복강경 담낭절제술과 개복성 담낭절제술에 대한 임상적 비교 고찰

김호성(Ho Sung Kim),지경천(Kyung Choun Chi),이정효(Jeong Hyo Lee),장인택(In Taik Chang),김상준(Sang Jhoon Kim) 대한외과학회 1993 Annals of Surgical Treatment and Research Vol.45 No.5

위선암종에서 p53 단백 및 CREB-결합 단백의 면역조직화학적 발현양상

노태호(Tae Ho Noh),지경천(Kyung Choun Chi),임현묵(Hyun Muk Lim),이정효(Jung Hyo Lee),박용검(Yong Gum Park),김범규(Beom Gyu Kim),김미경(Mi Kyung Kim),김진수(Jin Soo Kim) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.6

Purpose: The wild-type p53 protein participates in suppressing cell transformations while its mutant forms has tumorigenic potential. Alterations in the structure of the p53 protein are one of the most common changes associated with human cancers. CREB-binding protein (CBP) and its homologue, p300, are transcriptional co-activators of various sequence-specific DNA-binding transcription factors and are involved in a wide range of cellular activities, such as DNA repair, cell growth, differentiation, and apoptosis. Several studies suggested that an association between p53 and p300 might account for the p53-responsible negative regulation. This study examined the relationship between p53 and CBP expression in terms of the clinicopathological factors and significance. Methods: The level of p53 protein and CBP expression was measured in 150 gastric adenocarcinoma patients, who had undergone a gastrectomy, and the relationship between p53 and CBP was examined. Immunohistochemical stain was performed on formalin-fixed paraffin-embedded sections using monoclonal anti-p53 and anti-CBP antibody. Results: 1. p53 protein was expressed in 46.3% (31/67) of early gastric cancers (EGC), 69.9% (58/83) of advanced gastric cancers (AGC)(P<0.05), 69.1% (65/94) of the intestinal type, 42.9% (24/56) of the diffuse type (P<0.05), 78.5% (55/70) of patients with a lymph node metastasis and 42.5% (34/80) of patients without a lymph node metastasis (P<0.01). 2. CBP expression was observed in 65% (61/94) of intestinal type, 51% (29/56) of the diffuse type (P>0.05), 47.8% (32/67) of EGC, 69.8% (58/83) of AGC (P<0.05), 68.6% (48/70) of patients with a lymph node metastasis and 52.5% (42/80) of patients without a lymph node metastasis (P>0.05). 3. p53 protein and CBP expression was coincidentally observed in 66.7% of gastric adenocarcinomas, and there was a significant correlation between the expression of both (P<0.05). Conclusion: That the expression of the p53 protein and CBP indirectly indicate the malignant potential of a cell, and may play an indirect role in the CBP and p53-mediated tumorigenic potential.

위선암종에서 핵의 Retinoic Acid Receptor (RAR) 및 cAMP Response Element Binding Protein (CREB)의 면역조직화학적 발현양상

한호선,김용석,박중민,최유신,차성재,김미경,지경천,Han, Ho-Sun,Kim, Yong-Seok,Park, Joong-Min,Choi, Yoo-Shin,Cha, Seong-Jae,Kim, Mi-Kyung,Chi, Kyung-Choun 대한위암학회 2008 대한위암학회지 Vol.8 No.4

목적: 인체 내 여러 조직에서 상피세포의 분화 및 증식에 중요한 역할을 담당한다고 알려진 retinoic acid (RA)와 여러 유전자들에서 전사조절인자로 성장관여 유전자들의 활성화에 관여하며 세포증식 및 분화에 매우 중요한 세포내 조절인자인 CREB의 발현정도와 위선암종간의 상호 연관성 및 병리학적 인자들과의 관계를 관찰하였다. 대상 및 방법: 중앙대학교 의과대학 용산병원에서 1998년 1월부터 2007년 12월까지 위절제술을 시행 받고 위선암종으로 진단받은 환자의 위조직표본 중 보존상태가 양호한 파라핀 포매괴 150예를 연구대상으로 조직 표본에서 면역 조직화학적 염색을 통해 관찰하였다. 결과: 1. RAR의 발현은 장형 위선암종(72.2%)에서 미만형 위선암종(40.5%)보다 높게 나타났으며(P<0.01), 림프절 전이가 있는 경우(74.7%)가 림프절 전이가 없는 경우(49.2%)보다 의미 있는 발현양상을 나타냈다(P<0.01). 2. cAMP response element binding protein (CREB)의 발현은 장형 위선암종(69.4%)에서 미만형 위선암종(38.1%)보다 높게 나타났으며(P<0.01), 림프절 전이가 있는 경우(71.1%)가 림프절 전이가 없는 경우(47.8%)보다 높은 발현양상을 나타냈다(P<0.01). 3. 총 150예의 위선암종에서 RAR은 63.3% (95/150), CREB은 60.7%(91/150)에서 발현을 나타냈다(P<0.01). 결론: 이상의 결과로 RAR과 CREB은 조직학적 분화도 및 종양의 전이와 관련이 있고, 이들의 발현이 장형 위선암종에서의 생물학적 악성도에 관한 예후인자로서 관련이 있으나 이들의 발현이 위선암종에 미치는 생물학적 기전에 대한 추가 연구가 필요하다. Purpose: Transcriptional factors of CREB (cAMP response element binding protein) are involved in regulating the gene expression in response to a variety of signaling pathways. The proteins produced by the CREB genes play key roles in many physiological processes, including memory and long-term potentiation. The retinoic acid receptor (RAR) axis mediates epithelial cell differentiation and proliferation in many tissues. This study examined the expressions of RAR and CREB and their relationship with the clinicopathologic factors and their significance. Materials and Methods: The levels of the RAR and CREB expressions were measured in 150 gastric adenocarcinomas by performing immunohistochemical staining. Results: 1. An RAR protein expression was found in 63.3% of the adenocarcinomas (95/150) and a CREB expression was found in 60.7% (91/150) of the adenocarcinomas. 2. An RAR protein expression was found in 72.2% (78/108) of the intestinal type adenocarcinomas and in 40.5% (17/42) of the diffuse type adenocarcinomas (P<0.05). Based on the depth of invasion, an RAR protein expression was found in 58.3% (14/24) of the T1 adenocarcinomas, in 61.9% (13/21) of the T2 adenocarcinomas, in 63.5% (61/96) of the T3 adenocarcinomas, in 77.8% (7/9) of the T4 adenocarcinomas and in 74.7% (62/83) of the adenocarcinomas with lymph node metastasis and in 49.2% (33/67) of the adenocarcinomas without lymph node metastasis (P<0.01). 3. A CREB expression was found in 69.4% (75/108) of the intestinal type and in 38.1% (16/42) of the diffuse type (P>0.05). Based on the depth of invasion, a CREB expression was found in 50% (12/24) of the T1 adenocarcinomas, in 52.4% (11/21) of the T2 adenocarcinomas, in 64.6% (62/96) of the T3 adenocarcinomas, in 66.6% (6/9) of the T4 adenocarcinomas, in 71.1% (59/83) of the adenocarcinomas with lymph node metastasis and in 47.8% (32/67) of the adenocarcinomas without lymph node metastasis (P<0.01). 4. The RAR protein and CREB expressions coincided in 71.4% of the gastric adenocarcinomas and a significant correlation between them was found (P<0.05). Conclusion: We found a significant relationship between the expression of RAR and CREB and the histology and lymph node metastasis of gastric cancer. Further studies are needed to confirm their biologic meaning in gastric carcinogenesis.

증례 : 내분비 ; 갈색세포종, 신경절신경종이 동반된 갑상선유두암 1예

안지현 ( Ji Hyun Ahn ),이승은 ( Seung Eun Lee ),정윤재 ( Yun Jae Chung ),지경천 ( Kyong Choun Chi ),김미경 ( Mi Kyung Kim ),오연상 ( Yeon Sahng Oh ),김재택 ( Jae Taek Kim ) 대한내과학회 2009 대한내과학회지 Vol.76 No.1

갈색세포종은 대부분 산발적으로 발생하고 다른 종양들과 연관되어 있으나 한 종양 내에서 갈색세포종과 신경절신경종이 동반되는 경우는 극히 드물다. 또한 다발내분비종양 제2형에서는 갈색세포종이 갑상선수질암과 관련되어 있으나 갑상선유두암과는 관련성이 드물고 이들간의 관계는 명백히 알려져 있지 않다. 저자들은 갈색세포종과 신경절신경종, 갑상선유두암이 동시에 발생한 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Composite tumors containing pheochromocytoma and ganglioneuroma are very rare. We report a 70-year-old female with papillary thyroid carcinoma and a compound adrenal medullary tumor, composed of pheochromocytoma/ganglioneuroma. She had complained of epigastric discomfort 2 months earlier. Chest computed tomography and pancreatic magnetic resonance imaging revealed an intrathoracic goiter and pancreatic cystic tumor. She underwent an explorative laparotomy, and a left adrenalectomy was done because of an adrenal mass, not the pancreatic mass. The pathological diagnosis was a compound adrenal medullary tumor, composed of pheochromocytoma and ganglioneuroma. Although there was no evidence of thyroid cancer on fine needle aspiration cytology, a total thyroidectomy was done because of the neck discomfort. The pathological diagnosis was a papillary thyroid carcinoma, and she underwent radioactive iodine therapy. (Korean J Med 76:85-89, 2009)

위선암에서 MUC2 및 MUC5AC 발현의 임상적 의의

박승배(Sung Bae Park),김대중(Dae Joong Kim),김용석(Yong Seok Kim),김범규(Beom Gyu Kim),지경천(Kyung Choun Chi),임현묵(Hyun Muck Lim),노재형(Jae Hyung Noh),손태성(Tae Sung Sohn),김성(Sung Kim) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.3

Purpose: We examined the clinical significance of MUC2 and MUC5AC gene expression in gastric adeno-carcinoma tissues. Methods: Two hundred specimens were obtained from gastric carcinoma patients who underwent gastric cancer operations at Samsung Medical Center between January 2001 and January 2005. MUC2 and MUC5AC expression were examined immunohistochemically, and correlated with clinicopathologic features and prognostic significance. Results: MUC2 expression was positive in 88 tissues (44.0%) and MUC5AC expression was positive in 125 tissues (62.5%). MUC2 expression was associated with cancer advancement, lymph node metastasis, T classification, distant metastasis, and endolymphatic invasion. Loss of MUC5AC expression was significantly related to cancer advancement, lymph node metastasis, advanced T stage, and distant metastasis. MUC2 expression was usually negative in early gastric cancer (78%), but usually positive in advanced gastric cancer (66%). MUC5AC was usually positive in early gastric cancer (74%). The prognosis of the MUC2(-) group was significantly better than the MUC2(+) group (P<0.001). There was no relationship with MUC5AC expression and survival. Multivariate analysis showed that T classification, lymph node metastasis, distant metastasis, endolymphatic invasion, and MUC2 expression were independent prognostic factors, but MUC5AC expression was not. Conclusion: MUC2 and MUC5AC expression correlated with several clinicopathologic parameters (cancer advancement, lymph node metastasis, advanced T classification, distant metastasis). MUC2 expression was a significant independent prognostic factor and positive MUC2 expression suggested poor prognosis. MUC2 expression may have prognostic significance in gastric adeno-carcinomas.

복강경 담낭 절제술 2,523예 시행 중 개복술로 전환한 111예에 대한 임상적 고찰

방지성(Ji Sung Bang),최유신(Yu Sin Choi),김범규(Beom Gyu Kim),차성재(Sung Jae Cha),지경천(Kyung Choun Chi),이정효(Jung Hyo Lee),장인택(In Taik Chang) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.3

Purpose: While laparoscopic cholecystectomy can be successfully performed in the majority of patients, conversion to open procedure is still necessary in certain cases. The purpose of this study was to identify the discerning factors that helped to predict the need for conversion to open cholecystectomy. Methods: A retrospective review was conducted on the data for 2,523 laparoscopic cholecystectomies performed at Chung-Ang University Hospital between January 2002 and July 2007. Patient sex, age, height, weight, body mass index (BMI), duration of preoperative hospital stay, preoperative physical examination, laboratory data, radiologic findings, and reasons for conversion to open procedure were evaluated. Results: Adhesion was perceived to be the most critical factor for conversion in 56 of 111 total cases (50.5%). Bleeding (22.5%), bile duct injury (11.7%), inflammation (9.0%), and uncertain anatomy (6.3%) followed sequentially in incidence. Factors found to significantly increase the risk of conversion on univariate analysis were patient age >70 years, male sex, previous abdominal operation, preoperative common bile duct stone, tenderness in the right upper quadrant, distended shape of the gallbladder, and pericholecystic fluid collection. On multivariate analysis, the following factors were found to be associated with a higher risk: patient age >70 years (p=0.002), male sex (p=0.012), previous abdominal operation (p<0.0001), and preoperative common bile duct stone (p=0.041). Conclusion: In the case of operations with such discerning factors, surgeons should be more cautious and delicate in all procedures throughout the operative period. Furthermore, to reduce the risk of additional severe complications, surgeons need to decide early on if they will perform a conversion.