Journal of Yeungnam Medical Science

Volume 30(2); December 2013

Reviews

Mission and Operation of Institutional Review Board.: Yong Jin Kim; Yeungnam Univ J Med. 2013;30(2):73-78. Published online December 31, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.2.73

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Abstract PDF: An institutional review board (IRB) should independently safeguard the right, safety, and well-being of all clinical trial subjects. It should consist of members who are qualified and experienced to review and evaluate the science, medical aspects, and ethics of the proposed trial. They have to pursue continuing efforts to improve the standards of review. The levels of review include the full board review, expedited review, continuing review, or exempt from review, while the levels of decision-making include approval, conditional approval, deferred approval, and disapproval. Investigators must follow the approved protocols and regulations honestly, and it is the IRB's mission to audit clinical trial sites as well.

What Is Integrative Medicine?.: Seungpil Jung; Yeungnam Univ J Med. 2013;30(2):79-82. Published online December 31, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.2.79

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Abstract PDF: The demand for complementary and alternative medicine (CAM) is increasing worldwide. High-technology medicine is not always effective and is often accompanied by neglected self-care and high cost. Also, conventional medicine has become dependent on expensive technological solutions to health problems. Integrated medicine is not simply a synonym for complementary medicine. It involves the understanding of the interaction of the mind, body, and spirit and how to interpret this relationship in the dynamics of health and disease. Integrative medicine shifts the orientation of the medical practice from a disease-based approach to a healing-based approach. In South Korea, CAM education was first provided 20 years ago, and integrative medicine is becoming part of the current mainstream medicine. Increasing numbers of fellowships in integrative medicine are being offered in many academic health centers in the U.S. Also, it has emerged as a potential solution to the American healthcare crisis and chronic diseases, which are bankrupting the economy. It provides care that is patient-centered, healing-oriented, emphasizes the therapeutic relationship, and uses therapeutic approaches originating from conventional and alternative medicine.

Original Articles

Risk Factors of Nosocomial Bacteremia of Extended-spectrum beta-Lactamase Producing Escherichia coli.: Daisik Ko, Song Mi Moon, Ji Sung Lee, Yoon Soo Park, Yong Kyun Cho; Yeungnam Univ J Med. 2013;30(2):83-89. Published online December 31, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.2.83

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Abstract PDF: BACKGROUND
The prevalence of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli is increasing rapidly worldwide. Treatment options for ESBL-producing E. coli are limited, and infections caused by this organism are associated with improper antibiotic use, a long hospital stay, and increased mortality. Thus, the assessment and early recognition of the risk factors of nosocomial infections due to ESBL-producing E. coli are important for the infection control and proper treatment. METHODS: A case-control study was performed that included nosocomial episodes of ESBL-producing E. coli bacteremia at a tertiary care hospital from January 2004 to December 2007. For each case patient, three controls were randomly selected and data on predisposing factors were collected. RESULTS: Fifty-five cases of nosocomial ESBL-producing E. coli bacteremia were studied. Carbapenem usage (OR: 11.3, 95% CI: 1.1-115.9, p=0.041), quinolone usage (OR: 4.5, 95% CI: 1.1-18.8, p=0.042), biliary obstructive disease (OR: 11.8, 95% CI: 3.0-46.7, p<0.001) and the APACHE II score (OR: 1.3, 95% CI: 1.2- 1.5, p<0.001) were analyzed as independent risk factors of nosocomial ESBL-producing E. coli bacteremia. CONCLUSION: Our results showed that physicians caring for patients with risk factors of nosocomial bacteremia should consider ESBL-producing E. coli as the causative organisms of the disease.

The Utility of Basal Serum Luteinizing Hormone Levels for Screening Central Precocious Puberty in Girls.: Jung Ki Ju, Hae Lyoung Lee, Young Ah Lee, Sang Keun Chung, Min Jung Kwak; Yeungnam Univ J Med. 2013;30(2):90-94. Published online December 31, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.2.90

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Abstract PDF: BACKGROUND
This study was conducted to examine if basal luteinizing hormone (LH) levels could be useful for screening central precocious puberty (CPP) in girls. METHODS: A total of 90 girls under the age of 8 years were included in this study. They underwent the gonadotropin-releasing hormone (GnRH) stimulation test at Good Gang-An Hospital from March 2008 to December 2012 for evaluation of premature sexual development. Patients were classified into two groups: the pubertal response group of patients who had 5 IU/L peak LH levels in the GnRH stimulation test, and the prepubertal response group of patients who had LH levels <5 IU/L. Chronological and bone ages, height, weight, body mass index, gonadotropin response to GnRH stimulation, and basal levels of LH, follicle-stimulating hormone, and estradiol were studied in both groups. The relationship between basal LH and peak-stimulated LH was evaluated using Spearman's correlation. To determine the optimal cut-off values of basal LH levels for differentiating between two groups, the receiver operating characteristic (ROC) curves were analyzed. RESULTS: When the correlation between basal LH levels and peak LH after GnRH stimulation was analyzed in all subjects (N=90), basal LH levels had a statistically significant positive correlation with peak stimulated LH levels (rs=0.493, p<0.001). The cut-off level of optimal basal LH was 0.1 IU/L, according to the ROC curves. Its sensitivity was 73.3%, and its specificity was 77.8%. CONCLUSION: The study results showed that serum basal LH levels are useful for screening CPP in girls.

Epidemiology and Clinical Features of Respiratory Viruses in Pediatric Inpatients in a Single Medical Center in Daegu from 2010 to 2012.: Eun Kyung Lee, Yun Young Lee, Kwang Hae Choi; Yeungnam Univ J Med. 2013;30(2):95-100. Published online December 31, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.2.95

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Abstract PDF

BACKGROUND
This study was performed to investigate the epidemiologic and clinical features of acute respiratory viral infection in hospitalized children. METHODS: From 2010 to 2012, we tested nasopharyngeal swab specimen in 1,584 hospitalized children with multiple real-time polymerase chain reactions to identify 10 kinds of respiratory viruses (including influenza virus A, B (FluA, FluB), respiratory syncytial virus (RSV), human metapneumovirus (MPV), adenovirus (AdV), human coronavirus (CoronaV), human enterovirus (HEV), human bocavirus (HBoV), parainfluenza virus (PIV), and human rhinovirus (Rhinovirus)). We analyzed the positive rate, annual and seasonal variations, and clinical features (respiratory tract and non-respiratory tract) according to the retrospective review of medical records. RESULTS: Respiratory viruses were detected from 678 (42.8%) of 1,584 patients. The most common detected virus was RSV (35.0%), and then AdV (19.0%), HEV (18.1%). The critical period of the respiratory viral infection was during the first 12 months of a child's life. PIV increased by 8.4%, 12.1%, and 21.1% annually. Bronchiolitis was most frequently caused by RSV, and croup was frequently caused by PIV. The most common cause of meningitis was HEV. Hepatitis-associated respiratory virus was developed 111 in 678 cases. CONCLUSION: Although this study was confined to a single medical center for three years, we identified the epidemiology and clinical feature of respiratory viruses in Daegu from 2010 to 2012. Future surveillance will be necessary for annual and seasonal variations.

Citations

Citations to this article as recorded by

Renal infarction associated with low dose intravenous immunoglobulin in a kidney transplant recipient with sepsis: a case report and literature review
Eun Woo Choi, Jun Young Do, A. Young Kim, Seok Hui Kang
BMC Nephrology.2021;[Epub] CrossRef
Correlation between Infection with Multiple Respiratory Viruses and Length of Hospital Stay in Patients from Cheonan, Korea
Jae-Sik Jeon, Jin-Wan Park, Jae Kyung Kim
The Korean Journal of Clinical Laboratory Science.2017; 49(1): 22. CrossRef
Infection Frequency and Mixed infection on Eight Viruses from Patients with Acute Respiratory Syndromes in Seoul
Heejin Ham, Jungim Jang, Sukju Jo, Younghee Oh, Sonil Pak
Journal of Bacteriology and Virology.2014; 44(3): 274. CrossRef

Case Reports

A Case of von Hippel-Lindau Disease with Aortic Valve Insufficiency.: Sang Hyeon Kang, In Chul Park, Duk Song Cho, Hye Jung Lee, Ho Jin Lee, Dong Hyun Lee; Yeungnam Univ J Med. 2013;30(2):101-104. Published online December 31, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.2.101

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Abstract PDF: Von Hippel-Lindau (VHL) disease is an autosomal dominant hereditary disorder caused by a germline mutation of the VHL gene. It is a multi-systemic disorder that is predisposed to benign or malignant tumors of visceral organs such as hemangioblastoma of the central nervous system, renal cell carcinoma, retinal angioma and pheochromocytoma. We report herein a case of VHL disease that initially manifested with aortic valve insufficiency.

A Case of Type 1 Neurofibromatosis Associated with Multiple Metastatic Gastrointestinal Stromal Tumors.: Hyo Jin Jang, Sung Ae Koh, Da Eun Jeong, Ji Yoon Jung, Eun Ju Goo, Kyoung Hee Lee, Joon Hyuk Choi, Myung Soo Hyun; Yeungnam Univ J Med. 2013;30(2):105-108. Published online December 31, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.2.105

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Abstract PDF: Type 1 neurofibromatosis (von Recklinghausen's disease, NF-1) is an autosomal-dominant neurocutaneous-disorder characterized by systemic cafe'-au-lait spots, multiple cutaneous neurofibromas, axillary or inguinal freckling, and Lisch nodules (pigmented iris hamartomas). Approximately 10-25% of NF1 patients have gastrointestinal neoplasms. Gastrointestinal stromal tumor (GIST) in patients with neurofibromatosis is most commonly found in the small bowel and the stomach, and approximately 60% of such patients have multiple tumors or multiple tumor sites. Although, the increased incidence of GIST in patients with neurofibromatosis is well documented in pathology literature in English, but has rarely been documented in Korea. Here, we report a case of multiple GISTs in a 48-year-old woman accompanied by NF1. She was admitted to Yeungnam University Hospital with complaints of melena and dyspnea. A contrast-enhanced computed tomography (CT) scan revealed that multiple soft tissue masses were occupying the entire peritoneal cavity. An ultrasonogram- guided biopsy was performed and the tumors were found to have been composed of tumor cells that were positive for c-kit protein. The patient was put on Imatinib mesylate treatment, and further follow-up will be carried out.

A Case of Continuous Ambulatory Peritonitis Dialysis Peritonitis Due to Stenotrophomonas maltophilia Using Antibiotic Combination.: Hee Sung Ko, Ah Ran Choi, Tae Hoon Kim, Chan Hee Kyung, Jang Ho Cho, Yong Hoon Kim, Jung Eun Lee; Yeungnam Univ J Med. 2013;30(2):109-111. Published online December 31, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.2.109

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Abstract PDF: Continuous ambulatory peritoneal dialysis (CAPD) peritonitis is a major complication of peritoneal dialysis (PD) and leads to the discontinuation of PD. Despite its limited pathogenicity, CAPD peritonitis caused by Stenotrophomonas maltophilia (S. maltophilia), an important nosocomial pathogen that is present in nature and is usually associated with plastic indwelling devices. Infection of S. maltophilia is associated with a poor prognosis, including inability to maintain the CAPD catheter, because of its resistance to multiple antibiotics. We report a case of CAPD peritonitis due to S. maltophilia that was treated successfully using oral Trimethoprim-sulfame-thoxazole and intraperitoneal Ticarcillin/clavulanate without removing the dialysis catheter.

Asymptomatic Isolate Tricuspid Regurgitation with Chordae Tendineae Rupture Caused by Blunt Chest Injury.: Min Hee Kim, Hyun Jae Kang, Byung Chun Jung, Bong Ryeol Lee, Ho Jin Jung, Jun Young Lee, Soo Hyun Bae, Dong Woo Shin; Yeungnam Univ J Med. 2013;30(2):112-115. Published online December 31, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.2.112

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Abstract PDF: The incidence and importance of tricuspid valve regurgitation after a blunt chest injury has risen with the increase in the number of automobile accidents and steering wheel traumas. This kind of injury has been reported more frequently in the last decade because of the better diagnostic procedures and understanding of the pathology. However, tricuspid valve regurgitation following a blunt chest injury can still be easily missed because most patients do not show symptoms at the time of the trauma. A 55-year-old male patient presented himself at our facility after suffering a chest injury from an automobile accident. His transthoracic echocardiography (TTE) revealed severe tricuspid valve regurgitation due to the prolapse of his anterior valve leaflet. We report a case of asymptomatic tricuspid regurgitation that developed after a blunt chest injury.

Burnt-out Metastatic Prostate Cancer.: Dong Suk Shin, Dong Hoe Koo, Suhyeon Yoo, Deok Yun Ju, Cheol Min Jang, Kwan Joong Joo, Hyun Chul Shin, Seoung Wan Chae; Yeungnam Univ J Med. 2013;30(2):116-119. Published online December 31, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.2.116

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Abstract PDF: A burnt-out prostate cancer tumor is a very rare clinical entity. The term 'burnt-out' refers to a primary tumor that has spontaneously and nearly completely regressed without treatment. Since metastasis of prostate cancer is usually encountered in the presence of advanced disease, distant metastasis with an undetectable primary tumor is very rare. We report herein a case of a burnt-out prostate cancer tumor that metastasized to the thoracic (T) spine and caused cord compression. A 66-year-old man visited the Emergency Department due to weakness of both legs for the past two days. His blood and urine tests were normal at the time. His spine magnetic resonance imaging (MRI) scans looked like bone metastasis that involved the T-7 vertebral body and a posterior element, and caused spinal cord compression. Other images, including from the brain MRI, neck/chest/abdomino-pelvic computed tomography (CT) scan and 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) and endoscopy, revealed no lesions that suggested malignancy. After total corpectomy T-7 and screw fixation/fusion at T5 to T10, the pathology report revealed a metastatic carcinoma that was strongly positive for prostate-specific antigen (PSA). The serum PSA value was 1.5 ng/mL. The transrectal 12-core prostate biopsy and ultrasonography showed no definitive hypoechoic lesion, but one specimen had slight (only 1%) adenocarcinoma with a Gleason score of 6 (3+3). The final diagnosis was burned-out prostate cancer with an initial normal PSA value. Although metastatic disease with an unknown primary origin was confirmed, a more aggressive approach in seeking the primary origin could provide a more specific treatment strategy and greater clinical benefit to patients.

Severe Mitral Regurgitation Due to Coronary Vasospasm, Confirmed by Ergonovine Echocardiography.: Jung Joon Cha, Chan Hee Kyung, Jang Ho Cho, Yong Hoon Kim, Haewon Kim, Sung Joo Lee, Se Joong Rim, Eui Young Choi; Yeungnam Univ J Med. 2013;30(2):120-123. Published online December 31, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.2.120

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Abstract PDF: The common causes of organic mitral regurgitation (MR) include mitral valve prolapse (MVP) syndrome, rheumatic heart disease, and endocarditis. MR also occurs secondary to dilated cardiomyopathy and coronary artery disease. In acute severe MR, the hemodynamic overload often cannot be tolerated, and mitral valve repair or replacement must be performed immediately. We report herein a case of severe MR due to coronary vasospasm that was confirmed via ergonovine echocardiography in a 70-year-old man. He was scheduled to undergo mitral valve surgery, but it did not push through and he was put on medical therapy.

Treatment of Bilateral Hawkins Type II Talar Neck Fractures.: Jee Hoon Kim, Jung Rae Kim, Chul Hyun Park; Yeungnam Univ J Med. 2013;30(2):124-127. Published online December 31, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.2.124

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Abstract PDF: Talus fracture is less common than most fractures, and bilateral talar neck fracture is extremely rare. Complications associated with talus fractures are generally deemed common because of the anatomical characteristics of the talus, but few reports have described the methods of treating such complications and the results of bilateral talar neck fracture. We report here a case of bilateral Hawkins type II talar neck fracture that had good clinical results without complications after early surgical treatment.

A Case of Pseudolymphomatous IgG4-Related Disease Involving the Maxilla.: Min Jung Kim, Seung Il Bae, Hoon Tae Kim, Young Hoon Hong, Hyun Je Kim, Choong Ki Lee, Mi Jin Gu; Yeungnam Univ J Med. 2013;30(2):128-131. Published online December 31, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.2.128

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Abstract PDF: Immunoglobulin G4 (IgG4)-related disease is an inflammatory condition characterized by IgG4 positive plasma cell infiltration. It can affect any organ in the body and mainly involves the pancreas, liver, biliary tracts, orbits, salivary glands and lymph nodes. It can manifest as an inflammatory pseudotumor. Pseudolymphoma as an inflammatory pseudotumor is a group of benign tumors that exhibit histological and clinical features suggestive of malignant lymphoma. Studies on IgG4-related disease are rarely reported, and no case of the disease that involved the maxillary bone and adjacent soft tissue, except for the skin, has been reported. Therefore, we report herein a case of pseudolymphomatous IgG4-related disease that involved the maxilla, with a literature review.

A Case of Gastric Lipoma with Upper Gastrointestinal Bleeding.: Min Geun Gu, Kook Hyun Kim, Byung Sam Park, Sung Yun Jung, Yo Han Jeong, Dong Won Lee, Hyeong Chan Shin, Mi Jin Gu; Yeungnam Univ J Med. 2013;30(2):132-135. Published online December 31, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.2.132

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Abstract PDF: Gastric lipoma is a typical benign submucosal tumor that is usually asymptomatic and is generally detected incidentally when performing gastroscopy. However, depending on its size and location, an atypical gastrointestinal lipoma can cause abdominal pain, diarrhea, constipation, intestinal obstruction, intussuception and life-threatening gastrointestinal bleeding. We report herein a case of gastric lipoma with bleeding in a 43-year-old man. The gastroscopy showed a 4x4 cm ulcero-fungating submucosal mass at the anterior wall of the gastric antrum. Laparoscopic gastric wedge resection was performed and the lesion was diagnosed as gastric lipoma.

A Case of Membranoproliferative Glomerulonephritis in a Patient with Type 2 Diabetes Mellitus.: Dong Hyun Kim, Jang Won Lee, Min Suk Jung, Seung Hyun Lee, Byung Cheol Min, Hyun Ju Kim; Yeungnam Univ J Med. 2013;30(2):136-140. Published online December 31, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.2.136

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Abstract PDF: Diabetic nephropathy (DN) is a common complication and the leading cause of end-stage renal disease (ESRD) in diabetic patients. The occurrence of non-diabetic renal disease (NDRD) in diabetic patients has been increasingly recognized in recent years. Generally, renal injuries in DN are deemed difficult to reverse, whereas some NDRDs are often treatable and even remittable. Thus, the diagnosis of NDRD in patients with diabetes mellitus (DM) via a kidney biopsy would be significant for its prognosis and therapeutic strategy. According to recent studies, the most common NDRD is IgA nephropathy in type 2 diabetic patients, and some cases of minimal change disease and membranous glomerulonephritis have been reported in Korea. However, membranoproliferative glomerulonephritis (MPGN) is an uncommon condition in diabetic patients. To our knowledge, there has been no case yet of MPGN, except in a child with type 1 DM. We present an unusual case of a 27-year-old woman who had type 2 DM with MPGN, as confirmed via a kidney biopsy.

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