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Neck*

No accepted standard currently exists to classify asphyxia and define its subtypes. Sauvageau and Boghossian proposed an asphyxia classification system in 2010 that divided asphyxia into suffocation, strangulation, mechanical asphyxia, and drowning. Here, we present a modification of this classification system. We propose to classify asphyxia into four main categories: suffocation, strangulation, mechanical asphyxia, and complicated asphyxia. Suffocation includes smothering and choking as well as confined spaces, entrapment, and vitiated atmosphere. Strangulation is subdivided into hanging, ligature strangulation, manual strangulation, and other unspecified strangulation. Mechanical asphyxia includes positional and traumatic asphyxia. Finally, complicated asphyxia is defined as cases with two or more identifiable mechanisms of asphyxia. In this study, we review autopsy cases from 2012 diagnosed as asphyxia and classify them according to our proposed asphyxia classification system. In 24.7% of cases, the age range was 40-49 years, and 51.9% were men. The most common method of asphyxia was hanging (245 cases, 55.1%), followed by ligature or manual strangulation (53 cases, 11.9%). Most hangings were suicides; smothering, ligature, and manual strangulation were usually homicides. Eighteen cases were complicated asphyxia. This classification provides a simplified, unified, and useful tool to classify and understand deaths due to asphyxia.
Airway Obstruction ; Asphyxia* ; Atmosphere ; Autopsy* ; Classification* ; Confined Spaces ; Drowning ; Homicide ; Humans ; Korea* ; Ligation ; Male ; Suicide

Rhinoscleroma is a chronic, granulomatous infectious lesion most frequently affecting the respiratory tract mucosa. This disease is endemic to Africa, Central and South America, South Central and Eastern Europe, the Middle East, and China. We report an extremely rare disease of nasal rhinoscleroma in Korea. The patient was a 63-yr-old man, who suffered from chronic nasal obstruction and septal deviation. Characteristic histology from a nasal biopsy was proven and special stains for bacteria were employed: periodic acid-Schiff, Warthin-Starry silver, Giemsa, and Gram stains. Isolation of Klebsiella rhinoscleromatis from a culture of nasal discharge was failed, but ultrastructural examination of numerous phagocyzed bacilli in the Mikulicz cells confirmed the diagnosis. The histiocytic nature of the Mikulicz cells was confirmed, using CD 68 and alpha-1 antitrypsin, and by the ultrastructural features of Mikulicz cells. Here, we emphasize the recognition of this rare entity in nonendemic regions, frequently leading to delayed diagnosis.
Endemic Diseases ; Fibrosis ; Human ; Klebsiella pneumoniae/*isolation & purification ; Korea ; Male ; Microscopy, Electron ; Middle Aged ; Nasal Mucosa/*microbiology/pathology/ultrastructure ; Rhinoscleroma/*pathology

The purposes of this study were to measure the service mind and customer orientation of employees and to identify the effect of service mind on customer orientation in elementary school foodservices. The questionnaires were distributed to foodservice employees of the 19 elementary schools, but collected from 12 schools in Gwangju, Gyeonggi. The statistical data analysis was completed using SPSS (ver. 18.0) for the independent sample t-test, ANOVA, Cronbach's alpha, principal component analysis, hierarchical & K-means cluster analysis, Pearson' correlation analysis, and multiple regression analysis. Foodservice employees highly rated their service mind (3.94 out of 5 points), especially their perceptions on the importance of service (4.13 points). The effort to provide service was significantly different depending on the serving place (P<0.05). Employees had a high level of customer orientation (4.02 points), which was significantly influenced by age, position, or career (P<0.05), and cook license (P<0.01). As a result of cluster analysis for service mind, employees were divided into two groups: a low-service mind group (cluster 1) and a high-service mind group (cluster 2). Cluster 2 had a significantly higher overall customer orientation than cluster 1 (P<0.001). The pride in providing services (beta=0.390, P<0.01) and the perception of the importance of services (beta=0.297, P<0.05) showed a significant and positive effect on customer orientation.
Data Interpretation, Statistical ; Humans ; Hypogonadism ; Licensure ; Mitochondrial Diseases ; Ophthalmoplegia ; Orientation ; Principal Component Analysis ; Surveys and Questionnaires

Delayed cerebral necrosis is a well-known complication of radiation therapy (RT). Because of its irreversible nature, it should be avoided if possible, but avoidance occurs at the expense of potentially compromised tumor control, despite the use of the modern advanced technique of conformal RT that minimizes radiation to normal brain tissue. Risk factors for radiation-induced cerebral necrosis include a higher dose per fraction, larger treatment volume, higher cumulative dose, and shorter time interval (for re-irradiation). The same principle can be applied to proton beam therapy (PBT) to avoid delayed cerebral necrosis. However, conversion of PBT radiation energy into conventional RT is still short of clinical support, compared to conventional RT. Herein, we describe two patients with excessively delayed cerebral necrosis after PBT, in whom follow-up MRI showed no RT-induced changes prior to 3 years after treatment. One patient developed radiation necrosis at 4 years after PBT to the resection cavity of an astroblastoma, and the other developed brainstem necrosis that became symptomatic 6 months after its first appearance on the 3-year follow-up brain MRI. We also discuss possible differences between radiation changes after PBT versus conventional RT.

The renal agenesis and ectopic ureter were relatively rare congenital disease, but their combined form was more extremely rare condition. We report a case of ectopic ureteral opening associated with ipsilateral renal agenesisthat noted recurrent epididymitis in 18 month old children with review of literatures.
Child ; Epididymitis ; Humans ; Infant ; Male ; Ureter*

As laparoscopic operation has become more widely practiced, the full spectrum of effects associated with this technique must be realized. The purpose of this study is to investigate the cardiovascular effects, blood gas changes and especially changes in respiratory variables during laparoscopic operation. We studied 10 patients undergoing elective laparoscopic cholecystectomy (group I) and another 10 patients undergoing elective laparoscopic salpingectomy (group II). In both groups, mean arterial pressure and PaCO2 were increased and pH was decreased. But there was no significant change in PaO2. The changes of respiratory variables in group I were not significant. But in group II, peak airway pressure was increased and compliances significantly decreased (p<0.05) owing to more head-down position. In condusion, patients who are undergoing laparoscopic operatian may require careful monitormg about hemodynamic changes, oxygenation and CO2 retention during anesthetic management.
Anesthesia, General* ; Arterial Pressure ; Cholecystectomy, Laparoscopic ; Hemodynamics ; Humans ; Hydrogen-Ion Concentration ; Laparoscopy ; Oxygen ; Salpingectomy

We report a 18 years old man of brainstem encephalitis with acute ataxia, areflexia and gaze evoked vertical and horizontal nystagmus which is mimicking Miller Fisher syndrome. He had evidences of both peripheral neuropathy in nerve conduction studies and a brainstem encephalitis in MR findings. The possible relationship of the Miller Fisher syndrome and brainstem encephalitis are discussed with brief review of literature.
Adolescent ; Ataxia ; Brain Stem* ; Encephalitis* ; Humans ; Miller Fisher Syndrome* ; Neural Conduction ; Nystagmus, Pathologic ; Peripheral Nervous System Diseases

High dose intravenous immunoglobulin (IVIg) therapy can improve the clinical course of several immune mediciated diseases. We evaluated clinical effects and side effects of IVIg in Guillain-Barre syndrome (GBS). 19 Patients with GBS were studied prospectively in a placebo-controlled trial. 11 Patients were received high dose IVIg (400mg/kg for 5 days) and controls received only conservative treatment. The disability scores using modified Rankin scores before and after treatment of each group were compared. Four weaks later, mean Rankin Score of IVIg group was 2.5 + 0.7 and control group was 3.3+ 0.5which showed significant difference(p<0.05). There were no serious advers effer of promote early improvement with safety in acute phase of Guillan-Barre syndrome.
Guillain-Barre Syndrome* ; Humans ; Immunization, Passive* ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Prospective Studies