Dubin - Johnson 증후군 (증후군) 10예에 대한 임상적 (임상적) 고찰

윤용범,이원표,김정용 ( Yong Bum Yoon,Won Pyo Lee,Chung Young Kim ) 대한소화기학회 1980 대한소화기학회지 Vol.12 No.1

The Dubin-Johnson Syndrome is characterized by chronic, mild, predominantly conjugated hyperbilirubinemia with a blcak liver and pigmentation of parenchymal liver cell. The disor- der result from an inherited abnormality in the excretion of various non-bile salt organic anion from the liver cell into the bile. It is benign non-progressive and not associated with any form of chronic hepatic or biliary tract disease. The diagnosis of the Dubin-Johnson synd- rome is established by secondary rise in BSP retension test and needle biopsy of the liver. The important consideration in managing patient with this disorder are the reassurrance that the abnormality is benign and leads to no disability or reduction in life expectancy and the avoidance of unnecessary biliary tract surgery. Clinical observation was made on 10 cases of Dubin-Johnson Syndrome admitted to department of internal medicine, Seoul Xatio- nal University Hospital from 1969 to 1979. The following results are obtained 1. The male to female ratio was 6: 4 and the majority of the caes are in 'rd decale 2. There avere 3 cases of jaundice on family history and 2 cases ,vere 'orother nd sister relationship The chief complaints on admission were in order of jaund!ce, Satigue, rigiit upper abd- ominal oain and darl- urine. Hepatomogaly was observed in 5 cases, but there was no case of splenomegaly The average serum total biliubin level was Z. 98+ l. 29mg/100ml and the average serum conjugated bilirubin level vas l. 7p0. 94 mg/lpQml. Other liver function tests revealed normal v lues. 6. HBsAg and aFP test were performed in 5 cases and the results wcre negative in all cases Oral cholecystography was performed in 6 cases and the gallbladder was visualized in 8 cases, suggesting that the important non-visualization of gall-bladder on oral cholecy- stography for the diagnosis of the disorders ought to be reconsidered.

원발성 소장 종양의 임상적 및 병리학적 고찰

윤용범(Yong Bum Yoon),송인성(In Sung Song),최규완(Kyoo Wan Choi),김정룡(Chung Yong Kim),박중원(Joong won Park),고광철(Kwang Cheol Koh),김용태(Yong Tae Kim),김태호(Tae Ho Kim),이준성(June Sung Lee) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.3

N/A We reviewed clinical records of 34 cases of primary tumors in the small intestine from 1986 to 1990. In total 34 cases, 26 cases were male and 8 cases were female. The mean age was 50.9 year. Benign tumors were 6 and malignant tumors were 28. The most common symptom of benign tumors was abdominl pain (83%) followed by anemia (50%) and intussusception (33%). The most common symptom of the malignant tumors was also abdominal pain (86%) followed by weight loss (50%), anemia (43%), constipation (43%), and palpable mass (39%). Leiomyoma was the most common benign tumor and adenocarcinoma was the most common malignant tumor. Adenocarcinomas occured predominatly in the duodenum and malignant lymphomas occured prednminantly in the ileum. In the duodenal tumors, the detectabilities of endoscopy and upper GI series were 79% and 77%, respectively. In the jejunal and the ileal tumors, the detectabilities of small bowel series were 50% and 71%, respectively and those of abdominal computed tomogram were 30% and 33%, respectively. The accuracy of preoperative diagnosis in pathology was 32% and only 65%. of patients could be diagnosed to have small intestinal tumors before surgery.

위장관 ( 胃腸管 ) : 식도 확장술에 합병된 식도 천공의 치료

윤용범(Yong Bum Yoon),송인성(In Sung Song),최규완(Kyoo Wan Choi),김정룡(Chung Yong Kim),정현채(Hyun Chae Jung),김용태(Yong Tae Kim),한철주(Cheol Joo Han),이준혁(Joon Hyeok Lee),김진욱(Jin Wook Kim),김태호(Tae Ho Kim),최상운(Sang Oun 대한소화기학회 1991 대한소화기학회지 Vol.23 No.3

N/A We reviewed the total 291 procedures in 134 patients in whom esophageal dilatation or esophageal endoprosthesis insertion had been performed in Seoul National University Hospital from March 1987 to September 1990. Twelve cases(4.1%) of esophageal perforation developed. Eight cases of them were managed successfully only with medical treatment. Two cases were not followed up after self-discharge during medical treatement. One case was treated successfully with immediate surgical intervention and one case underwent delayed surgical repair two times because of the failure of initial medical treatment. There were 7 cases of esophageal perforation with pleural or peritoneal involvement. Five of them were managed successfully with medical treatment. Thus we recommended the medical management as the first choice of treatment in iatrogenic esophageal perforation even in the cases with pleural or peritoneal involvement except in some selected cases.

위장관 ( 胃腸管 ) : 한국인에 있어서 대장용종

윤용범(Yong Bum Yoon),송인성(In Sung Song),최규완(Kyoo Wan Choi),김정룡(Chung Yong Kim),이효석(Hyo Suk Lee),윤세진(Sei Jin Youn),정현채(Hyun Chae Jung),김용태(Yong Tae Kim),김나영(Na Young Kim) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.2

N/A The present report analyzed a series of 767 polyps from 15,000 cases who wore undogone colonos- copy or sigmoidoscopy at the dept, of internal medicine, Seoul National Universily Hospital from June 1976 to Dec. 1989. The results are as follows. 1) The prevalence of colorectal polyp was 5,1% (767 cases out of 15,000 cases) and increased from 1976 to 1989. 2) The most common symptom was anal bleeding (27%). 3) The 43 cases out of 203 cases (21%) revealed a positive finding in occult blood examination of stool, and 88 cases out of 158 cases (55%) turned out to have polyps in colon study. 4) The most common histologic type of polyp was adenomatous (49%) and the most common gross iype was Yamada type II (30.%). 5) Eleven cases out of 30 cases (36.9%) whose polyps were over 2 cm in diameter were villous adenoma, and 4 cases out of 11 cases (36%) had a foci of cancer. Ten cases out of 245 cases (4%) whose polyps wore under 1 cm in diameter were villous adenoma, and the foci of cancer were not seen. These figure suggest that as polyps grow, the risk of villous adenoma and cancer increase. 6) When we compared endoscopic findings with histologic types in polypectomized specimens, 9 cases (64%) out of 14 cases were diagnosed as hyperplastic polyp by only endoscopy, and 68 cases (91%) out of 75 cases were diagnosed as adenomatose polyp by only endoscopy. 7) Six cases (4.4%) out of 135 cases in tubular, four cases (16.6%) out of 24 cases in villotubular, four cases (19%) out of 21 cases in villous adenoma, were colorectal cancer with polyp remnant, respectively. The annual prevalence of colorectal polyp increased and endoscopy was superior to Barium enema in diagnosing colorectal polyps. For prevention of colorectal cancer, more effort should be done in detecting and eradicating colorectal polyps.

만성 간질환에서 Ursodeoxycholic Acid 경구 부하 검사의 진단적 유용성

윤용범(Yong Bum Yoon),김정룡(Chung Yong Kim),김재준(Jae Jun Kim) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.1

N/A Serum bile acid (SBA) levels have been proposed as a sensitive test of liver function. However, the diagnostic value of SBA in liver diseases varies with the population studied and with the SBA estimation methods. The aims of this study were to determine the diagnostic value of the oral ursodeoxycholic acid (UDCA) tolerance test and to compare the results with those of the conventional liver function tests. An oral tolerance test using a 500 mg dose of UDCA was carried out in 33 healthy subjects, 23 patients with chronic active hepatitis and 52 patients with liver cirrhosis. Total serum bile acids (TSBA) after oral adminiatration of UDCA and the are under the curve (AUC) were significantly (p<0.0001) higher in patients with chronic active hepatitiis and in patients with liver cirrhosis than in healthy subjects. In order to define the diagnostic value of the oral UDCA tolerance test, sensitivity, specificity and predictive value of positive test [PV (+)] of TSBA were calculated and campared with those of conventional liver function tests. The sensitivity of TSBA was not superior to those of conventional liver function tests. The oral UDCA tolerance test was found to be not suitable as a screening test for chronic liver diseases. However, the specificity and PV (+) of TSBA were higher than those of conventional liver function tests. The PV (+) of a test is an accurate indicator of the presence of a disease and gives the odds that an abnormal result indicates its presence. The oral UDCA tolerance test has the high Specificity and PV (+), hence, this test has great value in the identification of a chronic liver disease when an abnor,mal result is found on conventional liver function tests.

만성 간질환 환자에 동반된 상부위장관 증상에 대한 Cisapride의 효과

윤용범(Yong Bum Yoon),최상운(Sang Woon Choi),김용태(Yong Tae Kim),최일주(Il Ju Choi) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.4

N/A We have investigated prospectively the effect of cisapride on dysfunctional upper and lower gastrointestinal symptoms such as nausea, vomiting, epigastric pain, abdominal fullness, early satiety and anorexia in patients with chronic liver diseases. Fifty-six patients were given clsapride 2.5 mg tid for 4 weeks. If the symptoms improved, the same dosage of cisapride was given an additional 4 weeks. If there was no symptomatic improvement, the dosage was increased to 5 mg tid for the next 4 weeks. The average of total symptom scores before the treatment and at 4th and 8th week after the treatment were 5.1 +- 1.6, 1.9 +- 1.8 and 1.6 +- 1.8 respectively. There was statistically significant improvement in the total symptom scores after the treatment (p 0.05). The score of each symptoms except vomiting improved significantly after the treatment. In 12 patients, the dosage of cisapride was increased but there was no improvement in the average symptom score even after the dose increment. The side effects were abdominal pain in 3 patients, epiga.;tric soreness, erythematous skin rash, facial edema and dizziness in each patient respectively. Cisapride did not cause abnormalities in laboratory data such as LFT, CBC and urinalysis. In conclusion, cisapride was effective and safe in relievinp dysfuncticinal upper and lower gastrointestinal symptomos in patients with chronic liver diseases.

자가면역성 (自家免疫性) 만성간염 (慢性肝炎) 보고

윤용범(Yong Bum Yoon),송인성(In Sung Song),김정룡(Chung Yong Kim),이효석(Hyo Suk Lee),이계희(Kyai Hi Lee),김남일(Yong Il Kim),정형배(Hyung Bae Chung),김효수(Hyo Soo Kim) 대한소화기학회 1986 대한소화기학회지 Vol.18 No.1

A case of autoimmune chronic active hepatitis was diagnosed in a 28 years old female. She came to the hospital because of proximal muscle weakness, anorexia, nausea, vomiting, cold intolerance, psychomotor retardation, jaundice and hepatomegaly. Liver biopsy showed chronic active hepatitis without evidence of viral infection nor injury by hepatotoxin. Other laboratory work-up showed polymyositis, renal tubular acidosis, and autoimrnune thyroidtis with antinuclear antibody, RA factor, and antimicrosomal antibody. we report this case as a autoimmune chronic active hepatitis accompanied by autoimmune thyroiditis, renal tubular acidosis and polymyositis, with a literature review.

총담관류 ( Choledochocele )

윤용범(Yong Bum Yoon),박용현(Yong Hyun Park),김선희(Sun Whe Kim),김태선(Tae Seon Kim) 대한소화기학회 1997 대한소화기학회지 Vol.30 No.2

Choledochocele or type III choledochal cyst is a rare anomaly of unknown etiology that consists of cystic or diverticular dilatation of the terminal intramural portion of the common bile duct protruding into the duodenum. Although the leison has distinctive radiologic appearances, it can be easily overlooked. The diagnosis of choledochocele is important for possibility of malignant degeneration and biliary obstruction. It should be considered in the differential diagnosis of otherwise unexplained biliary colic or recurrent pancreatitis. We present a case of choledochocele, the rarest of the choledochal cyst, with special attention to its unique aspects comparing with the origin, diagnosis, and treatment of other forms of choledochal cyst. (Korean J Gastroenterol 1997; 30:280-286)

위장관 ( 胃腸管 ) : 우리나라에서 흉골하작열감 내지 흉통의 원인으로서 식도운동성질환의 중요성에 관한 연구

윤용범(Yong Bum Yoon),송인성(In Sung Song),김정룡(Chung Yong Kim),최상운(Sang Woon Choi),최규완(Kyu Wan Choi),노임환(Im Hwan Roe),윤세진(Sei Jin Youn),정현채(Hyun Chae Jung),김용태(Yong Tae Kim),김나영(Na Young Kim) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.1

N/A Aims of this study are to investigate the proportion of esophageal motility disorder as the cause of heartburn and/or chest pain, to evaluate the relationship among the diagnostic tools for gastroeso-phageal reflux disease(GERD) such as manometry, esophagoscopy, Bernstein test and 24 hour esophageal pH monitor and to evaluate the usefullness of each test in the diagnosis of gastroeso-phageal reflux disease by estimating its sensitivity and specificity based on 24 hour esophageal pH monitor. For this study, 106 patients with heartburn and/or chest pain and 32 controls were enrolled. The results were as follows; 1) Of 106 patients with heartburn and/or chest pain, 36 patients (34#%) have GERD and 6 patients (5.6%) have Nutcracker esophagus as a cause of this symptom. 2) One hundred and six patients were divided into the two groups on the basis of LES pressure, one comprising 14 patients with LES pressure lower than 11 mmHg and the other 92 patients with the higher LES pressure; then the group of the lower LES pressure was found to have the smaller amplitude and the shorter duration of peristaltic waves, and the higher positive rates of esophagos-copic finding. Bernstein test and 24 hour esophageal pH monitor than the other group. On the basis of reflux esophagitis finding in esophagoscopy the same 106 patients were divided into two groups, one comprising 18 patients with positive esophagoscopic finding and the other 88 patients with negative esophagoscopic finding; then the group of positive esophagoscopic finding was found to have the smaller amplitude and shorter duration of peristaltic waves, the lower LES pressure and the higher positive rate of Bernstiein test and 24 hour esophageal pH monitor than the other group. 3) The sensitivity and the specificity, evaluated with reference to the 24 hour esophageal pH monitor, were 53.6% and 90% respectively for Bernstein test, and 25% and 90% respectively for the low LES pressure. From these results, we are led to the conclusions that firstly the occupying rate of the esophageal motility disorder was 39.6% as a cause of heartburn and/or chest pain, secondly there was a relationship among the diagnostic tools for GERD, and thirdly the 24 hour esophageal pH monitor is not needed only for the diagnosis of GERD when the LES pressure was below 11 mmHg or Bernstein test was positive.

췌장가성낭종의 보존적치료

윤용범(Yong Bum Yoon),김정룡(Chung Yong Kim),신건성(Gun Sung Shin),김용태(Yong Tae Kim),김태현(Tae Hun Kim) 대한내과학회 1996 대한내과학회지 Vol.51 No.3

N/A Objectives: Several results of clinical studies on the etiology, clinical manifestation, diagnosis and management of pancreatic pseudocysts were reported in Korea; however they were almost all in concerned with the surgical aspect and little attention was focused on the conservative management of pancreatic pseudocysts. This study was designed to evaluate the efficacy of conservative management of pancreatic pseudocysts in Korean patients. Methods : We reviewed the medical records of 55 patients with pancreatic paseudocysts managed from 1985. 1 to 1993. 12 in Seoul National University Hospital. Results: 1) Pancreatic pseudocysts were usually associated with acute pancreatitis caused abdominal pain, and were frequently located on the head and the tail of the pancreas. 2) Sixy five percent of pancreatic pseudocysts were managed successfully with conservative treatment, and the small pseudocysts associated with pancreatitis were more prone to successful conservative treatment. 3) With respect to decreases in the size of the pseudocysts, 86% of the cases showed some size decrease within 4 weeks after treatment. Conclusion: Conservative treatment alone is effective in 65% of pancreatic pseudocysts and in Korea at least 4 weeks of conservative treatment is necessary for the management of small pseudocysts associated with pancreatitis.