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Volume 28(2); December 2013
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Review articles
Current Status of Laparoscopic Partial Nephrectomy
Taek Sang Kim
Kosin Med J. 2013;28(2):79-86.   Published online January 19, 2013
DOI: https://doi.org/10.7180/kmj.2013.28.2.79
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Recently, nephron-sparing, minimally invasive surgery of small renal masses has become popular. The most typical surgery is laparoscopic partial nephrectomy (LPN). However, due to technical difficulties, the indications for LPN had been limited to small, exophytic, and peripheral tumors. This paper introduces current status of oncological outcomes and technical considerations.

Epidemiology and Causation
Jungwon Kim
Kosin Med J. 2013;28(2):87-97.   Published online January 19, 2013
DOI: https://doi.org/10.7180/kmj.2013.28.2.87
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

In medicine and public health areas, it is essential for researchers and clinicians to investigate causal relationships dealing with the terms of cause, causation and causality. In treating a patient, the treatment will be given based on the assumption that that treatment will cause an improvement or cure of the patient. For diagnosis, we need a causation concept to associate diseases with etiologic factors such as genetic, environmental, occupational and other components. The prevention and intervention of a disease involve the selecting process of probable causal factors too.

The causal problem is one of main issues in philosophy since ancient Greek. Aristotle theorized material, formal, efficient, and formal causes. Francis Bacon and Descartes mainly used induction and deduction, respectively. Hume denied the capacity of inductive methodologies to find truth. Among philosophers of science, the debates whether we can find objective truth or not will be continued. This causation can be two subsets, ontological and epistemological (or methodological). Traditional philosophical approaches mainly focus on ontological problems, such as what is causation?; are there causal laws? In general, scientific or epidemiological approaches are dealing with the epistemological dimension, i.e, causation criteria; test for a causal hypothesis.

For clinicians and researchers in medical and public health, it would be a good chance to review and re-think the notions of cause, causation and causality. Also there will be helpful understanding of more detail informations about the methodology such as causal inference, Hill’s criteria and Rothman’s causal pie model.

Original articles
Characteristics of Clinical Features between Isolated Left Side Ischemic Colitis and Non-Isolated Left Side Ischemic Colitis
Jae Joon Heo, Hyung Hun Kim, Jun Young Song, Seun Ja Park, Moo In Park, Won Moon
Kosin Med J. 2013;28(2):99-106.   Published online January 19, 2013
DOI: https://doi.org/10.7180/kmj.2013.28.2.99
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Objectives

Compared with all other patterns, isolated right colon ischemia has been found to be more associated with coronary artery disease and a poor prognosis. However, there has been no research on comparing isolated left side ischemic colitis (ILIC) and non-ILIC with vascular assessment. The aim of the present study was to evaluate the clinical and laboratory findings between these two different forms of ischemic colitis (IC).

Methods

We retrospectively investigated differences in clinical features, course, and mesenteric vascular (superior mesenteric artery, SMA; inferior mesenteric artery, IMA) findings between ILIC and non-ILIC patients who were hospitalized at Kosin University Gospel Hospital from 2004 to 2010.

Results

Our study population comprised 221 patients, all of whom met our entry criteria of biopsy-proven or -compatible IC. Of the 221 patients, 46 (20.8%) had non-ILIC. Congestive heart failure and hypercholesterolemia were more frequently observed in the non-ILIC group (P = 0.003 and P = 0.020, respectively). SMA atherosclerosis and SMA stenosis were more frequently observed in the non-ILIC group (P = 0.006 and P = 0.001, respectively). Recovery periods were longer in the non-ILIC group (P = 0.039), and mortality was lower in the ILIC group (6.9% vs. 17.3%, P = 0.026).

Conclusions

ILIC has favorable outcomes compared with non-ILIC. Furthermore, non-ILIC showed a close relationship with SMA atherosclerosis and SMA stenosis, which should be investigated carefully in the clinical field.

Preventive and Therapeutic Effects of Anisakis simplex Larval Protein in a Mouse Model of Crohn’S Disease
Hee-Jae Cha, Mee Sun Ock
Kosin Med J. 2013;28(2):107-113.   Published online January 19, 2013
DOI: https://doi.org/10.7180/kmj.2013.28.2.107
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

Some helminths have been known to have a treatment effect in inflammatory bowel diseases, including Crohn’s disease (CD); however, live parasite therapy can cause unwanted side effects. To develop a safe therapeutic, we investigated the preventive or therapeutic potential of proteins from the third stage larva of A. simplex in a mouse model. We also analyzed the cytokine profile from splenic and mesenteric lymph node lymphocytes to elucidate the underlying immunological mechanism.

Methods

CD was induced in mice with DSS, and the effect of an A. simplex larval protein on CD was assessed. A change in body weight and DAI (disease activity index) were observed in mice. The expression levels of cytokines from mesenteric lymph nodes (MLN) compared to splenic lymphocytes were measured with ELISA.

Results

Peritoneal administration of preventive and therapeutic A. simplex larval proteins attenuated DSS-induced CD by a reduction of the DAI and weight loss. A shortening of colon length was more definitely observed in the therapeutic group than in the preventive group. The cytokine expression levels were more obvious in lymphocytes from mesenteric lymph nodes than from splenic lymphocytes.

Conclusions

Taken together, these results suggest that A. simplex proteins can change cytokine profiles and may have a preventive effect in DSS-induced CD mice.

Comparative Study of an Ondansetron and a Ramosetron an Aprepitant in the Control of Nausea and Vomiting in Gynecologinc Cancer Patient with Chemotherapy
HANGGOO Yun, Heung Yeol Kim, Eun ae Jeh
Kosin Med J. 2013;28(2):115-121.   Published online January 19, 2013
DOI: https://doi.org/10.7180/kmj.2013.28.2.115
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Results

The efficacy of controlling nausea with an ondansetron regimen and a ramosetron regimen and an aprepitant regimen was 85.29%, 78.26%, 80% in acute periods (P-value = 0.037) and 88.23%, 98.26%, 87.5% in delayed periods (P-value = 0.000), respectively. The efficacy of controlling vomiting with an ondansetron regimen and a ramosetron regimen and an aprepitant regimen and an ondansetron regimen was 82.35%, 97.3%, 90% in acute periods (P-value=0.002) and 82.35%, 100%, 95% in delayed periods (P-value = 0.000), respectively. The common adverse effects in each groups were not significantly.

Conclusions

Appropriate to each patient’s symptoms, the choice of drugs will be needed since each of the drugs have different effects on vomiting. Even though the each antiemetic drug has good efficacy, the effect of the drug is not complete. Therefore the use of additional drugs are also needed.

Objectives

Chemotherapy induced nausea and vomiting is most distressing adversed effects in gynecologic cancer patients receiving chemotherapy. we compared effectiveness of ondansetron and ramosetron and aprepitant for optimal antiemetic treatment in gynecologic cancer patient receiving chemotherapy.

Methods

The study was performed retrospective on 189 patients who was diagnosed initially the gynecological cancer during chemotherapy at Kosin university hospital between January 2008 and December 2010. The efficacy of controlling acute/delayed nausea and vomiting were analyzed by counting numbers of nausea and vomiting reported in medical records of 189 patient receiving cisplatin-based chemotherapy. Statistical analysis was performed using the ANOVA and Fisher’s exact chi-square test.

Results

The efficacy of controlling nausea with an ondansetron regimen and a ramosetron regimen and an aprepitant regimen was 85.29%, 78.26%, 80% in acute periods (P-value = 0.037) and 88.23%, 98.26%, 87.5% in delayed periods (P-value = 0.000), respectively. The efficacy of controlling vomiting with an ondansetron regimen and a ramosetron regimen and an aprepitant regimen and an ondansetron regimen was 82.35%, 97.3%, 90% in acute periods (P-value=0.002) and 82.35%, 100%, 95% in delayed periods (P-value = 0.000), respectively. The common adverse effects in each groups were not significantly.

Conclusions

Appropriate to each patient’s symptoms, the choice of drugs will be needed since each of the drugs have different effects on vomiting. Even though the each antiemetic drug has good efficacy, the effect of the drug is not complete. Therefore the use of additional drugs are also needed.

Mid-term Results of Holmium Laser Enucleation of the Prostate (HoLEP) for the Treatment of Benign Prostatic Hyperplasia (BPH) by a Single Surgeon
Seong Choi
Kosin Med J. 2013;28(2):123-129.   Published online January 19, 2013
DOI: https://doi.org/10.7180/kmj.2013.28.2.123
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

Here the author report the mid-term clinical outcomes analysis with efficacy and safety of HoLEP.

Methods

From May 2010 to September 2012, 270 consecutive patients treated with HoLEP were enrolled in this study. All patients was evaluated by digital rectal examination (DRE), transrectal ultrasonography (TRUS), serum PSA preoperatively. International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), and postvoid residual urine (PVR) were documented preoperatively and 1, 3, 6, 12, 24 months postoperatively. The perioperative data and complications were analyzed. All procedures of HoLEP was done by a single surgeon.

Results

The mean patient age at the surgery was 67.5 years (45-82), and the mean PSA was 3.7 ng/mL (0.4-19.4). Mean operation time was 73.6 minutes (30-150). Mean prostate volume was 64.3 mL (20-150) and mean resected tisssue weight was 9.3 g (2-63). Mean catheter indwelling time was 2.7 day (1-6), and mean hospital stay was 3.2 day (1-7). The blood loss was minimal, so transfusion was not needed. The baseline data were IPSS; 23.0 (7-35), QoL score; 5.4 (4-6), Qmax (mL/s); 12.5 (1.2-16.5), PVR (mL); 59 (20-250). Postoperatively, IPSS and QoL scores and PVR decreased, and Qmax increased significantly. Intraoperative complication was minor capsular perforation (n = 5). Postoperative complications were acute urinary retention (n = 9), transient incontinence (n = 17), urinary tract infection (n=4), urethral stricture (n=4) and bladder neck contracture (n = 12).

Conclusions

HoLEP showed statistical improvement of clinical parameters after 1 month operation and these results sustained for 24 months regardless of prostatic size.

Application of Digital Infrared Thermographic Imaging (DITI) in the Monitoring of Change of Skin Temperature about Vascular Supply of Lower Abdominal Axial Flap in the Rabbit
Hyun nam Choi, Jin Hyung Park, Yea Sik Han, Sin Rak Kim, Han Kyeol Kim
Kosin Med J. 2013;28(2):131-136.   Published online January 19, 2013
DOI: https://doi.org/10.7180/kmj.2013.28.2.131
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Methods

Eight male New Zealand white rabbits with average weight of 3kg were used. A 10 x 10 cm unipedicled fasciocutaneous island flap was elevated based on the left superficial inferior epigastric vessel. The surface temperatures on designed flap were checked with DITI for 24 hours after the operation. On 14th day after the operation, the surviving area was measured and compared with DITI image which was taken on 24 hours after the operation using digital analysis software ImageJ. Statistical analysis was evaluated by paired T-test

Results

On DITI image 24 hours after the flap elevation, distal portion of the flap showed remarkable color change. The average percentage and the standard deviation of the survival area of the flap which is predicted by DITI and the average percentage and the standard deviation of the survival area of the flap which was actually measured 2 weeks after flap elevation were 55.3 (16.6), 56.2 (18.0), respectively. This shows no significant difference between the two.

Objectives

Monitoring viability of flap is important. The flap survival depends on the vascularity of the flap, on which the skin temperature depends. The authors applied digital infrared thermographic imaging (DITI) for monitoring the vascular supply of the flap and for the prediction of the prognosis of the flap survival.

Methods

Eight male New Zealand white rabbits with average weight of 3kg were used. A 10 x 10 cm unipedicled fasciocutaneous island flap was elevated based on the left superficial inferior epigastric vessel. The surface temperatures on designed flap were checked with DITI for 24 hours after the operation. On 14th day after the operation, the surviving area was measured and compared with DITI image which was taken on 24 hours after the operation using digital analysis software ImageJ. Statistical analysis was evaluated by paired T-test

Results

On DITI image 24 hours after the flap elevation, distal portion of the flap showed remarkable color change. The average percentage and the standard deviation of the survival area of the flap which is predicted by DITI and the average percentage and the standard deviation of the survival area of the flap which was actually measured 2 weeks after flap elevation were 55.3 (16.6), 56.2 (18.0), respectively. This shows no significant difference between the two.

Conclusions

This study shows that DITI system could be used in evaluation of flap vascularity with ease, quickness and safety for patient and flap. Thus, it could be used clinically for the prediction of flap survival.

A Comparison of the Recovery Characteristics between Propofol-remifentil and Sevoflurane-remifentail Anesthesia for Total Thyroidectomy
Dong Hee Kang, Jeong Gil Lee, Hyeong Ju Jung, Ju Deok Kim, Soo Bong Yu, Si Jeong Ryu, Gyeong Han Kim, Doo Sik Kim
Kosin Med J. 2013;28(2):137-143.   Published online January 19, 2013
DOI: https://doi.org/10.7180/kmj.2013.28.2.137
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

This study was investigated the recovery characteristics of propofol-remifentanil and sevoflurane-remifentanil anesthesia for total thyroidectomy

Methods

Eighty patients in ASA physical status 1 and 2 scheduled for total thyroidectomy were allocated randomly to either group P (n = 40) or group S (n = 40). Anesthesia was maintained with remifentanil effect site concentration (Ce) 1-3 ng/mL and propofol Ce 2-4 μ g/mL in the group P, and was maintained with remifentanil Ce 1-3 ng/mL and sevoflurane 1.5-2% in the group S. Blood pressure, heart rate, and bispectral (BIS) index were measured during perioperative period. The times from discontinuance of anesthetic agent to eye opening, to extubation, and to stating name were measured. Postoperative complications were evaluated.

Objectives

This study was investigated the recovery characteristics of propofol-remifentanil and sevoflurane-remifentanil anesthesia for total thyroidectomy

Methods

Eighty patients in ASA physical status 1 and 2 scheduled for total thyroidectomy were allocated randomly to either group P (n = 40) or group S (n = 40). Anesthesia was maintained with remifentanil effect site concentration (Ce) 1-3 ng/mL and propofol Ce 2-4 μ g/mL in the group P, and was maintained with remifentanil Ce 1-3 ng/mL and sevoflurane 1.5-2% in the group S. Blood pressure, heart rate, and bispectral (BIS) index were measured during perioperative period. The times from discontinuance of anesthetic agent to eye opening, to extubation, and to stating name were measured. Postoperative complications were evaluated.

Results

There were no significant differences between group P and S on the blood pressure, heart rate, and recovery time. BIS index of group P showed lower than that of group S during operation (P < 0.05). The incidences of side effects were similar in the two groups, though the incidence of nausea was higher in the group S (P < 0.05).

Conclusions

Propofol-remifentanil anesthesia was more advantageous than sevoflurane-remifentanil anesthesia for thyroidectomy in view of side effect incidences.

Clinical Features and Histological Findings of 17 Patients with Chronic Actinic Dermatitis
Min Soo Jang, Kang Hoon Lee, Sang Hwa Han, Jong Bin Park, Dong Young Kang, Sang Tae Kim, Kee Suck Suh
Kosin Med J. 2013;28(2):145-153.   Published online January 19, 2013
DOI: https://doi.org/10.7180/kmj.2013.28.2.145
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

This study was designed to evaluate the clinical, histological and immunohistochemical findings and treatment of chronic actinic dermatitis in Korean patients.

Methods

Seventeen Korean patients with chronic actinic dermatitis were enrolled for this study. The clinical and histological findings and the results of phototest were reviewed with medical records, clinical photographs and pathologic slides. We also reviewed the effectiveness of the treatments in all patients with chronic actinic dermatitis.

Results

In all patients with chronic actinic dermatitis, pruritus was severe, and the patients present in the early stages with erythemas on the face, neck and the back of the hands. As the eruption progresses, it became lichenified and scaly plaques and papules developed. The face, upper extremity and neck were most commonly affected. The most common abnormal results of the phototests were decreased MED-UVB alone. In 8 patients with actinic reticuloid, histopathologic findings showed irregular acanthosis, parakeratosis, spongiosis, atypical hyperchromatic cells with cerebriform nuclei, epidermotropism, Pautrier-like microabscess, deep perivascular lymphocytic infiltrates, vertically-streaked collagen in the papillary dermis, stellate and multinucleated fibroblasts. Treatment includes topical tacrolimus and corticosteroid, oral corticosteroid, azathioprine and cyclosporine.

Conclusions

Our study showed classic clinical and histological findings. The most common abnormal results of the phototests were decreased MED-UVB alone. Topical steroid, tacrolimus and systemic cyclosporine, azathioprine are effective in treating chronic actinic dermatitis.

Case reports
A Case of Endobronchial Actinomycosis with a Broncholith cured by Cryotherapy through a Flexible Bronchoscope
Jin Seok Yoo, Eun Ju Cho, Sangeon Gwoo, Hye Jung Kwon, Seong Kyeong Lim, Tae Won Jang, Chul Ho Oak
Kosin Med J. 2013;28(2):155-160.   Published online January 19, 2013
DOI: https://doi.org/10.7180/kmj.2013.28.2.155
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We report the case of a 53-year-old man who presented with obstructive pneumonitis and broncholithiasis. We attempted to remove the broncholith with forceps through a flexible endoscope, but the potential for bleeding due to partial synechia did not allow this. We succeeded in removing it with cryotherapy. The histopathological diagnosis was thoracic actinomycosis associated with broncholithiasis. Endobronchial actinomycosis with a broncholith is very rare. We successfully treated a patient with endobronchial actinomycosis with a broncholith by administering short-term antibiotics after broncholithectomy via cryotherapy through a flexible bronchoscope.

Bladder Pheochromocytoma Presented as Thunderclap Headache Triggered by Urination and Angina Pectoris
You Jin Han, Ho Sik Shin, Yeon Soon, Jung Hark Rim, So Young Ock, Eun Jeong Kim
Kosin Med J. 2013;28(2):161-165.   Published online January 19, 2013
DOI: https://doi.org/10.7180/kmj.2013.28.2.161
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Pheochromocytoma is a catecholamine-producing tumor characterized by hypertension, headache, tachycardia, excessive diaphoresis, and angina pectoris. The thunderclap headache is so named because the pain strikes suddenly and severely. Although the symptoms of bladder pheochromocytoma are rather evident, the diagnosis of this rare neuroendocrine tumor can be missed. This study reports the case of a woman diagnosed with bladder pheochromocytoma who experienced thunderclap headache triggered by urination and angina pectoris as an initial manifestation. This case study suggests that thunderclap headache and angina pectoris occurring concurrently with sudden blood pressure elevation during or immediately after urination are important diagnostic clues of bladder pheochromocytoma.

A Case of Type III Autoimmune Polyglandular Syndrome
Sangeon Gwoo, Young Sik Choi, Bu Kyung Kim, Yo Han Park, Keun Tae Kim, Jun Seop Lee
Kosin Med J. 2013;28(2):167-170.   Published online January 19, 2013
DOI: https://doi.org/10.7180/kmj.2013.28.2.167
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The autoimmune polyglandular syndromes (APS) are groups of syndromes comprising a combination of endocrine and nonendocrine autoimmune diseases. Among of those four types of APS, the main characteristics of the 3 APS are autoimmune thyroid diseases associated to other autoimmune diseases, excluding Addison’s disease. Type 3 APS are also subdivided into 3A, 3B, 3C, and 3D. Recently, we experience a case of APS manifesting 3A, 3C, and 3D subtype. A 28-year-old woman developed type I diabetes. According to her medical history, she had Graves’ disease, vitiligo, auimmune hemolytic anemia and systemic lupus erythematosus (SLE). The antoantibodies associated with Graves’ disease, SLE, and type I diabetes showed positive findings. We report this case with literatures review.

A Case of Pulmonary Hypertension Recurred by Graves’ Disease
Jun Seop Lee, Young Sik Choi, Jae Woo Lee, Jin Seok Yoo, Youn Jung Choi, Dong Hyun Park
Kosin Med J. 2013;28(2):171-176.   Published online January 19, 2013
DOI: https://doi.org/10.7180/kmj.2013.28.2.171
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A few cases of severe pulmonary hypertension with right heart failure associated with Graves’ disease were reported in the literature. However, cases of pulmonary hypertension with right heart failure recurred by Graves’ disease is very rare. We describe the case of a 60-year old woman who had been treated pulmonary hypertension caused by right pulmonary artery thromboembolism seven years ago. Recently, her pulmonary hypertension with right heart failure was recurred by Graves’ disease. The patient’s symptoms of pulmonary hypertension was resolved after treatment of Graves’ disease.

A Tubercus Sclerosis Case Accompanied by Cystic Angiomyolipoma and Chronic Kidney Disease Diagnosed during Treatment for Acute Cerebral Infarction
Heejun Kim, Inho Moh, Da-Hye Jung, Young-Ki Lee, Ji-Young Woo, Yul Lee, Jung-Woo Noh
Kosin Med J. 2013;28(2):177-182.   Published online January 19, 2013
DOI: https://doi.org/10.7180/kmj.2013.28.2.177
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Symptoms of tuberous scelrosis (TS) are mainly related with brain and kidneys. Seizure, mental retardation, other behavioral problems are dominant. A spectrum of renal tumors from benign angiomyolipoma (AML) to polycystic kidney disease, and rarely malignant renal cell carcinoma have been observed. Cystic AML is a rare phenotype of AML. No case of TS with renal cystic AML has been reported in Korea yet. And chronic kidney disease (CKD) in TS has been seldom reported. We experienced a TS case accompanied by renal cystic AML and CKD diagnosed in a 48-year-old female patient who was hospitalized for left side weakness and seizure under the diagnosis of acute cerebral infarction.

A Case of Adrenal Tuberculosis with Atypical Clinical Manifestation
Moo Hyun Son, Jung Kyu Park, Hyun Sik Hwang, Byung Ho Kim, Eui Dal Jung, Young Sik Choi
Kosin Med J. 2013;28(2):183-186.   Published online January 19, 2013
DOI: https://doi.org/10.7180/kmj.2013.28.2.183
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Addison’s disease is a rare disorder that causes fatigue, genral weakness, weight loss, pigmentation due to adrenal hypofunction and it’s underlying causes are various. We report a case of 42-year-old man with fatigue, generalized cutaneous pigmentation. Computed tomography showed bilateral adrenal enlargement, but no calcification. Adrenal tuberculosis was established by ultrasound-guided fine needle aspiration biopsy.


KMJ : Kosin Medical Journal