Hepatocellular carcinoma (HCC) is one of the leading causes of death in Korea. Chronic hepatitis, alcoholic liver disease and liver cirrhosis are predisposing factor of HCC. Bleeding tendency and hemorrhage resulting from reduced production of coagulation factors or portal hypertension are not uncommon in HCC, moreover spontaneous hemoperitoneum also can occur. Spontaneous hemoperitoneum is a complication of HCC, that is caused by the rupture of HCC mass which abuts on the hepatic capsule. However hemoperitoneum also occurs due to the rupture of vasculature of the mass. Emergency laparotomy is the recommended treatment, however these patients exhibit poor prognosis because of hemodynamic instability followed by combined liver disease. Herein, we report a case of spontaneous hemoperitoneum due to the rupture of subcapsular vessels with invasion of HCC in a 39-years-old man, whose tumor was left undetected.
Blood Coagulation Factors ; Carcinoma, Hepatocellular ; Cause of Death ; Emergencies ; Hemodynamics ; Hemoperitoneum ; Hemorrhage ; Hepatitis, Chronic ; Humans ; Hypertension, Portal ; Korea ; Laparotomy ; Liver Cirrhosis ; Liver Diseases ; Liver Diseases, Alcoholic ; Prognosis ; Rupture

Mushroom poisoning widely reported in Oriental and Western literature, is typically caused by accidental ingestion of toxic mushrooms that resemble edible mushrooms. Reports about poisoning due to species of Omphalotus, Amanita, Clitocybe, and other toxic mushroom species have been reported; toxicity depends on the mushroom species and the amount of toxin, which varies according to the climatic and environmental conditions. Symptoms of poisoning, such as unspecific nausea, vomiting, and diarrhea, as well as intestinal, hepatic and renal toxicities, also vary according to the mushroom species. Most patients recover with anti-muscarinic therapy and supportive care for nonspecific symptoms; however some cases of poisoning are fatal in children and elderly people. We report a case of sudden death due to mushroom poisoning in a 74-year-old woman, with hemorrhagic enteritis.
Agaricales* ; Aged ; Amanita ; Child ; Death, Sudden ; Diarrhea ; Eating ; Enteritis* ; Female ; Humans ; Mushroom Poisoning* ; Nausea ; Poisoning ; Vomiting

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: Objectives of this study were to investigate the association between efficiency and quality of health care in Long-term Care Hospitals (LTCH) and determine related factors that would enable achievement of both high efficiency and high quality at the same time. METHODS: Major data sources were the "2012 Korean Assessment of Propriety by Long-term Care Hospitals" obtained from the Health Insurance Review & Assessment Service. Cost variables were supplemented by a National Tax Service accounting document. First, data envelopment analysis was performed by generating efficiency scores for each LTCH. Second, matrix analysis was conducted to ascertain association between efficiency and quality. Lastly, kruskal-wallis and mann-whitney tests were conducted to identify related factors. RESULTS: First, efficiency and quality of care are not in a relationship of trade-offs; thus, LTCH can be confident that high efficiency-high quality can be achieved. Second, LTCH with a large number of beds, longer tenure of medical personnel, and adequate levels of investment were more likely to have improved quality as well as efficiency. CONCLUSION: It is essential to enforce legal standards appropriate to the facilities, reduce turnover of nursing staff, and invest properly in human resources. These consequences will help LTCH to maintain the balance of high efficiency-high quality in the long-run.
Databases, Factual ; Humans ; Long-Term Care/*standards ; *Quality of Health Care ; Republic of Korea

The primary tumor of the heart is rare and the myxoma is the most common primary cardiac tumor. Sudden death due to cardiac myxoma is mainly with atrial myxoma, tumor embolization, or obstruction of blood flow at the mitral or tricuspid valve. Thus it appears that histologically benign but potentially lethal. This report describes an unusual cause of sudden unexpected death and the autopsy findings for a 51-years-old woman with left atrial myxoma. She complained fatigue and weight loss during 1 year, without dyspnea or other systemic symptoms. On autopsy, the left atrium is slightly enlarged as ball-shaped. Opening it, a smooth surfaced pale, round and lobulated mass is found, attached on left atrial septum. On cut section, it is dark brown to dark red colored with gelatinous appearance, and shows focal interstitial fibrosis, calcification and hemorrhage. We present a case diagnosed at post-mortem of an left atrial myxoma without any informations of clinical symptoms. The cardiac myxoma must considered for cause of sudden death to cardiac problem.
Atrial Septum ; Autopsy ; Death, Sudden ; Dyspnea ; Fatigue ; Female ; Fibrosis ; Gelatin ; Heart ; Heart Atria ; Heart Neoplasms ; Hemorrhage ; Humans ; Myxoma ; Tricuspid Valve ; Weight Loss

Hydrothorax is an uncommon but a well-recognized complication of peritoneal dialysis, and is estimated at 1.6-10%. It is not a life-threatening condition, but massive hydrothorax (so called 'tension hydrothorax') has been documented rarely. We report an autopsy case showing the right-sided hydrothorax associated with peritoneal dialysis. A 27-year-old man who had suffered chronic renal failure and peritoneal dialysis, was found dead in his room. At autopsy, there were about 3 liters of clear transudate in the right pleural cavity and the right lung was collapsed. The biochemical study of the pleural fluid showed 266 mg/dL of glucose.
Adult ; Autopsy ; Exudates and Transudates ; Glucose ; Humans ; Hydrothorax ; Kidney Failure, Chronic ; Lung ; Peritoneal Dialysis ; Pleural Cavity

In Korea, small octopus (Octopus minor) and webfoot octopus (Octopus ocellatus) are food items and fatal laryngeal choking due to ingestion of live octopus is not uncommon. We recently encountered two autopsy cases of accidental choking on small octopus and webfoot octopus. Case 1 involved a 58-year-old fisherman who ingested two live webfoot octopuses in his fishing boat and collapsed. He was immediately taken to the hospital but died. During autopsy, one of the webfoot octopuses was found between his pharynx and esophagus; it was obstructing the epiglottis and upper esophagus. His blood alcohol concentration was 0.140%. Case 2 involved a 55-year-old man who ingested an intact body part of a small octopus and was found dead in his house. He had a history of cerebral infarction and angina pectoris. During autopsy, an intact body part of the small octopus was found to be lodged in the laryngeal inlet.
Airway Obstruction ; Angina Pectoris ; Autopsy ; Bays ; Blood Alcohol Content ; Cerebral Infarction ; Eating ; Epiglottis ; Esophagus ; Humans ; Korea ; Larynx ; Middle Aged ; Octopodiformes ; Pharynx ; Ships

In Korea, small octopus (Octopus minor) and webfoot octopus (Octopus ocellatus) are food items and fatal laryngeal choking due to ingestion of live octopus is not uncommon. We recently encountered two autopsy cases of accidental choking on small octopus and webfoot octopus. Case 1 involved a 58-year-old fisherman who ingested two live webfoot octopuses in his fishing boat and collapsed. He was immediately taken to the hospital but died. During autopsy, one of the webfoot octopuses was found between his pharynx and esophagus; it was obstructing the epiglottis and upper esophagus. His blood alcohol concentration was 0.140%. Case 2 involved a 55-year-old man who ingested an intact body part of a small octopus and was found dead in his house. He had a history of cerebral infarction and angina pectoris. During autopsy, an intact body part of the small octopus was found to be lodged in the laryngeal inlet.

Acute necrotizing esophagitis (AEN), also called "black esophagus," is a rare disorder with an unknown pathogenesis. Endoscopic findings generally show black pigmentation throughout the esophagus. This case also offered rare views of the gross anatomy of this disorder. Histological examination revealed that the mucosal and submucosal layers of the esophagus were involved in the severe necrotizing inflammation. The chief manifestation of this disease is hematemesis from hemorrhage of the upper gastrointestinal tract with a typically multifactorial etiology. AEN is also characterized by a clear boundary at the gastroesophageal junction where the necrosis stops. In this study, we report an autopsy case of a 61-year-old man with necrotizing inflammation throughout the esophagus and esophageal necrosis from the laryngopharynx to the gastroesophageal junction. The patient was a disabled person with a history of alcohol abuse who was also diagnosed with mild coronary arteriosclerosis and fatty liver on the basis of the underlying diseases. In this case, the main etiology for poor perfusion from the distal esophageal area was likely underlying illness, history of alcoholism, and malnutrition.
Alcoholism ; Autopsy* ; Coronary Artery Disease ; Disabled Persons ; Esophagitis* ; Esophagogastric Junction ; Esophagus ; Fatty Liver ; Hematemesis ; Hemorrhage ; Humans ; Hypopharynx ; Inflammation ; Malnutrition ; Middle Aged ; Necrosis ; Perfusion ; Pigmentation ; Upper Gastrointestinal Tract

Extra-adrenal paragangliomas and pheochromocytomas are rare but clinically important tumors, which produce, store, release, and metabolize catecholamines resulting in unexpected life-threatening effects. It is neither easy nor difficult to clinically diagnose these tumors despite the availability modern clinical methods because signs and symptoms such as recurrent episodes of paroxysmal hypertension and headache are nonspecific. Only a few cases of unexpected death in which the deceased had a non-diagnosed paraganglioma or pheochromocytoma have been reported. Death in these cases is usually sudden and occurs during emergency room care or during a major or minor abdominal operation, without prodromal symptoms. Death is considered to occur because of paroxysmal hypertension, cerebrovascular attacks, abrupt hemorrhage into the tumor parenchyma, or acute left ventricular failure. We report the case of a 73-year-old man who died 12 hours after undergoing decompression surgery for spinal stenosis. A medico-legal autopsy revealed that death in this case resulted from an undiagnosed paraganglioma around the abdominal aorta.
Aged ; Aorta, Abdominal ; Autopsy ; Catecholamines ; Death, Sudden ; Decompression ; Emergencies ; Headache ; Hemorrhage ; Humans ; Hypertension ; Paraganglioma ; Paraganglioma, Extra-Adrenal ; Pheochromocytoma ; Prodromal Symptoms ; Spinal Stenosis