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갑상선 수술 환자에서 세침흡인 세포검사와 조직검사와의 연관성
백종범,김성철,배금석,강성준,Jong Beom Baek,M.D.,Sung Chul Kim,M.D.,Keum Seok Bae,M.D. and Seong Joon Kang,M.D. 대한갑상선-내분비외과학회 2009 The Koreran journal of Endocrine Surgery Vol.9 No.4
Purpose: Fine needle aspiration cytology (FNAC) has become a standard diagnostic tool for thyroid nodules. The purpose of this study is to analyze the correlation between FNAC and the final histology to improve the diagnostic value. Methods: We collected 792 patients who had undergone thyroidectomy, and we selected 549 patients who had undergone preoperative FNAC. The FNAC results were classified as non-diagnostic, malignancy, indeterminate and benign. The final pathologic reports were classified into two categories: malignant or benign. The individual histology was also identified. We retrospectively analyzed the pathologic result, the sensitivity, the specificity and the predictive value of the FNAC. Results: Among 549 patients, their FNACs showed 47 non diagnostic results, 189 malignancies,136 indeterminate results and 177 benign results. The false positive rate was 1.1% and the false negative rate was 12.9%. The final pathology reports were 262 malignancies and 287 benign lesions. There were 42 (30.9%) malignancies among the 136 indeterminate cases. Adenomatous hyperplasia was the most common benign lesion and papillary carcinoma (containing micropapillary carcinoma) was the most common benign lesion. Conclusion: FNAC is an easy and safe diagnostic tool, but it still has many limitations. It is necessary to reduce the number of non diagnostic results. Technical advances, classification of the advanced categories of cytology and other staining methods can provide more specific results, and this can reduce the rate of performing unnecessary surgery. (Korean J Endocrine Surg 2009;9:223-227)
미세 갑상선 유두상암에서 양측성과 연관된 임상 병리학적 인자에 대한 분석
김광민,박준범,배금석,강성준,Kwang-Min Kim,Joon-Beom Park,Keum- Seok Bae and Sung-Joon Kang 대한갑상선-내분비외과학회 2011 The Koreran journal of Endocrine Surgery Vol.11 No.1
Purpose: Papillary thyroid carcinoma is the most common malignant tumor originating from the thyroid. The recent increase in frequency of thyroid ultrasonography is increasing the diagnostic rate of thyroid cancer, especially of the small-sized cancer. The appropriate extent of surgery for thyroid micropapillary carcinoma is still under debate, and bilaterality of the tumor may be an important factor determining the extent. Therefore, this study analyzed the clinicopathologic factors related to tumor bilaterality in order to help decide the extent of treatment. Methods: Subjects included 134 patients who received total thyroidectomy and central neck lymph node dissection at Wonju Christian Hospital under the diagnosis of thyroid micropapillary cancer from January 1<SUP>st</SUP>, 1994 to December 31<SUP>st</SUP>, 2009. The frequency of bilateral tumor among the subjects were studied, and the relationship between bilaterality and clinicopathologic factors, including patients' gender, age, tumor size, multiple mass in single lobe, capsule invasion, extrathyroidal extension, lymphovascular space invasion, central neck node invasion and lateral neck node invasion was analyzed. Results: There were 32 cases (23.9%) of bilateral tumor. Statistically significant factors related to bilaterality included two or more mass in a single lobe, perithyroidal soft tissue invasion. Conclusion: When we plan thyroidectomy for thyroid micropapillary cancer, one cannot rule out the possibility of bilateral thyroid micropapillary cancer in patients with clinicopathologic factors related to bilaterality. Closer preoperative examination is thought to be required for such patients. (Korean J Endocrine Surg 2011;11:18-21)
급성 경막하 혈종이 발생한 특발성 혈소판 감소성 자반병 환자에게 시행한 두개 천공 배액술: 증례보고
강지인 ( Jiin Kang ),배금석 ( Keum Seok Bae ),변진수 ( Jinsu Pyen ),김종연 ( Jong Yun Kim ),조성민 ( Sung Min Cho ),황금 ( Kum Whang ),김소현 ( Sohyun Kim ),오지웅 ( Ji Woong Oh ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.3
Idiopathic thrombocytopenic purpura (ITP) is the condition of having an abnormally low platelet count with an unknown cause. Acute subdural hematomas (ASDHs) usually develop in trauma patients and often involve a high bleeding tendency. However, ITP patients rarely have a large ASDH, and when a traditional decompressive craniectomy is performed on patients with coagulopathy, the mortality rate is higher because of the greater bleeding risk. We report the case of an ITP patient with a large ASDH who treated with a burr-hole trephination and irrigation and who was discharged without any neurological deficit.
혈복강 수술 환자에게서 발생한 지연성 외상성 뇌실질내 출혈
김소현 ( So Hyun Kim ),배금석 ( Keum Seok Bae ),변진수 ( Jinsu Pyen ),김종연 ( Jong Yun Kim ),조성민 ( Sung Min Cho ),노하니 ( Hany Noh ),황금 ( Kum Whang ),오지웅 ( Ji Woong Oh ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.3
Delayed traumatic intracerebral hemorrhage (DT-ICH) is a rare event in head trauma patients. However, it develops unexpectedly and results in very severe brain damage. Thus, close monitoring of the neurologic status is needed for every trauma patient. Sometimes, however, neurologic monitoring cannot be done because of sedation, especially in cases of abdominal surgery. In this case report, we describe the case of a 37-yr-old, male patients who had hemoperitoneum because of spleen and renal injury. At the initial operation, massive bleeding was found, so gauze-packing surgery was done first. After the first operation, we sedated the patient for about two days, after which the packed gauze was removed, and the abdominal wound was closed. Immediately after the second operation, we found pupil dilation. Emergent CT was performed. The CT revealed DT-ICH with severe brain edema and midline shifting. However, the patient condition deteriorated progressively despite emergency operation, he expired 2 days after hematoma evacuation.
위암 환자의 수술 전 림프절 전이 평가를 위한 PET-CT의 진단적 유용성
박성혁,조민수,류훈,배금석,김익용,김대성,Park, Sung-Hyuk,Cho, Min-Su,Ryu, Hoon,Bae, Keum-Seok,Kim, Ik-Yong,Kim, Dae-Sung 대한위암학회 2008 대한위암학회지 Vol.8 No.4
목적: PET-CT가 림프절 전이를 발견하는데 있어 그 정확도를 조사하여 수술 전 진단 도구로써의 유용성을 평가하였다. 대상 및 방법: 2006년 6월부터 2008년 7월까지 원주기독병원에서 위암으로 수술 전 복부(위)전산화단층촬영술 및 PET-CT를 시행 후 근치적 위절제술을 시행한 환자를 대상으로 복부(위)전산화단층촬영술과 PET-CT의 민감도, 특이도, 양성예측률, 음성예측률 그리고 정확도를 비교 평가하였다. 결과: 전체 119명의 PET-CT의 민감도는 32.6%, 복부(위)전산화단층촬영술의 민감도는 39.5%였다. 특이도는 PET-CT 86.8%였으며 복부(위)전산화단층촬영술은 76.3%였다. 양성예측률은 PET-CT 58.3%, 복부(위)전산화단층촬영술 48.6%, 음성예측률은 PET-CT 69.5%, 복부(위)전산화단층촬영술 69.0%였다. 정확도는 PET-CT 67.2%, 복부(위)전산화단층촬영술 63.0%였다. 조기 위암의 경우 PET-CT와 복부(위)전산화단층 촬영술의 특이도는 98.0%와 88.2%, 음성예측률 80.6%와 80.4%, 정확도 67.2%와 63.0%이었다. 진행성 위암인 경우에는 PET-CT와 복부(위)전산화단층촬영술의 민감도는 45.2%와 51.6%, 특이도 64.0%와 52.0%, 양성예측률 60.9%와 57.1%, 음성예측률 48.5%와 46.4%, 정확도 53.6%와 51.8%였다. 결론: 수술 전 PET-CT를 이용한 림프절 전이 여부 평가는 복부(위)전산화단층촬영술에 비해 치료 지침을 결정하는데 더 많은 도움을 줄 수 있을 것으로 사료된다. Purpose: The purpose of this study was to assess the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for detecting the lymph node (LN) metastasis of gastric cancer. Materials and Methods: 119 patients (M : F=89 : 30; mean age: 64) with gastric cancer were referred for preoperative FDG-PET/CT scanning and spiral enhanced abdominal pelvic CT from June 2006 to July 2008, and these were the subjects of our study. All the patients underwent curative radical gastrectomy and lymph node dissection. A final diagnosis was made for all the patients by the histology of the surgical specimens. Results: Both PET/CT and enhanced CT showed similar sensitivity for detecting regional lymph node metastasis (32.6% vs 39.5%, respectively). PET/CT was more accurate than enhanced CT for detecting regional lymph node metastasis (67.2% vs 63.0%, respectively), and PET/CT showed better specificity (86.8% vs 76.3, respectively) and a better positive predictive value (PPV) (58.3% vs 48.6%, respectively). PET/CT showed better specificity (98.0% vs 88.2%, respectively) and accuracy (79.4% vs 73.9%, respectively) than enhanced CT for detecting early gastric cancer. PET/CT showed better specificity (64.0% vs 52.0%, respectively), a better PPV (60.9% vs 57.1%), a better negative predictive value (NPV) (48.5% vs 46.4%, respectively) and better accuracy (53.6% vs 51.8%, respectively) than enhanced CT for detecting advanced gastric cancer. Conclusion: FDG-PET/CT is more usefulness than enhanced CT for making the preoperative diagnosis of regional LN metastases from gastric cancers.