EMJ THE EWHA MEDICAL JOURNAL

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  • Case Report 2020-04-30

    Severe Acute Kidney Injury with Familial Renal Hypouricemia Confirmed by Genotyping of SLC22A12

    Chang Min Cho, Hae Il Cheong, Jung Won Lee

    Abstract : Idiopathic renal hypouricemia is a hereditary disease characterized by abnormally high renal uric acid clearance. A defect in the SLC22A12 genes, which encodes the renal uric acid transporter, URAT1, is the known major causes of this disorder. Most patients are clinically silent, but exercise-induced acute kidney injury, urolithiasis or hematuria may develop. The patient presented with azotemia, decreased urine output and abdominal pain without vigorous exercise past history. He was diagnosed with rapidly progressive glomerulonephritis at admission, but low serum uric acid level was persisted. Since the diagnosis of the patient was familial renal hypouricemia, we performed sequence analysis of the SLC22A12 gene in all family members. We report a case of 17-year-old boy with severe acute kidney injury with familial renal hypouricemia confirmed by genotyping of SLC22A12.

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  • Review Article 2020-04-30

    Future Role of Neurosurgeons: Toward Convergence Neurosurgeon Beyond Hybrid Neurosurgeon

    Na Rae Yang

    Abstract : With advances in medicine and technology, treatment modalities for diseases have evolved. Consequently, physicians’ roles have also changed. Because of advances in endovascular treatment, neurosurgeons specializing in cerebrovascular surgery are increasingly using endovascular techniques. Accordingly, the number of so-called “hybrid neurosurgeons” who perform both traditional craniotomy cerebrovascular surgeries and endovascular treatments is on the rise. This phenomenon is also occurring in department of neurology, traditionally a non-surgical specialty, and the number of neurologists using endovascular treatments is also increasing. Nowadays endovascular treatments become more common across medical specialties such as neurointerveional radiology, neurosurgery, and neurology. In this time, what should be the role of neurosurgeons? Standardized hybrid surgeons should contribute to society by treating hemorrhagic stroke and ischemic stroke, maintaining a proper number of hybrid-neurosurgeons to ensure demand for such treatments is met. Further, more neurosurgeons should be trained to perform sophisticated traditional surgeries, as these surgeries cannot be performed by anyone else. Finally, neurosurgery patients often require a combination of surgical and medical treatment. In these situations, primary and secondary prevention are also crucial. And, many neurosurgery patients also have psychoneurotic symptoms. Within neurosurgery backgrounds, we, neurosurgeons, need to be intensivists for critical care medicine, hospitalization experts, epidemiologists, neuropsychiatry experts, and basic researchers. Because we have to be in charge of neurosurgical patients with various problems in our healthcare environment. Therefore, advancing beyond hybrid neurosurgeons and beginning an era of convergence neurosurgeons should be our role in the future.

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  • Original Article 2020-04-30

    Safety and Effectiveness of Indwelling Percutaneous Drainage in Hospitalized Terminally Ill Cancer Patients with Recurrent Ascites

    Kwonoh Park, Geon Woo Lee, Jae-Joon Kim, Sang-Bo Oh, So Yeon Oh, Eun-Ju Park, Jin Hyeok Kim, Joo Yeon Jang, Ung-Bae Jeon

    Abstract : Objectives: Terminally ill cancer patients in hospice palliative care unit are reluctant to undergo repetitive invasive procedures due to coagulopathies and poor performance or condition, while catheter management such as regular irrigation during hospitalization is easy. The purpose of this study was to investigate the safety and efficacy of indwelling intraperitoneal (IP) catheter in hospitalized terminally ill cancer patients with recurrent ascites. Methods: A retrospective review was conducted in patients who underwent IP catheter at the hospice palliative care unit of Pusan National University Yangsan Hospital between August 2016 and June 2018. All catheters were inserted by interventional radiologists with radiological guidance. The primary end-points were functional IP catheter maintenance rate, which is catheter maintained with patency for drainage until the intended time. Results: A total of 25 terminally ill cancer patients underwent IP catheters placements during the study period. All catheters were successfully inserted without major complications, but one patient had trivial bleeding and one other patient had temporary pain. The median time from admission to catheter insertion was 5 days (range, 1 to 49 days). Twenty-one catheters were maintained with function until the intended time, three cases were maintained without function, and the last one was removed early due to obstruction and pain. Finally, the functional IP maintenance rate was 84% (21/25) and the median functional catheter life span was 15 days (95% confidence interval, 10.8 to 17.2). Conclusion: Our study showed relatively favorable results for IP catheter maintenance and safety in hospitalized terminally ill cancer patients with malignant ascites.

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  • Case Report 2020-01-01

    Two Cases of Uterine Tumors Resembling Ovarian Sex-cord Tumors: Rare Case of Uterine Tumor

    Im Hyeon Kim, Yun Ha Hwang, Joong Gyu Ha, In Taek Hwang and Seung Hyun Kim

    Abstract : Uterine tumors resembling ovarian sex-cord tumors (UTROSCT) are very rare tumors that occur mainly in the uterine fundus of women in reproductive age. These tumors can be classified into group 1 and group 2 by histological results. In group 1, epithelial-like differentiation is partially observed in the tumors. In group 2, sex-cord elements are predominant in uterine mural mass. We experienced UTROSCT group 1 in a 29-year-old woman who complained of severe abdominal pain that started one week after delivery and UTROSCT group 2 case in a 49-year-old woman who complained of dysfunctional uterine bleeding. We report two different types of UTROSCT cases that we experienced.

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  • Original Article 2020-01-01

    Intelectin-1 and Endocrinological Parameters in Women with Polycystic Ovary Syndrome: Effect of Insulin Resistance

    Adnan Jassim Mohammed Al-Fartosy, Nadhum Abdulnabi Awad and Amel Hussein Mohammed

    Abstract : ObjectivesWe aimed to evaluate the effect of insulin resistance (IR) on serum Intelectin-1 and endocrinological hormones levels in obese and non-obese women with and without polycystic ovary syndrome (PCOS) in Basrah, Iraq.MethodsFrom 124 women volunteers, 60 patients with primary and 64 patients with secondary, while 56 normal ovulatory women were taken as controls. Their fasting insulin hormone, intelectin-1, anti-Mullerian hormone, luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin (PRL), estradiol (E2) and testosterones (T) were determined by ELISA methods. BMI, glucose and quantitative insulin sensitivity check index as well as IR was determined by the homeostasis model assessment.ResultsA significant changes (P<0.05) were seen in the level of homeostasis model assessment-IR, E2 and T. Levels of anti-Mullerian hormone, LH, LH/FSH ratio and prolactin were significantly (P<0.01) increased and level of intelectin-1 and E2/T ratio were significantly (P<0.01) decreased, while quantitative insulin sensitivity check index level was not significantly different (P>0.05) between the patients (1°PCOS and 2°PCOS) and control groups. On the other hand, our data reported that FSH level was significantly (P<0.05) lower in obese and higher in non-obese patients with PCOS as compared to control group.ConclusionLevels of intelectin-1 and endocrinological hormones have significantly associated with body mass index, IR and physical activity in patients and normal groups and the strategies that can modulate levels of these parameters would improve metabolic disarrangements in women with PCOS.

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  • Original Article 2019-10-01

    Systematic Review on Research Status of Workplace Violence

    Yeo Gyeong Yoon and Kyunghee Jung-Choi

    Abstract : ObjectivesResearch on workplace violence has been conducted, but rarely has been organized systematically. In this study, we summarize the definition and classification of workplace violence studies and review the literature on workplace violence.MethodsUsing academic search engines PubMed, Google Scholar and DBpia, we found 856 papers including “workplace violence” and “adverse social behavior” AND workplace in the title published until December 2018, and 208 papers were selected. The selected papers were classified by continent and country, year of publication, occupation, classification criteria of workplace violence, and research topic.ResultsBy country, the number of articles in the United States was the most with 40 (19.2%), followed by China 27 (13%), Korea 16 (7.7%), and Taiwan and Australia 15 (7.2%). By job category, healthcare workers accounted for the largest portion with 162 (79.0%) of the total, and 80 of them were conducted on nurses. Other occupations included civil servants, manufacturing workers, toll collectors and wageworkers. Among the classification methods of workplace violence, 147 (67.4%) articles were classified as type and there was a difference in the type of violence defined for each article. In the research topic, 114 (44.2%) articles analyzed the effects of workplace violence, and 105 (40.7%) articles describe the prevalence and characteristics of workplace violence, and 23 (8.9%) articles analyzing the causes of violence.ConclusionThe research topic is biased toward the field of healthcare, so it is necessary to expand to include various occupations or other specified occupations. It is also necessary to prepare appropriate measures against workplace violence.

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  • Case Report 2019-01-01

    Clear Cell Adenocarcinoma Originated from Adenomyosis

    Sunwha Park, Angela Cho and Chul Min Park

    Abstract : A 66-year-old postmenopausal woman received routine gynecologic check-up. Transvaginal ultrasonography and abdominal and pelvic computed tomography showed about 5-cm cystic mass in uterus with solid component and the patient had thin endometrium and the serum level of CA 125 was normal. We performed a total hysterectomy and bilateral salpingo-oophorectomy and found tumor which had brownish cystic fluid and about 2 cm sized and colored in light yellowish, polypoid protruding solid mass, located within the myometrial wall. Histopathological examination of frozen section revealed malignancy. The tumor was confined within the myometrium and its histologic type was clear cell adenocarcinoma. Finally we identified that the myometrial mass was clear cell adenocarcinoma originated from adenomyosis pathologically. The malignant transformation of adenomyosis is very rare. When we find a cystic change with solid component in adenomyosis patients, clear cell adenocarcinoma should be suspected as a differential diagnosis and magnetic resonance imaging should be considered for further evaluation.

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  • Original Article 2020-01-01

    A Qualitative Study of Students' Perception on Premedical Curriculum

    Claire Junga Kim, Hwa Young Lee, Young Mi Park, and Hee Jung Yi

    Abstract : ObjectivesA Womans University College of Medicine faces curriculum reform in 2020. To determine what reforms are needed in the premedical curriculum, a needs assessment was conducted.MethodsThis study utilizes qualitative study method. A focus group interview was conducted with four students who completed premedical courses from November to December 2018. Interviews were conducted in two groups by grade level, and each interview was recorded. After transcribing the recorded contents, four researchers analyzed the data using conventional content analysis.ResultsStudents chose A Womans University College of Medicine considering their future careers as female medical professionals and other considerations such as scholarships. The students expected diverse experiences, exchanges with students in different departments, and fusion of medicine with other fields during their premedical years. Overall, these expectations were met during the course, but individual needs for customized education, such as liberal arts, were unmet. In general, students' attitudes toward premedical courses were very motivated and they actively used resources provided by the university.ConclusionQualitative research can provide a better understanding of quantitative data, such as a student survey performed to prepare for curriculum reform. Based on this understanding, the curriculum will be reformed to reflect the educational needs of students, to motivate students and to provide satisfactory education.

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  • Original Article 2019-07-01

    Assessment of Right Ventricular Function by Tissue Doppler Imaging in Pulmonary Arterial Hypertensive Rat

    Jae Eun Hong, Kwan Chang Kim, and Young Mi Hong

    Abstract : ObjectivesElevated pulmonary pressure and right ventricular (RV) dysfunction are the hallmarks of pulmonary vascular disease in animal models and human patients with pulmonary arterial hypertension (PAH). Monocrotaline models of PAH are widely used to study the pathophysiology of PAH. The purpose of this study was to evaluate the severity of PAH rat model by tissue Doppler imaging (TDI).MethodsPAH was induced in Sprague-Dawley rats by monocrotaline (M) group. The peak systolic (s'), early diastolic (e'), and late diastolic myocardial velocities (a') were measured using TDI at basal segments. Tricuspid annular plane systolic excursion (TAPSE) was measured in the 4-chamber view. Velocity of a tricuspid regurgitation (TR) jet was measured to estimate the pulmonary artery pressure to assess the severity of PAH.ResultsDecrease in the RV shortening fraction and ejection fraction were observed in the M group compared with the control (C) group. RV e' velocity and s' velocity were significantly lower in the M group compared with the C group. The TAPSE was significantly lower in the M group compared with the C group (1.26±0.22 mm vs. 2.83±0.34 mm). The TR velocity was significantly higher in the M group compared with the C group (4.48±0.34 m/sec vs. 1.23±0.02 m/sec).ConclusionTAPSE is an easily obtainable, widely recognized and clinically useful echocardiographic parameter of global RV function in the PAH rat model. We recommend that TDI would be a helpful diagnostic tool to evaluate the RV function in PAH rat model.

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  • Review Article 2019-07-01

    Systematic Review on Sanitary Pads and Female Health

    Jingang Woo, Soyeon Kim, Haesoon Kim, Kyoung Sook Jeong, EunMee Kim, and Eunhee Ha

    Abstract : The majority of South Korean females use sanitary pads, which contain various organic solvents which could be excreted before and during their menstruation. However, they are not provided with findings from studies about the health effects of sanitary pads. Therefore, this study aims to establish a list of potential health hazards of sanitary pads and address the need for further extensive research by pointing out the limitations of the previous literature. A systematic review was adopted to conduct quantitative and qualitative reviews based on the PRISMA (preferred reporting items for systematic reviews and meta-analyses). Studies from electronic databases such as PubMed, RISS, and Google Scholar were retrieved for the final analyses. In accordance with our findings, we proposed a set of limitations of the previous studies. A systematic review revealed that there were effects of sanitary pads on vaginal or vulvar skin, endometriosis, and vaginal microflora. The review also revealed that organic solvents, which sanitary pads are composed of, bring potential harmful effects on pregnancy, autoimmune disease, cardiovascular disease, and neurological development. Social environments such as hygiene use or puberty education also turned out to affect female health. It was inferred that a lack of non-occupational and domestic studies reflecting the distinguishing features of sanitary pads with a reliable sample size remains as an important limitation. This study suggests that organic solvents in sanitary pads may increase some health risks bringing reproductive, autoimmune, cardiovascular, and neurological effects. Due to a lack of studies, a more extensive study can contribute to the public health of South Korean females.

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April, 2020
Vol.43 No.2

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EMJ THE EWHA MEDICAL JOURNAL
pISSN 2234-3180 eISSN 2234-2591