Kosin Medical Journal

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

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]

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Abstract PDF PubReader ePub Crossref - TDM: 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]

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Abstract PDF PubReader ePub Crossref - TDM: 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]

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Abstract PDF Supplementary Material PubReader ePub Crossref - TDM: 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]

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Abstract PDF PubReader ePub Crossref - TDM: 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]

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Abstract PDF PubReader ePub Crossref - TDM: 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.

Drug-induced immune-mediated thrombocytopenia due to bevacizumab-FOLFOX therapy: a case report: Minna Kim, Jong Hoon Lee, Jong Yoon Lee; Received April 23, 2023 Accepted June 4, 2023 Published online July 28, 2023; DOI: https://doi.org/10.7180/kmj.23.121 [Epub ahead of print]

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Abstract PDF PubReader ePub Crossref - TDM: Drug-induced immune thrombocytopenia (DITP) is a very rare disease, with an estimated annual incidence of 10 cases per million. Oxaliplatin and irinotecan are widely used as chemotherapy for high-risk stage II and III colorectal cancer, and DITP has been reported to occur in patients using those agents. To treat unresectable metastatic colorectal cancer, bevacizumab is used in combination with oxaliplatin or irinotecan, and there have been a few reports of DITP cases in patients receiving that regimen. In this report, we describe a 68-year-old male patient with metastatic colon cancer (KRAS mutant type) to the liver and lung who developed acute immune-mediated thrombocytopenia due to bevacizumab-FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) therapy. During treatment, he showed purpura in his lower extremities on 21st cycle day 2. Lab work revealed a platelet count of less than 2,000/mL, reflecting a decrease from 135,000/mL at the start of the cycle 1 day prior. He did not have any other types of cytopenia or significant changes in laboratory findings. We diagnosed DITP due to bevacizumab-FOLFOX, and the patient did not show isolated thrombocytopenia after switching to Ziv-aflibercept-FOLFIRI (5-fluorouracil, leucovorin, and irinotecan).

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