Spontaneously Developed Pulmonary Arterial Intramural Hematoma That Mimicked Thromboembolism

A 65-year-old woman visited our hospital with a complaint of acute onset dyspnea and radiological manifestations of pulmonary thromboembolism. The patient underwent an exploratory surgery to find a whitish-blue colored mass occupying almost the whole lumen of the main pulmonary arteries. Based on the pathological and radiological findings, the patient was diagnosed to have a pulmonary arterial intramural hematoma. Intramural hematomas are usually observed in the walls of the aorta, and we believe that an isolated intramural hematoma in the pulmonary artery has not been described previously.

The Effect of Elapsed Time on the Quantity of mRNA in Skin: A Study to Evaluate the Potential Forensic Use of mRNA to Determine the Postmortem Interval / 대한법의학회지

Ribonucleic acid (RNA) has potential use in forensic science for the determination of postmortem interval. We report the first study on serial sampling of messenger RNA (mRNA) from surgical specimens to determine if there is a correlation between mRNA quantity and elapsed time. Skin tissues were collected from modified radical mastectomy specimens. After a defined period of time, bisected skin sections were cut and frozen in liquid nitrogen. Serial collection of the specimens was conducted, and frozen sections were obtained from all samples. Quantitative real-time reverse transcription-polymerase chain reaction was performed using the extracted RNA to measure the transcriptional activity of 2 selected housekeeping genes. The selected loci were mRNA sequences that exhibited time-dependent quantitative changes in a previous study. We collected 44 samples from 9 different patients, with 3-10 samples collected per patient. The amount of mRNA transcripts present in the serial samples showed a weak time-dependent correlation trend only in some cases. Further studies to evaluate different target mRNA sequences are necessary, as is exploration of additional methods to evaluate mRNA transcript degradation.

Analysis of Traumatic Subarachnoid Hemorrhage due to Blunt Force Trauma on Facial Region / 대한법의학회지

Traumatic subarachnoid hemorrhage (T-SAH) is said to be typically occurred in a young, healthy, but intoxicated man who receives a minor blow, immediately collapses, and dies within minutes. Sixteen forensic cases of T-SAH were analysed in the point of time of collapse, blood alcohol level, injured site, vascular rupture sites, and sentenced servitude. Majority of the cases (12 cases) were autopsied in the department of Kyungpook National University. Two cases of National Institute of Scientific Investigation, South District Office and 1 case of Jeju National University were added. Autopsy was not done in one case. There were 14 male and 2 female victims. The peak age were their forties (7 cases) and under twenties (7 cases). The time of incident was most often at night. The survival time from the time of trauma until death indicates that 62.5% (10 victims) died immediately from the assault, 12.5% (2 victims) died within 30 minutes. Blood alcohol was detected in 11 cases (68.8%), and mean blood alcohol level was 0.16% (0.08-0.22%). The damage was generated to the facial region, especially around the jaw and below the ears (7 cases), and temporal areas (4 cases). Bleeding foci were detected in 7 cases; basilar artery (2 cases), left vertebral artery (2 cases), and right vertebral artery (3 cases). Meticulous autopsy techniques for identifying the vascular rupture sites are required. The author conclude that tremendous emphasis must be placed on the fact that fatal T-SAH can occur due to minor facial trauma and social campaign for alerting people to the danger of T-SAH is needed.

Present Situation of the Curriculum of Legal or Forensic Medicine in the Medical Schools of Korea / 대한법의학회지

No abstract available.

Usefulness of Immunohistochemistry in Various Types of Sudden Cardiac Death / 대한법의학회지

Postmortem diagnosis of early myocardial infarction is still a puzzling problem in forensic pathology practice, especially in sudden cardiac death. This study was undertaken to evaluate the distribution patterns of several immunohistochemical markers in various types of sudden cardiac death; 27 cases of obstructive coronary atherosclerosis (SCD-CAD) including 13 cases of critical coronary atherosclerosis, 6 cases of atherosclerotic heart disease and 8 cases of acute myocardial infarction, 26 cases of sudden cardiac death with obvious other causes (SCD-miscellaneous) including hypertensive heart disease, arrhythmogenic right ventricular cardiomyopathy, etc. and 14 cases of sudden cardiac death without any myocardial changes and/or minimal coronary atherosclerosis(SCDunknown). 10 cases of unnatural death were included in control group. Imnunohistochemical reactivity and the severity of reactivity loss were evaluated. The immunoreactivity against myoglobin and troponin C were excellent, and their reactivity loss were statistically significant in SCD-CAD compared to control group, SCD-unknown and SCD-miscellaneous (p<0.05). There were increasing pattern of loss of immunoreactivity in SCD-unknown and SCD-miscellaneous compared to control group. The pattern of expression and the severity of reactivity loss against vascular endothelial growth factor(VEGF) and basic fibroblast growth factor (bFGF) were with no differences in experimental group and control group. Immunohistochemistry may be partially useful in determination of early myocyte necrosis in sudden cardiac death, and myoglobin and troponin C may be better. But, its practical application in forensic pathology may be still limited.

Medical Students' Attitudes Toward Autopsy and the Effect of Their Attitudes Following a Forensic Pathology Course

BACKGROUND: The autopsy is a special surgical operation on a dead body to discover its cause of death. The autopsy is necessary for forensic uses, and it is also of great importance for educating students regarding medical uncertainty. METHODS: To evaluate medical studentsO attitudes toward autopsy and the effect of their attitudes following a forensic pathology course, a questionnaire with 25 items that addressed the usefulness of autopsies and discomfort reactions was used. One hundred eighty nine medical students from 3 medical schools in Daegu participated in this study. RESULTS: The medical students showed a high perception of an autopsy's principles, but the medical students were reluctant to become personally involved, despite being more aware of the necessities of the autopsy in forensic cases. Acceptance for the necessities of the autopsy for medical students who took the forensic pathology course was increased, but most of discomfort reactions were not improved. CONCLUSIONS: One way to fulfill the role of forensic pathology as an inspector for human rights and to retain the very special source of knowledge that autopsies represent would be to provide medical education that lead to reconciliation of the discomfort feelings.

Sudden Death from Cardiac Sarcoidosis: A Case Report

Sarcoidosis is a systemic granulomatous inflammation with an unknown cause. The commonly involved sites are the lymph nodes, lungs, skin, eyes, and heart. Although cardiac involvement in sarcoidosis is rarely detected clinically, it is reported in 20-50% of autopsied sarcoidosis patients. Cardiac involvement is one of the most severe conditions of sarcoidosis and may cause sudden death. We report a case of a sudden death due to a massive cardiac sarcoidosis in a 43-year-old man. The microscopic examination revealed an extensive noncaseating granulomatous inflammation in the mediastinal lymph nodes and the heart with no evidence of myocyte necrosis. A special stain and molecular study excluded the possibility of other causes such as fungi or mycobacterium. The authors concluded that the cause of death was attributed to arrhythmia due to a cardiac sarcoidosis with massive involvement of the conduction system.

A Case of Childhood Malignant Fibrous Histiocytoma with Multiple Metastasis / 대한소아혈액종양학회지

Malignant fibrous histiocytoma (MFH) is an aggressive and most common soft tissue sarcoma that occurs in the skeletal muscle of the extremities, trunk or retroperitoneum of late adult life. But the disease course, prognostic factors and outcome in younger patients have not been well described, because MFH rarely occurs in children. We report a case of MFH presenting on the left thoracic back in a 12 year-old boy with systemic metastasis of liver, kidney, bone and adrenal gland.

Expression of p53 and Vascular Endothelial Growth Factor mRNA in Angiogenesis of Non-Small Cell Lung Carcinoma

BACKGROUND: Angiogenesis is one of the most important factors in the progression and me-tastasis of malignancies. Angiogenesis is a multistep process requiring the interaction of numerous factors able to stimulate the growth and development of new vessels. But, understanding of the mechanism involved in VEGF expression is unclear. METHODS: Expressions of p53 and VEGF, and neovasculiarization were examined in 19 cases of surgically resected non-small cell carcinoma of the lung by the immunohistochemical staining. Furthermore, VEGF mRNA expressions were quantified in all cases using the real-time quantitative RT-PCR. These results were compared with clinicopathologic parameters such as histologic grade and stage. RESULTS: Tumors with high aberrant p53 expressions showed significantly higher VEGF mRNA ex-pressions and microvessel counts than those with low p53 expressions. Expressions of p53 as well as VEGF and micovessel counts were closely associated with the tumor stage, but not with the histologic grade and other clinical parameters. CONCLUSIONS: These results suggest that aberrant p53 expression may play a role in the regulation of VEGF expression and may be involved in controlling angiogenesis in non-small cell carcinoma of the lung.

Arrhythmogenic Right Ventricular Cardiomyopathy as a Cause of Sudden Unexplained Death

OBJECTIVE: Arrhythmogenic right ventricular cardiomyopathy(ARVC) is a progressive cardiac muscle disease characterized as progressive fibrofatty replacement of the right ventricle, severe ventricular arrhythmia, and sudden death. However, there is no report of ARVC as a cause of sudden death in Korea. METHODS and RESULTS: Postmortem studies were done to 115 cases of sudden unexplained death at department of legal medicine, school of medicine, Kyungpook national university in year 1999. We identified 7 cases(6%) of typical ARVC with no other identifiable cause of sudden death. The subjects included 5 males and 2 females, ranging in age from 19 to 41 years (mean 29.7 years). All were found dead at bed (5 cases) or workshop (2 cases). Five cases were fibrofatty types and two cases were fatty types. Right ventricular aneurysm, inflammatory infiltrates and left ventricular involvement were found in 4, 2 and 1 cases, repectively. Two cases had family history of sudden death before age 40. No one was suspected of having cardiovascular disease or ARVC before death. CONCLUSION: These findings indicate that ARVC in Taegu-Kyungpook area may be more frequent than previously thought. ARVC may be a major cause of sudden unexplained death.

The Effects of Nifedipine and Allopurinol on Shock Wave Induced Acute changes of Rabbit Ureter / 대한비뇨기과학회지

PURPOSE: Introduction of shock wave lithotripsy has provided an avenue for dealing with many urinary stones noninvasively. Although shock wave is known to cause pathologic changes in various organ, little is k nown about its effect on the ureter and recovery after shock wave, the target organ in SWL of injury induced by shock wave and the potential protective effect of allopurinol and nifedipine against shock wave. MATERIALS AND METHODS: A total 24 rabbits were assigned to 2 groups. 12 rabbits received allopurinol(10mg.each) and nifedipine (1mg.each) that were given orally 3 times a day for 5 days starting the night before SWL. The other 12 rabbits reseived no medication. The left lower Ureter segments of 24 rabbits were removed ureter. Groups of 8 rabbits(4were medication group and 4, no medication group) were sacrificed 1, 3 and 5 days after shock wave exposure. The histomorphological alterations were examined under light and transmission electron microscopy. RESULTS: The epithelial cells disclosed no change after shock wave application. Histologically the muscular layer was the most affected part of ureter. There was interstitial and intracellular edema on light microscopy and made chromatin and mitochondrial changes at the subcellular level. The adventitial layer wes also edematous. This chanfes were prominent on day 1and 3 and returned to normal on day 5. The medication group showed less severe features of injury, compared with the no medication group. CONCLUSIONS: Electromagnetic shock waves produce reversible morphological changes in rabbit ureteric muscle and allopurinol and nifedipine may have its role in protecting the tissue injury produced by high energy shock waves.

Interventricular Septum Rupture due to Blunt Chest Trauma: A Case Report / 대한법의학회지

Blunt chest trauma may cause a variety of cardiac injuries, such as cardiac contusion, congestive heart failure due to myocardial injury or disruption of intracardiac structures, and more severely, instantaneous death. Traumatic rupture of the interventricular septum secondary to blunt chest trauma is extremely rare. Rupture of the interventricular septum may occur almost immediately after injury or many days later. The most common site of rupture is in the muscular portion of the septum near the apex. The exact mechanism of ventricular septal rupture in blunt trauma is unknown but it is thought to occur by external compression of the heart between the sternum and the vertebrae or as a result of extreme changes in intrathoracic pressure during sudden deceleration. We report an autopsy case of intraventricular septum rupture due to blunt chest trauma. A comatous 28-year-old male was admitted to emergency room after blunt chest trauma by unidentified object. He was treated with supportive care but expired two days later. The autopsy findings were as follows. The dead boy was slightly slender. External wound and patterned bruise were not present. In submentopubic incision, both pleural fluid (right 700ml, left 450ml) and ascites (400ml) were noted. The posterior wall of left ventricle showed hemorrhage measuring 1cm in diameter. On opening the heart, there was interventricular septum rupture measuring 3.5cm in length. Other cardiac structures were unremarkable. On light microscopic examination, endothelial cell was not seen in ruptured portion and both lung showed severe congestion and edema.

Interventricular Septum Rupture due to Blunt Chest Trauma: A Case Report / 대한법의학회지

Blunt chest trauma may cause a variety of cardiac injuries, such as cardiac contusion, congestive heart failure due to myocardial injury or disruption of intracardiac structures, and more severely, instantaneous death. Traumatic rupture of the interventricular septum secondary to blunt chest trauma is extremely rare. Rupture of the interventricular septum may occur almost immediately after injury or many days later. The most common site of rupture is in the muscular portion of the septum near the apex. The exact mechanism of ventricular septal rupture in blunt trauma is unknown but it is thought to occur by external compression of the heart between the sternum and the vertebrae or as a result of extreme changes in intrathoracic pressure during sudden deceleration. We report an autopsy case of intraventricular septum rupture due to blunt chest trauma. A comatous 28-year-old male was admitted to emergency room after blunt chest trauma by unidentified object. He was treated with supportive care but expired two days later. The autopsy findings were as follows. The dead boy was slightly slender. External wound and patterned bruise were not present. In submentopubic incision, both pleural fluid (right 700ml, left 450ml) and ascites (400ml) were noted. The posterior wall of left ventricle showed hemorrhage measuring 1cm in diameter. On opening the heart, there was interventricular septum rupture measuring 3.5cm in length. Other cardiac structures were unremarkable. On light microscopic examination, endothelial cell was not seen in ruptured portion and both lung showed severe congestion and edema.

A Statistical Observation on Medico-Legal Autopsy in Taegu Area during the Year of 1998 / 대한법의학회지

This is a report revealing statical cause of death brought to the department of forensic medicine, Kyungpook National University School of Medicine based on the result of autopsy. The summary of result is as follows. 1. The number of autopsy made during 1998 were 356, of these 225 cases (63.2%) were male, and 131 (36.8%) were female. 2. 30's, 40's, 20's and 50's was the order according to the number of violent death, and in case of natural death, 30's, 50's, 40's was the oder. 3. August is the period during which autopsies are made most, with December placing second, and the other months are similar. 4. In distributing deaths by cases, violent deaths were 241 cases (67.7%), natural deaths were 105 (29.5%) and unknown cases were 10 (2.8%). 5. For the violent deaths, deaths due to injury were 128 cases (53.1%), asphyxia were 63 (26.1%), intoxications were 30 (12.4%) and abnormal temperature were 19 (7.9%). According to relationship with deaths, homicide is outstanding with 101 cases (41.9%), while suicide and accidental death was the same with 62 cases (25.7%). 6. For death due to injury, death due to blunt injury were 48 cases, sharp force injury which was used most in case of homicide were 43. 7. For the asphyxia, drowning is the most 20 cases, 13 cases of which is accidental death. 8. The deaths of intoxication is the largest part of suicide, and most of intoxication were involved in agrochemical. 9. Of 105 cases of natural death, deaths due to the disease of cardiovascular system were 51 cases (48.6%), of which deaths due to myocardial infraction were 35 cases. 10. Of all autopsy, alcohol intake were checked out in 90 cases and 21 cases of medical controversy took places. 11. Of all violent deaths, the cases involved in the discord between man and woman occupied percentage of 9.6. Of these, homicides were 18 cases, with all sacrificed being females, and of 16 cases of suicide, 13 cases were female.

LAN-based Autopsy Recording System for Documentation and Statistics / 대한법의학회지

The automation in autopsy data recording, particularly in the reporting and encoding system using computers requires well designed databases. This system employed multimedia computer techniques to design a database system with application programs along with the standardized autopsy data management flow. The benefit of the present development was verified by practical application into the autopsies performed in the department of forensic medicine, Kyungpook National University. The standardized medical information of forensic autopsy data provides mutual exchange of information between the institutions and information to law enforcement agencies. Statistics on autopsy data could be used not only for medical education and research, but also as a template for policy determination concerning forensic medicine in Korea. It is necessary to standardize information between the institutions.

Desseminated Intravascular Coagulopathy Caused By Acetic Acid Intoxication : A Case Report / 대한법의학회지

Strong corrosive acid is accidentally ingested by children or by psychiatric patients for the purpose of suicidal attempt. Late complications include chemical burn to pharyunx, perforation and stricture of upper gastrointestinal tract, respiratory insufficiencyand renal failure caused by hemoglobinuria following hemolysis. Acetic acid is difficult to ingestion large volume in a time because it is a strong irritant, provocating painful pharynx, and its autopsy case is rare. We report an autopsy case of acetic acid intoxication with acute disseminated intravascular coagulation (DIC) in several hours. We present pathogenesis of acetic acid intoxication and the associated forensic problems. A comatous 39-year-old female was admitted to emergency room 6 hours after she swallowed 90 gm of acetic acid. She was treated with gastric lavage but she was expired 9 hours after swallowing acetic acid. She was consulted to Department of Forensic Medicine of Kyungpook National University School of Medicine. She was grossly icteric and livor mortis was generally dark red. External wounds were 10 hemorrhagic lesions with 5 x 3.7cm and 3 x 2.8cm on the left arm and hand dorsum and facial abrasions. Internal gross examination revealed several purpural lesions in the gastric serosal surface and greater omentum. Microscopically, the stomach showed diffuse mucosal coagulation necrosis and intravascular hyalinized or fibrinoid thrombi in submucosal blood vessels. Liver showed necrosis of periportal area (zone I) and intracellular cholestasis around the central vein. Sections from renal tissue frequently show hemoglobin casts in the tubules and RBCs in the Bowman's capsules. Acetic acid of a remnant bottle, sampled blood and bloody necrotic tissues in the stomach were toxicologically examined in National Science Laboratory. The purity of ingested acetic acid is 98%, the concentration of acetic acid ion in blood is 734ppm and the content in gastric juice is 0.09%. In patients after acetic acid ingestion, DIC is most probably caused by procoagulants, produced by extensive acid-induced necrosis of the upper gastrointestinal tract. In this case, several purpural lesions were revealed on the arm, around facial abrasion and intravenous injection sites of the wrists. These are important to differentiate with contusion because she was battered before acetic acid ingestion. Purpurae in DIC are poorly demarcated, dark purple elevations with spreading margin but subcutaneous hemorrhage in contusion is grayish black or dark red with well demarcation (Table 2). But careful examination should be considered because traumatic hemorrhage is also exaggerated and mixed in DIC. (The Korean Journal of Legal Medicine)

Blunt Injury and Penetrating Inujury of the Abdomen / 대한법의학회지

In blunt abdominal trauma, the abdomen may be compressed and crushed without disruption of the skin, without external bruising, and yet extensive and fatal internal injuries may be present. The penetrating wounds are especially dangerous because of the possibility of grave injury to internal organs or major blood vessels. The majority are homicidal injuries: suicide by stabbing, or accidental stabbing, is infrequent. The abdominal injuries usually coexist with other-site injuries, especially with chest injuries. The homicide and the suicide often aim at the heart, in consequence wound the left side of the chest or upper abdomen. This review is discussed on the mechanism of the blunt and penetrating abdominal injury, types of injury, and significance of medicolegal aspects of the abdominal trauma.

Ultrastructural Feature of Proximal Convoluted Tubular Cells of Rat Induced by Gentamicin

Myeloid body formation is an ultrastructural feature of gentamicin induced nephrotoxicity in human being and experimental animals. The origin of the myeloid body is not satisfactorily understood and morphological verification of the developing process of this structure is not fully accomplished. We injected 100 mg/kg/12 hour of gentamicin in 20 Spraque-Dawley rats and examined the ultrastructural feature of the proximal convoluted tubular cells of the kidney every 30 minutes in the first 4 hours, and in 5 hours, 6 hours, 12 hours, 24 hours and 48 hours after injection of gentamicin, with a TEM and a SEM. Myeloid bodies were noted as concentric layers of membranous structures of degenerated endoplasmic reticulum and mitochondria in the lysosome. The number and size of the myeloid body containing lysosomes were increased with time. We can deduce from this observation that injured cell organelles by diffusible gentamicin within the cells are autophagocytosed by lysosomes which were also injured by the drug from pinocytotic vesicles, and incompletely digested organellar remnants are retained in the lysosomes as myeloid bodies. So we think that the myeloid body formation is a result of an exaggerated and a pathologic autophagocytic process due to cell injury induced by gentamicin.

Significance of Cathepsin-D Expression in Uterine Cervical Neoplasia / 대한부인종양콜포스코피학회잡지

Various clinical and histopathologic characteristics are currently used to obtain prognostic information about cervical carcinoma, but they do not predict accurately the outcome for any individual patients. Thus, there is a need to identify additional tumor characteristics that are able to predict more accurately the outcome for an individual patient with cervical cancer. In this study, we explored the relationship between cathepsin-D expression and progression of the cervical neoplasia, the correlation between response to neoadjuvant chemotherapy and cathepsin-D expression, and we investigated if tumor cell cathepsin-D expression could serve as a prognostic factor in cervical carcinoma. Tumor tissues were obtained from 14 patients with cervical intraepithelial neoplasia and 52 patients with squamous cell carcinoma of the cervix. Cathepsin-D expression was identified by immunohistochemical methods using monoclonal antibody cathepsin-D (BioGene). Positive cathepsin-D immunoreaction in greater than 30% of carcinoma cells was scored as high expression High cathepsin-D expression was seen in 15 of 52 invasive cervical cancer but was absent in cervical intraepithelial neoplasia. It was shown that cathepsin-D expression was independent of the tumor grade, tumor size, lymph node involvement, depth of invasion, parametrial invasion, and response to chemotherapy. In disease free survival analysis by log-rank test, cathepsin-D expression was not significantly associated with survival. These results show that cathepsin-D expression is not a clinically useful adjunct to assessment of prognosis in invasive squamous cell carcinoma of the cervix.

The Morphologic Changes of the Sinusoidal Endothelial Cells in N-diethylnitrosamine Induced Cirrhotic Rat Liver

The purpose of this study is to investigate the morphologic changes of the sinusoidal endothelial cells and the associated structures of the cirrhotic rat liver induced by repeat intraperitoneal injections of N-diethylnitrosamine (DEN) (100 mg/kg/week). One day to 6 weeks later, rat livers were observed under the light, transmission and scanning electron microscopy, and immunostained with laminin antibody. Two weeks after DEN treatment, the fibrillar material in Disse's space was noted, and then a basement membrane-like structure was found at 4 weeks after treatment. Laminin was detected in perisinusoidal areas after 4 weeks. Laminin was strongly positive on the fibrous septum and in the sinusoidal wall of cirrhotic nodules after 6 weeks of treatment. The diameters and numbers of sinusoidal endothelial fenestrations did not change significantly until 2 weeks. They decreased within 4 weeks, and then the sinusoidal endothelium was poorly fenestrated at 6 weeks after DEN treatment. These results suggest that as fibrosis develops in cirrhosis, the deposit of extracellular matrix such as laminin within Disse's space is a major contributing factor in the structural alteration of sinusoidal endothelial cells, and the capillarization of the sinusoidal endothelial cells may be a contributor to impairment of the hepatic function in cirrhosis.