Diagnosis of Suspicion: The Key to an Early Diagnosis of Fibrolamellar Hepatocellular Carcinoma

( Seung Woon Park ),( Soon Ho Um ),( Sun Young Yim ),( Tae Hyung Kim ),( Jemma Ahm ),( Eun Sun Kim ),( Bora Keum ),( Yeon Seok Seo ),( Yoon Tae Jeen ),( Hoon Jai Chun ),( Hong Sik Lee ),( Chang Duck K 대한내과학회 2015 대한내과학회 추계학술발표논문집 Vol.2015 No.1

Fibrolamellar hepatocellular carcinoma (FLHCC) is a rare form of hepatocellular carcinoma. The prevalence in Korea remains to be clarified and a few cases are reported so far. It usually occurs in young people without underlying liver disease. Although it has distinct radiologic and histologic features, liver enzymes and serum Α-fetoprotein (AFP) have no significance leading to difficult early diagnosis. Clinicians should be aware of the possibility of FLHCC in young patient and dynamic image studies should be considered. A 21 year-old Korean man was admitted to department of hepatology due to newly developed right diaphragmatic elevation in chest X-ray. He complained of abdominal pain. His laboratory tests showed mild elevation of liver enzymes. Viral markerswere negative. The positive finding in tumor marker was elevated PIVKA-II. No elevation was observed in AFP. Hepatic lesion was suspected and imaging studies were performed. Chest computed tomography shows a enhancing hepatic mass with central calcifications (Fig. A). Liver magnetic resonance imaging with primovist shows a lobulated contoured mass with low signal intensity central scar, suggestive of FLHCC (Fig.B). He underwent liver resection. Microscopically, the cords of neoplastic hepatocytes were separated by parallel arrays of collagenous stroma, stained blue in Masson’s trichrome stain (Fig. C). The tumor cells had large, vesicular nuclei with prominent nucleoli and eosinophilic cytoplasm (Fig. D). It was diagnosed as FLHCC. No recurrence was observed during follow up.

EVALUATION OF BRACHYTHERAPY FACILITY SHIELDING STATUS IN KOREA OBTAINED FROM RADIATION SAFETY REPORTS

Keum, Mi Hyun,Park, Sung Ho,Ahn, Seung Do,Cho, Woon-Kap Korean Nuclear Society 2013 Nuclear Engineering and Technology Vol.45 No.5

Thirty-eight radiation safety reports for brachytherapy equipment were evaluated to determine the current status of brachytherapy units in Korea and to assess how radiation oncology departments in Korea complete radiation safety reports. The following data was collected: radiation safety report publication year, brachytherapy unit manufacturer, type and activity of the source that was used, affiliation of the drafter, exposure rate constant, the treatment time used to calculate workload and the HVL values used to calculate shielding design goal values. A significant number of the reports (47.4%) included the personal information of the drafter. The treatment time estimates varied widely from 12 to 2,400 min/week. There was acceptable variation in the exposure rate constant values (ranging between 0.469 and 0.592 ($R{\cdot}m^2/Ci{\cdot}hr$), as well as in the HVLs of concrete, steel and lead for Iridium-192 sources that were used to calculate shielding design goal values. There is a need for standard guidelines for completing radiation safety reports that realistically reflect the current clinical situation of radiation oncology departments in Korea. The present study may be useful for formulating these guidelines.

Evaluation of Radiation Safety Reports for Brachytherapy Equipments in Korea

Mihyun Keum,Sung Ho Park,Seung Do Ahn,Woon Kap Cho 대한방사선방어학회 2011 대한방사선방어학회 학술발표회 논문요약집 Vol.2011 No.11

만성 B형간염환자의 재발 방지 및 삶의 질 향상을 위한 시스템 다이내믹스 모델 개발

백승운 ( Seung Woon Paik ),최은옥 ( Eun Ok Choi ),김금순 ( Keum Soon Kim ),이명선 ( Myung Sun Yi ),곽상만 ( Sang Man Kwak ) 한국시스템다이내믹스학회 2006 한국시스템다이내믹스 연구 Vol.7 No.2

A conceptual system dynamics model is developed to represent the dynamic mechanism between the number of hepatitis B virus and the defense system of the body. The simulation results shows that the model behaves within the reasonable ranges. The developed conceptual model is a first attempt to quantify the dynamic mechanisms of the hepatitis B virus, where only feedback structures are considered without bio-organism data. The next step would be to incorporate the model with bio-organism theory and to carry out case studies to identify personal characteristics. Since the current model is a conceptual model where quantitative results are not based on the sound background, the usage is limited only within the qualitative basis. It could be a effective educational tool for the patients. It also shows what-to-do lists in order to be used for forecast purposes. * This study was funded by "the Korea Research Foundation Grant" (KRF-2004-042-E00147) in 2004.

급성 췌장염이 초기 증세로 출현한 부갑상선종 1예

권영금,김진우,최영길,김영설,김광원,양인명,김성운,강흥선,이문목,유승호 대한내분비학회 1990 Endocrinology and metabolism Vol.5 No.2

The clinical course of hyperparathyroidism can be complicated by the deposition of insoluble calcium salts in various organs of the body including the pancreas. The coexistence of pancreatitis and hyperparathyroidism appears to be more than coincidental. Recently we have experienced one case of a parathyroid adenoma associated with acute pancreatitis as a intial manifestation. A 15-year-old female patient was admmited to the hospital because of epigastric pain and vomiting. Then the diagnosis of acute pancreatitis was made, but the hypercalcemia with a increased serum alkaline phosphatase activity led to the discovery of the parathyroid adenoma. After sugical removal of the parathyroid ademena, the patient became euparathyroid. It is suggested that hyperparathyroidism may have led to acute pancreatitis in this patient. Hyperarathyroidism should be condidered as one of the various cause of pancreatic insufficiency. (J Kor Soc Endocrinol 5: 141~144, 1990)

만성 B형 간염환자의 삶의 질과 제요인

김금순(Kim Keum Soon),이명선(Yi Myungsun),최은옥(Choi Eun Ok),백승운(Paik Seung Woon),곽상만(Kwak Sangman),권소희(Kwon So-Hi) 기본간호학회 2007 기본간호학회지 Vol.14 No.3

Purpose: This study aimed to investigate LDQOL (Liver Disease Quality of Life) and its related factors of patients with Hepatitis B. Method: A cross-sectional descriptive study. The LDQOL was formally translated to Korean and reliability was examined. One hundred thirty eight patients following gastroenterology outpatient clinic of S. hospital in Seoul, Korea participated. Results: The mean age of the patients was 45.43 years and 87.7% were men. The mean score of LDQOL was 77.34, and mean scores of subscale were followed; symptom of liver disease (SxLD) (82.12), effect of liver disease (ELD) (25.50), concentration (Cone) (84.47), memory (Mem) (83.24), health discomfort, (HD) (75.18), sexual function (SFun) (75.71), sexual problem (SProb) (84.70), Loneliness (85.50), Hopeless (67.43), and stigma of liver disease (SLD) (91.64). Women had a lower LDQOL score for Loneliness (p=.034), and over 45 year-old patients had a lower LDQOL overall score (p=.000). Patients who were HBV carriers, or who had Chronic Hepatitis B or Liver Cirrhosis reported lower QOL respectively (p=.032). Conclusion: Although the liver disease itself seemed to be stable, patients with HBV experienced poor QOL in ELD, SProb, SFun, and Hopeless. Therefore nursing interventions in these aspects are needed.

A case of diffuse alveolar hemorrhage presented with the gastrointestinal symptoms

Baek, Ki-hwan,Keum, Seung-woon,Oh, Yeon-kyun,Kim, Jong-duck,Yu, Seung-taek 원광대학교 의과학연구소 2009 圓光醫科學 Vol.24 No.1

Diffuse alveolar hemorrhage(DAH) is a potentially fatal condition. DAH may occur independently or in junction with other systemic disorders. Idiopathic pulmonary hemosiderosis(IPH) is referred to as an isolated DAH without any identifiable causation or associated systemic diseases. DAH may be associated with or without histopathologic evidence of pulmonary capillaritis(PC). PC is small-vessel vasculitis, which remains poorly understood. We have reported a case of the pulmonary hemorrhage. The infant did not have any respiratory symptoms and demonstrated only abdominal distension; however, during abdominal computed tomography(CT) examination with enhancement, she developed abrupt diffuse pulmonary hemorrhage and deterioration of her mental functions. After admission for 15 days, symptomatic improvement was shown and she was discharged. Therefore, we have reported a case of diffuse alveolar hemorrhage associated with gastrointestinal symptoms.

만삭아에서 증상이 있는 자발성 기흉의 임상적 연구

김옥란,금승운,황민우,유승택,이창우,최두영,김종덕,오연균 圓光大學校 醫科學硏究所 2008 圓光醫科學 Vol.23 No.1

Background: Symptomatic spontaneous pneumothorax is estimated to occur in 0.05-1% of all term newborn infants. This study was performed to analyze the clinical characteristics of symptomatic spontaneous pneumothorax by distinguishing primary and secondary pneumothorax and the differences between primary and secondary pneumothorax. Methods: We reviewed the medical records of term newborn infants who were born at Wonkwang University Hospital From January 2000 to June 2007, having respiratory difficulty, being shown pneumothorax in the chest X-ray. The subjects were divided into two groups according to preceding diseases; primary pneumothorax and secondary pneumothorax group, then each clinical characteristics were assessed. Results: The incidence of symptomatic spontaneous pneumothorax was 0.66%. There were no differences in sex, maternal age, gestational age, delivery mode, Apgar scores, oligohydramios, and renal and cardiac anomaly between primary and secondary pneumothorax. The onset of symptoms was within 6hours after birth in the majority, and there was no difference between primary and secondary pneumothorax. The pneumothorax was more frequent in right side. The most common preceding disease of secondary pneumothorax was respiratory distress syndrome. The treatment performed most commonly was oxygen therapy with chest tube insertion. The mean duration of oxygen therapy was 5.6±3.8 days, and it was longer in secondary pneumothorax than in primary pneumothorax. Conclusion: In this study, the incidence of symptomatic pneumothorax in term neonate infants was 0.66%, and most of them occurred in 6hours after birth. It occurred more frequently to right side. The major preceding disease of secondary pneumothorax was respiratory distress syndrome. Chest tube insertion and ventilator therapy was needed in most patients, and oxygen therapy was ceased rapidly in primary than secondary pneumothorax. 배경: 만삭아에서 증상이 있는 자발성 기흉의 빈도는 0.05-1% 정도로 보고되고 있다. 본 연구는 선행 질환 유무에 따라 일차성과 이차성으로 구분하고 임상적 양상을 비교하여 차이점을 알아보고자 하였다. 대상 및 방법: 2000년 1월부터 2007년 6월까지 원광대학교 병원에서 출생한 만삭아 중 호흡곤란으로 입원하여 흉부 방사선 소견에서 기흉으로 진단되어 신생아 중환자실에서 치료한 환아를 대상으로 선행 질환 유무에 따라 일차성과 이차성으로 구분하고 임상적 차이점을 비교하였다. 결과: 전체 4.821명의 만삭아 중 증상이 있는 자발성 기흉의 빈도는 0.66%였다. 일차성과 이차성 두 군 간의 성별, 산모 연령, 재태 주령, 분만 형태, Apgar 점수, 양수과소증, 콩팥과 심기형의 차이는 없었다. 증상 발생시간은 1시간 이내 15례(46.8%), 1-6시간 9례(28.1%)로 6시간 이내가 대부분을 차지하였으나, 일차성과 이차성 두 군간의 차이는 없었다. 기흉의 발생 부위는 우측이 20례(62.5%)로 가장 많았고, 일차성에서 이차성에 비해 더 의의 있게 우측에 발생하였다. 이차성 기흉의 선행 질환은 신생아 호흡곤란 증후군이 7례(21.9%)로 가장 많았다. 치료는 흉관 삽입과 함께 호흡기 치료를 받은 경우가 17례(53.1%)로 가장 많았으며, 이차성에서 일차성에 비해 더 많았다. 산소 투여 기간은 일차성은 7일 이내가 11례(64.8%), 이차성은 7일 이상이 8례(53.3%)로 가장 많아 의의를 보였으며, 평균 산소 투여 기간은 5.6±3.8일이고 일차성(4.1±3.2일)에 비해 이차 성(7.3±3.9일)에서 더 오래 산소가 필요하였다. 결론: 만삭아에서 증상을 보이는 기흉의 빈도는 0.66%였으며, 증상 발생 시기는 대부분 출생 후 6시간 이내였고, 발생 부위는 우측이었으며, 이차성의 주 선행 질환은 신생아 호흡곤란 증후군이었다. 대부분 흉관 삽입과 함께 호흡기 치료를 필요로 하였으며, 일차성에서 더 빨리 산소를 제 거할 수 있었다.

Job Stress, Life Event Stress, and the Quality of Life in Patients with HBV related Chronic Liver Disease

Eun-Ok Choi,Keum-Soon Kim,Myungsun Yi,Sangman Kwak,Seung Woon Paik 한국간호과학회 2005 한국간호과학회 학술대회 Vol.2005 No.10

선천성 담도 폐쇄증 환아에서 외상에 의한 손상으로 오인된 대퇴골 골절을 동반한 간성 골 이양증 1예

나종인,백기환,금승운,유승택,오연균 圓光大學校 醫科學硏究所 2007 圓光醫科學 Vol.22 No.1