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이엄석 ( Eaum Seok Lee ),김현수 ( Hyun Soo Kim ) 대한췌담도학회 2016 대한췌담도학회지 Vol.21 No.2
Complications that may occur after an endoscopic retrograde cholangiopancreatography (ERCP) procedure include pancreatitis, bleeding, cholangitis, cholecystis, perforation, and post-ERCP pancreatitis (PEP). Of these, PEP is the most common complication and 10% of patients can die from severe pancreatitis. Prevention of PEP requires the selection of an appropriate patient group according to their ERCP indications and a full awareness of the risk factors. The incidence rate can be reduced to some extent through medication and ERCP manipulation changes. The use of a spile through the guidewire during ERCP manipulation and temporary pancreatic duct stent insertion can be effective, and the administration of suppository NSAIDs as medication reduces the occurrence of PEP. Drugs such as glyceryl trinitrate (GTN), nafamostat, and somatostatin can be considered as the second best treatment in the cases where NSAIDs are contraindicated or where a plastic catheter cannot be inserted or fails after insertion into the pancreatic duct.
이엄석 ( Eaum Seok Lee ) 대한췌장담도학회 2014 대한췌담도학회지 Vol.19 No.2
A polypoid lesions of the gallbladder (PLGs) is defined as any elevated lesion of the mucosal surface of the gallbladder wall. Even though most of the gallbladder polyps are benign in nature, malignant polyps are found in some cases. Because advanced gallbladder cancer displays poor prognosis, early detection and appropriate early measures are important for curative treatment and improvement in long-term survival. Patients who have GB polyps are usually almost always asymptomatic and often diagnosed incidentally by abdomen CT scan or transabdominal ultrasonography (TAUS) imaging. However TAUS and CT scan can not differentiate precancerous and cancerous lesions from cholesterol polyps. To increase the diagnostic accuracy, New imanging modality is being performed. Of the available tests, the accuracy of EUS (or CEH-EUS) for the differentiation of neoplastic from nonneoplastic polyps was higher than that of transabdominal US or CT scan. The cholecystectomy should be undertaken only in cases where there are clinical signs of gallbladder polyps, polyps with diameters greater than 10 mm, fast-growing polyps, sessile polyps or wide-based polyps, patient aged over 50, concurrent gallstones, polyps of the gallbladder in fundibulum or abnormal gallbladder wall US. Gallbladder polyps that are not resected should be followed-up with serial ultrasound examinations. guidelines on the screening interval are not yet available, but follow-up with the same modality is generally recommended after 3-6 months. If there are no changes in size, contour, or vascualrity, the follow-up should be individualized; most often a follow up after another 12-24 months could be recommended up to 5 years at least.
증례 : 소화기 ; 췌장 전이를 동반한 원발성 후두 소세포암 1예
홍순창 ( Sun Chang Hong ),이엄석 ( Eaum Seok Lee ),김석현 ( Seok Hyun Kim ),이병석 ( Byung Seok Lee ),문희석 ( Hee Seok Moon ),정현용 ( Hyun Yong Jeong ),강대영 ( Dae Young Kang ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2S
원발성 폐외 소세포암은 드문 질환으로 위장관, 두경부, 비뇨생식기 등 전신에 걸쳐 발생하는 것으로 알려져 있다. 두경부의 소세포암은 후두부에 가장 흔하고, 절반 이상에서 경부 림프절 전이를 보이며, 14-18%에서 원격 전이를 보여, 예후가 불량한 것으로 알려져 있다. 저자들은 42세 남자의 후두에서 발생한 소세포암이 췌장으로 전이된 매우 드문 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Small cell carcinoma (SCC) is predominantly found in the lungs, and extrapulmonary small cell carcinoma (EPSCC) is a relatively rare disease, encompassing 2.5-4% of all SCCs. EPSCCs are commonly found in the esophagus, pancreas, skin, uterus, breasts, and prostate. SCC of the head and neck is aggressive and has a propensity for distant and regional spread. However, solitary metastasis to the pancreas is very rare. We report a case of laryngeal SCC with pancreatic metastasis in a 42-year-old man. The patient underwent resection of a primary SCC followed by a pylorus preserving pancreatoduodenectomy. (Korean J Med 2011; 80:S126-S130)
간경변을 동반한 간세포암종 환자에서 문맥 혈전증에 대한 항응고치료 3예
안병무 ( Byung Moo Ahn ),이엄석 ( Eaum Seok Lee ),김석현 ( Seok Hyun Kim ),이병석 ( Byung Seok Lee ),이헌영 ( Heon Young Lee ) 대한간암학회 2015 대한간암학회지 Vol.15 No.1
The reported prevalence of PVT is in the range of 0.6-15.8% in patient with liver cirrhosis or portal hypertension. If the patient has hepatocellular carcinoma, thrombus is likely to be malignant thrombus. Malignancy, frequently of hepatic origin, is responsible for 21-24% of over all cases. The overall mortality rate of chronic PVT has been reported to be less than 10%, but is increased to 26% when associated with hepatocellular carcinoma and cirrhosis. However, no treatment guideline has been established on anticoagulant therapy for PVT in patients with concomitant hepatocellular carcinoma and cirrhosis. Because actually it is not easy to distinguish between malignant thrombus and benign thrombus in clinical aspect, PVT in hepatocellular carcinoma are still debatable whether or not treatment when it diagnosed. We present 3 cases of portal vein thrombosis successfully treated with anticoagulation in hepatocellular carcinoma and liver cirrhosis, and we include a literature review. (Journal of Liver Cancer 2015;15:57-63)
이희정 ( Hee Jung Lee ),정현용 ( Hyun Yong Jeong ),박남환 ( Nam Hwan Park ),홍순창 ( Sun Chang Hong ),남관우 ( Gwan Woo Nam ),문희석 ( Hee Seok Moon ),이엄석 ( Eaum Seok Lee ),김석현 ( Seok Hyun Kim ),성재규 ( Jae Kyu Sung ),이병 대한소화기학회 2011 대한소화기학회지 Vol.57 No.4
Background/Aims: Recently colonoscopy and screening programs have led to the detection and removal of increasing numbers of early colorectal cancer (ECC), which can reduce its related mortality. We analysed the clinical, endoscopic, and histologic findings, as well as the follow-up data, to evaluate the effectiveness and the long-term results of endoscopic mucosal resection (EMR) for ECC. Methods: We analysed, retrospectively, 94 lesions in 92 patients who underwent EMR for ECC from January 2002 to June 2009. Results: The overage age of patients was 60 years old. The mean follow-up period was 22.1 months (6-80). En bloc resection rate was 64.9%. Submucosal invasion was found in 30 cases (31.9%). De novo cancer rate was 26.6% which had higher submucosal invasion rate (60%, p=0.003). The complete resection rate was 87.2%, and there was no recurrence of cancer during follow-up (p=0.000). Twelve incomplete resection cases had received further surgical treatments. No procedure-related mortality was found and no recurrent malignancy was found except 1 case. Conclusions: This study shows that EMR is an effective and safe treatment for ECC. En bloc resection provides precise histologic information and prevention of tumor recurrence. (Korean J Gastroenterol 2011;57:230-236)
경피 내시경하 위루술 후 발생한 상장간막 동맥 손상 1예
이서희 ( Seo Hee Lee ),문희석 ( Hee Seok Moon ),박재호 ( Jae Ho Park ),김주석 ( Ju Seok Kim ),강선형 ( Sun Hyung Kang ),이엄석 ( Eaum Seok Lee ),김석현 ( Seok Hyun Kim ),성재규 ( Jae Kyu Sung ),이병석 ( Byung Seok Lee ),정현용 ( H 대한소화기학회 2018 대한소화기학회지 Vol.72 No.6
Percutaneous endoscopic gastrostomy (PEG) is widely used to provide nutritional support for patients with dysphagia and/or disturbed consciousness preventing oral ingestion, and PEG tube placement is a relatively safe and convenient non-surgical procedure performed under local anesthesia. However, the prevention of PEG-insertion-related complications is important. A 64-year-old man with recurrent pneumonia underwent tracheostomy and nasogastric tube placement for nutritional support and opted for PEG tube insertion for long-term nutrition. However, during the insertion procedure, needle puncture had to be attempted twice before successful PEG tube placement was achieved, and a day after the procedure his hemoglobin had fallen and he developed hypotension. Abdominal computed tomography revealed injury to a pancreatic branch of the superior mesenteric artery (SMA) associated with bleeding, hemoperitoneum, and pancreatitis. Transarterial embolization was performed using a microcatheter to treat hemorrhage from the injured branch of the SMA, and the acute pancreatitis was treated using antibiotics and supportive care. The patient was discharged after an uneventful recovery. Clinicians should be mindful of possible pancreatic injury and bleeding after PEG tube insertion. Possible complications, such as visceral injuries or bleeding, should be considered in patients requiring multiple puncture attempts during a PEG procedure. (Korean J Gastroenterol 2018;72:308-312)
강구흠 ( Gu Hyum Kang ),문희석 ( Hee Seok Moon ),이엄석 ( Eaum Seok Lee ),김석현 ( Seok Hyun Kim ),성재규 ( Jae Kyu Sung ),이병석 ( Byun Seok Lee ),정현용 ( Hyun Yong Jeong ) 대한소화기학회 2012 대한소화기학회지 Vol.60 No.6
Colloid carcinoma of the liver is very rare, and its clinicopathologic features have not been well characterized yet. We describe herein a case of colloid carcinoma of the liver. Imaging revealed a lobulated mass, measuring 12 cm in diameter at the right lobe of the liver with direct invasion of adjacent peripheral intrahepatic bile ducts. Right hemihepatectomy of the liver was performed according to the possibility of the tumor`s malignant behavior. Histopathological examination of the specimen revealed large extracelluar stromal mucin pools containing floating cuboidal to columnar neoplastic cells without ovarian-like stroma. This case seemed to be colloid carcinoma arising in association with intraductal papillary neoplasm of the liver.
복강경 담낭절제술 후 헤모락 클립의 이동으로 발생한 복통 1예
류우선 ( Woo Sun Rou ),주종석 ( Jong Seok Joo ),강선형 ( Sun Hyung Kang ),문희석 ( Hee Seok Moon ),김석현 ( Seok Hyun Kim ),성재규 ( Jae Kyu Sung ),이병석 ( Byung Seok Lee ),이엄석 ( Eaum Seok Lee ) 대한소화기학회 2018 대한소화기학회지 Vol.72 No.6
During laparoscopic cholecystectomy, a surgical clip is used to control the cystic duct and cystic artery. In the past, metallic clips were usually used, but over recent years, interest in the use of Hem-o-lok clips has increased. Surgical clip migration into the common bile duct (CBD) after laparoscopic cholecystectomy has rarely been reported and the majority of reported cases involved metallic clips. In this report, we describe the case of a 53-year-old woman who presented with abdominal pain caused by migration of a Hem-o-lok clip into the CBD. The patient had undergone laparoscopic cholecystectomy 10 months previously. Abdominal CT revealed an indistinct, minute, radiation-impermeable object in the distal CBD. The object was successfully removed by sphincterotomy via ERCP using a stone basket and was identified as a Hem-o-lok clip. (Korean J Gastroenterol 2018;72:313-317)
우측 손목 방형 회내근으로 간외 전이된 원발성 간세포암 1예
송영욱 ( Young Wook Song ),이병석 ( Byung Seok Lee ),김석현 ( Seok Hyun Kim ),이엄석 ( Eaum Seok Lee ),이헌영 ( Heon Young Lee ) 대한간암학회 2015 대한간암학회지 Vol.15 No.1
Hepatocellular carcinoma (HCC) is usually associated with chronic liver disease such as liver cirrhosis. Primary HCC lesions and even recurrent intrahepatic lesions can be treated successfully by using variable modalities applicable to intrahepatic lesions. HCC can cause intrahepatic multiple occurrence and extrahepatic metastasis. Extrahepatic metastasis occurs in up to about 60% of patients of HCC, and a major of patients with extrahepatic HCC had late intrahepatic stage of tumor. Themost frequent site of extrahepatic metastasis of HCC was the lung. HCC metastasized to soft tissues was unusually reported. Extrahepatic metastasis of HCC, especially to unusual site, should not be overlooked and must be able to be controlled. We experienced a case that HCC was metastasized to the pronator quadratus muscle of right wrist and chould be removed surgically. (Journal of Liver Cancer 2015;15:41-45)
증례 : 소화기 ; 간세포암의 복강경하 고주파 소작술 후 천자침 경로를 통한 흉벽 전이 1예
김의식 ( Eui Sik Kim ),김윤정 ( Yun Jeung Kim ),이수윤 ( Su Youn Lee ),이엄석 ( Eaum Seok Lee ),김석현 ( Seok Hyun Kim ),이병석 ( Byung Seok Lee ),이헌영 ( Heon Young Lee ) 대한내과학회 2012 대한내과학회지 Vol.82 No.3
Radiofrequency ablation (RFA) is a popular technique and shows excellent local tumor control and acceptable morbidity. Although RFA is considered much safer than surgical treatment, it is not a complication-free procedure. The most common complications of percutaneous RFA areabdominal hemorrhage, abdominal infection (abscess), biliary tract damage, and ground-pad burns. Laparoscopic RFA (LRFA) is a safe, feasible treatment modality to achieve tumor destruction. LRFA has proven superior to the percutaneous approach for lesions that are difficult or impossible to treat percutaneously. Needle-track implantationafter LRFA is a rare complication in HCCs. We report a case of needle-tract implantation of HCC found in the chest wall, ribs,and diaphragm 11 months after LRFA in a 49-year-old man. Although treatment for needle-track implantation is not well established, the metastatic mass was surgically removed. (Korean J Med 2012;82:326-330)