Kosin Medical Journal

Articles in E-pub version are posted online ahead of regular printed publication.

Original article

Dietary education may reduce blood cadmium and mercury levels in chronic kidney disease patients with higher blood cadmium and mercury levels: Su Mi Lee, Young-Seoub Hong, Byoung-Gwon Kim, Jung-Yeon Kwon, Yongsoon Park, Seong Eun Kim, Won Suk An; Received January 3, 2023 Accepted February 24, 2023 Published online May 24, 2023; DOI: https://doi.org/10.7180/kmj.23.101 [Epub ahead of print]

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Abstract PDF Supplementary Material PubReader ePub Crossref - TDM: Background
Exposure to cadmium and mercury is associated with renal dysfunction. This study aimed to investigate the possible ability of dietary education to decrease blood cadmium and mercury levels in patients with chronic kidney disease (CKD).
Methods
Twenty-seven patients with CKD were enrolled in this prospective, single-arm pilot study. Patients with blood cadmium levels ≥1.4 μg/L were instructed to reduce their intake of shellfish, while those with blood mercury levels ≥5.0 μg/L were asked to reduce their intake of externally blue-colored fish.
Results
Seven dialysis patients and 15 pre-dialysis patients completed the study. Compared with baseline, the blood cadmium (2.0±0.7 μg/L vs. 1.8±0.7 μg/L, p=0.031) and mercury levels (4.4±2.6 μg/L vs. 3.5±1.9 μg/L, p=0.005) after 1 year significantly decreased, although the dietary intake was not significantly different in patients with blood cadmium levels ≥1.4 μg/L and blood mercury levels ≥5.0 μg/L. In pre-dialysis patients, kidney function worsened after 1 year compared with that at baseline despite the reduction in blood cadmium and mercury levels.
Conclusions
Reduction of food intake containing cadmium and mercury may lower the blood cadmium and mercury levels in CKD patients with higher cadmium and mercury levels. Higher blood cadmium levels may cause renal disease progression in pre-dialysis patients, and further studies are necessary to determine the underlying mechanisms.

Case reports

Dermoscopic features of an unusual case of targetoid hemosiderotic nevus: Sun Mun Jeong, Jang Hwan Jung, Do Ik Kwon, Seol Hwa Seong, Ji Yun Jang, Jong Bin Park, Min Soo Jang; Received June 24, 2022 Accepted October 26, 2022 Published online February 15, 2023; DOI: https://doi.org/10.7180/kmj.22.119 [Epub ahead of print]

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Abstract PDF PubReader ePub Crossref - TDM: Targetoid hemosiderotic nevus (THN) is a rare variant of melanocytic nevus, characterized by a sudden development of a targetoid ecchymotic halo around a pre-existing nevus. THN clinically raises concern for malignant transformation due to its abrupt change in color and size. THN should be distinguished from other diseases showing a peripheral halo, including targetoid hemosiderotic hemangioma, halo nevus, and Meyerson nevus. Dermoscopy can help clinicians to differentiate THN from these diseases. The typical dermoscopic features of THN are known to be divided into two distinctive areas: the central melanocytic area and the peripheral ecchymotic area. In our case, dermoscopy revealed a novel bull’s eye pattern composed of a central area with characteristic features of benign melanocytic nevus, an intermediated white circular ring, and a peripheral milky red area. When a sudden change occurs in a pre-existing nodule showing targetoid features, dermoscopy should be considered before conducting a biopsy or surgical intervention.

A case report of a carotid space abscess due to extraluminal migration of a fishbone into the deep cervical space: Tae-Hun Lee, Ki Ju Cho, Seong Jun Won, Jung Je Park; Received November 16, 2022 Accepted November 25, 2022 Published online December 19, 2022; DOI: https://doi.org/10.7180/kmj.22.141 [Epub ahead of print]

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Abstract PDF PubReader ePub Crossref - TDM: Laryngopharyngeal foreign bodies are among the cases most frequently encountered by otolaryngologists. Most foreign bodies can be easily removed without any complications. However, surgical removal is required in some cases. Therefore, a delayed diagnosis or misdiagnosis could cause fatal complications for patients who need a surgical approach. We report a rare case of extraluminal migration of a foreign body to the deep cervical space. The foreign body (a fishbone) was removed by a surgical approach. With a literature review, we also propose an algorithm for the management of suspicious foreign bodies in the neck.

Targeted temperature management in a patient with suspected hypoxic-ischemic brain injury after successful resuscitation from cardiac arrest: a case report: Christine Kang, Won Yong Lim, Young-hoon Jung, Jiseok Baik; Received August 26, 2022 Accepted October 28, 2022 Published online December 19, 2022; DOI: https://doi.org/10.7180/kmj.22.130 [Epub ahead of print]

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Abstract PDF PubReader ePub Crossref - TDM: Hypoxic-ischemic brain injury (HIBI) after cardiac arrest (CA) is a leading cause of mortality and long-term neurological disorders in survivors. Targeted temperature management (TTM) has been rigorously studied as a way to improve results compared to a normal body temperature for preventing secondary damage after HIBI. We report a case of successful TTM in a patient who was suspected to have HIBI after resuscitation from cardiovascular collapse due to respiratory failure during elective surgery under brachial plexus block with dexmedetomidine and remifentanil infusion. A 27-year-old male patient developed CA due to apnea during orthopedic surgery. TTM was performed in the surgical intensive care unit for 72 hours after resuscitation, and the patient recovered successfully. TTM application immediately after resuscitation from CA in patients with suspected HIBI may be an appropriate treatment.

Sigmoid colon plexiform neurofibroma as a colonic subepithelial mass: a case report: Hee Won Baek, Eun Jeong Choi, Seung Jung Yu, Myeongpyo Kim, Sang Heon Lee, Sam Ryong Jee, Hyungjoo Baik, Hong Sub Lee; Received July 18, 2022 Accepted September 7, 2022 Published online November 9, 2022; DOI: https://doi.org/10.7180/kmj.22.123 [Epub ahead of print]

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Abstract PDF PubReader ePub Crossref - TDM: Plexiform neurofibroma (PN) is an uncommon benign tumor, usually associated with neurofibromatosis type 1. As most PNs involve the craniomaxillofacial region, PN of the colon is very rare. Here we present a case of PN involving the sigmoid colon. A 43-year-old male patient presented to the outpatient clinic for the evaluation of an incidentally discovered sigmoid colon mass. A colonoscopic biopsy was performed for the mass, and the result revealed neuronal proliferation. The patient visited the outpatient clinic a year later with symptoms of abdominal pain and stool caliber change. Biopsy was repeated for the sigmoid colon mass, and the results showed mucosal Schwann cell proliferation and S-100 immunostaining positivity. Computed tomography and magnetic resonance imaging were performed for further evaluation, and neurofibroma or schwannoma was suspected based on the imaging studies. For an accurate diagnosis, the patient underwent surgery to remove the sigmoid colon mass. The final diagnosis of the mass was confirmed as PN. We hereby report a rare case of PN involving the sigmoid colon that could not be diagnosed before surgery.

Disseminated Staphylococcus aureus infection and acute bacterial pericarditis: a case report: Su Hyun Bae, Song-Hyun Lee, Joon-Young Choi, Bong-Joon Kim, Soo-Jin Kim, Sung-Il Im, Hyun-Su Kim, Jung-Ho Heo; Received June 15, 2022 Accepted June 27, 2022 Published online August 16, 2022; DOI: https://doi.org/10.7180/kmj.22.021 [Epub ahead of print]

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Abstract PDF PubReader ePub Crossref - TDM: We experienced a case of disseminated Staphylococcus aureus infection with bacterial pericarditis that progressed to septic shock and multiorgan failure despite pericardiocentesis and surgical removal of the original abscess with intensive antibiotic therapy. We report this case because of the patient’s very rare and remarkable echocardiographic findings and highly turbid pericardial effusion.

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