Journal of Yeungnam Medical Science

Original article

Hematology
Clinical impact of spine magnetic resonance imaging as a valuable prognostic tool for patients with multiple myeloma: a retrospective study: Jung Min Lee, Hee Jeong Cho, Joon-Ho Moon, Sang Kyun Sohn, Byunggeon Park, Dong Won Baek; J Yeungnam Med Sci. 2022;39(4):300-308. Published online March 23, 2022; DOI: https://doi.org/10.12701/jyms.2021.01648

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Background
This study investigated the prognostic impact of spine magnetic resonance imaging (MRI) in patients newly diagnosed with multiple myeloma (MM).
Methods
We retrospectively evaluated 214 patients who were newly diagnosed with MM between March 2015 and December 2019. The patients were classified into five different infiltration patterns based on spine MRI as follows: (1) normal appearance, (2) focal, (3) diffuse, (4) combined focal and diffuse infiltration, and (5) “salt-and-pepper.”
Results
Forty patients (18.7%) showed a normal appearance, whereas focal, diffuse, combined focal and diffuse infiltration, and “salt-and-pepper” patterns were identified in 68 (31.8%), 40 (18.7%), 52 (24.3%), and 14 patients (6.5%), respectively. The patients with normal and “salt-and-pepper” patterns were younger than patients with other patterns (median age, 61.6 vs. 66.8 years; p=0.001). Moreover, 63% and 59.3% of patients with normal and “salt-and-pepper” patterns were scored International Staging System (ISS) stage I and revised ISS (R-ISS) stage I, respectively, whereas only 12.5% of patients with other patterns were scored ISS stage I and R-ISS stage I. Patients with normal and “salt-and-pepper” patterns had a better prognosis than those with other patterns, whereas relapse and death rates were significantly higher in patients with focal, diffuse, and combined MRI patterns.
Conclusion
Characteristic MRI findings have a significant prognostic value for long-term survival in patients newly diagnosed with MM. In particular, focal, diffuse, and combined focal and diffuse infiltration patterns are unfavorable prognostic factors.

Citations

Citations to this article as recorded by

Evidence-based Korean guidelines for the clinical management of multiple myeloma: addressing 12 key clinical questions
Sung-Hoon Jung, Youngil Koh, Min Kyoung Kim, Jin Seok Kim, Joon Ho Moon, Chang-Ki Min, Dok Hyun Yoon, Sung-Soo Yoon, Je-Jung Lee, Chae Moon Hong, Ka-Won Kang, Jihyun Kwon, Kyoung Ha Kim, Dae Sik Kim, Sung Yong Kim, Sung-Hyun Kim, Yu Ri Kim, Young Rok Do,
Blood Research.2025;[Epub] CrossRef
Lesions of the spinal cord caused by multiple myeloma: A systematic review and meta-analysis regarding the neurosurgical aspects of patient management
Daniel Encarnacion, Gennady E Chmutin, Ismail Bozkurt, Jack Wellington, Emmanuel Batista Geraldino, Bipin Chaurasia
Journal of Craniovertebral Junction and Spine.2023; 14(4): 313. CrossRef

Case report

Surgery
Cardiopulmonary bypass preparation is mandatory in cardiac exploration for blunt cardiac injury patients: two case reports: Shin-Ah Son, Joon Yong Cho, Gun-Jik Kim, Young Ok Lee, Hanna Jung, Tak-Hyuk Oh; Yeungnam Univ J Med. 2021;38(4):356-360. Published online March 3, 2021; DOI: https://doi.org/10.12701/yujm.2020.00822

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Abstract PDF

Treating cardiac injuries following blunt trauma to the chest requires thorough examination, accurate diagnosis, and therapeutic plan. We present two cases; pulmonary vein rupture and left atrial appendage laceration, both as a result of blunt chest trauma. Through these cases, our team learned the importance of maintaining hemodynamic stability during the examination of injured cardiac structures. And based on the comprehensive cardiac examination, a decision to surgically intervene with median sternotomy via cardiopulmonary bypass was made, saving lives of the patient. This report introduces how such decision was made based on what supporting evidence and the diagnostic process leading to the initiation of surgical intervention. This report may help with decision-making process when confronted by blunt cardiac injury patients who need cardiac exploration.

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The role and timing of cardiopulmonary bypass in the surgical repair of traumatic cardiac injury
Mayo Kondo, Shinichi Ijuin, Tomonori Haraguchi, So Izumi, Reiko Kanno, Kazunori Sakaguchi, Kazumasa Edono, Haruki Nakayama, Satoshi Ishihara, Takuro Tsukube
General Thoracic and Cardiovascular Surgery.2023; 71(10): 561. CrossRef

Original Article

Oncology and Cancer Research
Chemotherapy adherence is a favorable prognostic factor for elderly patients with multiple myeloma who are treated with a frontline bortezomib-containing regimen: Hee-Jeong Cho, Sang-Kyung Seo, Dong Won Baek, Sung-Woo Park, Yoo-Jin Lee, Sang-Kyun Sohn, Ho-Sup Lee, Won Sik Lee, Ji Hyun Lee, Sung Hyun Kim, Joon-Ho Moon; Yeungnam Univ J Med. 2018;35(1):76-83. Published online June 30, 2018; DOI: https://doi.org/10.12701/yujm.2018.35.1.76

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Abstract PDF

Background
Elderly patients with multiple myeloma (MM) are vulnerable to adverse events (AEs). This study evaluated adherence to chemotherapy and treatment outcomes in elderly patients treated with a frontline bortezomib (BTZ), melphalan, and prednisone (VMP) regimen and regimens without BTZ.
Methods
One-hundred and forty elderly patients who were diagnosed with MM from March 2007 to March 2015 were included in this retrospective study. To evaluate regimen adherence, patients who were treated with more than 4 cycles were assigned to the good adherence group.
Results
Among the 140 patients, 71 were treated with a frontline VMP and 69 with non-BTZ regimens. The median age was 71 years (range, 65-90 years). The VMP group showed a higher complete response rate than the non-BTZ group: 26.8% vs. 7.2%. More patients in the VMP group achieved ≥very good partial response (VGPR) and ≥PR. In the VMP group, 27 patients (38.0%) received less than 4 cycles. The VMP good adherence group showed a higher 3-year overall survival (OS) rate (70.9%) than the poor adherence group (60.2%, p=0.059). In the multivariate analysis, treatment with ≥4 cycles of VMP was a favorable factor for OS.
Conclusion
A good adherence to a frontline VMP regimen resulted in favorable long-term survival. Adequate management of AEs will be needed to achieve favorable outcomes in elderly patients with MM.

Citations

Citations to this article as recorded by

The characteristics of Korean elderly multiple myeloma patients aged 80 years or over
Sang Hwan Lee, Hee-Jeong Cho, Joon Ho Moon, Ji Yoon Jung, Min Kyoung Kim, Mi Hwa Heo, Young Rok Do, Yunhwi Hwang, Sung Hwa Bae
The Korean Journal of Internal Medicine.2025; 40(1): 115. CrossRef
Solomon Islands Oncology Unit: Sustainability in Terms of Outcomes
Dylan Bush, Mark Love, Hugo Bugoro, Nixon Panda
JCO Global Oncology.2024;[Epub] CrossRef
Real World Adherence to and Persistence With Oral Oncolytics in Multiple Myeloma: A Systematic Review and Meta-analysis
Abdallah Y. Naser, Richard Ofori-Asenso, Safaa Al Awawdeh, Sami Qadus, Hassan Alwafi, Danny Liew
Clinical Lymphoma Myeloma and Leukemia.2022; 22(10): 760. CrossRef
Oral therapy adherence and satisfaction in patients with multiple myeloma
Marine Solano, Etienne Daguindau, Cyril Faure, Pierre Loriod, Coline Pain, Anne-Cécile Maes, Pauline Marguet, Marie Kroemer, Anne Rumpler, Jean Fontan, Eric Deconinck, Samuel Limat, Anne-Laure Clairet
Annals of Hematology.2021; 100(7): 1803. CrossRef

Case Reports

Obstetrics, Gynecology, and Reproductive Medicine
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.

Citations

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Cervical Cerclage at 17 Gestational Weeks for Delayed‐Interval Delivery at 15 and 27 Weeks of Gestation in a Dichorionic Twin Pregnancy: A Case Report
Motomu Suzuki, Toshiyuki Itai, Ryosuke Shindo, Nozomi Maruiwa, Sayaka Suzuki, Natsumi Ono, Azusa Tochio, Kazunori Mukaida, Soichiro Obata, Etsuko Miyagi, Shigeru Aoki
Journal of Obstetrics and Gynaecology Research.2026;[Epub] CrossRef

Pulmonary and Respiratory Medicine
Massive barium sulfate aspiration during upper gastrointestinal contrast material study in an elderly patient with dysphagia.: Hae Ryong Yun, Chang Gon Kim, Jihye Park, Yong Eun Park, Yong Il lee, Byung Woo Yoo, Kyung Soo Chung, Young Sam Kim, Joo Han Song; Yeungnam Univ J Med. 2016;33(2):162-165. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.162

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Abstract PDF: Barium sulfate is an inert material used as a radiographic contrast medium during upper gastrointestinal contrast studies for evaluation of patients with dysphagia. Oral barium aspiration is an uncommon but well-reported complication of this procedure. While barium aspiration of small amounts may not cause any symptoms, massive barium aspiration can be life-threatening, particularly in elderly patients with multiple comorbidities. In this case report, we describe an elderly patient with multiple comorbidities who presented with thyrotoxicosis and dysphagia, and then died after massive barium aspiration. Despite administration of intensive medical care with ventilator support and therapeutic bronchoalveolar lavage to remove the aspirated barium, the patient died of multiple organ failure 9 days after barium aspiration. Clinicians should pay attention to elderly patients with predisposing factors for aspiration in whom upper gastrointestinal barium contrast studies are indicated, and should consider other diagnostic tools for evaluation of dysphagia in this population.

Rheumatology
An overlap syndrome of Churg-Strauss syndrome and rheumatoid arthritis.: Seung Il Bae, Jong Geol Jang, Hun Tae Kim, Hee Yun Ahn, Min Jung Kim, Hyun Je Kim, Choong Ki Lee, Young Hoon Hong; Yeungnam Univ J Med. 2015;32(2):127-131. Published online December 31, 2015; DOI: https://doi.org/10.12701/yujm.2015.32.2.127

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Abstract PDF: Churg-Strauss syndrome (CSS) is a necrotizing vasculitis with extra-, peri-vascular eosinophilic infiltration. Chronic symmetric polyarthritis with the presence of rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody are the mainstay of rheumatoid arthritis (RA) diagnosis. Mononeuritis multiplex is a peripheral neuropathy involving more than 2 separate nerve areas. A 62-year-old male patient was referred for left foot drop and polyarthritis of both hands and feet for 4 months. During evaluation, mononeuritis multiplex was detected on nerve conduction study and electromyography tests: vasculitis with neutrophil, eosinophil, and lymphocyte infiltration on peroneal nerve biopsy. A positive response to methacholin and bronchodilator was observed on the pulmonary function test. Radiologic tests showed peri-articular soft tissue swelling and osteopenia on both hand and foot. Marked peripheral eosinophilia, high RF, and positive perinuclear anti-neutrophil cytoplasmic antibody were detected on blood tests. Here, we report on a patient with overlap syndrome of CSS and RA with review of the relevant literature, from which a few references to overlap syndrome of CSS and RA were available.

Endocrinology, Diabetes, and Metabolism
Recurrent thymic carcinoid tumor in familial isolated primary hyperparathyroidism.: Jeong Eun Song, Mu Hyun Shon, Ga Young Kim, Da Young Lee, Jung Hun Lee, Jong Ho Kim, Ho Sang Shon, Ji Hyun Lee, Eon Ju Jeon, Eui Dal Jung; Yeungnam Univ J Med. 2014;31(2):131-134. Published online December 31, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.2.131

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Abstract PDF: Familial isolated primary hyperparathyroidism(FIPH) is associated with multiple endocrine neoplasia type 1 (MEN1) syndrome, primary hyperparathyroidism accompanied by jaw-tumor syndrome, and familial hypocalciuric hypercalcemia. FIPH may be an early stage of MEN1 or an allelic variant of MEN1. Thymic carcinoid tumor is a rare tumor in MEN1 syndrome. Here, the authors report the case of a 40-year-old man diagnosed with recurrent thymic carcinoid tumor and FIPH. Both the patient and his elder sister had been previously diagnosed to have FIPH with a novel frameshift mutation in the MEN1 gene. Initially, the patient underwent thymectomy because of an incidental finding of a mediastinal mass in his chest X-ray, and had remained asymptomatic over the following 4 years. Pancreas computed tomography conducted to evaluate MEN1 syndrome revealed anterior and middle mediastinal masses, and resultantly, massive mass excision was performed. Histological findings disclosed atypical carcinoids with infiltrative margins. In view of the thymic carcinoid tumor relapse that occurred in this patient, the authors recommend that regular pancreas and pituitary imaging studies be conducted for FIPH associated with a MEN1 gene mutation.

Dermatology
Fast-growing multiple symmetric lipomatosis.: Jin Hwa Choi, Byung Su Kim, Seung Hyun Sohng, Hyo Jin Lee, Dong Hoon Shin, Jong Soo Choi, Young Kyung Bae; Yeungnam Univ J Med. 2014;31(1):48-51. Published online June 30, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.1.48

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Abstract PDF: Multiple symmetric lipomatosis (MSL) is a rare disease characterized by symmetrical massive fatty deposits on the face, neck, shoulders, and upper trunk. We report a 74-year-old man who complained of painless subcutaneous nodules on his posterior neck that developed 3 weeks earlier. In a week, variably-sized similar lesions developed on both his shoulders and upper extremities. At the time of his hospital visit, several firm nodules as big as a walnut to a child's fist and with the normal-skin-hue were observed on his posterior neck, both shoulders, upper extremities, and trunk. The histological examination of his upper left arm revealed more mature adipocytes without encapsulation in the subcutaneous tissue. MSL was generally known to occur slowly over months or years. However, this is an unusual case that showed a fast-growing nature.

Endocrinology, Diabetes, and Metabolism
Osteochondroma of the Rib Mimicking a Mediastinal Mass: Unexpected Menifestation in Hereditary Multiple Exostoses.: Sang Kyun Bae, Won Sik Kang, Seung Hoon Yoo, Jeong Hyeon Cho, Kyung Won Park, Bu Hyun Lee, Jung Hun Baek, Jae Ho Chung; Yeungnam Univ J Med. 2012;29(1):45-47. Published online June 30, 2012; DOI: https://doi.org/10.12701/yujm.2012.29.1.45

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Abstract PDF

Osteochondroma is a common bone tumor but a rare tumor in the rib. It is often asymptomatic and observed incidentally. This is a case report of a 49-year-old woman with an osteochondroma mimicking a mediastinal mass in hereditary multiple exostoses. The chest X-ray and computed tomography (CT) scans revealed the bony density feature of the mass. Surgical excision confirmed that the lesion was an osteochondroma.

Citations

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Spontaneous pneumothorax in a 17-year-old male patient with multiple exostoses: A case report and review of the literature
Koichi Nakamura, Kunihiro Asanuma, Akira Shimamoto, Shinji Kaneda, Keisuke Yoshida, Yumi Matsuyama, Tomohito Hagi, Tomoki Nakamura, Motoshi Takao, Akihiro Sudo
World Journal of Orthopedics.2021; 12(11): 945. CrossRef
COSTAL OSTEOCHONDROMA OF RIB: CASE REPORT
Chandra Sekharam Naidu M, Sankara Rao S, Murali Krishna Ch. V., Srinivasa Rao K, Ashok Kumar P
Journal of Evidence Based Medicine and Healthcare.2015; 2(17): 2624. CrossRef

Original Article

Laboratory Medicine
Tigecycline Treatment for Infections Caused by Multidrug-Resistant Pathogens.: Mi Jung Lee, A Young Seo, Sang Soo Bae, Dong Hyong Jeong, Kyung Hwa Yoon, Byung Sik Hwang, Sung Hoon Kang, Dae Myung Oh, Ki Tae Kwon, Shin Won Lee, Do Young Song; Yeungnam Univ J Med. 2011;28(2):133-144. Published online December 31, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.2.133

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Abstract PDF

BACKGROUND
Tigecycline (TIG), a new broad-spectrum glycylcycline with anti-multidrug-resistant-(MDR)-pathogen activity, was launched in March 2009 in South Korea, but there are insufficient clinical studies on its use in the country. As such, this study was performed to analyze cases of severe MDR-pathogen-caused infections treated with TIG. METHODS: Patients treated with TIG within the period from May 2009 to June 2010 were enrolled in this study. Their clinical and microbiologic data were reviewed retrospectively. RESULTS: Twenty-one patients were treated with TIG for complicated skin and soft-tissue infections (cSSTIs) (42.9%), complicated intra-abdominal infections (cIAIs) (38.1%), or pneumonia (19.1%) caused by MDR pathogens like carbapenem-resistant Acinetobacter baumannii (76.2%), methicillin-resistant Staphylococcus aureus (61.9%), extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae (38.1%), and penicillin-resistant Enterococcus species (33.3%). Thirteen patients (61.9%) had successful clinical outcomes while five (23.8%) died within 30 days. The rate of clinical success was highest in cSSTI (77.8%), followed by cIAI (50%) and pneumonia (50%), and the mortality rate was highest in pneumonia (50%), followed by cIAI (25%) and cSSTI (11.1%). CONCLUSION: Tigecycline therapy can be an option for the treatment of severe MDR-pathogen-caused infections in South Korea. Due to its high risk of failure and mortality, however, prudence is required in its clinical use for the treatment of severe infections like nosocomial pneumonia.

Citations

Citations to this article as recorded by

Evaluation of Clinical outcomes after Tigecycline and Colistin Treatment against Multidrug-resistant Acinetobacter baumannii
Sunhee Park, 최인, 김혜미, 최은주
Journal of Korean Society of Health-System Pharmacists.2016; 33(3): 228. CrossRef

Case Report

Hematology
A Case of Multiple Myeloma with AL Amyloidosis Successfully Treated with Autologous Stem Cell Transplantation: Ha-young Lee, Kyung Hee Lee, Min Kyoung Kim, Hee Soon Cho, Myung Soo Hyun; Yeungnam Univ J Med. 2007;24(2 Suppl):S676-682. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S676

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Abstract PDF: Myeloma is a disease of neoplastic B lymphocytes that synthesize abnormal amounts of immunoglobulin (Ig) or Ig fragments. Ten to twenty percent of myeloma patients are known to develop clinical evidence of amyloid-light chain(AL) amyloidosis. A high index of suspicion, however, is needed to make a diagnosis of amyloidosis. We report a case of multiple myeloma with AL amyloidosis successfully treated with autologous stem cell transplantation. In our case, the patient presented with longstanding abdominal discomfort and anterior chest pain. Chest X-ray showed several osteolytic changes on ribs. Endoscopic biopsy revealed massive amyloid deposits in the wall of stomach and rectum. Serum/urine protein electroporesis and bone marrow biopsy confirmed the diagnosis of multiple myeloma. At 18 months after high dose chemotherapy and autologous stem cell transplantation(ASCT), the patient maintained a complete response. In patients with multiple myeloma with AL amyloidosis, high dose chemotherapy and ASCT can be effective treatment strategy.

Original Article

Hematology
A clinical study on multiple myeloma.: Hyeong Ki Hwang, Choong Ki Lee, Myung Soo Hyun, Bong Sup Shim, Hyun Woo Lee; Yeungnam Univ J Med. 1991;8(2):106-113. Published online December 31, 1991; DOI: https://doi.org/10.12701/yujm.1991.8.2.106

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Abstract PDF: A clinical review of 31 cases of multiple myeloma which were diagnosed by criteria of the SWOG between May 1983 and February 1990 at Yeungnam University Hospital was done. The results were as followings: 1. The peak incidence was in 7th decade and male to female ratio was 1.8:1. 2. The most common presenting symptom at first diagnosis was bone pain (58%), but fever, dyspnea, dizziness and palpable mass were also noted. 3. The distribution of laboratory findings as following diagnostic criteria of Southwest oncology group (SWOG): Plasmacytoma on tissue biopsy was noted 6 cases, bone marrow plasmacytosis with more than 10% plasma cells was 22 cases, monoclonal globulin spike on serum electrophoresis was 24 cases, lytic bone lesions was observed 22 cases. 4. Initial clinical stages were classified as 2 cases in stage I, 3 cases in stage II, 26 cases in stage III (84%). 5. Immunoelectrophoresis revealed the distribution of IgG 64%, light chain 22%, IgA 10%, Kappa to Lambda ratio of 1.1:1. 6. Hematologic & biochemical findings revealed anemia with <8.5% of hemoglobin in 42%, hypercalcemia with <10.6 mg% of serum calcium in 22%, azotemia >2.0 mg% of serum creatinine in 19%. 7. The multiple punched out lesion of bone x-ray examination were noticed skull (65%), rib (42%), L-spine (35%), pelvis (23%), T-spine (19%). The initial skeletal roentgenographic findings showed osteoporosis, osteolytic lesion and fracture in 55%, only osteolytic lesion in 23%, only osteoporosis in 10%. 8. Complications of multiple myeloma, such as 10 cases of renal impairment, 8 cases of infection, 16 cases of compression fracture of spine were observed.

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