위 MALT 림프종에서 다발성 림프절 전이로 오인된 동시성 림프절 결핵 1예

김성은,김규종,김도현,송준영,문대성,장리라,유찬희,문원,박무인,박선자,김영옥 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.2

28세 남자가 내시경적 점막절제술을 통해 저등급 위MALT 림프종으로 진단되었다. 병기설정을 위해 18F-FDG PET 검사를 시행하였고 우측 쇄골상부, 우측상/하부 기관주위, AP window 부위에 강한 섭취가 관찰되어 전이성 림프절로 판단하였다. 그러나, 우측 쇄골상부 림프절에서 시행한 절제생검에서 만성육아종성염증소견이 관찰되었고 조직의 결핵 중합효소연쇄반응에서도 양성 반응을 보였다. 2개월간 항결핵제의 사용 후 시행한 추적 컴퓨터단층촬영 검사에서 림프절 크기의 감소를 보여 최종적으로 위 MALT 림프종에서 광범위 림프절 전이로 오인된 동시성 림프절 결핵으로 진단되었다. A 28-year-old man was diagnosed as gastric MALT lymphoma in diagnostic EMR (endoscopic mucosal resection). He subsequently underwent an 18F-FDG PET. 18F-FDG PET showed intense multifocal uptake in right supraclavicular, right upper and lower paratracheal, and AP window areas that was considered radiologically to represent widespread metastatic lymphadenopathy. Excisional biopsy of a supraclavicular lymph node, however, revealed chronic granulomatous lymphadenitis with a positive reaction of Tb-nested PCR. After antituberculosis treatment for 2 months, a follow-up CT scan showed complete resolution of the lesions. Intense 18F-FDG uptake could be due to an infectious process such as synchronous tuberculous lymphadenitis. Therefore, this could mimic a malignant condition such as lymphoma with extensive lymph node metastasis due to a false-positive finding, which may lead to a misdiagnosis.

내시경적 밴드 결찰술로 치료한 출혈을 동반한 위 혈관이형성증 1예

김갑식,허종현,성용완,조영화,구동영,유재훈,노지훈,문원 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.2

Gastric angiodysplasia is vascular ectasia in mucosa and submucosa of the gastric wall. It is an uncommon cause of upper gastrointesinal hemorrhage that may occur in the stomach or duodenum. There are many kinds of endoscopic treatments, such as argon plasma coagulation, electrocoagulation, heat probe, and submucosal injection of hypertonic saline mixed with epinephrine for gastric angiodysplasia. However, these treatment methods are associated with high rate of rebleeding. In order to avoid the recurrence, endoscopic band ligation has recently been used as an alternative method for endoscopic treatment of gastric angiodysplasia. We encountered a case of gastric angiodysplasia that presented with overt bleeding and anemia, and was successfully treated with endoscopic band ligation.

3년내 크기 증가를 보인 위 신경초종 1예

김도현,박무인,유찬희,김규종,문원,박선자,장희경 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.2

저자들은 65세 남자 환자의 위 중부체부 대만부 전벽에 발생한 점막하 종양에 대하여 3년간 추적관찰 중 크기증가소견으로 쐐기 절재술을 시행하였으며, 조직검사 및 면역 조직 화학 검사에서 위 신경초종으로 진단한 1예를 경험하였기에 보고하는 바이다. Gastric schwannoma is a very rare gastrointestinal benign tumor, which represents only 0.2% of all gastric tumors and 4% of all benign gastric tumors. We report a case of gastric schwannoma with enlargement of size through serial endoscopic examination. Endoscopic examination showed a hard mass of 4 x 3 cm in size with normal overlying gastric mucosa on the great curvature of the mid-body of stomach. The pathological finding revealed a picture of spindle cell tumor. Immunohistochemical stain was strongly positive for S-100 protein and non-reactive for CD34, C-kit and smooth muscle actin, thus leading to the diagnosis of gastric schwannoma.

부산 · 경남 지역의 고혈압 사례관리사업 실시 효과

최일호,유병철 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.2

Background : Hypertension is one of the high prevalence disease and 9th common death cause of Korean in 2006. The effective management for hypertension is continuous treatments and maintenance of healthy life style. So, we started this study to verify effect of the case management program as a method for maintenance of hypertension management which is conducted by the National Health Insurance Corporation. Method : We studied effect of the case management for hypertension patients during the period from January to December in 2006. Investigation subjects were 364 hypertension patients residing in Busan and Gyeongsangnam-do. We conducted the case management program for hypertension patient that case managers in each areas performed 3 times visiting and 1 time phone arbitration according to protocol of the case management program by the National Health Insurance Corporation. We evaluated effect of the case management program based on changes of blood pressure, knowledge level for hypertension, self-management level for hypertension patients. Data analysis was performed with t-test and paired t-test using SPSS Win(ver 12.0K) program. Result : After the case management program, mean blood pressure was improved from 113.88 ± 29.41 mmHg to 107.84 ± 25.47 mmHg(p<0.01), systolic blood pressure and diastolic blood pressure were decreased from 139.44 ±17.54 mmHg to 130.98 ± 12.82 mmHg and from 88.33 ± 10.73 mmHg to 84.70 ± 7.84 mmHg(p<0.01). The level of knowledge on 9-point scale for hypertension was increase from 5.65 ± 1.77 before the case management to 7.65 ± 1.36 after the case management(p<0.01) and the level of self-management behaviors for hypertension(sum of the score was 35 points) was improved from 22.69 ± 3.96 to 26.06 ± 3.48(p<0.01). Smoking quantity(cigarette per day) and drinking frequency(time per week) were reduced from 14.74 ± 7.48 and 3.45 ± 4.66 to 12.41 ± 8.24 and 2.56 ± 1.74(p<0.05), exercise frequency(time per week) was increased from 4.60 ± 1.75 to 4.79 ± 1.67(p<0.01). Conclusion : From the result, we can concluded that the case management program conducted by the National Health Insurance Corporation showed decrease of blood pressure, improvements of self-management and knowledge level for hypertension. The case management program for hypertension needs to be developed in a way that increases not only hypertension patient's motivation to manage their diseases but also improvement of public heath system. For the widespread use of the case management program among hypertension patients, media-based promotional campaign and supporting of public health system are much required

Expression of MAGE in Pleural Fluid for the Differential Diagnosis of Benign and Malignant Pleural Effusion

Chul-Ho Oak,Tae-Won Jang,Seong-Hoon Shin,Mann-Hong Jung 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.3

목 적 : 흉막액을 이용하여 MAGE gene family 중에서 MAGE A1 - A6 유전자를 동시에 검출할 수 있도록 고안된 common primer로 RT-PCR을 시행하여 이러한 검사가 악성 흉막액의 감별에 어느 정도 도움이 될 수 있는지 조사하였다. 대 상 : 2002년 1월부터 2002년 10월까지 고신대학교 복음병원에 흉수를 동반한 질환으로 내원한 환자 중 흉수 세포진 검사나 흉막 조직 검사상 악성 흉막액으로 진단 된 환자 36명과 양성 흉막액 환자 20명을 대상으로 하였다. 방 법 : 환자의 흉막액 30mL를 원심 분리하여 상층을 제거한 후 trizol을 이용하여 total RNA를 분리하였다. RNA 분리 후 역전사(reverse transcription)로 cDNA를 합성하여 그 산물로 PCR을 실시하였다. MAGE 1-6 유전자에 대한 RT-PCR & nested PCR-GAPDH로 mRNA가 성공적으로 분리된 것을 확인하였고 MAGE 1-6 common primer (C1,C2/C3,C4)를 사용하여 MAGE 유전자 발현 여부를 확인하였다. 결 과 : 양성 질환에 동반된 흉막액 20예에서는 MAGE가 전례 발현되지 않았고 악성 질환 36예 중 23예 (63.8%)에 서 MAGE 가 발현 되었다. (p<0.0001). 폐암의 조직형에 따른 MAGE 발현의 차이는 없었다. (p<0.9). 악성 질환을 동반한 환자의 흉막액 세포진 검사, CEA 그리고 MAGE검사의 민감도는 각각 55%, 20%, 63% 였다. 세포진 검사에서 음성이었던 16예 중 MAGE가 11예에서 양성이고 CEA는 7예에서 양성이었다. 흉막액 세포진 검사에 MAGE와 CEA를 추가 조사한 경우는 악성 흉막액의 진단율을 92%로 올렸다. 결 론 : 악성 흉막액의 감별진단에 MAGE의 발현을 조사 하는 것이 세포진 검사보다 더 유용하였으며 악성 흉수의 진단에 세포진 검사, 종양 표식자 검사와 함께 MAGE 검사가 보완적인 도구가 될 수 있을 것이다. 향 후 더 많은 환자를 대상으로 한 추가 검사가 필요할 것으로 생각된다. Background : Many tumor specific antigens have been studied for tumor diagnosis and immunotherapy. Among tumor specific antigens , Melanoma antigen gene(MAGE) is exclusively expressed in the testis or malignant cells. We investigated MAGE expression in pleural fluid to differentiate malignant from benign pleural effusion. And the results were compared with those of cytologic examination and tumor maker(CEA) Method : we studied 56 patients with pleural effusions to the Kosin University Gospel Hospital between April 2002 and April 2004( 31 men and 25 women: mean age, 56 years). Expression of MAGE was examined by RT-PCR method using a commercial kit. Tumor maker (carcinoembryonic antigen[CEA]) in pleural fluid was determined by immunoassay. Thirty six patients were proven to have malignant pleural effusion by cytology and pleural biopsy, while 20 patients had benign pleural effusion. Results : MAGE was not expressed in 20 patients with benign pleural effusion, while it was expressed in 23 patients (63.8%) of 36 patients with malignant effusion. The sensitivity of cytologic examinations were 50%. At 100% specificity, a pleural CEA > 50ng/mL had 20% overall sensitivity. The combination of cytology and MAGE reached 84% sensitivity, whereas the combined use of the cytology and tumor marker and MAGE increased sensitivity up to 92%. More than one third of cytology-negative malignant pleural effusion had expression of MAGE. Conclusion : Expression of MAGE in pleural fluid would be a useful and complementary method for differential diagnosis between benign and malignant pleural effusion.

기관지원성 낭종 - 한 기관에서의 10년간의 경험

정민정 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.3

Background : Bronchogenic cyst is rare malformation of primitive foregut. It is usually located in lung and mediastinum, but rarely presented in unusual locations, such as diaphragm, abdomen, retroperitoneum, esophagus, neck, soft tissue and skin. Their histologic finding shows cystic mass lined by ciliated columnar epithelium and supporting fibrous tissue containing glands, hyaline cartilage, smooth muscle, nerve bundle or alveolar units. Methods : We have reviewed medical records and corresponding slides of last ten years about each histologic component; cartilage, submucosal gland, smooth muscle, nerve bundle, alveolar units and epithelial metaplasia, particularly. Results : Ten cases of bronchogenic cyst is collected for ten years. The distribution of age is wide from 2 to 80 years old, and mean age is 42.4 years old, median age is 43 years old. The ratio of male relation to female is 2:8. They are presented in lung (2 cases) and mediastinum (5 cases), in addition anteior neck (1 case), hypopharynx (1 case) and retroperitoneum (1 case). All bronchogenic cyst are lined by pseudostratified ciliated columnar epithelium. There are focal squamous immature metaplasia (30%), hyaline cartilage (30%), submucosal glands (70%), smooth muscle (70%), nerve bundle (40%) and alveolar units (10%). Conclusion : Bronchogenic cyst is rare malformation. Pathologic diagnosis is made with some distinctive component seen in normal bronchus. But some case should be differentiated from cystic mass with pseudostratified ciliated columnar epithelium. So we search helpful findings for differential diagnosis.

잠김 금속판을 이용한 경골 골절의 치료에 대한 임상적 경험 및 초기 결과

권영호,정구희,박영균 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.2

Background : By this study, we evaluated the efficacy of locking compression plate in the treatment of a fractured tibia. Materials and Methods : eighteen tibial fractures were treated by percutaneous plating with locking compression plate. They were composed of nine cases of proximal fracture, two cases of comminuted shaft fracture and seven cases of distal fracture. The results were retrospectively evaluated by the knee and ankle joint motion and walking ability. Results : All fractures were healed except one. The average time for fracture healing was 16.5 weeks(range, 8-24 weeks). Complications included a genu valgus case, but there was no complication of superficial or deep infection. All patients had the recovery of knee and ankle joint motion to the level of pre-injury and could walk without crutch. Conclusion : The locking compression plate(LCP) enables the minimally invasive percutaneous plating technique to fix the tibial fracture and can be selected for the tibial fixation, especially comminuted or metaphyseal fracture because the fixed angle stability of LCP is sufficient to maintain the fracture stability and early joint motion.

원발성부갑상선 기능항진증의 임상적 고찰

류동원,김정훈 고신대학교의과대학 2006 고신대학교 의과대학 학술지 Vol.21 No.2

Background : The purpose of this strudy is to evaluate the clinical characteristics of patients with primary hyperparathyroidism by a retrospective analysis of therir medical records. Primary hyperparathyroidism is a relatively frequent disease in western countries. The rate of occuuuence in Korea is increasing due to increased concern of people and the development of imaging techniques. primary hyperparathyroidism if the most frequent cause of hypercalcemia and due to the routine examination of serum calcium levels, the number of patients with primary hyperparathyroidism has increased. Methods : We reviewed 10 patients treated by surgery over the 5-year period at the Kosin University Hostipal and retrospectively analyzed both the clinicopathologic and bio-chemical features of the presented cases and the effective methods of treatment and diagnosis retrospectively Results :10patients with symptomatic hyperparathyroidism underwent a parathyroidectomy from Jan.1999 to Dec.2003 at the Department of Surgery, Kosin University Hospital. The mean age of the patients was 47.6years old and the male-to-female ratio is 4:6.The most common presenting clinal manifestation were associated with neck palpable mass in 60%, and general weakness in 40%, andbone pain in 20%, and recurrent urinary stone in 20%And asympomatic in 20%. The mean duration of the major symptom of hyperparathyroidism was 10.3months. The level of preopeative serum clacium was 13.6mg, and the level of serum parathyroid hormone was greatly higher than the standard value of hospital laboratory. Preoperative localization study was performed with ultrasonography(USG),computed tomography(CT), Methoxylisobutyl isonitrile(MIBI)scan. The pathologic types of the enlarged glands were adenomas (8cases) and parathyroid carcinoma(2 cases). The mean size of the parathyroid tumors was 2.14cm and the mean weight was 4.7gram. Postoperative hypocalcemia developed in 9patients and was the most severe on post operative 3rd day. All patients showed hypercalcemia and the serum parathyroid hormone(PTH)level was elevated in all 10 patients after1999. Transient hypocalcemian following surgery occurred in 9patients and they were treated with calcium. There were no recurrent cases with the exception of one who displayed carcinoma Conclusion : There was 10.3 months interval from the onset of patients symptoms to the time of parathyroidectomy. Endocrine surgeons should pursue detecting the operable parathyroid tumors and remind medical endocirnologists that the best way of localizing parathyroid tumors is through an operationin. In the study, most of the patients were discovered with an advanced clinical and biochemical status but the number of the asymptomatic patients is increasing. Throught an accurate preoperative localization, they were successfully treated with parathyroidectomy without major complication

저신장이 주소인 소아와 청소년의 성장 평가

이정현 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.3

목 적 : 사회적으로 신장에 대한 관심이 증가하면서 저신장 때문에 성장 평가를 받고자 하는 소아청소년들이 많아지고 있다. 본 연구에서는 저신장이 주소인 소아청소년들의 성장 평가를 바탕으로 저신장의 원인을 알아보고 향후 성장평가와 관리 및 치료의 지침을 세우고자 하였다. 방 법 : 2007년 3월부터 2008년 7월까지 저신장을 주소로 고신대학교복음병원 소아청소년과 성장클리닉을 방문한 만 18세 미만의 남녀 소아청소년 155명을 대상으로 하여 과거력, 주산기 병력, 저신장의 가족력을 조사하였으며 방문 당시 역연령, 골연령, 신장, 체중, 체질량지수를 측정하였고, 실측 신장이 3 백분위수 미만인 경우를 저신장으로 보았다. 저신장의 원인적 분류는 Ranke의 분류에 따랐다. 결 과 : 대상아는 총 155명이었고, 남자와 여자의 성비는 1.25:1(86:69)이었다. 평균연령은 10.27±2.65세, 남아는 10.51±2.83세, 여아는 9.96±2.40세였다. 출생력에서 부당경량아는 총 7명이었고, 미숙아 6명이었으며 부당경량 아이면서 미숙아인 경우는 3명이었다. 부모의 신장이 둘다 3백분위수 미만인 경우는 전체 155명 대상아 중 3명이었고, 부모 중 한 명 이상이 저신장인 경우는 29명(18.7%)이었다. 3 백분위수 미만의 대상아 8명 중에서 1명이 아버지가, 2명이 어머니가 저신장이었다. 정상 신장은 147명(94.8%)이었고 저신장은 8명으로 5.2%였고 저신장 중 병적 저신장이 1명(12.5%), 정상 변이형은 7명(87.5%)이었다. 정상 변이형 중 체질 성장 지연은 3명(37.5%), 유전 저신장은 2명(25%), 체질 성장 지연과 유전 저신장의 혼합형은 2명(25%)이었다. 병적 저신장인 한 명은 출생 당시 자궁내 성장 지연이면서 미숙아로 출생하였고 성조숙증이 합병되어 있었다. 역연령 대비 골연령의 진행 정도는 남아에서 유의하게 지연되어 있었다. 남아의 예측성인신장은 목표성인신장보다 유의하게 컸으며, 여아의 예측성인신장은 목표성인신장과 차이가 없었다. 결 론 : 저신장 때문에 성장클리닉을 방문하여 신장에 대한 평가를 받는 소아청소년들이 많아지고 있으나 이들의 대부분은 정상이고 저신장은 정상 변이형이 대부분이었다. 병적 저신장의 경우 조기에 진단하고 치료하는 것이 최종성인신장 획득의 예후를 결정한다. Background : More and more children and adolescents want to assess of their growth due to the increase of interest in height. This study was undertaken to find out the cause of short stature in children and adolescents complaining of short stature and assessment, management, and treatment of growth. Methods : A retrospective review of medical record was analyzed for 155 children and adolescents complaining of short stature in growth clinic in Kosin Gospel hospital from March 2007 to July 2008. I have investigated history, physical examination, and auxological data such as chronological age, bone age, height, weight, body mass index. I have regarded short stature as below the 3 percentiles on the growth curve. Short stature was classified according to Ranke's etiologic classification. Results : Sex ratio of boys to girls was 1.25:1(86:69). Mean age was 10.27±2.65 years. Out of 155 study subjects, 147(94.8%) had normal stature, and 8(5.2%) had short stature. Out of short stature, pathologic short stature was 1(12.5%) and normal variant was 7(87.5%). In normal variant short stature, constitutional growth delay was 3(37.5%), genetic short stature was 2(25%), and mixed was 2(25%). Pathologic short stature was found in only one who was born as prematurity and intrauterine growth retardation combined with precocious puberty. Predicted adult height in comparison to midparental height was significantly high in boys. Conclusion : The majority of children and adolescents complaining of short stature have normal stature. Normal variant short stature was the most common cause of short stature. Final height gain in pathologic short stature depends on early diagnosis and treatment.

Histopathological Study of Breast Cancer After Ultrasound Guided Cryotherapy Ablation

Dong-Won Ryu 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.3

배 경: 유방암의 조기발견율의 증가에 의한 유방보존술이 증가하고 있으며 1cm 이하의 병변을 포함하여서 최소침습적 시도에 의한 종양의 제거방법이 다양해지고 있다. 최소침습적 시도 중 냉동요법을 이용한 방법은 아직 많은 보고가 없는 상태이다. 이에 본 연구는 냉동요법을 이용하여서 유방암 조직을 치료하였을 때 유방암 조직의 괴사율과 조직학적 변화를 알아보고자 본 연구를 시작하였다. 방 법: 유방암으로 본원에서 수술을 받은 6명의 환자를 대상으로 하였다. 환자의 평균연령은 63세였으며 종양의 평균 크기는 술 전 초음파 소견상 4.3cm였다. 환자는 정상적으로 유방암 수술을 받았으며 절제한 유방암조직을 가지고 냉동요법을 시작하였다. 3mm크기의 냉동치료를 위한 카테터를 이용하여서 초음파를 이용 종양의 가장자리에 카테터가 위치하도록 하였다. 두 번의 얼리고 녹이는 과정을 반복하였다. 얼리는 시간은 10분 이였고 녹이는 시간은 5분 이였다. 시술을 마치고 H&E 염색을 통해서 조직의 괴사유무 및 종양조직의 유무를 판단하였다 결 과: 냉동요법에 의해서 생성된 냉동된 영역의 지름은 2.8cm이였다. 2명의 환자의 조직에서는 완전괴사가 관찰 되었고 4명의 조직에서는 유방암세포가 여전이 남아 있었다. 결 론: 냉동요법을 이용한 유방암의 치료는 아직까지 많은 연구가 필요하다고 생각한다. 냉동요법을 이용한 유방암의 치료에서 가장 중요한 인자는 종양의 크기이며 2cm 이하의 종양을 대상으로 하여야 할 것으로 생각된다. 여기에 대해서는 많은 연구가 필요하다.