원위부 위암에서 위절제술 후 위재건술식에 따른 잔위기능 및 영양 증상학적 삶의 질 비교

김성근,김영균,허윤정,송교영,김진조,진형민,김욱,박조현,박승만,임근우,김승남,전해명,Kim, Sung Geun,Kim, Young Kyun,Heo, Youn Jung,Song, Kyo Young,Kim, Jin Jo,Jin, Hyung Min,Kim, Wook,Park, Cho Hyun,Park, Seung Man,Lim, Keun Woo,Kim, Seun 대한위암학회 2007 대한위암학회지 Vol.7 No.1

목적: 하부 위암의 절제술 후 각각의 재건술에 따른 환자의 위배출시간과 영양상태, 덤핑 증후군의 발생정도를 비교하여 환자의 증상과 삶의 질을 개선하는 방법을 찾고자 하였다. 대상 및 방법: 1999년 6월부터 2002년 7월까지 원위부 위암으로 절제술을 시행한 환자 중 2003년 1월 한 달간 외래에서 술 후 6개월 이상 경과한 환자 122명을 대상으로 하였다. 위십이지장문합술을 받은 환자(이하 B-I군)는 51명, 위공장문합술을 받은 환자(이하 B-II군)는 71명이었다. 위배출검사는 동위원소 검사법을 이용하여 T1/2값을 얻어 비교하였고, 식사 횟수와 양, 체중감소 정도를 비교하였다. 수술 후 복부증상을 비교하였으며, 덤핑증후군은 Sigstad score를 측정하여 비교하였다. 결과: 수술 후 6개월의 T1/2값은 B-I군에서 지연되어 있었다($159.4{\pm}31.0min$). 12개월 후에는 B-I군의 위배출시간이 빨라져 B-I군과 B-II군 사이의 위배출 시간의 차이가 없어졌다. 식사 횟수는 각 군 간의 차이가 없었고 일회식사량은 수술 전과 비교해 보았을 때 6개월째는 각군간의 차이가 없었으나 12개월에는 B-I군이 B-II군에 비해 식사량이 많은 것으로 나타났다(P=0.038). 수술 후 체중은 B-I군이 B-II군에 비해 체중감소가 의미있게 적은 것으로 나타났다(P=0.023). Sigstad dumping score는 B-I군에서 6개월째에는 7.6점, 12개월째에는 3.4점으로 시간이 경과함에 따라 덤핑 증후군의 빈도가 감소하나 B-II군에서는 시간의 경과해도 덤핑 증후군의 빈도에는 유의한 차이가 없었다. 결론: 원위부 위암환자에서 근치적 수술이 가능한 한도에서는 Billroth I 술식이 체중감소가 적고, 복부 증상도 적게 나타났으며 덤핑증후군의 빈도도 낮아 환자의 삶의 질을 개선하는데 B-II 술식보다 유용한 술식으로 생각된다. Purpose: The proper reconstruction technique to use after a distal subtotal gastrectomy for a gastric carcinoma, there has been a subject for debated what is the proper reconstruction technique. The aim of this study was to compare the gastricemptying time and the quality of life following both B-I and B-II reconstructions after a distal gastrectomy for a gastric adenocarcinoma. Materials and Methods: We studied 122 patients who had undergone a distal gastrectomy for a gastric adenocarcinoma between June 1999 and July 2002 at our hospital. 51 patients underwent B-I group, and 71 patients underwent B-II group. To evaluate the gastric-emptying time, we analyzed the T1/2 time by means of radionuclide scintigraphy using a gamma camera after ingestion of an $^{99m}Tc$-tin-colloid steamed egg. The nutritional status was measured by the weight change. Postgastrectomy syndrome was evaluated using an abdominal symptoms survey. Dumping syndrome was measured using the Sigstad dumping score. Results: The gastric-emptying time was somewhat delayed in the B-I group after a 6 month period, but there was no difference after 12 months between the two groups. There was less weight loss in the B-I group than in the B-II group (P=0.023). Fewer abdominal symptoms were occurred in the B-I group than in the B-II group. Dumping syndrome occurred less frequently in the B-I group than in the B-II group (P=0.013). Conclusion: In our study, the Billroth I reconstruction led to less weight loss, a better nutritional status, and a better quality of life than the Billroth II reconstruction. We concluded that after a distal subtotal gastrectomy, the Billroth I reconstruction would be considered when the procedure is oncologically suitable.

충청남도 지역에서 진단된 광선 각화증에 대한 임상 및 병리조직학적 고찰

김성근 ( Sung Keun Kim ),신정웅 ( Jung Woong Shin ),이성열 ( Sung Yul Lee ),이상훈 ( Sang Hoon Lee ),조문균 ( Moon Kyun Cho ),황규왕 ( Kyu Uang Whang ),박영립 ( Young Lip Park ),남두현 ( Doo Hyun Nam ),조현득 ( Hyun Deuk Cho ) 대한피부과학회 2010 大韓皮膚科學會誌 Vol.48 No.1

Background: Actinic keratoses (AK) have been recognized as precancerous lesions, they have been recently considered to be an early in situ squamous cell carcinoma (SCC). However, there have been few studies to determine the clinical and histopathological characteristics of AK, and especially in the Province of Chungcheongnam-do. Objective: The purpose of this study was to evaluate the clinicopathological characteristics of 80 cases of AK in the province of Chungcheongnam-do. Methods: The authors evaluated the clinical and histopathological features of 80 patients with AK at Soonchunhyang University Hospital in Cheonan from January 1998 to December 2008. Results: The ratio of male to female patients was 1:4.7. The age distribution ranged from 42 to 93 years old. Single lesions are more common than multiple lesions. The duration of lesions was variable with a mean duration of 25.1 months. The most commonly involved sites were the face and especially the cheek. The color was erythematous in 63.3% of the cases, brownish in 24.5%, dark-brownish in 9.5% and gray in 2.7%. Crust and scale were noted in 37.4% and 22.4% of the cases, respectively. SCC was associated with AK in 6.3% of the cases, basal cell carcinoma was associated with AK in 1.3%, and keratoacanthoma in 1.3%. The most common histopathological types of AK were atrophic types in 20.6%, and this was followed by the hypertrophic types in 18.6% of the cases and the hypertrophic and atrophic types in 14.7% of the cases. Conclusion: Our results are similar to those of the previous reports. In addition, we observed a consistently higher incidence in females than males in the Korean reports and a more frequent incidence of single lesions than multiple lesions in the Asian reports. We found that AK is not easily distinguishable from SCC both clinically and cytologically. Thus, we suggest that biopsies and active treatments should be performed on AK lesions. (Korean J Dermatol 2010;48(1):1∼7)

피부 악성 종양에서 CD133, CD24, CD44의 발현에 관한 연구

강상규 ( Sang Gue Kang ),김철한 ( Chul Hann Kim ),김성근 ( Sung Keun Kim ),최보라 ( Bo Ra Choi ),황규왕 ( Kyu Uang Whang ),조문균 ( Moon Kyun Cho ) 대한피부과학회 2008 大韓皮膚科學會誌 Vol.46 No.6

Background: Based on the unlimited proliferative and self-renewel properties of cancer cells similar to those of stem cells, the idea that cancer may originate from stem cells has been suggested in many different studies and has given rise to cancer stem cell hypothesis. CD133, being normally expressed on the surface of hematopoietic stem cells, has recently been suggested as a marker of cancer stem cells in several malignancies. CD24 and CD44 are membrane proteins reported as markers of various neoplasms. Objective: This study was designed to investigate the immunohistochemical expression of the CD24, CD44 and CD133 in squamous cell carcinoma (SCC), basal cell carcinoma (BCC) and malignant melanoma (MM). Methods: We performed immunohistochemical staining for CD24, CD44 and CD133 using 18 skin cancer tissue samples, including 6 SCCs, 6 BCCs and 6 MMs. The expression of each marker was standardized by the histochemical score (HSCORE). Results: The expression of CD24 showed positive in 1 case of 6 SCCs (mean HSCORE, H; 0.02) and showed negative in 6 BCCs (H; 0.00), 6 MMs (H; 0.00). The expression of CD44 was not observed in 6 SCCs (H; 0.00) but observed in 1 case of 6 BCCs (H; 0.04) and 1 case of 6 MMs (H; 0.03). The expression of CD133 showed positive in 2 cases of 6 SCCs (H; 1.21) and 1 case of 6 BCCs (H; 0.05) and 6 cases of 6 MMs (H; 2.78). Conclusion: Our data suggest that CD133 may be a reliable marker of which the higher expression is observed in the more invasive skin cancers and that the existence of cancer stem cells may enhance tumorigenic potential in cutaneous malignant tumors. (Korean J Dermatol 2008;46(6):742∼748)

공사기간 연장비용 관련 제도개선 방안

김용균(Kim, Yong Kyun),김성근(Kim, Sung-Keun) 대한토목학회 2016 대한토목학회 학술대회 Vol.2016 No.10

좌측어깨와 두피로 전이된 난소암(점액낭선암종) 1예

김윤지 ( Yoon Jee Kim ),김성근 ( Sung Keun Kim ),김형동 ( Hyung Dong Kim ),조문균 ( Moon Kyun Cho ),박영립 ( Young Lip Park ),이종석 ( Jong Suk Lee ),황규왕 ( Kyu Uang Whang ) 대한피부과학회 2010 大韓皮膚科學會誌 Vol.48 No.4

Metastasis to the skin from internal malignant neoplasms is an uncommon event. Although carcinoma of the ovary is the second most common malignancy in women, cutaneous involvement originating from ovarian cancer is particularly unusual. A 30-year-old woman had been treated with chemotherapy for ovarian cancer 4 years previously. She showed an erythematous indurated subcutaneous nodule on her left shoulder and scalp. Histopathologic findings showed multiple cribriform pattern cellular masses and some cords or tubular structures floating on a mucinous pool, which were similar to primary mucinous cystadenocarcinoma. We report this case of cutaneous metastasis from ovarian cancer. (Korean J Dermatol 2010;48(4):342~345)

하악후부에 발생한 무색소성 악성 흑색종 1예

김철한 ( Chul Hann Kim ),김정은 ( Jung Eun Kim ),김성근 ( Sung Keun Kim ),조문균 ( Moon Kyun Cho ) 대한피부과학회 2010 大韓皮膚科學會誌 Vol.48 No.8

Amelanotic melanomas comprise only 2% of malignant melanomas and are commonly a difficult clinical diagnosis, due to the lack of melanin pigment typically found in melanomas. Even rarer is the amelanotic malignant melanoma, which may clinically mimic a variety of other less serious cutaneous lesions such as erythema or pruritus, and therefore misdirecting the clinician toward improper treatments and frequently delaying necessary diagnostic biopsy. We report a rare case of amelanotic melanoma occurring in the left retromandibular area with a poor prognosis. A 73-year-old woman presented with a 3-year history of a erythematous lesion in the left retromandibular area. The lesion was surgically removed and biopsy was performed. The biopsy specimen showed atypical, pleomorphic tumor cells with little melanin pigment. On immunohistochemical study, the tumor cells were positive for S-100 protein, HMB-45 and Melan-A. These findings were consistent with amelanotic malignant melanoma. On positron emission tomography/computed tomography (PET/CT), hypermetabolic lesions were found in both the axillary lymph nodes. She was treated with chemotherapy. But four months later, the patient died. Amelanotic melanoma is extremely rare and is more aggressive than pigmented lesions in the similarly stage. The absence of pigmentation in the tumor may result in diagnostic confusion. The clinician should be familiar with the presentation of amelanotic malignant melanoma to facilitate prompt diagnosis. Early diagnosis is crucial since survival is related to tumor thickness and tissue invasion. (Korean J Dermatol 2010;48(8):714~717)

HBsAg 과 HBsAg 가 동시에 출현한 19 예에 대한 임상적 고찰

이남(Nam Lee),변동일(Dong Il Byun),김성근(Sung Kuen Kim),이광래(Kwang Lae Lee),최일균(Il Kyun Choi),최조영(Jo Young Choi),곽정재(Jung Jae Kwack),이상용(Sang Yong Lee) 대한내과학회 1987 대한내과학회지 Vol.33 No.4

N/A The usual sequence of events in the serum in response to infection with hepatitis B virus does not include the sustained presence of both HBsAg and it antibody, HBsAb becomes detectable after HRsAb has been cleared from the serum. The presence of HBsAg implies infectivity of the serum, wherase that of HBsAb indicated recovery from HBV infection, immunity from subsequent infection, and noninfectivity of the serum. However, we found and evaluated 19 patients who have had coexistent HBsAg and HRsAb. To study hepatitis B virus maker was done by using RIA technique (Ausria ll and Ausab, Abbott Laboratories, North Chicago, Illinois) The following results were obtained. 1) 2475 Patients with HBsAg positive were 26% in 9501 patients that studied both HBsAg and HBsAb. 19 patients with HBsAg and HBsAb present simultaiously, were 0.076% in 2475 patients with HBsAg positive. 2) HBcAb was positive in all of 14 patients. HBeAg was positive in 4 of 5 patients and HBeAb was negative in all of 5 patients. 3) 2 of 19 patients (10.5%) had liver cirrhosis and 3 of 19 patients (15.8%) had hepatoma at their initial medical evaluation. 4) 10 of 19 patients were positive persistently circulating hepatitis B surface antigen and antibody. The duration of concomitant HBsAb and HBsAb was from 2 to 211 weeks (mean 70.4 weeks) 5) 9 of 10 patients were positive for both HBsAg and HBsAb at their initial medical evaluation, And the presence of HBsAg antedated that of HBsAg and HBsAb simultaneously in one patient of pediatrics for 29 months. 6) Two patients had only HBsAb negative after both HBsAg and HBsAb were found, HBsAb titers of above two patients were significant lower than HBsAb titiers of 19 patients with concomitant HBsAg and HBsAb (HBsAb titer: 1124±174cpm VS 4977±4077cpm, P<0.01) 7) 5 of 10 patients were postivie persistently circulating hepatitis R surface antigen and antibo4y for above 6 months. There were no significant difference in HBsAb titer between above 5 patients and 19 patients with concomitant HBsAg and HBsAb. (HBsAb titer: 6909±4696cpm VS 4977±4007cpm) 8) HBsAb titer of 19 patients with concomitant HBsAg and HBsAb were significant lower than in HRsAb titer of 50 patients with HBsAg (-) HBsAb (+). This result suggest that 19 patients with concomitant HBsAg and HBsAb had relatively lower HBsAb titier. (HBsAg titer: 4977±4007cpm VS 7124±4011cmp, P<0. 05)

무인모선기반 무인잠수정의 3차원 위치계측 기법에 관한 연구

임종환(JONG-HWAN LIM),강철웅(CHUL-UNG KANG),김성근(SUNG-KYUN KIM) 한국해양공학회 2005 韓國海洋工學會誌 Vol.19 No.2

A 3-D localization method of an autonomous underwater vehicle (AUV) has been developed, which can solve the limitations of the conventional localization, such as LBL or SBL that reduces the flexibility and availability of the AUV. The system is composed of a mother ship (small unmanned marine prober) on the surface of the water and an unmanned underwater vehicle in the water. The mother ship is equipped with a digital compass and a GPS for position information, and an extended Kalman filter is used for position estimation. For the localization of the AUV, we used only non-inertial sensors, such as a digital compass, a pressure sensor, a clinometer, and ultrasonic sensors. From the orientation and velocity information, a priori position of the AUV is estimated by applying the dead reckoning method. Based on the extended Kalman filter algorithm, a posteriori position of the AUV is, then, updated by using the distance between the AUV and a mother ship on the surface of the water, together with the depth information from the pressure sensor.