Journal of Yeungnam Medical Science

Review articles

Digital therapeutics in Korea: current status, challenges, and future directions – a narrative review: Hee Jun Shin, Ik Tae Cho, Wan Suk Choi, Hong Rae Kim, Min Bong Kang, Won Jong Yang; Received September 3, 2024 Accepted October 9, 2024 Published online November 18, 2024; DOI: https://doi.org/10.12701/jyms.2024.01004 [Epub ahead of print]

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Abstract PDF: Digital therapeutics (DTx) are emerging as a transformative innovation in healthcare offering evidence-based digital interventions for the treatment, management, and prevention of various diseases and disorders. In Korea, DTx have gained significant attention as potential solutions to the increasing burden of chronic diseases and mental health conditions. However, the Korean DTx market faces several challenges that hinder its widespread adoption and integration into the national healthcare system. This study provides a comprehensive analysis of the current state of the DTx market in Korea, identifies the key challenges impeding its growth, and proposes strategies for overcoming these obstacles. This study utilized a literature review and market analysis approach to examine the latest research, industry reports, and regulatory documents related to DTx. The analysis focused on three primary areas: (1) the current regulatory landscape, (2) technological advancements and challenges, and (3) economic and commercial factors influencing DTx adoption in Korea. A comparative analysis of global regulatory practices was also conducted to identify best practices. The findings revealed that while Korea has made significant strides in supporting DTx development, the market remains in its early stages. The key challenges include underdeveloped regulatory frameworks, issues with data quality and security, and a lack of established reimbursement pathways. We recommend developing tailored regulatory frameworks for DTx, enhancing policy support for small and medium-sized enterprises involved in DTx development, and increasing investments in technological infrastructure. By addressing these challenges, Korea could position itself as a leader in the global DTx market, delivering innovative and effective treatments to enhance patient care and outcomes.

Failed back surgery syndrome—terminology, etiology, prevention, evaluation, and management: a narrative review: Jinseok Yeo; J Yeungnam Med Sci. 2024;41(3):166-178. Published online June 10, 2024; DOI: https://doi.org/10.12701/jyms.2024.00339

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Amid the worldwide increase in spinal surgery rates, a significant proportion of patients continue to experience refractory chronic pain, resulting in reduced quality of life and escalated healthcare demands. Failed back surgery syndrome (FBSS) is a clinical condition characterized by persistent or recurrent pain after one or more spinal surgeries. The diverse characteristics and stigmatizing descriptions of FBSS necessitate a reevaluation of its nomenclature to reflect its complexity more accurately. Accurate identification of the cause of FBSS is hampered by the complex nature of the syndrome and limitations of current diagnostic labels. Management requires a multidisciplinary approach that may include pharmacological treatment, physical therapy, psychological support, and interventional procedures, emphasizing realistic goal-setting and patient education. Further research is needed to increase our understanding, improve diagnostic accuracy, and develop more effective management strategies.

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Using Key Predictors in an SVM Model for Differentiating Spinal Fractures and Herniated Intervertebral Discs in Preoperative Anesthesia Evaluation
Shih-Ying Yang, Shih-Yen Hsu, Yi-Kai Su, Nan-Han Lu, Kuo-Ying Liu, Tai-Been Chen, Kon-Ning Chiu, Yung-Hui Huang, Li-Ren Yeh
Diagnostics.2024; 14(21): 2456. CrossRef

Original article

Effect of pitavastatin on erythrocyte membrane fatty acid content in patients with chronic kidney disease: two-arm parallel randomized controlled trial: Minna Kim, Seong Eun Kim, Su Mi Lee, Won Suk An; J Yeungnam Med Sci. 2024;41(3):188-195. Published online May 8, 2024; DOI: https://doi.org/10.12701/jyms.2024.00094

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Abstract PDF Supplementary Material: Background
Statins reduce the risk of cardiovascular events in patients with chronic kidney disease (CKD). Although diabetes mellitus (DM) is a reported side effect of statin treatment, some studies have indicated that pitavastatin does not cause DM. The present study investigated the effect of pitavastatin on the fatty acid (FA) content of erythrocyte membranes, which affects the occurrence of DM and cardiovascular diseases. In addition, changes in adiponectin and glycated hemoglobin (HbA1c) levels were evaluated after pitavastatin treatment.
Methods
A total of 45 patients were enrolled, 28 of whom completed the study. Over 24 weeks, 16 patients received 2 mg pitavastatin and 12 patients received 10 mg atorvastatin. Dosages were adjusted after 12 weeks if additional lipid control was required. There were 10 and nine patients with DM in the pitavastatin and atorvastatin groups, respectively. Erythrocyte membrane FAs and adiponectin levels were measured using gas chromatography and enzyme-linked immunosorbent assay, respectively.
Results
In both groups, saturated FAs, palmitic acid, trans-oleic acid, total cholesterol, and low-density lipoprotein cholesterol levels were significantly lower than those at baseline. The arachidonic acid (AA) content in the erythrocyte membrane increased significantly in the pitavastatin group, but adiponectin levels were unaffected. HbA1c levels decreased in patients treated with pitavastatin. No adverse effects were associated with statin treatment.
Conclusion
Pitavastatin treatment in patients with CKD may improve glucose metabolism by altering erythrocyte membrane AA levels. In addition, pitavastatin did not adversely affect glucose control in patients with CKD and DM.

Review articles

Hepatic encephalopathy on magnetic resonance imaging and its uncertain differential diagnoses: a narrative review: Chun Geun Lim, Myong Hun Hahm, Hui Joong Lee; J Yeungnam Med Sci. 2023;40(2):136-145. Published online January 10, 2023; DOI: https://doi.org/10.12701/jyms.2022.00689

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Abstract PDF

Hepatic encephalopathy (HE) is a severe neuropsychiatric abnormality in patients with either acute or chronic liver failure. Typical brain magnetic resonance imaging findings of HE are bilateral basal ganglia high signal intensities due to manganese deposition in chronic liver disease and hyperintensity in T2, fluid-attenuated inversion recovery, or diffusion-weighted imaging (DWI) with hemispheric white matter changes including the corticospinal tract. Low values on apparent diffusion coefficient mapping of the affected area on DWI, indicating cytotoxic edema, can be observed in acute HE. However, neuropsychological impairment in HE ranges from mild deficits in psychomotor abilities affecting quality of life to stupor or coma with higher grades of hepatic dysfunction. In particular, the long-lasting compensatory mechanisms for the altered metabolism in chronic liver disease make HE imaging results variable. Therefore, the clinical relevance of imaging findings is uncertain and differentiating HE from other metabolic diseases can be difficult. The recent introduction of concepts such as “acute-on-chronic liver failure (ACLF),” a new clinical entity, has led to a change in the clinical view of HE. Accordingly, there is a need to establish a corresponding concept in the field of neuroimaging diagnosis. Herein, we review HE from a historical and etiological perspective to increase understanding of brain imaging and help establish an imaging approach for advanced new concepts such as ACLF. The purpose of this manuscript is to provide an understanding of HE by reviewing neuroimaging findings based on pathological and clinical concepts of HE, thereby assisting in neuroimaging interpretation.

Citations

Citations to this article as recorded by

Pattern Clustering of Symmetric Regional Cerebral Edema on Brain MRI in Patients with Hepatic Encephalopathy
Chun Geun Lim, Hui Joong Lee
Journal of the Korean Society of Radiology.2024; 85(2): 381. CrossRef
Response to “Brain Lesions in Liver Cirrhosis May Not Only Be Due to Hepatic Encephalopathy”
Hui Joong Lee
Journal of the Korean Society of Radiology.2024; 85(4): 827. CrossRef
Altered Mental Status in the Solid-Organ Transplant Recipient
Nicolas Weiss, Henning Pflugrad, Prem Kandiah
Seminars in Neurology.2024; 44(06): 670. CrossRef
Rule out all differential causes before attributing cerebral bleeding to 5-aminolevulinic acid
Josef Finsterer, Sounira Mehri
Child's Nervous System.2023; 39(4): 847. CrossRef
Minimal hepatic encephalopathy: clinical, neurophysiological, neuroimaging markers
P. I. Kuznetsova, A. A. Raskurazhev, S. N. Morozova, I. M. Lovchev, M. S. Novruzbekov, M. M. Tanashyan
Russian neurological journal.2023; 28(5): 21. CrossRef
Prevalence of Precipitating Factors of Hepatic Encephalopathy at Nangarhar Regional Hospital
Ameerullah Razai, Ismail Khan Safi, Said Abdul Jamil Saidi, Said Inam Saidi
Nangarhar University International Journal of Biosciences.2023; : 34. CrossRef

Home mechanical ventilation in children with chronic respiratory failure: a narrative review: Soyoung Kwak; J Yeungnam Med Sci. 2023;40(2):123-135. Published online May 27, 2022; DOI: https://doi.org/10.12701/jyms.2022.00227

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Abstract PDF

Advances in perinatal and pediatric intensive care and recent advances in mechanical ventilation during the last two decades have resulted in an exponential increase in the number of children undergoing home mechanical ventilation (HMV) treatment. Although its efficacy in chronic respiratory failure is well established, HMV in children is more complex than that in adults, and there are more considerations. This review outlines clinical considerations for HMV in children. The goal of HMV in children is not only to correct alveolar hypoventilation but also to maximize development as much as possible. The modes of ventilation and ventilator settings, including ventilation masks, tubing, circuits, humidification, and ventilator parameters, should be tailored to the patient’s individual characteristics. To ensure effective HMV, education for the parent and caregiver is important. HMV continues to change the scope of treatment for chronic respiratory failure in children in that it decreases respiratory morbidity and prolongs life spans. Further studies on this topic with larger scale and systemic approach are required to ensure the better outcomes in this population.

Citations

Citations to this article as recorded by

The follow‐up of children on home invasive mechanical ventilation after hospital discharge
Halime Nayır Büyükşahin, Ebru Yalcın
Pediatric Pulmonology.2024; 59(8): 2145. CrossRef
Identifying and managing psychosocial problems in children on home invasive mechanical ventilation
Gizem Özcan, Nazan Çobanoğlu
Pediatric Pulmonology.2024; 59(8): 2149. CrossRef
Management of gastrointestinal and nutritional problems in children on home invasive mechanical ventilation
Ceyda Tuna Kirsaçlioğlu
Pediatric Pulmonology.2024; 59(8): 2170. CrossRef
Indications and practice of home invasive mechanical ventilation in children
Secahattin Bayav, Nazan Çobanoğlu
Pediatric Pulmonology.2024; 59(8): 2210. CrossRef
Rehabilitation in children with home invasive mechanical ventilation
Aysun Genç, Birkan Sonel Tur
Pediatric Pulmonology.2024; 59(8): 2203. CrossRef
Transitioning children using home invasive mechanical ventilation from hospital to home: Discharge criteria, disparities, and ethical considerations
Jennifer Henningfeld, Annie B. Friedrich, Grace Flanagan, Cynthia Griffith, Anna Hughes, Lisa Molkentine, Rebecca Steuart, Stuart Wilkinson, Christopher D. Baker
Pediatric Pulmonology.2024; 59(8): 2113. CrossRef
Mask interfaces and devices for home noninvasive ventilation in children
Sonia Khirani, Vivian Ducrot
Pediatric Pulmonology.2024; 59(6): 1528. CrossRef
Home Mechanical Ventilation in Children: Complications and Benefits—A Two-Year Experience at a Referral Children's Hospital
Majid Keivanfar, Mahnaz Kheiri, Sharareh Babaie, Mohsen Reisi
Iranian Journal of Pediatrics.2024;[Epub] CrossRef
Mapping health-related quality of life of children and families receiving pediatric invasive home mechanical ventilation: a scoping review protocol
Keisha White Makinde, Maysara Mitchell, Alexandra F. Merz, Michael Youssef
Systematic Reviews.2024;[Epub] CrossRef

Original articles

Association of advanced chronic kidney disease with diabetic retinopathy severity in older patients with diabetes: a retrospective cross-sectional study: Geun Woo Lee, Chul Ho Lee, Seong Gyu Kim; J Yeungnam Med Sci. 2023;40(2):146-155. Published online May 26, 2022; DOI: https://doi.org/10.12701/jyms.2022.00206

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Abstract PDF

Background
Despite the recent increasing trend in the prevalence of type 2 diabetes among older individuals, the relationship between diabetic retinopathy (DR) and chronic kidney disease (CKD) in these patients remains unclear. This study investigated the severity of renal dysfunction according to the degree of DR in older patients with type 2 diabetes.
Methods
A total of 116 patients with diabetes and CKD stage ≥3 who visited both the nephrology and ophthalmology outpatient departments between July 2021 and January 2022 were screened. There were 53 patients in the no DR group, 20 in the nonproliferative DR (NPDR) group, and 43 in the proliferative DR (PDR) group.
Results
DR severity was related to the deterioration of renal function. The proportion of patients with advanced CKD significantly increased with DR severity (p for trend <0.001). In the multivariate regression model adjusted for age of ≥80 years, male sex, poorly controlled diabetes, macroalbuminuria, insulin use, diabetes duration of ≥10 years, cerebrovascular accident, hypertension, hyperlipidemia, and cardiovascular disease history, the odds ratio compared with the no DR group was approximately 4.6 for the NPDR group and approximately 11.8 for the PDR group, which were both statistically significant (p=0.025 and p<0.001, respectively).
Conclusion
DR severity in older patients with diabetes may be associated with deterioration of renal function and high prevalence of advanced CKD. Therefore, periodic examination for DR in older patients with diabetes is important for predicting renal function deterioration and CKD progression.

Citations

Citations to this article as recorded by

Diabetic Macular Edema Is Predictive of Renal Failure in Patients With Diabetes Mellitus and Chronic Kidney Disease
Shih-Hsiang Ou, Wei-Che Chang, Ling-Ying Wu, Shiow-Ing Wang, James Cheng-Chung Wei, Po-Tsang Lee
The Journal of Clinical Endocrinology & Metabolism.2024; 109(3): 761. CrossRef
Study on Correlation between Renal Function and Diabetic Retinopathy
卓越郑
Advances in Clinical Medicine.2024; 14(03): 513. CrossRef
Evaluating the potential of retinal photography in chronic kidney disease detection: a review
Nur Asyiqin Amir Hamzah, Wan Mimi Diyana Wan Zaki, Wan Haslina Wan Abdul Halim, Ruslinda Mustafar, Assyareefah Hudaibah Saad
PeerJ.2024; 12: e17786. CrossRef

Effect of nonsurgical periodontal therapy and smoking status on hematological variables related to anemia of chronic disease in chronic periodontitis patient: a case-control study: Sangita Show, Somen Bagchi, Arka Kanti Dey, Ramanarayana Boyapati, Pritish Chandra Pal, Kanikanti Siva Tejaswi; J Yeungnam Med Sci. 2022;39(3):244-249. Published online May 16, 2022; DOI: https://doi.org/10.12701/jyms.2022.00045

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Abstract PDF: Background
Chronic infectious, inflammatory, or neoplastic disorders are associated with anemia of chronic disease. Chronic inflammatory diseases such as periodontitis may contribute to masked anemia, especially in smokers. This study was aimed at verifying and comparing the efficacy of nonsurgical periodontal therapy (NSPT) for improving anemia among chronic periodontitis patients with and without the habit of smoking.
Methods
Thirty systemically healthy individuals with chronic periodontitis were divided into two groups of 15 each, smokers (group A) and nonsmokers (group B). The groups were compared based on hematological parameters such as serum erythropoietin (SE) and serum ferritin (SF) levels at baseline and 3 months after NSPT for anemia evaluation.
Results
The baseline SE levels in groups A and B were 11.84 and 15.19 mIU/mL (p=0.031), respectively; the corresponding levels at 3 months after NSPT were 13.00 and 17.74 mIU/mL (p=0.022). The baseline SF levels in groups A and B were 95.49 and 44.86 ng/mL (p=0.018), respectively; the corresponding levels at 3 months after NSPT were 77.06 and 39.05 ng/mL (p=0.009). Group B showed a significant increase and decrease in the SE and SF levels, respectively, at 3 months after NSPT (p=0.035 and p=0.039, respectively), whereas group A showed insignificant changes (p=0.253 and p=0.618, respectively).
Conclusion
NSPT led to an improvement in anemia among chronic periodontitis patients. However, the improvement is less in smokers compared to that in nonsmokers. Furthermore, SF and SE levels might serve as effective biomarkers for assessing anemia in smokers and nonsmokers with chronic periodontitis.

Case report

Serotonin syndrome in a patient with chronic pain taking analgesic drugs mistaken for psychogenic nonepileptic seizure: a case report: Mathieu Boudier-Revéret, Min Cheol Chang; Yeungnam Univ J Med. 2021;38(4):371-373. Published online April 5, 2021; DOI: https://doi.org/10.12701/yujm.2021.00948

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Abstract PDF Supplementary Material: Serotonin syndrome (SS) is a potentially life-threatening condition that is caused by the administration of drugs that increase serotonergic activity in the central nervous system. We report a case of serotonin syndrome in a patient with chronic pain who was taking analgesic drugs. A 36-year-old female with chronic pain in the lower back and right buttock area had been taking tramadol hydrochloride 187.5 mg, acetaminophen 325 mg, pregabalin 150 mg, duloxetine 60 mg, and triazolam 0.25 mg daily for several months. After amitriptyline 10 mg was added to achieve better pain control, the patient developed SS, which was mistaken for psychogenic nonepileptic seizure. However, her symptoms completely disappeared after discontinuation of the drugs that were thought to trigger SS and subsequent hydration with normal saline. Various drugs that can increase serotonergic activity are being widely prescribed for patients with chronic pain. Clinicians should be aware of the potential for the occurrence of SS when prescribing pain medications to patients with chronic pain.

Original article

Polyunsaturated fatty acids, lung function, and health-related quality of life in patients with chronic obstructive pulmonary disease: Hyunji Choi, Taeyun Kim; Yeungnam Univ J Med. 2020;37(3):194-201. Published online April 7, 2020; DOI: https://doi.org/10.12701/yujm.2020.00052

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Abstract PDF

Background
Dietary polyunsaturated fatty acids (PUFA) are thought to modify systemic inflammation. The present study aimed to evaluate the relationship between PUFA intake, lung function, and health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD).
Methods
In this study, we used the dataset of 6th Korea National Health and Nutrition Examination Survey, in which, a total of 22,948 individuals including 573 participants with a high probability of developing COPD were enrolled. Participants with missing data for the investigated variables were excluded. Linear regression analyses were used to evaluate the association between PUFA intake (omega-3 [N3], omega-6 [N6], and total) with lung function, and HRQoL. HRQoL was determined according to the European Quality of Life-5 Dimensions (EQ-5D). Subgroup analysis of older patients was performed. Age, sex, body mass index, smoking, alcohol, education, residence, total calorie intake, and predicted FEV1% were adjusted in all analyses.
Results
Although lung function was not associated with PUFA intake, EQ-5D index was remarkably associated with N3, N6, and total PUFA intake in a dose-dependent manner. This association was more pronounced in elderly COPD patients. Mean levels of N3, N6, and total PUFA intake were significantly higher in patients having better HRQoL with respect to mobility, self-care, and usual activities.
Conclusion
Our results suggest that N3, N6, and total PUFA intake are associated with HRQoL in COPD patients. This association may be attributed to mobility, self-care, and usual activities. Further longitudinal study is required to clarify this relationship.

Citations

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Dietary modulation of lung lipids influences inflammatory responses to inhaled ozone
Russell Hunter, Brenna Baird, Milad Mazloumi-Bakhshayesh, Siem Goitom, Selita Lucas, Guy Herbert, David Scieszka, Edward Davis, Haiwei Gu, Yan Jin, Barry E. Bleske, Matthew J. Campen
Journal of Lipid Research.2024; 65(9): 100630. CrossRef
Nutrition as a modifiable factor in the onset and progression of pulmonary function impairment in COPD: a systematic review
Lieke E J van Iersel, Rosanne J H C G Beijers, Harry R Gosker, Annemie M W J Schols
Nutrition Reviews.2022; 80(6): 1434. CrossRef
Medium and long chain free fatty acid receptors in the pathophysiology of respiratory diseases
O. Yu. Kytikova, T. P. Novgorodtseva, Yu. K. Denisenko, M. V. Antonyuk, T. A. Gvozdenko
Bulletin Physiology and Pathology of Respiration.2021; (80): 115. CrossRef

Review article

Implementation of a care coordination system for chronic diseases: Jung Jeung Lee, Sang Geun Bae; Yeungnam Univ J Med. 2019;36(1):1-7. Published online December 20, 2018; DOI: https://doi.org/10.12701/yujm.2019.00073

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Abstract PDF

The number of people with chronic diseases has been increasing steadily but the indicators for the management of chronic diseases have not improved significantly. To improve the existing chronic disease management system, a new policy will be introduced, which includes the establishment of care plans for hypertension and diabetes patients by primary care physicians and the provision of care coordination services based on these plans. Care coordination refers to a series of activities to assist patients and their families and it has been known to be effective in reducing medical costs and avoiding the unnecessary use of the hospital system by individuals. To offer well-coordinated and high-quality care services, it is necessary to develop a service quality assurance plan, track and manage patients, provide patient support, agree on patient referral and transition, and develop an effective information system. Local governance should be established for chronic disease management, and long-term plans and continuous quality improvement are necessary.

Citations

Citations to this article as recorded by

Personalized, interdisciplinary patient pathway for cross-sector care of multimorbid patients (eliPfad trial): study protocol for a randomized controlled trial
Christoph Heinrich Lindemann, Volker Burst, Linus Alexander Völker, Sebastian Brähler, Dusan Simic, Ingrid Becker, Martin Hellmich, Clarissa Kurscheid, Nadine Scholten, Ruben Krauspe, Kerstin Leibel, Stephanie Stock, Paul Thomas Brinkkoetter
Trials.2024;[Epub] CrossRef
Evaluation of the Implementation of Integrated Primary Care for Patients with Type 2 Diabetes and Hypertension in Belgium, Cambodia, and Slovenia
Nataša Stojnić, Monika Martens, Edwin Wouters, Savina Chham, Josefien van Olmen, Katrien Danhieux, Nina Ružić Gorenjec, Ir Por, Antonija Poplas-Susič, Zalika Klemenc-Ketiš
International Journal of Integrated Care.2024;[Epub] CrossRef
Trends in the Quality of Primary Care and Acute Care in Korea From 2008 to 2020: A Cross-sectional Study
Yeong Geun Gwon, Seung Jin Han, Kyoung Hoon Kim
Journal of Preventive Medicine and Public Health.2023; 56(3): 248. CrossRef

Case Reports

Chronic hepatitis C healed by peginterferon-α and rivabirin treatment after kidney transplantation.: Min Gue Seok, Tae Hee Lee, Sung Ro Yun, Won Min Hwang, Se Hee Yoon, In Soo Choe, Seong Joo Kang, Ju Young Hong, Dae Sung Kim; Yeungnam Univ J Med. 2016;33(2):150-154. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.150

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Abstract PDF: Hepatitis C virus (HCV) infection is present in a high proportion of patients with kidney transplantation. Compared with uninfected kidney transplant recipients, HCV infected kidney recipient have higher prevalence of liver disease and worse allograft survival after transplantation. Interferon monotherapy before transplantation is standard therapy for HCV-infected kidney transplant candidates. If HCV infection is discovered after transplantation, interferon monotherapy is considered due to the limited critical situation. However, in this patient, who was a kidney recipient, HCV infection was treated after kidney transplantation with peginterferon-α and rivabirin. As a result, the patient achieved sustained virologic response.

Spontaneous abdominal intramuscular hematoma in a non-dialysis chronic kidney disease patient under cilostazol therapy.: Seonghui Kang, Hyung Min Yu, Ha Young Na, Young Kyung Ko, Se Woong Kwon, Chae Ho Lim, Sun Woong Kim, Young Il Jo; Yeungnam Univ J Med. 2014;31(2):139-143. Published online December 31, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.2.139

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Abstract PDF: Spontaneous intramuscular hematoma of the abdominal wall is a rare condition characterized by acute abdominal pain. It is often misdiagnosed as a surgical condition. It used to be associated with risk factors such as coughing, pregnancy, and anticoagulant therapy. Most cases of abdominal wall hematomas were rectus sheath hematomas caused by the rupture of either the superior or inferior epigastric artery, but spontaneous internal oblique hematoma was extremely rare. In this report, we present a case of spontaneous internal oblique hematoma in a 69-year-old man with non-dialysis chronic kidney disease who was taking cilostazol. The patient complained of abrupt abdominal pain with a painful palpable lateral abdominal mass while sleeping. The abdominal computed tomography showed an 8 cm-sized mass in the patient's left internal oblique muscle. The administration of cilostazol was immediately stopped, and the intramuscular hematoma of the lateral oblique muscle disappeared with conservative management.

A Case of Chronic Renal Failure Associated with Systemic Capillary Leak Syndrome.: Seon Ha Baek, Nara Shin, Hyo Jin Kim, Mi Yeun Han, Dong Ju Choi, Soo Mee Bang, Sejoong Kim, Jin Ho Paik; Yeungnam Univ J Med. 2012;29(2):145-149. Published online December 31, 2012; DOI: https://doi.org/10.12701/yujm.2012.29.2.145

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Abstract PDF

Systemic capillary leak syndrome (SCLS) is an unusual entity characterized by hypovolemic shock, hemoconcentration, and hypo-albuminemia associated with paraproteinemia as a result of marked capillary hyperpermeability. Complications of this syndrome can include compartment syndromes, pulmonary edema, thrombosis, and acute kidney injury. This paper reports a case of severe SCLS accompanied by acute tubular necrosis caused by hypoperfusion and myoglobinuria secondary to rhabdomyolysis, which resulted in chronic kidney disease that necessitated hemodialysis. However, there have been rare data of residual end-organ damage after acute attacks in Korea. Therefore, this paper reports a case of complicated SCLS enough to hemodialysis and that developed into chronic kidney disease.

Citations

Citations to this article as recorded by

Fatal Systemic Capillary Leak Syndrome after SARS-CoV-2Vaccination in Patient with Multiple Myeloma
Gwang-Jun Choi, Seon Ha Baek, Junmo Kim, Jung Ho Kim, Geun-Yong Kwon, Dong Keun Kim, Yeon Haw Jung, Sejoong Kim
Emerging Infectious Diseases.2021; 27(11): 2973. CrossRef
Systemic capillary leak syndrome (Clarkson's disease) during elective pylorus-preserving pancreaticoduodenectomy: case report
Kun Moo Choi, Cheon Soo Park, Mi Hye Kim
Korean Journal of Hepato-Biliary-Pancreatic Surgery.2014; 18(1): 38. CrossRef

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.

Review Article

Chronic Venous Insufficiency: Woo-Hyung Kwun; Yeungnam Univ J Med. 2007;24(2 Suppl):S234-244. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S234

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Abstract PDF: Venous insufficiency can be divided into primary venous insufficiency and chronic venous insufficiency. The latter is characterized by advanced skin changes of hyperpigmentation, edema, ulceration, scarring from healed ulcers or open ulcerations. Pretreatment evaluation is done with a standing ultrasound reflux examination. Thorough mapping of extremity reflux is desirable. Physiologic tests of venous function, such as plethysmography, are unnecessary. Treatment is directed at closing refulxing axial veins as well as controlling those perforating veins with outward flow. Varicose veins contribute to axial reflux and must be obliterated. In performing ablation of saphenous vein reflux, techniques include high ligation with strrpping, radiofrequency ablation, endovenous laser therapy, and foam sclerotherapy. Initial treatment of severe chronic venous insufficiency is usually carried out by controlling the edema with elastic bandaging or nonelastic support, such as Unna boot or the CircAid dressing. Incompetent perforation interruption can be accomplished surgically by subfascial endoscopic perforator surgery (SEPS) or controlled sclerotherapy using ultrasound.. Surgical intervention has been successful but the advent of foam sclerotherapy has proven to be an attractive alternative to surgery and has added a new tool for the treatment of severe chronic venous insufficiency.1)

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