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Nd:YAG 레이저조사 후 치근의 처치방법들이 치근면 치은섬유아세포부착에 미치는 영향에 관한 연구

문혜성,임기정,김병옥,한경윤,Moon, Hye-Seong,Lim, Kee-Jung,Kim, Byung-Ock,Han, Kyung-Yoon 대한치주과학회 1996 Journal of Periodontal & Implant Science Vol.26 No.3
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The purpose of this study was to evaluate the biocompatibility of the Nd:YAG lased root surface followed by root planing and/or tetracyline-HCI(T.C.-HCI) conditioning. $30,4mm{\times}4mm$ root segments were obtained from unerupted third molars and 21, periodontally involved root segments. The treatment groups were as follows : (1) healthy root cementum surface groups : 1) control(non-treated group), 2) lased only, 3) lased/root planed, and 4) lased/T.C.-HCI. (2) diseased root cementum surface groups : 1) control(root planed only), 2) lased/root planed, and 3) lased/root planed/T.C.-HCI. The specimens were treated with a Nd:YAG laser using a $320{\mu}m$ noncontact optic fiber handpiece with an energy setting of 1.5W($114.6J/cm^2$), 2.0W($152.9J/cm^2$), 5.0W($382J/cm^2$) for one minute. The fiber was held perpendicular to the petri dish(NUNC) 2cm apart in an attempt to expose the entire root segments equally. Human gingival fibroblasts were cultured from explants of normal interdental gingival tissue obtained during third morlar extraction. The attachment assay was performed with third-generation fibroblasts. The numbers of gingival fibroblasts attached to the root surface were counted on each specimen under the light microscope, and were statistically analyzed by the oneway ANOVA followed by Tukey's test in SPSS/PC+programs. The results were as follows : 1) In healthy root cementum surfaces, lased/root planed groups exhibited a significantly increased fibroblast attachment compared to controls, lased only, and lased/T.C.-HCI groups(p<0.05), 2) In diseased root cementum surfaces, laser treatment followed by root planing and/or T.C.HCl groups exhibited a increased tendency of fibroblast attachment compared to root planed only group. The results suggest that laser treatment followed by root planing and/or T.C.-HCl would appear necessary so as to render the root surface biocompatible.
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자궁경부암의 수술 후 방사선치료

이경자(Kyung-Ja Lee),문혜성(Hye Seong Moon),김승철(Seung Cheol Kim),김종일(Chong Il Kim),안정자(Jung Ja Ahn) 대한방사선종양학회 2003 Radiation Oncology Journal Vol.21 No.3
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  스콜라
목 적: 자궁경부암에서 수술 후 위험인자가 있는 환자에 방사선치료 후 생존율, 국소 제어율과 예후인자를 후향적으로 분석하여 수술 후 방사선치료의 효과를 알고자 한다. 대상 및 방법: 1986년 3월부터 1998년 12월까지 자궁경부암 FIGO 병기 IB-IIB로 자궁적출술 후 방사선치료를 받은 58명을 대상으로 국소 제어율, 5년 무병생존율과 생존율에 미치는 예후인자를 후향적으로 분석하였다. 수술 후 방사선치료의 적응증은 병리학적으로 림프절에 전이된 경우,암이 수술절제연이나,자궁주위조직 혹은 자궁체부에 침범하였거나,림프혈관강에 침범된 경우,자궁기질의 1/2 이상 깊이 침윤된 경우와 단순 자궁적출술 후 암으로 진단받은 환자로 하였다. 수술 후 방사선치료는 모든 환자에서 골반강에 외부조사를 시행하였으며 5명은 외부조사와 강내조사를 병용하였다. 외부조사는 6 MV x-선을 이용하여 매일 180 cGy를 4문으로 조사하였으며 총 방사선량은 4400˜5040 cGy (중앙값: 5040 cGy)이었다. 강내조사는 외부조사 후 2주에 Cs-137를 이용하여 저선량률로 질표면에서 5 mm 깊이에 4488˜4932 cGy (중앙값: 4500 cGy)를 시행하였다. 추적기간은 15개월에서 108개월로 중앙값은 44개월이었다. 결 과: 전체환자의 5년 무병생존율은 94%, 국소 제어율은 98%이었으며 원격 전이율은 5%이었다. 병기에 따른 5년 무병생존율은 IB 97.1%, IIA 100%, IIB 68.9% (p=0.0145)이었다. 질 절제연에 암의 침범이 없는 경우 5년 무병생존율이 97.8%, 있는 경우 60% (p=0.0002)이었으며, 자궁주위조직에 암이 침범이 없는 경우의 5년 무병 생존율은 97.8%이었고, 있는 경우는 33.3%이었다(p=0.0001). 다변량 분석에 의하면 자궁주위조직의 침범만이 통계학적으로 의의있는 예후인자이었다. 치료 후 만성합병증은 3명(5%)에서 RTOG grade 2의 방광염, 1명에서 grade 2의 직장염과 1명에서 하지에 림프부종이 나타났다. 결 론: 조기 자궁경부암 환자에 단순 자궁적출술을 시행하였거나, 근치적 자궁적출술 후 병리학적으로 재발 위험인자가 있는 환자에 수술 후 방사선치료를 시행하여 심각한 부작용 없이 비교적 높은 국소 제어율과 생존율을 얻을 수 있었다. 생존율에 영향을 미치는 예후인자는 병리학적으로 암이 자궁주위조직에 침범된 것으로 예후가 불량하였다. 수술 후 방사선치료의 실패원인과 예후인자를 분석한 본 후향적 연구결과를 토대로 앞으로 방사선치료와 항암화학요법을 병용하여 보다 적극적이고 전향적인 연구를 시도하는데 이정표로 이용할 수 있다고 생각한다. Purpose: This study was undertaken to evaluate the efficacy of postoperative radiotherapy, and to investigate the prognostic factors for FIGO stages IB-IIB cervical cancer patients who were treated with simple hysterectomy, or who had high-risk factors following radical hysterectomy and pelvic lymph node dissection. Materials and Methods: Between March 1986 and December 1998, 58 patients, with FIGO stages IB-IIB cervical cancer were included in this study. The indications for postoperative radiation therapy were based on the pathological findings, including lymph node metastasis, positive surgical margin, parametrial extension, lymphovascular invasion, invasion of more than half the cervical stroma, uterine extension and the incidental finding of cervix cancer following simple hysterectomy. All patients received external pelvic radiotherapy, and 5 patients, received an additional intracavitary radiation therapy. The radiation dose from the external beam to the whole pelvis was 45˜50 Gy. Vagina cuff irradiation was performed, after completion of the external beam irradiation, at a low-dose rate of Cs-137, with the total dose of 4488˜4932 chy (median: 4500 chy) at 5 mm depth from the vagina surface. The median follow-up period was 44 months (15˜108 months). Results: The 5-yr actuarial local control rate, distant free survival and disease-free survival rate were 98%, 95% and 94%, respectively. A univariate analysis of the clinical and pathological parameters revealed that the clinical stage (p=0.0145), status of vaginal resection margin (p=0.0002) and parametrial extension (p=0.0001) affected the disease-free survival. From a multivariate analysis, only a parametrial extension independently influenced the disease-free survival. Five patients (9%) experienced Grade 2 late treatment-related complications, such as radiation proctitis (1 patient), cystitis (3 patients) and lymphedema of the leg (1 patient). No patient had grade 3 or 4 complications. Conclusion: Our results indicate that postoperative radiation therapy can achieve good local control and survival rates for patients with stages IB-IIB cervical cancer, treated with a simple hysterectomy, as well as for those treated with a radical hysterectomy, and with unfavorable pathological findings. The prognostic factor for disease-free survival was invasion of the parametrium. The prognostic factor identified in this study for treatment failure can be used as a selection criterion for the combined treatment of radiation and chemotherapy.