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간장 및 담도 : 삼출성 복수증의 감별진단과 복강경 검사
정규원(Kyu Won Chung),차상복(Sang Bok Cha),선희식(Hee Sik Sun),김부성(Boo Sung Kim),정인식(In Sik Chung),안병민(Byung Min Ahn),김재광(Jae Kwang Kim),김태룡(Tae Ryong Kim),최규용(Gyu Yong Choi) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.1
N/A Exudative ascites should initiate an evaluation for peritoneal processes, most importantly infection and tumor. And the pathological diagnosis is required for a approapriate treatment in most cases. To assess the diagnostic accuracy and complication rates of diagnostic laparoscopy in patients with exudative ascites we studied in 73 patients with exudative ascites retrospectively. Thirty three patients had malgnancy related ascites, and peritoneal carcinomatosis was confirmed in thirty one patients. Twenty seven patients had tuberculous peritonitis, and thirteen patients had miscellaneous causes, among them eight patients had underlying liver cirrhosis and clinically spontaneous bacterial peritonitis were suspected in three patients in whom bacteria were cultivated in ascites. Pancreatic pseudocyst and leakage into peritoneal cavity was confirmed by endoscopic retrograde pancreatography in one case, but the remained four cases had not known the diagnosis. The most common primary cancer was gastric carcinoma which was diagnosed in fourteen patients, and then ovarian cancer in five patients, colon cancer in four patients, pancreatic cancer in three patients, mesothelioma in one patient and unknown origin in four patients. Cytology evaluation of the ascitic fluid was positive for tumor cells in 62% of patients with peritoneal carcinomatosis. Blind Cope needle biopsy yielded positive diagnosis of neoplastic or tuberculous in 65.4 per cent of rases. The major and minor complication rates of laparoscopy were 0% and 26.4%, respectively, with no fatalities. These findings compare favorably with general experience. We conclude that laparascopy is relatively safe and accurate diagnostic method of choice in exudative ascites, especially in cases when other non-invasive methods were failed.
과민성 대장염환자에서 이중 맹검 투여한 Tiropramide의 치료 효과
정규원(Kyu Won Chung),선희식(Hee Sik Sun),김부성(Boo Sung Kim),정인식(In Sik Chung),최명규(Myung Gyu Choi),최규용(Gyu Yong Choi),박수헌(Soo Heon Park),장창훈(Chang Hoon Jang),한준열(Jun Yeul Han) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.5
N/A A double-blind, randomized parallel group trial comparison study was performed in 63 patients with irritable bowel syndrome for evaluation of effectiveness and safety of Tiropramide. Over a treatment period of 4 weeks, Tiropramide (300 mgjday) were administered in 32 patients and placebo in 31 patients with irritable howel syndrome. The degrecs of symptom scores for abdominal pain, belching, flatulence, diarrhea, abdominal discomfortnesi, inadequate defecation, borborygmi, etc were assessed every week by interview of pat:ient.s during the treatment. At the end of the four week. treatment, 78.2% of the treatment group with Tiropramide and 40.5% of placebo group were markedly improved their symptoms. The degrees of symptom scores for abdominal pain, inconiplete evacuation, borborygmi, flatulence, abdominal distension, and intensity of nausea showed significant improvement in the treatment group compared with placebo group in each week assessrnent. One patient with Tiropramide treatment and two patients of placebo group experiencecl aggravation of symptoms during treatment but no one had adverse reaction during treatment. These results suggest that Tiropramide is effective and safe for the treatment of irriitable bowel syndrome.
정규원(Kyu Won Chung),정환국(Whan Kook Chung),선희식(Hee Sik Sun),정인식(In Sik Chung),양진모(Jin Mo Yang),심상인(Sang In Shim),최명규(Myung Gyu Choi),양시영(Si Young Yang),김종률(Jong Yul Kim),이교영(Kyo Young Lee) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.1
Primary biliary cirrhosis (PBC) is a chronic inflammatory disease of unknown cause that is characterized by the destruction of small intrahepatic bile ducts. It is rare disease in Asia, especially in Korea. We report here a case of a 64-year old female with primary biliary cirrhosis and Sjogren s syndrome who has suffered from generalized pruritis and intermittent dry eye since 6 years ago, and sudden hematemesis. She was treated with endoscopic sclerotherapy, cholestyamine and ursodeoxy- cholic acid. We report the second case of primary biliary cirrhosis withe Sjogren's syndrome in Korea.
정규원(Kyu Won Chung),선희식(Hee Sik Sun),정인식(In Sik Chung),양진모(Jin Mo Yang),심상인(Sang In Shim),최명규(Myung Gyu Choi),한현복(Hyun Bok Han),정홍량(Hong Ryang Jeong),이재학(Jae Hak Lee),강창석(Chang Suck Kang) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.3
Recent advent of non-surgical treatment for gallstones desires accurate in vivo analysis of chemical composition to select optimal candidate. As preliminary work, we undertook in vitro CT examimation of the surgically removed 53 gallstones and compared CT pattern with chemical compsotion. Those results were correlated with in vitro lithotripsy of the gallstones. The CT appearances were classified as follows: Laminated (43%), dense (32%), rimmed (11%), isodense (8%) and faint (6%). Dense pattern contains high calcium content. As CT density increased, calcium content increased, but cholesterol content decreased proportionslly. The number of shock waves to breakdown the gallstone ]ess than 2 mm in size, has increased as stone volume and cholesterol content increases but did not have any correlation with calcium content level. As a result, the CT exmination is very sensitive to detect small amount of calcium content in gallstones and CT pattern and density of the gallstones are well correlated with chemical compsotion and therefore in vivo CT exmination for ESWL candidate is desirable.
한국인 수혈후 간염과 만성 간질환 환자에서의 C형 간염바이러스 감염동태 (제1보)
정규원 ( Jeong Gyu Won ),선희식 ( Seon Hui Sig ),정환국 ( Jeong Hwan Gug ),신호균 ( Sin Ho Gyun ),박충기 ( Park Chung Gi ),유재영 ( Yu Jae Yeong ),( Adrian M. Di Bisceglie ),( Jeanne J. Waggoner ),( Jay H. Hoofnagle ) 대한내과학회 1990 대한내과학회지 Vol.38 No.6
N/A To investigate the prevalence of antibodies to hepatitis C virus infection in patients with various chronic liver diseases in Korea, we tested 240 serum samples using the Abbott enzyme immunoassay method. The result sare summarized as follows: 1) Among 57 patients with post-transfusion hepatitis(PTH), 38(66.7%) were positive for anti-HCV. Four out of 57 patients were also positive for HBsAg, of which three were positive for anti-HCV. 2) In 131 patients with chronic non-A, non-B hepatitis, who had no history of blood transfusions, 60(45.8%) were positive for anti-HCV; of them 42 out of 85(49.4%) patients with chronic hepatitis, 14 out of 34(41.2%) with liver cirrhosis, and four out of 12(33.3%) with fatty liver and alcoholic hepatitis were positive for anti-HCV. 3) In 27 patients with HBsAg negative hepatocellular carcinoma, 13(48.1%) were positive for anti-HCV. 4) In 25 patients with chronic hepatitis B, who were negative for HBeAg but had active liver disease by liver biopsy, two(8%) were positive for anti-HCV. In conclusion, the prevalence of type C hepatitis in Korea was similar to that of other countries. This test is useful in confirming the diagnosis of various chronic viral hepatitis patients in Korea. Meanwhile, studies of larger numbers of patients and blood donors are necessary to estimate the exact prevalence of this type of hepatitis in Korea.
정규원(Kyu Won Chung),선희식(Hee Sik Sun),심상인(Sang In Shim),강창석(Chang Suck Kang),박수헌(Soo Heon Park),한혁준(Hyeok Jun Han),노대근(Dae Keun Lo),박진노(Jin No Park),방춘상(Chun Sang Bang),최명규(Myong Gyu Choi) 대한소화기학회 1997 대한소화기학회지 Vol.30 No.1
Hepatocellular carcinoma is one of the most common malignancies reported in ost of the Africa and South-east Asia. As hepatocellular carcinoma metastases well to distant site, half of the cases metastases to distant site at diagnosis. Hepatocellular carcinoma usually spread to regional lymph nodes around porta hepatis via lyphatics and venous metastasis can occur via intrahepatic vein. The usual sites of extrahepatic metastasis are lung, local lymph nodes, adrenal glands and bones, but epidural metastasis is very rare. Although the prognosis of the hepatocellular carcinoma was very poor in the past, the survival time seemed to be prolonged by early diagnosis and improvement of medical therapy. Therefore the importance of metastatic lesion of the hepatocellular carcinoma might be reemphasized. Recently we experienced a case of the hepatocellular carcinoma who developed paraplegia suddenly. MRI revealed ovoid epidural rnass at 6th and 7th dorsal vertebra level posteriorly. After emergency operation, the resected mass was confirmed metaststic hepatocellular carcinoma. (Korean J Gastroenterol 1997;30:119-125)
위식도역류질환에서 십이지장위식도역류 - 장시간 보행성 식도내 pH및 빌리루빈의 동시측정에 의한 평가
최명규(Myong Gyu Choi),박수헌(Soo Heon Park),방춘상(Choon Sang Bang),한준열(Joon Yul Han),김재광(Jae Kwang Kim),최규용(Kyu Yong Choi),정인식(In Sik Chung),정규원(Kyu Won Chung),선희식(Hee Sik Sun),박두호(Doo Ho Park) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.4
N/A Background/Aims: Esophageal reflux damage may be produced by agents other than acid and the term alkaline esophagitis has been applied. Methods using esophageal pH monitoring to assess duodenogastroesophageal reflux have been suggested but gastric neutralization has made these methods difficult to prove conclusively. The purpose of this study were to investigate the role of duodenogastroesophageal reflux in gastroesophageal reflux disease(GERD) and to understand the relationship between pH and duodenogastroesophageal reflux. Methods: we performed simul- taneous esophageal pH and bilirubin rnonitoring(Bilitec 2000, Synetics) in 14 symptomatic patients with gastroesophageal reflux and 10 healthy controls. Abnormal gastroesophageal reflux was defined when the percent total time of pHC4 or bilirubin absorbance 0.14 exceeded the 95th percentile of the range obtained in healthy volunteers. Results: Abnormal gastroesophageal reflux was diagnosed in 12(85.7%) of 14 patients, who could be categorized into 3 acid refluxers, 1 bile refluxer or 8 combined acid and bile refluxers. All 6 patients with severe esophagitis(grade 2 by Savary Miller classification) were combined acid and bile refluxers and had markedly prolonged acid and bile reflux compared to 8 patients with normal or mild esophagitis(% total time of pH 4(mean+SE): 13.4+2.96 vs 5.0+1.8, p<0.05; % total time of bilirubin absorbance 0.14(mean+SE): 25.2+4.6% vs 7.9+3.8%, p<0.05). Mean pH of esophageal refluxate during bile reflux episode lasting longer than 5 minutes was 6.0(7.1% for pH C4, 8.8% for pH 4 5, 26.6% for pH 5-6, 47% for pH 6-7 and 8.3% for pH7). 4) 8 patients with a symptom index greater than 25% experienced 24 reflux symptoms of which 12(50.0%) were associated with acid reflux, 5(20.8%) were associated with bile reflux and 7(29.2%) were not associated with bile or acid reflux. Conclusions: Alkaline esophageal reflux is a misnomer. Esophageal pH monitoring does not adequately identify symptomatic non-acidic duodenogastroesophageal reflux. Patients with com- bined acid and bile reflux are more likely to develop severe esophagitis. (Korean J Gastroenterol 1996; 28:469 - 476)
Itopride가 정상 성인에서 상부 위긴장도와 위감각능에 미치는 영향
최명규(Myung Gyu Choi),추교영(Kyo Young Choo),김병욱(Byung Wook Kim),최황(Hwang Choi),박수헌(Soo Heon Park),오정환(Jung Hwan Oh),한석원(Sok Won Han),김재광(Jae Kwang Kim),정인식(In Sik Chung),정규원(Kyu Won Chung),선희식(Hee Sik Sun 대한소화기학회 2000 대한소화기학회지 Vol.36 No.3
Background/Aims : Itopride is a newly developed prokinetic agent and has antidopaminergic and anti- acetylcholine esterase activities. Our aim was to evaluate the effect of itopride on proximal gastric tone and visceral perception. Methods: Fifteen healthy subjects participated in two experiments with 7 days interval. Randomized double blinded cross-over design with 3 days pretreatment of placebo or itopride was followed by itopride or placebo treatment. After overnight fasting, itopride was given prior to barostat study. Sensory function was assessed by scoring the perception for nausea, fullness, and abdominal discomfort/pain during random-order distensions of 4, 8, and 12 mmHg above minimal intragastric distending pressure (MDP). Effect of distensions was studied three times. Results : Compliance was not different after pretreatment of itopride or placebo. Itopride has no effect on visceral perception at MDP+4 mmHg (92.5±45.3 vs. 79.1±30.2), 8 mmHg (117.7±41.1 vs. 118.9±41.5) and at MDP+12 mmHg (159.8±43.9 vs. 149.9±53.5). MDP and fasting tone were not different between the two experimental groups. After itopride pretreatment, significantly increased intragastric volume were recorded in 60 min postprandial period (p<0.05). Conclusions: Itopride enhances the gastric accommodation to meal. This observation suggests that itopride may provide benefits to patients with impaired postprandial relaxation of proximal stomach. (Kor J Gastroenterol 2000;36:293 - 301)
보행성 24시간 식도내압검사로 진단된 미만성 식도경련 1례
최명규(Myung Gyu Choi),추교영(Kyo Young Choo),김재광(Jae Kwang Kim),정규원(Kyu Won Chung),선희식(Hee Sik Sun),박수헌(Soo Heon Park),장데레사(Theresa Jang),김백선(Baek Sun Kim),김선명(Sun Myung Kim),한준열(Jun Yeol Han) 대한소화기기능성질환·운동학회 2000 Journal of Neurogastroenterology and Motility (JNM Vol.6 No.1
Diffuse esophageal spasm (DES) is a motility disorder of the esophagus characterized by symptoms of retrosternal chest pain and intermittent dysphagia. The diagnosis of DES has relied on criteria obtained from a standard esophageal manometry (more than one simultaneous contraction in a series of l0 wet swallows with the rest being peristaltic). Because symptoms and/or typical manometric findings are not always documented during the standard manometry, 24 hour manometry may be more useful in such cases. We recently assessed a 29-year-old male patient who complained of chest pain and dysphagia. He showed nonspecific, findings on the laboratory hiwi manometry, but DES was diagncwed by his typical manometric findings on the 24 hour manometry. Therefore, a 24 hour manometry. should always he performed when the patient's history suggests the presence of DES and the laboratory based manometry failed to detect the symptomatic contractions of DES. Following we report this case with a review of the literature. (Korean Journal of Gastrointestinal Motility 2000;6:63-68)
선천성 간섬유화증을 동반한 Caroli ` s Disease
정환국(Whan Kook Chung),선희식(Hee Sik Sun),김부성(Boo Sung Kim),양진모(Jin Mo Yang),최명규(Myung Gyu Choi),박수헌(Soo Heon Park),김성수(Sung Soo Kim),정인식(In Sik Jung),정규원(Gyu Won Jung) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.1
Carols disease with congenital hepatic fibrosis was diagnosed in a 34-year-old woman. She com- plained of sudden hematemesis and easy fatigability. She showed a esophageal varix, hepatomegaly and splenomegaly, but showed normal liver function test. We could not find peripheral stigmata of liver disease such as palmar erythema and spider angioma. Abdominal sonogram, ERCP, abdominal CT and celiac angiogram showed multiple intrahepatic ducts dilatations, characteristics of Carolis disease. Histologic finding of liver biopsy showed fibrous tracts containing dilated bile ductules connecting adjacent portal spaces that were widened by mature fibrosis tissue and liver parenchymal cells appeared normal. We should suspect the Carolis disease with congenital hepatic fibrosis those who showed hematemesis or cholangitis with normal liver function test and no peripheral stigmata of liver disease. As Caroli's disease combined congenital hepatic fibrosis frequently. Carolis disease was preoperatively diagnosed by radiologic study such as ultrasonography, ERCP and abdominal CT but congenital hepatic fibrosis was diagnosed only by liver biopsy. We presented a Carolis disease combined with congenital hepatic fibrosis and renal tubular ectasia with literature.