계획된 근치적 위암 수술에서 예방적 항생제의 단기 사용 가능성

시윤,허훈,김성근,전경화,진형민,김욱,박조현,박승만,임근우,김승남,전해명,Si, Yoon,Hur, Hoon,Kim, Sung Keun,Jun, Kyong Hwa,Chin, Hyung Min,Kim, Wook,Park, Cho Hyun,Park, Seung Man,Lim, Keun Woo,Kim, Seung Nam,Jeon, Hae Myung 대한위암학회 2008 대한위암학회지 Vol.8 No.3

목적: 위암 수술을 시행하는 임상의들은 광범위한 림프절 절제로 인한 수술 후 감염 가능성으로 인하여 대개 수술 후 3일 이상 예방적 항생제를 투여하고 있으나 투여기간의 결정은 임상의 개개인이나 기관에 따라 결정되고 있다. 본 연구는 위암 수술 후의 예방적 항생제의 투여 기간이 환자의 회복에 어떤 영향을 미치는지 알아보고자 시행하였다. 대상 및 방법: 2007년 1월 1일부터 2007년 12월 30일까지 가톨릭대학교 의과대학 성모병원 외과에서 위 선암으로 수술을 받은 환자 중 수술 전 감염이 없어 항생제의 선행투여가 없는 93명의 환자들을 대상으로 하였다. 수술 시기에 따라 31명의 환자들은 수술 후 24시간까지만 투여가 계획되었고(A군), 31명의 환자들은 3일간 투여가 계획되었으며(B군), 31명의 환자에겐 대조군으로 5일 이상 항생제 투여가 계획되었다(C군). 세 군 간 수술 후 7일 이내의 감염을 포함한 합병증과 체온, 중성구 개수 변화들을 비교하였다. 결과: 수술 후 감염률은 A군에서는 31명 중 4명(12.9%), B군은 31명 중 5명(16.1%), C군에서는 31명 중 6명(19.4%)로 세 군 간의 유의한 차이는 없었다(P=0.788). 수술 후 매일 가장 높이 조사된 체온들의 변화와 중성구 개수변화도 차이가 없었다(P=0.119, P=0.855). 결론: 위암 수술을 위한 위 절제 및 재건시의 예방적 항생제 투여는 수술 24시간 이내에만 시행하여도 환자 회복엔 영향이 없을 것으로 보인다. Purpose: Although most surgeons generally administer prophylactic antibiotics for more than three days, the optimal duration of antimicrobial prophylaxis in elective gastric surgery is still open to debate. The aim of this study was to determine if the duration of prophylactic antibiotic use can affect the recovery of patients after elective gastric surgery. Materials and Methods: A total of 93 patients with gastric cancer were enrolled in this study, between January 2007 and December 2007. Patients were excluded if they had an infection at the time of surgery or they underwent an emergency operation. The first antibiotics were commonly given from just prior to the operation. The patients were divided into three groups according to the operation periods: those who received antibiotics only on the day of operation (arm A), those who received antibiotics for up to 3 days (arm B), and those who received antibiotics for more than 5 days postoperatively (arm C). The antibiotic that was used was second generation cephalosporin. Results: The rate of surgical site infection was 12.9% (n=4) in arm A, 16.1% (n=5) in arm B and 19.4% (n=6) in arm C, respectively (P=0.788). No relationship was observed between the duration of prophylaxis and the rate of fever or the neutrophil counts during postoperative 7 days (P=0.119, P=0.855). Conclusion: The prophylactic effect of antibiotics on recovery, with the antibiotics being received only on the day of the operation, is as effective as receiving antibiotics for a longer duration after gastric cancer surgery.

사용자의 보컬 대역 추출을 통한 음악 추천 시스템

시윤(Yoon Si),부형돈(Hyeong?Don Boo),권준혁(Jun-Hyeok Gwon),정동재(Dong-Jae Jeong),이해연(Hae-Yeoun Lee) 한국정보기술학회 2018 Proceedings of KIIT Conference Vol.2018 No.6

항문관 주위에 발생한 악성 고립성 섬유성 종양

시윤(Yoon Si),김형진(Hyung Jin Kim),강원경(Won Kyung Kang),정찬권(Chan Kwon Jung),오승택(Seong Taek Oh) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.73 No.5

Solitary fibrous tumors (SFT) are rare spindle-cell neoplasms that are found principally in the pleura, and extrathoracic SFTs are even less common. We report here on a case of malignant solitary fibrous tumor in the perianal region. A 47-year-old man was referred to our hospital for surgical treatment of an incidentally discovered perianal mass. Pelvic MRI showed a slightly lobulated solid mass with central necrosis in the ischiorectal fossa. We performed complete removal of tumor with using a postanal approach. The resected specimen was 6.5×5.0×5.0 ㎝ in size, and it was an elastic solid tumor with invasion to the surrounding muscle structures. Histologically, the tumor was composed of a patternless proliferation of spindle cells with a collagenous matrix and the tumor cells showed increased cellularity, cellular pleomorphism and frequent mitotic figure. Immunohistochemical staining was positive for CD34 and negative for desmin, which indicated malignant SFT. We report here on a rare case of malignant SFT in the perianal region along with a review of the literature.

직결장암 난소 전이 환자의 특징 및 임상 양상

시윤(Youn Si),이재임(Jae-Im Lee),김수홍(Soo-Hong Kim),김지훈(Ji-Hoon Kim),김형진(Hyung Jin Kim),이윤석(Yoon Suk Lee),조현민(Hyun Min Cho),김준기(Jun Gi Kim),오승택(Seung Tack Oh),이인규(In Kyu Lee) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.4

Purpose: Treatment of ovarian metastasis from colorectal cancer has been controversial. We investigated the clinicopathologic features and treatment outcomes of patients with ovarian metastasis from colorectal carcinoma. Methods: From January 1996 to May 2009, 567 women were treated for colorectal cancer. Of those, 23 patients were diagnosed as having ovarian metastasis. We reviewed 19 pathologically proven cases, retrospectively. Results: The incidence of ovarian metastasis was 4.0%. The number of cases involving synchronous ovarian metastases was 9 (47.4%), and 10 cases (52.6%) involved metachronous ovarian metastases. Thirteen patients had metastases located in the pelvis and 6 also had peritoneal dissemination in addition to the ovarian metastasis. Twenty (63.1%) were treated with grossly complete resection. After a median follow-up duration of 45 months (range of 6∼96 months), the median survival after the diagnosis of ovarian metastasis was 40 months. The median overall survival was significantly longer in the grossly complete resection group (48.5 vs. 16 months; P=0.001). For median survival after the diagnosis of ovarian-metastasis, patients with grossly complete resection showed a significantly more favorable survival rate than the group with remnant tumors (46.5 vs 9 months; P=0.009). The survival of patients with metastases located in the pelvis was better than the group with peritoneal dissemination. Conclusion: Grossly complete resection would be of help to improve the prognosis in selective patients with metastasis from colorectal cancer, especially when metastasis is located in the pelvis.

간문맥 및 상장간막 정맥의 혈전증을 동반한 장회전이상

이정선(Jung Sun Lee),이인규(In Kyu Lee),심정호(Jungho Shim),시윤(Youn Si),이윤석(Yoon Suk Lee),오승택(Seung Tack Oh) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.6

Intestinal malrotation with volvulus is generally presented as a bilious vomiting and acute intestinal obstruction in the newborn period. It could compromise vascular supply of the small bowel secondary to torsion of superior mesenteric artery (SMA) and without urgent surgical management, it could lead to detrimental outcomes such as transmural bowel infarction and sepsis. However, in chronic cases, it is rarely obstructs the vascular supply and propagates to an acute bowel infarction. Rarely, chronic malrotation with midgut volvulus may not reduce the mesenteric blood supply because of collateral vessels, and the chronically stagnated blood flow of the superior mesenteric vein (SMV) favors thrombus formation within the lumen. The recommended treatment is Ladd’s procedure and anticoagulation therapy. The authors present an unusual case of intestinal malrotation with chronic volvulus resulting in superior mesenteric vein and portal vein thrombosis in a 28-year-old patient.

결장직장 점액성 선암의 예후에 대한 분석

최승봉(Seung Bong Choi),이인규(In Kyu Lee),원대연(Dae Youn Won),이윤석(Yoon Suk Lee),시윤(Yoon Si),이상철(Sang Chul Lee),강원경(Won Kyung Kang),박종경(Jong Kyung Park),안창혁(Chang Hyeok Ahn),김준기(Jun-Gi Kim),오승택(Seong Taek Oh) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.6

Purpose: Although many papers have reported poor prognosis of colorectal mucinous adenocarcinoma, the underlying cause for its unfavorable outcome is yet to be elucidated. In the peritoneal fluid studies, we observed that peritoneal recurrences and cytology positive cases were many times mucinous cancers. On the basis of these observations, mucinous and non-mucinous adenocarcinomas were compared and prognostic factors were studied. Methods: Five hundred and forty-six patients who underwent surgery for colorectal adenocarcinomas from January 2004 to December 2008 were included. Results: Among the 546 patients, mucinous adenocarcinomas were 30 (5.5%) and non-mucinous adenocarcinomas were 516 (94.5%). Mean age was 55.0 years, which was younger than 63.2 years in non-mucinous colon cancers. They tend to develop in the right colon. Mucinous adenocarcinomas were more advanced in depth of invasion and distant metastasis, but no significant difference in lymph node (LN) metastasis. Peritoneal CEA, CA19-9, and positive cytology were more apparent. Liver and peritoneal metastasis did not show significant increases. Five year survival rates were 82.9% and 91.7% and cancer free survival rates were 42.7% and 68.5% each, respectively, for mucinous and non-mucinous cancers. According to stage, only stage Ⅲ and Ⅳ patients showed differences in cancer free survival and overall survival (P=0.001, 0.040). Conclusion: Mucinous adenocarcinomas showed worse prognoses and significant differences in recurrences, but had similar prognoses in early cancers. Although no significant differences were in LN metastasis, dissimilarities were in infiltration depth. Infiltrations led to the increase in free cancer cells and peritoneal fluid tumor markers: ultimately cancer recurrences developed.