복수를 (腹水) 동반한 간경화증에서 (肝鏡化症) 복수내 (腹水內) Albumin 의 전신혈류로 (全身血流) 환류에 (還流) 관한 연구

기춘석(Chun Suk Ki),박경남(K N Park),함준수(J S Hahm),황흥곤(H K Hwang),이종숙(J C Rhee),조석신(S S Cho) 대한소화기학회 1984 대한소화기학회지 Vol.16 No.1

N/A Ascitic ultrafiltration and intraperitoneal reinfusion therapy for intractable ascites in liver cirrhosis removes ascites fluid rapidly and increases urine output, which is thought as a result of increased effective blood volume by inducing gradual backflow of concentrated ascitic albumin into circulation. To demonstrate a net transfer of ascitic albumin to blood by this therapy in cirrhotic intractable ascitic patient, I-181 labeld human serum albumin was administered intraperitoneally after ascitic ultrafiltration, and thereafter blood samples were chawn serially and radioactivity in these sample were measured. The blood levels of I-131-HSA increased gradually over 48 hours with the peak rate of blood uptake achieved at 6 hour and the peak levels is thought to be achieved at 72 hour considering the rate of uptake. At 48 hour, 6.47% of the isotope administered had appeared in the blood when corrections are made for transfer of labeled albumin into ascites and other extracellular space and degradation of labeled albumin, At 72 hour the precentage of ascitic albumin returned to blood appears to be at least 10% By this studies we can provides the therapeutic basis for ascitic ultrafiltration intraperitoneal reinfusion therapy in intractable ascites.

중증 간경화증환자에 (肝硬化症患者) 동반된 난치성 (難治性) 복수의 (腹水) 초여과에 (超濾果) 의한 치료효과

기춘석(Chun Suk Ki),박경남(K N Park),이호채(H C Lee),황흥곤(H C Hwang),정병천(B C Chung),허동헌(D H Hur),박한철(H C Park) 대한소화기학회 1983 대한소화기학회지 Vol.15 No.1

N/A There had been a considerable trouble in the management of refractory acites combined with liver cirrhosis. Such refractory ascites in advanced liver cirrhosis does not respond to conventicnal therapy such as bed rest, salt restriction, massive diuretics and albumin infnsion. And there are also serious corrplications including hepatic encephalopathy, functicnal renal failure and hyponatremia with massive administration of diuretics. So peritoneovenous shunt(Leveen shunt) had been developed in order to promote effective circulatory volume with increased renal function. But relatively large and serious complications such as DIC, fever, infection, pulmonary edema and pulmonary embolism had limited its widespread use in the magement of refractory ascites. So we have experienced intraperitoneal reinfusion of ultrafiltered ascites for 20 patients with intractable ascites combined with liver cirrhosis. We had performed this procedure via ultrafilter which was usually used in hemodialysis and pump. And the following results werc acquired. 1. About 6200 cc of acites was ultrafiltered for average 4. 5 hrs. and loss of body weight was 6.7kg which was more than the amount of filtered ascites. 2, Increasing tendency in serum albumin concentration after ultrafiltration with peak concentration about 0. 5 gm/dl gain at 3rd after this procedure. There were significant increase in the amount of daily urine output but statisitically nonsignificant increase in creatinine clearance. 4, The complications of this procedure were light headache, hearing disturbance, dizziness and there was no more serious complication such as DIC, variceal rupture, pulmonary edema. There was no recurrence of reaccumulation of ascites within 3 months with one time procedure in a certain case. The repeated with average of 4-6 weeks interval had controlled such refractory ascites. In summary, above results supported that intraperitoneal reinfusion of ultrafiltered ascites have beneficial effect in the control of refractory ascites combined with far advanced liver cirrhosis. The advantages of this procedure are the followings. 1.Low cost. 2. Time saving. 3. Ambulatory control. 4 Less complication. 5. Corresponding effect to intravenous albumin infusion (4-5 bottles)

원발성 간암의 종양 표식자로서 DNase 와 Rnase 에 관한 연구

기춘석(Chun Suk Ki),신봉재(B J Shin),조성옥(S O Cho),한중수(J S Han),고재경(J K Koh) 대한소화기학회 1988 대한소화기학회지 Vol.20 No.3

N/A Activities of acid deoxyribonuclease (DNase) and neutral ribonuclease (RNase) in liver tissue, serum and ascitic fluid and urinary excretion of the modified ribonucleosides were determined in patients with hepatocellular carcinoma (15 cases) and liver cirrhosis (18 cases) hospitalized in the department of internal medicine of Hanyang University Hospital. Comparing these results with those obtained from normal healthy persons (20 cases), the present study pursued whether these parameters could be used as diagnostic and biochemical markers for hepatocellular carcinoma. 1) Serum neutral RNase activity was unchanged in liver cirrhosis, but increased in hepatocellular carcinoma by 70% and the positive rate of the serum enzyme as a marker for hepatocellular carcinoma was 60%. 2) Ascitic fluid neutral RNase activity was increased in hepatocellular carcinoma by 54% as compared with that of liver cirrhosis, and the positive rate of the ascitic fluid enzyme as a marker for hepatocellular carcinoma was 67%. Rnases and proteins in ascitic fluid of hepatocellular carcinoma were isolated by a DEAE-cellulose column chromatography into 5 peaks each, of which two peak proteins and RNases appeared to be unique to the cancer. 3) Liver acid Dnase activity was unchanged in liver cirrhosis, but increased greatly in hepatocellular carcinoma (117% increase), and the positive rate of the liver enzyme as a marker for hepatocellular cancer was 80%. The present study indicate that serum and ascitic fluid RNase activity, liver acid Dnase activity and urinary excretion of modified ribonuclesides can be used for diagnostic and biochemical markers for hepatocellular carcinoma. The combined use of these parameters might be useful for making accurate diagnosis for hepatocellular carcinoma.

식도 정맥류 출혈에 대한 내시경적 경화요법의 장기적 관찰

이민호(M H Lee),기춘석(Chun Suk Ki),박경남(K N Park),윤인혁(I H Yoon),한덕호(D H Han),이성구(S G Lee),이종철(J C Rhee) 대한소화기학회 1986 대한소화기학회지 Vol.18 No.1

Esophageal variceal bleeding due to portal hypertension is very emergency state and needs emergency treatment. Crafoord and Frenckner introduced endoscopic injection sclerotherapy in esophageal variccal bleeding since 1939, its good effects are reported in many institute recently. This is to report the result of EIS of 88 patients with esophageal varix who had been admitted to the Department of Internal Medicine at Hanyang University Hospital. The result are as follows 1) Aiultivariate analysis revealed that grade of ascites, grade of encephalopathy, prothrombin time, bilirubin and GPT were distinguished best between survivors and nonsurvivors during the first 6 months after inclusion in the study. The difference in the 1-year survival rates of Childs group A and B versus Child's C patients was highly significant(p<0.002). 2) In the 88 cases, the survival cases beyond 36 months were noted in 4 cases and most long duration of survival was 42 months. 3) Rebleedings were noted in 19 cases(21.6%) and of these, re-rebleedings were noted in 9 cases(47.4%) but death due to variceal bleeding were only noted in 7 cases7.9%). Incidence of rebleeding were most high within 6 months(11.4%). 4) Major complications of the sclerotherapy were noted in 9 cases10.2%) but no correlations to direct cause of death were found. 5) Death were noted in 34 cases(38.6%) and cause of death were mostly hepatic failure and hepatocellular carcinoma(76.4%). 5) Furthermore EIS has advantages such as simple, safe, inexpensive. Therefore, EIS is proposed as treatment of choice for patients with esophageal variceal bleeding.

원발성 간암에서 혈청동 및 혈장 Fibrinogen 의 진단 및 예후판정의 의의

이동후(D H Lee),기춘석(Chun Suk Ki),박경남(K N Park),이진(J Lee),최영춘(Y C Choi),오기영(K Y Oh),함준수(J S Ham) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.4

N/A An increased serum copper (Scu) level has been observed in some solid tumor as lymphomas and also in hepatocellular carcinoma, and some studies suggested the usefulness of determination of Scu level in the differential diagnosis between hepatoma and cirrhosis. But there were no studies about the Scu changes after transhepatic arterial embolization (TAE), relationship between Scu and hepatoma size and portal vein thrombosis, and relationship between Scu and a-fetoprotein. To investigate the diagnostic and prognostic value of plasma fibrinogen (PF) as acute phase reactant and Scu in primary hepatocellular carcinomas, We studied 50 cases of hepatoma, 30 cases of liver cirrhosis and 30 cases of normal control. The results are follows: 1) In hepatomas, Scu level was 197.04±70.35 ug/dl (Mean+ SD) (92.0±59.06 ug/dl in cirrhosis: p < 0.0001, 92.15±20.92 ug/dl in normal controls: p<0.0001). 2) In hepatomas, PF level was 387.40±115.34 mg/dl (Mean+ SD) (266.89±59.06 mg/dl in cirrhosis; P < 0.0001, 282.03±74.03 mg/dl in normal control; P < 0.0001). 3) Scu had a relatively good sensitivity (0.64) and a very high specificity (1.00) at a cutoff value of 160 ug/dl. The combination of Scu and PF improved the diagnostic value slightly. 4) In 11 patients Scu levels decreased 2 Months after TAE from 193.81±44.54 ug/dl (Mean±SD) to 11.49± 39 52 ug/dl(p < 0.0001). 5) The Scu level of diffuse infiltrative hepatoma associated with portal vein thrombosis and larger sized hepatoma were more elevated than the one of localized hepatoma without portal vein thrombosis and smaller sized hepatomas, but there was no statistical significance. 6) There was no relationship between Scu level and α-fetoprotein level. 7) There was no relationship between Scu level and total bilirubin, SGOT/SGPT and alkaline phosphatase. In conclusion, these findings suggested that Scu level may be used as a screening test for early detection of neoplastic degeneration from cirrhosis. And it is corelated with the extension of tumor mass and simultaneous check of PF level with Scu level may provide the more diagnostic and prognostic value in hepatoma.

식도 (食道) 정맥류 (靜脈瘤) 출혈에 있어서 내시경적 (內視鏡的) 경화요법의 (硬化療法) 치료효과

신현성(H S Shin),이동후(D H Lee),기춘석(Chun Suk Ki),박경남(K N Park),황흥곤(H C Hwang),주상언(S U Joo),최일영(I Y Choi) 대한소화기학회 1983 대한소화기학회지 Vol.15 No.1

N/A Bleeding from esophageal varices is the most, severe complication in patients with cinhosis of the liver and portal hyrpertension. There has never been a uniform concept of emergency management of variceal bleeding because of pitfalls in the medical as well as the surgical therapeutic technics. Endoscopic injection sclerotherapy of esophageal varices is being reevaluated by many physicians because of increasing dissatisfaction with shunting procedures. This is to report the result of the EIS of 12 patients with esophageal varix. Who have been admitted to the department of internal medicine at Han Yang Universitv Hospital. The results are as follows: 1. 12 patients with liver cirrhosis who were proven to have esophaveal varices by esophagoscope were treated by EIS. There were 10 males and 2 females in the age range of 37 to 58 years. 2, Severity of liver cirrhosis was classified by Child method revealed cases in grade II and 7 cases in grade III, The varices were classified by the Sesoko method, revealed cases in moderate (B) and 8 cases in severe (C). Intravenous vasopressin was injected within 10 to 12 hours before EIS and b!ood transfusion was performed, if needed. 5.Solution of 5% sodium morrhuate was iniected into varices and Bovine thrombin was spraid around varices. 11 patients with active bleeding had control of their hemorrhage: 7 cases with first shooting, 3cases with second shooting, 1 case with third shooting. In the one patient without bleeding, esophageal varix was significantly decreased in size after EIS. 7. EIS has advantages such as simple, safe, inexpensive, low complication. 8. EIS is proposed as the emergency treatment of choice for patients with proven bleeding Esophageal varices who do not stop bleeding on conservative treatment.

식도정맥류 (食道靜脈瘤) 근절에 (根絶) 대한 내시경적 (內視鏡的) 경화요법과 (硬化療法) Propranolol 의 병합요법 (倂合療法)

이민호 ( M H Lee ),박경남 ( K N Park ),이동후 ( D H Lee ),기춘석 ( Chun Suk Ki ),정효철 ( H C Jung ),함준수 ( J S Hahm ),정태준 ( T J Chung ) 대한소화기학회 1984 대한소화기학회지 Vol.16 No.1

N/A Esophageal Variceal bleeding due to portal hypertension is very emergency state and difficult for management. In spite of many kinds of treatment in esophageal variceal bleeding such as medical and surgical method, but can't be expected of good results especially in Childs B & C groups. Crafoord and Frenckner introduced Endoscopic Injection Sclerotherapy in esophageal varical bleeding since 1939, its good effect are reported in many institute recently. Lebrec and Fleishman reported that propranolol is significantly decreased portal venous pressure in 1980. In order to prevent for rebleeding of esophageal varices and eradication of esophageal varices, we tried that combined therapy of endoscopic injection sclerotherapy and propranolol for over 6 months in 7 patients of Esophageal varices bleeding. Endoscopic Injection Sclertherapy is performed every week for 6 months and propranolol is 80-120 mg/day over 6 months per oral route. So, we have possibility that above combined therapy prevents rebleeding & eradicates esophageal varices.

류마치스 관절염과 담석증의 상관성에 관한 연구

백상현 ( Sang Hyun Baik ),함준수 ( Jun Soo Hahm ),전용철 ( Young Chul Jeoun ),이오영 ( O Young Lee ),이민호 ( Min Ho Lee ),기춘석 ( Chun Suk Ki ),박준용 ( Jun Yong Park ),은창수 ( Chang Soo Eun ),한동수 ( Dong Su Han ) 대한소화기학회 2002 대한소화기학회 춘계학술대회 Vol.2002 No.-

〈배경〉 현재까지 담석의 증가와 연관성을 가진 병적인 상태를 찾고자하는 연구가 진행되어 왔다. 대개의 류마치스 관절염환자는 NSAID를 복용하고 있는 자가 많고, 동물 실험을 NSAID가 담석 생성과 관련이 있음이 발표되기도 하였다. 본 연구에서는 류마치수 관절염환자에서의 담석의 빈도를 제시하고 matched control과의 여러 다른 기준척도등의 비교를 통해 이들간의 유의성을 비교하였다. 〈연구대상 및 방법〉 한양대 류마치스 병원에 입원하였던 선별검

성인에서의 장 회전 이상 1예

한동수,이민호,최춘식,박근태,이오영,기춘석,박경남,정진웅,조윤주,박문승,손주현,윤병철,최호순,권오정,임현철 대한소화기학회 1998 대한소화기학회지 Vol.31 No.2

Intestinal malrotation is a rare disorder typically found in childhood. In adults it is an uncommon disease, and usually presents as bowel obstruction. Occasionally the clinical picture is confusing and the diagnosis of mahotation is not discovered until operation. Intestinal malrotation represents an arrest in the normal counterclockwise rotation of the cecum from the left lower quadrant to the right upper quadrant. The example is nondescent of the cecum, in which this structure remains in the subhepatic position. These are the diagnostic problems of differentiating between acute appendicitis and acute cholecystitis and the difficulty of appendectomy through a lower abdominal incision. In some patients, the cecum that cross the duodenum (Ladd's bands) is often fixed in an abnormal position by dense adhesion. In addition, the colon and the small intestine have a common mesentery with a lack of fixation to the lateral and posterior regions of the abdominal cavity. The usual mechanism of obstruction is adhesive compression of the duodenum and volvulus of the small intestine. Herein we experienced the case with intestinal malrotation associated with Ladd's bands with duodenal compression, presenting with acute abdominal pain and vomiting.