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1.
Article in English | WPRIM | ID: wpr-875177

ABSTRACT

Rosacea fulminans is an extreme form of rosacea characterized by a rapid onset and fulminating course with prominent erythema, pustules,and cysts on the face. It can have an impact on obstetrical outcomes, and its treatments may have limitations during pregnancy. A 33-year-old woman and a 22-year-old woman presented with rosacea fulminans during the first pregnancy andwere treated with erythromycin and prednisone, respectively. After delivery, there was a significant improvement in the lesion. Rosacea fulminans recurred during the second pregnancy, but the skin lesions showed better progression. Rosacea fulminans can causesevere distress and different outcomes of pregnancy. It is recommended to consult about the risk of recurrence in future pregnancies.

2.
Article | WPRIM | ID: wpr-836734

ABSTRACT

Biodegradable stents have the highly attractive advantage that they do not need to be removed after insertion into human organs. For this reason, biodegradable stents using various biodegradable materials have been developed and applied to the several human organs for a long time with the possibility of success. In the gastrointestinal tract, benign esophageal stricture was the first indication of biodegradable stents, and several biodegradable stents are currently attempting to overcome several technical limitations and to be inserted benign bile duct and pancreatic strictures by endoscopic procedure. However, in order to maintain a high radial expansion force while properly controlling the degradation time, there are many problems to be solved because the thickness of the raw material must be adequately maintained at a constant thickness. In this review, the issues or previous clinical results related to biodegradable stents were reviewed, and the concepts of the basics and the problems related to the development of biodegradable stents were discussed.

3.
Clinical Endoscopy ; : 65-72, 2020.
Article | WPRIM | ID: wpr-832121

ABSTRACT

Background/Aims@#Using an appropriate guidewire can increase the success rate of selective cannulation in endoscopic retrograde cholangiopancreatography. The purpose of this technical study was to investigate the characteristics of each guidewire type and to evaluate its efficiency and rapidity of insertion. @*Methods@#We conducted a three-point bending test using a universal testing machine to investigate the flexibility and bending features of each guidewire. 3D-printed silicone tubes with various types of stricture and a hand-made biliary tree silicone model with six-stranded intrahepatic ducts were used to evaluate the success rate and insertion time of each guidewire. @*Results@#In the three-point bending test, the characteristics of each guidewire were classified. We found that the bending strengths and times were independent of shaft thickness. Using two in vitro biliary duct models, we determined that the success rate and total insertion time were better for guidewires with a resilient shaft and angled tip than for other types of guidewires (p<0.001). Although thickness of the guidewire affected the success rate (p<0.05), it did not affect the total insertion time (p≥0.05). @*Conclusions@#Among several types of guidewire, some factors (resilient shaft, highly flexible, and angled tip) appeared to be associated with the efficiency and rapidity of the guidewire insertion.

4.
Article in English | WPRIM | ID: wpr-830538

ABSTRACT

Purpose@#Repeating endoscopic retrograde cholangiopancreatography (ERCP) in patients with recurrent common bile duct (CBD) stones is problematic in many ways. Choledochoduodenostomy (CDS) and choledochojejunostomy (CJS) are 2 surgical treatment options for recurrent CBD stones, and each has different advantages and disadvantages. The aim of this study was to compare the 2 surgical options in terms of the recurrence rate of CBD stones after surgical treatment. @*Methods@#This retrospective multicenter study included all patients who underwent surgical treatment due to recurrent CBD stones that were not effectively controlled by medical treatment and repeated ERCP between January 2006 and March 2015. We collected data from chart reviews and medical records. A recurrent CBD stone was defined as a stone found 6 months after the complete removal of a CBD stone by ERCP. Patients who underwent surgery for other reasons were excluded. @*Results@#A total of 27 patients were enrolled in this study. Six patients underwent CDS, and 21 patients underwent CJS for the rescue treatment of recurrent CBD stones. The median follow-up duration was 290 (180–1,975) days in the CDS group and 1,474 (180–6,560) days in the CJS group (P = 0.065). The postoperative complications were similar and tolerable in both groups (intestinal obstruction; 2 of 27, 7.4%; 1 in each group). CBD stones recurred in 4 patients after CDS (4 of 6, 66.7%), and 3 patients after CJS (3 of 21, 14.3%) (P = 0.010). @*Conclusion@#CJS may be a better surgical option than CDS for preventing further stone recurrence in patients with recurrent CBD stones.

5.
Article in Korean | WPRIM | ID: wpr-761539

ABSTRACT

Pancreatic cancer is a major cause of cancer-related mortality and morbidity, and its incidence is increasing as the population is aging. On the other hand, significant improvement in the prognosis has not occurred. The absence of early diagnosis means that many patients are diagnosed only when they develop symptoms, such as jaundice, due to a biliary obstruction. The role of endoscopy in multidisciplinary care for patients with pancreatic cancer continues to evolve. Controversy remains regarding the best preoperative biliary drainage in patients with surgically resectable pancreatic head cancer. In general, patients undergoing a surgical resection usually do not require preoperative biliary drainage unless they have cholangitis or receive neoadjuvant chemotherapy. If biliary drainage is performed prior to surgery, the patient's condition and a multidisciplinary approach should be considered. With the increasing life expectancy of patients with pancreatic cancer, the need for more long-time biliary drainage or pre-operative biliary drainage is also increasing. Strong evidence of endoscopic retrograde cholangiopancreatography (ERCP) as a first-line and essential treatment for biliary decompression has been provided. On the other hand, the use of endoscopic ultrasound-guided biliary drainage as well as percutaneous biliary drainage has been also recommended. During ERCP, self-expandable metal stent could be recommended instead of a plastic stent for the purpose of long stent patency and minimizing stent-induced complications. In this review, several points of view regarding the relief of obstruction in patients with pancreatic cancer, and optimal techniques are being discussed.


Subject(s)
Aging , Cholangiopancreatography, Endoscopic Retrograde , Cholangitis , Decompression , Drainage , Drug Therapy , Early Diagnosis , Endoscopy , Hand , Head and Neck Neoplasms , Humans , Incidence , Jaundice , Life Expectancy , Mortality , Pancreatic Neoplasms , Plastics , Prognosis , Stents
6.
Article in English | WPRIM | ID: wpr-759763

ABSTRACT

Although the exact etiology of cutaneous angiosarcoma remains unclear, MYC gene amplification has been recently discovered as a new pathogenesis. MYC is a proto-oncogene, and aberration of MYC signaling in malignancies is associated with tumor metastasis, recurrence, and mortality. Moreover, upregulation of the miRNA polycistron, miR-17-92 cluster, were confirmed in both cutaneous angiosarcoma and multiple myeloma with MYC amplification. The correlation between MYC and miRNA expression is predictable as the coincident aberrant phenotype in two diseases. Moreover, the exploiting MYC dependency may be an attractive disease-specific strategy for the diagnosis and treatment of patients who are unaware of the causes of cutaneous angiosarcoma. Herein, a rare case of cutaneous angiosarcoma of the foot, which is also the first case of cutaneous angiosarcoma accompanied by multiple myeloma, has been described.


Subject(s)
Diagnosis , Foot , Genes, myc , Hemangiosarcoma , Humans , MicroRNAs , Mortality , Multiple Myeloma , Neoplasm Metastasis , Phenotype , Proto-Oncogenes , Recurrence , Up-Regulation
7.
Article in Korean | WPRIM | ID: wpr-759748

ABSTRACT

Elephantiasis nostras verrucosa (ENV) is an uncommon condition caused by repeated inflammation and lymphatic obstruction. It occurs mainly in the lower extremities and is characterized by skin changes, including hyperkeratotic mossy papules and plaques, non-pitting edema, and cobblestone-like appearances. ENV can be diagnosed based on its typical clinical manifestations (pseudoepitheliomatous hyperplasia with enlarged lymphatic spaces, fibrous tissue proliferation, and chronic inflammation) and by skin biopsy. Although ENV is difficult to treat, reduction of lymphedema and use of keratolytic agents may be helpful. To our knowledge, only three cases of ENV have been reported. However, the case of ENV treated with oral acitretin has not been reported in domestic literatures. Therefore, we report the case of a 45-year-old woman who developed ENV. She had a past history of cellulitis and was successfully treated with oral acitretin.


Subject(s)
Acitretin , Biopsy , Cellulitis , Edema , Elephantiasis , Female , Humans , Hyperplasia , Inflammation , Keratolytic Agents , Lower Extremity , Lymphedema , Middle Aged , Skin
9.
Article in Korean | WPRIM | ID: wpr-787187

ABSTRACT

Pancreatic cancer is a major cause of cancer-related mortality and morbidity, and its incidence is increasing as the population is aging. On the other hand, significant improvement in the prognosis has not occurred. The absence of early diagnosis means that many patients are diagnosed only when they develop symptoms, such as jaundice, due to a biliary obstruction. The role of endoscopy in multidisciplinary care for patients with pancreatic cancer continues to evolve. Controversy remains regarding the best preoperative biliary drainage in patients with surgically resectable pancreatic head cancer. In general, patients undergoing a surgical resection usually do not require preoperative biliary drainage unless they have cholangitis or receive neoadjuvant chemotherapy. If biliary drainage is performed prior to surgery, the patient's condition and a multidisciplinary approach should be considered. With the increasing life expectancy of patients with pancreatic cancer, the need for more long-time biliary drainage or pre-operative biliary drainage is also increasing. Strong evidence of endoscopic retrograde cholangiopancreatography (ERCP) as a first-line and essential treatment for biliary decompression has been provided. On the other hand, the use of endoscopic ultrasound-guided biliary drainage as well as percutaneous biliary drainage has been also recommended. During ERCP, self-expandable metal stent could be recommended instead of a plastic stent for the purpose of long stent patency and minimizing stent-induced complications. In this review, several points of view regarding the relief of obstruction in patients with pancreatic cancer, and optimal techniques are being discussed.


Subject(s)
Aging , Cholangiopancreatography, Endoscopic Retrograde , Cholangitis , Decompression , Drainage , Drug Therapy , Early Diagnosis , Endoscopy , Hand , Head and Neck Neoplasms , Humans , Incidence , Jaundice , Life Expectancy , Mortality , Pancreatic Neoplasms , Plastics , Prognosis , Stents
10.
Clinical Endoscopy ; : 502-505, 2019.
Article in English | WPRIM | ID: wpr-763468

ABSTRACT

Endoscopic submucosal dissection is recommended as an alternative therapy for early esophageal cancer. However, achieving curative resection in this procedure remains controversial since precise prediction of lymph node metastasis can be difficult. Here, we present the preliminary results of endoscopic submucosal dissection followed by concurrent chemoradiotherapy for early esophageal cancer with a high risk of lymph node metastasis. From May 2006 to January 2014, six patients underwent concurrent chemoradiotherapy after endoscopic submucosal dissection with a median follow-up period of 63 months. No complications were encountered during concurrent chemoradiotherapy. Although local recurrence did not occur in all patients, two patients were diagnosed with metachronous cancer. Overall, the survival rate was 100%. Thus, endoscopic submucosal dissection followed by concurrent chemoradiotherapy may be a feasible treatment for early esophageal cancer in patients with a high risk of lymph node metastasis. Future prospective large-scale studies are warranted to confirm our results.


Subject(s)
Chemoradiotherapy , Esophageal Neoplasms , Follow-Up Studies , Humans , Lymph Nodes , Neoplasm Metastasis , Prospective Studies , Recurrence , Survival Rate
11.
Clinical Endoscopy ; : 304-305, 2018.
Article in English | WPRIM | ID: wpr-714588

ABSTRACT

No abstract available.


Subject(s)
Pancreatic Pseudocyst
12.
Clinical Endoscopy ; : 510-512, 2018.
Article in English | WPRIM | ID: wpr-717979

ABSTRACT

No abstract available.

13.
Clinical Endoscopy ; : 404-405, 2017.
Article in English | WPRIM | ID: wpr-195021

ABSTRACT

No abstract available.


Subject(s)
Biopsy , Surgical Instruments
14.
Gut and Liver ; : 878-883, 2017.
Article in English | WPRIM | ID: wpr-82298

ABSTRACT

BACKGROUND/AIMS: This study aimed to evaluate the diagnostic role of low serum amylase and lipase values in the detection of chronic pancreatitis. METHODS: Patients underwent endoscopic retrograde cholangiopancreatography and were diagnosed with non-calcific chronic pancreatitis (NCCP; n=99) and calcific chronic pancreatitis (CCP; n=112). Patient serum amylase and lipase values were compared with those of healthy controls (H; n=170). RESULTS: The median serum amylase (normal range, 19 to 86 U/L) and lipase values (7 to 59 U/L) (P₂₅–P₇₅) were 47.0 (39.8 to 55.3) and 25.0 (18.0 to 35.0) for H, 34.0 (24.5 to 49.0) and 19.0 (9.0 to 30.0) for NCCP, and 30.0 (20.0 to 40.8) and 10.0 (3.0 to 19.0) for CCP, respectively. The cutoff values with the highest diagnostic accuracy for discriminating NCCP from H were 40 U/L for amylase and 20 U/L for lipase, respectively, and for CCP from H were 38 U/L for amylase and 15 U/L for lipase, respectively. For the diagnosis of NCCP with a criterion of serum amylase < 40 and lipase < 20 U/L, the sensitivity, specificity, positive predictive value, and negative predictive values were 37.4%, 88.8%, 66.1%, and 70.9%, respectively. CONCLUSIONS: Serum amylase and/or lipase levels below the normal serum range are highly specific for chronic pancreatitis patients. Clinicians should not ignore low serum pancreatic enzyme values.


Subject(s)
Amylases , Cholangiopancreatography, Endoscopic Retrograde , Diagnosis , Humans , Lipase , Pancreatitis , Pancreatitis, Chronic , Sensitivity and Specificity
15.
Clinical Endoscopy ; : 508-509, 2017.
Article in English | WPRIM | ID: wpr-89706

ABSTRACT

No abstract available.


Subject(s)
Colonoscopy , Hematoma
16.
Article in English | WPRIM | ID: wpr-148124

ABSTRACT

Spontaneous perforation of the bile duct without any traumatic or iatrogenic injury is extremely rare. We report a case of abscess formation related to spontaneous perforation of the common bile duct by a gallstone, mimicked a cholecochal cyst.


Subject(s)
Abscess , Bile Ducts , Cholangiopancreatography, Magnetic Resonance , Choledochal Cyst , Common Bile Duct , Gallstones
17.
Clinical Endoscopy ; : 81-85, 2016.
Article in English | WPRIM | ID: wpr-181516

ABSTRACT

Esophageal duplication (ED) is rarely diagnosed in adults and is usually asymptomatic. Especially, ED that is connected to the esophagus through a tubular communication and combined with bronchoesophageal fistula (BEF) is extremely rare and has never been reported in the English literature. This condition is very difficult to diagnose. Although some combinations of several modalities, such as upper gastrointestinal endoscopy, esophagography, computed tomography, magnetic resonance imaging, and endoscopic ultrasonography, can be used for the diagnosis, the results might be inconclusive. Here, we report on a patient with communicating tubular ED that was incidentally diagnosed on the basis of endoscopy and esophagography during the postoperational evaluation of BEF.


Subject(s)
Adult , Bronchial Fistula , Diagnosis , Endoscopy , Endoscopy, Gastrointestinal , Endosonography , Esophageal Fistula , Esophagus , Fistula , Humans , Magnetic Resonance Imaging
18.
Gut and Liver ; : 632-641, 2016.
Article in English | WPRIM | ID: wpr-164308

ABSTRACT

BACKGROUND/AIMS: The efforts to improve biliary plastic stents (PSs) for decreasing biofilm formation and overcome short patency time have been continued. The aim of this study is to evaluate the effect of advanced hydrophilic coating for patency and biodurability of PS. METHODS: Using an in vitro bile flow phantom model, we compared patency between prototype PS with hydrophilic coating (PS+HC) and prototype PS without hydrophilic coating (PS-HC). We performed an analysis of the degree of luminal narrowing by microscopic examination. Using an in vivo swine bile duct dilation model made by endoscopic papillary closure and stent insertion, we evaluated biodurability of hydrophilic coating. RESULTS: In the phantom model, PS+HC showed less biofilm formation and luminal narrowing than PS-HC at 8 weeks (p<0.05). A total of 31 stents were inserted into the dilated bile duct of seven swine models, and 24 stents were successfully retrieved 8 weeks later. There was no statistical difference of stent patency between the polyethylene PS+HC and the polyurethane PS+HC. The biodurability of hydrophilic coating was sustained up to 8 weeks, when assessing the coating layer by scanning electron microscopy examination. CONCLUSIONS: Advanced hydrophilic coating technology may extend the patency of PS compared to uncoated PS.


Subject(s)
Animals , Bile Ducts , Bile , Biofilms , In Vitro Techniques , Microscopy, Electron, Scanning , Phenobarbital , Plastics , Polyethylene , Polyurethanes , Stents , Swine
19.
Clinical Endoscopy ; : 282-288, 2016.
Article in English | WPRIM | ID: wpr-175023

ABSTRACT

BACKGROUND/AIMS: Colonoscopic perforations have been managed with exploratory laparotomy, and have resulted in some morbidity and mortality. Recently, laparoscopic surgery is commonly performed for this purpose. The aim of this study was to compare the outcomes of several management strategies for iatrogenic colonoscopic perforations. METHODS: We retrospectively reviewed the medical records of patients who had been treated for colonoscopic perforation between January 2004 and April 2013 at CHA Bundang Medical Center in Korea. RESULTS: A total of 41 patients with colonoscopic perforation were enrolled. Twenty patients underwent conservative management with a success rate of 90%. Surgical management was performed in 23 patients including two patients who were converted to surgical management after the failure of the initial conservative management. Among 14 patients who underwent surgery at 8 hours after the perforation, there was no considerable difference in adverse outcomes between the laparotomy group and the laparoscopic surgery group. The medical costs and claim rate were 1.45 and 1.87 times greater in the exploratory laparotomy group, respectively. CONCLUSIONS: Conservative management of colonoscopic perforation could be an option for patients without overt symptoms of peritonitis or with a small defect size. If surgical management is required, laparoscopic surgery may be considered as the initial procedure even with a delayed diagnosis.


Subject(s)
Colonoscopy , Delayed Diagnosis , Humans , Korea , Laparoscopy , Laparotomy , Medical Records , Methods , Mortality , Peritonitis , Retrospective Studies
20.
Clinical Endoscopy ; : 139-146, 2016.
Article in English | WPRIM | ID: wpr-72954

ABSTRACT

Biliary stenting via endoscopic retrograde cholangiopancreatography has greatly improved the quality of patient care over the last 30 years. Plastic stent occlusion limits the life span of such stents. Attempts to improve plastic stent patency duration have mostly failed. Metal stents (self-expandable metal stents [SEMSs]) have therefore replaced plastic stents, especially for malignant biliary strictures. SEMS are at least 10 times more expensive than plastic stents. In this focused review, we will discuss basic mechanisms of plastic stent occlusion, along with a systematic summary of previous efforts and related studies to improve stent patency and potential new techniques to overcome existing limitations.


Subject(s)
Biliary Tract , Biofilms , Cholangiopancreatography, Endoscopic Retrograde , Constriction, Pathologic , Patient Care , Plastics , Stents
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