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문희석,박선욱,김동환,강선형,성재규,정현용 대한대장항문학회 2014 Annals of Coloproctolgy Vol.30 No.4
Purpose: A colonoscopic polypectomy is an important procedure for preventing colorectal cancer, but it is not free from complications. Delayed hemorrhage after a colonoscopic polypectomy is one infrequent, but serious, complication. The aim of this study was to identify the risk factors for delayed hemorrhage after a colonoscopic polypectomy. Methods: This was a retrospective case-control study based on medical records from a single gastroenterology center. The records of 7,217 patients who underwent a colonoscopic polypectomy between March 2002 and March 2012 were reviewed, and 92 patients and 276 controls were selected. Data collected included comorbidity, use of antiplatelet agents, size and number of resected polyps, histology and gross morphology of resected polyps, resection method, and use of prophylactic hemostasis. Results: The average time between the procedure and bleeding was 2.71 ± 1.55 days. Univariate and multivariate analyses revealed that the size of the polyps was the only and most important predictor of delayed hemorrhage after a colonoscopic polypectomy (odds ratio, 2.06; 95% confidence interval, 1.12–1.27; P = 0.03). Conclusion: The size of resected polyps was the only independent risk factor for delayed bleeding after a colonoscopic polypectomy. The size of a polyp, as revealed by the colonoscopic procedure, may aid in making decisions, such as the decision to conduct a prophylactic hemostatic procedure.
Education and Training Guidelines for the Board of the Korean Society of Gastrointestinal Endoscopy
문희석,최은광,서지현,문정섭,송호준,김경오,현종진,신성관,이범재,이상헌 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.4
The Korean Society of Gastrointestinal Endoscopy (KSGE) developed a gastrointestinal (GI) endoscopy board in 1995 and related regulations. Although the KSGE has acquired many specialists since then, the education and training aims and guidelines were insufficient. During GI fellowship training, obtaining sufficient exposure to some types of endoscopic procedures is difficult. Fellows should acquire endoscopic skills through supervised endoscopic procedures during GI fellowship training. Thus, the KSGE requires training guidelines for fellowships that allow fellows to perform independent endoscopic procedures without supervision. This document is intended to provide principles that the Committee of Education and Training of the KSGE can use to develop practical guidelines for granting privileges to perform accurate GI endoscopy safely. The KSGE will improve the quality of GI endoscopy by providing guidelines for fellowships and supervisors.
문희석,강윤세,김연수,박기오,이엄석,성재규,이병석,노승무,송규상,조준식,신경숙,정현용,Moon Hee-Seok,Kang Yoon-Sae,Kim Yeon-Soo,Park Ki-Oh,Lee Eum-Seok,Sung Jae-Kyu,Lee Byong-Seok,Noh Seung-Moo,Song Kyu-Sang,Cho June-Sick,Shin Kyung-Sook,J 대한위암학회 2003 대한위암학회지 Vol.3 No.3
Purpose: The incidence rate and the mortality rate of gastric cancer have decreased in developed countries over the last several decades. On the other hand, they remain high in far eastern countries such as Korea, Japan, China and in many developing countries. The cure of patients with gastric carcinomas can be achieved mostly through complete surgical resection, but most gastric cancer patients are in advanced stages when diagnosed and have poor prognoses. therefore, the development of an effective systemic therapy is essential for far advanced gastric cancer patients. Until recently, the most commonly used combination chemotherapy was based on 5-flurouracil or cisplatin, but the results were not satisfactory, so recently etoposide, adriamycin and cisplatin (EAP-II) combination chemotherapy was introduced in patients with advanced gastric cancer. Early studies showed a high response rate and the ability to convert unresectable cases to resectable ones, but later studies couldn't duplicate the result. the purpose of this study was to evaluate the relative efficacy & toxicity of EAP-II chemotherapy and ELF chemotherapy which is based on 5-flurouracil. Materials and Methods: Between July 1992 and July 2002, sixty-five patients with inoperable advanced gastric cancer were enrolled for this study. Thirty-seven patient received EAP-II chemotherapy:etoposide (20 mg/$m^{2}$ IV for $1\∼5 days$), adriamycin (20 mg/$m^{2}$ IV for $1\∼5 days$) and cisplatin (20 mg/$m^{2}$ IV for $1\∼5 days$) and Twenty-eight patients receieved ELF chemotherapy : etoposide (100 mg/$m^{2}$ IV for $1\∼3 days$), leucovorin (20 mg/$m^{2}$ IV for $1\∼5 days$) and 5-FU (500 mg/$m^{2}$ IV for $1\∼5 days$). Each treatment schedule for each group was repeated every four weeks: EAP-II means 3.4 cycles per patient..ELF means 4.1 cycles per patient Results: Total respones rates were $5.4\%$ in the ELF group and $3.6\%$ in the EAP group (P-value>0.05). The median times to progression were 144 days in the ELF group and 92 days in the EAP-II group (P-value<0.05), and themedian overall survival times were 189 days in the ELF group and 139 days in the EAP-II group (P-value>0.05). The difference in the survival curves for the two regimens was not statistically significant. Non-hematologic toxicitis & hematologic toxicitis were more frequently observed for the EAP-II regimen. Anemia: $27.6\%$ in ELF vs $54\%$ in EAP-II; Leukopenia: $8.5\%$ in ELF vs $19\%$ in EAP-II; nausea & vomiting: $45.9\%$ in ELF vs $67.8\%$ in EAP-II. Conclusion: EAP-II regimen is not superior to ELF regimen in the tratment of inoperable advanced gastric cancer (J Korean Gastric Cancer Assoc 2003;3:122-127)
문희석 대한노인병학회 2009 Annals of geriatric medicine and research Vol.13 No.1
Malignant melanoma is a malignant neoplasm originating from the melanocytes, which are cells derived from the neural crest. Gastrointestinal metastasis that spreads through lymphatic or hematogenous routes is an important prognostic factor; however, esophageal metastasis has rarely been reported. A number of immunohistochemical staining methods for the pathological confirmation of esophageal metastasis have been introduced recently. Metastatic malignant melanoma is treated with chemotherapy and immunotherapy, but the prognosis is very poor. We report the case of a 66-year-old female who presented with difficulty swallowing, epigastric discomfort, and multiple variablesized esophageal nodules diagnosed as esophageal metastases from subcutaneous malignant melanoma. 악성 흑색종은 신경능선에서 유래된 멜라닌 세포에서 기원한 악성 종양으로 위장관으로 전이가 흔하며, 중요한 예후 인자로 평가 받고 있지만 식도로의 전이는 확인된 예가 극히 드물다. 악성 흑색종은 혈행성 및 림프절를 통하여 위장관으로 전이되며, 최근에 다양한 면역화학염색을 통하여 다른 악성 종양과의 감별에 도움을 받고 있다. 대개 위장관으로 전이한 경우 치료로는 전신화학 용법 및 면역치료 요법이 시행되고 있으나, 그 예후는 여전히 매우 불량한 것으로 알려져 있다. 이에 저자는 약 8개월 전 왼쪽 옆구리에 국한된 악성 흑색종으로 광범위 절제술 및 Limberg 피판술을 시행 받았고 수술 절제면에 암세포가 없음을 확인하고 추적 관찰 중, 급속하게 전신 피부에 재발과 함께 식사 시 발생하는 연하장애로 상부위장관 내시경 검사를 시행하여 악성 흑색종의 식도 전이라는 매우 드문 예를 경험하였기에 문헌 고찰과 함께 보고한다.