肝內膽石症의 臨床的 및 X-線像의 特異性

許景渤(K. B. Hur),金昇薰(S. H. Kim),朴基一(K. I. Park),孫宇鍾(W. J. Sohn),金光洙(K. S. Kim),閔珖植(K. S. Min),崔炳肅(B. S. Choi) 대한외과학회 1968 Annals of Surgical Treatment and Research Vol.10 No.6

乳癌 手術後 放射線 治療療法의 에너지別 比較 評價

崔慶姬,秋成實,南正祐,崔炳肅 최신의학사 1977 最新醫學 Vol.20 No.2

Routine postoperative radiation therapy has been widely employed to supplement the surgical -procedure. Following radical mastectomy, the volume to be irradiated will be the full thickness of the chest wall over an irregular area and the draining lymphatic chains including axillary, supraclavicular and internal mammary nodes. The principal aim of radiotherapy is to deliver adequate dose of radiation to the tumor bearing tissue and at the same time to avoid excessive damage to the underlying normal tissue. The anatomy of the breast. chest wall and lymph node drainage areas make the satisfactory homogeneous high dose irradiation of the required volume extremely difficult to achieve and has led to the progressive development for better irradiation techniques. In this article, authors have extensively reviewed and collected the various radiotherapy techniques which has been used since the days of conventional x-ray therapy from around 1930s up to the present time. They were divided into the seven representative methods according to the different energies of radiation. Their characteristics, and advantage and disadvantage were evaluated and compared in the physical and technical aspects. Clinical results including survivals, local recurrence, and complications were compared following a review of related articles. Conventional orthovoltage radiation and cesium-137 therapy have been largely replaced with cobalt-60 and electron bean treatment. The most widely used methods at present time are tangential therapy using cobalt-60 and direct appositional treatment with the appropriate energies of electron beam. The high energy electron beam therapy which has been rapidly developed since 1960s produce slightly more skin reaction than cobalt-60, but it is mild in degree and have many practical merits. They include technical simplicity, easy dose plan and calculation, small probability of error. and less radiation pneumonitis than cobalt-60. No sufficient clinical results are yet available for comparison of treatment effects between the two methods, however electron beam seems to be more suitable for the treatment of postmastectomy chest wall in breast cancer.

子宮頸部癌의 放射線治療에 關한 考察

楊秉喆,李道行,崔炳肅 최신의학사 1976 最新醫學 Vol.19 No.3

From 1969, four hundred forty four carcinoma of the cervix patients were received radiotherapy and 378 patients were treated by Co-6O Teletherapy unit and 66 patients were by 10 MeV. Linear accelerator. The base line study of the staging were consists of pelvic examination. IVP cystoscopy and sigmoidoscopy. An analysis of 444 patients were as follow; 1. Age incidence-most common in 40-50 2. Squamous cell carcinoma accounted for 94.7% of the lesions and 5.3% was adenocarcinoma. 3. Incidence of staging were; stage I 13.8 II 49.1 III 21.5% IV 7.2% Other 5.6% 4. Most common complications are sigmoiditis (28.3%) and cystitis (29.3%) 5. High incidence complications were noted in parallel AP & PA, lateral opposing portsis compare with 4 oblique portals. 6. Post-operative (TAH) irradiation revealed high incidence of complication. Three year survival rate was 84.3% in stage II.

特發性 肺因性 異常肥大 骨關節症

金良淑,吳琪根,徐廷鎬,崔炳肅 최신의학사 1977 最新醫學 Vol.20 No.2

Pulmonary Hypertrophic Osteoarthropathy is secondary change of chronic pulmonary diseases: such as benign and malignant lung tumor, lung abscess, bronchiectasis, and aneurysm. It represents with clinical symptoms of swelling and pain at involved articular joint with roentgenologic findings of symmertrical subperiosteal bone reaction. In our 4 cases of pulmonary hypertrophic osteoarthropathy, there were clinical symptoms of arthralgia, swelling of multiple joint, and one of which cases has clubbing finger. All roentgenologic finding of subperiosteal bone reaction of long bones were associated with pulmonary lesion without getting of pathologic confirmation.

선천성거대결장의 방사선학적 고찰

김병태,이영해,최병숙 최신의학사 1977 最新醫學 Vol.20 No.5

The pathogenesis of Hirschsprung's disease or Congenital Megacolon is an absence of ganglion cells of myenteric plexus in a segment of bowel. It has its onset in the newborn. The presenting signs and symptoms can be easily mistaken for mechanical obstruction in critically ill neonate. Definite radiological diagnosis is possible in the vast majority of cases in infancy. But it is difficult in neonate. This report presents a retrospective detailed review of presenting signs, symptoms and radiologic findings of 26 patients who had diagnosed as Congenital Megacolon at Severance Hospital by operation and pathology. The results are; 1. In 26 cases of Hirschsprung's disease are 25 males and only one female. 2. Onset of symptoms and signs appear within 1 week after birth in 73%. 3. Abdominal distention, constipation, dehydration and vomiting are the common symptoms and signs. 4. 79% of patients responding passed their first meconium after the first 24 hours of life. 5. In simple abdominal film, moderate and marked gaseous distention of small and large bowel, are noted in all cases. But multiple air fluid level are only in 12%. In 42%, specific diagnosis of Congenital Megacolon were obtained with only simple abdominal film, especially lateral view. 6. The most important pathognomic roentgen sign of Barium Enema is zone of transition. And others are irregular bizarre contraction of aganglionic segment, barium retention following a. barium enema study and parallel transverse folds in dilatated proximal colon. 7. Almost 96% of the patients had aganglinosis limited to the rectum and sigmoid colon. And which were identical with Barium Enema study finding.

Sr-85를 이용한 골 스캔 5예

유형식,박창윤,최병숙 대한핵의학회 1973 핵의학 분자영상 Vol.7 No.2

(85)^Sr를 이용하여 원발성골종양, 골수염, 골절, 골로 전이된 이차암 및 골 동통을 호소한 Hodgkin's씨 병 등 5예의 골 스캔을 시행하여 그 병소를 X-선 필름 소견과 비교 관찰하였으며, 골 스캔의 의의에 대해서 문헌과 함께 고찰하여 보았다. $quot; Bone scanning was attempted in the five representative cases in various diseases such as primary bone tumor, inflammatory or traumatic changes, secondary metastatic bone tumor and changes in the hermatopoietic system with Sr-85 which is available at this time. Each findings were correlated to the X-ray findings. Scan findings were more appreciable than the X-ray findings in elucidation of extent of bone pathology in cases of primary bone tumor and fracture cases. Especially, increased radioactivity was noted on the clinically suspected region which were not demonstrated on the plain X-rays.

자궁경부암 방사선치료 전후 Renogram의 의의

유형식,박창윤,최병숙,서정호,정순오,곽현모 대한핵의학회 1975 핵의학 분자영상 Vol.9 No.1

자궁경부암 50예를 대상으로 방사선치료전에 정맥성 신우조형술과 renogram을 시행하고 방사선 치료후 환자의 추적검사로써 renogram을 일정한 간격으로 시행한 후 그 결과를 비교 분석하여 다음과 같은 소견을 얻었다. 1) 방사선치료전 정맥성 신우조형술에서 비정상소견을 나타낸 환자는 28.8%였고 이중 stage Ⅲ와 Ⅳ인 예가 대부분이었으며 주로 수장증형(hydronephrosis pattern)과 무기능형(Non-visualization)이었다. 2) 방사선치료전 정맥성 신우조형술에서 정상소견을 보였던 예중 21.7%에서 renogram상 일측 또는 양측에 배설지연형을 보였고 반대로 정상 renogram을 나타냈던 예중 비정상 정맥성 신우조형상을 보인 예는 없었다. 3) 방사선치료전 비정상 renogram을 보인 예중 임상진행병기가 심할수록 제삼상(excretory phase)의 변화도 심하였다. 4) Stage Ⅰ또는 Ⅱ인 환자에서 비정상 renogram 소견을 보인 예가 31예중 12예(39.4%)가 있었다. 5) 방사선 치료전에 전 자궁적출술(TAH)를 행한 예에서는 모두 정맥성 신우조형상과 renogram상에 비정상 소견을 보였다. 6) 방사선 치료(point A:8000∼9000 rads, point B:5000∼6000 rads, point CO:11000∼12000 rads) 후치 또는 3개월내에 시행한 renogram 곡선의 변화는 별로 없었다. 그러나 6∼9개월에선 42.8%에서 9∼12개월에서는 약 75%에서 배설기능의 항진을 나타내는 배설상수(excretion index)의 변화가 있었다. 7) 자궁경부암 환자에 있어서 방사선치료 전후의 신의 배설기능의 변화는 특히 renogram상에서 Kex와 excretion index의 변화가 중요하다고 생각된다. It is a great value to find an early detection of involvement of ureteric obstruction in the carcinoma of cervix. Little or uo knowledge of the condition of the kidneys or the lower urinary tract are able to elucidate by the biochemical studies such as blood nitrogen or urine creatinine in carcinoma of cervix. Findings of urography delineates the condition of urinary tract stasis in the renal pelvis and ureters, however, slight stasis maybe difficult to demonstrate. On the other hand isotope nephrography is accepted as a sensitive method to observe renal function especially in regarding to the excretory function of kidney. It was attempted to analysis the findings of urography conjunction with isotope nephrography in 50 cases of unselected patients with invasive carcinoma of cervix through pre and post irradiation follow up studies. Urography was done as a routine procedure and analysed emphasising changes of collecting systems and ureter condition. Isotope nephrography was carried out by means of 15μci 131IHippuran injected intravenously and the curves were analysed as follows. Parameter were; time of maximum amplitude (Tmax), half time of maximum amplitude (T½), Kac and Kex value calculated from these two parameters in Tobe's method. The excretion index by Aurell defines the ratio between the maximum activity and the activity measured on the slope of the third phase ten minites after it has reached its maximum. Results: 1) 28.8% had an abnormal IVP suggestive of ureteric involvement before irradiation therapy and the patient of stage Ⅲ: and Ⅳ were the great part. 2) 21.7% had abnormal findings of per-irradiation renogram whom showed normal IVP. The other group showed nsrmal IVP which group also showed normal renogram prior irradiation. 3) The more severe the ureteric involvement, the change of excretion index was greater. 4) Even in stage Ⅰ and Ⅱ patient, abnormal renogram was revealed in 12 cases(39.4%) among 31 cases. 5) All cases of TAH showed abnormal findings of IVP and renogram. 6) No definite changeenogram was obtained just after the irradiation therapy (point A:8000∼9000 rads, B:5000∼6000 rads, Co:11000∼13000 rads). Each 3 month follow up study was performed and comparing with preirradiation study which showed significant changes of excretion index of renogram were 42.8% in 6∼9 month follow-up and 75% in 9∼12 month, respectively. 7) It seems to be important to observe the parameter Kex and excretion index of renogram to determine early abnormality of kidney excretory function by means of post-irradiation follow-up study.

두개내 동맥류에 대한 방사선학적 고찰

김호균,윤인숙,박창윤,최병숙 仁川基督病院 1977 仁川基督病院誌 Vol.1 No.1

^(169)Yb-DTPA를 이용한 Cisternography

도종웅,김상철,이규창,이헌재,양병철,박창윤,최병숙 대한신경외과학회 1977 Journal of Korean neurosurgical society Vol.6 No.1

The radioactive nucleid cisternography is being used as a diagnostic adjunct of CSF rhinorrhea and otorrhea, hydrocephalus, patency after ventricular shunt operation, brain tumor and cangenital anomalies of the central nervous system. In numerous radioactive nucleids, ^(169)Yb-DTPA is known to have moderately effective half life, high energy level for scintilation, and pure r-emitter in subarachnoid space. Authors review some clinical advantage of cisternography using ^(169)Yb-DTPA applied in the diagnosis of CSF rhinorrhea and otorrhea, hydrocephalus, CSF fistula and patency after ventricular shunt operation.

폐주사 : 심장질환의 폐관류주사 소견

이종태,박창윤,김정규,최병숙 대한핵의학회 1973 핵의학 분자영상 Vol.7 No.2

$quot;총 25명의 심장질환 환자의 폐관류 스캔소견과 심장 카테테르소견을 비교검토한 결과 다음과 같았다. 1) 후천성심장판막증 10명 중에서 쾌모판협착증(4명)과 대동맥판폐쇄부전증(1명)에서 방사성입자의 uptake가 폐상부가 폐하부에 비해 현저히 증가하였고 폐정맥혈압의 증가와 비례관계를 보였으며 2차적으로 폐동맥혈압의 증가와도 상관관계가 있었다. 이 경우 폐 wedge압은 최소 22mmHg이상, 폐동맥수축기혈압은 최소 33mmHg이상에서 시현하였다. 쾌모판협착증(1명), 쾌모판폐소부전증(2명)은 폐양측에 균등한 uptake를 보였고 폐정맥혈압은 정상범위내이고 폐동맥혈압은 경도로 증가하였다. 2) 선천성심장질환 15명 중에서 심방중격결손(1명)은 우상엽에 uptake가 증가, 심실중격결손(1명)은 좌측폐의 감소를 보였고 나머지 전예는 양측전폐의 uptake가 균등분포였으며 폐동맥혈압의 증가와는 관계가 없었다. 개방성동맥관(2명)은 특징적으로 좌측폐의 uptake가 감소하였다. Tetralogy of Fallot 증후 3명은 수술(total correction) 전 폐 uptake는 양측이 균등분포하였고 타장기 즉 간장과 신장(1명), 간장(1명)에 uptake가 있었으며 우좌 shunt 혈류량과 심실중격의 크기와 관계가 있었다. shunt$quot; Pulmonary perfusion scan with radioactive (113m)^In-iron hydroxide particle was performed in the 25 cases of heart disease which had been diagnosed by cardiac catheterization prior to surgery from July, 1972 to JuIy, 1973 at the Department of Radiology and Nuclear Medicine, Yonsei Medical College. It consists of 7 mitral stenosis, 2 mitral insufficiency, 1 aortic insufficiency, 3 atrial septal defect, 5 ventricular septal defect, 2 patent ductus arteriosus, 1 transposition of great vessel and 4 Tetralogy of Fallot. Findings of pulmonary perfusion scan in relation to hemodynamic data of cardiac catheterization were examined. 1) Out of 10 cases of acquired valvular heart disease, In 6 cases of stenosis and 1 case of aortic insufficiency, radioactivity was increased at both upper lung. This finding is noted when pulmonary wedge or venous pressure was elevated above 22 mmHg and arterial systolic pressure above 33 mmHg. 2) Out of 15 cases of congenital heart disease. In almost all cases of artial septal defect and ventricular septal defect except 2 cases, radioactivity was even at both entire lung. In 2 cases of patent ductras arteriosus, radioactivity was decreased especially at the left lung. It is observed that in acyanotic congenital heart disease, radioactivity of lung is not related with pulmonary arterial pressure. In 3 cases af Tetralogy of Fallot, radioactivity was even at both entire lung and in 2 of them, extrapulmonary radioactivity of liver or kidney which depends on size of defect and volume of right to left shunt reversible, was noted. $quot;