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갑상선 유두암 환자의 수술 전 초음파유도하 경부림프절 표식의 유용성
배자성,정소령,정찬권,채병주,박우찬,송병주,김정수,정상설 대한갑상선-내분비외과학회 2008 The Koreran journal of Endocrine Surgery Vol.8 No.1
Purpose: To assess the value of preoperative ultrasonography (US) - guided skin marking for the investigation of cervical lymph node (LNs) metastasis in papillary cancer patients who had not undergone evaluation of cervical LNs at the initial diagnosis. Methods: We evaluated cervical lymph nodes in 40 patients with papillary thyroid cancer. Ultrasonography wasperformed just prior to surgery. The shape, echogenicity, size, and location of lymph nodes were noted and the location of lymph nodes was marked on the skin surface with a pen under ultrasound guidance. The retrieved lymph nodes underwent intraoperative frozen section analysis to plan the extent of surgery. Results: One hundred thirty two LNs were detected on preoperative US, 1087 LNs were surgically removed. Of 40 patients, 28 patients had lymph node metastasis. The cystic appearance, the presence of calcifications, hyperechogenicity and the absence of an echogenic hilum were significantly greater in malignant LNs than in benign LNs (P< 0.001). Among these, the cystic appearance and the presence of calcifications showed a very high specificity and seemed to be the most reliable in indicating malignant LNs. Conclusion: In papillary thyroid cancer patients, preoperatively ultrasound-guided localization of cervical LNs with skin marking shows good potential to determine surgical extent. Ultrasound features of LNs help in the selection of the node to remove with intraoperative frozen section analysis. (Korean J Endocrine Surg 2008;8:23-27)
동시에 시행한 경동맥 내막절제술과 관상동맥 우회로 이식편 2예 : Two cases report
배자성,이성,윤상섭,최승혜,박종경,김승남,고용복,진웅,김치경 대한혈관외과학회 2002 Vascular Specialist International Vol.18 No.1
Combined carotid endarterectomy (CEA) and coronary artery bypass graft (CABG) has been traditionally advocated for patients in whom symptomatic disease has been elicited in both vascular territories. This rationale has related to the concern for an increased myocardial infarction rate following CEA with untreated coronary artery disease and conversely, the potential for stroke in patients receiving CABG with untreated carotid stenosis. Although significant cardiac and cerebral complication rates have been identified in these combined cases, justification for the procedure has stemmed from combined rates obtained which were lower than those encountered for either procedure performed in isolation. There has been a trend toward performance of combined CEA/CABG in patients with asymptomatic carotid stenosis. Release of the Asymptomatic Carotid Atherosclerosis Study (ACAS) in 1995 appears to have played a significant role in changing trend. Interpreting the ACAS data finding is problematic for the combined procedure. Yet controversy continues concerning the most appropriate management for patients with severe coronary artery disease who also have asymptomatic carotid stenosis. Recently we have successfully managed two cases of coronary artery disease and asymptomatic carotid stenosis patients by combined CEA and CABG without any surgical complication. We report these 2 cases and briefly review the literature.
수술전 중심부절침검사와 맘모톰 조직검사에서 상피내암으로 진단된 환자의 잔존 침윤성 유방암의 예측 인자
배자성,송병주,김동철,서영진,박우찬,김정수,정상설 한국유방암학회 2008 Journal of breast cancer Vol.11 No.1
Purpose : We wanted to identify the clinicopathologic factors that predict the presence of invasive cancer after core biopsy for ductal carcinoma in situ (DCIS) Methods : The patients diagnosed with ductal carcinoma in situ on core biopsy (stereotactic or ultrasound) from 2003 to 2006 were identified by retrospectively reviewing the collected data. We analyzed the demographic data, the characteristics on the imaging studies and the histologic features on DCIS. We assessed the factors that included age, the physical examination, the radiologic findings, the biopsy method, and the histologic findings related to the presence of invasive cancer after core biopsy. Results : 51 patients were diagnosed with ductal carcinoma in situ after core biopsy. Of the 51 patients, 19 patients had invasive carcinoma diagnosed on final excision. The factors that correlated with invasion were the biopsy method, a palpable mass and a mammographic mass, regardless of calcification. A high nuclear grade, the comedo type, age, and the tumor size were not related to presence of invasive cancer. Conclusions : A mass lesion on mammography, a palpable mass, and 14G core needle biopsy were significant predictors of invasion in patients with ductal carcinoma in situ. Surgeons always recognize the possibility of invasive cancer in patients with ductal carcinoma in situ on the core needle biopsy.