슬관절 등속성 운동시 근골격 모델의 검증:실험 및 모의실험 연구 : 실험 및 모의실험 연구 An Experimental and Simulatio study

배태수,강성재,최경주,김신기,유재욱,진미령,문무성 대한정형외과연구학회 2003 대한정형외과연구학회지 Vol.6 No.2

The Clinical Results of Thermo-Irradiation on the Locally Advanced Hepatoma with of without Hepatic Arterial Chemo-Embolization

Ryu,Mi Ryeong,Shin,Kyung Sub,Kang,Ki Mun,Jang,hong Seok,Yoon,Seung Kyoo,Kim,Sung Hwan,Kim,Boo Sung,Yoon,sei Chul 가톨릭중앙의료원 가톨릭암센터 1994 암심포지움 Vol.- No.2

Although follow-up duration was short, the thermoirradiation with/without hepatic arterial chemo-embolization was well tolerated and there were no serious complications. In future, it is considered the longer follow up and prospective, well controlled trials should be followed to evaluate the efficacies of survival advantage.

수술 후 국소재발한 자궁경부암에서의 방사선치료 성적

유미령(Mi Ryeong Ryu),계철승(Chul Seung Kay),강기문(Ki Moon Kang),김연실(Yeon Shil Kim),정수미(Su Mi Chung),남궁성은(Sung Eun Namkoong),윤세철(Sei Chul Yoon) 대한방사선종양학회 1999 Radiation Oncology Journal Vol.17 No.3

목 적 : 근치적 수술 후 국소재발한 자궁경부암 치료에 있어서 방사선치료의 역할 및 치료 결과에 영향을 미치는 인자들을 분석하고자 본 연구를 시행하였다. 대상 및 방법 : 1983년 10월부터 1996년 7월까지 가톨릭대학교 강남성모병원 치료방사선과에서 FIGO병기 I, II 자궁경부암의 근치적 수술 후 국소재발한 환자 중 방사선치료를 받았던 53명을 대상으로 치료결과에 대한 후향적 분석을 시행하였다. 환자의 연령은 33세에서 69세 사이(중앙값 53세)였으며, 병리조직학적 분류로는 편평상피암이 45명(84.9%), 선암이 7명(13.2%), 편평상피선암이 1명(1.9%)이었다. 수술 후 재발까지의 기간은 2 개월에서 25년 사이로 평균 34.4 개월이었다. 재발한 병소의 위치에 따라서 질 절제단(vaginal stump )이 41명(77.4%), 골반외벽(pelvic side wall)이 12명(22.6%)이었고, 재발한 병소를 크기에 따라 나누었을 때 3cm 이하인 경우가 43명(81.1%), 3 cm보다 큰 경우가 10명(18.9%)이었다. 방사선치료는 대부분 환자에서 전골반에 외부 방사선치료를 하루 1.8 Gy 의 양으로 주 5회씩 치료하여 46.8∼50.4 Gy 까지 치료한 후, 18명(34%)에서는 병소부위에 외 부방사선치료를, 24명(45.3%)의 환자에서는 강내근접치료를 각각 추가하여 총방사선량 46.8∼111 Gy(중앙값 70.2 Gy)까지 치료하였다. 추적조사 기간은 2 개월에서 153 개월 사이(중앙값 35 개월)였다. 결 과 : 방사선치료후 초기관해율은 66% (35/53) 이었고, 이 중 6명(17.1%)에서 방사선치료후 7 개월에서 116 개월사이(평균 47.7 개월)에 다시 국소재발하여 전체환자의 국소재발율은 45.3%였다. 전체환자의 5년 생존율은 78.9%였으며, 원격전이율은 10% (5/50)로 발생부위별로는 폐 2명, 뇌 1명, 원격 임파절 2명이었다. 생존율에 영향을 미치는 인자로는 수술후 재발까지의 기간( p=0.0055), 재발 병소의 크기( p=0.0039), 방사선치료에 대한 초기반응 유무( p=0.0428) 등으로 분석되었으며, 그 외에 초기 병기, 연령, 조직학적 유형, 재발병소의 위치, 방사선 조사량, 약물치료 유무 등은 영향이 없는 것으로 나타났다( p>0.05). 방사선치료의 합병증은 10명(20%)에서 발생하였으나, 대부분 경미하거나 중등도의 하부위장관 또는 비뇨기계, 피부 합병 증이었고, 한명이 강내 방사선치료 직후 폐전색증으로 사망하였다. 결 론 : 근치적 수술 후 국소재발한 자궁경부암 환자에서 방사선치료는 매우 효과적이며, 수술 후 재발까지의 기간, 재발병소의 크기, 방사선치료에 대한 초기반응 등이 예후에 영향을 미치는 인자로 나타났다. Purpose : To evaluate prognostic factors and survival rates of the patients who received radiation therapy for locally recurrent uterine cervical cancer after curative surgery. Materials and Methods : Between October 1983 and July 1996, fifty three patients who received radiation therapy for locally recurrent cervical cancer after curative surgery at the Department of Therapeutic Radiology, Kangnam St. Mary's Hospital, The Catholic University of Korea were analysed retrospectively. Age at diagn osis ranged from 33 to 69 years (median 53 years). Pathological analysis showed that forty five (84.9%) patients had squamous cell carcinoma, seven (13.2%) patients had adenocarcinoma, and one (1.9%) patient had adenosquamous cell carcinoma. The interval between hysterectomy and tumor recurrence ranged from 2 months to 25 years (mean 34.4 months). The recurrent sites were vaginal stump in 41 patients (77.4%) and pelvic side wall in 12 patients (22.6%). Recurrent tumor size was devided into two groups : less than 3 cm in 43 patients (81.1%) and more than 3cm in 10 patients (18.9%). External beam irradiation of whole pelvis was done first up to 46.8 Gy to 50.4 Gy in 5 weeks to 6 weeks, followed by either external beam boost to the recurrent site in 18 patient s (34%) or intracavitary irradiation in 24 patients (45.3%). Total dose of radiation ranged from 46.8 Gy to 111 Gy (median 70.2 Gy). Follow up period ranged from 2 to 153 months with a median of 35 months. Results : Overall response rate was 66% (35/53). Among them, six patients (17.1%) relapsed between 7 months and 116 months after radiation therapy (mean 47.7 months). Therefore overall recurrence rate was 45.3%. Overall five-year actuarial survival rate was 78.9% and distant failure rate was 10% (5/50). The significant prognostic factors affecting survival rate were interval between primary surgery and tumor recurrence ( p=0.0055), recurrent tumor size (p=0.0039), and initial response to radiation therapy (p=0.0428). Complications were observed in 10 (20%) patients, which included mild to moderate lower gastrointestinal, genitourinary, or skin manifestations. One patient died of pulmonary embolism just after intracavitary irradiation. Conclusion : Radiation therapy is the effective treatment for the patients with locally recurrent cervical cancer after curative surgery. These results suggest that interval between primary surgery and tumor recurrence, recurrrent tumor size, and initial response to radiation therapy were significant prognostic factors for recur rent cervical cancer.

절제 불가능한 췌장암의 고식적 방사선치료 결과

유미령(Mi-Ryeong Ryu),윤세철(Sei-Chul Yoon),김연실(Yeon-Sil Kim),정수미(Su-Mi Chung) 대한방사선종양학회 2006 Radiation Oncology Journal Vol.24 No.4

목 적: 췌장암은 진단 시 절제 불가능한 진행된 병변을 갖는 경우가 많으므로 방사선치료 시 고식적 증상완화의 효과 및 예후를 알아보고 영향을 미치는 인자에 대해 알아보고자 하였다. 대상 및 방법: 1984년 3월부터 2005년 2월까지 가톨릭대학교 강남성모병원에서 통증완화를 위한 고식적 방사선 치료를 받은 절제 불가능한 췌장암 환자 중 추적조사가 가능한 37명을 대상으로 치료결과 및 관련인자에 대하여 후향적 분석을 시행하였다. 환자의 성별은 남자 22명(59.5%), 여자 15명(40.5%)이었으며, 연령은 30세에서 80세 사이로 중앙값 57세였다. 진단 시 12명(32.4%)에서 간전이가 있었고, 22명(59.5%)에서 임파절 전이가 있었다. 방사선 치료는 종양 및 주변 임파절에서 1∼2 cm 범위까지 3,240∼5,580 cGy (중앙값 5,040 cGy)를 조사하였으며, 30명(81%)에서 항암화학요법을 병행하였는데 5-FU (fluorouracil) 단독을 투여한 경우가 21명이었고, 9명에서는 gemcitabine이 단독으로 또는 5-FU와 함께 투여되었다. 추적관찰기간은 1개월에서 44개월이었으며, 생존율 및 예후인자의 분석은 Kaplan-Meier 방법 및 Log-rank test를 이용하였다. 결 과: 전체환자의 평균 생존기간은 11개월, 중앙 생존기간은 8개월이었으며, 1년 생존율은 20%였다. 전체 환자중 33명에서 치료에 대한 반응을 평가할 수 있었는데, 7명(21.2%)에서 양호, 22명(66.7%)에서 보통의 반응을 보여 87.9%의 증상완화율을 나타냈다. 방사선치료의 부작용은 경증 및 중등도의 오심, 구토, 소화불량이 14명(37.8%)에서 나타났으나 치료의 중단을 요하는 중증의 부작용은 관찰되지 않았다. 항암화학요법은 방사선치료와 병행여부에 따라 생존율이나 증상의 고식정도에는 차이가 없는 것으로 나타났으며(p>0.05), 약제의 종류에 따라 gemcitabine 약제가 주가된 군에서 중앙생존기간이 12개월로 5-FU를 단독으로 투여한 군의 5.5개월보다 높은 것으로 나타났으나 통계적으로 유의한 차이를 보이지는 않았다(p>0.05). 예후에 영향을 미치는 인자로는 환자의 카르노프스키 활동도, 간전이 유무가 관련이 있는 것으로 나타났으며(p<0.05), 이외에 성별, 나이, 병변위치, 임파선 전이유무, CA19-9 수치는 관련이 없는 것으로 나타났다(p>0.05).결 론: 절제 불가능한 췌장암 환자에 있어서 방사선치료는 고식적 증상완화에 효과적이며, gemcitabine과 같은 항암화학요법과 더불어 다른 새로운 약제와 함께 생존율 향상에 역할을 할 것으로 기대되므로 앞으로 이에 대한 많은 연구가 필요할 것이다. Purpose: To evaluate the treatment results and prognostic factors of palliative radiation therapy in the patients with unresectable advanced pancreatic cancer. Materials & Methods: Thirty-seven evaluable patients with unresectable advanced pancreatic cancer who were treated by palliative radiation therapy for pain relief at the Department of Radiation Oncology, Kangnam St. Mary's hospital, the Catholic University of Korea between March 1984 and February 2005 were analysed retrospectively. There were 22 men and 15 women. Age at diagnosis ranged from 30 to 80 (median 57) years. Twelve patients (32.4%) had liver metastases and 22 patients (59.5%) had lymph node metastases. Radiation therapy was delivered to primary tumor and regional lymph nodes with 1∼2 cm margin, and total dose was 3,240∼5,580 cGy (median 5,040 cGy). Chemotherapy with radiotherapy was delivered in 30 patients (81%) with 5-FU alone (21 patients) or gemcitabine (9 patients). The follow-up period ranged from 1 to 44 months. Survival and prognostic factors were analysed using Kaplan-Meier method and log-rank test respectively. Results: Overall mean and median survival were 11 and 8 months and 1-year survival rate was 20%. Among 33 patients who were amenable for response evaluation, 7 patients had good response and 22 patients had fair response with overall response rate of 87.9%. Mild to moderate toxicity were observed in 14 patients with nausea, vomiting, and indigestion, but severe toxicity requiring interruption of treatment were not observed. Chemotherapy didn't influence the survival and symptomatic palliation, but the group containing gemcitabine showed a tendency of longer survival (median 12 months) than 5-FU alone group (median 5.5 months) without statistical significance (p>0.05). The significant prognostic factors were Karnofsky performance status and liver metastasis (p<0.05). Age, sex, tumor location, lymph node metastasis, and CA 19-9 level did not show any prognostic significance (p>0.05). Conclusion: Radiation therapy was effective for symptomatic palliation in the patients with unresectable advanced pancreatic cancer and would play an important part in the survival benefit with gemcitabine or other targeted agents.

The Results of Curative Radiation Therapy for 49 Patients of the Uterine Cervical Carcinomas

유미령(Mi Ryeong Ryu),김연실(Yeon sil Kim),최병옥(Byung Ock Choi),윤세철(Sei Chul Yoon),신경섭(Kyung Sub Shinn),남궁성은(Sung Eun Namkoong),김승조(Seung Jo Kim) 대한방사선종양학회 1992 Radiation Oncology Journal Vol.10 No.2

1983년 9월부터 1986년 10월 까지 37개월 동안에 강남성모병원 치료방사선과에서 50명의 자궁경부암 환자가 완치목적으로 골반부위에 외부방사선치료 및 자궁강내 방사선치료를 받았다. 외부방사선치료는 4500 cGy/5주에서 5940 cGy/6.5주를 골반부위에 먼저 시행하였고 강내방사선치료를 이어서 시행하였으며, A 점에 도달한 초 치료 선량은 6500 cGy에서 11344 cGy로 평균 6764 cGy 였다. 50명의 환자중 1명이 추적조사에서 제외되었으며, 나머지 49명의 환자를 대상으로 3개월에서 93개월 까지 추적조사하였는데, 중간 추적조사 기간은 32개월 이었다. FIGO 분류에 따라 병기별로 보면, 1기가 6명 (12.2%), 2a기가 6명 (12.2%), 2b기가 25명 (51%), 3기가 7명 (14%), 그리고 4기가 5 (10.2%)명 이었다. 환자의 나이는 33세에서 76세까지의 분포를 보였으며 (중앙 연령, 60세), 병리 조직학적 분류로는 편평상피암이 46명(94%), 선암이 2명(4%), 그리고 편평상피선암이 1명 (2%) 이었다. 전반적인 반응율은 84%였고, 5년 생존율은 49%였다. (병기별 5년 생존율은 1b기가 75%, 2a기가 83%, 2b기가 42.5%, 3기가 25%, 4기가 40%였다.) 합병증은 11명 (22.4%)에서 발생하였고, 직장내 합병증이 가장 흔한 합볍증이었으며, 나머지는 사소한 일과성의 자연치유되는 질환들이었다. 생존율과 여러 인자들 (나이, 방사선 치료선량, 헤모글로빈치, 골반임파절 전이상태, 전신상태, 그리고 국소 재발 유무) 광의 관련성에 대해 분석한 바, 나이와 국소재발유무를 제외하고는 모두 통계학적으로 유의하지 않게 나왔으며, 50세 미만의 생존율이 50세이상의 생존율보다 더 나빴고(p<0.05), 국소재발 존재시 생존율이 더 나빴다(ㅔ<0.05). Fifty patients with carcinoma of the uterine cervix received curative radiotherapy by external irradiation of the whole pelvis and intracavitary radiation at the Department of Therapeutic Radiology, Kangnam St. Mary's Hospital from September, 1983 to October, 1986. External beam whole pelvic irradiation was done first up to 4500-5940 cGy in 5 weeks to 6.5 weeks, followed by and intracavitary radiation. Total dose of radiation to point A varied from 6500 cGy 11344 cGy (average 6764 cGy). Of the 50 patients, one patient was lost to follow up and follow up period of the remaining 49 patients ranged from 3 months to 93 months (median 32 months). According to FIGO classification, 6 (12.2%) were in stage Ib, 5 (12.2%) in stage IIa, 25 (51%) in stage IIb, 7 (14%) in stage III, and t (10.2%) in stage IV, Age of the patients ranged from 33 to 76 years (median 60 years). Pathologically, fourty six (94%) patients had squamous cell carcinoma, 2 (4%) had adenocarcinoma, and 1 (2%) had adenosquamous cell carcimona. Overall response rate was 84%. 5-year survival rate was 49% for entire group (75% for stage Ib, 83% for Stage IIa, 42.5% for stage IIb, 25% for stage III, 40% for stage IV). Complications were observed in 11 (22.4%) patients, who revealed rectal complications with most common frequency. Others were self limiting trifle ones such as wet desquamation, fatigue, mild leukopenia, etc. The correlation of the survival rate with various factors (age, dose, Hb level, pelvic lymph node status, performance status, local recurrence) was evaluated but showed no statistical significance except the age and local recurrence in this series: survival of patients less than 50 years of age was worse than that of the older, and the presence of local recurrence had worse prognosis (p<0.05).

Combined Effect of Heptaplatin and Ionizing Radiation on Human Squamous Carcinoma Cell Lines

Su-Mi Chung,백순영,Mi-Ryeong Ryu 한국분자세포생물학회 2005 Molecules and cells Vol.19 No.1

Heptaplatin, cis-malonato [(4R,5R)-4,5-bis (amino-methyl)-2-isopropyl-1,3-dioxolane] platinum(II) (SKI-2053R, Sunpla) is a new platinum derivative with anti-tumor activity comparable to cisplatin on various can-cer cell lines. Preclinical studies suggest that it is less nephrotoxic than cisplatin. This study was undertaken to examine the combined effect of heptaplatin and ion-izing radiation on two established human squamous carcinoma cell lines (NCI-H520, SQ20B). The cytotoxic activity of heptaplatin was concentration-dependent in both cell lines. When low dose heptaplatin was com-bined with high dose ionizing radiation, there was an additive cytotoxic effect on NCI-H520 cells (P < 0.05), while a moderate dose of heptaplatin and a low dose of ionizing radiation had an additive cytotoxic effect on the growth of SQ20B cells (P < 0.05). FACS analysis and DAPI staining showed that their additive cyto-toxic effects were correlated with the induction of apoptosis. Further studies are warranted using hepta-platin and ionizing radiation in squamous cell carci-noma as a substitute for cisplatin.

중소병원 간호 · 간병 통합서비스병동 간호사의 업무경험 분석

송미령(Song, Mi Ryeong),류수향(Ryu, Su Hyang) 한국간호행정학회 2020 간호행정학회지 Vol.26 No.4

Purpose: This study was done to analyze the experience of nurses working in comprehensive nursing care unit, which is an essential task for developing job instructions and guidelines for nurses. Methods: In total, 161 nurses from comprehensive nursing care units in Seoul, Korea were surveyed from October to November 2018. Differences in work experience according to general characteristics were analyzed by independent t-test. The work experience of the nurses was analyzed by ranking the average by category and item, and the correlation between variables was obtained using Pearson correlation coefficients. Results: Among the sub-categories of work experience, ‘Advance for Better Nursing’ had the highest rank, while the highest item was ‘Patient classification criteria suitable for the use in comprehensive nursing care units are needed’ (4.39±0.78). ‘Advance for Better Nursing’ was significantly correlated with ‘Distributed Difficulties of Nursing’ (r=.48, p<.001). Conclusion: To improve the quality of comprehensive nursing care units in small and medium sized hospitals, job instructions and guidelines for comprehensive nursing care should be developed. Furthermore, a system should be implemented along with policies supporting comprehensive nursing care.

Clinical Experience of Patients with Ductal Carcinoma In Situ of the Breast Treated with Breast-Conserving Surgery plus Radiotherapy: A Preliminary Report

Ji-Young Jang,Mi-Ryeong Ryu,Sung-Whan Kim,Chul-Seung Kay,Yeon-Sil Kim,Yoon-Kyeong Oh,Hyung-Chul Kwon,Sei-Chul Yoon,Woo-Chan Park,Byung-Joo Song,Se-Jeong Oh,Jong-Man Won,Seung-Nam Kim,Su-Mi Chung 대한암학회 2005 Cancer Research and Treatment Vol.37 No.6

Purpose: Breast-conserving therapy (BCT) is a practical alternative to mastectomy for treating ductal carcinoma in situ (DCIS). We reviewed our experience for treating patients with DCIS of the breast to evaluate the outcome after performing breast-conserving surgery plus radiotherapy (BCS-RT).Materials and Methods: Between January 1983 and December 2002, 25 patients with clinically or mammographically detected DCIS were treated by BCS-RT. Onepatient was diagnosed with bilateral DCIS. Thirteen cases (50%) had symptomatic lesions at presentation. All 26 cases of 25 patients underwent BCS such as lumpectomy, partial mastectomy or quadrantectomy. All of them received whole breast irradiation to a median dose of 50.4 Gy. Twenty-four cases (92.3%) received a boost to the tumor bed for a median total dose of 59.4 Gy. The median follow up period was 67 months (range: 38 to 149 months).Results: Two cases (7.7%) experienced ipsilateral breast tumor recurrence (IBTR) after BCS-RT. The histology results at the time of IBTR showed invasive ductalcarcinoma (IDC), and the median time to IBTR was 25.5 months. On the univariate analysis, there were no significant factors associated with IBTR in the DCIS patients. The three-year local recurrence free survival rate was 96.0% and the overall survival rate was 96.3%. Conclusion: After the treatment for DCIS, the IBTR rate in our study was similar to other previous studies. Considering that we included patients who had many symptomatic lesions, close or positive margins and less that complete early data, our result is comparable to the previous studies. We could not find the prognostic significant factors associated with IBTR after BCS-RT. A longer follow up period with more patients would be required to evaluate the role of any predictive factors and to confirm these short-term results.

Prognostic Signifi cance of the Lymph Node Ratio Regarding Recurrence and Survival in Rectal Cancer Patients Treated with Postoperative Chemoradiotherapy

( Ji Yoon Kim ),( Su Mi Chung ),( Byung Ock Choi ),( In Kyu Lee ),( Chang Hyeok An ),( Jong Man Won ),( Mi Ryeong Ryu ) 대한소화기학회 2012 Gut and Liver Vol.6 No.2

Background/Aims: To evaluate the prognostic impact of the lymph node ratio (LNR: the ratio of positive lymph nodes to the total number of lymph nodes examined) on disease recurrence and survival among rectal cancer patients who received curative surgery and postoperative chemoradiotherapy (CRT). Methods: Between 1995 and 2008, 124 patients with pathologic T3-4 or node-positive rectal cancer underwent curative surgery and postoperative CRT. Postoperative radiotherapy was delivered at a median dose of 50.4 Gy (range, 45 to 59.4 Gy) for 6 weeks. Chemotherapy consisted of a bolus injection of 5-fl uorouracil and leucovorin in the first and last week of radiotherapy (91.9%) or daily capecitabine during radiotherapy (8.1%). Further adjuvant chemotherapy was administered after chemoradiation. Results: The median follow-up was 5.1 years. In the multivariate analysis, pathologic N (pN) stage and lymphovascular invasion were signifi cantly associated with disease-free survival and disease-specific survival (p<0.05). However, when the LNR with a cutoff value of 0.2 was included as a covariate in the model, the LNR was highly signifi cant (p<0.001), and the pN stage lost its signifi cance (p>0.05). Conclusions: The LNR predicts recurrence and survival more accurately than pN stage. The pN stage and the LNR should be considered together when estimating the risk of disease recurrence among rectal cancer patients. (Gut Liver 2012;6:203-209)

간세포암종으로 오인된 지방성분이 없는 간혈관근지방종 증례 보고

류수형 ( Yong Moon Woo ),우용문 ( Soo Hyung Ryu ),민정화 ( Jeong Wha Min ),김미령 ( Mi Ryeong Kim ),박태영 ( Tae Young Park ),문정섭 ( Jeong Seop Moon ),강윤경 ( Yun Kyung Kang ) 대한소화기학회 2018 대한소화기학회지 Vol.71 No.1

Angiomyolipoma (AML) is a rare benign mesenchymal tumor in the liver, which is composed of blood vessels, smooth muscle, and adipose cells. The proportion of each component varies, making a diagnosis difficult. This paper reports a case of AML in the liver without adipose tissue, mimicking a hepatocellular carcinoma (HCC), which was diagnosed by a surgical tissue biopsy. A 65-year-old woman was admitted for an evaluation of a hepatic mass that had been detected by ultrasonography. The serologic markers of viral hepatitis B and C were negative. The liver function tests and alpha fetoprotein level were within the normal limits. Magnetic resonance imaging revealed a 1.9 cm sized mass in segment 6 of the liver with early arterial enhancement and washout on the delayed phase accompanied by a rim-like enhancement, which is similar to the imaging findings of HCC. A frozen section examination during surgery indicated a hepatocellular neoplasm and suggested the possibility of HCC. On the other hand, the final pathologic diagnosis was epithelioid myoid type of AML with no adipose tissue component. The tumor cells were positive for human melanocyte B-45 and negative for cytokeratin and hepatocyte paraffin 1. This paper reports a very rare case of AML without adipose tissue in the liver mimicking HCC that was diagnosed by a surgical tissue biopsy. (Korean J Gastroenterol 2018;71:49-53)