분화갑상선암의 수술 전 병기진단: CT검사 필요한가?

나동규 대한갑상선학회 2011 International Journal of Thyroidology Vol.4 No.1

Ultrasound (US) is the essential primary imaging modality for preoperative staging of differentiated thyroid cancer. Although contrast-enhanced neck CT has been routinely used for the evaluation of general head and neck malignancy, routine use of contrast-enhanced CT is not recommended for the differentiated thyroid cancer by most international thyroid societies, and they recommend very conservative selective use of CT only for locally advanced thyroid cancers. This recommendation seems based on the fact that iodinated contrast media may interfere with radio-iodine treatment and the added value of CT has been little investigated. Although the safety issue of CT contrast media is still controversial, the effect of CT contrast media on radio-iodine treatment seems not clinically significant if there is more than 2 month interval between intravascular administration of iodinated contrast media and radio-iodine treatment. Although CT has been widely used for preoperative evaluation of differentiated thyroid cancers in Korea, the added value of CT for detection of metastatic nodes has been little investigated. Compared with US, CT has advantages of less operator dependency and capability of scanning the whole neck. This suggests that CT may have complementary roles for detection of possible missing diagnosis of metastatic nodes by US and for detection of metastatic nodes at retropharyngeal area and low central neck (level 7 and low level 6 in some cases)which are not accessible by US. Because CT features of metastatic lymph nodes are different from those of US, combination of US and CT may have a potential to increase the diagnostic sensitivity for detection of metastatic cervical nodes. Recent studies suggest that CT may have a helpful complementary role for the evaluation of cervical metastatic nodes in differentiated thyroid carcinoma. However, added diagnostic value of CT and indication for CT use should be further investigated in the preoperative staging of differentiated thyroid carcinomas.

두개 내 종양 절제술 후 확산강조영상

나동규,유재욱,변홍식,Na, Dong-Gyu,Yu, Jae-Uk,Byeon, Hong-Sik 대한영상의학회 2001 대한영상의학회지 Vol.45 No.6

PURPOSE: To evaluate the usefulness of diffusion-weighted imaging after intracranial surgery in patients with intracranial tumors. MATERIALS AND METHODS: Within ten days of intracranial surgery, diffusion-weighted MR images were obtained in 68 patients with intracranial tumors which included meningioma (n=31), glioma (n=21), neurogenic tumor(n=4), hemangiopericytoma (n=3), and in three cases involved metastasis. The signal intensity of the resected margin and adjacent parenchyma was visually assessed on diffusion-weighted images, and the signal intensities on seen T1-and T2-weighted images were also analyzed. In patients with newly developed hyperintense lesions in parenchyma adjacent to the resection sites seen on postoperative T2-weighted images, apparent diffusion coefficients (ADC) were calculated and analyzed on follow-up MR images. RESULTS: Immediate postoperative diffusion-weighted images showed various signal intensities at the resected margins visible on conventional and diffusion-weighted MR images. In 15 patients, newly developed hyperintense lesions adjacent to resected sites were seen on postoperative T2-weighted images. On diffusion-weighted images, nine of these lesions were hyperinteuse and and were shown by follow-up MR imaging to be subject to focal tissue loss and atrophy, and six were isointense but with no sign of tissue loss or atrophy. Among the 15 patients with postoperative lesions near the site of tumorectomy, diffusion-weighted imaging showed that the ADC values of hyperintense lesions were significantly lower than those of isointense lesions (independent sample t-test: p<0.05). CONCLUSION: In patients with intracranial tumors, immediate postoperative diffusion-weighted imaging is useful for differentiating between ischemic tissue damage and vasogenic edema. 목적:두개 내 종양 환자에서 수술 후 시행한 확산강조영상의 유용성을 평가하고자 하였다. 대상과 방법:두개 내 종양절제 후 10일 이내에 확산강조영상을 시행한 68명 (수막종 31예, 교종 21예, 신경초종 4예, 전이 암 3예, 혈관주위세포종 3예 등)을 대상으로 확산강조영상, T2 및 T1강조영상에서 종양 절제 부위 및 인접한 뇌실질의 신호강도를 육안적으로 분석하였다. 종양절제 주변조직에 수술 후 T2강조영상에서 새로 발생한 고신호강도 병변의 경우 병변의 현성확산계수를 측정하였고, 추적검사에서 변화 소견을 비교 분석하였다. 결과:종양절제술 후 초기에 시행한 통상적 자기공명영상과 확산강조영상에서 종양절제 경계에 다양한 신호강도를 보였다. 종양절제술 후 초기에 종양절제 주변에 T2강조영상에서 새로운 고신호강도를 보인 경우는 15예 (22%)였고, 그 중 9예 (60%)에서는 확산강조영상에서 고신호강도, 6예 (40%)에서는 등신호강도를 나타냈다. 추적검사에서 확산강조영상과 T2강조영상에서 모두 고신호강도를 나타낸 병변은 모든 예에서 뇌연화 소견을 나타냈고, 확산강조영상에서 등신호강도를 나타낸 6예 (40%)에서는 뇌연화 소견이 없었다. 종양절제 주변에 병변이 발생한 15예 중 확산강조영상에서 고신호강도를 보인 병변은 등신호강도를 보인 병변보다 통계적으로 유의하게 현성확산계수가 낮게 측정되었다 (independent sample t-test, p <.05). 결론:수술 직후 시행한 확산강조 영상에서 수술절제 경계부위는 다양한 신호강도를 나타냈으며, 확산강조영상은 수술 후 주변조직에서 발생한 혈관성 부종과 허혈성 조직 손상을 구분하는데 유용할 것으로 생각된다.

肺癰에 對한 文獻的 考察

羅東圭,金炳卓 대전대학교 韓醫學연구소 1998 한의학연구소 논문집 Vol.7 No.1

특허를 통해 본 북한

나동규 한국발명진흥회 2000 發明特許 Vol.25 No.6

양성갑상선결절과 갑상선재발암의 고주파절제 진료권고안

나동규,이정현,정소령,김지훈,성진용,신정희,김은경,이준형,김동욱,박정선,김규선,백선미,이영흔,정세민,심정석,허정인,배재익,김경태,한송이,배민영,김윤숙,백정환 대한초음파의학회 2012 ULTRASONOGRAPHY Vol.31 No.2

갑상선고주파절제는 양성갑상선결절과 갑상선재발암에사용되는 비수술적 치료이다. 대한갑상선영상의학회 갑상선고주파절제 진료권고안 제정위원회는 고주파를 이용한갑상선양성결절과 갑상선재발암의 치료권고안을 근거와전문가의 의견을 중심으로 제정하였다. Radiofrequency ablation is a new non-surgical treatment modality for patients with benign thyroid nodules and recurrent thyroid cancers. The Task Force Committee of the Korean Society of Thyroid Radiology has developed recommendations for the treatment of benign thyroid nodules and recurrent thyroid cancers using radiofrequency ablation. These recommendations are based on evidence from the current literature and expert consensus.

폐옹(肺癰)에 대(對)한 문헌적(文獻的) 고찰(考察)

나동규,김병탁,Na, Dong-Gyu,Kim, Byeong-Tak 대전대학교 한의학연구소 1998 혜화의학회지 Vol.7 No.1

제습위령탕가감이 집 먼지 진드기 추출물로 유도된 NC/Nga mouse의 아토피 피부염에 미치는 영향

나동규,한재경,김윤희,Na, Dong-Gyu,Han, Jae-Kyung,Kim, Yun-Hee 대한한방소아과학회 2008 대한한방소아과학회지 Vol.22 No.2

Objectives : The purpose of this study is to investigate the effect of Jeseupwiryeongtang-gagam(JWTG) on atopic dermatitis by in vivo experiment using NC/Nga atopic dermatitis mouse, which has histological and clinical similarities to the atopic dermatitis of human. Methods : To investigate the effect of JWTG on AD, we evaluated atopic dermatitis-like skin lesions by clinical skin index and analyzed immunological parameters in peripheral blood mononuclear cells(PBMCs), splenocytes, draining lymph node(DLN) and performed skin histology in ears and dorsal skin of atopic dermatitis-like skin NC/Nga mouse in vivo. Results and Conclusions : In vivo, clinical skin severity score were significantly lower in JWTG group than control group. IgE, IL-6, $TNF-{\alpha}$, IgM, IgG2a and IgG2b levels in serum were decreased remarkably in JWTG group than control group and $IFN-{\gamma}$ production, secreted in Th1 cell were increased by JWTG. After experiment ended, we analyzed immunological cells ($CD3^+$, $CD19^+$, $CD4^+$, $CD8^+$, $CD3^+$$CD69^+$, $CD4^+$$CD25^+$ and $CD49b^+$) by flow cytometry. It resulted that total absolute number of $CD3^+$, $CD19^+$, $CD4^+$ and $CD8^+$ cells were recovered as normal and $CD3^+$$CD69^+$ were decreased significantly compared with control group in isolated DLN and PBMCs from NC/Nga mouse and total absolute number of $Gr-1^+$, $CD11b^+$ and $CD3^+$ in dorsal skin of NC/Nga mouse were decreased by JWTG. We analyzed ear, DLN, and neck-back skin after biopsy and dyeing by hematoxyline/eosin(H&E) and toluidine staining (mast cells marker) and obtained results that JWTG were effective to histological symptoms (dermal and epidermal thickening, hyperkeratosis and inflammatory cell infiltration). Ear thickness was decreased significantly than the control group and the size of inflammatory lymphocytes cells(ILC) and plasma cells(PC) in DLN were also decreased.

Re: Clinical significance of isolated macrocalcifications detected by ultrasonography

나동규 대한초음파의학회 2020 ULTRASONOGRAPHY Vol.39 No.4

We appreciate the valuable comments on our manuscript. Isolated macrocalcifications were initially described as a benign ultrasonographic (US) pattern of a thyroid nodule in the French Thyroid Imaging Reporting and Data System [1] and defined as macrocalcifications with no solid component or vascular signal [2]. Subsequently, recent studies [3,4] have demonstrated that isolated macrocalcifications have an intermediate malignancy risk, are mostly found in papillary carcinomas, and that malignant tumors with isolated macrocalcifications may show aggressive behavior, such as advanced local invasion or macroscopic cervical lymph node metastasis. We agree that the term "isolated macrocalcification" may not be intuitive for "a calcified nodule with posterior acoustic shadowing in which any soft tissue component is not identified due to the dense posterior acoustic shadowing on US." Furthermore, we concur that the suggested terms ("totally calcified nodule" or "macrocalcified nodule without a solid component") are simple and more intuitive for understanding the US characteristics of isolated macrocalcifications. However, we need more consensus on the appropriate descriptors for US patterns of calcified nodules, and we therefore hope that a standardized terminology of isolated macrocalcifications will be established through the ongoing International Thyroid Nodule Ultrasound Working Group, in which the majority of professional thyroid societies are involved, including the Korean Society of Thyroid Radiology (KSThR). A previous study [3] reported that small thyroid cancers with isolated macrocalcifications may show the aggressive behavior of macroscopic lymph node metastasis. Therefore, even though the KSThR guideline currently recommends biopsy for isolated macrocalcifications only when the nodule size is equal to or larger than 1 cm, US monitoring of small isolated macrocalcifications may be necessary. Although our study revealed that the majority of isolated macrocalcifications are composed of coarse central calcifications [5], the histopathologic features of isolated macrocalcifications have only been investigated to a limited extent. We agree that the investigation of histopathologic features using core-needle biopsy specimen would be useful for identifying the characteristics of benign and malignant isolated macrocalcifications, which will be another step towards understanding the nature of isolated macrocalcifications in the thyroid gland.

Thyroid nodules with isolated macrocalcification: malignancy risk and diagnostic efficacy of fine-needle aspiration and core needle biopsy

나동규,김대식,김수진,유재욱,정소령 대한초음파의학회 2016 ULTRASONOGRAPHY Vol.35 No.3

Purpose: This study was performed to determine the malignancy risk of thyroid nodules withisolated macrocalcification and to evaluate the diagnostic efficacy of fine-needle aspiration (FNA)and core needle biopsy (CNB). Methods: From May 2008 to December 2014, a total of 44 patients with isolated macrocalcificationswere enrolled from 4,081 consecutive patients who underwent FNA or CNB at a singleinstitution. We assessed the malignancy risk of nodules with isolated macrocalcification. Wecompared the diagnostic results between FNA and CNB, and the diagnostic efficacy of eachprocedure was evaluated by the rate of inconclusive results. We compared the diagnosticperformance for malignancy between FNA and CNB with a criterion of malignant or atypia/follicular lesion of undetermined significance (indeterminate) diagnostic results. We investigatedwhether the ultrasonographic feature of isolated macrocalcification was predictive of malignancy. Results: The malignancy risk of nodules with isolated macrocalcification was 16.1% in 31nodules with final diagnoses and 11.4% in all nodules. CNB demonstrated a significantlylower rate of nondiagnostic and inconclusive results than FNA (7.7% vs. 53.8%, P=0.002 and15.4% vs. 57.7%, P=0.003, respectively) in 26 nodules that underwent both FNA and CNB. CNB showed a marginally higher diagnostic performance for identifying malignancy than FNA(P=0.067). The ultrasonographic features of the anterior margin of isolated macrocalcificationwere not predictive of malignancy (P>0.999). Conclusion: Thyroid nodules with isolated macrocalcification had a low to intermediatemalignancy risk and should not be considered benign nodules. CNB showed a higher diagnosticefficacy than FNA in these nodules.

소비자 신뢰도를 높인 친환경 인증마크의 등급제 제안

나동규,김지수,김민섭,나영주,Na, Dong-Kyu,Kim, Jisu,Kim, Minsup,Na, Youngjoo 한국의류학회 2017 한국의류학회지 Vol.41 No.5

This study measured consumer's recognition, reliability, emotion and images about current eco-marks as well proposed an eco-mark rating scale and mark designs to improve consumer's trust on the fashion product marks. We used a questionnaire survey to collect data from 150 persons about knowledge, interests, and practice on eco fashion products in relation to trustfulness and positive images for three domestic and three international eco-marks. We evaluated and gave eco scores to six fiber-type products (cotton, organic cotton, wool, polyester, biodegradable polyester and nylon) in terms of consumer's use, water & land consumption, waste amount, carbon footprint, and toxicity. We suggested a new 5-level rating scale for eco marks, which quantified the concept of environmental friendliness of fiber products. The design for eco-mark of rating scale showed the total grade with two sub scores of environmental sides and human sides developed with an improved visual understanding for consumers. The design is one through benchmarking the energy-consumption efficiency mark, which is familiar to consumers such as a half circle shape to save environment resources to alarm consumers to environment problems.