• 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.

• Archives of Pharmacal Research
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• 제22권1호
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• pp.60-67
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• 1999

The object of this work was to study the pharmacokinetic differences and the cause of these differences in cirrhotic rats induced by biliary obstruction when aminophylline (8 mg/kg as theophylline, i.v.) was administered. The concentrations of theophylline and its major metabolite (1,3-dimethyluric acid) in plasma were determined by HPLC. In addition, formation of 1,3-dimethyluric acid from theophylline in microsomes and the changes in the activity of drug metabolizing enzymes, which are suggested to be involved in theophylline metabolism, were determined. In cirrhotic rats, the systemic clearance of theophylline was reduced to 30% of the control value while AUC (area under the palsma concentration-tie curve) and (t1/2)$\beta$ were increased 1.3 fold and3.5 fold, respectively. The formation of 1,3-dimethyluric acid was decreased to 30% of the control value in microsomes of cirrhotic rat liver. In cirrhotic rat liver, activities of aniline hydroxylase (CYP2E1 related), erythromycin-N-demethylase (CYP3A related), and methoxyresorufin-O-demethylase (CYP1A2 related), which were reported to be related with theophyline metabolism, were decreased to 67%, 53%, and 76% that of normal rat liver, respectively. From the results, it can be concluded that in cirrhotic rats induced by biliary obstruction, the total body clearance of theophylline is markedly reduced and it may be due to decreased activity of drug metabolizing enzymes in liver.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제2권2호
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• pp.262-266
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• 1999

Obstruction of the extrahepatic bile ducts is the most common cause of conjugated hyperbilirubinemia in early infancy. More than 90% of such obstructive lesions are accounted for by extrahepatic biliary atresia. A rare lesion is obstruction of the common duct by impacted, thickened secretions and bile. Bile plug syndrome is defined as extrahepatic obstruction of the bile ducts by bile sludge in term infants without anatomic abnormalities, congenital chemical defects of bile, or hepatocellular lesions. Obstruction of extrahepatic ducts by plugs of biliary material apperas to be due to the inspissation and precipitation of bile and mucus within the lumen of the ducts. Cholestasis and precipitation of bile develop in association with abnormal composition of bile in cystic fibrosis, hepatocellular damage, prolonged erythroblastic jaundice, altered biliary dynamics with total parenteral nutrition, gut dysfunction, diuretic therapy, exchange transfusions and perinatal hemolysis. In those cases, the term inspissated bile syndrome is used. The clinical and laboratory findings in bile plug syndrome are identical to those observed in biliary atresia and choledochal cyst. The diagnosis can be suspected based on the findings of clinical and laboratory examinations together with hepatobiliary imaging, ultrasonography, radionuclide scan and liver biopsy. We experienced a case of spontaneous resolution of bile plug syndrome in a 4-year-old girl. We report this case with brief review related literatures.

• 대한수의학회지
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• 제58권4호
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• pp.227-230
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• 2018

A 2-year-old, spayed female, Korean domestic short-hair cat was presented with depression and vomiting. The patient had history of weight loss lasting seven months. Physical examination revealed icterus in the pinna, oral mucosa, and sclera. Based on ultrasonography and computed tomography, tentative diagnosis was extrahepatic biliary tract obstruction with acquired portosystemic shunt (PSS). Tumor or inflammation of hepatobiliary system was suspected as the cause of obstruction of the common bile duct. But it could not be determined without biopsy. The severely dilated cystic duct was considered to cause portal hypertension and secondary multiple PSS. The patient expired without histopathologic examination.

• 한국임상수의학회지
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• 제31권6호
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• pp.531-534
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• 2014

3년령의 암컷 사냥견이 구토, 호흡곤란, 식욕부진을 주증으로 내원 하였다. 환자는 내원 2주 전 멧돼지에 받힌 병력이 있었다. 환자는 방사선사진상 횡격막 탈장 소견, 초음파 검사상 확장된 담도계가 확인되었다. 탐색적 개복술 시 오른쪽 횡격막의 손상이 확인되었고 흉강내에서 일부 간엽과 소장분절, 확장된 담도계를 확인하였다. 수술적 처치로 흉강내 위치하는 복강 장기들을 환원시키고 횡격막 탈장 교정술을 실시하였으며 이후 임상증상, 방사선사진과 초음파 검사 소견은 모두 정상적인 수준으로 회복되었다. 이를 토대로 횡격막 탈장에 의해 속발된 간외담도계폐색으로 진단하였다. 본 증례는 횡격막 탈장에 의해 속발된 간외담도계폐색이 발생한 증례 보고이다.

• 대한영상의학회지
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• 제83권5호
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• pp.979-990
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• 2022

담도폐쇄증은 간외 담도의 진행성, 특발성, 섬유 폐쇄성 염증질환으로 신생아기에 담도 폐쇄가 나타나고 소아 간이식의 가장 흔한 적응증이다. 조기에 치료하지 않으면 간경화가 진행되어 2세 이전에 사망하게 된다. 오늘날 Kasai portoenterostomy와 간이식 수술기법의 발달로 담도폐쇄증 환자의 90% 이상이 성인기까지 생존한다. 따라서 Kasai portoenterostomy의 성공 가능성은 시간이 지날수록 줄어들기 때문에 조기 진단이 매우 중요하다. 이 고찰은 담도폐쇄증의 원인, 분류, 유병률, 임상양상, 치료와 예후를 최신 지견을 중심으로 종합적으로 검토하고자 한다.

• 대한핵의학회지
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• 제22권2호
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• pp.181-185
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• 1988

Since hepatocyte clearance, leading edge parencymal transit time and biliary excretion can be evaluated separately with hepatobiliary scan using $^{99m}Tc-DISIDA$, hepatobiliary scan may be useful in differentiating intrahepatic cholestasis from extrahepatic cholestasis. Excretory liver function was analysed in 13 healthy subjects and 11 patients with clinically suspected hepatocellular disease and 9 patients with extrahepatic biliary obstruction confirmed by surgery, radiological and clinical evidence. Indices of total liver activity (% TLA), liver parechymal uptake (% LPU), heart pool clearance (% HPC) and liver-heart rate (% LHR) were calculated from time activity curve over heart and liver. Compared with healthy subjects, significant reduction (p<0.05) in total liver activity (% TLA) and liver-heart rate (% LHR) was observed in all patients group. But no useful indices was demonstrated in differentiating hepatocellular disease from extrahepatic biliary obstruction.

• 대한세포병리학회지
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• 제2권2호
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• pp.73-78
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• 1991

A total of 362 bile samples from 104 patients with evidence of biliary tract obstruction were submitted for diagnostic cytology from January, 1989 to April, 1991. The patients were classified based on the obstructive cause, and the cytologic results were reviewed. 298 of the specimens were from patients with intrabiliary malignant structure, and 17 were from patients with extrabiliary malignant compression or benign biliary obstruction. Bile cytology was positive for carcinoma in 42 samples from patients with intrabiliary malignant stricture, and the diagnostic sensitivity was 14%. There were no false positive cases. We concluded that the cause of low sensitivity was degenerative change of cell due to prolonged sampling time. What is noteworthy was the high prevalence of Clonorchis sinensis eggs, being detected in 25 patients with intrabiliary malignancy, supporting the association between clonorchiasis and biliary tree malignancy.

• 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.

• 대한영상의학회지
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• 제84권6호
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• pp.1350-1360
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• 2023

목적 악성 담관 폐쇄 환자에서 경피경간 담도 배액술을 시행할 때 유증상 이탈을 유발하는 예측 인자에 대해 연구를 진행하고자 한다. 대상과 방법 2010년 1월부터 2015년 2월까지 572명의 악성 담관 폐쇄 환자에서 시행한 733건의 경피경간 담도 배액술을 대상으로 후향적 연구를 시행하였다. 카테터의 거치 기간, 접근 위치, 카테터 팁의 위치, 삽입 각도, 피그테일 루프의 유무, 도관 직경을 평가하였다. 결과 추적관찰 기간 동안 157명의 환자에서 224건(30.56%)의 도관 이탈이 발생하였다. 그중 146건(19.92%)가 유증상 도관 이탈이었다. 배액관 이탈 발생까지의 기간은 평균 30일(범위: 1-159일)이었다. 유증상 도관 이탈은 배액관의 교체(137명) 또는 담관 스텐트 삽입(9명)을 통해 치료하였다. 남성(교차비: 1.636, 95% 신뢰구간: 1.131-2.367, p = 0.009), 우측 접근(교차비: 1.567, 95% 신뢰구간: 1.080-2.274, p = 0.018), 도관 삽입 각도 증가(교차비: 1.015, 95% 신뢰구간: 1.005-1.026, p = 0.005), 불완전 피그테일 루프(교차비: 1.672, 95% 신뢰구간: 1.098-2.545, p = 0.016)가 독립적인 경피경간 담도 배액술 도관 유증상 이탈의 예측 인자였다. 결론 유증상 이탈을 유발하는 예측인자에는 남성, 우측 접근, 도관 삽입 각도 증가, 불완전 피그테일 루프가 있다.