갑상선 유두암에서 BRAF^V600E 돌연변이와 초음파 소견과의 연관성

조영석 ( Young Suk Jo ),김윤정 ( Yun Jeung Kim ),김성수 ( Song-soo Kim ),김진만 ( Jin-man Kim ),노흥규 ( Heung-kyu Ro ),송민호 ( Minho Shong ) 대한갑상선학회 2008 International Journal of Thyroidology Vol.1 No.1

Background and Objectives: According to wide use of thyroid ultrasound (US), the incidence of thyroid cancer has been increased. Interestingly, a number of studies have reported specific sonographic findings might predict papillary thyroid carcinoma (PTC). However, there was no study which investigated the relation between oncogene and sonographic findings. In this study, we have investigated the effect of BRAF^V600E mutation on sonographic findings. Materials and Methods: We included 141 nodules from patients who underwent US-guided fine-needle aspiration biopsy (FNAB) and compared sonographic findings between PTC (n=55) and benign nodules (n=86). And then we have also compared sonographic findings according to presence or absence of BRAF^V600E mutation. Results: Expectedly, PTCs have frequently showed irregular shape, solid content, hypoechogenicity (29.1% vs 46.3%, p=0.04) and microcalcification (54.5% vs 26.7%, p=0.01) compared to benign nodules. In the case of PTC, 36 cases of 53 PTCs posed BRAFV600E mutation (BRAF^V600E (+) PTC) and 17 cases did not (BRAF^V600E (-) PTC). Lymph node enlargement, multifocality, solidity, poorly defined margin, irregular shape, hypoechogenicity and bilaterality were not significantly different between two groups. But, interestingly, microcalcification was more frequently detected in BRAF^V600E (-) PTC (76.5%, p=0.03). Conclusion: Compared with BRAF^V600E (-) PTC, BRAFV600E mutation did not relate to malignant sonographic findings. This might represent that malignant sonographic findings were not BRAF^V600E induced specific phenomenon.

불현성 갑상선기능항진증의 진단과 치료

조영석 ( Young Suk Jo ) 대한갑상선학회 2009 International Journal of Thyroidology Vol.2 No.2

Subclinical hyperthyroidism is relatively common clinical problem and is diagnosed by laboratory test with few clinical signs or symptoms. In definition, subclinical hyperthyroidism is designated to decrease in serum TSH below the reference range (0.45∼4.5 mIU/L) with normal serum thyroid hormone concentrations. Recently, improved sensitivity of assays and frequent assessment of serum thyroid stimulating hormone (TSH) have made clinicians require proper interpretation and management of subclinical hyperthyroidism. The causes of subclinical hyperthyroidism are similar to those of overt hyperthyroidism. However, in the view of evidence-based medicine, there are a lot of uncertainty about the definition, clinical importance, and necessity for prompt diagnosis and treatment of subclinical thyroid disease. This article reviewed thyroid hormone actions on heart, bone and metabolism with summary about recent guidelines for subclinical hyperthyroidism.

약물치료에 반응을 하지 않았던 비폐쇄성 연하곤란 1 예

조영석(Young Seok Cho),최명규(Myung Gyu Choi),정우철(Woo Chul Chung),정정조(Jeong Jo Jeong),이인석(In Seok Lee),김상우(Sang Woo Kim),김성수(Sung Soo Kim),채현석(Hiun Suk Chae),한석원(Sok Won Han),정인식(In Sik Chung),박두호(Doo Ho Pa 대한소화기기능성질환·운동학회 2002 Journal of Neurogastroenterology and Motility (JNM Vol.8 No.1

Dysphagia is a frequent symptom which is observed in about 6% of all population. The most common causes of nonobstructive dysphagia are reported to be esophageal motility disorders, systemic disease and GERD. About 30% of GERD patients complain of dysphagia. Dysphagia in GERD patients is mostly due to peptic stricture but occasionally related to transient segmental esophageal motor disorder. A 42-year old male patient was admitted because of dysphagia and weight loss. He had renal transplantation 5 years ago. The results of esophagogastroduodenoscopic examination, esophagogram and esophageal manometry were normal. Treatment with proton pump inhibitor, prokinetic and anti-depressant was begun but the patient continued to complain of dysphagia. The result of 24 hour ambulatory pH monitoring revealed pathologic reflux. The results of 24 hour ambulatory esophageal manometry and video fluoroscopy were normal. After reassured, he didn`t complain of dysphagia. We report this case of nonobstructive dysphagia accompanied with GERD refractory to medical treatment in patient who had renal transplantation.(Korean Journal of Gastrointestinal Motility 2002;8:47-52)

포스터 전시 : 하부위장관 6 ; 혈전성 혈소판 감소성 자반증을 동반한 출혈성 대장염 1예

조영석 ( Young Seok Cho ),채현석 ( Hiun Suk Chae ),정정조 ( Jeong Jo Jung ),김성수 ( Sung Soo Kim ),한석원 ( Suk Won Han ),이창돈 ( Chang Don Lee ),최규용 ( Kyu Yong Choi ),정인식 ( In Sik Chung ),선희식 ( Hee Sik Sun ) 대한소화기학회 2002 대한소화기학회 추계학술대회 Vol.2002 No.-

자매에서 발생한 가성부갑상선기능저하증 2예

이인석 ( Ihn Suk Lee ),김윤정 ( Yun Jeung Kim ),최윤선 ( Yun Sun Choi ),김설영 ( Seul Young Kim ),이윤형 ( Yun Hyeong Lee ),조영석 ( Young Suk Jo ),송민호 ( Min Ho Shong ) 대한내과학회 2008 대한내과학회지 Vol.74 No.1S

갑상선 암의 분자 진단

이슬기(Seulgi Lee),조영석(Young Suk Jo),이잔디(Jandee Lee) 대한갑상선-내분비외과학회 2015 The Koreran journal of Endocrine Surgery Vol.15 No.3

With increasing prevalence of thyroid nodules, clinicians are increasingly impelled to identify the optimal predictor of thyroid cancer, with the goal of guiding management based on assessed risk. Fine-needle aspiration cytology is the gold standard diagnostic method for thyroid nodules. However, fine-needle aspiration cytology is not perfect and adjuncts which might complement its predictive value are being investigated from several innovative perspectives. For these vigorous efforts, remarkable advances have been achieved in understanding several major biologic areas of thyroid cancer, including the molecular alterations for loss of radioiodine avidity of thyroid cancer, the pathogenic role of the MAP kinase and PI3K/Akt pathways and their related genetic alterations in thyroid tumorigenesis and pathogenesis. These exciting advances provide unprecedented oppor-tunities for development of molecular-based novel diagnostic and therapeutic strategies for thyroid cancer. The common somatic genetic changes in thyroid cancer of follicular cell origin (RET/PTC, NTRK, RAS, BRAF, PAX8-PPARγ) are generally mutually exclusive, with distinct genotype–histologic subtype associations of thyroid cancer. Mutation analysis in fine needle aspiration samples has been applied to improve the diagnostic accuracy. In studies regarding gene expression profiling, aberrant gene methylation and miRNA have shown significant progress toward identification of biomarkers that could improve the accuracy of fine needle aspiration cytology in the evaluation of patients with thyroid nodule and prediction of disease aggressiveness. Future clinical trials evaluating the accuracy and cost-effectiveness of applying these biomarkers in the management of thyroid neoplasm should be considered.

갑상선유두암의 병인에 근거한 치료제의 개발과 문제점

이민희 ( Min Hee Lee ),조영석 ( Young Suk Jo ),송민호 ( Minho Shong ) 대한갑상선학회 2010 International Journal of Thyroidology Vol.3 No.2

Papillary thyroid cancer (PTC) is the most common endocrine malignancy. The prognosis of PTC is defined primarily by the principal clinical features such as patient’s age, tumor size, histological subtypes, regional nodal metastasis, extra-thyroidal invasion and distant metastasis. Although PTC prognosis is excellent, adverse clinical features increase the probability of recurrence and progression. To improve patients’ survival and reduce recurrence and progression, advances in molecular biological insights for principal clinical features will beneeded. It has been recognized for years that aberrant kinase activation can induce cellular transformation, carcinogenesis and disease progression. Based on this concept, many investigators have been focusing on the development of new small molecules to inhibit the aberrant kinase activation and conducted clinical trials. In this review article, we describe the background for development of new targeted therapy and define molecular biological insights into the carcinogenesis of PTC.

국소 뇌혈류 관류 감소를 동반한 하시모토 뇌병증 1예

김윤정 ( Yun Jeung Kim ),이인석 ( Ihn Suk Lee ),이주희 ( Ju Hee Lee ),배연선 ( Youn Sun Bai ),조영석 ( Young Suk Jo ),노흥규 ( Heung Kyu Ro ),송민호 ( Min Ho Shong ) 대한내과학회 2008 대한내과학회지 Vol.74 No.1S

Wrist PA–grip view에서 원위요척관절 측정의 왜곡도 평가 및 정확한 측정을 위한 검사법 제안

심지나(Ji-Na Shim),장은희(Eun-Hee Jang),조영석(Young-Suk Jo),진덕은(Deok-Eun Jin),강성호(Sung-Ho Kang),임재식(Jea-Sik Lim) 대한영상의학기술학회 2013 대한영상의학기술학회 논문지 Vol.2013 No.-

목적: 방사선 진단장치의 많은 발전이 있었지만 기하학적 요소에 따른 영상의 왜곡을 보정 하기에는 아직 문제점을 가지고 있다. 특히 수술여부가 1 mm 정도의 작은 차이로 결정되는 검사의 경우 보다 정확한 검사 및 측정법이 개발되어야 한다. 본 논문은 원위요척관절의 불안정성을 진단하기 위한 Wrist PA-grip view 검사에 있어 거리에 따른 왜곡의 정도를 다양한 조건의 실험연구를 통해 정량, 정성적으로 결과를 분석한 후 정확한 검사방법을 위한 기초 자료를 제안하고자 한다. 대상 및 방법: Wrist PA-grip view에서 True PA를 재현하기 위해 요골의 윗면에는 삼각 형모양의 납 조각을, 요골의 아랫면과 척골에는 네모난 납 조각을 부착한 후, 요골의 위와 아랫면에 부착된 두 개의 납 조각을 투시장비를 사용하여 하나의 영상으로 보이도록 각도를 조정하여 아크릴판에 고정하였다. SID를 110 cm, 130 cm, 150 cm의 세 그룹으로 나눈 후, 그룹별로 x축과 y축 방향으로 각각 0, 2, 4, 6, 8, 10 cm를 이동하여 distal articuluar surface of the radius와 ulna의 변화를 측정하였다. 측정은 척골의 납 조각을 기준으로 요골의 윗면과 아랫면을 각각 측정하였으며, 한 사람이 측정할 경우 발생할 수 있는 주관적 오류를 줄이기 위해 6명의 방사선사가 PACS 프로그램을 이용하여 동일한 영상을 측정하였 다. 각 그룹의 유의성은 SPSS(version 17.0, SPSS Inc Chicago, IL, USA) 통계 패키지 프로그램을 사용하여 kruskal wallis test와 사후검정으로 tukey test를 시행하여 검증 하였 으며 검증에 사용된 신뢰구간은 95 %이다. 결과: 각 그룹의 정량적 분석은 방사선사 6명이 측정한 평균값으로 비교하였다. SID 110 cm과 130 cm 그룹의 경우 정 중앙에서 y축 방향으로 손목이 4 cm 이상 움직였을 때 1 mm 이상, SID 150 cm 그룹은 손목이 6 cm 이상 움직였을 경우에만 1 mm 이상의 왜곡이 발생하여 SID가 클수록 손목의 위치에 의한 오차가 적게 나타났다. 손목이 정 중앙에서 어질 수 있는 경우를 알아보기 위한 설문지 조사 결과 CAST를 한 환자라는 응답이 가장 많았으며 오차 범위는 대략 4~6 cm 정도로 조사되었다. 그룹간 유의성 검증 결과 요골 윗면의 경우, y축 방향으로 2, 4, 6, 8, 10 cm, 아랫면에서는 y축 방향으로 6, 8 cm 움직였을 때 유의한 차이를 보였다. 결론: 본 연구를 통해 Wrist PA-grip view 검사 시, SID 변화와 손목의 위치 변화에 따른 왜곡 수준에 대해 평가할 수 있었으며, 이를 토대로 정확한 검사가 요구되는 wrist PA-grip view 검사에서는 주로 사용하는 SID 110 cm 보다, 거리 증가로 인한 영상의 질을 보완 할 수 있는 한도 내에서 SID 150 cm에서 검사하기를 제안한다. Purpose: Changes to DR(digital radiography) in CR(Computed Radiography), Although image quality has evolved a lot from image correction and dose control, the distortion of the image according to geometric elements would not be able to control yet. The examination for deciding surgery due to the detailed tolerance of 1mm must more accurate and measurement method should be developed. In this paper, Wrist PA-grip view distortion and accurate test for the diagnosis of distal radio ulna joint(DRUJ)instability for research is to build a basic material for the new test. Materials and Methods: In order to reproduce the actual Wrist PA-grip view, There is a triangular-shaped piece of lead at the top of radius, a square-shaped piece of lead at the bottom of the radius and ulna. Two lead pieces attached to the radius are matched to superimpose through fluoroscopic equipment, and put the acrylic plate to fix. The SID was defined as 110 cm, 130 cm, 150 cm. Depending on the SID, the location of the DRUJ was moved 0,2,4,6,8,10 cm each in the direction of the horizontal and vertical, and changes in the distal articuluar surface of the radius and ulna, measured via PACS. To reduce errors, the average values are compared to be measured by six radiological technologists. Based on lead piece of ulna, Radius as the lead piece of the ulna measured at the top and bottom, respectively, were measured. Last, We used SPSS(version 17.0, SPSS Inc Chicago, IL, USA) program. kruskal wallis test and tukey test confirmed the outcomes obtained mean value. Results: Six measurements were compared with the average of the values measured by the six workers. When compared according to the movement of the wrist, almost no distortion value at horizontal direction, distortion value was greater in the vertical direction. At SID 110 cm and 130 cm, there was distortion that beyond 1mm or more when wrist was put more than 4 cm in the vertical direction. At SID 150 cm, there was distortion beyond 1mm or more above 6 cm in vertical direction.The results of the questionnaire, patients with the CAST was the most common answer in case of being farther from the center, and it is mostly about 4~6 cm. there were significant differences at the top of radius when the wrist phantom moved 2,4,6,8,10 cm along the y- axis and when the wrist phantom moved 6,8 cm along the y- axis at the bottom of radius. Conclusion: In this study, Wrist PA-grip view could be evaluated from the current level of distortion. In a range that covers the quality of the image in the post processing of examination, Wrist PA-grip view that emphasizes the distortion, SID existing proposed to test at 150 cm than 110 cm.

호중구 감소를 동반한 Propylthiouracil 복용 후 발생한 p-ANCA 양성 혈관염 1예

이주희 ( Ju Hee Lee ),김민경 ( Min Kyeong Kim ),장혜원 ( Hye Won Jang ),조영석 ( Young Suk Jo ) 대한갑상선학회 2010 International Journal of Thyroidology Vol.3 No.1

Propylthiouracil (PTU) is a thiourea antithyroid agent commonly used in the treatment of Graves’ disease. Although PTU is a well tolerable drug, serious adverse events such as antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis have been reported. However, PTU-induced ANCA-positive vasculitis with neutropenia is relatively uncommon manifestation. Here, we describe a 14-year old woman who had taken high dose of PTU for Graves’ disease during 4 years. She presented with 1 week history of fever, arthralgia and erythematous patches on her hands, foots and buttocks. Laboratory examination exhibited marked neutropenia (ANC: 460/ ㎣) and p-ANCA positivity (anti-myeloperoxidase antibody, 282 AAU (0∼150)). The histology of skin biopsy samples revealed perivascular lymphocytic and eosinophilic infiltration. Furthermore, we could also find fibrinoid necrosis of vessel wall, suggesting vasculitis which was believed to be adverse effect of PTU. Taken together, we diagnosed her as PTU-induced ANCA-positive vasculitis. After discontinuation of the drug, her symptoms were resolved and absolute neutrophil count has been recovered (ANC: 930/ ㎣).