두경부 종양에서 99mTc - ( V ) - DMSA 영상술의 진단적 유용성

이규보(Kyu Bo Lee),이재태(Jae Tae Lee),김정균(Jeong Gyun Kim),배선근(Sun Kun Bae),박준식(June Sik Park),박인규(In Kyu Park),현동우(Dong Woo Hyun),이영학(Young Hak Lee),안병철(Byeong Cheal Ahn),최지용(Ji Yong Choi),손상균(Sang Gyun So 대한핵의학회 1995 핵의학 분자영상 Vol.29 No.4

N/A Introduction: Tc-99m-(V)-DMSA is a tumor seeking agent that has been used to image medullary carcinoma of thyroid, soft tissue sarcoma and lung cancer. This study was designed to assess the clinical role of Tc-99m-(V)-DMSA in the diagnosis of head and neck cancers. We has evaluated the diagnostic efficacy of planar and SPECT imaging using Tc-99m-(V)-DMSA. Patients and Method: Sixty-eight patients with head and neck mass were included in this study. All subjects were diagnosed by biopsy or surgery. Planar and SPECT images were obtained at 2 or 3 hour after intravenous injection of 740 MBq(20 mCi) Tc-99m-(V)-DMSA. Seventeen patients also underwent SPECT imaging using dual head camera. Results: The diagnostic sensitivity of Tc-99m-(V)-DMSA planar and SPECT imaging was 65% and 90%, and specificity was 80% and 66%, respectively. The sensitivity of planar imaging in squamous cell carcinoma was similar to overall sensitivity. Six metastatic lesion were first diagnosed by scintigraphy. But benign lesions such as Kikuchi syndrome, tuberculous lymphadenitis also revealed increased uptake. Conclusion: Tc-99m-(V)-DMSA imaging seems to be a promising method in the evaluation of patients with head and neck mass. We recommend SPECT imaging to delineate anatomic localization of the lesion.

과백혈구증가증을 동반한 급성 백혈병의 임상적 고찰

이영학(Young Hahk Lee),현동우(Dong Woo Hyun),김정균(Jung Gyun Kim),배선근(Sun Kun Bae),곽동석(Dong Suk Kwak),손상균(Sang Kyun Sohn),이재태(Jae Tae Lee),이규보(Kyu Bo Lee) 대한내과학회 1997 대한내과학회지 Vol.52 No.4

N/A Objectives: It is well known that Acute Leukemic patients with Hyperleukocytosis (ALH, leukocyte count≥100,000/μL) have poor prognosis. This is indebted in fatal complications arising from cerebral and pulmonary leukostasis. To investigate the factors influence on the prognosis of these patients, we have analyzed age, sex, laboratory findings and complications and their relationship to remission rate. Methods: Retrospective evaluation was done from January 1985 to March 1994 on fifty-four patients with ALH. We excluded secondary leukemias transformed from chronic myelogeneous leukemia, relapsed acute leukemia and myelodysplastic syndrome in this study. The prognostic factors associated with early death were also evaluated. Results: 1) Hyperuricemia and incidence of central nervous system and respiratory symptoms were higher in acute myelogeneous leukemia (AML) with hyperleu-kocytosis than in acute lymphocytic leukemia (ALL), 2) Twenty-two of fifty-four patients had complete remission by remission induction chemotherapy. Re- mission rate was 41%, median duration of remission was 26 weeks and 1 year survival rate was 11%. 3) There were no differences in remission rate between male and female and higher WBC group (WBC≥200,000/pL) and lower WBC group (WBC 100,000~200,000/u L). 4) The group with better performance status (ECOG score1-2), younger (age below 40) and higher hemoglobin level (Hb>10g/dL) had higher remission rate. The group of AML and with hepatomegaly had lower remission rate than the group of ALL and without hepatomegly. 5) Early death rate of AML was higher than that of All. Infection was the most common cause of early death in both AML and ALL. 6) Early death rate between the two groups managed with and without leukapheresis was not different. Conclusions: This result reveals that acute leukemia with hyperleukocytosis is grave disease, especially the patients with poor performance status (ECOG score : 3-4), older age above 40 and severe anemia (Hb<10g/dL) have poor prognosis, The group of AML and with hepatomegaly showed worse prognosis than the group of ALL and without hepatomegaly.

총담관낭종의 99mTc - DISIDA 간담도 스캔

이규보(Kyu Bo Lee),이재태(Jae Tae Lee),정병천(Byung Cheon Chung),최정일(Chung Il Choi),곽동석(Dong Suk Kwak),전석길(Seok Kil Zeon),김정균(Jeong Gyun Kim),배선근(Sun Kun Bae),이형우(Hyung Woo Lee) 대한핵의학회 1993 핵의학 분자영상 Vol.27 No.1

N/A In order to evaluate the scintigraphic features of choledochal cyst and these diagnostic value, authors investigated the findings of fourteen patients with choledochal cyst undergone hepatobiliary scan with Tc-99m-DISIDA before surgery. Five cases demonstrated the decreased hepatic uptake at 5-minute image of which four cases revealed severe jaundice. Seven cases demonstrated visualization of the cystic dilated common bile duct within 1 hour after injection. Two cases showed the cyst activity between 1 and 12 hour, but the cyst activity was not visible in five cases. Nonvisualization of the gall bladder was noted in ten cases, while four cases demonstrated visualization of the gall bladder within 1 hour. The time of visualization of gut activity was variably delayed. The intestinal activity was found in three cases within 1 hour and appeared in three cases between 1 and 2 hours and eight cases showed no visible gut activity. In four cases, intrahepatic ductal prominence was visible on the scintigram. Seven cases showed early and persistent accumulation of tracer in the common bile duct. Three cases showed persistent photon-deficient area in the gall bladder region. Two cases showed early photon-deficient area around gall bladder region with progressive accumulation of tracer in the same region. Two cases showed no evidence of activity in the biliary tract but noted late excretion into the sma11 intestine. We concluded that hepatobiliary scan using Tc-99m-DISIDA is a noninvasive test useful in the eva1uation and the diagnosis of choledochal cyst.

Adenosine 부하 99mTc-MIBI 심근 관류스캔도중 나타나는 ST 절 하강과 관상동맥 질환의 중증도와의 관계

이규보(Kyu Bo Lee),이재태(Jae Tae Lee),손상균,채성철,전재은,박의현,정병천(Byung Cheon Chung),최정일(Chung Il Choi),곽동석(Dong Suk Kwak),강승완(Seung Wan Kang),우언조(Eon Jo Woo),김정균(Jeong Gyun Kim),배선근(Sun Kun Bae),조정아(Jung Ah Cho) 대한핵의학회 1994 핵의학 분자영상 Vol.28 No.2

N/A Pharmacologic coronary vasodilation in conjunct.ion with myocardial perfusion scintigraphy has become an alternative to dynamic exercise test for the diagnosis and risk stratification of coronary arter y disease, especially in patients who are unable to perform adequate exercise. Dipyridamole and adenosine have been used for pharmacologic stress t,esting with myocardial perfusion imaging. Adenosine is a potent, coronary vasodilator with rapid onset of action, short half Iife, near maximal coronary vasodilation and less serious side effects. ST segment depression has been reported in about 7-15% of patients with coronary artery disease receiving dipyridamole in conjunction with myocar dial perfusion imaging. The exact cause and clinical significance are not known. In order to evaluate ihe relationship between adenosine-induced ST segment depression dur- ing Tc-MIBI myocardial perfusion scin(igraphy and the severity of coronary artery disease, we performed 99mTc-MIBI imaging after int#ravenous infusion of adenosine in 120 patients with susper,t.ed coronary artery disease. Of t.he 120 patients, 28 also performed coronary angiography. There were 24 patients with ST segment depression during 99mTc-5/IIBI scintigraphy and 96 patients without ST segment depression. Adenosine was infused intravenously at. a dose of 0.14mg/kg per minute for 6minutes and 99mTc-MIB1 was injected at 3 miinute. We then compared the hemodynamic changes, side effects, scintigraphic and angiographic findings. Heart, rate increased 90 +- 19 beats/minute in t.he group with ST depression compared with 80+16 beats/rninute in the group without ST depression(p<0.05). Baseline systolic blood pressure was significantly higher in the group with ST depression(152 +- 27 mmHg) than in the group without ST depression(140 +- 21mmHg, p<0.05). Double product, at baseline(10.90 +- 2.77 versus 9.55 +- 2.34beats/minutexmmHg) and during adenosine infusion(12.72 +- 3.89 versus 10.83+2.98 beats/minutexmrnHg) were significant,ly higher in t.he group with ST de pression(p<0.05). The incidenoe of anginal chest pain was also significantly higher in the group with ST depression(75 versus 29%, p<0.0001). The 99mTc-MIBI images were abnormal in 23(96%) patients wit.h ST segment depression and 66(69%) patients without ST segment depression(p<0.05). In patients with ST segment depression, there were more reversible per- fusion defects than in patients without ST segment depression(83 versus 55%, p<0.05). The number of abnormal segments were significantly higher in the group with ST depression(3.05 +- 2.01 versus 1.51 +- 1.45, p<0.005). In patients with ST segment depression, there were more segments of reversible perfusion defects than in patients without segment depression(2.15 +- 2. 11 versus 0.89 +- 1.24, p<0.05). There were no differences in the angiographic severity by ves sel(p, NS). We concluded that ST segment depression during 99mTc-MIBI myocardial perfusion scintigraphy with intravenous adenosine is related to the severity of coronary artery disease.

AML 환자에서 단순 객담 Giemsa염색으로 검출된 Pneumocystis carinii 폐렴 1례

배선근,현동우,이영학,김정균,곽동석,손상균,이재태,이규보 大韓血液學會 1995 大韓血液學會誌 Vol.30 No.2

급성백혈병의 화학요법에서 조혈간세포 보충요법

이규보,배선근,손상균,이재태,이건수,이경혜,서장수 경북대학교 병원 1997 경북대학교병원의학연구소논문집 Vol.1 No.1

1. 목적 급성백혈병의 화학요법에 있어서 관해유도 요법시에 보다 더 강력한 항암화학요법을 시행하고 골수억제의 회복을 위하여 말초혈액에서 채취한 조혈모세포의 투여로 그 효과를 증대시키고자 시도하였다. 2. 방법 관해유도 화학요법후에 골수억제시기로부터 회복단계로서 백혈구감소증이 호전도면서 단핵세포가 증가될 때에 말초혈액에서 조혈간세포(stem cell)로 인정되고 있는 CD34+세포의 함유량이 1% 이상되는 시기를 찾아내고 그 때부터 평균 4차례의 단핵구를 분리채집을 하여 -74。C에 냉동보관하였다가 제2차 화학요법후에 해동시켜서 정맥주입하였다. 3. 결과 대상 급성백혈병환자는 6명에 23회의 조혈간세포를 함유한 단핵구 채집을 시행하였고 유효한 단핵구의 채집은 4례에서 가능하였고 2례에서는 유효한 채집이 못되었다. 채집효율은 39.0-74.5%로서 평균 49.8%였다. 채집 후에 혈액학적 변화는 혈색소의 약간 감소 (평균 1.34g/dl)와 혈소판의 감소 (평균20.25%)를 나타내었다. 해동 단핵구를 투여할시에 일과성인 불쾌감, 기침, 흉부압박감, 호흡곤란 등이 있었다. 4. 결론 자가골수이식에서 자기말초혈액조혈간세포이식으로 관심이 이행되는 현시점에 자가조혈간세포를 채집하여 수혈하는 기술이 확립되는 기초를 이루었다고 본다. 이번 대상들은 재발된 금성백혈병들에 시행하였으나, 향후에는 초발시에 제일차 관해유도 화학요법 과정에 시도해야할 것으로 생각한다. Object: Peripheral blood stem cells(PBSC) were collected after remission induction chemotherapy and reinfused after intensified chemotherapy in order to increase the chemotherapeutic efficacy. Method: Collection of mononuclear cells (MNC) was started when CD34+ cells above 1% and WBC above 1,000/ul with mononuclear cell percentage above 30%, the collection procedures were done 2-6 time in each patient of total 6 cases. The collected MNCs were stored in - 750C and reinfused after thawing in the water bath at 370C Results: Twenty three collection procedures from the 6 cases of acute leukemia had made effective MNC collection in 4 cases and mean collection efficiency was 49.8%(from 39.0% to 74.5%). Hematological changes after the procedure were mean reduction of hemoglobin 1.34g/dl and mean 20.25% of decreased platelet count. There were noticed transient symptoms of discomfort, coughing, chest tightness and dyspnea in association with the infusion of stored cells. Conclusion: The basic process for the peripheral blood stem cell transplantation (PBSCT) was accomplished with this supportive care for the consolidation chemotherapy of acute leukemia. Effective PBSCT would be warrented with more qualified process and high does chemotherapy. (Korean J Blood Transfus 6(2) : 41~47,1995)

갑상설관낭의 임상적 분석

곽동석,이영학,김정균,배선근,최정일,이재태,이규보,이영하 慶北大學校 醫科大學 1994 慶北醫大誌 Vol.35 No.3

목적 : 갑상설관낭을 수술하여 조직학적 소견을 얻은 예들에서 임상적 소견, 갑상선 스캔 및 조직학적 소견 등을 조사하여 이 질환의 임상상을 정립하고자 이 분석을 시도하였다. 대상 및 방법 : 대상은 41예의 갑상설관낭 환자들로서 후향성 분석을 하였는데, 갑상선 스캔은 Tc-99m pertechnetate를 정맥주사한 후에 실시하였다. 결과 : 갑상설관낭 환자 41예 중에서 38예(93%)는 목의 정중부에 위치한 결절을 주소로 하였고, 일부에서는 누공을 형성하거나 감염된 경우도 있었다. 갑상선 기능검사 소견은 모두 정상이었고, 초음파소견은 주위와 경계가 분명한 저에코 낭종양상을 나타내었고, 갑상선 스캔에서는 결절부위에 방사능 섭취의 증가는 없었다. 갑상설관낭병소의 조직학적 소견에서는 17예(41%)에서 갑상선 여포세포가 발견되었고, 34예(83%)에서는 상피세포조직이 발견되었다. 결론 : 갑상설관낭은 93%에서 목의 전면 중앙 부위에 결절을 주소로하며, 갑상선 기능검사 소견과 Tc-99m 스캔 소견은 정상이며, 초음파에서는 저에코 낭종으로 나타나며, 조직학적 소견에서는 41%에서 갑상선 조직이 포함되어 있었고, 83%에서 상피조직으로 구성되어 있었다. A clinical analysis was done in forty one patients with surgically proven thyroglossal duct cyst. The most common symptom was palpable mass at the midline of neck(93%), but there were also fistulae formations and infection. Thyroid function tests revealed euthyroidism in all cases, and ultrasonogram showed hypoechoic cysts with well defined margines. Thyroid scan with Tc-99m pertechnetate showed no radioisotopic uptake on thyroglossal duct cysts. There noted thyroid follicles in the histological findings in 17 cases(41%) and epithelial cell lining in 34 cases(83%). The reason for nonvisualization of the thyroglossal duct cysts on scan might be that the amount of thyroid tissue is too small for the thyroid tissue to take the radiopharmaceuticals as doing of normal thyroid gland. There noted two cases of recurrence after Sistrunk's operation.

신이식 후 발생한 중추신경계 림프종 증례

김동환,정진태,김정균,조동규,권태환,김용림,이규보,손상균,배선근,김찬덕,이영학 대한내과학회 1997 대한내과학회지 Vol.53 No.3

Primary lymphoma of the central nervous system is a rare disease, occurring spontaneously and/or in conjunction with immunosuppressive state. Its incidence is increasing according to the increment of organ transplantation and AIDS. Recently we experienced a case of primary lymphoma occurred in central nervous system after renal transplantation in a 58-year-old women who had complained of persistent headache and left hemiparesis. CT scan of the brain showed two hyperdense mass lesions in right frontal and right basal ganglia areas. Immunohistochemical stain of the excised mass lesion revealed that tumor cells were derived from B cells. The patient was treated with discontinuance of immunosuppressive drug and irradiation, but expired due to pneumonia.

골 및 골수의 다발성 지방 괴사를 초래한 만성 췌장염 1예

이영학,김정균,최정윤,현동우,이재태,이규보,김이근,안병철,손상균,곽동석,배선근,김지희,김태석,김채기 대한내과학회 1996 대한내과학회지 Vol.51 No.3

Pancreatic and intra-abdominal fat necrosis are frequently in chronic pancreatitis, but fat necrosis of the bone marrow has been rarely reported. These extrapancreatic fat necrosis occur by circulating lipolytic enzymes. We report a case of multiple fat necrosis of the osseous medulla and skin associated with chronic recurrent pancreatitis.