Kosin Medical Journal

Volume 38(2); June 2023

Editorial

Impact of dietary education on blood cadmium and mercury levels in chronic kidney disease: a path to renal health improvement: Ho Sik Shin; Kosin Med J. 2023;38(2):73-74. Published online June 26, 2023; DOI: https://doi.org/10.7180/kmj.23.130

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Review articles

Polycystic liver disease: an overview of clinical manifestations, diagnosis, and treatment: Joonho Jeong, Hyun Joon Park; Kosin Med J. 2023;38(2):75-86. Published online June 28, 2023; DOI: https://doi.org/10.7180/kmj.23.128

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Polycystic liver disease (PLD) is a hereditary disease characterized by the presence of 20 or more liver cysts. It is classified into three types: isolated autosomal dominant PLD, PLD with autosomal dominant polycystic kidney disease, and PLD with autosomal recessive polycystic kidney disease. Genetic alterations, ciliary dysfunction of the biliary epithelial cells, and aberrant cell signaling pathways are the main factors contributing to the pathophysiology of PLD; however, other complicated mechanisms are also involved. The Gigot and Schnelldorfer classifications are widely used in clinical practice. Most patients with PLD are asymptomatic; however, a few patients with advanced-stage disease may develop symptoms and complications that impair their quality of life and require treatment. The known treatment options for PLD are somatostatin analogues, aspiration with sclerotherapy, fenestration, hepatic resection, and liver transplantation. Although liver transplantation remains the only curative treatment for PLD, medical therapies are gradually being developed with the increasing knowledge of the disease’s pathophysiology. This review focuses on the clinical manifestations and diagnosis of PLD, as well as treatment strategies, to support clinicians regarding the clinical management of the disease.

Citations

Citations to this article as recorded by

Predicting Safe Liver Resection Volume for Major Hepatectomy Using Artificial Intelligence
Chol Min Kang, Hyung June Ku, Hyung Hwan Moon, Seong-Eun Kim, Ji Hoon Jo, Young Il Choi, Dong Hoon Shin
Journal of Clinical Medicine.2024; 13(2): 381. CrossRef

Are you ready to accompany autosomal dominant polycystic kidney disease patients in their treatment journey? Real practice for selecting rapid progressors and treatment with tolvaptan: Yeonsoon Jung, Yun Kyu Oh; Kosin Med J. 2023;38(2):87-97. Published online June 28, 2023; DOI: https://doi.org/10.7180/kmj.23.125

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Abstract PDF PubReader ePub: Tolvaptan treatment is costly, often accompanied by aquaresis-related adverse events, and requires careful monitoring by medical staff due to the possibility of hepatotoxicity. Nevertheless, it is the only disease-modifying drug to date that has been shown to successfully delay renal replacement therapy. For more patients to receive proper treatment, medical doctors, the rest of the medical team, and the patient must all work together. This paper reviews parameters that can help identify rapid autosomal dominant polycystic kidney disease progressors, who are the target of tolvaptan therapy. It is expected that these parameters will help nephrologists learn practical prescription methods and identify patients who can benefit from tolvaptan treatment. Although several strategies can be used to find rapid progressors, the present review focuses on a practical method to identify rapid progressors according to the presence or absence of evidence and the factors associated with rapid progression based on the Mayo image classification.

Revolutionizing gut health: exploring the role of gut microbiota and the potential of microbiome-based therapies in lower gastrointestinal diseases: Yong Eun Park, Jae Hyun Kim; Kosin Med J. 2023;38(2):98-106. Published online June 23, 2023; DOI: https://doi.org/10.7180/kmj.23.115

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Abstract PDF PubReader ePub: The gut microbiota comprises a collection of microorganisms residing in the human digestive system, including bacteria, viruses, and fungi. These microbes have critical roles in food breakdown, immune system regulation, and the production of essential nutrients. Several lower gastrointestinal (GI) diseases, including inflammatory bowel disease, irritable bowel syndrome, and colorectal cancer, have been associated with dysbiosis, which refers to an imbalance in the gut microbiota. Additionally, the gut microbiome and its microbial compounds affect disease development and the host’s immune response. Alterations in the gut-brain axis microbiome are also implicated in lower GI diseases. Therefore, microbiome-based therapies that regulate the gut microbiota (e.g., fecal microbiota transplantation and probiotics) are essential for the prevention and treatment of these diseases. This review aims to highlight the significance of gut microbiota and microbiome-based therapies in managing lower GI diseases.

Original articles

Dietary education may reduce blood cadmium and mercury levels in chronic kidney disease patients with higher blood cadmium and mercury levels: Su Mi Lee, Young-Seoub Hong, Byoung-Gwon Kim, Jung-Yeon Kwon, Yongsoon Park, Seong Eun Kim, Won Suk An; Kosin Med J. 2023;38(2):107-116. Published online May 24, 2023; DOI: https://doi.org/10.7180/kmj.23.101

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Background
Exposure to cadmium and mercury is associated with renal dysfunction. This study aimed to investigate the possible ability of dietary education to decrease blood cadmium and mercury levels in patients with chronic kidney disease (CKD).
Methods
Twenty-seven patients with CKD were enrolled in this prospective, single-arm pilot study. Patients with blood cadmium levels ≥1.4 μg/L were instructed to reduce their intake of shellfish, while those with blood mercury levels ≥5.0 μg/L were asked to reduce their intake of externally blue-colored fish.
Results
Seven dialysis patients and 15 pre-dialysis patients completed the study. Compared with baseline, the blood cadmium (2.0±0.7 μg/L vs. 1.8±0.7 μg/L, p=0.031) and mercury levels (4.4±2.6 μg/L vs. 3.5±1.9 μg/L, p=0.005) after 1 year significantly decreased, although the dietary intake was not significantly different in patients with blood cadmium levels ≥1.4 μg/L and blood mercury levels ≥5.0 μg/L. In pre-dialysis patients, kidney function worsened after 1 year compared with that at baseline despite the reduction in blood cadmium and mercury levels.
Conclusions
Reduction of food intake containing cadmium and mercury may lower the blood cadmium and mercury levels in CKD patients with higher cadmium and mercury levels. Higher blood cadmium levels may cause renal disease progression in pre-dialysis patients, and further studies are necessary to determine the underlying mechanisms.

Citations

Citations to this article as recorded by

Impact of dietary education on blood cadmium and mercury levels in chronic kidney disease: a path to renal health improvement
Ho Sik Shin
Kosin Medical Journal.2023; 38(2): 73. CrossRef

The solid predominant subtype as an independent risk factor for recurrence in patients with pathologic stage I lung adenocarcinoma: Chul Ho Lee, Yun-Ho Jeon; Kosin Med J. 2023;38(2):117-125. Published online June 8, 2023; DOI: https://doi.org/10.7180/kmj.23.103

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Abstract PDF PubReader ePub: Background
Increasingly many patients have been diagnosed with stage I adenocarcinoma due to the use of low-dose chest computed tomography for lung cancer screening. Therefore, this study aimed to analyze tumor recurrence based on the predominant subtype in patients with stage I lung adenocarcinoma who underwent lobectomy.
Methods
We retrospectively analyzed 114 patients who underwent lobectomy for pathologic stage I lung adenocarcinoma from June 2001 to July 2019.
Results
In univariate analyses, significant factors were current smoking at the time of surgery (p=0.029), pathologic tumor size (p=0.006), central tumor location (p=0.003), maximum standardized uptake value on positron emission tomography-computed tomography (p=0.001), and the solid predominant subtype (p=0.012). In the multivariate analysis, only the solid predominant subtype (hazard ratio, 9.702; 95% confidence interval, 1.179–79.874; p=0.035) was an independent risk factor.
Conclusions
If the solid subtype is predominant in pathologic findings, adjuvant chemotherapy after standard surgical resection may be considered to help reduce the risk of tumor recurrence and increase survival.

Intraoperative tumor localization using a titanium ring strip in totally laparoscopic distal gastrectomy for middle-third gastric cancer: Jae-Kyun Park, Chang-In Choi, Tae Yong Jeon, Hyuk Jae Jung, Si Hak Lee, Sun Hwi Hwang, Dae-Hwan Kim; Kosin Med J. 2023;38(2):126-133. Published online June 23, 2023; DOI: https://doi.org/10.7180/kmj.23.113

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Abstract PDF PubReader ePub: Background
This study presents a novel technical tip for intraoperative tumor localization and determination of the proximal resection line using a titanium ring strip for totally laparoscopic distal gastrectomy in patients with middle-third gastric cancer and describes the short-term results of its application.
Methods
In total, 42 patients with middle-third gastric cancer who underwent intraoperative tumor localization using a titanium ring strip and determination of the proximal resection line through intraoperative radiography between January 2020 and December 2021 were enrolled in this study. We retrospectively analyzed patients’ prospectively collected clinical, pathological, and surgical data.
Results
Twenty-six men and 16 women with a mean age of 58.3±12.5 years were enrolled. The mean operation time and estimated blood loss were 212.6±43.0 minutes and 122.4±77.6 mL, respectively. The lengths of the proximal and distal resection margin were 2.0±0.4 cm (range, 0.8–3.7 cm) and 10.5±4.1 cm (range, 0.4–20.4 cm), respectively. Roux-en-Y anastomosis was performed in 30 patients, while Billroth II with Braun anastomosis was performed in 12 patients. There were no procedure-related complications, and the mean postoperative hospital stay was 7.2±1.9 days. For all patients, the negative proximal resection margin was confirmed by postoperative pathological examinations.
Conclusions
Intraoperative tumor localization and determination of the proximal resection line using a titanium ring strip is a useful alternative method that can be easily and safely performed. This method is especially useful for patients with middle-third gastric cancer requiring an appropriate proximal resection margin.

Case reports

Disseminated Staphylococcus aureus infection and acute bacterial pericarditis: a case report: Su Hyun Bae, Song-Hyun Lee, Joon-Young Choi, Bong-Joon Kim, Soo-Jin Kim, Sung-Il Im, Hyun-Su Kim, Jung-Ho Heo; Kosin Med J. 2023;38(2):134-137. Published online August 16, 2022; DOI: https://doi.org/10.7180/kmj.22.021

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Abstract PDF PubReader ePub: We experienced a case of disseminated Staphylococcus aureus infection with bacterial pericarditis that progressed to septic shock and multiorgan failure despite pericardiocentesis and surgical removal of the original abscess with intensive antibiotic therapy. We report this case because of the patient’s very rare and remarkable echocardiographic findings and highly turbid pericardial effusion.

Sigmoid colon plexiform neurofibroma as a colonic subepithelial mass: a case report: Hee Won Baek, Eun Jeong Choi, Seung Jung Yu, Myeongpyo Kim, Sang Heon Lee, Sam Ryong Jee, Hyungjoo Baik, Hong Sub Lee; Kosin Med J. 2023;38(2):138-143. Published online November 9, 2022; DOI: https://doi.org/10.7180/kmj.22.123

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Abstract PDF PubReader ePub: Plexiform neurofibroma (PN) is an uncommon benign tumor, usually associated with neurofibromatosis type 1. As most PNs involve the craniomaxillofacial region, PN of the colon is very rare. Here we present a case of PN involving the sigmoid colon. A 43-year-old male patient presented to the outpatient clinic for the evaluation of an incidentally discovered sigmoid colon mass. A colonoscopic biopsy was performed for the mass, and the result revealed neuronal proliferation. The patient visited the outpatient clinic a year later with symptoms of abdominal pain and stool caliber change. Biopsy was repeated for the sigmoid colon mass, and the results showed mucosal Schwann cell proliferation and S-100 immunostaining positivity. Computed tomography and magnetic resonance imaging were performed for further evaluation, and neurofibroma or schwannoma was suspected based on the imaging studies. For an accurate diagnosis, the patient underwent surgery to remove the sigmoid colon mass. The final diagnosis of the mass was confirmed as PN. We hereby report a rare case of PN involving the sigmoid colon that could not be diagnosed before surgery.

Targeted temperature management in a patient with suspected hypoxic-ischemic brain injury after successful resuscitation from cardiac arrest: a case report: Christine Kang, Won Yong Lim, Young-hoon Jung, Jiseok Baik; Kosin Med J. 2023;38(2):144-150. Published online December 19, 2022; DOI: https://doi.org/10.7180/kmj.22.130

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Abstract PDF PubReader ePub: Hypoxic-ischemic brain injury (HIBI) after cardiac arrest (CA) is a leading cause of mortality and long-term neurological disorders in survivors. Targeted temperature management (TTM) has been rigorously studied as a way to improve results compared to a normal body temperature for preventing secondary damage after HIBI. We report a case of successful TTM in a patient who was suspected to have HIBI after resuscitation from cardiovascular collapse due to respiratory failure during elective surgery under brachial plexus block with dexmedetomidine and remifentanil infusion. A 27-year-old male patient developed CA due to apnea during orthopedic surgery. TTM was performed in the surgical intensive care unit for 72 hours after resuscitation, and the patient recovered successfully. TTM application immediately after resuscitation from CA in patients with suspected HIBI may be an appropriate treatment.

A case report of a carotid space abscess due to extraluminal migration of a fishbone into the deep cervical space: Tae-Hun Lee, Ki Ju Cho, Seong Jun Won, Jung Je Park; Kosin Med J. 2023;38(2):151-155. Published online December 19, 2022; DOI: https://doi.org/10.7180/kmj.22.141

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Abstract PDF PubReader ePub: Laryngopharyngeal foreign bodies are among the cases most frequently encountered by otolaryngologists. Most foreign bodies can be easily removed without any complications. However, surgical removal is required in some cases. Therefore, a delayed diagnosis or misdiagnosis could cause fatal complications for patients who need a surgical approach. We report a rare case of extraluminal migration of a foreign body to the deep cervical space. The foreign body (a fishbone) was removed by a surgical approach. With a literature review, we also propose an algorithm for the management of suspicious foreign bodies in the neck.

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