• 한국임상수의학회지
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• 제25권4호
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• pp.295-302
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• 2008

Two dogs were referred to Veterinary Medical Center, Chungbuk National University with the clinical signs of vomiting, diarrhea, anorexia, and jaundice. Both dogs were diagnosed as extrahepatic biliary tract obstruction(EHBO) with concurrent pancreatitis based on dilated common bile duct and hyperechoic or mixed-echoic pancreas in abdominal ultrasonographic examination and serum biochemical abnormalities, such as high serum bilirubin, cholesterol, and increased cholestatic enzyme activity. Percutaneous ultrasound-guided cholecytocentesis(PUCC) was performed to examine bile and decompress the gall bladder. After PUCC with medical therapy, both dogs were steadily improved clinical signs of jaundice and anorexia. Also, cholestatic enzyme activity and serum bilirubin concentration decreased. Any complications that have been described in previous studies, such as peritonitis resulting from bile leakage and hemorrhage, were not identified. It is assumed that percutaneous ultrasound guided cholecystocentesis may be an useful diagnostic and therapeutic tool in canine gallbladder disease and can be used easily and safely to gain bile for diagnosis of bacterial cholecytitis.

• Clinical Endoscopy
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• 제56권2호
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• pp.143-154
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• 2023

Advanced malignant hilar biliary obstruction (MHBO) with inaccessible papilla poses a significant challenge to endoscopists, as drainage of multiple liver segments may be warranted. Transpapillary drainage may not be feasible in patients with surgically altered anatomy, duodenal stenosis, prior duodenal self-expanding metal stent, and after initial transpapillary drainage, but require re-intervention for draining separated liver segments. Endoscopic ultrasound-guided biliary drainage (EUS-BD) and percutaneous trans-hepatic biliary drainage are the feasible options in this scenario. The major advantages of EUS-BD over percutaneous trans-hepatic biliary drainage include a reduction in patient discomfort and internal drainage away from the tumor, thus reducing the possibility of tissue or tumor ingrowth. With innovations, EUS-BD is helpful not only for bilateral communicating MHBO but also for non-communicating systems with bridging hilar stents or isolated right intra-hepatic duct drainage by hepatico-duodenostomy. EUS-guided multi-stent drainage with specially designed cannulas and guidewires has become a reality. A combined approach with endoscopic retrograde cholangiopancreatography for re-intervention, interventional radiology, and intraductal tumor ablative therapies has been reported. Stent migration and bile leakage can be minimized with proper stent selection and technique, and stent blocks can be managed with EUS-guided interventions in a majority of cases. Future comparative studies are required to establish the role of EUS-guided interventions in MHBO as rescue or primary therapy.

• 한국간담췌외과학회지
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• 제27권3호
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• pp.322-327
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• 2023

Situs inversus totalis (SIT) is a rare condition in which cardiac and abdominal organs are inverted from their normal left-sided orientation. Mirizzi syndrome, characterized by the obstruction of the common hepatic duct or the common bile duct by gallstone, is a rare condition. Mirizzi syndrome co-occurrence in SIT patients is rare. Gallbladder in sinistroposition is extremely uncommon in SIT patients. We report a known case of diabetes, ventricular septal defect with transposition of the great arteries in a 32-year-old female who presented with jaundice, cholangitis, chills, and fever that had lasted for 10 days. She was confirmed to have SIT with type III Mirizzi syndrome following a series of diagnostic procedures. Primarily, endoscopic retrograde cholangiopancreatography along with common bile duct stenting was performed to initially reduce cholangitis. After an eight-week follow-up after the reduction of cholangitis, surgery was conducted. Mirror-imaged ports were used for the laparoscopic procedure, and the surgeon was on the patient's right side rather than the usual left side. The patient was discharged from the hospital following two days of uneventful healing.

• 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.

• The Korean Journal of Pancreas and Biliary Tract
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• 제22권4호
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• pp.165-171
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• 2017

배경/목적: 담도암에서 플라스틱 스텐트 너비에 따른 스텐트 생존 차이에 대한 데이터는 부족하다. 이번 연구의 목적은 담도암에서 7-프렌치와 10-프렌치 플라스틱 스텐트의 생존 차이를 보고 어떤 인자가 개방성에 영향을 미치는지 확인하고자 한다. 방법: 2010년 1월부터 2014년 10월까지 연세대학교 원주세브란스기독병원에서 담도암으로 담도가 막힌 환자들을 등록하였다. 결과: 총 215명(7-프렌치:10-프렌치 = 89명:126명)의 환자를 후향적으로 등록하였다. 암의 위치는 총담관(111명), 간문부 담관(45명), 바터팽대부(59명)였다. 스텐트 이동이나 폐쇄는 두 군 간에 통계적 차이가 없었다. 중앙 스텐트 생존은 7-프렌치의 경우 3.3개월이었고 10-프렌치의 경우 5.9개월이었다(p = 0.543). 플라스틱 스텐트 너비는 스텐트 생존에 영향을 미치지 않았다(Hazard Ratio: 1.11, 95% CI 0.71-1.73, p = 0.649). 결론: 담도암 치료에 있어 7-프렌치와 10-프렌치 플라스틱 스텐트는 스텐트 이동이나 폐쇄 차이가 없었고 스텐트 생존에 있어 7-프렌치 플라스틱 스텐트가 10-프렌치에 비해 열등하지 않았다.

• Journal of Yeungnam Medical Science
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• 제7권1호
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• pp.165-171
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• 1990

영남대학교 의과대학 외과학교실에서는 1989년 11월에 한국에서 발병한 간흡충병의 여섯번째 증례로, 특히 간내 담관에 발생한 첫 증례를 우측 간엽 절제술 및 담낭 적출술로 좋은 결과를 얻었으며, 간내 담관에 발생한 경우에는 간암과의 구별이 요구되어야 한다는 점을 상기 시키면서 증례보고와 더불어 문헌적 고찰을 하였다.

• BMB Reports
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• 제29권2호
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• pp.142-145
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• 1996

To investigate the cause of increased plasma catecholamine levels in liver disease, catechol-O-methyltransferase (COMT), which provides a major route of catabolism for circulating catecholamines, was studied under the cholestasis induced by mechanical biliary obstruction in rats. Monoamine oxidase (MAO) activity and the $K_m$ and $V_{max}$ values for both enzymes were also measured. Cytosolic, microsomal, and mitochondrial COMT activities in the cholestatic liver were significantly decreased throughout the experiment. Microsomal, and mitochondrial MAO activity in the cholestatic liver were also significantly decreased. Vmax values of COMT and MAO were lower. Serum COMT and MAO activities were detected after CBD ligation. These results indicate that plasma catecholamine levels are increased in liver disease due to decreased hepatic degradation of catecholamines by decreased activities of COMT and MAO. The decreased activity of these enzymes is caused by decreased biosynthesis and by flowage into the blood from the damaged hepatocyte.

• Parasites, Hosts and Diseases
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• 제49권1호
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• pp.65-68
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• 2011

A case of Fasciola gigantica-induced biliary obstruction and cholestasis is reported in Turkey. The patient was a 37-year-old woman, and suffered from icterus, ascites, and pain in her right upper abdominal region. A total of 7 living adult flukes were recovered during endoscopic retrograde cholangiopancreatography (ERCP). A single dose of triclabendazole was administered to treat possible remaining worms. She was living in a village of southeast of Anatolia region and had sheeps and cows. She had the history of eating lettuce, mallow, dill, and parsley without washing. This is the first case of fascioliasis which was treated via endoscopic biliary extraction during ERCP in Turkey.

• 한국임상수의학회:학술대회논문집
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• 한국임상수의학회 2009년도 춘계학술대회
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• pp.300-300
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• 2009

• 약학회지
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• 제46권3호
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• pp.192-196
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• 2002

To investigate the effect of intravenous ethanol administration on pancreatic exocrine secretion, we measured volume and protein amount in pancreatic juice and assayed amylase activity and phospholipase $A_2$ activity in pancreatic fragments and serum. Acute pancreatitis induced by obstruction of common bile-pancreatic duct (CBPD) and caerulein infusion (5 $\mu\textrm{g}$/kg/hr) showed typical characteristics, such as hyperamylasemia and pancreatic edema and increase of phospholipase $A_2$ activity in pancreatic fragments and serum. Intravenous ethanol infusion (50 mg/kg/hr) significantly stimulated pancreatic exocrine secretion, but such a stimulatory effect of ethanol disappeared at dose of 100 mg/kg/hr without typical symptoms of acute pancreatitis. In microscopic examination, there were no typical changes of edematous pancreatitis in ethanol administrated rats. These results suggest that acute ethanol administration has dual effect on exocrine pancreatic secretion: low dose of ethanol (50 mg/kg/hr) stimulates pancreatic exocrine secretion, whereas high dose of ethanol (100 mg/kg/hr) does not without typical changes of edematous pancreatitis.