Kosin Medical Journal

Case report

Traumatic neuroma of the right posterior hepatic duct with an anatomic variation masquerading as malignancy: a case report: Jae Ryong Shim, Tae Beom Lee, Byung Hyun Choi, Je Ho Ryu, Jung Hee Lee, Kwangho Yang; Received October 17, 2022 Accepted December 2, 2022 Published online January 18, 2023; DOI: https://doi.org/10.7180/kmj.22.135 [Epub ahead of print]

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Abstract PDF PubReader ePub Crossref - TDM: Traumatic neuroma (TN), also known as amputation neuroma, is a reactive hyperplasia of nerve fibers and connective tissue arising from Schwann cells after trauma or surgery. TN of the bile duct is usually asymptomatic, but rarely can lead to right upper quadrant pain, biliary obstruction, and acute cholangitis. It is very difficult to discriminate TN from malignancy before surgery, although doing so could avoid an unnecessary radical resection of the lesion. In the course of surgery, TN can be caused by unintentional injury of a nerve fiber near the common bile duct (CBD) and heat damage to an artery, complete ligation of an artery, and excessive manipulation of the CBD. Therefore, to prevent TN after cholecystectomy, surgery should be performed carefully with appropriate consideration of anatomic variations, and a cystic duct should not be resected too close to the CBD. The possibility of TN should be considered if a patient who has undergone CBD resection with hepaticojejunostomy or cholecystectomy long ago experiences symptoms of jaundice, cholangitis, or obliteration of the CBD. In this report, we present a case of TN mimicking cholangiocarcinoma that emerged from a cystic duct stump after cholecystectomy.

Original article

The effects of rebamipide, sucralfate, and rifaximin against inflammation and apoptosis in radiation-induced murine intestinal injury: Won Moon, Sangwook Lim, Yeonsoon Jung, Yuk Moon Heo, Seun Ja Park, Moo In Park, Sung Eun Kim, Jae Hyun Kim, Kyoungwon Jung; Kosin Med J. 2022;37(4):320-341. Published online December 26, 2022; DOI: https://doi.org/10.7180/kmj.22.140

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Abstract PDF PubReader ePub Crossref - TDM: Background
Radiotherapy improves overall survival in patients with abdominopelvic malignancies. However, the toxic effects of radiation restrict the maximum dose that can be given, and there are no well-established preventive or therapeutic strategies. This study was conducted to evaluate whether rebamipide, sucralfate, and rifaximin have a suppressive effect on acute ionizing radiation (IR)-induced inflammation in the intestines of mice.
Methods
Thirty-six ICR mice were divided into a vehicle-treated group with sham irradiation; a vehicle-treated group with irradiation; rebamipide, sucralfate, or rifaximin-treated groups with irradiation; and a rebamipide-treated group with sham irradiation. The expression of proinflammatory, anti-inflammatory, proapoptotic, and antiapoptotic factors was investigated.
Results
The downregulated expression of nicotinamide phosphoribosyltransferase by IR was attenuated by all drugs (p<0.05). All drugs suppressed the IR-induced activation of NF-κB and phosphorylation of MAPKs (p<0.05) and attenuated the production of TNF-α, IL-1β, and IL-6 in response to IR (p<0.05). The administration of all drugs markedly attenuated IR-induced increases in iNOS, COX-2, and PGE2 (p<0.05), as well as [Ca2+] oscillations that were increased by IR. The expression of proapoptotic genes and antiapoptotic genes was suppressed and induced, respectively, by all drugs. IR treatment increased the release of cytochrome C, which was attenuated by all drugs (p<0.05). All drug treatments resulted in a significant decrease in the expression of caspase-3 and caspase-7 (p<0.05), which were both upregulated following IR treatment.
Conclusions
The administration of rebamipide, sucralfate, or rifaximin prior to radiation therapy may prevent or attenuate acute radiation-induced enterocolitis.

Review article

Safety issues regarding melatonin use in child and adolescent patients with sleep problems: Eunsoo Moon, Jung Hyun Lee; Kosin Med J. 2022;37(4):264-270. Published online December 23, 2022; DOI: https://doi.org/10.7180/kmj.22.142

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Abstract PDF PubReader ePub Crossref - TDM: Several studies have reported that melatonin may be effective in treating sleep problems in children and adolescents. However, evidence regarding the safety of melatonin use in children and adolescents in their growth and developmental stages is warranted. Therefore, we aimed to summarize the literature on the safety of melatonin use in children and adolescents with insomnia and sleep disturbances. According to existing evidence, there are no serious adverse effects of long-term melatonin use in children and adolescents. The common adverse effects reported in long-term studies are fatigue, somnolence, and mood swings. In addition, there is no evidence that long-term use of melatonin inhibits the natural secretion of melatonin. It is necessary to monitor potential drug interactions with medications such as inhibitors and enhancers of cytochrome P450 1A2 (CYP1A2). Furthermore, low CYP1A2 expression in young children requires proper dose adjustment. Although sufficient experience of melatonin use in children and adolescents has yet to be attained, accumulating evidence suggests that the use of melatonin in children and adolescents with sleep problems might be effective and tolerable. Considering the abuse or overdose risk of hypnotics or benzodiazepines, melatonin supplements may be a good therapeutic alternative. Future studies on the long-term safety of melatonin for physiological and mental function in children and adolescents are required to establish certainty about melatonin use in children and adolescents.

Original article

Evaluation of automated calibration and quality control processes using the Aptio total laboratory automation system: Namhee Kim, Yein Kim, Jeongeun Park, Jungsoo Choi, Hyunyong Hwang; Kosin Med J. 2022;37(4):342-353. Published online December 22, 2022; DOI: https://doi.org/10.7180/kmj.22.144

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Abstract PDF PubReader ePub Crossref - TDM: Background
The objective of this study was to determine whether manually performed calibration and quality control (QC) processes could be replaced with an automated laboratory system when installed analyzers fail to provide automated calibration and QC functions.
Methods
Alanine aminotransferase (ALT), total cholesterol (TC), creatinine (Cr), direct bilirubin (DB), and lipase (Lip) items were used as analytes. We prepared pooled serum samples at 10 levels for each test item and divided them into two groups; five for the analytical measurement range (AMR) group and five for the medical decision point (MDP) group. Calibration and QC processes were performed for five consecutive days, and ALT, TC, Cr, DB, and Lip levels were measured in the two groups using automated and manual methods. Precision and the mean difference between the calibration and QC methods were evaluated using the reported values of the test items in each group.
Results
Repeatability and within-laboratory coefficients of variation (CVs) between the automated system and the conventional manual system in the AMR group were similar. However, the mean reported values for test items were significantly different between the two systems. In the MDP group, repeatability and within-laboratory CVs were better with the automation system. All calibration and QC processes were successfully implemented with the Aptio total laboratory automation system.
Conclusion
The Aptio total laboratory automation system could be applied to routine practice to improve precision and efficiency.

Review article

Considerations for experimental animal ethics in the research planning and evaluation process: Jaewon Shim, Jeongtae Kim; Kosin Med J. 2022;37(4):271-277. Published online December 22, 2022; DOI: https://doi.org/10.7180/kmj.22.139

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Abstract PDF PubReader ePub Crossref - TDM: Research using experimental animals has substantially contributed to advances in science and medicine. Animal experiments are nearly essential for biomedical research and development efforts. Because many animals are sacrificed, researchers should consider the welfare of experimental animals and related ethical issues, along with the successful results of their experiments. This review introduces the criteria that should be considered in terms of experimental animal ethics, based on the principles of the 3 R’s: replacement, representing careful consideration of the need for animal experiments; reduction, representing the use of the minimal number of animals to obtain meaningful experimental results; and refinement, representing continuous effects to find alternative methods to reduce pain and distress in experimental animals. Based on these principles, the following points should be considered when planning experiments: the necessity of animal experiments; alternatives to animal experiments; the relevance of the species and numbers of experimental animals; appropriate assessment and management of pain; the proper usage of sedatives, painkillers, and anesthesia; and valid timing for humane endpoints and euthanasia. These criteria are beneficial for both experimental animals and researchers because careful handling to ensure experimental animal welfare guarantees that scientific research will yield convincing, repeatable, and accurate results.

Original article

Correlation of long interspersed element-1 open reading frame 1 and c-Met proto-oncogene protein expression in primary and recurrent colorectal cancers: Kyung-Yoon Jeon, Eun-Ji Ko, Hee-Kyung Chang, Seung-Hyun Lee, Byung-Kwon Ahn, Mee Sun Ock, Hee-Jae Cha; Kosin Med J. 2022;37(4):283-290. Published online December 22, 2022; DOI: https://doi.org/10.7180/kmj.22.106

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Abstract PDF PubReader ePub Crossref - TDM: Background
Colorectal cancer is one of the most common cancers worldwide. Colorectal cancer that has recurred and metastasized to other organs also has a very poor prognosis. According to recent studies, the long interspersed element-1 (LINE-1) retrotransposon open reading frame (ORF) is located in the intron of the c-Met proto-oncogene, which is involved in cancer progression and metastasis, and regulates its expression. However, no study has compared the expression patterns of LINE-1 ORF1 and c-Met, which are closely related to cancer progression and metastasis, and their correlation in primary and recurrent cancers.
Methods
In the present study, we compared the expression patterns of LINE-1 ORF1 and c-Met in both primary and recurrent colorectal cancer tissues from 10 patients. Expression patterns and correlations between LINE-1 ORF1 and c-Met proto-oncogene proteins were analyzed by immunofluorescence staining using both LINE-1 ORF1 and c-Met antibodies.
Results
The expression patterns of LINE-1 ORF1 and c-Met showed significant individual differences, and the expression of both proteins was correlated in all colorectal cancer patients. However, the expression levels of LINE-1 ORF1 and c-Met were not significantly different between primary and recurrent colorectal cancers.
Conclusions
The protein expression levels of LINE-1 ORF1 and c-Met were correlated, but did not change significantly in cases of recurrent colorectal cancer in the same patient.

Editorial

Which endoscopic treatment is effective for the treatment of benign esophageal stricture: balloon or incision?: Kyoungwon Jung; Kosin Med J. 2022;37(4):261-263. Published online December 20, 2022; DOI: https://doi.org/10.7180/kmj.22.143

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PDF PubReader ePub Crossref - TDM

Case report

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; Received November 16, 2022 Accepted November 25, 2022 Published online December 19, 2022; DOI: https://doi.org/10.7180/kmj.22.141 [Epub ahead of print]

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Abstract PDF PubReader ePub Crossref - TDM: 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.

Original article

Risk factors for central and lateral lymph node metastasis in papillary thyroid carcinoma: Ji Hyun Ahn, Hee Kyung Chang; Kosin Med J. 2022;37(4):311-319. Published online December 19, 2022; DOI: https://doi.org/10.7180/kmj.22.136

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Abstract PDF PubReader ePub Crossref - TDM: Background
Lymph node metastasis (LNM) is commonly observed in papillary thyroid carcinoma. This study aimed to investigate the risk factors for LNM in patients with papillary thyroid carcinoma.
Methods
The clinicopathological factors of 417 patients were investigated, and differences according to the presence or absence of LNM were evaluated.
Results
LNM was associated with age <55 years, male sex, tumor size >10 mm, multiple and bilateral tumors, tumor involving the lower pole or entire lobe, lymphovascular invasion (LVI), perineural invasion (PNI), and extrathyroidal extension (ETE). Univariable and multivariable analyses showed that age <55 years, male sex, tumor size >10 mm, LVI, and ETE were related to central LNM. Male sex, tumor size >10 mm, and LVI were correlated with lateral LNM (p<0.05). Compared to central LNM, more lymph nodes were involved in metastases and the metastatic tumors were larger in lateral LNM. Extranodal extension (ENE) was more commonly observed in lateral LNM (p<0.001) and was associated with tumor size >10 mm, multifocality, PNI, ETE, and the absence of lymphocytic thyroiditis (p<0.05).
Conclusions
Younger age, male sex, tumor size >10 mm, LVI, and ETE were risk factors for central LNM, while male sex, tumor size >10 mm, and LVI were risk factors for lateral LNM. ENE was more commonly observed in lateral LNM, and tumor size >10 mm, multifocal tumors, PNI, ETE, and tumors unrelated to lymphocytic thyroiditis were risk factors for ENE.

Case report

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; Received August 26, 2022 Accepted October 28, 2022 Published online December 19, 2022; DOI: https://doi.org/10.7180/kmj.22.130 [Epub ahead of print]

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Abstract PDF PubReader ePub Crossref - TDM: 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.

Review article

Ethical issues in clinical research and publication: Hyoung Shin Lee; Kosin Med J. 2022;37(4):278-282. Published online December 15, 2022; DOI: https://doi.org/10.7180/kmj.22.132

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Abstract PDF PubReader ePub Crossref - TDM: Clinical research including human participants should be based on truth, demonstrate scientific integrity, and follow ethical standards and guidelines to protect study participants. The publication of clinical research should be transparent and adhere to strict criteria for authorship. A thorough understanding and knowledge of ethical issues will limit investigator misconduct in clinical research and publication. In this article, basic ethical issues in clinical research and publication are reviewed and summarized based on recent guidelines.

Original article

Students’ perceptions of the learning environment at a medical school in Korea: comparisons of the most recent 4 years’ results using the Dundee Ready Education Environment Measure (DREEM): Sejin Kim; Kosin Med J. 2022;37(4):299-310. Published online December 7, 2022; DOI: https://doi.org/10.7180/kmj.22.129

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Abstract PDF PubReader ePub Crossref - TDM: Background
The learning environment is an essential factor influencing students’ educational processes and personal quality of life. The purpose of this study was to examine medical students’ perceptions of the learning environment at a medical school over the most recent 4 years and explore possibilities for learning environment reform and revision based on the results.
Methods
Participating students were asked about their perceptions of the learning environment using the Dundee Ready Education Environment Measure (DREEM) questionnaire, which was distributed to first-year, third-year, and fourth-year students, representing each learning period. In total, 349 students participated in this study. Analysis of variance was conducted to determine differences in DREEM scores among years and learning periods.
Results
There were no statistically significant differences in DREEM scores by year and learning period, except for students’ perceptions of teachers and students’ perceptions of atmosphere. However, in an analysis of differences in DREEM scores in the class of 2018 cohort by learning period, four domains of the DREEM (except for students’ academic self-perceptions) and the total DREEM score were found to be significantly different.
Conclusions
Students’ perceptions of the learning environment at Kosin University College of Medicine were relatively high. The total score increased from 2019 to 2022, except for 2021. Another significant result was that basic science students had the highest perceptions, whereas students in basic clinical science had the lowest perceptions. To improve the learning environment for medical students, continuing support for students’ emotional stability, learning motivation, physical environment, social relationships, and counseling is essential.

Case report

Development of severe junctional bradycardia after dexmedetomidine infusion in a polypharmacy patient: a case report and literature review: Soeun Jeon, Eunsoo Kim, Sun Hack Lee, Sung In Paek, Hyun-Su Ri, Dowon Lee; Received June 5, 2022 Accepted August 23, 2022 Published online December 7, 2022; DOI: https://doi.org/10.7180/kmj.22.113 [Epub ahead of print]

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Abstract PDF PubReader ePub Crossref - TDM: The authors report a case of newly manifested severe junctional bradycardia following dexmedetomidine administration during spinal anesthesia in a polypharmacy patient. A 77-year-old woman receiving multiple medications, including a beta-blocker and a calcium channel blocker, underwent right total knee arthroplasty. After spinal anesthesia, intravenous dexmedetomidine was initiated as a sedative; her heart rate decreased, followed by junctional bradycardia (heart rate, 37–41 beats/min). Dexmedetomidine was discontinued, and a dopamine infusion was initiated. Seven hours after surgery, junctional bradycardia persisted; a temporary transvenous pacemaker was inserted, and the beta-blocker and calcium channel blocker were discontinued. The patient was discharged on postoperative day 11 without any sequelae. Anesthesiologists should be aware of dexmedetomidine’s inhibitory effects on the cardiac conduction system, especially in geriatric patients taking medications with negative chronotropic effects and in combination with neuraxial anesthesia.

Original article

Comparison of the efficacy and complications of endoscopic incisional therapy and balloon dilatation for benign esophageal strictures: Eun Jeong Choi, Sam Ryong Jee, Sang Heon Lee, Ji Hyun Kim, Jun Sik Yoon, Jae Hyuk Heo, Seung Jung Yu, Hee Won Baek, Hong Sub Lee; Kosin Med J. 2022;37(4):291-298. Published online November 16, 2022; DOI: https://doi.org/10.7180/kmj.22.128

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1 Citations

Abstract PDF PubReader ePub Crossref - TDM

Background
Benign esophageal strictures are treated endoscopically, often with balloon dilatation (BD) or bougie dilators. However, recurrent esophageal strictures have been reported after BD, and severe complications sometimes occur. The aim of this study was to compare the efficacy and complications of endoscopic incisional therapy (EIT) and BD for benign esophageal strictures.
Methods
We retrospectively reviewed patients who underwent BD or EIT as primary treatment for benign esophageal strictures between July 2014 and June 2021. Technical success was defined as restoration of the lumen diameter with <30% residual stenosis. Clinical success was defined as no recurrence of dysphagia within 1 month after BD or EIT and an increase of 1 grade or more on the Functional Oral Intake Scale.
Results
Thirty patients with benign esophageal stricture were enrolled. There were 16 patients in the BD group and 14 patients in the EIT group. No significant differences in technical and clinical success rates were found between the two groups. Furthermore, no significant differences in the re-stricture rate were observed between the groups. There was one complication in the EIT group and three complications in the BD group. Three patients who underwent BD had re-stricture and underwent EIT thereafter, and we regrouped patients who underwent EIT at least once. The clinical success rate was significantly higher in patients regrouped to the EIT group than in patients who underwent BD only.
Conclusions
EIT is not inferior to BD as the primary treatment for benign esophageal strictures, especially for recurrent cases.

Citations

Citations to this article as recorded by

Which endoscopic treatment is effective for the treatment of benign esophageal stricture: balloon or incision?
Kyoungwon Jung
Kosin Medical Journal.2022; 37(4): 261. CrossRef

Case report

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; Received July 18, 2022 Accepted September 7, 2022 Published online November 9, 2022; DOI: https://doi.org/10.7180/kmj.22.123 [Epub ahead of print]

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Abstract PDF PubReader ePub Crossref - TDM: 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.

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