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오디괄약근 기능부전의 방사선학적 진단기준 : 담도압력계 검사로 확진된 5예의 분석
오용호 대한영상의학회 1994 대한영상의학회지 Vol.30 No.3
목 적:오디괄약근 기능부전은 지금까지 여러 용어로 쓰여져 왔으며 그 정의 및 진단 등의 모호성과 잘못된 개념 등으로 혼동의 대상이 되었다. 방사선학적 소견 및 진단범주도 제 멋대로이고 혼동의 큰 요인의 하나이다. 최근에 들어서 담도압력계 검사를 이용하여 진단이 명확해 짐에 따라 확진된 환자들의 방사선학적 소견을 분석함으로써 앞으로의 진단에 도움을 주고자 하였다. 대상 및 방법' 1991년 1월부터 1992년 2월까지 담도압력계검사로 확진된 다섯명의 환자를 대상으로 하였다. 나이는 53세부터 75세였으며, 모두 여자환자였고, 환자의 역행적 경구 담관조영술 소견을 분석하였다. 몇몇 환자에서 CT와 초음파 검사가 시행되었지만 이 것은 보조적인 진단수단 혹은 다른 담도질환을 배제하려는 것이 주된 목적이었다. 모든 환자는 담도압력계검사로 다음 네가지 조건중 하나 이상의 소견이 있는 것을 진단의 기준으로 하였다. 첫번째, 기저압력이 40mmHg 이상, 두번째, tachyorddia(7회 이상), 세번째, cholecystokinin의 불규칙한 수축반응, 네번재, 비정상적인 wave 등이다. 결 과:모든 환자에서 총담관이 12mm 이상 이완되어 있는데 그 범위는 13-23mm이었고 지연배출이 네 환자에서 있었고 한 환자는 지연 검사를 하지 않았다. 네 환자에서 pseudomeniscus sign이 있었고 간내담관은 비례적이고 완만한 확장을 보였다. 한 환자에서 시행한 cholecystokinin 주사후 검사에서 persistent pseudomeniscus가 없어지면서 조영제의 십이지장으로의 유출을 볼 수 있었다. 결 론: 담도압력계 검사결과와 ERCP소견의 좋은 상관관계는 앞으로 시간이 많이 걸리고 환자에게 부담을 주는 담도압력계에 의한 진단없이 ERCP 소견만으로 오디괄약근 기능부전을 진단할 수 있는 가능성을 보여준다.적 경과가 CT상 조 출혈 분포보다 더 중요할 것으로 사료된다.않았다.인 방법과 비슷한 정도의 도움을 주며, 가격이 저렴하므로, 향후 그 사용이 기대된다.기후의 해빈자갈보다 더 낮은 값(0.30~0.55)을 보이는데, 이는 subangular에서 subrounded에 해당한다. 이러한 현저한 차이를 보이는 이유는 남극적 빙하성 환경 조건과 이 지역의 해양 퇴적학적 특성에 그 원인이 있다고 해석된다.ea. Our ancestors really began to drink teas from the period of Unified Sila on. This country turning to the Koryo dynasty, tea drinking manner began to prevail so much that drinking tea became a ceremony. Daring the Yi dynasty it was much camplicated to make and boil the leaf tea. As a result of the previous fact pure tea came to have disappeared and odorous pharmaceutical became prevailent. 7) For value of exploiting Kungjuk tea (ginger tea seasoned with phyllostachy and addition of honeyl) was the highest among many. The worth of developing all the teas among all the beverages was regarded as that high of 51%, while even the tea regarded as worthless obtained 4% of support, which is the Purpose: Biliary dyskinesia was considered as a wastebasket of quasi-biliary disease which could not be clearly explained under the basis of morphologic pathology. This entity was a source of confusion because of misconception and poor understanding. Recent introduction of biliary manometric technique enlightened some of these disorders. We evaluated the cholangiographic morphology of these disorders to clarify and to characterize the some characteristic findings, subsequently in order to help the diagnosis.Materials and Methods : Five cases were confirmed by this technique as sphincter of Oddi dysfunction for last 13 months. All patients were female and age range was 53 to 75 years old. All patients were suffered from intermittent and recurrent biliary type pain.Results: ERCP showed five common findings. The common bile duct was dilated over 12mm in all patients. Different from recurrent pyogenic cholangiohepatitis, intrahepatic ducts were proportionally dilated as extrahepatic ducts, in four patients and they branched normally and ductal wall was smooth. Transient or persistent meniscus sign was observed in four patients. All patients showed delayed emptying of contrast media from the common bile duct into the duodenum. Following IV injection of cholecystokinin, persistent meniscus disappeared and contrast media inflowed into the duodenum.Conclusion : Identification of all or some characteristic cholangiographic findings may eliminate a cumbersome and painful biliary manometric test for the diagnosis of sphincter of Oddi dysfunction.
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오용호 대한영상의학회 1975 대한영상의학회지 Vol.11 No.3
It is well established that pinealoma is radiocurable disease entity, but it is very harzardous even to obtain biopsy material because of its location and it has been suggested that after the surgical intervention to the pinealoma intraventricular seeding as well as hematogenous metastasis is frequent. So to give radiation therapy without pathological confirmation, accurate diagnosis must be made on the clinical bases. The purpose of this paper is how to make accurate diagnosis on the clinical bases and how to treat the pinealoma. During 7 years from May 1968 to May 1975 total 11 cases of pinealoma were met at the Department of Radiology in Seoul National University Hospital. Clinical and radiological findings, and the result of treatment are analized. The results obtained are as follows: 1. All patients are male and age distribution is localized to the 2nd and 3rd decades. 2. Most common chief complaint is increased intracranial pressure signs such as headache and voimiting. mpairment of conjugated upward gaze(Parinaud's syndrome) is noticed in 9 cases, and absence or diminishment of light reflex and papilledema are present in majority. Endocrinologic adnormalities are another characteristic finding so diabetes inspidus and precoxious puberty are noticed in 7 cases and 2 cases respectively. 3. Simple skull shows increased intracranial pressure signs in 6 cases and abnormal pineal calcification in 7 cases which are displaced downward and posteriorly in all cases. 4. Carotid angiography is done in 9 cases, which shows enlargement of the lateral ventricle in all cases and changes of internal cerebral vein in 4 cases. 5. Vertebral angiography is done in 3 cases, which shows bowing, approximantion and superolateral displacement of posterior choroidal arteries in all cases and abnormal tumor staining and vascularization in 2 cases. 6. Ventriculography is the most valuable diagnostic procedure and usually confirmative, of which typical finding is well demarcate tumor mass located in posterior portion of 3 rd ventricle. Besides complication Conray ventriculography is superior to the pneumoventriculography in visualization and determination of pineal tumor. 7. The most desirable treatment schedule is radiation therapy after simple shunt operation.
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