Obstructive Jaundice Caused by Clonorchiasis-associated Duodenal Papillitis: A Case Report

임준욱,주광로,신현필,차재명,이정일,임성직 대한의학회 2011 Journal of Korean medical science Vol.26 No.1

We describe an unusual presentation of Clonorchis sinensis infection with obstructive jaundice due to duodenal papillitis which was relieved dramatically by endoscopic sphincterotomy. A 26-yr-old male presented with complaints of fatigue, weight loss and painless jaundice. The history was significant for frequent ingestion of raw freshwater fish. The patient underwent endoscopic retrograde cholangiopancreatography for evaluation of obstructive jaundice. The duodenal papilla was markedly edematous with a bulging configuration and hyperemic changes at the orifice. Cholangiography revealed mild bile duct dilatation and irregular wall changes with multiple indentations. However, there were no biliary stricture or stones noted as the cause of obstructive jaundice. We performed an endoscopic sphincterotomy for effective bile drainage through the duodenal papilla. After the sphincterotomy, the patient’s jaundice was dramatically improved. Pathology of the duodenal papilla showed eosinophilic infiltration of the mucosa. Parasitic eggs, consistent with the diagnosis of C. sinensis, were found in the bile sample.

국가 암검진 사업의 대장암 선별검사로 시행한 면역화학 분변잠혈검사의 의의

임준욱 ( Jun Uk Lim ),배나영 ( Na Young Bae ),송원경 ( Won Koung Song ),차재명 ( Jae Myung Cha ),이정일 ( Joung Il Lee ) 대한장연구학회 2010 Intestinal Research Vol.8 No.2

Background/Aims: Colorectal cancer (CRC) is one of the major causes of death and poses a major public health concern. The National CRC Screening Programme (NCSP) provides annual CRC screening using a fecal occult blood test for individuals >50 years of age since 2004. The purpose of the current study was to determine the outcomes and efficacy of a fecal immunochemical test (FIT) based on the NCSP in a quality-controlled university hospital setting. Methods: We retrospectively reviewed the medical records and a standardized questionnaire from the NCSP of 3,852 individuals who underwent a FIT between March and December 2009. All of the subjects submitted a stool specimen for a FIT, while a double-contrast barium enema or colonoscopy was performed as a confirmatory examination for FIT-positive individuals. The CRC screening rate and rate of detection colorectal adenomas, advanced adenomas, and colorectal cancers by FIT were evaluated. Results: The CRC screening rate with FIT was very high (72.3%), but the positive rate of detection by FIT was only 1.3%. The rate of detection for colorectal cancers, adenomas, and advanced adenomas by FIT was 0.08%, 0.39%, and 0.13%, respectively. The quantitative values of FIT in individuals with colorectal adenomas and cancers were significantly higher than other colorectal diseases. Men (P=0.001) and elderly individuals (P=0.039) were significantly more common in the FIT-positive group than the FIT-negative group. Approximately 28% of the subjects with FIT-positive tests did not receive a confirmatory examination. Conclusions: Although the FIT had a low rate of detection, the FIT was a useful screening tool for detection of CRC in the NCSP. It will be important to increase CRC screening rates and confirmatory examination rates. (Intest Res 2010;8:126-134)

분산 제어를 위한 이동에이전트의 자율성 적용

임준욱(Jun-Wook Lim),정은지(Eun-Ji Jeong),이연식(Yon-Sik Lee),장민석(Min-Seok Jang) 한국정보통신학회 2021 한국정보통신학회 종합학술대회 논문집 Vol.25 No.1

센서네트워크 환경에서 접근이 용이하지 않은 시공간 데이터 획득 및 송신을 위해서는 무선통신 기능을 갖는 센서들이 필수적으로 요구된다. 그러나 이들 센서들은 대용량의 센싱 데이터 처리나 동적 환경에의 적응성이 미흡하여 전력의 과소비와 네트워크 부담을 유발한다. 본 논문은 임계값을 적용한 능동규칙을 통하여 필요한 데이터만을 획득, 전송 및 처리할 수 있는 이동에이전트 모델과 이동에이전트의 자율적 이주 및 통신 수행방법을 제안하여 다양한 센서네트워크 환경에서의 효율적 분산 제어방법을 제시한다. Sensors with wireless communication functions are essential for acquiring and transmitting spatio-temporal data that is not easily accessible in sensor network environments. However, these sensors lack adaptability to large amounts of sensing data processing or dynamic environments, resulting in over-consumption of power and network overhead. This paper proposes a mobile agent that can acquire, transmit, and process only the necessary data by applying thresholds, and presents methods for autonomous migration and communication processing of mobile agents.

조기 간세포암종에서 간동맥 색전술과 경피적 고주파열 병합치료

임준욱 ( Jun Uk Lim ),신현필 ( Hyun Phil Shin ),이정일 ( Joung Il Lee ),박재준 ( Jae Jun Park ),전정원 ( Jung Won Jeon ),임규성 ( Kyu Seong Lim ) 대한간암학회 2012 대한간암학회지 Vol.12 No.1

In most early hepatocellular carcinoma (HCC), surgical resection or liver transplantation is the first choice of treatment. However, surgery is often impossible because of patient`s physical condition such as advanced liver cirrhosis, other comorbidities, and radiofrequency ablation (RFA) can be used as substitute treatment. Recently, it has been reported that clinical outcomes of transarterial chemoembolization (TACE) combined with RFA were similar to that of surgical resection. This report describes a 49-year-old male with 1.5 cm sized HCC. Because the patient could not undergo surgical resection and the tumor was not localized on ultrasonography (US), TACE was performed instead. But the residual tumor was still detected on follow-up contrast enhanced US, we performed additional RFA. After combined treatment with TACE and RFA, viable portion of the tumor was not detected on one month follow-up CT and MRI image. The patient remains well without recurrence, 12 months after combined treatment. It is suggested that TACE combined with RFA can be an alternative choice of early small HCC treatment.

Esophageal bezoar who took crude drugs

양진선,임준욱 대한내과학회 2018 대한내과학회 추계학술대회 Vol.2018 No.1

Ectopic pancreas (heterotopic pancreas) in jejunum.

양진선,임준욱 대한내과학회 2018 대한내과학회 추계학술대회 Vol.2018 No.1

A Patient with Duodenal Mucinous Adenocarcinoma Presenting as a Laterally Spreading Tumor

채명준,백인현,오유미,임준욱,전정원,신현필,주광로,이정일 대한소화기내시경학회 2015 Clinical Endoscopy Vol.48 No.4

Primary duodenal carcinoma is rare. Duodenal mucinous adenocarcinoma (DMA) is even rarer, and its associated manifestations and typical endoscopic or imaging findings are not well characterized. Herein, we report a case of primary DMA in an asymptomatic 58-year-old man who visited our hospital for a regular health screening. Upper endoscopy revealed an approximately 4-cm lesion in the second portion of the duodenum, but the mass was not visualized on computed tomography. Biopsies revealed a tubular adenoma that was subsequently resected. Frozen biopsies demonstrated DMA with a background of low-grade tubular adenoma for which we performed Roux-en-Y duodenojejunostomy and jejunojejunostomy. To our knowledge, this is the first report of a patient with DMA in Korea.

수술 전 Carbohydrate Antigen 19-9 검사는 대장암 환자의 병기와 생존율을 예측할 수있다

문수영,차재명,이정일,주광로,신현필,박재준,전정원,임준욱,전승정,서윤종,이치훈 대한장연구학회 2013 Intestinal Research Vol.11 No.3

Background/Aims: The purpose of this study was to determine whether preoperative carbohydrate antigen 19-9 (CA 19-9) levels can predict the stage of diseases or survival rate in patients with resectable colorectal cancer (CRC). Methods: A total of 247 patients who underwent curative resections at Kyung Hee University Hospital at Gangdong between 2006 and 2011 were enrolled. We investigated the correlations of preoperative serum levels of CA19-9 with clinicopathological features of CRC. Receiver operative curve was constructed for evaluating the efficiency of the serum CA 19-9 levels in the stratifying stage of CRC. Survival analysis was performed with Kaplan-Meire method and log-rank test. Cox regression analysis was used for the multivariate analysis for survival. Results: Abnormal level of serum CA 19-9 (>37 IU/mL) were associated with advanced T stage (P<0.001), N stage (P=0.002) and TNM stage (P<0.001) in patients with resectable CRC. Furthermore, abnormal level of serum CA 19-9 were related with vascular invasion (P=0.002) and lymphatic invasion (P=0.026). The area under the curve was 0.75 (95% confidence interval [CI] 0.67-0.83) for T4 stage CRC and 0.680 (95% CI 0.61-0.75) for TNM stage III CRC. In patients with TNM stage III CRC, a preoperative CA 19-9 higher than 60 IU/mL (P=0.033) and presence of vascular invasion (P=0.002) were identified as significant predictors of survival rate on multivariate analysis. Conclusions: In patients with resectable CRC, preoperative CA 19-9 correlates with T stage, N stage and TNM stage of disease. Serum CA 19-9 >60 U/mL was an independent predictor of survival rate in the patients with TNM stage III CRC. (Intest Res 2013;11:184-190) 목적: 대장암에 대한 혈청 carbohydrate antigen 19-9 (CA 19-9)의 역할에 대한 연구는 많지 않으며, 특히 CA 19-9과 대장암의 임상 병리학적인 연관성 및 예후에 대한 보고는 거의 없었다. 이번 연구는 단일기관에서 대장암으로 수술을 시행하였던 환자를 대상으로 수술 전 혈청 CA19-9과 임상병리학적인 상관관계를 분석하고, 예후인자로서 혈청 CA 19-9의 역할에 대해 규명하기 위하여 시행하였다. 방법: 2006년 6월 1일부터 2011년 12월 31일까지 강동경희대학교병원에서 대장암으로 진단되어 수술 전 혈청 CA 19-9을 측정한 환자를 대상으로 후향적으로 분석하였다. 수술 전 혈청 CA 19-9와 대장암의 임상병리학적 상관관계를 분석하였다. 혈청 CA 19-9 수치가 진행성 대장암을 진단할 수 있는지 receiver operative curve 분석을 시행하였고, TNM III 병기 대장암 환자들의 5년 생존율을 분석하였다. 결과: 총 247명의 환자들이 연구에 포함되었다. T 병기, N 병기와 TNM 병기가 각각 높아질수록 혈청 CA 19-9 수치가 비정상(>37 U/mL)인 환자들의 빈도가 증가하였고, 혈청 CA 19-9 수치가 비정상인 환자군에서 림프관 침범과 혈관 침범의 빈도가 더 높았다. T4 병기의 대장암 진단에 대한 area under the curve (AUC)는 0.75 (95% confidence interval [CI] 0.67-0.83)였으며, TNM III 병기의 대장암 진단에 대한AUC는 0.680 (95% CI 0.61-0.75)였다. TNM III 병기 대장암 환자에서 혈관 침범과 혈청 CA 19-9 (>60 U/mL)은 5년 생존율에 영향을미치는 독립적인 예후인자로 판명되었다. 결론: 수술 전 혈청 CA 19-9을 측정하여 진행성 대장암의 병기에 대한 예측을 할 수 있을 뿐만 아니라, 혈청 CA 19-9은 TNM III 병기 대장암에서 수술 후의 생존율을 예측할 수 있는 독립적인 예후인자이다. 향후, 대장암 환자에 대한 CA 19-9의 예후적인 역할을 규명할 수 있는전향적인 대규모 생존율 연구가 필요할 것으로 생각한다.

치료 의사의 전문 분야에 따른 게실염의 임상 특성 및 치료 성적

전승정,차재명,이정일,주광로,신현필,박재준,전정원,임준욱,서윤종,문수영,이치훈 대한장연구학회 2013 Intestinal Research Vol.11 No.2

목적: 급성 대장게실염의 임상 경과에 영향을 주는 인자들로 나이, 비만, 병변의 위치 등이 알려져 있지만 진료 의사의 전문성이 미치는 영향에 대해서는 보고된 바가 없었다. 이번 연구에서는 진료 의사의 전문 분야에 따라 게실염의 임상 특성 및 치료 성적을 분석하였다. 방법: 2006년 6월부터 2012년 12월까지 경희대학교 강동경희대병원에서 급성 대장게실염을 처음 진단받고 입원 치료를 시작한 239명 환자의 의무기록을 후향적으로 분석하였다. 소화기내과 전문의가 진료했는지의 여부에 따라 게실염 환자의 임상 특성 및 치료 성적을 비교 분석하였다. 결과: 소화기내과 전문의가 치료한 환자는 38명(15.9%)이었으며, 소화기내과 전문의가 아닌 의사가 치료한 환자는 201명(84%)이었다. 두군 사이에 나이, 성별, 체질량지수, 동반질환, 재발률, 합병증 등에는 차이가 없었으나, 타 과 전문의가 진료했던 게실염 환자들에게 우측 게실염이 유의하게 많았다(79.0% vs . 91.0%, P=0.028). 또한 합병증이 없는 게실염 환자의 치료에서 소화기내과 분과 전문의는 소화기내과 전문의가 아닌 의사들보다 주사 항생제를 경구용 항생제로 더 일찍 변경하였다(평균 3.3일 vs . 4.4일, P=0.032). 주사용 항생제 사용 기간에대한 다변량 분석 결과 소화기내과 전문의의 진료 여부가 주사용 항생제 사용 기간에 대한 독립적인 예후 인자(교차비 3.272, 95% 신뢰구간1.005-10.650, P=0.049)로 판명되었으며, 소화기내과 전문의가 아닌 의사들은 소화기내과 전문의에 비해 주사 항생제를 3일 이상 사용할위험이 약 3.8배 더 높게 관찰되었다. 결론: 소화기내과 전문의는 합병증을 동반하지 않은 게실염 환자의 치료에서 수술이나 재발의 증가 없이 짧은 기간 주사 항생제를 사용하는효과적인 치료를 하고 있었기 때문에, 진료 의사의 전문성에 따라 주사용 항생제 사용 기간이 단축될 수 있다고 해석할 수 있다. Background/Aims: Several factors affecting the severity and outcomes of diverticulitis have been reported, but there is little research on physician specialty related with this disease. Therefore, we evaluated the clinical characteristics and outcomes of diverticulitis depending on physician’s specialty. Methods: Medical records of 239 patients, who had been hospitalized with first-diagnosed acute colonic diverticulitis at Kyung Hee University Hospital in Gang Dong (Seoul, Korea) from June 2006 to December 2012, were retrospectively analyzed. The patients were classified according to whether they had been managed by gastroenterologists or not. Clinical characteristics and treatment outcomes were compared between two groups. Results: Of these 239 patients, 38 (15.9%) patients were treated by a gastroenterologist and 201 (84.1%) patients by a non-gastroenterolo-gist. Clinical characteristics such as age, gender, body mass index, comorbidity, medication, laboratory results, recurrence and complication were not significantly different between two groups. However, right-sided diverticulitis predominated in the non-gastroenterologist group (79% vs. 91%, P=0.028). From the sub-group analysis of uncomplicated diverticulitis, intravenous anti-biotics was used for a shorter period of time by gastroenterologists than non-gastroenterologists (3.3±1.9 days vs. 4.4±2.8 days,P=0.032). Multivariate logistic regression analysis showed that the 3 day administration of intravenous antibiotics significantly depended on the physician’s specialty (odds ratio 7.984, 95% confidence interval 1.990-32.043, P=0.003). Conclusions: The results suggest that the duration of intravenous antibiotics for treating uncomplicated colonic diverticulitis was shortened by gastroenterology specialists without increasing operation or recurrence. (Intest Res 2013;11:92-99)

The Box Simulator Is Useful for Training Novice Endoscopists in Basic Endoscopic Techniques

차재명,이정일,주광로,신현필,박재준,전정원,임준욱,임규성 연세대학교의과대학 2012 Yonsei medical journal Vol.53 No.2

Purpose: The present study was aimed at evaluating the usefulness of box simulators for training novice endoscopists. Materials and Methods: An explanation of the goals, contents, and features of the simulator was given to study participants. The participants then received “hands-on training” in gastrointestinal endoscopy techniques using a box simulator. Subsequently, they were asked to answer 19 structured questions about the simulator. Ratings were scored on a scale from 1 to 5 for questions concerning their first impression of the simulator. Questions on the usefulness of the simulator and the training course were answered as “agree”, “disagree”,or “no opinion”. Results: A total of 32 participants filled out the questionnaire. The mean scores on the simulator’s usefulness, features, and realistic movements before the training were between 1.5 and 2.0. There were no significant differences between the mean values of the scores given by novice users compared to non-novice users. However, after receiving training on the simulator, 90.6% of the participants considered the box simulator a generally useful tool for learning basic endoscopic techniques, and 90.6% agreed that the simulator was useful for improving hand-eye coordination. Conclusion: Box simulators may be useful for training novice endoscopists in basic gastrointestinal endoscopic techniques.