Kosin Medical Journal

Volume 38(4); December 2023

Editorial

The old biomarkers you know are still useful: D-dimer and troponin I: Sanghyun Lee; Kosin Med J. 2023;38(4):229-230. Published online December 20, 2023; DOI: https://doi.org/10.7180/kmj.23.155

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Review articles

Prevention of myopia progression using orthokeratology: Stephanie Suzanne S. Garcia, Changzoo Kim; Kosin Med J. 2023;38(4):231-240. Published online December 26, 2023; DOI: https://doi.org/10.7180/kmj.23.141

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Abstract PDF PubReader ePub: The prevalence of myopia in children and juveniles has increased significantly in Korea and worldwide; in particular, the rates of myopia and high myopia in East Asia have grown rapidly. Myopia is easily corrected with spectacles or contact lenses. However, as children grow and mature, myopia can progress irreversibly and lead to vision-threatening complications. Thus, the prevention of myopia progression is an essential treatment goal. Many treatment strategies are being employed, including atropine eyedrops, specialized glasses, and orthokeratology (Ortho-K) lenses. Ortho-K is an effective treatment in managing myopia progression by lowering the rate of increase in refractive error and axial length. In this article, we review Ortho-K as a treatment for myopia progression, its history, mechanism, treatment regimen, and safety profile.

Basic knowledge of endoscopic retrograde cholangiopancreatography: Jung Wook Lee; Kosin Med J. 2023;38(4):241-251. Published online December 26, 2023; DOI: https://doi.org/10.7180/kmj.23.151

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Abstract PDF PubReader ePub: Endoscopic retrograde cholangiopancreatography (ERCP) was first performed in the late 1960s. Due to advancements in instruments, devices, and techniques, ERCP has played an important role in the management and diagnosis of pancreatobiliary disorders. However, ERCP is accompanied by the risk of various complications even if performed by an expert. The incidence of ERCP complications is approximately 4% to 10%, while the incidence of fatal complications, such as death, is less than 0.5%. To prevent adverse events, experts performing ERCP must recognize and address ERCP-related complications and understand the various techniques. In this review, we summarize the complications and techniques of ERCP.

Original articles

Troponin I and D-dimer levels as triaging biomarkers to distinguish acute pulmonary thromboembolism from myocardial infarction: Soo-Jin Kim, Moo Hyun Kim, Kwang Min Lee, Jin Woo Lee, Young Shin Cha, Da Eun Koh, Joo Yeong Hwang, Jong Sung Park; Kosin Med J. 2023;38(4):252-258. Published online December 20, 2023; DOI: https://doi.org/10.7180/kmj.23.133

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Background
Acute pulmonary thromboembolism (APTE) is often confused with myocardial infarction. Previous studies have shown that patients with APTE exhibit lower initial and peak cardiac troponin I (CTI) levels, but higher D-dimer (DD) levels, than patients with myocardial infarction. The present study aimed to reaffirm the tree model algorithm using an entirely new set of data.
Methods
We reviewed retrospective clinical and laboratory data from patients who were diagnosed with APTE or non-ST-elevation myocardial infarction (NSTEMI) between 2015 and 2016. Subjects who were not classified with a diagnosis or did not have their CTI or DD levels assessed were excluded. We categorized patients according to the previous algorithm and compared the outcomes with the previous test dataset.
Results
The analysis involved data from 156 patients with APTE and 363 patients with NSTEMI. In the validation data set, the APTE group showed higher initial DD levels (9.80±10.84 μg/mL) and lower initial CTI levels (0.17±0.54 μg/mL) than the NSTEMI group. The accuracy rate for the test dataset and the validation set were similar. The test set accuracy rate was 91.0%, while the accuracy rate in the validation set improved to 88.6%.
Conclusions
Patients with APTE exhibited lower initial and peak CTI levels, but higher DD levels than NSTEMI patients. The accuracy rate estimates were similar between the test set obtained from the tree model algorithm and the validation set. The study findings demonstrate that the assessment of cardiac biomarkers can be useful for differentiating between APTE and NSTEMI.

Citations

Citations to this article as recorded by

The old biomarkers you know are still useful: D-dimer and troponin I
Sanghyun Lee
Kosin Medical Journal.2023; 38(4): 229. CrossRef

Clinical outcomes of prostate artery embolization for management of benign prostate hyperplasia (prostate larger than 100 mL) with or without hematuria: Soodong Kim; Kosin Med J. 2023;38(4):259-266. Published online November 7, 2023; DOI: https://doi.org/10.7180/kmj.23.122

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Abstract PDF PubReader ePub: Background
In this study, we report 1-year follow-up clinical results of prostate artery embolization (PAE) in patients with glandular hematuria or acute urinary retention caused by a large prostate (over 100 mL).
Methods
Twenty-one consecutive patients undergoing PAE from March 2018 to July 2020 were included in this retrospective study. Clinical follow-up was conducted for all patients 1, 3, 6, and 12 months after the procedure. The outcome measures included the International Prostate Symptom Score (IPSS), quality of life (QoL), peak urinary flow rate (Qmax), post-void residual (PVR), prostate volume, prostate-specific antigen, and complications. A p-value <0.05 was considered statistically significant.
Results
Twenty-one patients with severe benign prostatic hyperplasia (BPH) with acute urinary retention or prostatic hematuria were enrolled in this study. Technical success rate was 90.5% (19/21), and unilateral PAE was done in 2/21 (9.5%) patients by pelvic vascular obliteration. In all patients, the mean IPSS, QoL score, Qmax, and PVR were significantly improved at 12 months post-PAE. The mean IPSS decreased from 26.1 to 12.1 points (p<0.05), mean QoL score decreased from 4.6 to 2.9 points (p<0.05), mean Qmax increased from 2.1 to 9.4 mL/s (p<0.05), and mean PVR decreased from 300.0 to 70.7 mL (p<0.05). The catheter was successfully removed from 19/21 patients and clinical success rate was 90.5%.
Conclusions
PAE was an effective and safe treatment option for patients with BPH and very large prostates (>100 mL) and urinary retention or gross hematuria associated with BPH in men unfit for surgery.

Initial experience with Retzius-sparing robot-assisted radical prostatectomy compared to the conventional method: is it a suitable option for robotic prostatectomy beginners?: Su Hwan Kang; Kosin Med J. 2023;38(4):267-273. Published online November 9, 2023; DOI: https://doi.org/10.7180/kmj.23.143

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Abstract PDF PubReader ePub: Background
Retzius-sparing robot-assisted radical prostatectomy (rsRARP) is a surgical procedure that can minimize the resection of surrounding prostate tissue by enabling access through the anterior surface of the Douglas pouch. We reported our initial experiences with rsRARP compared to conventional robot-assisted radical prostatectomy (RARP).
Methods
Retrospective data were collected from March 2019 to June 2022, including 69 patients who underwent robotic radical prostatectomy for localized prostate cancer. The operations were performed at a single center, and we alternated between the two methods. Perioperative characteristics and oncologic and functional outcomes were analyzed.
Results
In total, 35 patients underwent RARP and 34 patients underwent rsRARP. The preoperative characteristics of the patients were similar. Oncologic and functional parameters were analyzed postoperatively. Except for early recovery of urinary incontinence (immediate, 1 month, 3 months, 6 months: p<0.001, p=0.002, p=0.004, and p=0.014, respectively), there were no significant differences between the two groups. We also analyzed trends in operation time and oncologic and functional outcomes according to the progression of rsRARP cases.
Conclusions
rsRARP has the major advantage of enabling an early recovery from urinary incontinence after surgery, and it is also a good surgical approach that shows oncologically similar results to the conventional approach. It is also highly reproducible and can be recommended to surgeons new to robotic radical prostatectomy.

Comparison of transperitoneal and retroperitoneal robot partial nephrectomy for kidney tumors: Yongdeuk Seo, Su Hwan Kang, Taek Sang Kim, Dong Ha Kim, Seong Bin Kim; Kosin Med J. 2023;38(4):274-277. Published online December 20, 2023; DOI: https://doi.org/10.7180/kmj.23.145

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Abstract PDF PubReader ePub: Background
Surgical techniques for small kidney tumors have been developed for decades, from open to robotic surgery. There are two approaches for partial nephrectomy: transperitoneal and retroperitoneal. We divided robotic partial nephrectomy cases into transperitoneal robotic partial nephrectomy (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN) and compared the outcomes.
Methods
We retrospectively evaluated patients who underwent robotic partial nephrectomy at our hospital between November 2019 and May 2022. We reviewed patients’ demographic and perioperative data.
Results
Seventy robotic partial nephrectomies were performed (35 TRPN and 35 RRPN). There were significant differences in operation time, estimated blood loss (EBL), tumor size, and the RENAL Nephrometry Score (RNS) between those who underwent TRPN and those who underwent RRPN. Larger tumors were noted in the TRPN group, and the RNS was higher. In contrast, the operation time was shorter, EBL was lower, and tumors were more likely to be located in the posterior and lower portions in the RRPN group than in the TRPN group.
Conclusions
In our study, RRPN had advantages over TRPN in terms of operation time and EBL. However, TRPN tended to be performed rather than RRPN for tumors that were more complex in terms of size or RNS. Although the choice between RRPN and TRPN depends on the surgeon's preference, RRPN seems effective for treating small kidney tumors if selected appropriately.

The effectiveness of Moodle's “Lesson” feature in pre-learning about arterial puncture and blood transfusion procedures: Haeyoung Lee, Sang-Shin Lee, Hyunyong Hwang; Kosin Med J. 2023;38(4):278-287. Published online December 29, 2023; DOI: https://doi.org/10.7180/kmj.23.150

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Abstract PDF PubReader ePub: Background
This study evaluated the effectiveness of Moodle’s “Lesson” feature as a pre-learning tool for clinical skills among medical students.
Methods
The performance of 69 fourth-year medical students during practical sessions on arterial puncture and blood transfusion was assessed. These students engaged in pre-learning activities via Moodle's “Lesson” feature. We analyzed the survey results to gauge students’ satisfaction and perceived usefulness of the pre-learning approach. Additionally, we compared the performance of the 2023 cohort, which took part in the pre-learning process, with students from 2020 to 2022 who did not have this preparatory component.
Results
Among the students surveyed, data from 59 respondents were analyzed. Satisfaction with the pre-learning segment was high, with a mean satisfaction score of 4.69 (standard deviation [SD]=0.62) and Cronbach’s alpha of 0.918. The tool's perceived usefulness was also rated highly, with a mean score of 4.77 (SD=0.53) and Cronbach’s alpha of 0.956. Students who used the pre-learning tool had a mean score of 84.20 (SD=14.74), whereas those who did not use the tool scored slightly lower, with a mean of 80.40 (SD=13.07); however, this difference was not statistically significant (p=0.196). Nonetheless, the 2023 cohort scores were generally higher across the various percentile measures than those of the 2020–2022 groups.
Conclusions
The pre-learning tool using the “Lesson” feature on Moodle proved useful and satisfactory for students learning clinical procedures. Further research with larger cohorts is required to validate these findings.

Case reports

Perioperative cutaneous complications in an elderly patient due to inappropriate use of a forced-air warming device and underbody blanket: a case report: Myounghun Kim, Soo Jee Lee, Beomseok Choi, Geunho Lee, Seunghee Ki; Kosin Med J. 2023;38(4):288-292. Published online December 6, 2023; DOI: https://doi.org/10.7180/kmj.23.136

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Abstract PDF PubReader ePub: Forced-air warming is commonly utilized to prevent perioperative hypothermia. Underbody warming blankets are often employed to secure a larger area for patient warming. While forced-air warming systems are generally regarded as safe, improper usage poses a risk of cutaneous complications. Additionally, the influence of underbody blankets on cutaneous complications remains uncertain. We present a case of cutaneous complications resulting from the improper utilization of a forced-air warming device and an underbody blanket. A 79-year-old man presented to the hospital for robotic proctectomy under general anesthesia. The surgery lasted for 7 hours, and the forced-air warming device with underbody blanket operated continuously for 5 hours intraoperatively. The surgery was completed without any incidents. However, first-degree burns on the patient’s back, along with superficial decubitus ulcers on his right scapula, were observed after surgery. To prevent cutaneous complications, clinicians must adhere to the manufacturer's guidelines when utilizing a forced-air warming system. Compared to overbody blankets, underbody blankets have limitations in monitoring cutaneous responses. Ensuring patient safety requires selecting an appropriate blanket for scheduled operations.

Selective adjuvant radiation therapy for distant lymph node metastasis in patients with stage 4B epithelial ovarian cancer: a case series: Eun Taeg Kim, Seung Yeon Oh, Sun Young Ma, Tae Hwa Lee, Won Gyu Kim; Kosin Med J. 2023;38(4):293-299. Published online December 20, 2023; DOI: https://doi.org/10.7180/kmj.23.146

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Abstract PDF PubReader ePub: Although the efficacy of surgery followed by taxane- and platinum-based systemic chemotherapy has been clearly demonstrated in the standard first-line treatment of epithelial ovarian cancer, the role of radiation therapy for distant lymph node metastasis in patients with epithelial ovarian cancer is not well-established due to a lack of reported studies. We identified four patients who underwent selective adjuvant radiation therapy for neck and para-aortic lymph node lesions after primary debulking surgery between 2020 and 2022, followed by platinum-based chemotherapy for stage 4B high-grade serous ovarian cancer. Through a retrospective review of medical records, we analyzed patient clinicopathologic features, treatment course, and imaging findings. The median age was 49.25 years (range, 46–54 years). All patients had the International Federation of Gynecology and Obstetrics stage 4B disease. Following primary debulking surgery, all patients received weekly paclitaxel-carboplatin chemotherapy and maintenance treatment with poly(ADP-ribose) polymerase (PARP) inhibitors. All patients received selective adjuvant radiation therapy for neck and para-aortic lymph node metastasis before PARP inhibitor maintenance. The median follow-up time was 36.75 months (range, 19–45 months). All patients achieved a complete response. None of the patients experienced disease recurrence or died during the follow-up period. The management of distant lymph node metastasis in patients with epithelial ovarian cancer remains a matter of debate. Selective adjuvant radiation therapy in first-line treatment for ovarian cancer appears to be a feasible approach with maintenance therapy for stage 4B epithelial ovarian cancer.

Drug-induced immune-mediated thrombocytopenia due to bevacizumab-FOLFOX therapy: a case report: Minna Kim, Jong Hoon Lee, Jong Yoon Lee; Kosin Med J. 2023;38(4):300-306. Published online July 28, 2023; DOI: https://doi.org/10.7180/kmj.23.121

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Abstract PDF PubReader ePub: Drug-induced immune thrombocytopenia (DITP) is a very rare disease, with an estimated annual incidence of 10 cases per million. Oxaliplatin and irinotecan are widely used as chemotherapy for high-risk stage II and III colorectal cancer, and DITP has been reported to occur in patients using those agents. To treat unresectable metastatic colorectal cancer, bevacizumab is used in combination with oxaliplatin or irinotecan, and there have been a few reports of DITP cases in patients receiving that regimen. In this report, we describe a 68-year-old male patient with metastatic colon cancer (KRAS mutant type) to the liver and lung who developed acute immune-mediated thrombocytopenia due to bevacizumab-FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) therapy. During treatment, he showed purpura in his lower extremities on 21st cycle day 2. Lab work revealed a platelet count of less than 2,000/mL, reflecting a decrease from 135,000/mL at the start of the cycle 1 day prior. He did not have any other types of cytopenia or significant changes in laboratory findings. We diagnosed DITP due to bevacizumab-FOLFOX, and the patient did not show isolated thrombocytopenia after switching to Ziv-aflibercept-FOLFIRI (5-fluorouracil, leucovorin, and irinotecan).

Corrigendum

Corrigendum to: Unusual Magnetic Resonance Imaging Findings Contrast-induced Encephalopathy following Cerebral Angiography: Won Ho Cho, Jung Hwan Lee, Tae Hong Lee, Chang Hwa Choi, Jun Kyeung Ko; Kosin Med J. 2023;38(4):307-307. Published online October 30, 2023; DOI: https://doi.org/10.7180/kmj.2021.36.1.51.r1; Corrects: Kosin Med J 2021;36(1):51

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