Pregnancy-related acute myocardial infarction (AMI) is very rare and can be lethal if the diagnosis and management are delayed. The physiological changes during pregnancy, including in hemodynamics and hormonal status, can increase the risk of AMI even in young women. While atherosclerosis is the leading cause of AMI in the general population, coronary artery dissection is most common in pregnancy-related AMI. Pregnancy-related AMI, which is caused by coronary atherosclerosis, has been rarely reported in Korea. We report an autopsy case of postpartum sudden cardiac death in a 32-year-old woman.
Adult ; Atherosclerosis ; Autopsy ; Coronary Artery Disease ; Coronary Vessels ; Death, Sudden, Cardiac ; Diagnosis ; Female ; Hemodynamics ; Humans ; Korea ; Myocardial Infarction* ; Postpartum Period ; Pregnancy

The grading of astrocytoma has traditionally relied on histological assessment, but there are some differences in their parameters, application, and reproducibility. Recently, numerous studies have attempted to correlate biological aggresiveness with tumor proliferation index using new immunohistochemical methods. The purpose of this study is to correlate the histopathological grades of astrocytoma with the expression of Ki-67, PCNA, p53 protein and AgNORs. The paraffin sections of 41 consecutive cases of astrocytomas were examined. Histologically the tumors were graded as three groups under the St. Anne-Mayo system and showed 14 cases in grade II, 15 cases in grade III and 12 cases in grade IV (glioblastoma multiforme). As a result, the Ki-67 labelling index and p53 protein expression tended to increase with increasing grade of malignancy. But the univariate analysis showed that there was no significant difference between the tumor grades (p>0.05). The PCNA labelling index and number of AgNORs revealed striking differences between the grade II and grade III astrocytomas (p<0.05). We concluded that the PCNA labelling index and AgNORs counting are useful markers for differentiation between grade II and III astrocytomas.
Astrocytoma* ; Paraffin ; Proliferating Cell Nuclear Antigen* ; Strikes, Employee

We have reviewed seven cases of fracture-separation of the distal humeral epiphysis, one of which was initially misdiagnosed as a fracture of the lateral condyle. There were difficulties in making the diagnosis. The injury must be distinguished from an elbow dislocation and a fracture of the lateral humeral condyle. All seven patients revealed posteromedial displacement of the distal humeral epiphysis on initial x-rays. Three patients were treated by closed reduction and cast immobilization, and four patients by open reduction and internal fixation. All three patients with conservative treatment had slight cubitus varus (under 5 degrees). Two patients with operative treatment had significant deformities of the elbow, one 25 degrees of valgus and one 20 degrees of varus. In treatment of these injuries, accurate evaluation of the state of reduction is most important. We got acceptable results with a conservative treatment.
Child* ; Congenital Abnormalities ; Diagnosis ; Dislocations ; Elbow ; Epiphyses* ; Humans ; Immobilization

A retrospective quality assurance study of intraoperative consultation (frozen section) was carried out to assess the accuracy and to determine the reasons of discordance. Of 14,977 surgical pathology cases accessioned over a 6-month period in Asan Medical Center, frozen sections were done on 1,270 (8.5%) patients and 2,392 frozen sections (1.88 frozen sections/case) were performed. Discordance was noted in 106 cases (4.4%) and diagnosis was deferred in 26 cases (1.1%). All deferred cases were reviewed with the result of 53.8% justified and 46.2% unjustified. The discordant cases were divided into three categories as to their clinical significances: category A (no affect on patient care) 61.3%, B (minimal affect) 9.4%, and C (major affect) 29.2%. Of 31 category C cases, 7 cases were false positive and 24 cases were false negative. Misinterpretation (70.8%) was the leading cause of discordance, followed by sampling error (15.1%), failure to identify lesion (8.5%), and technical problem (5.7%). More than one-third (35.8%) of all discordances were of central nervous system cases. Total central nervous system cases were 403 (16.8%) with a significantly higher disordance rate (9.8%) and deferral rate (2.5%) in comparison to the other cases with 3.4% discordance rate and 0.8% deferral rate. There were 43 colorectal cancer cases of intraoperative consultation for adequacy of resectional margins. The surgical margins were between 0.4 cm and 28 cm (mean: 6.7 cm) away from the tumor and there was no tumor-positive case. The study indicates surgical pathology should 1) promote interpretative skills in cases involving minute fragments of neurosurgical cases, 2) defer the diagnosis and ask for more tissue on inadequate or inappropriate specimens and 3) give only gross opinions without unnecessary frozen section procedures in the event of simple, clear-cut cases.
Abscess ; Anti-Bacterial Agents ; Biopsy ; Central Nervous System ; Chungcheongnam-do ; Colitis, Ulcerative ; Colorectal Neoplasms ; Diagnosis ; Diagnosis, Differential ; Endoscopy ; Enterocolitis, Pseudomembranous* ; Frozen Sections* ; Humans ; Mucous Membrane ; Necrosis ; Pathology ; Pathology, Surgical ; Retrospective Studies ; Selection Bias

We herein report a case of AIDS-related Kaposi's sarcoma (KS) in a 36-year-old male patient, who had a solitary nodular skin lesion on the left supraclavicular area. The histopathologic findings showed typical features of KS as spindle cell proliferation and vascular spaces lined with endothelial cells. The patient's serum was positive for antibodies to the human immunodeficiency virus (HIV) and he had opportunistic infection of Pneumocystis carinii pneumonia and pulmonary tuberculosis. The WBC count was 1,200/mm3 and CD4 count was 50/mm3 with decreased CD4/CD8 ratio to 0.06. He died due to an aggravated respiratory infection.
Adult ; Antibodies ; CD4 Lymphocyte Count ; Cell Proliferation ; Endothelial Cells ; HIV ; Humans ; Male ; Opportunistic Infections ; Pneumonia, Pneumocystis ; Sarcoma, Kaposi* ; Skin ; Tuberculosis, Pulmonary

Pneumocystis carinii is the most common cause of diffuse pulmonary infiltrates in the immunocompromised patients. Microscopically, Pneumocystis carinii pneumonia(PCP) shows characteristic frothy intraalveolar exudate and interstitial lymphocytic and plasma cell infiltrate. However, sometimes the only histologic finding of PCP on routine hematoxylin-eosin stain is that of diffuse alveolar damage(DAD), when we can miss the diagnosis without aid of special stains. We report a case of Pneumocystis carinii pneumonia presenting as DAD in a 50-year old man after chemotherapy due to malignant lymphoma. Open lung biopsy specimen reveals the early stage of DAD without any characteristic findings, such as foamy exudate. However many cysts of Pneumocystis carinii were found on Gomori's methenamine silver(GMS) stain. Therefore, GMS stain should be routinely performed on all biopsy specimens obtained from immunocompromised patients.
Male ; Humans ; Cysts ; Biopsy

No abstract available.
Humans* ; Polymerase Chain Reaction*

No abstract available.
Muscular Dystrophies*

BACKGROUND: Propofol has a high incidence of pain with intravenous injection, and different methods have been used to minimize the incidence and severity of this pain. In this study, we have compared the effect of lidocaine pretreatment with that of ketamine pretreatment on propofol injection pain. METHODS: Ninety healthy female patients scheduled for general anesthesia were randomly divided into three groups; saline group (n=30), lidocaine group (n=30) and ketamine group (n=30). Each patient received 2 ml of pretreatment solution (normal saline, 1% lidocaine, 0.5% ketamine) via 18G angiocatheter inserted in the antecubital fossa after applying an arm tourniquet inflated to 50 mmHg. The tourniquet was released 1 minute later, followed by intravenous injection of 2.5 mg/kg of propofol. The assessment of pain was made at the induction of anesthesia and in the recovery room, and the severity of pain was classified as none, mild, moderate, severe by one observer. RESULTS: The severity and incidence of pain diminished significantly in the lidocaine group and the ketamine group compared with the saline group at the induction of anesthesia (p<0.05) and there was no significant difference between the lidocaine group and the ketamine group. We had similar results in the recovery room and one patient from the saline group and the ketamine group had no recall regarding injection pain. CONCLUSION: Intravenous ketamine pretreatment is as effective as intravenous lidocaine pretreatment in alleviating the propofol injection pain.
Anesthesia ; Anesthesia, General ; Arm ; Female ; Humans ; Incidence ; Injections, Intravenous ; Ketamine* ; Lidocaine* ; Propofol* ; Recovery Room ; Tourniquets

No abstract available.
Leukemia, Eosinophilic, Acute* ; Trisomy*