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Common bile duct stones on multidetector computed tomography:Attenuation patterns and detectability

World Journal of Gastroenterology 2013年第11期19卷 1788-1796页

作者： chang Whan Kim jae hyuck chang Yeon Soo Lim Tae Ho Kim In Seok Lee Sok Won Han Department of Internal Medicine College of MedicineThe Catholic University of Korea505 BanpoDongSeocho-GuSeoul 137-701South Korea Department of Radiology College of MedicineThe Catholic University of Korea505 Banpo-DongSeocho-GuSeoul 137-701South Korea

AIM:To investigate the attenuation patterns and detectability of common bile duct(CBD) stones by multidetector computed tomography(MDCT).METHODS:Between March 2010 and February 2012,191 patients with suspicion of CBD stones undergoing both MDCT and endoscopic retrograde cholangiopancreatography(ERCP) were enrolled and reviewed *** attenuation patterns of CBD stones on MDCT were classified as heavily calcified,radiopaque,less radiopaque,or *** association between the attenuation patterns of CBD stones on MDCT and stone type consisting of pure cholesterol,mixed cholesterol,brown pigment,and black pigment and the factors related to the detectability of CBD stones by MDCT were ***:MDCT showed CBD stones in 111 of 130 patients in whom the CBD stones were demonstrated by ERCP with 85.4% *** attenuation patterns of CBD stones on MDCT were heavily calcified 34(26%),radiopaque 31(24%),less radiopaque 46(35%),and undetectable 19(15%).The radiopacity of CBD stones differed significantly according to stone type(P < 0.001).From the receiver operating characteristic curve,stone size was useful for the determination of CBD stone by MDCT(area under curve 0.779,P < 0.001) and appropriate cut-off stone size on MDCT was 5 *** factors related to detectability of CBD stones on MDCT were age,stone type,and stone size on multivariate analysis(P < 0.05).CONCLUSION:The radiopacity of CBD stones on MDCT differed according to stone *** type and stone size were related to the detectability by MDCT,and appropriate cut-off stone size was 5 mm.

关键词： Common bile duct gallstones Gallstones Multidetector computed tomography Endoscopic retrograde cholangiography

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Unilateral versus bilateral Y-type stent-in-stent metal stent insertions in inoperable malignant hilar biliary strictures:A multicenter retrospective study

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Hepatobiliary & Pancreatic Diseases International 2021年第6期20卷 561-567页

作者： Ik Hyun Jo chang-Nyol Paik Dae Bum Kim jaesin Lee Jong Yul Lee jae hyuck chang Kyu-Hyun Paik Won-Suk Park Department of Internal Medicine College of MedicineSt.Vincent’s HospitalThe Catholic University of KoreaSeoulKorea Department of Internal Medicine College of MedicineIncheon St.Mary’s HospitalThe Catholic University of KoreaSeoulKorea Department of Internal Medicine College of MedicineBucheon St.Mary’s HospitalThe Catholic University of KoreaSeoulKorea Department of Internal Medicine College of MedicineDaejeon St.Mary’s HospitalThe Catholic University of KoreaSeoulKorea

Background:To date,there is controversy regarding unilateral versus bilateral stent placement in patients with malignant hilar biliary strictures(MHBSs).The aim of this study was to compare the clinical outcomes and complications of unilateral and bilateral(stent-in-stent method)stent placements for these ***:We conducted a multicenter retrospective analysis of patients with inoperable MHBS who underwent endoscopic self-expandable metal stent(SEMS)placement from January 2009 to December *** groups classified according to the stent procedure method were compared for demographic,procedural,and postprocedure *** analysis for patency loss and overall survival was also ***:A total of 236 subjects were included.A superior technical success rate was found in the unilateral stent group(98.8%vs.82.5%,P<0.001),whereas the clinical success rate was higher in the bilateral group(85.7%vs.70.5%,P=0.028).There was no significant difference with respect to complications or patency loss,and the bilateral group had better overall survival(P<0.01).In the Cox proportional hazard model,MHBSs from lymph node compression were associated with a higher risk of death(HR=9.803,P=0.003).In contrast,bilateral SEMS insertion showed reduced postprocedural mortality(HR=0.316,P=0.001).Conclusions:Y-type stent-in-stent bilateral SEMSs are technically difficult but demonstrated more favorable overall survival for palliative bile drainage of inoperable MHBS patients compared to unilateral insertions.

关键词： Cholestasis Extrahepatic neoplasm Cholangiopancreatography Endoscopy Self-expandable metal stents

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Undiagnosed Borrmann type Ⅱ gastric cancer due to necrosis and regenerative epithelium

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World Journal of Gastroenterology 2014年第28期20卷 9621-9625页

作者： Joon Hur jae hyuck chang Byung Kee Kim Hoon Young Ko Jong Hwan Lee Soo Jeong Kim Mi Ae Song Tae Ho Kim chang Whan Kim Sok Won Han Division of Gastroenterology Department of Internal MedicineBucheon St.Mary’s HospitalThe Catholic University of KoreaCollege of Medicine Department of Clinical Pathology Bucheon St.Mary’s HospitalThe Catholic University of KoreaCollege of Medicine

Endoscopic biopsy is essential to the proper diagnosis and treatment of gastric ***,the results of endoscopic biopsy are not always the same as what is expected based on gross endoscopic *** results of endoscopic biopsy can be negative for malignancy in Borrmann typeⅣadvanced gastric cancer(AGCa)or gastric ***,in the case of typeⅡAGCa,repeated biopsies negative for malignancy have not been reported.A 49-year-old male patient underwent esophagogastroduodenoscopy three times due to large gastric ulcer suspected to be Borrmann typeⅡ***,three repeat endoscopic biopsies with multiple specimens showed necrosis and superficial regenerative epithelium without malignant *** patient underwent laparoscopic distal gastrectomy with D2 lymph node *** surgical specimen revealed that the mucosal layer was completely replaced with regenerative epithelium without cancer cells.

关键词： Endoscopy Biopsy Stomach neoplasm Stomach ulcer Regeneration

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Current diagnosis and treatment of benign biliary stricturesafter living donor liver transplantation

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World Journal of Gastroenterology 2016年第4期22卷 1593-1606页

作者： jae hyuck chang Inseok Lee Myung-Gyu Choi Sok Won Han Division of Gastroenterology Department of Internal MedicineCollege of MedicineThe Catholic University of KoreaSeoul 137-701South Korea

Despite advances in surgical techniques, benign biliary strictures after living donor liver transplantation(LDLT) remain a significant biliary complication and play an important role in graft and patient survival. Benign biliary strictures after transplantation are classified into anastomotic or non-anastomotic strictures. These two types differ in presentation, outcome, and response to therapy. The leading causes of biliary strictures include impaired blood supply, technical errors during surgery, and biliary anomalies. Because patients usually have non-specific symptoms, a high index of suspicion should be maintained. Magnetic resonance cholangiography has gained widespread acceptance as a reliable noninvasive tool for detecting biliary complications. Endoscopy has played an increasingly prominent role in the diagnosis and treatment of biliary strictures after LDLT. Endoscopic management in LDLT recipients may be more challenging than in deceased donor liver transplantation patients because of the complex nature of the duct-to-duct reconstruction. Repeated aggressive endoscopic treatment with dilation and the placement of multiple plastic stents is considered the first-line treatment for biliary strictures. Percutaneous and surgical treatments are now reserved for patients for whom endoscopic management fails and for those with multiple, inaccessible intrahepatic strictures or Roux-en-Y anastomoses. Recent advances in enteroscopy enable treatment, even in these latter cases. Direct cholangioscopy, another advanced form of endoscopy, allows direct visualization of the inner wall of the biliary tree and is expected to facilitate stenting or stone extraction. Rendezvous techniques can be a good option when the endoscopic approach to the biliary stricture is unfeasible. These developments have resulted in almost all patients being managed by the endoscopic approach.

关键词： Biliary strictures Living donor liver transplantation Endoscopic retrograde cholangiography Percutaneous transhepatic cholangiography Biliarycomplication

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Clinical outcomes of self-expandable metal stents in palliation of malignant anastomotic strictures caused by recurrent gastric cancer

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World Journal of Gastroenterology 2009年第28期15卷 3523-3527页

作者： Yu Kyung Cho Sang Woo Kim Kwan Woo Nam jae hyuck chang jae Myung Park Jeong-Jo Jeong In Seok Lee Myung-Gyu Choi In-Sik Chung Department of Internal Medicine The Catholic University of Korea

AIM： To examine the technical feasibility and clinical outcomes of the endoscopic insertion of a selfexpandable metal stent （SEMS） for the palliation of a malignant anastomotic stricture caused by recurrent gastric cancer. METHODS： The medical records of patients, who had obstructive symptoms caused by a malignant anastomotic stricture after gastric surgery and underwent endoscopic insertion of a SEMS from January 2001 to December 2007 at Kangnam St Mary＇s Hospital, were reviewed retrospectively. RESULTS： Twenty patients （15 male, mean age 63 years） were included. The operations were a total gastrectomy with esophagojejunostomy （n = 12）, subtotal gastrectomy with Billroth-Ⅰ reconstruction （n = 2） and subtotal gastrectomy with Billroth- Ⅱ reconstruction （n = 8）. The technical and clinical success rates were 100% and 70%, respectively. A small bowel or colon stricture was the reason for a lack of improvement in symptoms in 4 patients. Two of these patients showed improvement in symptoms after another stent was placed. Stent reobstruction caused by tumor ingrowth or overgrowth occurred in 3 patients （15%） within 1 mo after stenting. Stent migration occurred with a covered stent in 3 patients who underwent a subtotal gastrectomy with Billroth-Ⅱ reconstruction. Two cases of partial stent migration were easily treated with a second stent or stent repositioning. The median stent patency was 56 d （range, 5-439 d）. The median survival was 83 d （range, 12-439 d）. CONCLUSION： Endoscopic insertion of a SEMS provides safe and effective palliation of a recurrent anastomotic stricture caused by gastric cancer, A meticulous evaluation of the presence of other strictures before inserting the stent is essential for symptom improvement.

关键词： Stents Surgical anastomosis Stricture Endoscopic gastrointestinal surgery Stomach neoplasms

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Newly developed autoimmune cholangitis without relapse of autoimmune pancreatitis after discontinuing prednisolone

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World Journal of Gastroenterology 2012年第41期18卷 5990-5993页

作者： Ji Hun Kim jae hyuck chang Sung Min Nam Mi Jeong Lee Il Ho Maeng Jin Young Park Yun Sun Im Tae Ho Kim chang Whan Kim Sok Won Han Department of Internal Medicine College of MedicineThe Catholic University of KoreaSeoul 137-701South Korea

A 57-year-old man presented with a 2-wk history of painless jaundice and weight Iossl He had a large ill- defined enhancing mass-like lesion in the uncinate pro- cess of the pancreas with stricture of the distal common bile duct. Aspiration cytology of the pancreatic mass demonstrated inflammatory cells without evidence of malignancy. Total serum immunoglobulin G level was slightly elevated, but IgG4 level was normal. After the 2-wk 40 mg prednisolone trial, the patient＇s symptoms and bilirubin level improved significantly. A follow-up computed tomography （CT） scan showed a dramatic resolution of the pancreatic lesion. A low dose steroid was continued. After six months he self-discontinued prednisolone for 3 wk, and was presented with jaundice again. ACT scan showed newly developed intrahepatic biliary dilatation and marked concentric wall thickening of the common hepatic duct and the proximal common bile duct without pancreatic aggravation. The patient＇ s IgG4 level was elevated to 2.51 g/L. Prednisolone was started again, after which his serum bilirubin level became normal and the thickening of the bile duct was resolved. This case suggests that autoimmune pancre- atitis can progress to other organs that are not involved at the initial diagnosis, even with sustained pancreatic remission.

关键词： Autoimmune disease Pancreatitis Cholan-gitis Prednisolone

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Comparative study of rendezvous techniques in post-liver transplant biliary stricture

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World Journal of Gastroenterology 2012年第41期18卷 5957-5964页

作者： jae hyuck chang In Seok Lee Ho Jong Chun Jong Young Choi Seung Kyoo Yoon Dong Goo Kim Young Kyoung You Myung-Gyu Choi Sok Won Han Department of Internal Medicine College of MedicineThe Catholic University of KoreaSeoul 137-701South Korea Department of Radiology College of MedicineThe Catholic University of KoreaSeoul 137-701South Korea Department of Surgery College of MedicineThe Catholic University of KoreaSeoul 137-701South Korea

AIM： To investigate the usefulness of a new rendezvous technique for placing stents using the Kumpe （KMP） catheter in angulated or twisted biliary strictures. METHODS： The rendezvous technique was performed in patients with a biliary stricture after living donor liver transplantation （LDLT） who required the exchange of percutaneous transhepatic biliary drainage catheters for inside stents. The rendezvous technique was performed using a guidewire in 19 patients （guidewire group） and using a KMP catheter in another 19 （KMP catheter group）. We compared the two groups retrospectively. RESULTS： The baseline characteristics did not differ between the groups. The success rate for placing insidestents was 100% in both groups. A KMP catheter was easier to manipulate than a guidewire. The mean pro- cedure time in the KMP catheter group （1012 s, range： 301-2006 s） was shorter than that in the guidewire group （2037 s, range： 251-6758 s, P = 0.022）. The cu- mulative probabilities corresponding to the procedure time of the two groups were significantly different （P = 0.008）. The factors related to procedure time were the rendezvous technique method, the number of inside stents, the operator, and balloon dilation of the stric- ture （P 〈 0.05）. In a multivariate analysis, the rendez- vous technique method was the only significant factor related to procedure time （P = 0.010）. The procedural complications observed included one case of mild acute pancreatitis and one case of acute cholangitis in the guidewire group, and two cases of mild acute pancre- atitis in the KMP catheter group. CONCLUSION： The rendezvous technique involving use of the KIVlp catheter was a fast and safe method for placing inside stents in patients with LDLT biliary stric- ture that represents a viable alternative to the guide- wire rendezvous technique,

关键词： Rendezvous Biliary stricture Liver trans-plantation Endoscopic retrograde cholangiography Percutaneous transhepatic biliary drainage

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Severe thrombocytopenia before liver transplantation is associated with delayed recovery of thrombocytopenia regardless of donor type

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World Journal of Gastroenterology 2008年第37期14卷 5723-5729页

作者： jae hyuck chang Jong Young Choi Hyun Young Woo Jung Hyun Kwon Chan Ran You Si Hyun Bae Seung Kew Yoon Myung-Gyu Choi In-Sik Chung Dong Goo Kim Department of Internal Medicine College of Medicine the Catholic University of Korea505 Banpo-Dong Seocho-Gu Seoul 137-040 Korea Department of Surgery College of Medicine the Catholic University of Korea505 Banpo-Dong Seocho-Gu Seoul 137-040 Korea

AIM： To compare the recovery of thrombocytopenia and splenomegaly during long-term follow-up after liver transplantation in patients receiving a living donor transplant or a cadaveric donor transplant. METHODS： This was a retrospective cohort study of 216 consecutive liver transplant patients who survived for 〉 6 mo after transplantation; 169 received a liver transplant from a living donor and 47 from a cadaveric donor. The platelet counts or spleen volumes were examined before transplant, i, 6, and 12 mo after transplant, and then annually until 5 years after transplant. RESULTS： The mean follow-up period was 49 mo （range, 21-66）. Platelet counts increased continuously for 5 years after orthotopic liver transplant. The restoration of platelet counts after transplant was significantly slower in patients with severe pretransplant thrombocytopenia （〈 50000/μL） until 4 years after transplant （P = 0.005）. Donor type did not significantlyaffect the recovery of platelet count and spleen volume in either patient group. In multivariate analysis, pretransplant severe thrombocytopenia （〈 50000/μL） was an independent factor associated with sustained thrombocytopenia （P 〈 0.001, odds ratio 6.314; confidence interval, 2.828-14.095）. Thrombocytopenia reappeared after transplant in seven patients with portal flow disturbance near the anastomosis site. CONCLUSION： Our study suggests that severe thrombocytopenia before transplant is closely associated with delayed recovery of platelet count after transplant and donor type did not affect the recovery of thrombocytopenia. The reappearance of thrombocytopenia after transplant should be considered a possible indicator of flow disturbance in the portal vein.

关键词： Liver transplantation Thrombocytopenia Splenomegaly Hypersplenism

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Duodenal obstruction following acute pancreatitis caused by a large duodenal diverticular bezoar

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World Journal of Gastroenterology 2012年第38期18卷 5485-5488页

作者： Ji Hun Kim jae hyuck chang Sung Min Nam Mi Jeong Lee Il Ho Maeng Jin Young Park Yun Sun Im Tae Ho Kim Il Young Park Sok Won Han Department of Internal Medicine College of Medicine The Catholic University of Korea Seoul 137-701 South Korea Department of Surgery College of Medicine The Catholic University of Korea Seoul 137-701 South Korea

Bezoars are concretions of indigestible materials in the gastrointestinal tract. It generally develops in patients with previous gastric surgery or patients with delayed gastric emptying. Cases of periampullary duodenal divericular bezoar are rare. Clinical manifestations by a bezoar vary from no symptom to acute abdominal syndrome depending on the location of the bezoar. Biliary obstruction or acute pancreatitis caused by a bezoar has been rarely reported. Small bowel obstruction by a bezoar is also rare, but it is a complication that requires surgery. This is a case of acute pancreatitis and subsequent duodenal obstruction caused by a large duodenal bezoar migrating from a periampullary diverticulum to the duodenal lumen, which mimicked pancreatic abscess or microperforation on abdominal computerized tomography. The patient underwent surgical removal of the bezoar and recovered completely.

关键词： Bezoar Diverticulum Pancreatitis Duodenal obstruction

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Etching characteristics and surface modification of InGaSnO thin films under Cl_(2)/Ar plasma

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Plasma Science and Technology 2023年第10期25卷 91-96页

作者： Young-Hee JOO jae-Won CHOI Bo HOU hyuck-In KWON Doo-Seung UM chang-Il KIM Department of Electronic and Electrical Engineering Chung-Ang UniversitySeoul 06974Republic of Korea Department of Firearms and Optics Daeduk UniversityDaejeon 34111Republic of Korea School of Physics and Astronomy Cardiff UniversityCardiff CF243AAUnited Kingdom Department of Electrical Engineering Sejong UniversitySeoul 05006Republic of Korea

Indium gallium tin oxide(IGTO)thin films have the potential for high mobility and lowtemperature processing,which makes them suitable for applications such as display backplanes and high-voltage switching ***,very few studies have investigated the plasmaetching characteristics of IGTO and changes in its properties after *** this study,the etching characteristics of IGTO were investigated using Cl_(2)/Ar plasma,and changes in surface properties were *** showed that the etch rate increased with an increase in the proportion of Cl_(2),with the highest etch rate observed at 69 nm min^(-1)in pure Cl_(2)plasma with a gas flow rate of 100 ***,increased radio-frequency power caused a rise in the etch rate,while a process pressure of 15 m Torr was *** primary etching mechanism for IGTO thin films under Cl_(2)plasma was a chemical reaction,and an increased work function indicated the occurrence of defects on the *** addition,the etching process reduced the surface roughness of Cl_(2)-containing plasma,whereas the etching process in pure Ar plasma increased surface *** study contributes to a better understanding of the plasmaetching characteristics of IGTO and changes in its properties after etching,providing valuable insights for IGTO-based applications.

关键词： InGaSnO Cl2-based plasma etching mechanism surface modification plasma etching

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