Hepatocellular Carcinoma in the Elderly: Clinical Characteristics, Outcomes and Treatment Efficacy, Safety in Older than 75 Years

( Ji Ho Seo ),( Sunmin Kim ),( Eunae Cho ),( Chung Hwan Jun ),( Sun Young Park ),( Sung Bum Cho ),( Chang Hwan Park ),( Hyun Soo Kim ),( Sung Kyu Choi ),( Jong Sun Rew ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: The number of elderly patients diagnosed with hepatocellular carcinoma (HCC) has been increasing because the increase in the longevity of the general population. But there is no proper management based on age stratification in elderly patients. We compared clinical characteristics, outcomes and treatment efficacy, safety between oldest-old (aged more than 85 years), middle-old (aged between 80 and 85 years) and young-old (aged between 75 and 80 years) patients with HCC. Methods: We conducted a retrospective cohort study, from January 2010 to December 2016, at Chonnam National University Hospital. A total of 550 elderly patients whose data included demographics, co-morbidity, etiology of liver disease, presence of cirrhosis, staging of HCC, treatment modality and treatment related adverse event were evaluated retrospectively. Also overall survival was assessed in enrolled patient. Results: Fifty one patients (oldest-old; median 87 years old), 153 patients (middle-old; median 82 years old) and 346 patients (young-old; median 77 years old) were diagnosed with HCC. Both oldest- and middle-old patients, compared to young-old patients had significantly lower rate of alcohol-related disease (13.7% vs 20.9% vs 34.1%, P = 0.001). There were no significant difference in underlying sex, body mass index, presence of co-morbidity, hepatitis C-related disease and stage of HCC. The Child-Pugh class (CPT class A 88.9% vs 84.1% vs 83.6%, CPT class B 11.1% vs 15.9% vs 15.0% and CPT class C 0.0% vs 0.0% vs 1.3%, respectively, P = 0.912) and Model for End Stage Liver Disease score (mean MELD score 7.22±3.34 vs 5.88±3.01 vs 5.77±3.14, P = 0.166) were no significant difference between the patients with active treatment. The modified UICC staging (stage I 5.6% vs 17.1% vs 18.6%, stage II 55.6% vs 46.3% vs 47.3%, Stage III 22.2% vs 24.4% vs 24.8%, Stage IV-A 11.1% vs 6.1% vs 4.9% and Stage IV-B 5.6% vs 6.1% vs 4.4%, respectively, P = 0.826) and Barcelona Clinic Liver Cancer staging (stage 0 5.6% vs 9.8% vs 9.3%, stage A 16.7% vs 17.1% vs 22.1%, stage B 27.8% vs 29.3% vs 24.8%, stage C 50.0% vs 43.9% vs 41.2% and stage D 0.0% vs 0.0% vs 2.7%, respectively, P = 0.878) were no significant difference between the patients with active treatment. Furthermore, there were no difference between the age groups in treatment modality (Surgical resection 0.0% vs 3.3% vs 5.2%, P = 0.166; Radiofrequency ablation 2.0% vs 8.5% vs 11.0%, P=0.113; Transcatheter arterial chemoembolization 21.6% vs 34.6% vs 41.6%, P=0.014; Best supportive care 62.7% vs 40.5% vs 29.2%, P < 0.001), adverse event related treatment (P = 0.731) and disease-free survival days (329 .3±309.1 days vs 271.7 ± 414.2 days vs 357.2 ± 511.6 days, P = 0.336). Multivariate analysis showed that age, performance status, CTP class, MELD score, modified UICC staging, presence of portal vein thrombosis and ruptured HCC are risk factors for mortality. Conclusions: Clinician should make an active treatment in elderly patients with HCC not a age but performance status, liver function and disease status of cancer.

성인 음낭수종의 치료로서 Window Operation의 효용성

서병욱,박영호,이남규,전윤수,김민의,김영호,송윤섭,구자현 순천향의학연구소 1999 Journal of Soonchunhyang Medical Science Vol.5 No.1

We intended to determine the usefulness of window operation for adult hydrocele repair. We reviewed medical records of 132 patients from January 1995 to June 1998 with primary hydrocele and evaluated complications and recurrence rates of eversion and/or excision, plication, and internal drainage technique. Recurrence rate was highest in internal drainage technique as 85.2%, and those of eversion and/or excision and plication technique were 1.3% and 4%, respectively. Complication rate was highest in eversion and/or excision technique, and lowest in internal drainage technique. Although complication rate was lowest in window operation, this operation could not be successful due to high recurrence, and we suggest that this operation should be abandoned for hydrocele repair.

한강수계분지내 하천수의 지구화학적 특성

서혜영,김규한 이화여자대학교 환경문제연구소 1997 이화환경연구 Vol.1 No.-

한강 수계 분지 내의 하천수 (지표수)와 서울 지역 지핫의 화학적 특성 규명과 용존 이온종의 기원을 연구하기 위해 1996년 3월-4월 동안 하천수 시료 60개에 대하여, pH, TDS 등과 용존이온의 화학분석을 실시하였다. 남한강과 북한강 하천수의 화학성분은 주로 수계분지 지역에 분포하는 암석에 의해 영향을 받고 있으며, 한강본류의 하천수는 인위적인 오염에 의한 영향이 크게 나타나고 있다. 즉, 남한강은 상류지역에 분포하는 탄산염암, 탄광 및 금속광산 폐수등에서 용출된 Ca(), Mg(), HCO(), SO() 등이 현저하며 북한강은 화강암질암의 풍화 산물인 K(), Na(), Ca()등의 이온종이 특징적이다. 한편 양수리에서 상기 2개 하천이 합류하여 서울 도심을 지나는 한강 본류는 SO(), NO(), PO(), Cl()등 생활하수 오염의 영향이 현저하게 나타나고 있다. 한강 본류로 유입되는 서울 지역의 왕숙천, 탄천, 중랑천, 안양천의 4개의 지천은 NO(), Cl(), PO(), SO(), Mn등 인위적인 오염현상이 크게 나타나고 있다. 한강 하천수의 화학 성분의 군집, 요인 및 회귀 분석 결과, 전체 자료 분산은 오염 인자에 의한 분산이 약 79%, 지질과의 물-암석 반응에 의한 분산이 약 7%이다. 남한강과 북한강의 합류 지점에서의 Cl에 대한 혼합 비율은 약 60:40이다. 1981년 분석 자료와 1996년 자료의 비교에서 암석 풍화에 의한 1차적 용존 성분인 Ca(), Mg(), HCO()등은 변화가 적으나 Na(), NO(), PO(), SO()등 인위적 오염원의 성분은 크게 증가하는 경향이 있다. To investigate geochemical characteristics and the sources of the dissolved ion species in the river water in the Han river drainage basin, samples were collected at 60 sites from the Han river drainage basin. The data for pH, conductivity, TDS(total dissolved solid), temperature, and concentrations of dissolved ions were obtained as follows:(1) The geochemical characteristics of the surface water in the South and North Han river drainage basins are mainly controlled by bed rock geology in the drainager basin and in the main stream of the Han river considerably affected by anthropogenic pollution. The South Han river water samples have high concentration of Ca() (ave. 15.42ppm), Mg()(ave. 2.74 ppm), HCO()(ave 51.9ppm), which evidently indicates that the bed rock geology in a limestone area mainly controls the surface water chemistry. The concentration of SO() is remarkably high(SHr10-2:129.9ppm) because of acid mine drainage from the metal and coal mines in the upper reaches of the South Han river. (2)The South Han river and the North Han river join the Han river in the Yangsuri, Kyounggido and flow through Seoul metropolitan city. The mixing ratio is about 60:40 at the meeting point(sample number HR10). (3)The result of factor analysis suggests that the pollution factor accounts for about 79% and the bed rock type factor accounts for about 7% of the data variation. This means that the geochemical characteristics of the Han river water mainly controlled by anthropogenic pollution in the South Han river and main stream of the Han river drainage basin. (4)The chmical data for four tributaries such as the Wangsukcheon, the Tancheon, the Zungrangcheon, and the Anyangcheon show that the concentration of pollution elements such as NO(), Cl(), PO(), SO() and Mn are high due to municipal waste disposal.

Helicobacter pylori 양성인 소화성 궤양 및 위염 환자에서 Helicobacter pylori 제균에 대한 판토프라졸 포함 삼제 요법의 임상효과 및 내약성에 대한 연구

서영호,이완식,주영은,김현수,최성규,유종선,김행재,서순팔,김세종 최신의학사 2000 最新醫學 Vol.43 No.11-12

플라즈마처리에 의한 폴리에스터섬유의 개질

서은덕,강영립,최창규 경남대학교 신소재연구소 1992 論文集 Vol.2 No.-

폴리에스터(PET)의 표면성질을 친수성으로 개질하기 위하여 Perfluoropropene을 13.65MHz의 RF 발진기를 이용하여 PEF직물상에 플라즈마중합하였다. 이때 생성된 박막의 표면성질을 플라즈마 후반용(post reaction)과 불포화결합을 이용하여 친수성으로 개질하였다. 친수성의 개질 효과는 적외선분광스펙트럼에서 수신기의 생성과 불포로 개질하였다. 친수성의 개질 효과는 적외선분광스펙트럼에서 수산기의 생성과 불포화결합에 대한 Br₂의 첨가반응에 따른 이중결합의 소멸로서 확인할 수 있었고 친수화의 정도는 마찰대전압을 측정하여 평가하였다. For the modification of PET surface, Perfluoropropene was plasma polymerized on the PET fabrics by means of 13.56MHz radio frequency generator. The surface preperties of PET fabrics were modified from hydrophobic to hydrphilic by application of the post reaction and hydration reaction of unsaturated bonds present in plasma thin film. The evaluation of the degree of hydrophilicity was performed by measuring friction static voltage of PET fabric with cotton fabric.

가열로의 열적해석 및 설계인자에 관한 연구

서용석,강성규,박원희,민동호,김태국 중앙대학교 기술과학연구소 1998 기술과학연구소 논문집 Vol.28 No.-

본 연구에서는 3차원 정육면체 가열로 내의 전도-대류-복사 복합열전달 특서을 해석하였으며, 연소가스의 유입속도, 벽면의 반사율과 매체의 흡수계수 등과 같은 인자들의 변화에 따른 영향을 살펴보았다. 가열로의 벽면들은 단열되어 있고 가열로 내부로 일정한 온도의 연소가스가 유입될 때 시스템 내부의 온도는 유입 온도와 비슷하게 균일한 온도 분포를 갖는 것으로 예측할 수 있었다. 유입 속도가 증가하더라도 가열로 내부의 온도에는 거의 영향을 미치지 않았으며, 가열로는 유입되는 연소가스의 흡수계수가 증가할수록 가열로 내부의 온도는 보다 균일하게 된다. 또한, 가열로 내부 벽의 반사율이 커질수록 벽의 온도는 감소하고 또한 벽면에 작용하는 유효복사열유속은 증가함을 알 수 있었다. 이러한 해석 결과로부터 가열로 내부의 온도 분포는 매체의 흡수계수가 클수록 그리고, 벽면 반사율이 작을수록 일정하게 유지될 수 있다는 것을 알 수 있었다. 그리고 이러한 결과들을 종합하여 볼 때 가열로의 설계 시 일정한 열의 유입과 가열로를 단열시키는 것이 중요하며, 그리고 매체의 흡수 계수를 크게 하고, 그리고 벽면의 반사율을 작게 하는 것은 가열로 내부의 온도를 일정하게 유지할 수 있는 중요한 조건이 된다는 것을 알 수가 있었다.

정신분열병 환자 가족을 위한 한 정신교육적 가족치료 모형의 효과

이영호,심주철,이상경,서영수,김용관,김규수,김영훈 大韓神經精神醫學會 2000 신경정신의학 Vol.39 No.3

연구목적 : 본 교실에서 정신분열병 환자 가족을 대상으로 시행 중인 장기 정신교육적 가족치료모형을 소개하고, 이모형이 가족의 대처방식과 우울증상, 환자가 자각하는 가족의 정서적 지지와 우울증상, 재입원율 및 사회재활상태에 미치는 영향을 평가하였다. 방 법 : 연구대상은 DSM-IV 진단기준에 의해 정신분열병으로 진단받고 외래 통원치료를 받고 있는 환자와 그 보호자였다. 교육군은 전체 19회 교육 중 최소 ⅔이상 참여한 11명의 환자와 가족이었고 비교육군은 부산소재의 종합병원에서 가족교육을 받지 않고 통원치료만을 받았던 11명의 환자와 가족이었다. 정신교육적 가족치료 모형의 효과는 가족의 대처방식과 우울증상, 환자가 자각하는 가족의 정서적 지지와 우울증상, 재입원율, 사호재활 실태로 나누어 평가했다. 평가도구는 The Ways of Coping Checklist의 국내번안용, Family Emotional Support Questionnaire for Transaction. Beck Depression Inventory를 이용했다. 재입원율 및 사회재활 실태에 대한 평가는 환자 및 가족과의 면담을 통해 조사했다. 결 과 : 본 연구의 정신교육적 가족치료 모형 실시 후 가족의 대처방식 중 적극적 대처는 교육군운 의미있게 증가한 반면 비교육군에서는 변화가 없었다. 소극적 대처 교육군은 의미있게 감소했으나 비교육군에서는 변화가 없었다. 가족치료모형 실시 전 가족들은 양군 모두 심한 우울증상을 갖고 있었다. 가족치료모형 실시 후 가족의 우울증상은 교육군에서 감소, 비교육군은 증가를 보였으나 통계적 유의성은 없었다. 환자가 지각하는 가족의 정서적 지지 평가척도점수는 교육군은 의미있는 증가를 보였으나 비교육군에서는 변화가 없었다. 환자의 우울증상의 교육군에서는 현저한 감소를 보인 반면 비교육군은 상반되게 증가했다. 가족의 적극적 대처가 환자가 자각하는 정서적 지지의 증가 및 우울증상 감소와 의미있는 상관관계를 나타냈다. 또한 교육군의 환자들이 비교육군의 환자들보다 장기가족교육 종료시점과 9개월 경과 후의 추적 평가에서 재입원율이 현저히 낮았고, 사회재활상태도 좋았다. 결 론 : 본 연구에서 실시된 장기 가족교육모형은 가족의 대처방식을 향상시키고, 우울증상의 감소를 가져오며, 환자가 자각하는 가족의 정서적 지지 향상 및 우울증상의 호전을 가져오고, 재입원율의 저하 및 사회재활의 향상을 보이는 것으로 나타났다. Objectives : This study was performed to introduce a psychoeducational family therapy model for the families of schizophrenic patient and to investigate the effect of this model on the changes in coping style and depressive symptoms of the family members, and in perception of emotional support by families and depressive symptoms of patients. Methods : Subjects were schizophrenic out-patients, who fufilled DSM-IV diagnostic criteria, and their families. The members of "education group" were 11 families and patients who participated in more than two thirds of 19 sessions of the program. The members of "non-education group" were 11 families and patients who had no experience of family education and were treated in a general hospital in Pusan. Clinical ratings were performed using by The Ways of Coping Checklist, Family Emotional Support Questionnaire for Transactions, and Beck Depression Inventory. Results : Coping style was changed positively, in education group but not in non-education group. The depressive symptoms of families were decreased in educated group and increased in non-educated group, although there were no statistical significance. In education group, patients felt much better emotional support by their families than patients in non-education group did. At the same time, their depressive symptoms were significantly reduced. The patients from education group were on more successful rehabilitation than those from non-education group were. Conclusion : Our results suggest that this psychoeducational family therapy model would be helpful to induce the positive changes in coping styles and reduce the depressive symptoms of family members, and it could also induce the reduction of depressive symptoms of schizophrenic patients and help their rehabilitation.

간 낭종을 동반한 성인 다낭신 환자에서 간 낭종의 감염 1예

정규성,서정철,주기산,김원식,임영국,정종훈,문철웅 朝鮮大學校 附設 醫學硏究所 1993 The Medical Journal of Chosun University Vol.18 No.1

Adult polycystic kidney disease(APKD) usually accompanies with renal and extrarenal manifestations and liver cysts are present in aproximately 30% of patients with APKD. Kidney cysts often accompany with hemorrhage, rupture, infection, however, liver cysts are usually asymptomatic and do not impair liver function. Rare complication of liver cysts in patient with APKD include portal hypertension with bleeding esophageal varices and hepatic failure with encephalopathy. But, in APKD patient, infection of liver cysts without infection of renal cysts is extremely rare. We report a case of infected liver cyst in a patient with APKD who has complained generalized abdominal pain and high fever which was confirmed by ultrasound and aspiration. The patient was treated successfully with repeated aspiration and systemic antibiotics.

USLE 계열모형의 매개변수 산정에 관한 연구

임재영,서규우,송일준,송무효 동의대학교 산업기술개발연구소 2000 産業技術硏究誌 Vol.14 No.-

In this study, USLE series parameter's characters are assessed each parameter. Main topic is propose for Assesment method. In case of Soil erosion energy factor for single storm, return period is commended 5 year. In case of Soil Erodibility factor, Percentage of Clay is increase then K value is decrease. In case of Slope Steepness-length factor, If the homogeneous slope length divide into short length, Sediment yield become exaggerated estimation. In condition of low steepness Slope basin, As the sensibility of Slope gradient, estimation of slope gradient must to be exceedingly careful. Also, the average slope where is low slope gradient basin is to be prudent. In spite of the same site, design engineer understood that site is convex configuration, soil erosion is estimated very much. In this study proposed cover factor estimation process. In case of soil conservation practice factor, I proposed that P factor substituted for delivery ratio, developed by US Forest Service.

여드름양 발진에서의 말라쎄지아 포자 검출 빈도에 관한 연구

박장규,이웅재,김연수,서영준,김경호,이증훈 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.2

Steroid acne and pityrosporum folliculitis have similar clinical manifestations. So it was not casy to do differential diagnosis of these two diseases. We have tried to find out the different points between these diseases in clinical characteristics, positive rate of the malassezia spores, and their response to antifungal agents. We studied 21 patients with acneiform eruptions which were distinct from acne vulgaris. Patients were divided into two groups by steroid treatment history. Among 21 patients, 6 were administered steroid just before eruption and 15 were free from steroid within 6 months. We have examined malassezia spores with 10% KOH/Parker blue black ink mount from papules, pustules and comedones according to the patients skin lesions. The malassezia spores detected in 5 paticnts(83.3%) in the former and 9 patients(60%) in the latter. In malassezia folliculitis, the frequency of which showed above the (3+) score of malassezia spore under microscopy was higher than in steroid acne. Mean duration of the disease was 70.4 weeks in latter group, which was longer than 5.2 weeks of the former group. And there were some differences between two groups in the distribution of the lesions. Mean treatment duration was same in two groups (4 wks, 3.5 wks). Steroid acne patients would be treated better with antifungal agents than with acne regimens.