Complication of Intraoperative Radiation Therapy (IORT) in Gastric Cancer

김명세(Myung Se Kim),김성규(Sung Kyu Kim),송선교(Sung Kyo Song),김홍진(Hong Jin Kim),권굉보(Koing Bo Kwan),김흥대(Heung Dae Kim) 대한방사선종양학회 1992 Radiation Oncology Journal Vol.10 No.2

영남대학교 의료원 치료방사선과에서 1988년 6월 15일에 위함 환자의 수술중 방사선치료를 시작한 이래 1992년 8월 30일까지 총 58예에서 시도하여 그중 53예에서 IORT를 실시하였으며, 정기적인 추적검사에서 한명의 국소개발 환자도 보고되지 않고 있다. 출혈(3예), 장관폐쇄(3예), 폐혈증(2예), 골수기능저차(1예)를 포함한 총 9예(17%)의 합병증이 보고되었고, 이중 6예(13%)가 사망하였다. IORT(1500cGy), 외부 방사선치료 (-4500cGy)와 강한 항암제를 병합치료 하였음에도 불구하고 주등(수술과 항암제 치료)의 25.2%, 김등(수술 불가능한 환자에서 항암제 투여)의 18%, 리등(수술)의 18.5%, Kraming등(IORT 2800-3500cGy)의 35.3%에 비해 낮은 합병증을 보여 IORT가 위암의 치료에 공헌할 수 있음을 시사하였다. 그러나 비교적 높은 치사율(11.3%)은 더욱 세심한 수술수기 및 수술 후 환자의 치료가 필요하며 외부 방사선치료와 항암제치료의 적절한 시기 조절 및 치료선량의 가감이 필요할 것으로 생각된다. Local control is the important prognostic factor in cancer treatment because local control decrease the relative risk of metastatic spread and increase distant metastasis free survival. IORT is the modality which could increase local control without increasing complication, combined with curative operation. Eventhough we could achieve significant deacreased local failure by IORT and curative resection, it should not be committed as a main treatment modality without proving acceptable complications. Therapeutic Radiology Department of Yeungnam University Medical Center have tried 58 IORT from June 15, 1988 and performed 53 IORT in patients with gastric cancer. No local failure had been reported including interstinal obstrution, hemorrhage, sepsis, and bone marrow depression. These complications could be comparable to Jo's 25.2% (chemotherapy + operation), Kim's 18% (chemotherapy only in inoperable patients), because our treatment regimen is consisted of IORT (1500cGy), external irradiation (--4500cGy) and extensive chemotherapy (FAM, 5FU + MMC, BACOP). Our data encouraged us to re-inforce further IORT in stomach cancer treatment.

복강경 담낭절제술시와 회복시의 혈역학적 변화와 혈중 Catecholamines, Vasopressin치의 변화

김흥대 ( Heung Dae Kim ) 영남대학교 기초/임상의학연구소 2007 Yeungnam University Journal of Medicine Vol.24 No.2S

Background:Laparoscopic cholecystectomy produces less tissue trauma than conventional open procedure does. But, during this procedure, the deliberate pneumoperioneum with carbon dioxide(CO2) gas insufflation may cause some problems, such as hypercarbia, hypertension, tachycardia, and other changes of cardiovascular function. We analyze the physiologic mechanism of these hemodynamic effects under laparoscopic surgery with CO2 gas insufflation during inhalation general anesthesia. Materials and Methods:We studied randomly selected 5 healthy patients undergoing laparoscopic cholecystectomy with CO2 gas insufflation. Each patient inhaled sevoflurane and nitrous oxide gas(50%). The blood pressure, heart rate, end-tidal carbon dioxide level were measured during all the anesthetic procedures. We collected venous blood samples to determine the plasma level of epinephrine, norepinephrine and vasopressin, at 10 minutes after insufflation of CO2 gas into peritoneal cavity, and at 10 minutes after patient arrived in recovery room. We measured the plasma level of epinephrine and norepinephrine using double antibody method, and vasopressin level using radioimmunoassay method. Results:Mean arterial pressure and heart rate was significantly increased, after intraperitoneal insufflation of CO2 gas(19.3%, 44.7% respectively), and in recovery period(15.8%, 28.6% respectively). The plasma concentration of epinephine was 47.1 ± 30.3 pg/ml(reference intervals, less than 100 pg/ml) at 10 minutes after insufflation of CO2 gas, and 53.1 ± 25.8 pg/ml at 10 minutes in recovery room. The plasma concentration of norepinephine was 125.7 ± 44.8 pg/ml (reference intervals, less than 600 pg/ml) after insufflation, and 179.1 ± 42.1 pg/ml in recovery room. The plasma concentration of vasopressin was 43.3 ± 34.5 pg/ml(reference intervals, less than 6.7 pg/ml) after insufflation, and 25.3 ± 16.7 pg/ml in recovery room. Conclusion:The laparoscopic cholecystectomy with CO2 gas insufflation in general anesthesia with sevoflurane and in recovery room results in increased mean arterial pressure, heart rate, and decreased plasma concentration of epinephine and norepinephine and increased plasma concentration of vasopressin.

전신마취하에서 동맥혈, 정맥혈 및 가온정맥혈의 가스분석치 비교

김흥대 ( Heung Dae Kim ) 영남대학교 기초/임상의학연구소 2007 Yeungnam University Journal of Medicine Vol.24 No.2S

Background:We determine whether venous blood, when sampled under carefully controlled conditions, was an acceptable alternative to arterial blood for the measurement of arterial blood gas analysis during inhalation general anesthesia. Materials and Methods:The arterial blood values of the carbon dioxide tension (PCO2), pH, base excess (BE), oxygen tension (PO2) and oxygen saturation (SO2) were compared with the values of venous blood drawn from the cephalic vein as non controlled routine method and as localized warmed method during inhalation general anesthesia with sevoflurane and N2O (50%) in 20 cases. 1) Results:The blood gas analysis values of non controlled cephalic venous blood were close to those of arterial blood. They was similar between the PCO2 (42.5 ± 0.97 vs. 38.7 ± 0.92 mmHg), pH (7.35 ± 0.01 vs. 7.39 ± 0.01) and BE (-3.13 ± 0.62 vs. -0.18 ± 0.13 mEq/l) of non controlled cephalic venous and of arterial blood. Although the PO2 in non controlled cephalic venous blood was significantly less than that in arterial blood(130.8 ± 8.1 vs. 245.3 ± 6.8 mmHg), the difference in SO2 was small(98.9 ± 2.1 vs. 99.7 ± 0.4%). The blood gas values of warmed cephalic venous blood were more similar to those of arterial blood (PCO2, 41.2 ± 0.91 vs. 38.7 ± 0.92 mmHg; pH, 7.37 ± 0.01 vs. 7.39 ± 0.01; BE, -2.30 ± 0.62 vs. -0.18 ± 0.13 mEq/l; PO2, 157.3 ± 11.4 vs. 245.3 ± 6.8 mmHg; SO2, 99.2 ± 1.3 vs. 99.7 ± 0.4%) than to those of non controlled cephalic venous blood. Conclusion:We found that warmed cephalic venous blood during inhalation general anesthesia can be arterialized and PCO2, pH, BE and SO2 of warmed cephalic venous blood were not significantly different to those of arterial blood. Therefore we conclude that it is reliable to use localized warmed cephalic venous blood for the measurement of arterial blood gas analysis during inhalation general anesthesia.

외상성 횡격막 손상 31예의 외과적 처치

김흥대(Heung Dae Kim),이지현(Jee Hyun Lee),지훈상(Hoon Sang Chi),이경식(Kyong Sik Lee) 대한외과학회 1988 Annals of Surgical Treatment and Research Vol.34 No.5

간경변증을 동반한 환자를 수술시 사망율에 미치는 인자의 분석

김흥대(Heung Dae Kim),김남규(Nam Kyu Kim),김병로(Byong Ro Kim),이경식(Kyong Sik Lee) 대한외과학회 1991 Annals of Surgical Treatment and Research Vol.40 No.4

Intraoperative Radiotherapy (IORT) for Locally Advanced Colorectal Cancer

김명세(Myung Se Kim),김성규(Sung Kyu Kim),김재황(Jae Hwang Kim),권굉보(Koing Bo Kwan),김흥대(Heung Dae Kim) 대한방사선종양학회 1991 Radiation Oncology Journal Vol.9 No.2

대장-직장암은 한국에서 남녀 모두 4위의 비교적 높은 빈도를 보이고 있으며 점점 증가되는 추세에 있다. 근치적 수술요법이 주 치료방법으로 사용되어 왔으나 그 생존율은 20~50%에 불과하다. 국소재발은 특히 직장암에서 가장 흔히 실패의 원인으로서 근치적 복합요법의 발달에도 불구하고 40~92%의 높은 국소재발율이 보고되고 있어 생존율을 높이고 생존의 질을 높이기 위하여는 국소재발을 줄이는 노력이 필수적이다. 수술중 방사선 치료는 수술중에 원하는 부위에만 다량의 방사선을 한번에 조사하는 방법으로 최근 보고에서 국소재발율을 5%까지 줄일 수 있었다고 보고되고 있다. 영남대학병원 치료방사선과에서는 국내에서는 처음으로 91년 5월 30일 직장암 환자에 수술중 방사선 치료를 실시한 후 현재까지 6명의 대장 직장암 환자에 수술중 방사선 치료를 실시하였기에 환자선택, 치료선량, 선량분포, 수술 및 방사선치료과정등을 보고하고저 한다. Colorectal cancer is the second most frequent malignant tumor in the United States and fourth most frequent tumor in Korea. Surgery has been used as a primary treatment modality but reported overall survivals after curative resection were from 20% to 50%. Local recurrence is the most common failure in the treatment of locally advanced colorectal cancer. Once recurrence ha developed, surgery has rarely the role and the five year survival of locally advanced rectal cancer is less than 5%, in spite of massive comvination therapy. Intraoperative radiotherapy(IORT) with or without external beam irradiation has been advocated for reducing local recurrence and improving survival. The recent report of local control could be achieved. We performed 6 cases of IORT for locally advanced colorectal cancer which is the first experience in Korea. Patient's eligibility, treatment applicator, electron energy, dose distribution no the surface and depth within the treatment field and detailed skills are discussed. We hope that our IORT protocol can reduce local failure and increase the long term survival significantly.

편측 성상신경절 차단에 의한 혈압 맥박 및 상지 피부온도의 변화

고준석,민병우,김흥대,Goh, Joon-Seock,Min, Byung-Woo,Kim, Heung-Dae 대한통증학회 1990 The Korean Journal of Pain Vol.3 No.1

성상신경절차단이 혈역학적 변화 및 차단부위의 피부온도에 마치는 영향을 알아보기 위하여 두경부와 어깨 및 상지에 통증을 호소하는 환자 45명 (남자 16명, 여자29명)을 대상으로 편측 성상신경절차단을 시행해 보았던 바 다음과 같은 결과를 얻었다. 1) 혈압의 변화 : 우측 성상신경절차단과 좌측 성상신경절차단의 어느 경우에서도 수축기 및 이완기 혈압에 마치는 영향은 거의 없었다. 2) 맥박수의 변화 : 우측 성상신경절차단후 30분과 60분에 각각 의의있는 맥박수의 감소를 나타내었으나 (p<0.05), 좌측 차단후에는 통계학적으로 의의있는 맥박수의 감소를 나타내지 않았다. 3) 차단측 상지피부온도의 변화 : 우측 성상신경절차단후에는 5분부터, 좌측차단후에는 10분부터 의의있는 피부온도의 상승 (p<0.01)을 보이기 시작하여 차단후 30분에 양측 모두에서 피부온도가 최대로 상승되었다가 60분에는 30분치에 비해 다소 하락하였다. 4) 시술환자 45명중 4명에서 성상신경절차단의 징후는 나타났으나 차단측상지의 피부온도 상숭은 동반되지 않았다. 이상의 결과로 미루어보아 제 6 경추 전결절에서 1.0% lidocaine 10 ml로 편측 성상신경절차단시에는 심순환계에 특별한 영향을 마치지 않았으며 또한 상지질환의 치료목적시에는 반드시 차단즉 상지피부온도의 상승을 확인하여야만 효과있는 차단이 이루어졌다고 판정할 수 있을 것으로 사료된다. In the past decades there has been a growth of interest in the use of stellate ganglion block (SGB) as part of the diagnosis and therapy for the disease of the head, neck and upper extremities. For the evaluation of changes in hemodynamics and temperature of the affected extremity after the SGB, unilateral SGB (either right or left) was performed by local injection of 10 ml of 1% lidocaine without epinephrine in 45 patients (right side SGB: 25, left side SGB: 20) with various diseases. Systolic and diastolic blood pressure, pulse rate and skin temperature of the ipsilateral hand were studied before and 1, 2, 3, 4, 5, 10, 15, 30 and 60 minutes after the block. The results were as follows: 1) Changes of blood pressure: Systolic and distolic blood pressure after either right or left side SGB showed no statistically significant change. 2) Changes of pulse rate: While the left side SGB showed a mild decrease without statistical significance, the right side SGB showed a statistically significant decrease at 30 and 60 minutes after the block (p<0.05). 3) Changes of skin temperature of the blocked hand: Either side SGB produced a gradual increase in temperature with time and showed statistical significance from 10 minutes in the left side block (p<0.01), and a from 10 minutes after the block in the right side (p<0.01). Both sides SGB showed a maximal increase at 30 minutes after the block and a small decrease at 60 minutes after the block compared to the 30 minutes value. 4) Despite the successful SGB. 4 of 45 patients failed to produce a significant increase in skin temperature on the affected upper extremity. In conclusion, unilateral SGB with 1% lidocaine at the 6th cervical vertebral level is a safe method for use on an outpatient basis, and an increase in skin temperature in the affected upper extremity is necessary to confirm the successful therapeutic effect on disease of the upper extremity.

경부 림프관종

김희수(Hee Soo Kim),김흥대(Heung Dae Kim),박정수(Cheong Soo Park),황의호(Eui Ho Hwang) 대한외과학회 1988 Annals of Surgical Treatment and Research Vol.34 No.4

전신마취 후 회복실에서 발견된 무기폐의 치료

황창재 ( Chang Jae Hwang ),김흥대 ( Heung Dae Kim ),박대팔 ( Dae Pal Park ),서일숙 ( Il Suk Seo ),송선옥 ( Sun Ok Song ),김세연 ( Sae Yeon Kim ),지대림 ( Dae Lim Jee ),이덕희 ( Deok Hee Lee ) 영남대학교 기초/임상의학연구소 2007 Yeungnam University Journal of Medicine Vol.24 No.2S

Atelectasis is a relatively common complication following surgery in anesthetized patient with respiratory symptoms, but rarely occur in normal healthy patient. Anesthesiologists must be wary to prevent atelectasis, because it may lead to hypoxia during and after the operation. This case reports a healthy patient without previous respiratory symptoms who developed left lower lobar atelectasis after general anesthesia. Vigorous chest physiotherapy including intended coughing, deep breathing, chest percussion and vibration under postural change was effective. Therefore, vigorous chest physiotherapy is essential part of early treatment modalities for atelectasis in postoperative recovery room.

가족성 용종증 환자에서 전결장절제술 및 회장직장문합술후 직장내 잔유 용종의 자연소실

성한제(Han Je Sung),김흥대(Heung Dae Kim),이진우(Jin Woo Lee),김광연(Kwang Yun Kim) 대한외과학회 1993 Annals of Surgical Treatment and Research Vol.44 No.4