종양치료제가 Ehrlich 종양세포를 이식한 생쥐 위점막 상피세포의 DNA합성에 미치는 영향

고정식(Jeong-Sik Ko),최필조(Pil-Cho Choi),안의태(E-Tay Ahn),박경호(Kyung-Ho Park),박대균(Dae-Kyoon Park) 대한해부학회 2005 Anatomy & Cell Biology Vol.38 No.6

이 실험에서는 Ehrlich 암세포를 이식한 후 5-fluorouracil, adriamycin 또는 mitomycin C를 투여하였을 때, 위점막의 형태학적 변화와 함께 DNA합성지수를 비교 연구하고자 3H-thymidine을 투여한 후 자기방사법적 연구를 시행하였다. 체중 25 gm내외의 성숙한 생쥐(ICR계통)를 실험동물로 이용하였으며, 정상대조군, 암세포이식대조군, 암세포 이식후 5-fluorouracil 투여군, 암세포이식후 adriamycin 투여군, 암세포이식후 mitomycin C 투여군으로 구분하였다. 정상대조군 이외의 암세포 이식군 동물들은 샅부위 피하에 각각 1×107개의 Ehrlich 암세포를 이식한 후, 다음날부터 실험군별로 5-fluorouracil 30 mg/kg, adriamycin 2 mg/kg 및 mitomycin C 400 μg/kg을 격일 간격으로 투여했다. 자기방사법적 관찰을 위하여 약제를 마지막으로 주사한 다음날 3H-thymidine 0.7 μCi/gm를 꼬리에 한차례 정맥주사하고, 70분 후 도살하여 위조직을 떼어내어 10% formalin에 고정하였다. 관찰은 점막근육판을 따라 점막길이 3.5mm의 위점막상피에 분포하는 3H-thymidine 표지세포의 수를 계수하였으며, 일반조직 관찰을 위하여는 hematoxylin-eosin (H-E)염색을 시행하였다. 5-fluorouracil 투여군과 mitomycin C 투여군은 정상대조군에 비하여 고유판에서 림프구와 호산성백혈구가 비교적 많이 관찰되었으나 그 외에는 정상대조군의 소견과 비슷하였다. 그러나 adriamycin 투여군은 위점막이 위축되고 위샘의 상피세포가 납작하고 속공간이 넓은 경우가 자주 관찰되었다. 자기방사법적 연구에서 정상대조군, 암세포이식대조군, 5-fluorouracil 투여군, adriamycin 투여군 및 mitomycin C 투여군은 점막길이 3.5 mm 당 출현하는 표지세포수가 각각 267.3 (±48.86), 273.6 (±59.41), 375.3 (±83.36), 15.3 (±9.66) 및 124.0 (±32.66)개였다. Adriamycin 투여군은 정상대조군에 비하여 은입자의 수가 매우 적어서 표지과립이 겨우 구별되는 세포가 많았으나, 5-fluorouracil 투여군은 은입자가 밀집되어 있는 세포가 정상대조군에 비하여 더 많이 관찰되었다. 이상의 결과를 종합하여 보면 5-fluorouracil, adriamycin 및 mitomycin C 중 adriamycin이 위점막상피세포의 DNA합성에 가장 억제적으로 작용하고 5-fluorouracil은 적은 양일 경우에는 위점막상피세포의 DNA합성에 억제적으로 작용하지 않는다고 생각된다. This experiment was performed to evaluate the morphological responses of the gastric epithelium of the mouse, inoculated with Ehrlich carcinoma cells, following administration of 5-fluorouracil, adriamycin or mitomycin C. Healthy adult ICR mice weighing 25 gm each were divided into normal control and experimental groups (tumor control group, 5-fluorouracil treated group, adriamycin treated group, and mitomycin C treated group). In the experimental groups, each mouse was inoculated with 1×107 Ehrlich carcinoma cells subcutaneously in the inguinal area. From next day after inoculations, 0.2 mL of saline, 5-fluorouracil (30 mg/kg), adriamycin (2 mg/kg) or mitomycin C (400 μg/kg) were injected subcutaneously to the animals every other day, respectively. The day following the 7th injection of anticancer drugs, each mouse was injected with a single dose of 0.7 μCi/gm of methyl-3H-thymidine (25Ci/mmol, Amersham Lab., England) through tail vein. Seventy minutes after the thymidine injection, animals were sacrificed. The number of labeled epithelial cells in the gastric mucosae (mean number of labeled epithelial cells per 3.5 mm length of mucosa) were observed and calculated. On histological study, in the gastric mucosae of adriamycin-treated groups, denatured surface epithelial cells, expanded lumen of the gastric gland, and congested lamina propria were observed. But in the 5-fluorouracil or mitomycin treated groups, severe morphological changes of the gastric mucosae were not observed. On autoradiographic study, numbers of the labeled cells in the gastric mucosae per 3.5 mm length of normal control, tumor control, 5-fluorouracil-treated, adriamycin-treated and mitomycin C treated groups were 267.3 (±48.86), 273.6 (±59.41), 375.3 (±83.36), 15.3 (±9.66) and 124.0 (±32.66), respectively. In the adriamycin and mitomycin C-treated group, poorly-labeled cells containing only a few silver grains of 3H-thymidine were observed more frequently as compared in those of the normal control group. But in the 5-fluorouracil-treated group, number of the heavy labeled cells were observed more frequently than in those of the normal control group. From the above results, adriamycin and mitomycin C may severely suppress the DNA synthesis of the epithelial cells of the gastric mucosae. But some amount of the 5-fluorouracil (30 mg/kg) may not suppress the DNA synthesis of gastric epithelial cells.

복부 전산화단층촬영 결과 진단된 급성 외상성 골반골 골절에서 추가적인 3차원 재구성 골반 전산화단층촬영이 필요한가?

김병권 ( Byoung Kwon Ghim ),신동혁 ( Dong Hyuk Shin ),한상국 ( Sang Kuk Han ),최필조 ( Pil Cho Choi ),이영한 ( Young Han Lee ),박하영 ( Ha Young Park ),배수호 ( Soo Ho Bae ),송형곤 ( Hyoung Gon Song ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.2

Purpose: Abdominal CT (computed tomography) is a principal diagnostic imaging modality for torso trauma at the Emergency Department (ED). When acute osseous pelvic injuries are detected by abdominal CT, additional three-dimensional (3D) reconstruction pelvic CT is often performed. We compared abdominal CT with pelvic CT to provide information about acute osseous pelvic injuries. Methods: A retrospective investigation of patients` electronic medical records during the five year period between January 1, 2004 and December 31, 2008 among Korean soldiers who underwent pelvic CT after abdominal CT at the ED was conducted. Axial images of abdominal CT were compared with axial images and 3D reconstruction images of pelvic CT. Results: Sixteen patients underwent subsequent pelvic CT after abdominal CT. Axial images of abdominal CT showed the same results in terms of fracture detection and classification when compared to axial images and 3D reconstruction images of pelvic CT. Pelvic CT (including 3D reconstruction images) followed by abdominal CT neither detected additional fracture nor changed the fracture type. Conclusion: This study has failed to show any superiority of pelvic CT (including 3D reconstruction images) over abdominal CT in detecting acute osseous pelvic injury. When 3D information is deemed be mandatory, 3D reconstructions of abdominal CT can be requested rather than obtaining an additional pelvic CT for 3D reconstruction. (J Korean Soc Traumatol 2009;22:206-11)

고해상도 전산화 단층촬영에서 확인된 골절 유형에 따른 측두골 골절의 진단에서 뇌전산화 단층촬영의 유용성

권봉석 ( Bong Seok Kwon ),신동혁 ( Dong Hyuk Shin ),최필조 ( Pil Cho Choi ),한상국 ( Sang Kuk Han ),이정훈 ( Jeong Hun Lee ),송형곤 ( Hyoung Gon Song ) 대한외상학회 2010 大韓外傷學會誌 Vol.23 No.1

Purpose: The clinical utility of brain computed tomography (CT) in detecting temporal bone fracture is not well established. We performed this study to determine the utility of brain computed tomography (CT) in detecting fractures of the temporal bones in correlation with fracture patterns. We used high resolution computed tomography (HRCT) as the gold standard for diagnosing temporal bone fracture and its pattern. Methods: From January 2007 to December 2009, patients who underwent both brain CT and HRCT within 10 days of head trauma were investigated. Among them, 58 cases of temporal bone fracture confirmed by HRCT were finally included. Fracture patterns (transverse or non-transverse, otic capsule sparing or otic capsule violating) were determined by HRCT. Brain CT findings in correlation with fracture patterns were analyzed. Results: Among 58 confirmed cases of temporal bone fracture by HRCT, 14 cases (24.1%) were not detected by brain CT. Brain CT showed a significantly lower ability to detect temporal bone fracture with transverse component than without transverse component (p=0.020). Moreover, brain CT showed lower ability to detect otic capsule violating pattern than otic capsule sparing pattern (p=0.015). Among the 14 cases of temporal bone fracture that were not detected by brain CT, 4 cases lacked any objective physical findings (facial palsy, hemotympanum, external auditory canal bleeding) suggesting fractures of the temporal bones. Conclusion: Brain CT showed poor ability to detect temporal bone fracture with transverse component and otic capsule violating pattern, which is associated with a poorer clinical outcome than otic capsule sparing pattern. Routine use of HRCT to identify temporal bone fracture is warranted, even in cases without evidence of temporal bone fracture on brain CT scans or any objective physical findings suggestive of temporal bone fracture. (J Korean Soc Traumatol 2010;23:38-42)

다발성 외상환자의 동반흉부손상 진단시 복부/골반 CT 촬영의 유용성

박상오 ( Sang O Park ),송형곤 ( Hyoung Gon Song ),심민섭 ( Min Seob Sim ),정연권 ( Yeon Kwon Jeong ),최필조 ( Pil Cho Choi ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.2

Background: The objective of this study is to investigate the effect of the Abdomen/Pelvis CT scan for diagnosis of additional thorax injuries in multiple trauma patients. Methods: This study was conducted with 143 multiple trauma patients who visited on the emergency department of Samsung Medical Center, from May. 1997 to Apr. 2004. We reviewed and analysed medical record, the result of their Chest AP view, abdomen/pelvis and Chest CT scan, retrospectively. Results: For 143 abdomen/pelvis injury patients, 84 patients (58.7%) were identified as having additional thorax injuries by Chest CT scans. Detection rate of rib fractures and pulmonary contusions were no difference between Chest AP view and Abdomen/Pelvis CT scan. But Abdomen/Pelvis CT scan had more effective detection rate than Chest AP view in pneumothoraces (15.9% Vs 93.6%) and hemothorace(69.2% Vs 92.3%). Conclusions: Abdomen/Pelvis CT scan provided more important information than Chest AP view for the diagnosis of the thoracic traumas that often missed on initial evaluation in multiple trauma patients. Among the thoracic injuries, pneumothoraces and hemothoraces can be highly detected in Abdomen/Pelvis CT scan.

슬부 외상환자에서 Ottawa Knee Rule의 유용성에 관한 연구

한상국 ( Sang Kuk Han ),송형곤 ( Hyoung Gon Song ),송근정 ( Kuen Jeong Song ),정연권 ( Yeon Kwon Jeong ),심민섭 ( Min Seob Sim ),최필조 ( Pil Cho Choi ) 대한외상학회 2003 大韓外傷學會誌 Vol.16 No.2

Background: We performed this study to validate the Ottawa Knee Rule for determining the need for radiography in patients with acute knee injuries. Methods: A prospective study was performed from August 2001 to July 2002. The patient population was composed of a convenience sample of 242 eligible adults out of 453 adult patients with acute knee injuries. The attending emergency physician assessed each patient for standardized clinical variables and determined the need for radiography according to the decision rule. After the findings of clinical evaluation had been recorded, radiography was performed in each patient, irrespective of the determination of the rule. The rule was assessed for its ability to correctly identify fracture of the knee. Results: The decision rule had a sensitivity of 1.0 and a specificity of 0.46. The potential reduction in use of radiography was estimated to be 40%. The probability of a fracture, existing when the decision rule was negative, is estimated to be 0%. Conclusion: A prospective validation has shown the Ottawa Knee Rule to be 100% sensitive for identifying fractures of the knee and to have the potential to allow physicians to reduce the use of radiography in patients with acute knee injuries.

응급실로 내원한 복부 대동맥류 환자의 임상적 고찰

최필조,한상국,신동혁,권운용,송형곤,송근정,정연권 대한응급의학회 2002 대한응급의학회지 Vol.13 No.4

Purpose: In old age, abdominal aortic aneurysm (AAA) is not a rare disease and potentially fatal. Also, there has been a lack of concern for this disease in the emergency department. Our study investigated the clinical characteristics of AAAs seen in the emergency center to assess the needs of the diagnostic approach to this disease in the emergency center. Methods: Eighty patients with an AAA between Jan. 1995 and Jul. 2002 were enrolled. Data were obtained from a retrospective review of medical records. We analyzed the clinical characteristics of the AAA on the basis of the patient's age and sex, risk factors, presenting symptoms and signs, physical findings, diagnostic tools, and findings. Results: AAAs were predominant in males (82.5%). A smoking history (57.5%), old age over 65 (71.3%) and hypertension (50.0%) were the most common risk factors. In this study, the initial diagnosis of a AAA was mostly determined by the existence of a pulsating abdominal mass, and the overall sensitivity of a pulsating abdominal mass was 57.5%. Although the most common presenting symptom was abdominal pain(51.3%), about one third of the patients had no subjective symptoms. Twenty-one of the patients had a ruptured AAA at the time of diagnosis. There was no remarkable difference in the incidence of large AAA (>5 ㎝) or ruptured AAA between elderly (>65 years) and the young (<65 years). Conclusion: Because of the absence or vagueness of symptoms and signs, an AAA might be initially excluded without a careful examination. For the early detection and prevention of a ruptured AAA, emergency medical doctors should carefully evaluate and assess patients with risk factors even though they have non-specific symptoms of the gastrointestinal or urinary system.

급성 충수돌기염 의증 환자의 진단에서 컴퓨터 단층촬영과 초음파검사의 비교 분석

이정훈,최필조,심민섭,송근정,정연권 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3

Background: This study was conducted to compare the accuracy of computered tomography(CT) and sonography(US) in diagnosing acute appendicitis and to analyze the radiologic factors which influence the result. Methods: We retrospectively studied the cases of 53 patients who were suspected of having appendicitis and who were examined by CT and US covered a three-year period. The final diagnosis was determined from the surgico-pathologic diagnosis and clinical follow-up for two months, as well as from the discharge diagnosis. Results: Thirty-eight(38) patients had acute appendicitis; 15 patients did not. In the analysis, CT and US, respectively, revealed sensitivities of 89.5% and 73.7%, specificities of 93.3% and 60.0%, positive predictive values of 97.1% and 82.4%, negative predictive values of 77.8% and 47.4%. Among patients diagnosed with acute appendicitis, 10 patients were discordant in the US and the CT examinations; CT findings were correct in 8 and US findings in 2. Among non-appendicitis patients, 5 patients were discordant in the US and the CT examinations; CT was correct in 5 and US in 0. Nighteen(19) patients had complications such as an abscess or a perforation. Among these patients, the degree and the extent of the complication were accurately evaluated by CT in 15 patients and by US in 5 patients. Conclusion: CT is more accurate than US in diagnosing and excluding acute appendicitis. The use of CT will substantially decrease unnecessary laparotomies and post-operation complications.

도시지역 3차 응급센터에서의 급성중독환자에 대한 의약분업의 영향

심민섭,최필조,송근정,장문준 대한응급의학회 2002 대한응급의학회지 Vol.13 No.4

Purpose: The separation of prescription and dispensation of drugs starting from July 2000 has led to a reduced exposure to drugs for the general population. Therefore, we hypothesize that the policy of separation the prescribing and the dispensing of drugs has decreased the actual incidence of drug intoxication from drug abuse. Methods: Patients with acute intentional drug intoxication who were admitted to emergency centers in Seoul were retrospectively studied. The study period was subdivided into three: before, during, and after the launch of the policy of separation of prescription and dispensation, corresponding to the periods January to June, 2000; January to June 2001; and January to June 2002, respectively. Results: Acute drug intoxication was associated with 0.2% of all prescriptions during the studied period. There was no significant difference in the types of intoxicating drugs whereas the most commonly abused drug was Doxylamine succinate. Prescribed medications accounted for 37.0%, 29.2%, and 32.3% of the acute drug intoxication cases in 2000, 2001, and 2002, respectively. There was no significant difference in the treatment outcomes between the three study groups although three patients died of paraquat intoxications in 2001. Conclusion: The launch of the policy of separation of prescription and dispension of drugs did not significantly reduce the rate of acute drug intoxication from drug abuse which questions the effectiveness of the policy in decreasing drug abuse. We suggest reassessment of sedatives, in particular, those prescribed medications, in order to decrease the incidence of acute intoxications.