Comparative analysis of BMS according to surgical type

Hye Seong Ahn(안혜성),Hyuk Joon Lee(이혁준) 대한외과학회 2014 대한외과학회 학술대회 초록집 Vol.2014 No.11

복강 내 미주신경에 발생한 퇴행성 신경초종의 복강경하 절제술

안혜성(Hye Seong Ahn),박도중(Do Joong Park),이혜승(Hye Seung Lee),이혁준(Hyuk-Joon Lee),김형호(Hyung-Ho Kim),양한광(Han-Kwang Yang) 대한외과학회 2006 Annals of Surgical Treatment and Research(ASRT) Vol.71 No.6

외과 환자에 있어서의 면역영양

안혜성 ( Hye Seong Ahn ),허승철 ( Seung Chul Heo ) 한국정맥경장영양학회 2012 한국정맥경장영양학회지 Vol.5 No.1

Patients undergoing major surgery are at increased risk of developing post-operative complications. In the last years, several clinical studies and meta-analyses focused on the potential clinical benefits of perioperative immunonutrition in surgical patients and showed contradictory results with regard to complications. The aim of this study is to summarize the concept of immunonutrition and the results of those clinical trials and to draw recommendations about the current indications of immunonutrition in surgery. A range of nutrients, including several amino acids, antioxidant vitamins and minerals, long-chain n-3 fatty acids, and nucleotides have been shown to upregulate the host immune function, modulate inflammatory response, and improve gut barrier function after surgery. Several experimental studies have been carried out that support potential benefits of these nutrients in the surgical patients. The majority of the randomized trials found that perioperative immunonutrition improved short-term outcomes in patients who underwent elective major gastrointestinal (GI) surgery. Five meta-analyses including a large number of randomized clinical trials showed that perioperative immunonutrition is associated with a reduction in both the infection rate and the length of hospital stay. These results have been demonstrated in all patients undergoing both the upper and lower GI surgery, regardless of their baseline nutritional status. Promising results have been obtained also in head and neck surgery. Considering these findings, perioperative immunonutrition should be implemented in patients undergoing elective major GI surgery. The use of perioperative immunonutrition could reduce both postoperative morbidity and costs for healthcare systems. However, large- scale trials are required before recommending the routine use of immunonutrition in head and neck surgery. (JKSPEN 2013; 5(1):10-14).

원발성 십이지장 선암의 수술적 치료 및 성적

안혜성(Hye Seong Ahn),장진영(Jin-Young Jang),이승은(Seung Eun Lee),양성훈(Sung Hoon Yang),이건욱(Khun Uk Lee),김선회(Sun Whe Kim) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.1

Purpose: Because of the rarity of primary duodenal adenocarcinomas, the factors affecting the management and survival of patients with this disease remain controversial. This study analyzed the nineteen-years of experience gained at one institution to define the surgical management and outcomes of patients with primary duodenal adenocarcinomas. Methods: A retrospective review of 77 patients, who underwent surgery for a primary duodenal adenocarcinoma at Seoul National University Hospital, between May 1985 and April 2004, was undertaken. The dermographics symptoms, operative variables, surgical pathology and survival data were analyzed. Results: A curative resection was performed in 40 patients (51.9%); a pancreaticoduodenectomies and/or resection of other organs, pancreas head resection with a duodenal segmentectomy and a segmental duodenectomy and resection of another organ in 37, 2 and 1, respectively. The remaining 37 patients underwent a palliative resection or bypass. The hospital mortality and complication rates were 2.6% (2 patients) and 42.9% (33 patients), respectively. The overall 5-year survival was 26.8%. The 5-year survival for the curative resection group was 42.7%, whereas that for the palliative surgery group was 0%. In a univariate analysis, nodal metastasis was found to have a significant negative impact on survival after a curative resection (P=0.028). The patients’ age, sex, operative procedure, tumor size, histologic type, differentiation and tumor depth had no influence on survival. Conclusion: A curative resection is associated with increased survival in patients with a duodenal adenocarcinoma. Following a curative resection, nodal metastasis is an independent prognostic factor. Therefore, the early diagnosis should be sought to achieve a curative resection and increased survival. As a curative resection, a pancreati-coduodenectomy is usually required, and a segmental duodenal resection may be appropriate in selected patients, especially in early duodenum cancers.

초등영어캠프에서 한·영 스토리텔링 활용이 학습자의 정의적 영역과 어휘력 향상에 미치는 효과

안혜성,방준,Ahn. Hye-Seong,Bang. Jyun 팬코리아영어교육학회(구 영남영어교육학회) 2015 영어교육연구 Vol.27 No.2

The purpose of this study is to analyze the effects of Korean-English storytelling on the development of elementary school students’ vocabulary abilities and affective domain. The experimental instruction was given to 40 third to sixth grade students in elementary school. Over a period of two weeks during which time they covered 40 hours worth of material from nine different chapters, three types of tests and two types of questionnaires were administered, in order to examine the effects of the experiment on the students’ vocabulary abilities and affective domain. The results are summarized as follows. First, over 90 percent of the students responded that they were satisfied with learning vocabulary using storytelling. Second, the results of the post-test show the scores greatly improved since the pre-test. Third, the results of the delayed-test show the scores are higher than the pre-test. There were positive results in the students’ affective domain. To conclude, the findings show that using Korean-English storytelling can be a powerful learning method to enhance students’ vocabulary ability. Further study should be developed but the preliminary results look promising when efficiently applied to English Education.

위암 수술 후 발생한 복강 내 체액 저류의 치료

전영민,안혜성,유문원,조재진,이정민,이혁준,양한광,이건욱,Jeon, Young-Min,Ahn, Hye-Seong,Yoo, Moon-Won,Cho, Jae-Jin,Lee, Jeong-Min,Lee, Huk-Joon,Yang, Han-Kwang,Lee, Kuhn-Uk 대한위암학회 2008 대한위암학회지 Vol.8 No.4

목적: 위암 수술 후 이환율 및 사망률과 관련된 인자로 복강 내 체액 저류가 보고되고 있다. 저자들은 위암 수술후 복강 내 체액 저류가 발생한 환자군의 임상적 특징과 이에 관한 치료 방법으로 경피적 배액술을 시행한 군의 임상적 특징에 대하여 분석하였다. 대상 및 방법: 2005년 4월부터 2006년 7월까지 서울대학병원 외과에서 위암으로 수술 받은 1,277명 환자 중 117명에서 체액 저류가 확인되었다. 체액 저류의 치료 방법에 따라 임상 병리학적인 인자들의 차이를 분석하였다. 결과: 복강 내 체액 저류가 확인된 117명의 병기는 1기 42명(36.8%), 2기 23명(20.2%), 3기 16명(14%), 4기 33명(28.9%)이었다. 수술 방법으로 위아전절제술은 38명(32.5%), 위전절제술은 27명(23.1%), 위확대전절제술은 41명(35%)이었다. 치료방법으로써 경피적 배액술 시행 군과 보존적 치료를 한 군 간에 나이, 성별, 동반 질환 유무, 림프절 청곽술 범위, 병기, 체질량지수 등에서 차이를 보이지 않았다(P>0.05). 그러나 복부 전산화 단층 촬영에서 체액 저류 크기가 4cm 이상인 경우와 감염증이 있는 경우에 치료 방법으로써 경피적 배액술을 더 많이 시행하였다(P<0.05). 결론: 위암 수술 후 복강 내 체액 저류가 발생한 환자는 4기 위암 또는 타 장기 합병 절제의 경우가 많았고 체액 저류에 대하여 2/3 (41명, 35%)에서 보존적 치료로써 호전이 되었다. 경피적 배액술은 체액 저류 크기가 4 cm 이상일 때 또는 감염증이 있을 때 필요하다고 생각한다. Purpose: Intra-abdominal fluid collection is one of the risk factors associated with postoperative morbidity or mortality for patients who undergo gastric cancer surgery. The aim of this study was to analyze the clinicopathological characteristics of the patients with postoperative intra-abdominal fluid collection and to identify the indications for inserting a percutaneous drain (PCD) in patients with intra-abdominal fluid collection. Materials and Methods: Among the 1,277 patients who underwent operations for gastric cancer at Seoul National University Hospital between April 2005 and July 2006, the data of 117 patients with an intra-abdominal fluid collection were reviewed. Results: The number of patients' with pathologic stage I, II, III and IV disease was 42 (36.8%), 23 (20.2%), 16 (14%) and 33 (28.9%), respectively. Forty-three patients (36.3%) underwent PCD insertion and the other 43 patients received conservative management. A univariate analysis of multiple clinical variables revealed that age, gender, diabetes, liver disease, lymph node dissection, the pathologic stage and the body mass index (BMI, $kg/m^2$) were not significantly associated with PCD insertion (P>0.05). However, the univariate analysis showed that two characteristics were associated with a significantly high incidence of PCD insertion: a diameter of an intra-abdominal fluid collection greater than 4 cm and infectious signs such as leukocytosis, fever and bacteremia. Conclusion: About two thirds of the intra-abdominal fluid collections after surgery for gastric cancer were managed with only conservative method without other morbidities of mortality. Surgeons should consider performing PCD insertion if the largest diameter of an intra-abdominal fluid collection is over 4 cm or if infectious signs are seen.

폐(廢) 자동차(自動車) 재활용(再活用) 과정의 경제성(經濟性) 평가(評價)에 관한 연구(硏究)

백미화,안혜성,김동수,Baek, Mi-Hwa,Ahn, Hye-Seong,Kim, Dong-Su 한국자원리싸이클링학회 2009 資源 리싸이클링 Vol.18 No.2

국내 자동차 보유대수는 정차 증가하고 있으며 2007년도에 1,600만대를 초과하였다. 자동차 보유대수의 증가는 결국 폐 자동차 발생의 증가로 이어지고 있으며 폐 자동차의 재활용 필요성은 더욱 강조되고 있다. 폐 자동차의 재활용은 폐 자동차 처리를 용이하게 함과 동시에 환경파괴는 물론 부족한 자원을 대체할 수 있는 효과를 가진다. 본 연구는 폐 자동차를 재활용 했을 때의 편익과 폐 자동차를 처리했을 때의 비용을 비교하는 경제성 평가를 하였다. 비용편익 분석결과에 의하면, 폐 자동차의 부품, 철, 비철 금속 스크랩을 재활용 하였을 경우 편익이 발생하는 것으로 나타났다. 즉, 본 연구의 결과는 폐 자동차를 재활용함으로써 얻을 수 있는 경제적인 이득을 시사하고 있다. 따라서 정부는 폐 자동차 및 소재의 재활용을 의무화하여야 하고 기업은 효율적인 폐 자동차의 해체 및 재활용 방법 개발 등을 고려해야 한다고 사료된다. Number of vehicles in Korea is gradually increasing and it exceeded 16 million in 2007. Holding of vehicles is connected to disposal, owing to this reason the importance of ELVs recycling has been emphasized. The recycling of ELVs makes the disposal of ELVs easier as well as protects environment and it has the alternative effect economizing the insufficient resource. This study was carried out to evaluate the economic effect of recycling of ELVs compared with disposal of ELVs. The analysis showed that recycling process makes a profit in comparison to the disposal of ELVs. Therefore the government has to consider establishing the regulation related to recycling of ELVs or materials and car manufactures have to develop the efficient dismantling and recycling methods.

진단 후 78개월 뒤에 근치적으로 절제된 진행위암 1예

손해정,유문원,공성호,안혜성,이인규,김우호,이혁준,양한광,Son, Hae-Jung,Yoo, Moon-Won,Kong, Seong-Ho,Ahn, Hye-Seong,Lee, In-Kyu,Kim, Woo-Ho,Lee, Hyuk-Joon,Yang, Han-Kwang 대한위암학회 2010 대한위암학회지 Vol.10 No.1

The natural history of gastric cancer is unclear. We report here on a rare case of advanced gastric cancer for which we performed curative gastrectomy 78 months after the diagnosis. A 74-year-old woman with epigastric pain underwent esophagogastroscopy in January, 2000 and she was diagnosed with advanced gastric cancer. Suspicious omental cake was noted on CT. After refusing all kinds of treatment, she underwent a follow up CT scan on September, 2002, which no longer suggested omental cake. She once again refused treatment, but she visited the hospital in June, 2006 due to severe epigastric pain and a decreased oral intake. Abdominal CT showed no distant metastasis, and so radical subtotal gastrectomy with regional lymph node dissection was performed in July, 2006 and the TNM stage was T2bN1M0 (stage II). 위암의 자연사는 불분명하다. 이에 저자들은 진행위암으로 진단받은 후 78개월 동안 치료 없이 지내다 수술 후 II기로 진단받은 1예를 경험하였기에 보고한다. 대상 환자는 74세 여자로 2000년 1월 상복부 통증으로 시행한 내시경 검사에서 전정부에 진행위암이 진단되었고 복부 전산화단층촬영(CT)에서 그물막 전이소견이 의심되었다. 이후 치료 없이 지내던 환자가 재평가를 원하여 2002년 9월에 시행한 복부CT에서 그물막 전이로 보였던 병변이 보이지 않았다. 이후에도 치료를 받지 않았고 2006년 6월에 식사량이 줄어 시행한 복부 CT에서 원격전이는 보이지 않았다. 2006년 7월 근치적 위아전절제술을 시행하였고 병기는 T2bN1M0로 II기였다.

소화성 궤양 합병증으로 응급수술을 시행한 환자에서 수술 후 합병증 예측인자로서 POSSUM-physiological Score의 유용성

김홍범(Hong Beom Kim),안혜성(Hye Seong Ahn),권준식(Jun Sik Kwon),정인목(In Mok Jung),안영준(Young Joon Ahn),허승철(Seung Chul Heo),황기태(Ki-Tae Hwang),정중기(Jung Kee Chung) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.77 No.6

Purpose: The POSSUM (Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity) score was developed to predict post-operative mortality and morbidity rates. The aim of this study was to validate the POSSUM physiologic score (POSSUM-P) in emergent operations for peptic ulcer complications. Methods: We retrospectively collected data on patients who underwent emergent operation for peptic ulcer complications at Boramae Hospital between January 2003 and April 2009. The data included patients’ characteristics (underlying disease, medication, duration of symptoms), operative characteristics (operation method, morbidity, and mortality) and the items for the POSSUM-P (basic information (age, sex, etc.), circulatory and respiratory signs, electrocardiogram, blood pressure, hemoglobin, white blood cell count, potassium level, sodium level, urea level and Glasgow coma scale). The POSSUM-P was calculated and compared according to the morbidity and mortality. Results: One hundred and twelve patients were included. As for operation methods, primary repair (48.2%) was most common, followed by truncal vagotomy with pyloroplasty (27.7%). Thirty-seven patients had morbidities including wound infections (20), pneumonias (14), fluid collections (9), and so on. Eight patients died due to sepsis or pulmonary edema. The means of POSSUM-P were significantly different between patients with and without mortality (37.8 vs. 19.2, P<0.001) and between patients with and without morbidity (26.7 vs. 17.3, P<0.001). Those were different between patients with and without postoperative pneumonia and wound infection (P=0.002 and P=0.029, respectively). Conclusion: The POSSUM physiologic score could help to predict the mortality or morbidity after emergency operation for complications of peptic ulcer disease, especially postoperative pneumonia or wound infection.

위 유암종의 임상병리학적 특징에 대한 후향적 연구

장정문,공성호,윤홍만,안혜성,이혁준,윤원재,김상균,양한광,이건욱,Jang, Jeong-Moon,Kong, Seong-Ho,Yoon, Hong-Man,Ahn, Hye-Seong,Lee, Hyuk-Joon,Yoon, Won-Jae,Kim, Sang-Kyoon,Yang, Han-Kwang,Lee, Kuhn-Uk 대한위암학회 2009 대한위암학회지 Vol.9 No.4

목적: 위 유암종의 임상병리학적 특성과 치료방법 및 예후 등을 분석하였다. 대상 및 방법: 1996년부터 2006년까지 본원에서 치료받았던 18명을 대상으로, 의무기록을 이용한 후향적 연구를 통해 Rindi 분류에 의해 구분하여, 기존의 보고와 임상병리학적 특성 및 치료, 생존율을 비교 분석하였다. 결과: Type I은 8명, type III가 10명이었으며 type II는 없었다. 평균발생 연령은 type I이 47.75세, type III는 57.90세였고, type I은 남자 4명, 여자 4명으로 성비가 1:1이었으나 type III는 남자 7명, 여자 3 명으로 남자에서 많았다. Type I에서도 단발성인 경우가 4예가 있었으며, 1예를 제외하고는 점막 또는 점막하층에 국한되어 있고, 림프절 전이나 원격전이는 없었다. Type III는 병변의 침습성에 관계없이 모두 국소림프절 전이 또는 원격 전이가 있었다. 진단 시 원격전이가 없었던 13명 중 5예에서 내시경적 절제술, 8예에선 수술이 시행되었으며 5년 생존율은 92.3%였다. 원격 전이가 있었던 5예는 평균 생존 기간이 22개월로 이 중 고식적 수술을 시행 받은 3예의 중위 생존 기간은 24개월이었다(95%, ${\pm}6.52$). 결론: 기존의 Rindi 분류법과 비교하여 보았을 때, 본 연구 결과 빈도에 있어서 type III가 type I보다 흔하였다. 또한 type I 유암종에 있어서 평균연령이 낮고, 단발성 종양이 절반 정도를 차지하며, 악성빈혈이 동반되지 않았던 점 등에서 서구와는 다른 특징이 관찰되었다. Purpose: We wanted to analyze the clinicopathologic characteristics of patients with gastric carcinoid tumor, which is a rare gastric tumor (less than 2% of all gastric tumors). Materials and Methods: We reviewed all the carcinoid patients who were treated from 1996 to 2006. The clinicopathologic characteristics, the treatment modalities and the survival rates were retrospectively analysed. Results: There were 8 type I patients and 10 type III patients, but there were no type II patients. The mean age of onset for type I was 47.75 years and that for type III was 57.90 years. More type III patients were female, but the gender ratio of type I patients was equal at a ratio of 1:1. There were 4 cases of solitary tumor, which were all T1 except for one case, and there was neither distant metastasis nor lymph node involvement for the type T1 cases. In the 13 patients who had no metastasis, 5 underwent endoscopic mucosal resection and 8 underwent surgery, and their combined 5 year survival rate was 92.3%. For the 5 cases who had metastastses, their mean survival was 22 months and especially, 3 of them underwent palliative surgery and their median survival were 24 months (95%, ${\pm}6.52$). Conclusion: Higher incidence of type III gastric carcinoid tumor and less multiplicity in type I gastric tumor were identified in our study compared with previous reports. For the type III cases, there were some noteable differences compared with the Western country's survival rate for the patients who underwent palliative surgery, so physicians must pay close attention to the definite clinicopathologic characteristics of gastric carcinoid patients.