Journal of Yeungnam Medical Science

Volume 28(1); June 2011

Reviews

Combined Hepatocellular-Cholangiocarcinoma: Recent Progress in Pathology and Classification.: Joon Hyuk Choi; Yeungnam Univ J Med. 2011;28(1):1-12. Published online June 30, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.1.1

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Primary liver carcinomas have been classified into hepatocellular carcinoma, cholangiocarcinoma, and combined hepatocellular-cholangiocarcinoma (CHC). CHC is a tumor containing unequivocal, intimately mixed elements of both hepatocellular carcinoma and cholangiocarcinoma. It forms a small but significant proportion of primary liver carcinomas. The origin and pathogenesis of CHC have not been well established. According to the 2010 WHO classification, CHCs are categorized into 2 groups: the classical type and a subtype with stem cell features. This review describes recent progress in pathology and classification of CHC.

Citations

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Synchronous Double Primary Hepatic Cancer: Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma
Jin Ok Kim, Dae Won Jun, Kiseok Jang
The Korean Journal of Gastroenterology.2013; 62(2): 135. CrossRef

Clinical Implications of Drug-Resistant Streptococcus pneumoniae as a Cause of Community Acquired Pneumonia.: Kyeong Cheol Shin; Yeungnam Univ J Med. 2011;28(1):13-19. Published online June 30, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.1.13

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Abstract PDF: The emergence of antibiotic-resistant pathogens is a serious clinical problem in the treatment of infectious diseases that increase mortality, morbidity, hospitalization length, and the cost of healthcare. In particular, Streptococcus pneumoniae is a major etiologic pathogen of pneumonia, sinusitis, otitis media, and meningitis. As the definition of penicillin resistance to S. pneumoniae was recently changed, macrolide-resistant S. pneumoniae is a major resistant pathogen in the community. Infections caused by antibiotic-resistant strains are associated with incorrect use of antibiotics and critical clinical outcomes. For the appropriate use of antibiotics to treat infections, physicians always should have up-to-date information on the current epidemiologic status of antibiotic resistance for common pathogens and their susceptibility to antimicrobials. Appropriate selection of antimicrobials, strict control of infection, vaccination, and development of a feasible national policy of infection control are important strategies for the control of antimicrobial resistance. This review article focuses on the current status of antibiotic-resistant S. pneumoniae in community-acquired pneumonia in Korea.

Original Articles

Predictors of Weight Reduction and Smoking Cessation in Overweight and Obese Patients with Acute Myocardial infarctions.: Jung Kyu Kang, Jang Hoon Lee, Su Young Ha, Myung Hwan Bae, Dong Heon Yang, Hun Sik Park, Yongkeun Cho, Shung Chull Chae, Jae Eun Jun; Yeungnam Univ J Med. 2011;28(1):20-30. Published online June 30, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.1.20

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Abstract PDF: BACKGROUND
Little is known about predictors of lifestyle modification in overweight or obese patients with acute myocardial infarctions. METHODS: Between October 2005 and May 2007, 311 overweight or obese patients with an AMI visited Kyungpook National University Hospital. Among them, 216 patients (63+/-11 years old, 144 males) with > or =1 year of follow-up were included. RESULTS: Body weight of all patients showed a significant decrease and 20% showed a >3% weight reduction at 1 year of follow-up. Ninety-six (44%) patients were smoking at baseline, and 52% of them had quit by 1 year of follow-up. Only six smokers were successful with both a >3% weight reduction and smoking cessation. In multivariate analysis, age (OR 1.084, 95% CI 1.028-1.144, p=0.003) and smoking cessation (OR 0.167, 95% CI 0.048-0.575, p=0.005) were independent predictors of weight reduction. Abdominal circumference was a negative predictor of smoking cessation (OR 0.903, 95% CI 0.820-0.994, p=0.037). CONCLUSIONS: Mean body weight of all patients showed a significant decrease at follow-up. Smoking cessation and age were independent predictors of weight reduction, and abdominal circumference was a negative predictor of smoking cessation.

Early or Late Gefitinib, Which is Better for Survival?: Retrospective Analysis of 228 Korean Patients with Advanced or Metastatic NSCLC.: Dong Gun Kim, Min Kyoung Kim, Sung Hwa Bae, Sung Ae Koh, Sung Woo Park, Hyun Je Kim, Myung Jin Kim, Hyo Jin Jang, Kyung Hee Lee, Kwan Ho Lee, Jin Hong Chung, Kyung Chul Shin, Hun Mo Ryoo, Myung Soo Hyun; Yeungnam Univ J Med. 2011;28(1):31-44. Published online June 30, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.1.31

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Abstract PDF: BACKGROUND
The optimal timing of treatment with EGFR-tyrosine kinase inhibitors (EGFR-TKI) in NSCLC patients has not yet been determined. METHODS: We separated 228 patients with advanced/metastatic NSCLC treated with gefitinib into an early gefitinib group (patients who received gefitinib as first- or second-line treatment) and a delayed gefitinib group (patients who received gefitinib as third or fourth-line treatment) and attempted to determine whether the timing of gefitinib treatment affected clinical outcomes. RESULTS: Median overall survival (OS), progression free survival (PFS), and median OS from first-line treatment of advanced/metastatic disease (OSt) for 111 patients in the early gefitinib group were 6.2 months, 3.3 months, and 11.6 months. However, median OS, PFS, and OSt for 84 patients in the delayed gefitinib group were 7.8 months, 2.3 months, and 22.7 months. No differences in OS and PFS were observed between the 2 groups. However, OSt was significantly longer in the delayed gefitnib group. Timing of gefitinib therapy was one of the independent predictors of OSt. Hb > or = 10 g/dl, and having never smoked, and ECOG performance status < or =1 were independent predictors of better PFS. CONCLUSION: Deferral of gefitinib therapy in patients with advanced or metastatic NSCLC may be preferable if they are able to tolerate chemotherapy.

Estimation of Secondhand Smoke Exposure in Clubs Based on Urinary Cotinine Levels.: Yu Jin Lee, Young Ji Lee, Man Joong Jeon, Joon Sakong; Yeungnam Univ J Med. 2011;28(1):45-53. Published online June 30, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.1.45

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Abstract PDF

BACKGROUND
Increasing numbers of young people go to clubs. In Korea, however, no studies have been conducted regarding the exposure of club patrons to secondhand smoke. The present study was conducted to evaluate the degree of club customers' exposure to secondhand smoke. METHODS: The study subjects included 10 male and 12 female non-smokers. The investigational site was a club located in Daegu. Urine samples were collected before exposure to secondhand smoke in the club and 6 hours after a 3-hour exposure. The urine cotinine levels were measured via the LC-MS/MS method. A survey was conducted to collect data regarding the subjects' smoking experiences and the degree of exposure to secondhand smoke in their daily lives. RESULTS: The average urine cotinine level increased from 1.09 microg/L to 5.55 microg/L (p<0.05). No significant difference existed in the change in urine cotinine level between the male and female subjects. In addition, there was no significant difference in the change in urine cotinine level by the degree of exposure to secondhand smoke in daily life. CONCLUSIONS: The average urine cotinine level in all the subjects significantly increased after exposure to secondhand smoke. This is the first study on exposure to secondhand smoke in clubs; these results can be used to craft measures that reduce exposure to secondhand smoke in public places, such as clubs.

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Level of Blood Lead and Urine Cotinine of Residents by Area
Yu-Jin Oh, Hyoung-Wook Kim, Yun-Jae Kim, Yoon-Deok Han, Sung-Hyeon Jung, Jong-Dae Lee, Bong-Ki Jang, Jin-Heon Lee, Bu-Soon Son
Journal of Environmental Science International.2019; 28(3): 329. CrossRef

Case Reports

Rhabdomyolysis Induced Acute Kidney Injury in a Patient with Leptospirosis.: Yoon Jung Choi, Jeung Min Park, Yo Han Jung, Jong Ho Nam, Hyun Hee Chung, Tae Woo Kim, Kyu Hyang Cho, Jun Young Do, Kyeung Woo Yun, Jong Won Park; Yeungnam Univ J Med. 2011;28(1):54-59. Published online June 30, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.1.54

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Abstract PDF: Leptospirosis is a spirochetal infectious disease caused by Leptospira interrogans, and may vary in degree from an asymptomatic infection to a severe and fatal illness. The kidney is one of the principal target organs of Leptospira. Renal disorders caused by Leptospira infection vary from an abnormality in urinalysis to acute kidney injury (AKI). Incidence of AKI in severe leptospirosis varies from 40% to 60%. AKI reflects the severity of leptospirosis and is generally accompanied by cholestatic jaundice. The pathophysiology of AKI in leptospirosis consists of hypovolemia, direct tubular toxicity, and rhabdomyolysis. Most patients with acute leptospirosis experience severe myalgias, and show laboratory evidence of mild rhabdomyolysis. However, occurrence of severe rhabdomyolysis is rare. We report here on a patient with leoptospirosis, who had severe rhabdomyolysis and acute kidney injury without jaundice.

Two Cases of Severe Pancytopenia Associated with Low-Dose Methotrexate Therapy in Patients with Chronic Kidney Disease and Rheumatoid Arthritis.: Hong Ik Kim, Woo Hyun Lee, Jang Seok Oh, Hyo Rim Hong, In Hee Lee; Yeungnam Univ J Med. 2011;28(1):60-69. Published online June 30, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.1.60

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Abstract PDF: Due to its efficacy and tolerability, low dose oral methotrexate(MTX) therapy has been widely used for treatment of rheumatoid arthritis(RA). However, it can rarely cause serious, life-threatening hematologic toxicities, such as pancytopenia. We report here on two patients with chronic kidney disease(CKD), who developed severe pancytopenia after 5 years (cumulative dose 1,240mg) and 4 years(cumulative dose 1,320mg) of low dose MTX therapy for treatment of RA, respectively. Both patients presented with renal insufficiency, hypoalbuminemia, concurrent use of nonsteroidal anti-inflammatory drugs, and elevated mean corpuscular volume of red blood cells(RBCs), all of which are known as risk factors of MTX-induced pancytopenia. Despite receiving treatment, which included RBC and platelet transfusions, antibiotic therapy, granulocyte colony stimulating factor, and leucovorin rescue, one patient died of sepsis. Based on our case study, prompt investigation of risk factors associated with MTX toxicity is required for all patients receiving MTX therapy. MTX treatment, even at a low dose, should be discontinued in patients with advanced CKD.

Paratesticular Alveolar Rhabdomyosarcoma with Multiple Lymph Nodes Metastasis Successfully Treated with Chemotherapy.: Ha young Lee, Myung Soo Hyun, Kyung Hee Lee, Min Kyoung Kim, Sung Ae Koh, Se Hoon Sohn, Sung Woo Park, Dong Geun Kim, Myung Jin Kim, Hyo Jin Jang, Mi Jin Kim; Yeungnam Univ J Med. 2011;28(1):70-76. Published online June 30, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.1.70

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Abstract PDF: Rhabdomyosarcomas are soft tissue sarcomas; while extremely rare in adults, they are one of the most common neoplasms in children and adolescents. Histologically, they can be classified into embryonal(ERMS), alveolar(ARMS), pleomorphic, and undifferentiated types. The ARMS type is very rare, and is associated with a poor prognosis. Common primary sites of ARMS are the trunk and extremities. We report on a case of paraaortic, supraclavicular, and axillary lymph node metastasis from paratesticular ARMS treated with VAC(vincristine, dactinomycin, cyclophosphamide)/ IE(ifosfamide, etoposide) chemotherapy in a young adult. Administration of six cycles of chemotherapy with VAC/ IE resulted in complete remission. The patient has maintained complete remission over the past 27 months.

Treatment of Hemangiopericytoma-Associated Hypoglycemia with Glucocorticoid Therapy.: Sung Woo Park, Dong Geun Kim, Myung Jin Kim, Hyo Jin Jang, Se Hoon Sohn, Sung Ae Koh, Ha Young Lee, Min Kyoung Kim, Kyoung Hee Lee, Myung Soo Hyun; Yeungnam Univ J Med. 2011;28(1):77-83. Published online June 30, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.1.77

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Abstract PDF: Non-islet cell tumor-induced hypoglycemia (NICTH) is associated with mesenchymal tumor types, including hemangiopericytoma, fibrosarcoma, mesothelioma, and neurofibroma, as well as carcinoma of the liver, adrenal glands, and kidneys. Non-islet cell tumors induce hypoglycemia by overproducing an abnormal form of insulin-like growth factor II (IGF II). Complete removal of the tumor or reduction of the tumor mass is a successful therapeutic strategy in cases of NICTH. However, if the tumor re-grows, curative resection is nearly impossible, and hypoglycemia occurs repeatedly. Glucocorticoids are effective in terms of long-term relief from hypoglycemia through promotion of gluconeogenesis in the liver, tumor suppression, production of 'big'-IGF-II, and correction of the attendant biochemical abnormalities involving the growth hormone (GH)-IGF axis. We found that administration of corticosteroid therapy to a patient suffering from NICTH resulted in improvement of hypoglycemia associated symptoms.

A Case of Duodenal Brunner's Gland Adenoma Treated by Endoscopic Rescetion.: Sung Joon Kim, Min Geun Gu, Jun Suk Park, Kyeong Ok Kim, Si Hyung Lee, Tae Nyeun Kim, Jun Hyuk Choi; Yeungnam Univ J Med. 2011;28(1):84-89. Published online June 30, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.1.84

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Abstract PDF

Brunneroma, also known as Brunner's gland adenoma or harmatoma, is a very rare benign tumor of the duodenum, which is usually asymptomatic, and is discovered incidentally during endoscopic exam. These lesions are most commonly located in the duodenal bulb and clinical manifestations are variable. We report on a case of a large Brunner's gland adenoma in a 54-year-old man, which was successfully removed by endoscopic resection without complications, such as bleeding or perforation. Microscopically, it was composed entirely of variable Brunner's gland.

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Solitary schwannoma of the ascending colon
Myeong Su Chu, Hyun Mo Kang, Hyeong Ju Sun, Dong Min Kim, Hyong Jong Kwak
Yeungnam University Journal of Medicine.2016; 33(1): 37. CrossRef

Torsade de Pointes Induced by Long-Term Oral Amiodarone Therapy.: Jong Ho Nam, Yoon Jung Choi, Min Kyu Kang, Sung Yun Jung, Su Mi Kim, Sang Hee Lee, Dong Gu Shin; Yeungnam Univ J Med. 2011;28(1):90-93. Published online June 30, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.1.90

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Abstract PDF: Although amiodarone is generally regarded as safe with a low incidence of associated arrhythmias, torsade de pointes (TdP) has been observed usually in the presence of predisposing factors. We report a case of amiodarone-induced TdP after long-term administration of a low dose of oral amiodarone in the absence of predisposing factors.

An Unexpected Vapor Leakage from Locked Vaporizer.: Hyun Seok Seong, Sang Jin Park, In Seong Kim; Yeungnam Univ J Med. 2011;28(1):94-98. Published online June 30, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.1.94

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Abstract PDF: One of the most popular types of vaporizer mounting sytems is Selectatec, as it possesses a simple detachment mechanism. Detachable units can loosen between the vaporizer and anesthetic machine, which can cause vapor leakage. A locking system was subsequently developed to prevent this issue; however, we report a case of an unexpected vapor leakage from a locked vaporizer.

A Case of Essential Thrombocythemia Presenting as Esophageal Varix Bleeding and Multiple Thrombosis.: So Yeon Yoon, Jun Hyeok Choi, Sun Mi Kang, Jung Nam Cho, Sung Hwa Bae, Hun Mo Ryoo; Yeungnam Univ J Med. 2011;28(1):99-104. Published online June 30, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.1.99

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Abstract PDF: Essential thrombocythemia (ET), a subcategory of chronic myeloproliferative disorder, is characterized by absolute thrombocytosis due to excessive clonal proliferation of platelets, hyperaggregability of platelets, and increased incidence of thrombosis and hemorrhage. We consider a diagnosis of ET when an unexplained and persistent thrombocytosis is observed. It is difficult to consider ET first when we meet a patient with esophageal varix bleeding or unusual multiple thromboses like mesenteric vein, splenic vein, and portal vein. This article reports a patient who presented initially with esophageal varix bleeding and unusual multiple thromboses, thereafter, she was diagnosed with ET after testing positive for the Janus Tyrosine Kinase 2 (JAK2) V617F mutation. In conclusion, in patients with varix bleeding and unusual multiple thromboses, myeloproliferative disorders like essential thrombocythemia should be considered as a potential cause and testing for the JAK2 mutation is warranted.

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