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간 , 담도 및 췌장 : 간내담석증 진단에 있어서 정량적 99mTc - DISIDA 스캔의 의미
김학산(Hak San Kim),이은주(Eun Joo Lee),위상오(Sang Oh Wee),최덕주(Duk Joo Choi),박원(Won Park),김종순(Jong Soon Kim) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.2
N/A To evaluate the usefulness of technetium99m-DISIDA scan for diagnosis of intrahepatic lithiasis, we studied 22 cases of normal subjects, 14 cases of intrahepatic stone (4 cases of right intrahepatic stone, 5 cases for left intrahepatic stone and 5 cases for bilateral intrahepatic stone), 7 cases of common hepatic and common bile duct stone, 7 of hepatitis and 17 cases of GB stone. The results are summarized as follows; 1) In normal control-group, the mean ratio+1s.d. was 0.47+0.18 for RRR, 0.54+0.17 for RRL and 0.91+0.24 for R/L DR. 2) The retention ratio was 0.85+0.52 in affected right lobe of right intrahepatic stone and 0.95+0.18 in affected left lobe of left intrahepatic stone. So ratio was significatnly increased in affected lobe when compared with that of the corresponding normal lobe (p<0.005). 3) The RRR and RRL of bilateral intrahepatic stone, common hepatic and common bile duct stone, GB stone and hepatitis were significantly increased than normal control groups (p<0.01). In conclusion, quantitative technetium-99mDISIDA scan was simple, objective, time-sparing and non-invasive method for screening intrahepatic stone.
김학산(Hak San Kim),이은주(Eun Joo Lee),김종순(Jong Soon Kim),최덕주(Duck Joo Choi),김관우(Kwan Woo Kim),김광일(Kwang Il Kim) 대한소화기학회 1988 대한소화기학회지 Vol.20 No.3
N/A To evaluate the diagnostic value of ascitic lipid in liver cirrhosis, malignant neoplasm and tuberculous peritonitis, ascitic fluid concentration of cholesterol, beta-lipoprotein, triglyceride and protein were studied (25 with liver cirrhosis, 12 with malignant neoplasm and 5 with tuberculous peritonitis). The results were as follows: 1) The mean value for cholesterol, beta-lipoprotein, triglycerides and protein were significantly higher in malignant ascites compared to the mean for those in cirrhotics 2) The best discrimination values were 40mg per dl for cholesterol, 75mg per dl for beta-lipoprotein, 40 mg per dl for triglyceride and 2.5 gm per dl for protein. 3) Applying the discrimination value, efficiency were 94.0% for cholesterol, 91.0% for beta-lipoprotein, 75.2% for triglyceride and 86.7% for protein. We conclud that the level of cholesterol in ascitic fluid was the best parameter of differential diagnosis between liver cirrhosis and malignant neoplasm.
각종 간질환에서 Tc - 99m pertechnetate 경직장 문맥신티그라피를 이용한 문맥 순환의 평가
김관우 ( Kwan Woo Kim ),김종순 ( Chong Soon Kim ),김학산 ( Hak San Kim ),박원 ( Won Park ),이범우 ( Bum Woo Lee ),서관식 ( Kwan Sik Suh ),이봉휘 ( Bong Hwi Lee ),김광일 ( Kang Il Kim ) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.4
N/A Portal circultion in patients with various liver diseases was evaluated by Tc-99m pertechnetate per-rectal scintigraphy. 10mCi of pertechnetate was instilled into the upper rectum, and serial scintigrams were taken. Time-activity curves for the liver and heart were recorded sequentially. Through analysis of these curves, the per-rectal portal shunt indices were calculated for 15 norrnal controls, 12 with acute hepatitis (AH), 28 with chronic hepatitis, 51 with liver cirrhosis, 1 with falminant hepatic failure (FHF ). 5 with hepatic congestion (I-IC) due to congestive heart failure (CHF). The results obtained were as follows: 1) 15 normal controls and the patients with acute and chronic hepatitis all had 'Pattern II' scintigrams, and the patients with liver cirrhosis (LC) and hepatic congestion had 'Pattern II' scintigrams. One patient with FHF showed 'Pattern II' scintigram. 2) The shunt index (SI) in the normal controls was l.32±1.30%, in AH 10.9±5.7%, in CPH 5.4±2.3%, in CAH 11.8±4.2%, in LC 72.4±21.6%, in HC 39.9±27.2%, and in one FHF 75.4%. 3) Patients with various liver diseases had the significantly higher SI than the normal controls (p < 0.001). Also, the SI in pts. with liver cirrhosis was significantly higher than that of all the other groups (p < 0.001). 4) The mean SI was significantly higher for chronic liver diseases, that were more severe, increasing in the order of CPH, CAH and liver cirrhosis (p<0.001). Also, pts. With AH and CAH showed the significantly higher SI than pts. With CPH (p<0.001), and there was no significant difference in the SI between pts. With AH and CAH (p>0.05). 5) The mean SI was significantly higher in the cirrhotic pts. With varices, encephalopathy, splenomegaly or ascites than in such patient without them (p<0.005). 6) The mean SI in the cirrhotic pts, was calculated according to the modified Child's classification, of which results were that the SI was increased significantly in the order of Grade A, B and C (p< 0.001). 7) In one patient with LC, SI was much decreased from 39.5% before surgery to 7.1% after surgery. The above results suggest that per-rectal portal scintigraphy can be used to evaluate the portal circulation non-invasively and diagnose the portal hypertension in various liver diseases. Also, it can be used to express the degree of any portal hypertension not only by images but also quantitatively, using shunt index, and it is considered useful for the observation of the course of liver diseases and eva]uation of effectiveness of therapy.
이영,김학산,손광현,서경필,이영균,Lee, Young,Kim, Hak-San,Sohn, Kwang-Hyun,Suh, Kyung-Phill,Lee, Yung-Kyoon 대한흉부심장혈관외과학회 1970 Journal of Chest Surgery (J Chest Surg) Vol.3 No.1
Six cases of broncho-pleural fistula due to complicated liver abscess were experienced at the department of chest surgery, Seoul National University Hospital from October 1967 to March 1970. Amebic liver abscess was the primary cause in the 5 cases and the remaining one case was due to pyogenic liver abscess. Involved lung was right side in all case. The clinical manifestation was fever,chill,cough, sputum, dyspnea, chest pain, hemoptysis and shoulder pain. The methods of the treatment employed were closed thoracotomy [1], thoracotomy & drainage [2],decortication [1],and right lower lobectomy[3]. The average duration of the post-operative course was 19.6 days. There was no operative mortality.
간경변증 환자에서 24 시간 심박동수변이를 이용한 자율신경 장애 측정
김철우(Chul Woo Kim),권재구(Jae Goo Kwon),채민수(Min Su Chae),안혜숙(Hye Sook Ahn),조영중(Young Jung Cho),이창원(Chang Won Lee),장덕환(Duk Whan Jang),이무용(Moo Yong Rhee),김학산(Hak San Kim),이홍순(Hong Soon Lee),유수웅(Soo Woong Yo 대한내과학회 1997 대한내과학회지 Vol.53 No.3
N/A Objective: Heart rate variability(HRV) is helpful to diagnosis autonomic disturbance and sympathetic-parasympathetic imbalance in patients with myocardial infarction and diabetes mellitus. Patients with liver cirrhosis demonstrate reduced blood pressure despite increased heart rate and increased cardiac output, indicating a fall in peripheral vascular resistance. Autonomic disturbance may contribute to this phenomenon. The aim of the present study is to evaluate the degree of autonomic disturbance and the circadian rhythm of autonomic nervous system by estimating HRV with 24 hour-Holter recorder, Methods : 24 hour-HRV with Del Mar Avionics 563 Holter recorder and cardiovascular reflex tests were carried out on 32 patients with liver cirrhosis and 20 control subjects. We evaluated the presence of autonomic disturbance, and assessed quantitatively the autonomic disturbance. Results: 1) Among cardiovascular reflex tests, Valsalva test, standing test and deep breathing test were showed a significantly decreased response in liver cirrhosis compared with control groups. 2) The standard deviation of 24hours average R-R intervals were showed a significantly decrease in liver cirrhosis than control groups(P<0.0001). The HRV of low frequency(LF. P<.D.001), high frequency(HF, P<0.0001) and total power spectral density (P<0.0001) in liver cirrhosis were statistically lower than control. 3) The LF/HF ratio of patients with liver cirrhosis was showed higher than control at night Conclusion: Non-invasive assessment of 24 hour-HRV has a few advantages in the diagnosis and degree of autonomic disturbance, evaluation of diurnal variation of autonomic tone.
아드레나린성 약물이 유문부결찰 백서의 위분비 기능에 미치는 영향
홍사석(Sa Suk Hong),김학산(Hak San Kim),김예식(Ye Sik Kim),김동구(Dong Goo Kim) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.1
N/A Gastric secretion is modulated largely by three major factors-the autonomic nervous system, the gastrointestinal hormones and the circulation. For autonomic nervous system, the parasympathetic influence on gastric secretion has been widely studied. However, the influence of sympatho-adrenal system has received much less attention and its role on gastric secretion remains a matter of controversy. Present investigation was undertaken to evaluate the adrenergic influence on gastric secretion using the experimental model of pylorus-ligated rat. Immediately after pylorus ligation intrinsic or synthetic adrenergic agents (methoxamine, norepinephrine, epinephrine, isoproterenol or dopamine) were injected subcutaneously. After 3-or 6-hour period of pyloric ligation the stomach was removed and gastric juice was collected for the evaluation of gastric secretory function. And blood glucose level was also measured. The results obtained are as folllows. 1) Gastric secretory function was active in the group of 3 hours pyloric-ligation and depressed greatly therafter. 2) All adrenergic drugs used in this experirnent suppressed the volume of gastric juice and acid output. The degree of suppression was marked in epinephrine or isoproterenol, moderate in methoxamine or norepinephrine and minimal in dopamine treated rats. 3) Blood glucose level was not directly correlated with the suppressive action of adrenergic drugs on gastric secretion. From the above results it is concluded that gastric secretory function is suppressed by adrenergic influence. And it is suggested that adrenergic beta-receptor acitivation plays a major role in the suppression of gastric secretion.
김성희(Seong Hee Kim),송태의(Tae E Song),서관식(Kwan Sik Suh),김학산(Hak San Kim),한창순(Chang Soon Han) 대한내과학회 1989 대한내과학회지 Vol.37 No.5
N/A Three cases of Vitamin B12 deficiency megaloblastic anemia are presented and the literature is briefly reviewed. The first 2cases were complicated with a previous gastrectomy due to stomach cancer 7 and 10 years earlier respectively, and the third case was combined with intrinsic factor deficiency and atropic gastritis. All ceses revealed anemic symptoms and peripheral neuropathy or painful beefy tongue. Laboratory findings showed markedly decreased serum Vitamin B, levels and increased LDH (with reversed subfraction; LD1>LD2). Peripheral blood and bone marrow findings were compatible with megaloblastic anemia, which included macrocytic anemia, anisocytosis, hypersegmented neutrophils, increased cellularity, decreased M:E ratio and increased iron storage. Symptomatic and hematological improvements were attained after scheduled Vitamin B therapy. But the intractable peripheral neuropathy in case 1 was not improved and the use of ganglioside was in vain.
간장 ( 肝臟 ) 및 담도 ( 膽道 ) : 생콩을 첨가 사육한 흰쥐의 이자 ( 膵臟 ) 외분비 기능 및 구조에 관한 연구
김경환(Kyung Hwan Kim),김학산(Hak San Kim),안영수(Young Soo Ahn),주일로(Il Lo Jou) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.4
N/A It has been reported that long term feeding of raw soybean which contains heat labile trypsin inhibitor resulted in hypertropby ae well as hyperplasia and in the development of hyperplastic naduIes and adenomas. This response of the pancreas to raw soybean is thought to be mediated largely by the CCK release and loss of feedback inhibition from intestinal pancreatic proteinases. Similar phenomena have afeo been reported by feeding synthetic trypsin inhibitor, camostat (FOY- 305). Moreover, there are changes of seeretory pattern of pancreatic enzymes by feeding trypsio inhibitor. Present study was done to investigate the integral effect of feedig raw soybean for upto two years on the exocrine secretory.function and morphology of pancreas in the rat. The Sprague-Dawley rats of either sex weighing about 70 g at the beginning of study were used. Two kinds of soybean were selected, those are Glycine max Merr. (Muktae) containing high trypsin inhibitor and Phaseolus anguIaris Wight var. nipponeneis Ohwi (Geodu) containing low trypsin inhibitor. Raw soybean flour was fed two days a week ad tib, whereas normaI rat chow was provided rest of the week. For control study the same schedule was applied for heated soybean. The rats were anesthetized with urethane (1.25 g/kg, s.c.) and pancreatic seeretions were colIected from duodenal end of pancreatic duct after proximal biliary duct was ligated. The exocrine pancreas was stimul#ated with secretin (0.5 CU/kg/hr) with or without cholecystokinin octapeptide (CCK-8, 1200 ng/kg/hr). Amylase and trypsin were assayed by the method of Bernfeld (1955) and Hummel (1959), respectively. Separation of enzyme protein was done by HPLC method (Padfield and Case, 1988) using TSK phenyl 5PW hydrophobic interacti,on column. At the end of experiment pancreas was resected and examined by light and electron microscopies. The results are as follows: 1) Feeding raw soybean retarded the growth of rat but increased the pancreas weight. However, there was little differenee to the content of trypsin inhibitor in the soybean. 2) The basal secretion of amylase and trypsin was increased by feeding raw soybean. 3) The CCK-8-Stimulated enzyme secretian was increaeed throughout the experimental period but there was little 6ifference ta the trypsin inhibitor content in the raw soybean.