• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제2권1호
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• pp.80-84
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• 1999

Dieulafoy's disease, a vascular anomaly mainly in the upper stomach, is a rare but potentially life-threatening cause of upper gastrointestinal bleeding. Pathogenesis is still controversial, but the most accepted theory is that a persistent caliber vessel in the submucosa is exposed by a small mucosal erosion leading to massive bleeding. The bleeding site is usually within 6 cm of the esophagogastric junction in the cardia or fundus of the stomach. The treatment of choice is therapeutic endoscopy or surgery. The age of patients reported is mainly between 50 and 70 years, and patients of pediatric age are extremely rare. We are reporting a 5-year-old male patient who had Dieulafoy's disease which was diagnosed by emergency upper gastrointestinal endoscopy. Endoscopic finding was a nodular lesion with an adherent clot on the lessor curvature of the stomach 2 cm below the esophagogastric junction. Epinephrine and $Beriplast^{(R)}$ was injected in the lesion. On the second day after endoscopic sclerotherapy, the patient had recurred massive hematemesis and accompanying shock. So we performed gastrotomy and ligation. After the operation, he showed an improved general condition and was discharged at the 12th hospital day.

• Clinical Endoscopy
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• 제57권2호
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• pp.141-157
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• 2024

Antithrombotic agents, including antiplatelet agents and anticoagulants, are widely used in Korea because of the increasing incidence of cardiocerebrovascular disease and the aging population. The management of patients using antithrombotic agents during endoscopic procedures is an important clinical challenge. The clinical practice guidelines for this issue, developed by the Korean Society of Gastrointestinal Endoscopy, were published in 2020. However, new evidence on the use of dual antiplatelet therapy and direct anticoagulant management has emerged, and revised guidelines have been issued in the United States and Europe. Accordingly, the previous guidelines were revised. Cardiologists were part of the group that developed the guideline, and the recommendations went through a consensus-reaching process among international experts. This guideline presents 14 recommendations made based on the Grading of Recommendations, Assessment, Development, and Evaluation methodology and was reviewed by multidisciplinary experts. These guidelines provide useful information that can assist endoscopists in the management of patients receiving antithrombotic agents who require diagnostic and elective therapeutic endoscopy. It will be revised as necessary to cover changes in technology, evidence, or other aspects of clinical practice.

• Journal of Gastric Cancer
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• 제5권1호
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• pp.40-46
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• 2005

배경: 위장관 간질성 종양(GISTs)은 위장관계에 발생하는 간엽성 종양이다. 위장관 간질성 종양은 면역조직화학 검사에서 c-kit 단백 발현의 양성을 나타내며 그 임상적 경과는 매우 다양하다. 저자들은 위장관 간질성 종양의 임상병리학적 특성을 고찰하고 예후 인자를 평가하기 위하여 후향적 연구를 시행하였다. 대상 및 방법: 본 연구는 고려대학교 의과대학 외과학교실에서 1996년부터 2003년까지 위장관 간질성 종양으로 수술적 절제를 시행한 40명의 환자를 대상으로 하였다. 종양의 크기와 핵분열 정도에 따라 저위험도 집단(23예), 고위험도 집단(17예)으로 분류하였으며 두 군간 임상병리학적 특성, 면역조직화학 검사 결과 및 예후를 비교 분석하였다. 결과: 환자의 평균 연령은 $61.3\pm11.1$세이었으며 남녀비는 1:1,1이었다. 임상병리학적 소견으로는 수술 전 임상 증상이 있었던 경우와 수술 전에 조직학적으로 진단이 되었던 경우, 종양의 크기가 클수록, 핵분열이 많을수록, 종양의 성상이 궤양을 동반하거나 괴사를 보일 때, 고위험군에 포함되는 빈도가 높았다. 단변량 분석 결과, 종양의 크기, 핵분열 정도, 궤양 및 괴사 소견 그리고 내시경적 초음파 이상소견이 통계학적으로 의미가 있는 인자들로 나타났으며, 다변량 분석을 시행한 결과 핵분열 정도가 생존율에 영향을 미치는 독립적인 예후 인자로 나타났다. 관찰 기간 중 8예에서 재발하였으며 STI-571(imatinib mesylate, $Gleeveo^{R}$)을 사용한 4예는 현재까지 생존하고 있으며 사용하지 않은 4예 중 2예는 질환이 진행하는 양상을 나타내었고, 나머지 2P는 사망하였다. 결론: 위에서 기원한 위장관 간질성 종양에서 종양의 크기, 궤양 및 괴사 소견은 생존율에 영향을 주는 임상병리학적 소견이며, 핵분열 정도는 유용한 예후 인자라고 할 수 있다. STI-571은 재발 혹은 전이 환자에 있어 치료 효과를 나타내므로 술후 치료에 적용하는 것이 예후 향상에 기여하리라 생각된다.

• Journal of Chest Surgery
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• 제9권2호
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• pp.117-124
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• 1976

Hemorrhage into the biliary system as a consequence of injury to the liver has been called "traumatic hemobilia," a term introduced by Sandblom in 1948. The source of gastrointestinal hemorrhage has been frequently misinterpreted, resulting in inadequate or inappropriate treatment, often with catastrophic results and needless fatalities. It is now being diagnosed with increasing frequency, due to more widespread knowledge of the syndrome and improved diagnostic means. we experienced 2 cases of hemobilia following blunt chest trauma, One patient had! multiple rib fractures on right chest by car traffic accident and 13 days later, suddenly massive melena was developed with nausea, vomiting, jaundice and severe pain on right upper quadrant. And so, he had operated on the ligation of Rt. hepatic artery and partial right hepatectomy for a traumatic hemobilia. The other one also revealed similar symptoms 20 days later following blunt chest injury by falling down accident. However, uneventful recovery was seen without any of surgical intervention in this case.

• Asian Pacific Journal of Cancer Prevention
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• 제16권3호
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• pp.997-1000
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• 2015

Esophageal cancer represents the fourth most common gastrointestinal cancer and generally confers a poor prognosis. Prostaglandin-producing cyclo-oxygenase has been implicated in the pathogenesis of esophageal cancer growth. Here we report that prostaglandin dehydrogenase, the major enzyme responsible for prostaglandin degradation, is significantly reduced in expression in esophageal cancer in comparison to normal esophageal tissue. Reconstitution of PGDH expression in esophageal cancer cells suppresses cancer cell growth, at least in part through preventing cell proliferation and promoting cell apoptosis. The tumor suppressive role of PGDH applies equally to both squamous cell carcinoma and adenocarcinoma, which enriches our understanding of the pathogenesis of esophageal cancer and may provide an important therapeutic target.

• 대한두경부종양학회지
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• 제30권1호
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• pp.28-30
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• 2014

Foreign bodies in upper aerodigestive tract migrating into retropharyngeal space are rarely encountered emergent cases in otolaryngologic fields. A 60-years-old female presented throat pain and lump sense after a meal. Computer tomography showed metallic foreign body impacted in the retropharyngeal space. A hypopharyngeal perforation was suspected by through flexible laryngoscopy and gastrointestinal endoscopy. It was successfully removed by external cervical approach, and we report this case with a review of the related literatures.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제40권6호
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• pp.313-315
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• 2014

An oral foregut cyst is a rare congenital choristoma lined by the respiratory and/or gastrointestinal epithelium. The exact etiology has not been fully identified, but it is thought to arise from misplaced primitive foregut. This lesion develops asymptomatically but sometimes causes difficulty in swallowing and pronunciation depending on its size. Thus, the first choice of treatment is surgical excision. Surgeons associated with head and neck pathology should include the oral foregut cyst in the differential diagnosis for ranula, dermoid cyst, thyroglossal duct cyst and lymphangioma in cases of pediatric head and neck lesions.

• Journal of Gastric Cancer
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• 제19권2호
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• pp.139-147
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• 2019

The incidence of esophagogastric junction (EGJ) cancer has been significantly increasing in Western countries. Appropriate planning for surgical therapy requires a reliable classification of EGJ cancers with respect to their exact location. Clinically, the most accepted classification of EGJ cancers is "adenocarcinoma of the EGJ" (AEG or "Siewert"), which divides tumor center localization into AEG type I (distal esophagus), AEG type II ("true junction"), and AEG type III (subcardial stomach). Treatment strategies in western countries routinely employ perioperative chemotherapy or neoadjuvant chemoradiation for cases of locally advanced cancers. The standard surgical treatment strategies are esophagectomy for AEG type I and gastrectomy for AEG type III cancers. For "true junctional cancers," i.e., AEG type II, whether the extension of resection in the oral or aboral direction represents the most effective surgical therapy remains debatable. This article reviews the history of surgical EGJ cancer treatment and current surgical strategies from a Western perspective.

• Journal of Digestive Cancer Research
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• 제10권2호
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• pp.74-81
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• 2022

Colorectal peritoneal metastasis has been an incurable disease for centuries. However, since the new millennium, recent advancements in therapies are achieved with modern chemotherapeutic agents, target agents, and immune checkpoint blockade introduction. Modern chemotherapies, from a nearly nonexistent median survival if untreated, have raised the duration to 16 months with target agents. Experts have once again surpassed its limit by introducing intraperitoneal chemotherapy and cytoreductive surgery (CRS). Numerous clinical trials regarding CRS and hyperthermic intraperitoneal chemotherapy have now opened new doors in peritoneal carcinomatosis treatment, even securing complete remission. In addition, up-to-date modalities, such as pressurized intraperitoneal aerosol chemotherapy and immunotherapies, showed promising results at an early stage.

• 임상간호연구
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• 제28권2호
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• pp.137-145
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• 2022

Purpose: This retrospective chart review study was conducted to examine the frequency of delirium and to identify the risk factors of delirium in elderly surgical patients. Methods: The subjects of this study were 394 patients aged 65 years or older who underwent surgery. The diagnosis of delirium was based on the nursing assessment records with scores from the day of surgery to the 4th day after surgery. The collected data were analyzed by binary logistic regression analysis. Results: The incidence of delirium was 4.3%, and delirium occurred most frequently on the first day of surgery and lasted for 2.16 days on average. Of delirium patients, 76.5% underwent gastrointestinal surgery, and the most common delirium pattern was disorientation. In terms of the characteristics of the subjects, the occurrence of delirium was statistically different by age (𝝌²=10.79, p=.005), systemic-specific disease (𝝌²=9.63, p=.047), use of delirium-inducing drug(benzodiazepine) before surgery (𝝌²=15.90, p<.001), walking ability before surgery (𝝌²=7.65, p=.006), history of delirium (𝝌²=35.92, p<.001), and emergency surgery (𝝌²=16.40, p<.001). As risk factors of delirium, gastrointestinal surgery was found to increase the risk of delirium by 12.57 times (95% CI=2.45~64.46, p=.002), and the use of benzodiazepines before surgery was shown to increase delirium by 10.07 times (95% CI=2.21~45.87, p=.003). Conclusion: It is necessary for nurses to actively evaluate delirium using screening tools for early detection and prevention of delirium in elderly surgical patients with delirium risk factors.