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갑상선 분화암 환자의 경과 관찰에서 수술 전 , 후 혈청 갑상선글로불린 측정의 유용성
원종철,이은주,이성진,문대혁,김상욱,류진숙,안일민,홍석준,한정희,김하영 대한내분비학회 2000 Endocrinology and metabolism Vol.15 No.4
Background: Thyroglobulin (Tg) measurement is primarily used to monitor patients with well differentiated thyroid carcinomas (WDTC) for tumor recurrence. We evaluated the correlations between fold responses of thyroglobulin levels and TNM stages (and MACIS scores) at recurrent group. Also correlations between preoperative Tg levels and Tg (on or off replacement) levels at the time of recurrence were evaluated. Postoperative Tg levels between recurrent and non-recurrent groups were analyzed for the use of assessing risk of recurrence. Methods: One hundred twenty five cases of WDTC who had total thyroidectomy and (131)I remnant thyroid ablation were finally included in this study. After optimal TSH stimulations ($gt;30 μIU/mL), (131)I whole body scan (WBS) was performed. We interpreted as a recurrence only when abnormal findings on the (131)I WBS were detected. Preoperative, immediate postoperative and follow-up Tg tlevels were regularly measured. Results: Difference of preoperative Tg levels between recurrent an non-recurrent groups was not significant (27.5±4.2 ng/mL vs. 16.0±10.9 ng/mL). Also differences of immediate postoperative Tg (on or off replacement) levels between two groups was not significant (2.4±3.8 ng/mL vs. 3.6±3.l ng/mL, 33.4±4.8 ng/ml vs. 24.5±4.8 ng/mL, respectively). Tg levels on replacement at 24 months after surgery between recurrent and non-recurrent groups were significantly different (2.2±4.8 ng/mL, 15.9±6.5 ng/mL, p$lt;0.001) and also Tg levels off replacement between recurrent and non-recurrent groups were significantly different (4.0±6.6ng/mL vs. 49.4±9.3 ng/mL, p$lt;0.001). Fold responses between recurrent and non-recurrent groups were significantly different (2.0±3.1 ng/mL, 5.0±4.1 ng/mL, p=0.009). Fold responses between recurrent and non- recurrent groups were significantly different according to TNM stages (p=0.002) but not different according to MACIS scores. Preoperative Tg levels were correlated Tg (on or off replacement) levels at the time of recurrence (p=0.02, r=0.4: p$lt;0.0espectively). Sensitivity, specificity, accuracy of Tg levels over 2 ng/mL on replacement were 95%, 73%, 84% but those of Tg levels over 7 ng/mL off replacement were 83%, 70%, 77%. Conclusion: Fold responses may predict prognosis of WDTC. Small postoperative increase in serum Tg levels may indicate a large increase of tumor mass in cases of normal or low preoperative Tg levels. Tg levels over 2 ng/mL on replacement or 7 ng/mL off replacement during follow-up may suggest the recurrence of WDTC (J Kor Soc Endocrinol 15:542-553, 2000).
그레이브스병 여성의 산후 갑상선 중독증 감별진단에서 항갑성선 수용체 측정의 임상적 의의
원종철,정윤이,문대혁,류진숙,안일민,김암,한정희,김하영,이성진 대한내분비학회 2001 Endocrinology and metabolism Vol.16 No.1
Background: It is known that pregnancy markedly influences the clinical course of autoimmune thyroid diseases. In the postpartum period, various kinds of autoimmune thyroid dysfunctions can be observed. Thyroid dysfunction is found in 5.57. L /r of postpartum women in the general population. Among those who show thyroid dysfunction after delivery, some will develop Graves disease and others will develop postpartum thyroiditis. It is also known that patients with Graves disease may manifest thyrotoxicosis in the postpartum period because of postpartum thyroiditis or relapse of the Graves disease itself. We evaluated the clinical features of postpartum thyrotoxicosis in Graves disease patients to find diagnostic indices that could be used in differentiating between postpartum thyroiditis and relapse of Graves' disease. Method: We reviewed the cases with postpartum thyrotoxicosis in patients that had a history of Graves disease between 1995 and 2000. The diagnosis of postpartum thyroiditis had been made by means of a 99m Tc thyroid scan or by the observation of a typical triphasic thyroid function change, in cases where a ' 99m Tc thyroid scan was not possible because of breast feeding. We measured the serum TSH, free T4, free T3, TSH binding inhibiting immunoglobulin (TBII), anti-thyroid peroxidase (TPO) antibody, and anti- thyroglobulin (Tg) antibody serially from the time of the diagnosis of Graves' disease to the time of postpartum thyroid dysfunction. Results: Eleven patients, 5 patients in the postpartum thyroiditis (PPT group) and 6 patients with relapse of the Graves' disease (GD group), were identified. The mean values of TBII of two groups at the time of diagnosis of Graves disease were 40.9?4.8 IU/mL (PPT group), 58.9+23.5 ?IU/mL (GD group) respectively, which were insignificant. The mean values of TBII of the two groups at early pregnancy were 3.2+1.9 ~pIU/mL (PPT group), 41.6+22.6 ~pIU/mL (GD group) and this difference was statistically significant (p=0.009). The mean values of TBIJ of the two groups the time of postpartum thyrotoxicosis were 1.9?1.6?IU/mL(PPT group), 51.5?23.2?IU/mL(GD group) which were also statistically significant (p0.003). The mean values of anti-TPO antibody, anti-Tg antibody, disease duration, and treatment duration between the two groups were not significantly different. The onsets of thyroid dysfunction after delivery in the two groups were 2.6?2.0 (PPT group), 4.0?3.9 (GD group) months which were statistically insignificant. Conclusion: These data suggest that the measurement of TBII at the time of the postpartum thyrotoxic period, could help to differentiate postpartum thyroiditis from a relapse of Graves disease in those patients that have a history of Graves disease especially when thyroid scan is not possible because of breast feeding (J Kor Soc Endocrinol l6:75-84, 2001).
1M.L.F. 공정을 사용하여 매립지 침출수에서 질산화와 탈질산화에 미치는 재순환 비율과 수압의 비율의 영향
원종철,이정우,이환규,남궁완,윤조희 한국폐기물자원순환학회 2002 APLAS Vol.2002 No.2
파일럿 스케일의 MLE 공정을 이용하여, 수도권매립지로부터 발생하는 약 1,500~2,000mg/L의 높은 농도의 NH4+-N을 포함한 침출수의 생물학적 질산화와 탈질산화의 재순환 비율과 수압 비율의 변화의 영향을 조사한다. 본 실험의 결과, 약 600%의 재순환 비율과 BOD/NH4+-N의 비가 약 3.0인 조건에서, 약 탈질산화 탱크에서는 2.3일, 질산화는 5.7일이 NH4+-N의 99%와 T-N 80%의 제거효율을 얻기 위한 적당한 HRT이다. 또한, 탈질산화와 질산화의 적절한 미생물농도를 유지하면서, 최대 질소 제거 효율을 얻기 위한 적절한 재순환 비율은 외부 순환에 200%이고 내부순환이 400%이다. T-N과 NH4+-N에서 제거할 수 있는 최대 질소량은 각각 0.55kgT-N/kgVSS/day와 0.07kgT- N/kgVSS/day이 다. T-N을 제거하기 위해 소비되는 알칼리량(△ 알칼리성/△T-N)은 약 5.0이다. We examined the effects of change in hydraulic loading rate and recycle ratio at the time of biological denitrification and nitrification of leachate containing NH4+-N with high concentration about 1,500~2,000 mg/L which is generated from SUDOKWON landfill site using pilot-scaled MLE(modified ludzack ettinger) process. As a result of this examination, we found out that about 2.3 days in denitrification tank and 5.7 days in nitrification are the proper HRT for obtaining the removal efficiency of about 80 % for T-N and 99% for NH4+-N at the conditions of recycle ratio of about 600 % and BOD/NH4+-N ratio of about 3.0. In addition, proper recycle ratio for obtaining the maximum nitrogen removal efficiency while keeping proper microbe concentration in nitrification and denitrification tank was 200 % for external recycle and about 400% for internal recycle. The maximum nitrogen quantities to be removed for each load of T-N and NH4+-N are 0.055 kgT-N/ kgVSS/day and 0.07 kgNH4+-N/kgVSS/day, respectively. Alkalinity quantity (△ alkalinity/△ T-N) to be consumed for removal of T-N was found to be about 5.0.