새로운 액체성 색전물질(Embol)을 이용한 신동맥 색전술: 토끼에서의 실험적 연구

정규식,고지호,김현철,이상희,오경승,허진도,조영덕,허방,박상수,Jung, Gyoo-Sik,Ko, Ji-Ho,Kim, Hyun-Chul,Lee, Sang-Hee,Oh, Kyung-Seung,Huh, Jin-Do,Joh, Young-Duk,Hur, Bang,Park, Sang-Soo 대한영상의학회 2002 대한영상의학회지 Vol.46 No.1

목적: 새로 개발된 액체성 색전물질로 토끼에서 신동맥 색전술을 시행하여 그 효과와 안전성을 입증하고 영구적 색전물질로서의 임상적용 가능성을 평가할 목적으로 이 연구를 시행하였다. 대상과 방법: 사용한 색전물질은 Polyvinylacetate(PVAc)를 부분 가수분해하여 만든 Embol로서 45%의 에탄올과 55%의 비이온성 수용성조영제를 용매로 사용하므로 우수한 방사선비투과성을 가진다. 15마리의 토끼를 실험동물로 사용하였으며, 투시 하에서 평균 0.8(0.5-0.9)cc의 Embol을 신동맥에 주입하여 색전을 하였고 5분 후에 추적 혈관조영술을 시행하여 색전의 효과를 확인한 뒤에 시술을 마쳤다. 토끼를 5마리씩 3군으로 나누어 각각 3일(I군), 2주(II 군), 4주(III군)후에 추적 혈관조영술을 시행한 뒤 토끼를 희생시켜 양측 신장과 신동맥을 적출하여 조직표본을 제작하였다. 각군에서 시술 직후와 추적기간 동안의 혈관조영술 소견과 조직 소견을 관찰하였다. 각군의 토끼 1마리에서 시술전과 희생시키기 전에 DMSA 신스캔을 시행하였고, 다른 3마리에서는 시술 전과 시술 후 1, 3, 5, 7, 14일에 혈액을 채취하여 혈청 BUN, Creatinine, Sodium(Na), Potassium(K)의 수치를 조사하였다. 결과: Embol은 투시 하에서 색전과정의 관찰이 용이할 정도로 방사선비투과성이 우수하여 안전하게 주입할 수 있었다. 시술 5분 후에 시행한 혈관조영술에서는 신동맥 원위부의 완전한 폐색이 14예, 엽간동맥(interlobar artery)의 폐색이 1예에서 관찰되어 전예에서 색전술은 성공적이었다. 시술 후 혈청 전해질 수치는 약간 증가하였으나 모두 정상범위였다. 각 군에서의 추적 혈관조영술에서는 I군과 III군의 각각 1마리를 제외한 모든 토끼에서 신동맥의 폐색이 유지되었다. 각군에서 시행한 신스캔에서는 모두 색전을 시행한 신장의 섭취가 전혀 관찰되지 않았다. 추적기간동안의 색전을 시행한 신장의 크기는 I 군에서는 정상 신장에 비해 커졌으나 II군과 III군에서는 계속해서 크기가 감소하였다. 조직 소견은 3 군 모두 신조직의 전반적인 응고괴사 소견이 관찰되었으며, III군에서는 신피질에 두꺼운 띠모양의 석회화가 관찰되었다. I군에서는 신동맥 내강이 기질화되지 않은 혈전으로 차 있었고, II군과 III군에서는 신동맥 내강은 기질화된 혈전으로 차 있었으며 III군에서는 혈전의 석회화도 관찰되었다. 결론: Embol을 이용한 토끼에서의 신동맥 색전술은 이 색전물질의 우수한 방사선비투과성으로 안전하게 사용할 수 있었으며 또한 효과적이고 영구적인 신조직의 괴사를 유발하여 앞으로 임상적용이 가능하다고 생각된다. Purpose: To evaluate the effectiveness and safety of a new liquid embolic agent in renal arterial embolization in the rabbit, and its clinical applicability. Materials and Methods: A new embolic agent, Embol, was obtained by partial hydrolysis of polyvinyl acetate and dissolved in a mixture of 45% ethanol and 55% non-ionic contrast medium. Its radioopacity was therefore good. An average of 0.8 cc(0.5-0.9 cc) of Embol was used to embolize the renal artery of one kidney in 15 rabbits. The immediate effect of this was examined angiographically 5 minutes after the procedure. To permit histologic examination, five rabbits in each group were sacrificed 3 days (I), 2 weeks (II), and 4 weeks (III) after embolization: prior to embolization and prior to sacrifice, one rabbit in each group underwent renal scanning, and prior to sacrifice all underwent follow-up angiography. In three rabbits, blood urea nitrogen (BUN), creatinine, sodium(Na), and potassium(K) levels were measured before and 1, 3, 5, 7 and 14 days after embolization. Results: Embol was easy to use and its radiopacity was good. Five minutes after embolization, angiography showed that total occlusion of the main renal or interlobar artery had been achieved in all rabbits. Serum BUN, creatinine, Na and K levels were within normal limits. Follow-up angiogram obtained in each group showed persistent occlusion of the renal artery in all but one rabbit in group I and one in group III. Renal scans revealed no evidence of radionuclide uptake in embolized kidneys, which were slightly enlarged in group I but became gradually smaller in groups II and III. In all animals, histologic examination showed diffuse coagulation necrosis of the embolized kidneys and in group III the cortex of these was extensively calcified. In group I the renal artery showed an apparently fresh occluding thrombosis, and in groups II and III a completely organized thrombosis was present. In group III this was calcified. Conclusion: Because of its good radioopacity, Embol is easy to controa, and is effective for renal artery embolization. As a permanent embolic agent, it appears suitable for clinical applications.

위암 날문부 폐쇄 환자에게 시행한 치료의 비교고찰: 위-공장 우회술과 금속성 자가팽창성 스텐트 삽입술

조성진,윤기영,최경현,박무인,박선자,고지호,이상호,Jo, Seung-Jin,Yoon, Ki-Young,Choi, Kyung-Hyun,Park, Moo-In,Park, Seun-Ja,Ko, Ji-Ho,Lee, Sang-Ho 대한위암학회 2007 대한위암학회지 Vol.7 No.2

목적: 위암에 의한 위출구 폐쇄는 다양한 소화기 증상과 영양 실조를 야기하며, 따라서 삶의 질을 떨어뜨리고 생명을 단축시킨다. 이처럼 위날문부 폐쇄 환자에게 시행하는 스텐트삽입 시술은 위 공장 우회술에 비교하여 덜 침습적이고 효과적인 시술로 알려져 있다. 그러나, 위암에서의 스텐트 시술의 효과와 위공장 우회술의 효과에 대한 비교연구는 찾아볼 수 없다. 대상 및 방법: 2000년 1월부터 2006년 8월까지 고신대학교 복음병원에서 내시경 및 위장관 조영술을 이용하여 위암으로 인한 위 날문부 폐쇄를 진단 받고, 위 날문부 스텐트 삽입시술을 받은 환자군과 위공장 우회술을 받은 환자군 간의 데이터 통계를 1개월에서 46개월까지 추적 관찰한 외래 차트를 바탕으로 후향적으로 비교하였다. 이 중 위암의 재발로 인해 시술을 받은 환자와 이중암(double cancer)으로 진단을 받은 환자는 제외하였다. 결과: 100명의 환자가 스텐트 삽입을 시행받았고, 31명의 환자가 위 공장 우회술을 시행받았다. 두 그룹 간 남녀 성별 비는 통계적인 의미가 없었으나(스텐트 M : F 2 : 1, 우회술 M : F 2 : 1, P=0.637) 연령은 스텐트군은 $67{\pm}10$, 우회술군은 $57{\pm}10$ (P<0.001)으로 통계적인 의미가 있었다. 스텐트 삽입군에서 수술을 못한 이유는 60%의 경우 암진행, 34%의 경우는 고령, 6%의 경우는 동반질환의 중중도에 의하였고, 스텐트 시술 후 가장 gms한 합병증은 스텐트내 종양성장, 다음으로 스텐트 이동이었고 시술의 실패는 3%였다. 두 군 간 시술 후 유동식까지 걸린 시간은 스텐트군 $3{\pm}2$ (일), 우회술군은 $6{\pm}2$ (일)(P=0.003) 그리고 시술 후 입원기간은 스텐트군 $5{\pm}2$ (일), 우회술군 $15{\pm}6$ (일)(P<0.001)로 모두 통계적으로 유의한 결과가 나왔다. 결론: 위암의 날문부 폐쇄 환자에게 시행한 자가팽창 금속성 스텐트 시술은 위장 우회술에 비하여 빠른 식 사진행과 짧은 입원기간으로 효과적인 시술일 수 있지만, 스텐트가 움직이거나 종양의 재성장으로 인해 스텐트를 다시 시술해야하근 불편함이 있는 등 스텐트로 인한 환자의 불편함이 많아서 향후 더욱 많은 연구가 필요할 것이다. Purpose: In gastric cancer patients with gastric outlet obstruction, there are several complications such as malnutrition and vomiting. Palliative enteral stenting is a less invasive procedure as compared with a gastrojejunostomy. The aim of this study was to determine whether there was a significant difference between patients that undergone palliative enteral slanting and patients that had received a bypass gastrojejunostomy. Materials and Methods: One hundred patients underwent palliative entering stenting and 3f patients were subjected to a surgical bypass gastrojejunostomy. We reviewed the medical records of the patients with gastric outlet obstruction secondary to far advanced gastric cancer that were diagnosed using a gastrofibroscope, UGI and abdominal CT, and were admitted to our institution between January 2000 and August 2006. The outcome of stent placement for gastric outlet obstruction was compared with palliative gastrojejunostomy during the same period. We excluded patients with recurrent gastric cancer and double cancer from this study. Results: There were significant differences between the group of patients that underwent slanting and the group of patients that received a gastrojejunostomy regarding the age of patients ($67{\pm}12$ vs. $57{\pm}9$, P<0.001) but not between the sex of the patients (M : F, 2 : 1 vs. 2 :1, P=0.637). The most common complication of stenting was tumor ingrowth (16/100, 16%) and the second most common complication was stent migration (14/100). Failure of the procedure occurred in only three patients. Twenty-three patients underwent re-slanting and one patient required open conversion with a gastrojejunostomy. The median time to the first meal was $4{\pm}2$ days in the stent group of patients and $6{\pm}2$ days in the gastrojejunostomy group of patients (P=0.001). The median postoperative hospital stays were 9 days in the stent group of patients and 15 days in the gastrojejunostomy group of patients (P=0.003). The mean survival periods were 11 months in the stent group of patients and 10 months in the gastrojejunostomy group of patients (P=0.937). Conclusion: There were no significant differences In the mean survival rates. An earlier first meal and a shorter hospitalization stay were found in the slanting group of patients compared to the bypass gastrojejunostomy group of patients. However, re-slanting was a concern due to tumor ingrowth and stent migration.

부비동염 및 폐포출혈로 나타난 현미경적 다발성 혈관염

김희규 ( Hee Kyoo Kim ),신호식 ( Ho Sik Shin ),정연순 ( Yeon Soon Jung ),고지호 ( Ji Ho Ko ),옥철호 ( Chul Ho Oak ),장태원 ( Tae Won Jang ),임학 ( Hark Rim ),정만홍 ( Maan Hong Jung ) 대한신장학회 2005 Kidney Research and Clinical Practice Vol.24 No.5

증례 : 복강 내 종양으로 오인된 미소 위유암종의 림프절 전이 1예

이지숙 ( Jee Suk Lee ),김규종 ( Kyu Jong Kim ),고지호 ( Ji Ho Ko ),박이천 ( Lee Chun Park ),문원 ( Won Moon ),박무인 ( Moo In Park ),박선자 ( Seun Ja Park ) 대한내과학회 2007 대한내과학회지 Vol.72 No.4

위유암종은 드문 질환으로 전체 원발성 위종양의 0.3%, 전체 유암종의 2% 이하로 알려져 있고, 대부분 무증상이다. 그러나 최근 들어 위내시경 검사의 시행이 빈번해지고 면역조직검사의 발달로 이들의 발견 빈도가 점차 증가하고 있는 추세이다. 위유암종은 크게 세 가지 형태로 분류되며, 산발적으로 발생하는 제3형의 경우 공격적인 임상상을 가지고 전이가 잘되는 것으로 알려져 있으나, 크기가 1.0 cm 이하인 미소 위유암종의 경우 일반적으로 전이는 극히 드물다. 저자 등은 연고지 병원에서 우연히 발견된 복강 내 종물을 주소로 내원한 42세 여자의 상부 위내시경 검사에서 약 0.8 cm 크기의 미소 위유암종을 발견하여 내시경적 절제술을 시행한 후 복강 내 종물에 대한 외과적 절제에서 이들이 위유암종의 림프절 전이로 확인된 1예를 경험하였기에 문헌고찰과 함께 보고한다. Gastric carcinoid tumors have been regarded as rare neoplasms, accounting for just 0.3% of all gastric tumors and fewer than 2% of all carcinoid tumors. Recently, there has been an increase in the number of reported studies of gastric carcinoid tumors with the widespread use of gastroscopy and improvements in immunohistochemical methods. Gastric carcinoid tumors are classified into three types. For type III gastric carcinoids not associated with hypergastrinemia, which tend to be larger and demonstrate a biologically more aggressive behavior with metastasis, and also for sporadic lesions, excision with regional lymph node clearance has been recommended. Tumors that are less than 1cm in size are called minute carcinoids, which seldom give rise to regional lymph node metastasis, except in rare cases. We report here a rare case of a minute gastric carcinoid tumor with regional lymph node metastasis that was misdiagnosed as an intraabdominal mass in a 42-year-old woman. Furthermore, we review the available literature on this entity. (Korean J Med 72:411-414, 2007)

후복막강으로 파급된 침윤성 황색육아종성 신우신염 : 증례보고

고지호 고신대학교의과대학 2006 고신대학교 의과대학 학술지 Vol.21 No.2

Xanthogranulomatous pyelonephritis is an uncommon form of granulomaous inflammation characterized by destruction of the renal parenchyma and replacement by solid sheets of lipid-laden macrophages. The process is typically unilateral and maybe focal, segmental or diffuse. The classic radiographic appearance of xanthogranulomatous pyelonephritis is an enlarged nonfunctioning kidney associated with an obstructing calculus at the ureteropelvic junction. We report a case of infiltrative xanthogranulomatous pyelonephritis with extension to the retroperitoneal space.

생체 외에서 시행한 정량적 자기공명영상, 단일 에너지 정량적 전산화단층촬영술, 그리고 이중엑스선 골밀도측정기 사이의 연관성

고지호,허진도,정규식,오경승,이승룡,조영덕 고신대학교 의학부 2004 高神大學校 醫學部 論文集 Vol.19 No.1

This study was performed to examine the correlation among quantitative magnetic resonance (QMR), single energy quantitative computed tomography (SE-QCT). and dual energy X-ray absorptiometry (DXA), and to examine the relation with bone mineral density (BMD) through in vitro experiment with pig lumbar vertebrae. The correlation among 1/T2 of QMR, SE-QCT, and DXA was investigated by measuring the pig lumbar vertebrae BMD five times each method. It was examined whether there is a significant difference in the values of 1/T2, SE-QCT, and DXA measured by changing the height (11㎝, 20㎝, 29㎝) of water in water bath in order to make the soft tissues different in quantity. The lumbar vertebrae were placed in 0.1N sodium hydroxide (NaOH) solution for 24 hours to remove the residual soft tissue. Each values of SE-QCT before and after removal of the soft tissue were compared. Real BMD, measured after burning only the body of lumbar vertebrae for e hours at 1200℃, was compared to BMD with three methods. Based on the correlation analysis of 1/T2 and SE-QCT (correlation coefficient, r= -0.729 to 0.737), 1/T2 and DXA (r= -0.709 to o.929) and SE-QCT and DXA (r= -0.878 to 0.862) after measuring BMD within the water bath, no significant correlation was observed among three methods. Also, there was no correlation between 1/T2 and SE-QCT (r= -0.587 to 0.447) xeasured in the outside of water bath. SE-QCT (p=0.094) and 1/T2 (P=0.012 to 0.094) measured in the inside and the outside, respectively, of the water bath significantly different. When the height of water in the water bath was different, the change value of the BMD showed a significant different in 1/T2 (p=0.012 to 0.403) and SE-QCT (p=0.012 to 0.527), but not in DXA (P=0.012). The values of SE-QCT measured before and after placing limbar vertebrae in 0.1N NaOH for 24 hours were not significantly different (P=0.3177). The BMD showed the different changing aspect (p<0.05). There was no correlation among QMR, SE-QCT, and DXA, however the significant relation was observed between the BMD and QMR. The value of the BMD was measured differently depending on the height of water in the water bath. Therefore, although QMR is influenced by the height of the water bath in some degree, it reflects the BMD very well.

PWM 전력 컨버터를 이용한 배전용 무효전력 보상기 제어

고지호,김용현,김재홍,김일환 제주대학교 산업기술연구소 2000 尖端技術硏究所論文集 Vol.11 No.1

This paper presents the control method of reactive power in distribution system using PWM power converter. The PWM power converter controlled by space vector PWM method is voltage source type using IGBT switching device. Using the Park's transformation, three phase load current can be written in terms of component α and β current in a synchronously rotating reference frame. Two axis, the direct axis, α, and the quadrature axis, β, mean the active and reactive component in load current. Also, two components appear as dc quantities in that frame. So it is easy to control the reactive power by controlling the d axis currents. And in accordance with the change of reactive power in load side, PWM power converter compensate the reactive power by generating the reactive current to the load side using PI control. To verify the theoretical analysis, results of computer simulation and experiment are presented to support the discussion

성인에서 발생한 간아세포종

고지호,이승룡,이은정 고신대학교 의학부 2005 高神大學校 醫學部 論文集 Vol.20 No.1

Hepatoblastoma is the most frequent primary malignant liver in children under the age of 2 years, but a few case have also been reported in adults. We present herein a rare case of hepatoblastoma in a 62 year male patient. He had been suffering from a pain and a palpable lump in the left upper abdominal area. His serum alpha-fetoprotein(AFP) was elevated to 77.89 ng/mL. Abdominal computed tomography demostrated a large, inhomogeneous low-density mass(14×11×10cm) occupying the left hepatic lobe, with some lower-density areas that showed hemorrhage and necrosis. With a suspicion of hepatocellular carcinoma of the left lobe, a left lateral segmentectomy was performed. The external surface showed a huge protruding mass and the capsule was previously reptures. The tumor had a variegated surface compsoed of yellow-white friable tissue with multifocal hemorrhage. Microscopic examination revealaed a mixed hepatoblastoma consisted of epithelial and mesenchymal elements.

PWM 전력 컨버터를 이용한 배전용 무효전력 보상기 제어

고지호,김용현,김재홍,김일환 濟州大學校 産業技術硏究所 2000 산업기술연구소논문집 Vol.11 No.1

This paper presents the control method of reactive power in distribution system using PWM power converter. The PWM power converter controlled by space vector PWM method is voltage source type using IGBT switching device. Using the Park's transformation, three phase load current can be written in terms of component α and β current in a synchronously rotating reference frame. Two axis. the direct axis. α. and the quadrature axis. β, mean the active and reactive component in load current. Also. two components appear as de quantities in that frame. So it is easy to control the reactive power by controlling the d axis currents. And in accordance with the change of reactive power in load side. PWM power converter compensate the reactive power by generating the reactive current to the load side using PI control. To verify the theoretical analysis. results of computer simulation and experiment are presented to support the discussion

이중엑스선 골밀도 측정기를 이용한 폐경 여성에서 호르몬 대치 요법 후의 골밀도 영향

고지호,정미희 고신대학교의과대학 2006 고신대학교 의과대학 학술지 Vol.21 No.2

Pulpose : To assess the change pattern and useful site of bone mineral density after hormone replacement therapy in postmenopause using dual energy X-ray absorptiometry. Materials and Methods : We evaluated 40 patients(22: postmenopause and 18: surgical menopause) who between June, 1999 and December 2002 underwent dual energy X-ray absorptiometry after hormone replacement therapy, except endocrine disease and drug abuse. Their ages ranged from 40 to 66(mean, 49.6) years and mean duration of hormone replacement therapy were 14.9(from 4 to 41) months. We investigated the bone mineral density effect and useful site(lumbar vertebrae, femoral neck, Ward's triangle, trochanter, femoral shaft), intraobserver variation, and interobserver variation, respectively. Results : The bone mineral density effect of lumbar vertebrae before and after hormone replacement therapy was significant correlation from 1.0658 g/cm2 to 1.1065 g/cm2(p<0.05). Other bone mineral density effects before and after hormone replacement therapy, femoral neck in 0.8717 and 0.8765, Ward's triangle in 0,6698 and 0.6798, trochanter in 0.6976 and 0.7218, shaft in 1.1305 and 1.1611, were not significant correlation. The intraobserver variations(lumbar vertebrae: 0.2% femoral neck: 1.7% ; Ward's triangle: 0.7% ; trochanter: 0.7% ; femoral shaft: 3.1%) and interobserver variations(lumbar vertebrae: 0.3% ; femoral neck: 1.9% ; Ward's triangle: 0.8% ; trochanter: 0.9% ; shaft: 3.0%) were measured. Conclusion : The bone mineral density of lumbar vertebrae using dual energy X-ray absorptiometry may be useful for the follow-up examination after hormone replacement therapy in postmenopause.