• Journal of Gastric Cancer
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• v.24 no.3
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• pp.327-340
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• 2024

Purpose: Results of initial endoscopic biopsy of gastric lesions often differ from those of the final pathological diagnosis. We evaluated whether an artificial intelligence-based gastric lesion detection and diagnostic system, ENdoscopy as AI-powered Device Computer Aided Diagnosis for Gastroscopy (ENAD CAD-G), could reduce this discrepancy. Materials and Methods: We retrospectively collected 24,948 endoscopic images of early gastric cancers (EGCs), dysplasia, and benign lesions from 9,892 patients who underwent esophagogastroduodenoscopy between 2011 and 2021. The diagnostic performance of ENAD CAD-G was evaluated using the following real-world datasets: patients referred from community clinics with initial biopsy results of atypia (n=154), participants who underwent endoscopic resection for neoplasms (Internal video set, n=140), and participants who underwent endoscopy for screening or suspicion of gastric neoplasm referred from community clinics (External video set, n=296). Results: ENAD CAD-G classified the referred gastric lesions of atypia into EGC (accuracy, 82.47%; 95% confidence interval [CI], 76.46%-88.47%), dysplasia (88.31%; 83.24%-93.39%), and benign lesions (83.12%; 77.20%-89.03%). In the Internal video set, ENAD CAD-G identified dysplasia and EGC with diagnostic accuracies of 88.57% (95% CI, 83.30%-93.84%) and 91.43% (86.79%-96.07%), respectively, compared with an accuracy of 60.71% (52.62%-68.80%) for the initial biopsy results (P<0.001). In the External video set, ENAD CAD-G classified EGC, dysplasia, and benign lesions with diagnostic accuracies of 87.50% (83.73%-91.27%), 90.54% (87.21%-93.87%), and 88.85% (85.27%-92.44%), respectively. Conclusions: ENAD CAD-G is superior to initial biopsy for the detection and diagnosis of gastric lesions that require endoscopic resection. ENAD CAD-G can assist community endoscopists in identifying gastric lesions that require endoscopic resection.

• Journal of Gastric Cancer
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• v.1 no.1
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• pp.55-59
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• 2001

Purpose: Several studies of an endoscopic mucosal resection(EMR) have been reported, but reports about benign protruding lesions that arise at the scar of EMR for early gastric cancer (EGC) or a gastric adenoma are rare. The purpose of this study was to elucidate endoscopic and histological characteristics of benign protruding lesions which arise at the scar of an EMR for EGC and a gastric flat adenoma. Materials and Methods: In 101 lesions (73 gastric flat adenomas and 28 EGCs) from 96 patients, 16 lesions developed new protruding lesions that arose at the scar of the EMR. We retrospectively analyzed the endoscopic findings of initial and protruding lesions, and several other clinical factors (H. pylori infection, eradication therapy, and proton pump inhibitor (PPI) or H2-blocker use). Results: 1. The mean duration until detection of the protruding lesion was 8.9 months ($1.5\∼27$). Protruding lesions arose at the scar of the EMR in 1 of 28 EGCs ($3.6\%$) and from 15 of 73 gastric flat adenomas ($20.5\%$). All of the patients were men. 2. With respect to the endoscopic findings, the shapes of the protruding lesions were as follows: 10 Yamada (Y) I, 4 Y-II, 1 Y-III, and 1 flat lesion. Histological examination of the protruding lesions revealed regenerating hyperplasia in 5 lesions, intestinal metaplasia in 5, and both in 6. 3. The incidence of these lesions was higher in cases of tubular adenomas with focal high-grade dysplasia than in cases of tubular adenomas without dysplasia (p<0.05). 4. The incidence of H. pylori infection was higher in patients ($81.7\%$) who developed a protruding lesion than in those ($51.8\%$) who did not develop (p=0.029); also, the incidence of use of PPI was higher in those patients (p=0.045). However, eradication therapy for H. pylori and duration of use of PPI or H2-blocker showed no difference between groups. Conclusions: It may be possible that the potential hyperplasia that may reside in normal mucosa surrounding EGC or a gastric adenoma might awaken during the healing process of the EMR ulcer and develop to benign protruding lesions. And, H. pylori and PPI might also be related to the development of the protruding lesions.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.9
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• pp.4491-4501
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• 2016

Verruco-papillary lesions (VPLs) of the oral cavity described in the literature involve a spectrum of conditions including squamous papilloma, verruca vulgaris, focal epithelial hyperplasia, condyloma, proliferative verrucous leukoplakia and verrucous carcinoma. A majority of the VPLs are slow growing, benign in nature and have a viral aetiology. Virus associated benign mucosal outgrowths are not too difficult to diagnose either clinically or by microscopy. Apart from virus-associated lesions, VPLs harboring malignant potential or behaviour such as verrucous carcinoma, proliferative verrucous leukoplakia, oral verrucous hyperplasia (OVH), oral papillary squamous cell carcinoma (PSCC) and oral conventional squamous cell carcinoma with papillary features (CSCC) need to be further clarified for better understanding of their predictable biologic behavior and appropriate treatment. Current understanding of potentially malignant VPLs is perplexing and is primarily attributed to the use of confusing and unsatisfactory terminology. In particular, the condition referred to as oral verrucous hyperplasia (OVH) poses a major diagnostic challenge. OVH represents a histopathological entity whose clinical features are not well recognised and is usually clinically indistinguishable from a verrucous carcinoma and a PSCC or a CSCC. A consensus report published by an expert working group from South Asia as an outcome of the 'First Asian Regional Meeting on the Terminology and Criteria for Verruco-papillary Lesions of the Oral Cavity' held in Kuala Lumpur, Malaysia, recognised the clinical description of these OVH as a new entity named 'Exophytic Verrucous Hyperplasia'. Previously described clinical features of OVH such as the 'blunt' or 'sharp' variants; and the 'mass' or 'plaque' variants can now collectively fall under this newly described entity. This paper discusses in detail the application of the standardized criteria guidelines of 'Exophytic Verrucous Hyperplasia' as published by the expert group which will enable clinicians and pathologists to uniformly interpret their pool of OVH cases and facilitate a better understanding of OVH malignant potential.

• Journal of Chest Surgery
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• v.27 no.12
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• pp.1015-1022
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• 1994

Over the past few years, video-assisted thoracic surgery [VATS] has been used increasingly for intrathoracic pathologic problems as a less invasive operative techniques. Today it is viewed as a sparing and safe alternative to thoracotomy for a wide spectrum of indications. Using video-assisted operative thoracoscopy, we performed consecutive 150 operations on 148 patients during the initial 2 years of our experience from July 1992 with the following indications: pneumothorax [n=53], hyperhidrosis [n=29], mediastinal mass [n=23], pleural disease [n=13], diffuse parenchymal or interstitial lung disease [n=12], benign pulmonary nodule [n=7], metastatic lung mass [n=3], primary lung cancer [n=3], bronchiectasis [n=2], malignant pericardial effusion [n=2], endobronchial tuberculosis [n=1], esophageal achalasia [n=1], and pulmonary parenchymal foreign body [n=1]. There were no death, and overall complicaton rate was 24.0%[n=36]. The most prevalent complication was persistent air leakage [longer than 5 days] in 14 cases [9.3%]. Persistent pleural effusion [longer than 5 days] occurred in 6 cases [4.0%]. Six patients were converted to an open thoracotomy because of inability to control the operative bleeding [n=3], failed adhesiolysis in bronchiectasis [n=2], and radical excision of an lung cancer [n=1]. Pneumothorax recurred in 3 cases[2.0%]. Other complications were Horner`s syndrome, diaphragm tears, temporary phrenic nerve palsy, hoarseness, subsegmental atelectasis, transient respiratory difficulty, and esophageal mucosal tear. The advantages of this minimally traumatizing operative technique lie in improved visualization, decreased pain, shortened hospital stay, and less postoperative morbidity. The indications of VATS has been extended increasingly to intrathoracic pathologies, but its role in the managements of primary lung cancer and esophageal disease remains to be defined.

• The Journal of Pediatrics of Korean Medicine
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• v.13 no.1
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• pp.191-204
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• 1999

Background: Nasal polyps are benign mass of nasal mucose, chronic sinusitis are swelling of nasal mucose, so nasal polyps and chronic sinusitis take a place at the same time. Nasal polyps are located lateral wall of nose, middle meatus, between middle nasal concha and inferior nasal concha. Objective: To demonstrate the effect of herbal medicine therapy in the chronic sinusitis and nasal polyps before and after treatment using computed tomography (CT). To compared before and after treatment of otitis media using earscope. Materials and methods: Five patients (4 mail and 1 femail) treated in our hospital between August 1998 and July 1999 were studied. Ages ranged from 9 to 23 years (mean age:13 years). All patients had a underlying family history, and past history(allergy or sinusitis of parents or brothers). Illness period was from 1 to 36 months (mean period:10.5 month). To ascertain the efficacy of treatment, CT were checked out. In the CT, three images were obtained 2cm interval on the coronal and axial plan. We classified treatment period into the type of allergic disease. Gamihyunggyeyungyo-tang was administered mainly. Gamigwaghyangjeungki-san, Gamizwakwi-eum and Gamihyangso-san were administered for through oral route additional symptoms. Results: Treatment period was from 126 to 157 days (mean period:140.7 days). To 3 patients with chronic sinusitis and nasal polyp, treatment period was 140.7 days, to 2 patients with otitis media and chronic sinusitis and nasal polyp, treatment period was 141.5 days. So they had no significance. Not nasal polyp from middle meatus, but also polypoid mucosal change of maxillary sinus is polyps Conclusion: We know that herbal medicine therapy is the effective treatment of pediatric chronic sinusitis and otitis media using earscope and CT. Herbal medicine therapy was effective in increasing immunity, inhibiting allergic reaction and inflammation of respiratory system. we practice ECP(eosinophil cataionic protein) and MAST examination, objectify herbal medicine therapy.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.32 no.1
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• pp.39-42
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• 2021

Granuloma is an uncommon benign disease that develops in the process of wound healing. Pharyngeal or laryngeal granuloma can be associated with gastric reflux, mechanical injury or trauma including intubation, voice abuse, or foreign body. 50-year-old female was transferred to our institute with a huge mass occupying the upper aerodigestive tract causing dysphagia. The patient has been suffering from a brain hemorrhage for several months and was kept in bed due to the quadriplegia with stuporous mental status, and was tracheotomized. On examination, the whole oropharynx and hypopharynx was covered by a smooth-surfaced soft big diffuse granular mass, which extended down to the upper trachea through the larynx. The huge granuloma was successfully removed with surgery and was found to have a pedunculating stalk on the oropharyngeal posterior wall with a small mucosal defect, suggestive of the origin of the mass. The defect was closed primarily after the cauterization. The patient is now followed up regularly without any recurrence of the disease.

• Journal of the Korean Society of Radiology
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• v.85 no.3
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• pp.637-642
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• 2024

Rectal syphilis is a rare form of syphilis presentation and its symptoms, endoscopic and radiologic findings are nonspecific. Rectal syphilis typically presents with features such as concentric rectal wall thickening, mucosal hyperemia, perirectal fat stranding, and lymphadenopathy. Rectal cancer exhibits asymmetric wall thickening and lymph node necrosis, aiding in the differentiation between these two diseases. However, due to the considerable overlap in their respective manifestations, distinguishing between rectal syphilis and rectal cancer is extremely challenging without considering the patient's medical history. Rectal syphilis often leads to unnecessary tests or delayed treatment, as it can be mistaken for other benign diseases such as inflammatory bowel diseases in addition to rectal cancer. In this case report, we aim to provide a detailed report on the endoscopic, imaging, and pathological findings based on our experience with a case of suspected rectal malignancy that turned out to be rectal syphilis.

• Tuberculosis and Respiratory Diseases
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• v.62 no.3
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• pp.192-196
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• 2007

Background: Right middle lobe syndrome (RMLS) is defined as transient or chronic and recurrent atelectasis of the right middle lobe. Although numerous conditions are associated with RMLS, there are very few recent reports in Korea. This study evaluated the causes of RMLS in a local tertiary hospitalover a period of 42 months. Method: Eighty-eight patients (M:F=64:22, mean age: $67.2{\pm}10.3years$), who had consistent chest radiography findings and underwent bronchoscopy in Gyeongsang University Hospital from January 2003 to July 2006, were enrolled in this study. The clinical characteristics and causes of RMLS in these patients were retrospectively reviewed. Results: The most common symptoms fo RMLS were cough, dyspnea and sputum. Tuberculosis was the most common cause (endobronchial tuberculosis in 22 and pulmonary tuberculosis in 1) The other causes were bronchial stenosis by benign fibrotic changes in 22 cases (25%), anthracofibrosis in 13 cases (14.8%), pneumonia in 11 cases (12.5%), lung cancer in 10 cases (11.4%), mucus impaction in 3 cases (3.4%), bronchiectasis in 2 cases (2.3%) and no demonstrable causes in 7 cases (8%). The bronchoscopy findings were mucosal edema with hyperemic changes in 38 cases (43.2%), mucosal edema with anthracotic pigmentation in 16 cases (18.2%), mucus impaction in 13 cases (14.8%), fibrotic stenosis in 13 cases (14.8%), a mass like lesion in 8 cases (9.1%), exudative necrotic material in 4 cases (4.5%), narrowing as a result of extrinsic compression in 2 cases (2.3%) and no demonstrable abnormalities in 12 cases (13.6%). Conclusion: Right middle lobe syndrome was observed more frequently in patients over the age of 65. The causes were mainly benign diseases with endobronchial tuberculosis being the most common.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.43.1-43.5
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• 2019

Background: Reconstructive surgery is often required for tumors of the oral and maxillofacial region, irrespective of whether they are benign or malignant, the area involved, and the tumor size. Recently, three-dimensional (3D) models are increasingly used in reconstructive surgery. However, these models have rarely been adapted for the fabrication of custom-made reconstruction materials. In this report, we present a case of maxillary reconstruction using a laboratory-engineered, custom-made mesh plate from a 3D model. Case presentation: The patient was a 56-year-old female, who had undergone maxillary resection in 2011 for intraoral squamous cell carcinoma that presented as a swelling of the anterior maxillary gingiva. Five years later, there was no recurrence of the malignant tumor and a maxillary reconstruction was planned. Computed tomography (CT) revealed a large bony defect in the dental-alveolar area of the anterior maxilla. Using the CT data, a 3D model of the maxilla was prepared, and the site of reconstruction determined. A custom-made mesh plate was fabricated using the 3D model (Okada Medical Supply, Tokyo, Japan). We performed the reconstruction using the custom-made titanium mesh plate and the particulate cancellous bone and marrow graft from her iliac bone. We employed the tunneling flap technique without alveolar crest incision, to prevent surgical wound dehiscence, mesh exposure, and alveolar bone loss. Ten months later, three dental implants were inserted in the graft. Before the final crown setting, we performed a gingivoplasty with palate mucosal graft. The patient has expressed total satisfaction with both the functional and esthetic outcomes of the procedure. Conclusion: We have successfully performed a maxillary and dental reconstruction using a custom-made, pre-bent titanium mesh plate.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.18 no.2
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• pp.122-128
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• 2007

This study aims to analyze the voices of the patients with voice disorders including vocal fold paralysis, vocal fold cyst and vocal nodule/polyp in the aspect of acoustic phonetics. This study intends to collect subsidiary acoustic data in order to make a speech treatment and an standardization of vocal disorders. Subjects and Methods: The subjects of this study were 64 adult patients who underwent indirect laryngoscopy and laryngostroboscopy, and were diagnosed as vocal fold paralysis, vocal fold cyst or vocal nodule/polyp. Experimental group consisted of 20 patients who were diagnosed as vocal fold paralysis, 21 patients who were diagnosed as vocal fold cyst and had the average age of 42.0 $({\pm}10.03)$ ; and 23 patients who were diagnosed as vocal nodule/polyp and had the average age of 40.9 $({\pm}13.75)$. For the methodology of this study, the patients listed above were asked to sit in a comfortable position at intervals of 10cm apart from the patient's mouth and a microphone, and subsequently to phonate a vowel sound /e/ for the maximum phonation time with natural tone and vocal volume then the sound was directly inputted on a computer. During recording, sampling rate was set to 44,100Hz and the 1-second area corresponding to stable zone except the first and the last stage of waveform of the vowel sound /e/ vocalized by the individual patients was analyzed. Results: First, there was no statistically significant difference in jitter and shimmer between vocal fold paralysis and vocal fold cyst, while there was highly statistically significant difference in them between vocal fold paralysis and vocal nodule/polyp. Second, looking into the mean values obtained from NNE, HNR and SNR results associated with noise ratio, the disease showing the most abnormal characteristics was vocal fold paralysis, followed by cyst and nodule/polyp in order. For NNE, there was statistically significant difference between vocal nodule/polyp, and cyst or paralysis. In other words, it was found that the NNE of vocal nodule/polyp was weaker than that of cyst or paralysis. Similarly, HNR and SNR also showed the same characteristics; there was statistically significant difference between vocal fold paralysis and vocal fold cyst or nodule/polyp, and HNR and SNR values of vocal fold paralysis were lower than those of vocal fold cyst or nodule/polyp. Conclusion: For vocal fold paralysis, the abnormal values of acoustic parameters associated with frequency, amplitude and noise ratio were statistically significantly higher than those of vocal fold cyst and nodule/polyp. This finding suggests that the voices of the patients with vocal fold paralysis are the most severely injured due to less stability of vocal fold movement, asymmetry and incomplete glottic closure. In addition, there was no statistically significant difference in the acoustic parameters of tremor among vocal fold paralysis, vocal fold cyst and vocal nodule/polyp. Further studies need to ascertain reasonable acoustic parameters with various vocal disorders as well as to clarify the correlation between acoustics-based objective tools and subjective evaluations.