Marfan`s Syndrome 2예

이상협 , 윤평렬 , 윤병주 ( Sang Hyub Lee , Pyung Yul Yoon , Byung Joo Yoon ) 대한안과학회 1979 대한안과학회지 Vol.20 No.2

수중 드론을 이용한 물체의 탁도, 광각, 거리에 따른 측정 방법

이상협(Sang-hyub Lee),윤한삼(Han-sam Yoon),김헌태(Heon-Tae Kim) 한국해양환경·에너지학회 2022 한국해양환경·에너지학회 학술대회논문집 Vol.2022 No.6

증상 없는 아밀라아제, 리파아제 증가에 대한 평가

이상협 ( Sang Hyub Lee ) 대한췌담도학회 2017 대한췌담도학회지 Vol.22 No.3

건강검진이나 혈액검사의 일부로 혈청 췌장효소 수치의 상승이 발견되는 경우가 증가하고 있으나, 증상이 뚜렷하지 않은 아밀라아제와 리파아제 수치 상승의 임상적 중요성은 불분명하다. 췌장효소가 상승한 환자를 진료할 때, 급성 췌장염, 간기능 장애, 신장기능 부전과 같은 흔한 원인은 철저한 병력청취, 신체검진 및 기본적인 혈액검사로 우선 배제해야 한다. 복부 초음파 또는 전산화단층촬영, 지질 프로필, 종양표지자, 이소효소 및 amylase-to-creatinine clearance ratio 계산 또는 polyethylene glycol 침전검사 등 다양한 테스트를 통하여 다양한 원인에 대한 가능성을 타진해보고 배제한다. 췌장효소가 명백한 원인 없이 반복적인 검사에서 지속적으로 상승한 경우, 만성 비병인성 혈중 췌장효소증가증(CNPH)으로 진단하게 된다. CNPH 환자에 동반된 양성 질환의 임상적 의미에 대한 해석은 연구자들에 따라 다양한데, 동반소견의 대부분은 양성의 질병 경과를 나타낸다. 자기공명담췌관촬영술 (MRCP)은 CNPH 환자에게 매우 유용하고 중요하며, 세크레틴 자극 자기공명담췌관촬영술(MRCP-S)은 아직까지 국내에는 허가되지 않아 임상적 적용은 어렵다. 의사의 선호도에 따라 내시경 초음파를 통해 평가할 수 있지만 침습적인 측면이 있어 주기적인 추적관찰에는 적합하지 않다. CNPH와 연관된 양성 췌장질환에 대한 적극적인 치료 또는 정기적 추적관찰의 필요성을 고려한 후, 발견된 소견에 대한 개별적인 접근이 필요하다. CNPH 환자에서 진단을 위해 시행해야 하는 검사의 범위 그리고 동반된 양성 소견의 임상적 중요성과 추적관찰의 방식 및 종료시점에 대해서는 현재까지의 연구가 제한적이고 전문가들의 의견이 일치하지 않기에 향후 다양한 장기 데이터가 보고될 때까지는 결론을 내리기 어렵다. There are increasing number of cases of serum amylase and lipase levels being examined as part of health screening, but the clinical significance of these amylase and lipase levels is unclear. When the clinicians encounter patients with elevated pancreatic enzymes, the most common causes such as acute pancreatitis, hepatic or renal dysfunction should be ruled out first by thorough history taking, physical examination, and laboratory tests. Further tests including abdominal ultrasonography or computed tomography, lipid profile, tumor marker, isoenzyme, and calculation of amylase-tocreatinine clearance ratio or polyethylene glycol precipitation test should be performed to exclude other causes. If the pancreatic enzymes are continuously elevated through repeated tests without any apparent etiology, the diagnosis is made with chronic non-pathological pancreatic hyperenzymemia (CNPH). Magnetic resonance cholangiopancreatography is very useful and important modality for the patients with CNPH but the clinical significance of magnetic resonance cholangiopancreatography with secretin stimulation is still unclear. They can be evaluated through endoscopic ultrasonography with preference but it is less suitable for follow-up. Individualized approaches should be made after considering the need for active treatment or periodic follow-up for the benign pancreatic diseases associated with CNPH. It is difficult to conclude until more long-term data are reported because there are only limited number of researches and consensus on the range of tests to be performed for diagnosis, clinical significance of benign findings and end of follow-up in patients with CNPH.

수중 물체의 형상 왜곡률에 영향을 미치는 탁도와 광각에 관한 연구

이상협(Sang-hyub Lee),윤한삼(Han-sam Yoon),김민수(Min-su Kim),장성철(Sung-chul Jang) 한국해양환경·에너지학회 2021 한국해양환경·에너지학회 학술대회논문집 Vol.2021 No.10

본 연구에서는 수중 드론을 이용하여 수중에 존재하는 물체가 탁도 및 표면에서 입사되는 광의 각도에 따라 물체의 형상이 얼마나 왜곡되는지 수리 실험으로 파악하는 것에 목적이 있다. 수리 실험은 1.7×0.5×0.57 m 소형 수조에서 수행되었으며 실험 수위는 0.4m이었다. 수중의 탁도와 해수면으로 입사되는 광각을 재현하기 위하여 0.3×0.3m의 Grid plate를 수중 드론을 이용해 촬영하여 분석하였다. 본 연구에서 얻어진 결과는 다음과 같다. (1) 부산 연안의 환경측정망 데이터를 이용해 수리 실험의 기본 조건을 설정하였다. (2) 사전 실린더실험 결과 부유물질의 농도가 높아짐에 따라 탁도는 y=1.1287x + 2.6755로 선형 증가함을 알 수 있었다. (3) 수조실험 결과, 탁도가 증가함에 따라 물체의 왜곡률이 28.03% 증가하며 광각의 변화에 따라 동일 탁도 조건에서 물체의 왜곡률은 0.93% 변화하였다. The purpose of this study is to figure out how much the shape of an object in the water is distorted according to the turbidity and the angle of light incident from the surface using an underwater drone through a hydraulic experiment. The hydraulic experiment was performed in a 1.7×0.5×0.57 m small tank, and the experimental water level was 0.4 m. In order to reproduce the turbidity in the water and the Light angle incident to the sea level, a 0.3×0.3 m grid plate was photographed and analyzed using an underwater drone. The results obtained in this study are as follows. (1) The basic conditions of the hydraulic experiment were set using the environmental measurement network data of the Busan coast. (2) As a result of the mass cylinder experiment, it was found that the turbidity increased linearly to y=1.1287x + 2.6755 as the concentration of suspended matter increased. (3) As a result of the water tank experiment, the distortion rate of the object increased by 28.03% as the turbidity increased, and the distortion rate changed up to 0.93% according to the change of the Light Angle.

접촉피부염 환자의 조직 병변에서 보인 Incidental Acantholysis

이상협 ( Sang Hyub Lee ),최지호 ( Jee Ho Choi ),성경제 ( Kyung Jeh Sung ),문기찬 ( Kee Chan Moon ),고재경 ( Jai Kyoung Koh ) 대한피부과학회 1996 대한피부과학회지 Vol.34 No.3

Incidental acantholysis is a rare histologic findings, and reported in basal cell carcinoma, keratoacanthoma, psoriasis, tinea corporis, etc. We describe a case of contact dermatitis in a 64-year-old female who suffered from recurrent itchy, erythematous patches on face, neck, and shoulder. She presented with recently aggravated itchy skin lesions after using perfume and Tiger balm. Patch test showed strong positive reaction to balsam of Peru, fragrance anix, and Tiger balm. A biopsy specimen showed lichenoid dermatitis and incidental focal acantholysis which was not previously reported in literatures. (Kor J Dermatol 1996;34(3): 422-425)

간세포암종에 의한 폐쇄성 황달의 관리

이상협 ( Sang Hyub Lee ) 대한췌장담도학회 2015 대한췌담도학회지 Vol.20 No.2

간세포암종 환자에서 황달은 불량한 예후를 시사하는 소견이다. 간세포암종에 의한 황달 중 담도폐쇄에 의한 황달은 그 차지하는 비중은 낮으나 적절한 담도배액술을 통해서 황달을 호전시킬 수가 있고 이를 통해 환자의 삶의 질을 향상시키고 예후를 개선시킬 수 있다는 점에서 임상적으로 중요한 의의를 가진다. 간세포암종에 의해 담도폐쇄가 발생한 환자의 적절한 치료를 위해서는 우선 담도폐쇄의 기전을 파악하고 폐쇄 부위를 확인하는 것이 필요하며 그 결과에 따라서 담도배액의 방법을 선택하게 된다. 담도배액술은 내시경적역행성 담췌관조영술을 이용한 내시경적 배액술을 우선적으로 고려하고, 수술 등으로 인한 해부학적 구조의 변형으로 인하여 내시경적 접근이 불가능하거나 내시경적 배액술이 실패한 경우 등에서는 경피경간 담도배액술을 이용한 외배액술 혹은 드물게 내시경 초음파 유도하 담도배액술을 시행한다. 담도배액관은 플라스틱 스텐트와 자가 팽창형 금속 스텐트 중 적절한 것을 선택하여 사용하게 되는데, 둘 중 어느것이 더 좋은지에 대해서는 연구가 부족한 상태이며 병변의 특성과 환자의 여명을 고려하여 스텐트를 선택하는 것이 좋겠다. Jaundice is one of the poor prognostic factors in the patient with hepatocellular carcinoma (HCC). In HCC patients, the most common cause of jaundice is liver parenchymal dysfunction and jaundice due to biliary obstruction is relatively rare. However, it is clinically important because biliary obstruction can be treated effectively with biliary drainage procedure and by that quality of life and survival of the patient can be improved. It is important to identify the mechanism and location of the bile duct obstruction for an appropriate management of the biliary obstruction. Endoscopic retrograde biliary drainage (ERBD) has commonly been selected as the first-line treatment. However, percutaneous transhepatic biliary drainage or endoscopic ultrasound guided biliary drainage also can be used when the endoscopic approach is impossible or when ERBD fails. Between two types of stents - plastic or self-expandable metal, there is no definitive evidence about which one is superior. Stent type should be selected according to the characteristics of obstruction and expected survival of patient. Jaundice is one of the poor prognostic factors in the patient with hepatocellular carcinoma (HCC). In HCC patients, the most common cause of jaundice is liver parenchymal dysfunction and jaundice due to biliary obstruction is relatively rare. However, it is clinically important because biliary obstruction can be treated effectively with biliary drainage procedure and by that quality of life and survival of the patient can be improved. It is important to identify the mechanism and location of the bile duct obstruction for an appropriate management of the biliary obstruction. Endoscopic retrograde biliary drainage (ERBD) has commonly been selected as the first-line treatment. However, percutaneous transhepatic biliary drainage or endoscopic ultrasound guided biliary drainage also can be used when the endoscopic approach is impossible or when ERBD fails. Between two types of stents - plastic or self-expandable metal, there is no definitive evidence about which one is superior. Stent type should be selected according to the characteristics of obstruction and expected survival of patient. Korean J Pancreatobiliary 2015;20(2):57-63

Bcl - 2 단백을 이용한 면역조직학적 방법에 의한 기저세포암과 모낭 상피종의 감별

이상협 ( Sang Hyub Lee ),서호석 ( Ho Suk Suh ),최지호 ( Jee Ho Choi ),성경제 ( Kyung Jeh Sung ),문기찬 ( Kee Chan Moon ),고재경 ( Jai Kyoung Koh ) 대한피부과학회 1996 대한피부과학회지 Vol.34 No.1

Background: It is important to distinguish trichoepitheliomas from basal cell carcinomas because, despite the similarity of clinical and histological findings, the treatments and prognoses are different. bcl-2 is a newly characterized protooncogene that has been shown to suppress programmed cell death(apoptosis), which is involved in tumorigenesis, and its expression has been demonstrated within tumor cells in a variety of neoplasms. Objective : We tried to evaluate the staining pattern of bcl-2 protooncogene in basal cell carcinomas and trichoepitheliomas. Methods : We examined cases of basal cell carcinomas and trichoepitheliomas with the immunohistochemical method of labelled streptavidin-biotin complex in paraffin-embedded sections using the antigen retrieval method. Results : 1. The bcl-2 staining pattern in basal cell carcinomas was diffuse throughout the tumor lobules, but multifocal absences of bcl-2 staining were identified in sites of follicular differentiation. Also, inhomogeneous staining patterns were observed around the cystic, glandular structure of several subtypes of basal cell carcinoma. 2. The trichoepitheliomas showed staining of tumor cells limited to the outer layers of the tumor lobules. 3. Normal skin showed staining of basal keratinocytes, rnelanocytes in the epidermis, and eccrine gland secretory cells, basal layer of follicular structures, and dermal hair papilla in the dermis. Conclusion : The immunohistcchemical bcl-2 staining is helpful for the differentiation of basal cell carcinomas from trichoepitheliomas particularly in borderline cases and the explanation of different biologic courses for the two diseases. Further investigation of bcl-2 staining in other malignant skin diseases should be undertaken, and its practical adaptation should be more widely used in borderline cases. (Kor J Dermatol 1996;34(1): 31-37)

췌장 낭성 병변의 내시경적 치료

이상협 ( Sang Hyub Lee ) 대한소화기학회 2018 대한소화기학회지 Vol.71 No.1

The decision of the appropriate treatment for pancreatic cystic lesions (PCLs) is becoming increasingly important as the number of incidentally found PCLs increases. A range of modalities have been attempted because there has been an increasing demand for minimally invasive treatment for PCLs due to the large burden of a surgical resection. Endoscopic treatment using endoscopic ultrasonography (EUS), a representative of minimally invasive therapy, can be categorized into two types: ablation therapy by the injection of drugs and topical thermal coagulative therapy through the high topical energy. A number of studies reported the feasibility and efficacy of these treatments; the most common is EUS-guided ablation for PCLS with ethanol alone or in combination with anticancer drugs. Although ablation therapies with drug injection have proven safety and feasibility, there is no consensus regarding the actual treatment effects and indications of these modalities. EUS-guided radiofrequency ablation was recently attempted as a representative method of local thermal coagulation, but further studies will be needed because of the lack of evidence of its feasibility and safety. In addition, a range of treatments for malignant tumors rather than PCLs have been attempted, such as EUS-guided photodynamic therapy, EUS-guided neodymium-doped yttrium aluminum garnet laser, and high-intensity focused ultrasound, based on the data from animal experiments. Through further study, endoscopic treatment is expected to become established as a useful treatment modality for PCLs. (Korean J Gastroenterol 2018;71:10-17)

우연히 발견된 췌장 낭성 병변에 대한 임상적 접근

이상협 ( Sang Hyub Lee ) 대한소화기학회 2010 대한소화기학회지 Vol.55 No.3

Cystic lesions of the pancreas are being incidentally recognized with increasing frequency and become a common finding in clinical practice. Despite of recent remarkable advances of radiological and endoscopic assessment and a better understanding of natural history of certain subgroups of cystic lesions, differentiating among lesions and making an optimal management plan is still challenging. A multimodal approach should be performed to evaluate incidentally detected cystic lesions. Emerging evidence supports selective nonoperative management for the majority of patients with cystic lesions, but, for those in whom a suspicion of malignancy remains, surgery is indicated. Concerning long-term follow-up, there is limited data to support the ideal modality, intensity, and duration. Therefore, evidence-based guidelines for the diagnosis, management, and follow-up of cystic lesions of the pancreas should be established. (Korean J Gastroenterol 2010;55:154-161)

간문부 담관암의 광역학요법

이상협 ( Sang Hyub Lee ) 대한췌장담도학회 2014 대한췌담도학회지 Vol.19 No.2

Hilar cholangiocarcinoma is a fatal malignancy leading to high mortality rate despite recent therapeutic advances, and the photodynamic therapy has been noted as an emerging palliative strategy for the hilar cholangiocarcinoma. Photodynamic therapy is the treatment selectively destructing cancer tissue through the laser beam irradiation with particular wavelengths. Photosensitizer administered before the treatment is accumulated in malignant tissue, and activated in the limits of those wavelengths. The procedure is performed under percutaneous transhepatic biliary drainage or endoscopic retrograde cholangiopancreatography, and more appropriate for the periductal infiltrating type rather than mass-forming type of cholangiocarcinoma due to the shallow penetrating depth (<4.5 mm). Recent investigations demonstrated the survival gain of 4-6 months in patients with cholangiocarcinoma when it is added to palliative biliary drainage. In addition, newly developed 3rd generation photo sensitizer has enabled longer therapeutic effect with less skin phototoxicity than before. However, there are still some limitations should be concerned, including lack of large-scaled prospective studies, shallow penetrating depth of tumoricidal effects, lack of treatment response measure, and relatively expensive cost. Addressing these matters through the larger prospective studies or technical improvement may lead new era of photodynamic therapy not only for the palliative purpose but also in the therapeutic field of cholangiocarcinoma.