A Statistical Analysis of Forensic Autopsies Performed in the Jungbu Province of Korea in 2021 / 대한법의학회지

We analyzed 1,079 forensic autopsies conducted in 2021 by the National Forensic Service Daejeon Institute from the Jungbu province in the central part of South Korea, for their manner and cause of death. Among the manner of death (n=1,079), 45.3% (n=489) were categorised as unnatural, 39.5% (n=426) as natural, and 15.2% (n=164) were unknown. Among the unnatural deaths (n=489), 40.7% (n=199) were accidents, 36.8% (n=180) were suicides, 14.1% (n=69) were undetermined, and 8.4% (n=41) were homicides. The major causes of unnatural deaths (n=489) were by trauma, causing 34.4% (n=168), poisoning causing 26.8% (n=131), and asphyxia causing 17.2% (n=84). The major cause of death by trauma (n=168) was falling at 46.4% (n=78), and by asphyxia (n=84) was strangulation at 76.2% (n=64). Among natural deaths (n=426), heart disease was the major cause at 49.8% (n=212) followed by vascular disease at 16.7% (n=71). In future, a time-series statistical analysis on the manner and causes of death in Jungbu province may provide insight and allow for more advanced interpretations about both healthcare and public safety.

Estimation of Forensic Sex Based on Three-Dimensional Reconstruction of Skull in Korean: Non-metric Study / 대한법의학회지

This study performed the forensic anthropological sex estimation of Koreans in a non-metric way by reconstructing three-dimensional (3D) computed tomography (CT) images of skulls. The skull CT images used in this study were 100 (51 males, 49 females), and all CT images were taken with a slice thickness of 0.75 mm and then reconstructed into 3D images using the MIMICS 23.0 program. Using the reconstructed 3D image, measurements were repeated twice. The sex determination was male if the 4 point to 5 point was relatively more in five landmarks, and female if the points of 1 to 2 were relatively more. Results of the study show that, 88 of the 100 cases matched the actual sex. Among the 12 discrepant cases, ten cases were mismatched with the actual sex even though the estimation and repeated estimation readout of sexestimating were the same. Two cases, were “unknown,” showing different sexes in the first and repeated estimations. In conclusion, this study indicated that a forensic anthropological analysis from 3D images provided accurate point information on the landmarks of skulls, showing as high an accuracy as the sex estimation method using real bones. The ten cases of sex mismatch, except the two “Unknown” cases, are considered to be errors that did not consider differences in population groups. In further studies, further establishing a nonmetric, specifically Korean methods to increase the accuracy and reliability of sex estimation is need.

The Comparison of Clinical Variables Among Competitive Employment, Partial Employment, and Unemployment Group in Schizophrenic Outpatients / 신경정신의학

Objectives@#The purpose of this research was to examine differences between clinical variables among outpatients with schizophrenia in competitive and partial employed and unemployed groups. @*Methods@#The study subjects were 168 outpatients with schizophrenia, and these were divided into three groups, that is, competitive (n=20), partial (n=28), and unemployed (n=120) groups, based on employment status. Job and psychopathology data were collected by interview and using self-report questionnaires (self-stigma, will to recover, family attitude, perceived social support, insight into disease, self-esteem, hopelessness, and attitude to drugs). @*Results@#The proportion of male patients in the competitive employment group was greater than in the partial or unemployed groups. Education level was significantly higher, and the number of hospitalizations was significantly lower in the competitive group than in the unemployed group.Levels of self-stigma, will to recover, and perceived social support were significantly higher, and levels of self-esteem and hopelessness were significantly lower in the competitive and partial employment groups than in the unemployed group. Patients in these two groups also reported a more positive family attitude, more insight into the disease, and a more positive attitude toward drugs than patients in the unemployed group. @*Conclusion@#Most clinical variables were similar in the competitive and partial employment groups.The findings of this study suggest environmental and systematic factors are more important for the employment of outpatients with schizophrenia than disease-associated factors.

Death after Bronchoscopic Biopsy of a Pulmonary Artery Aneurysm Mimicking Bronchial Polyp / 대한법의학회지

Pulmonary artery aneurysms (PAAs) are rare, and massive hemoptysis can lead to death if appropriate diagnosis and treatment is not provided. PAAs can be of congenital, acquired, or idiopathic origin, and the clinical symptoms are various. Among all reported cases, one-third of the patients died due to rupture. Optimal treatment or guidelines for PAAs remain uncertain. Herein, we report autopsy findings from a woman with PAA. The patient was taking medication for tuberculosis. On bronchoscopy, a polypoid lesion was found, suspected to be an inflammatory polyp. Biopsy was performed and massive bleeding into the airway occurred. The bleeding could not be controlled by bronchoscopic suction, and cardiac arrest occurred 30 minutes after biopsy; the patient subsequently died. Autopsy revealed a round, calcified PAA in the bronchus of the right middle lobe; the end of the PAA was torn. Hypovolemic signs, including weak postmortem lividity and pallor of the skin and conjunctivae, were observed. Visual inspection and histopathological examination of the right lung revealed tuberculosis and congestion. Cases related PAA are not uncommon, but autopsy cases of death occurring after biopsy of PAA mimicking bronchial polyps are rarely reported.

Spontaneous Hepatic Rupture in a Pregnant Woman with Preeclampsia: An Autopsy Case / 대한법의학회지

Spontaneous hepatic rupture, which is a complication of hypertension in pregnancy, is extremely rare. However, high maternal and perinatal mortality rates are observed. Several factors, namely, age over 30 years, multiparity, severe preeclampsia, or HELLP syndrome (a group of symptoms which include hemolytic anemia, hepatic enzyme increase, and thrombocytopenia), are associated with this condition. An autopsy case of a woman with twin pregnancy was studied. She was at 36 weeks of gestational age and suffered from the sudden development and rapid progression of hypertension. Moreover, she died because of spontaneous hepatic rupture despite an emergency operation. Autopsy revealed a capsular rupture of the right lobe of the liver with numerous blood clots and hypovolemic signs, such as weak postmortem lividity and palor of the skin and conjunctiva. A close examination of the trunk and liver for the classification of the cause of rupture and an assessment of medical history, such as preeclampsia, are needed during postmortem examination of pregnant women with hepatic rupture or her fetus. To the best of our knowledge, this fatal complication in pregnant women is not yet presented in postmortem examinations in Korea. Thus, we report the findings of this case to share the knowledge.

Analysis of Cisternal Puncture Results during a Postmortem Examination / 대한법의학회지

Examination of cerebrospinal fluid (CSF) samples is important in postmortem examinations. CSF samples can be collected by performing lumbar or cisternal punctures. Additionally, if bloody fluid is aspirated during a spinal puncture, intracranial hemorrhage could be diagnosed. However, vascular injury and hemorrhage can occur during these procedures. The authors performed cisternal punctures during routine autopsies; further, to evaluate the usefulness of the former, the results were analyzed. Out of 50 cases, bloody fluid was aspirated in CSF samples of 20, while CSF samples of the other 30 were clear. Cases in which bloody fluid was aspirated were divided into blood-tinged and blood aspiration groups according to hemoglobin levels in the aspirated fluids. Cisternal punctures were characterized by high specificity and sensitivity; further, positive and negative predictive values were obtained that enabled detection of head and neck injuries including non-traumatic basal subarachnoid hemorrhage. Main head and neck injuries in blood aspiration group were skull base fracture, cervical fracture, and dislocation.

Prevalence and Antimicrobial Susceptibility of Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum in Individuals With or Without Symptoms of Genitourinary Infections

BACKGROUND: The aim of this study was to determine the prevalence and antimicrobial susceptibility of Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum among patients displaying symptoms of genitourinary infections and asymptomatic volunteers. METHODS: Genitourinary samples were collected from 897 participants (365 symptomatic patients and 532 asymptomatic volunteers). The samples were analyzed using multiplex real-time PCR (Anyplex™ II, Seegene, Korea), multiplex PCR (Seeplex®, Seegene), and Mycoplasma IST 2 Kit (bioMerieux, France). RESULTS: The prevalence of M. hominis, U. urealyticum, and U. parvum in the genitourinary samples of symptomatic patients compared with asymptomatic volunteers was 9.9% vs. 5.5%, 12.3% vs. 9.0%, and 36.4% vs. 30.8%, respectively. After eliminating cases of co-infections with other pathogens, there was a significant difference in the prevalence of M. hominis between symptomatic patients and asymptomatic volunteers (9.1% vs. 5.2%, P<0.05), but not in the prevalence of U. urealyticum and U. parvum organisms. When tested for antimicrobial susceptibility, more than 95.5% of each species were susceptible to tetracycline, doxycycline, josamycin, and pristamycin. More than 78.9% of Ureaplasma spp. were susceptible to azithromycin, erythromycin, and clarithromycin; however less than 4.2% of M. hominis were susceptible to these antibiotics. When tested with ofloxacin and ciprofloxacin, 40.9-58.9% and 9.1-25.0% of the three species were susceptible to these drugs, respectively. CONCLUSIONS: M. hominis is the leading causative pathogen for genitourinary infection; however the involvement of Ureaplasma spp. is debatable. For optimal antimicrobial therapy, the accurate detection of these organisms and determination of antimicrobial susceptibility is crucial considering their diverse antimicrobial susceptibility patterns.

Two Cases of Bacteremias Caused by Clostridium ramosum / 대한임상미생물학회지

Clostridium ramosum is Gram-positive anaerobic bacillus and is known as a non-pathogenic enteric bacterium. It is a member of the RIC group, which is a subgroup of Clostridium having atypical characteristics. Rarely, it has been reported as a pathogen of otitis media in young children or the cause of infection in immunosuppressed adults. Here, we report the first two Korean cases of C. ramosum bacteremia in colon cancer and pressure sore cases, respectively.

The Efficacy of Stereotactic Vacuum-assisted Biopsy and Needle Localization Vacuum-assisted Biopsy for Diagnosing Breast Microcalcification / 한국유방암학회지

PURPOSE: This study was conducted to evaluate the efficacy of 2 percutaneous breast biopsy techniques for diagnosing microcalcification: stereotactic Vacuum-assisted biopsy (VAB) and needle localization VAB. METHODS: Between November 2002 and September 2007, 138 patients underwent percutaneous breast biopsy for microcalcification. Of these, 59 patients underwent needle localization VAB and 79 patients underwent stereotactic VAB with using a prone-table mammographic unit, respectively. Patients with focally clustered microcalcification underwent stereotactic VAB. Patients with diffuse or deep seated microcalcification and patients with small breast underwent needle localization VAB. We retrospectively reviewed the characteristics of the lesions and the percutaneous biopsy results for all the cases. RESULTS: Percutaneous biopsy was successful in 135 cases (97.8%). Of the 135 successfully performed cases, 34 cases (25.2%) were malignant and there were 4 (11.8%) underestimations. For the stereotactic VAB group, 13 of the successfully performed 76 cases (17.1%) were malignant and there were 2 (15.4%) underestimations. In needle localization VAB group, 21 (36.6%) of the 59 cases were malignant and there were 2 (9.5%) underestimations. There was no major complication in all the cases. CONCLUSION: With using stereotactic VAB and needle localization VAB, we can biopsy accurately and safely in almost all cases with leaving only minimal scar. So, percutaneous biopsy can be considered as a substitute for surgical biopsy for microcalcification of the breast.

The Efficacy of Stereotactic Vacuum-assisted Biopsy and Needle Localization Vacuum-assisted Biopsy for Diagnosing Breast Microcalcification / 한국유방암학회지

PURPOSE: This study was conducted to evaluate the efficacy of 2 percutaneous breast biopsy techniques for diagnosing microcalcification: stereotactic Vacuum-assisted biopsy (VAB) and needle localization VAB. METHODS: Between November 2002 and September 2007, 138 patients underwent percutaneous breast biopsy for microcalcification. Of these, 59 patients underwent needle localization VAB and 79 patients underwent stereotactic VAB with using a prone-table mammographic unit, respectively. Patients with focally clustered microcalcification underwent stereotactic VAB. Patients with diffuse or deep seated microcalcification and patients with small breast underwent needle localization VAB. We retrospectively reviewed the characteristics of the lesions and the percutaneous biopsy results for all the cases. RESULTS: Percutaneous biopsy was successful in 135 cases (97.8%). Of the 135 successfully performed cases, 34 cases (25.2%) were malignant and there were 4 (11.8%) underestimations. For the stereotactic VAB group, 13 of the successfully performed 76 cases (17.1%) were malignant and there were 2 (15.4%) underestimations. In needle localization VAB group, 21 (36.6%) of the 59 cases were malignant and there were 2 (9.5%) underestimations. There was no major complication in all the cases. CONCLUSION: With using stereotactic VAB and needle localization VAB, we can biopsy accurately and safely in almost all cases with leaving only minimal scar. So, percutaneous biopsy can be considered as a substitute for surgical biopsy for microcalcification of the breast.

Study for Mammographic Patterns of Korean Breast Cancer / 한국유방암학회지

BACKGROUND: In Korea, the incidence of breast cancer is relatively lower than in western country, but it is in increasing slope. However the mammographic patterns of Korean breast cancer patients are not well known. METHODS: The authors collected the clinical and radiologic data from new breast cancer patients between January 1992 and December 1997, and analysed the mammographic pattern. RESULTS: Of the 418 patients, the age-specific incidences were 153 (37.0%) for 40 to 49 years of age, 99 (23.9%) for 30 to 39 years, 81 (19.6%) for 50 to 59 years, 55 (13.3%) for 60 to 69 years, 14 (3.3%) for over 70 years, and 12 (2.9%) for 20 to 29 years. According to the TNM staging system, there were 2 (0.6%) with stage 0, 102 (24.9%) with stage I, 147 (35.9%) with stage IIA, 72 (17.6%) with stage IIB, 85 (20.8%) with stage IIIA, 1 (0.2%) with stage IV. The non-palpable lesions were 7.5% on physical examination. According to Wolfe's classification, there were 78 (19.0%) for N1, 78 (19.0%) for P1, 133 (32.4%) for P2, and 122 (29.7%) for DY pattern. On mammography, lumps were found in 312 cases (75.8%). Among mammographic lumps, 51.9% was not clearly defined margin. The mammographic calcifications were found in 48.3% of all patients. In the distribution of calcification, 20.6% was diffuse type and 79.4% was localized type. The size of calcifications was variable in 92.9% and the shape of calcifications was amorphous pattern in 85.6%. We could not suspect cancer in 14.7% of patients on mammography, and 10.1% of patients on ultrasound examination. CONCLUSION: We believe that these baseline mammographic data of Korean breast cancer patients may contribute to the accurate diagnosis of breast cancer, but more data will be needed.

Usefulness of Ultrasound Guided Core Needle Biopsy of Breast Lesions with Automated Gun / 한국유방암학회지

It is necessary to confirm disease pathologically even though there are several methods of diagnosis for breast abnormality. Ultrasound guided core needle biopsy (UGCNB) of breast lesions with automated gun is widely accepted as a simple and accurate procedure for avoiding open biopsy. From January 1996 to February 1998, 121 breast lesions of 117 women detected with mammogram, ultrasound, physical examination or any combination were selected. UGCNB was performed in all 121 cases with 7.5 MHz transducer and Manan Pro-mag 2.2 automated biopsy gun (2.2 cm excursion). After local anesthesia, 5-6 cores were obtained through 2mm skin incision site. Lesions categorized as probably benign to highly suspicious were included as indications for core biopsy. 67.5% of the 117 patients were in age thirties and forties. The results of the biopsy were benign in 65 lesions and malignant in 56. 15 patients showing benign results which were contrary to clinical findings and pathologic results, underwent open biopsy. Four patients who had previously been diagnosed as being benign, were found to be malignant (false-negative 3.3%). Primary results of four cases of false negative were intraductal papilloma, severe inflammatory change, atypical ductal hyperplasia, and insufficient sampling, respectively. In case of insufficient sampling resulted from small gauge needle (18G), correct diagnosis was possible in all lesions with large needle (14G). Also excisional biopsy was required in women having intraductal papilloma, severe inflammation and atypical ductal hyperplasia which were difficult to differenciate from malignancy. The UGCNB is excellent biopsy method for multiple breast lesions. The method has demonstrated a 96.7% sensitivity specificity 100%, and positive predictive value (PPV) of 46.3%. We also conclude that UGCNB is proved To be an useful alternative to surgical biopsy on simpler procedure with no adverse cosmetic results.

Germline Mutation of BRCA2 Gene in Korean Breast / Ovarian Cancer Families / 대한암학회지

PURPOSE: Recent discovery of BRCA1 and BRCA2 genes has made it possible to perform presymptomatic diagnosis in hereditary breast/ovarian cancer families. We have previously reported germline mutations of the BRCA1 gene in Korean hereditary breast/ovarian cancer families. In that study two out of 13 families were found to have germline mutations in BRCA1 gene. One was a nonsense mutation in codon 1815, and the other was a frameshift mutation due to 2 base-pair deletion in codon 1701 of BRCA1 gene. This study was intended to identify germline mutations of the BRCA2 gene in Korean breast/ovarian cancer families. MATERIALS AND METHODS: Peripheral blood DNA was obtained from 10 breast cancer patients registered at the Korean Hereditary Tumor Registry with positive family history of breast and/or ovarian cancer. Exons 11 and 27 of the BRCA2 gene(together accounting for 50% of the coding region of the BRCA2 gene) were amplified by polymerase chain reaction(PCR) and screened for mutations by in vitro transcription/translation method. For confirmation of the mutations, automatic sequencing of the PCR products displaying abnormal truncated protein bands was perfomed. RESULT: We identified an abnormal truncated protein in the exon 11 of the BRCA2 gene from a member of hereditary breast cancer family, SNU-B4. Sequencing analysis revealed a 4 bp deletion in codons 1248-49 of the exon 11, resulting in frameshift that led to premature stop codon and truncation of the protein product. CONCLUSION: We have identified a germline mutation from a Korean hereditary breast cancer family. So far only one case of the same mutation has been registered in Database of BRCA2 mutation (BIC) by a commercial genetic diagnosis company, Myriad Genetics, Inc. Identification of the germline mutation in BRCA2 gene should aid in the accurate presymptomatic diagnosis of the at-risk members in this family.

Germline Mutations of BRCA1 Gene in Korean Breast and/or Ovarian Cancer Families / 대한암학회지

PURPOSE: To understand the involvement of BRCA1 gene in Korean breast and/or ovarian cancer families. MATERIALS AND METHODS: Germline mutations of BRCA1 gene were analyzed in 13 families which included 3 hereditary site-specific breast cancer families, 6 suspected breast cancer families, and 3 suspected breast-ovarian cancer family, and one Li-Fraumeni family by screening BRCA1 gene using single strand conformation polymorphism (SSCP) analysis on polymerase chain reaction (PCR) amplified genomic DNA and confirmed the results by sequencing. RESULTS: Including one family with previously reported nonsense mutation of BRCA1 gene, we detected two mutations in unrelated families. One newly identified mutation was frame shift mutation resulting from TG deletion in codon 1701, which results in a truncated BRCA1 protein, at codon 1714. CONCLUSION: The proportion of families who inherit the mutated BRCA1 gene seems to be small among Korean breast and/or ovarian cancer families.

Hematuria among Benzidine Dye Industry Workers / 예방의학회지

Benzidine Industry in Korea has started after Japan has banned its production in early 1970's. and it has been in operation in Korea for over 20 years. However, it is not known yet whether any bladder cancer has developed from benzidine exposure. This study was done to screen benzidine-exposed workers for bladder cancer, and to examine the feasibility of employing screening test at the workplace. All the workplaces that manufacture or use benzidine for more than 20 years in Korea have been covered in this study, and they include 2 benzidine manufacturing factories, 5 benzidine using factories, as well as 2 benzidine free factories as an outside control. In total, 516 workers were screened with urine stick test and urine cytology test for the evidence of hematuria and abnormal urothelial cells. Each worker was also asked about risk factors and symptoms of bladder cancer including past medical history, smoking, medication and occupational history. Benzidine in the air was measured by personal and area sampling. Out of 516 screened workers, 84(16.3%)workers showed positive hematuria in urine stick test, and 7(1.4%)workers showed degenerative cells in urine cytology tests. Those workers with abnormal urine test results who have been exposed to benzidine for more than 10 years were further screened, and, in total. 23 workers were examined with intra-venous pyelography and cystoscopy. None of those screened had any evidence of bladder cancer. When workers with only past hematuria history were included in the positive hematuria group, 96(18.5%) had positive hematuria. On the multiple logistic regression analysis, positive hematuria was significantly associated with benzidine exposure history of other occupations with elevated bladder cancer risk, pyuria and glycosuria. The association got stronger as direct benzidine exposure was accounted through individual task analysis, and as exposure duration was accounted with tenure analysis. For those with benzidine exposure with more than 10 years of tenure, the odds of having positive hematuria was elevated 2.14(95%C.I is 1.08 to 4.25) times more than for those without exposure. Even though bladder cancer was not detected for several limitations including short observation period, majority of studied workers with short latency, healthy worker effect, and low sensitivity of single screening test in a cross-sectional study, the study results suggest that hematuria screening is a feasible and very useful test for bladder cancer screening among benzidine exposed workers.

The first documentation of Li-Fraumeni syndrome in Korea

Li-Fraumeni syndrome(LFS) is an autosomal dominant disorder that predisposes individuals to multiple forms of cancer including breast cancer, soft tissue sarcoma, brain tumor, osteosarcoma, leukemia, and adrenocortical carcinoma. Recently, germ-line mutation of the p53 tumor suppressor gene has been implicated in this familial disorder. We report a case of a 25-year old woman who presented with bilateral breast cancer and uterine leiomyoma. Her mother had died of early-onset bilateral breast cancer. And her younger sister had breast carcinoma as well, which was identified at the age of 22, indicating her strong familial history. To test for the presence of the p53 germ-line mutation, we analyzed the genomic DNA from the peripheral blood of the proband and her sister by PCR-SSCP analysis of exon 5 through exon 8 of the p53 gene. As a result, a p53 mutation in exon 7 was detected in an allele, and it was shared with her sister as the same pattern. Sequencing analysis determined the altered nucleotide at codon 248(CGG < TGG) which is one of the most frequent mutation sites related to LFS. Therefore, this patient has the most consistent characteristic features of LFS phenotype and it is believed that this case is the first report of a family with Li-Fraumeni syndrome carrying the p53 germ-line mutation in Korea.

First year report of analytical proficiency testing program for industrial hygiene laboratories / 대한산업의학회지

No abstract available.

Ocular injudes, analytical view of 340 cases

The authors analysed 340 cases of the ocular injuries among 7633 out and in-patients who visited to the clinic of P.N.U. hospital during 5 years, from Jan. 1964 to Dec. 1968. Followings were discussed. 1. We found that 4.6% of all cases attending our eyes clinic was victims of ocular injuries. 2. The sex incidence showed that 78.9% of such ocular injuries occured in male and 21.1% in female. 3. The incidence was prevalent in young adult 21-30 years of age, and their large number of cases were injured from blowing and industrial accidents, while in children under 10 years of age sharp-pointed toys were more frequent causes. 4. The subconjunctival hemorrhage was the most frequent disturbance of ocular injuries and then came traumatic cataract and corneal foreign bodies in that order. 5. The prognosis of ocular injuries was generally poor, especially, poor, especially in the perforating and penetrating wound of the whether the foreign body was retained or not.

Two Cases of Synkinetic Oculopalpebral Phenomena

Several synkinetic oculopalpebral phenomena were described in the literature in relation to ophthalmoplegias, congenital as well as acquired. Several neurologic explanations have been offered to explain their occurrence, but the entity of the phenomenon is not well clarified yet. From the study of the cases, where the third cranial nerve showed a palsy, some observations appear to be significant. This was present in both cases. In each the affected eye was divergent in the primary position. When the contralateral sound eye was covered the divergent affected eye moved medially to assume fixation, the sound eye showed an exag-gerated secondary deviation behind the occluder and at the same time, the ptotic lid showed an elevation, making the palpebral aperture wider. Adduction of the affected eye was retricted and on atttmption it widtning of the palpebral aperature indicated the occurrence of Fuchs phenomenon, the sound eye being markedly abducted. On abduction the palpebral aperture of the affected eye became narrower due to an increased ptosis. The author quoted Gowers stating the possibility of the overflow of in voluntary impulses carried by one nerve from its usual channels into another giving rise to the phenomenon. On abduction, the size of pupil became wider due to an increased ptosis. It can be deduced to be over-impulses of parasympathetic nerve. Two cases of ophthalmoplegias are described in this paper and it is hoped that the conelusions drawn therefrom may throw some light on this matter.