Journal of Yeungnam Medical Science

Koing Bo Kwun

20 Articles

A Case of Type II Mirizzi Syndrome.: Hong Jin Kim, Joo Hyeong Lee, Myeong Jun Shin, Koing Bo Kwun, Jae Chun Chang, Moon Kwan Chung; Yeungnam Univ J Med. 1990;7(2):197-202. Published online December 31, 1990; DOI: https://doi.org/10.12701/yujm.1990.7.2.197

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Abstract PDF: Mechanical obstruction of the common hepatic duct includes the following causes; choledocholithiasis, sclerosis, cholangitis, pancreatic carcinoma, cholangiocarcinoma, postoperative stricture, primary hepatic duct carcinoma, enlarged cystic duct lymph nodes, and metastatic nodal involvement of the porta hepatis. Partial mechanical obstruction of the common hepatic duct caused by impaction of stones and inflammation surrounding the vicinity of the neck of the gallbladder had been reported on the “syndrome del conducto hepatico” in 1948 by Mirizzi. Nowadays, this disease was named by Mirizzi syndrome. Mrizzi syndrome is a rare entity of common hepatic duct obstruction that results from an inflammatory response secondary to a gallstone impacted in the cystic duct or neck of the gallbladder. It results from an almost parallel course and low insertion of the cystic duct into the common hepatic duct. In a variant of Mirizzi's syndrome, the cause of the common hepatic duct obstruction was a primary cystic duct carcinoma rather than gallstone disease. A 71-year-old man was admitted with a four-day history of right upper quadrant abdominal pain. Past medical history was unremarkable. On physical examination, the patient had a temperature of 38℃, icteric sclera and right upper quadrant tenderness. Pertinent laboratory findings included WBC 18,000/cm3; albumin 2.6 g/dl (normal 0-1) with the direct bilirubin, 4.4 mg/dl (normal 0-0.4). Ultrasonography revealed a dilated extrahepatic biliary tree. ERCP showed that the superior margin was angular and more consistent with a calculus causing partial CHD obstruction (Mirizzi syndrome). At surgery a diseased gallbladder containing calculi was found. In addition, there was two calculi partially eroding through the proximal portion of the cystic duct and compressing the common hepatic duct. A cholecystectomy and excision of common bile duct was performed, with Roux-en-Y hepaticojejunostomy. The postoperative course was uneventful.

A Clinical Study of Congenital Duodenal Obstruction.: Young Soo Huh, Bo Yang Suh, Koing Bo Kwun; Yeungnam Univ J Med. 1990;7(2):39-48. Published online December 31, 1990; DOI: https://doi.org/10.12701/yujm.1990.7.2.39

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Abstract PDF: Congenital duodenal obstruction in the newborn infant may be due to a variety of causes. Duodenal obstruction often presents with bilious vomiting and upper abdominal distention. Diagnosis is usually established on plain x-ray of the abdomen by the classic finding of the double-bubble. In the period July 1986 to June 1990, 16 patients with congenital duodenal obstruction were operated and the following results were obtained. 1. Sixteen patients were comprised of 11 males and 5 females, the ratio of male and female was 2.2:1. 2. Thirteen patients (81%) had been admitted to our hospital during one month of life. 3. Congenital duodenal obstruction was in 16 cases; malrotation in eight (50%), annular pancreas in six (38%), type 1 atresia in one (6%), and wind-sock anomaly in one (6%). 4. There were two premature patients and six patients of small for gestational age. 5. Overall, bilious vomiting, occurring in three fourths, was the single most frequent presenting complaint. 6. Polyhydramnios occurred in two of the patients. 7. Diagnosis was possible with clinical symptom and simple abdomen. 8. The operative procedures performed were; duodenoduodenostomy in five, duodenojejunostomy in two, excision of wind-sock membrane in one, and Ladd's procedure in eight. 9. A total of ten associated congenital anomalies were found in six patients. 10. Postoperative complications occurred in five cases (31%).

Preduodenal Portal Vein Associated with Duodenal Obstruction: A case report.: Young Soo Huh, Jae Hwang Kim, Bo Yang Suh, Koing Bo Kwun; Yeungnam Univ J Med. 1990;7(1):211-214. Published online June 30, 1990; DOI: https://doi.org/10.12701/yujm.1990.7.1.211

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Abstract PDF: Portal vein anomalies include absence, duplication, and malposition (preduodenal portal vein). Duplication of the portal vein or a preduodenal portal vein are hazards at the time of biliary or duodenal surgery, or liver transplantation. Preduodenal portal vein, which was first reported by knight in 1921, is extremely rare congenital anomaly and may cause duodenal obstruction. Recently, we experienced a case of preduodenal portal vein associated with dextrocardia, situs inversus, and duodenal obstruction in a 3 days old male newborn and report with review of the references.

A Human Case of Hepatic Resection for Liver Fascioliasis in Korea.: Hong Jin Kim, Sung Kyun Roh, Min Chul Shim, Koing Bo Kwun, Heun Ju Lee, Jae Chun Chang, Tae Sook Lee; Yeungnam Univ J Med. 1990;7(1):165-171. Published online June 30, 1990; DOI: https://doi.org/10.12701/yujm.1990.7.1.165

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Human Fasciola hepatica infection is a rare entity involving infestation of the liver and biliary tree with adult flukes, which can result in hepatitis, cirrhos is and biliary tract inflammation, obstruction and lithiasis. The patient had the typical diagnostic tetrad of fever, eosinophilic leukocytosis, tender hepatomegaly and fluke ova in the stools. Treatment consists of Emetine hydrochloride hydrochloride administration for hepatic involvement and common bile duct exploration for removal of flukes, with cholecystectomy for associated cholelithiasis. The combination of medical and surgical therapy can be expected to produce an arrest of this infection. The removed liver revealed eggs of the fasciola species in the intrahepatic bile duct. The clinical history, pathological findings and treatment of this case were described.

Citations

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Subcutaneous fascioliasis: a case report
E C Chang, H L Choi, Y W Park, Y Kong, S Y Cho
The Korean Journal of Parasitology.1991; 29(4): 403. CrossRef

Multiple Organ Failure Syndrome : MOF.: Koing Bo Kwun; Yeungnam Univ J Med. 1989;6(1):1-7. Published online June 30, 1989; DOI: https://doi.org/10.12701/yujm.1989.6.1.1

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Abstract PDF: No abstract available.

Mutiple Primary Malignant Tumor.: Su Jung Lee, Yun Woong Chung, Hong Jin Kim, Bo Yang Suh, Koing Bo Kwun; Yeungnam Univ J Med. 1988;5(2):221-230. Published online December 31, 1988; DOI: https://doi.org/10.12701/yujm.1988.5.2.221

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Abstract PDF: Though the occurrence of multiple primary malignant tumor is a rare finding but the reported cases of it has increased in recent years. We collected multiple primary cancer of different organ, tissue and the multicentric origin of bilaterally paired organs. This paper reports 6 cases of multiple primary malignant tumors which were experienced at Yeungnam university hospital in Taegu during the past 2 years with review of journals. The results were as follows. 1. The incidence of multiple primary cancer was 0.31% for 2 years (1987-1988). 2. The ratio between male and female was 1:1 and mean age of incidence was 54.1 years. 3. The ratio between synchronous and metachronous (interval more than 6 months) was 1:1. 4. The time interval between first and second cancer was average 2.7 years in metachronous cases. 5. The most frequent involved organ was stomach, breast and colon in order of frequency. 6. The incidence of familial cancer associations was found in one out of 6 cases. 7. The test of DNCB, multitest CMI and ratio of T4 to T8 were performed in 4 cases but there was no definitive evidence of abnormality. We concluded that every effort should be made to discover the presence of synchronous malignancies in the patients who are being treated for a known tumor, and also special care should be given to detect new metachronous lesions is required.

A Case of Insulinoma.: Sun Kyo Song, Sung Hoon Park, Koing Bo Kwun; Yeungnam Univ J Med. 1988;5(1):181-189. Published online June 30, 1988; DOI: https://doi.org/10.12701/yujm.1988.5.1.181

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Abstract PDF: Insulinoma is the most frequent endocrine tumor of the pancreas and the first of the endocrine-secreting tumor of the gut to be recognized by Nicholls in 1902. Recurrent episodes of hypoglycemia is the main cause of the symptoms and signs which were sweating, pallor, dizziness, habitual change, convulsion and coma. In 1935, Whipple and Frants were described so-called “Whipple's triad”: the patient's symptoms occur with fasting or exercise; at the time of symptoms, the serum glucose in 50mg/dl or less; and the symptoms are relieved by the administration of glucose. While these criteria were timely, they proved to be rather nonspecific and may be found in other conditions that result in fasting hypoglycemia. We experienced a 44-year-old female patient who had repeated attacks of convulsion, unconsciousness and coma for 3 years. Although she has been treated with anticonvulsant, the symptoms and signs were not disappeared. At the time of administration, she was a full coma state due to hypoglycemia and was dramatically reversed by intravenous administration of the glucose solution. The preoperative test such as provocative test, abdominal CT and celiac angiography revealed insulinoma and after enucleation the pathologic diagnosis was the same. We like to report an adult female patient with insulinoma and the review of literatures briefly.

Intraoperative Radiation Therapy of locally Advanced Gastric Cancers: Case report.: Kyeung Ae Kim, Seong Kyu Kim, Sei One Shin, Myung Se Kim, Hong Jin Kim, Koing Bo Kwun, Hung Dae Kim; Yeungnam Univ J Med. 1988;5(1):153-158. Published online June 30, 1988; DOI: https://doi.org/10.12701/yujm.1988.5.1.153

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Abstract PDF: Stomach cancer is the most popular tumor in Korea but the prognosis following extensive surgery and chemotherapy has not improved for many years. Conventional external radiotherapy also has some limitation, namely, a cancerocidal dose cannot be delivered to tumors because of low radiation tolerance of adjacent critical sensitive organs. In order to overcome these limitations of curative surgery and external radiotherapy, intraoperative radiotherapy was proposed in many centers and the results were excellent. We treated two cases of locally advanced gastric cancers with IORT by using NEC 18 MeV Linear Accelerator after standard subtotal resection of the stomach. After treatment, the patients are in good conditions so far, but in order to evaluate the effectiveness of IORT, a study will be performed on the survival rates between patients treated by IORT and those treated by surgery alone.

Diagnosis of a Bleeding Meckel's Diverticulum Using (99m)Technetium Pertechnetate Scanning.: Young Soo Huh, Jae Hwang Kim, Koing Bo Kwun; Yeungnam Univ J Med. 1987;4(1):129-132. Published online August 31, 1987; DOI: https://doi.org/10.12701/yujm.1987.4.1.129

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Abstract PDF: Two cases of Bleeding Meckel's Diverticulum Using (99m)Technetium-Pertechnetate Scanning are presented. (99m)TC-pertechnetate was used in the diagnosis of Meckel's Diverticulum by Jewette et al in 1970 for the first time. The affinity of this isotope for the parietal cell of the gastric mucosa makes it ideal for delincating ectopic gastric tissue. It noninvasiveness can be used in early screening test of occult gastrointestinal bleeding in pediatric age group.

Primary Sclerosing Cholangitis: One Case Report.: T J Park, Hyun Sik Min, Bo Yang Suh, Koing Bo Kwun, Tae Sook Lee; Yeungnam Univ J Med. 1986;3(1):351-355. Published online December 31, 1986; DOI: https://doi.org/10.12701/yujm.1986.3.1.351

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Abstract PDF: Sclerosing cholangitis is an uncommon disease which involves either all or part of the exrahepatic biliary duct system and, occasionally, affects the intrahepatic biliary radicles. The disease has also been called “obliterative cholangitis” and “stenosing cholangitis”, in reference to a progressive thickening of the bile duct walls encroaching upon the lumen. Several authors have proposed that the term “primary sclerosing cholangitis” be reserved for cases in which there are no associated diseases, and that all other cases be classified as “secondary sclerosing cholangitis.” Many rigid criterias have been established for the diagnosis of primary sclerosing cholangitis. Recently the authors experienced one case of primary sclerosing cholangitis which was coincided with rigid criterias and was confirmed by operation with histologic examination. We present our case and review the literatures.

A case Report of Splenic Abscess.: Min Chul Shim, Sun Kyo Song, Hong Jin Kim, Koing Bo Kwun; Yeungnam Univ J Med. 1986;3(1):339-342. Published online December 31, 1986; DOI: https://doi.org/10.12701/yujm.1986.3.1.339

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Abstract PDF: Splenic abscess is an uncommon lesion and may be present either as a localized area of infection in the spleen or as a part of generalized sepsis. The diagnosis is difficult because of the rather nonspecific clinical picture. Hence, splenic abscess has a high mortality rate and is after diagnosed only at autopsy. Computerized tomography (CT) offers the clinician a reliable tool for the diagnosis of intra-abdominal abscess. A successful outcome is dependent on an early diagnosis and prompt treatment by splenectomy with antibiotic cover. We experienced a care of splenic abscess which was diagnosed by CT and treated by splenectomy with antibiotics. Postoperative course was relatively uneventful.

Intestinal lipoma near the ileocecal calve Report of 3 cases and review of the literature.: Min Chul Shim, Soo Jung Lee, Hyun Sik Min, Koing Bo Kwun; Yeungnam Univ J Med. 1986;3(1):333-337. Published online December 31, 1986; DOI: https://doi.org/10.12701/yujm.1986.3.1.333

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Abstract PDF: Three cases of intestinal lipoma near the ileocecal valve are described. In patients of cecal and ileocecal valve lipoma, they had right lower quadrant abdominal pain secondary to partial intestinal obstruction. In rarely developed segmental lipomatosis of the ileum, the patient had right abdominal mass and pain to fecal impaction of the diverticula. Diagnosis may be made by an abnormal roentgenographic pattern and confirmed by colonoscopy. Surgical removal of the affected segment results in cure in symptomatic patients.

Leriche Syndrome: A case report.: Won Jong Lee, Hong Jin Kim, Min Chul Shim, Sun Kyo Song, Koing Bo Kwun; Yeungnam Univ J Med. 1986;3(1):319-323. Published online December 31, 1986; DOI: https://doi.org/10.12701/yujm.1986.3.1.319

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Abstract PDF: Leriche syndrome is a chronic disorder mostly in male and is a specific symptom complex due to thrombotic obliteration of the aortic bifurcation as result of an atherosclerotic change. The symptoms include 1) extreme liability to fatigue of both lower limbs; 2) symmetric atrophy of both lower limbs; 3) pallor of the legs and feets; 4) inability to maintain stable erection. There are several methods for surgical management of this disorder; 1) thromboendarterectomy with or without sympathectomy; 2) aortoiliac bypass graft; 3) aortofemoral bypass graft. Here we report a case of Leriche syndrome which was successfully managed with aortobifemoral bypass graft with Dacron and reviewed literatures on it briefly.

A Clinical Use of CT Scan in Rectal Cancer.: Bo Yang Suh, Yong Sik Chung, Su Jeung Lee, Min Chul Shim, Koing Bo Kwun; Yeungnam Univ J Med. 1986;3(1):67-72. Published online December 31, 1986; DOI: https://doi.org/10.12701/yujm.1986.3.1.67

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Abstract PDF: Authors evaluated the accuracy of preoperative pelvic CT scan staging and its effects on management in 12 biopsy proved rectal cancer patients. Authors also studied postoperative CT in 5 patients to detect disease recurrence and metastasis. Preoperative CT staging was identical to surgical and/or pathological staging in 9 patients (75%), but it was underestimated in two cases and overestimated in one instance than in surgical stagings. In 7 cases, CT scan did not alter original choice of procedures. However, preoperative CT staging gave definitive informations to change management plans in 5 cases otherwise the treatment would be difficult and inadequate. Postoperative CT showed local recurrence in one and liver metastases in 2 cases. One of them was not detected at exploratory laparotomy.

A Choledochal Cyst Associated with Hemorrhagic Tendency and a Cerebral Hematoma.: Young Bok Park, Myung Wo Lee, Hong Jin Kim, Koing Bo Kwun; Yeungnam Univ J Med. 1985;2(1):299-306. Published online December 31, 1985; DOI: https://doi.org/10.12701/yujm.1985.2.1.299

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Abstract PDF: Congenital dilatation of the common bile duct is relatively rare anomaly. Its pathogenesis has not been completely understood. Complications of the choledochal cyst are mainly suppurative cholangitis, liver cirrhosis, stone formation, malignant change, bile peritonitis due to spontaneous and traumatic rupture. We experienced one case of choledochal cyst associated with hemorrhagic tendency and a cerebral hematoma, which is extremely rare complication. The 3 months old male patient reported here was treated with complete excision of cyst and Roux-en-Y choledochojejunostomy after correction of bleeding tendency and removal of cerebral hematoma. Postoperative course was relatively uneventful. 11 days after operation, the patient was discharged with full improvement.

Leiomyosarcoma of Small Intestine: Two Cases Report with Literatural Review.: Yong Sik Chung, Bo Yang Suh, Koing Bo Kwun, Tae Sook Lee; Yeungnam Univ J Med. 1985;2(1):281-286. Published online December 31, 1985; DOI: https://doi.org/10.12701/yujm.1985.2.1.281

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Abstract PDF: Small bowel malignancy consists 1~2% of overall gastrointestinal tract cancer and leiomyosarcomas of small intestine are 10~20% of small bowel malignancy. Small bowel leiomyosarcomas are rare in incidence and have no specific symptoms, signs or definite radiologic findings, so it is not easy to diagnose at early stage of disease. They are found occasionally by unknown origined gastrointestinal bleeding, abdominal pain, intestinal obstruction, perforation and palpable mass, and diagnosed mostly by operation. Recently annual case reports are increasing trend in Korea. We experienced two cases of small bowel leiomyosarcomas which was diagnosed finally by pathologic findings, so we report them with literatural review.

Korean Aspect of the Medical Problems of the Aged.: Koing Bo Kwun, Jong Hak Chung; Yeungnam Univ J Med. 1985;2(1):191-202. Published online December 31, 1985; DOI: https://doi.org/10.12701/yujm.1985.2.1.191

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Abstract PDF: As the result of a significant improvement in the economic situation and development of scientific techniques in Korea during the last 20 years, the life expectancy of Korea people has lengthened considerably and as a result the number of old aged people has markedly increased. Such an increase of the number of aged people brought about many problems. Authors would like to take a medical look at the “Problem of old aged people” presently facing us in Korea. Currently the number of people over 65 has increased rapidly and is 1,620,000, 4% of total population. But it is still much lower than 8.9% in Japan, 10.7% in U.S.A., and 14.9% in the United Kingdom. Over 25% of these aged people were found to have at least more than one disease which requires medical care. Diseases occur in the circulatory system, 30.9%, respiratory system, 17.1%, digestive system 8.6%, metal disorders, 8.4%, malignant neoplasms, 7.0%. About 51% of the aged over 65 are under medical security benefit, mostly with partial coverage plan. Their clinic visit rate was very low (2.0% in 1981), which might be due to financial reasons. Since diseases affecting the aged progress chronically, early detection and long term care are utter most important. However there is almost no special facility, long term care center or geriatric specialist. For proper management of medical problems in the growing population of the Korea elderly expansion of medical security coverage, greater number of specialized facilities, education of geriatric special manpower and efficient operating system should be established.

Ultrasonographic Features of Intra-abdominal Abscess.: Kil Ho Cho, Kyung Hee Jung, Mi Soo Hwang, Jae Chun Chang, Koing Bo Kwun, Hyun Sik Min; Yeungnam Univ J Med. 1985;2(1):87-93. Published online December 31, 1985; DOI: https://doi.org/10.12701/yujm.1985.2.1.87

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Abstract PDF: Intraabdominal abscess usually causes distress with fever, leukocytosis, pain and toxicity. Diagnosis of intraabdominal abscess is occasionally difficult and it has high morbidity. However radiologic method, such as ultrasonography, CT scan, or RI scan are helpful to early detection of intraabdominal abscess. Among these methods, ultrasonography is a noninvasive technique and performed without discomfort to patient. And also differential diagnosis between cystic and solid lesion is very easy and sequential ultrasonography in same patient is valuable for the evaluation of treatment effect. We analyzed the ultrasonic features of 48 cases with intraabdominal abscesses and the results are as follows; 1. In total 48 cases, the intraabdominal abscesses were 30 cases, the retroperitoneal abscesses, 5 cases, and the visceral abscesses, 13 cases. 2. The causes of the intraabdominal abscesses were perforating appendicitis (25 cases), postoperative complications (5 cases), pyogenic and amebic hepatic abscesses (13 cases), and the other (5 cases). 3. Round or oval shaped lesions were 26 cases (54%), irregular shape, 18 cases (38%), and multiple abscess formation in 4 cases (8%). 4. The size of the lesions were between 5 and 10cm in diameter in 54% of total 48 cases, and the most frequent feature of the echo pattern of the lesions was cystic with or without internal echogenicity (69%).

A Case of Hepatic Hemangioma.: Si Hwan Kim, Young Hyun Lee, Heon Ju Lee, Moon Kwan Chung, Soo Bong Choi, Chong Suhl Kim, Koing Bo Kwun, Mi Soo Hwang, Jae Chun Chang, Tae Sook Lee; Yeungnam Univ J Med. 1984;1(1):161-169. Published online December 31, 1984; DOI: https://doi.org/10.12701/yujm.1984.1.1.161

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Abstract PDF: Hepatic hemangioma is a benign neoplastic disease of the liver and characterized by high vascularity and accompanied with bleeding episode. We report a case of giant hepatic cavernous hemangioma and review the literature briefly. A 44-year old female patient was admitted because of palpable abdominal mass, which growing for 15 years. She was diagnosed as hepatic hemangioma by abdominal CT scan and selective celiac angiography. She was performed the left lateral segmentectomy of liver and the pathological report was cavernous hemangioma of the liver.

Diagnosis and Management of Acute Renal Failure in Surgical Patient.: Koing Bo Kwun; Yeungnam Univ J Med. 1984;1(1):13-23. Published online December 31, 1984; DOI: https://doi.org/10.12701/yujm.1984.1.1.13

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Abstract PDF: Acute renal failure refers to a rapid reduction in renal function that usually occurs in an individual with no known previous renal disease. Development of a complication of acute renal failure in critically ill surgical patients is not unusual, and it causes high morbidity and mortality. Acute renal failure can be divided as Pre-renal (functional), Renal (organic), and Post-renal (obstructive) azotemia according to their etiologies. Early recognition and proper correction of pre-renal conditions are utter most important to prevent an organic damage of kidney. These measures include correction of dehydration, treatment of sepsis, and institution of shock therapy. Prolonged exposure to ischemia or nephrotoxin may lead a kidney to permanent parenchymal damage. A differential diagnosis between functional and organic acute renal failure may not be simple in many clinical settings. Renal functional parameters, such as FENa+ or renal failure index, are may be of help in these situations for the differential diagnosis. Provocative test utilizing mannitol, loop diuretics and renovascular dilators after restoration of renal circulation will give further benefits for diagnosis or for prevention of functional failure from leading to organic renal failure. Converting enzyme blocker, dopamine, calcium channel blocker, and propranolol are also reported to have some degree of renal protection from bioenergetics renal insults. Once diagnosis of acute tubular necrosis has been made, all measures should be utilized to maintain the patient until renal tubular regeneration occurs. Careful regulation of fluid, electrolyte, and acid-base balance is primary goal. Hyperkalemia over 6.5 mEq/L is a medical emergency and it should be corrected immediately. Various dosing schedules for medicines excreting through kidney have been suggested but none was proved safe and accurate. Therefore blood level of specific medicines better be checked before each dose, especially digoxin and Aminoglycosides. Indication for application of ultrafiltration hemofilter or dialysis may be made by individual base.

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