위암에서 $PPAR-{\gamma}$ 발현의 임상적 의의

조동희,강성구,박상수,윤진,김일명,윤성민,이윤경,이용직,양대현,조익행,신동규,Cho, Dong-Hui,Kang, Sung-Gu,Park, Sang-Su,Yoon, Jin,Kim, Il-Myung,Yoon, Seong-Min,Lee, Yun-Kyung,Lee, Yong-Jik,Yang, Dae-Hyun,Cho, Ik-Hang,Shin, Dong-Gue 대한위암학회 2006 대한위암학회지 Vol.6 No.4

목적: 최근 Peroxisome-proliferator-activated receptors (PPAR) 의 역할에 대한 관심이 고조되고 있으나 위암에 대한 실제 임상연구는 부족한 실정이다. 이에 저자들은 위암 조직에서의 $PPAR-{\gamma}$의 발현율과 임상적 의의에 대해 분석을 시행하였다. 대상 및 방법: 2001년 1월부터 2005년 12월까지 서울의료원에서 위암으로 근치적수술을 시행 받은 128명을 대상으로 하였다. 적출된 위조직으로 만들어진 파라핀 블록을 이용해 위암조직 125예와 위암주변 정상조직 128예를 채취하여 $PPAR-{\gamma}$ 발현을 면역조직화학염색으로 확인한 후 비교 분석하였다. 결과: 대상 환자의 평균 연령은 61세였으며 남자 84명 (65.6%), 여자 44명(34.4%)으로 1.9 : 1이었다. $PPAR-{\gamma}$ 발현의 양성률은 정상조직 73/128명(57.0%)에 비하여 위암조직에서는 104/128명(81.3%)으로 유의하게 높았다(P<0.001). 위암조직의 분화도에 따른 $PPAR-{\gamma}$ 발현의 차이에서 분화도가 양호한 경우의 양성률(87.0%)에 비해 나쁜 경우 발현율(74.6%)이 낮았으나 통계적 유의성은 없었다(P=0.074). 위암조직에서와 $PPAR-{\gamma}$ 발현 유무와 생존율 사이에 통계적 유의성은 없었으나(P=0.377) 정상조직에서 $PPAR-{\gamma}$의 발현은 단변량 분석에서 유의하게 높은 생존율을 보였다(P=0.003). 5년 생존율과 연관지어 다변량 분석 통계에서 의미가 있었던 것은 UICC TNM 병기뿐이었다(P<0.001). TNM 병기별 5년 생존율은 IA-89.9%, IB-90.0%, II-89.7%, IIIA-41.0%, IIIB-25.9%, IV-14.6% 였다. 결론: 위암조직에서 정상조직에 비하여 $PPAR-{\gamma}$ 발현이 유의하게 높았으며 위암조직의 분화도가 좋을수록 발현율이 높았다. $PPAR-{\gamma}$의 정상조직 내 발현이 단변량 분석상 유의한 생존율 향상이 있었지만 다변량 분석에서는 유의성이 없어 향후 이에 대한 좀더 많은 증례로 유의성을 찾는 연구가 필요할 것으로 생각된다. Purpose: Recently, interest in peroxisome-proliferator-activated receptors (PPAR) has increased, although clinical studies of the effect of $PPAR-{\gamma}$ expression on gastric cancer have not been reported yet. In this study, we investigated the role of $PPAR-{\gamma}$ expression in gastric cancer patients. Materials and Methods: One hundred twenty-eight (128) samples of both gastric cancer and normal tissues were obtained from 128 patients who had undergone at a curative gastrectomy at Seoul Medical Center from Jan. 2001 to Dec. 2005. $PPAR-{\gamma}$ expression was determined by using immunohistochemical staining, and the results were analyzed. The statistical analysis was based on clinicopathological findings and the differences in survival rates. Results: The mean age of the patients was 6n, and the male : female ratio was 1.9 : 1. $PPAR-{\gamma}$ expression was significantly higher in cancer tissues than in normal tissue (81.3% vs. 57.0%, p<0.001). There was insignificant difference between well and moderately differentiated types and poorly differentiated types in terms of the expression of $PPAR-{\gamma}$ (87.0% vs. 74.6%, P=0.074). In the univariate analysis the survival rate was significantly increased when $PPAR-{\gamma}$ was expressed in normal tissue (P=0.003). In the multivariate analysis, only the UICC TNM staging had significance related to the survival rate. Conclusion: The rate of $PPAR-{\gamma}$ expression was higher in cancer tissue than it was in normal tissue from gastric cancer patients. In the univariate analysis, $PPAR-{\gamma}$ expression in normal tissue had significance with respect to survival, but the multivariate analysis showed no such significance. Thus, we should further evaluate more cases to determine whether or not such a significance exists.

증례 : 호흡기 ; 비특이적 간질성 폐렴의 양상으로 발생한 IgG4 연관 폐 질환의 1예

조동희 ( Dong Hui Cho ),안지환 ( Ji Hwan An ),강유미 ( Yu Mi Kang ),채은진 ( Eun Jin Chae ),송준선 ( Joon Seon Song ),송진우 ( Jin Woo Song ) 대한내과학회 2015 대한내과학회지 Vol.88 No.3

특발성 비특이적 간질성 폐 질환과 IgG4 related lung disease는 증상, 폐기능 검사, 영상의학 소견만으로는 감별이 어려운 질환이다. 하지만 IgG4 related lung disease는 steroid 치료에 좋은 치료 반응을 보이는 것으로 알려져 있어 이들의 감별은 매우 중요하다고 할 수 있다. 본 증례는 특발성 간질성 폐 질환, 특히 비특이적 간질성 폐렴에서 혈청 IgG4의 증가 혹은 조직 소견상 lymphoplasmacytic infiltration이 다수 관찰되고 obliterative phlebitis, storiform fibrosis 등이 관찰된다면 IgG4 연관 질환의 폐 침범 가능성을 고려해야 함을 시사해 준다. Immunoglobulin (Ig) G4-related disease is a recently described systemic inflammatory disease characterized by high serum IgG4 concentrations and sclerosing inflammation of numerous IgG4-positive plasma cells that responds favorably to steroid treatment. Although initial description of this disorder focused on its pancreatic presentation, it has become apparent that it is a systemic disease. In this report, we describe a case of IgG4-related lung disease presenting as non-specific interstitial pneumonia in a 78-year-old male with interstitial lung disease. Pathological examination through video-assisted thoracic surgery showed a non-specific interstitial pneumonia pattern and numerous (> 50/high-power field) infiltrating IgG4-positive plasma cells. Laboratory tests also revealed a high serum IgG4 concentration. Prednisolone therapy was initiated and his symptoms and reticular opacity improved after two months of treatment.(Korean J Med 2015;88:308-312)

재발성 급성 췌장염의 진단과 치료

조동희 ( Dong Hui Cho ),송태준 ( Tae Jun Song ) 대한췌장담도학회 2016 대한췌담도학회지 Vol.21 No.1

Acute recurrent pancreatitis (ARP) refers to a clinical condition characterized by repeated episodes of acute pancreatitis, diagnosed retrospectively after at least the second episode of acute pancreatitis. It is still controversial that acute pancreatitis can progress to chronic pancreatitis, and acute, acute recurrent and chronic pancreatitis is a continuum of disease. The causes of ARP can be divided into mechanical, hereditary and metabolic factor. Despite recent advances in diagnostic technologies, the etiology of ARP still remains unknown in up to 30% of cases. Especially in recurrent episode of idiopathic pancreatitis, a clinician should be considered not only the common causes of ARP, such as gallstone disease and alcohol, but also rare causes of ARP. The common causes of ‘idiopathic’ recurrent pancreatitis are microlithiasis, sludge, sphincter of oddi dysfunction, pancreas divisum and hereditary pancreatitis. Various treatment options, such as cholecystectomy, endoscopic sphincterotomy, medical and surgery can be applied according to the identified etiology of ARP and treatment should be individualized. Currently, endoscopic treatment is increasingly performed and served as a curative treatment strategy. The medical treatment can be an option in microlithiasis and sludge, but it has limitation in terms of systemic side effect, efficacy and lack of long term outcome. Endoscopic treatment should be considered in selected patients with identifiable cause, and post procedural complication should be considered before endoscopic treatment.

갑상선 양성 종양으로 갑상선 부분절제술을 시행한 환자에서 수술 전후 갑상선 기능의 변화

황윤선,배수연,조동희,최민영,최준호,이정언,김지수,남석진,양정현,김정한,Yoon Sun Hwang,M.D.,Soo Youn Bae,M.D.,Dong Hui Cho,M.D.,Min-Young Choi,M.D.,Jun-Ho Choe,M.D.,Jeong Eon Lee,M.D.,Jee Soo Kim,M.D.,Seok Jin Nam,M.D.,Jung-Hyun Yan 대한갑상선-내분비외과학회 2010 The Koreran journal of Endocrine Surgery Vol.10 No.4

Purpose: Lobectomy or subtotal thyroidectomy in patients with a benign thyroid tumor or goiter can give rise to hypothyroidism due to the reduced volume of the hormone-secreting thyroid gland. This study investigated the incidence of hypothyroidism in such patients and the clinical risk factors. Methods: One hundred seven patients who underwent partial thyroidectomy for benign thyroid tumor or goiter from January 2003 to February 2005 in our institution were reviewed retrospectively. Patients who had been preoperatively diagnosed with hyper- or hypothyroidism preoperatively were excluded. Postoperative hypothyroidism was defined as an elevated serum thyroid stimulating hormone (TSH) level >6.5ՌIU/L at about 6 months post- thyroidectomy. Results: The mean age of the 107 patients was 42.2 years. Ninety patients (84.1%) were female. Subtotal thyroidectomy was performed in 20 patients, lobectomy in 83 patients and enucleation in four patients. The most common pathologic diagnosis was nodular hyperplasia (86.0%). Postoperative hypothyroidism developed after surgery in 19 (21.8%) patients. Patients were evaluated for age, gender, preoperative TSH level, tumor size, tumor number, extent of the resection, thickness of thyroid isthmus and the presence of pathologic thyroiditis or thyroid autoantibody. Advanced age, elevated preoperative TSH level and extensive resection of the thyroid gland were significantly associated with postoperative hypothyroidism. Conclusion: Since many patients with a benign thyroid nodule can maintain a normal thyroid function even after thyroidectomy, preservation of more thyroid tissue during the operation is desirable, especially in young patients with a low-normal TSH level, unless the possibility of disease recurrence is high. (Korean J Endocrine Surg 2010;10:213- 219)

중금속 제거를 위한 세라믹스 미세 중공구의 제조

이앙진 ( Ang Jin Lee ),조동희 ( Dong Hoe Cho ),이진휘 ( Jin Hui Lee ),정구춘 ( Koo Chun Chung ),박면용 ( Myon Yong Park ) 한국환경분석학회 2003 환경분석과 독성보건 Vol.6 No.4

IgG4 연관 경화성 담관염과 감별이 어려웠던 담관암

이상영 ( Sang Young Yi ),조동희 ( Dong Hui Cho ),황승하 ( Seung Ha Hwang ),오경환 ( Kyung Hwan Oh ),김현정 ( Hyeon Jeong Kim ),김지훈 ( Ji Hun Kim ),김명환 ( Myung-hwan Kim ) 대한췌담도학회 2016 대한췌담도학회지 Vol.21 No.3

IgG4-SC는 type 1 AIP의 가장 흔한 췌장 외 발현으로 type1 AIP 환자의 약 70%에서 발생하는 것으로 보고되었고 드물게 단독으로 발생하기도 한다. IgG4-SC의 진단은 임상적으로 매우 중요한데, 이는 영상 소견상 담관암과의 감별이 어렵기 때문이다. IgG4-SC의 경우, 스테로이드 투여로 회복될수 있다는 점에서 그 의의가 크다. 이번 증례 보고에서 저자들은 증상이 경미하고 영상 검사에서 IgG4-SC를 충분히 의심할만한 환자에서 조직검사 및 스테로이드 투여를 통해 담관암으로 확진된 증례를 경험하였기에 확진을 위한 생검의 중요성을 다시 강조하면서 문헌고찰과 함께 보고하는 바이다. IgG4-related sclerosing cholangitis (IgG4-SC) represents a rare but clinically challenging differential diagnosis in patients with biliary strictures which can be mistaken for cholangiocarcinoma. We present a case of a 73-year-old male presented with abdominal discomfort and weight loss. Biliary images showed long-segment luminal narrowing of extrahepatic bile duct associated with prominent enhanced wall thickening, but luminal patency was preserved. Pancreatic images revealed segmental irregular narrowing of main pancreatic duct without upstream duct dilatation. His liver function tests and CA19-9 level were normal. Putting all findings together, IgG4-SC associated with autoimmune pancreatitis was strongly suspected. However, endobiliary biopsy of extrahepatic bile duct revealed adenocarcinoma which was not resectable due to celiac axis involvement. Because there is an overlap in biliary imaging findings between IgG4-SC and cholangiocarcinoma, biopsy is essential for adequate differential diagnosis. We present a case of cholangiocarcinoma masquerading as IgG4-SC based on clinical and imaging findings. Korean J Pancreas Biliary Tract 2016;21(3):168-173

증례 : 혈액종양 ; ABO 일치 간 이식 후 발생한 Evans syndrome 증례보고

윤지현 ( Ji Hyun Yun ),안지환 ( Jee Hwan Ahn ),조동희 ( Dong Hui Cho ),김태은 ( Taeeun Kim ),송기원 ( Gi Won Song ),이승규 ( Sung Gyu Lee ),이규형 ( Kyoo Hyung Lee ) 대한내과학회 2015 대한내과학회지 Vol.88 No.4

Evans syndrome is a rare complication that develops in adults after liver transplantation. The possible etiologies include ABO mismatch, viral infection, post-transplantation lymphoproliferative disease, graft-versus-host disease, and the use of certain immunosuppressive drugs (e.g., calcineurin inhibitors). Here, we present a case of Evans syndrome that developed after an ABOmatched liver transplant. Glucocorticosteroid, intravenous immunoglobulin, and alternative immunosuppressant therapies all failed. Weekly rituximab (375 mg/m2) was then administered for 4 weeks. The cytopenia improved transiently after the second dose of rituximab, but soon worsened again. However, the cytopenia normalized after a splenectomy.

증례 : 감염 ; 세균혈증을 동반한 비장티푸스 살모넬라에 의한 화농성 천장관절염 1예

홍선인 ( Sun In Hong ),김태은 ( Taeeun Kim ),윤지현 ( Ji Hyun Yun ),조동희 ( Dong Hui Cho ),김양수 ( Yang Soo Kim ),우준희 ( Jun Hee Woo ),김성한 ( Sung Han Kim ) 대한내과학회 2015 대한내과학회지 Vol.88 No.3

화농성 천장관절염은 드문 질환으로 의심하지 않으면 진단이 늦어져 패혈증으로 진행하여 사망할 수 있는 질환이다. 정확한 조기 진단 및 적절한 항생제 치료와 배농술을 통해 치료해야 한다. 저자들은 특별한 위험인자 없이 우측 둔부통증으로 내원한 환자에서 비장티푸스 살모넬라에 의한 화농성 천장관절염을 경험하여 보고하는 바이다. Pyogenic sacroiliitis is a rare joint infection, with a challenging diagnosis due to its nonspecific indicators and symptoms. Staphylococcus aureus is the most common causative bacteria of pyogenic sacroiliitis, with Pseudomonas aeruginosa being the most common causative gram-negative bacteria. Interestingly, whereas Salmonella species. is reportedly the second most common cause of this disorder there have been no reported cases of acute sacroiliitis due to Salmonella spp. in Korea, to the best of our knowledge. In this study, we report on the first case in a young Korean adult caused by Salmonella enterica serotype Livingstone, with no underlying disease or predisposing factors. (Korean J Med 2015;88:346-349)