Experion(TM) assay system을 이용한 난소암 혈청 종양표지물의 발굴

민현진 ( Hyun Jin Min ),배수미 ( Su Mi Bae ),곽선영 ( Sun Yong Kwak ),양민아 ( Min Ah Yang ),이해남 ( Hae Nam Lee ),김용욱 ( Yong Wook Kim ),신종철 ( Jong Chul Shin ),김정식 ( Jung Sick Kim ),남계현 ( Kye Hyun Nam ),김용완 ( Yong 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.5

목적: 난소암은 세계적으로 여성에게서의 발생률과 사망률이 높은 악성 종양이다. 불행히도, 아직 임상적인 예후나 특징이 두드러지게 드러나지 않는다. 사실, 높은 사망률은 임상적인 조기진단의 어려움에 있다. 본 연구에서 LabChip 테크놀로지 시스템과 자동화 전기영동 시스템인 Experion(TM)으로 난소암과 관련한 단백질 발현을 위한 연구를 하였다. 재료 및 방법: 분석은 14명의 건강한 여성의 혈청과 28개의 난소암환자의 혈청을 사용하였다. 각각의 혈청은 가톨릭의과대학 임상연구위원회 (IRBC)의 승인을 받았고 강남성모병원으로부터 제공받았다. Experion(TM) (Bio-Rad, Hercules, CA)을 사용하여 분석하였다. 그 후 SDS-PAGE 전기영동하여 Coomassie stain으로 확인한 후, MALDI-TOF-MS로 단백질 확인하였다. 결과: 난소암 관련된 단백질의 분석은 Experion(TM)의 고 처리 검색 (High throughput screening)으로 단백질 정량 값을 볼 수 있었다. 난소암에 있어 높은 민감도와 특이성으로 선별함으로써 Experion(TM) 정량방법이 입증되었다. Ceruloplasmin (115.0 kDa), hemoglobin β chain (15.9 kDa), hemoglobin δ chain (10.7 kDa), serum amyloid A4 (14.8 kDa) 그리고 amyloid relate serum protein SAA (11.7 kDa)이 난소암 환자 혈청으로부터 발견되었다. 난소암 환자와 건강한 여성 사이에서 이들 5개의 단백질의 발현이 차이를 보였다. Experion(TM) assay system은 높은 수준의 정확도를 유지했고, 처리능을 증가시켜 난소암 관련 단백질의 분석을 위해 제공되었다. 결론: 고처리 Experion(TM) assay system으로 난소암에서 새로운 단백질을 확인할 수 있었다. 또한, Experion(TM) assay system은 임상적인 적용을 위한 확실한 데이터베이스로 난소암의 진단을 위해 쉽게 적용될 수 있을 것이다. 본 연구는 Experion(TM) assay system을 이용한 난소암의 잠재적인 혈청 종양표지물의 확인을 위한 첫 번째 보고임에 의미가 있다. Objective: The discovery of new biomarkers for ovarian cancer is clearly necessary for the detection and monitoring of the disease. Experion(TM) automated electrophoresis system can be employed in the identification of differentially expressed proteins in cancer cells. The objective of this study was to discover potential diagnostic serological biomarkers for ovarian cancer. Methods: We performed protein expression difference analyses for 14 healthy women and 28 ovarian cancer patients with stage I, III and IV using Experion(TM) system. And then we checked the protein expression as silver staining after loading at 8~16% gradient gel for comparison with Experion(TM) gel image. The candidate biomarkers were purified and determined using MALDI-TOF mass spectrometer. Results: The distinctive polypeptide peaks were detected at 115.40, 15.96, 14.8, 11.66, and 10.69 kDa and these five peaks were identified as ceruloplasmin, hemoglobin β chain, hemoglobin δ chain, serum amyloid A4, and amyloid related serum protein SAA, respectively. These proteins were significantly different between the sera of normal healthy women and ovarian cancer patients. Conclusions: Five proteins were found to be significantly different between the sera of normal healthy women and ovarian cancer patients. In addition, Experion(TM) assay system can provide high performance for analysis of ovarian cancer-related proteins by increasing the throughput while maintaining a high level of accuracy.

비정상자궁출혈에서 식염수 주입 초음파 자궁조영술의 진단적 가치

조희정 ( Hee Jung Cho ),남계현 ( Kye Hyun Nam ),김태희 ( Tae Hee Kim ),김정식 ( Jaeong Sik Kim ),정수호 ( Soo Ho Chung ),이권해 ( Kwon Hae Lee ),이정재 ( Jeong Jae Lee ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.4

난소 종양의 양성과 악성을 감별하기 위한 새로운 점수 체계의 고안

조인숙 ( In Sook Cho ),남계현 ( Kye Hyun Nam ),이해혁 ( Hea Hyuk Lee ),김정식 ( Jung Sik Kim ),김태희 ( Tae Hee Kim ),조희정 ( Hee Jung Cho ),정수호 ( Soo Ho Jung ),이권해 ( Kwon Hae Lee ),배동한 ( Dong Han Bae ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.8

목적: 이 연구의 목적은 초음파를 이용하여 난소 종양의 양성과 악성을 감별하기 위한 난소 종양 점수 체계의 효용성을 측정하여 새로운 점수 체계의 고안과 그 효용성을 평가하기 위한 것이다. 연구 방법: 난소 종양이 있는 환자 199명을 대상으로 하여 Alcazar, Ferrazi, Sassone, De Priest 및 새로 고안한 점수 체계(scoring system)을 이용하여 양성과 악성을 전향적으로 예측하였다. 악성은 23명이었고, 양성은 176명이었다. 본원에서 도안한 난소 종양의 점수 체계를 수신자 동작 곡선(receiver operation characteristic curve)을 이용하여 구한 절사점(cut-off level)은 11점이었다. 수술 후 병리 진단과 비교하여 각각의 민감도, 특이도, 양성 예측율과 음성 예측율을 구하여 임상적 효용성을 알아보았다. 결과: 본원에서 고안한 점수 체계는 종양의 벽의 두께, 중격의 수, 종양의 부피, 불규칙한 면의 유무, 혈류의 존재, 고음영을 요소로 하였다. 종양의 벽의 두께에 따라 나누어 다른 동일한 요소의 점수를 다르게 하였다. 새로 고안한 점수 체계를 이용하였을 때 민감도와 특이도는 각각 73.9%와 97.7%였으며, 양성 예측율과 음성 예측율은 각각 80.9%와 96.6%였다. 결론: 새로 고안한 점수 체계를 이용하여 측정하였을 때 민감도는 기존의 방법과 비슷하였으나 특이도는 향상되었다. 따라서 난소의 종양의 악성 여부 평가에 유용한 방법으로 사용될 수 있을 것으로 보인다. Objective: The purpose of this study was to design a new scoring system for differentiation between benign and malignant ovarian masses and to assess effectiveness of new scoring system comparing other scoring systems. Methods: This study was based on 199 women who visited Soonchunhyang Hospital for surgery of ovarian mass. Ultrasonography and scoring system based on De Priest, Sassone, Ferrazi and Alcazar was performed the day before operation. Pathologic diagnosis after operation was directly compared with diagnosis of scoring system. The cut-off level of the new index is 11 points. This study was evaluated by sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: Parameters of new scoring system were wall thickness, number of septum, volume of mass, irregularity, vascularity and echogenicity. The new scoring system had sensitivity 73.9%, specificity 97.7% and negative and positive predictive values of 96.6% and 80.9% respectively. Conclusion: Sensitivity of new scoring system was similar to previous ones but specificity of that is higher. Our new scoring system shows better to differentiate benign from malignant ovarian mass than four other scoring systems.

자궁경을 이용한 자궁각임신 치료

김정식 ( Jeong Sig Kim ),남계현 ( Kye Hyun Nam ),이해혁 ( Hae Hyeog Lee ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.12

목적: 자궁각임신을 치료하는 방법으로 자궁경수술이 가능한지 연구하고자 하였다. 연구 방법: 2005년 4월부터 2008년 12월까지 총 7명의 환자들이 자궁경수술을 받았다. 수술시 먼저 자궁경부를 확장시키고, 18F foley catheter를 넣은 후 임신 낭에서의 출혈을 감소시키기 위해 자궁강을 3.5% H2O2 용액 300 mL로 세척하였다. 이후 복부 초음파 유도하에 자궁각임신을 자궁경으로 합병증 없이 성공적으로 제거하였다. 결과: 수술 후 환자들의 경과는 양호하였다. 수술 후 모든 환자들의 혈청 β-hCG를 추적 검사하였으며 모두 정상 범위 이하로 감소하였고, 자궁에서 제거한 모든 환자들의 조직은 임신 조직으로 확인되었다. 측정된 출혈양은 약 30 mL 미만이었으며, 모든 환자들은 수술 후 1일째 또는 2일째 퇴원하였다. 결론: 자궁경하 자궁각임신 절제수술은 생체 징후가 안정된 환자들에서 안전하고 효율적인 치료 방법으로 시도될 수 있다. Objective: The purpose of this study introduces a safe, effective method for treating cornual pregnancy. Methods: Between April 2005 and December 2008, seven patients with cornual pregnancy underwent hysteroscopic surgery at a minimally invasive surgery clinic. An 18F Foley catheter was inserted after dilating the cervix; then, the uterine cavity was irrigated with 300 mL of H2O2 solution to prevent excessive bleeding. The cornual gestation was removed by hysteroscopy without complications under ultrasonographic guidance. Results: The serum β-human chorionic gonadotropin levels were monitored postoperatively and decreased optimally in all patients. All tissues removed from the uterus were confirmed to be gestational products. The estimated blood loss was less than 30 mL. All patients were discharged on the first or second postoperative day. Conclusion: Hysteroscopic removal of a cornual pregnancy with H2O2 is very practical and safe.

원발성 난관암

박선영 ( Sun Young Park ),이해혁 ( Hae Hyeog Lee ),김태희 ( Tae Hee Kim ),남계현 ( Kye Hyun Nam ),이권해 ( Kwon Hae Lee ),권계원 ( Kye Won Kwon ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.8

Primary tubal carcinoma is a rare carcinoma of the female genital tract, comparising with only 0.3% to 1% of female genital tract malignancies. Its histologic appearance and clinical behavior resemble that of primary ovarian carcinoma, thus the evaluation

자궁근종의 정맥혈관 파열로 인한 대량의 복강내 출혈

김대원 ( Dae Won Kim ),정의정 ( Eui Chung Chung ),김정식 ( Jeong Sig Kim ),남계현 ( Kye Hyun Nam ),배동한 ( Dong Han Bae ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.11

Spontaneous intraperitoneal hemorrhage from uterine leiomyomas is rarely encountered. The cause of hemorrhage is mainly trauma and torsion of myoma. Massive intraperitoneal hemorrhage from spontaneous rupture of a superficial uterine vein overlying a subserous myoma is extremely rare. A 48-year-old woman complained general weakness, lower abdominal discomfort and lower back pain. On admission to the hospital, hypovolemic shock, severe anemia and ascites were noticed. Ultrasonography and CT scan showed huge pelvic mass and much amount of fluid in the pelvic cavity. During emergent laparotomy, 3,500 mL of blood were drained from the abdominal cavity and a ruptured superficial vein was noted, located on the serosal surface of a fundal myoma. We report one case of massive intraperitoneal hemorrhage and hypovolemic shock due to spontaneous rupture of a superficial uterine vein overlying a subserous myoma.

임신 중 점액성 난소암종 파열과 복막가성점액종

정수호 ( Soo Ho Chung ),김정식 ( Jeong Sig Kim ),남계현 ( Kye Hyun Nam ),배동한 ( Dong Han Bae ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.11

The occurrence of ovarian cancer during pregnancy is a very rare, and the incidence is 1:10,000 to 1:50,000. However, this number is likely to increase since childbearing is more and more frequently delayed. The clinical outcome of patients with ovarian cancer is the same regardless of whether the diagnosis of ovarian carcinoma is done during pregnancy or in non-pregnant women; therefore, the same surgical staging procedures are recommended in the two groups. However, it should be considered to performed a diagnostic operation and preservation of pregnancy, advantage of the administration of chemotherapy, what time give birth to, what time perform a staging operation. We here report our experience with a case of advanced ovarian carcinoma during pregnancy, which was managed conservative surgery with chemotherapy until delivery.

폐동맥 색전증이 합병된 부인암으로 오인된 골반 내 후복막신경초종

정은영 ( Eun Young Jeong ),김정식 ( Jeong Sig Kim ),남계현 ( Kye Hyun Nam ),배동한 ( Dong Han Bae ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.6

Retroperitoneal schwannomas are rare tumors difficult to diagnose preoperatively. It may originate at the cranial nerves or nerves of the upper extremities, but origin along the nerves of the retroperitoneal space is very rare. Most of the retroperitoneal schwannomas are benign neoplasm. These tumor can be misdiagnosed as adnexal mass or carcinoma. Venous thromboembolism or pulmonary embolism is increasingly recognized as a common complication in patients with malignant disease. We report a 37-year-old woman presented with pulmonary thromboembolism and a pelvic mass which was incidentally found and misdiagnosed as ovarian cancer. Histopathologic results of the extirpated mass turned out to be a benign schwannoma.

악성 신경섬유종증이 있는 산모에서 발생한 자간전증

정은영 ( Eun Young Jeong ),김태희 ( Tae Hee Kim ),김정식 ( Jung Sik Kim ),이해혁 ( Hae Hyuk Lee ),남계현 ( Kye Hyun Nam ),이권해 ( Kwon Hae Lee ),이정재 ( Jung Jae Lee ) 대한주산의학회 2007 Perinatology Vol.18 No.2

제대부위에 전이되어 발견된 진행성 난소암

김정식 ( Jeong Sig Kim ),김태희 ( Tae Hee Kim ),이해혁 ( Hae Hyeog Lee ),이권해 ( Kwon Hae Lee ),남계현 ( Kye Hyun Nam ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.6

Umbilical metastasis may be the first presenting sign of the disease, or an indication of a recurrence from a previous malignancy. We recently encountered a 19-year-old woman with advanced ovarian adenocarcinoma whose first sign was having a Sister Mary Joseph`s nodule. This patient only presented an umbilical nodule with slight lower abdominal discomfort, without any other subjective symptom. The lesion was fresh red, firm, ulcerating and has 1.5 cm in diameter. A punch biopsy from the lesion revealed metastatic adenocarcinoma and a PET-CT scan showed hypermetabolism on the umbilicus. After a systemic evaluation, she had a laparotomy including right salpingo-oophorectomy, total omentectomy, pelvic and paraaortic lymphadenectomy, appendectomy, and extirpation of the umbilicus. The patient received a postoperative combination of chemotherapy with paclitaxel and carboplatin, and still remains alive. This case demonstrates the importance of careful evaluation of any umbilical lesion and pathologic examination.