무릎관절의 골 관절염 : 방사선 촬영술과 자기공명 영상의 비교 Comparison of Radiography and MR Imaging

최득린 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.1

X線 造影劑 注入量이 白鼠腎에 미치는 影響의 實驗的 硏究

崔得麟 고려대학교 의과대학 1984 고려대 의대 잡지 Vol.21 No.1

The clinical use of contrast media continue to increase at an enormous rate with new development in diagnostic modalities. Although reports of the contrast media in roentgenography producing acute renal impairment have increased, the pathogenesis is unclear. Predisposing factors include advanced age, previous renal insufficiency, diabetes mellitus, dehydration, multiple myeloma, cardiac disease and hyperuricemia. The author emphasize recent information concerning the pathophysiology of nephrotoxic acute renal impairment produced by radiocontrast media available nowadays and aminoglyconside antibiotics-Gentamycin, which administered subcutaneously twice daily for 10 days. 350 rats (Weight 180-200gm) classified into 3 group, dehydrate group, hydrate group and Gentamycin induced renal impaired group. The author injected small dose, proper dose and massive dose respectively and then took IVP and enforced nephrectomy for histologic examination whether tubular damages or not. The results were summarized as follows: 1. Incidence of contrast induced nephrotoxicity. 1) Dehydrate group Histologic changes developed in 29 rats among 125 rats with overall incidence of 23.2%. Ideal dose without nephrotoxicity ranges from 0.5ml to 1.5ml/㎏. 2) Hydrate group Histologic changes developed in 26 rats with overall incidence of 20.8%, lower than dehydrate group. Ideal dose without nephrotoxicity ranges from 0.5ml to 1.5ml/㎏. 3) Gentamycin treated group Histologic changes developed in 37 rats among 80 rats with overall incidence of 46.3%, 13 rats died with dosage of 5.0ml/㎏, motality rate of 52%. Proper dose range from 1.5ml and under 2.5ml/㎏. 2. Intravenous pyelography 1) Dehydrate group All rats showed good nephrogram and pyelogram during 5 minutes to 30 minutes. No evidence of visualization of large intestine even after 12 hours or 24 hours. 2) Hydrate group Good nephrogram and pyelograms were taken at 5 minutes to 30 minutes with dosage of 0.5ml to 1.5ml/㎏. 3) Gentamycin treated group Poorly visualized nephrogram taken at 30 minutes to 60 minutes. 12hours delayed film showed contrast filled large intestine, possibly due to extrarenal excretion because of renal impairment. 3. Histologic findings. There were variable findings including interstitial hemorrhage between renal cortex and medulla, eosinophilic proteinous round material in the distal convoluted tubules, hydropic degeneration of proximal convoluted tubules and toxic necrosis of proximal convoluted tubules with focal degeneration.

氣管枝擴張症 診斷 時 高解像力 CT의 意義

박재성,최득린,김기정 순천향대학교 1992 논문집 Vol.15 No.4

Bronchography has been classically considered the most accurate procedure by which to evaluate the presence, severity and distribution of bronchiectasis. Recently, the ability of computed tomography (CT) for imaging bronchiectasis was demonstrated. The authors performed a comparative study of HRCT and bronchography. Fifteen consecutive patients who were clinically suspected of having bronchiectasis, were investigated (4 unilateral, 11 bilateral). Fifteen HRCT and 26 bronchography was performed and total of 185 bronchopulmonary segments were evaluated. Segment-by-segment comparison of the 2 studies for the detection of ectatic bronchi were evaluated by 2 radiologists. The results were as follow; 1. The diagnostic concordance rate between the 2 modalities was 87.7%. 2. The sensitivity and specificity of HRCT were 88.1% and 87.5% for bronchography. concordance rate between the 2 modalities was 90.3%. 3. The rate of false negative study of HRCT was 5.5% for bronchography, 3 localized bronchiectasis(33.3%) and 3 mild ectatic change (33.3%) were missed on HRCT. 4. The rate of false negative study of bronchography was 42.9% for HRCT, 9 incomplete opacification of distal bronchi on bronchography. 5. On comparative study of bronchiectatic patterns, 5 varicose bronchiectasis were misdiagnosed as cystic bronchiectasis on HRCT. The HRCT showed a high diagnostic concordance rate with bronchography. Therefore HRCT should be considered as a promising diagnostic modality for detection of bronchiectasis.

대량재해시 방사선학적 검사에 의한 개인식별예

권귀향,최득린,강신몽,이혜경,김기정 大韓法醫學會 1992 대한법의학회지 Vol.16 No.1

There cases of mass disaster, KAL accident in Tripoli, express bus accident and park cemetry accident in Korea, were referred to the National Institute of Scientific Investigation, Seoul, Korea for individual identification (ID). All the cases were thoroughly investigated to establish the most scientifically sound ID possible. In addition to evidence from fingerprint, dental, anthropological, visual, pathological, blood typing and superimpose according to the case, X-ray studies were attempted. In KAL case, 52 of 59 were identified by comparison radiography. Differential diagnosis was accomplished in 2 misidentified bodies in express bus case by radiography. Radiologic examination also revealed good characteristics in park cemetry case, however, did not satisfactorily contribute to ID because of restricted information.

위선암에서 Compylobacter Pylori의 발견율

김의한,최득린,정태은 순천향대학교 1993 논문집 Vol.16 No.2

A close relationship between Campylobactor Pylori and gastric disease was reemphasized by many authors. Campylobactor was mainly observed in the antrum of the gastric mucosa, and considered as a cause of gastric ulcer following to gastritis or intestinal metaplasia. This study was carried out to observe the incidence of C.Pylori in the gastric carcinoma diagnosed by endoscopic biopsy. The following results were obtained. 1. Campylobactor pylori was identified in 61 cases(68.5%) of gastric carcinoma among 89 cases of gastric carcinoma. 2. C.Pylori was identified in 35 cases of carcinoma with intestinal metaplasia and 26 cases of that without intestinal metaplasia, indicating no difference between two groups. 3. C.Pylori was equally identified in well differentiated, moderately differentiated and poorly differentiated carcinoma. 4. C.Pylori was more frequently identified in carcinoma of antrum and pylori than that of body. The above result indicate that C.pylori may play a part of roll for the carcinogenesis of the gastric carcinoma following gastritis intestinal metaplasia and gastric ulcer

유방암과 섬유선종의 방사선학적 소견 : 유방 단순촬영술과 유방 초음파검사 소견의 비교 연구 Studies on mammographic and ultrasonographic findings evaluation

임한혁,최득린,고은석,이혜경,임철완,이상진,홍현숙,최교창,김영화,박재성 순천향의학연구소 1997 Journal of Soonchunhyang Medical Science Vol.3 No.2

Purpose : To evaluate the utility of mammography and ultrasonography in study of morphologic differential diagnosis between malignant and benign mass. Materials and Methods : Average age of patients with breast cancer was 48.4 year-old, and that of fibroadenoma was 29.4 year-old. The equipments used for examination were MF-159 high frequency mammography(Bennet Co.) and Acoustic image 5200S. We evaluated mammographic findings about breast parenchymal pattern, calcification, margin and size of the mass associated tumor nature, and ultrasonographic findings about shape, height and width, internal homogenicity and echo pattern, wall contour, boundary echo, and posterior shadow in breast mass. Thirty-seven of mammographic findings and 34 cases of ultrasonogreaphic findings in pathologically proven breast cancer and 34 case of mammographic findings and 71 cases of ultrasonographic findings in breast fibroadenoma were reviewed retrospectively. Results : In mammographic study, the parenchymal patterns of breast cancer according to Wolfe classification were NI(16.2%), PI(24.3%), P@(37.8%), and DY(21.6%) and those in fibroadenoma were NI(3.1%), Pl(11.7%), P2(35.2%),and DY(50%). Mammographic findings about presence of calcification were as follows; only calcification(16.2%), only mass(51.3%), and mass with calcification(32.5%) in breast cancer, and only mass(91.2%), mass with calcification(8.8%) in fibroadenoma. The features of mass margins were classified as ill-defined margin(45.9%), well-defined(5.4%), and well-defined with partial spiculation(48.6%) in breast cancer and ill-defined(20.5%), well-defined(73.5%), and well-defined with partial spiculation(5.8%) in fibroadenoma. The mass were grouped by size; 1-2cm(37.8%), 2-4cm(45.9%), and 4-6cm(16.3%) in breast cancer and 1-2cm(79.4%), 2-4cm(17.6%), and 4-6cm (3.0%) in fibroadenoma. On ultrasonographic study, the shape of masses in breast cancer were lobulated(82.3%),oval(14.7%), and round(3.0%),and those in fibroadenoma were lobulated(14.0%), oval(57.7%), and round(18.3%). The cases that the height was longer than width were 32.3% in breast cancer and 0% in fibroadenoma. The findings about homogenecity and echo patterns were as follows; hypoechoic(52.9%) and mixed(47.1%) in breast cancer and hypoechoic(2.8%), hypoechoic(63.4%), and mixed(33.8%) in fibroadenoma. The margin of masses were smooth in 85.9% of fibroadenoma, and irregular in 73.6% of breast cancer. The boundary echoes of masses and decreased posterior echo shadow were seen only in 61.8% and 55.9% of breast cancer, respectively. Conclusion: The margin and calcifications are more clearly delineated on mammography but breast cancer and fibroadenoma, both are more commonly developed in dense parenchymal pattern(P2+DY),and there findings are easily obscured in mammography. So ultrasoography is very useful in these masses evaluation, especially amoung young patients.

신동맥 협착 정도에 따른 도플러 초음파 소견

박재성,이혜경,김대호,최득린,권귀향,홍현숙,임한혁,김기정 순천향의학연구소 1995 Journal of Soonchunhyang Medical Science Vol.1 No.2

Renal artery stenosis is the one of causes of hypertension in a small percentage of all patients but is only anatomical cause that can be treated by means of surgery and percutanecous transluminal angioplasty. Angiography is the golden standard for diagnosis of renal artery stenosis, but a little invasive. With the advent of abdominal Doppler ultrasonography, renal artery stenosis could be diagnoed noninvasively. The experienced hands appears to be valuable in the doppler examination, ut some investigators consider it almost useless. The authors studied the effect of stenosis of renal artery on the downstream intrarenal blood flow, a snare was placed around renal artery in 12 rabbits and compressed to create stenosis while Doppler ultraonographic curve and flow index were obtained from main renal and interlobar arteries by means of placement of 10-MHz curved linear tranducer directly on the surface of kidney. The Doppler measurements were compared with the percentage of stenosis on angiograms. The results were as follow: 1. Ten satisfactory angiograms and Doppler ultrasonograms were obtained. 2. Three renal arteries were created stenosis below 70% (Group A), Seven were above 70% (Group B). 3. The ranges of RI (resistance index) were 0.61-0.86 (mean 0.78±0.154) at main renal arteries, 0.57-0.85 (mean 0.77±0.231) at interlobar artery. The range of PS (peak systolic velocity) were 13.1-28.8 (mean 21.65±4.445) m/sex at main renal artery, 5.2-18.1 (mean 11.74±4.095) m/sec at interlobar arteries. The RI of rabbits were higher than those of human (mean 0.58±0.05). 4. The range of RI in stenotic arteries of group B were 0.45-0.74 (mean 0.57±0.143) at main renal artery, 0.52-0.65 (mean 59±0.051) at interlobar arteries. The range of PS were 11.2-21.3 (mean 15.04±3.755) m/sec at main renal arte교, 5.7-11.3 (mean 8.24±2.056) at interlobar artery. The difference were statistical y significant (P=0.0302), but without remarkable change in group A. 5. Doppler ultrasonographic curve during progressive compression of renal artery showed dampened systolic waveform and diagonal upstroke at main renal arteries (71.4%) and interlobar arteries (85.7%) in group B, but without remarkable change in group A. 6. Release of the arterial compression caused higher than normal peak systolic velocity initially, at main renal arteries (42.9%) and interlobar arteries (28.6%). but the curve of all rabbits returned to normal within 5 minutes. The Doppler ultrasonographic index and curve were not changed on follow up Doppler ultrasonogram at 5 min. 10 min. 30 min. and 1 hour. The change of the systolic curves that compressed experimentally is identical to change in the pulsus tardus and parvus waveforms seen in both acute and chronic severe renal artery stenosis in humans, can helpul for the diagnosis of renal artery stenosis and the effects of treatment by percutaneous tranluminal angioplasty and surgery.

KAL기 추락에 의한 대량재해의 개인식별

강신몽,이원태,고영창,최상규,김윤희,이홍석,서재관,윤중진,이혜경,최득린,김종열,윤창육,변명식,이장홍 大韓法醫學會 1991 대한법의학회지 Vol.15 No.2

Individual identification is an important part in medicolegal field especially in mass disaster. At July, 27, 1989, KAL KE-803 was crashed on landing at Tripoli International Airport, Liba. The plane was caught in fire and sixty eight Koreans were sacrified. The majority of victims were severely charred and injured. The authors examed all dead bodies and successfully identified all the cases through visual, anthropological, odontological, radiological and pathological methods including fingerprint and blood typing.

장기투석을 받은 만성 신부전 환자에서 발생한 종양에 관한 고찰

황정화,이혜경,홍현숙,박재성,김대호,권귀향,최득린,황승덕,이희발 순천향의학연구소 1996 Journal of Soonchunhyang Medical Science Vol.2 No.2

The authors tried to evaluate tumor occurrence in long-term dialysis patients with chronic renal failure. Among 359 patients, 20 patients (about 5.6%) were diagnosed with malignancy during long-term dialysis from the period of 1983 to 1995 at our nephrology department. The ultrasonographic and computed tomographic findings including the clinical features of 20 patients that were retrospectively reviewed. The mean age of the patients was 53 (37-75)years old and the ratio of male to female was 9:1. Among the 20 cases, 7 cases of hepatoma (35%) were developed. Among them, urinary tract tumors such as renal and bladder cancer were developed in 4 (20%) and 2 (10%) of the cases. Other malignant tumors were lymphoma, stomach cancer, uterine cervical cancer, cholangiocarcinoma, lung cancer, meningioma, and acoustic neuroma one case of each (each of 5.3%). The most common tumor in patients with chronic renal failure, who were receiving long-term dialysis, was hepatoma and the second most common tumor was cancer of the urinary tract such as kidney and bladder.

소아 급성 신우신염환아의 색도플러 초음파 검사의 유용성

김은미,권귀향,이혜경,홍현숙,최득린 순천향의학연구소 1998 Journal of Soonchunhyang Medical Science Vol.4 No.1

Purpose: Urinary tract infections are common in childhood and are most frequent in those under 1 year of age. In these children, however, differentiation of the pyelonephritis from cystitis is clinically difficult. We investigated the utility of color doppler image ultrasound in the diagnosis of acute pyelonephritis(APN) in children. Results were compared with renal cortical scintigraphy using 99mTC-DMSA. Materials and Methods : 99mTc-DMSA SPECT and color doppler ultrasound were performed within 1 week intervals in 14 patients with clinically suspected APN. (aged 4months to 15years: mean 6.1 year, 7 girls and 7boys). Urine culture was considered positive if greater than 100.000 colonied of a single organism were isolated. CDI was performed with 3.5NHz convex linear probe Ultramark 9(ATL., Bothell, Washington, USA) following a standard gray scale sonogram of the kidneys. Renal cortical scintigraphy was performed with 99mTc DMSA SPeCT(PRISM 2000, Picker, USA), Axial, coronal, both sagittal pinhole images were obtained 1.5-2 hour after 1mCi isotope was injected. Renal scan was considered to be abnormal and indicative of APN when there was a focal, wedged shaped defect in radionuclide accumulation extending from the periphery of the kidney to centrally or if there was diffuse abnormality in renal tubular function. Renal scarring was defined when defects were shallow lesions along the periphery of the kidney with evidence of volume loss, or if they could be shown from prior examination to pre-date of the acute episode. The color doppler image were interpreted to be consistent with APN if there was decrease flows in the renal cortex. Results: Of the 28 kidneys were examined, renal scan showed 5 cases of abnomal findings, 3 cases were APN, 2 cases were chronic scarring. Two fo the three cases of APN showed decreased blood flow on CDI and positive culture, for a sensitivy 67%. Two cases of renal scarring due to grade V bilateral vesicoureteral reflux show decreased blood flow at right upper pole kidney on CDI, however DMSA scan had diffculties finding the new lesion due to underlying irregularity of scarred kidney. Color doppler US correctly identified 4 of 5 renal poles with APN and 21 of 23with no APN including 2 patients with false positive. The DMSA scan was used as the standard of comparison the study; the CDI has a sensitivity 67%, specificity 84%, positive predictive value 33%, negative predictive value 95%. 84% The lesion showed decreased blood flow and on one follow up case increased blood flow. The presence of prior renal scarring made interpretation of asymmetric vascularity difficult on DMSA, the use of CDI may increase the diabnostic sensitivity of sonography in pediatric pyelonephritis.