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갑상선 자극호르몬이 갑상선암세포의 VEGF, 신생혈관 형성, 성장, 침윤 및 전이에 미치는 영향
소의영,박희붕,김혜진,김현만<SUP>1<,SUP>,Euy Young Soh,M,D,Hee Boong Park,M,D,Hye Jin Kim,M,D,and Hyun Man Kim,M,D,<SUP>1<,SUP> 대한갑상선-내분비외과학회 2001 The Koreran journal of Endocrine Surgery Vol.1 No.1
Purpose: Vascular endothelial growth factor (VEGF) is a vascular endothelial cell specific mitogen and a major regulator of angiogenesis. VEGF secretion is activated in some thyroid cancers and that VEGF secretion is stimulated by TSH. So we postulated that TSH may promote growth and invasion in some thyroid cancers by stimulating VEGF secretion and angiogenesis. Methods and Results: We investigated the TSH effect for the VEGF secretion, endothelial cell proliferation and invasion in vitro with the primary cultured normal thyroid cell (NT-1) and thyroid cancer cell line (TPC-1). And to evaluate the relationship between TSH and VEGF, angiogenesis and tumor growth in vivo, we xenografted human dermal matrix inoculated with thyroid cells into nude mice or directly injected subcutaneously. For the study, mice were made hypothyroid (Group 1) by antithyroid hormone p.o, hyperthyroid (Group 2) by L-thyroxine injection and euthyroid (Group 3). One week after the treatment, significant difference were noted in T3, T4 and TSH level between each group, but the VEGF level showed significant difference in group 1 only compared with group 2 and 3. NT-1 or TPC-1 were seeded in the upper chamber of Transwell and HUVEC were cultured in lower chamber, and added different concentration of TSH. NT-1 and TPC-1 secreted VEGF under basal condition, but the level were similar. TPC-1 cells secreted significantly more VEGF than NT-1 after TSH (1, 10, 100 mIU/dl) stimulation, which were also parallel with the concentration of TSH. In low concentration of TSH (0, 1 mIU/dl), there were no difference of HUVEC proliferation between NT-1 and TPC 1. In high concentration of TSH (10, 100 mIU/dl), however, TPC-1 enhanced HUVEC proliferation than NT-1 significantly (p<0.05). Similar findings were noted in thyroid cell invasion. Invasion was higher in TPC-1 than in NT-1 in high concentration of TSH (10, 100 mIU/dl). In vivo study using the dermal matrix showed that number of blood vessels ingrowth were higher in Group 1 (25/HPF) than Group 2 (16/HPF) or Group 3 (17/HPF). But there was no difference between Group 2 and Group 3. Level of TSH and VEGF were also increased significantly in Group 1 compared with in Group 2 and Group 3. The size of tumor did not showed significant difference between each group during observation. The tumor from Group 1 (6.2 gm) were larger compared with Group 2 (5.1 gm) or Group 3 (5.6 gm), but this difference was not significant statistically (p>0.05). The number of blood vessels in tumor were also more increased in Group 1 and were commonly located in the peripheral portion of tumor. Conclusion: We conclude that thyroid cancer cell line secrete the VEGF and TSH secretion is more enhanced by the stimulation of TSH. And increased VEGF promote the vascular endothelial cell proliferation, invasion and angiogenesis in thyroid cancer. (Korean J Endocrine Surg 2001; 1:51-60)
고중화,소의영<SUP>1<.SUP>,양해동<SUP>2<.SUP>,전정민,김영주,이승주,Joong-Wha Koh,M.D.,Euy Young Soh,M.D.<SUP>1<.SUP>,Hae-Dong Yang,M.D.<SUP>2<.SUP>,Jeong-Min Chun,M.D.,Youngju Kim,M.D. and Seongju Lee,M.D. 대한갑상선-내분비외과학회 2001 The Koreran journal of Endocrine Surgery Vol.1 No.2
Purpose: Voice change after thyroidectomy has generally been the result of damage to the recurrent or superior laryngeal nerve. But many patients complain voice alteration without laryngeal nerve injury after thyroidectomy. The purpose of this study is to investigate whether strap muscle division results in any subjective or objective functional sequelae in voice, through long-term follow-up prospectively. Methods: Twenty-two female patients who had undergone thyroid surgery between July 1998 and December 1999, were studied. The patients who were planned for neck dissection, who had benign laryngeal disease or vocal cord paresis, and whose vocal cord paresis were developed after thyroid surgery, were excluded from this study. Twelve patients had undergone thyroidectomy via retraction of strap muscle and ten patients had undergone thyroidectomy via cutting of strap muscle. For evaluation of voice, questionnaires for changes of voice, acoustics (fundamental frequency, jitter, shimmer, signal to noise ratio, noise to harmonic ratio, voice range), and aerodynamic (maximal phonation time) analyses were done. Results: The subjective voice symptoms after thyroidectomy were disturbances of high pitch, singing, loud voice, and easy fatigue at phonation. There were no significant differences in voice parameters on acoustic and aerodynamic analyses between the strap muscle retraction group and the cutting group through long-term follow-up. Conclusion: We conclude that strap muscle division does not result in any subjective or objective functional problems in voice. We suggest that surgical division and reconstruction of these muscles should be employed routinely when opera-ting on large, toxic or neoplastic glands. (Korean J Endocrine Surg 2001;1:237-243)
갑상선 결절의 미세침 흡입 세포검사에 대한 권고안들의 고찰
이정훈,소의영,Jeonghun Lee,Euy Young Soh 대한갑상선-내분비외과학회 2015 The Koreran journal of Endocrine Surgery Vol.15 No.1
Thyroid cancer is a hot issue in Korea because there is debate on screening and diagnosis of thyroid cancer. Therefore, we reviewed the guidelines for the management of thyroid nodules of other countries. Western countries accepted the criteria of fine needle aspiration including the tumor size of thyroid nodules, although ultrasonographic morphologic characteristics are more important to diagnose the thyroid cancer than tumor size. This recommendation is based on good prognosis of papillary thyroid microcarcinoma. However, small subset of papillary thyroid microcarcinoma has aggressive behavior, which we cannot discern from those with benign behavior before operation. Therefore, further researches are necessary to resolve these problems and improve the management of papillary thyroid cancer avoiding overtreatment and mismanagement.
여포상 갑상선종양에서 신생혈관형성 및 혈관내피성장인자(VEGF)의 발현의 의의
류기선(Ki Sun Ryu),소의영(Euy Young Soh),임현이(Hyun ee Yim),김명욱(Myung Wook Kim) 대한두경부종양학회 1998 대한두경부 종양학회지 Vol.14 No.1
Tumor growth and metastasis depends on angiogenesis. Vascular endothelial growth factor (VEGF) is a potent mitogen for vascular endothelial cells in vitro and promotes neoangiogenesis in vivo. Objective: Follicular thyroid cancers(FTC) are a vascular tumor and traditionally metastasize via blood vessels. Likely other cancers, angiogenesis may playa important role in FTC. We, therefore, investigated the expression of VEGF and microvascular density by immunohistochemistry in FTC and follicular adenoma(FA). Materials and Methods: Findings of immunohistochemical stainings for VEGF and CD31 were measured by grading scale from +1 to 4+(strongest) and by counting the stained microvessels in 14 FTCs and 14 FAs. Results: 1) Expression of VEGF. a) FTCs have stronger expression than FAs in areas of tumor adjacent to capsule(mean±SD3.2±0.9vs2.0±0.9, p 2.3±0.7vs1.3±0.6, p 78.9±27.3vs38.7±15.6, p 75.5±23.3vs27.8±10.7, p 0.05). Conclusion: The higher expression of VEGF and microvascular density in FTC suggests angiogenesis plays an important role in progression of FTC.
Trachea Necrosis after Thyroidectomy ; Case Report and Review
최지우,이정훈,송영백,김철호,소의영,Choi, Ji Woo,Lee, Jeonghun,Song, Youngpeck,Kim, Chul-Ho,Soh, Euy Young The Korean Society for Head and Neck Oncology 2014 대한두경부 종양학회지 Vol.30 No.2
갑상선절제술은 내분비 외과의사가 하는 수술 중 가장 안전한 수술이지만 수술 중 기도나 식도가 손상 받을 수 있으므로 각별한 주의를 기울여야 한다. 특히 기도 괴사와 같이 생명에 위협을 주는 합병증이 있음을 유념해야 한다. 본 논문은 갑상선 전 절제술과 승모판 치환술을 함께 받은 72세 여성환자가 수술 후 3일만에 기도 괴사가 발생한 케이스이다. 3개의 기관륜에 걸쳐 괴사가 발생되어 있었다. 괴사된 조직을 제거하고, 이후 지속적인 괴사조직에 대한 제거와 치료와 적으로 기관개창술을 시행하고, 자연폐쇄를 유도하여 성공적으로 치료되었다. 비슷한 여러 논문들을 살펴본 결과 기도 괴사를 유발하는 요인으로는 조절되지 않는 기침, 여성, 갑상샘중독 결절, 기도 삽관 시 발생되는 손상, 삽관튜브 커프의 과팽창으로 기도가 장시간 높은 압력으로 압박되었을 때, 적절하기 않은 커프 크기, 삽관튜브 커프의 공기를 빼지 않고 무리하게 움직였을 때, 출혈이 많을 때, 과도한 전기소작으로 인한 손상, 기도로 가는 혈관손상으로 인한 혈액공급의 차단, 감염 등으로 보고 있다. 치료는 기도의 괴사와 감염의 정도에 따라 달라질 수 있다. 일차 봉합술, 일시적 스토마 형성, 일시적 기관조루술, 단단연결술, 기도 스텐트 설치술, 근육피판 재건술, 보존적 치료 등을 시행할 수 있다. 기도 괴사에 대한 위험인자와 치료에 대해서는 아직 확실히 적립되지 않은 상태이다. 드문 합병증이지만 생명을 위협할 수 있는 이러한 합병증에 대해 항상 염두 해 두고 수술 시 신중을 기하고 문제 발생시 신속한 대응을 해야겠다.
윤태일,안상익,정용식,소의영,Tae Il Yoon,M.D.,Sang Ick Ahn,M.D.,Yong Sik Jung,M.D. and Euy Young Soh,M.D. 대한갑상선-내분비외과학회 2004 The Koreran journal of Endocrine Surgery Vol.4 No.2
Purpose: The conventional surgical treatment for thyroid disease requires long skin incision with skin flap that can result in prominent scar, parethesia, hypesthesia in the neck. With recent developement in surgical techniques for thyroid tumors, several apporaches have been applied to neck surgery. We performed thyroid operations with 3 different methods and evaluated the role of respective operation method. Methods: Three different surgical methods; conventional, minimally invasive open, and endoscopic thyroidectomy with axillary approach, were performed on 60 patients who were admitted to Ajou medical center from June to December 2003. All patients were diagnosed as having a benighn mass in unilateral lobe of thyroid gland preoperatively by ultrasonography and fine needle aspiration cytology. We compared the clinical results of respective 3 operation methods each other. Results: Hospital stay and the operation time for minimal invasive open thyroidectomy was significantly shorter than those for endoscopic thyroidectomy (P<0.000). Amounts of post operative analgesics were the lowest in minimal invasive open thyroidectomy than other groups (P<0.019). The patients who was treated by using endoscopic procrdure were more satisfied with the cosmetic result. There was no significant complication in three groups. Conclusion: Minimally invasive open thyroidectomy and endoscopic thyroidectomy can be performed safely with cosmetic benefit, and then recommanded as a alternativeoperative method in selected patients. (Korean J Endocrine Surg 2004;4:97-100)