게이트 심근 SPECT를 이용한 좌심실의 국소탄성률 평가방법 개발 및 재현성 평가

이병일,이동수,이재성,강원준,정준기,이명철,최흥국 대한핵의학회 2003 핵의학 분자영상 Vol.37 No.6

목적: 게이트 심근 SPECT 영상에서 국소부피변화를 얻으면, 요골동맥 긴장도를 측정하여 얻은 중심 동맥의 압력 곡선으로부터 최대탄성률을 얻을 수 있다. 이 연구에서는 좌심실의 국소탄성률을 평가하기 위한 방법을 개발하고 국소탄성률 측정의 재현성을 평가하였다. 대상 및 방법: 게이트 Tc-99m MIBI 심근 관류 SPECT를 두 번 연속으로 시행한 환자 7명(남:여=5:2, 58±11.9세)을 대상으로 하였다. 국소적 부피변화를 측정하기 위하여 개발한 CSA(Cardiac SPECT Analyzer) 소프트웨어를 이용하여 좌심실의 부피변화를 측정하였으며, 시간-압력 곡선과 국소 시간-부피 곡선을 이용하여 반복연산을 통하여 구한 국소 시간-탄성율 곡선에서 국소탄성률을 얻었다. 같은 SPECT 영상에 대해서 두 번 측정한 국소탄성률의 재현성과, 같은 환자에서 연속하여 두 번 얻은 SPECT 영상에 대해서 측정한 국소탄성률의 재현성을 평가하였다. 결과: 평균 국소탄성률은 15분할모델에서 3.36±3.38 mmHg/mL이었으며, 7분할모델과 5분할모델에서 각각 3.16±2.25 mmHg/mL, 3.11±2.57 mmHg/mL이었다. 국소탄성률의 조화평균은 전체탄성률과 일치하였다. 동일한 데이터에서 두 번 측정한 국소탄성률 값의 상관계수는 모든 모델에서 0.97이상이었고, Bland Altman 도표에서 차이의 2-표준편차는 각각 1.5%, 1.0%, 0.9%였다. 동일 환자에서 두 번 연속 촬영한 SPECT 데이터로부터 측정한 국소탄성률의 상관계수는 모든 모델에서 0.95이상이었으며, Bland Altman 도표에서 차이의 2-표준편차는 각각 2.2%, 1.0%, 1.2%였다. 결론: 게이트 심근 SPECT를 이용한 좌심실의 국소탄성률을 측정하였으며 재현성 있는 결과를 얻었다. 심근 SPECT를 이용하여 얻은 국소탄성률의 평가방법은 향후 임상적인 데이터를 바탕으로 새로운 심기능 분석지표로 활용될 수 있을 것이다. Purpose: Regional contractility can be calculated using the regional volume change of left ventricle measured by gated myocardial SPECT image and curve of central artery pressure obtained from radial artery pressure data. In this study, a program to obtain the regional contractility was developed, and reproducibility of regional contractility measurement was assessed. Materials and Methods: Seven patients )male:female=5:2, 58±11.9 years) with coronary artery diseases underwent gated Tc-99m MIBI myocardial SPECT twice without delay between two scans. Regional volume change of left ventricle was estimated using CSA (Cardiac SPECT Analyzer) software developed in this study. Regional contractility was iteratively estimated from the time-elastance curve obtained using the time-pressure curve and regional time-volume curve. Reproducibility of regional contractility measurement assessed by comparing the contractility values measured twice from the same SPECT data and by comparing those measured from the pair of SPECT data obtained from a same patient. Results: Measured regional contractility was 3.36±3.38 mmHg/mL using 15-segment model, 3.16±2.25 mmHg/mL using 7-segment model, and 3.11±2.57 mmHg/mL using 5-segment model. The harmonic average of regional contractility value was almost identical to the global contractility. Correlation coefficient of regional contractility values measured twice from the same data was greater than 0.97 for all models, and two standard deviations of contractility difference on Bland Altman plot were 1.5%, 1.0%, and 0.9% for 15-, 7-, and 5-segment models, respectively. Correlation coefficient of regional contractility values measured from the pair of SPECT data obtained from a same patient was greater than 0.95 for all models, and two standard deviations on Bland Altman plot were 2.2%, 1.0%, and 1.2%. Conclusion: Regional contractility of left ventricle measured using developed software in this study was reproducible. Regional contractility of left ventricle will be a new useful index for myocardial function after analysis of the clinical data.

확률 뇌 지도를 이용한 뇌 영역의 위치 정보 추출

김진수,이동수,이병일,이재성,신희원,정준기,이명철 대한핵의학회 2002 핵의학 분자영상 Vol.36 No.6

목적: SPM 기법을 이용하여 뇌 영상을 분석할 때 Talairach 뇌 지도를 찾아 해부학적 정보를 추측함으로 생기는 문제점들을 해결하기 위하여 통계적 확률 뇌지도(SPAM)을 이용하여 뇌 영역에 대한 해부학적 위치와 확률을 추출하는 프로그램을 개발하였다. 대상 및 방법: 몬트리얼 신경과학연구소에서 개발한 MNI152 표준지도에 기반한 SPAM을 이용하였다. SPM 분석 결과로 주어진 x, y, z 좌표 값을 입력하면 SPAM의 해당 좌표에서 0이 아닌 확률 값을 갖는 영역의 이름 및 확률을 추출하여 출력하게 하였으며 가장 높은 확률을 갖는 영역의 SPAM표준지도 위에 표시하도록 하였다. IDL 및 자바를 기반으로 프로그램을 개발하였으며 향후 인터넷 기반 프로그램으로 확장이 용이하게 하였다. 이 프로그램의 유용성을 보이고자 기존의 SPM 결과보고형식과 이 프로그램에 대한 예비적인 검증을 위하여 활성화되는 영역이 국소화되고 또한 그 영역이 잘 알려져 있는 기억 활성화 PET 실험 분석에 이 프로그램을 적용하여 보았다. 결과: 기존의 SPM 분석한 결과는 MNI 좌표계에서의 좌표 값만을 보여주나 이 프로그램을 이용하여 그 좌표에 대한 확률적 해부학적 정보를 얻을 수 있었다. 기억 실험 결과 유의한 활성화를 보인 영역에 대해서 이 프로그램을 적용한 결과 좌측해마구성체일 확률이 80% 이상임을 알 수 있었으며 이는 이 영역이 기억기능을 담당한다는 기존의 널리 알려진 사실과 잘 부합되었다. 결론: 이 연구에서 개발한 프로그램을 이용하여 MNI 좌표에 대한 해부학적 위치와 확률을 빠르고 정확하게 찾을 수 있어서 뇌영상 분석에 유용할 것이다. Purpose: The use of statistical parametric mapping (SPM) program has increased for the analysis of brain PET and SPECT images. Montreal Neurological Institute (MNI) coordinate is used in SPM program as a standard anatomical framework. While the most researchers look up talairach atlas to report the localization of the activations detected in SPM program, there is significant disparity between MNI templates and Talairach atlas. That disparity between Talairach and MNI coordinates makes the interpretation of SPM result time consuming, subjective and inaccurate. The purpose of this study was to develop a program to provide objective anatomical information of each x-y-z position in ICBM coordinate. Materials and Methods: Program was designed to provide the anatomical information for the given x-y-z position in MNI coordinate based on the Statistical Probabilistic Anatomical Map (SPAM) images of ICBM. When x-y-z position was given to the program, names of the anatomical structures with non-zero probability and the probabilities that the given position belongs to the structures were tabulated. The program was coded using IDL and JAVA language for the easy transplantation to any operating system or platform. Utility of this program was shown by comparing the results of this program to those of SPM program. Preliminary validation study was performed by applying this program to the analysis of PET brain activation study of human memory in which the anatomical information on the activated areas are previously known. Results: Real time retrieval of probabilistic information with 1 ㎜ spatial resolution was archived using the programs. Validation study showed the relevance of this program: probability that the activated area for memory belonged to hippocampal formation was more than 80%. Conclusion: These programs will be useful for the result interpretation of the image analysis performed on MNI coordinate, as done in SPM program. (Korean J Nucl Med 2002;36;317-24)

무증상의 후두개곡 낭종 환자에서 예기치 못한 어려운 기관내 삽관 1례

이상모,최준석,이철승,김원태,박천희 朝鮮大學校 附設 醫學硏究所 2007 The Medical Journal of Chosun University Vol.32 No.1

Although vallecular cyst is often asymptomatic and harmless to the patient, discovery of large vallecular cyst after induction of anesthesia is a potentially life-threatening problem for thepatient and provides for the anesthesiologist a challenge in airway management. We describe a case of difficult intubation where the laryngeal inlet was obscured by a large vallecular cyst that was discovered during induction of general anesthesia. A 47-year-old man presented for elective laparoscopic colecystectomy due to GB polyp. He had normal mouth opening and neck extension; no mass or distortions of the tongue or neck were observed. Anesthesia and paralysis were induced with 80 ㎎ propofol, alfentanil 0.5 ㎎, midazolam 2.0 ㎎ and rocuromum 50 ㎎. It was noted that ventilation of the lungs via mask was difficult. Despite insertion of an oropharyngeal airway, ventilation proved to be more difficult. Intubation was attempted. Direct laryngoscopy (Macintosh 3 blade) revealed a 3-4 ㎝ tranlucent cyst arising from the left vallecula. The cyst completely obscured the view of epiglottis and vocal cords, preventing intubation despite multiple attempts by three anesthesiologists. StafF anesthesiologist was aspirated cyst using a 16-guage needle, syringe and 20 ㎖ of serous fluid were aspirated from cyst. The epiglottis and vocal cord were then exposed and tracheal intubation was performed easily with a size 7.0 cuffed oral tracheal tube. Anesthesia and the operation then proceeded uneventfully, following laparoscopic colecystectomy, an ENT surgeon removed the cyst.

비심장 수술 환자에서 수술 전후 심장사건의 위험도 평가를 위한 심근관류 SPECT 의 유용성

이명철,임석태,이동수,강원준,정준기 대한핵의학회 1999 핵의학 분자영상 Vol.33 No.3

Purpose: We investigated whether myocardial SPECT had additional usefulness to clinical, functional or surgical indices for the preoperative evaluation of cardiac risks in noncardiac surgery. Materials and Methods: 118 patients (M: F=66:52, 62.7±10.5 years) were studied retrospectively. Eighteen underwent vascular surgeries and 100 nonvascular surgeries. Rest T1-201/stress Tc-99m-MIBI SPECT was performed before operation and cardiac events (hard event: cardiac death and myocardial infarction; soft event: ischemic ECG change, congestive heart failure and unstable angina) were surveyed through perioperative periods (14.6±5.6 days). Clinical risk indices, functional capacity, surgery procedures and SPECT findings were tested for their predictive values of perioperative cardiac events. Results: Peri-operative cardiac events occurred in 25 patients (3 hard events and 22 soft events). Clinical risk indices, surgical procedure risks and SPECT findings but functional capacity were predictive of cardiac events. Reveible perfusion decrease was a better predictor than persistent decrease. Multivariate analysis sorted` out surgical procedure risk (p=0.0018) and SPECT findings (p=0.0001) as significant risk factors. SPECT could re-stratify perioperative cardiac risks in patients ranked with surgical procedures. Conclusion: We conclude that myocardial SPECT provides additional predictive value to surgical type risks as well as clinical indexes or functional capacity for the prediction of preoperative cardiac events in noncardiac surgery.

필러의 표면처리와 실리콘 고무의 트래킹특성

李水夫,崔鍾汶,李峻昊,池源泳 湖西大學校工業技術硏究所 1999 工業技術硏究所論文集 Vol.18 No.-

Polymer insulating materials are widely used in power distribution and transmission systems for their good dielectric properties, light weight, low cost, and good contamination performance. Tracking is one of the biggest problems to be overcome in polymer insulating materials. The alumina trihydrate(ATH) is widely used as a filler for improve the tracking performance of silicone rubber. In this paper, we have investigated the influence of surface treatment of fillers on the tracking performance of silicone insulator using the IEC 587 tracking test method.

대동맥 완전 폐쇄의 중재적 치료

심원흠,최동훈,이문형,이도연,장병철,권준 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.1

NK/T 세포 림프종 환자에서 시행된 비골수제거성 조혈모세포이식

정준원,김진석,장준호,서형찬,이승태,김현옥,양우익,민유홍,한지숙,고윤웅 대한조혈모세포이식학회 2001 대한조혈모세포이식학회지 Vol.6 No.2

저자 등은 맹장, 충수돌기 및 흉막을 침범한 고위험군 NK/T 세포 림프종 환자에서 비골수제거 조혈모세포이식을 시행한 후 이식연관 합병증 없이 무병생존하였기에 보고하는 바이다. NK/T cell lymphoma is a rare type of non-Hodgkin"s lymphomas. It has the histological features of angiocentric lymphoma characterized by prominent angio-invasion by tumor cells, and commonly presents in nasal and paranasal structures. Non-nasal form of NK/T cell lymphoma involves skin, gastrointestinal tract, or liver. With conventional chemotherapy and/or radiotherapy, NK/T cell lymphoma shows poor response rate and seldom results in long term survival. Especially, non-nasal form has more aggressive clinical manifestations and grave outcome than nasal form. We report a case of NK/T cell lymphoma presenting with small bowel perforation and malignant pleural effusion due to lymphoma infiltration, transplanted with allogeneic peripheral blood stem cells from HLA identical sibling donor after fludarabine-based nonmyeloablative chemotherapy. After transplantation, the patient achieved an enduring tri-lineage hematological complete response without any evidence of relapse for 10 months.

변이형 협심증 환자의 진단에 있어 Iodine-123Metaiodobenzylguanidine 심근 스캔의 유용성

하종원,이종두,장양수,정남식,권준,임세중,이영준,심원흠,조승연,김성순 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.2

大防風湯의 LPS誘發 關節炎 緩和效果에 관한 實驗的 硏究

田元準,辛吉祚,李源哲 동국대학교 한의학연구소 2000 東國韓醫學硏究所論文集 Vol.9 No.-

본 실험은 大防風湯이 혈관생성과 세포유착인자발현 억제를 통해 LPS(lipopolysaccharide)유발 관절염 완화에 미치는 영향을 조사하기 위해 LPS주사로 관절염이 유발된 생쥐에게 大防風湯 추출액을 음용 투여하였다. 실험동물은 20g된 female Balb/c계 생쥐암컷을 선별하여 아무런 처치를 하지 않은 대조군, 무릎관절에 LPS를 주사한 LPS군, LPS주사후 大防風湯 추출액을 투여한 DBP군으로 나누어, 다시 LPS와 DBP군을 LPS처리 후 시간의 경과에 따라 3, 7, 14일로 구분하였으며, 실험군 각각에는 실험동물을 10마리씩 배정하였다. 광학 현미경(BX50)으로 大防風湯 추출액 투여가 LPS주사 후 증가된 윤할 관절막내 혈관분포 증가에 미치는 영향과 아울러 윤활세포, 섬유화 및 섬유모세포, 비만세포와 염증관여세포, 세포유착인자 등의 윤활 관절막에서의 형태변화를 관찰하였다. DBP군에서는 자유면에서 윤활세포과형성의 억제와 침윤 림프구의 감소, 낮은 섬유화 양상과 침적 섬유모세포의 감소, 모세혈관 주변의 림프구 침적 감소와 비만세포 분포감소, 자유면과 섬유지지역분포 ICAM과 혈관주변분포VCAM 등과 같은 세포유착인자의 감소 등이 관찰되었다. 이상의 결과로 볼 때 大防風湯은 관절염 유발시 발생되는 혈관생성과 세포유착인자의 발현증가 등을 억제함으로써 이후 발생되는 윤활 관절막 손상을 완화하는 것으로 사료된다. Purpose : This study is to investigate the alleviation effects of Daebangpoongtang in LPS induced arthritis in mice knee joint. Methods : Daebangpoongtang was chosen to treat the arthritis caused by injecting 300 μg/kg LPS to mice knee joint. The control group had no treatment, while the LPS group was injected 300μg/kg LPS to mice knee joint and the DBP group was oral administrated of Daebangpoongtang. After injection of 300μg/kg LPS to mice knee joint, the alteration of synovial lining cell, vessel, fibrosis, distribution of collagen fiber, fibroblast, mast cell, infiltration of inflammation component cell and distribution of ICAM and VCAM was observed by light microscope(BX50). Results : In the DBP extract treatment group, the distribution of vessel, the enlargement of synovial lining cell layer, the synovial lining cells with filopodia, the fibrosis, the distribution of fibroblast in synovial membrane, the distribution of ICAM and VCAM on the knee joint was less than that of LPS group. Infiltrated lymphocyte into the apical surface had not observed in the DBP extract treatment group. The distribution of mast cell was as same as control group(no treatment group) and it showed granulated type. Conclusion : According to the above results, it might be considered that the administration of Daebangpoongtang has a curative effect on synovial membrane injury in arthritis by inhibiting increase of vessel, cell adhesion molecule(1CAM and VCAM) in LPS induced arthritis.

Trans-sphenoidal approach에 의한 pituitary microadenoma 수술 후의 임신 1례

여준규,이두룡,이미정,최종무,이원주,류효충,임만빈,최은주 啓明大學校 醫科大學 1993 계명의대학술지 Vol.12 No.3

We treated a patient with pituitary microadenoma having hyperprolactinemia and irregular menstruation infertility by transsphenoidal microsurgery. Her menstrual cycle become irregular after marriage but previous menstrual cycle was regular. When she visited our hospital due to infertility, initial serum prolactine level was slightly elevated 35.68ng/ml, During bromecriptine therapy, abrupt increase of serum prolactine level up to 126.52 ng/ml and headache and facial flush and galactorrhea developed. Pituitary microadenoma was confirmed by CT and MRI. The patient underwent transsphenoidal microsurgery. Patient was pregnant after surgery, and it was confirmed by USG and she is following up, OPD now.