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Volume 27(2); December 2012
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Review articles
Anisakidosis in Korea; Changes Over the Last Decade
Hee Jae Cha, Mee Sun Ock
Kosin Med J. 2012;27(2):73-78.   Published online December 27, 2012
DOI: https://doi.org/10.7180/kmj.2012.27.2.73
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Anisakidosis is caused by Anisakis simplex and other anisakids larvae parasitizing marine fish and cephalopods. A lot of case reports about anisakidosis have been published in Korea because of raw fish eating habits. Recently seafood consumption has continued to increase due to health concerns and thus, it increases the risk for infectious diseases including anisakidosis. The aim of this review is to analyze the clinical and epidemiological characteristics of anisakidosis during the last 10 years in Korea, based on the case reports published from 2000 to 2010. The incidence age was changed from 30s and 40s to 50s. The young generation was considered to consume seafood in various ways, including raw fish as well. The most noticeable change was the appearance of Anisakis allergy patients over the last decade. The patients showed abdominal pain, urticaria after eating sea food. It reaffirmed that anisakid infection induces not only gastric and intestinal anisakidosis but also cause allergic reaction. Anisakid should be considered as a possible causative food allergen provoking allergic responses after eating raw fish.

Mini-review: Eosinophils, a Useful Diagnostic Clue in Surgical Neuropathology
Junjeong Choi, Tai Seung Kim, Se Hoon Kim
Kosin Med J. 2012;27(2):79-89.   Published online January 19, 2012
DOI: https://doi.org/10.7180/kmj.2012.27.2.79
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Eosinophils are one of the polymorphonuclear granulocytes derived from bone marrow stem cells, and they contain many small cytoplasmic granules that stain bright red with eosin or brick-red with Romanowsky staining. Eosinophilic infiltration is also present in various human central nervous system (CNS) diseases such as parasitic infection, transverse myelitis, vasculitis, Langerhans cell histiocytosis, glioblastoma and etc... Due to the morphologic and functional characteristics, the presence of eosinophils in certain lesions may provide useful diagnostic clues in the right clinical setting. Consideration of this finding may facilitate the diagnosis of CNS pathologic lesions, especially in a small specimen such as a stereotactic biopsy.

Predictive Value of Maternal Serum Markers for Preeclampsia
Sue Hyun Oh, Heung Yeol Kim
Kosin Med J. 2012;27(2):91-97.   Published online January 19, 2012
DOI: https://doi.org/10.7180/kmj.2012.27.2.91
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

The study performed a systematic review of screening for preeclampsia with the combination of vascular parameters and maternal serum markers in the first and early second trimester. We identified eligible studies through a search of Medline, and, for each included study, we focused on the relationship between the maternal serum markers and preeclampsia. In the selected literature, a combination of maternal serum markers was analyzed, also. Several tests suggested moderate or convincing prediction of early preeclampsia, but screening for late preeclampsia was poor. Literatures for serum markers were selected. Each serum marker was identified independently, and where relevant, a combination of these markers was analyzed. Encouraging results for the first trimester screening were observed when it was combined with other markers. Even in the first trimester of pregnancy, we can present the reliable results for the prediction of early preeclampsia. Detection rate for combination markers may yield higher detection rate and be promising to identify patients at high risk of developing preeclampsia.

Original articles
Clinical Manifestations of 6 Cases of Septic Pulmonary Embolism at Increased Risk Recently
Su-Min Park, Kyung-Han Kim, Neul-Bom Yoon, Il-Hwan Jeong, Hye-won Lee, Soo-Keol Lee, Ki-Nam Lee, Choonhee Son, Soo-Jung Um
Kosin Med J. 2012;27(2):99-103.   Published online December 27, 2012
DOI: https://doi.org/10.7180/kmj.2012.27.2.99
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

The aim of this study was to investigate the clinico-radiologic features and microbiologic data of patients with SPE in a tertiary care hospital in Busan.

Methods

We retrospectively analyzed clinical and radiologic features of 6 cases with septic pulmonary embolism that occurred from March 2009 to March 2011 in Dong-A university medical center.

Results

The mean age of the study population was 58 years, and two men and four women were included. Clinical symptoms included general weakness (5 patients), febrile sensation (4 patients) and pleuritic chest pain (2 patients). Underlying conditions were chemoport infection (4 patients), dental abscess (1 patients), and cellulitis of hip (1 patient). Chest computed tomography revealed bilateral multiple nodular opacities in most patients, and cavitation, central necrosis, feeding vessels were identified. All patients received parenteral antimicrobial therapy with or without central catheter removal, drainage of the extrapulmonary infection. Causative organisms were Pseudomonas aeruginosa (2 patients), Candida albicans (1 patient), Bacillus species (1 patient), and Klebsiella pneumonia (1 patient).

Conclusions

Clinical and radiologic features of septic pulmonary embolism were various and nonspecific. The diagnosis was usually suggested by the presence of a predisposing factor of septic pulmonary embolism and CT findings of bilateral multiple nodular opacities in patients with infectious signs and symptoms. Most important underlying condition was intravascular device infection.

The Safety of Elective Colorectal Surgery without Mechanical Bower Preparation
Chul-Min Lee, Seung-Hyun Lee, Byung-Kwon Ahn, Sung-Uhn Baek
Kosin Med J. 2012;27(2):105-110.   Published online December 27, 2012
DOI: https://doi.org/10.7180/kmj.2012.27.2.105
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

To reduce the risk of postoperative infectious complications and anastomotic leakage in colorectal surgery, preoperative mechanical bowel preparation (MBP) is performed routinely. The aim of this study was to evaluate the safety of primary anastomosis in elective colorectal surgery without MBP.

Methods

From Jan. 2005 to Dec. 2006, three hundred and seventy-nine patients of elective colorectal surgery with primary anastomosis were performed with MBP in 352 cases (Prep group) and without MBP in 24 cases (Non-prep group). For preoperative MBP, 4 liters of polyethylene glycol solution was administered. Postoperative infectious complications and other morbidity were reviewed with medical records and prospectively collected data.

Results

Demographic, clinical and treatment characteristics did not differ significantly between the two groups. The overall rate of abdominal infectious complications (wound infection, anastomotic leak) was 2.9 % in the Prep group and 9 % in the Non-prep group (P > 0.05). Anastomotic leak occurred in nine patients (2.6%) in the Prep group and one (4.5%) in the Non-prep group.

Conclusions

The incidence of infectious complications after elective colorectal surgery without MBP did not differ significantly compare to that with MBP. However, prospective, randomized clinical trial is needed to assess the safety of primary anastomosis in elective colorectal surgery without MBP.

The Combination Therapy with Peg-interferon Alfa and Ribavirin for Chronic Hepatitis C in Korea as an Initial Treatment
Dong Hyun Park, Sang Uk Lee, Jin Seok Yu, Jun Seop Lee, Hye Jung Kwon
Kosin Med J. 2012;27(2):111-118.   Published online December 27, 2012
DOI: https://doi.org/10.7180/kmj.2012.27.2.111
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

The combination therapy with peginterferon and ribavirin has been used to treat chronic hepatitis C for several years in Korea but there is a few report about the results of the treatment. We evaluated safety and efficacy of the combination therapy with Peg-interferon and ribavirin and analyzed factors that may affect treatment.

Methods

Total 72 untreated chronic hepatitis C patients were administered pegylated interferon alfa-2a (180µg/week) or alfa-2b (1.5µg/kg/week) and ribavirin (800 mg/day in genotype 2, 1000-1200 mg/day in genotype 1). Duration of the treatment was 24 weeks in genotype 2 and 48 weeks in genotype 1. Response of the treatment was evaluated by rapid virologic response (RVR), early virologic response (EVR), end treatment virologic response (ETR), sustained virologic response (SVR) and adverse event.

Results

The RVR, EVR, ETR, SVR were 61.8%, 82.5%, 88.9% and 80.5% retrospectively. The SVR of genotype 1 was 63.4% and non-genotype 1 was 96.7%. Genotype (Odds ratio: 14.92) was an independent predictor of the SVR. Leukocytopenia, flu-like symptoms, itching, rash and anemia were common adverse events of the combination therapy and if then we reduced dose and there was one case of cessation.

Conclusions

The combination therapy with Peg-interferon and ribavirin shows efficacy to the Korean patients with chronic hepatitis C as an initial treatment. Genotypes 2 and 3 were more likely to have a sustained virologic response.

Outcome of Ductal Carcinoma in Situ in Patients with or Without p53 Mutations
Dong Won Ryu, Chung Han Lee
Kosin Med J. 2012;27(2):119-125.   Published online December 27, 2012
DOI: https://doi.org/10.7180/kmj.2012.27.2.119
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

p53 is a tumor suppressor gene and plays an important role in the etiology of breast cancer. The aim of this study is to clarify clinical significance of p53 in Ductal Carcinoma in situ (DCIS), and discuss about survival effect.

Methods

The study subjects, 69 women with breast cancer, were a subset of patients operated from Jan 2005 to Dec 2006. We used a cutoff of 10% to distinguish between positive and negative p53 staining. The University of Southern California (USC)/Van Nuys Prognostic Index (VNPI) were compared with 2 categories of p53.

Results

The positivity of p53 was found in 20 patients (29.0%) in DCIS. And negativity of p53 was found in 49 patients (71.0%). And 15 patients (21.7%) had a low USC/VNPI score, 42 patients (60.9%) intermediate and 12 patients (17.4%) a high score. The positivity of p53 was correlated with high USC/VNPI (P = 0.001). The univariate analysis for prognostic factors associated with Disease Free Survival (DFS) revealed that patients with p53 positivity show shorter Disease Free Survival (DFS) than patients with p53 negativity (P = 0.013) and USC/VNPI was also statistically significant (P = 0.030).

Conclusions

According to our study, p53 was associated with high USC/VNPI. These findings suggest that p53 can be used to classify DCIS into at least two subtypes with differing prognoses.

An Acoustic Study on Voice Change after Tonsillectomy
Hwan Ho Lee, Joo Yeon Kim, Yong Hyeon No
Kosin Med J. 2012;27(2):127-131.   Published online December 27, 2012
DOI: https://doi.org/10.7180/kmj.2012.27.2.127
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

Many people have been concerned about voice change after tonsillectomy. The purpose of this study is to analyze changes in the voice and to think about changes in the vocal tract after surgery by using CSL-MDVP.

Methods

Data of 27 patients who underwent tonsillectomy were prospectively evaluated. Acoustic analysis was performed before, after 1 week, after 1 month from the surgery. Nasometer was also conducted.

Results

In acoustic analysis, there were no significant changes in F0, jitter, shimmer, NHR, VTI, SPI. But vAM was statistically increased. Vowels and nasal consonants formant frequency analysis results in patients showed no statistically correlation in 1months after tonsillectomy. Although the statistically increased in the nasal consonants /하나/.

Conclusions

Although the temporary increase or decrease in the acoustic factor or formant in the vowels and nasal consonants after tonsillectomy, but most factors are make no difference. The voice change that come postoperatively could be considered as no concern, but surgeons need to aware of various facts, which can affect voice changes before the surgery.

Clinical Features and Factors Associated with the Frequency of Phototherapy in Premature Birth Gestation < 35 Weeks and Birth Weight ≤2,500 g
So Yoon Choi, Ho Yeon Hwang, Yoo Rha Hong, Yu Jin Jung
Kosin Med J. 2012;27(2):133-139.   Published online December 27, 2012
DOI: https://doi.org/10.7180/kmj.2012.27.2.133
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

Clinical features according to the frequency of phototherapy and clinical risk factors on the number of phototherapy were investigated in premature births with gestation <35 weeks and birth weight ≤2,500 g.

Methods

The 186 infants with gestation <35 weeks and birth weight ≤2,500 g were admitted to the neonatal intensive care unit of Kosin University Gospel Hospital from March 2009 to August 2010. The 171 infants were alive and had jaundice requiring phototherapy. Phototherapy was usually started to 50-70% of the maximal bilirubin level. They were divided into two groups according to the frequency of phototherapy as single phototherapy group (group I) and multiple phototherapy group (group II). We retrospectively reviewed the medical records of all patients.

Results

The mean gestational age and birth weight of group I were 31.0±2.9 weeks and 1,596±485 g and those of group II were 31.1±2.6 weeks and 1,592±430 g. Compared with group I, albumin and Apgar score at 1 minute of group II were significantly higher and the day of peak bilirubin was also late. Duration of phototherapy in group II was statistically longer than that group I but duration of ventilator and aminophylline use for apnea was significantly shorter. The frequency of antibiotic use, incidence of bronchopulmonary dysplasia (BPD), and intraventricular hemorrhage (IVH) of group II were significantly lower than those of group I.

Conclusions

The day of peak bilirubin was late and the frequency of antibiotic use, incidence of BPD, and IVH were low in group II. The aggressive phototherapy may be considered in premature births with jaundice.

The Study of Animal Model of Lymphedema Using the Mouse Tail
Ho Joong Jeong, Ki Hun Hwang, Young-Joo Sim, Ghi Chan Kim, Young-Ok Kim, Seong-Min Baek
Kosin Med J. 2012;27(2):141-149.   Published online December 27, 2012
DOI: https://doi.org/10.7180/kmj.2012.27.2.141
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

To investigate the time course of the development of acquired and experimental lymphedema.

Methods

We studied an experimental model of acute post - surgical lymphedema in the tails of female hairless mice. The procedures that remove the skin and subcutaneous tissue in tails of the mice (5-10 mm from tail base) were performed, and then the murine has acquired lymphatic insufficiency. We measured volume of the tails in 2 times per week for 5 weeks, histological biopsy, and lymphoscintigraphy to assess lymphatic flow.

Results

There was gradually increased volume of the tails and observed twice volume at post - surgical 18 days. In lymphoscintigraphy, we identified decreased lymphatic flow and dermal back flow in the tails. Histological biopsy showed inflammatory response that was edema and increased neutrophils in epidermis and subdermis, and lymphatic microvascular dilatation.

Conclusions

We have a mouse model of acute acquired lymphedema. This post - surgical murine tail model of lymphedema can be used to simulate an attribute of human lymphedema and provides knowledge about functional and structural alterations of lymphedema.

The Effectiveness of Medical Communication Skill of Medical Students, through an Emphasis on Role Play
Ho Seob Lihm, Heung Yeol Kim, Jong Soon Choi
Kosin Med J. 2012;27(2):151-159.   Published online December 27, 2012
DOI: https://doi.org/10.7180/kmj.2012.27.2.151
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

Medical doctors require outstanding communication skills when meeting with their patients. Thus medical student need to education and training about medical communication skill. More attention is being given to the subject but not many studies have been done in the medical education field. As communication skills are provided to students as a subject in medical educational curriculum, the assessment of its effectiveness needs to be undertaken.

Methods

In the year 2010 and 2011, first-year medical students at The Kosin University College of Medicine took 'Communication skills' course in total, 154 first-year medical students survey results was the modified and translated version of 'Beyer-Fetzer's Essential Elements of Communication Skills Assessment Sheet'. The assessment sheets were used as the pre-test and post-test to analyse the differences, which were put through the paired t-test.

Results

All categories of communication skills showed an improvement. For year 2010, a statistically significant difference was shown into the 22 questions, whereas in 2011, improvements were shown in all questions.

Conclusions

From the result, it is clear that in order to create an effective communication skills program, the content should be more structured and focused on the program objectives.

Case reports
A Case of Spontaneous Bladder Rupture Mimicking Diabetic Nephropathy in a Patient with Type 2 Diabetes Mellitus
Hae Kyung Yang, Na-Young Kim, Soo Jeong Yeom, Ji Hyun Kim, Jung Min Lee, Sang Ah Chang
Kosin Med J. 2012;27(2):161-165.   Published online December 27, 2012
DOI: https://doi.org/10.7180/kmj.2012.27.2.161
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Spontaneous rupture of the urinary bladder is a rare clinical entity, with the incidence reported as 1 in 126,000 hospital admissions. It is often associated with malignancy, inflammatory lesions, irradiation, calculus, diverticulum, binge alcohol drinking, continuous bladder irrigation, and neurogenic bladder. In rare instances, bladder rupture occurs without obvious causes. This rare clinical condition is difficult to diagnose because of vague symptoms. High index of suspicion is needed as the mortality rate is high if untreated. A 37-year-old woman with uncontrolled type 2 diabetes, was admitted to the emergency room complaining of progressive abdominal distension and discomfort. She had a past history of tubo-ovarian and bladder abscess, and had undergone multiple surgical operations. From ascites fluid study, she was diagnosed as spontaneous bladder rupture. A transurethral catheter was inserted and the symptoms and signs resolved. Bladder rupture, mimicking acute kidney injury of diabetic nephropathy was disclosed without surgery.

A Case of Thyrotoxic Periodic Paralysis Associated with Transient Thyrotoxicosis
Hye Jung Kwon, Young Sik Choi, Joon Seup Lee, Dong Hyun Park, Yeon Jung Choi, Jin Seok Yoo
Kosin Med J. 2012;27(2):167-171.   Published online December 27, 2012
DOI: https://doi.org/10.7180/kmj.2012.27.2.167
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Thyrotoxic periodic paralysis is an acute muscle weakness of the limbs associated with hypokalemia. It can occur with any form of thyrotoxicosis. Thyrotoxic periodic paralysis associated with transient thyrotoxicosis due to thyroiditis is very rare. We experienced a case of thyrotoxic periodic paralysis associated with transient thyrotoxicosis. A 39-yr-old man was referred to our hospital because of paralysis of upper and lower extremity. The laboratory results were hypokalemia and mild thyrotoxicosis. A thyroid scan with Tc-99m revealed decreased uptake in the thyroid area compatible with destructive thyroiditis. The paralytic attack did not recur after the patient recovered to euthyroid state.

Acute Severe Hyponatremia with Seizure Following Polyethylene Glycol-Based Bowel Preparation for Colonoscopy
Myung Hee Lee, Byung Hee Lee, Sook Kyung Oh, Ji Young Seo, Hyun Ju Kim, Bo Jung Seo
Kosin Med J. 2012;27(2):173-176.   Published online December 27, 2012
DOI: https://doi.org/10.7180/kmj.2012.27.2.173
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

4 liters of polyethylene glycol (PEG) solution is commonly used to evacuate the colon before colonoscopy. This substance, however, is known to cause electrolyte abnormalities such as hyponatremia. Seizures caused by hyponatremia associated with bowel preparation have only rarely been reported. We report the case that a 75-year-old woman with no prior history of seizures was developed severe hyponatremia (112 mEq/L) with generalized tonic-clonic seizure and mental change after ingestion of 4L of PEG solution. Past medical history was notable for thiazide diuretics. Her symptoms are improved during intravenous administration of hypertonic saline for the correction of hyponatremia. Patients with impaired ability to excrete free water those with renal insufficiency, hypothyroidism, mineralocorticoid deficiency, liver cirrhosis, or heart failure as well as those taking drugs which including thiazide diuretics, NASIDs, and ACE inhibitors have risk of hyponatremia following bowel preparation for colonoscopy. We conclude that physicians should check patient's condition and electrolyte abnormalities before colonoscopy procedures.

A Case of Glomerulonephritis Associated with Klinefelter' Syndrome
Jin Hyuk Cho, Yeoung Sin Sin, Eun Hee Sim, Min Gyu Park, Dong Heo, Hak Rim
Kosin Med J. 2012;27(2):177-180.   Published online December 27, 2012
DOI: https://doi.org/10.7180/kmj.2012.27.2.177
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Klinefelter' syndrome is a disorder of sexual differentiation in males, characterized by the presence of two or more X-chromosomes, hypogonadism, and lack of secondary sexual characteristics. The association between Klinefelter' syndrome and glomerulonephritis has been reported, while cases of glomerulonephritis associated with Klinefelter' syndrome are rare. We report the Korean case: a 31-year-old man with Klinefelter' syndrome who developed glomerulonephritis. The patient's urine analysis shows microscopic hematuria and the result of kidney biopsy was minimal change disease. The onset and course of his disease might have been influenced by the sex hormone imbalance.


KMJ : Kosin Medical Journal