A군 연쇄구균성 인두편도염 진단을 위한 두 종류 신속항원검사법의 비교

송승규,홍미애,오경창,안승인,태미현,신혜정,장진근,차성호,Song, Seung Kyu,Hong, Mi Ae,Oh, Kyung Chang,Ahn, Seung In,Tae, Mi Hyon,Shin, Hye Jung,Chang, Jin Keun,Cha, Sung Ho 대한소아청소년과학회 2002 Clinical and Experimental Pediatrics (CEP) Vol.45 No.8

목 적: A군 베타용혈성 연쇄구균은 급성 인두편도염의 원인이 되는 세균으로 류마티스성 열 및 사구체 신염과 같은 심각한 합병증을 유발할 수 있어 정확한 진단과 치료를 해야 하는 질병이다. A군 연쇄구균성 인두편도염은 증상만으로는 진단하기 어렵고, 가장 좋은 검사방법인 인두배양검사는 시간을 요하는 단점이 있다. 최근에 비교적 검사과정이 간단한 신속항원검사법을 이용할 수 있게 되었다. 이에 저자들은 두 종류의 신속항원검사법의 민감도와 특이도를 알아보고, 일치도를 평가하기 위해 본 연구를 시행하였다. 방 법: 2001년 11월부터 2002년 2월까지 한일병원 소아과 외래를 방문한 환자 중 인두의 발적과 부종, 인두의 삼출물, 인두의 점상 출혈이 있는 61명의 환자를 대상으로 인두배양검사와 신속항원검사를 시행하였다. 신속항원검사법은 BD $LINK2^{TM}$ Strep A(Becton, Dickinson & Company, U.S.A.)와 $QuickVue^{(R)}$ $In-LINK^{TM}$(Quidel Corporation, U.S.A.)를 사용하였다. 결 과 : 1) 61례의 검체 중 22례(36.1%)에서 인두배양검사상 A군 베타용혈성 연쇄구균이 배양되었다. 2) 집락수 1+는 2례(9.1%), 집락수 2+는 1례(4.5%), 집락수 3+는 10례(45.5%), 집락수 4+는 9례(40.9 %)로 배양되었다. 3) 인두배양검사에서 양성으로 나온 환자 중 3세에서 5세 사이가 14례(63.6%)로 본 연구에서 A군 연쇄구균성 인두편도염의 가장 흔한 연령층이었다. 4) 인두배양검사상 양성으로 나온 환자의 임상 증상 및 징후는 발열과 림프절 종대가 각각 18례(81.8%)에서 나타났고, 인두통 16례(72.7%), 구토 11례(50.0%), 성홍열양 피부발진 8례(36.4%), 두통 7례(31.8%), 복통 7례(31.8%), 딸기모양의 혀는 6례(27.7%)에서 관찰되었다. 5) 민감도는 BD $LINK2^{TM}$ Strep A가 81.8%(18례/22례), $QuickVue^{(R)}$ $In-LINK^{TM}$이 77.3%(17례/22례)이었다. 특이도는 BD $LINK2^{TM}$ Strep A가 89.7%(35례/39례), $QuickVue^{(R)}$ $In-LINK^{TM}$이 100%(39례/39례)이었다. 6) 양성 예측도는 BD $LINK2^{TM}$ Strep A가 81.8%, $QuickVue^{(R)}$ $In-Line^{TM}$이 100%이었다. 음성 예측도는 BD $LINK2^{TM}$ Strep A가 89.7%, $QuickVue^{(R)}$ In-Line$^{TM}$이 88.6%이었다. 7) 인두배양검사에 대한 BD $LINK2^{TM}$ Strep A의 k값은 0.72로 일치도 좋음을 보였고, $QuickVue^{(R)}$ $In-Line^{TM}$의 k값은 0.81로 일치도 아주 좋음을 나타냈다. 결 론 : 신속항원검사법인 BD $LINK2^{TM}$ Strep A와 $QuickVue^{(R)}$ $In-LINK^{TM}$은 민감도와 특이도, 일치도가 높을 뿐 아니라 신속하고 간편하게 결과를 알 수 있어서 인두배양검사와 병행하여 급성 인두편도염을 진단하고 치료하는데 많은 도움이 될 수 있을 것으로 사료된다. Purpose : Recently, a number of rapid antigen detection tests have been available to diagnose group A streptococcal pharyngotonsillitis. The purpose of this study was to determine the sensitivity, specificity and consistency of the two rapid antigen detection tests. Methods : Among the patients who visited our clinic from November 2001 to February 2002, 61 patients who had clinical findings of pharyngeal erythema or edema, pharyngeal exudates and soft palatine petechiae were enrolled in our study. A total of 61 patients were tested with rapid antigen detection tests and throat culture. BD $LINK2^{TM}$ Strep A(Becton, Dickinson & Company, U.S.A.) and $QuickVue^{(R)}$ $In-Line^{TM}$(Quidel Corporation, U.S.A.) were selected for rapid antigen detection tests. Results : Of the 61 patients tested, 22 patients were confirmed as group A streptococcal pharyngotonsillitis by throat culture. The BD $LINK2^{TM}$ Strep A had a sensitivity of 81.8% and a specificity 89.7%. The positive and negative predictive values were 81.8% and 89.7%, respectively. The $QuickVue^{(R)}$ $In-Line^{TM}$ had a sensitivity of 77.3% and a specificity of 100%. The positive and negative predictive values were 100% and 88.6%, respectively. The kappa values of BD $LINK2^{TM}$ Strep A and $QuickVue^{(R)}$ $In-Line^{TM}$ were 0.72 and 0.81, respectively. Conclusion : In addition to high sensitivity, specificity and consistency, both kits are easy to use and simple to interpret, and therefore have the potential to be used with backup throat culture for diagnosis of acute pharyngotonsillitis.

난소의 출혈성 병변에 대한 임상 및 조직병리학적 연구

김명찬(Myeong Chan Kim),하상범(Sang Bum Ha),최용석(Yong Suk Choi),김종오(Jong Oh Kim),이성림(Seong Lim Lee),이헌경(Hun Kyung Lee),송승규(Seung Kyu Song),조봉춘(Bong Choon Jo) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.10

목적 : 가임기 여성의 난소출혈은 전형적인 증상과 징후가 없어서 급성충수염이나 자궁외임신과 같은 외과적 응급 질환과 종종 혼동될 수 있다. 난소출혈 환자 101예를 분석하여 신속하고 정확한 감별 진단 및 적절한 치료에 도움이 되고자 본 연구를 시행하였다.연구방법 : 1993년부터 1997년까지 7년 동안 대림성모병원 산부인과에 급성 하복부 동통을 주소로 입원하여 수술적으로 확인된 난소출혈 환자 96예와 비수술적으로 치료한 5예의 총101예를 대상으로 발생연령, 산과력, 임상적 증상과 검사결과, 증상의 발현시 월경주기일, 병리조직학적 소견 및 수술방법에 대하여 분석하였다.결과 : 연령분포는 20대가 72예(71.3%)로 가장 많았고 평균 연령은 26.3세였으며 미산부가 58예(57.4%)이었다. 병변부위는 우측 난소가 64예(63.4%)로 더 많았으며 성교시 발생된 경우가 18예(17.8%)였고, 증상의 발현시 월경주기일은 제20∼30일 사이가 45예(44.6%)로 가장 많았다. 병리조직학적 소견상 황체낭의 파열이 31예(30.7%), 황체의 파열이 25예(24.8%), 난포낭종의 파열이 15예(14.9%), 난소임신이 9예(8.9%) 순이었다. 수술방법은 난소낭종절제술이나 난소부분절제술이 62예(61.4%)로 가장 많았다. 결론: 난소출혈은 비교적 흔한 질병으로 심한 동통과 함께 때로는 생명을 위협하는 다량의 혈복강을 동반하므로 가임기 여성의 다른 급성복증과 신속하고 정확하게 감별 진단을 하여 적응증이 된 경우는 조기에 수술적 치료를 하여 합병증을 예방하고, 미량의 출혈인 경우는 불필요한 개복수술을 하지 않고 관찰하거나 보존적 치료를 하여야 한다. Objective : Ovarian hemorrhage in a woman of reproductive age is often confused with other surgical emergencies such as acute appendicitis and ectopic pregnancy because there are no typical symptoms and signs that will make definitive diagnosis possible. The authors analyzed 101 cases of ovarian hemorrhages with the purpose of obtaining rapid and precise diagnosis and appropriate treatment. Methods : We analyzed 101 cases of ovarian hemorrhages at the Department of Obstetrics and Gynecology at Dae Rim Saint Mary's Hospital from 1993 to 1999. This analysis includes 96 preexisting cases involving finalized successful surgical treatment and 5 inpatient cases involving conservative treatment. We examined age, parity, clinical features, elapsed days of cycle, histopathologic findings, and operative methods.Results : Mean age of occurrence was 26.3 years, and 57.4% of the cases occurred in nullipara. 64 cases involved the right ovary, and 18 cases were associated with paracoital injuries. The onset of symptoms occurred most frequently between the 20th and 30th days of the menstrual cycle. The histopathologic findings were corpus luteum cyst(30.7%), corpus luteum(24.8%), follicular cyst(14.9%), and ovarian pregnancy(8.9%). The most common type of operation is ovarian cystectomy or ovarian wedge resection(61.4%).Conclusion : Ovarian hemorrhage is a relatively common disease which is accompanied by severe abdominal pain and often life-threatening surgical conditions. Therefore, differential diagnosis should be performed rapidly and precisely from other acute abdomens in a woman of reproductive age. Surgical management should be performed rapidly if indicated. If ovarian hemorrhage is minimal, it can be managed by observation or conservative treatment.

자궁경부 종양에서 p53, Proliferating Cell Nuclear Antigen(PCNA), c-myc 및 Epidermal Growth Factor Receptor(EGFR)의 발현

한구택 ( Ku Taek Han ),이형근 ( Hyung Kun Lee ),유순원 ( Sun Won Yoo ),송영훈 ( Young Hun Song ),최원영 ( Won Young Choi ),유기성 ( Ki Sung Ryu ),나종구 ( Jong Gu Rha ),송승규 ( Seung Kyu Song ),이헌영 ( Hun Young Lee ),김수평 ( S 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.12

Expression of four biologic markers known as p53, proliferating cell nuclear antigen(PCNA), c-myc, and epidermal growth factor receptor(EGFR), was studied immunohistochemically in 121 cases of cervical tissues, which included 15 cases of normal cervical tissues, 50 cases of squamous intraepithelial lesions(SIL), and 56 cases of invasive carcinomas. This study was designed to elucidate the roles of these factors in the genesis and progression of cervical neoplasia and to identify their association with clinical parameters such as cell type, tumor size, lymph node involvement, squamous cell carcinoma(SCC) antigen level, and prognosis. In additon, this study evaluates the differences of coexpression rates in normal cervical tissues, SILs, and invasive carcinomas. (1) The intensities of p53, c-myc, and EGFR expression and the rates of PCNA, c-myc, and EGFR expression in cervical SILs and invasive carcinomas were significantly higher than those in normal tissues (p<0.05 and p<0.01). But there were no significant differences between SILs and invasive carcinomas in both of intensities and rates of p53, PCNA, c-myc, and EGFR expression. (2) The intensities and rates of p53, PCNA, and c-myc expression in the invasive carcinomas did not correlate with clinical parameters including cell types, tumor sizes, lymph node involvements, see antigen, and prognosis. But only the intensity and rate of EGFR expression were significantly higher in cases with tumor size larger than 3 cm when it was compared with cases with tumor sizes smaller than 3 cm(p<0.01), in cases with lymph node involvement when it was compared with cases without lymph node involvement(p<0.05), and in cases with SCC antigen levels more than 2.5 ng/ml when it was compared with cases with SCC antigen levels less than 2.5 ng/ml(p<0.05). (3) C-myc immunoreactivity was significantly correlated with EGFR overexpression(p<0.01). (4) The rates of simultaneous expression of four factors were decreased significantly in normal tissues and significantly increased in invasive carcinomas(p<0.01). The coexpression rate of two factors or more was 6.7% in normal tissues, 62.7% in SILs, and 70.0% in invasive carcinomas and the simultaneous expression rate of three factors or more was none in normal tissues, 34.0% in SILs, and 47.5 % in invasive carcinomas. These results show that the immunohistochemical detection of p53, PCNA, c-myc, and EGFR expression will be useful in differentiating the normal tissues and cervical neoplasia. The results of simultaneous immunohistochemical detection of these four factor expression also suggest to contribute a better understanding of the genesis of cervical carcinoma and that coexpression of more factors indicate more aggressiveness in cervical neoplasia, and show that simultaneous detection of these factors can be used in the early detection of cervical neoplasia and to predict malignant transformation of cervical lesions.

태아 양측 유미흉의 흉부-양수 도관 관류 -도관의 흉곽내 이동증례 1예-

이용석 ( Yong Seok Lee ),김사진 ( Sa Jin Kim ),이해규 ( Hae Gyu Lee ),최윤경 ( Yun Kyung Choi ),이귀세라 ( Gui Sera Lee ),노승혜 ( Seung Hye Rho ),신종철 ( Jong Chul Shin ),송승규 ( Sung Kyu Song ),김수평 ( Su Pyung Kim ) 대한주산의학회 1998 大韓周産醫學會雜誌 Vol.9 No.4

자궁경부 종양 환자에서 세포진 검사, 질확대경조준하생검, 원추절제술의 진단적 정확도와 원추절제술 후 잔류 종양의 예측인자

길기철(Ki Cheol Kil),허수영(Soo Young Hur),이귀세라(Gui Se Ra Lee),양용재(Yong Jae Yang),이지현(Jee Hyun Lee),이희중(Hee Joong Lee),김사진(Sa Jin Kim),김은중(Eun Jung Kim),송승규(Seung Kyu Song),남궁성은(Sung Eun NamKoong),김수평(Soo P 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.9

목적: 세포진 검사, 질확대경 검사, 질확대경 조준하생검, 원추절제술 및 자궁적출술을 연속적으로 시행한 자궁경부 종양 환자에서 각각의 검사 결과를 조직병리학적으로 비교하여 상호간의 정확도를 분석하고 원추 절제술 후 잔류 종양의 예측 인자를 조사하여 자궁경부 초기암 환자의 진단과 치료 관리에 도움을 주고자 본 연구를 시작하였다. 연구방법: 1993년 1월부터 1998년 8월까지 가톨릭대학교 의과대학 부속 성가병원 산부인과를 방문하여 자궁경부 세포진 검사 및 질확대경 검사에서 이상 소견을 보이는 환자 중에서 질확대경 조준하생검 후, 적응증에 따라 연속적으로 원추 절제술과 자궁적출술을 시행한 167명을 대상으로 하였다. 결과: 세포진 검사의 진단적 정확도(완전 일치율)는 59.3%(99/167), 질확대경 조준하생검의 진단적 정확도(완전 일치율)는 71.3%(119/167), 원추 절제술과 자궁적출술 후 조직 소견을 비교한 결과 자궁적출술 조직 소견 중 51예(30.1%)에서 잔류 종양이 확인되었는데, 동일한 병변이 잔류한 것이 46예(90.2%), 원추절제술보다 낮은 병변이 잔류한 경우가 4예(7.8%)이었고 더 진행된 병리 소견을 보이는 경우는 1예(2.0%)이었다. 원추절제술 후 조직의 절제면에서 종양 세포의 침범 유무와 추후 실시한 자궁적출술 후 조직병리검사에서 잔류 종양 유무와의 상관관계를 관찰한 바 침범이 있었던 군에서 잔류 종양이 더 많음을 확인할 수 있었다(P<0.001). HPV 16 혹은 18 DNA 검출과 잔류 종양의 존재와는 관계가 없었다. 결론: 세포진 검사와 질확대경 조준하생검이 자궁경부 종양 환자의 진단에 유용하지만 자궁경부 상피내종양 III 또는 미세침윤암이 의심되는 경우에는 원추절제술을 시행하여 병변을 정확히 판단하여야 하며 원추절제술 후 절제면에서 종양 침범이 발견된 경우 잔류 종양의 가능성이 높으므로 보다 적극적인 치료가 필요 할 것으로 생각된다. Objective: This study was performed to evaluate the diagnostic accuracy of cytology, colposcopically directed biopsy and conization and to analyze predictive factors for residual tumor after conization in patients with cervical neoplasia. Methods: We reviewed 167 patients who had undergone cytology, colposcopically directed biopsy and conization followed by subsequent hysterectomy depending on their current disease status at the Department of Obstetrics & Gynecology, Catholic University of Korea Medical College, Holy Family Hospital from January, 1993 to August, 1998. The diagnostic accuracy of cytology, colposcopically directed biopsy and conization were investigated. Also, we investigated the significance of the margin status and the presence of HPV which were used to predict residual tumors in hysterectomy specimens after conization. Results: The results of each methods were analyzed with regard to the histopathologic findings of the surgical specimen. The accuracy rates of cytology, and colposcopically directed biopsy were 59.3% (99 of 167) and 71.3% (119 of 167), respectively. After conization, residual tumors were found in 30.1% of subsequent hysterectomized specimens (51 of 167). Underestimation by conization occurred in 2.0% of cases (1 of 51) and overestimation in 7.8% (4 of 51). Residual tumors were significantly more frequent in patients with positive conization margins than in those with negative margins (P<0.001). But the presence of HPV was not significant. Conclusion: These results suggest that diagnostic conization seems to be essential procedure in patients showing abnormal results by cytology and colposcopically directed biopsy, especially in those with CIN III or microinvasion, for the further proper management of cervical neoplastic lesion and margin status is useful in predicting residual tumor after conization.

자궁경부아 환자에서 핵산 교잡법을 이용한 인간 유두종 바이러스 검색

송승규,류기성 대한부인종양 콜포스코피학회 1990 Journal of Gynecologic Oncology Vol.1 No.1

Genomic DNAs were extracted from cervical lavages of 49 patients with cervical cancer. Dot and Southern blot hybridization were performed using the P-labeled HFV DNA probes to find high risk HPV(type 16 and 18) infection that is known as the mast prevalent pathogenic factor in cervical cancer. Furthermore, genomic DNAs purified from cervical cancer tissues were studied in 8 out of 49 patients allowing us to convince the results from cervical lavages. The results were as follows: 1. Dot blot analysis were used to examine the sensitivity and specificity of hybridization condition and HPV-DNA probes. Positive signals were obtained even at the level of 10pg for HPV DNA, but no signals could he detected at the level of as much as 400pg for salmon sperm DNA. 2. Dot blot of DNAs from cervircal lavages showed positive signals in 32.7%(16/49) with HPV type 16 probe and 20.4% (10/49)and one mixed infection was found. 3. When the DNAs from cervical lavages of 49 patients were classified according to the clinical stage of cervical cancer, the infection rates of HPV type 16 and 18 were 50% (2/4) in CIN, 80% (4/5) in stage I, 64. 2% (9/14) in stage I b, 45% (9I20) in stage II and 16. 7% (1/6) in stage Ill and K respectively. The occurrence of HPV type 16 and 18 seemed to be the highest in the cervical cancer stage 1 (68.4%(13/19) ). 4. Experiments performed with genomic DNAs from 8 cancer tissues showed similar results compared to those of cervical lavages, but the intensity of positive signals was stronger. 5. Genomic DNAs from 5 patients(3 cases from cervical lavages and 2 cases from cervical cancer tissues) which showed strong positive signals to the dot blot analysis were further examined by Southern blot hybridixation using HFV type 16 DNA probe. When DNAs were digested with Pst 1 restriction enzyme, the five characteristic fragments of HPV type 16(2.8, l. 9, l. 6, 1. 0 and 0. 5 kb long in length) were recognized in ell 5 cases. These results may suggest a direct relationship between HPV type 16 & 18 infections considered as the most effective methods for HPV detection and typing. Molecular biological studies in the research of HPV are expected to reveal and help us understand the pathogenesis of cervical cancer.