• Journal of Chest Surgery
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• v.34 no.8
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• pp.615-620
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• 2001

The new stage of metastatic lung cancer based upon resectability, disease-free interval, and the number of pulmonary metastases was proposed in 1998 by Ginsberg, et al. We evaluated the validity of the new staging proposal for pulmonary metastases through the analysis of experiences at Severance Hospital. Material and Method: The cases of 111 patients who underwent resection of metastatic lung cancer during the eleven-year period (1990-2000) were reviewed. Of these patients, 103(92.8%) underwent compete surgical resection. The primary tumor was carcinoma in 60 cases, sarcoma in 46, and others in 5. The disease-free interval(DFI) was 0 to 35 months in 79 cases adn more than 36 months in 32 cases. Single metastasis accounted for 53 cases and multiple lesions for 58 cases. Mean follow-up was 49 months. Result: The actuarial survival after complete metastasectomy was 48.2% at 3 years and 32.6% at 5 years; the corresponding values for incomplete resection were 21.9% at 3 years. The 3-year survival rate(3-YSR) for complete resction was 40.5% and 5-year survival rate(5-YSR) was 30.4% for patients with a DFI less than 36 months, the 3-YSR, 75.8% and 5-YSR, 39.0% for those with a DFI equal or more than 36 moths; 45.8% and 30.5% for single lesions, 50.0% and 34.4% for multiple lesions. The 3-YSR and 5-YSR were 58.5% and 43.8% for stage I patients, 54.0% and 37.4% for stage II, 38.2% and 27.9% for stage III and 21.9% for stage IV. Conclusion: The result of the analysis of new stage of pulmonary metastases showed that the survival rate was different according to stage and there was no statistical significance. We need more experiences and long-term follow up to determine the prognostic factor of metastatic lung cancer surgery.

• Journal of Chest Surgery
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• v.43 no.3
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• pp.246-253
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• 2010

Background: Our objective was to review the long-term prognosis of patients with preoperative mild to moderate ischemic mitral regurgitation who underwent off-pump coronary artery bypass grafting. Material and Method: We prospectively followed 1,000 consecutive and systematic off-pump coronary artery bypass grafting patients who were operated on between September 1996 and March 2004; follow-up was achieved for 97%. Sixty-seven patients (6.7%) had mild to moderate ischemic mitral regurgitation at the time of surgery. Operative mortality, actuarial survival and major adverse cardiac event free survival were compared to assess the effect of ischemic mitral regurgitation. Result: Average follow-up was $66{\pm}22$ months. Patients with ischemic mitral regurgitation were older (p<0.001), had lower ejection fractions (p<0.001) and more comorbidities. Significantly more female patients presented with ischemic mitral regurgitation (p=0.002). There was no significant difference in operative mortality and perioperative myocardial infarction in ischemic mitral regurgitation patients (p=0.25). Eight-year survival was decreased in ischemic mitral regurgitation patients ($39.6{\pm}11.8%$ vs $76.7{\pm}2.2$, p<0.001). However, after correcting for risk factors, mild to moderate ischemic mitral regurgitation was not found to be a significant independent risk factor for long-term mortality (p=0.42). Major adverse cardiac event free survival at 8 years was significantly lower in ischemic mitral regurgitation patients ($53.12{\pm}12%$ vs $77{\pm}2%$, p<0.001). After correction for risk factors, ischemic mitral regurgitation remained a significant independent cause of major adverse cardiac events (HR: 2.31), especially congestive heart failure and recurrent myocardial infarction. Conclusion: In our series, patients with preoperative mild to moderate ischemic mitral regurgitation had a higher prevalence of preoperative risk factors than patients without ischemic mitral regurgitation. They had comparable perioperative mortality and morbidity, but, in the long term, were found to be at elevated risk for recurrent cardiac events.

• Clinical and Experimental Pediatrics
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• v.46 no.2
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• pp.178-182
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• 2003

Purpose : Brain tumors are the second most common tumor in childhood, and medulloblastomas comprise 15-25% of brain tumors. The well known prognostic factors are age at diagnosis, stage of disease, and extent of surgical excision. In this study, we analysed the prognostic factors in patients who received chemotherapy after excision. Methods : We reviewed the medical records of 61 patients who received chemotherapy among the 94 patients who were diagnosed and treated between Jan 1985 and Sep 2001 in the Department of Pediatrics and Neurosurgery at Severance Hospital. Results : Among the total survival rate of patients who underwent chemotherapy, the 3-yr progression-free survival rate was $66.5{\pm}6.3%$ and the 15-yr progression-free survival rate was $60.3{\pm}6.7%$. The progression-free survival rate for patients with age at diagnosis over 3 yrs old and under 3 yrs old, was $64.5{\pm}7.7%$ and $48.2{\pm}12.9%$ respectively and there was no statistically significant difference. The survival rate of the high vs low risk group by staging was $72.7{\pm}10.5%$ and $54.6{\pm}8.3%$ respectively, and there was no significant difference. The survival rate of patients with total removal vs subtotal removal was $65.8{\pm}11.8%$ and $56.8{\pm}8.2%$ respectively, showing no statistical difference. Conclusion : The reason there is no difference in survival rate according to the traditional prognostic factors is that chemotherapy has improved not only the total survival rate but also the survival rate in patients with poor traditional prognostic factors. So, sufficient removal of tumor followed by proper chemotherapy and radiotherapy is an important factor which influences the survival rate of medulloblastoma patients.

• Journal of the Korean Orthopaedic Association
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• v.56 no.1
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• pp.34-41
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• 2021

Purpose: To evaluate the long-term clinical results and survivorship of unicompartmental knee arthroplasty (UKA) in elderly patients older than 70 years by analyzing cases that have been implanted for >10 years ago. Materials and Methods: The long-term follow-up results were evaluated in 39 patients (46 cases) who underwent medial UKA from March 2002 to February 2004. The mean age of the patients at the time of surgery was 74.0 years, and the preoperative diagnosis was degenerative arthritis of the knee in all cases. Results: Of the 46 cases, reoperation occurred due to the complications in four cases. In 22 cases without 14 cases of death and six cases of follow-up loss, follow-up more than 10 years was possible. The mean Knee Society knee and function scores improved significantly from 53.0 and 52.5 points pre-operatively to 89.4 and 80.9 points at the last follow-up, respectively (p<0.001). The mean range of motion of the knee recovered to 132.5°, and the mean tibiofemoral angle changed to 5.9° of valgus at the last follow-up. Complications following the UKA occurred in four cases; the most prevalent complication was mobile bearing dislocation (n=2). One case of failure occurred due to aseptic loosening and degenerative arthritis of the lateral compartment, respectively. The cumulative survival rate of the implants was 95.0% at 10 years and 85.7% at 15 years. Of the 40 cases, excluding six cases of follow-up loss, 36 cases (90.0%) could be used without reoperation until death or at the last follow-up after surgery. Conclusion: These results showed the outstanding functions of the knee and satisfactory long-term survivorship after UKA. Therefore, UKA could be a useful method for the treatment of osteoarthritis of the knee in elderly patients older than 70 years of age.

• Tuberculosis and Respiratory Diseases
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• v.49 no.4
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• pp.474-485
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• 2000

Background : Current studies on multimodal strategy for N2 non-small cell lung cancer are being high interest, have drawn much attention. N2 lung cancer, however, is composed of is divided into several sub groups with that have different prognoses. The prognostic factors still remain controversial. Methods : Between January 1990 and June 1999, 180 patients with N2 lung cancer who underwent surgical resection were investigated, excluding 10 of these for surgical mortality. All patients underwent mediastinal lymph node dissection. 20 clinicopathologic factors were investigated by univariable and multivariable analyses to identify significant prognostic factors among resected N2 disease. Results : The overall 5-year survival rate was 20.6%. Multivariable analyses among overall patients revealed 3 significant prognostic factors : Age, Histologic type, Vascular invasion. Based on the result, 49 patients with both age more than 60 and pathologic Non-squamous cell showed a 5-year survival of 5.0%, whereas 37 patients with neither of the factors showed a 5-year survival of 56.6%(p<0.001). And 12 patients with both vascular invasion and pathologic Non-squamous cell showed a 5-year survival of 11.9%, whereas 67 patients with neither of the factors showed a 5-year survival of 33.6%(p=0.01). Conclusion : The prognosis of surgically resected N2 disease varies according to the 3 significant prognosis factors. Tumor size may be an additional influencing factor in the prognosis of N2 disease.

• Journal of Chest Surgery
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• v.34 no.4
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• pp.311-321
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• 2001

배경: 본 연구에서는 16년간 본원에서 시행한 완전방실중격결손 환자의 수술성적을 고찰하고 수술후 사망 및 술후 잔존 좌측방실판막부전의 발생에 관여하는 위험인자들을 분석하고자 하였다. 대상 및 방법: 본원에서 84년 7월부터 2000년 6월까지 수술한 완전방실중격결손 환자 70명의 임상기록을 후향적으로 연구관 하였다. 70명의 대상환자중 남아 환아는 36명 여아 환아는 34명이었고 연령분포는 1개월에서 19세였다.(평균나이는 32.$\pm$71.9개월). 이중 다운증후군이었던 환자는 39명(55.7%)이었으며 술후 라스텔리 분류 A형이 42명(60.0%), B형이 6명(8.6%), C형이 20명(28.6%)이었고 기록상으로 분류를 확인 할 수 없는 경우가 2명 (2.9%)이었다. 결과: 9(12.9%)명에서 술후 조기사망했으며, 이를 기간별로 비교해 보면 1996년 이전은 20.0%, 1996년 이후 최근 5년간은 7.7% 였으며 둘 사이의 통계학적 유의한 차이는 없었다. 술후 10명(14.3%)에서 3도이상의 잔존좌측방실판막부전을 보였다. 5년 및 10년 장기 생존율은 79.4%였고, 4명의 환자에서 5례의 재수술을 시행하였으며 5년간의 7.7% 였으며 둘이상의 통계학적 유의한 차이는 없었다. 술후 10명(14.3%)에서 3도이상의 잔존 좌측방실판막부전을 보였다. 5년 및 10년 장기 생존율은 79.4% 였고, 4명의 환자에서 5례의 재수술을 시행했으며 5년 및 10년 장기 재수술 회피율은 91.4%였다. 수술후 사망에 관여하는 위험인자 분석을 시행하여 술후 잔존좌측방식판막부전이 3도 이상인 겨우 오즈비가 38.5 (p<0.001)로 통계적으로 유의한 위험 인자로 나타났다. 또한 술후 잔존좌측방실판막부전의 발생에 관여하여 위험인자 분석을 시행하여 술후 좌측방실판막의 교련을 교정한 경우 오즈비가 6.72(p=0.02)로 통계적으로 유의한 위험인자로 나타났다. 결론: 1세이하 환아를 포함한 완전방실중격결손증의 수술은 낮은 수술사망율과 재수술율 그리고 양호한 장기성적으로 보였다. 또한 이에는 3도 이상의 잔존 좌측방실판막부전의 발생이 술후 사망에 중요한 위험인자로 기여하여 수술적 교정후 잔존 좌측방실판막부전의 정도를 줄이고 좌측방실판막의 양호환 교합을 유지하기 위해서는 완전방실중격결손증의 방실판막의 다양한 해부학적 형태로 따른 개별적인 접근법이 유효하다고 생각한다.고 생각한다.

• Proceedings of the Korean Society of Fisheries Technology Conference
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• 2002.05a
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• pp.543-544
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• 2002

• Radiation Oncology Journal
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• v.18 no.4
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• pp.244-250
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• 2000

Purpose : To see the relationship between the response to chemotherapy and the final outcome of neoadiuvant chemotherapy and radiotherapy in patients with mocanry advanced hypopharyngeal cancer. Methods and Materials :A retrospective analysis was done for thirty-two patients with locally advanced hypopharyngeal cancer treated in the Seoul National University Hospital with neoadiuvant chemotherapy and radiotherapy from August 1979 to July 1997. The patients were treated with Co-60 teletherapy unit or 4MV or 6MV photon beam produced by linear accelerator. Daily fractionation was 1.75 to 2 Gy, delivered five times a week. Total dose ranged from 60.8 Gy to 73.8 Gy. Twenty-nine patients received continuous infusion of cisplatin and 5-FU. Other patients were treated with cisplatin combined with bleomycin or vinblastin. Twenty-four (75$\%$) patients received all three prescribed cycles of chemotherapy delivered three weeks apart. Six patients received two cycles, and two patients received only one cycle. Results :The overall 2-year and 5-year survival rates are 65.6$\%$ and 43.0$\%$, respectively. 5-year local control rate is 34$\%$. Organ preservation for more than five years is achieved in 12 patients (38$\%$). After neoadjuvant chemotherapy, 24 patients achieved more than partial remission (PR): the response rate was 75$\%$ (24/32). Five patients had complete remission (CR), 19 patients PR, and 8 patients no response (NR). Among the 19 patients who had PR to chemotherapy, 8 patients achieved CR after radiotherapy. Among the 8 non-responders to chemotherapy, 2 patients achieved CR, and 6 patients achieved PR after radiotherapy. There was no non-responder after radiotherapy. The overall survival rates were 60$\%$ for CR to chemotherapy group, 35.1$\%$ for PR to chemotherapy group, and 50$\%$ for NR to chemotherapy group, respectively (p=0.93). There were significant difference in five-year overall survival rates between the patients with CR and PR after neoadjuvant chemotherapy and radiotherapy (73.3$\%$ vs. 14.7$\%$, p<0.01). The prognostic factor affecting overall survival was the response to overall treatment (CR vs. PR, p<0.01). Conclusion :In this study, there were only five patients who achieved CR after neoadiuvant chemotherapy. Therefore the difference of overall survival rates between CR and PR to chemotherapy group was not statistically significant. Only the response to chemo-radiotherapy was the most important prognostic factor. There needs to be more effort to improve CR rate of neoadjuvant chemotherapy and consideration for future use of concurrent chemoradiotherapy.

• Radiation Oncology Journal
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• v.17 no.4
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• pp.281-286
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• 1999

Purpose : Brain metastases are the most frequent metastatic neurologic complication of systemic cancer. Even if the prognosis of brain metastases is grave, with available treatments, most patients experience effective palliation of neurologic symptoms and meaningful extension of life. We evaluated the clinical features and prognostic factors of the patients who were diagnosed as solid tumors with brain metastasis and received radiotherapy for brain metastases. Materials and Methods: Between January 1987 and January 1998, 71 patients with brain metastases from solid malignancy were included. We reviewed neurologic symptoms and signs of patients and evaluated improvememt of neurologic symptoms and signs. Survival durations after brain metastasis were ana lysed according to several factors such as age, performance status, primary malignancies, the pre-sence of brain metastasis at initial diagnosis of primary tumor, multiplicity of brain metastass, the presence of metastases other than brain, and treatment method. Results: Frequent symptoms associated with brain metastasis were headache (47.9$\%$), motor weakness (40.8$\%$), nausea and vomiting (19.7$\%$) and mental change (19.7%). Palliation of these symptoms was accomplished in 64.9$\%$ of cases. The overall median survival time was 16 weeks and 1- and 2-year survival rates were 15.0$\%$ and 5.1$\%$ respectively. Patients without extracranial metastases (n=27) had longer median survival than patients with extracranial metastases (33 weeks vs 10 weeks, p=0.0018). In patients with single brain metastasis (n=37), the median survival time was longer in patients treated with surgery plus radiotherapy than in patients treated with radiotherapy alone (40 weeks vs 16 weeks, p=0.0438). Conclusion: Patients who has brain metastases only constitute a prognostically favorable group and they may be benefited from radiotherapy and surgery if indicated.

• Journal of Periodontal and Implant Science
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• v.35 no.4
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• pp.1039-1052
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• 2005

IMZ는 "intramobile cylinder implant system" (IMZ)로 독일에서 가장 오래되고 많이 사용되어진 임플란트 중 하나이다. 이 임플란트에 관한 장기적 성공률과 생존률에 대한 연구는 대개 80% 이상을 보고하고 있다. 그러나, 연세대학교 치과병원 치주과에서 식립된 83개의 임플란트에서는 이전의 연구와는 다른 결과를 나타내었다. 1. IMZ 임플란트의 생존률은 67.5% 였다. 2. 변연 치조골 소실에 대한 성공 기준을 적용한 결과 성공률은 49.4%로 나타났다. 3. 발거된 총 27개의 임플란트 중에서 임플란트 주위 골소실을 가지는 경우는 17개, 내부구조 파절은 4개, 식립체 파절은 5개로 보고되었다. 4. 10년 이상 생존된 임플란트에서 변연골 소실의 평균치는 2.82mm였다. IMZ 임플란트는 장기적으로 높은 실패율을 보고하였다. 이는 cylindrical design, titanium plasma flame spray coating, prosthodontic complication 등의 요소에 기인한 것으로 사료된다. 임플란트는 그 형태, 표면 처리 등 여러 가지 요인들에 의해 실패가 나타날 수 있으며 본 연구를 통해 임플란트의 개발 및 선택에 바탕이 될 수 있을 것으로 생각된다.