A Fatal Case of Disseminated Tuberculosis Coincident with Measles-Rubella Vaccination / 한국역학회지

The authors report a fatal case of disseminated tuberculosis in a 14-yr-old girl, which developed immediately after a measles-rubella (MR) vaccination. Despite a markedly accelerated clinical course which led to death within two weeks, the authors could not identify any possible cause of the tuberculosis aggravation in this case, with the exception of the MR vaccination. The possible role that MR vaccination had on the clinical course of tuberculosis in this case is discussed.

Analysis of 12 Autopsy Cases related with Insurance Money / 대한법의학회지

Life insurance has been developed in means of providing economic compensation for unexpected accidental losses. As the insurance industry of Korea grows along with improvement of economic state, the life insurance crime has now appeared as an increasing social issue. The studies on the life insurance crime in Korea have been barely done with the viewpoint of forensic medicine and science. An understanding of insurance crime cases may be fundamental to develop the system to uncover or prevent it. The authors examined the definition of life insurance crime and twelve cases of insurance money related death investigated by postmortem examination through autopsy file of WDO, NISI in Korea. This article analyzes twelve autopsy cases related with insurance money, even though some cases have no proven investigative evidence or court ruling. A feature found in the cases is that it has the tendency of occurring among family members. Other characteristic is that automobiles are exploited with elaborately planned crime plots. To achieve an efficient prevention method for cutting down these insurance crimes, active government's engagement, assiduous operation of investigation authorities, insurance company's co-effort, and good information exchange system should be worked cooperatively.

A Medicolegal Study of Ear Lengths in the Forensic Autopsy Cases / 대한법의학회지

Authors measured the length of the auricle of both sides, and the length of face to know the medicolegal significance of them in 265 medicolegal autopsy cases. The data were analyzed by anthropometric study method to gain the ear-face height index (auricular length x 100/facial length). The results were as follows: 1. The relationship between the ear-face height indices of the length of life is statistically significant (r=0.34; p<0.001). 2. The relationship between the ear-face height indices of the length of life is higher than in females than males (males: r=0.28, females: r=0.51). 3. In the natural deaths and homicide cases, the relationship between the ear-face height indices of the length of life is higher than the accidental deaths and suicide cases, however, the natural death cases only show statistically significant relationship between the ear-face height indices of the length of life (p<0.05).

Anatomy in Disaster Victim Identification: Air China Crash near Kimhae Airport / 대한해부학회지

Positive identification of human remains is one of the most important tasks in mass disaster management. Intervention of highly trained anatomists is essential for the effective procedures. However, most anatomists have not so much chances and/or experiences in this field in Korea. Recently, there was an aircraft accident leaving 128 people dead or missing. Most of the bodies were severely fragmented and incinerated beyond recognition. We joined as a member of national identification team and supported identifying skeletal remains. Physical characteristics of the dead bodies were obtained through autopsies and X-ray. We also interviewed family members of the victims and collected antemortem medical and dental records. Collaboration between the different professional investigators involving anatomists, forensic pathologists, odontologists, and other scientists resulted in rapid resolution and identified 126 of the 128 victims in 26 days. This article represents diverse methods that were used and the results including DNA typing, dental records and specific anatomical or X-ray findings.

Mass Disaster Operational System of an Aircraft Accident in Korea / 대한법의학회지

Mass disasters usually include transportation accidents (aircraft, train or bus), structural failures of bridges and buildings, structural fires and industrial accidents. These often result in extensive damage of property and the loss of life. For the effective restoration and management of the situation, a well-organized operational plan is essential. Such a plan must consider facilities, specified personnel, administrative assistance and law enforcement. Recently, we experienced an aircraft accident leaving 128 people dead or missing. KDMORT (Korea Disaster Mortuary Operational Team) was tasked to perform the medicolegal investigations and identification. Difficulties were encountered during the procedures. In this article, we discuss some problems in the mass disaster operational system of Korea.

Clinicopathologic Review of Pulmonary Silicone Embolism with Special Emphasis on the Resultant Histologic Diversity in the Lung: A Review of Five Cases

It is known that the subcutaneous injection of silicone can lead to severe pulmonary complications, followed in some patients by respiratory failure. Currently, silicone is being increasingly applied in the field of plastic surgery and, unfortunately, the illicit injection of silicone fluid by uncertified practitioners is not uncommon in Korea. We offer a critical pathologic review of 5 cases of pulmonary silicone embolism following illegal injection to the vaginal wall, four of which were fatal and came to legal autopsy. Our findings again confirm that subcutaneously injected silicone can gain access to the pulmonary vascular tree and cause pulmonary embolism. The histologic changes observed in the lung are variable and include four patterns i.e., the mere presence of silicone emboli, congestion and hemorrhage, acute pneumonitis, and diffuse alveolar damage despite the severe critical course in all cases. We were unable to find any histologic pattern that correlates well with the clinical course. Apart from producing emboli in the pulmonary vessels, subcutaneous injection of silicone can obviously cause serious pulmonary disease due to its ability to induce acute to induce acute pneumonitis and even possibly acute respiratory distress syndrome.

Transmesenteric Hernia: An autopsy case / 대한법의학회지

Transmesenteric hernias through congenital mesenteric defects are the least common of intra-abdominal hernias and rare causes of acute intestinal obstruction in infants and children. Because of its rarity and difficulty of diagnosis, the mortality and morbidity were very high, and incarceration leads to intestinal obstruction and subsequently, strangulation and gangrene of varying lengths of intestine. We present an autopsy case of transmesenteric hernia through the defect of the mesentery of ileum, showing strangulationand obstruction of the affected small bowel.

An Analysis on the Normal and Near Normal Hearts in Adult Sudden Cardiac Death / 대한법의학회지

The authors analysed 53 cases of sudden cardiac death(SCD) without prominent structural abnormalies of heart out of witnessed 300 cases. Thirty four cases were associated with sleep and 19 with activity or rest. Twenty one cases were classified as having normal hearts, and the rest as structurally mild abnormal ones. Male was predominant, and almost of the victims were suffered in their twenties or thirties. All cases collapsed instantaneously or in very short time with various and not specific terminal symptoms. Inducing or trigger factors are not clarified in almost of the cases. Mechanisms or causes of death could not be defined clearly. We concluded that careful heart examination with detailed clinical history under the appropriate postmortem investigation system is only effective approach for the true mechanism and cause of death.

Tracheobronchial Aspergillosis An autopsy case report

Tracheobronchial aspergillosis is an unusual form of invasive aspergillosis characterized by noninvasive or only superficially invasive tracheobronchitis with a propensity for dissemination. We report a two-year-old male who suddenly died of respiratory failure. Postmortem examination revealed a pseudomembrane covering the mucosa of larynx, trachea and bronchial tree of both lungs. This pseudomembrane was composed predominantly of Aspergillus hyphae. There was transmural necrotizing bronchitis with fungal invasion to the narrow zone of peribronchial tissue, and dissemination to the stomach and kidney. This form of pulmonary aspergillosis had not been reported in this country.

Adult Polycystic Kidney Disease with Cardiovascular Assault / 대한법의학회지

Adult polycystic kidney disease is a genetic disease characterized by bilateral multiple renal cysts and is transmitted as an autosomal dominant traits. The disease usually manifests in the fourth decade of life. The affected patients usually die with end stage renal failure, cardiovascular assaults and infection etc. Cardiovascular assaults include ruptured berry aneurysm, spontaneous intracranial hemorrhage, acute myocardial infarction, dissecting aortic aneurysm and hypertensive heart failure. Fatal intracranial hemorrhage and hypertensive heart failure occur in 15% and 2% of patients, respectively. Genetically-determined structural weakness in the arterial wall have been suggested as a possible factor in the genesis of berry aneurysm. We have experienced three autopsy cases with cardiovascular causes of sudden death. Two cases have intracranial hemorrhage (1 berry aneurysm and 1 intracerebral hemorrhage) and the remaining one is dead with hypertensive cardiomyopathy. All of them are aged over 40 years and associated with polycystic liver disease. Histologically, myriad cysts of enlarged bilateral kidney are lined by single layer of cuboidal cells with focal hyperplastic epithelial configuration. Diffusely scattered liver cysts are also lined by flat to cuboidal epithelium and often associated with portal fibrosis.

Crush Syndrome Resulting from the Use of a Tourniquet: A case report / 대한마취과학회지

Although tourniquet application is a widely accepted adjuvant technique in the field of extremity surgery, its complication may be neglected. A 37-year-old healthy male underwent arthroscopic surgery for left posterior cruciate ligament reconstruction under a combination of spinal and epidural anesthesia. During the eleven hour operation, a tourniquet was applied four times in nine hours on the left thigh. The pressure reached 450 millimeters of mercury. Compartment syndrome developed with muscle ischemia and edema postoperatively. On the first day of the operation, a fasciotomy was performed to prevent the development of crush syndrome. However, bleeding due to vascular injury during the fasciotomy continued and crush syndrome including myoglobinemic renal failure, hyperkalemia, hypovolemic shock, and cardiac arrhythmia developed. On the second day, sudden cardiac arrest occurred during artery ligation. The patient was immediately resuscitated; he recovered, but his mental state was stuporous. Thereafter, the patient was cared intensively for eight days with fluid and electrolyte therapy, ventilatory care, hemodialysis, antibiotics for crush syndrome and renal failure, but the result was unsuccessful.

A Case Report of Gastric Dilatation / 대한법의학회지

Gastric dilatation is a rare life-threatening condition and consists of massive distention of the stomach by gas and fluid. Its etiology is unclear but predisposing factors include recent surgery, diabetic gastroparesis, fundoplication and gastric outlet obstruction. As the distended stomach grows larger, it hangs down across the duodenum, producing a mechanical gastric outlet obstruction, venous obstruction of the mucosa, ischemic necrosis and perforation. The distended stomach pushes the diaphragm upward, causing collapse of the left lung, rotation of the heart, and obstruction of the inferior vena cava. Hypochloremia, hypokalemia, and alkalosis may result from fluid and electrolyte losses and may precipitate cardiac arrhythmias. If acute gastric dilatation is not treated promptly, cardiovascular and pulmonary compromise may compound an increasing intravascular volume deficit leading to hypotension, which may be a cause of death.

A Case Report of Gastric Dilatation / 대한법의학회지

Gastric dilatation is a rare life-threatening condition and consists of massive distention of the stomach by gas and fluid. Its etiology is unclear but predisposing factors include recent surgery, diabetic gastroparesis, fundoplication and gastric outlet obstruction. As the distended stomach grows larger, it hangs down across the duodenum, producing a mechanical gastric outlet obstruction, venous obstruction of the mucosa, ischemic necrosis and perforation. The distended stomach pushes the diaphragm upward, causing collapse of the left lung, rotation of the heart, and obstruction of the inferior vena cava. Hypochloremia, hypokalemia, and alkalosis may result from fluid and electrolyte losses and may precipitate cardiac arrhythmias. If acute gastric dilatation is not treated promptly, cardiovascular and pulmonary compromise may compound an increasing intravascular volume deficit leading to hypotension, which may be a cause of death.

Neural toxicity induced by accidental intrathecal vincristine administration

Described here is a case of accidental intrathecal administration of vincristine with pathologic findings in the central nervous system. A 3-year-old boy with acute lymphoblastic leukemia, was given his ninth course chemotherapy. Vincristine was accidentally injected intrathecally. The clinical course was rapidly progressive (6-day course) and resulted in death. An autopsy was done. The brain and spinal cord was grossly edematous and congested without any specific feature. Histologically, profound loss of neuron was noted in the spinal cord. Remaining neurons in the spinal cord, particularly anterior horn cells were markedly swollen. The spinal nerves show diffuse axonal degeneration and myelin loss. The upstream portion of the spinal cord (brain stem, cerebellum, cerebrum) showed patchy loss of neurons, especially Purkinje cells and granular cells of the cerebellar cortex. Many neurons showed axonal reaction (chromatolysis) with swelling. Several neurons show intracytoplasmic eosinophilic inclusion body. Myelin loss, axonal swelling and enlargement of perivascular spaces were seen throughout the white matter of central nervous system.

Iatrogenic Abdominal Injury / 대한법의학회지

Surgical operation or invasive diagnostic procedure may inflict unwanted mechanical injury on either tissue or organ. Iatrogenic injury is said that unwanted, accidental mechanical injury of the body, caused by surgical procedures. Rarely intraabdominal operation, spinal surgery or invasive diagnostic procedures can cause iatrogenic abdominal injury, which becomes the subject of a medicolegal investigation by prolonged treatment period, sequelae, and death.

Lung Embolism / 대한법의학회지

An embolus is a detached intravasclar solid, liquid, or gaseous mass that is carried by the blood to a site distant from its point of origin. Virtually 90% of all emboli arise in thrombi (thromboembolism). Rare forms of emboli include fragments of bone or bone marrow, atheromatous debris from ruptured atherosclerotic plaques, droplets of fat, bits of tumor, foreign bodies such as bullets, and bubbles of air of nitrogen. Lung embolism is the disease condition caused by pulmonary vasculature obstruction with various kinds of material mentioned above.

The Formation of Giant Mitochondria in the Liver Cells Induced by Hydrazine

The authors studied the formation of giant mitochondria in liver cell. The Sprague Dawley rats were sacrificed following intervals; 5, 10, 20, 30, and 60 minutes after intraperitoneal injection of hydrazine in the amount of 200 microliter/kg. And the extracted liver tissues were examined with light and electron microscopes. The results obtained were summarized as follow; Light microscopically, there is little difference between control and experimental groups. Electron microscopically, elongated, bizzare shaped mitochondria are appears 5 minutes after hydrazine injection. Those show attenuated portion, Y, U, or C shaped feature suggesting fusion or budding mitochondria. The number of giant mitochondria is decreased after 10 minutes group and rarely present in 60 minutes group. The results suggest in this experiment that the formation of giant mitochondria is kind of reversible change and it is different from the mitochondrial swelling of cellular injury. Intermitochondrial fusion and mitochondrial budding may be related with the formation of giant mitochondria.

Ultrastructural Changes of Liver Cell Mitochondria in Autolysis

The authors studied the ultrastructural changes of liver cell mitochondria in autolysis. The male Sprague-Dawley rats, weighting 140~160 gm were sacrificed for extract liver tissue. The slices of the liver tissue were incubated in 37 degrees C aseptic normal saline, and those were examined by following intervals; 10, 20 and 30 minutes and 1, 2, 6, 12 and 24 hours with light and electron microscope. The results obtained by light microscopy were summerized as follow. Several fine intracytoplasmic vacuoles were observed 1 hour after incubation. After 3 hours, focal destruction of cytoplasmic membrane with pyknosis of nuclei were observed. More delicate intracytoplasmic architectural changes could not be detected at light microscopic studies. The cord arrangement and cellular boundaries were relatively well preserved until 24 hours after incubation. Electronmicroscopically, mild intramitochondrial swelling with diminution of intramatrical granules were observed at 20 minutes. These were the earliest findings. Both high amplitude swelling and destruction of mitochondrial membrane were observed concurrently at 1 hour after incubation. The earlier membrane changes were observed at inner membrane with cristae and followed by degeneration of the outer membrane. The intramatrical amorphous dense deposits were observed at 30 minutes when the membranes were not destroyed. These deposits were noted in the other experimental groups which were incubated longer than 30 minutes. More electron dense deposits were observed after 1 hour at that time the membrane changes appeared. Vhe results suggest in this experiment that the earliest autolytic changes of liver cell mitochondria is loss of intramitochondrial granules and the membraneous changes led to the irreversible mitochondiral injury. The appearance of two types of intramitochondrial dense deposits would be an interesting finding needed to require further investigation for the chemical stucture and mechanism of dense deposit formation.