악성 갑상선 우연종의 임상상 및 초음파 소견의 진단적 가치

강한욱,김광원,이병완,강보현,김형훈,김범진,정재훈,민용기,이명식,이문규 대한내분비학회 2002 Endocrinology and metabolism Vol.17 No.5

연구배경: 최근 갑상선 초음파 검사의 빈번한 시행으로 갑상선 우연종의 발견이 증가하고 있다. 이러한 갑상선 우연종은 임상적으로 어떻게 접근하고 치료를 해야 하는지 적지 않은 문제가 되고 있다. 본 연구에서는 직경 1.5㎝ 이하의 갑상선 우연종의 유병률, 입상적 특징 및 초음파 특성, 그리고 가장 효율적인 진단적 접근에 대해 알아 봤다. 방법: 1999년 1월부터 2000년 12월까지 삼성서울병원 내과 및 일반외과로 갑상선 결절을 주소로 내원한 1457명을 대상으로 후향적 연구를 시행하였다. 우연히 발견된 직경 1.5㎝ 이하의 갑상선 결절을 가지는 환자들에서 갑상선 결절의 촉지 유무, 갑상선 기능검사, 항갑상선 항체, 갑상선 초음파 및 미세침 흡인세포검사, 99m^Tc 갑상선 스켄, 수술 조직검사 및 병기를 검토하였다. 결과: 분석한 갑상선 결절 1475예 중 갑상선 우연종의 유병률은 13.4%(198예)였다. 갑상선 우연종에서 악성률은 28.8%(57예)으로 나왔다. 양성 및 악성 갑상선 우연종에서 나이, 성별, 갑상선 기능검사, 결절 크기에는 의미 있는 차이는 없었다. 갑상선 스켄은 갑상선 우연종의 감별에 적합하지 않았다. 갑상선 결절의 초음파 지표 점수만이 양성 및 악석 갑상선 우연종의 감별에서 초음파 지표 점수의 민감도는 88.9%, 특이도는 74.4%, 양성 예측률은 92.4%로 나왔고 진단적 정환도는 85.5%였다. 갑상선암으로 수술을 받은 50명중 stage 1은 34명, stage 2는 6명, stage 3은 10명으로 대부분의 악성 갑상선 우연종은 낮은 TNM 병기로 나타났으나, 상당수에서는 국소 침범의 소견을 보였다. TNM 병기의 3기 환자 전부는 45세 이상이였고, 주로 갑상선암의 피막 침범에 의한 것이었다. 임파절 전이는 6명의 환자에서 나왔다. 결론: 악성 갑상선 우연종은 비교적 흔히 접할 수 있는 질환이며 양성 우연종과는 임상적으로 구별이 안 된다. 악성 갑상선 우연종은 발견 당시 대부분 낮은 병기이나, 갑상선의 피막 침범 및 임파절 전이가 상당수에서 발견되었다. 갑상선 우연종의 초음파 소견은 향후의 진단 방향을 제시하는 중요한 길잡이가 될 수 있다. 초음파 지표 점수 2점 이상의 갑상선 우연종에서만 초음파 유도 미세침 흡입검사를 권장한다. Background: High-resolution ultrasonography has made the detection of asymptomatic small thyroid possible. Recent increases in the detection of incidentalomas have created a clinical dilemma on how to properly manage such incidental nodules. We investigated the prevalence, clinical and ultrasonographic characteristics, and optimal diagnostic approach toward incidentally detected benign and malignant thyroid nodules of less than 1.5㎝ in size. Methods: A retrospective review was undertaken on the 1,475 patients who had visited Samsung Medical Center, Seoul Korea between January 1999 and December 2000. The review consisted of a physical examination of the thyroid gland, thyroid function test, antithyroid antibodies, thyroid ultrasonography, fine-needle aspiration biopsy, pathology and TNA staging of the incidentally detected thyroid nodules of less than 1.5㎝ in size. Results: The prevalence of thyroid incidentalomas was 13.4% and the malignancy rate within them was 28.8%. There were no significant differences in age, sex, thyroid function test and size between the benign and malignant incidentalomas. Ultrasonographic characteristics showed meaningful diagnostic value for the detection of malignancy in incidentalomas. Most malignant incidentalomas were of a low stage. Conclusion: Occult thyroid cancers are fairly common finding. There are no clinical difference between benign and malignant thyroid nodules less than 1.5㎝; however, ultrasonographic findings can be used to decision of optimal management strategies (J Kor Soc Endocrinol 17:649∼656, 2002).

Analysis of prognostic factors affecting poor outcomes in 41 cases of Fournier gangrene

Hyung Min Hahn,Kwang Sik Jeong,Dong Ha Park,Myong Chul Park,Il Jae Lee 대한외과학회 2018 Annals of Surgical Treatment and Research(ASRT) Vol.95 No.6

Purpose: We present our experience involving the management of this disease, identifying prognostic factors affecting treatment outcomes. Methods: The patients treated for Fournier gangrene at our institution were retrospectively reviewed. Data collected included demographics, extent of soft tissue necrosis, predisposing factors, etiological factors, laboratory values, and treatment outcomes. The severity index and score were calculated. Multivariate regression analysis was used to determine the association between potential predictors and clinical outcomes. Results: A total of 41 patients (male:female = 33:8) were studied. The mean age was 54.4 years (range, 24-79 years). The most common predisposing factor was diabetes mellitus (n = 19, 46.3%). Sixteen patients (39.0%) were current smokers. Seven patients had chronic kidney disease. The most frequent etiology was urogenital lesion (41.5%). The mortality rate was 22.0% (n = 9). Multivariate regression analyses showed that extension of necrosis beyond perineal/inguinal area and pre-existing chronic kidney disease were significant and independent predictors of mortality. Extension of necrosis beyond perineal/inguinal area was a significant predictor of increased duration in the intensive care unit and hospital stay. In addition, pre-existing chronic kidney disease was a significant predictor of flap reconstruction in the wound. Conclusion: Fournier gangrene with extensive soft tissue necrosis and pre-existing chronic kidney disease was associated with poor prognosis and complexity of patient management. Early recognition of dissemination and premorbid renal function is essential to reduce mortality and establish a management plan for this disease.

Effect of renal dysfunction in free flap transfer for chronic wounds of the lower extremities

Hyung Min Hahn,Yon Soo Jeong,Il Jae Lee,Min Ji Kim,Hyoseob Lim 대한수부외과학회 2022 대한수부외과학회지 Vol.27 No.3

Purpose: Free flaps play an important role in the reconstruction of chronic wounds in the lower extremities. Nonetheless, the use of free flaps for chronic wound reconstruction tends to be challenging. A considerable number of patients with chronic wounds have noteworthy medical histories, such as chronic kidney disease or end-stage renal disease (ESRD). This study aimed to determine the relationship between the success rate and complications of free flap surgery according to the degree of kidney disease from normal renal function to ESRD. Methods: A retrospective study of all patients who underwent free tissue transfer procedures due to chronic wounds in the lower-extremity area over a 9-year period, between October 2011 and February 2020, was conducted. The primary outcome was flap failure, and major complications were set as the secondary outcome. Results: Sixty-seven consecutive free flaps were used for chronic wounds of the lower extremities at our institution. Flap failure occurred in six patients (9.0%), resulting in a total flap survival rate of 91.0%. Sixteen patients (23.9%) experienced major complications. Flap failure was correlated with the presence of ESRD and renal transplantation. Conclusion: There are several limiting factors for the reconstruction of chronic wounds in the lower extremity. In particular, ESRD and renal transplantation were significantly correlated with flap failure.

ACTG2 Variants in Pediatric Chronic Intestinal Pseudo-obstruction With Megacystis

( Jong Woo Hahn ),( Soo Young Moon ),( Min Soo Kim ),( Min Hyung Woo ),( Min Ji Sohn ),( Hyun-young Kim ),( Moon-woo Seong ),( Sung Sup Park ),( Sung-hye Park ),( Jin Soo Moon ),( Jae Sung Ko ) 대한소화기기능성질환·운동학회 2022 Journal of Neurogastroenterology and Motility (JNM Vol.28 No.1

Background/Aims Chronic intestinal pseudo-obstruction (CIPO) is a clinically heterogeneous syndrome characterized by compromised peristalsis and intestinal obstruction. Variants of actin gamma 2 (ACTG2), a protein crucial for correct enteric muscle contraction, have been found in CIPO patients. The aim of this study is to examine the clinical features and ACTG2 variants in Korean patients with CIPO. Methods From January 1995 to August 2020, 12 patients diagnosed with CIPO were included and genetic analysis testing of ACTG2 was performed. Results Heterozygous ACTG2 missense variants were found in 6 patients (50.0%). The p.Arg257Cys variant was found in 3 patients, and p.Arg63Gln and p.Arg178His variants were found in 1 patient each. A novel variant, p.Ile193Phe, was found in 1 patient. Three patients were diagnosed at birth, 2 at the age of 1 year, and 1 at 3 years of age. Abnormal prenatal genitourinary ultrasonographic findings were found in all 6 patients; microcolon was found in 4 patients (66.7%), and megacystis in all 6 patients. The pathology showed abnormal ganglion cells as well as myopathic findings. All patients are dependent on total parenteral nutrition and are to date alive. Conclusions ACTG2 variants are commonly found in Korean patients with CIPO. In CIPO patients with megacystis and abnormal prenatal ultrasonography, genetic testing of ACTG2 should be considered. Molecular diagnosis of CIPO is more important than pathologic diagnosis. (J Neurogastroenterol Motil 2022;28:104-110)

초기소견으로 미세혈관병성 용혈성 빈혈상을 보인 골수전이성 악성흑색종 1례

서형찬,민유홍,강웅철,이석,정소영,한지숙,고윤웅,양우익 大韓血液學會 1996 大韓血液學會誌 Vol.31 No.3

The Susceptibility Study of Fluconazole to Candida Species in Patients with Onychomycosis

( Hyung Jin Hahn ),( Sang Min Kim ),( Yang Won Lee ),( Yong Beom Choe ),( Kyu Joong Ahn ) 대한피부과학회 2013 大韓皮膚科學會誌 Vol.51 No.1

Background: With a growing number of people using a variety of medications, and suffering from systemic diseases, such as AIDS, Candida infection is also on the rise. This brings the issue of antifungal resistance into the spotlight. Objective: This study sought to evaluate the detection of oral Candida and the change of minimum inhibitory concentration (MIC) in patients on oral fluconazole for treatment of onychomycosis. Methods: We studied 25 patients who are on fluconazole for treatment of onychomycosis. We evaluated the MIC and detection of oral Candida at the time of the first visit, at the point of initial dosing, and subsequently, 12 and 24 weeks thereafter, and 12 weeks after the point of final dosing. Results: At the first visit, we collected strains from the oral cavity. At 12 and 24 weeks thereafter, and 12 weeks after final dosing, C. albicans were detected in all cases. MIC measured at the corresponding time points revealed sensitivity in all cases with MIC under 8.0 μg/ml. After 12 and 24 weeks of administration, we identified the same strains at the oral cavity, and MIC of the two regions was elevated. At 12 weeks after the point of final dosing, MIC was decreased or remained the same at the three sites, and the result was the same at 12 and 24 weeks thereafter. Conclusion: The purpose of this study was to ascertain that the acquisition of resistance to fluconazole by oral Canadida is not as serious as we had anticipated; however, further studies based on larger patient pools would provide greater assurance. (Korean J Dermatol 2013;51(1):21∼27)

Clinical use of perioperative magnetic resonance imaging-based breast volumetric analysis in final implant volume prediction for two-stage breast reconstruction

Min Ji Kim,Tae Wook Kim,Hyung Min Hahn,Il Jae Lee 대한외과학회 2022 Annals of Surgical Treatment and Research(ASRT) Vol.103 No.4

Purpose: Breast volume is an important factor in breast reconstruction; however, the surgeon is expected to deliver the volume expectation with his aesthetic inspiration. Therefore, objective volumetry must be developed. This study aimed to conduct an MRI-based breast volumetric analysis. With periodic analysis of 2-stage breast reconstruction, we suggest the possibility of clinical use of breast volumetry in implant volume prediction. Methods: This retrospective study included 140 patients who underwent unilateral 2-stage breast reconstruction (tissue expander followed by implant insertion) between January 1, 2017 and December 31, 2019. The MRI image was converted into a 3-dimensional image with a reconstruction program (A-VIEW, Coreline Soft). MRI image was obtained before the surgery and then at 1, 3, 6, 12, and 24 months postoperatively. The volume was automatically calculated. Results: Compared with the preoperative volume, maximized volume and differences were noted at 1 month and minimized at 1 year. The correlation between MRI-based preoperative breast volumetry and the mastectomy specimen volume was 0.611. Volume difference between the MRI-based preoperative state and the implant volume showed a minimal difference at 1 year. The final implant size prediction formula was calculated using the 1-year postoperative volume (P < 0.001, R2 = 0.594). Conclusion: To avoid breast reconstruction based solely on the surgeon’s subjective assessment, MRI-based breast volumetry could be a useful method to develop more scientific and objective breast reconstruction planning. We suggesta volume predicti on formula that describes the relationship between the postoperative breast volume and the final breast implant size.

A Clinical Application of Porcine Skin as a Biological Wound Dressing : Case Series

Min Ji Kim,Hyoseob Lim,Hyung min Hahn,Il jae Lee,Jun suk Lee 대한외과학회 2022 대한외과학회 학술대회 초록집 Vol.2022 No.11

Reconstruction of a high-energy penetrating injury from the abdomen to the sacral area using a latissimus dorsi free flap with monofilament polypropylene mesh and pedicled flap rotation: a case report

Kyung Min Yang,Hyung Min Hahn 대한수부외과학회 2022 대한수부외과학회지 Vol.27 No.4

A 50-year-old man was transferred to a level I trauma center for penetrating injury. Industrial metal had penetrated his trunk, and he was injured in internal organs. The injured internal organs were treated by the trauma surgery team. The peritoneum was reconstructed with artificial dermal matrix graft. The wound was managed with negative-pressure wound therapy, and several debridement procedures were performed. The full-thickness abdominal defect was covered with monofilament polypropylene mesh(Parietene mesh, 30×30 cm). A latissimus dorsi flap was elevated with a musculocutaneous flap measured 50×30 cm, and 6-cm thoracodorsal artery pedicle. Microvascular anastomosis was performed using the thoracodorsal and left femoral arteries. Two weeks later, we performed local flap rotation based on gluteal artery perforator in the sacral area. Polypropylene mesh was successfully inserted without complications. Combining a latissimus dorsi free flap on a polypropylene mesh can be an effective method for reconstructing large penetrating wounds on the trunk.

Carbon-Partitioning in Arabidopsis Is Regulated by the Fructose 6-Phosphate, 2-Kinase/Fructose 2,6-Bisphosphatase Enzyme

( Youn Hyung Lee ),( Dong Seok Lee ),( Jong Min Lim ),( Joo Mi Yoon ),( Seong Hee Bhoo ),( Jong Seong Jeon ),( Tae Ryong Hahn ) 한국식물학회 2006 Journal of Plant Biology Vol.49 No.1