다발성 원발성 악성종양

권혁문(Hyuck Moon Kwon),정재복(Jae Bock Chung),김주항(Joo Hang Kim),전상일(Sang Il Chun),조준구(Jun Koo Cho),박용준(Yong Jun Park),고은희(Eun Hee Koh),노재경(Jae Kyung Roh),서창옥(Chang Ok Suh),김귀언(Gwi Eon Kim),노준규(J . K . Loh) 대한내과학회 1987 대한내과학회지 Vol.33 No.1

N/A There is no acceptable evidence, either in this presentation of in the literature, that the patterns of occurance of multiple primary maligant neoplasms of different organs of tissues are governed by anything more than conincidence. The freqency of occurance of specific types of second primary cancers is probably largely determined by the age of the patient at the time of diagnosis of initial cancer and the expected longevity after treatment of the initial lesion. The absolute number of reported cases of multiple primary malignant tumors has increased in recent years and the freqency of occurance of this phenomenon has increased. There is no factual basis for assuming that the existence of any one malignant neoplasm influence or that it implies any susceptibility of any other organ or organ system to future cancer. But it becomes apparent that existence of one malignant neoplasm implies increased susceptibility to the development of a second lesion but also a malignant lesion in one organ may imply increased susceptibility of another organ to malignant neoplasm, particularly another organ in the same or an associated system. This report deals with the clincal analysis of 42 cases of multiple primary malignant tumors from tumor registry of Severance hospital and yonsei cancer center during 7 years from Jan 1979 to Dec. 1985 and review of the literatures, The following results were abtained. 1) The incidence of multiple primary malignant tumor was 0.26% of tumor registry (42/25, 863) and the mean age of 26 male patients at first cancer was 58.8 years old and 54.9 years old in 16 female patients. 2) The mean time interval between first and second cancer was 34.1 months in 12 metachronous tumors. 3) In male patients, the stomach cancer was the most common first cancer followed by lung cancer. In female patients, the cancer of uterine cervix was the most common first cancer. 4) The ratio between synchronous and metachronous multiple primary was 2.5:1 (30:12).

급성 간성 포르피리아가 동반된 인슐린 의존성 당뇨병 1 예

권혁문(Hyuck Moon Kwon),김경래(Kyung Rae Kim),김복성(Bok Seong Kim),임승길(Sung Kil Lim),허갑범(Kap Bum Huh) 대한내과학회 1986 대한내과학회지 Vol.30 No.6

N/A Acute intermittent porphyria may be defined most simply as an inborn error of metabolism characterized chemically by the excessive excretion of porphyria precursors(porphobilinogen and usually aminolevulinic acid) and characterized clinically by episodes of neurologic dysfuntion. The disaese is complex, involving variable patterns of autonomic and peripheral neuropathy as well as central nervous system manifestions. There may be alterations in carbohydrate, lipid, water, and electrolyte metabolism in addition to clinically inapperent endocrine abnormalities. The fundamental defect is though to be a 50% decrease of porphobilinogen deaminase, the third enzyme of the heme biosynthetic pathway. This is associated with a marked increase of hepatic δ-aminolevulic acid synthetase, the first and rate controlling enzyme of the pathway. We experienced that 30 year old female admitted to our hospital due to recurrent attacks of abdominal pain, nausea and vomiting just before mensturation or during pregnancy. On past history, she has suffered from juvenile onset insulin dependent diabetes mellitus and used insulin(NPH 16 units) for 10 years. She was diagnosed as acute hepatic porphyria by the positive PBG test of Haesch method, and treated by hypertonic dextrose solution with insulin. Although the glucose tolerance test is abnormal by classical criteria in many patients, paricularly during activity of the disease, the association of porphyria and diadetic ketoacidosis is rare. In this situation, the accurate diagnosis and prompt treatment may be delayed because of similar clinical manifestation and there is complexed problem between hypertonic dextrose solution required for porphyria and hypertonic dextrose solution aggrevated for diabetic ketoacidosis.

이동된 중심정맥도관으로 인한 간헐적 심계항진 환자의 경피적 도관 제거

정혜문 ( Hye Moon Chung ),이광원 ( Kwang Mon Lee ),하지윤 ( Ji Yoon Ha ),김승규 ( Seung Kyu Kim ),윤지영 ( Gi Young Yun ),권혁문 ( Hyuck Moon Kwon ),이병권 ( Byoung Kwon Lee ) 대한내과학회 2013 대한내과학회지 Vol.85 No.2

The totally implantable venous port device is used in patients undergoing chemotherapy. The complications associated with this device include venous thrombosis, infection, catheter fracture, extravasation, and intravascular dislodgement. The incidence of port catheter dislodgement is low. The treatment of choice for port dislocation involves immediate retrieval of the distal migrated part, and percutaneous transcatheter retrieval is regarded as the standard method. A 40-year-old female presented with intermittent palpitation. She was referred from the Department of General Surgery after detection of a fractured and dislocated implantable venous port system into the main pulmonary artery. We successfully retrieved the dislocated fractured device using a -Fr pigtail catheter and snare catheter. We herein report this case with a literature review. (Korean J Med 2013;85:194-198)

관동맥 질환에서 혈청 Troponin T 의 임상적 의의

이병권(Byoung Kwon Lee),권혁문(Hyuck Moon Kwon),박현영(Hyun Young Park),박광주(Kwang Joo Park),김현승(Hyun Seung Kim),최종락(Jong Rak Choi),송경순(Kyung Soon Song) 대한내과학회 1996 대한내과학회지 Vol.50 No.1

N/A Objectives: Although the diagnosis of coronary heart disease is usually straight forward, conventional diagnostic tests, such as CK, CK-MR, LDH, and AST have several drawbacks. The diagnostic efficiency of these conventional thests is disappointingly low, especially in minimal myocardial damage. l herefore, there has be necessity of more sensitive and specific diagnostic thest. Recently, cardiac TnT (TnT) was introduced with better sensitivity, specificity, and more wide diagnostic window. So we analyzed distribution of TnT in control, release kinetics, diagnositic significance of TnT in coronary heart disease including unstable angina and acute myocardial infarction, and efficiency of TnT as a marker of reperfusion in acute myocardial infarction. Methods: We tested cardiac TnT in 40 normal healthy subjects and 25 extracardiac traumatic patients as control group. We also tested cardiac TnT in 34 patients with acute myocardial infarction and 27 patients with unstable angina. We evaluated the distribution and serial change of cardiac TnT with other cardiac enxzymes after chest pain onset, the discriminant power of Tnl in discriminating of reperfusion after thrombolytic therapy in patients with acute myocardial infarction with conventional coronary angiography and the correlation between release kinetics of TnT and left ventricular ejection fraction with echocaroliography. Results: 1) In control group, all 65 cases serum TnT value were less than 0.2㎍/L. And its specificity (100%) and sensitivity in diagnosis of coronary heart disease including untable angina(acute myocardial infarction: 100%, unstable angina 70.4%) was better than those of other cardiac enzymes, such as CK, CK-MB. 2) In patient group, the release pattern of cardiac TnT was in bimodal curve pattern, while the pattern of other cardiac enzymes was in unimodal pattern. 3) In acute myocardial infarction, the first peak value of cardiac TnT appeared siginificantly earlier (9.53±2.36 hr in stable-reperfused group, 13.40±1.92 hr in non-reperfused group of acute MI than that of caridac enzymes; CK(17.65±6.48 hr in stable-reperfused group 27.53±10.26 hr in non-reperfused group), and CK-MH (16.84±7.93hr in stable-reperfused group, 24.33±10.36 hr in non-reperfused group of acute MI)(p<0.01). And troponin T was continuously increased above the cut-off value during the test period, so the diagnostic window of TnT was longer than other cardiac enzyme. 4) In acute myocardial infarction, cardiac TnT showed better discriminant power above 80% for reperfusion than those of CK(67.65%) and CK-MB (58.82%) In stable reperfused group of acute MI, cardiac TnT showed significant correlation with left ventri- cular ejection fraction(absolute value of r >0.6, p< 0.001). Conclusion: Cardiac troponin T was a good diagnostic marker for coronary heart disease including unstable angina and acute myocardial infarction with better sensitivity and specificity, for discriminating of reperfusion after thrombolytic therapy, and for the prognosis of remnant left ventricular global systolic function

소화기암에 있어서 각종 종양 표지자의 임상적 의의

최흥재(Heung Jai Choi),권혁문(Hyuck Moon Kwon),김병철(Byung Chul Kim),김경희(Kyung Hee Kim),문영명(Young Myung Moon),강진경(Jin Kyung Kang) 대한내과학회 1989 대한내과학회지 Vol.36 No.2

N/A Monoclonal antibody technology using the procedure of hybridization has giveen new hope for developing improved methods to define and quantify tumor markers by Kohler et al. Monoclonal antibodies with reported specificity for several major classes of tumors have been developed, such as 1116 NS19-9 (CA19-9) prepared by Koprowski et al and OC125 (CA125) prepar- ed by Bast et al. The usefulness of the serum ferritin as a tumor marker was reported by Alpert et al. The serum levels of tumor markers (AFP, CEA, CA19-9, CA125, and ferritin) were examined in 100 patients with digestive cancer, in 45 patients with corresponding benign conditions of the digestive system, in 5 patients with other malignancies and in 20 normal persons. The authors evaluated the sensitivity and specificity of each tumor marker and their combinations. The following results were obtained: 1) There were significant differences in concentrations and sensitivities of AFP in patients with hepatoma, and CEA in patients with gastric, colorectal, pancreatic cancer and cholangiocarcinoma, as compared with normal healthy persons, patients with benign liver disease (chronic hepatitis, liver cirrhosis) and patients with corresponding benign conditions of the digestive system (p<0.05). There were also significant differences in concentration and sensitivity of ferritin between patients with hepatoma and benign liver disease (p<0.025). There was a detectable increase in the CA125 serum level and sensitivity in patients with hepatobiliary malignancy but this was of low specificity due to benign conditions involving the hepatobiliary system. 2) In digestive cancers with metastasis, the serum levels and sensitivity of CEA, CA19-9, CA125 and ferritin increased significantly compared with localized cancers (p<0.005). 3) The most excellent combinations for elevating sensitivity were CEA, CA19-9 and CEA CA19-9 ferritin for stomach cancer, AFP CA125 or AFP ferritin and AFP CA125 ferritin for hepatoma, CEA CA19-9 and CEA CA19-9 CA125 for pancreatic cancer and CEA CA19-9 for cholangiocarcinoma, but no combination could elevate the specificity. In colorectal cancer, CEA was the only significant tumor marker.

폐질환에서 201 Thallium 의 섭취양상

김현승(Hyun Seung Kim),권혁문(Hyuck Moon Kwon),장양수(Yang Soo Jang),임상욱(Sang Uk Lim),남문석(Moon Suk Nam) 대한내과학회 1991 대한내과학회지 Vol.41 No.3

N/A 201 Thallium chloride has been described by Cox, Salvatore, Tonami as a positive indicator for lung neoplasm 201 Thallium scintiscan was performed in 10 patients with lung cancer and in 21 patients with benign lung diseases. Early scan demonstrated abnormal accumulation in 9 of 10 lung cancer and in 8 of,.,1 benign conditions(P=0.0066) and revealed strong positive uptake in all of 4 adenocarcinoma. Eight of twenty one benign conditions (4 in 8 active or cavitary pulmonary tuberculosis, 1 in 5 inactive pulmonary tuberculosis and 3 in 8 pneumonia or lung abscess) showed abnormal accumulation of 201Tl. And the fading apperance of radioactivity on some delayed scans was noted in benign conditions compared with persistent high radioactivity in lung cancer. 201Thallium scintiscan is useful in the differentiation of a pulmonary lesion whether is benign or malignant.

원저 : 만성 폐쇄성 폐질환에서 혈소판 활성도가 폐동맥 고혈압에 미치는 영향

김형중 ( Hyung Jung Kim ),남문석 ( Moon Suk Nam ),권혁문 ( Hyuck Moon Kwon ),안철민 ( Chul Min Ahn ),김성규 ( Sung Kyu Kim ),이원영 ( Won Young Lee ),송경순 ( Kyung Soon Song ) 대한결핵 및 호흡기학회 1993 Tuberculosis and Respiratory Diseases Vol.40 No.2

생체내 혈관조형술을 이용한 관상동맥의 차원 형상화 및 혈류특성 해석

노형운(Hyung-Woon Roh),서상호(Sang-Ho Suh),권혁문(Hyuck-Moon Kwon),이병권(Byung-Kwon Lee) 대한기계학회 2003 대한기계학회 춘추학술대회 Vol.2003 No.11

The purpose of the present study was to establish the mechanism of the generation of<br/> atherosclerosis by analyzing the hemodynamic variables in the coronary artery where atherosclerosis<br/> occurs frequently. From the previous results, the stenosis phenomena due to atherosclerosis were related<br/> to not only biochemical reaction between blood and blood vessel but also the hemodynamic factors like<br/> flow separation and oscillatory wall shear stress. The present study aimed to investigate the causes of<br/> the generation and progression of atherosclerosis in the coronary artery. This study also aimed to<br/> develop the softwares which generate automatically three dimensional vascular models obtained by the<br/> angiogram images and the computer vision techniques. In the present study, the flow patterns for full<br/> three-dimensional hemodynamic characteristics were analyzed. To understand the three-dimensional<br/> hemodynamic characteristics, the wall shear stress distributions and secondary flows were investigated<br/> quantitatively.

동맥경화증의 발생에 관한 혈류역학적 가설들에 대한 비교연구

서상호(Sang-Ho Suh),조민태(Min-Tae Cho),노형운(Hyung-Woon Roh),권혁문(Hyuck Moon Kwon) 대한기계학회 2003 대한기계학회 춘추학술대회 Vol.2003 No.4

Atherosclerosis, which is a degenerate disease, is believed to occur in the vascular system due to<br/> deposition of cholesterol and low density lipoprotein(LDL) or thrombosis on the blood vessel.<br/> Atherosclerosis narrows arterial lumen, which is known as stenosis phenomenon of blood vessel.<br/> Pathogenesis of atherosclerosis is thought to occur mainly by aging. Restenosis phenomenon is<br/> observed in the same site of insertion of a stent and balloon angioplasty after treatment of<br/> interventional theraphy. Several hypothetical theories related to the generation of atherosclerosis have<br/> been reported: high shear stress theory, low shear stress theory, high shear stress gradient theory, flow<br/> separation and turbulence theory and high pressure theory. However, no one theory clearly explains the<br/> causes of atherosclerosis. In the present study the generation of atherosclerosis in the left coronary<br/> artery is investigated. The hypotheses are verified by using the computer simulation.

관상동맥내 혈관벽 재형성에 의한 혈류역학적 응력변화에 관한 연구

조민태(Min-Tae Cho),서상호(Sang-Ho Suh),권혁문(Hyuck-Moon Kwon),유상신(Sang-Sin Yoo) 대한기계학회 2002 대한기계학회 춘추학술대회 Vol.2002 No.5

In this study, changes of shear stress and shear rate are obtained in order to investigate hemodynamic characteristics in the stenosed coronary artery with arterial remodeling. Two models for the arterial remodeling used for this research are a pre-stenotic dialation and a post stenotic dilation models. The wall shear stresses are calculated by the computer simulation. The peak shear stress appeared in the stenotic region of the post-stenotic model. Plaque rupture could be easily occured in the post-stenotic model. The area of negative shear stress values are distributed widely in the post-stenotic model. In the pre-stenotic dilation model, two small recirculation zones are formed, but the shear stresses are lower than in the post-stenotic dilation model. The shear stress on the surfaces of the pre-stenotic dilation model.