간장 ( 肝臟 ) 및 담도 ( 膽道 ) : 간경변증 환자에서 피부거미 혈관종과 식도 정맥류 출혈과의 관련성

김진도 ( Jin Do Kim ),강대환 ( Dae Hwan Kang ),양웅석 ( Ung Suk Yang ),조몽 ( Mong Cho ),백태현 ( Tae Hyun Paik ),문한규 ( Han Kyu Moon ),허윤 ( Yoon Huh ),송철수 ( Chul Soo Song ),이형유 ( Hyeong Yoo Lee ),강필중 ( Pill Joong K 대한소화기학회 1991 대한소화기학회지 Vol.23 No.2

N/A 40~60% of patients with choledochal cysts presented before 10 years of age, but it remained clinically silent until adulthood. Recently improved diagnostic techniques to visualize the biliary system were demonstration an increasing number of unsuspected choledochal cyst in adult patients. Choledochal cyst in adult were also frequently associated with coexisting disease such as cholangitis, cholelithiasis, cytolithiasis and carcinoma arising from cyst, gallbladder and pancreas. We reviewed 17 cases of choledochal cysts in adult who had undergone operation at Severance hospital during the period from January 1983 to December 1989. The results were as follows: 1) Male to female ration was 1:2 and the peak age incidence was 3rd decade (70.6%) 2) Clinical symptom and sign were right upper quadrant abdominal pain in 17 cases (100%), Jaundice 6 cases (35.3%) and Mass were 1 case (5.9%) Classical symptom triad were rare and Symptom duration were mainly within 5 months (70.6%) 3) Preoperative diagnostic method were ultrasonography in 17 cases (1009.), ERCP in 14 cases (82.4%) and Abdominal CT in 9 cases (53%). 4) In accordance with Todanis classification, Type I in 13 cases (76.5%) Type IVa in 3 cases (17.6%) and Type II in 1 csae (5.9%). 5) Operative procedures were as follows: In type I, total excision of cyst and Roux-en Y hepaticojejunostomy in 4 cases, partial excision in 1 case and Roux-en Y cysto-enterostomy in 4 cases. In type IVa, total excision in 1 case and cystoenterostomy in 2 cases. In type II, excision of cyst and T-tube choledochostomy. Complication were cholangitis in 4 cases, intrahepatic stone in 1 case and biliary fistula in 1 case. 6) Coexisting disease were ascending cholangitis 7 cases (41.2%), cystolithiasis 4 cases (23.5%), gallbladder hydrops 3 cases (17.6%). Carcinoma were associated with choledochal cyst, which was gallbladder cancer 2 cases (11.8%) and pancreas cancer 1 case (5.9%) In conclusion, Even unsuspected choledochal cyst in adult, treatment of choice was total excision of the cyst as much as possible because cyst has frequently coexisting disease and possible malignancy.

PIVKA - 2 ; 새로운 간세포암표지자로서의 의의

최성호(Seong Ho Choi),신영민(Young Min Shin),김상현(Sang Hyun Kim),박승근(Seung Keun Park),이헌직(Hun Jig Lee),강대환(Dae Han Kang),조몽(Mong Cho),양웅석(Ung Suk Yang),문한규(Han Gyu Moon) 대한내과학회 1993 대한내과학회지 Vol.45 No.1

N/A Background: AFP is known as one of the most sensitive tumor markers for hepatocellular carinoma. But in many cases of hepatocellular carcinoma, low or negative levels of AFP have been observed. And because AFP levels may be increased in cases of other liver diseases such as liver cirrhosis, its specificity and sensitivity are problems. PIVKA-II has been studied as a new tumor marker for hepatocellualr carcinoma with AFP. It is a precursor protein of prothrombin and is converted to active form of prothrombin by the action of Vitamin K dependent carboxylase in hepatocyte microsomes. As this process can be suppressed by Vitamin K deficiency or Vitamin K antogonist such as warfarin, PIVKA-II levels might be increased due to functional derangement of Vitamin K-dependent carboxylation in hepatocellular carcinoma. We measured the levels of PIVKA-II in patients with various liver diseases including hepatocellular carcinoma and evaluated the meaning of increased PIVKA-II levels. Methods: We measured the levels of PIVKA-II in the plasma of 30 patients with hepatocellular carcinoma and 41 patients with other liver diseases by EIA method using monoclonal antibody specific to PIVKA-II. AFP was checked by RIA method. Results: The levels of PIVKA-II were increased above 0.1 AU/mL in the plasma of 25 (83%) patients with hepatocellular carcinoma and 1 patient with liver cirrhosis and 1 chronic hepatitis, 1 receiving warfarin, 2 toxic hepatitis, 2 cholangiocarcinoma and 1 liver metastatis from stomach cancer. In this study, with diagnostic cut-off value of 0.1 AU/ mL, the sensitivity and specificity of PIVKA-II to detect hepatocellular carcinoma were 83.3% and 78% each. With cut-off value of 8.0 AU/ml, the sensitivity and specificity were 66.7% and 100% each. By the combination assay with the cut-off values of AFP above 100ng/mL & PIVKA-II above 0.1 AU/mL the sensitivity for hepatocellular carcinoma could be elevated to 86.7%. Conclusion: We can conclude that PIVKA-II is more sensitive and specific than AFP and is a useful tumor marker which can elevate the sensitivity and specificity to detect hepatocellular carcinoma by combination assay with AFP. And PIVKA-II can be a useful screening method to detect hepatocellular carcinoma arising from liver cirrhosis.

초음파와 내시경적 역행성 담췌관 조영술로 경험한 담낭선근종증 (adenomyomatosis) 1예

강대환,양웅석,조몽,백태현,이수걸,문한규,허윤,김무영,황병욱 대한소화기내시경학회 1991 Clinical Endoscopy Vol.11 No.2

Adenomyomatosis of the gallbladder is Characterized by hyperplastic changes including overgrowth of the mucosa, thickening of the muscle wall, and intramural diverticula, crypts, or sinus tracts(Rokitaasky-Aschoff sinuses). The main diagnostic test for the detection of this disease is oral cholecystography but it's use is being decreased. Recently, Ultrasound, ERCP, and CT have been used for diagnosis. We present a report of case in whom ademomyomatosis of gallbladder was disgnosed on ultrasound and ERCP and confirmed by surgery. The essential feactures of ultrasound and ERCP diagnosis are discussed.

잔유 총수담관 결석에 대한 담도내시경 직시하 Electrohydaulic Lithotripsy (EHL) 1예

김진도,강대환,양웅석,조몽,도창호,이동완,허윤,문한규 대한소화기내시경학회 1990 Clinical Endoscopy Vol.10 No.2

Electrohydraulic lithotripsy (EHL) is a method used to breakup the stone by electric discharge in the presence of liquid medium. Recently we experienced a case of successful common bile duct stone removal after EHL during choledochoscopy via T-tube tract, which was the first case of EHL in biliary tract stone in Korea. A 65-year-old female patient was admitted to our hospital because of generalized pruritus after cholcystectomy with T-tube insertion. Obtained cholangiogram showed retained CBD stone which was implssible to remove by Dormian basket and tto dissolute by monooctanoin. After only one session of EHL, we can disintergrat CBD stone into several small pieces and removal of stone was easily done by Basket. After Small cut endoscopic sphincterotomy (EST) remained distal impacted stone was freely passed and control choledochoscopy and cholangiogram showed no remained stone. We think that EHL may be play a potential role in removal of biliary tract stones as in urinary tract stones.

간디스토마 양성 및 음성 담도암의 비교 연구

김진도,강대환,양웅석,조몽,백태현,문한규,허윤,송철수,이형유,이정유 대한소화기학회 1992 대한소화기학회지 Vol.24 No.1

There are several kinds of possible causes of cholangiocarcinoma. Clonorchiasis is an endemic disease in Korea and longstanding infection with Clonorchis sinensis is highly associated with cholanglocarcinoma in endemic area. But there are also many cases of cholangiocarcnoma which are not associated with Glonorchis sinensis. This study was retrospectively compared Clonorchis sinensis-positive-cholangiocarcinpma with Clonorchis sinensis-negative cholangiocarcinoma. The author studied the differences of clinical pictures, laboratory findings, location of the tumor and duration of survival between two groups (one group: 37 cases of C. s. positive cholangiocarcinoma, the other group: 36 cases of C. s. negative cholangiocarcinoma). The results were as follows: 1) The mean age of both group was 62 years and male to female ratio was 2.1:1 and 2.6:1 respectively. 2) C. s. positive cholangiocarcinoma showed high incidence in Kyongsang provinces and C. s. negative cholangiocarcinoma in Pusan (p$lt;0.01). 3) C. s. negative group showed an increase in serums globulin level compared with C. s. positive group and the percentage of eosinophil was 10.6 in C. s. positive group and 4.6% in G. s. negative group (p$lt;0.01). 4) The positive rate of Anti-HBc was 69 o in C. s, positive group and 88% in C. s. negative group (p$lt;0.01). This meant low rate of past infection with viral hepatitis B in C. s. positive group (p$lt;0.01). 5) Mast of the tumor was involved in extrahepatic bile duct. And upper ⅓ of extrahcpatic bile duct was common location of C. s. positive and C. s. negative cholangioearcinoma (65% vs 50%). C. s. negative group showed higher incidence of location in distal portion of extrahepatie bile duct than C. s. positive group (p$lt;0.01) (42 % vs 21%). 6) The cases treated with surgical operation or PTBD showed longer duration of survival than those of no specific treatment. But the difference between the two groups was not significant. 7) There was no difference of duration of survival according to tumor location between them in the patients treated with surgical operation or PTBD. 8) The microscopic finding of cholangiocarcinoma was tubular structure resembling adenocarcinoma and fibrous stroma. The microscopic finding of chalangiocarcinoma associated with clonorchiasis was adenomatous hyperplasia as a premalignant lesion.

간흡충증의 내시경적 역행성 담도 조영술 소견

김상현,강대환,양웅석,조몽,문한규,허윤,최성호,전국진 대한소화기내시경학회 1993 Clinical Endoscopy Vol.13 No.1

An endoscopic retrograde cholangiographic study of 25 consecutive cases of hepatic clonorchiasis was performed during the period from Aug. 1986 to Sep. 1991 Hepatic clonorchiasis was confirmed by stool of examination for Clonorchis sinensis. The findings consist of characteristic filling defects and changes in the intrahepatic and extrahepatic bile ducts. The filling defects due to adult worms are significant diagnostic criteria of clonorchiasis. Its appearance is elliptical and/or round. The change in the intrahepatic bile ducts consisits of dilatation, irregularity(tortousity and elongation) and blunting of termieal branches of bile tree, irregular stenosis, fuzziness and raggedness. The characteristic changes in the extrahepatic bile ducts in clonorchiasis are duct wall irregularities and mild dilatation of bile duct. ERCP is an excellent method to evaluate biliary tree in patient with clonorchiasis because it reveals not only its characteristic findings of clonorchiasis but also its severity and associated lesions.