• Radiation Oncology Journal
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• 제18권4호
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• pp.265-276
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• 2000

목적 : 1983년부터 1988년 사이에 유방암으로 진단받고 근치적 유방절제술을 시행한 환자로써 조직학적으로 액와림프절 전이가 확인된 218명의 환자에서 수술 후 보조적 방사선치료 및 항암약물치료를 시행하였으며 이들 환자를 대상으로 한 치료 결과를 후향적 연구를 통해 분석하고자 하였다. 대상 및 방법 : 대상환자는 3개 군으로 분류하였는데, 1군은 항암약물치료 단독으로 치료한 80명의 환자가 포함되었고 2군은 방사선치료 단독으로 치료한 52명을 포함하였으며 3군은 방사선치료 및 항암약물치료를 병용하여 치료한 86명의 환자를 포함하였다. 이들의 평균 연령은 44세, 27$\~$70세의 연령분포를 보였으며 추적관찰 기간의 중앙값은 51개월이었다. 결과 : 7년 무병생존율 및 전체생존율은 각각 56$\%$와 67$\%$이었으며, 각 치료군에 따른 생존율은 1군에서는 50$\%$와 56$\%$, 2군은 51$\%$와 65$\%$, 3군은 62$\%$와 75$\%$이었다. 국소재발율은 13$\%$이었으며 원격전이율은 33$\%$ 이었다. 방사선치료가 포함되었던 2군과 3군에서는 국소재발 위험이 낮았으나(p<0.05) 원격전이율의 차이는 없었다. 단변량분석에서 무병 생존율에 영향을 주는 인자로서는 액와 림프절 양성 비율이었으며 전체생존율에 있어서는 원발 병소 크기, 액와 림프절 전이 개수 및 양성 비율, 병기가 관련있는 인자임을 알 수 있었다. 그러나 다변량분석에서는 치료방법만이 의미있는 예후인자임을 알 수 있었다. 전체 치료실패율과 원격전이율에 영향을 주는 예후인자는 액와 림프절 양성 비율이었으며 국소재발율은 치료방법이 의미있는 예후인자임을 알 수 있었다. 결론 : 결론적으로 이러한 결과는 폐경전 환자, 액와 림프절 전이 개수가 4개 이상이거나 양성 비율이 1/3이상인 환자에서 수술 후 방사선치료가 시행된 경우 국소재발율을 감소시킨다는 사실을 보여주고 있다. 또한 종양의 크기가 2$\~$5 cm, IIB 병기 및 액와 림프절 전이 개수가 4개 이상이거나 양성 비율이 1/3이상인 환자에서 수술후 보조적 치료로써 방사선치료/항암약물치료 병용요법이 가장 효과적인 치료방법임을 알 수 있었다.

• Journal of Trauma and Injury
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• 제19권1호
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• pp.21-27
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• 2006

Purpose: The liver is one of the most commonly injured organs by blunt or penetrating abdominal trauma. Patients with liver injury can be treated by using nonoperative or operative management. The aim of this study was to study patients with traumatic liver injury who were treated by using operative management. Methods: Ninety-eight patients with traumatic liver injury underwent surgical treatment from January 1995 to December 2004 at Soonchunhyang University Cheonan hospital. Medical records were reviewed retrospectively, and demographic, clinical, operative, and postoperative datas were collected and analyzed. Results: Among the patients with operative management, the peak incidence was in the third and the fourth decades. The male-to-female ratio was 1.9:1. The most frequent injury mechanism was blunt trauma (85.7%). Abdominal computed tomography was the diagnostic modality used most frequently. Severe liver injury above Grade III was seen in 80.6% of all patients, and long bone fracture was the most common combined injury. Patients were managed by using various techniques, including simple closure, liver resection, and perihepatic packing. Pulmonary complications were the most common postoperative complications (35.7%). the overall mortality rate was 17.3%. Between the survival group and the expired group, the amount of transfusion for the expired group was statistically more than that for the survival group. Conclusion: Operative management is an effective treatment modality for hemodynamically unstable patients with severe traumatic liver injury. The amount of transfusion is a significant prognostic factor for survival.

• Tuberculosis and Respiratory Diseases
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• 제42권4호
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• pp.502-512
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• 1995

연구배경: 최근까지 국소 진행된 비소세포 폐암의 치료율을 높이려는 여러 노력들이 있어왔지만 향상은 보이지 않는 설정에서 최근의 유도 화학요법 및 다각적 병합요법의 치료결과와 본 병원의 예를 봄으로 반응률 및 치료 성적을 비교하고 생존에 영향을 미치는 제반 요소들과의 상호 관계에 대해 조사하여 보고하는 바이다. 방법: stage III로 진단된 비소세포 폐암환자 총 67 명을 각각의 치료별로 분류하여 화학치료만 받은 군은 A 군이라 칭하였고, 화학 치료및 방사선 치료를 받은 군은 B군, 수술과 화학 치료를 받은 군은 C군, 비 치료군으로는 D군으로 명하여 이들 군간의 반응률 및 치료 성적을 상호 비교하였고 생존에 영향을 미칠 여러 제반요소들과의 상관관계를 알아 보았다. 결과: 1) 화학 치료만 받은 군은 27 명, 화학 치료 및 방사선 치료를 같이 받은 군은 18 명, 수술 및 화학 치료를 받은 군은 15 명, 비 치료군은 7 명으로 각 군간의 나이, 운동능력, 혈액형, 조직학적, 성별, 흡연력의 분포에 있어서 차이가 없었다(p>0.05). 2) 화학 치료만 받은 군과 방사선 치료도 병합하여 받은 군의 총 반응률은 47%으로 A군의 경우가 10%, B군이 11%를 차지하였으며 이들 간에 의미있는 반응율의 차이는 없었다(p=0.97). 3) 나이, 성별, 운동능력, 혈액형, 조직학적 차이, 흡연력의 치아가 반응률에 영향을 미치지는 않았다(p>0.05). 4) 치료별 A, B, C, D 각 군에 따론 생존 기간은 8.6개월, 13.4개월, 19.2개월, 5.4 개월로 의미있는 차이를 보였다(p=0.003). 비치료군보다는 치료군이, 화학 치료로 단독 치료만 받은 군보다는 병합 치료를 받은 군이 오랜 생존 기간을 보였다. 5) 치료시 생존기간에 영향을 미칠 요소라는 운동능력과 진단 당시 임상병기로 나타났으나 그 외 나이, 성별, 혈액형, 조직학적 분류, 흡연력이 의미있는 차이를 가져오지는 않았다. 결론: 국소 진행된 비소세포 폐암환자에서 복합 화학요법을 포함하여 수술 및 방사선 치료와의 병행은 화학요법 단독으로 치료한 군이든지 혹을 비치료군에 비해 월등하게 생존 기간의 향상을 가져옴으로 좋은 적응증을 가진 환자들을 선택하여 효과적인 화학 치료 및 다른 치료법을 병행하여야 할 것으로 사료된다. 하지만 이러한 여러 치료법들이 표준 치료로 정립되기 위해서는 보다 충분한 증례에서 추후연구가 필요하리라 여겨지는 바이다.

• 대한족부족관절학회지
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• 제23권3호
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• pp.105-109
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• 2019

Purpose: To compare the efficacy between cast immobilization and functional treatment using an ankle brace as a treatment for acute lateral ankle sprain. Materials and Methods: This study reviewed the medical records of 157 acute ankle sprain patients who were treated between 2009 and 2014. A total of 101 cases were included in this study except for cases with a combined injury, and could not be followed up for eight weeks after the first visit. The patients were divided according to the treatment modality: a cast immobilization group (64 cases) and functional treatment group (37 cases). The clinical outcomes were assessed retrospectively based on the medical records of each group. The residual symptoms, such as pain, swelling, and instability, at three weeks after the primary treatment and at the last visit were compared. Results: The residual pain and instability were significantly common in the functional treatment group at three weeks. Five cases (7.8%) of pain and one case (1.6%) of instability were in the cast group whereas nine cases (24.3%) of pain and six cases (16.2%) of instability in functional treatment group (p=0.021, p=0.014). On the other hand, there was no meaningful difference at the last follow-up. Residual pain, swelling, and instability at the last visit were noted in three (4.7%), six (9.4%), and four cases (6.3%) in the cast group, and three (8.1%), three (8.1%), and three (8.1%) were observed in the functional treatment group. Six patients refused cast immobilization. Conclusion: Although there was no significant difference at the last follow-up, cast immobilization appears to be more effective than a functional brace in terms of early pain relief and early restoration of ankle stability as a treatment for acute ankle lateral sprain in this study.

• Radiation Oncology Journal
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• 제13권1호
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• pp.27-31
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• 1995

Purpose : This study was done to evaluate preliminarily the role of intraluminal brachytherapy in the radiation treatment of non-metastatic esophageal cancer, Materials and Methods: We analyzed follow-up result of 21 patients treated at the dept. of therapeutic radiology in Gyeongsang national university hospital between April, 1989 and August, 1992. All patients received neoadjuvant chemotherapy(5-FU, Cispl-atin). Fifteen Patients were treated with external beam alone, and in remaining 6 patients, the external beam radiotherapy followed by intraluminal brachytherapy was done. Results : Among 21 patients, 7 patients showed complete tumor regression after completion of radiotherapy. But 2 of these complete responder recurred at the site of primary disease, so ultimate local control rate was $23.8\%$(5/21). Local control rate according to radiation treatment modality was $6.7\%$(1/15) in patients treaed with external irradiation only, and $66.7\%$ in patients treated with combined external irradiation and intraluminal brachytherapy. The 2 year NED survival rate was $6.6.\%$ in the former and $66.7\%$ in the latter. Conclusion: Although there should be consideration about case selection for addition of intraluminal brachytherapy intraluminal brachytherapy may be considerded as one of the method to enhance the local control probability of esophageal cancer.

• 대한장애인치과학회지
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• 제3권1호
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• pp.11-16
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• 2007

The use of general anesthesia as a special method of behavior management is necessary if certain handicapped or disabled child patient to receive dental treatment. This study was designed to report the results of 53 cases of complete oral rehabilitation under general anesthesia. The data were obtained from patients who were provided with dental treatment under general anesthesia for last 3years managed at the Dept. of pediatric dentistry in PNU Hospital. The distribution of age, gender, primary reason for general anesthesia, duration of dental procedure, number of treated tooth and periodic recall check-up were surveyed. In distribution of age, most(78%) were younger than 10 years and mean was 13.0 years. The reasons for providing general anesthesia were lack of cooperation due to various mental and physical handicapped situation(74%), congenital heart disease(13%), combined with medically compromised and behavior problem and others. The average duration of the treatments was 2 hours and 41 minutes and average duration of the anesthesia was 3 hours and 6minutes. The mean number of treated with restoration a children were 16.7 teeth. From the results, total dental rehabilitation under general anesthesia is a favorable modality to improve for disabled children's oral condition.

• Archives of Reconstructive Microsurgery
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• 제14권1호
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• pp.37-41
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• 2005

Purpose: The purpose of this study was to evaluate the effectiveness of internal transport using Ilizarov apparatus with free flap surgery for infected tibial nonunion. Materials and Methods: We reviewed 8 patients of infected tibial nonunion treated with internal transport using Ilizarov apparatus and free flap surgery. Seven of eight patients were available for at least 1 year follow-up. All patients were male. The mean age at the time of the surgery was All fractures were Gustilo's type III B open fracture. The mean length of the bone defect was 8.5 cm. All used flaps for covering the soft tissue defect were free rectus abdominis muscle flap. We evaluated bone and functional results with use of the Paley and Catagni's classification. And we classified the complication with use of the Paley's classification. Results: Acceptable length and solid union of bone was achieved in all cases. The mean size of the bone length was 7.2 cm. The mean healing index was 69.5 days/cm. All but one case needed bone graft at docking site. All flaps were survived. There was no recurrence of infection. According to Paley and Catagni's classification, all cases showed excellent or good results. Complications were pin tract infection in 3 cases, persistent pain in 2 cases and limitation of joint motion in 2 cases. Conclusion: Simultaneous free-tissue transfer and Ilizarov distraction osteogenesis was thought to be an attractive treatment modality for infected nonunion of the tibia.

• Radiation Oncology Journal
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• 제29권4호
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• pp.252-259
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• 2011

Purpose: To evaluate retrospectively the survival outcome, patterns of failure, and complications in patients treated with postoperative chemoradiotherapy (CRT) in advanced gastric cancer. Materials and Methods: Between January 2000 and December 2006, 80 patients with advanced gastric cancer who received postoperative concurrent CRT were included. Pathological staging was IB-II in 9%, IIIA in 38%, IIIB in 33%, and IV in 21%. Radiotherapy consisted of 45 Gy of radiation. Concurrent chemotherapy consisted of a continuous intravenous infusion of 5-fluorouracil and leucovorin on the first 4 days and last 3 days of radiotherapy. Results: The median follow-up period was 48 months (range, 3 to 83 months). The 5-year overall survival, disease-free survival, and locoregional recurrence-free survivals were 62%, 59%, and 80%, respectively. In the multivariate analysis, significant factors for disease-free survival were T stage (hazard ratio [HR], 0.278; P = 0.038), lymph node dissection extent (HR, 0.201; P = 0.002). and maintenance oral chemotherapy (HR, 2.964; P = 0.004). Locoregional recurrence and distant metastasis occurred in 5 (6%) and 18 (23%) patients, respectively. Mixed failure occurred in 10 (16%) patients. Grade 3 leukopenia and thrombocytopenia were observed in 4 (5%) and one (1%) patient, respectively. Grade 3 nausea and vomiting developed in 8 (10%) patients. Intestinal obstruction developed in one (1%). Conclusion: The survival outcome of the postoperative CRT in advanced gastric cancer was similar to those reported previously. Our postoperative CRT regimen seems to be a safe and effective method, reducing locoregional failure without severe treatment toxicity in advanced gastric cancer patients.

• Radiation Oncology Journal
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• 제12권1호
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• pp.99-107
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• 1994

Among the 63 patients with histopathologically proven primary squamous cell anal cancer who were managed in Presbyterian Medical Center and Yonsei University Cancer from Jan. 1971 to Dec. 1991, 34 patients, who were managed with surgery alone(abdominoperineal resection) or post-operative radiotherapy and concurrent chemoradiotherapy were analysed. With mean follow up time of 81.3 months, 30 Patients(88$ \% $) were followed up from 17 to 243 months. In methods, 10 patients were treated with surgery alone. 9 Patients were treated with combined surgery and postoperative radiotherapy(50$\∼$60 Gy in 28$\∼$30 fractions). 15 patients were treated with concurrent chemoradiotherapy. Chemotherapy (Mitomycin C 15 mg/squ, bolus injection day 1;5-FU, 750 mg/squ, 24hr infusion, day 1 to 5) and radiotherapy started the same day. A dose of 30 Gy was given to the tumor and to the pelvis including inguinal nodes, in 15 fractions. After 2 weeks a boost of radiotherapy(20 Gy) to the ano-perineal area and second cycle of chemotherapy completed the treatment. The overall 5-year survival rate was 56.2$ \% $. Concurrent chemoradiotherapy group was 70$ \% $ and surgery alone group was 16.7$ \% $. According to the cox proportional harzard model, there was significant difference between survival with concurrent chemoradiotherapy and surgery alone(p=0.0129), but post-operative radiotherapy was 64.8$ \% $, which was not stastically significant(p=0.1412). In concurrent chemoradiotherapy group, the anal funtion Preservation rate was 87$ \% $ and the severe complication rate(grade 3 stenosis and incontinence) was 13.3$ \% $. In conclusion, we conclude that the concurrent chemoradiotherapy may be effective treatment modality in patients with anal cancer.

• Journal of Chest Surgery
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• 제37권8호
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• pp.702-706
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• 2004

폐동정맥루는 선천적 혹은 후천적인 원인에 의해 발병할 수 있으며 단락이 존재하는 경우 호흡곤란, 청색증, 폐혈관 잡음 등의 증상이 나타날 수 있다. 진단 방법은 혈액검사, 흉부단순촬영, 흉부전산화 단층촬영, 폐동맥조영술 등이 있으며 그 중 가장 정확한 진단 방법으로는 폐동맥조영술이 있다. 폐동정맥루의 합병증으로는 파열로 인한 혈흉, 뇌농양, 뇌졸중 등이 있으며 이에 대한 치료법으로는 수술적 절제술과 치료적 색전술을 시행할 수 있다. 26세 여자 환자가 내원 30분 전 갑자기 발생된 호흡곤란을 주소로 내원하였다. 흉부전산화단층촬영과 폐동맥조영술상 우하엽 상분절에서 4${\times}$4${\times}$3 cm의 폐동정맥루가 진단되어 우하엽 절제술을 계획한 후 응급수술을 시행하였다. 저자들은 우하엽 상분절에 발병한 혈흉을 동반한 선천성 폐동정맥루를 치험하였기에 문헌고찰과 함께 증례보고하는 바이다.