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ESD Hands-on Course Using Ex Vivo and In Vivo Models in South Korea
Gene Hyun Bok,,조주영 대한소화기내시경학회 2012 Clinical Endoscopy Vol.45 No.4
Endoscopic submucosal dissection (ESD) is an established treatment for gastric neoplasias especially in regions with a high volume of gastric cancer. Although ESD has many advantages over endoscopic mucosal resection, ESD is technically more difficult and can result in severe complications. Therefore establishment of an effective training system is required to help endoscopists climb the ESD learning curve. Although a standard training system for ESD remains to be established, some centers are incorporating ex vivo and/or in vivo animal models to provide a safe and effective means of ESD training. However, it is unknown if these animal models are more effective than other programs. Moreover the efficacy of the animal model may vary according to socio-economic status and the volume of gastric cancer. In this article we introduce the basic and advanced ESD training model using the ex vivo and in vivo animal model from South Korea and review the associated literature from other regions.
만성 B형 간염 환자에서 간세포암종으로 오인되었던 1 cm 크기의 간내담관상피암종
복진현 ( Gene Hyun Bok ),정승원 ( Soung Won Jeong ),장재영 ( Jae Young Jang ),심광연 ( Kwang Yeun Shim ),이세환 ( Sae Hwan Lee ),김상균 ( Sang Gyune Kim ),김영석 ( Young Seok Kim ),김홍수 ( Hong Soo Kim ),김부성 ( Boo Sung Kim 대한간암학회 2012 대한간암학회지 Vol.12 No.1
Morphologically, intrahepatic cholangiocarcinoma (ICC) presents as a parenchymal mass, and it is occasionally resectable and potentially curable. In some cases, differentiation from other hepatic neoplasms such as metastatic lesions and hepatocellular carcinoma (HCC) can be extremely difficult, both clinically and histologically, and definitive diagnosis often needs correlation with clinical and radiologic finding.Contrasted computed tomography (CT) is useful in the diagnosis of ICC and in determining the extent of tumor involvement. Although the majority of liver tumors can be diagnosed by modern imaging modalities such as contrast CT, some cases of ICC show tumor enhancement in the arterial phase the same as that in HCC, or a biliary dilatation without stenosis by intraductal tumor growth. Differences in these patterns of tumor enhancement and status of the bile ducts in ICC may also reflect differences in cellular characteristics, clinical features, and prognosis after treatment. We present a case of a small ICC showing similar clinical and radiologic characteristics to HCC.
간세포암의 경동맥화학색전술 후 추적검사에서 조영증강초음파와 리피오돌 전산화단층촬영의 일치성 비교
복진현 ( Gene Hyun Bok ),정승원 ( Soung Won Jeong ),장재영 ( Jae Young Jang ),이세환 ( Sae Hwan Lee ),김상균 ( Sang Gyune Kim ),차상우 ( Sang Woo Cha ),김영석 ( Young Seok Kim ),조영덕 ( Young Deok Cho ),김홍수 ( Hong Soo Kim ) 대한간암학회 2014 대한간암학회지 Vol.14 No.2
목적: 간세포암의 경동맥화학색전술 후 잔존 간세포암의 추적검사에 있어서 리피오돌 전산화단층촬영과 조영증강 초음파의 일치성을 평가하고자 하였다. 대상과 방법: 간세포암의 경동맥화학색전술 시행 후, 잔존 간세포암의 평가를 위해 조영증강초음파와 리피오돌 전산화단층촬영을 모두 시행 받은 41명 환자의 65개의 병변을 후향적으로 검토하였고, 이중에서 조영증강초음파 검사 후4주 이내에 리피오돌 전산화단층촬영을 시행받았던 31명 환자의 47개 병변을 평가하여 두 검사 사이의 일치율과 일치율에 영향을 주는 인자들을 분석하였다. 결과: 전체 병변에서 조영증강초음파와 리피오돌 전산화 단층촬영의 일치율은 78.7% (37/47)였고, 잔존 간세포암을 대상으로만 비교했을 경우의 일치율은 95.2%, 그리고 비잔존 간세포암을 대상으로만 비교했을 경우의 일치율은 65.4% 였다(P <0.013). 일치율에 영향을 주는 인자의 분석에서는 미만성(diffuse) 간세포암이 경향성을 보였으나 통계적인 의미를 보이지는 못했고, 간의 dome 부위에 위치한 4개의 병변 가운데에서 3개의 병변에서 불일치를 보였으나 표본수가 적어서 통계적인 의미를 보이지는 못하였다. 검사의 일치를 보였던 간세포암과 일치를 보이지 않았던 간세포암의 평균 크기는 각각 2.9 과 3.0 cm 으로 의미를 보이지 않았고, 리피오돌 CT상에서의 잔존간세포암의 여부가 일치율에 있어서의 의미 있는 인자였다. 결론: 잔존 간세포암에 대한 조영증강초음파와 리피오돌 전산화단층촬영의 일치율은 높았지만, 비잔존 간세포암에 대한 일치율은 상대적으로 낮았다. Background/Aims: The aim of this study is to evaluate the concordance of contrast enhanced ultrasonography (CEUS) and lipiodol computed tomography (L-CT) for the assessment of viable hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE). Methods: We retrospectively reviewed the post-TACE CEUS and L-CT images of 65 consecutive HCCs in 41 patients to assess the presence of viable tumor tissue. Forty-seven HCCs in 31 patients that underwent post-TACE L-CT within 4 weeks of the CEUS examination were included. The degree of concordance between CEUS and L-CT and factors related to concordance were analyzed. Results: The overall concordance of CEUS and LDCT was 78.7% (37/47). The concordance with L-CT for viable tumor and non-viable tumor tissue on CEUS was 95.2%, and 65.4% respectively (P<0.013). Diffuse tumors had a tendency for non-concordance (P=0.066). Although 3 of 4 lesions located in the hepatic dome were non-concordant, the sample size was too small to establish significance. The mean tumor size for concordant and non-concordant tumors was 2.9 and 3.0 cm, with no significant difference. Conclusions: Although the concordance of CEUS and L-CT for viable tumor tissue was high, the concordance for non-viable tumor tissue was relatively low. Prospective studies using angiography as a gold standard should be performed in the future. (J Liver Cancer 2014;14:115-119)
간내담관암으로 오인된 간세포암종과 담관상피암종의 중간형
복진현 ( Gene Hyun Bok ),홍중락 ( Zoong Rock Hong ),노미오 ( Mi Oh Roh ),장재영 ( Jae Young Jang ),심찬섭 ( Chan Sup Shim ),김정훈 ( Jung Hoon Kim ),진소영 ( So Young Jin ) 대한내과학회 2008 대한내과학회지 Vol.75 No.3
저자들은 간내 종괴로 내원하여 방사선적 검사상 담도암으로 생각되었으나 수술 및 면역조직화학염색 후 간세포암종과 담관상피 암종의 중간형으로 진단된 증례를 경험하여 보고하는 바이다. Primary liver cancer has traditionally been classified as either hepatocellular carcinoma (HCC) or cholangiocarcinoma (CCC). However, primary liver cancer occasionally consists of elements from both HCC and CCC. Intermediate hepatic carcinoma and primary liver cancer of the intermediate type are extremely rare subtypes of primary liver cancer that show features intermediate between HCC and CCC. First reported in 1998, the clinical, radiologic, and histopathologic characteristics of this entity remain unclear. In this case report, we describe the clinical, magnetic resonance imaging, histopathological, and immunohistochemical findings in a patient with intermediate hepatic carcinoma who was initially thought to have intrahepatic cholangiocarcinoma. (Korean J Med 75:327-332, 2008)
한국의 1차 의료기관에서 발견된 대장용종: 발견율 및 가이드라인 적용 시 문제점
박상현 ( Sang Hyun Park ),홍광일 ( Kwang Il Hong ),박현철 ( Hyun Chul Park ),김영선 ( Young Sun Kim ),복진현 ( Gene Hyun Bok ),김경호 ( Kyung Ho Kim ),신동석 ( Dong Suk Shin ),한재용 ( Jae Yong Han ),김영관 ( Young Kwan Kim ),최 대한소화기학회 2021 대한소화기학회지 Vol.78 No.6
Background/Aims: There have been few multicenter studies on colonic polyps conducted by primary medical institutions. This study examined the detection rate of colonic polyps in primary health care institutions and the related factors while following the guidelines. Methods: The medical records of 14,029 patients who underwent colonoscopy between January-June 2020 at 40 primary medical institutions in Korea were analyzed. High-risk adenoma was defined as advanced adenoma, carcinoma, or ≥3 adenomas. Results: Most patients (71.2%) aged ≥50 years underwent re-colonoscopy within 5 years (51.3%) for diagnostic purposes (61.3%) in Korean primary medical institutions. The detection rates of colon polyps, adenoma, advanced adenoma, high-risk adenoma, and carcinoma was 59.9%, 38.9%, 5.9%, 11.4%, and 0.3% in all subjects and 59.8%, 37.5%, 8.5%, 12.9%, and 0.3% in average-risk patients, respectively. The incidences of adenoma in average-risk patients increased significantly with age (30s/40s/50s: 20.1%/29.4%/43% for adenoma, 4.4%/6.7%/10.3% for advanced adenoma, and 5.6%/9.5%/14.6% for high-risk adenoma; p<0.05). Before 50 years of age, high-risk adenoma was detected in 9.1% of patients in the first-time screening group, and the significant risk factors were being male and ≥40 years of age. The detection rate of high-risk adenoma in the normal index colonoscopy group within 5 years was 9.0%. The significant risk factors included older age, male sex, positive fecal occult blood test, stool form changes, and nonspecific symptoms (gas and indigestion). Conclusions: More colonic adenoma studies targeting real-world clinical practice will be needed to revise the Korean guidelines for colorectal cancer screening and surveillance. (Korean J Gastroenterol 2021;78:328-336)
증례 : 내분비-대사 ; 양측성 비폐쇄성 수신증 및 중추성 요붕증을 유발한 중격-시신경 형성장애 1예
김종현 ( Jong Hyun Kim ),이광복 ( Kwang Bok Lee ),이정훈 ( Jeong Hun Lee ),남수민 ( Soo Min Nam ),이강우 ( Kang Woo Lee ),황유진 ( Eu Gene Hwang ),길건 ( Geon Gil ) 대한내과학회 2014 대한내과학회지 Vol.87 No.2
저자 등은 양측성 비폐쇄성 수신증으로 방광창냄술을 시행했던 27세 남자 환자에서 중추성 요붕증 및 중격-시신경형성 장애를 진단하였다. 어려서부터 시야 장애 및 다뇨 등의 증상은 있었으나 적절한 검사와 진단이 이루지지 않아치료가 늦어지고 양측성 비폐쇄성 수신증까지 나타난 경우이다. 요붕증에 대하여 데스모프레신으로 치료 후 환자의 다음, 다뇨 증상과 양측 비폐쇄성 수신증도 호전이 되어 방광창냄술 제거 후 정상적인 배뇨가 가능한 상태이며 현재 외래 추적경과 중이다. A 27-year-old male with nonobstructive hydronephrosis was referred from the urology department for polyuria evaluation and management. The patient was hospitalized for urinary tract infection and cystostomy was performed due to neurogenic bladder of unknown origin. The patient was of short stature and had visual impairment. From the interview, we discovered he had been suffering from polyuria and polydipsia for more than 20 years. Urine output was 13 L/day and urine osmolarity was 85 mOsm/kg. The results of a water deprivation test were consistent with central diabetes insipidus. Septo-optic dysplasia (SOD) was observed on brain magnetic resonance imaging (MRI). SOD is a very rare condition characterized by agenesis of the septum pellucidum or corpus callosum, which may cause optic nerve aplasia or hypoplasia, midbrain abnormalities and/or hypopituitarism. After desmopressin treatment, polyuria and hydronephrosis were improved. We report a case of a 27-year-old male diagnosed with SOD including diabetes insipidus, resulting in nonobstructive hydronephrosis. (Korean J Med 2014;87:209-214)
( Sung Woo Ryu ),( Gene Hyun Bok ),( Jae Young Jang ),( Soung Won Jeong ),( Nam Seok Ham ),( Ji Hye Kim ),( Eui Ju Park ),( Jin Nyoung Kim ),( Woong Cheul Lee ),( Kwang Yeun Shim ),( Sae Hwan Lee ),( 대한소화기학회 2014 Gut and Liver Vol.8 No.3
Background/Aims: To evaluate the diagnostic value of contrast (SonoVue®) enhancement ultrasonography (CEUS) and to compare this method with computed tomography (CT) and magnetic resonance imaging (MRI) in evaluating liver masses. Methods: CEUS (n=50), CT (n=47), and MRI (n=43) were performed on 50 liver masses in 48 patients for baseline mass characterization. The most likely impression for each modality and the final diagnosis, based on the combined biopsy results (n=14), angiography findings (n=36), and clinical course, were determined. The diagnostic value of CEUS was compared to those of CT and MRI. Results: The final diagnosis of the masses was hepatocellular carcinoma (n=43), hemangioma (n=3), benign adenoma (n=2), eosinophilic abscess (n=1), and liver metastasis (n=1). The overall diagnostic agreement with the final diagnosis was substantial for CEUS, CT, and MRI, with κ values of 0.621, 0.763, and 0.784, respectively. The sensitivity, specificity, and accuracy were 83.3%, 87.5%, and 84.0%, respectively, for CEUS; 95.0%, 87.5%, and 93.8%, respectively, for CT; and 94.6%, 83.3%, and 93.0%, respectively for MRI. After excluding the lesions with poor acoustic sonographic windows, the sensitivity, specificity, and accuracy for CEUS were 94.6%, 87.5%, and 93.3%, respectively, with a κ value of 0.765. Conclusions: If an appropriate acoustic window is available, CEUS is comparable to CT and MRI for the diagnosis of liver masses.
Development of Biliary and Enteral Stents by the Korean Gastrointestinal Endoscopists
Chan Sup Shim,Jin Hong Kim,Gene Hyun Bok 대한소화기내시경학회 2016 Clinical Endoscopy Vol.49 No.2
Stenting in the gastrointestinal tract is a common procedure used for palliation of obstruction in the enteral and biliary tract. Today, stenting of malignant and benign strictures is performed at almost every major tertiary hospital in Korea. Moreover, Korea has become a major global supplier of cutting edge technology in the field of self-expanding metal stents. However, the history of stenting in Korea is relatively short and was far behind that of other nations such as Japan and Germany. The authors are humbled and gratified to have been able to observe the development and application of these stents in Korea, first hand. In this article, the authors review the overall history of stenting with a specific focus on the development of stenting in Korea. The development of esophageal, gastroduodenal, biliary, and colonic stents in Korea are reviewed in this article from a chronological and historical point of view, and a personal account of some of the significant moments of stent development in Korea are described.