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Volume 33(3); December 2018
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Review article
The ideal strategies of chemotherapy for the treatment of cervical cancer
Suk Bong Koh
Kosin Med J. 2018;33(3):283-288.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.3.283
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Abstract PDFPubReader   CrossRef-TDMCrossref - TDM

Historically, the standard treatment for early-stage cervical cancer has been radical surgery in patients with operable disease. Patients with locally advanced disease (defined as FIGO stage IB2 and usually with tumors greater than 4 cm, IIB, III and IVA) are usually treated with radical radiotherapy, which consists of external beam radiotherapy and internal brachytherapy. However, the discovery that cervical cancer tumors are sensitive to chemotherapy led to the initiation of studies looking at adding chemotherapy to both radiotherapy and surgery. Following a National Cancer Institute (NCI) alert in 1999 (NCI 1999), chemoradiotherapy became the standard of care for women with locally advanced cervical cancer.1

Original articles
Analysis of factors related systemic recurrence after breast conserving surgery in stage I breast cancer
Yoon-Seok Kim, Dong-Won Ryu, Chung-Han Lee
Kosin Med J. 2018;33(3):289-296.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.3.289
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Abstract PDFPubReader   CrossRef-TDMCrossref - TDM
Objectives

In these days, patients with stage I breast cancer have increased by regular health examination and diagnostic tool development. The aim of this retrospective study is to identify systemic recurrence related factors after breast conserving surgery (BCS) for stage I breast cancer.

Methods

In this study, we analyzed the correlation between systemic recurrence and pathologic factors. We reviewed 223 patients who underwent BCS for stage I breast cancer. Postoperative pathologic factors, recurrent rates and sites were studied. In addition, preoperative patients'data were also collected. Statistical analysis was done by using PASW 16.0 (SPSS Inc., Chicago, IL, USA).

Results

Systemic recurrence was found in 16 patients (7.17%) within 5 years after primary surgery. 5 patients had lymphatic invasion and 6 patients had vascular invasion. Lymphatic and vascular invasion had statistical correlation with systemic recurrence (P = 0.004, P = 0.001).

Conclusions

In this retrospective study, we can conclude that vascular invasion and lymphatic invasion are related systemic recurrence after BCS for stage I patients. Further studies with large cohort will be required to fully understand the risk factors of systemic recurrence for stage I breast cancer patients.

Diagnostic value of magnetic resonance imaging using superparamagnetic iron oxide for axillary node metastasis in patients with breast cancer: a meta-analysis
Ru Da Lee, Jung Gu Park, Dong Won Ryu, Yoon Seok Kim
Kosin Med J. 2018;33(3):297-306.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.3.297
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Abstract PDFPubReader   CrossRef-TDMCrossref - TDM
Objectives

Identification of axillary metastases in breast cancer is important for staging disease and planning treatment, but current techniques are associated with a number of adverse events. This report evaluates the diagnostic accuracy of superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) techniques for identification of axillary metastases in breast cancer patients.

Methods

We performed a meta-analysis of previous studies that compared SPIO enhanced MRI with histological diagnosis after surgery or biopsy. We searched PubMed, Ovid, Springer Link, and Cochrane library to identify studies reporting data for SPIO enhanced MRI for detection of axillary lymph node metastases in breast cancer until December 2013. The following keywords were used: “magnetic resonance imaging AND axilla” and “superparamagnetic iron oxide AND axilla”. Eligible studies were those that compared SPIO enhanced MRI with histological diagnosis. Sensitivity and specificity were calculated for every study; summary receiver operating characteristic and subgroup analyses were done. Study quality and heterogeneity were also assessed.

Results

There were 7 publications that met the criteria for inclusion in our meta-analysis. SROC curve analysis for per patient data showed an overall sensitivity of 0.83 (95% Confidence interval (CI): 0.75–0.89) and overall specificity of 0.97 (95% CI: 0.94–0.98). Overall weighted area under the curve was 0.9563.

Conclusions

SPIO enhanced MRI showed a trend toward high diagnostic accuracy in detection of lymph node metastases for breast cancer. So, when the breast cancer patients has axillary metastases histologically, SPIO enhanced MRI may be effective diagnostic imaging modality for axillary metastases.

Agreement of three commercial anti-extractable nuclear antigen tests: EUROASSAY Anti-ENA Profile, Polycheck Autoimmune Test and FIDIS Connective Profile
Namhee Kim, In-Suk Kim, Chulhun L Chang, Hyung-Hoi Kim, Eun Yup Lee
Kosin Med J. 2018;33(3):307-317.   Published online January 19, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.3.307
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Background

Detection of antibodies to extractable nuclear antigens (ENAs) is needed for the diagnosis in systemic autoimmune diseases. In this study, we compared three reagents using line immunoblot assay (LIA) or multiplex bead immunoassay for detecting the anti-ENAs.

Methods

A total of 89 sera were tested by 3 different assays: EUROASSAY Anti-ENA Profile (Euroimmune, Germany), Polycheck Autoimmune Test (Biocheck GmbH, Germany), and FIDIS™ Connective Profile (Biomedical Diagnostics, France). The following individual ENAs were investigated: Sm, SS-A (Ro), SS-B (La), Scl-70, Jo-1 and RNP. We reviewed medical records to investigate the discrepant results among three methods.

Results

Overall percent agreements were 96.1% between EUROASSAY Anti-ENA Profile and FIDIS™ Connective profile; 90.4% between EUROASSAY Anti-ENA Profile and Polycheck Autoimmune Test using the manufacturers’ cutoff; 96.4% between EUROASSAY Anti-ENA Profile and Polycheck Autoimmune Test using a upward cutoff; 90.4% between FIDIS™ Connective profile and Polycheck Autoimmune Test the manufacturers’ cutoff; and 96.4% between FIDIS™ Connective profile and Polycheck Autoimmune Test a upward cutoff.

Conclusions

The three assays showed excellent agreement with each other. With appropriate cutoff, the all three assays for six of the anti-ENA tests investigated in this study can be used in clinical laboratories for detecting the anti-ENAs.

The effect of suture by absorbable material on corneal astigmatism after phacoemulsification
Jae Ho Yoo, Sang Joon Lee
Kosin Med J. 2018;33(3):318-327.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.3.318
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Abstract PDFPubReader   CrossRef-TDMCrossref - TDM
Objectives

To investigate the effect of absorbable suture on surgically-induced corneal astigmatism in 3.0-mm sclera tunnel cataract surgeries.

Methods

Medical records of patients who underwent phacoemulsification cataract surgery using a 3.0-mm sclera tunnel incision made by a single surgeon were reviewed. Uncorrected distant visual acuity, corneal astigmatism and surgically-induced astigmatism were measured in 56 patients' eyes that underwent sclera tunnel cataract surgery with absorbable sutures (sutured group) and in 23 patients' eyes without sutures (unsutured group). Uncorrected visual acuity, intraocular pressure, slit lamp examination, and automated keratometry were evaluated preoperatively and at 3 days, 2 weeks, 4 weeks, and 8 weeks after cataract operation.

Results

There were no significant differences in preoperative average uncorrected distant visual acuity of the two groups (sutured group: 0.79 ± 0.64, unsutured group: 0.68 ± 0.72, P = 0.145). Corneal astigmatism measured using keratometry in the sutured and unsutured group at postoperative day 3 were 2.27 ± 2.12 D versus 0.83 ± 0.55 D at (P < 0.001), a difference which had disappeared after 4 weeks. Surgically induced astigmatism using the Holladay and Vector methods showed similar outcomes, suggesting that the sutured group exhibited higher astigmatism compared with the unsutured group until 2 weeks post-surgery.

Conclusions

TPatients undergoing scleral tunnel cataract surgery with absorbable sutures have greater surgically induced astigmatism, especially in the early postoperative period, compared with those without sutures. However, this surgically induced astigmatism due to absorbable sutures in scleral tunnel cataract surgery is temporary and disappears at 4 weeks post-surgery.

The association between T wave inversion and apical hypertrophic cardiomyopathy
Cheol Byoung Chae, Ju Hee Ha, Jun Ho Kim, Jae Joon Lee, Han Il Choi, Ki Beom Park, Jin Hee Kim, Jung Hyun Choi
Kosin Med J. 2018;33(3):328-336.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.3.328
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Abstract PDFPubReader   CrossRef-TDMCrossref - TDM
Objectives

Electrocardiograhy (ECG) is the first step in hypertrophic cardiomyopathy (HCMP) diagnosis. For various reasons, the T wave inversion (TWI) and ECG change with time and HCMP is not easy to diagnosis. The aim of this retrospective study was to investigate the association between TWI on ECG and apical HCMP.

Methods

A total of 4,730 ECGs presenting TWI from January 2011 to March 2013 in Pusan National University Hospital were enrolled. 133 patients who were examined by both echocardiography and coronary angiogram were analyzed. Patients were divided into two groups: Group A (TWI ≥ 10 mm) and Group B (5 mm ≤ TWI < 10 mm). HCMP is defined by a wall thickness ≥ 15mm in one or more LV myocardial segments. Apical HCMP is defined to be hypertrophy that is confined to LV apex. The patients who had ECGs with at least one month interval were divided 3 groups: Normal T wave, Abnormal T wave, and Persistent TWI. The prevalence of Apical HCMP and coronary artery disease (CAD) was reviewed among the three groups.

Results

In this study there were a total 133 patients, with patients divided into Group A which had 15 patients and Group B which had 118 patients. Among the 23 patients with apical HCMP, three patients were Group A and twenty patients were Group B (P = 0.769). Regarding constancy of TWI, persistent TWI group was higher in apical HCMP than in other groups (P = 0.038). CAD had no difference between groups (P = 0.889).

Conclusions

T wave negativity was not associated with incidence of apical HCMP. However, apical HCMP was diagnosed more frequently in patients with persistent TWI. Further follow up echocardiographic study is needed to evaluate the progression of apical HCMP in patients with TWI.

A study of the effectiveness of using the serum procalcitonin level as a predictive test for bacteremia in acute pyelonephritis
Ga Hee Lee, Yoo Jin Lee, Yang Wook Kim, Sihyung Park, Jinhan Park, Kang Min Park, Kyubok Jin, Bong Soo Park
Kosin Med J. 2018;33(3):337-346.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.3.337
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Objectives

Serum procalcitonin (PCT) is a specific biomarker that rises after bacterial infection, and levels of PCT are known to correlate with the severity and mortality of patients with pneumonia and sepsis. However, the usefulness of PCT levels in acute pyelonephritis is unknown. This study aimed to evaluate the effectiveness of using the PCT level as a predictive test for bacteremia in acute pyelonephritis.

Methods

Between January 2012 and June 2013, 140 patients diagnosed with acute pyelonephritis were admitted to Haeundae Paik Hospital. Serum PCT, C-reactive protein (CRP), and white blood cell (WBC) levels at pre- and post- treatment were measured. Blood and urine cultures were obtained from all patients. The levels of PCT, CRP, and WBCs were each compared between the blood culture-positive and blood culture-negative groups to assess their effectiveness in predicting bacteremia.

Results

Pre-treatment PCT level was 0.77 ng/mL (95% CI: 0.42–1.60 ng/mL) in the blood culture-negative group and 4.89 ng/mL (95% CI: 2.88–9.04 ng/mL) in the blood culture-positive group, and the increase between the two groups was statistically significant. The area under the receiver operating characteristic curve of PCT level for prediction of bacteremia was 0.728. A cut-off value of 1.23 ng/mL indicated a sensitivity of 79.0 % and specificity of 60.0 % for PCT level.

Conclusions

Serum PCT level is a useful predictive test for bacteremia in acute pyelonephritis. Through the early detection of bacteremia, serum PCT level can help estimate the prognosis and predict complications such as sepsis.

Clinical features of Epstein-Barr Virus-associated Infectious Mononucleosis According to Age Group in Children
Soram Lee, Ju-Young Chung, Jung Je Park, Ji-Hyun Seo, Jae Young Kim, Jung Sook Yeom, Eun-Sil Park, Jae-Young Lim, Hyang-Ok Woo, Hee-Shang Youn
Kosin Med J. 2018;33(3):347-357.   Published online January 19, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.3.347
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Abstract PDFPubReader   CrossRef-TDMCrossref - TDM
Objectives

Few studies of pediatric Epstein-Barr virus (EBV)-associated infectious mononucleosis (IM) have been conducted in Korea. We evaluated the clinical features of children with IM to define differences according to age.

Methods

We conducted retrospective chart reviews of 68 children aged 0 to 15 years who were diagnosed by EBV-associated IM with EBV-Viral Capsid Antigen(VCA) IgM at laboratory test and were admitted between 2010 and 2014. The children were classified into four age groups: aged 0–3, 4–6, 7–9, and 10–15 years.

Results

The age distribution of patients was as follows: 19 (27.9%) 0–3, 25 (36.8%) 4–6, 13 (19.1%) 7–9, and 11 (16.2%) 10–15. Fever was the most common presentation regardless of age. It was more common in the 0–3 group than the 4–6 group (P = 0.018). Pharyngitis was more common in the 7–9 group than the 0–3 group (P = 0.048), and myalgia was more common in the 10–15 group than the 0–3 group (P = 0.007). Pharyngitis was accompanied by lymphadenopathy, protracted fever, and rash. In the 0–3 age group, the prevalence of rash was higher while the percentage of atypical lymphocytes was lower, but there was no statistical support for this tendency. There were no differences in the frequency of hepatosplenomegaly or laboratory findings between age groups.

Conclusions

IM is not uncommon in young children and its clinical presentation varies with age. Therefore, IM should be suspected in young febrile children with pharyngitis and rash despite low percentages of atypical lymphocytes.

Correlation between nasal mucosal thickness around the lacrimal sac fossa and surgical outcomes in endonasal dacryocystorhinostomy
Jae Ho Yoo, Chang Zoo Kim, Ki Yup Nam, Seung Uk Lee, Jae Ho Lee, Sang Joon Lee
Kosin Med J. 2018;33(3):358-368.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.3.358
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Abstract PDFPubReader   CrossRef-TDMCrossref - TDM
Objectives

To identify the relationship between surgical success rate and preoperative nasal mucosal thickness around the lacrimal sac fossa, as measured using computed tomography.

Methods

We reviewed 33 eyes from 27 patients who underwent endoscopic dacryocystorhinostomy after diagnosis of primary nasolacrimal duct obstruction and who were followed-up with for at least six months between 2011 and 2014. We measured preoperative nasal mucosal thickness around the bony lacrimal sac fossa using computed tomography and analyzed patient measurements after classifying them into three groups: the successfully operated group, the failed operation group, and the non-operated group.

Results

Surgery failed in six of the 33 eyes because of a granuloma at the osteotomy site and synechial formation of the nasal mucosa. The failed-surgery group showed a clinically significantly greater decrease in nasal mucosal thickness at the rearward lacrimal sac fossa compared with the successful-surgery group. However, nasal mucosal thickness of fellow eyes (i.e., non-operated eyes) was not significantly different between the two groups, and the location of the uncinate process did not appear to influence mucosal thickness. In the failed group, posteriorly located mucosal thickness of operated eye fossa was thinner than that of the non-operated eyes, but not significantly so.

Conclusions

Our results from this quantitative anatomical study suggest that nasal mucosal thickness is a predictor of endoscopic dacryocystorhinostomy results.

Relation of Various Parameters Used to Estimate Cardiac Vagal Activity and Validity of pNN50 in Anesthetized Humans
Jae Ho Lee, In Young Huh, Jae Min Lee, Hyung Kwan Lee, Il Sang Han, Ho Jun Kang
Kosin Med J. 2018;33(3):369-379.   Published online January 19, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.3.369
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Abstract PDFPubReader   CrossRef-TDMCrossref - TDM
Objectives

Analysis of heart rate variability (HRV) has been used as a measure of cardiac autonomic function. According to the pNN50 statistic, the percentage of differences between successive normal RR intervals (RRI) that exceed 50 ms, has been known to reflect cardiac vagal modulation. Relatively little is known about the validity of pNN50 during general anesthesia (GA). Therefore, we evaluated the correlation of pNN50 with other variables such as HF, RMSSD, SD1 of HRV reflecting the vagal tone, and examined the validity of pNN50 in anesthetized patients. Methods: We assessed changes in RRI, pNN50, root mean square of successive differences of RRI (RMSSD), high frequency (HF) and standard deviation 1 (SD1) of Poincaré plots after GA using sevoflurane anesthesia. We also calculated the probability distributions for the family of pNNx statistics (x: 2-50 ms).

Results

All HRV variables were significantly decreased during GA. HF power was not correlated with pNN50 during GA (r = 0.096, P = 0.392). Less than pNN47 was shown to have a correlation with other variables.

Conclusions

These data suggest that pNN50 can not reflect the level of vagal tone during GA.

Comparative observational study of aminophylline with prophylactic and therapeutic uses for clinical outcomes in preterm infants
Mi Hye Bae, Na Rae Lee, Young Mi Han, Shin Yun Byun, Kyung Hee Park
Kosin Med J. 2018;33(3):380-385.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.3.380
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Abstract PDFPubReader   CrossRef-TDMCrossref - TDM
Objectives

Aminophylline has been used for prevention or treatment of apnea in preterm infants with idiopathic apnea of prematurity. The aim of this study was to assess the clinical usefulness of prophylactic in comparison with therapeutic aminophylline therapy.

Methods

This retrospective observational study included infants born with a birth weight of < 2,500 g or at < 36 weeks of gestation. Infants born between August 2013 and July 2014 who received aminophylline therapy within 24 hr after birth were assigned to the prophylactic group, while infants born between August 2014 and July 2015 who received aminophylline therapy after obvious apnea were assigned to the therapeutic group. We compared clinical characteristics, including days of ventilator and oxygen therapy and bronchopulmonary dysplasia (BPD) between both groups.

Results

Sixty—four patients and 25 infants were identified in the prophylactic and therapeutic groups, respectively. The mean gestational age and birth weight were 32.57 ± 1.96 weeks and 1765 ± 205 g, respectively, in the prophylactic group and 32.46 ± 1.82 weeks and 1770 ± 250 g, respectively, in the therapeutic group. No significant differences in clinical characteristics were found between the two groups. Similar clinical outcomes, including days of ventilator and oxygen therapy, intraventricular hemorrhage (IVH), periventricular leukomalacia, and BPD, were observed between the two groups.

Conclusions

The present study showed that the prophylactic use of aminophylline does not improve the clinical outcomes, including BPD, IVH, and ventilator dependency as compared with therapeutic use. In other words, routine prophylactic use of aminophylline is unnecessary.

Case reports
Congenital bronchoesophageal fistula in an adult: a case report and radiologic review
Bo Sung Kim, Eun-Ju Kang, Ki-Nam Lee, Pil Jo Choi
Kosin Med J. 2018;33(3):386-390.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.3.386
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Abstract PDFPubReader   CrossRef-TDMCrossref - TDM

Congenital bronchoesophageal fistula (BEF) is rarely reported in adults in the English literature. Herein, we present a rare case of congenital BEF in a 43-year-old man that was incidentally found on esophagogastroduodenoscopy. Chest CT and barium esophagography revealed a fistula between his lower esophagus and the right lower lobe segmental bronchus. After the fistula was surgically treated, the fistula was no longer noted on follow-up barium esophagography.

Case Report of Prostate Cancer Patient with Only Lymph Node Involvement on F-18 FDG PET/CT
Hyun Jin Jung, Sungmin Kang
Kosin Med J. 2018;33(3):391-395.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.3.391
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We report a case of a patient with locally advanced prostate cancer who had only lymph node involvement without bone metastasis on F-18 FDG PET/CT.

A 62-year-old Korean male was admitted to our hospital due to dysuria. His PSA level on admission was 79.35 ng/mL. A transrectal ultrasound-guided prostate biopsy confirmed prostate cancer and his Gleason score was 10 (5+5). F-18 FDG PET/CT demonstrated a hypermetabolic mass lesion with SUVmax 7.0 in the prostate and hypermetabolism with SUVmax 4.7 of the abdominal and pelvic lymph nodes. Tc-99m HDP bone scan showed no significant bone metastasis. The patient underwent hormonal therapy for 9 months. Follow-up F-18 FDG PET/CT showed significantly reduced size and FDG uptake in the prostate and abdominal and pelvic lymph nodes. In this case, treatment monitoring with F-18 FDG PET/CT showed decreased mass size and FDG uptake in the prostate and abdominal and pelvic lymph nodes.

Successful Removal of 15-year-old Pacemaker Leads by Weight and pulley method
Hyun-Woo Kim, Ho-Cheol Shin, Han-Young Jin, Jeong-Sook Seo, Jae-Sik Jang, Tae-Hyun Yang, Dae-Kyeong Kim, Dong-Soo Kim
Kosin Med J. 2018;33(3):396-401.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.3.396
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Abstract PDFPubReader   CrossRef-TDMCrossref - TDM

Extraction of old pacemaker leads remains a complex procedure owing to fibrotic encapsulation and lead adhesions. We report a case of extraction of 15-year-old pacemaker leads by weight and pulley method. A 81-year-old man presented with exposed pacemaker leads out of body with purulent discharge from a pacemaker insertion site. He inserted DDD (dual chamber pacing, dual chamber sensing dual function) pacemaker implantation 15 years ago for SSS. Previously pacemaker battery was removed 3 years ago due to recurrent infection of pacemaker scar site. We extracted the pacemaker leads by weight and pulley method successfully without any complications.

Case of hyperosmolar hyperglycemic state by a sodium-glucose cotransporter 2 inhibitor
In-Young Nho, Hae-Sung Kim, Nam-Kyu Kang, Myung-Won Lee, Soo-Kyung Kim, Seok-O Park
Kosin Med J. 2018;33(3):402-408.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.3.402
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Inhibitors of sodium-glucose cotransporters type 2 (SGLT2) are proposed as a novel approach for the management of type 2 diabetes mellitus. SGLT2 cotransporters are responsible for reabsorption of 90 % of the glucose filtered by the kidney. The glucuretic effect resulting from SGLT2 inhibition contributes to reduce hyperglycaemia and also assists weight loss and blood pressure reduction.

In this study, we presented the case of a 59-year-old male who developed hyperosmolar hyperglycemic state (HHS), possibly caused by a sodium-glucose cotransporter 2 (SGLT2) inhibitor, a novel class of antihyperglycemic agents. This case highlights that HHS can develop in patients with diabetes treated with SGLT2 inhibitors


KMJ : Kosin Medical Journal