새로운 액체성 색전물질(Embol)을 이용한 신동맥 색전술: 토끼에서의 실험적 연구

정규식,고지호,김현철,이상희,오경승,허진도,조영덕,허방,박상수,Jung, Gyoo-Sik,Ko, Ji-Ho,Kim, Hyun-Chul,Lee, Sang-Hee,Oh, Kyung-Seung,Huh, Jin-Do,Joh, Young-Duk,Hur, Bang,Park, Sang-Soo 대한영상의학회 2002 대한영상의학회지 Vol.46 No.1

목적: 새로 개발된 액체성 색전물질로 토끼에서 신동맥 색전술을 시행하여 그 효과와 안전성을 입증하고 영구적 색전물질로서의 임상적용 가능성을 평가할 목적으로 이 연구를 시행하였다. 대상과 방법: 사용한 색전물질은 Polyvinylacetate(PVAc)를 부분 가수분해하여 만든 Embol로서 45%의 에탄올과 55%의 비이온성 수용성조영제를 용매로 사용하므로 우수한 방사선비투과성을 가진다. 15마리의 토끼를 실험동물로 사용하였으며, 투시 하에서 평균 0.8(0.5-0.9)cc의 Embol을 신동맥에 주입하여 색전을 하였고 5분 후에 추적 혈관조영술을 시행하여 색전의 효과를 확인한 뒤에 시술을 마쳤다. 토끼를 5마리씩 3군으로 나누어 각각 3일(I군), 2주(II 군), 4주(III군)후에 추적 혈관조영술을 시행한 뒤 토끼를 희생시켜 양측 신장과 신동맥을 적출하여 조직표본을 제작하였다. 각군에서 시술 직후와 추적기간 동안의 혈관조영술 소견과 조직 소견을 관찰하였다. 각군의 토끼 1마리에서 시술전과 희생시키기 전에 DMSA 신스캔을 시행하였고, 다른 3마리에서는 시술 전과 시술 후 1, 3, 5, 7, 14일에 혈액을 채취하여 혈청 BUN, Creatinine, Sodium(Na), Potassium(K)의 수치를 조사하였다. 결과: Embol은 투시 하에서 색전과정의 관찰이 용이할 정도로 방사선비투과성이 우수하여 안전하게 주입할 수 있었다. 시술 5분 후에 시행한 혈관조영술에서는 신동맥 원위부의 완전한 폐색이 14예, 엽간동맥(interlobar artery)의 폐색이 1예에서 관찰되어 전예에서 색전술은 성공적이었다. 시술 후 혈청 전해질 수치는 약간 증가하였으나 모두 정상범위였다. 각 군에서의 추적 혈관조영술에서는 I군과 III군의 각각 1마리를 제외한 모든 토끼에서 신동맥의 폐색이 유지되었다. 각군에서 시행한 신스캔에서는 모두 색전을 시행한 신장의 섭취가 전혀 관찰되지 않았다. 추적기간동안의 색전을 시행한 신장의 크기는 I 군에서는 정상 신장에 비해 커졌으나 II군과 III군에서는 계속해서 크기가 감소하였다. 조직 소견은 3 군 모두 신조직의 전반적인 응고괴사 소견이 관찰되었으며, III군에서는 신피질에 두꺼운 띠모양의 석회화가 관찰되었다. I군에서는 신동맥 내강이 기질화되지 않은 혈전으로 차 있었고, II군과 III군에서는 신동맥 내강은 기질화된 혈전으로 차 있었으며 III군에서는 혈전의 석회화도 관찰되었다. 결론: Embol을 이용한 토끼에서의 신동맥 색전술은 이 색전물질의 우수한 방사선비투과성으로 안전하게 사용할 수 있었으며 또한 효과적이고 영구적인 신조직의 괴사를 유발하여 앞으로 임상적용이 가능하다고 생각된다. Purpose: To evaluate the effectiveness and safety of a new liquid embolic agent in renal arterial embolization in the rabbit, and its clinical applicability. Materials and Methods: A new embolic agent, Embol, was obtained by partial hydrolysis of polyvinyl acetate and dissolved in a mixture of 45% ethanol and 55% non-ionic contrast medium. Its radioopacity was therefore good. An average of 0.8 cc(0.5-0.9 cc) of Embol was used to embolize the renal artery of one kidney in 15 rabbits. The immediate effect of this was examined angiographically 5 minutes after the procedure. To permit histologic examination, five rabbits in each group were sacrificed 3 days (I), 2 weeks (II), and 4 weeks (III) after embolization: prior to embolization and prior to sacrifice, one rabbit in each group underwent renal scanning, and prior to sacrifice all underwent follow-up angiography. In three rabbits, blood urea nitrogen (BUN), creatinine, sodium(Na), and potassium(K) levels were measured before and 1, 3, 5, 7 and 14 days after embolization. Results: Embol was easy to use and its radiopacity was good. Five minutes after embolization, angiography showed that total occlusion of the main renal or interlobar artery had been achieved in all rabbits. Serum BUN, creatinine, Na and K levels were within normal limits. Follow-up angiogram obtained in each group showed persistent occlusion of the renal artery in all but one rabbit in group I and one in group III. Renal scans revealed no evidence of radionuclide uptake in embolized kidneys, which were slightly enlarged in group I but became gradually smaller in groups II and III. In all animals, histologic examination showed diffuse coagulation necrosis of the embolized kidneys and in group III the cortex of these was extensively calcified. In group I the renal artery showed an apparently fresh occluding thrombosis, and in groups II and III a completely organized thrombosis was present. In group III this was calcified. Conclusion: Because of its good radioopacity, Embol is easy to controa, and is effective for renal artery embolization. As a permanent embolic agent, it appears suitable for clinical applications.

증례 : 신장 ; 특발성 신경색증 1예

박남영 ( Nam Young Park ),이은영 ( Eun Young Lee ),신호식 ( Ho Sik Shin ),정연순 ( Yeon Soon Jung ),정규식 ( Gyoo Sik Jung ),임학 ( Hark Rim ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2

급성 신경색증은 혈전색전증의 위험인자를 가진 환자에서 잘 발생하며 이런 환자에서 지속되는 측복통이 있으면서 LDH가 증가할 경우 의심해 볼 수 있다. 실제 보고된 급성 신경색증의 대부분의 환자가 혈전색전의 기왕력, 심판막 또는 허혈성 심장 질환, 심방세동의 기왕력을 가진 환자이다. 그러나 이러한 기저 질환이 없이 특발성으로 신경색증이 발생하는 경우도 드물게 보고되고 있다. 이러한 특발성 신경색증은 위험인자가 없음으로 인해 의심하지 않기 때문에 신경색증의 진단이 늦어지거나 간과되기도 한다. 전통적인 심혈관계 질환의 위험인자가 없는 평소 건강했던 중년의 환자에서 원인 불명의 측복통이 있으면서 LDH가 증가한 경우는 꼭 특발성 신경색증의 가능성을 생각해야겠다. Renal thromboembolism almost always occurs in the setting of cardiac disease. Acute renal infarction may occur rarely in middle-aged patients without apparent risk factors for cardiac thromboembolism. We report a 40-year-old man who developed bilateral renal infarction and had no cardiovascular risk factors, except smoking. In middle-aged healthy patients with renal colic without lithiasis, the diagnosis of idiopathic renal infarction should be considered, especially if lactate dehydrogenase is elevated. (Korean J Med 2011;80:221-224)

두 차례 풍선 확장술로 치료하면서 장기간 추적 관찰한 식도 아칼라지아

한서룡 ( Seo Ryong Han ),박무인 ( Moo In Park ),문원 ( Won Moon ),박선자 ( Seon Ja Park ),김규종 ( Gyu Jong Kim ),정규식 ( Gyoo Sik Jung ),김낭희 ( Nang Hee Kim ),김성훈 ( Seong Hun Kim ),남지현 ( Ji Hyeon Nam ),박지은 ( Ji Eun P 대한소화기기능성질환·운동학회 2006 Journal of Neurogastroenterology and Motility (JNM Vol.12 No.2

Achalasia is a motility disorder of the esophagus that`s characterized by the loss of inhibitory neurons in the lower esophagus and lower esophageal sphincter. The primary motility disorders of the esophagus are usually considered to include two disease entities: achalasia and diffuse esophageal spasm. These two conditions are part of a spectrum of related motor disorders. Achalasia can change to diffuse esophageal spasm and show the return of peristalsis after balloon dilatation. We experienced a 64-year-old female patient who complained of dysphagia. Achalasia was diagnosed by performing barium esophagography and esophagogastroduodenoscopy, and by the typical esophageal manometric findings. After performing two sessions of balloon dilatation, the basal lower esophageal sphincter pressure decreased and peristalsis of lower esophagus returned. When the patient again complained of dysphagia, the basal lower esophageal sphincter pressure was increased and peristalsis was not seen. Consequently, we could observe the spectrum and natural course of this disease before and after treatment for achalasia. (Kor J Neuro-gastroenterol Motil 2006;12:177-180)

자가 용혈성 빈혈을 동반한 흉선종

이신화 ( Sin Hwa Lee ),박능화 ( Neung Hwa Park ),이금희 ( Keum Hee Lee ),김영우 ( Young Woo Kim ),장태원 ( Tai Weon Jang ),정만홍 ( Maan Hong Jung ),정규식 ( Gyoo Sik Jung ),조성래 ( Sung Rae Cho ) 대한결핵 및 호흡기학회 1995 Tuberculosis and Respiratory Diseases Vol.42 No.3

간세포암과 하대정맥 막성폐쇄의 치료 후 호전된 백혈구파괴혈관염 1예

이준엽 ( Jun Yeob Lee1 ),이주원 ( Ju Won Lee1 ),이진욱 ( Jin Wook Lee ),박현준 ( Hyun Joon Park ),장국환 ( Gook Hwan Jang ),김다정 ( Da Jung Kim ),김선민 ( Sun Min Kim ),한병훈 ( Byung Hoon Han ),정규식 ( Gyoo Sik Jung ),김근태 ( 대한류마티스학회 2015 대한류마티스학회지 Vol.22 No.5

저자들은 하지 자색반과 고환 통증으로 내원한 알코올성 간경화증 환자에서 LCV의 원인 감별하는 과정에서 HCC와 하대정맥 막성폐쇄를 진단하고 이에 대한 치료 후 LCV의 호전된 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Vasculitis is a heterogeneous group of diseases that destroy blood vessel walls by inflammation. Approximately half of vasculitis cases are idiopathic, but sometimes associated with genetic factors, medicines, chronic infection, autoimmune diseases, and malignancies. Although the mechanism remains unclear, vasculitis secondary to malignancy, also known as paraneoplastic vasculitis, has been reported. It is generally associated with hematologic malignancies rather than solid malignancies and commonly presents as leukocytoclastic vasculitis or polyarteritis nodosa. We experienced a case of leukocytoclastic vasculitis in a patient with hepatocellular carcinoma and membranous obstruction of the inferior vena cava. Here, we report this case with a brief review of literature. (J Rheum Dis 2015;22:322-326)

경동맥 혈관확장술과 스텐트삽입술 후에 발생한 치명적인 두개내출혈

김광수,정규식 고신대학교 의과대학 2010 고신대학교 의과대학 학술지 Vol.25 No.2

Cerebral hyperperfusion with intracranial hemorrhage is a rare complication of carotid angioplasty and stent placement. A 71-year-old man presenting with dysarthria underwent carotid angioplasty and stent placement for 85% and 90% stenosis of the right internal carotid artery. At 14 hours after carotid stenting the patient suddenly had generalized tonic-clonic seizures and deteriorated. Brain CT revealed hematomas in the right frontal lobe and right basal ganglia and diffuse subarachnoid hemorrhage with acute hydrocephalus. He subsequently died 11 hours later. We report the occurrence of fatal intracranial hemorrhage in a patient undergoing carotid angioplasty and stent placement

기능부전 혈액투석동정맥루 치료법으로서 경피경관혈관성형술의 임상적 의의 및 효과

정연순,김민대,신호식,정규식,유창현,김홍기,황일용,임학 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.2

목 적 : 기능부전 혈액투석동정맥루의 치료로서의 경피경관혈관성형술의 임상적 의의와 장기개통률에 영향을 미치는 요소에 대하여 알아보고자 본 연구를 시행하였다. 방 법 : 기능부전 혈액투석동정맥루로 정맥조영술을 시행한 53명의 환자(총 61예) 중 동정맥루의 협착 및 폐쇄로 경피경관혈관성형술이 시도된 환자는 49명(총 57예)이었으며 이들의 정맥조영술 적응증을 알아보았다. 이 중 경피경관혈관성형술을 성공적으로 시행받은 38명의 환자(총 46예)를 대상으로 하여 임상적 특성과 6, 12, 24개월의 개통률을 분석하였다. 환자의 연령, 당뇨병의 유무, 만성신부전의 병력기간, 동정맥루의 종류와 사용기간, 혈액투석동정맥루의 위치와 협착의 길이, 잔여협착의 정도 등이 장기개통률에 미치는 영향을 Kaplan-Meier method에 의한 log-rank test를 이용하여 평가하였고, multivariate analysis로 Cox Regression Model을 사용하여 평가하였다. 통계적 유의성 검정은 p값이 0.05 미만인 경우로 하였다. 경피경관혈관성형술을 실패한 경우의 정맥조영술 소견과 시술 전후의 합병증을 조사하였다. 결 과 : 시술의 성공률은 80.7%(46/57)였으며 성공한 예의 추적 검사에서 개통률(postintervention primary patency)은 6, 12, 24개월 각각 68, 38, 5%였다. 재협착으로 인해 2번의PTA를 시행받은 환자가 8명 있었으며, 이들 경우를 포함했을 때의 개통률(postintervention assisted primary patency)은 6, 12, 24개월 각각 69, 40, 10%였다. 환자의 연령, 당뇨병의 유무, 만성신부전의 병력기간, 동정맥루의 종류와 사용기간, 혈액투석동정맥루의 위치와 협착의 길이, 잔여협착의 정도 등이 장기 개통률에 미치는 영향은 통계학적으로 유의한 경우는 없었다(p>0.05). 혈관성형술을 실패한 경우는 총 11예로 대량혈전으로 인한 완전폐쇄가 6예, 광범위한 과도한 혈관협착이 5예였다. 시술과 연관된 합병증은 없었다. 결 론 : 이상의 결과로 동정맥루 협착이 동반된 혈액투석 환자에서 경피적경관혈관성형술은 안전하고 비교적 효과적인 치료법으로 사료되며, 장기 개통률에 영향을 미치는 요소는 없었다. Purpose : The purpose of this study was to evaluate the effect of percutaneous transluminal angioplasty( PTA) and to determine patency rates and the factors affecting the long-term patency rates in the management of insufficient arteriovenous fistulae. Methods : Sixty-one cases of insufficient dialysis shunts in 53 patients underwent venography of the fistula. These patients' indications of venographys were reviewed. Forty-six cases of insufficient dialysis shunts in 38 patients were treated by PTA. These patients' clinical characteristics and patency rates were evaluated. According to the patient's age, history of diabetes mellitus, duration of renal failure, type and age of the arteriovenous fistula, the site of AVF and length of the stenosis, and to the degree of residual stenosis, patency rates were compared within each subgroup using the Kaplan-Meier logrank test. To estimate reasons for the incidence of vascular access failure, Cox regression model was used. Venographic findings of failed PTAs and PTA related complications were evaluated. Results : The success rate was 80.7%. In cases in which initial success was obtained, postintervention primary patency rate at 6, 12 and 24 months were 68%, 38% and 5% respectively. With repeatitive PTAs, postintervention assisted primary patency rate at 6, 12 and 24 months were 69%, 40% and 10% respectively. The effect of the above mentioned factors(age, DM, duration of CRF etc.) on long-term patency was not statistically significant(p>0.05). Among 11 cases of failed PTA, there were 6 cases of total obstruction due to massive thrombosis and 5 cases of extensive vascular stenosis(>5 cm of length, >4 sites of stenosis and >75% of stenosis in all cases). There were no PTA related complications. Conclusion : PTA is considered to be an effective and safe treatment modality for shunt stenosis. No factors affected long-term patency rates in our study. (Korean J Nephrol 2002;21(2):276-284)

골육종의 흉곽내 전이형태

이승룡,정규식,오경승,고지호,허진도,조영덕 고신대학교 의학부 2004 高神大學校 醫學部 論文集 Vol.19 No.1

The purpose of this study is to evaluate findings of altered patterns of thoracic metastasis in patients treated for osteosarcoma with adjuvant chemotheapy. The author reviewed medical records and image findings of 60 osteosarcoma patients from 1991 to 1997. 18 patients had thoracic metastasis confirmed by needle biopsy(n=1) and clinical evidence of tumor progression(n=17). CT was available in 17 patients. In 6 patients, mean 3 times serial CT were obtained during follow-up period. Two radiologists retrospectively reviewed the CT findings of parenchymal lesion, pleural lesion, mediastinal lesion, lymphadenopathy, calcification, and the follow-up change. In 16 cases, single or multiple nodules, suggesting typical appearance of hematogeneous metastasis, were present. Pleural plaque or mass was present in seven cases. In two of these cases, small curvilinear calcification or calcific dot was noted along the pleura, initially. On serial follow up CT scans, these calcifications was gradually increased in size, which resulted in huge calcified pleural mass. One patient showed only diffuse pleural thickening without other involvement, which proved pleural metastasis of osteosarcoma by means of pleural biopsy. Linear calcification or calcified nodule along the bronchial wall was noted in three cases this finding gradually changed to huge calcified mass with associated atelectasis of lung parenchyma. Other sites of metastasis were pericardium, 3 patients, and lymph node, 4 patients. Interlobular septal thickening suggesting lymphangitic metastasis was noted in 2 patients. Calcification within parenchymal nodule and metastatic lymph node was seen in 7 patients. Pneumothorax was noted in 2 patients. Interestingly, parenchymal lesion was slowly increased in size and number, while pleural and endobronchial lesion revealed rapid change and affressive invasion into the parenchyma, mediastinum and chest wall on follow-up CT scans. Thoracic metastasis of osteosarcoma commonly presents hematogenous parenchymal nodules. However, adjuvant chemotherapy has resulted in prolonged survival, and may raised the unusual appearance of thoracic metastasis, which is more aggressive nature. We carefully concluded that any type of calcification should be suspected metastasis in osteosarcoma patient.

골다공증의 방사선학적 진단의 최신동향

허진도,조영덕,정규식,김소선 고신대학교 의학부 1993 高神大學校 醫學部 論文集 Vol.9 No.2

Early detection of osteoporosis is important and accurate evaluation for the progression and response to therapy should be seriously monitored. Efforts have been made in the development of methods for quantitatively assessing the bone mass so that osteoporosis can be detected early. There is no consensus on which method are most effective for the diagnosis and monitor of osteoporosis or screening of large populations. The selection of anatomic sites and methods for quantifying bone mass is considerably important. Knowledge about the proper use and interpretation of various bone densitomety studies is not universal among physicians. Discussions are focused on understanding instrumentation and interpretation of various technical performance of bone density measurement. Dual X-ray absorptiometry(DXA). Dual photon absorptiometry(DPA) and quantitative computed tomography(QCT) and other methods measuring bone density are presented and their inherent limitations are discussed. We anticipate that newer softwares of instrumentations will be available for a more accurate. versatile and convenient way of measuring bone mineral density.

생체 외에서 시행한 정량적 자기공명영상, 단일 에너지 정량적 전산화단층촬영술, 그리고 이중엑스선 골밀도측정기 사이의 연관성

고지호,허진도,정규식,오경승,이승룡,조영덕 고신대학교 의학부 2004 高神大學校 醫學部 論文集 Vol.19 No.1

This study was performed to examine the correlation among quantitative magnetic resonance (QMR), single energy quantitative computed tomography (SE-QCT). and dual energy X-ray absorptiometry (DXA), and to examine the relation with bone mineral density (BMD) through in vitro experiment with pig lumbar vertebrae. The correlation among 1/T2 of QMR, SE-QCT, and DXA was investigated by measuring the pig lumbar vertebrae BMD five times each method. It was examined whether there is a significant difference in the values of 1/T2, SE-QCT, and DXA measured by changing the height (11㎝, 20㎝, 29㎝) of water in water bath in order to make the soft tissues different in quantity. The lumbar vertebrae were placed in 0.1N sodium hydroxide (NaOH) solution for 24 hours to remove the residual soft tissue. Each values of SE-QCT before and after removal of the soft tissue were compared. Real BMD, measured after burning only the body of lumbar vertebrae for e hours at 1200℃, was compared to BMD with three methods. Based on the correlation analysis of 1/T2 and SE-QCT (correlation coefficient, r= -0.729 to 0.737), 1/T2 and DXA (r= -0.709 to o.929) and SE-QCT and DXA (r= -0.878 to 0.862) after measuring BMD within the water bath, no significant correlation was observed among three methods. Also, there was no correlation between 1/T2 and SE-QCT (r= -0.587 to 0.447) xeasured in the outside of water bath. SE-QCT (p=0.094) and 1/T2 (P=0.012 to 0.094) measured in the inside and the outside, respectively, of the water bath significantly different. When the height of water in the water bath was different, the change value of the BMD showed a significant different in 1/T2 (p=0.012 to 0.403) and SE-QCT (p=0.012 to 0.527), but not in DXA (P=0.012). The values of SE-QCT measured before and after placing limbar vertebrae in 0.1N NaOH for 24 hours were not significantly different (P=0.3177). The BMD showed the different changing aspect (p<0.05). There was no correlation among QMR, SE-QCT, and DXA, however the significant relation was observed between the BMD and QMR. The value of the BMD was measured differently depending on the height of water in the water bath. Therefore, although QMR is influenced by the height of the water bath in some degree, it reflects the BMD very well.