BACKGROUND: Neuromuscular ultrasound has emerged over the last decade as a useful tool for diagnosing peripheral neuropathy. Because nerve enlargement is the most important diagnostic marker of an abnormal nerve, quantification of nerve size is essential. METHODS: We included 80 healthy volunteers aged 21-60 years. The nerve cross-sectional area (CSA) was measured in all participants at the following common compressive sites: bilateral median nerve at the carpal tunnel and forearm, ulnar nerve at the wrist and medial epicondyle, radial nerve at the spiral groove, peroneal nerve at the fibular head and popliteal fossa, and tibial nerve at the popliteal fossa. Anatomical variants were also evaluated, including a bifid median nerve and persistent median artery. RESULTS: The CSAs were 9.58+/-1.55, 6.87+/-1.61, 4.72+/-0.91, 6.64+/-1.33, 6.48+/-1.68, 12.35+/-3.55, and 26.98+/-6.92 mm2 (mean+/-SD) for the median nerve at the carpal tunnel and forearm, ulnar nerve at the wrist and medial epicondyle, radial nerve at the spiral groove, peroneal nerve at the fibular head, and tibial nerve at the popliteal fossa, respectively. The nerve CSA was significantly larger in men than in women and was correlated with body mass index, weight, and height. A bifid median nerve and persistent median artery were seen in 12 (7.5%) and 4 (2.5%) of 160 hands, respectively. CONCLUSIONS: The information produced in this study can serve as reference data when evaluating these nerve sites using ultrasound.
Arteries ; Body Mass Index ; Female ; Forearm ; Hand ; Head ; Healthy Volunteers ; Humans ; Male ; Median Nerve ; Nerve Compression Syndromes ; Peripheral Nervous System Diseases ; Peroneal Nerve ; Radial Nerve ; Reference Values* ; Tibial Nerve ; Ulnar Nerve ; Ultrasonography ; Wrist

Intracranial hemorrhage is a major cause of sudden unexpected death and its identification is important for death investigations. Cisternal puncture of the cerebellomedullary cistern (CMC) can be used to identify intracranial hemorrhage during postmortem examination. Intracranial hemorrhage comprises various types of hemorrhage, and the possibility of hemorrhage identification by cisternal puncture can differ according to the type of intracranial hemorrhage. Postmortem computed tomography (PMCT) is non-invasive and can be performed before autopsy. In this study, we aimed to identify the hemorrhage in the CMC using PMCT in cases of various intracranial hemorrhage. PMCT was performed before the autopsy. Autopsy reports and PMCT were retrospectively reviewed for 108 cases of intracranial hemorrhage confirmed by conventional autopsy. Hemorrhagic regions showed ≥60 Hounsfield units on PMCT. Hemorrhage in the CMC was identified in 42.6% (46/108) by PMCT and was frequently identified in the cases of basal subarachnoid hemorrhage (SAH) (19/21). Hemorrhage in the CMC was identified in approximately 50% of patients with non-basal SAH and intracerebral hemorrhage. Detection of hemorrhage in the CMC by PMCT is hindered by several factors, such as dental artifacts. This study does not guarantee the usefulness of postmortem cisternal puncture. However, this study verified hemorrhage in the CMC according to the various types of intracranial hemorrhages using PMCT and showed its possibilities and limitations.

A malignancy is a fatal condition that could occur through various mechanisms. Forensic pathologists sometimes find unexpected findings during autopsy and post-mortem (PM) tests. Colorectal cancer is one of the leading causes of cancer-related deaths worldwide. The deceased was a 64-year-old man with a medical history of right hemicolectomy due to colon cancer approximately two years earlier. He was found dead at his home. He was admitted to the hospital due to subdural hemorrhage (SDH) two days prior to his demise and was discharged without the permission of the doctor after one day of hospitalization. An autopsy was performed within two days of his death. After gross dissection, the cause and manner of death were assumed to be SDH and unnatural death, respectively. Microscopic examination revealed fresh SDH and dural metastasis of signet-ring cell carcinoma. Furthermore, metastasis was identified in the heart, stomach, and peritoneum. Immunohistochemical examination revealed cancer cells to originate from the colon. After meticulous PM examination, including gross dissection, microscopic examination, PM computed tomography, and PM laboratory tests, the cause and manner of death were determined as SDH and natural death, respectively. This case report highlights the importance of comprehensive PM evaluation for investigating death.

Basal cell carcinoma (BCC) of the prostate, a rare variant of prostate cancer, is derived from the basal cells of prostatic ducts and acini. BCC generally occurs in elderly men with obstructive voiding symptoms and levels of serum prostate-specific antigen within the normal range. In most cases, diagnosis is made through transurethral resection or simple enucleation. Most cases are indolent, but local recurrence and metastasis have been reported in a few cases. Thus, radical surgery and long-term follow-up are recommended. We report a case of a 54-year-old man who underwent radical retropubic prostatectomy after being diagnosed with BCC during a transurethral resection performed for lower urinary tract symptoms. The patient has remained free of disease for 4 months after surgery.
Aged ; Carcinoma, Basal Cell ; Follow-Up Studies ; Humans ; Lower Urinary Tract Symptoms ; Male ; Middle Aged ; Neoplasm Metastasis ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms ; Recurrence ; Reference Values ; Transurethral Resection of Prostate

PURPOSE: To compare the accuracy of central true net corneal power (cTNP) and mean true net corneal power (mTNP) of the Pentacam system to give a keratometry (K) reading for calculating IOL (intraocular lens) power in eyes following refractive surgery. METHODS: Refraction, an automated K-reading (Km), cTNP and mTNP were measured for 15 eyes that required cataract surgery and had previously undergone refractive surgery. The difference between postoperative manifest refraction values and target refraction values calculated with the SRK/T formula using cTNP were compared with the one using mTNP. RESULTS: The mean deviation from the desired post-cataract refractive outcome was 0.60 diopter (D) +/-0.47 (standard deviation) using cTNP; 0.75+/-0.54 using mTNP (p=0.386). The actual refraction was within +/-0.50D of the intended refraction for 60% (cTNP) and 33.3% (mTNP) of eyes, and within +/-1.00D for 93% (cTNP) and 66.7% (mTNP) of eyes. CONCLUSIONS: Although not statistically significant, the cTNP showed better accuracy than mTNP to give a keratometry (K) reading for post-refractive surgery eyes requiring cataract surgery.
Adult ; Cornea/*pathology/physiopathology/surgery ; Corneal Topography/*methods ; Female ; Humans ; *Lenses, Intraocular ; Male ; Middle Aged ; Myopia/*surgery ; Prosthesis Design ; *Refraction, Ocular ; *Refractive Surgical Procedures

PURPOSE: Because depth of invasion by T3 rectal cancer can vary according to the extent of mesorectal invasion, the prognosis for invasive T3 rectal cancer is reported to be very different from that for minimal invasive cancer. Recently, with more emphasis on circumferential resection margin (CRM) status, the T stage, rather than the N stage, seems to be a more valuable prognostic marker in rectal cancer. Therefore, the aim of this study is to determine the prognostic significance of the CRM in invasive T3 rectal cancer. METHODS: Through reviewing 324 consecutive patients with rectal cancer who underwent a curative resection between January 1995 and December 2002 at Busan Paik hospital, 195 patients with invasive T3 rectal cancer, who had not received preoperative neoadjuvant therapy were selected. The patients were classified into a negative CRM group (negative group, n=173) or a positive CRM group (positive group, n=22), and the patients were subgrouped according to the presence of lymph-node (LN) metastasis and CRM status as negative LN and negative CRM (L-/CM-), negative LN and positive CRM (L-/CM+), positive LN and negative CRM (L+/CM-) and positive LN and positive CRM (L+/CM+). All pathological specimens were re-reviewed by a single pathologist, and the distance between the most advanced edge and the outermost aspect of the specimen was re-measured by using a microscope. Local relapse rates, disease free survival, and overall survival were compared using the Kaplan- Meier method. Multivariate analyses to identify independent prognostic factors were performed using the logistic regression model. RESULTS: Local recurrence rates in the positive group and the negative group were 38.6% and 15.3%, respectively (P=0.004, log-rank test). The multiple logistic regression model demonstrated positive CRM (hazard ratio 4.4, P=0.0007) and N2 nodal status (hazard ratio 2.4, P=0.02) as predictors of local recurrence. In the subgroup analysis, the overall recurrence rates and survival rates were, respectively, 12.3% and 86.5% in the L-/CM- subgroup, 53.1% and 50.3% in the L-/CM+ subgroup, 52.7% and 50.0% in the L+/ CM- subgroup, and 58.7 % and 33.8% in the L+/CM+ subgroup (log rank test for trend; P=0.0001 and P=0.0001, respectively). CONCLUSIONS: In the event of predicted CRM involvement in invasive T3 rectal cancer, adjuvant therapy should be performed to improve local control. Also, larger prospective studies are needed to clarify the prognostic role of the CRM in invasive T3 rectal cancer because the number of cases in this study was small, especially in the number of CRM positive cases.
Disease-Free Survival ; Humans ; Logistic Models ; Multivariate Analysis ; Neoadjuvant Therapy ; Neoplasm Metastasis ; Prognosis ; Rectal Neoplasms ; Recurrence ; Survival Rate

Malignant transformation of endometriosis is an infrequent complication. Clear cell carcinoma from endometriosis is very rare in the paraovarian cyst. To date no cases have been reported. We report a case of clear cell carcinoma arising from endometriosis of the paraovarian cyst with a brief review of literature.
Endometriosis ; Female

Agrocybe cylindracea, an edible mushroom belonging to Bolbitiaceae, Agaricales, is widely used as invaluable medicinal material in the oriental countries. This study was initiated to find the genes expressed during the fruiting body formation of A. cylindracea. The cDNAs expressed differentially during fruiting body morphogenesis of A. cylindracea were isolated through subtractive hybridization between vegetative mycelia and fruiting bodies. The cDNAs expressed in the fruiting body morphogenesis of A. cylindracea were cloned and twenty genes were identified. Eleven were homologous to genes of known functions, three were homologous to genes in other organism without any function known. Six were completely novel genes specific to A. cylindracea so far examined. Some genes with known functions were a pleurotolysin, a self-assembling poreforming cytolysins; Aa-Pri1 and Pir2p, specifically induced genes during fruiting initiation of other mushroom, Agrocybe aegerita; an amino acid permease; a cytochrome P450; a MADS-box gene; a peptidylprolyl isomerase; and a serine proteinase. For other clones, no clear function was annotated so far. We believe the first report of the differentially expressed genes in fruiting process of A. cylindracea will be great helps for further research.
Agaricales ; Agrocybe* ; Amino Acid Transport Systems ; Clone Cells ; Cytochrome P-450 Enzyme System ; Cytotoxins ; DNA, Complementary ; Fruit* ; Gene Expression ; Morphogenesis ; Peptidylprolyl Isomerase ; Perforin ; Serine Proteases

Methyl salicylate is widely used in various topical products, including sports creams, ointments, patches, and oral hygiene products. These products are mainly used for localized treatment of musculoskeletal pain. Given their intended topical application, their ingestion can result in salicylic acid poisoning due to their high concentrations of methyl salicylate. Symptoms of salicylic acid poisoning may include dizziness, vomiting, hallucinations, seizures, and, in severe cases, unconsciousness, respiratory failure, and circulatory disorders. We report a case of a 71-year-old male who ingested Mensolatum Lotion to commit suicide and died.

The aim of this study was to elucidate the diatomological investigation and the forensic role of spleen tissue in cases of drowning or non-drowning. Specimens of spleen tissue and other organ tissue from 136 drowning cases, as well as 21 cases where death resulted from causes other than drowning (acting as controls), were examined for the presence of diatoms. The diatom test was performed on all cases using the acid digestion method, involving fumed nitric acid on a hot sand bath. The presence of diatoms in spleen tissue was observed in drowning cases but not in non-drowning cases. Diatoms in spleen tissue showed a positive association with drowning (P=0.011). Among the 136 drowning cases, diatoms were most frequently found in lung tissue (n=134, 99%), followed by spleen (n=33, 24%), kidney (n=28, 21%), liver (n=27, 20%), and heart (n=22, 16%) tissues. Moreover, in 95 cases where putrefaction did not progress, diatoms were detected in spleen tissues in 14 cases, indicating that the highest detection rate among other enclosed organ tissues, excluding lung tissues. Furthermore, a significant correlation was observed between the presence of diatoms in spleen tissue and those in enclosed organs, including the liver, kidney, and heart, but not in lung tissues. Our results revealed a significant correlation between the presence of diatoms in spleen tissue and drowning. Thus, the present study provides evidence that the presence of diatoms in spleen tissue may be a reliable indicator of death by drowning.