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이규택 ( Kyu Taek Lee ),이종균 ( Jong Kyun Lee ),이준혁 ( Joon Hyoek Lee ),이풍렬 ( Poong Lyul Rhee ),김재준 ( Jae Jun Kim ),고광철 ( Kwang Cheol Koh ),백승운 ( Seung Woon Paik ),이종철 ( Jong Chul Rhee ),노재형 ( Jae Hyung Noh 대한소화기학회 1997 대한소화기학회지 Vol.29 No.6
A biliary enteric fistula may form between any part of the extrahepatic biliary system and any adjacent portion of the gastrointestinal tract. The incidence of biliary enteric fistulas varies between 0.9 and 5% of all cases of biliary disease. These fistulas are usually sequelae or complications of long standing calcareous biliary tract disease. The diagnosis is to be suspected whenever air is demonstrated within the biliary system on roentgenographic examination and may be confirmed by additional measures. The most common site of a biliary enteric fistula is between the gallbladder and the duodenum, and next common types of fistulas are cholecystocolic and choledochoduodenal. Cholecystocholedochocolic fistula is a very rare type of internal biliary fistulas. Recently, we encountered a case who suffered from hepatic abscess by ascending infection due to pre-existing gallstones combined with cholecystocholedochocolic fistula. So, we report a case of cholecystocholedochocolic fistula which was treated successfully by operation with a review of relevant literatures.(Korean J Gastroenterol 1997;29:853-858)
경미한 담석췌장염 환자에서 복상경 담낭 절제술 시행전 역행성 담췌관 조영술은 필요한가?
이규택 ( Kyu Taek Lee ),이종균 ( Jong Kyun Lee ),박형석 ( Hyung Suk Park ),박상종 ( Sang Jong Park ),김지은 ( Jee Eun Kim ),김창섭 ( Chang Seop Kim ),성인경 ( In Kyung Sung ),심상군 ( Sang Ken Sim ),최윤호 ( Uoon Ho Choi ),백승운 대한췌담도학회 1999 대한췌담도학회지 Vol.4 No.1
The large majority of patients with gallstone pancreatitis have a mild course that is not altered by ERCP and endoscopic sphincterotomy, a more selective use of ERCP might be advisable. This study is designed to evaluate the efficacy of preoperative endoscopic retrograde cholangiopancreatography (ERCP) in patients with mild gallstone pancreatitis and to determine criteria predictive of common bile duct stones (CBDS). Methods: We analyzed the value of serum biochemical tests and findings of ERCP in patients with mild gallstone pancreatitis. Preoperatively, ERCP revealed CBDS in 6 of 47 (12.8%) patients with mild gallstone pancreatitis. Laboratory values on admission did not predict CBDS. Persistent hyperamylasemia and increased serum ALT were associated with CBDS. It is unnecessary to perform preoperative ERCP in patients with mild gallstone pancreatitis who have a normalization of serum amylase and liver function tests.
이규택(Kyu Taek Lee),성건형(Keon Hyung Sung),양석철(Suck Chul Yang),이오영(Oh Young Lee),이종철(Jong Chul Rhee),함준수(Joon Soo Hahm),이동후(Dong Hoo Lee),기춘석(Choon Suck Kee),박경남(Kyung Nam Park) 대한내과학회 1991 대한내과학회지 Vol.40 No.6
N/A Clinical observations made on 970 patients with lower gastrointestinal bleeding (hematochezia) admitted to Hanyang Universtiy Hospital over a period of 7 years starting from January 1983, revealed the following results. During the study period, patients with lower GI bleeding comprised 1.6% of the total numbers of patients admitted to the Depatment of Internal Medicine and General surgery, and the annual distribution of the patients remained unchanged. Casses of 970 patients with lower gastrointerstinal bleeding were hemorrhoid and anal fissure in 65.5%, malignant neoplasm in 21.1% (rectal cancer 16.9%, sigmoid cancer 3.3%, and anal cancer 0.9%), benign neoplasm in 4.0%, ulcerative colitis in 3.3%, acute infectious colitis in 1.9%, ischemic colitis in 1.7%, radiation colitis in 1.3% diverticulosis in 0.3%, and miscellaneous in 0.1%. The annual incidences of ulcerative colitis and recto-sigmoid cancer increased but that of infectious colitis decreased and others remained unchanged. There was no overall sexual difference. The peak age for hemorrhoid and anal fissure were 30's, benign neoplastic polyps and ulcerative colits were the 40's, malignant neoplasm was the 50's, and radiation and ischemic colitis were the 60's. Patients who required transfusion were 10.8%. Patients with ulcerative colitis (21.9%) and radiation colitis (23.1%) required more transfusions. Patients who improved with conservative treatment only wre 20.2%, and 79.8% required surgical intervention. In the management of benign neoplastic polyps, 51. 2% was treated with ploypectomy.
기능성 소화불량증 환자에서의 Electronic Barostat을 이용한 위 팽창 반응에 관한 연구
이규택(Kyu Taek Lee),손희정(Hee Jung Son),이종균(Jong Kyun Lee),이준혁(Joon Hyeok Lee),이풍렬(Poong Lyul Rhee),김재준(Jae Jun Kim),고광철(Kwang Cheol Koh),백승운(Seung Woon Paik),이종철(Jong Chull Rhee),노재형(Jae Hyung Noh),최성호(S 대한소화기학회 1997 대한소화기학회지 Vol.29 No.2
N/A Background/Aims: A decreased perception threshold of gastric distension has been observed recently in selected patients with functional dyspepsia(FD) in the absence of changes in gastric compliance. The sensations induced by changes in intragastric pressure and volumes have been shown to be independent of gastric emptying times. In Korea, there has been no report about the response to gastric distension using electronic barostat in patients with FD. Thus, we aimed to evaluate whether decreased perception threshold to the gastric distension could be one of the pathogenic factors in FD. Methods: Thirty patients with dysmotility-like FD(9 men and 21 women; age range, 27-57 years) and 20 healthy individuals without gastrointestinal symptorns(10 men and 10 women; age range, 20-54 years) were included in this study after receiving written informed consent. We measured intragastric minimal distending pressure(MDP), gastric compliance, aMominal discomfort level, and gastric emptying rate of solid meal. We used a dual drive barostat (G&J Electronics, Canada) and biad gamma camera(Trionix). MDP was defined as the first pressure level to inflate an intra gastric bag volume > 30mL. And then, symptoms and volume of the intragastric bag, which was inflated by increasing intragastric bag pressur, was measured in 1 mmHg steps every 3 minutes, We compared gastric compliance at a low pressure zone(0-2 mmHg above MDP) and at a high preassre zone(6-8mmHg above MDP), We calculated the mean values( SD) of the parameters, and statistical comparisons were performed using tbe repeated measures ANOVA. Results: The MDP was significantly decreased in FD(3.9>1.8 mmHg) compared to the controls(5.7+ 1.7 mmHg; p<0.001). The gastric compliance(Cw) at a high pressure zone was significantly higher in FD(46.5+30.6 mL/rnmHg) compared to the control(31.3 + 15.3 mL/mmHg; p<0.05). Whereas there was no difference in compliance(C) at the low pressure zone(41.2+25.6 mL/mmHg in FD vs. 43.9+23.1 mL/mmHg in the control). Patients with FD had gastric hypersensitivity to distension(discomfort threshold at 8.3+3.8 mmHg and 392+109 mL in FD vs. 14.S+3.8 mmHg and 558+135 rnL in controls; p<0.001). There were no differences in MDP, compliance, and discomfort level according to gastric emptying times. Conclusions: We conclude that decreased perception threshold to gastric distension could be a pathogenic factor, and also an increased gastric compliance at high pressure zone may play a pathogenic role in FD. (Korean J Gastroenterol 1997;29: 135 - 144)
건강검진 수진자의 췌장암 발견에 있어서 혈청CA 19 - 9 의 의의
이규택(Kyu Taek Lee),이풍렬(Poong Lyul Rhee),손희정(Hee Jung Son),이종균(Jong Kyun Lee),이준혁(Joon Hyeok Lee),김재준(Jae Jun Kim),고광철(Kwang Cheol Koh),백승운(Seung Woon Paik),이종철(Jong Chul Rhee),신명희(Myung Hee Shin) 대한내과학회 1997 대한내과학회지 Vol.53 No.6
N/A Objectives: Although prognosis for pancreatic cancer is generally poor, it is well known that the survival rate for resected pancreatic cancer is much higher than that for more conservative treatment. The importance of early detection is emphasized for resection of pancreatic cancer. Measurement of serum CA 19-9 has shown satisfactory sensitivity and predictive value in symptomatic patients, but there was no available data in healthy asymptomatic subjects. Thus, we aimed to determine the clinical usefulness of CA19-9 for screening of pancreatic cancer in asymptomatic subjects. Methods: 11,974 asymptomatic persons visiting Samsung Health Promotion Center from December 1994 to July 1996 participated in this study. All subjects underwent ultrasonography and CA19-9 as initial screening tests. We analyzed sensitivity, specificity, and predictive values in detecting pancreatic cancer of CA 19-9 using statistical methods. Results: Mass screening of 11,974 asymptomatic persons resulted in the detection of only 2 cases of pancreatic cancer. 179 subjects had CA 19-9 values above the cutoff of 37u/ml, including the 2 cases diagnosed with pancreatic cancer. The prevalence of pancreatic cancer over the age of 30 in Korea is 14.8 per 100,000 population. Therefore, sensitivity is 100% and specificity is 98.5%. However, positive predictive value of CA19-9 for detection of pancreatic cancer is only 0.98% in asymptomatic population. Conclusion: Mass screening of pancreatic cancer using CA 19-9 in asymptomatic subjects is ineffective due to low predictive value, despite high sensitivity and specificity.
이규택(Kyu Taek Lee),이풍렬(Poong Lyul Rhee),김재준(Jae Jun Kim),고광철(Kwang Cheol Koh),백승운(Seung Woon Paik),이종철(Jong Chul Rhee),최진영(Jean Yung Chey) 대한내과학회 1996 대한내과학회지 Vol.51 No.5
N/A Objectives: The role of psychological factors contributing to the etiology of functional dyspepsia has been consistently recognized in the U.S. and the European countries. However, no study has been done with Korean patients. The purpose of the present study was to identify the specific psychological factors involved in functional dyspepsia in Korean population and compare them with those of Western counterpart. Further, it purported to examine how these factors differed in two patient groups of functional dyspepsia: a group of patients with delayed gastric emptying time and a group of patients with normal gastric emptying time. Methods: A double-blind study was done with 70 subjects; The internists and the psychologists were not aware of the status of the gastric emptying time of a patient when they measured the gastric emptying time and administered the MMPI, respectively. The patients (n=50) were suffering from dyspepsia for more than three months and complained of moderate to severe dysmotility symptoms. They were all outpatients in a private hospital. Normal controls were recruited via personal contact. Results: The psychological factors that significantly differentiated the patients from the normal controls were Depression (Scale 2), Hypochondriasis (Scale 1), Hysteria (Scale 3), and Psychasthenia (Scale 7). These factors were similar to those found to be significant in Western functional dyspeptic population. There was no association between the psychological profiles and the presence of delayed gastric emptying time. Two patient groups scored very similarly on all ten clinical scales. Among the 50 patients tested 12 patients received the clinical diagnoses and were recommended for psychiatric referral. The recommendations were based on a psychological interview and results of the MMPI of each patient which were administered by psychologists. Conclusion: The results of the study support the psychological factors in functional dyspepsia. However, it is difficult to conclude whether these factors are etiological in nature.