The Evolution of the Conventional Endoscope in an Era of 3-Dimensional Technology

Geun Am Song 대한소화기내시경학회 2012 Clinical Endoscopy Vol.45 No.3

Mallory-Weiss syndrome의 내시경적 진단과 치료

송근암(Geun Am Song),김태오(Tae Oh Kim),강대환(Dae Hwan Kang),조몽(Mong Cho),양웅석(Ung Suk Yang),배상문(Sang Moon Bae),류수형(Soo Hyung Ryu),안준협(Jun hyup An),이성훈(Seong Hwun Lee) 대한내과학회 2000 대한내과학회지 Vol.58 No.5

N/A Background : Mallory-Weiss syndrome is a laceration of gastroesophageal junction due to abruptly increased intraabdominal pressure. Bleeding from Mallory-Weiss tears stops spontaneously within 2-3 days without specific therapy in 80-90% of cases, but in some cases, aggressive treatment is required due to massive bleeding. Methods: Among two hundreds and fifteen cases of upper gastrointestinal bleeding from January 1997 to January 1999, twenty three cases (10.7%) were diagnosed as Mallory-Weiss syndrome by endoscopy. We assessed the site, number, coexisting diseases, precipitating factors and bleeding lesion according to the time interval after the tears. After supportive care or specific therapy, we performed follow-up endoscopy to evaluate the healing of the lesions. Results: The mean age was 49.1 years and male:female ratio was 4.8:1. The most common precipitating factors were nausea, vomiting and alcohol drinking. In twenty cases, coexisting diseases such as gastritis and esophageal varix were detected. As for the number of tears, one tear was the most common (69.6%), while two tears were identified in five cases and three were in two cases. Thirteen cases of the Mallory-Weiss tears were located on the gastroesophageal junction, seven cases on the lower esophagus, one case on the cardia and two cases from lower esophagus to cardia. Eighteen cases were diagnosed by endoscopy within 24 hours after bleeding, of whom fourteen cases had active bleeding. Among four cases diagnosed after 24 hours, endoscopic finding revealed active bleeding in two cases and blood clots in the other two cases. We treated thirteen cases with supportive care, one case with hypertonic saline injection and nine cases who had active bleeding or deep and long tears with endoscopic band ligation. One or two weeks later, we performed follow-up endoscopy, and no bleeding was detected in all cases. Conclusion: We diagnosed twenty three cases of Mallory-Weiss syndrome by endoscopy and treated all cases with supportive care or endoscopic band ligation successfully.(Korean J Med 58:542-547, 2000)

제3차 대한간학회 춘계학술대회 초록집 : 쥐의 간절편을 이용하여 t-butylhydroperoxide로 유발한 지질 과산화 및 세포 독성에 대한 Ca2+ 통로차단제, 세포 외부 칼슘 이온 농도와 phospholipase A2 저해제의 효과

송철수 ( Song Cheol Su ),허정 ( Heo Jeong ),김광하 ( Kim Gwang Ha ),박승근 ( Park Seung Geun ),송근암 ( Song Geun Am ),조몽 ( Jo Mong ),양웅석 ( Yang Ung Seog ),문한규 ( Mun Han Gyu ) 대한간학회 1997 Clinical and Molecular Hepatology(대한간학회지) Vol.3 No.2(S)

간흡충 감염가토의 간내 담관에 대한 병리조직학적 및 조직화학적 연구

송근암(Geun Am Song),김진도(Jin Do Kim),이동완(Dong Wan Lee),손춘희(Choon Hee Son),양웅석(Ung Suk Yang),허윤(Yoon Hue),문한규(Han Gue Moon),유방현(Bang Hyun Liu),이선경(Sun Kyung Lee) 대한내과학회 1989 대한내과학회지 Vol.37 No.3

N/A This study was undertaken to examine the histopathological changes of the bile duct in rabbits heavily infested with Clonorchis sinensis for 6-18 months, and then to investigate the histochemical properties and compositions of epithelial mucosubstances. In 9 rabbits, each rabbit was orally infested with about 500 metacercariae and was sacrificed when general conditions were poor. The specimens were stained with H-E, PAS, alcian blue (pH 2.5), alcian blue (pH 1.0), alcian blue (pH 2.5) -PAS, and FITC- conjugated lectins. The results obtained were as follow 1) The pathological changes in the infested rabbits were papillary and adenomatous hyperplasia, goblet cell and mucus-cell metaplasia, ductal wall fibrosis, and infiltration of eosinophils in the ductal wall, and then the metaplasia of ductal epithelium was more marked in the deep gland than in the surface. 2) The epithelial mucosubstances in the normal intrahepatic bile duct were produced in the border and supranuclear portion of the epithelium. The histochemical composition of these was a mixture of neutral and acid mucosubstances with a predominant acid group. 3) In infested rabbits, the epithelial mucosubstances were produced in the border and supranuclear portion of the covering epithelium, goblet cell, and hyperplasia and metaplasia cells of the deep gland. The mucosubstances were much more produced in the goblet cell, hyperplasia and metaplasia cell of deep gland, and the composition was mixture of neutral and acid substances with a predominance of the neutral group in goblet cell and adenomatous hyperplasia, and a predominance of the acid group in mucus-cell metaplasia of the deep gland. 4) In the normal intrahepatic bile duct, labeling of FITC-conjugated lectins of WGA and Con-A was weakly localized in the border of the epithelium and its grade was trace. 5) In infested rabbits, F1TC-WGA and FITC-Con-A labeling was seen in the border and supranuclear portion of the covering epithelium, goblet cell, and hyperplasia and metaplasia cells of the deep gland, but FITC-PNA and FITC-SBA labeling was graded from zero to trace. 6) Mucin secreting cell metaplasia stained by PAS and AB showed very significant labeling of E1TC-WGA and FITC-Con-A, which are lectins that are highly specific in their recognition of glycosylated residues.

직장 및 S자 결장에서 관찰되는 비교적 드문 질환

송근암 ( Geun Am Song ) 대한장연구학회 2006 Intestinal Research Vol.4 No.1

The rectum is approximately 10 to 15 cm in length and extends from the sigmoid colon to the anal canal. It contribute to defecation as the rectal walls expand, stretch receptors from the nervous system located in the rectal walls stimulate the desire to defecate. There are some differences between rectum and colon. The rectum is divided into two portion by peritoneal reflection and makes pouch. The pouch is associated with many pathologic conditions, such as rectal shelf in stomach cancer, rectal endometriosis, and spread of pelvic inflammation. The inferior mesenteric arteries and middle, inferior rectal arteries supply the rectum. This dual blood supply system causes different incidence of ischemic inserts and metastatic site in rectum and colon cancer. The function of anal sphincter and rectum in pelvic cavity is significantly important in defecation and its disturbance causes some specific rectal disease. Due to its position, rectum may be injuried by external and internal events and show the initial suggestion of colorectal disease. We describe uncommon specific diseases in rectum classified into inflammatory diseases, functional disease and tumor. (Intestinal Research 2006;4:1-6)

궤양성 대장염에서 대장 점막 Mucin의 조직화학적 특성과 Lectin 반응

송근암(Geun Am Song),김태오(Tae Oh Kim),안진광(Jin Kwang An),이준홍(Jun Hong Lee),강대환(Dae Hwan Kang),조몽(Mong Cho),양웅석(Ung Suk Yang) 대한내과학회 2000 대한내과학회지 Vol.58 No.5

N/A Backgrounds : In the pathogenesis of ulcerative colitis, a defective mucosal barrier to luminal antigens is currently under consideration, and alterations in mucin structure and lectin binding may play an important role in the defect of mucosal barrier. It is also, suggested that the differences in clinical manifestation and complication of ulcerative colitis are associated with the change in glycosylation of colonic mucus glycoconjugates. This study was performed in order to investigate the histochemical properties of the mucin in korean ulcerative colitis. Methods : The histochemical staining (HID-AB, mild PAS, PBT-KOH-PAS) and the binding of lectin (PNA, DBA, UEA-1, RCA-1, WGA, with avidin-biotin peroxidase complex method) to mucin glycoconjugates were analyzed in paraffin-embedded tissue sections obtained from 14 normal colons and 20 ulcerative colitis. Results : In the ulcerative colitis, number of goblet cell and amount of mucin were decreased, but the expression of its sulphomucin was consistently predominant and strong like normal colon. The expression of N-acetylated sialomucin was more common in the ulcerative colitis(80%) than normal colon(50%) and its grading mildly increased in ulcerative colitis. The expression of O-acetylated sialomucin was present in all cases of normal colon and its staining grade decreased in the ulcerative colitis. Compared to normal colonic mucosa, ulcerative colitis showed the increase in PNA and DBA binding in the supranuclear cytoplasm, the decrease in DBA and RCA-1 binding in the goblet cells, and no change in UEA-1 and WGA binding in both. In the ulcerative colitis, the increase in PNA and DBA binding was mild in the supranuclear cytoplasm and the expression of DBA and RCA-1 binding in goblet cells variably decreased. Conclusions : This study demonstrates the changes in the mucosal glycoconjugates between the ulcerative colitis and normal colon. The mucinous glycoconjugate expression of korean ulcerative colitis are different from that of western patients. There may be a genetic, racial variation in the glycoconjugate, which may also play a part in the differences in pathogenesis, clinical manifestation, and complication of ulcerative colitis.(Korean J Med 58:532-541, 2000)

Helicobacter pylori 양성인 소화성 궤양 환자에서의 pantoprazole 포함 삼제 요법의 치료 효과

송근암,강대환,조몽,양웅석 釜山醫師會 2000 釜山醫師會誌 Vol.36 No.3

고압성 하부식도 괄약근 환자에서 풍선확장술로 치유한 2예

송철수,송근암,조몽,양웅석 대한내과학회 1997 대한내과학회지 Vol.53 No.3S

약물치료로 연하장애 및 흉통의 증상이 호전되지 않는 고압성 하부식도 괄약근 환자에게 풍선확장술은 간편하고 효과적인 치료방법이라고 사료된다. We describe two patients with dysphagia and chest pain whose esophageal manometric abnormality was hypertensive lower esophageal motility disorder. They showed dilatation of esophageal body and distal tapering or spasm like constriction of distal esophagus on esophagogram. We treated them with calcium channel blockers for 2-3 months, but failed to give relief of symptoms. So we decided to treat with balloon dilatation. After balloon, lower esophageal sphincter pressure decreased significantly and they were free of sympoms during follow up of 5-7 months. In resistant hypertensive lower esophageal sphincter, balloon dilatation gave excellent subjective and objective results and longterm follow up should be required to evaluate the longterm effects and complications of balloon dilatation

장결핵과 크론병의 감별 진단에 있어서 체외 Interferon-γ 검사의 유용성

송근암,김일두 부산대학교 병원 암연구소 2008 부산대병원학술지 Vol.- No.24

배경/목적: 복부 증상과 회맹부 궤양을 나타내는 환자에서 장결핵과 크론병의 감별 진단은 임상적으로 매우 중요하나 증상과 내시경적 소견 및 조직 검사만으로 감별하는 것은 매우 어렵다. 이러한 환자에서 체외 interferon-γ (INF-γ) 검사의 장결핵의 진단에 있어서의 유용성을 알아보고자 하였다. 대상 및 방법: 2008년 1월 부터 2008년 8월까지 부산대학교병원에 복부 증상으로 내원하여 대장내시경을 시행한 만 18세 이상의 환자들 중 내시경 소견이 장결핵과 크론병에 모두 해당할 수 있다고 판단되어 내시경만으로 감별진단이 불가능한 환자 23명을 대상으로 체외 INF-γ 검사를 위해 T SPOT-TB 검사를 시행하였다. 최종 진단은 대장내시경의 육안적 소견, 조직학적 소견, 약물 치료에 대한 반응 및 2개월 이상의 추적 검사로 내려졌다. 결과: 체외 INF-γ 검사는 양성이 13명, 음성이 10명으로 측정되었다. 최종 진단은 양성인 13명 중 장결핵 7명, 크론병 3명, 비특이적인 장염 2명, 베쳇병 1명이었고 음성인 10명 중 장결핵은 없었고 크론병 7명, 비특이적인 장염 2명, 궤양성대장염 1명이었다. 검사의 장결핵에 대한 민감도는 100%, 특이도는 62.5%, 양성 에측치는 53.8%, 음성 예측치는 100% 였다. 결론: 임상적으로 장결핵과 크론병의 감별진단이 어려운 경우에 장결핵의 배제에 있어서 체외 INF-γ 검사가 유용한 검사로 생각된다. 장결핵의 진단을 위한 체외 INF-γ 검사의 유용성에 대해서는 좀 더 대규모 연구가 필요하다. Purpose: It is difficult to differentiate intestinal tuberculosis from Crohn's disease clinically and endoscopically. The aim of this study was to evaluate the effectiveness of in vitro interferon-γ (INF-γ) assay for differential diagnosis between intestinal tuberculosis and Crohn's disease. Methods: 23 patients with common symptoms and colonoscopic findings of intestinal tuberculosis and Crohn's disease were enrolled in this study. T SPOT-TB blood test was performed for in vitro INF-γ assay in all patients. Abdominal computed tomography, chest X-ray, and reviewing past history of tuberculosis were performed in all patients. AFB stain and culture and PCR of mycobacterium tuberculosis in colonoscopic biopsy specimen were also performed in all patients. All patients were diagnosed as intestinal tuberculosis, Crohn's disease or other disease after evaluation and follow up for two month. Results: 13 patients were tested as positive in INF-γ assay and 10 were as negative. Among the positive patients, 7 were intestinal tuberculosis, 3 were Crohn's disease, 2 were nonspecific colitis and 1 was Behcet's disease. Among the negative patients, 7 were Crahn's disease, 2 were nonspecific colitis, 1 was ulcerative colitis and none was intestinal tuberculosis. The sensitivity of T SPOT-TB blood test for intestinal tuberculosis was 100%, specificity was 62.5%, positive predictive value was 53.8% and negative predictive value was 100%. Conclusions: In vitro INF-γ assay was an effective diagnostic method to rule out intestinal tuberculosis when the assay result was negative and the differential diagnosis of intestinal tuberculosis and Crohn's disease was difficult. Prospective large scale studies are required for futher evaluation of the effectiveness of in vitro INF-γ assay for diagnosis of intestinal tuberculosis.

Endoscopic Submucosal Dissection of Gastric Epithelial Neoplasms after Partial Gastrectomy: A Single-Center Experience

Song, Byeong Gu,Kim, Gwang Ha,Lee, Bong Eun,Jeon, Hye Kyung,Baek, Dong Hoon,Song, Geun Am Hindawi 2017 Gastroenterology Research and Practice Vol.2017 No.-

<P><B>Aims</B></P><P> To investigate the feasibility and safety of endoscopic submucosal dissection (ESD) of gastric epithelial neoplasms in the remnant stomach (GEN-RS) after various types of partial gastrectomy. </P><P><B>Methods</B></P><P> This study included 29 patients (31 lesions) who underwent ESD for GEN-RS between March 2006 and August 2016. Clinicopathologic data were retrieved retrospectively to assess the therapeutic ESD outcomes, including en bloc and complete resection rates and procedure-related adverse events. </P><P><B>Results</B></P><P> The en bloc, complete, and curative resection rates were 90%, 77%, and 71%, respectively. The types of previous gastrectomy, tumor size, macroscopic type, and tumor histology were not associated with incomplete resection. Only tumors involving the suture lines from the prior partial gastrectomy were significantly associated with incomplete resection. The procedure-related bleeding and perforation rates were 6% and 3%, respectively; none of the adverse events required surgical intervention. During a median follow-up period of 25 months (range, 6–58 months), there was no recurrence in any case. </P><P><B>Conclusions</B></P><P> ESD is a safe and feasible treatment for GEN-RS regardless of the previous gastrectomy type. However, the complete resection rate decreases for lesions involving the suture lines.</P>