재발성 복부 통증을 호소한 환자에서 복벽에 발생한 자궁내막증 1예

홍현진,박성한,이준식,배용목,김지연,안광순,박선자 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.1

Endometriosis is the abnormal growth of endometrial tissue outside the uterine cavity. Endometriosis in the abdominal scar following cesarean section is very rare condition among the extrapelvic endometriosis. The frequency of abdominal wall endometriosis secondary to cesarean section is from 0.03% to 0.8% in some reports. It is difficult to diagnosed in spite of the typical symptoms. The typical symptom is aching swelling in the area of the surgical scar, which is influenced by the phases of menstruation. The definitive diagnosis is established by pathologic analysis. Surgical excision remains the treatment of choice. The majority of patients presented from 1 to 2 years after the precipitating operation. We experienced an unusual case of abdominal wall endometriosis presented over 10 years after cesarean section, who was admitted to our hospital complaining of recurrent left lower abdominal pain. So, we report this case with a brief review of the concerned literatures.

급성 골수성 백혈병에서 Adenosine deaminase 측정의 임상적 유용성

고광상,박정오,강성훈,김재석,박순철,서연실,김기헌,조무자 임상병리검사과학회 1999 임상병리검사과학회지 Vol.31 No.2

배경 : Adenosine deaminase(ADA) 는 adeno-sine을 inosine으로 deamination하는 반응을 촉매하는 효소로, 혈액 종양을 비롯한 결핵, 간 질환, 등의 다양한 질환에서 활성도가 증가하는 것으로 알려져 있으며, 여러 질환에서 연구가 이루어지고 있으나 측정의 기술적 어려움으로 이용이 확대되지 못하였다. 그러나 최근 고안된 자동 화학 분석기를 이용한 ADA 와 동위효소의 분별정량 방법으로 ADA 측정의 임상적 적용이 용이 해졌다. 저자들은 이 방법으로 혈장을 이용하여 AML에서의 ADA활성도와 동위효소의 분포양상의 특성과, 치료경과에 따른 변화를 관찰하여 AML에서 ADA측정의 임상적 유용성을 알아보고자 하였다. 방법 : AML 환자군 16 예와 정상 대조군 25 예의 혈장 ADA와 동위효소의 활성도를 측정 비교하고, 환자군중 10 예에서는 치료 후 1주 간격으로 최고 8 주까지 추적 관찰을 시행하였다. ADA측정은 자동화학 분석기로 발색 정량하고, 동위효소의 측정은 ADA_(1) 선택적 억제제인 EHNA를 첨가하여 ADA_(2)를 측정하는 방법을 이용하였다. 결과 : AML 환자 군 16명의 혈장 ADA 활성도는 34.0±20.8IU/L로 정상 대조군 25명의 혈장 ADA 활성도 14.28±3.26IU/L에 비해 유의하게 높았다. 정상 대조군에서는 ADA2 가 75.0%로 우세한 것에 비해 AML군에서는 ADA_(1)이 62.5%로 우세하였고, ADA_(1)은 모두 정상대조군보다 높은 값을 보였다 . AML 환자 군 중 추적 검사를 시행하였던 10 예 (완전관해 5예 , 불완전관해 5예)에서 ADA 값과 ADA1이 10예 모두에서 4주 안에(평균 2.8주) 정상범위로 감소하였고, 5 예에서 ADA활성도가 정상범위로 감소한 후 1 주 후까지 ADA_(1)활성도가 정상범위 이상으로 지속되었다. 결론 : AML의 진단과 경과 추적에 혈장에서 측정한 ADA활성도와 동위효소 분포 양상을 이용할 수 있으며, 특히 ADA_(1)이 total ADA나 ADA_(2)보다 더 유용함을 알 수 있었다. ADA 활성도는 치료 후 관해여부와 관계없이 세포수가 감소함에 따라 모두 감소하므로 관해 여부를 예측 할 수는 없으나, 재발을 검출할 목적으로 이용할 수 있으며, 이때는 ADA 활성도가 모두 정상범위로 감소하는 치료 후 4 주 이후부터 검사하는 것이 효율적이라고 생각된다. Adenosine deaminase(ADA) activiteis in sera are increased in various disease such as hematologic malignancies, tuberculosis, and liver diseases. To evaluate the clinical value of measuring ADA and its isoenzyme activites in plasma with the automated assay in acute myeloid leukemia, we compared ADA and its isoenzyme activities in normal control group with those in acute myeloid leukemia group, and followed up those during chemotherapy in AML group. The measurements of plasma ADA and its enzymes, especially ADA_(1) were useful for AML diagnosis. But they were not valuable markers to discriminate between complete remission and incomplete remission. For the detection of relapse, it could be valuable to measure ADA activities beyond 4 weeks after chemotherapy.

3년내 크기 증가를 보인 위 신경초종 1예

김도현,박무인,유찬희,김규종,문원,박선자,장희경 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.2

저자들은 65세 남자 환자의 위 중부체부 대만부 전벽에 발생한 점막하 종양에 대하여 3년간 추적관찰 중 크기증가소견으로 쐐기 절재술을 시행하였으며, 조직검사 및 면역 조직 화학 검사에서 위 신경초종으로 진단한 1예를 경험하였기에 보고하는 바이다. Gastric schwannoma is a very rare gastrointestinal benign tumor, which represents only 0.2% of all gastric tumors and 4% of all benign gastric tumors. We report a case of gastric schwannoma with enlargement of size through serial endoscopic examination. Endoscopic examination showed a hard mass of 4 x 3 cm in size with normal overlying gastric mucosa on the great curvature of the mid-body of stomach. The pathological finding revealed a picture of spindle cell tumor. Immunohistochemical stain was strongly positive for S-100 protein and non-reactive for CD34, C-kit and smooth muscle actin, thus leading to the diagnosis of gastric schwannoma.

크론병 환자에게서 발생한 뇌정맥굴혈전증

허소영,김종국,박선자 고신대학교 의과대학 2009 고신대학교 의과대학 학술지 Vol.24 No.1

Cerebral venous sinus thrombosis is an uncommon condition with dramatic clinical presentation of progressive headache, papilledema, seizures, focal neurological deficits and coma. It has many etiologies including infections, hypercoagulability, inflammatory disorders, head trauma and cancer. Although it is relatively uncommon, vascular complications are well documented extra-intestinal manifestations of inflammatory bowel disease. Among them, Crohn disease is an extremely rare cause of cerebral vascular disease. We present a case of cerebral venous sinus thrombosis in Crohn disease successfully treated by high dose steroid therapy.

담도에 국한되어 증상을 유발한 석회쓸개즙 2 예

윤성우,이지영,하경호,이수경,한나,배효근,박선자 고신대학교 의과대학 2010 고신대학교 의과대학 학술지 Vol.25 No.2

Limy bile is a rare condition characterized by excessive precipitation of calcium carbonate in the gallbladder or bile duct. Recently we experienced two cases with obstructive jaundice in which limy bile in the common bile duct but not in the gallbladder for one case, and in the common bile duct and intra hepatic duct but not in the gallbladder for another case. The patients were treated by endoscopic sphincterotomy. Here, we report the cases and review the literature.

위 MALT 림프종에서 다발성 림프절 전이로 오인된 동시성 림프절 결핵 1예

김성은,김규종,김도현,송준영,문대성,장리라,유찬희,문원,박무인,박선자,김영옥 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.2

28세 남자가 내시경적 점막절제술을 통해 저등급 위MALT 림프종으로 진단되었다. 병기설정을 위해 18F-FDG PET 검사를 시행하였고 우측 쇄골상부, 우측상/하부 기관주위, AP window 부위에 강한 섭취가 관찰되어 전이성 림프절로 판단하였다. 그러나, 우측 쇄골상부 림프절에서 시행한 절제생검에서 만성육아종성염증소견이 관찰되었고 조직의 결핵 중합효소연쇄반응에서도 양성 반응을 보였다. 2개월간 항결핵제의 사용 후 시행한 추적 컴퓨터단층촬영 검사에서 림프절 크기의 감소를 보여 최종적으로 위 MALT 림프종에서 광범위 림프절 전이로 오인된 동시성 림프절 결핵으로 진단되었다. A 28-year-old man was diagnosed as gastric MALT lymphoma in diagnostic EMR (endoscopic mucosal resection). He subsequently underwent an 18F-FDG PET. 18F-FDG PET showed intense multifocal uptake in right supraclavicular, right upper and lower paratracheal, and AP window areas that was considered radiologically to represent widespread metastatic lymphadenopathy. Excisional biopsy of a supraclavicular lymph node, however, revealed chronic granulomatous lymphadenitis with a positive reaction of Tb-nested PCR. After antituberculosis treatment for 2 months, a follow-up CT scan showed complete resolution of the lesions. Intense 18F-FDG uptake could be due to an infectious process such as synchronous tuberculous lymphadenitis. Therefore, this could mimic a malignant condition such as lymphoma with extensive lymph node metastasis due to a false-positive finding, which may lead to a misdiagnosis.

반복된 좌하복부 동통으로 수술을 시행한 게실염 1예

박정필,허진욱,김신,김유리,박찬복,임현정,이지영,박무인,박선자,천봉권,안병권,구자영 고신대학교 의학부 2004 高神大學校 醫學部 論文集 Vol.19 No.1

저자들은 좌하복부 동통을 주소로 내원한 환자에서 대장 조영술, 대장 내시경, 하복부 전산화 촬영을 통해 S자 결장 게실염으로 진단하고 약물적 치료를 통해 호전되었으나, 지난 3년간 수회에 걸쳐서 게실염의 재발로 내과적 치료를 받은 병력과 최근 시행한 대장 조영술상 S상 결장의 누공이 관찰되어 재발성 게실염의 근치적 치료 목적으로 수술을 시행하여 합병증 없이 좋은 경과를 보였기에 이에 보고하는 바이다. Diverticular disease of the colon is quite common in developed countries, and its prevalence increases with age. The large majority of patients will remain entirely asymptomatic. Nonetheless, an estimated 20% of those affected may manifest clinical illness, mainly diverticulitis, with its potential complications of abscesses, fistulas, and obstruction as well as lower intestinal hemorrhage. A case was experienced involving of diverticulitis operated due to recurrent left lower abdominal pain in 51-year-old female. We present this case with brief review of the related literature.

Importance of Early Diagnosis and Screening, Lessons from Gastric Cancer and Colorectal Cancer

Seun Ja Park Korean Society of Gastrointestinal Cancer 2014 Journal of digestive cancer reports Vol.2 No.1

Screening and early diagnosis of cancer is important. Screening lead to detect disease earlier, and earlier treatment of disease cause to yield a better outcome than treatment at the onset of symptoms. Some studies suggest that gastric cancer screening may be associated with a reduced risk of mortality from gastric cancer, although there are no definitive data from large controlled trials. Regular colorectal cancer screening or testing is one of the most powerful weapons for preventing colorectal cancer, because some polyps, or growths can be found and removed before they have the chance to turn into cancer. Screening can also result in finding colorectal cancer early, when it is highly curable. In conclusion, to increase utilization of screening is important to decrease gastric and colorectal cancer morbidity and mortality.

Slide Session : K-GIO-06 ; GI Oncology : Assessment of Response to Preoperative Chemoradiotherapy for Rectal Cancer: Tumor Regression Grade vs. Pathologic Stage

( In Ja Park ),( Chang Sik Yu ),( Chan Wook Kim ),( Yong Sik Yoon ),( Seok Byung Lim ),( Jong Lyul Lee ),( Jin Cheon Kim ),( Seong Kyeong Lim ),( Moo In Park ),( Seun Ja Park ),( Won Moon ),( Sung Eun 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background and Objectives: The aim of study is to compare the effectiveness of tumor regression grade (TR) with that of pathologic stage to assess the level of response to PCRT in terms of prediction of prognosis. Methods : The patients with locally advanced (cT3-4 or cN+ by EUS or MRI) rectal carcinoma diagnosed from 2006 to 2009 and treated with PCRT and radical resection were identified from our colorectal database and records retrospectively reviewed. Response to CRT was evaluated according to tumor regression grade (TRG; no, minimal, moderate, near total, and total regression) and pathologic stage. Recurrence-free survival (RFS) was compared among patients according to TRG and pathologic stage. Results : Overall, 504 were identifi ed. Total regression represents pathologic stage 0 in 84.7%. No patients with moderate and minimal regression had p Stage 0. Except, total regression and p Stage 0, TRG was not correlated with pathologic stage. At a mean follow-up of 52 months, among patients with the same TRG category, the 3-year RFS rate differed signifi cantly according to the pathologic stage. By contrast, signifi cant differences were not found in 3-year RFS within pathologic stage according to TRG. However, for pStage III patients, 3-year RFS was different according to TRG. In multivariate analysis, pathologic stage showed stratifi ed association with RFS, but, TRG could not stratify prognostic group. Conclusion: Pathologic stage was well associated with prognosis rather than TRG for patients without metastatic lymph node. However, patients with metastatic lymph node, 3-year RFS was different according to TRG. Among patients with rectal cancer received PCRT, tumor regression grade and pathologic stage could not predict prognosis adequately as a single response assessment.

저등급 직장 카르시노이드 종양에서 Ki-67 발현이 예후를 예측할 수 있는가?

박선자 ( Seun Ja Park ) 대한소화기학회 2013 대한소화기학회지 Vol.61 No.2

Prognostic Significance of Ki-67 Expression in Rectal Carcinoid Tumors