• Journal of Digestive Cancer Research
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• v.1 no.1
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• pp.6-16
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• 2013

Recent estimates for colon cancer incidence in Korea have been increased and continue to rank as the second most common in male and the third in female. Although colonoscopy has been known as the best screening tool for colon cancer, 20-25% of patients with colon cancer was diagnosed with stage IV cancer. During the past 10 years, intensive clinical studies helped to establish the value of palliative treatment for colon cancer with metastasis. The introduction of new chemotherapeutic agents such as irinotecan and oxaliplatin has led to a significant increase in tumor response and median survival. In advanced colon cancer, impressive prolongation or overall survival can be achieved through sequential application of combined systemic chemotherapy. In addition, targeted manipulation of molecular tumor mechanisms with new substances such as monoclonal antibodies against the epidermal growth factor receptor or vascular endothelial growth factor shows promising effects. Progress in the systemic treatment of colon cancer is evident, not only because of the significant increase in life expectancy in advanced colon cancer.

• Journal of Chest Surgery
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• v.34 no.2
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• pp.148-155
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• 2001

배경: 본 연구는 1987년부터 1997년까지 원자력병원에서 수술을 시행한 500명의 식도암환자를 대상으로 하여 휴향적 방법을 통해 조기 및 장기성적, 재발양상, 예후인자 등을 보고하고자 한다. 대상 및 방법: 대상환자 중에서 발병암이 있는 경우, 인두식도 경계부위나 위식도 경계부위 암, 고식적 우회술 또는 인공식도 삽입예 그리고 시험적 개흉술이나 개복술 만을 시행한 경우는 제외 시켰다. 식도 절제는 대부분 우측 개흉술을 이용한 Ivor Lewis 술식을 사용하였고 대부분의 문합은 stapler를 사용하였다. Extended lymph node dissection은 1994년 8월부터 시행하였고 그 이전에는 standard lymph node dissection을 하였다. 96.8%에서 위를 식도 대체장기로 사용하였고 경부에서 절제 및 재건술을 시행한 경우를 제외한 모든 식도재건은 후종격동을 통해 시행하였다. 결과: 474예(94.8%)가 편평상피 세포암이었고 대부분(58.2%)은 중부식도에 위치하였다. 술후병기는 47.4%가 stage III이었고 25%가 stage IIA이었다. 392예에서 근치적 절제가 가능하였고 74예는 고식적 절제를 시행하였으며, 식도열공을 통한 식도절제술과 경부에서의 유리공장 이식술을 시행한 34예는 위분류에서 제외하였다. 술후 유병율은 38.4%이었고 수술 사망률은 5.8%로 호흡기 감염, 문합부 유출이 주요 원인이었다. 대상환자의 99.8%에서 추적은 가능하였고 수술사망 예를 포함한 전체환자의 1, 2, 5년 생존율은 각각 63.5%, 38.9%, 19.4% 이었다. Standard lymph node dissection 그룹에서의 1, 2, 5년 생존율이 60.7%, 35.9%, 16.9%이었으나 extended lymph node dissection그룹에서는 1, 2, 4년 생존율이 70.2%, 46.5%, 30.9%이었다. 근치적 절제의 경우는 1, 2, 5년 생존률이 69.4%, 43.9%, 21.9%이었고, 고식적 절제의 경우는 37.8%, 17.6%, 7.3%이었다. 수술사망을 제외한 근치적 절제술과 extended lymph node dissection을 함께 시행한 경우의 4년 생존율은 35.6%이었다. 수술후 재발은 226예에서 발견되었고 주로 국소임파절(69%; 경부, 종격동, 복부)이었으며, 전신재발은 간, 폐, 뼈, 뇌 등의 순이었다. 결론: 저자들은 적절한 술후 환자관리가 선행되어야 하지만 근치적 절제와 광범위한 임파절 절제가 장기성적의 향상에 필수적 요소이고, 진행된 식도암에 있어서는 보다 효과적인 보강적 복합치료가 연구되어야 할 것으로 생각된다.

• Journal of Chest Surgery
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• v.38 no.6 s.251
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• pp.415-420
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• 2005

Recently the cases of varicose veins are increasing because the patients with latent disease have come to realize that they want a positive treatment. Accordingly, the purpose of this study is to compare and analyze two methods the conventional phlebectomy (CP) and transiliuminated powered phlebectomy (TIPP). Material and Method: From March 200f to December 2004, 114 patients (167 legs) with varicose vein were operated in Pusan National University Hospital. A retrospective review was performed on the clinical records. We analyzed age, sex, duration of illness, chief complaints, duplex doppler findings, number of skin incisions, operative time, length of hospitalization, complications, and remnant lesions. Result: Operative time was significantly shorter in the TIPP group than CP group (for one leg $108.4\pm27.6\;min\;vs\;83_4\pm24.4\;min,\;for\;both\;legs\;184.7\pm28.4\;min\;vs\; 137.8\pm24.4\;min)$. There was signifcant statistical difference in average number of skin incisions per leg between the CP group and the TIPP group $(5.9\pm2.2\;vs\;4.2\pm1.6)$. Mean duration of hospitalization was Significantly shorter in the TIPP group than CP group $(4.4\pm1.0\;days\;vs\;5.8\pm1.9\;days)$. Complications were pain $(15.9\%)$, remnant lesion $(9.5\%)$, and ecchymosis $(4.8\%)$ in the CP group and ecchymosis $(19.6\%),\;pain\;(7.8\%),\;and\;remnant\;lesion\;(7.8\%)$ in TIPP group. Sclerotherapy or reopertaion was done for the patients who had remnant lesions. Conclusion: Transilluminated powered phlebectomy in varicose vein could reduce operative time and number of skin incisions, and almost completely removed the multiple lesions. Although there were postoperative complications such as ecclymosis, they were absorbed within 2 months and patients were satisfied. Therefore, TIPP is a more effective operative technique than conventional phlebectomy in varicose veins.

• The Monthly Diabetes
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• s.166
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• pp.64-67
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• 2003

인슐린 치료를 필요로 하는 당뇨병 환자에서는 당뇨병성 합병증의 발생을 예방하거나 합병증이 진행된 경우에는 기존의 고식적인 치료로 만족할 만한 효과를 거두기가 어려워 이상적인 치료 방법에 대한 기대가 높은 상태이다. 특히 췌도이식 대상자는 급증하고 있으나 공급 가능한 췌장은 한정되어 있어 이식에 필요한 췌도는 절대적인 부족 상태로 오직 일부 제 1형 당뇨병 환자에서만 제한적으로 췌도이식이 적용 가능하다. 따라서 충분한 췌도 이식원을 확보할 수 있는 췌도 이식원의 개발은 췌도이식의 가장 큰 목표라 할 수 있다. 본 난에서는 당뇨병 치료에서 시험관내 및 생체실험에서 줄기세포의 현황과 줄기세포를 이용하여 당뇨병을 극복하고자 하는 연구의 성과와 이에 따른 새로운 치료법에 대한 최근 내용을 고찰해 보고자 한다.

• Journal of Chest Surgery
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• v.34 no.2
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• pp.162-166
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• 2001

배경: 흉선암은 드문 질환으로 치료경과 및 예후가 침윤성 흉선종에 비해 나쁜 것으로 알려져 있으며 병기의 분류나 병기에 따른 치료방법이 아직 표준화 되어있지 않아 치료에 어려운 점이 있다. 이에 본교실에서 흉선암으로 진단되었던 환자들의 피료방법 및 성적을 분석하여 그 결과를 보고하고자 한다. 대상 및 방법: 계명대학교 동산의료원 흉부외과학교실에서는 1984년 8월에서 흉선암으로 진단되었던 8례의 환자를 대상으로 의무기록을 참고하여 병기에 따른 치방법료 및 예후 등을 후향적으로 분석하였다. 결과: 연령은 23세에서 67세까지로 평균 46세였으며 전흉부통증이 주증상이었다. 조직학적으로는 임파상피양암(lymphoepithelioma-like carcinoma)이 2례, 편평상피암(squamous cell carcinoma)이 2례, 기저세포암(basaloid carcinoma)이 1례, 혼합형(mixed type)이 3례 있었다. 임상적 병기분류는 Masoka의 분류법을 사용하였으며 제I기 2례, 제II기 4례, 제III기 1례, 제IVAr기가 1례 있었다. 4례의 환자에서는 종양의 완전적출이 가능했으며 3례에서는 고식적 수술을 시행하였다. 1례의 환자는 주위조직으로의 침윤과 심낭에 퍼져있어 조직생검만을 시행하였다. 전례에서 보조적 항암치료를 받았고 술후 병기가 제III기 이상이거나 종양의 절제가 불완전했던 5례의 환자에서는 보조적 방사선치료를 병행하였다. 이들 중 5례에서 술후 보조적 항암치료 및 방사선치료를 받고 현재까지 생존해있다. 평균추적기간은 55.3$\pm$64.6 개원이었고, 3례의 환자는 사망하였으며 4례의 환자는 종양의 재발증거 없이 생존해있다. 결론: 종양의 조기진단과 완전종양적출후 적극적인 보조적 항암치료 및 방사선치료가 흉선암을 치료하는데 도움이 될 것으로 사료된다.

• Korean Journal of Head & Neck Oncology
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• v.15 no.2
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• pp.232-234
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• 1999

Distant metastases of head and neck cancer have become an increasingly common cause of death as local and regional control has improved. The most frequent metastatic sites of head and neck cancer are the lung, liver, bone and kidney; but metastases to the gastrointestinal tract, brain and heart have also been reported. We report a recent case of a 37-year-old male patient with squamous cell carcinoma of the tonsil who had undergone composite operation with left radical neck dissection and postoperative radiotherapy. The patient presented three years later, cachexic and complaining of severe deep seated headache. Radiologic evaluation revealed a cystic mass with peripheral enhancement in left temporal lobe that was proven to be metastatic cancer by burrhole exploration. However, in spite of various modalities, the patient expired.

• Journal of the Korean Arthroscopy Society
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• v.5 no.1
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• pp.27-31
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• 2001

Purpose : The purpose of this study was to evaluate results of the arthroscopic treatment of calcific tendinitis of the shoulder resistant to conservative treatment. Materials and Methods : From March, 1996 to June, 1998, fourteen patients underwent shoulder arthroscopy to treat resistant calcific tendinitis of the rotator cuff despite conservative treatment for more than 6 months. Calcium deposits were localized to the supraspinatus tendon only in eleven patients, the supraspinatus and infraspinatus tendon in two patients, and to the supraspinatus and subscapularis tendon in one patient. Each shoulder was evaluated with UCLA shoulder rating scale and Constant-Murley score Results : The Constant-Murley pain score improved from average score 3.2 before surgery to average score 8.3 after surgery, and the UCLA functional average score improved from 4.5 preoperatively to 8.3 postoperatively. Preoperative ROM averaged $110^{\circ}$ of flexion, $45^{\circ}$ of external rotation, $90^{\circ}$ of abduction, and internal rotation with the thumb reaching to the spinous process of the third lumbar vertebra, but postoperative range of motion averages improved as follows: $170^{\circ}$ or flexion, $50^{\circ}$ of external rotation, $140^{\circ}$ abduction, and internal rotation with the spinous process of the twelveth thoracic vertebra. Overall 3 patients were rated excellentm 9 were good, 2 were fair. Conclusion : Shoulder arthroscopy is an effective treatment in patients with refractory calcific tendinitis.

• Journal of the Korean Orthopaedic Association
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• v.54 no.1
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• pp.78-83
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• 2019

Tophi is one of the clinical manifestations of gout. On the other hand, it does not draw the patient's attention when it is asymptomatic, which leads to delayed management. The current case is a typical example of delayed diagnosis and management. The authors' preferred management of tophi was medical not surgical, even though the hitherto therapeutic issue has been conservative versus surgical. The authors chose conservative treatment in the osteolytic lesion resulting from huge tophi in the patella, and the report the results of 6 years follow-up.

• Radiation Oncology Journal
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• v.24 no.1
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• pp.11-20
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• 2006

Puroose: In order to find out whether stereotactic radiation therapy (RT) using CyberKnife (CK) could improve survival rate and lower acute toxicity compared to conventional RT. Materials and Methods: From April 2003 through April 2004, 19 patients with Eastern Cooperative Oncology Group (ECOG) performance status ${\leq}3$ and locally advanced pancreas cancer without distant metastasis, evaluated by CT or PET/CT, were included. We administered stereotactic RT consisting of either 33 Gy, 36 Gy or 39 Gy in 3 fractions to 6, 4 and 9 patients, respectively, in an effort to increase the radiation dose step by step, and analyzed the survival rate and gastrointestinal toxicities by the acute radiation morbidity criteria of Radiation Therapeutic Oncology Group (RTOG). Prognostic factors of age, sex, ECOG performance score, chemotherapy, bypass surgery, radiation dose, CA 19-9, planning target volume (PTV), and adjacent organ and vessel invasion on CT scan were evaluated by Log Rank test. Results: The median survival time was 11 months with 1-year survival rate of 36.8%. During follow-up period (range $3{\sim}20$ months, median 10 months), no significant gastrointestinal acute toxicity (RTOG grade 3) was observed. In univariate analysis, age, sex, ECOG performance score, chemotherapy, bypass surgery, radiation dose, CA 19-9 level, and adjacent organ and vessel invasion did not show any significant changes of survival rate, however, patients with PTV (80 cc showed more favorable survival rate than those with PTV>80 cc (p-value<0.05). In multivariate analysis, age younger than 65 years and PTV>80 cc showed better survival rate. Conclusion: In terms of survival, the efficacy of stereotactic radiation therapy using CK was found to be superior or similar to other recent studies achieved with conventional RT with intensive chemotherapy, high dose conformal RT, intraoperative RT (IORT), or intensity modulated RT (IMRT). Furthermore, severe toxicity was not observed. Short treatment time in relation to the short life expectancy gave patients more convenience and, finally, quality of life would be increased. Consequently, this could be regarded as an effective novel treatment modality for locally advanced, unresectable pancreas cancer. PTV would be a helpful prognostic factor for CK.

• Journal of Chest Surgery
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• v.34 no.11
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• pp.879-882
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• 2001

advancement in the treatment of esophageal perforation due to the development of ICU care and antibiotics. There were controversies in the treatment of esophageal perforation when diagnosed after 24hrs. From 1995 to 2000, we performed a buttressed primary repair and mediastinal drainage in 6 Boerhaave\`s syndrome patients among 13 esophageal perforation patients. Two patients died(33%). They died because of pneumonia, ARDS and sepsis on 38th, 39th post-operative day respectively. Two patients had leak at the site of repair which was treated completely with conservative treatment. We report on the result of a buttressed primary repair and mediastinal drainage for 6 Boerhavve\`s syndrome patients.