• Journal of Chest Surgery
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• 제33권8호
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• pp.662-668
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• 2000

Background: Many recent results of clinical trials show that pre-operative concurrent chemoradiotherapy and surgical resection could increase the survival of N2 positive stage IIIA non-small cell lung cancer. This study was performed to assess the feasibility, toxicity, and affect rates of concurrent chemoradiotherapy and surgical resection in N2 positive stage IIIA non-small cell lung cancer. Material and Method: Thirty-one patients who underwent preoperative concurrent chemoradiotherapy for N2 positive stage IIIA non-small-cell lung cancer from May 1997 to April 1999 were entered into the study. Mean age was 61 yrs(43∼70 yrs), There were 24 men and 7 women. The confirmation of N2 disease were achieved through mediastinoscopic biopsy(24) and CT scans(7). Induction was achieved by two cycles of cisplatin and etoposide(EP) plus concurrent chest radiotherapy to 45 Gy. Resections were done at 3 weeks after the complection of preoperative concurrent chemoradiotherapy. Resections were performed in 23 patients, excluding 5 refusals and 3 distant metastasis. Result: All patients were compled the thoracic radiotherapy except one who had distant metastasis. Twenty three patients were completed the planned 2 cycles of EP chemotherapy, and 8 patients were received only 1 cycle for severe side effects(6), refusal(1), and distant metastasis(1). There was one postoperative mortality, and the cause of death was ARDS. Three patients who had neutropenic fever and one patient who had radiation pneumonitis were required admission and treatment. Esophagitis was the most common acute side effect, but relatively well-tolerated in most patients. The complection rate of concurrent chemoradiotherapy was 74%, resection rate was 71%, pathologic complete remission rate was 13.6%, and pathologic down-staging rate was 68%. Conclusion: Morbidity related to each treatment was acceptable and many of the patients have benefited down staging of its disease. Further prospective, preferably randomized, clinical trials of larger scale may be warranted to confirm the actual benefit of preoperative concurrent chemoradiotherapy and surgical resection in N2-positive stage IIIA non-small cell lung cancer.

• Journal of Chest Surgery
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• 제45권4호
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• pp.236-241
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• 2012

Background: Prolonged usage of extracorporeal membrane oxygenation (ECMO) may induce multi-organ failure. This study is aimed to evaluate prognostic factors in the patients with ECMO. Also, the prognosis of ECMO with Kidney Injury Network Scoring system is studied. Materials and Methods: From May 2005 to July 2011, 172 cases of ECMO were performed. The cases of perioperative use of ECMO were excluded. Renal failure patient and younger than 15 years old one were also excluded. As a result, 26 cases were enrolled in this study. Male patients were 15 (57.7%), and mean age was $56.57{\pm}17.03$ years old. Demographic data, ECMO parameters, weaning from ECMO, and application of continuous renal replacement therapy are collected and Acute Kidney Injury Network (AKIN) scores were evaluated just before ECMO and day 1, day 2 during application of ECMO. Results: Venoarterial ECMO was applied in 22 cases (84.6%). The reasons for applications of ECMO were cardiac origin in 21 (80.8%), acute respiratory distress syndrome in 4, and septic shock in 1 case. Successful weaning from ECMO was achieved in 15 cases (57.7%), and survival discharge rate was 9 cases (34.6%). Mean duration of application of ECMO was $111.39{\pm}54.06$ hours. In univariate analysis, myocarditis was independent risk factors on weaning failure. Using the receiver operating characteristic curve, level of hemoglobin on 24 hours after ECMO, and base excess on 48 hours after ECMO were showed more than 0.7. AKIN score was not matched the prognosis of the patients with ECMO. Conclusion: In our study, the prognosis of the patients with myocarditis was poor. Hemoglobin level at first 24 hours, and degree of acidosis at 48 hours were useful methods in relating with prognosis of ECMO. AKIN scoring system was not related with the prognosis of the patients. Further study for prognosis and organ injury during application ECMO may be needed.

• Journal of Chest Surgery
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• 제40권10호
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• pp.685-690
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• 2007

배경: 상부 식도암에 대한 종래의 표준적 치료는 방사선 조사였으나 결과는 만족스럽지 않았으며, 아직도 수술적 치료를 적용하는 데에는 의견의 차이가 있다. 저자들은 상부식도암에 대하여 수술적 치료를 적극적으로 시행하여 왔으며, 그의 효과를 분석해 보고자 하였다. 대상 및 방법: 1995년부터 2005년까지 저자들이 수술을 시행한 식도암 증례는 모두 147예였으며, 이들을 상부 식도암(경부 및 상흉부 식도암) 23예와 하부 식도암(중, 하흉부 및 복부 식도암) 124예의 2군으로 구분하여, 수술의 완전 절제율과 수술의 합병증 및 사망률, 재발률,그리고 생존율 등을 비교함으로써 양군에서의 수술의 유용성을 비교해 보았다. 결과: 양 군 간에 병기 분포는 유사하였으며, 완전 절제율에서도 유의한 차이를 발견할 수 없었다. 수술의 합병증 발생률은 상부 식도암군에서 유의하게 높았으나(39.1% vs 16.9%, p<0.05), 수술 사망률이나 재발률 및 장기 생존율에서의 차이는 없었다. 결론: 양 군 간에 수술 사망률이나 수술의 효과 면에서 차이가 없어 상부 식도암에서도 수술적 치료는 유용하다고 판단되었으나, 향후 보다 많은 증례의 분석이 필요할 것이라고 생각한다.

• The Korean Journal of Pain
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• 제1권1호
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• pp.47-52
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• 1988

Since 1979 forty-three cancer patients have been given intrathecal block at the pain clinic of Yonsei Medical Center. The male patients numbered 23 and female 20 and most of them were in the 4th and 5th decades of age. In 78.6% of the patients, the diagnosis was rectal cancer in 20 cases, cervix cancer in 7 cases, bladder cancer in 4 cases and colon cancer in 3 cases. Thirty six patients with cancer pain were treated by intrathecal 10% phenol-glycerine block and rest of them had only test block. Fourteen patients whose pain sites were lumbar or lumbar and upper sacral dermatomes were put into the lateral recumbent position on the fluoroscopic table. The spinal puncture was performed as close to the spinal roots to be impregnated as possible. In 22 patients the pain sites were covered by the sacral dermatomes and so the L5-S1 interspace was punctured in the sitting position shifted 15 degree to the affected site. Fifty one blocks were performed and their results are classified into three categories: good, fair antral poor. We achieved good results in 38 patients(77.1%), fair in 6 patients(17.1%) and poor in 2 patient(5.7%). Thus a satisfactory pain relief was achieved in 94.2% of patients. After intrathecal block with phenol glycerine, transient voiding difficulty was noted in 7, defecation difficulty in 1, and transient paresthesia and/or muscle weakness was present in 3 patients. The mean duration of pain relief was 2.5 months and longer than the mean survival time of 2.25 months. When patients are selected carefully and tile block is performed with great caution and good technique, the risk is minimal and a long lasting relief of intractable cancer pain achieves a painless life until death.

• 한국재난정보학회 논문집
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• 제7권4호
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• pp.266-272
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• 2011

광주 전남지역 전문대학 경호학과 학생 120명을 대상으로 Skill Reporter Mannequin을 이용한 심폐소생술 교육전과 교육후의 심폐소생술 술기 정확도 평가를 실시하였으며 심폐소생술 교육의 만족도를 측정하였다. 조사대상자의 일반적인 특성은 남학생과 여학생이 각각 94명(78.3%)과 26명(21.7%)이었고 학년별로는 1학년 66명(55.0%), 2학년이 54명(45.0%)이었다. 심폐소생술 교육전 인공호흡의 술기는 $26.04{\pm}9.26$에서 교육후 $91.25{\pm}6.68$로 높아져 많은 차이가 있는 것으로 나타났으며(p<0.01) 기본 심폐소생술 교육전 흉부압박의 술기는 $24.33{\pm}8.55$이었으나 교육후 $91.50{\pm}5.25$로 높아져(p<0.01) 심폐소생술 교육은 전문대학 경호학과 학생들의 심폐소생술 술기에 많은 효과가 있음을 알 수 있었다. 남학생의 심폐소생술 교육 만족도는 $4.33{\pm}0.59$, 여학생은 $3.73{\pm}0.67$의 수치를 보여 남학생이 통계적 유의수준 하에서 심폐소생술 교육 만족도가 더 높은 것으로 나타났다(p<0.01). 심폐소생술 교육의 효과를 극대화할 수 있도록 심폐소생술 교육 프로그램 개발과 대학 경호학과의 교육과정에 심폐소생술 내용을 추가하여 교육이 이루어질 수 있도록 하여야 하며, 이에 따르는 교육 공간 및 실습기자재의 확보 등 다양한 정책이 수립되어야 할 것으로 판단된다.

• Journal of Hospice and Palliative Care
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• 제12권4호
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• pp.177-193
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• 2009

완화의학에서 환자의 평가는 치료의 의사결정과 그 결과에 이르기까지 중요한 역할을 한다. 평가도구의 사용 목적은 이를 환자 진료에 반영하여 개개인 환자와 가족들에 대한 돌봄의 질을 높이는 데 있다. 환자의 기능 상태와 통증 및 비 통증 증상을 평가하는 다양한 단일 영역 및 다차원 평가 척도들이 사용 가능하며, 삶의 질을 측정하는 다양한 도구들이 존재한다. 삶의 질이나 증상 측정에서 우월하다고 추천되는 단일 도구는 없는 실정이다. 도구마다 측정하는 시간의 틀이 다르고, 특성이 다르므로 사용 목적과 상황에 따라 적절한 도구를 선택하여야 한다. 여명 예측을 위해서는 예후 지수의 병용이 권고되는 추세이고, 웹을 기반으로 하는 예측 프로그램들도 등장하였다. 예후지수로는 최근 우리나라에서 다기관 연구를 통해 개발한 객관적 예후지수가 임상적인 여명 예측을 포함하지 않으면서 새로운 객관적인 예후 요인을 반영하여, 누구나 쉽게 사용이 가능하다. 완화의학 입문자의 경우 상대적으로 사용이 용이한 도구가 좋다. 따라서 기능의 평가에는 Eastern Cooperative Oncology Group 기능지수를 사용하고, 통증에서는 10점만점의 숫자 통증 등급(Numeric Rating Scale) 도구를 활용하면서 초기 통증 평가로는 간이 통증 조사지를 추천한다. 여러 가지 증상을 한꺼번에 측정하기 위해서는 숫자 등급으로 직접 물어보거나 혹은 M.D. Anderson 증상조사지(the Korean version of MD Anderson Symptom Inventory) 설문지를 사용하기 바란다. 삶의 질을 평가하는데에는 European Organization Research and Treatment Quality of Life Questionnaire Core 15 for Palliative Care, 예후 지수로는 객관적 예후 지수(Objective Prognostic Score)를 사용하기를 권한다. 향후 완화의학에서 평가도구의 발전방향은 국제 공동 연구의 활성화와 디지털 기기를 통한환자 보고의 전산화이고, 머지않은 앞날에 우리나라에도 이러한 경향이 도입될 것이다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제39권6호
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• pp.274-282
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• 2013

Objectives: The posterior maxillary region often provides a limited bone volume for dental implants. Maxillary sinus elevation via inserting a bone graft through a window opened in the lateral sinus wall has become the most common surgical procedure for increasing the alveolar bone height in place of dental implants in the posterior maxillary region. The purpose of this article is to assess the change of bone volume and the clinical effects of dental implant placement in sites with maxillary sinus floor elevation and autogenous bone graft through the lateral window approach. Materials and Methods: In this article, the analysis data were collected from 64 dental implants that were placed in 24 patients with 29 lacks of the bone volume posterior maxillary region from June 2004 to April 2011, at the Department of Oral and Maxillofacial Surgery, Inha University Hospital. Panoramic views were taken before the surgery, after the surgery, 6 months after the surgery, and at the time of the final follow-up. The influence of the factors on the grafted bone material resorption rate was evaluated according to the patient characteristics (age and gender), graft material, implant installation stage, implant size, implant placement region, local infection, surgical complication, and residual alveolar bone height. Results: The bone graft resorption rate of male patients at the final follow-up was significantly higher than the rate of female patients. The single autogenous bone-grafted site was significantly more resorbed than the autogenous bone combined with the Bio-Oss grafted site. The implant installation stage and residual alveolar height showed a significant correlation with the resorption rate of maxillary sinus bone graft material. The success rate and survival rate of the implant were 92.2% and 100%, respectively. Conclusion: Maxillary sinus elevation procedure with autogenous bone graft or autogenous bone in combination with Bio-Oss is a predictable treatment method for implant rehabilitation.

• Journal of Periodontal and Implant Science
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• 제36권3호
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• pp.683-691
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• 2006

This study is an analysis of distribution of patients who installed Implantium implant in Yonsei University Dental Hospital and types of implant site for about 1 years recall check and success rate. 164 implants were installed to 52 patients in this study. It shows the conclusion below. 1. Patients at the age of 40s and 50s were 65% of all implant cases and average number of implant was 4 (man), and 2.7 (woman). 75 implants were operated on maxilla and 89 were mandible. 19 implants on anterior region and 145 implants on posterior region. 2. Most distribution of bone qaulity for implant site was type III(37.2%) and bone quantity was type C(61. 7%) 3. The majority of implants were those of 10, 12mm in length (85%) and regular diameter in width (48.8%). 4. 30 implants were installed with the advanced technique-GER, window opemng, osteotome technique. 5. Two implants were removed before prosthodontic treatment due to the osseointegraton failure. The success rate was 98.8% in 15.2 months follow up period and the marginal bone loss was 0.28mm. The results provided us with basic data on patient type, implant distribution, bone condition, and survival rate. Within the limit of present study, It was concluded that Implantium implant could be used satisfactorily in various clinical situations.

• 디지털융복합연구
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• 제12권11호
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• pp.249-256
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• 2014

암 진단 및 치료 기술의 발달과 조기 검진으로 암 치료 후 장기간 생존하는 대상자들이 증가하여 기대수명이 증가하고 이에 따른 암환자의 유병률이 증가하여, 건강관리행태와 삶의 질이 중요성이 부각되고 있다. 일반인과 암환자의 건강관리행태를 삶의 질 측정도구인 EQ-5D(European Quality of Life-5 Dimensions)와 흡연, 음주 등 인구 사회학적 변수, 건강관리행태 등을 다중회귀분석으로 상관관계를 분석하여 입증하였다. 분석 결과 암환자의 삶의 질은 일반인보다 좋지 않았고 자궁경부암, 폐암의 경우 삶의 질이 매우 좋지 않았다. 결론적으로 암은 삶의 질을 저하시키는 영향을 주고 있다. 암환자에게 흡연과 음주는 상관관계가 있는 주요 요인이고 일반인에 비해 암환자는 흡연을 덜 하는 것으로 나타났다. 신체활동에서도 암환자보다 일반인의 운동시간이 많았다. 이는 암환자에게 건강관리행태와 삶의 질의 중요성을 인식시키고 중요성을 규명하여 삶의 질을 증진시키는 프로그램과 효과적인 PHR(Personal Health Records) 서비스 개발의 자료로 사용할 수 있다.

• Radiation Oncology Journal
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• 제36권4호
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• pp.285-294
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• 2018

Purpose: To determine the necessity of postmastectomy radiotherapy (PMRT) and which regions would be at risk for recurrence, we evaluated local and regional recurrence in breast cancer patients with 1-3 positive nodes and a tumor size of <5 cm. Materials and Methods: We retrospectively analyzed data of 133 female breast cancer patients with 1-3 positive nodes, and a tumor size of <5 cm who were treated with mastectomy followed by adjuvant systemic therapy between 2007 and 2016. The median follow-up period was 57 months (range, 12 to 115 months). Most patients (82.7%) were treated with axillary lymph node dissection. Adjuvant chemotherapy, endocrine therapy, and trastuzumab therapy were administered to 124 patients (93.2%), 112 (84.2%), and 33 (24.8%), respectively. The most common chemotherapy regimen was anthracycline and cyclophosphamide followed by taxane (71.4%). Results: Three patients (2.3%), 8 (6.0%), and 12 (9.0%) experienced local, regional, and distant failures, respectively. The 5-year cumulative risk of local recurrence, regional recurrence, distant metastasis, and disease-free survival was 3.1%, 8.0%, 11.7%, and 83.4%, respectively. There were no statistically significant clinicopathologic factors associated with local recurrence. Lymphovascular invasion (univariate p = 0.015 and multivariate p = 0.054) was associated with an increased risk of regional recurrence. Conclusion: Our study showed a very low local recurrence in patients with 1-3 positive nodes and tumor size of <5 cm who were treated with mastectomy and modern adjuvant systemic treatment. The PMRT volume need to be tailored for each patient's given risk for local and regional recurrence, and possible radiation-related toxicities.