간장 및 담도 : 전격성간염의 사망예견 인자

최흥재(Heung Jai Choi),문영명(Young Myoung Moon),정재복(Jae Bock Chung),이상인(Sang In Lee),한광협(Kwang Hyub Han),전재윤(Chae Yoon Chon),김상애(Sang Ae Kim),조준구(Jun Koo Cho) 대한소화기학회 1986 대한소화기학회지 Vol.18 No.2

N/A We assessed predicting factors of fafality in 42 patients with fulminant hepatitis such as age, sex, etiology, serurn levels of albumin, total bilirubin, SGOT, SGPT and alpha-fetoprotein, SGOT/SGPT ratio, plasma level of ammonia, prothrombin time, degree of encephalopathy and complication. Singificant differences were observed between the survivors (14 patients) and the non-survivors (28 patient.) by plasma level of ammonia and serum level of alpha-fetoprotein. Mortality tended to be increased by decreasing serum level of albumin and alpha-fetoprotein, prolonging prothrombin time, increasing plasma level of ammonia, a SGOT/SGPT ratio above than 1.0, deepening of encephalopathy and developing complication such as respiratory failure, cardiac dysfunction, cerebral edema or renal dysfunction. In patients with fulminant hepatitis B, the absence of HBsAg in serum had favorable prognostic value. In conclusion, the serum level of alpha-fetoprotein, plasma level of ammonia, prothrombin time, SGOT/SGPT ratio, degree of encephalopathy, and complication such as respiratorv failure, cardiac dysfunction. Cerebral edema and renal dysfunction may be used as predicting factors of fatality in fulminant hepatitis.

각종 간질환 환자에서 섬유소용해 활성도 ( Fibrinolytic Activity ) 에 관한 연구

최흥재(Heung Jai Choi),문영명(Young Myoung Moon),정재복(Jae Bock Chung),한광협(Kwang Hyub Han),전재윤(Chae Yoon Chon),박준용(Joon Yong Park),윤홍섭(Hong Sup Yoon) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.1

N/A To assess the fibrinolytic activity and coagulation defects in various liver diseases, antithrombin III, fibrin degradation products and prothrombin time were measured in the plasma of 49 patients with various liver diseases including liver cirrhosis, hepatoma, acute viral hepatitis and obstructive jaundice. Also antithrombin III was measured in the plasma of 29 normal controls. The results were as follows: 1) The antithrombin III level was significantly lower in liver cirrhosis and hepatoma than in controls. 2) The fibrinogen was significantly higher in obstructive jaundice than in the others. 3) Small amounts of FDP were found in some patients with liver cirrhosis and hepatoma. 4) In the cirrhotic patients, a significant difference in antithrombin III level was found between patients with FDP (+) and those with FDP (-). 5) The prothrombin time was significnatly more prologned in liver cirrhosis than in the others. 6) A significant correlation was found between antithrombin III and prothrombin time (r=0.48). 7) Comparing cirrhotic patients classified as Child A, B and C, the antithrombin III level was lower in Child C and the prothrombin time was more prolonged than in Child A and B. FDP was found in all but one of the patients classified as Child C.

위장관 ( 胃腸管 ) : 십이장궤양에 있어서 Niperotidine의 치료 효과

강진경(Jin Kyung Kang),최흥재(Heung Jai Choi),박인서(In Suh Park),정재복(Jae Bock Chung),이상인(Sang In Lee),전재윤(Chae Yoon Chon),김원호(Won Ho Kim),함기백(Ki Baik Hahm) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.3

N/A For the evaluation of clinical efficacy of niperotidine, a new potent histamine H, receptor anta-gonist, it was orally administered 460 mg once daily at bedtime for 4 weeks in 30 patients with active duodenal ulcer endoscopically diagnosed and then followed up by endoscopy. The observed results were as follows; 1) Clinical symptoms disappeared in 70.0%, 83.3%, and 96.7% of patients with duodenal ulcer at 1, 2, 4 weeks respectively. 2) The complete healing rates of duodenal ulcer by endoscopy at 4 and 8 weeks were 80.0% and 100.0% respectively. 3) Mild adverse reaction was observed in 5 patients including one cae of mild r-GTP elevation, two cases of loose stool, one case of drowsiness, and one case of skin rash, but not severe enough to stop or change medications. In conclusion, we thought that niperotidine was effective, safe and convenient to use in the treatment of duodenal ulcer.

초음파검사상 간 echogenicity 의 변화와 간생검상 병리조직학적 변화와의 비교관찰

강진경(Jin Kyung Kang),최흥재(Heung Jae Choi),박인서(In Suh Park),문영명(Young Myoung Moon),정재복(Jae Bock Chung) 대한소화기학회 1985 대한소화기학회지 Vol.17 No.2

N/A The association of high amplitude echoes returned from the cirrhotic liver and fatty liver is well recognized. And some degree of correlation between the severity of histologic change and tissue echo pattern was reported. It has been suggested that ultrasonography can predict parenchymal disease by variations in the intensity and pattern of the reflected sound waves. To test the correlation of hepatic parenchymal echogenicities with the severities and types of pathologic changes, such as inflamation, necrosis, fibrosis and fatty change, we have compared the echogenicities with the types and severities of pathological changes of liver observed with peritoneoscopic biopsy in 66 patients witn liver diseases 7 with cirrhosis, 18 chronic active hepatitis with cirrhosis, 19 chronic active hepatitis, 5 chronic per- sistent hepatitis, 10 fatty liver, 9 acute unresolved hepatitis and 8 minimal inflamation. The ultrasonography and peritoneoscopic liver biopsy were done within 5 days interval. There was a good correlation between the echogenicity of liver and the severity of fatty change but no correlation between echogenicity and severity of the other pathologic changes such as inflammation, necrosis and fibrosis.

소화성 궤양에 대한 Famotidine 의 치료효과

강진경(Jin Kyung Kang),최흥재(Heung Jai Choi),박인서(In Suh Park),문영명(Young Myung Moon),정재복(Jae Bock Chung),이상인(Sang In Lee),전재윤(Chae Yoon Chon),김상애(Sang Ae Kim),함기백(Ki Back ham),한광혀(Swang Hyub Han) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.1

N/A For the evaluation of clinical efficacy of famotidine, a new, potent, long-acting histamine H2-receptor antagonist, in patients with gastric and duodenal ulcer, 42patients with endoscopically-proved active gastric ulcer (19 patients) and duodenal ulcer (23 patients) were admitted to this trial. Thirty two patients were treated with famotidine 20 mg b.i.d. and 10 with cimetidine 200 mg q.i.d. up to 8 weeks. The observed results were as follows: 1) The complete healing rates of gastric ulcer by endoscopic examination at 4,6 and 8 weeks were 50.0%, 68.8% and 93.8% in famotidine group, and 33.3%, 66.7% and 100.0% in cimetidine group, respectively. 2) The complete healing rates of duodenal ulcer by endoscopic examination at 4, 6 and 8 weeks were 62.5%, 81.3% and 100.0% in famotidine group, and 57.1%, 71.4% and 85.7% in cimetidine group, respectively. 3) Abnormal laboratory finding after treatment was found only in one case in famotidine group, but 3 cases in cimetidine group. 4) There was no significant difference in symptomatic improvement between two groups and mild side effects were complained of in 5 of 32 famotidine group (15.6%) and 4 of 10 cimetidine group (40. 0%). In conclusion, data from the present ivestigation suggest that Famotidine is effective in the treatment of gastric and duodenal ulcer, and is well tolerated on a short-term basis. Further and more extensive studies are necessary to confirm these findings.

간의 국소적 지방 침윤 1예

강진경(Jin Kyung Kang),최흥재(Heung Jai Choi),정재복(Jae Bock Chung),한광협(Kwang Hyub Han),김원호(Won Ho Kim),박찬일(Chan Il Park),유형식(Hyung Sik Yoo),김중영(Joong Young Kim),한은경(Eun Kyung Han) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.2

N/A Focal fatty infiltration of the liver, a poorly characterized entity, was discovered incidentally at postmortem examination in the past, After both ultrasound and computed tomography (CT) have been extensively used over the past few years for imaging the hepatic parenchyma, it was possible to demonstrate focal fatty infiltration of the liver. Focal fatty infiltration of the liver may simulate mass lesions, so it is important to distinguish from space occupying lesions of the liver. Recently we encountered a case of focal fatty infiltration of the liver, which mimicked a liver tumor. It was detected by ultrasound and we performed abdominal CT, RBC liver scan, angiography and ultrasound guided needle biopsy. The diagnosis of focal fatty infiltration of the liver was established histologically.

간장 ( 肝臟 ) · 담도 ( 膽道 ) 및 췌장 ( 膵臟 ) : 원발성 간외담관암의 임상적 고찰

강진경(Jin Kyung Kang),최흥재(Heung Jai Choi),박인서(In Suh Park),최원(Won Choi),정재복(Jae Bock Chung),김원호(Won Ho Kim),김영수(Young Soo Kim),임대순(Dae Soon Yim),송시영(Si Young Song) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.4

N/A Despite significant advances in the diagnosis and treatment of various malignancies, the manangement of extrahepatic bile duct carcinoma remains most frustrating. Unfortunately complete excision of the tumor often impossible, because non-expandable anatomic structures are involved early. In an effort to identify the clinical characteristics and those factors associated with these car- cinomas which might have prognostic value, we analyzed the 216 patients with carcinoma of extrahe- patic bile ducts who were admitted to Severance Hospital, Yonsei University from January 1979 to July 1989. 1) The mean age of the patients clinical manifestations included jaundice in 198 cases (91.7%), abdominal pain in 125 cases (57.9%), hepatomegaly in 124 cases (57.4%) and weight loss in 120 cases (55.6%). The biliary stones were associated in 20.4% and the Clonorchis sinesis in 7.4%. 2) The range of total bilirubin levels on admission was 2.0 +- 9.9 mg/dl in 54 cases (25.0%), 10.0 +- 19. 9mg/dl in 78cases (36.1%) and more than 20mg/dl in 68cases (31.5%). 3) Abdominal ultrasonography, computed tomography, ERCP and PTC were performed in 178, 125, 133, 87 cases respectively, and their diagnostic accuracies were 51.1%, 66.4%, 84.2% and 93.1%, respecti vely. 4) The tumors were located in upper third in 83 cases (38.4%), middle third in 51 cases (23.6%) and lower third in 56 cases (25.9%). And the cases of diffuse type were found in 26 cases (12.0%). 5) The direct invasion of surrounding structures were found in 84.9% of patients, the regional lymph node metastasis in 43.9% and the distant metastasis in 12.% 6) Among 129 cases histologically confirmed the diagnosis, the tumor was well differentiated in 28 cases (21.7%), moderately differentiated in 34 cases (26.4%), poorly differentiated in 36 cases (27.9%), undetermined differentiation in 36 cases (27.9%), and epidermoid carcinoma in 1case (0.8%) and pleomorphic giant cell carcinoma in 1 case (0.8%). 7) The conservative treatment was performed in 52 cases (24.1%), non-operative biliary drainage in 41cases (18.9%). Among 119 (55.1%) cases who underwent operation, 67cases (31.1%) had t-tube choledochostomy, 29 cases (13.4%) biliary-enteric bypass and 23 cases (10.6%) radical resection. 8) The cumulative postoperative median survival from the date of definitive diagnosis was 5.8 months and its mean survival was 9.5 months. a) When analyzed survival rate according to the location of the lesion, the survival data were: upper third lesions, 12.8%, 3.7% and 3.7% at 1 year, 3year and 5year, respectively; middle third lesion, 33.7%, 7.9% and 3.9%, respectively; the lower third lesions 40.0%, 16.8% and 8.4%, respectively. And the 1 year and 2 year survival rate were 31.0% and 12.0% respectively in the patients with diffuse lesions. The survival in patients with carcinoma of lower third bile duct lesions were significantly higher than in upper third lesions and diffue leseions (p<0.05), and there was no statistical significance between in lower third and middle third lesions. b) Survival rates according to the histologic differentiation were; well differentiated lesions, 58.1%, 29.5% and 14.8% at lyear, 3year and 5year, respectively; moderate differentiated lesions, 38.6%, 18.0% and 18.0%, respectively; poorly differentiated lesions, 12.5%, 6.3% and 0.0% respectively. The survival in well differentiated lesions were significantly higher than in poorly differentiated lesions (p<0,05). c) Survival rates according to the stage were: stage II, 83.3%, 37.0% and 27.8% at lyear, 3year and 5year, respectively; stage III, 39.2%, 8.7% and 8.7%, respectively; stage IV, 17.7%, 4.7% and 2.4%., respectively. The survival rate in stage II lesions were significantly higher than stage III (p < 0. 01) and stage IV (p<0.001). d) Survival rate according to the modalities of treatment were: conservative treatment group, 6.2% at 6 month without any surviver longer than lyear; non-operative biliary drainage group

만성 간질환 및 원발성 간세포암 환자의 혈청 α1 - Antitrypsin 표현형의 변화

강진경(Jin Kyung Kang),최흥재(Heung Jai Choi),박인서(In Suh Park),문영명(Young Myung Moon),정재복(Jae Bock Chung),한광협(Kwang Hyub Han),전재윤(Chae Yoon Chon),김원호(Won Ho Kim),임대순(Dae Soon Yim),함기백(Ki Baik Hahm),신용준(Yong 대한소화기학회 1993 대한소화기학회지 Vol.25 No.2

N/A In parallel with the discovery of nev alleies inceasing the complexity of the Pi system, technical refinements have made the classification of an individual with respect to his Pi system relativeiy simple. Isoelectrofocusing in polyacrylamide gels is advantageous method in analyzing pisystem because of ease of performance, high resolution and reproclucibility. Most individuals have the PiMM phenotype resulting in normal plasma a1-antitrypsin (a,-AT) levels. The classical a1-AT deficiency is designated as Pizz in its homogygous form and has 15% of normal plasma a1-AT level, which is known to be associated with increased risk of cirrhosis and primary liver cancer But there is stilJ debate as the cause of this associated liver disease. This study is aimed to know the distribution and contribution of structural variants of a1-AT in South Korean patients with chronic liver diseases inr.uding hepatocellular carcinoma. One hundred thirty nine patients with chronic liver diseases or hepatocellular carcinoma were studied. Rlood sarnples were taken frorn each. Phenotypes of a1-AT were determined by electrofocusing in polyacrylamide gel electrophoresis. The results obtained were as folloas, None of the cases showed deficiency or null variant of a1-AT in patients with chronic liver diseases, hut two cases with hepatocellular carcinoma showed MS phenotype. About half of the cases with chronic liver disease and hepatocellular carcinoma showed homologcius polymorphism of a1-AT phenotype suballeles such as M1M1. M2M2 and M3M3. The distribution of the structural variants of a1-AT phenotype in patients with chronic liver diseases and hepatocellular carcinoma were in order as tollows; M1M1 (51.8%), M1M2(24.5%), M2M2 (7.9%), M3M3 (6.5%), M1M3, (5.8%),M3M3 (2.2%) and M1S (1.3%). In con, lusion, none of the cases with chronic liver diseases showed deficiency or null typed structural variants of a1-AT, but there were two cases with MS phenotype among the 39 patients with hepatocellular carrcinoma. Therefore, genetically determined a1-AT. deficiency seems to be not etiological]y important in South Korean patients with chronic liver disease.

개에서 회장내 단백이 췌효소 및 담즙분비와 위배출 및 소장주행 시간에 미치는 영향

강진경(Jin Kyung Kang),최흥재(Heung Jai Choi),박인서(In Suh Park),정재복(Jae Bock Chung),이상인(Sang In Lee),송시영(Si Young Song),정준표(Jun Pyo Chung),(Hiroshi Tohno),(eugene P . DiMagno) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.6

N/A The aim of this study is to determine if protein in the ileum of dogs affects postprandial pancreaticobiliary secretion, gastric emptying, small bowel transit time, and circulating levels of gastrointestinal regulatory peptides such as peptide YY (PYY), neurotensin (NT), and pancreatic polypeptide (PP). Five dogs were prepared with permanent infusion and aspiration catheters in the duodenum and ileum. Ileal infusion (2 ml/rnin) was begun coincidentally with feeding a 300 Cal mixed nutrient meal containing both a iiquid marker (PEG 4000) and a solid marker (99mTc-sulfur colloid) in a conscious state of dogs. Ileal infusates were isosmolar solutions containing either 0.9% NaCl (control study) or 20 mg/rnl of protein solution (protein infusion study) in the 3:1 ratio of casein to essential amino acids. The secretory pattern of amylase and lipase was parallel, but. the secretion of trypsin was non-parallel to secretion of amylase and lipase. The pattern of exocrine pancreatic enzyme secretion was similar both in control and intraileal protein infusion studies. The secretion of exocrine pancreatic enzymes including amylase, lipase and trypsin, were increased by intraileal protein infusion compared with their secretion in control studies, and the secretion of amylase was significantly decreased (p<0.02) by intraileal protein infusion compared with their results in control studies. Although gastric emptying of both liquid and solid meals was delayed by the intraileal infusion compared with the control studies, there was no significant delay in gastric emptying (Tl/ 2) of liquid, whereas significant difference was noticed in gastric emptying (Tl/4) ol solid (p<0.02) between the control and intraileal protein infusion studies. The small bowel transit time was significantly prolonged (p<0.01) by intraileal protein infusion compared with time measured in control studies. The mean serum levels of PYY and NT were increased by intraileal protein infusion compared with those of control studies, but the mean serum level of PP was not changed. ln conclusion, it is suggested that intraileal protein riiay promote digestion and absorption of nutrients by increasing the enzyme secretion of the pancreas, delaying gastric emptying and prolonging small bowel transit time which may be influenced by hormones such as PYY and NT.

위장관 ( 胃腸管 ) : 약년자 대장 및 직장암의 임상적 고찰

강진경(Jin Kyung Kang),최흥재(Heung Jai Choi),박인서(In Suh Park),정재복(Jae Bock Chung),김원호(Won Ho Kim),김경희(Kyung Hee Kim),노성훈(Sung Hoon Noh),김도영(Doe Young Kim) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.1

N/A Colorectal carcinoma in young patients reportedly has a poor prognosis. Several reviews have suggested multiple explantations, including a low index of suspicion, delay in diagnosis or uniquely virulent tumor cells. However, some recent articles have suggested that the outlook is not necessarily dismal. To identify any distinctive characteristics of colorectal cancer in young patients, we studied the difference of incidence, initial symptoms, duration of symptoms, the location, gross types and size of the tumor, depth of invasion, resectability, lymph node involvement, distant metastasis, tumor stage by Astler-Coller classification, histologic types and five-year survival rates between 91 cases of young patients (less than 35 years of age) with colorectal cancer and 915 cases of eldly patients (35 years of age or more) as control, who were operated at Yonsei University Medical College, Severance Hospital during the 18 year period between January 1971 and December 1988. The results obtained are as follows: 1) The incidence of colorectal carcinoma in the young among total colorectal cancer patients was 9.0% (91/1,006 cases). There were 44 males and 47 females in the young age group, and the male to female ratrio was 0.93 : l. 2) There were no differences in the clinical symptoms, location, size, gross types of tumor and resectability between the two groups. 3) The duration of symptoms was longer in the younger age group than in the older age group. 4) The incidence of lymph node involvement was significantly higher in the younger age group than in the older age group (62.8% vs 39.2%; p<0.001). 5) The incidence of modified Dukes C cases was significantly higher in the younger age group than in the older age group (49.5% vs 33.49% p<0.001). 6) The incidence of mucinous carcinoma was significantly higher in the younger age group than in the older age group (32.5% vs. 10.1%; p<0.001). 7) The cumulative five-year survival rate was significantly lower in the younger age group than in the older age group (34.1% vs. 58.0%; p<0.005). 8) Even in the same stage or in the same status of lymph node involvement or with the same histologic type, the five-year survival rate was significantly lower in the younger age group than in the older age group. We conclude that the colorectal caricr in younger patients is worse than older patients. This unfavorable prognosis in young patients with colorectal cancer may be related to delayed diagnosis, more malignant histologic feature and other unidentified causes such as host factor. We suggest that a high degee of index of suspicion and aggressive treatment is mandatory even in young patients.