Clinical Endoscopy

원저 : 식도정맥류 출혈의 경화요법의 대치치료로써 내시경적 정맥류 결찰요법 ( Original Articles : Endoscopie Variceal Ligation As an Alternative Treatment to Sclerotherapy for Esophageal Varices ): Korean J Gastrointest Endosc 1994;14(1):1-7. Published online November 30, 1993

Abstract PDF: Currently, endoscopic injection sclerotherapy(EIS) is the most widely used method for treating and eradicating acutely bleeding esophageal varices in repeated sessions, but may be associated with some undesirable local and systemic complications. (continue...)

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원저 : 비식도정맥류 상부위장관 출혈에서 Hypertonic Saline Epinephring 용액의 치료요법 - 지혈성적 및 시간대별 진단율과 지혈율 비교 - ( Original Articles : Endoscopic Local Injection of Hypertionic Saline Epinephrine Solution for Arrest Hemorrhage from Upper Gastrointestinal Tract - Hemostatic and diagnostic rate according to the time interval - ): Korean J Gastrointest Endosc 1994;14(1):8-18. Published online November 30, 1993

Abstract PDF: A prospective randomised trial was performed to assess the diagnostic accuracy according to the time interval and the efficacy of endoscopic injection of hypertonic saline-epinephrine(HS- E)solution, consisting of 3.5% sodium chloride with 0.0045% epinephrine, for actively bleeding peptic ulcers, exposed vessel or blood clot on ulcer bed, or Mallory-Weiss tear. Over 24 month, emergency endoscopy in 180 patients admitted for upper gastrointestinal hemorrhage identified 51 patients with nonvariceal hemorrhage. The causes of bleeding were; gastric ulcer in 32; duodenal ulcer in 13; gastric cancer in 4; Mallory-Weiss tear in 2. With this method, the hemostatic effect was permanent in 40 cases(84.3%), temporary in 9 cases(11.8%), and failed in 2 cases(3.9%). By applying this method, the rate of emergency operation for patients with bleeding from the upper gastrointestinal tract was significantly reduced from 20.0% (8/40)to 3.9%(2/51)(p<0.05). Emergency endoscopy in acute UGI bleeding increases the accuracy of detection of actual bleeding sites(p<0.05), but if the endoscopic procedure was performed within 48 hours, the hemostatic rate was not affected(p<0.05). We concluded that hypertonic saline-epinephrine injection method could provide a simple maneuver with reasonable cost, high safety, and satisfactory hemostatic efficacy in the treatment of nonvariceal upper gastrointestinal bleeding.

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원저 : Brunner 선의 과오종성 증식을 시사하는 6예의 임상 - 병리학적 분석 ( Original Articles : Brunner's Gland Hamartoma. A Clinicopathologic Analysis of Six Cases ): Korean J Gastrointest Endosc 1994;14(1):19-23. Published online November 30, 1993

Abstract PDF: Pathological proliferation of Brgnners gland is rare, and its wide range of morphologieal variations have led to confusing the terminology with considerable lack of agreement. Six cases of duodenal nodular lesions which consisted of pathological proliferation of Brunners glands were examined by light microscopy. Polypectomy was made in two cases, and the remaining 4 cases were examined with endoscopic biopsy materials. Two polypectomy specimens, 2 cm and 3 cm each in great diameters, consisted of protruded ovoid mass with broad and short stalks. Microacopically, all of 6 cases revealed thin strands of fibrous connective tissue which separated the normal-looking Brunners glands in lobules. Individual lobules were composed of groups of acini formed by cuboidal cells admixed with occasional endocrine cells. Presence of glandular and ductal configuration of the Brunners gland aside from thick, randomly arranged bundles of smooth muscle were featured without distinct relation to interlobular septa. Also, one polypectomy case disclosed the nests of fat cells interspersed with the glandular acini. One mucosal biopsy case contained not only the smooth muscle bands but also the intimate mixture of both acini and ducts. We conclude that some of heterogeneous composition of duodenal nodular proliferation of Brunners gland is indicative of a hamartomatous growth.

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원저 : 내시경적 위장관 용종 절제술 148예의 임상적 고찰 ( Original Articles : Clinical Observaton of 148 Endoscopic Gastrointestinal Polypectomy ): Korean J Gastrointest Endosc 1994;14(1):24-31. Published online November 30, 1993

Abstract PDF: Gastrointesinal polyp is a premalignant lesion, it is recommanded to be removed. Endoscopic polypectomy has long been considered as a safe and effective method for removal of polyps. One hundred forty eight endoscopic gastrointestinal polypectomy were done in 111 patients who visited Chungnam National University Hospital from January in l991 to August in l993, and clinical character including histopathology were evaluated. (continue...)

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원저 : 비 염증성 장질환에 수반되는 수지상 폴립증 - 5예의 임상-병리학적 분석 - ( Original Articles : Filiform Polyposis in Non-Inflammatory Bowel Disease - A clinicopathologic analysis of five cases - ): Korean J Gastrointest Endosc 1994;14(1):32-36. Published online November 30, 1993

Abstract PDF: Filiform polyposis(FP), an unusual form of inflammatory polyposis, has been recently designated to a lesion characterized by multiple, long slender, finger-like projections of mucosa and submucosa of the gastrointestinal tract. We present 5 cases of FP, of which two were associated with irritable bowel syndrome, two with advanced colon carcinoma, and one with active ileotyphlitis(Behcet's disease). The polyps ranged from 1.0 cm to 3 cm; they were either isolated or aggregated, and their numbers were up to 100. The common microscopic feature was filiform polyps which consisted of central submucosal core covered by intact or minimally inflamed intestinal mucosa, comparable with that in reparative processes and formation of inflammatory(redundant) pseudopolyps. We conclude that awareness of FP in non-inflammatory bowel disease may promote the endoscopists to search its underlying disease and prevent un- necessary surgical procedure. Behcets enterocolitis in the ileocecal junction seems an additional preceding disorder of a localized form of FP.

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원저 : 내시경적 역행성 담췌관 조영술후 발생하는 고아밀라제혈증의 병인에 산소유리기의 역할 ( Original Articles : Role of Oxygen - Derived Free Radical in the ERCF - Induced Hyperamylasemia ): Korean J Gastrointest Endosc 1994;14(1):37-48. Published online November 30, 1993

Abstract PDF: There is growing evidence that oxygen-derived free radicals(OFR's) play a role in the pathogenesis of pancreatic diseases, especially of acute pancreatitis. Many types of experimental ex vivo and in vitro pancreatitis can be inhibited by superoxide dismutase and catalse. (continue...)

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원저 : 내시경적 역행성 담췌관 조영술로 진단된 담췌관 합류이상의 임상적 의의 ( Original Articles : Clinical Significance of Anomalous Pancreaticobiliary Ductal Union Diagnosed by Endoscopic Retrograde Cholangiopancreatography ): Korean J Gastrointest Endosc 1994;14(1):49-55. Published online November 30, 1993

Abstract PDF: To evaluate the clinical significance of anomalous pancreaticobiliary ductal union(PBDU), we analysed 11 cases(0.19%) of anomalous PBDU among 5675 cases performed ERCP from Jan. 1973 to Aug. 1992. According to the classification of Kimura et al., 4 cases were type 1(P-C union) and 7 cases type 2(C-P union). The length of common channel ranged from 1.5 cm to 3.1 cm(mean 1.9 cm). The common associated disease were choledochal cyst(7 cases), carcinoma of the gallbladder(5 cases) and biliary stone(3 cases). Four cases of carcinoma of the gallbladder were type 1. The incidence of anomalous PBDU was significantly higher in cases with carcinoma of the gallbladder(5 cases among 49 cases) than in case without carcinoma of the gallbladder(6 cases among 5626 cases). And the incidence of gallbladder carcinoma(45%) among the 11 cases of anomalous PBDU was significantly higher than that(0.78%) among those who did not have anomalous PBDU. In conclusion, the common associated diseases with the anomalous PBDU were choledochal cyst, carcinoma of the gallbladder and stone, and the anomalous PBDU may be risk factor in the development of carcinoma of the gllbladder.

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원저 : HBsAg 양성 간질환 환자의 간 우엽 및 좌엽의 조직학적 소견의 비교 ( Original Articles : Histologic Diagnosis between Right Lobe and Left Lobe in Patients with HBsAg(+) Chronic Liver Diseases ): Korean J Gastrointest Endosc 1994;14(1):56-63. Published online November 30, 1993

Abstract PDF: We compared the histological diagnosis and activity between the right and left lobes in order to assess the sampling variability in HBsAg(+) chronic liver diseases. From May 1987 to September 1991, we prospectively evaluated 23 patients(male 19, female 4, mean age: 32.0+8.8)with HBsAg(-) chronic liver diseases. (continue...)

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원저 : 담낭절제술시 고식적 수술과 복강경을 통한 수술의 임상적 비교 ( Original Articles : Chinical Comparison of the Traditional Versus Laparoscopic Surgery in Cholecystectomy for Cholelithiasis ): Korean J Gastrointest Endosc 1994;14(1):64-73. Published online November 30, 1993

Abstract PDF: Laparascapic Cholecystectomy is a recentely rapidly emerged, minimally invasive procedure whereby the gallbladder is removed using laparoscopic techniques. The procedure offers the patient reduced hospital stay, faster to work, less pain, less complication, less expensiveness, and improved cosmetic results over the traditional open cholecystectomy. (continue...)

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증례 : 단백질 상실성 장질환을 동반한 호산구성 위장관염 1예 보고 ( Case Reports : A Case of Eosinophilic Gastroenteritis Associsted with Protein - losing Enteropathy ): Korean J Gastrointest Endosc 1994;14(1):74-81. Published online November 30, 1993

Abstract PDF: Eosinophilic gastroenteritis is characterized by peripheral eosinophilia, eosinophilic infiltration of the bowel and gastrointestinal symptoms. The disease may affect any area of the gastrointestinal tract. Various manifestations are present, corresponding to the predominant layer of the eosinophilic infiltration. We experienced a case of eosinophilic gastroenteritis presenting as protein-losing entero- pathy in a 36-year old male patient with acute upper abdominal pain and watery diarrhea. He showed peripheral eosinophilia, hypoalbuminemia, penile., thigh and ankle edema. The patient was treated with oral corticosteroid, and supportive care such as parenteral albumin, fluid and electrolytes. Almost all symptoms resloved within 1 week. The present report concerns a case of eosinophilic gastroenteritis associated with protein loss. Cases, of eosinophilic gastroenteritis with protein-losing enteropathy are not common. To our knowledge, no case has reported in Korea. So we report this case with brief review of the literature.

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증례 : 십이지장의 Brunner's Gland 선종 4예 ( Case Reports : Four Cases of Brunner's Gland Adenoma ): Korean J Gastrointest Endosc 1994;14(1):82-88. Published online November 30, 1993

Abstract PDF: Brunners gland adenoma is a benign epithelial tumor of the duodenum originating from submucosal Brunners gland. This is an extremely rare entity that account for only 10.6% of benign duodenal tumor, which are themselves relatively rare, representing 0.008% of all surgical and autopsy specimens. The clinical manifestation are nonspecific gastrointestinal complaints, such as bloating or epigastric pain, and the tumor gives rise to melena or anemia, due to the ulceration or erosion of the tumor. The diagnosis is usually made by radiologic studies and gastroduodenal endoscopy which can also provide definitive treatment. The aim of treatment is complete removal of the lesion and exclude malignancy. We report on 4 cases of Brunners gland adenoma which was confirmed by operation or endoscopic polypectomy.

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증례 : 십이지장에 발생한 평활근육종 1예 ( Case Reports : A Case Report of Leiomyosarcoma of the Duodenum ): Korean J Gastrointest Endosc 1994;14(1):89-93. Published online November 30, 1993

Abstract PDF: Leiomyosarcoma of the duodenum is an uncommon tumor and have not specific symptoms and signs, almost all cases of tumor were diagnosed in operating room. This tumor is generally firm, relatively well encapsulated, lobulated and often soft if they undergo hemorrhagic necrosis. Most authors emphasized the relative number of mitosis as the most reliable findings of leiomyosarcoma. Recently, we experienced a case of leiomyosarcoma of duodenum which was confirmed by operative and pathological diagnosis.

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증례 : 십이지장 구부에 이상 개구한 총수담관 3예 ( Case Reports : Three Cases of Anomalous Drainage of Common Bile Duct into the Duodenal Bulb ): Korean J Gastrointest Endosc 1994;14(1):94-99. Published online November 30, 1993

Abstract PDF: Classic anatomical descriptions state that the common bile duct enters to the medial border of the second part of duodenum. Isolated case reports of the common bile duct in other sites, including the fourth part of duodenum, the pyloric canal, stomach, and the duodenal bulb, have appeared in the literature. We report three cases of anomalous drainage of the common bile duct into duodenal bulb, which caused recurrent cholangitis and peptic ulcer. All patients required choledochoenteric anastomosis to relieve their syrnptoms.

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증례 : 장중첩증을 초발증세로 한 회장의 원발성 림프종 1예 ( Case Reports : Primary Malignant Lymphoma of the Small Intestine Causing Adult Intussusception as an Initial Symptom ): Korean J Gastrointest Endosc 1994;14(1):100-104. Published online November 30, 1993

Abstract PDF: While intussusception can occur at any age, the disease is most often seen in children and no etiologic factor can be seen in most cases of childhood intussusception. In contrast, the adult intussusception is rare and usually has an identifiable causes such as benign tumor, malignant tumor, sarcoma, Meckel's diverticulum and congenital anomaly. Especially, adult intussusception due to primary malignant lymphoma of small intestine is rare clinical condition. Here, we describe the case of a 49-year-old male patient with ileo-ileo-colic intussusception due to primary malignant lymphoma of the small intestine. The clinical, radiographic and pathologic findings are described with brief review of the literature.

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증례 : 담낭축농을 동반한 십이지장 구부로 이상 개구한 총수담관 1예 ( Case Reports : A Case of Anomalous Termination of Common Bile duct into Duodenal Bulb with the Gall Bladder Empyema ): Korean J Gastrointest Endosc 1994;14(1):105-110. Published online November 30, 1993

Abstract PDF: Although it is commonly appreciated that there is an inordinately large number of anormalies associated with the excretory ducts of the liver, comparatively little attention has been paid to the position of the orfice of the common bile duct into the duodenum. But, obiviously the site of entrance of the common bile duct into the duodenum becomes of great importance to the endoscopist, radiologist, and surgeon in diseases of the extra-hepatic biliary tract diag-nostically and therapeutically. We report 'a case of anomalous termination of the common bile duct into the duodenal bulb with the gall bladder empyema.

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증례 : 바륨을 이용한 내시경적 역행성 담췌관 조영술 ( Case Reports : Endoscopic Retrograde Cholangiopancreatography Using Barium Sulfate As a Contrast Material ): Korean J Gastrointest Endosc 1994;14(1):111-114. Published online November 30, 1993

Abstract PDF: An occasional patient has both a pressing need for visualization of the biliary system in spite of a past history of reaction to iodinated contrast media. We report a patient, who had reacted adversely to contrast media, underwent ERCP using barium sulfate in order to opacify the biliary and pancreatic duct without side effect successfully. In conclusion, ERCP using barium sulfate as a contrast material is of value in patients who are intolerant of the iodinated contrast media.

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증례 : 폐쇄성 황달을 유발한 결핵성 림프선염 1예 ( Case Reports : A Case of Tuberculous Lymphadenitis Causing Obstructive Jaundice ): Korean J Gastrointest Endosc 1994;14(1):115-120. Published online November 30, 1993

Abstract PDF: Obstructive disorders of the biliary trees include occlusions of the bile duct lumen by stones, intrinsic disorders of the bile ducts, and extrinsic compressions. The most common biliary cause of obstructive jaundice is the presence of stones. Intrinsic disorders of the bile ducts may be inflammatory, infectious, or neoplastic. And significant enlargement of adjacent lymph nodes due to metastatic tumors or lymphoma can occasionally obstruct the extrahepatic bile ducts. But obstructive jaundice produced by periportal tuberculous lymphadenitis with no evidence of pulmonary tuberculosis is very rare. We report a case of tuberculous lymphadenitis causing obstructive jaundice with a mass around mid common bile duct on abdominal sonogram, CT scan and ERCP, and it was confirmed by an exploratory laparotomy.

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