Fisting is an uncommon sexual activity, and death due to fisting is very rare. In the present report, we describe a case of a woman who died from fisting by her male partner. A 38-year-old woman went to a motel with a man after consuming alcohol, and there they kissed each other. As desired by woman, the man inserted his fingers into her vagina and anus, and later inserted his fist and forearm into her vagina and anus. After 20-30 minutes of fisting, the woman became unconscious and died. The autopsy confirmed the presence of perineal and vaginal lacerations with massive internal pelvic soft tissue injury with uterine artery rupture. A partial tear was noted at the rectosigmoid junction. The cause of death was hypovolemic shock due to uterine artery rupture. Following court trials, the assailant was sentenced to 4 years of imprisonment for the felony of inflicting bodily injury resulting in death.
Anal Canal ; Autopsy ; Cause of Death ; Female ; Fingers ; Forearm ; Humans ; Lacerations ; Male ; Rupture ; Sexual Behavior ; Shock ; Soft Tissue Injuries ; Unconscious (Psychology) ; Uterine Artery ; Vagina

PURPOSE: The purpose of this study was to compare mammography and breast sonography in detection of breast cancer and to suggest reasonable guideline of breast imaging in breast cancer patients under 30 years of age in whom breast cancer shows different clinicopathologic characteristics compared with breast cancer in older women. MATERIALS AND METHODS: A. uthors reviewed medical records of 27 patients under 30 years of age with pathologically-proven breast cancer. Age, family history, physical examination findings, indications for breast s0nography were reviewed. Cases in whom breast cancer lesion is detectable and cases in whom not detectable using mammography or breast sonography were reviewed. And then, authors evaluated the usefulness of each method and reasons for nonvisualization of lesion on mammography. RESULTS: Among 27 patients, 25 patients had palpable breast mass as indication of mammography and breast sonography. Cancer lesions were detectable in 16 of 25 patients (64%) on mammography and 24 of 25 patients (96%) on breast ultrasonography. Reasons for nonvisualization of cancer lesions on mammography were dense breast with nodular parenchyma pattern and minimal breast change of ductal carcinoma in situ. CONCLUSION: In breast cancer patients under 30 years of age who have palpable breast mass as a initiaJ, and main clinical problem, breast ultrasonography is superior to mammography in detecting and diagnosing breast cancer. We suggest that guidelines can avoid unnecessary mammography in these patients.
Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Female ; Humans ; Mammography ; Medical Records ; Physical Examination ; Ultrasonography* ; Ultrasonography, Mammary

PURPOSE: The purpose of this study was to compare mammography and breast sonography in detection of breast cancer and to suggest reasonable guideline of breast imaging in breast cancer patients under 30 years of age in whom breast cancer shows different clinicopathologic characteristics compared with breast cancer in older women. MATERIALS AND METHODS: A. uthors reviewed medical records of 27 patients under 30 years of age with pathologically-proven breast cancer. Age, family history, physical examination findings, indications for breast s0nography were reviewed. Cases in whom breast cancer lesion is detectable and cases in whom not detectable using mammography or breast sonography were reviewed. And then, authors evaluated the usefulness of each method and reasons for nonvisualization of lesion on mammography. RESULTS: Among 27 patients, 25 patients had palpable breast mass as indication of mammography and breast sonography. Cancer lesions were detectable in 16 of 25 patients (64%) on mammography and 24 of 25 patients (96%) on breast ultrasonography. Reasons for nonvisualization of cancer lesions on mammography were dense breast with nodular parenchyma pattern and minimal breast change of ductal carcinoma in situ. CONCLUSION: In breast cancer patients under 30 years of age who have palpable breast mass as a initiaJ, and main clinical problem, breast ultrasonography is superior to mammography in detecting and diagnosing breast cancer. We suggest that guidelines can avoid unnecessary mammography in these patients.
Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Female ; Humans ; Mammography ; Medical Records ; Physical Examination ; Ultrasonography* ; Ultrasonography, Mammary

This study is the study on health promoting behaviors of 6th grade students according to sex. The purpose of this study is to find the difference in the value of health in their lives among 6th grade students according to sex, to examine the differences in practicing health promoting behaviors, and to determine the correlation between the practice of health promoting behaviors and the characteristics of these students. The subjects of this study were 177 6th grade students who were randomly selected from two elementary schools in Taegu City. The tools used to measure health promoting behaviors were the measuring utility for practicing health promoting behaviors developed by Kyung-Suk Ki (1983) and the utility for the values of health in lives developed by Wallston, Maides and Wallston and translated by Gin Yoon (1989). The data collected were analyzed with t-test, Pearson correlation coefficient, and descriptive statistics using SPSS program. The results of the present study were as follows : 1) According to the results of the value placed in health in their lives, the number of students who placed health high in their lives was 69 boys (75%) and 64girls(75.3%). 2) According to the results obtained from comparing the degree of practicing health promoting behaviors according to sex, in the field of personal hygiene and daily habits, the girls showed a higher degree of practice with 3.26+/-0.33 and the boys, 3.05+/-0.45(t=-3.484, p=0.001): and in the field of contagious diseases, the girls scored significantly higher with 3.40+/-0.39 than the boys with 2.99+/-0.54(t=-2.363, p=0.019). In the filed of preventing accidents, the girls showed a meaningfully high significant result with 3.16+/-0.46 than the boys with 2.99+/-0.54(t=-2.362, p=0.019). When the results from the total questions in the field of health promoting behaviors were compared, the girls showed a meaningfully high correlation with 3.19+/-0.28 than the boys with 3.07+/-0.36(t=-2.601, p=0.010). Thus, the results showed that the girls, compares with the boys, practice more behaviors of personal hygiene & daily habit s, prevention of communicable diseases, and prevention of accidents. 3) According to the results of the relationship between the subjects' characteristics and their health promoting behaviors according to sex, in the case of the boys, they showed a meaningful positive correlation with health promoting behaviors and the current status of health(r=0.266, p=0.005). Thus, for the boys, as their health status was better, the more health promoting behaviors they showed. In the case of the girls, the meaningful variables had a correlation with the health promoting behaviors were the number of extra-curricula activities(r=0.182, p=0.047) and the birth order(r=-0.192, p=0.024). In overall regardless of sex, the health status(r=0.188, p=0.006) and birth order(r=-0.149, p=0.024) showed a meaningful correlation with practicing health promoting behaviors. With the above results, we suggest the following proposals : 1) In elementary children of lower and upper classmen as applied with the current school age, developing a utility to measure health promoting behaviors is needed since the physical, emotional and intellectual development of these children exist. 2) According to the results of this study, developing a program for health promotion is needed in 6th grade students.
Child ; Communicable Diseases ; Daegu ; Female ; Habits ; Health Promotion ; Humans ; Hygiene ; Parturition ; Child Health

29 isoniazid (INH) resistant isolated strains and INH sensitive reference strain (H37Rv) of Mycobacterium tuberculosis were analysed by polymerase chain reaction-single strand conformational polymorphism (PCR-SSCP) and NciI restriction mapping for the detection of mutations in katG gene and inhA gene. The katG gene was divided into 3 parts (Akat, Bkat, Ckat; each part is about 800 bp) and amplified, inhA gene was amplified as a whole. Each of the amplified 800 bp DNA was digested into small fragments of less than 400 bp with restriction enzymes for the direct PCR-SSCP analysis. Firstly, 10 strains were analysed. All the 10 isolates showed clearly distinct SSCP patterns in Bkat from that of the reference strain, but only two isolates showed distinct SSCP patterns in Akat, and no isolated strain showed any distinct SSCP patterns in Ckat. 10 isolates also showed distinct SSCP patterns in inhA. NciI restriction mapping of Bkat showed mutation in codon 463 in 7 strains among 10 isolated strains. With these results an early detection strategy for the INH resistant M. tuberculosis was applied to the rest of 19 isolated INH resistant strains. Firstly, isolates were screened by Ncsl mapping in Bkat, and 13 strains showed mutations in codon 463. Secondly, the rest of 6 INH resistant isolates were analysed by PCR-SSCP with restriction enzyme digestion (PCR-SSCP-RE) in Bkat, and all the strains showed distinct SSCP patterns from that of the INH sensitive reference strain. This proved our strategy as effective and economic and time saving method in early detection of INH resistant M. tuberculosis.
Codon ; Diagnosis* ; Digestion ; DNA ; Isoniazid* ; Korea* ; Mycobacterium tuberculosis* ; Mycobacterium* ; Polymorphism, Single-Stranded Conformational ; Restriction Mapping ; Tuberculosis

Fine needle aspiration of the breast is an important diagnostic tool in malignant lesions, but is also useful in differentiation of inflammatory breast diseases mimicking carcinoma clinically and radiologically. Recently, the authors have experienced eight biopsy-proven cases of chronic inflammatory diseases of the breast, which consisted of 4 cases of duct ectasia, 2 cases of fat necrosis, and a case of tuberculous mastitis and granulomatous mastitis respectively, Their cytoiogic features mainly based on the components and the relative frequency of inflammatory cells were evaluated for differential diagnosis of chronic inflammatory breast diseases. The results are as follows ; 1. In cases of duct ectasia, varying amount of neutrophils, mononuclear leukocytes, histiocytes and multinucleated giant cells were intermixed with benign epithelial cell clusters. 2, Abundant fat tissue fragments were diagnostic for fat necrosis. Histiocytes and mononuclear cells were main components but not rich, and neutrophils and giant cells were infrequently observed. 3. Characteristic granulomas composed of epithelioid cells, mononuclear leukocytes and Langhans' type giant cells and lymphocytic infiltrates were conspicuous in tuberculous mastitis, and occasionally neutrophils, necrotic materials and epithelial cell clusters were found. 4. In granulomatous mastitis, epithelioid cell granulomas were also noted but numerous neutrophils and histiocytes were intermingled within or outside the granulomas.
Biopsy, Fine-Needle ; Breast ; Breast Diseases ; Child* ; Diagnosis, Differential ; Dilatation, Pathologic ; Epithelial Cells ; Epithelioid Cells ; Fat Necrosis ; Female ; Giant Cells ; Granuloma ; Granulomatous Mastitis ; Histiocytes ; Humans ; Leukocytes, Mononuclear ; Mastitis ; Mothers* ; Neutrophils ; Salivary Glands

In a six-year period(1988. 5-1994. 4), fine needle aspiration cytology(FNAC) of 322 pulmonary lesions from 296 patients were performed at Soonchunhyang University Hospital. Of these 322, malignancy was diagnosed cytologically in 139(43.2%), suspicious malignancy in 7(2.2%), negative in 164(50.8%), and insufficient material in 12(3.8%). Malignant lesions consisted of 54 cases of adenocarcinoma, 50 cases of squamous cell carcinoma, 18 cases of small cell carcinoma. They were verified by histologic examination in 70 cases. There were 2(0.6%) false positive cases due to florid bronchoalveolar hyperplasia and atypical bronchial epithelial cells associated with granulomatous lesion. The overall accuracy rate was 90%, the sensitivity 84.3% and the specificity 94.7%.
Adenocarcinoma ; Biopsy, Fine-Needle ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Child* ; Epithelial Cells ; Humans ; Hyperplasia ; Multicystic Dysplastic Kidney* ; Sensitivity and Specificity ; Tuberculosis, Pulmonary

PURPOSE: The aim of this study was to investigate treatment results, toxicity and efficacy of hyperfractionated radiation therapy combined with paclitaxel for paraaortic node recurrence in cervix cancer. MATERIALS AND METHODS: Between September 1997 to March 1999, 12 patients with paraaortic node recurrence in cervix cancer who previously received radical or postoperative radiotherapy were treated with hyperfractionated radiation therapy combined with paclitaxel. Of these, 2 patients who irradiated less than 30 Gy were excluded, 10 patients were eligible for this study. Median age was 5 1 years. Initial FlGO stage was 1 stage IB1, 2 stage IIA, 7 stage IIB. For initial treatment, 7 patients received radical radiotherapy and 3 received postoperative radiotherapy. The paraaortic field encompassed the gross recur rent disease with superior margin at T 12, and inferior margin was between L5 and S 1 with gap for previously pelvic radiation field. The radiation field was initially anterior and posterior opposed field followed by both lateral field. The daily dose was 1.2 Gy, twice daily fractions, and total radiotherapy dose was between 50.4 and 60 Gy(median, 58.8 Gy). Concurrent chemotherapy was done with paclitaxel as a radiosensitizer. Dose range was from 20 mg/m to 30 mg/m (median, 25 mg/m'), and cycle of chemotherapy was from 3 to 6 (median, 4.5 cycle). Follow-up period ranged from 3 to 21 months. RESULTS: Interval between initial diagnosis and paraaortic node recurrence was range from 2 to 63 months (median, 8 months). The 1 year overall survival rate and median survival were 75% and 9.5 months, respectively. The 1 year disease free survival rate and median disease free survival were 30% and 3 7 months, respectively. At 1 month after treatment, 4 (40%) achieved a complete response and 6 (63%) experienced a partial response and all patients showed response above the partial response. There was distant metastasis in 6 patients and pelvic node recurrence in 2 patients after paraaortic node irradialion. There was 2 patients with grade 3 to 4 leukopenia and 8 patients with grade 1 to 2 nausea/ vom ting which was usually tolerable with antiemetic drug. There was no chronic complication in abdomen and pelvis during follow up period. CONCLUSION: Hyperfractionated radiation therapy combined with paclitaxel as a radiosensitizer showed high response rate and few complication rate in paraaortic node recurrence in cervix cancer. Therefore, present results suggest that hyperfractionated radiation therapy combined with paclitaxel chemotherapy can be used as optimal treatment modality in this patients.
Abdomen ; Cervix Uteri* ; Diagnosis ; Disease-Free Survival ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Leukopenia ; Neoplasm Metastasis ; Paclitaxel* ; Pelvis ; Radiotherapy ; Recurrence* ; Survival Rate ; Tolnaftate ; Uterine Cervical Neoplasms*

No abstract available.
Graves Disease* ; Insulin*

Diffuse alveolar hemorrhage is life-threatening situation which is rarely caused by paraganglioma or pheochromocytoma. Here, we describe anesthetic management of 64-year-old man underwent laparoscopic pararenal mass excision and later on this mass diagnosed as paraganglioma. We induced anesthesia with propofol 120 mg, sufentanil 12.5 μg, and rocuronium 50 mg. Anesthesia was maintained with sevoflurane administration. Patient position was changed to right lateral decubitus position for laparoscopic approach. Vital signs were stable until direct stimulation of mass. When surgeon started to manipulate pararenal mass, blood pressure suddenly increased to 274/169 mmHg and heart rate also increased to 140 beat/minute. SpO2 dropped to 69% and bilateral lung sounds decreased. We used intravenous esmolol to control blood pressure and heart rate. In doubt for bronchial spasm, we used intravenous hydrocortisol and chlorpheniramine maleate. Discharge of bloody fluid was obtained from endotracheal tube. Immediate postoperative chest x-ray showed diffuse air space consolidation in right lung field. We assessed as unilateral alveolar hemorrhage and patient was transferred to intensive care unit (ICU) without endotracheal extubation. The patient was followed up with ventilator care and antibiotic treatment in ICU, and daily chest x-ray was taken. He was extubated after showing favorable prognosis on postoperative day (POD) 4, and discharged on POD 7. Anesthesiologist should be aware that incidental manipulation of undiagnosed catecholamine producing tumor can lead to fatal consequences, and should know the management of hypertensive crisis and bronchial spasm.