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백서에서 간외폐쇄성 황달의 간손상 및 Ursodeoxycholic Acid의 예방 효과
최원충(Won Choong Choi),류호상(Ho Sang Ryu),현진해(Jin Hai Hyun) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.2
Background/Aims: Generally many reports were known that the liver function was decreased with different forms of extrahepatic obstructive jaundice. To clarify the mechanism of these hepatic dysfunction in extrahepatic obstructive jaundice, we studied histologica] and biochemical alterations of experimental rats with obstructive jaundice induced by common bile duct(CBD) ligation at two time periocL(group I) and the limiting effects of administration of ursodeoxycholic acid(UDCA) or NSAID(lndomethacin) on the histological and biochernical alterations(group II). Methods: In control, lO rats underwent laparotomy without CBD-ligation(sham-operation). In group I, the CBD of 20 rats was ligated by laparotomy. Three(group Ia) and Four(group Ib) weeks aft=r ligation and 4 weeks after in case of control rats, the liver was isolated and microscopic examination was done. In group II, 40 rats with ligation of CBD were ramdomly assigned to receive UDCA(25 mg/kg/day) for 15 rats and NSAID(indomethacin, 4 mg/kg/day) for 15 rats and placebo for 10 rats. Results: In the study of group I, bi]e ducts proliferation was observed from portal tracts to porta] tracts and to hepatic lobules in group la, and hepatic ]obules were destroyed by severe prc>]iferation and fibrosis, and the area ratio of hepatocytes and sinusoid was decreased relatively in thie microscopic field in group lb. In the study of group II, the decreased area ratio of hepatocytes and sinusoid was limited in UDCA treoted group, but not in indomethacin group. Biochemical abnormalities(s-GPT, alkaline phosphatase, tota] bilirubin) were not limited significantly in both drug treated groups. Conclusions: Impairment of liver function of the rats with extrahepatic obstrutive jaundice may be due to relatively decreased hepatocytes and sinusoid ratio by bile duct proliferation and interstitial fibrosis and this alteration may be prevented by administration of UDCA. (Korean J Gastroenterol 1996; 28:232 240)
Prostaglandin E2 가 신기능장애에 따라 고혈압에 미치는 영향
김형규(Hyoung Kyu Kim),최원충(Won Choong Choi),노정우(Jung Woo Noh) 대한내과학회 1988 대한내과학회지 Vol.34 No.4
N/A The renal prostaglandin E2 (PGE2) is primarily synthesized in renal medulla, and is entirely removed from blood on passage across the lung before it enters systemic circulation, and so is called the local hormone. The main physiologic effects of the PGE, on kidney are known as the natriuresis, water diuresis, vasodilatation and interaction with renin-angiotensin system. The authors attempted to evaluate the role of PGE2 on hypertension according to the state of impairment of renal function. The study of subjects were classified as following groups; namely Group A is a 24 normal control person without renal disease as well as impariement of renal function, Group B that of a 23 cases is essential hypertension without impairement of renal function. Group C is a 22 cases chronic renal insufficiency with hypertension of which creatinine clearance 21~59 ml/min. and Group D is a 24 cases with chronic renal failure with hypertension of which creatinine clearance is below 20 ml/min, Urine prostaglandin E2 diastolic blood pressure, twenty four hour urine Na excretion, creatinine clearance, plasma renin activity (PRA) and plasma aldosterone were investigated in all subjects and the interrelations among these parameters were analysed by multiple analysis method. Urine prostaglandin E2 was measured by radioim-munoassay with gamma counter. The NEM prostaglandin E2 I125 -radio-immunoassay kit is based on the use of an iodinated analog of prostaglandin E2 as the tracer. The results obtained are as follows: 1) Urine prostaglandin E2 (Mean±S.E): The value of group A, normal control groups is 365.1±20.65pg/ml., group B, essential hypertension; 353.9±20.71pg/ml., group C, chronic renal insufficiency; 149.1±10.70pg/ml. and group D chronic renal failure 83.3±8.30pg/ml. The value of group A is similar with group B (P>0.05), that of group C and D are significantly decreased in the comparsion with group A and B (P<0.01), while in the group C show the significantly high value in the comparsion with group D (P<0.01), group D is the lowest value among the comparison of group A, B and C (P<0.01). 2) Urine prostaglandin E2 has not significant relation to diastolic blood pressure, 24 hour urine Na excretion, creatinine clearance and plasma renin activity in all groups. 3) Urine prostaglandin E2 has significant correlation to plasma aldosterone in essential hypertension (r=0.489) (P<0,05), but has not significant relation to other groups. This findins suggest that the failure of compensatory protective role by renal FGE2 which is due to decreased PGE2 synthesis according to renal function impairment with diminished renal parenchyme may depend on the machanism of hypertension also is possible to mediate Na metabolism.
원혜진 ( Hye Jin Won ),한성훈 ( Seong Hoon Han ),박혜경 ( Hye Kyeong Park ),안효승 ( Hyo Seung Ahn ),임현민 ( Hyun Min Lim ),김정연 ( Jung Yeon Kim ),최원충 ( Won Choong Choi ) 대한류마티스학회 2007 대한류마티스학회지 Vol.14 No.4
Wegener`s granulomatosis is an uncommon disease that is characterized by granulomatous necrotizing vasculitis affecting small vessels. It typically targets the upper and lower respiratory tract and the kidney, but gastrointestinal involvement is rare. A 41-year-old man who has been already diagnosed with Wegener`s granulomatosis by nasal cavity biopsy was admitted with bloody diarrhea and high fever. He had discontinued taking the immunosuppressive medication. His colonoscopic finding revealed colitis and ulcer lesions which biopsies show vasculitis and ill-defined granuloma. Therefore he was treated with systemic steroid and improved dramatically.
포스터 전시 : 위장관 ; 지방종에 의한 성인의 대장 장중첩증 1예
허웅 ( Woong Huh ),신정아 ( Jung A Shin ),김성준 ( Seong Jun Kim ),신원창 ( Won Chang Shin ),이진호 ( Jin Ho Lee ),최원충 ( Won Choong Choi ),김관엽 ( Kwan Yap Kim ),김영덕 ( Young Duk Kim ) 대한소화기학회 2002 대한소화기학회 춘계학술대회 Vol.2002 No.-
<배경> 소아에서 흔한 장중첩증은 성인에서는 전체의 5%이하로 드물며, 소아와는 다르게 90%이상에서 일차적 병소(lead point)로 인하여 발생한다. 특히 대장에서는 일차적 병소가 반수이상이 악성 종양이며 양성질환은 드물고, 지방종, 근종, 용종, 내막증식증, 과거 수술의 문합부 등이 있다. 저자들은 간헐적 복통을 주소로 내원한 대장 지방종에 의한 장중첩증 1례를 경험하여 보고하고자 한다. <증례> 환자는 64세 여자이며, 약 1 개월간의 간헐적인
간경변증 환자에서 저위산증의 빈도 및 위산분비 억제제의 투여
박철구 ( Cheol Gu Park ),김성준 ( Seong Jun Kim ),이진호 ( Jin Ho Lee ),최원충 ( Won Choong Choi ),김관엽 ( Kwan Yeop Kim ),한태희 ( Tae Hui Han ) 대한소화기학회 2003 대한소화기학회지 Vol.41 No.4
Background/Aims: Bacterial overgrowth in the small intestine can induce bacterial translocation and spontaneous bacterial peritonitis in liver cirrhosis patients, which is probably associated with alkaline gastric juice. We assessed the frequency of achlorhydria (pH>4) for the purpose of rational use of acid-suppressive therapy in liver cirrhosis patients. Methods: Twenty-eight liver cirrhosis patients and 33 health examinee for screening stomach cancer were enrolled. The pH of fundal gastric juice aspirated through endoscope after overnight fast were measured with pH meter. The patients who had peptic ulcer disease, stomach cancer, history of upper G-I bleeding and experience of acid-suppressive drug (ASD) treatment before endoscopy were excluded. Chart review was undertaken to determine the use of ASD after endoscopy. Results: The average gastric pH was 4.58±1.76 in the liver cirrhosis group and 3.48±1.48 in the control group (p<0.05). Fifty-seven percent (17/28) of liver cirrhosis patients and 75% (12/16) of the patients receiving ASD prescription among liver cirrhosis patients were achlorhydria at fasting state. Conclusions: Our study confirms that pH of liver cirrhosis patients is higher than that of control. Further studies for the rational use of ASD to the patients with liver cirrhosis is required, as a large number of achlorhydria patients exist in liver cirrhosis. (Korean J Gastroenterol 2003;41:290-294)
내시경적 역행성담도조영술의 담낭천공에 대한 진단적 가치
이진호(Jin Ho Lee),함희용(Hee Yong Hahm),전수영(Soo Young Jeon),최원충(Won Choong Choi),신원창(Won Chang Shin),정운태(Woon Tae Jeong),김관엽(Kwan Yeob Kim) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.6
The gallbladder perforation was found in patients of cholecystitis with alarmingly high mortality rate. These high morbidity and mortality rates were caused by the delay in diagnosis. Therefore early dianosis and early operative intervention can decrease the confirmatively by demonstration of extravasated contrast media from the lumen of the gallbladder into loculated spaces around it. The purposes of our study are to review the clinical manifestations and values of endoscopic retrograde cholangiography in diagnosis of perforation of the gallbladder.
사례보고 : 급성 A형간염에 의해 발생한 혈구포식증후군 1예
서지영 ( Ji Young Seo ),서동대 ( Dong Dae Seo ),전태주 ( Tae Joo Jeon ),오태훈 ( Tae Hoon Oh ),신원창 ( Won Chang Shin ),최원충 ( Won Choong Choi ),유수진 ( Soo Jin Yoo ),한태희 ( Tae Hee Han ) 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.1
혈구포식증후군은 매우 드물지만 발생할 경우 매우 심각한 임상 경과를 보인다. 조직병리학적으로는 활성화된 대식세포나 조직구가 골수나 세망내피계에서 혈구를 포식하는 모습을 관찰할 수 있으며 임상적으로는 고열, 간비종대, 혈구감소, 간기능이상 및 고페리틴혈증을 보인다. A형간염바이러스는 이차성 혈구포식증후군을 일으키는 매우 드문 원인이다. 저자들은 급성 A형간염 후 혈구포식증후군이 합병된 22세 여자 환자를 보고한다. 환자는 급성 A형간염의 전형적인 경과를 보이며 검사실 검사 및 임상적으로 호전되다가 혈구포식증후군이 발생하면서 간부전 및 파종혈관내응고가 진행되었고 결국 복강 내 출혈로 사망하였다. Hemophagocytic syndrome (HPS) is a rare but serious condition that is histopathologically characterized by activation of macrophage or histiocytes with hemophagocytosis in bone marrow and reticuloendothelial systems. Clinically it presents with high fever, hepatosplenomegaly, pancytopenia, liver dysfunction, and hyperferritinemia. Hepatitis A virus is a very rare cause of secondary HPS. We report a case of a 22-year-old woman infected by hepatitis A virus who was consequently complicated with HPS. She presented typical clinical features of acute hepatitis A, and showed clinical and biochemical improvements. However, HPS developed as a complication of acute hepatitis A and the patient died of intraperitoneal bleeding caused by hepatic decompensation and disseminated intravascular coagulation. (Korean J Hepatol 2010;16:79-82)
백승석 ( Seung Suk Baek ),윤아일린 ( Eileen L. Yoon ),김현정 ( Hyun-jung Kim ),배경은 ( Kyung Eun Bae ),박경미 ( Kyeongmee Park ),최원충 ( Won-choong Choi ) 대한간암학회 2017 대한간암학회지 Vol.17 No.2
Heterogeneous features of liver cancer can mimic liver abscess. Therefore it is essential to double- check tumor markers in the diagnosis of liver abscess. Herein, we report a case of combined hepatocellular-cholangiocarcinoma (cHC) occurred in an unrecognized chronic hepatitis B patient initially misdiagnosed as liver abscess. A 49-year old male initially presented with chill, right upper quadrant pain, and a liver mass. Mass showed peripheral enhancement in arterial phase of computed tomography, which was not typical for hepatocellular carcinoma (HCC). Strikingly elevated alpha-fetoprotein and fine needle aspirated pathology revealed HCC. Despite discordant image findings he was treated with transarterial chemoembolization. He was treated with sorafenib due to metastatic retrocaval lymphadenopathy afterwards. The mass presumed to be HCC progressed with sorafenib. It was surgically resected and he was finally confirmed as cHC. Discordant tumor markers with presumptive image findings should prompt the suspicion of rare type of primary liver cancer, the cHC. (J Liver Cancer 2017;17:174-181)