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.

위장관 ( 胃腸管 ) : 진행성 전신경화증 환자에서의 폐확산능과 위 - 식도 역류와의 상호관계에 관한 연구

윤용범(Yong Bum Yoon),송인성(In Sung Song),최규완(Kyoo Wan Choi),김정룡(Chung Yong Kim),정현채(Hyun Chae Jung),윤병철(Byung Chul Yoon),이풍렬(Poong Lyul Rhee),송영욱(Young Wook Song),정준기(June Key Chung),성명훈(Myung Hoon Sung) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.4

N/A To investigate the correlation of DLCO (carbon monoxide diffusing capacity) with gastro-esophageal reflux in patients with progressive systemic sclerosis (PSS), we performed esophageal manometry, 24 hour pH monitoring, esophagoscopy endoscopy, indirect laryngoscopy, Tc-sulfur colloid aspiration scan and pulmonary function test including DLCO. For this study 10 patients with PSS, diagnosed according to the preliminary criteria of ARA, were enrolled. The results were as follows; 1) The mean age of the patients with PSS was 37.5 +- 15.9 years and male to female ratio was 1:4. 2) There was no statistical difference of DLCO according to the gastroesophageal symptoms such as heartburn, chest pain and dysphagia. But the DLCO of the patients with exertional dyspnea was significantly lower than that of patients without. 3) The DLCO of the patients correlated with the amplitude of peristaltic waves of lower esophageal body, but not with the pressure of LES. 4) There were no stastical differences of DLCO as for the results of tests such as Bernstein test and 24 hour pH monitoring. 5) The DLCO of the patients with esophagoscopic finding of reflux esophagitis was not statistically different with that of the patients without, and also was for the indirect laryngoscopic findings of laryngeal edema, hyperemia or food stasis showing an indirect evidence of pulmonary aspiration.

간장 ( 肝臟 ) 및 담도 ( 膽道 ) : 담석의 석회화 유무에 따른 체외 충격파 쇄석술의 치료 효과

윤용범(Yong Bum Yoon),박용현(Yong Hyun Park),최병인(Byung Ihn Choi),김정룡(Chung Young Kim),김용태(Yong Tae Kim) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.2

N/A To investigate the difference in the therapeutic effect and complication of the extracorporeal shock wave lithotripsy (ESWL) between patients with non-calcified and calcified gallstones, a total 64 patients (36 with non-calcified gallstones and 28 with calcified gallstones) were selected to undergo ESWL treatment of their gallbladder stones using a piezoelectric lithotripter. Only patients who gave a history of biliary pain and who had fewer than three stones with a maximal diameter of 30 mm were admitted to this study. Treatment with ursodeoxycholic acid at a dose of 10 mg/kg/day was started 1 week before the lithotripsy. The percentage of patients whose gallstones were fragmented to particles under 3 mm was 67%: in the non-calcified gallstone group and 50%. in the calcified gallstone group. There was no significant difference in the fragmentation rate between the two groups (p>0.05). Forty-six percent of patients with non-calcified gallstones were free of stones after 6 months of oral bile acid therapy compared with 14% of those with calcified gallstones (p<0.05). Shock wave therapy had no adverse effects except cutaneous petechia (1.6%), transient gross hematuria (1.6%) and some episodes of abdominal pain (30%). Acute cholecystitis occured in 5% of the patients. One patient underwent elective

원발성 Achalasia 와 감별이 어려웠던 속발성 Achalasia

윤용범(Yong Bum Yoon),송인성(In Sung Song),최규완(Kyoo Wan Choi),김정룡(Chung Yong Kim),정원재(Won Jae Chung),정현채(Hyun Chae Jung),유권(Kwon Yoo),김용태(Yong Tae Kim),김나영(Na Young Kim),남택서(Taek Seo Nam) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.3

Malignancy involving the gastroesophageal junction can present with features very similar to those of the primary achalasia. Faliure to identify such cases may delay effective treatment of a curable tumor. We report one patient with secondary achalasia resulting from the gastroesophageal junction tumor. The findings of the esophagography, and the esophageal manometry were consistent with primary achalasia. The esophagoscopy and the chest CT scan showed no evidence of a tumor. Medical management failed to relieve the symptoms, so he was operated, and was confirmed to have adenocancinoma at the gastroesophageal junction.

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.

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.

항결핵약제에 의한 간독성에 대한 임상적 연구

윤용범(Yong Bum Yoon),정영화(Young Hwa Chung),이영상(Yung Sang Lee) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.2

N/A On the 44 patients who was admitted and diagnosed as toxic hepatitis due to antituberculous agents, the clinical details were reviewed. The results were summerised as following: 1) Male to female ratio was 1:1, and mean age was 34.7. They took at least two or more kinds of hepatotoxic agents, so that one definite cause of hepatotoxicity conldn't be determined. 2) Typical symproms of hypersensitivity such as fever, skin rash or lymphadenopathy were found only 2 patients, and eosionophilia above 500/㎣ was demonstrated in 28.6% of the patients. 3) 18 patients, 4.9% of total, showed severe hepatotoxicity that serum bilirubin was above 2.0 mg %, and 45.5% of the patients had mild hepatotoxicity that serum transaminase levels were belew the fivefolds of the normal range. 4) Severe jaundice, acute renal fai1ure, fever and lymphadenopathy were noted in two patients and were thonght as hepatotoxicity due to intermittent use of rifampin. 5) Readministrations of isoniazid and rifampin were successful in 81.3% and 86.7% of the patients respectively, but 71.4% of retrials of pyrazinamide were failed. No clinical differences were recognized between success and failure groups, but the frequency of eosinophilia was higher in failure group. 6) No differences between icteric and anicteric groups were noted in age, sex, used drugs, past history of drug use, the response to the readministration of the dnigs and frequency of eosinophilia, but the duration of treatment in icteric group was much prolonged in comparison with anicteric group.

99m - Tc DISIDA Scan 을 이용한 정상인과 담석증 환자에서의 담낭역학에 관한 연구

윤용범(Yong Bum Yoon),박용현(Yong Hyun Park),이영철(Young Cheol Lee),정준기(Joon Ki Jung),고창순(Chang Soon Ko) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.1

N/A Gallbladder stasis has been implicated as one of factors in gallstone formation. To evaluate the gallbladder dynamics, gallbladder filling and emptying were quantitated by the computer assisted 99m-Tc DISIDA scan in 8 normal subjects and 23 patients with gallstones. Gallstone patients exhibited normal gallbladder filling rate, and there seemed to be three periods (Lag period, Rapid contraction period, Slow contraction period) in gallbladder contraction induced by a fatty meal. In patients with gallstones, ejection fraction in whole contraction period, ejection fraction and ejection rate in rapid contraction period of gallbladder were reduced (p<0.05) when compared with controls. On closer inspection, the gallstone patients fell into two subgroups, separated by ejection fraction 72%(x-2S.D. of control). There were no significant differences in opacity, number, size of gallstones and biliary colic episodes between these two subgroups. When we divided 3 contraction parameter which were significant differences between control and gallstone group into two subgroups by E.F. 72%, E.F.a 38.9%, E.R.a 2.9%/min (x-2S.D. of control) and compared them with gallbladder wall thickness by ultrasonography, the thicker gallbladder wall brought about the decreased ejection fraction and ejection rate in rapid contraction period, but the ejection fraction in whole emtying period was not influenced by gallbladder wall thickness. To elucidate the relationship between gallbladder inflammation and contraction, Spearmans rank correlation analysis between inflammatory scorings of chronic cholecystitis and several parameters of gallbladder contraction was used; the linear relationships between two groups were not found (p> 0,05), but owing to small number of cases the result was hard to be accepted. Thus defective gallbladder emptying is evident in a subgroup of gallstone patients and is indepen- dent of clinical features, stone size, number and opacity. The gallbladder wall thickness influenced to ejection fraction and ejection rate in rapid contraction period, but not to whole ejection fraction. Relationship between gallbladder inflammation and gallbladder contractions was not elucidated.

경피적 담즙 배액술의 임상적 평가

윤용범(Yong Bum Yoon),송인성(In Sung Song),김정룡(Chung Young Kim),고광철(Kwang Cheol Koh),이진호(Jin Ho Lee),유권(Kwon Yoo),최병인(Byung In Choi) 대한소화기학회 1988 대한소화기학회지 Vol.20 No.2

N/A The mecical records of 267 patients who underwent percutaneous transhepatic biliary drainage (PTBD) for either benign or malignant biliary obstruction were reviewed with attention given to the complications associated with placement and maintenance of the catheter. In this series, successful drainage was achieved in 471(91.9%) out of the 512 procedures performed. One hundred eighty one of the 267 patients experienced total 470 cases of complications, of which minor complications were 91.7%. The details of complications that occurred are descrihed herein. The risks associated with placement and maintenance of the catheter are serious, and the proper management of the catheter on an outpatient basis requires a cooperative, well-informed patient and a dedicated rnedical team for close follow-up.

급성 괴사성 췌장염의 원인과 예후지표들의 유용성

임영석(Young Seok Lim),류지곤(Ji Kon Ryu),이한주(Han Chu Lee),김용태(Yong Tae Kim),윤용범(Yong Bum Yoon),김정룡(Chung Yong Kim) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.5

N/A Background/Aims: About ten to twenty percent of patients with acute pancreatitis progress to pancreatic necrosis. Little is known about the etiology of necrotizing pancreatitis. It has been suggested that even in the necrotizing pancreatitis group, the prognosis of patients vary greatly according to the degree of necrosis of the pancreas. Methods: We investigated retrospectively the etiology and predictive value of four prognostic indicators (Ransons criteria, APACHE-II score, analysis of peritoneal fluid, CT severity index) in fourteen patients with necrotizing pancreatitis who were admitted to Seoul National University Hospital from Jan. 1987 to Jun. 19!)5. Results: The most common cause was alcohol(9 patients), and no case was associated with cholelithiasis. Of the fourteen patients, five died, and three had more than 3 major complications. In contrast, another six patients had less than 2 complications. The sensitivity and specificity for prediction of serious prognosis (death or more than 3 major complications) of four prognostic indicators were all more than 70%, however, the CT severity index was most valuable. There were. Significant correlation between the CT severity index and Ransons criteria and analysis of peritoneal fluid. Conclusions: Alcohol seems to be the leading etiologic factor in necrotizing pancreatitis, and all prognostic indicators were effective for the prediction of serious prognosis. However, in the case of severe acute pancreatitis, the contrast enhanced dynamic CT(CECT) scan should be performed and proper management is necessary. (Korean J Gastroenterol 1997;29:667-677)