충수돌기에 발생한 점액구종증

이승현(Seung Hyun Lee),안병권(Byung Kwon Ahn),백승언(Sung Uhn Baek),오경승(Kyung Seung Oh),이재화(Jae Hwa Lee),박진경(Jean Kyoung Park),김순영(Sun Young Kim),허방(Bang Hur) 대한외과학회 2002 Annals of Surgical Treatment and Research(ASRT) Vol.62 No.4

새로운 액체성 색전물질(Embol)을 이용한 신동맥 색전술: 토끼에서의 실험적 연구

정규식,고지호,김현철,이상희,오경승,허진도,조영덕,허방,박상수,Jung, Gyoo-Sik,Ko, Ji-Ho,Kim, Hyun-Chul,Lee, Sang-Hee,Oh, Kyung-Seung,Huh, Jin-Do,Joh, Young-Duk,Hur, Bang,Park, Sang-Soo 대한영상의학회 2002 대한영상의학회지 Vol.46 No.1

목적: 새로 개발된 액체성 색전물질로 토끼에서 신동맥 색전술을 시행하여 그 효과와 안전성을 입증하고 영구적 색전물질로서의 임상적용 가능성을 평가할 목적으로 이 연구를 시행하였다. 대상과 방법: 사용한 색전물질은 Polyvinylacetate(PVAc)를 부분 가수분해하여 만든 Embol로서 45%의 에탄올과 55%의 비이온성 수용성조영제를 용매로 사용하므로 우수한 방사선비투과성을 가진다. 15마리의 토끼를 실험동물로 사용하였으며, 투시 하에서 평균 0.8(0.5-0.9)cc의 Embol을 신동맥에 주입하여 색전을 하였고 5분 후에 추적 혈관조영술을 시행하여 색전의 효과를 확인한 뒤에 시술을 마쳤다. 토끼를 5마리씩 3군으로 나누어 각각 3일(I군), 2주(II 군), 4주(III군)후에 추적 혈관조영술을 시행한 뒤 토끼를 희생시켜 양측 신장과 신동맥을 적출하여 조직표본을 제작하였다. 각군에서 시술 직후와 추적기간 동안의 혈관조영술 소견과 조직 소견을 관찰하였다. 각군의 토끼 1마리에서 시술전과 희생시키기 전에 DMSA 신스캔을 시행하였고, 다른 3마리에서는 시술 전과 시술 후 1, 3, 5, 7, 14일에 혈액을 채취하여 혈청 BUN, Creatinine, Sodium(Na), Potassium(K)의 수치를 조사하였다. 결과: Embol은 투시 하에서 색전과정의 관찰이 용이할 정도로 방사선비투과성이 우수하여 안전하게 주입할 수 있었다. 시술 5분 후에 시행한 혈관조영술에서는 신동맥 원위부의 완전한 폐색이 14예, 엽간동맥(interlobar artery)의 폐색이 1예에서 관찰되어 전예에서 색전술은 성공적이었다. 시술 후 혈청 전해질 수치는 약간 증가하였으나 모두 정상범위였다. 각 군에서의 추적 혈관조영술에서는 I군과 III군의 각각 1마리를 제외한 모든 토끼에서 신동맥의 폐색이 유지되었다. 각군에서 시행한 신스캔에서는 모두 색전을 시행한 신장의 섭취가 전혀 관찰되지 않았다. 추적기간동안의 색전을 시행한 신장의 크기는 I 군에서는 정상 신장에 비해 커졌으나 II군과 III군에서는 계속해서 크기가 감소하였다. 조직 소견은 3 군 모두 신조직의 전반적인 응고괴사 소견이 관찰되었으며, III군에서는 신피질에 두꺼운 띠모양의 석회화가 관찰되었다. I군에서는 신동맥 내강이 기질화되지 않은 혈전으로 차 있었고, II군과 III군에서는 신동맥 내강은 기질화된 혈전으로 차 있었으며 III군에서는 혈전의 석회화도 관찰되었다. 결론: Embol을 이용한 토끼에서의 신동맥 색전술은 이 색전물질의 우수한 방사선비투과성으로 안전하게 사용할 수 있었으며 또한 효과적이고 영구적인 신조직의 괴사를 유발하여 앞으로 임상적용이 가능하다고 생각된다. Purpose: To evaluate the effectiveness and safety of a new liquid embolic agent in renal arterial embolization in the rabbit, and its clinical applicability. Materials and Methods: A new embolic agent, Embol, was obtained by partial hydrolysis of polyvinyl acetate and dissolved in a mixture of 45% ethanol and 55% non-ionic contrast medium. Its radioopacity was therefore good. An average of 0.8 cc(0.5-0.9 cc) of Embol was used to embolize the renal artery of one kidney in 15 rabbits. The immediate effect of this was examined angiographically 5 minutes after the procedure. To permit histologic examination, five rabbits in each group were sacrificed 3 days (I), 2 weeks (II), and 4 weeks (III) after embolization: prior to embolization and prior to sacrifice, one rabbit in each group underwent renal scanning, and prior to sacrifice all underwent follow-up angiography. In three rabbits, blood urea nitrogen (BUN), creatinine, sodium(Na), and potassium(K) levels were measured before and 1, 3, 5, 7 and 14 days after embolization. Results: Embol was easy to use and its radiopacity was good. Five minutes after embolization, angiography showed that total occlusion of the main renal or interlobar artery had been achieved in all rabbits. Serum BUN, creatinine, Na and K levels were within normal limits. Follow-up angiogram obtained in each group showed persistent occlusion of the renal artery in all but one rabbit in group I and one in group III. Renal scans revealed no evidence of radionuclide uptake in embolized kidneys, which were slightly enlarged in group I but became gradually smaller in groups II and III. In all animals, histologic examination showed diffuse coagulation necrosis of the embolized kidneys and in group III the cortex of these was extensively calcified. In group I the renal artery showed an apparently fresh occluding thrombosis, and in groups II and III a completely organized thrombosis was present. In group III this was calcified. Conclusion: Because of its good radioopacity, Embol is easy to controa, and is effective for renal artery embolization. As a permanent embolic agent, it appears suitable for clinical applications.

원저 : 폐암 환자에서 촉진되지 않는 경부 림프절에 대한 초음파 유도 하 세침흡인 세포검사의 유용성

김희규 ( Hee Kyoo Kim ),하승인 ( Seung In Ha ),김유리 ( Yu Ri Kim ),박찬복 ( Chan Bog Park ),옥철호 ( Chul Ho Oak ),장태원 ( Tae Won Jang ),정만홍 ( Maan Hong Jung ),오경승 ( Kyung Seung Oh ),천봉권 ( Bong Kwon Chun ),이민기 ( Min 대한결핵 및 호흡기학회 2004 Tuberculosis and Respiratory Diseases Vol.56 No.5

증례 : Von Hippel-Lindau 유전자 배선 돌연변이와 동반된 가족성 양측성 갈색 세포종 1예

양재홍 ( Jae Hong Yang ),최영식 ( Yonung Sik Choi ),박요한 ( Yo Han Park ),오경승 ( Kyung Seung Oh ),천봉권 ( Bong Kwon Chun ),이상준 ( Sang Jun Lee ),김일진 ( Il Jin Kim ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-

Von Hippel-Lindau (VHL)병은 VHL 유전자의 배선 돌연변이(germline mutation)의 결과로 발생하며, 상염색체 우성으로 유전하는 질환으로 소뇌, 척수, 뇌간 및 망막의 혈관모세포종과 신세포암, 갈색세포종 및 췌도종양 등의 여러 장기에 양성 및 악성 종양을 초래 하는 질환이다. 저자들은 양측성 갈색세포종을 가진 딸과 양측성 갈색세포종과 시력장애 및 췌장종양을 가진 환자에서 시행한 유전자 검사상 VHL exon2, codon 121에서 GAT (Asp)가 AAT (Asn)으로 배선돌연변이를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Von Hippel-Lindau (VHL) disease is an autosomal dominant inherited tumor syndrome characterized by multiple benign and malignant tumors of the central nervous system (CNS), retina, kidney, pancreas and adrenal glands. VHL disease is associated with a germline mutation of the VHL tumor suppressor gene on the short arm of chromosome 3. VHL disease has been divided in four subtypes, based on development of different tumors. VHL diseases without pheochromocytoma are classified as type 1, and those with pheochromocytoma type 2. VHL disease type 2 is divided into 2A based on the presence of renal cancer or 2B by the absence of renal cancer, and 2C has pheochromocytoma only. Recently we experienced a family with VHL type 2A and VHL type 2C who carry a novel type GAT (Asp) to AAT (Asn) missense germline mutation in codon 121 of exon 2 of VHL gene. The authors report this case with literature review. (Korean J Med 69:S873-S878, 2005)

갑상선암 예측에 있어 초음파적 변수 분석

임현정,최영식,박요한,오경승,이강대 고신대학교 의학부 2004 高神大學校 醫學部 論文集 Vol.19 No.1

Background: The introduction of high resolution sonography has made it possible to detect nodules in the thyroid gland. However, there has been no reliable sonographic sign for distinguishing between benign and malignant thyroid conditions. The aim of present study was to evaluate ultrasonographic (US) parameters in predicting thyroid cancer. Methods: One hundred fifty three patients who underwent thyroidectomy at Kosin Medical Center from January, 2000 to April, 2002 were included in the study. All patients were checked high resolutional US before surgery. Of the 153 patients 89 were malignant tumors and 64 benign. Malignant US parameters were defined as calcification, irregular margin, more taller than wide, and fat line obliteration. Calcification pattern was classified with single, punctated, and amorphous calcification. The US characteristics to predict malignancy were evaluated by means of multiple logistic regression analysis. Results: All of the malignant sonographic parameters such as calcification, 53 (89.8%) were thyroid carcinoma. The incidence rate of malignancy was 55.9% in solitary nodules and 65.7% in multiple nodules (p=0.303). Even though nodule size was less than 1.5㎝, the incidence of malignant tumor was 69.5% (p=0.04). Of 53 malignant nodules with calcification, the incidence of single, punctated, and amorphous calcification pattern was 6 (11.3%), 22 (41.5%), 25(47.2%), respectively. The sensitivity, specificity, positive and negative predictive value, and accuracy of sonographic parameters were 76.4%, 87.5%, 89.5%, 72.7% and 81.0%, respectively. Upon the correlation of US-guided FNA cytology with pathologic diagnosis, the sensitivity of ultrasound-guided FNA cytology in differentiating benign and malignant nodule was 85.9%, the specificity 100% and overall diagnostic accuracy was 91.2%. The sensitivity, specificity, and accuracy of US parameters associated to follicular neoplasm, all were 75.0%. Conclusion : All the malignant US parameters including calcification, irregular margin, and more tall than wide showed high level of sensitivity, specificity and accuracy. Of these parameter, calcification and irregular margin were more significants. The more presence of calcifications with punctated and amorphous pattern could suggest the higher possibility of malignancy. However, further study is needed for clinical application of malignant US parameters in the thyroid tumors.

우연성 갑상선종양에 대한 초음파 유도하 세침흡인 세포검사의 진단적 가치

최영식,서지영,권기범,박요한,오경승,김성만,천봉근,장희경 대한내분비학회 1999 Endocrinology and metabolism Vol.14 No.1

Background: The introductian of highly sensitive imaging techniques has made it possible to detect many nonpalpable nodules, or incidentaloma. Because these nodules are small sized or deep seated, the diagnostic approach is difficult with conventional methods but it is easy with ultrasound-guided fine needle aspiration (FNA). However, the role of ultrasound-guided FNA on the incidentalomas has been poorly evaluated, so we tried to assess the diagnostic value of high resolution ultrasound-guided FNA in the incidentalomas. Methods: One hundred forty-nine patients who underwent high resolution ultrasound-guide FNA for nonpalpable nodules that was smaller than 1.5 cm in diameter at Kosin Medical Center from June, 1996 to April, 1998 were included in the study. Ultrasound-guided FNA was performed with a 22-guage needle attached to 10 mL syringe with 10 MHz linear transducer in a free hand fashion. The aspirated materials were smeared and stained with Papanicolaou stain. For those who underwent surgery histopathologic diagnoses were compared to cytological diagnoses, Results: The mean age of the patients was 45 and most of them were middle aged. Male to female ratio was 1:11.4. Of 149 patients 16 were involutional change, 55 hyperplasia, 42 Hashimotos thyroiditis, 8 follicular neoplasm, 19 papillary carcinoma, 1 subacute thyroiditis, and 6 inadequate specimen. Of the 149 nodules, 123 cases were solid, 11 cystic, and 15 mixed. Malignant nodules were more frequent in the solid nodule, but there was no significant difference between each group. Ten of 93 cases (10.7%) measured less than 1 cm and nine of 56 cases (16.1%) between 1.0 cm to 1,5 cm were malignant nodules. The difference of incidence rate of malignant nodules between each group was not significant. The incidence of malignancy was 13.6% (12/88) in solitary nodule and 11.5% (7/61) in multiple nodules. The difference of incidence rate of malignant nodules between each group was not significant. Eighteen cases including 14 malignancies diagnosed by FNA underwent operation. Of those 13 were papillary carcinoma and 5 adenomatous goiter. Upon the correlation of ultrasound-guided FNA cytology with pathologic diagnosis, the sensitivity of ultrasound-guided FNA cytology in differentiating benign and malignant nodule was 92.3% and overall diagnostic accuracy was 80.0%. The obtainability of adequate cytologic specimen by ultrasound-guided FNA was 95.9%. No complication except pain was noted during this study. Conclusion: High resolution ultrasound-guided FNA cytology may be useful for the diagnosis of thyroid cancer in the thyroid incidentalomas and also useful for early detection of recurrence of thyroid cancer (J Kor Soc Endocrinol 14:71 80, 1999).

갑상선결졀에 대한 초음파 유도하의 세침흡인세포 검사의 진단적 가치

최영식,임학,구양훈,장희경,홍성준,최휘,박요한,오경승 대한내분비학회 1996 Endocrinology and metabolism Vol.11 No.4

Background: Thyroid nodule is a common disease of thymid gland. The incidence of malignant nodule is about 3%, so most of thyroid nodules are benign. Because most thyroid nodule morbidity is related to cancerous lesions, early detection of malignant nodule is important. However, some of these nodules are srnall sized or deep seated which were not detected by physieal exarnination but by ultrasonography incidentally. In these cases the diagnostic approach is difficult with conventional methods but it is easy with ultrasound-guided fine needle aspiration (FNA). However, the role of ultrasound-guided FNA on the thyroid nodules has been poorly evaluated, so we tried to assess the diagnostic value of high resolution ultrasound-guided FNA in the thyroid nodules. Methods: We examined the medical records retrospectively of all patients who were engaged in high resolution ultrasonography(ATL Ultramark-9, 10 MHz linear transducer) due to thyroid nodules and/or other thyroid abnormalities from September, 1995 to March, 1996. Ultrasound- guided FNA was performed in 137 patients with palpable or nonpalpable(small sized or deep seated) nodules which were detected by high resolution ultrasonography. Results: The mean age of the patients was 45 and most of them were middle aged. Male to female ratio was 1:8.1. Malignant nodules were frequent in patients over 30 yus of age. Of 137 patients 43 were involutional change, 45 hyperplasia, 12 Hashimotos thyroiditis, 12 follicular neoplasm, ll papillary carcinoma, 1 Hurthle cell tumor, 1 medullary carcinoma, and 12 inadequate specimen. In 22 cases thyroid nodules were not detected by physical examinatian but by ultrasonography and in 31 cases additional thyroid nodules were detected by ultrasonography. In the nature of thyroid nodules, 99 cases were solid, 16 cystic, 22 mixed. Malignant nodule were more frequent in the solid nodule, but thete was no significant difference between each group. The size of masses was categorized into four groups. Thirty-one cases measured less than 1cm, 63 between 1cm and 1.9cm, 29 between 2cm to 2.9cm, and 14 over 3cm. The malignant nodule was not palpable in 3 cases and the smallest was 0.7cm in diameter. Most of malignant lesions were between 1cm and 2.9cm, but the difference of incidence rate of rnalignant nodules between each group was not significant. The incidence rate of malignancy was 8.8% in solitary nodule and 8.7% in multiple nodules. Twenty-three cases including 12 malignancies diagnosed by FNA underwent operation. Of those 13 were papillary earcinoma, 1 follicular carcinoma, 1 medullary carcinoma. Upon the correlation of ultrasound-guided FNA cytology with pathologic diagnosis, the sensitivity of ultrasound-guided FNA cytology in differentiating benign and malignant nodule was 80.0%, the specificity 100% and overall diagnostic accuracy was 86.1%. The obtainability of adequate cytologic specimen by ultrasound-guided FNA was 91%. No complication except pain was noted during this study. Conclusion: High resolution ultrasound-guided FNA cytology in the thyroid nodules may be useful in the diagnosis of thyroid cancer especially in the nodules which were small sized or deep seated and also useful in early detection of recurrence of thyroid cancer. (J Kor Soc Endocrinol 11:391, 1996)