• Archives of Reconstructive Microsurgery
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• 제11권2호
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• pp.125-134
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• 2002

This study was designed to investigate the process of re- or neo-vascularization in the prefabricated cutaneous flap using a skeletonized arteriovenous pedicle implantation. Fourty-eight flaps were divided into six groups of eight flaps, including control group of the conventional epigastric flap. In experimental groups, skin flap was fabricated by subcutaneous implantation of a distally ligated saphenous arteriovenous pedicle in left abdomen. At 2, 4, 6, 8, and 10 weeks after, prefabricated flap was elevated as an island flap based on implanted pedicle and sutured back in place. Three days after flap repositioning, the area of flap viability was quantified, the pattern of flap vascularization was evaluated with microangiography, and the quantification of vessels was assessed histologically. There were statistically significant differences in flap viability between group 2, 3, 4, and the control (p<0.05), with increased survival area in order. But Group 5 and 6 showed higher flap viability as much as the control did. In the microangiographis study, numerous small meander vessels were newly developed in the vicinity of the implanted pedicle just only 2 weeks after pedicle implantation, but neovascularization around the tip of implanted pedicle, and its anastomosis with native vasculatures was more important for overall flap survival, which was usually developed at least 4 weeks after pedicle implantation. Histologically, vessels are evenly spread over all layers of the flap at 6 weeks after pedicle implantation. The quantification of vessels was correlated well with the improvement of flap viability (p<0.05). In conclusion, neo- and re-vascularization around the tip of implanted pedicle was an important factor for overall survival of the prefabricated flap. Therefore, skeletonized pure vascular pedicle transfer, even though it used alone without surrounding was sufficient to get higher flap viability. The optimal duration of pedicle implantation was8 weeks to obtain maximal survival.

• Radiation Oncology Journal
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• 제31권1호
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• pp.18-24
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• 2013

Purpose: The purpose of this study was to assess the clinical outcomes of hypofractionated radiotherapy (HFRT) with three-dimensional conformal technique for medically inoperable patients with early stage non-small-cell lung cancer (NSCLC) and to evaluate prognostic factors. Materials and Methods: We performed a retrospective review of 26 patients who underwent HFRT for early stage NSCLC between September 2005 and August 2011. Only clinical stage T1-3N0 was included. The median RT dose was 70 Gy (range, 60 to 72 Gy) and the median biologically equivalent dose (BED) was 94.5 Gy (range, 78.0 to 100.8 Gy). In 84.6% of patients, 4 Gy per fraction was used. Neoadjuvant chemotherapy with paclitaxel and cisplatin was given to 2 of 26 patients. Results: The median follow-up time for surviving patients was 21 months (range, 13 to 49 months). The overall response rate was 53.9%, and the initial local control rate was 100%. The median survival duration was 27.8 months. Rates of 2-year overall survival, progression-free survival (PFS), local control (LC), and locoregional-free survival (LRFS) were 54.3%, 61.1%, 74.6%, and 61.9%, respectively. Multivariate analysis showed that BED (>90 vs. ${\leq}90$ Gy) was an independent prognostic factor influencing PFS, LC, and LRFS. Severe toxicities over grade 3 were not observed. Conclusion: Radical HFRT can yield satisfactory disease control with acceptable rates of toxicities in medically inoperable patients with early stage NSCLC. HFRT is a viable alternative for clinics and patients ineligible for stereotactic ablative radiotherapy. BED over 90 Gy and 4 Gy per fraction might be appropriate for HFRT.

• 한국패류학회지
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• 제20권1호
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• pp.93-105
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• 2004

Arkshell clams, Scapharca broughtonii, are economically important edible bivalves and widely cultivated in the Southern coast of Korea. Recently, the production of S. broughtonii has been dramatically decreased and various reasons including chemical pollution were suspected to be related to the production declines. However, it remains unknown whether the chemical pollution levels of the surrounding environments were high enough for the biological and ecological disturbance for the population of S. broughtonii, because no systematic toxicological study using S. broughtonii has been conducted previously. In the present study, we exposed arkshell clams, S. broughtonii to various waterborne pollutants including heavy metals (Cd, Cu and Hg), ammonia and organotins (tributyltin and triphenyltin) to determine the effect concentrations of these pollutants for the survival of S. broughtonii for 20 days. The median lethal concentrations ($LC_50$) of S. broughtonii were 2.1 mg/l for Cd, 0.065 mg/l for Cu, 0.40 mg/l for Hg, 79.4 mg/l for total ammonia (1.9 mg/l for unionized ammonia), 0.5 ${\mu}$g/l for TBT, and 14${\mu}$g/l for TPhT. Lethal toxicity of the most pollutants increased with both exposure duration and concentration. The toxicity of TBT was greatest for S. broughtonii, followed by TPhT > Cu > Hg > Cd > ammonia. The sensitivities of S. broughtonii to heavy metals and TBT were comparable to those of other aquatic organisms, but they were relatively tolerable to ammonia. The environmental concentrations of the tested pollutants were compared with the effect concentrations of those for the survival of S. broughtonii to assess the potential risks of the pollutants in the field conditions.

• 대한임상독성학회지
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• 제16권1호
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• pp.9-14
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• 2018

Purpose: Intravenous lipid emulsion (ILE) has been shown to have significant therapeutic effects on calcium channel blocker overdose in animal studies and clinical cases. In this preliminary experiment, we investigated the hemodynamic changes and survival in a rat model of verapamil intoxication. Methods: Fourteen male Sprague-Dawley rats were sedated and treated with ILE or normal saline (control), followed by continuous intravenous infusion of verapamil (20 mg/kg/h). Mean arterial pressure and heart rate of rats were monitored during the infusion. In addition, the total dose of infused verapamil and the duration of survival were measured. Results: Survival was prolonged in the ILE group ($32.43{\pm}5.8min$) relative to the control group ($24.14{\pm}4.3min$) (p=0.01). The cumulative mean lethal dose of verapamil was higher in the ILE group ($4.3{\pm}0.7mg/kg$) than in the control group ($3.2{\pm}0.5mg/kg$; p=0.017). Conclusion: ILE pretreatment prolonged survival and increased the lethal dose in a rat model of verapamil poisoning.

• Journal of Chest Surgery
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• 제56권3호
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• pp.197-203
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• 2023

Background: The survival benefit of coronary artery bypass grafting (CABG) using the bilateral internal thoracic arteries (BITA) is well known; however, the role of BITA in concomitant aortic valve replacement (AVR) and CABG has not been studied. Methods: We retrospectively reviewed patients who underwent concomitant AVR and CABG. Cases not using an internal thoracic artery and less than 2 bypass grafts were excluded. We enrolled 114 patients in this study. The mean follow-up duration was 61.5±43.5 months. Results: Forty patients (35.1%) underwent CABG with a single internal thoracic artery (SITA) and 74 patients (64.9%) underwent CABG with BITA. The preoperative clinical characteristics were not significantly different between the 2 groups, with the exception of a higher prevalence of atrial fibrillation in the SITA group. Postoperative mortality and morbidity were not significantly higher in the BITA group than in the SITA group. In the univariable analysis, the survival of the BITA group was similar to that of the SITA group (p=0.157). Multivariable analysis showed that only mean age was a predictor of death (p=0.042), but using BITA was not an independent predictor (p=0.094). In low-risk patients whose preoperative ejection fraction was >45%, the survival of the BITA group was significantly better than that of the SITA group (p=0.043). Conclusion: BITA use in concomitant AVR and CABG showed no difference in mortality compared to using SITA. Although its impact on long-term survival was inconclusive, BITA use can be considered for low-risk patients.

• Journal of Gastric Cancer
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• 제24권2호
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• pp.199-209
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• 2024

Purpose: Long-term outcomes of patients with positive lateral margins (pLMs) after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). This study aimed to evaluate the remnant cancer and survival rates of patients with pLMs compared with those who underwent curative resection. Materials and Methods: A retrospective analysis was performed on consecutive patients with pLMs as the only non-curative factor of expanded indication who underwent ESD for EGC with a follow-up duration of 5 years or more. The rates of remnant cancer, recurrence, and survival were analyzed and compared to those of control patients who underwent curative resection by propensity score matching. Results: Among 3,515 patients treated with ESD between 2005 and 2018, 123 non-curative EGCs were retrospectively analyzed. A total of 108 patients were followed up without endoscopic or surgical resection for 8.2 years. The control group was matched in a 1:1 ratio with patients with EGC who underwent curative resection after ESD. The observation group with pLMs had a higher incidence of remnant cancer (25.9%; 28/108) compared to that in the curative resection group (0/108; P=0.000). The remaining tumors were treated with surgical or endoscopic resection, and no additional recurrences were observed. The overall survival analysis demonstrated no significant difference between the observation and curative resection groups (P=0.577). Conclusions: No difference was observed in the overall survival rate between observation and curative resection groups. Therefore, observation may be a possible option for incomplete ESD with pLMs if continuous follow-up is performed.

• Journal of Korean Neurosurgical Society
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• 제30권sup2호
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• pp.221-227
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• 2001

Objective : The therapeutic impact of tumor resection in glioblastomas is poorly defined and still questionable. Therefore, we conducted the current study to verify the role of tumor resection in the treatment of these highly malignant tumors. Methods : A retrospective study was performed(1990-1999) to compare the treatment results of surgical resection plus radiotherapy(130 patients) with those of stereotactic biopsy plus radiotherapy(19 patients) in glioblastomas. Only adult patients with supratentorial, de novo glioblastoma located in one lobe were included. Survival time/rate was analysed with Kaplan-Meier method, and prognostic variables were obtained from the univariate log-rank test and the multivariate Cox's proportional hazards model. Results : The resection group and the biopsy group did not differ in terms of age, gender, duration of symptoms, presenting symptoms, tumor location, tumor side, tumor size, and the frequency of midline shift. Patients in the biopsy group more often were found to have worse preoperative Karnofsky performance status(KPS)(p=0.001). On univariate analysis, age, KPS, and tumor side were associated with survival(p=0.0053, 0.0001, and 0.0331 respectively). Median survival time and 1-year survival rate were also statistically improved by tumor resection ; resection group - 13 months and 61.2%, and biopsy group - 8 months and 19.7%, respectively(p=0.0001). In patients with midline shift of the tumor, resection was highly effective comparing to biopsy(p=0.0001), but in patients without midline shift, external beam radiation alone was as effective as tumor resection(p=0.0605). Other prognostic variables did not affect survival. On multivariate analysis after variable selection, survival was independently associated with KPS(p=0.001), but not the surgical resection(p=0.2837). Even in biopsy group with midline shift of the tumor, survival rate was not different from that seen after tumor resection(p=0.3505). Conclusions : Radiotherapy alone was as effective as tumor resection plus radiotherapy in patients without midline shift of the tumor. Although there was not statistically significant, tumor resection looked like effective in patients with midline shift. For supratentorial, lobar glioblastoma patients without mass effect of the tumor, biopsy with radiotherapy is one of rational treatment strategies. We consider that tumor resection should be performed in patients with pretreatment midline shift.

• Journal of Medicine and Life Science
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• 제15권2호
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• pp.95-100
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• 2018

We conduct this study to compare the difference in duration of labor in nulliparous women received epidural analgesia or non-epidural analgesia for labor pain. This retrospective, observational study based on the review of the medical records from February 2014 to July 2017. Epidural analgesia was initiated with a 10 mL epidural bolus of 1% lidocaine and was maintained with a 0.1% mixture of ropivacaine with fentanyl. Non-epidural analgesia was initiated with pethidine 12.5 mg bolus, followed by additional boluses as needed. The primary outcome was the duration of the labor. 149 healthy nulliparous women at term pregnancies with no evidence of fetal distress were enrolled in this study. 92 women received non-epidural analgesia (Group NE) and 57 women received epidural analgesia (Group E). There were no significant differences between the two groups in maternal demographic characteristics. Using a Kaplan-Meier survival analysis, there was no significant difference in the overall duration of the labor(P=0.233). The duration of the first stage of labor was $187.6{\pm}167.3min$ in Group NE, $248.6{\pm}168.7min$ in Group E (Mean${\pm}$SD, P=0.032). The duration of the second stage of labor was $67.1{\pm}57.8min$ in Group NE, $64.1{\pm}47.5min$ in Group E (Mean${\pm}$SD, P=0.693). Epidural analgesia delayed the first stage of labor in this study. But there were no significant differences between the two groups in the duration of the second stage and the total duration of labor.

• Radiation Oncology Journal
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• 제10권2호
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• pp.163-169
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• 1992

1980년 1월부터 1991년 6월까지 경희대학교 부속병원 치료방사선과에서 수술후 방사선치료를 받은 뇌의 악성 성상세포종과 교아세포종 환자 53명을 대상으로 후향적 분석을 실시하였다. 48명이 추적 가능하였으며 5년생존율은 악성 성상세포종이 $29.4\%$였고 교아세포종이 $2.8\%$였으며 중앙생존기간은 각각 27개월, 11개월이었다. 조직 분화도, 나이, 수행능력, 방사선량이 통계학적으로 유의하게 의미있는 예후인자로 나타났다. 종양절제 정도, 증상발현 기간, 종양의 위치에따라 생존율의 차이를 보였으나 통계적인 유의성은 없었다.

• Journal of Chest Surgery
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• 제17권4호
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• pp.819-828
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• 1984

Between September 1973 and December 1983, 61 patients with carcinoma of the esophagus were treated surgically at the Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital. Among 61 patients, male patients were 51 cases, female 10 cases and the age ranged from 21 years old to 72 years old with the average of 54.6 years old. Min symptoms of esophageal cancer were dysphagia (91.5%), weight loss (40.4%), pain(27.6%), and the average symptom duration was 3.85 months. The anatomical locations of esophageal cancer in preoperative esophagogram revealed 41.7% in middle 1/3, 8.3% in esophagograstic junction or cardia. Among 61 cases, 9 cases were managed by feeding gastrostomy due to inoperability, 8 cases by exploratory thoracotomy or lapatotomy only without curative or palliative resection, and 44 cases by curative or palliative resection with reconstruction. Among 52 cases of exploration, 44 cases were managed with curative or palliative resection of cancer and the resectability revealed 84.6% in operated cases. Among palliative or curative resected group, the esophagogastrostomy was performed in 40 cases (90.9%), esophagojejunostomy in 3 cases(6.8%), esophagectomy only in 1 case(2.3%). Postoperative complications were noticed in 12 cases, such as anastomotic leakage in 7 cases(15.6%), empyema in 2 cases (4.4%), respiratory failure in 2 cases (4.4%), anastomotic stricture in 1 case (2.2%). among 7 postoperative anastomotic leakage, 2 patients died as a result of that complication and the operative mortality revealed 4.3%. During follow-up work, the mean survival period was 19.3 months in patients who discharged hospital alive, and the 2 year survival rate was 34.6%.