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N/A Background/Aims: H. pylori infection and gastric metaplasia are frequently associated in patients with duodenal ulcers. However, the pathogenesis of duwlenal ulcer in relation to H, pilori infecri<in and gastric metaplasia has not reacbed a consistent result, yet. The aim of this study v,as to assess whether H. pylori infection and gastric metapla.ia contrihute to duodenal ulcerogenesis. Methods: Multiple endoscopic biopsy specimens were tnken frorn duodenum and gastric antrum of ?I subjects(21 active duodenal ulcers; 30 scarred duodenal ulcers; 20 normal controls). The specimens were examined histologically for the presence ot' H. pylori, gastric metaplasia, and degree of gastritis and duodenitis. Rapid tissue urease test was performed t'or detection of H, pi krri infc cti<in. Results: The positive rate of H. pylrri in gastric antrurn was not significantly different aniong ttlTCC groups, while it was increasing in duodenum, I,e., normal controls(3%'), scarred DU's(37,r), active DU's(62%) in ascending order. The incidence of duodenal gastric metaplasia in the active DU'.I was 95.2% in contrast with the scarred duodenal ulcer's(72.07<) and the nonnal contrnls(2i.04) Diffuse gastric metaplasia lesions were more prevalent in active duodenal ulcers. 1n the duodenum, a strong association was shown between the H. pylrri and gastric rnetaplasia. The severity ot' duodenitis were significantly increased in the order ot' groups of normal controls, scarrecl duodena1 ulcers, and active duodenal ulcers. In duoclenum, there was a strong association with the grade c>f' intlammation anci H. pylori. Conclusions: These results suggest that gaslric metaplasia in the duodenum and concurrent H. pilori infection may play a synergistic role in the pathogene.I. Vt' duodenal ulcer. (Korean J Gastroenterol 199S;27: 617-62S)
Background/Aims: The incidence of duodenal tumors has increased by health surveillance. However, preoperative diagnosis of subepithelial duodenal tumors remains difficult because of the wide variety of pathologies and the location of the tumors. We analyzed endoscopic, radiological, and pathological features of subepithelial benign duodenal tumors (BDTs), which were treated by surgical resection. Methods: Five patients with subepithelial BDTs treated by surgical resection were analyzed retrospectively. We compared the preoperative and postoperative diagnosis and evaluated the clinical presentations, endoscopic and radiological findings, surgical treatments, pathological results, and outcomes of these patients. Results: All the patients underwent successful surgical resection. There were two cases of gastrointestinal stromal tumors (GISTs) treated with segmental duodenectomy, one case of carcinoid tumor treated with antrectomy, one case of gangliocytic paraganglioma treated with ampullectomy, and a lipoma removed by mass excision. The two GISTs were in the duodenal third and fourth segment close to the pancreas, and it was difficult to exclude pancreatic tumors by imaging studies. All the patients remained healthy for more than three years. Conclusions: Subepithelial BDTs are rare and difficult to diagnosis. Awareness and preoperative diagnosis of subepithelial BDTs can lead to minimally invasive treatment, including endoscopic or local surgical resection. Korean J Pancreatobiliary 2014;19(1):18-25
박선미(Seon Mee Park),김명환(Myung Hwan Kim),채희복(Hee Bok Chae),최호순(Ho Soon Choi),이성구(Sung Koo Lee),민영일(Young Il Min),박광민(Kwang Min Park),이영주(Young Ju Lee),이승규(Sung Gyu Lee) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.6
N/A Background/Aims: Although supersaturation of bile with cholesterol is a prerequisite for cholesterol gallstone formation, bile is not always supersaturated in patients with cholesterol gallstones and is also frequeztly saturated in controls. Tbere have been several reports that contributive factors or proces., to the nucleation of cholesterol crystals are more important than lithogenic bile itse]f in the pathogenesis of cholesterol gallstones. This study was conducted to identify the cholesterol saturation index and nucleation time of gallbladder bile in the patients with cholesterol gallstones and conlrols. Pvfethods: Cholesterol saturation index and nucleation time of gallbladder bile obtained during operation were measured in 36 gallbladder stone patients(cholesterol stone 20, pigment stone 16) and 17 controls and the relationship between cholesterol saturation index aid nucleation time was evaluated. Results: The mean cholesterol saturation index of cholesterol stone patients and controls was not different from each other(1.08 vs 0.97 respectively,p>0.05). There were no differences in the value of cholesterol, phospholipid, and total bile acid in between I:holesterol stone patients and controls. In 11(55%) out of cholesterol stone patients, gallbladder bile was supersaturated with cholesterol, while for control biles, 6(35%) were supersaturated. The mean nucleation time in cholesterol stone group was 8.3 days and it was shorter than 16.1 days in pigment stone group and 16.9 days in controls. There was no significant coivelation between cholestero. Saturation index and nucleation time in cholesterol stone group and controls. Conclusions: The p.tients with and without cholesterol gallstones cannot be distinguished by cholesterol saturation indei of bile. Supersaturation with cholesterol was also noted in bile of controls. However, the mean nucleation time in patients with cholesterol stones was significantly shorter than that in pigment stones or controls. The process of nucleation for cholesterol crystal may rnore contribute to the fcrmation of cholesterol gallstones than lithogenic bile dose. (Korean J Gastroenterol 1996;28:853-860)
성차의학은 성과 젠더의 차이가 정상 상태, 병리기전 및 질병의 특징에 미치는 영향을 중요하게 다루고 있다. 성과 젠더의 차이를 고려해서 질병의 진단, 치료 및 예방을 한다면 개개인은 과학적 근거를 갖춘 최적화된 진료를 받을 수 있다. 여기에서는 담석증, 급성 담낭염, 급성 및 만성 췌장염, 담도 및 췌장암 등의 췌장·담도 질환에서 성과 젠더의 차이에 대하여 고찰하였다. 또한, 임상 및 전임상 연구에서 연구의 계획, 실행 및 분석에 성과 젠더분석을 반드시 포함시켜야 한다는 최근의 정책 방침과 성차의학에 관한 정보를 갖춘 웹사이트들을 소개 하였다. 이 고찰을 통하여 연구, 진료 및 의학교육 분야에서 성과 젠더의 관점을 갖추는 것이 중요하다는 점을 강조한다. Sex and gender medicine investigates the impact of sex and gender differences on normal conditions, pathogenesis, and clinical features of diseases. By considering sex and gender differences during diagnosis, treatment and prevention, a person can receive the best individualized treatment based on scientific evidence. In this review, sex and gender differences in the field of pancreatobiliary diseases are described regarding gallstones, acute cholecystitis, acute and chronic pancreatitis, and cancers of the pancreas and biliary tract. In addition, recent policy on clinical and preclinical research which states that sex and gender analysis should be included during planning, conducting, and interpretation of the researches and websites containing resources about sex and gender medicine are introduced. This review highlights the importance of considering sex and gender aspect in research, clinics, and medical education. Korean J Pancreas Biliary Tract 2019;24(2):55-60
Treatment for chronic pancreatitis (CP) should be started early to prevent further pancreatic fibrosis and managed with a multidisciplinary approach to prevent complications and to maintain a good quality of life. The management strategies of CP can be divided into medical, endoscopic, and surgical treatment. The role of pancreatic enzymes and antioxidants for pain relief is not clearly defined, but their role in maintaining nutritional support by correcting exocrine insufficiency is well established. Endoscopic treatment is applied for resolution of pancreatic or bile duct strictures, clearance of pancreatic duct stones, and pseudocyst drainage. Endosonography-guided celiac plexus or celiac ganglia block for pain relief are known to be safe procedures but evidence for their effectiveness is still lacking. Surgery is commonly recommended when endoscopic therapy fails or there is suspicion of malignancy. New evidence-based guidelines for the management of CP are needed. (Korean J Gastroenterol 2015;66:144-149)
박선미(Seon Me Park),최강현(Kang Hyeon Choe),진재용(Jae Yong Chin),김형호(Hyeong Ho Kim),김미경(Mee Kyung Kim),양석균(Suk Kyung Yang),정영화(Young Hwa Chung),이영상(Young Sang Lee),민영일(Young Il Min),이문규(Mun Gyu Lee),성규보(Kyu 대한내과학회 1993 대한내과학회지 Vol.45 No.5
N/A Background: Hepatocellular carinoma (HCC) with major bile duct invasion is a particular type that invades and ruptures into the bile duct in the early stage of HCC. It will be different from the other types of HCC in the clinical characteristics, progonosis and prognostic factors. Method: We investigated 16 patients, who were confirmed to have major bile duct invation by surgical pathology (6 cases), cholangiogram (7 cases), or computed tomography (3 cases), to find clinical features and to evaluate prognosis and prognostic factors affecting the mean survival time. Results: 1) Sixteen (2.8%) of 566 patients with HCC were associated with major bile duct invasion. 2) The macroscopic types of tumor by computed tomography were nodular in 6, infiltrative in 8, and invisible in 2 cases. 3)The mean survival time of 16 patients was 3.3 months. 4) weight loss (>10%) and infiltrative tumor type were correlated to poor prognosis, However, age, total bilirubin, alpha-fetoprotein, and HBsAg positivity did not affect the survival time. Conclusion: In our series, the frequency of HCC with major bile duct invasion was not uncommon and the infiltrative tumor type was more frequent than the nodular tumor type. The assessment of weight loss and gross tumor type can identify some prospect of pro- longed survival in patients with HCC showing major bile duct invasion.
Background/Aims: EUS can detect bile duct stones (BDS) that are undetectable on multidetector computed tomography (MDCT). BDS associated with acute biliary pancreatitis (ABP) are small and tend to be excreted spontaneously. This study evaluated the usefulness of early EUS in patients with ABP and undetectable BDS on MDCT. Methods: Forty-one patients with ABP and undetectable BDS on MDCT underwent EUS within 24 hours of admission and were diagnosed with BDS, sludge, dilated common bile duct (CBD), or normal CBD. ERCP was performed in patients with BDS, sludge, or clinical deterioration. The diagnostic yield and the effects of early EUS on morbidity, mortality, and the length of hospitalization were evaluated. Results: EUS detected BDS or sludge in 48.8% of patients examined. BDS was the diagnosis in 13 patients, sludge in seven, and neither for 21 patients. ERCP was performed in 20 patients with BDS or sludge, in two patients with coexisting cholangitis, and in one patient with worsening liver function tests. ERCP identified BDS in 12 patients and sludge in seven. No lesions were diagnosed in four patients by ERCP. All patients improved, and the length of hospitalization in patients with ERCP was 9.0 days, without ERCP 7.1 days. Two patients with major complications by ERCP were hospitalized for a prolonged time. Conclusions: Early EUS may be useful to select patients for therapeutic ERCP in cases of suspected ABP with undetectable BDS on MDCT. (Korean J Gastroenterol 2016;68:202-209)
〈목적〉 알코올과 CCl4를 동시에 투여할 때 간독성의 상승효과가 둘다 중심정맥부위에 괴시와 지방변성이 특징적이다. 두가지 약물을 투여하여 간경변이 유도되는 기간을 조사하여 보고자 하였다. 또한 저용량의 lipopolysaccharide(LPS)가 NO를 생산하여 간손상에 대한 세포보호효과가 있다고 Kamiya등이 보고한 바대로 동시에 위의 모델에 저용량의 LPS를 투여하여 그 효과를 알아 보고자 하였다. 〈방법〉 태령 5주된 250g 가량의 Sprag