• Neonatal Medicine
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• 제25권4호
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• pp.186-190
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• 2018

Esophageal atresia (EA) with proximal tracheoesophageal fistula (TEF; gross type B) is a rare defect. Although most patients have long-gap EA, there are still no established surgical guidelines. A premature male infant with symmetric intrauterine growth retardation (birth weight, 1,616 g) was born at 35 weeks and 5 days of gestation. The initial diagnosis was pure EA (gross type A) based on failure to pass an orogastric tube and the absence of stomach gas. A "feed and grow" approach was implemented, with gastrostomy performed on postnatal day 2. A fistula was detected during bronchoscopy for recurrent pneumonia; thus, we confirmed type B EA and performed TEF excision and cervical end esophagostomy. As the infant's stomach volume was insufficient for bolus feeding after reaching a body weight of 2.5 kg, continuous tube feeding was provided through a gastrojejunal tube. On the basis of these findings, esophageal reconstruction with gastric pull-up was performed on postnatal day 141 (infant weight, 4.7 kg), and he was discharged 21 days postoperatively. At 12 months after birth, there was no catch-up growth; however, he is currently receiving a baby food diet without any complications. In patients with EA, bronchoscopy is useful for confirming TEF, whereas for those with long-gap EA with a small stomach volume, esophageal reconstruction with gastric pull-up after continuous feeding through a gastrojejunal tube is worth considering.

• Journal of Gastric Cancer
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• 제22권2호
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• pp.145-155
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• 2022

Purpose: Weight loss and deterioration in body composition are observed in patients with gastric cancer (GC) following gastrectomy. This study aimed to investigate the impact of residual stomach volume (RSV) on the nutritional status and body composition of patients with GC treated with distal gastrectomy. Materials and Methods: In total, 227 patients who underwent minimally invasive distal gastrectomy with Billroth 1 anastomosis for stage I GC between February 2015 and May 2018 were enrolled. Clinicodemographic and laboratory data were collected from the GC registry. The RSV, abdominal muscle area, and subcutaneous/visceral fat areas were measured using computed tomography data. Results: A larger RSV was associated with a lower decrease in the nutritional risk index (P=0.004) and hemoglobin level (P=0.003) during the first 3 months after surgery, and better recovery at 12 months. A larger RSV demonstrated an advantage in the preservation of abdominal muscle area (P=0.02) and visceral fat (P=0.04) after surgery, as well as less reduction in weight (P=0.02) and body mass index (P=0.03). Conclusions: Larger RSV was associated with improved nutritional status and better preservation of muscle and fat after distal gastrectomy.

• Journal of International Society for Simulation Surgery
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• 제1권2호
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• pp.75-79
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• 2014

Purpose The region growing has a critical problem that it often extract vessels with unexpected objects such as a bone which has a similar intensity characteristics to the vessel. We propose the new method to extract arterial vascular anatomy around the stomach from the CTA volume without the post-processing. Materials and Methods Our method, which is also based on the region growing, requires the two seed points from the use. I automatically extracts perigastric arteries using the adaptive region growing method and it does not need any post-processing. Results The three region growing based methods are used to extract perigastric arteries - the conventional region growings with restrict and loose thresholds each and the proposed method. The 3D visualization from the result of our method shows our method extracted the all required arteries for gastric surgery. Conclusion By extracting perigastric arteries using the proposed method, over-segmentation problem that unexpected anatomical objects such as a rib or backbone are also segmented does not occurs anymore. The proposed method does not need to sensitively determine the thresholds of the similarity function. By visualizing the result, the preoperative simulation of arterial vascular anatomy around the stomach can be possible.

• Journal of Gastric Cancer
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• 제20권3호
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• pp.277-289
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• 2020

Purpose: To evaluate the feasibility and safety of intracorporeal overlapping gastrogastrostomy between the proximal anterior wall and antrum posterior wall (PAAP; PAAP anastomosis) of the stomach in minimally invasive pylorus-preserving gastrectomy (PPG) for early gastric cancer (EGC). Materials and Methods: From December 2016 to December 2019, 17 patients underwent minimally invasive PPG with PAAP anastomosis for EGC in the high body and posterior wall of the stomach. Intraoperative gastroscopy was performed with the rotation maneuver during proximal transection. A longer antral cuff (>4-5 cm) was created for PAAP than for conventional PPG (≤3 cm) at the point where a safe distal margin and good vascular perfusion were secured. Because the posterior wall of the proximal remnant stomach was insufficient for intracorporeal anastomosis, the anterior wall was used to create an overlapping anastomosis with the posterior wall of the remnant antrum. The surgical and oncological outcomes were analyzed, and the stomach volume was measured in patients who completed the 6-month follow-up. The results were compared to those after conventional PPG (n=11 each). Results: PAAP anastomosis was successfully performed in 17 patients. The proximal and distal resection margins were 2.4±1.9 cm and 4.0±2.6 cm, respectively. No postoperative complications were observed during the 1-year follow-up esophagogastroduodenoscopy (n=10). The postoperative remnant stomach (n=11) was significantly larger with PAAP than with conventional PPG (225.6±118.3 vs. 99.1±63.2 mL; P=0.001). The stomach length from the anastomosis to the pylorus was 4.9±2.4 cm after PAAP. Conclusions: PAAP anastomosis is a feasible alternative for intracorporeal anastomosis in minimally invasive PPG for highly posteriorly located EGC.

• 핵의학기술
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• 제14권2호
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• pp.93-99
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• 2010

위암 환자의 PET/CT검사 시에 전신 검사를 한 후 물을 약 300 mL 정도 마시게 한 후 환자의 위가 위치한 부분을 추가적으로 검사를 진행하고 있다. 이는 오랜 금식으로 인해 위의 위-아래 위벽이 붙어있어 진단에 어려움이 있기에 물을 마시게 함으로써 위벽을 팽창시켜 진단의 효율을 높이기 위함이다. 검사 시에 보통 환자의 자세는 앙와위즉, 바르게 누운 자세에서 검사가 이루어지고 있다. 본 연구에서는 같은양의 물을 먹이고 복와위 즉, 바르게 엎드린 자세에서 촬영하여 앙와위에서 촬영 시와 위 체부의 용적의 팽창 정도를 비교하고, 이를 바탕으로 위의 구조상 하단부에 위치한 유문부와 위의 아래쪽 병변에 대한 정확한 위치와 진단의 효율을 높이고자 한다. 또한, 두 자세의 검사 영상을 비교하여 위의 용적의 차이를 수치화 시키고, 표준화 섭취계수의 변화가 있는지의 여부를 알아보고자 한다. 본원에서 2009년 7월-2010년 1월까지 조기 위암과 진행성 위암을 진단 받고, 수술을 하기 전의 환자와 부분절제를 한 후 추적 검사를 하고 있는 30명을 대상으로 하였다. 검사를 위해 환자에게 $^{18}F$-FDG 7.4 MBq(0.2 mCi/kg)을 정맥주사하고 60분간 누운 자세로 안정을 취하도록 하였다. 검사 시작 전 물을 300 mL 마시게 한 후 먼저 환자를 앙와위로 눕히고 위 부분을 PET/CT 촬영하고, 전신 촬영 한 후 환자에게 다시 물을 300 mL 마시게 한 후 복와위로 눕히고 위 부분을 PET/CT 촬영하였다. 위 체부의 용적을 앙와위와 복와위에서 비교해본 결과 30명의 환자에서 앙와위 평균 위 체부의 용적은 460.29 $mm^2$이고, 복와위 평균 위 체부의 용적은 641.39 $mm^2$로 평균적으로 약 41.3%확장된 것으로 나타났다. 그리고, 앙와위와 복와위에서 위 종양의 최대 표준화 섭취 계수를 각각의 환자에게서 비교해 보았을 때 거의 차이가 없는 것으로 나타났다. 위의 결과로 보았을 때 앙와위 검사보다 복와위에서 환자의 검사가 위 체부의 용적이 보다 더 확장된다는 것을 알 수 있었다. 또한 표준화 섭취 계수의 변화가 없는 것으로 나타났기 때문에 앙와위에서의 판독 결과와 다르지 않다는 것을 보여주고 있다. 거동이 불편한 환자에게는 복와위 추가 촬영이 어렵겠지만, 앙와위 추가 촬영과 더불어 복와위 추가 촬영을 한다면 위암환자의 진단에 많은 도움이 되리라 생각되고, 거동이 불편한 환자에게 사용할 수 있는 복와위 에서의 보조용구의 연구에도 도움이 되리라 사료된다.

• Radiation Oncology Journal
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• 제27권4호
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• pp.194-200
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• 2009

목 적: 위부분절제술 후 방사선치료를 받는 환자들 중에서 위 내 음식물의 배출지연으로 인한 위 용적 및 주변 장기의 위치 변화와 이것의 임상적 의의를 알아보고자 하였다. 대상 및 방법: 2005년 3월 1일부터 2008년 12월 31일까지 위암으로 위부분절제술을 받은 후 보조적 동시항암화학 방사선치료를 받았던 총 32명의 환자들 중, 전산화단층촬영모의치료 영상에서 12시간 이상의 금식에도 불구하고 위 내 음식물이 50 ml 이상 남아 잔존 위의 팽대를 보였던 경우들이 이번 연구 대상이었다. 이 환자들에 대해 방사선치료 기간 동안 주기적으로 시행된 컴퓨터단층촬영 자료를 바탕으로 잔존 위 용적 및 주변 장기들의 위치 변화를 평가하였다. 또한 방사선치료 설계 자료를 바탕으로, 잔존 위 및 주변 장기들의 변화를 고려하지 않고 치료를 지속했을 경우의 치료 표적 및 정상조직의 방사선분포 변화를 알아보았다. 결 과: 총 5명의 전산화단층촬영모의치료 영상에서 배출장애에 의한 50 ml 이상의 위 내 음식물의 저류가 확인되었다. 대상 환자들에서 위 용적은 치료과정 중에 다양한 변화양상을 보였고, 각 환자에서 최대 64.2~340.8 ml (평균, 188.2 ml)의 변화를 보였다. 또한 위 용적에 따라 좌측 신장이 각 환자별 최대 0.7~2.2 cm (평균, 1.2 cm)까지 상하 방향으로 이동하는 양상을 보였다. 모의치료 시의 설계를 위 용적의 변화에 따라 변경하지 않고 치료를 진행한 경우 유의하게 계획용표적체적(V43, 79.5${\pm}$10.4%)에 조사선량이 부족하고 좌측 신장(V20, 34.1${\pm}$12.1%; Mean dose, 23.5${\pm}$8.3 Gy)에 과도한 선량이 조사되는 결과를 얻을 수 있었다. 결 론: 위부분절제술 후 방사선치료를 받는 일부 환자에서 배출지연에 따른 위 용적의 변화와 좌측 신장의 위치변화를 확인할 수 있었다. 배출지연이 발생하는 환자를 선별하여 위 용적의 변화를 파악하고 이를 방사선치료 설계에 반영하는 것이 효과적일 것으로 생각된다.

• Ecology and Resilient Infrastructure
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• 제5권1호
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• pp.54-58
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• 2018

Diet composition of amphibians usually reflects the distribution of potential prey within habitats, as well as their diet preference. We identified the diet items of Japanese tree frog (Hyla japonica) using a stomach flushing method in a rice paddy for the establishment of bio-monitoring systems of landscape changes. During the reproductive period, 71% of calling males had empty stomachs. All prey items in the stomachs belonged to the phylum Arthropoda, from eight orders of Insecta and one order of Arachnida. Among insect prey, the most common items in the stomachs were adults of beetles, flies and bugs, and larvae of butterflies and moths. There was a significant positive correlation between the body mass of Japanese tree frogs and the volume of prey items. Our results can provide a basic framework to guide the monitoring systems using prey identification of Japanese tree frogs.

• 한국의학물리학회지:의학물리
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• 제8권2호
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• pp.103-109
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• 1997

위암뇨에서 7 ppm과 8 ppm 사이에 네 개의 특성 핵자기공명신호가 나타남을 최근의 핵자기공명분석으로 알게 되었고 , 이 신호들은 정상뇨와 타질병 환자뇨에 비하여 자주 일어남을 발견하였다. 이 네 개의 신호들은 각각 7.25 ppm, 7.38 ppm, 7.63 ppm 그리 고 7.80 ppm이었다. 스핀결합상수의 계산에 의하면, 이 네 개의 공명신호는 종래에 알려졌던 p-hydroxyphenyl이 아니라 m-hydroxyphenyl 임이 밝혀졌다. 본 연구에서는 핵자기공명신호가 자주 일어남을 이용하여 암진단을 가능케 하였고, 이들 네 방향족 핵자기공명신호의 체적자화율을 측정하여 타 목적에 기여할 수 있게 하였다. 체적자화율의 측정 결과는 각각 10.01$\times$$10^{-6}$, 10.07$\times$$10^{-6}$, 10.19$\times$$10^{-6}$ 그리고 10.27$\times$$10^{-6}$이었고, m-hydroxyphenyl의 총체적자화율은 10.27$\times$$10^{-6}$이었다.

• 대한의용생체공학회:의공학회지
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• 제27권2호
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• pp.53-58
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• 2006

In this study, transverse relaxation time (T2) measurement and the evaluation of the characteristics of the spectral peak related to stomach tissue metabolites were performed using ex vivo proton magnetic resonance spectroscopic imaging (MRSI) at 1.5-T MRI/S instruments. Thirty-two gastric tissues resected from 12 patients during gastric cancer surgery, of which 19 were normal tissue and 13 were cancerous tissue, were used to measure the $T_2$ of the magnetic resonance spectroscopy (MRS) peaks. The volume of interest data results from the MRSI measurements were extracted from the proper muscle (MUS) layer and the composite mucosa/submucosa (MC/SMC) layer and were statistically analyzed. MR spectra were acquired using the chemical shift imaging (CSI) point resolved spectroscopy (CSI-PRESS) technique with the parameters of pulse repetition time (TR) and echo times (TE) TR/(TE1,TE2)=1500 msec/(35 msec, 144 msec), matrix $size=24{\times}24$, NA=1, and voxel $size=2.2{\times}2.2{\times}4mm^3$. In conclusion, the measured $T_2$ of the metabolite peaks, such as choline (3.21ppm) and lipid (1.33ppm), were significantly decreased (p<0.01 and p<0.05, respectively) in the cancerous stomach tissue.

• Clinical Endoscopy
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• 제55권1호
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• pp.77-85
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• 2022

Background/Aims: Endoscopic submucosal dissection (ESD) of gastric tumors in the mid-to-upper stomach is a technically challenging procedure. This study compared the therapeutic outcomes and adverse events of ESD of tumors in the mid-to-upper stomach performed under general anesthesia (GA) or monitored anesthesia care (MAC). Methods: Between 2012 and 2018, 674 patients underwent ESD for gastric tumors in the midbody, high body, fundus, or cardia (100 patients received GA; 574 received MAC). The outcomes of the propensity score (PS)-matched (1:1) patients receiving either GA or MAC were analyzed. Results: The PS matching identified 94 patients who received GA and 94 patients who received MAC. Both groups showed high rates of en bloc resection (GA, 95.7%; MAC, 97.9%; p=0.68) and complete resection (GA, 81.9%; MAC, 84.0%; p=0.14). There were no significant differences between the rates of adverse events (GA, 16.0%; MAC, 8.5%; p=0.18) in the anesthetic groups. Logistic regression analysis indicated that the method of anesthesia did not affect the rates of complete resection or adverse events. Conclusions: ESD of tumors in the mid-to-upper stomach at our high-volume center had good outcomes, regardless of the method of anesthesia. Our results demonstrate no differences between the efficacies and safety of ESD performed under MAC and GA.