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백굴채(白屈菜)의 물추출물이 lipopolysaccharide로 유도된 Nitric Oxide의 생성 및 iNOS와 COX-2의 발현에 미치는 영향
조용걸,김영우,변성희,김상찬,Zhao Rong-Jie,Kim Young-Woo,Byun Sung-Hui,Kim Sang-Chan 대한한의학방제학회 2004 大韓韓醫學方劑學會誌 Vol.12 No.2
Chelidonii Herba (CHE, Baek-gul-chae in Korean), which has its original description in Gu-Hwang-Bon-Cho, a classic book of oriental Herbal book, is widely used in the treatment of stomach cancer, jaundice, gasrtic ulcer, edema and stomach pain, in Korea, Japan and China. The present study was conducted to evaluate the effect of CHE on the nitric oxide (NO) production, iNOS and COX-2 expression in lipopolysaccharide - activated Raw 264.7 cells. After the treatment of CHE, NO production was monitored by measuring the nitrite content in culture medium, cell viability was measured by MIT assay. COX-2 and iNOS were determined by lmmunoblot analysis. The production of nitric oxide was significantly inhibited by pretreatment (1h) with CHE (0.1-0.3 mg/ml) on LPS-activated Raw264.7 cells. The expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase 2 (COX-2) protein were up-regulated by LPS, but the increased levels of iNOS and COX-2 were inhibited by pretreatment of CHE (0.1-0.3 mg/ml), respectively. Thus, the present data suggest that CHE may play an important role in adjunctive therapy in Gram-negative bacterial infections.
복강경 대장 직장 절제술 후 표준화 조기회복 프로그램이 환자 회복과 치료에 미치는 영향
조용걸,이정은,유상화,김승한,정규영,정춘식,이동근 대한대장항문학회 2010 Annals of Coloproctolgy Vol.26 No.3
Purpose: A multidisciplinary program for early recovery after colorectal surgery has been developed continuously since 2000. The purpose of this study was to evaluate the effects of the standardized postoperative enhanced recovery program (SPERP) after a colorectal resection. Methods: The patients undergoing laparoscopic colorectal resection for colorectal cancer were cared for by using the SPERP after surgery. The comparison group consisted of patients who had undergone similar surgery before establishment of the SPERP. The two groups were compared with respect to the patients’ characteristics, operation methods, operation time,blood loss, amounts of intravenous fluid and intravenous antibiotics, complications, postoperative hospital stay, readmission rate, and reoperation rate. Results: The number of patients being treated with the standardized postoperative recovery program, the standardized group (SG), was 63, and that of the traditional group (TG) was 61. Even though the day of oral feeding (1.02 vs. 2.67 days) was faster in the SG, the day of flatus and defecation was not different between two groups. The postoperative hospital stay in the SG (6.76 days) was significantly shorter than that in the TG (10.43 days). The total amount of intravenous fluid after surgery in the SG was 8,574.75 mL, compared with 19,568.22 mL in the TG. The duration of intravenous antibiotics was 2.69days in the SG and 7.38 days in the TG (P=0.0001). The rates of complication (27.0% in SG vs. 39.3% in TG), reoperation (3.17% vs. 9.84%), and readmission (7.94% vs. 6.56%) did not increase after implementation of this program. Conclusion: The standardized postoperative recovery program reduced the amounts of postoperative intravenous fluid and antibiotics and the postoperative hospital stay without increasing either complications or the readmission rate. A prospective multi-center study of this program is needed.
조용걸,김선한,한구용,이동근 대한대장항문학회 2004 Annals of Coloproctolgy Vol.20 No.5
Purpose: The aim of this study was to evaluate the interim oncologic outcome following a laparoscopic resection of colon cancer. Methods: Prospectively collected data was obtained on 119 patients (M:F=60:59, mean age=56 years) undergoing a laparoscopic colon-cancer resection between January 2001 and May 2004. Fifty-nine tumors were in the sigmoid, 17 in the right colon, 15 in the transverse colon, 12 in the hepatic flexure, 12 in the left colon, 10 in the cecum, and 4 in the splenic flexure. Results: The operative procedures included 51 sigmoidectomies, 48 right colectomies, 15 left colectomies, 3 transverse colectomies, and 2 total abdominal colectomies. The mean operative time was 186 minutes. The mean blood loss was 91 ml. Conversion to an open procedure was not required. TNM stages were 0 in 11 patients, I in 19, II in 55, III in 30, and IV in 4. The portion of T3 plus T4 was 73%. The mean number of resected lymph nodes was 27. The mean proximal and distal margins were 14 cm and 12 cm. The overall morbidity rate was 26% (15 wound seromas/ abscesses, 5 chylous leaks, 3 perianastomotic inflammations, 2 ileus, 2 intraabdominal bleedings, 1 anastomotic leak, 1 anastomotic obstruction, 1 intractable hiccup, 1 fungal peritonitis). There were no operative mortalities. The mean hospital stay was 10 days. Ninety eight patients were followed-up longer than 6 months (median 19 months, range 6∼40 months) after the curative resection. Distant metastases occurred in 3 stage-IIIB and 3 stage-IIIC patients (6%): liver (2), liver & peritoneum (1), lung (1), paraaortic and iliac lymph nodes (1), and peritoneum (1). The mean time to recurrence was 10.3 months after the operation.There were no local or port-site recurrences. Conclusions: In this study, Laparoscopic resections of colon cancer provided an acceptable morbidity rate and satisfactory early oncologic outcomes. Long-term follow-up is mandatory and ongoing. 다음과 같다 .1) 좌측결장절제술 및 에스결장절제술배꼽직하부에 개방법으로 10 m 투관침을 설치하여 0도 카메라를 넣고 우상복부 5 mm, 우하복부 12 mm 투관침을 뚫어 수술자가 사용하고 좌상하복부에 5 m 투관침 두 개를 뚫어 보조자가 사용하였다 . Trendelenberg 위치에서 환자의 우측을 기울여 소장을 우상복부로 자연 이동시켜 시야를 확보한 후 , 종양의 위치에 따라 하장간막동맥 혹은 좌결장동맥을 기시부에서 절단하였다 . 에스 및 좌측결장을 내측에서 외측 방향으로 박리해 나가며 생식샘혈관과 뇨관을 확인하였다. 좌측결장절제술시 후복막 박리를 근위부 좌측결장과 원위부 횡행결장으로 확대하여 무혈관면을 따라 좌측신장 및 췌장 등의 후복막 구조물과 완전히 박리하여 수술이 편하게 진행되었다 . 좌측복막굴곡부를 비장만곡부위까지 올라가면서 완전히 절개한 후 비장결장인대를 박리하였다 . 종양의 위치에 따라 그물막(omentum) 동반절제 여부를 판단하여 횡행결장을 위로부터 분리하였다. 역시 종양의 위치를 고려하여 에스결장 근위부 혹은 에스결장 -직장 이행부를 복강경용 자동절단기로 절단한 후 , 배꼽부 투관침이나 좌상 혹은 좌하복부 투관침부를 4∼6 cm 연장 절개하여 비투과성 비닐막을 설치하고 병변을 꺼내어 중결장혈관의 좌측 가지를 자르고 횡행결장을 체외에서 절단하였다 . 마지막으로 체외 문합을 시행하거나 복강경 술식을 통한 경항문 자동문합을 시행하였다. 2) 우측결장절제술배꼽직하부에 개방법으로 10 m 투관침을 설치하여 0도 카메라를 넣고 우상복부 5 m, 우하복부 5 m 투관침을 뚫어 보조자가 사용하고 좌상하복부에 10 m, 5 m 투관침 두 개를 뚫어 수술자가 사용하였다 . Trendelenberg 위치에서 환자를 좌측으로 기울여 소장을 좌상복부로 자연 이동시켜 시야를 확보한 후 회결장동맥 (ileocolic artery)을 기시부에서 박리 절단한 다음 우측결장을 내측에서 외측 방향으로 박리하였다. 후복막 박리를 우측결장과 근위부 횡행결장으로 확대하여 무혈관면을 따라 우측신장 및 십이지장 등의 후복막 구조물과 완전히 박리하였다. 우결장혈관과 중결장혈관의 기시부나 우측 분지를 자르고 종양의 위치에 따라 그물막 (omentum) 동반절제 여부를 판단하였다. 역시 종양의 위치를 고려하여 회장과 횡행결장을 복강경용 자동절단기로 절단하거나 배꼽부 투관침부를 4∼6 cm 연장 절개하여 비투과막을 설치하고 병변을 꺼내어 절단하고 마지막으로 체외 문합을 시행하였다.