T1b 병기의 신세포암에서 수술 후 예후를 예측할 수 있는 임상 및 병리학적 인자에 대한 연구

오승용, 김영원, 윤형윤, 서성필, 이상근, 김원태, 윤석중, 이상철, 김원재, 김용준 충북대학교 의과대학 충북대학교 의학연구소 2014 忠北醫大學術誌 Vol.24 No.1

연구목적: T1병기의 국소신세포암(localized clear-cell renal cell carcinoma)은 근치적신적출술이 나 부분신절제술이 표준치료이며 수술 후 타 병기에 비해 양호한 예후를 보인다. 하지만, 많은 수의 환 자에서 추적관찰 중 재발 및 사망이 발생하는데, 이는 T1b 병기에서 더 높게 보고되고 있다. 본 연구 에서는 국소신세포암 중 T1b 병기의 신세포암에서 표준적 치료 후 환자의 예후에 영향을 주는 임상 및 병리학적 인자에 대하여 알아보고자 하였다. 대상 및 방법: 1999년부터 2011년 까지 5개 기관에서 근치적신적출술이나 부분신제술을 시행 받은 3567명의 국소신세포암 환자들 중 병리학적 병기가 T1b로 확진 된 702명을 대상으로 하였다. 이들 환자가 가지는 임상 및 병리학적 특성 [연령, 성별, 고혈압, 당뇨, 비만도, European Cooperative Oncology Group(ECOG) 수행도, 증상유무, 수술방법, 종양크기, 분화도, 조직학적 형태 등]을 이용 하여 환자의 예후 [무재발생존율(relapse-free survival), 암특이생존율(cancer-specific survival) 및 전체생존율(overall survival)]에 영향을 미치는 인자에 대하여 다양한 방법으로 비교분석 하였다. 결과: 추적 관찰 기간은 34.0개월 (중앙값, 0-152개월)이었으며, 이 기간 중 재발, 사망 및 암특이사 망은 각각 72례 (10.3%), 57례 (8.1%) 및 24례 (3.4%)에서 발생하였다. 단변량 및 다변량 Cox 비례위험회귀분석에서 다양한 인자들이 무재발생존율(당뇨 유무, 종양크기 및 Fuhrman등급), 암특이 생존율(나이, 체질량지수, 당뇨 유무, 종양크기) 및 전체생존율(나이, 체질량지수, ECOG 수행도, 종 양크기)에 영향을 줄 수 있는 독립적 예후인자였다. 결론: 본 연구결과 국소신세포암의 예후를 예측할 수 있는 다양한 임상 및 병리학적 인자를 확인 할 수 있었다. 이러한 위험인자를 가지고 있는 환자는 보다 적극적인 추적관찰을 통하여 재발을 조기에 발 견한다면 이들의 생존율 향상에 많은 기여를 할 수 있을 것으로 생각한다.

2축 서보시스템을 위한 위치제어장치 설계

김기택,김형중,장석호 江原大學校 産業技術硏究所 1991 産業技術硏究 Vol.11 No.-

In this study, we design a position controller or two axis servo system.The position controller performs numerical control(NC)to DC or AC servo motor or step motor, and also has a digital input output sequence capability. The control program composed of position and sequence command, which is called channel, is programed easily and user interactivtively. And it is interpreted and the straight line and are position command iinterpolated . We develop the Z80 microprocessor based system and the software with assembly and Clanguage, and also PC based graphic simulator for the debugging and educational purposes.

응급실 난동환자에 대한 연구

김성중,장석준,이한식 大韓應急醫學會 1992 대한응급의학회지 Vol.3 No.1

Authors have reviewed emergency room violentee for 6 months and obtained following results; 1) Of violentees in the emergency room, male was 4 times much as female and a high incidence in third and fourth decade. 2) Traumatic patients were more violent than non-traumatic patients. Among traumatic: patients, assault was highest. The departmental distribution was Orthopedic Surgery, Internal Medicine and Plastic Surgery in order. 56 patients (21.2%) was drunken status. 3) The emergency room violence occured mostly in the night shift. 4) Patient caused more violence than a guardient. It happened mostly in front of the nursing station and in the emergency care unit. 5) The most of violence happened within 30 minutes in arrival. 6) The leading cause of violence was the delay of laboratory study and treatment. 7) The violence was mostly verbal abuse to the ED nurse. 8) Sixteen cases were reported to the police and they react in average 23 minutes. It is important to know the nature of the violent in emergency room. It helps in dealing with them and makes us realize about the education and training to the emergency personnels. It is necessary to solve the problems faced in the emergency deparment not only administrative and financial aids but also further study and endeaver of the emergency personnel.

계층분석기법을 이용한 하수관거 결합항목별 가중치 산정

김응석,이정호,김중훈 대한상하수도학회 2003 상하수도학회지 Vol.17 No.2

In domestic sewer rehabilitation works, the numerical weighting based on number of sewer defect is used to determine the propriety of rehabilitation order. In case of the decision standard in each defect contents of inside and outside of the country, the weight for determining sewer rehabilitation order is composed of several distribution of marks, not considering the weight in each sewer defects. In this study, the fifteen defect contents are determined suitable for domestic situation based on the sewer defect data of inside and outside of the country. Also, we select persons in charge of the business to calculate the detail weight and pose questions about important level of each sewer defect contents. The results of using Delphi method which is a question survey method apply the AHP and calculate the weight in each sewer defect. The appropriate marks matrix of sixteen sewer defects is made for laying precise decision standard of sewer condition through the result of analysis. The marks matrix of sixteen sewer defects can solve the complicated decision making problems of sewer rehabilitation works.

U343 교종 세포주에서 GFAP와 Fascin과의 상호작용

김동석,박승우,김태곤,이규성,최중언 The Korean Neurosurgical Society 2004 Journal of Korean neurosurgical society Vol.35 No.5

척추강내에 발생한 선천성 표피양 낭종

김용배,허륭,김동석,윤도흠,최중언 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.3

토목공사 정보관리를 위한 Uniclass 시스템의 활용성 분석

김창학,곽중민,강정호,강인석 진주산업대학교 2000 산업과학기술연구소보 Vol.- No.7

A standardized construction information classification system is essential for organizing construction CALS and CM. In 1997, Uniclass system was developed for superseding CI/SfB system that was being used as a representative WBS. Uniclass system is organized on the basis of ISO frame and consists of tables for classifying information related to construction management and electronic commerce. This study was implemented for the analysis of applicability of Uniclass system, comparing with CI/SfB system, as a WBS for the construction CALS. This study suggests a alternative table of Uniclass to improve applicability in practical use. Uniclass system was analyzed as the best classification system for the civil engineering project among the existing systems, howewer, the classified items for CM and construction CALS need to be modified with more detailed items.

간과된 건성 추지의 수술적 치료

김융성,서중배,이석재,홍장수 충북대학교 의학연구소 2001 忠北醫大學術誌 Vol.11 No.2

연구목적 . 손상 후 3주 이상 경과된 건성 추지에 대하여 tuft를 만들어 주고 신전상태에서 K-강선으로 고정하는 수술적 치료 방법의 유용성을 분석하고자 하였다. 대상 및 방범: 1997년 8월부터 2001년 3월까지 본 교실에서 건성 추지로 치료받은 예 중 손상 후부터 3주 이상 경과된 환자 11예를 대상으로 하였다. 평균 추시 기간은 7개월(3개월-9개월)이었으며, 평균 연령은 19세(2년 3개월-48세)였다. 11예 중 4예는 15세 미만의 소아였다. 수상 후 수술까지 경과된 기간은 평균 12개월(3주-7년)이었다. 우측 수부가 7예였고, 좌측은 4예였다 수지 별로는 인지가 3예, 중지가 4예, 약지가 2예, 소지가 2예였다. 모든 예에서 신전건의 절단, K-강선에 의한 원위지 관절의 고정, tuft의 형성, Roll-stitch 등의 동일한 방법을 사용하였으며, 최종 추시일에 Crawford 평가방법을 사용하여 환자를 평가하였다. 결과: Crawford의 방법을 이용한 평가 결과, 11예 중 7예(64%)가 우수(Excellent)의 결과를 보였고, 3예(27%)는 우량(Good), 1예(9%)는 양호(Fair)로 판명되었다. 즉 11예 중 1예를 제외하고는 모두, 즉 91%에서 만족스런 결과를 얻었다 우량 또는 양호의 결과를 보였던 4예의 경우 수상 후 경과된 기간이 각각 4개월, 9개월, 3년, 7년으로 수상 후 경과된 기간이 길수록 결과가 나빴다. 15세 미만의 소아 4예는 모두 우수한(Excellent) 결과를 보였고, 반면에 양호로 판정된 환자는 연령이 48세로 대상 환자 중 가장 고령이었다. 손상된 수지가 좌측이거나 우측인지 여부와 몇 번째 수지인지 여부는 결과와 무관한 것으로 보인다. 성별과도 관련성을 알 수 없었다. 결론: 손상 후 상당기간이 경과한 후에도 비교적 간단한 수술 방법에 의한 치료가 가능하였으며, 결과도 만족스러웠으나, 지나치게 오래된(손상 후 수 개월 이상이 경과한) 건성 추지의 경우, 그리고 나이가 많은 경우 예후가 좋지 않다는 사실을 알게 되었다. Purpose : The authors have attempted to analyze the effectiveness of making tuft and fixing the distal interphalangeal joint in extension with a K-wire in patients whose injured finger were left over 3 weeks without treatment for the tendinous mallet finger. Materials and Methods : Eleven fingers of eleven patients were analyzed who were treated operatively from August 1997 to March 2001. The average follow-up period was 7 months(3-9 months). The average age of the patients was 19 years(2 years 3 months-48 years) Four out of the 11 cases were children under age of 15. The average duration between injury and operation was 12 months(3 weeks-7 years) . All cases were treated by only one surgeon(Seo, JB) and with same procedure, just cutting and reattaching the extensor tendon tightly(tuft) and fixing the joint in extension. Crawford method was used for evaluating the patients. Results : Ten out of eleven patients(91%) came out to be satisfactory according to Crawford method. Excellent in 7 cases, good in 3, fair in 1, respectively. Four patients whose duration between injury and surgery seemed to be too long(4 months, 9 months, 3 years, 7 years respectively), have not showed excellent results. Excellent results were reported in all children. On the contrary, the age of the patient who had the poorest result was 48 years(the oldest in our series) Which hands or which fingers were injured seemed to have not made any differences. So as the surgery was performed earlier and the patients were younger, the results were better. Conclusion : We advocate that it is possible to treat operatively and to get good results in Patients with neglected mallet finger deformities. But it should be emphasized that the earlier the operation is performed, and the younger the patients are, the better the results are.

성인 만성 부비동염에서 내시경적 부비동 수술 전·후의 증상 호전도와 음향비강통기도 검사 결과

김용대,김재열,장근영,이형중,송시연,윤석근 영남대학교 의과대학 2002 Yeungnam University Journal of Medicine Vol.19 No.1

Background: Chronic paranasal sinusitis is one of the most common disease in the otorhinolaryngologic field. Endoscopic sinus surgery is treatment of choice in chronic paranasal sinusitis. The aim of this study was to evaluate objective and subjective treatment outcomes of endoscopic sinus surgery in adult chronic paransal sinusitis with or without polyp. Materials and Methods: We reviewed 84 adult patients underwent endoscopic sinus surgery by one surgeon from June 1999 to June 2000, prospectively. We analyzed preoperative and postoperative subjective symptom scores and acoustic rhinometric results. Results: Fifty cases were male and thirty four cases female. The average age was of 33 year-old (range: 17 to 66 years). There was significantly improvement of symptom scores in postoperative 3 months and 6 months compared with preoperative symptom scores. There was significantly increased postoperative total volume of nasal cavity. When we compared high score group with low score group, there was statistically significant improvement of symptom scores between preoperative stage and postoperative 3 months in radiologic grading group. Conclusion: Endoscopic sinus surgery is considered to be effective for the treatment of chronic paranasal sinusitis. It seems to be helpful to employ subjective symptom score system and objective total volume change of nasal cavity through acoustic rhinometric test to analyze effectiveness of endoscopic sinus surgery. In this study, the most important preoperative factor of sinus surgery outcomes is radiologic grading system.

사망 진단서(시체 검안서) 작성의 문제점

김규석,임용수,이중의,서길준,윤여규,어은경,염석란,정연권,이윤성 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4

Background: This study was conducted to analyze the current problems in completing death certificates and to identify the correct method for completing death certificates Methods: We reviewed 262 death certificates in three hospitals from March 1 to April 30, 2000, and 119 death certificates in one hospital from March 1 to 31, 2000. We identified major and minor errors and analyzed and compared them retrospectively. Results: A total of 381 death certificates were reviewed: 59 in Seoul National University Hospital,101 in Ewha Woman's University Hospital, and 102 in Gachon Medical College Hospital, which has no education program for completing death certificates in postgraduate training, and 119 in Samsung Medical Center which has an education program for completing death certificates. 358 certificates(94.0%) had at least one error. There were only 23 death certificates(6.0%) without an error. In 182 cases(47.8%), there was one major error. In 321 death certificates(84.3%), there were more than two errors. A comparison of Samsung Medical Center with the other hospitals showed that the number of total errors was statistically different(p=0.001). Conclusion: There were few death certificates without an error in this study. In a hospital which has postgraduate training in completing death certificates, there are fewer errors than in other hospitals which have no training course. Emergency physicians actually certify many deaths, so they must know the correct method of completing death certificates for statistics on morbidity and mortality.