1.Successful Management of Periampullary Diverticular Bleeding with Hemoclipping Using Side-viewing Endoscope during Endoscopic Retrograde Cholangiopancreatography.
Bo Geun PARK ; Young Wook YOO ; Joon Cheol SONG ; Sung Hee GAM ; Mi Sung KIM ; Byeong Seong KO
The Korean Journal of Gastroenterology 2016;67(3):146-149
Periampullary diverticulum is commonly found during endoscopy and can occur at any age although its prevalence increases with age. Periampullary diverticular bleeding is a rare and difficult to diagnose during clinical practice because of its unique appearance and location. This often can lead to massive bleeding and interfere with adequate bleeding control. Endoscopic management on duodenal diverticular bleeding is limited compared to colonic diverticular bleeding due to lack of experience. Herein, we report a case of active bleeding from a periampullary diverticulum during bile duct stone extraction diagnosed by side-viewing endoscope and successfully controlled using hemoclips without any complications.
Aged
;
Ampulla of Vater/surgery
;
Cholangiopancreatography, Endoscopic Retrograde
;
Diverticulum/*diagnosis/surgery
;
Gastrointestinal Hemorrhage/etiology/*therapy
;
Humans
;
Male
;
Surgical Instruments
;
Tomography, X-Ray Computed
2.The Effects of Amniotic Membrane Contact Lens for Cornea Wound Healing.
Jang Won SEO ; Byeong Wook KO ; Dong Jun LEE ; Woo Chan PARK
Journal of the Korean Ophthalmological Society 2009;50(7):989-995
PURPOSE: To investigate the efficacy of an amniotic membrane contact lens on corneal epithelial wound healing. METHODS: We made a model with a corneal epithelial wound by applying 6 mm round filter paper soaked with 1 N NaOHonto the central cornea in 24 eyes of 12 rabbits. The rabbits were divided into three groups: AMCL (amniotic membrane contact lens), T-AMT (temporary amniotic membrane transplantation) and the control group. We evaluated corneal wound healing every postoperative day using a digital photo slitlamp and fluorescein dye. The corneas were harvested for histopathologic studies after seven days and analyzed with hematoxylin-eosin (H & E) stain and TUNEL staining. RESULTS: The average wound healing time was similar between the amniotic membrane contact lens and the temporary amniotic membrane transplantation group. The number of the infiltrated PMNs (polymorphonuclear cells) was 8.8+/-2.58, 8.6+/-2.19 and 48.6+/-7.12 in the AMCL, T-AMT and control groups, respectively. Apoptotic keratocytes were 3.8+/-1.1, 3.6+/-1.09 and 23.2+/-5.06 in the AMCL, T-AMT and control groups, respectively. In the AMCL and T-AMT groups, the number of infiltrated PMNs and apoptotic keratocytes were significantly less than those the control group (p<0.05). There were not significant differences in the number of PMNs and apoptotic cells in the AMCL and the T-AMT groups. CONCLUSIONS: Amniotic membrane contact lenses have the benefits of being an easily applied method and having a wound healing ability comparable to that possible with conventional suture methods.
Amnion
;
Contact Lenses
;
Cornea
;
Eye
;
Fluorescein
;
In Situ Nick-End Labeling
;
Membranes
;
Rabbits
;
Sutures
;
Transplants
;
Wound Healing
3.Cardiac arrest after sugammadex administration in a patient with variant angina: a case report.
Myoung Jin KO ; Yong Han KIM ; Eunsu KANG ; Byeong Cheol LEE ; Sujung LEE ; Jae Wook JUNG
Korean Journal of Anesthesiology 2016;69(5):514-517
A 76-year-old man with no notable medical history was scheduled for a robot-assisted radical prostatectomy. After the operation, he was given sugammadex. Two minutes later, ventricular premature contraction bigeminy began, followed by cardiac arrest. Cardiac arrest occurred three times and cardiopulmonary resuscitation was done. The patient recovered after the third cardiopulmonary resuscitation and was transferred to the intensive care unit. Coronary angiography was done on postoperative day 1. The patient was diagnosed with variant angina and discharged uneventfully on postoperative day 8.
Aged
;
Cardiopulmonary Resuscitation
;
Coronary Angiography
;
Heart Arrest*
;
Humans
;
Intensive Care Units
;
Prostatectomy
4.Transection of the Internal Jugular Vein by a Neck Stab Injury : A case report.
Young Gil KO ; Byeong Wook LEE ; Ki Seog LEE ; Kwang Je BAEK ; Jun Sig KIM ; Young Up CHO ; Kee Chun HONG ; Kyung Rae KIM
Journal of the Korean Society of Emergency Medicine 2003;14(4):447-451
Injuries to the internal jugular vein rarely occur in Korea. However, neck veins are damaged more frequently than any other structure by neck stab injuries, and jugular venous injuries are caused almost exclusively by penetrating neck trauma. Vascular injury is the leading cause of death from trauma. Bleeding from injury to jugular veins is a main contributing factor of mortality as a result of penetrating neck trauma. When we meet a patient of neck stab injury, we must do a careful physical examination and some selective special diagnostic studies. Patients with penetrating neck injuries who are taken directly to the operating room are those with severe external hemorrhage and expanding hematoma and those who are hemodynamically unstable despite of resuscitation. A 22-year-old woman received a stab injury to the neck. On the neck CT scan, the patient was revealed to have a pseudoaneurysm caused by transection of the internal jugular vein. The patient recovered well from the injury as a result of a selective operation, an end-to-end anastomosis. We report that case of a penetrating neck injury resulting in transection of the internal jugular vein and give a review of other reported cases.
Aneurysm, False
;
Cause of Death
;
Female
;
Hematoma
;
Hemorrhage
;
Humans
;
Jugular Veins*
;
Korea
;
Mortality
;
Neck Injuries
;
Neck*
;
Operating Rooms
;
Physical Examination
;
Resuscitation
;
Tomography, X-Ray Computed
;
Vascular System Injuries
;
Veins
;
Young Adult
5.Clinical Implications of Moderate Coronary Stenosis on Coronary Computed Tomography Angiography in Patients with Stable Angina.
Choongki KIM ; Sung Jin HONG ; Chul Min AHN ; Jung Sun KIM ; Byeong Keuk KIM ; Young Guk KO ; Byoung Wook CHOI ; Donghoon CHOI ; Yangsoo JANG ; Myeong Ki HONG
Yonsei Medical Journal 2018;59(8):937-944
PURPOSE: The present study investigated the diagnostic accuracy and clinical implications of moderate stenosis (50–69%, Coronary Artery Disease Reporting and Data System, grade 3) on coronary computed tomography angiography (CCTA), compared with invasive coronary angiography (ICA). MATERIALS AND METHODS: Two hundred and seventy-six patients who underwent ICA due to moderate stenosis alone on CCTA were selected from our prospective registry cohort. RESULTS: Diagnostic concordance between CCTA and ICA was found in only 50 (18%) patients. Among the 396 vessels and 508 segments with moderate stenosis, diagnostic concordance was found in 132 vessels (33%) and 127 segments (25%). Segments with calcified plaque had lower diagnostic concordance than those with mixed or non-calcified plaque (22% vs. 28% vs. 27%, respectively, p=0.001). While calcified plaque burden did not have an influence on severe stenosis (≥70%) on ICA, higher burden of non-calcified plaque was correlated with a greater incidence of ICA-based severe stenosis, which was more frequent in patients with ≥3 segments of non-calcified plaque (75%) than those without non-calcified plaque (22%, p < 0.001). Typical angina and mixed or non-calcified plaque were correlated with a higher incidence of under-diagnosis, while the use of next-generation computed tomography scanners reduced the incidence of under-diagnosis. Increased body weight, left circumflex artery involvement, and calcified plaque were independent factors that increased the risk of over-diagnosis of CCTA. CONCLUSION: The diagnosis of moderate stenosis by CCTA may be limited in estimating the exact degree of ICA-based anatomical stenosis. Unlike calcific burden, non-calcific burden was positively correlated with the presence of severe stenosis on ICA.
Angina, Stable*
;
Angiography*
;
Arteries
;
Body Weight
;
Cohort Studies
;
Constriction, Pathologic
;
Coronary Angiography
;
Coronary Artery Disease
;
Coronary Stenosis*
;
Diagnosis
;
Humans
;
Incidence
;
Information Systems
;
Prospective Studies
6.Coronary Computed Tomographic Angiography Does Not Accurately Predict the Need of Coronary Revascularization in Patients with Stable Angina.
Sung Jin HONG ; Ae Young HER ; Yongsung SUH ; Hoyoun WON ; Deok Kyu CHO ; Yun Hyeong CHO ; Young Won YOON ; Kyounghoon LEE ; Woong Chol KANG ; Yong Hoon KIM ; Sang Wook KIM ; Dong Ho SHIN ; Jung Sun KIM ; Byeong Keuk KIM ; Young Guk KO ; Byoung Wook CHOI ; Donghoon CHOI ; Yangsoo JANG ; Myeong Ki HONG
Yonsei Medical Journal 2016;57(5):1079-1086
PURPOSE: To evaluate the ability of coronary computed tomographic angiography (CCTA) to predict the need of coronary revascularization in symptomatic patients with stable angina who were referred to a cardiac catheterization laboratory for coronary revascularization. MATERIALS AND METHODS: Pre-angiography CCTA findings were analyzed in 1846 consecutive symptomatic patients with stable angina, who were referred to a cardiac catheterization laboratory at six hospitals and were potential candidates for coronary revascularization between July 2011 and December 2013. The number of patients requiring revascularization was determined based on the severity of coronary stenosis as assessed by CCTA. This was compared to the actual number of revascularization procedures performed in the cardiac catheterization laboratory. RESULTS: Based on CCTA findings, coronary revascularization was indicated in 877 (48%) and not indicated in 969 (52%) patients. Of the 877 patients indicated for revascularization by CCTA, only 600 (68%) underwent the procedure, whereas 285 (29%) of the 969 patients not indicated for revascularization, as assessed by CCTA, underwent the procedure. When the coronary arteries were divided into 15 segments using the American Heart Association coronary tree model, the sensitivity, specificity, positive predictive value, and negative predictive value of CCTA for therapeutic decision making on a per-segment analysis were 42%, 96%, 40%, and 96%, respectively. CONCLUSION: CCTA-based assessment of coronary stenosis severity does not sufficiently differentiate between coronary segments requiring revascularization versus those not requiring revascularization. Conventional coronary angiography should be considered to determine the need of revascularization in symptomatic patients with stable angina.
Aged
;
Angina, Stable/*diagnostic imaging
;
Coronary Angiography/*methods
;
Coronary Stenosis/*diagnostic imaging
;
Female
;
Humans
;
Male
;
Middle Aged
;
Myocardial Revascularization
;
Predictive Value of Tests
;
Tomography, X-Ray Computed
;
United States
7.A Phase 3 Randomized Clinical Trial to Compare Efficacy and Safety between Combination Therapy and Monotherapy in Elderly Patients with Advanced Gastric Cancer (KCSG ST13-10)
Keun-Wook LEE ; Dae Young ZANG ; Min-Hee RYU ; Hye Sook HAN ; Ki Hyang KIM ; Mi-Jung KIM ; Sung Ae KOH ; Sung Sook LEE ; Dong-Hoe KOO ; Yoon Ho KO ; Byeong Seok SOHN ; Jin Won KIM ; Jin Hyun PARK ; Byung-Ho NAM ; In Sil CHOI
Cancer Research and Treatment 2023;55(4):1250-1260
Purpose:
This study evaluated whether combination therapy is more effective than monotherapy in elderly patients with metastatic or recurrent gastric cancer (MRGC) as first-line chemotherapy.
Materials and Methods:
Elderly (≥ 70 years) chemo-naïve patients with MRGC were allocated to receive either combination therapy (group A: 5-fluorouracil [5-FU]/oxaliplatin, capecitabine/oxaliplatin, capecitabine/cisplatin, or S-1/cisplatin) or monotherapy (group B: 5-FU, capecitabine, or S-1). In group A, starting doses were 80% of standard doses, and they could be escalated to 100% at the discretion of the investigator. Primary endpoint was to confirm superior overall survival (OS) of combination therapy vs. monotherapy.
Results:
After 111 of the planned 238 patients were randomized, enrollment was terminated due to poor accrual. In the full-analysis population (group A [n=53] and group B [n=51]), median OS of combination therapy vs. monotherapy was 11.5 vs. 7.5 months (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.56 to 1.30; p=0.231). Median progression-free survival (PFS) was 5.6 vs. 3.7 months (HR, 0.53; 95% CI, 0.34 to 0.83; p=0.005). In subgroup analyses, patients aged 70-74 years tended to have superior OS with combination therapy (15.9 vs. 7.2 months, p=0.056). Treatment-related adverse events (TRAEs) occurred more frequently in group A vs. group B. However, among severe TRAEs (≥ grade 3), there were no TRAEs with a frequency difference of > 5%.
Conclusion
Combination therapy was associated with numerically improved OS, although statistically insignificant, and a significant PFS benefit compared with monotherapy. Although combination therapy showed more frequent TRAEs, there was no difference in the frequency of severe TRAEs.
8.The Clinical Significance of Specialized Intestinal Metaplasia in the Diagnosis of Barrett's Esophagus: Nationwide Prospective Multicenter Study.
Hyun Kyung PARK ; Nayoung KIM ; Byoung Hwan LEE ; Jin Il KIM ; So Young LEE ; Hyun Min CHA ; Hyerang KIM ; Soo Hyun PARK ; Jong Jae PARK ; Sang Woo LEE ; Ki Nam SHIM ; Seong Eun KIM ; Su Jin HONG ; Il Kwun CHUNG ; Gwang Ho BAIK ; Hyun Soo KIM ; Sungkook KIM ; Jae Kyu SEONG ; Geom Seog SEO ; Sam Ryong JEE ; Jeong Seop MOON ; Mee Yon CHO ; Jae Woo KIM ; Moon Gi CHUNG ; Seon Mee PARK ; Byung Kyu NAH ; Su Youn NAM ; Kang Seok SEO ; Byung Sung KO ; Yun Ju JO ; Jae Young JANG ; Byeong Gwan KIM ; Ji Won KIM ; Kyung Sik PARK ; Hyun Shin PARK ; Young Sun KIM ; Seon Hee LIM ; Chung Hyeon KIM ; Min Jung PARK ; Jeong Yoon YIM ; Kyung Ran CHO ; Donghee KIM ; Seun Ja PARK ; Geun Am SONG ; Hyun Jin KIM ; Sang Wook KIM ; Eui Hyeog IM ; Kyoung Soo LEE ; Dong Hyo HYUN ; Hyun Young KIM ; Sun Mi KIM ; Jeong Eun SHIN ; Chan Guk PARK ; Chang Hun YANG ; Soo Heon PARK ; Hyun Chae JUNG ; In Sik CHUNG
The Korean Journal of Helicobacter and Upper Gastrointestinal Research 2012;12(3):171-177
BACKGROUND/AIMS: The meaning of specialized intestinal metaplasia (SIM) in the diagnosis of Barrett's esophagus (BE) is not clear. This study was designed to determine the clinical significance of SIM in the diagnosis of Barrett's esophagus. MATERIALS AND METHODS: Biopsies were taken from 601 subjects with endoscopically suspected columnar-lined esophagus. Under light microscopy with Alcian-blue stain, SIM was identified. Demographic characteristics, gastroesophageal (GE) reflux symptoms and endoscopic findings were compared between the SIM-present group and the SIM-absent group. RESULTS: Among 601 subjects, 184 (30.6%) were confirmed by pathology to have SIM. Age over 40 years (P<0.001) and a medication history of proton pump inhibitor or H2 blocker were found more frequently in the SIM-present group (P=0.01) than in the SIM-absent group. Any of 7 GE reflux symptoms (heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, cough and epigastric soreness) were more frequent in the SIM-present group than SIM-absent group (P<0.001). Specifically, heartburn, chest pain and cough were significantly more common in the SIM-present group. There was no clinically significant difference associated with endoscopic findings or other clinical characteristics. CONCLUSIONS: When subjects with endoscopically suspected BE are analyzed based on the presence or absence of SIM, the SIM-present group was significantly associated with GE reflux symptoms suggestive of frequent GE reflux. However, the presence of SIM did not correlate with endoscopic findings.
Barrett Esophagus
;
Biopsy
;
Chest Pain
;
Cough
;
Esophagus
;
Gastroesophageal Reflux
;
Heartburn
;
Hoarseness
;
Light
;
Metaplasia
;
Microscopy
;
Prospective Studies
;
Proton Pumps
;
Sensation
9.The Distribution of Endoscopic Gastritis in 25,536 Heath Check-up Subjects in Korea.
Hyun Kyung PARK ; Nayoung KIM ; Sang Woo LEE ; Jong Jae PARK ; Jin Il KIM ; So Young LEE ; Hyun Min CHA ; Hyerang KIM ; Soo Hyun PARK ; Ki Nam SHIM ; Seong Eun KIM ; Su Jin HONG ; Il Kwun CHUNG ; Gwang Ho BAIK ; Hyun Soo KIM ; Sungkook KIM ; Jae Kyu SEONG ; Geom Seog SEO ; Sam Ryong JEE ; Jeong Seop MOON ; Jae Woo KIM ; Moon Gi CHUNG ; Seon Mee PARK ; Byung Kyu NAH ; Su Youn NAM ; Kang Seok SEO ; Byung Sung KO ; Yun Ju JO ; Jae Young JANG ; Byeong Gwan KIM ; Ji Won KIM ; Kyung Sik PARK ; Hyun Shin PARK ; Young Sun KIM ; Seon Hee LIM ; Chung Hyeon KIM ; Min Jung PARK ; Jeong Yoon YIM ; Kyung Ran CHO ; Donghee KIM ; Seun Ja PARK ; Geun Am SONG ; Hyun Jin KIM ; Sang Wook KIM ; Eui Hyeog IM ; Kyoung Soo LEE ; Dong Hyo HYUN ; Hyun Young KIM ; Sun Mi KIM ; Jeong Eun SHIN ; Chan Guk PARK ; Chang Hun YANG ; Soo Heon PARK ; Hyun Chae JUNG ; In Sik CHUNG
The Korean Journal of Helicobacter and Upper Gastrointestinal Research 2012;12(4):237-243
BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P<0.001) and in the older age group (> or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.
Dyspepsia
;
Endoscopy
;
Female
;
Gastritis
;
Gastritis, Atrophic
;
Helicobacter pylori
;
Humans
;
Incidence
;
Korea
;
Male
;
Metaplasia
;
Peptic Ulcer
;
Prevalence
;
Stomach Neoplasms
10.The Distribution of Endoscopic Gastritis in 25,536 Heath Check-up Subjects in Korea.
Hyun Kyung PARK ; Nayoung KIM ; Sang Woo LEE ; Jong Jae PARK ; Jin Il KIM ; So Young LEE ; Hyun Min CHA ; Hyerang KIM ; Soo Hyun PARK ; Ki Nam SHIM ; Seong Eun KIM ; Su Jin HONG ; Il Kwun CHUNG ; Gwang Ho BAIK ; Hyun Soo KIM ; Sungkook KIM ; Jae Kyu SEONG ; Geom Seog SEO ; Sam Ryong JEE ; Jeong Seop MOON ; Jae Woo KIM ; Moon Gi CHUNG ; Seon Mee PARK ; Byung Kyu NAH ; Su Youn NAM ; Kang Seok SEO ; Byung Sung KO ; Yun Ju JO ; Jae Young JANG ; Byeong Gwan KIM ; Ji Won KIM ; Kyung Sik PARK ; Hyun Shin PARK ; Young Sun KIM ; Seon Hee LIM ; Chung Hyeon KIM ; Min Jung PARK ; Jeong Yoon YIM ; Kyung Ran CHO ; Donghee KIM ; Seun Ja PARK ; Geun Am SONG ; Hyun Jin KIM ; Sang Wook KIM ; Eui Hyeog IM ; Kyoung Soo LEE ; Dong Hyo HYUN ; Hyun Young KIM ; Sun Mi KIM ; Jeong Eun SHIN ; Chan Guk PARK ; Chang Hun YANG ; Soo Heon PARK ; Hyun Chae JUNG ; In Sik CHUNG
The Korean Journal of Helicobacter and Upper Gastrointestinal Research 2012;12(4):237-243
BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P<0.001) and in the older age group (> or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.
Dyspepsia
;
Endoscopy
;
Female
;
Gastritis
;
Gastritis, Atrophic
;
Helicobacter pylori
;
Humans
;
Incidence
;
Korea
;
Male
;
Metaplasia
;
Peptic Ulcer
;
Prevalence
;
Stomach Neoplasms