비장동맥 저항지수는 알콜성 간경화와 B형 간경화를 구분하는 보조 인자가 될 수 있는가?

변주남,김동훈 대한초음파의학회 2007 ULTRASONOGRAPHY Vol.26 No.2

=PURPOSE : We wanted to assess the usefulness of the splenic artery resistive index (RIS) for differ-entiating between alcoholic cirrhosis (AC) and hepatitis B-virus related cirrhosis (VC). MATERIALS and METHODS :A total of 109 subjects (28 normal healthy controls, 38 patients with VCand 43 patients with AC) were included in this study. The spleen sizes, Child-Pugh scores andRISs were compared between the two cirrhotic groups. The receiver operating characteristic(ROC) curve was used to determine an RIS cutoff value for the differentiation of the two cir-rhotic groups. RESULTS :The mean spleen size and mean RIS in the controls were less than those of the two cir-rhotic groups (p < 0.05), and the mean spleen sizes and Child-Pugh scores were not differentbetween the two groups (AC vs. VC), (13.1 ±3.2 cm vs. 12.9 ±2.6 cm, p > 0.05; 6.6 ±1.9vs. 5.9 ±1.6, p > 0.05, respectively). In contrast, the mean RIS of the AC patients was signifi-cantly higher than that of the VC patients (0.72 ± 0.07 vs. 0.62 ± 0.06, respectively, p <0.01). The sensitivity, specificity and accuracy at an RIS cut-off value of 0.7 for differentiatingthe two cirrhotic groups were 76.7%, 68.4% and 72.8, respectively. CONCLUSION : The RIS is useful factor for differentiating the patients with AC from the patientswith VC. 비장동맥 저항지수는 알콜성 간경화와 B형 간염 간경화를구분하는 보조 인자가 될 수 있는가?조선대학교병원 영상의학과변 주 남·김 동 훈목적 : 비장 동맥 저항 지수가 알코올성 간경화 환자군과 B형 간염 간경화 환자군의 감별에 유용한지 알아보는것이다. 대상 및 방법: 28명의 대조군, 38명의 B형 간염 간경화 환자, 43명의 알콜성 간경화 환자가 포함되었다. 두 간경화 환자군에서 비장 크기, Child-Pugh 수치, 비장 동맥 저항지수를 비교하였다. 비장 동맥 저항지수를

재발성화농성담낭염의 방사선학적 고찰

변주남 대한영상의학회 1984 대한영상의학회지 Vol.20 No.3

Recurrent pyogenic cholangitis (RPC) is defined as a condition in which there is a primary bacterial cholangitis, characterized clinically by recurrent attacks of fever, chills, abdominal pain, and jaundice. 17 cases of recurrent pyogenic cholangitis at Won Kwang University Hospital during the past three years were analyzed by clinical, radiological and surgical findings. The results were as follows: 1. Peak incidence was noted at fifth decade (35%) and the ratio of male to female was almost equal (1:1:1). 2. Most of patients were undernurished and rural population in low socio-eccnomic state. 3. The characteristic and most frequent symptoms were fever, chills, abdominal pain, and jaundice. 4. Serum alkaline phosphatase level was elevated almost 4 times to the upper limit of normal. 5. There was a history of cholecystectomy with or without T-tube drainage in 65% of 17 cases. 6. The cholangiographic findings in the biliary trees were stricture, stones and dilated ducts, and occured more commonly in the left hepatic duct than right. 7. Most stones of biliary trees were pigment stones, and occasionally muddy stones were seen. 8. Most of the organism obtained from bile culture were E. coli, supported an infective etiology.

침습성 이행세포암으로 오인한 집합관 신세포암: 1예 보고

변주남,임형근,임성철 대한초음파의학회 2007 ULTRASONOGRAPHY Vol.26 No.2

Approximately 100 cases of collecting duct carcinoma have been reported in the medical literature. We herein report on a case of collecting duct carcinoma of the kidney in a 75-year-old patient. The abdominal sonography depicted a relatively poorly defined 7×6 cm sized, isoechoic mass lesion, as compared to the normal parenchyma, at the left kidney lower pole and the affected kidney showed preservation of the reniform shape. CT revealed a heterogeneous poorly defined low-attenuation mass that was mainly located in the medulla with involvement of the cortex and the lower half of the renal pelvis. Retrograde ureteropyelography showed a filling defect at the lower renal pelvis and severe narrowing of the left proximal ureter. We initially thought this lesion was invasive transitional cell carcinoma. Subsequent surgery confirmed a collecting duct carcinoma. 집합관 신세포암(collecting duct carcinoma)은 전세계적으로 약 100예 정도 발표된 신세포암의드 문 아형이다. 저자들은 75세 남자 환자의 신장에서 발생한 집합관 신세포암(collecting duct carcinoma)을 경험하여 이를 보고하고자 한다. 복부 초음파에서 좌측 신장의 하부에 위치한 약 7 ×6 cm 종괴가 발견되었는데, 비교적 경계가 불분명하고 정상 실질과 동에코로 관찰되었다. CT에서는 신수질에 종괴의 중심이 있고 신피질과 신우를 침범한 경계가 불분명하고 조영증강이 잘 되지 않는 종괴로 나타났다. 역핵성요관신우조영술에서 좌측 신우의 하부에 충만결손이 보이고 요관 근위부가 심하게 좁아져 있었다 이에 저자들은 여러 방사선학적 소견을 고려하여 침습성 이행세포암으로 진단하였으나 수술을 통해 집합관 신세포암으로 확진되었다.

Renal Hypoperfusion Associated with Splenorenal Shunts in Liver Cirrhosis

변주남,김동훈,강성권 대한영상의학회 2008 대한영상의학회지 Vol.58 No.4

Purpose: To determine whether spontaneous a splenorenal shunt can be used as an imaging predictor of early renal hemodynamic changes in patients with cirrhosis. Materials and Methods: The study included 82 cirrhotic patients and 41 control subjects. Three-phase CT was performed and CT attenuation values (Hounsfield units) of the renal cortex in three phases were measured to evaluate renal perfusion. Likelihood ratio tests for trend were conducted for age, presence of ascites, and Child’s grade. Results: The mean CT attenuation values of the renal cortex in cirrhotic patients were significantly lower than the values of control subjects in three phases: 153.3 ± 37.9 versus 173.3 ±25.2 in the arterial phase, 172.6 ± 41.0 versus 197.6 ± 26.5 in the portal phase and136.9 ± 26.0 versus 152.7 ± 20.0 in the delayed phase, respectively. The mean CT attenuation value of cortices in patients with renal hypoperfusion was 119.9 ± 11.8 in the portal phase. Child’s class C (aOR: 58.4, 95% CI: 3.6-956.2; p < 0.01) and the presence of a renal shunt (aOR: 7.5, 95% CI: 1.8-30.5; p < 0.01) were associated with renal hypoperfusion. The incidence of renal hypoperfusion was associated with Child’s grade (trend: p < 0.01), and not with the grade of ascites or age. Conclusion: A dilated spontaneous splenorenal shunt may be a risk factor for renal hypoperfusion in cirrhosis.

신장동맥 저항 지수의 의의: 알코올성 간경변 환자에서 식도정맥류 파열과의 연관성

변주남,김동훈 대한영상의학회 2007 대한영상의학회지 Vol.56 No.4

Purpose: To determine whether resistive indices of the renal artery (RIR) or the splenic artery (RIS) can be used as predictors of bleeding in patients with alcoholic liver cirrhosis. Materials and Methods: According to esophageal variceal bleeding episodes, 33 patients with cirrhosis were divided into two groups, a bleeder group (n=17) and a nonbleeder group (n=16). These two groups were compared with respect to five variables (age, spleen size, Child's score, RIS, and RIR). Sensitivity, specificity, and accuracy for the detection of bleeders were calculated using a cutoff value of 0.7 for RIR. Results: The mean values of variables were higher for bleeders than for non-bleeders. With the exception of age, four variables were significantly correlated with bleeding (r=0.43 for spleen size; r=0.36 for Child's score; r=0.37 for RIS; p<0.05, respectively; r=0.63 for RIR, p<0.01). Only RIR was found to be significantly a predictive variable for bleeders (adjusted Odds ratio=19.9; 95% confidence interval: 1.3-306, p<0.05) when the RIR was more than 0.7. RIR had a sensitivity of 88.3% and a specificity of 75% with an accuracy of 81.8% at a cutoff value of 0.7 for identifying bleeders. Conclusion: A high RIR value will be useful in predicating esophageal variceal bleeding in patients with alcoholic liver cirrhosis. 목적: 신장 동맥 및 비장 동맥 저항 지수가 알코올성 간경변 환자에서 출혈의 지표로 사용될 수 있는지 알아보고자 하였다. 대상과 방법: 식도정맥류 출혈력에 따라 33명의 간경변 환자를 출혈군(17명)과 비출혈군(16명)으로 분류하였다. 이들 두 군에서 나이, 비장 크기, Child 수치, 신장 동맥 저항 지수, 비장 동맥 저항 지수를 비교하였다. 식도 정맥류 출혈을 발견하는 민감도, 특이도, 정확도를 기준점(cutoff value)을 통해 계산하였다. 결과: 변수들의 평균값은 출혈군에서 높았다. 나이를 제외하고 4개의 변수는 출혈과 의미 있는 연관성을 보였다(비장크기: r=0.43, Child 수치: r=0.36, 비장 동맥 저항 지수: r=0.37, 각각 p < 0.05, 신장 동맥 저항 지수: r=0.63, p < 0.01). 이중 신장 동맥 저항 지수는 0.7보다 클 때, 출혈의 높은 예측 인자로 확인되었다(교정 확률비=19.9; 95% 신뢰구간: 1.3-306, p < 0.05). 이때 출혈에 대한 민감도는 88.3%, 특이도는 75%, 정확도는 81.8%였다. 결론: 높은 신장 동맥 저항지수는 알코올성 간경변 환자에서 식도정맥파열을 예측하는데 도움이 된다.

Usefulness of Ultrasound in the Evaluation of Morphologic Change of a Cirrhotic Liver During Respiration

변주남,김동훈,석은하 대한초음파의학회 2010 ULTRASONOGRAPHY Vol.29 No.4

Purpose: This study was designed to determine whether transabdominal ultrasound can detect different hepatic stiffness between patients with cirrhosis and control subjects. Materials and Methods: Sevent-three patients (Child-Pugh class A stage) with liver cirrhosis and 57 control subjects were included in this study. All patients were subdivided arbitrarily into two groups: early cirrhosis (n = 53) and overt cirrhosis (n =20). Two sagittal images of the left lobe of the liver were obtained in the left hepatic vein level during the resting state and at full inspiration while pushing their belly out, by abdominal US (i.e., resting and stress image). The length between the inferior hepatic angle and the midpoint of the liver dome was measured in all images for the evaluation of liver distortion. The elongation was calculated by a formula: (L2-L1/L1) ×100(%); where L1 and L2 are the length of the liver for both the resting and stress image. The calculated elongated length (L2-L1, EL) and elongation rate were compared between cirrhotic patients and control subjects. Results: For the control subjects, early cirrhosis, and overt cirrhosis groups, the mean ELs (elongation rate) were 2.34±0.98 cm (30.2±13.2%), 1.18±0.73 cm (14.9±9.5%) and 0.53±0.54 cm (6.3±6.6%), respectively. This difference among the three groups was statistically significant (p < 0.05). A possible best cut-off value of liver elongation rate is 17% for the prediction of cirrhosis (sensitivity: 90%, specificity:75.3%). Conclusion: The liver of patients with liver cirrhosis is stiffer than that of control subjects. Calculation of the elongation rate in the left lobe of the liver during a respiratory maneuver may be used as an ancillary method of US for the evaluation of liver cirrhosis.

유행성 마이코플라스마 폐렴에 대한 고찰

변주남 ( Joo Nam Byun ),김영철 ( Young Chul Kim ) 대한결핵 및 호흡기학회 1994 Tuberculosis and Respiratory Diseases Vol.41 No.3

1993년 전남의 한 해안지역에서 발생한 Mycoplasmal 폐렴에 대한 고찰

변주남(Joo-nam Byun),양은석(Eun-suk Yang) 한국농촌의학 지역보건학회 1993 농촌의학·지역보건 Vol.18 No.2

비장동맥 가성동맥류로부터의 하부위장과 출혈에 대한 컴퓨터단층촬영 및 혈관조영술 소견 : I 예보고

변주남,최정렬,김영철 朝鮮大學校 附設 醫學硏究所 2002 The Medical Journal of Chosun University Vol.27 No.2

Most pseudoaneurysms of splanchnic arteries are caused by pancreatitis, biopsies or operative trauma, In the cases of pseudoaneurysms by pancreatitis, the splenic arbeiy is the most common site of bleeding, Complication of splenic artery pseudoaneurysms is the rupture into the peritoneal cavity and hemorrhage by the erosion of adjacent structure, In this case, we report the CT findings and angiographic findings of lower gastrointestinal hemorrhage by erosion into colon of the splenic artery pseudoaneurysm.

소아 가와사끼 환자에서 관상동맥 자기공명 혈관조영술의 유용성

김동훈 · 변주남 · 최상일 조선대학교 의학연구원 2008 The Medical Journal of Chosun University Vol.33 No.1

.