• Archives of Reconstructive Microsurgery
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• 제19권1호
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• pp.12-20
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• 2010

Purpose: Industrial punch accidents involving fingers cause segmental injuries to tendons and neurovascular bundles. Although multiple-level segmental amputations are not replanted to regain function, most patients with an amputated finger want to undergo replantation for cosmetic as much as functional reason. The authors describe four cases of digital amputation by an industrial punch that involved the reinstatement of the amputated finger involving a joint and neurovascular bundle. Amputated segments were replanted to restore amputated surfaces and distal segments. Methods: A single institution retrospective review was performed. Inclusion criteria of punch injuries requiring replantation were applied to patients of all demographic background. Injury extent (size, tissue involvement), operative intervention, pre- and postoperative hand function were recorded. Result: Four cases of amputations were treated at our institute from 2004 to 2008 from industrial punch machine injury. Average patient age was 32.5 years (25~39 years) and there were three males and one female. Sizes of amputated segments ranged from $1.0{\times}1.0{\times}1.2\;cm^3$ to $3{\times}1.5{\times}1.6\;cm^3$. Tenorrhaphy was conducted after fixing fractured bone of the amputated segments with K-wire. Proximal and distal arteries and veins were repaired using the through & through method. The average follow-up period was thirteen months (2~26 months), and all replanted cases survived. Osteomyelitis occurred in one case, skin grafting after debridement was performed in two cases. Because joints were damaged in all four cases, active ranges of motion were much limited. However, a secondary tendon graft enhanced digit function in two cases. The two-point discrimination test showed normal values for both static and dynamic tests for three cases and 9 mm and 15 mm by dynamic and static testing, respectively, in one case. Conclusion: Though amputations from industrial punch machines are technically challenging to replant, our experience has shown it to be a valid therapy. In cases involving punch machine injury, if an amputated segment is available, the authors recommend that replantation be considered for preservation of finger length, joint mobility, and overall functional recovery of the hand.

• Journal of Gastric Cancer
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• 제10권4호
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• pp.254-258
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• 2010

Gastric lipomatosis is an extremely rare condition. We present a case of a 69-year-old woman admitted with epigastric soreness. Computerized tomography (CT) revealed extrinsically compressing, fat-containing mass lesions on the entire gastric wall of the antrum and body except for the lesser curvature. A subtotal gastrectomy was performed. Pathology findings confirmed a gastric lipomatosis with multiple gastric ulcerations and extensive disruptions of the muscular layers. This case and reports of other gastric lipomatosis cases indicate that CT should be used to characterize large submucosal masses because CT can show the specific nature and extent of the disease. We believe that surgical treatment is the most appropriate treatment for symptomatic gastric lipomatosis that shows extensive gastric involvement, or when there are multiple gastric lipomas.

• 대한종양외과학회지
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• 제14권2호
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• pp.142-145
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• 2018

Metastases to the liver can be found in various malignancies, most commonly originating from the colon, rectum, pancreas, stomach, esophagus, breast, lung, and melanoma. Surgical resection of liver metastasis is generally considered to be the definitive therapy fore cure. However, many patients are unable to undergo surgical resection due to medical comorbidities or multifocal extent of malignant disease affecting the liver. Among patients not eligible for surgery, other therapies exist for treatment in order to down stage the disease for surgical resection or for palliation. Radioembolization of hepatic metastases has shown to improve outcomes among patients with variety of malignancies including more common malignancies such as colorectal cancer. Yttrium-90 (Y-90) radioembolization has been successfully used in the management of hepatic metastases. A small series of metastatic sarcoma to the liver treated with radioembolization showed a promising response. We report a case of metastatic gastric leiomyosarcoma to the liver treated with Y-90 glass microspheres therapy using the radiation segmentectomy approach, previously described for hepatocellular carcinoma.

• Journal of Korean Neurosurgical Society
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• 제59권1호
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• pp.26-36
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• 2016

Objective : This study investigated whether pyrosequencing can be used to determine the methylation status of the MGMT promoter as a clinical biomarker using relatively old archival tissue samples of glioblastoma. We also examined other prognostic factors for survival of glioblastoma patients. Methods : The available study set included formalin-fixed paraffin-embedded (FFPE) tissue from 104 patients at two institutes from 1997 to 2012, all of which were diagnosed histopathologically as glioblastoma. Clinicopathologic data were collected by review of medical records. For pyrosequencing analysis, the PyroMark Q96 CpG MGMT kit (Qiagen, Hilden, Germany) was used to detect the level of methylation at exon 1 positions 17-39 of the MGMT gene, which contains 5 CpGs. Results : Methylation of the MGMT promoter was detected in 43 (41.3%) of 104 samples. The average percentage methylation was $14.0{\pm}16.8%$ overall and $39.0{\pm}14.7%$ for methylated cases. There was no significant pattern of linear increase or decrease according to the age of the FFPE block (p=0.687). In multivariate analysis, age, performance status, extent of surgery, method of adjuvant therapy, and methylation status estimated by pyrosequencing were independently associated with overall survival. Additionally, patients with a high level of methylation survived longer than those with low methylation (p=0.016). Conclusion : In this study, the status and extent of methylation of the MGMT promoter analyzed by pyrosequencing were associated with overall survival in glioblastoma patients. Pyrosequencing is a quantitative method that overcomes the problems of MSP and a simple technique for accurate analysis of DNA sequences.

• Journal of Korean Neurosurgical Society
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• 제42권4호
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• pp.276-280
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• 2007

Objective : The purpose of this study was to review the characteristics of falcine meningioma retrospectively and to identify the parameters associated with tumor recurrence. Methods : The analysis included; age, sex, extent of resection, and radiologic and pathologic findings. Falcine meningiomas were classified by location as anterior, middle, or posterior as described for parasagittal meningiomas. Results : Of the 795 meningioma patients treated between 1990 and 2004 at the authors' institution, 68 patients with meningiomas arising from the falx underwent craniotomies. There were 22 male and 46 female patients (1:2.1). Mean age was 55 years and ranged from 14 to 77 years. Locations of falcine meningioma were; the anterior third in 33 cases, middle in 20, and posterior in 15. Mean tumor volume was 42 cc and ranged from 4 to 140 cc. In 58 of the 68 patients tumors were totally removed. Additional surgery for recurrence was performed in 6 patients over 15 years. Of these 6 patients, only two patients underwent gross total tumor resection at first operation; the other four underwent subtotal tumor resection. Based on pathologic reports, the largest tumor subtype was transitional. There were four patients with a high grade tumor-three atypical and one anaplastic meningioma. Of the 68 patients, 59 achieved a good outcome (no neurological deficit or recurrence), six had temporary complications, two suffered new permanent postoperative deficits, and the remaining one died due to severe brain swelling despite postoperative intensive care. Extent of surgical resection was found to be significantly related to tumor recurrence. Conclusion : Falcine meningioma accounted for 8.5% of intracranial meningiomas and the transitional meningioma was the most common subtype of falcine meningioma. Gross total resection of tumor was the single most important predictor of an improved surgical outcome.

• Nuclear Medicine and Molecular Imaging
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• 제42권sup1호
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• pp.39-45
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• 2008

PET or PET/CT detects only less than 50% of early gastric cancer and 62-98% of advanced gastric cancer. Therefore, mass screening programs are recommended for all adults over the age of 40 for early detection and early treatment of gastric cancer through endoscopy or various radiological tests. The most important step after diagnosis of gastric cancer is accurate staging, which mainly evaluates tumor resectability to avoid unnecessary surgery. Important factors that affect tumor resectability are whether the tumor can be separated from adjacent organs or important blood vessels, the extent of lymph node metastasis, presence of peritoneal metastasis, or distant organ metastasis. To evaluate the extent of local tumor invasion, anatomical imaging that has superior spatial resolution is essential. There are a few studies on prognostic significance of FDG uptake with inconsistent results between them. In spite of lower sensitivity for lymph node staging, the specificity of CT and PET are very high, and the specificity for PET tends to be higher than that for CT. Limited data published so far show that PET seems less useful in the detection of lung and bone metastasis. In the evaluation of pleural or peritoneal metastasis, PET seems very specific but insensitive as well. When FOG uptake of primary tumor is low, distant metastasis also tends to show low FDG uptake reducing its detection on PET. There are only a few data available in the evaluation of recurrence detection and treatment response using FDG PET or PET/CT.

• 대한수의학회지
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• 제50권2호
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• pp.155-160
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• 2010

The objective of this study was to compare wound healing in stomach with $CO_{2}$ laser and scalpel incision by measuring the extent of bleeding, the ease of gastric incision, incision time, degree of adhesion and wound healing degree in dogs. Sixteen healthy dogs were used. Two symmetrical incisions were made in ventral aspect of the stomach between the greater and lesser curvatures were made with scalpel and 0.2 mm spot diameter $CO_{2}$ laser (8W, continuous wave) in sixteen dogs. And then each wound was closed with absorbable suture in a two-layer inverting seromuscular pattern. At 3, 7, 14 and 21 days after initial wounding, each wound was taken for histological observation. On surgery, the extent of bleeding, the ease of incision and incision time showed significant differences between the groups. The $CO_{2}$ laser provided better hemostasis (p < 0.05) and smaller postoperative adhesion compared with the scalpel. However, the scalpel produced faster speed of incision and was easier to handle than the $CO_{2}$ laser (p < 0.05). Although there was no considerable difference between the two groups in histological observation, necrosis and calcium deposit tended to be larger in the $CO_{2}$ laser than in the scalpel.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제23권2호
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• pp.137-145
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• 2020

Purpose: The Oral-anal Transit Test (OTT) is a simple method of obtaining information about colonic transit. We aim to assess the correlation of OTT with the neuromuscular integrity of the colon determined by colonic manometry (CM). Methods: All patients who had OTT followed by CM were evaluated. Less than 6 of 24 markers remaining on OTT was considered normal. CM was performed per previously published guidelines. A normal CM was defined as at least one High Amplitude Propagating Contraction progressing from the most proximal sensor through the sigmoid colon. Results: A total of 34 patients underwent both OTT and CM (44% male, age 4-18 years, mean 11.5 years, 97% functional constipation +/- soiling, Hirschsprung's Disease). Of normal and abnormal OTT patients, 85.7% (6/7) and 18.5% (5/27) respectively had normal CM. When all markers progressed to at least the sigmoid colon, this was 100% predictive against colonic inertia. Greater than 50% of patients with manometric isolated sigmoid dysfunction had markers proximal to the recto-sigmoid. Conclusion: OTT and CM are both valuable studies that assess different aspects of colonic function. OTT can be used as a screening test to rule out colonic inertia. However, the most proximal extent of remaining markers does not predict the anatomical extent of the manometric abnormality, particularly in isolated sigmoid dysfunction.

• Journal of Chest Surgery
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• 제37권1호
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• pp.64-71
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• 2004

배경: 비디오흉강경에 의한 교감신경차단술은 본태성 다한증환자에서 수술 즉시 증세의 호전을 보이는 안전하고 효과적인 방법이다. 하지만 이것은 곤혹스러운 보상성발한과 같은 높은 빈도의 부작용 발생으로 상쇄된다. 그래서 본태성다한증에서 교감신경차단술의 차단범위와 부위에 따른 임상결과와 컴퓨터 적외선 체열 영상에 의해 측정한 온도 사이의 관계를 비교하고 평가하였다. 컴퓨터 적외선 체열 영상에 의해서 보상성발한의 정도와 분포를 더 객관적으로 그리고 정확하게 예기할 수 있는가, 또한 임상적 유용성을 확인하기 위해서 시행하였다. 대상 및 방법: 2000년 1월부터 2002년 6월까지 원광대병원 흉부외과학교실에서 다한증을 갖고 있는 28명의 환자에서 흉강경에 의한 흉부 교감신경차단술을 시행하였다. 환자는 각각 7명 인 4군으로 분리하였는데 I군은 제2번 T2 교감신경차단술, II군은 T3 교감신경차단술, III군은 T3,4 교감신경차단술 그리고 IV군은 T2,3,4 교감신경차단술을 시행하였다. 변수는 치료의 만족도, 보상성발한의 빈도, 족부 발한의 정도 그리고 DITI에 의해 측정한 전신의 체열 변화로 구성하였다. 결과: 나이와 추적기간에는 차이가 없었다. 모든 치료한 환자에서 수술 즉시는 만족할 만한 완화를 얻었다. 하지만 만기 시의 만족도는 I, II, III, IV군에서 각각 85.8%, 85.8%, 42.9%, 그리고 28.6%를 보였다. 곤혹스러울 정도 이상의 보상성발한은 I, II, III, IV군에서 각각 14.2%, 14.2%, 57.2%, 그리고 71.4%를 보였다. 족부 발한에서는 다소 호전을 보였으나 각 군 사이에 의미는 없었다. DITI에 의해 측정한 체열의 명백한 상승은 충분한 탈 신경을 암시하고 본태성다한증의 지속적인 완화를 예기할 수 있으며 체간부와 하지의 체열하강은 수술후의 만족도와 보상성발한과 일치하였다. 결론: 보상성발한의 정도와 빈도는 흉부 교감신경차단술의 범위와 부위에 밀접하게 연관된다. 제3번째 늑골상단에서 제2번 교감신경절의 하신경절 간 신경섬유의 차단이 다른 수술방법보다 실질적이고 최소 침습적 치료이다. 또한 DITI에 의해서도 보상성발한의 분포와 정도를 확실하게 그리고 객관적으로 예기할 수 있으며 임상적 유용성을 확인할 수 있었다.

• Radiation Oncology Journal
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• 제10권2호
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• pp.171-180
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• 1992

저분화 성상세포종에 대한 방사선 치료의 역할이나 적정 방사선량, 치료시기등은 논란의 여지가 많다. 후향적 분석결과로 얻은 정보는 방사선량이나 외과적 또는 방사선 치료에 의한 시술시기 등의 관점에서 전향적인 연구계획을 세우는데 도움이 된다. 저자들은 1979년부터 1989년까지 경희대학병원에서 수술로 확진된 저분화 성상세포종 환자중 천막하부를 제외한 총 56(남 : 여 =29:27)명에 대한 치료결과를 후향적으로 분석하였다. 수술절제범위는 38명 ($68\%$)에서 근치수술하였고, 18예 ($32\%$)는 부분절제 또는 조직생검만 시행하였다. 총 56예중 수술후 방사선치료를 받은 환자는 36명 ($64\%$)이었고, 방사선량은 최저 5000 cGy를 국소조사하였다. 총 56예의 5년 및 10년 생존율은 각각 $44\%$와 $32\%$였으며, 중간 생존기간은 4.1년이었다. 조직소견에 따른 5년 및 10년 생존율은 grade I(23명)이 각각 $52\%$와 $35\%$이고, grade II(23명)는 $20\%$와 $10\%$였다. Oligodendroglioma 환자는 성상세포종보다 생존율이 높았으며(5년 생존율=$65\%$ vs $36\%$)장기간 생존율은 각각 $54\%$와 $23\%$로 현저한 차이가 있었다. 다량의 방사선치료를 받은 (<54 Gy)환자는 소량의 방사선 (<54 Gy)이나 수술만 받은 환자보다 5-년 및 10-년 생존율이 높았다(P<0.05). 수술범위에 따른 5년 생존율은 $46\%$와 $41\%$로 비슷하였으나, 10년 생존율은 근치수술한 경우가 $41\%$, 부분절제 또는 조직생검한 경우는 $12\%$로 현저한 차이가 있었다(p<0.01). 과거 여러 저자들의 연구에 의하면 환자나이, 수술범위, 방사선치료유무, 악성도, 증상 발현기간, 수행능력 상태등이 성상세포종의 중요 예후인자라고보고하였으나, 본 저자들의 예에서는 grade I조직소견 (p<0.025)과 환자나이 (p<0.001)가 가장 중요한 예후일자였으며 향후 무작위화한 전향적인 연구가 필요할 것으로 생각된다.