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Volume 29(1); June 2014
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Review articles
Management of Low Bone Mass in Female Athletes
Hoon Choi
Kosin Med J. 2014;29(1):1-10.   Published online December 17, 2014
DOI: https://doi.org/10.7180/kmj.2014.29.1.1
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Abstract

As female athletic participation has increased, the positive effects of exercise on health have become evident. However, with this growth in sports activity, a set of health problems unique to the female athlete has emerged. The female athlete triad and its components can occur in females of all ages in every sport. The Female Athlete Triad poses serious health risks, both short and long term, to the overall well-being of affected individuals. Sustained low energy availability can impair health, causing many medical complications within the skeletal, endocrine, cardiovascular, reproductive, and central nervous systems. With the surge of females participating in athletics within the past 10 to 15 years, it is both conceivable and likely that the prevalence of this syndrome will continue to grow. Therefore, it is imperative that appropriate screening and diagnostic measures are enacted by a multidisciplinary team of health care providers, counselors, teachers, and dieticians in order to provide the proper care to affected athletes. Initial awareness should take place within the educational confines of elementary and high schools. Screening for female athletes exhibiting risk factors for the triad should also take place at the time of sports physicals. If one component of the triad is identified, the clinician should take the time to effectively workup the other. Treatment for each component of the triad includes both pharmacological and nonpharmacological measures, with emphasis placed upon increased energy availability and overall improved nutritional health. Using this all-encompassing type of approach, sports medicine practitioners should feel empowered to continue to promote the lifelong well-being of female athletes in the years to come.

Systemic Review for The Effectiveness of Current Conservative Treatment in Necrotizing Pancreatitis
Jungik Park, Ungseok Yang
Kosin Med J. 2014;29(1):11-16.   Published online December 17, 2014
DOI: https://doi.org/10.7180/kmj.2014.29.1.11
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Abstract

The standard treatment of pancreatic necrosis has been surgical necrosectomy. There has been debate on whether early surgical intervention can reduced by infected pancreatic necrosis (IPN). Early emergency laparotomy and multiple organ failure remain associated with high mortality. However, reports have presented during the last 10 years of survival of severe acute pancreatitis with medical management. Large and multicenter study showed that about two thirds of patients with necrotizing pancreatitis can be treated conservatively with relatively low mortality. Patients with IPN benefit from postponding intervention and minimal invasive treatment. We reviewed 4 literatures including 2 Korean institute reseached reports concerning non-surgical, conservative treatments of necrotizing pancreatitis including IPN. Large and multicenter study showed that about two thirds of patients with necrotizing pancreatitis can be treated conservatively with relatively low mortality.

Original articles
Diagnostic Value of Preoperative Serum Thyroglobulin Measurement for the Diagnosis of Malignancy in Follicular or Hürthle Cell Neoplasms of the Thyroid Gland
Nam Kyu Kim, Seong Joo Kang, Weon Hyoung Lee, Go Eun Yeo, You Jin Han, Bu Kyung Kim, Su Kyoung Kwon, Yo-Han Park, Young Sik Choi
Kosin Med J. 2014;29(1):17-22.   Published online December 17, 2014
DOI: https://doi.org/10.7180/kmj.2014.29.1.17
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Abstract Objectives

The aim of this retrospective study was whether serum Tg predicts malignancy in follicular or Hürthle-cell neoplasms on fine needle aspiration.

Methods

A chart review of 111 patients (90 females, 21 males; mean age 46.8 ± 11.9 years) with follicular or Hürthle-cell neoplasms on fine needle aspiration, who were surgically treated between Sep. 2001 and Sep. 2011, was performed. Predictive factors for malignancy were identified by the chi-squared test and multivariate logistic regression.

Results

There were no differences between 41 malignant and 70 benign lesions in serum Tg or any of the normalized indexes. Receiver-operator characteristic analysis revealed no cutoff value. Lesions with serum Tg levels greater than 500 g/L had no significant difference. And also there were no independent predictors of malignancy by multivariate logistic regression.

Conclusions

In this study, the author found that serum Tg has poor accuracy for predicting malignancy in follicular or Hürthle cell neoplasms on fine needle aspiration.

Minimally Invasive Plate Osteosynthesis for Fractures of Distal Tibia
Tae Hun Kim, So Hak Chung
Kosin Med J. 2014;29(1):23-29.   Published online December 17, 2014
DOI: https://doi.org/10.7180/kmj.2014.29.1.23
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Abstract Objectives

This study analyzed clinical and radiologic results, and complications of minimally invasive plate osteosynthesis(MIPO) for distal tibia fracture.

Methods

16 patients (17 cases) who were performed MIPO for distal tibia fractures between January 2007 and June 2011, postoperative followed up at least for one year, were selected for this study. The average age was 55.0(26-76) years old and the average period of followup was 15.1(6-27) months. Most of the patients were encouraged to perform ankle dorsiflexion and straight leg raising exercise on splints, from the next day of the operation. As radiologic evaluation, we checked period until bone union, degree of angulation. And postoperative complications were also checked. For functional evaluation of the ankles, American Orthopaedic Foot and Ankle Society(AOFAS) score was used.

Results

16 of the 17 cases were achieved primary bone union, and average period of bone union in all the cases was 17.4 (12-42) weeks. Mean varus/valgus angulation after the bone union was 0.8 degrees and mean anteroposterior(AP) angulation was 1.8 degrees. Mean AOFAS score was 85.2(71-95) points; 5 cases of excellent, 10 cases of good, 1 case of fair, showing that 93.8% of the patients represented at least good AOFAS scores. As complications, there were 2 cases of superficial infection, and each 1 case of nonunion and skin irritation. There were no cases of deep infection, metal breakage, nor limb length discrepancy.

Conclusions

MIPO for distal tibia fracture is considered to be an effective operative method, because of its high bone union rate and low complications by minimal disruption of soft tissue and improved bone fixation strength. Also, for earlier return to daily life, ankle joint exercise should be started as soon as possible after the operation.

Efficacy of Foreign Body Removal using a Cryoprobe in Flexible Bronchoscopy
Go Eun Yeo, Sung-Jin Nam, Yu Jin Han, Eun Jeong Kim, Nam Kyu Kim, So Young Ock, Weon Hyoung Lee, Chul Ho Oak, Mann Hong Jung, Tae Won Jang
Kosin Med J. 2014;29(1):31-36.   Published online December 17, 2014
DOI: https://doi.org/10.7180/kmj.2014.29.1.31
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Abstract Objectives

Endobronchial foreign body impaction is a medical emergency because of the air way obstruction. Therefore, immediate foreign body removal is crucial in such situations. Recently, there have been several reports about cryoprobe use as a tool for removal of foreign bodies. In this study, we determined the efficacy and complications of foreign body removal using a cryoprobe during flexible bronchoscopy.

Methods

This is a retrospective review of 27 patients who visited Kosin University Gospel Hospital from August 2007 to August 2010 with respiratory symptoms due to a foreign body in the airway. There were 17 males and 10 females, aged from 7 to 78 years. The foreign bodies were more frequently located (55%) in the right bronchus. The cryoprobe was inserted through the forceps channel of the flexible bronchoscope under local anesthesia. The lesion was quickly frozen for 5 seconds at -80℃, and the bronchoscope was removed with the probe after crystal formation on the contacted area.

Results

The success rate of removal of foreign bodies was 85% (23/27) using the cryoprobe. One case of broncholith did not undergo attempted removal because of the possibility of excessive hemorrhage by the tight bronchus impaction, and three cases (plastic, silicon, and implant) failed due to limited crystal formation. There were no severe hemorrhages, arrhythmias, or casualties during the procedure.

Conclusions

The removal of foreign body using a cryoprobe during flexible bronchoscopy was shown to be safe and effective. The nature of the material should be attempted before removing a foreign body.

High Proportion of Nervous System Disease among Major Cause of Under-Five Death in Korea; Compared with OECD 14 Nations (2005-2010)
Hyun Seok Seo, Seok Won Choi, Ji Sung Kim, Jae Yong Choi, Cheol Am Kim, Byeong Hee Son, Kyun Woo Lee, Kwang Wook Koh
Kosin Med J. 2014;29(1):37-45.   Published online December 17, 2014
DOI: https://doi.org/10.7180/kmj.2014.29.1.37
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Abstract Objectives

To compare the mortality rate of children under ages five from different countries by their causes and to explore the cause of death that is relatively higher in South Korea and came up with measures for resolution.

Methods

The statistics were based from section ICD(International Classification of Diseases)-10 of WHO(World Health Organization) Mortality Database. Among the OECD(Organization for Economic Cooperation and Development) countries, 15 countries with higher GDP(Gross Domestic Product) than South Korea were studied by the mortality rate from 2005 to 2010 sorted into two groups: 0 year group and 1-4 years group. Then the cause of death investigated in detail.

Results

Among the 15 countries, average mortality of 0 year group in Korea ranked 8th and the average mortality of 1-4 years group ranked 4th out of 15. There were no significance in the mortality of 0 year group caused by any specific disease, but unnatural death was ranked 2nd after the United States. The natural death of 1-4 years group was ranked 6th, and the unnatural death was ranked 2nd after the Unites States. Among the natural deaths of 1-4 years group, the cause of death significantly higher was found to be disease G(nervous system disease). Among the subgroups of disease G, the orders went epilepsy, cerebral palsy, paralysis, and inflammatory disease.

Conclusions

We have identified major causes of death of children under age 5. The highest proportion of cause of death in 1-4 years group was nervous system disease and we have proposed resolution. Henceforth, this data will be used as a foundational data for formulating policies relation to the Mother-Child Health.

Characteristics of Peripheral versus Central Lung Cancer Since 2000
So Young Ock, Tae Won Jang, You Jin Han, Go Eun Yeo, Eun Jung Kim, Won Hyoung Lee, Nam Kyu Kim
Kosin Med J. 2014;29(1):47-52.   Published online December 17, 2014
DOI: https://doi.org/10.7180/kmj.2014.29.1.47
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Abstract Objectives

The aim of this study was to explore the changes of bronchoscopic features according to epidemiologic change of lung cancer.

Methods

We performed a retrospective review of the clinical characteristics of 1,139 lung cancer patient who underwent bronchoscopy at Kosin University Hospital from January 2000 to December 2010.

Results

The age of patients increased significantly during the last decade (P < 0.001). The most common histological type was adenocarcinoma (38.1%), followed by squamous carcinoma (35.7%) and small cell carcinoma (15.3%). There was an increasing incidence of adenocarcinoma over the time (P < 0.001). Bronchoscopic feature were divided into two classes; central type, peripheral type. The peripheral type was predominant (62.3%). The proportion of peripheral type has been increased in process of time (49.7% vs. 63.7% vs. 73.7%; P < 0.01). Among the major histopathologic type of lung cancer, adenocarcinoma (81.3%) and unclassifiable non-small-cell lung cancer (73.4%), small cell carcinoma (56.9%) were associated with preferential occurrence of peripheral type. Squamous cell carcinoma of the lung more often arised in central type (59%). However, the proportion of peripheral squamous cell carcinoma has been increased. On the subgroup analysis, the median survival time of peripheral type with adenocarcinoma and small cell carcinoma were longer than central type (P < 0.05).

Conclusions

The age of the lung cancer patients at diagnosis was getting older. The most frequent histopathologic type was adenocarcinoma. The proportion of peripheral type lung cancer gradually increased over the time. The survival time of peripheral type lung cancer was longer than central type.

Case reports
A Case of Hydrothorax Aggravated by Peritoneal Dialysate Leakage in Compensated Liver Cirrhosis Patient with Ascites
Gain You, Ho Sik Shin, Yeon Soon Jung, Hark Rim
Kosin Med J. 2014;29(1):53-57.   Published online December 17, 2014
DOI: https://doi.org/10.7180/kmj.2014.29.1.53
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Abstract

The cirrhotic patients with ascites present unique challenge to the renal caregiver. Hydrothorax in a cirrhotic patient treated with PD poses a diagnostic dilemma. Proposed mechanisms for the development of a pleuroperitoneal communication include congenital diaphragmatic defects, acquired weakening of diaphragmatic fibers caused by high intra-abdominal pressures during peritoneal dialysis, and impairments in lymphatic drainage. Pleural fluid analysis and diagnostic imaging assist in differentiation from other causes of pleural effusion. We report a case of hydrothorax in a compensated cirrhotic patient after recent introduction to peritoneal dialysis.

A Case of Oliguric Mannitol Induced Acute Kidney Injury Early Treated by Continuous Renal Replacement Therapy
Kyungo Hwang, Yeo-Jin Kang, Eun Jin Bae, Se-Ho Chang, Dong Jun Park
Kosin Med J. 2014;29(1):59-62.   Published online December 17, 2014
DOI: https://doi.org/10.7180/kmj.2014.29.1.59
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Abstract

We report oliguric mannitol-induced acute kidney injury (AKI) early treated by continuous renal replacement therapy. A 70-year-old woman was admitted to the Department of Neurology with diagnosis of acute intracranial hemorrhage. Mannitol was infused for intracranial pressure control. At admission third day, urine output was abruptly decreased to 57 ml during first 6 hours and blood urea nitrogen (BUN) and serum creatinine was increased to 54.2 mg/dL and 5.3 mg/dL respectively. Plasma osmolality was 340 mOsm/kg and osmolar gap was 70. Mannitol was immediately withdrawn and continuous renal replacement therapy (CRRT) was performed to remove mannitol rapidly. Urine output was increased 6 hours later after continuous veno-veno hemodiafiltration (CVVHDF) start. BUN and creatinine was decreased to 21.4 and 1.2 mg/dL at admission ninth day. Mannitol can develop oliguric AKI and CRRT may be of more benefit than conventional hemodialysis in the case of increased intracranial pressure.

A Case of Seizure and Metabolic Acidosis Due to Renal Adjustment Dosage of Isoniazid in an Elderly Woman
Young Shin Shin, Eun Hee Sim, Chang Woo Yeo, Jin Doo Kang, Ji Yeon Kim, Seon Ja Park
Kosin Med J. 2014;29(1):63-68.   Published online December 17, 2014
DOI: https://doi.org/10.7180/kmj.2014.29.1.63
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Abstract

Isoniazid is one of the most commonly used antituberculosis drug. Acute into xication is characterized by repetitious convulsions, high anion gap metabolic a cidosis and coma. The basis of theraphy consists of parental pyridoxine admi nistration in a dose equivalent to that of isoniazid ingested. Here we present a case of seizure and metabolic acidosis due to only renal adjustment dosage of Isoniazid in an elderly woman.

A Case of Lead Migration Caused by Involuntary Movement in Implanted Spinal Cord Stimulation
Ju-Deok Kim, Jeong-Gil Lee, Sang-Su Kim, Hye-Young Shin
Kosin Med J. 2014;29(1):69-73.   Published online December 17, 2014
DOI: https://doi.org/10.7180/kmj.2014.29.1.69
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Abstract

Spinal cord stimulation (SCS) is a reliable clinical option for treatment of refractory chronic pain. It is known to be effective method for treating sympathetic pain, failed back surgery syndrome, and complex regional pain syndrome etc. The devices and implantation techniques for SCS are already highly developed and continuously improving, but there are some complications that can not be corrected easily. Lead migration is the most common complication after SCS. It can cause failure of SCS that can make discomfort to patients. Here we describe our experience of lead migration in implanted SCS which was inserted to a patient with complex regional pain syndrome patient.

A Case of Adult onset Bartter Syndrome with Nephrocalcinosis
Min Gyu Park, Tae Won Lim, Hee Taek Oh, Seung Un Song, Dong Heo, Hark Rim
Kosin Med J. 2014;29(1):75-79.   Published online December 17, 2014
DOI: https://doi.org/10.7180/kmj.2014.29.1.75
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Abstract

Bartter syndrome is a renal tubular defect in electrolyte transport characterized by hypokalemia, metabolic alkalosis, hyperreninemia, hyperaldosteronism, normal blood pressure, and other clinical symptoms. As a clinical and genetical heterogeneous disorder, this syndrome can be classified into two clinical variants, antenatal Bartter syndrome and classic Bartter syndrome according to the onset age. Nephrocalcinosis is common in antenatal Bartter syndrome, but is rare in classic Bartter syndrome. It can also be classified into five genetic subtypes by the underlying mutant gene, all of which are expressed in the tubular epithelial cells of the thick ascending limb of the loop of Henle. Patients with Bartter syndrome type 1, 2 and 4 present at a younger age than classic Bartter syndrome type 3. We have experienced a case of Bartter syndrome with nephrocalcinosis in a 42-year-old woman diagnosed by biochemical and radiologic studies. We had successful response with potassium chloride and spironolactone.


KMJ : Kosin Medical Journal