• Journal of Korean Neurosurgical Society
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• 제30권5호
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• pp.586-591
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• 2001

Objective : Transseptal or sublabial transsphenoidal surgery has been standard teatment for pituitary tumors for decades. However, as an alternative to this surgery endonasal endoscopic technique has been reported with encouraging results. We have started endoscopy-assisted transsphednoidal surgery from May 1998. In this paper we analyzed the methods, outcome, advantage and disadvantage of this surgical approach for the purpose of planning optimal treatment of pituitary tumors. Methods : This study consisits of 13 cases of pituitary tumors who were treated by endoscopy-assisted transsphenoidal surgery using one nostril from May 1998 to July 1999. Mean follow up period was 12.9 months. Results : There was no septal or sublabial incision and little surgical damage to nasal structure. With this technique, rapid surgical approach and short hospital day were possible, being 3-6 days in patients without CSF leakage. Using various angled endoscope, good surgical view was obtained. Initially it was difficult to use various instruments in narrow nasal cavity, but became feasible after several procedures. Among 13 cases, total removal was possible in 11 cases. One of two cases in whom tumor was incompletely removed underwent gamma-knife radiosurgery and second underwent reoperation through subfrontal approach. There were 6 cases of hormone secreting tumors and hormonal remission was achived in all of these cases. Postoperative complications were CSF leakage(6 cases), diabetes insipidus(2 cases) and panhypopituitarysm(1 case). Lumbar drainage was done in all cases of CSF leakage. Conclusion : The advantage of endoscopy-assisted transsphenoidal surgery are rapid surgical approach, low postoperative morbidity, short hospital day and good surgical view. The disadvantage of this appoach are difficulty in manupulating various instruments in narrow nostril and difficulty in distance perception but these problems can be overcome by practice and using stereoscopic endoscope.

• Journal of Chest Surgery
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• 제46권2호
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• pp.104-110
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• 2013

Background: We reviewed the long-term outcomes of aortic root replacement at Asan Medical Center and investigated the predictors affecting mortality. Materials and Methods: A retrospective analysis was performed on 225 consecutive adult patients undergoing aortic root replacement with mechanical conduits (n=169), porcine aortic root prosthesis (n=23), or aortic homografts (n=33) from January 1992 to September 2009. The median follow-up duration was 6.1 years (range, 0 to 18.0 years). Results: The porcine root group was older than the other groups (freestyle $55.9{\pm}14.3$ years vs. mechanical $46.3{\pm}14.6$ years, homograft $48.1{\pm}14.7$ years; p=0.02). The mechanical group had the highest incidence of the Marfan syndrome (mechanical 22%, freestyle 4%, homograft 3%; p=0.01). Surgery performed for infective endocarditis was more frequent in the homograft group (mechanical 10%, freestyle 10%, homograft 40%; p<0.001). The overall 30-day mortality was 5.3% (12/225). Actuarial survival rates in the mechanical, porcine root, and homograft groups were 79.4%, 81.5%, and 83.5% at 5 years and 67%, 61.9%, and 61.1% at 10 years, respectively (p=0.73). By multivariate analysis, preoperative diabetes mellitus, older age, and longer cardiopulmonary bypass time were independent predictors of mortality. Incidence of postoperative complications, including infective endocarditis and thromboembolism were comparable in all of the groups. Conclusion: Aortic root replacement can be safely performed with different types of prostheses as the outcome was not affected by the choice of prosthesis. Further studies are required to assess the long-term durability of biological prostheses.

• 한국산학기술학회논문지
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• 제19권8호
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• pp.449-455
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• 2018

본 연구는 뇌졸중, 치매 병력이 없는 50-75세 건강한 성인을 대상으로 뇌 CT를 통해 대뇌 백질 변성과 뇌혈관 위험인자들이 상관성이 있는지 분석하고자 하였다. 2016년과 2017년에 일개 병원에서 건강 검진을 받은 900명 중 722명을 대상으로 연구를 진행하였으며 의무기록을 토대로 후향적으로 조사하였고, SPPS를 이용하여 카이제곱검정, 독립표본 t검정, 단변량 로지스틱 회귀분석을 이용하여 분석하였다. 대뇌 백질 변성이 있는 집단과 없는 집단으로 나누어 연구 대상자 특성을 확인하였는데, 대뇌 백질 변성이 있는 군이 없는 군보다 평균 연령과 고혈압, 당뇨 유병률이 높았고, 교육 기간은 짧았으며, 호모시스테인 농도가 높았다. 대뇌 백질 변성이 있는 군에서는 호모시스테인 농도가 증가함에 따라 백질 변성군 내에서 차지하는 비율도 증가했다. 호모시스테인 농도를 4분위하여 가장 낮은 집단(Q1)을 기준으로 상대적 위험도를 비교하였을 때, 나이[p<0.001], 고혈압[p<0.001], 고호모시스테인혈증(Q4)[p=0.021]이 대뇌 백질 변성의 위험인자임을 확인하였다. 이는 건강한 사람에게서 고혈압, 고호모시스테인혈증과 같은 대뇌 백질 변성의 조절 가능한 위험 인자를 확인했다는데 임상적으로 의의가 있다. 하지만 지금까지 고호모시스테인혈증의 일으키는 원인별 위험성에 대한 보고가 없고, 고호모시스테인혈증과 대뇌 백질 변성에 대해 한국인을 대상으로 한 연구가 알려지지 않아 대규모 전향적 연구가 필요할 것으로 사료된다.

• Journal of Nutrition and Health
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• 제53권1호
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• pp.1-12
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• 2020

본 연구에서는 고혈당으로 인해 유발되는 당뇨병성 신장병증의 대표적인 증상인 사구체 경화증을 완화시키는 nobiletin의 효능에 대해 알아보고자 하였다. 신장 세포인 HRMC를 이용하여 고혈당에서의 세포외 기질 축적 단백질의 발현과 경화에 관여하는 신호 전달 억제 효능을 확인한 결과 nobiletin은 고혈당의 자극에 의해 증가하는 섬유화 단백질인 collagen IV, fibronectin 그리고 CTGF의 발현을 억제하였으며, 여기에 관여하는 TGF-β1-Src-caveolin-1 신호 전달 경로를 통해 사구체 경화증을 억제하는 것을 확인하였다. 따라서 nobiletin은 고혈당으로 유도된 당뇨병성 신장병증에 있어 사구체 경화증을 예방하는 기능성 성분으로서의 활용 가능성을 확인하였다.

• 한국산학기술학회논문지
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• 제10권10호
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• pp.2873-2878
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• 2009

1990년 동독과 서독이 독일로 통일 된 후 우리나라만이 세계에서 유일한 분단국가로 남아있다. 이로 인해 전 세계적인 관심 및 안전에 대한 의구심을 야기하여 국가 이미지 실추 및 관광 수입의 저하 등 여러 분야로 나쁜 영향을 미치고 있는 것이 현 실정이다. 북한은 사회주의체제 국가로서 국방위원장에 의한 독재 체제를 유지하고 있으며 현재 김정일 국방위원장이 정권을 장악하고 있으나 근래 들어 건강에 대한 이상설과 후계자 미결정으로 정치적 불안감이 커져감에 따라 외교 및 남북 관계에 대한 걱정이 증가하고 있다. 따라서 이 같은 상황에서 김정일 위원장에 대한 건강 정보는 대단히 중요한 자료가 된다. 이를 위해 본 논문에서는 한의학의 진단법인 망진 기법을 적용하여 최근 공개된 김정일 국방위원장의 사진에서 안면 분석을 행하여 실제 김정일 국방위원장의 건강에 대한 정보를 추출해 보고자 한다. 그러나 김정일 국방 위원장의 영상의 경우 동일한 환경에서 촬영된 영상이 아니고 여러 가지 분석을 방해하는 요소가 많기 때문에 색상 보정을 통한 분석 방법과 색상 보정 없이 안면 각 부위에 따른 색차의 차이에 대한 비교를 통해 가장 큰 의혹을 받고 있는 당뇨합병증에 대한 분석을 수행하고자 한다.

• The Korean Journal of Physiology and Pharmacology
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• 제4권3호
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• pp.185-195
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• 2000

Vascular diseases are significant complications of diabetes mellitus (DM), and the endothelial cells may play a pivotal role in the development of vascular disease in DM. Endothelin-1 (ET-1) released from endothelium is a potent vasoconstrictor peptide and circulating level of ET-1 is increased in a variety of disease states. The purpose of this study was to determine the changes of responsiveness to ET-1 in DM, and we experimented on the changes in the ET-1-induced contraction, levels of nitrite and lipid peroxidation, and ET-1 immunoreactivity in aorta from streptozotocin-induced DM rats. DM was induced by single injection of streptozotocin (55 mg/kg, i.p.). The immunoreactive ET-1 levels in endothelial layer of thoracic aorta were much higher in DM rats than control rats. Nitrite in tissue homogenate was decreased and plasma nitrite was increased in DM rats. Malondialdehyde (MDA) was significantly increased in DM rats and cGMP was not significantly different between control and DM rats. ET-1 produced concentration- dependent contractile responses that are significantly attenuated in DM rats compared to controls. In the presence of selective $ET_A$ receptor antagonist BQ610, the maximum contraction was decreased and the concentration ratios for BQ610 yielded $pA_2$ values of 7.3 (slope, 0.65) in control rats, whereas BQ610 had no antagonistic effect on ET-1-induced contraction in DM rats. However, pretreatment with BQ788, an $ET_B$ receptor antagonist, maximum response was decreased and the dose-response curves for ET-1 were shifted to the right in both groups and $pA_2$ values were 7.9 and 7.7 (slope, 1.05 in control and DM rats), respectively. IRL 1620 and sarafotoxin S6c, $ET_B$ agonists, induced relaxation in control rats but not in DM rats. These results indicate that endothelial cell dysfunction and enhanced immunoreactivity of ET-1 have been found in DM rat and ET-1-induced contraction was attenuated in DM rat. These attenuated responses might be at least in part caused by the alteration of $ET_A$ receptor properties (e.g. desensitization), and partly related with an alteration in intracellular mechanism for contraction to ET-1.

• Radiation Oncology Journal
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• 제33권1호
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• pp.12-20
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• 2015

Purpose: To evaluate treatment outcomes and determine prognostic factors in patients with esophageal cancer treated with esophagectomy after neoadjuvant chemoradiotherapy (NCRT) Materials and Methods: We retrospectively evaluated 39 patients with esophageal cancer who underwent concurrent chemoradiotherapy followed by esophagectomy between 2002 and 2012. Initial clinical stages of patients were stage IB in 1 patient (2.6%), stage II in 5 patients (12.9%), and stage III in 33 patients (84.6%). Results: The median age of all the patients was 62 years, and the median follow-up period was 17 months. The 3-year overall survival (OS) rate was 33.6% in all the patients. The 3-year locoregional recurrence-free survival (LRFS) rate was 33.7%. In multivariate analysis with covariates of age, the Eastern Cooperative Oncology Group performance status, hypertension, diabetes mellitus, tumor length, clinical response, clinical stage, pathological response, pathological stage, lymphovascular invasion, surgical type, and radiotherapy to surgery interval, only pathological stage was an independent significant prognostic factor affecting both OS and LRFS. The complications in postoperative day 90 were pneumonia in 9 patients, anastomotic site leakage in 3 patients, and anastomotic site stricture in 2 patients. Postoperative 30-day mortality rate was 10.3% (4/39); the cause of death among these 4 patients was respiratory failure in 3 patients and myocardial infarction in one patient. Conclusion: Only pathological stage was an independent prognostic factor for both OS and LRFS in patients with esophageal cancer treated with esophagectomy after NCRT. We could confirm the significant role of NCRT in downstaging the initial tumor bulk and thus resulting in better survival of patients who gained earlier pathological stage after NCRT.

• 생명과학회지
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• 제18권9호
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• pp.1278-1283
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• 2008

본 연구의 목적은 type 1 당뇨 아동에서 12주 유산소운동 트레이닝이 심장 QT 간격과 심혈관 위험 인자들에 어떠한 변화가 있는지를 조사하였다. 연구의 대상자는 9-17세 사이의 type 1 당뇨 아동 11명을 대상으로 하였다. 대상자들은 유산소운동 프로그램을 총 12주간 주 3회 실시하였다. 운동 강도는 3주까지 HRR 45%, 그 이후에는 HRR 55%를 적용하였다. 심장 QT 간격의 평가는 심박수 변이성 파워 스펙트랄 분석을 이용하였으며, 심혈관 위험인자들은 대상자들의 혈액 샘플을 채취하여 검사하였다. 연구결과 유산소운동 트레이닝 후 수축기 혈압(p<0.05)과 확장기 혈압(p<0.05)에서 유의한 감소가 있었다. 또한 심장 QT 간격(p<0.05), TC 농도(p<0.05), 그리고 HDL-C 농도(p<0.05)의 감소를 보였다. 이상의 연구결과와 선행연구를 고려할 때 운동 강도와 빈도가 고려된 장기간 규칙적인 신체활동은 type 1 당뇨 아동의 당뇨 합병증 예방 및 심혈관 건강관리에 효과적이고 중요한 작용을 할 수 있으리라 기대할 수 있다.

• 생명과학회지
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• 제27권6호
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• pp.680-687
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• 2017

미생물을 이용한 천연물 발효 시 유용생리활성 증가가 보고된 바, 천년초(Opuntia humifusa; OH)를 Lactobacillus plantarum 을 이용하여 발효시켰으며(fermented Opuntia humifusa; fOH), fOH 의 비만 억제 효과를 확인하기 위해 45%Kcal 고지방식이(HFD)로 비만을 유도하였다. 이 전의 동물실험에 근거하여 OH 400 mg/kg 농도로 처리하였으며, fOH 는 최고 농도 400 mg/kg을 비롯하여 200, 100 mg/kg으로 처리하였다. 지속적인 HFD 공급으로 HFD 대조군에서는 체중, 복부지방 밀도, 난소주위 축적 지방 및 복부 축적 지방량 등이 증가하였으나, fOH 400, 200 mg/kg 처리군에서는 이들 비만인자들이 모두 유의적으로 감소하였다. fOH 100 mg/kg 처리 된 HFD 마우스는 OH 400 mg/kg 처리 마우스에 비해 의미 있는 억제 효과가 나타나지 않았다. 이는 OH에 비해 L. plantarum 로 발효된 fOH가 HFD공급 마우스에서 항비만 효과를 상승시키는 것으로 보인다. 추가적으로 2형 당뇨병 및 관련 합병증으로 확대하여 비만, 고지질혈증, 간지방증, 신장 기능 등을 이용하여 억제 기작 연구가 진행되면 대사증후군을 위한 새로운 강력한 치료제로서의 제안될 가능성이 있다.

• Archives of Reconstructive Microsurgery
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• 제9권1호
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• pp.1-5
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• 2000

The microsurgical reconstruction is necessary for elderly patients to treat severe trauma and head and neck tumor. The aim of this study is to analyze the risks of microvascular surgery and whether or not happening of more complication in elderly patients who are older than 60 years old and to suggest the solution of the complication. The retrospective study included 41 elderly patients who underwent treatment of 44 microsurgical reconstructions among total 271 cases of microsurgical reconstruction from July, 1988 to December, 1998. Their ages ranged from 61 years to 79 years. There were 26 males and 15 females. The involved sites were 23 head and necks, 13 upper gastrointestinal tracts, 3 lower extremities, 1 chest and 1 sacral region. The causes of microsurgical reconstruction were 36 head and neck tumors, 2 radionecrosis, 2 traumas and 1 melanoma in lower limb. The used flaps were 14 radial forearm flaps, 13 jejunal flaps, 10 latissimus dorsi muscle flaps, 3 rectus abdominis muscle flaps, 2 lateral arm flaps, 1 scapular flap, and 1 iliac osteocutaneous flap. They had medical problems which were 29 tobacco abuse, 14 hypertensions, 13 alcohol abuse, 10 chronic obstructive pulmonary diseases, 7 diabetes mellituses, 3 ischemic heart diseases. All patients have had successful results without specific complications except 3 cases of free flap failure and 3 perioperative death. The causes of 3 flap failures were 2 flap necrosis due to arterial insufficiency and 1 flap loss due to secondary infection. All of these cases were treated with secondary free flap surgery. However 3 patients died perioperatively due to 2 respiratory arrests and 1 sepsis. It was not related to operate microsurgical reconstruction itself, but was correlated with the complication of postoperative care after head and neck surgery. We conclude that plastic surgeons consider the importance of prevention of expected complication as thorough analysis of operative risk factor and appropriate treatment. We had to select the donor and recipient vessel appropriately to perform successful microsurgery in elderly patients and consider vein graft and end-to-side anastomosis to reduce complication if necessary. In addition, we emphasize the importance of pre, peri and postoperative care in head and neck cancer patients to reduce postoperative complication and morbidity.