Publications by authors named "Sang Goon Shim"

37 Publications

Combination treatment with sofosbuvir and ribavirin for patients diagnosed with hepatitis C genotype 2: A real-world, single-center study.

Arab J Gastroenterol 2021 Mar 19;22(1):23-27. Epub 2020 Nov 19.

Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea. Electronic address:

Background And Study Aims: The demand for treatments for viral hepatitis using direct antiviral agents (DAAs) has increased; however, few real-world clinical studies are available. The objective of this study was to evaluate the efficacy and safety of sofosbuvir combined with ribavirin for patients with chronic hepatitis C (CHC) genotype 2 (GT2).

Patients And Methods: A total of 106 consecutive CHC GT2 patients treated with sofosbuvir plus ribavirin between May 2016 and August 2018 (median age: 52.5 years, male: 51 [48.1%], treatment-naïve patients: 98 [92.5%]) were analyzed. The primary endpoint was sustained virologic response at 12 weeks (SVR12). The secondary endpoint was the occurrence of side effects during treatment.

Results: Of a total of 106 patients with CHC GT2, 103 were genotype 2a (97.2%), and 3 were 2b (2.8%). SVR12 was confirmed in 105 of 106 patients (99.1%). The one patient with treatment failure had combined liver cirrhosis and hepatocellular carcinoma. Twenty-five patients had liver cirrhosis in addition to hepatitis C virus (HCV) (Child-Turcotte-Pugh (CTP)-A, n = 24; C, n = 1), and SVR12 was confirmed in 24 of these patients (96.0%). The mean HCV RNA titer was 2,629,159 IU/ml. Reductions in haemoglobin levels occurred in 23 patients during treatment (3.0 mg/dL, mean), and consequently, ribavirin dose reduction was required (365.2 mg, mean).

Conclusion: Sofosbuvir plus ribavirin was highly effective for the treatment of patients with CHC GT2 and had no serious, treatment-related adverse effects.
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http://dx.doi.org/10.1016/j.ajg.2020.09.001DOI Listing
March 2021

Comparison of ICC patients with hepatitis B infection to those with no major risk factors for HCC.

HPB (Oxford) 2021 Jun 31;23(6):945-953. Epub 2020 Oct 31.

Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. Electronic address:

Background: There has been renewed interest in HBV-associated ICC, because it could share a common carcinogenesis disease process with HCC. We investigated whether there is a difference in clinical outcome between ICC patients with HBV infection and those without any major risk factors for HCC.

Methods: A total of 253 curatively resected, surgically diagnosed ICC patients were analyzed and divided into two groups according to the presence or absence of major risk factors for HCC: an HBV group (n = 45) and a non-HCC-risk (NHR) group (n = 208).

Results: Lymph node metastasis was more frequently observed in the NHR group (HBV vs. NHR: 8.89% vs. 24.52%, P = 0.027). Patients in the HBV group demonstrated more favorable survival than those in the NHR group. However, this difference was not statistically significant (5-year survival rate, 54.7% vs. 42.3%, P = 0.128). Cumulative recurrence rate in the HBV group was 62.2%, which was not significantly different from 63.0% in the NHR group (P = 1.000).

Conclusion: This study found that while ICC patients with HBV infection showed some favorable tumor characteristics, patients' stage-specific survival and recurrence rates were not significantly different compared to those without any major risk factors for HCC.
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http://dx.doi.org/10.1016/j.hpb.2020.10.011DOI Listing
June 2021

Child-Pugh, MELD, MELD-Na, and ALBI scores: which liver function models best predicts prognosis for HCC patient with ascites?

Scand J Gastroenterol 2020 Aug 23;55(8):951-957. Epub 2020 Jul 23.

Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, South Korea.

Objective: It remains controversial whether certain treatments should apply to HCC patients with ascites due to concerns about worsening liver function. The objective of the present study is to compare the prognostic performance of 4 liver function models currently in use for HCC patients with ascites.

Methods: A total of 437 treatment-naïve, newly diagnosed HCC patients were analyzed. The predictive performance of Child-Pugh, MELD, MELD-Na, and ALBI scores were examined using ROC curve analysis.

Results: MELD-Na score showed good performance in predicting 1-, 2-, and 3-year mortality, particularly 1-year mortality. MELD-Na score significantly increased at 30 days after treatment in cases initially receiving best supportive care (14-17,  < .001), TACE (9-11,  < .001), and other treatment (radiotherapy, sorafenib, or systemic chemotherapy) (9-11,  = .021). For patients with advanced tumor stage and MELD-Na score ≥12, HCC-specific treatment did not offer significantly better prognosis compared with only the best supportive care (median survival: 2.2 vs. 1.8 months for HCC-specific treatment vs. best supportive care,  = .15).

Conclusion: MELD-Na can effectively identify liver functional reserve and prognosis in HCC patients with ascites. MELD-Na, together with the tumor stage, may help establish a therapeutic strategy for them.
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http://dx.doi.org/10.1080/00365521.2020.1788139DOI Listing
August 2020

Efficacy and safety of compound tri-metal stent placement for malignant perihilar biliary obstruction.

Niger J Clin Pract 2018 Sep;21(9):1121-1126

Division of Hematology and Medical Oncology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.

Background: Despite many attempts to improve the patency rate of biliary stents in patients with inoperable perihilar cholangiocarcinomas, the longevity of these stents has not been satisfactory. The purpose of the present study is to report technical outcomes and clinical efficacy of the placement of compound tri-metal stent in patients with malignant perihilar biliary obstruction.

Materials And Methods: Retrospective analysis was performed of the medical records of 26 consecutive patients with inoperable malignant perihilar biliary obstruction who underwent compound tri-metal stent placement through a percutaneous transhepatic biliary drainage tube from January 2012 to April 2017.

Results: Placement of the compound tri-metal stent was successfully completed in all 26 patients (technical success, 100%). There was neither procedure-related mortality nor 30-day mortality. None of these patients underwent additional metallic stent placement within 60 days secondary to recurrent cholangitis or stent occlusion. Successful drainage was achieved in 25 (96.2%) of 26 patients who received a compound tri-metal stent. Patients treated with compound tri-metal stent placement had a median stent patency of 145 days (range, 24-426 weeks) and a median survival time of 188 days (range, 37-1732 days).

Conclusions: Placement of compound tri-metal stent in patients with malignant perihilar biliary obstruction may offer a safe and effective alternate technique to improve biliary drainage and stent patency.
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http://dx.doi.org/10.4103/njcp.njcp_290_17DOI Listing
September 2018

Clinicopathological Features and Prognosis of Mixed-Type T1a Gastric Cancer Based on Lauren's Classification.

Ann Surg Oncol 2016 12 9;23(Suppl 5):784-791. Epub 2016 Sep 9.

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

Background: Recent studies have reported that mixed-type (MT) gastric cancer, as per Lauren's classification, exhibits aggressive behavior. However, the behavior of early gastric cancer is unclear. In this study, we addressed the influence of mucosa-confined MT gastric cancer, according to Lauren's classification, on lymph node metastasis (LNM) and long-term outcomes.

Methods: Among patients who underwent gastrectomy for gastric cancer from January 2000 to December 2012, 3170 had mucosa-confined gastric cancer. According to Lauren's classification, 1449 (45.7 %), 1528 (48.2 %), and 193 (6.1 %) patients had intestinal type (IT), diffuse type (DT), and MT cancer, respectively. Moreover, patients with MT cancer were histologically subdivided into IT-predominant MT (3.0 %) and DT-predominant MT (2.5 %) groups. We analyzed and compared the clinicopathological characteristics, incidence of LNM, overall survival, and recurrence-free survival between these groups.

Results: Clinicopathological characteristics showed that mucosa-confined MT gastric cancer had larger size, deeper invasion, and more frequent lymphovascular invasion compared with IT or DT cancers. The LNM of MT lesions (4.7 %) was comparable with that of DT lesions (4.8 %), and multivariate logistic regression analysis indicated that Lauren's classification was a significant predictor for LNM (P < 0.001). However, the overall survival and recurrence-free survival of patients with MT lesions did not differ significantly (P = 0.506 and 0.359, respectively).

Conclusions: Thus, among patients with mucosa-confined gastric cancer, those with MT cancer as per Lauren's classification have aggressive clinical features and a risk of LNM. Hence, surgical treatment may be the preferred option in these patients.
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http://dx.doi.org/10.1245/s10434-016-5549-9DOI Listing
December 2016

Effect of oral antiviral treatment on long-term outcomes of radiofrequency ablation therapy for hepatitis B virus-related hepatocellular carcinoma.

Oncotarget 2016 Jul;7(30):47794-47807

Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Objectives: This study aimed to investigate the effect of oral antiviral treatment on the prognosis of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after radiofrequency (RF) ablation.

Methods: Between January 2003 and December 2010, 228 patients without a history of antiviral treatment were treated with RF ablation for a single HBV-related HCC. We divided the patients into two groups, patients who received (n=125) or did not receive antiviral treatment (n=103), based on whether oral antiviral treatment was administered after RF ablation. The median duration of antiviral treatment was 60.1 months. HCC recurrence and overall survival were compared in the two groups in the full cohort and the propensity score-matched cohort.

Results: In the matched cohort, the probability of HCC recurrence at 5 years was 43.8% for the non-antiviral treatment group and 14.7% for the antiviral treatment group (p<0.001). The probability of overall survival at 5 years was 77.2% for the non-antiviral treatment group and 93.5% for the antiviral treatment group (p=0.002). Multivariable analysis showed that risk factors for HCC recurrence included large tumor size (hazard ratio (HR)=1.30, p=0.022), HBV DNA serum level (HR=1.11, p=0.005), and serum AFP level ≥20 ng/mL (HR=1.66, p=0.005). Overall survival was associated with larger tumor size (HR=1.86, p=0.001) and Child-Pugh Class B (HR=2.13, p=0.019). Oral antiviral treatment after RF ablation was significantly associated with a lower risk of tumor recurrence and death (HR=0.33, p<0.001, and HR=0.44, p=0.004).

Conclusion: Use of oral antiviral treatment after curative RF ablation was associated with favorable outcomes in terms of tumor recurrence and overall survival in patients with HBV-related HCC.
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http://dx.doi.org/10.18632/oncotarget.10026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5216979PMC
July 2016

Prevalence of colorectal adenomas in asymptomatic young adults: a window to early intervention?

Scand J Gastroenterol 2016 14;51(6):731-8. Epub 2016 Jan 14.

b Department of Medicine , Samsung Changwon Hospital, Sungkyunkwan University School of Medicine , Changwon , Korea ;

Objective: The prevalence of colorectal adenoma is increasing in the average-risk population. However, little research is available on colorectal adenoma in young adults under age 40. The aim of this study was to investigate the prevalence and risk factors of colorectal adenoma in 20- to 39-year-old adults.

Methods: We evaluated 4286 asymptomatic young adults aged 20 to 39 years who underwent first colonoscopy screening as part of an employer-provided health wellness programme at the Health Promotion Centre of Samsung Changwon Hospital, Korea from January 2011 to December 2013. Logistic regression modelling was used to identify risk factors for colorectal adenoma in asymptomatic young adults.

Results: The prevalence of colorectal adenoma and advanced adenoma was 11.6% (497/4286) and 0.9% (39/4286), respectively. By age group, the prevalence of colorectal adenoma was 5.4% (33/608) in participants aged 20 to 29 years and 12.6% (464/3678) in participants aged 30 to 39. Colorectal adenoma was found in 13.1% (403/3072) of men and 7.7% (94/1214) of women. Increased risk of colorectal adenoma was associated with age over 30 years (OR, 2.37; 95% CI, 1.64-3.42), current smoker status (OR, 1.48; 95% CI, 1.14-1.91), and alcohol consumption (OR, 1.29; 95% CI, 1.03-1.63).

Conclusions: Our findings indicate that even if the prevalence of colorectal adenoma was low in young adults aged 20 to 39, being over 30, cigarette smoking, and alcohol consumption can affect young adults who have no other CRC risks.
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http://dx.doi.org/10.3109/00365521.2015.1130163DOI Listing
November 2016

Comparison of enhancement and image quality: different iodine concentrations for liver on 128-slice multidetector computed tomography in the same chronic liver disease patients.

Korean J Intern Med 2016 May 23;31(3):461-9. Epub 2015 Dec 23.

Department of Occupational and Environmental Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.

Background/aims: The objective of this study was to compare the degree of hepatic enhancement and image quality using contrast media of different iodine concentrations with the same iodine dose.

Methods: From July 2011 to June 2013, 50 patients with chronic liver disease who underwent baseline and follow-up 128-slice multidetector computed tomography(MDCT) using contrast media with 350 mg I/mL (group A) and 400 mg I/mL (group B) iodine concentrations were included in this prospective study. The patients were randomly allocated to one of two protocols: 350 mg I/mL initially and then 400 mg I/mL; and 400 mg I/mL initially and then 350 mg I/mL. The bolus tracking technique was used to initiate the arterial phase scan. The computed tomography values of hepatic parenchyma, abdominal aorta and portal vein were measured. The degrees of hepatic and vascular enhancement were rated on a 4-point scale for qualitative assessment. The paired Student t test was used to compare outcome variables.

Results: The mean hepatic enhancement was significantly higher in group B than in group A during the portal (p = 0.025) and equilibrium phases (p = 0.021). In all phases, group B had significantly higher mean liver-to-aorta contrast (p < 0.05) and mean visual scores for hepatic and vascular enhancement (p < 0.001).

Conclusions: This study showed that a higher iodine concentration (400 mg I/mL) in contrast media was more effective at improving hepatic enhancement in portal and equilibrium phase images and overall image quality using 128-slice MDCT in chronic liver disease patients.
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http://dx.doi.org/10.3904/kjim.2014.210DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855087PMC
May 2016

Association of nonalcoholic fatty liver disease with bone mineral density and serum osteocalcin levels in Korean men.

Eur J Gastroenterol Hepatol 2016 Mar;28(3):338-44

aDepartment of Internal Medicine, Changwon Hanmaeum Hospital bDepartment of Internal Medicine, Division of Gastroenterology cHealth Promotion Center, Sungkyunkwan University Samsung Changwon Hospital, Changwon-si dDepartment of Internal Medicine, Jinju Bando Hospital, Jinju-si, Republic of Korea.

Objective: Bone mineral density has been reported to negatively associate with nonalcoholic fatty liver disease. Osteocalcin, a bone formation marker and metabolic regulator, has been previously evaluated as the mediator between bone mineral density and nonalcoholic fatty liver disease. Herein, we aimed to investigate the correlations of nonalcoholic fatty liver disease with bone mineral density and serum osteocalcin levels in Korean men.

Methods: A total of 859 men (249 and 610 men with and without nonalcoholic fatty liver disease, respectively) were recruited for this retrospective cross-sectional study. All participants underwent hepatic ultrasonography and dual energy X-ray absorptiometry. Anthropometric and biochemical data, including the serum osteocalcin levels and homeostasis model assessment of insulin resistance (HOMA-IR), were collected.

Results: Nonalcoholic fatty liver disease negatively associated with right-hip bone mineral density (odds ratio, 0.797; 95% confidence interval, 0.645-0.984; P=0.035) and serum osteocalcin (odds ratio, 0.948; 95% confidence interval, 0.910-0.988; P=0.011) after adjusting for BMI and HOMA-IR. The mean right-hip bone mineral density was lower in men with versus without nonalcoholic fatty liver disease after adjusting for serum osteocalcin, BMI and HOMA-IR (0.11±0.06 vs. 0.29±0.04; P=0.019).

Conclusion: Nonalcoholic fatty liver disease negatively associated with right-hip bone mineral density and serum osteocalcin in Korean men. General population-based prospective studies evaluating the causal relationship between bone metabolism and nonalcoholic fatty liver disease are needed, and the mechanism linking nonalcoholic fatty liver disease to bone mineral density beyond insulin resistance and osteocalcin should be evaluated in the future.
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http://dx.doi.org/10.1097/MEG.0000000000000535DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4739310PMC
March 2016

Serum exosomal microRNAs as novel biomarkers for hepatocellular carcinoma.

Exp Mol Med 2015 Sep 18;47:e184. Epub 2015 Sep 18.

Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Recent studies have shown that circulating microRNAs are a potential biomarker in various types of malignancies. The aim of this study was to investigate the feasibility of using serum exosomal microRNAs as novel serological biomarkers for hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). We measured the serum exosomal microRNAs and serum circulating microRNAs in patients with CHB (n=20), liver cirrhosis (LC) (n=20) and HCC (n=20). Serum exosomal microRNA was extracted from 500 μl of serum using an Exosome RNA Isolation kit. The expression levels of microRNAs were quantified by real-time PCR. The expression levels of selected microRNAs were normalized to Caenorhabditis elegans microRNA (Cel-miR-39). The serum levels of exosomal miR-18a, miR-221, miR-222 and miR-224 were significantly higher in patients with HCC than those with CHB or LC (P<0.05). Further, the serum levels of exosomal miR-101, miR-106b, miR-122 and miR-195 were lower in patients with HCC than in patients with CHB (P=0.014, P<0.001, P<0.001 and P<0.001, respectively). There was no significant difference in the levels of miR-21 and miR-93 among the three groups. Additionally, the serum levels of circulating microRNAs showed a smaller difference between HCC and either CHB or LC. This study suggests that serum exosomal microRNAs may be used as novel serological biomarkers for HCC.
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http://dx.doi.org/10.1038/emm.2015.68DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4650928PMC
September 2015

Scrub typhus associated hepatic dysfunction and abdominal CT findings.

Pak J Med Sci 2015 Mar-Apr;31(2):295-9

So Hee Kim, Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Gyeongsangnam-do, Korea.

Objective: This retrospective study investigated abnormal hepatic dysfunction and abdominal computed tomography (CT) findings in scrub typhus.

Methods: Three hundred forty nine adult patients were diagnosed with scrub typhus. Ninety four underwent abdominal CT. The CT images were reviewed by the attending radiologist. Patient data of history, symptoms, signs, and results of laboratory tests were collected from the electronic medical records.

Results: In 349 patients with scrub typhus, elevation of aspartate aminotransferase (78.5%) and alanine aminotransferase (63.0%) were dominant compared to alkaline phosphatase (27.2%) and total bilirubin (16.1%). Abdominal CT findings of 94 patients were, in descending order of frequency, enlarged lymph node (53.2%), inhomogeneous enhancement of liver (47.9%), splenomegaly (46.8%), ascites (28.7%), low attenuation of periportal areas (27.7%), gallbladder wall thickening (17.0%), and splenic infarct (6.4%). Also, the level of aspartate aminotransferase tended to be elevated according to the number of CT findings (P= 0.028).

Conclusions: We found that abdominal CT manifestations of scrub typhus with elevated aminotransferases were varied and not specific. However, knowledge of these findings may evoke the recognition of scrub typhus by clinicians in endemic areas.
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http://dx.doi.org/10.12669/pjms.312.6386DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4476329PMC
June 2015

A Comparison of Preoperative Biliary Drainage Methods for Perihilar Cholangiocarcinoma: Endoscopic versus Percutaneous Transhepatic Biliary Drainage.

Gut Liver 2015 Nov;9(6):791-9

Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.

Background/aims: Controversy remains over the optimal approach to preoperative biliary drainage in patients with resectable perihilar cholangiocarcinoma. We compared the clinical outcomes of endoscopic biliary drainage (EBD) with those of percutaneous transhepatic biliary drainage (PTBD) in patients undergoing preoperative biliary drainage for perihilar cholangiocarcinoma.

Methods: A total of 106 consecutive patients who underwent biliary drainage before surgical treatment were divided into two groups the PTBD group (n=62) and the EBD group (n=44).

Results: Successful drainage on the first attempt was achieved in 36 of 62 patients (58.1%) with PTBD, and in 25 of 44 patients (56.8%) with EBD. There were no significant differences in predrainage patient demographics and decompression periods between the two groups. Procedure-related complications, especially cholangitis and pancreatitis, were significantly more frequent in the EBD group than the PTBD group (PTBD vs EBD 22.6% vs 54.5%, p<0.001). Two patients (3.8%) in the PTBD group experienced catheter tract implantation metastasis after curative resection during the follow-up period.

Conclusions: EBD was associated with a higher risk of procedure-related complications than PTBD. These complications were managed properly without severe morbidity; however, in the PTBD group, there were two cases of cancer dissemination along the catheter tract.
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http://dx.doi.org/10.5009/gnl14243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4625710PMC
November 2015

Association of erectile dysfunction with depression in patients with chronic viral hepatitis.

World J Gastroenterol 2015 May;21(18):5641-6

Bong Oh Ma, Sang Goon Shim, Hae Jin Yang, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon-si 630-723, South Korea.

Aim: To investigate the prevalence of erectile dysfunction (ED) and its association with depression in patients with chronic viral hepatitis.

Methods: This single center cross-sectional study was conducted from August 2013 through January 2014. All outpatients with chronic viral hepatitis in our liver clinic between 18 and 80 years of age were considered eligible for this study. The exclusion criteria included well-established causes of ED, such as diabetes, hypertension, hyperlipidemia, alcohol abuse, liver cirrhosis, ischemic heart disease, renal disease, neurologic disease, and malignancy. We also excluded the patients who had incompletely answered the questionnaires. ED was assessed using the validated Korean version of the International Index of Erectile Function (IIEF-5) scale. The Korean version of the self-administered Beck Depression Inventory (BDI) scale was used to assess depression in the patients. Demographic and medical data were obtained from the patients' medical records. Current or past history of psychiatric diagnosis and drug history including the use of an antiviral agent and an antidepressant were also recorded.

Results: A total of 727 patients met the initial eligibility criteria. Six hundred seventeen patients were excluded because their medical records contained one or more of the previously determined exclusion criteria. The remaining 110 patients were assessed based on the BDI and IIEF-5 questionnaires. Based on the IIEF-5 scale, the prevalence of ED among patients with chronic viral hepatitis was 40%. Compared with the non-ED group, patients in the ED group were older. The proportion of patients in the ED group who had a job or who were naïve peg-interferon users was lower than that in patients in the non-ED group. Patients with ED had significantly lower scores on the IIEF-5 scale than patients without ED (11.75 ± 4.88 vs 21.33 ± 1.86, P = 0.000). Patients with ED rated significantly higher scores on the BDI scale compared with patients without ED (12.59 ± 7.08 vs 5.30 ± 4.00, P = 0.000). Also, the IIEF-5 scores were negatively correlated with age, employment, and BDI scores. In the multiple logistic regression analysis, age and depression were independently associated with erectile dysfunction (P = 0.019 and 0.000, respectively).

Conclusion: Patients with chronic viral hepatitis have a high prevalence of ED. Age and depression are independent factors for ED in male patients with chronic viral hepatitis.
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http://dx.doi.org/10.3748/wjg.v21.i18.5641DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4427689PMC
May 2015

Comparison of dexmedetomidine with on-demand midazolam versus midazolam alone for procedural sedation during endoscopic submucosal dissection of gastric tumor.

J Dig Dis 2015 Jul;16(7):377-84

Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.

Objective: Endoscopic submucosal dissection (ESD) is commonly performed as a treatment for gastric neoplasms. However, sedation with midazolam (MDZ) often does not reach satisfactory sedation levels during the procedure and the drug may suppress respiration and blood pressure. This study aimed to investigate the safety and efficacy of dexmedetomidine (DEX) with on-demand MDZ (the DEX group) in comparison with MDZ alone (the MDZ group) as a sedative during ESD of gastric neoplasms.

Methods: Eighty patients undergoing ESD for gastric tumor were randomly assigned to one of two treatment regimens (40 patients in each). We investigated the depth of sedation by using a Modified Observers Assessment Alertness/Sedation score, the number of patients' reactions interfering with the procedure, sedation related-adverse events and the degree of satisfaction of patients and doctors.

Results: There was no statistically significant difference between the two groups regarding their age, gender, body mass index, American Society of Anesthesiologists physical status classification and the characteristics of the tumor. Appropriate sedation rate and the degree of satisfaction of the doctors were significantly higher in the DEX group than in the MDZ group. Patients' reactions interfering with the procedure were more numerous in the MDZ group than in the DEX group. There was no significant difference in adverse events between the two groups.

Conclusions: DEX with on-demand MDZ for sedation during gastric ESD is as safe as MDZ alone and the sedation effect of DEX with MDZ is superior to that of MDZ alone.
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http://dx.doi.org/10.1111/1751-2980.12254DOI Listing
July 2015

Clinical features in liver cirrhosis patients who have experienced ischemic stroke.

Turk J Gastroenterol 2014 Dec;25(6):696-701

Division of Gastroenterology, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.

Background/aims: The actual incidence of ischemic stroke in patients with liver cirrhosis remains controversial. The aim of this study was to analyze the clinical features of patients with liver cirrhosis who have experienced ischemic stroke.

Materials And Methods: A retrospective analysis was performed on the medical records of 23 ischemic stroke cases who were also diagnosed with liver cirrhosis, over a 10 year period from January 2001 to December 2010.

Results: Using the Child-Pugh classification system, Class B (39%) was the most common among the liver cirrhosis patients with ischemic stroke. There were six patients who presented with Class C (26%). Alcohol was analyzed as the main cause for liver cirrhosis in 14 patients (60.8%). Among the risk factors of ischemic stroke, nine of the 23 patients (39.1%) were diagnosed with obesity, and seven patients each (30.4%) were diagnosed with arrhythmia or smoking history. In total, only two patients (8.7%) had no association with any of the risk factors for ischemic stroke.

Conclusion: Our results show that a comparatively high frequency of ischemic stroke occurs in patients with alcohol-induced liver cirrhosis and in patients with a less compromised liver function. In addition, it was found that most patients possessed at least one risk factor of ischemic stroke.
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http://dx.doi.org/10.5152/tjg.2014.5959DOI Listing
December 2014

United Rapid Urease Test Is Superior than Separate Test in Detecting Helicobacter pylori at the Gastric Antrum and Body Specimens.

Clin Endosc 2012 Nov 30;45(4):392-6. Epub 2012 Nov 30.

Department of Internal Medicine and Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea.

Background/aims: The rapid urease test (RUT) is an invasive method to diagnose Helicobacter pylori infection, which relies on the acquisition and examination of gastric antrum and body tissues. We determined and compared the efficacy of RUT when the tissues were examined separately or after being combined.

Methods: Two hundred and fourteen patients were included and underwent esophagogastroduodenoscopy from July 2008 to June 2010. The separate test was defined as evaluating the status of infectivity of H. pylori from the antrum and body separately; whereas the united test was carried out putting both tissues from the antrum and body in the same RUT kit. All RUTs were read by a single observer 1, 3, 6, 12, and up to 24 hours later. We also got two biopsy specimens stained with hematoxylin and eosin and quantified H. pylori density was calculated on a scale of 0 to 3.

Results: Overall positivity for H. pylori was 137 (64%) for the separate test and 148 (69.2%) for the united test (p<0.01). The mean time to a positive test was 3.58 hours for the separate test and 1.69 hours for the united test (p<0.01). The correlation between the time to positive RUT and the severity of histology showed r=+0.556 for the antrum (p<0.01) and r=+0.622 for the body (p<0.01).

Conclusions: Combining tissues prior to RUT enhances the detection of H. pylori, as compared with the examination of separate tissues, and shortens the time to develop a positive reaction by approximately 50%. These diagnostic advantages are also accompanied by increased cost-savings.
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http://dx.doi.org/10.5946/ce.2012.45.4.392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3521941PMC
November 2012

Risk factors for residual cancer and lymph node metastasis after noncurative endoscopic resection of early colorectal cancer.

Dis Colon Rectum 2013 Jan;56(1):35-42

Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.

Background: Endoscopic resection could be a curative treatment for early colorectal cancer without the possibility of lymph node metastasis. However, if the resection margin is positive, and there is a risk of lymph node metastasis, additional surgery should be performed.

Objective: The aim of this study was to investigate the characteristics of patients who underwent additional surgery to determine risk factors associated with residual tumor and lymph node metastasis.

Design: This study is a retrospective analysis.

Settings: This study was conducted at a tertiary academic hospital.

Patients: We evaluated 85 patients who underwent additional surgery with curative intent after endoscopic resection for early colorectal cancer at the Samsung Medical Center, Seoul, South Korea, between January 2001 and April 2010.

Main Outcome Measures: We identified risk factors associated with residual tumor or lymph node metastasis in surgical specimens after noncurative endoscopic resection for early colorectal cancer.

Results: Among 85 patients who underwent additional surgery after noncurative endoscopic resection, 76 (89.4%) had submucosal invasion greater than 1000 μm. Twenty-one (24.7%) and 25 patients (29.4%) had a positive lateral or vertical resection margin, and 11 patients (12.9%) had inadequate lifting sign. After additional surgery, patients were divided into 2 groups according to the presence or absence of residual tumor and/or lymph node metastasis. There was no significant difference between the groups in positive lateral margin, but there was a significant difference in positive vertical margin (p = 0.015 with an OR of 15.02). In patients with inadequate lifting sign, the OR was 13.68 (p = 0.013).

Limitations: This study was limited by its retrospective nature.

Conclusion: There is a greater need for additional surgery in cases with positive vertical resection margin or inadequate lifting sign, because the risk of residual tumor and lymph node metastasis is higher than in other cases.
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http://dx.doi.org/10.1097/DCR.0b013e31826942eeDOI Listing
January 2013

Treatment outcomes according to endoscopic treatment modalities for rectal carcinoid tumors.

Clin Res Hepatol Gastroenterol 2013 Jun 5;37(3):275-82. Epub 2012 Sep 5.

Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.

Background: Despite a growing understanding of the clinical effectiveness of endoscopic treatment for small rectal carcinoid tumors, there is still controversy concerning the best endoscopic treatment for resecting rectal carcinoid tumors easily and effectively.

Objectives: The objective of the present study was to compare the therapeutic efficacy and safety of endoscopic submucosal resection with a ligation device (ESMR-L) with endoscopic submucosal dissection (ESD) for rectal carcinoid tumors. In addition, a conventional snare-based endoscopic mucosal resection (EMR) was included in the study and compared with both ESMR-L and ESD.

Methods: A retrospective analysis was performed in 115 patients who underwent endoscopic resection of a rectal carcinoid tumor between January 2005 and June 2011. These patients were classified into three groups according to the type of endoscopic procedure: EMR group (n=33), ESMR-L group (n=40) and ESD group (n=44).

Results: The complete resection rate of the EMR group was significantly lower than those of the ESMR-L and ESD groups (77.4 vs. 100 and 97.7%, P=0.002 and P=0.007). Tumor-free vertical margins were significantly greater in the ESMR-L and ESD groups than in the EMR group (ESMR-L and ESD vs. EMR group, P=0.013 and P=0.041). The curative resection rate of rectal carcinoid tumors in the EMR group was 77.4%, which was significantly lower than that of the ESMR-L (95%, 38/40) and EDS groups (97.7%, 43/44) (77.4% vs. 95%, P=0.036 and 77.4% vs. 97.7%, P=0.007).

Conclusions: Our results show that ESMR-L and ESD might be superior to conventional EMR for the treatment of small rectal carcinoid tumors.
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http://dx.doi.org/10.1016/j.clinre.2012.07.007DOI Listing
June 2013

A comparison of bilateral stenting methods for malignant hilar biliary obstruction.

Hepatogastroenterology 2012 Mar-Apr;59(114):341-6

Department of Medicine, Samsung Medical Center, Seoul, Korea.

Background/aims: Despite common use of stent-instent methods for endoscopic bilateral metal stenting in malignant hilar obstruction, the longevity of these stents and clinical outcomes of patients who receive them are less well known than for the side-by-side method. We aimed to compare treatment outcomes according to bilateral stenting method.

Methodology: A total of 41 patients were divided into two groups: a bilateral side-by-side metal stenting group (side-by-side group, n=19) and a bilateral stent-in-stent metal stenting group (stent-in-stent group, n=22).

Results: During the study period, successful drainage was achieved in 15 of 19 patients (78.9%) with the side-by-side placement, which did not differ significantly from the proportion with the stent-in-stent placement (18 of 22 patients, 81.8%). The two groups did not differ significantly in rates of early complications (31.6% vs. 22.7%, p=0.725), late complications (36.8% vs. 50.0%, p=0.531) or death (47.4% vs. 54.5%, p=0.647). Comparing stent patency and survival curves according to bilateral stenting type, patients with stent-in-stent placement and those with side-by-side placement did not differ significantly (p=0.771 and p=0.769).

Conclusions: Our results show no significant difference in clinical outcomes, including stent patency and overall survival, between side-by-side and stent-in-stent bilateral metal stenting in patients with malignant hilar obstruction.
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http://dx.doi.org/10.5754/hge11533DOI Listing
April 2013

Drug-Induced Liver Injury: Twenty Five Cases of Acute Hepatitis Following Ingestion of Polygonum multiflorum Thunb.

Gut Liver 2011 Dec 21;5(4):493-9. Epub 2011 Nov 21.

Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.

Background/aims: Complementary medicines, including herbal preparations and nutritional supplements, are widely used without prescriptions. As a result, there has been growing interest in the risk of hepatotoxicity with these agents. It is difficult to determine causal relationships between these herbal preparations and hepatotoxicity. We report on 25 patients diagnosed with toxic hepatitis following ingestion of Polygonum multiflorum Thunb.

Methods: Twenty-five patients (median age, 48 years [24 to 65 years]; M:F=18:7) with suspected P. multiflorum Thunb-induced liver injury were admitted to our hospital between 2007 and 2009. We analyzed clinical and histological data, including the types and the duration of P. multiflorum Thunb intake and the duration of hospital care. We also determined the type of liver injury using the R ratio (serum activity of ALT/serum activity of ALP).

Results: The types of complementary medicine used included tea (n=16), liquor (n=5), tea and liquor (n=2), powder (n=1), and honeyed pudding (n=1). The most common presenting sign was jaundice (76%), and 18 patients (72%) had evidence of hepatocellular liver injury. Histological findings were consistent with acute hepatitis in all cases (n=10) for which liver biopsy was performed. Twenty-three patients (91.6%) recovered with conservative management, 1 patient (4%) had a liver transplant, and 1 patient (4%) died of hepatic failure.

Conclusions: In our cases, we found that P. multiflorum Thunb could be hepatotoxic and could lead to severe drug-induced liver injury, and even death.
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http://dx.doi.org/10.5009/gnl.2011.5.4.493DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3240794PMC
December 2011

Impact of previous gastric or colonic resection on polyethylene glycol bowel preparation for colonoscopy.

Surg Endosc 2012 Jun 15;26(6):1554-9. Epub 2011 Dec 15.

Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong Gangnam-gu, Seoul, Korea.

Introduction: Adequate bowel preparation is essential for successful completion of colonoscopy. This study examines whether previous bowel resection affects the quality of bowel preparation.

Methods: This study prospectively included patients who had gastric or colonic resection (bowel resection group, n = 92) and a control group (n = 92). All patients received 4 L polyethylene glycol (PEG) for bowel preparation. Quality of colonic preparation was assessed using the Aronchick scale (excellent, good, fair, or poor) and was categorized as satisfactory (excellent or good) or unsatisfactory (fair or poor). We analyzed whether previous gastric or colonic resection is associated with unsatisfactory preparation.

Results: Bowel preparation quality was significantly different between the resection group (0, 39.1, 43.5, and 17.4%, for excellent, good, fair, and poor) and control group (3.3, 53.3, 38.0, and 5.5% for excellent, good, fair, and poor, P = 0.011). Inadequate bowel preparation was significantly higher in the resection group than in the control group (60.9% vs. 43.5%, P = 0.018). Univariate analysis revealed height, weight, body mass index, and bowel resection to be predictors of unsatisfactory preparation. Multivariate analysis revealed bowel resection [odds ratio (OR) 2.12; 95% confidence interval (CI): 1.16-3.86] and obesity (body mass index ≥ 25 kg/m(2)) (OR 2.16; 95% CI: 1.13-4.12) to be independent predictors of unsatisfactory preparation. The prevalence of unsatisfactory and poor bowel preparation quality was 79.3 and 37.9% in obese patients with previous bowel resection.

Conclusions: Previous bowel resection was an independent predictor of unsatisfactory PEG bowel preparation. More attention is needed for patients with previous bowel resection, especially for obese patients.
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http://dx.doi.org/10.1007/s00464-011-2068-4DOI Listing
June 2012

[A single institution's experience of endoscopic retrograde cholangiopancreaticography in the eldery patients: outcomes, safety and complications].

Korean J Gastroenterol 2011 Dec;58(2):88-92

Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.

Background/aims: As the population ages, endoscopic retrograde cholangiopancreaticography (ERCP) is being used increasingly as a diagnostic and therapeutic tool for elderly patients with pancreatobiliary disease. The aim of this study was to assess the outcomes, safety and complications associated with ERCP performed in the elderly patients.

Methods: We retrospectively reviewed the medical record of 596 patients who were 50 years of age or older and underwent ERCP from January 2005 to September 2010. The patients were classified into two groups according to the age: non-elderly, 50-74 years old and elderly, ≥75 years old. Comparisons were made between two groups.

Results: Five hundred and ninety-six patients (132 elderly and 464 non-elderly patients) were enrolled. The success rate of ERCP was 89.4% in the elderly and 91.9% in the non-elderly. The major complications were occurred in 11 patients of the elderly and 16 of the non-elderly, and the complication rate was significantly higher in the elderly compared to the non-elderly (8.3% vs. 3.4%, p=0.011). Pancreatitis occurred in 2 elderly patients and 10 non-elderly patients (1.5% vs. 2.1%, p=1.0). There was a higher rate of bleeding in the elderly patients (4.5% vs. 1.3%, p=0.01).

Conclusions: ERCP is effective and safe even in elderly patients. Outcomes of diagnostic and therapeutic ERCP in the elderly patients were similar to those in non-elderly patients. Elderly patients undergoing ERCP carried similar risk of pancreatitis but a higher risk of bleeding and perforation compared to non-elderly patients.
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http://dx.doi.org/10.4166/kjg.2011.58.2.88DOI Listing
December 2011

Association between colorectal cancer and colonic diverticulosis: case-control study based on computed tomographic colonography.

Abdom Imaging 2012 Feb;37(1):70-3

Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background: The association between colorectal cancer (CRC) and diverticulosis is uncertain, and there is little data reported in Asia. This study examined the association of both diseases based on the computed tomographic colonography (CTC).

Methods: This study was designed as a case-control study. Korean subjects undergoing CTC between April 2002 to April 2008 in Samsung Medical Center were eligible. Patients with histologically proven colorectal cancer (case group) and asymptomatic age and gender matched controls (control group) were analyzed retrospectively.

Results: A total of 604 subjects were enrolled in this study (Case group N = 302, Control group N = 302). The case group was 54.6% male and the median age was 56.9 years old. Among them 24.5% of CRC patients had diverticulosis compared to 29.5% of controls (P = 0.169). The distribution of diverticulosis between the two groups was similar. Subset analysis revealed no difference in the location of diverticulosis in patients with right colon cancer and left colon cancer (P = 0.781).

Conclusions: This study indicates that CRC is not associated with diverticulosis.
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http://dx.doi.org/10.1007/s00261-011-9743-8DOI Listing
February 2012

[A case of superior mesenteric venous thrombosis due to protein C deficiency in a patient with duodenal ulcer bleeding].

Korean J Gastroenterol 2011 Jan;57(1):34-7

Department of Internal Medicine, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea.

Mesenteric venous thrombosis is a clinically very rare disease, and may cause bowel infarction and gangrene. Difficulty in the diagnosis the disease due to its non-specific symptoms and low prevalence can cause a clinically fatal situation. Mesenteric venous thrombosis may be caused by both congenital and acquired factors, and protein C deficiency, which is a very rare genetic disorder, is one of many causes of mesenteric thrombosis. The authors experienced a case of mesenteric venous thrombosis caused by protein C deficiency in a patient with duodenal ulcer bleeding, so here we report a case together with literature review.
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http://dx.doi.org/10.4166/kjg.2011.57.1.34DOI Listing
January 2011

Coexistence between carotid artery stenosis and colorectal adenomatous polyps in middle-aged men.

Digestion 2010 30;81(1):20-6. Epub 2009 Dec 30.

Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.

Background: Colorectal neoplasia and cardiovascular disease appear to share common risk factors. This study aimed to investigate the association between the thickness of the intima-media complex (IMT) or carotid artery stenosis (CAS) on carotid artery ultrasonography and the presence of colorectal adenomas in middle-aged asymptomatic men.

Methods: This study was conducted among 1,877 asymptomatic male subjects, 40-59 years, who underwent both carotid artery ultrasonography and colonoscopy for routine health examination. Clinical information was collected from a standardized questionnaire, physical examination and blood tests.

Results: The prevalence of overall colorectal adenomatous polyps (APs) was 31.4% (591/1,877). The subjects were divided into two groups according to the presence of APs in the colorectum. The prevalence of IMT >or=10 mm was significantly higher in the subjects with CAS than in those without CAS (10.1 vs. 0.7%, p < 0.001). CAS was more prevalent in the AP-positive group than in the AP-negative group (40.5 vs. 30.2%, p = 0.001). Moreover, CAS was more prevalent in the advanced AP-positive group than in the advanced AP-negative group (15.2 vs. 8.2%, p = 0.048).

Conclusion: This study suggests that there is a relationship between colorectal AP and CAS, probably due to common risk factors.
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http://dx.doi.org/10.1159/000217451DOI Listing
May 2010

[Colonoscopic perforation; a 10-year experience in single general hospital].

Korean J Gastroenterol 2009 Dec;54(6):371-6

Department of Gastroenterology, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background/aims: Colonoscopy is the principal method for diagnosis, treatment, and follow up of colorectal disease. The study aimed to assess the incidence, clinical features, and management of colonoscopic perforations at a local general hospital.

Methods: A retrospective review of patient record was performed for all patients with iatrogenic colonic perforation after sigmoidoscopy and colonoscopy between 1997 and 2007.

Results: In the 10-year period, 16,388 colonoscopic and sigmoidscopic procedure were performed. All 10 cases of procedure related colonic perforation were developed. Perforation occurred in 9 cases during therapeutic procedure; 5 cases due to polypectomy and 4 cases due to endoscopic submucosal dissection. Perforation occurred in one case during diagnostic procedure.

Conclusions: Therapeutic procedure is a clear risk factor of colonic perforation. When colonic perforation occurs, we should be able to make early diagnosis. Early diagnosis can lead to a good treatment and can produce good prognosis with short hospital days.
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http://dx.doi.org/10.4166/kjg.2009.54.6.371DOI Listing
December 2009

Procedure-related musculoskeletal symptoms in gastrointestinal endoscopists in Korea.

World J Gastroenterol 2008 Jul;14(27):4359-64

Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Dong 50, Gangnam-Gu, Seoul 135-710, South Korea.

Aim: To determine the prevalence and risk factors of work-related musculoskeletal disorders in gastrointestinal endoscopists in Korea.

Methods: A survey of musculoskeletal symptoms, using a self-administered questionnaire, was conducted on 55 endoscopists practicing in general hospitals or health promotion centers.

Results: Forty-nine (89.1%) endoscopists reported musculoskeletal pain on at least one anatomic location and 37 (67.3%) endoscopists complained of pain at rest. Twenty-six (47.3%) endoscopists had severe musculoskeletal pain defined as a visual analogue score greater than 5.5. Factors related to the development of severe pain were (1) standing position during upper endoscopy, (2) specific posture/habit during endoscopic procedures, and (3) multiple symptomatic areas. Finger pain was more common in beginners, whereas shoulder pain was more common in experienced endoscopists. Sixteen percent of symptomatic endoscopists have modified their practice or reduced the number of endoscopic examinations. Only a few symptomatic endoscopists had sought professional consultation with related specialists.

Conclusion: The prevalence of musculoskeletal pain in endoscopists is very high. The location of pain was different between beginners and experienced endoscopists. Measures for the prevention and adequate management of endoscopy-related musculoskeletal symptoms are necessary.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2731189PMC
http://dx.doi.org/10.3748/wjg.14.4359DOI Listing
July 2008

[A case of ischemic skin necrosis after glypressin therapy in liver cirrhosis].

Korean J Gastroenterol 2008 Jun;51(6):381-4

Department of Internal Medicince, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Terlipressin is a synthetic analogue of vasopressin, which has been used in the treatment of acute variceal hemorrhage. In contrast to vasopressin, terlipressin can be administered as intermittent injections instead of continuous intravenous infusion. Thus, it has a less adverse reaction than vasopressin. We report a case of ischemic skin complication in a cirrhotic patient treated with terlipressin. A 71-year-old man with liver cirrhosis was admitted because of hematemesis and melena. He was commenced on terlipressin at a dose 1 mg every 6 hours for the treatment of varicieal bleeding. After 36 hours of treatment, skin blistering and ecchymosis was noted on the skin of his upper thigh, scrotal area and trunk. We found that terlipressin was a possible cause of ischemic skin complication based on the skin biopsy finding. Terlipressin may induce a complication of the ischemic event. In spite of rarity, special attention needs to paid on the peripheral ischemic complication of terlipressin.
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June 2008

Risk factors of lymph node metastasis in T1 esophageal squamous cell carcinoma.

J Gastroenterol Hepatol 2008 Apr 13;23(4):619-25. Epub 2007 Dec 13.

Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background And Aim: To perform endoscopic mucosal resection (EMR) for T1 esophageal cancer, it is essential to estimate the lymph node status exactly. In order to evaluate the feasibility of EMR for esophageal cancers, we evaluated the clinicopathological features of T1 esophageal squamous carcinomas with an emphasis on the risk factors and distribution patterns of lymph node metastasis.

Methods: From 1994 to 2006, a total of 200 patients with T1 esophageal carcinoma were treated surgically in our institution. Among them, clinicopathological features were evaluated for 197 consecutive patients with T1 squamous cell carcinoma.

Results: The frequency of lymph node involvement was 6.25% (4/64) in mucosal cancers and 29.3% (39/133) in submucosal cancers (P < 0.001). In patients with M1 (n = 32) and M2 (n = 14) cancers, no lymph node metastasis was found. In multivariate analysis, size larger than 20 mm, endoscopically non-flat type, and endo-lymphatic invasion were significant independent risk factors for lymph node metastasis. The differentiation of tumor cell was not a risk factor for lymph node metastasis.

Conclusions: We suggest that EMR may be attempted for flat superficial squamous esophageal cancers smaller than 20 mm. After EMR, careful histological examination is mandatory.
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http://dx.doi.org/10.1111/j.1440-1746.2007.05259.xDOI Listing
April 2008

The comparison of the risk factors and clinical manifestations of proximal and distal colorectal cancer.

Dis Colon Rectum 2008 Jan 21;51(1):56-61. Epub 2007 Nov 21.

Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Dong 50, Gangnam-gu, Seoul, South Korea.

Purpose: Colorectal cancers in the proximal or distal site have distinct clinical characteristics. In this study, the authors compared the risk factors of proximal and distal colorectal cancer.

Methods: A 16-page questionnaire was administered to 529 patients with colorectal cancer before operation. Cancers were classified as proximal or distal relative to the splenic flexure. Of these 529 patients, 6 patients were excluded because of the presence of synchronous colorectal cancers. Data of the 523 patients were analyzed.

Results: Total numbers of proximal and distal cancers were 123 and 400. The proportion of patients with Type 2 diabetes was significantly higher for distal cancer (P = 0.034), whereas a greater proportion of patients with proximal cancer had a gallstone history (P = 0.005). Multivariate analysis revealed Type 2 diabetes to be a risk factor for distal colorectal cancer (P = 0.027) and cholelithiasis to be a risk factor for proximal cancer (P = 0.049). The odds ratio for distal colorectal cancer among males with Type 2 diabetes was 4.1 (95 percent confidence interval, 1.4-12.1). On the other hand, a gallstone history was more associated with proximal colon cancer, especially in females (odds ratio = 5.5; 95 percent confidence interval, 1.4-20.9).

Conclusions: A comparison of the risk factors of proximal and distal colorectal cancer showed that Type 2 diabetes is associated with distal colorectal cancer in males and that cholelithiasis is associated with proximal colon cancer in females.
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http://dx.doi.org/10.1007/s10350-007-9083-5DOI Listing
January 2008
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