척추 손상 환자에서 고환 종물로 오인된 거대 요도 결석과 요도루

박승철(Seung Chol Park),이재환(Jea Whan Lee),최정우(Jeong Woo Choi),황용(Yong Hwang) 한국산학기술학회 2017 한국산학기술학회논문지 Vol.18 No.12

요도 결석은 매우 드믄 질환으로 보고된 증례가 많지 않으며, 대부분 요도 협착이나 요도 게실이 있는 남성에게서 대게 발생한다. 이에 우리는 20년 전 자동차 사고로 인한 척수 손상 후 하반신 마비가 발생한 42세 남성에서 발견된 거대 요로 결석 증례를 보고하고자 한다. 낮 동안에 다원적 증상을 가지고 있고, 고환 밑으로 종물이 만져지며 혈뇨 및 배뇨시 발생하는 통증을 보이면서 최근에는 소변이 전혀 나오지 않는 증상으로 응급실에 내원하여 비뇨기과 협진이 의뢰되었다. 고환 종물의 성상을 확인하기 위해 복부와 골반 컴퓨터 단층 촬영(CT)이 시행되었다. 검사 결과 종양은 관찰되지 않았다. 하지만, 요도 결석이 확인되었다. 우선적으로 요도성형술을 시행하여 방광루를 제거하였으며, 이후 요로 결석은 제거되었다. 2주 후에 요도조형술을 시행하였고 특이사항이 없음을 확인 후 소변줄을 제거하였다. 현재는 배뇨에 대한 특별한 문제는 없는 상태이다. 거대 요도 결석은 때때로 종양과 감별이 필요하며, 크기와 위치에 따라 치료법이 달라질 수 있어 좀 더 면밀한 검사가 필요하다. A urinary calculus in the urethra is rarely seen and usually encountered in men with a urethral stricture or diverticulum. Herein, we report a rare case of a giant calculus in the urethra of a 42-year-old male patient with paraplegia after spinal cord injury due to car accident 20 years ago. A recent urologic consultation from the emergency room was performed since the patient had multidisciplinary symptoms during the day without any urination and presented with urinary difficulties due to hematuria and pain symptoms occurring with a mass in the bottom of the testicles. Abdomen and pelvic computed tomography (CT) was performed to examine the tumor mass, which was found to be absent. In addition, urethral stones were observed in the CT. Cystostomy was performed after the first urethroplasty, and the stone was removed from the urethra. Two weeks later, the patient was subjected to urethrography to remove the Foley catheter. No specific finding in voiding was detected. Giant urethral stones sometime require differentiation from tumor status. Treatment may vary according to size and location, requiring careful examination.

상부요로상피암에서 요관경의 실제

박승철(Seung Chol Park) 대한비뇨기종양학회 2013 대한비뇨기종양학회지 Vol.11 No.2

Upper urinary tract urothelial carcinomas involving renal pelvis or ureter are relatively uncommon, accounting for 5-7% of all renal tumors and about 5% of all urothelial tumors. The most common symptom is gross or microscopic hematuria. Flank pain and lumbar mass are common symptoms of upper tract urothelial carcinoma. Diagnosis of upper urothelial carcinoma based on imaging study included computed tomography urography, cystoscopy with urine cytology, and diagnostic ureteroscopy with biopsy. The traditional pitfalls of upper tract urothelial carcinoma diagnosis, namely poor visualization and difficulty in obtaining representative histological samples, are being circumvented by the introduction of modern digital flexible ureteroscope that can be combined with phothodynamic diagnosis and narrow band image to improve tumor classification, deferring to conservative treatment. The accuracy of the diagnostic work-up of upper tract urothelial carcinoma is very important for decision-making of treatment. The development of technology can allow us more accurate biological information of upper tract urothelial carcinoma.

고위험군 전립선암이란 무엇인가?

박승철(Seung Chol Park) 대한비뇨기종양학회 2012 대한비뇨기종양학회지 Vol.10 No.1

An accurate estimate of overall and disease-specific survival is critical for an informed discussion of treatment options among men with newly diagnosed prostate cancer. The risk of relapse following therapy has been estimated by using multiple definitions ranging from a single parameter, including clinical stage, prostate specific antigen, and Gleason score, to a combination of variables to scoring system or nomogram definition. The most commonly accepted definition was proposed by D’Amico and defines high risk prostate cancer as prostate specific antigen more than 20ng/ml or Gleason score 8-10 or clinical stage of at least T2c. High risk prostate cancer had shown low disease specific survival and overall survival. Long-term survival depends, in part, on risks posed by the tumors and risks posed by existing comorbidity. Therefore more accurate stratification of the individual patient’s risk for progression and likelihood of response to treatment are required. And the new biomarkers are needed to predict survival. This article reviewed the definition of high risk prostate cancer and natural history of high risk prostate cancer.

호르몬불응성전립선암에서 Paclitaxel, Estramustine과 Etoposide를 이용한 병합항암화학요법

박승철(Seung Chol Park),임정식(Joung Sik Rim) 대한비뇨기종양학회 2007 대한비뇨기종양학회지 Vol.5 No.3

다른 고형 장기의 전이 없이 피부전이를 보인 침윤성 방광암

유승현(Seung Hyun You),박승철(Seung Chol Park),백상훈(Sang Hoon Baick),임정식(Joung Sik Rim) 대한비뇨기종양학회 2006 대한비뇨기종양학회지 Vol.4 No.3

부신으로만 전이된 방광의 요로상피세포암

이정우(Jung Woo Lee),박승철(Seung Chol Park),임정식(Joung Sik Rim) 대한비뇨기종양학회 2009 대한비뇨기종양학회지 Vol.7 No.1

흥미영상 : 신경섬유종증 환자의 F-18 FDG PET/CT에서 육종전환으로 오인된 신경섬유종

박순아 ( Soon Ah Park ),송정훈 ( Jeong Hoon Song ),양충용 ( Chung Yong Yang ),김헌수 ( Hun Soo Kim ),박승철 ( Seung Chol Park ) 대한핵의학회 2009 핵의학 분자영상 Vol.43 No.4

We present a patient with high 18F-fluorodeoxyglucose (FDG) uptake detected in a neurofibroma that was confused with sarcomatous transformation on a positron emission tomography/computed tomography (PET/CT) scan. A 39-year-old male patient with a 20-year history of neurofibromatosis-1 (NF-1) performed FDG PET/CT scan for the evaluation of lesions with sarcomatous transformation. The FDG PET/CT images demonstrated varying degrees of increased FDG uptake in the multiple nodules throughout whole body. The left pelvic mass with the highest FDG uptake had a maximum standardized uptake values (maxSUV) 5.0 and surgical resection was performed. Histological analysis confirmed the presence of a benign neurofibroma infiltrated with inflammatory cells. (Nucl Med Mol Imaging 2009;43(4):361-362)

전이성 거세 저항 전립선암에서 Docetaxel 전신 화학요법의 최적의 횟수

안성훈(Sung Hoon Ahn),박승철(Seung Chol Park) 대한비뇨기종양학회 2013 대한비뇨기종양학회지 Vol.11 No.2

Metastatic prostate cancer is initially treated with androgen deprivation therapy, which induces rapid decrease in bone pain and decrease in serum prostate specific antigen level. However, most of cases with prostate cancer eventually progress to castration-resistant prostate cancer within a median of 18-24 months. Docetaxel-based systemic chemotherapy is now the standard treatment for CRPC, based on the results of 2 phase III studies. However, the optimal cycles of docetaxel-based systemic chemotherapy for CRPC has not been defined. Herein, we present two cases of castration-resistant prostate cancer treated by docetaxel-based systemic chemotherapy and reviewed recent literatures.

요로감염의 주요 원인균과 항생제 감수성의 변화에 관한 고찰

하태욱(Tae Uk Ha),황용(Yong Hwang),박승철(Seung Chol Park),이재환(Jea Whan Lee) 한국산학기술학회 2017 한국산학기술학회논문지 Vol.18 No.3

요로감염은 병원 내 감염의 주요한 부분이며 최근 항생제의 남용 등으로 인해 요로감염에서의 효과적인 항생제의 선택이 제한받고 있다. 연구자들은 본 병원을 방문하여 시행한 요배양검사에서 의미있는 균이 동정된 외래 및 입원 환자의 요로감염의 주요 원인균과 항생제 감수성을 조사하여 요로감염의 치료에 도움을 주고자 하였다. 2010년 1월 1일부터 2015년 12월 31일까지 6년간 본 병원에서 시행한 요배양검사에서 의미 있는 원인균이 동정된 외래 및 입원환자를 대상으로 하였으며 균집락 단위(colony forming unit: CFU)가 10<SUP>5</SUP>/ml이상인 환자를 대상으로 하였다. 배양된 동정균주에서 가장 흔한 원인균은 E.coli로 28.1%의 비율이었다. E.coli의 경우 남성에서는 2010년부터 2015년까지 빈도의 차이는 없었으나 여성의 경우 2014년 이후 그 빈도가 점차 감소하였다. 항생제 감수성 결과 가장 흔한 균주인 E.coli의 감수성 검사에서는 ampicillin 72.2%, TMP/SMX (trimethoprim/sulfamethoxazole) 44.9%, ciprofloxacin 41.3%의 내성율을 보였으며, cefazolin 12.4%, 2,3,4세대 cephalosporin에는 5% 이하의 낮은 내성율을 보였다. 요로감염의 원인균은 시간이 지날수록 다양해지고 빈도 또한 변화를 보인다. 따라서 TMP/SMX와 ciprofloxacin 등 기존 항생제에 대한 내성도 또한 비교적 높은 것으로 나타나 향후 요로감염에 대한 경험적인 항생제의 사용에 대해 더욱 신중한 선택을 해야 할 것으로 생각한다. The urinary tract infection (UTI) is one of the most important infections in hospital. The overuse and misuse of antimicrobial agents and the resulting emergence of resistant microorganisms have made choices regarding antimicrobial therapy more difficult. This study examined the changes in the antibiotic susceptibility to the causative organisms of urinary tract infections to provide useful information on the choice of adequate drugs in the treatment of urinary tract infections. The medical records of 2,707 patients with more than 10<SUP>5</SUP>/ml microorganism in urine culture between January 2010 and December 2015 were reviewed retrospectively. The most common pathogenic organism was E. coli (28.1%). In the case of E.coli, there were no differences in frequency from 2010 to 2015 in men, but since 2014, the frequency decreased gradually since 2014 in women. For E. coli, the resistance rates to antibiotics were 72.2% in ampicillin, 44.9% in trimethoprim/sulfamethoxazole (TMP/SMX), and 41.3% in ciprofloxacin, but the 2nd, 3rd, and 4th cephalosporin (5%) had low antibiotic resistance rates. The pathogens of urinary tract infection are becoming diverse and their frequencies are also changing over time. These results suggest that the recommended drugs for UTI should be selected more carefully for in-patients and out-patients.

한국인 전립선암 환자에서 술 전 중등도위험군에서 술 후 고위험군으로 이행할 수 있는 인자

유제국(Je Guk Ryu),황인상(Insang Hwang),임동훈(Dong Hun Im),정영범(Young Beom Jeong),박승철(Seung Chol Park),노준화(Joonwha Noh),권동득(Dong Deuk Kwon),강택원(Taek Won Kang) 대한비뇨기종양학회 2013 대한비뇨기종양학회지 Vol.11 No.3

Purpose: We aimed to examine a change and relevant predictors in intermediate-risk prostate cancer which have a wide range of treatment options from active surveillance to radical prostatectomy (RP). Materials and Methods: Of 1,159 patients who underwent RP in multi-institution between January 2009 and December 2012, 390 patients who were classified as intermediate-risk prostate cancer group by preoperative evaluation according to NCCN guideline were enrolled in this retrospective study. The rates of Gleason score upgrading, upstaging and migrating to high-risk prostate cancer group at final pathology and there risk factors were assessed. Results: The mean age of enrolled patients were 67.33±6.17 years with mean PSA level of 9.34±4.34 ng/ml. The number of patients with worsening upgrading, worsening upstaging and worsening prognosis were 42 (10.77%), 83 (21.28%) and 108 (27.7%), respectively. In analysis compared between upgrading group and non-upgrading group, there was no difference in patient’s features. However, in analysis on upstaging and worsening prognosis, serum PSA (p=0.029, p=0.042) and %positive biopsy core (p=0.010, p=0.013) showed significant difference. In univariable analysis, serum PSA (p=0.030, p=0.042) and %positive biopsy core (p=0.004, p=0.014) were predictive of upstaging and worsening prognosis, also, in multivariable analysis, serum PSA (p=0.016) and %positive biopsy core (p=0.042) were statistically relevant factors of worsening upstaging. Conclusions: In this study, 27.7% of patients with preoperative intermediate-risk prostate cancer were re-stratified into high-risk prostate cancer group after RP. Serum PSA and %positive biopsy core were the predictive factors for migrating to high risk group.