통일 후 북한 보건의료 지원방안

옥철호 고신대학교 의과대학 2010 고신대학교 의과대학 학술지 Vol.25 No.1

Backgroud: North Korea's healthcare system have been collapsed since the late 1990's because of a long series of economic woes, natural disasters, and its continuing stance of isolationism. Moreover, recently issued Nuclear crisis from North Korea and health problem of North Korean leader, Kim Jung Il are suggesting imminent collapse of North Korea. and the reunification of North and South Korea. Method: Unification expenditure is, however, the sum of all the expenses that will be required until both territories form a united nation and accomplish economic stabilization. These expenses include crisis administration, structural adjustment, and economic investment. Therefore, in view of reconstruction of medical heath care system of North Korea after Reunification, inter-cooperation of non-governmental organizations, including the UN, Religious organization, Korean government, and medical mission organization have been strongly recommended. Result: Thus, this study investigate the intergovernmental relations between the two Koreas in Cooperation in Health Care and Medicine and international and non-governmental organizations, including the UN, WHO, and Social welfare organization of Korea. Conclusion: In conclusion, this study propose korean medical mission organization's roles in supporting the collapsed medical system in North Korea after Reunification. and other principles and a plan of action which prescribes the objectives the South Korean authorities should pursue, which involve taking the initiative in support projects, building mid-to-long term strategies and setting common goals in cooperation with non-governmental organizations, and allocating authorities and resources to non-governmental organizations and coordinate, direct and support them toward the goals.

상어 간유 흡인에 의한 급성 지방성 폐렴 1예 : 증례보고

임성경,옥철호,김희규,장태원,정만홍 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4

저자들은 상어 간유를 과량 복용하고 기침, 호흡곤란을 주소로 내원한 48세 여자 환자에서 방사선 소견과 기관지 폐포 세척액 검사를 통해 급성 지방성 폐렴으로 진단하고 스테로이드에 불응하는 경과를 취하자 우측 전폐 기관지 폐포 세척술을 시행하여 폐 병변과 증상의 호전을 보인 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Acute lipoid pneumonia is uncommon condition of the lungs that results from the aspiration of vegetable, animal, or mineral oils. Shark liver oil (so called Squalene) is taken as a traditional remedy in some Asian countries, and is used widely also in cosmetics. It results in foreign body type inflammatory reaction of the lung and can show various clinical presentations from asymptomatic incidental finding to severe pneumonia leading to acute respiratory failure. Although many cases have been reported, severe lipoid pneumonia requiring steroid or whole lung lavage for treatment is rare. We experienced a case of acute lipoid pneumonia of 48 year old female with dyspnea and cough caused by regular ingestion of large amount Shark liver oil, treated by whole lung lavage. We reported this case with a brief review of related literatures.

기관지 탄분 섬유화증 환자의 임상 경과와 고감도 C-반응 단백(high sensitivity C-reactive protein, hsCRP)과의 상관 관계 비교

이규원,옥철호,장태원,정만홍 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4

Background: To investigate the association between bronchial anthracofibrosis(AF) and tuberculosis(TB). and the clinical utility of high sensitivity C-reactive protein(hsCRP) for diagnosis of active pulmonary TB in patients with bronchial AF. Method: Eighty three patients(62 women and 21 men ranging in age from 55 to 87), who were diagnosed with bronchial AF by a bronchoscopy, were enrolled in this study. The hsCRP was measured in patient's blood. The hsCRP results were compared with the bacteriological, and clinical finding. Results: The common respiratory symptoms were cough(70%), sputum(35%), dyspnea(20%), and hemoptysis(10%). The sputum AFB smear, culture were positive in 20(22.8%) and 37(44.5%) patients, respectively. The level of hsCRP in patients with postive culture was significantly higher than that of patients with negative culture.(4.67±7.5, 0.90±1.59, p=0.005). Of 63 patients with negative smear, the level of hsCRP in patients(n=18) with positive culture was higher than that of patients(n=45) with negative culture.(3.39±5.78, 0.92±1.50, p=0.013). Of 20 patients with negative smear and positive culture who were empirically treated with anti-TB medication, 11 patients showed radiologic response. and their level of hsCRP was higher than that of 9 patients who showed no radiologic response.(1.56±1.89, 0.81±0.10,p=0.03) Conclusion: hsCRP appears to be useful diagnostic tool for predicting active pulmonary tuberculosis. in patients with bronchial AF.

경부임파선 전이가 동반된 폐암환자에서 초음파 유도 하 알코올 주입술의 효과

박진희,옥철호,장태원,전만홍 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4

Background: Percutaneous ethanol injection therapy(PEIT) has been infrequently tried to treat hepatic tumors, thyroid tumors, renal tumors. We adopted this technique for treating locally recurrent lung cancer. The object of this study is to evaluate the local therapeutic efficacy, side effects of ethanol injection for treating locally neck node metastasis of lung cancer. Materials and Methods: Between May 2006 and october 2006, 20 lung cancer patients(17 males and 3 females) with 35 histologically proven symptomatic neck node metastatic lesions underwent sonography guided PEIT(US-PEIT) under local anesthesia . We analyzed relation between PEIT and size, the amount of pain. The amount of pain that patients feel was evaluated by VAS(Visual Analogue Scale). Result: A significant decrease of tumor size was observed in 19 lesions. The mean pre-injection diameter of the lesions was 24.2 mm, and this was decreased to 16.8 mm(p=0.001). The VAS score before injecting ethanol into the lesions was 5±3, this was decreased to 2.5±1.5(p=0.001). Conclusion: US-PEI is a valuable treatment option for patients with symptomatic cervical nodal metastases from advanced lung cancer who are not amenable to further therapy.

Fogarty Catheter를 이용한 소아 기도 이물의 제거 1례 : 증례 보고

김예나,옥철호,장태원,정만홍 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4

Foreign body aspiration is a common problem in children necessitating prompt recognition and early treatment to minimize the potentially serious and sometimes even fatal conseqeunce. We report the case of a 7-year-old boy with a button lodged in his right main bronchus. Under general anesthesia, ultrathin bronchoscopy identified the foreign body which was then removed by the combined use of a Fogarty catheter and extraction forcep. This case differs from previous reports, in that the forcep extraction through working channel of ultrathin scope was used simultaneously with Fogarty catheter even in relately small airway of children.

폐주변부 병변 진단 시 기관지솔질에 의한 출혈이 병소확인에 주는 유용성 연구

김예나,정수현,김혜수,옥철호,장태원,정만홍,천봉권 고신대학교 의과대학 2009 고신대학교 의과대학 학술지 Vol.24 No.2

Background : Diagnosis of peripheral pulmonary lesion by conventional bronchoscopy is still challenging. The sheathed bronchial brush has been used to collect samples from the visible endobronchial lesion. Recently developed endobronchial ultrsonography (EBUS). can obtain image of peripheral pulmonary lesion at bronchus suspected by bleeding sign of sheathed brush. This study evaluated availibility of detected lesions by bleeding after bronchial brushing in pheripehal pulmonary lesions before transbronchial lung biopsy Methods : Between August 2006 and November 2008, 50 patients(38 men and 12 women, median age, 65 yrs) whose peripheral pulmonary lesions could not be detected with flexible bronchoscopy were included in this study. Among 50 patients, 40 cases were malignant lesion(non-small cell carcinoma 35, small cell carcinoma 5), and 10 cases were benign lesions(inflammatory disease 7, others 3) Results : Of the 50 patients, lesions detected bleeding after bronchial brushing was 34 cases(68%) and lesions detected by EBUS was 33 cases(66%). Sensitivity was 90.0-95.4%, Specificity was 83.3-80%, Positive predictive value(PPV) was 83.3-95.4% and Negative predictive value(NPV) was 80-90.9%. Diagnostic rates in visualized lesion by EBUS and otal peripheral lesions were 75%(25/33), 58%(29/50) respectively. There was no significant complication related with bronchial brushing. Conclusions : Bleeding sign by bronchial brushing was safe and effective method to predict location of peripheral pulmonary lesion with sufficient diagnostic yield

반복치료로 호전된 호산구성 폐렴 유사 폐흡충증 1예

박세진,김희규,김봉준,이천우,옥철호,정만홍 고신대학교 의과대학 2010 고신대학교 의과대학 학술지 Vol.25 No.2

우리나라에서 인기 있는 게장등의 섭취로2) 성인뿐만 아니라 소아에서도 지속적으로 보고되고 있는 폐흡충증은 다양한 임상양상을 보일 수 있다. 저자들은 방사선 소견상 만성 호산구성 폐렴과 유사하였고, 반복적인 치료로 호전된 폐흡충증 1예를 경험하였기에 보고하는 바이다. Paragonimiasis mostly occurs by ingestion of raw or undercooked freshwater crabs or crayfish. Recently, re-emergence of paragonimiasis is reported because of ingestion of raw food such as freshwater fish and Gejang (marinated raw crabs). As the radiological features as well as the laboratory findings are similar to those of chronic eosinophilic pneumonia, the diagnosis of pulmonary paragonimiasis is often difficult and delayed. A 43 year-old female was visited our hospital for migrating and new developing consolidative lung lesions and peripheral blood eosinophilia. The eosinophil profile of leukocyte was 32% (absolute count 2,690 /mm3). Histologic finding was organizing pneumonia pattern with severe infiltration of eosinophils. Parasite specific antibody IgG forParagonimus westermani was positive (titer:0.61, normal range<0.20). After treatment with praziquantel (75mg/Kg once a day for 2days), the chest x-ray was clearly resolved. Follow-up study showed right pleural effusion, newly developed focal infiltration, and several nodules. After retreatment, we couldn't find any recurrent evidence.

진행성 폐 종양 환자에서 종양 내 OK-432 주입술의 효과

정수현,김성빈,박진희,탁희상,옥철호,장태원,정만홍,천봉권 고신대학교 의과대학 2009 고신대학교 의과대학 학술지 Vol.24 No.2

Background: Intratumoral injection of OK-432 produced significant antitumor effects. There are reports that OK-432 was injected directly into tumor tissue on gastrointestinal tracts and HCC tissue, producing decrease in serum alpha-fetoprotein level. We adopted this technique for treating locally advanced lung cancer. The object of this study is to evaluate the local therapeutic efficacy, side effects of injection for treating symptomatic mass. Methods: Twenty lung cancer patients (13 males and 7 females) underwent sonography guided OK-432 injection. We analyzed relationships between response of OK-432 and response of skin test, histology and age. Pain that patients feel was evaluated by VAS (Visual Analog scale). Results: A significant decrease of tumor size was observed. The mean pre-injection diameter of the lesions was 54.7±11.3mm, PR rate were 15.0% (3/20) and minimal change (50%<tumor size decreased.) patients were 35.0% (7/20). The VAS score before injecting OK-432 into the lesion was 5±3, this was decreased to 2.5±1.5 (p=0.04). Object response was significantly correlated with skin response, adenocarcinoma, and age. Conclusion: A significant decrease of tumor size and pain was observed. So OK-432 is a valuable treatment option for patients with symptomatic lesion from advanced lung cancer who are not amenable to further therapy.

Expression of MAGE in Pleural Fluid for the Differential Diagnosis of Benign and Malignant Pleural Effusion

Chul-Ho Oak,Tae-Won Jang,Seong-Hoon Shin,Mann-Hong Jung 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.3

목 적 : 흉막액을 이용하여 MAGE gene family 중에서 MAGE A1 - A6 유전자를 동시에 검출할 수 있도록 고안된 common primer로 RT-PCR을 시행하여 이러한 검사가 악성 흉막액의 감별에 어느 정도 도움이 될 수 있는지 조사하였다. 대 상 : 2002년 1월부터 2002년 10월까지 고신대학교 복음병원에 흉수를 동반한 질환으로 내원한 환자 중 흉수 세포진 검사나 흉막 조직 검사상 악성 흉막액으로 진단 된 환자 36명과 양성 흉막액 환자 20명을 대상으로 하였다. 방 법 : 환자의 흉막액 30mL를 원심 분리하여 상층을 제거한 후 trizol을 이용하여 total RNA를 분리하였다. RNA 분리 후 역전사(reverse transcription)로 cDNA를 합성하여 그 산물로 PCR을 실시하였다. MAGE 1-6 유전자에 대한 RT-PCR & nested PCR-GAPDH로 mRNA가 성공적으로 분리된 것을 확인하였고 MAGE 1-6 common primer (C1,C2/C3,C4)를 사용하여 MAGE 유전자 발현 여부를 확인하였다. 결 과 : 양성 질환에 동반된 흉막액 20예에서는 MAGE가 전례 발현되지 않았고 악성 질환 36예 중 23예 (63.8%)에 서 MAGE 가 발현 되었다. (p<0.0001). 폐암의 조직형에 따른 MAGE 발현의 차이는 없었다. (p<0.9). 악성 질환을 동반한 환자의 흉막액 세포진 검사, CEA 그리고 MAGE검사의 민감도는 각각 55%, 20%, 63% 였다. 세포진 검사에서 음성이었던 16예 중 MAGE가 11예에서 양성이고 CEA는 7예에서 양성이었다. 흉막액 세포진 검사에 MAGE와 CEA를 추가 조사한 경우는 악성 흉막액의 진단율을 92%로 올렸다. 결 론 : 악성 흉막액의 감별진단에 MAGE의 발현을 조사 하는 것이 세포진 검사보다 더 유용하였으며 악성 흉수의 진단에 세포진 검사, 종양 표식자 검사와 함께 MAGE 검사가 보완적인 도구가 될 수 있을 것이다. 향 후 더 많은 환자를 대상으로 한 추가 검사가 필요할 것으로 생각된다. Background : Many tumor specific antigens have been studied for tumor diagnosis and immunotherapy. Among tumor specific antigens , Melanoma antigen gene(MAGE) is exclusively expressed in the testis or malignant cells. We investigated MAGE expression in pleural fluid to differentiate malignant from benign pleural effusion. And the results were compared with those of cytologic examination and tumor maker(CEA) Method : we studied 56 patients with pleural effusions to the Kosin University Gospel Hospital between April 2002 and April 2004( 31 men and 25 women: mean age, 56 years). Expression of MAGE was examined by RT-PCR method using a commercial kit. Tumor maker (carcinoembryonic antigen[CEA]) in pleural fluid was determined by immunoassay. Thirty six patients were proven to have malignant pleural effusion by cytology and pleural biopsy, while 20 patients had benign pleural effusion. Results : MAGE was not expressed in 20 patients with benign pleural effusion, while it was expressed in 23 patients (63.8%) of 36 patients with malignant effusion. The sensitivity of cytologic examinations were 50%. At 100% specificity, a pleural CEA > 50ng/mL had 20% overall sensitivity. The combination of cytology and MAGE reached 84% sensitivity, whereas the combined use of the cytology and tumor marker and MAGE increased sensitivity up to 92%. More than one third of cytology-negative malignant pleural effusion had expression of MAGE. Conclusion : Expression of MAGE in pleural fluid would be a useful and complementary method for differential diagnosis between benign and malignant pleural effusion.

Angiogenic Squamous Dysplasia as a Biomarker to Predict Progression to Lung Cancer

( Chul Ho Oak ),( Tae Won Jang ),( Maan Hong Jung ),( Bong Kwon Chun ),( Soon Kew Park ) 한국조직공학·재생의학회 2009 조직공학과 재생의학 Vol.6 No.4

Angiogenic squamous dysplasia(ASD) is a term that has been introduced to describe a neoangiogenesis seen in bronchial dysplasias. One of many important angiogenic cytokines are the VEGFs. The VEGFs and their receptors are prime regulators of both physiological and pathological angiogenesis. But it is not clear whether ASD demonstrates the angiogenic switch or not, what is the mechanism of ASD. In this study, Immunohistochemical studies showed an expression of vascular endothelial growth factor in dysplastic bronchial epithelium. VEGF in the dysplastic cells in preneoplastic epithelium was observed in twenty-nine of 31 patients with ASD(93.5%), indicating that angiogenic switch occurred in early preneoplastic lesion including hyperplasia, metaplasia. ASD lesions were not identified in patients with COPD, whereas in 31 of 90 (34.4%) patients with squamous carcinoma, ASD was evident. In addition, the incidence of ASD increased as the hisological grade of preneoplastic lesion advanced, suggesting that the ASD may be a direct precursor lesion(P = 0.03). The author followed up the biologic behavior of dysplasia with respect to the status of ASD. There were significant associations between histological outcome and ASD status during the follow-up period(P = 0.04). These results suggested that ASD be used as biomarkers to predict which dysplasias will progress to squamous cell carcinoma. Macrophages were identified in all(100%) tumor stroma and ASDs. The number of macrophage beneath ASD was significantly higher than that beneath other abnormal epithelium. In addition, the number of macrophages beneath ASD was significantly correlated with the count of microvessels beneath ASD. The results of the present study suggested that Angiogenic squamous dyplasia(ASD) may represent an precursor of lung cancer and may serve as an useful intermediate pathologic biomarker for early detection of lung cancer and chemoprevention. Macrophage beneath ASD may play an important role in early angiogenesis of ASD.