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콜레스테롤 담낭 담석 환자에서의 담즙내 콜레스테롤 포화지수와 결정화 시간의 측정
박선미(Seon Mee Park),김명환(Myung Hwan Kim),채희복(Hee Bok Chae),최호순(Ho Soon Choi),이성구(Sung Koo Lee),민영일(Young Il Min),박광민(Kwang Min Park),이영주(Young Ju Lee),이승규(Sung Gyu Lee) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.6
N/A Background/Aims: Although supersaturation of bile with cholesterol is a prerequisite for cholesterol gallstone formation, bile is not always supersaturated in patients with cholesterol gallstones and is also frequeztly saturated in controls. Tbere have been several reports that contributive factors or proces., to the nucleation of cholesterol crystals are more important than lithogenic bile itse]f in the pathogenesis of cholesterol gallstones. This study was conducted to identify the cholesterol saturation index and nucleation time of gallbladder bile in the patients with cholesterol gallstones and conlrols. Pvfethods: Cholesterol saturation index and nucleation time of gallbladder bile obtained during operation were measured in 36 gallbladder stone patients(cholesterol stone 20, pigment stone 16) and 17 controls and the relationship between cholesterol saturation index aid nucleation time was evaluated. Results: The mean cholesterol saturation index of cholesterol stone patients and controls was not different from each other(1.08 vs 0.97 respectively,p>0.05). There were no differences in the value of cholesterol, phospholipid, and total bile acid in between I:holesterol stone patients and controls. In 11(55%) out of cholesterol stone patients, gallbladder bile was supersaturated with cholesterol, while for control biles, 6(35%) were supersaturated. The mean nucleation time in cholesterol stone group was 8.3 days and it was shorter than 16.1 days in pigment stone group and 16.9 days in controls. There was no significant coivelation between cholestero. Saturation index and nucleation time in cholesterol stone group and controls. Conclusions: The p.tients with and without cholesterol gallstones cannot be distinguished by cholesterol saturation indei of bile. Supersaturation with cholesterol was also noted in bile of controls. However, the mean nucleation time in patients with cholesterol stones was significantly shorter than that in pigment stones or controls. The process of nucleation for cholesterol crystal may rnore contribute to the fcrmation of cholesterol gallstones than lithogenic bile dose. (Korean J Gastroenterol 1996;28:853-860)
박선미(Seon Mee Park),서장원(Jang Won Seo),최호순(Ho Soon Choi),이성구(Sung Koo Lee),김명환(Myung Hwan Kim),민영일(Young Il Min),이영주(Young Joo Lee),이승규(Sung Kyu Lee) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.4
A 67-year-old man with gallstone was admitted to the Asan Medical Center for right upper quarant abdominal pain and intermittent vomiting. Physical examination showed normal except soft palpable mass accompanying tenderness on epigastrium. Abdominal coputered tomograpy revealed ill defined low density mass at GB fossa. Gastrofiberscopic exam showed huge dark brown colored stone impacted with fluid collection of GB fossa. 3.0 cm sized calcifying mass located at duodenun at bulb of duodenum. A barium meal outlines the stone which is obstructing the duodenum. At operation, 3.0 cm sized egg shaped gallstone was impacted in a markedly edematous duodenum. Partial cholecystectomy and enterolithotorny were done and he was recovered uncomplicated. Gallstone obstruction of duodenum is a rare condition but awareness of this complication is important because early diagnosis and proper management prevent high mortality. Duodenal obstruction secondary to a gallstoue is a rare entity, usually reported as 1 to 3 per cent of patients with gallstone ileus. (Korean J Gastroenterol 1996;28:587 - 591)
박선미(교신저자) ( Seon Mee Park ) 대한소화기학회 2015 대한소화기학회지 Vol.66 No.3
Treatment for chronic pancreatitis (CP) should be started early to prevent further pancreatic fibrosis and managed with a multidisciplinary approach to prevent complications and to maintain a good quality of life. The management strategies of CP can be divided into medical, endoscopic, and surgical treatment. The role of pancreatic enzymes and antioxidants for pain relief is not clearly defined, but their role in maintaining nutritional support by correcting exocrine insufficiency is well established. Endoscopic treatment is applied for resolution of pancreatic or bile duct strictures, clearance of pancreatic duct stones, and pseudocyst drainage. Endosonography-guided celiac plexus or celiac ganglia block for pain relief are known to be safe procedures but evidence for their effectiveness is still lacking. Surgery is commonly recommended when endoscopic therapy fails or there is suspicion of malignancy. New evidence-based guidelines for the management of CP are needed. (Korean J Gastroenterol 2015;66:144-149)
수술로 절제한 상피하 양성 십이지장 종양: 단일 기관의 증례들
박선미 ( Seon Mee Park ),김지훈 ( Ji Hoon Kim ),류동희 ( Dong Hee Ryu ),장이찬 ( Lee Chan Jang ),강성이 ( Sung Yi Kang ),성노현 ( Ro Hyun Sung ),최재운 ( Jae Woon Choi ) 대한췌장담도학회 2014 대한췌담도학회지 Vol.19 No.1
Background/Aims: The incidence of duodenal tumors has increased by health surveillance. However, preoperative diagnosis of subepithelial duodenal tumors remains difficult because of the wide variety of pathologies and the location of the tumors. We analyzed endoscopic, radiological, and pathological features of subepithelial benign duodenal tumors (BDTs), which were treated by surgical resection. Methods: Five patients with subepithelial BDTs treated by surgical resection were analyzed retrospectively. We compared the preoperative and postoperative diagnosis and evaluated the clinical presentations, endoscopic and radiological findings, surgical treatments, pathological results, and outcomes of these patients. Results: All the patients underwent successful surgical resection. There were two cases of gastrointestinal stromal tumors (GISTs) treated with segmental duodenectomy, one case of carcinoid tumor treated with antrectomy, one case of gangliocytic paraganglioma treated with ampullectomy, and a lipoma removed by mass excision. The two GISTs were in the duodenal third and fourth segment close to the pancreas, and it was difficult to exclude pancreatic tumors by imaging studies. All the patients remained healthy for more than three years. Conclusions: Subepithelial BDTs are rare and difficult to diagnosis. Awareness and preoperative diagnosis of subepithelial BDTs can lead to minimally invasive treatment, including endoscopic or local surgical resection. Korean J Pancreatobiliary 2014;19(1):18-25
십이지장 궤양 발생에 있어서 H . pylori와 위상피화생의 연관에 대한 연구
박선미(Seon Mee Park),양석균(Suk Kyun Yang),홍원선(Weon Seon Hong),민영일(Young Il Min),이인철(In Chul Lee) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.6
N/A Background/Aims: H. pylori infection and gastric metaplasia are frequently associated in patients with duodenal ulcers. However, the pathogenesis of duwlenal ulcer in relation to H, pilori infecri<in and gastric metaplasia has not reacbed a consistent result, yet. The aim of this study v,as to assess whether H. pylori infection and gastric metapla.ia contrihute to duodenal ulcerogenesis. Methods: Multiple endoscopic biopsy specimens were tnken frorn duodenum and gastric antrum of ?I subjects(21 active duodenal ulcers; 30 scarred duodenal ulcers; 20 normal controls). The specimens were examined histologically for the presence ot' H. pylori, gastric metaplasia, and degree of gastritis and duodenitis. Rapid tissue urease test was performed t'or detection of H, pi krri infc cti<in. Results: The positive rate of H. pylrri in gastric antrurn was not significantly different aniong ttlTCC groups, while it was increasing in duodenum, I,e., normal controls(3%'), scarred DU's(37,r), active DU's(62%) in ascending order. The incidence of duodenal gastric metaplasia in the active DU'.I was 95.2% in contrast with the scarred duodenal ulcer's(72.07<) and the nonnal contrnls(2i.04) Diffuse gastric metaplasia lesions were more prevalent in active duodenal ulcers. 1n the duodenum, a strong association was shown between the H. pylrri and gastric rnetaplasia. The severity ot' duodenitis were significantly increased in the order ot' groups of normal controls, scarrecl duodena1 ulcers, and active duodenal ulcers. In duoclenum, there was a strong association with the grade c>f' intlammation anci H. pylori. Conclusions: These results suggest that gaslric metaplasia in the duodenum and concurrent H. pilori infection may play a synergistic role in the pathogene.I. Vt' duodenal ulcer. (Korean J Gastroenterol 199S;27: 617-62S)
주담관 ( Major Bile Ducts ) 을 침범한 간세포암에 대한 임상적 고찰
박선미(Seon Me Park),최강현(Kang Hyeon Choe),진재용(Jae Yong Chin),김형호(Hyeong Ho Kim),김미경(Mee Kyung Kim),양석균(Suk Kyung Yang),정영화(Young Hwa Chung),이영상(Young Sang Lee),민영일(Young Il Min),이문규(Mun Gyu Lee),성규보(Kyu 대한내과학회 1993 대한내과학회지 Vol.45 No.5
N/A Background: Hepatocellular carinoma (HCC) with major bile duct invasion is a particular type that invades and ruptures into the bile duct in the early stage of HCC. It will be different from the other types of HCC in the clinical characteristics, progonosis and prognostic factors. Method: We investigated 16 patients, who were confirmed to have major bile duct invation by surgical pathology (6 cases), cholangiogram (7 cases), or computed tomography (3 cases), to find clinical features and to evaluate prognosis and prognostic factors affecting the mean survival time. Results: 1) Sixteen (2.8%) of 566 patients with HCC were associated with major bile duct invasion. 2) The macroscopic types of tumor by computed tomography were nodular in 6, infiltrative in 8, and invisible in 2 cases. 3)The mean survival time of 16 patients was 3.3 months. 4) weight loss (>10%) and infiltrative tumor type were correlated to poor prognosis, However, age, total bilirubin, alpha-fetoprotein, and HBsAg positivity did not affect the survival time. Conclusion: In our series, the frequency of HCC with major bile duct invasion was not uncommon and the infiltrative tumor type was more frequent than the nodular tumor type. The assessment of weight loss and gross tumor type can identify some prospect of pro- longed survival in patients with HCC showing major bile duct invasion.
증례 : 소화기 ; 내시경 절제술로 치료한 팽대부 주위 신경절세포 부신경절종 1예
채희복 ( Hee Bok Chae ),박선미 ( Seon Mee Park ),성노현 ( Ro Hyun Sung ),전원중 ( Won Joong Jeon ),서의근 ( Eui Keun Seo ),주혜진 ( Hye Jin Joo ),조영심 ( Young Shim Cho ) 대한내과학회 2010 대한내과학회지 Vol.79 No.5
Gangliocytic paraganglioma is a rare tumor that is usually seen in the duodenum. This neoplasm generally behaves in a benign fashion, although instances of recurrence and lymph node metastasis have been described. We experienced a case of incidentally found gangliocytic paraganglioma treated with endoscopic resection. A 61-year-old man was referred because of submucosal tumor adjacent to the major papilla. Endoscopic biopsy revealed paraganglioma. Abdominal CT showed that there was no evidence of a duodenal mass or lymphadenopathy. This tumor was resected endoscopically by electrosurgical snare polypectomy. The excised tumor measured 1.0 cm in diameter. Histopathological examination revealed a benign gangliocytic paraganglioma and the resection margins were free of tumor. At the 6-month follow-up, the patient was still asymptomatic and no residual tumor was detected at the resection site. (Korean J Med 79:543-548, 2010)
다중검출 전산화단층촬영에서 담석이 보이지 않는 급성 담석성 췌장염에서 조기 내시경초음파검사의 유용성
박재근 ( Jae Geun Park ),김기배 ( Ki Bae Kim ),한정호 ( Joung-ho Han ),윤순만 ( Soon Man Yoon ),채희복 ( Hee Bok Chae ),윤세진 ( Sei Jin Youn ),박선미 ( Seon Mee Park ) 대한소화기학회 2016 대한소화기학회지 Vol.68 No.4
Background/Aims: EUS can detect bile duct stones (BDS) that are undetectable on multidetector computed tomography (MDCT). BDS associated with acute biliary pancreatitis (ABP) are small and tend to be excreted spontaneously. This study evaluated the usefulness of early EUS in patients with ABP and undetectable BDS on MDCT. Methods: Forty-one patients with ABP and undetectable BDS on MDCT underwent EUS within 24 hours of admission and were diagnosed with BDS, sludge, dilated common bile duct (CBD), or normal CBD. ERCP was performed in patients with BDS, sludge, or clinical deterioration. The diagnostic yield and the effects of early EUS on morbidity, mortality, and the length of hospitalization were evaluated. Results: EUS detected BDS or sludge in 48.8% of patients examined. BDS was the diagnosis in 13 patients, sludge in seven, and neither for 21 patients. ERCP was performed in 20 patients with BDS or sludge, in two patients with coexisting cholangitis, and in one patient with worsening liver function tests. ERCP identified BDS in 12 patients and sludge in seven. No lesions were diagnosed in four patients by ERCP. All patients improved, and the length of hospitalization in patients with ERCP was 9.0 days, without ERCP 7.1 days. Two patients with major complications by ERCP were hospitalized for a prolonged time. Conclusions: Early EUS may be useful to select patients for therapeutic ERCP in cases of suspected ABP with undetectable BDS on MDCT. (Korean J Gastroenterol 2016;68:202-209)