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

No abstract available.
Skin Diseases*

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

Even though several techniques are available for repairing lower extremity skin defects, it is hard to challenge the advantages of local flaps (advancement, rotation, or transposition) due to lack of skin laxity of lower extremities. Modified keystone flap (MKF) is a simple and effective method of closing a large skin defect. It is especially useful for wound closure in circumstances where the defects show limited skin laxity. Compared to the keystone flap (KF), MKF has many advantages, including quick healing time, high flap viability, minimal postoperative pain, and excellent aesthetic results. Here, we report two cases of reconstruction of large skin defects of the lower extremities using MKF with satisfactory results.
Lower Extremity* ; Methods ; Pain, Postoperative ; Skin ; Wounds and Injuries

Cowden Syndrome (CS) is a rare genodermatosis of autosomal-dominant inheritance, with variable expressivity and multiple types of hamartomas. The most consistent features of CS are small wart-like papillomatous papules on the face, hands, and mouth. A 31-year-old woman presented with a history of pearly papules on the face, hand, and foot for several years. The lesions were initially diagnosed as warts, and treated accordingly, but they did not subside. There was a history of endometrial cancer, breast cancer, and thyroid nodule, and her father had a history of thyroid cancer. A biopsy specimen from the facial papule showed plate-like growth of anastomosing epithelial cords, extending parallel to the epidermis. It was diagnosed as a tumor of the follicular infundibulum (TFI). The patient refused further treatment. Here, we report a rare case of CS presenting with TFI.
Adult ; Biopsy ; Breast Neoplasms ; Endometrial Neoplasms ; Epidermis ; Fathers ; Female ; Foot ; Hamartoma ; Hamartoma Syndrome, Multiple* ; Hand ; Humans ; Mouth ; Pituitary Gland* ; Thyroid Neoplasms ; Thyroid Nodule ; Warts ; Wills

Leiomyoma of the vulva is rare neoplasm. It is usually located in the labium majors and in the area of the Batholin gland. We experienced two cases of leiomyoma around urethral meatus which displaced urethra. So we report cases with review of literature.
Leiomyoma* ; Urethra* ; Vulva*

Background: Modified tension band wiring is one of the most preferred surgical methods for transverse patellar fractures. However, the optimal depth or sagittal position of a Kirschner wire (K-wire) in modified tension band wiring has yet to be determined.The purpose of this study was to evaluate whether the depth of a K-wire affects the biomechanical characteristics of modified tension band wiring using the finite-element method. Methods: A patella model was designed with a cuboid shape (length, 34.3 mm; width, 44.8 mm; and thickness, 22.4 mm) and divided into the cortical and cancellous bone parts. A transverse fracture line was formed on the midline of the cuboid shape model.The cuboidal model was applied to modified tension band wiring. The depth or sagittal position of the K-wire was divided into superficial, center, and deep. With the Abaqus v2017 program (Dassault System Inc.), the distal part of the model was fixed, and a tensile load of 850 N was applied to the proximal part of the model at an angle of 45°. The maximum pressures of the cortical and cancellous bones at the fracture plane were measured. The largest von Mises values of the K-wire and stainless steel wire were also measured. The fracture gap on the distracted or anterior side was measured. Results: In deep K-wire placement, the highest peak von Mises values of the cortical and cancellous bones were observed. The Kwire and stainless steel wire showed the highest von Mises values in deep K-wire placement. The fracture gap was also largest in deep K-wire placement. Conclusions The depth of the K-wire affects the biomechanical characteristics of modified tension band wiring. Deep placement of the K-wire will be more favorable for bone union than the empirically known 5-mm anterior or center placement of the K-wire.

Background: Modified tension band wiring is one of the most preferred surgical methods for transverse patellar fractures. However, the optimal depth or sagittal position of a Kirschner wire (K-wire) in modified tension band wiring has yet to be determined.The purpose of this study was to evaluate whether the depth of a K-wire affects the biomechanical characteristics of modified tension band wiring using the finite-element method. Methods: A patella model was designed with a cuboid shape (length, 34.3 mm; width, 44.8 mm; and thickness, 22.4 mm) and divided into the cortical and cancellous bone parts. A transverse fracture line was formed on the midline of the cuboid shape model.The cuboidal model was applied to modified tension band wiring. The depth or sagittal position of the K-wire was divided into superficial, center, and deep. With the Abaqus v2017 program (Dassault System Inc.), the distal part of the model was fixed, and a tensile load of 850 N was applied to the proximal part of the model at an angle of 45°. The maximum pressures of the cortical and cancellous bones at the fracture plane were measured. The largest von Mises values of the K-wire and stainless steel wire were also measured. The fracture gap on the distracted or anterior side was measured. Results: In deep K-wire placement, the highest peak von Mises values of the cortical and cancellous bones were observed. The Kwire and stainless steel wire showed the highest von Mises values in deep K-wire placement. The fracture gap was also largest in deep K-wire placement. Conclusions The depth of the K-wire affects the biomechanical characteristics of modified tension band wiring. Deep placement of the K-wire will be more favorable for bone union than the empirically known 5-mm anterior or center placement of the K-wire.

Inclusion body myositis is a rare condition of idiopathic inflammatory myopathy. Prior criteria for the diagnosis of inclusion body myositis essentially required pathological features of rimmed vacuoles, tubulofilamentous inclusions, and amyloid deposits. However, recently developed new diagnostic criteria emphasize clinical characteristics including weakness of finger flexors and knee extensors. In addition, a serological evaluation of anti-cN1A antibody is helpful for the diagnosis. We report a case of inclusion body myositis with clinical, pathological, and serological consideration.