• 핵의학기술
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• 제22권1호
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• pp.28-34
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• 2018

국내 의료기관의 방사성옥소(I-131) 사용과 관련하여 배수 중 방사능농도가 원자력안전법의 허용치를 초과한 사례가 발견되어, 원인 분석 및 배수 중 방사능농도 분석을 통해 주변 환경 공공수역에 대한 관계를 평가하여 유용성에 대해 알아보고자 한다. 2014년 11월 1일부터 2015년 4월 30일까지 6개월에 걸쳐 국내 20개 병원을 대상으로 하였다. 장비는 HpGe 감마선 분광 측정기(Canberra DSA1000)를 사용하였으며, 분석방법으로는 GENIE-2000 Analysis을 이용하여 방사성옥소의 배수 중 방사능농도를 측정하여 비교 분석하였다. 연구 결과, 7개 기관이 I-131 배수 중 배출관리 기준을 초과하였음을 확인하였으며, 20개 병원의 평균 배수 중 방사능 농도는 $4.21E+4 Bq/m^3$로 나타났다. 방사능농도가 높은 병원의 특징으로는 I-131을 이용한 다수의 외래환자 진료 건수, 외래전용 화장실의 부재로 확인되었다. I-131 whole body scan 전 반드시 소변을 보게 하는 과정에서 체내에 잔류한 I-131이 배출되는 것으로 판단된다. 공공수역 내 배수 중 방사능 농도가 초과 검출되는 원인으로는 진료용 방사성옥소라 판단되며, 저용량 투여환자 외래전용 화장실 설치와 안전관리 지침서 제공 및 교육 강화의 중요성을 확인할 수 있었다. 또한 배수 중 배출관리기준과 관련하여 법적, 제도적 관리 체계 구축이 필요할 것으로 사료된다.

• 한국산학기술학회논문지
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• 제20권11호
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• pp.232-238
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• 2019

본 연구는 계획된 행동이론에 근거하여 문제도박자의 단도박 의도를 예측하는 모형의 적용가능성을 검증하기 위함이다. 지역사회 기관을 이용하는 문제도박자 100명을 대상으로 단도박 태도, 주관적 규범, 지각된 통제력과 단도박 의도를 조사하였다. 그리고 계획된 행동이론에 기반한 모형검증을 위해 단도박 태도, 주관적 규범, 지각된 통제력이 단도박 의도에 영향을 미치는지 구조방정식 모형으로 분석하였다. 연구모형 분석결과 단도박 의도에 가장 강력한 예측요인은 지각된 통제력이고 그다음이 단도박 태도였다. 그러나 주관적 규범은 단도박 의도에 의미 있는 영향력을 가지지 않았다. 이러한 결과를 바탕으로 본 연구자들은 문제도박자의 회복을 위해 단도박 효능감과 단도박 행동에 대한 긍정적 태도를 향상시키기 위한 인지행동적 개입을 제안하였다. 즉, 도박문제로부터 회복할 수 있다는 신념 강화를 위해 지속적인 지지와 대처기술훈련이 필요하고, 긍정적 태도를 향상하기 위한 도박문제 정보제공과 교육 역시 도움이 될 수 있다. 따라서 중독관리기관을 중심으로 도박문제에 대한 치료뿐만 아니라 예방 차원의 개입을 고려해 볼 수 있다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권22호
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• pp.9949-9953
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• 2014

Objective: To evaluate the long term results among patients with soft tissue sarcoma of the thoracic wall. Materials and Methods: Twenty-six patients who were treated with pre-or postoperative radiotherapy between December 1980-December 2007, with a diagnosis of soft tissue sarcoma of the thoracic wall were retrospectively evaluated. Results: The median age was 44 years (14-85 years) and 15 of them were male. A total of 50% of patients were grade 3. The most common histologic type of tumor was undifferentiated pleomorphic sarcoma (26.9%). Tumor size varied between 2-25 cm (median 6.5 cm). Seventeen of the cases had marginal and 9 had wide local resection. Four cases received preoperative radiotherapy and 22 postoperative radiotherapy. Six of the patients with large and high grade tumors received chemotherapy. Median follow-up time was 82 months (9-309 months). Local recurrence and metastasis was detected in 34.6% and 42.3% of patients, respectively. Five-year local control (LC), disease-free survival (DFS), overall survival (OS), and disease-specific survival (DSS) were 62%, 38%, 69%, and 76% respectively. On univariate analysis, the patients with positive surgical margins had a markedly lower 5-year LC rate than patients with negative surgical margin, but the difference was not significant (43% vs 78%, p=0.1). Five-year DFS (66% vs 17%) and DSS (92% vs 60%) rates were significantly worse for the patients who had high grade tumors (p=0.01, p=0.008 respectively). Conclusions: Tumor grade and surgical margin are essential parameters for determining the prognosis of thoracic wall soft tissue sarcoma both in our series and the literature.

• Clinical and Experimental Pediatrics
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• 제58권10호
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• pp.386-391
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• 2015

Purpose: To evaluate the outcomes and prognostic factors in children with extracranial germ cell tumors (GCTs) treated at a single institution. Methods: Sixty-six children diagnosed with extracranial GCTs between 1996 and 2012 were included in the study. Primary treatment was surgical excision, followed by six cycles of cisplatin-based chemotherapy. The survival rates were compared according to the International Germ Cell Cancer Cooperative Group classification used for GCTs in adults to validate the classification guidelines for GCTs in children. Results: The median patient age was 4.4 years. In 34 patients (51.5%), the primary tumor site was the gonad. Extragonadal GCTs were detected in 32 patients. The 5-year overall survival and event-free survival (EFS) were $92.0%{\pm}3.5%$ and $90.4%{\pm}3.7%$, respectively. In univariate analysis, tumor histology, metastasis, and elevated alpha-fetoprotein were not prognostic factors in children with extracranial GCTs. However, EFS was poorer in patients with mediastinal disease (n=12, $66.7%{\pm}13.6%$) than in those with nonmediastinal disease (n=54, $96.0%{\pm}2.8%$) (P=0.001). The 5-year EFS was lower in patients older than 10 years, (n=21, $80.0%{\pm}8.9%$) compared with those younger than 10 years (n=45, $95.2%{\pm}3.3%$) (P=0.04). Multivariate analysis identified the mediastinal tumor site as the only independent prognostic factor. Conclusion: The prognosis of children with extracranial GCTs was favorable. However, nongerminomatous mediastinal tumors were associated with poor survival in children. Further research is needed to improve the prognosis of children with malignant mediastinal GCTs.

• Journal of Korean Neurosurgical Society
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• 제29권1호
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• pp.51-57
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• 2000

Objective : For relief of back pain related to spondylolisthesis, fusion with or without internal fixation may be necessary. Currently, bilateral wide posterior decompression and fusion with or without internal fixation are used for treatment of spondylolisthesis. In case of severe osteoporosis, discectomy may be done without fusion to decompress the nerve roots. However, the procedure may aggravate radicular symptom because slippage may increase and thus foramen may become narrower. In these settings, inferomedial partial pediculectomy has been done in our institution, The object of this study was to evaltuate such cases with regard to per- and postoperative clinical courses. Patients and Methods : Fifteen patients complaining radicular pain with mild or no back pain underwent inferomedial partial pediculectomy. It was done in lytic spondylolisthesis after extension of isthmic defect. In degenerative spondylolisthesis of L4-5 interspace, intertransverse pediculectomy was done via paraspinal approach not to injure the posterior segment with intact isthmus. But, in degenerative spondylolisthesis of L5-S1 interspace however, partial pediculectomy was done after making artificial isthmic defect via midline approach. Then, reconstructive laminoplasty of L5 was performed to avoid iatrogenic instability resulted from artificial isthmic defect. They were followed up for average 14.4 months(3-31 months). Results : Radiating pain was relieved in all cases(100%). Postoperative result was excellent in 7 cases(46.7%), good in 7(46.7%) and fair in 1(6.6%). Only 1 case(6.7%) showed increase in slippage during follow-up period. Conclusion : Inferomedial partial pediculectomy is considered as a useful procedure for severely osteoporotic patients with spondylolisthesis with regards to keeping stability and decompressing the nerve roots.

• Journal of Korean Neurosurgical Society
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• 제29권6호
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• pp.754-762
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• 2000

Objectives : The surgical results of 80 patients with growth hormone(GH)-producing pituitary adenoma were analyzed retrospectively to evaluate the clinical manifestations and to determine which preoperative factors significantly influenced the surgical outcome. Patients and Methods : The patients consisted of 39 men and 41 women and the age of patients at the time of initial operation ranged from 17 to 67 years(mean age, 40.5 years) Between January 1990 and June 1996, 77 patients underwent transsphenoidal surgery and 3 patients underwent craniotomy for GH-producing pituitary adenoma at our institution. Preoperative administration of octreotide was performed in 18 patients. Surgical control was defined as a postoperative serum basal level of GH less than 5ng/ml. A logistic regression model was used for univariate and multivariate analysis. Probability value of less than 0.05 was considered as statistically significant. Results : The most common presenting symptom was acromegaly, followed by headache, visual disturbance, and fatigability. Visual symptoms were present in 39% of the patients. Diabetes mellitus was associated in 24 patients and hypertension in 12. Preoperative mean basal level of GH was 93.2ng/ml(range 72-500ng/ml) which was closely related with tumor size(p<0.05). Grade II by Hardy's classification was the most common radiological type. Preoperative octreotide treatment significantly reduced the level of GH(p<0.05), but not enough to induce endocrinological remission. One patient died of cerebral infarction after craniotomy. The most common surgical complication was transient diabetes insipidus. The symptom of the earliest improvement after surgery was paresthesia and tightness of the hand and foot, followed by headache and easy fatigability. The preoperative visual symptom was improved in all patients. The patients who had hypertension or DM experienced alleviated symptoms in 67% and 92%, respectively. The overall rate of endocrinological remission was 44%. By multivariate logistic regression analysis, the size of tumor, extrasellar extension, and extent of removal were significant prognostic factors for endocrinologial remission. Conclusion : Early detection of a small tumor without extrasellar extension followed by a complete resection is highly recommended in order to achieve endocrinological cure of GH-producing pituitary adenomas.

• Journal of Korean Neurosurgical Society
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• 제60권6호
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• pp.654-660
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• 2017

Objective : Mechanical thrombectomy is increasingly being used for the treatment of acute ischemic stroke. The population over 80 years of age is growing, and many of these patients have acute infarction; however, these patients are often excluded from clinical trials, so the aim of this study was to compare the functional outcomes and complication rates in very elderly patients (age ${\geq}80$ years) and aged patients (60-79 years) treated with mechanical thrombectomy. Methods : Between January 2010 and June 2015, we retrospectively reviewed 113 senior patients (over 60 years old) treated at our institution for acute ischemic stroke with mechanical thrombectomy. They were divided into a very elderly (${\geq}80$ years) and aged (60-79 years) group, with comparisons in recanalization rates, complications, death and disability on discharge be reported. Results : The mean age was 70.3 years in the aged group and 83.4 years in the very elderly group. Elderly patients had higher rates of mechanical thrombectomy failure than the younger group (40% vs. 14%; odds ratio [OR] 4.1; 95% confidence interval [CI] 1.4-11.9; p=0.012). Results from thrombolysis in cerebral ischemia and modified Rankin scale at discharge were worse in the older group (p=0.005 and 0.023 respectively). There were no differences in mortality rate or other complications, but infarction progression rates were significantly higher in the very elderly group. (15% vs. 2.2%; OR 8.0; 95% CI 1.2-51.7; p=0.038). The majority (92.3%) of the patients who failed in aged group were not successful after several trials. However, in half (4 of 8) of the very elderly group, the occlusion site could not be accessed. Conclusion : Patients older than 80 years of age undergoing mechanical thrombectomy for acute infarction were more difficult to recanalize due to inaccessible occlusion sites and had a higher rate of infarction progression, However, mortality and other complications were similar to those in younger patients.

• Journal of Chest Surgery
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• 제45권1호
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• pp.40-44
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• 2012

Background: The experience of a single-institution regarding surgery for small cell lung cancer (SCLC) was reviewed to evaluate the surgical outcomes and prognoses. Materials and Methods: From July 1990 to December 2009, thirty-four patients (28 male) underwent major pulmonary resection and lymph node dissection for SCLC. Lobectomy was performed in 24 patients, pneumonectomy in eight, bilobectomy in one, and segmentectomy in one. Surgical complications, mortality, the disease-free survival (DFS) rate, and the overall survival rate were analyzed retrospectively. Results: The median follow-up period was 26 months (range, 4 to 241 months), and there was one surgical mortality (2.9%). Six patients (17.6%) experienced recurrence, all of which were systemic. Eight patients died during follow-up; four died of disease progression and the other four died of pneumonia or of another non-cancerous cause. The three-year DFS rate was $79.2{\pm}2.6%$ and the overall survival rate was $66.4{\pm}10.5%$. Recurrence or death was significantly prevalent in the patients with lymph node metastasis (p=0.001) as well as in those who did not undergo adjuvant chemotherapy (p=0.008). The three-year survival rate was significantly greater in the patients with pathologic stage I/II cancer than in those with stage III cancer (84% vs. 13%, p=0.001). Conclusion: Major pulmonary resection for small cell lung cancer is feasible in selected patients. Patients with pathologic stage I or II disease showed an excellent survival rate after surgery and adjuvant treatment. Prospective randomized studies will be needed to define the role of surgery in early-stage small cell lung cancer.

• Radiation Oncology Journal
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• 제17권4호
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• pp.275-280
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• 1999

목 적 :국소적으로 진행된 비인두암환자에서 선행보조 항암화학요법의 실행 용이성과 부작용의 정도를 평가한다. 대상 및 방법 : 77명의 조직학적으로 비인두암으로 확진 되고 이전에 치료를 받은 적이 없는 진행된 병기의 비인두암 환자들이 1984년부터 1996년까지 서울대학교병원에서 선행보조 항암화학요법과 방사선치료를 시행 받았다. 환자군의 병기분포는 다음과 같다. 1992년 AJCC 분류법에 따라 제 3 병기에 속하는 환자가 2명이었고 제 4병기에 속하는 환자가 75명이었다. 방사선치료 시행 전에 선행보조 항암화학요법으로 66명의 환자가 5-FU와 Cisplatin의 정맥 내 투여를 시행 받았고, 11명의 환자가 5-FU와 Carboplatin의 정맥 내 투여를 시행 받았다. 생존환자의 중앙추적기간은 44개월이었다. 결 과 :항암화학요법에의 반응율은 87$\%$였다. 항암화학요법의 부작용은 심하지 않았다. 3명의 환자만이 3도의 부작용을 경험하였다. 1명은 백혈구 감소증을 보였고 2명은 오심과 구토의 부작용을 보였다. 방사선에 의한 점막염도 심하지 않았는데, 10명의 환자에서 2도의 점막염이 발생하였다. 5년 생존율과 5년 무병생존율은 각각 68$\%$와 65$\%$였다. 5년 무원격전이율은 82$\%$였으며 5년 국소 치유율은 75$\%$였다. 결 론 : 선행보조 항암화학요법이 진행된 병기의 비인두암 환자에 있어서 부작용을 크게 증가시키지 않으면서 효과적인 치료방법임을 알 수 있었다.

• Journal of Acupuncture Research
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• 제33권1호
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• pp.1-7
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• 2016

Objectives : This study was conducted to analyze the single dose toxicity of Mecasin (Gami-Jakyak Gamcho buja Decoction) herbal acupuncture administered in the vein of Sprague-Dawley rats. Methods : All experiments were performed at the Medvill, an institution licensed to conduct nonclinical studies, under the Good Laboratory Practice (GLP) regulations. Sprague-Dawley rats were chosen in this pilot study. In the experiment, Sprague-Dawley rats were divided into four groups of five male and five female animals per group. Doses of Mecasin herbal acupuncture, at 0, 500, 1,000, and 2,000 mg/kg, were given to the experimental groups, and a dose of normal saline solution, at 2 ml/kg, was administered to the control group. Mecasin herb acupuncture and normal saline were injected into the vein at once, and we observed mortality, clinical signs, weights, and gross findings for 14 days after injection. This study was conducted under the approval of the Institutional Animal Ethics Committee. Results : There is no death or abnormality in any of the four groups. All groups put on weights favorably. There are no significant gross findings in necropsy examinations. Conclusions : The above results showed that intravenous injection of 500-2,000 mg/kg of Mecasin herb acupuncture did not cause any changes in weight or, in the results of necropsy examinations, in mortalities. Therefore, the toxicity of Mecasin herb acupuncture was not confirmed, and the presumptive lethal dose of Mecasin herb acupuncture was higher than 2,000 mg/kg. The outcomes suggest that treatment with Mecasin herbal acupuncture is relatively safe. Further evaluations on this subject are needed to yield more concrete evidence.