간세포암종에서 간절제술 후 이환율과 사망률에 영향을 미치는 위험 인자

김완욱,이광웅,최성호,허진석,김용일,김성주,이대성,이환효,백승운,고광철,이준혁,최문석,유병철,조재원 대한간학회 2004 Clinical and Molecular Hepatology(대한간학회지) Vol.10 No.1

목적: 간세포암종은 우리나라에서 간절제의 가장 흔한 적응증이다. 그러나 간경변을 동반한 경우가 많아 수술 후 이환율과 사망률이 높아 수술 전후 처치에 주의를 요한다. 최근에는 외과적 술기의 발전과 수술 전 및 수술 후 처치의 향상으로 이환율과 사망률이 감소하고 있으나 다른 수술에 비해 여전히 높다. 이에 본 연구에서는 간세포암종의 수술 중 위험 인자를 알아보고 수술 후 이환율과 사망률을 줄일 수 있는 방법을 찾아보고자 하였다. 대상과 방법: 1994년 11월부터 2001년 12월까지 간세포암종으로 진단받고, 간절제술을 시행받은 환자 510명을 대상으로 하였다. 대상 환자의 평균 연령은 51.6세였고, 남녀 비는 4.01 : 1이었다. 수술 전 HBsAg (+)는 76.0%, 수술 전, anti-HCV (+)는 8.2%였으며 종양의 크기는 평균 5.19 ㎝이었다. 환자 중 26.2%에서 수술 전 경도자 동맥색전술의 병력이 있었으며 8.7%에서 수술 전 경피적 간문맥색전술을 시행받았다. 시행받은 수술은 종양절제술 55예, 분절절제술 127예, 구역절제술 77예, 반간절제술 214예, 동반 혹은 확대 반간절제술 37예였다. 위험 인자로 나이, 성별과 각종 임상 지표(간기능 수치, 프로트롬빈시간, 혈청 알부민, 혈당, 알파태아단백, ICG 검사, 수술 전 경도자 동맥색전술, 경피적 간문맥색전술 시행 여부) 등의 수술 전 인자, 수술의 종류, 수술 시간, 수혈량 등의 수술 인자, 그리고 종양의 크기, 종양의 수, 간경변 여부 등의 병리조직학적 인자 등을 분석하였다. 분석자료는 대상 환자들의 의무기록을 통해 후향적 방법으로 조사하였다. 수술 사망은 수술 후 30일 이내에 사망한 경우로 정의하였고, 입원 사망은 수술 후 합병증으로 퇴원하지 못하고 사망한 경우로 정의하였다. 단변량 분석은 student t test와 x² test를 이용하였으며, 다변량 분석은 logistic regression을 이용하였다. 결과: 수술 후 합병증은 총 56예(10.5%)에서 나타났으며, 조절되지 않는 복수 19예, 호흡기 합병증 10예, 상처 합병증 8예, 간기능 이상으로 인한 고빌리루빈혈증 6예, 출혈 5예, 고질소혈증 4예 등이었다. 수술 사망은 5예(0.98%), 입원 사망은 수술 사망을 포함하여 6예(1.1%)였다. 이중 간부전과 연관된 사망이 5예였고, 간부전과 동반된 흡인성 폐렴으로 사망한 예가 1예 있었다. 이환율에 영향을 미치는 인자를 다변량 분석을 통해 알아본 결과, 수술 중 수혈량(P=0.002), 프로트롬빈시간(P=0.038), 혈당 수치(P=0.002)가 통계학적으로 의미가 있었고, 다변량 분석 상 수술 후 사망률과 관련된 인자로는 나이(P=0.028), 혈당 수치(P=0.011), 수술 전 경도자 동맥색전술 시행 여부(P=0.046) 등이 의미 있는 것으로 나타났다. 결론: 위의 위험 인자 분석을 통해 간세포암종에서 간절제시에 수술 후 이환율을 중이기 위해 가능한한 수술 중 출혈을 최소화하면서 불필요한 수혈을 피하고, 당뇨 환자에서는 수술 후 이환율과 사망률이 상대적으로 높고, 고령 환자에서는 사망률이 상대적으로 높으므로 수술 전후 처치에 세심한 주의가 필요함을 알 수 있었다. 수술전 경도자 동맥색전술 시행 여부가 수술 후 사망률과 유의한 상관성이 있었고 이에 대한 지속적인 연구가 필요하리라 생각된다. Background/Aims: Recently, mortality following surgical resection for hepatocelluar carcinoma has been reduced significantly. Morbidity, however, is still significant. This study evaluated the risk factors leading to morbidity and mortality. Methods: 510 patients who had a hepatic resection form Nov. 1994 to Dec. 2001 were included. The patient demographics showed a mean age of 51.6 years with a male to female ratio of 4:1. The HBsAg was positive in 76.0% and the anti-HCV was positive in 8.2%. The mean tumor size was 5.2 cm, 26.2% of patients had preoperative transcatheter arterial embolization (TAE), and 8.7% had preoperative percutaneous transhepatic portal embolization (PTPE). Limited resection was performed in 259 cases (50.7%), and major resection was conducted in 251 cases (49.1%). Risk factors included age, sex, laboratory findings (liver function test, prothrombin time, albumin, glucose, α-fetoprotein, ICG test), preoperative TAE, PTPE, operation type, operation time, intraoperative transfusion, tumor size, and cirrhosis. Results: The morbidity was 10.5% (54 cases). Operative death occurred in 5 cases (1.0%). Hospital death, including operative death, occurred in 6 cases (1.2%). Five cases were associated with hepatic failure and 1 case was associated with aspiration pneumonia accompanying hepatic failure. Transfusion (P=0.002), glucose (P=0.002), and prothrombin time (P=0.038) were significantly related to morbidity. Age (P=0.028), glucose (P=0.011), and TAE (P=0.046) were significantly related to mortality. Conclusions: Intraoperative transfusion, which is mainly related to intraoperative bleeding, should be reduced if possible to decrease morbidity. Diabetes mellitus patients and the elderly need careful perioperative management.(Korean J Hepatol 2004;10:51-61)

비뇨기과 입원환자에서 진통이 미치는 Nabumetone(Unimetone^(�))의 임상적 효과

이홍우,김세웅,이광돈,조용현,윤문수 최신의학사 1994 最新醫學 Vol.37 No.6

잔디의 立枯病菌[Curvularia geniculata(Tracy & Earle) Boedjin]의 營養要求性에 關한 硏究

李敏雄,金光布 동국대학교 대학원 1974 연구논집 Vol.4 No.

석회화 치성 낭종 1례

이상학,염범우,이승훈,한승훈,김응식,김광일 한국의학사 1998 診斷과治療 Vol.18 No.10

번데기동충하초(Cordyceps militaris CMO02)의 인공자실체 형성조건

이준우,강신욱,방광웅 慶北專門大學(영주경상전문대학) 2002 慶北專門大學 論文集 Vol.21 No.-

This study was conducted to investigate cultural conditions for artificial fruiting body production of Cordyceps militaris CMO02. The artificial fruiting body showed redness in colour and the length was 89∼93mm, and the number was 150∼170 in a bottle. The length and number of fruiting body were longer and many in media of the hulled rice and naked barley than that of silkworm pupa. The culture medium of hulled rice and naked barley showed higher artificial fruiting body compared to that silkworm pupae. The formation period of an artificial fruiting body of Cordyceps militaris treated with hulled rice and naked barley were 45 and 46 days, respectively. The optimum illumination was 400 lux for the fruiting body formation. Pinheading and development of Cordyceps militaris was quickly decreased at passage of three subculture.

극화놀이가 유아의 언어 능력에 미치는 영향

이남정,김광웅 숙명여자대학교 생활과학연구소 1991 生活科學硏究誌 Vol.6 No.-

The aim of this study is to reveal the education effects of a dramatic play upon children. To approach this aim we made children perform dramatid play and analyzed the effects of dramatic plays on the language development of children who are at poor language environment in the lower class. The object of this study consists of 26 members at S kindergarten: they were randomly selected among children of the age 5 with a poor language ability and we divided them into two group, the experimental groupand the comparative group. As a device to test the language ability of children we used "The Test of Language Ability" made for children the age 4-6 by Jang Youngae in 1981. The process of the study is composed of three part: a pretest, and experiment, and a posttest. The experiment were given 3 times a week for 4 weeks which totalled 12 times. With 12 fables through 12 times we made the experimental group perform dramatic plays and the comparative one hear of storytellings. To prove that the dramatic play have the effects on the development of language ability we analyzed the results of grades before and after each experiment between the experimental group and the comparative group. The conclusions of this study are the following. First, Children who got the training of dramatic play were more progressive in the language ability than children who heard of storytellings. Second, Children who got the training of dramatic plays were more progressive in the words power than children who heard of storytelling. Third, Children who got the training of dramatic plays were more progressive in the language understanding than children who heard of storytelling. Finally, Children who got the training of dramatic plays were more progressive in the linguistic expression than children who heard of storytelling.

Electrosurgery를 이용한 치료증례

이상훈,이광수,한세현,윤재웅 大韓小兒齒科學會 1996 大韓小兒齒科學會誌 Vol.23 No.3

Electrosurgical technique have been used in dentistry as an aid to soft tissue management for nearly 60 years. However, it was not until the late 1960s that the principles of electrosurgery were understood and improved equipment became available. Electrosurgery is a surgical procedure performed on soft tissue utilizing controlled high frequency electrical(radio-frequency) currents in the range of 1,500,000 to 7,500,000 cyclesper second. The radio-frequency energy used in electrosurgery is able to cut and coagulate tissue because it focuses the energy at the small, active electrode. Advantages of electrosurgery for soft-tissue management during dental procedures include improved hemostasis, ease of tissue modification, improved visibility and so on, but adverse healing response-including necrosis of soft tissue and sequestration of alveolar bone-have been reported. The present report provides examples of treatment of soft tissue and pulp tissue of primary teeth by electrosurgery. The results are as follows ; 1. Electrosurgical techniques can be used for various procedures in pedodontics. 2. Electrosurgical procedures provide improved hemostasis and visibility in the operating field, which enable to remove, reshape, and contour soft tissues easily. 3. In pulpotomy technique, it was difficult to expect the variable pulpal response based on the degree of heat accumulation and the conditions of pulp tissues. Therefore, electrosurgical pulpotomy could not be considered as a method superior to formocresol pulpotomy. 4. A greater degree of dexterity and experiences in manipulation of the electrode is required compared with the conventional scalpel surgery.

微生物에 의한 石油內 硫黃分除去에 관한 硏究 : Ⅳ. 脫黃菌의 特性에 대한 生理學的 硏究 Ⅳ. Physiological Studies on Characters of Sulfur-oxidizing Bacteria

李敏載,河永七,李光雄,邊宇玄 서울대학교 1975 서울대학교 論文集 Vol.25 No.-

Serveral physiological characterstics of sulfur­oxidizing bacteria such as Thiobacillus thiooxidans and T. concretivorus are described. 1) Effect of pH on inhibitory function of pyruvate. The rate of oxygen uptake was reduced in accordance with decrease of pH. And on the other hand inhibition rate of pyruvate was more severe in lower pH than in higher pH. High concentration of hydrogen ion seemed to accelerate inhibitory function of pyruvate. Limiting concentration of pyruvate which absolutely inhibit oxygen uptake was lowered with time. In O time, 10^-2M of pyruvate absolutely inhibited oxygen uptake in pH 5. After 24 hours limiting concentration was lowered to 10^-3M. 2) Effect of organic compounds on the oxygen uptake of T. concretivorns. Effect of glucose, fructose, xylose, glutamate, succinate, malate, glycine, lactate, acetate, pyruvate, citrate, formate, and cis­aconitate on thiosulfate oxidation and availability of these compounds as sloe source of energy by T. concretivorus were observed. A 0.5% concentration of malate and glycine accelerated thiosulfate oxidation almost react somewhat inhibitory. Pyruvate and citrate inhibited thiosulfate oxidation. In thiosulfate­free medium, organic compounds except formate and pyruvate affected no significant influences on oxygen uptake. 3) Enzyme assay. Of enzymes concerned TCA cycle and glycolysis, T. concretivorus had most of those enzyme activities even though they were low. Activities of hexokinase and succinic dehydrogenase were somewhat high and that of aconitase was very low on the contrary. 4) Optimum condition of mass culture of sulfur oxidizing bacteria. In a large jar fermenter opimum conditions including agitations speed, volume of supplying gases, and constitution rate of oxygen and carbon dioxide, etc. were experimented. The sulfur­oxidier, T. thiooxidans was grown most effectively under the condition of autom­atically controlled pH of 1.0, and with the aeration of oxygen and carbon dioxide mixture (5 : 1) at the flow rate of 0.05 vvm, and at the agitation velocity of 200 rpm in this laboratory scale fermenter.

Mossbauer 분광법에 의한 Fe₂SiO₄의 연구

이성호,김웅태,채광표,정덕조 建國大學校基礎科學硏究所 1988 理學論集 Vol.13 No.-

Fe₂SiO₄에 관한 X-선 회절실험과 Mossbauer 분광실험을 하였다. X-선 회절실험 결과 본 시료는 olivine group에 속하는 fayalite로서 orthorhombic 구조(??)임을 알 수 있었다. Mossbauer 분광실험은 60K-834K의 온도구간에서 행하여 졌으며, Mossbaure 스펙트럼을 분석한 결과 철은 high spin 2+ 상태임을 알 수 있었고, X-선 회절실험 결과와는 다르게 철이 산소 이온들과 함께 일그러진 octahedron을 형성하고 있음을 알 수 있었다. The Fe₂SiO₄ has been studied by means of X-ray diffractometry and Mossbauer spectroscopy. The analysis of X-ray diffraction pattern shows that Fe₂SiO₄is fayalite of orthorhombic structure(??). The Mossbauer spectra which have been taken between 60K and 834K show that the valence state of iron is ferrous and high spin state and that the iron ions occupy sites of distorted octahedron whereas the X-ray analysis shows it is at a site of regular one.

잔디의 立枯病菌[Curvularia geniculata(Tracy & Earle) Boedjin]의 營養要求性에 關한 硏究

李敏雄,金光布 동국대학교 대학원 1974 大學院硏究論集-東國大學校 大學院 Vol.4 No.-

The nutritional requirements of Curvularia blight pathogens of turf (Agrostis cannina L,) causing by Curvularia geniculate were examined of various nutritional sources. The experimental results obtained summarized as follows. 1. The effects of optimum hydrogen lon concentration on the growth of this fungus in Czapek's solution medium were 6.0 and the mycelial growth was also observed in the range of pH 3.0∼9.0 2. The effects of optimum temperature on the growth of the fungus in Czapek's solution medium was 25-30℃. 3. In the effects of carbon sources on the growth of this fungus, sucrose showed the best result, and followed glucose, soluble starch, and xylose. Polyalcohol and organic acid as carbon sources affect the growth of this fungus only slightly. 4. In the effects of nitrogen sources on the growth of this fungus, ammonium nitrate and ammonium citrate affect the best results, and followed ammonium phosphate, ammonium oxalate, ammonium tartrate, and potassium nitrate. Ammonium nitrite affect the growth of this fungus only slightly. In generally, NH_4-N and NO_3-N showed the best results, whereas NO_2-N was less effective in all the nitrogens. 5. The effects of various chemicals in the formation of inhibition zone were larger in Dexon and Thiram 75, and followed PTM-V, Difolatan and Thiuramin, whereas Bla-s was not effective.