방사선 투과성 담낭결석에 대한 경구 담즙산 제제 ( ursodeoxycholic acid ) 의 용해 효과

김명환(Myung Hwan Kim),유병무(Byeong Moo Yoo),박선미(Seon Mee Park),김석균(Suk Gyun Kim),송일한(Il Han Song),최호순(Ho Soon Choi),이성구(Sung Goo Lee),서동진(Dong Jin Suh),민영일(Young Il Min) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.4

N/A Background/Aims: The gallstone composition among Asians is known to be different from that of Caucasians. Thus, we tested the hypothesis that the dissolution rate of radiolucent gallbladder stones by oral bile acid may be different between Koreans and Caucasians. Methods: Sixty patients with radiolucent gallbladder stones were treated with ursodeoxycholic acid(10mg/kg) for 6 months. Abdominal ultrasonogram was measured monthly for evaluation of complete dissolution. Results: Complete dissolution of gallstones occurred in 7 patients(l2%), especially in the patients with gallstone diameter5mm. However, symptoms of biliary colic and dyspepsia were relieved during ursodeoxycholic acid treatment in 30(75%) out of 40 patients, without relationship to complete dissolution. Conclusion: The complete dissolution rate of radiolucent gallbladder stones by ursodeoxycholic acid is lower than that of Caucasians. This may be related to the mixing of' calcium bilirubinate and cholesterol stones in the radiolucent stones. Calcium bilirubinate stones of the gallbladder origin are not rare in Koreans and such stones commonly show radiolucency by simple abdominal x-ray film. (Korean J Gastroenterol 1995;27:457-462)

만성간질환에서의 혈청 procollagen 1/3 propeptides 농도비 측정의 의의

유용걸(Yong Keol Yoo),이숭환(Soong Hwan Lee),김병훈(Byoung Hun Kim),조영중(Young Jung Cho),백인규(In Kyu Paik),유병무(Byeong Moo Yoo),이오영(Oh Young Lee),한동수(Dong Soo Han),손주현(Joo Hyun Sohn),최호순(Ho Soon Choi),이동후(Dong Ho 대한소화기학회 1996 대한소화기학회지 Vol.28 No.6

N/A Background/Aims: Most of Ihe chronic liver diseases of variable etiologies are accompanied by a pathobiochemical reaction So-called fibrosis. Liver fibrosis was recently recognized as all the complexity of dynamic changes of the hepatic extracellular matrix(ECM). And ECM consists of four major components: collagen, glycoprotein such as fibronectin and laminin, proteoglycan, and elastin. Among these, collagen I and III are the representatives of disproportion of synthesis and degradation in conjunction with fibrogenesis. To elucidate the clinical significance of procollagen propeptide I(PICP) and III(PIIINP) measurements among the sera out of patients with chronic liver diseases, radioimmunoassay 4vas employed in this investigation. Methods: Sera tested were obtained from pathologically-proven 54 patients; 4 cases of fatty liver, 11 cases of chronic persistent hepatitis, 13 cases df chronic active hepatitis, 15 cases of liver cirrhosis and 11 cases of hepatocellular carcinoma. All:the patients except 4 cases of fatty liver were shown positivity of HBsAg. PICP and PIIINP radioimmunoassay kits(Farmos Diagnostica, Oulunsalo, Finland)were purchased for this study. ResOlts: PICP concentration (mean+standard error) was highest in liver cirrhosis (280.06>39,83 pg/L). PICP in liver cirrhosis was significantly elevated in cornparison to that (109.30+14.58) in fatty:liver(p=0.045), that (122.22>10.26) in chronic persistent hepatitis (p=0.003), and that (158.59>21.58) in chronic active hepatitis(p=0.016), PICP in hepatocellular carcinoma was decreased to 1'94.05+ 29.89. Similarly, PIIINP concentration revealed highest level in liver cirrhosis(17.29+3.58 pg/L). This value was significantly higher than that of chronic persistent hepatitis(5.12+0.59)(p=0.008). Contrarily to these results, concentration ratio of PICP/PIIINP was high in fatty liver (29.27>6.29) and chronic persistent hepatitis (25.04+2.00), These value were statistically higher than that of chronic active hepatitis (17.632.67) (p=0.043). PICP/PIIINP ratio in liver cirrhosis (21.58+3.29) showed no statistical difference. Conclusions: On the basis of these data, it is suggested that the elevation of PICP and PIIINP in the sera of the patients with chronic liver diseases means emerging the liver cirrhosis. And the ratio of these markers can be helpful in differential diagnosis of chronic liver diseases. (Korean J Gastroenterol 1996; 28:815-823)

한국인의 원발성 간내 담석의 성분은 변하고 있는가?

김명환(Myung Hwan Kim),최호순(Ho Soon Choi),이성구(Sung Koo Lee),유병무(Byeong Moo Yoo),서동완(Dong Wan Seo),이미화(Me Hwa Lee),서동진(Dong Jin Suh),민영일(Young Il Min),이승규(Sung Gyu Lee),민병철(Pyung Chul Min) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.1

N/A Background/Aims: Primary intrahepatic stones can usually be distinguished from secondary intra- hepatic stones by the presence of intrahepatic strictures. In Asia, primary hepatolithiasis predo- minates, whereas secondary hepatolithiasis is more commonly found in the West. About 20 years ago, the major chemical element of intrahepatic stones was calcium bilirubinate in Korea. Recently patients with intrahepatic mixed stones which carries high cholesterol content are increasing in Korea. This study indicates our results of systemic analysis on the structure and composition of primary intrahepatic stones. Methods: Multiple intrahepatic stones were harvested by choledochos- copic stone extraction from 84 patients with biliary stricture. We described the external appearance and color of the stones, and then cut the sample stone which was collected from eaclh patient in two pieces. A half of the stone was used for the measurement of chemical compositiion and the rest for electron microscope scanning . The cross sectional appearance was also recorded. Results: Intrahepatic stones were separated as mixed stones in 44 patients(52%) and brown pigiment stones in 40 patients(48%) on the basis of their gross and cross sectional appearance and cholesterol content. The mixed stones had a smooth and distinct black-colored outer shell and a yellow inner body on cross section. The consistency of mixed stoness was hard. The yellow inner body revealed the combination of the radial and concentric pattern. In contrast to the mixed stones, the brown stones were rough surfaced, light to dark brown in shade and soft and friable in consistency. They revealed multiple concentric layers of varying shades of brown on the cross section. In mixed stones, the percentage of cholesterol and calcium bilirubinate was 51.6--6.4% and 24.8 9.1%, respectively. In brown stones, the percentage of cholesterol and bilirubin was 12.5 .5.2% and 42.8 ' 10.2%, respectively. There was a significant difference in the percentage of cholesterol and bilirubin(p 0.001) between mixed stones and brown pigment stones. Conclusions: Primary intrahepatic stones in the past were mainly brown pigment stones. Primary intrahepatic mixed stones in our cases have not been reported in the Korean literature. About a half of our study subjects have had primary intrahepatic mixed stones, which contained high cholesterol <:ontent. We suggest that the chemical composition of primary intrahepatic stones in Korea I.; changing. (Korean J Gastroenterol 1996;28: 85 - 91)

원발성 간내 담석에 대한 각종 접촉성 용해제의 용해 효과

김명환(Myung Hwan Kim),임미경(Mi Kyeong Rim),김태형(Tae Hyeoung Kim),유병무(Byeong Moo Yoo),서동완(Dong Wan Seo),정훈용(Hwoon Yong Jung),이성구(Sung Koo Lee),민영일(Young Il Min),박광민(Kwang Min Park),이영주(Young Joo Lee),이승규(Su 대한소화기학회 1996 대한소화기학회지 Vol.28 No.5

N/A Background/Aims: Often it is difficult to remove intrahepatic stones completely. Thus, to study for development of contact solvent for dissolution of primary intrahepatic stones has clinical irnplication. The aim of this study is to compare the dissolution effect of various contact so]vents for dissolution of primary intrahepatic stones. Methods: Tbe contact solvents we used were ethylenediaminetetraacetic acid(EDTA), dimethylsulfoxide(DMSO), N-acetylcysteine, taurocholic acid and methyl tert-butyl ether(MTBE). The dissolution effect of intact gallstone was evaluated until 24 hours by dry weight and the diameter of residual stone. The intrahepatic stones were obtained from patients with brown stones(n=15) and rnixed stones(n=15). Results: In brown stone the dissolution effect of DMSO was the most superior by residual stone weight(57.2% of initial weight). However, in mixed stone EDTA was the most superior (37.9% of initial weight). The smallest diameter(p 2mm) of residual stone after dissolution was obtained by DMSO in both brown and mixed stones. Conclusions: Although our results have shown the partial dissolution effect of intrahepatic stones by contact solvents, significant decrease of tbe stone size was also observed. By diminishing the size and the weight of the stones, the improvement of stone removal rate and the shortening of the treatment period may be expected.(Korean J Gastroenterol 1996;28: 705 - 713)

살모넬라 간농양 1예

최정우 ( Jeong Woo Choi ),최승준 ( Sung Jun Choi ),권혁춘 ( Hyeock Choon Kwon ),정재연 ( Jae Youn Cheong ),이기명 ( Ki Myung Lee ),유병무 ( Byeong Moo Yoo ),함기백 ( Ki Baik Hahm ),김진홍 ( Jin Hong Kim ),조성원 ( Sung Won Cho 대한소화기학회 2006 대한소화기학회지 Vol.47 No.4

Community-Acquired Acinetobactor 폐염

최완영 ( Wan Young Choi ),신동호 ( Dong Ho Shin ),박성수 ( Sung Soo Park ),이정희 ( Jung Hee Lee ),최태열 ( Tae Yul Choi ),유병무 ( Byeong Moo Yoo ),임병성 ( Byung Sung Lim ) 대한결핵 및 호흡기학회 1991 Tuberculosis and Respiratory Diseases Vol.38 No.1

담낭 답즙에서의 칼슘 결합 단백질 ( Calcium - binding Protein ) 에 관한 연구

김명환(Myung Hwan Kim),정성애(Sung Ae Jung),채희복(Hee Bok Chai),김해경(Hae Kyung Kim),김태형(Tae Hyung Kim),유병무(Byeong Moo Yoo),서동완(Dong Wan Seo),이미화(Mee Hwa Lee),이성구(Sung Koo Lee),정훈용(Hwoon Yong Jung),민영일(Young Il 대한내과학회 1997 대한내과학회지 Vol.52 No.4

Objectives: Calcium salts are usually present in the center of all types of gallstones, including pure cholesterol stones. It has been postulated that precipitation of calcium salts might act as a nidus for gallstone formation. Our goal was to determine whether a calcium-binding protein was present in bile and whether this protein has any calcium-binding properties. Methods: Calcium-binding moiety was obtained by addition of CaC1(2) into the gallbladder bile. Calcium-binding protein was identified by SDS-PAGE (sodium dodecyl sulfate-polyacrylamide gel electrophoresis). The capacity to bind calcium was confirmed by autoradiography with (45)Ca(+). Results: We identified a protein(M.W.≤kD) that precipitates from bile on addition of CaC1(2) at the final concentration of 0,5mol/L in control subjects. The protein was also observed in bile and stones of gallstone patients. The protein had the capacity to bind calcium and it. was confirmed by autoradio-graphy with (45)Ca(+). Conclusion: The presence of calcium-binding protein in bile and its ability to bind calcium suggest that it may play a functional role in the pathogenesis of gallstones.

췌담관 결찰에 의한 백서 췌장의 조직학적 변화에 관한 연구

민영일(Young Il Min),이성구(Sung Koo Lee),김명환(Myung Hwan Kim),남승우(Seung Woo Nam),서동완(Dong Wan Seo),김연석(Yeon Suk Kim),명승재(Seung Jae Myung),김효정(Hyo Jung Kim),유병무(Byeong Moo Yoo),공구(Gu Kong),김현숙(Hyun Sook Kim) 대한소화기학회 1997 대한소화기학회지 Vol.30 No.1

N/A Background/Aims: Gallstone is the one of the most common causes of acute pancreatitis. But the pathogenesis of biliary pancreatitis remains controversial. And the fact that sampling of pancreatic tissue is not usually done for biochemical and morphological evaluation during the early stages of pancreatitis has made it virtually impossihle to explore issue concerning the pathogenesis of acute gallstone pancreatitis. However, transient obstruction of both biliary and pancreatic duct during the passage ot gallstone through the ampullary orifice is a well-known theory in the pathogenesis of gallstone pancreatitis. Thus, we created a pancreaticobiliary duct(PBD) obstruction in rat to evaluate the biochemical and pathological change of pancreas. Methods: Twenty-four male Sprague-Dawley rats were divided into four groups; Group A, sham operated; Group B, PBD obstruction for 24 hours; Group C, PBD obstruction for 48 hours; Group D, PBD obstruction for 72 hours. In each rat we evaluated biochemical and pathological change. Results: Serum amylase and lipase level peaked 48 hours after obstruction and then dropped. Serum alkaline phosphatase level had been in the elevated level as the obstruction was sustained. Fourty-eight hours after obstruction the pancreatic ductules were slightly dilated. Marked dilatation and proliferation of pancreatic ductules was observed 72 hours after obstruction. And acinar cell deletion was also observed 72 hours after obstruction but any evidence of inflammation couldnt be found. Conclusions: Pancreaticobiliary obstruction of rat caused dilatation and proliferation of pancreatic ductules and acinar cell deletion without intlammation. (Korean J Gastroenterol 1997; 30:106 - 113)

경피적 내시경적 담도배액관 삽입술의 성적

김진홍,조성원,유병무,함기백,김영준,배원엽,신용준 대한소화기학회 1998 대한소화기학회지 Vol.31 No.5

Background/Aims: In malignant biliary obstruction, percutaneous endoscopic biliary stenting (PEBS) has been perfomed as a combined percutaneous-endoscopic method for conversion of percutaneous biliary drainage (PBD) into endoscopic biliary drainage (KBD). The aim of this study was to assess the clinical significance of PERS. Methods: The PEBS was performed to insert biliary stents in 20 cases for 18 patients (mean age 65.7 years, 10 males and 8 females) with unresectable malignant biliary obstruction (gallbladder cancer 5, pancreas cancer 2, Klastkin tumor 8, common bile duct cancer 1, ampullary cancer I, icteric hepatoma 1). A guidewire was advanced into the duodenum through a percutaneous route of PBD, trapped with a basket, and pulled out through the working channel of a duodenoscope. Based on this guidewire, the EBD was performed. Results: The reasons for performing the initial PBD were debilitated conditions such as sepsis in 7 cases and a failure of initial EBD in 13 cases (failure of selective cannulation of bile duct in 2, failure of guidewire insertion through the stenotic lesion in 3, and failure of guidewire insertion into the intrahepatic bile duct to be drained in 8). The biliary stents (a single plastic stent in 8, double plastic stents in 10, a single metallic stent in 2) were successfully inserted through the percutaneous route (PTBD in 19, T-tube in 1) with the PEBS method. No complications such as choleperitonitis, hemobilia, migration of stents, cholecystitis, or pancreatitis were observed. Conclusions: PEBS is an easy and useful drainage method for conversion of PBD into EBD in unresectable malignant obstruction, when initial ERD is inappropriate.

만성 간염, 간경변 및 간세포암종에서 TGF - α발현의 특성에 관한 면역조직화학적 연구

박성수,이동후,유병무,이중달 대한간학회 1997 Clinical and Molecular Hepatology(대한간학회지) Vol.3 No.4

Background / Aim : Transfiorming growth factor-α(TGF-α )is a polypeptide cytokine related to cell proliferation and transformation . TGF-α binds to EGF receptor and stimulationg DNA synthesis in liver cell. The hepatitis B virus(HBV) by itself is also believed to play a role in the hapatic carcinogenesis. Recently, it was reported that TGF-α and HBV were synergistic in action with rapid apperance of hepatocelluer carcinoma in birtansgenic moice. Although TGF-α in thought to play an important role in hepatocarcinogenesis, its expression during the natural the dynamic changes and distinct immunohistochemical staining patterns in the course of chronic HBV hapatitis with specific reference to hepatocelluer carcinoma and to explain the role of TGF-α in the pathogenesis of hepatocelluer carcinoma . Materials / Methods : Employing TGF-α monoclonal antibody, signal detection was carried of by peroxidase-conjugated sterptavidin in deparaffinized liver tissue sections taken from HBsAg positive patients, All of the liver tissue section were proven HBV DNA positive by in situ hybridization. Immunohistochemical staining was performed in the tissue asctions obtained from for normal controls, six from patients with chronic persistent hepatitis, five with chronic active hepatitis, eight with liver cirrhosis and eleven with hepatocelluer carcinoma . Results : The patterns of TGF-α immunoreactivity were cytoplasmic-grain types in normal controls and persistent hepatitis, honeycomb types in chronic active hepatitis, occaional cytoplasmic-flooding types in liver cirrhosis, and cytoplasmic-rape types in hepatocelluer carcinoma. A Shapiro-Wilk W test for frequency table analysis for the expression of TGF-α in theses different disease groups was statistically significant. Conclusion : Theses data suggest that step-wise distinct expression of TGF-α enhancement in HBV associated chronic liver diseases which eventually resulted in the development of hepatocelluer carcinoma were conceivably due to dysregulation of liver cell cycles by both HBV and TGF-α during the persistent repetition of cell cycles.