연구논문 : 만성 바이러스간질환에서 간섬유화의 다양한 비침습 혈청표지자검사의 비교

김선민 ( Sun Min Kim ),손주현 ( Joo Hyun Sohn ),김태엽 ( Tae Yeob Kim ),노영욱 ( Young Wook Roh ),은창수 ( Chang Soo Eun ),전용철 ( Yong Cheol Jeon ),한동수 ( Dong Soo Han ),오영하 ( Young Ha Oh ) 대한간학회 2009 Clinical and Molecular Hepatology(대한간학회지) Vol.15 No.4

목적: 만성 바이러스간질환에서 병의 경과와 예후를 평가하고 치료반응을 예측함에 있어 간섬유화의 진단은 중요하다. 최근 간섬유화 평가에 표준방법이지만 침습적 간생검을 대신하여 여러 가지 비침습적 진단법이 이용되고 있고, 또한 새로운 검사법들이 개발되고 있다. 저자들은 만성 B형 및 C형간염 환자를 대상으로 임상에서 광범위하게 흔히 시행하는 혈액검사와 임상 소견을 이용한 아래와 같은 진단법들만으로 간섬유화를 얼마나 정확하게 평가할 수 있는지 알아보고, 단일 검사로 간섬유화를 평가하는 데 유용하다고 알려져 있는 hyaluronic acid(HA)와 IV형 콜라겐 농도와 비교하여 그 임상적 유용성을 평가하였다. 대상과 방법: 2002년 3월부터 2007년 2월까지 만성 바이러스간 질환으로 간생검을 시행받은 225명의 환자(HBV 180명, HCV 43명, HBV+HCV 2명)를 대상으로 분석하였다. 간생검을 시행하는 날에 말초혈액검사, 혈액응고검사, 혈청생화학검사를 시행하고, 혈중 HA, IV형 콜라겐 농도를 측정하였다. 간섬유화의 정도는 F0(섬유화가 없음), F1(문맥역 섬유화), F2(문맥주변부 섬유화), F3(섬유성 격막) 및 F4(간경변증)의 4단계로 구분하였다. 대상 환자를 F0-1, F2-4 혹은 F0-2, F3-4의 두 집단으로 분류하여 두 집단을 구분하고자 할 때 AAR(AST/ALT ratio), API(age-platelet index), APRI(AST to platelet index), CDS(cirrhosis discriminant score), platelet count, HA, IV형 콜라겐의 예측능을 area under the receiver operating characteristic curve (AUROC)값을 이용하여 비교하였다. 결과: 대상환자의 섬유화의 단계는 F0 집단은 17명, F1 집단은 40명, F2 집단은 61명, F3 집단은 74명, F4 집단은 33명이었다. 의미 있는 간섬유화를 F2 이상으로 판단할 때, 의미 있는 섬유화의 예측에 대한 AUROC 값은 APRI=0.822, CDS=0.776, platelet count=0.773, API=0.756, HA=0.749, IV형 콜라겐=0.718, AAR=0.642 순이었고, F3 이상의 광범위한 섬유화 예측에 대한 AUROC값은 CDS=0.835, platelet count=0.795, API=0.794, HA=0.766, AAR=0.711, IV형 콜라겐=0.697, APRI=0.691 순으로 관찰되었다. 결론: 만성 바이러스간질환에서 간섬유화를 평가하는 데 임상 소견 및 혈액검사를 이용한 방법들이 비침습적 진단법 중 단독 검사로도 유용한 것으로 알려져 있는 혈중 HA와 IV형 콜라겐 농도와 비교하여 우월하거나 대등하였다. 특히 APRI는 다른 인자들에 비해 F2 이상의 의미 있는 섬유화를 예측하는 데 가장 유용하였고, CDS는 F3 이상의 광범위한 섬유화를 예측하는 데 가장 유용하였다. Background/Aims: The aim of this study was to determine the clinical performances of noninvasive serum markers for the prediction of liver fibrosis in chronic viral liver diseases. Methods: We analyzed a total of 225 patients with chronic viral liver diseases (180 with hepatitis B virus, 43 with hepatitis C virus, and 2 with hepatitis B+C virus) who underwent a liver biopsy procedure at the Hanyang University Guri Hospital between March 2002 and February 2007. Serum was also obtained at the time of liver biopsy. Liver fibrosis was staged according to the scoring system proposed by the Korean Study Group for the Pathology of Digestive Diseases. Various noninvasive serum markers were evaluated, including the aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AAR), age-platelet (AP) index, AST/platelet ratio index (APRI), cirrhosis discriminant score (CDS), platelet count, hyaluronic acid (HA), and type IV collagen. Results: There were 17, 40, 61, 74, and 33 patients at stages F0, F1, F2, F3, and F4, respectively. The overall diagnostic accuracies of each marker, as determined by the area under receiver operating characteristics curves, were APRI=0.822, CDS=0.776, platelet count=0.773, AP index=0.756, HA=0.749, type IV collagen=0.718, and AAR=0.642 for predicting significant fibrosis (≥F2); and CDS=0.835, platelet count=0.795, AP index=0.794, HA=0.766, AAR=0.711, type IV collagen=0.697, and APRI=0.691 for predicting extensive fibrosis (≥F3). Conclusions: Conclusions: All noninvasive serum markers evaluated in this study were useful for predicting significant or extensive liver fibrosis in chronic viral liver diseases. In particular, APRI was most useful for the prediction of significant fibrosis, and CDS was most useful for the prediction of extensive fibrosis. (Korean J Hepatol 2009;15:454-463)

가슴샘 카르시노이드종양의 세침흡인 세포소견 - 1예 보고 -

오영하,장기석,송영수,이철범,박충기,박문향,박용욱,Oh, Young-Ha,Jang, Ki-Seok,Song, Young-Soo,Lee, Chul-Burm,Park, Choong-Ki,Park, Moon-Hyang,Park, Yong-Wook The Korean Society for Cytopathology 2005 대한세포병리학회지 Vol.16 No.1

Carcinoid tumors of the thymus are vanishingly rare, and the characteristic cytologic findings of this condition have never before been reported in Korea. Recently, we encountered a 58-year-old woman who had been suffering from general weakness and weight loss for several months. Radiological imaging revealed a large anterior mediastinal mass. A fine needle aspiration biopsy (FNAB) of the mass showed predominantly scattered single cells, as well as some loose clusters of small cells with scanty cytoplasm. Some of these small cells exhibited plasmacytoid features, with moderately granular cytoplasm. We also discuss the cytological differential diagnosis between thymic carcinoid and other mediastinal tumors.

법정관리에서의 채권자와 주주의 지위에 관한 소고

오영하(Oh, Young-Ha) 중앙대학교 법학연구원 2016 法學論文集 Vol.40 No.3

Korea’s shipbuilding and marine transportation industries, which have been struggling since their economic base weakened in 2008, are undergoing major restructuring as they are unable to sustain further losses. Unlike Hyundai Merchant Marine and Daewoo Shipbuilding & Marine Engineering, Hanjin Shipping has filed for court receivership instead of a corporate workout. Opposition parties and financial authorities have criticized the unprincipled restructuring moves amidst allegations that Choi Soon-sil is related to Hanjin’s court receivership. While it is best for companies to attempt restructuring once signs of distress are identified, most do so only after their liabilities exceed their assets or when facing insolvency. The main reason behind this vicious cycle is that corporate restructuring involves many stakeholders, such as creditors, companies, shareholders, management, employees, and subcontractors. In other words, the key to successful restructuring lies in ensuring not only the efficiency of the restructuring process but also in maintaining agreeable relationships among interested parties. Due to differences in initiation, companies’ insolvencies, liabilities, support for new funds, and the status of existing management or shareholders, corporate workouts and court receiverships differ in their efficiency at restructuring and maintenance of compatible relationships among those involved. Although court receiverships have flaws of their own, they are considered a more powerful policy compared to workouts, in terms of the protection of interested parties.

노동관계법 입법과정에 대한 노·사·정 참여와 대응에 관한 연구

오영하(Young-Ha Oh) 고려대학교 노동문제연구소 2014 노동연구 Vol.28 No.-

입법을 통한 법·제도의 변화 여부나 그 정도가 노사관계에 있어 갈수록 중요해지는 추세인데, 이러한 경향은 입법주체인 정부가 노사관계시스템의 한 축을 담당하는 당사자로서의 지위도 함께 가진다는 점에서, 또 급격한 경제·사회적 환경의 변화를 겪으면서 적극적인 노동시장정책과 노동문제에 대한 법·제도의 개입이 확대되고 있다는 점 등에서 더욱 강화되고 있다. 2010년 1월에 개정된 노조법의 입법과정은 입법과 노사관계의 관계를 가장 잘 나타내주는 사례라 할 수 있다. 입법과정 속에서 입법참여자로서의 노·사·정과 국회, 정치권은 각자의 이해관계에 따라 자신들의 입장을 관철하기 위해 연대와 대립을 반복하며 활발한 상호작용을 펼쳤다. 그런데 이 과정에서 당시의 경제·사회적 배경과 정치적 환경으로 인해 지나친 정치과잉현상을 보이는데, 그 결과 입법과정에서 제기된 노·사·정의 주장이 수용된 공감대 형성을 통한 개정이 아니라 입법과정 이전에 제시된 노사정위원회의 공익위원안 즉, 지난 사회적 대화의 결과에 바탕을 두고 정치권이 주도한 협상에 의해 법 개정이 일어나게 된다. 입법과정을 거치면서 노정관계와 노사관계가 악화되고 노사 모두 내부의 심각한 내홍사태까지 겪었지만, 정작 그 결과는 정치권에 의해 노동정책과 노사관계의 기본 틀이 훼손 내지 왜곡되는 현상이 일어난 것이다. 이러한 문제점을 개선하기 위해서는 사회적 대화기구인 노사정위원회에서 노·사·정이 양보와 타협으로 조금 더 만족할 만한 결론을 얻고, 그 결과를 정치권에 요구하는 방향으로 노동관계법 입법에서의 커뮤니케이션과정을 바꾸어나가는 것이 옳을 것이다.

원발성 폐 아밀로이드증의 세침흡인 세포학적 소견 - 1예 보고 -

조현이,오영하,정성환,하승연,Cho, Hyun-I,Oh, Young-Ha,Jeong, Seong-Hwan,Ha, Seung-Yeon 대한세포병리학회 2000 대한세포병리학회지 Vol.11 No.2

Pulmonary amyloid deposition generally occurs with concurrent primary systemic amyloidosis. Localized forms of pulmonary amyloidosis are rare and appear most frequently as an incidental finding on chest radiographs. We present a case of nodular pulmonary amyloid tumor suggested by fine needle aspiration cytology(FNAC) and confirmed by histology examination with the polarizing light microscopy. A 41-year-old woman presented with ill-defined nodules. In the middle and lower lobes of both lungs. FNAC of the nodules revealed waxy, acellular amorphous fragments. Thoracotomy for diagnosis may be avoided by FNAC diagnosis of this unusual lesion.

자궁경부 선양낭성암종의 세포학적 소견 - 1예 보고 -

하승연,조현이,오영하,류근신,Ha, Seung-Yeon,Cho, Hyun-I,Oh, Young-Ha,Lyu, Geun-Shin 대한세포병리학회 1998 대한세포병리학회지 Vol.9 No.2

Adenoid cystic carcinoma of the uterine cervix is a rare tumor accounting for less than 1% of all cervical adenocarcinoma. This tumor is characterized by aggressive biological behavior with frequent local recurrence or metastatic spread, postmenopausal onset, and occasional association with conventional squamous cell carcinoma. The cytologic diagnosis of adenoid cystic carcinoma in the uterine cervix is often difficult because of negative smear due to intact overlying mucosa, cytologic findings mimicking endometrial cells, and masquerade as squamous ceil carcinoma. Recently we have experienced a case of adenoid cystic carcinoma arising in the uterine cervix, which was identified on the routine Papanicolaou smear and was histologically confirmed by the consequent biopsy. The smear showed abundant cellularity composed of relatively uniform cells. The tumor cells were arranged in small clusters, acini, naked cells, and loose sheets with abortive cribriform pattern. There were scattered globoid basement membrane-like materials and tumor diathesis. The nuclei were pleomorphic and showed hyperchromatic and coarsely granular choromatin with inconspicuous nucleoli. The punch biopsy of the uterine cervix showed typical histologic findings of adenoid cystic carcinoma characterized by tumor nests composed of hyperchromatic uniform basaloid cells, cribriform pattern, and cylindrical hyaline bodies.

폐포 단백증의 세포학적 소견 - 1예 보고 -

하승연,조현이,오영하,Ha, Seung-Yeon,Cho, Hyun-I,Oh, Young-Ha 대한세포병리학회 2000 대한세포병리학회지 Vol.11 No.2

Pulmonary alveolar proteinosis(PAP) is a rare disease in which the alveolar spaces are filled with an eosinophilic, PAS-positive material, whereas the interstitial architecture of the lung usually remains unaffected. Although a definitive diagnosis is usually made by an open lung biopsy, bronchoalveolar lavage(BAL) cytology may play a decisive role in the diagnosis and therapy of these patients and may spare a patient a more invasive diagnostic procedure. The author presents a patient in whom BAL cytology specimen contained the characteristic globules of amorphous proteinaceous PAS-positive material accompanied by background of rare macrophages and inflammatory cells. Ultrastructural study using BAL specimen can confirm the diagnosis of PAP.

자궁목 반지세포암종의 세포학적 소견 -2예 보고-

조현이,하승연,정재걸,오영하,정동해,김나래,이종민,이의돈,Cho, Hyun-Yee,Ha, Seung-Yeon,Chung, Jae-Gul,Oh, Young-Ha,Chung, Dong-Hae,Kim, Na-Rae,Lee, Jong-Min,Lee, Eui-Don 대한세포병리학회 2003 대한세포병리학회지 Vol.14 No.2

Signet ring cell carcinoma is a rare type of mucinous adenocarcinoma of the uterine cervix. To the best of our knowledge, there is no report on cytologlc findings of primary signet ring cell carcinoma of the uterine cervix in the literature. Recently, we experienced two cases of signet ring cell carcinoma of the uterine cervix. The finding of characteristic signet ring cells on cervicovaginal smear led to the diagnosis of signet ring cell carcinoma. However, primary signet ring cell carcinoma could not be cytologically distinguished from more common metastatic tumor. Therefore, diagnosis rests upon the recognition of signet ring cells and the absence of signet ring cell carcinoma elsewhere.

비강 T/NK 세포형 림프종 1례

이정복,전인상,임호준,오영하,김지혜,Lee, Jung Bok,Jeon, In-sang,Im, Ho Joon,Oh, Young Ha,Kim, Ji Hye 대한소아청소년과학회 2003 Clinical and Experimental Pediatrics (CEP) Vol.46 No.12

저자들은 비강내 종괴로 내원한 14세 환아에서 종괴 생검 및 면역 표현형 검사로 비강 T/NK 세포형 림프종으로 진단하고 치료 중인 1례를 보고하는 바이다. The advance of the immunobiology clarifies the nature of non-Hodgkin's lymphoma(NHL). In addition the proceed in the immunophenotyping renders the classification of NHL. According to the Revised European American Lymphoma(REAL) classification, classified by the etiologic factors, molecular biological characteristics, immunophenotype, cytogenetics and histologic feature, nasal T/NK-cell lymphoma(=angiocentric lymphoma) belongs to the category of peripheral T-cell and natural killer cell lymphoma. Nasal T/NK-cell lymphoma is a distinct clinicopathologic entity characterized by progressive necrotic lesions in the nasal cavity, nasopharynx, and palate. The cellular origin of this tumor has been controversial. Although most nasal T/NK-cell lymphomas are of NK-cell lineage, being CD56+, negative for surface CD3(Leu4), and unassociated with rearrangements of the T-cell receptor genes, other minor variants have been reported. This lymphoma is a rare disease and usually experienced in adult. Recently, we experienced a rare type lymphoma, nasal T/NK-cell lymphoma, in 14 years old boy. His soft mass occupied the right nasal cavity including the nasal septum and turbinate. Pathologically this nasal mass showed the infiltration into the vascular wall, illustrating angiodestructive lesion. The cellular origin was NK-cell lineage, being CD56+ and negative to CD3. Now, we report the case with a brief review of related literatures.

다발성 경화 소견으로 발현된 림프구성 간질성 폐렴

황규식 ( Kyu Sig Hwang ),노영욱 ( Young Wook Roh ),송성헌 ( Sung Heon Song ),김상헌 ( Sang Heon Kim ),손장원 ( Jang Won Sohn ),윤호주 ( Ho Joo Yoon ),신동호 ( Dong Ho Shin ),박성수 ( Sung Soo Park ),오영하 ( Young Ha Oh ),김태형 ( 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.1

Lymphocytic interstitial pneumonia (LIP) is a rare disorder characterized by a diffuse infiltration of the alveolar space, interstitium by lymphocytes, plasma cells, and reticuloendothelial cells. Although its etiology is unknown, LIP has been associated with autoimmune disorders and with viral infections. Because it`s clinical and radiographic features are nonspecific, a confirmatory diagnosis is performed by open lung biopsy. A 59-year-old female presented dry cough, which had been present for 1 month. On initial findings of multifocal consolidation at the right middle lobe on both lower lobes in chest radiography, the first diagnosis of cryptogenic organizing pneumonia was suggested. On open lung biopsy, LIP was diagnosed. The patient had no autoimmune disease, viral infection or monoclonal gammopathy. After 3 months of corticosteroid treatment, the patient experienced improved symptoms, reduced abnormalities on chest radiography, and improved pulmonary function testing.