• Clinical Endoscopy
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• 제57권1호
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• pp.122-127
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• 2024

Benign biliary stricture (BBS) is a complication of chronic pancreatitis (CP). Despite endoscopic biliary stenting, some patients do not respond to treatment, and they experience recurrent cholangitis. We report two cases of CP with refractory BBS treated using endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) fistula creation. A 50-year-old woman and a 60-year-old man both presented with obstructive jaundice secondary to BBS due to alcoholic CP. They underwent repeated placement of a fully covered self-expandable metal stent for biliary strictures. However, the strictures persisted, causing repeated episodes of cholangitis. Therefore, an EUS-CDS was performed. The stents were eventually removed and the patients became stent-free. These fistulas have remained patent without cholangitis for more than 2.5 years. Fistula creation using EUS-CDS is an effective treatment option for BBS.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제3권1호
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• pp.63-67
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• 2000

목 적: 신생아 담즙정체증의 흔한 원인중 하나인 담도폐쇄증의 진단에 많이 이용되고 있는 Tc-99m DISIDA간담도 주사의 진단적 의의에 대하여 알아보고자 하였다. 방 법: 1995년 1월부터 1999년 8월까지 4년 8개월 동안 서울 중앙병원 소아과와 소아외과에서 신생아담즙정체증으로 Tc-99m DISIDA간담도 주사를 시행한 60명의 환자를 대상으로 그 결과를 분석하였다. 결 과: 전체 60명의 환자 중에서 담도폐쇄증으로 14례(23%), 신생아 간염으로 33례(55%), 간내 담도형성부전증으로 9례(15%), 경정맥 고영양법으로 인한 황달로 4례(7%)가 진단되었다. Tc-99m DISIDA 간담도주사의 민감도는 100%를 보였고 특이도는 80%였다. 결 론: Tc-99m DISIDA 간담도주사에서 장관내 방사능이 관찰되면 담도폐쇄증을 진단에서 제외할 수 있지만 관찰되지 않을 경우에는 경피간침생검이나 시험적 개복술 등의 적극적인 진단방법을 고려해야 할 것으로 생각된다.

• 대한소아치과학회지
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• 제27권1호
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• pp.70-76
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• 2000

Intra- & extra-hepatic duct system의 경화를 야기하는 Biliary atresia는 출생시 1 : 10,000의 발생빈도를 보이며, 5년 이하의 생존율을 나타내는 예후가 좋지 않은 질환이다. 담도폐쇄증의 원인은 아직 명확하지 않으나, 유전적인 요소나 발육성 원인으로 믿고 있다. 임상적 특징으로 두드러진 황달, 간비증대, 가려움증, 지방변, 황색종, 성장지연, 문맥압항진증, 출혈, 골연하증, 복수 그리고 호흡기계 감염 등을 나타낸다. 구강내 소견으로 녹색을 띄는 변색치아, 유치의 확장된 치수강과 치근관, 치아맹출지연, 법랑질 형성부전, 그리고 심한 치아 우식 등이다. 담도폐쇄증은 조기진단과 수술에 의해 사망률이 감소되고, 성장과 발달이 정상으로 돌아오며 생존율도 향상되었으나 여전히 그 원인과 치료에 대한 연구가 계속되어야 할 것이다. 이에 저자는 전북대학교 치과병원에 내원한 2명의 담도폐쇄증환아에 대해 임상, 방사선학적 특징 및 적합한 처치에 대하여 보고하고자 한다.

• Journal of Gastric Cancer
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• 제14권1호
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• pp.58-62
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• 2014

We report an extremely rare case of primary squamous cell carcinoma of the stomach. A 69-year-old man was admitted to our hospital with a 2-month history of dysphagia and tarry stools. Endoscopic examination revealed a cauliflower-shaped protruding mass along the lesser curvature of the gastric cardia. Biopsy of the lesion revealed squamous cell carcinoma of the stomach. Computed tomography revealed a thickened stomach wall and a mass protruding into the gastric lumen. Total gastrectomy with splenectomy, distal pancreatectomy, and Roux-en-Y reconstruction was performed, together with a lower thoracic esophagectomy via a left thoracotomy. Histopathological examination of the specimen revealed well-differentiated squamous cell carcinoma of the stomach. Postoperative follow-up was uneventful for the first 18 months. However, multiple liver metastases and para-aortic lymph node metastasis developed subsequently. Despite systemic combination chemotherapy, the patient died because of progression of the recurrent tumors. Here, we review the characteristics of 56 cases of gastric squamous cell carcinoma reported in Japan.

• 한국간담췌외과학회지
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• 제26권3호
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• pp.270-276
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• 2022

Backgrounds/Aims: Thoracic epidural analgesia (TEA) is an established analgesic method in open Kausch-Whipple pancreaticoduodenectomy (KWPD). Although, it can cause hemodynamic instability and neurological complications. Inter pleural analgesia (IPA) is an alternative option. We aim to evaluate the effectiveness of IPA versus TEA after KWPD. Methods: We retrospectively studied the efficacy of IPA against TEA in patients, operated by a single surgeon. The primary outcome was the analgesic efficacy and secondary outcomes were analgesia-related complications, inotrope use, and duration. Results: Forty patients (TEA, 22; IPA, 18) were included. Both groups were well matched for patient characteristics, type, and duration of surgery. TEA was associated with higher analgesia-related complications (n = 8, 36.4% vs. n = 1, 5.6%; p = 0.027). TEA complications included analgesia not working (n = 4), leakage (n = 2), refractory hemodynamic instability (n = 1), and lower limb anaesthesia (n = 1). One patient in the IPA group encountered leakage. TEA was associated with longer inotrope requirement (35 vs. 18 hours; p = 0.047). There was no significant difference in intensive care unit (ITU) admission rate (81.8% vs. 77.8%; p > 0.999), median ITU stay (3 vs. 2 days, p = 0.385), or hospital stay (11 days in both groups). Conclusions: In open KWPD, IPA is not inferior to TEA in its efficacy of pain control. IPA was associated with less analgesia-related complications and shorter inotrope requirements. However, this was a small retrospective study. Larger randomized controlled trials are needed to study the effectiveness of IPA.

• 대한핵의학회:학술대회논문집
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• 대한핵의학회 1997년도 제36차 춘계학술대회 초록집
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• pp.124-126
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• 1997

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제4권1호
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• pp.71-76
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• 2001

목 적: 신생아 담즙울체를 진단하는 데 도움이 되는 많은 방법들이 있지만 아직까지 담관폐쇄증을 확실히 진단할 수 있는 방법은 없는 실정이다. 저자들은 담즙울체에 의한 황달을 보이는 영아에서 담즙폐쇄를 효과적으로 진단하고자 전향적 연구를 시행하였다. 방 법: 담즙울체에 의한 황달을 보이는 영아 27명을 대상으로 위십이지장 내시경을 시행하였다. 모든 환아에서 검사 전 4시간 이상 금식시켰으며 검사 직전에 10% 포도당용액을 20 ml 먹게 하였다. 5분 동안 관찰하여 담즙분비의 증거가 없는 경우에는 내시경을 제거한 후 다시 포도당용액을 20ml 먹인 후 내시경을 삽입하여 5분간 관찰하였다. 결 과: 모든 담도폐쇄 환아에서는 담즙분비의 증거가 없었으나 비담도폐쇄가 있었던 10명의 환아 중 8명에서 첫 번째 시도시 담즙의 배설이 관찰되었고 또 두 번째 시도시 두 명 중 한 명(Alagille syndrome)에서도 답즙의 배설이 관찰되어 모두 10명 중 9명에서 담즙의 배설을 관찰할 수 있었다. 이상의 결과로 내시경을 이용한 담도폐쇄 진단의 정확도는 96.3%였으며 진단적 민감도는 100.0%, 특이도는 90.0%였다. 결 론: 비록 연구된 증례수가 많지 않아 일반화하는 데는 다소 어려움이 있겠지만 내시경을 이용하여 담도폐쇄를 감별하는 방법은 비교적 쉽고 빠르게 수행할 수 있는 좋은 검사법으로 생각된다.

• 한국간담췌외과학회지
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• 제26권1호
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• pp.40-46
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• 2022

Backgrounds/Aims: The role of inflammation in malignant cell proliferation has been well described. High values of platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) as markers of systemic inflammation have shown associations with unfavorable long-term outcomes. The purpose of this study was to determine values of NLR and PLR evaluated prior to and after surgery and their associations with mortality and recurrence rates of liver transplant patients with hepatocellular carcinoma (HCC). Methods: A total of 105 patients with HCC who underwent orthotopic liver transplantation (OLT) were retrospectively reviewed. NLR and PLR values were obtained from complete blood counts prior to and after surgery. Overall survival (OS) and recurrence-free survival (RFS) in relation with delta NLR and PLR were estimated. Results: Serum alpha-fetoprotein levels > 100 ng/mL (p = 0.014) and lymphovascular emboli in the specimen (p = 0.048) were identified to be significant predictors of RFS. Child-Pugh score (p = 0.016) was found to be an independent factor associated with poorer OS. An increasing delta PLR was associated with worse RFS, although it showed no significant association with OS. Conclusions: The analysis of PLR as a continuous variable may predict recurrence outcomes in patients undergoing OLT for HCC. It is more representative than isolated values.

• Preventive Nutrition and Food Science
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• 제2권1호
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• pp.42-48
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• 1997

the exocrine pancreatic secretion is an important factor in the maintenance of zinc homeostasis. The daily pancreatic secretion of zinc into the gastrointestinal tract may be two or more times the daily dietary zinc intake. The objective of this study was to examine the distribution of proteins and zinc in pancreatic/biliary fluid following intraperitoneal {TEX}${65}^Zn${/TEX} injection into dietary prepared Sprague-Dawly rats. Distribution of zinc-binding protein in Sephadex G-75 subfractions showed a peak corresponding to the high molecular weight protein standard(<66kDa) in the pancreatic/biliary fluid. Zinc also was associated with the 29~35kDa mole-cular weight proteins. These are similar in size with zinc-containing enzymes, carboxypeptidase A and car-boxypeptidase B. A more remarkable small molecular weight fraction eluted beyond the 6.5kDa standard pro-tein peak. These results show the presence of small molecular weight compound in pancreatic/biliary fluid associated with zinc . These small molecular weight compounds may serve as zinc-binding ligands for the secretion of enogenous zinc into the duodenum. These findings suggest that these lignads may dissociate zinc in the duodenum thus making it vulnerable to complexation with phytate in the upper gastrointestinal tract rendering the zinc unavailable for reabsorption.

• Advances in pediatric surgery
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• 제14권2호
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• pp.125-133
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• 2008

To evaluate the long-term prognosis of biliary atresia after Kasai operation, a total of 14 patients (of the 41 patients operated upon from 1982 to 1997), who had been followed up for more than 10 years, were included in this retrospective study. Eleven out of 14 patients survived with their native livers, and their data analyzed for age at operation, clearing time of jaundice, histological outcome, postoperative complications, effectiveness after the application of an intussusception anti-reflex valve, and quality of life. Average age at surgery was 62.8 days. Serum bilirubin was normalized within three months in all patients. Six among the eleven long-term survivors had ascending cholangitis as one of the postoperative complications. The application of an intussusception anti-reflux valve did not show any statistical significance in long-term survival. Most of long-term survivors appeared to enjoy good quality of life. Kasai operation might not be the definitive treatment for biliary atresia; however, Kasai operation made it possible to achieve long-term survival for patients with biliary atresia when the patients were detected and treated as early as possible.