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JYMS : Journal of Yeungnam Medical Science

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Case reports
Crowned dens syndrome as a rare cause of anterior neck pain after transurethral resection of the prostate: a case report
Myeong Geun Jeong, Bum Soon Park, Eun-Seok Son, Jang Hyuk Cho
J Yeungnam Med Sci. 2023;40(3):289-292.   Published online August 5, 2022
DOI: https://doi.org/10.12701/jyms.2022.00388
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  • 78 Download
AbstractAbstract PDF
We describe the case of a 79-year-old man who presented with progressive aggravation of severe axial neck pain and fever 3 days after transurethral resection of the prostate (TURP), despite maintaining neutral neck posture during surgery. Laboratory examination revealed markedly elevated C-reactive protein levels and erythrocyte sedimentation rates. Computed tomography revealed crown-like calcifications surrounding the odontoid process. We diagnosed crowned dens syndrome (CDS) as the cause of acute-onset neck pain after TURP. The patient was treated with nonsteroidal anti-inflammatory drugs for 5 days, and his symptoms resolved completely. CDS is a rare disease characterized by calcific deposits around the odontoid process with acute onset of severe neck pain and restricted motion. Evidence of inflammation on serological testing and fever are typical of CDS. However, the prevalence and pathophysiology of CDS remain unclear. We hypothesized that systemic inflammation after prostate surgery may have induced a local inflammatory response involving calcification around the odontoid process.
Severe congenital neutropenia mimicking chronic idiopathic neutropenia: a case report
Juhyung Kim, Soyoon Hwang, Narae Hwang, Yeonji Lee, Hee Jeong Cho, Joon Ho Moon, Sang Kyun Sohn, Dong Won Baek
J Yeungnam Med Sci. 2023;40(3):283-288.   Published online July 28, 2022
DOI: https://doi.org/10.12701/jyms.2022.00353
  • 2,155 View
  • 121 Download
AbstractAbstract PDFSupplementary Material
Severe chronic neutropenia is classified as severe congenital, cyclic, autoimmune, or idiopathic. However, there is a lot of uncertainty regarding the diagnosis of severe congenital neutropenia (SCN) and chronic idiopathic neutropenia, and this uncertainty affects further evaluations and treatments. A 20-year-old man presented with fever and knee abrasions after a bicycle accident. On admission, his initial absolute neutrophil count (ANC) was 30/µL. He had no medical history of persistent severe neutropenia with periodic oscillation of ANC. Although his fever resolved after appropriate antibiotic therapy, ANC remained at 80/µL. Bone marrow (BM) aspiration and biopsy were performed, and a BM smear showed myeloid maturation arrest. Moreover, genetic mutation test results showed a heterozygous missense variant in exon 4 of the neutrophil elastase ELANE: c597+1G>C (pV190-F199del). The patient was diagnosed with SCN. After discharge, we routinely checked his ANC level and monitored any signs of infection with minimum use of granulocyte colony-stimulating factor (G-CSF), considering its potential risk of leukemic transformation. Considering that SCN can be fatal, timely diagnosis and appropriate management with G-CSF are essential. We report the case of a patient with SCN caused by ELANE mutation who had atypical clinical manifestations. For a more accurate diagnosis and treatment of severe chronic neutropenia, further studies are needed to elucidate the various clinical features of ELANE.
Original articles
Safety of low-dose anticoagulation in extracorporeal membrane oxygenation using the Permanent Life Support System: a retrospective observational study
Kyungsub Song, Jae Bum Kim
J Yeungnam Med Sci. 2023;40(3):276-282.   Published online May 18, 2023
DOI: https://doi.org/10.12701/jyms.2023.00339
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  • 1 Web of Science
AbstractAbstract PDF
Background
Bleeding and thrombosis are major complications associated with high mortality in extracorporeal membrane oxygenation (ECMO) management. Anticoagulant therapy should be adequate to reduce thrombosis. However, related studies are limited.
Methods
We retrospectively reviewed all patients supported with ECMO at a single institution between January 2014 and July 2022 and included those on all types of ECMO using the Permanent Life Support System. Patients were classified into two groups according to their measured mean activated partial thromboplastin time (aPTT) during ECMO management: a high-anticoagulation (AC) group (aPTT, ≥55 seconds; n=52) and a low-AC group (aPTT, <55 seconds; n=79). The primary outcome was thrombotic or bleeding events during ECMO.
Results
We identified 10 patients with bleeding; significantly more of these patients were in the high-AC group (n=8) than in the low-AC group (15.4% vs. 2.5%, p=0.01). However, thrombus events and oxygenator change-free times were not significantly different between the two groups. Four patients in the high-AC group died of bleeding complications (brain hemorrhage, two; hemopericardium, one; and gastrointestinal bleeding, one). One patient in the low-AC group developed a thrombus and died of ECMO dysfunction due to circuit thrombosis.
Conclusion
Heparin did not significantly improve thrombotic outcomes. However, maintaining an aPTT of ≥55 seconds was a significant risk factor for bleeding events, especially those associated with mortality.
Rates and subsequent clinical course of fetal congenital anomalies detected by prenatal targeted ultrasonography of 137 cases over 5 years in a single institute: a retrospective observational study
Haewon Choi, Hyo-Shin Kim, Joon Sakong
J Yeungnam Med Sci. 2023;40(3):268-275.   Published online November 2, 2022
DOI: https://doi.org/10.12701/jyms.2022.00514
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  • 55 Download
AbstractAbstract PDF
Background
With the establishment of international guidelines and changes in insurance policies in Korea, the role of targeted ultrasonography has increased. This study aimed to identify the rates and clinical course of anomalies detected using prenatal targeted ultrasonography.
Methods
This study was a retrospective analysis of all pregnancies with targeted ultrasonography performed in a single secondary medical center over 5 years.
Results
Fetal anomalies were detected by targeted ultrasonography in 137 of the 8,147 cases (1.7%). The rates of anomalies were significantly higher in female fetuses (2.0% vs. 1.3%). In cases of female fetuses, the rate of anomalies was significantly higher in the advanced maternal age group (2.4% vs. 1.2%). In cases of male fetuses, the rate of anomalies was significantly higher in nulliparous (2.4% vs. 1.5%) and twin (5.7% vs. 1.9%) pregnancies. Pulmonary anomalies were significantly more common in the multiparity group (17.6% vs. 5.8%). Among the 137 cases, 17.5% terminated the pregnancy, 16.8% were diagnosed as normal after birth, and 42.3% were diagnosed with anomalies after birth or required follow-up.
Conclusion
Through the first study on the rates and clinical course of anomalies detected by targeted ultrasonography at a single secondary center in Korea, we found that artificial abortions were performed at a high rate, even for relatively mild anomalies or anomalies with good prognosis. We suggest the necessity of a nationwide study to establish clinical guidelines based on actual incidences or prognoses.
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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  • 53 Download
AbstractAbstract 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.
Novel cystography parameter to predict early recovery from urinary continence after radical prostatectomy for prostate cancer: a retrospective study
Yeong Uk Kim
J Yeungnam Med Sci. 2023;40(3):252-258.   Published online July 21, 2022
DOI: https://doi.org/10.12701/jyms.2022.00311
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  • 84 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDF
Background
The purpose of this study was to investigate whether postoperative cystography findings can predict early and long-term recovery from incontinence after radical prostatectomy (RP), compared with the other cystography parameters.
Methods
I retrospectively reviewed 118 patients who underwent robot-assisted RP (RARP) for localized prostate cancer at single institution between January 2016 and April 2021. One hundred and seven patients were included in the study. Postoperative cystography was routinely performed 7 days after surgery. The bladder neck to pubic symphysis ratio, vesicourethral angle, and bladder neck anteroposterior length (BNAP) ratio (the bladder neck-posterior margin distances divided by the anteroposterior lengths) were evaluated. Continence was defined as cessation of pad use. The association between these variables and urinary incontinence was also analyzed.
Results
The urinary incontinence recovery rates 1, 3, 6, and 12 months after RARP were 43.92%, 66.35%, 87.85%, and 97.19%, respectively. Multivariate logistic regression analysis demonstrated that a lower BNAP ratio and wider vesicourethral angle were significantly associated with continence restoration at 1, 3, and 6 months after surgery. In addition, in terms of days of pad usage, lower BNAP ratio, wider vesicourethral angle, and bladder neck preservation were significantly associated with recovery from urinary incontinence within 12 months as assessed by Cox proportional hazard analysis.
Conclusion
This study demonstrated that vesicourethral angle and BNAP ratio were independent predictors of early recovery from post-prostatectomy incontinence. I suggest that both the sagittal and coronal views of postoperative cystography help anticipate early continence restoration after RARP.

Citations

Citations to this article as recorded by  
  • A single‐center retrospective comparative analysis of urinary continence in robotic prostatectomy with a combination of umbilical ligament preservation and Hood technique
    Hiroaki Shimmura, Taro Banno, Kazutaka Nakamura, Anju Murayama, Haruki Shigeta, Toyoaki Sawano, Yukiko Kouchi, Akihiko Ozaki, Fumito Yamabe, Junpei Iizuka, Toshio Takagi
    International Journal of Urology.2023; 30(10): 889.     CrossRef
Effects of propofol-remifentanil versus sevoflurane-remifentanil on acute postoperative pain after total shoulder arthroplasty: a randomized trial
Eun Kyung Choi, Saeyoung Kim, Do young Kim
J Yeungnam Med Sci. 2023;40(3):247-251.   Published online March 30, 2022
DOI: https://doi.org/10.12701/jyms.2022.00129
  • 2,483 View
  • 100 Download
AbstractAbstract PDF
Background
While some evidence indicates that propofol-based anesthesia has less postoperative pain than sevoflurane-based anesthesia, these results are controversial. We compared acute postoperative pain intensity and opioid consumption after total shoulder arthroplasty between propofol-remifentanil (PR) and sevoflurane-remifentanil (SR) anesthesia.
Methods
Among 48 patients undergoing shoulder arthroscopic surgery anesthetized with PR or SR, postoperative pain intensity was assessed at 30 minutes and at 2, 6, 12, and 24 hours. The total patient-controlled analgesia volume and number of patients requiring rescue analgesics were assessed.
Results
No significant difference in postoperative pain intensity was observed between the two groups. Postoperative opioid consumption and analgesic requirements were also comparable in the first 24 hours after surgery.
Conclusion
PR and SR anesthesia for shoulder arthroscopic surgery provide comparable postoperative analgesia results.
Review articles
Advances in management of pediatric chronic immune thrombocytopenia: a narrative review
Jae Min Lee
J Yeungnam Med Sci. 2023;40(3):241-246.   Published online January 9, 2023
DOI: https://doi.org/10.12701/jyms.2022.00745
  • 2,891 View
  • 194 Download
  • 1 Crossref
AbstractAbstract PDF
Immune thrombocytopenia (ITP) is a disease in which thrombocytopenia occurs because of immune-mediated platelet destruction and decreased platelet production. Although many pediatric patients with ITP experience spontaneous remission or reach remission within 12 months of first-line therapy, approximately 20% progress to chronic ITP. Patients who do not respond to first-line treatment or experience frequent relapses are of great concern to physicians. This review summarizes recent treatments for second-line treatment of pediatric chronic ITP.

Citations

Citations to this article as recorded by  
  • Beta-Thalassemia with Initial Presentation as Immune Thrombocytopenia: A Case Report
    Hyun Sik Kang
    Clinical Pediatric Hematology-Oncology.2023; 30(1): 42.     CrossRef
Evaluation research in Korean medical education: a systematic review
Hye Jin Park, Yu Ra Kim
J Yeungnam Med Sci. 2023;40(3):233-240.   Published online December 5, 2022
DOI: https://doi.org/10.12701/jyms.2022.00563
  • 1,634 View
  • 79 Download
AbstractAbstract PDFSupplementary Material
The purpose of this study aims to analyze research trends related to ‘evaluation’ in Korean medical education through a systematic review. This study used a systematic review method, which is a research methodology for research trends and ‘literature analysis.’ Researchers searched the Korean journal literature published until the end of December 2020 in the Korean research database with keywords related to medicine and evaluation. Thus, 5,205 cases were identified. Based on these data, 143 papers were selected through a logical screening process, requiring 1 month to complete the data search and analysis process. In terms of publications, medical journals overwhelmingly outnumbered nonmedical journals until 2015; however, after 2016, the number of papers published in nonmedical journals increased, and the number of published papers was similar to that of medical journals. In terms of evaluation-related research, research on student and program evaluations has been very active compared to that on accreditation. As the number of evaluation studies has gradually decreased over the past 10 years, preparing a plan to revitalize them in Korean medical education is necessary. Considering that the role of evaluation in education has been emphasized in recent years, research on reestablishing the concept of evaluation; developing evaluation indicators; analyzing the status of student evaluation, program evaluation, and accreditation; and deriving measures to improve medical education through evaluation is required.
Hypertension and cognitive dysfunction: a narrative review
Eun-Jin Cheon
J Yeungnam Med Sci. 2023;40(3):225-232.   Published online November 29, 2022
DOI: https://doi.org/10.12701/jyms.2022.00605
  • 2,542 View
  • 165 Download
  • 3 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Cognitive dysfunction is relatively less considered a complication of hypertension. However, there is sufficient evidence to show that high blood pressure in middle age increases the risk of cognitive decline and dementia in old age. The greatest impact on cognitive function in those with hypertension is on executive or frontal lobe function, similar to the area most damaged in vascular dementia. Possible cognitive disorders associated with hypertension are vascular dementia, Alzheimer disease, and Lewy body dementia, listed in decreasing strength of association. The pathophysiology of cognitive dysfunction in individuals with hypertension includes brain atrophy, microinfarcts, microbleeds, neuronal loss, white matter lesions, network disruption, neurovascular unit damage, reduced cerebral blood flow, blood-brain barrier damage, enlarged perivascular damage, and proteinopathy. Antihypertensive drugs may reduce the risk of cognitive decline and dementia. Given the high prevalence of dementia and its impact on quality of life, treatment of hypertension to reduce cognitive decline may be a clinically relevant intervention.

Citations

Citations to this article as recorded by  
  • Chronic Neuroinflammation and Cognitive Decline in Patients with Cardiac Disease: Evidence, Relevance, and Therapeutic Implications
    Jan Traub, Anna Frey, Stefan Störk
    Life.2023; 13(2): 329.     CrossRef
  • The A-to-Z factors associated with cognitive impairment. Results of the DeCo study
    María Gil-Peinado, Mónica Alacreu, Hernán Ramos, José Sendra-Lillo, Cristina García, Gemma García-Lluch, Teresa Lopez de Coca, Marta Sala, Lucrecia Moreno
    Frontiers in Psychology.2023;[Epub]     CrossRef
Imagery
"Smiling sunflowers"
J Yeungnam Med Sci. 2023;40(3):i.   Published online July 18, 2022
DOI: https://doi.org/10.12701/jyms.2022.00423
  • 1,724 View
  • 50 Download
PDF
Resident fellow section: Teaching images
A 40-year-old man with neuropathic pain in the entire left foot
Jae Hwa Bae, Mathieu Boudier-Revéret, Min Cheol Chang
J Yeungnam Med Sci. 2023;40(2):223-224.   Published online August 30, 2022
DOI: https://doi.org/10.12701/jyms.2022.00486
  • 1,154 View
  • 57 Download
PDF
Communication
The art of diabetes care: guidelines for a holistic approach to human and social factors
Muhammad Jawad Hashim
J Yeungnam Med Sci. 2023;40(2):218-222.   Published online November 11, 2022
DOI: https://doi.org/10.12701/jyms.2022.00577
  • 1,343 View
  • 70 Download
AbstractAbstract PDF
A holistic approach to diabetes considers patient preferences, emotional health, living conditions, and other contextual factors, in addition to medication selection. Human and social factors influence treatment adherence and clinical outcomes. Social issues, cost of care, out-of-pocket expenses, pill burden (number and frequency), and injectable drugs such as insulin, can affect adherence. Clinicians can ask about these contextual factors when discussing treatment options with patients. Patients’ emotional health can also affect diabetes self-care. Social stressors such as family issues may impair self-care behaviors. Diabetes can also lead to emotional stress. Diabetes distress correlates with worse glycemic control and lower overall well-being. Patient-centered communication can build the foundation of a trusting relationship with the clinician. Respect for patient preferences and fears can build trust. Relevant communication skills include asking open-ended questions, expressing empathy, active listening, and exploring the patient’s perspective. Glycemic goals must be personalized based on frailty, the risk of hypoglycemia, and healthy life expectancy. Lifestyle counseling requires a nonjudgmental approach and tactfulness. The art of diabetes care rests on clinicians perceiving a patient’s emotional state. Tailoring the level of advice and diabetes targets based on a patient’s personal and contextual factors requires mindfulness by clinicians.
Case reports
Transient osteoporosis of the hip with a femoral neck fracture during follow-up: a case report
Yusuke Tabata, Shuhei Matsui, Masabumi Miyamoto, Koichiro Omori, Yoichiro Tabata, Tokifumi Majima
J Yeungnam Med Sci. 2023;40(2):212-217.   Published online September 26, 2022
DOI: https://doi.org/10.12701/jyms.2022.00479
  • 2,008 View
  • 58 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDF
We report a case of transient osteoporosis of the hip with a femoral neck fracture found during follow-up. A 53-year-old man presented with left hip pain without trauma. The pain did not improve after 2 weeks and he was brought to our hospital by ambulance. Magnetic resonance imaging (MRI) of the left hip joint showed diffuse edema in the bone marrow, which was identified by low signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and increased signal intensity on short tau inversion recovery. This edema extended from the femoral head and neck to the intertrochanteric area. He was diagnosed with transient osteoporosis of the left hip. Rest gradually improved his pain; however, 3 weeks later, his left hip pain worsened without trauma. X-ray, computed tomography, and MRI results of the hip joint demonstrated a left femoral neck fracture, and osteosynthesis was performed. Differential diagnoses included avascular necrosis of the femoral head, infection, complex regional pain syndrome, rheumatoid arthritis, leukemia, and other cancers. Transient osteoporosis of the hip generally has a good prognosis with spontaneous remission within a few months to 1 year. However, a sufficient length of follow-up from condition onset to full recovery is necessary to avoid all probable complications such as fractures.

Citations

Citations to this article as recorded by  
  • Hip effusion/synovitis influences results after multiple drilling core decompression for bone marrow edema syndrome of hip
    Hua-zhang Xiong, Yan-li Peng, Yu-hong Deng, Ying Jin, Ming-hong Tu, Shu-hong Wu
    BMC Surgery.2023;[Epub]     CrossRef
Cerebral fat embolism syndrome: diagnostic challenges and catastrophic outcomes: a case series
Hussein A. Algahtani, Bader H. Shirah, Nawal Abdelghaffar, Fawziah Alahmari, Wajd Alhadi, Saeed A. Alqahtani
J Yeungnam Med Sci. 2023;40(2):207-211.   Published online September 7, 2022
DOI: https://doi.org/10.12701/jyms.2022.00360
  • 2,189 View
  • 100 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDF
Fat embolism syndrome is a rare but alarming, life-threatening clinical condition attributed to fat emboli entering the circulation. It usually occurs as a complication of long-bone fractures and joint reconstruction surgery. Neurological manifestations usually occur 12 to 72 hours after the initial insult. These neurological complications include cerebral infarction, spinal cord ischemia, hemorrhagic stroke, seizures, and coma. Other features include an acute confusional state, autonomic dysfunction, and retinal ischemia. In this case series, we describe three patients with fat embolism syndrome who presented with atypical symptoms and signs and with unusual neuroimaging findings. Cerebral fat embolism may occur without any respiratory or dermatological signs. In these cases, diagnosis is established after excluding other differential diagnoses. Neuroimaging using brain magnetic resonance imaging is of paramount importance in establishing a diagnosis. Aggressive hemodynamic and respiratory support from the beginning and consideration of orthopedic surgical intervention within the first 24 hours after trauma are critical to decreased morbidity and mortality.

Citations

Citations to this article as recorded by  
  • Occurrence of Numerous Cerebral White Matter Hyperintensities in Trauma Patients With Cerebral Fat Embolism: A Systematic Review and Report of Two Cases
    Gregory S Huang, C. Michael Dunham, Elisha A Chance
    Cureus.2023;[Epub]     CrossRef

JYMS : Journal of Yeungnam Medical Science