식도에 발생한 거대 해면혈관종 수술치험 - 1례 보고 -

이창민,박성달,조성래,허방,Lee, Chang-Min,Park, Sung-Dal,Cho, Sung-Rae,Huh, Bang 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.3

식도에 발생하는 혈관종은 식도에 드물게 발생하는 양성종양의 2% 내지 3% 정도 차지할 정도로 매우 희귀하여 세계적으로 보고된 증례수가 많지 않다. 저자들은 식도에 발생한 매우 희귀한 해면혈관종 1례를 수술치험하였기에 문헌고찰과 더불어 보고하고자 한다. 환자는 40세 남 米\ulcorner경미한 연하장애를 주소로 내원하여 식도조영술, 식도 내시경검사, 조영제를 이용한 흉부 전산화 단층촬영등을 시행하여 하부 식도의 점막하층에서 발생하여 근육층 밖으로 돌출되어 나온 식도 종양이 추정되어 수술을 시행하였다. 수술소견상 하부 식도 및 식도-위 문합부에 걸쳐 과혈관성의 7x7x3.5cm 크기의 거대한 종괴가 식도점막하층과 식도근육층 그리고 주위조직으로의 침범이 심하게 되어 있어 종양을 포함한 식도절제술 및 식도-위 문합술을 시행하여 병리 조직학적으로 해면 혈관종으로 확진되었으며 환자는 특별한 문제없이 술후 제14일째 건강한 상태로 퇴원하였다. Esophageal hemangioma is an extremely rare benign tumor that causes dysphagia and massive upper gastrointestinal bleeding. Although certain abnormalities seen on a barium swallow esophagography or at endoscopy may suggest an esophageal hemangioma, a contrast CT and radionuclide angiography using a blood-pool radiopharmaceutical can characterize the intense vascularity of the tumor. We experienced the ase of a 7$\times$7$\times$3.5 cm in size giant cavernous hemangioma of the lower 1/3 of esophagus in a 40 year old man. A mural cavernous hemangioma was diagnosed with a barium swallowed esophagogaphy, endoscopy, and a contrast CT. It was treated successfully by transthoracic esophagectomy including the tumor and esophagogastrostomy.

새로운 액체성 색전물질(Embol)을 이용한 신동맥 색전술: 토끼에서의 실험적 연구

정규식,고지호,김현철,이상희,오경승,허진도,조영덕,허방,박상수,Jung, Gyoo-Sik,Ko, Ji-Ho,Kim, Hyun-Chul,Lee, Sang-Hee,Oh, Kyung-Seung,Huh, Jin-Do,Joh, Young-Duk,Hur, Bang,Park, Sang-Soo 대한영상의학회 2002 대한영상의학회지 Vol.46 No.1

목적: 새로 개발된 액체성 색전물질로 토끼에서 신동맥 색전술을 시행하여 그 효과와 안전성을 입증하고 영구적 색전물질로서의 임상적용 가능성을 평가할 목적으로 이 연구를 시행하였다. 대상과 방법: 사용한 색전물질은 Polyvinylacetate(PVAc)를 부분 가수분해하여 만든 Embol로서 45%의 에탄올과 55%의 비이온성 수용성조영제를 용매로 사용하므로 우수한 방사선비투과성을 가진다. 15마리의 토끼를 실험동물로 사용하였으며, 투시 하에서 평균 0.8(0.5-0.9)cc의 Embol을 신동맥에 주입하여 색전을 하였고 5분 후에 추적 혈관조영술을 시행하여 색전의 효과를 확인한 뒤에 시술을 마쳤다. 토끼를 5마리씩 3군으로 나누어 각각 3일(I군), 2주(II 군), 4주(III군)후에 추적 혈관조영술을 시행한 뒤 토끼를 희생시켜 양측 신장과 신동맥을 적출하여 조직표본을 제작하였다. 각군에서 시술 직후와 추적기간 동안의 혈관조영술 소견과 조직 소견을 관찰하였다. 각군의 토끼 1마리에서 시술전과 희생시키기 전에 DMSA 신스캔을 시행하였고, 다른 3마리에서는 시술 전과 시술 후 1, 3, 5, 7, 14일에 혈액을 채취하여 혈청 BUN, Creatinine, Sodium(Na), Potassium(K)의 수치를 조사하였다. 결과: Embol은 투시 하에서 색전과정의 관찰이 용이할 정도로 방사선비투과성이 우수하여 안전하게 주입할 수 있었다. 시술 5분 후에 시행한 혈관조영술에서는 신동맥 원위부의 완전한 폐색이 14예, 엽간동맥(interlobar artery)의 폐색이 1예에서 관찰되어 전예에서 색전술은 성공적이었다. 시술 후 혈청 전해질 수치는 약간 증가하였으나 모두 정상범위였다. 각 군에서의 추적 혈관조영술에서는 I군과 III군의 각각 1마리를 제외한 모든 토끼에서 신동맥의 폐색이 유지되었다. 각군에서 시행한 신스캔에서는 모두 색전을 시행한 신장의 섭취가 전혀 관찰되지 않았다. 추적기간동안의 색전을 시행한 신장의 크기는 I 군에서는 정상 신장에 비해 커졌으나 II군과 III군에서는 계속해서 크기가 감소하였다. 조직 소견은 3 군 모두 신조직의 전반적인 응고괴사 소견이 관찰되었으며, III군에서는 신피질에 두꺼운 띠모양의 석회화가 관찰되었다. I군에서는 신동맥 내강이 기질화되지 않은 혈전으로 차 있었고, II군과 III군에서는 신동맥 내강은 기질화된 혈전으로 차 있었으며 III군에서는 혈전의 석회화도 관찰되었다. 결론: Embol을 이용한 토끼에서의 신동맥 색전술은 이 색전물질의 우수한 방사선비투과성으로 안전하게 사용할 수 있었으며 또한 효과적이고 영구적인 신조직의 괴사를 유발하여 앞으로 임상적용이 가능하다고 생각된다. Purpose: To evaluate the effectiveness and safety of a new liquid embolic agent in renal arterial embolization in the rabbit, and its clinical applicability. Materials and Methods: A new embolic agent, Embol, was obtained by partial hydrolysis of polyvinyl acetate and dissolved in a mixture of 45% ethanol and 55% non-ionic contrast medium. Its radioopacity was therefore good. An average of 0.8 cc(0.5-0.9 cc) of Embol was used to embolize the renal artery of one kidney in 15 rabbits. The immediate effect of this was examined angiographically 5 minutes after the procedure. To permit histologic examination, five rabbits in each group were sacrificed 3 days (I), 2 weeks (II), and 4 weeks (III) after embolization: prior to embolization and prior to sacrifice, one rabbit in each group underwent renal scanning, and prior to sacrifice all underwent follow-up angiography. In three rabbits, blood urea nitrogen (BUN), creatinine, sodium(Na), and potassium(K) levels were measured before and 1, 3, 5, 7 and 14 days after embolization. Results: Embol was easy to use and its radiopacity was good. Five minutes after embolization, angiography showed that total occlusion of the main renal or interlobar artery had been achieved in all rabbits. Serum BUN, creatinine, Na and K levels were within normal limits. Follow-up angiogram obtained in each group showed persistent occlusion of the renal artery in all but one rabbit in group I and one in group III. Renal scans revealed no evidence of radionuclide uptake in embolized kidneys, which were slightly enlarged in group I but became gradually smaller in groups II and III. In all animals, histologic examination showed diffuse coagulation necrosis of the embolized kidneys and in group III the cortex of these was extensively calcified. In group I the renal artery showed an apparently fresh occluding thrombosis, and in groups II and III a completely organized thrombosis was present. In group III this was calcified. Conclusion: Because of its good radioopacity, Embol is easy to controa, and is effective for renal artery embolization. As a permanent embolic agent, it appears suitable for clinical applications.

Aspergillus fumigatus 각막염에 대한 Itraconazole 의 치료효과에 관한 연구

한영호(Young Ho Hahn),최수환(Soo Hwan Choi),장명웅(Myung Woong Chang),김광혁(Kwang Hyuk Kim),허만하(Man Ha Huh),허방(Bang Hu) 대한안과학회 1994 대한안과학회지 Vol.35 No.10

약년층과 노년층 위암에서의 임상적 및 병리학적 비교 분석

서경호(Kyoung Ho Seo),이충한(Chung Han Lee),이승도(Sung Do Lee),서재관(Jae Kwan Seo),박영훈(Young Hoon Park),허방(Bang Huh),허만하(Man Ha Huh) 대한외과학회 1991 Annals of Surgical Treatment and Research Vol.41 No.2

단기 배양 각질형성세포의 세포간 표면접착분자 ICAM-1의 발현 -감마 인터페론, 자외선 B 및 레티노인산의 영향-

허방,김덕하,허만하 대한병리학회 1995 Journal of Pathology and Translational Medicine Vol.29 No.6

자궁 내막 선암종을 동반한 Stein-Leventhal 증후군 : 1증례 보고 A Case Report

허방,전인선,허만하 고신대학교 의학부 1990 高神大學校 醫學部 論文集 Vol.6 No.1

Stein-Leventhal first described a syndrome consisting of amenorrhea, infertility, and a pathologic feature of bilateral polycystic ovries This syndrome is not infrequently associated with endometrial hyperplasia or carcinoma Through a number of possible theories regarding etiologic factors have been explored, the pathogenetic mechanisms are including hypothalamus-pituitary axis, adrenal factors, and ovarian steroidogenesis. The authors present a case of Stein-Leventhal syndrome associated with endometrial adenocarcinoma in a 30-year-old female, who complained of intermittent vaginal bleeding for 10 years and infertility for 5 years of marriage. A diagnostic endometrial curettage showed grade I endometrial adenocarcinoma Total hysterectomy with bilateral salpingo-oophorectomy was performed. Both ovaries revealed symmetrical enlargement and disclosed multiple subcapsular cystic follicles. Numerous primodial follicles were noted. However, corpus luteum and albicans were not identified. The endometrial mucosal surface showed irregular mucosal elevation which was confirmed to be endometrial adenocarcinoma. We report this case in view of its rarity and academic interest along with a literature review on the pathogenesis.

과립성 에나멜아세포종 1례 : A Case Report

허방,장희경,김혜숙,허만하 高神大學 醫學部 1988 高神大學醫學部 論文集 Vol.4 No.1

간세포암의 Type Ⅳ Collagen 및 Fibronectin의 분포에 관한 면역조직화학적 검색

허방,임학,허만하 고신대학교 의학부 1992 高神大學校 醫學部 論文集 Vol.8 No.1

It is well known that some of the basement membrane glycoproteins are sysnthesized and expressed in neoplastic hepatic tissue in spite of absence of an intact, organized basement membrane in the normal liver parenchyma. In an attempt to examine the distribution and expression patterns of basement membrane glycoproteins in hepatocellular carcinoma (HCC), immunohistochemical localization of type Ⅳ collagen and fibronectin is performed. Fifty cases of HCC are histologically analy zed and paraffin-embedded sections are immunostained with monoclonal antibodies to type Ⅳ collagen and fibronectin(Avidin-Biotin-Peroxidase Complex). Positive reactions to type Ⅳ collagen and fibronectin are obsewed in extracellular spaces. Intracellular expression of fibronectin in some cases is observed. The distribution patterns of these glycoproteins are categorized into four locations : pericsinusoidal(Pattern Ⅰ), periacinar(Pattern Ⅱ ), stromal(Pattem Ⅲ), and pericellular (Pattem Ⅳ) areas. patterns Ⅰ and Ⅱ are distributed throughout the lesion, while patterns Ⅲ and Ⅳ are observed in focal areas of the neoplastic tissues. These findings suggest that deposition of basement membrane glycoproteins in the extracellular matrix may be related to the histologic types of HCC. In well-differentiated neoplastic cells(Edmondson grades I and Ⅱ) organized in trabecular and/or acinar pattern, type Ⅳ collagen and fibronectin are always detected in the sinusoidal surface as pattern Ⅰand/or Ⅱ. In normal liver prenchyma, type Ⅱ collagen and fibronectin are also expressed in the sinusoidal surface. However, in less-differentiated neoplasms(Edmondson grades Ⅲ and Ⅳ), sinusoids are almost absent and only fibrotic stroma with vascularized connective tissue is reactive to type Ⅳ collagen and fibronectin. These findings suggest that the expression of basement membrane glycoproteins may be influnced by the degree of differentiation. Intracellular expression of fibronectin is noted in 30 cases of hepatocellular carcinoma(60% ), while it is not observed in normal liver cells. The expression modes can be classified into 3 patterns : 1) scattered, 2) stromal interface, or 3)mixed pattern. The stromal interface pattern is frequently observed in highly differentiated tumors and clear cell type of HCC. The significances of these findings are remained to be resolved.

고 prolactin혈증을 동반한 STH 뇌하수체 선종 : 전자현미경적 고찰을 주로한 1예 보고 A case report with emphasis on the ultrastructural features

허방,허만하,황용순,이화동 고신대학교 의학부 1993 高神大學校 醫學部 論文集 Vol.9 No.1

Pituitary adenoma has become not uncommon tumors because of recent advances in diagnostic radiologic techniques and surgical approach. However, it has been difficult to correlate microscopic features with hormonal function in these tumors. Although immunohistochemistry and ultrastructural studies play crucial roles for the morphofunctional classification of the pituitary tumors. light and electron microscopic features may be diagnostic in some cases. We experienced a case of pituitary adenoma with elevation of both growth hormone and prolactin in a 22-year-old female, who had headache, lowered visual acuity, galactorrhea, and symptoms of acromegaly-amenorrhea syndrome. The tumor cells are chromophobic with PAS-orange G stain. With electron microscopy, the tumor cells are characterized by sparse granularity, frequent fibrous bodies enmashing secretory granules, and prominent RER without nebenkern formation. Frank evidences of misplaced exocytosis and alterations of mitochondria are not seen. We report this case with an emphasis on the diagnostic application of ultrastructural examination in the pituitary adenoma.

늑막에 발생한 양성 한국성 섬유성 중피세포종 : 병리발생을 고찰한 1예 보고 A case report with a review on histogenesis

허방,허만하 고신대학교 의학부 1989 高神大學校 醫學部 論文集 Vol.5 No.1

Localized fibrous mesothelioma of pleura is a relatively uncommon tumor of which histogenesis of the tumor cells is still controversial. It remains uncertain whether this tumor takes origin from mesothelial cells or submesothelial connective tissue. Although some of tissue culture and eletron microscopic studies reveal both epithelial and fibroblastic nature, others, employing immunohistochemical studies, fail to reveal an evidence of epithelial characteristics. The authors report a typical case of histologically benign form of localized fibrous mesothelioma of the right pleura in a 54-year-old Korean female along a brief review of some related literatures with a special reference on the histogenesis of the tumor cells. This is the second reported case of benign localized fibrous mesothelioma of pleura, followed by the report of Kwon et al(1984) in Korea.