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

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

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

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

PURPOSE: In chronic renal failure (CRF), extracellular fluid (ECF) volume is maintained close to normal, often until end-stage renal disease is imminent. This remarkable feat is accomplished by an increase in fractional excretion of sodium (FENa) in inverse proportion to the decline in glomerular filtration rate (GFR). Many researchers have carried out to try to indentify in animal study but human study was not done in Korea. METHODS: The study is an investigation of the changes of plamsa and urine electrolytes and FENa and fractional excretion of potassium (FEK) in 19 patients (13 men and 6 women) with chronic renal failure. Ages of 19 patients were average 54.6 year-old (range, 29-74 years). Underlying renal disease of the CRF was 42.1% in diabetic nephropathy, 31.6% in chronic glomerulonephritis, 10.5% in hydronephrosis with ureter reflux, and 5.3% in IgA nephropathy. RESULTS: In CRF, plasma Na+ is decreased significantly from normal control 141 +/- 2.1 mEq/L to 139.9 +/- 3.2 mEq/L and GFR from 75.9 +/- 42.9 mL/min to 9.7 +/- 6.3 mL/min, but plasma K+ is increased significantly from 4.2 +/- 0.4 mEq/L to 4.7 +/- 0.8 mEq/L. In CRF however, urine Na+ is decreased significantly from normal control 175.4 +/- 68.5 mEq/L to 89.9 +/- 31.6 mEq/L and osmolality from 610.6 +/- 210.9 mOsm/kg to 397.7 +/- 119.1 mOsm/kg, but urine K+ is decreased tendency from control 32.1 +/- 22.7 mEq/L to 24.3 +/- 14.8 mEq/L. FENa, FEK, and transtubular potassium gradient (TTKG) on CRF were 3.4 +/- 5.4%, 15.4 +/- 20.8% 7.1 +/- 6.9% each and 0.6 +/- 0.6%, 2.2 +/- 2.3% 3.2 +/- 2.8% on normal persons. The difference between CRF and normal control in FENa, FEK, TTKG and osmolar clearance were statistically significant. CONCLUSION: These results suggest that renal tubular cells of CRF were responsible for the decreased Na+ and K+ reabsorption and enhance K+ secretion.
Animals ; Diabetic Nephropathies ; Electrolytes ; Extracellular Fluid ; Glomerular Filtration Rate ; Glomerulonephritis ; Glomerulonephritis, IGA ; Humans ; Hydronephrosis ; Kidney Failure, Chronic* ; Korea ; Male ; Osmolar Concentration ; Plasma ; Potassium ; Sodium ; Ureter

Superior mesenteric vein thrombosis and portal vein thrombosis are rare conditions that are difficult to diagnose due to vague symptoms, but they are usually fatal when they occur. Appendicitis is the one of the most common causes of superior mesenteric vein thrombosis, via venous drainage from the appendiceal area into the portal system. We report a case of superior mesenteric vein thrombosis and portal vein thrombosis secondary to appendicitis presenting with diarrhea, low abdominal pain, and jaundice. The patient was treated with antibiotics and anticoagulants, without fatal complications, but developed a chronic sequela of portal vein thrombosis. It is important to consider thrombosis of the superior mesenteric vein and portal vein in patients who have intra-abdominal infection with specific or non-specific symptoms.
Abdominal Pain ; Anti-Bacterial Agents ; Anticoagulants ; Appendicitis ; Diarrhea ; Drainage ; Humans ; Intraabdominal Infections ; Jaundice ; Mesenteric Veins ; Portal System ; Portal Vein ; Thrombosis