Although tuberculosis can affect various parts of the central nervous system, tuberculous meningitis is the most lethal form. Tuberculous meningoencephalitis and cranial tuberculosis are extremely rare. Therefore, the authors present an autopsy case of tuberculous meningoencephalitis resulting in skull perforation. This condition can be mistaken for trauma, which may cause forensic confusion. A 45-year-old woman died at home. External examination revealed an unhealed open wound on the left side of the occiput. The scalp incision revealed extensive congestion, purulent exudate, and an irregular perforation in the corresponding skull area. When the skull was opened, adhesion of the dura mater to the skull was found, accompanied by purulent inflammation. Cerebral edema and hydrocephalus were present, with necrosis in the upper part of the right basal ganglia. Pathological examination identified purulent and chronic granulomatous inflammation in the dura and brain parenchyma, with a few acid-fast bacilli detected. Additionally, an adenosquamous carcinoma measuring approximately 2.5×2 cm was found in the left upper lobe of the lung. This case highlights the importance of a thorough legal autopsy to accurately determine the cause of death, as the inflammatory changes in the scalp could be misinterpreted as trauma from a forensic perspective.

Although tuberculosis can affect various parts of the central nervous system, tuberculous meningitis is the most lethal form. Tuberculous meningoencephalitis and cranial tuberculosis are extremely rare. Therefore, the authors present an autopsy case of tuberculous meningoencephalitis resulting in skull perforation. This condition can be mistaken for trauma, which may cause forensic confusion. A 45-year-old woman died at home. External examination revealed an unhealed open wound on the left side of the occiput. The scalp incision revealed extensive congestion, purulent exudate, and an irregular perforation in the corresponding skull area. When the skull was opened, adhesion of the dura mater to the skull was found, accompanied by purulent inflammation. Cerebral edema and hydrocephalus were present, with necrosis in the upper part of the right basal ganglia. Pathological examination identified purulent and chronic granulomatous inflammation in the dura and brain parenchyma, with a few acid-fast bacilli detected. Additionally, an adenosquamous carcinoma measuring approximately 2.5×2 cm was found in the left upper lobe of the lung. This case highlights the importance of a thorough legal autopsy to accurately determine the cause of death, as the inflammatory changes in the scalp could be misinterpreted as trauma from a forensic perspective.

Although tuberculosis can affect various parts of the central nervous system, tuberculous meningitis is the most lethal form. Tuberculous meningoencephalitis and cranial tuberculosis are extremely rare. Therefore, the authors present an autopsy case of tuberculous meningoencephalitis resulting in skull perforation. This condition can be mistaken for trauma, which may cause forensic confusion. A 45-year-old woman died at home. External examination revealed an unhealed open wound on the left side of the occiput. The scalp incision revealed extensive congestion, purulent exudate, and an irregular perforation in the corresponding skull area. When the skull was opened, adhesion of the dura mater to the skull was found, accompanied by purulent inflammation. Cerebral edema and hydrocephalus were present, with necrosis in the upper part of the right basal ganglia. Pathological examination identified purulent and chronic granulomatous inflammation in the dura and brain parenchyma, with a few acid-fast bacilli detected. Additionally, an adenosquamous carcinoma measuring approximately 2.5×2 cm was found in the left upper lobe of the lung. This case highlights the importance of a thorough legal autopsy to accurately determine the cause of death, as the inflammatory changes in the scalp could be misinterpreted as trauma from a forensic perspective.

Although tuberculosis can affect various parts of the central nervous system, tuberculous meningitis is the most lethal form. Tuberculous meningoencephalitis and cranial tuberculosis are extremely rare. Therefore, the authors present an autopsy case of tuberculous meningoencephalitis resulting in skull perforation. This condition can be mistaken for trauma, which may cause forensic confusion. A 45-year-old woman died at home. External examination revealed an unhealed open wound on the left side of the occiput. The scalp incision revealed extensive congestion, purulent exudate, and an irregular perforation in the corresponding skull area. When the skull was opened, adhesion of the dura mater to the skull was found, accompanied by purulent inflammation. Cerebral edema and hydrocephalus were present, with necrosis in the upper part of the right basal ganglia. Pathological examination identified purulent and chronic granulomatous inflammation in the dura and brain parenchyma, with a few acid-fast bacilli detected. Additionally, an adenosquamous carcinoma measuring approximately 2.5×2 cm was found in the left upper lobe of the lung. This case highlights the importance of a thorough legal autopsy to accurately determine the cause of death, as the inflammatory changes in the scalp could be misinterpreted as trauma from a forensic perspective.

Keratoacanthoma(KA) is a rapidly growing benign cutaneous neoplasm, usually occurring on sunexposed sites in elderly people, and it has a close clinical and pathologic resemblance to squamous cell carcinoma. Giant KA of the lower lip is extremely rare. Various treatment modalities have been reported including radiation therapy, systemic oral retinoids, and the intralesional application of 5-fluorouracil(5-FU), methotrexate(MTX) or interferon alpha-2a. Excisional surgery, however, remains the treatment of choice for the majority of KA. The disadvantages of excision are the possible requirement for extensive reconstructive surgery and the resultant cosmetic or functional deficit. Recently, we experienced a case of giant KA of the lower lip in a 60-year-old male, and he was treated successfully with intralesional methotrexate. Now we report the case with a brief review of literature.
Aged ; Carcinoma, Squamous Cell ; Humans ; Interferons ; Keratoacanthoma* ; Lip* ; Male ; Methotrexate* ; Middle Aged ; Retinoids

PURPOSE: The purpose of this study is to compare the prognostic efficacy of the number and location of positive lymph nodes (LN), LN ratio (LNR), and log odds of positive LNs (LODDs) in high-risk cervical cancer treated with radical surgery and adjuvant treatment. MATERIALS AND METHODS: Fifty high-risk patients who underwent radical hysterectomy and pelvic node dissection followed by adjuvant treatment were analyzed retrospectively. The patients had International Federation of Gynecology and Obstetrics (FIGO) stage IA2-IIB. Upper LN is defined as common iliac or higher LN, and LNR is the ratio of positive LNs to harvested LNs. LODDs is log odds between positive LNs and negative LNs. Radiotherapy was delivered to the whole pelvis with median 50.4 Gy/28 Fx± to the para-aortic regions. Platinum-based chemotherapy was used in most patients (93%). The median follow-up duration was 80 months. RESULTS: The 5-year disease-free survival (DFS) rate was 76.1%, and the overall survival (OS) rate was 86.4%. Treatment failure occurred in 11 patients, and distant failure (DF) was the dominant pattern (90.9%). In univariate analysis, significantly lower DFSwas observed in patients with perineural invasion, ≥ 2 LN metastases, LNR ≥ 10%, upper LN metastasis, and ≥ -1.05 LODDs. In multivariate analysis, ≥ -1.05 LODDs was the only significant factor for DFS (p=0.011). Of patients with LODDs ≥ -1.05, 40.9% experienced DF. LODDs was the only significant prognostic factor for OS as well (p=0.006). CONCLUSION: LODDs ≥ -1.05 was the only significant prognostic factor for both DFS and OS. In patients with LODDs ≥ -1.05, intensified chemotherapy might be required, considering the high rate of DF.
Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Gynecology ; Humans ; Hysterectomy ; Lymph Nodes* ; Multivariate Analysis ; Neoplasm Metastasis ; Obstetrics ; Pelvis ; Prognosis ; Radiotherapy ; Retrospective Studies ; Treatment Failure ; Uterine Cervical Neoplasms*

OBJECTIVE: Compared to elderly men, elderly women have substantially reduced performance of postural balance and greater risk of falls. To investigate the effect of age and sex on electromyographic (EMG) reaction time of tibialis anterior muscle contraction. METHOD: Fifty-nine elderly subjects and 29 young subjects participated in this study. Subjects were instructed to dorsiflex the ankle of the dominant leg as forcefully and quickly as possible in response to audible beeps. EMG activity was recorded over the tibialis anterior muscle and delays in initiation and termination of EMG signal were measured by two examiners. Mean and intrasubject variability of each delay were used as outcome measures. RESULTS: Both the intra-examiner and inter-examiner reliability of delay variables were above 0.97. Delays in initiation and termination of muscle contraction, as well as their intrasubject variability, were significantly greater in the elderly (p<0.01). However, there were no sex differences or interaction in all outcome measures. CONCLUSION: These results demonstrate that the EMG reaction time and their variability increase in the elderly population with no sex difference.
Aged ; Animals ; Ankle ; Electromyography ; Female ; Humans ; Leg ; Male ; Muscle Contraction ; Muscles ; Oxazoles ; Postural Balance ; Reaction Time ; Sex Characteristics

Liposarcoma is a relatively common malignant tumor that can be originated from adipose tissue in the body, especially in the lower extremity and in the retroperitoneal space. But it is extremely rare in the head and neck region. Liposarcoma can be classified histopathologically into four subtypes; well differentiated, myxoid, round cell, and pleomorphic type. The prognosis of liposarcoma is known to be generally poor due to the high local recurrence rate in spite of complete resection. We report a case of myxoid liposarcoma of the neck in a 41-year old male, who was treated with primary excision of tumor and postoperative radiation therapy. The histopathology, clinical appearance, management and prognosis of this rare condition are discussed.
Adipose Tissue ; Adult ; Head ; Humans ; Liposarcoma ; Liposarcoma, Myxoid* ; Lower Extremity ; Male ; Neck* ; Prognosis ; Recurrence ; Retroperitoneal Space

Epidermolysis bullosa (EB) is a rare hereditary disorder characterized by formation of blisters following minor trauma. It has been traditionally categorized by the level of basement membrane zone separation into EB simplex (EBS), junctional EB (JEB), and dystrophic EB (DEB). Recently, hemidesmosomal EB has been proposed as a fourth category, which includes EB with muscular dystrophy and EB with pyloric atresia. We report here on a case of concomitant occurrence of EB and pyloric atresia, a rare form of EB.
Basement Membrane ; Blister ; Ectodermal Dysplasia ; Epidermolysis Bullosa ; Gastric Outlet Obstruction ; Methylmethacrylates ; Muscular Dystrophies ; Polystyrenes ; Pylorus

Pancreatic tissue is maintained by a simple proliferation of the preexisting cells in adulthood, whereas, they are dynamically derived from precursor/ stem cells from ductal epithelia during prenatal life. It has been known that tissue regeneration rarely occurs in the normal adult pancreas, particularly in the human pancreas. However, regeneration can be experimentally induced in the adult pancreas in response to various tissue injuries such as partial resection, pancreatitis by obstruction of the duct, and chemical insults. Regenerating pancreatic tissue shares a common morphogenic feature of "neogenic regeneration" in all regenerating animal models. Neogenic regeneration occurs at the site of tissue injury by forming small tubular structures with elongated epithelial cells (ductules) which grow to form pancreatic ducts and acini. The endocrine cells, including insulin secreting beta cells, are also derived from these ductules. As a sequential process of neogenesis, the regenerating tissue becomes heterogeneous in composition. Some areas were composed by tubules and ductules in surrounding loose connective tissue while others were denser with differentiating acini derived from tubules or ductules. Such neogenic regeneration mimics tissue development during fetal pancreatic organogenesis. In the process of pancreatic neogenesis, we found unique expressions of bioactive proteins such as nestin and clusterin as morphogenic factors. It is likely that the stem/precursor cells could be recapitulated and regenerated to functional cells, including endocrine and exocrine pancreatic cells with acinar and ductal cells during neogenic regeneration of the pancreas.
Adult ; Candidiasis, Cutaneous ; Clusterin ; Connective Tissue ; Endocrine Cells* ; Epithelial Cells ; Humans ; Insulin ; Models, Animal ; Nestin ; Organogenesis ; Pancreas ; Pancreatic Ducts ; Pancreatitis ; Regeneration* ; Social Change ; Stem Cells ; Tinea