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Volume 36(2); December 2021
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Review Articles
The Roles of Human Endogenous Retroviruses (HERVs) in Inflammation
Eun-Ji Ko, Hee-Jae Cha
Kosin Med J. 2021;36(2):69-78.   Published online December 31, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.2.69
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Human endogenous retroviruses (HERVs) are ancient, currently inactive, and non-infectious due to recombination, deletions, and mutations in the host genome. However, HERV-derived elements are involved in physiological phenomena including inflammatory response. In recent studies, HERV-derived elements were involved directly in various inflammatory diseases including autoimmune diseases such as rheumatoid arthritis (RA), multiple sclerosis, amyotrophic lateral sclerosis (ALS), and Sjogren’s syndrome. Regarding the involvement of HERV-derived elements in inflammation, two possible mechanisms have been proposed. First, HERV-derived elements cause nonspecific innate immune processes. Second, HERV-derived RNA or proteins might stimulate selective signaling mechanisms. However, it is unknown how silent HERV elements are activated in the inflammatory response and what factors and signaling mechanisms are involved with HERV-derived elements. In this review, we introduce HERV-related autoimmune diseases and propose the possible action mechanisms of HERV-derived elements in the inflammatory response at the molecular level.

Psychosomatic Approach to Fibromyalgia Syndrome: Concept, Diagnosis and Treatment
Sang-Shin Lee
Kosin Med J. 2021;36(2):79-99.   Published online December 31, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.2.79
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Fibromyalgia syndrome (FMS) has chronic widespread pain (CWP) as a core symptom and a variety of associated somatic and psychological symptoms such as fatigue, sleep problems, cognitive disturbances, multiple somatic pain, and depression. FMS is the subject of considerable controversy in the realm of nosology, diagnosis, pathophysiology, and treatment. Moreover, the fact that FMS and mental illness are closely associated with each other might intensify the confusion for the distinction between FMS and mental disorders. This narrative literature review aims to provide the concept, diagnosis, and treatment of FMS from the integrative biopsychosocial and psychosomatic perspective. This article first explains the concepts of FMS as a disease entity of biopsychosocial model, and then summarizes the changes of diagnostic criteria over past three decades, differential diagnosis and comorbidity issue focused on mental illnesses. In addition, an overview of treatment of FMS is presented mainly by arranging the recommendations from the international guidelines which have been developed by four official academic associations.

Original Articles
Effects of Changes in Inspiratory Time on Inspiratory Flowrate and Airway Pressure during Cardiopulmonary Resuscitation: A Manikin-Based Study
Jung Ju Lee, Su Yeong Pyo, Ji Han Lee, Gwan Jin Park, Sang Chul Kim, Hoon Kim, Suk Woo Lee, Young Min Kim, Hyun Seok Chai
Kosin Med J. 2021;36(2):100-108.   Published online December 31, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.2.100
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

Given that cardiopulmonary resuscitation (CPR) is an aerosol-generating procedure, it is necessary to use a mechanical ventilator and reduce the number of providers involved in resuscitation for in-hospital cardiac arrest in coronavirus disease (COVID-19) patients or suspected COVID-19 patients. However, no study assessed the effect of changes in inspiratory time on flowrate and airway pressure during CPR. We herein aimed to determine changes in these parameters during CPR and identify appropriate ventilator management for adults during CPR.

Methods

We measured changes in tidal volume (Vt), peak inspiratory flow rate (PIFR), peak airway pressure (Ppeak), mean airway pressure (Pmean) according to changes in inspiratory time (0.75 s, 1.0 s and 1.5 s) with or without CPR. Vt of 500 mL was supplied (flowrate: 10 times/min) using a mechanical ventilator. Chest compressions were maintained at constant compression depth (53 ± 2 mm) and speed (102 ± 2/min) using a mechanical chest compression device.

Results

Median levels of respiratory physiological parameters during CPR were significantly different according to the inspiratory time (0.75 s vs. 1.5 s): PIFR (80.8 [73.3 – 87.325] vs. 70.5 [67 – 72.4] L/min, P < 0.001), Ppeak (54 [48 – 59] vs. 47 [45 – 49] cmH2O, P < 0.001), and Pmean (3.9 [3.6 – 4.1] vs. 5.7 [5.6 – 5.8] cmH2O, P < 0.001).

Conclusions

Changes in PIFR, Ppeak, and Pmean were associated with inspiratory time. PIFR and Ppeak values tended to decrease with increase in inspiratory time, while Pmean showed a contrasting trend. Increased inspiratory time in low-compliance cardiac arrest patients will help in reducing lung injury during adult CPR.

The Natural Course of Total Kidney Volume in Patients with Autosomal Dominant Polycystic Kidney Disease undergoing Hemodialysis
Ye Na Kim, Yeonsoon Jung, Ho Sik Shin, Hark Rim, Jung Gu Park, Dong Yeol Lee, Joong Kyung Kim
Kosin Med J. 2021;36(2):109-115.   Published online December 31, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.2.109
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

The natural course of native kidneys after hemodialysis initiation in patients with autosomal dominant polycystic kidney disease (ADPKD) remains poorly understood.

Methods

We measured the total volumes of native kidneys in 12 patients who had at least one enhanced computed tomography (CT) image both before and after initiation of hemodialysis (group 1) and in 18 patients who had no image before dialysis but more than two images after dialysis (group 2). In patients with images, the last image was used for analysis only after dialysis.

Results

The mean total kidney volume (TKV) (± SD) before hemodialysis initiation was 3132 ± 1413 mL and the mean TKV of the last image was 3047 ± 1323 mL in group 1. The mean TKV change rate (%) was −5.2 ± 27.4% (P > 0.05) during follow-up of 3.9 ± 1.9 years in group 1. The mean TKV change rate was 2.8 ± 34.4% (P > 0.05) in group 2. The follow-up period after dialysis initiation ranged from 4.2 ± 4.7 to 8.0 ± 5.2 years.

Conclusions

The results suggest that the TKV of native polycystic kidneys decreases substantially after hemodialysis initiation. This reduction occurs mainly during the early post-hemodialysis period and followed by a slow enlargement of TKV.

Observational Study for Adverse Effects and Discontinuation with Long-Term Post-Operative Hormonal Treatment for Endometriosis in Real-World Practice
In Hye Kim, Hyungjoon Yoon, Hyun Joo Lee, Hye Kyung Noh, Jong Kil Joo, Ki Hyung Kim
Kosin Med J. 2021;36(2):116-124.   Published online December 31, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.2.116
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

To evaluate the side effects and causes of discontinuation of either combined oral contraceptives or dienogest (DNG) used to prevent recurrence in patients with surgically confirmed endometriosis.

Methods

We retrospectively analyzed the medical records of 213 women with endometriosis who had been treated with combined oral contraceptives (ethinyl estradiol 0.02 mg/drospirenone 3 mg [EE/DRSP]) or DNG 2 mg for 12 months or more. The side effects reported by the patients, laboratory parameters, causes of discontinuation of medication, and recurrence rates were evaluated one, two, three, four, and five years after starting medication (Y1, Y2, Y3, Y4, and Y5).

Results

EE/DRSP were administered to 59 patients, while DNG was administered to 154 patients. The mean durations of postoperative use of EE/DRSP and DNG were 44.5 ± 22.6 months and 23.6 ± 13.5 months, respectively. The prevalence of side effects was 27.1%, 19.0%, 10.0%, 10.5%, and 7.4% in the EE/DRSP group and 29.2%, 15.7%, 14.0%, 23.1%, and 0.0% in the DNG group at Y1, Y2, Y3, Y4, and Y5, respectively. The discontinuation rates were 1.7%, 1.7%, 4.0%, 0.0%, and 7.4% at Y1, Y2, Y3, Y4, and Y5, respectively, in the EE/DRSP group and 10.4%, 3.3%, 4.0%, 3.8%, and 0.0% at the same times in the DNG group. The recurrence rates were less than 4% in both the groups.

Conclusions

The side effects of commonly prescribed postoperative hormone treatments were relatively mild, and the occurrence of side effects decreased with continuous administration. Further, the long-term use of postoperative hormone treatments is likely to prevent recurrence of endometriosis after surgery.

Association of Weight Change and Physical Activity with Knee Pain and Health-Related Quality of Life in East Asian Women Aged 50 Years and Older with Knee Osteoarthritis: A Population-Based Study
Chong Bum Chang, Young Choi, Seung Baik Kang, Chin Youb Chung, Moon Seok Park, Kyoung Min Lee
Kosin Med J. 2021;36(2):125-135.   Published online December 31, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.2.125
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

This study aimed to investigate the association of self-reported weight change and physical activity with the level of knee pain and health-related quality of life in East Asian women with knee osteoarthritis using population-based data.

Methods

A total of 564 women (mean age, 68.2 years, standard deviation, 8.9 years) aged 50 years or older with knee osteoarthritis (Kellgren-Lawrence (K-L) grade ≥ 2) were included in the data analyses from the fifth Korea National Health and Nutrition Examination Survey. Data regarding the radiographic grade, self-reported weight change during the past year, physical activity, level of knee pain, and health-related quality of life (EuroQOL five-dimension (EQ-5D) index) were collected. Multiple regression analysis was performed to identify factors significantly associated with the level of knee pain and health-related quality of life in subgroups according to the body mass index (BMI) range (≤ 22.5, between 22.6 and 27.5, and > 27.5 kg/m2).

Results

In the whole group, the level of knee pain was significantly associated with K-L grade (P < 0.001), and EQ-5D was negatively associated with age (P < 0.001), the level of knee pain (P < 0.001), and weekly hours of vigorous-intensity activity (P = 0.026). In the subgroup analysis, weight gain showed significant association with the level of knee pain only in women with 22.5 kg/m2 < BMI ≤ 27.5 kg/m2 (P = 0.006). Weight gain showed significant association with EQ-5D in women with BMI ≤ 22.5 kg/m2 (P = 0.047) whereas weekly hours of moderate-intensity activity was negatively associated with EQ-5D in women with BMI > 27.5 kg/m2.

Conclusions

The association of weight change and physical activity with knee pain and health-related quality of life might be different according to BMI ranges. Well-designed interventions to improve both knee pain and health-related quality of life need to be investigated in future studies that would strictly control physical activity, diet, and weight changes.

Rasmussen’s Aneurysm, Rare yet Acknowledged Cause of Massive Hemoptysis: Retrospective Review of 16 Cases
Seungwoo Chung, I Re Heo, Tae Hoon Kim, Sun Mi Ju, Jung-Wan Yoo, Seung Jun Lee, Yu Ji Cho, Sung Un Park, Kyung Nyeo Jeon, Ho Cheol Kim
Kosin Med J. 2021;36(2):136-143.   Published online December 31, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.2.136
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

Rasmussen’s aneurysm may cause life-threatening hemoptysis. We investigated the clinical characteristics and outcomes of patients with hemoptysis and Rasmussen’s aneurysm.

Methods

We retrospectively investigated patients who clinically presented with hemoptysis and were diagnosed with a Rasmussen’s aneurysm on spiral chest computed tomography (CT).

Results

Our study included 16 patients (men:women, 12:4; mean age, 65.25 ± 13.0 years). Massive hemoptysis was observed in nine patients (56%) and blood-tinged sputum in four patients (25%). Ten patients (62.5%) had a history of pulmonary tuberculosis, and three patients (18.7%) had underlying lung cancer. Chest CT revealed coexisting fungal balls in seven patients (43.7%). Bronchial artery embolization (BAE) was performed in 12 patients (75%). One patient died of uncontrolled massive hemoptysis.

Conclusions

Patients with Rasmussen’s aneurysm showed hemoptysis during the course of the disease; however, bleeding can be controlled with conservative therapy and radiological interventions, such as BAE.

Case Reports
Usefulness of Kaloderm® in Finger Tip Necrosis : A Case Report
Chung-Min Yoon, Seung Cheol Lee, Ji-An Choi
Kosin Med J. 2021;36(2):144-147.   Published online December 31, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.2.144
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

We experienced a case of crush injury of the hand for which we performed a flap surgery and treated the necrotic parts placement using cultured allogeneic keratinocytes (Kaloderm®) with good results.

The patient was a 31-year-old woman whose left middle finger was caught in a door, causing a crush injury. Although primary repair was performed, a 2 × 2.5-cm-sized necrosis developed, and a V-Y advancement flap was performed after the removal of dead tissues. However, a 1 × 2-cm-sized partial necrosis occurred and was treated using Kaloderm®.

After the use of Kaloderm®, the patient’s wound was healed, and no complications, except for mild pain, were observed for 1 year after the surgery.

If a necrotic site appears after flap placement of fingertip, its treatment is difficult. If used well, Kaloderm® may be a good option for necrosis of the fingertips and other areas that are difficult to cure.

Spontaneous Disappearance of Unruptured Intracranial Aneurysm: A Case Report
Sang Hoon Jeong, Jung Hwan Lee, Tae Hong Lee, Chang Hwa Choi
Kosin Med J. 2021;36(2):148-152.   Published online December 31, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.2.148
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Spontaneous resolution or thrombosis of giant or ruptured intracranial aneurysms is occasionally reported. However, spontaneous resolution of unruptured aneurysms without any intervention is extremely rare. Recently, we encountered a case of spontaneous resolution of a small unruptured aneurysm of the anterior communicating artery. We describe this rare case and discuss the mechanism of resolution with a review of the related literature.

Nilotinib-Induced Acute Interstitial Nephritis during the Treatment of Chronic Myeloid Leukemia
Min Jeong Kim
Kosin Med J. 2021;36(2):153-160.   Published online December 31, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.2.153
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Tyrosine kinase inhibitors (TKIs) are targeted therapy drugs that selectively inhibit protein kinases. Nephrotoxicity associated with TKIs is uncommon. We report a case of a 39-year-old man with acute kidney injury that developed after nilotinib treatment for chronic myeloid leukemia (CML). The renal function of the patient decreased during treatment with nilotinib but improved when treatment was discontinued due to neutropenia. However, the renal function of the patient deteriorated again with the reintroduction of nilotinib for treatment. A renal biopsy revealed acute interstitial nephritis (AIN). The patient had no history of comorbidities and medication causing renal injury. Finally, we diagnosed the patient with nilotinib-induced AIN. After switching to imatinib mesylate, the renal function of the patient stabilized without further deterioration. Our case indicates that nilotinib can be a potential cause of renal dysfunction by inducing AIN when renal function deteriorates in patients treated with nilotinib.

Efficacy of Hepatic Arterial Infusion Chemotherapy and Radiofrequency Ablation against Hepatocellular Carcinoma Refractory to Transarterial Chemoembolization and Vascular Variation: A Case Study
Sang Yi Moon, Sang Young Han, Yang-Hyun Baek
Kosin Med J. 2021;36(2):161-168.   Published online December 31, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.2.161
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Transarterial chemoembolization is often the first-line treatment for multiple hepatocellular carcinomas. However, hepatic arterial infusion chemotherapy is a treatment option for hepatocellular carcinoma refractory to multiple sessions of transarterial chemoembolization. Hepatic arterial infusion chemotherapy requires implantation of an appropriate port into the hepatic artery. However, it may be impossible to implant a port due to hepatic artery variation. We report a case of hepatocellular carcinoma refractory to transarterial chemoembolization and hepatic artery variation treated successfully with hepatic arterial infusion chemotherapy and radiofrequency ablation with complete response after implantation of ports in both liver lobes.

The Importance of Lamina Size Measurement and Proper Implants Selection before Laminoplasty : Two Case Reports
Dong Hwan Kim, Su Hun Lee, Dong Ha Kim, Kyoung Hyup Nam, In Ho Han, Byung Kwan Choi
Kosin Med J. 2021;36(2):169-174.   Published online December 31, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.2.169
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Open door laminoplasty using plates is a safe and effective procedure for multi-level cord compression. To achieve stable laminar arch, various types of plate have been developed and used. Now, we introduce two rare complications related to the laminar shelf of plate.

In the first case, we used the wider laminar shelf plate because the elevated lamina did not fit well into the usual laminar shelf. During follow-up, cord compression due to laminar shelf was observed.

And in the second case, the laminar shelf of plate did not fit into the elevated lamina, so we inserted it with a little bit of force. But the patient’s symptom was not improved. On CT image, the inner cortical bone of the lamina was fractured.

To prevent these complications, surgeons need to consider the thickness of the lamina and the size of the laminar shelf before surgery.

Hemangioma in Renal Pelvis
Myeong Su Chu
Kosin Med J. 2021;36(2):175-179.   Published online December 31, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.2.175
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Hemangioma in the renal pelvis is a very rare benign tumor that may be mistaken for renal cell carcinoma. We present, herein, a case of a 59-year-old woman with a renal mass that was diagnosed as a cavernous hemangioma in the renal pelvis. The patient underwent intravenous pyelography, urine cytology, retrograde pyelography, kidney dynamic computed tomography (CT), and surgical excision.

Removal of Large Urinary Stone Using Percutaneous Nephrolithotomy in a Patient with Crohn’s Disease
Young Joo Park, Dong Hoon Baek, Young Min Kwak, Yong Bo Park, Dong Chan Joo, Tae Kyung Ha, Da Mi Kim, Geun Am Song
Kosin Med J. 2021;36(2):180-186.   Published online December 31, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.2.180
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Extraintestinal manifestation (EIM) of inflammatory bowel disease (IBD) is approximately 36%. Of genitourinary complications as an EIM of Crohn’s disease (CD), nephrolithiasis is the most common urinary complication in patients with CD. CD patients have been shown to have decreased urinary volume, pH, magnesium, and excretion of citrate, all of which are significant risk factors for nephrolithiasis. Genitourinary complications often occur in case of a severe longstanding disease and are associated with, the activity of bowel disease, especially in those who have undergone bowel surgery. As uncontrolled nephrolithiasis could impair renal function as well as adversely affect quality of life, proper monitoring, early detection, and prevention of the occurrence of urologic complications in CD is crucial. Few data are available about urolithiasis in patients with CD. Herein we report a case of a successful removal of a 2.7 cm calcium oxalate stone using percutaneous nephrolithotomy from a patient with long-standing CD with a previous surgery for small intestinal and colonic stricture.

Refractory Ascites with Intrahepatic Portal Thrombosis after Living Donor Liver Transplantation Successfully Treated by Splenic Artery Embolization and Apixaban (Case Report)
Hyung Hwan Moon
Kosin Med J. 2021;36(2):187-192.   Published online December 31, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.2.187
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Refractory ascites is a rare complication after liver transplantation, and its incidence ranges from 5% to 7%. A 56-year-old man diagnosed with HBV-LC with massive ascites underwent living donor liver transplantation. After transplantation, more than 1000 ml/day of ascites was steadily drained until two weeks after LT. CT showed intrahepatic Rt. portal vein thrombosis and many remnant collaterals with splenomegaly. We decided to embolize the proximal splenic artery and use apixaban to reduce portal flow and resolve the intrahepatic portal thrombosis. One day after splenic artery embolization, the patient’s ascites dramatically decreased. Three days later, he was discharged from the hospital. Three months later, a follow-up liver CT showed resolution of thrombosis and no ascites. Splenic artery embolization was an effective and safe procedure for portal flow modulation in portal hyertension. Apixaban was effective for partial portal vein thrombosis in a liver transplant recipient.


KMJ : Kosin Medical Journal