No abstract available.
Cleft Lip* ; Congenital Abnormalities*

No abstract available.
Durapatite* ; Forehead*

PURPOSE: Antivenin is a standard therapy in snakebite victims. While the required antivenin dose can be easily estimated, based on the initial symptoms, this strategy may be unsuccessful if the initial symptoms progressively worsen. The purpose of this study was to identify the progression rate of the initial symptoms following snakebite and its associated factors. METHODS: The medical records of 44 patients treated for snakebite from give the actual dates of the study period were retrospectively examined. Thirty-two of these patients were enrolled. Demographic data, local wound grade and local effect score at initial presentation (G-0 and LES-0, respectively) and 12 hours after admission (G-12 and LES-12, respectively) were reviewed, along with laboratory data. RESULTS: The 32 patients had an average age of 54.0+/-14.5 years and were predominantly male (n=26) and presented mainly during summer. Compared to G-0 and LES-0, re-evaluated G-12 and LES-12 were significantly increased despite initial administration of proper antivenin dosage (p=0.001 and p=0.000, respectively). Total amounts of antivenin correlated with LES-12 (correlation co-efficiency 0.558, p<0.05). However, factors associated with symptom progression were not revealed. CONCLUSION: Initial snakebite symptoms might progressively worsen within hours despite acceptable initial antivenin therapy. Therefore, re-evaluation within several hours must be considered if when the initial snakebite symptoms are minimal or mild.
Antivenins ; Chronology as Topic ; Disease Progression ; Humans ; Male ; Medical Records ; Retrospective Studies ; Snake Bites

Pulmonary artery aneurysms (PAAs) are rare, and massive hemoptysis can lead to death if appropriate diagnosis and treatment is not provided. PAAs can be of congenital, acquired, or idiopathic origin, and the clinical symptoms are various. Among all reported cases, one-third of the patients died due to rupture. Optimal treatment or guidelines for PAAs remain uncertain. Herein, we report autopsy findings from a woman with PAA. The patient was taking medication for tuberculosis. On bronchoscopy, a polypoid lesion was found, suspected to be an inflammatory polyp. Biopsy was performed and massive bleeding into the airway occurred. The bleeding could not be controlled by bronchoscopic suction, and cardiac arrest occurred 30 minutes after biopsy; the patient subsequently died. Autopsy revealed a round, calcified PAA in the bronchus of the right middle lobe; the end of the PAA was torn. Hypovolemic signs, including weak postmortem lividity and pallor of the skin and conjunctivae, were observed. Visual inspection and histopathological examination of the right lung revealed tuberculosis and congestion. Cases related PAA are not uncommon, but autopsy cases of death occurring after biopsy of PAA mimicking bronchial polyps are rarely reported.
Aneurysm* ; Autopsy ; Biopsy* ; Bronchi ; Bronchoscopy ; Conjunctiva ; Diagnosis ; Estrogens, Conjugated (USP) ; Female ; Heart Arrest ; Hemoptysis ; Hemorrhage ; Humans ; Hypovolemia ; Lung ; Pallor ; Polyps* ; Pulmonary Artery* ; Rupture ; Skin ; Suction ; Tuberculosis

Spontaneous hepatic rupture, which is a complication of hypertension in pregnancy, is extremely rare. However, high maternal and perinatal mortality rates are observed. Several factors, namely, age over 30 years, multiparity, severe preeclampsia, or HELLP syndrome (a group of symptoms which include hemolytic anemia, hepatic enzyme increase, and thrombocytopenia), are associated with this condition. An autopsy case of a woman with twin pregnancy was studied. She was at 36 weeks of gestational age and suffered from the sudden development and rapid progression of hypertension. Moreover, she died because of spontaneous hepatic rupture despite an emergency operation. Autopsy revealed a capsular rupture of the right lobe of the liver with numerous blood clots and hypovolemic signs, such as weak postmortem lividity and palor of the skin and conjunctiva. A close examination of the trunk and liver for the classification of the cause of rupture and an assessment of medical history, such as preeclampsia, are needed during postmortem examination of pregnant women with hepatic rupture or her fetus. To the best of our knowledge, this fatal complication in pregnant women is not yet presented in postmortem examinations in Korea. Thus, we report the findings of this case to share the knowledge.
Anemia, Hemolytic ; Autopsy* ; Classification ; Conjunctiva ; Emergencies ; Female ; Fetus ; Gestational Age ; HELLP Syndrome ; Humans ; Hypertension ; Hypertension, Pregnancy-Induced ; Hypovolemia ; Korea ; Liver ; Parity ; Perinatal Mortality ; Pre-Eclampsia* ; Pregnancy ; Pregnancy, Twin ; Pregnant Women* ; Rupture* ; Rupture, Spontaneous ; Skin

BACKGROUND: Asthma is one of the most prevalent diseases in Korea. Although the guidelines of asthma management were reported in Korea, the present pattern of asthma management by primary physicians has not been studied. The purpose of this study is to elucidate the pattern of asthma management by primary physicians. METHODS: In November 2002, 710 primary physicians specializing in internal medicine in Seoul, Korea were provided with two scenarios of asthmatic patients, one mild and the other severe. By mail or interview, the physicians were asked several questions about their present pattern of asthma management for the patients in each scenario. RESULTS: Among 710 primary physicians, we obtained the answers from 325 physicians (response rate 46%). The most preferred prescription was oral theophylline. 71% and 81% of the physicians answered that they would prescribe oral theophylline for the mild and severe asthmatics, respectively. The next prescription preferred were mucolytics and oral beta2-agonist, in that order. However, 36% and 56% of the physicians answered that they would prescribe inhaled steroids for the mild and severe asthmatics, respectively. Among diagnostic tests, physicians preferred pulmonary function test to the rank next tochest radiography. CONCLUSION: The primary physicians in Seoul prefer oral bronchodilators to inhaled steroids in asthma management. More efforts should be made to reduce the difference between the present pattern of asthma management by primary physicians and the asthma guidelines.
Asthma* ; Bronchodilator Agents ; Diagnostic Tests, Routine ; Expectorants ; Humans ; Internal Medicine ; Korea ; Postal Service ; Prescriptions ; Radiography ; Respiratory Function Tests ; Seoul* ; Steroids ; Theophylline

The Kidd system of blood group is clinically significant since the anti-Kidd antibody can cause immediate or delayed hemolytic transfusion reactions as well as hemolytic disease of newborn (HDN). In contrast to the hemolytic activity of Kidd antibodies in incompatible transfusion, the severity of HDN varies but usually tends to be a benign clinical course with favorable outcomes. And severe HDN due to anti-JKa incompatibility is a rare, which is still not reported in Korea. We experienced a newborn with severe jaundice to be detected within 24 hours from birth due to anti-JKa incompatibility. The laboratory data on admission indicated hemoglobin 13.2 g/dL, reticulocyte 4.08%, total bilirubin 18.7 mg/dL, and direct and indirect antiglobulin tests were positive (2+/2+). But, there are no ABO and Rh (D) incompatibilities between the mother and newborn. Maternal serum was found to contain an antibody that recognized JKa , and also seen in neonate. This patient completely recovered with intensive phototherapy without exchange transfusion. We report this case with a brief review of relevant literature.
Antibodies ; Bilirubin ; Blood Group Incompatibility ; Coombs Test ; Erythroblastosis, Fetal ; Hemoglobins ; Humans ; Infant, Newborn ; Jaundice ; Korea ; Mothers ; Parturition ; Phototherapy ; Reticulocytes

The Kidd system of blood group is clinically significant since the anti-Kidd antibody can cause immediate or delayed hemolytic transfusion reactions as well as hemolytic disease of newborn (HDN). In contrast to the hemolytic activity of Kidd antibodies in incompatible transfusion, the severity of HDN varies but usually tends to be a benign clinical course with favorable outcomes. And severe HDN due to anti-JKa incompatibility is a rare, which is still not reported in Korea. We experienced a newborn with severe jaundice to be detected within 24 hours from birth due to anti-JKa incompatibility. The laboratory data on admission indicated hemoglobin 13.2 g/dL, reticulocyte 4.08%, total bilirubin 18.7 mg/dL, and direct and indirect antiglobulin tests were positive (2+/2+). But, there are no ABO and Rh (D) incompatibilities between the mother and newborn. Maternal serum was found to contain an antibody that recognized JKa , and also seen in neonate. This patient completely recovered with intensive phototherapy without exchange transfusion. We report this case with a brief review of relevant literature.
Antibodies ; Bilirubin ; Blood Group Incompatibility ; Coombs Test ; Erythroblastosis, Fetal ; Hemoglobins ; Humans ; Infant, Newborn ; Jaundice ; Korea ; Mothers ; Parturition ; Phototherapy ; Reticulocytes

Alcohol-related disorders are among the most costly health problems worldwide. Ingested alcohol is mainly metabolized by an oxidative pathway in the liver. Alcohol and its metabolic products (e.g., acetaldehyde and reactive oxygen species) have toxic effects on multiple organs, especially the nervous system. The diverse mechanisms of alcohol-related neurologic disorders include the direct toxic effects of alcohol, the alcohol withdrawal effect, nutritional deficiency secondary to alcoholism, and abnormalities of serum electrolytes and osmolality. We analyzed 156 cases of alcoholrelated neurologic disorders among admitted patients that had been referred in Korea during the previous 10 years. The duration of alcohol consumption ranged from 0.5 to 47 years (mean=17.8 years) and the mean amount of alcohol intake per day was 245.5 g. The 156 patients had the following diseases: Wernicke's encephalopathy (n=81, 51.9%), peripheral neuropathy (n=68, 43.6%), delirium tremens (n=59, 37.8%), Rum fit (n=31, 19.9%), pellagra encephalopathy (n=29, 18.6%), Korsakoff's psychosis (n=22, 14.2%), cerebellar atrophy (n=11, 7.0%), and alcoholic myopathy (n=6, 3.8%). We report on these cases and review the literature on alcohol-related neurologic disorders.
Acetaldehyde ; Alcohol Drinking ; Alcohol Withdrawal Delirium ; Alcoholic Neuropathy ; Alcoholics ; Alcoholism ; Atrophy ; Electrolytes ; Humans ; Korea ; Liver ; Malnutrition ; Marchiafava-Bignami Disease ; Muscular Diseases ; Nervous System ; Nervous System Diseases ; Osmolar Concentration ; Oxygen ; Pellagra ; Peripheral Nervous System Diseases ; Psychotic Disorders ; Wernicke Encephalopathy

BACKGROUND AND OBJECTIVES: Although human papillomavirus (HPV) infection has been recognized as having an important role in the pathogenesis of head and neck squamous cell carcinoma (HNSCC), there is no simple and reliable screening test of HPV infection in HNSCC to date. In the present study, we investigated the usability of p16 immunohistochemical staining as a screening test for HPV infection in HNSCC. SUBJECTS AND METHOD: Paraffin blocks were obtained from 45 tonsil SCC patients, who underwent surgery as an initial treatment between 1995 and 2004. Paraffin blocks were also obtained from 20 normal controls. Expression of p16 was investigated immunohistochemically and these results were compared with results of HPV genotyping and the real-time polymerase chain reaction (PCR) assay of viral oncoprotein to validate p16 staining as a reliable diagnostic tool of HPV infection. RESULTS: The expression of p16 was found to be significantly different between tonsil SCC (32/45, 71.1%) and normal control tissues (0/20, 0%)(p<0.05). Among the 45 patients, HPV genotyping and real-time PCR assay were performed in 21 of the 32 p16 (+) patients and in 6 patients of the 13 p16 (-) patients. HPV-16 was detected in 18 (85.7%) out of the 21 p16 (+) patients and in 2 (33.3%) out of the 6 p16 (-) patients. The p16 expression and HPV-16 status was significantly correlated (p<0.05). The two patients who had HPV-16 infection but did not have p16 expression showed an episomal infection or very low viral copy number each. CONCLUSION: The p16 expression may be an useful marker of HPV infection in HNSCC and may be used as a screening test for HPV infection in HNSCC.
Carcinoma, Squamous Cell ; Coat Protein Complex I ; Head ; Human papillomavirus 16 ; Humans ; Immunohistochemistry ; Mass Screening ; Neck ; Palatine Tonsil ; Papillomavirus Infections ; Paraffin ; Real-Time Polymerase Chain Reaction