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소세포폐암에서 Neuron Specific Enolase의 면역조직 화학염색과 혈청농도에 관한 연구
곽승민 ( Seung Min Kwak ),김형중 ( Hyung Jung Kim ),신동환 ( Kong Hwan Shin ),장중현 ( Joong Hyun Jang ),이홍렬 ( Hong Lyeol Lee ),김세규 ( Se Kyu Kim ),안철민 ( Chul Min Ahn ),김성규 ( Sung Kyu Kim ),이원영 ( Won Young Lee ),이 대한결핵 및 호흡기학회 1992 Tuberculosis and Respiratory Diseases Vol.39 No.6
EGFR 유전자 돌연변이를 보였던 비흡연 여성 선암 환자에서 Gefitinib 투여 후 발생한 급성호흡부전
김상구 ( Sang Gu Kim ),류정선 ( Jeong Seon Ryu ),한지영 ( Jee Young Han ),김현정 ( Hyun Jung Kim ),조재화 ( Jae Hwa Cho ),곽승민 ( Seung Min Kwak ),이홍렬 ( Hong Lyeol Lee ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.1
Gefitinib를 사용할 경우 발생할 수 있는 급성호흡부전은 주로 남성, 흡연자, 편평상피세포암 혹은 사이성 폐질환 등에서 발생하는 것으로 알려져 있다. 따라서 이와 같은 임상적 요인이 없는 경우 이 약제를 안전하게 사용할 수 있을 것이다. 연구자 등은 흡연한 적이 없고, EGFR 유전자의 19번 엑손 돌연변이를 보였던 47세 여성 선암 환자에서 gefitinib 투여 후 발생한 급성호흡부전을 보고하며, 부작용의 발생기전이 밝혀지지 않은 시점에서, 이들 임상적 특성을 보이는 환자에서도 호흡기계 부작용의 발생 가능성에 대한 임상의사의 주의를 촉구하는 바이다. (Tuberc Respir Dis 2008;64:44-47)
기성호 ( Sung Ho Ki ),이승희 ( Seung Hee Lee ),현인영 ( In Young Hyun ),이경희 ( Kyung Hee Lee ),조재화 ( Jae Hwa Cho ),류정선 ( Jeong Seon Ryu ),이홍렬 ( Hong Lyeol Lee ),곽승민 ( Seung Min Kwak ) 대한내과학회 2006 대한내과학회지 Vol.71 No.6
목적: PET-CT는 PET 스캐너에 CT 스캐너를 부착시켜 대사영상인 PET 영상과 해부학적 형태영상인 CT의 융합영상을 얻을 수 있어서, 두 영상법의 장점을 살려 종격동 림프절에 있어서 진단 정확도를 향상 시킬 수 있는 것으로 알려져 있다. 그러나 국내에서는 아직까지 PET-CT의 성적에 대한 연구가 없었다. 이에 본 저자들은 N병기 결정에 있어서 CT와 비교하여 PET-CT의 성적을 알아보고자 하였으며, PET-CT의 시행이 종격동 내시경에 의한 조직생검과 같은 침습적 방법을 피할 수 있게 해 주는지와 병기 결정에 있어서 PET-CT가 추가됨으로써 얻는 다른 이익이 있는지를 알아보고자 하였다. 방법: 조직학적으로 확진된 비소세포폐암 환자에서 수술 전 병기 결정을 위하여 PET-CT와 CT를 둘 다 시행한 38명의 환자를 대상으로 후향적으로 조사하여, 그 중 수술적 절제가 가능한 병기 Ⅰ~Ⅲa인 22명이 연구대상이 되었다. 결과: 림프절 병기에서 CT는 민감도, 특이도, 정확도, 양성 예측치, 음성 예측치에서 각각 44%, 71%, 64%, 57%, 67%이었고, PET-CT는 각각 78%, 95.2%, 86%, 88%, 86%이었다. PET-CT에서 1명의 위양성 환자와 2명의 위음성 환자가 있었으며 3명의 환자에서 전신골스캔에서 발견하지 못한 뼈 전이를 PET-CT에서 먼저 발견하였다. 결론: PET-CT는 림프절 병기 결정에 있어서 CT보다 좋은 결과를 보여 주었고, 음성 예측치가 높으므로 PET-CT에서 음성인 경우에는 비용대비 효과적인 면에서 종격동내시경을 시행하지 않는 것을 고려해 볼 수 있다. 그러나 PET-CT에서 양성이 나온 경우는 꼭 조직학적 확인을 해 주어야 한다. 또한 원격 전이를 발진하는 데도 도움이 되고, 불필요한 수술을 막아주며 비용면에서도 절감되므로 이제는 비소세포폐암의 수술 진 평가에 있어서 이전의 고식적 방법들과 함께 PET-CT를 시행함으로써 더 정확한 병기 결정을 할 수 있으리라 기대한다. Background: PET-CT can provide both a physiological and anatomical image with the benefits of both PET and CT scanners. This may improve the accuracy of a diagnosis of a mediastinal lymph node metastasis. The aims of this study were to compare PET-CT versus CT on the nodal staging of lung cancer and to determine if it could be used to avoid an invasive diagnostic examination. The benefit of the additional PET-CT as preoperative evaluation of the lung cancer was also assessed. Methods: The results of CT and PET-CT scanning in 22 patients with a proven non-small cell lung cancer (NSCLC) were correlated with the pathological findings of lymph node sampling using mediastinoscopy or surgery. Results: The sensitivity, specificity, accuracy, positive and negative predictive values of CT for detecting metastatic lymphadenopathy were 44%, 77%, 64%, 57%, and 67%, respectively. For PET-CT, these were 78%, 92%, 86%, 88%, and 86%, respectively. The earlier detection of a bone metastasis was obtained by PET-CT in 3 cases, which was not detected in bone scan. Conclusions: Better results for nodal staging and higher negative-predictive values by PET-CT (than CT) can avoid the need for invasive mediastinal staging of the lung cancer with negative mediastinal lymph node metastasis. An additional histological evaluation by mediastinoscopy needs to be done when positive findings are detected by PET-CT. PET-CT is also helpful in detecting a distant metastasis and avoiding unnecessary surgery. More accurate diagnostic staging can be expected using the simultaneous execution of PET-CT with a conventional preoperative evaluation of lung cancer. (Korean J Med 71:627-634, 2006)
이홍렬(Hong Lyeol Lee),곽승민(Seung Min Kwak),장중현(Jung Hyun Chang),김세규(Se Kyu Kim),김성규(Sung Kyu Kim),이원영(Won Young Lee),신동환(Won Young Lee) 대한내과학회 1992 대한내과학회지 Vol.43 No.6
N/A Backgrounds: Endobronchial metastasis of extrapulmonary malignancies was defined as those cases in which metastatic foci were grossly evident in the main or lobar bronchi and occurs in less than 5% of all cases. The common extrapulmonary tumors associated with metastatic involvement of a central airway are carcinomas of the breast, kidney, colorectum and malignant melanoma. In the majority of cases, the primary tumor site is clinically apparent before symptoms of endobronchial metastasis. The clinical and roentgenographic features of endobronchial metastasis and primary bronchogenic carcinoma were found to be indistinguishable. Mostly, the histologic appearance of the bronchoscopic biopsy suggests the correct diagnosis but in some instances it may be impossible to differentiate metastatic involvement of the bronchus by an asymptomatic extrathoracic adenocarcinoma from a primary central adenocarcinoma of the lung. In addition to the treatment aspect of neoplasm spread, palliative surgical removal of endohronchial metastatic malignancies are strongly recommended to improve the patients qualify of life and to prevent resultant obstructive complications. Methods: We experienced 5cases of endobronchial metastasis during the recent 1½ years and reviewed the medical records of 12cases previously confirmed as endobronchial metastasis by bronchoscopic bioposies since 1985 to 1990. We investigated the clinical manifestations, primary sites, time intervals and bronchoscopic findings. Results: Breast carcinoma was the most common primary malignancy leading to the endobronchial metastasis. We also found the metastatic cases of hepatocellular carcinoma, sebacious gland adenocarcinoma and mouth floor carcinoma. Mostly patients complained of dyspnea and productive cough and chest X-ray revealed atelectasis. Endobronchial metastasis developed within 3 years in more than half of the cases and the mean time interval was 40,6months. In one prostate cancer and one thyroid cancer, metastasis was diagnosed prior to primary site presentation. On bronchoscopic examination, the right upper lobar bronchus was most commonly involved and subtotal obstruction was the most frequent finding. More than half of the patients expired within 2 years after the diagnosis of endobronchial metastasis. Conclusion: Endobronchial metastasis has unique clinical significance in that it requires differential diagnosis with primary bronchogenic carcinoma and aggressive palliative surgical management. If atypical clinical features are present or atypical cell type is discovered by biopsy of the lesion in lung ca, appropriate diagnostic studies should be undertaken to exlude the possibility of an asymptomatic extrapulmonary tumor before definite therapy is undertaken.
결핵성 및 암성 흉수의 감별진단에서 흉수내 SC5b - 9 농도 측정의 진단적 의의
서동완(Dong Wan Seo),곽승민(Seung Min Kwak),김우성(Woo Sung Kim),김동순(Dong Soon Kim),서을주(Eul Ju Seo),민원기(Won Ki Min),김원동(Won Dong Kim),고윤석(Youn Suk Koh) 대한내과학회 1994 대한내과학회지 Vol.47 No.6
N/A To evaluate the diagnotic value of pleural SCSb-9 in the differential diagnosis of tuberculous and malignant pleural effusion, we measured pleural ADA activity and SCSb-9 concentration in 71 cases of pleural effusions due to tuberculosis (n=35) and malignancy (n=36). And we also measured pleural C4d fragment and Bb fragment concentration to determine by which pathway the complement activation occurs in pleural space. The results were as follows: 1) The median value of pleural SC5b-9 concentration of tuberculous effusion was 6.4 ug/ml (interquartile range 2.6~11.7) and was significantly higher than that of malignant effusion (p<0.005). 2) The median values of pleural C4d fragment concentration were 15.5 mg/ml (9.9~18.9) in tuberculous effusion and 12.8 mg/ml (7.3~19.6) in malignant effusion. There were no significant difference between two groups. The median value of pleural Bb fragment concentration of tuberculous effusion was 7.8 mg/ml (5.5~12.8) and was significantly higher than that of malignant effusion (p<0.01). 3) The SC5b-9 concentration showed no significant correlation with C4d fragment concentration both in tuberculous effusion and malignant effusion. But the SC5b-9 concentration showed significant correlation with Bb fragment concentration both in tuberculous effusion (r=0.48, p<0.005) and malignant effusion (r=0.72, p<0.001). 4) The median value of pleural ADA activity of tuberculous effusion was 64.3 U/L (40.9~103.5) and significantly higher than that of malignant effusion (p<0.001). 5) Pleural ADA activity showed significant correlation with pleural SC5b-9 concentration in tuberculous effusion (r=0.53, p<0.005). 6) According to the receiver-operating characteristic curve analysis, the measurement of pleural ADA activity is superior to that of pleural SC5b-9 concentration in the differential diagnosis of tuberculous and malignant effusion. In conclusion, the measurement of pleural SC5b-9 concentration can be used as an adjunctive test in the differential diagnosis of tuberculous and malignant effusion but pleural ADA activity measurement was superior to pleural SC5b-9 concentration measurement. And pleural SC5b-9 concentration of tuberculous effusion was higher than that of malignant effusion and it seems to be due to the difference in activation of alternative pathway activation of complement in two groups.
원저 : 흉막삼출 원인질환의 감별진단에 있어서 흉막액 Adenosine Deaminase 활성도 및 Carcinoembryonic Antigen 병행측정의 임상적 의의
이장훈 ( Jang Hoon Lee ),장상호 ( Sang Ho Jang ),이홍렬 ( Hong Lyeol Lee ),곽승민 ( Seung Min Kwak ),장중현 ( Jung Hyun Chang ),김병일 ( Byung Il Kim ),천선희 ( Sun Hee Cheon ),김세규 ( Se Kyu Kim ),장준 ( Joong Chang ),김성규 ( 대한결핵 및 호흡기학회 1993 Tuberculosis and Respiratory Diseases Vol.40 No.1