Purpose: This study examines errors in death certificates (DCs) issued to cases of poisoning. Methods: DCs issued in poisoning cases were retrospectively reviewed. Errors in the DC were classified as major and minor errors, and were evaluated in accordance with their impact on the process of selecting the cause of death (COD). Results: A total of 79 DCs were evaluated; 43 (54.4%) DCs were issued in the emergency department (ED), and 36 (45.6%) DCs were issued outside the ED. The average major and minor errors per DC were determined to be 0.4 and 3.3, respectively. Moreover, an average of 3.0 errors were discovered in DCs issued at the ED, and 4.4 errors in DCs issued outside the ED. The most common major errors were incorrect manner of death (11.4%, 9/79), followed by unacceptable COD (7.6%, 6/79), and the mode of dying as an underlying COD (5.1%, 4/79). The common minor errors most frequently encountered were incorrect time interval (86.1%, 68/79), followed by incorrect other significant conditions (73.4%, 58/79), and no record for date of onset (62.0%, 49/79). Conclusion Our results indicate that the total numbers of major errors, minor errors and cases of misjudged cause of death were greater in DCs issued outside the ED than in DCs issued at the ED. The most frequently quoted major error of DCs related to poisoning was determined to be the incorrect manner of death.

Purpose: Errors in pediatric death certificates (DCs) have been rarely reported. We analyzed the errors in writing the DCs issued in an emergency department (ED). Methods: The DCs issued at the ED to patients aged 18 years or younger were retrospectively analyzed. Their medical records were reviewed by 4 emergency physicians. Major and minor errors in the DCs were defined based on the International Statistical Classification of Diseases and Related Health Problems 10th revision guidelines. The DCs were classified into the disease group and the external group by the manner of death, and the errors were compared. Results: Among a total of 87 DCs issued in the ED, 97.5% and 100% were confirmed to contain at least 1 error in the disease (n = 40) and external (n = 47) groups, respectively. The median numbers of errors in the analyzed DCs were 2.0 and 3.0 in the disease and external groups, respectively (P = 0.004). In the disease group, the most frequent major error was reporting only a secondary condition as the underlying cause of death without antecedent causes (6 cases [15.0%]). In the external group, the most frequent major error was writing 2 or more causes in a single line for the cause of death (17 cases [36.2%]). In both groups, the most common minor error was omission of a time interval record for the cause of death (disease, 37 cases [92.5%]; external, 42 cases [89.4%]). Conclusion Any errors were identified in 98.9% of pediatric DCs issued in the ED, and the total number of errors was larger in the external group.

PURPOSE: Post-stroke seizures and epilepsy were mainly studied in adults. Selected groups of children with stroke were studied to evaluate the incidence of seizures and epilepsy and the risk factors of epilepsy after stroke. METHODS: Seventy consecutive stroke children younger than 15 years of age were retrospectively reviewed to evaluate the incidence, times, causes of epilepsy and the risk factors epilepsy after stroke. The number and location of the lesion as imaged on the CT scan, and MRI scan were determined. RESULTS: Epilepsy after stroke was diagnosed in 38(54.3%) of 70 stroke patients:16 (45.7%) of 35 with hemorrhagic stroke and 22(62.9%) of 35 with ischemic stroke. Arteriovenous malformation(18), vitamin K deficiency(7), hemophilia(5) were frequent causes in hemorrhagic stroke, and idiopathic(15), moyamoya disease(11), hemiconvulsion-hemiplegia-epilepsy syndrome(6) were frequent in ischemic stroke. No statistically significant differences were noted with relation to sex, type of stroke, number of the lobar lesions, between cortical and subcortical lesions and onset time of initial seizure. Epilepsy developed more often in patients who had lesions located in the left cerebral hemisphere (76.7%) than on the right(42.3%)(P<0.01). CONCLUSION: Epilepsy developed more often in children who had lesion located in left cerebral hemisphere. No statistically significant differences noted in relation to sex, type of stroke, number of the lobar lesions and between cortical and subcortical lesions.
Adult ; Cerebrum ; Child* ; Epilepsy* ; Humans ; Incidence ; Magnetic Resonance Imaging ; Retrospective Studies ; Risk Factors* ; Seizures ; Stroke* ; Tomography, X-Ray Computed ; Vitamin K

PURPOSE: Myoepithelioma of the lacrimal gland is an extremely rare monomorphic adenoma. We report a case of myoepithelioma of the lacrimal gland. METHODS: A 34-year-old woman visited with an asymptomatic palpable mass on the left upper lid for a year. On ophthalmic examination, the visual acuity was 20/20 in both eyes and other ophthalmic examinations were unremarkable. Computed tomographic scan revealed a well-circumscribed, low-attenuated mass lesion in the lacrimal gland. The mass was excised and histopathologic examination and immunohistochemical staining were performed. RESULTS: The lesion consisted of a brown mass, up to 1.5 x 1.0 x 1.0 cm. Histopathologically, there were round, ovoid nuclei associated with an interstitial hyaline deposition. Immunohistochemical staining was strongly positive for S-100 protein and vimentin, intermediately positive for cytokeratin and smooth muscle actin, and negative for glial fibrillary acid protein. Recurrence of the neoplasm was not observed during 5 months of follow-up after surgery. CONCLUSIONS: The case was diagnosed with myoepithelioma of the lacrimal gland on the basis of clinical and histopathological findings. Myoepithelioma of the lacrimal gland is very rare and only a few cases have been reported.
Female ; Humans

Author reviewed the 31 cases of multiple intracranial aneurysms clinically from January 1981 to July 1987, at Inje College Busan Paik Hospital. The results obtained were as follows: 1) The incidence of multiple intracranial aneurysm was 7.8%. In most cases(94%), the number of aneurysm was two. 2) Approximately over 70% of patients were 6th and 7th decades, male to female ratio was 1:3.4. 3) The location of multiple intracranial aneurysms was in order, on the opposite side(39%), on the same side(26%), one in the midline and one on the side(29%). The location of indivisual aneurysms was in order, P-com. A(36%), MCA(25%), A-com. A(17%), ICA(13%). 4) The site of the ruptured aneurysm was determined by CT finding(55%), focal mass effect and spasm in angiography(29%), and others. The accurary was 97%. The possibility of rupture at each location was A-com. A(73%), P-com. A(57%), ICA(38%), MCA(31%). 5) 12 cases among them were treated with one-stage operation and 9 cases with two-stage operation. The post-operative favorable outcome was estimated in 13 cases(54%), the surgical mortality was 13%. There was no statistical difference between two groups.
Aneurysm ; Aneurysm, Ruptured ; Busan ; Female ; Humans ; Incidence ; Intracranial Aneurysm* ; Male ; Mortality ; Rupture ; Spasm

Author reviewed the 31 cases of multiple intracranial aneurysms clinically from January 1981 to July 1987, at Inje College Busan Paik Hospital. The results obtained were as follows: 1) The incidence of multiple intracranial aneurysm was 7.8%. In most cases(94%), the number of aneurysm was two. 2) Approximately over 70% of patients were 6th and 7th decades, male to female ratio was 1:3.4. 3) The location of multiple intracranial aneurysms was in order, on the opposite side(39%), on the same side(26%), one in the midline and one on the side(29%). The location of indivisual aneurysms was in order, P-com. A(36%), MCA(25%), A-com. A(17%), ICA(13%). 4) The site of the ruptured aneurysm was determined by CT finding(55%), focal mass effect and spasm in angiography(29%), and others. The accurary was 97%. The possibility of rupture at each location was A-com. A(73%), P-com. A(57%), ICA(38%), MCA(31%). 5) 12 cases among them were treated with one-stage operation and 9 cases with two-stage operation. The post-operative favorable outcome was estimated in 13 cases(54%), the surgical mortality was 13%. There was no statistical difference between two groups.
Aneurysm ; Aneurysm, Ruptured ; Busan ; Female ; Humans ; Incidence ; Intracranial Aneurysm* ; Male ; Mortality ; Rupture ; Spasm

PURPOSE: The purpose of this study is to analyze the clinical characteristics of anaphylaxis and anaphylactic shock caused by bee venom. METHODS: We retrospectively collected the data of the patients who experienced anaphylaxis caused by natural bee sting or acupuncture using bee venom from January 1999 to December 2008. Seventy subjects were divided into the shock and non-shock groups. The clinical characteristics, sources of bee venom, treatments and outcomes were compared between the two groups. RESULTS: The mean age of the subjects was 45.5 +/- 16.3 years old and the number of males was 44 (62.9%). There were 25 patients in the shock group and 45 in the non-shock group. The age was older (P=0.001) and females (P=0.003) were more frequent in the shock group. Transportation to the hospital via ambulance was more frequent in the shock group (p<0.001). No difference was found in species of bee between the two groups. The cephalic area, including the face, was the most common area of bee venom in both groups. Anaphylaxis caused by bee sting commonly occurred between July and October. Cutaneous and respiratory symptoms were the most frequent symptoms related to anaphylaxis. Cardiovascular and neurologic symptoms were more frequent in the shock group. The amount of intravenously administered fluid and subcutaneous injection of epinephrine were much more in the shock group than that in the non-shock group. CONCLUSION: Older age was the factors related to anaphylactic shock caused by bee venom. Further validation is needed to evaluate the gender factor associated with shock.
Acupuncture ; Ambulances ; Anaphylaxis ; Bee Venoms ; Bees ; Bites and Stings ; Epinephrine ; Female ; Humans ; Injections, Subcutaneous ; Male ; Neurologic Manifestations ; Retrospective Studies ; Shock ; Transportation

PURPOSE: The medical director is a core factor in maintaining high quality emergency medical services. This study was conducted to evaluate the agreement of medical oversight for prehospital emergency care between medical directors. METHODS: Two medical directors assessed the same 119 rescue run sheets with 28 cases of cardiac arrest, 12 cases of withhold or interruption of cardiopulmonary resuscitation (CPR), and 22 cases of severe trauma. The assessment for prehospital evaluation of patients, treatment and medical direction was compared between the two medical directors, RESULTS: The use of an automated external defibrillator in cardiac arrest that was assessed as appropriate was 17/28, 22/28, respectively. In assessing for withhold or interruption of CPR, one medical director assessed as all appropriate for checking for pulse, respiration, and mental status regardless of recording on a 119 rescue runsheet, but the other medical director as inappropriate if there are no records on the runsheet. The assessment for airway treatment, aid for circulation, appropriateness of treatment for trauma, and appropriateness of medical direction in severe trauma differed between the two medical directors. CONCLUSION: Some differences were found in assessing the prehospital care between medical directors. A quality program for improving agreement between medical directors is necessary and the protocol for prehospital care should be modified according to the local situation.
Cardiopulmonary Resuscitation ; Defibrillators ; Emergency Medical Services ; Heart Arrest ; Humans ; Physician Executives* ; Quality Control ; Respiration

The nutcracker syndrome does not occur frequently. The condition usually results from compression of the left renal vein between the superior mesenteric artery and the abdominal aorta, and leads to varicocele, flank pain and lateralizing hematuria. With a full review of the literature, we now report and discuss a case of nutcracker syndrome in which a 30-year-old female visited the emergency center for left flank pain. She experienced complete recovery after conservative treatment.
Adult ; Aorta, Abdominal ; Emergencies ; Female ; Flank Pain ; Hematuria ; Humans ; Mesenteric Artery, Superior ; Peripheral Vascular Diseases ; Renal Veins ; Varicocele

Esophageal hiatal hernia occurs when a portion of the stomach prolapses through the esophageal hiatus into the thoracic cavity. The most common symptoms are epigastric or substernal pain, nausea, vomiting and dyspepsia, but most people with hiatal hernia are asymptomatic or have nonspecific symptoms. Hiatal hernia is usually discovered as an incidental finding on upper gastrointestinal studies or gastroscopy. We now report a case of type II paraesophageal hiatal hernia with gastric perforation. It is important to consider panperitonitis caused by perforation of a herniated stomach when the patient with hiatal hernia has acute abdominal pain.
Abdominal Pain ; Dyspepsia ; Gastroscopy ; Hernia, Hiatal ; Humans ; Incidental Findings ; Intestinal Perforation ; Nausea ; Peritonitis ; Prolapse ; Stomach ; Thoracic Cavity ; Vomiting