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허병원(Byung Won Hur),송치욱(Chi Wook Song),김혜랑(Hye Rang Kim),김윤배(Yun Bae Kim),강창돈(Chang Don Kang),이정환(Jung Whan Lee),진윤태(Yoon Tae Jeen),전훈재(Hoon Jai Chun),엄순호(Soon Ho Um),이상우(Sang Woo Lee),최재현(Jae Hyun Cho 대한소화기기능성질환·운동학회 2000 Journal of Neurogastroenterology and Motility (JNM Vol.6 No.2
N/A Background/Aims : Transient lower esophageal sphincter relaxation (tLESR) is the main cause of gastroesophageal reflux (GER) in both healthy subjects and patients with GER disease. Unfortunately, we have no data on tLESR and its relationship with GER in Korea. Therefore, this study was performed to evaluate the characteristics of tLESR in Korean subjects and the mechanisms of GER after Korean meals. Methods: Eight healthy volunteers (8 men, 23 to 25 yrs) received a Korean meal (laver-rolled rice, fried egg, sweet rice juice, 640 Kcal). A mylohyoid electromyogram, LES pressure using a Dent sleeve and esophageal pH were simultaneously recorded for 1 hour while fasting and 3 hours after the meal. We compared the manometric profile of swallow-induced LES relaxation (sLESR) with the manometric profile of tLESR and evaluated the frequency of tLESR and reflux episodes, and their relationship. Results : Compared with sLESR, tLESR showed longer time onset to completion, slower relaxation rate, longer duration of relaxation, and a lower nadir pressure. Incidence of tLESR increased after the meal, which was mostly accompanied by GER. Also, the frequency of GER increased after the meal, which mostly occurred during tLESR. Conclusions : Our results suggest that tLESR is a main cause of GER in healthy Korean adults, which is a similar result to studies of Westerners.
CT 및 EUS 상 원격전이 소견이 없는 진행위암에서 복강경 검사의 유용성
허병원(Byung Won Hur),전훈재(Hoon Jai Chun),진윤태(Yoon Tae Jeen),강창돈(Chang Don Kang),이정환(Jung Whang Lee),이홍식(Hong Sik Lee),송치욱(Chi Wook Song),엄순호(Soon Ho Um),이상우(Sang Woo Lee),최재현](Jai Hyun Choi),김창덕(Chang Du 대한내과학회 2001 대한내과학회지 Vol.61 No.2
N/A Background : The proper staging of advanced gastric cancer has crucial role in determining resectability and operative method, to prevent unnecessary operation and to predict the prognosis and survival rate. Although marked improvements have been made in computed tomography (CT) technology and endoscopic ultrasonography (EUS) in recent years, reassessment of the laparoscopy for gastric cancer is required as a preoperative staging tool. Therefore, we determined the usefulness of laparoscopy for staging of advanced gastric cancer without distant metastasis in CT and EUS. Methods : Staging laparoscopy was performed in 48 patients with advanced gastric cancer staged T3 or T4 by CT and EUS. Laparoscopy was carried out with the patients under local anesthesia, and included visual inspection of abdomen, and biopsies for suspicious metastatic lesions. Laparoscopic results were compared with the postoperative pathologic findings. Results : Laparoscopy was performed successfully in 48 patients. Laparoscopy disclosed unrecognized distant metastases in 7 patients (14.6%) judged to be eligible for potentially curative resection by CT and EUS. Preoperative laparoscopy showed an accuracy of 74% for serosal infiltration. Conclusion : Our results suggest that laparoscopy is an effective means of evaluating resectability of advanced gastric cancer staged T3 or T4 and can provide valuable help in planning surgical approach.(Korean J Med 61:127-132, 2001)
증례 : 외과적 클립의 이동으로 초래된 총담관 폐색 1예
권영우 ( Young Woo Kwon ),허병원 ( Byung Won Hur ),오웅식 ( Woong Sik Oh ),이정환 ( Jung Hwan Lee ),김해경 ( Hae Kyung Kim ),박성우 ( Sung Woo Park ),류성태 ( Seong Tae Ryu ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-
복강경 담낭 절제술은 담낭 결석 및 용종 등의 담낭 질환의 치료법으로 널리 이용되고 있다. 드물게 이 수술의 합병증으로 클립의 총담관, 십이지장 및 폐동맥으로 이동이 보고되고 있다. 복강경 담낭 절제술 후 복통, 황달, 발열, 오심, 구토 등의 담관염 증세가 있으며, 추적 단순 방사선 소견에서 우상복부에 존재하는 클립의 위치 변화가 있을때, 클립의 이동에 의한 총담관 폐색을 의심해 보아야 한다. 저자들은 내원 7개월 전 복강경 담낭 절제술을 시행받았던 환자에서 외과적 클립의 이동으로 초래된 총담관 부분 폐색을 내시경적 역행성 담관조영술로 진단하고 제거하였기에 이를 문헌고찰과 함께 보고하는 바이다. The laparoscopic cholecystectomy, which was originally developed in Europe, is now gaining wide acceptance due to a less painful surgery, a shortened hospital stay and less scarring. But the laparoscopic cholecystectomy were reported serious complications such as, gallbladder bed hemorrhage, bile duct injury, jejunal perforation and rarely dislocation and migration of the surgical clips. We report a 61-year-old man with obstructive jaundice that was generated surgical clips migration into the common bile duct, who had undergone a laparoscopic cholecystectomy because of acute calculous cholecystitis 7 months ago. Abdominal CT scan revealed multiple clips into the distal CBD and mild dilatation of intrahepatic biliary tree. The clips were removed using basket after endoscopic sphincterotomy. (Korean J Med 69:S772-S776, 2005)
이정환(Jung Whan Lee),송치욱(Chi Wook Song),허병원(Byung Won Hur),강창돈(Chang Don Kang),진윤태(Yoon Tae Jeen),전훈재(Hoon Jai Chun),이홍식(Hong Sik Lee),이상우(Sang Woo lee),엄순호(Soon Ho Um),최재현(Jai Hyun Choi),김창덕(Chang Duck 대한소화기기능성질환·운동학회 2000 Journal of Neurogastroenterology and Motility (JNM Vol.6 No.1
N/A Background/Aims: It is suggested that diffuse esophagenl spasm (DES), nutcracker esophagus (NUT), and hypertensive lower esophageal sphincter (HLES) could be re-classified together as a spastic esophageal motility disorder of similar clinical background. However, there were no studies to evaluate the pathophysiological characteristics of these motor abnormalities. The aim of the study was to evaluate the changes of esophageal motor function depending on the different types of the bolus (water vs semi-solid bolus). Methods: Twenty-one healthy subjects and 42 subjects with primary esophageal motility disorders (4 DES, 12 NUT, 5 HLES, 12 nonspecific esophageal motility disorders, 9 normal) underwent a perfusion manometry with a low compliance pneumo-hydraulic capillary infusion system. Consecutively, each patient had l0 swallows of water and 10 swallows of Jello, 5 ml each. Results: In the healthy controls, the Jello swallow showed an increased amplitude and duration of distal esophageal contraction, and the velocity of peristalsis was decreased (p<0.05). Among all patients diagnosed by manometry with the water swallow, 2 cases diagnosed with HLES (40%) and 4 with NUT (33%) were changed to a diagnoses of DES after the Jello swallow. Moreover, HLES was found in 1 patient with DES (25%) and in 6 patients with NUT (50%). Conclusions: Semi-solid bolus swallows increase the contractile force of the esophagus more than water swallows. A conventional manometric diagnosis could be changed to a different spastic motility disorder of the esophagus after a semi-solid bolus swallow. It is suggested that DES, NUT, and HLES can be considered as a spectrum of spastic esophageal motility disorders sharing a similar pathophysiology. (Korean Journal of Gastrointestinal Motility 2000;6;ll-19)
건강 성인에서 라니티딘(300mg)과 오메프라졸(10mg, 20mg)의 위식도역류 및 위내 pH에 대한 효과
김영선(Young Sun Kim),송치욱(Chi Wook Song),김윤홍(Yoon Hong Kim),김혜랑(Hye Rang Kim),김윤배(Yun Bae Kim),허병원(Byung Won Hur),이정환(Jung Whan Lee),진윤태(Yoon Tae Jeen),김창덕(Chang Duck Kim),류호상(Ho Sang Ryu),현진해(Jin Hai Hy 대한소화기기능성질환·운동학회 2000 Journal of Neurogastroenterology and Motility (JNM Vol.6 No.2
N/A Background/Aims : This study was done to compare the effects of Omeprazole (OMD) 10 or 20 mg with Ranitidine(RAN) 300 mg on intragastric acidity and gastroesophageal reflux in healthy subjects. Methods : Ten healthy male volunteers were studied after administrations of 5 days dosing with either RAN 300 mg, OMD 10 mg or 20 mg, once each morning. On the 5th day, intragastric pH and lower esophageal pH were measured by a dual channel antimony pH catheter for 10 hours. Results : Gastroesophageal reflux was reduced after administrations of RAN 300 mg, OMD 10 mg or 20 mg (p<0.05) and there was no significant difference among the three drugs (p>0.05). The gastric holding time of pH >4 was significantly prolonged over fasting and postprandial periods after RAN 300 mg, OMD 10 mg or 20 mg administrations (p<0.05). OMD 20 mg showed the most potent effect on gastric acid suppression (p<0.05), but there was no significant difference between RAN 300 mg and OMD 10 mg (p>0.05). OMD administrations (10 mg or 20 mg) exhibited a more potent effect on gastric acid suppression during the postprandial period than RAN 300 mg (p<0.05). Conclusions : OMD 10 mg was as potent as RAN 300 mg on inhibition of gastric acid, but less potent than OMD 20 mg. There was no difference among the three drugs in regard to gastroesophageal reflux in healthy subjects.
간내 담석이 위치한 부위와 다른 부위에 병발된 간내 담관암 1예
이정환,이정용,김진호,이진수,김재선,허병원,박영태,박상훈,김종극,임형준,손장욱 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.6
An association of hepatolithiasis and cholangiocarcinoma is thought to be rare, with a rate reported to be 2.36%-10%. Most of the cholangiocarcinomas concurrent with intrahepatic stones are found in the vicinity of the hepatolithiasis, and the diagnosis of intrahepatic cholangiocarcinoma in cases with hepatolithiasis is very difficult to detect preoperatively in spite of recent developments in techniques of imaging studies. Recently, the development of cholangiocarcinoma was reportd even after the complete removal of the hepatic stones. Thus, bile stasis and bacterial infecton appear to be important causative factors causing cholangiocarcinoma rather than the stone itself. A rare case is reported on intrahepatic cholangiocarcinoma developed in a remote region from the site of the hepatolithiasis. Therefore, the possible presence of cholangiocarcinoma should always be considered and sought during the diagnosis and treatment of hepatolithiasis.