표재성 종괴로 나타난 척골신경의 슈반세포종: 수술적 치험 2예

김상림 ( Sang Lim Kim ),장용현 ( Yong Hyun Jang ),이원주 ( Weon Ju Lee ),김도원 ( Do Won Kim ),김경태 ( Kyoung-tae Kim ),이석종 ( Seok-jong Lee ) 대한피부과학회 2015 대한피부과학회지 Vol.53 No.4

24세 남자 환자(증례 1)가 약 5년 전 좌측 위팔 내측 부위에 발생한 피하결절을 주소로 내원하였다. 상기 병변은 인접 조직에 약간 고정된 느낌이었으며 주위로 방사하는 압통을 동반하였다. 진단을 위해 시행한 초음파 및 자기공명영상 검사 결과 근막 하부에 척골 신경에서 연결된 직경1.4 cm 크기의 연부조직종양이 관찰되었다(Fig. 1). 39세 여자 환자(증례 2)가 수개월 전 발생한 좌측 위팔 내측 부위의 압통을 동반하며 주위 조직에 고정된 느낌의 피하결절을 주소로 내원하였다. 초음파 및 자기공명영상 검사 결과 근막하부에 척골신경에서 연결된 직경 1.6 cm 크기의 연부조직종양이 관찰되었다. 두 환자 모두 근전도와 신경전도검사를 시행하여 척골신경에서 유래한 슈반세포종으로 추정 하였으며, 이들을 통하여 술 전 신경학적 이상이 없음을 확인하였다. 절제 동안 신경학적 모니터링이 필요하다고 판단되어 본원 신경외과로 전과되어 근전도와 운동유발전위를 관찰하면서 종양 절제술을 시행하였으며, 벙리조직검사 결과 두 증례 모두 전형적인 슈반세포종의 조직소견을 보였다. 환자는 수술 후 각각 20개월과 5개월까지 신경학적 손상이나 종양의 재발 없이 경과 관찰 중이다. 슈반세포종은 슈반세포에서 유래하여 신경 축색을 둘러싸는 양성의 피막형성 종양으로, 치료로는 종양의 단순 절제수술이 대표적이며 대부분 별다른 합병증 없이 시행된다1. 그러나 중요한 신경에서 발생하는 슈반세포종이 매우 표재성으로 위치하는 경우 단순한 진피 또는 피하 종괴로 오인되어 일반적인 피부외과적 절제 수술을 시행하게 되면 자칫 치명적인 문제가 발생할 가능성이 있어 이에 대한 경각심이 요구된다. 피내 또는 피하에 종양이 발생하여 점차 커지고 신체검사에서 Tinel’s sign 등을 보일 경우신경계 유래 종양 등이 의심될 수 있다. 이 때는 신경전도검사와 근전도 외에도 초음파 검사 등의 영상의학적 검사를 시행하여 종양의 유래와 해부학적 위치를 파악하는 것이 필요하다. 추가적으로 자기공명영상 검사를 통하여 인접구조물과의 관계를 파악할 수 있으며, 진단이 확실하지 않은 경주의해야 한다. 보고된 바에 따르면 절제 후 피부 감각 소실(25%), 운동 기능 손상(13%), 혈종 발생으로 인한 수술직후 광범위 신경 마비 및 통증, 혈관의 손상, 심한 신경병성 통증(10%), 슈반세포종의 재발 등의 다양한 합병증이 발생하였다5. 더욱이 본 증례와 같이 피부에 얕게 위치하는 신경(Fig. 2)에서 슈반세포종이 발생하여 피부 종괴로 촉지되는 경우 일반적인 피부 또는 연부종양으로 오인될수 있다. 이 때 신경검사 등의 추가적인 검사 없이 일반적인 피부 양성종양에 준하여 절제한다면 이와 같은 합병증 발생의 위험은 더욱 증가할 것으로 생각된다.

메조테라피 약제가 모낭의 기관배양 및 모유두 세포배양에 미치는 효과

이원주 ( Weon Ju Lee ),최윤석 ( Yoon Seok Choe ),이재철 ( Jae Chul Lee ),이석종 ( Seok Jong Lee ),김도원 ( Do Won Kim ),민복기 ( Pok Kee Min ) 대한피부과학회 2006 대한피부과학회지 Vol.44 No.10

Background: Hair loss including androgenetic alopecia and chronic telogen effluvium is recognized increasingly as a physically and psychologically harmful medical condition. Mesotherapy is considered as a new therapeutic modality for hair loss. Objective: We studied to determine the effect of medications used in mesotherapy on hair organ culture and culture of dermal papilla cells. Methods: First, occipital hair follicles were collected from patients with androgentic alopecia and separated into single hair follicles. The single hair follicles were cultured in William E media mixed with mesotherapy medications such as lidocaine, placental extract, Pondil(R), CRP-1000(R), and mixture of all these medications at different concentrations (1, 10, 50㎕). On the 8th day, the cultured single hairs were stained with H&E and the length of those was measured under a microscope to compare with control group. Immunofluorescent study was performed to check expression of Ki-67, Bcl-2 and Bax on the hairs. Second, dermal papilla cells were isolated from occipital anagen hairs of patients with androgenetic alopecia and cultured in Dulbeco`s modified Eagle`s medium (DMEM). The mesotherapy medicines were added to the medium with one and two thousand dermal papilla cells, respectively. At the 3rd day, survival of the cells was evaluated with ELISA method comparing with control group. Results: There were no statistical differences of the length of the hairs and the survival of the dermal papilla cells between experimental and control groups. With Bcl-2, we couldn`t see any differences between experimental and control groups. With Ki-67, experimental groups showed less expression than control group. On the contrary, experimental groups showed more expression than control group in case of Bax. Conclusion: We can conclude from the results that the four medications used in mesotherapy are not effective for growth of cultured hair follicles and survival of cultured dermal papilla cells. However, more study would be needed for the establishment of objective and scientific evidences supporting mesotherapy and we should be in search for new medications for mesotherapy. (Korean J Dermatol 2006;44(10):1178~1185)

형광 편광 면역측정법을 이용한 Diffusion Chamber에서의 경피 흡수 측정

이원주 ( Weon Ju Lee ),김용현 ( Yong Hyun Kim ),김도원 ( Do Won Kim ),전재복 ( Jae Bok Jun ),정상립 ( Sang Lip Chung ) 대한피부과학회 1996 대한피부과학회지 Vol.34 No.5

Background: The penetraton in vivo of topically applied substances can be assessed by physiological or pharmacalogical signs or analysed by chemical or histological techniques. In vitro absorption can be commonly quantitated by measuring the passage of a radioisotope-labelled substance across skin that has been mounted in a diffusion chamber. Objective : Fluorescence polarization immunoassay technique has made the possible rapid growth of therapeutic drug nonitoring. We applied this methodology in measuring percutaneous absorption in a diffusion chamber. Methods : We utilized sheets of whole epidermis prepared from the circumcised prepuce. Some epidermal sheets were treated with 2 ml of acetone for 2 minutes, and others not. The epidermal sheet was mounted in a diffusion chamber between the donor compartment for the penetrant and the receptor compartment containing saline. Lidocaine HC1(10 microgram/cm) in vehicle(propylene glycol:ethanol; 7:3vol/vol) was applied to the donor compartment for the penetrant. With flow rate of about 3 ml/h all of the receptor phase collected during 2 hours interval were quantitated for 10 hours by the fluorescence polarization immunoassay. Results : Total absorption of lidocaine HC1 in the acetone-untreated group was 2.14-0.74% of the applied dose. Total absorption in the acetone-treated group showed no substantial difference (2.09+1.25%) compared to those of acetone-untreated group. The amount of lipid extracted from a epiderrnal sheet with acetone was 19+2.97%. Conclusion : Fluorescence polarization immunoassay may be a useful method in measuring percutaneous absorption in vitro. (Kor J Dermatol 1996;34(5): 718-724)

수종 용매의 각질층 지질 제거능력 비교

이원주 ( Weon Ju Lee ),김도원 ( Do Won Kim ),전재복 ( Jae Bok Jun ),정상립 ( Sang Lip Chung ) 대한피부과학회 1995 대한피부과학회지 Vol.33 No.5

Background : The efficiency of lipid extraction by different kinds of solvents from stratum corneum may vary. Objective : To assess the efficiency of lipid extraction by several solvents from the stratum corneum, the total lipids weights were measured by an electronic microbalance, and lipids compositions of a stratum corneum were analyzed by thin layer chromatography(TLC) after pretreatment of several solvents, respectively. Methods : Stratum corneums separated fro circumcised prepuce were pretreated with acetone, petroleum ether, or distillecl water for 10 minutes. Lipids of stratum corneum were extracted with methanol chlorofonn-H,O mixture(4: 2: 1.6, v/v, Bligh Dyer solvent). Lipids weights were weighed, and the ratio of lipid weight and wet weight of stratum corneum were measured. TLC was performed and lipids compositions were quantitated by photodensitometer. Lipids extraction in viva was performed on both forearms. After two times stripping with sellotape, lipids were extrected with the solvents using cup method. These were dried and lipids weights were weighed. Results : The efficiency of lipid extraction from the stratum corneum of circumcised prepuce were acetone, petroleum e1 her, and distilled water in decreasing order. All groups were similar in the compositions of the stratum corneum lipids except for those of cholesterol esters and sphingolipids. The efficiency of lipid extraction from in vivo skin were ranked in order from petroleurn ether, acetone, down to distilled water. The efficiency of lipid extraction of petroleum ether and acetone were higher than that of distilled water. Conclusipn : The efficiency of lipid extraction is influenced by the kinds of solvents as well as the materials and the methods of extraction. (Kor J Dermatol 1995;33(5): 830-840)

이상지각성 대퇴신경통

이원주 ( Weon Ju Lee ),윤기성 ( Ki Seong Yoon ),김도원 ( Do Won Kim ),정상립 ( Sang Lip Chung ) 대한피부과학회 1995 대한피부과학회지 Vol.33 No.4

Meralgia paresthetica is a syndrome consisting of numbness, pain, tingling, burning and/or a variety of other paresthesias on the distribution of the lateral femoral cutaneous nerve (LFCN) of the thigh. We report a case of meralgia paresthetica in a 41-year-old woman who complained of the symptoms of pain, burning sensation, and dysesthesia which occurred whilst standing up without any other constitutional symptoms. The authors suspect that frequent. and persistent squatting may play a role in the development of the present symptoms. (Kor J Dermatol 1995;33(4): 755-758)

Tape Stripping 후 민감성 피부와 비민감성 피부의 젖산 자상 검사 결과 비교

이원주 ( Weon Ju Lee ),장윤환 ( Yun Hwan Jang ),김도원 ( Do Won Kim ),이석종 ( Seok Jong Lee ),나건연 ( Gun Yeon Na ),정상립 ( Sang Lip Chung ) 대한피부과학회 2004 대한피부과학회지 Vol.42 No.5

비구순구와 비익부를 침범한 악성종양 제거 후 단순 봉합과 전위피판을 응용한 결손부의 복원

이원주 ( Weon Ju Lee ),이석종 ( Seok Jong Lee ),김도원 ( Do Won Kim ),이재철 ( Jae Chul Lee ),김호연 ( Ho Youn Kim ),성현철 ( Hyun Chul Sung ) 대한피부과학회 2007 대한피부과학회지 Vol.45 No.6

The performance of facial cutaneous reconstructive surgery requires understanding and application of many important principles. Facial surgical defects can be repaired by simple primary suture, secondary intention healing, skin graft or by cutaneous flap. Tissue reservoirs, mechanisms and effects of tissue movement, and favorable incision placement should be considered when planning a local flap repair for surgical defects. Surgical techniques that maximize the aesthetic and functional outcome should be conducted. Management of surgical defects of the nose is often challenging. Maintenance of an aesthetically and functionally normal nose requires careful preoperative planning and meticulous surgical technique. One of the challenges in nasal reconstruction is the lack of excess skin within the nasal cosmetic unit. We reconstructed the defect of the nasolabial fold and nose with simple primary suture and modified transposition flap and achieved a good cosmetic result. (Korean J Dermatol 2007;45(6):592∼595)

Liposome δ-5-aminolevulinic Acid에 의한 배양 피지세포와 모낭기관에서의 Protoporphyrin 9의 발현

이원주 ( Weon Ju Lee ),이석종 ( Seok Jong Lee ),김도원 ( Do Won Kim ),박경덕 ( Kyung Duck Park ),손미영 ( Mi Yeung Sohn ),김문규 ( Moon Kyu Kim ),김정철 ( Jung Chul Kim ),한인숙 ( In Sook Han ) 대한피부과학회 2007 大韓皮膚科學會誌 Vol.45 No.4

Background: Photodynamic therapy with topical δ-5-aminolevulinic acid (ALA) has been introduced for effective treatment of facial acne. Topical routes for ALA have been explored via a photosensitizer delivery system. Objective: We performed this study to evaluate absorption of liposome ALA (Lipo-ALA) into the sebocytes of cultured sebaceous glands and hair organs. Methods: We cultured KGM sebocytes that were derived from human sebaceous glands. In addition, we cultured William E media pilosebaceous hair units that were isolated from the occipital scalp. Lipo-ALA (10μg/ml) and ALA (10μg/ml) were added to the 1 ml KGM containing sebocytes for 24 hours and the 1 ml William E media containing pilosebaceous hair units for 6, 24, 48 and 72 hours, respectively. Results: Absorption of Lipo-ALA into the sebocytes of cultured sebaceous gland and hair organs was higher than that of ALA. Conclusion: Lipo-ALA may be considered as an effective photosensitizer in photodynamic therapy for facial acne. (Korean J Dermatol 2007;45(4):327~331)

안드로겐탈모증에 사용되는 보완대체의학에 관한 예비연구

김준영 ( Jun Young Kim ),김원정 ( Won Jeong Kim ),김호연 ( Ho Youn Kim ),이원주 ( Weon Ju Lee ),이석종 ( Seok Jong Lee ),김도원 ( Do Won Kim ),김병수 ( Byung Soo Kim ),황보민 ( Bo Min Hwang ),서형식 ( Hyung Sik Seo ) 대한피부과학회 2011 대한피부과학회지 Vol.49 No.7

Background: Use of treatments categorized as complementary and alternative medicine (CAM) have increased considerably in the field of dermatology. However, most studies have been focused on atopic dermatitis and psoriasis, and little is known of the prevalence of use of CAM in patients with androgenetic alopecia (AGA). Objective: We aimed to determine the frequency, type, duration, and factors associated with the use of CAM in the treatment of AGA at a dermatologic outpatient clinic. Methods: AGA patients at the outpatient clinic (n=151) received a face-to-face structured questionnaire covering 5 types of CAM plus an open alternative labeled ``other type``. Results: Overall 70.2% (106/151) of the subjects with AGA reported the current or previous use of at least 1 CAM. Topical application (85, 56.3%) was most frequently used, followed by diet therapy (35, 23.2%), health food supplements (15, 9.9%), massage therapy (13, 8.6%), and Oriental medicine (10, 6.6%). With respect to the reasons for using CAM, ``recommendation by people around the patient`` (59.4%) was most commonly chosen by the patients. The subjective therapeutic effect and satisfaction with CAM were the best with health food supplements and topical application (80.0% and 21.1%, respectively). Conclusion: As our results indicate that the use of CAM continues to rise by patients with AGA, the need for reliable sources of information about specific CAM therapies becomes more essential. To assist AGA patients in selecting proper treatment modalities, further longitudinal and controlled studies are required to assess the efficacy and safety of CAM.

건선에 사용되는 보완대체의학에 관한 조사

김준영 ( Jun Young Kim ),이원주 ( Weon Ju Lee ),이석종 ( Seok Jong Lee ),김도원 ( Do Won Kim ),김태훈 ( Tae Hoon Kim ),전재복 ( Jae Bok Jun ),김문범 ( Moon Bum Kim ),김병수 ( Byung Soo Kim ) 대한피부과학회 2010 대한피부과학회지 Vol.48 No.6

Background: Psoriasis is a chronic and intractable disease that drives patients to seek a complete cure. Recently, the patients who have failed with conventional medicine increasingly appear to be turning to complementary and alternative medicine (CAM), yet little is known of CAM`s prevalence of use, and its effectiveness and safety, and especially for treating psoriasis. Objective: The aim of this study was to qualify and quantify the usage of CAM for the treatment of psoriasis, and to offer valid information for dermatologists. Methods: A total of 158 patients suffering from psoriasis were interviewed and they filled out a face-to-face structured questionnaire. Results: Sixty-nine of 158 (43.7%) psoriasis patients reported the current or previous use of CAM. In the order of frequency, oriental medicine (49, 31.0%) was the most commonly used, followed by spa and bath therapy (31, 19.6%), health food supplements (28, 17.7%), topical applications (14, 8.9%) and dietary therapy (14, 8.9%). The majority of patients (60.9%) used CAM from the `Desire to try everything`. The subjective therapeutic effect and satisfaction with CAM were predominant with health food supplements (57.1% and 53.6%, respectively). After the use of CAM, the patients most frequently complained of `aggravation of psoriasis` as a side effect of CAM (14.0%). Conclusion: These results indicate that CAM is being widely used by patients with psoriasis. However, the use of CAM seems to not be very effective and it is not free of risks. Thus, the direct and indirect risks, and the merits and disadvantages of CAM should always be considered with prudence before using CAM in clinical practice. (Korean J Dermatol 2010;48(6):494∼502)