A Case of Superior Mesenteric Vein and Portal Vein Thrombosis Associated with Normal Delivery Presented by Acute Pancreatitis

Na, Youn Ju,Kang, Min Jung,Jung, Ji Min,Ha, Chang Yoon,Jung, Hae Sun,Baik, Su Jung,Yi, Sun Young 이화여자대학교 의과학연구소 2008 EMJ (Ewha medical journal) Vol.31 No.1

급성 췌장염의 가장 흔한 원인은 술과 담석으로 알려져 있다. 간정맥과 장간막 정맥의 혈전을 동반한 급성 췌장염은 임신이나 분만 뒤에 드물게 발견될 수 있다. 임신 전에 복부 손상, 자가면역성질환, 혈전의 과거력의 없었던 28세 여자 환자가 정상 분만 후에 계속되는 우상복부 통증을 주소로 내원하였다. 복부 전산화 단층촬영술에서 혈전은 호전되었으나 해면상 정맥 형성은 진행하였다. 이에 정상 분만 뒤에 급성 췌장염을 동반한 복부정맥혈전의 1예를 보고하는 바이다.

Biliary Disorders/Pancreatic Disorders : Primary Adenosquamous Cell Carcinoma Of Pancreas With Duodenal Invasion Misdiagnosed With Same Duodenal Cancer

( Youn Ju Na ),( Ki Nam Shim ),( Tae Hun Kim ),( Sung Ae Jung ),( Kwon Yoo ),( Il Hwan Moon ),( Kyu Won Chung ),( Min Jung Kang ),( Ji Min Jung ),( Chang Yun Ha ),( Hae Sun Jung ),( Su Jung Baik ),( H 대한소화기학회 2007 SIDDS Vol.9 No.-

Background/Aims: The most common pancreatic cancer is adenocarcinoma. Primary adenosquamous cell carcinoma of the pancreas is very rare and aggressive. We reported a case of adenosqumous cell carcinoma of pancreas. Results: A 46-year-old man presented with a 3-month history of dyspepsia and weight loss of 7 kg. He had no history of disease. On admission, the pulse rate was 70/min, the respiration rate was 20/minutes, blood pressure was 130/80 mmHg. There was no jaundice. Physical examinations showed direct tenderness on the right upper quadrant area on the abdomen. But rebound tenderness and Murphy`s sign was abscent. There were slightly elevated 170 U/L of amylase, elevated 338 U/L of lipase. But among tumor makers, especially CA 19-9 was elevated to 566.7 U/mL. The other lab test was normal. Gastroduodenoscopy showed hard ulceroinfiltrative mass with yellowish exudates and easy touch bleeding in second portion of duodenum. At that we considered it as primary duodenal cancer. Biopsy of duodenum showed adenosquamous cell carcinoma. Abdominal computed tomography showed 7.1 x 6.3 cm sized heterogeneous enhancing mass in pancreatic head portion. Main pancreatic duct was dilatation due to mass. Pancreatic mass was invaded into duodenum wall, gastric antrum and gastroduodenal artery encasement. Fine needle biopsy cytology of the pancreatic mass revealed adenosquamous cell carcinoma with anaplastic type. We concluded that an adenosquamous cell carcinoma of pancreas was invaded into duodenal mucosa with ulceration. Conclusions: We report a rare case with primary pancreatic adenosquamous cell carcinoma with duodenal invasion.

Case Report : Primary Esophageal Adenoid Cystic Carcinoma

( Youn Ju Na ),( Ki Nam Shim ),( Min Jung Kang ),( Ji Min Jung ),( Chang Yun Ha ),( Hae Sun Jung ),( Su Jung Baik ),( Seong Eun Kim ),( Sung Ae Jung ),( Kwon Yoo ),( Il Hwan Moon ),( Min Sun Cho ) The Editorial Office of Gut and Liver 2007 Gut and Liver Vol.1 No.2

Adenoid cystic carcinoma (ACC) is common in the salivary glands but rare in the esophagus. Routine esophagogastroscopy performed in a 54-year-old woman as part of a medical check-up revealed a submucosal tumor (1.5×1.0 cm) at the mid-esophagus. Endoscopic ultrasonography revealed a lesion with mixed echogenicity in the submucosal layer. The submucosal mass was removed by incisional endoscopic enucleation, and pathological analysis revealed epithelial cells with small hyperchromatic angular nuclei in tubular and cribriform patterns. The lesion was pathologically confirmed as an ACC of the esophagus. (Gut and Liver 2007;1:178-181)

Primary Adenosquamous Cell Carcinoma of the Pancreas: A Case Report with a Review of the Korean Literature

( Youn Ju Na ),( Ki Nam Shim ),( Min Sun Cho ),( Sun Hee Sung ),( Sung Ae Jung ),( Kwon Yoo ),( Kyu Won Chung ) 대한내과학회 2011 The Korean Journal of Internal Medicine Vol.26 No.3

The most common pancreatic cancer is adenocarcinoma. Primary adenosquamous cell carcinoma of the pancreas is very rare and aggressive. A 46-year-old man presented with a 3-month history of dyspepsia and a 7-kg weight loss. The physical examination showed tenderness of the right upper quadrant of the abdomen. There was no jaundice. Amylase and lipase were elevated. CA 19-9 was elevated to 566.7 U/mL. Gastroduodenoscopy showed a hard ulceroinfiltrative mass with a yellowish exudate that bled readily on touch in the second portion of the duodenum. Abdominal computed tomography showed a 7.1 × 6.3-cm heterogeneously enhancing mass in the pancreatic head. The pancreatic mass had invaded the duodenum wall, gastric antrum, and gastroduodenal artery sheath. Fine-needle aspiration biopsy of the pancreatic mass revealed adenosquamous cell carcinoma, anaplastic type. We concluded that an adenosquamous cell carcinoma of pancreas had invaded the duodenal mucosa causing ulceration.

Clinicopathologic Charateristics and Gallbladder Dysfunction in Patients with Endoscopic Bile Reflux

Na, Youn Ju,Chung, Kyu Won,Yi, Sun Young 이화여자대학교 의과학연구소 2013 EMJ (Ewha medical journal) Vol.36 No.1

Objectives: To investigate clinicopathologic findings and gallbladder (GB) function in patients with endoscopic bile reflux at outpatients clinic. Methods: We classified endoscopic bile reflux into two groups by bile reflux index (BRI). Those who scored above 14 were the BRI (+) group, and those below 14 were the BRI (-) group. We analyzed clinical characteristics, endoscopic findings including Helicobacter pylori, GB function by DISIDA scan, and electron microscope (EM) findings of endoscopic bile reflux. And we compared clinicopathologic characteristics and GB function between two groups. Results: Endoscopic bile reflux identified in 9.7% of all cases with gastrointestinal symptoms. There are cholecystectomy in 6.7%, gastrectomy in 2.7%, and GB dysfunction in 20.0%. They had prominent gastrointestinal symptoms with variable endoscopic findings. Foveolar hyperplasia is the most common pathologic finding and H. pylori colonization of the stomach was inhibited in cases of bile reflux gastritis. Bile reflux also had distinguishable ultra-structural changes identifiable by EM. BRI (+) group had more old age, GB dysfunction than BRI (-) group. Clinical symptoms and endoscopic findings did not differ between the two groups of endoscopic bile reflux. Conclusion: Endoscopic bile reflux was common findings with young adults (30’s) at outpatients clinic. Foveolar hyperplasia is common pathologic finding. GB dysfunction were identified as significant risk factors for BRI (+) group.

Development and validation of a quantitative food frequency questionnaire to assess nutritional status in Korean adults

Youn Ju Na,Seon Heui Lee 한국영양학회 2012 Nutrition Research and Practice Vol.6 No.5

This study was performed to evaluate the validity of the food frequency questionnaire (FFQ), which is being used at the Samsung Medical Center. In total, 305 (190 males and 115 females) participants consented and completed the 3-day diet records and FFQ. Age, gender and energy-adjusted and de-attenuated correlations ranged from 0.317 (polyunsaturated fatty acid) to 0.748 (carbohydrate) with a median value of 0.550. The weighted kappa value ranged from 0.18 (vitamin A) to 0.57 (carbohydrate) with a median value of 0.36. More than 75% of the subjects were classified into the same or adjacent quartiles. The FFQ had reasonably good validity compared with that of another study. Therefore, our FFQ is considered a proper method to assess nutrient intake in healthy Korean adults.

Blocking Energy Metabolism by Hexokinase II Inhibitor Overcomes Sorafenib Resistance via Augmenting Endoplasmic Reticulum Stress in Hepatocellular Carcinoma

( Jeong-ju Yoo ),( Su Jong Yu ),( Juri Na ),( Kyungmin Kim ),( Young Youn Cho ),( Hyeki Cho ),( Dong Hyeon Lee ),( Eun Ju Cho ),( Jeong-hoon Lee ),( Yoon Jun Kim ),( Chung Yong Kim ),( Hyewon Youn ),( 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: Enhancing sorafenib sensitivity is essential for achieving efficient control of intractable hepatocellular carcinoma (HCC). Considering that sorafenib exerts its effect by endoplasmic reticulum (ER) stress due to hypoxia and energy depletion through anti-angiogenic aspect, hexokinase (HK) II which is an important rate-limiting glycolytic enzyme can be a key player in countervailing the effect of sorafenib. Pyruvate analog 3-bromopyruvate (3-BP), a HK II inhibitor, can promote tumor cell death by augmenting endoplasmic reticulum (ER) stress in human HCC cell lines. We evaluated inhibition of HK II potentiated sorafenib-induced ER stress in HCC cells. We also postulated that simultaneous treatment with sorafenib and 3-BP might synergistically enhance their anti-tumor efficacies against HCCs in vivo models. Methods: HCC apoptotic cell death was assessed by DAPI staining and apoptotic signaling pathways were explored by immunoblot analysis. Energy depletion was assessed by lactate assay. In vivo ectopic model of HCC was established in BALB-c nu/nu mice intradermally implanted with SNU-761 cells. Moreover, orthotopic model of HCC was established by subcapsular injection of SNU-761 cells via mini-laparotomy in BALB-c nu/nu mice. Sorafenib with/without 3-BP was subsequently administered. The anti-tumor efficacies were

소화성 궤양 출혈에서 노인군과 청장년군의 임상 특징과 경과의 후향 비교

나윤주 ( Youn Ju Na ),심기남 ( Ki Nam Shim ),강민정 ( Min Jung Kang ),정지민 ( Ji Min Jung ),김성은 ( Seong Eun Kim ),정성애 ( Sung Ae Jung ),유권 ( Kwon Yoo ),문일환 ( Il Hwan Moon ) 대한소화기학회 2009 대한소화기학회지 Vol.53 No.5

목적: 소화성 궤양 출혈은 H. pylori 감염과 비스테로이드소염제가 주된 원인으로 알려져 있다. 그러나 최근 노인 환자의 소화성 궤양에 대한 연구에서 H. pylori의 역할은 감소되고, 비스테로이드소염제 및 동반된 만성질환 등이 궤양의 형성에 더 기여하고 있다고 한다. 이에 이번 연구는 소화성 궤양 출혈을 동반한 환자들을 노인군과 청장년군으로 나누어 각각의 임상 특징과 임상 경과를 비교해 보았다. 대상 및 방법: 2006년 1월부터 12월까지 상부위장관출혈로 내원하여 응급 상부위장관내시경검사를 시행하여 소화성 궤양 출혈로 진단되어 입원한 환자들을 대상으로 65세 이상의 노인군과 65세 미만의 청장년군의 두 군으로 나누어 의무기록을 후향 분석하고 비교하였다. 음주력, 흡연력, 만성질환, 궤양 유발성 약물의 복용력, 상부위장관내시경 소견 및 H. pylori의 유무 등을 조사하였고, 임상 경과인 수혈량, 재원기간, 중환자실 재원기간, 재출혈률, 수술률, 사망률 등을 알아보았다. 결과: 소화성 궤양 출혈로 진단된 88명 중에서 노인군은 34명, 청장년군은 54명이었다. 노인군에서 만성질환 특히 고혈압(52.9% vs. 24.1%), 심혈관계 질환(35.3% vs. 13.0%) 및 만성폐쇄폐질환(20.6% vs. 3.7%)이 유의하게 많았다(p<0.05). 궤양유발 약물의 복용력은 노인군에서 유의하게 많았으며(64.7% vs. 33.3%), 아스피린과 항혈전제인 클로피도그렐(Plavix(R))의 병합 사용군(17.0%)이 가장 많았다. H. pylori 음성 궤양 출혈(25.9% vs. 18.4%)의 빈도는 노인군과 청장년군 간에 차이가 없었다. 노인군과 청장년군의 수혈량, 중환자실 재원기간, 재출혈률, 수술률, 사망률은 차이가 없었으나, 노인군에서 재원기간이 길었으며(12.3±10.6 vs. 7.2±5.9, p<0.05), 궤양유발성 약물과 만성질환의 위험인자를 보정하여도 65세 이상의 노인군에서 유의하게 재원기간이 길었다. 결론: 출혈성 소화성 궤양을 동반한 노인군은 청장년군에 비하여 재출혈률, 수술률, 사망률에는 차이가 없었으나, 재원기간이 유의하게 길었다. 출혈성 궤양의 위험인자가 될 수 있는 H. pylori의 제균 치료와 함께 동반된 만성질환의 유무와 궤양유발 약물의 복용력을 반드시 확인해야 한다. Background/Aims: In geriatric patients with peptic ulcer, the use of NSAID and prevalence of chronic illness have been increased, but the Helicobacter pylori (H. pylori) infected portion decreased. The aim of this study was to evaluate the clinical characteristics and outcomes of geriatric patients (aged 65 or older) with peptic ulcer bleeding and compare with non-geriatric patients (less than 65 years old). Methods: We conducted a retrospective study of 88 patients with peptic ulcer bleeding treated with therapeutic endoscopy from January 2006 to December 2006. We compared the clinical characteristics and outcomes of geriatric patients (n=34, 38.6%) with those of non-geriatric patients (n=54, 61.4%). Results: Hypertension (52.9% vs. 24.1%), cardiovascular disease (35.3% vs. 13.0%), and chronic obstructive pulmonary disease (20.6% vs. 3.7%) were more prevalent in the geriatric group, compared with the non-geriatric group (p<0.05). The geriatric group had taken more ulcerogenic drugs than the non-geriatric group (64.7% vs. 33.3%, p<0.05); aspirin plus clopidogrel (23.6% vs. 13.0%) and aspirin (20.6% vs. 11.0%). Sixteen (21.1%) of the 76 cases had H. pylori-negative ulcer. Between the two groups, there was no difference in the prevalence of H. pylori-negative ulcer (25.9% vs. 18.4%, p>0.05). The amount of transfusion length of ICU stay, rebleeding rate, operation rate and mortality were not different between the two groups. The length of hospital stay in the geriatric patients was significantly longer than the non-geriatric group (12.3±10.6 vs. 7.2±5.9 days, p<0.05). In multiple regression analysis, old age was a significant risk factor for longer hospital stay (p<0.05). Conclusions: The geriatric patients with bleeding peptic ulcer had longer hospital stay than the non-geriatric patients in our study. The important emerging etiologies such as ulcerogenic drug and associated chronic illness should be checked and treated in these patients. (Korean J Gastroenterol 2009;53:297-304)

Hexokinase-II Inhibition Synergistically Augments the Anti-tumor Efficacy of Sorafenib in Hepatocellular Carcinoma

Yoo, Jeong-Ju,Yu, Su Jong,Na, Juri,Kim, Kyungmin,Cho, Young Youn,Lee, Yun Bin,Cho, Eun Ju,Lee, Jeong-Hoon,Kim, Yoon Jun,Youn, Hyewon,Yoon, Jung-Hwan MDPI 2019 INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES Vol.20 No.6

<P>This study aimed to examine whether inhibition of hexokinase (HK)-II activity enhances the efficacy of sorafenib in in-vivo models of hepatocellular carcinoma (HCC), and to evaluate the prognostic implication of HK-II expression in patients with HCC. We used 3-bromopyruvate (3-BP), a HK-II inhibitor to target HK-II. The human HCC cell line was tested as both subcutaneous and orthotopic tumor xenograft models in BALB/c nu/nu mice. The prognostic role of HK-II was evaluated in data from HCC patients in The Cancer Genome Atlas (TCGA) database and validated in patients treated with sorafenib. Quantitative real-time PCR, western blot analysis, and immunohistochemical staining revealed that HK-II expression is upregulated in the presence of sorafenib. Further analysis of the endoplasmic reticulum-stress network model in two different murine HCC models showed that the introduction of additional stress by 3-BP treatment synergistically increased the in vivo/vitro efficacy of sorafenib. We found that HCC patients with increased HK-II expression in the TCGA database showed poor overall survival, and also confirmed similar results for TCGA database HCC patients who had undergone sorafenib treatment. These results suggest that HK-II is a promising therapeutic target to enhance the efficacy of sorafenib and that HK-II expression might be a prognostic factor in HCC.</P>

ORiginal Article : Cost Comparison between Surgical Treatments and Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer in Korea

( Youn Hee Kim ),( Young Woo Kim ),( Il Ju Choi ),( Joo Young Cho ),( Jong Hee Kim ),( Jin Won Kwon ),( Ja Youn Lee ),( Na Rae Lee ),( Sang Yong Seol ) The Editorial Office of Gut and Liver 2015 Gut and Liver Vol.9 No.2

Background/Aims: This study was conducted to evaluate whether medical costs can be reduced using endoscopic submucosal dissection (ESD) instead of conventional surgeries in patients with early gastric cancer (EGC). Methods: Patients who underwent open gastrectomy (OG), laparoscopy-assisted gastrectomy (LAG), and ESD for EGC were recruited from three medical institutions in 2009. For macro-costing, the medical costs for each patient were derived from the expenses incurred during the patient’s hospital stay and 1-year follow-up. The overall costs in micro-costing were determined by multiplying the unit cost with the resources used during the patients’ hospitalization. Results: A total of 194 patients were included in this study. The hospital stay for ESD was 5 to 8 days and was significantly shorter than the 12-day hospital stay for OG or the 11- to 17-day stay for LAG. Using macro-costing, the average medical costs for ESD during the hospital stay ranged from 2.1 to 3.4 million Korean Won (KRW) per patient, and the medical costs for conventional surgeries were estimated to be between 5.1 million and 8.2 million KRW. There were no significant differences in the 1-year follow-up costs between ESD and conventional surgeries. Conclusions: ESD patients had lower medical costs than those patients who had conventional surgeries for EGC with conservative indications. (Gut Liver, 2015;9:174-180)