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홍성관,박형주,이은주,이영수,김기수,송헌호,이철룡 대한내분비학회 1999 Endocrinology and metabolism Vol.14 No.2
Isolated ACTH deficiency is a rare disorder, and usually characterized by its chronic course. The 59 year-old woman patient who had been healthy until 2 months ago, admitted because of abdomial pain, general weakness and loss of weight about 12kg for 2 months. She looked a little pallor but color of skin was not remarkable. Blood pressure, serum electrolyte, and glucose on admission were within normal range. Serum calcium was elevated with the value of 12.6mg/dL, which was normalized after hydration. Cortisol response to RI induced hypoglycemia did not show any response. Anterior pituitary hormone except ACTH showed normal response during combined pituitary hormone stimulation test. These clinical and laboratory finding reveals that isolated ACTH deficiency was developed in a short term period. There were no abnormalities in sellar MRI except pineal cyst. Her complaints were disappeared dramatically after hydroccetisone replacement at 4th. hospital day. Here we report a case of isolated ACTH deficiency, which was rapidly developed, with hypercalcemia, abdominal pain, and loss of weight about 12kg for 2 months. (J Kor Soc Endocrinol 14:396-400, 1999)
이은주,이성진,문대혁,류진숙,정준기,안일민,소영,홍석준,송헌호,김하영,이철룡 대한내분비학회 1999 Endocrinology and metabolism Vol.14 No.3
Background: FDG-PET has been suggested to have a supplementary role in localizing recurred sites of differentiated thyroid carcinoma. This study was performed to show whether FDG-PET is feasible as an alternative diagnostic modality for patients with I-131 scan negative thyroid carcinoma by verification of post-surgical pathology findings. Methods: Eighteen patients of papillary thyroid carcinoma (M:F=4:14, age 41±16 year) who had total thyroidectomy and I-131 ablation therapy were included. All patients showed negative I-131 scan on therapeutic dose but they were suspected as disease recurrence because of elevated serum Tg or anti-Tg Ab during follow-up periods. FDG-PET was performed, and then cervical lymph node dissection on either side or both sides of the neck was done according to FDG-PET results. Results: A total of 77 cervical lymph node groups were dissected in 18 patients; internal jugular chain 49, spinal accessory 9, jugulodigastric 5, anterior jugular 4, paratracheal 3, supraclavicular 2, and oters 5. Forty eight lymph node groups revealed metastatic papillary carcinoma on pathology and their largest diameter ranged from 0.4 to 7.0cm (1.2±0.7cm). All patients had at least one malignant lymph node group. FDG-PET detected 37 among 48 malignant lymph nodes (sensitivity 77%), and their count ratio ranged 1.7-31.1 (6.1±6.3). Among the 30 malignant lymph nodes less than 1cm, FDG-PET detected 20 lymph nodes. Of the 29 lymph node groups without malignant cells, FDG-PET was also negative in 24 groups (specificity S3%). Positive predictive value of FDG-PET on I-131 scan negative differentiated thyroid carcinoma was 88%; negative predictive value was 69%. Conclusion: FDG-PET has been confirmed as a valuable diagnostic modality to detect cervical lymph nodes of differentiated thyroid carcinoma who are suspicious for recurrence but with negative I-131 scan, by pathologic findings (J Kor Soc Endocrinol 14:520-530, 1999).
원발성 간외 담관암의 임상적 고찰 : 예후 인자 분석을 중심으로
김성호,박완,이정희,김명환,이성구,민영일,주광로,방성조,주연호,명승재,공경엽,김해경,이철룡 대한소화기학회 1999 대한소화기학회지 Vol.33 No.1
Background/Aims: The prognosis of extrahepatic bile duct carcinoma is very poor. The value of the gross morphology and location of the tumor in the bile duct as prognostic factors have been contro versial. Thus, we conducted a retrospective analysis of the prognostic factors. Methods: During the period between June, 1989 and December, 1996, 193 cases of extrahepatic bile duct carcinomas were selected and 108 cases of them were curatively resected. We collected data at the point of August 1997. Results: The mean age was 61.9 (17-87) years and the male to temale ratio was 2.5:1. Th frequency of tumor according to the location was 32.1% in the upper part, 31.6% in the middle par and 5.3% in diffuse type. The overall 1,2,3, and 5-year survival rate was 49.9%, 32.2%, 23.4%, and 17.8%, respectively. In the patients with curative surgery (n=108), the 1-, 2-, 3-, and 5- year surviva rate was 70.0%, 48.0%, 37.1% and 27.2%, respectively. In the patients without carative surgery (n=85), the 1-, 2-, 3-, and 5-year survival rate was 24.0%, 12.5%, 7.1%, and 3.0%, respectively. The survival rates of stage I were significantly better than those of stage II, stage III and stage IV-A. Th survival rates of well differentiated histology were significantly better than those of moderate or poo differentiation. Conclusions: The stage, histologic differentiation and curative resectability of the extrahepatic bile duct carcinoma were significant prognostic factors. However, the gross morphology and location of the tumor had no prognostic significance. (Kor J Gastroenterol 1999;33:114 - 123)