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64절편 다검출기 CT 관상동맥 조영술을 이용한 관상동맥 질환 진단의 정확도
남궁준 ( June Namgung ),최현민 ( Hyun Min Choe ),권성욱 ( Sung Uk Kwon ),도준형 ( Joon Hyung Doh ),이성윤 ( Sung Yun Lee ),허감 ( Gham Hur ),이원로 ( Won Ro Lee ) 대한내과학회 2008 대한내과학회지 Vol.75 No.1
목적: 관상동맥 질환의 진단에 있어서 현재까지 가장 정확한 방법은 고식적 관상동맥 조영술(conventional coronary angiography)이었다. 다검출기 CT (multidetector computed tomography, MDCT) 관상동맥 조영술은 1999년에 처음 등장한 이래로 빠른 기술적 진보를 보여 최근에 임상에 도입된 64절편 MDCT는 공간 및 시간해상도를 더욱 향상시켜 비관혈적으로 관상동맥 영상을 보다 정확히 규명하기에 이르렀다. 이에 본 연구에서는 64절편 MDCT를 사용하여 MDCT 관상동맥 조영술의 진단 정확도를 확인하여 기존의 관혈적 관상동맥 조영술을 대치할 수 있는지 판정하였다. 방법: 고식적 관상동맥 조영술이 예정된 101명(남자 63명, 여자 38명; 평균연령 63.7±10.5세)을 대상으로 MDCT와 고식적 관상동맥 조영술을 7일 이내에 시행하였다. 관상동맥 각 분절의 유의한 협착은 관상동맥 내경의 50% 이상 협착으로 정의하여 고식적 관상동맥 조영술의 영상과 비교하여 MDCT의 진단적 정확도를 측정하였다. 관상동맥의 유의한 협착정도를 각각 관상동맥의 분절별, 혈관별, 환자별로 구분하여 판정하였다. 결과: 총 1,440개의 관상동맥분절 중 1,348개의 분절(94%)이 MDCT로 분석 가능한 영상을 얻을 수 있었고 이중 고식적 관상동맥 조영술에서 209개의 관상동맥 분절의 유의한 협착이 있었다. MDCT의 진단정확도는 민감도, 특이도 양성예측도, 음성예측도가 분절별 평가에서 각각 96%, 97%, 85%, 99%, 혈관별 평가에서 각각 99%, 95%, 88%, 99%, 환자별 평가에서 각각 100%, 94%, 97%, 100%였다. 위양성이 37분절에서 있었고 관상동맥 석회화(26분절)가 위양성의 주요 원인이었다. 결론: 본 연구에서 64절편 MDCT 관상동맥 조영술은 높은 진단정확도를 보였다. 따라서 선택적인 환자에서 불필요한 관혈적 관상동맥 조영술의 시행을 줄이고 이를 대치할 수 있는 유용한 검사로 판단된다. Background/Aims: Invasive coronary angiography remains the gold standard in the diagnosis of coronary artery disease. However, multidetector CT (MDCT) coronary angiography is an emerging technique that is available for the non-invasive detection of coronary artery stenoses. While the diagnostic accuracy of first generation MDCT is limited, recently released 64-slice MDCT has yielded promising results due to increased temporal and spatial resolution. The objective of this study was to investigate the diagnostic accuracy of non-invasive 64-slice MDCT for coronary artery disease. Methods: One hundred one patients (63 males and 38 females; mean age, 63.7±10.5 years) undergoing conventional coronary angiography were included in this study. All coronary arteries, including the distal segments and side branches, were analyzed for the presence of significant stenosis (≥50% diameter stenosis) and compared with of the quantitative coronary angiographic findings. Results: Of the 1,440 coronary artery segments studied, 1,348 segments were assessed quantitatively by both MDCT and conventional coronary angiography (94%). Two hundred nine significant stenoses were detected by conventional coronary angiography. On a segment-based analysis, the senisitivity, specificity, and positive and negative predictive values of 64-slice MDCT were 96, 97, 85, and 99%, respectively. On a vessel-based analysis, the sensitivity, specificity, and positive and negative predictive values of 64-slice MDCT were 96, 97, 85, and 99%, respectively. The corresponding values obtained on a patient-based analysis were 100, 94, 97, and 100%, respectively. Coronary calcification was the major cause of false-positive findings. Conclusions: This study demonstrated that 64-slice MDCT coronary angiography is of similar accuracy as conventional coronary angiography for the detection of coronary artery disease. In selected groups of patients, 64-slice MDCT may replace the more invasive coronary angiography. (Korean J Med 75:42-53, 2008)
기관지내시경 검사상 우연히 발견된 무증상의 기관지 과립세포종 2예
강은희,이성홍,나영숙,최태영,남궁준,정병오,이혁표,김주인,염호기,최수전,조혜제,이혜경,Kang, Eun-Hee,Lee, Sung-Hong,Na, Young-Sook,Choi, Tae-Young,NamGung, June,Jeoung, Byung-Oh,Lee, Hyuk-Pyo,Kim, Joo-In,Yum, Ho-Kee,Choi, Soo-Jeon,Cho, Hye 대한결핵및호흡기학회 1999 Tuberculosis and Respiratory Diseases Vol.46 No.1
저자들은 타질환으로 입원중 기관지내시경검사상 우연히 발견된 과립세포종 2예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Granular cell tumor(formerly named to be granular cell myoblastoma) was first described by Abrikossoff in 1926 and is a rare tumor thought to be of Schwann cell origin. It can occur at any soft tissue of the body, but most cases are found at the tongue, skin, breast and GI tract Only 6% of them occur in respiratory system. We report two cases of asymptomatic granular cell tumor of the bronchus that were detected incidentally by bronchoscopy. One patient had aspiration pneumonia, the other had immotile cilia syndrome. The former patient was simply observed and bronchoscopic extirpation of the tumor was done in the latter patient.
기관지내시경 검사상 우연히 발견된 무증상의 기관지 과립세포종 2예
강은희 ( Eun Hee Kang ),이성홍 ( Sung Hong Lee ),나영숙 ( Young Sook Na ),최태영 ( Tae Young Choi ),남궁준 ( June Namgung ),정병오 ( Byung Oh Jeoung ),이혁표 ( Hyuk Pyo Lee ),김주인 ( Joo In Kim ),염호기 ( Ho Kee Yum ),최수전 ( So 대한결핵 및 호흡기학회 1999 Tuberculosis and Respiratory Diseases Vol.46 No.1
남궁준,이승철,이승훈,이현경,정재용,김홍주,박원도 인제대학교 2000 仁濟醫學 Vol.21 No.1
In this case report we described the case of an unexplainable newsy developed ascites following renal allograft transplantation in the patient who was free of ascites during a period of peritoneal dialysis. This case suggests that ascites in the patients with end-stage renal failure is not limited to the period of maintenance dialysis and that renal transplantation may paradoxically followed by development of ascites. There has been no previous reported in Korea, so we report this case along with the brief review of the literature.
남궁준,유영진,김성록 인제대학교 1999 仁濟醫學 Vol.20 No.1
5-Fluorouracil은 투여 방법에 따라 효과가 달라지는 항암약제로서 지난 수년간 5-Fluorouracil의 치료효과를 향상시키기 위한 많은 연구가 있었다. 저자들은 치료효과를 높이기 위한 예비실험으로서 5-Fluorouracil 불응성 위장관 암 환자를 대상으로 저용량의 leucovorin과 5-Fluorouracil의 급속 및 지속주입을 병합한 방법으로 제2상 실험을 한 후 그 효과 및 독성을 관찰하였다. Object: To determine the efficacy and toxicity of low dose leucovorin and hybrid regimen of bolus and contunuous infusion of 5-fluorouracil for the refractory gastrointestinal tract cancers. Material and Method: 13 patients with advanced gastrointestinal cancer refractory to 5-FU containing chemotherapy entered on this study between July 1987 to September 1998. Among 13 patients, there were 2 patients with stomach cancer, 3 colon cancer, 6 rectal cancer, 1 pancreatic cancer and 1 bile duct cancer. 9 patients are presently evaluable for response; 4 patients were lost to follow up before evaluation. The chemotherapy regimen consisted of leucovorin 20mg/m2 IV bolus followed by 5-FU 400mg/m2 IV over 15 minutes and continuous 5-FU 800mg/m2 IV for 18hours daily for 4 days. The treatment was repeated every 3 weeks. Results: This regimen resulted in no objective response out of 9 evaluable patients; Six of 9(67%) had stable disease and 3(33%) had progressive disease. Overall survival of evauable patients were 7+∼48+ weeks(median : 28 weeks) and time to progression were 5+∼23+weeks(median: 14 weeks). Toxicities were moderate but tolerable. No one was hospitalized due to toxicity. The most common and dose limiting toxicity was stomatitis (53.8%). Conclusion: This regimen with low dose leucovorin and hybrid regimen of bolus and continuous infusion of 5-FU was tolerable and failed to show good effect on the patients with gastrointestinal tract cancer refractory to 5-FU containing chemotherapy. As 6/9 patients were in stable disease, the comparative study on the standard chemotherapy and this regimen is warranted.
김종훈,남궁준,박혜연,황철웅,박경일,도준형,이성윤,이원로 白中央醫療院 2005 仁濟醫學 Vol.26 No.1
The transient left ventricular apical ballooning syndrome, also known as takotsubo cardiomyopathy is a recently described novel cardiac syndrome. This syndrome is characterized by transient asynergy of the ventricular apex or mid-ventricle in the absence of obstructive epicardial coronay artery disease. This report concerns two types of morphologic difference about left ventricular apex and mid-ventricle. In this case, we report two types of stress-induced cardiomyopathy with review of literatures.