각종 췌장 질환에서 Secretin-enhanced Magnetic Resonance Cholangiopancreatography의 임상적 유용성

김선영 ( Sun Young Kim ),김명환 ( Myung Hwan Kim ),이상수 ( Sang Soo Lee ),김정호 ( Jung Ho Kim ),박도현 ( Do Hyun Park ),김현준 ( Hyun Jun Kim ),배종석 ( Jong Suk Bae ),서동완 ( Dong Wan Seo ),이성구 ( Sung Koo Lee ),민영일 ( You 대한소화기학회 2003 대한소화기학회지 Vol.41 No.5

Background/Aims: Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive diagnostic technique for evaluation of the pancreatic duct, but it has several limitations compared with endoscopic retrograde cholangio pancreatography. The aim of this study was to assess the usefulness and clinical indication of secretin-enhanced MRCP (S-MRCP) in patients with various pancreatic diseases. Methods: From 2001 to 2002, S-MRCP was performed in 47 patients with chronic pancreatitis (group 1, n=19), pancreas divisum (group 2, n=11), acute pancreatitis (group 3, n=8), and other pancreatic diseases (group 4, n=9). Image quality and presence of pancreas divisum were analyzed before and 10 minutes after the IV administration of 1 CU/kg secretin. Size of the main pancreatic duct and improvement scale before and after secretin stimulation were measured quantitatively. Results: After administration of secretin, image quality was significantly improved in all four groups. However, such improvement was significantly lower in group 1 of chronic pancreatitis than in other groups. The S-MRCP has changed treatment plan, especially in patients with acute necrotizing pancreatitis or pancreas divisum. Conclusions: The administration of secretin improves visualization of all pancreatic disease. Especiallys, S-MRCP would be useful as a primary diagnostics tool for assessment of patients to be suspected of having acute necrotizing pancreatitis or pancreas divisum. (Korean J Gastroenterol 2003;41:391-397)

복강경 담낭절제술에 있어 내시경적 역행성 담췌관 조영술의 역활에 대한 임상적 고찰

이선영(Sun Young Yi),이성구(Sung Koo Lee),김명환(Myung Hwan Kim),민영일(Young Il Min),이승규(Sung Kyu Lee) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.3

N/A 'A'idespread enthusiasm for laparoscopic cholecystectomy(LC) has raised new and inter- esting questions for the endoscopic retrograde cholangiopancraetography(ERCP) manage- ment of duct sotnes. Few laparoscopic surgeons currently explore the bile duct at cholecystectomy, which has focused attention on the role ERCP in the diagnosis and treatment of duct stones. We assessed the use of ERCP before and after LC at our hos- pital. Indications for ERCP depend on the likehood of duct patho)ogy,'clinical, biochemical and radiologic predictive factors are established. Prediction of duct stones and indication for ERCP before LC were 3 groups,'historic factors(recent jandice, cholangitis, pancreati- tis) 25%(29/116), abnormality of liver function tests 45%(53/116), and bile duct size<as measured at ultrasonography) 37%(43/116) in this study. ERCP is highly efficient in the management of patients with symptoms after LC in order to exclude, diagnose, and treat complications such as retained stones, cystic duct leaks, and strictures. Overall, ERCP technique are used in about 12.2% patients before and after LC of this study. The fundamental question is whether t.he combination(LC and endoscopic duct ex- ploration) is a better option for the patients than old fasioned operative intervention. Each surgical and endoscopic team will need to develop and test algorithms in the hope of minimizing the risk of unfortunate scenarios.(Korean J Gastroenterol 1994; 26: 541 548)

건강검진자의 담석증에 대한 임상적 고찰

이선영(Sun Young Yi),이성구(Sung Koo Lee),이승규(Sung Kyu Lee),민영일(Young Il Min),김명환(Myung Hwan Kim),한동수(Dong Soo Han),김정원(Jung Won Kim) 대한내과학회 1994 대한내과학회지 Vol.47 No.3

N/A Objectives: Gallstone disease is the most common biliary disease, of which prevalence, composition, and location has different dermographic charateristics. Because there was difference in composition of gallstone between Korea and other countries, percentage of symptomatic stone, symptom in relation to size, number of gallstone and lucency of gallstone will have some difference. We carried out this study to determine the prevalence of gallstone and symptoms in related size, number and lucency among general health screening people. Method: 4,395 cases who visited general health screening center of Asan medical center during 9 mothperiod from June, 1990 to March, 1991 were surveyed by abdominal ultrasound. Gallstone disease group, which is defined by gallstone positive in ultrasonogram and postcholecystectomy du to gallstone. The number of stone was devided into 3 groups (1, 2-3, 4<) and size of stone was devided into 3 groups (<1cm, 1cm<@<3cm, 3cm<). And lucency of stone was evaluated by simple scout X-ray. We assessed the sex and age related prevlence, size, number, and lucency of stone related to symptom. Result: We experienced 160 cases of gallstone disease in 4,395 cases examined (133 case of gallstone, 27 cases of postcholecystectomy), Total age adjusted prevalence is 3.43%. And sex-adjusted prevalence 3.70% (95% CI 3. 14-4.26) of female is significantly higher than 2.08% (95% CI 3.14-4.26) of male. The prevalence of gallstone disease increased along with the increasing age with a significant linear trend. Asymptomatic gallstone cases were 104 case (2.37%) and lucent stone was 52 cases (66. 6%) of 78 cases who was examined by oral GB study. The patients who had biliary symptom increased along with increasing number of stone with a significant linear trend (p=0.044). In contrast, the size of stone was not related to symptom (p=0.668). But there was significant relation between size and number of stone, so the statistic correction of size and number was done. And then, the relation of number and symptom was not significant correlation (p=0.071). Also the lucency of stone was not related with symptom (p=0.539). Conclusion: Age adjusted prevalence of gallstone disease in general health screening people is speculated as 3.34% and increased along with the increasing age. The number and size of stone, and the lucency had no significant relation with symptom.

건강검진자의 역류성 식도염에 대한 임상적 고찰

이선영(Sun Young Yi),이성구(Sung Koo Lee),김명환(Myung Hwan Kim),한동수(Dong Soo Han),김정원(Jung Won Kim),민영일(Young Il Min) 대한내과학회 1994 대한내과학회지 Vol.46 No.4

N/A Objectives: Gastroesophageal reflux disease (GERD) is used to describe any symptomatic clinical condition or histopathologic alteration resultant from episode of gastroesophageal reflux; reflux esophagitis describes a condition experienced by subset of GERD patients with histopathologically demonstrable changes in the esophageal mucosa. GERD is widely reported to be one of the most prevalent clinical condition affecting the gastrointestinal tract, the figures on its incidence and prevalence was not studied in Korea, Therefore we carried out this study to determine the prevalence of reflux esophagitis, in related with symptom, smoking, drugs, and overweight among general health screening people. Method: 2,795 cases which were visited at general health screening center of Asan medical center during 5 month-period from April, 1993 to August, 1993 were surveyed by esophagogastroscopy. We devided patients ioto reflux esophagitis by Savary-Miller stage. We assessed the prevalence of reflux esophagitis endoscopically and sex and age related prevalence, symptom, associated disease, smoking, drug, and overweight related esophagitis. Result: We expierenced 66 cases of reflux esophagitis in 2,795 cases examined (63 cases of stage I, 3 cases of stage II). Total age adjusted prevalence in 2.74% (95% CI 1.98~2.87). In sex-adjusted prevalence, male vs female prevalence is 32 to 1, so there was significantly higher prevalence of male than female. Asymptmatic reflux esophagitis case were 48 cases (72.7%). Having associated disease and ingested drug were not related with the prevalence of reflux esophagitis (p >0.05). Reflux esophagitis patients of smoking were significantly higher than non-smoking (p<0.01). Also, reflux esophagitis patients of overweight were significantly higher than ideal or underweight (p<0.001). Conclusion : Age adjusted prevalence of reflux esophagitis in general health screening people is speculated as 2.74%. And the most patient of reflux esophagitis is asymptomatic. The smoking and overweight have significantly related with reflux esophagitis.

췌장 전이성 종양의 임상적 특징

부선진 ( Sun Jin Boo ),김명환 ( Myung Hwan Kim ),김유석 ( Yu Seok Kim ),류충헌 ( Choong Heon Ryu ),김홍준 ( Hong Jun Kim ),박도현 ( Do Hyun Park ),이상수 ( Sang Soo Lee ),서동완 ( Dong Wan Seo ),이성구 ( Sung Koo Lee ),김송철 ( So 대한소화기학회 2011 대한소화기학회지 Vol.57 No.6

Background/Aims: Histologically confirmed metastatic pancreatic cancers are infrequent. The aim of this study was to analyze clinical, therapeutic and prognostic features of pancreatic metastases. Methods: We retrospectively evaluated stage of primary malignancies, interval between diagnosis of primary tumors and detection of pancreatic metastases, treatment for metastases to the pancreas, survival rate, and prognostic factors in 31 patients with pancreatic metastases. Results: The mean age at the time of primary cancer diagnosis was 52.4±13.2 years. Primary cancers were renal cell carcinoma (n=16), non-small cell lung cancer (n=6), small cell lung cancer (n=3), colorectal carcinoma (n=2), osteosarcoma (n=1), gastric carcinoma (n=1), malignant melanoma (n=1), and thymic carcinoma (n=1). Pancreatic metastases were synchronous in six cases and metachronous in twenty five cases, with median interval time of 40.8 months (range 3-186) between the diagnosis of primary tumor and detection of pancreatic metastases. The median survival after the detection of the metastases was 16 months. In multivariate analysis, non-renal cell carcinoma as primary malignancy and positive symptom related to pancreatic metastases were associated with poor prognosis (hazard ratio [HR], 8.33; 95% CI, 2.1-33; p=0.003, and HR, 4.02; 95% CI, 1.27-12.7; p=0.018). Conclusions: Metastatic tumors to the pancreas have to be kept in mind when a patient with pancreatic mass has a history of other malignancy, even if treated several years before. In the absence of widely metastatic disease, aggressive diagnostic and therapeutic approach may offer the chance of long-term survival in selected patients. (Korean J Gastroenterol 2011;57:358-364)

P3HT, BDT-3T Polymer 고분자 유기박막태양전지에서의 안정도 및 효율감소에 대한 고찰

선욱 ( Wook Sun ),이경균 ( Kyeong K. Lee ),이성구 ( Sung Koo Lee ),이효수 ( Hyo Soo Lee ),임은희 ( Eun Hee Lim ) 한국공업화학회 2010 응용화학 Vol.14 No.2

In this writing, in order to understand stability/degradation in organic solar cell devices, the device stability of poly(3-hexylthiophene) P3HT and poly(benzo[1,2-b:4,5-b` ]dithiophene- alt-terthiophene (BDT-3T) is discussed. The OPVs were fabricated using the polymers and [6,6]-phenyl-C61-butyricacidmethylester (PC[60]BM) as donor and acceptor, respectively. The effect of O(2) on device stability was examined by keeping the P3HT and BDT-3Tdevices in N(2) and airand the humidity was controlled by introducing getter on encapsulation of device. The experiment was done until thousands of hours. The device stabilityof new copolymer BDT-3T was comparable to that of P3HT.

중심부 석회화를 동반한 간내 담관암 1예

김효선 ( Hyo Sun Kim ),윤재훈 ( Jai Hoon Yoon ),엄정호 ( Jeong Ho Eom ),이석원 ( Seok Won Lee ),박태영 ( Tae Young Park ),이성구 ( Sung Koo Lee ) 대한췌담도학회 2016 대한췌담도학회지 Vol.21 No.2

중심부 석회화를 동반한 간내 담관암은 국외에서 1예 보고되었을 정도로 매우 드문 증례이며, 담관내 석회화 소견을 보이는 환자의 감별진단에 있어서 간내 담도암에 대한 고려와 조직검사가 필요할 것으로 판단되어 중심부 석회화가 동반된 간내 담관암 증례를 보고하는 바이다. A 50-year-old woman complained of jaundice and dyspepsia that started 2 weeks prior to consultation. Abdomen-pelvic computed tomography showed a 3 cm mass in the right hepatic duct with central calcification, which was spreading into the second branch. Repeated biopsies through endoscopic retrograde cholangiopancreatography were needed for pathology, which was consistent with an adenocarcinoma. Imaging studies including positron emission tomography showed no evidence of distant metastasis. The patient underwent right lobectomy with bile duct resection. The final diagnosis was intrahepatic cholangiocarcinoma with central calcification. We reported a very rare case of centrally calcified mass growing in the second branch of the right hepatic duct. The possibility of intrahepatic cholangiocarcinoma with central calcification should be considered for differential diagnosis of intrahepatic calcification.

급성 췌장염의 중증도 판정에 있어서 임상적 기준 ( Ranson 기준 ) 과 방사선학적 ( CT ) 기준의 비교 검토

민영일(Young Il Min),이성구(Sung Koo Lee),김병식(Byung Sik Kim),한동수(dong Soo Han),김명환(Myung Hwan Kim),이문규(Moon Kyu Lee),이선영(Sun Young Yi),이미화(Mi Hwa Lee),김미경(Mee Kyung Kim) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.4

N/A The assessment of severity has a key role in the management of patients with acute pancreatits. A total of 55 patients were enrolled in this study. Ransons cinical severity was determined within 48 hours after admission and radiologic severity was determined based on Balthazar criteria using computed tomography (CT) scan taken not later than 2 hours after admission. The seventy of pancreatitis based on Ransons criteria was mild (0-2 signs) in 39 patients (71%), moderate (3-6 signs) in 10 (18%), and severe ( 7 signs) in 6(11%). with increase in Ranson's score, average days of fasting, hospitali#zation and ICU care were increased. The mortality rate was also increased with CT criteria, the: patients showed mild .;everity in 29 patients (53%) (A:18, B:11). moderate in 20(36%) (C:16, D:4), and severe in 6(11%) (E:6). With increase in CT grade, above mentionr:d clinical parameters were similarly increased When clinical and CT criteria were compared simultaneously, of 39 patients with mild by rlinical rriteria 24 patients were in mild (grade A or B) and remaining 15 patients in moderate (grade C or D) by CT criteria. In 10 clinically moderate patients, 5 were in mild (grade A or B), 3 in rnoderate (grade C or K)) and 2 in severe' (grade E1 by CT critqria. In 6 cIimcally severe patient, were in moderate (grade C or D) and 4 were in severe (grade E) by CT criteria. In conclusion, Ranson's clinical criteria and CT grading were both useful in assessing the clinical course oi acute pancreatitiis. Signaficant statistical correlation was not found between two criteria hut combined prognostic criteria may be more helpful in determination of final outcome of acute pancreatitis.

원발성 경화성 담관염

민영일(Young Il Min),이성구(Sung Koo Lee),김명환(Myung Hwan Kim),이승규(Sung Gyu Lee),이선영(Sun Young Yi),홍진선(Jin Sun Hong),박흥동(Hung Dong Park),공경엽(Kyung Youp Kong),김미경(Mee Kyung Kim) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.2

Primary sclerosing cholangitis is a chronic disease of unknown cause, characterized by inflammation and fibrosis of the biliary tree with diffuse multifocal stricture formation. In our case, the cholangiogram showed multifocal strictures in the intrahepatic ducts and beading of extrahepatic bile ducts. Also severe periductal fibrosis and proliferation of bile ductules were noted by liver biopsy. Authors eport one case of primary sclerosing cholangitis in 27-year-old rnale who complained right upper quadrant abdominal pain and pruritus.

담석 췌장염의 임상적 고찰

민영일(Young Il Min),이성구(Sung Koo Lee),김병식(Byung Sik Kim),한동수(dong Soo Han),김명환(Myung Hwan Kim),이승규(Sung Gyu Lee),이선영(Sun Young Yi),이미화(Mi Hwa Lee) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.4

N/A Etiologic diagnosis is important in the management of a patient with acute pancreatitis. Early differentiation of gallstone pancreatitis from nongallstvne pancreatitis by imaging methods is often difficult. The objectives of this study are to assess valucs of clinical and laboratory data in establishing gallstone as an etiology of pancreatitis and to analyze endoscopie retrograde clholangiopancreato- grophy (ERCP) findings of gallstome panrreatitis. Age, sex, serum alkaline phosphatase, aminotransferase (SGPT), amylase, lipase, and total bilirubin levels were significantly clifferent (p < 0.05, chi square) between gallstone and nongallstone groups. The item which favor gallstone pancreatitis are age.50 years, female sex, amylase>1000 IU/ml, lipase 3000 IU/ml, SGPT-100 IU,/L, alkaline phosphatase2400 IU/L, and total bilirubin 2.5 mg, dl. It was found that, those who had more than 4 of above factors (21 cases) were more likely to have gallstone pancreatitis (15 cases, 71.4%). ERCP findings of 22 patients with gallstone pancreatitis were analysed. l5 cases (68.2%) had common bile duct stones, of which 9 had undertaken endoscopic sphincterotomy and removal of stones. In conclusion, clinical and biochemical predictive systems for presence of gallstones in acute pancreatitis may have useful roles in evaluation of etiology in acute pancreatitis and in planing early interventional treatment. ERCP and endoscopic sphinctivotomy in gallstone pancreatitis are safe and effective diagnostic and therapeatic measures.