The Korean Journal of Medicine

Journal Information
ISSN / EISSN : 1738-9364 / 2289-0769
Total articles ≅ 1,639
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Hea Ran Lee, Si Chan Kim, Eun Hye Yang, Su Yun Jung, Jai Won Chang, Eun Kyoung Lee
Korean Journal of Medicine, Volume 97, pp 271-276; https://doi.org/10.3904/kjm.2022.97.4.271

Abstract:
Renal infarction is a condition caused by sudden disturbance of renal arterial blood flow, which occurs frequently in cardioembolic disease, renal artery injury (trauma, Marfan syndrome, rarely Ehlers-Danlos syndrome), and in association with a hypercoagulable state. Ehlers-Danlos syndrome is a rare hereditary connective tissue disease characterized by skin fragility, hyperelasticity, hypermobility of small joints, and easy bruising. Among the subtypes, vascular Ehlers-Danlos syndrome is a very rare genetic disease caused by a mutation in the COL3A1 gene. As blood vessels are fragile due dysfunctional collagen synthesis, complications of bleeding due to arterial dissection or rupture are common in patients with this disease. Here, we report a case of vascular Ehlers-Danlos syndrome diagnosed based on a renal infarction caused by thrombus and renal artery injury; we also present a review of the relevant literature.
Jisoo Jeong, Jung Hun Ohn
Korean Journal of Medicine, Volume 97, pp 238-243; https://doi.org/10.3904/kjm.2022.97.4.238

Abstract:
Hospitalists are specialists in inpatient care who aim to improve patient safety and quality of care. Accordingly, hospitalist research focuses on patient safety and quality improvement (QI). Major hospital medicine journals publish studies on patient safety and QI. This review introduces the latest research related to patient safety and QI research in the field of hospital medicine.
Tae Hee Lee
Korean Journal of Medicine, Volume 97, pp 253-256; https://doi.org/10.3904/kjm.2022.97.4.253

Abstract:
Small intestinal bacterial overgrowth (SIBO) occurs when the small bowel is colonized by high numbers of abnormal microorganisms. There is no gold standard diagnostic test for SIBO. Both small bowel aspiration and breath testing have limitations as diagnostic tests. However, breath testing has the practical advantages of being readily available, inexpensive, and noninvasive.
Eun Young Cho, , Hyung Yoon Kim, Hyuk Jin Park, Hyun Ju Yoon, Kye Hun Kim, Young Keun Ahn
Korean Journal of Medicine, Volume 97, pp 257-270; https://doi.org/10.3904/kjm.2022.97.4.257

Abstract:
Background/Aims: Pulmonary hypertension (PH) in patients with heart failure contributes to a poor prognosis. However, the role of PH in the long-term clinical outcome is unclear in those with acute myocardial infarction (AMI). The clinical significance of elevated right ventricular systolic pressure (RVSP) on routine echocardiography is underestimated.Methods: This study enrolled 2,526 AMI patients (65.1 ± 12.7 years; 1,757 males [69.6%]) from the Korean AMI registry who underwent successful percutaneous coronary intervention and pre-discharge transthoracic echocardiography (TTE). The patients were divided into four groups according to the RVSP on TTE: normal RVSP (RVSP < 35 mmHg, n = 1,695), mild PH (35 ≤ RVSP < 45 mmHg, n = 601), moderate PH (45 ≤ RVSP < 70 mmHg, n = 211), and severe PH (RVSP ≥ 70 mmHg, n = 19). Major adverse cardiac events (MACE) were compared among the four groups.Results: During the 3-year clinical follow-up period, MACE occurred in 562 patients (22.2%), including 321 (18.9%), 145 (24.1%), 83 (39.3%), and 13 patients (68.4%) in the normal RVSP and mild, moderate, and severe PH groups, respectively. On multivariate analysis, independent factors for MACE were moderate or severe PH, age ≥ 65 years, Killip class ≥ III, left ventricular ejection fraction < 40%, hypertension, and diabetes.Conclusions: Measuring RVSP is useful for stratifying the risk of patients with AMI; MACE occurred in patients with moderate or severe PH.
Ja Min Byun, Sung-Soo Yoon
Korean Journal of Medicine, Volume 97, pp 229-237; https://doi.org/10.3904/kjm.2022.97.4.229

Abstract:
Chimeric antigen receptor (CAR) T-cell therapy constitutes a revolutionary advancement in personalized cancer treatment. During this treatment, a patient's own T cells are genetically engineered to express a synthetic receptor that binds a tumor antigen. CAR-T cells are then expanded for clinical use and infused back into the patient's body to attack cancer. CAR-T cells have produced remarkable clinical responses with B-cell malignancies. However, CAR-T cells therapy is not without problems. Barriers to effective CAR-T cells therapy include severe life-threatening toxicities and modest anti-tumor activity. In this review, we introduce the concept of CAR-T cells therapy, currently available CAR-T cells therapy options, and how to deal with adverse events.
Yongwhi Park, Ae-Young Her, Hyun Kuk Kim, Jae Youn Moon, Jae Hyoung Park, Keun-Ho Park, Kyung Hoon Lee, Hyung Joon Joo, Ho Yeon Won, Sung Gyun Ahn, et al.
Korean Journal of Medicine, Volume 97, pp 204-228; https://doi.org/10.3904/kjm.2022.97.4.204

Abstract:
Given the progressive improvements in antithrombotic strategies, management of cardiovascular disease has become sophisticated/refined. However, the optimal perioperative management of antithrombotic therapy in patients with acute coronary syndrome or who are scheduled for percutaneous coronary intervention remains unclear. Assessments of the thrombotic and hemorrhagic risks are essential to reduce the rates of mortality and major cardiac events. However, the existing guidelines do not mention these topics. This case-based consensus document deals with common clinical scenarios and offers evidence-based guidelines for individualized perioperative management of antithrombotic therapy in the real world.
Joong Sik Eom
Korean Journal of Medicine, Volume 97, pp 199-203; https://doi.org/10.3904/kjm.2022.97.4.199

Abstract:
Infection control is an essential factor for improving the quality of acute and long-term care facilities, including patient safety. Infection control should be implemented in all medical facility sectors, and participation of all healthcare workers is required. For efficient infection control, securing and maintaining professionals with sufficient experience and training to establish and implement infection control plans focusing the infection control unit is imperative. Moreover, there should be no shortage of infection control supplies, including consumables and disposables necessary for hand hygiene, personal protective equipment, and isolation. The fee for infection prevention and control should be resourced as necessary funding to establish such infection control infrastructure. Moreover, re-evaluating whether the standard for the fee for infection prevention and control is appropriate, improving the current payment mode, and monitoring whether the fee used is executed as infection control costs are necessary.
Hayoung Choi, Hyun Lee
Korean Journal of Medicine, Volume 97, pp 244-252; https://doi.org/10.3904/kjm.2022.97.4.244

Abstract:
Patients with non-cystic fibrosis bronchiectasis (hereafter referred to as bronchiectasis) often present with comorbidities. These comorbidities significantly impact symptoms, acute exacerbation, hospitalization, disease progression, and mortality in patients with bronchiectasis. Thus, accurate diagnosis and management of comorbidities associated with bronchiectasis are essential to reduce the disease burden of bronchiectasis. This review provides a state-of-the-art summary of key pulmonary and extra-pulmonary comorbidities associated with bronchiectasis, outlines clinical tools to quantify the prognosis of bronchiectasis, and suggests a workflow to diagnose and manage comorbidities associated with bronchiectasis.
Korean Journal of Medicine, Volume 97, pp 179-185; https://doi.org/10.3904/kjm.2022.97.3.179

Abstract:
Nitric oxide is produced by the human lungs and increases in response to type 2 inflammation. The level of fractional exhaled nitric oxide (FeNO) may reflect type 2 inflammation in the airways, which is related to eosinophilic inflammation and treatment responsiveness to corticosteroids. The FeNO test is a non-invasive, simple, and safe point-of-care test to evaluate airway inflammation. It has been standardized for clinical use and has been widely utilized in daily medical practice. However, various intrinsic and extrinsic factors can affect FeNO levels, and understanding and controlling such factors will improve the utility of this measure. The FeNO test can be used to confirm an asthma diagnosis, predict treatment responses to corticosteroids, and guide inhaled corticosteroid therapy for asthma treatment.
Huapyong Kang, Eui Joo Kim, Yeon Suk Kim
Korean Journal of Medicine, Volume 97, pp 164-170; https://doi.org/10.3904/kjm.2022.97.3.164

Abstract:
Malignant hilar biliary obstruction (MHBO) frequently accompanies cholestasis and cholangitis, and requires biliary stent placement. To prevent stent occlusion and prolong survival, local ablation therapy can be considered adjunctive to stent placement. Intraductal radiofrequency ablation (ID-RFA) is a recently developed local therapy for malignant biliary obstruction that can be easily performed employing endoscopic retrograde cholangiography. The use of ID-RFA to treat MHBO (as distinct from distal biliary obstruction) was suggested to be associated with severe adverse events. However, recent comparative studies have shown that ID-RFA is feasible and safe, and acceptably efficacious, in patients with advanced MHBO; newer temperature-controlled ID-RFA devices may enhance safety further. Regularly repeated ID-RFA with stent exchange affords better survival than stenting alone. However, the optimal ID-RFA strategy for MHBO remains inconclusive given the lack of data. Further large-scale clinical trials are needed.
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