만성 골수성 백혈병에서 골수 Hemosiderin 의 의의

하승우(Sung Woo Ha),손상균(Sang Kyun Shon),김광원(Gwang Weon Kim),이규보(Kyu Bo Lee),황기석(Kee Suk Whang) 대한내과학회 1989 대한내과학회지 Vol.37 No.2

N/A We studied the relationship among the level of bone marrow hemosiderin, clinicohematologic findings and ferrokinetics. The subjects were patients taken from 30 cases who had been diagnosed as chronic granulocytic leukemia at Kyungpook National University Hospital from January 1980 through July 1988. Among these 30 cases 22 cases (73.3%) had a de- creased level of bone marrow hemosiderin. One case(3.3%)had an increased level of bone marrow hemosiderin while 7 eases(23.3%)were normal. In all cases, the level of serum ferritin was likely to be decreased but it was within the normal range. The 7 eases (22.3%)had an increased level of serum ferritin and 23 cases(77.7%)had a normal level. The level of serum iron was increased in 18 cases(60.0%)but decreased in 12 cases(40.0%). Among 15 cases with a study of the half life of plasma iron disappearance, the half life was shortened in 2 cases (13.3%), lengthened in 5 cases(33.3%)and normal in 8 cases(53.3%). There was no correlation between the degree of splenomegaly and the level of bone marrow hemosiderin. However, as the spleen became larger, the level of bone marrow hemosiderin tended to decrease. In 9 cases, there was an occurrence of blast crisis. The level of bone marrow hemosiderin was decreased in 3(33.3%)of the 9 cases, normal in 4 of the cases(44.4 %) while slightly increased in the other 2 cases(22.2%). The level of serum ferritin was normal in 6 of the 9 cases(66.7%)and increased in 3 cases(33.3%). The level of serum ferritin was below normal range in 5 out of 9 cases(55.6%) and within normal limits in the other 4(44.4%). The chronic granulocytic leukemia patients had a tendency to have a decreased level of bone marrow hemosiderin while the patients with blast crisis showed a tendencey to have an inceased level of bone marrow hemosiderin.

관해된 급성 골수성 백혈병 환자에서 발생한 과립성 육종의 67Ga - citrate Scan 소견

이규보(Kyu Bo Lee),이재태(Jae Tae Lee),황기석(Kee Suk Whang),김광원(Gwang Weon Kim),정병천(Byung Cheon Chung) 대한핵의학회 1990 핵의학 분자영상 Vol.24 No.2

N/A A case of a 39-year-old man with granulocytic sarcoma documented by positive Ga-67 scan is described and brief review of literature was performed. He was diagnosed as acute myelogenous leukemia and got complete remission with antileukemic chemotherapy for 7 months. On admission, picture of his bone marrow and peripheral blood showed remission state of leukemia. Radiologic examinations were performed for evaluation of lesions in head and chest, and findings of granulocytic sarcoma were suspected. So we got 67Ga-citrate scan and pleural biopsy for identification of causes of intractable pleural effusion and skin lesion. Myeloblastomas (or granular sarcomas) proved by pleural biopsy were correctly identified by 67Ga-citratre scan, and disease extent was clearly delineated. We believe that 67Ga-scintigraphy is very helpful in localizing and follow-up evaluation of granulocytic sarcoma.

Dipyridamole 부하 심장 풀 스캔을 이용한 관동맥질환의 평가

이규보(Kyu Bo Lee),이재태(Jae Tae Lee),김광원(Gwang Weon Kim),박의현(Wee Hyun Park),정병천(Byung Cheon Chung),최정일(Chung Il Choi),채성철(Shung Chull Chae),전재은(Jae Eun Jun),박희명(Hee Myung Park) 대한핵의학회 1991 핵의학 분자영상 Vol.25 No.1

N/A Thirty-one patients with coronary artery disease and twenty-six normal subjects underwent 99mTc-GBPS before and aft.er coronary vasodilatation was induced by dipyridamIe 0.54 mg/kg given IV over 4 min. LVKF, EF and regional wall motion by phase analysis were measured during rest and dipyridamole infusion. The results were as follows: 1) Mean LVEF of normal subjects was significantly higher than that of MI group (p=0.001), but similar to that of angina group during rest. Among Ml group, mean LVEF of anterior MI group was significantly lower than that of inferior MI group during rest (p=0,024). 2) The normal subjects had a significnat increase in mean LVEF during dipyridamole infusion (+ 12 +- 3,8), while the CAD group had no increase (+ 2=5.0) (p<0.001). If an increase of LVEF during stress is less than 5%., it suggests an abnormality. The sensitivity and specificity of LUEF changes aft:er dipyridamole infusion were 81%, 96%, respectively. 3) With phase analysis, LV mean phase angle af normal subjects and CAD patients was 143+20, 5, 132 +- 20.6 rc.spectively, durign rest (p=0.049). But an ncrease of LV mean phase angle during dipyridamole infusion in t.hese two groups was not signifieantly different. Dipyridarnole infusion did not affect standard deviation and FWHM of phase angle. 4) Regional wall motion was abnormal in 5 patients (16%) during dipyridamole infusion. 5) Side effects with dipyridamole infusion include; headache, angina pain, chest discomfirt, nausea, weakness sense. In conclusion, dipyridamole GBPS might be useful in detection and follow up of CAD.

ECG Gated Blood Pool Scan을 이용한 심실벽 역행성 운동의 평가 - Cine Loop , Phase analysis , Paradox Image의 비교 -

이규보(Kyu Bo Lee),이재태(Jae Tae Lee),황기석(Kee Suk Whang),정병천,전재은,정진홍(Jin Hong Chung),김광원(Gwang Weon Kim),채성철(Sung Chul Chae),박의현(Wee Hyun Park),이형우(Hyong Woo Lee) 대한핵의학회 1990 핵의학 분자영상 Vol.24 No.2

N/A Sixty-four patients with paradoxical ventricular wall motion noticed both in angiocardiography or 2-dimensional echocardiography were assessed by ECG gated blood pool scan (GBPS). Endless cine loop image, phase and amplitude images and paradox image obtained by visual inspection of each cardiac beat or Fourier transformation of acquired raw data were investigated to determine the incremental value of GBPS with these processing methods for identification of paradoxical ventricular wall motion. The results were as follows:1) Paradoxical wall motions were observed on interventricular septum in 34 cases, left ventricular free wall in 26and right ventricular wall in 24. Underlying heart diseases were is chemic (23 cases) valvular(9), congenita1 heart disease (12), cardiomyopathy (5). pericardial effusion(5), post cardiac surgery(3), cor pulmonale (2), endocarditis (l) and right ventricular tumor(l). 2) Left ventricular ejection fractions of patients with paradoxical left ventricular wall motion were significantly lower than those with paradoxical septal motion (p〈0.005). 3) The sensitivity of each processing methods for detecting paradoxical wall motion was 76.9% by phase analysis, 74.6% by endless cine loop mapping and 68.4% by paradox image manipultion respectively. Paradoxial motions visualized only in phase, paradox or both images were appeared as hypokinesia or akinesia in cine loop image. 4) All events could be identified by at least one of above three processing methods, however only 34 cases (48.4%) showed the paradoxical motions in all of the three images. By these findings, we concluded that simultaneous inspection of all above three processing methods-endless cine loop, phase analysis and paradox image is necessary for accurate identification and assessment of paradoxical ventricular wall motion when performing GBPS.

방사성핵종 복막촬영술을 이용한 복수에 동반된 수흉의 감별진단

이규보(Kyu Bo Lee),이재태(Jae Tae Lee),황기석(Kee Suk Whang),조동규(Dong Kyu Cho),김광원(Gwang Weon Kim),정병천(Byung Cheon Chung),정준모(Joon Mo Chung) 대한핵의학회 1990 핵의학 분자영상 Vol.24 No.2

N/A Simultaneous presence of ascites and pleural effusion has been documented in patients with cirrhosisof the liver, renal disease, Meigs' syndrome and in patients undergoing peritoneal dialysis. Mechanisms proposed in the formation of pleural effusion in most of the above diseases are lymphatic drainage and diaphragmatic defect. But sometimes, hepatic hydrothoraxes in the absence of clinical ascites and pleural effusion secondary to pulmonary or cardiac disease are noted. It is not always possible to differentiate between pleural effusion caused by transdiaphragmatic migration of ascites and by other causes based soly on biochemical analysis. Authors performed radionuclide scintigraphy after intraperitoneal administration of Tc-99m-labeled colloid in 23 patients with both ascites and pleural effusion in order to discriminate causative mechanisms responsible for pleural effusion. Scintigraphy demonstrated the transdiaphtagmatic flow of fluid from the peritoneum to pleural cavities in 13 patients correctly. In contrast, in 5 patients with pleural effusion secondary to pulmonary, pleural and cardiac diseases, radiotracers fail to traverse the diaphragm and localize in the pleural space. Ascites draining to mediastinal lymph nodes and blocked passage of lymphatic drainage were also clarified, additionaly. Conclusively, radionuclide peritoneal scintigraphy is an accurate, rapid and easy diagnostic tool in patients with both ascites and pleural effusion. It enables the causes of pleural effusion to be elucidated, as well as providing valuable information required when determining the appropriate therapy.

재생불량성 빈혈의 Antilymphocyte Globulin 요법 : Androgen 요법과의 비교 Comparison with Androgen Treatment

김광원,최정일,정병천,이재태,이규보,황기석 대한내과학회 1992 대한내과학회지 Vol.42 No.1

1970년 1월부터 1990년 8월 사이에 경북대학교 병원에서 재생불량성 빈혈로 진단받은 환자들중 ALG 치료를 받은 33명과 androgen 치료를 받은 88명, 그리고 수혈 등 보존적 치료만을 한 15명을 대상으로 각 치료에 따른 치료 반응도와 생존율을 비교하고 그 예후인자를 살펴보았다. 1) ALG 치료와 androgen 치료의 치료반응도를 비교해 보면 ALG 치료군이 42%였고 androgen 치료군은 38%로 두군 사이에 유의한 차이가 없었다. 2) ALG 치료군에서는 30세 이상에서 30세 미만보다 반응도가 높았고(58% 대 33%), T4/T8이 1미만인 5명 중 4명이 반응하였는데 반하여 T4/T8 비율이 1이상인 8명에서는 반응이 없었다. 진단으로부터 치료까지의 기간이나 호중구 수치는 치료반응과 상관이 없었다. 3) ALG 요법에서 치료반응 환자와 무반응 환자간의 말초혈액 소견이나 골수소견, 혈청 철소실 반감시간들을 비교하면 치료반응군에서 T4/T8 비율이 낮았고, 혈철 철 소실 반감시간이 비교적 짧았다. 4) 6개월 내에 사망한 조기 사망자에서는 중증 재생불량성 빈혈이 62%로서 많이 분포되어 있었다. 5) 전대상 환자의 생존율은 2년 생존율이 64%, 10년 생존율이 50%였다. 2년 생존율을 치료방법으로 구분하면 ALG 치료군이 78%로서 angrogen 치료군 66%, 보조적 치료군 27%에 비하여 유의하게 높았으며(p=0.0000), ALG 치료군 중에서도 치료반응군에서 생존율 94%가 치료무반응군 47%에 비하여 월등히 높았고 비중증 재생불량성 빈혈군의 2년 생존율이 77%로서 중증 재생불량성 빈혈의 43%에 비하여 유의하게 높았다(p=0.0000). 6) ALG 치료에 따른 부작용은 발열 및 완, 자반증, 발적, 치주출혈, 주사부의 동통, 관절통 등이 있었다. 이상의 결과를 보아 ALG 치료는 angrogen 치료나 보존적 요법에 비해 재생불량성빈혈 환자의 생존율을 높일 수 있고, 그중에서도 조기 사망률이 높은 중증 재생불량성빈혈 환자에게 또한 연령이 많은 환자에서 우선적으로 사용할 수 있는 것으로 판단된다. In order to evaluate the therapeutic efficacy of antilymphocyte globulin (ALG) in the aplastic anemia, the authors investigated 136 cases of aplastic anemia that comprised 33 cases of ALG treatment and 103 cases of non-ALG treatment in Kyungpook National University Hospital from january 1, 1970 to August 31, 1990. The response rate of ALG was 42%, while the response rate of androgen was 38%, which showed little significant difference. In responded patients showed a lower T4/T8 ratio and relatively short plasma radioiron disappearance half time. Severe aplastic anemia was 62% of the early death group which died within 6 months after diagnosis. A two year survival rate was 64% in the all cases, but the 2 year survival rate was 78% in the ALG treated group, and 27% in the support treated group, that revealed a significant difference. The responders to ALG treatment had remarkably high survival rate in comparison to nonresponders. The non-severe aplastic anemia had a higher survival rate than severe aplastic anemia. The side reactions of ALG were: fever and chills, purpura, erythema, gum bleeding, pain on the injection site, arthralgia and so on. We observed that ALG was more effective in the treatment of aplastic anemia than the androgen and supportive therapy only and so concluded that the ALG is useful in severe aplastic anemia of old age.

간스캔에서 Hepatic Dome의 변형을 나타낸 예의 분석

하승우,손상균,김광원,유병애,이재태,이규보,황기석 慶北大學校 醫科大學 1989 慶北醫大誌 Vol.30 No.3

Abnormal appearances of the hepatic dome in liver scans cannot be described strictly as a pathologic condition or normal variation. Many hepatic and extrahepatic conditions associated with deformed hepatic dome have been reported. We evaluated 105 cases with deformed hepatic dome and then analyzed underlying causes. These occurred among 4800 liver scans performed with Tc-99m-phytate between January 1983 and March 1989 at Kyungpook National University Hospital. Fifty five domes were flattened, and 32 domes were protruded upwardly. Twelve domes showed focal filling defect, and 6 domes had irregular and serrated border. Analysis of the causes of deformities revealed that 29 cases(27.6%) were due to intrahepatic lesion, and 53 cases(50.5%) were associated with adjacent organ disorders such as heart, pleura, diaphragm and lung. However, no detectable abnormalities were noted in 23 cases(21.9%), despite intensive diagnostic effort.