Clinical Endoscopy

상부소화관 내시경검사가 혈중 Catecholamine 농도에 미치는 영향에 관한 연구 ( Response of the Sympathetic System During and After Fiberoptic Gastroscopy ): Korean J Gastrointest Endosc 1988;8(2):121-126. Published online November 30, 1987

Abstract PDF: Cardiovascular changes induced by a variety of physiological, surgical or emotional stresses are associated with increased sympathetic nervous system activtity. Sympathetic stimulation lowers the ventricular resistance in patients with ischemic heart disease. Thus sympathoadrenal aetivation may play role in sudden cardiac death. We measured the catecholamine levels just before and after fiberoptic gastroscopy, The results were as follows: 1) Though there was no statistical significance, plama catecholamine levels tends to increase during and after fiberoptic gastroscopy. 2) Significant changes in mean blood pressure did not occur during and after fiberoptic gastroscopy. 3) Before fiberoptic gastroscopy, norepinephrine level of three hypertensive patients were lower than the levels of studied patients, But during and after fiberoptic gastroacopy, norepinephrine level increased by 3 times. 4) The highest norepinephrine level was 847 pg/ml and epinephrine level was 110 pg/ml. Though sympathetic response was enhanced by fiberoptic gastroscopy, norepinephrine level did not increase up to the level shown in myocardial infarction or severe exercise.

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상부소화관출혈에 대한 내시경적 마이크로파 응고지혈법의 검토 ( Clinical Evaluation of Endoscopic Microwave Coagulation Therapy for Upper Gastrointestinal Bleeding ): Korean J Gastrointest Endosc 1988;8(2):127-132. Published online November 30, 1987

Abstract PDF: The hemostatic effect of endoscopic microwave coagulation method for upper gastrointestinal bleeding was evaluated clinically. Hemostasis over 72 hours was achieved in 18 of 20 cases (90%) with upper gastrointestinal bleeding by the endoscopic microwave coagulation method. It is noteworthy that this method was effective in all 4 cases of pulsatile bleeding from exposed vessels. We conclude that this method is useful for emergency endoscopic hemostasis on upper gastrointestinal bleeding, especially bleeding from exposed vessels.

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급성 위 Anisakis 증 - 인체기생 3예 보고와 임상고찰 -: Korean J Gastrointest Endosc 1988;8(2):133-136. Published online November 30, 1987

Abstract PDF: Acute gastric anisakiasis is occurred when men intake a raw or inadequate cooked anisakis infected fish. The clinical symptoms are severe cramping abdominal pain, nausea, vomiting, and epigastric fulling sensation. It is well known that the whale is final host and man is opportunistic host. Recently, we experienced three cases of acute gastric anisakiasis. We think that acute gastric anisakiasis is probably rather undetected than rare disease. So through immediate gastrofiberscopy of patients with severe cramping epigstric pain occuring after ingestion of raw fish,we can find more cases of the anisakis larvae. In is adequate to abstract of larvae by biopsy forceps through gastrofiberscopy.

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Multiple Gastric Diverticula 1예 ( A Case of Multiple Gastric Diverticula ): Korean J Gastrointest Endosc 1988;8(2):137-140. Published online November 30, 1987

Abstract PDF: Gastric diverticula have been considered to be rave when compored with diverticula in other sites of the gastrointestinal tract. It's prevalence is 0.043% of routine gastrointestinal radiologic examination by Palmer's extensive review. Gastric diverticula almost always occur as a single lesion and approximately 75% of gastric diverticula occur in the juxtacardiac region, high on the posterior wall of the stomach, about 2 cm below the esophagogastric junction and 3 cm from the lesser curvature. We report a case of 75-year-old male patient with multiple gastric diverlicula which was first encountered by endoscopy and confirmed by upper gastrointestinal radiologic examination.

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위의 평활근아세포증 1예 ( A Case of Leiomyoblastoma of Stomach ): Korean J Gastrointest Endosc 1988;8(2):141-144. Published online November 30, 1987

Abstract PDF: In 1960 Martin and his associates described another type of tumor of the stomach derived from the smooth muscle, which they named myoid tumor in a study of six patients. In 1962 Stout applied the term "lelomyoblastoma" to this interesting entity in a report of a collected series of 69 patients. Tumor cells are round or polygonal epithelioid cells, which contain perinuclear vacuole or clear zone. A 58 year-old female was admitted to this hospital because of epigastric discomfort for three months. At Upper gastrointestinal series and gastrofiberscope, a round hemispherical submucosal tumor was noted at posterior wall near the lesser curvature of gastric antrum. After subtotal gastrectomy, the submucosal tumor was diagnosed as leiomyoblastoma. Because leiomyoblastoma are rare and easily misdiagnosed as leiomyoma or leiomyosarcoma, careful histologic study is recommended.

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이물연하에 의한 십이지장천공 1예 ( Duodenal Perforation due to Foreign Body Swallow ): Korean J Gastrointest Endosc 1988;8(2):145-148. Published online November 30, 1987

Abstract PDF: A 23 year old female patient swallowed a tooth brush about one month prior to admission. She has been felt discomfort in epigastrium and dull aching pain recently around umbilicus. Upper gastrointestinal X-Ray and gastroduodenoscopic examination disclosed that a full size, yellow tooth brush is lodged transversely in the stomach and duodenal bulb, Endoscopic remova.l was tried and failed because of impaction of the both ends into mucosa. The tooth brush was removed by gastrotomy under general anesthesia. The free end of the brush handle penetrated the duodenal bulb wall and the impaction of the tip prevented the leakage of duodenal contents before removal. Though the primary method of the gastroduodenal foreign body is endoscopic, if sharp end of the forei body seems to be impacted into the gastrointestinal wall, and if it retained same position for long duration, it should not tried to remove by force fo prevention of leakage and resulting peritonitis. Surgical removal may be safer method in these cases.

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십이지장 구부에 이상개구한 총수담관 1예 ( A Case of Anomalous Termination of the Common Bile Duct into the Duodenal Bulb ): Korean J Gastrointest Endosc 1988;8(2):149-151. Published online November 30, 1987

Abstract PDF: Anatomy of the pancreaticobiliary ductal system is so variable that one should think of its normal anatomy as nonexistent. But exact location of the termination of the common bile duct in important to the biliary surgeon when performing transduodenal exploration of the common bile duct, to the physician and radiologist when diagnosing pancreaticobilijary disease by ERCP. We report a case of Lnomalous termination of the common bile duct into thii. duadenal bulb diagnosed by ERCP and operative cholangiogram.

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십이지장 평활근 육종 1예 ( A Case of Leiomyosarcoma of the Duodenum ): Korean J Gastrointest Endosc 1988;8(2):153-156. Published online November 30, 1987

Abstract PDF: Malignant growth of the small bowel accounts for approximately 1 to 3 percent of malignant tumors of the gastrointestinal tract. Leiomyosarcomas are the second most common primary tumor of the small bowel, their frequency being one-third to one-half of adenocarcinoma. The common clinical symptoms of leiomyosarcoma of the small intestine are hemorrhage and abdominal pain. Accurate diagnosis cannot be based on solely on the roentgenographic finding, although in certain situations the dignosis of leiomyosarcoma may be suggested strongly. We report a case of bleeding leiomyosarcoma located in the second portion of the duodenum which was first recognized by endoscopic examination and confirmed by explolaparotomy.

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내시경적 담석 제거술의 임상적 고찰 ( Common Bile Duct Stone Removed by Endoscopic Sphincterotomy ): Korean J Gastrointest Endosc 1988;8(2):157-162. Published online November 30, 1987

Abstract PDF: Endoscopic sphincterotomy (E.S.T.) has relatively low complications and is the theraphy of choice in patients with common bile duct stones. It is also an useful technique for decompression of biliary tract obstruction. Thirty two cases of patients were selected according to opedrative risks: old age, severe jaundice and recurrent or retained bile duct stones after cholecystecomy from 1986 to 1988. The results were as follows, 1) In thirty two cases nf E.S.T., male to female ratio was 1:1.46. Most frequent age was older than 40 years. (male, 84.6%, female, 84.2%). 2) Out of thirty two cases, 20 cases (62.5% were under post clholecystectomy state, 12 eases (37.5%) were obstructive jaundice. 3) Spontaneous stone passage after E.S.T. was 81.3% (26 cases), and total stone remoral rate was 87.5% (28 cases), 4) Complications of E.S.T. were noted in three cases. In the two cases of bleeding, it was spontaneously improved and a case of acute pancreatitis was treated by medical care.

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체외충격파쇄석술 ( ESWL ) 을 이용한 총수담도결석 치유 1예 ( A Case of Common Bile Duct Stones Treated by Extracorporeal Shock Wave Lithotripsy ( ESWL ) ): Korean J Gastrointest Endosc 1988;8(2):163-166. Published online November 30, 1987

Abstract PDF: We report the case of a 44-year-old woman underwent cholecystectomy with two common bile duct stones (2.6 x 1,9 cm and 1.6 X 1.0 cm) which failed to be captured by endoscopic mechanical lithotriptor. However, those were successfully dia-integrated with extracorporeal shock wave lithotripsy (ESWL), permitting subsequent endosaopic extraction using the Dormia basket of the fragments without complication; In our experience, ESWL is considered to be a new and safe method to treat patients with common bile duct stone which cannot be removed by endoscopic mechanical lithotripsy.

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장기간 생존한 담낭 및 총수담관에 발생한 중복암 1예 ( Multicentric Extrahepatic Tumor Involving the Gallbladder and Common Bile Duct A Case Report of Longterm Survival ): Korean J Gastrointest Endosc 1988;8(2):167-170. Published online November 30, 1987

Abstract PDF: A 60-year-old woman has experienced of right upper quadrant abdominal discomfort. This partient took cholecytectomy due to gall stone 15 years ago. At that time microscopic finding the neck of gallbladder showed well differentiated papillary adenocarcinoma confined to superficial part of musele layer. 3 years before admission she took T-tube drainage due to obstructive jaundice. The microscopic finding af distal common bile duct showed well differentiated adenocarcinoma. Recently she complained of pain and discomfort on T-tube site and so we perforrned endoscopic retrograde biliary drainage after removal of T-tube. The computed tomogram showed no mass in liver or lymph node enlargement. 4 months after procedure of ERBD; we changed to the new catheter for the prevention of cloggiag of prosthesis. We report here a case of longterm survival over 15 years after the diagnosis of cancer of extrahepatic bile duct.

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한국인의 대장게실증에 관한 연구 ( Diverticular Diseases of the colon in Korea ): Korean J Gastrointest Endosc 1988;8(2):171-176. Published online November 30, 1987

Abstract PDF: The purpose of this study is to review epidemiological and clinical characteristics of diverticular disease of the colan in Korea and to discuss the difference of the findings from those in other countries. Reviewing all thebarium enema films taken at the Seoul National University Hospital retrospectively for the last 8 years. that is, from January 1, 1980 to December 31, 1987, we observed the annual and overall incidence of the disease, the number and location of the diverticula, and the presenting symptoms of the cases. The results are summarized as follows: 1) Out of the patients examined, 237 cases had one or more diverticula in the colon, the overall incidence being 1.32%, 2) The annual incidence increased progressively for the last 8 years, from 0.25% in 1980 to 2.53% in 1987. 3) The mean age of the patients at the time of diagnosis was 51 years. The male to female ratio was 2.5. 4) The diverticula were located on the right side in 81.0% of the cases, on the left side in 10.6%, and on both sides in 8.4%. 5) In 82 cases (34.6%) single diverticulum was found, whereas 34 cases (14.3%) had more than 10 diverticula. 6) The most frequent symptoms for taking barium enema were abdominal discomfort and pain (34. 2%) and changes in bowel habits (33.8%}, whereas 45 casea (19.0%) had the examination just for a routine health check. In conclusiion, the diverticular disease of the colon is still uncommon in Korea as compared with in western countries, and the right colon type is far more freqtaent than the left colon type. However in recent years the incidence increases quite rapidly and the left colon type is getting more common.

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대장의 거대 망상 염증성용종 3예 ( Three Cases of Membranous Reticular Inflammatory Polyp of the Colon ): Korean J Gastrointest Endosc 1988;8(2):177-181. Published online November 30, 1987

Abstract PDF: Inflammatory polyposis of the colon is rare portion of the colon polyp entity. We experienced three patieats who suffered from colitis of unknown'etiology and discovered membranous retkular with/ without filiform polyp in the distal sigmoid colon of the them. Case 1, 56-year-old female, combined with basaloid cercinoma of the rectal canal that confirmed by pathology after abdominoperineal resection. So we obtained specimen of inflammtory polyp end tried to evaluate the mechanism of it. We found healed ulcer under the mucosal bridge. Case 2. 55-year-old male, had been suffered from irritable bowel syndrome. Prior to visit outpatient clinic, he complained tenesmus with diarrhea for a week. Inflammatory polyp was discovered by colonoacopy but his symptoms relieved by tranqulizers only. Case 3. 57-year-old male, has been a good health. He undertook colonoscopy for routine check thst revealed membranous reticular with filiform inflammatory polyp from distal sigmoid colon to hepatic flexure. Such shape of inflammatory polyp was not documented in Korea, so we reported three cases of it with review of the literature.

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Carcinoid 종양 2예 ( Two Cases of Carcinoid Tumors - Rectum and Stomach Origin - ): Korean J Gastrointest Endosc 1988;8(2):183-186. Published online November 30, 1987

Abstract PDF: Carcinoid tumors of the intestinal tract are uncommon neoplasms thought to arise from argentaffin cells in the base of the intestinal crypts. Carcinoid tumors of other sites have since been reported with increasing frequency. We experienced one case of rectal carcinoid tumor and the other case of stomach carcinoid turnor. A 52-year-old male patient was admitted to the hospital because of right upper abdominal discomfort. On the CT scan, multiple low density masses were noticed. Sigmoidoscopy revealed the whitish yellow ulcerofungating mass which had vague margin. And a 31-year-old male patient was admitted to the haspital because of hematemesis. On the gastrofiberscopic examination, an ovoid shallow ulcer crater which had elevated margin, smooth tapered fold and vissible vessel was noticed on the anterior wall side of the high body. The biopsy specimen in both these cases showed carcinoid cells. 24h urine 5-HIAA of these cases was negative. Awareness of carcinoid tumor in differential diagnosis of hepatic metastasis and of gastric ulcer is necessary.

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복강경으로 확진된 결핵성 복막염의 임상적 고찰 ( A Clinical Analysis of Laparoscopically Confirmed Tuberculous Peritonitis ): Korean J Gastrointest Endosc 1988;8(2):187-194. Published online November 30, 1987

Abstract PDF: This is a clinical analysis of 48 patients who had tuberculous peritonitis laparoscopically confirmed at the Gastroenterologic Department of the Korea University Hae Wha Hospital from March 1980 to February 1988, and the results are as fallows: 1) The ratio of male to female was 1:1.7, and the age of the peak incidence was the third decade. 2) The freqeent symptoms were abdominal distension (77.1%), abdominal pain (60.4%), and fever (60.4%); others were indigestion (27.1%), diarrhea (18.8%), weight loss (6.3%), abdominal mass (6.3% ), vomiting (6.3%), and dysmenorrhea (2.1%). The freguent physical signs were ascites (93.8%) and abdominal tenderness (45.8%); others were palpable mass (8.3%), hepatomegaly (8.3%), and mild jaundice (4,2%). 3) Hematologic findings in mean value revealed 11.8 g/m% in hemoglobin, 6088/mm in WBC, and 36 mm/hour in ESR, 4) Ascitic analysis revealed 1,031 in specific gravity, 5.2% in protein, and 1700/mm in WBC count with lymphocytic predominance (83%). AFB stain and culture were all negative in the specimens less than 20 ml. 5) On chest X-ray, pulmonary Tuberculosis or associated lesions were noted in 19 patients (39.6%). 6) Studded whitish miliary tubercle, omental change, ad adhesions were noted in a mixed nature. 7) Classifications according to laparoscopic finding revealed wet type in 28 patients (58.3%), mixed type in 13 patients (27.1%), and dry type in 7 patients (14.6%); and laparoscopic type was not related with the duration of symptom up to admission. 8) Microscopic finding of biopsy specimens revealed caseous necrosis or granuloma in 43 patient (89.6%) and nonspecific inflammation in 5 patients. In these 5 patients, characteristic gross findings of tuberculous peritionitis were noted. 9) Intestinal perforation was developed in 2 patients.

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제25회 대한소화기내시경학회 학술대회 : 심포지움 ; 전자 내시경의 의공학적 기본 원리: Korean J Gastrointest Endosc 1988;8(2):199-203. Published online November 30, 1987

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제25회 대한소화기내시경학회 학술대회 : 심포지움 ; 방사선과적 측면에서 내시경과 방사선과 검사: Korean J Gastrointest Endosc 1988;8(2):205-210. Published online November 30, 1987

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제25회 대한소화기내시경학회 학술대회 : 심포지움 ; 위 내시경 생검의 병리학적 진단 - 내시경 생검결과와 절제위 병리검색 결과간의 상치 예들의 분석 - ( Pathologic Diagnosis of Endoscopic Biopsy in Stomach - Analysis of cases showing discrepancy between biopsy diagnosis and diagnosis of resected stomach - ): Korean J Gastrointest Endosc 1988;8(2):211-216. Published online November 30, 1987

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