Kosin Medical Journal

Original article

Capsule endoscopy in Kazakhstan: a multicenter clinical experience: Sang Jun Sohn, Kanat Batyrbekov, Ainura Galiakbarova, Laura Yerdaliyeva, Jamilya Kaibullayeva, Jeongwoo Ju, Haejin Lee, Yeoun Joo Lee; Received April 18, 2024 Accepted May 31, 2024 Published online July 26, 2024; DOI: https://doi.org/10.7180/kmj.24.116 [Epub ahead of print]

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Abstract PDF PubReader ePub: Background
By analyzing small bowel capsule endoscopy (SBCE) performed in two large hospitals in Kazakhstan, we aimed to explore the characteristics of patients representative of Central Asia and the technical characteristics of SBCE.
Methods
SBCE cases were retrospectively analyzed. A descriptive analysis was conducted on the patients’ demographic data, diagnosis, and clinical symptoms. The results of SBCE, such as the lesions found, transit time and retention rate in the stomach and small bowel, and bowel visualization quality, were analyzed. Complications related to SBCE were investigated.
Results
SBCE was performed in 123 patients. Abdominal pain (81.3%) and chronic diarrhea (66.7%) were the most common symptoms, followed by weight loss (25.2%) and gastrointestinal bleeding (15.4%). The most common disease was Crohn’s disease (52.0%). Definite lesions, such as ulcers, polyps, and bleeding, were identified in 55.3% of patients. SBCE was successfully completed in all cases except for 11 (9.1%). The average small bowel transit time was 4 hours and 28 minutes. Excellent visualization (>75% of mucosa) was reported in 82.5% of patients. No patients experienced complications.
Conclusions
SBCE performed in Kazakhstan showed a high diagnostic yield with high-quality patient selection and no complications.

Case report

Effective protocol for continuous pericapsular nerve group block in femur fracture patients undergoing hip surgery: two case reports: Younghoon Jung, Sangmin Choi, Siyoung Lee, Nara Kim, Eunsoo Kim; Received April 1, 2024 Accepted June 15, 2024 Published online July 24, 2024; DOI: https://doi.org/10.7180/kmj.24.114 [Epub ahead of print]

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Abstract PDF PubReader ePub: Pericapsular nerve group (PENG) block was introduced as an effective way to control postoperative pain in patients who have undergone hip surgery. Therefore, we would like to discuss how to perform PENG block accurately on the basis of two cases, both of which involved hip fracture patients. Ultrasound-guided continuous PENG block was performed, and postoperative pain was adequately controlled in both cases. To mount the catheter in the correct position, it should be inserted after the needle enters at the lowest angle possible. If it is confirmed that the psoas tendon is pushed upward without an increase in injection pressure during drug injection, an accurate continuous PENG block has been achieved. We also analyzed fluoroscopic images to determine how the drug spread, and we observed that the drug spread around the hip capsule along the iliacus and psoas muscle.

Original article

Preliminary data on Computed Tomography-based radiomics for predicting programmed death ligand 1 expression in urothelial carcinoma: Chang Mu Lee, Seung Baek Hong, Nam Kyung Lee, Hong Koo Ha, Kyung Hwan Kim, Byeong Jin Kang, Suk Kim, Ja Yoon Ku; Received January 5, 2024 Accepted May 22, 2024 Published online July 18, 2024; DOI: https://doi.org/10.7180/kmj.24.103 [Epub ahead of print]

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Abstract PDF Supplementary Material PubReader ePub: Background
Programmed death ligand 1 (PD-L1) expression cannot currently be predicted through radiological findings. This study aimed to develop a prediction model capable of differentiating between positive and negative PD-L1 expression through a radiomics-based investigation of computed tomography (CT) images in patients with urothelial carcinoma.
Methods
Sixty-four patients with urothelial carcinoma who underwent immunohistochemical testing for PD-L1 were retrospectively reviewed. The number of patients in the positive and negative PD-L1 groups (PD-L1 expression >5%) was 14 and 50, respectively. CT images obtained 90 seconds after contrast medium administration were selected for radiomic extraction. For all tumors, 1,691 radiomic features were extracted from CT using a manually segmented three-dimensional volume of interest. Univariate and multivariate logistic regression analyses were performed to identify radiomic features that were significant predictors of PD-L1 expression. For the radiomics-based model, a receiver operating characteristic (ROC) analysis was performed.
Results
Among 64 patients, 14 were included in the PD-L1 positive group. Logistic regression analysis found that the following radiomic features significantly predicted PD-L1 expression: wavelet-low-pass, low-pass, and high-pass filters (LLH)_gray-level size-zone matrix (GLSZM)_SmallAreaEmphasis, wavelet-LLH_firstorder_Energy, log-sigma-0-5-mm-3D_GLSZM_SmallAreaHighGrayLevelEmphasis, original_shape_Maximum2DDiameterColumn, wavelet-low-pass, low-pass, and low-pass filters (LLL)_gray-level run-length matrix (GLRLM)_ShortRunEmphasis, and exponential_firstorder_Kurtosis. The radiomics signature was –4.0934+21.6224 (wavelet-LLH_GLSZM_SmallAreaEmphasis)+0.0044 (wavelet-LLH_firstorder_Energy)–4.7389 (log-sigma-0-5-mm-3D_GLSZM_SmallAreaHighGrayLevelEmphasis)+0.0573 (original_shape_Maximum2DDiameterColumn)–29.5892 (wavelet-LLL_GLRLM_ShortRunEmphasis)–0.4324 (exponential_firstorder_Kurtosis). The area under the ROC curve model representing the radiomics signature for differentiating cases that were deemed PD-L1 positive based on immunohistochemistry was 0.96.
Conclusions
This preliminary radiomics model derived from contrast-enhanced CT predicted PD-L1 positivity in patients with urothelial cancer.

Review article

Bone-modifying agents for bone metastasis in patients with breast cancer: Lee Chun Park, Eun Mi Lee; Kosin Med J. 2024;39(2):83-88. Published online June 28, 2024; DOI: https://doi.org/10.7180/kmj.24.121

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Abstract PDF PubReader ePub: The bone is the most common location of breast cancer metastasis. Bone metastasis causes pain and skeletal-related events (SREs), and affects the quality of life and survival of breast cancer patients. Bone-modifying agents, including bisphosphonates and denosumab, reduce the risk of SREs in these patients. Among bisphosphonates, zoledronic acid is preferred due to its higher efficacy. Denosumab is marginally more effective than zoledronic acid in reducing the frequency of SREs. Patients with renal impairment should receive zoledronic acid with caution due to nephrotoxicity, and denosumab is an alternative option in these patients. Osteonecrosis of the jaw is a rare but severe complication of both zoledronic acid and denosumab, and all patients should undergo dental examinations before and during treatment. Although these drugs can reduce the risk of SREs in bone metastasis, no significant improvement in survival has been noted. This study reviews the effects and adverse events of bone-modifying agents for the treatment of bone metastasis from breast cancer.

Editorial

Coronavirus disease 2019 infection in pediatric patients in Korea: insights and implications: Yu Jin Jung; Kosin Med J. 2024;39(2):81-82. Published online June 26, 2024; DOI: https://doi.org/10.7180/kmj.24.122

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Review articles

Treatment of pediatric obstructive sleep apnea: Tae Kyung Koh, Jooyeon Kim; Kosin Med J. 2024;39(2):89-93. Published online June 21, 2024; DOI: https://doi.org/10.7180/kmj.24.120

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Abstract PDF PubReader 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; Kosin Med J. 2024;39(2):94-98. Published online June 18, 2024; DOI: https://doi.org/10.7180/kmj.24.117

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Abstract PDF PubReader 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 PDF PubReader 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; Kosin Med J. 2024;39(2):99-111. Published online June 10, 2024; DOI: https://doi.org/10.7180/kmj.24.106

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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.

Citations

Citations to this article as recorded by

Coronavirus disease 2019 infection in pediatric patients in Korea: insights and implications
Yu Jin Jung
Kosin Medical Journal.2024; 39(2): 81. CrossRef

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; Kosin Med J. 2024;39(2):112-119. Published online June 5, 2024; DOI: https://doi.org/10.7180/kmj.23.152

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Abstract PDF PubReader 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; Kosin Med J. 2024;39(2):120-126. Published online June 4, 2024; DOI: https://doi.org/10.7180/kmj.24.111

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Abstract PDF PubReader 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 PDF PubReader 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; Kosin Med J. 2024;39(2):144-149. Published online May 9, 2024; DOI: https://doi.org/10.7180/kmj.23.156

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Abstract PDF PubReader 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

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 Med J. 2024;39(1):1-4. Published online March 25, 2024; DOI: https://doi.org/10.7180/kmj.24.109

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Review article

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 PDF PubReader 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.

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