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Intraoperative radiofrequency ablation with or without tumorectomy for hepatocellular carcinoma in locations difficult for a percutaneous approach

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Hepatobiliary & Pancreatic Diseases International 2009年第6期8卷 591-596页

作者： Hyung Ook kim Seung Kwon kim byung Ho Son Chang Hak Yoo Hyun Pyo Hong Yong Kyun Cho Byung Ik Kim Departments of Surgery Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Radiology Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Division of Interventional Radiology Mallinckrodt Institute of RadiologyWashington University School of Medicine Internal Medicine Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine

BACKGROUND:Although hepatic resection is widely accepted as a proper modality for treating hepatocellular carcinoma(HCC),a majority of patients are unable to undergo surgical resection due to various tumor and patient factors.Radiofrequency ablation(RFA)has mostly been used as a therapeutic alternative to resection for treating HCC.The objective of this study was to evaluate the results of intraoperative RFA for HCCs in locations difficult for a percutaneous approach.METHODS:Eight patients(male,seven;age,49-67 years) with 8 HCCs in difficult locations were treated by intraoperative RFA.Six of the patients had local tumor progression after initial transarterial chemoembolization or ultrasound(US)guided percutaneous RFA.The locations of the tumors were hepatic dome in six patients,posterior subcapsule in one,and caudate lobe in one.The tumor size was 2.0 to 6.4 cm(mean,3.9 cm).Intraoperative RFA was performed at the tumor itself and an anticipated resection line under US guidance with 3 cm monopolar single or clustered internally cooled electrodes.Tumor resection was performed in six patients.One month later,treatment response was assessed by contrast material-enhanced computed tomography(CT).CT studies were performed every 2 or 3 months after RFA.RESULTS:RFA was technically successful in all tumors,and the contrast-enhanced CT images acquired one month later showed complete disappearance of tumor enhancement.One pneumothorax occurred.After a median follow-up of 18 months(range,6-30 months),no tumors showed local progression.During the follow-up period,four new recurrent tumors were observed in three patients.Four patients were alive at the time of this report and the other four died of hepatorenal syndrome,liver failure,and progression of new recurrent tumors.CONCLUSION:Intraoperative RFA with tumor resection can be an alterative treatment option for HCC in locations difficult for a percutaneous approach.

关键词： hepatocellular carcinoma radiofrequency ablation intraoperative

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Clinical significance of tumor-infiltrating lymphocytes for gastric cancer in the era of immunology

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World Journal of Gastrointestinal Oncology 2017年第7期9卷 293-299页

作者： byung Woog Kang Jong Gwang kim In Hee Lee Han ik Bae An Na Seo Department of Hematology/Oncology Kyungpook National University Hospital Kyungpook National University School of Medicine Department of Pathology Kyungpook National University Hospital Kyungpook National University School of Medicine

Immunotherapy has begun to revolutionize cancer treatment, by introducing therapies that target the host immune system instead of the tumor, therapies that possess unique adverse event profiles, and therapies that may cure certain types of cancer. The immune microenvironment of tumors is emerging as the most important means of understanding the relationship between a patient' immune system and their cancer, informing prognosis, and guiding immunotherapy, such as an antibody blockade of immune checkpoints. For some solid tumors, simple quantitation of lymphocyte infiltration would seem to have prognostic significance, suggesting that lymphocyte infiltration is not passive but may actively promote or inhibit tumor growth. For gastric cancers, several studies have provided strong evidence that immune cells contribute to determining prognosis. However, the exact role of immune cells in gastric cancer remains unclear. Therefore, this review focuses on the clinical significance of immune cells, especially tumor-infiltrating lymphocytes, in gastric cancer.

关键词： Gastric cancer Tumor-infiltrating lymphocytes Immunotherapy

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Efficacy of 0.5-L vs 1-L polyethylene glycol containing ascorbic acid as additional colon cleansing methods for inadequate bowel preparation as expected by last stool examination before colonoscopy

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World Journal of Clinical Cases 2019年第1期7卷 39-48页

作者： Joon Hyun Cho Eun Joo Goo Kyeong Ok kim Si Hyung Lee byung ik Jang Tae Nyeun kim Division of Gastroenterology and Hepatology Department of Internal Medicine Yeungnam University College of Medicine

BACKGROUND No consensus has been reached in patients suspected of having inadequate bowel preparation regarding optimal salvage methods, which negatively affects the efficacy and quality of colonoscopy. The most ideal and reasonable rescue option involves early suspicion and identification of patients with inadequate preparation before sedation, additional oral ingestion of a suitable preparation formulation, and same-day colonoscopy.AIM To compare 0.5-L and 1-L polyethylene glycol containing ascorbic acid(PEG +Asc) as additional bowel cleansing methods after a 2-L split-dose PEG + Asc regimen in patients with expected inadequate bowel preparation before colonoscopy.METHODS Individuals with expected inadequate bowel preparation based on last stool form, such as turbid liquid, particulate liquid, or liquid with small amounts of feces, were randomized to either a 0.5-L PEG + Asc group or a 1-L PEG + Asc group. The primary endpoint was bowel preparation as assessed using the Aronchick bowel preparation scale(ABPS) and Boston bowel preparation scale(BBPS) scores. The secondary endpoints were cecal intubation time, withdrawal time, polyp detection rate(PDR), adenoma detection rate(ADR), individual compliance with additional PEG + Asc, and patient satisfaction.RESULTS Initially, 98 patients were included, but 8 were later excluded due to withdrawal of consent to participate in the study. Adequate bowel preparation(as assessed by ABPS) was observed in 80.9%(38/47) of subjects in the 0.5-L group and in88.4%(38/43) of subjects in the 1-L group(P = 0.617). Mean total BBPS was 6.7 points in the 0.5-L group and 7.0 points in the 1-L group(P = 0.458). ADRs and PDRs were similar in the two groups, and cecal intubation and withdrawal times were not significantly different. However, mean patient satisfaction score was significantly higher in the 0.5-L group(P = 0.041).CONCLUSION The bowel cleaning efficacy of additional 0.5-L PEG + Asc was not inferior to that of 1-L PEG + Asc. Additional 0.5-L PEG + Asc is worthwhile when inade

关键词： Inadequate bowel preparation Additional colon cleansing Colonoscopy Polyethylene glycol

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Technical issues and new devices of ESD of early gastric cancer

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World Journal of Gastroenterology 2011年第31期17卷 3585-3590页

作者： Wan Sik Lee Jin Woong Cho Young Dae kim Kyu Jong kim byung ik Jang Division of Gastroenterology Department of Internal MedicineChonnam University Medical School Division of Gastroenterology and Hepatology Department of Internal MedicinePresbyterian Medical Center Division of Gastroenterology and Hepatology Department of Internal MedicineSchool of MedicineChosun University Division of Gastroenterology Department of Internal MedicineKosin University College of Medicine Division of Gastroenterology Department of Internal MedicineYeungnam University College of Medicine

Endoscopic submucosal dissection(ESD) is a highly refined technique compared to conventional endoscopic mucosal resection.It enables complete resection of early gastric cancer(EGC) which has no possibility of lymph node metastasis.Indication for ESD of EGC generally entails early gastric cancer confined to the mucosa with well differentiated histology,though there are clinically suitable expanded criteria.As ESD requires specific skill and expertise,endoscopists need to be familiarized with basic methods and the use of special devices.The essence of the technique is to dissect the submucosal layer with direct vision and maintain thecutting plane above the underlying proper muscle layer.Although there are some differences in the detailed technical aspect,the cardinal method of ESD is now well established and standardized.Furthermore,research and development of new ESD devices that render more efficient,safe ESD are still in progress to improve the overall result of ESD on early gastric cancer.

关键词：公共服务电子化新设备胃癌早期技术 ESD 扩展标准

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Comparison of brush and basket cytology in differential diagnosis of bile duct stricture at endoscopic retrograde cholangiopancreatography

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Hepatobiliary & Pancreatic Diseases International 2014年第6期13卷 622-627页

作者： Ki Bae Bang Hong Joo kim Jung Ho Park Dong Il Park Yong Kyun Cho Chong Il Sohn Woo Kyu Jeon Byung Ik Kim Department of Internal Medicine Sungkyunkwan University Kangbuk Samsung Hospital 108 Pyung-Dong Jongro-Ku Seoul 110-746 Korea

BACKGROUND： A previous report has identified a significantly higher sensitivity of cancer detection for dedicated grasping basket than brushing at endoscopic retrograde cholangiopancreato- graphy （ERCP）. This study aimed to compare the diagnostic accuracy of Geenen brush and Dormia basket cytology in the differential diagnosis of bile duct stricture. METHOD： The current study enrolled one hundred and fourteen patients who underwent ERCP with both Geenen brush and Dormia basket cytology for the differential diagnosis of bile duct stricture at our institution between January 2008 and December 2012. RESULTS： We adopted sequential performances of cytologic samplings by using initial Geenen brush and subsequent Dormia basket cytology in 59 patients and initial Dormia basket and subsequent Geenen brush cytology in 55 patients. Presampling balloon dilatations and biliary stentings for the stricture were performed in 17 （14.9%） and 107 patients （93.9%）, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of Geenen brush cytology for the diagnosis of malignant bile duct stricture were 75.0%, 100.0%, 100.0%, 66.7% and 83.3%, respectively, and those of Dormia basket cytology were 64.5%, 100.0%, 100.0%, 58.5% and 76.3%, respectively （P=0.347 and 0.827 for sensitivity and accuracy, respectively）. The good and excellent cellular yields （≥grade 2） were obtained by Geenen brush and Dormia basket cytology in 88 （77.2%） and 79 （69.3%） patients, respectively.CONCLUSION： The sensitivity, specificity and accuracy of biliary sampling with a Dormia basket are comparable to those with conventional Geenen brush cytology in the detection of malignant bile duct stricture.

关键词： bile duct stricture cholangiocarcinoma brush cytology basket cytology

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Different risk factors for advanced colorectal neoplasm in young adults

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World Journal of Gastroenterology 2016年第13期22卷 3611-3620页

作者： Ji Yeon kim Yoon Suk Jung Jung Ho Park Hong Joo kim Yong Kyun Cho Chong Il Sohn Woo Kyu Jeon Byung Ik Kim Kyu Yong Choi Dong Il Park Comprehensive Health Care Center Korea Cancer Center Hospital Korea Institute of Radiological and Medical Sciences Department of Internal Medicine Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine

AIM: To compare the risk of developing advanced colorectal neoplasm(ACRN) according to age in Koreans.METHODS: A total of 70428 Koreans from an occupational cohort who underwent a colonoscopy between 2003 and 2012 at Kangbuk Samsung Hospital were retrospectively selected. We evaluated and compared odds ratios(OR) for ACRN between the young-adults(YA < 50 years) and in the older-adults(OA ≥ 50 years). ACRN was defined as an adenoma ≥ 10 mm in diameter, adenoma with any component of villous histology, high-grade dysplasia, or invasive cancer.RESULTS: In the YA group, age(OR = 1.08, 95%CI: 1.06-1.09), male sex(OR = 1.26, 95%CI: 1.02-1.55), current smoking(OR = 1.37, 95%CI: 1.15-1.63), family history of colorectal cancer(OR = 1.46, 95%CI: 1.01-2.10), diabetes mellitus related factors(OR = 1.27, 95%CI: 1.06-1.54), obesity(OR = 1.23, 95%CI: 1.03-1.47), CEA(OR = 1.04, 95%CI: 1.01-1.09) and low-density lipoprotein-cholesterol(OR = 1.01, 95%CI: 1.01-1.02) were related with an increased risk of ACRN. However, age(OR = 1.08, 95%CI: 1.06-1.09), male sex(OR = 2.12, 95%CI: 1.68-2.68), current smoking(OR = 1.38, 95%CI: 1.12-1.71), obesity(OR = 1.34, 95%CI: 1.09-1.65) and CEA(OR = 1.05, 95%CI: 1.01-1.09) also increased the risk of ACRN in the OA group.CONCLUSION: The risks of ACRN differed based on age group. Different colonoscopic screening strategies are appropriate for particular subjects with risk factors for ACRN, even in subjects younger than 50 years.

关键词： Young-adult Advanced colorectal neoplasm Risk factors Age Metabolic abnormality

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Metabolic syndrome is associated with erosive esophagitis

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World Journal of Gastroenterology 2008年第35期14卷 5442-5447页

作者： Jung Ho Park Dong IL Park Hong Joo kim Yong Kyun Cho Chong IL Sohn Woo Kyu Jeon Byung Ik Kim Department of Medicine Kangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulSouth Korea

AIM: To clarify whether insulin resistance and metabolic syndrome are risk factors for erosive esophagitis. METHODS: A case-control study was performed using the database of the Kangbuk Samsung Hospital Medical Screening Center. RESULTS: A total of 1679 cases of erosive esophagitis and 3358 randomly selected controls were included. Metabolic syndrome was diagnosed in 21% of the cases and 12% of the controls (P < 0.001). Multiple logistic regressions confirmed the association between erosive esophagitis and metabolic syndrome (Odds ratio, 1.25; 95% CI, 1.04-1.49). Among the components of metabolic syndrome, increased waist circumference, elevated serum triglyceride levels and hypertension were significant risk factors for erosive esophagitis (all P < 0.01). Furthermore, increased insulin resistance (Odds ratio, 0.91; 95% CI, 0.85-0.98) and fatty liver, as diagnosed by ultrasonography (Odds ratio, 1.39; 95% CI, 1.20-1.60), were also related to erosive esophagitis even after adjustment for a series of confounding factors. CONCLUSION: Metabolic syndrome and increased insulin resistance are associated with an increased risk of developing erosive esophagitis.

关键词：新陈代谢综合症侵蚀性食道炎胰岛素抵抗脂肪肝

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Association between Helicobacter pylori status and metachronous gastric cancer after endoscopic resection

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World Journal of Gastroenterology 2016年第44期22卷 9794-9802页

作者： Sung Bum kim Si Hyung Lee Seung Il Bae Yo Han Jeong Se Hoon Sohn Kyeong Ok kim byung ik Jang Tae Nyeun kim Department of Internal Medicine Yeungnam University College of Medicine

AIM To investigate the effect of Helicobacter pylori(H. pylori) status test and H. pylori eradication on the occurrence of metachronous gastric cancer(MGC) after endoscopic submucosal dissection(ESD) of early gastric cancer(EGC) and risk factors of MGC. METHODS The authors retrospectively reviewed the medical records of 433 patients(441 lesions) who underwent ESD for EGC from January 2005 to January 2015 in Yeungnam University Hospital. Patients were categorized into two groups; the H. pylori tested group(n = 257) and the H. pylori non-tested group(n = 176) based on performance of H. pylori status test after ESD of EGC. The H. pylori tested group was further categorized into three subgroups based on H. pylori status; the H. pylori-eradicated subgroup(n = 120), the H. pylori-persistent subgroup(n = 42), and the H. pylori-negative subgroup(n = 95). Incidences of MGC and risk factors of MGC were identified.RESULTS Median follow-up duration after ESD was 30.00 mo(range, 6-107 mo). Total 15 patients developed MGC during follow-up. MGC developed in 11 patients of the H. pylori tested group(7 in the H. pylori-negative subgroup, 3 in the H. pylori-eradicated subgroup, and 1 in the H. pylori-persistent subgroup) and 4 patients of the H. pylori non-tested group(P > 0.05). The risk factors of MGC were endoscopic mucosal atrophy in the H. pylori tested group and intestinal metaplasia in all patients. CONCLUSION H. pylori eradication and H. pylori status test seems to have no preventive effect on the development of MGC after ESD for EGC. The risk factors of MGC development were endoscopic mucosal atrophy in the H. pylori tested group alone and intestinal metaplasia in all patients.

关键词： Metachronous gastric cancer Endoscopic submucosal dissection Helicobacter pylori

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Characterization of smooth muscle, enteric nerve, interstitial cells of Cajal, and fibroblast-like cells in the gastric musculature of patients with diabetes mellitus

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World Journal of Gastroenterology 2016年第46期22卷 10131-10139页

作者： Kyung Sik Park Kwang Bum Cho Il Seon Hwang Jae Hyung Park byung ik Jang Kyeong Ok kim Sung Woo Jeon Eun Soo kim Chang Sik Park Joong Goo Kwon Department of Internal Medicine Keimyung University School of Medicine Department of Pathology Keimyung University School of Medicine Department of Physiology Keimyung University School of Medicine Department of Internal Medicine Youngnam University College of Medicine Department of Internal Medicine Kyungpook National University School of Medicine Department of Advanced Materials Convergence Korea Institute of Ceramic Engineering and Technology Department of Internal Medicine Catholic University of Daegu School of Medicine

AIM To investigate histologic abnormalities in the gastric smooth muscle of patients with diabetes mellitus(DM).METHODS Full-thickness gastric specimens were obtained from patients undergoing surgery for gastric cancer. H&E stain and Masson's Trichrome stain were performed to assess the degree of fibrosis. Immunohistochemical staining using various antibodies was also performed [antibodies against protein gene product 9.5(PGP9.5), neuronal nitric oxide synthase(n NOS), vasoactive intestinal peptide(VIP), neurokinin-1(NK1) receptor, c-Kit, and platelet-derived growth factor receptor-alpha,(PDGFRα)]. Immunofluorescent staining and evaluation with confocal microscopy were also conducted.RESULTS Twenty-six controls and 35 diabetic patients(21 shortduration patients and 14 long-duration patients) were included. There were no significant differences in basic demographics between the two groups except in mean body mass index(BMI)(higher in the DM group). Proportions of moderate-to-severe intercellular fibrosis in the muscle layer were significantly higher in the DM group than in the control group(P ike cells are found in the smooth muscle of DM patients. These abnormalities may contribute to changes in gastric motor activity in patients with DM.

关键词：糖尿病 mellitus Cajal 的空隙的房间像成纤维细胞的房间 Gastroparesis 伤寒神经系统

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Pre-operative predictive factors for gallbladder cholesterol polyps using conventional diagnostic imaging

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World Journal of Gastroenterology 2008年第44期14卷 6831-6834页

作者： Ji-Hoon Choi Jung-Won Yun Yong-Sung kim Eun-A Lee Sang-Tae Hwang Yong-Kyun Cho Hong-Joo kim Jung-Ho Park Dong-Il Park Chong-Il Sohn Woo-Kyu Jeon byung-ik kim Hyoung-Ook kim Jun-Ho Shin Department of Internal Medicine Kangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoul 110-746South Korea Department of Surgery Kangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoul 110-746South Korea

AIM:To determine the clinical data that might be useful for differentiating benign from malignant gallbladder (GB) polyps by comparing radiological methods,including abdominal ultrasonography (US) and computed tomography (CT) scanning,with postoperative pathology fi ndings. METHODS:Fifty-nine patients underwent laparoscopic cholecystectomy for a GB polyp of around 10 mm. They were divided into two groups,one with cholesterol polyps and the other with non-cholesterol polyps. Clinical features such as gender,age,symptoms,size and number of polyps,the presence of a GB stone,the radiologically measured maximum diameter of the polyp by US and CT scanning,and the measurements of diameter from postoperative pathology were recorded for comparative analysis. RESULTS:Fifteen of the 41 cases with cholesterol polyps (36.6%) were detected with US but not CT scanning,whereas all 18 non-cholesterol polyps were observed using both methods. In the cholesterol polyp group,the maximum measured diameter of the polyp was smaller by CT scan than by US.Consequently,the discrepancy between those two scanning measurements was greater than for the non-cholesterol polyp group. CONCLUSION:The clinical signs indicative of a cholesterol polyp include:(1) a polyp observed by US but not observable by CT scanning,(2) a smaller diameter on the CT scan compared to US,and (3) a discrepancy in its maximum diameter between US and CT measurements. In addition,US and the CT scan had low accuracy in predicting the polyp diameter compared to that determined by postoperative pathology.

关键词：胆固醇息肉胆囊计算机断层摄影术超声检查

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