조기 위암에서 CT Gastrography를 이용한 위점막 표면 거리 측정

최향희,유완식,염헌규,이재혁,최재정,김희수,정호영,Choi, Hyang-Hee,Yu, Wan-Sik,Ryeom, Hun-Kyu,Lee, Jae-Hyuk,Choi, Jae-Jeong,Kim, Hee-Su,Cleary, Kevin,Mun, Seong-Ki,Chung, Ho-Young 대한위암학회 2006 대한위암학회지 Vol.6 No.3

목적: 위암의 조기발견이 갈수록 많아져서 근래에는 수술 환자에서 조기위암의 비율이 50%를 넘고 있다. 그런데 조기위암은 수술 중 촉각이나 시각에 의해 인지되지 않는 경우가 드물지 않게 있으며 수술 전 위 내시경조차도 병변의 위치에 대한 정확한 정보를 제공하지 못하여 술 중에 절제범위를 결정하는 데 어려움이 있다. 저자들은 이 연구를 통하여 1) CT gastrography를 이용하여 해부학적 경계지점에서부터 조기 위암 병변까지의 생체내 실제의 표면 거리를 측정할 수 있는 소프트웨어를 개발하고 2) 개발된 소프트웨어에 의해 측정된 거리와 술 후 병리 표본에 의해 측정된 거리를 비교하여 수술에서의 유용성을 알고자 하였다. 대상 및 방법: 2004년 1월부터 2005년 9월까지 경북대학교 병원에서 술 전 복부 3차원 CT gastrography를 촬영하고 위 절제술을 시행한 60명의 조기 위암 환자를 대상으로 하였다. 이들은 남자 45명, 여자 15명이었으며 평균 연령은 57.8세였다. 수술 전 컴퓨터 단층촬영은 5 Fr 비위장관을 통해 실내 공기를 흡입시킨 후 시행되었고 이 영상은 절편 두께 0.625 mm의 thin section과 kVp:120, mAs:200의 low dose radiation의 Protocol을 적용하였다. 본 연구에서 개발된 표면거리 측정 소프트웨어를 Rapidia 2.8 CT 3차원 재구성 프로그램과 연동하여 3차원 볼륨 렌더링 및 조기 위암 병변에서 유문, 또는 분문까지의 표면 거리를 측정하였고, 술 후 병리 표본에 의해 측정된 거리와 개발된 소프트웨어에 의해 술 전 생체 내에서 측정된 거리 사이의 관계를 평가하였다. 결과: 병소와 유문, 또는 분문 사이의 거리에 대한 병리 표본과 CT gastrography로부터 측정된 거리간의 차이는 $5.04{\pm}2.97\;mm(range,\;0{\sim}11\;mm)$였으며 CT gastrography에 기초한 거리측정은 병리표본에 비하여 18명의 환자에서는 더 길었고 3명의 환자에서는 더 짧았다. CT gastrography로 측정된 술 전 생체 내 표면거리와 술 후 병리 표본에서 측정된 거리 사이에는 유의한 상관관계가 있었다(r=0.995, P<0.01). 결론: 이러한 결과들은 해부학적 경계지점으로부터 조기위암 병변까지의 표면 거리가 CT gastrography에 의해 정확하게 측정될 수 있다는 사실을 시사한다. 이 기법은 수술적 절제의 적절한 범위를 결정하기 위한 조기 위암의 술 전 위치 결정에 이용될 수 있을 것으로 보인다. Purpose: Recently, the incidence of early gastric cancer (EGC) patients is rapidly increased in Korea. However, they're often not perceptible by surgical palpation or inspection. The aim of this study is 1) to develope a software that can locate the tumor and measure the mucosal distance from an anatomic landmark to the tumor using CT gastrography and 2) to compare the distance measured by the developed software with the distance measured by the pathologic findings. Materials and Methods: Between January 2004 and September 2005, sixty patients (male=45, female=15, mean 57.8 years old) estimated for EGC with preoperative CT scans and undergone gastrectomies in Kyungpook National University Hospital were enrolled in this study. Preoperative CT scans were performed after insufflations of room air via 5 Fr NG tube. The scans included the following parameters: (slice thickness/reconstruction interval: 0.625 mm, kVp: 120, mAs: 200). 3D volume rendering and measurement of the surface distance from the pylorus to the EGC were performed using the developed software. Results: The average difference between the lesion to pylorus distances measured from pathologic specimens and CT gastrography was $5.3{\pm}2.9\;mm(range,\;0{\sim}23\;mm)$. The lesion to pylorus distance measured from CT gastrography was well correlated with that measured from the pathologic specimens (r=0.9843, P<0.001). Conclusion: These results suggest that the surface distance from an anatomic landmark to the EGC can be measured accurately by CT gastrography. This technique could be used for preoperative localization of early gastric carcinomas to determine the optimal extent of surgical resection.

구연발표 : 저 Alpha - Fetoprotein 치를 보인 원발성 간암 환자에서의 혈청 구리농도 측정 의의

최향희(Hyang Hee Choi),김종웅(Jong Woong Kim),심경보(Kyung Bo Sim),김창덕(Chang Duck Kim),류호상(Ho Sang Ryu),현진해(Jin Hai Hyun) 대한소화기학회 1987 대한소화기학회 추계학술대회 Vol.1987 No.-

요충층에 있어서 항문주위 도말법의 검토

김종성,최향희,주경환,임한종,Kim, Jong-Seong,Choi, Hyang-Hee,Joo, Kyoung-Hwan,Rim, Han-Jong 한국농촌의학지역보건학회 1987 농촌의학·지역보건 Vol.12 No.1

Enterobiasis is common helminthic infections found in man. But control of this disease is still troublesome because of its difficulty in the d diagnosis and prevention of infection. Considering the difficulty of accurate diagnosis of pinworm infection, which is very common and somewhat pathogenic, reevaluation of cellotape anal swab method for the diagnosis of enterobiasis was performed. A total of 147 children ranging the ages of 1-12 years in 3 orphanages in the suburbs of Seoul, Korea was subjected for this study. Repeated cellotape anal swabs were carried out against 70 children, 7 times for 3 days interval, in the morning 6am. Finally 10 mg/kg body weight pyrantel pamoates were given to all children including egg negative cases and whole stools of 3 following successive days were collected for the confirmation of residual worm ourden at the time of treatment. Cellotape anal swabs were also performed to another 77 children at 6am, 3pm, 9pm, twice for 3 days interval. The resultant findings were summarized as follows; 1) While the each time average detection rate of Enterobius egg was 28.8% in this study group, the accumulative detection rate up to 7th examination was 62.8%. The accumulative detection rate rose continuously up to 6th examination. 2) After administration of pyrantel pamoate 10 mg/kg body weight, final infection rate was increased to 72.9% by adding worm positive cases who didn't show any evidence of infection in the cellotape anal swabs. 3) Although pinworms were detected in 35 among 70 children treated, 7 cases (20%) of them were egg negative cases in 7 consecutive cellotape anal swabs. 4) Pinworms were expelleded in 14 (87.5%) among 16 children whose swab result was positive in the last examination which was done concurrently with drug administration. 5) Estimated infection rate calculated by best asymptotically normal estimate of Neuman from Moriya's modification revealed 71.5% similar to 72.9% of present results. 6) The result of anal swab performed at 6am was higher than that of 3pm or 8pm. In conclusion, cellotape anal swab method for Enterobius vermicularis infection was considered as method having relatively high positive accuracy. However to gain the reliable infection rate, at least 6 examination is required in the group with 25-30% infection rate by single swab. Moriya's modification of Neuman could be used efficiently in the mass control of this diease for the estimation of true infection rate of E. vermicularis in the sampled population.

갑상선 전절제술 및 중앙경부 림프절 박리술 후 발생한 유미누출: 3예 증례보고

황승욱·,최향희·,김완욱·,박호용·,정진향,Seung Ook Hwang,Hyang Hee Choi,Wan Wook Kim,Ho Yong Park,Jin Hyang Jung 대한갑상선-내분비외과학회 2013 The Koreran journal of Endocrine Surgery Vol.13 No.3

Chyle leakage is a rare complication of surgery for thyroid cancer that generally develops after lateral neck dissection. Here, we describe chyle leakages experienced after central neck dissection (CND). A total of 615 patients with thyroid cancer were treated by total thyroidectomy with CND between Jan 2012 and Dec 2012 at our facility, and three (0.49%) developed chyle leakages. The amounts of leakage were all less than 100 ml/day. One patient was resolved with conservative management, while the others were treated with conservative treatment and fibrin glue injection in chylous lymphocele. Chyle leakage after CND is very uncommon, and most cases involve minor leakage. Fibrin glue could be a treatment option for chyle leakage following CND.

하지정맥류 환자의 정맥벽에서 정수압 스트레스에 따른 기질 금속단백분해효소 발현도 분석

허승(Seung Huh),최향희(Hyang Hee Choi),김형기(Hyung-kee Kim) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.77 No.5

Purpose: The expression of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinase (TIMPs) caused by hydrostatic pressure stress is important in the development of varicose veins (VVs). This study was performed to analyse the expression of various MMPs and TIMPs according to the hydrostatic stress and the anatomical level of human great saphenous vein (GSV). Methods: Forty-nine vein samples were obtained from 10 patients with VVs (control group), and 34 samples from 7 VV patients after 1-hour hydrostatic stress just before surgery (stress group) at each anatomical site (proximal, Hunter, Dodd, and Boyd perforators) of GSV. Light microscopic examination and immunohistochemistry for MMP-1, -2, -9, -13 and TIMP-1, -2 were performed. Results: Intimal hyperplasia, fragmentation and loss of elastic fibers, infiltration of collagen fibers, and disorganization of medial muscle layers were evident in most vein samples. The degree of vein wall degeneration was not different between the 2 groups, and the anatomical sites of GSV. By immunohistochemistry, the expression of MMPs and TIMPs was not significantly different according to the group and the site. The expression of MMP-9 was more intense than that of other MMPs and TIMPs in all samples. MMP-9 was well localized to endothelial cells, medial muscle layers, and adventitial vasa vasorum. Conclusion: There are no distinct differences in the varicose vein samples after short-term postural blood stasis compared to the resting group. MMP-9 may be the key enzyme of the venous wall remodeling.

복부대동맥류 환자에서 합병된 원발성 대동정맥루

김형기(Hyung-Kee Kim),최향희(Hyang Hee Choi),허승(Seung Huh) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.76 No.1

Primary aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysm (AAA), occurring in only 4% of ruptured cases and less than 1% of all AAAs. The hemodynamic changes resulting from the major shunt caused by the ACF include a sudden increase in inferior vena caval pressure and volume with renal venous hypertension and a decrease in total peripheral resistance. So, if untreated, it leads to irreversible high output heart failure. Preoperative diagnosis is crucial, as adequate preparation should be made for massive bleeding expected at operation. Successful treatment depends on management of perioperative hemodynamics, control of bleeding from fistula and prevention of thromboembolism. We report two cases of successfully treated spontaneous ACF with a review of the literature.

하지정맥류 환자 및 정상인에서 대복재정맥의 기질 금속단백분해효소 및 금속단백분해효소-조직억제제의 발현도 분석

허승(Seung Huh),최향희(Hyang Hee Choi),김형기(Hyung-kee Kim),김상준(Sang Joon Kim) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.6

Purpose: Although varicose veins are very common in adults, the mechanism of the disease has not been established. Degradation of the extracellular matrix is regulated by various matrix metallopreteinases (MMPs) and their inhibitors tissue inhibitor of metallaproteinase (TIMPs). This study was performed to analyse the relationship between venous wall degeneration and expression of these matrix proteinases. Methods: Twelve great saphenous vein (GSV) segments from 7 patients without varicose veins (control) and 86 GSV segments from 18 patients (22 limbs) with varicose veins (C2,4,5EPASPR) were used for this study. Light microscopic examination was used in the evaluation of vein wall degeneration, immunohistochemistry and Western blotting for the expression of MMPs (MMP-1, MMP-2, MMP-9 and MMP-13) and TIMPs (TIMP-1 and TIMP-2), and zymography for gelatinolytic activity of MMP-2 and MMP-9 were performed. Results: MMP-9 was more strongly expressed in the vein wall of both control and patient groups, especially in the endothelial cells and medial muscle layers and TIMP-2 followed. The expression of MMP-9 was closely related to the degree of venous wall degeneration. Activated MMP-2 and MMP-9 were observed in both groups and expressed more in the proximal GSV of the patients. In the Western blotting, the expression of MMP-9 and TIMP-1 were significantly higher than other MMPs and TIMP-2 in the patients with varicose veins. Conclusion: MMP-9 is much more expressed in the wall of degenerative veins. This matrix-degrading enzyme may play an important role in the degeneration of venous wall followed by its remodeling.

지상발표 : 소장 임파관 확장증 1예

최석주(S.J. Choi),유진목(J.M. Yoo),최향희(Hyang Hee Choi),조원용(Y.Y. Cho),박영태(Young Tae Park),김종극(Jong Guk Kim),이창홍(Chang Hong Lee) 대한소화기학회 1987 대한소화기학회 추계학술대회 Vol.1987 No.-

요충증에 있어서 항문주위 도말법의 검토

金鍾成(Jong-Seong Kim),崔向希(Hyang-Hee Choi),朱炅煥(Kyoung-Hwan Joo),林漢鍾(Han-Jong Rim) 한국농촌의학 지역보건학회 1987 농촌의학·지역보건 Vol.12 No.1

복부대동맥류 수술 후 장기 추적관찰 결과

김형기(Hyung-Kee Kim),조민정(Min-Jung Jo),최향희(Hyang Hee Choi),허승(Seung Huh),김영욱(Young-Wook Kim) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.1

Purpose: The purpose of this study was to analyze the causes of late death and the long-term survival of patients following abdominal aortic aneurysm (AAA) repair. Methods: From 1993 to 2005, 146 (98 intact and 48 ruptured) consecutive AAA patients underwent open repair. The perioperative data was supplemented with a retrospective review of the medical records and the use of the database of the National Statistical Office to calculate the survival rates and the causes of death. Results: There was one operative death (1%) in the intact AAA group and 12 (25%) in the ruptured AAA group. After exclusion of the operative deaths, the survival rates of the intact AAA patients were 94.5% at 1 year, 77.0% at 5 years and 33.2% at 10 years; these findings demonstrated a significant longer survival for the intact AAA patients than for patients with ruptured AAA (86.1% at 1 year, 56.7% at 5 years and 0% at 10 years, respectively). The causes of late death included cardiovascular disease in 52.8% (coronary artery disease in 22.6%, cerebrovascular disease in 20.8%, other arterial aneurysms in 5.7% and graft-related death in 3.8%), malignancies in 11.3% and pulmonary disease in 11.3%. The multivariate analysis showed that the long-term survival rates were influenced by the rupture status, the history of cerebrovascular disease and hypertension. Conclusion: This study showed that the long-term survival after intact AAA repair was better than that for ruptured AAA repair even if we exclude the operative deaths. The most common cause of late death was cardiovascular disease. Our findings suggest that the patients with preoperative cerebrovascular disease and hypertension require additional care.