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Funded articles(2020~)
Review articles
Treatment of pediatric obstructive sleep apnea
Tae Kyung Koh, Jooyeon Kim
Received May 2, 2024  Accepted June 7, 2024  Published online June 21, 2024  
DOI: https://doi.org/10.7180/kmj.24.120    [Epub ahead of print]
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Abstract PDFPubReader   ePub   
In the majority of cases, pediatric obstructive sleep apnea (OSA) is associated with adenotonsillar hypertrophy. Therefore, adenotonsillectomy is typically considered as the first line of treatment. However, the severity of pediatric OSA is not always directly correlated with the size of the adenoids and tonsils. Other factors, such as upper airway anatomy or obesity, may interact in a multifactorial manner to contribute to its occurrence. For these reasons, sleep apnea in obese children may resemble the condition in adults. Furthermore, in these cases, if adenotonsillar hypertrophy is present, adenotonsillectomy is likely to be prioritized. Reevaluation should be conducted 6 to 8 weeks post-surgery, and additional treatment for residual sleep apnea should be performed thereafter when necessary.
Surgical management of recurrent laryngeal nerve invasion by papillary thyroid carcinoma
Jae Hong Park, Hyoung Shin Lee
Received April 25, 2024  Accepted June 4, 2024  Published online June 18, 2024  
DOI: https://doi.org/10.7180/kmj.24.117    [Epub ahead of print]
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Abstract PDFPubReader   ePub   
Preservation of the recurrent laryngeal nerve (RLN) is a priority for surgeons during thyroidectomy in patients with papillary thyroid cancer (PTC). RLN invasion by PTC in a patient presenting with preoperative vocal fold paralysis may require resection of the nerve with the tumor. However, the decision should be made regarding whether to preserve or sacrifice a functioning RLN invaded by PTC. Under certain conditions, preservation of the nerve with incomplete tumor resection could be considered. An RLN that has been resected due to PTC invasion may be managed by various reinnervation techniques to improve vocal outcomes. This article reviews clinical considerations and rationales for surgical decisions related to patients with PTC invasion of the RLN.
Case report
Heavy-chain deposition disease associated with multiple myeloma: a case report
Young Rong Lee, Jin Hyeog Lee, Beom Jin Lim, Yoon Jung Choi, Soo Jeong Kim, Jung Eun Lee
Received February 21, 2024  Accepted April 15, 2024  Published online June 10, 2024  
DOI: https://doi.org/10.7180/kmj.24.110    [Epub ahead of print]
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Abstract PDFPubReader   ePub   
Heavy-chain deposition disease (HCDD) is a rare disorder characterized by the deposition of monoclonal immunoglobulin. Due to the disease's rarity and diagnostic challenges, its prognosis is generally poor. Herein, we report a case of successful treatment of HCDD coexisting with multiple myeloma. A 56-year-old man presented at an outpatient clinic with complaints of whole-body pain, edema, and dyspnea that had persisted for 2 weeks. Diagnostic tests confirmed nephrotic syndrome, hematuria, and progressive renal failure. Serum immunofixation electrophoresis identified the presence of IgG kappa paraprotein. A diagnosis of multiple myeloma was established following a bone marrow biopsy. A renal biopsy revealed antibodies specific to the heavy chains of IgG on immunofluorescence, and electron microscopy showed diffuse electron-dense "powdery" densities in the glomerular basement membrane. Based on these findings, the patient was diagnosed with both HCDD and multiple myeloma. Following the diagnosis, the patient immediately began anti-plasma cell therapy using bortezomib, lenalidomide, and dexamethasone. Intermittent hemodialysis was initiated due to persistent azotemia during the diagnostic process; however, renal function improved significantly after only 1 month of therapy, allowing the discontinuation of dialysis. Early intervention with anti-plasma cell therapy, such as bortezomib, is known to improve prognosis in the early stages of the disease. This case report is presented to enhance understanding of HCDD and underscore the importance of prompt diagnosis and treatment in managing this rare condition.
Original articles
Clinical features of coronavirus disease 2019 in Korean pediatric patients: a single-center retrospective study
Ji Eun Jeong, Hai Lee Chung, Young Hwan Kim, Nawon Lee, Younghyun Kim, Yoon Young Jang
Received January 12, 2024  Accepted May 17, 2024  Published online June 10, 2024  
DOI: https://doi.org/10.7180/kmj.24.106    [Epub ahead of print]
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Abstract PDFPubReader   ePub   
Background
To address the public’s fear of coronavirus disease 2019 (COVID-19), understanding the clinical features of the disease is essential. However, research on the clinical features of COVID-19, including illness duration and post-acute COVID-19, in Korean pediatric patients has been limited. Therefore, this study investigated the clinical features of COVID-19 based on the medical records of pediatric patients with a history of COVID-19 who visited a single center.
Methods
In total, 311 patients were included in this study. The presence and duration of 19 symptoms were examined. Additionally, clinical features were investigated by dividing the patients into different age ranges. Patients aged 6 and above were further categorized according to the presence of asthma, while adolescent patients were divided into vaccinated and unvaccinated groups.
Results
Fever and cough were the most common symptoms. The mean illness duration was 2–4 days. Only 3.5% of the patients were asymptomatic. Post-acute COVID-19 was observed in 13.2% of the patients. The incidence of most symptoms tended to increase with age. Post-acute COVID-19 was observed more frequently in patients with asthma than in those without asthma. Vaccinated patients experienced less fever, vomiting, and fatigue than unvaccinated patients.
Conclusions
Our data suggest that most patients had mild disease lasting less than a week, and the clinical course may differ depending on the presence of asthma. The findings also indicate that vaccination may alleviate the symptoms of COVID-19 in breakthrough infections.
Statins as a possible factor affecting fluoroquinolone resistance of coagulase-negative Staphylococcus in the conjunctiva: a case-control study
Yoo Rha Hong, Chi Eun Oh, Sang Joon Lee
Received November 13, 2023  Accepted May 20, 2024  Published online June 5, 2024  
DOI: https://doi.org/10.7180/kmj.23.152    [Epub ahead of print]
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Abstract PDFPubReader   ePub   
Background
Conjunctival bacterial flora is a common cause of endophthalmitis after ophthalmic procedures. This study investigated the conjunctival bacterial flora, especially coagulase-negative Staphylococcus (CoNS), and their antibiotic sensitivity in patients who underwent ophthalmic procedures. Factors related to fluoroquinolone resistance were also investigated.
Methods
In total, 167 samples were analyzed from 135 patients who underwent cataract surgery or intravitreal injection at Kosin University Gospel Hospital between April 14, 2014, and September 29, 2016. Bacterial identification was performed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry or VITEK 2 equipment. Antibiotic sensitivity tests were performed using an AST-P600 card with VITEK 2 equipment. Clinical information was extracted from patients’ medical records. Sixty-eight individuals with conjunctival flora containing CoNS were classified into the fluoroquinolone-sensitive and fluoroquinolone-resistant CoNS groups, and their characteristics were compared.
Results
A total of 192 isolates of Gram-positive bacteria were identified, including Staphylococcus epidermidis (33.3%), Corynebacterium spp. (18.8%), and CoNS other than S. epidermidis (9.2%). Of the 106 CoNS isolates, 68.9%, 69.8%, and 58.5% were sensitive to ciprofloxacin, levofloxacin, and norfloxacin, respectively. In patients with CoNS, statin use within 3 months before sample collection was significantly associated with fluoroquinolone resistance (p=0.016). Statin use was a significant risk factor for fluoroquinolone resistance in multivariate logistic regression analysis (odds ratio, 4.86; 95% confidence interval, 1.25–18.91; p=0.022).
Conclusions
CoNS, including S. epidermidis, was the most common conjunctival bacterial flora, with a fluoroquinolone sensitivity rate ranging from 58.5% to 69.8% in patients undergoing ophthalmic procedures. Statin use was a significant risk factor for fluoroquinolone resistance.
Orbital complications of acute rhinosinusitis in adults: a 21-year experience
Yung Jin Jeon, Woohyen Jin, Yeon-Hee Joo, Hyun-Jin Cho, Sang-Wook Kim
Received March 3, 2024  Accepted May 17, 2024  Published online June 4, 2024  
DOI: https://doi.org/10.7180/kmj.24.111    [Epub ahead of print]
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Abstract PDFPubReader   ePub   
Background
Orbital complications arising from acute rhinosinusitis (ARS) are a major concern for clinicians and serve as important warning indicators of ARS. Prompt recognition and appropriate management are crucial for preventing potential vision-threatening sequelae. Orbital complications of rhinosinusitis are markedly more common in children than in adults. The aim of this study was to investigate the clinical characteristics and treatment outcomes of orbital complications of ARS in adult patients.
Methods
This retrospective observational cohort study analyzed the medical records of 176 patients admitted for orbital cellulitis/abscess (ICD code: H050) who underwent orbit or paranasal computed tomography from January 2001 to February 2022 at a tertiary hospital.
Results
Eighteen adults with a mean age of 53.2±18.9 years were diagnosed with orbital complications due to ARS: five (27.8%) had preseptal cellulitis, eight (44.4%) had orbital cellulitis, and five (27.8%) had subperiosteal orbital abscess. None of the patients had an orbital abscess or cavernous sinus thrombosis. All patients had unilateral orbital complications (7 right and 11 left) and were managed with intravenous antibiotics for an average of 10.3±6.6 days. Five patients with subperiosteal orbital abscesses underwent intranasal endoscopic drainage at an average of 1.4±1.9 days after admission, while two patients required additional external drainage. Complete recovery was observed in all patients.
Conclusions
Conservative antimicrobial therapy can be effective for treating orbital complications from ARS, and not all adult patients require immediate surgical intervention for subperiosteal abscesses. Nonetheless, careful monitoring is essential, and an ophthalmologist must check patients’ visual acuity to prevent irreversible blindness.
Case reports
Remimazolam in pediatric surgery under general anesthesia: a case series
Hong-Sik Shon, Seyeon Park, Jung-Pil Yoon, Yeong Min Yoo, Jimin Lee, Da Eun Lee, Hee Young Kim
Received January 8, 2024  Accepted April 1, 2024  Published online May 9, 2024  
DOI: https://doi.org/10.7180/kmj.24.105    [Epub ahead of print]
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Abstract PDFPubReader   ePub   
Remimazolam is a promising drug for general anesthesia due to its rapid onset, short duration, and short context-sensitive half-life. However, its use in pediatric patients remains off-label, and limited prospective data have been published. Herein, we report successful anesthesia using remimazolam in pediatric patients who had a history of epilepsy or required shared airway surgery. In all cases, remimazolam provided general anesthesia, and flumazenil was used for reversal with rapid recovery. Remimazolam offers advantages for pediatric anesthesia in scenarios with a risk of seizure or shared airway surgery. However, the potential for higher bispectral index values and the risk of anaphylaxis in dextran-allergic patients necessitate caution and further research.
Total intravenous anesthesia using remimazolam for patients with heart failure with reduced ejection fraction: a case series
Jimin Lee, Ji-Uk Yoon, Gyeong-Jo Byeon, Hong-Sik Shon, Ahhyeon Yi, Hee Young Kim
Received December 16, 2023  Accepted April 3, 2024  Published online May 9, 2024  
DOI: https://doi.org/10.7180/kmj.23.156    [Epub ahead of print]
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Abstract PDFPubReader   ePub   
Patients with heart failure undergoing surgery that requires general anesthesia face substantial perioperative risks; however, clear guidelines are not available for anesthesia management in patients with a reduced left ventricular ejection fraction. Traditional intravenous and volatile anesthetics require careful administration to prevent severe hypotension and bradycardia in patients with heart failure. Remimazolam has emerged as a promising alternative to conventional anesthetics because of its reduced cardiovascular depressive effects. We present three cases illustrating the successful use of remimazolam to induce and maintain general anesthesia in patients with heart failure and reduced cardiac function. Our cases demonstrate the safe use of remimazolam for general anesthesia in patients with heart failure and a reduced ejection fraction.
Editorial
Review articles
Gastric cancer and metabolic syndrome
Hyeong Ho Jo
Kosin Med J. 2024;39(1):26-34.   Published online March 22, 2024
DOI: https://doi.org/10.7180/kmj.24.108
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Abstract PDFPubReader   ePub   
Gastric cancer (GC), a prevalent disease in Asian countries, presents a substantial global health challenge. The risk factors for GC include Helicobacter pylori infection, diet, smoking, alcohol, and metabolic syndrome (MetS). This review meticulously examines the intricate connections between MetS and GC, focusing on visceral adipocytes, hormonal factors, obesity, and their impact on survival outcomes. Visceral adipocytes, which secrete inflammatory cytokines and hormones, play a pivotal role in influencing cancer development. Hormonal factors demonstrate nuanced associations with specific GC subtypes, underscoring the complexity of their impact. Large-scale studies exploring obesity-related factors reveal sex-specific nuances and underscore the importance of considering overall weight and body composition. Furthermore, the review explores the impact of eradication therapy for H. pylori infection, which is the most significant factor in the onset of GC, on the components of MetS. Additionally, the influence of MetS on postoperative outcomes and survival in GC patients highlights the interplay between therapeutic interventions and lifestyle factors. This comprehensive exploration sheds light on the multifaceted relationship between MetS and GC, providing valuable insights for future research and preventive strategies.
Clinical challenges and advancements in diagnosing Staphylococcus aureus-associated musculoskeletal infections
Irvin Oh
Kosin Med J. 2024;39(1):5-17.   Published online March 22, 2024
DOI: https://doi.org/10.7180/kmj.24.104
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Abstract PDFPubReader   ePub   
Musculoskeletal infections (MSKI) present a significant health challenge, with a rising incidence linked to the aging population and advancements in orthopedic surgical care. Staphylococcus aureus is the most prevalent pathogen associated with orthopedic infections. The conventional culture method for identification of pathogen frequently lacks accuracy and is challenged by false-positive or false-negative results. Inflammatory markers such as the erythrocyte sedimentation rate and C-reactive protein are not site-specific or accurate, as they can be confounded by other medical conditions. Identifying the dominant pathogen and monitoring treatment response following surgical debridement and antibiotics therapy continues to pose challenges. Understanding the pathogenesis of MSKI is crucial for the development of innovative diagnostics and alternative therapeutics. S. aureus immune evasion stands out as a key component of the pathogenic mechanism, complicating clinical decisions. Other unique mechanisms such as biofilm and abscess formation, as well as osteocyte-lacuno canalicular network invasion, underscore the need for aggressive debridement and the complete removal of infected implants and bone tissues. Ongoing efforts focus on exploring and developing innovative diagnostics, such as serum immunoassays, next-generation sequencing of infected tissue, transcriptomics of peripheral blood mononuclear cells, and serum proteomics. These endeavors offer promising avenues for improved diagnostics, medical management, and innovative therapeutics for MSKI.
Original article
Clinical efficacy and safety of autologous serum intramuscular injection in patients with mild-to-moderate atopic dermatitis: a prospective, open-label, uncontrolled study
Gil-Soon Choi, Jong Bin Park, Young-Ho Kim, Hee-Kyoo Kim
Kosin Med J. 2024;39(1):51-59.   Published online March 19, 2024
DOI: https://doi.org/10.7180/kmj.24.101
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Abstract PDFPubReader   ePub   
Background
Autologous blood therapy (ABT) has been used to treat atopic dermatitis (AD) for over a century, even though evidence supporting its efficacy is lacking. We aimed to investigate the effectiveness and safety of autologous serum intramuscular injection (ASIM), which is a modified form of ABT, in treating mild-to-moderate AD.
Methods
This study was a 12-week, open-label, prospective, uncontrolled trial. Following a 4-week run-in period, 22 out of 25 screened patients received ASIM once a week for 4 weeks in conjunction with standard treatment. The primary outcome measure was the Eczema Area and Severity Index (EASI), while the secondary outcomes included the Scoring Atopic Dermatitis (SCORAD) score, Dermatologic Life Quality Index (DLQI), and patient ratings of pruritus, sleep difficulty, disease status, and treatment effectiveness. Safety parameters were also assessed.
Results
EASI scores showed a non-statistically significant trend toward improvement during ASIM intervention. Patients with at least a 50% improvement in the EASI score at 4 weeks were older and had lower peripheral eosinophil counts (p<0.05). Secondary endpoints, including the SCORAD score, pruritus, sleep difficulty, and DLQI, demonstrated statistically significant improvements at week 4 compared to baseline (p<0.05). No significant adverse reactions were observed.
Conclusions
This pioneering study suggests that repeated ASIM may improve the clinical symptoms of mild-to-moderate AD, particularly in terms of pruritus and overall quality of life. However, further research with a larger sample size is required to establish the clinical significance of these findings.

Citations

Citations to this article as recorded by  
  • What are the clinical usefulness and scientific value of intramuscular injection of autologous serum (autologous serum therapy) in patients with atopic dermatitis?
    Dong-Ho Nahm
    Kosin Medical Journal.2024; 39(1): 1.     CrossRef
Review article
Exploring the nexus between obesity, metabolic syndrome, and colorectal cancer
Jong Yoon Lee
Kosin Med J. 2024;39(1):18-25.   Published online March 12, 2024
DOI: https://doi.org/10.7180/kmj.24.107
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Abstract PDFPubReader   ePub   
The increasing global prevalence of obesity and metabolic syndrome (MetS) is strongly associated with the incidence of colorectal cancer (CRC). Obesity and MetS detrimentally impact the treatment outcomes of CRC and share similar mechanisms that contribute to the development of CRC. Increased insulin resistance in patients with obesity is linked to CRC, and altered levels of sex hormones and adipokines affect cell growth and inflammation. Obesity and MetS also alter the gut microbiome. Bile acids, which are crucial for lipid metabolism, are elevated in patients with obesity. Moreover, specific bile acids are associated with colonic damage, inflammation, and the development of CRC. Obesity and MetS increase the risk of postoperative complications and affect the response to chemotherapy. The promotion of weight loss and the resolution of MetS can reduce the occurrence of CRC and increase treatment efficacy. Therefore, it is imperative to implement appropriate management strategies to address obesity and MetS with the aim of improving the prognosis and reducing the incidence of CRC. Moreover, additional research should be conducted to determine the optimal timing for tailored CRC screening in patients with obesity or MetS. In this review, we explore the impact of obesity and MetS on the development of CRC and examine potential strategies to mitigate CRC risk in individuals with obesity and MetS.
Case reports
Interpedicular approach in percutaneous sacroplasty for treating pain due to direct invasion of rectal cancer into the S3 body: a case report
Jinseok Yeo, Saeyoung Kim, Chang Sub Lee
Received November 14, 2023  Accepted January 7, 2024  Published online February 20, 2024  
DOI: https://doi.org/10.7180/kmj.23.153    [Epub ahead of print]
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Abstract PDFPubReader   ePub   
Percutaneous sacroplasty is mainly used as an intervention for pain associated with sacral insufficiency fractures or sacral metastatic tumors. However, sacroplasty for managing the pain associated with direct sacral invasion of rectal cancer has been rarely reported. We present a case of a 74-year-old patient who underwent sacroplasty via the interpedicular approach under fluoroscopic guidance to relieve pain resulting from direct tumor invasion into the S3 body. After the procedure, the patient experienced immediate pain relief and did not feel worse pain with ambulation. Aside from peritumoral vascular leakage, no other significant complications occurred immediately post-procedure. Our results suggest that fluoroscopically guided interpedicular sacroplasty is a safe and effective option for relieving the pain associated with direct sacral invasion by rectal cancer.
Disseminated herpes zoster with vagus nerve involvement in a kidney transplant recipient: a case report
Dong Eon Kim, Da Woon Kim, Hyo Jin Kim, Harin Rhee, Sang Heon Song, Eun Young Seong
Received November 20, 2023  Accepted January 7, 2024  Published online February 19, 2024  
DOI: https://doi.org/10.7180/kmj.23.154    [Epub ahead of print]
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Abstract PDFPubReader   ePub   
Herpes zoster virus infection is common and results in significant morbidity in patients who have undergone solid organ transplantation. Herpes zoster can involve the cranial nerves, and vagus nerve involvement is an infrequent primary manifestation of herpes zoster. Here, we describe a rare presentation of disseminated herpes zoster infection with vagus nerve involvement in a kidney transplant recipient. A 62-year-old man who had undergone kidney transplantation 3 years prior presented to our clinic with sore throat and hoarseness, followed by multiple vesicular-pustular rashes on the face and trunk. Flexible laryngoscopy revealed left paramedian vocal cord paralysis with multiple ulcerative lesions extending from the left pyriform sinus to the epiglottis. Computed tomography of the neck, abdomen, and chest revealed no significant abnormalities that could have caused vocal cord paralysis. We confirmed the diagnosis of disseminated herpes zoster after herpes zoster laryngitis based on positive blood tests and polymerase chain reaction for varicella zoster virus antibodies. The skin rashes and laryngeal ulcers rapidly resolved after treatment with intravenous acyclovir and high-dose steroids. The patient still had persistent dysphagia and microaspiration as assessed by a video fluoroscopic swallowing study, but showed improvement in dysphagia in response to swallowing rehabilitation therapy. This case provides valuable insights into the presenting symptoms of disseminated herpes zoster, which can cause acute vagus neuritis in solid organ transplantation recipients.

KMJ : Kosin Medical Journal