급성 췌장염의 예후판정에 있어 복부전산화 단층촬영의 의의

서정일(Jeong Ill Suh),장병익(Byeong Ik Jang),김태년(Tae Nyeun Kim),정문관(Moon Kwan Chung),이현우(Hyun Woo Lee),변우목(Woo Mok Byun) 대한내과학회 1995 대한내과학회지 Vol.48 No.2

N/A Objectives: The purpose of this study is to evaluate the usefulness of computed tomography (CT) in the prognosis of acute pancreatitis. Methods: 70 patients with acute pancreatitis visited to Yeungnam University hospital emergency room between March 1991 and April 1993 were studied prospectively with early computerized tomography. The diagnosis of pancreatitis was based on typical clinical presentation and elevation of serum amylase levels. Prognostic score, fasting days and hospital days were record. The initial computerized tomograpic findings were graded A to E and we studied the correlation of CT grade and prognostic score and fasting days and hospital days. And also we studied the correlation of CT grade and prognostic score. Result: 1) Prognostic score of acute pancreatitis correlated with fasting days and hospital days (p<0.05). 2) There was no correlation between CT grade and prognostic score (p>0.05). 3) CT grade correlated well with fasting days and hospital days (p<0.01). Conclusion: In conclusion, we suggest that both prognostic score (Ranson score, Glasgow score) and early CT examination of patients with acute pancreatitis are useful prognostic indicator.

문맥압 항진증의 혈역학적 특성

김태년(Tae Nyeun Kim),서정일(Jeong Ill Suh),장병익(Byeong Ik Jang),정문관(Moon Kwan Chung),이현우(Hyun Woo Lee) 대한내과학회 1997 대한내과학회지 Vol.53 No.1

N/A Objectives: Hemodynamic measurements of chronic portal hypertension were done to study the mechanisms that maintain high portal pressure despite well developed collateral circulations. Methods: A prehepatic portal hypertensive rat model was produced by partial portal vein ligation. Cardiac output, organ blood flow and porto-systemic shunt were measured by radioisotope labeled microsphere methods, and vascular resistance was calculated by standard equation. Results: There was a significant reduction in the weight of the liver and increase in the weight of the spleen in the portal stenotic rats. Porto-systemic shunting, representing development of the collateral circulations, was 96.7±0.6% in the portal stenosis group compared with 0.9±0.2% in the control group (p<0.01). Portal pressure was significantly increased in the portal stenosis group compared with the control group(12.8±1.4 vs. 6.5±0.6mmHg; p<0.01). Mean arterial pressure was significantly decreased in portal stenosis group compared with control group(101.4±2.5 vs, 129.9±3.9mmHg; p<0.01). In the portal stenosis group, cardiac output(135.7±8.0 vs. 111.0±4.2ml/min; p<0.01) and splanchnic organ blood flow (28.97±2.03 vs. 17.90±1.27ml/min, p<0.01) were significantly increased, with concomitant decrease in total peripheral vascular resistance(58.0±3.3 vs. 88.2±4.8 dyne sec/cm5×105; p<0.01) and splanchnic vascular resistance(2.54±0.20 vs. 5.47±0.33 dyne sec/cm5×105; p<0.01), However, the portal venous resistance was not significantly different in both groups of rats (3.57±0.31 vs. 3.03±0.38 dyne sec/cm5×105; p>0.05). Conclusion: The hemodynamic results of this study indicate that hyperdynamic status of systemic and splanchnic circulation was present in chronic portal hypertension and that the primary factor contributing to the persistently elevated portal venous pressure was the markedly increased portal venous inflow.

담낭결석 환자에서 수술전 내시경적 역행성 담도 조영술의 적응증

김기덕(Ki Duk Kim),김기윤(Ki Yun Kim),서정일(Jeong Ill Suh),장병익(Byung Ik Jang),김태년(Tae Nyeun Kim),정문관(Moon Kwan Chung),이현우(Hyun Woo Lee) 대한내과학회 1996 대한내과학회지 Vol.50 No.1

N/A Objectives: Preoperative evaluation of common duct stones by ERCP is important in the management of gallbladder stones. But, considering the complications and cost of ERCP and the low incidence of choledocholithiasis, it is not necessary to perform ERCP before cholecystectomy in all patients with gallbladder stones. This study was undertaken to propose the indications of preoperative ERCP by predicting common duct stones in patients with gall- bladder stones. Methods: Routine use of ERCP was prospectively studied in all patients with gallbladder stones undergoing elective cholecystectomy. Presence or absence of common duct stones identified by ERCP were analyzed with variable parameters of abdominal pain, fever, number of stones, ultrasonographic criteria of common duct dilatation, and biochemical tests of alkaline phosphatase(ALP), bilirubin, and γ-glutamyl transpeptidase(γ-GTP). Results: A total of 237 patients were included in this study. There was no significant differences between abdominal pain or number of stones and freguency of ductal stones, but incidence of common duct stones was significantly higher in patients with fever than without fever(59.0% vs. 30.7%, p<0.01). There was significantly increased incidence of common duct stones in patients with nondilated ducts(72.5% vs 20.4%, p<0.01), and in patients with abnormalities in any one parameters of ALP, bilirubin, and γ-GTP compared to patient with normal liver function tests(49.7% vs, 7.6%). The incidence of choledocholithiasis was only 1.9% in cases with nondilated duct and normal liver function tests, but the incidence was increased to 20.4%, 33.3%, and 79.0% in cases with nondilated duct and abnormal liver function tests, with dilated duct and normal liver function tests, and with dilated duct and abnormal liver function tests, respectively. Conclusion: The incidence of choledocholithiasis was significantly correlated with presence of fever, liver function tests, and common duct diameter by ultrasonography, but, not with presence of abdominal pain and number of stones. When common bile duct was dilated by ultrasonography and/or liver function tests were abnormal, the probability of ductal stones was high and preoperative ERCP was required to identify choledocholithiasis

증례 : 강직성척추염과 병발한 IgG , 입 (入) 형의 다발성골수종 1 예

김종설 ( Chong Suhl Kim ),이헌주 ( Heon Joo Lee ),이영현 ( Young Hyun Lee ),양창헌 ( Chang Heon Yang ),정문관 ( Moon Kwan Jeong ),윤경우 ( Kyoung Woo Yoon ) 대한내과학회 1985 대한내과학회지 Vol.28 No.4

내시경적 담관 결석 제거 후 담낭 절제술의 필요성에 관한 연구

박찬원(Chan Won Park),김준환(Jun Hwan Kim),이동준(Dong Jun Lee),김기윤(Ki Yun Kim),서정일(Jeong Ill Suh),김태년(Tae Nyeun Kim),정문관(Moon Kwan Chung) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.5

N/A Background/Aims: There has been much debate over the fate of the gallbladder after endoscopic common bile duct stone removal. Current data suggest that the majority of patients remain asyrnptomatic and without complications related to the gallbladder when endoscopic extraction of the bile duct stones is successful. The aims of this study was to assess the natural course of patients with gallbladder in situ following endoscopic sphincterotomy for choledocholithiasis with particular reference to the need for subsequent cholecystectorny. Methods: Patients were studied who had undergone comon bile duct stone removal by endoscopic sphincterotorny at Yeungnam University hospita] between January 1988 and July 1993. The patients were followe<l regularly by phone call and personal interview at our outpatient clinic. The overall length of fo]low-up ranged from 6 months to 70 months. When more detailed information was required, a new investigation was undertaken by liver function test, abdominal ultrasonography, or endoscopic retrograde cholangiopancreatography. Results: Immediate complications of endoscopic sphincterotomy occurred in 26 patients(14.5%), of which hemorrhage was the most frequent. 2 of 21 patients required pack cell transfusion for bleeding. Acute pancreatitis occurred in 5 paients, which was successfully managed by conservative treatment.. Three patients in group of gallbladder in situ without gallstone required cholecystectorny for symptoms or complication related to the gallbladder calculi. The reason for surgery were acute cholecystitis in two patients, biliary colic in one. In the group of gallbladder in situ with gallstone one patient required cholecystectomy for GB empyema. The frequency of cholecystectomy was not significantly different between two groups. Recurrence of common bile duct stone was observed in 4 patients of the group without gallbladder(5.6%) and 7 patients of the group with gallbaldder in situ(6.5%). The recurrence rate was nqt significantly different between two groups. Conc)usions: Elective cholecystectorny after endoscopic common bile duct stone removal is not necessary in patients without gallstones, howevet, one should be aware of possible formation of new stones in the gallbladder and biliary complication. (Korean J Gastroenterol 1997;29:659-666)

위정맥류 출혈에 응급 내시경적 경화요법의 치료효과

서정일,정문관,이현우,김태년,장병익,박찬원,이경희 대한소화기내시경학회 1996 Clinical Endoscopy Vol.16 No.3

A study carried out to evaluate the bleeding control and prophylactic effect of rebleeding using emergency endoseopic sclerotherapy in patients with hleeding gastric varices. 42 patients with gastric variceal bleeding were admitted to the Yeungnam University Hospital from May, 1983 to August, 1992. Patients were randomly classified into control group, 20 patients treated with conservative management, and sclerotherapy group, 22 patients treated with emergency endoscopic sclerotherapy. The two group were analysed with age, sex, etiology of liver cirrhosis, nature of bleeding episode, hematocrit on admitting day, amount of sclercsants used, rebleeding episodes, complications, and mortality. There were no significant differences in the severity of underlying liver disease and hematocrit on admission between two groups. Blood transfusion were performed in 19 cases of control group and 21 cases in sclerotherapy group(p$gt;0.05). The amounts of transfusion were 7. 7units in control group and 6.1 units in sclerotherapy group(p$lt;0,05). Rebleeding were developed in 65% and 18% of the patiehts with control and sclerotherapy group, respectively(p$lt;0.05). Chest pain and mild fever were observed after endoscopic sclerotherapy. These results suggest that the endoscopic sclerotherapy is effective method in hemostasis of bleeding gastric varices and short-term prevention of rebleeding, but mortality rate was not decreased compared to control group. Development of more effective methods to treat gastric variceal bleeding is required.

소아에 있어서의 상부위장관 내시경검사에 대한 고찰

김정호,박용훈,정문관 대한의학협회 1990 대한의학협회지 Vol.33 No.5

급성담관염에서 응급 내시경적 경비담관 배액술

박찬원,서정일,정문관,김태년,장병익 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.3

Background/Aims: Acute suppurative cholangitis is associated with significant mortality. It is best managed by drainage of biliary tree such as endoscopic, percutaneous or surgical, We evaluated the role of emergency endoscopic nasobiliary drainage(ENBD) in the acute suppurative cholangitis. Methods: For 55 patients with acute calculous cholangitis, who did not respond to conservative management and the stone could not be removed from bile duct by endoscopic papillotomy due to poor condition or bleeding tendency, ENBD tube(7.5Fr) was inserted at proximal side of obstruction. ENBD was done at 39.4 hours (mean) after arrival to hospital. Results: ENBD was successful in all patients (100%). All patients responded with striking improvement of the abdominal pain, fever and stabilized vital signs within 3 days. After patients conditions were stabilized clinically, common bile duct stones were removed successfully by endoscopic sphincterotomy or surgery. No patients died of acute suppurative cholangitis. Conclusion: These results show that ENBD is a simple, safe, and effective measure for the initial control of acute suppurative cholangitis due to cholelithiasis.

내시경적 담관결석 제거술의 임상적 고찰

김기덕,서정일,정문관,이현우,김태년,장병익 대한소화기내시경학회 1995 Clinical Endoscopy Vol.15 No.4

From January 1988 to December 1994, endoscopic sphincterotomy with stone extraction was attempted in 395 patients with common duct stones at Yeungnam University Hospital. Endoscopic sphincterotomy was successful in 389 patients(98.5 %), and clearance of the duct was achieved in 364 patients with an overall success rate of 92.2%. After sphincterotomy, stone extraction by basket or balloon was undertaken in 298 patients without lithotripsy, and stones could be extracted after fragmentation of stones in 19 patients. In 47 patients, stones were passed into duo denum spontaneously. There were 6 cases of sphincterotomy failure due to large periampullary diverticulum or previous gastrojejunostomy. In patients with success ful sphincterotomy, endoscopic stone extraction was failed in 25 cases due to 14 large stones, 5 bile duct strictures, 4 impacted stones, and 2 cases of technical fail ure. Complications were developed in 13 patients(3.3%); 8 pancreatitis and 5 bleedings. All of them were improved with medical therapy only. Despite relatively high success rate and low complications of the endoscopic management of choledocholithiasis, there were significant difficulties in removing large stones. Developement of more effective and inexpensive methods of lithotripsy, and the search for rapidly effective solvent dissolving stones were needed.

담즙산에 의한 위 점막 손상

조현홍,서정일,이경희,김태년,정문관,이현우,최원희,양창헌 영남대학교 의과대학 1992 Yeungnam University Journal of Medicine Vol.9 No.2

십이지장으로 분비되고 위내로 역류될 수 있는 bile acid가 위점막에 끼치는 영향을 알아보기 위해 체중 200-250gm전후의 Sprague-Dawley흰쥐를 사용하여 pH3인 염산과 TCDA 15mM혼합용액을 위장내에 주입하고 같은 산도의 염산을 위장내로 투여한 대조군과 비교 조사한 결과 다음과 같은 성적을 얻었다. TCDA에 의한 위점막 손상은 TCDA 투여후 75분이 지난 후 제일 저명하게 나타났고 15 분, 30분, 120분 및 150분에는 뚜렷한 변화를 관찰할 수 없었다. TDCA 투여후 75분에 나타나는 소견으로는 점막과 점막하조직의 울혈, 혈관 확장, 임파선 확장, 부종 등을 나타내었으며 시간이 경과함에 따라 혈관 확장 및 부종은 점차 소실되는 소견을 나타내었다. 이상의 결과로 보아 TCDA가 급성 위점막 손상을 일으킬 수 있지만 만성적 위점막 손상에 대해서는 여러 조건하에서 더 많은 연구가 있어야 할 것으로 사료된다. To investigate the effect of bile acid on gastric mucosa, we performed biologic test using Sprague-Dawley rat. Mixture solution of TDCA 15mM and HCl of pH 3 was given into stomach to one group and HCl of pH 3 was given into stomach to another group. The significant gastric mucosal change was vasodilatation and edema, that was disappeared progressively. These findings suggest the bile acid can damage gastric mucosa.