Pulmonary lymphangioleiomyomatosis is a rare disease which is defined as an abnormal proliferation of smooth muscles around lymphatics, venules, and bronchioles. The most frequent presenting complaint is dyspnea, either in conjunction with pneumothorax, chylothorax, or on exertion. Common extrapulmonary features are retroperitoneal adenopathy, tuberous sclerosis and renal angiomyolipomas. This case was a 34-year-old pregnant woman who died of pneumothorax. She had no past history of illness. At autopsy, both lungs showed honey-comb appearance, and was proven histopathologically pulmonary lymphangioleiomyomatosis. The proliferating smooth muscles were immunoreactive for alpha-smooth muscle actin and HMB-45. Multiple angiomyolipomas of left kidney coexisted. However, no stigmata of tuberous sclerosis was present. Pregnancy was thought to aggravate her clinical course.
Actins ; Adult ; Angiomyolipoma ; Autopsy* ; Bronchioles ; Christianity ; Chylothorax ; Dyspnea ; Female ; Humans ; Kidney ; Lung ; Lymphangioleiomyomatosis* ; Muscle, Smooth ; Pneumothorax* ; Pregnancy ; Pregnant Women ; Rare Diseases ; Tuberous Sclerosis ; Venules

Because the postmortem changes rapidly distort values of many constituents in the body fluids, the determination of postmortem chemical changes and relation among body fluids is very important in medicolegal community. A laboratory result is not useful if appropriate data for comparison are lacking. The aim of this paper is to determine the reference ranges and the postmortem changes for chemical constituents in postmortem specimen. We examined 17 clinical laboratory parameters in cadaveric blood and vitreous humor obtained from 51 autopsy cases. The mean, standard error, standard deviation and confidence interval of all measured constituents were shown in Table 2 & Figure 1. The postmortem blood level of amylase, phosporus, LDH, ALT, AST and CPK are very higher than those of antemortem blood. The postmortem vitreous level of total bilirubin, triglyceride, GGT, alkaline phosphatase, albumin, total protein and cholesterol are very low and is not reliable. The ratio of vitreous/blood in calcium, BUN, creatine and uric acid are 0.74, 0.68, 0.29 and 0.23 in decreasing orders(Table 3,4). For the medical examiner or pathologist, routine chemical examinations of the vitreous humor can provide evidence of abnormality not apparent in gross or microscopic examination of the tissue. A more extensive study will be required, using a larger number of subjects, to establish the full range of variability.
Alkaline Phosphatase ; Amylases ; Autopsy ; Bilirubin ; Body Fluids ; Cadaver ; Calcium ; Cholesterol ; Confidence Intervals ; Coroners and Medical Examiners ; Creatine ; Humans ; Postmortem Changes ; Reference Values ; Triglycerides ; Uric Acid ; Vitreous Body

BACKGROUND: Propioriacterium acnes plays an importantol in the development of inflammatory acne, and inflarnmatory lesions are improved by oralnc topical antibiotics. But as Pacnes frequently develop resistance to antibiotics in patients neing long term systemic antibiotic therapy, the theravuti effects diminish, and eventually thay fails. OBJECTIVE: The purpose of this study is to evaluate theerral susceptability of P. acnes to antibiotics and the difference in the MIC depending on the of oral and/or topical antibiotics, therapeutic effects and disease duration in patients with acie ulgaris. METHODS: We used twenty six strains of P. acnes which were obtained from patients with acne and performcd suseptibility testing for antibiotics usir the E test procedure. RESULTS: 1. The growth of P. acnes was completely inhibited by e ythromycin and chloramphenicol at concentrations of 0.023ug/ml and 0.064ug/ml, respectively cefoxitin at 0.094ug/ml, and by tetracycline and clindarnycin at 0.190 ug/ml. 2. P. acnes was mot susceptible to erythromycin, and olwed by chloramphenicol, cefoxitin, tetracycline, clindamycin in order of decreasing susceptibilit . 3. There were no significant differences in the MIC in reat in to previous antibiotic treatment. 4. For tetracycline, The MIC was significantly lower(p<0.01) in patients who improved after treatment. 5, For tetracycline and chloramphenicol, the MIC was grficantly lower(p<0.05) in patients with less than 2 years disease duration. CONCLUSION: The susptibility of antibiotics for P. acneias highest in erythromycin. There were no significant differences in the MIC in relation to prvious antibiotic treatment, and for some antibiotics the suseptibility was low in patients who dill not show clinical improvement or who had long disease duration.
Acne Vulgaris* ; Anti-Bacterial Agents* ; Asian Continental Ancestry Group ; Cefoxitin ; Chloramphenicol ; Clindamycin ; Erythromycin ; Humans ; Propionibacterium acnes* ; Propionibacterium* ; Tetracycline

Here we report an autopsy case of diabetic ketoacidosis (DKA) with severe hypertriglyceridemia (12,900 mg/dl). A 29-year-old woman with a history of type 1 diabetes was found dead at a motel. There was no injury on external inspection, but a lump of cheese-like material was noted in the heart at autopsy and peripheral blood plasma had a creamy appearance. After postmortem biochemical analysis, we made a diagnosis of DKA with severe hypertriglyceridemia and concluded that these unusual autopsy findings were caused by DKA and postmortem change. Uncontrolled diabetes often causes DKA and hypertriglyceridemia. To the best of our knowledge, this is the first report in Korea of DKA with severe hypertriglyceridemia diagnosed by autopsy.
Adult ; Autopsy* ; Diabetic Ketoacidosis* ; Diagnosis ; Female ; Heart* ; Humans ; Hypertriglyceridemia* ; Korea ; Plasma ; Postmortem Changes

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

The level of initial media response will depend on the type of incident and the location of occurrence. Mass fatality incidents that occur in easily accessed areas will probably attract more and longer media visibility than an incident that occurs in a remote and possibly inhospitable climate. The actions the participates take should be based on doing what is right regardless of who is watching. However, we prepared for the problems the media can cause and have the ability to solve them. Many agencies have learned the hard way that no matter how well they managed the response to an incident, if the media coverage is unfavorable, the perception will be that they did a poor job. Having a good media-management plan is also something that does not just happen. Pre-incident coordination is key, as well as having trained spokespersons who can get along with the media and understand the media's role. The quality of our response will in large part be judge by the public's perception of our actions. No matter the cause of the incident or the size of the response force, the success of any incident response will depend on how well the families were cared for. So, the family assistance operations are very important. The quality of our overall response will, in large part, be judged by our response to the families. Mistakes should not happen, but when they do, we cannot undo them. Therefore, it is critical to listen to the families, provide them with what we can, and do our best.
Climate ; Disasters ; Humans

Paragonimiasis is widely distributed in Far East and Southeast Asia, particularly in Korea. The centralnervous system is the most frequent location for paragonimiasis outside the lungs. We analized the computedtomographic findings of 17 cases which were diagnosed pathologically and clinically as cerebral paragonimiasis.The results were as follows; 1. The ratio of male to female was 10:7 and about 88% of cases were under the age of40 years. 2. The common location so cerebral paragonimiasis were the occipital (12 cases ) and temporal (11 cases) lobes. 3. Precontrast CT findings of cerebral paragonimiasis were low density with calcifications in 6 cases,low and isodensities in 4 cases, mixed densities in 3 cases, only low density in 2 cases and only calcification sin 2 cases. Hydrocephalus (7 cases), mass effect (6 cases), atrophic change(6 cases) and cyst formation (3 cases)were associated. 4. The shape of calcifications in CT scan were soap-bubble or ring in 6 cases, nodular or oval in6 cases, stippled in 4 cases and amorphous conglomerated in 2 cases. 5. The contrast-enhanced 8 cases were 5 ringor rim like, 2 nodular and 1 irregular enhancements, while 9 cases were not enhanced.
Asia, Southeastern ; Far East ; Female ; Humans ; Hydrocephalus ; Korea ; Lung ; Male ; Paragonimiasis ; Tomography, X-Ray Computed

BACKGROUND: A two-dose measles vaccination schedule is recommended routinely for either school entry or 11 to 13 years of age in America since 1989. But, several studies were performed on measles antibody in Korea and it remains controversial whether a second dose measles vaccine after 15 months is necessary. To generate baseline data, measles antibody prevalence and its levels according to different age groups in children and young adults in Taejon area were studied. METHODS: A total of 261 subjects at 3 to 21 years of age, who had received a single dose of measles vaccine, were tested for measles antibody by quantitative alpha enzyme immunoassay. The subjects were divided into five age-groups based on the educational system (preschool, elementary school, middle school, high school, young-adult). RESULTS: The seropositivity rates were 97.7% and not significantly different among groups. The expected tendency of declining antibody levels with advancing age, as reported by other studies, was not observed in this study. Except for between Group I and Group II, no significant difference was noted in the antibody levels among the five age groups. Group II showed significantly higher antibody levels than those of Group I (P=0.0025). CONCLUSIONS: No declining tendency of measles antibody levels with advancing age is different from many other studies and contradicts the current recommendations for supplementary vaccinations after 15 months. These might reflect the regional characteristics of the study population in Taejon area and current vaccination rate. Therefore, futher studies with larger population in different geographic regions by quantitative EIA would be needed.
Americas ; Appointments and Schedules ; Child ; Daejeon ; Humans ; Immunoenzyme Techniques ; Korea ; Measles Vaccine ; Measles* ; Prevalence ; Vaccination* ; Young Adult

Four cases medical accidents related to the iatrogenic injury of neck vessels are reported. The first case was a 54-year-old woman. Under the diagnosis of the herniated cervical disc, the operation was performed. After five hours from starting the operation, respiratory difficulty, facial cyanosis and syncope were found, suddenly. The autopsy finding were large hematoma at the posterior portion of neck organ and perforation of right carotid artery. The second case was a 61-year-old woman. Under the diagnosis of the aneurysm of the anterior communicating artery, the coiling and embolization were performed. After one hour from removal of catheter of right carotid artery, respiratory difficulty, facial cyanosis and syncope associated with right neck hematoma were found, suddenly. Eventually, she died after 41 days due to hypoxic brain injury. The third case was a 55-year-old woman. Under the diagnosis of the thyroid cancer, total thyroidectomy was performed. After three hours from operation, respiratory difficulty, facial cyanosis and syncope associated with severe neck hematoma were found, suddenly. Eventually, she died after 25 days due to hypoxic brain injury. The last case was a 34-year-old man. He visited the hospital due to stab wound of left neck. The irrigation and simple suture were performed at the first visit. After he went home, respiratory difficulty and syncope were found, suddenly. He returned the hospital and cardiopulmonary resuscitation was performed. However, he died. The autopsy finding were large hematoma around the neck organ and stab wound of left carotid artery.
Adult ; Aneurysm ; Arteries ; Autopsy* ; Brain Injuries ; Cardiopulmonary Resuscitation ; Carotid Arteries ; Catheters ; Cyanosis ; Diagnosis ; Female ; Hematoma ; Humans ; Middle Aged ; Neck* ; Sutures ; Syncope ; Thyroid Neoplasms ; Thyroidectomy ; Wounds, Stab

We reports a woman's death caused by massive intraabdominal hemorrhage, who was in chronic alcoholic state with advanced liver cirrhosis and found dead in her room. No macroscopic source for the bleeding was found in her intraabdomen and there was no circumstances of traumatic forces to the individual's body around the death. The presenting unsuspected death could be consistent with the forensic pathological cases described as sudden, unexpected death due to massive nontraumatic intraabdominal hemorrhage in association with liver cirrhosis by DiMaio in 1987.
Alcoholics ; Hemorrhage* ; Humans ; Liver Cirrhosis* ; Liver*