급성 임파성 백혈병의 말초혈액 검사소견

김성집,안경남,조무자,김춘식,심상인,김선무 대한임상병리사협회 2001 대한임상병리사회지 Vol.21 No.1

간세포암에서 중앙 2구역 절제술의 유용성

김태윤,김성용,백무준,이문수,조무식,김창호 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.1

Liver resection for hepatocellular carcinoma(HCC) is now popular. For treatment of centrally located hepatocellular carcinoma, central bisegmentectomy is recommended as a radical surgical procedure and may have an important advantage. Five patients with HCC underwent central bisegmentectomy with an operating time of 380-420 minutes. One patient who had undergone preoperative live artery embolization died by car accident. Four patients survived without relapse 13-35 months postoperatively. Central bisegmentectomy is a safe and effective operative procedure for the treatment of centrally located HCC.

수술 전 고빌리루빈혈증 환자에서 췌십이지장 절제술의 안정성

김태윤,김성용,백무준,이문수,조무식,김창호 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.1

Backgrounds: Pancreaticoduodenectomy is accompanied by a considerable risk of postoperative complication and potential death. Pancreaticoduodenectomy in patient with obstructive jaundice carry on increased risk of postoperative complication. Preoperative biliary drainage has been developed to reduce this morbidity and mortality but the benefit of preoperative biliary drainage is still questioned for several reasons. This study evaluated postoperative outcomes following pancreaticoduodenectomy in relation to patients with hyperbilirubinemia. Methods: Ninety two patients who underwent pancreaticoduodenectomy between 1992 and 2001 were divided into two groups. Group A included 11 cases in patient with preoperative hyperbilirubinemia (serum bilirubin > 10 mg/dl), and the other 81 cases (serum bilirubin < 10 mg/dl) were Group B. In group A, 6 patients underwent preoperative biliary drainage. In group B, 31 patients underwent preoperative biliary drainage. Postoperative morbidity and mortality were anlaysed comparing with two groups by chi-squared test retrospectively. Results: In group A, whose average value of serum bilirubin was 15.2 mg/dl (range 10.2-20.3 mg/dl), wound complications were seen in 9.0%, hemorrhage in 18.1%, delayed gastric empting in 18.1%, anastomosis leakage in 18.1%, abscess in absent, and mortality in 9%. In group B, whose average value of serum bilirubin was 2.3 mg/dl (range 0.8-7.3 mg/dl), wound complications were seen in 14.8%, hemorrhage in 8.6%, delayed gastric empting in 9.8%, anastomosis leakage in 22.1%, abscess in 4.9%, and mortality in 4.9%. There was no significant difference in morbidity and mortality between two groups. Conclusion: Preoperative hyperbilirubinemia did not influence the incidence of postoperative outcomes following pancreaticoduodenectomy. It can be performed safely in patient with hyperbilirubinemia.

췌십이지장절제술 후 발생한 담즙누출의 치료

김태윤,김성용,백무준,이문수,조무식,김창호 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.1

Operative morbidity and mortality of pancreaticoduodenectomy has been decreasing but remains high. Unintended postoperative cutaneous biliary fistula involving the major bile ducts is an uncommon complication of pancreaticoduodenectomy. Prolonged biliary drainage may lead to severe metabolic disturbances, renal failure and cardiovascular collapse, and usually requires operative reintervention. Among 90 patients who underwent pancreaticoduodenectomy from Feb. 1992 to Dec, 2000, 70 patients whose hospital records could be reviewed were included in this study. Cutaneous biliary fistula were observed in 19 cases(27.1%). In the 14 cases, a biliary drain was inserted around the injured duct via the biliocutaneous fistula. In these cases, biliary drainage alone resulted in resolution of the bile leak, because the injury was partial without a stricture. In the 5 cases, biliary stents were placed percutaneously across the injured portion of the bile duct. Pancreaticoduodenectomy is still associated with high mortality and morbidity even though there has been significant progress in the field of pancreatic surgery and postoperative follow-up. In the absence of organic stenosis, percutaneous drainage approach may be useful in patients with postoperative biliocutaneous fistula.

한국인 알코올 의존 환자에서 알코올 대사 효소 유전자형 빈도의 남녀 차이

김성곤,김철민,이덕기,황인복,이현숙,김성연,전은숙,송영상,박제민,최병무,김명정 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.2

Objectives : There are a number of preceding epidemiological studies reporting gender differences in the genetic etiology of alcohol dependence. The author investigated gender difference in the frequencies of ADH2 and ALDH2 genoypes between the patients with alcohol dependence and normal control. Methods : The subjects were 141 alcohol dependent patients (104 males, 37 females) and 138 normal control (79 males, 59 females). The frequencies of 1/1 and 1/2+2/2 (2+ afterward) genotypes for ADH2 and ALDH2 were investigated in male and female between alcohol dependence and normal control group. DNA was extracted from WBC in peripheral venous blood and PCR-RFLP method was used out for genotyping. Results : First, the frequency of ADH2 1/1 genotype was significantly higher in alcohol dependent patients than normal control in both genders. Second, while there was no gender difference in the frequency of ADH2 1/1 genotype in normal controls, in the patient group however, the frequency was significantly higher in females than males. Third, in male subjects with alcohol dependence, the frequency of ALDH2 1/1 genotype was significantly higher than in male normal control subjects. On the other hand, in female subjects with alcohol dependence, the frequency of ALDH2 2+ genotype was significantly higher than in female normal control subjects. Conclusion : These results suggest that while the risk of alcohol dependence is predominantly affected by ALDH2 1/1 geno-type in male, the female ADH2 1/1 genotype is mainly associated with the risk of alcohol dependence. This means that there are gender differences in the genetic etiology of alcohol dependence.

위 MALT 림프종에서 다발성 림프절 전이로 오인된 동시성 림프절 결핵 1예

김성은,김규종,김도현,송준영,문대성,장리라,유찬희,문원,박무인,박선자,김영옥 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.2

28세 남자가 내시경적 점막절제술을 통해 저등급 위MALT 림프종으로 진단되었다. 병기설정을 위해 18F-FDG PET 검사를 시행하였고 우측 쇄골상부, 우측상/하부 기관주위, AP window 부위에 강한 섭취가 관찰되어 전이성 림프절로 판단하였다. 그러나, 우측 쇄골상부 림프절에서 시행한 절제생검에서 만성육아종성염증소견이 관찰되었고 조직의 결핵 중합효소연쇄반응에서도 양성 반응을 보였다. 2개월간 항결핵제의 사용 후 시행한 추적 컴퓨터단층촬영 검사에서 림프절 크기의 감소를 보여 최종적으로 위 MALT 림프종에서 광범위 림프절 전이로 오인된 동시성 림프절 결핵으로 진단되었다. A 28-year-old man was diagnosed as gastric MALT lymphoma in diagnostic EMR (endoscopic mucosal resection). He subsequently underwent an 18F-FDG PET. 18F-FDG PET showed intense multifocal uptake in right supraclavicular, right upper and lower paratracheal, and AP window areas that was considered radiologically to represent widespread metastatic lymphadenopathy. Excisional biopsy of a supraclavicular lymph node, however, revealed chronic granulomatous lymphadenitis with a positive reaction of Tb-nested PCR. After antituberculosis treatment for 2 months, a follow-up CT scan showed complete resolution of the lesions. Intense 18F-FDG uptake could be due to an infectious process such as synchronous tuberculous lymphadenitis. Therefore, this could mimic a malignant condition such as lymphoma with extensive lymph node metastasis due to a false-positive finding, which may lead to a misdiagnosis.

섬유층판 간세포암 1례

김태윤,김성용,백무준,이문수,조무식,김창호 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Fibrolamellar hepatocellular carcinoma is a distinct variant of ordinary hepatocellular carcinoma and is very rare in the Orient. Contrary to ordinary hepatocellular carcinoma, Fibrolamellar hepatocellular carcinoma has very good prognosis and usually occurs in adolescents and young adults without sexual preference. We report a case of fibrolamellar hepatocellular carcinoma, which occurred in a 79-year-old woman with normal liver function. Preoperative ultrasonography, computed tomography and magnetic resonance imaging depicted a large tumor in the right anterior and left madial segment, which was compatible with the typical radiological features of fibrolamellar hepatocellular carcinoma. she underwent central bisegmentectomy. Macroscopic findings of the resected liver demonstrated a well-defined whitish-yellow tumor with a central scar. Microscopic findings of the tumor showed cords of tumor cells, which were surrounded by abundant collagenous fibrous tissue arranged in a lamellar distribution. Two years later, she is asymptomatic and evidences no recurrence of the disease. The clinical, pathological, radiological features, treatment options and prognoses of fibrolamellar carcinoma were discussed.

Mirizzi 증후군의 변형된 분류와 치료

김형철,강길호,채만규,김성용,백무준,이문수,박상흠,이문호,김창호,송옥평,조무식,박희주 순천향의학연구소;Soonchunhyang Medical Research Institute 2000 Journal of Soonchunhyang Medical Science Vol.6 No.1

Purpose : The Mirizzi syndrome is relatively rare and preoperative diagnosis of this disease is difficult. In 1978, Morelli suggested the subclassification of the Mirizzi syndrome into acute or chronic form. We experienced 5 cases of acute form. We analysed clinical features, preoperative radiologic findings and operative findings of 18 cases including acute forms which were diagnosed as Mirizzi syndrome and should suggest the modified classification of Mirizzi syndrome for choice of appropriate treatment. Method : From January 1995 to December 1998, 18 cases, of which 8 cases were diagnosed at Soonchunhyang University Chunan Hospital, and 10 cases were reported in the Korean Journal were retrospectively analysed with regard to clinical features, preoperative radiologic findings and operative findings. According to the clinical features, whole cases were divided into type Ⅰ(acute form) and type Ⅱ(chronic form) and then each type of cases were subclassified according to preoperative radiologic findings and operative findings. Results : Of 18 cases there were 5 cases in type Ⅰ(27.8%), 13 cases in type Ⅱ(72.2%). Type Ⅱb was most common. Type Ⅰa cases were treated only with cholecystectomy. We applied cholecystectomy, T-tube choledochostomy and patch technique in type Ⅰb and thpe Ⅰc cases. Cholectystectomies including removal of gallstones and internal drainage procedures were done in type Ⅱ chronic forms. Conclusion : The acute form(Type Ⅰ) of Mirizzi syndrome was suggested by Morelli might be subclassified into typeⅠa,Ⅰb and Ⅰc following the presence of the necrotic defect in common hepatic duct. Through the modified classification of Mirizzi syndrome based on clinical feature, preoperative radiologic findings and operative findings, we can choice appropriate treatment.

간절제술 후 발생한 기관지 담도 누공 2예

김태윤,김성용,백무준,이문수,조무식,김창호 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

A bronchobiliary fistula (BBF), which is defined by an abnormal communication between the biliary system and the bronchial tree, is an uncommon complication after hepatic resection, trauma, hydatid disease, choledocholithiasis and other causes of biliary obstruction. Bronchobiliary fistulae are rare complications of hepatic resection that can present from days to years after operation. Endoscopic retrograde cholangiopancreatography and PTC are the diagnostic studies of choice and offer the possibility of therapeutic intervention. We report the cases of a 56-year-old woman with cholangiocarcinoma, who developed a BBF 7 months after right hepatic lobectomy and 64-year-old man with intrahepatic duct stones who underwent hepatic resection.

노치 형상 및 냉각속도에 따른 Zr-2.5Nb 압력관의 DHC거동

김상재,김영석,임경수,김성수,정용무 대한금속재료학회 2003 대한금속·재료학회지 Vol.41 No.1

The objective of this study is to investigate the delayed hydride cracking (DHC) velocity and the incubation time for the water-quenched and furnace-cooled Zr-2.5Nb tube with the different radius of a notch tip. DHC tests were carried out at constant K_1 of 20 MPa√m and 250℃ on the cantilever beam (CB) specimens subjected to furnace cooling or water quenching after electrolytic charging with 57 or 72 ppm hydrogen, respectively. An acoustic emission sensor was attached to the CB specimens to detect the incubation time before the start of DHC. The shape of the notch tip changed from the fatigue crack to the dull crack with its radius ranging from 0.1 to 0.15 mm. The DHC incubation time increased remarkably with the increasing radius of the notch tip, which appeared more strikingly on the furnace-cooled CB specimens than on the water-quenched ones. However, both furnace-cooled and water-quenched CB specimens indicated little change in the DHC velocity with the radius of the notch tip unless their notch tip exceeded 0.125mm. These results demonstrate that the uncleation rate of hydrides at the notch tip determines the incubation time and the DHC velocity becomes constant after the concentration of hydrogen at the notch tip reaches the terminal solid solubility for dissolution (TSSD). This observation agrees well with Kim's DHC model. A difference in the incubation time and the DHC velocity between the furnace-cooled and water-quenched specimens is discussed in terms of the uncleation rate of hydrides at the notch tip and the hysteresis of hydrogen solubility.