Gua Sha is a traditional Asian medicine with different names in many Asian countries. It is a treatment to scrape the petechiae of the skin with ointment. It has generally been administered to patients with upper respiratory infections, heat syndrome, and pain. Herein, we report the case of a 31-year-old Cambodian man who was found dead at a farm accommodation. During the autopsy, multiple linear intradermal hemorrhages without subcutaneous damage were observed in the upper chest and both shoulders. The cause of death was sudden unexpected nocturnal death syndrome because he was a young Asian man who died while sleeping without specific findings. Since it is an unfamiliar traditional medicine in Korea compared to other Asian countries, forensic officers without background knowledge about Gua Sha initially suspected that he was severely assaulted or pressed against a particular object enough to cause crush asphyxia. Because of the difficulty of going to the hospital during the coronavirus disease 2019 pandemic, Gua Sha was used to treat headaches and mild fever. Therefore, this case shows that understanding the culture of other countries could be helpful for investigations especially with the increase of multicultural families in Korea.

BACKGROUND: Psoriasis is an immune-mediated, chronic inflammatory disease affecting multiple aspects of patients' lives. Its epidemiology varies regionally; however, nationwide epidemiologic data on psoriasis depicting profile of Korean patients has not been available to date. OBJECTIVE: To understand nationwide epidemiologic characteristics and clinical features of adult patients with psoriasis visited university hospitals in Korea. METHODS: This multicenter, non-interventional, cross-sectional study recruited 1,278 adult patients with psoriasis across 25 centers in Korea in 2013. Various clinical data including PASI, BSA, DLQI, SF-36 and PASE were collected. RESULTS: A total of 1,260 patients completed the study (male:female=1.47:1). The mean age was 47.0 years with a distribution mostly in the 50s (24.9%). Early onset (<40 years) of psoriasis accounted for 53.9% of patients. The mean disease duration was 109.2 months; mean body mass index was 23.9 kg/m²; and 12.7% of patients had a family history of psoriasis. Plaque and guttate types of psoriasis accounted for 85.8% and 8.4%, respectively. Patients with PASI ≥10 accounted for 24.9%; patients with body surface area ≥10 were 45.9%. Patients with DLQI ≥6 accounted for 78.8%. Between PASI <10 and PASI ≥10 groups, significant difference was noted in age at diagnosis, disease duration, blood pressure, waist circumference of female, and treatment experiences with phototherapy, systemic agents, and biologics. CONCLUSION: This was the first nationwide epidemiologic study of patients with psoriasis in Korea and provides an overview of the epidemiologic characteristics and clinical profiles of this patient population.
Adult ; Biological Products ; Blood Pressure ; Body Mass Index ; Body Surface Area ; Cross-Sectional Studies* ; Diagnosis ; Epidemiologic Studies ; Epidemiology ; Female ; Hospitals, University ; Humans ; Korea* ; Phototherapy ; Psoriasis* ; Waist Circumference

Carcinosarcoma of gallbladder (CSGB) is a rare malignancy characterized by malignant epithelial and mesenchymal components. Its pathogenesis is unknown and most CSGBs are associated with poor survival because the disease normally presents at an advanced stage, and as a result, curative resection is uncommon. This report describes a case that underwent curative resection. A 77-year-old woman presented with right upper quadrant pain. The preoperative diagnosis was gallbladder (GB) cancer, and thus, curative radical cholecystectomy was performed. However, pathologic examination of the surgical specimen revealed that the tumor was composed of two histologic components of squamous cell carcinoma and spindle cell sarcoma, which was consistent with a diagnosis of carcinosarcoma. The tumor was found to extend to the perimuscular connective tissue and to have metastasized to one lymph node (LN). The prognosis of CSGB remains poor despite curative resection, and thus, the authors recommend that effort be made to improve surgical outcomes.
Aged ; Carcinoma, Squamous Cell ; Carcinosarcoma ; Cholecystectomy ; Connective Tissue ; Female ; Gallbladder ; Humans ; Lymph Nodes ; Prognosis ; Sarcoma

PURPOSE: The purpose of this study was to evaluate the clinical benefits of preoperative percutaneous transhepatic drainage (PTGBD), especially regarding morbidity and mortality, in patients aged 60 or older with acute cholecystitis. METHODS: A retrospective study was done on a series of elderly patients (>60 years old; n=132) who had been diagnosed between January 2007 and December 2009 as having acute cholecystitis. The patients were divided into 4 groups; cases in which only laparoscopic cholecystectomy (LC) was done (Group 1, n=84), cases in which LC was done after preoperative PTGBD (Group 2, n=15), cases in which only open cholecystectomy was done (Group 3, n=23), and cases in which open cholecystectomy was done after preoperative PTGBD (Group 4, n=10). We analyzed between group differences in surgical outcomes including periods of postoperative fast and postoperative hospital stay, OP. morbidity, and open conversion rate. RESULTS: Patients in Group 1 had fewer underlying medical problems and lower ASA scores than patients in groups 2, 3, or 4 (p<0.05). Mean operating time in Group 2 (113.66+/-107.5 min) was significantly longer than in group 1 (72.02.9+/-34.2 min) (p<0.05) and the open conversion rate was higher (8.33% vs 26.67%). But, blood loss (ml) and OP time in Group 2 were lower than in Group 3 or 4 (p<0.001). Postoperative recovery progression (periods of postoperative fasting and length of postoperative hospital stay) of Group 2 were better than in groups 3 or 4 (p<0.001). CONCLUSION: Pre-operative PTGBD procedures in elderly patients with acute cholecystitis is a good clinical option as a pretreatment to a cholecystitis operation.
Aged ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Drainage ; Fasting ; Gallbladder ; Humans ; Length of Stay ; Retrospective Studies

Thoracic disc herniation is a rare condition in which a posterior approach, extrapleural approach, posterolateral approach, or transthoracic approach is currently used. The posterior approach is not recommended in thoracic disc herniation surgery because of the risk of spinal cord injury. The transthoracic approach makes it possible to remove the intervertebral disc and is considered a standard method. However, due to an extensive transverse skin incision, division of the latissimus dorsi muscles, and rib resection, the conventional open approaches involve a risk of complications, such as infection and post-thoracotomy pain syndrome; and a long period of rehabilitation and recovery is required. Excision of the intervertebral disc under thoracoscopic guidance can reduce the damage to the skin and muscles, but the equipment and surgical materials are expensive and a long learning curve is required. Therefore, we report a case and a new muscle splitting transthoracic approach that can be performed by incising 10 cm of skin longitudinally and preserving the serratus anterior and latissimus dorsi muscles.
Intervertebral Disc ; Learning Curve ; Muscles ; Rehabilitation ; Ribs ; Skin ; Spinal Cord Injuries ; Superficial Back Muscles*

Purpose: The aim of this study was to evaluate complementary and alternative medicines (CAM) employed for treating patients with erectile dysfunction. Materials and Methods: A total of 204 patients with erectile dysfunction who completed a questionnaire between January and June 2005 were evaluated. The questionnaire was composed of 13 questions. This survey employed a broad definition for CAM, including acupuncture, biofeedback, folk remedies, chiropractic, homeopathy, hypnosis, massage, psychotherapy, relaxation, energy healing, imagery, special diet, spiritual healing and herbal medicine. The CAMs used by the patients with erectile dysfunction were divided into processed health foods, natural health foods and other therapies, and these were all analyzed. Results: The mean age was 57.9+/-10.1 years. 78 of the total patients with erectile dysfunction had employed at least one CAM. CAM users were more likely to be high school educated, nonsmokers and exercisers. The CAMs used were processed health foods 62% (48/78), natural health foods 15% (12/78), and other therapies 66% (52/78). The processed health foods were soy 25%, ginseng 23% and mushroom 19%. Of the natural health foods, tomato was 42%, soy was 25% and ginseng was 17%. Of the other therapies, herbal medicine was 45%, acupuncture was 25%, moxibustion and cupping a boil were 17%. 35% (27/78) of the patients with erectile dysfunction had employed more than one of the processed health foods, natural health foods and other therapies. Conclusions: Patients with erectile dysfunction had mainly employed processed health foods more than the natural health foods, herbal medicine and acupuncture. We think that more research is required about the effects and benefits of CAM in association with ED.
Acupuncture ; Agaricales ; Biofeedback, Psychology ; Chiropractic ; Complementary Therapies* ; Diet ; Erectile Dysfunction* ; Health Food ; Herbal Medicine ; Homeopathy ; Humans ; Hypnosis ; Lycopersicon esculentum ; Male ; Massage ; Medicine, Traditional ; Moxibustion ; Panax ; Psychotherapy ; Surveys and Questionnaires ; Relaxation ; Spiritual Therapies ; Food, Organic

Electrocardiographic abnormalities commonly associated with hypopituitarism are low QRS voltage, ST-segment depression, inverted T waves and a prolonged QT interval. Although the mechanism remains unclear, glucocorticoid therapy, an intracelluar-extracellular electrolyte imbalance of myocytes, and histopathological changes in the myocardium are thought to play a role in this disorder. We discribe a 64 year old woman with recurrent ventricular tachycardia associated with QT prolongation in Sheehan's syndrome. Ventricualr tachycardia was treated by lidocain and direct current cardioversion. Sheehan's syndrome was confirmed by past history, anterior pituirary stimulation test and brain MRI showed empty sella. After hormone replacement treatment, inverted T waves and prolonged QT interval was normalized and ventricular tachycardia did not recur.
Brain ; Depression ; Electric Countershock ; Electrocardiography ; Female ; Humans ; Hypopituitarism* ; Magnetic Resonance Imaging ; Middle Aged ; Muscle Cells ; Myocardium ; Tachycardia ; Tachycardia, Ventricular*

BACKGROUND: Although nucleotides -like Adenosine Triphosphate (ATP) and its derivatives Adenosine, were known to induce growth inhibition and apoptosis in diverse cell lines, little is known about their effects on trophoblast. OBJECTIVE: To elucidate the effects of extracellular ATP and adenosine on trophoblast cell growth and to delineate if apoptosis is involved in this mechanism. MATERIALS AND METHODS: We used TL cell line, derived from human term placenta. The cells were cultured for 24, 48, and 72 hours after being treated with ATP and adenosine, each. Also, cell growth according to different concentrations of ATP and adenosine was evaluated. To test whether apoptosis was induced by each nucleotide, DNA fragmentation and nuclear condensation by Hoechst 33258 stain and P53 protein expression were evaluated. RESULTS: Cell growth was inhibited by ATP and adenosine in time and dose-dependent manner. Furthermore, the growth inhibitory effect of adenosine was stronger than ATP, whereas signs of DNA fragmentation and nuclear condensation were observed in ATP treated cells, but not in adenosine treated ones. CONCLUSION: Our results shows that ATP and adenosine exert inhibitory effect on growth in TL cell line. These findings suggest that pathological production of ATP or its metabolites, adenosine, may lead to a pathologic status such as preeclampsia or intrauterine growth restriction.
Adenosine Triphosphate* ; Adenosine* ; Apoptosis* ; Bisbenzimidazole ; Cell Line* ; DNA Fragmentation ; Humans* ; Nucleotides ; Placenta ; Pre-Eclampsia ; Trophoblasts

Facial aging is a complex process of gravity-induced soft tissue ptosis and photoaging. In the standpoint of ideal rejuvenation, face lifting combined with laser resurfacing offers significant improvement in aesthetic outcome unachievable by either procedure alone and has many advantages. Neverthless, the simultaneous combination has never been popularized due to the non-specific thermal effects of the laser and risks of skin necrosis in Korea. This report documents the safety and effectivness of combined procedures when using systematic consideration and modified techniques in orientals. This study included 26 Fitzpatrick type III, IV orientals who didn't complaint lower face aging. A dramatic rejuvenation in soft tissue reposition and skin quality was produced in combined endoscopic forehead and midface lift with laser resurfacing cases. The standard forehead lift using endoscopic subperiosteal deep plane seldom interfere flap resurfacing. An endoscopic subperiosteal and subcutaneous midface lift repositions the midface tissue effectively without preauricular incision. Newer variable pulse Er:YAG lasers allow precise ablation and coagulation separately. The minimal excessive thermal injury from variable Er:YAG lasers, modified techniques for flap and skin care program would make it possible to safely perform laser resurfacing with surgical facial rejuvenations on non smokers. There were no incidents of persistent erythema or pigmentation abnormality, scar, full thickness flap necrosis. By following the considerations suggested in this report, the combination of controlled skin resurfacing with face lifting may be safe and effective in orientals.
Aging ; Cicatrix ; Erythema ; Forehead ; Korea ; Necrosis ; Pigmentation ; Rejuvenation* ; Rhytidoplasty* ; Skin ; Skin Care

Vacuum Assisted Closure (V.A.C.) has been reported to speed up the healing of various chronic wounds including pressure sores, stasis ulcers, cutaneous gastrointestinal fistula, hardware exposure almost due to intrinsic factors. We applied V.A.C. for the treatment of the nonhealing wounds with impaired healing mechanism due to extrinsic factors. The extrinsic factors of our cases were systemic factors that have local effects on the wound healing response, including diabetes mellitus, systemic steroid administration, chemotherapy and end stage renal disease. A total of ten patients whose wound failed conservative management over 2 weeks were successfully treated by V.A.C. therapy. The healthy granulation tissue was formed and the wounds were closed by skin graft or delayed closure. In theses cases, the positive effect of V.A.C may be the local compensation of extrinsically deviated cellular environment by dressing foam structure, continuous drainage of inhibitory wound fluid and sufficient blood supply required for inflammatory response and cell proliferation. Our results demonstrate the usefulness of V.A.C. as an adjunct in management of chronic wounds with other extrinsic factors as well as diabetes mellitus.
Bandages ; Cell Proliferation ; Compensation and Redress ; Diabetes Mellitus ; Drainage ; Drug Therapy ; Fistula ; Granulation Tissue ; Humans ; Intrinsic Factor ; Kidney Failure, Chronic ; Negative-Pressure Wound Therapy ; Pressure Ulcer ; Skin ; Transplants ; Varicose Ulcer ; Wound Healing ; Wounds and Injuries*