복강경을 이용한 자궁근종 절제술의 임상적 효용성에 관한 연구

조백설 ( Baik Seol Cho ),강귀언 ( Gui Eon Kang ),이홍주 ( Hong Jue Lee ),천상훈 ( Sang Hoon Cheon ),조출현 ( Chool Hyun Cho ),김성희 ( Seong Hee Kim ),이정한 ( Jung Han Lee ),조삼현 ( Sam Hyun Cho ),김승룡 ( Seung Ryong Kim ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.10

목적: 복강경을 이용한 자궁근종 절제술 환자 185명을 대상으로 복강경적 자궁근종 절제술의 안전성 및 임상적 효용성을 평가하고자 하였다. 연구 방법: 2004년1월부터 2008년 12월까지 한양대학교 의과대학 구리병원 산부인과에서 자궁근종 절제술을 받은 환자 185명의 의무기록을 통해 연령, BMI (body mass index), 출산력, 자궁근종의 크기, 개수, 종류 및 수술 술기 (투관침의 개수, 근종체외배출 방법 등), 수술시간, 수술 후 헤모글로빈 감소치, 수혈량, 합병증, 입원기간 등을 조사하였다. 결과: 자궁근종의 종류는 근층내 (intramural) 근종이 115명 (62.2%)으로 가장 많았으며, 각 환자의 가장 큰 자궁근종의 평균 직경은 6.67±0.16 cm (range, 2.5~15 cm)이었고 자궁근종의 개수는 평균 2.07±0.15개 (range, 1~15개) 이었다. 과거 수술력, 골반 내 유착의 유무는 수술시간과 관련이 없는 요인이었고, 근종의 종류, 크기, 개수, 투관침 (trocar)의 개수, 근종 제거방법은 수술 시간과 관련이 있었다. 가장 큰 근종 직경이 8 cm 미만이거나, 개수가 4개 이하인 저위험군 (n=122)과 가장 큰 근종의 직경이 8 cm 이상이고, 개수가 5개 이상인 고위험군 (n=63)으로 나누어 두 군을 비교 분석한 결과, 고위험군에서 수술 시간(137.58±4.37 min vs. 193.73±9.88 min) 뿐만 아니라, 수술 후 헤모글로빈감소량 (2.89±0.10 g/dL vs. 4.03±0.23 g/dL) 및 수혈량 (2.89±0.10 pints vs. 4.03±0.23 pints)이 유의하게 증가하였으나 (각각 P-value=0.000), 입원기간은 차이가 없었다 (4.98±0.12일 vs. 5.44±0.24일, P-value=0.098). 결론: 본 연구를 통해 근종 절제술의 대상이 확대되고 있음을 알 수 있었다. 수술 시간에 영향을 주는 요인으로는, 근종의 크기와 무게, 근종의 개수, 근종의 종류, 투관침 (trocar)의 개수, 근종의 체외배출 방법 등이었고, 과거의 수술 유무, 골반 내 유착, BMI 등은 영향 요인이 아니었다. 또한 근종의 직경이 8 cm 이상이거나 근종의 개수가 5개 이상인 고위험군은 저위험군에 비하여 수술시간과 수술 후 헤모글로빈 감소량이 증가하였다. Objective: The objective of this study is to evaluate the safety and the clinical efficacy of the laparoscopic myomectomy through analyzing several operation factors. Methods: There were 185 cases of laparoscopic myomectomy between January 2004 and December 2008 at the department of obstetrics and gynecology in Hanyang University Guri Hospital. Retrospectively many factors of the operation were analyzed. The factors include the size, number and type of the myoma, BMI (body mass index), operation method, operation time, and complication and the prognosis of the operation. Results: For the type of myomas, 115 (62.2%) cases were intramural myomas, 38 (20.5%) cases were subserosal types and 32 (17.3%) cases were mixed types. The average diameter of the biggest myoma was 6.67±0.16 cm (range, 2.5~15 cm) and the average number of the myoma was 2.07±0.15 (range, 1~15). Previous operation history and pelvic adhesion did not show correlation with the operation time. The size, type and number of myoma and the operation methods showed correlation with the operation time. According to myoma size and number, we divided the cases into two groups, low risk group (122 cases) and high risk group (63 cases). The analysis showed that post-operation hemoglobin drop (2.89±0.10 g/dL vs. 4.03±0.23 g/dL) and blood transfusion amount (2.89±0.10 pints vs. 4.03±0.23 pints) as well as the operation time (137.58±4.37 min vs. 193.73±9.88 min) showed noticeable increase in the high risk group. Conclusion: This statistics show that laparoscopic myomectomy is now being applied to patients with larger and more myomas. Factors affecting operation time were the weight of myomas, number of myomas, type of myomas, number of trocars and methods of resected myomas removal. Also, operation time and post-operative hemoglobin drop increased in the high risk group.

젊은 성인의 음경에 발생한 피지샘 증식

최광현 ( Koang Hyun Choi ),오신택 ( Shin Taek Oh ),이준영 ( Jun Young Lee ),조백기 ( Baik Kee Cho ),박현정 ( Hyun Jeong Park ) 대한피부과학회 2009 대한피부과학회지 Vol.47 No.2

Sebaceous hyperplasia usually presents as solitary or multiple, small, yellowish papules on the face, particularly on the forehead. It occurs most commonly in middle-aged individuals and rarely in early adult life. It has also been reported in the vulva, penis, and areola. Histological examination reveals a single greatly enlarged sebaceous gland composed of numerous lobules grouped around a centrally located, wide sebaceous duct. We report a case of a 26-year-old man with sebaceous hyperplasia in the ventral surface of the distal penile shaft, an unusual site. (Korean J Dermatol 2009;47(2):189∼191)

배액관이 있는 5 mm 투관침 부위에서 발생한 소장 탈장과 이의 복강경적 복원

조백설 ( Baik Seol Cho ),김승룡 ( Seung Ryong Kim ),강귀언 ( Gui Eon Kang ),호정규 ( Jeong Kyu Hoh ),김성희 ( Seong Hee Kim ),이정한 ( Jung Han Lee ),조삼현 ( Sam Hyun Cho ) 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.6

The incisional hernia through trocar site is an uncommon complication of gynecologic laparoscopy. Its incidence is less than 1% and most of them are occurring through 10 mm trocar site. Small bowel herniation through 5 mm trocar site is very rare. Furthermore, 5 mm trocar site bowel herniation with drain tube in situ has not yet been reported. We present a case of small bowel herniation through 5 mm trocar site with drain tube in situ and its reduction by laparoscopy with a brief review of literature.

상피성 난소암에서 면역반응성 렙틴 (Leptin)과 그 수용체의 발현

김영재 ( Young Jae Kim ),조백설 ( Baik Seol Cho ),조삼현 ( Sam Hyun Cho ),김경태 ( Kyung Tai Kim ),박문일 ( Moon Il Park ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.10

목적: 렙틴 (Leptin)은 Obese (Ob) 유전자에 의해 백색 지방세포에서 분비되는 단백질로서, 뇌에서의 식품섭취 및 에너지 소비조절에 있어 중요한 역할을 하며, 정상 및 유방암세포에서 강력한 성장인자로서의 작용 가능성이 제기되고 있다. 그러나 난소암에 있어 렙틴의 내분비적 조절인자로서의 기능은 아직 알려져 있지 않다. 따라서 본 연구에서는 여러 조직학적 형태의 난소암과 불멸화된 난소암 세포주들에서 렙틴과 그 수용체의 발현양성을 알아보았다. 방법: 렙틴 (Ob)과 그 수용체 (Ob-R)의 면역조직화학염색을 위해 장액성 (5증례), 점액성 (12증례), 자궁내막양 (14증례) 등의 난소암 조직이 사용되었다. 또한 난소암세포주들 (비점액성: SNU-8, OVCAR-3, SKOV-3)을 사용하여 RT-PCR, Western blot분석을 시행하였고, 세포증식과 MAP키나제 (Mitogen-activated protein kinase)활성도를 알아보기 위해 [H3]-Thymidine incorporation assay를 시행하였다. 결과: 비 점액성 난소암 조직 (장액성난소암, 투명세포암, 자궁내막양암종)과 난소암 세포주에서는 Long isoform (Ob-Rb)과 Short isoform (Ob-Rt)의 렙틴 수용체가 모두 발현되었으나, 점액성 난소암조직과 그 세포주에서는 렙틴과 그 수용체가 발현되지 않음을 알 수 있었다. 비 점액성 난소암 조직의 조직면역화학염색에서 면역반응성 렙틴은 중층입방상피 및 중층원주상피의 핵 내에서 염색되었고, 그 수용체는 속층 상피세포무리 (innermost epithelial cell cluster)와 세포질 내에 엷게 퍼져 염색되는 양상을 보였다. 그러나 점액성 난소암 조직에서는 렙틴과 그 수용체가 염색되지 않는 것을 관찰할 수 있었다. 또한 난소암 세포주의 증식관찰을 위해 렙틴을 처리한 경우 ERK (Extracellular signaling-regulating kinase) 1/2의 활성화와 p38 MAP키나제의 구성 인산화 (Constitutive phosphorylation) 억제효과를 관찰할 수 있었다. 결론: 연구결과, 렙틴과 그 수용체의 발현은 난소암의 조직학적 형태에 따라 다르다는 것을 알 수 있었으며, 비 점액성 난소암에서 주로 핵 내에 위치하는 것으로 보아 핵내 전사인자로 작용할 가능성을 제시해주었다. 앞으로 렙틴의 중요 난소암 조절인자로서의 기능을 규명하기 위해 추가적인 연구가 시행되어야 할 것으로 보인다. Objective: Leptin, a secreted protein of the Ob gene by white adipose tissue, plays an important role in the regulation of food intake and energy consumption in the brain and acts as a potential growth stimulator in normal and neoplastic breast cancer cells. However, a potential role of leptin as an endocrine regulator is unknown in ovarian cancer. In the present study, we investigated the expression of leptin and its receptors in various histologic types of ovarian cancer and immortalized ovarian cancer cell lines to find out potential effect of leptin on the cell growth and activation of ovarian cancer cell line. Methods: The ovarian cancer tissues, serous (n=18), mucinous (n=15), clear cell (n=12) and endometrioid type (n=14), were used for immuno-histochemical staining for leptin (Ob) and leptin-receptors (Ob -R). Ovrian cancer cell lines (non-mucinous: SNU-8, OVCAR-3, and SKOV-3) and mucinous: MUC) were used for RT-PCR, Western blot analysis, and [H3] thymidine incorporation assay for the cell growth and activation of mitogen-activated protein kinase. Results: Both long (Ob-Rb) and short (Ob-Rt) isoforms of leptin receptors are expressed in non-mucinous type of ovarian cancer tissues (serous, clear cell carcinoma and endometrioid cell carcinoma) and in non-mucinous ovarian cancer cell lines (SNU-8, OVCAR-3 and SKOV-3 cells). However, leptin and its receptors are not found in mucinous cancer cells and mucinous cancer cell line (MUC). In immunohistochemical staining, the immunreactive leptin is expressed on the nuclei of the stratified cuboidal-to-columnar epithelial cells whereas its receptor was sparsely expressed on the innermost epithelial cell clusters and cytoplasm in non-mucinous tumor. However, there are no immunoreactive leptin and its receptor expressions in the mucinous tumor. In addition, treatment with leptin resulted in the growth stimulation of ovarian cancer cell line, an activation of ERK 1/2 and inhibition of constitutive phosphorylation of p38 Mitogen-activated protein kinase (MAPK). Conclusion: Taken together, our data demonstrates preliminary that the expression of leptin and its receptor is different according to the cell types of the ovarian cancer. Also it canbe thought that leptin immunolocalized on the nuclei in non-mucinous type but not in mucinous possibly acts as a nuclear transcription factor. Further studies are necessary to validate whether leptin may be a potential regulator for ovarian cancer.

Localization of Cyclooxygenase Isozymes in Skin Wound Healing in Mouse

고준혁(Jun Hyuk Koh),조백현(Bek Hyun Cho),허탁(Tag Heo),배미옥(Mi Ok Bae),이송은(Song Eun Lee),안규윤(Kyu Youn Ahn),배춘상(Choon Sang Bae),김백윤(Baik Yoon Kim),박성식(Sung Sik Park),남광일(Kwang Il Nam) 대한해부학회 2003 Anatomy & Cell Biology Vol.36 No.2

Cyclooxygenase (COX)-1 and -2 expressions in the incisional wound healing of mouse skin were determined by immunohistochemistry and Western blot analysis. By Western blotting, compared to normal skin, COX-2 activity was increased at days 1, 4, 8, and 12 and was maximal at 4 day after incisional wound of mouse skin whereas COX-1 was barely detectable. In normal skin, COX-1 immunostaining was observed among the basal cells of epidermis whereas COX-2 immunostaining was detected in the more differentiated, suprabasal keratinocytes. At 1~4 days after wound, COX-2 staining was particularly prominent in the inflammatory cells, and at day 8, many macrophage-like cells were stained positively. COX-2 immunoreactive fibroblast, macrophage-like cells, and newly formed vascular endothelial cells were increased in number at 12 days after incision. These data suggest that COX-2 is constitutively expressed, just as is COX-1, in epidermis and is associated with keratinocyte differentiation. In addition, these findings support the well-established role for COX-2, the prostaglandins that they generate, as mediators of inflammatory response. 생쥐 피부상처 치유과정에서 cyclooxygenase(COX)-1과 COX-2의 분포 및 역할을 Western blot 분석과 면역조직화학 염 색을 통하여 알아보고자 하였다. Western blotting 실험에서 COX-2 단백질은 정상 피부에 비해 손상 후 1일부터 증가하여 4일째 최고치를 나타내며 12일 까지 증가한 반면에, COX-1은 검출이 되지 않을 정도의 적은 단백량을 나타내었다. 면역조직화학 염색에서 COX-1은 정상 및 손상 피부의 표피 바닥층과 털주머니의 윗부위에서 드물게 양성 반응을 나 타내었다. COX-2는 정상 및 손상군 표피에서 바닥층 위의 각질세포와 털주머니의 윗부위 및 진피유두에서 양성이었다. 손상 후 1일과 4일째 진피의 염증세포에서 COX-2에 강한 양성 반응을 나타냈고, 8일째는 큰포식세포에서, 12일째는 큰포 식세포, 섬유모세포와 신생혈관 내피세포에서 양성 반응을 보였다. 이상의 결과로서, COX-2가 COX-1과 마찬가지로 표피에 상재하는 구성요소로서 각질세포의 분화를 조절할 것임을 암 시하였고, 진피에서는 염증과 같은 자극에 대한 반응을 매개함을 확인할 수 있었다.

원저 : Endorphin 의 심맥관계 (心脈關系) 조절에 관한 연구

조규박(Kyu Park Cho),은홍배(Hong Bai Eun),김동수(Dong Soo Kim),송은석(Eun Suck Song),조백현(Baik Hyun Cho),곽용근(Yong Geun Kwak) 전북대학교 의과학연구소 1987 全北醫大論文集 Vol.11 No.4

광선각화증에 대한 임상 및 병리조직학적 소견 - 대한피부과학회 피부병리연구분과위원회 공동연구 -

장성남,전수일,김수남,조백기,전재복,김낙인,서기석,조광현,김수찬,고재경,김방순,이승철,원영호,김종민 ( Sung Nam Chang,Soo Il Chun,Soo Nam Kim,Baik Kee Cho,Jae Bok Jun,Nack In Kim,Kee Suck Suh,Kwang Hyun Cho,Soo Chan Kim,Jai Kyoung Koh,Bang Soon 대한피부과학회 1997 대한피부과학회지 Vol.35 No.5

Background: Although actinic keratoses is the most common precancerous cutaneous lesion, there has been no clinical and histopathological study about actinic keratoses in Korea. Objective : Our purpose was to carry out a clinical and histopathological study about actinic keratoses in Korea. Methods : 158 patients, diagnosed with actinic keratoses from 1987 to 1995 in Korea, were analyzed clinically and histopathologically. Results 1. The ratio of males to females was 1:2.4 and the most frequent age groups were the 6th(29.1%) and 7th decade(33.5%). 2. The duration of the lesions was more than 1 year in most cases. 3. The most commonly involved sites were the face, in which the cheek, nose and forehead were the most common sites. 4. Clinically, the size of the lesions was less than 1cm in many cases(66.8% ). The color was erythematous in 57.9%, brownish in 26.7%, and dark brownish in 15.3%. Crust and scale were noted in 28.7% and 25.2%, respectively. In 4% of patients, cutaneous horn also was noted. 5. Squamous cell carcinoma was associated with actinic keratoses in 5.7%, basal cell carcinoma in 3.2%, and keratoacanthoma in 1.3%. 6. Histopathologically, hypertrophic types of actinic keratoses were noted in 25.0%, atrophic types in 21.3%, hypertrophic and atrophic types in 18.1%, bowenoid types in 17.6%, acantholytic types in 13.3%, and pigmented types in 4.7%. 7. The most commonly used methods of treatment for actinic keratoses were cryotherapy, surgical excision, 5 FU ointment, and electrodesiccation with good effect. Conclusion : Actinic keratoses in Koreans was present on the face most commonly over 50 years of age. It showed a more frequent incidence in females than males. The clinical course of the lesions was chronic and the association with other cutaneous malignancies was noted to be less than 6%. The various histopathological types were noted, including hypertrophic, atrophic, hypertrophic and atrophic, bowenoid, acantholytic, and pigmented. The most commonly used methods of treatment. for actinic keratoses were cryotherapy, surgical excision, 5-FU ointment, and electrodesiccation. (Korean J Dermatol 1997;35(5): 931-939)

칼슘 차단제 전신처리가 백서의 임의형 피부판 생존에 미치는 영향

백영홍,최석현,조백현,박희만,이삼용 大韓成形外科學會 1989 Archives of Plastic Surgery Vol.16 No.3

Skin flap necrosis can be a catastrophe in reconstructive surgery. Many attempts have been made clinically and experimentally to improve the survival in random pattern flaps. As the delay phenomenon theory, that is, vascular smooth muscle relaxation augments the blood flow to the capillary bed of the skin flap, experimental study using the Sprague-Dawley rats performed with the calcium antagonists which cause the dilatation of vascular smooth muscle by blocking the calcium-influx into the cells. Total 100 rats were grouped into control group(10) and 3 experimental groups. Each experimental group was subdivided into pre-operation, post-operation and pre-operation & post-operation group in accordance with the injection period of calcium antatonists, nifedipine and diltiazem. All the experimental groups increased the surviving skin flap area than the control group. This suggests that sustained vasodilatation by the calcium antagonists ia a major factor of flap survival increment. The mean survival area in all experimental groups was significantly greater than that in the control group.

白鼠에서 Ketamine의 鎭痛作用 棋戰에 關한 硏究

김연진,조백현,송윤강,곽용근,조규박 의과학연구소 1988 全北醫大論文集 Vol.12 No.2

In this study, the effect of ketamine on the response to painful stimuli and modification by some antagonists to norepinephrine serotonin and opiate receptors were investigated in rats. And also, the influence of ketamine on the [^3H]-naloxone binding in vitro and on the plasma β-endorphin content were determined. Ketamine(30-120mg/kg, i.p.) increased the tail-flick latency(TFL), measured by tail immersion method, in dose-dependent manner. This analgesic action of ketamine was significantly inhibited by pretreatment of phentolamine(10mg/kg, i.p., ID50=0.49±0.03mg/kg), naloxone and methysergide(0.1-10mg/kg, i.p., ID50=0.064±0.005mg/kg), respectively. The analgesic action of ketamine was greatly potentiated in the reserpine-pretreated rats(1mg/kg, i.p., for 6 days), while the effect of ketamine was almost abolished in the p-chloro-phenylalanine-pretreated animals(300mg/kg, i.p., once 2 days before experiment). In a radioligand binding assay with (^3H)-naloxone, ketamine(0.3-300uM) produced dose related inhibition of [^3H]-naloxone binding in vitro. The inhibitory potency of ketamine on [^3H]-naloxone binding was far weaker than that of morphine or naloxone. Intraperitoneal ketamine(60mg/kg)-induced increase of the plasma immunoreactive β-endorphin content was significantly inhibited by methysergide(1mg/kg, i.p.,) pretreatment, while that not influenced by phentolamine (10mg/kg). These results suggest that the analgesic effect of ketamine is due to at least three possible mechanisms ; central sympathetic nervous system which modify pain perception, direct agonistic action to opiate receptor and increase of β-endorphin content by central serotoninergic system.

Endorphin의 心脈關系 調節에 關한 硏究

송은석,조백현,김동수,곽용근,은홍배,조규박 의과학연구소 1987 全北醫大論文集 Vol.11 No.4

Experiments were designed to evaluate the role of β-endorphin in the central cardiovascular control of the two-kidney on clipped hypertensive rats. 1. In the two-kidney one-clipped rat, blood pressure was significantly increased after 7 days of operation, whereas heart rate did not change. 2. In these preparations, β-endorphin contents in brain were significantly increased es-pecially in hypothalamus, medulla and pons, while decreases of maximum specific(^3H)-mor-phino binding were observed in thalamus, hypothalamus, medulla and pone. 3. Decreasing effects of intraventricular morphine on blood pressre and heart rate was potentiated in the two-kidney one-clipped hypertensive rats. These effects of intraventricular morphine were not blocked by intraventricular phenotolamine, phenoxybenzamine, yohimbine, piperoxan or prazosin, but by intraventricular naloxone. 4. In the two-kidney one-clipped hypertensive rats, decreasing effects of intraventricular clonidine on blood pressure and heart rate were potentiate. These effects of clonidine were inhibited by intraventricular naloxone. From the above results, it is suggested that changes of β-endorphin contents and opiate receptors in brain will take a role of centrol cardiovascular control of two-kidney one-clipped hypertensive rats by modulating the central cardiovascular control of two-kidney one-clipped hypertensive rats by modulating the central stmpathetic activity through a_2-adrenergic receptors. (Key words: endorphin, cardiovascular system)