WDHA(Watery diarrhea, Hypokalemia, Achlorhydria) syndrome 1예

박기룡,김현영,김지혜,임영찬,최영식,박요한,최경현,이재화,장희경 고신대학교 의학부 2003 高神大學校 醫學部 論文集 Vol.18 No.1

저자들은 부갑상선절제술 이후에도 교정되지 않는 고칼슘혈증과 계속된 수양성 설사로 인한 하지마비 및 전신쇠약을 주소로 내원한 70세 남자환자에서 일반 화학검사, 호르몬 건사, 방사선 검사 등으로 VIPoma와 동반된 MEN Ⅰ으로 진단하여 외과적 절제술 후 수양성설사, 저칼슘혈증 및 고칼슘혈증이 호전된 1례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Multiple endocrine neoplasia I (MEN Ⅰ) is a genetic disorder that consists of neoplasia of neuroendocrine type in the parathyroid glands, in the islets of Langerhans in the pancreas, and in the anterior pituitary gland. Primary hyperparathyroidism is most common feature of the MEN I and occurs is approximately 95% of patients. Pancreatic islet cell tumors occur in 40% of MEN I patients. Most of these tumors produce excessive amounts of hormone, such as gastrin, insulin, glucagon and vasoactive intestinal polypeptide (VIP). VIP-producing pancreatic tumors (VIPoma) associated with MEN I are rare and there was only one case report in Korea so far. Recently we experienced a case of MEN I, especially VIPoma presented in a 70 year old man. He got subtotal parathyroidectomy for hyperparathyroidism 5 months ago, but his symptoms of watery diarrhea, severe general weakness and paralysis of lower limbs were not improved and hypercalcemia, hypokalemia were persisted. On computerized tomography scan of abdomen, demonstrated a mass of 3㎝ in diameter at the tail of pancreas. Serum level of VIP hormone was 250pg/㎖ (normal range : 0∼23pg/㎖). After partial pancreatectomy, his symptoms were improved dramatically and biochemical parameters such as, serum potassium, calcium, and VIP returned to the normal ranges.

원발성 갑상선 미세 악성림프종 1예

박달수,임진형,편준철,이영수,최영식,박요한,김중규,장희경 高神大學 醫學部 1998 高神大學醫學部 論文集 Vol.13 No.1-2

질소산화물 제거를 위한 V₂O_5/TiO₂촉매 코팅된 다공성 실리카 필터의 제조 및 특성

한요섭,고재철,박영구,김승호,박재구 三陟大學校 2005 論文集 Vol.38 No.-

The prepared porous support from silica coated with TiO₂ and V₂O_(5) catalysts were studied by selective catalytic reduction of NOx with NH₃ The effects of V₂O_(5) loading, reaction temperature, space velocity and filter-type(disk and sphere) on the characteristics of NOx reduction with NH₃ were mainly investigated. At space velocity 6000h^(-1), reaction temp rature 350℃, V₂O_(5) loading 6.Owt.% and oxygen content 5%, the NOx reduction was higher to about 91%. The efficiency of porous silica on V₂O_(5)/TiO₂ catalytic disk-filter was higher than that of the V₂O_(5)/TiO₂ catalytic sphere-filter. It has been experimentally observed that the V₂O_(5)/TiO₂ catalytic disk-filter has strong resistance of gas flow.

원발성 갑상선 미세 악성림프종 1예

박달수,임진형,편준철,이영수,최영식,박요한,김중규,장희경 고신대학교 의학부 1998 高神大學校 醫學部 論文集 Vol.13 No.1-2

Primary malignant lymphoma of the thyroid is a relatively rare malignant tumor of the' thyroid gland. It is known to be frequently associated with Hashimoto's thyroiditis. In Korea, 8 cases of primary lymphoma of the thyroid have been reported. All patients were over 64 years of age and the size of masses was over 5cm. A 23-year-old woman complained of diffuse goiter. High resolutional ultrasonography revealed 0.6×0.3×0.7cm sized focal low echoic lesion at the deep portion of the left lobe and 0.9×0.5×0.8cm sized focal low echoic lesion at the mid-portion of the right lobe of the thyroid gland. We performed ultrasound-guided fine needle aspiration on the both nodules. The cytologic finding of the nodule in the right lobe suggests malignant nodule and that of the left lobe showed Hashimoto' s thyroiditis. Near total thyroidectomy was performed and confirmed a tumor of low-grade mucosa-associated lymphoid tissue which size was 0.8cm. She was treated with combination chemotheraphy (cyclophosphamide, oncovin, epirubicin, methylprednisolone and bleomycin). We report this case with a review of literatures.

말초혈액에서 Tg mRNA에 대한 역전사 중합효소 연쇄 반응법의 갑상선 재발암의 분자생물학적 진단

권성일,박기룡,김현영,신채희,임영찬,최영식,박요한,이강대,장희경,이재화,염하용 대한내분비학회 2002 Endocrinology and metabolism Vol.17 No.4

연구배경: 갑상선암은 다른 조직에 발생한 암에 비해 비교적 천천히 자라므로 대부분 예후가 양호하지만, 일부에서는 주위 조직으로 침윤하거나 혹은 원격 전이로 인하여 치명적인 결과를 초래할 수 있다. 갑상선전절제술 및 131^I 제거술 후 경과 관찰시 갑상선암의 재발과 전이의 진단에 있어 131^I 스캔과 혈청 Tg의 측정이 현재 임상에서 가장 많이 이용되고 있으나 이 방법에는 여러 가지의 결점이 있다. 최근 Tg mRNA에 대한 RT-PCR법을 이용한 여러 연구결과는 131^I 스캔과 혈청 Tg 측정의 결점을 보완할 수 있는 좋은 보조적인 진단법으로 이용할 수 있을 가능성을 제시하였다. 이에 말초혈액에서 측정한 Tg mRNA에 대한 RT-PCR법이 갑상선 절제술 및 방사성요드 치료 후 갑상선암의 재발 및 전이 유무의 진단에 유용한가를 알아보고자 이 연구 시행하였다. 방법: 분화된 갑상선암으로 진단된 후 갑상선전절제술을 시행받고 방사성요드 치료를 받은 환자 중 현재까지 한차례에 이상 추적 방사성요드 전신 스캔을 시행하고 추적관찰이 가능했던 유두선암 35예, 여포선암 5예를 대상으로 연구를 시행하였다. 대상군은 131^I 스캔 소견상 음성인 군(Group Ⅰ), 잔여조직이 있는 군(Group Ⅱ), 국소전이가 있는 군(Group Ⅲ), 및 원격전이 군(Group Ⅳ)으로 구분하였다. 정상 대조군은 갑상선질환이 없는 10예의 건강인으로 하였다. 대상환자의 말초혈액을 이용한 Tg mRNA에 대해 특이적인 primer를 이용하여 RT-PCR 및 nested RT-PCR을 시행하였다. 결과: 본 연구 결과는 다음과 같다. 1) 131^I 스캔 소견상 음성인 군 21예 중 1예에서 Tg가 양성소견을 보였다. Anti Tg Ab가 양성인 4예 모두 Tg가 음성을 보였다. 잔여조직이 있거나 국소전이 및 원격전이를 보인 군 19예 중 Tg가 양성인 경우는 4예였으나, Tg mRNA는 전예에서 양성이었다. 2) 131^I 스캔에서 국소 및 원격전이 소견을 보인 8예 중 4예에서 Tg가 음성으로 131^I 스캔과 혈청 Tg 사이에 불일치 소견을 보였다. 3) 말초혈액에서 특이적인 primer를 이용하여 RT-PCR 및 nested RT-PCR을 시행한 결과 대상군 40예 및 정상 대조군 10예 모두에서 Tg mRNA가 양성을 보였다. 결론: 본 연구에서 갑상선 절제술 및 방사성요드 치료 후 갑상선암의 재발 및 전이 유무를 평가함에 있어 역전사 중합효소 연쇄 반응법을 이용한 Tg mRNA 측정의 의의는 재평가되어야 한다고 생각된다. Background: Differentiated thyroid cancer is the most common endocrine malignancy. Despite advances in the treatment of thyroid cancer, disease recurrence and metastasis may occur in as many as 20% of patients, and so continues to pose major problems in its clinical management. Serum thyroglobulin (Tg) measurements, by immunoassay, are used to detect residual or recurrent thyroid cancer following thyriod ablation. However, the usefulness of immunoassay is limited by both the requirement for thyroid hormone withdrawal, to attain optimal test sensitivity, and interference by the antithyroglobulin antibody (Anti-Tg Ab). Recent studies have reported the clinical usefulness of reverse transcription-polymerase chain reaction (RT-PCR) detection of Tg mRNA in the peripheral blood of patients with differentiated thyroid carcinomas. We performed this study to evaluated the usefulness RT-PCR of Tg mRNA in peripheral blood of patients with thyroid carcinoma following a total thyroidectomy and radioiodine ablation therapy. Methods: Forty cases that underwent a total thyroidectomy and radioiodine ablation therapy were included in this study. Of the 40 patients, 35 were papillary carcinomas and 5 were follicular carcinomas. Ten normal control subjects were also studied. Tg mRNA was extracted. Then RT-PCR and nested RT-PCR, were run with specific Tg primers. Concurrently, DNA sequencing of the isolates was carried out to prove the isolates were identical to the nucleotide sequence of the Tg. Results: The Tg was detected in 4 of 19 patients, with either a residual thyroid bed, or metastasis, on a 131^I whole body scan and in 1 of 21 patients with a negative radioiodine scan. Surprisingly, the Tg mRNA was detected in all the patients and normal controls. Conclusion: From our results we can not recommend Tg mRNA, detected by RT-PCR in peripheral blood, as a tumor marker superior to that of the Tg serum level. We consider an intensive re-evaluation of the method is required before considering its clinical applications (J Kor Soc Endocrinol 17:501∼513, 2002).

Graves 병과 혈청 면역글로불린-E의 연관성

김현영,박기룡,김성훈,김지연,송수근,최영식,박요한 대한내분비학회 2002 Endocrinology and metabolism Vol.17 No.5

연구배경: Graves 병은 미만성 갑상선종, 갑상선기능한진, 안구침법 등을 특징으로 하는 자가면역성 질환으로, 갑상선자극호르몬 수용체에 대한 자가항체(TRAb)가 갑상선을 자극하여 발생된다. TRAb는 Graves병 환자의 약 85%이상에서 검출되며 활성화된 TRAb는 대부분 IgE로 알려져 있다. 그러나 최근 Graves병 환자의 갑상선조직과 안구조직에 IgE의 침착과 꽃가루 등에 의한 알레르기성 비염으로 인해 Graves병이 발생하거나 재발된 견우가 보고되어 Graves병의 병인에 IgE의 연관성이 제기 되고 있으나, 국내에서는 이에 대한 연구가 드물다. 본 연구에서는 Graves병에서의 혈청 IgE농도와 Graves병의 병기와의 관계 및 TRAb와 IgE 농도와의 연관성을 살펴보고자 하였다. 대상 및 방법 : 2000년 4월 1일부터 7월 1일까지 고신의료원 내분비내과를 방문한 환자 중 Graves병 46예, 만성갑상선염 6예 및 고신의료원 건강증진센터를 방문한 환자 중 갑상선질환의 병력이나 가족력 및 알레르기성 비염의 병력이 없는 35예의 정상대조군을 대상으로 연구를 시행하였다. TRAb는 갑상선자극호르몬 결합 억제 면역글로불린(TBII)으로 측정하였으며, IgE는 효소면역분석법으로 측정하였다. 결과: IgG인 TBII는 Graves병에서 만성갑상선염과 대조군에 비해 높았으며, IgE 평균농도는 Graves병에서 598.1±1112.9U/mL로 만성갑상선염 환자의 98350±79.7U/mL, 대조군 161.72±194.4U/mL에 비해 높았다(p<0.05). Graves병에서 알레르기성 비염의 발병율은 10.9%(5/46)였으며, Graves 병에서의 혈청 IgE 농도는 알레르기성 비염의 병력이 있는 경우 903.1±1152.2U/mL로 없는 경우 560.8±1117.0U/mL보다 높은 경향을 보였다. Graves병의 병기에 따른 TBII와 IgE 농도의 변화를 항갑상선제로 치료하지 않은 군(비치료군)과 치료한 군(치료군) 및 재발군으로 나누어 비교하였을 때, TBII는 치료군(7.4±18.6%)에 비해 비치료군(49.9±23.9%)과 재발군(21.1±3.1%)에서 높았으며(p<0.05), 혈청 IgE치도 치료군(233.8±432.7U/mL)에 비해 비치료군(758.6±1250.0U/mL)과 재발군(1198.5±1952.1U/mL)에서 높은 경향을 보였다. 항갑상선제로 치료한 치료기간에 따른 TBII와 IgE 농도 변화에서, TBII는 비치료군(49.9±23.9%)과 1년 미만 치료군(24.8±3.8%)에서 1년 이상 치료군(2.22±1.97%)에 비해 높았으며(p<0.05), 혈청 IgE 농도는 비치료군(758.6±1250.2U/mL)에서 1년 미만 치료한 군(158.3±91.5U/mL)과 1년 이상 치료군(252.7±483.4U/mL)에 비해 높았으나 유의하지는 않았다. 결론: Graves 병에서 IgE 농도는 증가되어 있었으며, Graves 병의 각각 다른 병기에서의 혈청 IgE 농도의 변화는 Graves qudd의 경과에 영향을 미치는 IgG인 TBII치의 변화와 유사한 경향을 보였다. 그러나 혈청 IgE와 Graves 병과의 연관성을 알아보기 위해서 IgE와 더불어 CD23항원 등의 다른 검사도 병행하는 전향적 연구가 필요할 것으로 생각된다. Background: It is widely believed that Graves' disease is and autoimmune disorder characterized by the presence of the circulation TSH receptor antibody (TRAb). The majority of the activity of TRAb is of the immunoglobulin G(IgG) class. However, other immunoglobulin such as immunoglobulin E(IgE), may play a rloe in the activity. IgE accumulation has been reported to occur in the thyroid gland and ocular muscles of subjects with Graves' disease. Furthermore, it has been noted that recurrence of Graves' disease can be induced by and allergy to pollen. Because an allergy to pollen is commonly associated with IgE, IgE might play a role in the induction of Graves' disease. Therefore, investigated whether IgE was elevated in Graves' disease, and evaluated the potential relationship between the levels of TRAb and IgE Graves' disease. Methods: Forty-six patients with Graves' disease, and 6 with chronic thyroiditis, diagnosed at the Kosin Medical Center between April, 2000 and July, 2000 were included in this study. Thirty-five persons without thyroid disease or a history of allergic rhinitis were used as normal controls. The level or TRAb was measured using thyrotropin binding inhibitory immunoglobulin (TBII). Serum total IgE was measured using as enzymeimmunoassay method. Test for thyroid function, TBII and total IgE were performed in all cases, and the results statistically analyzed. Results: TBII, as IgG, and the serum IgE level were higher in the patients with Graves' disease, and the levels of the latter were 598.1±1112.9U/mL, 98.5±79.7U/mL and controls 161.7±194.4U/mL in the Graves' patients, those with thyroiditis and the controls, respectively (p<0.05). The prevalence of allergic rhinitis in Graves' disease was 10.9%. The serum IgE level in Graves' disease with, and without, allergic rhinitis were 903.1±1152.2U/mL and 560.8±1117.0U/mL, respectively, although there was no significancant difference between the two groups. According to the clinical stage, the serum TBII level was higher in the untreated Graves', and relapsed patients 49.9±23.9% and 21.1±3.1%, respectively, than in the treated group, 7.4±18.6% (p<0.05). The serum IgE level was higher in the untreated Graves' and relapsed patients 758.6±1250.2U/mL and 1198.5±1952.1U/mL, respectively, than in the treated group 233.8±432.7U/mL, although this was not significant. According to the duration of treatment, the serum TBII levels were higher in the untreated Graves' patients, and those treated for less than 1 year, than in those treated for more than 1 year, with values of 49.9±23.9, 24.8±3.8 and 2.22±1.97%, respectively (p<.05). The serum IgE level was higher in the untreated Graves' disease (758.6±1250.2U/mL) than in the groups treated for less than 12 months (158.3±91.5U/mL) and more than 12 months (252.7±483.4U/mL), but the differences were not significant. Conclusions: The concentration of IgE was high in Graves' patients, and although not statistically significant, the serum igE level in Graves' patients with allergic rhinitis was higher than those without. With regard to the clinical stage of Grave's disease, the change in the IgE level tended to follow that of the TBII. Further study will be required to define the possible role of IgE in the pathogenesis in Graves' disease (J Kor Soc Endocrinol 17:640∼648, 2002).

해수에 의한 부식속도 데이터 베이스의 구축과 이용에 관한 연구

윤우생,한주철,박만호,송요승 한국항공대학교 1996 論文集 Vol.34 No.-

해수분위기에서 부식속도에 관한 데이터 베이스를 구축하였다. 본 데이터 베이스 system 프로그램은 커다랗게 두가지의 기능을 가지고 있는데 한가지는 데이터를 입력하는 기능이며 다른 한가지는 검색기능이다. 각각의 기능들은 몇개의 필드로 구성 되어 있다. 데이터베이스의 주된 필드들은 record, key-no, material type, material common name, environmental condition, corrosion rate등이다. 이중 중요한 연결고리용 필드는 각 데이터 들의 key-no로 사용하였다. We construct the Data-Base about corrosion rate of metal material in the sea water. In Data-Base system program have mainly 2 functions, one is data-input mode, the other is search mode. Each mode enclose some fields. Main fields are compose of record, key-no, material type, material common name, environmental condition, corrosion rate. Relation field is key-no of each data.

동종골수이식 환자에서 발생한 지역사회발생 Parainfluenza virus 3형 폐렴 1예

신종욱,조요한,강철인,김성한,이상윤,김의석,오명돈,이환종,박선양,김병국,최강원 대한감염학회 2002 감염 Vol.34 No.5

갑상선 유두선암 환자의 말초 혈액 단핵구로부터 수지상세포분화와 자가 세포독성 T 림프구 활성화 유도

송수근,최영식,박요한,이대희,장희경 고신대학교 의학부 2004 高神大學校 醫學部 論文集 Vol.19 No.1

Background: Dendritic cells (DCs) are rare leucocytes that are uniquely potent in their ability to capture, process and present antigens to T cells, and so selectively migrate through tissues to reach lymph nodes and spleen where initiation of immune responses takes place. It has been reported that a dense infilteration of dendritic cells correlates with a favorable prognosis in several types of cancer. A similar correlation also has been noted in patients with papillary carcinoma of thyroid. The purpose of this study is to determine whether DCs are generated from peripheral blood monocytes by using cytokines such as GM-CSF, TNF-α, and IL-4 and whether cytotoxic T cells activated by DCs attack the papillary carcinoma tissues. Methods: Peripheral blood was obtained from 2 patients with thyroid papillary cancer. DCs were established from monocytes by culturing in the presence of GM-CSF, Flt-3 ligand. TNF-α , and IL-4 for14 days. At day 14, expression of surface markers typical for DCs was analyzed morphologically. The immunophenotypic features of DCs such as CDla, CD83, and CD86 were analyzed by phase contrast microscopy. At day 15 DCs were incubated with thyroid cancer tissues and normal thyroid tissues for 7 days. Results: DCs were generated from the peripheral blood monocytes. The generated cells had the classic morphology of DCs. Activated cytotoxic T lymphocytes (CTLs) were observed. Veiled cell known as circulating DCs attached to the thyroid cancer tissues were observed. The CTLs activated by DCs were observed to attack the papillary carcinoma tissues by scanning electron microscope. However, normal tissues were not attacked by CTLs. Conclusion: DCs can be generated from the peripheral blood monocytes. Futhermore, the CTLs activated by DCs also can attack the papillary carcinoma tissues. These results that DCs can be used as adjuvants for adoptive immunotherapy of papillary thyroid cancer.

갑상선암에서 MAGE-1, -2, -3, -4, -5 및 -10 유전자의 발현

최영식,임학,박요한,이강대,이재화,장희경 대한내분비학회 2001 Endocrinology and metabolism Vol.16 No.4-5