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함준수,장현동,김창희,이옥찬 한양대학교 의과대학 1994 한양의대 학술지 Vol.14 No.1
The incidence of gallstone disease seems to be incerasing and the composition of stone has been changed in Korea. Therefore, a collective review of 4,491 gallstone patients during the last twenty years from January 1973 to December 1992 were carried out at Hanyang university hospital, Seoul, Korea. The total prevlence of localization, physicochemical characteristics, blood type, associated diseases, and the composition of stones were evaluated retrospectively. The statistical analysis was evaluated by Student's t-test. The results are as follows (1)The prevalence among total hospitalized patient was 1.1% and showed increasing tendency annually. (2)The prevalence increased with age, reaching peak in 50 and the male/female was 1:1.13. (3)The prominent clinical manifestations included biliary pain(50.64%), fatty fool intolene(17.14%), jaundice(14.69%), and vomiting(11.73%). (4)The associated diseases were diabetes mellitus(29%), hypertension, chronic liver disease, pacreatitis, and Clonorchiasis. (5)The pigment stones were more prevalent than cholesterol stones(2.5:1), however, choesterol stones seemed to be increasing gradually. These results indicate that in Korea, most gallstones are pigment stones, however, cholesterol stone seems to be increasing, and the overall incidence of gallstone disease is throught to be increasing annually.
담석의 병인에 있어서 담낭수축 기능의 의의에 관한 연구
이옥찬(Ock Chan Lee),박경근(Kyung Geun Park),안유헌(Yoo Hern Ahn),임헌길(Heon Kil Rhim),함준수(Joon Soo Hahm),이민호(Min Ho Lee),기춘석(Choon Suhk Kee),박경남(Kyung Nam Park) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.1
N/A Gallstone is the most common disease in the biliary system, and the incidence is increasing gradually. Furthermore, the composition of stones in Korea seems to be changed to approach that of stones formed in the west. Factors responsible for this change may include rapidly pro- ceeding urbanization and changing food habits. The method of medical therapies for gall- stones is also increasing and results in a number of clinical studies for pathogenesis of gall- stones such as stasis, supersaturation, and crystal formation of bile juice. We studied for 40 subjects, healthy controls were 20 (11 male, 9 female: mean age, 44.45 years, mean body mass index, 24.07), and gallstone patients were 20 (1 1 male, 9 female: mean age, 54.7 years, mean body mass index, 22.78). The gallbladder volumes were measured by real time ultrasonography using the ellipsoidal method. And then, we calculated ejection fraction (EF) by these results. The results were expressed as mean + standard deviation, and differ- ence in the mean values of each group were evaluated by the Students t test. Statistical sig- nificance was assigned if P was <0.05. There was no significant difference between gallstone patients and healthy controls in age, body mass index, and biochernical laboratories. Both fasting gallbladder volume and ejection fraction were not different between obese and non obese group. However, ejection fraction in gallstone patients was significantly lower than normal controls in obese group. Ejection frac- tion(EF, %) was significantly greater in controls than gallstone patients. No significant differ- ences were observed in fasting gallbladder volumes between gallstone patients and healthy controls, but gallbladder volume after fatty meal was significantly larger in gallstone patients than control subjects. Fasting gallbladder volumes were significantly reduced after fatty meal in both groups. The gallbladder motility rnay play a role on gallstone formation, and the estimation of its motility may be an important factor in deterrnining the response to medical therapy.(Korean J Gastroenterol 1994; 26: 143 150)
윤석부,이옥찬,함준수 한양대학교 의과대학 1989 한양의대 학술지 Vol.9 No.1
Two major type gallstones have been described which have different characteristics and etiologies, cholesterol and pigment gallstone. Fromation of cholestrol gallstones depend upon 2 factors, cholesterol superstaturation and nucleation, and it has been proposed that cholesterol gallstones originates from microcrystals of cholesterol. Pigment stones, esp. calcium bilirubinate stones occur most commonly in association with chronic infectious cholangitis that is almost unique to Orient. The pigment is present entirely as unconjugated bilirubte to the formation of pigment stones by producign β-glucuronidase and thus deconjugating bilirubin diglucuronide to unconjugated bilirubin which in turn combines with calcium, leading to stone formation. Bile samples were obtained by Entero-Test, centrifuged and a single drop was immediately examined microscopically, and bacteria isolated from bile were cultured and the β-glucurondase activity were determined. The results were as follows: 1. Total 51 patients were studies; 18 GB stones, 18 CBD stones, and 15 controls. 2. Of the 18 GB stones, 15 (83%) had CMC (Cholesterol Monohydrate Crystal) and 4(22%) of the 18 CBD stones had CMC. (p<0.01 3(17%) of 18 GB stones and 11(61%) of 18 CBD stones had CBG (Calcium Bilirubinate Granule). (p<0.01) 3. No significant difference was found in bacterial incidence between GB and CBD stones. Most frequently isolated bacteria was Escherichia coli and it was more common in CBD stones than in GB stones. (p<0.05) 4. β-glucuronidase activity was found only in CBD stones and was 100% in Escherichia coli. These result suggest that crystalization and β-glucuronidase activity secondary to bacterial infection have an important role in the formation of cholesterol and pigment gallstone, and microscopic bile examination may be helpful in predicting the presence of gallstones.