Bizarre Parosteal Osteochondromatous Proliferation (Nora's Lesion) -5예 보고-

김봉희,박용구,김윤화,양문호 대한병리학회 1996 Journal of Pathology and Translational Medicine Vol.30 No.8

폐의 방사선 손상을 예방하기 위한 전후방 전신 방사선 조사법에 관한 연구

최일봉,김인아,장지영,강기문,강영남,박수정,서정곤,김희제,민창기,이종욱,민우성,김춘추 대한조혈모세포이식학회 1998 대한조혈모세포이식학회지 Vol.3 No.2

연구배경: 전신 방사선 조사법 중 전후 전신 방사선 조사법은 기존의 측면 방사선 조사법에 비해 폐 차폐를 적극적으로 할 수 있고 균일한 방사선 조사량 분포를 얻을 수 있으나 시술 방법이 복잡하고 치료 준비 시간이 많이 걸리며 차폐물의 재현성이 떨어져 널리 사용되지 못하고 있다. 가톨릭 의대 성모병원 치료 방사선과에서는 12명의 백혈병 환자를 대상으로 간편하고 높은 치료 재현성을 가질 수 있는 전후방 전신 방사선 조사를 개발하기 위하여 본 연구를 시작하였다. 방법: 총 12명의 골수 이식 예정자를 대상으로 전후방 다분할 전신 방사선 조사를 하였다. 질병별로 보면 ALL 3명, AML 4명, CML 5명 이었으며 환자에 조사된 방사선량은 총 1200 cGy에서 1375cGy 였으며 분할 조사 횟수는 6회에서 11회로서 1일 2-3회 다분할 전신 방사선 조사를 하였다. 환자의 위치를 고정하기 위하여 자체 제작한 환자 고정대를 사용하였다. 의자, 환자 자세 유지용 손잡이, 폐 차폐물 거치대, 방사선 산란판 등으로 구성되어 있다. 치료시와 치료 계획시의 오차를 줄이고 총 6회 이상 11회까지 다분할 방사선을 치료 하는 동안 일정하게 폐를 차폐하기 위하여 본 저자들이 개발한 5점 방식을 사용하였다. 5점 방식은 환자 흉곽 전면 및 후면 피부의 상하, 좌우, 중심에 각각 1개씩 임의의 5개 점을 선정한 후 각각 환자의 피부에 방사선 촬영시 확인이 가능한 납으로 제작한 특수 마크를 1개씩 붙인 후 이를 기준점으로 치료 계획 시부터 치료 완료시 까지 사용하게 된다. 결과: 폐 차폐물 거치대와 환자의 피부에 동일한 다섯 개의 표지를 부착하고 전과정을 컴퓨터로 조정하며 특수 치료대를 제작 사용하여 기존 전신 방사선 치료 준비 시간을 10분 이내로 대폭 줄일 수 있었다. 또한 방사선 폐렴을 방지하기 위한 폐 차폐물의 재현시 오차를 3 mm 이내로 줄여 치료의 정확도를 개선할 수 있었다. 그리고 방사선 조사 균질성(Homogeneity of radiation dose)을 높여 임상에 사용할 수 있는 충분한 균일한 방사선 선량 분포도를 얻을 수 있었다. 결론: 본 방식의 전후방 전신 방사선 조사법은 기존의 전신 방사선 조사법에 비해 방사선 폐 차폐 정확도가 높으며 전후 전신 방사선 조사법의 가장 큰 단점중 하나이었던 긴 치료 준비 시간도 측면 전신 방사선 조사법과 동일하게 짧아 간편하게 정확한 전신 방사선 조사가 가능하게 되었다. 또한 간질성 폐렴 발생 위험 인자를 가진 환자를 대상으로 사용할 경우에는 전신 방사선 조사 후 폐 병변 발생 억제가 가능함을 알 수 있어 대상 환자의 선별 기준에 대한 연구와 임상에서 전후 전신 방사선 조사법의 선별적 사용이 기대된다. Background: Total body irradiation was used for bone marrow transplantation. There were many technique of total body irradiation ( TBI). Although the patients who was irradiated whole body by lateral projection of beam was comfortable, there was a disadvantage of inhomogenous irradiation of whole body including lung. Another disadvantage was the difficulty of lung shielding. In anterior-posterior/posterior-anterior fields (AP TBI), the patients have better homogeneity of radiation dose and easier lung shielding, but difficult positioning and time consuming. We presented AP TBI system for accurate positioning with highly reproducible and a shorter setup time. Methods: Our AP TBI technique was used for the transplant-conditioning regimen of 12 patients diagnosed with leukemia. Patients were treated in a semistanding position with alternating anterior and posterior facing to the beam in a special stand with small seat and handgrips. We used the radiation technique consisted with a 6 MV x-ray horizontal beam. A total dose 1200- 1375 cGy, 6 - 11 fractions of 125 - 200 cGy were given two or three times a day over 3 - 4 days. We used the lung shielding on all fractions for both anterior and posterior projections. A beam spoiler in front of the patients was used for allowing adequate build-up of dose at the patient's surface and prevented the underdose. We calculated the homogeneity of radiation dose by in vivo dosimety. For the analysis of the reproducibility of lung shielding, we measured the horizontal deviations of the infero-external corners of the lung blocks, and the vertical deviation of the apical corners of the lung block in simulation and the port films. Results: There was sharp reduction in the patient setup errors especially an alignment of lung blocks after the use of five point system . The mean vertical deviation of lung block was from 2.5 to 3.0 mm and the mean horizontal deviation of block was from 2.3 mm to 3.0 mm. There was small dose variation in different area, which is considered acceptable clinically. Conclusion: We observed the reproducibility and accuracy of positioning and treatment AP total body irradiation by using five point system. The five point system was a simple immobilization method with a highly accuracy and a short setup time. AP TBI can be clinically applicable as the conditioning regimen for high risk group of interstitial pneumonia.

전신 방사선 조사와 cyclophosphamide 투여 순서가 성인형 급성 골수성 백혈병 치료에 미치는 영향

최일봉,김인아,장지영,강기문,강영남,박수정,서정곤,김희제,민창기,이종욱,민우성,김춘추 대한조혈모세포이식학회 1998 대한조혈모세포이식학회지 Vol.3 No.2

연구배경: 다른 고형암의 항암제-방사선 병용 치료에서와 마찬가지로 백혈병 치료에 있어서도 조혈모세포 이식의 표준적인 전처치 요법으로 전신 방사선 조사와 cyclophosphamide의 병용 치료법이 널리 사용되고 있다. 이러한 화학 요법제와 방사선 병용 치료에 있어서 방사선 조사나 사용되는 약제에 대한 개별적인 치료효과와 부작용은 많은 임상적 연구가 되어 있으나 병용치료시 투여 순서에 따른 치료 효과나 부작용에 대한 임상적 연구는 많지 않다. 이에 본 저자들은 전신 방사선 조사와 cyclophosphamide 병용 치료에 있어서 방사선 조사와 cyclophosphamide 병용 치료에 있어서 방사선 생물학적 근거를 둔, 보다 더 적합한 치료 순서를 임상에서 적용하고저 본 연구를 시작하였다. 방 법: 모든 대상 환자는 cyclophosphamide를 전처치 화학요법의 일부로서 사용하였으며 투여양은 60㎎/㎏/day로 2일간 사용하였다. 전신 방사선 조사는 측면 전신 방사선 조사법을 사용하였으며 방사선 선량률은 10cGy/min으로 고정 조사하였다. Cyclophosphamide를 전신 방사선 조사보다 먼저 투여한 경우에는 모든 환자에서 1회당 165cGy씩 1일 2회 조사하여 총 8회를 분활 조사하였으며 조사된 총 방사선량은 1320cGy였다. Cyclophosphamide를 전신 방사선 조사보다 나중에 투여한 경우 환자 군에서는 한 환자에서만 1회당 200cGy 씩 총 6회를 3일간 하여 총 조사량 1200cGy의 방사선 조사를 하였으며 나머지 환자는 cyclophophamide를 전신 방사선 조사보다 먼저 투여한 경우와 같은 방사선 조사법을 시행하였다. 결과: 1. Cyclophosphamide를 전신 방사선 조사보다 나중에 투여한 경우에는 평균 생존 기간이 13.3개월로서 최소 6개월부터 32개월까지 매우 다양하였다. cyclophosphamide를 전신 방사선 조사보다 나중에 투여한 경우가 약간 생존기간이 낮은 수치를 보였으나 통계학적으로 유의차가 없어 cyclophosphamide와 전신 방사선 주사의 투여 순서에 따라 생존기간은 큰 차이가 없었다. 2. Cyclophosphamide를 전신 방사선 조사보다 먼저 투여한 경우는 6개월 평균 생존율이 84.6%이었고 1년과 2년 평균 생존율은 70.5%로 1년과 2년 평균 생존율이 같았다. cyclophosphamide를 전신 방사선 조사 보다 나중에 투여한 경우에는 6개월, 1년, 2년 평균 생존율이 각각 82.6%, 69.6% 그리고 65.2%로서 cyclophosphamide를 전신 방사선 조사보다 나중에 투여한 경우와 cyclophosphamide를 전신 방사선 조사보다 먼저 투여한 경우 사이에 평균 생존율의 차이는 없었다, 3. 치료 환자 36명중 총 11명이 이식 후 사망하였으며 사망 원인은 재발이 2예이었으며 폐렴과 패혈증으로 사망한 경우가 4예였고 3예에서는 이식 편대 숙주질환이 사망원인이었고 한 예는 이식 편대 숙주 질환과 폐렴으로 사망하였고 나머지 한 예는 간성 혼수로 사망하였다. cyclophosphamide를 전신 방사선 조사 보다 먼저 투여한 경우에서는 13명 중 3명이 사망하였는데 이식 편대 숙주 질환이 사망 원인이 된 것이 2예였고 나머지 한 명은 폐렴과 이식 편대 숙주 질환으로 사망하였다. cyclophosphamide를 전신 방사선 조사보다 먼저 투여한 경우 군에서는 총 23명 중 8명이 사망하였는데 사망 원인으로는 재발이 2예, 폐렴과 폐혈증이 4예, 이식 편대 숙주 질환이 1예, 그리고 1예에서 간성 혼수로 사망하였다. 4. 급성 이식 편대 숙주 질환 발생률은 cyclophosphamide를 전신 방사선 조사보다 전에 투여한 경우가 46%, 전신 방사선 조사보다 후에 투여한 경우가 52%로서 두 군간에 통계학적 유의차는 없었으나 만성 이식편대 숙주 질환 발생률은 cyclophosphamide를 전신 방사선 조사보다 먼저 투여한 경우가 53.9% ,cyclophosphamide를 전신 방사선 조사 후 나중에 투여한 경우가 26.1%로서 cyclophosphamide는 전산 방사선 조사 후에 투여하여야만 만성 이식 편대 숙주 질환 발생률을 낮출 수 있었다. 5. 간질성 폐렴 발생률은 cyclophosphamide를 전신 방사선 조사보다 전에 투여한 경우가 38.5% cyclophosphamide를 전신 방사선 조사 후에 투여한 경우가 30.4%로서 전신 방사선 조사를 cyclophosphamide 투여전에 실시하여야만 간질성 폐렴은 그 발생률이 감소하는 경향을 보였다. 결 론: 전신 방사선 조사와 cyclophosphamide를 병용하여 골수 이식 전처치를 할 경우에는 전신 방사선 조사를 한 후 cyclophosphamide 투여를 하게 되면 간질성 폐렴과 만성 이식 편대 숙주 질환 발생률을 감소시킬 수 있으며 재발 빈도 감소도 기대할 수 있을 것으로 사료된다. Background: Bone marrow transplantation (BMT) has become a well-established procedure in the treatment of leukemia. Interstitial pneumonia and graft versus host disease (GVHD) are the most important toxicity after BMT. The significance of sequence of the conditioning regimen with total body irradiation (TBI) and chemotherapy for developing toxicity is still unknown. Animal studies have reported that both sequence and time interval between total body irradiation and cyclophosphamide are so important to effect the damage of lung and bone marrow. There is no clinical study that investigated the change of treatment related toxicity by the sequence of conditioning regimen. Methods: Between April 1995 and September 1996, 36 AML patients were treated with TBI and cyclophosphamide for BMT in Catholic Bone Marrow Transplantation Center. The age of patients ranged from 19 to 42 years. There were 23 males and 13 females. Conditioning regimen consisted of cyclophosphamide 60mg/kg/day for 2 days and total body irradiation 1200-1320cGy/ 6-8fr/3-4day. 13 patients were received the cyclophosphamide before TBI, 23 patients after TBI. Patient received bone marrow from an HLA identical sibling. Patients were treated with a lineac accelerator with horizontal beam. Results: Of the 36 patients treated, alive and well, 6 to 32 months (mean: 15.3 months) after BMT. 13 patients died of various causes: 2 patients died of relapse and other causes of death were GVHD(3 patients), interstitial pneumonia with or without septicemia(5 patients), hepatic coma(1 patients). We observe difference in the rate of chronic GVHD and interstitial pneumonia between pre-TBI group and post-TBI group. Interstitial pneumonia when given before or after TBI was observed in 38.5% and 30.4% respectively. The chronic GVHD was occurred in pre-TBI group or post TBI group, 53.9% and 26.1% respectively. Our present analysis demonstrates that there is no difference in the survival rate and acute GVHD. Conclusions: The clinical study in search of an optimal sequence of conditioning regimen show that there is no compelling reasons to give cyclophosphamide before TBI. The cyclophosphamide given before TBI causes more complication after BMT without survival gain.

Ultrasonographic Study on Kinetics of the Normal Gallbladder after Ingestion of Regular Diet, Rice Gruel, and Orange Juice

Choi, Ihl Bohng,Park, Seog Hee,Byun, Jae Young,Shinn, Kyung Sub,Bahk, Yong Whee CATHOLIC MEDICAL CENTER 1987 Bulletin of the Clinical Research Institute Vol.15 No.1

Ultrasonography is now widely used in examining the gallbladder (GB) because of its accuracy, noninvasiveness, and easy accessibility. Ultrasonography requires a period of fasting which is not always agreeable for a weakened patient. The authors, being interested in the indiscriminate use of this fasting period, attempted to establish judicial criteria of fasting by studying the contraction and relaxation of the GB after the ingestion of three different kinds of food. Twenty healthy men aged twenties, with normal liver function tests and without gastrointestinal disorder, were selected for the study. After overnight fasting, an ultrasonographic examination of the GB was performed and the maximal surface area measured. After ingestion of a meal, the test was performed at 30-minute intervals for 3½ hours to 4½ hours and the maximal surface area was measured to calculate a contraction rate of the GB as expressed in terms of percentage cross-sectional area before and after the meal. Meals were of three different kinds: regular diet, rice gruel, and orange juice. The examination was repeated three times at 1-week intervals following the ingestion of different meal each time. We compared contraction and relaxation of the GB after ingestion of each meal by surface area measurement and reached the following conclusions: 1. All three meals provoked contraction of GB, although intensity was different by the composition of the meals. Thus, a regular diet provoked a marked contraction of the GB, while rice gruel and orange juice a mild contraction. 2. The degree of contraction of the GB was not uniform in terms of time and varied makedly from subject to subject. The maximal contraction occurred at 90 minutes after regular diet and at 120 minutes after rice gruel, and at 30 minutes after orange juice. 3. After ingestion of the rice gruel and orange juice, the contraction rate did not exceed 50%. This study showed that rice gruel and orange juice do not cause significant contraction of the GB. Therefore, it is concluded that there is no need of strict fasting prior to a US examination of the GB as far as rice gruel and orange juice ingested.

자궁목 융모샘 샘암종의 세포 소견 -2예 보고-

김봉희,Kim, Bohng-Hee 대한세포병리학회 2006 대한세포병리학회지 Vol.17 No.2

Villoglandular adenocarcinoma of uterine cervix has recently been described, and is characterized by good prognosis and occurrence in young women, except a small number of cases. Morphologically, it exclusively shows villoglandular growth and mild to moderate nuclear atypia, the cytologic diagnoses have been frequently missed due to interpretation error. We report here on the cytologic findings of two cases, and both cases were not diagnosed as adenocarcinoma before punch biopsy. One of these cases showed previously described characteristic features such as high cellularity and large tissue fragments with long villous fronds lined by columnar cell with mild nuclear atypia. The other showed moderate cellularity of somewhat smaller clusters without long villous structures. The clusters showed marked nuclear overlapping and the nuclei showed distinct moderate atypia with hyperchromasia and coarse chromatin pattern. The nucleoli were indistinct. Recognition of these features will be helpful to avoid underdiagnosis as a benign lesion, although diagnosis is still difficult in a portion of the cases.

골 병변에서 세침흡인 세포검사의 유용성

김봉희,공경엽,Kim, Bohng-Hee,Gong, Gyung-Yub 대한세포병리학회 2002 대한세포병리학회지 Vol.13 No.2

To determine the usefulness on fine needle aspiration cytology(FNAC) of bone lesions and the complementary role of FNAC and percutaneous needle biopsy, 75 cases of FNAC taken from bone lesions were analyzed. Correlations with histopathology were possible in 47 cases, including 14 cases of simultaneous core biopsy and 33 cases of subsequent open biopsy due to inadequate aspirates. Among 75 cases, 4 cases were benign tumors and tumor-like lesion, 11 cases were malignant primary bone tumors, 17 cases were metastatic tumors, and 43 cases were nonneoplastic bone lesions. The aspirates were adequate in 35 cases(46.7%), in all of which the discrimination between benignancy and malignancy was possible. The main reason for Inadequate aspirates was due to hypocellularity. In the cases of aspiration and core biopsy simultaneously done, the diagnostic accuracy of aspiration, core biopsy, and both were 57%(8/14), 78.6%(11/14), and 92.9%(13/14), respectively. We conclude that a final diagnosis based on cytology is possible with the adequate aspirates and the clinical and radiological findings. Also we confirm the complementary role between FNAC and core biopsy in bone lesions.

초음파를 이용한 일반식, 저지방죽 및 오렌지 주스 섭취후의 담낭운동

변재영,최일봉,박석희,신경섭,박용휘 대한초음파의학회 1987 ULTRASONOGRAPHY Vol.6 No.2

원발성 간암의 방사선치료 및 온열요법의 병용치료 효과

강기문(Ki Mun Kang),최일봉(Ihl Bohng Choi),계철승(Chul Seung Kay),최병옥(Byung Ok Choi),정수미(Su Mi Chung),김인아(In Ah Kim),한성태(Sung Tae Han),선희식(Hee Sik Sun),정규원(Kyu Won Chung),신경섭(Kyeong Sub Shinn) 대한방사선종양학회 1994 Radiation Oncology Journal Vol.12 No.2

Purpose : This study was undertaken to show the clinical resuts of combined radiotherapy and hyperthermia in primary hepatoma Materials and Methods : Between December 1989 and March 1993, 50 patients with hepatomas were treated by combined radiotherapy and hyperthermia. Among them, we analyzed retrospectively 33 patients who received the complete course of treatment. The ages of the patients ranged from 36 to 75(mean age : 55.5 years). Twenty six patients (78.8%) were men and 7 (21.2%) were women. According to Child's classification. nine patients (27.3%) were A group 9 (27.3%) were B group 15(45.4%) were C group. Radiation therapy was done by a 6 MV and 15 MV linear accelerator. Patients were treated with daily fractions of 150-180 cGy to doses of 2550 cGy-4950 cGy (median : 3000 cGy). Local hyperthermia was done by 8 MHZ RF capacitive heating device (Cancermia, Green Cross Co., Korea), 50-60 min/session, 1-2 sessions/wk, and 8.5 sessions (median number)/patient. We analyzed the prognostic factors including age, sex, tumor type, Child's classification, α-fetoprotein, liver cir-rhosis, ascites, portal vein invasion, esophageal varix, number of hyperthermia, chemotherapy, total bilirubin level, Karnofsky performance status. Results : The overall 1-year survival was 24.2% with a mean survival of 10 months. Of 33 patients, tumor regression (PR+MR) was seen in 30.4% no response was seen in 52.2%, 17.4% patient was progressed. In patients who had tumor regression, the overall 1 year survival was 42.1% with a mean survival of 14 months. Factors influencing the survival were sex (p=0.05), tumor type (p=0.0248). Child's classification (p=0.0001), liver cirrhosis (p=0.0108), ascites (p=0.0009), and Karnofsky performance status (p=0.0028). Complications developed in 28 patients, including 18 hot pain 5 fat necrosis, 3 transient fever, 2 nausea and vomiting. Conclusion : In this study the results suggests that combined radiotherapy and hyperthermia may improve the survival rate of hepatoma.

Response of Murine Skin to Local Hyperthermia

Kim, Choon Yul,Choi, Ihl Bohng,Park, Seog Hee,Bahk, Yong Whee CATHOLIC MEDICAL CENTER 1987 Bulletin of the Clinical Research Institute Vol.15 No.1

The time course of change in the skin response of balb/c mice in vivo was investigated following heating at 42℃ and 44℃. Mouse feet were exposed to single hyperthermic treatment at 42℃ or 44℃ for up to 60 min. When mouse feet were exposed to 42℃ hyperthermia, the response score was slight increased with duration of treatment (F = 4.80). Skin damage form 42℃ hyperthermic exposure was minimal. For 44℃ hyperthermia, the response score was proportionally increased with the duration of the exposure time (F = 61.32). After 15 min exposure at 44℃, the score became larger as compared with that for 42℃ (p < 0.05), but when mouse feet were exposed at 42℃ for 15 min, the response score was similar with 44℃ heating. For the application of hyperthermia to cancer therapy, normal tissue damage by hyperthermia must be considered and the temperatures of the tissue should be accurately measured for prevention of thermal injury of normal tissue.

재발된 혹은 불응성 비호지킨 림프종에서 고용량 항암요법과 표준 구출요법의 비교

홍영선,민창기,김정아,김희제,엄현석,조석구,이종욱,진종률,한치화,최일봉,박재후,민우성,김춘추,김동집 대한조혈모세포이식학회 1997 대한조혈모세포이식학회지 Vol.2 No.1

Background: Patients with intermediate- or high-grade non-Hodgkin's lymphoma (NHL) who have a relapse or refractoriness after initial standard chemotherapy generally have a poor prognosis. Conventional salvage treatment can induce lengthy remission. It is, however, not generally agreed that long-term survival has been expected in patients receiving salvage chemotherapy. The combination of high dose therapy and autologous stem cell transplantation has been considered promising in refractory or relapsed patients with NHL. Methods: The response rate and survival (disease-free and overall survival) of 15 patients with relapsed or refractory NHL who only received salvage chemotherapy was compared with those of 14 patients who has been assigned to receive high dose therapy and autologous stem cell transplantation. Results: the overall rate of response to salvage chemotherapy was 13% but that of high dose therapy with stem cell support was 58%. Disease free survival (DFS) in the salvage chemotherapy group was very low; only 2 patients survived in remission without a relapse of disease in long duration. On the contrary the rate of DFS in the transplantation group was 48% at 3 years. At 3 years, the rate of overall survival (OS) was 17% in the group receiving salvage chemotherapy and 31% in the transplantation group. Conclusion: As compared with salvage chemotherapy, treatment with high dose therapy and autologous stem cell transplantation increases disease-free and overall survival in relapsed or refractory patients with non-Hodgkin's lymphoma.