위암 진단에 있어서의 CT 위장 조영술과 상부위장관 조영술과의 비교

백용해,이순진,이지연,노재형,손태성,김성,김용일,Baik Yong Hae,Lee Soon Jin,Lee Ji Yun,Noh Jae Hyung,Sohn Tae Sung,Kim Sung,Kim Yong Il 대한위암학회 2003 대한위암학회지 Vol.3 No.4

Purpose: Advancement of computed tomography (CT) hardware and software has allowed thin section scanning and reconstruction of fascinating 2-dimentional (2D) and 3- dimentional (3D) images. Especially, the reconstruction of 3D images of gastrointestinal tract has been used in the detection and diagnosis of pre-malignant and malignant diseases. To compare the efficacy of CT gastrography with conventional upper gastrointenstinal series (UGIs) in gastric cancer patients. Materials and Methods: During Nov. 2002 and Mar. 2003, twenty-seven patients who had gastric cancer received both double contrast upper GI series and CT gastrography prior to radical surgery. Among these patients, nineteen had early gastric cancer (EGC) and 8 had advanced gastric cancer (AGC). Fifteen patients were male and 12 were female. The mean age was 54 yrs (range, $27\∼75$ yrs). The patients were placed on NPO and Stomach was distended with gas in fasting state prior to CT scanning. Double contrast upper GI series were performed as routine manual. CT scan was conducted in all patients using 8 or 16-channel multidetector CT in this study. The collimation and reconstruction for CT scanning were set at 2.5 mm and 1.25 mm, respectively. CT scanning was performed in the supine position. For image processing, CT gastrography, in which raysum and surface rendering images were constructed, virtual and 2D image in coronal and sagittal images were performed. The detectability of gastric cancer was assessed between UGIs and CT gastrography. Results: In AGCs, the detection rate of cancer using CT gastrography and virtual gastroscopy was higher than EGC cases. However, CT gastrography and virtual gastroscopy showed less favorable results than UGIs. Even though only a small number of cases had been studied, we might conclude that CT gastrography and virtual gastroscopy could replace UGIs in the detection of AGC cases. Conclusion: The detection rate used with CT gastrography and Virtual gastroscopy is not better than that of UGIs in early gastric cancer, however, in advanced gastric cancer cases, it is nearly equal to that of UGIs.

네트워크 인프라 가상화를 위한 딥러닝 기반 MVNO 트래픽 예측 모델의 최적화 기법에 대한 연구

임한여름(Han Yeo Reum Im),Kyi Thar,홍충선(Choong Seon Hong) 한국정보과학회 2019 한국정보과학회 학술발표논문집 Vol.2019 No.12

2기 위암환자의 수술 후 보조 항암요법 및 방사선 치료가 생존율에 미치는 영향

홍성권,최민규,백용해,노재형,손태성,김성,Hong, Seong-Kweon,Choi, Min-Gew,Baik, Yong-Hae,Noh, Jae-Hyung,Sohn, Tae-Sung,Kim, Sung 대한위암학회 2005 대한위암학회지 Vol.5 No.4

목적: UICC 분류에 의한 2기 위암환자의 임상병리학적 특징에 대하여 알아보고 수술 후 보조요법으로서의 항암, 방사선 치료가 5년 생존율에 미치는 효과에 대하여 알아보고자 하였다. 대상 및 방법: UICC에 의한 병리학적 분류로 병기2기로 판정된 954명을 대상으로 하였다. 항암치료는 수술 후 3주째부터 5-Fluorouracil $400mg/m^2/day$와 Leucovorin $20mg/m^2/day$를 사용하였으며 방사선 치료는 총 4,500 cGy를 25회로 나누어 시행하였다. 결과: 임상병리학적 인자들의 생존율분석에서 환자의 나이, 수술방법, 종양의 크기와 항암 및 방사선 치료가 의미 있는 예후 인자로 분석되었다. 수술 후 항암 방사선 치료에 따른 생존율 분석에서 보조요법을 시행하지 않은 425예의 5년 생존율은 67.9%, 항암 치료 군 187예는 79.8%, 항암방사선 치료 군 342예는 83.6%로 조사되어 통계적으로 유의한 차이를 보였으며(P<0.0001) 항암치료 군과 항암방사선 치료 군과의 생존율 비교에서는 항암방사선 치료 군에서 생존율의 향상을 보여주기는 하였으나 통계적으로 유의하지는 않았다(P=0.1264). 결론: 2기 위암환자에서 환자의 나이, 수술방법, 종양의 크기 및 수술 후 보조적인 항암 및 방사선 치료가 5년 생존율에 영향을 주는 의미 있는 예후인자로 조사되었다. 수술 후 보조요법의 시행이 통계적으로 의미 있는 생존율을 보였으나 임상병리학적 인자들을 고려한 무작위 연구를 통해 그 의미를 검증해야 할 것으로 생각된다. Purpose: This study was conducted to evaluate the effectiveness and the role of post-operative adjuvant chemoradiation therapy in a stage-II (UICC, 1997) primary gastric cancer. Materials and Methods: From September 1994 to December 2004, 954 stage-II gastric-cancer patients were seen, and all of them underwent a curative resection with extensive (D2) lymph-node dissection. The chemotherapy consisted of fluorouracil $(400mg/m^2)$ plus leucovorin $(20mg/m^2)$ for 5 days, followed by 4,500 cGy of radiotherapy for 5 weeks with fluorourcil and leucovorin on the first 4 days and the last 3 days of radiotherapy. Two five-day cycles of chemotherapy were given four weeks after the completion of radiotherapy. The Kaplan-Meier method was used to estimate the survival rates. To assess the importance of potential prognostic factors, we performed univariate and multivariate analyses using a log-rank test and Cox's proportional hazards regression model. A P value <0.05 was considered significant. Results: Univariate analysis revealed that age, tumor size, gross type, surgical method, and postoperative adjuvant therapy had statistical significance. Among these factors, age, surgical method, tumor size, surgical method, and postoperative adjuvant therapy were found to be independent prognostic factors by using a multivariate analysis. The postoperative adjuvant chemotherapy group and the chemoradiation therapy group had survival benefit compared to the surgery-only group. However the chemoradiation therapy group had no significant survival benefit compared to the chemotherapy group. Conclusion: The postoperative adjuvant therapy in stage-II gastric-cancer patients had significant benefit. Therefore, postoperative adjuvant chemoradiation therapy has an acceptable effect. A large-scale, randomized study is needed to evaluate the effectiveness and the role of postoperative radiation therapy.

위암 환자의 혈장 및 종양 조직에서 측정된 그렐린 농도의 임상적 의의

안지영,최민규,홍성권,백용해,노재형,손태성,김성,An, Ji-Yeong,Choi, Min-Gew,Hong, Seong-Kweon,Baik, Yong-Hae,Noh, Jae-Hyung,Sohn, Tae-Sung,Kim, Sung 대한위암학회 2005 대한위암학회지 Vol.5 No.4

목적: 그렐린은 위에서 주로 생산되며 체내 영양상태를 반영하고 에너지 항상성 유지에 관여한다. 위암으로 위 절제수술을 받은 환자의 혈장 및 조직의 그렐린 수치와 임상소견과의 관련성, 혈중 그렐린 수치와 위 암 조직 의 그렐린 수치의 상관성에 대해 알아보고자 한다. 대상 및 방법: 2004년 7월부터 9월까지 위암으로 진단받고 근치적 위전절제술과 위아전절제술을 시행 받은 환자를 대상으로 하였다. 수술 전 3개월 이내에 체중이 5% 이상 감소한 군과 5% 미만으로 감소한 군으로 나누어 임상적 특징, 생화학 검사소견, 체질량지수, 종양의 병기, 조직 유형, 혈액과 조직의 그렐린 펩타이드 농도를 측정하였다. 또한 수술 방법에 따라 수술 전후의 체질량지수, 생화학적 검사 소견, 혈중 그렐린 농도의 변화를 측정하였다. 결과: 체중 감소 정도에 따른 환자들의 임상 양상, 혈중 그렐린 농도, 종양 조직 및 정상조직의 그렐린 수치에는 유의한 차이가 없었고 이들 사이에 상호 연관성 역시 찾을 수 없었다 그러나 두 군 모두에서 종양 조직의 그렐린 수치는 정상 조직의 그렐린 수치에 비해 유의하게(P<0.0001)감소되어 있었고 종양의 분화도에 따라 종양 조직의 그렐린 수치에 유의한 차이가 있었다(P=0.007). 위아전 절제술을 시행 받은 환자들의 수술 후 7일 째 혈장 그렐린 농도는 수술 전 농도의 $36.5{\pm}25.6%$로, 위전절제술을 시행한 경우는 수술 전 농도의 $47.3{\pm}34.3%$로 감소하였다. 절제 범위에 따른 수술 전 후의 혈중 그렐린 농도에는 유의한 차이가 없었다. 결론: 위암의 발생 및 종양의 분화도는 그렐린의 생성에 영향을 미치며 위 조직의 그렐린 수치는 체내 그렐린 생성량을 반영하지 못한다. 위는 그렐린 생성의 주요 장소이며 위 절제 범위에 따라 혈중 그렐린 농도에 유의한 차이가 없는 것으로 보아 위전절술 후 다른 장기에서 그렐린이 대상성으로 더욱 증가하였음을 알 수 있다. 그렐린의 생성에 영향을 미치는 다른 인자들에 대한 추가적인 연구가 필요할 것으로 생각한다. Purpose: Ghrelin, produced primarily in the gastrointestinal tract, including the stomach, has been reported to reflect nutritional status and to control homeostasis by influencing food intake and adiposity. The purpose of this study is to evaluate nutritional status, as well as plasma and gastric tissue ghrelin levels, in patients with gastric cancer who underwent a gastrectomy. Materials and Methods: Eighty patients were analyzed by the degree of weight loss $(weight\;loss{\geq}5%\;or\;<5%)$ and the extent of gastrectomy (subtotal or total gastrectomy). Blood samples were collected from all patients preoperatively and postoperatively especially at seven days. Gastric tissues, including tumor and normal tissues, were obtained from the resected stomach. levels of plasma and tissue ghrelin were measured with a commercial ELISA kit. Results: There were no significant differences in the clinical characteristics and ghrelin levels of plasma, gastric tumor tissue and normal tissue by the degree of weight loss. The ghrelin levels in plasma and tumor tissue showed no correlations with each other while the ghrelin level in tumor tissue was significantly lower than that in normal tissue. The degree of cellular differentiation also had an association with ghrelin production. A gastrectomy proved to decrease significantly plasma ghrelin levels, body mass index, and biochemical markers, regardless of the extent of gastric resection. Conclusion: These results show that gastric cancer affects the production of ghrelin in the gastric mucosa and that ghrelin is mainly produced in stomach even though it could be partially covered by endogenous ghrelin from other organs following a gastrectomy. However, we should further investigate which other factors have an impact on energy consumption, ghrelin secretion, and changes in ghrelin levels after a gastrectomy.

위의 소세포암

안지영(Ji Yeong An),백용해(Yong Hae Baik),노재형(Jae Hyung Noh),손태성(Tae Sung Sohn),김성(Sung Kim) 대한외과학회 2004 Annals of Surgical Treatment and Research(ASRT) Vol.67 No.5

복부둔상에 의한 소장천공에서 시간경과에 따른 CT와 임상소견의 분석

강영준(Young Jun Kang),이용석(Yong Seuk Lee),백용해(Yong Hae Baik),최원용(Won Yong Choi),곽범석(Beom Seok Kwak),김연대(Yeon Dae Kim),박영진(Young Jin Park),김홍용(Hong Yong Kim) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.75 No.4

Purpose: The high mortality and morbidity rates associated with traumatic rupture of the small bowel have been attributed to the clinical difficulty of establishing an early diagnosis. CT scan is the most widely used tool for the diagnosis of blunt abdominal trauma, but its accuracy in diagnosing small bowel perforation is still controversial. This study was conducted to determine the overall and time-dependent diagnostic value of abdominal CT and the clinical findings of small bowel perforation. Methods: The clinical data and CT images of 21 patients with small bowel perforation after blunt trauma were retrospectively analyzed. The patients were divided into the early and late elapsed time groups based on the elapsed time of 8 hours from the initial trauma to the time of evaluation. Results: Any changes of the vital signs, including hypotension, tachycardia or fever, were observed in only half of the patients. Signs of peritonitis were evident in 7/11 of the early lapse group and in 10/10 of the late lapse group. The most common CT finding of small bowel perforation was free peritoneal air (17 of 21 patients), followed by segmental bowel wall thickening (15/21), high density ascites (14/21), an intermesentric fluid collection (13/21) and mesentic fat obliteration (11/21). Extraluminal air and segmental bowel wall thickening were detected more frequently in the late lapse group (P=0.03 and 0.01, respectively). In the one patient, bowel perforation was not evident at the initial evaluation according to the clinical findings and CT, but the follow-up CT exam showed specific findings for bowel perforation. Conclusion: CT scanning is a sensitive and effective modality for the evaluation of small bowel perforation, but this is less sensitive during the earlier post traumatic period. Therefore, careful clinical and radiological follow up is necessary for suspected cases, and even when an initial evaluation shows negative findings for bowel injury.

유두상 갑상선암의 양측성과 관련된 임상병리학적 인자와 수술 전 초음파 검사의 유용성

이희승,곽범석,김연대,김홍용,박영진,백용해,오민구,최원용,Hee Seung Lee,Beom Seok Kwak,Yeon Dae Kim,Hong Yong Kim,Young Jin Park,Yong Hae Baik,Min Gu Oh,and Won Yong Choi 대한갑상선-내분비외과학회 2009 The Koreran journal of Endocrine Surgery Vol.9 No.2

위암 치료의 전략적 접근

백용해 동국대학교 의학연구소 2009 東國醫學 Vol.16 No.1

위암의 치료의 변화는 조기위암을 중심으로 삶의질을 향상시키기 위한 변화와 진행성위암에서의 근치도 를 높이기 위한 변화로 요약 할 수 있다. 저 침습치료인 내시경 치료와 복강경 수술 및 로봇 수술 둥이 조기 위암에서 새롭게 소개 되고 있고,좋은 결과를 얻고 있으며, 진행성위암의 경우, 생존율을 높이기 위한 전략적 방법으로, 림프절절제 범위의 결정 및,수술 전후 시행 돠는 항암 약물요법의 선택이 중요한 논란 거리로 받아 들여 지고 있다. 최상의 치료 결과를 얻기 위한 전략적 치료 방법으로는, 위암 환자 각개인의 전신 상태와 위암의 병기를 고려한 맞춤형 치료가 그 해답으로 받아들여 지고 있으며,이에 대한 환자와 의사간의 이해는 필수적이라 할 수 있겠다. Treatment modality for the stomach cancer is changing not only minimal invasive, such as endoscopic mucosal resection, laparoscopic assisted gastrectomy, robotic surgery, but also the range of lymph node dissection for standard gastric surgery, the goal of this treatment is to get better satisfactory outcome. Optimal strategic approach is thus needed, and tailored managements which consider patient's stage and body condition are the key approach. Good correlation ship between patient and doctor seems to be important in improving all requests.