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        한방병원 외래 환자에서 시행된 전신체열촬영의 유용도에 관한 연구

        박용현,이종덕,권영달 ( Kwon Young-Dal ) 대한한의학회 한방재활의학과학회 1998 한방재활의학과학회지 Vol.8 No.2

        한방병원 외래에 내원한 환자에서 컴퓨터 적외선 전신체열촬영이 어떻게 이용되고 있는지 비교분석하였고, 특히 경추 부위 전신체열촬열을 시 행한 환자중 경추 추간판 탈출증 환자 7명과 경추 단순 척추증 환자 17 례를 대상으로 부위별 평균 체표면 온도 및 환측과 건측의 체표차이를 측정하여 다음과 같은 결과를 얻었다. 1. 한 달간 내원한 총 8432명의 외래 환자 가운데 198명(2.35%)이 전신 체열촬영을 받았고, 198례를 부위별로 분류해보면 요추 부위가 91례(43 %)로 가장 많았고, 경추 부위 46례(22%), 안면부위 21례(10%), 전신 부 위 15례(7%), 발 부위 14례(6%), 무릎 부위 11례(5%), 손 부위 7례(3%), 흉추 및 발목 부위가 각 1례의 분포를 보였다. 2. 경추 추간판 탈출증 환자와 경추 단순 척추증 환자의 건측 및 환측의 평균 체표면 온도간에 비모수 통계검증중 Mann-Whitney test를 이용 하여 분석하였으나 각각의 군간에는 특이한 유의성이 없었다. 또한 경추 추간판 탈출증 환자의 환측과 건측의 체표면 온도차 간에도 특이한 유의성은 없었다.

      • 췌장원위부선암에서 변형적 Appleby씨 수술법 시행 1 예 보고

        박용현 한국간담췌외과학회 2000 한국간담췌외과학회지 Vol.4 No.1

        The prognosis of distal pancreatic cancer is even poorer than that of pancreatic head cancer because of its late symptom onset and tendency of aggressive retroperitoneal invasion at diagnosis. Since the first Appleby’s operation in 1952, it has been performed in stomach cancer by several surgeons. But the survival benefit is still controversial. Appleby’s operation includes total gastrectomy, splenectomy, distal pancreatectomy, celiac trunk division with ligation of common hepatic artery(CHA) and retroperitoneal lymph node dissection. In 1976, Nimura first adopted this method for distal pancreatic cancer. We report a case of modified Appleby’s operation for distal pancreatic cancer. The patient was 44- year old female. Her chief complaint was epigastric pain for 2 weeks. Preoperative liver function test was within normal range and CA19-9 was elevated to 200 U/ml. Preoperative CT angiography showed 4.5×3cm sized, pancreatic mass in body and tail area invading splenic artery and celiac trunk from its left side. In operation, splenectomy and distal pancreatectomy was initially performed. After ligation of CHA, we confirmed intact proper hepatic artery(PHA) flow by doppler and then divided CHA. After confirmation of intact gastric blood flow, left gastric artery(LGA) was divided. Celiac axis(CA) was divided near its origin. Then we dissected retroperitoneal lymph nodes. There was minor pancreatic leakage controlled by conservative management. CA19-9 was normalized to 33 U/ml on the 16th postoperative day. She was discharged on the 28th postoperative day and underwent adjuvant chemotherapy and radiotherapy. There is no evidence of recurrence for 15 months of follow-up. We suggest that modified Appleby’s operation should be considered for radical resection of distal pancreatic cancer which is invading CA or major CA branch but not involving PHA and superior mesenteric artery(SMA), if the CA root is resectable and PHA flow is intact from SMA after ligation of CHA. The prognosis of distal pancreatic cancer is even poorer than that of pancreatic head cancer because of its late symptom onset and tendency of aggressive retroperitoneal invasion at diagnosis. Since the first Appleby’s operation in 1952, it has been performed in stomach cancer by several surgeons. But the survival benefit is still controversial. Appleby’s operation includes total gastrectomy, splenectomy, distal pancreatectomy, celiac trunk division with ligation of common hepatic artery(CHA) and retroperitoneal lymph node dissection. In 1976, Nimura first adopted this method for distal pancreatic cancer. We report a case of modified Appleby’s operation for distal pancreatic cancer. The patient was 44- year old female. Her chief complaint was epigastric pain for 2 weeks. Preoperative liver function test was within normal range and CA19-9 was elevated to 200 U/ml. Preoperative CT angiography showed 4.5×3cm sized, pancreatic mass in body and tail area invading splenic artery and celiac trunk from its left side. In operation, splenectomy and distal pancreatectomy was initially performed. After ligation of CHA, we confirmed intact proper hepatic artery(PHA) flow by doppler and then divided CHA. After confirmation of intact gastric blood flow, left gastric artery(LGA) was divided. Celiac axis(CA) was divided near its origin. Then we dissected retroperitoneal lymph nodes. There was minor pancreatic leakage controlled by conservative management. CA19-9 was normalized to 33 U/ml on the 16th postoperative day. She was discharged on the 28th postoperative day and underwent adjuvant chemotherapy and radiotherapy. There is no evidence of recurrence for 15 months of follow-up. We suggest that modified Appleby’s operation should be considered for radical resection of distal pancreatic cancer which is invading CA or major CA branch but not involving PHA and superior mesenteric artery(SMA), if the CA root is resectable and PHA flow is intact from SMA after ligation of CHA.

      • 간세포암의 근치적 절제술후 재발 진단 방법의 유용성

        박용현 한국간담췌외과학회 2000 한국간담췌외과학회지 Vol.4 No.1

        Background/Aims : In spite of improved diagnostic and therapeutic methods, the prognosis of hepatocarcinoma( HCC) is still poor because of the high recurrence rate. Early detection and active treatment of recurrent HCC are important to improve the survival. The objective of this study is to compare the effectiveness of diagnostic tools for early detection of the recurrence of HCC. Methods : We retrospectively studied 236 patients who underwent curative hepatic resection for HCC at SNUH between 1993 and 1995. Postoperatively, we checked radiologic studies every three months and serum α- fetoprotein level monthly first, then every three months to detect recurrence. The patients were divided into four group (Low-Low;L-L, Low-High;L-H, High-Low;H-L, High-High;H-H) according to the serum levels of pre- and post-operative(3 months) α-fetoprotein levels (Low ; <20ng/ml, High >20ng/ml). Results : Overall recurrence rate was 55.1%. The recurrence rates in L-L gr., L-H gr, H-L gr., and H-H gr were 40.7%, 75.0%, 42.9% and 91.8% respectively. Increasing levels of α-fetoprotein at the time of dectection of recurrence were found in 13.6%, 66.7%, 25.9% and 92.9%, respectively(p<0.05). The 3- year disease-free survival rates are 62.1%, 25.0%, 57.8% and 6.3%, respectively(p<0.05). The 3-year overall survival rates are 79.2%, 50.0%, 83.6% and 51.1%, respectively(p<0.05). The detection rates of ultrasonography(US) and computed tomograpy(CT) were 82.4% and 97.2% respectively. Seven patients had lung metastasis on chest X-ray and two bone metastasis on bone scan, two spinal metastasis on spine X-ray and MRI and 2 adrenal metastasis by US and CT were detected. Conclusion : The patients who have high serum levels of α-fetoprotein postoperatively have a tendency to recur early. On the other hand, patients who have low serum levels of α-fetoprotein postoperatively recur late, usually without its elevation. Therefore, in former cases, early recurrence or remnant tumor should be suspected and in latter cases, regular US and/or CT is a more useful method for early detection of recurrent HCC than frequent checking of serum α-fetoprotein. Background/Aims : In spite of improved diagnostic and therapeutic methods, the prognosis of hepatocarcinoma( HCC) is still poor because of the high recurrence rate. Early detection and active treatment of recurrent HCC are important to improve the survival. The objective of this study is to compare the effectiveness of diagnostic tools for early detection of the recurrence of HCC. Methods : We retrospectively studied 236 patients who underwent curative hepatic resection for HCC at SNUH between 1993 and 1995. Postoperatively, we checked radiologic studies every three months and serum α- fetoprotein level monthly first, then every three months to detect recurrence. The patients were divided into four group (Low-Low;L-L, Low-High;L-H, High-Low;H-L, High-High;H-H) according to the serum levels of pre- and post-operative(3 months) α-fetoprotein levels (Low ; <20ng/ml, High >20ng/ml). Results : Overall recurrence rate was 55.1%. The recurrence rates in L-L gr., L-H gr, H-L gr., and H-H gr were 40.7%, 75.0%, 42.9% and 91.8% respectively. Increasing levels of α-fetoprotein at the time of dectection of recurrence were found in 13.6%, 66.7%, 25.9% and 92.9%, respectively(p<0.05). The 3- year disease-free survival rates are 62.1%, 25.0%, 57.8% and 6.3%, respectively(p<0.05). The 3-year overall survival rates are 79.2%, 50.0%, 83.6% and 51.1%, respectively(p<0.05). The detection rates of ultrasonography(US) and computed tomograpy(CT) were 82.4% and 97.2% respectively. Seven patients had lung metastasis on chest X-ray and two bone metastasis on bone scan, two spinal metastasis on spine X-ray and MRI and 2 adrenal metastasis by US and CT were detected. Conclusion : The patients who have high serum levels of α-fetoprotein postoperatively have a tendency to recur early. On the other hand, patients who have low serum levels of α-fetoprotein postoperatively recur late, usually without its elevation. Therefore, in former cases, early recurrence or remnant tumor should be suspected and in latter cases, regular US and/or CT is a more useful method for early detection of recurrent HCC than frequent checking of serum α-fetoprotein.

      • KCI등재
      • KCI등재

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