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Volume 35(2); December 2020
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Original Articles
Effects of White-coat Hypertension on Heart Rate Recovery and Blood Pressure Response during Exercise Test
Sol Jin, Jung Ho Heo, Bong Jun Kim
Kosin Med J. 2020;35(2):89-100.   Published online December 31, 2020
DOI: https://doi.org/10.7180/kmj.2020.35.2.89
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

White-coat hypertension is defined as high blood pressure (BP) on clinical assessment but normal BP elsewhere or on ambulatory measurement. Autonomic dysfunction may be one of the mechanisms causing white-coat hypertension. Slowed heart rate recovery and excessive BP response during exercise test are associated with autonomic dysfunction. The purpose of this study was to determine the association between white-coat hypertension and abnormal autonomic nervous system response.

Methods

We assessed 295 patients stratified into three groups via 24hr ambulatory BP monitoring, following 2017 ACC/AHA guidelines: normal BP group, white-coat hypertension group, and a hypertension group. We analyzed medical history, blood test, echocardiography, 24hr ambulatory BP monitoring, and exercise test data.

Results

There was no difference in basement characteristics and echocardiography among the groups. Blunted heart rate recovery of each group showed a significant difference. Control group had 0% blunted heart rate recovery, but 33.3% in white coat group and 27.6% in true hypertension group (P < 0.001). Also, in the control group, 4.5% showed excessive BP response, but 31.5% in the white coat hypertension group and 29.3% in the true hypertension group (P < 0.001). Excessive BP response during the exercise test or blunted heart rate recovery, which is an indicator of autonomic nervous system abnormality, was more common in the hypertensive group and white-coat hypertension group than in the normal BP group.

Conclusions

These results confirmed that white-coat hypertension has an autonomic nervous system risk. Therefore, white-coat hypertension can be a future cardiovascular risk factor.

Therapeutic Effects of Prolonged Release Melatonin (Circadin®) in Patients with Overactive Bladder and Chronic Insomnia in More Than 55 Years Old
Min Jung Park, Seon Young Seo, Hyun Jun Park, Jih Hoon Park, Mi Young Lim, Nam Cheol Park
Kosin Med J. 2020;35(2):101-113.   Published online December 31, 2020
DOI: https://doi.org/10.7180/kmj.2020.35.2.101
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

Bladder storage symptoms including nocturia is the most common cause of sleep disturbance in all age groups. Sleep disturbance is also a main cause of nocturia so that sleep recovery can clinically improve nocturia. Melatonin has main action to induce sleep and additional effects of smooth muscle relaxation, free radical scavenging, anti-inflammation, et cetera. This study was evaluated the improvement of sleep quality after administrating prolonged-release melatonin in elderly patients with overactive bladder and chronic insomnia.

Methods

This clinical trial was performed with a randomized single open study. Thirty-seven patients with overactive bladder and chronic insomnia were initially enrolled in this study. After 4 or 12 weeks treating with 2 mg of prolonged-release melatonin, clinical outcomes were evaluated with OABSS, IPSS, PSQI and WHO 5 well-being index.

Results

Of the 37 patients, 34 (91.9%) were included in the ITT group and 26 (76.5%) in the PP group. In the primary outcome of PP group, significant improvements were observed in total OABSS and nocturia frequencies at 12 weeks, respectively. Secondary outcome measurement including in voiding, storage symptoms, and total IPSS scores showed the improvement at 4 and 12 weeks and in total and sleep quality PSQI scores at 12 weeks, and in quality of life scores of the WHO 5 well-being index at 12 weeks. Only one (3.8%) adverse event was observed.

Conclusions

These results suggest clearly that prolonged-release melatonin in elderly patients with overactive bladder and chronic insomnia has the potential to control concomitant voiding and sleep difficulty.

Differences in Endoscopic Findings of Primary and Secondary Gastric Lymphoma
Kyoungwon Jung, Hae Soo Jeon, Moo In Park, Il Hyeong Choe, Hyun Seung Je, Jae Hyun Kim, Sung Eun Kim, Won Moon, Seun Ja Park
Kosin Med J. 2020;35(2):114-124.   Published online December 31, 2020
DOI: https://doi.org/10.7180/kmj.2020.35.2.114
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

: Since endoscopic findings of primary gastric lymphoma are ambiguous and diverse, it is not easy to distinguish them from gastric adenocarcinoma or secondary gastric lymphoma. The aim of this study was to investigate the difference in clinical and endoscopic features between primary gastric lymphoma and gastric involvement of lymphoma.

Methods

: Forty-eight patients were enrolled in this retrospective study between June 2008 and February 2017. The patients were divided into primary gastric lymphoma group (primary group, n = 18) and gastric involvement group (secondary group, n = 30) based on whether or not they carried gastric lesions alone. Patients’ clinical characteristics, endoscopic findings and pathologic data were retrospectively reviewed based on electronic medical records.

Results

: The mean age of patients was 63.3 ± 13.1 years and 29 patients were female (60.4%). Diffuse large B-cell lymphoma pathology (81.3%), gastric body involvement (47.9%) and ulceroinfiltrative morphology on endoscopy (43.8%) were common features. Regardless of the two groups, the initial endoscopic diagnosis was considered as lymphoma only in 41.7%. Compared with the primary group, fundus (P = 0.035) and regional lymph node (P < 0.001) were significantly associated with the secondary group. However, there was no significant difference in endoscopic findings including location, size, number, and morphology of lesion.

Conclusions

: Endoscopic diagnosis of gastric lymphoma is a challenge. There is no difference in endoscopic findings between the primary and secondary groups even when confirmed separately. However, when the lesion is present in the fundus, we keep in mind the possibility of secondary gastric lymphoma.

Efficacy of Evolocumab in Patients with Hypercholesterolemia
Xuan Jin, Moo Hyun Kim, Young-Rak Cho, Jong-Sung Park, Kai Song, Song Lin Yuan
Kosin Med J. 2020;35(2):125-132.   Published online December 31, 2020
DOI: https://doi.org/10.7180/kmj.2020.35.2.125
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

The FOURIER trial reported that inhibition of PCSK9 with evolocumab on a background of statin therapy lowered low-density lipoprotein (LDL) cholesterol levels to a median of 30 mg per deciliter (0.78 mmol per liter) and reduced the risk of cardiovascular events. Here, we report data from a single center focusing on the effect of a PCSK9 inhibitor antibody on hyperlipidemia.

Methods

We enrolled 29 hypercholesterolemia patients who had LDL cholesterol levels ≥ 70 mg per deciliter or non-HDL cholesterol ≥ 100 mg per deciliter and were divided into two groups (placebo n = 14, evolocumab n = 15), and participated in a 72 – 96 week, randomized, double-blind, placebo-controlled trial with statin therapy. Patients were randomly assigned to receive evolocumab (140 mg every 2 weeks or 420 mg monthly) or matched placebo via subcutaneous injection. Lipid changes during follow-up were analyzed.

Results

The median LDL cholesterol level at baseline was 88 mg per deciliter, and the average LDL cholesterol level was 101.8 ± 20.0 mg per deciliter. At 4 weeks, the median LDL cholesterol level was 39 mg per deciliter, and the average LDL cholesterol level was 34.8 ± 51.8 mg per deciliter. Compared to placebo group, the LDL cholesterol levels were significantly reduced after treatment (P < 0.001), as well as total cholesterol, ApoB, and ApoB/ApoA1 levels. During follow-up, no discomfort was reported at local injection sites, and no cases of abnormal liver function were observed.

Conclusions

Evolocumab significantly reduced LDL cholesterol levels and was well tolerated.

Usefulness of Psoas Muscle Cross-Sectional Area in Evaluating Physical Performance in Patients with Liver Cirrhosis
Bo Seong Jang, Han Eum Choi, Jae Hyun Lee, Young Joo Sim, Ghi Chan Kim, Ho Joong Jeong
Kosin Med J. 2020;35(2):133-142.   Published online December 31, 2020
DOI: https://doi.org/10.7180/kmj.2020.35.2.133
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

To investigate the relationship between the psoas muscle cross-sectional area and physical performance in patients with liver cirrhosis.

Methods

This study analyzed ambulatory patients with liver cirrhosis aged < 65 years, who underwent abdominal computed tomography (CT) and Short Physical Performance Battery (SPPB) tests from December 2018 to December 2019. A total of 46 patients (36 men, 10 women) were included. In abdominal CT scans, the psoas muscle cross-sectional area (mm2) was measured at the distal end-plate level of the L4 vertebral body and normalized by dividing by height (m). Physical performance was evaluated using SPPB. A correlation analysis between the psoas muscle cross-sectional area and SPPB was performed. Kruskal-Wallis test was used to determine differences in the psoas muscle cross-sectional area and SPPB according to the Child-Pugh classification. Multiple regression analysis was performed to determine factors affecting SPPB.

Results

The correlation coefficient between the psoas muscle cross-sectional area and SPPB was 0.459 at the P < 0.01 level. No difference was observed in the psoas muscle cross-sectional area and SPPB according to the Child-Pugh classification. The psoas muscle cross-sectional area was a factor affecting SPPB in multiple regression analysis.

Conclusions

Abdominal CT is an essential diagnostic tool in patients with liver cirrhosis. Ambulatory patients with liver cirrhosis aged < 65 years could have reduced physical performance. In this study, the psoas muscle cross-sectional area was correlated with physical performance and was a factor affecting physical performance. The psoas muscle cross-sectional area and physical performance should be evaluated in patients with liver cirrhosis.

Case Reports
A Case of Trisomy 9 Mosaicism Confirmed by Microarray Test
Park Chang-Eon, Chung Mi-Lm, Hwang Ji-Hye, Lee Min-Kyeong
Kosin Med J. 2020;35(2):143-150.   Published online December 31, 2020
DOI: https://doi.org/10.7180/kmj.2020.35.2.143
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Trisomy 9 mosaicism syndrome is a rare chromosomal abnormality with a high incidence of natural abortion and perinatal death. This syndrome is characterized by intrauterine growth retardation, mental retardation, craniofacial dysmorphism including a prominent nasal bridge with a short root and a fish-shaped mouth with thin lips, skeletal abnormalities, congenital heart defects, and genital abnormalities. The incidence and severity of malformations depend on the percentage of trisomic cells in the different tissues. We report a neonate who had the characteristic features of trisomy 9 syndrome with dysmorphic features including micrognathia, microcephaly, a low-set and malformed ear, a prominent lip, and cardiac defect. No chromosomal abnormalities were detected on a routine peripheral blood chromosomal analysis; however, a chromosomal abnormality with trisomy 9 mosaicism (low-level mosaic type) was detected on genetic tests. This is thought to be due to the low proportion of trisomic cells, and for this reason, the patient in this case shows a better prognosis than four patients previously reported in Korea, they were all diagnosed by peripheral blood chromosome testing.

Use of Three-dimensional Transesophageal Echocardiography for the Chiari Network
Jeong-Min Hong, Ah-Reum Cho, Seung-Hoon Baik, Dea-Hwan Moon
Kosin Med J. 2020;35(2):151-155.   Published online December 31, 2020
DOI: https://doi.org/10.7180/kmj.2020.35.2.151
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

The Chiari network is an embryonic remnant of the sinus venosus valve, which is characterized by a fenestrated, netlike structure in the right atrium and has the potential to be misdiagnosed as another right atrial pathology. Additionally, the Chiari network has been frequently reported to entrap intracardiac devices during surgical procedures. In this case report, we present two patients with a Chiari network confirmed by three-dimensional transesophageal echocardiography, which assisted in preventing device entrapment during intracardiac procedures.

Subcapsular Hepatic Hematoma after Cardiopulmonary Resuscitation
Song-I Lee
Kosin Med J. 2020;35(2):156-162.   Published online December 31, 2020
DOI: https://doi.org/10.7180/kmj.2020.35.2.156
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Cardiopulmonary resuscitation (CPR) is an important life-saving procedure in emergency care. However, CPR is associated with various complications. A 41-year-old man was admitted to the intensive care unit after CPR. A sudden decrease in the blood pressure and hematocrit level was recorded. An abdominal computed tomography (CT) showed a large subcapsular hematoma in the left lobe of the liver. With conservative treatment, the hematoma reduced in size, but it was later managed with percutaneous drainage. The patient recovered and was discharged. We obtained a favorable outcome with conservative, nonsurgical treatment. Subcapsular hepatic hematoma is a potential life-threatening complication that should be considered in CPR survivors.


KMJ : Kosin Medical Journal