• Title/Summary/Keyword: 수술 후 예후

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External Beam Radiotherapy in the Management of Low Grade Astrocytoma of the Brain (뇌 성상세포종 환자의 외부 방사선치료)

  • Chun, Ha-Chung
    • Radiation Oncology Journal
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    • v.27 no.1
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    • pp.23-28
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    • 2009
  • Purpose: This study was designed to evaluate the effectiveness of postoperative radiotherapy for patients with low-grade astrocytomas and to define an optimal radiotherapeutic regimen and prognostic factors. Materials and Methods: A total of 69 patients with low-grade astrocytomas underwent surgery and postoperative radiotherapy immediately following surgery at our institution between October 1989 and September 2006. The median patient age was 36 years. Forty-one patients were 40 years or younger and 28 patients were 41 years or older. Fourteen patients underwent a biopsy alone and the remaining 55 patients underwent a subtotal resection. Thirty-nine patients had a Karnofsky performance status of less than 80% and 30 patients had a Karnofsky performance status greater than 80%. Two patients were treated with whole brain irradiation followed by a coned down boost field to the localized area. The remaining 67 patients were treated with a localized field with an appropriate margin. Most of the patients received a dose of $50\sim55$ Gy and majority of the patients were treated with a dose of 54 Gy. Results: The overall 5-year and 7-year survival rates for all of the 69 patients were 49% and 44%, respectively. Corresponding disease free survival rates were 45% and 40%, respectively. Patients who underwent a subtotal resection showed better survival than patients who underwent a biopsy alone. The overall 5-year survival rates for patients who underwent a subtotal resection and patients who underwent a biopsy alone were 57% and 38%, respectively (p<0.05). Forty-one patients who were 40 years or younger showed a better overall 5-year survival rate as compared with 28 patients who were 41 years or older (56% versus 40%, p<0.05). The overall 5-year survival rates for 30 patients with a Karnofsky performance status greater than 80% and 39 patients with a Karnofsky performance status less than 80% were 51% and 47%, respectively. This finding was not statistically significant. Although one patient was not able to complete the treatment because of neurological deterioration, there were no significant treatment related toxicities. Conclusion: Postoperative radiotherapy following surgery is a safe and effective treatment for patients with low-grade astrocytomas. The extent of surgery and age were noted as significant prognostic factors in this study. However, further effective treatment might be necessary in the future to improve long-term survival rates.

Pulmonary Thromboendarterectomy for Pulmonary Hypertension Caused by Chronic Pulmonary Thromboembolism (만성폐색전중으로 인한 폐동맥고혈압 환자에서 시행한 폐동맥내막절제술)

  • Song Seung-Hwan;Jun Tae-Gook;Lee Young-Tak;Sung Ki-Ick;Yang Ji-Hyuk;Choi Jin-Ho;Kim Jin-Sun;Kim Ho-Joong;Park Pyo-Won
    • Journal of Chest Surgery
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    • v.39 no.8 s.265
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    • pp.626-632
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    • 2006
  • Background: Pulmonary hypertension caused by chronic pulmonary embolism is underrecognized and carries a poor prognosis. Medical therapy is generally unsatisfactory and palliative. With the improvement of operative technique and postoperative management, pulmonary endarterectomy has been the treatment of choice for this condition. Material and Method: Between January 2001 and December 2005, eleven patients were received pulmonary endarterectomy. All patients had chronic dyspnea and exercise intolerance. Diagnosis was made with cardiac echocardiography, lung perfusion scan and computed tomography. Before the operation, Greenfield vena cava filter were placed in all patient except one. Deep hypothermic circulatory arrest was used for the distal-most portion of the endarterectomy procedure. More than moderate degree of tricuspid reguirgitation was repaired during operation. Result: There was no early and late death. Right ventricular systolic pressure was reduced significantly after operation from $91{\pm}21$ mmHg to $40{\pm}17$ mmHg on echocardiography (p=0.001). NYHA class and tricuspid reguirgitaion were improved postoperatively. Although mild reperfusion injury in three case and postoperative delirium in one case were observed, all of them recovered without complication. Conclusion: Pulmonary thromboendarterctomy offers to patient an acceptable morbidity rate and anticipation of clinical improvement. This method is safe and effective operation for pulmonary hypertension caused by chronic pulmonary thromboembolism.

Improved Clinical Staging of Esophageal Cancer with FDG-PET (양전자단층촬영술을 이용한 식도암의 병기 결정 성적 향상)

  • Kim, Young-Hwan;Choi, Joon-Young;Lee, Kyug-Soo;Choi, Yong-Soo;Lee, Eun-Jeong;Chung, Hyun-Woo;Lee, Su-Jin;Lee, Kyung-Han;Shim, Young-Mog;Kim, Byung-Tae
    • The Korean Journal of Nuclear Medicine
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    • v.38 no.4
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    • pp.282-287
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    • 2004
  • Purpose: Since preoperative staging in esophageal cancer is important in both therapy and prognosis, there had been many efforts to improve its accuracy. Recent studies indicate that whole body FDG-PET has high sensitivity in detection of metastasis in esophageal cancer. Therefore, we added FDG-PET to other conventional methods in staging esophageal cancer to evaluate the usefulness of this method. Materials & Methods: Subjects were 142 esophageal cancer patients (average $62.3{\pm}8.3$ yrs) who received CT and PET just before operation. First, we compared N stage and M stage of the CT or PET with those of the post-operative results. Then we compared the stage according to the EUS (T stage) and CT (N and M stage) or SUS (T stage) and CT & PET (N and M stage) to that according to the post-operative results. Results: Among 142 patients, surgical staging of 69 were N0 and 73 were N1. In M staging, 128 were M0 and 14 were M1. Sensitivity, specificity, and accuracy of N staging were 35.6%, 89.9%, 62.0% with CT and 58.9%, 71.0%, 64.7% with PET, respectively. In M staging, 14.3%, 96.9%, 88.7% with CT and 50.0%, 94.5%, 90.1%, with PET, respectively. The concordances of [EUS+CT] and [EUS+CT+PET] with post-operative results were 41.2% and 54.6%, respectively and there was significant improvement of staging with additional PET scan (p<0.005). Conclusion: The concordance of [EUS+CT+PET] with post-operative result was significantly increased compared to that of [EUS+CT]. Thus, the addition of FDG-PET with other conventional methods may enable more accurate preoperative staging.

Experimental Studies on the Effect of Ginsenoside Rg1 Mixtures in an Isolated Rat Heart after Ischemic Arrest and Reperfusion (흰 쥐 적출 심장에서 비작업성 관류 회로를 이용한 인삼 성분 Ginsenoside Rg1 Mixtures의 심근 보호 효과에 관한 실험적 연구)

  • 김동원;신원선;이재영;김범식;조규석;유세영
    • Journal of Chest Surgery
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    • v.31 no.6
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    • pp.567-575
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    • 1998
  • Panax Ginseng C.A. Meyer has been known for hundreds of years as the most valuable drug having mysterious effects among all the herbal medicines and plants in Korea. Also, many experimental studies have been performed recently that the various effects were identified and applied clinically. So we attempted an experimental study on the effect of ginsenoside Rg1 mixtures in an isolated rat heart with the use of the Langendorff model. The objective of this study was to determine whether this ginsenoside Rg1 mixtures would protect the myocardial injury after ischemic arrest and reperfusion. Isolated rat hearts were allowed to equilibrate for 20 minutes and were then subjected to 15 minutes of normothermic ischemia. After this ischemic period, isolated rat hearts were allowed to reperfusion for 10 minutes(Ischemic Group). In other group , isolated rat hearts were perfused for 60 minutes continuously with normothermia( Normothermic Group). Hemodynamic and biochemical parameters such as heart rate, left ventricular pressure, +dp/dt max, coronary blood flow and cardiac enzymes were measured during initial perfusion, ischemia, reperfusion period (Ischemic group) and 20, 40 and 60 minutes after continuous perfusion(Normothermic group). After completion of the experiment, this data was evaluated and the following results were obtained. 1. Heart rates showed an increase in both ischemic and normothermic experimental groups, but statistically significant differences were not identified. 2. LVP(Left Ventricular Pressure) showed statistically significant differences in both ischemic and normothermic experimental groups(p<0.005, p<0.01). 3. +dp/dt max showed statistically significant differences in both ischemic and normothermic experimental groups(p<0.01, p<0.01). 4. There were no statistically significant differences in coronary blood flow and cardiac cenzymes in all groups, but experimental groups seemed to have better protection and recovery. These results suggest that ginsenoside Rg1 mixtures has a protective effect on the myocardial injury after ischemia and reperfusion.

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Conversion of Total Atrio-pulmonary Connection to Total Cavo-pulmonary Connection - Review of Indications and Hemodynamic Characteristics - (심방-폐동맥 문합술 후 총 체정맥-폐동맥 문합술로의 전환 - 수술 적응증 및 혈역학적 특징의 검토 -)

  • Seo, Jung Ho;Lee, Jong Kyun;Choi, Jae Young;Sul, Jun Hee;Lee, Sung Kyu;Park, Young Whan;Cho, Bum Koo
    • Clinical and Experimental Pediatrics
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    • v.45 no.2
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    • pp.199-207
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    • 2002
  • Purpose : Since the successful application of total atrio-pulmonary connection(TAPC) to patients with various types of physiologic single ventricles in 1971, post-operative survival rates have reached more than 90%. However some patients have been shown to present with late complications such as right atrial thrombosis, atrial fibrillation and protein losing enteropathy eventually leading to re-operation to control the long-term complications. The aim of this study is to review the results of total cavo-pulmonary connection(TCPC) in cases with late complications after TAPC. Methods : Between Jan. 1995 and Dec. 2000, 6 patients(5 males and 1 female) underwent cardiac catheterization $11{\pm}3$ months after conversion of previous TAPC to TCPC. We compared the hemodynamic and morphologic parameters before and after TCPC and also assessed the clinical outcomes. The indications for TAPC were tricuspid atresia in 4 cases and complex double-outlet right ventricle with single ventricle physiology in 2 cases. Results : There was no peri-operative mortality and all patients were clinically and hemodynamically improved at a mean follow-up of 11 months(range : 4 to 13). However, protein losing enteropathy recurred in 2 patients; this was were successfully treated with subcutaneous administration of heparin. Right atrial pressure before TCPC was $18.0{\pm}3.6mmHg$, but baffle pressure, corresponding to right atrial pressure decreased to $14.8{\pm}3.6mmHg$ after TCPC. The size of the pulmonary arteries did not regress after TCPC. Conclusion : The conversion of TAPC to TCPC improves clinical and hemodynamic status by decreasing the right atrial pressure and by providing a laminar cavo-pulmonary flow which enhances the effective pulmonary circulation in the so-called Fontan circulation.

Metastatic Carcinoma of the Neck Node from an Unknown Primary Site (확인불능의 원발병소로부터의 경부임파절 전이에 대한 치료 성적)

  • Kim, Jae-Sung;Park, Charn-Il
    • Radiation Oncology Journal
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    • v.8 no.1
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    • pp.59-64
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    • 1990
  • From 1980 to 1986,26 patients with metastatic carcinoma of the neck node from an unknown primary site were seen in the Department of Therapeutic Radiology of Seoul National University Hospital. Among these, three patients were excluded from further analysis due to incomplete treatment. So a retrospective analysis was undertaken on 23 patients who had complete treat-ment with radiation therapy alone or in combination with surgical treatment and chemotherpay. The overall three year actuarial survival rate was $32\%$. According to the staging system of the American Joint Committee on Cancer, the three year survival rates with N2 and N3 patients were $43\%\;and\;13\%$, respectively. In 16 patients with squamous cell carcinoma and seven with non-squamous cell carcinoma, the three year survival rates were $34\%\;and\;29\%$, respectively. Analysis according to site of nodal involvement was also done. Patients with cervical node and supraclavicular node involvement recorded $44\%\;and\;17\%$ of three year survival, rate, respectively. In this study, six patients eventually manifested the primary sites (three in the lung, one in the esophagus, one in the stomach, one in the nasopharynx). Presence of the primary site seemed to influence the prognosis ($17\%\;vs\;38\%$). In analyzing the prognostic factors, the nodal stage and site of nodal involvement were important prognostic factors, and the presence of a primary site seemed to influence the patients' survival, but histology did not.

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Clinical Evaluation of Syndromic and Nonsyndromic Intrahepatic Bile Duct Paucity (증후군성 및 비증후군성 간내담도부족증의 임상적 고찰)

  • Han, Soo-Jin;Choi, Bo-Hwa;Kang, Kyung-Hoon;Kim, Kyung-Mo
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.2 no.2
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    • pp.178-184
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    • 1999
  • Purpose: The aims of this study were to evaluate the clinical manifestations and prognosis of the syndromic and nonsyndromic intrahepatic bile duct paucity (IHBDP). Methods: We studied histology of 42 infants with neonatal cholestasis. Fourteen patients were diagnosed as IHBDP. We evaluated the clinical manifestations, courses and prognosis retrospectively. Results: Underlying disease of the 42 infants with neonatal cholestasis were biliary atresia in 23, intrahepatic bile duct paucity in 14 (Alagille syndrome in 4 and nonsyndromic IHBDP in 10), neonatal hepatitis in 5 infants. The mean ratio of the bile ducts per portal tract was 0.087 (range: 0~0.5). The manifestations in 4 patients with Alagille syndrome demonstrated as follows: characteristic face in 3, chronic cholestasis in 4, posterior embryotoxon in 2, vertebral anomalies in 2, peripheral pulmonary stenosis in 2. One of 4 patients of Alagille syndrome improved cholestasis and the other 3 patients were remained their cholestasis and growth retardation. All patients of the nonsyndromic IHBDP were idiopathic. Seven out of 8 patients of nonsyndromic IHBDP showed improvement of cholestasis, and one patient received liver transplantation due to cirrhosis. Conclusion: This study suggested that IHBDP should be considered in the differential diagnosis of neonatal cholestasis. The outcome of idiopathic IHBDP was better than predicted.

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The Risk Factors Influencing the Postoperative Mortality of the Patients with an Abdominal Aortic Aneurysm (복부대동맥류 환자에서의 수술 후 사망의 위험인자 분석)

  • Lee, Seong-Kwang;Jun, Hee-Jae;Park, Kyung-Taek;Yoon, Young-Chul;Han, IL-Yong;Lee, Yang-Haeng;Cho, Kwang-Hyun
    • Journal of Chest Surgery
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    • v.43 no.6
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    • pp.655-662
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    • 2010
  • Background: Despite the rapid expansion of percutaneous endovascular repair, open surgical repair is still recognized as an option to achieve a cure. We retrospectively analyzed over a 6 year period the surgical outcomes, the complications and the mortality-related factors for patients with abdominal aortic aneurysms. Material and Method: We analyzed 36 patients who underwent surgery for abdominal aortic aneurysms between May 2001 and June 2005, and between April 2007 and November 2009. The indications for surgery were rupture, a maximal aortic diameter > 50 mm, and medically intractable hypertension or pain. Result: The mean patient age was $69.67{\pm}6.97$ years (range: 57 to 84 years). Thirty two patients (88.9%) were males and 4 patients (11.1%) were females. Extension to the iliac artery existed in 28 patients (77.8%). Thirteen patients (36.1%) had ruptured aortic aneurysms. The mean maximal diameter of the aorta was $73.7{\pm}13.3$ mm (60 to 100 mm). Surgery was performed by a midline laparotomy and 10 patients (27.8%) underwent emergency surgery. The mortality rate was 8.3%; the mortality rate for the patients with ruptured aneurysms was 23.1 % and the mortality rate for patients with unruptured aneurysms was 0%. The postoperative complications included wound infection (3 cases), sepsis (2 cases), renal failure (2 cases) and pneumonia (1 case). Unstable vital signs, pre-operative transfusion, ruptured aneurysm, emergency surgery, comorbidity (DM and syncope) and complications (sepsis and renal failure) were the statistically significant mortality-related factors (p < 0.05). Conclusion: Emergency surgery for ruptured aortic aneurysms continues to have high mortality, but the unruptured cases are repaired with relative safety. Even though endovascular aortic repair is the trend for abdominal aortic aneurysms, an elective operation of the unruptured aneurysms could decrease the procedure's morbidity and the inconvenient for repeat evaluation with good surgical results.

Lymphoproliferative Disease After Lung Transplantation in Transplanted Lung (폐이식후 발생한 이식폐의 임파종 1예)

  • 이교준;김도형;함석진;김해균
    • Journal of Chest Surgery
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    • v.34 no.12
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    • pp.956-959
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    • 2001
  • The Iymphoproliferative disease after the organ transplantation is more commonly seen with the increase according to the increasing number of the organ transplantations and it occurs more frequently in the cases of heart and lung transplantations that needs more aggressive immunosuppression. It demands urgent evaluation and management because of poor prognosis. We transplanted left lung of a man to the woman who suffered from severe dyspnea due to terminal pulmonary emphysema in discrepancy of ABO blood type. Postoperatively, We used triple regimen immunotherapy(cyclosporin, azathioprine, prednisolone) and followed up in the out patient clinic. During the follow up, we found abnormal mass lesion on the transplanted lung and performed gun biopsy. We confirmed malignant lymphoma on the pathollgic examination and two cycled chemotherapy was given after reducing dose of immunosupression. The patient died of sudden onset of pulmonary edema of the transplanted lung.

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Factors Related to Patients' Satisfaction Level of Treatment Outcome of Oral Malodor (구취치료 후 만족도에 영향을 미치는 예견인자)

  • Lee, Jeong-Yun;Kho, Hong-Seop;Kim, Young-Ku;Chung, Sung-Chang;Lee, Sung-Woo
    • Journal of Oral Medicine and Pain
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    • v.26 no.1
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    • pp.27-38
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    • 2001
  • 본 연구에서는 환자들에 의해 구취와 관련이 있다고 일반적으로 믿어지고 있는 여러 요인들이 치료 후의 환자의 만족도에 미치는 영향에 대해 알아봄으로써 환자의 만족도의 예후를 판단할 수 있는 자료를 마련하고자 하였다. 서울대학교 치과병원 구강진단과에 구취를 주소로 내원한 환자 194명을 대상으로 설문지를 이용하여 구취와 관련성이 있는 것으로 알려져 있는 항목들을 조사하였다. 조사 항목으로는 1) 본인확인가능여부, 2) 타인확인가능 여부, 3) 구취의 기간, 4) 구취의 빈도, 5) 축농증, 6) 비염, 7) 코수술 병력, 8) 콧물이 목뒤로 넘어감, 9) 코막힘, 10) 비호흡 곤란, 11) 구강건조감, 12) 편도선부종, 13) 가래, 14) 신물의 역류, 15) 소화불량, 16) 흡연여부가 포함되었다. 구취의 평가는 portable sulfide monitor인 $Halimeter^{(R)}$(Interscan Co., Chatsworth, CA, USA)를 이용하여 치료 전, 후에 각각 측정하였고, 혀배면의 세정, 치면 세균막 조절, 0.25% $ZnCl_2$ 양치액의 사용을 내용으로 하는 구취의 치료를 시행한 뒤 자신의 구취개선정도에 대해 %로 질문하여 치료 후 만족도를 조사하였다. 각 조사 항목과 치료 후 만족도 사이의 상관관계 및 실제 $Halimeter^{(R)}$ 수치의 개선정도와 만족도 사이의 상관관계를 분석하였으며, Symptom Checklist - 90 Revised(SCL-90R)의 분석결과에 따라 환자를 두 그룹으로 분류하고 두 그룹 사이의 치료 후 만족도의 차이를 조사한 결과 다음과 같은 결론을 얻었다. 1. 본인 및 타인 확인가능여부, 구취가 항상 나는지 여부, 구취의 기간, 축농증, 비염, 코수술 병력, 코막힘, 비호흡 곤란, 콧물이 목뒤로 넘어감, 흡연여부에 따른 치료 후 만족도의 유의한 차이는 없었다. 2. 신물의 역류(p=0.003), 소화불량(p=0.007), 구강건조감(p=0.016), 편도선 부종(p=0.018), 가래(p=0.033)에 따른 치료 후 만족도는 통계적으로 유의한 수준의 차이를 보였다. 3. $Halimeter^{(R)}$ 수치의 개선정도와 만족도 사이의 유의한 상관관계는 관찰되지 않았다(r=0.092, p=0.201).

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