Castleman 병(거대 종격동 림프절 증식)의 전산화단층촬영 소견

한헌,김광국,임정기,한만청,Han, Heon,Kim, Kwang-Kook,Im, Jung-Gi,Han, Man-Chung 대한영상의학회 1986 대한영상의학회지 Vol.22 No.5

Castleman disease is a rare disease entity of unknown etiology, with the characteristics of large, well marginated benign lymphoid masses occuring predominently in the mediastinum. The value of contrast enhancement in solid soft tissue masses of mediastinum has little been written because most of the solid mediastinal tumors show no significant degree of enhancement. But Castleman disease, because of its hypervacularity, show significant degree of enhancement in most cases. Authors report 3 cases of Castleman diseases and suggests good diagnostic probability of CAstleman disease in cases that show benign looking homogeneously enhancing mediastinal mass by CT scan.

Foley 도간을 이용한 식도이물 제거

한헌,김인원,연경모,Han, Heon,Kim, In-One,Yeon, Kyung-Mo 대한영상의학회 1987 대한영상의학회지 Vol.23 No.4

The fluroscopically controlled foley catheter technique is an easy, safe, and successful method of removal of blunt esophageal foreign bodies such as coins, and avoids the risks of general anesthesia and endoscopy. AAuthors successfully removced four coins and one baduk-stone which obstructed upper esophagusm using Foley cathether technique at Seoul National Univ. Children's Hospital from November 1986 to April 1987.

위염전증의 방사선학적 소견

한헌,김인원,연경모,Han, Heon,Kim, In-One,Yeon, Kyung-Mo 대한영상의학회 1987 대한영상의학회지 Vol.23 No.6

Gastric volvulus, organoaxial or mesenteroaxial rotation, is an uncommon cause of uper gastrointestinl obstruction in childhood. It may be suspected on plain radiographic examination of the abdomen and confirmed by upper gastrointestinal series. Six affected children are described. Symptoms wer3e mainly acute vomiting and abdominal distension. All patients had defect in perigastric ligaments.

비관통성 흉부외상 환자에서 앙와위 단순흉부전후촬영에 의한 혈흉 양의 측정

한헌,양주현,나명훈,백희종,Han, Heon,Yang, Joo-Hyun,Na, Myung-Hoon,Baik, Hee-Jong 대한영상의학회 1994 대한영상의학회지 Vol.31 No.4

췌십이지장 절제술후의 가성동맥류: 혈관조영술을 이용한 진단과 색전술

정준용,이상현,김삼수,한헌,정혜원,한준구,최병인,정진욱,박재형,Jeong, Jun-Yong,Lee, Sang-Hyeon,Kim, Sam-Su,Han, Heon,Jeong, Hye-Won,Han, Jun-Gu,Choe, Byeong-In,Jeong, Jin-Uk,Park, Jae-Hyeong 대한영상의학회 2002 대한영상의학회지 Vol.47 No.2

목적: 췌십이지장 절제술후 합병증으로 출혈을 보인 환자에서 혈관조영술을 이용한 가성동맥류의 진단 및 색전술을 통한 지혈의 효과를 알아보고자 하였다. 대상과 방법: 총 51개월 동안 췌십이지장 절제술을 시행 받은 298명의 환자 중 임상적으로 의미 있는 출혈로 혈관조영술을 시행한 19명(6.4%)의 환자에서 가성동맥류가 발견된 9명(3.0%)을 대상으로 출혈 전후의 임상소견, 혈관조영술 소견 및 색전술의 지혈효과를 후향적으로 분석하였다. 결과: 총 9명의 환자에서 혈관조영술로 가성동맥류를 진단하였다(총간동맥 4명, 위십이지장동맥 3명, 고유간동맥 1명, 좌위대망막동맥 1명). 크기는 0.3 cm에서 6.5 cm로 평균 1.9 cm이었고 조영제의 혈관외유출은 5명(55.6%)에서 보였다. 혈관조영술을 시행받은 나머지 10명의 환자에서는 혈관조영에서 출혈의 증거를 찾을 수 없었다. 수술 2주일 이내와 이후의 조기 또는 지연출혈에 동반된 경우는 각각 5명, 4명이었다. 가성동맥류를 진단받은 9명 환자 중 대량 출혈이전에 문합부 유출로 인한 복강내의 체액 또는 농양 배출을 위해 경피적배액술을 시행받은 환자는 7명(77.8%)이었으며 9명 모두에서 소량의 예기출혈을 보였다. 혈관조영술로 정확한 가성동맥류 위치를 파악하여 환자는 8명에서 코일을, 나머지 한명에서는 gelfoam을 이용하여 색전술을 시행하였고 모두에서 지혈에 성공하였다. 색전술과 연관된 주요 합병증을 경험한 환자와 추적기간 중(72-1336일,평균 640일)재출혈을 보인 환자는 없었다. 결론: 췌십이지장 절제술후 가성동맥류는 드물지만 출혈의 원인으로 중요하며 혈관조영술 및색전술로 가성동맥류의 조기 진단 및 성공적인 지혈을 하여 위험이 높은 응급수술을 최소화할수있다. Purpose: To evaluate the efficacy of angiography in the diagnosis and treatment of pseudoaneurysm manifesting arterial hemorrhage as a significant complication following pancreatoduodenectomy. Materials and Methods: For 51 months, of a total of 298 patients who had undergone pancreatoduodenectomy, 19 patients (6.4%) developed clinically significant hemorrhage and nine patients proved to have a pseudoaneurysm on angiography. These nine patients (3.0%) were managed by transcatheter arterial embolization. We analyzed clinical feature, angiographic findings and hemostatic effect of embolization retrospectively. Results: In nine patients (3.0%), pseudoaneurysm was diagnosed on angiography (common hepatic artery in four, gastroduodenal artery in three, proper hepatic artery in one, and left gastroepoploic artery in one patient). The size ranged from 0.3 cm to 6.5 cm (mean 1.9 cm). And extravasation was noted in five patients (55.6%). The remained ten patients showed no evidence of bleeding on angiography. Those who manifested as early bleeding (within two weeks) or delayed bleeding (later than two weeks) were five and four patients respectively. Before the onset of major bleeding, among the nine pseudoaneurysm patients, seven patients (77.8%) had experienced percutaneous drainage due to intra-abdominal fluid collection with or without abscess resulting from anastomotic leak, and all nine patients had had preliminary minor bleeding. The angiogram demonstrated an exact site of bleeding as a pseudoaneurysm followed by transcatheter arterial embolization (microcoil in eight patients, gelfoam in one) and achieved complete hemostasis yielding a success rate of 100%. Overall, no patients experienced complications related directly to the transcatheter arterial embolization technique. During the follow-up period (72-1,336days, mean 640), no recurrence of bleeding was noted. Conclusion: Although pseudoaneurysm is a rare complication, it is important as a cause of hemorrhage after pancreatoduodenectomy. Angiography followed by transcatheter arterial embolization allows early diagnosis and hemostasis of pseudoaneurysm and minimizes the need for high-risk emergency surgery.

단순 유방촬영술상 동반되는 종괴 없이 보이는 군집성 미세석회화 : 양성과 악성의 예측

한윤희,도영수,조병제,한헌,최연현,박정미,한부경,오훈일,김기환,진수일,Han, Yoon-Hee,Do, Young-Soo,Cho, Byung-Jae,Han, Heon,Choi, Yeun-Hyeun,Park, Jung-Mi,Han, Boo-Kyung,Oh, Hoon-Il,Kim, Ki-Hwan,Chin, Soo-Yil 대한영상의학회 1996 대한영상의학회지 Vol.35 No.5

Purpose : The purpose of this study is to evaluate the accuracy of differentiation between benign andmalignant clustered microcalcifications without mass on mammogram. Material and Methodes : Fourty six mammogramsof 44 patients showing clustered microcalcifications without mass were interpreted blindly by five independentobservers majoring in breast imaging from different institutions. Twenty two were malignant (10 infiltratingductal carcinomas, 12 intraductal carcinomas) and 24 were benign (all fibrocystic disease). The observers judgebenignancy or malignancy of microcalcifications. The authors assess the accuracy of differential diagnosis ofclustered microcalcifications. Result : Of 24 cases proved benign microcalcifications, five radiologists correctlyinterpreted 20 on average as benign and of malignant 22 cases, 16 on average were correctly interpreted asmalignant. The diagnostic accuracy of malignant microcalcifications was 71.8% on average(63.6%~81.8%) and thediagnostic accuracy for benign microcalcifications was 83% on average(71%~ 92%). It was 9 among total 46 casesthat were misinterpreted by more than three radiologists. Among these 9 cases, malignant microcalcifications thathad been misinterpreted as benign were seven, benign microcalcifications misinterpreted as malignant were two.Conclusion : The diagnostic accuracy of clustered malignant microcalcifications(71.8%) without mass on mammogramwas lower than that of benign microcalcifications(83.3%). So, in case of suspected malignant microcalcification onmammogram, it is preferable that along with magnification view, histopathologic confirmation by core biopsy mustbe obtained.

북한의 국가이미지가 개성공업지구 제품구매에 미치는 영향에 관한 연구

김남정(Kim Nam Jung),한헌(Han Heon),강명수(Kang Myung Soo) 한국도시행정학회 2009 도시 행정 학보 Vol.22 No.1

This research studied the Gaeseong Industrial District that is being developed to attain political and economic objectives as one of the three core initiatives to increase economic cooperation between South Korea and North Korea to draw out the implications that can be applied to the development of marketing strategy in the near future by analyzing the effect of North Korea’s image on the decision to consumers’ purchase products produced at the Gaeseong Industrial District. This research analyzes the correlation between the will to purchase products produced at the Gaeseong Industrial District and the consumers’perception of North Korea. The analysis shows that 80.4% of the research subjects are in fact willing to purchase especially clothes, bags and shoes since they expect lower prices and perceive that this increased interaction will stabilize the joint economic initiative conducted by South Korea and North Korea, as well as increase economic assistance to the North Korea. This will to purchase is affected by the economic, political and developmental aspects between North Korea and South Korea. Will to purchase is greater when the consumers perceive that the South Korea and North Korea’s relations are positive on the economic and political cooperation levels. In addition, the will is greater when there is perception that the economic and political threats are weak.

안와를 제외한 두경부의 염증성 가성종양: CT 및 MR 소견

노은진,유재욱,나동규,김삼수,한헌,한춘환,이시경,No, Eun-Jin,Yu, Jae-Uk,Na, Dong-Gyu,Kim, Sam-Su,Han, Heon,Han, Chun-Hwan,Lee, Si-Gyeong 대한영상의학회 2002 대한영상의학회지 Vol.46 No.5

목적: 안와를 제외한 두경부에서 발생한 염증성 가성종양의 MR 및 CT소견을 알아보고자 하였다. 대상과 방법: 조직학적으로 증명된 11명의 안와를 제외한 염증성 가성종양 환자를 대상으로 MR(n=10)와 CT (n=9)을 후향적으로 분석하였다. 9명의 환자에서 추적 검사를 시행했고 스테로이드에 대한 반응을 알아보았다. 결과: 병변은 저작공간 (n=8),협공간 (n=6),인두 (n=5),부비동 (n=4),인두주위간극 (n=3), 추전공간 (n=2), 안와 (n=2),경동맥공간 (n=2), 척추주위공간 (n=1), 이하선아 (n=1), 비 강및구강(n=1)을 침범하였다. 11명의 환자중 10명에서 주변 골 변화가 있었으며, 6명의 환 자에서 두개강내로 침범이 있었다. MR을 시행한 10명의 환자중 9명에서 T2-강조영상에서 병변이 저신호강도를 보였고, 이 중 4명에서는 현저한 저신호강도를 포함하고 있었다.종괴 전체에 고신호강도를 보이는 경우는 없었다.5명의 환자에서 스테로이드 투여후 종괴 크기가 감소하였다. 결론: 염증성 가성종양은 주변의 여러 공간을 침범하며 T2-강조영상에서 동등신호 강도부터 저신호강도까지 보였으며 림프절 종대를 보이지 않았다. Purpose: To determine the MR and CT imaging findings of inflammatory pseudotumor of the extraorbital head and neck. Materials and Methods: We reviewed the MR (n=10) and CT (n=9) imaging studies of 11 patients with this condition (M:F=5:6, age range: 35-75 years), analysing each case in terms of location, occupying space, signal intensity, intracranial involvement, degree of contrast enhancement and adjacent bone change. Follow-up images were obtained in nine cases, and the response of each patient to steroid treatment was reviewed. Results: Lesions involved the masticator space (n=8), the buccal space (n=6), the nasopharynx (n=5), the paranasal sinus (n=4), the parapharyngeal space (n=3), the prevertebral space (n=2), the orbit (n=2), the carotid space (n=2), the paravertebral space (n=1), parotid space (n=1), and the oral cavity (n=1). In ten of eleven cases, there was adjacent bone change. In three cases, the cavernous sinus was involved, and in two, the dura. One case involved both of them. At T2-weighted imaging, the lesions showed hypointensity in nine of ten cases; in four of nine, signal intensity was markedly low, and in no case was it diffusely high. In five of nine cases, the mass decreased in size after steroid therapy. Conclusion: Inflammatory pseudotumor showed iso-to hypointensity at T2-weighted imaging. Lymphadenopathy was not apparent.

유지 혈액투석 환자에서 관상동맥 석회화와 C-반응단백 및 감염질환 항체가와의 상관관계

최대희 ( Choe Dae Hui ),한선숙 ( Han Seon Sug ),이성원 ( Lee Seong Won ),이희영 ( Lee Hui Yeong ),정해혁 ( Jeong Hae Hyeog ),이승준 ( Lee Seung Jun ),이상현 ( Lee Sang Hyeon ),한헌 ( Han Heon ) 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.2

목 적 : 말기신부전 환자에서 심혈관계 질환의 유병률과 그로 인한 사망률은 매우 높으나 그 원인 인자에 대해서는 명확히 밝혀져 있지 않다. 최근 고전적 위험인자 외에 염증반응이나 만성감염성 질환이 심혈관계 질환 발생에 관여함을 시사하는 연구 결과들이 나오고 있다. 저자들은 말기신부전 환자에서 관상동맥 질환의 발생을 관상동맥 석회화 수치 (coronary artery calcification score, CACs)를 측정하여 알아보고 이들 새로운 위험인자들과의 관련성을 밝혀보고자 하였다. 방 법 : 강원대학교병원에서 유지 혈액투석 중인 33명의 환자 (남:여=23:10, 연령=57±12세)를 대상으로 단면적 연구를 시행하였다. Multirow spiral CT (MSCT)를 이용하여 면적과 부피를 기준으로 CACs를 측정하였고, 염증반응의 지표로서 high sensitivi쇼 C-반응단백 (hs-CRP)과 IL-6를 측정하였으며, C. pneumoniae의 IgA 및 IgG 항체가와 H. pylori, cytomegalovirus, herpes simplex 등의 IgG 항체가를 측정하여 다음과 같은 결과를 얻었다. 결 과 : MSCT로 측정한 CACs는 중앙값 (범위)이 면적:379 (0-3662), 부피:338 (0-2,968)이었고, 면적 및 부피에서 100 이상의 높은 수치를 보인 경우는 각각 24명으로 73%에서 관찰되었다. Log (hs-CRP)와 log (CACs)는 상관관계 (면적:r=0.37, p<0.05, 부피:r=0.39, p<0.05)를 보였으나 log (IL-6)는 log (CACs)와 유의한 상관관계를 보이지 않았다. C. pneumoniae IgA와 IgG 양성률 (>1:64)은 각각 35%와 97%였고, C. pneumoniae의 IgA 및 IgG 항체가는 CACs와 유의한 관련성이 없었으며, H. pylori, cytomegalovirus IgG, herpes simplex 등의 IgG 항체가도 CACs와 관련성이 없었다. 환자의 연령과 log(CACs)는 양의 상관관계 (면적:r=0.39, p<0.05, 부피:r=0.39, p<0.05)를 보였으나, 당뇨유무, 흡력, 투석기간, 신체질량지수, 혈압, 혈중 cholesterol, albumin, PTH, calcium, phosphorous 등은 CACs와 유의한 관련성이 없었다. 결 론 : 혈액투석 중인 말기피신부전 환자에서 관상동맥의 심한 석회화를 흔하게 관찰할 수 있었고, 염증지표인 hs-CRP가 관상동맥 석회화와 관련이 있었다. C. pneumoniae 등 만성감염성 질환들의 항체가는 관상동맥 석회화와 유의한 관련성을 보이지 않았으나, 향후 보다 많은 환자를 대상으로 전향적인 연구가 필요할 것으로 생각된다. Background : Cardiovascular mortality is high in patients with end-stage renal disease (ESRD). Although the factors contributing to ESRD-related vascular disease are incompletely understood, recent studies suggest that inflammatory reaction or chronic infectious disease may play an important role as new risk factors. The aim of present study was to measure coronary artery caleification score (CACs) and to investigate the association with various markers of systemic inflammatory reaction. Methods : We conducted a cross-sectional study in 33 ptients (M : F=23:10, age=57±12 years) on maintenance hemodialysis. Multirow spiral CT (MSCT) was performed in all patients to measure CACs utilizing area and volume calculations. We measured high sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) as indicators of inflammatory reaction, and measured IgA and IgG antibodies to C. pneumoniae, and IgG antibodies to H. pylori, cytomegalovirus, and herpes simplex. Results : Median CACs equaled 379 (range, 0-3,662) by area and 338(range, 0-2,968) by volume. CACs more than 100 was present in 24 (73%) patients. Log (hs-CRP) was positively correlated with log (CACs) (area : r=0.37, p<0.05, volume : r=0.39, p<0.05), but log (IL-6) was not. There was no significant relationship between CACs and antibody titers to C. pneumoniae, H. pylori, cytomegalovirus, and herpes simplex. Age was positively correlated with log (CACs) (area : r=0.39, p<0.05, volume : r=0.39, p<0.05), but the presence of diabetes, smoking history, the duration of dialysis, body mass index, blood pressure, and serum cholesterol, albumin, PTH, calcium, and phosphorous levels were not. Conclusion : Coronary artery calcification was common in ESRD patients on hemodialysis, and associated with increased hs-CRP, an indicator of the presence of inflammatory reaction. There was no significant relationship between antibodies to chronic infections such as C. pneumoniae, but large-scale longitudinal studies are needed to evaluate fully that. (Korean J Nephrol 2004;23(2):278-286)

혈액투석 중인 말기 신부전증 환자에서 관상동맥혈관 석회화와 혈청 Osteoprotegerin 및 Fetuin-A 농도의 상관관계

김상욱 ( Sang Wook Kim ),정해혁 ( Hae Hyuk Jung ),한헌 ( Heon Han ) 대한내과학회 2007 대한내과학회지 Vol.72 No.5

목적: 투석을 받고 있는 말기 신부전증 환자에서 관상동맥혈관 석회화 점수(coronary artery calcification score, CACs)와 혈청 OPG 농도 및 혈청 fetuin-A 농도의 상관관계를 알아보았다. 방법: 51명의 말기 신부전증 환자를 대상으로 MSCT를 촬영하여 CACs를 구하였으며, 혈청 OPG 농도와 fetuin-A 농도를 측정하였다. 모든 환자에서 체중, 신장, 혈압을 측정하였으며 심혈관 질환 병력과 투석기간을 조사하였다. 환자의 혈액을 채취하여 hs-CRP, 혈청 인, 혈청 CaxP, 혈청 지질 농도를 측정하였다. 결과: 대상 환자에서 혈청 OPG 농도의 평균값은 3,561±1,160 pg/mL, fetuin-A 농도의 평균값은 28.5±4.1 mg/dL이었다. 대상군의 연령, 성별, 체질량지수 (BMI), 흡연력, 당뇨병 유무를 보정하였을 때, 투석기간(p=0.0225), hs-CRP (p=0.0392), 혈청 인(p=0.0341), Ca x P(p=0.0434), 혈청 OPG 농도(p=0.0026), LDL 콜레스테롤(p=0.0438)이 관상동맥혈관 석회화 점수와 유의한 양의 상관관계를 나타내었다. 다변량 회귀분석에서는 혈청 OPG 농도(p<0.0001)와 혈청 인 농도(p=0.0003)가 CACs에 유의한 독립변수로 나타났다. CACs에 따라 3군으로 분류하여 비교한 결과, 혈청 OPG 농도는 CACs가 400 이상인 중증인 군에서 최소 또는 경미한 군 또는 중등도의 군과 비교하여 유의하게 높게 나타났으며 혈청 fetuin-A 농도는 CACs가 400 이상인 군에서 최소 또는 경미한 군과 비교하여 유의하게 낮게 나타났다. 결론: 유지 혈액투석을 받고 있는 말기 신부전증 환자에서 관상동맥혈관 석회화는 무기 인 대사의 장애, 혈청 OPG 농도의 증가와 밀접한 상관관계가 있었으며 혈청 fetuin-A 농도는 특히 관상동맥혈관 석회화가 심한 경우 저하되어 있음을 알 수 있었다. Background: Coronary artery calcification is frequently seen in hemodialysis patients. The development and progression of coronary artery calcification is similar to osteogenesis, and a naturally occurring serum inhibitor of calcification may be involved. The aim of this study was to evaluate the relationship between coronary artery calcification, bone remodeling related factor, serum osteoprotegerin (OPG), calcification inhibitor and the serum fetuin-A levels in hemodialysis patients. Methods: A total of 51 hemodialysis patient were assessed for their coronary artery calcium (CAC) scores with using multirow spiral computed tomography and measuring the serum OPG level, the serum fetuin-A level, the biochemical markers of inflammation, the lipid profile and the mineral metabolism. Results: The mean serum OPG level was 3,561±1,160 pg/mL and the mean serum fetuin-A level was 28.5±4.1 mg/dL. The CAC scores were significantly correlated with the duration of dialysis (p=0.0225), hs-CRP (p=0.0392), serum phosphate (p=0.0341), Ca x P (p=0.0434), the serum OPG level (p=0.0026) and LDL-cholesterol (p=0.0438), after adjusting for age, gender, BMI, smoking history and the presence of diabetes. Multiple regression analysis showed that the CAC scores were significantly associated with the serum OPG level (p<0.0001) and the serum phosphate level (p=0.0003). The subgroup of the patients with a CAC score greater than 400 (the severe CAC group) had significantly higher OPG levels and lower fetuin-A levels than the groups of the patients with lower CAC scores. Conclusions: Our data suggest that the CAC scores in the patients undergoing hemodialysis were related with higher serum OPG and higher serum phosphate levels. The serum fetuin-A level was significantly lower in the patients with severe coronary artery calcification. (Korean J Med 72:451-458, 2007)