위-식도 주위 혈관 제거술을 시행 받은 위저부 정맥류 출혈환자의 추적 관찰 결과

구민영(Min-Young Koo),이주호(Joo-Ho Lee),김현아(Hyun-Ah Kim),민석기(Seog-Ki Min),이현국(Hyeon-Kook Lee),한호성(Ho-Seong Han) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.5

Purpose: Gastric variceal bleeding in cirrhotic patient is an emergent, life threatening disease of which the adequate treatment is still in dispute. The periesophagogastric devascularization (PD) would be the alternative operative procedure. The aim of this study is to evaluate the safety and long-term results of PD for the gastric fundal variceal bleeding. Methods: A retrospective analysis was made of fifty-two patients with gastric variceal bleeding who underwent PD with or without fundectomy from August 1994 to March 2006. We evaluated the clinical characteristics, operative morbidity, mortality and long-term follow up results. Results: The operative morbidity was 34.9% and overall mortality was 17.3%. The Child-Pugh classification at operation, the number of previous varix bleeding episode, the success of preoperative intervention, splenectomy, esophageal transection, and ongoing bleeding at operation had a significant effect on postoperative mortality. Most common cause of postoperative death was hepatic failure. Child-Pugh classification and esophageal transection were significant risk factor for postoperative mortality comparing before and after year 2001. During the mean follow-up period of 33.58±27.08 months, there was no recurrent bleeding from gastric varices. The cumulative 5-year survival rate was 64.1%. 0f 14 patients deceased, 6 patients died of hepatocellular carcinoma. Not only there was no death caused by recurrent variceal bleeding, but there was no recurrent gastric variceal bleeding. Hepatic functional reserve and concomitant hepatocellular carcinoma were the most important prognostic factors in the long term survival by multiple regression analysis. Conclusion: We concluded that PD reached both low postoperative mortality and recurrent bleeding rate with good long-term survival. So it could be one of the most effective treatment for the gastric fundal variceal bleeding.

한국인에서 다발성 내분비선종 증후군의 초기 증상 및 임상 양상

김기호,구민영,허성모,이세경,최준호,이정언,김지수,정재훈<SUP>1<.SUP>,남석진,양정현,김정한,Ki-Ho Kim,M.D.,Min-Young Koo,M.D.,Sung-Mo Hur,M.D.,Se-Kyung Lee,M.D.,Jun-Ho Choe,M.D.,Jeong Eon Lee,M.D.,Jee Soo Kim,M.D.,Jae-Hoon Chung,M.D.<SU 대한갑상선-내분비외과학회 2010 The Koreran journal of Endocrine Surgery Vol.10 No.4

Purpose: Multiple endocrine neoplasia (MEN) syndrome is an inherited, autosomal dominant disease that presents as a combination of several endocrine tumors. Early diagnosis of this syndrome is difficult, because of the nonspecific symptoms and signs. This study analyzed early manifestations and clinical characteristics in patients with MEN syndrome. Methods: Medical records were retrospectively reviewed and telephone interviews were conducted with 35 patients diagnosed as MEN syndrome at Samsung Medical Center from December 1994 to December 2009. Results: The 35 patients had been diagnosed as MEN1 (n=14), MEN2A (n=19) and MEN2B (n=2). The early manifestations of the 14 MEN1 patients were related with hyperparathyroidism (n=5), pituitary tumor (n=3), and pancreatic endocrine tumor (n=2). There were tumors of the parathyroid gland in all 14 patients, anterior pituitary in eight patients, and pancreatic islet cells in seven patients. Four cases were incidentally detected during the screening examination. Six cases harbored a MEN1 gene mutation. The twenty-one patients diagnosed with MEN2 comprised medullary thyroid cancer (n=20), adrenal pheochromocytoma (n=15), and hyperparathyroidism (n=4). The MTC-related symptoms in the 21 MEN2 patients included neck mass or discomfort in 12 patients and pheochromocytoma-related symptoms in seven patients. Two cases were detected through familial genetic screening test. The RET gene mutationwas detected in 19 cases. Conclusion: Early manifestations of MEN syndrome were very different between the types of MEN and the types of its presenting tumor. The early diagnosis and proper management of MEN requires awareness of the clinical characteristics of each expressed tumor and is influenced by genetic screening methods. (Korean J Endocrine Surg 2010; 10:266-275)

고령의 대장악성종양 환자에서 수술적 치료의 결과와 타당성

황혜원(Hye-Won Hwang),구민영(Min-Young Koo),이정은(Jeong-Eun Lee),이령아(Ryung-Ah Lee),김광호(Kwang-Ho Kim) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.2

Purpose: As life expectancy increases, elderly colorectal cancer patients are also increasing. Compared to younger patients, the elderly manifest higher co-morbidity with more advanced and emergent disease. However, recent studies have reported similar surgical approaches irrespective of age distribution. We evaluated the outcome and propriety of surgical treatment of colorectal cancer in the elderly. Methods: The medial records of 464 colorectal patients, who underwent surgery during 2003 to 2007 in Ewha Womans University Mokdong Hospital were reviewed retrospectively. The patients were divided into three groups according to age: Ⅰ (younger than 70), Ⅱ (71∼80), Ⅲ (older than 81). Clinical and histological characteristics, surgical outcomes and survival rates were analyzed. Results: Three hundred and thirty-eight patients belonged to group Ⅰ, and 104 patients to group Ⅱ, and group Ⅲ included 22 patients. Although, male patients were more prevalent in all three groups, female distribution was slightly higher in group Ⅲ. Clinical characteristics among the three groups did not reveal specific differences except TNM stage distribution. In group Ⅰ and Ⅱ, patients with stage Ⅱ were more common compared to group Ⅲ, whereas the latter showed most frequently stage Ⅲ. Histological characteristics and postoperative morbidity rates did not show any difference among the three groups. The survival rate was lowest in group Ⅲ. However, emergency operation was more frequent in group Ⅲ, in accordance with increased postoperative complications. Conclusion: The elderly demonstrated comparable operative morbidity and mortality to the younger patients. Emergency operation was the only significantly influencing factor in the surgical outcome. Therefore, in colorectal cancer patients, surgical treatment in the elderly should be no longer contraindicated.

Gastric gastrointestinal stromal tumor

Hyeongcheol Kim(김형철),Seung Jong Oh(오승종),Min Young Koo(구민영),Jenny Jimmy Hong,Young Taek Koh(고영택),Min Gew Choi(최민규),Tae Sung Sohn(손태성),Kyoung Mee Kim(김경미),Jae Moon Bae(배재문),Sung Kim(김성) 대한종양외과학회 2016 Korean Journal of Clinical Oncology Vol.12 No.2

Purpose: The main limitation of the National Institutes of Health (NIH) consensus criteria is the biological and prognostic heterogeneity of tumors while the utility of the newly proposed UICC TNM staging system has not yet been validated. Our object is to compare the overall and disease-free survival (DFS) of patients with gastric gastrointestinal stromal tumors (GIST) using the UICC TNM staging system and the NIH consensus criteria and to determine the optimal risk stratification system for GIST. Methods: Retrospective analysis of 164 patients who underwent operative management for primary gastric GIST between 1994 and 2004. Results: The overall five-year survival rate was 89.6%. In the 149 patients who underwent an R0 resection, the five-year DFS rate was 86.3%. According to the NIH consensus criteria, the five-year survival rate after resection was 100% for patients in the very low-, low-, and intermediate-risk groups and 71.9% for patients in the high-risk group. The UICC TNM stages IA, IB, and II had the same survival rates (100%) and stage IIIA (75.0%) and stage IIIB (69.5%) showed no significant difference in survival compared to the NIH criteria, which precluded better risk stratification. The patients who were included in the high-risk group by NIH consensus criteria (>10 cm, ≤5/50 high power field) and were stage II by the UICC TNM staging system had a 100% five-year survival rate. Conclusion: Using the current schemes, one system does not demonstrate superior prognostic ability over the other. However, the high-risk group (T4/low mitotic rate) and stage II patients appear to be appropriately classified.

중 장년층 남성에서 건강검진 상 발견되는 갑상선 결절의 임상적 특성 및 발생률

전연진(Yeon Jin Jeon),고영택(Young Teag Koh),오승종(Seung Jong Oh),구민영(Min Young Koo) 대한갑상선-내분비외과학회 2015 The Koreran journal of Endocrine Surgery Vol.15 No.4

Purpose: Thyroid nodules are a common disease in clinical practice. The prevalence of thyroid nodules has recently increased according to the development of thyroid ultrasonography. Thyroid nodules are more commonly found in women, but the potential for malignant nodules is much higher in men. The purpose of this study was to assess clinical characteristics and the incidence of thyroid nodules and malignancy in the adult male population. Methods: Clinical characteristics and incidence of thyroid nodules was examined by screening ultrasonography targeting 6,968 male patients over the age of 40 who visited the National Police Hospital from January 2012 and April 2015. Results: Among 6,968 male patients, 2,481 (35.6%) showed abnormal findings on ultrasonography. Of the 2,481 patients, 2,370 patients (34.01%) had a thyroid nodule and 111 patients (4.47%) had thyroiditis without a thyroid nodule, previous thyroidectomy, lymphadenopathy, esophageal diverticulum, parathyroid cyst, and benign calcification. Of the 2,481 patients, 958 patients (38.6%) had abnormal TFT and 204 patients (8.22%) had thyroiditis with or without a thyroid nodule. Thyroid nodules were benign in 1993 (80.33%) cases, indeterminate in 313 (12.61%) cases, and suspicious in 64 (2.56%) cases. Among the 2,481 subjects, thyroid cancer was detected in 37 subjects (1.49%). Conclusion: The incidence of thyroid nodules has recently increased according to the development of thyroid ultrasonography.

변형 근치 경부 림프절 절제술시 Iron-Intern 사용의 초기 경험

박융석<SUP>1<,SUP>,정승필<SUP>1<,SUP>,구민영<SUP>2<,SUP>,최준호<SUP>1<,SUP>,김정한<SUP>1<,SUP>,김지수<SUP>1<,SUP>,Yoong Seok Park<SUP>1<,SUP>,Seung Pil Jung<SUP>1<,SUP>,Min Young Koo<SUP>2<,SUP>,Jun-Ho Choe<SUP>1<,SUP> 대한갑상선-내분비외과학회 2013 The Koreran journal of Endocrine Surgery Vol.13 No.1

Purpose: Modified radical neck dissections (MRND) in papillary thyroid cancer surgery usually leave a long incision in the neck, causing cosmetic problems. We introduce a new surgical approach to MRND, with minimal lateral extension of transverse collar incisions, using the Iron-Intern. Methods: Between Jan 2008 and Dec 2008, 135 patients with papillary thyroid cancer who had undergone MRND were enrolled in this study. Total thyroidectomy and central node dissection with Kocker transverse collar incision with minimal additional lateral extension were performed before MRND. MRND were performed including level II, III, IV and V. Among 135 patients, we performed MRND with the Iron-Intern in 70 patients (Group I) and 65 patients who had MRND performed without the Iron-Intern (Group II) were included as a control group. In Group I, the Iron-Intern, with some modifications, was applied during the dissection of the level II area. The postoperative outcomes of the patients were analyzed and compared retrospectively. Results: The median hospital stay was significantly lower in Group I compared to Group II (P=0.003). The median operation time was significantly higher in Group I than Group II (P=0.002). The median numbers of harvested central and lateral lymph nodes were 10, 29 (group I) and 8, 23 (group II), respectively (P=0.073, P=0.148). Median levothyroxine off thyroglobulin levels were 1.2 and 1.8 in Group I and II, respectively (P=0.110). Conclusion: MRND, with minimal lateral extension using the Iron-Intern, can be easily and safely performed, leaving only minor scars in the neck.

목초 중 Methoxyfenozide와 Etofenprox의 잔류 분석 및 안전성 평가

김성수,이상민,구민영,박동식,허장현 강원대학교 농업과학연구소 2003 강원 농업생명환경연구 Vol.14 No.-

This study was conducted to determine residue of methoxyfenozide and etofenprox in pastures using high performance liquid chromatography (HPLC) with ultra-violet detector (UVD) and to assess th safety uses of these two chemicals in pastures. Methoxyfenozide and etofenprox is used to control armyworm (Mythimna separata, W.) on pastures. In methoxyfenozide and etofenprox, recoveries at 0.5, 2.5 mg kg^(-1) and 0.4, 2.0 mg kg^(-1) spike level were 86.3, 85% and 85.8, 95.9% respectively. The amount of residues of methoxyfenozide from pastures treated 3-times (treated 10 days before harvesting), 3-times (treated 15 days before harvesting), and 3-times (treated 20 days before harvesting) were 0.15, 0.10 and 0.06 mg kg^(-1), respectively. The amount of residues of etofenprox from pastures harvested 1, 3, 5 and 7 days after treated 1-time were 13.75, 11.09, 7.28 and 5.09 mg kg^(-1) and 2-times were 17.63, 12.50, 8.21 and 6.10 mg kg^(-1), respectively. considering the tentative maximum residue limit (MRL) of ethfenprox in pastures is 0.65 mg kg^(-1), it could not be recommended on using in pastures.