Isolated Petroclival Craniopharyngioma with Aggressive Skull Base Destruction

이영흔,임동준,박정율,정용구,김영식,김상대 연세대학교의과대학 2009 Yonsei medical journal Vol.50 No.5

We report a rare case of petroclival craniopharyngioma with no connection to the sellar or suprasellar region. MRI and CT images revealed a homogenously enhancing retroclival solid mass with aggressive skull base destruction, mimicking chordoma or aggressive sarcoma. However, there was no calcification or cystic change found in the mass. Here, we report the clinical features and radiographic investigation of this uncommon craniopharyngioma arising primarily in the petroclival region.

Ultrasound-Guided Fine Needle Aspiration of Thyroid Nodules: A Consensus Statement by the Korean Society of Thyroid Radiology

이영흔,백정환,정소령,곽진영,김지훈,신정희,Korean Society of Thyroid Radiology (KSThR),Korean Society of Radiology 대한영상의학회 2015 Korean Journal of Radiology Vol.16 No.2

Ultrasound (US)-guided fine needle aspiration (US-FNA) has played a crucial role in managing patients with thyroid nodules, owing to its safety and accuracy. However, even with US guidance, nondiagnostic sampling and infrequent complications still occur after FNA. Accordingly, the Task Force on US-FNA of the Korean Society of Thyroid Radiology has provided consensus recommendations for the US-FNA technique and related issues to improve diagnostic yield. These detailed procedures are based on a comprehensive analysis of the current literature and from the consensus of experts.

Clinical features of recently diagnosed papillary thyroid carcinoma in elderly patients aged 65 and older based on 10 years of sonographic experience at a single institution in Korea

김은실,이영흔,서형석,손길수,권순영,김영식,서지아,김난희,서상일,유인선,유성혜 대한초음파의학회 2017 ULTRASONOGRAPHY Vol.36 No.4

Purpose: The aim of this study was to assess the characteristics of papillary thyroid carcinoma (PTC) in patients aged 65 and older in order to predict postoperative recurrence based on the results of ultrasonographic surveillance. Methods: Among 1,494 patients (200 male and 1,294 female; mean age, 46.6±11.3 years) who underwent surgery for thyroid cancer at our institution between 2006 and 2015, we retrospectively enrolled 150 PTC patients (29 male and 121 female; mean age, 69.4±4.2 years) aged 65 years and older. To identify the risk factors for recurrence, we analyzed age, gender, multiplicity, size, number, extrathyroidal extension (ETE) of the tumor, lymph node metastasis (LNM), type of surgery, and the dose of radioactive ablation using a Cox regression model to identify hazard ratios (HRs). Results: Among the 115 asymptomatic patients with PTCs detected by screening ultrasonography (n=86), other cross-sectional imaging modalities (computed tomography or positron emission tomography-computed tomography, n=13), or incidentally through a surgical specimen (n=16), 78 patients were confirmed to have papillary thyroid microcarcinomas (PTMCs). The other 35 patients presented with palpable neck masses (n=25), vocal cord palsy (n=9) or bloodtinged sputum (n=1). During the follow-up period (mean, 43.6 months), 17 patients (12.5%) experienced recurrence in the neck. None of the patients died due to PTC-related recurrence or distant metastasis during the follow-up period. Cox regression analysis demonstrated that tumor size (HR, 2.12; P<0.001) and LNM (central LNM: HR, 9.08; P=0.004; lateral LNM: HR, 14.71; P=0.002; both central and lateral LNM: HR, 58.41; P<0.001) significantly increased the recurrence rate. ETE, LNM, and recurrence were significantly less frequent in PTMCs than in non- PTMC (all P<0.001). Conclusion: PTCs of small size and absent LNM showed significantly better prognoses in patients 65 years and older.

Long-term Management of Copper-associated Hepatic Cirrhosis with D-penicillamine, SAMe, and DBB in a Dog

서경원,이영흔,방동하,안진옥,고예린,황철용,김대용,윤화영 한국임상수의학회 2011 한국임상수의학회지 Vol.28 No.2

A 4-year-old intact female American Cocker Spaniel presented with lack of appetite, shivering, and abdominal distension. It was initially diagnosed with chronic hepatitis with cirrhosis, by serum chemistry, radiography,ultrasonography, and histopathologic examination following liver biopsy. Abundant copper granules were detected in most hepatocytes with rhodanine stain, with hepatic copper concentration at 1460 ppm (reference range: < 400 ppm). Based on these findings, copper-associated hepatitis with cirrhosis was diagnosed and successfully managed with longterm D-penicillamine, s-adenosylmethionine, biphenyl-dimethyl-dicarboxylate and supportive care. The spaniel died 35months after diagnosis.

한국 문화정책의 변동에 관한 연구 - Hogwood & Peters의 모형을 중심으로 -

박화진,이영흔,조승현 한국자치행정학회 2023 한국자치행정학보 Vol.37 No.2

The purpose of this study is to systematically diagnose cultural policies that Korea has promoted so far and to seek policy alternatives for the cultural industry in the future. To this end, this study examined the process of change in Korean cultural policy by era for 70 years after the establishment of the government, and analyzed its contents and characteristics. In particular, in this study, the contents of cultural organizations, cultural budgets, and cultural laws were analyzed to confirm the policy goals and changes of cultural policy means. In conclusion, future cultural policies should first make continuous investments in consideration of the social utility of the cultural industry and come up with a strategy to open the era of 2% of the national budget. Second, efforts are needed to create new values by establishing convergence and convergence strategies with new technologies and high-tech industries. Third, a systematic supplementary policy should be prepared to become a cultural industry of humans and society so that side effects from continuous growth can be minimized. The alternatives presented in this study are limited in that they are only planar proposals. In analyzing the characteristics and types of content changes of Korean cultural policy, this study applied the typology of Hogwood and Peters (1982) to classify policy changes by government period by adding four variables: basic character, law, organization, and budget. However, the elements and business areas that make up cultural policy have great limitations in identifying and analyzing all components of cultural policy with great externality, diversity, and complexity. Moreover, long-term changes over 70 years are difficult to analyze for various reasons. Therefore, in order to analyze policy changes in more depth, there should be follow-up studies targeting policy areas by unit project and sector. 본 연구의 목적은 지금까지 한국이 추진해 온 문화정책을 체계적으로 진단하고, 향후 문화산업에 대한 정책대안을 모색하는 것이다. 이를 위해 본 연구는 정부수립 이후 70년간 한국문화정책이 시대별로 변화하는 과정을 살펴보고, 그 내용과 특징을 분석하였다. 특히 본 연구에서는 문화단체의 내용과 문화예산, 문화법 등을 분석하여 문화정책수단의 정책목표와 변화를 확인하였다. 결론적으로 미래 문화정책은 우선 문화산업의 사회적 효용을 고려해 지속적인 투자를 하고 국가예산 2% 시대를 여는 전략을 마련해야 한다. 둘째, 신기술과 첨단산업과의 융합과 융합전략을 수립하여 새로운 가치를 창출하려는 노력이 필요하다. 셋째, 지속적인 성장에 따른 부작용을 최소화할 수 있도록 인간과 사회의 문화산업이 될 수 있도록 체계적인 보완정책을 마련해야 한다. 본 연구에서 제시된 대안은 평면적 제안에 불과하다는 점에서 한계가 있다. 본 연구는 한국문화정책의 내용변화 특성과 유형을 분석함에 있어 Hogwood와 Peters(1982)의 유형론을 적용하여 기본적 성격, 법률, 조직, 예산의 4가지 변수를 추가하여 정부기간별 정책변화를 분류하였다. 그러나 문화정책을 구성하는 요소와 사업영역은 외부성과 다양성, 복잡성이 큰 문화정책의 모든 구성요소를 파악하고 분석하는 데 큰 한계가 있다. 더욱이 70년 이상의 장기적 변화는 다양한 이유로 분석하기 어렵다. 따라서 정책변화를 보다 심층적으로 분석하기 위해서는 단위사업별, 분야별 정책영역을 대상으로 한 후속연구가 있어야 한다.

심한 편측성 경동맥 협착에서 아세타졸라마이드 부하 뇌관류 CT를 이용하여 측정한 뇌혈류 예비능과 측부순환의 연관성

홍도란,이영흔,서형석,제보경,서상일,설혜영,이남준,김정혁,양경숙 대한영상의학회 2014 대한영상의학회지 Vol.70 No.1

Purpose: We correlated cerebrovascular reserve in unilateral high grade carotid artery stenosis or occlusion with a type of collateral circulation using acetazolamide-challenged perfusion CT (ACZ-PCT). Materials and Methods: Among the patients who underwent ACZ-PCT in our institution, we retrospectively selected the patients with unilateral high grade internal carotid artery or middle cerebral artery stenosis (> 70%) or occlusion; we verified the types of their dominant collateral circulation by digital subtraction angiography or 3T MR-angiography; first, the primary collaterals flow through the circle of Willis; second, the secondary collaterals that flow through the opthalmic artery, the basal artery or other external carotid artery. Using ACZ-PCT, we measured the difference in percentage change of cerebral blood flow of the stenotic hemisphere against contralateral normal hemisphere and compared cerebrovascular reserves of lesional hemisphere, according to the type of collaterals. Results: A total of 28 patients were included. The percentage changes of cerebral blood flow were significantly lower in the stenotic hemisphere than the contralateral hemisphere (14.34 ± 36.43% and 34.53 ± 47.82%, p < 0.001), and in the hemisphere predominantly supplied by secondary collaterals than primary (7.03 ± 32.71% and 24.37 ± 42.03%, p < 0.05), respectively. Conclusion: Cerebrovascular reserves in the ipsilateral hemisphere predominantly supplied by secondary collaterals were more impaired than primary collaterals in patients with unilateral high grade carotid stenosis or occlusion. 목적: 심한 편측성 경동맥 협착 또는 폐색 환자에서 측부순환의 형태에 따른 뇌혈류 예비능 상태를 아세타졸라마이드 부하 뇌관류 CT를 이용하여 비교하였다. 대상과 방법: 본원에서 아세타졸라마이드 부하 뇌관류 CT를 시행한 환자들 중, 디지털 감산처리 혈관조영술과 3T 자기공명영상 동맥조영술을 통하여 내경동맥 및 중뇌동맥의 중등도 이상의 편측성 협착 및 폐색을 보이고, 앞 혹은 뒤 교통동맥을 포함한 윌리스환을 통한 일차성, 이외의 안동맥, 기저부동맥, 전대뇌동맥과 후대뇌동맥, 또는 외경동맥 경유의 이차성 측부순환 중 우세한 측부순환의 형태가 확인된 환자들을 후향적으로 선택하였다. 아세타졸라마이드 부하 전과 후의 뇌관류 CT에서 뇌혈류량변화율을 측정하여, 병변 측 반구와 정상 측 반구의 변화율 차이를 조사하였다. 그리고 전체 환자를 측부순환의 형태에 따라 두 군으로 나누어 두 군 간에 병변 측 반구의 뇌혈류 예비능에 차이가 있는지를 조사하였다. 결과: 총 28명(일차성 8명, 이차성 20명)의 뇌혈류량변화율은, 협착이 없는 반대측 반구와 비교하여 협착 혈관 측 반구에서(14.34 ± 36.43%와 34.53 ± 47.82%, p < 0.001) 그리고 일차성보다 이차성 측부순환이 우세한 반구(24.37 ± 42.03%와 7.03 ± 32.71%, p < 0.05)에서 각각 유의하게 낮았다. 결론: 아세타졸라마이드 부하 뇌관류 CT를 이용하여 측정한 뇌혈류 예비능은 일차성에 비하여 이차성 측부순환이 우세한 반구에서 감소되어 있었다.

기관허탈이 있는 개들에서 기관 내 Stent 장착 후 나타난 합병증 3례

서경원,이영흔,장진화,황철용,윤정희,윤화영 한국임상수의학회 2010 한국임상수의학회지 Vol.27 No.4

Three dogs were presented with signs of recurrence of coughing, dyspnea and difficulty of barking after endotracheal stent placement. On the basis of history taking, physical examination, laboratory tests and radiography,complications of endotracheal stent were suspected. Dog 1 had unfitted stent diameter (stent diameter is larger than tracheal diameter) and getting disentangled of proximal tracheal stent wire. Dog 2 was suspected a foreign body reaction. Dog 3 had the migration of stent caudally. Based on these cases, the veterinarian should accurately evaluate the indicated patients before endotracheal stent and has to select the appropriate stent (diameter, length and location) to prevent complications after endotracheal stent and concern the regular follow-ups to assure proper endotracheal stent placement.

갑상선결절 및 경부 전이 림프절의 초음파 진단

나동규,이영흔 대한갑상선학회 2016 International Journal of Thyroidology Vol.9 No.1

Ultrasonography (US) has been a primary tool for assessing malignancy risk, fine-needle aspiration (FNA) decision, and management after FNA in patients with thyroid nodules. US also has an essential role for preoperative evaluation of primary tumor and cervical lymph nodes, for surveillance of postoperative patients with thyroid cancer, and for imaging guidance for nonsurgical ablation therapy. In the revised recommendations of Korean Society of Thyroid Radiology (KSThR), Korean Thyroid Imaging Reporting and Data System (K-TIRADS), a revised risk stratification system of thyroid nodules, was suggested to increase the efficacy of FNA and provide supplementary information for thyroid nodules after FNA. The role of US assessment of cervical lymph node needs to be emphasized for optimal management decision of thyroid nodules, preoperative staging, and postoperative surveillance of patients with thyroid cancers, and CT has a complementary role for the diagnosis of metastatic nodes in patients with thyroid carcinomas.

Comparison of Ultrasonographic Findings of Biopsy-Proven Tuberculous Lymphadenitis and Kikuchi Disease

유인선,서상일,이영흔,서형석,설혜영 대한영상의학회 2015 Korean Journal of Radiology Vol.16 No.4

Although tuberculous lymphadenitis and Kikuchi disease are common causes of cervical lymphadenopathy in Asians and exhibit similar clinical manifestations, their treatment strategies are totally different. The purpose of this study was to identify ultrasonographic features that distinguish these two diseases. This study was approved by the Institutional Review Board. The study included 77 patients with tuberculous lymphadenitis and 135 patients with Kikuchi disease. The sex and age distributions of the patients were analyzed. The size and shape of lymph nodes (LNs), presence of conglomeration, increased perinodal echogenicity, echogenic hilum, posterior neck involvement, internal calcification, patterns of internal necrosis, laterality of involved LNs, and hilar vascular patterns on ultrasonography were compared between the two groups. Multiple logistic regression analysis was conducted to identify independent findings to discriminate tuberculous lymphadenitis from Kikuchi disease. Finally, diagnostic accuracies were calculated using the independent findings. The presence of an echogenic hilum, internal calcification, patterns of internal necrosis, and LN hilar vascular structures on power Doppler ultrasonography were independent findings that discriminated tuberculous lymphadenitis from Kikuchi disease. The diagnostic accuracy of each of these four factors was 84.9% (181/212), 76.9% (163/212), 84% (178/212), and 89.2% (189/212), respectively. A combination of internal calcification and hilar vascular structures showed the best accuracy of 89.6% (190/212) (sensitivity, 86.7% [117/135]; specificity, 94.8% [73/77]) for diagnosing Kikuchi disease. The presence of an echogenic hilum, internal calcification, pattern of internal necrosis, and LN hilar vascular structures are useful ultrasonographic findings to differentiate tuberculous lymphadenitis from Kikuchi disease.

급성 골수성 백혈병의 최초 증상으로 안구 돌출을 초래한 양측 안와-부비동 과립세포육종: 증례 보고

김희선,제보경,이영흔,김백현 대한자기공명의과학회 2010 Investigative Magnetic Resonance Imaging Vol.14 No.1

과립세포육종은 골수성 백혈병의 발현 형태의 하나로써, 과립세포들의 원시 전구체가 골수가 아닌 연조직에 침착하여 생긴 고형 종괴를 지칭한다. 저자들은 다른 전신 증상 없이 양쪽 안구의 돌출을 주소로 내원하여 광범위한 양쪽 안와-부비동 과립세포육종으로 진단된 22개월 남아의 CT 및 MR 소견을 보고한다. 종괴는 양측 안와 외하벽을 침범하여 양쪽 안구를 돌출시켰으며, 부비동, 상악골, 측두골, 광대뼈, 나비뼈, 벌집뼈, 입천장뼈를 포함한 거의 모든 머리뼈바닥의 골수에 침윤하고 주변에 연부 조직 종괴를 형성하였고, 해면정맥동의 아래 1/2을 침범하고 측두골 안쪽의 경질막이 비후된 소견을 동반하였다. 환아는 골수를 이용한 염색체 검사를 통해 8번과 21번 염색체의 상호전좌 t(8;21) (q22;q22)를 동반한 급성 골수성 백혈병으로 진단되었다.