• Pediatric Infection and Vaccine
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• 제15권2호
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• pp.188-194
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• 2008

목 적 : 가와사끼병의 재발에 있어서의 임상양상 및 관련된 인자를 찾아보고자 하였다 방 법 : 2004년 1월부터 2007년 12월까지 세브란스 어린이병원 소아청소년과에서 가와사끼병으로 2회이상 치료받은 환아 20명을 대상으로 하여 초기 발병시와 재발시의 입원기록을 후향적으로 비교분석 하였다. 결 과 : 재발한 가와사끼병 환자 20명의 남여 성비는 1.2:1이었으며 평균연령은 $37.2{\pm}19.9$개월이었고, 재발 간격은 평균 3.3개월이었다. 첫 발병시보다 재발시에 발열 기간이 더 짧았고 발진이 적었으나 혈액학적 소견, 치료 결과 및 합병증은 차이가 없었다. 재발시 3명(15%)에서 정맥용 면역글로불린 초기치료에 반응하지 않았다. 재발 하지 않은 그룹에 비해 재발한 그룹에서 적혈구 침강속도 수치가 더 높았다. 결 론 : 가와사끼병은 재발하는 경우에는 비전형적 가와사끼병으로 표현될 수 있으므로 소아청소년과 의사는 이런 특징을 유념하여 진단과 치료를 수행하여야 할 것이다.

• Asian Pacific Journal of Cancer Prevention
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• 제16권15호
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• pp.6401-6406
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• 2015

Background: It is sometimes difficult to assess patients who have multiple hilar and mediastinal lymph nodes (MHMLN) with FDG accumulation in PET-CT. Since it is uncertain whether diffusion-weighted magnetic resonance imaging (DWI) is useful in the assessment of such patients, its diagnostic performance was assessed. Materials and Methods: Twenty-three patients who had three or more stations of hilar and mediastinal lymph nodes with SUVmax of 3 or more in PET-CT were included in this study. Results: For diagnosis of disease, there were 20 malignancies (lung cancers 17, malignant lymphomas 2 and metastatic lung tumor 1), and 3 benign cases (sarcoidosis 2 and benign disease 1). For diagnosis of lymph nodes, there were 7 malignancies (metastasis of lung cancer 7 and malignant lymphoma 1) and 16 benign lymphadenopathies (pneumoconiosis/silicosis 7, sarcoidosis 4, benign disease 4, and atypical lymphocyte infiltration 1). The ADC value ($1.57{\pm}0.29{\times}10^{-3}mm^2/sec$) of malignant MHMLN was significantly lower than that ($1.99{\pm}0.24{\times}10^{-3}mm^2/sec$) of benign MHMLN (P=0.0437). However, the SUVmax was not significantly higher ($10.0{\pm}7.34$ as compared to $6.38{\pm}4.31$) (P=0.15). The sensitivity (86%) by PET-CT was not significantly higher than that (71%) by DWI for malignant MHMLN (P=1.0). The specificity (100%) by DWI was significantly higher than that (31%) for benign MHMLN (P=0.0098). Furthermore, the accuracy (91%) with DWI was significantly higher than that (48%) with PET-CT for MHMLN (P=0.0129). Conclusions: Evaluation by DWI for patients with MHMLN with FDG accumulation is useful for distinguishing benign from malignant conditions.

• Asian Pacific Journal of Cancer Prevention
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• 제13권4호
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• pp.1317-1320
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• 2012

Biliary tract cancers, broadly described as malignancies that arise from the biliary tract epithelia, are usually divided into two major clinical phenotypes: cholangiocarcinoma and gallbladder cancer, differing in etiopathogenesis, risk factors, and perhaps molecular and genetic signatures. Atypical symptoms and lack of tumor biomarkers make it difficult to diagnose in early stages. At the time of presentation, few patients are candidates for potentially curative surgical resection. We here assessed and compared features of a total of 150 cases divided into extra- and intrahepatic cholangiocarcinomas and gallbladder cancers (GBC). Althought there were no significant differences in serum tumour marker levels, GBC patients had the poorest prognosis. Furthermore, gallbladder cancer respond poorly to chemotherapy or radiation therapy and approximately half of untreated patients died within 10 months. Therefore, treatment for patients with gallbladder cancer is still in challenge. Outcomes and survival of these patients had improved little over the past three decades - a period in which new successful treatments have greatly contributed to the prolonged patient survival for many other cancers.

• Asian Pacific Journal of Cancer Prevention
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• 제17권9호
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• pp.4409-4413
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• 2016

Background: Cervical cancer is the second most common of malignancy found in Thai women. Human papillomavirus (HPV) infection is a major cause. The objective of the present study was to evaluate the prevalence of HPV infection and association with abnormal cervical cytology in Thai women. Materials and Methods: This study was conducted at the Gynecologic Clinic, Thammasat University, Pathum Thani, Thailand. A total of 2,144 cases who underwent annual cervical cancer screening by co-testing (liquid based cytology and HPV testing, DNA versus mRNA) during the priod from July 2013 to June 2016 were recruited in this study. Results: Prevalence of positive high risk (HR) HPV DNA and mRNA test were 19.7 and 8.4%, respectively with a statistically significant difference. Majority of cases of abnormal cytology in this study were atypical squamous cells of undetermined significance (ASC-US). In patients with ASC-US, positive HR HPV DNA was greater than in the mRNA group (10.1 and 4.5%, p<0.001). Nonetheless, there was no significant difference in participants with cervical intraepithelial neoplasia (CIN). HPV mRNA test had slightly lower sensitivity but higher negative predictive value (NPV) than the DNA test to detect abnormal cytology during cervical cancer screening (p<0.001). Both HPV test (DNA and mRNA) had equally efficacy to detect high grade precancerous lesion or higher (CIN 2+). Conclusions: Prevalence of HR HPV DNA and mRNA were 19.7 and 8.4 percent, respectively. NPV of HPV mRNA was higher than DNA test. Both tests had equal efficacy to detect CIN 2+ with sensitivity and specificity of 63% vs 55.7% and 83% vs 92%, respectively.

• 대한세포병리학회지
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• 제10권2호
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• pp.121-126
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• 1999

체강액 내의 악성 종양세포와 중피세포의 구분이 종종 어려우나 환자의 치료나 종양의 임상기 결정에 큰 영향을 미치기 때문에 정확히 감별하는 것이 매우 중요하다. E-cadherin은 상피세포에서 표현되는 유착단백질이다. 본 연구에서는 체강액의 세포학적 검사에서 악성세포의 표지자로서 E-cadherin의 유용성을 알아보기 위하여 세포검사후 조직검사로 진단을 확인한 33예를 대상으로 체강액으로부터 만든 세포 블록에 대하여 E-cadherin에 대한 면역세포화학염색을 시행하였다. 33 예의 세포학적 진단은 선암종 25예, 비정형세포 8예였다. 선암종으로 진단하였던 25 예중 21예(84%)에서 E-cadherin 에 양성이었다. 비정형세포라고 진단하였던 8예중 6예에서 음성이었으며 양성으로 염색된 2예는 조직학적 검사로 전이성 암종임을 확인하였다. 반응성 중피세포나 염증세포는 모두 음성이었다. 민감도와 특이도는 각각 84%와 75%였다. 결론적으로 E-cadherin은 체강액에서 악성 종양세포와 반응성 중피세포와의 구분에 유용한 보조적인 표지자이다.

• Journal of Hospice and Palliative Care
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• 제19권3호
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• pp.201-210
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• 2016

섬망은 완화치료를 받는 말기암환자에서 흔히 나타나는 증상으로 임종기에 접어들수록 빈도는 증가한다. 섬망은 환자와 가족의 삶의 질에 부정적인 영향을 줄 뿐 아니라, 높은 사망률과 관련되어 있으나 실제 임상에서 의료진들이 적절히 인지하지 못하고 있다는 연구들이 보고되고 있다. 이는 우울이나 치매와 같은 정신질환과의 중복되는 특성, 섬망에 대한 평가 및 진단에 대한 지식의 부족 등이 원인으로 생각되고 있다. 이를 개선하기 위해 현재까지 알려진 섬망 선별검사를 통해 섬망환자를 정확히 인지하고, 진단하는 것이 완화의료 영역에서 섬망 증상 관리에 우선되어야 할 분야로 생각된다. 섬망이 진단되었을 때는 유발요인을 확인하고 약물이나 탈수, 감염 등의 가역적인 원인에 대해서는 이를 교정하는 것이 섬망을 조절에 가장 중요한 부분이다. 이와 함께 소음을 줄이거나, 적절한 조명을 유지하는 등의 환자의 주변 환경을 안정적으로 유지하는 등의 비약물적 치료가 병행되어야 한다. 비약물적 치료로 효과가 없거나, 증상이 심한 경우에 항정신병 약물과 벤조디아제핀과 같은 진정효과가 있는 약물을 사용할 수 있으며, 현재까지는 저용량의 할로페리돌 투여가 가장 효과적인 치료 약제로 인정되고 있다. 비정형적 항정신병 약물로는 Olanzapine, Quetiapine, Risperidone 등이 있으며 현재까지 보고된 바로는 할로페리돌과 비교하여 섬망 개선 효과는 비슷하나 추체외로 증상이 드물고 진정 효과가 있어 경구 섭취가 가능한 경우 고려해 볼 수 있는 약제로 생각된다. 현재까지 완화의료 영역에서의 섬망에 사용할 수 있는 약물에 대한 연구 결과는 근거가 충분하지 않은 상태이며, 이로 인해 임상에서 활용할 수 있는 임상진료 지침 또한 부족한 상태이다. 현재까지는 중환자실, 노인 환자에서의 연구 결과를 바탕으로 한 결과를 토대로 완화의료 영역에서의 섬망 치료에 이용하였지만 추후 말기암환자에서의 섬망에 대한 연구를 바탕으로 한 임상진료지침의 개발도 필요할 것으로 생각된다.

• 대한바이러스학회지
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• 제28권2호
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• pp.165-174
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• 1998

Characterizations of the VP4 (P type) and VP7 (G type) genes of Korean isolates of bovine rotavirus were performed using RT-PCR/RFLP and nucleotide sequencing analysis. After RT-PCR amplification of partial length (1094bp) of the VP4 and full length (1062bp) of the VP7 genes, amplified PCR products were digested with restriction endonucleases and digestion patterns were compared with those of reference rotaviruses. With the VP4 genes, four RFLP (A-D) profiles were observed; three (A, Band C) were the same as those of bovine rotavirus NCDV (P[1]), IND (P[5]) and B223 (P[11]), respectively. Profile D was the same as that of porcine rotavirus OSU (P[7]). With the VP7 genes, five RFLP profiles (I-V) were observed; three of them (I, II and III) were the same as those of bovine rotavirus NCDV (G6), Cody 1-801 (G8), and B223 (G10), respectively. Profile IV and V were atypical to those of reference bovine rotaviruses used in this study. These two profiles were identified as G6 and G5, respectively, after analyzing and comparing the nucleotide sequences. The G typing analysis revealed that 61.9% (26/42) were G6, which included G6 subtype; 28.6% (12/42) were G5; 7.1% (3/42) were G10; 2.4% (1/42) were G8. The P typing analysis revealed that 54.8% (23/42) were P[5]; 28.6% (12/42) were P[7]; 11.8% (5/42) were [11]; 4.8% (2/42) were P[1]. Our results showed that G6/P[5] were the most prevalent rotaviruses in diarrheic calves in Korea. Also, this is the first report that G5/P[7] rotaviruses were identified from cattle with diarrhea.

• 대한미생물학회지
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• 제35권3호
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• pp.203-214
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• 2000

Porphyromonas gingivalis has been implicated in periodontal diseases. Accumulating evidence suggests that cardiovascular disease is the most prevalent medical problem in patients with periodontal diseases. In order to check the possibility that P. gingivalis is involved in coronary heart disease, the present study was performed to observe P. gingivalis adherence and invasion of human coronary artery endothelial cells (HCAEC) and production of cytokines and growth factors by HCAEC upon P. gingivalis infection. $^3H$-labeled P. gingivalis 381 was incubated with HCAEC for 90 min. The radioactivity of the washed HCAEC was a measure of the absorbed (adhering and invading) P. gingivalis. The absorption radioactivity of the HCAEC infected by P. gingivalis was determined to be 59.58% of the input bacterial cells. In contrast, the absorption radioactivity of the cells infected by S. gordonii Challis which was employed as a control was negligible (0.59%). DPG3, a P. gingivalis mutant defective of fimbriae, appeared to be impaired to some extent in capability of adherence/invasion as compared to that of the parental strain 381, showing 43.04% of the absorption radioactivity. The absorption radioactivity of the HCAEC infected by P. gingivalis 381 in the presence of excessive fimbriae at the concentrations of $50\;{\mu}g$ and $100\;{\mu}g/ml$ was 57.27 and 45.44%, respectively. Invasion of HCAEC by P. gingivalis 381 was observed by an antibiotic (metronidazole) protection assay and transmission electron microscopy (TEM). In the antibiotic protection assay, invasion by the bacterium was measured to be 0.73, 1.09, and 1.51% of the input bacterial cells after incubation for 30, 60, and 90 min, respectively. Invasion by DPG3 was shown to be 0.16% after 90-min incubation. In comparison of invasion efficiency at 90 min of the incubation, the invasion efficiency of DPG3 was 0.37% while that of its parental strain 381 was 2.54%. The immunoblot analysis revealed fimbriae of P. gingivalis did not interact with the surface of HCAEC. These results suggest that fimbriae are not the major contribution to the adherence of P. gingivalis to HCAEC but may be important in the invasion of HCAEC by the bacterium. The presence of cytochalasin D ($1\;{\mu}g/ml$) and staurosporine ($1\;{\mu}M$) reduced the invasion of HCAEC by P. gingivalis 381 by 78.86 and 53.76%, respectively, indicating that cytoskeletal rearrangement and protein kinase of HCAEC are essential for the invasion. Infection of P. gingivalis induced HCAEC to increase the production of TNF-${\alpha}$. by 60.6%. At 90 min of the incubation, the HCAEC infected with P. gingivalis cells was apparently atypical in the shape, showing loss of the nuclear membrane and subcellular organelles. The overall results suggest that P. gingivalis may cause coronary heart disease by adhering to and invading endothelial cells, and subsequently damaging the cells.

• Tuberculosis and Respiratory Diseases
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• 제71권5호
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• pp.335-340
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• 2011

Background: Community-acquired pneumonia (CAP) is an important cause of morbidity and mortality throughout the world in all age groups. Viral causes of CAP are less well characterized than bacterial causes. We analyzed the characteristics of hospitalized patients with CAP who had a viral pathogen detected by multiplex polymerase chain reaction (PCR). Methods: Multiplex real-time PCR was performed for respiratory viruses in samples collected from 520 adults who developed CAP at Chungnam National University Hospital. Clinical, laboratory, and radiological features at presentation as well as other epidemiological data were analyzed. Results: Of 520 patients with CAP, a viral pathogen was detected in 60 (11.5%), and influenza A was the most common. The virus detection rate in patients with CAP was highest in November. Two or more pathogens were detected in 13 (21.7%) patients. Seven patients had severe disease and were administered in the intensive care unit. Most patients (49/60, 81.7%) had comorbidities. However, nine (15%) patients had no comorbidities, and their age was <60 years. The ground glass opacity pattern was the most common radiological feature. Seven (11.7%) patients died from CAP. Conclusion: Viral pathogens are commonly detected in patients with CAP, and a respiratory virus may be associated with the severity and outcome of pneumonia. Careful attention should be paid to the viral etiology in adult patients with CAP.

• 대한소아치과학회지
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• 제36권4호
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• pp.556-562
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• 2009

이소맹출은 유전적 요인 혹은 여러 가지 국소적 요인에 의해 치아가 비정상적인 위치로 맹출하는 경우를 말한다. 이소맹출이 가장 빈번히 발생하는 치아는 상악 제1대구치로 이를 방치할 경우 인접치의 치근흡수 및 이에 따른 조기탈락으로 영구치 맹출공간 부족을 야기하며, 결과적으로 부정교합을 유발하는 중요한 요인으로 작용한다. 그러나, 치료에 앞서 이소맹출중인 치아가 자발적으로 맹출하기를 기다려볼 것인지 혹은 조기에 치료를 하여 제2유구치의 치근흡수나 탈락을 예방해야 할 것인지에 대한 결정이 선행되어야 한다. 현재 이를 위한 몇몇 진단학적 기준이 제시되고 있으나 학자간 이견이 존재한다. 본 연구에서는 방사선학적 검사를 통해 상악 제1대구치의 이소맹출이 조기 발견된 증례들 중 전방에 위치한 제2유구치의 치근이 흡수되어 비가역적 특징을 보인다고 판단되는 증례에 대해 특별한 처치 없이 주기적인 검진을 통해 자발적으로 해소된 결과를 관찰하였다. 이와 함께 상악 제2유구치 치근흡수의 정도와 상악 제1대구치의 맹출 기울기에 따른 후향적 분석을 통해 상악 제1대구치 이소맹출의 유형을 예측하고자 하였다. 상악 제2유구치의 치근 흡수 정도에 따라 grade I에서 IV로 분류하였고, 파노라마 방사선 사진 상에서 양측 안와의 최하방점을 연결한 수평선과 상악 제1대구치의 근심면을 따라 연결한 수직선을 기준으로 하여 근심각(mesial angle)을 측정하였다. 결과적으로는 상악 제2유구치의 치근 흡수 정도보다 상악 제1대구치의 맹출 기울기가 이소맹출의 유형을 진단하는 데에 있어 더 신뢰할만한 기준이라고 판단할 수 있었다.