• Journal of Gastric Cancer
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• 제7권2호
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• pp.74-81
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• 2007

목적: 위암이 국소적으로 진행하여 췌장과 비장으로 직접 침윤이 발생되었을 췌-비장 절제를 시행하는 것에는 반대 의견이 없지만, 췌-비장의 보존이 가능함에도 불구하고, 비장혈관이나 비문부 림프절의 완전 절제를 위해서 췌-비장 절제가 시행되는 것은 논란의 여지가 많다 저자들은 위 중-상부의 진행암으로 위 전절제술과 함께 원위부 췌-비장 절제가 시행되었던 환자들의 수술 결과 분석을 통하여 불필요한 합병절제를 피할 수 있는 방법을 찾고자 하였다. 대상 및 방법: 1990년부터 2001년까지 가톨릭대학교 의과대학 외과학교실에서 위 전절제술과 동반되어 원위부 췌-비장 절제가 시행된 118명의 환자 중, 병리 조직학적으로 암의 췌장 침윤이 없었던 90예(I군)와 침윤이 확인된 28예(II군)의 임상병리학적 특성, 이환율과 사망률 및 생존율 등을 후향적으로 분석하였다. 결과: 전체 118예 중 췌장 침윤이 확인된 pT4는 28예(23.7%)였고, 침윤이 없었던 pT3과 pT2가 각각 65예(55.1%) 와 20예(16.9%)였으며, pT1도 5예(4.3%)였다. 병기는 28예의 pT4 중에서 림프절 전이가 있어 IV기인 경우가 25예(89.3%)였고, 림프절 전이가 없는 IIIa기는 3예(10.7%)에 불과하였다. 또한 I군은 la (pT1N0)기 4예, Ib (pT2N0)기 7예였고, II기는 pT2N1 8예, pT3N0 12예, pT1N2 1예였으며, III기는 IIIa 15예, IIIb 17예, IV기는 26예였다. 두 군의 임상병리학적 특성 중 병기, 절제연 및 근치도에서 유의한 차이를 보였고, 생존에 영향을 미치는 인자들의 단변량 분석에서는 병기, 위벽 침윤, 췌장 침윤, 림프절전이, 비장혈관과 비문부 림프절 전이, 전이 림프절 비율, 근치도, 간 및 복막 전이 등에서 유의한 차이를 보였으며, 이 중 병기와 전이 림프절 비율 및 근치도가 예후에 영향을 미치는 독립적 예후인자로 나타났다. 5년 생존율은 I군이 36.2%, II군이 13.9%였고, 술 후 합병증으로 췌장 루 6예(5.1%), 복강 내 농양 5예(4.2%), 출혈 5예(4.2%)로 수술로 인한 전체 이환율은 22.1%였으며, 사망률은 6.8% (8예)였다. 결론: 진행성 상부 위암으로 위 전 절제술을 시행할 때 원위부 췌-비장 절제는 이환율이 비교적 높은 술식이기 때문에 간이나 복막전이가 없는 상태에서 위암의 병기가 높고, 절제연이 불충분하며, 근치적 절제가 불가능하다고 판단될 때에만 선택적으로 시행되는 것이 좋다고 생각한다.

• Asian-Australasian Journal of Animal Sciences
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• 제31권3호
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• pp.403-409
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• 2018

Objective: The present study was conducted to investigate the effects of a lipid-coated zinc oxide (ZnO) supplement Shield Zn (SZ) at the sub-pharmacological concentration on intestinal morphology and gene expression in weanling pigs, with an aim to gain insights into the mechanism of actions for SZ. Methods: Forty 22-day-old weanling pigs were fed a nursery diet supplemented with 100 or 2,500 mg Zn/kg with uncoated ZnO (negative control [NC] or positive control [PC], respectively), 100, 200, or 400 mg Zn/kg with SZ for 14 days and their intestinal tissues were taken for histological and molecular biological examinations. The villus height (VH) and crypt depth (CD) of the intestinal mucosa were measured microscopically following preparation of the tissue specimen; expression of the genes associated with growth and immune function was determined using the real-time quantitative polymerase chain reaction. Results: There was no difference in daily gain, gain:feed, and diarrhea score between the SZ group and either of NC and PC. The VH and VH:CD ratio were less for the SZ group vs NC in the jejunum and duodenum, respectively (p<0.05). The jejunal mucosal mRNA levels of insulin-like growth factor (IGF-I) and interleukin (IL)-10 regressed and tended to regress (p = 0.053) on the SZ concentration with a positive coefficient, respectively, whereas the IL-6 mRNA level regressed on the SZ concentration with a negative coefficient. The mRNA levels of IGF-I, zonula occludens protein-1, tumor necrosis $factor-{\alpha}$, IL-6, and IL-10 did not differ between the SZ group and either of NC and PC; the occludin and transforming growth $factor-{\beta}1$ mRNA levels were lower for the SZ group than for PC. Conclusion: The present results are interpreted to suggest that dietary ZnO provided by SZ may play a role in intestinal mucosal growth and immune function by modulating the expression of IGF-I, IL-6, and IL-10 genes.

• Radiation Oncology Journal
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• 제34권4호
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• pp.265-272
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• 2016

Purpose: The purpose of this study is to evaluate the treatment outcomes of adjuvant radiotherapy using vaginal brachytherapy (VB) with a lower dose per fraction and/or external beam radiotherapy (EBRT) following surgery for patients with stage I endometrial carcinoma. Materials and Methods: The subjects were 43 patients with the International Federation of Gynecology and Obstetrics (FIGO) stage I endometrial cancer who underwent adjuvant radiotherapy following surgery between March 2000 and April 2014. Of these, 25 received postoperative VB alone, while 18 received postoperative EBRT to the whole pelvis; 3 of these were treated with EBRT plus VB. The median EBRT dose was 50.0 Gy (45.0-50.4 Gy) and the VB dose was 24 Gy in 6 fractions. Tumor dose was prescribed at a depth of 5 mm from the cylinder surface and delivered twice per week. Results: The median follow-up period for all patients was 57 months (range, 9 to 188 months). Five-year disease-free survival (DFS) and overall survival (OS) for all patients were 92.5% and 95.3%, respectively. Adjuvant radiotherapy was performed according to risk factors and stage IB, grade 3 and lymphovascular invasion were observed more frequently in the EBRT group. Five-year DFS for EBRT and VB alone were 88.1% and 96.0%, respectively (p = 0.42), and 5-year OS for EBRT and VB alone were 94.4% and 96%, respectively (p = 0.38). There was no locoregional recurrence in any patient. Two patients who received EBRT and 1 patient who received VB alone developed distant metastatic disease. Two patients who received EBRT had severe complications, one each of grade 3 gastrointestinal complication and pelvic bone insufficiency fracture. Conclusion: Adjuvant radiotherapy achieved high DFS and OS with acceptable toxicity in stage I endometrial cancer. VB (with a lower dose per fraction) may be a viable option for selected patients with early-stage endometrial cancer following surgery.

• Asian Pacific Journal of Cancer Prevention
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• 제14권3호
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• pp.2091-2095
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• 2013

Background: The $7^{th}$ TNM staging is the first authoritative standard for evaluation of effectiveness of treatment of gastric cancer worldwide. However, revision of pN classification within TNM needs to be discussed. In particular, the N3 sub-stage is becoming more conspicuous. Methods: Clinical data of 302 pN3M0 stage gastric cancer patients who received radical gastrectomy in Tianjin Medical University Cancer Institute and Hospital from January 2001 to May 2006 were retrospectively analyzed. Results: Location of tumor, depth of invasion, extranodal metastasis, gastric resection, combined organs resection, lymph node metastasis, rate of lymph node metastasis, negative lymph nodes count were important prognostic factors of pN3M0 stage gastric cancers. TNM stage was also associated with prognosis. Patients at T2N3M0 stage had a better prognosis than other sub-classification. T3N3M0 and T4aN3aM0 patients had equal prognosis which followed the T2N3M0. T4aN3bM0 and T4bN3aM0 had lower survival rate than the formers. T4bN3bM0 had worst prognosis. In multivariate analysis, TNM stage group and rate of lymph node metastasis were independent prognostic factors. Conclusions: The sub-stage of N3 may be useful for more accurate prediction of prognosis; it should therefore be applied in the TNM stage system.

• Journal of Gastric Cancer
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• 제4권3호
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• pp.143-148
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• 2004

Purpose: To determine the clinical value of the Siewert classification for gastic-cancer patients in Korea, we evaluated and compared the clinicopathologic factors of type II and type III cancer. Materials and Methods: The medical records of 89 consecutive patients who had undergone surgery for an adenocarcinoma of the gastroesophageal junction (GEJ) at the Department of Surgery, Hanyang University Hospital, between Jun. 1992 and Dec. 2003 were reviewed retrospectively. Results: There were one patient with type I, 12 pateints with type II and 77 patients with type III. During the same period, 1,341 patients underwent surgery for a gastric carcinoma, so proportion of GEJ cancer being $6.6\%$. The median followup duration was 31 months (range: $2\∼135$ months), and the follow-up rate was $100\%$. Between type II and type III cancers, there were no significant differences in the clinicopathologic variables including age, sex, gross appearance, histologic type, depth of invasion, and pathologic stage. The longest diameter of the tumor was larger in type III ($6.1\pm2.1$ cm) than in type II ($3.9\pm1.1$ cm)(P=0.001). A total gastrectomy with Roux-en-Y esophagojejunostomy was done most frequently, while jejunal interposition was done in 3 cases of type II and 2 cases of type III. More than a D2 lymphadenectomy was done all cases. The numbers of dissected lymph nodes and metastatic lymph nodes in type II were 43.8 and 5.8 respectively, while they were 49.8 and 8.1 in type III, but the difference between the two groups were not statistically significant. The mean length of the proximal resection margin was $15\pm5$ mm in type II and $21\pm13$ mm in type III, but this difference was not statistically significanct. The time to recurrence after operation was 19.3 months in type II and 16.9 months in type III. The five-year survival rates of type II and III were $68.8\%\;and\;52.7\%$ respectively, but difference was not significant. Conclusion: There were no significant differences in the clinicopathologic variables, including survival rate, between type II and type III cancers in Korean patients According to these findings, it appears to be reasonable to classify type III cancer as a cardia cancer in a broad sense.

• Journal of Gastric Cancer
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• 제1권3호
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• pp.161-167
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• 2001

Purpose: Although gastric carcinomas occur throughout the world and the incidence is on the decrease, they remain the most common type of carcinoma in Korea. Significant advancements in the diagnostics and the surgical treatment of gastric carcinomas have been achieved during the last three decades. The present retrospective study was undertaken to investigate the chronological changes in the clinical features, including clinicopathological findings, operative treatment, and prognosis of gastric carcinomas. Materials and Methods: A total of 1973 patients with a primary gastric adenocarcinoma who had been treated surgically during the period from 1983 to 1998 at the Department of Surgery, Korea University College of Medicine, were divided into two groups to evaluate chronological changes: 1007 patients had been treated during the period from 1983 to 1992 (early period) and 966 patients during the period from 1993 to 1998 (late period). Chronological changes in age, sex, ratio of early gastric cancer (EGC), and resectability were analyzed in all 1973 cases. For the 1755 resected cases, we also studied the chronological changes in the clinicopathological and treatment factors between the early-period (n=894) and the late-period (n=867) groups. Results: There were significant differences between the two periods with regard to age and ratio of EGC: EGC was more frequent in the late period. Univariate analysis of resected cases showed that gross type, tumor size, depth of invasion, UICC stage, and histological type were statistically significant. The analysis of the treatment factors revealed that total gastrectomies and extended lymphadenectomies were more frequent during the late period. The number of lymph nodes dissected was $26.0\pm12.7$ in the early period and $33.4\pm14.1$ in the late period (p<0.01). The 5-year survival rate in all cases was $51.4\%$ in the early period and $55.9\%$ in the late period. The stage-related survival rates (UICC 4th Ed., 1987) in the early vs. the late periods were $92.9\%\;vs.\;95.5\%$ in stage IA, $82.1\%\;vs.\;91.1\%$ in stage IB, $76.5\%\;vs.\;73.1\%$ in stage II, $46.5\%\;vs.\;52.1\%$ in stage IIIA, $14.5\%\;vs.\;33.6\%$ in stage IIIB, and $2.8\%\;vs.\;8.8\%$ in stage IV. There was a statistically significant difference in survival between stage IIIB and IV. Conclusion: These results suggest that the differences in the clinicopathological findings are related primarily to the increased number of early gastric cancer cases in the late period and that the improved survival noted during the late period for in stage IIIB and IV cancers might be related to extended surgery.

• Journal of Gastric Cancer
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• 제4권1호
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• pp.32-35
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• 2004

Purpose: The most important prognostic factors in gastric cancer is the depth of invasion of the primary tumor and lymph node metastasis. The nodal staging of the 5th edition of the Union Internationale Contrala Cancrums (UICC) TNM classification in 1997 was changed based on the number of metastatic lymph node. We attempted to evaluate the prognostic significance of N2 group metastasis in pT3pN1 gastric cancer patients by comparing two different nodal staging systems. Materials and Methods: A retrospective analysis was made for 352 gastric cancer patients who underwent curative resection, including D2 dissection, from 1991 to 1997 at Asan Medical Center. A clinicopathologic comparison between two groups by using a nodal staging systems was summarized into a table. Cumulative survival rates were calculated by using the Kaplan-Meier method. The difference between the two groups was evaluated by using the log rank test with SPSS 11.5 for Windows Results: There were no statistical differences in clinicopathologic factors. However, there was a significant difference in survival rate between the two groups (P=0.0009). This suggests that N2 group metastasis in pT3pN1 gastric cancer patients has a clinical significance for predicting prognosis. Conclusion: Our results suggest a possibility of prognostic significance of N2 group metastasis. Therefore, anatomical location of the lymph node should be described.

• 대한방사선기술학회지:방사선기술과학
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• 제25권1호
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• pp.63-71
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• 2002

The aim of this study Is to develop a simple and fast method which computes in-vivo doses from transmission doses measured doting patient treatment using an ionization chamber. Energy fluence and the dose that reach the chamber positioned behind the patient is modified by three factors: patient attenuation, inverse square attenuation. and scattering. We adopted a straightforward empirical approach using a phantom transmission factor (PTF) which accounts for the contribution from all three factors. It was done as follows. First of all, the phantom transmission factor was measured as a simple ratio of the chamber reading measured with and without a homogeneous phantom in the radiation beam according to various field sizes($r_p$), phantom to chamber distance($d_g$) and phantom thickness($T_p$). Secondly, we used the concept of effective field to the cases with inhomogeneous phantom (patients) and irregular fields. The effective field size is calculated by finding the field size that produces the same value of PTF to that for the irregular field and/or inhomogeneous phantom. The hypothesis is that the presence of inhomogeneity and irregular field can be accommodated to a certain extent by altering the field size. Thirdly, the center dose at the prescription depth can be computed using the new TMR($r_{p,eff}$) and Sp($r_{p,eff}$) from the effective field size. After that, when TMR(d, $r_{p,eff}$) and SP($r_{p,eff}$) are acquired. the tumor dose is as follows. $$D_{center}=D_t/PTF(d_g,\;T_p){\times}(\frac{SCD}{SAD})^2{\times}BSF(r_o){\times}S_p(r_{p,eff}){\times}TMR(d,\;r_{p,eff})$$ To make certain the accuracy of this method, we checked the accuracy for the following four cases; in cases of regular or irregular field size, inhomogeneous material included, any errors made and clinical situation. The errors were within 2.3% for regular field size, 3.0% irregular field size, 2.4% when inhomogeneous material was included in the phantom, 3.8% for 6 MV when the error was made purposely, 4.7% for 10 MV and 1.8% for the measurement of a patient in clinic. It is considered that this methode can make the quality control for dose at the time of radiation therapy because it is non-invasive that makes possible to measure the doses whenever a patient is given a therapy as well as eliminates the problem for entrance or exit dose measurement.

• Asian-Australasian Journal of Animal Sciences
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• 제25권11호
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• pp.1617-1626
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• 2012

The objective of this study was to evaluate the effects of adding essential oils to the diet of weaned pigs on performance, nutrient utilization, immune response and intestinal health. A total of 96 weaning pigs ($8.37{\pm}1.58$ kg) were allotted to one of three dietary treatments. The treatments consisted of an unsupplemented basal diet (negative control, NC) or similar diets supplemented with 0.01% of an essential oil product which contained 18% thymol and cinnamaldehyde (EOD) as well as a diet supplemented with 0.19% of an antibiotic mixture which provided 150 ppm chlortetracycline, 80 ppm colistin sulfate and 50 ppm kitasamycin (positive control, PC). Each treatment was provided to eight pens of pigs with four pigs per pen. Over the entire 35 d experiment, ADG and fecal score were improved (p<0.05) for pigs fed the PC and EOD compared with the NC. Dry matter and crude protein digestibility as well as lymphocyte proliferation for pigs fed the PC and EOD diets were increased significantly compared with NC (p<0.05). IGF-I levels in plasma were significantly increased (p<0.05) in pigs fed the PC diet compared with pigs fed the NC diet. Interleukin-6 concentration was lower (p<0.05) and the tumor necrosis factor-${\alpha}$ level was higher (p<0.05) in the plasma of pigs fed the EOD diet than the NC diet. Plasma total antioxidant capacity level increased (p<0.05) in pigs fed the EOD diet compared with pigs fed the NC. Villus height to crypt depth ratio in the jejunum was greater (p<0.05) in pigs fed the PC and EOD diets than the NC. The numbers of E. coli in the cecum, colon and rectum were reduced (p<0.05) in pigs fed the PC and EOD diets compared with the control. In the colon, the ratio of Lactobacilli to E. coli was increased (p<0.05) in pigs fed the EOD diet compared with NC diet. Total aerobe numbers in the rectum were decreased (p<0.05) in pigs fed the PC and EOD diets compared with the control. Collectively, these results indicate that blends of essential oils could be a candidate for use as an alternative to traditional antibiotics in weaning pig diets.

• Asian-Australasian Journal of Animal Sciences
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• 제33권4호
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• pp.605-614
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• 2020

Objective: This study was conducted to determine the effects of stale maize on growth performance, immunity, intestinal morphology, and antioxidant capacity in broilers. Methods: A total of 800 one-day-old male Arbor Acres broilers (45.4±0.5 g) were blocked based on body weight, and then allocated randomly to 2 treatments with 20 cages per treatment and 20 broilers per cage in this 6-week experiment. Dietary treatments included a basal diet and diets with 100% of control maize replaced by stale maize. Results: The content of fat acidity value was higher (p<0.05) while the starch, activities of catalase and peroxidase were lower (p<0.05) than the control maize. Feeding stale maize diets reduced (p<0.05) average daily feed intake (ADFI) throughout the experiment, feed conversion ratio (FCR) during d 0 to 21 and the whole experiment as well as relative weight of liver, spleen, bursa of Fabricius and thymus (p<0.05) on d 21. Feeding stale maize diets decreased jejunum villus height (VH) and VH/crypt depth (CD) (p<0.05) on d 21 and 42 as well as ileum VH/CD on d 42. The levels of immunoglobulin G, acid α-naphthylacetate esterase positive ratios and lymphocyte proliferation on d 21 and 42 as well as lysozyme activity and avian influenza antibody H₅N₁ titer on d 21 decreased (p<0.05) by the stale maize. Feeding stale maize diets reduced (p<0.05) serum interferon-γ, tumor necrosis factor-α, interleukin-2 on d 21 and interleukin-6 on d 21 and 42. Broilers fed stale maize diets had lower levels of (p<0.05) total antioxidative capacity on d 42, superoxide dismutase and glutathione peroxidase on d 21 and 42, but higher (p<0.05) levels of malondialdehyde on d 21 and 42. Conclusion: Feeding 100% stale maize decreased ADFI and FCR, caused adverse effects on immunity and antioxidant function and altered intestinal morphology in broilers.