갑상선암 예측에 있어 초음파적 변수 분석

임현정,최영식,박요한,오경승,이강대 고신대학교 의학부 2004 高神大學校 醫學部 論文集 Vol.19 No.1

Background: The introduction of high resolution sonography has made it possible to detect nodules in the thyroid gland. However, there has been no reliable sonographic sign for distinguishing between benign and malignant thyroid conditions. The aim of present study was to evaluate ultrasonographic (US) parameters in predicting thyroid cancer. Methods: One hundred fifty three patients who underwent thyroidectomy at Kosin Medical Center from January, 2000 to April, 2002 were included in the study. All patients were checked high resolutional US before surgery. Of the 153 patients 89 were malignant tumors and 64 benign. Malignant US parameters were defined as calcification, irregular margin, more taller than wide, and fat line obliteration. Calcification pattern was classified with single, punctated, and amorphous calcification. The US characteristics to predict malignancy were evaluated by means of multiple logistic regression analysis. Results: All of the malignant sonographic parameters such as calcification, 53 (89.8%) were thyroid carcinoma. The incidence rate of malignancy was 55.9% in solitary nodules and 65.7% in multiple nodules (p=0.303). Even though nodule size was less than 1.5㎝, the incidence of malignant tumor was 69.5% (p=0.04). Of 53 malignant nodules with calcification, the incidence of single, punctated, and amorphous calcification pattern was 6 (11.3%), 22 (41.5%), 25(47.2%), respectively. The sensitivity, specificity, positive and negative predictive value, and accuracy of sonographic parameters were 76.4%, 87.5%, 89.5%, 72.7% and 81.0%, respectively. Upon the correlation of US-guided FNA cytology with pathologic diagnosis, the sensitivity of ultrasound-guided FNA cytology in differentiating benign and malignant nodule was 85.9%, the specificity 100% and overall diagnostic accuracy was 91.2%. The sensitivity, specificity, and accuracy of US parameters associated to follicular neoplasm, all were 75.0%. Conclusion : All the malignant US parameters including calcification, irregular margin, and more tall than wide showed high level of sensitivity, specificity and accuracy. Of these parameter, calcification and irregular margin were more significants. The more presence of calcifications with punctated and amorphous pattern could suggest the higher possibility of malignancy. However, further study is needed for clinical application of malignant US parameters in the thyroid tumors.

원발성 갑상선 미세 악성림프종 1예

박달수,임진형,편준철,이영수,최영식,박요한,김중규,장희경 고신대학교 의학부 1998 高神大學校 醫學部 論文集 Vol.13 No.1-2

Primary malignant lymphoma of the thyroid is a relatively rare malignant tumor of the' thyroid gland. It is known to be frequently associated with Hashimoto's thyroiditis. In Korea, 8 cases of primary lymphoma of the thyroid have been reported. All patients were over 64 years of age and the size of masses was over 5cm. A 23-year-old woman complained of diffuse goiter. High resolutional ultrasonography revealed 0.6×0.3×0.7cm sized focal low echoic lesion at the deep portion of the left lobe and 0.9×0.5×0.8cm sized focal low echoic lesion at the mid-portion of the right lobe of the thyroid gland. We performed ultrasound-guided fine needle aspiration on the both nodules. The cytologic finding of the nodule in the right lobe suggests malignant nodule and that of the left lobe showed Hashimoto' s thyroiditis. Near total thyroidectomy was performed and confirmed a tumor of low-grade mucosa-associated lymphoid tissue which size was 0.8cm. She was treated with combination chemotheraphy (cyclophosphamide, oncovin, epirubicin, methylprednisolone and bleomycin). We report this case with a review of literatures.

원발성 갑상선 미세 악성림프종 1예

박달수,임진형,편준철,이영수,최영식,박요한,김중규,장희경 高神大學 醫學部 1998 高神大學醫學部 論文集 Vol.13 No.1-2

흰쥐 Nucleus Raphe Magnus에 투여한 Morphine이 척수 Serotonin 유리에 미치는 영향에 관한 연구

이신재,임요한,최영님,김형룡,정동균 대한구강생물학회 1991 International Journal of Oral Biology Vol.15 No.1

It is known that the interaction between opioid neuron and serotonergic neuron in bulbospinal pathway has an important role on pain control. This experiment was perfomed to directly measure the release of serotonin into spinal cord superfusates before and after the microinjection of morphine and its antagonist, naloxone into the NRM of rats. High performance liquid chromatography with electrochemical detection was used to quantitate the amine. The injection of morphine into the NRM induced a significant increase in the amount of serotonin released in the spinal cord, which was reversed after the intraperitioneal injection of naloxone. These results support the proposal that : the analgesia produced by morphine microinjected into the NRM is mediated by the activation of spinally projecting serotonergic neuron.

WDHA(Watery diarrhea, Hypokalemia, Achlorhydria) syndrome 1예

박기룡,김현영,김지혜,임영찬,최영식,박요한,최경현,이재화,장희경 고신대학교 의학부 2003 高神大學校 醫學部 論文集 Vol.18 No.1

저자들은 부갑상선절제술 이후에도 교정되지 않는 고칼슘혈증과 계속된 수양성 설사로 인한 하지마비 및 전신쇠약을 주소로 내원한 70세 남자환자에서 일반 화학검사, 호르몬 건사, 방사선 검사 등으로 VIPoma와 동반된 MEN Ⅰ으로 진단하여 외과적 절제술 후 수양성설사, 저칼슘혈증 및 고칼슘혈증이 호전된 1례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Multiple endocrine neoplasia I (MEN Ⅰ) is a genetic disorder that consists of neoplasia of neuroendocrine type in the parathyroid glands, in the islets of Langerhans in the pancreas, and in the anterior pituitary gland. Primary hyperparathyroidism is most common feature of the MEN I and occurs is approximately 95% of patients. Pancreatic islet cell tumors occur in 40% of MEN I patients. Most of these tumors produce excessive amounts of hormone, such as gastrin, insulin, glucagon and vasoactive intestinal polypeptide (VIP). VIP-producing pancreatic tumors (VIPoma) associated with MEN I are rare and there was only one case report in Korea so far. Recently we experienced a case of MEN I, especially VIPoma presented in a 70 year old man. He got subtotal parathyroidectomy for hyperparathyroidism 5 months ago, but his symptoms of watery diarrhea, severe general weakness and paralysis of lower limbs were not improved and hypercalcemia, hypokalemia were persisted. On computerized tomography scan of abdomen, demonstrated a mass of 3㎝ in diameter at the tail of pancreas. Serum level of VIP hormone was 250pg/㎖ (normal range : 0∼23pg/㎖). After partial pancreatectomy, his symptoms were improved dramatically and biochemical parameters such as, serum potassium, calcium, and VIP returned to the normal ranges.

말초혈액에서 Tg mRNA에 대한 역전사 중합효소 연쇄 반응법의 갑상선 재발암의 분자생물학적 진단

권성일,박기룡,김현영,신채희,임영찬,최영식,박요한,이강대,장희경,이재화,염하용 대한내분비학회 2002 Endocrinology and metabolism Vol.17 No.4

연구배경: 갑상선암은 다른 조직에 발생한 암에 비해 비교적 천천히 자라므로 대부분 예후가 양호하지만, 일부에서는 주위 조직으로 침윤하거나 혹은 원격 전이로 인하여 치명적인 결과를 초래할 수 있다. 갑상선전절제술 및 131^I 제거술 후 경과 관찰시 갑상선암의 재발과 전이의 진단에 있어 131^I 스캔과 혈청 Tg의 측정이 현재 임상에서 가장 많이 이용되고 있으나 이 방법에는 여러 가지의 결점이 있다. 최근 Tg mRNA에 대한 RT-PCR법을 이용한 여러 연구결과는 131^I 스캔과 혈청 Tg 측정의 결점을 보완할 수 있는 좋은 보조적인 진단법으로 이용할 수 있을 가능성을 제시하였다. 이에 말초혈액에서 측정한 Tg mRNA에 대한 RT-PCR법이 갑상선 절제술 및 방사성요드 치료 후 갑상선암의 재발 및 전이 유무의 진단에 유용한가를 알아보고자 이 연구 시행하였다. 방법: 분화된 갑상선암으로 진단된 후 갑상선전절제술을 시행받고 방사성요드 치료를 받은 환자 중 현재까지 한차례에 이상 추적 방사성요드 전신 스캔을 시행하고 추적관찰이 가능했던 유두선암 35예, 여포선암 5예를 대상으로 연구를 시행하였다. 대상군은 131^I 스캔 소견상 음성인 군(Group Ⅰ), 잔여조직이 있는 군(Group Ⅱ), 국소전이가 있는 군(Group Ⅲ), 및 원격전이 군(Group Ⅳ)으로 구분하였다. 정상 대조군은 갑상선질환이 없는 10예의 건강인으로 하였다. 대상환자의 말초혈액을 이용한 Tg mRNA에 대해 특이적인 primer를 이용하여 RT-PCR 및 nested RT-PCR을 시행하였다. 결과: 본 연구 결과는 다음과 같다. 1) 131^I 스캔 소견상 음성인 군 21예 중 1예에서 Tg가 양성소견을 보였다. Anti Tg Ab가 양성인 4예 모두 Tg가 음성을 보였다. 잔여조직이 있거나 국소전이 및 원격전이를 보인 군 19예 중 Tg가 양성인 경우는 4예였으나, Tg mRNA는 전예에서 양성이었다. 2) 131^I 스캔에서 국소 및 원격전이 소견을 보인 8예 중 4예에서 Tg가 음성으로 131^I 스캔과 혈청 Tg 사이에 불일치 소견을 보였다. 3) 말초혈액에서 특이적인 primer를 이용하여 RT-PCR 및 nested RT-PCR을 시행한 결과 대상군 40예 및 정상 대조군 10예 모두에서 Tg mRNA가 양성을 보였다. 결론: 본 연구에서 갑상선 절제술 및 방사성요드 치료 후 갑상선암의 재발 및 전이 유무를 평가함에 있어 역전사 중합효소 연쇄 반응법을 이용한 Tg mRNA 측정의 의의는 재평가되어야 한다고 생각된다. Background: Differentiated thyroid cancer is the most common endocrine malignancy. Despite advances in the treatment of thyroid cancer, disease recurrence and metastasis may occur in as many as 20% of patients, and so continues to pose major problems in its clinical management. Serum thyroglobulin (Tg) measurements, by immunoassay, are used to detect residual or recurrent thyroid cancer following thyriod ablation. However, the usefulness of immunoassay is limited by both the requirement for thyroid hormone withdrawal, to attain optimal test sensitivity, and interference by the antithyroglobulin antibody (Anti-Tg Ab). Recent studies have reported the clinical usefulness of reverse transcription-polymerase chain reaction (RT-PCR) detection of Tg mRNA in the peripheral blood of patients with differentiated thyroid carcinomas. We performed this study to evaluated the usefulness RT-PCR of Tg mRNA in peripheral blood of patients with thyroid carcinoma following a total thyroidectomy and radioiodine ablation therapy. Methods: Forty cases that underwent a total thyroidectomy and radioiodine ablation therapy were included in this study. Of the 40 patients, 35 were papillary carcinomas and 5 were follicular carcinomas. Ten normal control subjects were also studied. Tg mRNA was extracted. Then RT-PCR and nested RT-PCR, were run with specific Tg primers. Concurrently, DNA sequencing of the isolates was carried out to prove the isolates were identical to the nucleotide sequence of the Tg. Results: The Tg was detected in 4 of 19 patients, with either a residual thyroid bed, or metastasis, on a 131^I whole body scan and in 1 of 21 patients with a negative radioiodine scan. Surprisingly, the Tg mRNA was detected in all the patients and normal controls. Conclusion: From our results we can not recommend Tg mRNA, detected by RT-PCR in peripheral blood, as a tumor marker superior to that of the Tg serum level. We consider an intensive re-evaluation of the method is required before considering its clinical applications (J Kor Soc Endocrinol 17:501∼513, 2002).

CDMA대역용 휴대폰 PIFA내장형 안테나 급전위치에 따른 Hand Effect의 특성 변화 연구

임요한(Yo Han Lim),장기훈(Kihun Chang),윤영중(Young Joong Yoon),김용진(Yongjin Kim) 한국통신학회 2006 한국통신학회 학술대회논문집 Vol.2006 No.7

음색변환대응이론에 의한 한국적 시각 아이덴티티의 제안

임장한(Lim, Jang Han),송요한(Song, yo han),이형익(Lee, hyung ik) 한국디지털디자인협의회 2006 (사)한국디지털디자인협의회 conference Vol.2006 No.5

하악신경 절삭이 삼차신경절 신경세포와 연수후각 소교세포 활성화에 미치는 영향

임요한(Yo-Han Lim),최목균(Mok-Kyun Choie) 대한구강악안면외과학회 2007 대한구강악안면외과학회지 Vol.33 No.3

Microglial cell activation is known to contribute to neuropathic pain following spinal sensory nerve injuries. In this study, I investigated its mechanisms in the case of trigeminal sensory nerve injuries by which microglial cell and p38 mitogen-activated protein kinase (p38 MAPK) activation in the medullary dorsal horn (MDH) would contribute to the facial pain hypersensitivity following mandibular nerve transection (MNT). And also investigated the changes of trigeminal ganglion neurons and ERK, p38 MAPK manifestations. Activation of microglial cells was monitored at 1, 3, 7, 14, 28 and 60 day using immunohistochemical analyses. Microglial cell activation was primarily observed in the superficial laminae of the MDH. Microglial cell activation was initiated at postoperative 1 day, maximal at 3 day, maintained until 14 day and gradually reduced and returned to the basal level by 60 days after MNT. Pain hypersensitivity was also initiated and attenuated almost in parallel with microglial cell activation pattern. To investigate the contribution of the microglial cell activation to the pain hypersensitivity, minocycline, an inhibitor of microglial cell activation by means of p38 MAPK inhibition, was administered. Minocycline dose-dependently attenuated the development of the pain hypersensitivity in parallel with inhibition of microglial cell and p38 MAPK activation following MNT. Mandibular nerve transection induced the activation of ERK, but did not p38 MAPK in the trigeminal ganglion. These results suggest that microglial cell activation in the MDH and p38 MAPK activation in the hyperactive microglial cells play an important role in the development of facial neuropathic pain following MNT. The results also suggest that ERK activation in the trigeminal ganglion contributes microglial cell activation and facial neuropathic pain.

가상공간 생성을 위한 라이다와 스테레오 카메라 기반 포인트 클라우드 생성 방안

임요한(Yo Han Lim),정인혁(In Hyeok Jeong),이산성(San Sung Lee),황성수(Sung Soo Hwang) 한국멀티미디어학회 2021 멀티미디어학회논문지 Vol.24 No.11