거대 해면상간혈관종 2예

김세종(Sei Jong Kim),윤종만(Chong Mann Yoon),박일종(Il Chong Park),김석빈(Suck Bin Kim),범희승(Hee Seoung Bom),김성렬(Seoung Ryul Kim),양건호(Kim Ho Yang) 대한소화기학회 1986 대한소화기학회지 Vol.18 No.1

Benign tumors of the liver are rare, and Henson and associates collected only 34 hemangiomas between 1907 and 1954 at the Mayo Clinic. Most of the cavernous hemangiomas of the liver are small in size, and produce no symptoms during life, but some can reach massive proportions and often present as abdominal masses or causes symptoms by encroachment on adjacent viscera. We have recently been confronted by two case of those large tumors, which has prompted this report with a review of this relatively rare condition. 1) A 32-year-old woman was admitted because of anorexia and indigestion associated with headache, myalgia, mild elevation of fever and weight loss of 5kg in two months. Examination of the abdomen disclosed one finger breadth palpable liver which was slightly tender. A large intrahepatic space-occupying lesion was discovered on radionuclide scan, ultrasonography and computed tomography of the abdomen. Selective hepatic angiography revealed characteristic features of puddling of contrast media along the branches of right and middle hepatic arteries throughout the arterial and venous phase of the angiograms. The resected specimen using Cavitron Ultrasonic Surgical Aspirator was proved to a giant cavernous hemangioma of the liver on microscopic exam. A 32-year-old man came to the hospital because of abdominal pain and a extremely huge mass nearly occupying the whole of his belly. The lesion was found to be a multiloculated highly echogenic mass in the left lobe of the liver on ultrasonography, and a huge hypodense, well-circumscribed homogeneous one with central low density component in the liver on computed tomography of the abdomen. Extensive pooling of contrast media was found throughout the markedly enlarged liver with persistence of tumor stain wliich was measured to be about 25cm in diameter until the late venous phase of the selective hepatic arteriograms. The tumor was considered to be an unresectable one, and we recommended radiation therapy.

Percutaneous Balloon Membranotomy로 성공적으로 치료된 하대정맥 (下大靜脈) 막성폐쇄 (膜性閉鎖)

김세종(Sei Jong Kim),윤종만(Chong Mann Yoon),최성규(Sung Kyu Choi),김석빈(Suk Bin Kim),양건호(Kun Ho Yang),박일종(Il Chong Park),박해옥(Hae Ok Park),남광우(Kwang Woo Nam),김재규(Jae Kyn Kim),나병식(Byung Sik Ra) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.1

Idiopathic membranous obstruction of the inferior vena cava (MOVC) is the most common cause of hepatic outflow obstruction world-wide, especially among Orientals, and this lesion at its hepatic portion might be one of the common cause of portal hypertension in Korea, though having not been reported till now. Most of the symptoms and signs of the MOVC are those referable to portal hypertension, collateral circulation being the most prominent feature. Distribution and direction of collaterals of MOVC are, however, different from those observed in other causes of portal hypertension in that the collateral veins channels carry blood up-words to reach the superior vena caval system. So, large truncal collateral vessels, particulary on the back, strongly suggest MOVC. Final cliagnosis of MOVC comes from inferior vena caval catheterization and angiography using two catheters simultaneously inserted through the basilic and femoral vein by demonstrating web-like membranous structure in the IVC. The classical therapeutic approach has been transcardiac membranotomy by means of finger fracture technique, but percutaneous translumina1 angioplasty using balloon catheter has recently been recommended before proceeding to operative treatment because of its simplicity and safety. We have recently been confronted by one case of idiopathic membranous obstruction of the inferior vena cava (MOVC) that was successfully managed by percutaneous balloon membranotomy, which has prompted this report with a review of this relatively rare condition.

Vibrio vulinificus 감염증에 대한 임상적 고찰

윤종만 ( Chong Mann Yoon ),범희승 ( Hee Seung Bom ),김성렬 ( Seong Rhyul Kim ),윤영근 ( Young Gun Yoon ),박광숙 ( Gwang Sook Park ),양건호 ( Kun Ho Yang ),김석빈 ( Suk Bin Kim ),정명호 ( Myung Ho Chung ) 대한내과학회 1985 대한내과학회지 Vol.29 No.1

간장 및 담도 : 만성간질환 및 간외담도폐쇄 환자에서 99mTc - DISIDA 간담도스캔을 통한 간세포기능의 평가

최성규 ( Sung Kyu Choi ),범희승 ( Hee Seung Bom ),양건호 ( Kun Ho Yang ),윤종만 ( Chong Mann Yoon ),김석빈 ( Suk Bin Kim ),박일종 ( Il Chong Park ),박해옥 ( Hae Ok Park ) 대한소화기학회 1986 대한소화기학회지 Vol.18 No.1

N/A Scintigraphic studies were performed in 15 normal subjecte, and 33 patients suffering from chronic parenchymal liver disease(liver cirrhosis 7, chronic hepatitis 5, hepatocellular carcinoma 1), and extrahepatic biliary obstruction(CBD stone 8, postoperative CBD stricture 4, pancreatic head ca 4, CBD ca 3, ampullary ca 1) using 99mc-DISIDA. Extraction and excretory functions of hepatocytes were evaluated with respect to liver-to-cardiac blood pool ratio(LCBPR) and washout index(WI). And relationships between these indexs and SGOT, total bilirubin levels were evaluated also. LCBPR was reduced in both patients groups(p< VVI was reduced only in those with extrahepatic biliary obstruction. LCBPR and WI were inversely correlated with total bilirubin levels(r=-0.49,-0 33, respectively).

식도암의 내시경 및 병리조직학적 고찰

윤종만(Chong Mann Yoon),범희승(Hee Seung Bom),국돈표(don Pio Kook),김성렬(Seong Rhyul Kim),양건호(Keon Ho Yang),김석빈(Suk Bin Kim) 대한소화기학회 1985 대한소화기학회지 Vol.17 No.2

N/A Esophageal carcinomas are relatively rare among those of arising in gastrointestinal tract, but are important because of the high mortality and poor prognosis they have. This report was attempted to deal with an endoscopicopathological evaluation of 114 cases which had been diagnosed as esophageal cancer in the Department of Internal Medicine, Chonnam University Hospital during the period from January 1975 to August 1984. The results were as following 1) In 114 cases of esophageal cancer, male to female ratio was 7.8: 1. The peak age incidence was the 6 th decade with 39.5% 2) The tumors located at the middle one third in 48, at the lower one third in 40, at the cardia in 17, and at the upper one third in 9 cases. 3) Endoscopically, 53 cases were elevated types, 22 cases were stenotic, the remainings were 18 depressed, 15 superficial, and 6 unclassified types in order of frequency. 4) Endoscopic biopsy positive rate was 65%, in 114 cases of esophageal cancer and there was no significant difference in the involved sites but significant difference in the endoscopic tumor types: In elevated types, biopsy positive rate was 81% and in stenotic types 36% 5) Histological classification of the esophageal cancer in our study was squamous cell carcinoma in 56 cases, adenocarcinoma in 14 cases, undifferentiated carcinoma in 3 cases, and mucinous cell carcinoma in 1 case in order of frequency. 6) The histopathological types of the non-malignant cases were normal mucosa in 23 cases (59.5%), inflammation in 8 cases(20%), dysplasia in 5 cases(12.5%), hyperplasia in 2 cases (5.0%), and ulceration in 1 case(2.5%).

간경변증 환자의 중증도 판단지표로서의 갑상선 호르몬 측정

양건호,윤종만,박일종,박해옥,최성규,김석빈 대한내과학회 1986 대한내과학회지 Vol.31 No.3

Liver is one of the major sites of thyroxine(T4) metabolism. This study examined the influence of degree of hepatocellular damage on thyroid hormone concentrations in cirrhotic patients. The concentrations of triiodothyronine(T3), thyroxine (T4), free thyroxine(free T4) and T3/T4 ratio were investigated in 32 cirrhotic patients and 20 controls. Cirrhotic patients were divided into several groups according to the severity of hepatic cirrhosis as defined by Composite Clinical and Laboratory Index(CCLI). The results were as follows: 1) Serum T4 was reduced in group 1 with CCLl $gt;20. However, no significant correlation was observed between T4 and CCLI or any of the liver function tests. 2) Serum T3 declined as CCLI increased. A significant negative correlation was observed between two parameters(p$lt;0.01). Furthermore, if liver function tests were individually examined, serum T3 demonstrated significant negative correlations with serum bilirubin and prothrombin time(sec) (p$lt;.0.05, p$lt;.0,05). 3) The fall in serum T3 may be secondary to reduced synthesis of T3 from T4 as reflected by decreased T3/T4 ratio. 4) Moreover, T3 synthesis from T4 appeared to be dependent on severity of hepatocellular damage as demonstrated by a significant negative correlation between CCLI and T3/T4 ratio(p$lt;0.01). These results suggest that T3/T4 ratio represents the severity of hepatocellular damage in liver cirrhosis.

급성 간내담즙정체성 황달 환자의 혈청 γ-Glutamyl transpeptidase 활성도에 관한 연구

남광우,양건호,윤종만,박일종,김석빈 대한내과학회 1986 대한내과학회지 Vol.31 No.2

The serum γ-GTP activity was measured by modified Orlowski`s method in 23 patients with acute intrahepatic cholestasis(13 cases of acute hepatitis, 7 cases of acute cholestatic hepatitis, and 3 cases of acute fulminant hepatitis) and 26 patients with extrahepatic cholestasis(7 cases of pancreatic head cancer, 2 cases of ampulla of Vater cancer, 6 cases of CBD malignancy, 7 cases of CBD stone, p cases of CBD ascaris, 1 case of clornochiasis and 1 case of sclerosing cholangitis). Forty persons with no liver problem servedas a control group. The results were as follows; 1) The mean value of serum γ-GTP in the control group was 36.13±11.83 U/L, and there was no significant difference between the two sexes. 2) In cases of acute intrahepatic cholestasis, serum γ-GTP activity was relatively low(acute cholestatic hepatitis 57,00±20.66 U/L and fulminant hepatitis 36.67±13.89 U/L) in spite of a marked increase in serum bilirubin concentration and alkaline phosphatase activity. 3) In cases of extrahepatic cholestasis, serum γ-GTP showed increased activity with mean value of 451.19±245.77 U/L together with elevation of serum bilirubin and alkaline phosphatase levels. 4) The ratio of γ-GTP to serum alkaline phosphatase in cases of acute intrahepatic cholestasis was markedly decreased as compared to that in cases of extrahepatic cholestasis(p$lt;0.001). This finding suggests that low γ-GTP activity is useful in the differentiation of acute intrahepatic cholestasis from extrahepatic cholestasis.

식도심막누관 1예

범희승,김성렬,양건호,윤종만,김석빈,박일종,박광숙 대한소화기내시경학회 1985 Clinical Endoscopy Vol.5 No.1

Esophagopericardial fistala is a rare and usually life threatening complication of both benign and malignant esophageal disease. A case of pyopneumopericarduim in 45 year-old female is reported. Streptocoeeus viridana in pas celtore was isolated from pericardial pus. The disorder resulted from eaqyhagoyericardial fistula which probably developed as a complication of esophageal diverticnlum. The diagnasis of the fistula was established preoperatively on the basis of chest X-ray, esophagogram and. endoeeopic findings. The treatment was thoracotorny with drainage of pericardium, diverticulectomy and antimicrobial chemotherapy. The patient improved postoperatively.

Dieulafoy`s Disease 3예

범희승,박광숙,양건호,윤종만,김석빈,박일종,김성렬 대한소화기내시경학회 1986 Clinical Endoscopy Vol.6 No.1

Dieulafoys lesion consists of abnormally large gastric submucosal artery which ruptures into the stomach causing massive or recurrent intragikstric bleeding. The lesion is very small and easily overlooked even at laparatomy and can only be correctly diagnosed by endoscopy or arteriography if the patient is actively bleeding. Three patients who were admitted with bleeding of upper gastrointestinal tract and eventually diagnosed as having Dieulafoys lesions were analysed. All were men with age range of 44 to 55 years. All patient were asymptomatic before presenting with hematemesis. Two of the three patients had had history of upper Gl bleeding. One patient used analgesics daily for ureteral colic and two patient drank alcohol excessively. Gastroscopy was performed during the bleeding episode in all three patients. Dieulafoy's lesion was seen in all three cases and in the second case, there was concomittent diffuse petechia in the whole stomach. The lesion was situated on the posterior wall of upper body in one, on anterior wall of upper body in another, lesser curvature side of gastric fundus in the other case. All three patient underwent laparotomy for persistent bleeding and the lesion was suture ligated only in two patients while in one patient vagotomy and pyloroplasty was added. Resection biopsy was performed in two cases and both revealed only normal gastric mucosa. All patients discharged after complete recover.

소화기계 평활근 경련에 의한 기능장애 및 통증에 대한 Drotaverine hydrochloride(No-Spa^(�))에 대한 임상 효과

윤종만,김성렬,범희승,양건호,김석빈,박일종 최신의학사 1985 最新醫學 Vol.28 No.10