위절제술 후 경구섭취가 영양상태에 미치는 영향

이규언,이혁준,김지영,김윤호,이건욱,최국진,양한광,Lee Kyu Eun,Lee Hyuk-Joon,Kim Ji Young,Kim Yoon Ho,Lee Kuhn Uk,Choe Kuk Jin,Yang Han-Kwang 대한위암학회 2002 대한위암학회지 Vol.2 No.4

Purpose: Malnutrition is a common postoperative complication that occurs after gastric resection. Several causes for malnutrition have been proposed, which include malabsorption and poor oral calorie intake. We performed this study to evaluate whether nutritional counseling would increase oral calorie intake and improve nutritional status in patients who had undergone gastrectomy. Materials and Methods: Twenty-two patients were randomly selected as the study group from among patients who had undergone gastrectomy for early gastric cancer and gastric polyp between October 1999 and December 2000. Body weight, hemoglobin, serum albumin, and serum transferrin were checked before and after the gastrectomy. Oral calorie intake was evaluated by using a 3-day oral-intake diary, and one nutritionist performed outpatient-based nutritional counseling. Eighteen patients who had undergone gastrectomy for the same disease during the same period were selected as the control group. Results: During an average interval of 14.8 months, the study patients received nutritional counseling an average of 3.4 times at an average interval of 4.4 months. The study group took a mean of $2055.6\pm418.1$ Cal per day and the control group $1792.1\pm421.9$ Cal (P=0.05). Sixty-eight percent (15 patients) of the study group patients reached the daily-required calorie intake. Postoperative bodyweights were $64.0\pm9.9$ kg for the study group and $64.3\pm10.8$ kg for the control group (P>0.05). No statistically significant differences were observed among the other. Sixty-five percent of the patients (26 patients) had a weight loss of less than $10\%$ of the preoperative body weight, and $35\%$ had more than a $10\%$ weight loss, but there was no statistical difference between the calorie intakes of these patients. Conclusions: Nutritional counselling increased the oral calorie intake, but nutritional status was not improved. These results suggest that nutritional derangement after gastrectomy cannot be corrected by adequate oral intake itself.

여포세포 유래 갑상선암의 유전자 이상

이규언,지현근,윤여규,Kyu Eun Lee,Hyun-Keun Chi and Yeo-Kyu Youn 대한갑상선-내분비외과학회 2010 The Koreran journal of Endocrine Surgery Vol.10 No.1

개회충에 의한 호산구 간농양 환자에서 시행한 복강경보조 간절제술 1예

이규언(Kyu Eun Lee),서경석(Kyung-Suk Suh),이남준(Nam-Joon Lee),장성환(Seong Hwan Chang),최석호(Seokho Choi),김성훈(Seong Hoon Kim),이건욱(Kuhn Uk Lee) 대한외과학회 2003 Annals of Surgical Treatment and Research(ASRT) Vol.64 No.3

간정맥 및 하대정맥 손상에서의 정맥-정맥 우회술과 총혈관 격리술을 이용한 수술적 치료

이규언(Kyu Eun Lee),이혁준(Hyuk-Joon Lee),김상범(Sang Beom Kim),김성훈(Seong Hoon Kim),김광식(Kwang Sik Kim),허규희(Kyu Hee Her),서경석(Kyung-Suk Suh),이건욱(Kuhn Uk Lee) 한국간담췌외과학회 2002 한국간담췌외과학회지 Vol.6 No.1

재발한 위암의 진단에 사용된 FDG-PET의 유용성

이현국,이규언,김윤호,정재민,양한광,정준기,이건욱,최국진,Lee Hyeon Kook,Lee Kyu Eun,Kim Yoon Ho,Jeong Jae Min,Yang Han-Kwang,Chung June Key,Lee Kuhn Uk,Choe Kuk Jin 대한위암학회 2001 대한위암학회지 Vol.1 No.3

Purpose: For curative resection of recurrent gastric cancer, it is imperative that there be no unrecognized foci of tumoral disease outside the operation field. PET (positron emission tomography) with FDG (18 fluoro-2 deoxy-D-glucose) is a whole-body imaging technique that exploits the increased rate of glycolysis in tumor cells to detect disease. The authors evaluated the usefulness of FDG-PET in assessing resectability of recurrent gastric cancer. Materials and Methods: Seven patients with recurrent gastric cancer were studied with FDG-PET from December 1998 to October 2000. All FDG-PET images were interpreted in conjunction with conventional diagnostic methods. All imaging results were correlated with the pathological diagnosis and clinical outcome. Results: A final diagnosis of recurrence was obtained at 14 sites in all 7 patients by histology or clinical follow up. Locoregional recurrence, including distant metastasis, developed in 6 of 7 patients and distant recurrence in only one. FDG-PET detected all recurrent sites (5 locoregional and 5 distant) in 5 patients without peritoneal recurrence, but did not detect peritoneal seeding in 2 patients with peritoneal recurrence. The accuracy of FDG-PET in estimating resectability was $71.4\%$ (5/7), and that of CT and PET together was $85.7\%$ (6/7). A curative resection could be performed in three of the recurrent patients (2 locoregional and 1 distant recurrence). Conclusion: Our results suggest that FDG-PET may be useful for detecting locoregional and distant recurrence of gastric cancer and for selecting appropriate treatment. However, considering that FDG-PET was limited in detecting peritoneal seeding and determining the exact anatomical extension of tumor, it should be used in conjunction with other anatomical images.

부갑상샘종 및 부갑상샘 암에 대비되는 비정형 부갑상샘종의 임상병리학적 특성

오은미 ( Eun Mee Oh ),이규언 ( Kyu Eun Lee ),김수진 ( Su Jin Kim ),윤여규 ( Yeo Kyu Youn ),박귀원 ( Kwi Won Park ),오승근 ( Seung Keun Oh ),정경천 ( Kyeong Cheon Jung ),김영태 ( Young Tae Kim ),김광현 ( Kwang Hyun Kim ) 대한임상종양학회 2010 Korean Journal of Clinical Oncology Vol.6 No.2

목적: 일차성 부갑상샘항진증을 일으키는 질환인 부갑상샘종, 비정형 부갑상샘종, 부갑상샘 암 에 대하여 임상병리학적 특징을 후향적으로 분석해보고 특히 비정형 부갑상샘종의 특징에 대하여 알아보고자 하였다. 대상 및 방법: 1993년 1월부터 2008년 12월까지 서울대학교병원에서 일차성 부갑상샘항진증으로 부갑상샘 절제술을 시행한 88명의 부갑상샘종 환자와 10명의 비정형 부갑상샘종 환자, 2명의 부갑상샘 암 환자의 의무기록을 후향적으로 분석하였다. 결과: 비정형 부갑상샘종 군은 남녀 비율이 동일한데에 비하여 부갑상샘종은 여성에서, 부갑상샘 암은 남성에서 호발하였다. 비전형 부갑상생종 군과 부갑상샘종 군의 평균연령은 비슷하였으나 부갑상샘 암 환자는 두 군에 비하여 낮았다 (PA: 50.18±15.07yrs, AA: 49.1±13.76yrs, PC: 44.0±18.39yrs, p= 0.832.) 술전 시행한 혈청 칼슘 (PA: 11.90±1.46mg/dl, AA: 11.96±1.48mg/dl, PC: 14.25±2.76mg/dl, p= 0.091), 이온화 칼슘 (PA: 1.57±0.21mg/dl, AA: 1.54±0.34mg/dl, PC: 2.27mg/dl, p= 0.008)에서는 비전형 부갑상샘종 군과 부갑상샘종 군이 비슷하고 부갑상샘암 환자 군은 더 높았다. 술전 부갑상샘호르몬은 부갑상샘 암 환자에서 가장 높았고 비전형 부갑생종, 부갑상샘종 환자 순으로 높게 측정되었다. (335.30±465.40pg/ml, AA: 992.88±612.30pg/ml, PC: 1221.00±227.69pg/ml, p< 0.001) 부갑상샘 암 군은 술전 임상증상이 모두 나타났으며 비전형 부갑상샘종 군과 부갑상샘종 환자 군은 증상이 없이 발견된 경우가 많았다. 병변의 크기와 무게는 부갑상샘 암 군에서 가장 높았으며 비전형 부갑상샘종, 부갑상샘종군이 뒤를 이었다. 결론: 비정형 부갑상샘종은 임상병리학적 특성 상 부갑상샘종과 부갑상샘 암의 중간단계에 위치한다고 할 수 있으며 이에 수술 후 면밀한 추적관찰이 필요하다고 할 수 있다. Purpose: The causes of primary hyperparathyroidism include parathyroid adenoma(PA), atypical parathyroid adenoma(AA) and parathyroid carcinoma(PC). This retrospective study aimed to find the clinicopathologic characteristics among these three diseases and unique characteristics of AA. Patients and Methods: One hundred patients who underwent parathyroidectomy due to primary hyperparathyroidism from January 1993 to December 2008 in Seoul National University Hospital were enrolled. The electronic medical records of 88 patients of PA, 10 patients of AA and 2 patients of PC were analyzed retrospectively. Results: Male to female ratio was same in AA group but female predominance was found in PA group and male predominance in PC group. The mean age of AA group was similar to PA group but PC group was younger than other groups (PA: 50.18±15.07yrs, AA: 49.1±13.76yrs, PC: 44.0±18.39yrs, p= 0.832). The patients with PC showed higher preoperative serum calcium (PA: 11.90±1.46mg/dl, AA: 11.96±1.48mg/dl, PC: 14.25±2.76mg/dl, p= 0.091), ionized calcium (PA: 1.57±0.21mg/dl, AA: 1.54±0.34mg/dl, PC: 2.27mg/dl, p= 0.008) than other two groups and PA and AA showed similar results. PC group showed high parathyroid hormone levels than those of AA and PA (PA: 335.30±465.40pg/ml, AA: 992.88±612.30pg/ml, PC: 1221.00±227.69pg/ml, p< 0.001). Clinical symptoms were found more in PC group and majority of other two groups were found asymptomatic. PC group measured heavier and larger than AA and PA. Conclusion: AA might be an intermediate stage between PA and PC. Close follow up might be needed after operation for AA.

인슐린종의 임상적 분석

이한별,이규언,장진영,김선회,윤여규,이건욱,오승근,Han-Byoel Lee,M.D.,Kyu Eun Lee,M.D.,Jin-Young Jang,M.D.,Sun-Whe Kim,M.D.,Yeo-Kyu Youn,M.D.,Kuhn Uk Lee,M.D. and Seung Keun Oh,M.D. 대한갑상선-내분비외과학회 2010 The Koreran journal of Endocrine Surgery Vol.10 No.2

Purpose: Insulinoma is a rare disease for which early diagnosis followed by proper surgical management provides a chance for cure. Analyses of clinicopathological features of patients can help optimize the surgical approach in the treatment of insulinoma. Methods: The records of 13 patients (seven male, six female mean age 44.3 years; age range 17∼62 years) who were diagnosed clinically and pathologically with insulinoma and who underwent surgery between March 1997 and April 2007 at the Department of Surgery, Seoul National University Hospital. Hospital in English please were retrospectively examined. Results: All patients had findings compatible with Whipple's triad. Mean fasting blood sugar was 40.5 mg/dl, serum insulin level was 33.5ՌU/ml, and insulin-to-glucose ratio was 0.6. A prolonged starvation test was performed on six patients. Tumors were localized in 10 patients with a computed tomography (CT) scan and in three patients with CT angiography. Five tumors were located in the pancreas head and uncinate process, five in the body, and four at the body-tail border and tail. Patients underwent resection of tumorby enucleation, distal pancreatectomy, pylorus-preserving pancreaticoduodenectomy, laparoscopic distal pancreatectomy, and duodenum-preserving resection of pancreas head. Four immediate postoperative complications (fluid collection, pancreatic fistula, delayed gastric emptying) occurred. No symptoms or recurrences were apparent during the median 15 month follow-up. Conclusion: Insulinoma is difficult to diagnose correctly without a prolonged duration of symptoms. Localization of insulinoma can be aided by a CT scan and/or CT angiography. Less aggressive operative procedures such as simple enucleation might be a sufficient and feasible procedure for curative resection of benign insulinomas. (Korean J Endocrine Surg 2010;10:99-105)

일차성, 이차성 그리고 삼차성 부갑상선 기능 항진증 환자의 수술 후 임상결과: 서울대학교 병원에서의 14년 경험

최윤석 ( Yun Suk Choi ),이규언 ( Kyu Eun Lee ),박귀원 ( Kwi Won Park ),노동영 ( Dong Young Noh ),오은미 ( Eun Mee Oh ),최준영 ( June Young Choi ),윤여규 ( Yeo Kyu Youn ),오승근 ( Seung Keun Oh ),구도훈 ( Do Hoon Koo ) 대한임상종양학회 2011 Korean Journal of Clinical Oncology Vol.7 No.1

목적: 일차성, 이차성, 삼차성 부갑상선 기능 항진증은 각각 원인과 치료방법 그리고 임상 경과가 서로 다르지만 부갑상선 절제술이 표준치료로 알려져 있다. 본 연구에서는 각각의 부갑상선 항진증의 수술 전후의 임상적 변화를 알아보고 부갑상선 절제술의 의미를 재고 해보고자 하였다. 방법: 1996년부터 2009년까지 총 126명이 서울대학교 병원에서 부갑상선 절제술을 시행 받았으며 각각 일차성 96명, 이차성 24명, 삼차성 6명이었다. 환자들의 나이, 성별, 생화학적 검사, 수술방법, 병리학적 검사 결과를 전자 의무기록을 통해 후향적으로 분석하였다. 결과: 모든 세 군의 환자에서 혈청 칼슘, 부갑상선 호르몬, 이온화 칼슘이 수술 전보다 호전을 보였다. 이차성 환자군은 다른 두 군에 비해 수술 전, 후의 부갑상선 호르몬이 높았으며(p<0.001, p=0.036), 수술 후 지속적인 부갑상선 기능 항진증(30.4%) 및 일과성 저칼슘혈증(87.5%)도 다른 두 군에 비해 많이 발생하였다.(p< 0.001) 일과성 저칼슘혈증의 대부분(90.4%) 은 6개월 이내 회복 되었다. 이차성 환자에서 부갑상선 아전 및 전 절제술을 시행 받은 경우 수술 후 일과성 저칼슘혈증이 많이 나타났으나(71.4%), 제한적 절제술을 시행 받은 경우 지속적 부갑상선 기능항진증이 더 많이 나타났다.(50%) 결론: 부갑상선 절제술은 생화학 검사상의 호전을 위한 치료 방법으로 추천될 수 있으며, 이차성에서는 제한적 절제를 하는 경우 지속적 부갑상선 항진증의 빈도가 더 높으므로 부갑상선 아전 및 전 절제술을 시행해야 한다. Purpose: Primary hyperparathyroidism(PHPT), secondary hyperparathyroidism(SHPT) and tertiary hyperparathyroidism(THPT) are different in the cause, treatment and prognosis. However the parathyroidectomy has been an efficient treatment in all hyperparathyroidism groups. A single institution`s 14 year experience of surgical treatment was analyzed to investigate perioperative changes of clinical characteristics and reconsider the value of parathyroidectomy as the treatment option. Materials and Methods: From 1996 to 2009, 126 patients underwent parathyroidectomy at single institute and the number of patients with PHPT, SHPT and THPT were 96, 24 and 6 retrospectively. The electronic medical records of age, sex, biochemical analysis, operative method, and pathologic results were reviewed retrospectively. Results: Postoperative calcium (Ca), parathyroid hormone (PTH), ionized calcium (iCa) levels were improved definitely than preoperative Ca, PTH, iCa level in all three groups. Pre and postoperative PTH level in SHPT was higher than in PHPT and THPT(p<0.001, p=0.036) and postoperative persistent PTH increased status were more common in SHPT.(30.4%, p<0.001) Postoperative temporary hypocalcemia was more common in SHPT(87.5%, p<0.001), almost of them (90.4%) were recovered in 6 month. In SHPT group, temporary hypocalcemia were more common in subtotal or total parathyroidectomy group than in limited resection group (94.1%) but persistent iPTH increase were more common in limited resection group (50%). . Conclusion: Parathyroidectomy is highly recommended to improve biochemical laboratory findings in patients with hyperparathyroidism. And in SHPT, subtotal or total parathyroidectomy is more appropriate surgical method for reducing the high incidence of persistent hyperparathyroidism.

갑상선 수질암의 재발에 미치는 예후인자에 관한 연구

이주희<SUP>1<,SUP>,이규언<SUP>1,2<,SUP>,박경식<SUP>1,2<,SUP>,구도훈<SUP>1,2<,SUP>,오승근<SUP>1<,SUP>,윤여규<SUP>1,2<,SUP>,Ju Hee Lee,M,D,<SUP>1<,SUP>,Kyu Eun Lee,M,D,<SUP>1,2<,SUP>,Kyung Sik Park,M,D,<SUP>1,2<,SUP>,Do 대한갑상선-내분비외과학회 2008 The Koreran journal of Endocrine Surgery Vol.8 No.3

<B>Purpose:</B> Medullary thyroid carcinoma (MTC) is an uncommon thyroid tumor and the clinical course is variable. Many prognostic factors for MTC have been studied, but the significance of some of these factors remains con</B>troversial. This study aimed to evaluate the prognosis of recurrent disease in patients suffering with MTC. <P><B>Methods: </B>Fifty three patients who were operated for MTC from 1987 to 2006 in Seoul National University Hospital (SNUH) was retrospectively analyzed. Their medical records were reviewed for the demographic data, the laboratory data and the clinical course, the treatment and the long-term outcome. The median duration of follow-up was 66.5 months. Forty-two patients who were operated on primarily in this hospital were analyzed for their recurrence free survival. <P><B>Results:</B> The mean age atdiagnosis was 41.8 years. There were 28 femaleand 25 male patients. Eleven patients (22.9%) had multifocal disease. There were 32 sporadic MTC patients, 15 MEN2A patients, 3 familial medullary thyroid carcinoma (FMTC) patients and 1 MEN 2B patient. The 10- and 15-year overall survival rates were 91.9% and 76.5%, respectively; the 5- and 10-year recurrence-free survival rates were 70.6% and 45.5%, respectively. By univariate statistical analysis, the stage (stage I/II vs. III/IV, P= 0.025), extrathyroidal extension (P=0.039), cervical lymph node metastasis (P=0.044), and the postoperative calcitonin level (≥25 pg/ml) (P=0.003) were the significant factors that influenced recurrence. <P><B>Conclusion:</B> The overall prognosis of MTC is favorable. The significantfactors for a poor prognosis were the presence of lymph node metastasis, TNM stage III and IV, positive extrathyroidal extension at the first diagnosis and a high postoperative calcitonin level.<B> (Korean J Endocrine Surg 2008;8:183-188)</B>

갑상선 미세침흡인세포검사 슬라이드에서 BRAF Mutation 검출을 통한 갑상선 유두암의 진단

박원서<SUP>1<,SUP>,이규언<SUP>2<,SUP>,송정윤<SUP>1<,SUP>,정유승<SUP>3<,SUP>,김훈엽<SUP>4<,SUP>,고석환<SUP>1<,SUP>,윤여규<SUP>2,5<,SUP>,Won Seo Park,<SUP>1<,SUP>,Kyu Eun Lee,<SUP>2<,SUP>,Jeong Yoon Song,Ph,D,<SUP>1<,SUP>,Y 대한갑상선-내분비외과학회 2010 The Koreran journal of Endocrine Surgery Vol.10 No.1

Purpose: The prevalence rate of the BRAF mutation in papillary thyroid cancer (PTC) is as high as about 52 to 83% in Korea. Preoperative detection of BRAF mutation on fine needle aspiration cytology (FNAC) slides may help the surgeon make better therapeutic decisions. The present study aims to assess the feasibility of the mutant allele specific amplification (MASA) and restriction fragment length polymorphism (RFLP) method with using conventional FNAC slides and we also wanted to evaluate the clinical role of preoperatively detecting BRAF mutation. Methods: We extracted the genomic DNA from 59 FNAC slides and performed direct sequencing (DS) for detecting BRAF mutation. We could use only 17 slides for the MASA method and 6 slides for the RFLP method due to the shortage of extracted DNA. Additionally, we retrospectively analyzed the cases for which a histological diagnosis could be made. Results: Genomic DNA was extracted from 23 out of the 59 FNAC slides. The BRAF mutation status could be assessed via DS in 33 out of the 59 FNAC slides. The concordance between the MASA method and DS and the RFLP method and DS was 36.3% and 66.7% respectively. The positive and negative predictive value of the 13 indeterminate nodules was 87.5% and 20%, respectively. We could not find any association between the BRAF mutations and the alleged risk factors of PTC. Conclusion: We believe that the purity and the amount of the DNA template must be increased to detect BRAF mutation with using a FNAC slide. Preoperative detection of the BRAF mutation on a FNAC slide may refine the cytological diagnosis, but the application of assessing BRAF mutation as a prognostic marker is debatable. (Korean J Endocrine Surg 2010;10:12-18)