Aneurysm of the internal carotid artery is a rare disease and is known to be associated with congenital arterial anomalies such as neurofibromatosis type I (NF-I). NF-I is an autosomal dominant neurocutaneous disorder characterized by a variety of manifestations that involve the central and peripheral nervous systems, skin, vascular system, and skeleton. In particular, the involvement of vascular abnormalities in NF-I is well known. Any vessel may be affected by this condition, although the renal artery is most frequently involved. The vascular abnormality can be occlusive or an aneurysmal degenerative change. Therefore, symptomatic presentations might assume an indolent pathophysiologic course such as hypertension, or manifest as a catastrophic event such as arterial rupture that could result in sudden death. We report a rare autopsy case of an aneurysmal rupture of the internal carotid artery in a woman with suspected NF-I, who collapsed in her home.
Aneurysm ; Autopsy ; Carotid Artery, Internal ; Death, Sudden ; Female ; Glycosaminoglycans ; Humans ; Hypertension ; Neurocutaneous Syndromes ; Neurofibromatoses ; Neurofibromatosis 1 ; Peripheral Nervous System ; Rare Diseases ; Renal Artery ; Rupture ; Skeleton ; Skin

Anaphylactic deaths are frequently observed at autopsies. Since death associated with medical practice has become social concern, the identification of anaphylactic shock is an important part of forensic medicine. However, autopsy findings of anaphylactic shock are usually non-specific; therefore, the diagnosis of anaphylactic shock must be inferred from collecting data on the past history of the deceased, circumstances of death, and negative autopsy findings. The analysis of serum mast cell tryptase level is a well-known, useful ancillary test for the diagnosis of anaphylactic shock, but is not widely used in daily practice in Korea. We recently encountered 2 autopsy cases of anaphylactic shock and confirmed that analysis of serum mast cell tryptase level was useful for the diagnosis of anaphylactic shock. In this report, we present these 2 autopsy cases of anaphylactic shock, with literature review of the usefulness and limitations of serum mast cell tryptase analysis.
Anaphylaxis ; Autopsy ; Forensic Medicine ; Korea ; Mast Cells ; Tryptases

PURPOSE: To evaluate the prevalence of the opacification of paranasal sinuses and to correlate the prevalence and severity of the sinus opacification with presence of upper respiratory infection (URI) in infants and children using CT. MATERIALS & METHODS: We analyzed CT scans of 162 children aged under 16 who have no signs and symptoms of paranasal sinusitis. Both sides of maxillary and ethmoidal sinuses were evaluated. We scored from 0 to 3 according to the degree of soft tissue opacification of each sinus and then summed up the scores of each sinus. We divided the children into 5 groups according to their age. We paid particular attention to the following respects: 1) the prevalence of the opacification of the paranasal sinuses in each group; 2) the difference in the prevalence between the children with and without URI ;3) the correlation between the severity of the sinus opacification and the presence of URI. RESULTS: Of 162 children, one or more paranasal sinus opacification was noted in 76(47 %):31(65%) less than 1 year old;11(52%) between 1 and 2 years old;16(53%) between 2 and 6 years old ;15(28%) between 6 and 12 years old;and 3(33%) above 12 years old. In children less than 1 year old, no significant difference in the prevalence of the sinus opacification was found between URI-positive(71%) and URI-negative(58%) subgroups. In chilren between 1 and 12 years old, although the prevalence of the sinus opacification in URI-positive subgroups was much greater than that in URI-negative subgroup, statistically significant difference was noted only in children between 2 and 6 years old. As to the correlation between the severity of the sinus opacification and the presence of URI, these was a statistically significant difference in children between 2 and 6 years old and between 6 and 12 years old. CONCLUSION: Although the exact pathophysiology is not fully understood, the opacification of the paranasal sinuses is not an uncommon finding at CT in children without the signs and symptoms of sinusitis. We think that the clinical correlation is essential in determining the diagnosis and treatment plan in cases that the sinus radiographs or CT scans show the abnormal findings.
Child* ; Diagnosis ; Humans ; Infant* ; Paranasal Sinuses ; Prevalence* ; Sinusitis* ; Tomography, X-Ray Computed

To evaluate the normal development of the paranasal sinuses in children with CT, authors prospectively studied with brain CT scans of 260 children without known sinus diseases, ranging in age from 7 days to 16 years. Maximal anteroposterior and transverse diameters(mm) and maximal cross-sectional area(mm2) of both sides of the maxillary sinus were measured with the aid of computer device. As to the ethmoidal and sphenoidal sinuses, we simply documented the presence of the aplastic ethmoidal sinus and calculated the age-incidence of the sphenoidal sinus pneumatization, respectively. There noted three phases in the development of the maxillary sinus. The anteroposterior and transverse diameters of the maxillay sinus increased nearly in parallel. The former was always greater than the latter. In no cases was the ethmoidal sinus aplastic and almost all sinuses were pneumatized even in infants as early as 7 days old. CT identified the conchal pattern of sphenoidal sinus pneumatization in infants as early as 11 days old. Sphenoidal sinus pueumatization was seen in 38% of the children under the age of 1 year, 82% of the children between the age of 1 and 2 years, and almost all children older than 2 years. The anteroposterior and transverse diameters of the maxillary sinus seem to reach the adult size by 8 years of age, and the conchal pattern of sphenoidal sinus pneumatization can be recognized earlier with CT than on the plain radiographs.
Adult ; Brain ; Child* ; Humans ; Infant ; Maxillary Sinus ; Paranasal Sinuses* ; Prospective Studies ; Tomography, X-Ray Computed

PURPOSE: This study was designed to evaluate the difference in the degree of patient pain during an ultrasoundguided fine-needle aspiration biopsy (US-FNAB) with the use of a one-needle puncture for thyroid nodules with the application of local anesthesia. MATERIALS AND METHODS: We prospectively examined patients who simultaneously received US-FNAB for two thyroid nodules, for one nodule in the right lobe and one nodule in the left lobe, where the nodules were larger than 10 mm in the maximum diameter. US-FNAB with or without local anesthesia was performed with the use of a 23-guage needle in all patients. The degree of pain after performing US-FNAB was evaluated by the use of an 11-point numeric rating scale. RESULTS: For all 20 patients, US-FNAB was performed with an alternative selection of the nodules. There were 14 patients with a higher pain score where local anesthesia was administered, two patients with a higher pain score where local anesthesia was not administered and four patients with the same score where both methods were used. There was a statistically significant difference in the pain score between the use of the two methods (Wilcoxon sign rank test, p = 0.014). The mean value of the pain score was 3.1 in patients who received local anesthesia and 2.1 in patients that did not receive local anesthesia, respectively. CONCLUSION: The use of local anesthesia is not superior to the use of no anesthesia regarding pain relief if USFNAB is performed with a one-needle puncture.
Anesthesia ; Anesthesia, Local ; Biopsy, Fine-Needle ; Humans ; Needles ; Prospective Studies ; Punctures ; Thyroid Gland ; Thyroid Nodule

The purpose of this study was to evaluate the tooth color changes of resin bonding sites and their adjacent sites on orthodontic bracket bonding. Sixty extracted sound premolars were used and the tooth color was recorded according to the CIE L(*)a(*)b(*) color system using a spectrophotometer. The tooth colors of the twenty premolars were measured and compared before bracket bonding and after removal. On a further twenty premolars, the tooth color was measured before and after only primer application. In the change of L(*) values, according to the bracket bonding and primer application, the lightness was decreased, and in the change of a(*) and b(*) values, the color was changed into a more yellowish color. The color differences (delta E(*)) were calculated from the L(*)a(*)b(*) values and compared with the standard value of clinical detection (delta E(*)=3.7). The color differences between before the bracket bonding and after removal noted exceeded the standard value and those of between before and after the primer application were not larger than the standard value. Toothbrushing was performed after application of the primer to evaluate the color changes according to the primer abrasion. As a control, toothbrushing was performed on the last twenty premolars. The color differences noted were larger than the standard value after toothbrushing. Also, to evaluate the color changes of the tooth which is exposed to sun irradiation after bracket removal, additional photoaging was performed and the color was measured for all teeth. The additional color differences after photoaging were smaller than the standard value. The above results suggest that the tooth color changes after fixed orthodontic treatment.
Bicuspid ; Orthodontic Brackets ; Solar System ; Tooth* ; Toothbrushing

As higher mortality rate and frequent incidence of morbidity, early surgical treatment is generally recommended for the multivalvular endocarditis. A 46-year-old female presented with high fever. Echocardiography showed the vegetation on pulmonic valve, tricuspid valve and mitral valve with a ventricular septal defect. Emergency operation was conducted due to uncontrolled infection. We present a clinical success of this rare case with review of the medical literature.
Echocardiography ; Emergencies ; Endocarditis ; Female ; Fever ; Heart Septal Defects, Ventricular ; Humans ; Incidence ; Middle Aged ; Mitral Valve ; Tricuspid Valve

In the case of pregnancy complicated by intrauterine device, complications such as ectopic pregnancy, septic abortion, preterm delivery are increased significantly. Especially in relation to intrauterine pregnancy, IUD should be removed to prevent complication. But when the tail is missed, therapeutic abortion has been done as an alternative method conventionally. Recently we experienced a case of hysteroscopic removal of IUD complicated by intrauterine pregnancy of 9th week without any harm to the G -sac or embryo. And she delivered healthy girl weighing 2950 gm. So we report this case with the review of articles related.
Abortion, Septic ; Abortion, Therapeutic ; Embryonic Structures ; Female ; Humans ; Intrauterine Devices* ; Pregnancy* ; Pregnancy, Ectopic

Cerebral cavernous angioma is a rare form of vascular malformations which is histologically composed of closely-packed, thin-walled blood vessels without neural tissue intervened. One of the most common symptoms is seizure, which is usually well-controlled by medication or surgery and known to be rarely intractable or fatal. Because sudden, unexpected death in epilepsy patients reveals generally its unclear death mechanism and negative autopsy finding in forensic pathology practice, particular attention should be paid. We recently experienced an autopsy case of 32-year-old woman who had suffered from epilepsy and showed cerebral cavernous angioma on autopsy. We report this case with literature review.
Adult ; Autopsy ; Blood Vessels ; Caves ; Central Nervous System ; Epilepsy ; Female ; Forensic Pathology ; Hemangioma ; Hemangioma, Cavernous ; Humans ; Seizures ; Vascular Malformations

OBJECTIVE: Intraoperative somatosensory evoked potentials (SEPs) are widely used for the early detections of cerebral ischemia during temporary occlusive procedures of the parent vessels in aneurysm surgery. This study intended to evaluate the usefulness of median nerve SEPs during intracranial aneurysm surgery. METHOD: Between September 1995 and June 1997, we monitored 42 aneurysm patients in Uijongbu St. Mary's hospital. Median nerve SEPs were detected on scalp and cervical spine during surgery. We measured latencies, amplitudes of N20 and N13 waveforms and central conduction time (CCT, N20-N13). We analyzed pre- and post-surgical radiologic findings and changes of neurologic signs. RESULTS: The delayed latencies, CCT, and reduced amplitudes of median nerve SEPs during intraoperative monitoring were closely related to neurological deficits after surgery. CONCLUSION: Intraoperative SEPs are useful in preventing clinical neurological injury during surgery of intracranial aneurysm and in predicting which patients will have unfavourable outcomes.
Aneurysm ; Brain Ischemia ; Evoked Potentials, Somatosensory* ; Humans ; Intracranial Aneurysm* ; Median Nerve* ; Monitoring, Intraoperative* ; Neurologic Manifestations ; Parents ; Scalp ; Spine