위선암에서 p53 단백의 과발현과 임상 및 병리학적 예후인자와의 상관관계

서병조,유항종,이주호,주미,이혜경,김진복 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.2

Objective: Mutations in the p53 gene, one of the most common genetic alterations in human cancer, are implicated in tumorigenesis and tumor progression. Wild-type p53 negatively regulates the cell cycle; a loss of function by mutation might be expected to result in enhanced proliferating activity and tumor progression. A large number of immunohistochemical studies have confirmed p53 accumulation to be a very common feature of human malignancy. The aim of the present study was to determine whether p53 status in gastric cancer is correlated statistically with various histopathological indicators or not. Methods and Materials: A total of 197 surgically resected gastric adenocarcinomas were examined to determine whether a correlation exited between immunohistochemical expressions of the p53 protein and other histopathological factors. Results: p53 overexpression was observed in 46.2% of the gastric cancers. Overexpression of p53 was correlated with vascular invasion of gastric cancer(p=0.004). In early gastric cancer, the p53 overexpression rate was 42.3%, and of them, a correlation was found between the intestinal type of the Lauren classifcation(p=0.013) and histologically differentiated gastric cancer(p=0.014). Conclusion: p53 overexpression was significantly correlated with vascular invasion of gastric cancer. In cases of early gastric cancer, p53 overexpression was correlated with Lauren classification and differentiation. These results suggest that p53 mutation plays an important role in carcinogenesis in gastric adenocarcinomas. Further study in needed to determine the correlation between p53 overexpression and the prognosis for the gastric cancer patient.

13,135예의 위암의 최신치료요법 : 면역화학수술요법

김진복,서병조 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.1S

■ Objectives The purpose of this study is to analyze the clinicopathologic characteristics of gastric cancer patients and to evaluate the survival and prognostic factors and effect of immunochemosurgery for gastric cancer patients. ■ Methods and materials The clinicopathologic characteristics were analyzed for 13,135 consecutive patients who underwent operation for gastric cancer from 1970 to 2001. We also evaluated the survival and prognostic factors for 9,262 consecutive patients from 1981 to 1996. The prognostic significance of treatment modality [surgery alone, surgery + chemotherapy, surgery + immunotherapy + chemo-the apy (immunochemosurgery)] were evaluated in stage Ⅲ gastric cancer. ■ Results The 5-year survival rate (5-YSR) of overall patients was 55.8%, and that of patients who received curative resection was 64.8%. The 5-YSRs according to TNM stage were 92.9% for Ⅰa, 84.2% for Ⅰb, 69.3% for Ⅱ, 45.8% for Ⅲa, 29.6% for Ⅲb and 9.2% for Ⅳ. Regarding adjuvant treatment modality, significant survival difference was observed in stage Ⅲ patients. The 5-year survival rates were 44.3% for immunochemosurgery group, 36.8% for surgery + chemotherapy group and 27.2% for surgery alone group. Curative resection, depth of invasion and lymph node metastasis were the most significant prognostic factors in gastric cancer. ■ Conclusions Consequently, early detection and curative resection with radical lymph node dissection, followed by immunochemotherapy especially in patients with stage Ⅲ gastric cancer should be recommended as a standard treatment principle for patients with gastric cancer.

정신보건 관련 시설의 재원 기간 및 관련 요인에 대한 연구

조성진,이병조,조맹제,김용익,서동우,정인과 大韓神經精神醫學會 2006 신경정신의학 Vol.45 No.4

Object : This study was aimed to find the contributing factors that influence the length of stay in mental health related facilities and to present future direction for the mental health policy. Methods : The 1,875 patients who are aged between eighteen and sixty-five are chosen by the stratified random sampling from ten psychiatric hospitals, six psychiatric nursing facilities and five homeless asylums. We investigate about length of stay of all subjects by sociodemographic characteristics, socioeconomic status, functional status, disease related characteristics and analyse contributing factors. Results : From total subjects, average length of stay was 1,906 days, and facilities, where subjects are institutionalized, explains 40% of length of stay. Other related factors are female, old age, single, lack of supportive system before admission and after discharge, medical assistance type I, unavailable of public transportation and utility, long duration of illness, and psychotic disorder. Conclusion : For lowering the rate of long-term hospitalization, evaluation of appropriateness is needed for admission to nursing facility and homeless asylum and make up for the medical payment system and the supportive system from family and community.

병원성 칸디다 혈증에 관한 임상적 고찰

고경식,권선희,김병준,김구엽,서환조 대한감염학회 1995 감염 Vol.27 No.5

목 적 : 최근 칸디다혈증의 발생율이 매우 증가하여 병원 감염의 중요한 원인으로 대두되고 있다. 이에 저자등은 칸디다혈증에 대한 임상적 특성을 알아보기위하여 다음과 같이 연구하였다. 방 법 : 1988년 1월부터 1993년 12월까지 경희대학부속병원에서 발생하였던 병원성 칸디다혈증 61예를 대상으로 의무기록지를 검토하였다. 결 과 : 1) 연도별 발생 빈도는 1988년 부터 1933년까지 각각 2예, 7예, 9예, 11예, 15예, 17예로 증가하였으며, 최근에는 non-albicans 균주에 의한 감염이 증가하고 있었다. 2) 연령분포는 4-83세였으며 평균연령은 51.0±17.4세였고, 남자 32예, 여자 29예였다. 50대와 60대가 57.3%로 가장 많았다. 3) 균주별 발생빈도는 C. albicans 30예, C. tropicalis 13예, C. parapsilosis 10예, C. glabrata 6예, C. guilliermondii 1예, C. krusei 1예로서 C. albicans가 가장 많았다. 4) 기저질환으로 뇌혈관계질환이 25예(41%)로 가장 많았으며, 외과적질환 11예(18%), 고형악성종양 10예(16.4%), 혈액종양질환 9예(14.8%), 기타 내과적질환 6예(9.8%)였다. 5) 균주간 선행인자는 비슷하였으나, C. albicans와 C. tropicalis에서는 수술을 시행받은 예가 많았고, C. parapsilosis는 정주 영양 공급을 받은 경우가 많았다. 6) Amphotericin B 치료군(20예)과 fluconazole 치료군(11예) 사이에 예후에서 유의한 차이는 없었다. 7) 총 61예중 28예에서 사망하여 사망율은 45.9%였으며 정형외과적 수술을 시행받은 경우(83.3%)와 C. glabrata인 경우 사망율이 가장 높았다(83.3%). 결 론 : 칸디다 혈증은 중요한 병원 감염으로 대두되고 있으며 최근에는 non-albicans 진균주에 의한 병원성 칸디다 혈증의 발생율이 증가하는 추세이다. Background : The aim of this study is to determine the annual occurrence of nosocomial candidemia, the relation between Candida species and underlying illness, the relation bewteen Candida species and predisposing factors, and also to compare between the outcome of candidemia of the amphotericin B treatment group and that of the fluconazole treatment group. Methods : We reviewed medical records of 61 cases with nosocomial candidemia between 1988 and 1993 in Kyung Hee University Hospital retrospectively. Results : Two cases occurred in 1988, 7 in 1989, 9 in 1990, 11 in 1991, 15 in 1992, and 17 in 1993. The incidence of candidemia by non-albicans species has increased during this period and accounted for 64.7% in 1993. The infecting candida species were C. albicans(30 cases, 49.2%), C. tropicalis(13 cases, 21.3%), C. parapsilosis(10 cases, 16.4%), C. glabrata(6 cases, 9.8%), C. guilliermondii(1 case, 1.8%), and C. krusei(1 case, 1.8%). The most common underlying disease was cerebrovascular disease(41%) followed by surgical disease(18%), solid cancer(16.4%), hematological malignancies(14.8%), and other medical illness. There were no significant differences between the amphotericin B treatment group(n=20) and the fluconazole treatment group(n=11) in mortality. Overall mortality was 45.9%. The highest mortality was in patients with previous orthopaedic surgery(83.3%) and with C. glabrata candidemia(83.3%). Conclusion : Candidemia emerged as an important hospital infection and candidemia caused by non-albicans species has significantly increased in recent years.

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

A Case of Malignant Gastrointestinal Stromal Tumor Initially Misdiagnosed as Malignant B-Cell Lymphoma

Byoung Jo Suh 대한종양외과학회 2020 대한임상종양학회 학술대회지 Vol.2020 No.7

Methylenetetrahydrofolate Reductase, Thymidilate Synthase and Dihydropyrimidine Dehydrogenase Gene Polymorphisms in Korean Gastric Cancer Patients : Genomic Predictor of Clinical Response to Capecitabine-Based Chemotherapy

Byoung Jo Suh,Hang Jong Yoo,Joon Hee Kim,Jin Pok Kim 대한외과학회 2004 대한외과학회 학술대회 초록집 Vol.2004 No.10

위암에 동반한 양성 유두양 중피종 1례

서병조,김태현,이주호,유항종,김진복 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.3

Benign papillary mesothelioma in peritoneum is very rare lesion which is often found incidentally in abdominal surgery. Gross findings are similar to dissemination of intraabdominal malignant lesion, so it is hard to make differential diagnosis between them. Benign papillary mesothelioma is not related with exposure of asbestos which is related with development of malignant mesothelioma. To make differential diagnosis between peritoneal seeding of malignant lesions and benign papillary mesothelioma, it is often necessary to do frozen biopsy during abdominal operation. The patient was 53-year-old man and was transferred to KGCC under the diagnosis of advanced gastric cancer in private clinic. In gastrofiberscopic examination. pylorus was completely obstructed with Borrman Ⅲ gastric cancer. Operation findings revealed complete obstruction of antrum and serosal invasion, enlargement of number 8 lymph node, 0.5㎝ sized multiple nodules in mesentery of small bowel and colon and frozen biopsies of nodules were made and no cancer cell was noted. We did radical subtotal gastrectomy with D2 lymph node dissection. Adjuvant chemotherapy with protocol(Picibanil 1.0K.E, Mitomycin 4㎎, 5-FU 500㎎) was started after 8 days of operation and discharged after 21 days of operation.

A Study on Chlorophyll Estimating Algorithm in Kwangyang bay Using Satellite Images

Jo, Myung Hee,Suh, Young Sang,Kim, Byoung Suk 대한원격탐사학회 1999 International Symposium on Remote Sensing Vol.15 No.1

Water pollution is becoming a serious problem in the populous cities and coastal areas near industrial complex. Sometimes, phytoplankton is considered as the most important element in the coastal environment. Phytoplankton is easily estimated by measuring chlorophyll content in the laboratory. In this study, to build up estimating algorithm of the chlorophyll amount related to the monitoring of coastal environments in Kwangyang bay, the correlationship the respective in situ observed data with Landsat TM and SeaWiFS satellite image was analyzed. It showed that Landsat TM band 3 image has the highest correlationship with observed data, and based upon this result the monitoring algorithm of chlorophyll in coastal area was extracted. This algorithm will be an important for extracting and controlling environment elements in coastal areas in the future. And it has a significant meaning that it has established a spatial data construction in which satellite image alone could monitor the coastal environment.

소화기 Behcet병 4예

서병조,장석효,백인욱 인제대학교 1999 仁濟醫學 Vol.20 No.1S

베체트병은 반복되는 구강 및 생식기의 궤양, 안구의 염종 그리고 피부병변을 특징으로하는 전신적인 질환이다. 위장관의 궤양을 동반하는 소화기 베체트병은 전체 베체트병의 약 1%정도로 주로 말단 회장과 공장에 발발하나, 식도, 십이지장, 결장 및 항문직장부 등 장관 어디에나 궤양이 발생할 수 있다. 저자들은 1990년 이래 인제대학교 서울백병원 일반외과학 교실에서 수술을 시행한 소화기 메체트병 4예를 문헌고찰과 함께 보고하는 바이다. Behcet's disease is a systemic disease involving skin, joint, gastrointestinal tract, vascular and nervous systems characterized by recurrent oral and genital ulcerations and ocular inflammation. Although GI manifestations such as vomiting, abdominal pain, and diarrhea are present approximately in 50% of the patients, GI ulcers are not often demonstrated. Behcet's disease with GI ulcers, so called Intestinal Behcet's disease, account for about 1∼2% of Behcet's disease. The intestinal ulcers are frequently found in the terminal ileum and the cecum. Because intestinal ulcers in this disease tend to perforate at multiple sites, surgery is often performed for intestinal ulcers. Resection of ileocecal region or right half of the colon is usual procedures. We experienced 4 cases of intestinal Behcet's disease which was cured successfully by surgical treatment.