‘Hummingbird’ Sign in a Patient with Guam Parkinsonism-Dementia Complex

We present a case of a 71-year-old male Chamorro patient from Guam who presented with progressive supranuclear palsy (PSP)-Richardson’s syndrome. Considering his strong family history of parkinsonism and a PSP phenotype, he was clinically diagnosed with Guam parkinsonism-dementia complex (PDC). Magnetic resonance imaging (MRI) of the brain revealed prominent midbrain atrophy with preserved pontine volume, forming the ‘hummingbird’ sign, which has not been described before in Guam PDC. Molecular analysis of the chromosome 9 open reading frame 72 gene (C9orf72) showed only 6 GGGGCC repeats. We discuss the clinico-pathological similarities and differences between PSP and Guam PDC, and highlight the topography of neuropathological changes seen in Guam PDC to explain the appearance of the ‘hummingbird’ sign on MRI.

Sea Urchin Injury Accompanied by Paresthesia / 대한피부과학회지

Sea urchins are marine invertebrates commonly found in coastal areas around the world. The potential mechanisms of injury are primary puncture wounds, envenomation, and the foreign body reaction. A 20-year-old woman presented with multiple, 0.2 to 0.3 cm-sized, erythematous papules with central blackish particles accompanied by numbness and pain on the dorsum of the right foot and ankle for 7 days. She had been injured by a sea urchin 7 days prior at the seaside in Guam. A skin biopsy of the lesion showed inflammation with foreign body reaction. The attending physician removed all the blackish particles and applied mupirocin ointment. Although skin lesions improved over time, numbness and pain still remained. There have been only six reported cases of sea urchin granuloma in Korea, but no reports of sea urchin injury with neurologic symptoms. Herein, we report a rare case of sea urchin injury accompanied by paresthesia.

Fatal Wound Infection by Chromobacterium violaceum after Open Ankle Fracture Surgery / 계명의대학술지

Chromobacterium violaceum (C. violaceum) is a gram negative, facultative anaerobe widely distributed in natural aquatic environments and is sensitive to temperature. Its infection has a predilection to tropical or subtropical regions that between latitude 35degrees N and 35degrees S. Infection due to C. violaceum is rare. But human infection with this organism can result in severe, systemic disease with a high fatality rate. C. violaceum infection may rapidly progress to sepsis with multiple organ abscesses, predominantly in lungs, liver, and spleen. The organism is usually resistant to most antibiotics commonly prescribed for gram-negative bacterial infection like aminoglycosides, extended spectrum beta-lactam antibiotics etc. In Korea, two cases of C. violaceum infections were reported in patients injured in a Guam airplane accident, and one case was reported local C. violaceum infection. Here, we report a case of fatal C. violaceum postoperative wound infection in Korea.

Study of Human Factors Accident Investigation Tool through CFIT Aircraft Accident Cases / 항공우주의학회지

The purpose of this study was is leading landmark efforts to prevent the major causes of commercial-aviation fatalities about controlled flight into terrain (CFIT) in approach-and-landing accidents. The paper of major analysis for controlled flight into terrain (CFIT) was Guam accident, Mokpo accident and Gimhae accident in commercial transport-aircraft accidents from 1997 through 2002. CFIT occurs when an airworthy aircraft under the control of the flight crew is flown unintentionally into terrain, obstacles or water, usually with no prior awareness by the crew. This type of accident can occur during most phases of flight, but CFIT is more common during the approach-and-landing phase. The paper believed that prevention for CFIT accident was education and training for flying crew and upgrade for equipment such as EGPWS, and need more research for professional organizations of airlines.

A Study of Accident Prevention through Controlled Flight into Terrain Accident / 항공우주의학회지

The purpose of this study was to make landmark efforts to prevent the major causes of commercial-aviation fatalities on controlled flight into terrain (CFIT) in approach-and-landing accidents. Major analysis for controlled flight into terrain (CFIT) of Guam accident, Mokpo accident and Gimhae accident in commercial transport-aircraft accidents from 1993 through 2002 was made. CFIT occurs when an airworthy aircraft under the control of the flight crew is flown unintentionally into terrain, obstacles or water, usually with no prior awareness by the crew. This type of accident can occur during most phases of flight, but CFIT is more common during the approach-and-landing phase. Key prevention for CFIT accident was education and training for flying crew and to upgrade for equipment such as EGPWS, and the need for more research by professional organizations of airlines.

Ethnic disparities in cancer mortality among residents of Guam.

Cancer mortality data collected by the Guam Cancer Registry for the period 1998 through 2002 were analyzed by cancer site, age, and ethnicity. Ethnicity and site specific age-adjusted cancer mortality rates for Guam were calculated utilizing Guam 2000 census data, the US 2000 standard population and compared to U.S. 2002 age-adjusted cancer mortality rates. Age-adjusted cancer mortality rates for ethnic populations represented on Guam, except those of leukemia and non-Hodgkins lymphoma, were high in relation to other population groups and higher than U.S. averages. Some highlights include: 1. Chamorros had high age-adjusted mortality rates for mouth and pharynx (15.5 vs. 2.7 [corrected] U.S.), nasopharynx (9.1 vs. 0.2 U.S.), lung and bronchus (66.9 vs. 54.9 U.S.), colon-rectum-anus (28.6 vs. 19.7 U.S.), breast (32.0 vs. 28.0 U.S.) and prostate cancer (40.9 vs. 27.9 U.S.); 2. Chamorros (6.4 vs. 2.5 U.S.) and Micronesians (6.3) had high and nearly identical age-adjusted mortality rates for cancer of the mouth and pharynx when nasopharyngeal cancers were excluded; 3. Micronesians had the highest mortality rate for liver cancer over all ethnicities documented (43.5 vs. 4.9 U.S.); 4. Asians had the highest mortality rates for pancreatic (12.5 vs. 10.5 U.S.) and cervical cancer (8.5 vs. 2.6 U.S.); 5. Caucasians had the highest mortality rates for leukemia (19.9 vs. 7.5 U.S.) and Non-Hodgkin's lymphoma (17.6 vs. 7.6 U.S.). Suggestions are made for further research on both explaining and ameliorating cancer mortality disparities among ethnic groups on Guam.

Amyotrophic lateral sclerosis and diabetes on Guam: changing patterns of chronic disease in an island community.

Amyotrophic lateral sclerosis (ALS) occurred on the island of Guam with unusually high incidence rates for many years but began to disappear with the island's westernization after WW II. The authors document these changes and suggest that they support a hypothesis that cultural changes could be responsible for both the virtual disappearance of this chronic degenerative neurologic disease as well as a concurrent surge in the prevalence of diabetes.

A Study on the Applications of super-Impose ID Image System / 대한의료정보학회지

In this paper, a new superimposition scheme using a computer vision system was proposed with pairs of skull and ante-mortem photographs, which were already identified through other tests and DNA fingerprints at the Korea National Institute of Scientific Investigation. In this computer vision system, an unidentified skull was caught by video-camcoder with the MPEG and the other ante-mortem photograph was scanned by scanner. These two images were processed and superimposed using pixel processing. This recognition of individual identifications by anatomical references can be performed on the two superimposed images for many big cases like as Guam KAL accident in 1997.

An Analysis of the Victim's Identification Results from Commercial Aircraft Accidents in Guam

No abstract available.

A Report of the KE 801 Victim Identification Results Using Conventional Method

Aircraft accidents are not new occurrences. Most people considered flying to be particularly dangerous in the early days of flight, and fatal aircraft crashes were not surprising Although investigation into the mechanical causes of crashes progressed, it was not until the 1950s that value of medical investigation of aircraft crashes became apparent. The identification process is an essential elements of an adequate investigation. Accurate identification of all fatalities incurred in an aircraft accident is often the first step in determining where each person was located at the time of the disaster and what role they may have played in its cause, Separated into basic elements, the identification process involves (1) the collection of identification information about missing persons, (2) the observation of identifying features of the victims, and (3) the comparison of the two groups of information. Many investigators know about identification techniques, but they have considered them as an isolated process anti have not integrated them into the overall investigation. Typically, physicians, dentists, and other medical personnel are assigned tasks based on a preconceived disaster plan that they had no role in developing to identify the victims of aircraft crash occurred in Guam at 6 August 1997, we performed analysis the data filed from the National Transportation Safety Board (NTSB), Office of Chief Medical Examiner, Territory of Guam, U.S.A. and National Institute of Scientific Investigation, Korea (NISI). The total of passengers on boards were 254 including 23 all-crews, Among them, only 25 (22 passengers and 3 air crews) were survived. We obtained that the first identified bodies were 100 remains including hospital dead 7 cases using by conventional methods such as finger prints, medical & dental records, and so on. We also analyzed he victims' seating configuration based on boarding pass and surveyed the process from the identification & notification to releasing the body, funeral services and transportation.

The Role of Chief Medical Examiner and Some Experiences of Victim Identification in an Aircraft Crash on Guam

No abstract available.

Suggested Protocol for Investigation of Airplane Crash

It has become our common knowledge nowadays that the airplane crash occurs so often in late years. as the aviation transportation is in wide use for both domestic and international travels. The following operational protocol is suggested based on my personal experience with investigation of the Air Manila crash we had here on Guam in 1976 killing 46 people plus the lessons we learned from United Airlines Flight 232, a wide-bodied DC-10 crash at Sioux City, iowa, in July 1989, killing 112 people. Whenever we encounter such a disaster, we tend to be apprehensive and we do not know what to start off first. The most important thing is to calm down and make a well-thought-out plan by forming a disaster management team. The main purpose of the operation is first to give medical aids to those survivors, then identify the deceased, determine the cause of death, investigate into the cause of crash, protect the valuable personal properties of the passengers, and finally to find ways to prevent such tragedy in the future. In this regard, we should pay attention to the pilots and maintenance crew of the aircraft. Following this, we must field any mechanical defects of aircraft with a high index of suspicion for a possible sabotage, i .c. deliberate destruction of the airplane with an explosive device. The following is a step-by-step plan which I strongly recommend in the event of an airplane disaster.

Comparative horizontal starch gel isoenzyme electrophoresis of Lymnaea (Bullastra) cumingiana (Pulmonata: Lymnaeidae) and related taxa in the Indo-Pacific region.

Foot muscle tissue extracts from six lymnaeid species of the Indo-Pacific region [Lymnaea (Bullastra) cumingiana and L. (Radix) quadrasi from the Philippines, L. (R.) rubiginosa from Indonesia and Thailand, and L. (R.) viridis from Guam and Hong Kong] were subjected to horizontal starch gel isoenzyme electrophoresis and assayed for seven isoenzymes (AcP, AlP, CA, EST, LAP, CAT and GOT) to elucidate their taxonomic relationships. L. cumingiana exhibited banding patterns for EST, LAP and CAT uniquely different from the rest, thus supporting the hypothesis that it is a distinct species. Zymogram patterns for AlP, CA, EST and LAP attest to the close affinity between L. quadrasi and L. rubiginosa (Indonesia and Thailand). Minor differences suggest a closer relationship between the two geographical strains of L. rubiginosa than with L. quadrasi, lending support to the hypothesis that L. quadrasi is inseparable as a race or variety from the typical L. swinhoei Adams, which in turn is but a race of L. auricularia, which also encompasses L. rubiginosa. The two geographical strains of L. viridis from Guam and Hong Kong showed the greatest consistency with regards to similarity and congruence in banding patterns. Non-specific esterases (EST) were the most useful in distinguishing the six species from each other.

Comparative shell morphology of Lymnaea (Bullastra) cumingiana (Pulmonata: Lymnaeidae) and related taxa in the Indo-Pacific region.

Comparative shell morphology using both quantitative and qualitative parameters was employed to investigate the taxonomic relationship between the endemic Philippine species, Lymnaea (Bullastra) cumingiana and five other lymnaeid "species" in the Indo-Pacific region, namely: L. (Radix) quadrasi (Philippines). L. (Radix) rubiginosa (Indonesia), L. (Radix) rubiginosa (Thailand), L. (Radix) viridis (Guam) and L. (Radix) viridis (Hong Kong). Fifty randomly chosen adult specimens of each species were studied and compared, although only field-collected specimens were studied for the first four groups and laboratory-raised specimens for the last two group. Results strongly suggested that L. cumingiana is a distinct species among the rest. L. quadrasi, L. rubiginosa (Indonesia) and L. rubiginosa (Thailand) exhibited great affinity towards each other. Likewise, the two geographical isolates of L. viridis were practically identical to each other except for some minor size differences.

Comparative radular morphology of Lymnaea (Bullastra) cumingiana (Pulmonata: Lymnaeidae) and related taxa in the Indo-Pacific region.

The radular morphology of Lymnaea (Bullastra) cumingiana was compared to that of five other Indo-Pacific lymnaeid "species", namely: L. (Radix) quadrasi (Philippines), L. (R.) rubiginosa (Indonesia and Thailand) and L. (R.) viridix (Guam and Hong Kong) in order to investigate the taxonomic relationship among the six species. Although all six species uniformly exhibited a unicuspid, slightly asymmetrical central (rachidian) tooth and tricuspid laterals, interesting differences were noted among the outer marginals. These were observed to be uniquely bicuspid in L. cumingiana, predominantly tricuspid in L. quadrasi, tetracuspid in L. rubiginosa (Indonesia and Thailand) and multicuspid in L. viridis (Guam and Hong Kong). Thus, the results support the hypotheses that L. cumingiana is a unique species compared to the rest, that L. quadrasi is closely related to L. rubiginosa (Indonesia and Thailand) and that the two geographical isolates of L. viridis have not diverged. Radular morphology was therefore found to have a limited significance in elucidating the taxonomic relationship between the six groups of lymnaeids studied.

Are the endemic motor neuron diseases of Guam really disappearing?

Death certificates were reviewed to observe trends in the number of persons on Guam reported to have chronic degenerative motor neuron diseases (amyotrophic lateral sclerosis, parkinsonism-dementia or Parkinson's disease) at the time of death. Additional data, including age and race of the deceased and the name of the certifying physician were also collected. The number of persons having been diagnosed with amyotrophic lateral sclerosis is apparently decreasing while their mean age is increasing suggesting that the etiologic agents or factors causing this disease are less prevalent on Guam today than they have been in the past. Trends with regard to parkinsonism-dementia and Parkinson's disease are less clear.

A search for infant salmonellosis risk factors on Guam.

A study was conducted in the hope of identifying risk factors associated with a 10-year epidemic of salmonellosis among infants on Guam. Salmonella bacteria were found in soil and vacuum cleaner samples suggesting that Salmonella infections may result from contamination introduced into homes from the outdoor environment by mechanical means rather than by the ingestion of contaminated animal-origin foods.