Journal of Yeungnam Medical Science

Case report

Recovery of the ascending reticular activating system and consciousness following comprehensive management in a patient with traumatic brain injury: a case report: Sung Ho Jang, Young Hyeon Kwon; J Yeungnam Med Sci. 2022;39(4):332-335. Published online August 12, 2021; DOI: https://doi.org/10.12701/yujm.2021.01172; Funded: National Research Foundation of Korea, Ministry of Science, ICT and Future Planning

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Abstract PDF: We report on changes in the ascending reticular activating system (ARAS) concurrent with the recovery of impaired consciousness following rehabilitation and cranioplasty in a patient with traumatic brain injury (TBI), which were demonstrated on diffusion tensor tractography (DTT). A 34-year-old male patient was diagnosed with a traumatic intracerebral hemorrhage after falling from a height of approximately 7 m and underwent a right frontoparietotemporal decompressive craniectomy and hematoma removal. At 5 months after onset, when starting rehabilitation, the patient showed impaired consciousness, with a Glasgow Coma Scale (GCS) score of 4. Comprehensive rehabilitative therapy was provided until 14 months after onset, and his GCS score improved to 8. Cranioplasty was performed using auto-bone at 14 months after onset. One month after cranioplasty, his GCS score improved to 12. On the 15-month DTT, the deviated lower dorsal ARAS was restored on both sides, and the right side had become thicker. The right lower ventral ARAS was reconstructed, and increased neural connectivity of the upper ARAS was detected in both the prefrontal cortices. Thus, changes in the ARAS were demonstrated in a patient with TBI during recovery of consciousness following rehabilitation and cranioplasty.

Original articles

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; J Yeungnam Med Sci. 2022;39(4):314-321. Published online August 16, 2022; DOI: https://doi.org/10.12701/jyms.2022.00437; Funded: Yeungnam University Medical Center

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Background
In this study, the degree of anxiety, depression, and stress caused by coronavirus disease 2019 (COVID-19) was identified, as well as the need for psychological prevention measures among medical students in the Daegu region that was designated the first special disaster area due to the spread of COVID-19.
Methods
The subjects of this study were 318 medical students in Daegu who voluntarily participated in an online test using the Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised Korean version. As a result of the test, risk students received immediate telephone counseling, and the effect of this telephone counseling was analyzed.
Results
There were no differences in depression, anxiety, or stress according to gender and grade. As a result of immediate telephone counseling for risk students, significant differences were found in depression, anxiety, and stress, and the counseling was found to be effective.
Conclusion
For medical students who are easily exposed to stress, the importance of psychological prevention measures and effectiveness of non-face-to-face counseling should be recognized. In the field of medical education, we must do our best to build a system that can be used immediately at the appropriate time for these programs.

Citations

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Study on the Learning Environment of Medical Students in the COVID-19
Yu Ra Kim, Hye Jin Park, Saeyoon Kim
Keimyung Medical Journal.2023; 42(2): 80. CrossRef

Intensive care unit management of uncomplicated type B aortic dissection in relation to treatment period: a retrospective observational study: Chul Ho Lee, Jae Seok Jang, Jun Woo Cho; J Yeungnam Med Sci. 2022;39(4):294-299. Published online February 10, 2022; DOI: https://doi.org/10.12701/jyms.2021.01690; Funded: Catholic University of Daegu

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Abstract PDF: Background
Medical therapy is the standard treatment for uncomplicated acute type B aortic dissection (ATBAD), but there is little evidence of the need for intensive care unit (ICU) management. Therefore, we aimed to investigate the effects of ICU treatment on uncomplicated ATBAD.
Methods
We retrospectively studied patients with uncomplicated ATBAD who were medically treated between January 2010 and July 2020. Patients were divided into long-term ICU stay (LIS) and short-term ICU stay (SIS) groups, according to a 48-hour cutoff of ICU stay duration. The incidence of pneumonia and delirium, rate of aortic events, hospital mortality, and survival rate were compared.
Results
Fifty-five patients were treated for uncomplicated ATBAD (n=26 for LIS and n=29 for SIS). The incidence of pneumonia (7.7% vs. 3.6%) and delirium (34.6% vs. 14.3%) was higher in the LIS group than in the SIS group, but the differences were not statistically significant. The survival rates at 1, 3, and 5 years were not different between the two groups (LIS: 96.2%, 88.0%, and 54.2% vs. SIS: 96.4%, 92.2%, and 75.5%, respectively; p=0.102). Multivariate Cox regression analysis for aortic events showed that using a calcium channel blocker lowered the risk of aortic events.
Conclusion
Long-term ICU treatment is unlikely to be necessary for the treatment of uncomplicated ATBAD. Active use of antihypertensive agents, such as calcium channel blockers, may be needed during the follow-up period.

Review articles

Pediatric headache: a narrative review: Saeyoon Kim; J Yeungnam Med Sci. 2022;39(4):278-284. Published online September 14, 2022; DOI: https://doi.org/10.12701/jyms.2022.00528; Funded: National Research Foundation of Korea, Ministry of Education

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Abstract PDF

Headache is one of the most common neurological disorders in children and adults and can cause significant distress and disability in children and their families. The spectrum of pediatric headaches is broad, and the underlying etiology is variable. The symptoms and phenotypes of headaches in children may differ slightly from those in adults. It is important to have a good understanding of headaches in children and to distinguish between primary and secondary headaches through appropriate history assessment and neurological examination. Accurate diagnosis and appropriate drug selection are helpful for effective treatment. This article reviews headaches in children and adolescents, focusing on approaches for diagnosis and management.

Citations

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Exploring downstream effects of gender roles in healthcare decision-making and relationships within systems: A cross-sectional analysis of openness to treatment in pediatric headache
Zoë Schefter, Allison M. Smith
Journal of Psychosomatic Research.2024; 179: 111611. CrossRef
Occipital nerve stimulation in pediatric patients with refractory occipital neuralgia
James Mossner, Nour B. Saleh, Maryam N. Shahin, Joshua M. Rosenow, Jeffrey S. Raskin
Child's Nervous System.2024;[Epub] CrossRef
Multivariate prediction of long COVID headache in adolescents using gray matter structural MRI features
Minhoe Kim, Sunkyung Sim, Jaeseok Yang, Minchul Kim
Frontiers in Human Neuroscience.2023;[Epub] CrossRef

Optogenetic neuromodulation with gamma oscillation as a new strategy for Alzheimer disease: a narrative review: Haneol Ko, Sang-Pil Yoon; J Yeungnam Med Sci. 2022;39(4):269-277. Published online February 14, 2022; DOI: https://doi.org/10.12701/jyms.2021.01683; Funded: Jeju National University

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Abstract PDF

The amyloid hypothesis has been considered a major explanation of the pathogenesis of Alzheimer disease. However, failure of phase III clinical trials with anti-amyloid-beta monoclonal antibodies reveals the need for other therapeutic approaches to treat Alzheimer disease. Compared to its relatively short history, optogenetics has developed considerably. The expression of microbial opsins in cells using genetic engineering allows specific control of cell signals or molecules. The application of optogenetics to Alzheimer disease research or clinical approaches is increasing. When applied with gamma entrainment, optogenetic neuromodulation can improve Alzheimer disease symptoms. Although safety problems exist with optogenetics such as the use of viral vectors, this technique has great potential for use in Alzheimer disease. In this paper, we review the historical applications of optogenetic neuromodulation with gamma entrainment to investigate the mechanisms involved in Alzheimer disease and potential therapeutic strategies.

Citations

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Modulating Proteasome Function with Polyphenol Metabolites: A Promising Therapeutic Avenue for Alzheimer's Disease
Nyerovwo Charity Okei
European Journal of Medical and Health Research.2024; 2(2): 16. CrossRef
Exogenous AMPA downregulates gamma-frequency network oscillation in CA3 of rat hippocampal slices
Chengzhang Li, Zhenrong Li, Sihan Xu, Sanwei Jiang, Zhenli Ye, Bin Yu, Shixiang Gong, Junmei Li, Qilin Hu, Bingyan Feng, Mengmeng Wang, Chengbiao Lu
Scientific Reports.2023;[Epub] CrossRef
Light-Controlled Modulation and Analysis of Neuronal Functions
Carlo Matera, Piotr Bregestovski
International Journal of Molecular Sciences.2022; 23(21): 12921. CrossRef

Case report

Primary hepatic sarcoidosis presenting with cholestatic liver disease and mimicking primary biliary cholangitis: a case report: Young Joo Park, Hyun Young Woo, Moon Bum Kim, Jihyun Ahn, Jeong Heo; J Yeungnam Med Sci. 2022;39(3):256-261. Published online August 10, 2021; DOI: https://doi.org/10.12701/yujm.2021.01151; Funded: Pusan National University Hospital

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Abstract PDF Supplementary Material: Sarcoidosis often involves the liver. However, primary hepatic sarcoidosis confined to the liver without evidence of systemic involvement is rare. We report the case of a 37-year-old man with hepatic sarcoidosis who initially presented with elevated liver enzymes and suspicious cirrhotic nodules on computed tomography. The patient had cirrhosis but did not have portal hypertension. Based on the initial histopathologic finding of chronic granulomatous inflammation and the common clinical characteristics of sarcoidosis, he was initially diagnosed with primary biliary cholangitis, and his daily dosage of ursodeoxycholic acid was increased to 900 mg. After 14 months of treatment, his total serum bilirubin concentration was 10.9 mg/dL (upper normal limit, 1.2 mg/dL). Additionally, a transjugular liver biopsy revealed multiple noncaseating granulomas. He was diagnosed with primary hepatic sarcoidosis involving the lungs, heart, spleen, kidneys, and skin. Treatment with methylprednisolone was initiated. Two weeks later, he was started on azathioprine, and the dose of steroid was simultaneously reduced. These findings indicate the importance of including hepatic sarcoidosis as a possible diagnosis in patients with elevated liver enzymes or cryptogenic cirrhosis.

Original article

Assessment of normal anal sphincter anatomy using transanal ultrasonography in healthy Korean volunteers: a retrospective observational study: Daeho Shon, Sohyun Kim, Sung Il Kang; J Yeungnam Med Sci. 2022;39(3):230-234. Published online December 2, 2021; DOI: https://doi.org/10.12701/yujm.2021.01515; Funded: National Research Foundation of Korea, Ministry of Science and ICT

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Abstract PDF

Background
To date, there have been no studies on the normal anatomic values of the anal sphincter in healthy Koreans. Therefore, this study aimed to determine the normal anatomic values of transanal ultrasonography (TAUS).
Methods
The thickness of the external anal sphincter (EAS) and internal anal sphincter (IAS) was measured by TAUS from healthy Korean volunteers between September 2019 and August 2021.
Results
Thirty-six volunteers with a median age of 37 years (range, 20–77 years) and a median body mass index (BMI) of 23.5 kg/m2 (range, 17.2–31.2 kg/m2) were examined. The median thickness of the EAS at 4 cm and 2 cm from the anal verge was 7.4 mm (range, 5.8–8.8 mm) and 6.5 mm (range, 5.6–8.0 mm), respectively. The median thickness of the IAS at 2 cm from the anal verge was 1.8 mm (range, 0.8-4.3 mm). There were no differences in sphincter muscle thickness between the sexes. However, the EAS tended to thicken as the BMI increased (EAS at 2 cm and 4 cm from the anal verge, Spearman rho=0.433, 0.363; p=0.008 and p=0.029, respectively).
Conclusion
In healthy Korean, the median thickness of the IAS at 2 cm from the anal verge was 1.8 mm and the median thickness of the EAS at 2 cm and 4 cm from the anal verge was 6.5 mm and 7.4 mm respectively. There were no differences in anal sphincter thickness between sexes, but BMI was related to EAS thickness.

Citations

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Anal Sphincter Defect and Fecal Incontinence
Sherief Mansi, Karla Vaz, Neha R. Santucci, Khalil El-Chammas, Kahleb Graham, Nelson G. Rosen, Ajay Kaul
JPGN Reports.2022; 3(4): e254. CrossRef

Review article

Ultrasound-guided interventions for controlling the thoracic spine and chest wall pain: a narrative review: Donghwi Park, Min Cheol Chang; J Yeungnam Med Sci. 2022;39(3):190-199. Published online April 26, 2022; DOI: https://doi.org/10.12701/jyms.2022.00192; Funded: National Research Foundation of Korea

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Abstract PDF

Ultrasound-guided injection is useful for managing thoracic spine and chest wall pain. With ultrasound, pain physicians perform the injection with real-time viewing of major structures, such as the pleura, vasculature, and nerves. Therefore, the ultrasound-guided injection procedure not only prevents procedure-related adverse events but also increases the accuracy of the procedure. Here, ultrasound-guided interventions that could be applied for thoracic spine and chest wall pain were described. We presented ultrasound-guided thoracic facet joint and costotransverse joint injections and thoracic paravertebral, intercostal nerve, erector spinae plane, and pectoralis and serratus plane blocks. The indication, anatomy, Sonoanatomy, and technique for each procedure were also described. We believe that our article is helpful for clinicians to conduct ultrasound-guided injections for controlling thoracic spine and chest wall pain precisely and safely.

Citations

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The blind spot and challenges in pain management
Min Cheol Chang
Journal of Yeungnam Medical Science.2022; 39(3): 179. CrossRef

Original articles

User perception of medical service robots in hospital wards: a cross-sectional study: Jung Hwan Lee, Jae Meen Lee, Jaehyun Hwang, Joo Young Park, Mijeong Kim, Dong Hwan Kim, Jae Il Lee, Kyoung Hyup Nam, In Ho Han; J Yeungnam Med Sci. 2022;39(2):116-123. Published online October 5, 2021; DOI: https://doi.org/10.12701/yujm.2021.01319; Funded: Ministry of Trade, Industry and Energy

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Abstract PDF

Background
Recently, there have been various developments in medical service robots (MSRs). However, few studies have examined the perceptions of those who use it. The purpose of this study is to identify user perceptions of MSRs.
Methods
We conducted a survey of 320 patients, doctors, and nurses. The contents of the survey were organized as follows: external appearances, perceptions, expected utilization, possible safety accidents, and awareness of their responsibilities. Statistical analyses were performed using t-test, chi-square test, and analysis of variance.
Results
The most preferred appearance was the animal type, with a screen. The overall average score of positive questions was 3.64±0.98 of 5 points and that of negative questions was 3.24±0.99. Thus, the results revealed that the participants had positive perceptions of MSR. The overall average of all expected utilization was 4.05±0.84. The most expected utilization was to guide hospital facilities. The most worrisome accident was exposure to personal information. Moreover, participants thought that the overall responsibility of the robot user (hospital) was greater than that of the robot manufacturer in the case of safety accidents.
Conclusion
The perceptions of MSRs used in hospital wards were positive, and the overall expected utilization was high. It is necessary to recognize safety accidents for such robots, and sufficient attention is required when developing and manufacturing robots.

Citations

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Robotic Anesthesia: A Vision for 2050
Thomas M. Hemmerling, Sean D. Jeffries
Anesthesia & Analgesia.2024; 138(2): 239. CrossRef
Exploring the influence of anthropomorphic appearance on usage intention on online medical service robots (OMSRs): A neurophysiological study
Yi Ding, Ran Guo, Muhammad Bilal, Vincent G. Duffy
Heliyon.2024; 10(5): e26582. CrossRef
Customer acceptance of service robots under different service settings
Yi Li, Chongli Wang, Bo Song
Journal of Service Theory and Practice.2023; 33(1): 46. CrossRef

Clinical performance of FractionLab in patient-specific quality assurance for intensity-modulated radiotherapy: a retrospective study: Se An Oh, Sung Yeop Kim, Jaehyeon Park, Jae Won Park, Ji Woon Yea; J Yeungnam Med Sci. 2022;39(2):108-115. Published online September 9, 2021; DOI: https://doi.org/10.12701/yujm.2021.01123; Funded: National Research Foundation of Korea, Ministry of Science and ICT

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Abstract PDF: Background
This study was aimed at comparing and analyzing the results of FractionLab (Varian/Mobius Medical System) with those of portal dosimetry that uses an electronic portal imaging device. Portal dosimetry is extensively used for patient-specific quality assurance (QA) in intensity-modulated radiotherapy (IMRT).
Methods
The study includes 29 patients who underwent IMRT on a Novalis-Tx linear accelerator (Varian Medical System and BrainLAB) between June 2019 and March 2021. We analyzed the multileaf collimator (MLC) DynaLog files generated after portal dosimetry to evaluate the same condition using FractionLab. The results of the recently launched FractionLab at various gamma indices (0.1%/0.1 mm–1%/1 mm) are analyzed and compared with those of portal dosimetry (3%/3 mm).
Results
The average gamma passing rates of portal dosimetry (3%/3 mm) and FractionLab are 98.1 (95.5%–100%) and 97.5% (92.3%–99.7%) at 0.6%/0.6 mm, respectively. The results of portal dosimetry (3%/3 mm) are statistically comparable with the QA results of FractionLab (0.6%/0.6 mm–0.9%/0.9 mm).
Conclusion
This paper presents the clinical performance of FractionLab by the comparison of the QA results of FractionLab using portal dosimetry with various gamma indexes when performing patient-specific QA in IMRT treatment. Further, the appropriate gamma index when performing patient-specific QA with FractionLab is provided.

Storing information of stroke rehabilitation patients using blockchain technology: a software study: Min Cheol Chang; J Yeungnam Med Sci. 2022;39(2):98-107. Published online September 7, 2021; DOI: https://doi.org/10.12701/yujm.2021.01368; Funded: National Research Foundation of Korea

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Abstract PDF

Background
Stroke patients usually experience damage to multiple functions and a long rehabilitation period. Hence, there is a large volume of patient clinical information. It thus takes a long time for clinicians to identify the patient’s information and essential pieces of information may be overlooked. To solve this, we stored the essential clinical information of stroke patients in a blockchain and implemented the blockchain technology using the Java programming language.
Methods
We created a mini blockchain to store the medical information of patients using the Java programming language.
Results
After generating a unique pair of public/private keys for identity verification, a patient’s identity is verified by applying the Elliptic Curve Digital Signature Algorithm based on the generated keys. When the identity verification is complete, new medical data are stored in the transaction list and the generated transaction is verified. When verification is completed normally, the block hash value is derived using the transaction value and the hash value of the previous block. The hash value of the previous block is then stored in the generated block to interconnect the blocks.
Conclusion
We demonstrated that blockchain can be used to store and deliver the patient information of stroke patients. It may be difficult to directly implement the code that we developed in the medical field, but it can serve as a starting point for the creation of a blockchain system to be used in the field.

Citations

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Prediction of motor outcome based on brain perfusion single photon emission computed tomography in corona radiata infarct
Eunjung Kong, Donghwi Park, Min Cheol Chang
International Journal of Neuroscience.2023; : 1. CrossRef
Use of QR Codes for Promoting a Home-Based Therapeutic Exercise in Patients with Lumbar Disc Herniation and Lumbar Spinal Stenosis: A Prospective Randomized Study
Min Cheol Chang, Donghwi Park, Yoo Jin Choo
Journal of Pain Research.2022; Volume 15: 4065. CrossRef

Review article

Coronavirus disease 2019 (COVID-19) vaccine platforms: how novel platforms can prepare us for future pandemics: a narrative review: Jae Kyung Lee, Ok Sarah Shin; J Yeungnam Med Sci. 2022;39(2):89-97. Published online February 14, 2022; DOI: https://doi.org/10.12701/jyms.2021.01669; Funded: National Research Foundation of Korea, Ministry of Science, ICT and Future Planning

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Abstract PDF

More than 2 years after the explosion of the coronavirus disease 2019 (COVID-19) pandemic, extensive efforts have been made to develop safe and efficacious vaccines against infections with severe acute respiratory syndrome coronavirus 2. The pandemic has opened a new era of vaccine development based on next-generation platforms, including messenger RNA (mRNA)-based technologies, and paved the way for the future of mRNA-based therapeutics to provide protection against a wide range of infectious diseases. Multiple vaccines have been developed at an unprecedented pace to protect against COVID-19 worldwide. However, important knowledge gaps remain to be addressed, especially in terms of how vaccines induce immunogenicity and efficacy in those who are elderly. Here, we discuss the various vaccine platforms that have been utilized to combat COVID-19 and emphasize how these platforms can be a powerful tool to react quickly to future pandemics.

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Preclinical evaluation of immunogenicity, efficacy and safety of a recombinant plant-based SARS-CoV-2 RBD vaccine formulated with 3M-052-Alum adjuvant
Waranyoo Phoolcharoen, Balamurugan Shanmugaraj, Narach Khorattanakulchai, Piyanate Sunyakumthorn, Sathit Pichyangkul, Pornnarin Taepavarapruk, Wanlapa Praserthsee, Suchinda Malaivijitnond, Suwimon Manopwisedjaroen, Arunee Thitithanyanont, Kanjana Srisutth
Vaccine.2023; 41(17): 2781. CrossRef

Case reports

Stent graft treatment of an ilioenteric fistula secondary to radiotherapy: a case report: Joo Yeon Jang, Ung Bae Jeon, Jin Hyeok Kim, Tae Un Kim, Jae Yeon Hwang, Hwa Seong Ryu; J Yeungnam Med Sci. 2022;39(1):77-80. Published online July 7, 2021; DOI: https://doi.org/10.12701/yujm.2021.01053; Funded: Pusan National University Yangsan Hospital

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Abstract PDF

Fistulas between the arteries and the gastrointestinal tract are rare but can be fatal. We present a case of an ilioenteric fistula between the left external iliac artery and sigmoid colon caused by radiotherapy for cervical cancer, which was treated with endovascular management using a stent graft. A 38-year-old woman underwent concurrent chemoradiotherapy for cervical cancer recurrence. Approximately 9 months later, the patient suddenly developed hematochezia. On her first visit to the emergency room of our hospital, computed tomography (CT) images did not reveal extravasation of contrast media. However, 8 hours later, she revisited the emergency room because of massive hematochezia with a blood pressure of 40/20 mmHg and a heart rate of 150 beats per minute. At that time, CT images showed the presence of contrast media in almost the entire colon. The patient was referred to the angiography room at our hospital for emergency angiography. Inferior mesenteric arteriography did not reveal any source of bleeding. Pelvic arteriography showed contrast media extravasation from the left external iliac artery to the sigmoid colon; this was diagnosed as an ilioenteric fistula and treated with a stent graft. When the bleeding focus is not detected on visceral angiography despite massive arterial bleeding, pelvic arteriography is recommended, especially in patients with a history of pelvic surgery or radiotherapy.

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Resection of sigmoid cancer with bladder invasion using laparoscopic combined with a cystoscopic holmium laser: an innovative surgical procedure
Ronghua Wu, Cong Xu, Xing Liu, Weihua Fu, Yujia Chen, Jingzhen Zhu, Guangsheng Du
Lasers in Medical Science.2023;[Epub] CrossRef

Multilocular cystic hemangioma of the liver mimicking mucinous cystic neoplasm: a case report: Nam Kyung Lee, Suk Kim, Seung Baek Hong, So Jeong Lee, Hyung Il Seo; J Yeungnam Med Sci. 2022;39(1):53-57. Published online April 7, 2021; DOI: https://doi.org/10.12701/yujm.2021.00969; Funded: Pusan National University Hospital

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Abstract PDF: Hepatic hemangiomas infrequently exhibit atypical imaging features, which may cause diagnostic confusion with hepatic malignancies and lead to unnecessary surgery. We report a rare case of multilocular cystic hemangioma of the liver mimicking a mucinous cystic neoplasm of the liver in a 48-year-old female, focusing on computed tomography and magnetic resonance imaging features and their differential diagnosis.

Original article

Puncture needle with a hard plastic sheath and plastic wings minimizes repuncture attempts in ultrasound-guided paracentesis: a retrospective case-control study: Il Wan Son, Suk Kim, Seung Baek Hong, Nam Kyung Lee, Mi Ri Jeong, Sung Yong Han, Hyun Young Woo; J Yeungnam Med Sci. 2022;39(1):18-23. Published online July 12, 2021; DOI: https://doi.org/10.12701/yujm.2021.01109; Funded: Pusan National University

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Abstract PDF: Background
This study was performed to evaluate periprocedural factors, complications, and repuncture rate of the newly developed puncture needle and compare it with the routinely used puncture needle for ultrasound (US)-guided paracentesis.
Methods
We retrospectively identified 137 patients who underwent US-guided paracentesis between July 2018 and March 2019. Among them, 82 patients underwent US-guided paracentesis with a newly developed puncture needle. The other 55 patients underwent US-guided paracentesis with a routinely used puncture needle. The periprocedural factors, complications, and repuncture rate were compared between the two groups using the Mann-Whitney U test and Fisher exact test. The repuncture-associated factors were assessed using logistic regression analysis.
Results
There were no major or minor complications in either group. The rate of repuncture was significantly lower in the group using the newly developed puncture needle compared with the group using the routinely used puncture needle (p=0.01). The duration of the procedure was significantly shorter with the newly developed puncture needle compared with the routinely used puncture needle (p=0.01). In univariate analysis, the thickness of the abdominal wall (p=0.04) and the use of the newly developed puncture needle (p=0.01) were significantly associated with the rate of repuncture. In multivariate analysis, only the use of the newly developed puncture needle was significantly associated with the rate of repuncture.
Conclusion
Using this novel puncture needle with a hard plastic sheath and plastic wings, the rate of repuncture and the duration of the procedure were decreased without complications of US-guided paracentesis.

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