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A 75-Year-Old Natural Survivor with Uncorrected Tetralogy of Fallot Presenting with Hypoxic Spell.

Ho Young SONG ; Soo Yeon KANG ; Ok Jeong LEE ; Ji Hee KWAK

The Ewha Medical Journal.2017;40(2):94-98. doi:10.12771/emj.2017.40.2.94

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Only a few patients reach adulthood without surgical correction. Unrepaired TOF patients with mild to moderate right ventricular outflow tract (RVOT) obstruction may be clinically silent until adulthood. TOF with hypoxic spells present as periods of profound cyanosis that occur because of almost total RVOT obstruction. So, hypoxic spell typically occurs in a crying infant but is rare in an adult. In this report, we presented a case of a 75-year-old patient with uncorrected TOF presenting with hypoxic spell, consequent pulmonary hypertension and chronic heart failure. This is the oldest case of natural survivor with uncorrected TOF in Korea and the oldest patient presenting hypoxic spell worldwide.
Adult ; Aged* ; Anoxia ; Crying ; Cyanosis ; Heart Defects, Congenital ; Heart Failure ; Humans ; Hypertension, Pulmonary ; Infant ; Korea ; Survivors* ; Tetralogy of Fallot*

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Early Detection of Hidden Adenocarcinoma through the Prompt Pericardiocentesis in Patient with Small Pericardial Effusion.

Batzaya SHINEBAYAR ; Se Yong GILL ; Haemin JEONG ; Kyung Chan CHOI ; Junshik HONG ; Sang Min PARK

The Ewha Medical Journal.2017;40(2):91-93. doi:10.12771/emj.2017.40.2.91

Pericardial drainage is an important diagnostic and therapeutic option in the symptomatic patient with large amount of pericardial effusion (PE). However, when the amount of PE is relatively small, physicians are often reluctant to perform the invasive drainage of the fluid due to the increased risk of causing myocardial injury during the procedure. Even in some cases of suspected pericarditis with small amount PE, an initial empirical anti-inflammatory therapy is often recommended. A 65-year-old woman presented with mild dyspnea for two weeks. The echocardiography revealed small amount of PE. A careful fluoroscopy-guided pericardiocentesis, subsequent pericardial fluid cytology, and thorough whole body check-up demonstrated adenocarcinoma with no proven primary site. After the palliative chemotherapy, she had survived for 15 months until her death due to asphyxia. Although pericardiocentesis is considered dangerous in small amount of PE, a prompt and careful drainage may provide early detection of hidden malignancy and better survival outcome.
Adenocarcinoma* ; Aged ; Asphyxia ; Drainage ; Drug Therapy ; Dyspnea ; Echocardiography ; Female ; Humans ; Pericardial Effusion* ; Pericardial Fluid ; Pericardiocentesis* ; Pericarditis

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Malignant Hypertension with Pulmonary Alveolar Hemorrhage Needing Dialysis.

Younghun KIM ; Ki Tae BANG ; Jong Ho SHIN ; Ju Ri KIM ; Joo Heon KIM ; Jin Uk JEONG

The Ewha Medical Journal.2017;40(2):87-90. doi:10.12771/emj.2017.40.2.87

A 35-year-old man presented with progressive dyspnea and hemoptysis. His blood pressure was 230/140 mmHg and serum creatinine level was 20.13 mg/dL. Chest radiography and computed tomography revealed pulmonary hemorrhage. His renal function was low, thus emergent renal replacement therapy was required. Malignant hypertension and acute kidney injury were diagnosed, and antihypertensive therapy and hemodialysis started immediately. Renal biopsy was performed to examine the underlying disease. Typical pathological changes of malignant hypertension, fibrinoid necrosis of the afferent arterioles, and proliferative endoarteritis at the interlobular arteries were observed. His renal function improved gradually and pulmonary hemorrhage completely disappeared with administration of antihypertensive agents. Here, we report this rare case of malignant hypertension with pulmonary alveolar hemorrhage and speculate that the hemorrhage may be related to vascular injuries at the alveolar capillary level caused by malignant hypertension.
Acute Kidney Injury ; Adult ; Antihypertensive Agents ; Arteries ; Arterioles ; Biopsy ; Blood Pressure ; Capillaries ; Creatinine ; Dialysis* ; Dyspnea ; Hemoptysis ; Hemorrhage* ; Humans ; Hypertension, Malignant* ; Necrosis ; Pulmonary Alveoli ; Radiography ; Renal Dialysis ; Renal Replacement Therapy ; Thorax ; Vascular System Injuries

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Role of β₁-Integrin in Colorectal Cancer: Case-Control Study.

Bo Young OH ; Kwang Ho KIM ; Soon Sup CHUNG ; Kyoung Sook HONG ; Ryung Ah LEE

The Ewha Medical Journal.2017;40(2):77-86. doi:10.12771/emj.2017.40.2.77

OBJECTIVES: In the metastatic process, interactions between circulating tumor cells (CTCs) and the extracellular matrix or surrounding cells are required. β1-integrin may mediate these interactions. The aim of this study was to investigate whether β1-integrin is associated with the detection of CTCs in colorectal cancer. METHODS: We enrolled 30 patients with colorectal cancer (experimental group) and 30 patients with benign diseases (control group). Blood samples were obtained from each group, carcinoembryonic antigen (CEA) mRNA for CTCs marker and β1-integrin mRNA levels were estimated by using reverse transcription-polymerase chain reaction, and the results were compared between the two groups. RESULTS: CEA mRNA was detected more frequently in colorectal cancer patients than in control patients (P=0.008). CEA mRNA was significantly reduced after surgery in the colorectal cancer patients (P=0.032). β1-integrin mRNA was detected more in colorectal cancer patients than in the patients with benign diseases (P<0.001). In colorectal cancer patients, expression of β1-integrin mRNA was detected more for advanced-stage cancer than for early-stage cancer (P=0.033) and was significantly decreased after surgery (P<0.001). In addition, expression of β1-integrin mRNA was significantly associated with that of CEA mRNA in colorectal cancer patients (P=0.001). CONCLUSION: In conclusion, β1-integrin is a potential prognostic factor following surgical resection in colorectal cancer patients. β1-integrin may be a candidate for use as a marker for early detection of micrometastatic tumor cells and for monitoring the therapeutic response in colorectal cancer patients.
Carcinoembryonic Antigen ; Case-Control Studies* ; Colorectal Neoplasms* ; Extracellular Matrix ; Humans ; Integrins ; Neoplastic Cells, Circulating ; RNA, Messenger

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Change in Subfoveal Choroidal Thickness after Argon Laser Panretinal Photocoagulation.

Ga Eun CHO ; Ah Young KIM ; Hee Yun CHO ; Yun Taek KIM

The Ewha Medical Journal.2017;40(2):71-76. doi:10.12771/emj.2017.40.2.71

OBJECTIVES: To evaluate changes in subfoveal choroidal thickness (SFCT) and macular thickness as measured by enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT) after argon laser panretinal photocoagulation (PRP) in patients with severe diabetic retinopathy. METHODS: This prospective, comparative case series included 21 patients (28 eyes) with severe diabetic retinopathy. All patients underwent three sessions of PRP. The SFCT and macular thickness were measured using EDI-OCT at baseline and one week after completion of 3 sessions of PRP. RESULTS: SFCT before PRP was 318.1±96.5 µm and increased to 349.9±108.3 µm; P=0.001 after PRP. Macular thickness significantly increased at one week after PRP from 273.1±23.9 µm at baseline 295.8±25.3 µm at one week; (P<0.001). No significant relationship between the changes in macular thickness and SFCT was observed (r=−0.13, P=0.52). CONCLUSION: PRP induced increases in both SFCT and macular thickness. Changes in SFCT did not correlate with changes in macular thickness.
Argon* ; Choroid* ; Diabetic Retinopathy ; Humans ; Light Coagulation* ; Macular Edema ; Prospective Studies ; Tomography, Optical Coherence

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Introduction to the Medical Research Using National Health Insurance Claims Database.

Dong Ryeol RYU

The Ewha Medical Journal.2017;40(2):66-70. doi:10.12771/emj.2017.40.2.66

All Korean citizens should join the National Health Security System by law. The National Health Insurance Service (NHIS) and the Health Insurance Review and Assessment Service (HIRA) are one of major components to support this system, and all data about medical expenses for the medical claims are stored and managed in the institutions. Recently, medical research using administrative claims databases has dramatically progressed in Korea and worldwide, and the methods how to use them are briefly reviewed in this article. Research using these databases have several strengths. Researchers can perform the complete enumeration survey in a real world. They can get new valuable findings because the number in the database is usually large enough to detect the minute difference with a big statistical power. They can obtain more detailed and reproducible results. Moreover, they can investigate a very rare disease or infrequent side effects of drugs. However, we must recognize that research using administrative claims database also has several incoherent limitations. These databases have not been constructed originally for research, but for reimbursement. Therefore, there are no important data including medical history and laboratory findings of each patient, which are crucial to adjust baseline characteristics. In addition, it is hard to discover causal relationship and direct association with the included information. In spite of limitations, researchers can easily use these databases for their research now than ever, and the results may be utilized not only to expand the academic knowledge but also to influence the determination of national healthcare policy.
Delivery of Health Care ; Drug-Related Side Effects and Adverse Reactions ; Humans ; Insurance, Health ; Jurisprudence ; Korea ; National Health Programs* ; Rare Diseases

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Intensivist as a Surgeon: The Role of a Surgeon in Critical Care Medicine.

Kyung Sook HONG

The Ewha Medical Journal.2017;40(2):61-65. doi:10.12771/emj.2017.40.2.61

Critical care medicine is to provide advanced medical care to critically ill-patients threatened by severe diseases. Although critical care is a core area of surgery, surgeons have fewer interests and opportunities for participating in it, and the dedicated intensivists with other specialties have had a deeper involvement. It is difficult to recruit surgical intensivists or trauma surgeons for critical care due to the high labor intensity, high risk of medical accidents and conflicts, and inappropriate remuneration. The most common cause, however, is the lack of opportunities for surgical cases. There is a negative perception among surgeons that surgical intensivists are ‘the surgeons who do not operate.’ That makes the surgeons feel the gap between what they majored and what they practice. Acute care surgery, that is a relatively new, but more specialized surgical area including emergency surgery, trauma and critical care, can be a good alternative. Critically ill-patients who suffered from hemorrhagic shock, septic shock, acute renal injury, and acute respiratory distress syndrome need the intensive and aggressive treatments. Surgeons have been used to these invasive and aggressive procedures. Surgeons who have trained the critical care may be able to acquire the expertise, easily. The intensivists as a surgeon, who fully understands the operations, postoperative courses or complications, or the optimal time of surgery, can provide more efficient and accurate treatments for surgically critically ill-patients than any intensivists with other specialties. It is needed to change the surgeons' negative perceptions themselves with the support of the Korean Society of Surgery.
Acute Kidney Injury ; Critical Care* ; Critical Illness ; Education ; Emergencies ; Intensive Care Units ; Remuneration ; Respiratory Distress Syndrome, Adult ; Shock, Hemorrhagic ; Shock, Septic ; Surgeons

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What's Wrong with the Gift Author?.

Ryung Ah LEE

The Ewha Medical Journal.2017;40(2):59-60. doi:10.12771/emj.2017.40.2.59

No abstract available.
Human ; Authorship ; Biomedical Research ; Scientific Misconduct ; Publications

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Reliability and Validity of Korean Bowel Disease Questionnaire for Functional Gastrointestinal Disorders.

Hyun Joo SONG ; Hye Kyung JUNG

The Ewha Medical Journal.2011;34(2):39-46. doi:10.12771/emj.2011.34.2.39

OBJECTIVES: The Korean version of Bowel disease questionnaire (BDQ-K) was developed to evaluate the symptom items required to meet the definition of functional gastrointestinal disorders (FGIDs). We evaluated the test-retest reliability and validity of the self-reported BDQ-K and prevalence of functional dyspepsia (FD) and irritable bowel syndrome (IBS) according to the Rome-III criteria. METHODS: Sixty-nine patients participated in the test-retest reliability study, with a two week interval, and another 74 patients were enrolled to assess the self-reported questionnaire versus a doctor's interview (concurrent validity). A total of 3,325 subjects (mean age, 44+/-9 yrs; 58.3% male) presenting for an upper endoscopy responded to the BDQ-K at a health promotion center, but 797 subjects with organic diseases were excluded. RESULTS: In the validity study of the BDQ-K, the median kappa value was 0.74 (0.36~1.0). The median kappa value for the test-retest was 0.56 (range 0.22~1.0), including abdominal pain (kappa=0.51, P<0.001), pain onset before 6 months (kappa=0.51, P<0.001), epigastric pain (kappa=0.69, P<0.001), early satiety (kappa=0.40, P<0.001), and postprandial fullness (kappa=0.34, P<0.001). The prevalence of FD was 8.3% (209/2,528); epigastric pain more than once a week 4.4%, early satiety 2.5%, and postprandial fullness 6.1%. FD was more prevalent in women (P=0.001). The prevalence of IBS was 6.1% and IBS also predominated in women (7.1% vs 5.1% in men, P=0.032). CONCLUSION: The BDQ-K is a reliable and valid instrument for identifying FGIDs. The prevalence of FD according to the Rome III criteria was 8.3% and that of IBS was 6.1%.
Abdominal Pain ; Dyspepsia ; Endoscopy ; Female ; Gastrointestinal Diseases ; Health Promotion ; Humans ; Irritable Bowel Syndrome ; Male ; Prevalence ; Reproducibility of Results ; Rome ; Surveys and Questionnaires

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The Clinical Effect of Androgen Replacement Therapy for Female Sexual Dysfunction.

Seong Ju LEE ; Woo Sik CHUNG ; Hana YOON

The Ewha Medical Journal.2011;34(2):33-38. doi:10.12771/emj.2011.34.2.33

OBJECTIVES: Androgen plays an important role in female sexual function, and its insufficiency causes a clinically significant sexual dysfunction. This study examines the association between sex hormones and the clinical effect of testosterone replacement therapy in female sexual dysfunction. METHODS: This study examined 75 female patients who visited our hospital from March 2002 to June 2008 to treat sexual dysfunction. For the rest of the patients, we performed primary treatment and physiotherapy in accordance with the main cause of their sexual dysfunction. We also performed combination treatment of androgen replacement therapy for the patients who did not make medical progress after two months of primary treatment and for the patients whose free testosterone level is in the bottom group out of three normal range groups. RESULTS: The mean age of target patients was 39.6+/-8.7 years (range, 35~66 years) old. 10 patients out of 75 patients were postmenopausal women, and estrogen replacement therapy had been performed without androgen replacement therapy. We performed a combination treatment of androgen replacement therapy for the patients with sexual desire disorder, and 60% of them answered that they had an increased sexual response after they were given combination treatment of androgen replacement therapy. CONCLUSION: The results support the concepts that sex hormones significantly affect sexual response in women with sexual dysfunction. Clinically, it is effective and safe to perform a combination treatment of androgen replacement therapy in treating sexual dysfunction if medication is administered properly and carefully.
Estrogen Replacement Therapy ; Female ; Gonadal Steroid Hormones ; Humans ; Reference Values ; Testosterone

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