Journal of Yeungnam Medical Science

Volume 33(2); December 2016

Review

The roles of endoscopic ultrasound in the diagnosis of pancreatobiliary cancer.: Kook Hyun Kim; Yeungnam Univ J Med. 2016;33(2):77-84. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.77

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Abstract PDF: Pancreatic cancer, the 4th leading cause of cancer-related death in the United States, has a very poor prognosis. Cholangiocarcinoma originates from either intrahepatic or extrahepatic bile duct, and its incidence is gradually increasing worldwide. Endoscopic retrograde cholangiopancreatography with brush cytology has a high false-negative rate for the diagnosis of biliary malignancy. Recently, endoscopic ultrasonography (EUS) has emerged as the potential modality to detect pancreatic cancer. EUS-guided fine needle aspiration for cytologic analysis made it possible to overcome the obstacle in differentiating between benign and malignant lesions in the pancreatobiliary lesion, and it has been well established as a safe and effective procedure. Herein, the clinical application of EUS in the diagnosis of pancreatobiliary cancer was reviewed.

Original Articles

The effect of formaldehyde on neurobehavioral performance of student during cadaver dissection.: Yong Sakong, Hee Yoon Jo, In Gook Lee, Kyeong Soo Lee, Man Joong Jun; Yeungnam Univ J Med. 2016;33(2):85-89. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.85

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Abstract PDF

BACKGROUND
Formaldehyde is used to preserve cadaver in medical schools, and students are exposed to formaldehyde during cadaver dissection classes. When humans are exposed to formaldehyde, it induces mucosal inflammation, skin inflammation, and declining of neurobehavioral function including attention and memory executive functions. The purpose of this study is to identify the effects of formaldehyde exposure on student's neurobehavioral performance during cadaver dissection classes. METHODS: The level of formaldehyde was measured in a cadaver dissection class. A total of 16 students were randomly divided into two groups. One group wore respiratory protection masks, while the other group did not. Among many subtests in Korean Computerized Neurobehavioral test, backward digit span was tested on all subjects before and after the class. RESULTS: The length of memorized digit span between the two groups was not significant; however there was a greater decrease in neurobehavioral function after formaldehyde exposure in the non-mask group than the mask group. CONCLUSION: Formaldehyde exposure during cadaver dissection may likely decrease neurobehavioral performance of students. Therefore, proper ventilation system and respiratory protective equipment are necessary to protect medical school students from adverse effects of formaldehyde exposure.

Citations

Citations to this article as recorded by

Safety and Management Status of Anatomical Labs in Medical Schools
Jae-Hee Park, Kwang-Rak Park, An-Na Bae, Han-Gyu Jeong, Jae-Ho Lee
Keimyung Medical Journal.2022; 41(2): 76. CrossRef
Associations between smartphone addiction scale and sociopsychological aspects in medical school students
Hye In Kim, Seong Hi Cheon, Hwa Jeong Kang, Keunmi Lee, Seung Pil Jung
Yeungnam University Journal of Medicine.2017; 34(1): 55. CrossRef

Attenuation of pneumoperitoneum-induced hypertension by intra-peritoneal lidocaine before pneumoperitoneum in laparoscopic cholecystectomy.: Sun Ok Song, Hae Mi Lee, Sung Soo Yun, Hwarim Yu, Soo Young Shim, Heung Dae Kim; Yeungnam Univ J Med. 2016;33(2):90-97. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.90

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Abstract PDF: BACKGROUND
We have previously found that intra-peritoneal lidocaine instillation before pneumoperitoneum attenuates pneumoperitoneum-induced hypertension. Whether this procedure alters patient's hemodynamic status during operation should be determined for clinical application. This study elucidated the possible mechanism of the attenuation of the pneumoperitoneum-induced hypertension by intra-peritoneal lidocaine before pneumoperitoneum. METHODS: Thirty-four patients underwent laparoscopic cholecystectomy (LC) were randomly allocated into two groups. After induction of general anesthesia, 200 mL of 0.2% lidocaine (lidocaine group, n=17), or normal saline (control group, n=17) were sub-diaphragmatically instilled 10 minutes before pneumoperitoneum. The changes in systolic blood pressure, heart rate, central venous pressure, stroke volume, cardiac output, and systemic vascular resistance were compared between the groups. The number of analgesics used during post-operative 24 h was compared. RESULTS: Systolic blood pressure was elevated during pneumoperitoneum in both groups (p<0.01), but the degree of elevation was significantly reduced in the lidocaine group than in the control (p<0.01). However, stroke volume and cardiac output were decreased and systemic vascular resistance was increased after induction of pneumoperitoneum (p<0.05) without statistical difference between two groups. The number of analgesics used was significantly reduced in the lidocaine group (p<0.01). CONCLUSION: These data suggest that intra-peritoneal lidocaine before pneumoperitoneum does not alter patient's hemodynamics, and attenuation of pneumoperitoneum-induced hypertension may be the consequence of reduced intra-abdominal pain rather than the decrease of cardiac output during pneumoperitoneum. Therefore, intra-peritoneal lidocaine instillation before pneumoperitoneum is a useful method to manage an intraoperative pneumoperitoneum-induced hypertension and to control postoperative pain without severe detrimental hemodynamic effects.

Clinical features according to chest radiologic patterns of Mycoplasma pneumonia in children.: Young Hyun Kim, Jin Hyeon Kim, Sae Yoon Kim, Young Hwan Lee; Yeungnam Univ J Med. 2016;33(2):98-104. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.98

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Abstract PDF: BACKGROUND
Clinical differences in Mycoplasma pneumonia (MP) in children and adolescent patients according to abnormal infiltrate patterns on the chest X-ray were compared. METHODS: From 2012 to 2015, patients (n=336) diagnosed with MP at Yeungnam University Medical Center have been classified as eiher lobar pneumonia or bronchopneumonia based on the infilterate patterns observed on chest X-ray. Cases were analyzed retrospectively for gender, age, seasonal incidence rate, main symptoms (fever duration, extrapulmonary symptoms), and laboratory results, including white blood cell count, hemoglobin, platelets, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), as well as concurrent respiratory virus infection. RESULTS: The following results were observed. First, lobar pneumonia affected 22.0% of all MP patients and was the most common in preschool children, with a high incidence rate in November and December. Second, lobar pneumonia had a longer fever duration than bronchopneumonia (p<0.001), and also showed significantly higher platelets (336.8 vs. 299.1 k/µL, p=0.026), ESR(46.3 vs. 26.0mm/hr, p<0.001) and CRP (4.86 vs. 2.18mg/dL, p=0.001). Third, viral co-infection was more common in bronchopneumonia (p=0.017), affecting 66.7% of infants and toddlers (p=0.034). Finaly, lobar consolidation was most common in both lower lobes. CONCLUSION: MP in children has increased in younger age groups, and the rate of lobar pneumonia with severe clinical symptoms is higher in older children.

Urinary tract infections in pediatric oncology patients with febrile neutropenia.: Kyoo Hyun Suh, Sun Young Park, Sae Yoon Kim, Jae Min Lee; Yeungnam Univ J Med. 2016;33(2):105-111. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.105

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Abstract PDF: BACKGROUND
Neutropenic fever is one of the most common and potentially severe complications of chemotherapy in pediatric oncology patients, while urinary tract infection (UTI) is one of the most prevalent bacterial infections in these patients. Therefore, this study was conducted to investigate features of UTI with neutropenic fever in pediatric oncology patients. METHODS: We retrospectively reviewed and analyzed the medical records, laboratory results and image findings of cases of neutropenic fever in the Department of Pediatrics of Yeungnam University Medical Center, South Korea between November 2013 and May 2015. Episodes were divided into two groups, UTI vs. non-UTI group according to the results of urine culture. The results were then compared between groups. The analysis was performed using IBM SPSS 23.0. A p-value <0.05 was considered to indicate a significant difference between groups. RESULTS: Overall, 112 episodes of neutropenic fever were analyzed, among which 22 episodes (19.6%) showed organisms on urine culture and were classified as UTI. The remaining 90 episodes were classified as non-UTI. Only four episodes (18.2%) of the UTI group showed pyuria on urine analysis. In the UTI group, 76.5% were sensitive to the first line antibiotics and showed higher clinical response than the non-UTI group. Among hematologic malignancy patients, the UTI group revealed higher serum β 2-microglobulin levels than the non-UTI group (1.56±0.43 mg/L vs. 1.2±0.43 mg/L, p<0.028). CONCLUSION: UTI in pediatric neutropenic fever responds well to antibiotics. Hematologic malignancy cases with UTI reveal increased serum β2-microglobulin level. These results will be helpful to early phase diagnosis of UTI.

Case Reports

Lymphocytic interstitial pneumonia in a patient with Sjögren's syndrome.: Eun Hye Lee, Ji Eun Park, Eun Kyong Goag, Young Joo Kim, In Young Jung, Chi Young Kim, Young Mok Park, Jung Mo Lee, Moo Suk Park; Yeungnam Univ J Med. 2016;33(2):112-115. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.112

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Abstract PDF: Lymphocytic interstitial pneumonia (LIP) is a rare benign lymphoproliferative disorder characterized by diffuse infiltration of the pulmonary parenchymal interstitium by polyclonal lymphocytes and plasma cells. LIP has been associated with a variety of clinical conditions; such as connective tissue disorders and other immune system abnormalities. Treatment usually involves administration of corticosteroids and other immunosuppressants. We report on a 38-year-old female patient who complained of shortness of breath, dry mouth, and dry eyes for more than 1 month, and was positive for Raynaud's phenomenon. Based on surgical biopsy, she was diagnosed as having LIP accompanied by Sjögren's syndrome. The patient was treated with high-dose steroids followed by maintenance therapy for approximately 2 years, and her condition improved.

Adult intussusception caused by inverted Meckel's diverticulum treated with operation.: Sung Yun Lee, Jae Yoon Jeong, Seung Hyun Hong, Seung Min Woo, Su Heui Lee, Hyun Joo You, Dong Won Kim; Yeungnam Univ J Med. 2016;33(2):116-119. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.116

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Abstract PDF: Intussusception is a serious disease where part of the intestine slides into an adjacent part of the intestine. Adult intussusception is mainly due to benign or malignant neoplasm. Therefore, in most cases of adult intussusception, treatment by surgery would be preferable to conservative therapy. However, we report on a 28-year-old female patient who underwent intussusception operation delayed 3 months. Abdominal computed tomography 3 months ago showed a small bowel intussusception measuring 20 cm long. Three months later, the previously identified small bowel intussusception appeared without change. The patient underwent surgery, and ectopic gastric mucosa was observed in the biopsy. Therefore, Meckel's diverticulum was diagnosed.

Subcutaneous tissue calcification in a patient with rheumatoid arthritis.: Dong Hyun Kim, Kyung Jin Kim, Sung Min Kwon, Sung Ouk Cha, Jung Ouk Lee; Yeungnam Univ J Med. 2016;33(2):120-124. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.120

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Abstract PDF: Subcutaneous tissue calcification in rheumatic diseases usually occurs in connective tissue diseases, such as systemic lupus erythematosus, scleroderma, and dermatomyositis. Domestic cases of calcification in rheumatoid arthritis have not been reported. The mechanism of subcutaneous tissue calcification may differ depending on the cause and it can develop on all parts of the body. Calcification occurring in rheumatic diseases is a major mechanism of tissue damage caused by chronic inflammation. No standard therapy for calcification has been established; however, many studies have reported on medical and surgical treatment. We report on subcutaneous tissue calcification in a rheumatoid arthritis patient tissue calcification on both sides of the buttocks, the upper limbs, and the lower limbs.

A patient with stress induced cardiomyopathy that occurred after cessation of hormone replacement therapy for panhypopituitarism.: Seoung Wan Nam, Jun Won Lee, Jeong Han Sim, Hyun Sung Pack, Changjo Im, Jung Soo Lim, Sung Gyun Ahn; Yeungnam Univ J Med. 2016;33(2):125-129. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.125

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Abstract PDF: Stress induced cardiomyopathy (SC) is characterized by transient left ventricular (LV) dysfunction in the absence of coronary artery disease. We report on a patient with panhypopituitarism who developed SC resulting from withdrawal of hormonal replacement therapy (HRT). A 52-year-old male visited our hospital for progressively worsening dyspnea. The patient had discontinued HRT 7 days ago, which had been administered for 18 months after transsphenoidal adenomectomy for pituitary macroadenoma. Initial electrocardiogram showed marked sinus bradycardia. Transthoracic echocardiography showed apical ballooning with an LV ejection fraction of 25%. No significant obstructive lesions were observed on coronary angiography. With a clinical diagnosis of SC associated with panhypopituitarism, HRT was restarted, including glucocorticoid and thyroxine, along with standard heart failure management. His LV function had normalized at 2-month follow-up. He remains asymptomatic and administration of beta-blocker and angiotensin converting enzyme inhibitor were discontinued He currently only requires HRT.

Lymphangioma involving whole mesentery confirmed by core needle biopsy.: Won Young Jang, Min Young Do, Byung Chan Ahn, Myeong Soon Park, Hyun Ah Kim, Seong Yeol Ryu, Sang Pyo Kim, Keon Uk Park; Yeungnam Univ J Med. 2016;33(2):130-133. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.130

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Abstract PDF: Lymphangiomas are malformations of the lymphatic system accounting for approximately 5% of all benign tumors in infants and children. Abdominal lymphangiomas are rare, and can arise from either the retroperitoneum, gastrointestinal tract, or the mesentery of the abdominal viscera. Lymphangioma involving the whole mesentery is particularly rare. Most lymphangiomas are detected during infancy or childhood, but intraabdominal lymphangiomas such as mesentery are not found until adulthood. We report here on a patient with uncommon lymphangioma involving the whole mesentery who presented with fever and abdominal pain. This patient is unusual because he was confirmed through core needle biopsy which showed variable sized lymphatic spaces representing a immunoreactive for D2-40 antibody with involvement of the whole mesentery. No cases of mesenteric lymphangioma confirmed preoperatively have been previously reported in Korea.

Lower limb ischemia after bee sting.: Hee Yun Ryu, Min Seok Yoo, Ji Young Park, Jae Woong Choi, Sung Kee Ryu, Seunghwan Kim, Se Jin Lee, Young Bin Kim; Yeungnam Univ J Med. 2016;33(2):134-137. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.134

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Abstract PDF

Bee sting causes mild symptoms such as urticaria and localized pain, and severe symptoms including anaphylaxis, cardiovascular collapse, and death. We reported on a patient with arterial thrombotic occlusion and severe ischemia in the lower limb after multiple bee stings. The patient was stung 5 times and complained of pallor, pain, and coldness in the left toe, and did not have dorsalis pedis pulsation. Computed tomography angiography showed multiple thrombotic occlusion of the anterior and posterial tibial artery below the knee. Local thrombolytic therapy using urokinase was administered and the occluded arteries were successfully recanalized.

Citations

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A Rare Case of Acute Lower Limb Ischemia following Bee Sting
Jayesh Patel, Arya Patel, Shivangi Jha, Ketul S Barot, Pratiksha Patel, Dwisha Poptani
Indian Journal of Vascular and Endovascular Surgery.2023; 10(3): 231. CrossRef

Retrieval of a dislodged and dismounted coronary stent; using a rendezvous and snare technique at the brachial artery level via femoral approach.: Min Woong Jeong, Chang Bae Sohn, Su Hong Kim, Jong Ik Park, Se Ryeong Park, Jun Sik Min; Yeungnam Univ J Med. 2016;33(2):138-141. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.138

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Abstract PDF: Coronary stent dislodgement during percutaneous coronary intervention, which occurs when the stent is passed through tortuous and calcified lesions, is not a rare complication. Without proper treatment, such as fixing with another stent in the coronary artery or removing the undeployed stent from the coronary artery or systemic artery system, this complication can cause serious problems. We experienced the unusual situation of a dismounted and dislodged coronary stent, in which retrograde retrieval to the radial artery was impossible during transradial coronary intervention. We report on use of a rendezvous and snare technique at the brachial artery level via femoral puncture, which resulted in resolution without surgery.

Metastatic eyelid cancer from gastric adenocarcinoma.: Ji Yoon Jung, Eun Joo Goo, Jae Chang Lee, Jay Song, Sung Ae Koh, Kyung Hee Lee, Young Kyung Bae; Yeungnam Univ J Med. 2016;33(2):142-145. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.142

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Abstract PDF: Gastric cancer is the most common cancer in Korean males and can easily spread to distant organs such as the liver, lungs, brain, or bones. However, skin metastasis, particularly of the eye, is rare. Metastatic eyelid cancer is extremely rare; metastases from internal organs have not been reported so far. We recently experienced a patient with metastatic eyelid cancer from adenocarcinoma of the stomach. A 62-year-old female was admitted with a right upper eyelid mass and foreign body sensation. She had a history of stomach cancer of 3 years. She was treated by chemotherapy and radiotherapy for pathologic fracture. After receiving supportive care for 2 years, the mass appeared on her right pupil. Punch-biopsy of the mass was performed and histological examination revealed adenocarcinoma, the same as the initial histological result. We report this case with a review of related literature.

Heterotopic bone formation in normal gastric cardiac mucosa.: Seok Hyeon Eom, Chang Hwan Park, Duk Won Chung, Sang Hyeok Lee, Ji Young Seo, Yeong Sung Kim, Dong Hyup Kwak, Jung Hee Kim; Yeungnam Univ J Med. 2016;33(2):146-149. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.146

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Abstract PDF: Heterotopic bone formation in the gastrointestinal tract is a rare phenomenon. Most reported cases were associated with benign and malignant neoplasms, except for a case in which heterotopic bone formation was found in a patient with Barrett's esophagus. The exact pathogenesis of the disease has not yet been established. However, most heterotopic bones found in the gastrointestinal tract were associated with mucinproducing tumors of the appendix, colon, and rectum. Inflammation may also play a role in osseous metaplasia in a case with bone formation at the base of an ulcer in Barrett's esophagus. Here, we report on a patient with heterotopic bone formation in normal gastric cardiac mucosa. A 50-year-old female visited our hospital for a routine health examination. She had no gastrointestinal symptoms, and her physical examination, blood test, X-ray, urine, and stool examination results were normal. A 0.3 cm sized polypoid lesion located just below the squamocolumnar junction was observed on upper gastrointestinal endoscopy. A piece of biopsy was taken. Histologically, a lamella bone trabecula and chronic inflammatory cells were observed in the gastric cardiac mucosa. The follow-up endoscopy performed one month later showed no residual lesion.

Chronic hepatitis C healed by peginterferon-α and rivabirin treatment after kidney transplantation.: Min Gue Seok, Tae Hee Lee, Sung Ro Yun, Won Min Hwang, Se Hee Yoon, In Soo Choe, Seong Joo Kang, Ju Young Hong, Dae Sung Kim; Yeungnam Univ J Med. 2016;33(2):150-154. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.150

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Abstract PDF: Hepatitis C virus (HCV) infection is present in a high proportion of patients with kidney transplantation. Compared with uninfected kidney transplant recipients, HCV infected kidney recipient have higher prevalence of liver disease and worse allograft survival after transplantation. Interferon monotherapy before transplantation is standard therapy for HCV-infected kidney transplant candidates. If HCV infection is discovered after transplantation, interferon monotherapy is considered due to the limited critical situation. However, in this patient, who was a kidney recipient, HCV infection was treated after kidney transplantation with peginterferon-α and rivabirin. As a result, the patient achieved sustained virologic response.

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