Paraquat 중독 환자에서 전폐 방사선치료의 효과

이창걸(Chang Geol Lee),김귀언(Gwi Eon Kim),서창옥(Chang Ok Suh) 대한방사선종양학회 1995 Radiation Oncology Journal Vol.13 No.4

목적 : 제초제로 사용되는 Paraquat(Gramoxone??)는 10cc미만의 소량복용으로 사망이 가능하여 자살목적 혹은 사고로 복용한 후 응급실로 내원하게 되는데 적극적인 치료방법으로 신장 및 간장에 대한 독성은 가역적으로 회복이 가능하나 폐에 대한 독성은 가장 치명적으로 초기에 폐부종, 폐출혈등의 성인형호흡곤란증후군의 양상을 보이며 더욱 진행하면 폐섬유화를 초래하여 궁극적으로 사망하게 된다. 1984년 Webb등이 폐부종이 진행되는 paraquat중독환자에서 전폐방사선치료를 시행, 폐섬유화로의 진행을 억제하여 생존시킨 예를 보고한 이래 전폐 방사선치료가 paraquat에 의한 폐독성을 방지할 수 있는 가에 대한 연구가 시도되었다. 저자들은 연세의대 치료방사선과에서 paraquat중독으로 전폐방사선치료를 시행받은 환자들을 후향적으로 분석하여 폐섬유화 예방에 대한 효과 및 궁극적으로 생존율 향상에 기여하였는지 보고자 하였다. 방법 : 1987년 6월부터 1993년 8월까지 paraquat중독으로 연세의료원에 내원하여 치료하였던 30명의 환자들을 대상으로 분석하였다. 이 중 14예에서 전폐방사선치료를 시행받았다. 환자들의 특성을 보면 남녀비가 12:18 이었고 3-76세의 연령에서 20-30세사이가 가장 많았고, 자살목적이 22예, 우발적인 사고로 복용한 예가 8예였다. 환자 및 보호자의 진술에 따라, 복용한 양을 소량(<5cc), 한모금(5-50cc) 그리고 과량(>50cc)군으로 세 군으로 나누어 분석하였다. 방사선치료는 응급실에 도착하여 적극적인 치료와 함께 24시간 이 내 시작하였고 방사선량은 10Gy/5ft/1주으로, 전폐를 범위로 폐밀도 보상 없이 전후 2문 대향조사하였다. 3예에서 방사선치료도중 중단하였는데 치료거절(2Gy) 및 사망(2Gy, 6Gy)이 원인이었다. 결과 : 소량복용군에서는 방사선치료와 상관없이 7예 전원이 생존하였고 대조군에서 2예의 경미한 폐부종이 나타났으나 방사선치료군에서는 나타나지 않았다. 한모금 복용군의 경우 15예 전예에서 폐독성이 나타났는데, 대조군에서는 7예중 1예(14%0에서만 회복된 반면 방사선치료군에서는 8예중 4예(50%)에서 폐독성에서 회복되었다. 한모금 복용군에서 음독후 4일이내에 방사선치료를 받은 경우 5예중 4예(80%)에서 폐독성이 회복된 반면 5일 이후에 치료한 3예에서는 전원(100%)이 호흡부전으로 사명하여 차이를 보였다. 4일이내 방사선치료군에서 2Gy 조사 후 치료를 거절한 1예를 제외하면 4예 전원(100%)에서 폐섬유화를 예방할 수 있었다. 과량복용군에서는 방사선치료와 상관없이 8예 전원이 다기관 손상과 함께 호흡부전으로 사명하였는데 방사선치료는 3예 모두 음독2일 이내에 시행되었지만 모두 폐섬유화로 진행되어 사망하였다. 결과 : Paraquat중독으로 궁극적인 사망의 원인이되는 폐섬유화를 방지하기 위한 방법으로 전폐방사선치료는 비록 복용량이 정확하지는 않으나 약 한모금(5-50cc)정도 복용한 경우 paraquat배설을 위한 적극적인 치료와 함께 조기에(적어도 4일 이내에) 시행될 경우 폐섬유화로의 이행을 방지하여 궁극적으로 생존이 가능함을 알 수 있었고, 소량복용의 경우와 과량을 복용한 경우 전폐방사선치료는 필요가 없을 것으로 생각되었다. 향후 음독후 정확한 혈중 paraquat농도를 측정하여 대조군과 비교하여 전폐방사선효과를 규명하는 임상실험이 필요하리라 사료된다. Purpose : To evaluate whether the early pulmonary irradiation can prevent or decrease the pulmonary damage and contribute to improve ultimate survival in paraquat lung. Materials and Methods : From Jun. 1987 to Aug. 1993. thirty patients with paraquat poisoning were evaluated. Fourteen of these patients were received pulmonary irradiation(RT). All of the patients were managed with aggressive supportive treatment such as gastric lavage, forced diuresis, antioxidant agents and antifibrosis agents. Ingested amounts of paraquat were estimated into three groups(A: minimal <about 5cc. B: mouthful 5-50cc. c: large>50cc). Pulmonary irradiation was strated within 24 hours after admission(from day 1 to day 11 after ingestion of paraquat). Both whole lungs were irradiated with AP/PA parallel opposing fields using Co-60 teletherapy machine. A total of 10Gy(2Gy/fr. x 5days) was delivered without correction of lung density. Results : In group A, all patients were alive regardless of pulmonary irradiation and in group C, all of the patients were died due to multi-organ failure, especially pulmonary fibrosis regardless of pulmonary irradiation. However, in group, six of 7 patients(86%) with no RT were died due to respiratory failure, but 4 fo 8 patients with RT were alive and 4 of 5 patients who were received pulmonary irradiation within 4 days after ingestion of paraquat were all alive though radiological pulmonary change. One patient who refused RT after 2Gy died due to pulmonary fibrosis. All 3 patients who were received pulmonary irradiation after 4 days after ingestion were died due to pulmonary fibrosis in spite of recovery from renal and hepatic toxicity Conclusion : It is difficult to find out the effect of pulmonary irradiation on the course of the paraquat lung because the precise plasma and urine paraquat concentration were not available between control and irradiation groups. But early pulmonary irradiation within 4 days after paraquat poisoning with aggresive supportive treatment appears to decrease pulmonary toxicity and contribute survival in patients with mouthful ingestion of paraquat who are destined to have reversible renal and hepatic damage but irreversible pulmonary toxicity.

연구논문 : 종분포모형을 이용한 히어리 서식지의 분포 특성 연구

권혁수 ( Hyuk Soo Kwon ),류지은 ( Ji Eun Ryu ),서창완 ( Chang Wan Seo ),김지연 ( Ji Yeon Kim ),임동옥 ( Dong Ok Lim ),서민환 ( Min Hwan Suh ) 한국환경영향평가학회 2012 환경영향평가 Vol.21 No.5

Since the CBD(Conservation on Biological Diversity)`s 10th Conference of the Parties adopted the protocol on access to genetic resources and benefit sharing in Nagoya 2010, the importance of endangered species studies such as habitat distribution, protection and management have been more emerged. Corylopsis coreana, an endangered species in Korea, was isolated nationally and has been damaged by anthropogenic factors. In this paper, we identified the factors affecting C. coreana habitat at the national scale and regional scale using National Survey of Natural Environment and predicted the distribution of C. coreana. Annual precipitation, precipitation of wettest quarter, temperature seasonality and Digital Elevation Model(DEM) were derived as important factors at the national scale, and precipitation of wettest quarter, DEM and solar radiation on spring were identified as important factors at regional scale. Colylopsis distribution was affected by an effect of climate significantly at the national scale, and by additionally the microclimate and topography at regional scale. These findings will be used as the basis on habitat conservation and restoration plan and climate change.

Treatment of Carcinoma of the Uterine Cervix with High-Dose-Rate Intracavitary Irradiation using Ralstron

Chang Ok Suh(서창옥),Gwi Eon Kim(김귀언),John J.K. Loh(노준규) 대한방사선종양학회 1990 Radiation Oncology Journal Vol.8 No.2

1979년 5월부터 1981년 12월까지 총 524명의 자궁경부암 환자가 근치적 목적하에 방사선 치료를 받았다. 524명의 환자중, 356명이 코발트 선원을 사용한 원격 조정 아프터로딩 고선량률 강내조사 시스템(Rastron)으로써 치료받았으며 168명의 환자는 라듐 선원을 사용한 저선량률 강내 조사를 받았다. 외부조사는 골반부 전체에 총 40-50 Gy가 주어졌으며, 이어서 A지점에 10-13번에 걸쳐 30-38Gy의 강내 조사를 시행하는 치료지침이 사용되었다. 강내조사는 3Gy씩, 일주일에 세 번 주어졌다. 고선량률 강내조사를 받은 군에서의 5년 실제생존율은 ⅠB기 (N=20)가 77.6% Ⅱ기 (N=182)가 68.2% 그리고 Ⅲ기(N=148)가 50.9%였다. 저산량률 강내조사군에서의 5년 생존율은 ⅠB기(N=22)가 87.5% Ⅱ기(N=91)가 66.3%, 그리고 Ⅲ기 (N=52)가 55.4%였다. 생존율은 병기에 따라서는 통계학적으로 유의한 차이를 보였지만, 두 강내조사군 간에는 유의한 차이가 없었다. 방사선 치료후 내장의 후기 합병증은 고선량률 강내조사 군에서 3.7%, 저산량률 강내조사군은 8.4%에서 관찰되었다. 그러나 외과적 치료가 필요할 만큼 심한 합병증은 없었다. 방광에서 발생한 합병증의 빈도는 고선량률 강내조사군이 1.4%, 저산량률 강내조사군은 2.4%였다. 고선량률 강내조사의 시술은 외래 환자에 시행하기에 기술적으로 간단하고 쉬우며 마취가 필요없고, 환자가 매우 잘 견딘다. 담당자에 대한 방사선 피폭도 저선량률 강내조사에 비해 사실상 거의 없다. 고선량률 강내조사의 경우 치료시간이 짧기 때문에 주어진 시간내에 더 많은 환자를 치료할 수 있어진다. 따라서 많은 환자를 치료해야 하는 암센터의 경우, 고선량률 강내조사 시스템이 훨씬 더 권장되어 진다. 그러나 더욱 향상된 결과를 얻기 위하여, 다른 치료 방식으로 광범위한 연구를 통해, 고선량률 강내조사의 적절한 선량-분할조사 계획과 외부조사와 강내조사의 적절한 배합이 이루어져야 할 것이다. From May 1979 through December 1981 a total of 524 patients with carcinoma of the uterine cervix were treated by radiation therapy with curative intent. Among the 524 patients, 356 were treated with a high-dose-rate(HDR), remote-controlled, afterloading intracavitary irradiation(ICR) system using a cobalt source(Ralstron), and 168 patients received a low-dose-rate (LDR) ICR using a radium source. External beam irradiation with a total dose of 40-50 Gy to the whole pelvis followed by intracavitary irradiation with a total dose of 30-39 Gy in 10-13 fractions to point A was the treatment protocol. ICR was given three times a week with a dose of 3 Gy per fraction. Five-year actuarial survival rates in the HDR-ICR group were 77.6% in stage ⅠB(N=20), 68.2%% in stage Ⅱ(N=182), and 50.9% in stage Ⅲ(N=148). In LDR-ICR group, 5-year survival rates were 87.5% in stage ⅠB(N=22), 66.3% in stage Ⅱ(N=91), and 55.4% in stage Ⅲ(N=52). Survival rates showed a statistically significant difference by stage, but there was no significant difference between the two ICR groups. Late bowel complications after radiotherapy were noted in 3.7% of the HDR-ICR group and 8.4% of the LDR-ICR group. There was no severe complication requiring surgical management. The incidence of bladder complications was 1.4% in the HDR-ICR group and 2.% inthe LDR-ICR group. The application of HDR-ICR was technically simple and easily performed on and outpatient basis without anesthesia, and the patients tolerated it very well. Radiation exposure to personnel was virtually nil in contrast to that of LDR-ICR. Within a given period of time, more patients can be treated with HDR-ICR because of the short treatment time. Therefore, the HDR-ICR system is highly recommended for a cancer center, particularly one with a large number of patients can be treated. In order to achieve an improved outcome, however, the optimum dose-fractionation schedule of HDR-ICR and optimum combination of intracavitary irradiation with external beam irradiation should be determined through an extensive protocol study with different treatment regimens.

Effect of Radiofrequency Induced Local Hyperthermia on Normal Canine Liver

Chang Ok Suh(서창옥) , John J.K.Loh(노준규) , Jin Sil Seong(성진실) , Sun Rock Moon(문성록) Hyung Sik Lee(이형식) , Hyun Soo Shin(신현수) , Sung Sil Chu(추성실) , Gwi Eon Kim(김귀언) , Chan Il Park(박찬일) ,Eun Kyung Han(한은경) 대한방사선종양학회 1991 Radiation Oncology Journal Vol.9 No.1

간조직에 온열치효를 시행시 출현하는 조직병리학적 소견 및 혈액의 생화학적 소견을 관찰하고자 13마리의 정상 간에 8MHz 라디오파를 이용한 온열치료를 시행하였다. 42.5±0.5°C로 30분간 온열치료를 받은 군 (제1군, n=5), 45±0.5°C로 30분간 온열치료를 받은 군 (제2군, n=5) 및 온열치료를 받지않은 대조군(n=3)으로 나누어 분석하였을때, 혈액의 SGOT의 SGPT는 온열치료를 시행한 두군 공히 증가된 소견을 보였고 제 1군에서는 간세포의 부종소견의 특이한 조직병리학적소견이 관찰되지않아 가역성 변화로 생각되었지만 제2군에서는 간 세포의 심한 괴사소견이 관찰되어 있는 불가역성의 가조직 손상으로 생각되었다. 이상의 결론으로 유추할 때 임상에서 행하여지는 간암의 온열치료시에 정상 가조직의 손상을 가능한 방지하기위하여는 정확한 종괴의 구역에 치료온도의 주의깊은 관찰이 요구된다. In order to assess the effects of radiofrequency-induced local hyperthermia on the normal liver, histopathologic findings and biochemical changes after localized hyperthermia in canine liver were studied. Hyperthemia was externally adminsitered using the Thermotron RF-8 (Yamamoto Vinyter Co., Japan; Capacitive type heating machine) with parallel opposed electrodes. Thirteen dogs were used and allocated into one control group (N=3) and two treatment groups according to the treatment temperature. Group I (N=5) was heated with 42.5±0.5°C for 30 minutes, and Group Ⅱ (N=5) was heated with 45±0.5°C for 15-30 minutes. Samples of liver tissue were obtained through a needle biopsy immediately after hyperthermia and 7, 14, and 28 days after treatment. Blood samples were obtained before treatment and 1, 3, 5, 7, 14 and 28 days after treatment and examined for SGOT, SGPT and alkaline phosphatase. Although SGOT and SGPT were elevated after hyperthermia in both groups (three of five in each group), there was no liver cell necrosis or hyperthermia related mortality in Group Ⅰ. A hydropic swelling of hepatocytes was prominent histologic finding. Hyperthermia with 45°C for 30 minutes was fatal and showed extensive liver cell necrosis. In conclusion, liver damage dy heat of 42.5±0.5°C for 30 minutes is reversible, and liver damage by heat of 45±0.5°C for 30 minutes can be fatal or irreversible. However, these results cannot be applied directly to human trial. Therefore, in order to apply hyperthermic treatment on human liver tumor safely, close observation of temperature with proper thermometry is mandatory. Hyperthermic treatment should be confined to the tumor area while sparing a normal liver as much as possible.

2 . 연구원 활동 : 3 ) 발표논문요약 < 재료공학분야 > Polyethylene/Ethylene n - Butyl Acrylate Copolymer 블렌드의 물리적 성질

(Ok Kim),(Chang R Lee),(Mi Kyung Lee),(Kwang S . Suh),(Oh Sung Kwon) 고려대학교 공학기술연구소 1997 공학기술연구소보 Vol.4 No.-

Discovery of a Novel HDAC3 Selective Inhibitor and its Evaluation in Lymphoma Model

Chang-Ju Choi,Mira Kim,Sun Young Han,Jiyoung Jeon,Jae Ho Lee,Jeong-In Oh,Kwee-Hyun Suh,서동철,Kwang-Ok Lee 대한화학회 2016 Bulletin of the Korean Chemical Society Vol.37 No.1

Histone deacetylase (HDAC) inhibition is a potentially attractive approach to cancer therapy. A number of HDAC inhibitors are in clinical development stages for the treatment of cancer as well as immune and inflammatory disorders. Although there are several approved HDAC inhibitors by the US FDA, they show a broad inhibitory spectrum against HDAC subfamily. Herein, we synthesized a series of novel hydroxamate analogs, and evaluated them with lymphoma cancer cell. Conclusively, we identified an HDAC3 selective inhibitor which shows good anticancer activity for the lymphoma model, as well as a good drug metabolism and pharmacokinetics (DMPK) profile.

Antiapoptotic Effect of Paricalcitol in Gentamicin-induced Kidney Injury

Suh, Sang Heon,Lee, Ko Eun,Park, Jeong Woo,Kim, In Jin,Kim, Ok,Kim, Chang Seong,Choi, Joon Seok,Bae, Eun Hui,Ma, Seong Kwon,Lee, Jong Un,Kim, Soo Wan The Korean Society of Pharmacology 2013 The Korean Journal of Physiology & Pharmacology Vol.17 No.5

While the anti-apoptotic effect of paricalcitol has been demonstrated in various animal models, it is not yet clear whether paricalcitol attenuates the apoptosis in gentamicin (GM)-induced kidney injury. We investigated the effect of paricalcitol on apoptotic pathways in rat kidneys damaged by GM. Rats were randomly divided into three groups: 1) Control group (n=8), where only vehicle was delivered, 2) GM group (n=10), where rats were treated with GM (150 mg/kg/day) for 7 days, 3) PARI group (n=10), where rats were co-treated with paricalcitol (0.2 ${\mu}g/kg/day$) and GM for 7 days. Paricalcitol attenuated renal dysfunction by GM administration in biochemical profiles. In terminal deoxynucleotidyl transferase dUTP nick end labeling staining, increased apoptosis was observed in GM group, which was reversed by paricalcitol co-treatment. Immunoblotting using protein samples from rat cortex/outer stripe of outer medulla showed increased Bax/Bcl-2 ratio and cleaved form of caspase-3 in GM group, both of which were reversed by paricalcitol. The phosphorylated Jun-N-terminal kinase (JNK) expression was increase in GM, which was counteracted by paricalcitol. The protein expression of p-Akt and nitro-tyrosine was also enhanced in GM-treated rats compared with control rats, which was reversed by paricalcitol co-treatment. Paricalcitol protects GM-induced renal injury by antiapoptotic mechanisms, including inhibition of intrinsic apoptosis pathway and JNK.

노말부틸아크릴레이트 그라프트 폴리에틸렌의 전기적 성질

李昌龍(Chang R. Lee),吳祐政(Woo J. Oh),徐光錫(Kwang S. Suh),金億(Ok Kim) 대한전기학회 1998 전기학회논문지 Vol.47 No.1

Conservative Surgery and Primary Radiotherapy for Early Breast Cancer : Yousei Cancer Center Experience

서창옥(Chang Ok Suh),이희대(Hy de Lee),이경식(Kyung Sik Lee),정우희(Woo Hee Jung),오기근(Ki Keun Oh),김귀언(Gwi Eon Kim) 대한방사선종양학회 1994 Radiation Oncology Journal Vol.12 No.3

병기 1기, 2기 유방암에서 유방보존적 수술 후 방사선치료는 기존의 유방전적출술을 대치할 수 있는 치료법으로 정립되었다. 연세암센터에서는 1991년 부터 유방보존술을 적극적으로 시행하였고 첫 3년동안 140예를 치료하였다. 목적 : 연세암센터에서 시행하고 있는 유방보존술의 적응증, 치료방침과 방사선치료 방법을 소개하고 결과 및 방사선치료의 부작용을 보고하고자 한다. 방법 : 1991년 1월부터 1992년 12월까지 연세암센터 치료방사선과에서 유방보존적수술 후 근치적 방사선치료를 받았던 64명의 조기 유방암 환자를 대상으로 하였다. 모든 환자들은 종괴 또는 병변을 포함한 부분유방절제술과 액와임파절 곽청술을 시행받은 후 방사선치료를 받았다. 방사선치료는 수술후 3-18주에 시행되었는데 선형가속기 4MV X-ray를 사용하여서 침범된 유방 전체에 4500-5040 cGy를 5-6주에 걸쳐서 조사하였고 원발 병소 주변에 전자선을 사용하여서 1-2주에 걸쳐서 1000-2000cGy를 추가 조사하였다. 치료를 받앗던 환자들의 임상적 특성과 치료방법, 방사선치료에 따르는 부작용, 재발 여부 등을 분석하였더. 결과 : 대상환자들의 연령은 23세 에서 59세로 중앙값이 40세 였다. 총 64명중 T1은 27명, T2는 34명 이었으며 3명은 비침윤성 암이었따. 또한 전체의 42.2%인 27명은 액와임파절 침윤이 있었따. 추적 기간(6-30개월, 중앙값 14개월) 동안 1예의 유방내 재발과 2예의 원격 전이가 관찰되었는데 유방내 재발은 원발병소와 다른 사분원에 위치하여서 처음 진단에서 발견하지 못했던 유방조영술상의 미세석회화음영에서 종괴가 자랐던 예로 다시 유방전적출술을 받은 후 무병생존 중이다. 방사선치료 중 또는 석회화음영에서 종괴가 자랐던 예로 다시 유방전적출술을 받은 후 부병생존 중이다. 방사선치료 중 또는 추적 기간 동안 치료를 요하는 부작용으로는 1예에서만 방사선 폐렴이 있었으나 대중요법으로 완쾌되었다. 결론 : 추적 기간이 짧기 때문에 국소재발율, 생존율, 미용효과 등의 치료 결과를 평가하기는 이르지만 조기 유방암에서 유방보존적 수술과 근치적 방사선 치료는 심한 급성 또는 아급성 부작용이 없는 안전하고 편안한 치료법임을 확인할 수 있었다. 또한 국소재발율을 낮추기 위해서는 유방보존술에 적합한 환자들을 선태하기 위한 철저한 평가가 필수적임을 알 수 있었다. Breast conserving surgery and irradiation is now accepted as preferable treatment method for the patients with stage Ⅰ and Ⅱ breast cancer. Our institution activated team approach for breast conservation in 1991 and treated on hundred and fourty patients during the next three years. Purpose : To present our early experience with eligibility criteria, treatment techniques, and the morbidities of primary radiotherapy. Materials and Methods : Sixty four patients with early stage breast cancer who received breast conserving treatment between January 1991 and December 1992 were evaluated. all patients received partial mastectomy(wide excision to quadrantectomy) and axillary node dissection followed by radiotherapy. Total dose of 4500-5040 CGy in 5-5 1/2 weeks was given to entire involved breast and boost dose of 1000-2000 cGy in 1-2 week was given to the primary tumor site. Linac 4 MV X-ray was used for breast irradiation and electron beam was used for boost. Thirty five patients received chemotherapy before or after radiotherapy. Patients characteristics, treatment techniques, and treatment related morbidities were analyzed. Results " Age distribution was ranged from 23 to 59 year old with median age of 40. Twenty-seven patients had T1 lesions and 34 patients had T2 lesions. In three patients pathologic diagnosis was ductal carcinoma in situ. Thirty-seven parients were No and 27 patients were N1. There were three recurrences. one in the breast and two distant metastases during follow-up period(6-30 months, median 14 months). Only one breast recurrence occured at undetected separate lesion with microcalcifications on initial mammogram. There was no serious side reaction which interrupted treatment courses or severe late complication. Only one symptomatic radiation pneumonitis and one asymptomatic radiation pneumonitis were noted. Conclusion : Conservative surgery and primary radiotherapy for early breast cancer is proven to be safe and comfortable treatment method without any major complication. Long-term follow up is needed to evaluate our treatment results in terms of loco-regional control rate, survival rate and cosmetic effect.

Prevention of heterotopic bone formation after total hip arthroplasty using 600 rad in single dose in high risk patient

Han, Chang Dong,Choi, Chong Hyuk,Suh, Chang Ok Yonsei University, College of Medicine 1997 Yonsei medical journal Vol.38 No.2