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궁성수 충북대학교 의학연구소 2002 忠北醫大學術誌 Vol.12 No.2
Thyroid cancer patients must be followed for a long time after surgery, because thyroid cancer occurs commonly in young individuals and it is slow in progression. For the past several decades, many researchers and organizations published reviews or guidelines for following up thyroid cancer patients after surgery. But they had somewhat different opinions each other and there are no universal guidelines approved by experts, currently. In this article, many useful methods for following thyroid cancer patients were reviewed and adequate following-up method proposed. After thyroidectomy, development of new nodules in the neck area or increase in serum thyroglobulin (Tg) with thyroxine therapy heralds the recurrence of thyroid cancer. These patients should be treated with surgery or radioiodine. In patients without theses fingings, stimulated serum Tg level by endogenous TSH and I-131-whole body scan (WBS) are a very sensitive and basic tests for the detection of thyroid cancer recurrence. The optimal interval for Tg measurement and I-131 WBS depends on the individual patient's risk of recurrence. It can be 6 months or longer than 5 years. Patients with abnormal Tg value and normal I-131-WBS findings need another imaging studies for localizing the recurrence sites such as high-dose I-131-WBS, ultrasonography of neck, chest CT, F-18-FDG PET, Tc-99m-MIBI, T1-201 or Tc-99m-tetroformin. The selection of approate imaging studies depends on availability, cost and patient status. Currently, ultrasonography of neck, chest CT and F-18-FDG are most widely used studies.
두경부 림프종에 대한 방사선과학적 접근: 충북대학교병원에서의 경험
차상훈,김주창,한기석,김성진,박길선,궁성수 충북대학교 의과대학 충북대학교 의학연구소 1999 忠北醫大學術誌 Vol.9 No.2
목적: 충북대학교병원에서 두경부의 림프종으로 진단된 증례들을 방사선학적으로 분석하여 임파절외 병변과 임파절 병변의 특징에 관하여 알아보고 이전의 문헌들과 비교하여 고찰하고자 하였다. 대상 및 방법: 병리학적으로 두경부의 림프종으로 진단된 31명을 대상으로 후향적 분석을 하였다. 조직검사로 확인된 병변 외에 다발성 병변에서는 조직 검사로 확인되지 않았더라도 치료 전 CT나 MRI 상 분명한 경우, 치료 후의 추적 CT 또는 MRI 상 명백한 호전이 있으면 병변으로 간주하였고 특히, 치료 전 림프절의 크기가 1-1.5cm보다 작아도 치료 전·후 분명한 차이를 나타내면 병변으로 간주하였다. 림프절외 병변의 부위, 림프절 병변의 위치와 크기, 전신 림프종 여부, 림프종의 병리학적 진단 등에 관해 분석하였다. 결과: 호지킨 림프종은 1명이고 림프절 병변만이 분명하였다. 나머지 30명은 비호지킨 림프종으로서 그중에는 혼합형 병변이 가장 많았으며(n=20) 림프절 외 병변만 있는 경우가 7명, 림프절 병변만 있는 경우가 3명이었다.림프절 외 병변은 Waldeyer's ring의 다발성 병변이 대부분이었는데 이중 인후부에 별도의 병변이 동반된 경우, lingual tonsil 만 침범된 경우가 각기 1례씩 있었다. 또한 Waldeyer's ring 병변이 mouth floor나 soft palate로 침범하기도 하였다. 비강 림프종이 진단된 7명 중에 최초 진단 시 또는 치료후 경과 추적 시 양측 비강이 침범된 각 1명씩이 있었고 3명에서는 비익과 주변조직으로의 침범이 있었으며 세포유형은 다양하였다.다형성 세망증으로 진단된 병변은 모두 4례로 비강에 2례, Waldeyer's ring 2례 등이었다.림프절 병변은 23명의 환자에서 모두 71개 림프절 군이 진단되었는데 20명은 2개 이상의 림프절군이 양성인 다발성 병변을 가졌고 이 중 36개 림프절 군에서 1cm이하의 림프절 병변이 진단되었다. 림프절과 림프절 외 병변이 동반된 혼합성 림프종(n=20)의 경우 림프절 외 병변과 동측에 림프절 병변이 있는 환자가 7명이고 양측의 림프절 병변은 13명이었으며 반대측에만 림프절 병변이 확인된 것은 없었다. 결론: 본 연구를 통하여 충북대병원에 내원하였던 두경부 림프종 증례들의 방사선학적 특성을 알 수 있었으며 림프절 외 병변과 림프절 병변이 동반된 경우가 많았는데 이는 치료 전후의 비교를 하여 기존의 연구들과 다른 기준을 설정하였기 때문인데 이에 관하여는 추후 별도의 연구가 필요하다고 여겨진다. Purpose: 31 cases were retrospectively assessed to analyse radiological features of nodal and extranodal lesions which were diagnosed at Chungbuk National University Hospital(CNUH) and literature review was focused to the previous Korean reports. Materials and Methods: Other than biopsy-proven lesions, nodal and extranodal lesions showing definite size reduction in the post-treatment CT and MRI were also analysed. Cervical lymph nodes smaller than 1-1.5cm in initial size were included when the treatment caused significant improvement. Case analysis was focused to size and location of the nodal and extranodal lesions, pathological types, presence of the systemic involvement. Results: Only one patient was HD with nodal disease. NHL patients(n=30) had both nodal and extranodal(combined) disease(n=20), extranodal disease only(n=7) and nodal only(n=3). Waldeyer's ring was the most common extranodal location. Among the seven nasal cavity NHLs', both sides were occupied by the tumor initially(n=1) or during the follow-up(n=1) and 3 cases showed the invasion to ala nasi and cheek, and cell types were various. 2 cases of PMR(n=4) involved nasal cavity and other 2 had diseased Waldeyer's ring. 23 patients revealed nodal disease in total of 71 cervical spaces, most of them(20/23) had more than 2 diseased L/N groups. Among 71 L/N groups, 36 showed node size smaller than 1cm initially. NHL patients with combined nodal and extranodal pathology(n=20) had nodal lesions ipsilateral to extranodal disease in 7, bilateral in 13. Conclusion: Combined nodal and extranodal disease was more prevalent in our study than in the previous literatures because the inclusion criteria for the nodal lesion was wider. We could note several differences that should be pursued in further studies.
누드마우스에 이식된 인체 대장암 모델에서 주입된 항 CEA 단세포군 항체의 종양내 집적에 관련하는 인자
궁성수(Sung Soo Koong),김승택(Seoung Taik Kim),이복희(Bok Hi Lee),정준기(June Key Chung),이명철(Myung Chul Lee),고창순(Chang Soon Koh),정홍근(Hong Keun Chung) 대한내과학회 1992 대한내과학회지 Vol.43 No.5
N/A It has been supposed that several factors are related to the localization of antibody against tumor-associated antigen in tumors. However, the significance of these factors has not been evaluated in detail. The purpose of the present study was to analyze the effect of these factors on the localization of infused monoclonal anti-CEA (CEA 79), expressed in percent injected dose per gram (%ID/G), in human colon carcinoma grafted to nude mice. The evaluated factors in tumor were tissue weight, blood weight, vascular permeability to antibody, relative blood flow and CEA concentration (Bmax). The percent injected dose per gram of CEA 79 in tumor correlated significantly with vascular permeability (r= 0.61, p<0,001) and CEA concentration in tumor (r= 0.49, p<0.001), while tissue weight, blood weight and relative blood flow did not show a significant correlation (p>0.05) in linear regression analysis. Stepwised multiple regression analysis in tumor indicated that vascular permeability was a significant predictor of the percent injected dose per gram (multiple R=0,59, p<0,001). Inclusion of CEA concentration in tumor increased the correlation coefficient from 0.59 to 0.67 (p<0.001). Adding all the other variables was not significant (p>0.05). In conclusion, vascular permeability to antibody and CEA concentration in tumor were important factors determining the localization of CEA 79 in human colon carcinoma grafted to nude mice.