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Giant Right Atrial Thrombus associated with Tunneled Cuffed Hemodialysis Catheter: A Case of Successful Treatment with Thrombolytic Agent and Anticoagulant.

Young Jin SONG ; Young Ki LEE ; Sun Ryoung CHOI ; Ji Hyun KIM ; Sun Woo KIM ; Jung Woo NOH

Kosin Medical Journal.2013;28(1):61-65. doi:10.7180/kmj.2013.28.1.61

There are a variety of tunneled cuffed hemodialysis catheter-related complications including infection, thrombus formation, and catheter dysfunction. Catheter-related thrombus in right atrium is a rare complication and treatment guideline for atrial thrombus does not exist. A 3.0x2.8 cm sized giant atrial thrombus was found in a 35-year-old female hemodialysis patient. She was treated with catheter removal, thrombolysis and anticoagulation therapy. Size of atrial thrombus was gradually decreased and left ventricular systolic function was clearly improved after treatment. We experienced and reported a case of giant right atrial thrombus associated with tunneled cuffed hemodialysis catheter that was successful treated with thrombolytic agent and anticoagulant.
Catheters ; Female ; Heart Atria ; Humans ; Renal Dialysis ; Thrombolytic Therapy ; Thrombosis

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Treatment of Stent Dislodgement Complicated by Coronary Artery Dissection using Parallel Wire Technique and Small Balloon.

Su Young KIM ; Seung Hee HAN ; Kyung Han KIM ; Moo Hyun KIM ; Jong Sung PARK

Kosin Medical Journal.2013;28(1):55-60. doi:10.7180/kmj.2013.28.1.55

Stent dislodgement is a rare complication of complex percutaneous coronary artery intervention and is often associated with significant morbidity. We report a case of stent dislodgement complicated by coronary artery dissection and acute total occlusion of left circumflex coronary artery. Direct expansion of the dislodged stent was performed using parallel wire technique and small balloon. An overlapping stent was implanted for remained coronary artery dissection. Coronary artery flow was restored and ST segment elevation was normalized after successful intervention.
Coronary Vessels ; Stents

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Two Cases of Increased Parasympathetic Nerve System in Irritable Bowel Syndrome with Diarrhea as a Predominant Symptom.

Eui Kyu KANG ; Jong Soon CHOI

Kosin Medical Journal.2013;28(1):49-54. doi:10.7180/kmj.2013.28.1.49

The irritable bowel syndrome(IBS) is a chronic functional gastrointestinal disorder, characterized by abdominal pain, bloating and bowel disturbance. The pathophysiology of IBS is very complicated. Recent studies indicate that the most important mechanisms include visceral hypersensitivity, abnormal gut motility, autonomic nervous system(ANS) dysfunction and disorder of regulation of the brain-gut axis. Patients with IBS frequently present impaired autonomic regulation. Heart rate variability(HRV) is an acknowledged tool for estimating autonomic function. We experienced two cases of increased parasympathetic nervous system by HRV in irritable bowel syndrome with diarrhea as a predominant symptom.
Abdominal Pain ; Autonomic Nervous System ; Axis, Cervical Vertebra ; Diarrhea ; Gastrointestinal Diseases ; Heart Rate ; Humans ; Hypersensitivity ; Irritable Bowel Syndrome ; Parasympathetic Nervous System

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Extended Spectrum beta-lactamase-producing E. coli-related Nosocomial Peritonitis Treated Successfully with Meropenem in a Patient on Peritoneal Dialysis.

Seong Kyu JEONG ; Yeong Hee HAM ; Jin Hyuk JO ; Yeong Sin SIN ; Dong HEO ; Hark RIM

Kosin Medical Journal.2013;28(1):43-47. doi:10.7180/kmj.2013.28.1.43

Peritonitis is a common and potentially serious infection in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The most common organisms usually associated with CAPD peritonitis are Staphylococcus aureus and Staphylococcus epidermidis. Rarely, aerobic gram negative bacilli have been the causative agents of CAPD peritonitis. The treatment of CAPD peritonitis requires removal of the peritoneal catheter and treatment with parenteral antibiotics active against the causative pathogen. While hospitalized for CAPD peritonitis, a 55-year-old man on CAPD had nosocomial peritonitis secondary to infection by ESBL-producing E.coli, that was sensitive to imipenem and meropenem. He was treated successfully with a 4-week course of intraperitoneal meropenem therapy without subsequent relapse, loss of peritoneal catheter, ultrafiltration failure, or dialysis inadequacy.
Anti-Bacterial Agents ; Catheters ; Dialysis ; Escherichia coli ; Humans ; Imipenem ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Recurrence ; Staphylococcus aureus ; Staphylococcus epidermidis ; Thienamycins ; Ultrafiltration

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The Association Between Serum GGT Level and Bone Mineral Density in Postmenopausal Women.

Heung Yeol KIM ; Eun Hee KONG

Kosin Medical Journal.2013;28(1):35-41. doi:10.7180/kmj.2013.28.1.35

OBJECTIVES: The aim of this study was to identify the relationship between serum gamma-glutamyltransferase (GGT) and bone mineral density (BMD) in postmenopausal women. METHODS: We evaluated 200 postmenopausal women who were visiting a health promotion center at a university hospital from January 2009 to December 2011. Their current medical diseases and medication history were collected through medical records. Basic physical examinations and laboratory tests were performed on all subjects. RESULTS: The levels of serum GGT within their normal range were positively correlated with waist circumference (P = 0.01), triglycerides (P <0.001), alkaline phosphatase (P = 0.009), and uric acid (P = 0.01). The serum GGT within their normal range were negatively associated with the femur neck BMD (P = 0.002). In adjusted analysis including age and body mass index, the BMD of the femur neck was more strongly associated with a high-normal serum GGT level among the postmenopausal women as compared with those with a low-normal serum GGT level (P = 0.02). CONCLUSIONS: Serum GGT within its normal range is negatively correlated with the BMD in the femur neck among postmenopausal women. It can be useful for selecting a group that is at high risk for the bone fracture regardless of the underlying mechanism.
Alkaline Phosphatase ; Body Mass Index ; Bone Density ; Female ; Femur Neck ; Fractures, Bone ; gamma-Glutamyltransferase ; Health Promotion ; Humans ; Medical Records ; Physical Examination ; Postmenopause ; Reference Values ; Triglycerides ; Uric Acid ; Waist Circumference

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Laparoscopy-assisted Distal Gastrectomy with Systemic D2 Lymphadenectomy for Gastric Cancer: Usefulness of Noncompliance Rate to Validate the Completion of D2.

Kyung Won SEO ; Kae Won PARK ; Ki Young YOON

Kosin Medical Journal.2013;28(1):27-33. doi:10.7180/kmj.2013.28.1.27

OBJECTIVES: Laparoscopy-assisted distal gastrectomy (LADG) is a common surgical procedure that has recently been accepted as safe and feasible for the treatment of early gastric cancer. There have been many efforts to expand the indications of LADG to include the treatment of advanced gastric cancer. The aim of this study was to determine the usefulness of noncompliance rate as an indicator for D2 lymph node dissection (LND) validation in LADG. METHODS: The subjects were 48 patients who underwent distal gastrectomy with D2 LND at Kosin University Gospel Hospital from October to December 2010. Of them, 28 underwent LADG and 20 underwent open distal gastrectomy (ODG). We compared several factors including noncompliance rate to validate D2 LND. RESULTS: There were no significant differences in clinicopathologic factors except for BMI and tumor depth between the two groups. The average number of retrieved lymph nodes was significantly greater in the ODG group (45.9 +/- 2.9) than in the LADG group (35.5 +/- 2.0). The noncompliance rate was 43% in the LADG group and 40% in the ODG group with no significant difference. CONCLUSIONS: In terms of no difference of noncompliance rate, LADG with D2 lymph node dissection is a safe, feasible and oncologicallycamparable with open gastrectomy. A large scaled prospective randomized trial should be needed to confirm the benefit of LADG.
Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Stomach Neoplasms

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Endovascular or Microsurgical Treatment of Intracranial Aneurysms: Single Center Analysis.

Jin Wook KIM ; Won Bae SEUNG ; Yong Seok PARK

Kosin Medical Journal.2013;28(1):19-26. doi:10.7180/kmj.2013.28.1.19

OBJECTIVES: The objective of this study was to assess effectiveness and outcomes of endovascular versus microsurgical treatment for intracranial aneurysms in single hospital. METHODS: This was a retrospective study, using data collected during 4 year (between 2008 and 2011) from single hospital(Kosin University Gospel Hospital). A total of 274 treated, intracranial aneurysm cases were evaluated. The measurements used were effectiveness as measured by hospital discharge outcomes: 1) mortality (in-hospital death), 2) clinical outcomes(modified Ranking Scale: mRS). RESULTS: Among total of 274 cases, unruptured intracranial aneurysm cases were 132 cases and ruptured cases were 142 cases. Among unruptured 132 cases, 65 cases were treated by microsurgical treatment and 67 cases were treated by endovascular treatment. Among ruptured 142 cases, 61 cases were treated by microsurgical treatment and 81 cases were treated by endovascular treatment. In unruptured cases, there was not any fatal complication and same adverse outcomes (3% versus 3%). In ruptured case, in regards of treatment modality (i.e., endovascular versus microsurgical treatment), each clinical outcomes were as followings; good clinical outcome was 53.1% (43/81) versus 41.0% (25/61), moderate clinical outcome was 13.6% (1/81) versus 9.8% (6/61), severe clinical outcome was 18.5% (15/81) versus 22.9% (29/142) and fatal outcome was 14.8 (12/81) versus 26.2% (16/61). CONCLUSIONS: This analysis of single hospital data indicates that endovascular therapy is associated with significantly less morbidity, less mortality, compared with conventional microsurgical treatment for all intracranial aneurysms. Endovascular therapy, as a treatment alternative to microsurgical clipping, should be offered as a viable therapeutic option for all patients considering treatment of an intracranial aneurysm.
Fatal Outcome ; Humans ; Intracranial Aneurysm ; Retrospective Studies

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The Efficacy of Carpal Tunnel Release with Mini-Open Incision.

Young Ho KWON ; Jae Man KWAK

Kosin Medical Journal.2013;28(1):13-18. doi:10.7180/kmj.2013.28.1.13

OBJECTIVES: We evaluated the effects of carpal tunnel release with a mini-open incision by analyzing symptom improvement. METHODS: We retrospectively reviewed 64 carpal tunnel syndrome patients who underwent carpal tunnel release with mini-open incisions between January 2001 and December 2010. The 22 males and 42 females had a mean age of 49 years and a mean follow-up of 12 months. We analyzed postoperative symptoms using The Michigan Hand Outcome Questionnaire. RESULTS: Patients reported complete resolution of their symptoms, and some patients who had presented with residual symptoms improved gradually. No complications or scar hypersensitivity were observed. MHQ(Michigan Hand outcomes Questionnaire) scores improved significantly between preoperative and postoperative 6 months and 12 months. CONCLUSIONS: Carpal tunnel release with mini-open incision provides a clinically effective, reliable and safe procedure.
Carpal Tunnel Syndrome ; Cicatrix ; Female ; Follow-Up Studies ; Hand ; Humans ; Hypersensitivity ; Male ; Michigan ; Retrospective Studies

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Nutritional Treatment: New Strategy for Management of Chronic Pelvic Pain.

Jong Soon CHOI ; Heung Yeol KIM

Kosin Medical Journal.2013;28(1):7-12. doi:10.7180/kmj.2013.28.1.7

Chronic pelvic pain is a common condition in women of reproductive age and can be described as chronic nociceptive, inflammatory and neuropathic pain characterized by spontaneous pain or a response to various stimuli. Oxidative stress is a component of the inflammatory reaction associated with pain processes. Iron and NF-kappaB are well-known inducers of oxidative stress, and reactive oxygen species (ROS) are associated with chronic pelvic pain and play an important role in the regulation of genes expressing immunoregulators, cytokines, and other molecules. Chronic pelvic pain treatment is often unsatisfactory and limited to symptom control. However, dietary treatment with antioxidants can improve the function of the immune system and overcome free radical damage. Therefore, dietary supplementation is suggested as a means to treat some chronic medical conditions that respond poorly to medication. In summary, dietary treatment with antioxidants could be considered for new strategy for treatment of chronic pelvic pain and may be better tolerated by patients than current treatments.
Antioxidants ; Cytokines ; Dietary Supplements ; Female ; Humans ; Immune System ; Inflammation ; Iron ; Neuralgia ; NF-kappa B ; Oxidative Stress ; Pelvic Pain ; Reactive Oxygen Species

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Treatment of Unstable Intertrochanteric Fracture with Bipolar Hemiarthroplasty of Hip in Elderly Population: Short-term Results.

Gun Woo LEE ; Jae Man KWAK ; So Hak CHUNG

Kosin Medical Journal.2012;27(1):37-43. doi:10.7180/kmj.2012.27.1.37

OBJECTIVES: The aim of this study is to evaluate the short-term results and complications of treating the intertrochanteric fracture with bipolar hemiarthroplasty (BHA) in elderly population. METHODS: We retrospectively reviewed 31 unstable intertrochanteric fracture patients who were treated with BHA between January 2007 and August 2009 in older populations more than 65 years old. The 6 males and 25 females had a mean age of 79.8 years (range: 66-88) and a mean follow-up of 36.3 months (range: 24-55). We analyzed the radiological outcomes, functional recovery grade, using Jensen's social function score and Harris hip score (HHS), and complications. RESULTS: The average operation time and blood loss was 148.9 min (range, 110-215 min) and 455.2 mL (range, 200-1200 mL). Mean preoperative and postoperative hemoglobin (Hb) was 10.9 g/dL (range, 8.6-13.4 g/dL) and 10.5 g/dL (range, 5.1-14.1 g/dL) respectively. Average 1.3 pints of blood transfusion was performed. Ambulation with (or without) crutch was possible at mean 6.8 days postoperatively. The stability and alignment indices were adequate in all cases at final follow-up. On clinical results, the average HHS score, was changed from 79.7 points (range, 44-100) preoperatively to 73.0 points (range, 46-92) postoperatively, and the preoperative and postoperative Jensen's score was 1.8 (range, 1-3) and 2.1 (range, 1-4) respectively. CONCLUSIONS: The BHA is an acceptable alternative for unstable intertrochanteric fractures in older population.
Aged ; Blood Transfusion ; Butylated Hydroxyanisole ; Female ; Femur ; Follow-Up Studies ; Hemiarthroplasty ; Hemoglobins ; Hip ; Hip Fractures ; Humans ; Male ; Retrospective Studies ; Walking

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