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Volume 30(2); December 2015
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Review articles
Effect of Docosahexaenoic Acid (DHA) on Breast Cancer Cells
Sun-yong Hwang, Tae-Hee Kim, Hae-Hyeog Lee, Heung Yeol Kim, Juhyun Seo
Kosin Med J. 2015;30(2):103-107.   Published online January 20, 2015
DOI: https://doi.org/10.7180/kmj.2015.30.2.103
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Abstract

Today, many materials as drug are developed having various prominent function in order to treatment of disease or cancer. Among these materials, especially docosahexaenoic acid (DHA), main constituents of omega-3 fatty acid, has a lot of beneficial and natural effects, so it has been known as anticancer material especially breast cancer. Breast cancer is disease taking high occurrence level among feminine diseases. DHA has anticancer effects on breast cancer cell, representatively inducing apoptosis, inhibiting proliferation or metastasis. Main effect of DHA on breast cancer cell is apoptosis inducing, which has mechanism that treated DHA causes lipid peroxidation increasing reactive oxygen species (ROS) level and it activates caspase 8 and caspase 9 so activated caspase occurs apoptosis. Cell lines of breast cancer are MDA-MB-231, MCF-7, SK-BR-3, T47D and ZR75. Especially this article uses the MCF-7 cell line at experiment of anti-proliferation by DHA, the MDA-MB-231 cell line at experiment of anti-metastasis by DHA, because that cell line has specialized metastasis activity. Therefore, this paper discusses the effects of natural material DHA as drug of breast cancer.

Polycystic Ovary Syndrome
Yong-Il Ji, Min Jeong Kim
Kosin Med J. 2015;30(2):109-114.   Published online January 20, 2015
DOI: https://doi.org/10.7180/kmj.2015.30.2.109
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Abstract

Polycystic ovary syndrome affects 6%-7% of reproductive-aged women, making it the most common endocrine disorder in this population. It is characterized by chronic anovulation and hyperandrogenism. Affected women may present with reproductive manifestations such as irregular menses or infertility, or cutaneous manifestations, including hirsutism, acne, or male-pattern hair loss. Over the past decade, several serious metabolic complications also have been associated with polycystic ovary syndrome including type 2 diabetes mellitus, metabolic syndrome, sleep apnea, and possibly cardiovascular disease and nonalcoholic fatty liver disease. In addition to treating symptoms by regulating menstrual cycles and improving hyperandrogenism, it is imperative that clinicians recognize and treat metabolic complications. Lifestyle therapies are first-line treatment in women with polycystic ovary syndrome, particularly if they are overweight. Pharmacological therapies are also available and should be tailored on an individual basis. This article reviews the diagnosis, clinical manifestations, metabolic complications, and treatment of the syndrome.

Original articles
Simultaneous Laparoscopy-Assisted Resection for Synchronous Colorectal and Gastric Cancer
Seung-Hyun Lee, Byung-Kwon Ahn, Sung-Uhn Baek
Kosin Med J. 2015;30(2):115-121.   Published online January 20, 2015
DOI: https://doi.org/10.7180/kmj.2015.30.2.115
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Abstract Objectives

The purpose of this study is to evaluate feasibility and safety of simultaneous laparoscopy-assisted resection for synchronous colorectal and gastric cancer.

Methods

From January 2001 to December 2013, a total of 29 patients underwent simultaneous resection for synchronous colorectal and gastric cancers. Medical records were reviewed, retrospectively.

Results

Eight patients (5 male) underwent laparoscopy-assisted resection (LAP group) and twenty one patients (17 male) underwent open surgery (Open group). In the both group, the mean age (65.2 vs. 63.7 years, p =0.481), body mass index (22.6 vs. 22.3, p = 0.896) was comparable, respectively. In LAP group, laparoscopy-assisted distal gastrectomy was performed for all eight patients. In Open group, subtotal gastrectomy with billroth I gastroduodenostomy was most common procedure (66.7%). The operation time, blood loss volume was similar between the two groups. Gas out was earlier (3.0 vs. 4.6 days p = 0.106), postoperative hospital stay was shorter (12.0 vs. 18.3 days, p = 0.245) in LAP group. The postoperative complications were an ileus, a wound seroma and a bile leakage in LAP group, pneumonia (10.0%), wound bleeding (5.0%) and leakage (5.0%) in Open group.

Conclusions

The simultaneous laparoscopy-assisted resection for synchronous colorectal cancer and gastric cancer is a feasible and safe procedure.

Complications caused by perfluorocarbon liquid used in pars plana vitrectomy
Jae Ho Yoo, Ki Yup Nam, Seung Uk Lee, Ji Eun Lee, Sang Joon Lee
Kosin Med J. 2015;30(2):123-130.   Published online January 20, 2015
DOI: https://doi.org/10.7180/kmj.2015.30.2.123
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Abstract Objectives

To assess the inadvertent intraocular retention of perfluorocarbon liquid (PFCL) after vitreoretinal surgery and their complications.

Methods

We retrospectively reviewed the medical records of 108 patients who underwent vitreoretinal surgeries using intraoperative PFCL (perfluoro-n-octane (C8F18), 0.69 centistoke at 25℃, PERFLUORN®, Alcon, USA) and the removal of PFCL through fluid-air exchange. The analysis was focused on the occurrence of intraocular retained PFCL, diagnoses, surgicalprocedures, and complications.

Results

Retinal detachment (51 cases, 47%) was the most common surgery which used PFCL intraoperatively. Other causes were vitreous hemorrhage (24 cases, 22%), posteriorly dislocated lens (22 cases, 21%), and trauma (11 cases, 10%). Intraocular PFCL was found in a total of 9 (8.3%) eyes. PFCL bubbles remained in anterior chamber and vitreous cavity were observed in 4 cases and subretinal retained PFCL was observed in 5 cases. Three of 5 cases of subretinal PFCL exhibited in subfoveal space. Among the three subfoveal cases, macular hole developed after PFCL removal in 1 case, epiretinal membrane in the area where had been PFCL bubble. However, we observed no complications in 1 case of subfoveal PFCL that was removed by surgery. PFCL in anterior chamber and vitreous cavity were in 4 cases.

Conclusions

The presence of subfoveal PFCL might affect visual and anatomic outcomes. However, subfoveal PFCL may induce visual complications, and therefore requires special attention.

Mucinous precursor lesions of mucinous carcinoma in breast: Incidence and histopathologic features
Min Jung Jung, Young Ok Kim
Kosin Med J. 2015;30(2):131-139.   Published online January 20, 2015
DOI: https://doi.org/10.7180/kmj.2015.30.2.131
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Abstract Objectives

Columnar cell lesion (CCL), atypical ductal hyperplasia (ADH) and ductal carcinoma in situ (DCIS) may be premalignant lesion of mammary invasive carcinoma. A few recent investigators reported that the precursor lesions exhibited mucin production and they might be potential precursor lesion for mucinous carcinoma (mCA). This study aims to investigate the incidence and histopathologic characteristics of mucinous precursor lesions, including mucinous DCIS (mDCIS) and mucinous CCL (mCCL).

Methods

We retrospectively analyzed invasive carcinomas with mucin. Cases were grouped into three subgroups: pure mCA, mixed mCA, and invasive carcinoma of no special type with mucin production (IC of NST-m). Precursor lesions were evaluated with PAS and alcian blue staining.

Results

Total 27 cases of invasive carcinoma with mucin were analysed and classified as 18 pure mCA, 7 mixed mCA, and 2 IC of NST-m. mDCISs were found in 12 pure mCA, 4 mixed mCA and 2 IC of NST-m. mCCLs were found in 7 pure mCA and 2 mixed mCA. Majority of mucin was identified in both cytoplasm and ductal lumen, while some tumors exhibited only cytoplasmic mucin. We also observed three patterns of mDCIS classifiable by location of mucin and architecture of tumor cells.

Conclusions

Cytoplasmic mucin suggested that mucinous feature of precursor lesions in the vicinity of mCA might not be a passive morphologic finding but be involved in development of mCA.

Analysis of an EGFR mutation by PNA clamping method in lung carcinoid tumors
Jong In Kim
Kosin Med J. 2015;30(2):141-147.   Published online January 20, 2015
DOI: https://doi.org/10.7180/kmj.2015.30.2.141
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Abstract Background

Pulmonary carcinoid tumors consisting of typical carcinoid tumors (TC) and atypical carcinoid tumors (AC) are rare, accounting for 2–5% of all lung tumors. TC is considered a low-grade tumor with a rate of distant metastasis up to 12%. In contrast, ACs are more aggressive tumors, displaying a metastatic rate up to 70%. Surgery is the treatment of choice; however, the current treatment outcomes of metastatic lung carcinoids are discouraging. This study aimed to investigate the EGFR mutation using the PNA-mediated clamping method and to provide basic data for using EGFR-TK1 and its clinical implications.

Materials and Methods

A total of 14 cases that underwent surgery were diagnosed as carcinoid tumors and pathologically classified as TC and AC. The paraffin-embedded tissues were analyzed for EGFR mutations using the PNA-mediated PCR clamping technique. The mutant type was noted in the cases with aCt greater than 2.0.

Result

Of 14 cases, eight were AC and six cases were TC. No known EGFR mutation was detected with aCt less than 2.0.

Conclusion

The EGFR genotype determined using the PNA-mediated PCR clamping method was wild-type in all pulmonary carcinoid tumors. Therefore, the application of EGFR-TK1 is limited in pulmonary carcinoid tumors.

Students' Satisfaction and Perception of Problem Based Learning Evaluated by Questionnaire
Min Jeong Kim
Kosin Med J. 2015;30(2):149-157.   Published online January 20, 2015
DOI: https://doi.org/10.7180/kmj.2015.30.2.149
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Abstract Objectives

The aim of this study is to analyze the student's satisfaction and perception in problem based learning of Kosin University College of Medicine, and to propose effective strategies for improvement of problem based learning.

Methods

Students satisfaction of problem based learning was assessed using the structured questionnaire. The questionnaire consisted of 33 items covered satisfaction of self-evaluation and small group activity, learning resources and environment, tutor and content and construction of modules.

Result

A total of 80 students were surveyed. Students recognized PBL as more effective and interesting learning method than traditional lectures. Most of students highly satisfied with self-directed learning of their own and small group, tutor, composition and contents of modules. Students had difficult process to build a logical clinical reasoning by combining clues in the PBL process. Students regard that they can easily connect knowledge in real-clinical situations with the greatest advantages of PBL. Students cited as the biggest disadvantage is that students may not receive a fair evaluation.

Conclusion

Through the results of this survey it showed that students are satisfied with the PBL classes and recognized as effective compared to traditional instructor-led classes. However, further efforts in improving evaluation system and learning environments was necessary for the success of the PBL curriculum.

Case reports
Post-traumatic tricuspid regurgitation with anterior papillary muscle rupture, corrected by papillary muscle reimplantation
Hae Young Lee, Sung Ho Cho, Jong In Kim
Kosin Med J. 2015;30(2):159-162.   Published online January 20, 2015
DOI: https://doi.org/10.7180/kmj.2015.30.2.159
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Abstract

A 60-year-old male patient with blunt chest trauma was transferred to our facility because of unstable vital signs and pericardial effusion. These conditions occurred after orthopedic surgery to repair multiple left finger fractures at a local medical center. Trans-thoracic echocardiography showed severe tricuspid regurgitation and he underwent papillary muscle reimplantation and tricuspid annuloplasty open heart surgery for post-traumatic tricuspid regurgitation with anterior papillary muscle rupture. We report early surgical traumatic valve disease correction without complications.

A Case of Disseminated Extranodal Interdigitating Dendritic Cell Sarcoma Arising from Parotid Gland
Young Hoon Park, Shin Il Kim, Suk Jin Choi, Joo Han Lim, Hyeon Gyu Yi, Moon Hee Lee, Chul Soo Kim
Kosin Med J. 2015;30(2):163-169.   Published online January 20, 2015
DOI: https://doi.org/10.7180/kmj.2015.30.2.163
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Abstract

Interdigitating dendritic cell sarcoma (IDCS) is an extremely rare tumor derived from professional antigen presenting cell and primarily found in lymph nodes, with rarer case report about extranodal presentation of IDCS. A 71-yr-old man was admitted with progressively enlarging and painless mass in the right parotid area for 2 months. Computed tomography of the neck and chest revealed enhancing mass in right parotid gland, multiple lymphadenopathies around neck and mediastinum, and an osteolytic metastasis at thoracic spine. Morphological and immunohistochemical analysis of an excisional biopsy specimen from parotid mass were consistent with a diagnosis of IDCS. Palliative chemotherapy with 6 cycles of CHOP (cyclophosphamide, adriamycin, vincristine, and prednisolone) regimen and 2 cycles of ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) regimen plus radiotherapy on parotid mass failed in tumor reduction. We describe a rare case of disseminated extranodal IDCS arising from parotid gland.

A Case Of Huge Brunner's Gland Adenoma With Acute Bleeding Treated By Endoscopic Resection
Pyung Kang Park, Woo-Cho Chung, Kyoung Yong Lee, Sung Hak Lee, Jae Jung Jang, Seungchul Suh
Kosin Med J. 2015;30(2):171-174.   Published online January 20, 2015
DOI: https://doi.org/10.7180/kmj.2015.30.2.171
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Abstract

Brunner's gland adenoma is a rare benign small bowel neoplasm and it represents 10% of small bowel benign tumor. Most of adenoma manifest as polypoidal, multiple and size does not exceed 1 cm and mostly asymptomatic, but the lesion larger than 1 ㎝ is solitary and can cause bleeding, obstruction, intussusception and there are some reports of showing malignant transformation. Until the present, there are two cases of over 8㎝ huge Brunner's gland adenoma in Korea and each of their chief complaint was abdominal discomfort and melena, but there is no case report of over 8 ㎝ Brunner's gland adenoma accompanied with acute bleeding as seen in this case. We diagnosed an 8 ㎝ sized, huge duodenal Brunner's gland adenoma which accompanied with acute bleeding and treated it by endoscopic resection using an IT-knife, successfully.

Complication of Amebic Liver Abscess: Biliary Fistula
Han Wook Chung, Song Ee Park, Hyun Jeong Park, Jae-Cheol Kwon, Hyung Joon Kim
Kosin Med J. 2015;30(2):175-180.   Published online January 20, 2015
DOI: https://doi.org/10.7180/kmj.2015.30.2.175
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Abstract

In amebic liver abscess, communication between liver abscess and intrahepatic bile ducts is an uncommon cause of bile leak. This condition can be treated surgically or endoscopically. However, these treatment modalities are related with high morbidity and mortality. A 49-year-old man was diagnosed with amebic liver abscess. Percutaneous drainage was performed due to poor medical response and for the purpose of preventing abscess rupture. Liver abscess-biliary communication was found at follow-up imaging study. He was treated successfully with medical therapy and supportive care without further interventions.

Meningoencephalitis associated with Parvovirus B19 Infection in an Immunocompetent Patient
Dae-Seung Lee, Jin-Hyung Lee, So-Young Huh, Min Jeong Kim, Meyung-Kug Kim, Bong-Goo Yoo
Kosin Med J. 2015;30(2):181-185.   Published online January 20, 2015
DOI: https://doi.org/10.7180/kmj.2015.30.2.181
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Abstract

Parvovirus B19 (PVB19) infection is a rare cause of meningoencephalitis. A 53-year-old previously healthy woman presented with fever, headache, and multiple erythema on the both legs. Cerebrospinal fluid study revealed pleocytosis and elevated opening pressure and protein level. Brain MRI showed multiple, asymmetric, hyperintensity in the brain stem, basal ganglia, white matter, and gray matter. Anti-B19 IgM antibody and PCR for PVB19 were positive in serum. Clinician should consider PVB19 infection in any case of acute febrile illness with erythema and meningoencephalitis


KMJ : Kosin Medical Journal