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.

우측 쇄골하동맥의 기시이상으로 인한 연하곤란증

문한규(Han Kyu Moon),허윤(Yoon Huh),양웅석(Ung Suk Yang),김치호(Chio Ho Kim),최장락(Jang Rack Choi),강필중(Pill Joong Kang),유방현(Bang Byun Liu),박희욱(Hee Ug Park) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.3

The presence of aberrant right subclavian artery which causes dysphagia in adults is rare. However its recognition as a possible cause of dysphagia is important because of its benign prognosis. This type of dysphagia must be considered in the differential diagnosis of difficulty in swallowing in the elderly as well as in children and young adults. We report a case of an aberrant right subclavian artery (Dysphagia Lusoria), 53-year-old woman who presented dysphagia. This case was confirmed and treated by surgical operation.

소화기 양성질환 및 악성종양에 있어서 CA 19 - 9 , CEA , CA125 및 AFP 에 관한 연구

문한규(Han Kyu Moon),허윤(Yoon Huh),차광수(Kwang Soo Cha),양웅석(Ung Suk Yang),최장락(Jang Rack Choi),강필중(Pill Joong Kang),이광욱(Kwang Uk Lee) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.2

Serum concentrations of CA19-9, CEA, and CA125 in 147 patients with gastrointestinal and hepatobiliary diseases, 68 malignant and 79 nonmalignant, were investigated to analyze the clinical significance of these tumor markers, and furthermore, these tumor markers were compared with AFP in the patients with hepatic diseases, both benign and malignant. The results were summarized as following: 1) The serum concentrations of CA19-9, CEA, and CA125 were much higher in the malignant diseases than those of benign diseases, and also significantly higher sensitivities were observed in CA19-9 and CA125 in the malignant diseases. But the sensitivities of CEA inthe malignant and benign diseases were not showed statistical difference (28% vs 15%). 2) The serum concentrations of AFP in patients with hepatoma were significantly higher than those of liver cirrhosis or other benign liver diseases, and also significantly higher sensitivity of AFP was observed in the patients with hepatoma than the others. 3) Between the each disease and each tumor marker, there were no significant correlations. 4) According to the presence of metastasis or not, no significant diffetence in the mean values of the tumor markers was observed. But in the patients with hepatoma, much higher value of AFP was obtained in the patients with metastasis (107.7 +- 148.9 ng/ml vs 281.8 +- 108.1 ng/ml, p<0.05). 5) ln the patients with cancer of biliary tract, pancreas and colorectal region, there noted high serum levels and sensitivities of CA19-9, and highest sensitivity of CA19-9 in the patients with benign biliary tract disease, mainly composed of acute cholangitis. But the statistical significance was not defined in these small number of groups. 6) In the patients with the malignant diseases, the sensitivity of CA125 was 46%, and with color- ectal, pancreatic, and stomach cancer, the sensitivities of CA125 were 60%, 56%, and 53% in order. 7) Single CEA test is not sufficient for the screening of gastrointestinal malignancy. Combined tumor marker tests among CEA, CA19-9 and CA125 were more accurate than single test.

간농양을 유발한 Sparganosis 1 예

문한규,허윤,송철수,이동완,강필중,문원국,양웅석,송수복 대한내과학회 1990 대한내과학회지 Vol.39 No.5

Sparganosis, an infection transmitted to humans by sparganum, was first reported by Manson at 1882. Many cases have been reported in korea, the sites are subcutaneous tissue, fascia, body cavities, urinary tract, orbit, brain, and spinal canal. This 59-year-old male, who had a history of having eaten snakes frequently 15-20 years ago, suffered from right upper quadrant pain and intermittent fever and chills. An abdominal ultrasound revealed an echolucent area on the right lower lobe of the liver. Aspiration was done, and through a drainage tube, the parasite was expelled. On parasitologic evaluation, sparganum was confirmed. It was the first report of sparganum found in liver parenchyme in korea. We report a case of sparganosis combined with liver abscess with a review of the literature,

류마치스성 관절염과 동반된 Ochronosis(조직갈변증) 1 예

김상현,이종수,김진도,문한규,최장락,강필중,이광욱,나하연,이헌직,여동승,윤영권,황병욱,곽임수 대한내과학회 1991 대한내과학회지 Vol.41 No.1

Ochronosis, which is autosomal recessive, results from a decreased amount of the enzyme homogentisic acid oxidase, due to which tyrosine and phenylalanine cannot be broken down via the normal pathway. The clinical manifestations of ochronosis usually appear after the age of 30 as a result of the deposition of pigment in the extracellular macromolecules of the connective tissue, particular of the skin and joints. The diagnosis is made by determination of urinary homogentisic acid excretion, and the clinical and radiological findings can help to diagnose this disease. We report a case of Ochronosis with Rheumatoid arthritis presented with skin pigmentation and migrating polyarthritis in a 57-year-old female patient who was managed with an antiinflammatory agent, steroids, and symptomatic care.

당뇨병에 합병된 비대뇌 모균증 1 예

김동수,김용기,박인철,손덕현,이일두,정희,차광수,강필중,이정유 대한내과학회 1990 대한내과학회지 Vol.39 No.5

Rhinocerebral mucormycosis is a serious and commonly fatal fungal infection. The causative organism. ordinarily a saprophyte, becomes pathogenic in person who are made susceptible by coexisting. debilitating disease such as diabetic ketoacidosis and immunosup-pressed condition. We report a well-documented case of rhinocerebral mucormycosis in not controlled diabetic woman, Her condition rapidly deteriorated. The diagnosis was con- firmed by demonstration of the characteristic broad, branching, nonseptate hyphae by histopathology. And the mucormycete Rhizopus was isolated from the infected tissue culture.