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위암 세포에서 RKIP (Raf-1 Kinase Inhibitor Protein)의 발현 및 돌연변이 분석
장연수(Yeon Soo Chang),이길연(Kil Yeon Lee),이석환(Suk-Hwan Lee),고석환(Suck Hwan Koh),홍성화(Sung Wha Hong),지성길(Sung-Gil Chi) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.73 No.2
Purpose: RKIP (Raf kinase inhibitor protein) is a novel candidate tumor suppressor, known to inhibit the MAPK signaling by interfering with the MEK phosphorylation by Raf-1. The aim of this study was to investigate the expression of RKIP and analyze the pattern of inactivation and mutation of the RKIP gene in human gastric cancer. Methods: To explore if RKIP inactivation is implicated in gastric tumorigenesis, an expression analysis on the transcription and protein expression levels and a mutational analysis of RKIP were performed in 15 human gastric cancer cell lines and 92 primary carcinoma tissues. Results: Abnormal reduction of the level of RKIP expression was frequently detected in the cancer cell lines and primary tumor tissues, at both the transcript and protein levels. Moreover, the expression level of RKIP in the tumor cells was inversely correlated with the level of Erk phosphorylation, indicating that RKIP plays a key role in the regulation of the Raf-MEK-Erk signaling pathway in human gastric cells. While the expression of the RKIP transcript was not re-activated in low expressor cells by treatment with the demethylating agent 5’Aza-dC, the genomic RKIP was detected at low levels in many cancer cell lines, suggesting that an abnormal reduction of level of RKIP expression in tumors might be caused by allelic deletion of the gene rather than transcriptional silencing due to aberrant DNA hypermethylation. A loss of heterozygosity study, using an intragenic polymorphic marker, revealed that approximately 21% of the gastric cancers harbored allelic loss of the RKIP gene. Conclusion: Collectively, this study has demonstrated that RKIP is a tumor suppressor, whose expression is frequently downregulated by allelic deletion in human gastric cancers. This study also suggests that an altered expression of RKIP might contribute to the development of gastric cancer via abnormal elevation of the Raf-Erk signaling pathway.
송창우,고석환,이길연,이석환,이상목,박호철,홍성화,오수명,윤충,Chang Woo Song,M.D.,Suck Hwan Koh,M.D.,Kil Yeon Lee,M.D.,Suk Hwan Lee,M.D.,Sang Mok Lee,M.D.,Ho Chul Park,M.D.,Sung Hwa Hong,M.D.,Soo Myung Oh,M.D. and Choong Yoon,M 대한갑상선-내분비외과학회 2003 The Koreran journal of Endocrine Surgery Vol.3 No.1
Primary hyperparathyroidism is a rare disease that can be accurately diagnosed and effectively treated in most patients. The diagnosis is established by a persistent elevation of serum calcium and parathyroid hormone and by clinical evaluation. With the introduction of a biochemical screening test for calcium and the development of radiologic techniques, the detection of hyperparathyroidism has increased slightly. However, the parathyroidectomy is still not a common operation in Korea. Twenty-eight patients with primary hyperparathyroidism comprised of 14 males and 14 females, were treated by operation from January 1986 to December 1995 at Kyunghee University Hospital and the data were analyzed retrospectively. The results are as follows: 1) The sex distribution was 14 males & 14 females, and the age distribution was from 14 to 79 years. 2) The clincal manifestations were renal symptoms (42.9%), skeletal symptoms (28.6%), a neck mass (10.7%), pancreatitis (7.1%) , no symptoms (7.1%), polydipsia (3.6%) in order of frequency. 3) Most of the patients showed hypercalcemia above 11mg/dl, but five patients had calcium levels which were either slightly increased or in the upper normal range. 4) The preoperative localization methods were mainly combinations of sonography, C.T.,and Tl-Tc subtraction scans and showed high sensitivity & specificity (above 90%). 5) The main tumor locations were the Rt. lower pole in 10 cases, the Rt. upper pole in 5 cases, the Lt. upper pole in 3 cases, the Lt. lower pole in 7 cases; there were 2 cases of ectopic location and 1 case of hyperplasia at the Rt. upper & the Lt. lower pole. 6) The pathologic findings revealed a solitary adenoma in 25 patients, a carcinoma in two patients, and hyperplasia associated with MEN2a in 1 patient. 7) We experienced one case of recurrence after primary excision at the Rt. lower pole. Reoperation for a missed gland, after the primary operation, was performed in one patient; the excision of the tumor was performed successsfully. 8) We performed surgical excisions and 17 patients showed hypocalcemia postoperatively. Most of the hypocalcemia was transient and disappeared after ingestion of oral calcium agents or usuage of Vit. D3. (Korean J Endocrine Surg 2003;3:15-25)
돼지진피아교질(Porcine Dermal Collagen, Permacol<SUP>®</SUP>)로 만든 삽입물을 이용한 오염된 근막 결손의 재건
최성일(Sung Il Choi),이길연(Kil Yeon Lee),박선진(Sun Jin Park),이석환(Suk-Hwan Lee) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.77 No.3
Reconstruction of the fascia defect, especially complicated one is challenging problem. We report our experiences of porcine acellular dermal collagen (Permacol<SUP>®</SUP>) in contaminated fascia defects. Three patients with contaminated fascia defect were reconstructed using Permacol<SUP>®</SUP>. Permacol<SUP>®</SUP> was fixed to fascia with 2-0 polypropylene sutures and at least 2 cm of the implant was allowed to overlap the defect. Types of fascia defect consisted of large parastomal hernia in rectal cancer patients, multiple enterocutaneous fistulas in Crohn’s disease and evisceration due to surgical site infection. Postoperative complication was 1 case of graft infection in a Crohn’s disease patient, but infection was controlled using antibiotics.
자가팽창형 대장 스텐트 유치 후 발생한 구불결장-직장 장중첩증 1예
이창균 ( Chang Kyun Lee ),김효종 ( Hyo Jong Kim ),장재영 ( Jae Young Jang ),동석호 ( Seok Ho Dong ),김병호 ( Byung Ho Kim ),장영운 ( Young Woon Chang ),장린 ( Rin Chang ),김형중 ( Hyoung Jung Kim ),이길연 ( Kil Yeon Lee ) 대한장연구학회 2008 Intestinal Research Vol.6 No.1
Self-expandable metallic stents are widely used to relieve acute colorectal obstruction that’s secondary to malignancy. They are utilized for both palliation and preoperative decompression prior to colorectal surgery. Although stents have been documented as a relatively safe therapeutic modality, procedure-related complications such as perforation, bleeding, stent reobstruction and migration can occur during or after colonic stent placement. Therefore, clinicians must be aware of the various complications associated with colonic stent placement. We present here a very rare case of sigmoidorectal intussusception that developed after fluoroscopic placement of a self-expandable metallic stent for preoperative decompression of sigmoid colon cancer. We misdiagnosed the intussusception as a distal stent migration on the plain radiography. On the sigmoidoscopic examination to evaluate the unrelieved colonic obstruction, we diagnosed a sigmoidorectal intussusception of the stent-implanted malignant tumor. The patient was successfully treated by laparoscopic partial reduction, followed by a curative anterior resection. This case demonstrates that careful examination must be done in cases of unrelieved colonic obstruction with suspicious stent migration, and intussusception must be considered as a rare complication of self-expandable metallic stent placement in the colon. (Intest Res 2008;6:70-75)
절제 불가능한 우측 결장암 환자에서 선행 항암화학요법 후 근치적 절제를 시행한 1예
박순도 ( Soon Do Park ),이길연 ( Kil Yeon Lee ),박선진 ( Sun Jin Park ),이상목 ( Sang Mok Lee ),홍성화 ( Sung Wha Hong ) 대한임상종양학회 2009 Korean Journal of Clinical Oncology Vol.5 No.1
국소적으로 진행된 대장암이란 대장암이 원격전이가 아닌 직접 주변장기로 침범된 경우를 말하는데 대장암의 병기 분류상(AJCC TNM stage, 2002) T4에 해당한다. 이의 치료로 주 병변과 주위 장기를 한꺼번에 절제(multivisceral, en bloc resection)하는 것을 권하고 있다. 진행된 대장암의 치료는 보통 근치적 절제술과 수술 전후의 항암화학요법이 시행되지만 다른 장기로의 전이가 있을 때에는 항암화학요법과 고식적 수술만이 가능한 경우가 있다. 저자들은, 1차 수술 시 인접장기로의 암의 직접 침윤과 암 주위부로의 심한 유착으로 절제가 불가능하여 고식적 장우회술을 시행한 후 2번의 추가적인 항암화학요법을 시행한 후 재차 시행한 수술로 근치적 절제가 가능했던 체험 예를 보고하고자 한다. Locally advanced colon cancer means T4 stage cancer directly invading adjacent organ regardless of distant metastasis. When the cancer is resectable, multivisceral en bloc resection is recommended. Overall survival can be prolonged by multivisceral en bloc resection in right colon cancer invading pancreas head or duodenum. We report a case of curative resection after neoadjuvant chemotherapy in locally advanced, unresectable right colon cancer. 52-year-old female was diagnosed as cancer in hepatic flexure of colon, which was involving pancreas head and 2nd portion of duodenum. Right hemicolectomy and pylorus preserving pancreaticoduodectomy (PPPD) were planned at the 1st operation, but palliative ileocolostomy was constructed because of massive peritumoral invasion and adhesion. After 5 cycles of XELOX chemotherapy regimen, patient`s CEA level decreased to normal and CT scans showed smaller colonic tumor, and disappeared pancreatic and duodenal metastasis. So we could do right hemicolectomy and lymph node dissection. 5 months later after adjuvant chemotherapy (12 cycles of FOLFIRI), recurrent cancer was found in 2nd portion of duodenum, so we had to do PPPD. The patient still alives without cancer recurrence for 19 months after the last operation. This case highlights the possibility of curative resection after neoadjuvant chemotherapy in initially unresectable locally advanced right colon cancer.