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1.
Article in Korean | WPRIM | ID: wpr-1044792

ABSTRACT

As fluoroscopy-guided interventional procedures gain popularity, the associated health threats from radiation exposure to interventionalists during these procedures are increasing. Therefore, an understanding of the potential risks of radiation and careful consideration on minimizing exposure to radiation during the procedures are of paramount importance. The Korean Pancreatobiliary Association has developed a clinical practice guideline to minimize radiation exposure during fluoroscopy-guided interventional procedures. This guideline provides recommendations to deal with the risk of radiation exposure to interventionalists who perform fluoroscopy-guided procedures, and emphasizes the importance of proper and practical approaches to avoid unnecessary radiation exposure.

2.
Clinical Endoscopy ; : 413-419, 2021.
Article in English | WPRIM | ID: wpr-897787

ABSTRACT

Background/Aims@#Irreversible electroporation (IRE) is a relatively new ablation method. However, the application of IRE ablation in the treatment of biliary disease has not been attempted. A minimally invasive approach using endoscopic retrograde cholangiopancreatography (ERCP) can be a novel therapeutic modality for IRE ablation. In this study, we aimed to investigate the feasibility of endoscopic IRE for the biliary tract using an animal model. @*Methods@#A new catheter-type electrode was developed for endoscopic IRE ablation of the biliary tract. We performed ERCP and endoscopic IRE ablations in the normal common bile duct of Yorkshire pigs. The experimental setting of IRE was 500 V/cm (50 pulses, 100-µs length). The animals were sacrificed after 24 hr, and the ablated bile duct was examined. @*Results@#Well-demarcated focal color changes were observed on the mucosa of the common bile duct. The depth of change after IRE was confined to the mucosal and submucosal layers. Apoptotic changes in the bile duct were observed only around the IRE ablation area. Immunohistochemistry assay showed cell death in the bile duct along the electrode. @*Conclusions@#Endoscopic IRE ablation using ERCP was successfully performed in the common bile duct. It can be a potential option for the treatment of biliary tumors.

3.
Clinical Endoscopy ; : 694-700, 2021.
Article in English | WPRIM | ID: wpr-897810

ABSTRACT

Background/Aims@#Several attempts have been made to incorporate smart glasses in the medical field. We applied wearable display glasses to show the position of an observer during endoscopy and compared students’ responses between the conventional and new methods. @*Methods@#We surveyed 28 medical students regarding the use of wearable display devices. The students used wearable display glasses to observe an endoscopic procedure and answered the prepared questionnaire. Their collected responses were analyzed for statistical correlations between each variable. @*Results@#The survey of medical students revealed disadvantages including dizziness (dissatisfied and very dissatisfied: 21.5%) and eye fatigue (25% dissatisfied) and advantages including concentration (satisfied and very satisfied: 57.2%) and securing patient rights (71.4%). The students showed more positive than negative reviews regarding the new devices (32.1% vs. 21.5%). @*Conclusions@#We investigated the advantages and disadvantages of viewing the endoscope image with new wearable display glasses compared to the conventional method using the survey to record user experience. The results revealed relatively positive responses from the medical students in the survey. If the new device compensates for some shortcomings, its use in the endoscopy room will be feasible.

4.
Clinical Endoscopy ; : 413-419, 2021.
Article in English | WPRIM | ID: wpr-890083

ABSTRACT

Background/Aims@#Irreversible electroporation (IRE) is a relatively new ablation method. However, the application of IRE ablation in the treatment of biliary disease has not been attempted. A minimally invasive approach using endoscopic retrograde cholangiopancreatography (ERCP) can be a novel therapeutic modality for IRE ablation. In this study, we aimed to investigate the feasibility of endoscopic IRE for the biliary tract using an animal model. @*Methods@#A new catheter-type electrode was developed for endoscopic IRE ablation of the biliary tract. We performed ERCP and endoscopic IRE ablations in the normal common bile duct of Yorkshire pigs. The experimental setting of IRE was 500 V/cm (50 pulses, 100-µs length). The animals were sacrificed after 24 hr, and the ablated bile duct was examined. @*Results@#Well-demarcated focal color changes were observed on the mucosa of the common bile duct. The depth of change after IRE was confined to the mucosal and submucosal layers. Apoptotic changes in the bile duct were observed only around the IRE ablation area. Immunohistochemistry assay showed cell death in the bile duct along the electrode. @*Conclusions@#Endoscopic IRE ablation using ERCP was successfully performed in the common bile duct. It can be a potential option for the treatment of biliary tumors.

5.
Clinical Endoscopy ; : 694-700, 2021.
Article in English | WPRIM | ID: wpr-890106

ABSTRACT

Background/Aims@#Several attempts have been made to incorporate smart glasses in the medical field. We applied wearable display glasses to show the position of an observer during endoscopy and compared students’ responses between the conventional and new methods. @*Methods@#We surveyed 28 medical students regarding the use of wearable display devices. The students used wearable display glasses to observe an endoscopic procedure and answered the prepared questionnaire. Their collected responses were analyzed for statistical correlations between each variable. @*Results@#The survey of medical students revealed disadvantages including dizziness (dissatisfied and very dissatisfied: 21.5%) and eye fatigue (25% dissatisfied) and advantages including concentration (satisfied and very satisfied: 57.2%) and securing patient rights (71.4%). The students showed more positive than negative reviews regarding the new devices (32.1% vs. 21.5%). @*Conclusions@#We investigated the advantages and disadvantages of viewing the endoscope image with new wearable display glasses compared to the conventional method using the survey to record user experience. The results revealed relatively positive responses from the medical students in the survey. If the new device compensates for some shortcomings, its use in the endoscopy room will be feasible.

6.
Article in English | WPRIM | ID: wpr-891546

ABSTRACT

Prognosis of patients with pancreatic cancer is poor due to difficulty in early diagnosis and low resectability rate at the time of diagnosis. Apart from the progression of cancer, venous thromboembolism― a complication that can increase patient mortality ― is known to occur frequently in pancreatic cancer. This review was aimed at identifying whether venous thromboembolism is more common in pancreatic cancer than in other cancer types. In addition, we reviewed several studies to determine whether thromboprophylaxis increases the survival rates of patients with pancreatic cancer.

7.
Article in English | WPRIM | ID: wpr-899250

ABSTRACT

Prognosis of patients with pancreatic cancer is poor due to difficulty in early diagnosis and low resectability rate at the time of diagnosis. Apart from the progression of cancer, venous thromboembolism― a complication that can increase patient mortality ― is known to occur frequently in pancreatic cancer. This review was aimed at identifying whether venous thromboembolism is more common in pancreatic cancer than in other cancer types. In addition, we reviewed several studies to determine whether thromboprophylaxis increases the survival rates of patients with pancreatic cancer.

8.
Article in Korean | WPRIM | ID: wpr-65577

ABSTRACT

PURPOSE: To determine the prognostic factors associated with surgical time of endonasal dacryocystorhinostomy (DCR). METHODS: From April 2009 to June 2014, 66 eyes of 66 patients who underwent endonasal DCR for 5-year periods were retrospectively evaluated with regard to surgical time and several other factors. The factors were patient factors (age, sex), category of diagnosis (inflammation and non-inflammation), and systemic factors (diabetes mellitus [DM], hypertension [HTN], anticoagulant agents, sinusitis history). We divided the study period into three subperiods and compared their surgical time. The anatomical factor of thickness of the maxillary frontal process was evaluated by computed tomography (CT), as was the existence of symptom recurrence after surgery and reoperation according to surgical time. A total of 66 cases (right: 31, left: 35) were included. Any case with concurrent surgery, abnormal structure of the nasal cavity, or bilateral DCR was excluded. RESULTS: Average surgical time was 49.95 minutes. Surgical time of endonasal DCR was short in inflammatory cases (p = 0.047), in the third surgical period (p = 0.001), and was correlated with thickness of the maxillary frontal process (p = 0.001). In addition, surgical time correlated with the existence of symptom recurrence after surgery and reoperation (p = 0.012). CONCLUSIONS: It is considered that surgeon skill affects surgical time, and the thickness of the maxillary frontal process by CT will aid in the prediction of surgical time and success rate of endonasal DCR.


Subject(s)
Humans , Anticoagulants , Dacryocystorhinostomy , Diagnosis , Hypertension , Nasal Cavity , Operative Time , Recurrence , Reoperation , Retrospective Studies , Sinusitis
10.
Article in Korean | WPRIM | ID: wpr-160941

ABSTRACT

PURPOSE: To compare the measurement results of 3 ocular biometry devices, A-scan ultrasound and two types of partial coherence interferometers in normal and cataractous eyes. METHODS: This study included 42 normal eyes and 40 cataractous eye. Axial length and anterior chamber were measured using three ocular biometry measurements, ultrasonography (HiScan®, Optikon 2000, Rome, Italy), IOL Master® (Carl Zeiss, Jena, Germany), and AL-scan® (Nidek, Gamagori, Japan), and mean corneal curvature and corneal diameter were measured using two partial coherence interferometers. The results were compared in each group. RESULTS: Significant differences in measurements existed among the 3 ocular biometry devices (A-scan ultrasound, IOL Master® and AL-scan®) in normal eyes (p < 0.001) and cataractous eyes (p = 0.034). However, the measurements were not significantly different between the 2 partial coherence interferometers (IOL Master® and AL-scan®) in both groups. We confirmed lower agreement among the 3 ocular biometry devices in cataractous eyes compared with normal eyes in terms of a larger range of 95% agreement and error in cataractous eyes. CONCLUSIONS: Significant differences in measurements were observed when using the 3 ocular biometry devices in both normal and cataractous eyes. Because of low agreements between ocular biometry devices in cataractous eyes, complementing the measurements between ocular biometry devices is necessary when measuring cataractous eyes.


Subject(s)
Anterior Chamber , Biometry , Cataract , Complement System Proteins , Ultrasonography
11.
Article in Korean | WPRIM | ID: wpr-150286

ABSTRACT

PURPOSE: The purpose of this study was to evaluate the systemic effects of ranibizumab and bevacizumab by examining the plasma levels of anti-vascular endothelial growth factor (anti-VEGF) and VEGF before and after a single intravitreal injection. METHODS: Twenty-eight eyes of 28 patients with various retinal diseases were enrolled. Seventeen eyes received an injection of intravitreal bevacizumab, and 11 eyes received an injection of ranibizumab. Blood samples were collected just before and 1 day, 1 week, and 1 month after injection. Concentrations of anti-VEGF and VEGF in plasma were measured using enzyme-linked immunosorbent assay (ELISA). RESULTS: In the bevacizumab group, anti-VEGF concentration before the injection was 91.0 ng/mL, while those at 1 day, 1 week, and 1 month post-injection increased to 153.6, 196.3, and 140.3 ng/mL, respectively (p 0.05 for all). VEGF level also showed no significant change. VEGF concentration before the injection was 80.9 pg/mL, while those at 1 day, 1 week and 1 month post-injection were 96.7, 106.3, 106.1 pg/mL, respectively (p > 0.05 for all). CONCLUSIONS: Contrary to ranibizumab, intravitreal bevacizumab significantly lowers plasma VEGF level in patients with various retinal diseases. The study suggests the consideration of the systemic effects of intravitreal bevacizumab injection.


Subject(s)
Humans , Endothelial Growth Factors , Enzyme-Linked Immunosorbent Assay , Intravitreal Injections , Plasma , Retinal Diseases , Vascular Endothelial Growth Factor A , Bevacizumab , Ranibizumab
12.
Article in Korean | WPRIM | ID: wpr-135862

ABSTRACT

PURPOSE: To evaluate the differences in dry eye and meibomian gland dysfunction (MGD) by comparing ocular surface status before and after wearing an orthokeratologic (OK) lens and rigid gas permeable (RGP) lens made of the same material. METHODS: The ocular surface and meibomian gland statuses of 12 eyes of 12 OK lens wearers (OK lens group) and 16 eyes of 16 RGP wearers (RGP lens group) were evaluated before and 1 and 3 months after lens wearing. Ocular surface disease index (OSDI), tear film break-up time (TBUT), Schirmer's test I, and ocular surface staining score were evaluated for ocular surface parameters. Meibomian gland function was evaluated by assessing lid margin abnormality, meibomian gland expressibility, and meibum quality. RESULTS: TBUT and ocular surface staining score after 1 and 3 months of wearing an OK lens were significantly aggravated (p= 0.004, p < 0.001). The MGD grade, lid margin abnormality, meibomian gland expressibility, and meibum quality were aggravated after 1 and 3 months of wearing an OK lens (p < 0.001, p < 0.001, p < 0.001, p= 0.002). After 1 and 3 months of wearing an RGP lens, OSDI, TBUT, and ocular surface staining score were aggravated (all p < 0.001). The MGD grade, lid margin abnormality, meibomian gland expressibility, and meibum quality were aggravated after 1 and 3 months of wearing an RGP lens (all p < 0.001). MGD grade, lid margin abnormality, meibomian gland expressibility, and meibum quality were significantly more aggravated in the RGP lens group than in the OK lens group after 3 months (p < 0.001, p < 0.001, p= 0.001, p < 0.001). CONCLUSIONS: Use of OK and RGP lenses affects ocular surface status. Especially, meibomian gland parameters and OSDI showed greater changes in RGP lens wearers than OK lens wearers.


Subject(s)
Meibomian Glands , Tears
13.
Article in Korean | WPRIM | ID: wpr-135867

ABSTRACT

PURPOSE: To evaluate the differences in dry eye and meibomian gland dysfunction (MGD) by comparing ocular surface status before and after wearing an orthokeratologic (OK) lens and rigid gas permeable (RGP) lens made of the same material. METHODS: The ocular surface and meibomian gland statuses of 12 eyes of 12 OK lens wearers (OK lens group) and 16 eyes of 16 RGP wearers (RGP lens group) were evaluated before and 1 and 3 months after lens wearing. Ocular surface disease index (OSDI), tear film break-up time (TBUT), Schirmer's test I, and ocular surface staining score were evaluated for ocular surface parameters. Meibomian gland function was evaluated by assessing lid margin abnormality, meibomian gland expressibility, and meibum quality. RESULTS: TBUT and ocular surface staining score after 1 and 3 months of wearing an OK lens were significantly aggravated (p= 0.004, p < 0.001). The MGD grade, lid margin abnormality, meibomian gland expressibility, and meibum quality were aggravated after 1 and 3 months of wearing an OK lens (p < 0.001, p < 0.001, p < 0.001, p= 0.002). After 1 and 3 months of wearing an RGP lens, OSDI, TBUT, and ocular surface staining score were aggravated (all p < 0.001). The MGD grade, lid margin abnormality, meibomian gland expressibility, and meibum quality were aggravated after 1 and 3 months of wearing an RGP lens (all p < 0.001). MGD grade, lid margin abnormality, meibomian gland expressibility, and meibum quality were significantly more aggravated in the RGP lens group than in the OK lens group after 3 months (p < 0.001, p < 0.001, p= 0.001, p < 0.001). CONCLUSIONS: Use of OK and RGP lenses affects ocular surface status. Especially, meibomian gland parameters and OSDI showed greater changes in RGP lens wearers than OK lens wearers.


Subject(s)
Meibomian Glands , Tears
14.
Article in English | WPRIM | ID: wpr-215896

ABSTRACT

Sjogren's syndrome (SS) is a chronic autoimmune disorder characterized by lymphocyte-mediated destruction of exocrine glands, which produces classical symptoms of dry eyes and dry mouth. Aside from the clinical manifestations associated with exocrine glands, extraglandular features of SS include a major long-term concern for development of lymphoma. The lifetime risk of non-Hodgkin's lymphoma (NHL) in an SS patient is approximately 5% to 10%, 20 times higher than that of the normal population. This case report describes a rare occurrence of NHL in the eyelid and lung of an adolescent female with SS, whose disease activity had been monitored closely. This is the first reported case in Korea.


Subject(s)
Adolescent , Female , Humans , Conjunctiva , Exocrine Glands , Eyelids , Korea , Lung , Lymphoma , Lymphoma, Non-Hodgkin , Mouth , Sjogren's Syndrome
15.
Article in English | WPRIM | ID: wpr-36340

ABSTRACT

Hypothyroid myopathy is observed frequently and the resolution of the clinical manifestations of myopathy following thyroid hormone replacement is well known. However, a specific subtype of hypothyroid myopathy, Hoffmann's syndrome, characterized by increased muscular mass (pseudohypertrophy), proximal muscle weakness, muscle stiffness and cramps, is rarely reported. Herein, we describe a 34-year-old male who presented with proximal muscle weakness and non-pitting edema of the lower extremities. He initially visited the neurology department where he was suspected of having polymyositis. Additional laboratory evaluation revealed profound autoimmune hypothyroidism and elevated muscle enzymes including creatine kinase. The patient was started on levothyroxine treatment and, subsequently, clinical symptoms and biochemical parameters resolved with the treatment. The present case highlights that hypothyroidism should be considered in the differential diagnosis of musculoskeletal symptoms even in the absence of overt manifestations of hypothyroidism. To our knowledge, this is the first case reported in Korea.


Subject(s)
Adult , Humans , Male , Creatine Kinase , Diagnosis, Differential , Edema , Hypothyroidism , Korea , Lower Extremity , Muscle Cramp , Muscle Weakness , Muscular Diseases , Neurology , Polymyositis , Thyroid Gland , Thyroxine
16.
Korean Journal of Medicine ; : 728-732, 2015.
Article in Korean | WPRIM | ID: wpr-46992

ABSTRACT

A 37-year-old woman was admitted to our hospital because of cervical and axillary lymphadenopathy that developed after delivery. An axillary lymph node biopsy revealed metastatic adenocarcinoma. Immunohistochemical staining indicated that the tumor cells expressed c-ErbB-2, but were negative for the estrogen and progesterone receptors. No definite evidence of breast cancer was detected. The patient underwent chemotherapy for suspected metastatic breast cancer. She complained of swelling in the left breast 22 months later, and a biopsy showed invasive ductal carcinoma. Here, we report a case of hormone receptor-negative occult breast cancer in a patient with cervical and axillary lymphadenopathy presenting as a cancer with an unknown primary site.


Subject(s)
Adult , Female , Humans , Adenocarcinoma , Biopsy , Breast Neoplasms , Breast , Carcinoma, Ductal , Drug Therapy , Estrogens , Lymph Nodes , Lymphatic Diseases , Receptors, Progesterone
17.
Article in English | WPRIM | ID: wpr-103829

ABSTRACT

Interferon-alpha (IFN-alpha) is an important therapeutic agent for hepatitis C virus (HCV) infection, but has various side effects including thyroiditis. We report a case of interferon-induced non-autoimmune hypothyroidism followed by autoimmune-medicated Graves' disease. A 59-year-old woman was diagnosed with chronic active hepatitis C; she had been treated with IFN-alpha and ribavirin for 24 weeks. Before starting the IFN-alpha, her thyroid function was normal and she was negative for autoantibodies. Severe hypothyroidism developed 5 weeks after halting the IFN-alpha, with the Graves' disease phase arising at 32 weeks. For accurate diagnosis and appropriate treatment of thyroid dysfunction during treatment with IFN-alpha, we need to understand and consider rare cases of multiphasic disorder involving both non-autoimmune and autoimmune thyroiditis induced by IFN-alpha.


Subject(s)
Female , Humans , Middle Aged , Autoantibodies , Diagnosis , Graves Disease , Hepacivirus , Hepatitis C , Hepatitis , Hepatitis, Chronic , Hypothyroidism , Interferon-alpha , Interferons , Ribavirin , Thyroid Gland , Thyroiditis , Thyroiditis, Autoimmune
19.
Article in Korean | WPRIM | ID: wpr-223618

ABSTRACT

Duodenal diverticulitis is a rare cause of upper abdominal pain and is usually not considered when evaluating patients with acute upper abdominal pain. Furthermore, the duodenum is located near the pancreas and bile duct, and duodenal diverticulitis can be misdiagnosed as acute pancreatitis, cholangitis, cholecystitis, or other pancreatobiliary disorders such as pancreatic cystic neoplasms. Recently, we experienced a rare case of duodenal diverticulitis in the 3rd portion of the duodenum. The patient presented with deep seated upper abdominal pain aggravated by supine posture and relieved by sitting up. The patient was initially diagnosed with acute pancreatitis. However, serum levels of pancreatic enzymes were normal and abdominal CT scan revealed diverticulitis in the 3rd portion of the duodenum. The patient was successfully managed conservatively. Delayed diagnosis of duodenal diverticulitis can result in substantial morbidity and mortality if duodenal perforation occurs and should be considered as a possible cause of upper abdominal pain.


Subject(s)
Humans , Abdominal Pain , Bile Ducts , Cholangitis , Cholecystitis , Delayed Diagnosis , Diverticulitis , Duodenum , Mortality , Pancreas , Pancreatic Cyst , Pancreatitis , Posture , Tomography, X-Ray Computed
20.
Korean Journal of Medicine ; : 495-502, 2013.
Article in Korean | WPRIM | ID: wpr-144660

ABSTRACT

BACKGROUND/AIMS: Advanced glycation end-products (AGEs) exert various toxic effects through the receptor for AGEs (RAGE). Soluble RAGE (sRAGE) is a naturally occurring inhibitor of AGE-RAGE. Recent studies have suggested that inhibition of angiotensin-converting enzyme (ACE) reduces the accumulation of AGEs in diabetes partly by increasing the production and secretion of sRAGE into the plasma. This report describes the relationship between sRAGE and ACE polymorphism in maintenance hemodialysis patients. METHODS: The levels of sRAGE and advanced oxidation protein products (AOPPs) were assessed by enzyme-linked immunosorbent assay (ELISA), and ACE polymorphism was detected by PCR amplification. RESULTS: The distributions of ACE genotypes in 105 hemodialysis patients were as follows: II, 56 (35.9%); ID, 29 (18.6%); and DD, 20 (12.8%). According to the ACE genotypes, the study group consisted of II (n = 56) and ID + DD group (n = 49). sRAGE was correlated with age (r = -0.24; p = 0.013). There were significant differences in sRAGE, AOPP, age, duration of dialysis, C-reactive protein, or 24-h urine volume between two genotype groups. There were no significant differences in sRAGE levels, even though the effect of age was treated as a covariate. CONCLUSIONS: Our findings suggested that sRAGE may be affected only by age, and not by ACE polymorphism in maintenance hemodialysis patients.


Subject(s)
Humans , Advanced Oxidation Protein Products , C-Reactive Protein , Dialysis , Enzyme-Linked Immunosorbent Assay , Genotype , Plasma , Polymerase Chain Reaction , Rage , Renal Dialysis , Urine
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