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우측 반회후두신경을 침범한 갑상선 유두상암 환자의 수술 후 발생한 양측 성대 마비의 회복 1예
문미진,왕수건,이윤세,임윤성,이진춘,강양호,손석만,김인주,Mun, Mi Jin,Wang, Soo Geun,Lee, Yoon Se,Lim, Yun-Sung,Lee, Jin Chun,Kang, Yang Ho,Son, Seok Man,Kim, In Joo 대한기관식도과학회 2011 大韓氣管食道科學會誌 Vol.17 No.1
Vocal cord paralysis (VCP) is a common complication after thyroidectomy despite the continuity of the recurrent laryngeal nerve (RLN) is preserved. Much efforts have been made into preventing VCP, but few of them focuses on the treatment strategies and prognosis after VCP take place. In this case, patient visited the clinic for papillary thyroid cancer in Rt. thyroid gland without VCP. She underwent total thyroidectomy with central neck dissection. During dissection, Rt main mass was encircling Rt. RLN. To make matters worse, Lt. RLN was severed due to tight attachment with Berry's ligament. After that, intratumoural dissection of Rt. RLN and end to end anastomosis of Lt. RLN were performed with microscopy to preserve the functions of RLNs as much as possible, otherwise permanent bilateral VCPs were inevitable. We report this case, since both vocal cords recovered from VCPs with symmetric, synchronous movements at postoperative follow up.
크기 1.5 cm 이하의 작은 갑상선 유두암의 예후를 고려한 조직학적 고찰
신선혜 ( Sun Hye Shin ),나민아 ( Min Ah Na ),강양호 ( Yang Ho Kang ),손석만 ( Seok Man Son ),김인주 ( In Ju Kim ),김용기 ( Yong Ki Kim ) 대한내과학회 2007 대한내과학회지 Vol.73 No.1
목적: 예후와 연관되어 있는 갑상선 유두암의 병리조직학적 특징을 종양의 크기 1.5 cm을 기준으로 두 군으로 나누어 비교하여 보고 크기가 1.5 cm 이하의 작은 갑상선 유두암의 치료적 방향을 제시하기 위해서 본 연구를 시행하였다. 방법: 1996년 1월부터 2000년 12월까지 부산대학병원에서 갑상선 유두암으로 진단받고 수술을 시행 받은 178명의 환자를 대상으로 하였다. 모든 환자의 병력 기록지를 조사하여 후향적으로 분석하였다. 모든 병리조직학적 검체는 수술을 통해 얻어졌고 병리학자에 의해 기술되었다. 예후와 연관하여 중점적으로 조사한 병리 조직학적 특징은 진단 당시의 림프절 전이, 다발성, 갑상선외 침범, 양 엽의 침범이었다. 결과: 갑상선 유두암으로 수술한 환자는 총 178명으로 이 중 여자는 150명으로 84.3%이었으며 1.5 cm 이하의 작은 갑상선 유두암은 총 48명(27%)이었다. 병리조직학적 특징을 1.5 cm 이하의 종양군과 1.5 cm 보다 큰 종양군으로 나누어 비교하였을 때 림프절 전이는 두 군 사이에 통계학적으로 유의한 차이를 보였지만(p=0.043) 다발성, 갑상선외 침범, 양 엽의 침범은 통계학적으로 유의한 차이를 보이지 않았다. 결론: 1.5 cm 이하의 작은 갑상선 유두암도 진단 당시 1/3에서 림프절 전이를 보이며 1.5 cm 보다 큰 갑상선 유두암과 비교하여 유사한 정도로 다발성, 양 엽의 침범, 갑상선외 침범이 발견되므로 일반적인 갑상선 유두암의 표준치료가 바람직하다고 생각된다. Background: A number of studies have shown that papillary microcarcinomas have a more favorable prognosis than do the larger tumors. However, some microcarcinomas may have a negative outcome. So, we investigated the histological features of small (≤1.5 cm) papillary thyroid carcinomas, and we compared them with the larger (>1.5 cm) tumors. Methods: Between January, 1996 and December, 2000, 178 patients were diagnosed and operated on for their differentiated papillary thyroid carcinoma at Pusan National University Hospital. We reviewed the charts and pathologic records of these patients and we analyzed them retrospectively. According to the tumor size 1.5cm, we divided the tumors into two groups and then compared the histological features. Results: Small papillary thyroid carcinomas have a favorable outcome in most cases. However, small papillary thyroid carcinomas present with signs of aggressiveness at presentation, including lymph node metastases (33.3%), multifocality (12.5%), bilateral involvement (12.5%) and extrathyroidal extension (16.7%). Compared with larger tumors, the frequency of theses signs was similar, except for lymph node metastases, in the small papillary thyroid carcinomas. Conclusions: Approximately one third of the small papillary thyroid cancer 1.5 cm and less in size had neck lymph node metastases at presentation and the signs of aggressiveness were similarly present as compared with the larger tumors. We suggested that the standard treatment is desirable as a therapeutic strategy of small papillary thyroid carcinoma.(Korean J Med 73:44-49, 2007)
김용기(Yong Ki Kim),김인주(In Joo Kim),강양호(Yang Ho Kang),손석만(Seok Man Son),이경석(Kyoung Seog Lee),이재복(Jae Bok Lee),서봉직(Bong Jik Seo),박준상(June Sang Park),고명연(Myung Yun Ko),손성표 대한핵의학회 1995 핵의학 분자영상 Vol.29 No.4
N/A Bone scan is a very sensitive diagnostic imaging test for detecting bone and joint disorders. So it might be useful in the diagnosis of temporomandibular disorders of the joint origin. Thus, the effectiveness of bone scan for detecting temporomandibular joint(TMJ) diseases and differentiating the TMJ disc displacement from the TMJ arthritis was evaluated. Bone scan was done in 21 patients with TMJ disc displacement(l3 unilaterally affected, 8 bilaterally affected), 26 patients with TMJ arthritis(23 unilateral, 3 bilateral), and 39 volunteers with no signs, symtoms, or history of TMJ disease TMJ simple uptake rate(SUR) and difference of both TMJ SUR were calculated from the 100,000 count lateral image of head and neck region in Tc-99m MDP bone scan. Transcranial and panorama X-ray examination was also done in all patients. TMJ SUR(%) were 1.673±0.606 in TMJs affected with arthritis, 1.350±0.351 in TMJs affected with disc displacement, and 1.084±0.172 in TMJs of controls Significant differences were demonstrated among them(p〈001). Difference of bith TMJ SUR was highest in patients with unilateral TMJ arthritis(0.608±0.533, p〈001), and there is no significant difference between that of controls and that of unilateral TMJ disc displacement patients(0.062±0.063 vs 0.122±0.100). TMJ SUR of joint with bone change on X-ray finding was not significantly different from that of joint with normal X-ray finding. Those in patients with unilateral TMJ disc displacement(69.6% and 87% vs 23.1% and 23%). The proportions of patients with increased TMJ SUR and difference of both TMJ SUR(〉mean+2SD of controls) in unilateral TMJ arthritis patients were significantly higher than those in patients with unilateral TMJ disc displacement(69.6% and 87% vs 23.1% and 23%). Conclusively, bone scan may help to detect TMJ disease and differentiate TMJ disc displacement from TMJ arthritis.
고혈당과 유리 지방산에 의한 호중구의 NAD(P)H Oxidase 활성화로부터의 혈관내피세포 손상
김상수 ( Sang Soo Kim ),김선영 ( Sun Young Kim ),이수형 ( Soo Hyung Lee ),강양호 ( Yang Ho Kang ),김인주 ( In Ju Kim ),김용기 ( Yong Ki Kim ),손석만 ( Seok Man Son ) 대한당뇨병학회 2009 Diabetes and Metabolism Journal Vol.33 No.2
연구배경: 산화스트레스가 당뇨병에서 혈관내피세포의 기능장애에 관여하여 혈관합병증의 발생에 중요한 역할을 하는 것으로 알려져 있다. 또한 죽상동맥경화증은 혈관세포들의 산화-환원 신호의 이상으로 인한 혈관의 만성 염증성현상으로 설명되고 있어, 산화스트레스와 염증이 당뇨병 합병증의 병태생리에 있어 중요한 역할을 하는 것으로 여겨지고 있다. 당뇨병에서 혈관합병증을 일으키는 기전에 대해 보다 명확히 규명하고자 본 연구에서는 호중구로부터의 superoxide 음이온 생성에 대한 고농도의 포도당과 유리 지방산의 효과와 이로 인한 혈관내피세포의 손상에 대해 알아 보고자 하였다. 방법: 인간 호중구를 5.5 mmol/L, 30 mmol/L D-glucose와 3 nmol/L, 30 μmol/L oleic acid를 함유한 배양배지를 만들어 1시간 동안 배양하였다. 인간대동맥 내피세포를 위배지로부터 배양한 호중구와 같이 배양하여 호중구의 혈관내피세포 부착률, 호중구의 활성화 및 superoxide 음이온 생성량, 호중구에 의한 내피세포의 세포독성 및 호중구의 NAD(P)H oxidase 소단위 발현 등을 측정하였다. 결과: 30 mmol/L D-glucose와 30 μmol/L oleic acid 배양조건에서 5.5 mmol/L D-glucose와 3 nmol/L oleic acid 배양조건에 비해 호중구의 혈관내피세포에 대한 부착률, 호중구의 활성화, 호중구의 superoxide 음이온 생성량 및 호중구에 의한 내피세포의 세포독성이 현저히 높았다. 30 mmol/L D-glucose와 30 μmol/L oleic acid로 처치하였을때 호중구의 NADPH oxidase의 막구성 요소인 gp91(phox)의 발현이 유의하게 증가하였다. 30 mmol/L D-glucose와 30 μmol/L oleic acid에 동시 노출로 인해 증가한 호중구의 내피세포에 대한 부착률, 호중구의 superoxide 음이온 생성, 혈관내피 세포독성 등은 NAD(P)H 억제제인 N-acetylcysteine로 전처치하였을 때 유의하게 감소하였다. 결론: 고농도의 포도당과 유리 지방산은 호중구를 활성화시키고, 호중구의 혈관내피세포에 대한 부착능을 증가시킨다. 또한 호중구에서 NAD(P)H oxidase을 통해 반응성 산소유리기 생성을 증가시켜 내피세포 주변의 염증반응을 일으켜 세포 손상을 증가시킨다. Background: Oxidative stress and inflammation are important factors in the pathogenesis of diabetes and contribute to the development of diabetic complications. To understand the mechanisms that cause vascular complications in diabetes, we examined the effects of high glucose and/or free fatty acids on the production of superoxide from neutrophils and their role in endothelial cell damage. Methods: Human neutrophils were incubated in the media containing 5.5 mM D-glucose, 30 mM D-glucose, 3 nM oleic acid, or 30 μM oleic acid for 1 hour to evaluate superoxide production through NAD(P)H oxidase activation. Human aortic endothelial cells were co-cultured with neutrophils exposed to high glucose and oleic acid. We then measured neutrophil adhesion to endothelial cells, neutrophil activation and superoxide production, neutrophil-mediated endothelial cell cytotoxicity and subunits of neutrophil NAD(P)H oxidase. Results: After 1 hour of incubation with various concentrations of glucose and oleic acid, neutrophil adherence to high glucose and oleic acid-treated endothelial cells was significantly increased compared with adhesion to low glucose and oleic acid-treated endothelial cells. Incubation of neutrophils with glucose and free fatty acids increased superoxide production in a dose-dependent manner. High glucose and oleic acid treatment significantly increased expression of the membrane components of NAD(P)H oxidase of neutrophil (gp91(phox)). Endothelial cells co-cultured with neutrophils exposed to high glucose and oleic acid showed increased cytolysis, which could be prevented by an antioxidant, N-acetylcysteine. Conclusion: These results suggest that high glucose and/or free fatty acidsincrease injury of endothelial cells via stimulating NAD(P)H oxidase-induced superoxide production from neutrophils. (Korean Diabetes J 33:94-104, 2009)
당뇨병성 미세혈관 합병증 및 신경병증 환자에서 혈청 Lipoprotein ( a ) 의 농도
이경인(Kyoung In Lee),정준훈(Joon Hoon Jeong),최영근(Young Keun Choi),김영민(Young Min Kim),강양호(Yang Ho Kang),손석만(Seok Man Son),김윤성(Yun Seong Kim),김사웅(Sa Woong Kim),유석동(Seok Dong Yoo),김인주(In Joo Kim),김용기(Yong Ki 대한내과학회 1998 대한내과학회지 Vol.54 No.2
N/A Background: Several epidemiological studies have shown that high plasma concentration of lipoprotein(a) [Lp(a)] is associated with an increased risk for atherosclerotic cardiovascular disease and works as an independent risk factor for atherosclerosis. But, the significance of Lp(a) in diabetic microangiopathy & neuropathy is unclear essentially due to a paucity of relevant studies. This study was designed to evaluate whether Lp(a) concentration may be increased in patients with diabetic microangiopathy & neuropathy. Methods : We studied 96 patients who visited the department of internal medicine in Pusan National University Hospital from May 1995 to May 1996. The patients were grouped according to the presence of diabetic complications(microangiopathy and neuropathy, microangiopathy included retinopathy and nephropathy) and therapeutic modalities(diet, insulin, insulin with oral hypoglycemic agent, and oral hypoglycemic agent). Results: 1) Concentration of Lp(a) was significantly higher(p<0.05) in patients with diabetic retinopathy(nonproliferative, 38.6±33.6 mg/dl, proliferative, 39.5±32.1 mg/dl) than that of patients without retinopathy(23.3±25.3 mg/dl). The duration of diabetes was significantly longer(p<0.05) in patients with diabetic retinopathy(nonproliferative, 12.0 years, proliferative, 13.2 years) than that of patients without retinopathy(5.9 years). 2) Concentration of Lp(a) was significantly higher(p<0.05) in patients with diabetic nephropathy(36.5±39.3 mg/dl) than that of patients without nephropathy(23.3±17.8 mg/dl) and the duration of diabetes was also longer in patients with diabetic nephropathy(10.7±7.2 years vs 6.3±5.8 years, p<0.005). 3) Concentration of Lp(a) was significantly higher and the duration of diabetes was longer in patients with diabetic neuropathy than that of patients without neuropathy(35.9±31.7 mg/dl vs 23.2±25.1 mg/dl, p<0.05 and 10.8 years vs 6.2 years, p<0.005). 4) Concentration of Lp(a) was significantly higher in patients with three complications(53.6 mg/dl, p<0.005) and duration of diabetes was significantly longer in patients with two or three complications(11.3 years, 13.6 years, respectively, p<0.0001). than those in patients without complications. 5) When the patients were subgrouped according to the treatment modalities, there were no significant difference in Lp(a) concentration, however the duration of diabetes was longer in patient group treated with combination of insulin and oral hypoglycemics than that of the other groups(p<0.05). 6) In multivariate logistic regression analysis, concentration of Lp(a) ≥ 50 mg/dl was significantly correlated with diabetic retinopathy & nephropathy, but was not significantly correlated with diabetic neuropathy. Duration of diabetes(≥7 years) and total cholesterol(≥20 mg/dl) were signi5cantly correlated with diabetic retinopathy, nephropathy and neuropathy. Conclusions: Lp(a) concentration is increased in patients with diabetic microangiopathy and neuropathy compared with patients without these complications. So, Lp(a) may works as risk factor for diabetic microangiopathy and neuropathy, and further study to evaluate the role of Lp(a) as a risk factor of such complications would be necessary in large number of patients.
제2형 당뇨병환자의 사망원인에 대한 10년간의 추세 변화 : 부산 시내 6개 종합병원을 중심으로
박수경 ( Su Kyung Park ),박미경 ( Mi Kyoung Park ),석지혜 ( Ji Hye Suk ),김미경 ( Mi Kyung Kim ),김용기 ( Yong Ki Kim ),김인주 ( In Ju Kim ),강양호 ( Yang Ho Kang ),이광재 ( Kwang Jae Lee ),이현승 ( Hyun Seung Lee ),이창원 ( Chang 대한당뇨병학회 2009 Diabetes and Metabolism Journal Vol.33 No.1