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Diagnosis and treatment of gastroenterologic disease have been progressed after twentieth century. Nowdays a lot of diseases, which were called incurable diseases before have been treated or managed successfully. But, there are still many incurable diseases left, including advanced cancer and inflammatory bowel disease in gastroenterology. Here we reviewed some cases of celebrities` gastroenterologic incurable diseases. We hoped to widen our understandings of those diseases and give opportunities for the better treatment. Embracements of patients suffering from gastroenterologic incurable diseases were diverse. We can find out they ended their lives doing the most precious things. Among them, the love for their family members were the most universal and important concerns. We hope the patients suffering from gastroenterologic incurable diseases can have more opportunities for better treatments and to be understood in their situations. (Korean J Gastroenterol 2012;60:155-161)
Angiomyolipoma (AML) is a rare benign mesenchymal tumor in the liver, which is composed of blood vessels, smooth muscle, and adipose cells. The proportion of each component varies, making a diagnosis difficult. This paper reports a case of AML in the liver without adipose tissue, mimicking a hepatocellular carcinoma (HCC), which was diagnosed by a surgical tissue biopsy. A 65-year-old woman was admitted for an evaluation of a hepatic mass that had been detected by ultrasonography. The serologic markers of viral hepatitis B and C were negative. The liver function tests and alpha fetoprotein level were within the normal limits. Magnetic resonance imaging revealed a 1.9 cm sized mass in segment 6 of the liver with early arterial enhancement and washout on the delayed phase accompanied by a rim-like enhancement, which is similar to the imaging findings of HCC. A frozen section examination during surgery indicated a hepatocellular neoplasm and suggested the possibility of HCC. On the other hand, the final pathologic diagnosis was epithelioid myoid type of AML with no adipose tissue component. The tumor cells were positive for human melanocyte B-45 and negative for cytokeratin and hepatocyte paraffin 1. This paper reports a very rare case of AML without adipose tissue in the liver mimicking HCC that was diagnosed by a surgical tissue biopsy. (Korean J Gastroenterol 2018;71:49-53)
정태엽 ( Tae Yeob Jeong ), 김유선 ( You Sun Kim ), 박경준 ( Kyung Jun Park ), 이종성 ( Jong Sung Lee ), 허진국 ( Jin Gook Huh ), 류수형 ( Soo Hyung Ryu ), 이정환 ( Jung Hwan Lee ), 문정섭 ( Jeong Seop Moon ) 대한소화기학회 2008 대한소화기학회지 Vol.51 No.3
Leiomyosarcoma is a rare tumor of the liver. It usually arises from many other organs including uterus, gastrointestinal tract, retroperitoneum, and soft tissues. Primary hepatic leiomyosarcoma progresses very slowly and is not associated with chronic liver disease. When the tumor is detected early enough to be treated by operation, the prognosis is favorable. While several cases of primary hepatic leiomyosarcoma have been reported in Korea, there was no case associated with acute bleeding. We report a 80-year old male patient with huge primary hepatic leiomyosarcoma, who presented with acute bleeding and IVC obstruction. The patient was treated by embolization and IVC stenting. (Korean J Gastroenterol 2008;51:194-198)
The pathogenesis, incidence, complication rates, response to acid suppression and Helicobacter pylori (H. pylori) eradication therapy in peptic ulcer associated with chronic disease such as liver cirrhosis, chronic renal failure, diabetes mellitus, and critically ill conditions are different from those with general population, so that the management strategies also should be differentiated. The eradication of H. pylori are not so effective for preventing recurrence of peptic ulcer in liver cirrhosis patients as shown in general population, and conservative managements such as preventing deterioration of hepatic function and decrease in portal pressure are mandatory to reduce the risk of ulcer recurrence. The standard triple therapy for H. pylori eradication are as effective in chronic renal failure patients as in normal population, but the frequency of side effects of amoxicillin is higher in the patients not receiving dialysis therapy. Delay in eradication therapy until beginning of dialysis therapy or modification of eradication regimen should be considered in such cases. High prevalence of asymptomatic peptic ulcers and increased mortality in complicated peptic ulcer disease warrant regular endoscopic surveillance in diabetic patients, especially with angiopathy. The prolongation of duration of eradication therapy also should be considered in diabetic patients with angiopathic complication because of lower eradication rate with standard triple regimens as compared to normal population. Prophylactic acid suppressive therapy is highly recommended in critically ill patients with multiple risk factors. Herein, we propose evidence-based treatment guidelines for the management of peptic ulcer disease in special conditions based on literature review and experts opinion. (Korean J Gastroenterol 2009;54:318-327)
목적: 국내에 유통되는 음료식품에 의한 속쓰림 발생의 빈도를 조사하고 음료식품이 속쓰림을 일으키는 기전을 규명하고자 하였다. 대상 및 방법: 2004년 11월부터 2005년 6월까지 속쓰림을 주소로 서울백병원에 내원한 382명의 환자를 대상으로 설문지를 통하여 35종류의 음료식품에 의한 속쓰림의 빈도를 조사하여 점수화하였다. 각 음료의 수소이 온지수, 적정산, 삼투질농도를 측정하여 속쓰림 점수와의 관련성을 검정하였다. 결과: 속쓰림 점수가 가장 높은 음료는 커피(1.15)와 소주(1.12)였으며 가장 낮은 음료는 우롱차(0.17)와 당근주스(0.18)였다. 과실채소음료의 적정산이 속쓰림과 관련성이 있었다(r=0.78; p=0.023). 탄산음료는 가장 낮은 수소이온지수를 보였으나 속쓰림 점수와의 관련성은 없었다(r=?0.54; p=0.460). 주류는 수소이온지수가 높을수록 속쓰림 점수가 높았으며(r=0.84; p=0.037) 삼투질농도와는 역의 관계가 있었다(r=?0.86; p=0.028). 무카페인커피는 일반커피보다 속쓰림 점수가 의미 있게 낮았으며(p<0.001) 일반우유는 저지방우유보다 속쓰림 점수가 더 높게 나타났다(p=0.008). 결론: 이번 논문은 속쓰림을 호소하는 환자들에게 적절한 음료식품을 선택할 수 있도록 정보를 제공하여 치료에 도움을 줄 수 있을 것이다. Background/Aims: The aim of this study was to investigate the frequency of heartburn produced by beverages available in Korea and to clarify the mechanism causing heartburn. Methods: We measured pH, titratable acidity, and osmolality of 35 beverages in vitro and correlated them with the severity of heartburn reported by questionnaire in 382 patients from November 2004 to June 2005. Results: Coffee (1.15) and soju (1.12) showed the highest heartburn score, while oolong tea (0.17) and carrot juice (0.18) showed the lowest heartburn score among all beverages. Titratable acidity of citrus juices correlated with heartburn (r=0.78; p=0.023). Soft drinks had the lowest pH, which was unrelated with heartburn scores (r=?0.54; p=0.460). Increasing pH among alcoholic beverages was correlated with heartburn scores (r=0.84; p=0.037), and osmolality was inversely associated with heartburn scores (r=?0.86; p=0.028). The heartburn score of decaffeinated coffee was significantly lower than that of regular coffee (p<0.001). Regular milk caused more heartburn than low-fat milk (p=0.008). Conclusions: Our findings provide dietary information that helps to select appropriate beverages to the patients with heartburn. (Korean J Gastroenterol 2010;55:109-118)
정성연 ( Seong Yeon Jeong ), 박원우 ( Won Wo Park ), 김유선 ( You Sun Kim ), 박영일 ( Young Il Park ), 김승협 ( Seung Hyup Kim ), 윤원재 ( Won Jae Yoon ), 문정섭 ( Jeong Seop Moon ), 이병모 ( Byung Mo Lee ), 홍성우 ( Seong Woo Hong ), 강) 대한소화기학회 2014 대한소화기학회지 Vol.64 No.2
목적: 현재까지 위장관기질종양(GIST)을 양성과 악성으로 분류할 수 있는 명확한 조직학적 기준은 없지만, 전이나 재발을 일으킬 수 있는 위험도를 종양세포의 유사분열 수와 종양의 크기를 기준으로 나누고 있다. Ki-67은 세포 증식의 표지자로 사용되는 단백질로, GIST의 예후 인자로의 가능성이 주목되고 있다. 이에 저자들은 수술 치료를 시행한 GIST 환자 중 Ki-67 면역조직화학염색을 시행한 32예의 Ki-67 지수와 유사 분열 지수와의 관련성, GIST의 재발률 및 무병 생존율에 대하여 분석 검토하여 보았다. 대상 및 방법: 인제대학교 서울백병원에서 수술 치료를 통하여 GIST를 제거한 32명의 환자를 대상으로 연구를 시행하였고 환자들의 의무기록을 통하여 성별, 연령, 증상 등의 임상적 특징과, 종양의 크기, 위치 등의 조직학적 특징 및 재발률에 대하여 조사하였다. 결과: NIH 진단기준으로 very low risk는 4예, low risk는 9예, intermediate risk는 14예, high risk는 5예였다. Ki-67 지수는 1-18%의 범위 내에 있었고, 평균은 5.56±4.48%였다. 평균 추적관찰 기간은 35.72±29.04개월이었고 관찰 도중 6 예(18.7%)에서 재발 혹은 전이가 발견되었다. Ki-67 지수가 5% 이하인 군의 누적 무병 생존율은 12개월, 24개월, 60개월에 각각 100%, 100%, 86%였다. 반면 Ki-67 지수가 5% 초과인 군의 누적 무병 생존율은 12개월, 24개월, 60개월에 각각 82.1%, 70.3%, 46.9%로 Ki-67 지수가 5% 이하인 환자에 비하여 무병 생존율에 유의한 차이를 보였다(p=0.007) 결론: Ki-67 지수가 5% 초과할 경우 GIST 재발의 고위험성을 시사한다. 향후 Ki-67 지수의 표준화와 치료 방향의 결정에 미치는 Ki-67 지수의 역할에 대한 연구가 필요하다. Background/Aims: Assessment of malignant potential in gastrointestinal stromal tumor (GIST) is still problematic. The maximum tumor diameter and the mitotic index are generally used as an index of malignancy of GISTs. The Ki-67 labeling index has recently been used as an index of cell growth. The aim of this study was to investigate the prognostic value of K -67 in GIST. Methods: We retrospectively reviewed the medical records of 32 patients with GIST who underwent surgical resection at Inje University Seoul Paik Hospital. We analyzed their Ki-67 expression, histologic finding, and prognosis. Results: According to the tumor size and mitotic count, 4 patients were classified as very low risk, 9 patients as low risk, 14 patients as intermediate risk and 5 patients as high risk. The average Ki-67 index was 5.56±4.48%. The median follow-up duration was 35.72±29.04 months, and local/distant recurrences were observed in 6 (18.7%) patients. The overall cumulative disease free survival rates in patients with Ki-67 index ≤5% at 1 year, 2 years, and 5 years were 100%, 100%, and 86%, respectively. The overall cumulative disease free survival rates in patients with Ki-67 index >5% were at 1 year, 2 years, and 5 years were 82.1%, 70.3%, and 46.9%, respectively. There was significant relationship between elevated Ki-67 and disease free survival rate (p=0.007). Conclusions: Our study suggests that Ki-67 index >5% confers a higher risk of relapse in patients with GIST. Future work should focus on standardization of Ki-67 assessment and specification of its role in making treatment decisions.(Korean J Gastroenterol 2014,64:87-92)
이연호 ( Yun Ho Lee ), 정성연 ( Seong Yeon Jeong ), 김유선 ( You Sun Kim ), 정혜진 ( Hye Jin Jung ), 권민정 ( Min Jung Kwon ), 곽철훈 ( Cheol Hun Kwak ), 배송이 ( Song I Bae ), 문정섭 ( Jeong Seop Moon ), 김지원 ( Ji Won Kim ), 김수환 ( Su) 대한소화기학회 2015 대한소화기학회지 Vol.65 No.1
목적: PEG (polyethylene glycol)는 안정적인 장정결제로 인정받아 왔지만, 환자의 순응도가 좋지 않아 장 정결이 제대로 되지 않을 수 있다는 단점이 있다. 이 연구에서는 sodium phosphate (NaP) 정제와 PEGA (PEG with ascorbic acid)를 사용하는 대장 정결법의 효용성과 순응도를 알아보고자 하였다. 대상 및 방법: 다기관, 전향적 무작위 대조 연구이며, 1차 연구 목적은 대장내시경 전처치에서 NaP 정제와 PEGA 방법의 대장 정결도를 비교하는 것이고, 2차 목적은 대장 내시경 시행 직전 조사한 설문을 이용하여 양 군 간의 환자의 순응도와 만족도를 비교하는 것이다. 결과: 총 189명 중 사전 무작위 배정을 통해서 NaP 정제(n=96) 또는 PEGA (n=93) 방법을 통해 장정결한 뒤 대장내시경을 시행하였다. 양 군 간에 BBPS는 NaP 정제군에서 평균 8.3 (SD, ±1.12)이었고, PEGA군에서는 평균 8.4 (SD, ±0.96)로 나타나 통계적으로 유의한 차이는 없었다(p=0.441). 양 군 간의 폴립 및 선종의 발견율 또한 유의한 차이가 나지 않았다(p=0.079, 0.790, respectively). 반면 NaP 정제를 복용한 환자의 2.0%가 복용해야 할 분량을 다복용하지 못하였고, PEGA군에서는 8.6%가 복용하지 못하였다(p=0.045). 또한 만족도는 NaP 정제군에서 평균 7.9 (SD, ±1.63)였고, PEGA군에서는 평균 7.4 (SD ±1.53)로 나타나 유의한 차이를 보였다(p=0.022). 결론: NaP 정제를 이용해 대장 정결을 하는 것은 PEGA 방법과 비교하여 정결도, 폴립(선종)의 발견율, 부작용 발생에 큰 차이가 없으면서 순응도 및 만족도가 더 높은 방법이다. Background/Aims: Performance of polyethylene glycol solution (PEG) is often unsatisfactory as bowel preparation agent for colonoscopy. In order to provide equivalent efficacy with better patient tolerance, sodium phosphate tablet (SPT) has been developed. This study was carried out to compare the efficacy and compliance of two bowel preparation methods: PEG with ascorbic acid (PEGA) vs. SPT preparation. Methods: A multicenter, randomized controlled trial was performed. Primary efficacy variable was overall quality of colon cleansing assessed by Boston bowel preparation scale (BBPS) during colonoscopy. Patient`s satisfaction and adverse events were evaluated by means of symptom questionnaire completed by each patient immediately before colonoscopy. Results: A total of 189 patients were randomly assigned to undergo pre-colonoscopic bowel preparation with either SPT (n=96) or PEGA (n=93). Overall BBPS score was 8.3±1.12 in the SPT group and 8.4±0.96 in the PEGA group (p=0.441). Among the 189 patients, 90 had polyps (47.6%) and 50 had adenomas (26.5%). The polyp/adenoma detection rate was 54.2% (n=52)/27.1% (n=26) for SPT group and 40.9% (n=38)/25.8% (n=24) for PEGA group (p=0.079 and 0.790, respectively). More number of patients were unable to take the prescribed dose of PEGA compared with the SPT regimen (8.6% vs. 2.0%, p=0.045). Overall satisfaction score was 7.9±1.63 in the SPT group and 7.4±1.53 in the PEGA group (p=0.022). Conclusions: Degree of colon preparation, polyp/adenoma detection rate and adverse effect were similar between SPT group and PEGA group. Patient compliance and satisfaction were greater in the SPT group.
A visceral artery pseudoaneurysm after ERCP is a rare adverse event that is potentially life-threatening. Most cases reported previously originated from the peripancreatic arteries, including the splenic artery, gastroduodenal artery, or pancreaticoduodenal artery. The mechanism of the occurrence of visceral artery pseudoaneurysms after ERCP has not been elucidated until now. Recently, a pseudoaneurysm rupture originating from the superior mesenteric artery after ERCP was observed in a patient without a history of pancreatitis. This paper reports this case with a review of the relevant literature.