• The Korean journal of helicobacter and upper gastrointestinal research
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• v.18 no.3
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• pp.215-216
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• 2018

위암의 발병률이 감소하고 있기는 하지만 전 세계적으로 여전히 연 100만 명 이상이 새롭게 위암으로 진단되고 있으며, 앞으로 향후 몇십 년 동안은 인구의 고령화로 인하여 위암에 대한 사회적 경제적 부담이 줄어들지 않을 것으로 추측된다. 최근 메타분석에서 Helicobacter pylori 제균 치료가 위암발병을 33~47% 감소시킨다고 보고하였으나, 중국에서 시행된 무작위 대조 연구에서는 제균 치료가 위암의 전구 병변 감소에 도움이 되지 않았다고 보고하고 있어 위축성 위염이나 장상피화생을 동반한 경우 제균 치료가 위암 예방에 큰 도움이 되지 않을 수 있음을 제시하고 있다. 그렇다면 위축성 위염이 있는 경우가 많은 고령 환자에서는 과연 헬리코박터 제균 치료가 도움이 될 것인가? 저자들은 빅데이터 분석을 통해 헬리코박터 제균 치료가 위암 발병에 미치는 영향을 성별과 연령에 따라 분석하였다. 2003년부터 2012년까지 'Hospital Authority'에 등록된 clarithromycin 포함 3제 요법을 받은 환자들에서의 위암 발생률과 2003년부터 2013년까지 'Hong Kong Cancer Registry'에 등록된 성별과 연령이 일치된 대조군에서의 위암기대 발생률(expected incidence)을 비교하였다. 3제 요법을 받은 73,237명의 환자들을 확인하였을 때, 평균 7.6년의 추적기간 중 200명(0.27%)에서 위암이 발생하였다. 연령에 따라 40세 미만, 40~59세, 60세 이상의 그룹으로 나누어 각각 위암발생률을 대조군과 비교한 결과 60세 이상 환자군에서만 standardized incidence ratio (SIR)가 0.82로 감소하였다. 치료 성공여부에 따라 위암 발생률을 분석하였을 때, 제균 치료에 성공한 60세 이상 군에서 SIR이 0.78로 감소하였으나 재 치료를 받은 40~59세 군에서는 SIR이 2.43으로 증가하였다. 제균 치료시점이 위암 발생률에 미치는 영향으로는 제균 치료 후 10년 미만에서의 위암 발생률에는 큰 영향이 없었으나 10년 이상 경과한 경우 60세 이상 군과 40~59세 군에서의 위암 발병률이 대조군의 위암 예측 발병률보다 낮았다.

• Journal of Chest Surgery
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• v.32 no.1
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• pp.32-37
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• 1999

Background: Early detection and surgical resection offer the most advantage out of all cures for lung cancer. Elderly patients may fail to benefit maximally from these interventions because of their general condition and residual lung function. To study the impact of age on stages, histology, symptoms, and treatments of the patients with non-small cell lung cancer, we undertook a retrospective review. Material and Method : Two hundred eleven patients with non-small cell lung cancer were operated on at Samsung Seoul hospital between October 1994 and June 1997. Patients were arbitrarily arbitrarily by age less than 70 years(176 patients) and 70 years or more(35 patients), and their medical records were reviewed. Result: There were no differences in pathologic staging and diagnosis. But there were differences in surgical methods, complications, and mortality rates between the two groups. There were much more complications in the 70 years or more group(p=0.02). We chose less invasive surgical methods in the 70 years or more group. Conclusion: More complications were experienced in the 70 years or more group. Although thoracic operation imparts the greatest survival advantage, this benefit is diminished in elderly patients because of their high complications and mortality rate. We recommend serious consideration of surgical indications and operative methods.

• Journal of Gastric Cancer
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• v.5 no.4 s.20
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• pp.217-221
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• 2005

Purpose: The incidence of gastric neoplasms is increasing in the elderly population, and a rational method of treatment for gastric cancer in the elderly is needed to improve survival. The purpose of the present study was to clarify whether the patient's age is an independent prognostic factor and to determine clinicopathological characteristics in the elderly. Material and Methods: Curative or palliative surgery for gastric cancer was carried out on 706 patients in Chosun University Hospital from March 1995 to February 2002. They were divided into the following two groups: elderly group (75 years or older) and control group (under 74 years old). The clinicopathologic features of these patients were reviewed retrospectively, and a multivariate analysis was performed. Results: There was no difference in clinicopathological appearances between the two groups, and the postoperative morbidity and mortality rates were similar in the two groups. The two groups showed similar survival rates. Conclusion: In this study, age was not a prognostic factor in surgery for gastric cancer. In the elderly, an oncologically correct surgical procedure can safely be prosecuted with satisfactory early and late results.

• Clinical and Experimental Reproductive Medicine
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• v.33 no.4
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• pp.237-243
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• 2006

Objective: The aim of this study was to evaluate the efficacy of frozen-thawed ET in poor prognosis patients such as the old age (38~44 years; OA group) and the patients who did not achieve clinical pregnancy with the first fresh ET cycle (non-pregnant patients; NP group). Methods: Laboratory and clinical data were collected from fresh and frozen-thawed ET cycles of OA and NP group. Controlled ovarian hyperstimulation (COH) and conventional insemination or ICSI, in vitro culture and ET were performed by routine procedures. Supernumerary embryos were frozen by the slow freezing method, and frozen embryos were thawed by the rapid thawing method. Embryo development, pregnancy and implantation rates were statistically analyzed by Student t-test and chi square test Results: Mean ages were similar between fresh ET ($40.0{\pm}1.8$ years, n=206) and frozen-thawed ET ($39.9{\pm}1.9$ years, n=69) cycles in OA group. However, the clinical pregnancy and implantation rate of subsequent frozen-thawed ET significantly higher than those of fresh ET cycles (29.0% and 11.2% vs. 16.5% and 7.0%, p<0.05). In NP group, there was no difference in the mean age between fresh ET ($31.2{\pm}2.3$ years, n=40) and frozen-thawed ET ($31.9{\pm}3.1$ years, n=119) in subsequent cycles. The clinical pregnancy and implantation rates were similar between the subsequent fresh ET (42.5% and 22.6%) and the frozen-thawed ET (40.3% and 18.8%). Conclusion: In old age patients, higher pregnancy rate of frozen-thawed ET compared to fresh ET cycles in this study. It may be related that better uterine environments for implantation in frozen-thawed ET cycles than that of non-physiological hormonal condition in uterus of fresh COH cycles.

• Journal of Chest Surgery
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• v.42 no.2
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• pp.206-213
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• 2009

Background: Previous series have suggested that younger patients with primary lung cancer exhibit a more aggressive disease course with a worse prognosis, as compared to older patients, although this issue is still debatable. Material and Method: We reviewed the medical records of 79 patients (32 patients 50 years and younger (Group I) and 47 patients 70 years and older (Group II)) who underwent curative resection for primary lung cancer between July 2000 and June 2008. Result: The median age of the patients was 46.5 years in Group I and this was 73 years in Group II. The older patients were more likely to have major comorbidities (44% versus 77%, respectively; p=0.003). Histological examinations identified that the minor histological types (excluding non-small cell lung cancer (NSCLC)) were predominantly found in the Group I patients (16% versus 2%, respectively; p=0.037). For the TNM staging of the NSCLC, with excluding the minor histologic types, a higher proportion of patients had stage III disease in Group I (33% versus 13%, respectively; p=0.038). There was no significant difference in major morbidity (16% versus 30%, respectively; p=0.148) and operative mortality (0% versus 4.3%; p=0.512) between the groups. The mean follow-up interval was 33 months (range: $1{\sim}98$ months) for patients in both groups. For the patients with NSCLC, the five-year overall survival rate was 52.3% for Group I and 53.7% for Group II (p=0.955). The rate of freedom from recurrence at five years was significantly lower for the Group I patients than for the Group II patients (39.4% versus 70.4%, respectively; p=0.027), and only being a member of Group I impacted recurrence, based on the Cox proportional hazard analysis (p=0.034). Of the patients who had recurrence, four patients in Group I underwent aggressive surgical treatment. All of these patients exhibited long-term survival (range: $46{\sim}87$ months). Conclusion: In our study, the early outcome and long-term survival were similar for the younger and older patients after curative resection of primary lung cancer. However, we think that younger patients require meticulous follow-up as they had a tendency to proceed to surgery with advanced stage disease, a higher recurrence rate than did the older patients and the survival rates were improved, even for the recurred cases, with early aggressive treatment.

• Journal of Oral Medicine and Pain
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• v.19 no.2
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• pp.111-123
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• 1994

저자는 1990년부터 1993년 사이에 부산대학병원 구강내과에 내원하여 두 개하악장애로 진단되어 보존적 치료를 시행받은 884명의 환자를 대상으로 Solberg의 악관절장애조사 설문지를 작성케한 후, 성, 연령, 병력기간, 진단명, SCL-90-R, 치료에 대한 반응에 따라 환자군을 세분하여 각 환자군의 설문지 문항별 응답양태 및 이에 따른 예후예측을 분석한 바 다음과 같은 결론을 얻었다. 1. 악기능 및 예후악화요인 문항에서는 여성이 높은 응답수를 보인 반면, 기여요인 및 습관문항에 서는 남성이 높은 응답수를 나타내었다. 2. 고령층의 환자에서 행동 및 예후악화요인이 두드러졌다. 3. 만성군이 급성군에 비해 전 문항에서 높은 응답수를 나타내었다. 4. 혼합군 및 근육장애혼자가 관절장애환자에 비해 설문지 전 문항에서 많은 응답을 하였다. 5. SCL-90-R에서 비정상인 환자가 정상군의 환자에 비해 악기능을 제외한 전 문항에서 높은 응답수를 보였다. 6. 치료에 무반응인 환자가 성공한 환자에 비해 습관요인 문항을 제외한 설문지 전체에서 많은 응답을 하였다.

• Tuberculosis and Respiratory Diseases
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• v.63 no.5
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• pp.412-416
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• 2007

Background: The possibility of developing pulmonary tuberculosis usually increases with increasing age. Therefore, the incidence of endobronchial tuberculosis in older people may increase. We evaluated the clinical characteristics in patients with endobronchial tuberculosis above the age of 70 years. Methods: We enrolled 74 patients (12 males and 62 females; mean age $64.6{\pm}16.2 $years) that were diagnosed with endobronchial tuberculosis from March 2003 to July 2006 at Gyeongsang University Hospital. We retrospectively evaluated the clinical characteristics of endobronchial tuberculosis for patients 70 years or older (older group) and for patients below the age of 70 years (younger group). Results: The number of patients in the older group was 41 (55%). Cough was the most common symptom in the two groups of patients and dyspnea on exertion was more common in the older group of patients than in the younger group of patients (31.7% vs. 12.1%). The actively caesating type of disease was more common in the younger group of patients than in the older group of patients (66.7% vs. 39%). The edematous type of disease was more common in the older group of patients than in the younger group of patients (53.7% vs. 27.2%) (p<0.05). Tracheal and main bronchial involvement of lesions were more common for the younger group of patients than for the older group of patients (30.3% vs. 9.7%) (p<0.05). Conclusion: Endobronchial tuberculosis was commonly observed in patients older than 70 years and this group of patients had some clinical characteristics that were different from the younger group of patients.

• 대한위암학회:학술대회논문집
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• 2002.04a
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• pp.53-60
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• 2002

1. 병원에 입원하는 환자들 중 상당수에서 어느정도의 영양실조가 있는 것으로 보고되므로 수술하기 위해 입원하는 환자에서 영양과 관계있는 측면에서 병력청취 및 이학적 검사상 약 6개월간 평소체중의 $10\%$ 이상 감소, 혈장단백(알부민, 트란스페린 등) 저하, 총임파 구수감소 등이 있으면 철저한 영양평가를 시행하여 중등도 이상의 위험군에서는 술 전 약 $7\~10$일간 영양지원을 하는 것이 약 $10\%$의 술 후 합병증을 줄이는 것으로 보고되나 이는 수술의 스트레스 정도, 술 후 영양 섭취 지연의 기간 및 정도 및 수술의 응급여부에의 해 결 정한다. 2. 영양지원이 결정되면 그 경로는 경장이 좋으며 그것이 안될 때 정맥영양을 시행한다. 3. 술 전 영양지원을 받지않은 중등도 이상의 영양실조 환자에서 술 후 조기 영양지원에 대한 연구에서는 TPN군에서 대조군보다 오히려 약 $10\%$의 합병증 발생률이 높다. 4. 영양실조가 없는 환자에서도 술 후 약 7일 이상의 금식이 예상되면 TPN을 시행하는 것이 좋다.

• Journal of Gastric Cancer
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• v.2 no.3
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• pp.127-132
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• 2002

1) 병원에 입원하는 환자들 중 상당수에서 어느정도의 여양실조가 있는 것으로 보고되므로 수술하기 위해 입원하는 환자에서 영양과 관계있는 측면에서 병력청취 및 이학적 검사상 약 6개월간 평소체중의 $10\%$ 이상 감소, 혈장단백(알부민,트란스페린) 저차, 총임파 구수감소 등이 있으면 철저한 영양평가를 시행하여 중등도 이상의 위험군에서는 술 전 약 $7\∼10$일간 영양지원을 하는 것이 약 $10\%$의 술 후 합병증을 줄이는 것으로 보고되나 이는 수술의 스트레스 정도, 술 후 영양섭취 지연의 기간 및 정도 및 수술의 응급여부에 의해 결정한다. 2) 영양지원이 결정되면 그 경로는 경장이 좋으며 그것이 안될 때 정맥영양을 시행한다. 3) 술 전 영양지원을 받지않은 중등도 이상의 영양실조 환자에서 술 후 조기 영양지원에 대한 연구에서는 TPNrns에서 대조군보다 오히려 약 $10\%$의 합병증 발생률이 높다. 4) 영양실조가 없는 환자에서도 술 후 약 7일 이상의 금식이 예상되면 TPN을 시행하는 것이 좋다.

• Journal of Chest Surgery
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• v.32 no.8
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• pp.715-721
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• 1999

Background:The number of old patients receiving coronary artery bypass grafting(CABG) is increasing. With the more recent advances in operative techniques, the age at which CABG is indicated has also increased. This study evaluated the risk factors associated with the hospital mortality and the morbidity following CABG in elderly patients. Material and Method: Between March 1991 and June 1998, we retrospectively reviewed 45 consecutive patients aged 65 years or older who underwent CABG. We compared the data with the results of 179 patients under the age 65 years operated during the same period. Result: Mean age was 68${\pm}$1.41 years(range 65 to 74 years). Emergency surgery was required in 4, and elective surgery in 41 patients. The mean number of distal anastomosis per patient was 3.62 ${\pm}$0.81 and mean aortic cross-cramp time was 69.84${\pm}$18.5 minutes. Thirty patients had Canadian class III or IV preoperatively, but 43 patients had class I or II postoperatively. The left ventricular ejection fraction increased significantly from 54.23${\pm}$10.62% preoperatively to 58.14${\pm}$9.88% postoperatively(p<0.05). Postoperative complication was pneumonia in 2 patients, acute renal failure in 2 patients, sternal wound infection in 1 patient, and postoperative myocardial infarction in 1 patient. There were two postoperative deaths. The causes of deaths were low output syndrome in one patient, and sepsis due to pneumonia in the other patient. The hospital mortality was higher in the elderly group(4.4 versus 2.86%) but was not statistically significant(p>0.05). Incremental risk factors for hospital deaths in the elderly were emergent operation, preoperative PTCA, postoperative use of IABP and postoperative ARF(p<0.05). The duration of hospital stay after operation was significantly longer for the elderly group than the younger group(19.27${\pm}$12.51 vs 15.55${\pm}$6.99 days; p＜ 0.05). Follow-up was complete for 34 of the hospital survivors and ranged from 1 to 73 months(mean: 23.58${\pm}$19.56 months). There was no late mortality of cardiac origin. Conclusion: Age is an important factor in selecting optimal management for elderly patients with coronary compromise, but age alone should not dictate the choice of therapy. Coronary artery bypass surgery in the elderly is associated with acceptable early mortality and excellent long-term results.