• 한국간담췌외과학회지
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• 제28권1호
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• pp.42-47
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• 2024

Backgrounds/Aims: Hepatolithiasis and choledocholithiasis are frequent pathologies and unfortunately, with the current treatment strategies, the recurrence incidence is still high. This study aimed to assess the outcomes of laparoscopic choledochotomy using cholangioscopy via the percutaneous-choledochal tube for the treatment of hepatolithiasis and choledocholithiasis in Vietnamese patients. Methods: A cross-sectional study of patients with hepatolithiasis and/or choledocholithiasis who underwent laparoscopic choledochotomy using intraoperative cholangioscopy via percutaneous-choledochal tube at the Department of Hepatopancreatobiliary Surgery, 108 Military Central Hospital, from June 2017 to March 2020. Results: A total of 84 patients were analyzed. Most patients were females (56.0%) with a median age of 55.56 years. Among them, 41.8% of patients had previous abdominal operations, with 33.4% having choledochotomy. All patients underwent successful laparoscopic common bile duct exploration followed by T-tube drainage without needing to convert to open surgery. Most patients (64.3%) had both intrahepatic and extrahepatic stones. The rate of stones ≥ 10 mm in diameter was 64.3%. Biliary strictures were observed in 19.1% of patients during cholangioscopy. Complete removal of stones was achieved in 54.8% of patients. Intraoperative complications were encountered in two patients, but there was no need to change the strategy. The mean operating time was 121.85 ± 30.47 minutes. The early postoperative complication rate was 9.6%, and all patients were managed conservatively. The residual stones were removed through the T-tube tract by subsequent choledochoscopy in 34/38 patients, so the total success rate was 95.2%. Conclusions: Laparoscopic choledochotomy combined with cholangioscopy through the percutaneous-choledochal tube is a safe and effective strategy for hepatolithiasis and/or choledocholithiasis, even in patients with a previous choledochotomy.

• BMB Reports
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• 제45권1호
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• pp.51-56
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• 2012

The purpose of this study was to determine the effects of duration and timing of glucocorticoid treatment on the expansion and differentiation of porcine neonatal pancreas cell clusters (NPCCs) into ${\beta}$-cells. After transplantation of NPCCs, the ductal cyst area and ${\beta}$-cell mass in the grafts both showed positive and negative correlations with duration of dexamethasone (Dx) treatment. Pdx-1 and HNF-3${\beta}$ gene expression was significantly downregulated following Dx treatment, whereas PGC-1${\alpha}$ expression increased. Pancreatic duct cell apoptosis significantly increased following Dx treatment, whereas proliferation did not change. Altogether, transdifferentiation of porcine NPCCs into ${\beta}$-cells was influenced by the duration of Dx treatment, which might have been due to the suppression of key pancreatic transcription factors. PGC-1${\alpha}$ plays an important role in the expansion and transdifferentiation of porcine NPCCs, and the initial 2 weeks following transplantation of porcine NPCCs is a critical period in determining the final ${\beta}$-cell mass in grafts.

• Clinical Endoscopy
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• 제56권6호
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• pp.802-811
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• 2023

Background/Aims: Covered self-expandable metallic stents (cSEMS) have become popular for endoscopic ultrasound-guided hepaticogastrostomy with transmural stenting (EUS-HGS). We compared the time to recurrent biliary obstruction (TRBO), complications, and reintervention rates between EUS-HGS using plastic stent (PS) and cSEMS in patients with unresectable malignancies at multicenter institutions in Japan. Methods: Patients with unresectable malignant biliary obstruction who underwent EUS-HGS between April 2015 and July 2020 at any of the six participating facilities were enrolled. Primary endpoint: TRBO; secondary endpoints: rate of complications other than recurrent biliary obstruction and technical success rate of reintervention were evaluated. Results: PS and cSEMS were used for EUS-HGS in 109 and 43 patients, respectively. The TRBO was significantly longer in the cSEMS group than in the PS group (646 vs. 202 days). Multivariate analysis identified two independent factors associated with a favorable TRBO: combined EUS-guided antegrade stenting with EUS-HGS and the use of cSEMS. No significant difference was observed in the rate of complications other than recurrent biliary obstruction between the two groups. The technical success rate of reintervention was 85.7% for PS and 100% for cSEMS (p=0.309). Conclusions: cSEMS might be a better option for EUS-HGS in patients with unresectable malignancies, given the longer TRBO.

• 대한수의학회지
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• 제32권4호
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• pp.497-510
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• 1992

This study was attempted to comparative investigate the types and regional distribution of the endocrine cells in several vertebrates immunohistochemically using seven antisera. From carp pancreas could be observed 4 types which are insulin-, glucagon-, som- and BPP-immunoreactive cells. Insulin-immunoreactive cells were mainly distributed at the periphery and a few cells occupied the central region of the islets. Glucagon-immunoreactive cells were distributed at the periphery of the islets, and som - and BPP-immunoreactive cells were located at the central region. From frog pancreas could be observed 4 types which are insulin-, glucagon-, som- and BPP-immunoreactive cells. Insulin-immunoreactive cells were distributed throughout the islets. Som-immunoreactive cells were distributed at the periphery of the islets, and glucagon- and BPP-immunoreactive cells were found as single cell or as small groups located between the pancreatic acini. From snake pancreas could be observed 3 types which are insulin-, glucagon- and som -immunoreactive cells. Insulin-immunoreactive cells were distributed throughout the small islets, and they also were scattered at the periphery of the large islets. Glucagon-immunoreactive cells were distributed at the periphery of the islets, whereas som-immunoreactive cells were occupied the central region. From Ogolgae pancreas could be observed 4 types which are insulin-, glucagon-, som-and BPP-immunoreactive cells. Insulin-immunoreactive cells were distributed throughout the small islets, but at the periphery of the large one. Glucagon- immunoreactive cells were distributed at the periphery of the small islets and in the large islets showed scattering entired. Som-immunoreactive cells were distributed at the periphery of the small islets and in the large islets were located at the central region. A small numbers of BPP-immunoreactive cells were located at the periphery of the small islets and the exocrine regions. From the pancreas of the Korean native goat could be observed 6 types which are insulin-, glucagon-, som-, BPP-, 5-HT- and porcine-CG-immunoreactive cells. Insulin-immunoreactive cells were distributed throughout the islets. Som-immunoreactive cells were located at the periphery of the islets, but a tew were scattered at the central region of islets and in the epithelium of the secretory duct. Glucagon-, BPP-, 5-HT- and porcine CG-immunoreactive cells were distributed at the periphery of the islets. These findings indicated that the regional distribution patterns and cell types of pancreatic endocrine cells in vertebrates varies considerably among phylogenetically different vertebrates.

• 대한방사선기술학회지:방사선기술과학
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• 제25권2호
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• pp.65-70
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• 2002

1997년 8월부터 2002년 5월까지 서울아산병원에 내원하여 췌관결석 진단을 받은 후, 내시경적 결석제거에 실패하고 ESWL을 시행받은 59명을 대상으로 하였다. 췌관 결석의 방사선학적 특징을 결석 수, 가장 큰 결석의 최대 직경 길이, 결석의 농도, 그리고 생긴 모양으로 분류하였다. 전체대상 59예 중 45예(76.3%)에서 결석의 완전한 제거가 확인되었으며 14예(23.7%)에서는 결석의 완전한 제거에는 실패한 것으로 확인되었다. 1. 단일 결석을 가진 28예 중 21예(75.0%)에서 결석이 완전 제거되었으며, 두 개 이상의 다결석을 가진 31예 중 24예(77.4%)에서 결석이 완전 제거되었다. 2. 결석의 최대 직경이 30m 이하의 경우인 53예 중 41예(77.4%)에서 결석의 완전한 제거가 확인되었으며, 30mm 보다 큰 경우인 6예 중 4예(66.7%)에서 결석의 완전한 제거가 확인되었다. 3. 척추의 체부(body)와 비교한 결석의 농도측면에서, 척추의 체부 보다 농도가 낮은 경우, 즉 비석회화 결석 8예 중 8예(100%) 모두에서 결석이 완전 제거되었으며, 농도가 같은 경우인 43예에서는 37예(86.0%)가 결석의 완전한 제거를 보였으나, 농도가 척추 체부 보다 높은 3예 중 3예(100%) 모두에서 결석의 완전한 제거에 실패하였으며, rim calcified stone 5예 중 5예(100%) 모두에서 또한 결석의 완전한 제거에 실패하였다. 4. 각이진 모양의 결석 9예 중 2예(22.2%)에서 결석이 완전 제거되었으며, 그렇지 않은 원형이나 타원형 모양의 경우인 50예 중 43예(86.0%)에서 결석의 완전한 제거를 확인하였다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제17권3호
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• pp.170-177
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• 2014

Purpose: Choledochal cyst is a cystic dilatation of common bile duct. Although the etiology is presently uncertain, anomalous pancreaticobiliary ductal union (APBDU) is thought to be a major etiology of choledochal cyst. In this study, we analyzed the clinical and anatomical characteristics and pathologies of patients diagnosed with choledochal cyst in a single institute for 25 years. Methods: A total of 113 patients, diagnosed with choledochal cyst and who received an operation in Severance Children's Hospital from January 1988 to May 2013, were included. Medical records were reviewed, including clinical and demographic data, surgical procedures. Abdominal ultrasonography, magnetic resonance cholangiopancreatography, and intraoperative cholangiography were used as diagnostic tools for evaluation and classification of choledochal cyst and the presence of anomalous pancreaticobiliary ductal union. Todani's classification, and relationship between APBDU and surgical pathology. Results: Among 113 patients, 77 patients (68.1%) presented symptoms such as hepatitis, pancreatitis and/or cholecystitis. Eighty three patients (73.5%) had APBDU, and 94 patients (83.2%) showed inflammatory pathologic changes. APBDU, pathologic inflammation, and serological abnormalities such as hepatitis or pancreatitis showed a statistically significant correlation to one another. Conclusion: APBDU is thought to be one of the etiologic factors of choledochal cyst. It is related to the inflammatory changes in bile duct that can lead to the cystic dilatation.

• The Korean Journal of Physiology and Pharmacology
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• 제8권6호
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• pp.335-338
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• 2004

There are numerous studies on transepithelial transports in duct cells including $Cl^-$ and/or $HCO_3^-$. However, studies on transepithelial $K^+$ transport of normal duct cells in exocrine glands are scarce. In the present study, we examined the characteristics of $K^+$ currents in single duct cells isolated from guinea pig pancreas, using a whole-cell patch clamp technique. Both $Cl^-$ and $K^+$ conductance were found with KCI rich pipette solutions. When the bath solution was changed to low $Cl^-$, reversal potentials shifted to the negative side, $-75{\pm}4\;mV$, suggesting that this current is dominantly selective to $K^+$. We then characterized this outward rectifying $K^+$ current and examined its $Ca^{2+}$ dependency. The $K^+$ currents were activated by intracellular $Ca^{2+}$. 100 nM or 500 nM $Ca^{2+}$ in pipette significantly (P<0.05) increased outward currents (currents were normalized, $76.8{\pm}7.9\;pA$, n=4 or $107.9{\pm}35.5\;pA$, n=6) at +100 mV membrane potential, compared to those with 0 nM $Ca^{2+}$ in pipette $(27.8{\pm}3.7\;pA,\;n=6)$. We next examined whether this $K^+$ current, recorded with 100 nM $Ca^{2+}$ in pipette, was inhibited by various inhibitors, including $Ba^{2+}$, TEA and iberiotoxin. The currents were inhibited by $40.4{\pm}%$ (n=3), $87.0{\pm}%$ (n=5) and $82.5{\pm}%$ (n=9) by 1 mM $Ba^{2+}$, 5 mM TEA and 100 nM iberiotoxin, respectively. Particularly, an almost complete inhibition of the current by 100 nM iberiotoxin further confirmed that this current was activated by intracellular $Ca^{2+}$. The $K^+$ current may play a role in secretory process, slnce recycling of $K^+$ is critical for the initiation and sustaining of $CI^-$ or $HCO_3^-$ secretion in these cells.

• Journal of Digestive Cancer Research
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• 제10권2호
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• pp.92-98
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• 2022

Self-expandable metal stent (SEMS) is effective for biliary drainage, especially in pancreaticobiliary cancer. The mechanical properties, material, and design of SEMS are important in preventing recurrent biliary obstruction and complication. Radial and chronic expansion forces play roles in preventing stent migration and collapse. Complications, such as stent impaction, cholecystitis, and pancreatitis, were related to the axial force. The nickel-titanium alloy shows more flexibility, conformability, and optimal axial force compared to previously used stainless steel. Additionally, the stent structure affected the mechanical properties of SEMS. Therefore, understanding the mechanical properties, material, and design of SEMS will provide the best outcome for biliary drainage, as well as better SEMS development.

• Journal of Digestive Cancer Research
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• 제11권2호
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• pp.93-98
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• 2023

Ampullary tumor is a rare disease whose prevalence rate has increased gradually in recent years with the increase in endoscopic examinations. Ampullary lesions are observed via endoscopy, and biopsy is done to determine whether such lesions are adenomas or carcinomas. Endoscopic papillectomy is performed on ampullary adenomas without intraductal lesions. Before the procedure, bleeding tendencies and pancreatitis are assessed, and the lesion is resected using a high-frequency wave and a thin wire snare. Thereafter, pancreatic duct stent insertion or clipping of the resection site is performed to prevent postprocedural pancreatitis. Although 47-93% of the patients achieve complete endoscopic papillary resection, the recurrence rate is 5-31%. Hence, regular follow-up via endoscopy is required.

• Clinical Endoscopy
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• 제56권2호
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• pp.261-261
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• 2023