위장관암 환자에서 혈청 CA 72-4, CA 19-9 및 CEA의 진단적 의의

장우익 ( Jang U Ig ),김철한 ( Kim Cheol Han ),김현수 ( Kim Hyeon Su ),이종인 ( Lee Jong In ),이동기 ( Lee Dong Gi ),권상옥 ( Kwon Sang Og ),심영학 ( Sim Yeong Hag ),김대성 ( Kim Dae Seong ),윤갑준 ( Yun Gab Jun ),장세진 ( Jang Se 대한내과학회 1992 대한내과학회지 Vol.42 No.6

연구배경 : 종양표지자는 암의 조기진단, 임상적 병기 구분 및 치료효과 판정에 사용될 수 있다. 위장관암에서 alpha-fetoprotein, carcinoembryonic antigen 및 CA 19-9가 중요한 종양표지자로 사용되고 있으나 위암에 대한 적당한 종양표지자가 없는 실정이다. 이에 저자등은 위암에 대한 새로운 종양표지자로 CA 72-4의 역할을 규명하고자 위암을 비롯한 각종 위장관암에서 CA 19-9 및 CEA를 동시 측정하여 비교하였다. 방법 : 대상은 위장관 악성종양환자 273예, 위장관 양성질환자 215예 및 정상대조군 93명이었으며, CA 72-4는 CIS ELSA CA 72-4 RIA kit, CA 19-9는 Abbott CA 19-9 RIA kit 그리고 CEA는 Abbott CEA RIA kit를 이용하여 측정하였으며, 각각의 정상 상한치는 4 U/ml, 37U/ml 그리고 5ng/ml로 하였고 다음과 같은 결과를 얻었다. 결과 : 1) CA 72-4, CA 19-9 및 CEA의 평균치는 악성종양군에서 정상대조군이나 양성질환군보다 높았다(p<0.05). 2) CA 72-4는 장기별 양성질환에서 95~100%의 높은 특이도를 보였으나 CA 19-9는 담도질환에서 54%, CEA는 간장질환에서 63%로 CA 72-4에 비해 낮은 특이도를 보였다. (p<0.05). 3) CA 72-4는 위암에서 민감도가 49%로 CEA(31%) 및 CA 19-9(31%)보다 높았다(p<0.05). 4) CA 72-4는 췌장암 및 담도암에서 민감도가 각각 43%, 44%로서 CA 19-9(각각 79%, 87%)보다 낮았으며 (p<0.05), 대장암에서도 35%로 CEA(74%)보다 매우 낮았다(p<0.05). 5) 8예의 조기위암환자 전예에서 CA 72-4를 비롯한 CA 19-9 및 CEA가 모두 음성이었다. 6) 위암에서 림프절 전이 유무에 따른 CA 72-4의 차이는 없었으나, 원격 전이가 없는 환자군(10%)에 비해 원격전이군(77%)에서 현저하게 높은 양성률을 보였다(p<0.05). 7) 위암의 병기별 CA 72-4의 분포는 4병기에서 83%로 1병기(7%), 2병기(8%) 및 3병기(13%)보다 현저히 높았다(P<0.05). 8) 근치적 위절제술을 시행한 5예의 위암환자에서 수술후 CA 72-4치가 정상 상한치 이하로 감소하였고 항암 약물요법에 반응을 보였던 4예의 진행성 위암환자에서도 약물치료후 현저한 감소가 있었다. 9) CA 72-4는 전이성 대장암 및 췌장암에서 국소 및 국소진행성 대장암 및 췌장암에 비해 현저히 높은 양성률을 보였다. 10) 위암환자에서 CA 72-4와 CA 19-9 또는 CA 72-4와 CEA사이의 상관관계는 없었다. 결론 : 이상과 같이 CA 72-4는 위암에서 CA 19-9 및 CEA 보다 높은 민감도를 보였으며 특히 4병기 위암에서 현저히 높은 민감도를 보이는바 CA 72-4가 양성인 경우 치료방침을 결정하는데 신중한 고려가 필요할 것으로 생각된다. 또한 CA 72-4는 위암에서 수술 혹은 항암 약물 요법의 치료 monitoring에 적절히 사용될 수 있는 종양 표지자로 생각된다. 또한 각종 위장관 질환에서 CA 72-4는 기존의 종양표지자에 비해 높은 특이도를 보이는바 CA 72-4가 양성인 경우 항상 악성종양의 가능성을 고려하여야 한다. Background: Detection of tumor markers could offer an accessible method for screening risk groups in order to achieve an early diagnosis of cancers, to contribute to an adequate staging, and to help evaluate effects of therapy. Alpha-fetoprotein, carcinoembryonic antigen and CA 19-9 are regarded as valuable tumor markers for gastrointestinal cancers. But in spite of the high incidence of gastric cancer in Korea, ideal tumor markers for gastric ancer have proved unrelible. So we investigated whether new tumor marker CA 72-4 is a reliable tumor marker for gastric cancer. And we compared CA 72-4 with CA 19-9 and CEA in the serodiagnosis of gastrointestinal cancers. Methods: Serum CA 72-4, CA 19-9 and CEA were determined radioimmunologically with monoclonal antibodies. A cut-off value of 4 U/ml, 37 U/ml and 5 ng/ml were used, respectively. Results: The results are summarized as follows. 1) The mean value of 72-4, CA 19-9 and CEA in malignant diseases were significantly higher than those of the benign digestive diseases (p<0.05). 2) CA 72-4 had high specificity ranged from 95%-100% in benign digestive disease groups but CA 19-9 (54%) had lower specificity in cholelithiasis(p<0.05) and CEA (63%) in benign liver diseases (p < 0.05). 3) In gastric carcinoma, the sensitivity of CA 72-4 (49%) was higher than that of CA 19-9 (31%, p<0.05) and CEA (31%, p<0.05). 4) The sensitivities of CA 72-4 was inferior to CA 19 -9 in pancreatic cancer (43% versus 79%, p<0.05) and in bile duct cancer (44% versus 87%, p<0.05) and to CEA in colon cancer (35% versus 749& p<0.05). 5) Eight of 45 resected gastric carcinoma patients had TI lesion (early gastric cancer), and CA 72-4, CA 19-9 and CEA were demonstrated all negative results for early gastric cancer. 6) In gastric carcinoma, there was no correlation between CA 72-4 positivity and occurrence of lymph node metastasis but significant difference of CA 72-4 positivity was observed between those with distant metastasis and those without metastasis(p<0.05). 7) The positive ratings in stages Ⅰ, Ⅱ, Ⅲ, and Ⅳ gastric carcinoma were 7% (1 of 14 patients), 8% (1 of 12 patients), 13% (2 of 16 patients), and 83% (24 of 29 patients) respectively and significant higher CA 12-4 positivity was observed in stage IV gastric carcinoma (p<0.05). 8) Elevated levels of serum CA 72-4 decreased to below the cut-off value after radical gastric resection in five patients with resectable gastric carcinoma and decreased also after chemotherapy in four patients with chemo-responsive metastatic gastric carcinoma. 9) Comparing with local or locally advanced colon cancer and pancreatic cancer, high positivity of CA 72-4 was observed in metastatic colon cancer and pancreatic cancer. 10) No significant correlation was observed between CA 72-4 and CA 19-9 or between CA 72-4 and CEA in gastric carcinoma. Conclusion: In conclusion, our data indicates that CA 72-4 is a reliable new tumor marker of disease stages and activity in gastric carcinoma. And CA 72-4 had a very high specificity in benign digestive diseases, so that elevated serum levels of CA 72-4 should always be taken seriously.

현행 중학교 과학 실험·실습교육에 대한 교사들의 견해와 개선방안

이윤종,기우항,김영호,정원우,양승영,강용희,안병호,임성규,윤일희,김중욱,강동진 경북대학교 과학교육연구소 1996 科學敎育硏究誌 Vol.20 No.-

The status of facilities, management of the experiment, practices, and Science education teaching method in middle school have been investigated. The present status and reasonable management of middle school science education have been grasped from the questionaires. The results are as follows : The reasonable management for expeiments and practices of science education were scanty in the middle school around the urban and rural schools owing to the shortage of facilities and equipments, crowded class, excessive classes, work for teachers, excessive contents of present textbook and insufficience of administrative support etc. The current teaching method of middle school science has emphasized knowledge. This fact does not satisfy the objective of learning due to lack of teaching method. Desirable directions for the improvement of present status of middle school science education were proposed in this paper.

고등학교 지구과학 실험·실습 요목 비교 분석

정원우,이윤종,기우항,김영호,양승영,강용희,안병호,임성규,윤일희,김중욱,윤성효,강동진 경북대학교 과학교육연구소 1997 科學敎育硏究誌 Vol.21 No.-

The purpose of this study is to investigate the status of the experimental and practical education in high school earth. The present status and reasonable management of the experimental and practical education in high school earth science have been grasped from the questionaires. To do this, eighty eight earth science teachers in Korea are administered questionaires. The frequency of the experimental and practical items in the seven kind of earth science text books were investigated. The problems and the reasonable management for experimental and practical education were proposed in this paper.

크롬계 탄화물의 분포와 형태가 니켈계 합금 600의 염기응력부식에 미치는 영향

김선재,최종호,성진경,김우곤,박순동,이창규,정용환,국일현,Kim, Seon-Jae,Choe, Jong-Ho,Seong, Jin-Gyeong,Kim, U-Gon,Park, Sun-Dong,Lee, Chang-Gyu,Jeong, Yong-Hwan,Guk, Il-Hyeon 한국재료학회 1998 한국재료학회지 Vol.8 No.8

32$0^{\circ}C$, 40%NaOH 용액의 autoclave에서 약 300wppm의 탄소를 함유하고 있는 15Cr-9Fe-balanced Ni 합금 판상시편에 대해 응력부식 저항성을 조사하였다. 부식시편은 $700^{\circ}C$, 100시간 동안의 열처리로 합금내부에 석출될 수 있는 가능한 한 많은 양의 크롬계 탄화물을 석출시킨 후, 다시 재용해에 의해 크롬계 탄화물의 형태를 조절하는 $800^{\circ}C$-$950^{\circ}C$범위의 최종열처리를 시행하고 급냉시킨 다음 U-자형으로 응력을 가하여 준비되었다. 최종열처리 온도가 올라감에 따라 시편들의 입계응력부식균열(IGSCC ) 전파속도는 $900^{\circ}C$까지는 거의 직선적으로 증가하다가 $950^{\circ}C$에서는 $700^{\circ}C$에서 얻은 값보다도 더 낮게 감소하였다. 즉, 크롬계 탄화물이 재용해되어 그 밀도가 감소함에 따라 IGSCC저항성이 감소하다가 완전히 재용해된 $950^{\circ}C$ 열처리 조건에서 오히겨 가장 큰 IGSCC 저항성을 나타내었다. 이와같은 최조열처리 온도에 따른 니켈계 합금 600의 부식거동은 입계에 존재하는 크롬계탄화물의 형태변화 때문이 아니라 입계에서 탄소-크롬계 탄화물-크롬간의 상평형에 의해 이루어지는 탄소의 입계편석량이 크롬계탄화물이 존재할 때에는 열처리 온도에 따라 증가하다가 그것이 완전히 재용해 되었을 때 가장 낮아지기 때문인 것으로 생각된다.

고립성 폐결절에 관한 임상적 고찰

이종인 ( Lee Jong In ),이상수 ( Lee Sang Su ),원구태 ( Won Gu Tae ),안강현 ( An Gang Hyeon ),이성우 ( Lee Seong U ),백순구 ( Baeg Sun Gu ),김승률 ( Kim Seung Lyul ),용석중 ( Yong Seog Jung ),신계철 ( Sin Gye Cheol ),정순희 ( Jeong 대한내과학회 1993 대한내과학회지 Vol.44 No.2

N/A Background : Because there aremany different reporting results about the etologies of solitary pulmonary nodules (SPNs), we cannot know the exact incidence of each causative disease. SPNs have a good prognosis relatively even if it is a malignant lesion. In Korea, where there is a high incidence of pulmonary tuberculosis, the differential diagnosis of SPNs should be performed. Methods : Among 351 patients who visited Wonju Chistian Hospital for SPNs in chest x-ray between 1982 and 1989, we evaluated 74 patients in whom the causes of SPNs could be elucidated by sputum AFB study, cytology, histolgic study, chest of solitary pulmonary nodule (SPN) seen at the Wonju Christian Hospital from 1982 to 1989. The followings were obtained. 1) The malignancies of SPN 74cases were 25 cases (33.7%). The primary lung carcinomas were 24 cases : The epidermoid carcinomas of these were 11 cases (45.8%), metastasis I case, tuberculoma 42 cases, and the other 7 cases. 2) The age distribution of benign lesions was from 19 to 73 years old with the mean age of 46 years old, and the age distribution of malignancies was from 17 to 77 years old with the mean age of 57 years old. The 23 cases (92.0%) of malignant nodules were more than 40 years old. The malignant frequency of SPN in a group of age more than 40 years old was 40.3% and in a group of age less than 40 years old, it was 11.7%. The malignant frequency was directly proportional to the increase of age(p<0.05). 3) The 3 cases of SPN were detected accidentally during physical up, all were benign. The 14 cases were detected during the evaluation of other diseases, 12 cases were benign. The 23 cases (40%) of 57 cases were symptomatic. Chest pain, dyspnea, and weight loss frequency in a group of less than 3cm in size was 11.9% and in a group of less than 3cm in size, it was 62.5% (p<0.05). 6) Calcifications were noted in 15 cases of 74 cases on the plain films, all were 7 central types, 7 diffuse types and 1 popcorn type. One of malignant cases had calcification on the chest CT scar. Among the 59 cases with non-calcified nodules, 25 cases were malignant (42.3%). The mean Hounsfield Unit of benign lesions was 182.5U and that of malignancies was 94U, there was a statistical difference between both groups(p<0.01). 7) The 21 cases (50%) of tuberculomas were located at the apicoposterior segment of upper lobe or the superior segment of lower lobe, but the 7 cases (28%) of malignancies were located at above sites. 8) The diagnostic accuracy of sputum study was 9.4% and that of fiberoptic bronchoscopy (FOB) was 33.3%. The diagnostic accuracy of transbronchial lung biopsy (TBLB) and transthoracic needle aspiration biopsy (TTNAB) was 57.4%. The percentage of primary lung cancer among SPNs which are larger than 3cm in size, occurring in the age of older than 40 years old and with no calcifications on radiologic examintion should be suspected as malignancies and diagnosed with sputum study, fiberoptic bronchoscopy, TBLB, and TTNAB.

성인 급성 골수성 백혈병 환자의 관해후 장기 생존율을 얻기 위한 치료 방침 - 골수이식과 항암요법의 생존율 비교 -

이종욱 ( Lee Jong Ug ),민창기 ( Min Chang Gi ),김동욱 ( Kim Dong Ug ),진종률 ( Jin Jong Lyul ),한치화 ( Han Chi Hwa ),민우성 ( Min U Seong ),박종원 ( Park Jong Won ),김춘추 ( Kim Chun Chu ),김동집 ( Kim Dong Jib ),한창순 ( Han Cha 대한내과학회 1993 대한내과학회지 Vol.44 No.4

연구배경 : 성인 급성 골수성 백혈병(AML)의 치료성적은 복합 항암요법의 개발 및 보조요법의 발달에 힘입어 관해률이 60~80%의 수준까지 향상되었으나, 관해 후 재발방지를 위해 항암요법(공고요법)을 실시함에도 불구하고 관해 유지기간은 약 1년정도이고, 장기 생존율은 약 20~35%에 불과하다. 한편 AML의 1차 관해시 동종골수의식(BMT)을 실시할 경우 장기 생존율은 약 45~65%이다. 방법 : 1986년 7월부터 1991년 12월까지 가톨릭의대 부속 성모병원과 국립의료원에서 AML로 진단받고 관해유도요법을 실시하여 완전관해(CR)에 도달한 92명의 환자중 40세 이하에서 1회 이상의 항암요법을 실시한 군(41명) HLA가 일치하는 형제 자매로부터 BMT를 실시한 군(16명) 간의 장기 생존율 및 재발율을 후향적으로 비교하였다. 결과 : 1) 대상환자 57명중 50명에서 추적관찰이 가능하였으며 3개월부터 57개월(중앙치 21개월)까지 관찰한 결과, 4년간 장기 생존율은 BMT 군과 항암치료군에서 각각 66%와 27%이었고(p<0.05), 4년간 재발율은 각각 24%와 69%이었다(p<0.005). 2) 전체 생존기간 및 무병 생존기간의 중앙치는 BMT 군에서는 아직 중앙치에 도달하지 않았으며, 항암치료군에서는 각각 17개월 및 13개월이었다. 3) 사망원인으로는 BMT군(16명) 은 백혈병 재발이 2예(13%), 치료와 관련된 합병증으로 2예(13%)에서 사망하였고, 항암치료군(41명)은 백혈병 재발이 21예(51%), 치료와 관련된 합병증으로 4예(10%)에서 사망하였다. 결론 : 이상의 결과로 성인 AML의 관해후 치료방침으로서 BMT가 항암치료(공고요법)보다 성적이 우수한 것으로 판단하여, 1차 관해후 40세 이하에서 HLA가 일치하는 공여자가 있을 경우 높은 장기 생존율을 얻기위해서는 BMT를 추천하는 것이 바람직하리라고 사료된다. Background: Although substantial progress in the treatment of acute myelogenous leukemia (AML) has produced complete remission (CR) in 60% to 80% of patients receiving induction chemotherapy, the median remissio duration is about 12 months and only 20% to 35% of patients undergoing consolidation chemotherapy achive long-term disease-free survival (DFS). Allogenei bone marrow transplantation (BMT) in first remission has resulted in a 45% to 65% overall survival rate. Methods: From July 1986 to December 1991, 92 patients with AML who had reached a CR following induction chemotherapy were assigned to a retrospective study comparing allogeneic BMT with consolidation chemotherapy as a postremission treatment. The results in 16 patients, aged 16 to 40 years, who underwent a HLA matched BMT in first remission were compared with those in 41 patients, age-matched, lacked an HLA-identical sibling, treated with one or more cycles of consolidation chemotherapy. Results: 1) After a median follow-up of 21 months (3~57 months), the acturaial DFS at 4 years was significantly higher in the transplantation group than in the chemotherapy group (66% v 27%; p<0.05), and the actuarial probability of leukemic relapse was considerably lower in the group treated with BMT (24% v 69%; p<0.005). 2) The median survival and DFS has not yet been reached for BMT group, and 17 months, 13 months, respectively for chemotherapy group. 3) Treatment-reached mortality was similar in both groups (13% in BMT group, 10% in chemotherapy group). Conclusion: Our results show that allogeneic BMT appears to be superior to consolidation chemotherapy and offers the best chance of long-term DFS in patients with AML in first remission. It will therefore be appropriate postremission treatment strategy to undergo allogeneic BMT for patients with AML in first remission under the age of 40 who have an HLA-identical sibling donor.

제5차 대한간학회 춘계학술대회 초록집 : 포스터 전시 순서 ; 4년간 지속적으로 혈청 종양표지자 α-FP수치는 높으나 간세포암종이 없는 환자 1예

김성우 ( Kim Seong U ),김종철 ( Kim Jong Cheol ),남승우 ( Nam Seung U ),이동후 ( Lee Dong Hu ) 대한간학회 1999 Clinical and Molecular Hepatology(대한간학회지) Vol.5 No.1(S)

호산구성 기관지염 환자의 임상적 경과: 전향적 관찰연구

박종근 ( Park Jong Geun ),박성우 ( Park Seong U ),이재학 ( Lee Jae Hag ),박종숙 ( Park Jong Sug ),서기현 ( Seo Gi Hyeon ),이영목 ( Lee Yeong Mog ),이준혁 ( Lee Jun Hyeog ),장안수 ( Jang An Su ),박재성 ( Park Jae Seong ),김양기 ( K 대한천식알레르기학회 2003 천식 및 알레르기 Vol.23 No.4

일반연제 발표 : 중증 화상 환자에서 합병된 급성신부전

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