• 한국임상수의학회지
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• 제34권4호
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• pp.295-298
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• 2017

A 6-year-old female Pekingese dog, weighing 3.85 kg was presented with regurgitation, ptyalism, weight loss and anorexia. The dog was cachexic and severely dehydrated. Physical examination of the dog confirmed upper respiratory noise, which was classified as a stridor most apparent on inspiration, respiratory effort with stenotic nares. Upper respiratory signs were thought to be caused by brachycephalic syndrome. On the lateral thoracic radiograph, the caudal one third of the esophagus was visible as a soft tissue band. CT revealed oval-shaped, soft tissue attenuating mass in size of $2.3{\times}1.0{\times}1.1cm$ arising from caudal one third of the esophagus. The mass was protruding from esophageal wall to lumen and irregular margined with heterogenous contrast enhancement. The wall of cardia and fundus was focally thickened. Gastric lymph node was enlarged with contrast enhancing. On histopathologic examination, esophageal mass was confirmed as papillary adenocarcinoma, and the gastric sample showed the same result. In human, adenocarcinoma commonly occur in esophagus and cardia, but it has not been commonly reported in veterinary medicine. This report described computed tomographic features of adenocarcinoma of the esophagocardia region in a Pekingese dog with brachycephalic syndrome.

• Journal of Chest Surgery
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• 제40권1호
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• pp.56-59
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• 2007

흉통을 주소로 입원한 65세 남자 환자가 불안정형 협심증으로 관상동맥우회수술이 필요한 상태였다. 이학적 검사상 심한 빈혈소견이 동반되었고 혈색소는 5.7 g/dL이었다. 빈혈에 대한 검사 중에 위내시경검사상 출혈을 동반하고 있는 4 cm크기의 종괴가 위소만부에서 관찰되었다. 조직학적 검사상 선암으로 진단되었고, 종양의 출혈로 인해 관상동맥우회수술과 위전절제술이 동시에 계획되었다. 환자는 체외순환 없이 관상동맥우회수술을 시행 받은 후에 동시에 이어서 위전절제술을 시행 받았다 수술 후 경과는 순조로웠다. 환자는 술 후 12일째 퇴원하여 9개월째 추적관찰 중이다. 이에 저자들은 협심증과 위암을 동시에 수술하였기에 보고하는 바이다.

• Journal of Gastric Cancer
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• 제18권3호
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• pp.230-241
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• 2018

Purpose: Enhanced recovery after surgery (ERAS) protocols for gastric cancer patients have shown improved outcomes in Asia. However, data on gastric cancer ERAS (GCERAS) programs in the United States are sparse. The purpose of this study was to compare perioperative outcomes before and after implementation of an GC-ERAS protocol at a National Comprehensive Cancer Center in the United States. Materials and Methods: We reviewed medical records of patients surgically treated for gastric cancer with curative intent from January 2012 to October 2016 and compared the GC-ERAS group (November 1, 2015-October 1, 2016) with the historical control (HC) group (January 1, 2012-October 31, 2015). Propensity score matching was used to adjust for age, sex, number of comorbidities, body mass index, stage of disease, and distal versus total gastrectomy. Results: Of a total of 95 identified patients, matching analysis resulted in 20 and 40 patients in the GC-ERAS and HC groups, respectively. Lower rates of nasogastric tube (35% vs. 100%, P<0.001) and intraabdominal drain placement (25% vs. 85%, P<0.001), faster advancement of diet (P<0.001), and shorter length of hospital stay (5.5 vs. 7.8 days, P=0.01) were observed in the GC-ERAS group than in the HC group. The GC-ERAS group showed a trend toward increased use of minimally invasive surgery (P=0.06). There were similar complication and 30-day readmission rates between the two groups (P=0.57 and P=0.66, respectively). Conclusions: The implementation of a GC-ERAS protocol significantly improved perioperative outcomes in a western cancer center. This finding warrants further prospective investigation.

• Journal of Gastric Cancer
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• 제6권1호
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• pp.47-51
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• 2006

위에서 생기는 점막하 종양은 내시경적 조직검사로는 그 기원을 알기 어려운 경우가 많다. 이러한 점막하 종양 중, 슈반 세포(Schwann cell)로부터 분화하여 생기는 종양을 신경초종(Schwannoma)이라고 하며, 위에서 생기는 전체 종양의 0.2%를 차지한다고 알려져 있다. 이 증례는 2개월 전부터 시작된 다량의 흑색변과 빈혈을 주소로 내원한 57세 여자 환자에 대한 보고이다. 복부 컴퓨터 단층 촬영 및 상부 위장관 내시경에서 위 분문에서 3 cm정도 아래부터 위각 직상부까지 위체부 소만을 대부분 차지하는 약 8 cm 이상의 돌출된 종양이 관찰되었고, 수 차례에 걸친 내시경적 조직검사를 시행하였으나 괴사조직과 육아종성 조직, 만성 위염 소견만 반복해서 나왔다. 출혈을 동반한 진행성 위암, 림프종 등을 생각하여 정확한 진단 및 출혈에 대한 치료를 위해 수술을 시행하였다. 술 후 조직검사에서 전반적으로 소엽상 형태(lobulating pattern)로 주변에 림프구 침윤(lymphocyte cuffing)이 있었고 책상핵(palisading nuclei), 방추세포(spindle-cell) 등이 보였다. C-kit, CD34, SMA 모두 음성이었으며 S-100 양성으로 신경초종으로 진단되었다.

• Journal of Gastric Cancer
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• 제7권1호
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• pp.42-46
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• 2007

원위부 위암으로 위아전절제술을 시행할 때는 잔위의 경색을 방지하기 위해 비장을 보존하여 단위동맥으로 하여금 잔위의 혈액공급을 할 수 있게 한다. 위아전절제술을 하던 중 비장손상을 받아 지혈을 위해 계획에 없던 비장절제술을 하게 되는 경우에는 blue stomach을 방지하기 위해 종종 위전절제술로 전환해야 하는 경우도 있다. 본원에서는 2개월간의 소화불량을 주소로 내원한 67세 여자환자가, 내시경상 원위부 위암의 소견과 함께 술 전 복부 CT에서 비장의 전이를 확실하게 배제할 수 없는 1.5 cm 크기의 혈관종 의증 소견이 보여 확진을 위한 검사 및 치료의 목적으로 원위부 위아전절제술 및 비장절제술을 계획하였으며 복강경보조로 좌위동맥과 정맥을 보존하면서 림프절 곽청을 포함한 근치적 위아전절제 및 비장 절제술을 성공적으로 시행하였다. 수술 후 잔위 경색을 비롯한 합병증 없이 만족스러운 경과를 보였으며 최종적으로 비장의 종양은 림프관종이었다. 병기는 T1 (sm1) N0 (0/26) M0으로 1aI기로, 현재 외래 추적 관찰 중이다.

• Journal of Gastric Cancer
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• 제17권4호
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• pp.283-294
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• 2017

Purpose: This study primarily aimed to investigate the short- and long-term remission rates of type 2 diabetes (T2D) in patients who underwent surgical treatment for gastric cancer, especially patients who were non-obese, and secondarily to determine the potential factors associated with remission. Materials and Methods: We retrospectively reviewed the clinical records of patients with T2D who underwent radical gastrectomy for gastric cancer, from January 2008 to December 2012. Results: T2D improved in 39 out of 70 (55.7%) patients at the postoperative 2-year follow-up and 21 of 42 (50.0%) at the 5-year follow-up. In the 2-year data analysis, preoperative body mass index (BMI) (P=0.043), glycated hemoglobin (A1C) level (P=0.039), number of anti-diabetic medications at baseline (P=0.040), reconstruction method (statistical difference was noted between Roux-en-Y reconstruction and Billroth I; P=0.035) were significantly related to the improvement in glycemic control. Unlike the results at 2 years, the 5-year data analysis revealed that only preoperative BMI (P=0.043) and A1C level (P=0.039) were statistically significant for the improvement in glycemic control; however, the reconstruction method was not. Conclusions: All types of gastric cancer surgery can be effective in short- and long-term T2D control in non-obese patients. In addition, unless long-limb bypass is considered in gastric cancer surgery, the long-term glycemic control is not expected to be different between the reconstruction methods.

• Journal of Gastric Cancer
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• 제2권2호
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• pp.91-95
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• 2002

Purpose: We compared the quality of life (QOL) and nutritional outcomes following both Billroth I (BI) and Billroth II (BII) reconstructions after a subtotal gastrectomy in order to identify which reconstruction would produce a better QOL and nutritional outcomes and to provide better follow-up management. Materials and Methods: We studied 273 patients without evidence of recurrent disease following a curative distal subtotal gastrectomy for gastric cancer. Among them, 135 underwent a BI reconstruction and 138 a BII reconstruction. The nutritional status was assessed by using levels of hemoglobin, serum albumin, iron, and vitamin B12 and by calculating the relative body weight, the body mass index, and the percentage of body fat. The QOL was measured by using the Troidl score and by treatment-specific symptoms based on the criteria, somewhat modified by the authors, of Korenaga and others. Results: There was no significant difference in QOL between the BI and the BII groups. More than half of the patients revealed anemia, regardless of the type of reconstruction. The serum vitamin $B_{12}$ level of the BII group was lower than that of the BI group. The BII group showed a tendency toward lower hemoglobin levels and serum iron concentrations than the BI group did. Conclusions: The quality of life was not impaired in most patients after either a BI or a BII reconstruction. However, both resulted in iron deficiency anemia, although the incidence was higher after a BII reconstruction. The patient's serum iron and vitamin B12 should be measured periodically and these must be administered if the measurements reveal a below normal range.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제17권3호
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• pp.196-200
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• 2014

Co-existing pyloric submucosal masses with hypertrophic pyloric stenosis (HPS) are very rare and treating these lesions is always a problem. A 20-day-old boy presented with recurrent episodes of projectile non-bilious vomiting lasting for 5 days. HPS was suspected due to the presenting age and the symptoms. The sonography demonstrated not only circumferential wall thickening of the pylorus, but also a pyloric submucosal mass. At laparotomy, a 0.8 cm sized pyloric submucosal mass was identified along with a hypertrophied pylorus. Pyloric excision was performed due to the possibility of sustaining the symptoms and malignancy. The pathological report of the submucosal mass was ectopic pancreas. Coexisting pyloric lesions can be diagnosed along with HPS, and surgical excision, not just pyloromyotomy, should be considered in these circumstances. To the best of our knowledge, this is the first case report of pyloric ectopic pancreas and HPS to be diagnosed concurrently.

• Nutrition Research and Practice
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• 제15권4호
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• pp.456-467
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• 2021

BACKGROUND/OBJECTIVES: The prevalence of morbid obesity in Korean women has consistently been increasing, while the overall prevalence rate of obesity in Korean women seems to be stable. In addition to bariatric surgery, intragastric balloons (IGBs), as a nonsurgical therapy, have been reported to be effective in weight loss. However, the beneficial effects of IGB in Korean women with obesity have not been fully investigated. The aim of this study was to evaluate the changes in fat mass in Korean women with obesity who had undergone IGB treatment for 6 mon. SUBJECTS/METHODS: Seventy-four women with obesity (body mass index [BMI] ≥ 25.0 kg/m²) were recruited. Clinical data, including general information, comorbidities with obesity, anthropometric data, and changes in the body fat composition before and after IGB treatment, were obtained from the subjects. RESULTS: Most subjects had one or more comorbidities, such as osteoarthropathy and woman's disease, and had poor eating behaviors, including irregular mealtimes, eating quickly, and frequent overeating. Body composition measurements showed that weight, fat mass, and waist-hip circumference ratio decreased significantly at 6 mon after IGB treatment. In particular, women with morbid obesity (BMI ≥ 30 kg/m²) showed 33% excess weight loss. There was no significant difference in skeletal muscle mass and mineral contents after IGB treatment. CONCLUSIONS: This study suggested that 6 mon of IGB treatment can be a beneficial treatment for obesity without muscle mass and bone mineral loss.

• 대한영상의학회지
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• 제85권2호
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• pp.445-450
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• 2024

자궁 경부암의 위 전이는 매우 드물며, 소수의 증례만이 영문 문헌에서 보고되었다. 자궁경부 위형 점액샘암종은 드문 아형의 점액샘암종이다. 위형 점액샘암종은 진행성 암에서 발견되는 공격적인 암이지만, 위로의 전이는 보고된 바 없다. 저자들은 61세 여성의 자궁경부 위형 점액샘암종이 위 날문방에 전이된 증례를 보고하며 위 전이 및 자궁경부 점액샘암종의 영상의학적 소견을 서술하고자 한다. 위 전이는 조영증강이 잘되지 않는 점막 하 종괴로 보였다. 점액샘암종은 조영증강이 잘되지 않는 침윤성 종괴로 보였다. 확산강조영상에서는 경도의 고신호강도를 보였고 겉보기확산계수 지도에서는 낮은 값을 보였다. 이 사례는 매우 드물며 진단이 어렵지만, 자궁경부암의 유형이 사람유두종바이러스 비의존 위형 점액샘암종이며 동시에 위의 점막 하 병변이 발견된 경우, 우리 사례와 유사한 패턴의 전이 가능성을 고려할 수 있다.