耳下腺 腫瘍의 臨床的 考察

崔在云(Jae Won Choi),金善會(Sun Whe Kim),朴在甲(Jae-Gahb Park),金鎭福(Jin-Pok Kim) 대한외과학회 1989 Annals of Surgical Treatment and Research Vol.36 No.6

직장암에 있어서 EEA 봉합기 및 수기문합을 시행한 저위 전방 절제술에 대한 고찰

최재운(Jae Won Choi),윤여규(Yeo Kyu Youn),홍성국(Song Kuk Hong),최국진(Kuk Jin Choe) 대한외과학회 1989 Annals of Surgical Treatment and Research Vol.37 No.1

총담관에 발생한 원발 소세포암종 1예

전원중 ( Won Joong Jeon ),채희복 ( Hee Bok Chae ),박선미 ( Seon Mee Park ),윤세진 ( Sei Jin Youn ),최재운 ( Jae Woon Choi ),김석형 ( Seok Hyoung Kim ) 대한소화기학회 2006 대한소화기학회지 Vol.48 No.6

Small cell carcinoma is usually seen in the lung, but rarely involves the gastrointestinal tract including biliary tract. A 65 year-old man was admitted because of obstructive jaundice. A smooth-surfaced round intraluminal mass with proximal bile duct dilatation was seen in the proximal common bile duct on endoscopic retrograde cholangiogram. Under the diagnosis of bile duct cancer, pylorus-preserving pancreatoduodenectomy was done. Pathology revealed a 2 ㎝ sized small cell carcinoma in the proximal common bile duct and distal common hepatic duct. On immunohistochemical stain, the tumor cells were positive for neuroendocrine markers CD56 and synaptophysin. After surgery, the patient received 5 cycles of adjuvant chemotherapy with VIP (etoposide, ifosfamide, and cisplatin) regimen. However, the patient died of liver metastasis 12 months after the diagnosis. We report a case of extrapulmonary small cell carcinoma arising from the common bile duct. (Korean J Gas­troenterol 2006;48:438-442)

햄스터에서 제한식이가 담석형성에 미치는 영향

장이찬(Lee Chan Jang),최재운(Jae Won Choi),김선희(Sun Whe Kim),박용현(Yong Hyun Park) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.2

N/A Background/Aims: Epidemiologic studies and animn1 experiments have suggested that high-carbohydrate diet affects the formation of pigment gallstone. Although the mechanism is not clear, recent evidence .uggest 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<0.0001). Gallbladder bile compostion including cholestero1(S8.8 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 t 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(362.1 l ' 23.30 vs 395.6 9.76mg/ dL, p=0.46), calcium level(12.98 ! O. 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. (Korean J Gastroenterol 1995; 27: 206-212)

개 자가부분 간이식에서 이식간 초기 기능 지표로서 혈청 젖산 및 아미노산의 단계별 대사 변화

김상준(Sang Joon Kim),서경석(Kyung Suk Suh),이건욱(Kuhn Uk Lee),최재운(Jae Won Choi),안세현(Sae Hyun Ahn),정성은(Sung Eun Jung),배수동(Soo Tong Pai),김주섭(Joo Seop Kim),조홍래(Hong Rae Cho),정중기(Jung Kee Chung),이우정(Woo Jung Lee 대한소화기학회 1993 대한소화기학회지 Vol.25 No.5

N/A Living-related segmental liver transplantation is currently accepted as one method of treatments of pediatric endstage liver diseases. Immediate recovery of graft function is prerequisite for patients survival, In case of graft failure, early prediction is necessary for retransplantation to avoid decease. Since amino acids and lactic acid are metabolized in liver, levels of those components lin plasma are frequently used as indicators for hepatic graft function. we have investigated the wequential changes of amino acids and lactic acid following autologous segmental liver transplantation in canine to identify the significance of these indicators. Ten mongrel dogs were prepared by harvesting the left lobe frorn experimental dogs, removing the rest of liver using total vascular exclusion and veno-venous bypass, and implanting the left lobe taken at first stage in the orthotopic position. The plasma amino acids and lactic acid concentrations in arterial blood obtained at preoperative period, anhepatic phase, reperfusion-15 min., 1 hour, 3 hours, 6 hours, were measured on Beckman system 6300 amino acid analyzer and Kodak Ektachem 700 XR, Among ten dogs, five of them died within 20 hours (Group 1), and the rest of them died after 20 hours (Group 2). The results indicate: (1) ln both Group, all plasma amino acid levels were increased in anhepatic phase except Valine, Isoleucine, and Arginine. Most highly increased amino acid was Alanine. (2) In group 1, most amino acids were slightly decreased till reperfusion 1 hour, and then increased to the level of anhepatic phase in reperfusion 6 hours. (3) In group 2, most plasma amino acid levels were decreased to preoperative values within 6 hours following reperfusion. (4) The changing patterns of TFPAA (total free plasma amino acid), BCAA/AAA ratio (Branched chain amino acid/aromatic amino acid ratio), and severaI amino acids (Phenylalanine, alanine Proline, Tyrosine) revealed statistically significant difference between two Groupe. (5) While plasma concentration of lactate continued to rise until 6 hours after reperfusion in Group 1, already increased plasma concentration of lactate in anhepatic phase reached plateau during 6 huurs after reperfusion in Group 2. The above changing pattern of plasma concentration of lactate showed statistically significant difference between both Groups (p<0.05). (6) Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were increased equally during operation and reperfusion in two Groups. Therefore, the sequential changes of plasma amino acids and lactic acid are useful indicators for detection of early graft function in canine autologous segmental liver transplantation

간장 ( 肝臟 ) 및 담도 ( 膽道 ) : 간내 담석증 치료로서의 간부분 절제

박용현(Yong Hyun Park),서경석(Kyung Suk Suh),최재운(Jae Won Choi),김수진(Soo Jin Kim) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.4

N/A Intrahepatic duct stones that have caused irreversible ductal damage may need meticulous treatment modality. When localized, resecton of the affected portion of the liver is usually curative. We anal fifty patieots who had hepatic resecions for intrahepatic stanes from Jan. 1981 to Dec. 1989. The location of iotrahepatic stone was left intrahepatie duct with or without extraheyatic duct stonee (N=28), both intrahepatic duct with or without extrahepatic duct (K =21), and right heaptic duct (N=l). Ductal strictures were observed in 45 casea; left hepatic duct (N =35), right hepatic duct (N =1), both hepatic duct(N=8), and extrahepatic duct (N =1). Hepatic resections were three types; left lateral segmentectomy (N=47), left lobectomy (N=2), right posterior inferior segmentectomy (N =1). Additional biliary drainages were performed in 5 patients. Operative mortality was 2% and operative complications occured in 15 cases (30%). After hepatic reseetion, the heptic duct strictures were removed 31 cases but, in the 14 cases, hepatic duct strictures were remained. The stones were completely removed in 26 cases (52%) and residual stones were observed in 24 cases (48%). In the left hepatic stones with or without extrahepatic stones, residual stones were obaerved in 8 cases (28.6%) but in the both hepatic diuct stones 15 cases (71.4%). Overall results of follow-up study were gaod in 72%, fair in 12%, and poor in 6%. In the left hepatic duct stones, we found good result in 88%, fair in 4% and poor in 8%. In the both hepatic duct stane good in 68,4%, fair in 26.3% and poor in 5.3% were observed. Conclusively we suggest that partial hepetectomy is the treatment of choice for left hepatic duct stanes. And in bath hepatic duct stones in which the main focus is left hepatic duct and the right hepatic duct stones are few, easily extractable or impacted in the peripberal duct, partial hepatectomy of main focus shows good results.

간외 담도 악성 종양의 치료 및 성적

박용현(Yong Hyun Park),김선희(Sun Whe Kim),최재운(Jae Won Choi) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.2

N/A One hundred and forty six patients with carcinoma of extrahepatic bile ducts were treated at the Department of Surgery, Seoul National University Hospital, during 10 years period from 1977 to 1986. Of those, 135 patients who underwent operation, 41 patients had tumors at the upper third of bile duct, around the cystic duct opening, 23 at the middle third, 31 at the lower third. In 23 patients more than two-thirds of the extra hepatic bile ducts were involved by the tumor (diffuse lesions). Curative resections were perfomed in 28 patients (19.2%) and palliative resection in 14 patients (9. 5%). The mean survival of the curative resection group was 37.2+4.9 months (mean+ S.E.) and 18.8 +4.2 months in the palliative resection group. Operative external drainage was performed in 50 patients (mean survival 11.2+ 1.6 months), internal drainage in 16 patients (mean survival 13.3+3.4 months) and U-tube intubation in the 16 patients (mean survival 11.2+2.3 months). Percutaneous transhepatic biliary drainage alone was performed in 14 patients (mean survival 5.5+1.3 months). Operative mortality was 12.6%. In conclusion, an aggressive approach to resect the tumors of bile duct is recommended with acceptable operative mortality and offers the best opportunity for cure as well as good palliation. Palliative resections are better than other palliative drainages in survival. There are no significant differences between pal]iative drainage methods, but percutaneous transhepatic biliary drainage showed the worst prognosis.

총담관 평활근종 1예

구자충 ( Ja Chung Goo ),이미연 ( Mi Yeoun Yi ),전원중 ( Won Joong Jeon ),서정철 ( Jeong Chul Seo ),채희복 ( Hee Bock Chae ),박선미 ( Seon Mee Park ),윤세진 ( Sei Jin Youn ),김석형 ( Seok Hyoung Kim ),최재운 ( Jae Woon Choi ) 대한소화기학회 2006 대한소화기학회지 Vol.47 No.1

창상 치유의 산소 공급 효과에 관한 실험적 연구

윤여규 ( Yeo Kyu Youn ),배성환 ( Sung Hwan Bae ),최재운 ( Jae Won Choi ),조홍래 ( Houng Rae Cho ),김진복 ( Jin Pok Kim ) 대한외상학회 1988 大韓外傷學會誌 Vol.1 No.2

It is qenerally accepted that high oxygen tension in local wounds accelerate the activity of fibroblast which is an essential component for wound healing. In the present study. wound infection were made In rats using four standard inocular of streptococcus aureus (3.0X108) injected into subcutaneous wounds. The inoculation was done on the day of stripping, a 2X2 cm2 area of the dorsal skin from the rat. One uninoculated wound served as a control in each group. We directly measured the wound size by computer digitizer and the wound oxygen tension using Oxymeter, after applying a 1% povidone-iodone solution soaking (Group II), local TCDO applicafion (Group Ⅲ) fwice a day in each groups and using a hyperbaric chamber conditioned by 2.4 ATA for 90 minutes (Group Ⅳ). Also, we cultured the infected wounds and counted the colony numbers, after three day``s inoculation in each groups (×10(-2)). We found that the rate of wound healing and the tissue P02 in Group Ⅲ were very high, compared to the other groups The colony counts from the infected wound was high only in Group Ⅳ Also, culture counts were significantly low in the plasma with TCDO group .

담낭선종 혹은 선종연관 병변의 조직 병리학적 분석

이승호 ( Seung Ho Lee ),이달식 ( Dal Sik Lee ),유일영 ( Il Young You ),전원중 ( Won Joong Jeon ),박선미 ( Seon Mee Park ),윤세진 ( Sei Jin Youn ),최재운 ( Jae Woon Choi ),성노현 ( Ro Hyun Sung ) 대한소화기학회 2010 대한소화기학회지 Vol.55 No.2

목적: 담낭 선종에서 암종으로 진행 여부를 알아보기 위해 담낭 절제술을 시행한 검체에서 담낭 선종과 선종 연관병변의 조직학적 특징을 조사하였다. 대상 및 방법: 1,847예의 담낭절제술을 받은 환자에서 담낭 선종 26예, 상피내암 9예, 침윤성 선암 28예를 포함한 63예의 담낭 절제 조직을 대상으로 하였다. 한 명의 병리 의사가 선종과 선종의 바탕 위에 국소적인 악성화 혹은 선암에서 발견되는 선종 잔류조직 등 선종 연관 병변을 조사하였다. 담낭 선종은 형태학적으로 관형, 관유두형, 유두형으로 분류하고, 구성하는 표피세포에 따라 담상피, 위상피화생, 장상피화생으로 분류하였다. 양성 선종과 암성 선종에서 환자의 나이와 병변의 크기를 비교하였다. 결과: 전체 담낭 절제술에서 선종 연관병변은 1.8%에서 발견되었다. 상피내암 9예와 침윤성 암종 28예 중에서 선종 연관 병변은 각각 7예, 1예가 있었다. 선종에 동반된 암종 8예는 모두 고분화암이었고, 단일 병변이었다. 암성 선종은 양성 선종에 비하여 종양의 장경이 컸고(1.8 cm 대 0.9 cm, p=0.01), 환자들의 나이가 많았지만 통계적인 차이는 없었다(57세 대 47세, p=0.09). 선종을 구성하는 상피 세포 및 형태학적 분류에 따라 양성 선종 혹은 암성선종의 빈도는 차이가 없었다. 담낭 선종에서 악성 변화를 보인 선종은 23.5%였다. 결론: 담낭 선종은 드문 질환이나 악성화 진행은 자주 발견되었다. 암성 선종은 상피내암이 많고, 고분화암이며, 단일 병변이었다. 담낭 선종은 전암성 병변으로 담낭 선종-선암 연속은 담낭암 병인 중의 하나로 생각한다. Background/Aims: In order to determine the malignant potential of gallbladder adenoma for progression to carcinoma, we evaluated the histopathologic features of adenoma and adenoma-related lesions on cholecystectomized specimens. Methods: Among 1,847 cholecystectomized specimens, 63 specimens from 26 benign adenomas, 9 carcinomas in situ (CIS), and 28 invasive carcinomas were selected. A pathologist reviewed all specimens and selected benign adenomas, CIS in the adenoma, and adenoma residue in invasive carcinomas. Adenomas and adenoma- related lesions were classified according to morphology (tubular, tubulopapillary, and papillary) and the consisting epithelium (biliary, pyloric metaplasia, and intestinal metaplasia). The age and the size of the benign adenomas and carcinomas in the adenoma were also compared. Results: Adenoma and adenoma-related lesions were found in 34 out (1.8%) of all resected gallbladder. Among 9 CIS and 28 invasive carcinomas, adenoma-related lesions were detected in 7 and 1 case, respectively. All eight carcinomas arising in the adenoma were well-differentiated solitary tumors. The diameters of the carcinomas in the adenoma were, on average, larger than that of the benign adenomas (1.8 cm vs. 0.9 cm, p=0.01). The patients with carcinomas in the adenoma were, on average, older than those with benign adenomas, although the difference was insignificant (57 years vs. 47 years, p=0.09). The morphology and consisting epithelium did not differ between the benign adenomas and carcinomas in the adenoma. The malignant transformation occurred in 23.5% of adenomas. Conclusions: Gallbladder adenoma is a rare disease, although malignant transformation occurs frequently. Adenoma is a precancerous lesion and the adenoma-carcinoma sequence is one of the gallbladder cancer carcinogenesis. (Korean J Gastroenterol 2010;55: 119-126)