The t(3;21) (q26;q22) is associated with chronic myelogenous leukemia in blast crisis, leukemia evolving from therapy-related myelodysplasia, and with leukemia following other hematopoietic proliferative diseases. The t(3;21) is rare secondary aberration in blast crisis of Philadelphia(Ph)-positive chronic myeloid leukemia, which may be restricted to patients entering myeloid blast crisis. We report here in one case of chronic myeloid leukemia in blast crisis which reveals both t(9;22) (q34;q11), and t(3;21) (q26 ;q22). A 62-year-old male was diagnosed as chronic myeloid leukemia 5 years ago, received hydroxyurea therapy, and admitted because of gingival bleeding and fever. On examination, splenomegaly and leukocytosis with proliferated blasts(91%) in peripheral blood were noted. Bone marrow aspirate showed hypercellularity with severe blast proliferation(92.5%) which revealed all negative in peroxidase and PAS stain. Cytogenetic study of bone marrow cells showed the karyotype 46, XY, t(3;21) (q26;q22), t(9;22) (q34;q11), which might be suspected as myeloid blast crisis. Above finding was confirmed by the result of immunophenotyping(CD13 43.6%, CD34 68.2%, HLA-DR 91.6%). He received intensive chemotherapy, but still sustained proliferation of blasts was noted . The follow up cytogenetic study was as follows: 46, XY, 4(3;21) (q26:22), t(9;22) (q34;q11)/46, XY, t(3;21)(q26;q22), del(8) (q22), t(9:22) (q34,q11)/46, XY (16/3/1). He died soon from severe pancytopenia and sepsis.
Blast Crisis* ; Bone Marrow ; Bone Marrow Cells ; Cytogenetics ; Drug Therapy ; Fever ; Follow-Up Studies ; Hemorrhage ; HLA-DR Antigens ; Humans ; Hydroxyurea ; Karyotype ; Leukemia ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Leukocytosis ; Male ; Middle Aged ; Pancytopenia ; Peroxidase ; Sepsis ; Splenomegaly

No abstract available.

Congenital dislocation of the knee is very rare skeletal deformity and was firstly described by Chatelaine in 1822. Since then there have been a few number of case reports and some series discussing the etiology and treatment. The tibia is displaced anteriorly in relation to the femur. It is generally subdassified as simple hyperextention, subluxation, and dislocation depending on the degree of the joint displacement and the severity of disease. Early gentle manipulation and serial splintage or plaster cast are recommended for treatment and were successful in the majority except the case of quadriceps contrarture or late correction. The authors experienced one case of congenital dislocation of the right knee and brief review of the related literatures was made.
Casts, Surgical ; Congenital Abnormalities ; Dislocations* ; Femur ; Joints ; Knee* ; Tibia

This is a comparative study based on the data of legal autopsies performed at the National Institute of Scientific Investigation, Seoul, during the year of 2000. In South Korea, the pathologists usually do not attend the death scene, and the scene investigation is performed only by the law enforcement agency. The latter collects the information needed for clarifying the cause and manner of death. The authors tried to estimate the efficiency of the death investigation through the discrepancy between the presumed and the most possible cause of death. We presumed the cause of death on the ground of police investigation and external examination by the general physicians, The most possible cause of death means the best diagnosis after autopsy by pathologists, with the consideration of police information. Followings are the summary of the results. The coincidence rate with the most possible death are over 90% in presumed trauma, asphyxia, thermal injuries, electrocution, starvation/neglect, and over 80% in drowning and natural deaths. The rate was low in medical injuries(26.6%) and poisoning(67.2%). 7.3 to 8.2% were natural in presumed blunt trauma, traffic injury and fall down injuries. Among 48 cases of presumed ligature strangulation, 6 were other type of asphyxia or other injuries, and 2 unknown. The coincidence rate was only 30.8% in acute alcohol poisoning. 5.9% of presumed fire death was proved other type of violent injuries. In the field of medical practices, only 6.3% of accused general medical procedures were proved dead due to themselves. But the rate was increased up to 49.0% in presumed surgery/anesthetic deaths. 12.9% were violent death in presumed natural death, and 64.6% were dead due to violent causes in the cases of no presumable cause of death.
Asphyxia ; Autopsy* ; Cause of Death* ; Diagnosis ; Drowning ; Fires ; Humans ; Korea ; Law Enforcement ; Ligation ; Poisoning ; Police ; Seoul

Silicone gel breast implants may induce local(fibrous capsular contracture) or systemic(rheumatoid arthritis, systemic sclerosis, etc) complications. The exact mechanism of fibrous capsular contracture has not been fully understood. In the present study, we tried to find out the effect of silicone gel on the fibroblast proliferation which has been known as a major contributing factor in fibrous capsular contracture formation. In vitro, activated macrophages are known to secrete monokines which affect fibroblast proliferation and collagen synthesis. And tumour necrosis factor-alpha(TNF-alpha) and interleukin-6(IL-6), which were released by macrophages, were reported as potent stimulator of fibroblast proliferation. The goal of this study is to investigate the role of macrophages and tumour necrosis factor-alphaor interleukin-6 in the interaction of fibroblasts and silicone gel. We designed four groups, two experimental and two control, using Institute for Cancer Research(ICR) mouse peritioneal macrophage and silicone gel. For the preparation of the conditioned medium of macrophages, peritoneal macrophages were prepared and cultured for 24 hours on the silicone gel-coated and naked (not coated) surface [silicone gel-macrophage conditioned medium(SCM; experimental group) and normal polystyrene-macrophage conditioned medium(NCM; control group) respectively]. To correct the effect of 10% fetal bovine serum which was included in Rapid Prototyping and Manufacturing Institute (RPMI) 1640 medium and draw the effect only by macrophages, the RPMI 1640 medium with 10% fetal bovine serum was cultured by the same method on the silicone gel-coated and naked surface (silicone gel-macrophage free conditioned medium; SFM and normal polystyrene-macrophage free conditioned medium; NFM respectively). Each conditioned medium was added onto NIH 3T3 fibroblasts culture at a final 25% concentration of total culture medium and followed by the cultivation for 24 hours. For antibody neutralizing experiments, each conditioned medium was preincubated with polyclonal rabbit anti-mouse TNF-alpha antibody or polyclonal rat anti-mouse IL-6 antibody for 1 hour and then, conditioned medium with antibody was added to the culture medium of NIH 3T3 fibroblasts by the same method. After 24 hours cultivation, total number of viable fibroblast(cell growth), DNA synthesis and collagen synthesis of fibroblasts with each medium were measured by sulforhodamine B(SRB) assay, 3H-thymidine and 3H-proline incorporation respectively. The results were as follows: 1. In the experiment about the effect of the conditioned medium on the fibroblast activity, the experimental group(SCM), compared with the control group(NCM), showed a significant increase of the cell growth (p<0.01), a significant decrease of DNA synthesis(p<0.001), but no significant difference in the collagen synthesis. 2. In the experiment about the effect of polyclonal rabbit anti-mouse TNF-alpha antibody on the fibroblast activity, after the addition of antibody the experimental group, compared with the control group, showed a significant decrease of the cell growth(p<0.001), a significant increase of DNA synthesis(p<0.01), but no significant difference in the collagen syn thesis. 3. In the experiment about the effect of polyclonal rat anti-mouse IL-6 antibody on the fibroblast activity, after the addition of antibody the experimental group, compared with the control group, showed a significant decrease of the cell growth(p<0.001), a significant increase of DNA synthesis(p<0.0001), but no significant difference in the collagen synthesis. In conclusion, culture supernatants (conditioned medium) of peritoneal macrophages, activated by silicone gel, stimulate the NIH 3T3 fibroblast proliferation. TNF-alpha and IL-6, products of macrophage, are involved in the stimulation of NIH 3T3 fibroblast proliferation in an in vitro condition.
Animals ; Arthritis ; Breast Implants ; Collagen ; Contracture ; Culture Media, Conditioned ; DNA ; Fibroblasts* ; Interleukin-6* ; Macrophages ; Macrophages, Peritoneal* ; Mice ; Monokines ; Necrosis ; Rats ; Scleroderma, Systemic ; Silicone Gels* ; Tumor Necrosis Factor-alpha*

OBJECTIVE: Cerebral vasospasm still remains a major cause of the morbidity and mortality, despite the developments in treatment of aneurysmal subarachnoid hemorrhage. The authors measured the utility and benefits of external lumbar cerebrospinal fluid (CSF) drainage to prevent the clinical vasospasm and its sequelae after endovascular coiling on aneurysmal subarachnoid hemorrhage in this randomized study. METHODS: Between January 2004 and March 2006, 280 patients with aneurysmal subarachnoid hemorrhage were treated at our institution. Among them, 107 patients met our study criteria. The treatment group consisted of 47 patients who underwent lumbar CSF drainage during vasospasm risk period (about for 14 days after SAH), whereas the control group consisted of 60 patients who received the management according to conventional protocol without lumbar CSF drainage. We created our new modified Fisher grade on the basis of initial brain computed tomography (CT) scan at admission. The authors established five outcome criteria as follows : 1) clinical vasospasm; 2) GOS score at 1-month to 6-month follow-up; 3) shunt procedures for hydrocephalus; 4) the duration of stay in the ICU and total hospital stay; 5) mortality rate. RESULTS: The incidence of clinical vasospasm in the lumbar drain group showed 23.4% compared with 63.3% of individuals in the control group. Moreover, the risk of death in the lumbar drain group showed 2.1% compared with 15% of individuals in the control group. Within individual modified Fisher grade, there were similar favorable results. Also, lumbar drain group had twice more patients than the control group in good GOS score of 5. However, there were no statistical significances in mean hospital stay and shunt procedures between the two groups. IVH was an important factor for delayed hydrocephalus regardless of lumbar drain. CONCLUSION: Lumbar CSF drainage remains to play a prominent role to prevent clinical vasospasm and its sequelae after endovascular coiling on aneurysmal subarachnoid hemorrhage. Also, this technique shows favorable effects on numerous neurological outcomes and prognosis. The results of this study warrant clinical trials after endovascular treatment in patients with aneurysmal SAH.
Aneurysm ; Brain ; Drainage ; Hemorrhage ; Humans ; Hydrocephalus ; Incidence ; Length of Stay ; Prognosis ; Subarachnoid Hemorrhage ; Vasospasm, Intracranial

This is a statistical analysis based on the data of legal autopsies performed at the Headquarters of the National Institute Scientific Investigation(NISI), requested by every kind of law enforcement agencies during the year of 2001. NISI is located in Seoul, Korea and has three branches throughout the country. The Seoul NISI covers all legal autopsies in Seoul City, Incheon City, and Kyunggi Province and some cases referred from other regions. This report aims to analyse various aspects of 2,807 unusual deaths in Korea, chiefly Seoul and its surrounding area. Followings are the summary of the results. 1. The number of male was 2,043 cases (72.8%) and that of female 764 (27.2%). Male was over twice more than female. The forties were 723 cases (25.8%), the thirties 641 (22.8%), and these two decades occupied 48.6%. 2. Unnatural deaths were 1,690 cases (60.2%), natural 1020 (36.3%), and the unknown 97 (3.5%). Among 1,690 unnatural deaths, suicide was 415 (24.6%), homicide 418 (24.7%), accident 505 (29.9%), and the unclear 352 (20.8%). Homicide occupied 37.1% of trauma, 44.1% of blunt force injury excluding traffic and fall-down injury, and 83.5% of sharp force injury. The homicide rate in asphyxia was 32.5%, but it went up to 62.7% excluding hanging. It showed only 1.0% of homicide in poisoning. 3. Traumatic deaths were 825 cases, occupying 48,8% of 1,690 unnatural deaths, followed by asphyxial death (249 cases). Blunt trauma was 295 cases (35.8%) and the leading cause of death in traumatic death. Poisoning was 213 cases, among which the agrochemicals were dominant (68 cases). Thermal injuries were 193 cases, electrocution 31 cases, and starvation/neglect 10 cases. 36 cases were direct- 4. Among 1,020 natural deaths, heart diseases were 398 cases (39.0%), and vascular diseases 145 (14.2%), and these two categories were added up to 543 (53.2%). 5. Child deaths under the age of 10 were 194 cases. Homicide was 43 cases (48.9%) out of 88 unnatural deaths. Neonates including still births were the leading period of age in unnatural death, counting 64 cases(33.0%).
Agrochemicals ; Asphyxia ; Autopsy* ; Cause of Death ; Child ; Female ; Gyeonggi-do ; Heart Diseases ; Homicide ; Humans ; Incheon ; Infant, Newborn ; Korea ; Law Enforcement ; Male ; Parturition ; Poisoning ; Seoul ; Suicide ; Vascular Diseases

Spinal dural arteriovenous fistulas are rare abnormal connections of artery and vein within the dura, at the level of the intervertebral foramen. A 57-year-old male developed weakness in both lower extremities and sphincteric dysfunction, which had stepwisely, progressive and fluctuating course since 6 months ago. He showed areflexia in both ankle & right knee. T-spine MRI showed high signal intensity with ill defined margin in T2WI and intensely enhanced by con-trast agent through lower thoracic and lumbosacral spinal cord. Selective spinal angiography revealed a dural arteriove-nous fistula with a nidus at thoracolumbar vertebral level, supplied by the internal iliac artery and enlarged medullary veins. Superselective angiographic embolization was done. Clinically, his symptoms has been ameliorated. We report a rare case of thoracic myelopathy due to spinal dural arteriovenous fistulas exclusively supplied by the branches of internal iliac artery.
Angiography ; Ankle ; Arteries ; Central Nervous System Vascular Malformations* ; Fistula ; Humans ; Iliac Artery* ; Knee ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Spinal Cord ; Spinal Cord Diseases* ; Veins

This is a statistical analysis based on the data of legal autopsies performed at the Headquarters of the National Institute Scientific Investigation(NISI), requested by every kind of law enforcement agencies during the year of 2002. NISI is located in Seoul, Korea and has three branches throughout the country. The Seoul NISI covers all legal autopsies in Seoul City, Incheon City and Kyunggi Province and some cases referred from other regions. This report aims to analyse various aspects of 3,045 unusual deaths in Korea, chiefly Seoul and its surrounding area. Followings are the summary of the results. 1. The number of male was 2,199 cases (72.2%) and that of female 846 (27.8%). Male was over twice more than female. The forties were 766 cases (25.2%), the thirties 692 (22.7%), and these two decades occupied 47.9%. 2. Unnatural deaths were 1,810 cases (59.5%), natural 1082 (35.5%), and the unknown 153 (5.0%). Among 1,810 unnatural deaths, suicide was 416 (23.0%), homicide 394 (21.8%), accident 592 (32.7%), and the unclear 408 (22.5%). Homicide occupied 33.3% of trauma, 49.3% of blunt force injury excluding traffic and fall-down injury, and 88.2% of sharp force injury. The homicide rate in asphyxia was 31.7%,but it went up to 59.2% excluding hanging. It showed only 0.4% percent of homicide in poisoning. 3. Traumatic deaths were 867 cases, occupying 47,9% of 1,810 unnatural deaths, followed by poisoning deaths (269 cases). Blunt trauma was 284 cases (32.8%) and the leading cause of death in traumatic death. Poisoning was 269 cases, among which the agrochemicals were dominant (64cases). Thermal injuries were 193 cases, electrocution 16 cases, and starvation/neglect 9 cases. and 17 cases were directly due to medical procedures.4. Among 1,082 natural deaths, heart diseases were 450 cases (41.6%), and vascular diseases 186 (17.2%), and these two categories were added up to 636 (58.8%). 5. Child deaths under the age of 10 were 179 cases. Homicide was 35 cases (37.2%) out of 94 unnatural deaths. Neonates including still births were the leading period of age in unnatural death, counting 48 cases (26.8%)
Agrochemicals ; Asphyxia ; Autopsy* ; Cause of Death ; Child ; Female ; Gyeonggi-do ; Heart Diseases ; Homicide ; Humans ; Incheon ; Infant, Newborn ; Korea ; Law Enforcement ; Male ; Parturition ; Poisoning ; Seoul ; Suicide ; Vascular Diseases

PURPOSE: To describe the pattern of various shoulder abnormalities with an associated superior labrum anterior to posterior (SLAP) lesion type II using magnetic resonance (MR) arthrography, and to assess the clinical significance of the associated abnormalities. MATERIALS AND METHODS: A retrospective review of the MR arthrographic findings of 92 cases of a shoulder with an arthroscopically confirmed SLAP lesion type II was performed. The MR arthrography images were reviewed and analyzed. MR arthrographic analysis noted the presence of a rotator cuff abnormality, acromioclavicular arthritis, adhesive capsulitis, glenohumeral arthritis, a labral abnormality besides the SLAP lesion, and a paralabral cyst. The patients with SLAP lesions were divided into two age groups: those over 40 years of age and those forty years old or younger. Statistical analysis was performed to evaluate the influence of age on the various shoulder abnormalities with associated SLAP lesion. RESULTS: Of the 92 SLAP lesions type II, there were 7 cases (8%) of isolated SLAP lesions without any associated any shoulder abnormality. Eighty-five (92%) SLAP lesions were associated with various shoulder abnormalities including rotator cuff tendinosis (30/92, 33%), partial-thickness tear (36/92, 39%), full-thickness tear (2/92, 2%), acromioclavicular arthritis (46/92, 50%), adhesive capsulitis (7/92, 8%), glenohumeral arthritis (15/92, 16%), labral abnormality (26/92, 28 %) and paralabral cyst (7/92, 8%). The SLAP lesions (60/92, 65%) in patients over forty years of age were accompanied by a significantly high number of rotator cuff abnormalities (p < 0.001), glenohumeral osteoarthritis (p = 0.001), and acromioclavicular osteoarthritis (p < 0.001). In contrast, the SLAP lesions (32/92, 35%) in patients forty years old or younger had a significantly high number of anterior or posterior labral lesions (p < 0.001). CONCLUSION: Isolated SLAP lesions type II without other associated shoulder abnormalities are uncommon, and the age of the patient influences the prevalence of other shoulder abnormalities associated with SLAP lesions. In addition, MR arthrography can help detect shoulder abnormalities accompanying the SLAP lesions.
Arthritis ; Arthrography ; Bursitis ; Humans ; Osteoarthritis ; Prevalence ; Retrospective Studies ; Rotator Cuff ; Shoulder* ; Tendinopathy