• The Korean Journal of Medicine
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• v.99 no.1
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• pp.4-10
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• 2024

Malignant hilar biliary obstruction (MHO), an aggressive type of perihilar biliary obstruction caused by cholangiocarcinoma, gallbladder cancer, or other metastatic malignancies, has a poor prognosis. Surgical resection is the only curative treatment for biliary malignancies. However, most patients with MHO cannot undergo surgery upon presentation because of their advanced inoperable state or poor performance resulting from old age or comorbid diseases. Therefore, palliative biliary drainage is required to improve symptomatic jaundice and quality of life. Preoperative biliary drainage is controversial in resectable cases of MHO. Preoperative biliary drainage should be considered according to specific selection criteria. Palliative drainage is currently the mainstay of symptomatic treatment. Compared with percutaneous access, primary endoscopic palliation using plastic or metal stents has recently shown higher technical feasibility and clinical success without increasing the frequency of adverse events, even in high-degree MHO. However, the use of stents still has numerous limitations, including challenges in determining the optimal type of stent, number of stents, deployment method, and additional local therapies. Therefore, this report presents the current optimal endoscopic drainage status for MHO based on recent guidelines and published literature.

• The Korean Journal of Nuclear Medicine
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• v.16 no.2
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• pp.71-80
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• 1982

In the present communication, the results will be reported on a clinical study of how well scintigraphic visualization of the hepatobiliary elements and several commonly used clinical liver function tests correlate each other in various diseases oft hepatobiliary system. The demonstrability of the biliary tract, gallbladder (GB) and duodenum was rather closely paralleled to serum bilirubin level and less closely to alkaline phosphatase and rather poorly to SGOT and SGPT. The biliary tree could not be visualized scintigraphically when bilirubin exceeded 10.5mg/dl. The usefulness of Tc-99m EHIDA [N-(2,6-diethylacetanilido) iminodiacetic acid, made by Amersham, England] hepatobiliary scintigraphy (Tc EHIDA HBS) in settling diagnostic controversy and ambiguity raised by oral cholecystography, intravenous cholangiography and ultrasonography in many hepatobiliary diseases is well known. The purpose of this investigation was to semiquantitatively evaluate the scintigraphic demonstrability of the hepatobiliary tract, GB and duodenum following intravenous injection of Tc-99m EHIDA in normal subjects and in patients with a disturbed liver function from various hepatobiliary diseases. The hepatobiliary scintigraphy was performed in 10 normal subjects and 39 patients with various hepatobiliary diseases (Table 1) at the Dept. of Radiology, St. Mary's Hospital Catholic Medical College, Seoul, Korea during 2 years period from September 1979. Scintigraphic examination was started at end of 3 minutes after intravenous injection of Tc-99m EHIDA in the amount of $50{\mu}Ci/kg$ and was continued until after 30 minutes at 5 minutes interval. The imaging was usually terminated when the tracer could be seen in the duodenum. Late scintigrams were obatained at 1 1/2, 3, 4 and 6 hours when reeded. Scintigrams were analyzed in terms of promptness and clarity of visualization of the biliary tree, GB and duodenum and demonstrability of these anatomical landmarks was correlated with the values of liver function tests. The demonstrability of the common hepatic duct, common bile duct, GB and duodenum was closely paralleled to the level of serum bilirubin when it is less than 10.5 mg/dl as shown in figure 1. However when the bilirubin exceeded 10.5 mg/dl the time of visualization between protracted reaching a flat curve or plateau around 10.5 mg/dl. The biliary tract could not be visualized when the bilirubin was higher than 10.5 mg/dl. The correlability between scintigraphic demonstration and serum alkaline phosphatase was less strong and between scintigraphic demonstration and SGOT and SGPT was rather poor. The present clinical study confirmed the usefulness and limitation of Tc-99m EHIDA hepatobiliary scintigraphy in visulizing and diagnosing the biliary system and duodenum when radiogrpahy and ultrasonography failed to provide useful informations. Scintigraphy was very helpful in the diagnosis of neonatal hepatitis, biliary atresia, cholecystitis and extrahepatic biliary obstruction. The hepatobiliary system and duodenum were visualized when serum bilirubin level was less than 10.5 mg/dl, SGOT 135 units, SGPT 114 units and alkaline phosphatase 52.2 KAU.

• Journal of Magnetics
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• v.17 no.2
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• pp.138-144
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• 2012

3-dimensional magnetic resonance cholangiopancreatography (MRCP) images reconstructed using the maximum intensity projection technique were analyzed qualitatively in patients diagnosed with pancreatobiliary diseases to determine their diagnostic utility. Single shot fast spin echo (SSFSE), fast spin echo (FSE) and 3-dimensional reconstructive images were acquired from 20 patients diagnosed histologically with pancreatobiliary diseases using a 3.0T MR scanner. According to qualitative analysis, the fast spin echo images and 3-dimensional reconstructed images of the hepatic duct, gall bladder and common bile duct had a higher signal to noise ratio (SNR) than the single shot fast spin echo images. Fast spin echo images and 3-dimensional reconstructed images did not show any differences. The contrast to noise ratio of the hepatic duct, gallbladder and common bile duct on the fast spin echo images and 3-dimensional reconstructed images was higher than that of the single shot fast spin echo images. The fast spin echo images and 3-dimensional reconstructed images showed similar quality.

• Tuberculosis and Respiratory Diseases
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• v.41 no.5
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• pp.562-567
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• 1994

Signet ring cell carcinoma has been previously described in many organs, most frequently in the stomach, and rarely in the colon, rectum, gallbladder, pancreas, breast, nadsal cavity, prostate, urinary bladder and ureter. Signet ring cell carcinomas in the lung, especially, when examined by small biopsies, are generally believed to be metastatic. This case was diagnosed by bronchoscopic biopsy. We also examined various organs by noninvasive method, including UGI series, barium enema and abdomen CT scan, but all studies were nomal. Patient received cisplatin and etoposide combination chemotherapy followed by local radiotherapy as a primary non-small cell lung cancer. Patient died of his disease 6 months after diagnosis. Now we report a case of primary signet ring cell carcinoma of the lung.

• The Journal of Pediatrics of Korean Medicine
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• v.32 no.4
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• pp.51-62
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• 2018

Objectives The purpose of this study is to analyze the characteristic of pediatric patients who visited oriental medical hospital for growth treatment. Methods The study was conducted with 130 pediatric patients who visited ${\bigcirc}{\bigcirc}$ Korean medicine hospital from January 2016 to August 2017. The patient's data was classified by sex, age, pattern identification and diseases. The classified data was analyzed to find the correlations and characteristics among variables. Results There were 50.8% of boys and 49.2% of girls. 6.2% of the total patients were in 'early childhood', 50.8% were in 'late childhood' and 43.1% were in 'puberty' stage. In terms of pattern identification, 44.6% of the total patients were 'Spleen-lung Qi Deficiency', 53.8% were 'Lung-kidney Yin Deficiency' and 1.5% were 'Weakness of Heart and gallbladder'. 44.3% of the patients had various diseases including rhinitis (77.6% of 120.7%). Height percentile of the children with using the Growth chart of 2017 was lower than using the Growth chart of 2007. Predicted height based on the child's bone-age were higher than the predicted height based on the parental height, although both of the precited factors were correlated to the current child's height. Conclusions This study showed the characteristic of the pediatric patients who visited oriental medical hospital for growth treatment. It helps to determine prognosis and treatment, and to explain treatment measures.

• The Korea Journal of Herbology
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• v.28 no.6
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• pp.25-29
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• 2013

Objectives : The dried root of Sophora flavescens Aiton have been used to treat patient with skin diseases such as eczema in Eastern countries. S. flavescens can clear away heat and dry dampness and purge sthenic-fire from the liver and gallbladder. Recently, anti-allergic effect of S. flavescens has been reported. However, the effect on skin condition of contact dermatitis still remains unknown. Thus, the purpose of this study is to evaluate the efficacy of S. flavescens on contact dermatitis. Methods : In order to investigate the effects of S. flavescens (methanol extract of S. flavescens, MESR) on skin condition, the contact dermatitis was induced in mice skin by using 1-fluoro-2,4-dinitrofluorobenzene (DNFB). As the effective endpoints, skin thickness, skin weight, histopathological change were checked. In addition, effects on skin lesion, body weight and spleen/body weight ratio were also investigated. Results : Topical application of MESR ($500{\mu}g/day$) lowered skin thickness (P < 0.05) and skin weight (P < 0.05), respectively. MESR-treated group showed diminished spongiosis and immune cell infiltration in skin tissues compared to those of non-treated control group. The inhibition of skin lesions was also observed in MESR-treated group. In addition, MESR did not affect body weight gain and spleen/body weight ratio in contrast with those in dexamethasone-treated group. Conclusion : These data suggest that Sophorae Radix could improve skin lesion of contact dermatitis. This indicates the possibility for Sophorae Radix to be used to patients with skin diseases such as contact dermatitis.

• The Journal of Korean Medicine
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• v.34 no.1
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• pp.52-68
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• 2013

Objectives: Hyungsang medicine (HM) is an inspection which emphasizes the relationships between pathological patterns and one's facial or bodily shape, color and movement. The purpose of this study was to review previously published study results of the HM. Methods: The authors reviewed a total of 51 HM-related studies published from 2000 to 2012 found on PubMed and various domestic Oriental medicine journals. Each study was classified into theoretical, diagnostic, or treatment-related category. Results: Theoretical studies were mostly based on the Nei-Ching and Dong-Eui-Bo-Gam texts, and dealt with differences in form between types such as masculine and feminine, the five organ image types, the four-type categorization of body essence, vital energy (Qi), mentality, and Blood, Gallbladder and Bladder, the four-type categorization of fish, bird, horse, and turtle types, and the six meridian types. Research on diagnosis has been performed on diagnostic characteristics of HM, correlation between HM and general coordinative manipulation (GCM), and Hyungsang medicine and ante-disease pattern (未病類型). Studies on treatments could largely be classified as treatments for specific diseases using certain acupuncture or herbal prescriptions based on HM. Treatments were mostly evaluated solely through subjective symptom improvement of patients. Conclusions: Our review results suggest that HM-related studies were focused on the constitutional characteristics and clinical utility of HM. To strengthen the theoretical basis of HM and its clinical utility, clinical trials including randomized, treatment-placebo and blind methods are needed.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.18 no.3
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• pp.180-186
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• 2015

Purpose: Bile duct dilatation is a relatively common sonographic finding; nevertheless, its clinical significance in children is controversial because little research has been done in the area. Therefore, we investigated the natural course and clinical significance of biliary duct dilatation in children. Methods: We performed a retrospective study of 181 children (range, 1-day-old to 17-year-old) in whom dilatation of the intrahepatic duct and/or common hepatic duct and/or common bile duct was detected by abdominal ultrasonography at the Severance Children's Hospital between November 2005 and March 2014. We reviewed and analyzed laboratory test results, clinical manifestations, and clinical course in these patients. Results: Pediatric patients (n=181) were enrolled in the study and divided into two groups. The first group included 59 subjects, without definitive cause of bile duct dilatation, who did not require treatment; the second group included 122 subjects, with definitive cause of bile duct dilatation or underlying biliary disease, who did require treatment. In the first group, 24 patients (40.7%) showed spontaneous resolution of bile duct dilatation, 20 patients (33.9%) showed no change, and 15 patients (25.4%) were lost to follow-up. In the second group, 31 patients were diagnosed with choledochal cysts, and 91 patients presented with biliary tract dilatations due to secondary causes, such as gallbladder or liver disease, post-operative complications, or malignancy. Conclusion: Biliary dilatation in pediatric patients without symptoms, and without laboratory and other sonographic abnormalities, showed a benign clinical course. No pathologic conditions were noted on follow-up ultrasonography.

• Journal of Genetic Medicine
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• v.18 no.2
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• pp.142-146
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• 2021

Alagille syndrome (AGS) is a rare autosomal dominant inherited disorder, with major clinical manifestations of bile duct paucity, cholestasis, cardiovascular anomaly, ophthalmic abnormalities, butterfly vertebrae, and dysmorphic facial appearance. It is caused by heterozygous mutations in JAG1 or NOTCH of the Notch signaling pathway presenting with variable phenotypic penetrance and involving multiple organ systems. The following case report describes a unique case of a 16-year-old female with AGS who presented with the primary complaint of renovascular hypertension. She had a medical history of ventricular septal defect and polycystic ovary syndrome. The patient had a dysmorphic facial appearance including frontal bossing, bulbous tip of the nose, a pointed chin with prognathism, and deeply set eyes with mild hypertelorism. Stenoocclusive changes of both renal arteries, celiac artery, lower part of the abdominal aorta, and left intracranial artery, along with absence of the left internal carotid artery were found on examination. Whole exome sequencing was performed and revealed a pathologic mutation of JAG1, leading to the diagnosis of AGS. Reverse phenotyping detected butterfly vertebrae and normal structure and function of the liver and gallbladder. While the representative symptom of AGS in most scenarios is a hepatic problem, in this case, the presenting clinical features were the vascular anomalies. Clinical manifestations of AGS are diverse, and this case demonstrates that renovascular hypertension might be in some cases a presenting symptom of AGS.

• Korean Journal of Pharmacognosy
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• v.53 no.3
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• pp.138-144
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• 2022

Obesity is a disease in which an abnormally large amount of fat accumulates in the body. Various diseases such as type 2 diabetes, dyslipidemia, high blood pressure, fatty liver, gallbladder disease, and coronary artery disease are induced. In this study, we investigated the effect of betaone, a type of barley, on obesity suppression. After the betaone extract was treated with 3T3 L1 adipocytes, the effect on adipocyte formation was investigated through Oil Red O staining. It was observed that differentiation was inhibited without affecting the viability of 3T3 L1 adipocytes. The effect of betaone extract on obesity inhibition in a mouse model was investigated. As a result of administering betaone extract after a high-fat diet, it was confirmed that the level of blood sugar and body weight was decreased, and glucose uptake ability was improved in a glucose tolerance test. The formation of mouse adipose tissue was suppressed, and the expression of genes involved in the formation and degradation of obesity in liver tissue was improved. These results suggest that betaone extract is a useful substance for improving obesity and is an excellent material for health functional food.