BACKGROUND: This study was conducted to analyze the current problems in completing death certificates and to identify the correct method for completing death certificates. METHODS: We reviewed 262 death certificates in three hospitals from March 1 to April 30, 2000, and 119 death certificates in one hospital from March 1 to 31, 2000. We identified major and minor errors and analyzed and compared them retrospectively. RESULTS: A total of 381 death certificates were reviewed: 59 in Seoul National University Hospital, 101 in Ewha Woman's University Hospital, and 102 in Gachon Medical College Hospital, which has no education program for completing death certificates in postgraduate training, and 119 in Samsung Medical Center which has an education program for completing death certificates. 358 certificates(94.0%) had at least one error. There were only 23 death certificates(6.0%) without an error. In 182 cases(47.8%), there was one major error. In 321 death certificates(84.3%), there were more than two errors. A comparison of Samsung Medical Center with the other hospitals showed that the number of total errors was statistically different(p=0.001). CONCLUSION: There were few death certificates without an error in this study. In a hospital which has postgraduate training in completing death certificates, there are fewer errors than in other hospitals which have no training course. Emergency physicians actually certify many deaths, so they must know the correct method of completing death certificates for statistics on morbidity and mortality.
Death Certificates* ; Education ; Emergencies ; Mortality ; Retrospective Studies ; Seoul

Suprarenal IVC obstruction occurs rarely but has various causes. Because this obstruction proceed chronically and usually has collateral circulation, if there is no IVC or hepatic vein obstruction symptom such as Budd-Chiari syndrome, operation is usually needless. However, although symptom is not combined, if malignancy can not be ruled out and there is no proper and radiologically visible collateral, mass resection with IVC wall and bypass graft should be done. 58 year-old female patient visit the hospital for IVC mass that is occasionally discovered by routine abdominal ultrasonography examination. After abdominal CT scanning and IVC venography, IVC obstructive mass between renal vein and hepatic vein was found. Patient didn't show any abnormality in hematological examination such as coagulation and platelet counts. There was no IVC obstruction symptom such as lower limb swelling. Inferior hepatic vein was abnormally dilated and this was regarded as collateral vessel for IVC obstruction. Radiologically, primary leiomyosarcoma was not ruled out and so operation was decided. Suprarenal IVC was dissected and mass was exposed. And with the use of femoral vein and right atrium, temporally veno-veno bypass was performed. Mass including IVC wall was excised and upper end of divided IVC was sutured. Lower end of divided IVC was anastomosed with 16 mm Dacron graft and graft was anastomosed with right atrium by end-to-end methods (Cavoatrial shunt). Postoperative pathologic examination revealed the mass to be organized thrombi. After 2 weeks later, follow-up IVC venography was performed and good patency was found from IVC to right atrium through artificial bypass graft and patient was discharged without complications.
Budd-Chiari Syndrome ; Collateral Circulation ; Female ; Femoral Vein ; Follow-Up Studies ; Heart Atria ; Hepatic Veins ; Humans ; Leiomyosarcoma ; Lower Extremity ; Middle Aged ; Phlebography ; Platelet Count ; Polyethylene Terephthalates ; Renal Veins ; Thrombosis* ; Tomography, X-Ray Computed ; Transplants ; Ultrasonography

A newly recognized, distinctive fibrous soft tissues lesion called 'calcifying fibrous pseudotumor' is a rare benign condition characterized by the presence of abundant hyalinized collagen with psammomatous or dystrophic calcifications and lymphoplasmacytic infiltration. It wasin soft tissues of the extremities, trunk, groin, scrotum, neck and also rarely in the mediastinum, pleura, and visceral mediastinum. We report a case of calcifying fibrous pseudotumor in the right adrenal gland which was incidentally found in a 43-year-old women.
Adrenal Glands* ; Adult ; Collagen ; Extremities ; Female ; Granuloma, Plasma Cell ; Groin ; Humans ; Hyalin ; Mediastinum ; Neck ; Pleura ; Scrotum

PURPOSE: To evaluate correlations between vascular endothelial growth factor (VEGF) which is associated with tissue remodeling and bone repair and systemic and tissue inflammation in osteoarthritis. MATERIALS AND METHODS: Sixty patients who were above grade 2 in Kellgren-Lawrence radiologic classification of osteoarthritis were classified into group 1 (grade 2, 16 patients), group 2 (grade 3, 18 patients) and group 3 (grade 4, 26 patients). All patients were checked C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and total WBC count in the blood and VEGF and total WBC count in the synovial fluid by ELISA. RESULTS: The severe in osteoarthritic change in radiographs, the more VEGF in the synovial fluid (mean value; group 1 82.7 pg/ml, group 2 111.6 pg/ml, group 3 152.6 pg/ml). VEGF in the synovial fluid were related with total WBC count in the blood and in the synovial fluid (p=0.012, p=0.028 respectively), but not related with CRP and ESR in the blood. CONCLUSION: The severe in osteoarthritic change in radiographs, the more VEGF in the synovial fluid. This facts suggested that there were much neovascularization and bone repair in the synovium of advanced osteoarthritis. Therefore further study elucidating mechanisms of tissue remodeling and its associated factors will be needed.
Acute-Phase Proteins ; Blood Sedimentation ; C-Reactive Protein ; Humans ; Inflammation ; Osteoarthritis ; Synovial Fluid ; Synovial Membrane ; Vascular Endothelial Growth Factor A

Crohn's disease is a condition of chronic inflammation potentially involving any location of the alimentary tract from mouth to anus. Numerous extraintestinal manifestations can also be present. Urologic complications of inflammatory bowel disease are seen in up to 25% of patients, but renal parenchymal disease has been rarely reported. IgA nephropathy is recognized worldwide as a most common form of primary glomerulonephritis. Clinical manifestations vary, ranging from microscopic hematuria to nephrotic syndrome. Recently, IgA nephropathy associated with systemic diseases has been reported. We describe a case of a 22 year-old man with Crohn's disease associated with IgA nephropathy. At the age of 8 years, microscopic hematuria appeared. After fourteen years, he presented with melena, mild fever, recurrent oral ulcer, microscopic hematuria and proteinuria. Colonoscopic examination revealed characteristic features of Crohn's disease such as multiple ulcers. Microscopic findings showed superficial ulceration with small noncaseating granulomas. Renal biopsy revealed IgA nephropathy. The patient was treated with oral prednisolone, olsalazine, and metronidazole followed by maintenance therapy with sulfasalazine and azathioprine resulting in clinical improvement of Crohn's disease and IgA nephropathy.
Adult ; Crohn Disease/*complications/pathology ; Glomerulonephritis, IGA/*complications/pathology ; Humans ; Male

Transgenic plants have been tested as an alternative host for the production and delivery of experimental oral vaccines. Here, we developed transgenic potatoes that express the major antigenic sites A and D of the glycoprotein S from transmissible gastroenteritis coronavirus (TGEV-S0.7) under three expression vector systems. The DNA integration and mRNA expression level of the TGEV-S0.7 gene were confirmed in transgenic plants by PCR and northern blot analysis. Antigen protein expression in transgenic potato was determined by western blot analysis. Enzyme-linked immunosorbent assay results revealed that based on a dilution series of Escherichia coli-derived antigen, the transgenic line P-2 had TGEV-S0.7 protein at levels that were 0.015% of total soluble proteins. We then examined the immunogenicity of potato-derived TGEV-S0.7 antigen in mice. Compared with the wild-type potato treated group and synthetic antigen treated group, mice treated with the potato-derived antigen showed significantly higher levels of immunoglobulin (Ig) G and IgA responses.
Administration, Oral ; Animals ; Blotting, Northern ; Blotting, Western ; Coronavirus ; DNA ; Enzyme-Linked Immunosorbent Assay ; Escherichia ; Gastroenteritis ; Glycoproteins* ; Immunoglobulin A ; Immunoglobulins ; Mice* ; Plants, Genetically Modified ; Polymerase Chain Reaction ; RNA, Messenger ; Solanum tuberosum* ; Transmissible gastroenteritis virus* ; Vaccines