간세포암과 감별이 어려웠던 악성중피종 치험 1예

김선문,허원석,채경훈,강윤세,정재훈,김연수,박기오,문희석,이엄석,김석현,성재규,이병석,이헌영,신경숙,조준식,송인상,강대영 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Malignant peritoneal mesothelioma is a rare neoplasm that arises from the mesothelium of a serosal cavity and is a rapidly fatal disease with a median survival of 4 to 12 months for untreated cases. Recently, we experienced a case with malignant peritoneal mesothelioma who was suspected hepatocelluar carcioma by abdominal CT scan and was confirmed by biopsy including immunohistochemical stain(calretinin) after surgery. We performed tumor excisions and wedge resection of the liver(segment Ⅷ)and inserted Tencoff catheter in abdominal cavity at 25th day of post-operation. We treated with intraperitoneal paclitaxel(25mg/m^(2)/day for 5 days) six courses monthly. She was well tolerable and is still living without any evidence of recurrence for 14th month of post-operation.

HPLC를 이용한 Alnus속 식물에서의 diarylheptanoids의 정량분석

정동욱,김준식,조수민,이연아,김광호,김세원,이민원 중앙대학교 약학연구소 1999 약학 논총 Vol.13 No.-

Quantitative determination of diarylheptanoids (oregonin and hirsutanonol), which were characteristic components of Alnus spp. has been conducted by High Performance Liquid Chromatography. The HPLC analysis was carried out using an YMC J'sphere ODS-H80 column [150×4.6mm, S-4μm. 80A(particle)] and a combination of acetonitrile and H2O was used as mobile phase in gradient solvent system. The results showed differnce in the species (Alnus japonica, A hirsuta and A. hirsuta var. sibirica)

Brugada 증후군 환자의 경접형동 선종절제술을 위한 마취 경험

허민정,김세연 영남대학교 의과대학 2009 Yeungnam University Journal of Medicine Vol.26 No.2

Brugada syndrome is characterized by an ECG pattern of right bundle branch block and ST segment elevation in the right precordial leads (V1-V3) without structural heart disease. It is also characterized by sudden cardiac death that’s caused by ventricular fibrillation. This is a familial syndrome with an autosomal dominant inheritance pattern and it may be considerably more common in Southeast Asia. Many factors during anesthesia can precipitate malignant dysrrhythmia in these patients, so careful choice of anesthetics is required. We experienced a case of Brugada syndrome in a 59-year-old male patient who was under general anesthesia for trans-sphenoidal surgery to treat a pituitary adenoma, and the patient was diagnosed as having Brugada syndrome without any untoward cardiovascular events.

대장수술 후에 발생한 급성신부전의 위험인자

이혜미,황창재,김재황,김흥대,박대팔,서일숙,송선옥,김세연,이덕희,지대림 영남대학교 의과대학 2007 Yeungnam University Journal of Medicine Vol.24 No.2

연구 배경 : 급성 신부전은 술 후 발생할 수 있는 합병증 중에서 사망률은 큰 영향을 줄 수 있으므로 이 연구를 통해 위험인자를 알아보려고 한다. 재료 및 방법 : 2004년 1월부터 2006년 12월까지 3년간 영남대학교 의과대학 부속병원에서 대장 수술을 받은 570명의 환자들을 대상으로 하였다. 환자들의 성별과 연령, 미국 마취과학회 신체등급, 동반질환, 수술의 종류, 응급수술의 여부, 수술 시간, 재수술의 여부, 술 중의 투약 상황, 술 후에 자가 통증 조절기에 사용한 약제, 술 중에 저혈압의 유무, 수혈 여부, 술 후 기계적 환기를 시행한 경우를 비교하였다. 결과 : 비교 결과에서 성별과 수술의 종류, 응급 수술의 여부, 개복여부 등에는 유의한 차이를 보이지 않았다. 반면 환자의 나이와 수술 시간, 재수술의 여부, 술중에 이뇨제 등을 사용한 경우, 술 중에 저혈압의 유무, 술 후에 기계적 환기를 시행한 경우 등에는 유의한 차이를 보였다. 결론 : 이상의 결과로 급성신부전의 원인은 어느 한 가지라고 하기 보다는 위험인자에 얼마나 노출되어 있는가가 결정하는 것 같고, 그 원인들이 모여서 상승효과를 내는 것 같다. 그러므로 수술 전부터 많은 위험에 노출된 환자는 술 중 더 적극적인 감시를 시행하여 수술 후의 합병증 발생을 줄이는 노력을 기울여야 하겠다. Background : Acute renal failure is one of the leading causes of postoperative morbidity and mortality. The purpose of this study was to determine the risk factors that are associated with acute renal failure after colorectal surgery. Materials and Methods : Five hundred seventy patients who operated colorectal surgery at the Yeungnam University Medical Center over three years from 2004 to 2006 were enrolled in this study. The effects of gender, age, ASA classification, concomitant disease, surgery type and duration, reoperation, urogenital manipulation, medication, hypotension, hypovolemia, transfusion, and postoperative ventilatory care on the occurrence of acute renal failure after colorectal surgery were studied. Results : The major risk factors of acute renal failure after colorectal surgery were age of patients (P=0.003), ASA classification (P<0.001), concomitant disease (P<0.001), duration of the time surgery (P=0.034), reoperation (P=0.001), use of intraoperative diuretics (P=0.005), use of postoperative diuretics (P<0.001), intraoperative hypotension (P=0.018), intraoperative transfusion (P<0.001), postoperative transfusion (P<0.001), and postoperative ventilatory care (P=0.001). Conclusion : Multiple factors cause synergistic effects on the development of acute renal failure after colorectal surgery. Therefore, efforts to reduce the risk factors associated with acute renal failure are needed. In addition, intensive postoperative care should be provided to all patients.

고속액체크로마토그래피-가시선/자외선 검출기를 이용한 Di(2-ethylhexyl)phthalate 검출 방법 검증과 일부 한국 성인 남성 혈액 중 DEHP 정량

양윤정,명순철,김세철,홍연표 大韓産業醫學會 2005 대한직업환경의학회지 Vol.17 No.1

목적: 이 연구는 HPLC-UV를 이용한 생체 시료 중 저농도의 DEHP 분석법을 CDER 기준에 따라 검증하고 검증된 분석법으로 일부 한국의 혈장 중의 DEHP를 분석하여 인체 노출 정도를 뒷받침할 수 있는 기초 자료를 제시하고자 한다. 방법: 혈액 내 DEHP 정량을 위한 HPLC-UV 정량 분석법을 CDER의 검증 기준인 검량선 및 직선성과 정밀성, 정확성에 대해 시행하였다. 검증된 분석법으로 울산과 춘천 일부 지역의 근로자 30세 이상 60세 이하의 건강한 남성 255명으로부터 채취한 혈액 내 DEHP를 정량하였다. 결과: 혈액 중 DEHP 정량을 위해 사용된 HPLC-UV는 표준액 0∼150 μg/l 에서 직선성을 나타냈다(r²=0.999). 검량한계는 5.22 μg/l , 정량한계는 15.81 μg/l 이었다. 정밀성과 정확도는 2.5 μg/l DEHP 농도에서 첫째 날을 제외하고는 둘째 날과 셋째 날은 CDER 기준에 적합하였다. 50 μg/l 과 150 μg/l DEHP 농도는 모두 CDER 기준에 적합하였다. 대상자의 98 %가 10 μg/l 이하이었고, 85%는 5 μg/l 이하이었고 왼쪽으로 치우친 분포를 나타냈으며, 최고 농도는 18.9 μg/l 이었다. 대상자의 혈액의 DEHP 농도의 기하평균과 기하표준편차는 0.4±1.5 μg/l 이었다. 결론: 본 연구에 사용된 HPLC-UV를 이용한 혈액 중 DEHP 분석법은 CDER 기준에 따라 검증한 결과 정밀도, 정확도, 검출한계 및 정량한계 등 모든 항목에서 기준에 적합하였다. 일부 한국 성인 남자의 혈액 중 DEHP 농도는 0∼18.9 μg/l 이었으며 왼쪽으로 치우친 분포를 나타냈다. Objectives: This study was conducted to validate a simple, rapid and sensitive reverse-phase high-performance liquid chromatographic method with UV detector (HPLC-UV) and present the plasma level of di(2-ethylhexyl)phthalate (DEHP) in some Korean male workers. Methods: HPLC-UV for quantification of plasma DEHP was validated by the following guideline from the Center for Drug Evaluation and Research (CDER) - calibration/standard curve, precision, accuracy and recovery. Plasma DEHP from 255 healthy Korean male workers aged from 30 to 60 years was analyzed by validated HPLC-UV method. Results: The calibration curve over the range 0∼150 μg/l for the plasma DEHP standard solution showed linearity(r²=0.999). The limit of detection (LOD) and limit of quantification (LOQ) of plasma DEHP were 5.22 μg/l and 15.81 μg/l , respectively. The accuracy and precision for 2.5 μg/l of DEHP were acceptable in CDER guideline on the second and third day but not first day, and those for 50 μg/l and 150 μg/l of DEHP were acceptable on all three days(Ed-confirm this addition). The distribution of plasma DEHP level was skewed to the left and ranged from 0 to 18.9 μg/l. The plasma DEHP level was lower than 10 μg/l for 98 % of subjects and lower than 5 μg/l for 85 %. The geometric mean and standard deviation of plasma DEHP were 0.4±1.5 μg/l. Conclusions: The HPLC-UV method for quantification of plasma DEHP was acceptable by CDER guideline. The plasma DEHP of 255 Korean male workers ranged from 0 to 18.9 μg/l and the distribution was skewed to the left.

자가 면역성 간염에서 자가항체의 발현 양상과 스테로이드 치료의 효과

박기오,채경훈,허원석,강윤세,정재훈,김연수,문희석,이엄석,김선문,이병석,김남재,이헌영 충남대학교 의과대학 의학연구소 2003 충남의대잡지 Vol.30 No.1

목적 : 최근 8년간 본원에서 경험한 자기면역성 간염의 혈액학적 특징과 스테로이드의 치료효과를 알아보고자 본 연구를 시행하였다. 방법 : 1996년 이후부터 2002년까지 충남대학교 병원에서 1999년 International Autoimmune Hepatitis Group(LAHG)에서 제시한 수정 진단 기준안에 의거하여 총 진단점수가 probable 이상에 해당하는 환자들을 대상으로 임상적 특징, 검사실 및 조직 소견과 스테로이드와 azathioprine의 치료 효과를 후향적으로 조사하였다. 결과 : 9예의 환자들은 여성이 78%, 40대가 많았고, 급성 발병이 33.3%, 피로감, 식욕부진 및 황달 등이 나타났으며, 항핵항체가 55.6%에서 그리고 항평활근 항체가 77.8%에서 양성이었고, 동반 질환은 류마치스 관절염이 2예, 특발성 혈소판 감소증 1예, Henoch-Sch nlein 자반증 및 그레브스병이 각각 1예 씩이었다. 7예에 대해서 스테로이드와 azathioprine으로 치료하여 생화학적 임상적 완해가 이루어져서 유효한 치료 결과를 얻었다. 결론 : 자가면역성 간염은 우리 나라에서 원인을 찾을 수 없는 만성 간질환의 경우, 특히 중년여성에서 다른 자가면역성 질환이 동반되었을 때 자가면역성 간염을 의심하여 자가항체 선별검사를 시행해 보아야 할 것으로 생각된다. 향후 다기관 연구를 통하여 좀 더 많은 증례를 모으고 전향적인 연구를 시행하여야 할 필요가 있다. Although autoimmune hepatitis(AIH) is common in western contries, some studties have been reported in Korea. The aim of the study was to analyze the clinical and histological features and expression pattern of the autoantibody and to examine clinical course of AIH in Korea. For 9 patients diagnosed as having AIH in our hospital since 1996, we reviewed medical records and analyzed clinical and laboratory findings retrospectively. They had a probable or definite AIH according to the revised criteria of International AIH group. The mean age was 42.7(21∼68)years and 7(77.8%) were female. Three of them(33.3%) showed acute hepatitis and five of them showed cirrhosis. Fatigue and anorexia were the most frequently complained symptoms(55.6%). Four patients(44.4%) were accompanied with other autoimmune diseases. Antinuclear antibody was detected in 5(55.6%) and anti-smooth muscle antibody was detected in 7(77.8%). Three patients showed focal picemeal necrosis and four showed periportal fibrosis. Among 7 patients who received immunosuppressive therapy, six patients(85.7%) showed initial response. and biochemical and serologic remission were achived in 5(71.4%) and 3(42.8%) patients, AIH seems to be partly responsible for chronic liver disease of unknown etiology in Korea. AIH should be suspected in female patients with unknown chronic liver disease of unknown etiolgy, especially accompanied with other autoimmune disease. The clinical characteristics of AIH may not be quite different from those of Western countries.

Nomogram for Predicting Breast Conservation after Neoadjuvant Chemotherapy

Kim, Min Kyoon,Han, Wonshik,Moon, Hyeong-Gon,Ahn, Soo Kyung,Kim, Jisun,Lee, Jun Woo,Kim, Ju-Yeon,Kim, Taeryung,Lee, Kyung-Hun,Kim, Tae-Yong,Han, Sae-Won,Im, Seock-Ah,Kim, Tae-You,Park, In Ae,Noh, Dong Korean Cancer Association 2015 Cancer Research and Treatment Vol.47 No.2

<P><B>Purpose</B></P><P>The ability to accurately predict the likelihood of achieving breast conservation surgery (BCS) after neoadjuvant chemotherapy (NCT) is important in deciding whether NCT or surgery should be the first-line treatment in patients with operable breast cancers.</P><P><B>Materials and Methods</B></P><P>We reviewed the data of 513 women, who had stage II or III breast cancer and received NCT and surgery from a single institution. The ability of various clinicopathologic factors to predict the achievement of BCS and tumor size reduction to ≤ 3 cm was assessed. Nomograms were built and validated in an independent cohort.</P><P><B>Results</B></P><P>BCS was performed in 50.1% of patients, with 42.2% of tumors reduced to ≤ 3 cm after NCT. A multivariate logistic regression analysis showed that smaller initial tumor size, longer distance between the lesion and the nipple, absence of suspicious calcifications on mammography, and a single tumor were associated with BCS rather than mastectomy (p < 0.05). Negative estrogen receptor, smaller initial tumor size, higher Ki-67 level, and absence of <I>in situ</I> component were associated with residual tumor size ≤ 3 cm (p < 0.05). Two nomograms were developed using these factors. The areas under the receiver operating characteristic curves for nomograms predicting BCS and residual tumor ≤ 3 cm were 0.800 and 0.777, respectively. The calibration plots showed good agreement between the predicted and actual probabilities.</P><P><B>Conclusion</B></P><P>We have established a model with novel factors that predicts BCS and residual tumor size after NCT. This model can help in making treatment decisions for patients who are candidates for NCT.</P>

2017 Thyroid Radiofrequency Ablation Guideline: Korean Society of Thyroid Radiology

Kim, Ji-hoon,Baek, Jung Hwan,Lim, Hyun Kyung,Ahn, Hye Shin,Baek, Seon Mi,Choi, Yoon Jung,Choi, Young Jun,Chung, Sae Rom,Ha, Eun Ju,Hahn, Soo Yeon,Jung, So Lyung,Kim, Dae Sik,Kim, Soo Jin,Kim, Yeo Koon The Korean Society of Radiology 2018 KOREAN JOURNAL OF RADIOLOGY Vol.19 No.4

<P>Thermal ablation using radiofrequency is a new, minimally invasive modality employed as an alternative to surgery in patients with benign thyroid nodules and recurrent thyroid cancers. The Task Force Committee of the Korean Society of Thyroid Radiology (KSThR) developed recommendations for the optimal use of radiofrequency ablation for thyroid tumors in 2012. As new meaningful evidences have accumulated, KSThR decided to revise the guidelines. The revised guideline is based on a comprehensive analysis of the current literature and expert consensus.</P>

Pleural fluid ADA level in tuberculous pleurisy can be low in old age, critically ill patients with multi-organ failure

( Sae Byol Kim ),( Beomsu Shin ),( Ji-ho Lee ),( Seok Jeong Lee ),( Myoung Kyu Lee ),( Won-yeon Lee ),( Suk Joong Yong ),( Sang-ha Kim ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Purpose: Adenosine deaminase (ADA) level in tuberculous pleural effusion (TPE) is typically elevated, but low ADA in TPE has been reported not infrequently. The characteristics of these patients are not well known. This can falsely negate the possibility of TPE, resulting in a delayed diagnosis. Method: We retrospectively reviewed patients with microbiologically or pathologically confirmed TPE between 2012 to 2018 in a tertiary hospital in South Korea. Patients were categorized into two groups: a high ADA (≥40 IU/L) and a low ADA (<40 IU/L) group. Clinical characteristics and the Sequential Organ Failure Assessment (SOFA) score were obtained and analysed. Result: A total of 192 patients with TPE were included and 36 (18.8%) had ADA <40 IU/L with a mean ADA level of 20.9 (±9.2) IU/L. Patients with low ADA were older (75.3 vs. 62.0 years, p<0.001) and showed lower lymphocyte percentage (47.6% vs. 69.9%, p<0.001) than those with high ADA. Patients in the low ADA group had significantly higher SOFA score (2.31 vs. 0.68, p<0.001), and patients with organ dysfunction were significantly more common in the low ADA group (p<0.001). Patients with 2 or ≥3 organ dysfunctions involved were 19.4% and 13.9% in the low ADA group, and 7.1% and 1.3% in the high ADA group (p<0.001). Multivariate logistic regression analysis showed that age (OR=1.030, 95% CI 1.002-1.060, p=0.038) and SOFA score (OR=1.598, 95% CI 1.239-2.060, p<0.001) were significantly associated with low ADA level in TPE. Conclusion: ADA level in TPE can be low in elderly, critically ill patients with multiorgan failure. Low ADA level cannot completely exclude the diagnosis of TPE, and physicians should be careful in interpreting pleural fluid exams.

Metformin Enhances Leptin Sensitivity in Aged Rats

Sae Rom Kim,So-Young Park,Jong Yeon Kim,Yong Woon Kim 대한생리학회-대한약리학회 2006 The Korean Journal of Physiology & Pharmacology Vol.10 No.1

To evaluate whether metformin restores leptin sensitivity in aged rats with leptin resistance, we measured leptin sensitivity in aged (2 year old) and adult (5 month old) rats after 4 weeks of treatment with metformin (300 mg/kg/D, mixing in drinking water), by measuring food intake, body weight and visceral fat losing effects. Leptin (15μg/D) was administered by intracerobroventricular (i.c.v.) infusion through osmotic minipump for 1 week. Metformin treatment decreased body weight and daily food intake in both adult and aged rats compared with their control rats, however, these effects were more prominent in aged rats than in adult rats. Anorexic and fat losing responses following i.c.v. leptin were attenuated in aged rats compared to adult rats. However, these responses of aged rats to leptin were restored by metformin treatment. Moreover, serum concentration of leptin in aged rats was significantly decreased by combined treatment with metformin and leptin. These results suggest that metformin enhances leptin sensitivity in aged rat model, and that combination therapy with metformin and leptin would be helpful for treatment of aging-associated obesity.