한국인 담석증에 대한 임상적 고찰

김광하(Gwang Ha Kim),옥창민(Chang Min Ok),김병진(Byung Jin Kim),주형준(Hyung Jun Joo),송철수(Chul Soo Song),송근암(Guen Am Song),조몽(Mong Cho),양웅석(Ung Suk Yang) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.3

N/A Background/Aitns: It has been reported frequently that clinical features of gallstone diseases in Koreans were different from those of Occidentals. These differences were thought to be due to inherent racial difference and acquired living habits. The purpose of this study is to evaluate whether the pattern of gallstone disease changes or not in Korea. Methods: We analyzed 5,488 cases of gallstone diseases which were reported in Korea frorn 1966 to 1994. We divided the period into 6 groups: the first period was 1,000 cases reported from 1966 to 1970, the second was 331 cases from 1971 to 1975, the third was 1,000 cases from 1976 to 1980, the fourth was 1,957 cases from 1981 to 1985, the fifth was 1,000 cases from 1986 to 1990, and the sixth was 200 cases from 1991 to 1993. Results: The age group of highest incidence was the fifth and sixth decade. The incidence below the third decade showed a decreasing tendency. In contrast, the incidence above sixth decade showed an increasing tendency. The male to female ratio was 1:1.25 to 1:1.71 and had no periological change. The duration of illness of highest frequency was below 6 months. In the case of duration above 5 years these was a decreasing tendency. The major complaints of biliary stone were right upper quadrant pain and tenderness. Nausea, vomiting, jaundice, and radiating pain showed a decreasing tendency. The major laboratory findings were leukocytosis, elevated SGOT and SGPT, elevated alkaline phosphatase, hyperbilirubinemia and hypoalbuminemia. Of these, only hypoalbuminernia had a decreasing tendency. By the second period, the main diagnostic procedures were oral cholecystogram and intravenous cholecysto- graphy. From the fourth period, ultrasonography, ERCP, CT and PTC were been used comrnonly. For the location of gallstone, the gallbladder stone revealed the only increasing tendency, the common bile duct stone had a decreasing tendency, and the intrahepatic duct stone had no periological change. From 1980, the cholesterol stone became the main composition of gallstones. But, there was no periological change between early and late 1980s. Positive bacterial culture rate was 57.0% and the most common microorganism was E. coli. Klebsiella and Enterobacter. Pseudomonas showed an increasing tendency. Of the diseases associated with gallstone, only diabetes had an increasing tendency. The frequency of residual stone had an increasing tendency. Conclusions: The age of peak incidence of gallstone diseases was the fifth and sixth decades and there was a little predominance in females. From 1980, the cholesterol stone becarne the main composition of gallstones. For the location of gallstone, the gallbladder stone showed an increasing tendency and the common bile duct stone revealed a decreasing tendency. These suggested clinical features of gallstone diseases in Koreans are somewhat similar to those of Occidentals. (Korean J Gastroenterol 1997;29:352 - 361)

근위부 담도암의 임상적 고찰

주형준(Hyung Jun Joo),고원욱(Won Ook Ko),박승근(Seung Keun Park),하태정(Tae Jung Ha),최성호(Sung Ho choi),송철수(Chul Soo Song),송근암(Guen Am Song),조몽(Mong Jo),양웅석(Ung Suk Yang),문한규(Han Kyu Moon) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.6

N/A Background/Aims: Carcinoma of the proximal bile ducts is a rare condition that occurs more frequently in men than in women. The majority of patients present with obstructive jaundice and the main aim of treatment should be to relieve jaundice while at the same time, if possible, removing the tumor. However, even when surgical resection is contraindicated or technically impossible, it should still be possible to achieve satisfactory palliation of jaundice. Methods: We ana]yzed the 72 patients with carcinoma of proximal bile ducts who were admitted to Pusan National University Hospital from January 1982 to December 1993. Results: The mean age of the patients was 69.1 years old and the ratio of male to female was 1.88:1. The clinical manifestations showed jaundice(97%), right upper quadrant pain(31%), pruritus(22%), epigastric pain(19%) and weight loss(117c). Prevalence rate of proximal cholangiocarcinoma according to the level of lesion in proximal bile duct was 71% in Klatskin tumor(Bismuths type I 16%, type II 0%, type III 6%, type IV 49%), 11% in common hepatic duct, 9% in common bile duct(the area in which cystic duct is communicated with common hepatic duct in this article), and 9% in intrahepatic duct (left 3%, right 6%). The Clonorchis sinensis infestation was associated in 50%, which was the most common associated disease with proximal cholangiocarcinoma. The cholangitis was associated in 5k, the sepsis in 15%, the hepatitis B in 117o, and the liver cirrhosis in 10%. The choledocholithiasis was associated in 5%, which consists of the gallstones in 3%, the common bile duct stones in 1%, and intrahepatic duct stones in 1%. The direct invasion of surrounding structures and metastasis were found in 23 cases. Among 23 cases, direct invasion was found in 18 cases, especially liver invasion in 14 cases, and distant metastasis in 4 cases, among which peritoneal metastasis was 2 cases. Staging could be reviewed in 70 cases. Among them, stage I was found in 46 cases(69%), stage III in 3 cases(3%), stage IV in 21 cases(28%), and stage II was not found. Percutaneous transhe- patic biliary drainage(PTBD) was performed in 43 cases (60%) and T-tube insertion in 7 cases (10%). Nothing was performed in 22 cases(30%). Conclusions: A clinical awareness of the manifestation of proximal cholangiocarcinoma will result in early diagnosis and treatment. Even when surgical resection can not be performed, palliation of jaundice should be required for prolonged survival of patients. (Korean J Gastroenterol 1995;27:700-710)

원발성 간세포암의 자연병력 및 예후에 관한 연구

허윤(Yoon Hur),문한규(Han Kyu Moon),양웅석(Ung Suk Yang),김성은(Seong Eun Kim),백대근(Dae Geun Baek),도창호(Chang Ho Do),송근암(Guen Am Song),유방현(Band Hyun Liu) 대한소화기학회 1988 대한소화기학회지 Vol.20 No.2

N/A Hepatocellular Carcinoma (HCC) is considered a highly malignant tumor with a poor prognosis. It is usually not resectable and there is no other effective treatment. The current study was undertaken to evaluate the survival time of patients wit.h hepatocellular carcinoma and to find clinical and biologic criteria. A total of 106 patients with HCC seen during the last 3 >ears were analyzed retrospectively for survival in relation to prognostic factors, treatment and disease stage. The results obtained were summarized as follow; 1) HCC vas found frequently in men, and male and female ratio vas 2.5:1. The average age was 55 years in both sex. 2) A prognostic study hased on 91 untreated patients was undertaken. The median survival times according to age, sex, performance status, positive serologic determination of hepatitis B, alcohol intake, alpha-fetoprotein, transaminase, BUN, creatinine values at the time of cliagnosis were statistically not significant. Whereas in all series of patients, bilirubin, tumor size, ascites, serum albumin values were statistically significant. A new staging scheme based on above factors was used. Clearly, thc prognosis depended on clisease stage. The midian survival of stage I patients who receivecl no specific treatment ivas 4.1 months and stage II patients was 1.8 M, and stage III patients svas 0.9 M (p<0.001). 3) The median survival of 91 patients who received no specific treatment was 2.1 M, however 2.3 M for the group of patients(8) placed on systemic chemotherapy, and 9.9 M of the group of patients(7) for hepatic resection. 1) The major causes of death were hepatic failure; 37%(40/106), gastrointestinal bleeding; 28 % (30/106), cachexia; 14% (14/106), respiratory failuire due to lung metastasis; 8% (8/106), intraperitoneal rupture; 3%(3/106). Unclear; 11% (11/106).

위궤양환자에서 Rebamipide의 자유산소유리기제거에 의한 궤양치료효과

박수헌(Soo Heon Park),정운태(Woon Tae Jung),서정한(Jung Han Suh),정명희(Myung Hee Chung),정인식(In Sik Chung),이용찬(Yong Chan Lee),박인서(In Suh Park),송근암(Guen Am Song),양웅석(Ung Suk Yang),유종선(Jong Sun Rew),윤종만(Chong Mann 대한소화기학회 1997 대한소화기학회지 Vol.29 No.5

N/A Background/Aims: Helicobacter pylori has been shown to be an important pathogen of gastric disorder including gastritis and gastric ulcer. One of the potential toxic factors involving gastric mucosal cell injury is reactive oxidants, which are released from activated neutrophils. Rebamipide had been reported to promote mucus synthesis, mucosal prostaglandin content, and rapid ulcer healing, It has recently been reported to inhibit the production of oxygen derived free radicals from stimulated neutrophils. We conducted this study to evaluate the effects of rebamipide on gastric ulcer healing and reactive oxygen metabolite production. Methods: In this multicenter study conducted in Korea, combination treatment of rebamipide and ranitidine was compared with ranitidine alone in 108 patients with gastric ulcer patients. Pre- and post-treatment endoscopic findings and concentration of reactive oxygen metabolite produced were used to evaluate efficacy. The efficacy of rebamipide and ranitidine versus ranitidine was evaluated using endoscopy results, and tissue lipid peroxides by thiobarbituric acid and myeloperoxide concentration. Results: The percentage of ulcer size reduction was significantly higher with rebamipide and ranitidine group than with placebo and ranitidine group(size reduction: 71.5% vs 58.3% P=0.04556). The myeloperoxidase activities at ulcer margin in rebamipide and ranitidine group patients were 96.7+-13.4 unit/mg protein in baseline and 53.8+9.9 unit/mg protein in follow up (P=0.0065). The myeloperoxidase activities at ulcer margin in placebo and ranitidine group patients were 90.2+9.1 unit/mg protein in baseline and 63.1+6.7 unit/mg protein in follow up (P=0.0668). The thiobarbituric acid activities at ulcer margin in rebamipide and ranitidine group patients were 34.7+5.3 nmol of MDA/mg protein in baseline and 24.1W3.1 nmol of MDA/mg protein in follow up. The thiobarbituric acid activities at ulcer margin in placebo and ranitidine group patients were 14.8+1.5 nmol of MDA/mg protein in baseline and 24.3+2.7 nmol of MDA/mg protein in follow up (P=0.0059). The thiobarbituric acid activities at ulcer margin in H. pylori positive and negative patients were 28.1+2.1 nmol of MDA/mg protein and 25.3+4.7 nmol of MDA/mg protein, respectively. The myeloperoxidase activities at ulcer margin in H. pylori positive and negative patients were 79.9+5.3 unit/mg protein and 40.4+25.3 unit/mg protein, respectively (P=0.0001). The cumulative relapse rate was examined starting at 24 week after ulcer treatment. The rate was lower in rebamipide and ranitidine group patients, but insignificantly(19.2% vs 27.3%, P=0.0857). Conclusions: These results suggest that rebamipide promote gastric ulcer healing by decreasing reactive oxygen metabolite production in patients with gastric ulcer. (Korean J Gastroenterol 1997;29:569-578)

비심인성흉통환자에서 식도질환의 빈도

허정,양웅석,조몽,송철수,송근암,김광하,성은영 대한소화기학회 1998 대한소화기학회지 Vol.30 No.2

Background/Aims: Recurring chest pain is an important clinical problem, causing anxiety for patients and their physicians because of the fear of possible cardiac disease. In these patients without evidence of cardiac disease, we investigated the esophageal origin of chest pain using manotaetry, provocative tests and 24 hour ambulatory esophagea] pH monitoring. Methods: Between August 1995 and September 1996, 199 patients(M:76, F;123) were included in this study. They had no evidence of cardiac disease with echocardiography, exercise stress test and coronary perfusion scan. Results: 89 out of 199 patients(44.7%) had abnormal manometric findings which were 31(34.8%) nonspecific esophageal rnotility disorder, 27(30.3%) Nutcracker esophagus, 22(24.7%) hypertensive lower esophagea] sphincter, 2(2.2%) diffuse esophageal spasm, 7(7.9%) achalasia. 18 out of 89 patients(20.2%) had positive edrophonium test which were 3(16.7%) nonspecific esophageal motility disorder, 4(22.2%) hypertensive lower esophageal sphicter, 2 (11.1%) diffuse esophageal spasm, 4(22.2%) achalasia. 11 patients(10%) had positive Bemstein test and 2 patients which showed both positive provocation results were nonspecific esophageal motility disorder. In patients with normal esophageal motility, negative Bernstein test and symptoms of gastroesophageal reflux disease(GERD), we examined 24 hour ambulatory esophageal pH monitoring and 9(23%) had pathologic reflux. In these 9 patients, amplitude of distal esophageal peristaltic contraction and lower esophagea] sphincter pressure were significantly lower than controls ($lt;0.05). Conclusions: These results suggest that the esophagus is a sourse of chest pain and dista] esophageal motility may be an important role in preventing GERD. 24 hour ambulatory esophageal pH monitoring with esophageal manometry and provocative tests can increase the diagnostic rate of the esophageal origin of chest pain.

만성 바이러스 간염 환자에서 간조직의 철과 구리 농도

김태오,강대환,양웅석,조몽,송철수,송근암,김형욱,류수형 대한소화기학회 1999 대한소화기학회지 Vol.34 No.4

Background/Aims: In viral hepatitis, it is unclear whether iron and copper play a role in the pathogenesis of hepatic injury. The purpose of this study was to investigate the presence of correlation between the hepatic concentrations of these metals and the grades of inflammation or stages of fibrosis in patients with chronic viral hepatitis. Methods: This study included 53 patients consisting of 44 patients with chronic hepatitis B, 6 patients with chronic hepatitis C, and 3 patients with cirrhosis. Hepatic iron and copper concentrations were determined by Inductively Coupled Plasma- Atomic Emission Spectrometry. Results: Average hepatic iron concentration was 583.2±606.5 ㎍/g dry weight. In one patient (1.9%), hepatic iron concentration was unusually high (4573.0 ㎍/g dry weight). Hepatic iron concentrations were not different according to the grade of portal/periportal and lobular inflammation, or the stage of fibrosis. Average hepatic copper concentration was 65.3±35.3 ㎍/g dry weight and hepatic coponcentrations were increased in 25 patients (47.2%). Hepatic copper concentrations were significantly related with the grade of portal/periportal inflammation (rs=0.475, p$lt;0.001), lobular inflammation (rs=0.362, p=0.008), and the stage of fibrosis (rs=0.410, p=0.002). Conclusions: These results suggest that copper may have an important role as a cofactor in the pathogenesis of hepatic injury in chronic viral hepatitis.