Necrotizing fasciitis (NF) is an aggressive soft-tissue infection involving the deep fascia and is characterized by extensive deterioration of the surrounding tissue. Immediate diagnosis and intensive treatment, including debridement and systemic antibiotics, represent the most important factors influencing the survival of NF patients. In this report, we present a case of NF in the abdomen due to an infection caused by a perforated small bowel after abdominal liposuction. It was successfully treated using negative-pressure wound therapy, in which a silicone sheet functioned as a barrier between the sponge and internal organs to protect the small bowel.
Abdomen ; Abdominal Wall* ; Anti-Bacterial Agents ; Debridement ; Diagnosis ; Fascia ; Fasciitis, Necrotizing* ; Humans ; Lipectomy ; Negative-Pressure Wound Therapy* ; Peritoneum ; Porifera ; Silicon* ; Silicones*

Kinship testing in forensic casework is largely based on a likelihood ratio (LR) approach with short tandem repeat (STR) markers; however, in order to efficiently identify potential relatives in a specific population, the threshold values for kinship prediction should be determined by analyzing the kinship index distributions of the population in question. In this study, 250,000 DNA profiles were simulated using allele frequencies at 20 autosomal STR loci in Koreans, then the LRs were calculated for true close relatives and unrelated pairs. The LR distributions in related and unrelated pairs under a given relationship were compared in 2 sets of 13 Combined DNA Index System (CODIS) and 20 STR profiles. Using 13 CODIS STRs, true relatives in parent/child and full-sibling relationships were sufficiently discriminated from unrelated pairs with LR thresholds of 1,000 and 100, respectively. However, the CODIS STRs lacked the discriminatory power to differentiate between related and unrelated pairs in uncle/nephew and first cousin relationships due to high false-positive and false-negative rates with a LR threshold of 10. Increasing the number of STR loci to 20 increased discrimination of close relatives, but high false results remained in uncle/nephew and first cousin relationships. The kinship index data from this study will help make decisions on various kinship testing and familial searching in Koreans.
Asian Continental Ancestry Group ; Discrimination (Psychology) ; DNA ; Gene Frequency ; Humans ; Microsatellite Repeats

Human mitochondrial DNA (mtDNA) is generally used to identify highly degraded forensic samples, particularly when the extracted DNA is not sufficient for nuclear DNA analysis. However, direct sequencing, the most widely used mtDNA analysis method, is laborious and time-consuming, and precludes the simultaneous analysis of many samples. Here, we describe a rapid and simple screening method for mtDNA analysis in Koreans using single base extension (SBE) methods. Sixteen highly polymorphic mtDNA SNPs from the control region were selected, and a multiplex SBE system was constructed to analyze them. Because the developed system consists of two duplex PCRs, which produce small amplicons with fewer than 270 bp, it works well with highly degraded samples such as old skeletal remains. Using this multiplex SBE system, 145 different haplotypes were expected to be observed from 593 unrelated Koreans. Seventy-three haplotypes were expected to be observed only once, and the most frequent haplotype was expected to occur 80 times. Since the mean number of pairwise differences was estimated to be 4.55, the developed system could be useful to exclude samples that do not match evidence and reference samples. Therefore, the multiplex SBE system used in this study will be a useful tool to analyze many samples simultaneously and to efficiently screen out non-matching mtDNA sequences in forensic casework.
Asian Continental Ancestry Group ; DNA ; DNA, Mitochondrial* ; Haplotypes ; Humans ; Mass Screening* ; Methods ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide*

In effort to determine whether aircraft noise can have health effects such as hearing loss, hypertension and psychological stress, a total of 111 male professors and administrative officers working a college near a military airport in Korea(exposed group) and a total of 168 males and 112 females matched by age groups(control groups) were analyzed. Personal noise exposure and indoor and outdoor sound level of jet aircraft noise were measured at the exposed area. And pure tone, air conduction test and measurement of blood pressure were given to the exposed(males) and matched control groups(males and females). BEPSI(Brief Encounter Psychological Instrument) and psychological response to aircraft noise were examined for the exposed group. The noise dosimetry results revealed time-weighted averages(TWAs) that ranged from 61 to 68 dBA. However the levels encountered during taking off jet airplanes reached 126 dBA for two half minutes time period. The audiometric test showed that mean values of HTL(hearing threshold level) in exposed group at every frequency(500, 1,000, 2,000, 4,000, and 8,000 Hz were much lower than them of male and female control groups. And in old age groups, interaction of age and noise was observed at 8,000 Hz in both ears(p< 0.05). Conclusively, aircraft noise does not appear to induce hearing loss directly, but may decreased hearing threshold level by interaction of aging process and noise exposure. However, difference of mean values of exposed and control groups on blood pressure was not significantly. In psychological test, annoyance was the most severe psychological response to noise in exposed group, but mean value of BEPSI was not correlated with job duration in exposed group
Aging ; Aircraft* ; Airports ; Blood Pressure* ; Female ; Hearing Loss* ; Hearing* ; Humans ; Hypertension ; Male ; Military Personnel ; Noise* ; Presbycusis ; Psychological Tests ; Stress, Psychological*

Purpose: To evaluate the intraocular pressure (IOP) reduction, success rate and prognostic factors after trabecular micro-bypassstent implantation in patients with open-angle glaucoma. Methods: We retrospectively reviewed 33 eyes of 33 patients with open-angle glaucoma who were followed-up for more than6 months after trabecular micro-bypass stent implantation. The success of surgery was defined as an IOP ≤ 21 mmHg and anIOP reduction ≥ 20% from baseline, regardless of whether glaucoma medication was used. Results: During the follow-up at 6 months after trabecular micro-bypass stent implantation, the IOP was significantly decreasedfrom 23.70 ± 6.26 mmHg before surgery to 18.03 ± 4.64 mmHg after 6 months, and the glaucoma medication was significantlydecreased from 3.73 ± 0.67 before surgery to 3.43 ± 0.67 after 6 months (p < 0.001 and p = 0.027, respectively). The successrate at 6 months was 33.7 ± 5.5% in patients with only trabecular micro-bypass stent implantation. Using multiple regressionanalyses of the risk factors, age was associated with success rate (odds ratio, 1.076; 95% confidence interval, 0.996-1.164;p = 0.045). Conclusions In patients in the Republic of Korea, trabecular micro-bypass stent implantation was an effective surgery for IOPreduction, and showed a better surgical success rate in younger patients.

Purpose: Necrotizing fasciitis (NF) is one of the most severe healthcare-associated infections. Early diagnosis of NF is difficult because of nonspecific signs and symptoms in the early stage. NF often presents with risks of medicolegal disputes. This study aimed to provide baseline data on the general characteristics of medical accidents involving NF, features of NF, and typical court opinions regarding medical malpractice in Korea. Methods: In this study, 25 cases of medical malpractice litigation involving NF sentenced between 1998 and 2018 were analyzed with respect to 3 variables: medical accident, NF, and breach of duty. Results: The department of colorectal surgery was most frequently involved in litigation cases (40.0%), and colorectal surgery was the most frequent procedure before the diagnosis of NF (40.0%). The most common sites were the upper and lower extremities. The courts agreed that there was typically improper monitoring after treatment, frequently related to NF. Conclusion These litigation cases imply that physicians cannot be blamed for the failure to prevent NF. The timely recognition and management of NF might be considered as one of the main factors for deciding malpractice in court.Therefore, surgeons, especially in the department of colorectal surgery, should pay attention to changes in the patient’s status after surgery. Surgeons need to learn from medical accidents, as it is important for risk management, preventing the occurrence of similar cases, and improving the quality of healthcare services. We report the medicolegal implications from medical lawsuits involving NF.

OBJECTIVE: To assess the reliability of triple marker screening test in midtrimester pregnancy for fetal Down syndrome. METHODS: From October 1, 1996 to May 31, 1998 at Nowon Eulji Hospital, 3700 Pregnant women underwent serum tiple marker screening for Down syndrome during 15-20weeks of gestational age. The results of serum triple marker screenig tests for Down syndrome and the outcomes of pregnancies were retrospectively assesed. RESULTS: Sixty seven of 3700 cases(1.81%) were positive in screening test, and 3633(98.18%) cases were negative. Among 67 cases of positive screening test, 1 case(1.49%) was diagnosed as Down syndrome. Among 3633 cases of negative screening test, 4 cases(0.1%) were diagnosed as chromosomal abnormalies postnatally. Two of these 4 cases of chromosomal abnormalies were Down syndrome. CONCLUSION: With this results, sensitivity of triple marker screeing test for Down syndrome is very low as 33.3%. In order to increase the sensitivity, some compensatory adjustment is required in triple marker screening test.
Down Syndrome* ; Equidae ; Female ; Gestational Age ; Humans ; Mass Screening* ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Second* ; Pregnant Women ; Retrospective Studies

Malignant pleural effusion in breast cancer has been associated with poor prognosis. The response rate of local treatment has been very low and in some case, complications have resulted in death. We investigated the efficacy and safety of paclitaxel, as an intrapleural chemotherapeutic agent. From January 2006 to December 2009, ten breast cancer patients who had developed malignant pleural effusion were infused with intrapleural paclitaxel through a chest tube, which was clamped for 48 hours. The chest tube was maintained until drainage was reduced to less than 50-100 mL/day. The average time spent with a chest tube attached following intrapleural chemotherapy was 9.3 days. During the follow-up period, six patients had no recurrent pleural effusion and two received a second round of intrapleural chemotherapy following which no further pleural effusion recurred. There were no severe side effects except for mild toxicity. It is suggested that intrapleural paclitaxel chemotherapy may be superior to conventional local treatment and may represent an effective treatment modality with low toxicity.
Breast ; Breast Neoplasms ; Chest Tubes ; Drainage ; Follow-Up Studies ; Humans ; Paclitaxel ; Pleural Effusion ; Pleural Effusion, Malignant ; Prognosis

Metformin, commonly prescribed for type 2 diabetes, is considered safe with minimal side-effect. Acute pancreatitis is rare but potentially fatal adverse side-effect of metformin. We report a patient on hemodialysis with metformin-related acute pancreatitis and lactic acidosis. A 62-year-old woman with diabetic nephropathy and hypertension presented with nausea and vomiting for a few weeks, followed by epigastric pain. At home, the therapy of 500 mg/day metformin and 50 mg/day sitagliptin was continued, despite symptoms. Laboratory investigations showed metabolic acidosis with high levels of lactate, amylase at 520 U/L (range, 30-110 U/L), and lipase at 1,250 U/L (range, 23-300 U/L). Acute pancreatitis was confirmed by computed tomography. No recognized cause of acute pancreatitis was identified. Metformin was discontinued. Treatment with insulin and intravenous fluids resulted in normalized amylase, lipase, and lactate. When she was re-exposed to sitagliptin, no symptoms were reported.
Acidosis ; Acidosis, Lactic* ; Amylases ; Diabetes Mellitus ; Diabetic Nephropathies ; Female ; Humans ; Hypertension ; Insulin ; Lactic Acid ; Lipase ; Metformin* ; Middle Aged ; Nausea ; Pancreatitis* ; Renal Dialysis* ; Sitagliptin Phosphate ; Vomiting

Penile metastases are rare, and usually secondary to other genitourinary primary tumors. Bladder, prostate and renal tumors are the main sources of penile metastasis. Rectal and respiratory neoplasms also metastasize to the penis. However, metastatic penile cancer originating from the pancreas is extremely rare. Here, a case of pancreatic cancer, with penile metastasis, is reported.
Male ; Neoplasm Metastasis ; Pancreas* ; Pancreatic Neoplasms ; Penile Neoplasms* ; Penis ; Prostate ; Urinary Bladder