두경부 골수외 형질세포종의 임상적 고찰

심광용(Kwang Yong Shim),안중배(Joong Bae Ahn),김귀언(Gwi Eon Kim),정현철(Hyun Cheol Chung),김주항(Joo Hang Kim),김병수(Byung Soo Kim),노재경(Jae Kyung Roh) 대한두경부종양학회 1999 대한두경부 종양학회지 Vol.15 No.1

Objectives: This study was carried out to analyze the clinical profile and the results of treatment of a series of patients with extramedullary plasmacytoma(EMP) of the head and neck. Materials and Methods: The clinical features, treatment and survival of 14 patients with EMP seen at Yonsei Medical Center between 1970 and 1998 were carefully reviewed. Results: The median age was 48 years(range 15-75) and there was a male predominance(M:F 1.8:1). Nasal cavities and paranasal sinuses account for 50% of the primary sites and the most common symptom was airway obstruction(50%). Five patients(36%) showed evidence of adjacent bone destruction, one patient had lymph node involvement and one patient had an IgG monoclonal gammopathy at the time of diagnosis. All 5 patients treated with radiotherapy alone achieved local control. Of 5 patients treated with surgery alone, 2 patients(40%) had local failure. Of 3 patient treated with a combination of surgery and radiotherapy, one patient had local recurrence. A total of7 patients(54%) had local, distant or nodal relapses after primary treatment. Six of them received salvage treatment. With salvage treatment of surgery and/or radiotherapy, local control was achieved in 4 of 6 patients. Conversion to multiple myeloma was seen in one patient. Conclusion: Radiotherapy should be recommanded as treatment of choice for EMP of the head and neck. Surgery should be reserved for radioresistant or recurrent tumors, but tumors that are localized and can be removed relatively easily with little morbidity may be treated by primary surgery.

위암 및 간암환자의 치료에 있어 양.한방 협진의 효과에 관한 임상시험

이종인,심광용,김호영,최서영,방대건,조경숙,Lee, Chong-In,Shim, Kwang-Yong,Kim, Ho-Young,Choi, Seo-Young,Bang, Dae-Geon,Cho, Kyung-Sook 대한암한의학회 2001 大韓癌韓醫學會誌 Vol.7 No.1

Objectives: We compared the therapeutic response, the treatment-related toxicity, and the improvement of subjective symptoms between the chemotherapy alone group and the western-oriental combined treatment group and evaluated the role of oriental medicine for the improvement of chemotherapy-related toxicity in the advanced gastric cancer and hepatocellular carcinoma. Methods: We evaluated 36 gastric cancer or hepatocellular carcinoma patients(chemotherapy alone group 25 patients, combined treatment group 11 patients) who had been treated in Wonju Christian Hospital and Hana Hospital of Oriental Medicine between June 1999 and October 2000. Enrolled patients' general medical records, results of laboratory and imaging studies, treatment-related toxicities, and subjective symptoms were recorded regularly according to the planned protocol. Therapeutic responses were estimated according to the WHO response criteria and the changes of tumor marker value such as CEA, CA 72-4 and AFP. Results: 1. There was no significant difference of therapeutic response by the WHO response criteria between the two groups(p=.459). 2. There was a significant decrease of tumor marker value in the combined treatment group compared to the chemotherapy alone group(p=.023). 3. There was less comprehensive treatment-related toxicity in the combined treatment group compared to the chemotherapy alone group(p=.037), but there was not a significant difference of comprehensive improvement of subjective symptoms between the two groups(p=.091). Conclusions: Based on the above results, we could expect the possibility of improvements in therapeutic response and treatment-related toxicity with the western-oriental combined anticancer treatment.

인슐린 비의존형 당뇨병 환자에서의 당뇨병 유병기간에 의한 미세혈관 합병증 발생 시기의 추정

원영준(Young Jun Won),신영구(Young Goo Shin),심광용(Kwang Yong Shim),홍애라(Ae La Hong),송창호(Chang Ho Song),정춘희(Choon Hee Chung),서병기(Byeong Ki Seo) 대한내과학회 1996 대한내과학회지 Vol.51 No.4

N/A Objectives: Microvascular complications in NID-DM patients have a positive correlation with the duration of diabetes. However, it is difficult to know about the duration of diabetic period before clinical diagnosis that the microvascular complications have been progressed, Harris et al previously presented in Diabetes Care that the patients with NIDDM had the prediagnostic period of 4-7 years before clinical diagnosis. We can find frequently the microvascular complications at the time of clinical diagnosis of diabetes, and thus assume that the microvascular complications have developed before the clinical diagnosis of diabetes. We estimate the periods, between the onset of diabetes and its clinical diagnosis in Korean diabetic patients. Methods - We studied 281 NIDDM patients who were admitted at Wonju Christian Hospital from January 1993 to July 1994. Weighted linear regression was performed to examine the relationship between the duration of diabetes and the prevalence of microvascular complications of diabetes. We can find the linear relationship between the two parameters (prevalence and duration of diabetes). By extraplotting at this linear relationship to the time when the prevalence of microvaseular complication was estimated to be zero, the time of onset of detectable complication was calculated. Results: 1) Prevalence of neuropathy at clinical diagnosis of diabetes was estimated to be 35.9%, and neuropathy has occurred 10.6 years before the clinical diagnosis of NIDDM. 2) Prevalencd of retinopathy at clinical diagnosis of diabetes was estimated to be 21.6%, and retinopathy has occurred 6.4 years before the clinical diagnosis of NIDDM. 3) In the cases of nephropathy, the correlation between the duration of diabetes and the prevalence was not statistically significant. Conclusion: In our study, the microvascular complications may develop several years before the clinical diagnosis of diabetes, and therefore, checkup for the microvascular complications is essential at the diagnosis of diabetes.

비장에 이식된 간세포의 조직학적 특성과 알부민 유전자의 발현

권상옥(Sang Ok Kwon),이동기(Dong Ki Lee),김준명(Jun Myeong Kim),박의련(Eui Ryun Park),심광용(Kwang Yong Shim),정필호(Phil Ho Jung),조미연(Mee Yon Cho),허만욱(Mann Uk Hur) 대한내과학회 1997 대한내과학회지 Vol.53 No.4

N/A Background: The morphological characteristics of hepatocytes transplanted into the spleen have been studied. However few attempts has been made to determine the expression of genes in intrasplenically transplanted hepatocytes. The aim of this study was to explore whether the pattern of expression of albumin gene in intrasplenically transplanted hepatocytes is similar to that in adult liver, resulting in the long-term expression of this hepatocyte-specific gene. Methods: Hepatocytes isolated from liver of syngeneic Fischer 344 rats and transplanted into the spleen of rats from the same strain survived for 12 months in the absence of immunosuppressive drugs. Microscopic examination of intrasplenic hepatocytes and Northern blotting for albumin gene expression of RNA extracted from liver and spleen was performed. Results: Microscopy demonstrated that hepatocytes attached themselves only in the red pulp of the spleen and isolated hepatocytes preserved the fine structures characteristic of normal hepatic parenchymal cells. Throughout the 12 months period, intrasplenically transplanted hepatocytes expressed albumin mRNA. Conclusions: Intrasplenically transplanted hepatocytes represent a unique in vivo system of extrahepatic maintenance of hepatocytes. This novel transplantation system could be used to investigate hepatocyte engraft, proliferation and gene expression.

위암종과 Epstein-Barr 바이러스와의 연관성에 대한 연구

심광용,김호영,김효열,백순구,권상옥,조미연,이창훈,이종인 건국대학교 의과학연구소 2004 건국의과학학술지 Vol.14 No.-

Objectives: Epstein-Barr virus (EBV) has been known to be linked to a spectrum of neoplastic conditions, including nasopharyngeal carcinoma, Burkitt's lymphoma, peripheral T-cell lymphoma and Hodgkin's disease. This study aims to investigate the association of EBV with gastric carcinoma in Korea. Methods: Fifty-three cases of gastric adenocarcinoma were studied for evidence of EBV infection by EBV-encoded small RNA (EBER) in situ hybridization (ISH) on the paraffin sections and amplifying the EBV genome encoding envelop glycoprotein (gp220) with polymerase chain reaction (PCR) in fresh gastric cancer specimens. Results: EBER was detected in 7 (13.2%) of 53 gastric carcinomas and all cases were male. In 6 (85.7%) of 7 EBER-positive cases, the tumors were located in the upper and middle part of the stomach. EBER ISH study showed strong positivity in all the tumor cells, but negativity in surrouning lymphocytes, stromal cells and normal gastric mucosa. DNA PCR was positive in 23 (43.4%) of 53 gastric carcinomas, including all of 7 EBER-positive cases. Conclusion: We could observe some association of EBV with gastric carcinoma, and our findings about the charateristics of EBV-positive gastric cancers involving sex, site and histological type are similar to those in Japan. However, EBV-positive rate of gastric cancer is higher than in Japan and lower than in Western countries. Further studies to elucidate oncogenic mechanism of EBV in gastric cancer should be performed.

상안와열 증후군을 동반한 안와로 전이된 원발성 간세포암 1예

김유미,심광용,노재경,박정엽,유내춘 대한내과학회 2001 대한내과학회지 Vol.60 No.2

The superior orbital fissure syndrome is a rare condition characterized by opthalmoplegia, ptosis, and proptosis of the eye, fixation and dilation of the pupil, and anesthesia of the upper eyelid and forehead. Tumor metastasis to the orbit is uncommon and there were only 11 histologically proven cases of metastatic hepatocellular carcinoma to the orbit. There was only one case of metastatic hepatocellular carcinoma to the orbit with superior orbital fissure syndrome. The prognosis were poor for all reported cases, but palliative radiotherapy could be some help. We report a rare case of metastatic hepatocellular carcinoma to the orbit with superior orbital fissure syndrome.(Korean J Med 60:179-182, 2001)

원발성 간세포암과 함께 진단된 점액표피양종양 1 예

김용수,김유미,박영년,심광용,박찬일,유내춘,강혜윤,노재경,박정엽,강이화 대한내과학회 2001 대한내과학회지 Vol.61 No.2

Mucoepidermoid carcinoma is a common malignant tumor of the salivary glands, but rare in other sites. Only 10 cases of mucoepidermoid carcinoma of liver have been reported, and there was 1 case of double primary cancer of hepatocellular carcinoma and mucoepidermoid carcinoma. The definite diagnosis and pathogenesis are still controversial. However, hepatocellular carcinoma is the second most common cancer in Korea. Its etiology is better known compared to mucoepidermoid carcinoma. We report a rare case of double primary cancer of mucoepidermoid carcinoma and hepatocellular carcinoma in liver.(Korean J Med 61:162-167, 2001)

비노출형 유두부암

백순구,심광용,김준명,박의련,권상옥,이동기,정필호,조도연 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.3

Background: Ampullary cancer is a malignant lesion in the pancreatobiliary system with a relatively good prognosis because of its slow growth, early appearance of symptoms and high resectability. Hndoscopic retrograde cholangiopancreaticography(ERCP) is an important and useful method in the diagnosis of ampullary cancer because it identifies the location of lesions endoseopically and by opacification of the bilio-pancreatic ducts and allows confirmation by biopsy, But the diagnostic accuracy of endoscopic forcep biopsy was variable according to the macroscopic appearance of ampullary cancer. In unexposed type ampullary cancer, biopsy after endoscopic sphincterotomy or intraluminal cannulatian biopsy has been recommended because the cancer tissue was either not visible at all or barely visible from the lumen of the duodenum. The purpose of this study was to evaluate the contribution of endoscopic sphincterotomy to the diagnosis of ampullary cancer and to compare the clinical eharasteristics of unexposed type ampullary cancer with those of exposed type ampullary cancer. Method: Thirty-one cases of the ampullary cancers over the past 5 years were reviewed. Macroscopically, thirty one ampullary cancers were classified into two types. The unexposed type ampullary cancer was defined normal ampullary mucosa with or without protruding. The exposed type ampullary cancer was defined abnormal ampullary mucosa including nodular, ulcerative, nodulo-ulcerative and polypoid appearance. Ampullary cancers were diagnosed preoperatively by forcep biopsy, biopsy after endoscopic sphincterotomy, or brushing cytology. Result: The proportion of unexposed type in ampullary cancer was 29%(9 cases). There were no differences of age, sex, diagnostic clue, distal common bile duct(CBD) shape and CBD dilatation by ERCP between unexposed and exposed type ampullary cancers. The serum bilirubin, alkaline phosphotase and GGT were lower in unexposed type comparing with exposed type. The unexposed ampullary cancers could be diagnosed with biopsy after endoscopic sphincterotomy except one case. Biopsy samples were successfully obtained immediately after spltincterotomy in 3 patients and a few days(3day later-lmonth later) after sphincterotorny in 5 patients. Conclusion: We consider the possibility of unexposed amullary cancer in cases of jaundice or duct dilatation with normal ampulla mucosa and should perform biopsy after endoscopic sphincterotomy.

십이지장 유두주위 게실의 임상적 특성

이동기,백순구,심광용,김준명,박성진,박의련,권상옥,정필호 대한소화기내시경학회 1996 Clinical Endoscopy Vol.16 No.6

Background/Aims: Periampuilary diverticulum has been known to be associated with various bilio-pancreatic diseases such as choledocholithiasis and disturbs performing selective cannuiation of ERCP and EST. This present study aims to investigate anatomical morphology of periampullary diverticulum and to determine whether periampullary diverticulurn influences difficulty and complication performing of ERCP and to analyse the relationship between periampullary diverticulum and choledocholithiasis. Methods: We reviewed records of chart and diverticular pictures in 1389 cases of underwent ERCP and evaluated the incidence, size, direction, location of periampullary diverticulum and its influence against performing of ERCP and investigated its relationship with bilio-pancreatic diseases such as choledocholithiasis. Results: The incidence of periampullary diuerticulum was 19.4% and showed 18.5 in male, 20.6% in female. There was a trend towards a higher rate with increasing age. In a aspect of morphology, 95.9% of diverticula were presented as single and almost directed on the upper portion of ampulla and located adJacent to ampulla. In the presence of periampullary diverticulum, the incidence of choledocholithiasis was 30.3% higher than 13.1 % without periampullary diverticulum and showed a statistically significant difference in incidence between patients with and without periampullary diverticulum. The rate of selective cannulation failure performing of FRCP was 9.3% with periampuilary diverticulum and 9.7% without periampullary diverticulum and showed no statistical difference between the two groups. In the patients with EST, rate of complication such as bleeding was with 5.9% with periampullary diverticulum and 12.7% without periampullary diverticulum and no statistical difference between the two groins was found. Conclusion: These results indicate that pariampullary divertieulum vas often found during ERCP and its incidence was nearly close to the other fareign reports. Periampullary diverticulum was correlated with chollocholithasis and didn't influence the techniques in perfarmitng of ERCP and EST.

진행성 위암 및 간암에서 양한방 협진의 치료효과

김호영,이종인,심광용,윤상진,박종구,방대건,최서영,이창훈 건국대학교 의과학연구소 2004 건국의과학학술지 Vol.13 No.-

Objectives: We compared the therapeutic response, the treatment-related toxicity, and the improvement of subjective symptoms between the chemotherapy alone group and the western-oriental combined treatment group and evaluated the role of oriental medicine for the improvement of chemotherapy-related toxicity in gastric cancer and hepatocellular carcinoma. Methods: We evaluated 36 gastric cancer or hepatocellular carcinoma patients(chemotherapy alone group 25 patients, combined treatment group 11 patients) who had been treated in Wonju Christian Hospital and Hana Hospital of Oriental Medicine between June 1999 and October 2000. Enrolled patients' general medical records, results of laboratory and imaging studies, treatment-related toxicities, and subjective symptoms were recorded regularly according to the planned protocol. Therapeutic responses were estimated according to the WHO response criteria and the changes of tumor marker such as CEA, CA 72-4 and AFP. Results: 1. There was no significant difference of therapeutic response by the WHO response criteria 2. There was a significant decrease of tumor marker results in the combined treatment group compared to the chemotherapy alone group(p=.023). 3. There was less comprehensive treatment-related toxicity in the combined treatment group compared to the chemotherapy alone group(p=.037), but there was no significant difference of comprehensive improvement of subjective symptoms between the two groups(p=.091). Conclusions: Based on the above results, we could expect the possibility of improvements in therapeutic response and treatment-related toxicity with the western-oriental combined anticancer treatment. between the two groups(p=.459).