Wolter 금속판를 이용한 제 2형 원위부 쇄골 골절의 치료

신성일(Sung-Il Shin),송경원(Kyung-Won Song),이진영(Jin-Young Lee),이승용(Seung-Yong Lee),김갑래(Gab-Rae Kim),현윤석(Yoon-Suk Hyun),이광남(Kwang-Nam Lee),이은수(Eun-Soo Lee) 대한견주관절의학회 2009 대한견주관절학회지 Vol.12 No.1

목적: 본 연구는 Wolter 금속판을 이용한 제 2형 원위부 쇄골 골절 치료의 임상적 결과를 평가하고자 하였다. 대상 및 방법: 2004년부터 2007년까지 Wolter 금속판으로 치료한 제 2형 원위부 쇄골 골절을 가진 16명의 환자를 대상으로 하였다. 평균 나이는 32.6세 이었고, 수술 후 평균 추시 기간은 22.9 개월이었다. 정복 및 골유합의 평가는 수술 직후 및 최종 방사선 소견을 이용하였고, 기능적 평가는 Kona의 기능적 평가 기준 및 Constant 점수를 사용하였다. 결과: Kona의 기능적 평가기준에 의해 우수 12예, 양호 3예, 보통 1예의 결과를 보였으며 Constant 점수는 평균 90점을 보였다. 16예 모두에서 골 유합을 확인하였으며, 합병증으로는 1예에서 금속판의 갈고리 부분이 돌출되어 피부에서 촉지 되었으며, 1예에서 견봉 골절이 발생하였으나 2예 모두 만족할 만한 골유합 소견을 보였으며, 그 외 견봉-쇄골 관절의 관절염, 감염증 등 다른 합병증은 관찰되지 않았다. 결론: 제 2형 원위부 쇄골 골절에서 Wolter 금속판을 이용한 고정법은 쉽게 만족스런 정복과 견고한 고정을 얻을 수 있고, 불유합의 발생이 적으며, 임상적 결과가 우수한 수술 방법이라고 생각된다. Purpose: This study examined the clinical results of the treatment of type 2 distal clavicle fracture with using a Wolter plate. Materials and Methods: Between 2004 and 2007, 16 patient treated for type 2 distal clavicle fracture using a Wolter plate were included in this study. Their average age was 32.6 years and the postoperative mean follow-up period was 22.9 months. The reduction and union were qualified according to the immediate post-operative and final radiographs. The functional outcome was evaluated by Kona’s system and the Constant score Results: By Konas functional evaluation, there were 12 cases with excellent results, 3 cases with good results and 1 case of fair results and the average Constant score was 90. All 16 cases showed bony union. As complications, there was 1 case in which the protruded hook of the plate could be palpated at the skin, and 1 case showed an acromial fracture, but all the cases dispalyed successful bony union and there was no acromioclavicular joint arthritis, infection or any other complications. Conclusion: Wolter plate fixation for type 2 distal clavicle fracture is a reliable surgical method for satisfactory reduction and rigid fixation, a lower incidence of nonunion and excellent clinical result.

미세 천공술을 이용한 슬관절 관절 연골 손상의 치료

신성일,송경원,이진영,이승용,김갑래,현윤석,서은호,Shin, Sung-Il,Song, Kyoung-Won,Lee, Jin-Young,Lee, Seung-Yong,Kim, Gab-Lae,Hyun, Yoon-Suk,Seo, Eun-Ho 대한관절경학회 2008 대한관절경학회지 Vol.12 No.3

목적: 슬관절에서 미세 천공술을 이용하여 전층 관절 연골 병변을 치료하고 추구 검진의 기간에 따라 변화하는 임상적 결과를 조사하였다. 대상 및 방법: 1999년 1월 1일부터 2005년 12월 31까지 본원에서 슬관절경 수술과 미세 천공술로 치료한 123예의 전층 관절 연골 병변 환자 가운데 연구에 적합한 37예를 선정하였다. 평균 2.7년 추구 검진을 하였으며, 남자는 28명, 여자는 9명 이었다. 평균 나이는 31세 (21~38세)로 비교적 젊은 연령을 선정하였다. 외상의 병력은 27예에서 보였으며, 10예에서는 외상력은 없었다. 수술 시에 모든 환자들의 병소 위치와 크기를 기록하였다. 또한 결과의 평가는 질문서를 작성하여 activity of daily living(ADL), Tegner activity scale, IKDC knee form, Lysholm score, 최종적 추구 검진시 치료의 만족도 등을 기록하였다. 모든 평가는 수술 후 1년, 1년 6개월, 그리고 2년에 동일하게 시행하여 결과를 비교하였다. 결과: 슬관절의 동통은 수술 후 1년 이내에 82%, 1년 6개월에 80% 호전되었으나 2년에는 62%로 감소하였다. ADL과 Tegner activity scale는 1년 6개월까지 환자군의 83%에서 호전되었으나 2년에는 66%로 감소하였다. IKDC score는 수술 전 58에서 수술 후 1년에 86, 1년 6개월에는 79, 그리고 2년에는 68로 감소하였다. Lysholm score는 수술 전 61에서 수술 후 1년에 89, 1년 6개월에 92이었으나 2년에는 73으로 감소하였다. 최종 추구 검진시 슬관절의 기능은 양호 내지 우수가 22예(59%), 보통 12예(32%), 불량 3예(9%)이었다. 결론: 슬관절의 관절 연골 손상에서 미세 천공술 치료는 수술 전에 비하여 슬관절의 기능 향상은 1년 이내에 가장 뚜렷하였으나, 시간이 경과할수록 점직적으로 효과가 감소하였다. Purpose: To evaluate the clinical results after microfracture surgery for full-thickness chondral lesion of the knee. Materials and Methods: Thrity-seven patients, who had underwent microfracture surgery for full-thickness chondral lesion of the knee between January 1999 and December 2005, were reviewed. Their mean age at the time of operation was 31 years (range, 21~38 years) and mean follow up period was 2.7 years. All patients were reviewd every 6 months after operation. Clinical outcomes were evaluated by activity of daily living (ADL), Tegner activity scale, International Knee Documentation Committee (IKDC) knee examination form, Lysholm score and satisfaction of treatment. Results: ADL and Tegner activity score improved in 83% of patients during first 18 months, but decreased during next 6months. IKDC score improved from 58 points at operation time to 86 points after 12 months, but decreased to 79 points and 68 points at 18 and 24 months after operation, respectively. Also, Lysholm score improved from 61 points at operation time to 89 points after 12 months, to 92 points after 18 months, but 73 points after 24 months. At the last follow-up, 22 patients were excellent or good in satisfaction of treatment, whereas 12 patients were fair, 3 patients were poor. Conclusion: Microfracture surgery for full-thickness chondral lesion of the knee has a good functional improvement for first 12 months after operation, but its effectiveness has decreased over time.

견관절 석회성 건염의 체외충격파 치료

신성일(Sung Il Shin),송경원(Kyung Won Song),이진영(Jin Young Lee),이승용(Seung Yong Lee),김갑래(Gab Rae Kim),김희천(Hee Chun Kim),최대은(Dea Eun Choi) 대한정형외과학회 2006 대한정형외과학회지 Vol.41 No.5

목적: 본 연구의 목적은 여러 고전적인 보존적 치료에 반응하지 않는 만성적인 석회성 건염의 치료에 대한 체외충격파 치료의 유효성을 평가하는 데 있다. 대상 및 방법: 연구 대상자는 37세에서 64세까지의 연령 분포로 평균 48세였으며 남자 17명, 여자 55명으로 구성되었다. 임상적으로 소염진통제나 스테로이드 주사, 물리치료 등의 보존적 치료에 반응하지 않고 견관절 통증이 3개월 이상 지속되며 방사선 검사상 최소 직경이 10 mm 이상, Garner type Ⅰ, Ⅱ의 석회성 결절이 존재하는 환자를 분석하였다. 체외충격파 치료는 Energy flux density 0.14 mJ/㎟, Frequency는 120 impulse/min, 그리고 총 충격파는 800회로 설정하였으며 치료 후 1, 3, 6, 12개월마다 방사선 검사에서 석회성 결절의 변화를 관찰하고 임상적인 평가로서 Constant and Murley Scale (CMS)과 Visual Analog Scale (VAS)을 측정하였다. 결과: 체외충격파 치료를 한 다음 방사선 검사상 1개월 후 19명(26%)의 환자에서 석회성 결절이 사라졌으며 26명(36%)은 부분적으로 크기가 감소하였으나 27명(38%)은 변화가 없었다. 그러나 치료 후 6개월에는 42명 (68%)의 환자에서 석회성 결절이 완전히 소설되었으며, 10명(14%)은 결절의 크기가 변하지 않았다. 이러한 소견은 1년 뒤의 추적 검사에서도 같은 양상을 보였다. CMS와 VAS의 평가에서 주목할 만한 통증의 감소와 견관절의 기능이 호전되었는데 6개월 뒤의 측정에서 76%의 환자가 만족할 만한 회복을 보여주었다. 15%는 주관적, 객관적으로 호전되었으나 6명(8%)의 환자에서는 염상 증상의 개선이 전혀 없었을 뿐 아니라 방사선 검사상 석회성 결절의 변화 역시 발견할 수 없었다. 편측과 환측 견관절의 CMS는 776.2와 87.2점으로 부분적인 차이를 보여 회복 추세를 알 수 있었고 12개월의 추적 검사에서도 통일한 임상결과를 확인할 수 있었다. 결론: 견관절의 석회성 건염 환자의 체외충격파 치료는 과거 보존적 치료에 반응이 없는 환자에서 대안적인 치료로 이용될 유용한 치료법이라 할 수 있다. Purpose: To evaluate whether Extracorporeal Shock Wave Therapy (ESWT) is an effective treatment without side effects for chronically painful calcifying tendinitis. Materials and Methods: Study subjects were 72 patients (17 males and 55 females) aged 37-64 years, with a mean of 48, showing chronic, symptomatic, calcifying tendinitis of the shoulder refractory to other conventional conservative therapies. Calcifications were type Ⅰ or type Ⅱ according to the classification of Gartner, and with a minimum diameter of 10 mm. Patients with type 3 calcific tendinitis were excluded, because this type has a strong tendency to spontaneous resolution. Extracorporeal shock wave therapy comprised one or two treatments, each consisting of 800 shocks, with a frequency of 120 impulse per minute and the energy density of 0.14 mJ/㎟. We assessed the presence and size of calcified deposits at 1, 3, 6 and 12 months by conventional radiography. All patients also underwent clinical examination, and the Constant (and Murley) score and pain were calculated. The intensity of pain was measured with the visual analogue scale (VAS) from 0 to 10 points, where 0 represents the absence of pain and 10 unbearable pain. Results: One month after the treatment, complete resorption of the calcium deposits was observed in 19 patients (26%), partial resorption was observed in 26 patients (36%), and no modification in the calcium deposits was observed in 27 patients (38%). At six months the complete disappearance of the calcium deposits was noted in 42 patients (68%), but in the 10 patients (14%), calcium deposit appeared unchanged. This result is remained unvaried after 6 month follow-up, Using the Constant and Murley score, this study showed a significant decrease in pain and a significant increase in shoulder function (p<0.001). At six months, 76% of the patients presented satisfactory functional result. About 15% reported a subjective and objective recovery, and only 6 patients (8%), classified as poor result but in our series no differences were found between results at 6 month and 12 month follow-up, At 12 month follow-up there were differences in the Constant score between treated shoulder and contralateral side, respectively 77.6 (59-91) and 87.2 (74-96), but not significant. There were no side effects. Conclusion: ESWT is an effective treatment without side effects and an alternative therapy for chronically painful calcifying tendinitis of the shoulder refractory to conventional therapies.

방사선치료로 인한 통증 및 암성통증에 대한 듀로제식의 효과

신성수(Seong Soo Shin),허승재(Seung Jae Huh),최은경(Eun Kyung Choi),김종훈(Jong Hoon Kim),안승도(Seung Do Ahn),이상욱(Sang-Wook Lee),김연실(Yeun Sil Kim),이규찬(Kyu Chan Lee),이창걸(Chang Geol Lee),노준규(John JK Loh),전미선(Mison Ch 대한방사선종양학회 2006 Radiation Oncology Journal Vol.24 No.4

목 적: 방사선치료로 인해 발생하는 점막염, 식도염 등의 통증과 암성 통증을 가진 환자에 대한 듀로제식의 통증 완화 및 일상생활 개선 효과를 알아보고자 하였다. 대상 및 방법: 다기관 전향적 4상 임상시험으로 방사선치료로 인한 통증을 호소하거나(A군) 암성통증으로 방사선치료를 시행 받고 있는 환자(B군) 중에 진통제를 복용 중임에도 숫자등급평가(Numeric rating scale, NRS)가 4 이상이거나 진통제 복용 없이 NRS가 6 이상인 환자를 대상으로 듀로제식 25 ug/hr을 처방한 후에 1주일과 2주일 후에 통증횟수와 강도변화, 통증이 일상생활에 미치는 영향평가, 피험자와 임상의 만족도 평가, 그리고 이상반응 평가를시행하였다. 결 과: 2005년 3월 28일부터 6월 15일까지 26개 기관에서 총 312명의 피험자를 등록하였고 그 중 249명이 임상시험을 완료하였는데 A군은 185명, B군은 64명이였다. 평균 연령은 60세였고, 남자가 189명, 여자가 60명이였다. 2주후 가장 심한 통증의 강도 변화를 보면 A군에서 6.9에서 3.9로 B군에서는 7.1에서 3.9로 통계적으로 유의하게(p=0.003) 감소하였고 일상생활의 미치는 영향을 보기 위한 수면방해 정도와 일상적인 일의 저하 그리고 삶의 질의저하는 투여 2주 후에 모두 호전되었다. 연하통증의 변화는 A군에서만 유의하게 투여 후 호전되었으며 피험자의 만족도는 매우 만족이 A에서 47%, B군에서 41%로 좋았고 만족 이유는 진통효과 우수, 전반적 만족, 편리성 순이었다. 임상의 만족도는 매우만족이 50% 정도로 좋았다. 이상반응은 A군에서 40% B군에서 34%로 총 38%에서 나 타났고 오심이 30%로 가장 많았고 소양증 16%, 어지러움 14%, 변비 10% 순이었다. 중대한 이상반응은 없었다.결 론: 듀로제식의 통증완화 효과 일상생활 개선효과는 우수하였고 피험자와 임상의의 만족도도 좋았고 중대한 이상반응도 없었다. Purpose: To evaluate the effectiveness and safety of fentanyl-TTS in the management of radiotherapy induced acute pain and cancer pain treated with radiotherapy. Materials and Methods: Our study was open labelled prospective phase IV multi-center study. the study population included patients with more 4 numeric rating scale(NRS) score pain although managed with other analgesics or more than 6 NRS score pain without analgesics. Patients divided into two groups; patients with radiotherapy induced pain (Group A) and patients with cancer pain treated with radiotherapy (Group B). All patients received 25 ug/hr of fentanyl transdermal patch. Primary end point was pain relief; second end points were change in patient quality of life, a degree of satisfaction for patients and clinician, side effects. Results: Between March 2005 and June 2005, 312 patients from 26 participating institutes were registered, but 249 patients completed this study. Total number of patients in each group was 185 in Group A, 64 in Group B. Mean age was 60 years and male to female ratio was 76:24. Severe pain NRS score at 2 weeks after the application of fentanyl was decreased from 7.03 to 4.01, p=0.003. There was a significant improvement in insomnia, social functioning, and quality of life. A degree of satisfaction for patients and clinician was very high. The most common reasons of patients' satisfactions was good pain control. Ninety six patients reported side effect. Nausea was the most common side effect. There was no serious side effect. Conclusion: Fentanyl-TTS was effective in both relieving pain with good tolerability and improving the quality of life for patients with radiotherapy induced acute pain and cancer pain treated with radiotherapy. The satisfaction of the patients and doctors was good. There was no major side effect.

자궁경부암 환자의 근치적 방사선치료성적

허승재(Seung Jae Huh),김보경(Bo Kyong Kim),임도훈(Do Hoon Lim),신성수(Seong Soo Shin),이정은(Jeong Eun Lee),강민규(Min Kyu Kang),안용찬(Yong Chan Ahn) 대한방사선종양학회 2002 Radiation Oncology Journal Vol.20 No.3

목적 : 삼성서울병원 치료방사선과에서 근치적 목적으로 외부조사와 고선량율 강내치료를 이용하여 치료한 자궁경부암 환자의 치료 성적을 분석하고자 하였다. 대상 및 방법 : 1994년 9월부터 1998년 7월까지 근치적 목적으로 방사선치료를 시행한 106명의 환자를 대상으로 분석하였으며, 환자의 연령분포는 22~89세(중앙값, 61세)이었다. 98명의 환자에서 편평상피암이었다. 환자의 FIGO 병기는 CIS 4명, IA 4명, IB 17명, IIA 15명, IIB 33명, IIIA 2명, IIIB 27명, IVA가 4명이었다. ECOG 활동도는 88명에서 1이하였다. 11명의 환자에서 전보조화학요법이 시행되었다. 방사선치료는 상피내암인 4명을 제외한 102명에서 30.6-50.4 Gy를 외부 조사하였으며 고선량율 강내치료를 모든 환자에서 A점 기준으로 24 Gy/6회 시행하였다. 치료 예후 인자는 연령(≤60세 vs >60세), 병리조직학적 소견(편평상피암 vs 기타 병리), FIGO 병기(IIA 이하 vs IIB vs IIIA 이상), ECOG 활동도(ECOG 0, 1 vs 2), 항암화학요법의 시행여부, 그리고 방사선치료 후 반응정도(완전관해 vs 부분관해), 방사선치료기간(≤55일 vs >55일)에 따라 비교하였다. 환자의 추적관찰기간은 6~66개월(중앙값, 28개월)이었다. 결과 : 전체 3년 및 5년 생존율은 각각 82%, 73%이었으며, 무병생존율은 각각 72%, 69%이었다. FIGO 병기별 생존율은 병기 IB, IIA, IIB, 그리고 III에서 3년 생존율이 각각 100%, 83%, 87%, 62%이었고 5년 생존율은 IB 100%, IIA 69%, IIB 80%, III에서는 62%이었다. 단변량분석에 따른 예후인자를 살펴보면 전체생존율에서는 FIGO 병기와 방사선치료의 반응이 무병생존율과 골반부 조절율에는 나이와 병기, 방사선치료의 반응, 방사선치료기간이 의미 있는 인자로 확인되었다. 방사선치료 부작용으로 직장 출혈은 모두 14명(13%)의 환자에서 나타났다. 결론 : 자궁경부암 환자의 고선량율 강내치료와 외부 방사선치료는 효과적인 치료방법임을 확인하였으며, 치료기간의 단축이 중요한 예후 결정 요인임을 확인할 수 있었다. Purpose : This study was conducted to evaluate the treatment results, prognostic factors, and complication rates after high dose rate (HDR) brachytherapy in patients with uterine cervix cancer who were treated with curative aim. Materials and Methods : Of 269 cervix cancer patients treated at the department of radiation oncology, Samsung Medical Center from September 1994 to July 1998, the 106 who were treated with radical radio-therapy were analyzed. The median age was 61 years (range 22 to 89). All patients except 4 with carcinoma in situ (CIS) were given external beam radiotherapy (range 30.6~50.4Gy to whole pelvis) and HDR brachytherapy. The common regimens of HDR brachytherapy were a total dose of 24~28Gy with 6~7 fractions to point A at two fractions per week. The median overall treatment time was 55 days (range 44 to 104) in patients given both external beam radiotherapy and HDR brachytherapy. Results : Early responses of radiotherapy were evaluated by gynecologic examination and follow-up MRI 1 month after radiotherapy. Treatment responses were complete remission in 72 patients, partial response in 33 and no response in 1. The overall survival (OS) rate of all patients was 82%, and 73%, and the disease free survival (DFS) rate was 72%, and 69%, at 3, and 5 years, respectively. The pelvic control rate (PCR) was 79% at both 3 and 5 years. According to the FIGO stage,3 and 5 year OS were 100% and 50% in CIS/IA, 100% and 100% in IB, 83% and 69% in IIA, 87% and 80% in IIB, and 62% and 62% in III, respectively. The 3 year OS in 4 patients with stage IVA was 100%. Three-year DFS were 80% in CIS/IA, 88% in IB, 100% in IIA, 64% in IIB, 58% in III, and 75% in IVA. Three-year PCR were 100% in CIS/IA, 94% in IB, 100% in IIA, 84% in IIB, 69% in III, and 50% in IVA. By univariate analysis, FIGO stage and treatment response were significant factors for OS. The significant factors for DFS were age, FIGO stage, treatment response and overall treatment time (OTT). For pelvic control rate, treatment response and OTT were significant factors. By multivariate analysis, FIGO stage had a borderline significance for OS (p=0.0825) and treatment response had a borderline significance for DFS (0=0.0872). A total of 14 patients (13%) experienced rectal bleeding, which occurred from 3 to 44 months (median, 13 months) after the completion of radiotherapy. Conclusion : HDR brachytherapy protocol of Samsung Medical Center combined with properly optimal external beam pelvic irradiation is a safe and effective treatment for patients with uterine cervix cancer. The authors found that OTT of less than 55 days had a positive impact on pelvic control and survival rate.

A predictive model for the level of sIgA based on IgG levels following the oral administration of antigens expressed in Sacchromyces cerevisiae

유한상,신성재,Seung Won shin,Eun Jin Choi,Deog Yong Lee,Jeong Min Ahn,양문식,장용석 대한수의학회 2005 Journal of Veterinary Science Vol.6 No.4

Oral vaccination may be the most efficient way of inducing an immune response at the remote mucosal site through the common mucosal immune network. Antigenspecific secretory IgA (sIgA) is the major immunoglobulin type generally detected in the secretions of experimental animals following an effective oral immunization. Actinobacillus pleuropneumoniae causing disease in the lung of pig initially interacts, colonizes, and infects the host tissues at the mucosal surface of the respiratory tract. Also, importantly for A. pleuropneumoniae protection, the quantity of sIgA in the lung had merits associated with the mucosal immunity. However, there is no simple method to monitor the level of sIgA as an indicator for the induction of local immune responses by an oral vaccination in the target tissue. Therefore, the relationship between sIgA and IgG was analyzed to evaluate the induction of local immune responses by an oral immunization with Saccharomyces cerevisiae expressing the apxIA and apxIIA genes of A. pleuropneumoniae in this study. The correlation coefficient of determination (r2 × 100) for paired samples in both vaccinated and control groups showed a significant positive-relationship between IgG in sera and sIgA in the lung or intestine. These results indicated that IgG antibody titers in sera could be useful to indirectly predict local immune response, and sIgA, in the lung or intestine to evaluate the efficacy of an oral vaccination. Oral vaccination may be the most efficient way of inducing an immune response at the remote mucosal site through the common mucosal immune network. Antigenspecific secretory IgA (sIgA) is the major immunoglobulin type generally detected in the secretions of experimental animals following an effective oral immunization. Actinobacillus pleuropneumoniae causing disease in the lung of pig initially interacts, colonizes, and infects the host tissues at the mucosal surface of the respiratory tract. Also, importantly for A. pleuropneumoniae protection, the quantity of sIgA in the lung had merits associated with the mucosal immunity. However, there is no simple method to monitor the level of sIgA as an indicator for the induction of local immune responses by an oral vaccination in the target tissue. Therefore, the relationship between sIgA and IgG was analyzed to evaluate the induction of local immune responses by an oral immunization with Saccharomyces cerevisiae expressing the apxIA and apxIIA genes of A. pleuropneumoniae in this study. The correlation coefficient of determination (r2 × 100) for paired samples in both vaccinated and control groups showed a significant positive-relationship between IgG in sera and sIgA in the lung or intestine. These results indicated that IgG antibody titers in sera could be useful to indirectly predict local immune response, and sIgA, in the lung or intestine to evaluate the efficacy of an oral vaccination.

제한적 후방 도달법을 이용한 관절내 종골 골절의 치료

현윤석,송경원,신성일,이진영,이승용,김갑래,신건호,서은호,반태서,Hyun, Yun-Seok,Song, Kyung-Won,Shin, Sung-Il,Lee, Jin-Young,Lee, Seung-Young,Kim, Gab-Lae,Shin, Kun-Ho,Seo, Eun-Ho,Ban, Tae-Seo 대한족부족관절학회 2007 대한족부족관절학회지 Vol.11 No.1

Purpose: To evaluate the clinical efficacy of the limited posterior approach for the surgical treatment of intraarticular fracture of calcaneus. Materials and Methods: From March 2000 to February 2006, we studied retrospectively 186 patients, 203 cases who were treated with open reduction and internal fixation through limited posterior approach and were followed up for more than 1 year. The clinical results were evaluated with Creighton-Nebraska score and circle draw test after 1 year. We checked simple AP, lateral, axial and Broden's view preoperatively and 1 year after surgery, and compared $B{\ddot{o}}hler$ angle and Gissane angle. Results: By Creighton-Nebraska score, Sanders type 2 was 86.4, type 3 was 74.3, type 4 was 62.4. And by circle draw test, type 2 was 8.9 cm, type 3 was 7.2 cm, type 4 was 5.9 cm. $B{\ddot{o}}hler$ angle and Gissane angle were $7.6^{\circ}$, $102.4^{\circ}$, and it increased to $23.5^{\circ}$, $128.6^{\circ}$ after postoperative 1 year. Conclusion: Limited posterior approach for the surgical treatment of intraarticular fracture of calcaneus was considered to an effective treatment modality.

T1N0 성문암의 방사선치료관련 예후 인자 분석

송시열(Si yeol Song),신성수(Seong Soo Shin),김수산(Su Ssan Kim),김종훈(Jong Hoon Kim),조경자(Kyung Ja Cho),최승호(Seung Ho Choi),남순열(Soon Yuhl Nam),김상윤(Sang Yoon Kim),최은경(Eun Kyung Choi),이상욱(Sang wook Lee),안승도(Seung Do 대한두경부종양학회 2003 대한두경부 종양학회지 Vol.19 No.1

Objective: To analyze the treatment-related parameters after the radiotherapy of T1N0 squamous cell carcinoma of the glottic larynx. Materials and Methods: Between October 1989 and August 2000, 54 patients with histologically proven T1N0 squamous cell carcinoma of the glottic larynx who received definitive radiation therapy in Department of Radiation Oncology, Asan Medical Center were analyzed. They were all males with age ranged from 31 to 80 years (median 61 years). 1997 AJCC stages were 31 T1a, 23 T1b. Patients were treated with 4-MV X-rays with a parallel-opposed two-field technique. Ten patients received 66.0-68.4Gy at 1.2Gy per fraction twice daily, 21 patients received 64.8-66.6Gy at 1.8Gy per fraction once daily, and 23 patients received 66.0Gy at 2.0Gy per fraction once daily. Follow-up period was 16-119 months (median 56 months). Results: 5-year overall survival and local control rates for patients with T1 lesions were 87.0% and 88.5%, respectively. 5-year local control with larynx preservation rate was 90.5%. Host and tumor-related prognostic factors including age, stage, anterior commissure involvement and tumor bulk proved not to be significant. Only shorter overall treatment time among treatment-related factors had correlation with imporved local control. Conclusion: Comparable high local control rate with organ preservation was achieved with primary radiation therapy and salvage surgery. Shortening of overall treatment time is related to improved local control rate. To determine the optimal fractionation scheme, randomized trial is mandatory.

자궁 내막암의 수술 후 방사선치료 결과

노오규(O Kyu Noh),신성수(Seong Soo Shin),이상욱(Sang-Wook Lee),안승도(Seung Do Ahn),최은경(Eun Kyung Choi),김종혁(Jong-Hyeok Kim),김용만(Yong-Man Kim),남주현(Joo-Hyun Nam),목정은(Jung-Eun Mok),김종훈(Jong Hoon Kim) 대한방사선종양학회 2007 Radiation Oncology Journal Vol.25 No.2

목 적: 근치적 자궁절제술 후 보조적 방사선 치료를 시행 받은 자궁내막암 환자의 치료 성적 및 예후 인자를 알아 보고자 하였다. 대상 및 방법: 1991년 9월부터 2003년 8월까지 서울아산병원에서 자궁내막암으로 자궁 절제술을 시행한 후 보조적 방사선치료를 받은 76명을 대상으로 하였다. FIGO 병기는 I, II, III기가 각각 41명(53.9%), 12명(15.8%), 23명(30.3%)이었다. 조직분화도는 1이 29명(38.2%), 2가 20명(26.3%), 3이 27명(35.5%)이었다. 방사선치료는 외부방 사선 조사와 강내 조사를 함께 시행한 환자가 42명, 외부 방사선 조사만 시행한 환자가 33명, 강내 조사만 시행한 환자는 1명이었다. 외부 방사선 치료의 조사 선량은 50.4 Gy였으며, 강내 조사는 1회 분할 선량을 4~5 Gy씩 4~6 회 실시하였다. 생존환자의 추적기간은 5개월에서 121개월로서 중앙값은 51개월이었다.결 과: 5년 전체 생존율은 89.6%이었으며, FIGO I기는 96.8%, II기는 91.7%, III기는 75.7%였다. 5년 무병 생존율은 83.7%이었고, FIGO 병기에 따라 I기는 94.8%, II기는 91.6%, III기는 59.8%이었다. 단변량 분석에서 전체 생존율에 유의한 영향을 미치는 인자에는 FIGO 병기, 림프절 양성 유무, 조직분화도였고, 무병 생존율에서는 관계되는인자는 FIGO 병기, 림프절 양성 유무, 림프혈관침범 유무였다. 총 11명에서 재발하였고, 국소재발 1명, 원격전이가 10명이었다. 방사선 치료 후에 중등도 이상의 합병증을 보이는 경우는 없었다. 결 론: 자궁내막암의 수술 후 방사선 치료의 성적은 좋은 결과를 보였다. 그러나 주로 원격전이로 재발하는 양상으로 보이므로 항암치료가 도움이 되리라 생각된다. 따라서 FIGO 병기가 높거나, 림프절 양성이거나, 림프혈관침범이 있거나, 조직 분화도가 높은 고위험 군에서 항암제를 포함한 방사선치료 방법에 대한 연구가 필요할 것으로 판단된다. Purpose: To evaluate the outcome and prognostic factors of postoperative radiotherapy in endometrial carcinoma. Materials and Methods: From September 1991 to August 2003, 76 patients with endometrial carcinoma received postoperative adjuvant radiotherapy after hysterectomy at Asan Medical Center. Stage was classified as FIGO I in 41 (53.9%), II in 12 (53.9%), and III in 23 (30.3%). Histologic grade 1, 2 and 3 were in 29 (38.2%), 20 (26.3%), and 27 (35.5%) respectively. Forty two patients received both external beam radiation therapy (EBRT) and intracavitary radiation (ICR), 34 patients were treated with EBRT or ICR alone. EBRT dose was 50.4 Gy, ICR was performed in 4∼6 fractions with 4∼5 Gy per fraction. Median follow‐up period was 51 (range 5∼ 121) months. Results: Five‐year overall survival was 89.6%. In univariate analysis, statistically significant factors to overall survival were FIGO stage, lymph node metastasis and histologic grade. In disease free survival, FIGO stage, lymph node metastasis and lymphovascular invasion were significant prognostic factors. Recurrence was seen in 11 patients. Of these, systemic failure was in 10 patients. There were no moderate to severe complications after radiation therapy. Conclusion: The outcome of postoperative adjuvant radiotherapy in endometrial carcinoma was good. Main pattern of failure after postoperative radiotherapy was distant metastasis. So, adjuvant chemotherapy may help in improving outcome. Further study on chemotherapy in combined with postoperative radiotherapy will be needed, especially for patients with high risk factors such as high FIGO stage, lymphovascular invasion, and high histologic grade.

물벼룩에 대한 나노독성 데이터의 나노성질 및 조건에 대한 메타분석

신현길(Hyun Kil Shin),서명원(Myung Won Seo),신성은(Seung Eun Shin),김광연(Kwang-Yon Kim),박준우(June-Woo Park),노경태(Kyoung Tai No) 환경독성보건학회 2016 한국독성학회 심포지움 및 학술발표회 Vol.2016 No.10