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Volume 32(2); December 2017
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Review articles
The early diagnosis and treatments in multiple sclerosis
So Young Huh
Kosin Med J. 2017;32(2):151-163.   Published online January 19, 2017
DOI: https://doi.org/10.7180/kmj.2017.32.2.151
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system that leads to neurological disability. The diagnosis of MS relies on the MRI criteria, which can demonstrate dissemination in space and time. Exclusion of other demyelinating mimics is essential because there are no specific biomarker for MS and MRI criteria are still have imperfect. There is incremental improvements in MS treatment option that have contributed to the delay of disease progression. The early initiation of DMT may ameliorate the neurological disability. In this review, we discusses the new diagnostic MS criteria and summarize the evidences supporting the early treatment in the course of MS.

Morphine as a suspect of aiding the propagation of cancer cells
Yusom Shin
Kosin Med J. 2017;32(2):164-169.   Published online January 19, 2017
DOI: https://doi.org/10.7180/kmj.2017.32.2.164
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Controlling pain in cancer patients is important for several reasons including patient quality of life (QOL). In moderate-to-severe cancer-pain management, opioid analgesics are indispensable. Among these, morphine is the most representative. Unfortunately, many studies have shown that morphine is potentially associated with cancer growth, recurrence, and metastasis. Specifically, in animal as well as in vivo and in vitro studies, morphine has been demonstrated to have possibly positive effects on cancer progression. However, those effects have not yet been confirmed as entirely harmful, for several reasons: the results of animal and laboratory research have not been subjected to clinical trials; there are as yet no well-designed clinical studies, and indeed, some studies have shown that morphine can have negative, suppression effects on tumor growth. This review paper will present some of the data on the potentially positive relationships between morphine and cancer. It should not be forgotten, though, that such relationships remain controversial, and that pain itself promotes cancer progression.

Original articles
Retrospective analysis on the clinical efficacy of bevacizumab combined with FOLFOX4 in the first line treatment of metastatic colorectal cancer
Eun Mi Lee, Lee Chun Park, Ho Sup Lee, Seong Hoon Shin, Yang Soo Kim
Kosin Med J. 2017;32(2):170-178.   Published online January 19, 2017
DOI: https://doi.org/10.7180/kmj.2017.32.2.170
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

The addition of bevacizumab to standard chemotherapy has been improved survival outcomes in patients with metastatic colorectal cancer. However, the combination of bevacizumab with oxaliplatin-based chemotherapy as first-line treatment showed limited survival benefit. The purpose of this study was to investigate the clinical efficacy and toxicity of the combination of bevacizumab to oxaliplatin and leucovorin (FOLFOX4) in the first-line treatment of patient with metastatic colorectal cancer.

Methods

Between December 2004 and September 2009, medical records of patients who were diagnosed with metastatic colorectal cancer and received the first line chemotherapy with bevacizumab and FOLFOX4, were retrospectively reviewed.

Results

A total of forty patients were analyzed. The median age of the patients was 55 years (range, 33-80), and 55% was male. The patients received a total of 206 cycles of therapy (median 4 cycles per patient; range 1 – 15 cycles). Of these 40 patients, none achieved complete response (CR) and 15 achieved a partial response (PR), for the overall response rate (ORR) 37.5% (95% CI, 22.5-52.5). Median progression free survival (PFS) was 6.9 months (95% CI, 3.4-10.5) and median overall survival (OS) was 22.6 months (95% CI, 17.3-27.8The most common grade 3 or 4 hematologic toxicity and non-hematologic toxicity were neutropenia (10.0%) and diarrhea (10.0%), respectively. Two patients experienced gastrointestinal perforation.

Conclusions

In this study, the combination bevacizumab with FOLFOX4 was associated with favorable OS, but did not showed favorable PFS and ORR.

The significance of blood pressure variation and metabolic risk factors in patients with different stages of hypertension
Sun Min Kim, In Kyoung Shim, Ju Won Lee, Jun Yeob Lee, Si Won Lee, Kyoung Im Cho, Hyun Su Kim, Jae Woo Lee, Jung Ho Heo
Kosin Med J. 2017;32(2):179-190.   Published online December 29, 2017
DOI: https://doi.org/10.7180/kmj.2017.32.2.179
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

Blood pressure variation (BPV) and metabolic syndrome is an independent risk factor for cardiovascular events. Ambulatory blood Pressure (ABP) has been shown to be more closely related to cardiovascular events in hypertensive patients than conventional office BP (OBP). Using both OBP and ABP, 4 groups of patients were identified: (1) normotensive patients (NT); (2) white coat hypertensives (WCHT); (3) masked hypertensives (MHT); and (4) sustainedhypertensives (SHT). We investigated the significance of BPV and metabolic risks of these 4 groups.

Methods

This study is a retrospective analysis of patients between January 2008 and May 2013. Echocardiography and 24 hour ABP monitoring were performed.

Results

BMI was significantly higher in the MHT compared with the NT. There were progressive increases in fasting glucose level from NT to WCHT, MHT, and SHT.MHT and SHT had higher 24h and nighttime BPV than NT.MHT was significantly related with BMI (r = 0.139, P = 0.010), creatinine (r = 0.144, P = 0.018), fasting glucose (r = 0.128, P = 0.046), daytime systolic BPV (r = 0.130, P = 0.017), and daytime diastolic BPV (r = 0.130, P = 0.017). Dyslipidemia (r = 0.110, P = 0.043), nighttime systolic BPV (r = 0.241, P < 0.001) and nighttime diastolic BPV (r = 0.143, P = 0.009) shown correlation with SHT. In multivariate logistic regression, MHT was independently associated with Body mass index (OR 1.086, 95% CI 1.005–1.174, P = 0.038) and creatinine (OR 1.005, 95% CI 1.001–1.010, P = 0.045).

Conclusions

BPV and metabolic risk factors were found to be greater in MHT and SHT compared with NT and WCHT. This suggests that BPV and metabolic risks may contribute to the elevated cardiovascular risk observed in patients with MHT and SHT.

The clinical features and infectious etiologies of acute diarrhea in immunocompromised hosts
Jin Young Lee, Ye Na Kim, Namho Kim, Kyoung Soon Cho, Ji Young Park
Kosin Med J. 2017;32(2):191-203.   Published online December 29, 2017
DOI: https://doi.org/10.7180/kmj.2017.32.2.191
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

The acute diarrhea is a common complaint among immunocompromised hosts, and may cause life threatening event. The infectious etiologies vary depending on virus, bacteria, and parasites. The most common etiology of acute gastroenteritis is known as enteric virus in Korea.1 But there are few studies about the infectious etiology of acute gastroenteritis in immunocompromised hosts.23 The aim of this study was to investigate the infectious etiologies of acute diarrhea in immunocompromised hosts.

Methods

Seventy three patients were enrolled prospectively in a university hospital from January 2013 to July 2014. Immunocompromised hosts included above 65-year-old people, patients with chronic diseases, solid organ or stem cell transplants, solid organ malignancies, hematologic malignancies, immunosuppressive or steroid taking patients. The clinical data were collected and stool samples collected during diarrhea were undergone laboratory analysis for enteric viruses and bacterial enteropathogens including Salmonella spp., Shigella spp., and Clostridium difficile.

Results

Fifty five patients were analyzed as follows : above 65 year-old people were 36 cases (66%), previous antibiotic usage was 22 cases (41.5%). 44 cases (81.1%) were admitted to general ward whereas 9 cases to ICU (17%). 41 cases (73.6%) were treated with antibiotics. Positive C. difficile toxin assays were 6 cases (11.9%). Other infectious etiologies were not found.

Conclusions

C. difficile infection was more common infectious etiology while enteric viruses and other bacteria are not associated with acute diarrhea among immunocompromised hosts in this study. So C. difficile infection must be considered preferentially in immunocompromised hosts with acute diarrhea.

Influence of Orthokeratology Lens on Axial length Elongation and Myopic Progression in Childhood Myopia
Su Jin Kim, Ji Eun Lee
Kosin Med J. 2017;32(2):204-211.   Published online December 29, 2017
DOI: https://doi.org/10.7180/kmj.2017.32.2.204
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

To investigate the clinical effects of orthokeratology lens wear on inhibition of the myopic progression and axial length elongation in Korean children with myopia.

Methods

The authors reviewed out-patient records of 37 eyes of 19 patients wearing orthokeratology lenses. The 46 eyes of 23 patients wearing spectacles were included into the control group. We evaluated the relationship between orthokeratology lens wear and control group according to age, initial myopia, initial astigmatism, axial length elongation.

Results

There were no significant differences between two groups as for age, initial myopia, astigmatism, spherical equivalent, and axial length at baseline (t-test, P > 0.05). Significant reduction of refraction was shown in patients with wearing lenses after 1 year (t-test, P < 0.001). The mean axial length before and after 1 year was 24.62 ± 1.39 mm and 24.73 ± 1.28 mm respectively after lens wearing, and 24.59 ± 0.74 mm and 24.80 ± 0.71 mm respectively after wearing glasses. The axial length elongation was 0.11 ± 0.12 mm, and 0.21 ± 0.07 mm in patients with wearing lenses and glasses, respectively, which showed statistically significant difference (t-test, P < 0.0001).

Conclusions

The orthokeratology lens was found to be effective in suppression of myopic progression through less axial length elongation, compared with the glasses.

Usefulness of neutrophil gelatinase-associated lipocalin(NGAL) to confirm subclinical acute kidney injury and renal prognosis in patients following surgery
Se Jun Park, Hoseok Koo, Kyoung Jin Lee, Seo Hyun Kim, Seo Young Yun, Seunghyup Kim, Dong Hee Whang, Shin Young Joo, Byungmo Lee, HoJun Chin, Sihyung Park
Kosin Med J. 2017;32(2):212-220.   Published online January 19, 2017
DOI: https://doi.org/10.7180/kmj.2017.32.2.212
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

The neutrophil gelatinase-associated lipocalin (NGAL) level following non cardiac surgery is useful for predicting acute kidney damage. However, there is insufficient conclusive evidence as to whether NGAL can be used to predict subclinical AKI following non-cardiac surgery.

Methods

We measured serum NGAL and creatinine levels in 41 patients following non-cardiac surgery, and the increase of these variables was used to predict acute decreases in kidney function.

Results

The study included a total of 41 patients. The mean age was 64.65 ± 17.09 years. The serum creatinine concentration was increased 12 hours after surgery. The mean SD serum NGAL decreased after 4hours after surgery and continued to decrease after 12 hours after surgery. The incidence of subclinical AKI determined by the 4 hour serum NGAL level was 10(24.4%), and the incidence of serum creatinine elevation was 0(0.0%). The incidence of subclinical AKI determined by the 12 hour serum NGAL level was 4(9.8%), and the incidence of subclinical AKI determined by serum creatinine was 4(9.8%). The elevation of NGAL was more rapid than the serum creatinine 4 hours after surgery

Conclusions

We verified the usefulness of the serum NGAL level as a predictive factor for subclinical AKI after non-cardiac surgery.

Case reports
A 14-year-old boy with endobronchial carcinoid tumor presenting with asthma
Yunmo Gu, Youngjin Hwang, Sung Won Kim
Kosin Med J. 2017;32(2):221-226.   Published online January 19, 2017
DOI: https://doi.org/10.7180/kmj.2017.32.2.221
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Introduction

Bronchial carcinoid tumors seldom occur in children, sometimes mistaken for a minor disease and diagnosed slowly. Materials and Methods: We report on a patient who diagnose tumors slowly because confused with asthma.

Results

This case describes a 14-year-old boy, presenting with asthma-like symptoms throughout 3 years. He was treated as asthma but wax and wane. Chest x-ray showed an hyperlucent left lung, so we rechecked high resolution computed tomography (HRCT) for unilateral hyperinflation diseases diagnosis. It was found 1×1㎝ nodule in left main bronchus. We did bronchoscopy and discovered a round mass in the left bronchus, 2∼3㎝ away from carina. In the biopsy, it was bronchial carcinoid tumor, so we resected tumor.

Discussion

Because symptoms of bronchial carcinoid tumors are various, it can often be misdiagnosed firstly. It is confused with asthma, pneumonia and foreign body. An additional examination were necessary when respiratory symptoms persist.

Pulmonary Hypertension in Patient with Neurofibromatosis Type 1
Yeong min Lee, Tae Hyun Yang, HeeSoo Jung, Tae-Seon Oh, Jeong-Hoon Song, Seung-Jung Yu
Kosin Med J. 2017;32(2):227-232.   Published online December 29, 2017
DOI: https://doi.org/10.7180/kmj.2017.32.2.227
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Neurofibromatosis type 1 (NF1) is a rare genetic disease. Precapillary pulmonary hypertension (PH) with NF1 is an extremely severe complication. A 65-year-old woman was admitted in our hospital with 3-year history of gradually worsening dyspnea on exertion (New York Heart Association functional class III-IV). Considering her clinical feature and examination findings, she could be diagnosed as PH associated with NF1. She was treated with endothelin receptor antagonist. However her dyspnea was not significantly improved. This is the first Korean case of NF1 patient with PH which confirmed with right heart catheterization.

IgG4-Related Disease with lymphadenopathy Presenting as a Cervical lymph node enlargement
Yeon Seok Choi, SungMin Kim, Jang Sihn Sohn, JiYong Hwang, TaeSoo Chang, Do Yeon Cho
Kosin Med J. 2017;32(2):233-239.   Published online December 29, 2017
DOI: https://doi.org/10.7180/kmj.2017.32.2.233
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

During the course of evaluation and management of neck masses, consideration for Immunoglobulin G4-related disease (IgG4-RD) should be given. IgG4-RD is relatively a new growing entity of immune-mediated origin, characterized by a mass-forming lesion, the infiltration of IgG4-positive plasma cells and occasionally elevated serum IgG4. The most common manifestations are parotid and lacrimal swelling, lymphadenopathy and autoimmune pancreatitis.

A previously healthy 72-year-old man was referred to our clinic with a 2-month history of left cervical lymph node enlargement without systemic manifestations . A cervical lymph node biopsy was planned because of elevated serum IgG4 levels. Pathological findings showed prominent infiltration of IgG4-postive plasma cells in the lymph node. After steroid therapy, a computed tomography scan revealed a decrease in the cervical lymph node size.

This case illustrates the importance of including IgG4-RD in the differential diagnosis of a cervical lymph node enlargement.

Spontaneous Coronary Artery Dissection in a female patient with fragile X syndrome
Hyun-Young Park, Jin-Man Cho, Dong-Hee Kim, Chang-Bum Park, Chong-Jin Kim
Kosin Med J. 2017;32(2):240-243.   Published online January 19, 2017
DOI: https://doi.org/10.7180/kmj.2017.32.2.240
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

We report a case of Spontaneous coronary artery dissection associated with fragile X syndrome. The relationship between fragile X syndrome and Spontaneous coronary artery dissection is unclear. However, More research will need about the causes and treatment of Spontaneous coronary artery dissection.

Recurrent fetal postpartum stress induced cardiomyopathy after normal vaginal delivery
Yong-Sun Noh, Sung-Ho Her, Jong Bum Kwon, Chan Joon Kim, Tae-Seok Kim
Kosin Med J. 2017;32(2):244-250.   Published online December 29, 2017
DOI: https://doi.org/10.7180/kmj.2017.32.2.244
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Stress induced cardiomyopathy is a disease that shows a dysfunction of the ventricle, but it can be rapidly reversible. It often occurs in older women primarily who suffers from emotional or physical stress. There are some case reports about postpartum stress induced cardiomyopathy. Most of the patients are recovered naturally within days to weeks. We report a case of a 37 years-old woman, who had experienced postpartum stress induced cardiomyopathy 8 years ago, revisited hospital because of cardiomyopathy after secondary delivery. Herein we report a rare case of recurrent stress induced cardiomyopathy after secondary normal vaginal delivery.

A Case of needle-tract implantation of hepatocellular carcinoma in the ovary after radiofrequency ablation
Seong Woon Yoon, Jin-Sook Jeong, Su Young Kim, Sung Wook Lee, Seun Ja Park
Kosin Med J. 2017;32(2):251-257.   Published online January 19, 2017
DOI: https://doi.org/10.7180/kmj.2017.32.2.251
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Radiofrequency ablation (RFA), a local ablative modality, is gaining acceptance for the treatment of liver malignancies. Despite a relatively low complication rate, tumor seeding resulting from RFA in hepatocellular carcinoma (HCC) treatment can occur. A 44-year-old woman was diagnosed with HCC. Spiral computed tomography (CT) revealed a 2.3 × 2.0-cm mass in the S5 segment, which was treated with RFA on May, 2005. Follow-up imaging, performed at 6-month intervals after RFA, showed complete tumor necrosis. In October 2009, CT revealed a heterogeneous mass, 5.7 cm in diameter, in the right ovary. Since the lesion was limited to the right ovary without evidence of spread, bilateral salpingo-oophorectomy was performed. Histopathology indicated that the metastatic spread from the HCC to the ovary was positive for hepatocyte-specific antigen on immunohistochemistry. The ovary is a rare site for HCC metastasis. Moreover, needle tract implantation of HCC in the ovary is very rare.

A Case of Primary Tracheal Schwannoma
Sung Min Choi, Ji Hong You, Sang Bae Lee, Seong Han Kim, Yon Soo Kim
Kosin Med J. 2017;32(2):258-262.   Published online December 29, 2017
DOI: https://doi.org/10.7180/kmj.2017.32.2.258
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Although benign nerve sheath tumors have been described, primary tracheal schwannomas are extremely rare. We report a case of primary tracheal schwannoma, a rare benign nerve sheath tumor in a 58-year-old man with atypical symptoms of chronic cough, sputum and dyspnea for 2 months. Chest computerized tomography showed a 1.7 cm polypoid lesion in posterior wall of mid trachea. The results of bronchoscopic biopsy and immuno-histo-chemical studies were consistent with schwannoma. A surgical treatment of tumor resection and tracheal reconstruction by end-to-end anastomosis was performed.

Spontaneous uterine rupture due to placenta percreta in the second trimester of pregnancy: a case report
So Young Seo, Dong Wook Kim, Bo Mi Kim, Sung Wook Chun
Kosin Med J. 2017;32(2):263-268.   Published online December 29, 2017
DOI: https://doi.org/10.7180/kmj.2017.32.2.263
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A 32-year-old multiparous woman (gravida 2, para 2) with a history of previous cesarean section had acute abdominal pain and collapsed at 21 weeks of gestation. Exploratory laparotomy was performed because of the patient's worsening condition; ultrasound examination results were suggestive of massive hemoperitoneum, and fetus in vertex presentation with bradycardia. Uterine rupture between the left lower segment and borderline of the cervix in the anterior wall with active bleeding was confirmed. An uncomplicated classical cesarean section was performed, but the fetus was stillborn due to preterm birth. Hysterectomy was performed after the cesarean section. The patient was admitted to intensive care units for 3 days and was discharged in 12 days following delivery. Placenta percreta at the anterior lower segment of the uterus was confirmed in the pathology report.


KMJ : Kosin Medical Journal