Both death certificates and postmortem examination certificates are used as proof of death. These certificates sometimes contain erroneous information but how frequently they do so is unknown. In particular, only a few studies have measured the accuracy of the cause and manner of death on Korea death documents. In this study, we compared the cause and manner of death on both kinds of certificates with those on autopsy reports to determine the frequency of errors, and to identify way to improve the accuracy of these certificates. In 2012, 528 autopsies were requested of out institute, and certificates were submitted in 241 of the cases. The manner of death was classified as natural, unnatural, or unknown. The cause of death in the autopsy report matched that on the death certificate in 37 of 63 cases (58.7%), and the manner of death matched in 40 of 63 cases (63.5%). The cause of death in the autopsy report matched that on the postmortem examination certificate in 62 of 178 cases (34.8%), and the manner of death matched in 74 of 178 cases (41.6%). Death certificates and postmortem examination certificates are important documents. We identified many incorrect reports of causes and manners of death on both kinds of documents, especially the postmortem death certificates. These inaccuracies are presumably due to a lack of forensic information and education, as well as lack of interest on the part of medical doctors.
Autopsy* ; Cause of Death ; Death Certificates* ; Education ; Korea

No abstract available.
Caves ; Facial Paralysis ; Fistula

Simultaneous subarachnoid hemorrhage and infarction is a quite rare presentation in a patient with a spontaneous dissecting aneurysm of the anterior cerebral artery. Identifying relevant radiographic features and serial angiographic surveillance as well as mode of clinical manifestation, either hemorrhage or infarction, could sufficiently determine appropriate treatment. Enlargement of ruptured aneurysm and progressing arterial stenosis around the aneurysm indicates impending risk of subsequent stroke. In this setting, prompt treatment with stent-assisted endovascular embolization can be a reliable alternative to direct surgery. When multiple arterial dissections are coexistent, management strategy often became complicated. However, satisfactory clinical results can be obtained by acknowledging responsible arterial site with careful radiographic inspection and antiplatelet medication.
Aneurysm ; Aneurysm, Dissecting ; Aneurysm, Ruptured ; Anterior Cerebral Artery ; Cerebral Infarction ; Constriction, Pathologic ; Hemorrhage ; Humans ; Infarction ; Stroke ; Subarachnoid Hemorrhage

BACKGROUND: Humanized mouse models are still under development, and various protocols exist to improve human cell engraftment and function. METHODS: Fourteen NOD/SCID/IL-2Rγnull (NSG) mice (4‒5 wk old) were conditioned with busulfan and injected with human umbilical cord blood (hUCB)-derived CD34+ hematopoietic stem cells (HSC) via retro-orbital sinuses. The bone marrow (BM), spleen, and peripheral blood (PB) were analyzed 8 and 12 weeks after HSC transplantation. RESULTS: Most of the NSG mice tolerated the regimen well. The percentage of hCD45+ and CD19+ cells rose significantly in a time-dependent manner. The median percentage of hCD45+cells in the BM was 55.5% at week 8, and 67.2% at week 12. The median percentage of hCD45+ cells in the spleen at weeks 8 and 12 was 42% and 51%, respectively. The median percentage of hCD19+ cells in BM at weeks 8 and 12 was 21.5% and 39%, respectively (P=0.04). Similarly, the median percentage of hCD19+ cells in the spleen at weeks 8 and 12 was 10% and 24%, respectively (P=0.04). The percentage of hCD19+ B cells in PB was 23% at week 12. At week 8, hCD3+ T cells were barely detectable, while hCD7+ was detected in the BM and spleen. The percentage of hCD3+ T cells was 2‒3% at week 12 in the BM, spleen, and PB of humanized NSG mice. CONCLUSION: We adopted a simplified protocol for establishing humanized NSG mice. We observed a higher engraftment rate of human CD45+ cells than earlier studies without any significant toxicity. And human CD45+ cell engraftment at week 8 was comparable to that of week 12.
Animals ; B-Lymphocytes ; Bone Marrow ; Busulfan* ; Fetal Blood ; Hematopoietic Stem Cells ; Humans* ; Mice* ; Spleen ; T-Lymphocytes ; Umbilical Cord*

PURPOSE: Osteoporosis is currently receiving particular attention as a sequela in survivors of childhood osteosarcoma. The aim of this study was to evaluate bone mineral density (BMD) changes during methotrexate-based chemotherapy in children and adolescents with osteosarcoma. METHODS: Nine patients with osteosarcoma were included in this retrospective study and compared with eight healthy controls. BMD of the lumbar spine and unaffected femur neck of patients was serially measured by dual-energy x-ray absorptiometry (DXA) before and just after chemotherapy and compared with controls. RESULTS: Four patients (44%) showed decreased lumbar spine BMD and seven patients (78%) showed decreased femur neck BMD, while all controls showed increased lumbar and femur BMD (P=0.024 and P=0.023). The femur neck BMD z-scores decreased from -0.49+/-1.14 to -1.63+/-1.50 (P=0.032). At the end of therapy, five patients (56%) showed femur neck BMD z-scores below -2.0. CONCLUSION: The bone metabolism is disturbed during therapy in children with osteosarcoma, resulting in a reduced BMD with respect to healthy controls. Since a reduced BMD predisposes to osteoporosis, specific attention and therapeutic interventions should be considered.
Absorptiometry, Photon ; Adolescent ; Bone Density* ; Chemotherapy, Adjuvant* ; Child ; Drug Therapy ; Femur ; Femur Neck ; Humans ; Korea ; Metabolism ; Osteoporosis ; Osteosarcoma* ; Retrospective Studies ; Spine ; Survivors

Purpose: To assess the clinical efficacy of microblepharoexfolication using BlephEx™ (Scope Ophthalmics, London, UK) in meibomian gland dysfunction (MGD) patients. Methods: We performed a prospective study involving 48 eyes of 24 patients who were diagnosed with MGD. All patients were treated with BlephEx™ for 8-10 minutes, and the ocular surface disease index (OSDI), tear break-up time (TBUT), Schirmer’s I test, corneal staining score, lid margin abnormality, MGD score, and lipid thickness layer using the Lipiview II (TearScience, Morrisville, NC, USA) were assessed before treatment and after one month. Results: Significant changes were observed after microblepharoexfoliation using BlephEx™. The TBUT improved from 2.65 ± 1.16 to 3.77 ± 1.80 after 1 month (p < 0.001) and the OSDI improved from 38.83 ± 17.13 to 18.67 ± 15.01 after 1 month (p < 0.001). Before and after 1 month of treatment, the lid margin abnormalities were 2.98 ± 1.16 and 2.50 ± 1.01 (p < 0.001) and the MGD scores were 21.60 ± 6.95 and 18.02 ± 6.68 (p = 0.001), respectively. Conclusions BlephEx™ improved the patients’ ocular surface symptoms, MGD score, and TBUT. Using steroid eye drops, there was a synergistic effect in improvement. Therefore, using BlephEx™ may be suggested as a treatment option for MGD patients.

Spontaneous bilateral rupture of the quadriceps tendons without a significant history of trauma is an uncommon disease. It is generally associated with mechanical factors and coexisting systemic and local factors are taken into consideration in the pathogenesis of these ruptures. In patients with some chronic systemic diseases, simultaneous rupture can occur spontaneously or with minor trauma. We present a case of patient with chronic renal failure on hemodialysis for the past 9 years, who sustained this injury, and subsequently had surgical repair of both tendons. We performed a preoperative magnetic resonance imaging to confirm the diagnosis, then we repaired the ruptured quadriceps tendons and performing MRI postoperatively 1 yr later. He regained his normal knee joint functions 1 yr after the operation.
Humans ; Kidney Failure, Chronic ; Knee Joint ; Magnetic Resonance Imaging ; Quadriceps Muscle ; Renal Dialysis ; Rupture ; Rupture, Spontaneous ; Tendons

PURPOSE: The surgical treatment of burn patient is associated with substantial blood loss. Therefore, multiple hemostatic techniques have been proposed for this problem. Unfortunately, a clear conclusion as to the best hemostatic agent cannot be made. Then, we present our experience of using Fibrin sealant (TISSEEL(TM)) in extremity operation. METHODS: We reviewed the medical records of 10 patients treated in our burn center who conducted the extremity operation using Fibrin sealant from January 2010 to December 2010. RESULTS: The mean tourniquet time is within 60 minutes and no need of transfusion during the operation in all patients. The average take rate for skin graft is over the 98%. No one has nerve injury and other problems. CONCLUSION: Fibrin sealant is a human derived factors that are designed to reproduce the final step of the physiologic coagulation cascade of a stable fibrin clot. In addition, Fibrin sealant has the advantage of being biocompatible and biodegradable, without inducing inflammation, foreign body reaction, and tissue necrosis. Fibrin sealant is shown to be effective methods to achieve hemostasis for the extremity burn surgery.
Burn Units ; Burns ; Extremities ; Fibrin ; Fibrin Tissue Adhesive ; Foreign-Body Reaction ; Hemostasis ; Hemostatic Techniques ; Humans ; Imidazoles ; Inflammation ; Medical Records ; Necrosis ; Nitro Compounds ; Skin ; Tourniquets ; Transplants

Emphysematous pyelonephritis (EPN) is a severe gas-forming infection of the renal parenchyma and surrounding tissues. Patients with EPN commonly present with high fever, chills, and flank pain. These symptoms mimic a simple urinary tract infection, such that diagnosis is often delayed. Because of its life-threatening fulminant course, the early detection of EPN and its prompt treatment with intravenous antibiotics with or without percutaneous drainage are critical. Here we describe a case of a 63-year-old Korean female with diabetes mellitus who had no specific symptoms or signs of EPN. A chest computed tomography (CT) scan to assess a right pleural effusion incidentally detected an abnormal gas shadow in the renal parenchyma. An abdominal CT scan performed 5 days later showed increased gas within the kidney parenchyma, but the patient still had no symptoms of EPN. She was treated with intravenous antibiotics alone. A follow-up abdominal CT scan revealed the complete disappearance of the features of EPN.
Anti-Bacterial Agents ; Chills ; Diabetes Mellitus ; Diagnosis ; Drainage ; Female ; Fever ; Flank Pain ; Follow-Up Studies ; Humans ; Kidney ; Middle Aged ; Pleural Effusion ; Pyelonephritis* ; Thorax ; Tomography, X-Ray Computed ; Urinary Tract Infections

OBJECTIVES: We tried to evaluate the agreement of the Charlson comorbidity index values (CCI) obtained from different sources (medical records and National Health Insurance claims data) for gastric cancer patients. We also attempted to assess the prognostic value of these data for predicting 1-year mortality and length of the hospital stay (length of stay). METHODS: Medical records of 284 gastric cancer patients were reviewed, and their National Health Insurance claims data and death certificates were also investigated. To evaluate agreement, the kappa coefficient was tested. Multiple logistic regression analysis and multiple linear regression analysis were performed to evaluate and compare the prognostic power for predicting 1 year mortality and length of stay. RESULTS: The CCI values for each comorbid condition obtained from 2 different data sources appeared to poorly agree (kappa: 0.00-0.59). It was appeared that the CCI values based on both sources were not valid prognostic indicators of 1-year mortality. Only medical record-based CCI was a valid prognostic indicator of length of stay, even after adjustment of covariables (beta = 0.112, 95% CI = [0.017-1.267]). CONCLUSIONS: There was a discrepancy between the data sources with regard to the value of CCI both for the prognostic power and its direction. Therefore, assuming that medical records are the gold standard for the source for CCI measurement, claims data is not an appropriate source for determining the CCI, at least for gastric cancer.
Aged ; Comorbidity ; Female ; Humans ; Insurance Claim Review ; *Length of Stay ; Male ; Medical Records ; Middle Aged ; Neoplasm Staging ; Prognosis ; Severity of Illness Index ; Stomach Neoplasms/diagnosis/*mortality