. The operations were performed by an extrapleural-retroperitoneal approach. The anterior instrumentation was performed with the Kaneda system and a titanium mesh cage. All cases were followed for more than 12 months. RESULTS: All cases had a solid bony fusion. The immediate postoperative average local kyphotic angle was 10.3 degrees, ranging from -14 to 22 degrees, and the correction loss at the last follow-up was 2.6 degrees, ranging from 0 to 9 degrees. All 12 patients with incomplete preoperative neurological deficits improved, postoperatively, to Frankel group E. CONCLUSIONS: The one stage anterior spinal decompression and reconstruction, with a Kaneda instrument and a titanium mesh cage, afforded enough stability in patient with an osteoporotic vertebral collapse to enable early ambulation and to achieve realignment and solid fusion, and seems to have merit in the neurological recovery following an operation.