• Korean Journal of Head & Neck Oncology
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• v.25 no.1
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• pp.24-27
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• 2009

Backgrounds and Objectives : Most patients with neck schwannomas are asymptomatic. Surgical management of neck schwannomas could cause various complications. The aim of this study is to evaluate the necessity of surgical management in all of the neck schwannoma patients. Material and Methods : Thirty-four patients diagnosed and undergone surgical management as neck schwannomas and 30 patients diagnosed and observed closely by OPD base from 1996 to 2005 were included. The medical records were reviewed retrospectively. Results : In surgical management group, mean age was 39.3 years and mean size of tumors was 4.4cm. Twenty-five patients had their tumors at parapharyngeal space, 2 at anterior neck and 7 at lateral neck. Nerves of origin were vagus nerve in 12 patients, cervical sympathetic chain in 11. Presenting symptoms were neck mass in 22 patients and no symptom in 9. On the other hand, in close observation group, mean age was 47.1 years and mean size of tumor was 3.7cm. Seventeen patients had their tumors at parapharyngeal space, 5 at anterior neck and 8 at lateral neck. Presenting symptoms were neck mass in 13 patients and no symptom in 13. There were no patients with neurologic complications. Mean follow-up duration was 38.2 months and there were only 2 patients whose size of tumors was increased and no patients who had newly emerged symptoms. Conclusion : Neck schwannomas grows slowly, has little chance of malignant transformation, but can complicate serious problems after surgical management. Therefore close observation could be considered in many asymptomatic patients.

• Journal of Acupuncture Research
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• v.17 no.2
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• pp.95-117
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• 2000

The purpose of this morphological studies was to investigate the relation between the meridian, acupoints and viscera using neuroanatomical tracers. The common locations of the spinal ganglia, sympathetic chain ganglia, spinal cord and brain projecting to the large intestine meridian were observed following injection of transganglionic tracer, WGA-HRP and transsynaptic neurotropic virus, pseudorabies virus(PRV), Bartha strain(Ba) and PRV-Ba-Gal (Galactosidase)) into the the large intestine(cecum, colon and rectum), ST37 and LI4. After survival times of 96 hours following injection into the thirty rats with WGA-HRP, PRV-Ba and PRV-Ba-Gal. They were perfused, and their spinal ganglia, sympathetic chain ganglia, spinal cord and brain were frozen sectioned($30{\mu}m$). These sections were stained by HRP and X-gal histochemical and PRV immunohistochemical staining method, and observed with a light microscope. The results were as follows : 1. WGA-HRP labeled neurons innervating the large intestine were observed bilaterally within the T13-L4 sympathetic chain ganglia, and T9-11 spinal ganglia. WGA-HRP labeled neurons innervating ST37 were observed within the L3-5 sympathetic chain ganglia, and L2-4 spinal ganglia. WGA-HRP labeled neurons innervating LI4 were observed in the middle cervical ganglion and stellate ganglion, and C5-8 spinal ganglia. 2. In spinal cord, PRV-Ba labeled neurons projecting to the large intestine, ST37 and LI4 were found in thoracic, lumbar and sacral spinal segments. Densely labeled areas of each spinal cord segment were founded in lamina N, V, VII(intermediolateral nucleus), Ⅸ, X and dorsal nucleus. 3. In medulla oblongata, PRV-Ba and PRV-Ba-Gal labeled neurons projecting to the large intestine, ST37 and LI4 were commonly found in the A1 noradrenalin cells/C1 adrenalin cells/caudoventrolateral reticular nucleus, dorsal motor nucleus of vagus nerve, nucleus tractus solitarius, raphe obscurus nucleus, raphe pallidus nucleus, raphe magnus nucleus and gigantocellular nucleus. 4. In pons, PRV-Ba and PRV-Ba-Gal labeled neurons were commonly found in locus coeruleus, Kolliker-Fuse nucieus and A5 cell group. 5. In midbrain, PRV-Ba and PRV-Ba-Gal labeled neurons were commonly found in central gray matter. 6. In diencephalon, PRV-Ba and PRV-Ba-Gal labeled neurons were commonly found in paraventricular hypothalamic nucleus. These results suggest that PRV-Ba and PRV-Ba-Gal labeled common areas projecting to the large intestine may be correlated to that of the large intestine meridian, ST37 and LI4. Especially, These morphological results provide that interrelationship of meridian-acupoints -viscera may be related to the central autonomic pathways.

• Journal of Chest Surgery
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• v.37 no.4
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• pp.349-355
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• 2004

Non-small cell lung cancer (NSCLC) with invasion of mediastinal structures is classified as stage IIIB, and has been considered surgically unresectable However, in a selected group of these patients, better results after surgical resection compared to non-surgical group have been reported. The aim of this study is to evaluate the role of surgical resection in treatment of mediastinal T4 NSCLC. Material and Method: Among 1067 patients who underwent surgical intervention for non-small cell lung cancer from Aug 1987 to Dec 2001 in Korea cancer center hospital, 82 patients had an invasion of T4 mediastinal structures (7.7%). Resection was possible in 63patients (63/82 resectability 76.8%). Their medical records in Data Base were reviewed, and they were followed up completely until Jun 2002. Surgical results and prognostic factors of NSCLC invading mediastinal structures were evaluated retrospectively. Result Lung cancer was resected completely in 52 patients (63.4%, 52/82). Lung resection was lobectomy (or more) in 14, pneumonectomy in 49. The mediastinal structures invaded by primary tumor were great vessel (61.9%), heart (19%), vagus nerve (9.5%), esophagus (7.9%), and vertebral body (7.9%). Nodal status was N0 in 11, N1 in 24, and N2 in 28 (44.4%). Neoadjuvant therapy was done in 6 (9.5%, 5 chemotherapy, 1 radiotherapy), and adjuvant therapy was added in 44 (69.8%, 15 chemotherapy, 29 radiotherapy) in resection group (n=63). Complication was occurred in 23 (31.7%), and operative mortality was 9.5% in resection group. Median and 5 year overall survival including operative mortality was 18.1 months and 21.7% in resection group (n=63), 6.2months and 0% in exploration only group (n=19, p=.001), 39 months and 32.9% in N2 (-) resection group (n=35), and 8.8 months and 8.6% in N2 (+) resection group (n=28, p=.007). The difference of overall survival by mediastinal structure was not significant. Conclusion: The operative risk of NSCLC invading mediastinal structures was high but acceptable, and long-term result of resection was favorable in selected group. Aggressive resection is recommended in well selected pateints with good performace and especially N2 (-) NSCLC with mediastinal invasion.

• The Korean Journal of Physiology
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• v.20 no.1
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• pp.1-7
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• 1986

It has been well documented that the peripheral autonomic nervous system plays an important role in exocrine pancreatic secretion. However, the role of the central nervous system in pancreatic function is still obscure even though the central nervous system has been known to control gastrointestinal functions through the autonomic nervous system. Since the reticular formation in the mesencephalone seems to integrate the autonomic function, the present study was undertaken to investigate a possible influence of the reticular formation upon the exocrine pancreatic secretion. Twenty·two albino rats fasted for 24 hours were anesthetized by intraperitoneal injection of urethane in a dose of 1 g/kg, The pancreatic duct was cannulated to collect pancreatic juice and bile juice was diverted to the jejunum. The gastroduodenal junction was ligated to Prevent passage of gastic juice into the duodenum. A pair of electrodes were bilaterally inserted in the reticualr formation of the mesencephalone with aid of a stereotaxic apparatus. When the volume of pancreatic juice secreted for 10 min became constant, the reticular formation was electrically stimulated for 10 min. Parameters of the electical stimulation was 1.3V, 40 Hz and 2 msec. When the pancreatic secretion returned to the level before the electrical stimulation, cervical vagotomy (11 rats) or administration of propranolol (11 rats) in a dose of 0.1 mg/kg through the jugular vein was carried out. Ten minutes after the treatment, the electrical stimulation of the reticular formation was repeated. The brain was fixed by perfusion of 10% formaline solution through the heart, and then placement of the electrode tip was examined histologically. Protein concentration and amylase activity in samples of Pancreatic secretion were measured. The electrical stimulation of the reticular formation significantly increased in volume $({\mu}l/10\;min)$, Protein output $({\mu}g/10\;min)$ and amylase output (U/10 min) in the pancreatic secretion. The stimulatroy effects were not affected by the cervical vagotomy but completely abolished by propranolol. Meantime, it was also observed that both vagotomy and propranolol significantly reduced the pancreatic secretory function. These results indicate that the reticular formation in the mesencephalone may exert a stimulatory effect upon the Pancreatic secretory function not through the vagus nerve but through the sympathetic pathway in anesthetized rats.

• Journal of Gastric Cancer
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• v.8 no.1
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• pp.20-26
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• 2008

Purpose: Pylorus-preserving gastrectomy (PPG), which retains pyloric ring and gastric function, has been accepted as a function-preserving procedure for early gastric cancer for the prevention of postgastrectomy syndrome. This study was compared laparoscopy-assisted pylorus-preerving gastrectomy (LAPPG) with laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction (LADGB I). Materials and Methods: Between November 2006 and September 2007, 39 patients with early gastric cancer underwent laparoscopy-assisted gastrectomy in the Department of Surgery at Korea Cancer Center Hospital. 9 of these patients underwent LAPPG and 18 underwent LADGBI. When LAPPG was underwent, we preserved the pyloric branch, hepatic branch, and celiac branch of the vagus nerve, the infrapyloric artery, and the right gastric artery and performed D1+$\beta$ lymphadenectomy to the exclusion of suprapyloric lymph node dissection. The distal stomach was resected while retaining a $2.5{\sim}3.0\;cm$ pyloric cuff and maintaining a $3.0{\sim}4.0\;cm$ distal margin for the resection. Results: The mean age for patients who underwent LAPPG and LADGBI were $59.9{\pm}9.4$ year-old and $64.1{\pm}10.0$ year-old, respectively. The sex ratio was 1.3 : 1.0 (male 5, female 4) in the LAPPG group and 2.6 : 1.0 (male 13, female 5) in the LADGBI group. Mean total number of dissected lymph nodes ($28.3{\pm}11.9$ versus $28.1{\pm}8.9$), operation time ($269.0{\pm}34.4$ versus $236.3{\pm}39.6$ minutes), estimated blood loss ($191.1{\pm}85.7$ versus $218.3{\pm}150.6\;ml$), time to first flatus ($3.6{\pm}0.9$ versus $3.5{\pm}0.8$ days), time to start of diet ($5.1{\pm}0.9$ versus $5.1{\pm}1.7$ days), and postoperative hospital stay ($10.1{\pm}4.0$ versus $9.2{\pm}3.0$ days) were not found significant differences (P>0.05). The postoperative complications were 1 patient with gastric stasis and 1 patient with wound seroma in LAPPG group and 1 patient with left lateral segment infarct of liver in the LADGB I group. Conclusion: Patients treated by LAPPG showed a comparable quality of surgical operation compared with those treated by LADGBI. LAPPG has an important role in the surgical management of early gastric cancer in terms of quality of postoperative life. Randomized controlled studies should be undertaken to analyze the optimal survival and long-term outcomes of this operative procedure.

• Tuberculosis and Respiratory Diseases
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• v.49 no.4
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• pp.486-494
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• 2000

Background : The dominant innervation of airway smooth muscle is parasympathetic fibers which are carried in the vagus nerve. Activation of these cholinergic nerves releases acetylcholine which binds to $M_3$ muscarinic receptors on the smooth muscle causing bronchocontraction. Acetylcholine also feeds back onto neuronal $M_2$ muscarinic receptors located on the postganglionic cholinergic nerves. Stimulation of these receptors further inhibits acetylcholine release, so these $M_2$, muscarinic receptors act as autoreceptors. Loss of function of these $M_2$ receptors, as it occurs in animal models of hyperresponsiveness, leads to an increase in vagally mediated hyperresponsiveness. However, there are limited data pertaining to whether there are dysfunctions of these receptors in patients with asthma. The aim of this study is to determine whether there are dysfunction of $M_2$ muscarinic receptors in asthmatic patients and difference of function of these receptors according to severity of asthma. Method : We studied twenty-seven patients with asthma who were registered at Pulmonology Division of Korea University Hospital. They all met asthma criteria of ATS. Of these patients, eleven patients were categorized as having mild asthma, eight patients moderate asthma and eight patients severe asthma according to severity by NAEPP Expert Panel Report 2(1997). All subjects were free of recent upper respiratory tract infection within 2 weeks and showed positive methacholine challenge test ($PC_{20}$<16mg/ml). Methacholine provocation tests were performed twice on separate days allowing for an interval of one week. In the second test, pretreatment with the $M_2$ muscarinic receptor agonist pilocarpine($180{\mu}g$) through inhalation was performed be fore the routine procedures. Results : Eleven subjects with mild asthma and eight subjects with moderate asthma showed significant increase of $PC_{20}$ from 5.30$\pm$5.23mg/ml(mean$\pm$SD) to 20.82$\pm$22.56mg/ml(p=0.004) and from 2.79$\pm$1.51mg/ml to 4.67$\pm$3.53mg/ml(p=0.012) after pilocarpine inhalation, respectively. However, in the eight subjects with severe asthma significant increase of $PC_{20}$ from l.76$\pm$1.50mg/ml to 3.18$\pm$4.03mg/ml(p=0.161) after pilocarpine inhalation was not found. Conclusion : In subjects with mild and moderate asthma, function of $M_2$ muscarinic receptors was normal, but there was a dysfunction of these receptors in subjects with severe asthma. ηlese results suggest that function of $M_2$ muscarinic receptors is different according to severity of asthma.