질 세척액의 β-hCG치를 이용한 조기양막파수의 진단

강석선 ( Seok Seon Kang ),윤성도 ( Sung Do Yoon ) 대한주산의학회 1998 Perinatology Vol.9 No.4

난관임신에서 영양배엽세포의 침투 깊이의 예측

이정호(Jeong Ho Rhee),강석선(Seok Seon Kang),김종인(Jong In Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.10

목적: 난관임신에서 임상적 진단 요소들과 영양배엽세포의 침투 깊이와의 관계를 평가하고 가장 예측능이 우수한 임상적 진단 요소를 확인하기 위하여 본 연구를 실시하였다. 연구방법: 조직 병리학적으로 확진된 50명의 난관임신 환자를 연구 대상군으로 설정 하였다. 임신기간과 임신 위치의 크기 및 혈중 β-hCG 가 측정 되었고 수술 표본 조직의 병리학적소견에 따라 두 군으로, 즉 영양배엽세포의 난관내 성장군(군I)과 근육층내 침투군(군II)으로 분류하였으며 각각 22, 28명이었다. 세가지 임상적 진단 요소 간과 각각의 진단요소와 영양배엽세포의 침투 깊이 사이의 관계에 대하여 통계학적 검증을 실시하였으며 통계적 분석은 SPSS 프로그램을 이용하여 Student's t-test, Chi square, 선형회귀(linear regression), 선형상관(linear correlation)을 통하여 연관성과 유의성을 검증하였고 통계학적 유의성은 P<0.05일 때로 정했다. 결과: β-hCG의 정량은 군 I에서는 1843.7±1524.7 mIU/ml(평균±표준편차), 군 II에서는 12144.3±10561.6 mIU/ ml(평균±표준편차) 이었다. 임신 위치의 크기와 β-hCG 사이에는 연관성이 있었으나(P<0.05), β-hCG와 임신기간, 임신위치의 크기와 임신 기간 사이에는 연관성이 없었다. β-hCG의 혈중치는 영양배엽세포의 침투 깊이를 예측하는데 통계적 유의성이 있었으며(P<0.05) 기준치 3,500 mIU/ml가 가장 높은 민감도, 특이도, 양성 예측도, 음성 예측도를 보였고 각각 0.79, 0.86, 0.88, 0.76 이었다. 임신 기간이나 임신 위치의 크기는 영양막세포의 침투 깊이를 예측하기 위한 요소로는 통계적 유의성이 없었다. 결론: 난관임신에서 내과적 치료의 성공은 약제 전달을 위한 병변 부위 혈관 구조의 완전성에 의존할 것으로 추측됨으로 내과적 치료를 위한 환자의 선택에서 영양배엽세포의 침투 깊이를 예측하는 것이 매우 중요하리라 사료된다. 본 연구에서는 난관임신 진단을 위한 여러 가지 임상 요소 중 β-hCG만이 유일하게 영양배엽세포의 침투 정도를 예측하는데 유의성이 있었으며 그 기준치 3,500 mIU/ml가 가장 이상적이라고 사료된다. Objectives: To evaluate the relation between diagnostic clinical parameters and the depth of trophoblastic invasion in tubal pregnancy and decide the most predictable parameter. Methods: Total 50 patients who were confirmed as tubal pregnancy pathologically, from Jan. to Dec. 1997, were included in this study. Menstrual missed periods was calculated by clinical history, volume of gestational mass was calculated as sphere, β-hCG was titered with preoperative blood sample. All surgical specimens were examined pathologically and divided into two groups such as intraluminal and extraluminal, defined as intact tubal musculature and trophoblastic invasion beyond musculature, n=22 and n=28, respectively. Statistical analysis was performed among three parameters and between each parameter and the depth of trophoblastic invasion. Statistical analysis included were Student's t-test, Chi square, linear regression, and linear correlation analysis using SPSS statistical package and statistical significance was determined as P<0.05. Results: There was a correlation between volume of gestational mass and β-hCG(P<0.05), but not between β-hCG and missed period or volume of gestational mass and missed period. β-hCG level was 1843.7±1524.7 mIU/ml(Mean±SD) in intraluminal and 12144.3±10561.6 mIU/ml(Mean±SD) in extraluminal. There was a predictive correlation between β-hCG and the depth of trophoblastic invasion(P<0.05), and cut off level 3,500 mIU/ml showed the highest sensitivity, specificity, positive predictive value, negative predictive value, 0.79, 0.86, 0.88, 0.76, respectively. Two parameters(volume of gestational mass and missed period) had no ability to predict whether intraluminal or extraluminal. Conclusion: We suggest that successful medical treatment of tubal pregnancy depend on lesional intactness of vasculature for drug delivery. In patient selection for medical treatment, it should be important to predict intraluminal type because of intact vasculature. Of clinical parameters, β-hCG is single most predictive parameter, cut off level of 3,500 mIU/ml was the most reasonable level in this study.

맘모톰 시술에 의해 진단된 양성 엽상낭 종양은 반드시 재수술이 필요한가?

박해린(Hai-Lin Park),강석선(Seok Seon Kang),김도연(Do Youn Kim),심정연(Jung Yeon Shim) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.73 No.3

Purpose: Phyllodes tumors are characterized by a double-layered epithelial component arranged in cleft-like ducts surrounded by a hypercellular spindle-celled stroma. Currently, phyllodes tumors are classified as benign, borderline, or malignant based on microscopic features. The relatively high rate of recurrence is an unsolved management problem. If a malignant phllodes tumor is treated inadequately, it may show a propensity for rapid growth and metastatic spread. However, benign phyllodes tumor are often indistinguishable from fibroadenoma, and can be cured by local surgery. Percutaneous removal of benign breast tumors using the Mammotome system has recently been regarded as a feasible, safe method without serious complications. The Mammotome system has an expanding role in the surgical treatment of benign breast disease, and may further extend its role to the excision of small malignant lesions. The aim of this study was to evaluate the efficacy and the safety of the Mammotome biopsy device in the treatment of benign phyllodes tumor, and to identify whether surgical excision is necessary for benign phyllodes tumors diagnosed and excised by Mammotome. Methods: From Jan. 2003 to Feb. 2007, a total of 2,751 US- guided mammotome excisions were performed in 2,226 patients at Kangnam Cha hospital. Out of 2,751 lesions, 30 lesions were proved to be benign phyllodes tumors. All lesions were removed using an 8-gauge probe without any residual lesions. Ultrasonographic follow-up was performed at a 3- to 6-month interval to assess recurrence. The mean follow-up period was 33.2 months (max, 51 months; min, 2 months). Results: The mean patient age was 31.4 years. The average size of the lesion was 1.5 ㎝ (SD+0.43 ㎝). The majority of lesions, 73.3% (22 cases), were palpable, and 26.7% (8 cases) were nonpalpable. Twenty-two lesions (73.8%) were classified as BIRADS category 3, eight lesions (26.7%) were classified as category 4A by ultrasound. During the follow-up period, local recurrence developed in only one patient, making the local recurrence rate 3.3%. No distant metastasis was observed. Conclusion: Benign phyllodes tumors found on mammotome excision may not require surgical reexcision if surgeons are sure that the targeted lesions were excised completely and the follow-up ultrasound does not show any residual lesions, especially in small phyllodes tumors, the greatest dimension of which is less than 3 ㎝.

46 , XX 남성 1 례

김종인(Jong In Kim),이정호(Jeong Ho Rhee),강석선(Seok Seon Kang) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.3

46, XX male is a rare sex cluomasomal constitution characterized by the development of bilateral testis in persons who lack a Y chomosome. The majority of affected persons have normal external genitalia and usually seek medical advice due to infertility, hypogonadism and/or gynecomastia in adulthood. Although Y chromosomsl sequences can be detected in the majority of male subjects with 46, XX karyotype, several studies have shown thst approximately 10 % of patients lack Y chromosomal material including the SRY ( sex-determining region of Y-chromosome) gene. Several hypothesis have been proposed to explain the etiology of this constitution. 1. Translocation of the testis-determining factor (TDF) fiom the Y to the X chromosome or autosome. 2. Acquisition of Y chromosome function by a mutant autosomal or X-linked gene. 3. Undetected mosaicism with Y-bearing cell line 4. Loss of Y chmmosome hom the XXY Klinefelter zygote. We experienced a case of 46, XX male who was 30 years old. We report a case with review of the literature.

잠재성 유두상 갑상선암에서 원발종양의 크기에 따른 공격성 정도 분석

박해린(Hai-Lin Park),곽진영(Jin Young Kwak),강석선(Seok Seon Kang),김도연(Do Youn Kim),강형곤(Hyung Gon Kang),심정연(Jung Yeon Shim),김유리(Yoori Kim),박원근(Won Kun Park),최영길(Young Gil Choi) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.73 No.6

Purpose: Occult papillary thyroid carcinomas (OPC) are defined as tumors measuring <15 ㎜. These tumors are believed to be a less aggressive subset of papillary cancers. They generally behave more like benign lesions and are often more conservatively treated. However, it is unclear if a cancer 1.0 to 1.5 ㎝ in diameter will have a similar favorable clinical behavior as tumors <1.0 ㎝ (micropapillary thyroid carcinoma). Therefore, a retrospective chart review study of patients with OPC in order was carried out in order to answer this question and characterize the biology and optimal treatment for OPCs. Methods: From October 2001 to January 2007, Among the impalpable thyroid nodules detected incidentally during screening examinations, 260 patients underwent surgery for occult papillary thyroid cancer (OPC) at Kangnam Cha University hospital. The data from these patients was analyzed retrospectively. The mean follow up period was 25.6 ± 14.5 (max:63, min:1) months. Results: The mean age of these patients was 42.8 years, and 233 (89.5%) were female. 46.2% of patients underwent a total or neartotal thyroidectomy, and 54.6% underwent a central lymph node dissection. Of the 260 patients, 55 (21.2%) had lymph node metastases. The OPC presented with signs of aggressiveness including multifocality (34.2%), bilaterality (17.7%), capsular invasion (52.7%), and lymph node metastases (21.2%). A progressively increasing frequency of the signs of tumor aggressiveness was observed with increasing tumor size at presentation. LN metastases were associated with the tumor size (P=0.0063), extracapsular invasion (P=0.0015) and multfocallity (P=0.0020). However, there was no association with age and gender. With a follow-up of up to 63 months, 3 patients had a local recurrence (0.014%). No patients currently have active disease and no patients with OPC died during this period. Conclusion: In OPC patients, there is a progressively increasing frequency of the signs of tumor aggressiveness with increasing tumor size. Moreover, a small size itself cannot guarantee low risk and low recurrence rate. The prevalence of LN metastases and extracapsular invasion were higher in those with a tumor size >0.5 ㎝. A near-total or total thyroidectomy with a central lymph node dissection is the preferred treatment. The early detection and treatment of OPC might be warranted through the routine use of thyroid USG and USG-guided FNA.

산전초음파로 진단된 단일 제대동맥태아에 관한 연구

권태희 ( Tae Hee Kwon ),지은경 ( En Kyung Ji ),김화영 ( Wha Young Kim ),김도연 ( Do Youn Kim ),강석선 ( Seok Seon Kang ),전혜선 ( Hye Sun Jun ),김수연 ( Su Yeon Kim ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.5

목적: 산전 초음파로 단일 제대동맥으로 진단된 태아의 동반기형 빈도, 종류와 예후에 대하여 알아보고자 연구를 시행하였다. 대상 및 연구방법: 2001년 1월부터 2005년 12월까지 산전초음파에서 단일제대동맥으로 진단되었고 출산으로 확진된 41예를 대상으로 하였으며, 임신중기 (임신 16-27주) 정밀초음파를 시행한 39예와 임신 말기 본원에 전원 되어 진단된 2예의 동반기형을 조사하였으며. 산전기록지를 검토하여 예후를 관찰하였다. 결과: 단일 제대동맥으로 진단되고 분만이 이루어진 41예 중 8예 (19.5%)에서 동반기형이 발견되었고, 자세한 진단명은 무뇌증 1예, 팔로사징 1예, 신장기형 3예 (한쪽 신장 무형성증 2예, 신우확장증 1예), 배꼽탈장과 동반된 맥락총낭종 1예, 선천성 횡경막 헤르니아와 좌심실 형성부전 증후군 1예와, 식도폐쇄증과 기관식도루공 1예가 있었다. 또한 동반 기형이 없는 단일 제대동맥 33예 중 3예 (9.1%)에서 자궁내발육제한 소견을 관찰하였다. 3예의 염색체 검사에서 정상 2예와 배꼽탈장과 동반된 맥락총낭종 1예에서 에드워드증후군이 관찰되었다. 결론: 산전 초음파 검사에서 단일 제대동맥으로 진단되면 높은 빈도 (19.5%)의 동반기형 진단을 위하여 정밀초음파 검사를 시행하여야 하며, 동반기형이 없는 단일 제대동맥의 경우 예후에 큰 영향을 미치지 않는 것으로 사료된다. Objective: To evaluate the incidence, combined anomaly, and prognosis of prenatally diagnosed Single Umbilical Artery (SUA) by ultrasound. Methods: From January 2001 to December 2005, a single umbilical artery (SUA) was observed in 41 cases out of 22,868 deliveries. Among 41 cases, 39 cases were examined by targeted imaging to rule out fetal anomalies in the mid trimester (intrauterine pregnancy 16-27 weeks). The remaining two cases were detected in the third trimester, which were transferred from a local clinic, and were examined by routine sonogram. Pregnancy and perinatal outcome data were retrieved by review of the medical records. Results: The incidence of SUA in our population was 0.18%. Of 41 fetuses with SUA, 8 cases presented congenital malformations (19.5%) such as acrania (n=1), Tetralogy of Fallot (n=1), renal anomalies (unilateral renal agenesis n=2, pyelectasis n=1), esophageal atresia (EA) with tracheoesophageal fistula (TEF)(n=1), omphalocele with choroid plexus cyst (CPC)(n=1), and congenital diaphragmatic hernia with hypoplastic left heart syndrome (n=1). Of 33 fetuses with isolated SUA, 3 (9.1%) demonstrated growth restriction. Karyotype analysis was performed in three cases. Two were normal and omphalocele with CPC was Trisomy 18. Conclusion: During the prenatal period, the fetus with SUA by ultrasound examination must be carefully monitored with targeted prenatal ultrasound because of its frequent association with fetal congenital anomalies (19.5%). Isolated SUA without associated anomaly dose not affect the outcome of the pregnancy.