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JYMS : Journal of Yeungnam Medical Science

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Volume 17(1); June 2000
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Reviews
Nonsteroidal Anti-inflammatory Drugs.
Choong Ki Lee
Yeungnam Univ J Med. 2000;17(1):1-11.   Published online June 30, 2000
DOI: https://doi.org/10.12701/yujm.2000.17.1.1
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Inhibition of cyclooxygenase(COX), and thus prevention of the formation of prostaglandins, provided a unifying explanation of the therapeutic and toxic actions of nonsteroidal anti-inflammatory drugs(NSAIDs). Recently, the discovery of the two isoforms of COX was made by molecular biologists studying neoplastic transformation in chick embryo cells. The constitutive enzyme, COX-1, is obviously responsible for the production of prostaglandins involved in housekeeping functions such as maintenance of integrity of the gastric mucosa, renal blood flow and platelet aggregation. The inducible form of COX(COX-2) is responsible for the formation of prostaglandins that pathologic effects of inflammation, pain and fever. Clearly, all the experimental and clinical data support the hypothesis that the beneficial effects of NSAIDs are due to inhibition of the COX-2 enzyme, whereas the gastrotoxicity is due to inhibition of COX-1. The COX-2/COX-1 ratios of the NSAIDs in common use have been measured and compared with epidemiological data on their side effects. there is little evidence to suggest that one NSAID is clearly more efficacious than another and substantial individual variability is present with respect to the pharmacology and pharmacokinetics of these drugs, it is essential to adjust the dosage and choose specific drug to the patient`s response.
Memory of Pain and Preemptive Analgesia.
Sun Ok Song
Yeungnam Univ J Med. 2000;17(1):12-20.   Published online June 30, 2000
DOI: https://doi.org/10.12701/yujm.2000.17.1.12
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AbstractAbstract PDF
The memory of pain can be more damaging than its initial experience. Several factors are related the directions of pain memory; current pain intensity, emotion, expectation of pain, and peak intensity of previous pain. The possible mechanisms of memory of pain are neuroplastic changes of nervous system via peripheral and central sensitization. Peripheral sensitization is induced by neurohumoral alterations at the site of injury and nearby. Biochemicals such as K+, prostaglandins, bradykinin, substance P, histamine and serotonin, increase transduction and produce continuous nociceptive input. Central sensitization takes place within the dorsal horn of spinal cord and amplifies the nociceptive input from the periphery. The mechanisms of central sensitization involve a variety of transmitters and postsynaptic mechanisms resulting from the activations of NMDA receptors by glutamate, and activation of NK-1 tachykinnin receptors by substance-P and neurokinnin. The clinical result of peripheral and central sensitization is hyperalgesia, allodynia, spontaneous pain, referred pain, or sympathetically maintained pain. These persistent sensory responses to noxious stimuli are a form of memory. The hypothesis of preemptive analgesia is that analgesia administered before the painful stimulus will prevent or reduce subsequent pain and analgesic requirements in comparison to the identical analgesic intervention administered after the painful stimulus, by preventing or reducing the memory of pain in the nervous system. Conventionally, pain management was initiated following noxious stimuli such as surgery. More recently, many have endorsed preemptive analgesia initiated before surgery. Treatments to control postsurgical pain are often best started before injury activates peripheral nociceptors and triggers central sensitization. Such preemption is not achieved solely by regional anesthesia and drug therapy but also requires behavioral interventions to decrease anxiety or stress. Although the benefit of preemptive analgesia is not obvious in every circumstance, and in many cases may not sufficient to abolish central sensitization, it is an appropriate and human goal of clinical practice.
Original Articles
Effect of Exercise on Antioxidant Enzyme Activities of Skeletal Muscle and Liver in STZ-diabetic Rats.
Kwang Ho Seok, Suck Kang Lee
Yeungnam Univ J Med. 2000;17(1):21-30.   Published online June 30, 2000
DOI: https://doi.org/10.12701/yujm.2000.17.1.21
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BACKGROUND
The purpose of the present study was to investigate the effect of exercise on the activities of antioxidant enzymes, superoxide dismutase(SOD), glutathione peroxidase(GPX) and catalase(CAT) of skeletal muscle(gastrocnemius) and liver in streptozotocin(STZ) induced diabetic rats. The malondialdehyde(MDA) concentration was also measured as an index of lipid peroxidation of the tissues by exercise-induced oxidative stresses in the diabetic rats. MATERIAL AND METHODS: Male Sprague-Dawley rats were randomly divided into control and STZ-induced diabetic rats. The STZ in citrate buffer solution was injected twice at 5 days intervals intraperitoneally(50, 70 mg/kg respectively). On the 28th day after the first STZ injection, the diabetic animals were randomly divided into pre- and post-exercise groups. The exercise was introduced to the rats of post-exercise group by treadmill running till exhaution with moderate intensity (VO2max: 50-70%) of exercise. The duration of average running time was 2 hours and 19 minutes. RESULTS: The blood glucose concentration was increased(p<0.001) and plasma insulin concentration was decreased(p<0.001) in the diabetic rats. The glycogen concentration in the muscle and liver was decreased by exhaustive exercise in the diabetic rats(p<0.001). In the skeletal muscle, the activities of GPX was increased(p<0.05) and the activities of SOD and CAT were not changed in the diabetic rats compare to the control rats. The activities of GPX was not changed by exercise but the activities of SOD(p<0.01) and CAT (p<0.01) were decreased by exercise in the diabetic rats. The concentration of MDA was not changed by exercise in diabetic rats. and the values of pre-exercise and post-exercise diabetic rats were not different from the value of control rats. In the liver, the activities of SOD was decreased(p<0.01) and the activities of GPX and CAT were not changed in diabetic rats compared to the values of control rats. The activities of SOD, GPX and CAT were not changed by exercise in diabetic rats but the the slight decreasing tendency of the activity of SOD was observed. The MDA concentration was increased in the diabetic rats compared to the values of control rats(p<0.001) but there was no change of MDA concentration by exercise in diabetic rats. CONCLUSIONS: In summary, the exhaustive physical exercise has not been shown to impose oxidative stress on skeletal muscle due to oxygen free radicals regardless of decreament of SOD and CAT in the diabetic rats. In liver tissue, the tissue damage by oxidative stress was observed in diabetic rats but the additional tissue damage by the exhaustive physical exercise was not observed.
The Effect of Early IABP and Reperfusion therapy in Patient of Post MI Cardiogenic shock.
Jong Suk Lee, Min Kyeung Kim, Woong Kim, Hyung Jun Kim, Jun Ho Bae, Jong Seon Park, Dong Gu Sin, Young Jo Kim, Bong Sup Shim
Yeungnam Univ J Med. 2000;17(1):31-38.   Published online June 30, 2000
DOI: https://doi.org/10.12701/yujm.2000.17.1.31
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AbstractAbstract PDF
BACKGROUND
We sought to examine the use and outcomes with early intraaortic balloon couterpulsation(IABP) combined early reperfusion therapy in patients presenting with cardiogenic shock complicating acute myocardial infarction. The use of IABP in patients with cardiogenic shock is widely accepted. however, there is a paucity of information on the use of this technique in patients with cardiogenic shock who are treated with reperfusion therapy in Korea. MATERIALS AND METHODS: Twenty-eight Patients presented with cardiogenic shock were classified into two groups: the early IABP group (insertion within 12 hours after AMI onset time) and late IABP group (insertion after 12 hours). We compared In-hospital mortality in two group (early IABP group vs late IABP group). RESULTS: Two groups show no significant difference at clinical feature and coronary angiographic results. Among total 28 patients, 7 patients were treated with thrombolytic therapy and 21 patients with PTCA. Insertion site bleeding, fever, thrombocytopenia were reported as some of the complications of IABP insertion. In-hospital mortality of early IABP group and late IABP group were 4 patients(25%) and 8 patients(66%), respectively(p<0.05). Early IABP insertion and early PTCA showed lower hospital mortality rates. There was significant difference in the time to PTCA after AMI onset between the to groups(p<0.05). CONCLUSION: IABP appears to be useful in patients presenting with cardiogenic shock unresponsive medical therapy. Early IABP insertion and early Reperfusion therapy may reduce In-hospital mortality rates in PostMI Cardiogenic shock patients.
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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AbstractAbstract 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
Statistical analysis of patients referred to pediatric cardiologic clinic for diagosis of heart disease.
Kwang Hae Choi, Young Hwan Lee
Yeungnam Univ J Med. 2000;17(1):49-54.   Published online June 30, 2000
DOI: https://doi.org/10.12701/yujm.2000.17.1.49
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AbstractAbstract PDF
BACKGROUND
Echocardiography is rapidly established itself as the primary diagnostic technique for investigation of children with heart disease, and referrals are increasing to the pediatric cardiology clinic for investigation. However, because there is a lack of analysis data on the patients referred to pediatric cardiology clinics, we have proceeded to compare and analyze their characteristics to provide basic data base. METHODS: From Oct. 1, 1998 to Jul. 10, 1999, total 443 cases referred to the pediatric cardiology clinic of Yeungnam University Hospital were studied retrospectively by medical records, chest X-ray, EKG and echocardiography, etc. RESULTS: The results were as follows. 1. The proportion of male was 61.0%(261 cases) and that of female was 39.0%(167 cases). The ratio of male to female was 1.6:1. The proportion infants less than 1 year-old was 62.6%(268 cases) of all patients. 2. Cardiac murmur was present in 248 cases(57.9%), which was the most common case of referral to the pediatric cardiology clinic. The impression at referral was more congenital heart disease(70.6%) than acquired heart disease(17.8%) and arrhythmia(11.6%). 3. The final diagnosis was as follows : congenital heart disease was present in 212 cases(49.5%), acquired heart disease, 59 cases(13.9%); arrhythmia, 13 cases(3.0%); normal heart, 144 cases(33.6%). CONCLUSION: Among the patients referred to pediatric cardiology clinic, 33.6%(144 cases) had normal hearts and why these patient were referred may be possibly due to more dependence on echocardiography than on auscultation instruction. Threfore, clinical and auscultatory skill should be emphasized to minimize dependence on expensive echocardiography for evaluation of pediatric heart disease.

Citations

Citations to this article as recorded by  
  • Evaluation and diagnostic approach for heart murmurs in children
    Hee Joung Choi
    Journal of the Korean Medical Association.2020; 63(7): 398.     CrossRef
Comparision of Clinical Results of Excimer Laser Correction of Myopia and Compound Myopic Astigmatism Using VISX 20/20B isionKeyTM.
Sang Bumm Lee, Sang Bok Bae
Yeungnam Univ J Med. 2000;17(1):55-65.   Published online June 30, 2000
DOI: https://doi.org/10.12701/yujm.2000.17.1.55
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AbstractAbstract PDF
PURPOSE: To compare the efficacy, predictability, stability and safety of excimer laser photorefracive keratectomy(PRK) for mypia and photoastigmatic refractive keratectomy(PARK) for compound myopic astigmatism. METHODS: Two-hundred-three eyes(118 eyes <-7D spherical equivalent, 85 eyes> or =-7D spherical equivalent) received excimer laser correction for compound myopic astigmatism and 152 eyes(116 eyes <-7D, 36 eyes > or =-7D) for simple myopia. A VISX 20/20B VisionKeyTM excimer laser was used to perform either PARK or PRK. Visual acuity with and without correction, refraction, IOP, corneal haze, and topography were evaluated at 1, 3, 6, and 12 months postoperatively. All patients were followed up for more than 12 months. RESULTS: Postoperative refraction were generally stable after 3 months without significant early overcorrection. At 12 months, 110(94.8%) eyes that underwent PRK and 104(88.1%) eyes that underwent PARK achieved UCVA of 20/30 or better in the group who had lower than -7D correction. For eyes treated with -7D or more, these figures were 31(86.1%) eyes after PRK and 57(67.1%) eyes after PARK. The incidence of within 1D of plano refraction at 1 year follow-up were 97.4% after PRK and 93.2% after PARK in group who had lower than -7D correction. For eyes treated with -7D or more, there figures were 80.6% after PRK and 70.6% after PARK. CONCLUSIONS: Myopia with or without astigmatism was successfully treated in most of the eyes using PRK or PARK with VISX 20/20B VisionKeyTM excimer laser. The predictability and stability of the postoperative refraction during the first 12 months seem to be quite reliable. Futher improvement of excimer laser system and software should increase the clinical outcomes and safety of refractive procedures.
The effect of Transarterial Chemoembolization(TAE) on Lung metastasis of Hepatocellular Carcinoma.
Heon Ju Lee, Jong Ryul Eun, Young Doo Song, Chan Won Park
Yeungnam Univ J Med. 2000;17(1):66-74.   Published online June 30, 2000
DOI: https://doi.org/10.12701/yujm.2000.17.1.66
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AbstractAbstract PDF
BACKGROUND
During follow up period after transarterial embolization(TAE), cases of pulmonary metastasis were more prevalent in TAE-treated patients than in TAE-untreated patients. Therefore, a study was conducted to evaluate whether TAE increases the incidence of pulmonary metastasis of hepatocellular carcinoma and to clarify the risk factors for pulmonary metastasis. METHODS: From march 1991 to march 1995, 156 patients who had been diagnosed with hepatocellular carcinoma by serology, and radiographic and histologic method at Yeungnam university hospital were involved in this study. We excluded 12 patients with lung metastasis on initial diagnosis and the others. The remaining 144 patients had been followed up for at least 5 months, and divided into four groups according to lung metastasis and trans-arterial embolization treatment, and evaluated the age, sex, child-pugh score, liver cirrhosis, and the level of AFP. RESULTS: Pulmonary metastasis was found in 18.0% (26/144), of witch 92.3%(24/26) and 7.7%(2/26) of the patients with and without transarterial chemoembolization, respectively. Of thepatients, 23.5% (24/102) with TAE had lung metastais during follow-up periods and 4.7% (2/42) without TAE had lung metastasis. there was more likelihood for lung metastasis after TAE, but there was no difference between two groups in age, sex, child-pugh class, the presence of liver cirrhosis, and AFP. CONCLUSIONS: The incidence of pulmonary metastasis of hepatocellular carcinoma after TAE was higher. child-pugh class was the only related clinical precipitating factors for pulmonary metastasis in TAE in our study. Our results suggest that regular chest X-ray check-up may be more frequently needed by patients who had TAE treatment for hepatocellular carcinoma.
The Predictors of Cerebral infarction in Mitral Stenosis.
Hyung Jun Kim, Woong Kim, Jong suk Lee, Gue Ru Hong, Jong Seon Park, Dong Gu Sin, Young Jo Kim, Bong Sup Shim
Yeungnam Univ J Med. 2000;17(1):75-81.   Published online June 30, 2000
DOI: https://doi.org/10.12701/yujm.2000.17.1.75
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AbstractAbstract PDF
BACKGROUND
Systemic embolism especially, cerebral infarction is one of the most important complications in patients with mitral stenosis. The authors analyse the some that could predict the development of cerebral infarction in cases of mitral stenosis and propose preventive therapeutic measures. METHODS: Retrospective study of 127 patients with rheumatic mitral stenosis was performed by analysis their medical records for transthoracic(TTE) or transesophageal echocardiography(TEE) over a 12months period. The patients were divided into two groups according to the presence (Group I: n=26, age: 55+/-13 years) or absence (Group II: n=101, age: 48.5+/-13 years) of cerebral infarction. No significant difference was observed between the two groups with respect to sex and functional class. RESULTS: Patients of group I were older (55.0+/-13 vs 48.5+/-13;p<0.05), had more dilated left atrial size(5.10+/-0.48 vs 4.81+/-0.70;p<0.05) and smaller mitral surface area(1.01+/-0.39 vs 1.21+/-0.45;p<0.05). In Group I, the incidence of atrial fibrillation(22 out of 26 vs 57 out of 101;p<0.05) and spontaneous left intra-atrial contrast phenomenon(22 out of 26 vs 44 out of 101;p<0.05) was more frequently observed. On multivariate analysis, atrial fibrillation and anticoagulant therapy were the independent predictive factors. CONCLUSION: Age, left atrial dilatation, the severity of mitral stenosis, the presence of spontaneous contrast and especially the presence of atrial fibrillation are the main predictive factors of the development of cerebral infarction in mitral stenosis. Patients presenting one or several of these factors may benefit from prophylactic anticoagulant treatment.
Case Reports
Primary Cardiac Lymphoma: Case Report.
Jun Ho Bae, Jong Suk Lee, Hyung Jun Kim, Min Kyung Kim, Young Ho Park, Gue Ru Hong, Jong Sun Park, Dong Gu Sin, Young Jo Kim, Bong Sup Sim
Yeungnam Univ J Med. 2000;17(1):82-86.   Published online June 30, 2000
DOI: https://doi.org/10.12701/yujm.2000.17.1.82
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AbstractAbstract PDF
Primary cardiac lymphoma defined as involving only the heart and pericardium, is very rare and is diagnosed predominantly late in the course of illness or autopsy. This tumor is commonly fatal and until recently were rarely diagnosed antemortem. Recently, it was reported in patients with acquired immunodeficiency syndrome. We report a case of primary cardiac lymphoma in a 56 year old female who showed progressive exertional dyspnea. On echocardiogram and CT scan, large ill defined mass was demonstrated in right atrial and ventricular wall. It was diagnosed as B-cell type lymphoma on open cardiac biopsy.
Mesenchymal Chondrosarcoma: 3 Cases Report.
Mi Jin Gu, Young Kyong Bae, Joon Hyuk Choi, Mi Jin Kim, Won Hee Choi, Duk Seop Shin, Jang Soo Suh
Yeungnam Univ J Med. 2000;17(1):87-92.   Published online June 30, 2000
DOI: https://doi.org/10.12701/yujm.2000.17.1.87
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Mesenchymal chondrosarcoma is a rare malignant tumor of skeletal and extraskeletal origin, and which shows aggressive local behavior as well as a high metastatic potential. We report 3 cases of mesenchymal chondrosarcoma. Two cases were male and one was female. The ages ranged from 25 to 32 years(mean: 28 years). Tissue was obtained by wide excision in two patients, and incisional biopsy in one. The mass locaterd in the rib(case 1), orbital floor(case 2), and abdominal wall(case 3). Roentgenographically, the tumor resembles ordinary chondrosarcoma, showing osteolytic and obstructive appearance with stippled calcification. Grossly, the tumor was lobulating, solid fish-fleshy like mass with calcification and ossification. Histologically, the tumor shows characteristic bimorphic pattern composed of islands of well differentiated hyaline cartilage admixed with a cellular area of undifferentiated small cells. The small cells usually displayed a hemangiopericytoid or an alveolar pattern.
Three cases of symphysis pubis separation associated with delivery.
Jae Hong Ahn, Young Jin Jang, Dong Hyuk Lee, Young Gi Lee, Yoon Ki Park
Yeungnam Univ J Med. 2000;17(1):93-98.   Published online June 30, 2000
DOI: https://doi.org/10.12701/yujm.2000.17.1.93
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AbstractAbstract PDF
Symphysis pubis separation is an uncommon but not rare complication of delivery. Characteristic symptoms of symphyseal separation include suprapubic pain and tenderness which radiate to the back or legs, difficult ambulation, and bladder dysfunction. Clinical history, presenting symptoms, and response to therapy are sufficient to make the diagnosis, although radiographic documentation of symphyseal separation by x-ray or ultrasound are frequently used to confirm the diagnosis. The underlying etiology of symptomatic symphyseal separation has not been fully elucidated. Associations with macrosomia, pathological joint loosening, and increased force placed on the pelvic ring have been suggested as possible etiologies. Conservative therapy, including bed rest, pelvic binders, ambulation devices, and mild analgesics usually result in complete recovery within 4-16 weeks. Our experience of three cases of peripartum symphysis pubis separation delivered from 1998 to 1999 were reviewed with related articles.

JYMS : Journal of Yeungnam Medical Science