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기춘석(Choon Suhk Kee),박경남(Kyung Nam Park),이민호(Min Ho Lee),이종철(Jong Chul Lee),최호순(Ho Soon Choi),배상철(Sang Cheol Bae),차호진(Ho Jin Cha),함준수(Jun Su Ham) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.2
N/A The diagnosis of pancreatic cancer is very difficult because the pancreas is located in the retroper- itoneum, symptoms are diverse, and physical findings are not specific. In the USA & western Europe, the incidence of pancreatic cancer has increased since 1930 and is the fourth most common cancer of all sites as a cause of death. Although recently, ERCP ultrasonogra phy (US) & computed tomography (CT) have been widely used for the diagnosis of pancreatic cancer is still difficult. The prognosis of pancreatic cancer is very poor because the retroperitoneal location of the cancer is unsuitable for diret palpation & the profuse lymphatics & venous drainage of the pancreas invite early & widespread dissemination of the tumor cells. In order to evaluate the incidence, epidemiology, clinical manifestations, laboratory findings & ERCP findings, the author analysed 91 cases of pancreatic cancer which were confirmed by surgery 8r ERCP at the Deparment of Internal Medicine, Hanyang University, College of Medicine between January 1972 & September 1986. The results were as follows 1) The pancreatic cancer was most prevalent in 6th & 7th decade (62.7%). Male to female ratio was 1.5:1, with male preponderance. 2) Epigastric pain was most common symptom complained (91%). Weight loss (88%), anorexia (61 %) & vomiting (42%) were also frequently noted in order of frequency. 3) The patient who had under 3 months duration of illness before confirmatory detection was found in 82.4% and those over 1 year duration in 4.4%. 4) The obstructive jaundice (23.1%) was the most common clinical impression of the patients followed by pancreatic cancer (16.4%), peptic ulcer disease (15.4%), pancreatitis (11%) & GB stone (5. Goyo). 5) In physical examination, hepatomegaly was palpable in 52% of patients. Jaundice (37%), abdominal mass (15%) & ascites (10%) were noted in order of frequency. 6) In laboratory findings, the elevated alkaline phophatase was most frequent in 79% of pathients. The elevated SGOT (62%), hyperbilirubinemia (55%) & anemia (32%) were frequently found in order of frequency. 7) In relation with diabetes mellitus, the patient of pancreatic cancer had the DM in 4%. The developmont of diabetes de novo is in 18%. 8) In the 91 patients who were diagnosed, the head of the pancreas was the most common site (68 %) of the tumor following by body (20%) & tail (12%). 9) Regional lymph node metastases were found in 57% & other metastaic sites were liver (53%), abdominal viscera (5%), adrenal (4%) & lung (3%) in order of frequency. 10) According to Fukumotos classification, the most common type was obstructive type (62.5%), followed by the stenosing type (29.1%), narrowing type (5.6%) & abnormal branching type (3.7%) 11) According to Takakis classification, Type 1 (obstruction or stenosis of the main pancreatic ctuct) was the most common (82.7%), followed by Type III (pancreatic dilatation) (9.3%), Type II (obstruction of Wirsung's duct or Santorini's duct) (4%), & Type IV (normal pancreatic duct) (4%).
기춘석(Choon Suhk Kee),박동일(Dong Il Park),이오영(Oh Young Lee),한동수(Dong Soo Han),손주현(Joo Hyun Son),윤병철(Byung Chul Yoon),안유헌(Yoo Hern Ahn),함준수(Jun Su Ham),이민호(Min Ho Lee),박경남(Kyung Nam Park) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.5
N/A Gynecomastia occurs in about 30% to 50% of patients with cirrhosis of the liver. Since es- trogens stimulate breast tissue whereas androgens antagonize these effects, gynecomastia has long been considered the result of an imbalance between these hormones. Several mechanisms may operate to produce a relative estrogen excess in hepatic disorders, especially alcoholic cir- rhosis. We have studied the prevalence of gynecomastia and measured the estrogen/testoster- one ratio in cirrhotic subjects and control. Twenty male patients with hepatic cirrhosis were identified from the medical inpatient services of our institution and ten nonobese healthy rnedi- cal students with no history or physical findings of liver disease cornposed the noncirrhotic control group. The mean BMI in the control subjects was 21.3 + 0.8kg/m and that in the group with cirrhosis was 22.1 + l.lkg/m. Therefore, no statistical significance was found. Gy- necomastia was present in 30% of the control subjects and 25% of the cirrhotic subject. No significant correlation existed between breast tissue diameter and the BMI in the subjects with cirrhosis. In the control group, TT concentrations were higher and TE concentrations were lower than the cirrhotic groups, therefore the ratio of TE/TT were more decreased compared with the subjects with cirrhosis. In contrast, the mean total and free serum testosterone con- centrations were considerably lower and the mean total estrogen concentrations were higher in cirrhotic patients with gynecomastia compared with those without gynecomastia as were the ratio of TE/FT, E2/FT, TE/TT and E2/TT. In conclusion, the prevalence of gynecomastia in cirrhotic patients was 25%. Total and free serum testosterone concentrations did not differ statistically significant in the cirrhotic men with and without gynecomastia. Neither the TE FT ratio nor the E2 FT ratio was statistically increased in cirrhotic subjents with gynecomastia compared with those without gynecomastia. These findings imply that factors other than the estrogen testosterone ratio may play a role in the development of gynecomastia in both cirrhotic and control subjects. (Korean J Gastroente- rol 1994; 26: 842 849)
이형접합제 PiMZ 및 α1 - Antitrypsin 결핍을 보인 간경변증
기춘석(Choon Suhk Kee),박경남(Kyung Nam Park),이민호(Min Ho Lee),안명주(Myung Ju Ahn),고윤석(Youn Suck Koh),함준수(Joon Soo Ham),이종철(Song Chul Lee),강종명(Jong Myung Kang) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.1
In 1969, Sharp described the first cases of aplhai-antitrypsin deficiency disease in children with juvenile liver cirrhosis. Since then, this inborn error has been recognized as one of the more common factors in cirrhosis of infancy and childhood, especially in Caucasians of Northern Europeans. PiZZ phenotype is the only one associated with liver disease, there have been a few rescent reports of cirrhosis in heterozygous patients. We experienced a case of 24-year-old male patient who was diagnosed as liver cirrhosis by biopsy but had no defintie causes of liver cirrhosis. The laboratory findings were compatible with liver cirrhosis. By biopsy, the liver is composed of variable sized, micro and macronodules. Dense fibrous tissue encase these nodules. The hepatocytes are strongly positive granules and diastase resistant. Pi phenotype was Pi MIZ by IEF (immunoelectric Focusing) method and the plasma alphai- antitrypsin level is lower than normal.
각종 위장관 악성 종양에 있어서 TATI 의 임상적 고찰
기춘석(Choon Suhk Kee),박경남(Kyung Nam Park),이민호(Min Ho Lee),이종철(Jong Chul Lee),윤호주(Ho Ju Yun),안광무(Kwang Moo Ahn),함준수(Jun Su Hahm) 대한소화기학회 1988 대한소화기학회지 Vol.20 No.3
N/A Tumor-Associated Trypsin Inhibitor (TATI) is a 6000-dalton peptide which has been identified in the urine of an ovarian cancer patient by using immunochemical techniques. Purification and characterization revealed that it was identical to the pancreatic secretery trypsin inhibitor (PSTI). This peptide occurs in high concentrations in the urine and serum of patients with malignant tumors, also in some extracts from malignant tumors and in early amniotic fluid. We have studied the clinical significance of tumor marker, TATI in various gastrointestinal malignancies (61 cases) compared with normal controls (23 cases) and benign diseases (53 cases) fnim February, 1987 to September, 1987 in Hanyang University Hospital, Seoul, Korea The results were as followings; 1) There was no age and sex difference in TATI serum level of normal controls. 2) The positive rate in benign diseases was 26%, especially high mean serum level was seen in liver cirrhosis (cut off level; 21mcg/L). 3) The sensitivity of TATI in various gastrointestinal malignancies was 62%, especially high mean serum level was seen in hepatoma with underlying liver cirrhosis (cutoff level; 21 mcg/L). 4) There was no statistically significant difference in mean serum TATI level between metastatic and non-metastatic gastrointestinal malignancies. 5) There was no statistically significant difference in mean serum TATI level between normasl controls and benign diseases (p) 0.05). But various gastrointestinal malignancies showed statistically significant elevation in mean serum TATI level compared with normal controls and benign diseases (p < 0.05). 6) TATI may also be elevated in connection with inflammatory disease. However, the elevition is mostly moderate, i.e. less than two-fold the upper limit of the reference range except one case of systemic lupus erythematosus (87.4 mcg/L) and one case in liver cirrhosis (143 mcg/L). Therefore, higher levels are relatively specific for cancer. In conclusion, TATI is a universal tumor marker and it is also elevated in most types of gastrointestinal cancer, Assay of TATI appears to be useful for detecting and monitoring patients with gastrointestinal cancer.
한국의 정상인 및 간경변증 환자에서의 Pi 표현형의 출현빈도
기춘석(Choon Suhk Kee),박경남(Kyung Nam Park),이민호(Min Ho Lee),이종철(Jong Chul Lee),안명주(Myung Ju Ahn),차호진(Ho Jin Chan),함준수(Joon Su Ham),조율희(Youl Hey Cho),백용균(Yong Kyun Paik) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.1
N/A Alphai-antitrypsin is a major component of alpha-1-electrophoretic band of serum protein. Because alphai-antitrypsin is a broad spectrum inhibitor of proteolytic enzymes such as trypsin, elastase or collagenase, it is so called as Pi (Protease inhibitor) system. It is generally believed that the inhibition of granulocytic proteases by alphai-antitrypsin is most important for protecting the human organism against autodigestion. Alphai-antitrypsin is under genetic control, and more than 30 codominant variant alleles at a single chromosomal locus have been identified. Some of these alleles (particularly the alleles z, s, null) have been associated with serum alphai- antitrypsin deficiency of varying degree and with pulmonary emphysema or juvenile liver cirrhosis by autodigestion of normal tissue. We determined Pi phenotypes by IEF (isoelectric focusing) method in 440 normal controls and 143 patient of liver cirrhosis probably at first in Korea. Our purposes were determination of the distribution of Pi phenotypes in Korea and the clinical significance of Pi phenotypes in liver cirrhosis patients. The results as follows; 1) The Pi gene frequencies of 440 normal population are M1 = 0.7447, M2 = 0.1682 M3 = 0.0761, M4 = 0.0046, I=0.0023, S =0.0011, G=0.0034 (p>0.10). 2) The Pi gene frequencies of 143 liver cirrhosis patients (male 97, female 46) are M1 = 0.7443, M2 = O.Zll63 M3=0.0489, P=0.0070, Z=0.0035, (p>0.70) and alphai-antitrypsin deficiency case was seen only one patient. 3) There was no significant difference between normal population and liver cirrhosis patients in Pi gene frequency (p>0.20). Therefore, in Korea, there was almost no clinical signinficance of alphai- antitrypsin deficiency in old age liver cirrhosis except Juvenile cirrhosis.