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Volume 33(2); December 2018
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Review articles
Oxidative stress and endometriosis
Yeon Jean Cho, Heung Yeol Kim
Kosin Med J. 2018;33(2):135-140.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.2.135
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Endometriosis is an estrogen-dependent chronic inflammatory condition that affects women in their reproductive period and is associated with pelvic pain and infertility. Oxidative stress (OS) occurs when reactive oxygen stress (ROS) and anti-oxidants are in imbalance. OS is a potential factor involved in the pathophysiology of endometriosis. Iron-induced ROS may trigger a chain of events resulting in the development and progression of endometriosis. Endogenous ROS are correlated with increased cellular proliferation and ERK1/2 activation in human endometriotic cells. An oxidative environment leads to stimulation of the ERK and PI3K/AKT/mTOR signaling pathways that facilitate endometriotic lesion progression through adhesion, angiogenesis, and proliferation. OS is also known to be involved in epigenetic mechanisms in endometriosis. We summarize the recent knowledge in our understanding of the role of oxidative stress in the pathogenesis of endometriosis.

What to do with troublesome hot flush?
Su Hyun Chae, Chulmin Lee, Heung Yeol Kim, Ji Young Lee
Kosin Med J. 2018;33(2):141-149.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.2.141
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Hot flush (hot flush or facial flush) is the most frequent symptom experienced by women of peri-menopausal age. It may appear on women or even men after surgery or chemotherapy. Hot flush is one of the biggest reason for women to undergo hormone replacement therapy (HRT). It also crucially affects various aspects of life quality such as occupation, social life, daily routine and health awareness. The most effective and fundamental remedy for hot flush is HRT. However, a few women is not responsive to HRT and investigation to elucidate other causes of hot flush is warranted, especially in elderly. The contraindications such as breast cancer mandates other modality of treatment. Variety of treatment for hot flush other than HRT will be discussed herein.

Original articles
Experience of Campylobacter gastroenteritis in Korean children: Single-center study
Seung Hyeon Seo, Yeoun Joo Lee, Sang Wook Mun, Jae Hong Park
Kosin Med J. 2018;33(2):150-158.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.2.150
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

Although Campylobacter is the main cause for bacterial acute gastroenteritis (AGE), there has been no notable clinical research into it, especially for Korean children. In this study, we share our experience of clinical, laboratory and image findings with Campylobacter AGE.

Methods

Between May 2013 and June 2016, children diagnosed as having Campylobacter AGE were retrospectively enrolled in our study. Campylobacter AGE was considered diagnosed when a patient had symptoms of bacterial AGE and a positive Campylobacter result in stool using multiplex PCR.

Results

Among 539 patients with suspected bacterial AGE, 31 (5.8%) patients had a positive result for Campylobacter. The average age of the 31 patients was 10.2 ± 5.0 years with a range between 1.1 and 16.9 years. Eighteen (58%) of the total patients were hospitalized between June and August. Diarrhea (93.5%), abdominal pain (83%) and fever (83%) were common symptoms. For 20 patients (65%), diarrhea lasted for less than three days, and fever lasted for 2.1 days on average. Among the 20 patients subjected to imaging studies, 12 patients (60%) showed bowel wall thickening on the right side of colon. In blood tests of 30 patients, 22 (73%) and 29 (97%) patients exhibited leukocytosis and elevated C-reactive protein, respectively. During treatment for Campylobacter AGE, prediagnostic empirical antibiotics were used for 6 (19%) patients. All patients recovered without complications.

Conclusions

Among the children with suspected bacterial AGE, 5.8% had a positive result on Campylobacter in stool using multiplex PCR. Therefore, we observe that Campylobacter AGE should be considered in school-age children who have diarrhea, fever, and abdominal pain.

Empirical antibiotics for recurrent urinary tract infections in children
Hyun Gil Choi, Ji Young Lee, Chi Eun Oh
Kosin Med J. 2018;33(2):159-170.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.2.159
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

The purpose of this study was to compare antibiotic resistance patterns between first urinary tract infection (UTI) and recurrent UTI groups and to obtain information regarding empirical antibiotic selection for treating recurrent UTI.

Methods

We retrospectively reviewed 148 children treated for UTIs from January 2009 to June 2016. The patients were divided into two groups: first UTI (N = 148) and recurrent UTI (17 patients and 20 episodes).

Results

In both groups, Escherichia coli was the most frequent causative organism, accounting for 89.9% and 75.0% in the first and recurrent UTI groups, respectively. When E. coli or Klebsiella pneumoniae was the causative organism, extended-spectrum β-lactamase (ESBL)-producing organisms were more frequent in the recurrent UTI group (17.6%) than in the first UTI group (14.0%); however, this difference was not statistically significant (P = 0.684). Cefotaxime was the most frequently used first-line empirical antibiotic in both groups. In the first UTI and recurrent UTI groups, 7.4% and 15.0% of patients were treated with intravenous antibiotics as definitive therapy, respectively (P = 0.250). Fifteen out of 17 patients having a second UTI had different causative organisms or antibiotic susceptibility patterns compared to their previous episode.

Conclusions

Escherichia coli was the most frequent causative organism in the recurrent UTI group. There were no differences in the proportion of ESBL-producing organisms between the first UTI and recurrent UTI groups. Therefore, when a UTI recurs in children, the antibiotics effective on the most common causative organism might be administered as empirical antibiotics.

The effect of short-term particular matter2.5 exposure on asthma attacks in asthma children in Fukuoka, Japan
Song Han Lee, Koh Woon Lee, Yoon Ha Hwang, Hiroshi Odajima
Kosin Med J. 2018;33(2):171-180.   Published online January 19, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.2.171
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

We investigated whether asthma attacks in asthmatic children were caused by short-term exposure to particulate matter(PM)2.5.

Methods

Subjects were 411 patients who received inhalation therapy in National Fukuoka Hospital, from March to May 2013. All subjects were outpatients. We surveyed the air quality measurement results in the stations closest to the address of the patients. Data were used from the City of Fukuoka website data on air pollution. We carried out a case-crossover study and compared PM2.5 concentration between 7 days after asthma attack occurred and the day asthma attack occurred and 1, 2 and 3 days before asthma attack occurred.

Results

Highest hourly concentration of the day (OR 1.013, 95%CI 1.000-1.025) showed a significant association with 1 day before PM2.5 concentration statistically. And 0-1 year-old infants were more vulnerable to the highest concentration of 1 day before PM2.5 concentration(P < 0.05). Average concentration of NO2 and O3 and asthma attack also showed a significant association.

Conclusions

Maximal daily PM2.5 concentrations within 24 hours prior to the attack affect asthma exacerbation. 0-1 year-old infants are particularly vulnerable to PM2.5 concentration. Asthma exacerbation is aggravated by NO2 and O3 concentration on the day of the asthma attack.

Comparative study between an intensive small group teaching and a 1-year clinical practice on OSCE
Sinjae Kim, Minhwan Park, Ji-Hyun Seo, Hyang-Ok Woo, Hee-Shang Youn, Jung Je Park, Sea-Yuoug Jeon, Jung Seok Hwa, Patricia Mullan, Larry D. Gruppen
Kosin Med J. 2018;33(2):181-190.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.2.181
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

Our school introduced a new curriculum based on faculty-directed, intensive, small-group teaching of clinical skills in the third-year medical students. To examine its effects, we compared the mean scores on an OSCE between the third- and fourth-year medical students.

Methods

Third- and fourth-year students did rotations at the same five OSCE stations. They then completed a brief self-reporting questionnaire survey to examine the degree of satisfaction with new curriculum in the third-year students and clinical practice in the fourth-year students, as well as their perception of confidence and preparedness. We analyzed the OSCE data obtained from 158 students, 133 of whom also completed the questionnaire.

Results

Mean OSCE scores on the breast examination and wet smear stations were significantly higher in the third-year group (P < 0.001). But mean OSCE scores of motor-sensory examination and lumbar puncture were significantly higher in the fourth-year group (P < 0.05). The mean OSCE scores had no significant correlation with satisfaction. In addition, the self-ratings of confidence had a high degree of correlation with satisfaction with new curriculum (r = 0.673) and clinical practice (r = 0.692). Furthermore, there was a moderate degree of correlation between satisfaction and preparedness in both groups (r = 0.403 and 0.449).

Conclusions

There is no significant difference in the effect on the degree of clinical performance and confidence between an intensive-small group teaching and a 1-year clinical practice. If combined, intensive small group teaching and clinical practice would be useful to improve the degree of ability and confidence in medical students.

Comparative study of off-clamp, laparoscopic partial nephrectomy (OCLPN) and conventional hilar control, laparoscopic partial nephrectomy (HCLPN) for renal tumors: One-year follow-up results of renal function change
Su Hwan Kang, Hyun Yul Rhew, Taek Sang Kim
Kosin Med J. 2018;33(2):191-199.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.2.191
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

We designed the study to compare the oncologic and renal function outcomes of off-clamp, laparoscopic partial nephrectomy (OCLPN) and conventional laparoscopic partial nephrectomy (HCLPN) for renal tumors.

Methods

Between March 2008 and July 2015, 114 patients who underwent laparoscopic partial nephrectomy (LPN) of a renal neoplasm were studied. We performed LPN without hilar clamp on 40 patients (OCLPN, Group 1), and conventional LPN with hilar control and renorrhaphy on another 40 patients (HCLPN, Group 2). We retrospectively reviewed the medical records of each patient's age, sex, R.E.N.A.L. nephrometry score (RNS), operation time, complications, hospitalization period, tumor size, positive resection margin, histologic classification of tumor, pathologic stage, Fuhrman grade, estimated blood loss (EBL), warm ischemic time (WIT), and estimated glomerular filtration rate (eGFR) before and one year after surgery.

Results

There were no significant differences in age, sex, preoperative eGFR, EBL, surgical (anesthesia) time, and tumor size between the two groups. The mean eGFR was not significantly different between the OCLPN and HCLPN groups 1 month (95 and 86.2 mL/min/1.73 m2, respectively; P = 0.106), 6 months (92.9 and 83.6 mL/min/1.73 m2, respectively; P = 0.151) and 12 months (93.8 and 84.7 mL/min/1.73 m2, respectively; P = 0.077) postoperatively. The change in eGFR after one year was 3.9% in the OCLPN group and −7.9% in the HCLPN group.

Conclusions

OCLPN was superior to HCLPN in preserving renal function one year after surgery, and there was no statistically significant difference in tumor treatment results.

Case reports
Pulmonary tuberculosis occurred in patient with Tracheobronchopathia Osteochondroplastica
Jung Woo Shim, Joon Hwan Kim, Young Woo Jang, Yon Mi Sung, Narae Kim, Sang Min Lee
Kosin Med J. 2018;33(2):200-207.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.2.200
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Tracheobronchopathia osteoplastica (TO) is a rare benign disease in which the anterior inner wall of the tracheobronchus changes because of abnormal chondrogenesis or ossification, while the posterior wall of the trachea is spared. The etiology is not clearly understood, but may relate with chronic infection, inflammation, and trauma. In some case studies, it has also been reported to be accompanied by other chronic diseases such as atrophic rhinitis and amyloidosis. However, Coexistence of TO and tuberculosis has rarely been reported, and has never been reported in Korea. Here, we report a case of a 70-year-old male patient who complained of hemoptysis and whose case was diagnosed as TO and pulmonary tuberculosis through bronchoscopy with bronchial washing and biopsy.

Transient Inferior Oblique Muscle Palsy Following Transconjunctival Lower Lid Blepharoplasty
Hye Jin Lee, Soolienah Rhiu, Dong Eun Oh, Jin Ho Jeong
Kosin Med J. 2018;33(2):208-214.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.2.208
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Although the inferior oblique (IO) muscle is positioned considerably deep in the orbit, transconjunctival lower lid blepharoplasty may affect it and transient or permanent IO muscle palsy might result. Therefore diplopia should be explained before cosmetic blepharoplasty performed with transconjunctival approach.

Adrenal incidentaloma: a case of asymptomatic pheochromocytoma
Sang Yoong Park, Jong Cheol Rim, Hyun Chul Cho, Yoon Chan Lee, Jung A Kim, So Ron Choi
Kosin Med J. 2018;33(2):215-222.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.2.215
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

An incidentaloma is a tumor found incidentally without clinical symptoms or suspicion; the lesion may be adrenal, pituitary, or thyroidal. We report the case of an asymptomatic individual with preoperatively undiagnosed pheochromocytoma (size: 4.86 cm) that was revealed using elective nonadrenal surgical procedures. The patient demonstrated peri- and post-operative hypertensive crisis and tachycardia. Three days after the dramatic onset of symptoms, the patient expired due to pulmonary edema, multiple organ failure, and terminal sepsis, despite administration of extracorporeal membrane oxygenation-assisted cardiopulmonary resuscitation. A left medial kidney mass obtained at autopsy confirmed pheochromocytoma.

A Case of Fitz-Hugh-Curtis syndrome in a male patient
Si Hyeong Lee, Ju Il Yang, Jung Sik Choi
Kosin Med J. 2018;33(2):223-227.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.2.223
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Fitz-Hugh-Curtis syndrome has been described as perihepatitis associated with pelvic inflammatory disease (PID). It is classically seen in premenopausal young women who have right upper quadrant pain, usually but not always accompanied by symptoms of PID, and is frequently confused with biliary tract disease. However, the syndrome has rarely been reported in males. The predominant symptom is right upper quadrant pain, but PID may not be present in male patients. Here, we report a case of Fitz-Hugh-Curtis syndrome in a young male patient, which was diagnosed by serological tests and computed tomography. Fitz-Hugh-Curtis syndrome should be considered as a possible cause of pain in the right upper quadrant in male patients, although such a case is very rare.

A Case of Ceruminous Adenoma Arising from the External Auditory Canal
Seong-Chul Yeo, Ho Joong Lee, Jin Yong Kim, Dae Whan Kim, Jin Hyun Seo, Seong-Ki Ahn
Kosin Med J. 2018;33(2):228-234.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.2.228
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Ceruminous adenoma is a benign neoplasm of the ceruminous gland, and its development in human external auditory canal is very rare. Due to the limited number of cases, controversy still exists about nomenclature, classification, diagnosis and its treatment. Recently we experienced a 55 years old woman who was diagnosed with ceruminous adenoma of the external auditory canal, and who was treated with wide excision. So we report this uncommon case in combination with a review of the literature.

Mallory-Weiss Tear After Cardiopulmonary Resuscitation in a Patient Suffering From Acute Myocardial Infarction
Jin Seok Yu, Woo Suk Ko, June Hyun Kim, Kwang Uk Bae
Kosin Med J. 2018;33(2):235-239.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.2.235
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

A report of a 79 year old male patient suffering from acute myocardial infarction with Mallory-Weiss tear after successful cardiopulmonary resuscitation(CPR) by emergency medical technician in the swimming pool is presented. Successful percutaneous coronary intervention(PCI) was done after appropriate transfusion. The patient survived and discharged without major complications after admitting 11days in the hospital. Importance of CPR in AMI patient is reiterated as complication such as Mallory-Weiss tear may arise.

A double-knotted pulmonary artery catheter with large loop in the right internal jugular vein: A case report
Kyoung Sub Yoon, Jung A Kim, Jeong In Hong, Jeong Ho Kim, Sang Yoong Park, So Ron Choi
Kosin Med J. 2018;33(2):240-244.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.2.240
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Knotting of a pulmonary artery catheter (PAC) is a rare, but well-known complication of pulmonary artery (PA) catheterization. We report a case of a double-knotted PAC with a large loop in a patient with hepatocellular carcinoma (HCC) undergoing liver transplantation, which has been rarely reported in the literature. A PAC was advanced under pressure wave form guidance. PAC insertion was repeatedly attempted and the PAC was inserted 80 cm deep even though PAC should be normally inserted 45 to 55 cm deep. However, since no wave change was observed, we began deflating and pulling the balloon. At the 30-cm mark, the PAC could no longer be pulled. Fluoroscopy confirmed knotting of the PAC after surgery (The loop-formed PAC was shown in right internal jugular vein); thus, it was removed. For safe PA catheterization, deep insertion or repeated attempts should be avoided when the catheter cannot be easily inserted into the pulmonary artery. If possible, the insertion of PACs can be performed more safely by monitoring the movement of the catheter under fluoroscopy or transesophageal echocardiography.

Anaphylaxis occurred immediately after prophylactic antibiotics injection with negative intradermal skin test during laparoscopic cholecystectomy
Hyung Joo Jeong, Hsi Chiang Kung, Tae Woo Park, Dong Hee Kang, Yu Som Shin, Ju Deok Kim
Kosin Med J. 2018;33(2):245-251.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.2.245
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Prophylactic antibiotics that are used to prevent post-operative infection can commonly cause anaphylactic reactions during anesthesia. It is therefore necessary to perform a skin test before antibiotics are administered in order to diagnose and prevent anaphylactic reactions. However, the results of the antibiotic skin test can differ according to the drug, dose, and reagent concentration.

We report a case of anaphylactic shock with bronchospasm and cardiovascular collapse immediately following administration of the prophylactic cefazedone after induction of general anesthesia for laparoscopic cholecystectomy.


KMJ : Kosin Medical Journal