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Background/Aims: Epidemiologic studies and animal experiments have suggested that high-carbohydrate diet affects the formation of pigment gallstone. Although the mechanism is not clear, recent evidence suggest that high carbohydrate diet may cause poor cholecystokinin(CCK) release. Thus, antiproteinase, which increase cholecystokinin, has been suggested as a candidate for prophylaxis against pigment gallstone. However increased CCK decreases food intake and weight gain. Therefore the present study was undertaken to define the relationship between restricted intake of high carbohydrate diet and pigment gllstone. Methods: Fourty hamsters were divided into 2 groups: Group I was fed high carbohydrate diet ad libitum, and Group II was fed 90% of ad libitum for 8 weeks. Hamsters was sacrificed at the 9th week. Grallbladder was explored to detect whether gallstone was present or not. Grallbladder hile was aspirated. Blood was aspirated by direct cardiac puncture and serum was collected by centrifuge. Bile composition was analysed by Kits, one sample was composed of gallbladder hile from 3 or 4 hamsters. Serum was analysed by automatic analyser, one sample was composed of serum from two hamsters. Results: Gallstones were found in 80%(16/20) of group I and 20%(4/20) of group II(p$lt;0.0001). Gallbladder bile compostion including cholestero1(58.8?4.65 vs 69.2?7.33mg/ dl, p=0.29), phospholipid(652?88.99 vs 480?7l.5mg/dl, p=0.2l), bilirubin(l9.4?9.61 vs l6.8?3.22mg/dl, p=0.40) and bile acid(20.7?4.2 vs 20.4?3.0 mmol/L, p=0.99) were not different between group I and group II. Serum albumin(3.7l? 0.03 vs 3.62?0.04 mg/dl, p=0.2), cholesterol(76.88?3.07 vs 77.6?3.65mg/ dL, p=0.9), triglyceride(182.66?l2.54 vs l66.9?7.63mg/dL, p=0.43) phospholipid(362.1l?23.30 vs 395.6?9.76mg/ dL, p=0.46), calcium level(12.98?0.l4 vs 12.96?0.12mg/dL, p=0.96) and phosporous(8.94?0.15 vs 8.73?0.19mg/dL, p=0.34) were not different hetween group I and group II. Conclusion: Restricted diet inhibits gallstone fortnation in hamsters, but the mechanism was not defined.
Biliary tree has anatomical and pathophysiological features liable to reoperation. The reoperative rate has been reported 4,1% to 25%, which is higher compared to that of Western countries. It has been suggested that the high reoperative rate in our country is related to the high incidence of intrahepatic duct stones, pigment stones and parasites. To investigate clinical features of the reopertive biliary surgery, we reviewed the patients who underwent reoperation on biliary tree for benign diseases especially gallstone disease. The results are as follows; Among the 1,018 biliary operation cases, 130 reoperations (12.8%) were performed from January 1987 to December 1991. The reasons of reoperation were recurrent stone 54.6%, remant stone 32.3% and stricture 4.6%. The mean interval between first operation and reoperation was 7 years and 17 cases received 3 operations, 3 cases 4 operations, 1 case 5 operations. The ratio of reoperation according to the site of the stone in first operation were 9. 1%, 22.9% and 61.7% for GB stone, CRD stone and IHD stone respectively. The patients who underwent reoperative biliary surgery, recieved first biliary operation at younger age, had more female predominance, and higher proportion of pigment and IHD stone, compared to those who did not need reoperation. Reoperative biliary surgery is related to prolonged operativc time, larger amount of transfusion and higher operative morbidity. In conclusion, since reoperative biliary surgery is related to high morbidity, we should try to lower the rate of residual stone and find the measures to prevent recurrent stone and avoid operative injury possibly causing biliary stricture.
This is a case report that suggests the possible association between multiplesplanchnic arterial aneurysms and long-distance running. The clinical featuresof one patient admitted at Chungbuk National University Hospital for treatmentof multiple splanchnic arterial aneurysms were reviewed. A 54-year-old manhad a recurrent, intermittent and epigastric pain for 2 months. There was noabnormality in gastroscopy and colonoscopy. An abdominal computed tomographyangiography documented calcified superior mesenteric artery (SMA) and splenicartery aneurysms. The patient had a history of recreational long-distance runningfor over 10 years. His average running time per week was more than 10 hours. There was no evidence of systemic arteritis, connective tissue disorder or infectiousprocess that may have caused the aneurysms. He did not take any drugs. The SMAaneurysm was opened, and the aneurysmal segment of SMA was replaced with avein graft. The splenic aneurysm was observed. The patient recovered without anysequelae.
The most duodenal diverticulum is asymptomatic and incidental finding. Less than 10 percent of demonstrated duodenal diverticula are ever the source of the symptom, and only about 1% require operation due to serious complication of duodenal diverticulum. Elective operation, on the basis of persistent discomfort still remains controversial because of high mortality (8-10%) and recurrence of symptom. Forty cases of duodenal diverticula treated at the Department of Surgery, Seoul National University Hospital for 12 years were reviewed. The most common site of duodenal diverticula was second, medial portion of duodenum. The associated disease were existed in 22 cases. The most common associated disease was gallstone (10 cases). The surgical indications were persistent pain (5 cases), cholangitis symptom (2 cases) and intestinal obstruction symptom (1 cases). In two cases, symptom recurred and in one case, unidentified stomach cancer was cause of symptom. There was one mortality. In conclusion, operation of duodenal diverticulum should be reserved for seriously complicated diverticulum and the surgeon should be aware that duoenal diverticulum may be symptomatic, but other causes should be considered.