A Case of Histiocytic Sarcoma Diagnosed by Bone Marrow Biopsy in a Patient Suffering from Fever for 8 Months

장윤하,박찬정,허주령,지현숙,장성수 대한진단검사의학회 2009 Annals of Laboratory Medicine Vol.29 No.4

Histiocytic sarcoma is a malignant proliferation of cells showing morphologic and immunophenotypic features similar to those of mature tissue histiocytes and is known for its rapid progression and poor prognosis. We describe a case of histiocytic sarcoma diagnosed by bone marrow biopsy. A 64-yr-old male was admitted for fever and weight loss that persisted for 8 months. The patient died undiagnosed on the 7th hospitalization day. A bone marrow biopsy performed just before the patient’s death revealed diffuse proliferation of large pleomorphic neoplastic cells with large, round to oval nuclei, vesicular chromatin, and abundant foamy cytoplasm. These cells were positive for histiocytic markers, CD68, lysozyme, CD21, and S-100 protein, but negative for B-cell, T/NK-cell, and epithelial cell markers, thus confirming the presence of histiocytic sarcoma. Histiocytic sarcoma is a malignant proliferation of cells showing morphologic and immunophenotypic features similar to those of mature tissue histiocytes and is known for its rapid progression and poor prognosis. We describe a case of histiocytic sarcoma diagnosed by bone marrow biopsy. A 64-yr-old male was admitted for fever and weight loss that persisted for 8 months. The patient died undiagnosed on the 7th hospitalization day. A bone marrow biopsy performed just before the patient’s death revealed diffuse proliferation of large pleomorphic neoplastic cells with large, round to oval nuclei, vesicular chromatin, and abundant foamy cytoplasm. These cells were positive for histiocytic markers, CD68, lysozyme, CD21, and S-100 protein, but negative for B-cell, T/NK-cell, and epithelial cell markers, thus confirming the presence of histiocytic sarcoma.

특집 - 자살! 위험수위를 넘다 -소통과 연결성

장윤하,Jang, Yun-Ha 한국가톨릭의료협회 2011 Health & mission Vol.24 No.-

Filopodia Formation and Proliferation of Mammalian Cells Are Increased on Closely Packed Silica Nanobeads

장윤하,윤서영,Young-hoo Cho,Dahyun Lee,이진석,임광일 대한화학회 2016 Bulletin of the Korean Chemical Society Vol.37 No.8

Toxigenic Clostridium difficile 배양에서 종동정과 독소확인 다중 PCR 검사의 적용

장윤하,정재우,성흥섭,김미나,백승미,박숙자 대한임상미생물학회 2009 Annals of clinical microbiology Vol.12 No.1

Background: We evaluated multiplex PCR for species identification and toxin typing to improve the sensitivity and turnaround time of toxigenic Clostridium difficile culture (TCDC). Methods: We performed multiplex PCR using primers targeting the species-specific gene, tpi, and the toxin genes, tcdA and tcdB. From January to March 2008, 528 stool specimens were tested with direct toxin assay (DT) using C. difficile Tox A/B II (Techlab, Blacksburg, USA) and TCDC. For 288 specimens from early study period, toxin production by C. difficile isolates of TCDC was measured by enzyme immunoassay with culture supernatants using VIDAS C. difficile Toxin A&B (CDAB; bioMérieux, Marcy-l'Etoile, France) and multiplex PCR with isolated colonies. For 240 specimens from late period, only multiplex PCR was used to test toxin production by the isolates. Results: During the early period, 29 C. difficile were isolated and their toxin-positive rates were 65.5% by PCR and 44.8% by CDAB (P<0.05). Among 528 stool specimens, the results of DT+/TCDC+, DT+/ TCDC-, and DT-/TCDC+ were 32 (6.1%), 33 (6.3%), and 10 (1.9%), respectively, when tested with PCR. 13.3% of total 75 positive specimens was detected only by TCDC. Of the 42 toxigenic C. difficile isolates, all were positive for tpi, 30 (71.4%) were tcdA+/tcdB+, and 12 (28.6%) were tcdA-/tcdB+. Conclusion: TCDC using multiplex PCR for species identification and toxin typing is sensitive and rapid to be used as a routine diagnostic test.

초고도로 증가된 페리틴 수치를 보이는 원인불명열 환자 1예

김혜원,장윤하,정희정,이우창,전사일,민원기 대한진단검사의학회 2013 Laboratory Medicine Online Vol.3 No.1

Fever of unknown etiology that occurs along with highly elevated serum ferritin concentrations ( >500 ng/mL) is mostly observed in hematologic malignancies and rheumatic diseases such as systemic lupus erythematosus, temporal arteritis, and adult-onset Still’s disease (AOSD), among which AOSD is a type of systemic inflammatory disorder with unknown pathophysiology and has very low incidence. AOSD presents with various nonspecific symptoms and signs such as high spiking fever, joint pain, skin rash, and increased leukocytes. Because AOSD is diagnosed after excluding the possibility of other conditions such as neoplasms, infections, and inflammations, diagnosis and treatment are generally delayed. Patients with AOSD often have high serum ferritin levels than those with other conditions, although the underlying mechanism for this is not clearly understood. In addition, decreased proportion of glycosylated ferritin are observed in most patients with AOSD. Therefore a combination of high serum ferritin and a decreased proportion of glycosylated ferritin seems to be important for the differential diagnosis of AOSD that thus may allow early diagnosis of AOSD. Here we report a case of AOSD diagnosed via extremely high serum ferritin levels and decreased glycosylated ferritin proportion. 원인불명열의 원인질환 중 류마티스질환이 가장 흔하며, 그 중성인형스틸병은 매우 드문 원인 미상의 전신염증성질환이다. 발열,발진 및 관절염, 백혈구 증가 등의 매우 다양한 증상 및 징후를 보이지만 질병특이적인 양상은 없다. 종양, 감염, 염증성 질환 등을배제해야 진단이 가능하기 때문에 진단 및 치료 시기가 지연될 때가 많다. 성인형스틸병 환자에서 혈청 페리틴 수치의 증가가 흔하게 관찰되므로 혈청 페리틴 검사는 성인형스틸병을 진단하는데 중요한 검사이다. 또한 당화페리틴 비율의 감소가 성인형스틸병 환자에서 특징적으로 관찰되므로 두 검사를 동시에 실시하면 성인형스틸병의 감별진단에 도움을 받을 수 있다. 저자들은 높은 혈청페리틴 수치와 당화페리틴 비율 감소 소견을 보인 AOSD증례 1례를관찰하였기에 이를 보고하는 바이다.

메티실린 내성 황색포도알균이 토착화된 중환자실에서 비강보균자 검출을 위한 BD GeneOhm MRSA PCR Assay의 수행능 평가

박상혁,장윤하,성흥섭,김미나*,김재석,박연준 대한진단검사의학회 2009 Annals of Laboratory Medicine Vol.29 No.5

Background : The BD GeneOhm MRSA PCR assay (Becton Dickinson, USA) is a qualitative realtime PCR test for rapid detection of nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA). We evaluated the performance of BD GeneOhm MRSA PCR assay versus MRSASelect (Bio-Rad, France) and broth enrichment cultures for detection of MRSA from nasal swabs. Methods : From August 2008 to January 2009, 295 nasal swabs were taken from patients in intensive care units and transported to the laboratory with BD CultureSwab Liquid Stuart Single Swab (Becton Dickinson, USA). The swabs were inoculated onto MRSASelect first and then suspended into GeneOhm sample buffer: 100 μL of the suspension was inoculated into 6.5% NaCl-tryptic soy broth (Becton Dickinson, USA), which was subcultured on MRSASelect after overnight incubation (TSBS). Performances of GeneOhm MRSA and MRSASelect were compared to TSBS. Results : With GeneOhm MRSA, 125 swabs (44.6%) were positive for MRSA, 13 (4.4%) were unresolved, and 2 were not determined. With MRSASelect and TSBS 86 (29.4%) and 106 swabs (36.2%), respectively, were positive. The sensitivity, specificity, and positive and negative predictive value of GeneOhm MRSA were 85.8%, 77.5%, and 72.8% and 93.5%, respectively, and corresponding values for MRSASelect were 78.3%, 94.8%, and 96.5% and 88.9%. Of the 33 patients whose 34 specimens were found false positive in GeneOhm MRSA, 23 patients were MRSA-positive either previously or subsequently to this study. All of the 10 patients with false-negative specimens in GeneOhm MRSA PCR assay were previously MRSA or methicilln-resistant coagulase negative staphylococci (MRCNS)-positive and were treated for MRSA, but they became MRSA-positive after 1 to 4 negative surveillance cultures. Conclusions : GeneOhm MRSA PCR assay showed a relatively high negative predictive value. However, its low specificity and frequent occurrence of unresolved results would be problematic in the endemic areas with a high prevalence of MRSA. 배경 : BD GeneOhmTM MRSA PCR assay (Becton Dickinson, USA)은 메티실린 내성 황색포도알균 비강보균자의 신 속한 검출을 위한 정성적 실시간 PCR 검사이다. 저자들은 전비 공 도말 검체에서의 MRSA 선별에 GeneOhm MRSA의 수행능 을 MRSASelect (Bio-Rad, France) 선별배지와 액체증균배지 에 비교하여 평가하였다. 방법 : 2008년 8월에서 2009년 1월 사이에 중환자실에서 의 뢰한 295개의 전비공 도말 검체를 대상으로 하였고, 이들은 BD CultureSwab Liquid Stuart Single Swab (Becton Dickinson, USA)으로 채취, 수송되었다. 전비공 도말 검체는 먼저 MRSASelect에 접종 후 GeneOhm 검체완충튜브에 풀었고 현탁액 100 μL을 6.5% NaCl을 첨가한 tryptic soy broth (Becton Dickinson, USA)에 접종하고 하룻밤 배양 후 MRSASelect 선 별배지에 계대배양하였다(TSBS). GeneOhm MRSA와 MRSASelect의 수행능을 TSBS에 비교하여 평가하였다. 결과 : GeneOhm MRSA는 125검체(44.6%)가 양성이었고 13검체(4.4%)가‘판독불가’, 2검체가‘작동오류’였다. MRSASelect와 TSBS는 각각 86검체(29.4%), 106검체(36.2%)가 양 성이었다. GeneOhm MRSA와 MRSASelect의 민감도/특이/ 양성예측도/음성예측도는 각각 85.8%/77.5%/72.8%/93.5%, 78.3%/98.4%/96.5%/88.9%이었다. 34개의 GeneOhm MRSA 위양성 검체는 33명의 환자에서 얻어졌고, 23명은 직전 또는 직 후 감시배양에서 MRSA 양성이었다. 10개의 GeneOhm MRSA 위음성 검체는 모두 이전에 MRSA 또는 메티실린 내성 coagulase negative staphylococci 양성이었으며 항 MRSA 항균 제 치료를 받았고 1-4회의 감시배양이 음성이다가 양성으로 전 환된 경우였다. 결론 : GeneOhm MRSA는 상대적으로 높은 음성예측도를 보이나 특이도가 낮고‘판독불가’결과가 존재하여 MRSA 유병 률이 높은 토착화된 장소에서 감시배양을 대치하는데 문제가 될 수 있다.

Gender affirmative care of transgender people: a single center’s experience in Korea

임현혜,장윤하,최규연,이정재,이은실 대한산부인과학회 2019 Obstetrics & Gynecology Science Vol.62 No.1

ObjectiveTo investigate the clinical characteristics and medical management of transgender people in South Korea. MethodsThe electronic medical records of 54 transgender persons who had visited Soonchunhyang University Hospital fromJanuary 2016 to December 2017 for medical care were retrospectively reviewed. We identified patient demographicsand gender identity-related characteristics. Moreover, we compared our hospital protocol with official guidelines. ResultsAt the time of the medical record search, the average age of these 52 transgender persons was 27 years, and 46(88.5%) were Korean. Ten (19.2%) persons had a mental disorder other than gender dysphoria. Gonadotropinreleasinghormone agonist, estrogen, antiandrogen agents, and testosterone were used according to the guidelinesissued by the World Professional Association for Transgender Health and the Endocrine Society. Ten (19.2%)transgender persons, including 6 (22.2%) male-to-females (MTFs) and 4 (16.0%) female-to-males (FTMs), had a mentaldisorder other than gender dysphoria. Among persons who were administered testosterone, 3 had high triglycerideand lipoprotein cholesterol levels. Nine patients, including 6 (66.7%) MTFs and 3 (33.3%) FTMs, underwent bothgonadectomy and gender affirmative surgery. Seven (43.8%) persons, including 1 (14.3%) MTF and 6 (85.7%) FTMs,underwent only gonadectomy. There was a significant difference (P=0.040) between MTFs and FTMs. ConclusionMedical providers should have adequate knowledge of and experience in managing transgender persons and befamiliar with the relevant guidelines and literature. Long-term follow-up examinations should also be performed.

Interfacial Polymer Brush Layer for DNA Sensors Based on Graphene Transistors

구광모,김진우,장윤하,김승현,임광일,이위형 한국섬유공학회 2018 Fibers and polymers Vol.19 No.12

Graphene field-effect transistors (FETs) provide an efficient platform for enabling the label-free detection of DNA molecules. In this study, we used an interfacial polymer brush layer, which is inserted between graphene and SiO2, to enhance the electrical properties of the DNA sensors based on graphene FETs. When a polymer brush with no net dipole moment was used as a surface modification layer of SiO2, high field-effect mobility and stability were obtained in graphene FETs. In addition, it was confirmed that the graphene FETs exhibited stable operation in aqueous environments. To examine the response of DNA sensors based on graphene FETs, four types of DNA oligomers with homogeneous nucleotides (i.e. 12mer of adenine, thymine, cytosine, and guanine) were consecutively dropped onto the graphene surface and changes of electrical properties in the graphene FETs were monitored after complete drying of DNA solutions. These DNA oligomers n-doped the graphene due to the electron-rich characteristics of the nucleobases. In addition, electron and hole mobilities decreased gradually upon the addition of DNA solution because DNA molecules served as charged impurities. Graphene FETs with polymer brush provide a platform for detecting DNA molecules with low concentration.

자살시도자의 알코올 사용에 따른 자살치명도

박서연,민성호,김민혁,고상백,김현,장윤하,안정숙,신정호 대한우울조울병학회 2011 우울조울병 Vol.9 No.3

Objectives : Although a lot of studies on the demographic and clinical characteristics of the suicide attempters with drinking were done, there have been few researches on the impact of drinking patterns on the intent and lethality of suicide attempts, which is the aim of this study. Method : The subjects were 330 suicide attempters visited in the emergency center. Based on drinking pattern at the suicide attempt, we divided them into alcohol use disorder group (AUD), acute alcohol use group (AAU) and no alcohol use group (NAU), and examined suicide lethality with the risk rescue rating scale (RRR). Results : AUD and AAU revealed lower rates of planned suicide and previous suicide attempt. There were no significant differences in the risk-rescue scores. However, AAU showed higher rescue scores than NAU. For the risk factors, AAU showed least in ‘severe toxicity.’ For the rescue factors, AAU was least in ‘key person’ of the ‘person initiation’ category and ‘dose not ask for help’. Also, AAU showed highest in ‘drop clues’ and ‘immediate 1 hour delay until discovery’. Conclusion : NAU tended to do planned suicide more, whereas AUD was most lethal with impulsivity and aggression. And AAU attempted suicide impulsively. These findings would potentially contribute to develop more individualized approach to preventive strategies and therapeutic interventions for suicidal attempters related to alcohol. (J of Kor Soc for Dep and Bip Disorders 2011;9:212-219)