• Journal of Digestive Cancer Research
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• 제7권1호
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• pp.18-21
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• 2019

Serine protease inhibitor Kazal-type 1 (SPINK1) is a gene expressed from pancreatic acinar cell which its mutation is known to be associated with chronic pancreatitis (CP) and pancreatic cancer. We report a case of a 47-years-old female with nausea and weight loss with yellow discoloration of skin. Initial imaging and endoscopic study led us to an impression of chronic pancreatitis with pancreatic cancer with common bile-duct dilation. Biopsy result was confirmed with pancreatic adenocarcinoma and additional imaging revealed lymph node and bone metastasis. Our genetic analysis revealed 194+2T>C mutation of SPINK1. Biliary obstruction was successfully decompressed by stent insertion and underwent chemotherapy and radiotherapy. Although there is accumulating evidence of association between SPINK1 mutation and CP, the relationship between SPINK1 mutation and pancreatic cancer in CP patient is an emerging concept. Genetic analysis should be considered in patients with young age especially when diagnosed with both CP and pancreatic cancer.

• 한국간담췌외과학회지
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• 제26권4호
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• pp.407-411
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• 2022

Mesenchymal hamartoma of the liver (MHL) is a rare benign tumor that often presents in early childhood, and it rarely occurs in adulthood. Aberrant development of the portal tract is a known cause of MHL. Although limited information is available on the natural course of MHL, malignant transformation has been reported in a few cases. Here, we report a case of a 26-year-old female with intrahepatic cholangiocarcinoma secondary to unresected MHL. The patient underwent resection of the hepatic mass, which was diagnosed as MHL at 2 years of age, due to an increase in mass size and a suspicion of malignant transformation during work-up. Histopathology confirmed intrahepatic adenosquamous carcinoma in the background of MHL, with a T2N0M0 pathological stage (stage II). The surgical margin was free from tumor cells. The patient fully recovered postoperatively and started receiving adjuvant chemotherapy. Previous case reports have only reported about the development of undifferentiated embryonal sarcoma or angiosarcoma as malignant transformation of MHL. Cases of other malignancies have not been published; however, it is difficult to rule out the occurrence of various malignancies related to the portal tract when considering the pathogenesis of the disease. To the best of our knowledge, this is the first case report of adenocarcinoma of bile duct origin secondary to MHL. This case report suggests that aggressive surgical management should be considered after the initial diagnosis of MHL.

• 한국간담췌외과학회지
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• 제26권2호
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• pp.159-167
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• 2022

Backgrounds/Aims: The optimal timing of percutaneous transhepatic gallbladder drainage (PTGBD) and subsequent laparoscopic cholecystectomy (LC) according to the severity of acute cholecystitis (AC) has not been established yet. Methods: This single-center, retrospective study included 695 patients with grade I or II AC without common bile duct stones who underwent PTGBD and subsequent LC between January 2010 and December 2019. Difficult surgery (DS) (open conversion, subtotal cholecystectomy, adjacent organ injury, transfusion, operation time ≥ 90 minutes, or estimated blood loss ≥ 100 mL) and poor postoperative outcome (PPO) (postoperative hospital stay ≥ 7 days or Clavien-Dindo grade ≥ II postoperative complication) were defined to comprehensively evaluate intraoperative and postoperative outcomes, respectively. Results: Of 695 patients, 403 had grade I AC and 292 had grade II AC. According to the receiver operating characteristic curve and multivariate logistic regression analyses, an interval from symptom onset to PTGBD of > 3.5 days and an interval from PTGBD to LC of > 7.5 days were significant predictors of DS and PPO, respectively, in grade I AC. In grade II AC, the timing of PTGBD and subsequent LC were not statistically related to DS or PPO. Conclusions: In grade I AC, performing PTGBD within 3.5 days after symptom onset can reduce surgical difficulties and subsequently performing LC within 7.5 days after PTGBD can improve postoperative outcomes. In grade II AC, early PTGBD cannot improve the surgical difficulty. In addition, the timing of subsequent LC is not correlated with surgical difficulties or postoperative outcomes.

• 한국간담췌외과학회지
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• 제26권3호
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• pp.277-280
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• 2022

Backgrounds/Aims: Biliary colic is a common cause of emergency department (ED) visits; however, the natural history of the disease and thus the indications for urgent or scheduled surgery remain unclear. Limitations of previous attempts to elucidate this natural history at a population level are based on the reliance on the identification of biliary colic via administrative codes in isolation. The purpose of our study was to validate the use of International Statistical Classification of Diseases and Related Health Problems codes, 10th Revision, Canadian modification (ICD-10-CA) from ED visits in adequately differentiating patients with biliary colic from those with other biliary diagnoses such as cholecystitis or common bile duct stones. Methods: We performed a retrospective validation study using administrative data from two large academic hospitals in Toronto. We assessed all the patients presenting to the ED between January 1, 2012 and December 31, 2018, assigned ICD-10-CA codes in keeping with uncomplicated biliary colic. The codes were compared to the individually abstracted charts to assess diagnostic agreement. Results: Among the 991 patient charts abstracted, 26.5% were misclassified, corresponding to a positive predictive value of 73% (95% confidence interval 73%-74%). The most frequent reasons for inaccurate diagnoses were a lack of gallstones (49.8%) and acute cholecystitis (27.8%). Conclusions: Our findings suggest that the use of ICD-10 codes as the sole means of identifying biliary colic to the exclusion of other biliary pathologies is prone to moderate inaccuracy. Previous investigations of biliary colic utilizing administrative codes for diagnosis may therefore be prone to unforeseen bias.

• 한국간담췌외과학회지
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• 제28권3호
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• pp.364-370
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• 2024

Backgrounds/Aims: We evaluated long-term pancreatic functional outcomes, including pancreatic volumetry after pancreaticoduodenectomy (PD) for peri-ampullary neoplasm. Methods: We retrospectively reviewed 353 patients with a 12-month follow-up who underwent elective pancreaticoduodenectomies for peri-ampullary neoplasms at a single university hospital between January 2011 and December 2020. Perioperative and postoperative outcomes, long-term pancreatic endocrine functions, and pancreatic volume changes 12 month postoperatively were evaluated. Results: The mean age was 65.4 years, and the sex ratio was 1.38. The patients with prediagnosed diabetes mellitus (DM) comprised 31.4%. The peri-ampullary neoplasm origins were: the pancreas (49.0%), common bile duct (27.2%), ampulla of Vater (18.4%), and duodenum (5.4%). The 1-week, and 3-, 6-, and 12-month postoperative proportions of patients with DM diagnosed before surgery combined with new-onset postoperative DM were 39.7%, 42.8%, 43.9%, and 49.6%, respectively. The preoperative and postoperative 1-week, and 3-, 6-, and 12-month mean pancreatic volumes were 82.3, 38.7, 28.1, 24.9, and 25.5 mL, respectively. Univariate risk factor analyses for new-onset DM after PD observed no significant difference between the 'No DM after PD' and 'New-onset DM after PD' groups. Conclusions: Following PD for peri-ampullary neoplasms, pancreatic endocrine functions and volumes continued to decrease for a minimum of 12 months. The current study did not identify any causal relationship between pancreatic endocrine dysfunction and pancreatic atrophy following PD.

• Clinical Endoscopy
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• 제57권4호
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• pp.508-514
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• 2024

Background/Aims: This study aimed to examine the synergistic effect of independent risk factors on post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Methods: This multicenter retrospective study included 1,273 patients with native papillae who underwent ERCP for bile duct stones in Japan. Independent PEP risk factors were identified using univariate and multivariate analyses. Significant risk factors for PEP in the multivariate analysis were included in the final analysis to examine the synergistic effect of independent risk factors for PEP. Results: PEP occurred in 45 of 1,273 patients (3.5%). Three factors including difficult cannulation ≥10 minutes, pancreatic injection, and normal serum bilirubin level were included in the final analysis. The incidences of PEP in patients with zero, one, two, and three factors were 0.5% (2/388), 1.9% (9/465), 6.0% (17/285), and 12.6% (17/135), respectively. With increasing risk factors for PEP, the incidence of PEP significantly increased (1 factor vs. 2 factors, p=0.006; 2 factors vs. 3 factors, p=0.033). Conclusions: As the number of risk factors for PEP increases, the risk of PEP may not be additive; however, it may multiply. Thus, aggressive prophylaxis for PEP is strongly recommended in patients with multiple risk factors.

• 사상체질의학회지
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• 제7권2호
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• pp.59-88
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• 1995

Three groups have participated in this study. 1) The first group consists of 57 patients were who had been treated in the Oriental Medical Hospital at Kyung Hee Medical Center. 2) The second group consists of 37 outpatients who had been treated in the Oriental Medical Hospital at Kyung Hee Medical Center. 3) The third group consists of 76 students of the Oriental Medical School at Kyung Hee University. The following conclusions were made in comparison with EAV measurement values, SaSang Constitution Classfication and CVA. 1. The following conclusions were made in comparison with EAV measurement values and Type(SaSang Constitution Classfication). 1) The analsis of the Correlation in Normal group with EAV measurement values and Type(SaSang Constitution Classfication). 2) The analysis of the correlation in patient group with EAV measurement values showed significant differences in Right meridians(Nerval degeneration vessel, Circulation, Allergy) and in Left meridian(Liver). 3) The analysis of the correlation in Total(Normal+patient)group with EAV measurement values showed significant differences in Right meridians(Large intestine, Nerval degeneration vessel, Circulation, Allergy, Pancreas) and in Left meridians(Lymph vessel, Nerval degeneration vessel, Spleen, liver). 4) The above results showed common-significant differences in Right Allery meridian and in Left Liver meridian. 2. The analysis of the correlation in EAV measurement values and Group (Cerebrovascular accident) showed significant differences in Right meridians(Lymph vessel, Lung, Nerval degeneration vessel, Allergy, Paren & Epith. degeneration vessel, Triple warmer, Heart, Pancreas, Stomach, Fibroid degeneration vessel, Skin, Fatty degeneration vessel, Heart, Stomach, Fibroid degeneration vessel, Skin, Fatty degeneration vessel, Bile duct, Kidney). 3. The analysis of the correlation in EAV measurement values and Para(GROUPS according to PARALYSIS)showed significant differences in Left Stomatch meridian. The analysis of the correlation in EAV measurement values and Para(GROUPS according to PARALYSIS) about the differance of right measurement values and left measurement values showed significant differences in Nerval degeneration vessel, Stomatch, Gall bladder & Bile duct, Kidney and Urinary Bladder meridians. 4. The analysis of the correlation in EAV measurement values and Compl(GROUPS according to COMPLICATION with CVA)showed significant differences in Right meridians(Lymph vessel, Articular degeneration vessel, Fatty degeneration vessel) and in Left meridians(Lung, Stomatch, Fatty degeneration vessel). 5. The analysis of the correlation in Type and MORPHOROGICAL DIAGRAMING (HTOUPS according to MORPHOROGY) showed significant differences in Cranium region, Chest region, Stomatch region and Umbilicum region. 6. The analysis of the correlation in BAZ measurement values and Group(Cerebral Vascular Attack)showed significant differences, the analysis on the correlation of BAZ measurement values and Type(SaSang Constitution Classfication) didn't show any significant differences. 7. In comparison with Actual measurement vales and Voll's measurement values, BAZ measurement values agree with Voll's measurement values but CMP measurement values lower than the Voll's measurement values. Later We have to research further about classifications of race, age, sex etc. The EAV measurement values have Group(Cerebrovascular accident) more correlative than Type(SaSang Constitution Classfication). The EAV may well be that it will be used as an accessory method in SaSang Constitution Classfication and as a diagnostic method in medicine too.

• 생명과학회지
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• 제21권12호
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• pp.1772-1777
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• 2011

본 연구는 흰쥐의 담관 세포와 간세포에서 CFTR과 $AE1{\cdot}AE2{\cdot}AE3$ 유전자들의 발현 유무를 조사하고 흰쥐에서 담관 결찰 후 AE2 유전자의 발현의 변화를 관찰하고자 하였다. 200-250 g의 Sprague Dawley 계 흰쥐 24마리의 총담관을 결찰한 후 4 주 동안 1 주일에 6마리씩 희생하여 간세포와 담관 세포를 분리하였다. 6마리는 대조군으로 사용하여 간세포와 담관 세포에서 CFTR 유전자와 $AE1{\cdot}AE2$와 AE3 유전자 발현을 조사하고 담관 결찰 후 1 2 3 4주 간격으로 AE2 유전자 발현을 조사하였다. $AE1{\cdot}AE2$ 와 AE3는 간세포와 담관 세포에서 발현되었고 CFTR은 담관 세포에서만 발현되었다. 담관 결찰 담관세포군에서 AE2 유전자의 발현은 대조군인 정상 담관세포군에 비해서 낮았다. 결찰 담관세포군에서 AE2 유전자의 발현은 결찰 기간에 따라 차이가 없었다. 담관 결찰 간세포군에서 AE2 유전자의 발현은 대조군인 정상 간세포군에 비해서 경계적 유의성을 보이며 증가하는 경향이 있었다. 결찰 간세포군에서 AE2 유전자의 발현은 결찰 기간에 따라 차이는 없었다. 따라서 $CFTR{\cdot}AE1{\cdot}AE2$ 그리고AE3 는 간세포와 담관 세포에서 중탄산염이온과 수액을 매개하는 주된 이온 전달체라는 사실을 고려할 때 담도 담즙정체 간질환에서CFTR과 AE2 발현의 변화는 병리학적 기전에 중요한 역할을 할 수 있으리라고 생각된다.

• 한국방사선학회논문지
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• 제15권7호
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• pp.983-989
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• 2021

본 연구에서는 환자상태가 좋지 않은 환자에게 적용하기 위하여 Fast MRCP 검사 방법를 이용한 2D TSE(RT)와 3D GRASE(BH) 기법에 적용하여 영상의 질을 평가하고 임상에 기초자료로 제공하고자한다. MRCP 검사를 시행한 환자 30명(남자 15명, 여자 15명, 평균나이 64±4.26)을 대상으로 데이터를 분석하였다. 사용된 장비는 Ingenia CX 3.0 T 장비를 사용하였고 Data 획득은 Ds anterior Coil을 사용하였다. 정량적 분석으로 각 영상의 SNR과 CNR을 측정하고 정성적 평가를 위해 5등급으로 나누어 영상의 질을 평가하였다. 영상평가는 paired t-test와 wilcoxon 검정을 하였으며 p 값이 0.05 이하 일 때 유의성이 있는 것으로 간주하였다. SNR과 CNR에 대한 정량적 분석 결과 2D TSE(RT) MRCP 와 3D GRASE(BH) 두 기법을 비교했을 때 3D GRASE(BH)가 높게 측정되었다(p<0.05). 정성적 분석결과는 담관의 선예도: 3D GRASE(BH):4.12 ± 0.03, 전반적인 영상의 질: 3D GRASE(BH):4.21 ± 0.91로 높게 나타났다(p=0.001). 담관의 움직임 인공물은 두 기법(2D TSE(RT): 4.41 ± 0.04, 3D GRASE(BH): 4.53 ± 0.14로 유의성 있는 차이를 보이지 않았다(p=0.067). 그러나 배경소거부분은 2D TSE(RT)가 4.14 ± 0.55로 유의성 있는 결과를 얻었다(p=0.001). 결론적으로, Fast MRCP 검사방법을 이용한 결과 3D GRASE (BH)로 획득한 MRCP 영상이 2D TSE(RT)를 사용한 MRCP 영상에 비해 우위의 결과를 얻었다. 그러나, 호흡을 참기 힘든 환자의 경우 2D TSE(RT) MRCP 기법이 유용성이 있는 결과가 있을 것이다.

• Toxicological Research
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• 제21권2호
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• pp.141-150
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• 2005

1,3-Dichloro-2-propanol (1,3-DCP) is known as chloride chemicals and causes severe hepatotoxic agent. The Ito cells and Kupffer's cells of the liver in the 5 old F344 Rats were exposed to 1,3-DCP gas chamber for 6 hours/ a day, 5 days/ a week, and 13 weeks, in the 0, 5, 20, 80 ppm, respectively. After then the body weights, liver weights, and relative liver weight to body weight were measured, and the hepatic tissues were prepared by the routine and Immunostain method, and observed by the LM, and EM. In the results, there were severe body weight decrease (p<0.05) in the 80 ppm of the male and female rats. The relative liver weights to the body weight were increased relate with exposed 1,3-DCP concentration (P<0.001). Inflammatory cells, infiltration was observed at the perivascular area in the 20 ppm exposed group, and bilirubin pigment infiltration, bile duct hyperplasia, inflammation hepatocytic necrosis, fibrosis were observed in the 80 ppm exposure group. In the 80 ppm exposure group, disarrangement of the endothelial cells, erythrocytes and hepatic cell fragment in the Disse space and numerous migration macrophages were observed in the necrotic area by EM observation. In the immunostained hepatic tissues positive stained ED1 cells were extremely increased (P<0.05) in central vein area, but ED2 was weakly positive immunostained in the 80 ppm exposed group. Immunostained desmin was observed in the Ito cell. It was no difference in the low and medium exposed group but it was typical increase in the necrotic area. In conclusion, These results suggest that NOAEL of 1,3-DCP may be 5 ppm in rats and the Immunostained of desmin, ED1 and ED2 positive cells activated in the inflammatory liver were related to the exposure volume and density. The increase of the Ito cells were related to the severe phagocytosis of the Kupffer's cells.