Usefulness of Rapid On site Microscopic Evaluation (ROME) of Core Biosy-specimen to Improve Diagnostic Efficasy of EBUS-TBNA

옥소영,여고은,한유진,옥철호,장태원,정만홍,천봉권 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-

Background: EBUS-TBNA is performed to harvest cytologic and core-biopsy specimen. Although feedback from rapid cytology tests are expected to improve diagnostic rates, the value of the routine use of rapid cytology tests has not been established. Puorpose: We evaluated the clinical relevancy of Rapid on site microscopic evaluation (ROME) of core-biopsy specimens using USB microscope. Methods: We performed ROME in 20 core-biopsy specimens after EBUS-TBNA. The core-biopsy specimens were classified to five groups under microscopic view. The first group have no visual evidence of whitish tumor islet (-). The second group have one or several tiny suspicious tumor islet (-/+). The third group have less than 5 visible tumor islets (+). The fourth group have 5-10 ten tumor islets (++), The fifth group have more than 10 tumor islets (+++). The ROME was compared with final pathologic examination. Results: Among 20 specimens, 3 (15%) specimens were classified as first group (-), 2 (10%) as second group (-/+), 5 (25%) as third group (+), 7 (35%) as fourth group (++), 3(15%) as fifth group, respectively. 100% (10/10) clinical relevancy was confirmed in the fourth, the fifth group with 90% (9/10) diagnostic rate. 70% (5/7) clinical relevancy was confirmed in third group with 57% diagnostic rate (4/7). There was no clinical relevancy(5/5) in the first group and second group with no diagnostic value (5/5). Conclusion: ROME have usefullness for predicting the diagnostic value and clinical relevancy in EBUS-core biops specimens. The further study would be warranted to suppor the usefulness of ROME.

Serum 25-Hydroxyvitamin D Concentration Is Independently Inversely Associated with Insulin Resistance in the Healthy, Non-Obese Korean Population

옥소영,하경화,김부경,김현창,심지선,이명하,윤영미,김대중 대한당뇨병학회 2016 Diabetes and Metabolism Journal Vol.40 No.5

Background: We evaluated the associations between 25-hydroxyvitamin D (25(OH)D) concentrations in serum and insulin resistance in the healthy Korean population. Methods: We conducted this cross-sectional analysis in 1,807 healthy Korean people (628 men and 1,179 women) aged 30 to 64 years in the Cardiovascular and Metabolic Disease Etiologic Research Center study. All participants were assessed for 25(OH)D, fasting glucose, and insulin levels, and completed a health examination and lifestyle questionnaire according to standard procedures. Insulin resistance was defined as the homeostasis model assessment insulin resistance higher than the 75 percentile. Results: Compared to those in the highest tertile (≥14.3 ng/mL), the odds ratio (OR) for insulin resistance was 1.37 (95% confidence interval [CI], 1.01 to 1.86) for the 1st tertile (<9.7 ng/mL) and 1.19 (95% CI, 0.08 to 1.62) for the 2nd tertile (9.7 to 14.3 ng/ mL) after adjusting for age, gender, waist circumference, alcohol consumption, smoking status, physical exercise, season, and cohort. After stratification of the subjects by adiposity, these associations remained only in non-obese subjects (lowest tertile vs. highest tertile, multivariable OR, 1.64; 95% CI, 1.05 to 2.56). Conclusion: Serum 25(OH)D has an independent inverse association with insulin resistance in the healthy, non-obese Korean population, even among people with vitamin D insufficiency.

S-497 : Inmmune reconstitution inflammatory syndrome after central nervous system infection in HIV patient

옥소영,박지영,이진영 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1

The treatment of HIV infection has changed the quality of life in immunosuppressed patient. The term immune reconstitution inflammatory syndrome (IRIS) has been defined as a paradoxical deterioration in clinical status attributable to the recovery of the immune system during highly active antiretroviral therapy (HAART). We present a case of suspected IRIS associated with immune restoration in a patient with AIDS related CNS oppotunistic cryptococcal infection. A 42-year-old male with AIDS was admitted with severe headache and stiff neck, and diagnosed as cryptococcal meningitis. His initial CSF cryptococcal antigen titer was 1:32 and CSF culture grew C. neoformans. At presentation the CD4 cell count was 14 cell/μl and HIV viral load was 142,000 copies/mL. He treated with amphotericin B and lopinavir, ritonavir, lamivudine and zidovudine as HAART. 6 months after initiation of therapy, the patient presented with slowly progressive articulation difficulty and both lower limb weakness. Neurologic examination showed dysarthria, mild both upper and lower limb weakness and tingling sensation on both hands. Brain MRI demonstrated confluent symmetrical scalloped appearanced T2 hyperintensities in both parietal and temporal, right occipital white matter and extensive leptomeningeal enhancement of both temporoparietal regions. In followed CSF study, cryptococcal antigen and culture were negative. The CD4 cell count had risen to 221 cell/μl and HIV viral load had decreased to 45 copies/mL. CSF polymerase chain reaction for JC virus DNA is negative. The patient was diagnosed with immune reconstitutional inflammatory syndrome and treated with 5 days IV methylprednisolone followed by oral prednisolone. His antiretroviral treatment regimen was maintained. The patient demonstrated a partial improvement of his upper extremities weakness and dysarthria. Follow up MRI showed much improvement of T2 hyperintensity of parietotemporoccipital white matter and leptomeningeal enhancement. CNS-IRIS remains a serious complication of HARRT for HIV-infected individuals. As no specific biomarkers are currently available, restoration of immune function in any immunesuppressed patient requires extreme caution and close follow-up.

The Impacts of C-Reactive Protein and Atrial Fibrillation on Carotid Atherosclerosis and Ischemic Stroke in Patients with Suspected Ischemic Cerebrovascular Disease:A Single-Center Retrospective Observational Cohort Study

옥소영,조경임,김형준,이나영,김은정,김남규,이원형,여고은,허재준,한유진,차태준 대한심장학회 2013 Korean Circulation Journal Vol.43 No.12

Background and Objectives: Carotid intima-media thickness (IMT) is associated with chronic inflammation, and C-reactive protein (CRP)level is elevated in patients with atrial fibrillation (AF). We investigated the impacts of CRP and AF on carotid atherosclerosis and ischemic stroke in patients with suspected ischemic cerebrovascular disease. Subjects and Methods: One-hundred forty patients (78 males) with suspected ischemic cerebrovascular disease underwent carotid ultrasonography. The mean common carotid artery IMT, mean internal carotid artery (ICA) IMT, and plaque score were measured. Patients were divided into four groups according to the presence of AF and elevated CRP level {n=46 for AF(-)CRP(-), n=38 for AF(-)CRP(+), n=43for AF(+)CRP(-), and n=13 for AF(+)CRP(+)}. Results: Common carotid artery IMT was significantly higher in the AF(-)CRP(+) (0.98±0.51 mm) and AF(+)CRP(+) (0.96±0.27 mm)groups compared to the AF(-)CRP(-) (0.80±0.32 mm) and AF(+)CRP(-) (0.77±0.19 mm) groups (p=0.027). Although there was no significant difference in mean ICA IMT among the groups, plaque score was the highest in the AF(+)CRP(+) (4.18±3.84 mm) group, followed by AF(-)CRP(+) (3.87±2.78 mm), AF(+)CRP(-) (1.34±2.61 mm), and AF(-)CRP(-) (1.17±2.02 mm) (p<0.001). The AF(+)CRP(+) group showed significantly higher incidence of ischemic stroke than the other groups (all p<0.05). Binary logistic regression analysis showed that age {odds ratio (OR)=1.033, p=0.001}, elevated CRP (OR=3.884, p=0.001), and the presence of AF (OR=1.375, p=0.018) were significantly correlated with incidence of ischemic stroke. Conclusion: Elevated plasma CRP concentration may be a reliable surrogate marker for predicting carotid atherosclerosis in patients with AF, which may be related to increased risk of ischemic stroke.

Changes in bone mineral density and trabecular bone score in Graves’ disease patients after anti-thyroid therapy

옥소영,정윤석,최용준 대한골다공증학회 2016 Osteoporosis and Sarcopenia Vol.2 No.3

Objective: The purpose of this study was to evaluate changes in bone quantity based on bone mineral density (BMD) and bone quality based on trabecular bone score (TBS) in Graves' disease patients after anti-thyroid therapy. Research design and method: This retrospective study included premenopausal female and male patients with Graves' disease who received BMD measurement more than two times during treatment. BMD and thyroid function tests with free thyroxine (FT4), total triiodothyronine (T3), thyroid stimulating hormone (TSH), and TSH receptor antibody (TRAb) levels were collected two times during follow-up. TBS was calculated using TBS insight® software (version 2.1) from dual-energy X-ray absorptiometry images. Results: Thirty Graves' disease patients (17 males, 56%; 13 premenopausal females, 44%) with a mean age of 35.3 ± 9.9 years were included. The mean follow-up period was 20.7 ± 8.5 months. The median levels of FT4, TSH and TRAb improved at follow-up [2.55 ng/dL (Interquartile range (IQR) 2.07e3.78) to 1.28 ng/dL (IQR 1.23e1.39), 0.015 mIU/L (IQR 0.01e0.04) to 0.89 mIU/L (IQR 0.35e1.55), 17.0 IU/L (IQR 5.0e40.3) to 5.0 IU/L (5.0e6.0), respectively; p < 0.001]. Median BMD (lumbar spine) values also improved from 1.118 g/cm2 (IQR 1.000e1.119) to 1.167 g/cm2 (IQR 1.050e1.219) ( p ¼ 0.001) at follow-up. TBS increased from 1.377 (IQR 1.299e1.422) to 1.390 (IQR 1.327e1.430) after treatment ( p ¼ 0.038). Conclusion: Both bone quality and density improved after anti-thyroid treatment in premenopausal female and male Graves' disease patients.

S-285 : The Neuron-Specific Enolase (NSE) as a biomarker of pulmonary tuberculosis.

옥소영,옥철호,장태원,정만홍 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1

NSE (Neuron specific enolase) is the neuronal form of the glycolytic enzyme enolase found in extracts of neuroendocrine cells and neuroendocrine tumors including SCLC. Recently non-malignant Inflammatory lung disorders have associated with abnormal serum levels of NSE. The purpose of this study was to measure the level of NSE in patients with active pulmonary tuberculosis, confirm the relationship between the level of NSE and the extent of inflammation in patient with active tuberculosis. In this retrospective study, 60 patients with active pulmonary tuberculosis were included. 25 males and 35 females. All patients underwent a clinical, laboratory, and radiologic evaluation and were grouped into one of following categories: tuberculosis pneumonia (35 patients), tuberculoma (15 patients), tuberculosis pleuritis (10 patients). All three groups elevated NSE levels. The mean level of NSE was 22 (7-40) ng/mL (tuberculosis pneumonia 25 ng/mL: tuberculoma 20 ng/mL: tuberculosis pleuritis, 16 ng/mL) at cut off value: 12 ng/mL. And significant differences in NSE levels were observed among the three groups (p=0.04). This results revealed patients with diffuse infiltration had higer NSE levels than those with focal localized infiltration. And we also investigated the changes of NES levels, before and after tuberculosis treatment. And then there was statistically signigicant changes (p=0.002). So we consider NSE can be used for monitoring treatment responses like IGRA. But more studies may be need to use NSE as a biomarker of pulmonary tuberculosis.

2000년도 이후에 진단된 중심성 폐암과 말초성 폐암의 임상적 차이

옥소영,장태원,한유진,여고은,김은정,이원형,김남규 고신대학교(의대) 고신대학교 의과대학 학술지 2014 고신대학교 의과대학 학술지 Vol.29 No.1

Objectives: The aim of this study was to explore the changes of bronchoscopic features according to epidemiologic change of lung cancer. Methods: We performed a retrospective review of the clinical characteristics of 1,139 lung cancer patient who underwent bronchoscopy at Kosin University Hospital from January 2000 to December 2010. Results: The age of patients increased significantly during the last decade (P < 0.001). The most common histological type was adenocarcinoma (38.1%), followed by squamous carcinoma (35.7%) and small cell carcinoma (15.3%). There was an increasing incidence of adenocarcinoma over the time (P < 0.001). Bronchoscopic feature were divided into two classes; central type, peripheral type. The peripheral type was predominant (62.3%). The proportion of peripheral type has been increased in process of time (49.7% vs. 63.7% vs. 73.7%; P < 0.01). Among the major histopathologic type of lung cancer, adenocarcinoma (81.3%) and unclassifiable non-small-cell lung cancer (73.4%), small cell carcinoma (56.9%) were associated with preferential occurrence of peripheral type. Squamous cell carcinoma of the lung more often arised in central type (59%). However, the proportion of peripheral squamous cell carcinoma has been increased. On the subgroup analysis, the median survival time of peripheral type with adenocarcinoma and small cell carcinoma were longer than central type (P < 0.05). Conclusions: The age of the lung cancer patients at diagnosis was getting older. The most frequent histopathologic type was adenocarcinoma. The proportion of peripheral type lung cancer gradually increased over the time. The survival time of peripheral type lung cancer was longer than central type.

Excessive Iodine Status among School-Age Children in Korea: A First Report

최영식,옥소영,권석영,정상봉,석광혁,김영진,김부경,정지영 대한내분비학회 2017 Endocrinology and metabolism Vol.32 No.3

Background: Korea is considered an iodine sufficient country, and several studies have been conducted regarding iodine status in healthy Korean adults, pregnant women, and preschool children. However, data on iodine status in Korean school-age children are lacking. Therefore, the iodine nutrition status of Korean school-age children was investigated by measuring urine iodine concentration (UIC). Methods: This cross-sectional study conducted between April and September 2016 comprised 373 school-age children. UIC was determined using a modified microplate method employing ammonium persulfate digestion followed by Sandell-Kolthoff reaction. Results: The median UIC was 458.2 μg/L. Excessive iodine intake (>300 μg/L) was found in 286 children (76.7%), with extremely high values exceeding 1,000 μg/L in 19.6% of subjects. Insufficient iodine intake (<100 μg/L) was observed in eight children (2.1%). UIC values were not significantly different between sexes. Conclusion: Korean school-age children showed excessive iodine intake. Therefore, education regarding adequate iodine intake in school-age children is needed.

AIDS 환자에서 ganciclovir 투여 후 발생한 신성요붕증의 예

박지영,옥소영 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.-

AIDS 환자에서 ganciclovir 투여 후 발생한 신성요붕증의 예

박지영,옥소영 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1

신성 요붕증은 항이뇨호르몬(ADH)의 정상적인 분비에도, 신장의 집합관의 ADH에 대한 반응이 저하되어 요 농축능력에 이상이 초래되는 질환이다. 드물긴 하나 약제에 의해 발생할 수 있으며, 대표적으로 리튬이 있지만, 다른 약제에 의한 신성 요붕증을 보고하였다.AID환자의 거대세포바이러스 폐렴(Cytomegalovirus pneumonia)의 치료에서 ganciclovir의 사용으로 인한 신성요붕증을 경험하여 이를 보고하는바이다.34세 남자로 3개월 전부터 시작된 호흡곤란으로 내원하였다. 흉부 방사선에서 간질성 폐렴이 의심되었고, 검사 중 AIDS test 양성으로 처음 진단되었다. 흉부전산화단층촬영검사에서 거대세포바이러스 폐렴이 의심되어 PCR 검사 시행 후 sulfamethoxazole-trimethoprim과ganciclovir를 투여하였다. 당시 검사 결과 Pneumocystis jirovecii PCR은 음성으로 확인되었고, CMV RT PCR 1157copies/mL로 증가되어 있었으며, 객담검사에서도 CMV PCR양성으로 확인되었다. 거대세포바이러스 폐렴에 대해 ganciclovir 250 mg를 하루 2번 투여하였고 치료 12일째부터 소변이 시간당 400~500cc/hr로 증가하였다. 검사 소견에서 혈청 Na 132mEq/L, K 4.2mEq/L, 혈청 삼투압 283 mOsm/Kg, 소변 삼투압은83mOsm/L, ADH 1.99 pg/ml이었다. 환자는 호흡곤란 악화로 기관삽관 후 기계호흡을 시작하였고, 탈수 검사는 환자의 임상적 상태를 고하여시행하지 못했다. AIDS 환자에서 발생할 수 있는 두 개내 감염이나 육아종성 질환, 또는 종양으로 인한 중추성 요붕증을 감별하기 해Brain MRI 시행하였으나 정상이었고, vasopressin 투여 후에도 소변이 시간당 1000cc/hr로 점점 증가하였다. 이에 신성 요붕증 의심 에 sulfamethoxazole-trimethoprim과 ganciclovir를 중단하였다. 신성요붕증의 치료로 알려진 thiazide계 이뇨제와, amiloride 등은 hyponatremia로 인해 투여하지 못했다. 이후 점차 소변 양 감소하여, ganciclovir 중단 5일째에는 소변양 2500ml/day로 정상화 되었다. 검사결과 혈청삼투압277 mOsm/Kg, 소변 삼투압 437mOsm/L, ADH 2.2 pg/ml이었다. 이후 sulfamethoxazole-trimethoprim를 다시 투여 시작하였으나 소변양는 변화가 없었다. 현재는 호전되어 외래에서 경과 관찰중이다.