Journal of Yeungnam Medical Science

Original articles

Association between total body muscle percentage and prevalence of non-alcoholic fatty liver disease in Korean adults findings from an 18-year follow-up: a prospective cohort study: Byoung Chan Ahn, Chul Yong Park, Jung Hee Hong, Ki Ook Baek; J Yeungnam Med Sci. 2023;40(Suppl):S47-S55. Published online August 29, 2023; DOI: https://doi.org/10.12701/jyms.2023.00605

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Abstract PDF Supplementary Material: Background
This study aimed to elucidate the association between total lean muscle mass and the incidence of non-alcoholic fatty liver disease (NAFLD) in the adult Korean population.
Methods
Utilizing data derived from the 18-year prospective cohort of the Korean Genome and Epidemiology Study, NAFLD was diagnosed via the hepatic steatosis index with an established cutoff value of 36. Lean muscle mass was assessed via bioelectrical impedance analysis and subsequently divided into tertiles. A generalized mixed model with a logit link was employed for repeated measures data analysis, accounting for potential confounders.
Results
Analysis encompassed 7,794 participants yielding 49,177 measurements. The findings revealed a markedly increased incidence of NAFLD in the lower tertiles of muscle mass, specifically, tertile 1 (odds ratio [OR], 20.65; 95% confidence interval [CI], 9.66–44.11) and tertile 2 (OR, 4.57; 95% CI, 2.11–9.91), in comparison to tertile 3. Age-dependent decreases in the OR were observed within the tertile 1 group, with ORs of 10.12 at age of 40 years and 4.96 at age of 80 years. Moreover, each 1%-point increment in total muscle mass corresponded with an estimated OR of 0.87 (95% CI, 0.82–0.93) for NAFLD resolution.
Conclusions
The study demonstrates a significant association between total muscle mass and NAFLD prevalence among Korean adults. Given the potential endocrine role of muscle mass in NAFLD pathogenesis, interventions aimed at enhancing muscle mass might serve as an effective public health strategy for mitigating NAFLD prevalence.

Association between fatty liver disease and hearing impairment in Korean adults: a retrospective cross-sectional study: Da Jung Jung; J Yeungnam Med Sci. 2023;40(4):402-411. Published online June 26, 2023; DOI: https://doi.org/10.12701/jyms.2023.00304

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Background
We hypothesized that fatty liver disease (FLD) is associated with a high prevalence of hearing loss (HL) owing to metabolic disturbances. This study aimed to evaluate the association between FLD and HL in a large sample of the Korean population.
Methods
We used a dataset of adults who underwent routine voluntary health checkups (n=21,316). Fatty liver index (FLI) was calculated using Bedogni’s equation. The patients were divided into two groups: the non-FLD (NFLD) group (n=18,518, FLI <60) and the FLD group (n=2,798, FLI ≥60). Hearing thresholds were measured using an automatic audiometer. The average hearing threshold (AHT) was calculated as the pure-tone average at four frequencies (0.5, 1, 2, and 3 kHz). HL was defined as an AHT of >40 dB.
Results
HL was observed in 1,370 (7.4%) and 238 patients (8.5%) in the NFLD and FLD groups, respectively (p=0.041). Compared with the NFLD group, the odds ratio for HL in the FLD group was 1.16 (p=0.040) and 1.46 (p<0.001) in univariate and multivariate logistic regression analyses, respectively. Linear regression analyses revealed that FLI was positively associated with AHT in both univariate and multivariate analyses. Analyses using a propensity score-matched cohort showed trends similar to those using the total cohort.
Conclusion
FLD and FLI were associated with poor hearing thresholds and HL. Therefore, active monitoring of hearing impairment in patients with FLD may be helpful for early diagnosis and treatment of HL in the general population.

Citations

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The inflammatory and metabolic status of patients with sudden-onset sensorineural hearing loss
Jônatas Bussador do Amaral, Kelly Abdo Peron, Tracy Lima Tavares Soeiro, Marina Cançado Passarelli Scott, Flávia Tatiana Pedrolo Hortense, Michelly Damasceno da Silva, Carolina Nunes França, Luiz Henrique da Silva Nali, André Luis Lacerda Bachi, Norma de
Frontiers in Neurology.2024;[Epub] CrossRef
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Gregory M. Zarus, Patricia Ruiz, Rae Benedict, Stephan Brenner, Krystin Carlson, Layna Jeong, Thais C. Morata
Toxics.2024; 12(9): 650. CrossRef

Review article

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.

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Pattern Clustering of Symmetric Regional Cerebral Edema on Brain MRI in Patients with Hepatic Encephalopathy
Chun Geun Lim, Hui Joong Lee
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Hui Joong Lee
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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

Case report

Thallium poisoning: a case report: Oscar Jimenez, Hector Cáceres, Luis Gimenez, Luciana Soto, Micaela Montenegro, Jhon Alexander Avila Rueda; J Yeungnam Med Sci. 2023;40(3):311-314. Published online December 15, 2022; DOI: https://doi.org/10.12701/jyms.2022.00647

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Abstract PDF

Thallium poisoning is usually accidental. We present a case of a 51-year-old woman who was evaluated in June 2018 for myalgia, vertigo, asthenia, and abdominal pain. Physical examination revealed temporal-spatial disorientation, jaundice, and asterixis. The laboratory reported the following: bilirubin, 10.3 mg/dL; aspartate transaminase, 78 U/L; alanine transaminase, 194 U/L; albumin, 2.3 g/dL; prothrombin time, 40%; and platelet count, 60,000/mm3. Serology performed for hepatitis A, B, and C; Epstein-Barr virus; cytomegalovirus; and human immunodeficiency virus was negative, and a collagenogram was negative. Physical reevaluation revealed alopecia on the scalp, armpits, and eyebrows; macules on the face; plantar hyperkeratosis; and ulcers on the lower limbs. Tests for lead, arsenic, copper, and mercury were carried out, which were normal; however, elevated urinary thallium (540 µg/g; range, 0.4–10 µg/g) was observed. The patient was treated with ᴅ-penicillamine 1,000 mg/day and recovered her urinary thallium levels were within normal range at annual follow-up. Thallium poisoning is extremely rare and can be fatal in small doses. An adequate clinical approach can facilitate early diagnosis.

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Іmprovement of the differential diagnostics of acute oral and inhalation poisoning by thalium compounds, pathohistology and treatment strategy (based on group cases)
G.M. Balan, B.S. Sheyman, P.G. Zhminko, D.O. Dziuba, O.N. Rozhkova, N.V. Kurdil, A.H. Kudriavtseva, V.S. Lisovska, N.P. Chermnykh
Ukrainian Journal of Modern Toxicological Aspects.2023; 95(2): 66. CrossRef

Review article

Hepatic ischemia-reperfusion injury with respect to oxidative stress and inflammatory response: a narrative review: Eun Kyung Choi, Dong Gun Lim; J Yeungnam Med Sci. 2023;40(2):115-122. Published online March 21, 2022; DOI: https://doi.org/10.12701/jyms.2022.00017

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Abstract PDF

Hepatic ischemia-reperfusion injury is a major complication of liver transplantation, trauma, and shock. This pathological condition can lead to graft dysfunction and rejection in the field of liver transplantation and clinical hepatic dysfunction with increased mortality. Although the pathological mechanisms of hepatic ischemia-reperfusion injury are very complex, and several intermediators and cells are involved in this phenomenon, oxidative stress and inflammatory responses are the key processes that aggravate hepatic injury. This review summarizes the current understanding of oxidative stress and inflammatory responses and, in that respect, addresses the therapeutic approaches to attenuate hepatic ischemia-reperfusion injury.

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Case reports

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

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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.

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Liver biopsy as a useful diagnostic tool for hepatic sarcoidosis: A case report
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Navigating Challenges in a Case of Unusual Hepatic and Pulmonar Sarcoidosis: A Comprehensive Clinical Journey
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GE - Portuguese Journal of Gastroenterology.2024; : 1. CrossRef
The clinical management of hepatic sarcoidosis: A systematic review
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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

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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.

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Case series multilocular cystic hemangioma of the liver: Three cases and literature review
Chunmiao Liang, RiSheng Yu, Liuhong Wang, Ying Chen
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Gastric cancer and adenomatous colorectal polyp concomitant with pyogenic liver abscess and bacteremia: Min Kyu Kang, Hee Jung Kwon, Min Cheol Kim; Yeungnam Univ J Med. 2020;37(3):246-249. Published online April 10, 2020; DOI: https://doi.org/10.12701/yujm.2020.00094

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Abstract PDF: Synchronous gastric cancer and adenomatous colorectal polyp in patients with Klebsiella pneumoniae-induced pyogenic liver abscess (KP-PLA) and bacteremia is a rare presentation. A 58-year-old man with a 6-month history of diabetes mellitus (DM) presented with febrile sensation and dull abdominal pain in the right upper quadrant of the abdomen. Subsequent to laboratory test results and abdominal computed tomography findings, KP-PLA with bacteremia was diagnosed. After intravenous antibiotic administration, his symptoms improved, and upper endoscopy and colonoscopy were performed to evaluate the cause of KP-PLA. Biopsy specimens of the prepyloric anterior wall revealed a moderately differentiated adenocarcinoma. Endoscopic mucosal resection of the colon revealed high-grade dysplasia. Early gastric cancer (EGC) and adenomatous colorectal polyps with high-grade dysplasia concomitant with KP-PLA and bacteremia were diagnosed in our patient who had DM. Intravenous antibiotic treatment for KP-PLA, subtotal gastrectomy for EGC, and colonoscopic mucosal resection for the colon polyp were performed. After 25 days of hospitalization, subtotal gastrectomy with adjacent lymph node dissection was performed. Follow-up ultrasound imaging showed resolution of the abscess 5 weeks post-antibiotic treatment, as well as no tumor metastasis. Upper gastrointestinal endoscopy and colonoscopy should be performed to evaluate gastric cancer in patients with PLA or bacteremia, accompanied with DM or an immunocompromised condition.

Review article

Drug-induced liver injury: Jeong Ill Suh; Yeungnam Univ J Med. 2020;37(1):2-12. Published online August 27, 2019; DOI: https://doi.org/10.12701/yujm.2019.00297

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Abstract PDF

Drug-induced liver injury (DILI), including herbal and dietary supplement hepatotoxicity, is often passed lightly; however, it can lead to the requirement of a liver transplant or may even cause death because of liver failure. Recently, the American College of Gastroenterology, Chinese Society of Hepatology and European Association for the Study of the Liver guidelines for the diagnosis and treatment of DILI have been established, and they will be helpful for guiding clinical treatment decisions. Roussel Uclaf Causality Assessment Method scoring is the most commonly used method to diagnose DILI; however, it has some limitations, such as poor validity and reproducibility. Recently, studies on new biomarkers have been actively carried out, which will help diagnose DILI and predict the prognosis of DILI. It is expected that the development of new therapies such as autophagy inducers and various other technologies of the fourth industrial revolution will be applicable to DILI research.

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Case report

Imatinib-induced hepatitis treated by corticosteroids in a patient with metastatic gastrointestinal stromal tumor: Min Kyu Kang, Heon Ju Lee, Joon Hyuk Choi; Yeungnam Univ J Med. 2019;36(2):155-158. Published online January 21, 2019; DOI: https://doi.org/10.12701/yujm.2019.00115

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Abstract PDF

Imatinib mesylate is currently used as the first-line treatment for metastatic gastrointestinal stromal tumors (GISTs). Imatinib-induced hepatotoxicity in patients with GIST is very rare. Its features vary from subclinical elevation of serum aminotransferase to clinically apparent acute hepatitis, which is associated with immunologic reactions. Imatinib-induced hepatotoxicity with autoimmune-like features can be treated by the discontinuation of imatinib mesylate and the administration of oral steroids. Here, we report a case of late-onset imatinib-induced hepatitis with autoimmune-like features in a patient with metastatic GIST, which was improved by oral corticosteroids.

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The prevalence of hepatic and thyroid toxicity associated with imatinib treatment of chronic myeloid leukaemia: a systematic review
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Case Reports

Successful delayed-interval delivery performed 128 days after the vaginal delivery of the first fetus in a twin pregnancy: Yu-Jin Koo; Yeungnam Univ J Med. 2018;35(1):135-139. Published online June 30, 2018; DOI: https://doi.org/10.12701/yujm.2018.35.1.135

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Abstract PDF: There has been a significant increase in the number of multiple pregnancies that are associated with a high risk of preterm delivery among Korean women. However, to date, delayed-interval delivery in women with multiple pregnancy is rare. We report a case of delayed-interval delivery performed 128 days after the vaginal delivery of the first fetus in a dichorionic diamniotic twin pregnancy. The patient presented with vaginal leakage of amniotic fluid at 16 weeks of gestation and was diagnosed with a preterm premature rupture of membranes. Three days later, the first twin was delivered, but the neonate died soon after. The second twin remained in utero, and we decided to retain the fetus in utero to reduce the morbidity and mortality associated with a preterm birth. The patient was managed with antibiotics and tocolytics. Cervical cerclage was not performed. The second twin was delivered vaginally at 34 weeks and 5 days of gestation, 128 days after the delivery of the first-born fetus. This neonate was healthy and showed normal development during the 1-year follow-up period. Based on our experience with this case, we propose that delayed-interval delivery may improve perinatal survival and decrease morbidity in the second neonate in highly selected cases.

Simultaneous chylothorax and chylous ascites: Tae Soo Jang, In Beom Jeong, Do Yeun Cho, Sung Ju Kang, Oh Jung Kwon; Yeungnam Univ J Med. 2017;34(2):265-269. Published online December 31, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.2.265

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Abstract PDF: Chylothorax or chylous ascites are rare manifestations of liver cirrhosis. We report a rare case of simultaneous chylothorax and chylous ascites in a patient with hepatitis B virus-related liver cirrhosis. A 76-year-old woman was referred to our hospital with a pleural effusion on her right side. She had no history of recent medical procedures, trauma or tumor. There was no evidence of mass or thoracic duct obstruction in a computed tomography scan. Pleural fluid and ascites were confirmed as chylothorax and chylous ascites by chemistry analysis. Despite thorough conservative care, there was no improvement. Pleurodesis was planned, but hepatic encephalopathy developed suddenly and she did not recover.

Budd-Chiari syndrome with antiphospholipid syndrome and systemic lupus erythematosus in a patient with Klinefelter's syndrome: Mingee Lee, Jin Young Huh, Ji Hyang Lee, Sun myoung Kang, Jae Yong Lee, Oh Chan Kwon, Eun Na Kim, Jihun Kim, Danbi Lee; Yeungnam Univ J Med. 2017;34(2):260-264. Published online December 31, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.2.260

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Abstract PDF: Klinefelter's syndrome is the most common congenital abnormality that causes primary hypogonadism. It is associated with diseases that predominantly affect women, such as systemic lupus erythematosus (SLE), and it can sometimes cause veno-occlusive disease. We experienced a case of Budd-Chiari syndrome (BCS) in a 33-year-old man with Klinefelter's syndrome presented with hematemesis and edema in both lower extremities. The clinical and laboratory findings were compatible with SLE, antiphospholipid syndrome, and BCS. To the best of our knowledge, this is the first case report to describe a simultaneous presentation of these four clinical syndromes in a single patient.

Amebic liver abscesses resulting in diagnosis of human immunodeficiency virus infection: Seok Weon Kim, Hyeok Choon Kwon, Seung Woo Nam, Jong Kyung Choi, Joo Won Chung, Dong Won Jang, Soo Yoen Park; Yeungnam Univ J Med. 2017;34(1):96-100. Published online June 30, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.1.96

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Abstract PDF: Amebic liver abscess (ALA) is the most common extraintestinal manifestation of amebiasis. Amebiasis, a parasitic infection caused by Entamoeba histolytica, used to be a prevalent protozoan disease in Korea, however, with an improving sanitary system, it has been among very uncommon etiology of liver abscess. A recent report suggested that ALA is an emerging parasitic infection in human immunodeficiency virus (HIV)-infected patients even in areas where the disease is not endemic and recommended HIV screening in patients in areas where ALA is not endemic, particularly those without history of travel to a disease-endemic area. We report on two patients who were admitted for treatment of ALA and then diagnosed as HIV infection. We also reviewed the etiology and characteristics of ALA in our hospital during the last 5 years.

Massive bleeding from a rectal Dieulafoy lesion in a patient with alcoholic cirrhosis: Young Hoon Choi, Jong Ryeol Eun, Jae Ho Han, Hyun Lim, Jung A Shin, Gun Hwa Lee, Seung Hee Lee; Yeungnam Univ J Med. 2017;34(1):88-90. Published online June 30, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.1.88

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Abstract PDF: Although Dieulafoy lesion can occur in any part of the gastrointestinal tract, its occurrence in the rectum is rare. Rectal Dieulafoy lesions have been associated with advanced age, renal failure, burns, liver transplantation and cirrhosis. Here, we report on a case of massive bleeding from a rectal Dieulafoy lesion after lung decortication surgery in a 57-year-old male patient with alcoholic cirrhosis. Although rare, a rectal Dieulafoy lesion should be included in the differential diagnosis of massive lower gastrointestinal bleeding in a patient with cirrhosis.

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