영구형 심박조율기 시술에 대한 임상경험

조정관(Jeong Gwan Cho),정명호(Myung Ho Jeong),박종춘(Jong Chun Park),양승진(Seung Jin Yang),박찬형(Chan Hyung Park),길광채(Gwang Chae Gill),조길우(Keal Woo Cho),강정채(Jung Chaee Kang) 대한내과학회 1989 대한내과학회지 Vol.37 No.1

N/A Pacemaker implantation for symptomatic bradycardia is becoming popular recently in this country. Though its clinical benefit has been documented clearly there are still a lot of clinical problems arising from surgical problems, implanting techniques and pacemaker inherited problems. This study was designed to evaluate the indications, clinical manifestations and complications of 62 implantation procedures in 55 patients who had undergone the implantation procedure in Chonnam University Hospital by reviewing the pertinent clinical records. From 1983 to 1988, 62 implantation procedures in 55 patients (19 men and 36 women) were carried out. Annual numbers of implantation had been increasing, with 5 cases in the beginning year up to 20 cases in 1987, the numbers increased. The most common age was the fifties and patients older than fifty years comprised 74.5% of the total. The main symptoms which brought the 52 patients who underwent the first implantation to the hospital were syncope in 26, dyspnea in 14, dizziness in 9, shock in 2, and nonspecific in l. Electrocardiographic manifestations of the patients were atrioventricular block in 32 (58.2%, 28 complete AV blocks, 3 type II 2nd AV blocks, and one trifascicular block) and sick sinus syndrome in 23 patients (41.8%, 10 sinus arrests, 9 sinus bradycardias, 3 tachy-bradycardias, and one second degree SA block). Associated diseases were hypertension in 20, coronary artery disease in 7, cerebral infarction in 4, surgical correction of VSD in 2, dilated cardiomyopathy in 2, diabetes mellitus in 2, thyrotoxicosis in l, and liver cirrhosis in 1 patient. But, abaut one fourth of the patients had no associated disease. The systems implanted were all ventricular demand pacing system, among which 41 (70%) were multi-programmable. Pacing leads were introduced via the cephalic vein in most of the cases and via the external jugular vein in some cases. At implantation the pacing threshold was 0.67±0.25 volts (M±SD), electrode impedance 1258±266 ohm (M±SD), and intracardiac R wave amplitude 10.3±9.7 mvolts (M±SD). The causes of revision due to complications were 2 chronic exit blocks, 2 erosions of the generator or lead, one preerosion followed by infection after a revision, one generator pocket abscess shortly after an implantation, one power depletion, and 3 occasions of twiddler's syndrome in a patient. Other complications which were controllable without revision of the system were one indifferent electrode skeletal muscle pacing treated by reprograming the output, chronic increase of threshold in another 2, pacemaker syndrome in one treated by reprograming, and a hematoma in the generator pocket resolved by needle aspiration. We learned from this review that although pacemaker implantation has been helpful in the majority of the patients treated, same annoying and potentially life threatening complications warranted, and efforts to prevent or detect them early are necessary mention.

비인강암 환자의 고선량 강내 방사선 치료의 효과

조정길 (Jeong Gill Cho),장혜숙 (Hye Sook Chang),최은경 (Eun Kyung Choi) 대한방사선종양학회 1993 Radiation Oncology Journal Vol.11 No.1

From September 1989 to June 1992, 22 patients with nasopharyngeal carcinoma were treated in Asan Medical Center with an external beam of 60 Gy followed by a boost dose of 15 Gy HDR brachytherapy. There were 5 females and 17 males with median age of 44 years (range: 20-69 years). All patients were histologically confirmed and staged by physical examination, CT scan and/or MRI. By the AJCC TNM staging system, there were 2 patients with stage II (T2NO), 4 with stage III (T3NO, T1-3N1), and 16 with stage IV (T4 or N2-3). Four patients received chemotherapy with 5-FU and cisplatin prior to radiotherapy. All patients were followed up periodically by a telescopic examination and radiologic imaging study of CT scan or MRI with a median follow-up thime of 13 months (range: 3-34 months). Twenty one patients showed a complete response one month after completing therapy and one patient showed a compete response after three months. At the time of this analysis, seventeen patients remain alive without evidence of disease, but four patients developed distant metastasis and one patient died a month after treatment. the local control rate was 100% in a median follow-up time of 13 months. The two year overall and disease free survival rates by the Kaplan-Meier method were 94% and 67%, respectively. Serious radiation sequelae have not been observed yet. Although longer follow-up in needed, this retrospective analysis suggests that HDR brachytherap. given as a boost therapy for nasoharyngeal carcinoma may improve the local control. To reduce the incidence of distant metastasis, we need to develop a more effective systemic chemotherapy.

방실결절 이중전도로의 빈도 및 방실결절 회귀성 빈맥의 유발 여부에 따른 전기생리학적 특성의 차이

길광채(Gwang Chae Gill),서정평(Jeong Pyeong Soe),박주형(Joo Hyung Park),정명호(Myung Ho Jeong),조정관(Jung Gwan Cho),박종춘(Jong Chun Park),강정채(Jung Chaee Kang) 대한내과학회 1997 대한내과학회지 Vol.52 No.4

N/A Objectives: Refractory period and conduction time of the slow and fast pathways in the atrioven-tricular node are known to be the most important determinant of the inducibility of atrioventricular nodal reentrant tachycardia (AUNRT) but their relationship has not been determined in Korean. Methods: Two hundred and ten patients under-gone electrophysioiogic study. One hundred twenty two patients with dual AV nodal pathways were divided into two groups (group I, 77 patients with no inducible AVNRT; group II, 45 patients with inducible AVNRT). Results: Antegrade dual AV nodal pathways were documented in 77 patients (47%) out of 165 patients on whom AVNRT was not induced, Antegrade ERP of slow pathway in paced rhythm (600 msec) was shorter in group II than in group I (331±14 msec vs 269±47 msec, p<0.05). Ventriculoatrial block cycle length (VABCL) and retrograde ERP of the AV conduction system were significantly shorter in group 2 than in group 1 (p<0.001). Maximum slow pathway conduction times in sinus rhythm and paced rhythm (600msec) in group 2 were significantly longer than in group 1 (sinus rhythm: 332±68msec vs. 379±88msec, p<0.005; paced rhythm: 332±69msec vs. 392±85msec, p<0.005). The ERP gaps of two AV nodal pathways of group 2 in sinus rhythm and in paced rhythm were also significantly longer than those of group 1 (sinus rhythm 41±3msec vs. 78±50msec, p<0.001; paced rhythm 36±32 msec vs. 72±19msec, p<0.005). The incidence of intact ventriculoatrial conduction was significantly higher in group 2 than in group 1 (p<0.05). Antegrade slow pathway conduction time (A2H2 interval) at the time of AVNRT induction with single atrial premature depolarization (APD) with a coupling interval over 10 msec less than that of an APD producing AH jump were not correlated with VABCL (r=0.193, p<0.05). Conclusion: Dual AV nodal pathways were observed in 47% of patients with no-inducible AVNRT group. The inducibility of AVNRT appears to be closely ralated to the some conduction characteristics of the dual pathways and the refractoriness, i.e. maximum slow pathway conduction time, the ERP gap of two pathways, retrograde fast pathway ERP, VABCL.

심실상성 빈맥의 기전 규명에 있어서 심전기생리학적 지표인 △VACT와 VACT Ratio 의 가치

조정관(Jeong Gwan Cho),박상진(Sang Jin Park),류제영(Jay Young Rhew),배열(Youl Bae),김성희(Sung Hee Kim),김준우(Jun Woo Kim),김주한(Ju Han Kim),길광채(Gwang Chae Gill),박주형(Joo Hyung Park),정명호(Myung Ho Jeong),박종춘(Jong Chun Pa 대한내과학회 1996 대한내과학회지 Vol.51 No.2

N/A Background: Electrophysiologic methods useful in determining the mechanism of paroxysmal supra- ventricular tachycardia (PSVT) accurately and easily have been continuously studied. Most studies were focused on the development of a method to differentiate AVNRT and AVRT using the septal atrioventricular bypass tract, since these two tachycardias are very difficult to differentiate even with electrophysiologic study (EPS). Several methods previously reported have some limitation in accuracy and/or applicability, Objectives: The purpose of this study is to develop a new electrophysiologic parameter by evaluating the usefulness of the difference (△VACT) and ratio(VACT ratio) of VA conduction time (VACT) during right ventricular pacing at the cycle length of supraventricular tachycardia (SVT) in determining the mechanism of SVT and localizing accessory pathways (AP) in AVBT. Methods: Total of 94 SVT patients undergoing EPS and radiofrequency (RF) catheter ablation for 35 AVNRT (17 male, 18 female; mean age 45.6±17.2 years) and 59 AVRT (36 male, 23 female; mean age 37.5 ±15.3 years) were included in this study, The electrophysiologic mechanism of SVT and the location of APs in A VRT were confirmed by RF catheter ablation in all the patients. AVNRT was typical form in 34 patients and atypical (slow-slow) form in one. Among 59 APs, 19 (32.2%) APs were right side (12: free wall, RFW group; 7: septum, SPT group), 40 (67.8%) APs were left side (37: free wall, LFW group; 3: septum, SPT group), EPS was performed using the standard technique. 6F multipolar electrode catheters were positioned at the high right atrium (HBA), atrioventricular junction (HIS), right ventricular apex (RVA) in all the patients, and coronary sinus if needed. SVT was induced in all the patients with programmed electrical stimulation. VA conduction time (VACT) was measured from the onset of QRS complex to the onset of atrial electrogram from the HRA during SVT (VACT-SVT) and during RVA pacing at the SVT cycle length (VACT-RVP). △VACT was calculated by subtracting VACT-SVT from VACT- RVP and VACT ratio by dividing VACT-RVP by VACT-SVT. AVNRT and AVRT were differentiated using the previously reported criteria and then RF catheter ablation was performed. RF was delivered at the target site through a 7F 4 mm-tipped deflectable ablation catheter using continuous unmodulated sine wave with 350 KHz or 500 KHz generated from RF generator (RFG-3B, Radionics, Burlington, Mass or HAT 200S, Osypka, Germany). Results: The preexcitation index (PI) could be measured with a single ventricular extrastimulus in 22 (62.9%) of 35 AVNRT patients and 49 (83.1%) of 59 AVRT patients. PI was 139±31 (range 90-200) in AVNRT, 30±11 (range 15-40) in RFW group, 29 20 (range 10-70) in SPT group, and 92±24 (range 55- 160) in LFW group, showing a significant difference between each groups, but considerable overlap (52.6% of 76) between each groups except between AVNRT and AVRT with right side AP, DVACT was 126±20 (range 76-168) ms in AVNRT, 179 (range 4-35) ms in RFW group, 29 ±25 (5-76) ms in SPT group, 79±16 (50-110) ms in LFW group, showing a significant difference between AVNBT and 3 groups of AVRT and between 3 groups of AVRT except between RFW group and SPT group (p<0.01). The frequency of the patients with overlap in AVACT was lower than that in PI(52.6% vs. 24.5%, p<0.05). △VACT with a cut-off value of 50 ms differentiated the sideness (right vs. left) of APs in 58 (98.3%) of 59 AVRT patients, VACT ratio was 3.671.22 (range 2.20-8.30) in AVNRT, 1.10,1 (range 1.03-1.29) in RFW group, 120.2 (range 1.03-1.29) in SPT group, and 1.5±0.1 (range 1.30-1,86) in LFW group, showing no overlap between AVNRT and AVRT. AVNRT and AVRT were completely differentiated with VACT ratio with a cut-off value of 2.0. Conclusion : It is concluded that the mechanism of SVT may be accurately differentiated into AVNRT or AVRT using VACT ratio with a cut-off value of 2.0 and the location of accessory pathwa

Effects of 2-Deoxy-D-Glucose on Metabolic Status, Proliferative Capacity and Growth Rate of FSall Tumor: Observations made by In Vivo $^{31}P$-Nuclear Magnetic Resonance Spectroscopy and Flow Cytometry

장혜숙,최은경,조정길,임태환,이대근,이윤,조영주,김곤섭,Chang Hyesook,Choi Eun Kyung,Cho Jeong Gill,Lim Tee-Hwon,Lee Tae-Keun,Yi Yun,Cho Young Joo,Kim Gon Sup The Korean Society for Radiation Oncology 1991 Radiation Oncology Journal Vol.9 No.2

2-ODG가 쥐의 섬유육종(FSall)에 미치는 영향에 대한 연구로 에너지 신진대사는 체내에서의 $^{31}P$-자기공명 분광기를 이용하여 관찰하였고 세포 증식 능력은 유세포 분석기를 사용하여 연구하였다. 성장속도는 10개의 세포를 $C_3Hf/Sed$ 쥐의 발등에 이식한 후 3차원적으로 측정하여 관찰하였다. 2-DDG를 투여한 경우에는 이식후 12일에 복강내로 주사하였다. 이식후 12일의 종양의 평균 크기는 $250mm^3$이었다. Fsall종양의 성장속도는 semilog graph의 기울기와 종양의 doubling time으로 측정하였다. 2-DDG를 투여한 후 성장속도가 감속되었다. 5~12일 사이의 성장속도의 기울기가 0.828, 종양의 Idubling time이 0.84일이고 대조군에서는 13~28일 사이의 기울기가 0.218, doubling time이 3.2일인 반면 2-DOG 투여군에서는 성장속도의 기울기가 0.135이고 doubling time이 5.1일이었다. $^{31}P$-자기공명 분광기를 이용하여 2-DDG의 영향을 분석해 본 결과 2-DDG 투여후 종양증식 속도의 감속과 더불어 phosphornonester (PME)와 inorganic phosphate (Pi)의증가속도가 감소하였다. 이것은 2-DDG투여후 세포의 괴사가 감소하였다는 의미가 있다. 유세포 분석기를 이용하여 종양의 증식 능력을 분석한 결과는 2-DDG 투여후 5-phase와 G2+M phase의 DNA분포가 크게 증가하였다. 이것은 2-DDG투여후 세포가 좀더 방사선에 민감한 cycle로 진행함을 의미하는 것으로 해석할 수 있다. 이에 저자들은 2-DDG가 Fsall 종양세포에 미치는 흥미있는 결과를 토대로 방사선 치료에 미치는 영향과실제 이용 가능성에 대하여 더 연구하고자 한다. The effect of 2-deoxy-d-glucose (2-DDG) on $C_3H$ mouse fibrosarcoma(FSall) was studied. Metabolic status, especially for energy metabolism, was studied using in vivo $^{31}P$-MRS, proliferative capacity was observed on flow cytometry(FC) and growth rate was measured after transplantation of $10^6$ viable tumor cells in the dorsum of foot of $C_3Hf/Sed$ mice. One gram of 2-DDG Per kg of body weight was injected intraperitoneally on 12th day of implantation. Average tumor size on 12th day of implantion was $250mm^3$. Growth rate of Fsall tumor was measured by tumor doubling time and slope on semilog plot. After 2-DDG injection, growth rate slowed down. Tumor doubling time between tumor age 5-12 days was 0.84 days with slope 0.828 and tumor doubling time between tumor age 13-28 days was 3.2 days with slope 0.218 in control group. After 2-DDG injection, tumor doubling time was elongated to 5.1 days with slope 0.136. The effect of 2-DDG studied in vivo $^{31}P$-MRS suggested that the increase of phosphomonoester (PME) and inorganic phosphate (Pi) by increasing size of tumor, slowed down after 2-DDG injection. Flow cytometry showed significantly increased S-phase and $G_2+M$ phase fraction suggesting increased proliferative capacity of tumor cells in the presence of 2-DDG. Authors observed an interesting effect of 2-DDG on FSall tumor and attempt to utilize as an adjunct for radiotherapy.

폐 부위 Planning Target Volume(PTV)설정시 폐 움직임의 객관적 측정

정원규(Weon Kuu Chung),조정길(Jeong Gill Cho) 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.4

목 적 : ICRU 50의 권고에 따라 치료 범위를 Planning Target Volume(PTV)으로 설정하고 있다. 진단 영상장치의 발달과 특히 CT Simulator 등의 도움으로 Gross Tumor Volume(GTV) 설정은 쉬워지고 있으나, 내부장기의 움직임에 의한 경계의 선정에 대하여는 특별한 지침이 없고, 단지 경험에 의존하고 있는 실정이다. 본 연구에서는 폐의 움직임 유형을 분석하여 폐 부위의 PTV 설정시 폐의 움지임을 고려하기 위한 정량적인 지침을 마련하려는데 있다. 대 상 및 방 법 : 폐암, 식도암 등 폐 및 흉부 주변의 방사선으로 치료받는 환자 10명을 대상으로 Simulator 투시 촬영기로 폐의 움직임을 관찰하였다. 우측 폐는 12부위와, 좌측폐는 10부위로 각각 나누었다. 우측 폐 부위는 상엽은 2부분, 중엽은 2부분, 하엽은 2부분으로 나누었고, 그 각각을 측면에서 전, 후 2부분으로 나누었다. 좌측 폐 부위는 상엽, 하엽 모두 2부분으로 나누고, 측면에서 다시 전, 후로 다시 2부분으로 나누었다. 부위마다 4-5점을 택해 X선 투시 장치에서 생성된 영상을 컴퓨터에 입력시켜 폐포의 움직임을 x, y, z 3좌표 방향으로 수치화 하였다. 결 과 : 우측과 좌측 폐 부위 중 양측 상엽 부위의 움직임이 상대적으로 적었으며, 좌우이동이 전후 이동에 비해 크게 나타났다. 좌우 이동은 심장 박동 효과로 심장 또는 대동맥 근처에서 가장 두드러지게 나타나서 양측 폐문 부위가 가장 큰 이동을 보였으며(평균 6.6mm), 상하 이동은 호흡 효과로 양측 폐 하엽 부위, 횡격막 근처에서 가장 컸다(평균 14.1mm). 결 론 : X선 투시로 폐의 움직임을 관찰할 수 있으며 컴퓨터의 궤적 추적으로 정량화 할 수 있었다. 폐 부위의 방사선 치료시 설정되는 PTV에는 장기의 움직임을 고려해야 하는데 본 연구의 결과를 이용하여 치료 부위에 따라 여유를 차등을 둔다면 치료 조사면을 최적화 하는데 도움이 될 것으로 생각된다. Purpose:To quantify the movement of lung parenchyma for ICRU 50 Planning Target Volume(PTV) delineation of the lung region. Materials and Methods :Fluoroscopic observations and measurements are performed on 10 patients with chest region cancer who have normal pulmonary functions. We have divided the lung region into 12 parts for the right lung, 10 parts for the left lung and four to five points of lung parenchyma were selected for anatomical analysis points. Fluoroscopic images are sent to a computer and then movements are measured. Results:Both lower lobes showed the longest longitudinal movements because of breathing (average 14.1mm, maximum 22.1mm), while antero- posterior displacement showed the smallest value. Lateral movements of the lung parenchyma averaged 6.6mm, and the maximum value was 9.1mm. (both hilar regions showed maximum values because of cardiac motion) Conclusion:We could quantify the lung movements by measuring parenchyma displacements. The movements of both upper lobes were less than those of the middle and upper lobes in longitudinal and transverse movements. Optimal margins can be selected for PTV delineation using these results.

비인두강 종양의 방사선치료성적

노영주(Young Ju Nho),조정길(Jeong Gill Cho),안승도(Seung Do Ahn),최은경(Eun Kyung Choi),김종훈(Jong Hoon Kim),강원철(One Chul Kang),장혜숙(Hyesook Chang) 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.4

목 적 : 비인두강종양의 방사선치료의 결과를 후향적으로 분석하여 방사선치료의 효과와 예후인자를 분석하고자 하였다. 대상 및 방법 : 1989년부터 1996년까지 서울중앙병원에서 비인두강종양으로 진단받고 근치적 방사선치료를 시행한 56명을 대상으로 하였다. 병기별로 보면 T1, T2, T3, T4가 각각 17, 10, 11, 18명이었고 N0, N1, N2, N3가 각각 11명, 27명, 4명, 14명이었다. 근치적 방사선치료만 시행한 환자는 28명, 유도항암요법을 병용한 환자는 7명, 매주 CDDP 항암요법을 병용한 환자는 21명이었다. 조사량은 6940-8620cGy였고 중앙값은 7440cGy였다. 외부방사선조사 60Gy이후 원발병소에 대한 부가적치료는 1명은 외부방사선조사, 46명은 강내조사, 9명은 삼차원 입체조형치료를 받았다. 추적관찰기간은 5-92개월이었고 중앙값은 34개월이었다. 결 과 : 전치료후 47명은 완전관해, 8명은 부분관해, 1명은 무반응을 보였다. 5년 생존율은 67.2%, 5년 무병생존율은 53.6%이였다. 국소재발이 생긴 시기는 6-45개월(중앙값 : 14개월)이었으며 전신적 전이가 생긴 시기는 3-49개월(중앙값 : 16개월)이었다. 8명의 환자(14.3%)에서 국소재발이 발생하였고 18명의 환자(32.1%)에서 전신적 전이가 발생하였다. T3나 T4 환자 중 강내조사를 받은 20명중 4명(20%)에서 원발병소에 재발이 있었고 삼차원 입체조형치료를 받은 9명 중 1명(11%)에서 원발병소에 재발이 발생하였다. 전신적 전이는 골전이가 가장 많았다. 생존율에 영향을 주는 예후인자로는 생존율에는 KPS( P=0.005), 방사선치료에 대한 반응(P=0.0001)이 통계학적으로 유의하였고 무병생존율에는 KPS(P=0.02), 방사선치료에 대한 반응(P=0.005)이 통계학적으로 유의하였다. 국소재발과 관련있는 예후인자는 없었으며 원격전이와 관련있는 예후인자는 N stage(P=0.06), 병기(P=0.06)가 다소 의미있는 경향을 보였고, 방사선치료에 대한 반 응(P=0.009)이 통계학적으로 유의하였다. 결 론 : 비인두강종양에서 방사선치료로 5년생존율 67.2%이었고 5년 무병생존율은 53.6%이였다. 재발양상을 보면 국소재발보다는 전신적 전이율이 높음을 알 수 있었고 항암치료와의 병용은 관련이 없었다. T3 혹은 T4 병기에서 삼차원 입체조형치료를 받은 환자에 대해서는 앞으로 추적관찰이 좀더 필요할 것으로 생각된다. 앞으로 국소관해를 높이기 위한 방사선치료방법과 전신적 전이율의 감소를 위한 항암요법에 관한 연구가 필요할 것으로 생각된다. Purpose : This is a retrospective study to evaluate the results of radiation therapy and prognostic factors influencing the results in nasopharyngeal carcinoma. Materials and Methods : From October 1989 to May 1996, 56 patients were treated for nasopharyngeal carcinoma at Department of Radiation Oncology. According to stage, patients were distributed as follows : stage I (2), II (13), III (11), IV (30). Twenty-eight patients were treated with radiation therapy only, 7 patients were treated with neoadjuvant chemotherapy followed by radiation therapy. Twenty-one patients were treated with radiation therapy and weekly CDDP. After external beam radiotherapy of 60Gy, 46 patients received boost dose with intracavitary radiation and 9 patients with 3D conformal therapy. One patient received boost dose with 2 dimensional photon beam therapy. The tumor dose ranged from 69.4Gy to 86.2Gy with median dose of 74.4Gy. The follow -up period ranged from 5 months to 92 months with a median of 34 months. Results : Forty-seven patients achieved complete response and 8 patients showed partial response. One patient showed minimal response. Patterns of failure were as follows : locoregional recurrence (8) and distant metastasis (18). Among these patients, 2 patients failed locoregionally and distantly. The sites of distant metastasis were bone (8), lung (8) and liver (4). Five years survival rate was 67.2% and 5 years disease-free survival rate was 53.6%. KPS (P=0.005) and response of radiation therapy (P=0.0001) were significant prognostic factors for overall survival. KPS (P=0.02) and response of radiation therapy (P=0.005) were significant prognostic factors for disease-free survival. Conclusion : This retrospective study showed that distant metastasis was the predominant pattern of relapse in nasopharyngeal cancer. Neoadjuvant chemotherapy or weekly CDDP did not influence the distant metastasis-free survival. For advanced T stage, 3D conformal therapy provided an improved dose coverage compared to ICR. But further follow -up was needed in patients with 3D conformal therapy to assess the efficacy of this therapy. Development of techniques of radiation therapy to improve locoregional control and of more effective systemic chemotherapy regimen are needed.

Effect of 2-Deoxy-D-Glucose on Metabolic Status, Proliferative Capacity and Growth Rate of FSall Tumor

Hyesook Chang(장혜숙) , Eun Kyung Choi최은경) , Jeong Gill Cho(조정길) , Tae-Hwan Lim(임태환) , Tae-Keun Lee(이대근) ,Yun Yi(이윤) ,Young Joo Cho(조영주) , Gon Sup Kim(김곤섭) 대한방사선종양학회 1991 Radiation Oncology Journal Vol.9 No.1

2-DDG가 쥐의 섬유육종(FSall)에 미치는 영향에 대한 연구로 에너지 신진대사는 체내에서의 ³¹P - 자기공명 분광기를 이용하여 관찰하였고 세포 증식 능력은 유세포 분석기를 사용하여 연구하였다. 성장속도는 개의 세포를 C₃Hj/Sed 쥐의 발등에 이식한 후 3차원적으로 측정하여 관찰하였다. 2-DDG를 투여한 경우에는 이식후 12일에 복강내로 주사하였다. 이식후 12일의 종양의 평균 크기는 250㎣이었다. FSall 종양의 성장속도는 semilog graph의 기울기와 종양의 doubling time으로 측정하였다. 2-DDG를 투여한 후 성장속도가 감속되었다. 5~12일 사이의 성장속도의 기울기가 0.828, 종양의 Idubling time이 0.84일이고 대조군에서는 13~28일 사이의 기울기가 0.218, doubling time이 3.2일인 반면 2-DDG 투여군에서는 성장속도의 기울기가 0.135이고 doubling time이 5.1일이었다. ³¹P-자기공명 분광기를 이용하여 2-DDG의 영향을 분석해 본 결과 2-DDG 투여후 종양증식 속도의 감속과 더불어 phosphomonester (PME)와 inorganic phosphate (Pi)의 증가속도가 감소하였다. 이것은 2-DDG 투여후 세포의 괴사가 감소하였다는 의미가 있다. 유세포 분석기를 이용하여 종양의 증식 능력을 분석한 결과는 2-DDG 투여후 S-phase와 G₂+M phase의 DNA 분포가 크게 증가하였다. 이것은 2-DDG 투여후 세포가 좀더 방사선에 민감한 cycle로 진행함을 의미하는 것으로 해석할 수 있다. 이에 저자들은 2-DDG가 FSall 종양세포에 미치는 흥미있는 결과를 토대로 방사선 치료에 미치는 영향과 실제 이용 가능성에 대하여 더 연구하고자 한다. The effect of 2-deoxy-d-glucose (2-DDG) on C₃H mouse fibrosarcoma(FSall) was studied, Metabolic status, especially for energy metabolism, was studied using in vivo P-MRS, prolifer-ative capacity was observed on flow cytometry(FC) and growth rate was measured after trans-plantation of viable tumor cells in the dorsum of foot of C₃Hf/Sed mice. One gram of 2-DDG per kg of body weight was injected intraperitoneally on 12th day of implantation. Average tumor size on 12th day of implantion was 250㎣. Growth rate of FSall tumor was measured by tumor doubling time and slope on semilog plot. After 2-DDG injection, growth rate slowed down. Tumor doubling time between tumor age 5-12 days was 3.2 days with slope 0.218 in control group. After 2-DDG injection, tumor doubling time was elongated to 5.1 days with slope 0.136. The effect of 2-DDG studied in vivo P-MRS suggested that the increase of phosphomonoes-ter (PME) and inorganic phosphate (Pi) by increasing size of tumor, slowed down after 2-DDG injection. Flow cytometry showed significantly increased S-phase and G₂ + M phase fraction suggesting increased proliferative capacity of tumor cells in the presence of 2-DDG. Authors observed an interesting effect of 2-DDG on FSall tumor and attempt to utilize as an adjunct for radiotherapy.

Tc - 99m MIBI 와 Tl - 201 심근 SPECT에서 역재분포의 임상적 의의

김지열(Ji Yeul Kim),범희승(Hee Seung Bom),송호천(Ho Cheon Song),박주형(Joo Hyung Park),정명호(Myung Ho Jeong),조정관(Jeong Gwan Cho),박종춘(Jong Choon Park),강정채(Jung Chaee Kang),길광채(Kwang Chae Gill) 대한핵의학회 1996 핵의학 분자영상 Vol.30 No.1

N/A Reverse redistribution(RRD) refers to a perfusion defect that develops or becomes more evident on rest imaging compared with the stress imaging. This phenomenon was not uncommonly noted on myocardial perfusion single photon emission computed tomography(SPECT). However, the clinical significance and pathophysiological mechanism of RRD were unclear. The aim of this study was to evaluate the incidence and clinical significance of RRD on either dipyridamole T1-201 or Tc-99m MIBI myocardial perfusion SPECT. RRD was defined as≥10% decrease in relative T1-201 and Tc-99m MIBI uptakes on rest images compared to the stress images or as an appearance of new perfusion defects on rest images. It was observed in both T1-201 (44/463, 9.5%) and Tc-99m MIBI (124/999, 12.4%) myocardial SPECTs similarly, with an overall incidence of 11.5%(168/1462). Many apparently unrelated disease groups showed the finding: post-revascularization(53.9%), coronary artery disease(24.6%), myocardial infarction(l2.3%), and those with normal coronary arteries(9.2%). Clinical and angiographic characteristics of 65 consecutive patients who underwent coronary arteriography in 168 patients who had RRD on myocardial perfusion SPECT were reviewed. Tc-99m MIBI was used in 44 patients, and TI-201 was used in 21 patients. Of the 81 myocardial segments analyzed which showed RRD, 32 segments(39.5%) were in septum, 24(29.5%) in inferior wall, 12(14.8%) in anterior wall, 7(8.7%) in apex and 6(7.4%) in lateral wall. There was no clear association between RRD and coronary arterial stenosis or presence of collateral circulations. Ventriculographical wall motion was evaluated in 27 regions with RRD; it was normal in 12 regions, hypokinetic in 12 regions and dyskinetic in 3 regions. In 14 of 21 patients who showed RRD on T1-201 myocardial SPECT, T1-201 reinjection was performed immediately after the 3-4 hour redistribution studies. Ten of 14(71.4%) showed enhanced T1-201 activity(≥10% increased) after reinjection. We conclude that RPD is not related to mode of stre

경피적 관동맥 성형술시 반복적인 혈류차단 - 재관류에 따른 관동맥내 심전도의 변화

김주한(Ju Han Kim),김준우(Joon Woo Kim),김성희(Sung Hee Kim),김남호(Nam Ho Kim),박우석(Woo Suck Park),박주형(Joo Hyung Park),길광채(Gwang Chae Gill),정명호(Myung Ho Jeong),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),강정채(Jung Cha 대한내과학회 1997 대한내과학회지 Vol.53 No.3

N/A Objective : Brief epidodes of ischemia have been shown to make the heart more resistant to subsequent ischemia in animal studies(known as ischemic preconditioning, IP). This phenomenon was tested in patients undergoing percutaneous transluminal coronary angioplasty(PTCA). Methods: Thirteen patients who had significant epicardial coronary stenosis without myocardial infarction, ventricular hypertrophy or conduction defect, received two to four 2-min balloon inflations separated by 5 min of reperfusion. Surface electrocardiogram(S-ECG) and intracoronary electrocardiogram (IC-ECG) from an angioplasty guide wire were recorded before and after balloon inflation. Results: The changes of ST segment were observed in 13 out of 15 lesions on IC-ECG and 7 on S-ECG. The maximal ST changes on IC-ECG and S-ECG were 20.2±13.7mm and 1.21.5mm respectively(p<0.01). The time to beginning of ST segment change after balloon inflation were 10.1±12.6 seconds and 63.3±14.2 seconds on IC-ECG and S-ECG, respectively(p<0.01). The maximal changes of ST segment on IC-ECG during the second inflation were significantly lower than that during the first(20.2±13.7 vs 16.312.3mm, p<0.05). However, changes of R wave, T wave and QT interval were not significantly different between two inflations. The recovery time to baseling ECG after initiation of reperfusion were 50.2±41.7 seconds and 38.5±29.6 seconds for the first inflation and the second, respectively(P<0.05). Conclusion: These results suggest that IC-ECG is more sensitive and reliable than S-ECG in detection of myocardial ischemia and that IP may occur during PTCA since ST segment shift is decreased and is normalized earlier at the second balloon inflation compared with the first.