간장 및 담도 : 간상해를 동반한 당뇨병 - 특히 HBs Ag 양성빈도 및 동위원소 간 소견 -

유방현(Bang Hyun Liu),김성은(Seong Eun Kim),도창호(Chang Ho Do),이형유(Hyeong Yoo Lee),조몽(Mong Jo) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.1

N/A To evaluate of the possibility of diabetes mellitus in the precipitating factor of liver cirrhosis, the authors have made a clinical analysis on 56 patients of diabetes mellitus with chronic hepatopathy (Cirrhotic Liver Group (29 cases): Noncirrhotic Liver Group (27 cases)} who were admitted at Pusan National University Hospital from Feb. 1987 to Jun. 1989. The results were as follows; 1) The mean age of DM group with cirrhosis was significantly older than that of DM group without cirrhosis (p<0.01). 2) On duration of DM, especially more than 6 years, DM group with cirrhosis was longer than that of DM group without cirrhosis (62% : 32%). 3) On fasting blood sugar level, especially more than 201 mg%, DM group with cirrhosis was higher than that of DM group without cirrhosis, and in cirrhotic group complications of portal hypertension were higher in high FBS level cases. 4) On body weight, especially range of IBW +- 10%, DM group with girrhosis was less controlled than DM group without cirrhosis (41% : 59%). 5) On complications of DM, both group are 76% and 71%, respectively, and the high incidence of complication suggest that duration of DM was long. 6) The positive rate of HBs Ag in DM group with cirrhosis was significantly higher than that of DM group without cirrhosis (28% : 4%, p<0.05). 7) On chemical liver function studies, DM group with cirrhosis showed more increased abnormal value except SGPT, total protein than that of DM group without cirrhosis. 8) On comparison of liver size by radiosotope liver scan, DM group with cirrhosis was smaller than that of DM group without cirrhosis (9.70 +- 1.59:12.68 +- 1.16, p<0.001). 9) On radiosotope liver scan, mottling of DM group with cirrhosis was coarse, but DM group without cirrhosis was fine (p<0.005), and spleen visualization in DM group with cirrhosis was more significant than that of DM group without cirrhosis (92% : 40%, p<0.001).

간경변증의 중증도에 관한 연구 - HBsAg 양성도와 습관적 음주의 영향에 관한 고찰 -

유방현(Bang Hyun Liu),김성은(Seong Eun Kim),도창호(Chang Ho Do),이형유(Hyeong Yoo Lee),이용규(Yong Kyu Lee) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.3

N/A The severity and other clinical features were assessed in a series of 80 patients with postnecrotic liver cirrhosis, based on Pughs modification of Child- Turcotte classification (CTC), according to the HBsAg positivity and the history of habitual alcohol intake, respectively. Among 80 patients, male was 66%, habitual alcoholics was 48%, of which 95% was male. HBsAg was positive in 45%, HBsAg positive and negative group showed no difference in the severity estimated by CTC, but the habitaual alcoholics showed more severe tendency than the remained(p<0.05). The difference was prominent in variables of serum albumin, bilirubin, and prolongation of prothrombin time (p<0.01). In addition, the number of alcoholics with increased serum gamma-GTP and of serum ALT level was greater than that of non-alcoholics (p<0.01), while HBsAg positive group has no significant difference from HBsAg negative group in chemical liver function test. On the other hand, non-alcoholics had more splenomegaly and hypersplenism (p<0.005), but no more esophageal varix.

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.

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.