Acute necrotizing encephalopathy is a recently established disease entity, proposed by Mizuguchi et al in 1995, that shows a characteristic symmetric and multifocal involvement of both thalamus, brainstem tegmentum, cerebral periventricular white matter, and cerebellar medulla. It is known to be prevalent in Japan and other Far Ease countries. The etiology of the acute necrotizing encephalopathy remains unknown. The typical course of acute necrotizing encephalopathy is the development of the irreversible neurologic symptoms related to brain lesions. The diagnosis can be made on the basis of the combination of a typical clinical profile and characteristic radiologic findings. We experienced a first case of acute necrotizing encephalopathy in a 9 month old boy in Korea. We report this case with the brief review of related literatures.
Brain ; Brain Stem ; Diagnosis ; Humans ; Infant ; Japan ; Korea ; Male ; Neurologic Manifestations ; Thalamus

Allergic contact dermatitis that is attributable to contact with environmental sensitizers boine by a second individual, especially in marital or sexual relationships, has been described as connubial contact dermatitis. Severely pruritic multiple erythematous plaques, vesicles and bullae in a 35-year-old woman occurred on the face, posterior area of the neck, breasts, buttock, and both upper arms. No direct contact to allergens was obtained. However her husband had eaten some cooked sprouts from a lacquer tree for lunch at a restaurant the day before her eruption, then he caressed her that night. A patch test with extracts of lacquer tree in ethanol(2%), crushed extracts of lacquer tree (as is), and urushiol(0.002% pet.) on the patients back showed strong positive reactions.
Adult ; Allergens ; Arm ; Breast ; Buttocks ; Dermatitis, Allergic Contact ; Dermatitis, Contact* ; Female ; Humans ; Lacquer ; Lunch ; Neck ; Patch Tests ; Restaurants ; Rhus* ; Spouses ; Trees

PURPOSE: We proposed a new index for predicting death resulting from hemorrhagic shock, which was calculated by dividing measured lactate concentration by perfusion. METHODS: Using 24 Sprague-Dawley (S-D) rats, we induced uncontrolled hemorrhage and then measured blood lactate concentration and perfusion in addition to vital signs such as heart rate, blood pressure, respiration rate and temperature. Perfusion and lactate concentration were measured by laser Doppler flowmetry and a lactate concentration meter, respectively. We collected the data for 15 min, which consisted of 3 intervals after homeostasis, and thus obtained a new index. RESULTS: The proposed index revealed an earlier death prediction than lactate concentration alone with the same timing as perfusion. The new index showed generally better sensitivity, specificity and accuracy than lactate concentration and perfusion. Using a receiver operating characteristic curve method, the mortality prediction with the proposed index resulted in a sensitivity of 98.0%, specificity of 90.0%, and accuracy of 93.7%. The mortality prediction with the proposed index resulted in a sensitivity of 98.0%, specificity of 90.0% and accuracy of 93.7%. CONCLUSION: This index could provide physicians, in emergency situations, with early and accurate mortality predictions for cases of human hemorrhagic shock.
Animals ; Blood Pressure ; Emergencies ; Heart Rate ; Hemorrhage ; Homeostasis ; Humans ; Lactic Acid ; Laser-Doppler Flowmetry ; Perfusion ; Rats ; Respiratory Rate ; ROC Curve ; Sensitivity and Specificity ; Shock, Hemorrhagic ; Vital Signs

PURPOSE: We proposed a new index for predicting death resulting from hemorrhagic shock, which was calculated by dividing measured lactate concentration by perfusion. METHODS: Using 24 Sprague-Dawley (S-D) rats, we induced uncontrolled hemorrhage and then measured blood lactate concentration and perfusion in addition to vital signs such as heart rate, blood pressure, respiration rate and temperature. Perfusion and lactate concentration were measured by laser Doppler flowmetry and a lactate concentration meter, respectively. We collected the data for 15 min, which consisted of 3 intervals after homeostasis, and thus obtained a new index. RESULTS: The proposed index revealed an earlier death prediction than lactate concentration alone with the same timing as perfusion. The new index showed generally better sensitivity, specificity and accuracy than lactate concentration and perfusion. Using a receiver operating characteristic curve method, the mortality prediction with the proposed index resulted in a sensitivity of 98.0%, specificity of 90.0%, and accuracy of 93.7%. The mortality prediction with the proposed index resulted in a sensitivity of 98.0%, specificity of 90.0% and accuracy of 93.7%. CONCLUSION: This index could provide physicians, in emergency situations, with early and accurate mortality predictions for cases of human hemorrhagic shock.
Animals ; Blood Pressure ; Emergencies ; Heart Rate ; Hemorrhage ; Homeostasis ; Humans ; Lactic Acid ; Laser-Doppler Flowmetry ; Perfusion ; Rats ; Respiratory Rate ; ROC Curve ; Sensitivity and Specificity ; Shock, Hemorrhagic ; Vital Signs

ansen's disease, death certificates of the inpatients of Sorokdo National Hospital between 2001 and 2008 and died during the same time period were used to analyze the causes of their death, and the morbidity patterns of those patients who are hospitalized in the same hospital as of 2008 were analyzed. The results are as follows: The average number of diseases per inpatient was 3.4 with the maximum being 10. The distribution of morbidity was 67.2% for circulatory diseases, 58.4% for musculoskeletal diseases, and 36.3% for infectious diseases and skin diseases respectively. The morbidity rank of all patients was 50.1% for primary hypertension, 34.4% for chronic viral hepatitis, 27.4% for arthritis, 27.2% for skin diseases, and 23.7% for cataracts. The age-standardized death rate of males per 100,000 was 557.6 for heart diseases, 500.2 for liver diseases, 460.5 for respiratory diseases, and 459.8 for cancers. The age-standardized death rate of females was 266.3 for sepsis, 232.6 for liver diseases, 212.0 for cancers, 208.8 for pneumonia and 206.9 for respiratory diseases. The standardized death rate for all patients was 456.6 for heart diseases, 414.7 for liver diseases, 393.8 for respiratory diseases, and 383.0 for malignant neoplasms. In conclusion, the patterns of morbidity and mortality of patients with Hansen's disease was different than those of the general population. Additional public health approaches will be needed to improve the health status and quality of life of these patients, and additional studies on related factors will also be in order.
Arthritis ; Cataract ; Communicable Diseases ; Death Certificates ; Female ; Heart Diseases ; Hepatitis ; Humans ; Hypertension ; Inpatients ; Leprosy ; Liver Diseases ; Male ; Musculoskeletal Diseases ; Pneumonia ; Public Health ; Quality of Life ; Sepsis ; Skin Diseases

PURPOSE: A number of clinical decision tools for osteoporosis risk assessment have been developed to select postmenopausal women for the measurement of bone mineral density. We developed and validated machine learning models with the aim of more accurately identifying the risk of osteoporosis in postmenopausal women compared to the ability of conventional clinical decision tools. MATERIALS AND METHODS: We collected medical records from Korean postmenopausal women based on the Korea National Health and Nutrition Examination Surveys. The training data set was used to construct models based on popular machine learning algorithms such as support vector machines (SVM), random forests, artificial neural networks (ANN), and logistic regression (LR) based on simple surveys. The machine learning models were compared to four conventional clinical decision tools: osteoporosis self-assessment tool (OST), osteoporosis risk assessment instrument (ORAI), simple calculated osteoporosis risk estimation (SCORE), and osteoporosis index of risk (OSIRIS). RESULTS: SVM had significantly better area under the curve (AUC) of the receiver operating characteristic than ANN, LR, OST, ORAI, SCORE, and OSIRIS for the training set. SVM predicted osteoporosis risk with an AUC of 0.827, accuracy of 76.7%, sensitivity of 77.8%, and specificity of 76.0% at total hip, femoral neck, or lumbar spine for the testing set. The significant factors selected by SVM were age, height, weight, body mass index, duration of menopause, duration of breast feeding, estrogen therapy, hyperlipidemia, hypertension, osteoarthritis, and diabetes mellitus. CONCLUSION: Considering various predictors associated with low bone density, the machine learning methods may be effective tools for identifying postmenopausal women at high risk for osteoporosis.
Aged ; *Artificial Intelligence ; Bone Density/*physiology ; Female ; Humans ; Middle Aged ; Osteoporosis, Postmenopausal

PURPOSE: To achieve early diagnosis of hemorrhagic shock using a survival prediction model in rats. METHODS: We measured heart rate, mean arterial pressure, respiration rate and temperature in 45 Sprague-Dawley rats, and obtained an artificial neural network model for predicting survival rates. RESULTS: Area under the receiver operating characteristic (ROC) curves was 0.992. Applying the determined optimal boundary value of 0.47, the sensitivity and specificity of survival prediction were 98.4 and 96.6%, respectively. CONCLUSION: Because this artificial neural network predicts quite accurate survival rates for rats subjected to fixed-volume hemorrhagic shock, and does so with simple measurements of systolic blood pressure (SBP), mean arterial pressure (MAP), heart rate (HR), respiration rate (RR), and temperature (TEMP), it could provide early diagnosis and effective treatment for hemorrhagic shock if this artificial neural network is applicable to humans.
Animals ; Arterial Pressure ; Blood Pressure ; Early Diagnosis ; Heart Rate ; Humans ; Neural Networks (Computer) ; Rats ; Rats, Sprague-Dawley ; Respiratory Rate ; ROC Curve ; Sensitivity and Specificity ; Shock, Hemorrhagic ; Survival Rate

BACKGROUND: Pilomatricoma (PM) is benign follicular tumor composed of the basophilic cells, transitional cells, shadow cells, squamoid cells and keratin filaments/amorphous debris. At present, PM is assumed to differentiate toward hair-forming cells of hair follicles but definite direction is not clear. OBJECTIVES: This study was made in order to investigate the pathways of cell differentiation associated with sudden keratinization in PM. METHODS: In the present study, 19 cases of human PM was histopathologically examined and classified into 4 groups according to the chronological stages. RESULTS: In the chronological stages according to Kaddu's classification, there were 2 cases of early lesion, 6 cases of fully developed lesion, 7 cases of early regressive lesion and 4 cases of late regressive lesion. The basophilic cells changed into the shadow cells or amorphous debris through the transitional cells moving toward the exterior of the PM, as well as toward the interior. As keratinization occurs, some inner basophilic cells which had been located in marginal areas of keratinization lost their tight cell-cell bonding. These cells showed edematous/vesicular and squamoid changes. High molecular weight cytokeratin was expressed in a linear pattern in some early and fully developed lesions. There were fewer layers of basophilic cells between the stroma and squamoid cells/amorphous debris than between the stroma and shadow cells. Ki-67 was expressed strongly both basal and overlying basophilic cells. Apoptotic bodies were detected in most transitional cell layers and some amorphous debris zones. CONCLUSIONS: The present study suggests dual pathways of cell differentiation in PMs. In the sudden keratinization pathway, the basophilic cells, transtional cells, shadow cells, and squamoid cells are suddenly keratinized, and the basophilic cells become early the transitional cells or squamoid cells. Cytoplasmic expressions of Ki-67 and cytokeratin in the basophilic cells show that the basophilic cells differentiate toward the innermost layer of the outer root sheath cells.
Apoptosis ; Basophils ; Cell Differentiation ; Classification ; Cytoplasm ; Hair Follicle ; Humans ; Keratins* ; Molecular Weight ; Pilomatrixoma*

Anesthesiologists are faced with a growing number of patients in need of cardiac pacing with symptoms of increasing complexity. Because intraoperative pacemaker malfunction can lead to sudden death, it is important for the anesthesiologists to possessthe information necessary to evaluate and treat such patients. On the other hand, torsade de pointes, a particular form of life-threatening polymorphic ventricular tachycardia, is known to be elicited in patients with cardiac pacemakers in the setting of abnormally long QT intervals, decreased heart rate and severe electrolyte disturbances, notably hypokalemia. We herein report a case of intraoperative torsade de pointes that was triggered by pacemaker malfunction-induced bradycardia in a patient with a VVI-type cardiac pacemaker, whose serum potassium and magnesium level were low preoperatively. (Korean J Anesthesiol 1999; 37: 164~167)
Bradycardia ; Death, Sudden ; Hand ; Heart Rate ; Humans ; Hypokalemia ; Magnesium ; Potassium ; Tachycardia, Ventricular ; Torsades de Pointes*

A 31-year-old man presented with an erythematous tumor within a giant pigmentation on the left arm, which was partially covered with hairs and had a few subcutaneous nodules within it. Also he had a bluish tumor on the left palm, multiple tumors and cafe au lait spots on the upper trunk. Histologic examination from the tumor, pigmentation and subcutaneous nodules on the left arm, and the tumors on the upper trunk and left palm all revealed neurofibromas. Interestingly, the rare types of the neurofibromas, diffuse and pigmented neurofibroma were included in these.
Adult ; Arm ; Cafe-au-Lait Spots ; Hair ; Humans ; Neurofibroma* ; Neurofibromatoses* ; Pigmentation*