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악성 폐쇄성황달에 대한 각종 내시경적 역행성담관배액법 ( ERBD ) 비교 평가
심찬섭(Chan Sup Shim),조영덕(Young Deok Cho),문종호(Jong Ho Moon),이영홍(Young Hong Lee),김진오(Jin Oh Lee),봉형근(Hyung Keun Bong),조주영(Joo Young Cho),김연수(Yun Soo Kim),이준성(Joon Seong Lee),이문성(Moon Sung Lee) 대한내과학회 1998 대한내과학회지 Vol.54 No.4
N/A Objectives : Endoscopic biliary drainage has been established as the palliative treatment of choice for malignant obstructive jaundice. At present, the major drawback of endoscopic biliary stenting is occlusion of the endoprosthesis with sludge, resulting in recurrence of jaundice or cholangitis. Recently, there are variable stents that have different materials, sizes, and designs have been used in efforts to overcome this problem To determine the success rate of stent insertion, successful drainage rate, duration of patency, complications related to stent insertion, and cause of stent malfunction, plastic endoprosthesis compared to metal stents in palliative treatment of malignant biliary obstruction. Method: We retrospectively evaluated 157 patients (total number of stent insertion: 308 cases) with unresectable malignant biliary obstruction to receive either a plastic stent(group I, 261 cases) or metal stent(group II, 47 cases). The patients who were recieved plastic stent were subdivided to general plastic stents(group Ia, polyethylene, polyurethane, polyvinylchloride, 225 cases) and Tannenbaum stent(group 1b, Teflon, 36 times) group. And the patients who were received metal stent were subdivided to uncovered metal stents(group IIa, Gianturco- Rosch, Wall, Strecker, EndoCoil stent, 26 times) and membrane covered self-expandable metal stent(group Ilb, 21 cases) group. Results 1) There were no statistical difference in successful rate of stent insertion and drainage effect of stent according to the types of stent(p>0.05). 2) Median patency of the stent was significantly prolonged in patients with a metal stent(group II) compared with those with a plastic stent(group I) (249 vs 123 days; p < 0.05). Median patency of the gorup Ib was significantly prolonged than those of group Ia(137 vs 109 days ; P < 0.05), but there was no statistical difference in median patency between group IIa and Ilb(233 vs 267 days; p > 0.05). 3) The rate of early complication related to stent insertion showed no significant difference in plastic and metal stent groups(P > 0.05). 4) Major causes of stent malfunction in plastic and metal stent were sludge(90% vs 21,4%), tumor ingrowth (4.4% vs 71.4%), and dislocation(5.6% vs 7.2%), respectively. Conclusion : Metal stents have a longer patency than plastic stent in patients with malignant biliary obstruction. In plastic stents, Tannenbaum stents have a slighlty longer patency than other plastic stents, but there were no differences in the success rates, drainage effect and complication rates according to types of stents.
악성폐쇄성황달에 대한 내시경적역행성담관 배액법 ( ERBD ) 의 임상적평가
심찬섭(Chan Sup Shim),김진홍(Jin Hong Kim),조성원(Sung Won Cho) 대한내과학회 1988 대한내과학회지 Vol.35 No.5
N/A To examine the clinical applicability and complications of ERBD in malignant obstructive jaundice, 52 patients were entered into this study. ERBD was successfully performed in 43 (82.7%) of 52 patients and was effective in 35 patients (81.4%) from March 1986 to June 1988. The most frequent cause of unsuccessful ERBD was the inability to insert the guidewire due to severe irregular long stenosis. The functional life time of a 10 Fr polyethylene endoprosthesis was 4.7 months (range: 2 to 9 months). Early complications within 2 weeks after ERBD occurred in 7 patients (9.3%). There were no deaths associated with ealry complications. Most frequent late complications were clogging and cholangitis. ERBD is a safe and effective noninvasive biliary drainage method and is indicated with malignant obstructive jaundice in patients on whom endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic papillotomy (EPT) can be performed.
심찬섭 ( Chan Sup Shim ) 대한소화기학회 2005 대한소화기학회지 Vol.45 No.3
Photodynamic therapy (PDT) was first used for the treatment of esophageal cancer in early 1980s, Since then, numerous applications have been reported for its use in gastrointestinal tract including Barrett`s esophagus, gastric, duodenal, biliary, pancreat
생체외 ( In - Vitro ) 에서 직접 용해제에 의한 간내 담석 용해도의 고찰
박찬욱(Chan Wook Park),류권호(Kwon Ho Ryu),권강호(Kang Ho Kwon),이종태(Jong Tae Lee),이준성(Joon Seong Lee),김연수(Yun Soo Kim),이문성(Moon Sung Lee),황성규(Seong Gyu Hwang),김선주(Sun Joo Kim),심찬섭(Chan Sup Shim),(H . Igimi) 대한내과학회 1996 대한내과학회지 Vol.50 No.4
N/A Objectives: The incidence of intrahepatic duct (IHD) stone is higher in east Asia including Korea than western contries. IHD stone has been regarded as a troublesome disease with poor surgical results. Recently, percutaneous transhepatic choledochoscopic lithotripsy with electrohydraulic lithotripsy of IHD stones showed good success rate, but it also couldn't remove stones in case of severe stenosis, acute angulation or peripheral impacted stones. A MTBE, widely used for dissolving cholesterol stone, was considered to be little effect for dissolving pigment stones. So we analysed IHD stones and dissolved them by direct solubilizer to investigate the dissolution rate of IHD stones. Methods. We have analyesd the compositions of 13 IHD stones removed during the percutaneous transhepatic cholangioscopy or pos-operative cholangioscopy by infrared spectrophotometer and dissoluted by direct solubilizer. Dry intact IHD stones were weighed and then inserted into 50ml glass tube. Within an 8hours incubation time, the 25ml of solvent were exchanged every 30minutes. After 2 and 8hours of incubation, the stone residue was dried-up at 60℃ for check weight reduction and compare to the initial dry weight. The solvent A medium was a 0.1M boric acid/sodium carbonate buffer (pH 9.4), EI)TA 1%(w/v), 1 M urea and solvent B was solvent A medium plus 0.04 M Lubrol PX and N-acethylcysteine. Results: The sites of dissolved IHD stons were both IHD stones 8cases(61.5%), left IHD stones 3(23.1%) and right IHD stones 2(15.4%), The components of IHD stones were calcium bilirubinate stones in 11cases(84.6%), followed by mixed stones 2 (15.4%). The dissolution rates after 2 and 8hours dissolution by solvent A is 11.7%, 24.7% and by solvent B is 25.7%, 62.7% respectively. The dissolution rates after 8hours in solvent B is higher than solvent A (p<0.05). Conclusion: In order to improve dissolution rates of IHD stones, the development of new solvent and the improvement of currently used solvents and methodology should be considered.
사무원 , 중동파견노무자 , 의료종사자에서 HBsAg 발현율
조성원(Sung Won Cho),심찬섭(Chan Sup Shim),이성희(Sung Hee Lee),어수택(Soo Taik Uh) 대한소화기학회 1985 대한소화기학회지 Vol.17 No.1
N/A It is well known that the positive rates of HBsAg or anti-HBs related to sanitory condition and occupation. We tested 542 clerks, 542 laborers, 571 medical personnels(164 doctors, 299 nurses, 108 medical technicians) for Hepatitis B surface antigen(HBsAg) with reversed passive hemagglutinin(RPHA) method and hepatitis B surface antibody(anti-HBs) with passive hemagglutinin(PHA) method. 1) Among 542 clerks. 31(5.7%) were positive for HBsAg and 79(14.6%) were positive for anti-HBs. The positive rate of HBsAg was higher in man(7.8%) than that in female (2.7%.). The positive rate of anti-HBs was higher in female(17.0%) than in male(12.9%) 2) Among 571 medical personnels, 42(7.4%) were positive for HBsAg(9.1%) In medical doctors, 5.4% in nurses, and 10.2% in technicians. 3) The occurrence rate of HBsAg and anti-HBs in laborers and clerks was not related with age(p>0.5), but that of HBsAg and anti-HBs in medical doctors was increased with advancing age significantly (p<0.05). 4) HBsAg was found positive in 42(7.4%) of 571 medical personnels and 35(6.5%) of 542 laborers and 31(5.7%) of 542 clerks. The positive rate of HBsAg in medical personnels was higher than that of other workers. 5) The exposure rate of medical personnels and clerks were 36.4% and 20.2% respectively.