1.Inadvertent Intrathecal Contrast Injection during Percutaneous Epidural Neuroplasty: Two Autopsy Cases
Korean Journal of Legal Medicine 2023;47(2):52-57
Percutaneous epidural neuroplasty (PEN) is an interventional technique used to manage spinal pain. However, the procedure may lead to various complications, such as dural puncture and inadvertent intrathecal injection of contrast agents. Conventional autopsy techniques may have limitations in identifying these complications, but postmortem computed tomography (PMCT) scans may be helpful in this respect. The pseudosubarachnoid hemorrhage sign on a PMCT scan is an important finding that suggests an inadvertent intrathecal injection of a contrast agent during the procedure. Here, we report on two rare cases of intrathecal contrast injection that mimicked a subarachnoid hemorrhage after PEN. These rare cases should be considered during autopsies of PEN-related deaths, and a PMCT scan should always be performed prior to such autopsies.
2.Incarcerated Meckel’s Diverticulum (Littre Hernia): A Rare Cause of Unexpected Death
Korean Journal of Legal Medicine 2021;45(2):69-71
Meckel’s diverticulum is the most common congenital malformation of the small intestine that can cause various complications, including obstruction, intussusception, inflammation, hemorrhage, or perforation. Littre hernia is a rare complication that refers to a Meckel’s diverticulum within the hernia sac. This condition is usually asymptomatic and is often discovered incidentally intraoperatively or at autopsy. Therefore, only extremely rare cases of death caused by Littre hernia are described in the literature. We report a rare case of unexpected death secondary to Littre hernia, which was diagnosed at the time of autopsy in a 71-year-old man.
3.Image analytic study of nuclear area in mantle cell lymphoma.
Taehwa BAEK ; Jooryung HUH ; Hyoungjong KWAK ; Meeja PARK ; Hyekyung LEE
Korean Journal of Hematology 2010;45(3):193-196
BACKGROUND: Malignant lymphomas are classified on the basis of morphology, immunohistochemistry, and genetic and molecular biological features. Morphology is considered the most important and basic feature. Lymphomas can be classified as small, medium, or large depending on the cell size, but this criterion tends to be rather subjective. The aim of this study was to investigate the usefulness of an objective approach based on quantitative measurements. METHODS: Twenty specimens of mantle cell lymphoma and 2 specimens of the tonsil were examined. The nuclear area of 6,401 tumor cells of mantle cell lymphoma and 743 normal mantle cells of reactive tonsils were measured by 3 authors by using a user-controlled image-analyzer. The images of the nuclei were outlined using the spline method and the i-solution software, and the data were assessed using ANOVA and Student's t-test. RESULTS: The mean nuclear areas of mantle cell lymphoma cells measured by the 3 authors were 37.9 [7.9] microm2, 37.9 [7.2] microm2, and 38.2 [7.7] microm2 and those of normal mantle cells in reactive tonsil were 28.6 [2.3] microm2, 28.8 [2.0] microm2, and 27.0 [3.0] microm2. There was no statistical difference between the 3 observations of mantle cell lymphoma (P=0.580) and normal tonsils. CONCLUSION: For morphology, nuclear area is considered an important feature in the classification schemes of lymphoma. We showed that nuclear area measurement by using image analyzer can be used as an objective quantitative method. We think that nuclear morphometry may play a significant role in the diagnosis of lymphoma.
Cell Size
;
Immunohistochemistry
;
Lymphoma
;
Lymphoma, Mantle-Cell
;
Palatine Tonsil
4.Sudden Cardiac Death Caused by a Septic Coronary Artery Embolism as the First Clinical Presentation of Infective Endocarditis
Eojin KIM ; Taehwa BAEK ; Sookyung LEE ; Han Na KIM
Korean Journal of Legal Medicine 2021;45(4):122-126
This report describes an uncommon and fatal case of myocardial infarction due to coronary embolus arising from vegetation in the aortic valve with a background of infective endocarditis (IE). There are various causes of fatal IE. Myocardial infarction due to septic emboli is rare. We report a case of sudden death in a 69-year-old woman with hyperlipidemia and no known cardiac disease. She had severe general weakness and was hospitalized for colonoscopy. The patient unexpectedly presented with cardiac arrest and died. The autopsy showed total occlusion of the left anterior descending artery by an embolus, which originated from the septic vegetation of the aortic valve. Myocardial infarction from septic emboli associated with IE can be fatal and manifested as the first presentation. In autopsy practice of deceased patients with IE, careful examination of the coronary arteries is required.
5.Nuclear Image Analysis Study of Neuroendocrine Tumors.
Meeja PARK ; Taehwa BAEK ; Jongho BAEK ; Hyunjin SON ; Dongwook KANG ; Jooheon KIM ; Hyekyung LEE
Korean Journal of Pathology 2012;46(1):38-41
BACKGROUND: There is a subjective disagreement about nuclear chromatin in the field of pathology. Objective values of red, green, and blue (RGB) light intensities for nuclear chromatin can be obtained through a quantitative analysis using digital images. METHODS: We examined 10 cases of well differentiated neuroendocrine tumors of the rectum, small cell lung carcinomas, and moderately differentiated squamous cell lung carcinomas respectively. For each case, we selected 30 representative cells and captured typical microscopic findings. Using an image analyzer, we determined the longest nuclear line profiles and obtained graph files and Excel data on RGB light intensities. We assessed the meaningful differences in graph files and Excel data among the three different tumors. RESULTS: The nucleus of hematoxylin and eosin-stained tumor cells was expressed as a combination of RGB light sources. The highest intensity was from blue, whereas the lowest intensity was from green. According to the graph files, green showed the most noticeable change in the light intensity, which is consistent with the difference in standard deviations. CONCLUSIONS: The change in the light intensity for green has an important implication for differentiating between tumors. Specific features of the nucleus can be expressed in specific values of RGB light intensities.
Chromatin
;
Hematoxylin
;
Image Processing, Computer-Assisted
;
Light
;
Lung
;
Neuroendocrine Tumors
;
Rectum
;
Small Cell Lung Carcinoma
6.Secondary publication Sudden Aortic Rupture in Ehlers-Danlos Syndrome Type IV.
Taehwa BAEK ; Minjung KIM ; Chang Seok KI ; Seong Hwan PARK ; Heon LEE ; Kyung Ryoul KIM ; Byung Ha CHOI
Korean Journal of Legal Medicine 2016;40(2):61-64
Ehlers-Danlos syndrome type IV (EDS IV) is a hereditary disorder of the connective tissue, characterized by easy bruising, thin skin with visible veins, and spontaneous rupture of the large arteries, uterus, or bowel. EDS IV is caused by mutations of the gene for type III procollagen (COL3A1), resulting in insufficient collagen production or a defect in the structure of collagen. EDS IV can have fatal complications such as the rupture of great vessels or organs, which can cause hemorrhaging and sudden unexpected death. Here, we report a case of a 43-year-old female who collapsed after a struggle with a neighbor. In this patient, the bifurcation of the bilateral common iliac artery ruptured, with no evidence of trauma, inflammation, or atherosclerosis. Genetic analysis of COL3A1 showed the presence of a c.2771G>A (p.Gly924Arg) mutation, which may be associated with EDS IV. The forensic pathologist should consider the possibility that the spontaneous visceral or arterial rupture was caused by EDS IV. Genetic analysis is not currently a routine procedure during autopsy. However, in this case, we suggest that the patient possibly had an underlying EDS IV condition, and we recommended family members of the deceased to seek genetic analysis and counseling.
Adult
;
Aortic Rupture*
;
Arteries
;
Atherosclerosis
;
Autopsy
;
Collagen
;
Collagen Type III
;
Connective Tissue
;
Counseling
;
Ehlers-Danlos Syndrome*
;
Female
;
Humans
;
Iliac Artery
;
Inflammation
;
Rupture
;
Rupture, Spontaneous
;
Skin
;
Uterus
;
Veins
7.Pneumomediastinum and pneumothorax after orthognathic surgery: A case report.
Taehwa KIM ; Jin Yun KIM ; Young Cheol WOO ; Sun Gyoo PARK ; Chong Wha BAEK ; Hyun KANG
Korean Journal of Anesthesiology 2010;59(Suppl):S242-S245
The occurrences of pneumomediastinum and pneumothorax after oral and/or maxillofacial surgery are rare, but both are potentially life-threatening complications. Most of the cases that present pneumomediastinum and pneumothorax in the oral and/or maxillofacial surgery result from air dissecting down the fascial planes of the neck. We report a case of a 23-year-old male patient who underwent bilateral sagittal split ramus osteotomy under general anesthesia and developed pneumomediastinum and pneumothorax without any traumatic introduction of air through the cervical fascia three days postoperatively. The possible causes and its prevention are discussed with a review of the relevant literature.
Anesthesia, General
;
Fascia
;
Humans
;
Male
;
Mediastinal Emphysema
;
Neck
;
Osteotomy, Sagittal Split Ramus
;
Pneumothorax
;
Surgery, Oral
;
Young Adult
8.Microbiologic pattern and clinical outcome of non-ICU-acquired pneumonia: Korean HAP registry analysis
Jin Ho JANG ; Hye Ju YEO ; Taehwa KIM ; Woo Hyun CHO ; Kyung Hoon MIN ; Sang-Bum HONG ; Ae-Rin BAEK ; Hyun-Kyung LEE ; Changhwan KIM ; Youjin CHANG ; Hye Kyeong PARK ; Jee Youn OH ; Heung Bum LEE ; Soohyun BAE ; Jae Young MOON ; Kwang Ha YOO ; Hyun-Il GIL ; Kyeongman JEON ;
The Korean Journal of Internal Medicine 2023;38(3):450-450
9.Microbiologic pattern and clinical outcome of non-ICU-acquired pneumonia: Korean HAP registry analysis
Jin Ho JANG ; Hye Ju YEO ; Taehwa KIM ; Woo Hyun CHO ; Kyung Hoon MIN ; Sang-Bum HONG ; Ae-Rin BAEK ; Hyun-Kyung LEE ; Changhwan KIM ; Youjin CHANG ; Hye Kyeong PARK ; Jee Youn OH ; Heung Bum LEE ; Soohyun BAE ; Jae Young MOON ; Kwang Ha YOO ; Hyun-Il GIL ; Kyeongman JEON ;
The Korean Journal of Internal Medicine 2022;37(4):800-810
Background/Aims:
Most studies on hospital-acquired pneumonia (HAP) have been conducted in intensive care unit (ICU) settings. This study aimed to investigate the microbiological and clinical characteristics of non-ICU-acquired pneumonia (NIAP) and to identify the factors affecting clinical outcomes in Korea.
Methods:
This multicenter retrospective cohort study was conducted in patients admitted to 13 tertiary hospitals between July 1, 2019 and December 31, 2019. Patients diagnosed with NIAP were included in this study. To assess the prognostic factors of NIAP, the study population was classified into treatment success and failure groups.
Results:
Of 526 patients with HAP, 379 were diagnosed with NIAP. Overall, the identified causative pathogen rate was 34.6% in the study population. Among the isolated organisms (n = 113), gram-negative bacilli were common pathogens (n = 91), such as Pseudomonas aeruginosa (n = 25), Acinetobacter baumannii (n = 23), and Klebsiella pneumoniae (n = 21). The multidrug resistance rates of A. baumannii, P. aeruginosa, and K. pneumoniae were 91.3%, 76.0%, and 57.1%, respectively. Treatment failure was significantly associated with K. pneumoniae (odds ratio [OR], 3.50; 95% confidence interval [CI], 1.35 to 9.05; p = 0.010), respiratory viruses (OR, 3.81; 95% CI, 1.34 to 10.82; p = 0.012), hematological malignancies (OR, 3.54; 95% CI, 1.57 to 8.00; p = 0.002), and adjunctive corticosteroid treatment (OR, 2.40; 95% CI, 1.27 to 4.52; p = 0.007).
Conclusions
The causative pathogens of NIAP in Korea are predominantly gram-negative bacilli with a high rate of multidrug resistance. These were not different from the common pathogens of ICU-acquired pneumonia.
10.Risk Factors for the Mortality of Patients With Coronavirus Disease 2019Requiring Extracorporeal Membrane Oxygenation in a Non-Centralized Setting: A Nationwide Study
Tae Wan KIM ; Won-Young KIM ; Sunghoon PARK ; Su Hwan LEE ; Onyu PARK ; Taehwa KIM ; Hye Ju YEO ; Jin Ho JANG ; Woo Hyun CHO ; Jin-Won HUH ; Sang-Min LEE ; Chi Ryang CHUNG ; Jongmin LEE ; Jung Soo KIM ; Sung Yoon LIM ; Ae-Rin BAEK ; Jung-Wan YOO ; Ho Cheol KIM ; Eun Young CHOI ; Chul PARK ; Tae-Ok KIM ; Do Sik MOON ; Song-I LEE ; Jae Young MOON ; Sun Jung KWON ; Gil Myeong SEONG ; Won Jai JUNG ; Moon Seong BAEK ;
Journal of Korean Medical Science 2024;39(8):e75-
Background:
Limited data are available on the mortality rates of patients receiving extracorporeal membrane oxygenation (ECMO) support for coronavirus disease 2019 (COVID-19). We aimed to analyze the relationship between COVID-19 and clinical outcomes for patients receiving ECMO.
Methods:
We retrospectively investigated patients with COVID-19 pneumonia requiring ECMO in 19 hospitals across Korea from January 1, 2020 to August 31, 2021. The primary outcome was the 90-day mortality after ECMO initiation. We performed multivariate analysis using a logistic regression model to estimate the odds ratio (OR) of 90-day mortality. Survival differences were analyzed using the Kaplan–Meier (KM) method.
Results:
Of 127 patients with COVID-19 pneumonia who received ECMO, 70 patients (55.1%) died within 90 days of ECMO initiation. The median age was 64 years, and 63% of patients were male. The incidence of ECMO was increased with age but was decreased after 70 years of age. However, the survival rate was decreased linearly with age. In multivariate analysis, age (OR, 1.048; 95% confidence interval [CI], 1.010–1.089; P = 0.014) and receipt of continuous renal replacement therapy (CRRT) (OR, 3.069; 95% CI, 1.312–7.180; P = 0.010) were significantly associated with an increased risk of 90-day mortality. KM curves showed significant differences in survival between groups according to age (65 years) (log-rank P = 0.021) and receipt of CRRT (log-rank P = 0.004).
Conclusion
Older age and receipt of CRRT were associated with higher mortality rates among patients with COVID-19 who received ECMO.