| Il Hwan Moon | 16 Articles |
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[English]
Ingestion of corrosive substances can produce severe injury to the gastrointestinal tract and can even result in death in the acute phase. The extent and degree of damage depends on the type and amount of substances. There are occasional reports of severe contiguous injury to the esophagus and stomach caused by strong alkali ingestion in the acute phase. Usually the deaths occur within a couple of days due to multi-organ failure after ingestion of relatively much amount of agent for a suicidal attempt. But death due to late progression is very rare. We have reported a case of 60-year-old female patient who was diagnosed as corrosive esophagitis after accidental ingestion of strong alkali. Initial endoscopic findings were compatible with IIa-IIa-0(according to Zargar's classification) in the esophagus, stomach and duodenum, respectively. After several weeks of supportive care, her subjective symptoms were much improved during she had been wating for the operation of colon interposition due to esophageal stricture. Metabolic acidosis and thrombocytopenia developed abruptly probably due to upper gastrointestinal tract necrosis and she died when 60 days had passed after the occurrence of initial esophageal injury. Citations Citations to this article as recorded by
[English]
Mixed hepatocellular-cholangiocarcinoma accounts for about 1% of all hepatocellular carcinoma. In many cases, mixed hepatocellular-cholangiocarcinoma has been misdiagnosed as hepatocellular carcinoma or cholangiocarcinoma because of the indistinctive clinical course and radiologic findings. The clinical course and the pathologic characters are not known well, but it resembles the characteristics of hepatocellularcarcinoma rather than cholangiocarcinoma. So mixed hepatocellular-cholangiocarcinoma was classified as a kind of hepatocellular carcinoma. But the growth and dissemination rate is faster than that of hepatocellular carcinoma and the prognosis more poor. So the exact diagnosis is important. Authors experienced a patient who has the mixed hepatocellular-cholangiocarcinoma diagnosed by liver and neck node biopsy in patient who complain-ed abdominal discomfort and palpable mass, so we report the case. Citations Citations to this article as recorded by
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Small cell lung cancer accounts for about 20% of all lung cancers. At the time of diagnosis, the majority of patients already have metastasis. The liver is one of the most common sites of distant metastasis of lung cancer. Small cell lung cancer arises from neuroendocrine cells which produce hormone, hormone producing granules can be seen under electron microscope . A 65-year-old male was admitted to hospital because of jaundice and right upper quadrant pain. The chest roentgenogram and chest computed tomography(CT) scan showed a 3 cm mass in right upper lobe with bilateral mediastinal lymphadenopathy and right pleural effusion. The abdomen CT scan revealed multiple masses in the liver with heterogenous pattern suggesting metastatic orgin. Though the immunohistochemistry and electron miscroscopy, he was diagnosed as metastatic small cell lung cancer of liver. We report a case of the Immunohistochemical and Electron Microscopic Observation of Metastatic Small Cell Lung Cancer of Liver.
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CLO test™ is simple, rapid and a commonly used rapid urease test for the diagnosis of From January 1996 to January 1998, 1,370 cases of CLO test were performed. A gastric biopsy specimen from the greater curvature of antrum within 2cm from pylorus was used for CLO test. The proportion of performed CLO tests among total endoscopic examinations was 14.1%(1,370/9,709). The most common indication of CLO test was duodenal ulcer, followed by chronic gastritis and gastric ulcer in order. In male, duodenal ulcer was the most common indication of CLO test, while in female, chronic gastritis was the most common. The positive rate of CLO test of total 1,370 cases was 62.0%. The positive rate of CLO test in male was significantly higher than that in female and the 4th decade of age showed the highest prevalence. According to the endoscopic diagnosis, the positive rate of CLO test was the highest in active stage of duodenal ulcer(84.3%), 56.5% in gastric ulcer, 54.6% in chronic gastritis, and 52.8% in gastric cancer. Comparing between 1996 and 1997, the number of CLO test increased, but its positive rate decreased significantly. Although the most common indication of CLO test was duodenal ulcer in this study, the result that CLO test was also commonly used in chronic gastiritis implies an increasing interest about the role of
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Autoimmune hepatitis is a rare cause of chronic hepatitis in Korea. The cause of autoimmune hepatitis is unknown. A loss of tolerance to autologous liver tissue is regarded as the primary pathogenetic mechanism. The clinical course of this disease is slowly progressive. The clinical picture of autoimmune hepatitis is also often associated with extrapehatic disease, many of which have a presumed autoimmune origin. Untreated patients have a poor prognosis, however immunosuppressive treatment prolongs survival. In this report, we describe a 59-year-old female who had a history of hemolytic anemia. She was admitted to the hospital due to the jaundice, her liver function test had been known to be abnormal. Laboratory test showed hypergammaglobulinemia and autoantibody.
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Hepatocellular carcinoma(HCC), a highly malignant tumor with a poor prognosis, is one of the common cancers in Korea like other Asian and African countries. Despite of recent advances in diagnostic and surgical techniques, early diagnosis of HCC is difficult and chance of surgical resection is still very low due to the multiplicity of tumor and associated liver cirrhosis. Transcatheter arterial chemoembolization(TAE) is a proven effective method of treating HCC regardless of operability. The current study was undertaken on 111 cases to evaluate the survival period of the pat-ients with HCC and to find their prognostic factors. The results were as follows: 1) The mean age of the patients was 54.8 years, with a range from 33 to 79 years. The highest incidence of age was in the 6th decade and the male to female ratio was 4.6:1. 2) The survival period of the patients was significantly related to serum albumin, SGOT, bilirubin and treatment(TAE). 3) The survival period was not significantly related to size and type of tumor. 4) The revised staging systems by Primack and Okuda were not significantly related to the survival period. But Child's classification was significantly related to the survival period. 5) The median survival period of TAE group was 11 months while non-TAE group was 0.5 month(p=0.0023). 6) Multivariate Cox regression analysis showed that the treatment modality(TAE or non-TAE group) was the factor with the greatest relative risk and an independent prognostic value. Accordingly, it is suggested that TAE is an effective method for treating unresectable HCC, and the prospective investigations on TAE are needed.
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Cirrhotic patients may exhibit circulatory derangement and renal dysfunction during the clinical course. Renal dysfunction on cirrhosis can occur without specific causative factors. This functional renal failure in cirrhosis is considered as a consequence of renal vasoconstriction. These alteratons of renal hemodynamics are already present in the early phase of the disease, even in the condition that the conventional kidney function tests are normal. A new method for noninvasive evaluation of arterial tone is duplex Doppler sonography. Among the various sonographic indices proposed, the renal resistive index(RI) is the most widely used for the estimation of intrarenal arteriolar vascular resistence. This study was performed to evaluate the role of Doppler sonography in early detection of renal dysfunction and to assess the clinical significance of RI. In 25 cirrhotic patients without overt kidney failure and ten control subjects, the RI of the acurate artery in both kidneys was measured by Doppler sonography. The mean RI of cirrhotic group was significangly higher than that of control subjects(0,68±0.08 vs -0.62±0.05,p<0). Accordiing to Child class, the RI showed increasing tendency from A to C, through witout statistical significance. In this study, the RI was significantly inversely correlated with 24hr urinary sodium amount(r=-0.39, p<0,05)and correlated with serum creatinine(r=6.60,p<0.01). This study indicates that the measurement of RI is a sensitive method to assess intarenal hemodynamics and to detect early changes of the renal dysfunction in cirrhotic patients.
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To determine the possibility of for sexual transmission of hepatitis C virus, we report a study on 26 cases of type C liver disease that were evaluated in the Department of Internal Medicine of the Ewha Womans University(Mok-dong hospital) over a period of 22 months from January of 1994 to October of 1995. The results were as follows, 1) There were 1 acute hepatitis case, 19 chronic hepatitis cases, and 6 liver cirrhosis cases. 2) The positive rate of anti-HCV of spouse was 3.8%. The positive rate was not significant compared to control group(total age adjusted prevalence). 3) The positive rate of anti-HCV of spouse was not significantly related with duration of mar-riage or severity of disease. Intrafamilial spread of HCV by sexual transmission is one of the route for transmission of disease. But these result suggested it was uncommon route of transmission of hepatitis C.
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We studied the clinical features of 43 patients of trberculous peritonitis who had been admitted to Ewha Womans University Hospital from January, 1984 to December, 1994. The results are summarized as followings : 1) The male to female ratio was 1:2.3 and the peak incidence was between 21 and 30 years of age. 2) Chief complaints were abdominal distension(65.1%), and abdominal pain(51.2%). Besides these symptoms, indigestion, diarrhea, abdominal mass and general weakness were also noted. 3) Physical findings were abdominal tendemess(53.5%), abdominal mass(32.6%), jaundice(14.0%) and heparomegaly(2.3%) 4) The mean values of hemoglobin, WBC and ESR were 11.9g/dl. 8,300/mm3, and 65mm/hr respectively 5) The ascitic fluid analysis showed that the specific gravity was 1.031, protein concentration 5.0g/dl, mean lymppcyte percentage 98%, and the mean ADA activity was 61u/l. 6) On chest X-ray, the findings related to the pulmonary tuberculosis were noted in 26 patients(60.5%).
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Pancreatic pseudocyst is one of the most common compications of pancreatitis or pancreatic injury. It can occur at any site in ted abdomen but rarely in the liver. The ultrasound and computed tomography are invaluable imaging techniques for the detection of a pseudocyst We have recently experienced an uncommon case of pseudocyst in 54-year-old man, who had complained of severe epigastric pain and fever. The pseudocyst in the left hepatic lobe was diagnosed by abdominal sonography and computed tomography with clinical and laboratory findings. It was treated successfully by percutaneous catheter drainage.
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To investigate the prevalence of antibody against hepatitis C virus(HCV), anti-HCV wasdetected by enzyme immunoassay in 170 patients with liver cirrhosis, 77 patients with hepatocellular carcinoma, and 100 healthy controls. The results were as follows : 1) Prevalence of anti-HCV was 15.3% in liver cirhosis and 9.1% in hepatocellular carcinomabut no significant difference was found between two groups. Anti-HCV was not detected inhealthy control group. prevalence of hepatitis B surface antigen(HBsAg) was 3% in healthycontrol, 52.9% in liver cirrhosis, and 72.7% in hepatocelltular carcinoma. 2) Prevalence of anti HCV in HBsAg positive patients with liver cirrhosis was 2.2% and30.0% in HBsAg negative patients. In HBs Ag negaive patients with liver cirrhosis, the prevalenceof anti-HCV was 40.9% in patients with antibodies to hepatitis B core antigen (anti-HBc)only, 21.1% in patients with anti-HBc and antibody to hepatitis B surface antigen(anti-HBs),and 35.0% in patients with no HBV markers. 3) Anti-HCV was not detected in HBsAg positive patients with hepatocellular carcinoma,but the prevalence of anti-HCV was 33.3% in HBsAg negative patients. In HBsAg negativepatients with hepatoccllular carcinoma, the prevalence of anti-HCV was 12.5% in patients withanti-HBc only, 45.5% in patients with anti-HBc and anti-HBs, and 50.0% in patients withno HBV markers. 4) In studying the relation of anti-HBc and anti-HCV in HBsAg negative patients withliver cirrhosis and hepatocellular carcinoma, prevalence of isolated anti-HCV, positive for bothanti-HBc and anti-HCV, negative for both anti-HBc and anti-HCV showed no significant difference between two groups. Prevalence of isolated anti-HBc showed significant difference betweentwo groups(p<0.01). According, it is suggested that the most important factor in the pathogenesis of liver cirrhosisand hepatocellular carcinoma in Korea is HBV but in HBsAg negative patients, HCV is suggested to play an important etiologic role. In endemic areas of HBV such as Korea, whetherHCV acts in the process of development of hepatocellular carcinoma from liver cirrhosis andwhether HCV superinfection modifies the natural course of chronic HBV infection need furtherinvestigation.
[English]
Ulcerative colitis is an waxing and waning inflammatory bowel disease characterized by rectal bleeding and diarrhea, affecting principally the mucosa of the rectum and colon. Its incidience is being higher in Europe and America and it also seems to be rising increasingly in our country because diagnostic methods are much developed and Korean life styles are westernized. So, we investigated its clinical characteristics. We analyzed 36 cases of ulcerative colitis which had been treated in the Hospital of Ewha Womans' University from Jan. 1983 to Feb. 1993, retrospectively. 1) The most prevalent age group was 3rd decade and male to female ratio was 1:1.77. 2) The duration of symptoms was less than 6 months in 63.9%. 3) The most common clinical manifestation was hematochezia(86.1%), abdominal pain(75.0%), diarrhea(72.2%), fever(30.6%), weight loss(27.8%) in the order of frequency. 4) According to the severity, moderate type was shown in 52.8%, severe in 33.3% and mild in 13.9%. 5) According to the anatomical distribution of the lesion, pancolitis was shown in 36.1%, the involvement of the rectum and sigmoid colon in 16.6%, the left-sided colon in 13.8%, rectum only in 13.8%, transverse colon in 8.3% and backwash ileitis in 11.1%, respectively. 6) The hematologic laboratory finding was non-specific including anemia, leukocytosis, increased erythrocyte sedimentation rate, bypoalburninemia, electrolyte imbalance, increased serum transaminase and alkaline phosphatase. 7) Colonoscopy revealed ulceration(77.1%) commonly, including hyperemia(51.4%), bleeding(42.5%), mucosal friability(22.9%), pseudopolyp(22.9%), granularity(20.2%). 8) The Barium enema showed granularity commonly and loss of haustral marking(55.2%), luminal narrowing(34.5%), lead pipe rigidity(13.8%), pseudopolyp(3.4%). Also, normal finding was shown in 10.3%. 9) The most common histopathologic finding was inflammation(83.3%) and ryptitis(55.6%), ulceration(50%), goblet cell depletion(19.4%), pseudopolyp(19.4%), necrosis(13.9%), granolarity(8.3%) were also noted. 10) With the medical treatment, 76.5% of the cases showed initial improvement of the symptom, but the recurrence developed in 17.7%. The surgery was performed in 6 cases of patients(16.7%). Emergency operation was performed in 2 cases due to bowel perforation and elective operation in 4 cases.
[English]
With the recent advent of real time ultrasound and computed tomography. the number of hepatocellular carcinoma(HCC) diagnosed clinically is increasing. Recently hepatic transarterial chemoembolization(TAE) is a proven effective means of treating hepatocellular carcinoma whether it is operable or not. The authers analyzed the therapeutic effect of transarterial chemoembolization in 64 cases of hepatocellular carcinoma, who were diagnosed and had undergone TAE in Ewha Womans University Hospital from May 1987 to December 1990. Changes of the tumor volume were analyzed on the base of follow-up CT. arteriogram and ultrasound. Methods of TAE were the infusion of mixture of Lipiodol and Adriamycin. Mitomycin C with or without following administration of Gelfoam. The total tumor response rate for 64 cases were 87%. The tumor response rate was 100% for stage III (n=16), 85.7% for stage II (n=42), 66% for stage III (n=6). The tumor response rate was 90% for noncirrhotic patients (n=20), 86.4% for cirrhotic patients(n=44). The median survival of total cases (n=64) was 7.6 months.
[English]
A Clinical study on 94 cases of primary liver cancer who were confirmed at Ewha Womans University Hospital from January 1984 to December 1986 was carried out. The result obtained are as follows: 1) The ratio of male to female is 3.9 : 1, and highest incidence rate is 42.6% in 6th decade. 2) The chief complaints are RUQ abdominal pain, epigastric discomfort, dyspepsia, weight loss in the decreasing order. Physical examination shows hepatomegaly, ascites and jaundice. 3) Clonorchis sinensis infestation reveals 8.5% of cases. 4) Liver function tests shows serum globulin elevation in 96.8%, AST(aspartate aminotransferase, SGOT) elevation in 91.5%, alkaline phoaphatese elevation in 86.2%, in order of frequency. 5) Alpha-fetoprotein is positive (>400ng/ml) in 72.3% of cases. 6) Serum HBsAg is positive in 75.0% of cases. 7) Alpha-fetoprotein is apt to be positive in the HBsAg positive cases. 8) Space occupying lesions are demonatrated by liver scanning in 93.6% of cases: 73.9% in the right lobe, 11.4% in the left lobe and 14.7% in the both lobes. 9) Twelve (70.6%) of cases are assoiated with cirrhosis of liver. Of cases 75.0% is macronodular.
[English]
Ketoconazole-induced hepatitis was found in 36-year-old woman who developed easy fatiguability and jaundice, with abnormal liver function tests after taking ketoconazole 400mg a day for 6 months. All of the viral hepatitis serologic markers were negarive. Clinical and biochemical abnormalities spontaneously improved within 3 weeks after cessation of drug administration.
[English]
Vial serologic markers for hepatitis B virus infection are known as HBsAg, anti-HBs, anti-HBc and anti-HBe, and also recently IgM class antibodies are measurable for both hepatitis A and B. Five serologic markers for hepatitis B virus infection were measured routinely in patients with acute and chronic liver diseases and IgM class antibodies were evaluated in patients with acute viral hepatitis. The results were as follows: 1) Men are more frequently affected than women in chronic liver diseases and as the disease progressed to chronic diseases, the mean ages of patients increased. 2) Positivities of HBsAg were 79.7% in acute viral hepatitis, 88.9% in chronic hepatitis, 47.2% in cirrhosis and 72.0% in primary liver cancer respectively. 3) In forty cases of acute viral hepatitis, IgM anti-HBe was positive in two HBsAg negative cases and negative in three HBsAg positive cases. 4) Anti-HBc was positive in majority of various liver diseases and appeared usually with HBsAg or anti-HBs,but sigly positive in minority of patients. 5) Positivities of HBeAg in HBsAg positive liver diseases were 68.1% in acute viral hepatitis, 75.0% in chronic hepatitis, 41.2% in cirrhosis and 61.1% in primary liver cancer respectively.
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, Ki-Nam Shim
