• 핵의학기술
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• 제12권3호
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• pp.184-191
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• 2008

본 연구의 목적은 $^{18}F$-FDG PET/CT검사 시 우연히 발견된 갑상선병변의 악성여부를 평가하기 위하여 위양성으로 판독되어지는 양성종양이나 염증질환과 악성 종양의 감별이 가능한 검사법으로 지연영상(Delay scan)을 적용하고 결과 값(SUV)의 기준안을 마련하며 이 연구에서 제시되는 검사법의 유용성을 평가하는데 그 목적이 있다. 2008년 1월부터 2008년 4월까지 E대학병원에 내원하여 $^{18}F$-FDG PET/CT를 시행한 환자 800명을 대상으로 후향적 분석을 실시하였다. 같은 연구기간 중에 갑상선의 원발암으로 $^{18}F$-FDG PET/CT을 실시한 1명은 연구에서 제외하였다. 최종적으로 799명이 연구대상이었으며 $^{18}F$-FDG PET/CT검사를 실시한 이유는 기존에 암이 증명되어 예후 관찰로 검사하거나 암이 의심되는 경우가 696명, 건강 검진 목적으로 실시한 경우가 103명이었다. $^{18}F$-FDG PET/CT영상 촬영은 SIEMENS사에서 만든 Biograph-Duo에서 시행하였으며, $^{18}F$-FDG PET/CT 정상영상(1 hr)을 취득한 후 갑상선 이상섭취가 있고 SUV 2.0 이상인 환자를 대상으로 1시간 후에 갑상선부위를 1 bed 지연영상을 촬영하였고, 한 bed에 2분 동안 영상을 얻었다. 갑상선 이상섭취가 있고 SUV 2.0 이상인 환자를 대상으로 이상섭취가 있는 부위의 1시간 영상과 2시간 지연영상의 SUVmax를 측정하여 비교 분석하였다. 본 연구에서 $^{18}F$-FDG PET/CT 검사 시 우연히 갑상선에 $^{18}F$-FDG 섭취를 보인 환자 중 갑상선 우연종(Thyroid incidentaloma)이 5명으로 0.63%로 나타났으며 모두 양성병변을 시사하는 소견을 나타냈다. 그리고 우연히 갑상선에 $^{18}F$-FDG섭취가 있는 경우 먼저 갑상선부위의 2시간 지연검사를 통해 $SUV_{max}$의 변화치를 이용하여 간접적으로 양성 혹은 악성여부를 판단하는 하나의 기준이 될 수 있고 판독의 오류도 줄일 수 있다. 발견된 갑상선 우연종(Thyroid incidentaloma)의 경우 1) 국소부위의 갑상선병변 SUVmax가 5.0 이상이고, 2) $^{18}F$-FDG PET/CT 정상검사(1 hr)와 지연검사(2 hr)의 갑상선병변 $SUV_{max}$차이가 $1.0{\pm}0.5$인 경우 Malignant를 의심하고 조직학적 확진을 진행한다. 그렇지 않은 경우에도 추후 PET이나 CT를 이용한 면밀한 영상검사로 추적 관찰하는 것이 병변의 진단을 위한 합리적인 접근방법이라고 생각한다.

• 대한핵의학회지
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• 제29권3호
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• pp.319-327
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• 1995

목적 : 악성 갈색세포종 및 갑상선수질암의 치료에서 $^{131}I-MIBG$의 유용성에 대하여 분석하고자 한다. 방법 : 1993년 2월부터 1995년 2월까지 원자력병원에서 $^{131}I-MIBG$를 이용하여 치료한 악성 갈색세포종 3예, 갑상선수질암 6예(1예은 다발성 내분비선종 제IIb 형)에 대한 의무기록을 후향적으로 분석하였다. 결과 : 악성 갈색세포종 3예중 수술후 미소전이 병소에 대해 치료한 1예는 19개월간 무병기간을 유지하고 있으며, 수술후 재발한 1예는 불변, 절제가 불가능한 1예는 진행하였다. 갑상선수질암 6예중 평가 가능한 경우는 5예였으며, 완전관해가 2예, 그 중 1예는 완전관해후 9개월에 재발, 불변이지만 증상의 호전이 1예, 진행이 2예였다. 진행되는 환자의 특징은 진단시에 절제불능이거나 수술후 종양이 남아있는 경우로 보였다. 결론 : $^{131}I-MIBG$ 치료는 수술후 미소전이 병소의 치료와 수술후 재발 혹은 전이성 갈색세포종 및 갑상선수질암에서 일부 효과가 있어 다른 선택 가능한 치료방법이 없을 경우 시도해 볼만한 치료방법으로서 향후 충분한 임상례를 통하여 연구되어야 할 것으로 생각된다.

• Journal of Breast Cancer
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• 제21권4호
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• pp.415-424
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• 2018

Purpose: Triple-positive breast cancer is defined by estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) positivity. Several systemic breast cancer therapies target hormonal and HER2 responsiveness. We compared clinical outcomes of triple-positive disease with those of HER2-enriched and luminal HER2-negative disease and investigated the clinical efficacy of anti-HER2 therapy for triple-positive disease. Methods: We retrospectively compared overall and recurrence-free survival among cases included in the Korean Breast Cancer Society (KBCS) and Seoul St. Mary's Hospital breast cancer registries and the therapeutic efficacy of trastuzumab for triple-positive and HER2-enriched cases. Results: KBCS registry data (2006-2010; median follow-up, 76 months) indicated that patients with triple-positive breast cancer had intermediate survival between those with luminal A and HER2-enriched subtypes (p<0.001). Trastuzumab did not improve overall survival among patients with triple-positive breast cancer (p=0.899) in contrast to the HER2-enriched subtype (p=0.018). Seoul St. Mary's Hospital registry data indicated similar recurrence-free survival outcomes (p<0.001) and a lack of improvement with trastuzumab among patients with triple-positive breast cancer (median follow-up, 33 months; p=0.800). Multivariate analysis revealed that patients with triple-positive breast cancer had better overall survival than those with HER2-enriched disease and similar survival as those with the luminal A subtype (triple-positive: hazard ratio, 1.258, p=0.118; HER2-enriched: hazard ratio, 2.377, p<0.001). Conclusion: Our findings showed that anti-HER2 therapy was less beneficial for treatment of triple-positive breast cancer than for HER2-enriched subtypes of breast cancer, and the triple-positive subtype had a distinct prognosis.

• 한국임상수의학회지
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• 제23권2호
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• pp.149-152
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• 2006

The canine thyroglobulin autoantibody assay is to be used for the diagnosis of autoimmune thyroid disease in dogs. Antithyroglobulin antibodies are present in about 50 percent of hypothyroid dogs. In this report, the sera of the five canine patients ($P1{\sim}P5$) referred to the Veterinary Medical Teaching Hospital in Seoul National University were assessed by T4, TSH and thyroglobulin autoantibody (TgAA). P1 was diagnosed as severe hypothyroidism since he showed very high TSH levels with low T4 values. P2 and P3 born with a genetic predisposition were assessed as normal in thyroid function. P4 was normal, but needed follow-up examination for TgAA assay. P5 showed the positive result in TgAA assay, so it was diagnosed as autoimmune thyroiditis. As the cases above show, not only T4 and TSH, but also TgAA assay to be considered for more accurate assessment of the status of the thyroid.

• 대한한방내과학회지
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• 제28권3호
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• pp.624-631
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• 2007

Hypothyroidism is a common disease of the endocrinal system, characterized by fatigue, cold intolerance, bradycardia, and so on. Subclinical hypothyroidism is a common biochemical abnormality which can be found in routine screening tests of thyroid function. It is defined as an asymptomatic state which characterized by normal free thyroxine(FT4) and elevated thyroid stimulating hormone(TSH) levels. The purpose of this study was to evaluate the effect of treatment with palmijihwang-tang and to observe the changes in triiodothyronine(T3), free thyroxine(FT4), thyroid stimulating hormone(TSH) level and VAS of cold intolerance, hoarseness, dry skin. After the treatment, triiodothyronine(T3) increased from 57.12ng/dl to 120.53ng/dl. Free thyroxine(FT4) increased from 12.59pg/ml to 14.21pg/ml. Thyroid stimulating hormone(TSH) decreased from 10.61mU/L to 1.57mU/L. Cold intolerance, hoarseness and dry skin changed for the better. These results support a role for oriental medical therapy in treating subclinical hypothyroidism. Further case studies of herbal treatment of this ailment are needed.

• 대한두경부종양학회지
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• 제14권2호
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• pp.199-205
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• 1998

Objective: Telomerase, a specialized ribonucleoprotein polymerase associated with cellular immortality, is expressed by most malignant cells and is inactive in most normal somatic cells. The assays of telomerase activity in various tumors have provided both diagnostic and prognostic information. This study was carried out to determine whether telomerase activity could be useful in distinguishing benign and malignant thyroid diseasees. Materials & Methods: Telomerase activity was determined using Oncor $TRAP_{EZE}^{TM}ELISA$ Telomerase Detection Kit for performing PCR-based telomeric repeat amplification protocol (TRAP) assay followed by ELISA detection in both normal and tumor tissues of 23 adenomatous hyperplasias, 12 follicular adenomas, 4 follicular carcinomas, 16 papillary carcinomas, 4 Hashimoto's thyroiditises and 3 malignant lymphomas. We also examined all cases microscopically to review the status of lymphoid infiltrate. Results: Of the 62 cases, extensive lymphoid infiltrates were contained in 20 tumor tissues(4 Hashimoto's thyroiditises, 3 malignant lymphomas, 6 adenomatous hyperplasias and 7 papillary carcinomas), all of which showed positive telomerase activity. All the normal tissues without lymphoid infiltrates(n=43) did not express telomerase activity. Of 42 tumor tissues without lymphoid infiltrates, 37(88.0%) showed positive telomerase activity: 13 of 17 adenomatous hyperplasias(76.5%), 11 of 12 follicular adenomas(91.7%), 4 of 4 follicular carcinomas(100.0%) and 9 of 9 papillary carcinomas(100.0%). Conclusions: Our methods showed high sensitivity in the detection of telomerase activity and the exclusion of lymphoid infiltrates may be important in telomerase assay. In our work, the measurement of telomerase activity was not useful in distinguishing benign and malignant thyroid diseases.

• 대한두경부종양학회지
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• 제13권1호
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• pp.74-80
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• 1997

We have experienced 5 cases of unusual well differentiated thyroid carcinoma with insular component during the past 5 years. 4 cases were presented with cervical masses but I case (patient 2.) was initiallty with lung and brain metastasis. The tumors from 4 cases showed invasive growths but that of 1 cases(patient 1.) showed intrathyroidal. Total thyroidectomy and cervical lymphnode dissection(CCND or RND) was performed in 4 cases but only RND was performed in spite of mediastinal metastasis of the tumor in patient 5 under the patient's choice. During the follow-up period, we also performed radical nephrectomy and metastatectomy for the kidney and iliac bone metastasis respectively, in patint 2. Microcsopically, the tumors showed the insular growth patterns, focally(less than 50%) in 3 cases and predominantly(more than 75%) in 2 cases. And the insular componentas were combined with papillary carcinoma in 2 cases and follicular carcinoma in 3 cases. Cervical lymphnode metastases were confirmed in 4 cases. Patient 2 died of disease with metastases to lung, brain, bone and kidney, 52 months after initial therapy. Patient 1, 3 and 4 are alive and have no recurrence and distant metastasis. Patient 5 is also alive with the mediastinal metastasis. In our experience, the well differentiated thyroid carcinomas with insular component showed characteristic histologic features, aggressive behavior in initial presentation and unfavorable prognosis regardless of the percentage of the insular component.

• Safety and Health at Work
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• 제12권3호
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• pp.390-395
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• 2021

Background: Health-care providers typically undergo shift work and are subjected to increased stress. Night shift work may induce disturbed sleep cycles and circadian rhythm. The objective of this study was to explore if night shift workers (NSWs) show an increased risk of abnormal thyroid-stimulating hormone (TSH). Methods: We conducted a retrospective cohort study of 574 employees without thyroid disease and abnormal TSH at baseline who underwent annual check-ups between 2007 and 2016 in a medical center. NSWs were defined as those with working time schedules other than daytime hours. We calculated the incidence rate and estimated the adjusted hazard ratio (HR) for incident abnormal TSH and subclinical hypothyroidism compared with non-NSWs using a Cox regression model. Results: A total of 56 incident abnormal TSH cases and 39 subclinical hypothyroidism cases in NSWs were identified during 3000 person-years of follow-up. In models adjusted for age, sex, obesity, and working departments, we found no increased relative risk for incident abnormal TSH (HR: 0.72, 95% confidence interval: 0.33-1.60) or subclinical hypothyroidism (HR: 0.52, 95% confidence interval: 0.19-1.45) when comparing NSWs to non-NSWs; nor were incidence rates significantly different among exclusively medical employees after excluding administrative staff. Conclusion: In this hospital-based nine-year follow-up retrospective cohort study, NSWs were not associated with increased relative risk of incident abnormal TSH and subclinical hypothyroidism, in contrast to previous cross-sectional studies.

• 임상이비인후과
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• 제29권2호
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• pp.316-320
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• 2018

Esophageal diverticulum is very rare disease. Since it usually has no symptoms, it is hard to find and diagnose. Moreover, if the diverticulum is located nearly to thyroid gland, surgeons sometimes misdiagnose as a thyroid nodule. Here, we represent our case which has papillary thyroid cancer and esophageal diverticulum together. In this case, we experienced the surgical procedure and postoperative complications of the esophageal diverticulum. Even though esophageal diverticulum was in preoperative computed tomography and ultrasound, it was neglected before the surgery so that found during the operation. The purpose of this study was to know the preoperative radiological findings of the esophageal diverticulum and to find out what to be aware of during surgery and how to manage the complications after surgery.

• 농촌의학ㆍ지역보건
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• 제48권2호
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• pp.81-90
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• 2023

Objectives: This study analyzed the decline in quality of life according to age in the chronic disease patient group, quantified it as a quantitative index, and compared it by sex and chronic disease. Methods: In the 2017-2019 Korea National Health and Nutrition Examination Survey database, 11,473 adults aged 19 years or older, excluding cancer patients, were analyzed for age-specific changes in the EQ-5D Index by chronic disease. The decline in quality of life according to age in patients with chronic diseases was analyzed by linear regression analysis while controlling for general characteristics. Then, linear regression analysis was performed according to sex. Results: In the case of the control group, the quality of life decreased by 0.0004 for every 1-year increase in age(P<0.001). By chronic disease, asthma(β=0.0019, P<0.001), arthritis(β=0.0017, P=0.002), thyroid dis- ease(β=0.0016, P=0.015), dyslipidemia(β=0.0011, P=0.020), and hypertension(β=0.0009, P=0.027) mostly showed a greater decrease in quality of life than the control group. In addition, when divided into two groups by sex, hypertension(β=0.0012, P=0.029), thyroid disease(β=0.0041, P=0.038), and arthritis(β=0.0022, P<0.001) showed a significant decrease in quality of life only in male. Diabetes(β=0.0056, P=0.038), dyslipi- demia(β=0.0022, P=0.001) significantly decreased quality of life only in female. Conclusions: Chronic disease had a negative impact on patients perception of quality of life, and the more severe the pain and activity limitation due to the chronic disease, the more severe it was. It also showed different patterns according to sex. Therefore, it is necessary to allocate more medical resources and provide policy support to prevent chronic diseases, which are serious social problems.