다발성 대장암 간전이 환자의 간절제를 위한 새로운 시도

주종우,김형철,임철완,신응진,조규석,유기원,송옥평,홍대식,박성진,조준희,이혜경,김희경,권계원,고은석 순천향의학연구소;Soonchunhyang Medical Research Institute 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Multiple bilobar liver matastases (MBLM) are the main cause of low resectability in the colon cancer liver metastases. The authors experienced one case of initially non-resectable colon cancer liver metastases. He was curatively and safely treated with a two-stage hepatectomy using the new method of future remnant liver volume growing. A 54-year-old man was referred to our department with the sigmoid colon cancer combined with MBLM, which were checked in two small metastatic lesions in the left lobe and five large sized lesions in the right lobe in the computed tomogram (CT). A laparoscopic assisted anterior resection was primarily performed. We performed the 1^(st) stage hepatectomy 3 weeks after the colon resection. Intra-operative Ultrasonogram (US) found 9 small superficial metastatic lesions in the left lobe. All that lesions were completely removed by non-anatomical wedge resection. An occlusion ballon catheter was placed in the right portal vein through a small branch of the inferior mesenteric vein at that time. The future remnant liver volume was sufficiently increased 3 weeks after the 1^(st) hepatectomy. A right hepatectomy was safely performed 22 days after the 1^(st) hepatectomy. The patient received a regional chemotherapy (interleukin2 based immuno-chemotherapy through hepatic artery) for 4 months, then received 9 cycles of systemic chemotherapy (biweekly Oxaliplation, leucovorin, plus 5-fluorouracil) without any recurrence evidence.

상부 조기 위암 환자의 복강경하 상부 위절제술 3례 경험

조규석,김형철,박경규,이문수,송옥평,임철완,신웅진,주종우,유기원 순천향의학연구소;Soonchunhyang Medical Research Institute 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Background : The reported incidence of early gastric cancer located in the upper portion of the stomach has been increasing with the recent advances in its diagnosis and screening. Recently, we have successfully performed laparoscopic assisted proximal gastrectomy and gastric tube reconstruction without pyloroplasty on three patients with early gastric carcinoma localized to the upper third of the stomach. We describe our modification of this procedure in this report. Method : After creating an surgical pneumoperitoneum, the stomach was mobilized using laparoscopic coagulating shears. Upper half of the greater curvature and three-quarters of the lesser curvature were then dissected along with regoinal D2 lymphadenectomy. This was followed by a 5 cm, longitudinal mini-laparotomy in the upper abdomen, and the construction of the exteriorized stomach with a gastric tube measuring 20 cm long and 4 cm wide. Reconstruction with an esophagogastrostomy was performed using a circular stapler. Result : No post-operative morbidity or mortality was observed in this small series of patients. The average operative time was 250 minutes (range 220-300 minutes), and the average blood loss was 150 ml (range 90-180 ml). The mean number of lymph nodes harvested during these laparoscopic proximal gastrectomies was 24 nodes (range 22-25 lymph nodes). The average postoperative hospital stays was 7.5 days (range 7-8 days). Conclusion : Our technique of laparoscopic assisted proximal gastrectomy and gastric tube reconstruction without phloroplasty offers a minimally invasive technique with the potential of impoving the post-operative quality of life patients with an early-stage proximal gastric cancer.

직장암 수술 후 국소재발과 예후

김태윤,백무준,김성용,신응진,박내경,이문수,김창호,송옥평 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.1

Locally recurrent rectal cancer is a difficult clinical problem. Local recurrence following treatment for rectal cancer is a major cause of morbidity and mortality. The reported range of local recurrence rates following surgical treatment for rectal cancer has varied from 4% to 50%. We retrospectively reviewed the charts of 142 rectal cancer patients from January 1991 to December 1999. Analysis of patients factors included age, gender, type of surgery, and adjuvant therapy. Tumors were assessed for level, stage, and grade. Local recurrence and distant metastases were also documented. Variables influencing local recurrence in this group were identified and disease-free survival is determined. Of the 142 patients(74 males, 68 females; mean age 62.6 years), 137 consecutive patients operated on for rectal cancer and followed up to December 2000 (range 23-118months) were analyzed. Local recurrence rate was 18.3%. Age and sex of patients, type of surgery, location of tumor in the rectum, size, morphology and grading of the tumor were all unrelated to the event under investigation. At Cox regression, the Dukes stage and the postoperative radiotherapy were the only independent prognostic factors for local recurrence, and Dukes stage (Hazard ratio=2.89, p<0.001) and local recurrence (Hazard ratio=3.31, p<0.01) were the only independent factors associated with improved survival.

Mirizzi 증후군의 변형된 분류와 치료

김형철,강길호,채만규,김성용,백무준,이문수,박상흠,이문호,김창호,송옥평,조무식,박희주 순천향의학연구소;Soonchunhyang Medical Research Institute 2000 Journal of Soonchunhyang Medical Science Vol.6 No.1

Purpose : The Mirizzi syndrome is relatively rare and preoperative diagnosis of this disease is difficult. In 1978, Morelli suggested the subclassification of the Mirizzi syndrome into acute or chronic form. We experienced 5 cases of acute form. We analysed clinical features, preoperative radiologic findings and operative findings of 18 cases including acute forms which were diagnosed as Mirizzi syndrome and should suggest the modified classification of Mirizzi syndrome for choice of appropriate treatment. Method : From January 1995 to December 1998, 18 cases, of which 8 cases were diagnosed at Soonchunhyang University Chunan Hospital, and 10 cases were reported in the Korean Journal were retrospectively analysed with regard to clinical features, preoperative radiologic findings and operative findings. According to the clinical features, whole cases were divided into type Ⅰ(acute form) and type Ⅱ(chronic form) and then each type of cases were subclassified according to preoperative radiologic findings and operative findings. Results : Of 18 cases there were 5 cases in type Ⅰ(27.8%), 13 cases in type Ⅱ(72.2%). Type Ⅱb was most common. Type Ⅰa cases were treated only with cholecystectomy. We applied cholecystectomy, T-tube choledochostomy and patch technique in type Ⅰb and thpe Ⅰc cases. Cholectystectomies including removal of gallstones and internal drainage procedures were done in type Ⅱ chronic forms. Conclusion : The acute form(Type Ⅰ) of Mirizzi syndrome was suggested by Morelli might be subclassified into typeⅠa,Ⅰb and Ⅰc following the presence of the necrotic defect in common hepatic duct. Through the modified classification of Mirizzi syndrome based on clinical feature, preoperative radiologic findings and operative findings, we can choice appropriate treatment.

급성 충수염으로 진단된 예측 불가 염증성 맹장 종물에 대한 외과적 고찰

민경진,백무준,채만규,김성용,이문수,김창호,김재준,송옥평 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

Purpose: An unexpected inflammatory cecal mass of uncertain etiology was encountered during surgery for presumed appendicitis. In this case, the surgeon couldn't exclude differential diagnosis which were severe appendicitis involving the cecal region, diverticular disease, other inflammatory bowel diseases, and neoplasm. Therefore, this finding leads to a therapeutic dilemma for the surgeon, when making surgical decisions during the operation. The aim of this study was to resolve this dilemma, a retrospective review was undertaken in this study. Methods: A retrospective study was performed to review the management of this problem at Soonchunhyang University Chunan Hospital for eight and half years from July 1991 to December 1999. A review of the emergency operation records identified 50 patients who had undergone ileocecal resection or right hemicolectomy for an inflammatory ileocecal mass of uncertain etiology when operated on for probable appendicitis. Results: Altogether, 39 patients underwent ileocecal resection, and 11 patients underwent right hemicolectomy. The final pathologic diagnosis was appendiceal abscess in 32 patients (63%), cecal diverticulitis in 7 patients (14%), neoplasm in 6 patients (12%), appendiceal phlegmon in 3 patients (6%), ileal tuberculosis in 1 patient (2%) and Anisakiasis in another patient (2%). The neoplasm of the 6 neoplasm patients was ascending colon cancer for 4 patients and cecal cancer for 2 patients. There was no mortality in this group. Conclusion: Although most inflammatory cecal masses are caused by benign disease, all cases in which the intraoperative diagnosis is unclear, any pathologic diagnosis including neoplasm cannot be ruled out. So this suggest ileocecal resection or right hemicolectomy to remove a possible underlying malignancy, and to decrease morbidity and mortality.

외상성 췌장손실에 대한 임상적 고찰

송옥평,전성진,조무식 대한외상학회 1993 大韓外傷學會誌 Vol.6 No.2

Pancreatic trauma has been reported with increasing frequency due to high speed automobile accidents and other acts of violeuce. The key to treatment is thought to be early and accurate evaluation and proper management according to the degree of injury. A retrospective review of 42 patients suffering injuries to the pancreas between 1983 and 1992 at the surgical department of the Soon Chun Hyang university hospital was undertaken. There were 39 men and 3 women, in the ratio 13: l. Age incidence was the highest in the second and third decades (70%). Most of them (97%) were injured by blunt trauma, 28 out of 41 cases by traffic accident, thirteen by altercation and violation. One case was injured by penetrating trauma. The time interval between the injury and operation was within 12 hours in the majority of pancreatic trauma. The preoperative serum amylase was increased in 32 cases (76%) of pancreatic trauma. The injury site of pancreas was 19 cases in the body, 15 cases in the tail, 7 cases in the head. According to the classification by Lucas, pancreatic injuries of Class I were 7 cases, pancreatic injuries of class II were 14 cases, pancreatic injuries of class III were 18 cases and combined pan$lt;=reaticoduodenal injuries (class IV) were 3 cases. Seven patients with pancreatic injuries were treated by hemostasis and drainage, 31 by distal pancreatectomy and one by Roux-en-Y distal pancreaticojejunostomy. One patient with pancreaticoduodenal injury was treated by duodenal diverticulization. Two patients were performed Whip- ples pancreaticoduodenectomy due to severe combined pancreaticoduodenal injury. The postoperative complications were present in 24 cases (57.1k), pancreatic fistula (13 cases), pleural effusion (11 cases), wound infection (6 cases), intraabdominal abscess (5 cases), pseudocyst (5 cases). The mortality of pancreatic injuries was 19% (8 cases), the causes of death were ARDS (3 cases), sepsis (2 cases), ARF (1 case) and hypovolemic shock(1 case).

회장에 발생한 아니사키스증 1예

송옥평,조무식,김창진 순천향대학교 1993 논문집 Vol.16 No.4

Human anisakiais is a helminthic disease caused by opportunistic infestation of the third stage larval nematodes of the family Anisakidae and encountered in people who eat inadequately prepared raw salt-water fish or squid. Within a few hours of ingestion, larvae invade the wall of stomach or intestine and cause clinical gastrointestinal symptoms. Though the gastric anisakiasis can be easily diagnosed endoscopically, the intestinal anisakiasis is hard to be found not only due to its rarity but also its inconspicuous clinical symptoms and radiologic pictures. The diagnosis is made by the presence of the helminth in the tissue with its characteristics of a thick multilayered cuticle, well developed musculature beneath the hypodermis, two Y-shaped lateral chords, and large esophagus at center. The authors report a case of human anisakiasis involving the distal ileum in 32 yer-old man and briefly review the literatures.

一酸化炭素 血色素의 正常値에 對하여

安鈺平,李用雨,金箕洪 최신의학사 1978 最新醫學 Vol.21 No.3

The deleterious effects of carbon monoxide on the human body have long been known. Recently, increasing incidence of carbon monoxide poisoning has been a serious problem since coal briquette has come into a wider use. The development of an accurate method of screening the possible cases of carbon monoxide poisoning urgently needed. Normal values of carboxyhemoglobin will be a acquired by more studies. The author reports the normal values of carboxyhemoglobin of 388 random cases of age of 20-50 in Hanyang Hospital by the Heilmyer-modified method. The results obtained are as follows: 1. In a normal individual who do not smoke, man's average of carboxyhemoglobin saturation was 1.98±1.94%, while woman's was 2.08±1.65%, higher than man's. 2. In subjects who smoke, the mean value of carboxyhemoglobin was 3.84±2.75%. 3. The level of carboxyhemoglobin was slightly higher in heavy smoker than in light smoker.

A Simple and Reproducible Regeneration Protocol for Zoysia japonica Based on Callus Cultures

In-Ja Song,Markkandan Ganesan,Eun Jeong Kang,Hyeon-Jin Sun,Tae-Woong Bae,Pyung-Ok Lim,Pill-Soon Song,Hyo-Yeon Lee 한국원예학회 2010 Horticulture, Environment, and Biotechnology Vol.51 No.3

In vitro zoysia grass regeneration has several difficulties. We report here a simple and reproducible protocol by using seed explants. We selected the yellow colored calli for plant regeneration, as other types of calli were found to be poor in their capacity for callus multiplication and/or shoot induction. However, both previous reports and the present study encountered difficulties in plant regeneration with the yellow type calli during their growth and shoot multiplication. Some of the major difficulties included the formation of different types of calli from a single explant that appeared to be of a regenerable type of calli (yellow compact, yellowish white compact and white friable), abnormal growth induction from the callus (hairy root formation, browning, and formation white compact structures resembling somatic embryos), greening of callus without further shoot formation, micro-shoot formation without further growth and conversion of micro-shoots into callus. To circumvent these difficulties, we established an improved protocol for zoysia regeneration. Results showed that 2iP (1.0 ㎎ · ℓ?¹) and GA3 (1.0 ㎎ · ℓ?¹) not only enhanced shoot induction percentage, but also increased the number of shoots from the callus cultures when compared with BAP treatments. During shoot initiation, the difficulties mentioned above were substantially alleviated. Both shoot induction and simultaneous shoot elongation were satisfactorily achieved on the same medium. The elongated shoots were rooted on half MS media. The simple but reproducible regeneration protocol established in this study may facilitate the work on transformation and genetic improvements for Zoysia japonica Steud. and other closely related grass species.

Assessment of pollen viability, Longevity, and development of wild type and transgenic zoysiagrass (JejuGreen 21) on synthetic media

In Ja Song,Hyo Yeon Lee,Hong Gyu Kang,Tae Woong Bae,Pyung Ok Lim,Ok Chul Chung,Tae Gun Cho,Hyeon Jin Sun 한국육종학회 2009 한국육종학회 학술발표회 발표요지 Vol.41 No.1