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간외담도 결석의 내시경적 치료 성적과 이에 영향을 미치는 요인
백순구(Soon Koo Baik),김준명(Jun Myeong Kim),김광현(Kwang Hyun Kim),정연수(Yon Soo Jeong),이동기(Dong Ki Lee),권상옥(Sang Ok Kwon) 대한내과학회 1998 대한내과학회지 Vol.54 No.4
N/A Objectives : Developments in endoscopic technique and equipments have improved duct clearance rate in patients with extrahepatic bile duct(EHBD) stone. In this study, we reviewed our experience in extracting EHBD stones with standard and more advanced technique and equipments such as mechanical lithotripsy and extracorporeal shock wave lithotripsy. Aims of this study were to determine the overall success rate of endoscopic extracting for EHRD stone, to identify risk factors for failed duct clearance at initial and final therapeutic ERCP. Methods : We retrospectively reviewed 214 consecutive patients who underwent Endoscopic Retrograde Cholangiopancreatography(ERCP) for EHBD stone over 45 months period. Factors evaluated for failed duct clearance included stone size, stone number, stone shape, concomitant stone of gallbladder and intrahepatic duct, presence of distal bile duct stricture, periampullary diverticula(PAD), Billroth-II gastrojejunostomy, and sepsis at admission. Results: The overall success rate of endoscopic treatment for EHBD stone was 93.5% (200/214). The causes of failed duct clearance were failed endoscopic sphincterotomy in 5/214 (2.3%), technical failure of extracting stone in 5/214(2.3%), and aggravation of acute cholecystitis between therapeutic endoscopic sessions in 4/214(1.9%), Risk factors for failed duct clearance with endoscopic extraction of EHBD stone were size and shape of the stone, concomitant stone of gallbladder and intrahepatic duct, and stricture of distal common bile duct. The duct clearance rate with initial therapeutic ERCP was 56.5%(121/200). Risk factors for failed duct clearance with initial therapeutic ERCP were size, shape and number of stone, and sepsis at admission. The complications of endoscopic treatment for EHBD stone were major bleeding in 5/200 (2.5%), pancreatitis in 18/200 (9.0%), but there was no perforation. Conclusion: Eventhough risk for failure of endoscopic treatment for EHBD stone were giant or piston shaped stone, concomitant stone of gallbladder and intrahepatic duct, and stricture of distal common bile duct, we conclude that endoscopic treatment for EHBD stone is safe and effective treatment modality, and choice of treatment.
백순구 ( Soon Koo Baik ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.2
Currently, the most effective treatment for end-stage liver fibrosis is liver transplantation; however, transplantation is limited by a shortage of donor organs, surgical complications, immunological rejection and high medical costs. Hence, stem cell transplantation has been suggested as an effective alternate therapy for hepatic disease. Hematopoietic stem cell, mesenchymal stem cell (MSC), umbilical cord blood cells, fetal liver progenitor cells, adult liver progenitor cells, and mature hepatocytes have been reported to be capable of self-renewal, giving rise to daughter hepatocytes both in vivo and in vitro. Bone marrow comprises two main populations of stem cells, hematopoietic stem cells and MSC, of which the latter have been considered as alternative cell sources for liver or hepatocyte transplantation because of their high capability for self-renewal and differentiation without ethical or tumorigenic problems. Indeed, stem cell therapies have shown promising benefits for hepatic fibrosis in experimental and clinical studies. In liver damage, MSC are able to differentiate into hepatocytes, stimulate the regeneration of endogenous parenchymal cells, migrate to damaged sites, and enhance fibrous matrix degradation indicating antifibrotic effect. Furthermore, several clinical studies have demonstrated favorable effects such as MSC improving the liver function and histological grading of fibrosis in patients with cirrhosis. Recently, multicenter randomized clinical trial conducted in Korea shows clinical efficacy and safety of MSC application, indicating that it has a potential to be a new strategy for chronic liver disease such as cirrhosis. Therefore, further clinical trials are required to validate and support the results for objective confirmation of clinical advantages of MSC therapy.
간경변증에 동반된 특발성 세균성 복막염의 재발빈도 및 예견인자
백순구(Soon Koo Baik),권상옥(Sang Ok Kwon),박의련(Eui Ryun Park),김준명(Jun Myeong Kim),이용규(Yong Gyu Lee),최윤종(Yeun Jong Choi),김일희(Il Hoi Kim),이동기(Dong Ki Lee) 대한내과학회 1998 대한내과학회지 Vol.54 No.6
N/A Objectives: Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication of cirrhosis. In the most recently published studies, the prevalence of SBP among hospitalized cirrhotics with ascites has been estimated to be around 10-15%, the mortality rate related to this complication being more than 50%. SBP is thought to appear as a consequence of the impaired defensive mechanisms against infection present in cirrhotic patients, such as depressed reticuloendothelial system phagocytic activity, impaired leukocyte function, reduced serum compliment levels, and low antibacterial activity of ascitic fluid. It has proposed that ascitic fluid opsonin capacity is directly correlated to ascitic protein concentration and that this explains an observed predisposition to infection in patients with low ascitic fluid protein concentration. This present study aims to investigate the frequency of the recurrence of SBP in u large series of cirrhotic patient who recovered from the first episode of SBP and to identify any possible predictors of recurrent SBP. Method: We reviewed records of chart in 312 consecutive cirrhotics with ascites patients treated in our hospital between January, 1988 and August, 1995. Results: The incidence of SRP was 21.8% (68 cases) and showed 80.9% in male, 19.1% in female. Seven- teen (25%) of the 68 patients included in the study after the resolution of their first episode of SBP developed one or more episodes of SBP during follow-up. SBP recurred once in 16 of these patients, twice in 1 patients. The cumulative probability of SBP recurrence was 47.1% at 6 months, 64.7% at 12 months, and 82% at 18 months of follow-up. This study reveals that neither ascitic fluid total protein nor the severity of liver disease(Child's class) predicts the occurence of recurrant SBP. Conclusion: We conclude that the occurrence of recurrent SBP is unrelated to the type of liver disease, and severity of liver disease did not predict the presence of recurrent SBP. Also, ascitic fluid total protein ≤1.0 g/dl, prothrombin time 45% may not be a sensitive predictor of recurrent SBP.
간경변 환자의 문맥압 항진증에 대한 Terlipressin 의 효과
백순구(Soon Koo Baik),김영주(Young Ju Kim),박중화(Joong Wha Park),서정인(Jung In Seo),정필호(Pil Ho Jeong),김문영(Moon Young Kim),박동훈(Dong Hun Park),김현수(Hyun Soo Kim),이동기(Dong Ki Lee),권상옥(Sang Ok Kwon) 대한소화기학회 2002 대한소화기학회지 Vol.39 No.3
Background/Aims: We conducted this prospective study to evaluate portal hypotensive effect of terlipressin in patients with liver cirrhosis and to find out the factors that contribute to effective reduction of portal pressure after terlipressin administration. Methods: A total of 34 patients with cirrhosis who have experienced variceal bleeding were selected. We measured the mean blood pressure (MBP), heart rate (HR), hepatic venous pressure gradient (HVPG), and portal venous flow (PVF) before and 5, 10, 15, 20 minutes after terlipressin administration. Patients who showed an average HVPG reduction of ≥ 20% from 5 min to 20 min after terlipressin administration were defined as responder. Results: At 5 minutes after terlipressin administration, HVPG and PVF decreased from 17.5±5.5 mmHg to 14.1±4.7 mmHg (-19.4±14.8%, p<0.01) and, from 842.6±386.0 mL/min to 642.5±358.5 mL/min (-25.5±12.2%, p<0.01). Elevation of MBP and reduction of HR started after 5 min (p<0.01) and sustained until 20 min. Twenty six patients (76.5%) were classified as responder. In multivariate analysis to identify factors which affect responder, only the Child-Pugh score was a significantly independent factor for responder (Child-Pugh score < 10, odds ratio 135.3, 95% CI [2.45, 7472.33], p=0.016). Conclusions: Terlipressin might be helpful in control of variceal bleeding due to reducing portal pressure and more effective in cirrhotic patients with a low Child-Pugh score. (Korean J Gastroenterol 2002;39:198-203)
문맥압 항진증의 약물 치료 -국내 자료와 경험을 중심으로-
백순구 ( Soon Koo Baik ) 대한소화기학회 2005 대한소화기학회지 Vol.45 No.6
Portal hypertension as a consequence of liver cirrhosis is responsible for serious complications such as variceal bleeding, ascites and hepatic encephalopathy. Successful pharmacological treatment of portal hypertension can prevent the risk of the varicea