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

Basal cell carcinomas usually arise from the epidermis and show some epidermal connections. It is very unusual that basal celi carcinomas occur as subderrnal mass without epidermal connections. A 51 year-old female h;d an asymptomatic skin colored indurated plaque with linear old scar on the left side of nose fcr about 20 years. She had had a tumor that supposed to be a epidermal cyst, on the same site and the lesion was excised about 20 years ago. We performed the punch biopsy on her first visit which revealed hypertrophic scar. She was treated with intralesional injection of triamcinolone acetonide to reduce the size of hypertrophic scar. However, the lesion had not been reduced. She underwent the surgery to remove the scar at plastic surgery and the excisional biopsy showed a subdermal basal cell carcinoma. We recommend that the newly developed skin tumor in the pre-excised region should be required excisional biopsy instead of punch and close observation
Biopsy ; Carcinoma, Basal Cell* ; Cicatrix ; Cicatrix, Hypertrophic ; Epidermal Cyst ; Epidermis ; Female ; Humans ; Injections, Intralesional ; Middle Aged ; Nose ; Skin ; Surgery, Plastic ; Triamcinolone Acetonide

No abstract available.
Parathyroid Neoplasms* ; Radionuclide Imaging* ; Thymoma*

BACKGROUND: Reperfusion of ischemic myocardium has been postulated to result in a specific oxygen radical mediated tissue injury. Iron may liberate during ischemia and we hypothesized that administration of the iron chelator, deferoxamine during ischemia would result in improved recovery after postischemic reperfusion. PURPOSE: To test whether iron-catalyzed processes contribute to myocardial necrosis during ischemia and reperfusion, deferoxamine was administered to block iron catalyzed hydroxyl radical formation in rabbits. METHODS: Eleven rabbits were divided into two groups: control group (n=5) and deferoxamine pretreatment group (n=6). the left circumflex coronay artery was ligated for 30 minutes and reperfused for 180 minutes. Area at risk (AR) was measured by non-stained area with ethylene blue injection into left atrium after left circumflex coronary artery ligation. Infarct size was measured by weighing after tripheyltetrazolium chloride staining. Heart rate was measured using electrocardiographic recording and systemic blood pressure was monitored by pressure transducer connected to the catheter in the left ventricle. RESULTS: 1. There was no significant difference of heart rate and blood pressure in deferoxamine pretreatment group compared with control group. 2. There was significant decrease of serum iron concentration after continuous infusion of deferoxamine compared with serum iron concentration before ligation of coronary artery (P<0.05). 3. There was no significant difference of area at risk between control and deferoxamine pretreatment group. 4. Area at necrosis to area at risk was significantly reduced in deferoxamine pretreatment group compared with control group (P<0.05) The results suggest that deferoxamine infusion prior to coronary artery occlusion has a significant benefit in reducing infarct size in this model.
Arteries ; Blood Pressure ; Catheters ; Coronary Vessels ; Deferoxamine* ; Electrocardiography ; Heart Atria ; Heart Rate ; Heart Ventricles ; Hydroxyl Radical ; Iron ; Ischemia ; Ligation ; Myocardial Infarction* ; Myocardium ; Necrosis ; Oxygen ; Rabbits ; Reperfusion ; Transducers, Pressure

Osteoma is the most common benign tumor of the paranasal sinuses and the frontal sinus is the most frequently involved site. Osteomas are slow growing osteoblastic lesions commonly seen in the outer table of the calvarium, the mandible, the frontal and ethmoid sinus, and occasionally in tubular bones. They are usually detected during the second to fifth decades of life, and reported ratio of male to female is 1.5:1 to 2:1. The symptoms of osteomas are usually developed as gradual growth. They are headaches, facial pain, proptosis, decreased visual acuity, chemosis, diplopia, epiphora, nonpulsating exophthalmus, and transient blindness. Posterior intracranial extension of a frontoethmoid osteoma may lead to brain abscess, intracranial mucocele, tension pneumocephalus. We experienced a 60-year-old male patient who came to the emergency room with acute and severe left periorbital swelling, red eye, and epiphora lasted for 10 days. In a plain radiographs and computerized tomographic scans, a 2.5 x 2.5 x 3.0 cm well marginated mass impressed by osteoma in frontoethmoidal sinus was detected. After the symptoms subsided by conservative treatment, total excision was made by bicoronal approach. Authors reported a frontoethmoidal osteoma presenting periorbital cellulitis without orbital mucocele, which is very rare symptom.
Blindness ; Brain Abscess ; Cellulitis* ; Diplopia ; Emergency Service, Hospital ; Ethmoid Sinus ; Exophthalmos ; Facial Pain ; Female ; Frontal Sinus* ; Headache ; Humans ; Lacrimal Apparatus Diseases ; Male ; Mandible ; Middle Aged ; Mucocele ; Orbit ; Osteoblasts ; Osteoma* ; Paranasal Sinuses ; Pneumocephalus ; Skull ; Visual Acuity

PURPOSE: To translate and evaluate the reliability and validity of the Korean version of the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25). METHODS: Two bilingual ophthalmologists independently translated the original English version of the NEI-VFQ-25 into written Korean. A panel of the Korean Retina Society reviewed the translations to form a single reconciled forward translation of the Korean version of the NEI-VFQ-25. Another ophthalmologist back-translated this first draft into English. Both the first draft and back-translated draft were edited by a professional translator. To evaluate the correlation and validity, results between the original NEI-VFQ-25 and the Korean version, completed by the bilingual participants, were compared. RESULTS: The Korean version of the National Eye Institute Visual Functioning Questionnaire-25 was developed by translation, back-translation, and expert supervision. Results from 23 bilingual participants between the original NEI-VFQ-25 and the Korean version were compared and showed statistically significant correlation, with a Spearman's correlation coefficient of 0.4 or greater. The Kolmogorov-Smirnov test results showed no statistically significant differences between the two questionnaires. CONCLUSIONS: Translation and validation of the Korean version of the NEI-VFQ-25 was achieved.
National Eye Institute (U.S.) ; Organization and Administration ; Surveys and Questionnaires ; Reproducibility of Results ; Retina ; Translations

Primary malignant pericardial mesothelioma is a very rare and highly aggressive tumor with a poor prognosis. Here, we present the case of a 71-year-old man with symptoms of chest discomfort and exertional dyspnea starting 1 week prior to admission. We identified a pericardial mass using transthoracic echocardiography, but could not diagnose the patient using other multimodal imaging approaches and effusion cytology. Findings on contrast cardiac computed tomography (CT) and magnetic resonance imaging (MRI) were more consistent with angiosarcoma than malignant mesothelioma. Ultimately, the patient was diagnosed with malignant pericardial mesothelioma, based on immunohistochemical staining of the tumor tissue. In recent years, several cases have reported the efficacy of chemotherapy in malignant mesothelioma. Thus, we suggest that accurate diagnosis of pericardial tumors with pathology may have a profound impact on the final prognosis.
Aged ; Dyspnea ; Echocardiography ; Heart Neoplasms ; Hemangiosarcoma ; Humans ; Magnetic Resonance Imaging ; Mesothelioma ; Pericardial Effusion ; Prognosis ; Thorax

STUDY DESIGN: Retrospective evaluation. PURPOSE: To analyze the effect of T1 slope on degree of degeneration in patients with cervical disc degeneration. OVERVIEW OF LITERATURE: The T1 slope is well known parameter that may be very useful in evaluating sagittal balance. There are no reports on the analysis of the relationship between T1 slope and cervical disc degeneration. We hypothesized that T1 slope has an effect on the degree of cervical degeneration. METHODS: Sixty patients who had cervical spine magnetic resonance imaging (MRI) in our orthopedic clinic were enrolled. Patients were divided into two groups according to T1 slope. Radiologic parameters obtained from radiography and cervical spine MRI were compared between low T1 slope group (< or =25) and high T1 slope group (>25). RESULTS: Among low T1 slope group, average degeneration grade of each cervical segment was 2.65 in C2-3, 2.50 in C3-4, 2.62 in C4-5, 3.23 in C5-6, and 2.81 in C6-7. And that of high T1 group was 2.35 in C2-3, 2.32 in C3-4, 2.59 in C4-5, 2.79 in C5-6, and 2.32 in C6-7. Grade of degeneration of low T1 group was significantly higher, as compared with high T1 group in C5-6 (p=0.028) and C6-7 (p=0.009). Percentage of high grade degeneration of more than grand III was 65.4% in low T1 group and 32.4% in high T1 group (p=0.018). Risk of high grade degeneration of C6-7 was significantly higher in low T1 group (odds ratio, 5.63; 95% confidence interval, 1.665-19.057; p=0.005). CONCLUSIONS: Patients with low T1 slope had higher grade of degeneration regardless of age and gender. Low T1 slope is a potential risk factor of cervical spondylosis especially in the C6-7 cervical segment.
Humans ; Intervertebral Disc Degeneration* ; Magnetic Resonance Imaging ; Orthopedics ; Radiography ; Retrospective Studies ; Risk Factors ; Spine ; Spondylosis

BACKGROUND: Autoimmune cytopenia (AIC) is a rare complication of allogeneic hematopoietic cell transplantation (HCT). In this study, we reviewed the diagnosis, treatment and response to therapy for pediatric patients with post-HCT AIC at our institution. METHODS: Of the 292 allogeneic HCTs performed from January, 2011 to December, 2015 at the Department of Pediatrics, The Catholic University of Korea, seven were complicated by post-HCT AIC, resulting in an incidence of 2.4%. RESULTS: All seven patients with post-HCT AIC had received unrelated donor transplant. Six of seven patients had a major donor-recipient blood type mismatch. The subtypes of AIC were as follows: immune thrombocytopenia (ITP) 2, autoimmune hemolytic anemia (AIHA) 2, Evans syndrome 3. Median time from HCT to AIC diagnosis was 3.6 months. All but one patient responded to first line therapy of steroid±intravenous immunoglobulin (IVIG), but none achieved complete response (CR) with this treatment. After a median duration of treatment of 15.3 months, two patients with ITP achieved CR and five had partial response (PR) of AIC. Five patients were treated with rituximab, resulting in the following response: 2 CR, 2 PR, 1 no response (NR). Median time to response to rituximab was 26 days from first infusion. All patients are alive without event. CONCLUSION: Post-HCT AIC is a rare complication that may not resolve despite prolonged therapy. Rapid initiation of second line agents including but not limited to B cell depleting treatment should be considered for those that fail to achieve CR with first line therapy.
Anemia, Hemolytic, Autoimmune ; Cell Transplantation* ; Child* ; Diagnosis ; Humans ; Immunoglobulins ; Incidence ; Korea ; Pediatrics ; Purpura, Thrombocytopenic, Idiopathic ; Rituximab ; Transplants* ; Unrelated Donors

We report a case of acute upper limb ischemia suspected to have originated from methicillin-resistant Staphylococcus epidermidis native valve endocarditis in a 57-year-old man who had complained of sudden-onset fever and pain in the right hand. 3D computed tomography of the right upper extremity detected a thrombus occluding the brachial artery. Echocardiography showed a large vegetation on the aortic valve. Thus, we suspected, clinically, brachial artery occlusion by septic emboli originating from a large vegetation of the aortic valve. The patient was treated with intravenous antibiotics for the suspected methicillin-resistant Staphylococcus epidermidis-native valve endocarditis with a combination of percutaneous aspiration thromboembolectomy and selective intra-arterial thrombolysis for acute thromboembolic occlusion in the right upper limb. The large vegetation of the aortic valve resolved without surgery and aortic regurgitation improved. The patient recovered uneventfully with no complications, including septic embolism, over the following 11 months.
Anti-Bacterial Agents ; Aortic Valve ; Aortic Valve Insufficiency ; Brachial Artery ; Echocardiography ; Embolism ; Endocarditis* ; Fever ; Hand ; Humans ; Ischemia* ; Methicillin Resistance ; Middle Aged ; Staphylococcus ; Staphylococcus epidermidis* ; Thromboembolism ; Thrombosis ; Upper Extremity*