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Volume 29(2); December 2014
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Review articles
An overview of the pathogenic mechanisms of autoimmune thyroid disorders
Keun Yong Park
Kosin Med J. 2014;29(2):93-98.   Published online December 18, 2014
DOI: https://doi.org/10.7180/kmj.2014.29.2.93
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Abstract

Objectives, recent epidemiologic studies in humans suggest an increased prevalence of thyroiditis associated with the excessive administration of iodine. More than three times of recommended daily intake of iodine was observed among people in North America. These people generally presented higher level of anti-thyroglobulin antibody, anti-thyroperoxidase antibody, serum thyroid-stimulating hormone and exacerbation of lymphocytic infiltration in thyroid, which indicated the overconsumption of iodine could induce hypothyroidism and enhance the autoimmune response. However, the precise mechanism of excessive iodine intake induced autoimmune thyroid disease remains largely unknown.

Over half a century has elapsed since the 1956 identification of thyroglobulin antibodies and the devising of the first experimental model of autoimmune thyroiditis. Since then an incredible amount of experimental work has led to an ever deeper understanding of the nature of thyroid auto-antigens, the main immune mechanisms responsible for Hashimoto's thyroiditis and graves’ disease, their genetics, and therir environmental risk factor. Yet, in the majority of genetically predisposed people the individual trigger of thyroid autoimmunity remains obscure. Similarly, effective prevention strategies still remain to be established and, hopefully, will be the target of future studies.

Antenatal Magnesium Sulfate for Neuroprotective Effects In Preterm Infants
Young lim Oh
Kosin Med J. 2014;29(2):99-106.   Published online December 18, 2014
DOI: https://doi.org/10.7180/kmj.2014.29.2.99
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Abstract

Fetal or neonatal brain injury can result in lifelong neurologic disability. Although survival rates for preterm infants have increased dramatically with the advent of modern perinatal and neonatal intensive care, but the rates of neurologic abnormalities in survivors, particularly motor disorders such as cerebral palsy, have not diminished. Antenatal magnesium sulfate may reduce the rates of cerebral palsy in survivors of preterm birth. There are five randomized controlled trials of magnesium sulfate administered to women at risk of preterm delivery before 34 weeks of gestation which have reported neurological outcomes for the child. From meta-analysis of these randomized trials, the rate of cerebral palsy was reduced by magnesium sulfate (RR, ᄋ·69; 95% CI, ᄋ·54-ᄋ·87; five trials; 6,145 infants) as did the moderate/severe cerebral palsy incidence (RR, 0.64; 95% CI, ᄋ·44-ᄋ·92; three trials; 4387 infants). There was no statistically significant difference between the rates of neonatal adverse outcomes of the magnesium administration group and the control group. In most prospective randomized studies, no significant difference in the severe mother-side side effects between the magnesium sul- fate administration group and the control group.

Antenataᅵ magnesium sulfate therapy is neuroprotective against motor dysfunction in offspring for the preterm infant; however the possibility of an increase in the fetal or neonatal death rate was not completely excluded.

Original articles
Increased carotid atherosclerosis and carotid artery stiffness according to the disease duration and activity in patients with systemic lupus erythematosus
Gi Sup Byun, Ji Hyun Lee, Kyoung Im Cho, HongJik Lee, Hyun Jung Yeo, Min Jeong Kim, Ho Joon Im
Kosin Med J. 2014;29(2):107-116.   Published online December 18, 2014
DOI: https://doi.org/10.7180/kmj.2014.29.2.107
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Abstract Objective:

The ᅵink among carotid intimamedia thickness (IMT), vascular elastic property and the disease activity of systemic lupus erythematosus (SLE) is not well defined. We investigated the association between carotid atherosclerosis, elastic properties of the carotid arterial wall and clinical parameters of SLE.

Methods:

Fifty-one SLE patients and fifty healthy controls were included. Peak systolic global circumferential and posterior radial strains of carotid artery were measured to assess the elastic properties. Beta stiffness index was used as conventional method for the distensibility of the carotid artery. Information concerning SLE duration, cumulative dose of steroids and/or immunosuppressive drug intake was recorded, and SLE activity was assessed by SLE disease activity index (SLEDAI) score.

Results:

Carotid plaques were more common in SLE patients. SLE patients with plaques were 㢌der and showed the increased mean ᅵMT, high sensitivity C-reactive protein (hs CRP), IgG anti-cardi㢌ipin antibody (aCL), and longer disease duration compared with those without plaques. Peaksyst㢌ic global circumferential and posterior radial strain as well β stiffness index were significantly lower in SLE group. Age, disease duration, hsCRP, IgG aCL showed significant correlations with mean ᅵMT and parameters of carotid elastic property (all P's<0.05).

Conclusions:

Carotid atherosclerosis was more common in SLE patients, and carotid arterial stiffness had significant correlation with disease duration, hsCRP and IgG aCL level. Speckle tracking strain imaging is a comparative method for the assessment of elastic properties of carotid artery of SLE patients.

Pathological differences between forceps biopsy specimens and endoscopic resection specimens in early gastric cancer patients
Joo Seok Kim, Sae Hee Kim, Min Gyu Kim, Ah Jeong Ryu, Il Hwan Ryu, Jae Jun Lee, Jae Woong Jeon, Ji Wook Choi, Anna Kim
Kosin Med J. 2014;29(2):117-124.   Published online December 18, 2014
DOI: https://doi.org/10.7180/kmj.2014.29.2.117
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Abstract Objective:

Endoscopic resection(ER) is effective therapy on EGC and which is treated according to the histological diagnosis of forcep biopsy. But sometimes the histological diagnosis of forcep biopsy and post-ER does not match with each other and it might lead to wrong treatment. The aim of this study is to find the frequency of histologic differences between forcep biopsy and post-ER, and to confirm the characteristics of lesions which make errors.

Methods:

We selected the confirmed cancer cases of 141 patients of 1359 gastric tumor lesions which were treated under the ER in Eulji university hospital from May 2005 to March 2013. They were sorted by the age and sex of patient, location of lesion, present of ulcer and depression to identify the discordance between forcep biopsy and ER. The discordant group was compared with non-cancer-diagnosed controlled group, retrospectively.

Results:

70 cases(5.5%) of 1283 cases of “cancer negative” in forceps biopsy were fo䴸nd to be diagnosed cancer on final diagnosis of cancer by post-ER result. In this discordant group showed characteristics of bigger size that are with more frequently in tumor size D15mm(17.9% vs. 31.4%, p=0.03), have depressed lesion(ᄀ 4.3% vs. 41.4%, p<0.01) and have 䴸lceration(2.4% vs.18.6%, p<0.01) than that of 84 control gro䴸p not diagnosed cancer.

Conclusions:

In cases of tumor with size D15mm, presented with depressed lesion and ulceration, we should consider combined cancer, even the result of forcep biopsy was negative. Therefore, more careful and accurate resection should be taken with characters listed above.

The Change of Thyroid Stimulating Hormone Values of Healthy Subjects According toTemperature and Aging
Sung Su Kim, Dong Hoon Lew, Ja Yoon Choi, Eun Ju Lee, Min Gyo Kim, Kyong Young Kim, Soo Kyoung Kim, Jung Hwa Jung, Jae Hoon Jung, Jong Ryea l Hahm
Kosin Med J. 2014;29(2):125-134.   Published online December 18, 2014
DOI: https://doi.org/10.7180/kmj.2014.29.2.125
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Abstract Objective:

We conducted a study to investigate the normal range for TSH and within-individual variations of TSH according to temperat䴸re and aging.

Patients and Methods:

We enrolled patients who underwent periodic medical examinations five times over a six year period (2007.8~2013.6). Anthropometric data and thyroid ultrasonography were evaluated, and serum TSH, T3, and T4 were assayed.

Results:

Subjects were 19-64 years old, 120 were female, and 208 were male. Reference ranges for TSH were 0.53-4.94 mlU/L in the first test, 0.49-5.61 mlU/L in the second test, 0.46-6.06 mlU/L in the third test, 0.48-5.99 mlU/L in the fourth test, and 0.52-6.3 mlU/L in the fifth test. When the TSH level was analyzed according to temperature and sex, mean TSH was higher in months in which the average monthly temperatures were below 100C in Jinju, Gyeongnam and female. The aging and low temperatures are associated with increased serum TSH concentrations in the within-individual.

Conclusions:

This study showed that aging is associated with increased serum TSH concentrations in the within- individual and serum TSH concentrations are different in the within-individual according to the temperature.

Nerve-Sparing Cryoablation for the Treatment of Primary Prostate Cancer: the Preliminary Report
Seong Choi
Kosin Med J. 2014;29(2):135-140.   Published online December 18, 2014
DOI: https://doi.org/10.7180/kmj.2014.29.2.135
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Abstract Background:

To present a pilot study of nerve-sparing cryoablation for the treatment of primary prostate cancer. Materials and Methods: Between 2008 and 2011, 9 patients underwent nerve-sparing cryoablation (unilateral 5, bilateral 4 patients). One neurovascular bundle (NVB) was spared on the side opposite the positive biopsy, and two NVBs were spared when indicated and possible. Just before the start of freezing, a 22-gauge spinal needle was placed into Denonvilliers fascia using a transperineal route, and normal saline was injected to separate the rectum from the prostate. The prostate-specific antigen (PSA) level was sampled every 3 months for the first 2 years and then every 6 months thereafter. Patients were considered to have a stable PSA if they had two consecutive PSA measurements without a rise.

Results:

The follow-up was 4ᄋ-months (19-66 months). All patients had stable PSA levels at last follow-up. Potency (defined as an erection sufficient to complete intercourse to the satisfaction of the patient) was maintained in 4 of 9 patients, 5 were potent with phosphodiesterase 5 inhibitors or intracavernosal injection. Conclusions: Nerve-sparing cryoablation, in which one or two neurovascular bundle is spared, showed the possibility of preserving potency in most patients without compromising cancer control. These preliminary results warrant further study.

Gender Differences in Risk Factor and Clinical Outcome in Patients with Ischemic Stroke
Kwang Soo Kim
Kosin Med J. 2014;29(2):141-146.   Published online December 18, 2014
DOI: https://doi.org/10.7180/kmj.2014.29.2.141
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Abstract Objective:

Gender is an important determinant for risk factors and outcomes of ischemic stroke. The aim of this study was to compare risk factors, and clinical outcomes after ischemic stroke between male and female patients.

Methods:

The hospital records of patients with ischemic stroke were reviewed retrospectively. Demographic data, stroke risk factors, clinical severities and outcomes after stroke were collected and compared between male and female patients. Stroke severity and clinical disability after ischemic stroke were evaluated by means of the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) respectively.

Results:

Among 447 patients with ischemic stroke, 195 (43.6%) patients were women. The mean age at ischemic stroke was higher in women than in men (p<0.01). As compared to men, women had a significantly lower prevalence of hyperhomocysteinemia, smoking and drinking (all p<0.01). NIHSS and mRS scores were not different between the 2 genders.

Conclusions:

Profiles of risk factors differed between the 2 genders, with men having a higher prevalence of hyperhomocysteinemia, smoking and drinking. There were no gender differences in stroke severity and disability after ischemic stroke.

A Case of Ischemic Colitis Related with Usual Dosage of Ibuprofen in a Young Man
Eun Jeong Kim, Moo In Park, Seun Ja Park, Won Moon, Go Eun Yeo, Weon Hyoung Lee
Kosin Med J. 2014;29(2):147-150.   Published online December 18, 2014
DOI: https://doi.org/10.7180/kmj.2014.29.2.147
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Abstract

Ischemic colitis is a medical condition in which inflammation and injury of the large intestine result from inadequate blood supply. Although unoommon in the general p㢌pulation, ischemic colitis occurs with greater frequency in the elderly, and is the most common form of bowel ischemia. Other possible causes include medications s䴸ch as NSAIDs(non-steroidal antiinflammatory drugs), oral contraceptives, diuretics and others. In recent years, many of NSAID use in young age can cause ischemic lesions, but it is not common. Here we report a case of ischemic colitis in a 31-year-old man who had no specific medical history except taking 200mg of ibuprofen three times a day for seven days. It suggests the importance of precise history taking, including medications usage such as NSAIDs and other risk factors.

Case reports
A Case with Empty Sella Syndrome Combined with Multiple Anterior Pituitary Hormone Deficiencies Presenting as Hypoglycemic Coma
Soo Kyoung Kim, Sung Su Kim, Bo Ra Kim, Jung Hwa Jung, Jae Hoon Jung, Jong Ryeal Hahm
Kosin Med J. 2014;29(2):151-155.   Published online December 18, 2014
DOI: https://doi.org/10.7180/kmj.2014.29.2.151
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Abstract

A 55-year-old male was admitted to emergency department with a hypoglycemic shock of unknown origin. He was presented with tonic seizure activity after admission. Initial diagnostic procedure could exclude diabetes mellitus, drug side effects, and exogenous insulin application. Detailed evaluation of the patient's history revealed that the patient had experienced repeated hypoglycemic episodes for 2 years. He was diagnosed with hypothyroidism six years ago. Initial laboratory investigations revealed hypoglycemia, hyponatremia, and low plasma cortisol level (0.18 pg/dᄂ)· Sellar magnetic resonance imaging showed empty sella. Replacement therapy with hydrocortisone resulted in the improvement of clinical symptoms. Combined pituitary stimulation test with exception of hypoglycemia induced growth hormone and cortisol stimulation test was performed. The response of thyroid stimulating hormone, prolactin, follicle-stimulating hormone, and luteinizing hormone was normal. We report the case of empty sella syndrome associated with hypoglycemic shock due to with multiple anterior pituitary hormone deficiencies.

A Case of Rectal Squamous Cell Carcinoma Mistaken for Rectal Adenocarcinoma
Jung Ik Park, Ung Seok Yang, Sung Won Moon, Oun Ouk Nam, Hyo Jong Kim, Jeong Seok Lee, San Gyu Oh
Kosin Med J. 2014;29(2):157-160.   Published online December 18, 2014
DOI: https://doi.org/10.7180/kmj.2014.29.2.157
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Abstract

We report a case of anal squamous cell carcinoma extended to the rectal mucosa that was clinically mistaken for rectal adenocarcinoma and literature reviwed. Sigmoidoscopic finding showed spherical shaped elevated lesion with central ulceration, interpreted as rectal adenocarcinoma in the distal portion of rectum. Anal squamous cell carcinoma is very rare among gastrointestinal cancer. Pathological study of the biopsy specimen demonstrated squamous cell carcinoma and normal rectal glands. Sigmoidoscopic finding of the presented case showed the ulcerarive lesion contineuosly extended from anal verge upward to the rectum. We postulate that the presented case is primarilly originated from the anal squamous cell carcinoma extended proximally to the rectum. Immunohistochemical stain(p-63) of the biopsy specimens showed squamous cell carcinoma. This patient has been completely recovered after treartment of chemoradiation and trans-anal excision. We present a case of anal squamous cell carcinoma invading rectal mucosa clinically mistaken for rectal adenocarcinoma and literature reviewed.

A Case of Reactivation of Hepatitis B and Fulminant Hepatitis which developed 3 months following Chemotherapy Including Rituximab in a Patient with Lymphoma
Tae Won Lim, Hee Taek Oh, Seung Un Song, Hae Won Lee, Ji Yeon Kim, Seon Ja Park
Kosin Med J. 2014;29(2):161-168.   Published online December 18, 2014
DOI: https://doi.org/10.7180/kmj.2014.29.2.161
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Abstract

Since Wands et al. reported for the first time in 1975 the reactivation of the hepatitis B virus in hematologic disease patients who had been receiving chemotherapy, the efficacy of chemotherapy and immunosuppressants has improved. As a result, the frequency of the reactivation of hepatitis B is increasing. Reported herein is a case of a non-Hodgkin lymphoma patient in her 70s who was suspected to have had HBsAg negative/anti-HBs negative occult HBV infection. The patient experienced fulminant hepatitis caused by the reactivation of hepatitis B, and died three months after the R-CHOP regimen was completed. In the HBsAg negative plus HBV DNA-negative case, there were few instances of viral activation of HBV. In this case, antiviral therapy was needed when the patient was confirmed to have become HBV DNA positive through regular monitoring, but its necessity is often overlooked, unlike the preemptive antiviral treatment in the HBsAg positive cases.


KMJ : Kosin Medical Journal