This study was conducted to evaluate the accuracy of the official death registry in rural area. The base data used for the study was 379 deaths registered during the period of 1993 and 1994 in 4 rural townships of Chonnam Province. The interview survey for cause-of-death was performed on the next of kin and/or neighbor. Additional medical informations were collected from hospitals and medical insurance associations for the purpose of verification. The underlying cause-of-death of 278 cases presumed by the survey was compared to the cause on official death registry. There was a prominent disagreement of cause-of-death between the survey data and the registry data(agreement rate: 38.9~44.6%%, according to disease classification method). These results may be caused by extremely low rates of physicians' certification, which were mostly confined to the poisoning and injury. Symptoms, signs, and ill defined conditions on death registry could be classified into circulatory disease(32.3%), neoplasm(21.2%), digestive disease(7.l%), injury and poisoning(7.l%) and so on. These results suggest that careful attention and verification be required on utilization of death registry data in rural area.
Cause of Death ; Certification ; Classification ; Insurance ; Jeollanam-do ; Poisoning

Desmoplastic small round cell tumor (DSRCT) is a rare and highly aggressive neoplasm. The cytological diagnosis of this tumor has only been reported in a few cases. In most of these cases, the diagnosis was made using fine-needle aspiration cytology. Most DSRCTs resemble disseminated carcinomatoses in their clinical manifestation as well as cytomorphologically, even in young-adult patients. These authors report a case of using peritoneal-washing and pleural-effusion ThinPrep cytology to diagnose DSRCT, with extensive glandular differentiation and mucin vacuoles. We found that fibrillary stromal fragment, clinical setting, and adjunctive immunocytochemical staining were most helpful for avoiding misdiagnosis.
Biopsy, Fine-Needle ; Carcinoma ; Desmin ; Desmoplastic Small Round Cell Tumor ; Diagnostic Errors ; Humans ; Mucins ; Vacuoles

BACKGROUND: It is known that propofol protects myocardium against a global ischemia-reperfusion injury in the isolated rat heart model. The aim of this study was to investigate whether propofol, at a clinically relevant concentration infused during the peri-ischemic period, also provides a protective effect against a regional myocardial ischemia-reperfusion injury in vivo. METHODS: Rats were subjected to 25 minutes of coronary artery occlusion followed by 24 hours of reperfusion. Propofol or intralipid was administrated during 35 minutes starting 5 minutes before the onset of ischemia until 5 minutes after the onset of reperfusion. A micromanometer catheter was advanced into the left ventricle and the hemodynamic function was evaluated. The infarct size was determined by triphenyltetrazolium staining after 24 hours of reperfusion. RESULTS: Propofol administration during the peri-ischemic period demonstrated protective effects on hemodynamic function and infarct size reduction. In the control group, the peak rate of the ventricular pressure increase (+dP/dt(max))(P = 0.0001) and the peak rate of the intraventricular pressure decline (-dP/dt(max))(P = 0.0001) were significantly decreased compared to the sham group. In the propofol group, the +dP/dt(max) (P = 0.003) and -dP/dt(max) (P = 0.002) were significantly improved compared to the control group. The infarct size was 47.6% of the area at risks in the control group, and was reduced markedly by administration of propofol during the peri-ischemic period to 26.2% in the propofol group (P = 0.004). CONCLUSIONS: Propofol, at a clinically relevant concentration infused during the peri-ischemic period, have protective effect after regional myocardial ischemia-reperfusion injury in an in vivo rat heart model.
Animals ; Catheters ; Coronary Vessels ; Emulsions ; Heart ; Heart Ventricles ; Hemodynamics ; Ischemia ; Myocardium ; Phospholipids ; Propofol ; Rats ; Reperfusion ; Reperfusion Injury ; Salicylamides ; Soybean Oil ; Tetrazolium Salts ; Ventricular Pressure

Acquired amegakaryocytic thrombocytopenia (AAMT) is an unusual disease characterized by severe thrombocytopenia resulting from a marked decrease in bone marrow megakaryocytes. Various pathogenic mechanisms have been suggested, and several treatments have been tried, with varying outcomes. In some case reports, cyclosporine and anti-thymocyte globulin have had good clinical results in the treat of AAMT. There are few reports on the treatment of relapsed AAMT with cyclosporine. We report a patient with relapsed AAMT who was treated successfully with an additional course of cyclosporine. The initial remission was achieved with cyclosporine 4 years earlier and a second remission was induced by cyclosporine. Cyclosporine may be effective for relapsed AAMT that previously responded to cyclosporine.
Antilymphocyte Serum ; Bone Marrow ; Cyclosporine* ; Humans ; Megakaryocytes ; Thrombocytopenia*

A 29-year-old pregnant woman with recurrent pericardial effusion and a cardiac tumor, diagnosed as an angiosarcoma, was treated with surgical resection of the tumor followed by radiotherapy. Immediately after completion of radiotherapy, she developed bilateral breast masses, which were also confirmed as angiosarcomas. We thought this might be the first case of bilateral angiosarcoma of the breast metastasizing to heart mimicking a primary cardiac angiosarcoma, although we could not conclude with certainty that angiosarcoma of the heart was not the primary site.
Adult ; Biopsy ; Breast Neoplasms/*pathology ; Cardiac Surgical Procedures ; Female ; Heart Neoplasms/complications/*pathology/surgery ; Hemangiosarcoma/*pathology ; Humans ; Magnetic Resonance Imaging ; Pericardial Effusion/etiology ; Positron-Emission Tomography ; Pregnancy ; Radiotherapy, Adjuvant ; Tomography, X-Ray Computed

Paragonimiasis typically results from the consumption of raw or improperly cooked crustacea, especially crabs and crayfish. Although previously endemic in Korea, the prevalence of this disease decreased in the early 1970s because of educational campaigns and fewer intermediate hosts as a result of ecological changes. Recently, we were presented with a family where all members were infected with Paragonimus after ingestion of Kejang (= drunken crab). The mother was hospitalized for general myalgia and weakness first, followed by the father, who was hospitalized for dyspnea 2 month later. After the parents were diagnosed with paragonimiasis, we recommended their daughter to visit our hospital for a checkup, because they all had eaten freshwater crabs soaked in soybean sauce. She complained of generalized myalgia, fever, and pleuritic pain, and was also diagnosed with paragonimiasis. Peripheral blood of the 3 patients revealed hypereosinophilia, and computed tomography (CT) scans of their chests showed pleural effusion. The results of antibody tests by ELISA were positive for paragonimiasis. We report here the case series of familial paragonimiasis in a modern urban city, rather than in a typical endemic area.
Adult ; Animals ; Family ; Female ; Humans ; Korea ; Lung Diseases, Parasitic/*diagnosis/radiography ; Male ; Middle Aged ; Paragonimiasis/*diagnosis/radiography ; Paragonimus/isolation & purification

Primary central nervous system lymphoma (PCNSL) is an aggressive non-Hodgkin's lymphoma (NHL), usually composed of diffuse large B-cells. Although rituximab is known for its curative effect on B-cell NHL, data on the use of intrathecal rituximab for PCNSL are limited. In this report, we present two patients showing relapsed PCNSL with lymphomatous meningitis. Both patients were refractory to conventional methotrexate-based intrathecal chemotherapy. However, after intrathecal rituximab with or without conventional intrathecal chemotherapy, both patients showed stable disease on magnetic resonance brain imaging and cerebrospinal fluid analysis. There were no serious adverse events during each of 3 and 6 cycles with intrathecal rituximab immunotherapy.
B-Lymphocytes ; Central Nervous System* ; Cerebrospinal Fluid ; Drug Therapy ; Humans ; Immunotherapy ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Meningitis ; Neuroimaging

Histiocytic sarcoma (HS) is a very rare neoplasm that often shows an aggressive clinical course and systemic symptoms, such as fever, weight loss, adenopathy, hepatosplenomegaly and pancytopenia. It may present as localized or disseminated disease. We describe here a 63-yr-old male who manifested systemic symptoms, including fever, weight loss and generalized weakness. Abdominal and chest computed tomography failed to show specific findings, but there was suspicion of multiple bony changes at the lumbar spine. Fusion whole body positron emission tomography, bone scan and lumbar spine magnetic resonance imaging showed multiple bone lesions, suggesting a malignancy involving the bone marrow (BM). Several BM and bone biopsies were inconclusive for diagnosis. Necropsy showed replacement of the BM by a diffuse proliferation of neoplastic cells with markedly increased cellularity (95%). The neoplastic cells were positive for lysozyme and CD68, but negative for T- and B-cell lineage markers, and megakaryocytic, epithelial, muscular and melanocytic markers. Morphologic findings also distinguished it from other dendritic cell neoplasms.
Antigens, CD/metabolism ; Antigens, Differentiation, Myelomonocytic/metabolism ; Bone Marrow/metabolism/pathology ; Bone Marrow Neoplasms/*diagnosis/pathology ; Diagnosis, Differential ; Histiocytic Sarcoma/*diagnosis/pathology ; Humans ; Magnetic Resonance Imaging ; Male ; Muramidase/metabolism ; Positron-Emission Tomography ; Tomography, X-Ray Computed

A 76 year-old female who was diagnosed with multiple myeloma (IgG, lambda) had received bortezomib, melphalan and prednisolone as first-line treatment. After completing six cycles of chemotherapy, her serum monoclonal protein level decreased from 7.28 g/dL to 0.65 g/dL, indicating a partial response. However, at the next scheduled visit she complained of slowly progressing dyspnea. On chest X-ray, newly developed pleural effusion was found, and rapidly progressing extramedullary plasmacytoma was detected in the anterior mediastinum on chest computerized tomography. However, there was no change in her serum monoclonal protein level. In Korea, extramedullary involvement is encountered in 5% of patients with multiple myeloma. However, evaluation of treatment response using solely the serum monoclonal protein level may not accurately reflect disease status in these patients.
Drug Therapy ; Dyspnea ; Female ; Humans ; Korea ; Mediastinum ; Melphalan ; Multiple Myeloma* ; Plasmacytoma* ; Pleural Effusion ; Prednisolone ; Thorax ; Bortezomib

High-dose methotrexate (MTX) is frequently used for the treatment for various malignancies. The primary route of MTX excretion is through the kidneys, and so it may cause toxicities in patients with renal insufficiency. Prolonged high levels of serum MTX can result in renal dysfunction, pancytopenia and mucositis, but the strategies used for MTX removal have not been universally accepted. We report here on a case of a 55-year-old man with NK cell lymphoma and who was treated with high-dose MTX. He had been receiving hemodialysis due to acute renal failure that was induced by previous chemotherapy. After 24, 48, and 72 hours of MTX infusion, the serum MTX levels were markedly increased to 146.07micromol/L, 111.30micromol/L and 94.37micromol/L, respectively, and so leucovorin rescue was intensified. Therapeutic plasma exchange (TPE) was started on post-MTX day 4, which was after the day of the peak MTX concentration, and this was continued on days 5 and 7 to rapidly reduce the MTX level. The serum MTX level decreased to the normal range without any rebound phenomenon after 2 weeks. However, MTX-induced pancytopenia occurred and the patient then died of septic shock. It is suggested that if the MTX level is very high in spite of conventional treatments, then immediate TPE should be started to avoid MTX toxicities.
Acute Kidney Injury ; Humans ; Kidney ; Killer Cells, Natural ; Leucovorin ; Lymphoma ; Methotrexate ; Middle Aged ; Mucositis ; Pancytopenia ; Plasma ; Plasma Exchange ; Reference Values ; Renal Dialysis ; Renal Insufficiency ; Shock, Septic