Journal of Yeungnam Medical Science

Original article

Impact of Controlling Nutritional Status score on short-term outcomes after carotid endarterectomy: a retrospective cohort study: Hee Won Son, Gyeongseok Yu, Seung Jun Lee, Jimi Oh; J Yeungnam Med Sci. 2023;40(3):259-267. Published online October 26, 2022; DOI: https://doi.org/10.12701/jyms.2022.00507

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Abstract PDF: Background
Malnutrition and impaired immune responses significantly affect the clinical outcomes of patients with atherosclerotic stenosis. The Controlling Nutritional Status (CONUT) score has recently been utilized to evaluate perioperative immunonutritional status. This study aimed to evaluate the relationship between immunonutritional status, indexed by CONUT score, and postoperative complications in patients undergoing carotid endarterectomy (CEA).
Methods
We retrospectively evaluated 188 patients who underwent elective CEA between January 2010 and December 2019. The preoperative CONUT score was calculated as the sum of the serum albumin concentration, total cholesterol level, and total lymphocyte count. The primary outcome was postoperative complications within 30 days after CEA, including major adverse cardiovascular events, pulmonary complications, stroke, renal failure, sepsis, wounds, and gastrointestinal complications. Cox proportional hazards regression analysis was used to estimate the factors associated with postoperative complications during the 30-day follow-up period.
Results
Twenty-five patients (13.3%) had at least one major complication. The incidence of postoperative complications was identified more frequently in the high CONUT group (12 of 27, 44.4% vs. 13 of 161, 8.1%; p<0.001). Multivariate analyses showed that a high preoperative CONUT score was independently associated with 30-day postoperative complications (hazard ratio, 5.98; 95% confidence interval, 2.56–13.97; p<0.001).
Conclusion
Our results showed that the CONUT score, a simple and readily available parameter using only objective laboratory values, is independently associated with early postoperative complications.

Communication

Yeungnam University type drive-through (YU-Thru) coronavirus disease 2019 (COVID-19) screening system: a rapid and safe screening system: Wan Seok Seo, Seong Ho Kim, Si Youn Song, Jian Hur, Jun Lee, Sunho Choi, Yoojung Lee, Dai Seg Bai; Yeungnam Univ J Med. 2020;37(4):349-355. Published online September 18, 2020; DOI: https://doi.org/10.12701/yujm.2020.00640

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Active and prompt scale-up screening tests are essential to efficiently control the coronavirus disease 2019 (COVID-19) outbreak. The goal of this work was to identify shortcomings in the conventional screening system (CSS) implemented in the beginning of the outbreak. To overcome these shortcomings, we then introduced a novel, independently developed system called the Yeungnam University type drive-through (YU-Thru), and distributed it nationwide in Korea. This system is similar to the drive-throughs utilized by fast food restaurants. YU-Thru system has shortened the time taken to test a single person to 2–4 minutes, by completely eliminating the time required to clean and ventilate the specimen collection room. This time requirement was a major drawback of the CSS. YU-Thru system also reduced the risk of subjects and medical staff infecting one another by using a separate and closed examination system. On average, 50 to 60 tests were conducted per day when using the CSS, while now up to 350 tests per day are conducted with the YU-Thru system. We believe that the YU-Thru system has made an important contribution to the rapid detection of COVID-19 in Daegu, South Korea. Here, we will describe the YU-Thru system in detail so that other countries experiencing COVID-19 outbreaks can take advantage of this system.

Citations

Citations to this article as recorded by

Experience of operating a medical humanities course at one medical school during the COVID-19: a retrospective study
Yu Ra Kim, Hye-won Shin, Young Hwan Lee, Seong-Yong Kim
Journal of Yeungnam Medical Science.2023; 40(2): 179. CrossRef
Lessons Learned From an Analysis of the Emergency Medical Services’ COVID-19 Drive-Through Testing Facilities in Israel
Itay Zmora, Evan Avraham Alpert, Uri Shacham, Nisim Mishraki, Eli Jaffe
Disaster Medicine and Public Health Preparedness.2022; 16(5): 2091. CrossRef
A study on the mental health of students at a medical school during COVID-19 outbreak: a retrospective study
Yu Ra Kim, Hye Jin Park, Bon-Hoon Koo, Ji Young Hwang, Young Hwan Lee
Journal of Yeungnam Medical Science.2022; 39(4): 314. CrossRef

Case Report

Guide wire fracture during percutaneous coronary intervention.: Hak Ro Kim, Tae Hoon Yim, Byung Chul Kim, Ho Jun Lee, Hong Geun Oh, Hyun Sik Ju, Tae Jin Kim, Young Bok Kim; Yeungnam Univ J Med. 2016;33(1):52-55. Published online June 30, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.1.52

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Abstract PDF: Guide wire fracture during percutaneous coronary intervention (PCI) is rare. It can cause fatal complications such as thrombus formation, embolization, and perforation. Guide wire fracture could occur during intervention for severely calcified stenotic lesions, and rarely from distal small branches of stenotic lesions. There are several methods for its management depending on the material character, position, length of the remnant, and the patient's condition. If percutaneous retrieval was not achieved, the surgical procedure should be considered for prevention of potential risks, although the remnant guide wire does not usually cause complications. We experienced a patient with a guide wire fracture during PCI, and managed to prevent its complications through surgical removal of the remnant wire. We report this case here.

Original Article

Usefulness of the BACTEC MGIT 960 System for Mycobacterial Culture and TB Ag MPT64 Immunochromatographic Assay to Identify Mycobacterium tuberculosis.: Seung Hun Lee, Min Jeong Lee, Jeong Mi Lee, Su Jin Yim, Seung Jun Lee, You Eun Kim, Yu Ji Cho, Yi Yeong Jeong, Ho Cheol Kim, Jong Deog Lee, Sun Joo Kim, Young Sil Hwang; Yeungnam Univ J Med. 2012;29(2):83-88. Published online December 31, 2012; DOI: https://doi.org/10.12701/yujm.2012.29.2.83

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Abstract PDF

BACKGROUND
This study was conducted to evaluate the usefulness of the BACTEC MGIT (Mycobacterium Growth Indicator Tube) 960 system for mycobacteria culture and immunochromatographic assay to identify Mycobacterium tuberculosis (MTB) in positive MGIT culture. METHODS: Mycobacteria-culture-positive cases were retrospectively analyzed from December 2010 to July 2011. The detection rates and the recovery times of the mycobacteria between the Ogawa media and the MGIT were compared. An immunochromatographic assay (ICA) (SD BIO-LINE) was also performed in the positive MGIT culture for identification, and the results were compared with those of the Ogawa media in the Korea National Tuberculosis Association. RESULTS: Among the 261 patients (M:F, 168:93; mean age, 61.6+/-17.16 yrs), 450 specimens (sputa, 365; bronchial washing, 61; and pleural effusion, 24) were found positive with mycobacteria. Mycobacteria were grown both on the MGIT and Ogawa media in 310 cases (68.9%); only on the MGIT in 115 cases (22.6%); and only on the Ogawa media in 25 cases (5.5%) (p<0.05).The recovery time was 28.2+/-8.9 days in the Ogawa media and 11.1+/-5.8 days in the MGIT (p<0.05). Among the 127 cases from the positive MGIT culture, all 92 cases that were confirmed as MTB cases bythe Korea National Tuberculosis Association were identified as MTB by ICA, with 100% sensitivity. CONCLUSION: MGIT increases the detection rate and shortens the recovery time of mycobacteria in clinical respiratory specimens, and the TB Ag MPT64 kit using ICA is useful in identifying MTB in a positive MGIT culture.

Citations

Citations to this article as recorded by

A Low Cost/Low Power Open Source Sensor System for Automated Tuberculosis Drug Susceptibility Testing
Kyukwang Kim, Hyeong Kim, Hwijoon Lim, Hyun Myung
Sensors.2016; 16(6): 942. CrossRef

Case Reports

Three Cases of Primary Thyroid Lymphoma at a Single Institution.: Seung Jun Lee, Ji Yeun Kim, Jung Kyu Park, Sung Woo Kim, Ji Hun Kim, Tae Won Kim, Geun Jin Ha, Ho Sang Shon, Eui Dal Jung, Kyu Jang Won; Yeungnam Univ J Med. 2010;27(2):165-172. Published online December 31, 2010; DOI: https://doi.org/10.12701/yujm.2010.27.2.165

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Abstract PDF: Primary thyroid lymphoma is a relatively rare thyroid tumor and usually a non-Hodgkin type. Its most common histologic type is the diffuse large B cell lymphoma followed by mucosa-associated lymphoid tissue (MALT). It is known to be frequently associated with autoimmune thyroiditis such as Hashimoto's thyroiditis. We report three cases of thyroid lymphoma at a single institution with a review of the literature.

Fibromuscular Dysplasia of the Distal Internal Carotid and Middle Cerebral Artery.: Ju Hyun Kim, Jun Lee; Yeungnam Univ J Med. 2009;26(1):78-83. Published online June 30, 2009; DOI: https://doi.org/10.12701/yujm.2009.26.1.78

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Abstract PDF

Fibromuscular dysplasia is an uncommon condition of idiopathic, non-inflammatory and non-atherosclerotic disease of the musculature of arterial walls. The disease is rare, but it commonly affects young and middle aged women. Isolated intracranial cerebral fibromuscular dysplasia is extremely rare because cerebral fibromuscular dysplasia usually affects extracranial vessels. A 26-year-old woman was admitted with right hemiplegia and global aphasia. Brain MRI and MRA demonstrated acute left middle cerebral artery territory infarction with a multifocal stenosis and dilatation of the left middle cerebra artery and left internal carotid. The characteristic conventional cerebral angiographic findings demonstrated a typical string-of-beads appearance in the left distal internal carotid artery and proximal portion of the left middle cerebral artery, which suggested a medial type fibromuscular dysplasia. We report a case of isolated intracranial fibromuscular dysplasia with left middle cerebral artery territory infarction. Fibromuscular dysplasia should be considered as a stroke risk factors in children and young adults, especially in patients with no known cardiovascular risk factors.

Citations

Citations to this article as recorded by

Cerebral Infarction and Recovery in a 12-Year-Old Child With Intracranial Fibromuscular Dysplasia
Min Hwan Kim, Jae In Lee, Shin-seung Yang
Brain & Neurorehabilitation.2023;[Epub] CrossRef

Original Article

Relationship between Clinical Grading of Carpal Tunnel Syndrome and Electrophysiological Parameter: Hyun Chul Do, Jun Lee, Se Jin Lee, Mee Young Park, Jung Sang Hah; Yeungnam Univ J Med. 2007;24(2 Suppl):S407-415. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S407

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Abstract PDF: Background
：To investigate the relationship between clinical grading and electrophysiological parameter in carpal tunnel syndrome. Materials and Methods：This studies examined 75 outpatients (100 hands) who were diagnosed as carpal tunnel syndrome at neurologic clinic from March to July in 2006. They were divided into three groups by clinical grading and then each groups were compared with sensory nerve conduction velocity (SNCV) and sensory compound nerve action potential (CNAP) amplitude of I-W, F-W, and P-W segments, motor terminal latency (TL), motor compound muscle action potential (CMAP) amplitude of distal segment, and disto-proximal ratio on the third finger.
Results
：The first group(mild) was 46 (51 hands) patients, second group(moderate) was 29 (35 hands) patients, and the third group (severe) was 14(14 hands) patients. The mean ages were 55.9, 57.4 and 57.0 years in each group, and there were no statistical differences in age and sex between 3 groups. SNCV of I-W, F-W and P-W segments and motor TL were different significantly between 3 groups, but disto-proximal ratio on the third finger was not different significantly(P<0.05). Motor TL was correlated with clinical grading. And also sensory CNAP amplitude of I-W, F-W, and P-W segments, and motor CMAP amplitude of distal segment were different significantly between 3 groups. Especially, sensory CNAP amplitude of P-W segment and motor TL were correlated with higher clinical grading groups(2, 3 groups)(p<0.05).
Conclusion
：SNCV of F-W and P-W segments, motor TL, motor CMAP amplitude of distal segment and sensory CNAP amplitude of each segments were correlated with the clinical grading of carpal tunnel syndrome.

Case Reports

A case of Bilateral Near Blindness Secondary to Isolated Sphenoid Sinus Aspergillosis with Headache.: Jun Pil Yoon, Se Jin Lee, Jun Lee, Ju Hyun Kim, Hyun Doo Noh; Yeungnam Univ J Med. 2007;24(1):79-84. Published online June 30, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.1.79

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Abstract PDF: Sphenoid sinus aspergillosis is notorious for its serious complications, such as permanent cranial nerve deficits and possible death. The most common associated symptoms are headache, followed by visual changes, and cranial nerve palsies. Because of an insidious onset, frequently resulting in missed and delayed diagnosis, sphenoid sinus aspergillosis is a potentially lethal medical condition. We report a case of visual loss secondary to isolated sphenoid sinus aspergillosis. A 69-year-old man presented to our hospital with the complaint of headache. The headache started one year previously and was described as severe dull pain localized bilaterally to the temporo-orbital region. The patient took daily NSAIDs for the pain. The neurological examination was normal. The MRI of the brain showed a left sphenoid sinusitis. A transnasal endoscopic superior meatal sphenoidotomy was performed. Aspergillosis was confirmed after a surgical biopsy was obtained. The patient was discharged from hospital without antifungal therapy. One month later, the patient complained of headache and loss of vision bilaterally. The orbital MRI showed a left cavernous sinus and bilateral optic nerve invasion. The loss of visions was permanent. In our case, the diagnosis was delayed; antifungal agents were not administered after surgery and the patient lost his vision as a result. Therefore, early diagnosis and proper treatment are important. Although the treatment of an invasive type of aspergillus has not been established, surgical removal of a nidus and aggressive antifungal therapy are recommended.

A Family of Dentatorubropallidoluysian Atrophy.: Ji Yoon Chung, Mee Young Park, Jun Lee, Jun Pil Yoon, Hyun Jung Park; Yeungnam Univ J Med. 2006;23(1):118-123. Published online June 30, 2006; DOI: https://doi.org/10.12701/yujm.2006.23.1.118

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Abstract PDF: Dentatorubropallidoluysian atrophy (DRPLA) is a rare neurodegenerative disorder usually inherited in an autosomal dominant pattern. DRPLA has been shown to be associated with expansion of an unstable cytosine-adenine-guanine (CAG) trinucleotide repeat in a gene on chromosome 12p. We evaluated a family with DRPLA that affected three members; A 35-year-old female presented with seven year history of gait ataxia, dysarthria and mild cognitive impairment. The MRI of the brain revealed diffuse cerebellar atrophy with an incidental lipoma in the midbrain. Her 30-year-old brother presented with progressive cerebellar ataxia that developed at the age of 20. Her grandmother and mother were reported to have developed ataxia during the late period of their life, and died at the age of 60 and 55, respectively. The demonstration of an expanded CAG repeat in the gene for DRPLA was used to confirm the diagnosis.

A Case of Systemic Lupus Erythematosus Presenting with Amaurosis Fugax without Antiphospholipid Antibodies Syndrome.: Jung Hyun Kim, Jung Sang Hah, Mee Young Park, Se Jin Lee, Jun Lee; Yeungnam Univ J Med. 2006;23(1):113-117. Published online June 30, 2006; DOI: https://doi.org/10.12701/yujm.2006.23.1.113

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Abstract PDF: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that may affect many organ systems including the nervous system. The immune response in patients with SLE can cause inflammation and other damage that can cause significant injury to the arteries and tissues. A 48-year-old woman was admitted to the hospital because of transient monocular blindness. Magnetic resonance imaging and conventional angiography showed severe stenosis of the distal intracranial internal carotid artery. The patient was diagnosed as having SLE but the antiphospholipid antibodies were negative. Amaurosis fugax has not been previously reported as an initial manifestation of SLE in Korea. We report a patient with a retinal transient ischemic attack as the first manifestation of SLE.

A Case of Wernicke's Encephalopathy Associated with Hyperemesis Gravidarum.: Seung Hyun Lee, Se Jin Lee, Yun Kyung Lee, Jung Sang Ha, Jun Lee; Yeungnam Univ J Med. 2004;21(1):91-95. Published online June 30, 2004; DOI: https://doi.org/10.12701/yujm.2004.21.1.91

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Abstract PDF: Wernicke's encephalopathy is an acute-onset illness characterized by mental confusion, ataxia and ophthalmoplegia due to a thiamine deficiency. Immediate administration of thiamine prevents progression of the disease and reverses brain lesions. We have experienced a case of Wernicke's encephalopathy associated with hyperemesis gravidarum. As Wernicke's encephalopathy is mostly associated with chronic alcoholism, the possibility of Wernicke's encephalopathy may be ignored in young women. We emphasize the need for thiamine supplementation in the patient requiring intravenous alimentation such as hyperemesis gravidarum.

Review

Antithrombotic Therapy for Ischemic Stroke.: Jung Sang Hah, Jun Lee; Yeungnam Univ J Med. 2003;20(1):1-12. Published online June 30, 2003; DOI: https://doi.org/10.12701/yujm.2003.20.1.1

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Abstract PDF: Ischemic stroke is among the principal causes of death and disability in the elderly. Although control of blood pressure, decreased cigarette smoking, and modified dietary habits are among important reasons for stroke decline, the use of antithrombotic therapy, rigorously prescribed. Several antiplatelet agents are approved to reduce the risk of recurrent stroke. Aspirin is the best-studied and most widely used antiplatelet agent for stroke prevention; it provides approximately 15% to 25% relatively risk reduction for secondary prevention of stroke or the major vascular death. Combining 2 antiplatelet agents with different mechanism of action was demonstrated to provide a substantial increase in efficacy in several studies. Anticoagulation should be considered first with potential cardiac sources of embolism. Heparin reduces development of erythrocyte-fibrin thrombi that form in regions of vascular stasis especially within the heart, in severely stenosed arteries sometimes engrafted on white thrombi, in acute arterial occlusion. Heparin should not be indiscriminately given to all acute brain ischemia patients, but may contribute to treatment of large artery occlusion and severe stenosis, cardiogenic embolism with a high acute recurrence risk, and dural sinus and cerebral venous thromobosis.

Original Articles

Comparison of the Repetitive Nerve Stimulation Test(RNST) Findings Between in Upper and Lower Extremity Muscles in Myasthenia Gravis.: Yun Seuk Jung, Jun Lee, Se Jin Lee, Jung Sang Hah, Wook Nyeon Kim; Yeungnam Univ J Med. 2000;17(2):129-136. Published online December 31, 2000; DOI: https://doi.org/10.12701/yujm.2000.17.2.129

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Abstract PDF: BACKGROUND
AND PURPOSE: This study was undertaken to compare the sensitivity of the Repetitive Nerve Stimulation Test (RNST) between the upper and lower extremity muscles in myasthenia gravis(MG) patients. MATERIALS AND METHODS: The study population consisted of 20 normal persons(control group) and 10 MG patients(MG group). Using Stalberg's method. RNST was systemically performed in orbicularis oculi muscle. upper extremity muscles(flexor carpi ulnaris. abductor digiti quinti), and lower extremity muscles(tibialis anterior. extensor digitorum brevis. vastus medialis). RESULTS: There were statistical differences of decremental response(mean+/-SD) in orbicularis oculi and upper extremity muscles between the control and MG groups(p<0.05 or p<0.01). However, there was no statistical difference of decremental response(mean+/-SD) to RNST in lower extremity muscles between the control and MG groups. There were highersensitivity in orbicularis oculi and upper extremity muscles than lower extremity muscles. Although positive reponse were detected in the lower extremity muscles, the positive response rates of lower extremity muscles were lower than o.oculi and upper extremity muscles. CONCLUSIONS: When the response rates of RNST in facial and upper extremity muscles are normal, may not be required RNST in lower extremity muscles.

The Significance of Small Polyp of colon in Koreans.: Soon Uk Kwon, Eun Ju Lee, Jong Ryul Eun, Sun Taek Choi, Hak Jun Lee, Byeong Ik Jang, Tae Nyeun Kim, Moon Kwan Chung; Yeungnam Univ J Med. 2000;17(1):39-48. Published online June 30, 2000; DOI: https://doi.org/10.12701/yujm.2000.17.1.39

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Abstract PDF

BACKGROUND
There are two theories in the development of colon cancer. One is the adenoma-carcinoma sequence theory and the other is the de novo cancer theory. Western countries believe in the adenoma-carcinoma sequence theory, however there are many recent reports from Japan about cancers developing from small adenomas. METHODS: The present study analyzed 408 polyps from 508 cases that were taken by colonoscopic polypectomy at the Departmant of Internal Medicine, Yeung-Nam University Hospital. RESULTS: The percentage of patients who have polyp was 41.3%(210cases out of 526cases) and the peak incidence was noted in patients in their 50's and 60's. There was no difference between the sexes, but we noted significant increase in the incidence of polyps in patients over age of thirty. We found 395 polyps below 1cm and 13 polyps above 1cm. Among 408 polyps, 5 cases cancerous polyps and 3 cases showed polyp size of less than 1cm each. The first case was a polyp of 0.4cm in size with elevated mucosa at the ascending colon. The second was 0.5cm in size with round elevation and hyperemic mucosa in the rectum. The third polyp was 0.6cm in size with tubular elevation at the hepatic flexure. CONCLUSIONS: colon polyp is common disease in Koreans. even small polyps can have cancer tissue, which should be removed if discovered during colonoscopy. We believe that not all colon cancer originates in the manner described by the adenoma-carcinoma sequence theory. However further studies with a larger sample population are needed to determine the exact role colon polyps plays in the development of colon cancer.

Citations

Citations to this article as recorded by

Histologic discrepancy between endoscopic forceps biopsy and endoscopic mucosal resection specimens of colorectal polyp in actual clinical practice
Moon Joo Hwang, Kyeong Ok Kim, A Lim Kim, Si Hyung Lee, Byung Ik Jang, Tae Nyeun Kim
Intestinal Research.2018; 16(3): 475. CrossRef

Case Report

A Case of Becker's Type Congenital Myotonia.: Sung Hwan Yun, Jung Sang Hah, Jun Lee; Yeungnam Univ J Med. 1999;16(1):125-130. Published online June 30, 1999; DOI: https://doi.org/10.12701/yujm.1999.16.1.125

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Abstract PDF: Congenital myotonia is a hereditary disorder of the skeletal muscle. The most characteristic features of the disease are myotonia and variable muscular hypertrophy. Molecular biologic investigations have revealed that mutations in the gene of the human skeletal muscle chloride ion channel protein are a cause of the disease. The Becker's type congenial myotonia is clinically similar to the autosomal dominantly inherited congenital myotonia (Thomsen's disease). Both disorders are characterized electrophysiologically by increased excitability of muscle fibers, reflected in clinical myotonia. In general, Becker's type congenital myotonia is more severe than Thomsen's disease in muscular hypertrophy and weakness. The authors recently experienced a 25-year-old female patient who has no family-related disease history and who has conspicuous muscular hypertrophy and the stiffness with muscles which occurred from the age of 3 or 4. Clinically she showed the authors a percussion myotonia. On electrophysiological study, exercise and repetitive stimulation of the abductor digiti quinti muscle disclosed a decline in the compound muscle action potential. Biopsy of biceps muscle revealed enlargement of muscle fibers with marked nuclear internalization. After the oral taking the Mexiletine, the patient showed a favorable turn a little with her stiffness of muscles. So we authors are reporting one case of Becker's type congenital myotonia with review of literatures.

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