• Applied Microscopy
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• 제30권1호
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• pp.21-44
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• 2000

동면기 (11월부터 3월까지) 동안의 한국산 관박쥐(Rhinolophus ferrumequinum korai) 자성 생식도관 내의 정자저장, 정자 생존 여부 및 정자이동을 알아보기 위하여 전자현미경으로 관찰한 결과는 다음과 같았다. (1) 자궁내강, 자궁선내의 정자들은 다수의 백혈구들에 의해 포식되고 소멸되었다. (2)정자들은 수란관 미측 협부에서만 저장되었고, 정자들의 두부는 상피세포쪽을 향하고 있었다. 이는 교미기(10월 초-중순경)에 사출된 정자들이 긴 동면기 동안에 수란관 미측 협부에서만 생존 가능함을 의미하며, 수란관의 미측 협부가 정자의 수정능 획득(capacitation)에 필요한 최적의 장소임을 의미한다. (3) 동면후기인 3월의 수란관 미측협부에는 정자들이 관찰되지 않았다. 이는 배란기인 4월에 난자를 만나기 위해 정자들이 수정부위인 팽대부 쪽으로 이행하였음을 의미한다. 이상의 결과로 미루어 보아, 긴 동면기 동안의 자성 생식도관 내에서의 정자의 장기저장과 생존여부 및 정자이동은 수정을 위한 일종의 mechanism이라 여겨진다.

• Clinical Endoscopy
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• 제57권2호
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• pp.226-236
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• 2024

Background/Aims: This study aimed to compare the safety of the double-guidewire technique (DGT) with that of the conventional single-guidewire technique (SGT) in real-world situations. Methods: A total of 240 patients with naïve papilla who underwent endoscopic retrograde cholangiopancreatography (ERCP) at Daegu Catholic University Medical Center between January 2021 and December 2021 were included. The primary outcome was the rate of post-ERCP pancreatitis (PEP) in the SGT and DGT groups. Results: A total of 163 patients (67.9%) belonged to the SGT group, and 77 (32.1%) belonged to the DGT group. The rates of successful biliary cannulation were 95.7% and 83.1% in the SGT and DGT groups, respectively (p=0.002). In the study group, PEP occurred in 14 patients (5.8%). The PEP rates were not significantly different between the SGT and DGT groups (4.3% vs. 9.1%, p=0.150). In the multivariate analysis, the age of <50 years (odds ratio [OR], 9.305; 95% confidence interval [CI], 1.367-63.358; p=0.023) and hyperlipidemia (OR, 7.384; 95% CI, 1.103-49.424; p=0.039) were significant risk factors for PEP in the DGT group. Conclusions: DGT did not increase the PEP rate in patients with naïve papilla. In addition, the age of <50 years and hyperlipidemia were significant risk factors for PEP in the DGT group.

• Clinical Endoscopy
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• 제55권6호
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• pp.736-741
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• 2022

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastric bypass anatomy is a well-documented challenge. Traditionally, this problem has been overcome with adjunctive techniques, such as device-assisted ERCP, including double-balloon or single-balloon enteroscopy and laparoscopy-assisted transgastric ERCP. Endoscopic ultrasound-directed transgastric ERCP (EDGE) is a novel technique that enables access to the ampulla using a duodenoscope without surgical intervention and has shown high clinical and technical success rates in recent studies. However, this approach is technically demanding, necessitating a thorough understanding of the gastrointestinal anatomy as well as high operator experience. In this review, we provide a technical overview of EDGE in parallel with our personal experience at our center and propose a simple algorithm to select patients for its appropriate application. In conjunction, the outcomes of EDGE compared with those of device-assisted and laparoscopy-assisted transgastric ERCP will be discussed.

• 한국간담췌외과학회지
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• 제28권3호
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• pp.364-370
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• 2024

Backgrounds/Aims: We evaluated long-term pancreatic functional outcomes, including pancreatic volumetry after pancreaticoduodenectomy (PD) for peri-ampullary neoplasm. Methods: We retrospectively reviewed 353 patients with a 12-month follow-up who underwent elective pancreaticoduodenectomies for peri-ampullary neoplasms at a single university hospital between January 2011 and December 2020. Perioperative and postoperative outcomes, long-term pancreatic endocrine functions, and pancreatic volume changes 12 month postoperatively were evaluated. Results: The mean age was 65.4 years, and the sex ratio was 1.38. The patients with prediagnosed diabetes mellitus (DM) comprised 31.4%. The peri-ampullary neoplasm origins were: the pancreas (49.0%), common bile duct (27.2%), ampulla of Vater (18.4%), and duodenum (5.4%). The 1-week, and 3-, 6-, and 12-month postoperative proportions of patients with DM diagnosed before surgery combined with new-onset postoperative DM were 39.7%, 42.8%, 43.9%, and 49.6%, respectively. The preoperative and postoperative 1-week, and 3-, 6-, and 12-month mean pancreatic volumes were 82.3, 38.7, 28.1, 24.9, and 25.5 mL, respectively. Univariate risk factor analyses for new-onset DM after PD observed no significant difference between the 'No DM after PD' and 'New-onset DM after PD' groups. Conclusions: Following PD for peri-ampullary neoplasms, pancreatic endocrine functions and volumes continued to decrease for a minimum of 12 months. The current study did not identify any causal relationship between pancreatic endocrine dysfunction and pancreatic atrophy following PD.

• 한국간담췌외과학회지
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• 제28권3호
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• pp.371-380
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• 2024

Backgrounds/Aims: The published data had contradictory information on the role of adjuvant therapy on resected periampullary carcinomas (PACA). The study was performed to evaluate the survival benefit of adjuvant treatment. Methods: This was a propensity score matched case-control study from a prospectively maintained database from 2004-2019. The study included patients with nonpancreatic PACA who underwent curative resection. The patients (cases) who received adjuvant chemotherapy were compared with patients (controls) who were observed alone after surgery. Results: Of 510 patients with PACA, 230 patients (cases = 107, controls = 123) formed the unmatched study cohort. After propensity score matching, 140 patients (cases = 70, controls = 70) formed the matched study cohort. The median overall survival (OS) was similar in cases than controls in the unmatched population but doubled non-significantly in cases after matching (unmatched population, 54 months vs. 54 months, p-value = 0.624; matched population, 71 months vs. 36 months, p-value = 0.087). However, the median recurrence-free survival (RFS) was non significantly higher in the control group (unmatched population, 59 months vs. 38 months, p-value = 0.195; matched population, 53 months vs. 40 months, p-value = 0.797). In cox regression analysis, age < 60 years, advanced T stage, and presence of perineural invasion were independent factors for worse RFS, while tumor recurrence was an independent factor for poor OS. Conclusions: Patients with nonpancreatic PACA may have an OS benefit from adjuvant chemotherapy, and this needs to be validated with large prospective randomized studies.

• The Korean Journal of Physiology
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• 제4권1호
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• pp.59-67
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• 1970

In recent observations on vestibular eye movements in mammals, reported by several different workers, it was indicated that the pattern of reflex eye movement from semicircular canal nerve stimulation in rabbits was different from that observed in the other species such as cats and dogs. Observing the different anatomical features of the extraocular muscles of rabbits, Kim ascribed the different pattern of eye movement of rabbits to the functional difference of inferior and superior oblique muscles from those of other species. Present experiment was carried out to elucidate a physiological mechanism underlying in such particular pattern of reflex eye movement in rabbits. An individual canal nerve was selectively stimulated, under a dissecting microscope, by a fine electrode induced into an ampulla through a hole provided on the wall of corresponding osseous canal, and responses of the extraocular muscles were checked by recording the isotonic changes of muscle length. Following results were obtained. 1. Direct stimulation of the superior or inferior oblique muscles Produced upward or downward movement of the eye turning toward medial side respectively. 2. Stimulation of the unilateral canal nerve Produced a marked contraction of a main contracting ocular muscle and simultaneous relaxation of an antagonistic muscle in both eyes. Less potent contraction of an additional ocular muscle was observed and it appeared to augment the function of the main contracting muscle in the ipsilateral eye. 3. Stimulation of superior semicircular canal nerve caused a primary contraction of superior rectus, synergic contraction of superior oblique and relaxation of inferior rectus in ipsilateral eye. Contraction of inferior oblique and relaxation of superior oblique were observed in the contralateral eye. 4. Stimulation of lateral semicircular canal nerve produced a primary contraction of medial rectus, synergic contraction of superior oblique and relaxation of lateral rectus in the ipsilateral eye. Contraction of lateral rectus and relaxation of medial rectus were observed in the contralateral eye. 5. Stimulation of inferior semicircular canal nerve produced a primary contraction of superior oblique, synergic contraction of superior rectus and relaxation of inferior oblique in the ipsilateral eye. Contraction of. inferior rectus and relaxation of superior rectus were observed in the contralateral eye. 6. Upon stimulation of individual canal nerve, the pattern of eye movement in rabbits is different from those of cats, however, the responses of the extraocular muscles appear to be similar in two species. Therefore, it is concluded that the different Pattern of eye movement in both species are not due to the possible difference of vestibule-ocular reflex pathways but to the functional difference of superior and inferior oblique muslces.

• Applied Microscopy
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• 제42권2호
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• pp.67-76
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• 2012

고강성 나노섬유 생산이 가능한 전기방사장치 방사노즐의 설계를 위해 자연을 모방하는 공학적 방법론을 도입하여, 무당거미(Nephila clavata L.Koch) 대병상선의 토사관과 그 생체방적 시스템이 지닌 미세구조적 특성을 고해상도의 전자현미경 관찰을 통해 분석하였다. 자연계에서 가장 강도가 높은 드래그라인을 생성, 분비하는 대병상선의 토사관은 bullet type spigot을 통해 전방적돌기 표면에 개구되어 있었으며, 신축성 구조를 지닌 토사관 말단마디의 노즐을 통해 고체상의 실크가 생성되었다. 분비낭과 토사관 사이를 연결한 분비관은 루프를 형성한 후 방적돌기에 수납되었고, 분비관 내강의 직경은 점진적으로 축소되어 노즐을 통해 방사되는 실크의 직경은 펀넬 부위의 1/10 이하인 것으로 관찰되었다. 한편, 실크 중합과정에서 수분을 제거하기 위한 큐티클의 특수구조가 관찰되었는데, 분비낭의 펀넬 부위에서는 해면상 큐티클 구조가 그리고 분비관의 말단부에서는 비후된 subcuticle 구조와 함께 잘 발달된 상피의 미세융모 층이 확인되었다. 또한 분비관의 내강부 큐티클 표면에서 확인된 나선형 강선구조는 실크 전구물질의 신속한 유동을 촉진하는 장치일 것으로 해석되었다.

• The Korean Journal of Pancreas and Biliary Tract
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• 제22권4호
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• pp.165-171
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• 2017

배경/목적: 담도암에서 플라스틱 스텐트 너비에 따른 스텐트 생존 차이에 대한 데이터는 부족하다. 이번 연구의 목적은 담도암에서 7-프렌치와 10-프렌치 플라스틱 스텐트의 생존 차이를 보고 어떤 인자가 개방성에 영향을 미치는지 확인하고자 한다. 방법: 2010년 1월부터 2014년 10월까지 연세대학교 원주세브란스기독병원에서 담도암으로 담도가 막힌 환자들을 등록하였다. 결과: 총 215명(7-프렌치:10-프렌치 = 89명:126명)의 환자를 후향적으로 등록하였다. 암의 위치는 총담관(111명), 간문부 담관(45명), 바터팽대부(59명)였다. 스텐트 이동이나 폐쇄는 두 군 간에 통계적 차이가 없었다. 중앙 스텐트 생존은 7-프렌치의 경우 3.3개월이었고 10-프렌치의 경우 5.9개월이었다(p = 0.543). 플라스틱 스텐트 너비는 스텐트 생존에 영향을 미치지 않았다(Hazard Ratio: 1.11, 95% CI 0.71-1.73, p = 0.649). 결론: 담도암 치료에 있어 7-프렌치와 10-프렌치 플라스틱 스텐트는 스텐트 이동이나 폐쇄 차이가 없었고 스텐트 생존에 있어 7-프렌치 플라스틱 스텐트가 10-프렌치에 비해 열등하지 않았다.

• Korean Journal of Radiology
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• 제25권3호
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• pp.243-256
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• 2024

Objective: We aimed to investigate whether 2-[¹⁸F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (2-[¹⁸F]FDG PET/CT) can aid in evaluating the risk of malignancy in ampullary tumors detected by endoscopy. Materials and Methods: This single-center retrospective cohort study analyzed 155 patients (79 male, 76 female; mean age, 65.7 ± 12.7 years) receiving 2-[¹⁸F]FDG PET/CT for endoscopy-detected ampullary tumors 5-87 days (median, 7 days) after the diagnostic endoscopy between June 2007 and December 2020. The final diagnosis was made based on histopathological findings. The PET imaging parameters were compared with clinical data and endoscopic features. A model to predict the risk of malignancy, based on PET, endoscopy, and clinical findings, was generated and validated using multivariable logistic regression analysis and an additional bootstrapping method. The final model was compared with standard endoscopy for the diagnosis of ampullary cancer using the DeLong test. Results: The mean tumor size was 17.1 ± 7.7 mm. Sixty-four (41.3%) tumors were benign, and 91 (58.7%) were malignant. Univariable analysis found that ampullary neoplasms with a blood-pool corrected peak standardized uptake value in earlyphase scan (SUVe) ≥ 1.7 were more likely to be malignant (odds ratio [OR], 16.06; 95% confidence interval [CI], 7.13-36.18; P < 0.001). Multivariable analysis identified the presence of jaundice (adjusted OR [aOR], 4.89; 95% CI, 1.80-13.33; P = 0.002), malignant traits in endoscopy (aOR, 6.80; 95% CI, 2.41-19.20; P < 0.001), SUVe ≥ 1.7 in PET (aOR, 5.43; 95% CI, 2.00-14.72; P < 0.001), and PET-detected nodal disease (aOR, 5.03; 95% CI, 1.16-21.86; P = 0.041) as independent predictors of malignancy. The model combining these four factors predicted ampullary cancers better than endoscopic diagnosis alone (area under the curve [AUC] and 95% CI: 0.925 [0.874-0.956] vs. 0.815 [0.732-0.873], P < 0.001). The model demonstrated an AUC of 0.921 (95% CI, 0.816-0.967) in candidates for endoscopic papillectomy. Conclusion: Adding 2-[¹⁸F]FDG PET/CT to endoscopy can improve the diagnosis of ampullary cancer and may help refine therapeutic decision-making, particularly when contemplating endoscopic papillectomy.

• Investigative Magnetic Resonance Imaging
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• 제6권2호
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• pp.129-136
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• 2002

목적 : 총담관 확장을 유발하는 원인 중 결석과 종양을 제외한 여러 원인을 평가하는데 있어서 MRCP의 진단적 유용성을 알아보고자 하였다. 대상 및 방법 : ERCP와 MRCP를 모두 시행받은 환자 26명 (남:여=15:11, 평균연령 62세)을 대상으로 하였으며, 이들 중 12명은 역동적 MRCP를, 10명은 조영증강 MRI를 추가로 시행하였다. 총담관, 간내 담도, 췌관 등의 확장 정도, 간내 담도 결석, 췌장 가성낭종, 유두부의 부종이나 결절성 종대 등을 관찰하였다. 총담관은 T2-강조 관상영상에서 담낭절제술을 받지 않은 경우 7 mm 이상, 절제술을 받은 경우 10 mm 이상을 비정상적인 확장으로 판정하였다. 결과 : 담낭절제술을 받지 않은 환자의 총담관 평균 직경은 12.7mm(n=21, 9-19 mm)였고, 절제술을 받은 환자의 평균 직경은 13.0 mm(n=5, 10-15mm)였다(p〉0.05). MRCP에서 담관염 11명(42.3%), 만성 췌장염 8명(30.8%), 원위부 총담관 협착 6명(23.1%), 팽대부 주위 게실 3명(11.5%), Vater 팽대부 협착, 오디 괄약근 기능장애, 췌장 두부의 국소적 췌장염이 각각 2명 (7.7%), 유두염, 췌장 두부 가성낭종에 의한 총담관 확장, 총담관 내 회충이 각각 1명(3.8%) 있었다. 췌관의 확장은 10명(38.5%)에서 보였고, 십이지장 게실은 3명(11.5%)에서 관찰되었다. 역동적 MRCP(n=12)에서 2명(16.7%)은 일반 MRCP에서 보이지 않던 원위부 총담관이 관찰되었고, 조영증강 MRI를 시행한 10명 중 1명 (10.0%)만이 유두염의 소견을 보였다. 결론 : 비결석, 비종양성 총담관 확장의 원인을 찾는데 있어서 MRCP는 총담관 원위부 협착 및 만성 췌장염, 역동적 MRCP를 이용한 생리적 총담관의 확장, 조영증강 MRI 를 통한 담관염 및 담관 외 병소의 발견 등에 있어서 도움이 되는 것으로 생각된다.