• Journal of Yeungnam Medical Science
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• 제2권1호
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• pp.39-44
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• 1985

상복부 수술후 진통을 위하여 경막외 narcotics 주입시 임상에서 경막외강 천자가 가장 많이 시술되고 있는 부위 안 요부 경막외강에 morphine과 demerol을 각각 주입하여 진통 효과를 관찰하였다. 전신 마취하에서 상복부 수술을 받은 환자 20명을 대상으로 하여서 morphine 1 mg을 주입한 10명의 I군, demerol 10mg을 주입한 10명의 II군에서의 진통 효과를 관찰하였던 바 다음과 같은 결론을 얻었다. 1. Morphine 을 주입한 I군에서는 평균 진통 시간이 29.4시간이었다. 2. Demerol을 주입한 II군에서는 평균 진통 시간이 4.0시간이었다. 3. Morphine을 주입한 I군이 Demerol을 주입한 II군보다 진통 시간이 훨씬 길었으며 통계학적으로 유의하였다. (P<0.05) 이상의 결과로 보아 상복부 수술후 진통 목적으로 마약제를 경막외강에 투여시 시술이 안전한 요부 경막외강내로 투여하여도 우수한 진통효과를 얻을 수 있으며 마약제로는 morphine의 투여가 demerol의 투여보다 더욱 진통 효과가 우수한 것으로 사료된다.

• 대한지역사회영양학회지
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• 제13권2호
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• pp.288-297
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• 2008

It has been reported frequently that clinical features of gallstone disease in Korean were similarly changing to those of Occidentals. This changing was thought to be due to Westernized lifestyle and dietary patterns in Korean. The purpose of this study was to investigate the nutritional risk factor among patients with gallstone. The subjects of this study were 90 gallstone group with biliary stone as confirmed by cholecystectomy and 111 control group with no biliary stone as confirmed by ultrasonography adjusted according to age and gender. Anthropometric indices and biomarkers were measured and dietary habit as well as nutrient consumption pattern were investigated using a structured checklist of health-related eating behavior and a semi-quantitative food frequency questionnaire. The mean age was higher in GG (gallbladder stone patient group) than CG (control group). The average BMI and WHR (waisthip ratio) tended to be higher than those in CG. WC (waist circumference) and WHR of women in GG were significantly higher than in CG. GG had lower levels in TC (p < 0.01), LDL-C (p < 0.05), and HDL-C (p < 0.05), but higher FBG levels (p < 0.001). GG tended to be associated with lower physical activity and more frequent consumption of meat, meats with high fat and high sugar content food. The consumption levels of fiber (p < 0.05), vitamin C (p < 0.05), calcium (p < 0.01) in GG were significantly lower than in CG. These findings showed that the association with incidence of gallbladder stone and anthrophometric indices and dietary consumption patterns. Further study may be necessary to elucidate the dietary risk factors in the changing patterns of gallstone disease.

• 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.

• 대한소화기학회지
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• 제72권6호
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• pp.318-321
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• 2018

Primary neuroendocrine tumors originating from the extrahepatic bile duct are rare. Among these tumors, large cell neuroendocrine carcinomas (NECs) are extremely rare. A 59-year-old man was admitted to Sanggye Paik Hospital with jaundice that started 10 days previously. He had a history of laparoscopic cholecystectomy, which he had undergone 12 years previously due to chronic calculous cholecystitis. Laboratory data showed abnormally elevated levels of total bilirubin 15.3 mg/dL (normal 0.2-1.2 mg/dL), AST 200 IU (normal 0-40 IU), ALT 390 IU (normal 0-40 IU), and gamma-glutamyl transferase 1,288 U/L (normal 0-60 U/L). Serum CEA was normal, but CA 19-9 was elevated 5,863 U/mL (normal 0-37 U/mL). Abdominal CT revealed a 4.5 cm sized mass involving the common bile duct and liver hilum and dilatation of both intrahepatic ducts. Percutaneous transhepatic drainage in the left hepatic duct was performed for preoperative biliary drainage. The patient underwent radical common bile duct and Roux-en-Y hepaticojejunostomy for histopathological diagnosis and surgical excision. On histopathological examination, the tumor exhibited large cell NEC (mitotic index >20/10 high-power field, Ki-67 index >20%, CD56 [+], synaptophysin [+], chromogranin [+]). Adjuvant concurrent chemotherapy and radiotherapy were started because the tumor had invaded the proximal resection margin. No recurrence was detected at 10 months by follow-up CT.

• 대한한방내과학회지
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• 제43권3호
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• pp.477-484
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• 2022

Objective: The purpose of this study was to report the improvement effect of symptoms of integrative cancer treatment (ICT) on recurrent gallbladder cancer patients. Methods: A 73-year-old patient with recurrent gallbladder cancer visited the Daejeon Korean Medicine Hospital of Daejeon University East West Cancer Center (EWCC) on February 2022. After the diagnosis of gallbladder cancer, the patient underwent cholecystectomy and relapsed during follow-up. After the operation, the cancer recurred during follow-up, and after radiation treatment, she had been receiving ICT since February 2022. The clinical outcomes were measured by X-ray, computed tomography (CT), laboratory findings, including tumor markers (CEA, CA19-9), and numeric rating scales (NRS). Results: After treatment, abdominal pain was relieved from NRS 5 to 2, and abdominal circumference decreased from 74.5 to 67. During and after treatment, we found neither hepatotoxicity nor nephrotoxicity in the laboratory findings. Conclusion: This case study suggests that ICT may improve symptoms in patients with gallbladder cancer.

• 한국간담췌외과학회지
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• 제27권2호
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• pp.180-188
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• 2023

Backgrounds/Aims: The present study looked at the role of radical surgery in gallbladder cancers (GBC) with limited metastatic disease. Methods: The retrospective observational study was conducted to screen the database from 1st January 2010 to 31st December 2019. Patients of GBC found to have low-volume metastatic disease upon surgical exploration were included. Results: Of the 1,040 patients operated for GBC, 234 patients had low-volume metastatic disease (microscopic disease in station 16b1 node or N2 disease isolated port-site metastases, or low burden peritoneal disease with deposits less than 1 cm, in adjacent omentum or adjacent diaphragm or Morrison's pouch or a solitary discontinuous liver metastasis in adjacent liver parenchyma) detected intraoperative. Of these, 62 patients underwent radical surgery for R-0 metastatic disease followed by systemic therapy, while the remaining 172 patients did not undergo radical surgery and were given palliative systemic chemotherapy. Patients who underwent radical surgery had significantly superior overall survival (19 months versus 12 months, p < 0.01) and superior progression-free survival (10 months versus 5 months, p < 0.01) when compared to the rest. This difference in survival was more significant amongst patients when operated on after neoadjuvant chemotherapy. Regression analysis showed that a sub-group of patients with incidental GBC with limited metastases showed more favorable outcomes with radical surgery. Conclusions: Authors suggest a possible role for radical treatment of advanced GBC with a limited metastatic burden. Neoadjuvant chemotherapy can be used for preferentially selecting patients of favorable disease biology for curative treatment.

• 한국간담췌외과학회지
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• 제27권3호
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• pp.277-286
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• 2023

Backgrounds/Aims: To study histopathological changes in gall bladder mucosa in cholelithiasis patients, and analyse their relation to the number and size of gallstones. These findings were evaluated in the context of age distribution of the study population. Methods: One hundred cases of cholecystectomy were part of the study, which was conducted in collaboration with the pathology department. The time period of the study was January 2020 to June 2021. Results: Maximum cases had multiple stones (69.0%), while one third cases (31.0%) had solitary stones. While initial univariate analysis showed age (odds ratio [OR], 6.882; p = 0.043), gallstone number (OR, 9.1; p = 0.050), gallstone size (OR, 17.111; p = 0.013), and duration of symptom (OR, 34.125; p = 0.001) to be significant risk factors associated with gallbladder carcinoma, multivariate analysis found none of these variables to be significant. However, conditional multivariate analysis for the duration of symptom (p = 0.008; OR, 21.118) yielded significant p-value. With histopathological diagnoses, 5% of cases had gallbladder cancer. Conclusions: This study shed light on the rising incidence of cholelithiasis in the young population and the high rate of gallbladder carcinoma in Punjab, India. Although gall stone characteristics (size, number) and patient age appeared to be significant risk factors when their individual relation with gallbladder carcinoma was studied, multivariate analysis, could not prove that. Conditional multivariate analysis showed the duration of symptom to be the only significant risk factor associated with gallbladder carcinoma. Further research with larger sample size is needed to study the rising incidence of gallbladder carcinoma, and the risk factors associated with it.

• 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.

• Journal of Yeungnam Medical Science
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• 제11권1호
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• pp.42-48
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• 1994

저자들은 1987년 12월부터 1993년 8월까지 영남대학교 의과대학 부속병원에 입원하여 유전성 구상 적혈구증으로 진단받고 비장적출술을 시행한 9례를 대상으로 임상분석하여 다음과 같은 결론을 얻었다. 1. 총 9명중 남아 5명, 여아 4명으로 남녀비가 비슷하였으며, 6세에서 10세 사이가 9례중 5례로 전체의 반이상을 차지하였다. 2. 가족력을 나타낸 경우는 9례중 4례(44.4%)이었다. 3. 주요임상 증상으로는 빈혈, 황달 및 비장종대가 주증상이었으며, 담석증 및 총담관결석을 동반하였던 2례에서는 우상복부 동통을 나타내었다. 4. 검사실 소견으로는 말초혈액 도말검사상 구상 적혈구를 발견할 수 있었으며, 혈색소 $8.1{\pm}2.4gm/dl$, 헤마토크리트 $23.4{\pm}10.2%$ 망상적혈구 $15.9{\pm}11.7%$이었으며, 삼투압 취약성은 모두에서 증가되어 있었다. 혈청 전 빌리루빈 $8.6{\pm}10.9mg/dl$, LDH $370.1{\pm}169.1IU/L$으로 증가되었다. Coombs 검사상 9례 모두 음성반응을 보였다. 5. 9례 모두 비장적출술을 시행하였으며 이들중 담석증을 동반한 1례에서는 담낭절제술, 총담관 결석을 동반한 1례에서는 담낭절제술, 총담관 결석제거술 및 T-tube 담관조루술을 동시에 시행하였다. 수술 소견상 비장의 무게는 350(150-600)gm이었고, 9례중 3례에서 부비장(accessory spleen)이 관찰되었다. 6. 비장 적출후 유전성 구상 적혈구증 9례에서 수술전 혈색소 $8.1{\pm}2.4gm/dl$, 헤마토크리트 $23.4{\pm}10.2%$, 수술후 혈색소 $12.3{\pm}1.2gm/dl$, 헤마토크리트 $37.0{\pm}5.3%$로 증가되어 술후 빈혈이 교정되었음을 관찰할 수 있었다. 수술후에 수혈의 필요성은 없었으며, 술후 특별한 합병증없이 9명 모두 현재까지 건강하게 잘 자라고 있다.

• Radiation Oncology Journal
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• 제10권1호
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• pp.49-58
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• 1992

1986년 1월부터 1990년 9월까지 7예의 간외담도계 암 환자를 대상으로 외부 방사선치료와 온열치료를 병행하였다. 7예중 3예는 간외담도암으로 이중 2예는 원발성 담도암 이었고 1예는 위암에서 담도주위로 전이된 암이었다. 7예중 나머지 4예는 담낭암으로 이중 2예는 담낭 절제후 국소적으로 재발된 암이었고 나머지 2예는 원발성 담낭암 이었다. 그리고 7예는 모두 선암으로 확인 되었다. 조사된 방사선의 양은 3000 cGy/2주 조사한 1예를 제외하고 6예에서는 $4500\~5040\;cGY/6\~7$주 조사되었다. 온열치료는 모든 환자에서 방사선치료후 30분 이내에 시행되었으며 방사선치료 기간동안 주 1회 내지 2회씩 총 4회에서 12회까지 시행되었다. 치료효과의 판정은 T-관 T-관 담도촬영술. PTC, 그리고 CT등의 소견으로 하였으며 7예중 6예($86\%$)에서 부분관해를 보였으며 완전관해는 없었다. 7예중 6예는 4개월에서 11개월 애내 사망하였으며 나머지 1예는 현재 11개월째 생존하고 있으나 치료부위 밖에서 국소전이가 관찰되었다. 그리고 7예환자의 정중생존기간은 7개월이었다. 사망환자 6예의 사망원인으로는 원발성 담도암환자 1예에서 폐혈증, 전이성 담도암환자에서 원격 전이, 나머지 4예에서는 원발병소의 진행이 확인되었다. 관찰기간이 짧았으나 모든 환자에서 치료에 잘 적응하였으며 간, 십이지장, 위내의 합병증은 없었고 전이성 담도암 환자에서 일과성 카보닐산혈증이 관찰되었다.