Journal of Yeungnam Medical Science

Volume 30(1); June 2013

Editorial

30th Volume Anniversary of Yeungnam University Journal of Medicine.: Hosun Park; Yeungnam Univ J Med. 2013;30(1):1-3. Published online June 30, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.1.1

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Abstract PDF: No abstract available.

Review

Improvement of Leptin Resistance.: Yong Woon Kim; Yeungnam Univ J Med. 2013;30(1):4-9. Published online June 30, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.1.4

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Abstract PDF: Leptin, a 16-kDa cytokine, is secreted by adipose tissue in response to the surplus of fat store. Thereby, the brain is informed about the body's energy status. In the hypothalamus, leptin triggers specific neuronal subpopulations (e.g., POMC and NPY neurons) and activates several intracellular signaling events, including the JAK/STAT, MAPK, PI3K, and mTOR pathway, which eventually translates into decreased food intake and increased energy expenditure. Leptin signal is inhibited by a feedback inhibitory pathway mediated by SOCS3. PTP1B involves another inhibitory pathway of leptin. Leptin potently promotes fat mass loss and body weight reduction in lean subjects. However, it is not widely used in the clinical field because of leptin resistance, which is a common feature of obesity characterized by hyperleptinemia and the failure of exogenous leptin administration to provide therapeutic benefit in rodents and humans. The potential mechanisms of leptin resistance include the following: 1) increases in circulating leptin-binding proteins, 2) reduced transport of leptin across the blood-brain barrier, 3) decreased leptin receptor-B (LRB), and/or 4) the provocation of processes that diminish cellular leptin signaling (inflammation, endoplasmic reticulum stress, feedback inhibition, etc.). Thus, interference of the cellular mechanisms that attenuate leptin signaling improves leptin action in cells and animal models, suggesting the potential utility of these processes as points of therapeutic intervention. Various experimental trials and compounds that improve leptin resistance are introduced in this paper.

Original Article

Role of Extracellular Signal-Regulated Kinase 1/2 and Reactive Oxygen Species in Toll-Like Receptor 2-Mediated Dual-Specificity Phosphatase 4 Expression.: So Yeon Kim, Suk Hwan Baek; Yeungnam Univ J Med. 2013;30(1):10-16. Published online June 30, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.1.10

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Abstract PDF: BACKGROUND
Toll-like receptors (TLRs) are well-known pattern recognition receptors. Among the 13 TLRs, TLR2 is the most known receptor for immune response. It activates mitogen-activated protein kinases (MAPKs), which are counterbalanced by MAPK phosphatases [MKPs or dual-specificity phosphatases (DUSPs)]. However, the regulatory mechanism of DUSPs is still unclear. In this study, the effect of a TLR2 ligand (TLR2L, Pam3CSK4) on DUSP4 expression in Raw264.7 cells was demonstrated. METHODS: A Raw264.7 mouse macrophage cell line was cultured in Dulbecco's modified Eagle's medium supplemented with 10% fetal bovine serum and 1% antibiotics (100 U/mL penicillin and 100 g/mL streptomycin) at 37degrees C in 5% CO2. TLR2L (Pam3CSK4)-mediated DUSP4 expressions were confirmed with RT-PCR and western blot analysis. In addition, the detection of reactive oxygen species (ROS) was measured with lucigenin assay. RESULTS: Pam3CSK4 induced the expression of DUSP1, 2, 4, 5 and 16. The DUSP4 expression was also increased by TLR4 and 9 agonists (lipopolysaccharide and CpG ODN, respectively). Pam3CSK4 also induced ERK1/2 phosphorylation and ROS production, and the Pam3CSK4-induced DUSP4 expression was decreased by ERK1/2 (U0126) and ROS (DPI) inhibitors. U0126 suppressed the ROS production by Pam3CSK4. CONCLUSION: Pam3CSK4-mediated DUSP4 expression is regulated by ERK1/2 and ROS. This finding suggests the physiological importance of DUSP4 in TLR2-mediated immune response.

Case Reports

A Case of ANCA-Negative Generalized Wegener's Granulomatosis.: Seung Kyu Kim, Yong Jin Kwon, Heae Surng Park, Kwang Won Rhee, Ji Yoon Ha, Hee Sung Ko, Ki Hyun Kim, Min Kwang Byun; Yeungnam Univ J Med. 2013;30(1):17-20. Published online June 30, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.1.17

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Abstract PDF: Wegener's granulomatosis is a very rare systemic vasculitis characterized by necrotizing granulomatosis. The detection of antineutrophil cytoplasm antibody (ANCA) is a valuable finding in diagnosing Wegener's granulomatosis because ANCA is positive in approximately 90 percent of patients with active, generalized Wegener's granulomatosis. But ANCA is not necessarily positive to make a diagnosis. A 59-year-old man was transferred to our hospital. He was diagnosed with lung abscess and treated with antibiotics at previous hospital. Initially, the ANCA was negative in immunofluorescence assay but we suspected Wegener's granulomatosis because of systemic inflammatory symptoms. Clinical symptoms deteriorated rapidly so we did bronchoscopic biopsy early. Wegener's granulomatosis was diagnosed according to pathologic finding that reported necrotizing granulomatous inflammation associated with vasculitis. Thus we treated with steroid then clinical symptoms and laboratory findings were improved.

A Case of Hemolytic Disease of a Newborn by an Anti-Di(a) Antibody Treated with Intravenous Immunoglobulin.: Chang Eon Lee, Su Jin Park, Won Duck Kim; Yeungnam Univ J Med. 2013;30(1):21-24. Published online June 30, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.1.21

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Abstract PDF: Hemolytic disease in a newborn that causes early jaundice is common. It is often due to the Rh (D) and ABO incompatibility, but rarely due to unexpected antibodies. Among these unexpected antibodies, the anti-Di(a) antibody rarely occurs. The anti-Di(a) antibody was observed in the serum and red-cell eluate of an infant, and in the serum of his mother. The frequency of the appearance of the Di(a) antigen in the Korean population is estimated to be 6.4-14.5%. This paper reports a case of hemolytic disease in a newborn associated with the anti-Di(a) antibody. A full-term male infant was transferred to the authors' hospital due to hyperbilirubinemia the day after his birth. The laboratory data indicated a hemoglobin value of 11.6 g/dL, a reticulocyte count of 10.6%, a total bilirubin count of 14.4 mg/dL, a direct bilirubin count of 0.6 mg/dL, and a positive result in the direct Coombs' test. Due to the identification of an irregular antibody from the maternal serum, an anti-Di(a) antibody was detected, which was also found in the eluate made from the infant's blood. The infant had been treated with phototherapy and intravenous immunoglobulin since the second day after his birth and was discharged due to an improved condition without exchange transfusion. Therefore, in cases of iso-immune hemolytic disease in a newborn within 24 hours from birth who had a negative result in an antibody screening test, the conduct of an anti-Di(a) antibody identification test is recommended due to the suspicion of an anti-Di(a) antigen, followed by early administration of intravenous immunoglobulin.

A Case of Osmotic Demyelination Syndrome in a Patient with Severe Hyponatremia Complicated by Rhabdomyolysis.: Da Young Lee, Chang Woo Hong, In Hee Lee; Yeungnam Univ J Med. 2013;30(1):25-30. Published online June 30, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.1.25

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Abstract PDF

Hyponatremia, the most common electrolyte disorder, has been rarely reported as causing rhabdomyolysis. Osmotic demyelination syndrome (ODS), a demyelinating disease of the central pons and/or other areas of the brain, is infrequently reported as associated with rapid correction of hyponatremia. This paper reports a case of ODS after correction of severe hyponatremia complicated by rhabdomyolysis. A 47-year-old female with a history of chronic alcoholism presented herself at the hospital with altered consciousness after three days of nausea and vomiting. She was on a thiazide diuretic for essential hypertension. Her blood tests upon her hospital admission showed hyponatremia (Na+ 98 mEq/L), hypokalemia (K+ 3.0 mEq/L), and elevation of her serum creatine phosphokinase (3,370 IU/L) with an increase in her serum myoglobin level 11,267 ng/mL). She was treated with intravenous fluid therapy that included isotonic and hypertonic salines along with potassium chloride. She became more alert, and her neurological condition gradually improved after the first five days of her therapy. On the ninth day after her admission, she developed progressive quadiaresis associated with dysarthria, dysphagia, and dystonia despite the resolution of her hyponatremia. Magnetic resonance imaging of her brain on 16th day revealed symmetrical areas of signal hyperintensity in her central pons, basal ganglia, and precentral gyrus in T2-weighted images, which are consistent with ODS. Her neurological symptoms steadily improved after six weeks with only supportive treatment and rehabilitation.

Citations

Citations to this article as recorded by

Severe hyponatremia and seizures after bowel preparation with low-volume polyethylene glycol plus ascorbic acid solution
Jae Young Lee, Byung Ik Jang, Yoon Jeong Nam, Jay Song, Min Cheol Kim, Seung Min Chung, Jong Geol Jang, Jae Ho Cho
Yeungnam University Journal of Medicine.2015; 32(1): 55. CrossRef

Deep Vein Thrombosis Due to Hematoma as a Rare Complication after Femoral Arterial Catheterization.: Minsoo Kim, Jong Young Lee, Cheol Whan Lee, Seung Whan Lee, Soo Jin Kang, Yong Hoon Yoon, Sang Yong Om, Young Hak Kim; Yeungnam Univ J Med. 2013;30(1):31-35. Published online June 30, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.1.31

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Abstract PDF

Hematoma is quite a common complication of femoral arterial catheterization. However, to the best of our knowledge, there have been no previous studies regarding deep vein thrombosis (DVT) caused by compression of a vein due to a hematoma. We report a case of a hematoma developing after femoral arterial catheterization and causing extensive symptomatic DVT. A 59-year-old male was seen in our Emergency Department with right lower leg swelling 15 days after coronary stent implantation performed using right femoral artery access. Computed tomographic (CT) scanning revealed a large hematoma (45 mm in its longest diameter) compressing the common femoral vein and with DVT from the right external iliac vein to the popliteal vein. Due to the extensive DVT involvement, we decided to release the compressed common femoral vein by surgical evacuation of the large hematoma. However, even following evacuation of the hematoma, as the DVT did not resolve soon, further mechanical thrombectomy and catheter-directed thrombolysis were performed. Angiography then showed nearly resolved DVT, and the leg swelling was improved. The patient was discharged with the anticoagulation medication, warfarin.

Citations

Citations to this article as recorded by

Femoral Vein Thrombosis Following Femoral Access Cardiac Catheterisation – A Rare Complication
Laurence Disler, Mathew Disler, Dayle Disler Biddle, Camilla Friedman, Janet Couper-Smith
Cardiovascular Revascularization Medicine.2023; 53: S224. CrossRef
A Case of Puncture-Site Giant Pseudoaneurysm Following Recanalization Therapy for Acute Ischemic Stroke: Marked Growth and Rupture of a Femoral Artery Pseudoaneurysm
Noriaki Matsubara, Yusuke Fukuo, Kohei Yoshimura, Hideki Kashiwagi, Gen Futamura, Yangtae Park, Toshihiko Kuroiwa, Masahiko Wanibuchi
Journal of Neuroendovascular Therapy.2021; 15(6): 366. CrossRef
Deep Vein Thrombosis after Femoral Arterial Access: Pathophysiologic and Therapeutic Challenges
Evan Harmon, Yoo Jin Lee, Sula Mazimba, Kanwar Singh, Aditya Sharma, Younghoon Kwon
Case Reports in Cardiology.2019; 2019: 1. CrossRef
Treatment of pulmonary thromboembolism using Arrow-Trerotola percutaneous thrombolytic device
Tae Kyun Kim, Ji Young Park, Jun Ho Bae, Jae Woong Choi, Sung Kee Ryu, Min-Jung Kim, Jun Bong Kim, Jang Won Sohn
Yeungnam University Journal of Medicine.2014; 31(1): 28. CrossRef

Two Cases of Spinal Epidural Abscess in Hemodialysis Patients.: Young Hwan Kim, Jin Taek Yoo, Soon Myung Jung, Sang Chang Kwon, Seung Min Ryu, Mun Jang, Jung Choi; Yeungnam Univ J Med. 2013;30(1):36-38. Published online June 30, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.1.36

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Abstract PDF: While epidural abscesses are rare in hemodialysis patients, they can cause severe neurological complications that can be fatal because only nonspecific symptoms appear in the early stages of the infection. Their incidence increased recently due to intravenous drug abuse, invasive spinal surgery, percutaneous vertebral procedures, and the development of diagnostic modalities. The increased number of cases is related to the use of dialysis catheters in hemodialysis patients. If a patient has fever and back pain, doctors should eliminate the possibility of other common diseases and consider spinal epidural infection. Early diagnosis and proper treatment are important to prevent neurological complications. In this paper, the symptoms, blood work, magnetic resonanceimaging (MRI) findings, and clinical course of two hemodialysis patients who developed spinal epidural abscesses are described.

A Case of Recurrent Liver Abscess Due to Choledochoduodenal Fistula.: Jun Ho Hur, Sun Taek Choi, Min Su Sohn, Ji Eun Lee, In Hee Chung, Sung Ho Ki; Yeungnam Univ J Med. 2013;30(1):39-42. Published online June 30, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.1.39

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Abstract PDF: Cholelithiasis, duodenal ulcer, duodenal perforation and tumor invasion may lead to choledochoduodenal fistula (CDF). CDF often has no specific symptoms and may be incidentally detected in an upper gastrointestinal radiographic study or endoscopy; but in some cases, it may be accompanied by recurrent cholangitis and liver abscess. In this paper, a case of recurrent liver abscess caused by CDF is reported. A 62-year-old female was admitted to the authors' hospital because of right upper quadrant pain and fever. The abdominal computed tomography showed a liver abscess in the right lobe. A duodenal fistulous orifice was detected with endoscopy, and a contrast was injected through the duodenal orifice using a catheter under fluoroscopy. The injection of the contrast revealed a fistulous track between the duodenal bulb and the common hepatic duct. In fistulas complicated by recurrent liver abscess, surgery or medical management may be needed. The CDF in this case study was treated via endoscopic clipping.

An Unusual Cause of Gastrointestinal Hemorrhage: Gastrocolic Fistula Caused by Colon Cancer Invasion.: Jeong Hyeon Cho, In Tae Kim, Jin Yi Choi, Song Wook Chun, Beo Deul Kang, Sang Kyun Bae, Hee Man Kim, Ji Sun Song; Yeungnam Univ J Med. 2013;30(1):43-46. Published online June 30, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.1.43

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Abstract PDF: Gastrocolic fistula is a fistulous communication between the stomach and the colon. It is a passage between the gastric epithelium and the colonic epithelium. This uncommon complication is caused by benign and malignant diseases of the stomach or the colon. Its clinical manifestations include weight loss, diarrhea and fecal vomiting; occasionally, anemia, poor oral intake, fatigue and dizziness; and very rarely, gastrointestinal bleeding. In this paper, an unusual case of gastrocolic fistula accompanied by hematochezia, which was revealed to have been caused by colon cancer invasion, is described.

A Case of Pancytopenia with Hyperthyroidism.: Tae Hoon Kim, Ji Sung Yoon, Byung Sam Park, Dong Won Lee, Jae Ho Cho, Jun Sung Moon, Eui Hyun Kim, Kyu Chang Won, Hyoung Woo Lee; Yeungnam Univ J Med. 2013;30(1):47-50. Published online June 30, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.1.47

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Abstract PDF

There has been an increase in the number of reports of atypical manifestations of Graves' disease (GD), such as jaundice, anemia, thrombocytopenia and leukopenia. Pancytopenia also rarely occurs in GD. In this paper, a case of pancytopenia with GD that was successfully treated with an anti-thyroid drug is reported. In this case, a 69-year-old woman showed pancytopenia with a normal peripheral blood smear, bone marrow aspiration smear and bone marrow biopsy. Her thyroid function test and thyroid scintigraphy confirmed her hyperthyroid status. Her laboratory abnormality and clinical condition improved after she was treated with an anti-thyroid drug. This is a rare case of pancytopenia associated with GD.

Citations

Citations to this article as recorded by

Therapeutic plasma exchange for Graves’ disease in pregnancy
Matthew Lumchee, Mimi Yue, Josephine Laurie, Adam Morton
Obstetric Medicine.2023; 16(2): 126. CrossRef
Non-myeloproliferative Pancytopenia: A Rare Presentation of Thyrotoxicosis
Izzathunnisa Rahmathullah, Maheswaran Umakanth, Suranga Singhapathirane
Cureus.2023;[Epub] CrossRef
Atypical Complications of Graves’ Disease: A Case Report and Literature Review
Khaled Ahmed Baagar, Mashhood Ahmed Siddique, Shaimaa Ahmed Arroub, Ahmed Hamdi Ebrahim, Amin Ahmed Jayyousi
Case Reports in Endocrinology.2017; 2017: 1. CrossRef

A Case of Synovial Sarcoma in Mediastinum.: Yong Hoon Yoon, Dong Uk Kang, Eun Jeong Gong, Sang Yong Om, Jin Seo Lee, Ji Won Lyu, Woo Sung Kim; Yeungnam Univ J Med. 2013;30(1):51-54. Published online June 30, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.1.51

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Abstract PDF: Synovial sarcoma is a rare malignancy in the thoracic cavity, especially in the mediastinum. In this paper, a case of primary mediastinal synovial sarcoma is reported. A 34-year-old woman was hospitalized with dyspnea. Her chest X-ray and computed tomography (CT) showed a 16x13x11 cm mass in her anterior mediastinal space. Surgical resection was performed but was incomplete. The pathological and immunohistochemical analysis confirmed the diagnosis of monophasic spindle cell synovial sarcoma. The patient underwent adjuvant radiotherapy for two months, but local recurrence and metastasis occurred in her pleural cavity. She eventually underwent chemotherapy for one year and died 18 months after her operation.

A Case of Successful Treatment of Refractory Synovitis Acne Pustulosis Hyperostosis Osteitis (SAPHO) Syndrome with Adalimumab.: Jin Taek Yoo, Young Hwan Kim, Soon Myung Jung, Sang Chang Kwon, Seung Min Ryu, Jun Ouk Ha, Joung Wook Lee; Yeungnam Univ J Med. 2013;30(1):55-57. Published online June 30, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.1.55

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Abstract PDF: Synovitis acne pustulosis hyperostosis osteitis (SAPHO) syndrome is a rare disease that involves the skin, bones and joints. It is thought to be caused by infection with low-toxicity bacteria and to be the result of reactive infectious osteitis. However, this hypothesis has not yet been clearly established. New SAPHO syndrome treatment methods are needed because the disease does not respond to treatment in many cases. In this paper, a case is reported of SAPHO syndrome with pain in the acromioclavicular joint and with squamous and pustular macules on the palms and soles. First, the patient was treated with aceclofenac, prednisolon and sulfasalazine for two weeks. However, the symptoms were not relieved, so methotrexate and pamidronate were added to the treatment. Since no improvement was seen after four weeks of treatment, adalimumab was prescribed. The skin lesions were relieved two weeks later, and the bone pain and arthralgia, four weeks later. No recurrence or adverse effects were observed at the 22-week follow-up.

A Case of Severe Enterovirus Pneumonia in an Immunocompetent Adult.: Dong Won Lee, Eun Young Choi; Yeungnam Univ J Med. 2013;30(1):58-61. Published online June 30, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.1.58

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Abstract PDF: Enterovirus commonly causes neurologic diseases (aseptic meningitis, encephalitis, etc.), hand-foot-mouth disease, herpangina, and acute hemorrhagic conjunctivitis. However, it rarely causes pneumonia in immunocompetent adults. In Korea, no case has been reported about pneumonia caused by enterovirus in healthy adults. We can cite the case of a 20-year-old woman who presented severe community-acquired pneumonia caused by enterovirus. The diagnosis was based on reverse transcriptase polymerase chain reaction (RT-PCR) of a respiratory specimen.

A Case of Huge Gastric Bezoar Removed by Endoscopic Combination Therapy with Coca-Cola Injection.: Min Suk Jung, Jang Won Lee, Seung Hyun Lee, Dong Hyun Kim, Sang Hwan Byun, Yeong Muk Kim; Yeungnam Univ J Med. 2013;30(1):62-65. Published online June 30, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.1.62

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Abstract PDF

Gastric bezoars are concretion of undigested material in the gastrointestinal tract. In the past, gastric bezoars were generally treated with surgical management. Recently, the efficacy of oral intake or endoscopic injection therapy with Coca-Cola has been reported. We report a case of a 47-year-old-man with huge gastric bezoar (4x2.5 cm) that was successfully removed by endoscopic fragmentation with Coca-Cola injection. Compared with a single endoscopic fragmentation therapy, the combination therapy with Coca-Cola injection shortened the procedure time and reduced the complication associated with fragmented bezoar.

Citations

Citations to this article as recorded by

Successful removal of a foreign body by endoscopic balloon dilatation at the colonic stricture
Chang Jo Im, Ji Hoon Na, Hyun Sik Kim, Sung Sam Ha, Yoo Li Lim, Ji Hyeon Lee, Hee Kyoung Choi, Hee Man Kim
Yeungnam University Journal of Medicine.2016; 33(1): 29. CrossRef

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