인슐린 비의존형 당뇨병 환자에서 PABA 검사에 의한 췌장 기능의 평가

정춘희(Choon Hee Chung),안광진(Kwang Jin Ahn),이은직(Eun Jig Lee),최광준(Kwang Jun Choi),송영득(Young Duk Song),임승길(Sung Kil Lim),정재복(Jae Bok Chung),이상인(Sang In Lee),이현철(Hyun Chul Lee),허갑범(Kap Bum Huh) 대한내과학회 1992 대한내과학회지 Vol.43 No.1

N/A Background and Methods: Exocrine pancreatic dysfunction is frequently seen in patients with fibrocal-culous pancreatic diabetes and insulin dependent diabetes mellitus. Also decreased pancreatic size in those patients has been reported. But exocrine dysfunction in patients with non-insulin dependent diabetes mellitus (NIDDM) is controversial. Simple tubeless PABA test has been widely used to test the chymotrypsin activity. In order to investigate the exocrine dysfunction in patients with NIDDM and to find out the factors affecting it, we performed PABA test and pancreatic size measurement in 20 diabetic patients and 8 controls. Results: 1) Excretion rate PABA in diabetic patients was significantly lower than that of healthy controls (58.3±17.5vs 76,5±11.49p, p<.0,05). 2) Among diabetic patients, underweight diabetics showed significantly lower excretion rate of PABA than non-underweight diabetics (50.2±18.5% vs 66,4±12,7%, p<0.05). 3) In non-underweight subjects, excretion rate of PABA was 66.4±12.7%, which is significantly lower than that of healthy controls (82.0±10.59%)(p<0.05), 4) In diabetic patients, urinary PABA excretion rate was not correlated with age, duration of diabetes mellitus, HbA1C and pancreatic size, but positively correlated with the ratio of ideal body weight. Conclusion: Exocrine pancreatic function was decreased in NIDDM patients and it seems to be negatively correlated with underweight

간 , 담도 및 췌장 : 원발성 간암환자 및 만성 HBsAg carrier 의 세포면역기능에 관한 연구

최흥재(Heung Jai Choi),이상인(Sang In Lee),정재복(Jae Bok Chung),신용운(Yong Woon shin),전재윤(Jae Yoon Chon) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.2

N/A The extremely variable course of disease after infection with hepatitis B virus is usually explained by differences in the host response to the hepatocytes carring viral antigens. Since the hepatitis B virus is not directly cytopathic for infected hepatocytes, host determined immunologic response is considered a likely pathogenetic determinant in this disease. These immunological reactions may be regulated by T lymphocyte subpopulations, especially helper and suppressor cells. The importance of a balance between helper and suppressor cells in maintaining immune homeostasis has recently been illustrated. In order to determine cellular immune function, the peripheral blood lymphocyte count, total T and B lyrnphocyte subsets, and T cell function by phytohemagglutinin (PHA) and concanavalin A (Con A) stimulation were estimated in 30 patients with primary hepatorna, 8 chronic HBsAg carriers and 20 healthy controls in Yonsei University Severence Hospital during the period from March to October 1986. The results were as fol)ows: 1) The peripheral blood lymphocyte count decreased significantly m patients with hepatoma than chronic HBsAg carriers and normal control(p<0.05), but there was no significant difference in patients with hepatoma between HBsAg positive and negative group. Active and total T lymphocytes decreased significantly in patients with hepatoma than normal control (p<0.05), but there was no significant difference in patients with hepatoma between HBsAg positive and negative group. 2) OKT4 and OKT4/OKT8 ratio decreased, and OKT8 increased significantly in patients with hepatoma than normal control(p<0.05), but there was no significant difference in patients with hepatoma between HBsAg positive and negative group. 3) The ratio of stimulation index by Con A decreased in patients with hepatoma but increased in chronic HBsAg carriers. The ratio of suppressor cell removal index to con A increased significanty in patients with hepatoma but not increased significantly in chronic HBsAg carriers. In summary, the status of HBsAg was not important but an immunoregulatory abnormality might contribute to the pathogenesis and natural course of primary hepatoma.

지상발표 : 위액 내의 Calcium 농도와 위염의 정도와의 관계

이은경(Yen Keng Lee),박효진(Hyo Jin Park),정재복(Jae Bok Chung),문영명(Young Myoung Mon),최흥재(Heung Jai Choi),김경환(Kyung Hwan Kim) 대한소화기학회 1987 대한소화기학회 추계학술대회 Vol.1987 No.-

간 , 담도 및 췌장 : 정상인 및 간경변증에 있어서 Doppler 복부 초음파검사에 의한 문맥계의 혈역학적 연구

강진경(Jin Kyung Kang),최흥재(Heung Jai Choi),박인서(In Suh Park),문영명(Young Myoung Moon),김원호(Won Ho Kim),정재복(Jae Bok Chung),한광협(Kwang Heup Han) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.2

N/A Portal systemic bleod flow can be measured quantitatively by the recently developed pulsed Doppler flowmetry system that consist of a mechanical sector scanner and a pulsed Doppler flowmeter. Since both modes are displayed in real time, Doppler signals can be retrieved at will from any depth. The blood flow velocity determined by the Doppler spectrogram and the vascular cross-sectional area measured from the B-mode tomographic image enables the quantitiative calculation of the blood flow volume. To evaluate the changes of portal hemodynamics in liver cirrhosis, we observed the cross-sectional area, blood flow velocity and blood flow volume of portal vein, splenic vein and superior mesenteric vein in 22 healthy adults as control and 21 patients with liver cirrhosis by the pulsed Doppler flowmetry system. The results obtained are as follows: 1) The cross-sectional area of the portal vein was significantly enlarged in patients with liver cirrhosis (1.19+-0.32 cm) cornpared with controls (0.81+-0.16 cm'), and the blood flow velocity was significantly reduced in patients with liver cirrhosis (11.46+-2.08 cm/sec) compared with controls (16.47+-3.82 cm/sec). But the blood folw volume of the portal vein was not significantly different in patients with liver cirrhosis (817.4+-265.2 ml/min) from controls (790.2+-207.2 ml/min) 2). The cross-sectional area of the splenic vein was significantly enlarged in patients with liver cirrhosis (0.54+-0.30 cm2) compared with controls (0.35+-0.12 cm), and the blood flow velocity was significantly reduced in patjents with liver cirrhosis (13.81+-5.13 cm/sec) compared with controls (22.15+-10.83 cm,'sec). But the blood flov; volume of the splenic vein was not significantly different in patients with liver cirrhosis (423.5+-220.2 ml/min) from controls (389.0+-90.4 ml-min). 3) The cross-sectional area of the superior mesenteric vein was significantly enlarged in patients with liver cirrhosis (0.59+-0.18 cm) compared with controls (0.37+-0.12 cm), and the blood flow velocity was significantly reduced in patients with liver cirrhosis (13.30+-4.98 cm/sec) compared with controls (20.21+-5.65 cm/sec). But the blood flow volume of the superior meseteric vein was not significantly different in patients with liver cirrhosis (436.4+-115.1 ml/min) frorn controls (393.3+-107. 0 ml/min). 4) In patients with liver cirrhosis, there was no significant hemodynamic change according to the presence or absence of ascites and the degree of esophageal varices. But the cross-sectional area and the blood flow volume of the splenic vein was significantly larger in patients with severe splenomegaly than in patients with mild splenomegaly. These results suggest that the pulsed Doppler flowmetry system is simple, non-invasive and particularly useful method in studying the changes of portal hemodynamics.

간경변증에 있어서 초음파검사상 문맥의 크기와 간정맥 계압의 상관관계에 관한 연구

최흥재(Heung Jai Choi),박인서(In Suh Park),문영명(Young Myong Moon),전재윤(Chae Yoon Chon),김두식(Doo Sik Kim),정재복(Jae Bok Chung) 대한소화기학회 1985 대한소화기학회지 Vol.17 No.1

N/A Diagnosis of portal hypertension can be made clinically by observing the esophageal varices, splenomegaly and/or ascites, but it is impossible in case without such clinical finding. For the measurement of portal pressure, wedged hepatic venous pressure, splenic pulp pressure, umblical vein pressure, mesentic vein pressure and direct punture of portal vein at laparotomy have been used, but these methods have not been frequently applied because their procedures are complicated and risky. After introduction of ultrasound in the field of clinical medicine, the portal vein size is easily visualized and the diagnosis of portal hypertension has been made by observing the portal venous system without difficulty. But the normal size of portal and splenic veins which are very important diagnostic criteria in ultrasound examination are not clearly defined and the diagnostic rate by the size of portal and splenic veins are reported by several authors with variable results. In this study we measured the diameter of splenic and portal vein with realtime ultrasonography in inspiratory and expiratory phase and checked the wedged hepatic venous pressure in 29 patients with liver cirrhosis and 14 persons without liver diease for control to see the normal range of diameter of vessels and the relationship between portal pressure and size of vessels. The results are as follows: l) The means of the diameter of splenic and portal veins of 14 control persons in inspira- tory phase were 0.49+-0.166cm and 0.79+-0.209cm and in expiratory phase 0.37% +-0.127cm and 0.67+-0.181cm respectively. The mean wedged hepatic venous pressure in control was 2. 1<1. 013 mmHg. 2) The means of the diameter of splenic and portal vein of 29 patients with liver cirrhosis in inspiration were 1.04+-0.233 cm and 1.30+-0.220 cm and expiration 0.96+-0.281 and 1.21+-0.231cm respectively. The mean wedged hepatic venous pressure in patients group was 14.0+-8.19 mmHg. 3) The upper criteria of normal diameter(mean+2SD) of splenic vein were 0.8cm in inspiration and 0.6 cm in expiration and of portal vein l. 2 cm in inspiration and 1. 0 cm in expiration. The splenic vein was within normal criteria in 13 out of 14 normaI persons in inspiration and expiration. The portal vein was in normal criteria in all in inspiration and in 13 in expiration. 4) In liver cirrhosis the wedged hepatic venous pressure was high (over 5 mmHg) in 24 cases and within normal limits in 5 cases. The size of splenic vein was larger than normal criteria in 2 cases from 5 with normal wedged hepatic venous pressure in inspiration and expiration and in 19 cases from 24 with high wedged hepatic venous pressure in inspiration and 22 cases in expiration. The size of portal vein was larger than normal criteria in 2 cases from 5 with normal wedged hepatic venous pressure in inspiration and 4 in expiration, and 17 cases from 24 with high wedged hepatic venous pressure in inspiration, and 21 cases in expiration, 5) The diagnostic efficacy of size of vessels on ultrasonography for portal hypertension was as follows. The sensitivity of splenic vein was 79.2% In inspihatory phase and 91.7% in expiratory phase and that of portal vein was 70.8% in inspiratory phase and 89.5 in expitatory phase. The specificity of splenic vein was 84.2% in inspiratory and expiratory phase and that of portal vein was 89.5% in inspiratory phase and 73.7% in expiratory phase. The positive predictability of splenic vein was 86.4% in inspiratory phase and 88.0% in expiratory phase and that of portal vein was 89.5% in inspiratory phase and 80.8% in expiratory phase. The negative predictability of splenic vein was 76.2% in inspiratory phase and 88.9% in expiratory phase and that of portal vein was 70.5% in inspiratory phase and 83.4% in expiratory phase. 6) The correlation coefficiencies between wedged hepatic venous pressure and the diameter of splenic and portal vein in control and diseased group were under 0.5, but in total the correlation coeffi