자궁내막암 수술시 임파절 전이의 예측인자로서 CA 125의 임상적 유용성

김진휘,이성종,임채춘,남궁성은 대한부인종양 콜포스코피학회 2002 Journal of Gynecologic Oncology Vol.13 No.4

목적 : 자궁내막암 환자에 있어서 골반 임파절 전이의 예측인자로 수술 전 CA 125 값의 유용성을 알아보고자 하였다. 연구 방법 : 1992년 10월부터 2002년 10월까지 가톨릭대학교 의과대학 강남성모병원에서 자궁내막암 진단하에 수술받은 환자 100명을 대상으로 의무기록을 토대로 수술전 CA 125와 임파절 전이유무의 관계를 살펴보았다. 통계적 방법으로는 만-휘트니 유 테스트와 카이 제곱 피셔 테스트를 사용하였다. 결과 : 수술 전 CA 125 값은 병기가 증가함에 따라, 자궁근층을 1/2 이상 침범한 경우, 자궁경부나 부속기를 침범한 경우, 골반 임파절 전이가 있는 경우 유의하게 높게 측정되었다(p<0.05). 결론 : 수술 전 CA 125의 증가는 자궁내막암의 골반 임파절 전이를 예측하는데 있어 유용하다고 할 수 있다. Objective : The aim of this study is to evaluate the clinical usefulness of preoperative CA 125 levels in determining the need for lymphadenectomy in patients with endometrial carcinoma. Methods : CA 125 levels were measured in 100 patients diagnosed with endometrial carcinoma who underwent surgery at Kangnam St. Mary's Hospital between October 1992 and October 2002. Statistical analysis was performed using the Mann-whitney U test and x-Fisher's exact test. Results : Univariate analyses showed that elevated CA 125 levels were significantly correlated with an advanced stage, increasing depth of myometrial invasion, cervical invasion, adnexal involvement, high grade hystology and lymph node metastases (p<0.05). Conclusion : Our data provide an evidence that the elevation of preoperative CA 125 levels can be considered as a predictor for full pelvic lymphadenectomy in the surgical staging of endometrial cancer.

Clinical Trial of Sentinel Node Detection using Technetium-99m colloid albumin and Isosulfan Blue Dye in Early Stage Cervical Cancer

( Chae Chun Rhim ),( Jong Sup Park ),( Jin Woo Kim ),( Woong Sik Ahn ),( Seog Nyeon Bae ),( Joon Mo Lee ),( Sung Eun Namkoong ) 대한산부인과학회 2001 대한산부인과학회 학술대회 Vol.87 No.-

Sentinel node detection in early stage cervical cancer

( Chae Chun Rhim ),( Sung Joo Kim ),( Young Han Park ),( Jung Bae Kang ),( Pong Rheem Jang ) 대한산부인과학회 2011 Journal of Womens Medicine Vol.4 No.2

Objective: To investigate the feasibility of sentinel node frozen biopsy to minimize the extensive pelvic lymph nodes dissection in early stage cervical cancer patients on the basis that the risk of skip metastasis to the paraaortic area is negligible. Methods: The 45 patients with early stage cervical cancer were enrolled in this study. Technetium-99 m colloid albumin was injected intradermally around the tumor for allowing preoperative lymphoscintigraphy and intraoperative hand-held gamma probe detection of seninel lymph nodes. For visual detection, isosulfan blue dye was injected into the peritumoral sites before peritoneal opening. Postoperative morbidity and negative predictive value were the endpoints of this study. Results: The 45 patients, ranging in age from 32 to 71 year, underwent intraoperative sentinel nodes mapping. There were 33 benign and 12 malignant cases on frozen biopsy. On permanent histopathological specimen, there were 31 benign and 14 malignant cases. In 31 out of 33 cases determined to be benign on the sentinel node frozen biopsy, there were no pelvic lymph node metastasis on the permanent pathology. In only 2 cases found to be benign on the sentinel node frozen biopsy, there were pelvic lymph node metastasis on the permanent histopathology. These results are statistically significant(P<0.0001).Conclusion: This new technique of sentinel node mapping is safe and simple to perform. Further clinical trials using the combination of Technetium-99 m and isosulfan blue dye are warranted and this technique will make a true advance for lessaggressive management of patients with early stage cervical cancer.

선행제왕절개임부의 반복수술시 근막상 종절개방법의 효과

임채춘(Chae Chun Rhim),김용옥(Yong Ok Kim),박기영(Ki Young PARK),상미란(Mi Tan Sang),유순원(Soon Won Ryu),김진홍(Jin Hong Kim) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.9

목적 : 본 연구는 반복제왕절개술시 복부 반월형 횡절개후 새로운 술기인 근막상 종절개술(Vertical incision on fascia) 을 비교하여 수술부위의 동통강도와 감각회복기간 및 재원기간에 미치는 영향을 알아보고자 하였다. 연구방법 : 1997년 1월 1일부터 동년 8월 31일 까지 가톨릭대학교 의과대학부속 성모병원에서 반복제왕절개술을 받은 산모들중 최초의 수술반흔이 복부 반월형 횡절개술(Pfannenstiel skin incision)로 시행받은 200명을 대상으로, 근막상 종절개술과 근막상 횡절개술로 수술한 산모를 각각 100명씩 선정한 후 이를 비교군과 대조군으로 나눈 뒤 설문조사를 시행하였다. 설문은 전화문의 및 입원기록을 병행하였다. 결과 : 수술 후 1병일 동통의 강도는 근막상 종절개술이 근막하 횡절개술보다 낮게 나타났다. (p<0.032) 제왕절개술후 수술부위 감각의 회복기간은 1개월이내 및 3개월이내에서 근막상 종절개술이 근막상 횡절개술보다 더 빨리 회복되는 것으로 나타났으며(p<0.0001), 수술후 평균 재원일수는 근막상 종절개술의 경우가 근막상 횡절개술보다 짧은 것으로 나타났다. (p<0.05) 결론 : 반복 제왕절개수술시 제12번 흉곽신경의 외측 피부가지신경, 음부대퇴신경 및 장골서혜신 경의 손상을 최소화함으로써, 수술후 동통의 감소 ,수술부위 감각회복기간의 단축 및 평균 재원기간의 단축에 근막상 종절개술(Vertical incision on fascia)이 근막상 횡절개술(Transverse incision on fascia) 보다 유의하게 우수한 것으로 나타난 바, 미용적효과와 수술후 산모의 만족도를 증진시킬 수 있는 근막상 종절개술기의 도입을 고려해볼 필요가 있다고 생각된다. Objective : Our purpose was to minimize the nerve and muscle injury during operation and to compare the strength of pain and sensory recovery intervals between vertical and transverse incision on fascia after Pfannenstiel skin incision in repeated cesarean section. Method : Two hundred women delivered by cesarean section from January 1st,1997. to August 31st, 1997. at St. Mary's Hospital were selected. They were divided into two groups. Each group was composed of one hundred women, respectively. One was vertical incision on fascia and the other was transverse incision on fascia. All of their initial skin scars were caused by Pfannenstiel approach and the cases of infraumbilical midline skin incision were excluded.Results : The strength of pain at postoperative first day (POD#1) was significantly diminished in vertical incision on fascia than in transverse incision on fascia(p<0.032). The sensory recovery intervals and mean hospitalization periods were significantly shortened in vertical incision than transverse incision on fascia(p<0.001 and p<0.05 respectively). Conclusion : The vertical incision on fascia after Pfannenstiel skin incision was significantly beneficial to repeated cesarean section delivery by diminishing the strength of pain, minimizing abdominal muscle injury, shortening the sensory recovery intervals and mean hospitalization periods. So it is the time that the introduction of new method-vertical incision on fascia after Pfannenstiel skin incision - that not only provides cosmetic effects but also improves the satisfaction of patients after operation will be taken into consideration.

암 수술시 Sentinel Lymph Node 의 임상적 유용성

임채춘(Chae Chun Rhim),황성진(Seong Jin Hwang),박종섭(Jong Sup Park),남궁성은(Sung Eun Namkoong) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.6

목적 : 이 연구의 목적은 외음부 암 환자의 수술시 sentinel lymph node를 탐색하고 동결절편의 조직병리학적 결과를 통해 수술을 최소화 할 수 있는지에 대한 임상적 적용가능성을 평가하는 데 있다. 연구 대상 및 방법 : 2001년 3월부터 2002년 1월까지 가톨릭대학교 강남성모병원에서 외음부 암 확진 후 근치적 외음부 절제술 및 일측 또는 양측 서혜 대퇴부 임파절 절제술을 시행한 4명의 환자를 대상으로 하였으며, 수술전 technetium-99 m colloid albumin의 주입과 수술중 isosulfan blue dye를 주사한 후 sentinel lymph node를 찾아낸 뒤 이를 임상병리과에 보내고 그 동결생검 결과를 얻는다. 결과 : 4명의 환자에서 총 10개의 sentinel lymph node와 110개의 non-sentinel lymph node를 얻었다. 동결생검 결과 10개의 sentinel lymph node는 모두 음성 (benign)이었고 sentinel lymph node가 음성일 때 영구 조직검사 결과가 양성 (malignant)으로 나온 경우는 없었다. 결론 : 외음부 암 환자에서 sentinel lymph node를 찾아 이를 제거한 후, 동결절편의 조직병리학적 결과가 음성 (benign)일 경우에는 더 이상의 광범위한 서혜 대퇴부 임파 절제술을 피함으로써, 수술 후 합병증을 최소화하고 삶의 질을 향상시키는 데 임상적 유용성이 있을 것으로 생각된다. Objective : The purpose of this study is to evaluate the validity of sentinel lymph node detection and the possibility of clinical application in treatment of vulvar cancer patients. Patients and Methods : From March 2001 to January 2002, four patients with vulvar cancer were eligible for this study. All the patients were preoperative technetium-99 m colloid albumin and intraoperative isosulfan blue dye injection intradermally at the junction of tumor mass and normal skin. Superficial lymphatic channels and groin lymph node dissections were made to detect sentinel lymph node and then complete inguinofemoral lymph nodes dissection was performed. All the sentinel lymph nodes were sent to pathologic department for frozen biopsy. Results : Ten sentinel lymph nodes were identified in one-hundred and ten groin lymph nodes. All the ten sentinel lymph nodes showed benign. There was no case that non-sentinel lymph nodes were positive in the presence of negative sentinel lymph nodes by frozen biopsy (negative predictive value was 100%). Conclusion : Sentinel lymph nodes detection by combination use of technetium-99 m colloid albumin and isosulfan blue dye injection was simple and accurate in our preliminary study. To reduce postoperative morbidity, lymphedema and to minimize extensive inguinofemoral lymph nodes dissection, sentinel lymph node frozen biopsy may be a reasonable alternatives and a suitable method for limited control of vulvar cancer. This preliminary study showed the possibility of clinical application of sentinel lymph node detection in vulvar cancer surgery.

자궁경부암 환자에서 sentinel lymph node 탐색을 위해 isosulfan blue dye 사용시 발생한 급성 과민반응

임채춘 ( Chae Chun Rhim ),남궁성은 ( Sung Eun Namkoong ) 대한산부인과학회 2003 Obstetrics & Gynecology Science Vol.46 No.2

The sentinel lymph node is defined as the first node of a regional lymphatic basin that receives the lymphatic drainage from a tumor, thus representing an elective site of lymph node metastasis. According to the sentinel lymph node hypothesis, histologica

자궁경부에 발생한 악성 림프종 1 예

임채춘(Chae Chun Rhim),노성래(Sung Rae Roh),김동주(Dong Joo Kim),송민경(Min Kyung Song),이재성(Jae Sung Lee),주하경(Ha Kyong Joo),박윤희(Youn Hee Park),유기성(Ki Sung Ryu),한구택(Gu Taek Han),이종건(Jong Kun Lee),이준모(Joon Mo Lee) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.8

The malignant lymphomas are neoplastic transformation of cells that reside predominantly in lymphoid tissues. The two major variants of malignant lymphoma are non-Hodgkin's lymphoma and Hodgkin's disease. Although both of these tumors infiltrate reticuloendothelial organs, their biologic and clinical behaviors suggest that they are probably not related. More than 90% of all cases of non-Hodgkin's lymphomas are of B-cell derivation. This observation is based upon the expression of B-lineage-restricted antigens as well as clonal rearrangements of immunoglobulin heavy and light chain genes. The malignant lymphoma localized in uterine cervix is rare and characteristically symptom-free expressed. We experienced a case of malignant lymphoma originated from uterine cervix, so we report with a brief of literature.

Investigation of the Incorporation Efficiency of $\beta$-Carotene into Liposomes

Rhim, Chae-Hwan,Lee, Kyong-Eun,Yuk, Hyun-Gyun,Lee, Sang-Chun,Lee, Seung-Cheol The Korean Society of Food Science and Nutrition 2000 Preventive Nutrition and Food Science Vol.5 No.3

Chemical and photochemical precesses during food storage an preparation rapidly degrade $\beta$-carotene, the most active form of carotenoids. We investigated the possibility of liposomes as tool to preserve $\beta$-carotene. Liposomes with $\beta$-carotene were prepared as multilamellar vesicles by using soybean phosphatidylcholine, in terms of the ratio of $\beta$-carotene to phospholipid and pH. Incorporated efficiency was 99.7% at 1:0.05 of phospholipid : $\beta$-carotene and at pH 9.0. As the concentration of $\beta$-carotene increased, the incorporated efficiency increased progressively. pH did not affect the incorporation efficiency greatly.

Investigation of the Incorporation Efficiency of β - Carotene into Liposomes

Chae-Hwan Rhim,Kyong-Eun Lee,Hyun-Gyun Yuk,Sang-Chun Lee,Seung-Cheol Lee 한국식품영양과학회 2000 Preventive Nutrition and Food Science Vol.5 No.3

Chemical and photochemical processes during food storage and preparation rapidly degrade β-carotene, the most active form of carotenoids. We investigated the possibility of liposomes as a tool to preserve β-carotene. Liposomes with β-carotene were prepared as multilamellar vesicles by using soybean phosphatidylcholine, in terms of the ratio of β-carotene to phospholipid and pH. Incorporated efficiency was 99.7% at 1 : 0.05 of phospholipid : β-carotene and at pH 9.0. As the concentration of β-carotene increased, the incorporated efficiency increased progressively. pH did not affect the incorporation efficiency greatly.

리포솜 내의 콜레스테롤 함량이 Ascorbic Acid 의 안정성에 미치는 영향

임채환(Chae Hwan Rhim),이유원(Yu Weon Lee),이상천(Sang Chun Lee),이승철(Seung Cheol Lee) 한국응용생명화학회 1999 Applied Biological Chemistry (Appl Biol Chem) Vol.42 No.3

Cholesterol plays an important role in various physiological responses and membrane stability. To investigate the effect of cholesterol in liposome on the stability of encapsulated ascorbic acid, the physico-chemical experiments using various amounts of cholesterol-containing liposomes were performed. The encapsulation efficiency of ascorbic acid was decreased with increasing cholesterol content in liposome, whereas size of liposome was increased. Furthermore, the stability of encapsulated ascorbic acid was increased with increasing the content of cholesterol. The stability was not affected by pH. Encapsulated ascorbic acid in liposome stored at 37℃ was rapidly oxidized compared to those stored at 4℃. These results suggest that cholesterol in liposome affects largely to the stability of encapsulated ascorbic acid.