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최용만,최금자 中央醫學社 1976 中央醫學 Vol.30 No.4
Although rare perforation of the gall bladder is associated with high mortality. Perforation of the gall bladder is usually a consequence of acute cholecystitis with gangrene but occasionally results from other special conditions such as typhoid. One of the early classical articles on the subject of perforation of the gall bladder is by McWilliams(19I2). Strohl et al. reported an incidence of perforation in acute?cholecystitis of about 8 3 percent, and Glenn cites a mortality rate of from 5.8 to 75 percent; with an average 25.5 percent. Therefore, early or emergency operation for acute cholecystitis has been advised by many authors to avoid this mortality. This recommendation is justified since mortality and morbidity of, holecystectomy are low (1 to3 per cent). Also, mortality rates of emergency or early cholecystectomy and elective operation, appear to be the same. Authors are about to report two cases of spontanenous multiple perforation of gall bladder due to acute cholecystitis in one 58 year old female and the other 54 year old female in which the patients made recently a complete recovery following a surgical removal of the perforating gall bladder and abdominal drainage with massive antibiotics.
최용만 梨花女子大學校 醫科大學 醫科學硏究所 1991 EMJ (Ewha medical journal) Vol.14 No.4
Most of the progress in the diagnosis and treatment of biliary tract disease has been made in the last century. but the gallstones and their sequelae which cause most of the clinical problems. are not malady of modern times. Alternatives to traditional cholecystectomy were developed during the 1980s and are currently undue evaluation. They include oral chemolysis. extracorporeal shock wave lithotripsy. percutaneous dissolution and extaction, and laparoscopic cholecystectomy. One of the goals of interventional surgery is to simplify patient care by performing surgical techniques percutaneously. Cholecysrectomy is one technique that, lends itself to interventioal approach. one acan envision replacing surgery with a four step procedure. 1) percutaneous cholecystostomy 2) percutaneous stone removal 3) sclerosis and fibrosis of the gall bladder 4) cystic duct occlusion. Both percutaneous cholecystostomy and stone removal have been performed frequently and are in the interventional repertoire. Sclerosis of biliary system may be derived from experience with chemical agents. The aim of this study is a preliminary clinical application of chemical fibrosis of gallbladder with 95% Ethanol and 5% Phenol for treatment of gallbladder diseases. The following results were obtained: 1) The values of liver function test were normnal on postoperative 1 day. 1 week and 4 weeks in cystic duct ligated control group. 2) AST, ALT and ALP were increased markedly on postoperative 1 day after 10, 30 and 60 minutes injection groups into gallbladder with both 95% ethanol and 5% phenol. 3) The edema, congestion and inflammatory changes of gallbladder were mildly developed on postoperaive 1 day. 1 week and 4 weeks in 10, 30, and 60 minutes cystic duct ligated control group. 4) The fibrosis of gallbladder was moderately to severely developed on postoperative 4 weeks after 10, 30 and 60 minutes injection group into gallbladder with 95% ethanol. 5) The fibrosis of gallbladder was moderately developed on postoperative 4 weeks after 10, 30 and 60 minutes injection group into gallbladder with 5% phenol. Inspite of a limited number of observation, the chemical sclerosing agents may be useful treatmental method for gallstone patient if applied in selected cases and it should he opened for further study in lager experimental group.
최용만 梨花女子大學校 醫科大學 醫科學硏究所 1984 EMJ (Ewha medical journal) Vol.7 No.4
The formation of gall stone is considered to be occurred by vsrious factors. There major factors have been considered to be of etiologic importance : 1) a physiochemical disorders of bile, 2) stasis of bile, 3) infection or inflammation of the biliary system. Especially, bilirubin stone is found frequently in Korea and the formation of the bilirubin stones is much corelated to the infection or infla-mmation. This study is a review and analysis of 68 cases of the bile culture in the bili-ary tract disease that were admitted and treated at Ewha Womans University Ho-spital from June 1980 to June 1983. The results are as follows : 1) The age group of the highest incidence was 60 decades(29.4%) and 40 de-cades(25%) in next. 2) There was 22 male 46 female and male to female ratio was 1:2. 3) In 57 cases of calculus biliary tract disease, the location of stone were 29 ca-ses(42.6%)in gall bladder, 11 cases(16.2%) in common bile duct and 11 cases(16.2%)in gall bladder and common bile duct. No stone was 11 cases(16.2%). 4) In 68 cases fo the biliary tract disease, 47 cases(69.1%) were positive cul-ture and in 57 stone cases of biliary tract disease, 44 cases(77.2%) were posit-ive culture. 5) In relation to postop. Dx. and bile culture, the positive culture in G.B. bile was 58.3% and positive culture in CBD bile was 100% in acute cholecystitis wi-th stone cases, where as, the positive G.B. bile culture was 50% and the positive CBD bile was 59.3% in chronic cholecystitis with stone cases.