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.

간장 및 담도 : Lipiodol - I - 131 의 간동맥 주입에 의한 간암치료

최흥재(Heung Jai Choi),문영명(Young Myoung Moon),전재윤(Chae Yoon Chon),이경식(Kyung Sik Lee),김병수(Byung Soo Kim),김병로(Byung Ro Kim),이종태(Jong Tae lee),유형식(Hyung Sik Yoo),서정호(Jung Ho Suh),김동익(Dong Ik Kim),박창윤(chang 대한소화기학회 1986 대한소화기학회지 Vol.18 No.1

N/A An iodized oil such as Ethiodol or Lipiodol was selectively retained in the tumor vessls of the large hepatomas as well as in the small daughter hepatomas for long periods following the intraarterial hepatic injection of such contrast material. The specific aim of the study is to deliver a high internal radiation dose to hepatocellular carcinoma(HCC) in an atempt to control the disease. We were able to replace a small fraction of the stable iodine (I-127) of the 37% iodine in Lipiodol by the I-131 with 100% exchange efficiency. I-131 labeled Lipiodol was injected through the superselected tumor feeding artery under superselection or into the proper hepatic arterial level of patients who have malignant hep- atomas confirmed by aspiration cytology. I-131-Lipiodol was stable in vivo and no significant activity was noted in the thyroid, stomach, blood and urine after the injection. Only small fraction of radioisotope activity was noticed in the both side of lungs. Tumor to normal liver ratio was very high. Therefore, I-131-Lipiodol (or p-32-Lipiodol) will be effective delivering high internal radiation dose to the tumor while delivering small radiation doses to normal tissues. Labeling, tumor dose calculation and preliminary findings will be presented.

간장 ( 肝臟 ) 및 담도 ( 膽道 ) : 문맥 - 전신정맥 문합술 후 개존성 진단에 대한 Doppler 초음파검사의 유용성

최흥재(Heung Jai Choi),박인서(In Suh Park),문영명(Young Myoung Moon),이상인(Sang In Lee),전재윤(Chae Yoon Chon),김원호(Won Ho Kim),함기백(Ki Baik Hahm),배형미(Hyung Mee Bae) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.4

N/A Surgical porto-syitemic shurlt is usually performed in patients who have bled from esophageal varices, Patency of the shunt generally prevents further bleeding; whereas, thrombosis exposes the patients to the risk of renewed and often life-threetening hemorrhage. Asaessment of shunt patency is therefore imyortant in the follow up of these patiensts. We asseased patency of squgical parto-aystemic shunts in five patients using Doppler ultrasonography. Of the five, one patient received a side-to-side partacaval shunt operation, one an end-to-side portacval Shunt,one a graft-interpoaitioning mesocaval shunt and two patients received a distal spIenarenal (Warren) shunt operation. In all patients, flow signal through the shunt was detected by Doppler ultrasonography. Four of five patent shuts were directly seen. In three patients color Doppler ultrasonography was performed and color flow eignals were detected, In one patients, who received side-to-side portacaval shunt operation, and another, who received graft-interpositioning mesocaval shunt operation, the flow signal of the portal vein showed reve direction of flow and a phasic pattern influenced by cardiac pulsativn, which was similar with the flow signaI of inferior vena cava. We concluded that Doppler ultraeonogrephy is a simple, noninvasive and very useful procedure to assess the pitecy of photo-systemic shunt.

특발성 호산구 침윤성 위장관 질환의 임상적 고찰

최흥재(Heung Jai Choi),문영명(Young Myoung Moon),김경희(Kyung Hee Kim),이관식(Kwan Sik Lee),박종훈(Chong Hoon Park),권준(Jung Kwon),박효진(Hyo Jin Park) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.2

N/A Eosinophilic gastroenteritis is a disease entity of idiopathic infiltration of the gastrointestinal tract with eosinophils that produces a variety of clinical features accoriding to the wall involved, and is ciassified into diffuse and circumscribed forms. We have conducted a retrospective clinical study on 10 patients of diffuse eosinophilic gastroenteritis who had admitted to Yonsei University Severance and Yong Dong Severance Hospitals from Sep. 1981 to Sep. 198S. 1) The median age of the patients was 48 years ranging from 27 to 69, and the male to female ratio was 7 to 3. 2) No patient showed a history of allergic diseases and allergic diathesis to drugs or foods. 3) The most common manifestation was abdominal pain and 90% of the patients showed it. The other symptoms were nausea, vomiting, diarrhea, weight loss, and melena or hematochezia. Pyloric obstruction and duodenal perforation were found in one patient, respectively. Two patients showed massive amounts of ascites and signs of peritonitis. 4) The most common site of the involvement was the stomach, 7 cases. The duodenum was involved in 3 cases, of them the stomach was involved concomitantly in 1 case. In 1 patient the rectum and sigmoid colon as well as the stomach were involved and it was the first case of the colonic involvement except the cecum in Korea. 5) 8 out of all 10 patients were operated on the gastrofiberscopy and 6 of them were diagnosed by endoscopic biopsy. In one patient the colonoscopic biopsy was done, and the colonic involvement was revealed by it. 6) The predominant layer of the eosinophilic infiltration was the mucosa in 6 cases, the muscularis 2 cases, and the serosa 1 case. In one patient paracentesis was done and the peritoneal fluid examination showed 100% of eosinophils. In that case we could suggest that the predominant eosinophilic infiltrative layer was the serosa. 7) laboratory findings showed that the mean of total eosinophil count was 3952/mm3. The other laboratory data involving hemoglobin, hematocrit, serum iron, transferrin saturation, plasma protein, albumin, serum IgG. IgA, IgM, and the complement C3, C4 were all within normal limits. 8) In 5 out of 10 patients the serum IgE level was checked and 2 of them showed over 1,000 KU/L. 9) In 3 out of 10 patients the surgical treatment ivas needed and the preoperative diagnosis was acute appendicitis, duodenal perforation, and pyloric obstruction, respectively. The other 7 patients were treated medically. Steroid was used in 3 patients and all responded dramatically with complete resolution in follow-up. In the rest 4 patients conservative medical treatment was done with not-so- good responses. With these observations, though the etiology of diffuse eosinophilic gastroenteritis has not been proved yet, allergic basis for pathogenesis is suspected to some extents due to increased eosinophils in these patients and elevated serum IgE level in some patients. Though it is a relatively rare disease, diagnosis can be made by gastrofiberscopy alone, and when it is confirmed, uncomplicated case can be successfully treated with steroid and unnecessary surgicval management can be avoided.

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.

특발성 국소적 양성담도협착 2예

최흥재(Heung Jai Choi),문영명(Young Myoung Moon),한광협(Kwang Hyub Han),전재윤(Chae Yoon Chon),김원호(Won Ho Kim),김경희(Kyung Hee Kim),이관식(Kwan Sik Lee) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.3

A benign bile duct stricture is a relatively rare disease. Although the bile duct stricture is not malignant, the clinical course is serious and so identification of causes and adequate treatment is needed. The etiology of benign bile duct stricture is usually quite obvious. Traumatic causes include operative injury and blunt external abdominal trauma. Nontraumatic causes include choledocholithiasis, chronic pancreatitis, pericholedochal abscess, congenital lesion associated with choledochal cyst, therapeutic irradiation and primary sclerosing cholangitis. On the other hand, Muscroft et al and Cardwell et al reported cases of localized benign bile duct stricture of which causes were unknown. We experienced two cases of idiopathic localized benign bile duct stricture which were proved by operation. Before operation, we thought the causes of bile duct stricture were malignant and so radical operations were performed. Histologic examination of specimens showed chronic inflammation and fibrosis without malignant cells.

위장관 ( 胃腸管 ) : 악성복수 및 결핵성 복막염에서 복수 CEA 의 진단적 가치

최흥재(Heung Jai Choi),문영명(Young Myoung Moon),한광협(Kwang Hyub Han),전재윤(Chae Yoon Chon),김경희(Kyung Hee Kim),이관식(Kwan Sik Lee),이동기(Dong Ki Lee) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.3

N/A Ascites due to malignancy and tuberculous peritonitis are usually exudate in nature. The distinction between them is often difficult but critical. Recently ascitic CEA assay was known to be useful and simple marker for malignant ascites if CEA level is higher than 10 ng/ml. Previous studies had never distinguished between malignant ascites and benign ascites which consisted largely of exudate. This study was undertaken to access the diagnostic value of ascitic CEA for the diagnosis of malignant ascites. Serum CEA, ascitic CEA and various ascitic value of routine examination were measured and analyzed in 37 malignant ascites and 28 tuberculous peritonitis patients who were confirmed pathologically and bacteriologically. The result were as follows 1) The value of ascitic and serum CEA level was significantly higher in malignant ascites than in tuberculous peritonitis. The value of ascitic protein, LDH, WBC count and serum LDH level showed no statistical difference between them. 2) Serum CEA level was higher than 5 ng/ml in 16 of 30 patients with malignant ascites (53.%) and 2 of 14 patients with tuberculous peritonitis (14.3%). 3) Ascitic CEA level was higher than 10 ng/ml in 29 of 37 patients with malignant ascites (78.4%) while none of 27 patients with tuberculous peritonitis (0%). 4) In matignant ascites, patients with G-I tract malignancy, 26 patients all showed ascitic CEA level above 10 ng/ml (100%) but patients with malignancy from non G-I tract except unknown origin, 1 of 4 patients showed ascitic CEA level above 10 ng/ml(25%). 5) The sensitivity of ascitic CEA level in malignant ascites was 78.4% but that of cytologic examination was 34.3% In summary, the measurement of ascitic CEA level is useful and simple method in distinguishing between malignant ascites and tuberculous peritonitis. The sensitivity of ascitic CEA level was higher than that of serum CEA level or cytologic examination.

직시하생검용 (直視下生檢用) 위 (胃) Fiberscope 으로 절편채취한 (切片採取) 위석 (胃石) 2예

문영명(Young Myoung Moon),김창규(Chang Kyu Kim),박인서(In Suh Park),최흥재(Heung Jai Choi) 대한소화기학회 1972 대한소화기학회지 Vol.4 No.2

we have presented two cases of bezoa associated with beign gastric ulcer. Diagnosis was made by raentgenological and fibergastroscopic examinations and fragments of bezoar were taken by biopsy forcep incorporated with fibergastroscope under direct vision for microscopic examination. In one patient 54 year-old male, an egg-sized bezoar was found on roetgenological and endoscopic examinations, and it was confirmed as phytobezoarb by microscopic examination of the secimen taken by biopsy forsep under direct vision. The formation of phytobezoar in this case seemed to be related to to ingestion of large amount of the vegetable (herb medicine). In follow up study after treatment with antacid and diet thrapy for two inonths, the bezoar disappeared and the ulcer was healed completely. In the other patient, 31-year-old male, roentgenolgical and endoscopic examinations also revealed an egg-sized bezoar, but failed to confirm its components by microscopic examination which only showed amorphous, structureless findings.

만성위염 환자에서 위액내의 Calcium 이온 농도에 관한 연구

박영숙(Young Sook Park),문영명(Young Myoung Moon),김경희(Kyung Hee Kim),박인서(In Suh Park),최흥재(Heung Jai Choi),김경환(Kyung Hwan Kim) 대한내과학회 1989 대한내과학회지 Vol.36 No.6

N/A It was reported that ionized calciun in the Gl tract stimutates the parietal cells and induces gastric secretions. It also plays a role in preventing stress ulcers and in the functional and anatomical recovery of mucosal damage. This study was undertaken to investigate the relation-ship between gastric juice calcium, serum calcium, gastric juice pH and pathologic change on 103 patients with chronic gastritis. The results were as follows: 1) The mean value of the calcium concentration of gastric juice was 0.55 mM and 79% of the patients were within the range of 0.35 to 0.68 mM. 2) The calcium concentration of gastric juice of patients with atrophic change was significantly lower than that of patients with deffuse superficial gastritis. 3) The concentration of calcium of gastric juice of patients with intestinal metaplasia was lower than that of patients wihtout intestinal metaplasia. 4) No relation was found between the calcium concentration of gastric juice and the activity of chronic gastritis. 5) An inverse relation tended to be observed between the calcium concentration of gastric juice and gastric juice pH. 6) No correlation was found between the calcium concentration of gastric juice and serum calcium concentration. 7) The serum calcium concentration had no correlation with the gastric juice pH. In conclusion, the calcium concentration of gastric juice may be related to the histologic change in patients with chronic gastritis and it plays an important role in the recovery process of damaged gastric mucosa.

위점막 Ca++ 이 백서의 손상된 위점막 재생에 미치는 영향

문영명(Young Myoung Moon),함기백(Ki Baik Hahm),이상인(Sang In Lee),정재복(Jae Bock Chung),전재윤(Jae Yoon Chon),강진경(Jin Kyung Kang),박인서(In Suh Park),최흥재(Heung Jai Choi) 대한내과학회 1988 대한내과학회지 Vol.35 No.1

N/A A study was undertaken to investigate the influence of luminal Ca++ on the integrity of normal mucosa and the recovery process of damaged mucosa in rat stomachs using a perfusion system. The results were as follows: 1) The exposure of the stomach to EDTA at concentrations over 50mM significantly reduced the potential difference (PDimV). 2) Perfusion of the stomach with 5mM Ca++ led to a rapid recovery of the PD, which was reduced by preperfusion with 250mM EDTA. 3) An application of 50~9~o and 100% ethanol caused a rapid reduction of the ID and an addition of 5mM Ca++ significantly enhanced the recovery process of the damaged gastric mucosa. 4) An application of 0.4 M NaC1 and 1 M NaC1 also caused a prompt decrease of the PD and after an addition of 5mM CaC1 the reduced PD was increased to a near initial level. 5) The PD changes were well correlated with the microscopical changes of the resected stomach. In conclusion, luminal Ca+ seems to play an important role in maintaining the integrity of normal gastric mucosa and accelerating the recovery process of damaged gastric mucosa in rats.