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위십이지장 경계부위에 발생한 충돌종양 ( Carcinoma - Carcinoid ) 의 치험
노병선(Byoung Seon Rhoe),윤광수(Kwang Soo Yoon),조남천(Nam Cheon Cho) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.1
Carcinoid tumors display wider histologic spectrums than those we have previously known. Furthermore, an increasing number of tumors which contain an admixture of neoplastic endocrine and nonendocrine epithelial cells has been recently discribed. We report a case with collision tumor of the gastroduodenal junction composed of a gastric adenocarcinoma and duodenal carcinoid tumor which is extremely rare. The tumor mass was histologically diagnosed with carcinoid tumor by gastroscopic biopsy before operation. Whipples operation was performed after 6 cycles of chemotherapy with 5-FU, Adriamycin and Cisplatin. The operative specimen grossly disclosed two different types of tumor and was histologically identified as concurrent occurrence of carcinoid tumor adjacent gastric carcinoma.
간장 ( 肝臟 ) 및 담도 ( 膽道 ) : 간내 담석증의 임상적 고찰
노병선(Byoung Seon Rhoe),윤광수(Kwang Soo Yoon),조남천(Nam Cheon Cho),오진환(Jin Hwan Oh) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.2
N/A There were many preblems in the treatment of intrahepatic stones compared with other biliary stones. The management of primary intrahepatic stones is complex and the results are often unsatisfactory. The pathgenic mechanism of the intrahepatic stones is still obscure byr manu authors have believe that the bile stasts with secandary infection primarly makes soines in intrahepatic ducts. We experienced 448 patients with hepatobiliary stones during the period from January 1982 to September 1989. Among them, 87 pateents with intrahepatic stones were analysed for prevalent sites, pathogenic organism, histologic changes and operative precedures.We obtained following results; 1) Intrahepatic stones occurred more frequently in left side (50.6%) than right side (9.2%) 40.2% of the patients had stones in both hepatic ducts. Common bile stones were combined with intrahepatic stones in 62.1%.2) Bacterial cultrer disclosed positive result 72.5 and the most common orgainsm was E.coli cultures in 30.3% Parasitic infestation rate was 5.8%.3) Histologically, mucin production (85.7%) atypical epithelial huperpalsia (42.9%) and proliferation of endocrine cells (66.7) were noted in the epithelium of intrahepatic ducts.4) 33 of total 87 cases underwent hepatic resection and 54 cases underwent by-pass procedures without hepatic resection. 5) The postoperative complication rate was 6.9% in the group with hepatic resections and 18.4% in the group without hepatic resection. 6) The residual stones were in 5 cases (5.7%) with hepatic resection and in 24cases (27.6%) without hepatic resection. 7) If stones were localized to the left side of the liver, left lateral segmentectomy with TouX-en-Y hepaticojejunostomy or tith T-tube choledochostomy was more effective procedure than other procedures for minimal resedual stones after operation.
강성준(Seong Joon Kang),노병선(Byoung Seon Rhoe),김수용(soo Yong Kim),이연희(Yeon Hee Lee),이창일(Chang Il Lee) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.1
N/A Despite the support provided by adjuncts such as total parenteral nutrition, effective antibiotic. and hemodynamic monitoring, esophageal perforations continue to be associated with a mortality rate of more than 20%. In an effort to refine and improve treatment, we reviewed 6 cases of esophageal perforations from January, 1983 to August, 1992. The prevalent age group was 4th to 6th decades. The perforation site was cervical (2), thoracic (1) and distal (3). Clinical findings were fever, pain, dysphagia, and subcutaneous emphysema in cervical esophageal perforations compared with chest pain and epigastric pain in thoracic or distal esnphageal perforations. Causes of esophageal perforation were trauma, 2 cases, in cervical region and spontaneous rupture (Boerhaave syndrome), 4 cases in thoracic and distal region. Preoperatively, we performed simple neck and chest X-ray, esophagoscopy, fiberoptic gastroscopy (FGS) and esophagogram. Mortality was developed in 2 cases (33.3%p) and its causes were sepsis due to mediastinitis with delayed aclmission. In operative management, we recommed primary repair and drainage in cervical esophageal perforation. But in thoracic and distal esophageal perforation, the repair site should be butressed with viable serosal butress such as pleura and pericardium, if possible, to prevent subsequent leak at the suture line. 1n conclusion, early diagnosis and early operation is easential for patients with spill of contrast medium on esophagograms of clinical manifestations of esophageal soilage of the mediastinum or pleural cavities.
김대성(Dae Sung Kim),노병선(Byoung Seon Rhoe),윤광수(Kwang Soo Yoon),조남천(Nam Cheon Cho),이연희(Yeon Hee Lee) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.1
N/A The present study was undertaken to document operative mortality and morbidity and cumulative survival in patiients who underwent Whipple's operation due to periampullary cancer and benign lesions including trauma from January 1980 throught Apeil 1991. Patients fell one of six categories based upon pathologic diagnosis: adenocarcinoma at the head of the pancreas (n=9), carcinoma of the distal common bile duct (n =11), adenocareinoma of the ampulla of vater (n=9), duodenal carcinoma (n=9), other cancer not considered part of the periampullary region (n=3), and benign disease (n=12). Of the 19 patients alive at the time of this study, ten were patients with benign disease. Eight of the 53 patients were lost to follow-up. In malignant group, overall mean survival time was 23. 7 months until present study: 1 year survival rate, 75%, 2 year survival rate, 62.5%, 3 year survival rate, 38.5%, and 5 year survival rate, 25%. Postoperative death was developed in 6 (11.3%) of 53 patients: malignant group, 4 patients; non-maligant group, 2 patients. Its causes were sepsis (n=2), postoperative bleeding (n=2), hepatorenal syndrome (n=l), and long-standing anesthesia (n=l).
김대성(Dae Sung Kim),노병선(Byoung Seon Rhoe),김수용(soo Yong Kim),조남천(Nam Cheon Cho),이연희(Yeon Hee Lee),노광수(Kwang Soo Roh) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.6
N/A There are few published reports of septate gallbladder although it is generally stated that they are not uncommon at necropsy and in surgical specimens. In present study, all cases showed differential concentration of contrast material in the proximal and distal portions of the gallbladder. Pathologically, chronic inflammatory changes with cholelithiasis were most common findings, especially in the distal compartment. The more common occurrence of inflammatory changes with cholelithiasis on distal portion maybe due in part to the relatively slower exchange of bile across the stricture There is obvious difficulty in deciding to operate on a patients gallbladder where stones are not found. Rut, if septation with cholelithiasis in gallbladder is confirmed, we suggest that cholecystectomy is the best treatment
김대성(Dae Sung Kim),노병선(Byoung Seon Rhoe),윤광수(Kwang Soo Yoon),조남천(Nam Cheon Cho),권기범(Ki Bum Kwon),박진수(Jin Soo Park) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.5
N/A A clinical experience with 20 primary malignant tumcirs of the duodenum which underwent an operation at the Department of Surgery, Wonju College of Medicine during the 8 year period from January 1985 to December 1992, was analysed with the liter ature review. The mean age of the patients was 55.9 years. The peak incidence was 6th decades of life and the male to female rat:io was 1.2:1. The locations of the tumors were the 1st portion in 1 case, 2n(1 portion in 18 case, and the 3rd portion in remaining 1 case. The suprapapillary malignancy was found in 6 cases, peripapillary malignancy was found in 12 cases, and infrapapillary malignancy was found in 2 cases. Histopathologically, 18 cases were adenocarcinoma and 2 cases were stromal tumors. The frequent symptoms were abdominal pain and discomfort, vomiting, weight loss, indigestion, and palpable mass. Gastroduodenoscopy, hypotonic duodenography and abdominal C-T scan had important roles in the diagnosis of duoclenal cancer. We performed 11 radical operations, 4 palliative operations and 5 non-operation. There was no operative mortality. The major postoperative complictions were leakage at the anastomosis site and wound infection. 1n curative resection group, one, three, and five years survival rate were 75%, 38%, and 18% respectively.
간경변증 환자의 비정형 선종성 증식성 결절 ( Atypical Adenomatous Hyperplastic nodule ) 에서 발생한 소 간세포암
권상옥(Sang Ok Kwon),노병선(Byoung Seon Rhoe),장우익(Woo Ick Jang),이동기(Dong Ki Lee),이용규(Yong Gyu Lee),한병근(Byoung Geun Han),심영학(Young Hak Sim),조미연(Mi Yeon Cho) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.4
Adenornatous hyperplasia (AH), defined as a sizable parenchymal nodules that may follow acute or chronic liver injury, has been reported as precursor lesion of hepatocellular carcinoma in the cirrhotic liver. These lesions often coexist with obvious rnalignant foci as small nodule-in-nodule. Morphologically AH can be divided into 'ordinary' and atypical (AAH)' types. The former consisted of hepatocytes similar to those of the surrounding liver. The latter type was composed of hepatocytes showing nuclear, cellular and structural atypia relative to the surrounding liver, and shoved irregular or sparse portal tracts. Cytological and structural pattens are characteristically heterogenous within a nodule. Now AAH are considered to be precancerous lesion evolving to early hepatocellular carcinoma. Authots report one case of hepatocellular carcinoma eithin an atypical adenomatous hyperplastic nodule in 55-years-old male with a review of literatures.