The Bethesda System 2001의 최신지견

홍은경,남종희,박문향,Hong, Eun-Kyung,Nam, Jong-Hee,Park, Moon-Hyang 대한세포병리학회 2001 대한세포병리학회지 Vol.12 No.1

The Bethesda System (TBS) was first developed in 1988 for the need to enhance the communication of the cytopathologic findings to the referring physician in unambiguous diagnostic terms. The terminology used in this reporting system should reflect current understanding of the pathogenesis of cervical/vaginal disease so the framework of the reporting system should be flexible enough to accommodate advances in medicine including virology, molecular biology, and pathology. Three years after the Introduction of TBS, the second Bethesda workshop was held to set or amend diagnostic criteria for each categories of TBS. TBS 1991 is now widely used. The third Bethesda workshop, The Bethesda System 2001 Workshop, was held in National Cancer institute Bethesda, Maryland from April 30 to May 2, 2001. Again, the goals of this workshop were to promote effective communication and to clarify in reporting cervical cytopathology results to clinicians and to provide with the information to make appropriate decisions about diagnosis and treatment. Nine forum groups were made and there were Web-based bulletin board discussions between October, 2000 and the first week of April, 2001. On the basis of bulletin board comments and discussions, the forum moderators recommended revised terminologies in the Workshop. Hot discussions were followed after the presentation by forum moderators during the workshop. Terminologies confusing clinicians and providing no additional informations regarding patient management were deleted in the workshop to clarify the cervicovaginal cytology results. Any informations related to the patient management were encouraged to add. So 'Satisfactory for evaluation but limited by...' of 'Specimen Adequacy' catergory was deleted. Terminology of 'Unsatisfactory' was further specified as 'Specimen rejected' and 'Specimen processed and examined, but unsatisfactory'. Terminologies of 'Benign Cellular Change' and 'Within Normal Limits' were combined and terminology was changed to 'Negative for intraepithelial lesion or malignancy'. In General categorization, category 'Other' was newly inserted and the presence of 'Endometrial cells' in women over 40 years old can be checked. Although the category 'Benign Cellular Change' was deleted, the organisms or reactive changes of this category can be listed in the descriptive diagnoses. Terminologies of ASCUS and AGUS were changed to atypical squamous cell and atypical glandular cell, respectively. Diagnostic term of 'Adenocarcinoma in situ', which is highly reproducible with reliable diagnostic criteria, was newly Inserted. The category of hormonal evaluation was deleted. Criteria for liquid-based specimen were discussed. Reporting by computer-assisted cytology was discussed and terminology for automated review was newly inserted. This is not the final edition of Bethesda 2001. The final document can be prepared before the ASCCP meeting in which Consensus Guidelines for the Management on Cytology Abnormalities and Cervical Precursors will develop in September 2001.

일차성 갑상선 형질 세포종

고양석(Yang Seok Koh),제갈영종(Young Jong Gaegal),윤정한(Jung Han Yoon),박재우(Jae Woo Park),남종희(Jong Hee Nam),이민철(Min Cheol Lee) 대한외과학회 2002 Annals of Surgical Treatment and Research(ASRT) Vol.63 No.3

현미부수체 표지자를 이용한 연령에 따른 유방암 환자의 분자생물학적 차이에 관한 연구

서승원(Seung Won Seo),윤정한(Jung Han Yoon),박민호(Min Ho Park),남종희(Jong Hee Nam) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.6

Purpose: Younger women exhibit more aggressive pathological features of breast cancer than older women, based on previous studies. We wished to evaluate any molecular biological differences in breast cancer between younger and older women by determining the status of a microsatellite marker. Methods: Microsatellite instability (MSI) and loss of heterozygosity (LOH) were investigated in paired tumour and normal tissue DNA from 32 younger (age less than 40 years old) and 32 older (age more than 50 years old) breast cancer patients with 12 simple repeated primer sets. Results: MSI was observed at a single locus in 5 (15.6%) of the younger patients. In older patients, MSI was observed at a single locus in 5 (15.6%) and at multiple loci in 1 (3.1%) of the older patients. LOH was noted at a single locus in 7 (21.8%) and at multiple loci in 22 (68.7%) of 32 younger patients. In older patients, LOH was noted at a single locus in 9 (28.1%) and at multiple loci in 15 (46.9%). The greatest frequency of LOH was at loci UT5320 (37.5%), D8S321 (34.4%), D9S242 (31.3%), and D19S394 (31.3%) in younger patients and at loci L17686 (34.4%) and D19S394 (28.1%) in older patients. LOHs at D19S394 and L17686 were highly identified in both age groups. LOHs at D9S242 and D8S321 were significantly higher in the carcinomas of younger women (P=0.013, P=0.016, respectively). The LOH status was unrelated to clinical stage, nodal status, tumour size, histological grade or estrogen receptor (ER) status. A LOH at D8S321 was associated with tumor size (P=0.048) and a LOH at UT5320 was associated with histological grade (P=0.012) and ER status (P=0.018). Conclusion: These results indicate that the pattern of chromosomal alterations are not exactly the same, especially at loci D9S242 and D8S321, in the carcinomas of the two age groups and suggest that the molecular pathogenesis of the carcinomas is not similar

관류자기공명영상을 이용한 악성종양의 맥관형성에 대한 평가: 가토 간의 VX2 암종에서의 실험적 연구

윤웅,강형근,박진균,김재규,서정진,김윤현,정용연,정태웅,정광우,남종희,Yoon, Woong,Kang, Heoung Keun,Park, Jin Gyoon,Kim, Jae Kyu,Seo, Jeong Jin,Kim, Yun Hyun,Jeong, Yong Yeon,Chung, Tae Woong,Jeong, Gwang Woo,Nam, Jong Hee 대한영상의학회 2001 대한영상의학회지 Vol.45 No.2

목적: 실험적으로 가토 간에 VX2 암종을 이식시킨 후 관류(perfusion) 자기공명영상(MRI)을 시행하여 VX2 암종과 주위 정상 간 실질의 관류 특성을 분석하고. 병리조직학적 소견과 비교하여 간의 악성종양의 맥관형성에 대한 평가에 있어서 관류 MRI의 유용성을 알아보고자 하였다 대상과 방법: 가토 12마리에 개복술을 시행하여 , 간 실질 내에 VX2 암종을 이식한 후 7-14일째에 초음파 검사로 암종이 유발된 것을 확인한 후 단발포 경사에코 에코평면영상기법을 이용한 관류 MRI검사를 시행하였다. 관류 MRI 영상에서 각각의 YX2암종과 주위 정상 간 조직에 동일한 관심구역을 설정하여 신호강도를 측정한 후 조영증강율을 산출하여, 시간에 대한 조명 증강율을 표시한 시간-신호강도 관류 곡신을 작성하였다 작성된 관류곡선상에서 관류곡선의 양상. 최대 신호강도감소에 도달한 시간과 최대 조영증강율을 YX2 암종과 정상 간실질에서 각각 비교 분석하였다 실험이 끝난 가토를 희생시켜 간을 적출한 다음VIII 인자 관련항원을 이용한 면역조직화학염색 검사를 시행하여 YX2 암종과 정상 간 조직의 미세혈관밀도(MVD)를 측정하였다. 결과: 간에 유발된 YX2 암종은 모두 15개로 1-3 cm 크기였다. 관류곡선을 분석한 결과 모든 VX2 암종은 9-20초대의 초기 동맥 관류기에 신호강도의 감소와 회복 곡선이 급격히 변하는 양상을 보였고, 정상 간 조직은 12-50초대의 후기 문맥관류기에 완만한 신호강도의 감소와 회복곡선을 나타내었다 YX2 암종의 최대 신호강도 감소시간은 13-16초 (평균 15초)이었고 정상간 실질의 최대 신호강도 감소시간은 28-36초 (평균 32초)이었다 (7(0.01) . 최대 조영증강율은 VX2 암종에서는 27-84% (평균 47%)이었고, 정상 간 실질에서는 36-82% (평균 56%) 이었다. 면역조직화학염색 검사상 YX2 암종의 평균 MVD는 200배의 배율에서 시야당 75개로 정상 간 실질의 17개에 비해 유의하게 많았다 (7p〈0.01) 결론: 관류 MRI를 이용하여 가토 간의 VX2 암종의 일정한 관류특성을 관찰할 수 있었으며 이와 같은 관류특성은 병리조직학적으로 악성종양의 맥관형성에 의해 나타남을 확인할 수 있었다. 따라서 관류 MRI는 간 종양의 맥관형성을 잘 반영하는 방사선학적 검 사법으로서 , 향후 간종양의 감별진단에 유용하게 이용될 수 있을 것으로 사료된다 Purpose: To evaluate the perfusion-weighted MR imaging findings of hepatic VX2 carcinoma in rabbits and to explain the perfusion characteristics of this condition by correlation with the histopathological findings. Materials and Methods: Twelve New Zealand white rabbits, each weighing between 2.5 and 3.5 (mean) 3.1 kg, were used in this study. Perfusion MRI using single-shot gradient-echo EPI was performed 7-21 days after the injection of tumor cell suspension into the hepatic parenchyma by laparotomy On the basis of the calculated enhancement ratio, the time-intensity perfusion curves for VX2 tumor and normal liver parenchyma were created, and the shapes of these curves, the time to maximum Sl decrease, and the maximum enhancement ratio in each, were evaluated. To assess microvessel density in each VX2 carcinoma and in normal liver parenchyma, immunohistochenical study using factor VIII-related antigen was performed. Results: A total of 15 tumors 1-3 cm in diameter were revealed by MR imaging. The perfusion curve showed rapid decrement and immediate recovery of the signal intensity of VX2 carcinoma during the early arterial perfusion phase and slower decrement and gradual recovery of that of normal liver parenchyma during the late portal perfusion phase. In all cases, these were constant findings. The time to maximum signal intensity decrease was 13-16 (mean, 15) secs in VX2 carcinoma and 28-36 (mean,32) secs in normal liver parenchyma (p< 0.01). The maximum enhancement ratio of VX2 carcinoma and normal liver ranged from 27 to 84% (mean 47%) and from 36 to 82%, (mean, 56%), respectively. Immunohistochemical study showed that the MVD of VX2 carcinoma was significantly greater than that of normal liver parenchyma(75 vs 17, p< 0.01). Conclusion: Perfusion-weighted MR imaging appears to be a useful tool for the diagnosis of neoplastic angiogenesis, and thus holds promise differentiating liver tumors.

Improvement of cyclosporine regimen using poly(ethylene glycol) conjugation onto islet surface for prolongation of transplanted islet survival

Dong Yun Lee(이동윤),Sang Jin Park(박상진),Mi Su Lee(이미수),Jong Hee Nam(남종희),Youngro Byun(변영로) 한국생물공학회 2004 한국생물공학회 학술대회 Vol.2004 No.10

외음부 파젯씨병(Vulvar Paget`s Disease)

김병석(Byeong Seog Kim),이정원(Jeong Won Lee),정우길(Woo Gill Jeong),정재훈(Jae Hoon Jeong),남종희(Jong Hee Nam) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.8

Paget's disease is classified, according to location, as mammary or extramammary disease. Extramammary Paget's disease especially in the vulva is extremely rare. Several hundred cases have been described worldwide. Patients with Paget's disease of the vulva are usually white and postmenopausal. The cause of which remains elusive. A case of vulva Paget's disease is presented with brief review of literature.

실험 : 임신 중 비타민 C와 비타민 E 섭취 시 임부의 자궁정맥혈장, 양수 및 융모양막내 항산화제 농도 변화

양정선 ( Jung Sun Yang ),김윤하 ( Yoon Ha Kim ),김철홍 ( Cheol Hong Kim ),조문경 ( Moon Kyoung Cho ),김종운 ( Jong Woon Kim ),조혜연 ( Hye Yon Cho ),양성렬 ( Sung Yeul Yang ),안봉환 ( Bong Whan Ahn ),남종희 ( Jong Hee Nam ),송태복 대한주산의학회 2009 大韓周産醫學會雜誌 Vol.20 No.1

목적: 임신 중 비타민 C와 비타민 E를 섭취하여 분만 시 자궁정맥혈장, 양수 및 융모양막내 항산화제 농도 변화를 알아보고자 하였다. 방법: 단태아를 임신한 임부 중 제왕절개술이 예정된 산모에게 무작위로 임신 33~34주에서 만삭 제왕절개분만 전까지 하루에 비타민 C 1,000 mg과 비타민 E 400 IU를 투여했던 실험군 15명과 투여하지 않았던 대조군 15명을 대상으로 하였다. 제왕절개분만 시 자궁정맥혈, 양수 및 융모양막을 채취하였다. Thiobarbituric acid 반응을 이용하여 지질과산화물 농도를 측정하였고 Cao 등의 방법으로 항산화능(oxygen-radical absorbance capacity, ORAC)을 측정하였으며 high performance liquid chromatography를 이용하여 아스코르빈산, 요산, 베타-카로틴, 레티놀, 알파-토코페롤 및 감마-토코페롤 농도를 측정하였다. 융모양막의 조직절편을 헤마톡실린-에오신 및 Masson-trichrome 염색하여 조직학적 검사를 하였으며 제4형 교원섬유에 대한 면역조직화학 염색 검사를 하였다. 결과: 자궁정맥혈장내 지질과산화물 농도는 실험군에서 유의하게 낮았으며, 항산화능은 대조군은 실험군에서 유의하게 높았다. 자궁정맥혈장, 양수 및 융모양막의 알파-토코페롤 농도는 실험군에서 유의하게 높았다. 융모양막의 헤마톡실린-에오신 염색상에서 양막의 두께는 실험군에서 증가된 경향을 보였으나 통계학적 유의한 차이를 보이지는 않았다. Masson-trichrome 염색상 섬유질이 증가된 소견이 실험군에서 보였고, 면역조직화학 염색에서 제4형 교원섬유가 더 진하게 염색되었으나 대조군과 비교하여 차이는 없었다. 결론: 임신 중 비타민 C와 비타민 E 섭취는 산화적 스트레스로 생기는 산과적 질환에 예방적 목적으로 사용될 수 있으며 융모양막의 조직학적 충실성을 도모할 수 있을 것으로 사료된다. Purpose: To investigate the change in the antioxidant vitamin levels in maternal uterine venous plasma (MUVP), amniotic fluid (AF), and chorioamnion after vitamin C and E supplementation during pregnancy. Methods: Thirty pregnant women who were scheduled for elective cesarean section between 37 and 39 gestational weeks were randomized in this study. Fifteen women were given a daily oral dose of vitamin C 1,000 mg and vitamin E 400 IU from 33~34 gestational weeks to delivery. The other fifteen women were not given, as a control group. Maternal uterine venous blood, AF, and chorioamnion were obtained after cesarean section. Lipid peroxides and oxygen-radical absorbance capacity value were measured by thiobarbituric acid reaction and Cao`s method respectively. Ascorbic acid, uric acid, β-carotene, retinol, α-tocopherol, and γ-tocopherol were measured by high performance liquid chromatography. The tissue sections of chorioamnion were stained with hematoxylin-eosin and Masson-trichrome stain, and immunohistochemical stain for collagen type IV was also performed. Results: The lipid peroxide levels in MUVP of the study group were significantly lower than those of the control group but in contrast, ORAC (Oxygen-radical absorbance capacity) values were lower in the control group. The α-tocopherol levels in MUVP, AF, and chorioamnion study group were significantly higher than those of the control group. Amniotic membrane and subepithelial stromal tissue in the study group were thicker than those in the control group. And subchorionic type IV collagen of placenta tissue in the study group was more stained than that of the control group. Conclusion: Maternal vitamin C and E supplementation may be beneficial in the prevention of diseases caused by oxidative stress such as preeclampsia and PROM and in increasing fibrin and type IV collagen in chorioamnion.

임상 ; 조기분만 시 융모양막염 유무에 따른 제대정맥혈장내 Interleukin-6, C-reactive Protein 및 지질과산화물의 변화

강명선 ( Myoung Seon Kang ),김윤하 ( Yoon Ha Kim ),김철홍 ( Cheol Hong Kim ),김기민 ( Ki Min Kim ),조문경 ( Moon Kyoung Cho ),김종운 ( Jong Woon Kim ),김조헌 ( Jo Heon Kim ),남종희 ( Jong Hee Nam ),양성렬 ( Sung Yeul Yang ),안봉환 대한주산의학회 2007 Perinatology Vol.18 No.4

목적: 조기분만 시 제대정맥혈장내 Interleukin-6(IL-6)와 C-reactive protein (CRP) 및 지질과산화물을 측정하여 조직학적 융모양막염 유무에 따른 이들의 변화와 주산기 예후에 어떤 역할을 하는가 규명하고자 하였다. 방법: 양막파열이 없는 조기분만 임부 39명(조기분만군), 만삭전 조기양막파열 임부 27명(양막파열군)에서 분만시 태반조직과 제대정맥혈을 채취하여 IL-6, CRP, 지질과산화물 농도를 측정하고 비교하였고, 태반조직의 병리학적 소견을 얻었다. 결과: 조기분만군 39예 중 8예, 양막파열군 27예 중 16예에서 조직학적 융모양막염이 있었으며, 양막파열군에서 조기분만군보다 증가하였다. 조기분만군과 양막파열군 간에 IL-6, CRP, 지질과산화물의 차이가 없었다. 조직학적 융모양막염이 있는 군에서 없는 군보다 IL-6, CRP, 지질과산화물 농도가 증가하였다. 조직학적 융모양막염이 있는 조기분만군에서 없는 조기분만군보다 IL-6, CRP, 지질과산화물 농도가 증가하였다. 조직학적 융모양막염이 있는 양막파열군에서 없는 양막파열군에 비해 CRP는 증가하였으나, IL-6와 지질과산화물 농도는 차이가 없었다. 선천성 패혈증이 의심스러웠던 태아 3명의 IL-6와 지질과산화물 농도가 증가된 소견을 보였다. 조직학적 제대염을 동반한 경우의 IL-6 농도는 동반하지 않은 경우보다 증가하였으며, 제대염이 있었던 6예 중 신생아 패혈증 의증 2명, 호흡곤란증후군 1명, 뇌실내출혈 1명으로 주산기 이환율이 높았다. 결론: 조직학적 융모양막염이 동반된 조기분만에서 제대정맥내 IL-6, CRP 및 지질과산화물이 증가하였으며, 이에 따라 주산기 이환율이 영향을 받을 것으로 사료된다. Objective: To investigate interleukin-6 (IL-6), C-reactive protein (CRP), and lipid peroxide levels in the umbilical venous plasma of preterm birth with or without histologic chorioamnionitis and to evaluate their roles in the pathophysiology in preterm labor and perinatal outcome. Methods: This cohort study included 66 cases of preterm delivery with preterm labor and intact membranes (PTL) (n=39) and preterm premature rupture of membranes (PPROM) (n=27). The umbilical venous blood samples were collected at the time of delivery. IL-6, CRP, and lipid peroxide levels were measured by ELISA Kit, latex agglutination assay, and thiobarbituric acid reaction. Histologic chorioamnionitis was diagnosed by the presence of neutrophil infiltration into the subamnionic space. Results: The prevalence of histologic chorioamnionitis was significantly higher in PPROM (59.3%, 16/27) than in PTL (20.5%, 8/39). IL-6, CRP, and lipid peroxide levels in the umbilical venous plasma of histologic chorioamnionitis were significantly higher than those without histologic chorioamnionitis. IL-6, CRP, and lipid peroxide levels in the umbilical venous plasma of PTL with histologic chorioamnionitis were significantly higher than those of PTL without histologic chorioamnionitis. CRP levels in the umbilical venous plasma of PPROM with histologic chorioamnionitis were significantly higher than those of PPROM without histologic chorioamnionitis. Three suspected neonatal sepsis patients have increased IL-6 and lipid peroxide levels in the umbilical venous plasma compared with patients without neonatal sepsis. IL-6 levels in the umbilical venous plasma of histologic funisitis were significantly higher than those without funisitis. Conclusion: Preterm birth with chorioamnionitis is associated with an increased level of IL-6, CRP, and lipid peroxide in umbilical venous blood. Preterm birth with chorioamnionitis may have an effect on perinatal outcome.

양수 색전증에 의해 초래된 저산소성 허혈성 뇌증 신생아 1예

윤회경 ( Hoi Kyung Yoon ),김선희 ( Sun Hui Kim ),국진화 ( Jin Hwa Kook ),최영륜 ( Young Youn Choi ),오현식 ( Hyun Sik Oh ),남종희 ( Jong Hee Nam ) 대한주산의학회 2003 大韓周産醫學會雜誌 Vol.14 No.2

양수 색전증은 드물게 발생하나 신속한 진단과 적절한 치료가 이루어지지 않으면 모성 사망에까지 이를 수 있다. 양수 색전증의 정확한 원인은 아직 모르며 표준화된 진단과 치료는 아직 정립되어있지 않다. 저자들은 분만 시 산모에서 저혈압, 혈액 응고장애 및 출혈이 보였으며, 자궁 조직검사 상 확장된 혈관내에서 태아 조직으로 의심되는 상피 세포 emboli가 관찰되어 양수 색전증이 의심되었고, 이로 인해 태아 곤란 및 저산소성 허혈성 뇌증이 초래된 것으로 사료된 신생아 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Amniotic fluid embolism, one of the leading causes of maternal death, is a rare event, however, it can cause maternal death and neonatal morbidity when it unrecognized and untreated effectively. Its pathogenesis is unclear and clinical presentations are variable without standardized means of confirming diagnosis. We experienced one case of neonatal hypoxic ischemic encephalopathy possibly due to maternal amniotic fluid embolism, which was diagnosed by brain MRI, EEG and maternal uterine pathology. We report this case with a brief review of literatures.

암태아성 항원 펩타이드로 부가된 수지상세포를 이용한 특이 세포독성 T세포의 유도

박민호(Min Ho Park),이창석(Chang Seok Lee),조문형(Mun Hyeong Cho),한철(Chul Han),고양석(Yang Seok Koh),김정철(Jung Chul Kim),윤정한(Jung Han Yoon),제갈영종(Young Jong Jegal),남종희(Jong Hee Nam) 대한외과학회 2005 Annals of Surgical Treatment and Research(ASRT) Vol.69 No.5