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Identification of streptococcus dysgalactiae subsp. equisimilis from septic knee by 16S rRNA gene sequencing.

Ji Sang PARK ; Hye Won KIM ; Jeong Don CHAE ; Jin Wuk HUR ; Yoon Seok PARK ; Min Seok YOO ; Hee Yoon RYU

Kosin Medical Journal.2016;31(1):79-85. doi:10.7180/kmj.2016.31.1.79

Septic arthritis is the infection of a joint by an infectious agent, leading to arthritis. It is therefore important to identify and treat the correct bacteria in septic arthritis. However, accurate identification of bacteria by conventional methods is difficult because of the distinct biochemical characteristics of individual bacteria. This case report aims at assessing septic arthritis caused by Streptococcus dysgalactiae subsp. equisimilis(SDSE) using nucleotide sequences and discusses the associated treatment. Here, Streptococcus agalactiae was determined to be the causative bacteria for septic arthritis in a 77 year-old woman using the conventional method of hemolysis pattern interpretation and morphology. However, nucleotide sequence analysis of 16S ribosomal RNA revealed that SDSE was the causative strain. 16S rRNA gene sequencing can correctly identify bacteria strains that are difficult to be identified by traditional method, and this correct identification can provide patients with the opportunity for adequate treatment using the proper antibiotics.
Anti-Bacterial Agents ; Arthritis ; Arthritis, Infectious ; Bacteria ; Base Sequence ; Female ; Genes, rRNA* ; Hemolysis ; Humans ; Joints ; Knee* ; Methods ; RNA, Ribosomal, 16S ; Streptococcus agalactiae ; Streptococcus*

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Paradoxical response as a cervical lymph node enlargement after termination of anti-tuberculosis treatment in a patient with pulmonary tuberculosis.

Hye Rim KANG ; Ho Young LEE ; Mi Yeong KIM ; Young Min LEE ; Soo Jin JUNG ; Hyun Kyung LEE ; Si Hyeong LEE ; Yunmi KIM

Kosin Medical Journal.2016;31(1):71-78. doi:10.7180/kmj.2016.31.1.71

A paradoxical response is not uncommon in non-HIV-infected patients, particularly those with extra-pulmonary tuberculosis. It is defined as the radiological and clinical worsening of a previous lesion or the development of new lesion during anti-tuberculosis therapy. The paradoxical response has been attributed to host immunologic reactions, such as a delayed hypersensitivity or a response to mycobacterial antigens. In most reports of paradoxical response, these responses occurred in the same location as a previous lesion. In this patient with pulmonary tuberculosis, cervical lymph node enlargement occurred as a paradoxical response after the completion of anti-tuberculosis treatment. Although the new lesion developed in another location, it could be considered as a paradoxical response based on the negative culture result of acid fast bacilli from the new lesion and drug sensitivity result from initial bronchoalveolar lavage specimen. Therefore we were able to decide on the termination of unnecessary anti-tuberculous treatment. Based on our case, we can conclude that paradoxical response can occur after the termination of anti-tuberculosis therapy even in new site.
Bronchoalveolar Lavage ; Diagnosis ; Humans ; Hypersensitivity, Delayed ; Lymph Nodes* ; Tuberculosis ; Tuberculosis, Pulmonary*

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Metachronous anterior urethral metastasis of prostatic ductal adenocarcinoma.

Jeong Hyun OH ; Taek Sang KIM ; Hyun Yul RHEW ; Bong Kwon CHUN

Kosin Medical Journal.2016;31(1):66-70. doi:10.7180/kmj.2016.31.1.66

Prostate cancer is increasing in frequency in Korea. Among them, ductal adenocarcinoma (DCP) has a more aggressive and poor prognosis than acinar adenocarcinoma (ACP), despite its low incidence. Patients usually present with symptoms of lower urinary tract symptoms and hematuria due to increasing tumor mass within the lumen of the prostatic urethra, making diagnosis of DCP by the transrectal prostate biopsy difficult. DCP is often metastasized at the time of diagnosis. DCP is transferable to most other organs but the metastasis to the anterior urethra is rare. There is no doubt that localized DCP requires radical prostatectomy (RP) but the guidelines for adjuvant therapy after RP have not yet been established. Methods of the treatment are confounded by individual differences, and arriving at a consensus is challenging due to insufficient data. We report a case of DCP and urethral metastasis after RP, thus aiding in the determination of treatment guidelines.
Adenocarcinoma* ; Biopsy ; Consensus ; Diagnosis ; Hematuria ; Humans ; Incidence ; Individuality ; Korea ; Lower Urinary Tract Symptoms ; Neoplasm Metastasis* ; Prognosis ; Prostate ; Prostatectomy ; Prostatic Neoplasms ; Urethra

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Endovascular treatment of acute limb ischemia due to thrombotic occlusion of the suprainguinal artery.

Byung Woo KANG ; Jun Ho BAE ; Deuk Young NAH ; Jin Wook CHUNG ; Byeong Joo JO ; Jun Gi PARK

Kosin Medical Journal.2016;31(1):56-65. doi:10.7180/kmj.2016.31.1.56

Acute limb ischemia (ALI) is a serious condition requiring prompt intervention due to a sudden decrease in limb perfusion threatening limb viability. Treatment of ALI depends on the clinical status of the affected limb and patient comorbidities. Surgical therapy has been the historical standard of care for restoring limb perfusion; however, percutaneous endovascular intervention has been shown to be a promising treatment option in selected patients of ALI at high surgical risk. We report on a case of a 75-year-old man with ALI caused by thrombotic occlusion of the suprainguinal artery, successfully treated with endovascular therapy including stent insertion and thrombus aspiration and catheter-directed urokinase infusion in view of the clinical findings and imaging studies.
Aged ; Arteries* ; Comorbidity ; Endovascular Procedures ; Extremities* ; Humans ; Ischemia* ; Lower Extremity ; Perfusion ; Standard of Care ; Stents ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator

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Medical students' perception and satisfaction with group discussion and presentation in medical ohilosophy course.

Min Jeong KIM ; Si Sung PARK

Kosin Medical Journal.2016;31(1):41-55. doi:10.7180/kmj.2016.31.1.41

OBJECTIVES: The purpose of this study was to evaluate the self-achievement, perception and satisfaction of group discussion and presentation in medical philosophy class. METHODS: A questionnaire was developed based on topical subject of main textbook of medical philosophy and course evaluation reported by students. The questionnaire composed of self-learning achievement for the seven subjects, perception of necessity and profitability of contents and education method of medical philosophy and satisfaction with components of education method and overall class. RESULTS: The data were collected from 250 medical students who complete the course of medical philosophy. Regardless of grade and gender, students reported high self-achievement, perception and overall satisfaction of medical philosophy course, but there were difference in satisfaction of components of each education methods. Students recognized positively as discussion and presentation in philosophy class, but had low awareness of the benefits of private small-group activities. The more students regarded it is beneficial for the contents and methods of philosophy classes, the overall satisfaction with the medical philosophy course was high. And the more students regarded it is necessary to educate and beneficial for the contents and methods of philosophy classes, the satisfaction with the education methods of medical philosophy course was high. CONCLUSION: To improve the achievement level and satisfaction with the philosophy course, it is necessary to induce active interest in small group activities, and provide detailed and various discussion materials in class.
Education ; Education, Medical ; Evaluation Studies as Topic ; Humans ; Methods ; Philosophy ; Philosophy, Medical ; Students, Medical

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Quercetin induces cell death by caspase-dependent and p38 MAPK pathway in EGFR mutant lung cancer cells.

Eun Jin LIM ; Jeunghoon HEO ; Young Ho KIM

Kosin Medical Journal.2016;31(1):30-40. doi:10.7180/kmj.2016.31.1.30

OBJECTIVES: The aim of this study was whether quercetin induces cell death by caspase and MAPK signaling pathway in EGFR mutant lung cancer cells. METHODS: PC-9 cells, EGFR mutant lung cancer cells, were treated various times and concentrations of quercetin and harvested and measured using MTT assay, DNA fragmentation, Western blotting, and FACS analysis. RESULTS: Treatment with quercetin in PC-9 cells resulted in inhibition of cell growth through apoptosis. Quercetin-induced apoptosis was associated with caspase-dependent manner. Quercetin also significantly increased levels of phosphor-p38 and decreased levels of phosphor-ERK, indicating that quercetin induces p38 MAPK signaling pathway in PC-9 cells. Quecetin treatment also generated the release of cytochrome c in PC-9 cells; however, pretreatment with rotenone or z-LEHD-fmk, significantly attenuated quercetin-induced apoptosis. CONCLUSIONS: Our data indicate that quercetin exhibits EGFR mutant lung cancer effects through apoptosis by caspase dependent and mitochondrial pathway.
Apoptosis ; Blotting, Western ; Cell Death* ; Cytochromes c ; DNA Fragmentation ; Lung Neoplasms* ; Lung* ; Mitochondria ; p38 Mitogen-Activated Protein Kinases* ; Quercetin* ; Rotenone

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Comparison of survival outcomes between modified radical mastectomy and breast conserving surgery in early breast cancer patients.

Yoon Seok KIM ; Dong Won RYU ; Chung Han LEE

Kosin Medical Journal.2016;31(1):19-29. doi:10.7180/kmj.2016.31.1.19

OBJECTIVES: Breast conserving surgery (BCS) for early breast cancer is now an accepted treatment, but there are controversies about its comparability with mastectomy. Thus, we investigated the survival outcomes who underwent BCS and modified radical mastectomy (MRM). METHODS: In this retrospective review, we analyzed the survival outcomes of 618 patients with early breast cancer who underwent two different surgery from January 2002 to December 2009. Postoperative pathologic difference, disease free survival period, overall survival period, recurrence pattern, recurrent rate and site were compared. In addition, preoperative patients data are also collected. RESULTS: Disease free survival period of MRM and BCS was 108.46 months and 80.82 months, respectively (P < 0.01). However, there was no significant correlation between overall survival period and operative methods (P = 0.67). In addition, recurrence pattern (P = 0.21), recurrent rate (P = 0.36) and site (P = 0.45, P = 0.09) were not associated with operative method. CONCLUSIONS: In this study, we can suggest that early breast cancer patients could improve their disease free survival if they underwent MRM. So, when we operate high risk breast cancer patients, MRM could be considered for their disease free life. Further studies may be required to establish appropriate strategy of surgery for early breast cancer.
Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Humans ; Mastectomy ; Mastectomy, Modified Radical* ; Mastectomy, Segmental* ; Methods ; Recurrence ; Retrospective Studies

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Aging of the respiratory system.

Seung Hun LEE ; Su Jin YIM ; Ho Cheol KIM

Kosin Medical Journal.2016;31(1):11-18. doi:10.7180/kmj.2016.31.1.11

Changes in the respiratory system caused by aging generally include structural changes in the thoracic cage and lung parenchyma, abnormal findings on lung function tests, ventilation and gas exchange abnormalities, decreased exercise capacity, and reduced respiratory muscle strength. Decreased respiratory system compliance caused by reduced elastic recoil of the lung parenchymaand thoracic cage is related to decreased energy expenditure by the respiratory system. Lung function, as measured by 1-second forced expiratory volume and forced vital capacity (FVC), decreases with age, whereas total lung capacity remains unchanged. FVC decreases because of increased residual volume and diffusion capacity also decreases. Increased physiological dead space and ventilation/perfusion imbalance may reduce blood oxygen levels and increase the alveolar-arterial oxygen difference. More than 20% decrease in diaphragmstrength is thought to beassociated withaging-related muscle atrophy. Ventilation per minute remains unchanged, and blood carbon dioxide concentration does not increase with aging. However, responses to hypoxia and hypercapnia are decreased. Exercise capacity also decreases, and maximum oxygen consumption decreases by >1%/year. Consequence of these changes, many respiratory diseases occur with aging. Thus, it is important to recognize these aging-related respiratory system changes.
Aging* ; Anoxia ; Carbon Dioxide ; Compliance ; Diffusion ; Energy Metabolism ; Forced Expiratory Volume ; Hypercapnia ; Lung ; Muscular Atrophy ; Oxygen ; Oxygen Consumption ; Residual Volume ; Respiratory Function Tests ; Respiratory Muscles ; Respiratory System* ; Total Lung Capacity ; Ventilation ; Vital Capacity

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Uterine cancer and ezrin expression.

Yeon Suk KIM ; Tae Hee KIM ; Hae Hyeog LEE ; Heung Yeol KIM ; Dahyae JANG ; Arum LEE

Kosin Medical Journal.2016;31(1):5-10. doi:10.7180/kmj.2016.31.1.5

Today, almost 20% of female cancers are gynecological in nature. In particular, uterine cervical cancer and endometrial cancer (which have been intensively studied) seriously compromise female health. One of the ezrin-radixin-moesin (ERM) proteins, ezrin, has been associated with cancer in prior studies, including the two cancers mentioned above. Ezrin expression increases, as does the expression of other factors, in uterine cervical cancer; ezrin may promote cancer development by influencing the actions of the other factors. Also, an increase in ezrin level contributes to the development of diseases such as endometrial cancer.
Cervical Intraepithelial Neoplasia ; Endometrial Neoplasms ; Female ; Humans ; Uterine Cervical Neoplasms ; Uterine Neoplasms*

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A Case Of Huge Brunner's Gland Adenoma With Acute Bleeding Treated By Endoscopic Resection.

Pyung Kang PARK ; Woo Cho CHUNG ; Kyoung Yong LEE ; Sung Hak LEE ; Jae Jung JANG ; Seungchul SUH

Kosin Medical Journal.2015;30(2):171-174. doi:10.7180/kmj.2015.30.2.171

Brunner's gland adenoma is a rare benign small bowel neoplasm and it represents 10% of small bowel benign tumor. Most of adenoma manifest as polypoidal, multiple and size does not exceed 1 cm and mostly asymptomatic, but the lesion larger than 1cm is solitary and can cause bleeding, obstruction, intussusception and there are some reports of showing malignant transformation. Until the present, there are two cases of over cm huge Brunner's gland adenoma in Korea and each of their chief complaint was abdominal discomfort and melena, but there is no case report of over 8cm Brunner's gland adenoma accompanied with acute bleeding as seen in this case. We diagnosed an 8cm sized, huge duodenal Brunner's gland adenoma which accompanied with acute bleeding and treated it by endoscopic resection using an IT-knife, successfully.
Adenoma* ; Endoscopy ; Hemorrhage* ; Intussusception ; Korea ; Melena

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