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가족력이 있는 제2형 다발성 내분비선종(MEN Ⅱa) 1예
천상배,김성은,정윤석,안광진,이현철,허갑범,최윤정,이유복 대한내과학회 1992 대한내과학회지 Vol.42 No.6
저자들은 가족력이 있는 68세 남자환자에서, 6년전 좌측 부신적출술을 시행받고 재발된 악성 갈색세포종과 갑상선수질암 및 부갑상선비후를 동반한 제2형 다발성 내분비선종 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. The inherited cancer syndrome, multiple endocrine neoplasia type 2a (MEN 2a) is characterized by medullary thyroid carcinoma, pheochromocytoma and hyper-plasia of the parathyroid glands. The disease is transmitted as an autosomal dominant trait, but clinical penitrance is incomplete; 40% of gene carriers do not present with symtoms by the age of 70 years. Presymptomatic screening for hyperplasia of the thyroid C-cell by provocation tests for calcitonin release identifies about 90% of gene carriers by the age of 25. Regular prospective screening and appropriate surgical intervention can prevent metastasis of medullary thyroid carcinoma and can reduce the morbidity and mortality due to pheochromocytoma. Recent reports show that linkage of DNA markers to the MEN 2a gene on chromosome 10 is useful for carrier prediction of MEN 2a. Therefore DNA analysis will be introduced into the screening of MEN 2a families. We experienced a case of MEN 2a in a 65-year-old male patient whose 3rd daughter had been diagnosed to MEN 2a. He underwent left adrenalectomy six years ago due to pheochromocytoma, which recurred as malignant pheochromocytoma associated with medullary thyroid carcinoma and parathyroid hyperplasia. He had undergone total radical thyroidectomy with preservation of partial parathyroid gland. Now he is on the 4th cycle of combination chemotherapy for malignant pheochromocytoma.
위암의 심달도 판정에 있어서 내시경 초음파검사의 진단에 영향을 미치는 인자
천상배(Sang Bae Chun),정재복(Jae Bock Chung),송시영(Si Young Song),김범수(Pum Soo Ki m),문영명(Young Myung Moon),강진경(Jin Kyung Kang),박인서(In Suh Park) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.5
N/A Endoscopic ultrasonography(EUS) has been used in assessing the depth of cancer invasion of the stomach. To find out the factors affecting the diagnostic accuracy of EUS in determin- ing the depth of cancer invasion, we analysed 116 cases of gastric cancer performed EUS. One hundred and sixteen cases who were operated for gastric cancer were evaluated by EUS prior to operation. EUS was performed with a 7.5 MHz Olympus EUS. The results were compared with the depth of cancer invasion of the resected specimen and analysed the pathologic findings in mis-staging cases. The degree of vertieal invasion of gastric cancer was classified into 4 stages'. Mucosa, submucosa, muscularis propria, and serosa. Overall accuracy of EUS in determining the depth of cancer invasion was 67.2%(78 of 116 cases). The diagnostic accura- cy in the depth of tumor invasion showed no difference in relation to location of tumor, histo- logic type, and degree of differentiation. In contrast, the diagnostic accuracy was higher in small size(less than 4cm) of tumor than large size(more than 4cm) of tumor, and in non-ul- cerative type than ulcerative type in early gastric cancer. In advanced gastric cancer, the di- agnostic accuracy was higher in large size(more than 6cm) of turnor than small size(less than 2cm) of tumor. The main pathologic findings of overstaging were fibrosis coexisting ulcer and compression of adjacent layer by the tumor, and understaging was microinvasion of cancer. (Korean J Gastroenterol 1994; 26: 806 815)
박상진,박기호,박인서,한광협,박찬일,천상배,한승경,전재윤,박영년 대한내과학회 1994 대한내과학회지 Vol.46 No.3
A 51-year-old women, suffering from an onycomycosis of the toe nails, was treated with itraconazole, 100 mg daily. Fourteen weeks later, she complained of jaundice, nausea, and epigastric discomfort. Itraconazole treatment was stopped immediately. She did not use other drugs. There was no history of alcohol abuse, hepatitis or transfusion. The laboratory investigations revealed marked elevation of serum bilirubin, aspartate aminotransferase and alanine aminotransferase, Histologic findings of liver disclosed acute hepatic necrosis. There was no clinical or serologic evidence of viral hepatitis. One month later, the laboratory data become almost normal. It is suggested that itraconazole therapy was a causal factor in this case of drug induced hepatitis.
강진경,박인서,정재복,송건창,신동환,이현철,김명욱,천상배 대한소화기내시경학회 1993 Clinical Endoscopy Vol.13 No.3
A 45-year-old woman with recurrent disturbances of consciousness for 4 years with hypoglycemia was hospitalized with the clinical suspicion of an insulinoma. The findings of transabdominal ultrasonography, computed tomography and angiography were negative. Transhepatic venous sampling for pancreatic hormone assay showed sudden step-up of serum level of insulin in the venous blood from the tail of the pancreas. Finally, an endoscopic ultrasonographic examination established with certainty the origin of the tumor from the tail of the pancreas, which was subsequently confirmed at operation. In conclusion, endoscopic ultrasonography is a useful and valuable procedure for the localization of insulinoma especially in patient with insulinoma of the pancreas that cannot be localized by conventional methods.
위암의 심달도 판정에 있어서 내시경초음파검사상 오진된 예들의 병리조직학적소견의 검토
강진경,한지영,박인서,문영명,정재복,박찬일,김명욱,송시영,천상배 대한소화기내시경학회 1993 Clinical Endoscopy Vol.13 No.3
Endoscopic ultrasonography(EUS) has been used in assessing the depth of cancer invasion of the stomach. However, there are pathologic findings coexisting cancers which are unable to be detected by EUS resulting in mis-staging preoperatively. To find out the causes of mis-staging in determining the depth of cancer invasion we analysed the pathologic findings of mis-staged cases of gastric cancer by EUS. Ninety one cases who were operated for gastric cancer were evaluated by EUS prior to operation. EUS was performed with a 7.5 ㎒ Olympus-endoscopic ultrasonography(EU-M3) The results were compared with the depth of cancer invasion of the resected specimen and analysed the pathologic findings in mis-staged cases. The degree of vertical invasion of gastric cancer was classified into 4 stages: mucosa, submuosa, muscularis propria and deeper than subserosa. Overall accuracy of EUS in determining the depth of cancer invasion was 68.1%(62 of 91 cases). Among the 29 cases of mis-staging, the local extent of cancer infiltration was overstaged in 22 cases and understaged in 7 cases. The main pathologic findings of overstaging were fibrosis coexisting ulcexative cancer(10 of 22 cases) and compression of adjacent layer by the tumor(5 of 22 cases The main pathologic finding of understaging was microinvasion of cancer(6 of 7 cases). In conclusion, to improve the diagnostic accuracy of EUS in determining the depth of cancer invastion, further studies are needed to differentiate cancer and fibrosis, and to find out the method to detect microinvasion of cancer.