Outcome of Patients Undergoing Kasai Procedure for Biliary Atresia: a Study of Those Surviving More Than 10 Years with Their Native Livers

To evaluate the long-term prognosis of biliary atresia after Kasai operation, a total of 14 patients (of the 41 patients operated upon from 1982 to 1997), who had been followed up for more than 10 years, were included in this retrospective study. Eleven out of 14 patients survived with their native livers, and their data analyzed for age at operation, clearing time of jaundice, histological outcome, postoperative complications, effectiveness after the application of an intussusception anti-reflex valve, and quality of life. Average age at surgery was 62.8 days. Serum bilirubin was normalized within three months in all patients. Six among the eleven long-term survivors had ascending cholangitis as one of the postoperative complications. The application of an intussusception anti-reflux valve did not show any statistical significance in long-term survival. Most of long-term survivors appeared to enjoy good quality of life. Kasai operation might not be the definitive treatment for biliary atresia; however, Kasai operation made it possible to achieve long-term survival for patients with biliary atresia when the patients were detected and treated as early as possible.

A Case of Carcinoid Tumor of the Common Bile Duct

Carcinoid tumors arising in the extrahepatic bile duct are very rare, accounting for only 0.2%~2% of all gastrointestinal carcinoid tumord. We experienced one case of a carcinoid tumor in the common bile duct. A 43-years-old man was unexpectedly found to have a carcinoid tumor of the common bile duct. This patient had no obstructive jaundice, yet we thought that this tumor was a clinically malignant tumor, so we performed pylorus preserving pancreatoduodenectomy. Pathologically, an ill-demarcated mass that measured 1.5x1.5cm in size had invaded into the pancreas. Immunohistochemically, the mass was founded to be chromogranin, synaptophysin and CD56 positive. The patient who underwent curative resection is alive and disease-free at time of this publication. This report also reviews the relevant literature on carcinoid tumors in the common bile duct.

Clinical Evaluation of Hypercalciuria and Hematuria in NIDDM / 대한신장학회잡지

Background : hypercalciuria is defined as normocalcemia and increased urinary calcium excretion without any cause. Many studies have demonstrated that urinary calcium excretion is increased and glomerular hematuria is related to hypercalciuria in diabetic patients with severe proteinuria. This study was undertaken to elucidate whether patients with NIDDM are hypercalciuric and whether there is a pathophysiologic relationship between urinary calcium excretion, hematuria and the degree of diabetic nephropathy. The purpose of this study was to evaluate the incidence of hypercalciuria in NIDDM patients and the possible relationship among urinary calcium excretion, hematuria and proteinuria in diabetic nephropathy. Methods : We studied with 18 control subjects and 101 NIDDM patients without urinary infection. NIDDM patients with normal renal function (s- Cr<133micromol/L) followed at Kangbuk Samsung Hospital were included in this study from June, 1993 through March, 1995. Control group included 18 normal subjects and 101 NIDDM patients were divided into 3 groups : normoalbuminuria group, microalbuminuria group and macroalbuminuria group. Urinary albumin excretion rate (microalbumin) and urinary calcium and creatinine excretion ratio were measured. Kruskal-Wallis 1-way ANOVA test and multifactorial regression test were used to analyze. Results : 1) Age, duration of DM and serum creatinine level in macroalbuminuria group were significantly higher than normoalbuminuria group. 2) Calcium-creatinine ratio was significantly higher in NIDDM patients than in control subjects. Among diabetics it is significantly higher in microalbuminuria and macroalbuminuria groups than normoalbuminuria group. The incidence of hypercalciuria is 44.6% in patients with NIDDM. 3) Albumin excretion rate is correlated positively with calcium-creatinine ratio(r=0.26, p=0.0006), while no correlation was observed with serum creatinine, serum calcium, fasting blood glucose, postprandial 2hrs blood glucose, HbA1C, creatinine clearance, and body mass index. 4) Hematuria was observed in 3 cases with hypercalciuria(6.7%) and 4 cases without hypercalciuria(7.1%). No significant difference was observed between two groups. Conclusion : Hypercalciuria was more frequent in patients with NIDDM than in control. The severity of calciuria was correlated with the progression of diabetic nephropathy. There was no definite correlation between urinary calcium excretion and hematuria.