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( Ji Ho Kim ),( Sung Hoon Kim ),( Won Hyeong Park ),( Ji Sun Jang ),( Jei So Bang ),( Soo Hyun Yang ),( Jong Hoon Byun ),( Yoon Jung Kim ) 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1
Purpose: Recently, variable gastrointestinal tract tumors including early stage malignancies are treated by endoscopic procedure. But, sometimes the discrepancies of histologic diagnosis happened between the pretreatment results and post-treatment results, especially in the aspect of malignancy. So, we retrospectively reviewed the patients who were not diagnosed as malignancy by forcep biopsy and were treated by EMR or ESD. Then, we investigated the predictable factors of histologic discrepancy between forcep biopsied and endoscopically resected specimen in terms of malignancy by comparing the clinical and endoscopic features through the lesions which were diagnosed as adenoma in forceps biopsy but diagnosed as adenocarcinoma in endoscopically resected specimen. Methods: From March 2008 to April 2011, 129 gastric tumor lesions (119 patients) which were not diagnosed as malignancy and were treated with endoscopic procedure were enrolled retrospectively. We compared the pretreatment endoscopic forceps biopsy results and post-treatment specimen biopsy results, then, analyzed the tumor characteristics. Results: When we compared the biopsy results, histologic discrepancies happened in 21 cases (16.3%) in terms of malignancy. Especially, these situations occurred more frequently in depressed lesions than in the flat or elevated lesions (41.7% vs 13.7%, p=0.012), and in the lesions diagnosed as high grade adenomas than in those diagnosed as low or moderate grade adenomas (33.3% vs. 11.1%, p=0.004). Conclusions: Overall, 16.3% of meaningful histologic discrepancies happened in terms of malignancy between the forceps biopsy and post endoscopic procedure specimen, and those occurred frequently in depressed type lesion and those diagnosed as high grade adenoma significantly.
증례 : 위장관 출혈로 발견된 신세포암의 늦은 십이지장전이 1예
서재원 ( Jae Won Seo ),강은미 ( Eun Mi Kang ),김성훈 ( Sung Hoon Kim ),장지선 ( Ji Sun Jang ),방제소 ( Jei So Bang ),양수현 ( Su Hyun Yang ),박양순 ( Yang Soon Park ) 대한내과학회 2013 대한내과학회지 Vol.84 No.2
저자들은 신세포암으로 우측 근치적 신절제술을 시행하고 22년이라는 긴 시간 동안 무병상태로 지내던 환자에서 위장관 출혈로 발견된 신세포암의 십이지장 단일 전이 증례를 경험하였다. 신세포암으로 신절제술을 시행한 과거력을 가지고 있는 환자들 중 위장관 증상을 보이는 경우 신세포 암의 느린 성장속도를 고려하여 내시경 및 영상의학 검사를 통하여 전이성 병변을 확인하는 것이 필요할 것으로 생각된다. Gastrointestinal metastasis of a renal cell carcinoma is very rare, and the clinical course of the disease ranges from months to several decades. We experienced a case of solitary duodenal metastasis about 22 years after a right nephrectomy for clear-cell type renal cell carcinoma in a 77-year-old man who complained of melena. This case is the longest reported time interval between surgical nephrectomy to presentation with a duodenal metastasis. Patients usually present with recurrence within a year after radical nephrectomy but can present after many years, warranting lifelong surveillance. (Korean J Med 2013;84:245-248)
( Woong Sun Yoo ),( Won Hyeong Park ),( Seo Young Yang ),( Do Young Kim ),( Soo Hyun Yang ),( Sung Hoon Kim ),( Jei So Bang ),( Jisun Jang ),( Tae Gyun Kim ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: One of the previous drawback of full covered metal stents on the peripancreatic cancer is the risk of failure of biliary drainge from cystic duct. Therefore, cholecystitis occurs frequently by complication. We devise some special self expanded metal stent (SEMSs) which were combining the advantages of previous covered stent. Methods: We enrolled fi ve patients (mean age 69.2 years) who underwent endoscopic retrograde biliary drainage with newly designed two third polytetrafl uoroethylene (PTFE) partially covered SEMs for palliation of biliary obstruction secondary to unresectable peripancreatic cancer at our institutions from August 2013 to February 2014. The de nove partially covered SEMs (Taewoong Corporation, Seoul, Korea) is made with stent consists of an inner polyurethane layer to prevent tumor ingrowth and an outer uncovered nitinol wire tube to allow the mesh of the stent to embed itself in the biliary duct wall. Differently then traditional covered stent, One-third of stent is not covered. Follow-up data focused on clinical remissions and complication especially cholecystitis. Additory complications included stent migration, bleeding, perforation and 30-day mortality. Results: In total, 5 stents were placed successfully in 5 of 5 patients. All patients (5/5) did not need to repeat procedures. One hundred percent of the patients experienced adequate palliative drainage for the remainder of their lives. No patients experienced delayed stent migration with stone formation. The 30-day mortality rate was 0% Conclusions: The de nove two third PTFE-covered nitinol stent seems to be safe to use with acceptable complication rates. The PTFE-covered lay is located on the halfway and only covered two third. The rest uncovered one third of stent play an important role in biliary drainage. But there is a need for further large studies to determine the patency.
위장관 ; 겸자 조직검사와 내시경적 치료 후 검체 결과 사이에서 발생하는 위암의 조직학적 차이에 대한 예측인자
김지호 ( Ji Ho Kim ),김성훈 ( Sung Hoon Kim ),박원형 ( Won Hyeong Park ),장지선 ( Ji Sun Jang ),방제소 ( Jei So Bang ),양수현 ( Soo Hyun Yang ),변종훈 ( Jong Hoon Byun ),김윤정 ( Yoon Jung Kim ) 대한소화기학회 2012 대한소화기학회지 Vol.59 No.5
Background/Aims: Recently, variable gastrointestinal track tumors including early stage malignancies are treated by endoscopic procedure. However, the discrepancy of histologic diagnosis may sometimes exist between the pretreatment forceps biopsy results and those of post treatment specimen. So the prediction of malignant lesion is important in the aspect of treatment selection. In this study, we investigated the predictable factors of the histologic discrepancy through the clinical, endoscopic features of the lesion diagnosed as adenocarcinoma in the post-endoscopic treatment specimen after the adenoma was diagnosed by the endoscopic forceps biopsy. Methods: From March 2005 to April 2009, 129 gastric tumor lesions (129 patients) which were not diagnosed as malignancy and treated with endoscopic procedure were enrolled retrospectively. We compared the pretreatment endoscopic forceps biopsy results and post-treatment specimen biopsy results, then, analyzed the tumor characteristics. Results: Twenty-one cases (16.3%) were diagnosed as malignancy after endoscopic treatment. Especially, discrepancy occurred more frequently in depressed lesions than in flat or elevated lesions (41.7% vs. 13.7%, p=0.012), and in lesions diagnosed as high grade adenomas than low or moderate grade adenomas (33.3% vs. 11.1%. p=0.004). Conclusions: In cases of depressed type lesions in the pretreatment endoscopy or those diagnosed as high grade adenoma in the pretreatment forceps biopsy, we should consider combined malignant lesion. Therefore, treatment modalities ensuring accurate diagnosis and potentially curative resection, should be carefully selected and performed in cases which have these features. (Korean J Gastroenterol 2012;59:354-359)
( Seo Young Yang ),( Sung Hoon Kim ),( Woong Sun Yoo ),( Do Young Kim ),( Won Hyeong Park ),( Tae Gyun Kim ),( Jisun Jang ),( Jei So Bang ),( Soo Hyun Yang ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Endoscopic submucosal dissection (ESD) is one of the therapeutic modalities for early gastric cancer. After the ESD, synchronous or metachronous lesions occur in some cases. Agent Orange (AO) is an herbicide used in the Vietnam War to defoliate forest areas. Many Korean veterans who participated in the war were exposed to it. But the infl uence of the material to stomach cancer remained uncertain. So, we investigate the infl uence of AO to the synchronous or metachronous gastric cancer in patients treated by ESD. Methods: From January 2008 to December 2012, 87 male early gastric cancer patients, including 38 AO exposure veterans, treated by ESD and followed up more than 12 months were enrolled, retrospectively. All patients were checked by gastrofi berscope and CT scan regularly for recurrence. Synchronous and metachronous lesion were defi ned as a new lesion found within 1 year and a new lesion found after 1 year of primary ESD treatment. We analyzed the relationship between the synchronous and metachronous lesion occurrence and the clinical characteristics including AO exposure. Results: The median age was 70 (52-85) and the medial follow-up duration was 25 months (12-63). Overall, synchronous lesion incidence rate was 4.6% (4 cases) and metachronous lesion incidence rate was 11.5% (10 cases). In analysis, the metachronous lesion incidence rate was higher in old age group (=65), statistically (0% vs. 14.5%, p <0.05). Otherwise, there was no relationship between the synchronous or metachronous gastric cancer occurrence and other clinical characteristics such as AO exposure, the tumor size, location, histologic and tumor type. Conclusions: Old age is suggested as a risk factor of the metachronous early gastric cancer. It is suggested that there was no infl uence of AO exposure to the synchronous and metachronous gastric cancer.
성인에서 반복적인 복부통증을 유발한 Meckel 게실염에 의한 복막유착
김영수(Young Soo Kim),신용운(Yong Woon shin),문희용(Hee Yong Moon),김명식(Myong Sik Kim),권계숙(Kye Sook Kwon),방제소(Jei So Bang),조현근(Hyeon Geun Cho),김범수(Pum Soo Kim),김준미(Joon Mee Kim) 대한소화기학회 1997 대한소화기학회지 Vol.30 No.6
Meckel,s diverticulum is generally acknowledged to be the most prevalent congenital anomaly of the gastrointestinal tract. In the autopsy series, the incidence ranged from 0.5 to 2 percent. The preoperative diagnosis of Meckels divemiculum is difficult, especially in the adult, because of the lesions ability to masquerade as one of a variety of much more common abdominal pathologies. The diagnostic accuracy may be affected by the age of the patient and by complications of diverticulum. The complications that may result include ulcer bleeding, intestinal obstruction, perforation, diverticulitis, stone, and neoplasm. The ways a Meckels diverticulum can cause bowel obstruction are different. Recently we experienced a case of Meckels diverticulitis causing intlammatory reaction and adhesion with the abdominal wall and causing recurrent abdominal pain and obstruction in a 22-year-old woman. Therefore, we present this case with a brief review of the related literature. (Korean J Gastroenterol 1997; 30:826-830)