94세 노인에서 발생한 자발성 안구 파열

박대일,박종서,강혜윤,유혜린,Dae Il Park,Jong Seo Park,Hae Youn Kang,Helen Lew 대한안과학회 2011 대한안과학회지 Vol.52 No.6

Purpose: To report a case of spontaneous eye ball rupture without trauma in a 94-year-old patient. Case summary: A 94-year-old female patient diagnosed with cataract in both eyes 20 years was referred to this ophthalmologic department for treatment consultation of a painful left eye with spontaneous bleeding. She has used anticataract eye drops and artificial tears three times a day for several years without consulting a doctor. Fifteen days prior to presentation, the patient suffered severe left eyeball pain and headache and was diagnosed with acute angle-closure glaucoma secondary to hypermature cataract. She underwnet eviceration after ocular examination and systemic evaluation. Surgical findings included a thin cornea at the inferior limbus and protruding intraocular tissues. Additionally, the eyeball was filled with a blood clot from a choroidal hemorrhage. Morganella morganii were grown in a bacterial swap culture, and a corneal biopsy revealed suppurative inflammation. Conclusions: In old age, a thin corneal limbus due to infection and complicated acute angle-closure glaucoma can cause massive suprachoroidal hemorrhage with spontaneous eyeball rupture. J Korean Ophthalmol Soc 2011;52(6):734-737

위암에서 Microsatellite Instability와 Thymidylate Synthase의 상관관계

고현석,안창욱,강혜윤,김광일,홍성표,안대호,Ko, Hyun-Seok,Ahn, Chang-Wook,Kang, Hae-Youn,Kim, Kwang-Il,Hong, Sung-Pyo,Ahn, Dae-Ho 대한위암학회 2008 대한위암학회지 Vol.8 No.4

목적: 대장암에서 microsatellite instability high (MSI-H)를 보인 환자가 microsatellite stable (MSS) 또는 microsatellite instability low (MSI-L)를 가진 그룹보다 예후가 좋은 것으로 되어 있으나 II기, III기 대장암에서 MSI-H를 보인 환자가 MSS 또는 MSI-L를 가진 그룹보다 5-fluorouracil (5-FU)에 대한 효과가 떨어진다는 연구 보고가 있다. Thymidylate synthase (TS)는 DNA 합성에 필요한 물질임과 동시에 5-FU의 표적물질이며 암환자에서 TS 발현율이 높을수록 5-FU에 의한 항암치료 효과가 감소한다. 이와 같이 MSI가 높을수록, TS 발현이 높을수록 5-FU에 대한 감수성이 떨어지기 때문에 MSI와 TS간의 상관관계를 밝히려는 연구가 대장암 환자를 대상으로 시도되었으나 현재까지의 결과는 상관관계가 있다는 보고와 없다는 보고가 있어서 일정하지 않다. 위암 환자에서는 MSI와 TS의 관계에 대한 연구는 없다. 따라서 본 연구에서는 위암 환자에서의 MSI와 TS 발현정도의 상관관계를 분석하였다. 대상 및 방법: 2004년 1월부터 2006년 5월까지 분당차병원에서 위암으로 근치적 위절제술을 시행 받은 환자 중 99명을 대상으로 MSI 및 TS 발현 정도를 비교 분석하였다. MSI는 5개의 표지자(BAT25, BAT26, D2S123, D5S346, D17S250)에 대해서 분석하였고 TS는 면역조직화학 염색으로 그 발현 정도를 측정하였다. 결과: 전체 99예의 환자에서 MSS/MSI-L 및 MSI-H인 경우가 각각 92 (92,9%), 7 (7.1%)예였고 TS에 대한 면역조직화학 염색 정도에 따라 negative, low TS 및 high TS인 경우는 각각 46 (46.5%), 33 (33.3%), 20 (20.2%)예였다. MSS/MSI-L 92예에서 TS의 negative, low TS, high TS는 각각 46 (50%), 30 (32.6%), 16 (17.4%)예였고 MSI-H인 7예에서는 TS의 negative, low TS, high TS가 0 (0%), 3 (42.9%), 4 (57.1%)예로 MSI-H 7예 모두에서 TS를 발현하였고 검정 결과 통계적으로 유의하게 MSI-H와 high TS 간에는 상관관계가 있었다. 결론: 위암환자에서 MSI-H를 보인 경우가 MSS/MSI-L를 보인 경우보다 더 높은 TS의 발현을 보였다. Purpose: The main target of 5-fluorouracil (5-FU) is thymidylate synthase (TS). A high TS expression has been identified as promoting resistance to 5-FU. For colorectal cancers, the response to 5-FU based adjuvant chemotherapy is different according to the microsatellite instability (MSI) status. The reports on the relationship between MSI and the TS expression in colorectal cancer have been inconsistent. No data is available for gastric cancer regarding the relationship between MSI and the TS expression. Therefore, we studied the relationship between MSI and the TS expression in gastric cancer. Materials and Methods: Ninety-nine consecutive patients who underwent radical gastrectomy for gastric cancer from January 2004 to May 2006 at Bundang CHA hospital were studied. MSI was assessed for five markers (BAT25, BAT26, D2S123, D5S346, and D17S250) by PCR and with using an ABI prism 3100 Genetic analyzer. The TS expression was analyzed by immunohistochemistry with using mouse anti-thymidylate synthase monoclonal antibody to the TS 106 clone. Results: Out of the ninety-nine patients, MSS/MSI-L was detected in 92 (92.1%) cases and 7 cases (7.1%) were MSI-H. A negative TS expression was found in 46 (46.5%) cases, a low TS expression was found in 33 (33.3%) and a high TS expression was found in 20 (20.2%). Out of 92 MSS/MSI-L patients, the number of patients with negative, low and high TS expressions were 46 (50%), 30 (32.6%) and 16 (17.4%), respectively. Out of the 7 MSI-H patients, the number of patients with negative, low and high TS expressions were 0 (0%), 3 (42.9%) and 4 (57.1%), respectively. The relationship between MSI-H and a high TS expression was statistically significant. Conclusion: Gastric cancer with MSI-H showed higher levels of a TS expression compared to the gastric cancer with MSS/MSI-L.

폐출혈과 급속 진행성 사구체신염을 동반한 현미경적 다발성 동맥염 (Microscopic Polyangiitis) 1례

권해식,이영목,김지홍,김병길,강혜윤,홍순원,정현주,Kwon Hae Sik,Lee Young-Mock,Kim Ji Hong,Kim Pyung-Kil,Kang Hae Youn,Hong Soon Won,Jeong Hyeon Joo 대한소아신장학회 2001 Childhood kidney diseases Vol.5 No.2

현미경적 다발성 동맥염은 폐출혈과 급속 진행성 사구체신염을 특징으로 하는 전신성 혈관염의 일종으로 소아에서 매우 드문 질환이다. 저자들은 폐출혈과 급성신부전을 동반한 7년 9개월된 여자 환아에서 신장조직 검사와 p-ANCA(perinuclear antineutrophil cytoplasmic autoantibodies) 검사로 현미경적 다발성 동맥염을 진단할 수 있었으며 이후 methyl-prednisolone pulse therapy와 cyclophosphamide, 4회의 혈장 교환 치료를 병행하였다. 환아 내원 당시 BUN 117 mg/dL, Cr 2.3 mg였으나 입원 제 60병일째 BUN 20.8 mg/dL, Cr 1.6 mg 으로 감소하고 혈뇨, 단백뇨는 지속되었으나 폐출혈 소견 호전되고 전신상태 양호하여 현재 외래 추적 관찰 중에 있다. 이에 국내외의 문헌 고찰과 함께 보고하는 바이다. Microscopic Polyangiitis(MPA) belongs to a spectrum of systemic vasculits, and particularly antineutrophil cytoplasmic autoantibodies(ANCA)-associated small-vessel vasculitis which is characterized by involvement of the lung and kidney. The diagnosis of MPA is often difficult to make, and delayed because of the variability of the clinical presentation. Renal biopsies have a very important diagnostic and prognostic value in MPA. We experienced a case of microscopic polyangiits which was confirmed by renal biopsy and positive serum perinuclear ANCA, associated with alveolar hemorrhage and gastrointestinal bleeding. We began methylprednisolone pulse therapy, combined with a low dose of cyclophosphamide and plasmapheresis therapy. ACE inhibitor and Ca channel blocker were used when proteinuria and hypertention developed. On admission, the patient's lab findings showed BUN l17 mg/dL, Cr 2.3 mg/dL, while on the 60th hospital day BUN/Cr values fell to 20.8 mg/dL / 1.6 mg/dL and though proteinuria persisted, the patient's condition was tolerable and is currently under observation on an out-patient basis. The last lab values were BUN 26 mg/dL / Cr 1.6 mg/dL. (J. Korean Soc Pediatr Nephrol 2001 ; 5 : 213-18)

막성증식성 사구체신염 제 II형 (Dense Deposit Disease, DDD) 1례

권해식,오승진,이영목,김지홍,김병길,강혜윤,정현주,최인준,Kwon Hae Sik,Oh Seung-Jin,Lee Young-Mock,Kim Ji Hong,Kim Pyung-Kil,Kang Hae Youn,Jeong Hyeon Joo,Choi In Joon 대한소아신장학회 2001 Childhood kidney diseases Vol.5 No.2

제2형 막증식성 사구체 신염은 전자현미경 검사 상 기저막 내에 리본과 같은 형태의 전자고밀도물질이 참착되어 지속적인 보체의 감소와 혈뇨, 단백뇨등을 나타내는 원발성 사구체 질환이다. 저자들은 내원 4년 전에 신장조직검사상 연쇄상구균 감염 후 급성사구체 신염을 진단 받은 후 4년 이상 지속되는 혈뇨와 보체의 감소로 재차 시행한 신장조직검사상 확진된 제 2형 막증식성 사구체신염 1례를 경험하였기에 국내외 문헌 고찰과 함께 보고하는 바이다. Type II membranoproliferative glomerulonephritis (Dense deposit disease) is an acquired primary glomerular disease characterized by electron microscopic evidence of a continuous dense membrane deposition replacing the lamina densa. It is a subtype of idiopathic membra- noproliferative glomerulonephritis, and was described as a separate entity by Berger and Galle in 1963. It frequently occurs in older chilren and young adults and the clinical course is variable, but is generally progressive. The presenting feature is nephrotic syndrome in many patients, and proteinuria and hematuria are also seen frequently. The purpose of this paper is to present a case of DDD (Dense deposit disease) from a 10 year old boy who was diagnosed as a acute poststreptococcal glomurulonephritis with protenuria, hematuria, and facial edema by renal biopsy 4 years ago. (J, Korean Soc Pediatr Nephrol 2001 ; 5 : 188-95)

증례 : 순환기 ; 유방암 환자에서 동반된 폐동맥 종양 혈전성 미세혈관병증 1예

유정환 ( Jeong Hwan Yoo ),김용훈 ( Yong Hun Kim ),김대영 ( Dae Young Kim ),강혜윤 ( Hae Youn Kang ),김인재 ( In Jai Kim ),임상욱 ( Sang Wook Lim ),차동훈 ( Dong Hoon Cha ) 대한내과학회 2009 대한내과학회지 Vol.76 No.1S

무릎관절의 미만형 색소 융모 결절성 활액막염에서 관절경을 이용한 육안적 활액막 전 절제술 후 방사선치료

장세경(Sei Kyung Chang),김재화(Jae Hwa Kim),하두회(Doo Hoe Ha),강혜윤(Hae Youn Kang),정소영(So Young Chong),신현수(Hyun Soo Shin) 대한방사선종양학회 2006 Radiation Oncology Journal Vol.24 No.3

색소 융모 결절성 활액막염(pigmented villonodular synovitis, PVNS)은 병인이 밝혀지지 않은 증식성 질환으로, 병변 의 범위에 따라 국소형과 미만형으로 분류되며, 조직학적으로 양성이지만 파괴적인 성향을 보이므로 연골의 파괴나 주위 조직으로 광범위한 침윤이 가능한 질환이다. 활액막 절제술이 일차적인 치료방법이지만 미만형인 경우에는 주위 조직을 침윤하는 성향 때문에 재발률이 높다. 재발이 반복된 후에는 수술적 절제가 어려워져서 병변부위의 절단이 필요하게 되므로, 광범위한 병변인 경우, 수술이 용이하지 않은 경우, 또는 불완전 절제가 시행된 경우 등에서 방사선치료를 시행하여 재발을 방지할 수 있다고 보고되고 있다. 저자들은 무릎관절의 미만형 색소 융모결절성 활액막염으로 관절경을 이용한 육안적 활액막 전 절제술 후 방사선치료를 시행한 2예를 경험하였기에 문헌고찰과 함께 보고하고자 한다. Pigmented villonodular synovitis (PVNS) is a rare proliferative disease involving synovial membranes. Natural history and etiology of PVNS are not well known. PVNS presents as localized or diffuse tumor like nodular lesion of the synovial lining of the joint and the synovial spaces adjacent to the joints. Though histologically benign, it is a very aggressive lesion, capable of bone destruction and widespread infiltration of surrounding tissues. Standard therapy is surgical resection, but due to the infiltrative growth, the recurrence rate is significantly high. After several relapses surgical treatment of diffuse PVNS becomes difficult and may require amputation of the involved limb. Radiotherapy can provide an effective treatment option for patients with large lesions or lesions which are not suitable for surgery, after incomplete resection to prevent relapses or to avoid amputation. We report 2 cases of diffuse PVNS in the knee joint treated with arthroscopic gross total synovectomy and radiotherapy.

갑상선 기능항진증이 동반된 미분화 갑상선암 1예

이효상(Hyo Sang Lee),정웅윤(Woung Yoon Chung),강혜윤(Hae youn Kang),박정수(Cheong Soo Park) 대한두경부종양학회 2001 대한두경부 종양학회지 Vol.17 No.1

Anaplastic thyroid carcinoma, which is one of the most aggressive tumors of the thyroid, has been seldomly reposted to have altered thyroid function. There have been few reports of patients with anaplastic thyroid cancer presenting in a hyperthyroid state. In the literatures, the mechanism of hyperthyroidism in anaplastic thyroid cancer is supposed that the rapid invasive growth of cancer seems to cause destruction of thyroid tissue and develops a hyperthyroid state, which is thought to be anlalogous to that of subacute thyroiditis and several types of metastatic cancer of the thyroid: rapid tissue necrosis with resultant release of thyroid hormone. Recently, we experienced a case of anaplastic thyroid cancer presenting with rapid growing mass and hyperthyroidism in a 67-year-old woman and report it with the review of the literatures.

타액선에 발생한 상피-근상피암 4예

최동진(Dong Jin Choi),서진학(Jin Hak Suh),정웅윤(Woung Youn Cheong),최은창(Eun Chang Choi),김형준(Hyeong Joon Kim),강혜윤(Hae Youn Kang),박정수(Cheong Soo Park) 대한두경부종양학회 2001 대한두경부 종양학회지 Vol.17 No.2

Epithelial-myoepithelial carcinoma is a rare neoplasm comprising approximately 1% of all salivary gland neoplasms. Histopathologically, the carcinomas are characterized by a dual cell population of an inner duct-forming epithelium and an outer myoepithelial cell. They are characterized by their variable clinical course and a lack of features that predict clinical outcome. The following report describes our experience with this type of tumor. We suggest that radiation therapy and long term follow-up will be necessary because this tumor have a high risk of locoregional aggressiveness.

폐혈전색전증을 유발한 거대 자궁근종

이승은 ( Seung Eun Lee ),정상근 ( Sang Geun Jung ),김미경 ( Mi Kyoung Kim ),박지현 ( Ji Hyeon Park ),강혜윤 ( Hae Youn Kang ),김만득 ( Man Deuk Kim ),목정은 ( Jung Eun Mok ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.8

원발성 간세포암과 함께 진단된 점액표피양종양 1 예

김용수,김유미,박영년,심광용,박찬일,유내춘,강혜윤,노재경,박정엽,강이화 대한내과학회 2001 대한내과학회지 Vol.61 No.2

Mucoepidermoid carcinoma is a common malignant tumor of the salivary glands, but rare in other sites. Only 10 cases of mucoepidermoid carcinoma of liver have been reported, and there was 1 case of double primary cancer of hepatocellular carcinoma and mucoepidermoid carcinoma. The definite diagnosis and pathogenesis are still controversial. However, hepatocellular carcinoma is the second most common cancer in Korea. Its etiology is better known compared to mucoepidermoid carcinoma. We report a rare case of double primary cancer of mucoepidermoid carcinoma and hepatocellular carcinoma in liver.(Korean J Med 61:162-167, 2001)