Skip Navigation
Skip to contents

KMJ : Kosin Medical Journal

OPEN ACCESS
SEARCH
Search

Ahead-of print

Page Path
HOME > Browse articles > Ahead-of print
9 Ahead-of print
Filter
Filter
Article category
Keywords
Authors

Articles in E-pub version are posted online ahead of regular printed publication.

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]
  • 40 View
  • 0 Download
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]
  • 54 View
  • 3 Download
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.
Cardiovascular collapse during transcatheter aortic valve replacement in monitored anesthesia care using an end-tidal carbon dioxide monitor: a case report
Wonjin Lee, Jaewoo Suh
Received June 29, 2023  Accepted October 16, 2023  Published online January 2, 2024  
DOI: https://doi.org/10.7180/kmj.23.134    [Epub ahead of print]
  • 113 View
  • 2 Download
Abstract PDFPubReader   ePub   
Capnography is commonly used to monitor respiration during general anesthesia. However, it has limited utility in patients with respiratory distress during sedation. This case report examines capnography use in a transcatheter aortic valve replacement procedure performed on an elderly woman with severe aortic stenosis. A 73-year-old woman with a history of non-ST-elevation myocardial infarction and congenital heart failure presented with severe dyspnea caused by severe aortic stenosis. Transcatheter aortic valve replacement was preferred over surgery due to her comorbidities. Monitored anesthesia care was administered with a capnogram. During the procedure, the patient was sedated with remimazolam, maintaining a bispectral index range of 60–80 and a score of 2 on the Modified Observer’s Assessment of Alertness/Sedation scale. Although irregular breathing patterns and a gradual decrease in oxygen saturation were observed following remimazolam infusion, the patient’s respiration eventually stabilized. However, the patient experienced cardiovascular collapse 45 minutes after sedation began. The arterial carbon dioxide pressure measured by arterial blood gas analysis performed just before resuscitation was 68.4 mmHg. After one cycle of resuscitation, the patient recovered. The procedure was successfully performed under general anesthesia, which was replaced with monitored anesthesia care during resuscitation. Although most monitoring devices have similar utility for both general anesthesia and sedation, capnography has limitations for evaluating respiration during sedation, especially for patients with respiratory distress. Therefore, anesthesiologists or medical staff who provide sedation should not neglect periodical arterial carbon dioxide pressure observations via other methods, such as arterial blood gas analysis.
Surgical management of giant adrenal myelolipoma using a modified Makuuchi incision: a case report
Byeong Jin Kang, Seung Hyeon Kim, Kyoungha Jang, Kyung Hwan Kim, Hong Koo Ha
Received June 22, 2023  Accepted October 20, 2023  Published online December 14, 2023  
DOI: https://doi.org/10.7180/kmj.23.132    [Epub ahead of print]
  • 142 View
  • 3 Download
Abstract PDFPubReader   ePub   
Giant adrenal myelolipomas are rare, benign, and hormonally inactive tumors. We present the case of a 53-year-old man with a 19-cm retroperitoneal mass, initially suspected to be a retroperitoneal liposarcoma, angiomyolipoma, or adrenal myelolipoma. After conducting endocrine assessments, which were within normal ranges, we decided to perform surgical excision using a modified Makuuchi incision. The tumor was successfully removed, and the final pathological examination confirmed the diagnosis of adrenal myelolipoma. The patient was discharged with no complications and remained without disease recurrence or distant metastasis as of 1 year postoperatively. In conclusion, giant myelolipomas are rare and cause symptoms owing to their large size. Surgical removal is recommended for large or symptomatic myelolipomas. The modified Makuuchi incision allows efficient and safe tumor removal in open surgery for giant myelolipomas.
Original articles
Effects of cholecalciferol and omega-3 fatty acids on hepcidin levels in 5/6 nephrectomy rats
Yu In Jeong, Hyo Jin Jung, Mi Hwa Lee, Young Ki Son, Seong Eun Kim, Won Suk An, Su Mi Lee
Received July 19, 2023  Accepted August 23, 2023  Published online September 25, 2023  
DOI: https://doi.org/10.7180/kmj.23.137    [Epub ahead of print]
  • 393 View
  • 6 Download
Abstract PDFPubReader   ePub   
Background
Anemia is a common complication of chronic kidney disease (CKD). In patients with CKD-related anemia, an inverse relationship between vitamin D and hepcidin levels has been observed. Hepcidin is a key regulator of iron homeostasis, mediated via binding to ferroportin. The aim of this study was to investigate the effects of cholecalciferol and omega-3 fatty acids (FA) on hepcidin levels using 5/6 nephrectomized (Nx) rats.
Methods
Male Sprague-Dawley rats were divided into five groups: sham control, 5/6 Nx, 5/6 Nx treated with cholecalciferol, 5/6 Nx treated with omega-3 FA, and 5/6 Nx treated with both cholecalciferol and omega-3 FA. We measured the hepcidin and ferroportin levels in the kidney and liver by enzyme-linked immunosorbent assays and Western blots. We evaluated hepcidin expression in the kidney by immunohistochemical staining.
Results
Among the five groups, 5/6 Nx rats exhibited the worst kidney function. Compared with the sham controls, 5/6 Nx rats showed significantly increased serum hepcidin levels and decreased vitamin D levels. Supplementation with either omega-3 FA or cholecalciferol decreased hepcidin and increased vitamin D levels, with a concurrent improvement of anemia. Furthermore, 5/6 Nx rats treated with omega-3 FA/cholecalciferol showed decreased ferroportin and ferritin levels, while iron and total iron-binding capacity levels increased.
Conclusions
Treatment with a combination of cholecalciferol and omega-3 FA may improve anemia in a CKD rat model by decreasing hepcidin levels.
Human resources and medical supplies consumption during the COVID-19 pandemic: a single-center study
Hye Jin Park, Yu Bin Seo, Jin Ju Park, Sun Hee Na, Jacob Lee
Received May 24, 2023  Accepted August 7, 2023  Published online September 14, 2023  
DOI: https://doi.org/10.7180/kmj.23.126    [Epub ahead of print]
  • 357 View
  • 0 Download
Abstract PDFPubReader   ePub   
Background
In the face of the unexpected coronavirus disease 2019 (COVID-19) pandemic, every country has struggled with insufficient human resources and medical supplies. This study aims to provide the statistical information necessary for discussing how to model stockpiles of medical resources.
Methods
This study was conducted at the Hallym University Kangnam Sacred Heart Hospital, in South Korea. The study duration was 2 weeks, centered on March 16, 2022, when the number of daily confirmed patients with COVID-19 in Korea peaked. The number of human resources was obtained by counting the number of healthcare workers using CCTV. Drug prescriptions and medical device usage were obtained from electronic medical records.
Results
In total, 117 inpatients and 26,485 outpatients were managed at this hospital during the 2-week study period. Daily visits were highest among nurses in all units, followed by doctors and radiology technicians. The mean daily consumption of personal protective equipment (PPE) per bed was 4.3 sets in the intensive care unit (ICU), 1.8 in the semi-ICU, and 1.4 in the ward. Despite the four-fold difference in the number of patients, there was no statistically significant difference between the two wards in the number of daily visits. Drug prescription rates were higher among inpatients than at-home patients.
Conclusions
The higher the COVID-19 severity, the higher the consumption of PPE per patient. Among healthcare workers, nurses had the highest number of inpatient treatment visits for COVID-19. To efficiently utilize, PPE, structures containing more isolation beds in a single negative pressure isolation system would be preferred.
Case reports
Heterotopic ovarian hilus cells of the salpinx: a case report and review of the literature
Bomi Kim
Received April 20, 2023  Accepted August 6, 2023  Published online September 12, 2023  
DOI: https://doi.org/10.7180/kmj.23.120    [Epub ahead of print]
  • 290 View
  • 4 Download
Abstract PDFSupplementary MaterialPubReader   ePub   
Ovarian hilus cells (OHCs), a counterpart of testicular Leydig cells, are usually found in the ovarian poles and produce androstenedione. Their origin remains a matter of debate, although OHCs are assumed to come from the adrenogenital primordium. OHCs are rarely observed around the poles of the ovary, including the mesoovarium, stroma (perisalpinx) of the salpinx, and the wall of paratubal cysts. Their clinical and pathological characteristics are not well-known because of their rarity. Herein, we present a case of ectopic OHCs in a 48-year-old woman. The patient underwent total hysterectomy and bilateral salpingectomy for vaginal bleeding due to multiple leiomyomas. We incidentally found OHCs in the stroma of the infundibulum of the salpinx, just beneath the tubal epithelium. Their size was less than 1 mm, and they were composed of large cells with central round nuclei and abundant clear or granular cytoplasm. OHCs share morphological and immunohistochemical profiles with ectopic adrenal glands, and the differential diagnosis is sometimes difficult. They do not exhibit microscopic encapsulation or the normal adrenal cortex zonation pattern. The patient was discharged and did not show any abnormal findings during 19 months of follow-up. Analyzing the characteristics of testicular Leydig cells will help understand how OHCs develop and why heterotopic OHCs occur in and around the salpinges.
Primary gastric leiomyosarcoma: a case report and literature review
Yedaun Lee
Received April 10, 2023  Accepted July 5, 2023  Published online August 18, 2023  
DOI: https://doi.org/10.7180/kmj.23.118    [Epub ahead of print]
  • 336 View
  • 4 Download
Abstract PDFPubReader   ePub   
After separating gastrointestinal (GI) stromal tumors from true smooth muscle tumors of the GI tract, leiomyosarcoma (LMS) of the GI tract has become a rare tumor. Gastric LMS is extremely rare and accounts for 0.1% of all cases of LMS in the GI tract. There are few English-language reports of gastric LMS describing radiologic findings. Here, we report a case of gastric LMS and review the recent literature focusing on radiologic findings. An 80-year-old female patient was referred for evaluation of a gastric mass accompanied by severe anemia. The physical examination revealed no specific findings except for an anemic conjunctiva. Laboratory data showed a low hemoglobin level of 5.1 g/dL. Endoscopy revealed a huge subepithelial mass in the posterior wall of the gastric body. Contrast-enhanced computed tomographic images showed an intraluminal protruding enhancing mass with an internal stalk appearance in the gastric body. There was no internal necrosis or calcification. The patient underwent subtotal gastrectomy and was diagnosed with primary gastric LMS. The diagnosis of gastric LMS is challenging due to its rarity. Our case report suggests that the presence of an internal stalk or spouting appearance can help prompt the radiologist to consider gastric LMS in the differential diagnosis.
Squamous cell carcinoma of the pancreas with a pancreatic intraductal papillary mucinous neoplasm: a case report
Nam Kyung Lee
Received April 27, 2023  Accepted July 5, 2023  Published online August 17, 2023  
DOI: https://doi.org/10.7180/kmj.23.123    [Epub ahead of print]
  • 250 View
  • 2 Download
Abstract PDFPubReader   ePub   
Squamous cell carcinoma (SCC) of the pancreas is very rare. No reports have described SCC accompanied by intraductal papillary mucinous neoplasm (IPMN) of the pancreas. This report presents the first known case of SCC with IPMN of the pancreas in a 71-year-old man, with a focus on radiologic findings. Here, the imaging features of SCC with IPMN of the pancreas were similar to those of IPMN of the pancreas with high-risk stigmata features.

KMJ : Kosin Medical Journal