수술로 절제된 간의 국소 결절성 증식의 임상적 특징

황남철,최문석,이준혁,고광철,백승운,유병철,이종철,이광웅,조재원,박철근 대한간학회 2004 Clinical and Molecular Hepatology(대한간학회지) Vol.10 No.2

목적: 간의 국소 결정성 과형성은 일반적으로 특별한 치료가 필요 없는 양성 종양이다. 그러나 드물지만 합병증이 발생한 경우와 진단이 불확실한 경우에는 수술을 시행하게 된다. 이에 저자들은 간절제술을 시행한 국소 결절성 과형성의 임상적, 영상학적 특징들을 알아보고자 하였다. 대상과 방법: 1995년부터 2003년까지 수술을 시행하여 조직을 확인한 국소 결절성 과형성 환자 10명을 대상으로 연령, 성별, 실험실 검사 및 영상 소견과 조직 소견을 분석하였다. 결과: 연령의 중앙값은 37.5세, 남녀 비는 1.5:1이었다. 5예에서는 간세포선종이나 간세포암종을 감별할 수 없어서 수술을 시행하였으며, 수술 후 우연히 진단된 예는 4예이었다. 간세포암종의 위험 인자를 가지고 있었던 예는 4예(B형 간염 바이러스 보유자 3예, 간경변 2예)이었다. CT검사가 시행되었던 6예 중 5예는 동맥기에서 조영 증강을 보였고 문맥기 및 지연기로 감에 따라 주변과 동일(4예)한 또는 감소(2예)되는 양상을 보여 간세포암종과의 감별이 어려웠다. 크기는 3.2±2.2㎝이었으며 위치는 간우엽의 후하구역(S6)에 가장 많았다(30.0%). 4예에서 수술 전 침생검을 시행하였으나 고분화 간세포암종이나 간세포선종과의 감별이 어려웠다. 결론: 임상상, 영상검사 및 간침생검으로도 간세포암종이나 간세포선종과의 감별이 어려운 경우 수술을 시행하였으며 수술 전에는 발견하지 못하였지만 다른 질환으로 인한 수술시 우연히 발견된 경우도 있어 국소 결절성 과형성의 수술 전 진단이 어려운 경우가 적지 않음을 알 수 있었다. Background/Aims: Focal nodular hyperplasia (FNH) is a benign hepatic tumor with few serious complications and no malignant transformation. However, differential diagnosis between FNH and other liver tumors, especially hepatocellular carcinoma, is often difficult. Methods: Clinical features of surgically resected FNH were reviewed. From January, 1995 to February, 2003, 10 patients with surgically resected FNH were enrolled. Their age, sex, results of laboratory examination, imaging studies and pathologic findings were evaluated. Results: Median age was 37.5 years and sex ratio (male:female) was 1.5:1. In 5 cases, resection to exclude hepatic adenoma or HCC was performed. Four cases were diagnosed incidentally after surgery. Four patients had risk factors for HCC, such as hepatitis B virus infection, liver cirrhosis or both. The size of FNH was 3.2 2.2 cm. The most common site of the tumor was segment 6 (30.0%). Differential diagnosis with HCC was difficult in 5 of six cases in whom CT was performed. Although needle biopsies were performed preoperatively in 4 cases, it was difficult to distinguish FNH from hepatic adenoma or HCC. Conclusions: FNH was resected due to uncertainty of diagnosis, or incidentally during hepatectomy in patients with other liver disease. In the former, differential diagnosis with hepatic adenoma or HCC was a major problem despite extensive work-up including dynamic CT or biopsy. (Korean J Hepatol 2004;10:135-141)

효율적인 객체 지향 분석 방법에 관한 연구

정철원,고형대,고광신 木浦大學校 情報産業硏究所 1996 情報産業硏究誌 Vol.4 No.-

Various methodologies have been studied for producing complex software.Object-oriented technique has proposed in eighties and used in various fields. There are active on going researches on object-oriented method to use it as a software development technique. Applying this mothod in this analysis step of development life-cycle reduce the developers efforts. The proposed Object-oriented analysis method build natural object model based on dynamic behavior of each object. Visibility of a system, a easiness of maintenance and reusability of produced objects will be improved if we use this mothod along with the improved design method.

컴퓨터 단말기 업무자의 요통의 위험요인에 관한 연구

이철호,박정래,차애리,고광욱,김영욱,이수일 大韓産業醫學會 1999 대한직업환경의학회지 Vol.11 No.2

Low back pain in computer terminal operators is a very common but important symptom. While the occupational risk factors of low back pain were approved obscurely, there have been few studies on analysis or understanding of occupational risk factors. Therefore, we studied occupational risk factors of low back pain, especially for ergonomic factors as well as general characteristics of workers. We selected 98 subjects for this study, computer terminal operators ordinary using computers in Pusan. We calculated the subjective severity of low back pain of each operator by the Low Back Pain Scoring System. The relation of low back pain score to general characteristics of worker was also analyzed. We analyzed the relationship between low back pain score and individual efforts to prevent low back pain. We measured the ergonomic factors of each computer terminal operator-Trunk Inclination(TI), Arm Flexion(AF), Elbow Angle(EA), Head Tilting(HT), Knee Angle(KA), using of foot plate and gap between the popliteum and chair. The correlations between these ergonomic factors and low back pain score were then analyzed. And the results are as follows: 1. The prevalence rate of low back pain in computer terminal operators was 39.8% in this study, when low back pain score was converted by the low back pain scoring system. 2. According to general characteristics of workers related to low back pain, the scores were higher in the older age group, the married and the longer work carriers.(p<0.05) 3. In the analysis of the relationship between low back pain score and individual effort to prevent low back pain, regular exercise, history of schooling for prevention of low back pain, and declaration of intention to participate in low back pain education or exercise were stastistically significant(p<0.05). And the more severe the low back pain, the higher the intention to participate in low back pain education they had in this study. 4. In the analyses of relationships or correlations between low back pain score and each of the 7 categories of ergonomic factors, only head tilting had a weak reverse correlation with low back pain(r=0.2999, p<0.01). From now on, cohort studies for the risk factors of low back pain of workers, who have been forced to work in non-ergonomical positioning at the work site, will be necessary. On the background of these ergonomic studies, the occupational health profession should be required to manage ergonomic working conditions.

간세포암종에서 간절제술 후 이환율과 사망률에 영향을 미치는 위험 인자

김완욱,이광웅,최성호,허진석,김용일,김성주,이대성,이환효,백승운,고광철,이준혁,최문석,유병철,조재원 대한간학회 2004 Clinical and Molecular Hepatology(대한간학회지) Vol.10 No.1

목적: 간세포암종은 우리나라에서 간절제의 가장 흔한 적응증이다. 그러나 간경변을 동반한 경우가 많아 수술 후 이환율과 사망률이 높아 수술 전후 처치에 주의를 요한다. 최근에는 외과적 술기의 발전과 수술 전 및 수술 후 처치의 향상으로 이환율과 사망률이 감소하고 있으나 다른 수술에 비해 여전히 높다. 이에 본 연구에서는 간세포암종의 수술 중 위험 인자를 알아보고 수술 후 이환율과 사망률을 줄일 수 있는 방법을 찾아보고자 하였다. 대상과 방법: 1994년 11월부터 2001년 12월까지 간세포암종으로 진단받고, 간절제술을 시행받은 환자 510명을 대상으로 하였다. 대상 환자의 평균 연령은 51.6세였고, 남녀 비는 4.01 : 1이었다. 수술 전 HBsAg (+)는 76.0%, 수술 전, anti-HCV (+)는 8.2%였으며 종양의 크기는 평균 5.19 ㎝이었다. 환자 중 26.2%에서 수술 전 경도자 동맥색전술의 병력이 있었으며 8.7%에서 수술 전 경피적 간문맥색전술을 시행받았다. 시행받은 수술은 종양절제술 55예, 분절절제술 127예, 구역절제술 77예, 반간절제술 214예, 동반 혹은 확대 반간절제술 37예였다. 위험 인자로 나이, 성별과 각종 임상 지표(간기능 수치, 프로트롬빈시간, 혈청 알부민, 혈당, 알파태아단백, ICG 검사, 수술 전 경도자 동맥색전술, 경피적 간문맥색전술 시행 여부) 등의 수술 전 인자, 수술의 종류, 수술 시간, 수혈량 등의 수술 인자, 그리고 종양의 크기, 종양의 수, 간경변 여부 등의 병리조직학적 인자 등을 분석하였다. 분석자료는 대상 환자들의 의무기록을 통해 후향적 방법으로 조사하였다. 수술 사망은 수술 후 30일 이내에 사망한 경우로 정의하였고, 입원 사망은 수술 후 합병증으로 퇴원하지 못하고 사망한 경우로 정의하였다. 단변량 분석은 student t test와 x² test를 이용하였으며, 다변량 분석은 logistic regression을 이용하였다. 결과: 수술 후 합병증은 총 56예(10.5%)에서 나타났으며, 조절되지 않는 복수 19예, 호흡기 합병증 10예, 상처 합병증 8예, 간기능 이상으로 인한 고빌리루빈혈증 6예, 출혈 5예, 고질소혈증 4예 등이었다. 수술 사망은 5예(0.98%), 입원 사망은 수술 사망을 포함하여 6예(1.1%)였다. 이중 간부전과 연관된 사망이 5예였고, 간부전과 동반된 흡인성 폐렴으로 사망한 예가 1예 있었다. 이환율에 영향을 미치는 인자를 다변량 분석을 통해 알아본 결과, 수술 중 수혈량(P=0.002), 프로트롬빈시간(P=0.038), 혈당 수치(P=0.002)가 통계학적으로 의미가 있었고, 다변량 분석 상 수술 후 사망률과 관련된 인자로는 나이(P=0.028), 혈당 수치(P=0.011), 수술 전 경도자 동맥색전술 시행 여부(P=0.046) 등이 의미 있는 것으로 나타났다. 결론: 위의 위험 인자 분석을 통해 간세포암종에서 간절제시에 수술 후 이환율을 중이기 위해 가능한한 수술 중 출혈을 최소화하면서 불필요한 수혈을 피하고, 당뇨 환자에서는 수술 후 이환율과 사망률이 상대적으로 높고, 고령 환자에서는 사망률이 상대적으로 높으므로 수술 전후 처치에 세심한 주의가 필요함을 알 수 있었다. 수술전 경도자 동맥색전술 시행 여부가 수술 후 사망률과 유의한 상관성이 있었고 이에 대한 지속적인 연구가 필요하리라 생각된다. Background/Aims: Recently, mortality following surgical resection for hepatocelluar carcinoma has been reduced significantly. Morbidity, however, is still significant. This study evaluated the risk factors leading to morbidity and mortality. Methods: 510 patients who had a hepatic resection form Nov. 1994 to Dec. 2001 were included. The patient demographics showed a mean age of 51.6 years with a male to female ratio of 4:1. The HBsAg was positive in 76.0% and the anti-HCV was positive in 8.2%. The mean tumor size was 5.2 cm, 26.2% of patients had preoperative transcatheter arterial embolization (TAE), and 8.7% had preoperative percutaneous transhepatic portal embolization (PTPE). Limited resection was performed in 259 cases (50.7%), and major resection was conducted in 251 cases (49.1%). Risk factors included age, sex, laboratory findings (liver function test, prothrombin time, albumin, glucose, α-fetoprotein, ICG test), preoperative TAE, PTPE, operation type, operation time, intraoperative transfusion, tumor size, and cirrhosis. Results: The morbidity was 10.5% (54 cases). Operative death occurred in 5 cases (1.0%). Hospital death, including operative death, occurred in 6 cases (1.2%). Five cases were associated with hepatic failure and 1 case was associated with aspiration pneumonia accompanying hepatic failure. Transfusion (P=0.002), glucose (P=0.002), and prothrombin time (P=0.038) were significantly related to morbidity. Age (P=0.028), glucose (P=0.011), and TAE (P=0.046) were significantly related to mortality. Conclusions: Intraoperative transfusion, which is mainly related to intraoperative bleeding, should be reduced if possible to decrease morbidity. Diabetes mellitus patients and the elderly need careful perioperative management.(Korean J Hepatol 2004;10:51-61)

부산·울산·경남지역 직업병 감시체계

김정일,김병권,김정원,채창호,이철호,강동묵,김지홍,김진하,김영욱,이영하,이지호,김정호,윤형렬,유철인,정백근,장태원,김운규,윤동영,강진욱,김종은,안진홍,이동준,장준호,이광영,송혜란,최영희,이용환,조병만,최홍렬,고상백,김은아,이유진,홍영습,정갑열,김정만,김준연 大韓産業醫學會 2004 대한직업환경의학회지 Vol.16 No.1

Objective: Occupational medicine specialists in the Busan, Ulsan and Kyung-Nam areas established an area-based occupational disease surveillance system and used this system to collected case information for the purpose of preventing occupational diseases Methods: l l hospital participated in this system. The authors selected five main diseases, which were hand-arm vibration syndrome (HAVS), work-related musculoskeletal disorder (WRMSD), occupational asthma, occupational skin disease and occupational and occupational lung cancer and established their case definitions. All cases were reported on the web, and real time analysis was conducted. Results: Between April 2001 and April 2003, 192 cases of HAVS, 118 cases of WRMSD, 33 cases of occupational asthma, 17 cases of occupational skin disease and 17 cases of occupational lung cancer (for a total of 377 cases of these five main diseases) were reported. most of the HAVS cases came from shipbuilding, and 172 of them (92.7%) were associated with grinding. Of the four main types of WRMSD, carpal tunnel syndrome (CTS) was the most prevalent with 46 cases and shipbuilding was also the main industry involved (83.9%). The ergonomic risk factors involved mainly associated with the hand. In 19 (57.6%) and 4 (12.1%) cases of occupational asthma, the agents involved. The causative agents of occupational lung cancer included Cr, welding fume, PAH, Ni, etc. 10(58.8%) of the cases were diagnosed as squamous cell carcinoma and 5(29.4%) as adenoma. Conclusion: This result showed that an area-based occupational disease surveillance system might provide an effective method of evaluating the prevalence of such diseases, however the Busan, Ulsan and Kyung-Nam provinces are too large to be treated as individual areas. Therefore, the authors suggest that each province should establish its own surveillance system.

불명열 환자에서 진단된 중증 만성 활동성 Epstein-Barr virus 감염증

전경만,김응호,손준성,장현하,정숙인,오원섭,백경란,송재훈,고광철,정철원,고영혜 대한감염학회 2003 감염과 화학요법 Vol.35 No.4

최근 장기적이고 심각한 임상 증상을 유발하는 만성 활동성 EBV 감염증의 개념이 정립되면서 그 증례들이 보고되고 있다. 만성 활동성 EBV 감염증은 소아나 젊은 성인들에게서 주로 발생되며, EBV-VCA IgG, EBV-EA IgG의 수치가 높게 관찰되고, 지속적인 발열, 전신쇠약감, 광범위한 임파선비대증, 간비장비대, 범혈구감소증, 다크론성감마병증을 나타낸다. 이 질환은 환자의 임상소견, 혈액학적 소견, EBV 항체 역가 및 침범 장기의 EBV genome 검출로 확진 되며 치료로 항 바이러스 체제, 항암 치료, 골수이식술 등이 시도되고 있으나 아직 검증되어 있지 않다. 저자들은 불명열을 주소로 내원하여 중증 만성 활동성 EBV 감염증으로 진단된 증례 4례를 경험하였다. 한 례에서는 항 바이러스 제제를 추여 후 임상적, 혈액학적 호전을 보였으나 치료 20일째 발생한 세균성 복막염과 패혈증으로 사망하였고, 두 례에서 총 6회의 CHOP 항암치료와 자가조혈모세포이식을 시행 받은 후 현재까지 증상 없이 추적관찰 중이다. 지속되는 발열을 주소로 내원한 불명열 환자들에게서 EBV에 대한 검사를 시행할 경우 불명열의 원인을 규명하는데 하나의 단서를 제공할 수 있을 것으로 사료된다. Epstein-Barr virus (EBV) is one of eight human herpesvirus. Primary infection with EBV in childhood is generally asymptomatic or mild, however, often causes overt diseases such as infectious mononucleosis (IM) and lymphoproliferative disorder (LPD), the latter occursing in immunologically compromised individuals. Historically, EBV has been considered to be etiologically linked to human malignancies such as EBV genome positive Burkitt's lymphoma and nasopharyngeal carcinoma. Recently, however, another category of EBV-related disease, "chronic active EBV infection", has been made to describe persons without a clearly defined underlying disease. We report 4 cases of patients, presented with episodic fever of unknown origin (FUO), who were diagnosed as severe chronic active EBV infection. A combined application of serology for EBV and in-situ hybridization established the diagnosis of the EBV infection.

Universal Emergence of Precore Mutant Hepatitis B Virus along with Seroconversion to Anti-HBe Irrespective of Subsequent Activity of Chronic Hepatitis B

Kwang Cheol Koh,Hyo Suk Lee,Chung Yong Kim 대한내과학회 1994 The Korean Journal of Internal Medicine Vol.9 No.2

Octreotide Ameliorates the Increase in Collateral Blood Flow During Postprandial Hyperemia in Portal Hypertensive Rats

( Kwang Cheol Koh ) 대한간학회 2001 Clinical and Molecular Hepatology(대한간학회지) Vol.7 No.3(S)

Association of the Core Clustering Mutations (Codon 21-34) and the Severity of Chronic Hepatitis B in Korean Patients

( Kwang Cheol Koh ),( Hyo Suk Lee ),( Chung Yong Kim ) 대한내과학회 1995 The Korean Journal of Internal Medicine Vol.10 No.2

문맥압항진증의 실험 동물모델

고광철(Kwang Cheol Koh) 대한소화기학회 2001 대한소화기학회지 Vol.38 No.4

Pathophysiologic studies in patients with portal hypertension face many methodologic and ethical difficulties. Therefore, the knowledge of the pathophysiology of portal hypertension is largely based on the results of studies in experimental models. The most commonly used models are rat and murine. It should be emphasized that these models are extremely useful to enhance our understanding of the mechanism and pharmacology of portal hypertension, but they still have limitations and inconvenience. Some of these problems are related to the conditions in which the experiments are performed, the techniques used for hemodynamic measurements, or model-related limitations. These differences should be carefully considered when the results of experimental studies are analyzed, because they may influence the findings of some investigations. (Korean J Gastroenterol 2001;38: 227-232)