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김흥업 대한상부위장관ㆍ헬리코박터학회 2019 Korean Journal of Helicobacter Upper Gastrointesti Vol.19 No.1
Anisakidosis is a term that collectively refers to a human infection caused by larvae of the family Anisakidae. Because Anisakis simplex was the main cause, it was originally called anisakiasis or anisakiosis, but since other parasites such as Pseudoterranova decipiens also cause similar diseases, the family name is now used as the diagnostic name. Anisakidosis cases have been increasing steadily owing to the propagation of the Japanese raw-fish-eating culture, such as sushi and sashimi, around the world; the traditional raw-fish-eating habits of individual countries; the establishment of marine mammal protection laws; and the development of endoscopic diagnostic techniques. The disease continues to occur in Korea, where most human parasites are believed to have been eradicated and is probably the most common parasitic disease encountered in clinical practice. Anisakidosis is a disease associated with acute abdominal pain. Anisakid larvae can invade the entire digestive tract and abdominal cavity and cause abdominal pain and a variety of digestive system symptoms. Thus, the history of eating raw fish is very important for its differential diagnosis. The lack of a precise understanding of the pathogenesis and clinical course of this disease may lead to unnecessary surgery. Anisakidosis may also manifest as allergic symptoms. Therefore, it is necessary to understand anisakidosis from the perspective of public health, food hygiene, and preventive medicine. (Korean J Helicobacter Up Gastrointest Res 2019;19:23-37)
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김흥업,김영호,송상용,정정환,김종형,김경희,심상군,손희정,이풍렬,김재준,이종철 대한소화기내시경학회 2004 Clinical Endoscopy Vol.29 No.3
Background/Aims: Recently, early detection and treatment of early colon cancer (ECC) has increased, and the concept of de novo carcinogenesis of colon cancer was introduced. However there were few studies in Korea. So we tried to find the incidence of ECC and the possibility of de novo colon cancer (DCC) in Korea. Methods: From Jun 1995 to Jun 2003, 3072 patients who first treated as colon cancer at Samsung Medical Center were enrolled. We selected ECC by medical record review, and pathologic slides and endoscopic photos were reviewed to evaluate the underlying tissue of cancer focus and morphologic characteristics of ECCs. ECC was defined as the cancer confined to mucosa or submucosa, and DCC was defined as the cancer lesser than 1 cm but had no adenoma component. Results: The 192 patients (6.3%) had 196 cases of ECC. The ratio of mucosal and submucosal (SM) cancers was 36.7%:63.3%. The protruded type was the most frequent type (82.1%). The depressed type was the smallest (12.9 6.3 mm), in size and 100% showed and SM involvement. It has significantly higher rate of the cancer without underlying adenoma component (57.1%, p<0.001). The DCC were 6 cases and all were SM cancer and had 3 cases of protruded and depressed type each other. Conclusions: The most common shape of ECC was protruded type. However, depressed type was smaller and had higher rate of SM involvment and no adenoma component around the cancers. And we found some of DCC although the frequency was very low. 목적: 최근 대장암 발생률이 급격히 증가함에 따라 대장암의 조기발견 및 치료의 중요성이 높아지고 있으나 국내에서는 조기 대장암에 대한 연구가 부족하고 대장암의 발암기전으로 adenoma-carcinoma 기전 이외에 de novo 기전이 제시되고 있으나 국내 연구는 매우 드물다. 따라서 본 연구에서는 한국인에서 조기 대장암의 형태학적 특성과 de novo 대장암의 가능성을 알아보고자 하였다. 대상 및 방법: 1995년 6월부터 2003년 6월까지 삼성서울병원에서 대장암으로 치료 받은 환자를 대상으로 의무기록과 조직슬라이드를 검토하였다. 병변이 점막 또는 점막하층까지 침범한 경우를 조기 대장암으로 하였고, 크기가 1 cm 미만으로 암조직 주변에 선종이 동반되어 있지 않은 경우를 de novo 조기 대장암으로 정의하였다. 결과: 총 3,072명의 대장암 중 조기 대장암은 192명에서(6.2%) 196예가 발견되었고 심달도가 점막층, 점막하층인 경우가 각각 72예(36.7%), 124예(63.3%)이었다. 조기 대장암 중 융기형, 편평형, 함몰형이 각각 161예(82.1%), 21예(10.7%), 14예(7.1%), 평균직경은 각각 23.1±15.7 mm, 30.8±19.2 mm, 12.9±6.3 mm이었으며 점막하층 침범이 각각 99예(61.5%), 11예(52.4%), 14예(100%), 주변조직에 선종이 없는 경우가 각각 18예(11.2%), 4예(19.0%), 8예(57.1%)였다. De novo 조기 대장암은 총 6예로 모두 점막하층을 침범하였고 융기형과 함몰형이 각각 3예씩 있었다. 결론: 조기 대장암 중 형태학적으로 융기형이 가장 많았으나 함몰형의 경우 크기가 작고 점막하층을 침범한 경우와 선종조직이 동반되지 않는 경우가 많았다. 또한 한국에서도 적지만 de novo 조기 대장암이 발견되므로 향후 이에 대한 관심을 가져야 하겠다.
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Clinical Characteristics of an Esophageal Fish Bone Foreign Body from Chromis notata
김흥업,송현주 대한의학회 2012 Journal of Korean medical science Vol.27 No.10
Damselfish Chromis notata is a small fish less than 15 cm long and it is widespread in the Indo-Pacific Ocean. Of all the cases of fish bone foreign body (FBFB) disease at our hospital, a damselfish FBFB was very common, and a specific part of the bone complex was involved in the majority of cases. This study was performed to evaluate the clinical characteristics of damselfish FBFB in Jeju Island. We retrospectively reviewed the medical records from March 2004 to March 2011 for foreign body diseases. Among 126 cases of foreign body diseases, there were 77 (61.1%) cases of FBFB. The mean age ± standard deviation was 57.8 ± 12.7 yr, and this was higher in females 60.9 ± 14.6 yr vs 54.1 ± 8.7yr. Damselfish was the most common origin of a FBFB 36 out of total 77 cases. The anal fin spine-pterygiophore complex of damselfish was most commonly involved and cause more severe clinical features than other fish bone foreign bodies; deep 2.7 ± 0.8 cm vs 2.3 ± 0.8 cm; P < 0.01, more common mural penetration 23/36 vs 10/41; P < 0.01, and longer hospital stay 12.6 ± 20.0 days 4.7 ± 4.8 days; P = 0.02. We recommend removing the anal fin spine-pterygiophore complex during cleaning the damselfish before cooking.
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Diagnostic and Treatment Approaches for Refractory Peptic Ulcers
김흥업 대한소화기내시경학회 2015 Clinical Endoscopy Vol.48 No.4
Refractory peptic ulcers are defined as ulcers that do not heal completely after 8 to 12 weeks of standard anti-secretory drug treatment. The most common causes of refractory ulcers are persistent Helicobacter pylori infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs). Simultaneous use of two or more H. pylori diagnostic methods are recommended for increased sensitivity. Serologic tests may be useful for patients currently taking proton pump inhibitors (PPIs) or for suspected false negative results, as they are not affected by PPI use. NSAID use should be discontinued when possible. Platelet cyclooxygenase activity tests can confirm surreptitious use of NSAIDs or aspirin. Cigarette smoking can delay ulcer healing. Therefore, patients who smoke should be encouraged to quit. Zollinger-Ellison syndrome (ZES) is a rare but important cause of refractory gastroduodenal ulcers. Fasting plasma gastrin levels should be checked if ZES is suspected. If an ulcer is refractory despite a full course of standard PPI treatment, the dose should be doubled and administration of another type of PPI considered.
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손가락 촉진으로 발견할 수 있었던 인두에 매몰된 생선가시
김흥업,송현주,최은광,조유경,송병철 대한소화기내시경학회 2011 Clinical Endoscopy Vol.42 No.4
Emergent endoscopy is needed in cases of a fish bone foreign body in the upper gastrointestinal tract. A fish bone foreign body is common in the oral cavity and pharynx and has a high rate of complications because of the characteristic shape. A diagnosis is very difficult when the foreign body penetrates and impacts the surrounding tissue. Computed tomography is useful for the diagnosis; however, direct removal would be impossible if the foreign body was not localized during endoscopy. If the foreign body is anchored to the oral cavity and pharynx, finger palpation is useful to find the impacted fish bone. We report here on a case of an endoscopically missed pharyngeal impacted fish bone foreign body that was finally detected by finger palpation and successfully removed by rescue endoscopy. 상부 위장관의 생선가시 이물은 천공이나 농양 등의 합병증을 유발할 수 있어 응급 내시경을 해야 하는 질환이며 입인두에 많이 발생하고 가늘고 뾰족한 형태적 특징으로 인해 조직을 뚫고 들어가 매몰됨으로써 진단에 지장을 초래하는 경우가 있다. CT가 진단에 도움을 주지만 위치를 안다 하더라도 내시경 당시에 매몰된 부위를 파악하지 못한다면 치료로 이어지기 힘들다. 생선가시가 구강과 인두부분에 매몰되어 있다면 손가락 촉진이 진단에 도움이 될 수 있다. 경부 이물감을 호소하는 환자에서 첫 내시경 검사에서는 발견하지 못했으나 CT에서 이물로 보이는 병변을 발견한 후 손가락을 이용한 인두부분의 촉진으로 생선가시로 추정되는 부분을 발견하고 이 부위에 대해 내시경 검사를 다시 하여 점막 밖으로 보이는 생선가시의 끝을 발견하고 성공적으로 제거한 증례를 보고한다.
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