그레이브스병의 항갑상선제 치료

궁성수 대한내과학회 2004 대한내과학회지 Vol.66 No.2

갑상선 분화암의 수술 후 경과 관찰

궁성수 충북대학교 의학연구소 2002 忠北醫大學術誌 Vol.12 No.2

Thyroid cancer patients must be followed for a long time after surgery, because thyroid cancer occurs commonly in young individuals and it is slow in progression. For the past several decades, many researchers and organizations published reviews or guidelines for following up thyroid cancer patients after surgery. But they had somewhat different opinions each other and there are no universal guidelines approved by experts, currently. In this article, many useful methods for following thyroid cancer patients were reviewed and adequate following-up method proposed. After thyroidectomy, development of new nodules in the neck area or increase in serum thyroglobulin (Tg) with thyroxine therapy heralds the recurrence of thyroid cancer. These patients should be treated with surgery or radioiodine. In patients without theses fingings, stimulated serum Tg level by endogenous TSH and I-131-whole body scan (WBS) are a very sensitive and basic tests for the detection of thyroid cancer recurrence. The optimal interval for Tg measurement and I-131 WBS depends on the individual patient's risk of recurrence. It can be 6 months or longer than 5 years. Patients with abnormal Tg value and normal I-131-WBS findings need another imaging studies for localizing the recurrence sites such as high-dose I-131-WBS, ultrasonography of neck, chest CT, F-18-FDG PET, Tc-99m-MIBI, T1-201 or Tc-99m-tetroformin. The selection of approate imaging studies depends on availability, cost and patient status. Currently, ultrasonography of neck, chest CT and F-18-FDG are most widely used studies.

두경부 림프종에 대한 방사선과학적 접근: 충북대학교병원에서의 경험

차상훈,김주창,한기석,김성진,박길선,궁성수 충북대학교 의과대학 충북대학교 의학연구소 1999 忠北醫大學術誌 Vol.9 No.2

목적: 충북대학교병원에서 두경부의 림프종으로 진단된 증례들을 방사선학적으로 분석하여 임파절외 병변과 임파절 병변의 특징에 관하여 알아보고 이전의 문헌들과 비교하여 고찰하고자 하였다. 대상 및 방법: 병리학적으로 두경부의 림프종으로 진단된 31명을 대상으로 후향적 분석을 하였다. 조직검사로 확인된 병변 외에 다발성 병변에서는 조직 검사로 확인되지 않았더라도 치료 전 CT나 MRI 상 분명한 경우, 치료 후의 추적 CT 또는 MRI 상 명백한 호전이 있으면 병변으로 간주하였고 특히, 치료 전 림프절의 크기가 1-1.5cm보다 작아도 치료 전·후 분명한 차이를 나타내면 병변으로 간주하였다. 림프절외 병변의 부위, 림프절 병변의 위치와 크기, 전신 림프종 여부, 림프종의 병리학적 진단 등에 관해 분석하였다. 결과: 호지킨 림프종은 1명이고 림프절 병변만이 분명하였다. 나머지 30명은 비호지킨 림프종으로서 그중에는 혼합형 병변이 가장 많았으며(n=20) 림프절 외 병변만 있는 경우가 7명, 림프절 병변만 있는 경우가 3명이었다.림프절 외 병변은 Waldeyer's ring의 다발성 병변이 대부분이었는데 이중 인후부에 별도의 병변이 동반된 경우, lingual tonsil 만 침범된 경우가 각기 1례씩 있었다. 또한 Waldeyer's ring 병변이 mouth floor나 soft palate로 침범하기도 하였다. 비강 림프종이 진단된 7명 중에 최초 진단 시 또는 치료후 경과 추적 시 양측 비강이 침범된 각 1명씩이 있었고 3명에서는 비익과 주변조직으로의 침범이 있었으며 세포유형은 다양하였다.다형성 세망증으로 진단된 병변은 모두 4례로 비강에 2례, Waldeyer's ring 2례 등이었다.림프절 병변은 23명의 환자에서 모두 71개 림프절 군이 진단되었는데 20명은 2개 이상의 림프절군이 양성인 다발성 병변을 가졌고 이 중 36개 림프절 군에서 1cm이하의 림프절 병변이 진단되었다. 림프절과 림프절 외 병변이 동반된 혼합성 림프종(n=20)의 경우 림프절 외 병변과 동측에 림프절 병변이 있는 환자가 7명이고 양측의 림프절 병변은 13명이었으며 반대측에만 림프절 병변이 확인된 것은 없었다. 결론: 본 연구를 통하여 충북대병원에 내원하였던 두경부 림프종 증례들의 방사선학적 특성을 알 수 있었으며 림프절 외 병변과 림프절 병변이 동반된 경우가 많았는데 이는 치료 전후의 비교를 하여 기존의 연구들과 다른 기준을 설정하였기 때문인데 이에 관하여는 추후 별도의 연구가 필요하다고 여겨진다. Purpose: 31 cases were retrospectively assessed to analyse radiological features of nodal and extranodal lesions which were diagnosed at Chungbuk National University Hospital(CNUH) and literature review was focused to the previous Korean reports. Materials and Methods: Other than biopsy-proven lesions, nodal and extranodal lesions showing definite size reduction in the post-treatment CT and MRI were also analysed. Cervical lymph nodes smaller than 1-1.5cm in initial size were included when the treatment caused significant improvement. Case analysis was focused to size and location of the nodal and extranodal lesions, pathological types, presence of the systemic involvement. Results: Only one patient was HD with nodal disease. NHL patients(n=30) had both nodal and extranodal(combined) disease(n=20), extranodal disease only(n=7) and nodal only(n=3). Waldeyer's ring was the most common extranodal location. Among the seven nasal cavity NHLs', both sides were occupied by the tumor initially(n=1) or during the follow-up(n=1) and 3 cases showed the invasion to ala nasi and cheek, and cell types were various. 2 cases of PMR(n=4) involved nasal cavity and other 2 had diseased Waldeyer's ring. 23 patients revealed nodal disease in total of 71 cervical spaces, most of them(20/23) had more than 2 diseased L/N groups. Among 71 L/N groups, 36 showed node size smaller than 1cm initially. NHL patients with combined nodal and extranodal pathology(n=20) had nodal lesions ipsilateral to extranodal disease in 7, bilateral in 13. Conclusion: Combined nodal and extranodal disease was more prevalent in our study than in the previous literatures because the inclusion criteria for the nodal lesion was wider. We could note several differences that should be pursued in further studies.

갑상선암에서 Ⅰ-131 투여 후 stunning 현상 발생에 관여하는 인자

오태근,김미성,궁성수 충북대학교 의학연구소 2000 忠北醫大學術誌 Vol.10 No.2

연구목적 : 분화가 잘된 갑상선 암의 수술 치료 후, 경과 관찰에는 혈청 thyroglobulin 농도 측정과 I-131 진단적 전신 스캔이 표준방법으로 이용되고 있다. 그러나 최근 I-131을 이용한 진단적 전신 스캔 시행 후에 바로 I-131 치료를 하면 병변에 I-131의 섭취가 감소하여 치료 효과가 낮아지는 stunning 현상이 있음이 알려지면서, stunning 현상의 발생 기전과 이를 줄일 수 있는 방법에 대한 연구가 필요하게 되었다. 본 연구는 I-131 진단적 전신 스캔 시행 후 stunning 현상의 발생에 영향을 주는 인자들을 밝히고자 하였다. 대상 및 방법: 46명의 분화가 잘된 갑상선암 환자를 대상으로 후향절 연구를 시행하였다. 모든 환자는 갑상선 암에 대한 양측성 갑상선 전절제수술 혹은 근전절제수술을 받았으며, 1회 이상의 I-131 치료를 받은 병력이 있었다. 성별, 연령, 진단적 전신 스캔에 사용한 I-131의 용량, 1-131 진단적 전신스캔 후 I-131 치료기간 까지의 기간, 병변의 위치, I-131 진단적 전신스캔에서의 병변의 I-131 uptake 정도를 조사하고 이들이 stunning 현상 발생에 관여하는지를 확인하였다. 결과: I-131 진단적 전신스캔에서 모두 114 개의 병변이 확인되었다. 이중 목에서 관찰된 병변이 106병변 이었고 폐 7병변, 골 1병변 이었다. 총 114 병변중 18병변(15.8%) 에서 stunning이 관찰되었으며 목에서 13병변으로 12.3%, 폐와 골 병 변에서는 모두 5병변으로 62.5%의 stunning현상 발생율을 보였다. 1-131 진단적 전신 스캔 시행 시 사용한 I-131의 용량, 1-131 진단적 전신스캔 시행 후 치료까지의 기간, 병변의 위치 등이 stunning 현상 발생에 관여하는 의미 있는 인자들로 확인 되었다. 결론: 잘 분화된 갑상선 암의 치료 후 암의 재발 유무 확인을 위하여 I-131 진단적 전신스캔을 시행할 때에는 stunning 현상의 발생에 관여하는 인자에 대한 주의가 필요하며, 특히 검사 전 암재발의 가능성이 높은 환자의 경우에는 진단적 스캔을 시행하지 않고 바로 치료 용량의 I-131을 투여하거나, 다른 영상 진단 방법의 사용을 고려할 필요가 있다. Purpose: We performed a retrospective study to find out the factors related to the occurrence of the stunning with I-131 diagnostic whole body scan (Dx-WBS). Materials and Methods: Fifty-two pairs of Dx-WBS & post-therapeutic WBS (Tx-WBS) from 46 patients, performed between 1996-2000, were included in this study. The patients were operated in our hospital due to well differentiated thyroid cancer and had a previous history of I-131 ablation. Dx-WBS was taken 24 & 48hours after I-131 administration. Tx-WBS was taken 7 days after treatment. Dose of I-131 for Dx-WBS, interval between Dx-WBS & I-131 treatment, site of metastasis, intensity of I-131 uptake in Dx-WBS were evaluated as possible factors. Results: There were 15 male and 31 female patients. The age ranged over 14-75 (47±16). The I-131 dose for Dx-WBS ranged over 1.7-7.1 mCi (3.1±2.7mCi). The therapeutic 1-131 dose ranged over 60-200mCi (132±29.Bmci). The interval between Dx-WBS and treatment ranged over 7-48 days (21.1 ±8.5 days). Among 52 pairs of scans, 12 pairs(23.1%) showed stunning in at least one lesion. Among the 114 metastatic lesions, 18 lesions showed stunning (15.8%). Uptake in neck showed stunning in 13/106 (12.3%). Uptakes in lung or bone showed stunning in 5/8 (62.5%). Multivariate linear logistic regression analysis showed that diagnostic dose of I-131, interval between Dx-WBS & I-131 treatment, site of metastasis were significant factors contributing to the development of stunning. Conclusion: We suggest that further studies are required to define the relationship between occurrence of the stunning and clinical outcome.

Session F : Eukaryotic Gene Structure and Expression : INSERTION / DELETION OF THE HUMAN - SPECIFIC ALU FAMILY AND COⅡ / tRNA Lys INTERGENIC REGION OF HUMAN MITOCHONDRIAL DNA

Sung Soo Hong,Sung Ho Goh,Jae Jin Chae,Yong Nam Koong,Moon You Oh,Chung Choo Lee 생화학분자생물학회(구 한국생화학분자생물학회) 1993 추계학술대회집 Vol.- No.-

Session F : Eukaryotic Gene Structure and Expression : GENETIC CHARACTERIZATION OF KOREAN POPULATION USING FIVE VNTR LOCI

Sung Soo Hong,Jung Ae Suh,Jae Jin Chae,Un Kyung Kim,Yu Seob Kim,Sung Ho Goh,Yong Nam Koong,Chung Choo Lee 생화학분자생물학회(구 한국생화학분자생물학회) 1993 추계학술대회집 Vol.- No.-

Session F : Eukaryotic Gene Structure and Expression : KOREAN POPULATION AND THE PHYLOGENETIC ANALYSIS OF HUMAN MITOCHONDRIAL DNA

Sung Soo Hong,Jae Jin Chae,Yu Seob Kim,Sung Ho Goh,Un Kyung Kim,Yong Nam Koong,Moon You Oh,Chung Choo Lee 생화학분자생물학회(구 한국생화학분자생물학회) 1993 추계학술대회집 Vol.- No.-

Session F : Eukaryotic Gene Structure and Expression : MULTIPLE HAPLOTYPES AND EVOLUTION OF THE HUMAN Y CHROMOSOME

Sung Soo Hong,Sung Ho Goh,Yu Seob Kim,Jae Jin Chae,Un Kyung Kim,Yong Nam Koong,Chung Choo Lee 생화학분자생물학회(구 한국생화학분자생물학회) 1993 추계학술대회집 Vol.- No.-

Ethnic Differences in Allelic Frequencies of Two (CA)n Microsatellite Markers Located on Chromosome 5q

Hong, Sung-Soo,Chae, Jae-Jin,Goh, Sung-Ho,Yong, Koong-Nam,Lee, Chung-Choo The Korean Society for Integrative Biology 1997 Korean journal of biological sciences Vol.1 No.1

The characteristics of allelic polymorphisms of the two (CA)n microsatellite (p599 and ㅅ599) markers spanning the long arm of chromosome 5 were studied in 52 DNA samples from unrelated inhabitants of Seoul (Korea) by using the polymerase chain reaction (PCR) to investigate differences in allele frequencies between Korean and Caucasian populations. The 6 alleles were observed for p599 (CA)n with a polymorphism informative content (PIC) value of 0.71 and 9 alleles for ㅅ599 (CA)n with a PIC value of 0.82. The observed heterozygote frequencies of the loci were estimated to 0.730 and 0.846, respectively. Several allele frequencies of two loci showed significant differences between Korean and Caucasian populations. Genotype data from the two loci were consistent with the Hardy-Weinberg equilibrium by x2 test. Linkage disequilibrium between p599 (CA)n and ㅅ599 (CA)n loci was observed in x2 test between the observed and expected frequency of allelic association. The probability of matching calculated at each locus was 0.104 for p599 (CA)n and 0.043 for ㅅ599 (CA)n, respectively. These results demonstrate the need to determine populationspecific allele frequency distributions for polymorphic markers when performing genetic linkage studies in racially defined several populations.

누드마우스에 이식된 인체 대장암 모델에서 주입된 항 CEA 단세포군 항체의 종양내 집적에 관련하는 인자

궁성수(Sung Soo Koong),김승택(Seoung Taik Kim),이복희(Bok Hi Lee),정준기(June Key Chung),이명철(Myung Chul Lee),고창순(Chang Soon Koh),정홍근(Hong Keun Chung) 대한내과학회 1992 대한내과학회지 Vol.43 No.5

N/A It has been supposed that several factors are related to the localization of antibody against tumor-associated antigen in tumors. However, the significance of these factors has not been evaluated in detail. The purpose of the present study was to analyze the effect of these factors on the localization of infused monoclonal anti-CEA (CEA 79), expressed in percent injected dose per gram (%ID/G), in human colon carcinoma grafted to nude mice. The evaluated factors in tumor were tissue weight, blood weight, vascular permeability to antibody, relative blood flow and CEA concentration (Bmax). The percent injected dose per gram of CEA 79 in tumor correlated significantly with vascular permeability (r= 0.61, p<0,001) and CEA concentration in tumor (r= 0.49, p<0.001), while tissue weight, blood weight and relative blood flow did not show a significant correlation (p>0.05) in linear regression analysis. Stepwised multiple regression analysis in tumor indicated that vascular permeability was a significant predictor of the percent injected dose per gram (multiple R=0,59, p<0,001). Inclusion of CEA concentration in tumor increased the correlation coefficient from 0.59 to 0.67 (p<0.001). Adding all the other variables was not significant (p>0.05). In conclusion, vascular permeability to antibody and CEA concentration in tumor were important factors determining the localization of CEA 79 in human colon carcinoma grafted to nude mice.