위암에서 조직학적 특징에 따른 혈청 E-cadherin의 농도

허훈,송교영,김진조,진형민,김욱,박조현,박승만,임근우,박우배,김승남,전해명,Hur, Hoon,Song-Gyo-Young,Kim, Jin-Jo,Chin-Hyung-Min,Kim, Wook,Park, Cho-Hyun,Park, Seung-Man,Lim-Keun-Woo,Park, Woo-Bae,Kim, Seung-Nam,Jeon, Hae-Myoung 대한위암학회 2004 대한위암학회지 Vol.4 No.3

Purpose: While E-cadherin in normal cells induces calciumdependent cell-cell adhesion, in malignant cell, it plays a role in invasion and metastasis with a reduction of adhesion. Serum soluble E-cadherin is a result of the reduction of the cellular E-cadherin molecule and is found in the circulation of normal individuals, but it is particularly known to be increased in patients with malignancies. Accordingly, through checking the level of serum soluble E-cadherin in patients with gastric cancer and analyzing it in the view of clinicopathology, we investigated whether serum soluble E-cadherin could be translated into a clinicopathologic esult and used as a tumor marker. Materials and Methods: The investigation targeted 88 patients who had been diagnosed as having gastric cancer by the Department of Surgery, St. Mary's Hospital, from October 1, 2002, to July 30, 2003, and who had under gone performed surgery. We measured the level of preoperative serum E-cadherin in the 88 patients by unsing ELISA. Among them, we collected gastric cancer tissues from 54 patients and executed immunohistochemistry for E-cadherin. The samples were compared with normal tissues in terms of both serum E-cadherin level and immunohistochemistry level, as well as with other clinicopathologic factors. Result: The mean serum E-cadherin level of the 88 patients was 4368.7 ng/ml and was significantly higher than the level in 12 normal control patients, 3335.5 ng/ml (P=0.016). In terms of clinicopathology, the serum level of E-cadherin was significantly correlated with increasing age (P=0.0006) and was higher in positive venous invasion patients (P=0.0005). When the E-cadherin immunohistochemical stain was compared with the serum E-cadherin level in 54 patients, no significant statistically meaningful result was obtained (P=0.2881). However, 4 patients with serum E-cadherin levels about 6000 ng/ml were classified into the lower expression group ($<80\%$ of E-cadherin immunohistochemicals stain. In the analysis for 36 patients who were early gastric cancer patients, the serum E-cadherin level in lymph-node-metastatic patients was higher than it was in the other patients (P=0.0442). Conclusion: The serum E-cadherin level in gastric cancer patients was higher than the level in normal control patients. In advanced gastric cancer patients, that the difference was increased. Also, since the E-cadherin level correlated with the serum E-cadherin level with venous invasion, it can be used as an effective tumor marker for gastric cancer. Particularly, in that the serum E-cadherin level correlated with lymph node metastasis in early gastic cancer, it can be used when a therapeutic method for early gastric cancer is selected.

유두 미란성 선종증

허훈(Hoon Hur),정의철(Eui Chul Jeong),이창우(Chang Woo Lee),김중환(Joong Hwan Kim) 대한피부과학회 1986 대한피부과학회지 Vol.24 No.4

We experienced a case of erosive adenomatosis of the nipple (EAN) in a 20- year-old lady. She have had an eczematous, erosive and crusted nipple, on the right si.de, with a serosanguineous discharge for the past two years. The biopsy specimen of eczematous lesion on the affected nipple showed focal erosion and acanthosis in the epidermis. Florid intraductal epithelial proliferation and solid nests were scattered in the nipple stroma without showing any cellular pleomorphism. The lining epithelium maintained two layers of cells the inner colurnnar cells and the outer cuboidal cells. Chronic inflammatory infiltrates of relatively dense lymphohisiocytes were found in the surrounding stromal tissue, Paget cells or underlying malignancy were not seen, and a group of tumor netst was confined to the upper part of the subareolar tissue

위암의 수술 치료

허훈 ( Hoon Hur ),박조현 ( Cho Hyun Park ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.2

The gastric cancer is the most common cancer in Korea. The only treatment modality showing improved survival for gastric cancer is curative surgical resection, which comprises the resection of stomach, proper lymphadenectomy, and reconstruction. However, specific surgical procedures should be decided according to the location of the cancer, advancement of the tumor, and patients` condition. Surgical treatment for gastric cancer has been developed toward two directions that are minimal invasive surgery for early gastric cancer and multi-disciplinary approach for advanced gastric cancer. Laparoscopic surgery for early gastric cancer has been accepted for minimally invasive surgery. Moreover, the advancement of diagnostic tools to assess biological aggressiveness of the tumor enables physicians to perform endoscopic resection or minimized resection for early gastric cancer. Recently, surgeons try to extend the application of laparoscopic gastric resection and D2 lymphadenectomy to advanced gastric cancer. However, technical and oncological evidences based on clinical trials should be filed up before adopting it as a standard therapy. In case of advanced gastric cancer, in addition to radical surgery, various treatment modalities including chemotherapy, radiation, and molecular target therapy also have been applied in many clinical trials. However, it should be stressed that a prerequisite for precise evaluation of the efficacy of these combined treatment modalities would be the standardization of surgical procedure. (Korean J Gastroenterol 2009;54: 83-98)

환자 영양 상태 파악을 위한 선별 검사와 영양 평가

허훈 ( Hur Hoon ) 한국정맥경장영양학회 2012 한국정맥경장영양학회지 Vol.5 No.1

A large part of patients admitted to hospital are undernourished and managed without nutritional support because of physician`s failure to assess the nutritional state of patients. Therefore, nutritional screening and assessment of patients for malnutrition could be key to improving the treatment outcomes. It is the aim of this paper to inform the concept of nutritional screening and assessment, and introduce tools for general use. Several tools such as nutritional risk screening 2002, nutritional risk classification and others are available for nutritional screening. A recent change of weight, diet history, and the level of serum albumin are mainly included in these assessment tools. After an evaluation using screening tools, physicians can decide whether to start nutritional support or perform nutritional assessment in addition. Subjective global assessment (SGA), developed in 1987, has been mainly used for nutritional assessment. This tool takes into account the past history about the diet, weight variation, the degree of individual activity and fever. Several clinical studies have supported the efficacy of SGA to predict nutritional outcomes. Physicians should devise a plan for nutritional support based on the results of nutritional assessment. In conclusion, nutritional screening and assessment is essential for the evaluation of the patients who require medical or surgical intervention, because the patient`s nutritional state can affect treatment outcomes. Therefore, physicians must take care to assess the nutritional state of patients before treatment using appropriate tools. Moreover, the most appropriate tool for nutritional assessment of Korean patients should be suggested through clinical studies. (JKSPEN 2013;5(1):2-9).

군과 지역사회의 협동거버넌스 구축방안

허훈(Hoon Hur) 한국정책과학학회 2008 한국정책과학학회보 Vol.12 No.4

한국전쟁을 겪은 우리나라의 특수성 때문에 지방자치단체들 가운데 상당수가 군을 지역사회의 일원으로 받아들이고 있다. 하지만, 최근들어 군과 지역사회와의 관계는 군부대이전요구, 개발민원의 급증 등으로 인하여 갈등이 증가하고 있다. 반면, 군과 지역사회와의 협력적 관계는 아직 많지 않으며, 또 체계적이거나 제도화된 수준이 되지 못하고 있다. 군과 지역사회의 협력과 갈등관계를 설명하는 이론과 연구는 드문 형편이다. Huntington(1968) 등의 민군관계이론은 정치개입, 군사력에 대한 통제 등에 논의의 초점을 두었을 뿐 군과 지역사회의 관계의 측면을 분석하지 못한 것이다. 이글에서는 군과 지역사회의 협력적 관계에 대한 이론을 조직간 협력이론에서 찾아보고(Yepp, 1974; Hall, et. al., 1977; etc.), 이 이론에서 군과 지역사회의 교류유형을 상호 탐색적 교류, 상호지원, 공동이용, 정책협의, 공동생산으로 추출하고 실태를 조사해보았다. 그 결과 군과 지역사회간에는 관찰된 83건의 교류사례 중에서 초기의 교류유형인 상호탐색형과 상호지원형이 65건(78%)으로 분석되었으며, 쌍방간에 신뢰에 기초한 고도의 교류유형인 정책협의 혹은 공동생산형은 7건(8%)에 불과하였다. 군과 지역사회간에 교류협력이 미흡한 것은 군창군기부터 군이 사용하는 토지획득이 불합리하였고, 군의 권위적인 운용, 군사기지주변의 도시화, 민군교류추진체계의 부족 등이 원인으로 설명되었다. 이러한 분석결과에 따라 이 연구는 군과 지역사회간에 갈등을 완화하고, 국가가 군사시설에 대한 정책을 전향적으로 바꾸게 하기 위해서는 프로세스관점에 의한 협동 거버넌스(Collaborative Governance)를 구축해야 한다고 제언하였다. Most local governments accept the army as a member of communities. However, the relationship between the army and the community is getting worse, because of many problems, such as military base realignment and rapid increase of civil affairs for development. Unfortunately, the cooperative relationship of the army and the community is unstructured and not institutionalized. These situations cannot be explained by the civiil-military relation theoryl, suggested by Huntington (1968), focused on the intervention of army and politics, the control of military power and so on. In this article, the collaboration theory(Yepp, 1974; Hall, et. al., 1977; etc.) is adopted to explain the cooperative relationship of army and community. From this theory, the interchange patterns between army and community were extracted, in view of Mutual Searching, Mutual Support, Joint Use, Policy Agreement and Joint Production. As a result, in observed cases of 83, 78% of total cases(65 cases) are focused on Mutual Searching and Mutual Support, which are primary types, and only 8%(7 cases) is included in type of Policy Agreement or Joint Production, which is based on mutual trust. First of all, insufficiency of cooperative relationship between army and community is explained by the untoward land acquisition for military use. Authoritative use to army, urbanization around military base and insufficiency of cooperation system between army and community are reasons for insufficient relationship, also. According to these analytic results, it is needed to build 'collaborative governance', which can be reduce troubles between army and community and make the government change the national policy for military facilities, enterprisingly.

양성 태선양 각화증

허훈(Hoon Hur),이창우(Chang Woo Lee),김중환(Joong Hwan Kim) 대한피부과학회 1987 대한피부과학회지 Vol.25 No.2

A case of benign lichenoid keratosis(BLK) developed in a 25-year-old female is presented. She had two erythematous plaques with slightly verrucous surfaces on the lips for 4 weeks. A biopsy specirnen taken from the periphery of the lesion revealed a focal parakeratosis, the absence of granular cells, and hydropic degeneration of the basal cells in the epidermis. The upper dermal infiltrate composed chiefly of lymphacytes intermingled with a few histiocytes was also seen. The direct immunofluorescent study showed depositions of a few cytoid bodies and fibrin around the areas of the dermoepidermal junction. These plaques on her lips, demonstrating lichenoid tissue changes, cleared in 8 weeks from the evalution, without any treatment.

급성 충수염의 합병증으로 발생한 문맥염

허훈(Hoon Hur),성기영(Gi Young Sung),이도상(Do Sang Lee),김욱(Wook Kim),박일영(Il Young Park),원종만(Jong Man Won) 대한외과학회 2003 Annals of Surgical Treatment and Research(ASRT) Vol.64 No.2

조기위암으로 진단된 환자에서 소절개창 수술의 유용성

허훈(Hoon Hur),지성배(Sung Bae Jee),송교영(Kyo Young Song),김진조(Jin Jo Kim),진형민(Hyung Min Chin),김욱(Wook Kim),박조현(Cho Hyun Park),박승만(Seung Man Park),전해명(Hae Myung Jeon) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.3

Purpose: Laparoscopic gastrectomy has oncologic unreliability, technical problems, and is expensive. To overcome these drawbacks, we performed operations through a small laparotomy without using a laparoscopic procedure. Methods: From March to August, 2003, we successfully performed distal gastrectomy with minilaparotomy for 21 patients diagnosed with early gastric cancer in our hospital. An additional 24 patients with advanced gastric cancer underwent conventional laparotomy for distal gastrectomy. We performed distal gastrectomy with lymph node dissection, moving the abdominal window to the surgical site. We compared BMI, operating time, bleeding volume, and postoperative pain, and followed minilaparotomy patients for an average of 48 months. Results: There were no postoperative complications in minilaparotomy patients. The minilaparotomy group had a shorter hospital stay lower analgesic use than conventional laparotomy, but there were no differences in BMI, bleeding volume, or the number of harvested lymph nodes. Minilaparotomy alleviated the severity of postoperative pain, and there were no recurrences during follow-up. Conclusion: Minilaparotomy for early gastric cancer improved postoperative outcome without oncologic inadequacy compared with conventional laparotomy. Therefore, distal gastrectomy via a minilaparotomy may become a minimallyinvasive therapeutic strategy for early gastric cancer.

위암의 근치적 절제 후 재발한 위암 치료 전략: 전국적 현황조사를 중심으로

허훈 ( Hoon Hur ),송병주 ( Byung Joo Song ),정상설 ( Sang Seol Jung ),전해명 ( Hae Myung Jeon ) 대한임상종양학회 2008 Korean Journal of Clinical Oncology Vol.4 No.2

본 연구진은 국내에서 발생하는 위암환자의 대부분을 치료하고 있는 대한위암학회 회원을 대상으로 위암에 대한 근치적 절제술 시행 후 재발한 환자들에 대하여 어떻게 치료하고 있는지 설문조사를 통하여 알아보고자 하였다. 2007년 7월부터 9월까지 107개의 병원 급 이상의 기관에서 환자진료를 담당하고 있는 대한위암학회 회원 205명을 대상으로 e-mail과 우편을 통해 설문지를 발송하였으며 설문지를 회수하고 분석하였다. 설문지를 발송한 205명의 회원들 중 96명이 설문조사에 응답해서 응답률은 46.8%였다. 기관별로는 107개 기관들 중 63개 기관에서 응답을 해서 58.9%의 기관 응답률을 보였다. 재발 시에 항암제의 사용에 대하여, 단독 용법의 경우 어떤 항암제를 사용하는가에 대한 질문에는 TS-1을 사용한다는 응답이 59%로 가장 많았으며, 복합 항암 요법을 묻는 질문에는 Cisplatin과 경구용 혹은 정맥용 5-FU 제재라고 응답한 비율이 59%로 가장 높았다. 위암 재발의 경우 각 재발 장소에 따라 어떤 치료를 하고 있는지에 대하여, 복막 재발의 경우 72%인 60명이 항암화학요법을 시행한다고 응답하였으며, 단독으로 발생한 국소재발의 경우 66%인 63명이 항암요법을 한다고 응답하였다. 간의 단독 전이의 경우, 57%가 가능만 하다면 수술적으로 제거를 시도한다고 답하였다. 이번 설문 조사는 위암 환자에 대하여 근치적 절제 후 재발 시 치료현황에 있어서 국내에서 위암 환자를 치료하고 있는 많은 임상의사들의 의견을 반영한 설문조사 결과이며, 국내의 재발 치료에 대한 현황을 파악할 수 있는 동시에 앞으로 치료 방법의 정립을 위한 임상시험을 계획하는 데 있어서 주요한 근거자료로 활용될 수 있을 것으로 생각된다. Purpose: To date, the principles of treatment for patients with recurrent gastric cancer after curative resection have not been suggested, and most centers have managed them according to their experience. Therefore, we investigated current practice of management for recurrence after curative resection for gastric cancer through nationwide survey in Korea which is high incidence area. Materials and Methods: From July to September 2007, a questionnaire was sent out to 205 members of Korean Gastric Cancer Association (KGCA). A questionnaire was composed of cover letter, general information and main questionnaire about follow-up schedules and contents. Results: Forty-six percent (96/205) of the members of the KGCA returned the survey. Most common responders described that TS-1 was used for single chemotherapeutic agent for recurrent gastric cancer. Cisplatin combined with oral or intravenous 5-FU was commonly used as complex regimen. In treatment modality according to recurrent sites, the systemic chemotherapy was commonly used for patients with peritoneal or local recurrence. In case of single metastasis in liver, most physicians answered that resection was applied for them, if at all possible. Conclusion: It seems that clinicians remain variable regarding how to treat the patients with recurrence after curative resection for gastric cancer. Therefore, a multicenter randomized trial is needed to confirm the treatment modality according to recurrent sites, and our results could give an aid to design such study.

공간다중화 MIMO 시스템을 위한 높은 신뢰도의 연판정 값 발생방법

허훈(Hoon Hur),우현명(Hyun-Myung Woo),방승재(Seungjae Bahng),박윤옥(Youn Ok Park),김재권(Jae-Kwon Kim) 한국통신학회 2008 韓國通信學會論文誌 Vol.33 No.4A

본 논문에서는 공간다중화 방식을 사용하는 다중 안테나 시스템의 수신부를 위한 연판정 값 발생방식을 제안한다. 공간 다중화 MIMO 시스템의 수신기술의 복잡도는 일반적으로 생성하는 후보벡터의 수에 비례하여 증가한다. 모든 송신 가능한 벡터를 후보벡터로 하는 ML 신호검출 기법은 신뢰도가 높은 연판정 값을 발생하여 우수한 성능을 달성하나 연산복잡도가 매우 높다. 반면 적은 수의 후보벡터를 발생하여 낮은 복잡도를 갖는 검출기법은 연판정 값의 신뢰도가 저하되는 단점을 갖는다. 본 논문에서는 적은 수의 후보벡터만 가용할 때, 연판정 값의 신뢰도를 향상시키는 방법을 제안한다. In this paper, we propose a novel soft output generation method for spatially multiplexed MIMO systems. The receiver complexity of spatially mutiplexed MIMO system is in proportion to the number of candidate vectors. The ML signal detection method considers all possible vectors as candidates, thereby achieving a high performance, however, its complexity is very high. Low complexity receiver techniques involving a small number of candidate vectors, provide soft output values of low reliability. In this paper, we propose a method to improve reliability of the soft output values obtained using a small number of candidate vectors.