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인천 지역 남자 노인들의 주요 혈관질환들의 유병률과 그 특성에 관한 연구
김장용(Jang Yong Kim),전용선(Yong Sun Jeon),조순구(Soon Gu Cho),공은미(Eunmi Kong),정지은(Ji-eun Jung),박신구(Shin Goo Park),조재성(Jae-Sung Cho),김경래(Kyung Rae Kim),신석환(Seok-Hwan Shin),안승익(Seung-Ik Ahn),조영업(Young Up Cho) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.5
Purpose: As Korea is an aging society (WHO classification) and projected to be an aged society in 10 years, peripheral vascular diseases (PVD) in the elderly population has emerged as an important social and medical issue. But their prevalence was rarely reported in Korea. The purpose of this study is to define the prevalence of carotid artery stenosis (CAS), abdominal aortic aneurysm (AAA), and peripheral arterial occlusive disease (PAOD) of lower limb in the Incheon area. Methods: Elderly men (≥65 years) were referred randomly from the Incheon Federation of Korean Senior Citizens’ Association (from Nov 2008 to Sep 2009) to Inha Univeristy Hospital, Incheon, Korea for a PVD screening program. The subjects were screened for CAS and AAA by duplex. CAS was defined as ≥50% internal CAS and AAA as ≥3 ㎝ aortic diameter in minor axis. PAOD of lower limb was screened by measurement of ankle brachial index (ABI); ABI of ≤0.9 was considered abnormal. Results: 1150 subjects were screened including 103 octogenarians (9.0%). Mean age was 72.3±0.2 years. Combined conditions were hypertension (54.3%), diabetes mellitus (25.2%), coronary artery disease (15.6%), dyslipidemia (18.9%), obesity (31.1%) and smoking history (71.7%). CAS was detected in 7.7% (89/1,150) subjects. Thirty-three (2.9%) were diagnosed with AAA. PAOD was detected in 50 subjects (4.4%). Conclusion: Prevalence of PVD in Korea is not lower compared to that of western countries, especially the USA and the UK. A nationwide program for timely detection and treatment for PVD should be developed.
감시림프절 전이 양성인 유방암 환자에서 비감시림프절 전이 예측인자 및 예측체계의 비교 분석
박재영(Jae Young Park),박근명(Keun Myoung Park),박정미(Jeong Mi Park),이강연(Kang Yeun Lee),문연희(Youn Hee Moon),김세중(Sei Joong Kim),김준미(Joon Mee Kim),조영업(Young Up Cho),김장용(Jang Yong Kim),최윤미(Yun-Mee Choe),최선근(Sun K 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.1
Purpose: The purpose of this study was to investigate the predictors of nonsentinel lymph node (NSLN) metastasis in breast cancer and to evaluate the usefulness of the scoring systems and nomograms. Methods: In this analysis, we reviewed the clinicopathologic features of 70 patients who had undergone sentinel lymph node (SLN) biopsy and axillary lymph node dissection. The clinical features of patients, histologic parameters and hormonal receptor status of primary tumor and histopathologic features of SLN metastasis were noted retrospectively. Furthermore, the receiver operating characteristic (ROC) curve was drawn and the area under the ROC curve (AUC) was calculated to assess the discriminative power of the scoring systems and nomograms. Results: The metastatic tumor size in SLN (P<0.001), extracapsular invasion (P=0.002), percentage of positive SLNs among the removed SLNs (P=0.011), primary tumor size (P=0.038) were associated significantly with NSLN metastasis, statistically, in univariate analysis. Based on multivariate logistic regression, the metastatic tumor size was the only prognostic factor of NSLN metastasis (P=0.012). The AUC of Memorial Sloan-Kettering Cancer Center scoring system was greater than other systems, significantly (P=0.004). Conclusion: We have shown in this study that it would be possible to predict NSLN status based on the metastatic tumor size in SLN. Although the significance was not achieved in multivariate analysis, the size of primary tumor, extracapsular invasion of metastasis in SLN, percentage of positive SLNs among the removed SLNs had the potential to be a predictive factor of NSLN metastasis. MSKCC scoring system appears to be more effective and accurate than other scoring systems for selecting patients for whom axillary lymph node dissection can be avoided.
심부정맥 혈전증의 도관유도 혈전용해술 또는 약물기계적 혈전제거술 후에 하대정맥 여과기 제거율과 임상적인 특징
노효근(Hyo Keun No),김중석(Joong Suck Kim),김장용(Jang Yong Kim),김경래(Kyung Rae Kim),신석환(Seok-Hwan Shin),안승익(Seung-Ik Ahn),조영업(Young Up Cho),김세중(Sei Joong Kim),이건영(Keon-Young Lee),허윤석(Yoon-Seok Hur),최선근(Sun Keu 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.6
Purpose: Inferior vena cava (IVC) filter is commonly practiced to prevent pulmonary embolism during endovascular therapy of deep vein thrombosis (EndoDVT). When the thrombus is trapped inside the filter during intervention, its removal is quite challenging. The purpose of this study is to determine retrieval rates of IVC filter after EndoDVT and its characteristics. Methods: Patients who underwent EndoDVT in Inha Unversity Hospital from June 2004 to May 2009 were reviewed retrospectively. Retrievable IVC filter was inserted before EndoDVT. EndoDVT was done by catheter directed thrombolysis or pharmacomechanical thrombectomy using urokinase. IVC filter retrieval was decided according to computed tomography after 2 weeks. Results: 126 patients were treated with EndoDVT. Optease (n=101) and Tulip (n=25) IVC filters were inserted. IVC filters were retrieved in 42.9% (54/126). There was no IVC filter related complication during its insertion and removal. IVC filter was not retrieved in 72 patients. Reasons for its failure include residual thrombosis in IVC filter (n=28), high risk for recurrent DVT (n=34), massive pulmonary embolism (n=8), and death (n=2). Residual thrombus inside IVC filter disappeared in 5 patients during 6-month follow up. Conclusion: IVC filters retrieval rate after EndoDVT was 42.9%. This can be improved by thorough patient follow up and extended retrievability.
박근명,최윤미,김장용,최선근,허윤석,이건영,김세중,조영업,안승익,홍기천,신석환,김경래,서정민,Park, Keun-Myoung,Choe, Yun-Mee,Kim, Jang-Young,Choi, Sun-Keun,Heo, Yoon-Seok,Lee, Keon-Young,Kim, Sei-Joong,Cho, Young-Up,Ahn, Seung-Ik,Hong, Kee-C 대한소아외과학회 2010 소아외과 Vol.16 No.2
남녀의 비는 1.8로 남아가 많았으며, 진단시 나이는 76.9 % 에서 4주 이내 신생아시기에 진단되었다. 임상증상은 복부팽만 84.6 %, 태변 배출지연이 46.1 %, 설사 와 변비가 23.1 % 였다. 무신경절의 범위가 89.7 %에서 직장 및 에스자형 결장에 한정되었으며, 전결장에 침범한 경우가 8 %였다. 69.2 %에서 결장조루술 후 근치적 수술을 시행하였으며, 30.8 %에서 바로 근치적 수술을 시행하였다. 수술 후 6개월 이상 추적은 54 % 였으며, 추적 관찰 환자 중 14.3 %에서 대변 지림을 보였고, 19.0 %에서 변비를 보였다. The aim of this study is to review our clinical experience with patients with Hirschsprung's disease (HD) Medical records of 39 children who underwent definitive surgery for HD at Inha University Hospital from September 1996 to June 2008 were analyzed by age at presentation, sex, gestational age, birth weight, clinical presentation, diagnostic tools, level of aganglionosis, surgical procedures, postoperative complications, and postoperative bowel function. Twenty-five patients (64.1 %) were males and 14 (35.9 %) were females. Thirty patients (76.9 %) were diagnosed and treated in the neonatal period. The transitional zone was at the rectosigmoid region in 89.7 %. Twenty-seven patients (69 %) were treated by preliminary colostomy or ileostomy. Twenty-four patients had the Duhamel operation, 6 patients anorectal myectomy, and 9 patients had transanal endorectal pull-through (TEP). Five of 9 patients who had the TEP procedure did laparoscopic assistance. Postoperatively, seventeen patients (83 %) passed stool once or more times per day and 3 patients had stool soiling. This study demonstrated that the majority of the patients had good results. To determine which treatment is most effective comparative review by operation method would be required.
복부대동맥류의 혈관 내 치료 중 발생한 Endoleak 경험
박근명(Keun Myoung Park),김장용(Jang Young Kim),정지은(Ji Eun Jung),전용선(Yong Sun Jeon),조순구(Soon Gu Cho),최윤미(Yun-Mee Choe),최선근(Sun Keun Choi),허윤석(Yoon Seok Heo),이건영(Keon Young Lee),김세중(Sei-Joong Kim),조영업(Young 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.4
Purpose: Endoleak is a common complication following endovascular aortic aneurysm repairs (EVAR). The aim of this study was to discover the frequency and characteristics after EVAR with on-label use. Methods: A retrospective review was performed on 25 patients who underwent EVAR in Inha University Hospital between December 2005 and February 2009. The data included in this study accounted for patient characteristics, anatomic features, operative technical details, and types of devices used. The results of EVAR were analyzed for clinical success, technical success and endoleak. Results: Endoleaks were observed during 11 (47.8%) procedures. Type Ⅰ endoleaks were observed in 2 (18.2%) cases. A total of 6 type Ⅱ intraoperative endoleaks (54.5%) were observed. 3 type Ⅲ endoleaks (27.3%) occurred. But all endoleaks were resolved without additional intervention CT scan after 6 months. Conclusion: Although the endovascular management of AAAs is less invasive than open surgery, many complications including endoleak were still the most common adverse event during the first postoperative month. However, observation may be a good treatment for minor endoleak after EVAR.
진행된 자궁내막암 환자에서 수술 후 동시항암화학방사선요법 후 생긴 상부장간막동맥폐쇄증
김경미 ( Kyoung Mi Kim ),김장용 ( Jang Yong Kim ),홍기천 ( Kee Chun Hong ),김헌정 ( Hun Jung Kim ),한지영 ( Jee Young Han ),송은섭 ( Eun Seop Song ) 대한산부인과학회 2011 Obstetrics & Gynecology Science Vol.54 No.6
The incidence of endometrial cancer (EC) has increased and it has approximately 16% of gynecologic cancers in Korea. For locoregional or distant recurrence, adjuvant treatment after surgery is very important in patients with intermediate- or high-risk EC (IHR-EC). Recently clinical trials for treating patients with IHR-EC are focused on the effi cacy of concurrent chemoradiation (CCR). However, increase in intestinal complications in the group of radiotherapy combined with chemotherapy was reported. In case of chemoradiation-related superior mesenteric artery (SMA) occlusion, it could be fatal nevertheless with intensive care. We present a case report of radiation-related arteritis leading to stenosis in SMA, which led the patient with EC to death in a year after CCR.
체질량지수 25 ㎏/㎡ 미만의 2형 당뇨 환자에서 십이지장 공장 우회술의 효과
홍인기(In Ki Hong),김장용(Jang Young Kim),이연지(Yeon Ji Lee),최윤미(Yun-Mee Choe),최선근(Sun Keun Choi),이건영(Keon Young Lee),김세중(Sei-Joong Kim),조영업(Young Up Cho),안승익(Seung Ik Ahn),홍기천(Kee Chun Hong),신석환(Seok Hwan Sh 대한외과학회 2011 Annals of Surgical Treatment and Research(ASRT) Vol.80 No.2
Purpose: Diabetes mellitus refers to one of several risk factors for cardiovascular diseases, renal failure and so on. Medical treatments of T2DM cannot suggest a perfect cure. But gastric bypass resulting in the exclusion of the duodenum and proximal jejunum has been shown to improve or resolve T2DM. The goal of this study is to evaluate the effect of duodenojejunal bypass for T2DM patients below BMI 25 ㎏/㎡ in early postoperative period. Methods: Duodenojejunal bypass was performed on 25 patients at Inha University Hospital from July 2009 to April 2010. We compared 75 g OGTT, insulin, C peptide to those 7 days postoperative. The definitions for improvement are serum glucose level below 200 ㎎/㎗ of 75 g OGTT at 120 min or below 200 ㎎/㎗ at every other time in spite of over 200 ㎎/㎗ at 120 min. Results: A total of 25 patients (15 men and 10 women) were included. Median value BMI was 23.17 ㎏/㎡ and the mean duration of T2DM was 8.3 years. There was a significant decrease of postoperative 75 g OGTT levels from 176, 268, 345, 373, 371 ㎎/㎗ to 125, 170, 200, 225 and 241 ㎎/㎗, respectively (P<0.001). Only patients’ age was an independent factor resolution of T2DM based on this study. Conclusion: Duodenojejunal bypass could be one viable treatment modality for improving or resolving of T2DM although these are early results. This study has preliminary meanings only and the results of longer follow-up and a larger number of patients are necessary, by which we should be able to determine the effect and indications for surgical treatment of T2DM.