Confocal Laser Endomicroscopy in the Diagnosis of Biliary and Pancreatic Disorders: A Systematic Analysis

Do Han Kim,Somashekar G. Krishna,Emmanuel Coronel,Paul T. Kröner,Herbert C. Wolfsen,Michael B. Wallace,Juan E. Corral 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.2

Background/Aims: Endoscopic visualization of the microscopic anatomy can facilitate the real-time diagnosis of pancreatobiliarydisorders and provide guidance for treatment. This study aimed to review the technique, image classification, and diagnosticperformance of confocal laser endomicroscopy (CLE). Methods: We conducted a systematic review of CLE in pancreatic and biliary ducts of humans, and have provided a narrative of thetechnique, image classification, diagnostic performance, ongoing research, and limitations. Results: Probe-based CLE differentiates malignant from benign biliary strictures (sensitivity, ≥89%; specificity, ≥61%). NeedlebasedCLE differentiates mucinous from non-mucinous pancreatic cysts (sensitivity, 59%; specificity, ≥94%) and identifies dysplasia. Pancreatitis may develop in 2-7% of pancreatic cyst cases. Needle-based CLE has potential applications in adenocarcinoma,neuroendocrine tumors, and pancreatitis (chronic or autoimmune). Costs, catheter lifespan, endoscopist training, and interobservervariability are challenges for routine utilization. Conclusions: CLE reveals microscopic pancreatobiliary system anatomy with adequate specificity and sensitivity. Reducing costs andsimplifying image interpretation will promote utilization by advanced endoscopists.

제2형 당뇨병 환자에서 당화혈색소와 가장 좋은 상관성을 보이는 일종 혈당치의 비교

김형진,이태희,최성희,김수경,김대중,이유미,김세화,안철우,차봉수,송영득,임승길,김경래,이현철,허갑범 대한당뇨병학회 2002 임상당뇨병 Vol.3 No.1

연구배경 : 제2형 당뇨병 환자의 혈당조절을 평가하는데 하루 중 어느 시간의 혈당 측정치가 가장 의미 있는지를 평가하기위해 혈당이 안정화된 당뇨병 환자에서 하루동안 4차례 혈당을 측정하여 당화혈색소와 비교하였다. 방법 : 연세의료원 당뇨병센터에서 혈당을 관리하는 제2형 당뇨병 환자 118명이 실험에 참여하였다. 검사 3개월전에 환자의 식습관을 검토하였고 환자는 검사기간동안 평상시의 식사를 유지하게 하였다. 6시에 아침 공복혈당을, 정오에 점심 식전 혈당을, 오후 5시에 저녁 식전 혈당을, 밤 10시에 자기전 혈당을 측정하였다. 혈당은 모세혈관 전혈로 간이혈당측정기인 Surestep을 이용해 측정하였다. 당화혈색소는 high pressure liquid chromatography assay (VARIANTⅡ, BIORAD)로 측정하였다. 일원배치 분산분석으로 각군 간 혈당치의 차이를 조사하였고 단순회귀분석을 사용하여 혈당과 당화혈색소의 관계를 조사 하였으며 다중회귀분석을 이용하여 다양한 시간대의 혈당중 어느 것이 당화혈색소를 의미있고 독립적으로 예측할 수 있는 지를 조사하였다. 결과 : 당화혈색소에 따라 대상자들을 세 군으로 나누었을 때 오전 6시 혈당은 각 군간에 의미있는 차이를 보였으나 다른 시간대의 혈당은 일부 군들 사이에서만 의미있는 차이를 보였다. 선형회귀분석상 오전 6시 혈당, 정오 혈당, 오후 5시 혈당, 오후 10시 혈당 각각의 결정계수(Rsquare)가 0.187 (p<0.001), 0.035 (p=0.43), 0.116 (p<0.001), 0.108 (p<0.001)이어서 정오 혈당을 제외한 오전 6시 혈당, 오후 5시 혈당, 오후 10시 혈당은 모두 통계적으로 의미있게 당화혈색소를 예측할 수 있었다. 다중회귀분석상 오전 6시 혈당, 정오 혈당, 오후 5시 혈당, 오후 10시 혈당의 회귀계수가 각각 0.348 (p<0.05), -0.091(p=0.369), 0.168 (p=0.148), 0.103 (p=0.338)로 오전 6시 혈당만이 당화혈색소에 유의한 영향을 주는 것으로 나왔다. 결론 : 이상의 결과로 당뇨병 환자의 혈당관리에 있어서 당화혈색소와 가장 우수한 상관성을 보이는 혈당은 공복혈당이며 다른 시간대의 혈당보다 더 좋은 혈당조절의 예측자인 것으로 밝혀졌다. Background: We have designed a study to evaluate the relative value of Capillary blood glucose measurement at different times of the day in comparison with HbA1c measurement in a ssessing the mean glycemic control of type 2 diabetic patients. Methods: The 118 patients with type 2 diabetes, all of whom very regular visitors of the outpatient clinic of the Diabetic Center of the YonseiUniversity Hospital, were entered consecutively into the study. Three months before enrollment, the dietary habits of each participant were checked, and the patients received recommendations for continuing their usual diet throughout the entire period of the study. The first sample was examined before breakfat at 6:00 A.M. (prebreakfa stglucose and HbA_(1c) ); the second, at noon (prelunch glucose); and the third, at 5:00 P.M. (presupper glucose). The last sample was examined at 10:00 P.M. (bedtime glucose). The capillary whole blood glucose was used to determine blood glucose concentrations (by Surestep). A high-pressure liquid chromatography assay (VARIANTⅡ, BIO-RAD) was used to make all determinations of HbA_(1c) (normal range, 4~6%). Simple linear regression a nalysis was used to examine the relationship between capillary blood glucose and HbA1c at each time point. Multip le linear regression analysis was performed to determine which of the values of va rious capillary blood glucoses were significant and independent predictors of HbA1c. Results : Mean concentration of capillary blood glucose at 6 A.M. is significantly different between three groups classified by levels of HaA1c , but not at othertimes. Simple line arregression analysis demonstrated that R-squares between the blood glucose and HbA1c were 0.187 (6:00 A.M.), 0.035 (noon), 0.116 (5:00 P.M.), and 0.108 (10:00 P.M.). Levels of the blood glucose at 6:00 A.M.; 5:00 P.M.; and 10:00 P.M. were correlated with HbA1c , but that at noon was not. Multiple regression analysis demonstrated that the standardized coefficients (β ) of the glucose levels at 6:00 A.M.; noon; 5:00 P.M.; and 10:00 P.M. were 0.348 (P<0.05), -0.09 1(P=0.369), 0.168 (P=0.148), and 0.103 (P=0.338), respectively. Only, the blood glucose at 6:00 A.M. influenced to HbA1c . Conclusions: In type 2 diabetes, the blood glucose at 6:00 A.M. have most strong correlation with HbA_(1c) , and is better predictor of glycemic control than those of other times.

신입간호사를 위한 e-learning 예비교육 프로그램 개발 및 적용

김수영,최선숙,김연희,곽월희,김미순,현미숙 임상간호사회 2004 임상간호연구 Vol.10 No.1

Purpose: To develop and apply an e-learning orientation program that enables the new nurses to be acquainted with their works more rapidly so that they could perform their abilities more efficiently in the field. Method: The study was designed with 4 stages in the order of demand survey done by 159 new nurses, program development based on Network Instructional System Design Model, program application done by 433 other new nurses and user evaluation. Result: The total of the following 18 courses have been thoroughly developed in the order listed as follows: oxygen therapy, suctioning, peripheral intravenous therapy, emergency drugs, drug management, drug dosage calculation, clinical drugs Ⅰ, clinical drugs Ⅱ, blood transfusion, medication administration, tube feeding, enema, urinary catheterization, vital sign checking method, infection control, safety control, overview of clinical pathology and emergency nursing. The overall average score of the evaluation was 4.13 out of 5 points in satisfaction. Conclusion: In order to continuously develop and promote the e-learning program, the applicants study demand and clinical nursing practice must be reflected to the program.

Determination of the Absolute Configurations of Urinary Chiral Acids from Patients Suffering from Ornitine Transfer Carbamylase Deficiency, β-Ketothiolase Deficiency & Lactic acidosis by GC

Kim KR,Lee J,Ha D,Won S,Yoon HR,Kim JH 大韓藥學會 2000 大韓藥學會 總會 및 學術大會 Vol.2000 No.1

TDM검사 신빙도조사 결과보고(2002)

김정호,여운영,김병광,정영순,이수연,전사일,신동훈,송경은,권계철,이경률,김진규 대한임상검사정도관리학회 2003 臨床檢査와 精度管理 Vol.25 No.1

인간 자궁상피와의 공동배양이 미성숙 생쥐난자의 체외 성숙 및 초기 배아발달에 미치는 영향

김광례(KR Kim),문신용(SY Moon),장윤석(YS Chang) 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.6

The use of superovulation for human in vitro fertilization-embryo transfer (IVF-ET) produces a cohort of oocytes that can be of varing levels of maturity. Mature oocytes are incubated for 5 to 6 hours before sperm insemination, whereas immature oocytes are cultured for 20 to 36 hours before they are inseminated, but the fertilization rate for immature oocytes matured in vitro remains below than those achieved with mature oocytes. There have been reported that successful in vitro maturation of animal oocytes were achieved by culture alone, by adding gonadotropins or specific growth factors to that medium, or by coculture on the top of granulosal cells. To increase the fertilization and early embryo development, immature oocyte of mouse (ICR) were cocultrued with human uterine epithelial cells isolated from uterine stromal cells by highly purified method. The coculture system improved in vitro maturation of immature mouse oocyte by full expansion of cumulus cells(86% vs 41.5%) and extrusion of first polar body(58% vs 45.4%) in comparison with medium alone. The fertilization rates(58% vs 32.8%) and embryo cleavage rate (20.2% vs 9.2%) of in virto maturated immature oocyte were improved in coculture system. When mouse 1-cell embryo were coclutured on the top of monolayer of human uterine epithelial cells, embryo development rates(>4 cell embryo) were significantly higher than control group (45.4% vs 16.6%). The in vitro fertilization rates of mature oocytes(87.2% vs 79.9%) were increased in coculture system that showed good quality of embryo in subsequent embryo development, reducing in fragmentation(3.1% vs 26%). In conclusion, when cocultured with mouse immature oocytes, mature oocyte, and early embryos, human utreine epithelial cells improved the rate of in vitro maturation of oocyte, fertilization and early embryo development, respectively. This suggests that application of a permanent established stable endometrial cell line to assisted reproductive techniques may allow better results in selection of embryo for transfer therefore impove the following pregnancy.

관동맥 조영술상 정상 혹은 50% 미만의 협착과 흉통을 가진 환자의 장기 추적 결과

박기락,배장호,김기식,김윤년,김권배 대한순환기학회 2001 Korean Circulation Journal Vol.31 No.4

Hyperreactio Luteinalis 1 례

김창연(CY Kim),이계현(KH Lee),김병준(BJ Kim),김종구(JK Kim),이진식(JS Lee),손경락(KR Son) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.6

Hyperreactio Luteinalis refers to moderate to marked cystic enlargement of the ovaries due to multiple benign theca lutein cysts and is most often associated with hydatidiform mole or choriocarcinoma. We present a case of hyperreactio luteinalis unassociated with trophoblastic disease and review the literature. This case, 28-year old primigravida, was admitted to our hospital due to lower abdominal pain and increasing dyspnea. By ultrasonography, which was conducted because of uncertain gestatinal criteria, there was a single fetus and a normal-appearing placenta; the dimensions of the biparietal diameter and femur length were consistent with those of a 16-week gestation; also, bilateral multicystic adnexal masses were found (right, 19*11*14 cm; left, 15*10*17 cm). After bilateral wedge resection of the ovaries conservative treatment was done. A healthy 2900 g female infant was delivered in the 37th week of pregnancy. Pathologically theca lutein cysts were confirmed.

배아의 자궁내이식시 보조부화술을 이용한 자궁내막 착상율의 증진에 관한 연구

김석현(SH Kim),채희동(HD Chae),김광례(KR Kim),이재훈(JH Lee),류범용(BY Ryu),오선경(SK Oh),서창석(CS Suh),최영민(YM Choi),김정구(JK Kim),문신용(SY Moon),이진용(JY Lee) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.2

Although the fertilization rate exceeds to 80~90% with much progress in vitro fertilizaton and embyo transfer(IVF-ET) program, the prgnancy rate rmains at 20~30%, and the endometrial implantaion rate per embryo transferred at 10~15%. Recently, many attempts have been made to improve embrynic implantion after IVF-ET including serveral procedures of assisted hatching(AH) using micromanipulation, and pregnacies and births have been obtained after AH. This clinical study was performed to develop and estabilish AH as an effective procedure to improve embryonic implantioan in IVF-ET patients who had previous repeated failure of standard IVF-ET more than 2 times(Group R), were more than 37 years old(Group A), or had high basal serun FSH levels more than 15 mIU/ml(Group F). From January, 1995 to Februry, 1996, 132 cycles of AH using partial zona dissection(PZD) were performed in 104 infertile patients, and the outcomes of AH were analyzed according to pregnancy rate. The number of oocytes retrieved after controlled ovarian hyperstimulation(COH) was 9.9±7.1 in 71 cycles of 54 patients who had previous repeated failure more than two times(Group I: Group R,R+A,R+F, and R+A+F), 8.4+-5.9 in 62 cycles of 46 patients whose age was more than 37 years old(Group II : Groups A, R+A, A+F, and R+A+F), and 8.7±6.5 in 49 cycles of 47 patients who had high basal serum FSH levels more than 15 mIU/ml(Group III:Groups F,R+F, A+F, and R+A+F). The number of embroys transferred after AH was 4.7 ±1.8 in Group I, 4.2 ±1.9 in Group II, and 4.2±2.0 in Froup III. The mean cumulative embryo score(CES) was 56.8±30.0 in Group I, 52.6±30.6 in Group II, and 52.6±29.9 in Group III. There were no significant differences in the numbers of oocytes rerieved and embryos transferred, and CES among 3 groups. The overall clinical pregnancy rate was 14.4%(19/132) per cycle and 18.3%(19/104) per patient. THe clinical pregnancy rate per cycle and per patient was 12.7%(9/71) and 16.7%(9/54) in Group I, 4.8% (3/62) and 6.5%(3/46) in Group II, and 26.5%(13/49) and 27.7%(13/47) in Group III, and there was a significant difference between Group II and Group III. In conclusion, AH of human embryos using micromanipulation might be promising for IVF-ET patients, especially with the past history of repeated failure, old age, and high basal serum FSH level and AH will provide a range of novel techiques which may dramatically improve the implanatation and pregnancy rates in IVF-ET program and contribute much to effective management of infertile couples.

정상 임신과 동반된 Hyperreactio Luteinalis 1 예

김대연(DY Kim),도진우(JW Do),정재훈(JH Chung),이희선(HS Lee),김광례(KR Kim),김석현(SH Kim) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.10

We report a case of hyperreactio luteinalis in a patient with normal singleton pregna-ncy. In the 10th week of gestation, the patient developed lower abdominal pain accompanied by abdominal distension. Ultrasonography revealed bilateral ovarian cysts. Right salpingo-oophorectomy was performed due to torsion of right ovarian cyst. The pathologic diagnosis was corpus luteal cyst. Any signs of maternal virilization were not seen. The patient deliv-ered a normal male infant at 39th week of gestation. As hyperreactio luteinalis is a benign condition in itself with normal spontaneous remission after delivery, the conservative man-agement may be appropriate.