흉벽에 발생한 인대 모양 종양(靭帶模樣腫瘍) : 증례 보고

최영칠,김요한 건국대학교 의과학연구소 1994 건국의과학학술지 Vol.4 No.-

Desmoid tumors beiong to a group of disorders called fibromatoses, which are charecterized by fibroblastic proliferation without evidence of inflammation or definite neoplasia. Historically, the desmoid fibromatoses have been divided into those affecting the soft tissue, usually striated muscle, of abdominal wall(the abdominal desmoid) and those affecting other region(the extraabdominal desmoid), also known as musculoaponeurotic fibromatoses. Desmoid may occur at any age, with a peak incidence in the 3rd decade. Extraabdominal desmoids usally occur in the soft tissue of extremities, pelvis, buttock and neck. It is unusual in chest wall. Authors experienced a case of desmoid tumor of the chest wall. CT scan showed poorly marginated soft tissue mass under pectoralis muscle, involving 1st chondrosternal junction, with slight and inhomogeneous contrast enhancment. RI bone scan was normal. Enblock resection was done, and confirmed fibroblastic overgrowth.

위절제술 후 발생하는 당뇨병의 원인과 병태생리에 관한 연구

최영식,고용호,박요한 고신대학교 의학부 1996 高神大學校 醫學部 論文集 Vol.11 No.1-2

Recently several cases of diabetes were found after undergoing gastrectomy. The loss of stomach profoundly affects glucose metabolism which may lead to the development of diabetes in a certain group of patients, particularly those with diabetic risk factors such as family history. obesity, and other insulin resistance states. The purpose of this study is to investigate the changes in the plasma lipids and glucose metabolism and the risk factors of diabetes in patients who are planned to undergo gastrectomy so that it may help for the treatment and prevention of gastrectomy-related diabetes. The non-diabetic patients who admitted to Kosin Medical Center for gastrectomy were prospectively studied since March 1, 1995. They were divided into 2 groups; those with family history of diabetes, overweight, obesity, or impaired glucose tolerance on oral glucose tolerance test (OGTT) (group Ⅰ, n=5) and those without (group Ⅱ, n=5). The ability to control blood glucose was evaluated by measuring blood glucose, insulin, C-peptide and glucagon during OGTT which was performed before and 1 month after gastrectomy. Ten out of 34 patients who entered the study were followed at 1 month after gastrectomy. Body weight decreased from 58.1±9.7 kg to 54.9±7.3 kg and values of other parameters of nutritional status also decreased. The levels of blood glucose, insulin, C-peptide, and glucagon generally increased at 0, 60, and 120 minutes during postoperative OGTT as compared to those levels during preoperative OGTT. The blood glucose level increased from 147.6±31.5 to 178.2±45.7 mg/dl at 60 min. (p=0.07) and the insulin level increased from 38.1±27.0 uU/ml to 113.6±96.1 uU/ml at 60 min. (p=0.05). In preoperative OGTT the insulin level was higher at 60 min. and at 120 min. in group I than in group Ⅱ (56.7±23.9 uU/ml vs. 19.4±11.6 uU/ml, p=0.03, 36.1±21.4 uU/ml vs. 8.51±6.9 uU/ml, p=0.03, respectively). Most patient took three meals a day and highly concentrated carbohydrate such as honey between meals. Impaired glucose tolerance developed postoperatively in one woman of overweight group but none of normal weight group. The development of impaired glucose tolerance in one of 3 overweighted women and abnormal glucose metabolism in general after gastrectomy suggests that postoperative risk of development of impaired glucose tolerance be substantial, particularly in patients with diabetic risk factors such as obesity. To prevent the development of postoperative abnormal glucose metabolism adequate weight control before operation, preferably from young age, and postoperative measures to decrease excessive insulin secretion and hence insulin resistance, such as frequent small meals which consist of low carbohydrate and increased mono- and polyunsaturated fatty acid are suggested.

지속형 인슐린 투여 중인 제2형 당뇨병환자에서 단기간 전화 상담이 혈당관리에 미치는 효과

최인환,최영식,박요한 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4

Background: Diabetes is a chronic non-curable diseases with chronic complications. To maintain within normal blood sugar level is demanded for the treatment and prevention of type 2 diabetes. The purpose of this study was to evaluate the effects of a short-term telephone counsel on glucose control in LantusⓇ using type 2 diabetes. Methods: Sevety-one type 2 diabetes patients who were treated with LantusⓇ at Kosin University Gospel hospital participated. Thirty-three were assigned to control group and 38 were intervention group. Telephone counsel was applied three times per week and both groups were assessed by pre-test, and at 1 month, 2 months, and 3 months. Results: In control groups, the mean fasting blood sugar level of pretest (199.03±37.62 mg/dL) was significantly decreased after 1 month (138.83±25.88 mg/dL), 2 months (129.21±27.07 mg/dL), and 3 months (112.48±9.165 mg/dL), respectively (p<0.001). HbA1c level of pretest (9.95± 1.28 %) also significantly decreased after 3 month (7.92±0.65 %) (p<0.001). In intervention groups, the mean fasting blood sugar level of pretest (199.82±46.94 mg/dL) was significantly decreased after 1 month (145.24±21.53 mg/dL), 2 months (127.21±17.89 mg/dL), and 3 months (123.06±17.66 mg/dL), respectively (p<0.001). HbA1c level of pretest (10.67± 2.11 %) also significantly decreased after 3 month (7.15±0.49%) (p<0.001). After 3 months of consults, significant differences of the mean fasting blood sugar and HbA1c levels between both groups were founded. Increasement of mean body weight was lower than 0.5kg in both group. Care satisfaction scale was also significantly differed between control and intervention groups. Conclusions: These findings indicated that short-term telephone counsel would improve glucose levels and HbA1c in insulin treated type 2 diabetes.

갑상선암에서 MAGE-1, -2, -3, -4, -5 및 -10 유전자의 발현

최영식,임학,박요한,이강대,이재화,장희경 대한내분비학회 2001 Endocrinology and metabolism Vol.16 No.4-5

요고가와 吸蟲 및 肝吸蟲의 疫學的 調査 : 耽津江流域을 中心으로

최신철,문재규,정요한 조선의대 1984 The Medical Journal of Chosun University Vol.9 No.1

미만성 경화 아형 갑상선 유두암 1예

최정민,이송주,김부경,최영식,박요한,김정훈,허방 고신대학교 의과대학 2009 고신대학교 의과대학 학술지 Vol.24 No.1

The diffuse sclerosing variant (DSV) is a rare malignant tumour that accounts for 0.7-5.3% of all papillary thyroid cancers. DSV tends to occur at a younger age and has a higher incidence of cervical lymph node metastases, compared with papillary thyroid carcinoma. A 62-year-old female patient diagnosed thyroid nodule with diffuse and mild increased 18F-deoxy-glucose (FDG) on FDG positron emission tomography (PET)-computed tomogram (CT) scan. The ultrasound images showed typical findings of DSV such as diffusely enlarged thyroid lobes and diffusely scattered microcalcification. We performed this patient ultrasonography guided fine needle aspiration and cytologic analysis revealed papillary carcinoma. Total thyroidectomy with central compartment node dissection and lateral lymph node dissection was performed and finally diagnosed DVS. The authors report this case with literature review.

QFD 기법을 이용한 업무상질병 예방을 위한 근로자 의식분석

임영문,최요한 한국안전학회 2003 한국안전학회지 Vol.18 No.2

There are many and various problems due to a disease in the work. These problems result in serious social problems such as individual and family problem, economical loses of company. The objective of this study is to analyze the worker's consciousness and provide the precautionary measures for prevention of a disease in the work. Also, this paper presents quantitative value of priorities for prevention of a disease in the work using QFD technique. The samples for this study are chosen from the companies with less than 300 employees under charge of the Kangnung Ministry o1 Labor during three months (2002. 3. 2 ~ 2002. 5. 31).

갑상선암 예측에 있어 초음파적 변수 분석

임현정,최영식,박요한,오경승,이강대 고신대학교 의학부 2004 高神大學校 醫學部 論文集 Vol.19 No.1

Background: The introduction of high resolution sonography has made it possible to detect nodules in the thyroid gland. However, there has been no reliable sonographic sign for distinguishing between benign and malignant thyroid conditions. The aim of present study was to evaluate ultrasonographic (US) parameters in predicting thyroid cancer. Methods: One hundred fifty three patients who underwent thyroidectomy at Kosin Medical Center from January, 2000 to April, 2002 were included in the study. All patients were checked high resolutional US before surgery. Of the 153 patients 89 were malignant tumors and 64 benign. Malignant US parameters were defined as calcification, irregular margin, more taller than wide, and fat line obliteration. Calcification pattern was classified with single, punctated, and amorphous calcification. The US characteristics to predict malignancy were evaluated by means of multiple logistic regression analysis. Results: All of the malignant sonographic parameters such as calcification, 53 (89.8%) were thyroid carcinoma. The incidence rate of malignancy was 55.9% in solitary nodules and 65.7% in multiple nodules (p=0.303). Even though nodule size was less than 1.5㎝, the incidence of malignant tumor was 69.5% (p=0.04). Of 53 malignant nodules with calcification, the incidence of single, punctated, and amorphous calcification pattern was 6 (11.3%), 22 (41.5%), 25(47.2%), respectively. The sensitivity, specificity, positive and negative predictive value, and accuracy of sonographic parameters were 76.4%, 87.5%, 89.5%, 72.7% and 81.0%, respectively. Upon the correlation of US-guided FNA cytology with pathologic diagnosis, the sensitivity of ultrasound-guided FNA cytology in differentiating benign and malignant nodule was 85.9%, the specificity 100% and overall diagnostic accuracy was 91.2%. The sensitivity, specificity, and accuracy of US parameters associated to follicular neoplasm, all were 75.0%. Conclusion : All the malignant US parameters including calcification, irregular margin, and more tall than wide showed high level of sensitivity, specificity and accuracy. Of these parameter, calcification and irregular margin were more significants. The more presence of calcifications with punctated and amorphous pattern could suggest the higher possibility of malignancy. However, further study is needed for clinical application of malignant US parameters in the thyroid tumors.

PTEN 유전자 돌연변이를 동반한 Cowden병 1예

남성진,최영식,박요한,김규종,박선자 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4

Cowden's disease, also known as various hamartomatous malformations of multiple organs, is a rare autosomal dominant disorder. The most important feature of Cowden's disease is an increased incidence of malignant neoplasm, particularly in the breast and thyroid gland. PTEN (phosphatase and tensin homologue deleted in chromosome 10) is a candidate tumor suppressor gene. Mutations of this gene are responsible for PTEN hamartoma tumor syndromes, including Cowden's disease, Bannayan-Riley-Ruvalcaba syndrome, Proteus syndrome, and Proteus-like syndromes. After identification of PTEN as the gene for Cowden's disease, the incidence of Cowden's disease was estimated to be 1 in 200,000. However Cowden's disease with malignant neoplasm is quite rare in Korea so far. Recently we experienced a family with Cowden's disease who carry a frame shift germline mutation(C.606del T) at 10q23, exon 6 of PTEN gene. The authors report this case with literature review.

갑상선 유두선암 환자의 말초 혈액 단핵구로부터 수지상세포분화와 자가 세포독성 T 림프구 활성화 유도

송수근,최영식,박요한,이대희,장희경 고신대학교 의학부 2004 高神大學校 醫學部 論文集 Vol.19 No.1

Background: Dendritic cells (DCs) are rare leucocytes that are uniquely potent in their ability to capture, process and present antigens to T cells, and so selectively migrate through tissues to reach lymph nodes and spleen where initiation of immune responses takes place. It has been reported that a dense infilteration of dendritic cells correlates with a favorable prognosis in several types of cancer. A similar correlation also has been noted in patients with papillary carcinoma of thyroid. The purpose of this study is to determine whether DCs are generated from peripheral blood monocytes by using cytokines such as GM-CSF, TNF-α, and IL-4 and whether cytotoxic T cells activated by DCs attack the papillary carcinoma tissues. Methods: Peripheral blood was obtained from 2 patients with thyroid papillary cancer. DCs were established from monocytes by culturing in the presence of GM-CSF, Flt-3 ligand. TNF-α , and IL-4 for14 days. At day 14, expression of surface markers typical for DCs was analyzed morphologically. The immunophenotypic features of DCs such as CDla, CD83, and CD86 were analyzed by phase contrast microscopy. At day 15 DCs were incubated with thyroid cancer tissues and normal thyroid tissues for 7 days. Results: DCs were generated from the peripheral blood monocytes. The generated cells had the classic morphology of DCs. Activated cytotoxic T lymphocytes (CTLs) were observed. Veiled cell known as circulating DCs attached to the thyroid cancer tissues were observed. The CTLs activated by DCs were observed to attack the papillary carcinoma tissues by scanning electron microscope. However, normal tissues were not attacked by CTLs. Conclusion: DCs can be generated from the peripheral blood monocytes. Futhermore, the CTLs activated by DCs also can attack the papillary carcinoma tissues. These results that DCs can be used as adjuvants for adoptive immunotherapy of papillary thyroid cancer.