식도에 발생한 거대 해면혈관종 수술치험 - 1례 보고 -

이창민,박성달,조성래,허방,Lee, Chang-Min,Park, Sung-Dal,Cho, Sung-Rae,Huh, Bang 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.3

식도에 발생하는 혈관종은 식도에 드물게 발생하는 양성종양의 2% 내지 3% 정도 차지할 정도로 매우 희귀하여 세계적으로 보고된 증례수가 많지 않다. 저자들은 식도에 발생한 매우 희귀한 해면혈관종 1례를 수술치험하였기에 문헌고찰과 더불어 보고하고자 한다. 환자는 40세 남 米\ulcorner경미한 연하장애를 주소로 내원하여 식도조영술, 식도 내시경검사, 조영제를 이용한 흉부 전산화 단층촬영등을 시행하여 하부 식도의 점막하층에서 발생하여 근육층 밖으로 돌출되어 나온 식도 종양이 추정되어 수술을 시행하였다. 수술소견상 하부 식도 및 식도-위 문합부에 걸쳐 과혈관성의 7x7x3.5cm 크기의 거대한 종괴가 식도점막하층과 식도근육층 그리고 주위조직으로의 침범이 심하게 되어 있어 종양을 포함한 식도절제술 및 식도-위 문합술을 시행하여 병리 조직학적으로 해면 혈관종으로 확진되었으며 환자는 특별한 문제없이 술후 제14일째 건강한 상태로 퇴원하였다. Esophageal hemangioma is an extremely rare benign tumor that causes dysphagia and massive upper gastrointestinal bleeding. Although certain abnormalities seen on a barium swallow esophagography or at endoscopy may suggest an esophageal hemangioma, a contrast CT and radionuclide angiography using a blood-pool radiopharmaceutical can characterize the intense vascularity of the tumor. We experienced the ase of a 7$\times$7$\times$3.5 cm in size giant cavernous hemangioma of the lower 1/3 of esophagus in a 40 year old man. A mural cavernous hemangioma was diagnosed with a barium swallowed esophagogaphy, endoscopy, and a contrast CT. It was treated successfully by transthoracic esophagectomy including the tumor and esophagogastrostomy.

증례 : 감염 ; 국소적 농흉으로 나타난 Mycobacterium bovis 감염 1예

임성경 ( Seong Kyeong Lim ),박지영 ( Ji Young Park ),박성달 ( Sung Dal Park ),장희경 ( Hee Kyung Chang ) 대한내과학회 2011 대한내과학회지 Vol.81 No.6

국내에서는 M. bovis에 대한 사람 감염의 보고는 없었으나 소에서의 감염률은 약 0.15%로 보고되고 있고, 개발도상국에서 M. bovis 감염률은 10-15% 정도로 보고되고 있다. 최근 다문화 가정이 증가하고 이주민 특히 개발도상국에서 국내로 이주가 증가함에 따라 이주민들에서 결핵 진단 시 M.bovis 등의 감염을 감별할 필요가 있다. 따라서 저자들은 베트남 이주 여성에서 국소적으로 발생한 농흉에서 얻은 조직으로 M. bovis를 진단하고 치료하였기에 문헌고찰과 함께 보고하는 바이다. Bovine tuberculosis, which is caused by Mycobacterium bovis, a member of the M. tuberculosis complex, is a zoonosis transmitted through the inhalation of infected droplets or the ingestion of raw milk. Human bovine tuberculosis has been reported rarely in most countries since the introduction of pasteurized milk and M. bovis eradication programs. However, it has been reported in other areas with poorly controlled programs. We encountered a case of localized empyema due to M. bovis infection in a pregnant female immigrant from Vietnam. We report this case with a brief review of the related literature. (Korean J Med 2011;81:792-796)

위장관 ; 절제 불가능한 Stage IV 진행성 식도암의 치료방법에 따른 효과 비교

이규진 ( Gyu Jin Lee ),박무인 ( Moo In Park ),구상건 ( Sangeon Gwoo ),정현주 ( Hyun Joo Jung ),김주훈 ( Joo Hoon Kim ),박선자 ( Seun Ja Park ),문원 ( Won Moon ),김형훈 ( Hyung Hun Kim ),김양수 ( Yang Soo Kim ),박성달 ( Sung Dal P 대한소화기학회 2012 대한소화기학회지 Vol.59 No.4

Background/Aims: The aim of this study was to compare palliative treatments such as chemotherapy, chemoradiotherapy or radiotherapy with best supportive care in patients with inoperable advanced esophageal cancer. Methods: A total of 67 patients with inoperable advanced esophageal cancer visiting Kosin University Gospel Hospital between January 2000 and July 2010 were included in a retrospective analysis. Patients were categorized as having palliative treatment or best supportive care to compare their prognosis. Results: The median survival was 6.4 months in 67 patients. There was significant difference in median survival between the palliative and best supportive treatment (9.8 months vs. 4.5 months, p=0.01). The patients who underwent palliative treatment had superior 1-year and 3-year overall survival rate than those with best supportive treatment (27%, 10% vs. 5%, 5%, respectively). The 1-year and 3-year overall survival rate of palliative treatment was 18% (1-year overall survival rate) in chemotherapy, 33% (1-year overall survival rate) in radiotherapy, 45% and 9% in concurrent chemoradiotherapy, and 20% and 20% in sequential chemoradiotherapy, respectively. Conclusions: These results may suggest that palliative treatments are more effective than best supportive care. Further prospective studies are still needed to elucidate beneficial effect of palliative treatments on inoperable advanced esophageal cancer. (Korean J Gastroenterol 2012;59:282-288)

개심술 치험 51례 : A review of fifty one cases

박성달,박효수,조성래,김송명,이성행 고신대학교 의학부 1986 高神大學校 醫學部 論文集 Vol.2 No.1

Fifty one patients were operated open heart surgery under cardio-pulmonary bypass from June 14th in 1984 to Dec 31th in 1985 at department of Thoracic & Cardiovascular Surgery, Kosin Medical College In 51 cases of heart diseases, congenital anomalies were 34 cases (66.7%) and acquired lesions were 17 cases (33.3%). The sex ratio of congenital and acquired heart diseases was represented 1.2:1, 1:1.4 respectively. The age distribution was ranged from 1½ to 56 years old. The most common lesion among congenital anomaly was disclosed as 15 cases (44.1%) of ventricular septal defect and nest lesion was disclosed as 11 cases (32.4%) of atrial septal anomalies. The 8 cases (23.5%) of cyanotic anomalies were included 4 cases of Tetralogy of Fallot group. 1 case of total anomalous pulmonary venous connection and one case of double outlet right ventricle There were 2 cases of left atrial myxoma and 15 case of valvular lesions among 17 cases of acquired heart diseases. The valvular lesions were disclosed as 2 cases of aortic regurgitation. 9 cases of mitral valvular lesions and 4 cases of tricuspid valvular lesions. The valvular lesions were aortic and mitral valvular replacement with artificial bio-or mechanical valves, annuloplasty for mitral or tricuspid regurgitation and removal of myxoma Over all mortality were 6 cases, which included 3 cases of cyanotic lesions and 3 cases of acquired heart diseases. But there was none operative mortality in acyanotic heart diseases.

개심술 치험 51례

박성달,박효수,조성래,김송명,이성행 高神大學 醫學部 1986 高神大學醫學部 論文集 Vol.2 No.1

폐암 환자와 폐암 세포주를 주입한 Nude Mice에서 종양성장인자의 변화

김상범,박성달,김송명,허방 고신대학교 의과대학 2010 고신대학교 의과대학 학술지 Vol.25 No.1

Background and purpose : The incidence of non-small cell lung cancer has decreased than past decades but the prevalence rate of squamous cell carcinoma is highest among the various types of lung cancer. There have been one of the most difficult problems of the medical areas because of the law rate of operative treatment by micrometastasis still. The released growth regulating factors from the tumor cells have heen researching targets recently. This study is to know the changes of the tumor growth factors by examining the change of transforming growth factor-β1 (TGF-β1) within plasma of nude mouse was measured after each of different quantity of cultured cell of squamous cell carcinoma was injected into plerual caviry of nude mouse in animal experiment, while comparing the values of TGF, Insulin-like growth factor and epidermal growth factor between experimental trial and clinical trial. Method : Between June of 2006 and June of 2007 at Kosin University Hospital, 17 patients were chosen for this study where 13 of them were pathologically diagnosed of squamous cell carcinoma after initial diagnosis of lung cancer followed by radical pneumonectomy and pathologic biopsy, while 4 patients were pathologically diagnosed of benign tumor. Blood sample was collected prior to a surgery from the lung cancer patients scheduled for surgery, and the sample was cryopreserved. During surgery, dense tumor tissue without necrosis was excised in a size of 5mm3 and quickly frozen to be used for experimental tissue, whereas the tissue, which was located farthest from the lesion and deemed free of cancer cell, was to be used for control tissue. And the tissue obtained from benign tumor or normal tissue of granuloma patient was classified as a control tissue B, while the sample from malignant tissue of lung cancer was categorized as experimental tissue M. In animal experiment with 15 male nude mice without immunity, 5 subjects without cancer cell were used for control group, another 5 subjects with of 2×106 of cancer cell line (SW-900 G IV) injected into intrathoracic were used for experimental group I, and the other 5 subjects injected with twice quantity of cancer cell line of group I were classified as experimental group II. After breeding the subjects in the clean room for 8 weeks, blood sample was collected from their heart, and quantitative test of plasma TGF-β was performed. For the test of tumor growth factor, human TGF-β ELISA kit was used for quantitation of TGF-β1&2, and active TM non-eztraction IGF kit was for quantitation of IGF-I&II, while GE healthcare kit was used for EGF. Results : In animal experiment, TGF-β1 was expressed within the serum of all nude mice from control group as well experimental group I and II, where control group was at 28.49 fmol/ml while experimental group I and II were at 32.19 fmol/ml and 42.36 fmol/ml respectively. In clinical trial, TGF-β1 was measured higher from experimental group with 40.9 fmol/ml than from control group with 28.5 fmol/ml, and TGF-β2 was lower from experimental group with 12.3 fmol/ml than from control group with 30.3 fmol/ml, while the difference was insignificant with EGF (p<0.05) where control group and experimental group were at 0.11 ng.ml and 0.12 ng/ml respectively. Moreover, TGF-β1 was at 40.88 fmol/ml from control tissue B and at 15.55 fmol/ml from experimental tissue M, where as TGF-β2 was at 12.31 fmol/ml from control tissue B and 23.95 fmol/ml from experimental tissue M (p<0.05). TGF-β1 within the serum of control group was at 812.4 fmol/ml before surgery and at 989.1 fmol/ml after surgery, which showed a slight amplifiction, while TGF-β2 was at 16.8 fmol/ml before surgery and at 20.2 fmol/ml after surgery, exhibiting a slight increase (p<0.05). Serum IGF-I was at 117.9 ng/ml before surgery and at 214.4 ng/ml after surgery, and IGF-II was at 552.8 ng/ml and 552.8 ng/ml after surgery, while EGF showed insignificant changes between before surgery at 0.67 ng/ml and after surgery at 0.74 ng/ml (p<0.05). In lung cancer stage Ia,b, TGF-β1 was decreased through surgery as it was at 972.94 mol/ml before and 866.92 mol/ml after, and TGF-β2 was also decreased as measured at 42.40 mol/ml before surgery and 38.24 mol/ml after surgery. In stage IIIa,b, TGF-β1 was decreased as measured at 980.31 mol/ml before surgery and at 928.18 mol/ml, while TGF-β2 showed not much changes (p<0.05). In lung cancer stage Ia,b, serum IGF-I was decreased as measured at 112.7 mol/ml before surgery and at 87.92 mol/ml after surgery. and IGF-II was also decreased as measured 468.78 ng/ml before surgery and at 358.59 ng/ml after surgery (p<0.05). In stage III,b, IGF-I showed not much changes, but IGF-II was at 438.31 ng/ml before surgery and 404.2 ng/ml after surgery, where EGF was not all influenced by the phase. Conclusion : In the experiment with nude mice, TGF-β1 was increased as the number of cancer cell was increased after injection of cancer cell. The number of cancer cell from early tumor, such as Ia,b from post-surgery clinical lung cancer patients, was reduced after the surgery, and TGF-β1 was also reduced as the cancer cell was reduced as well. Therefore, it was believed that TGF-β1 can be a feasible prognostic factor for early diagnosis of lung cancer at Ia,b of early phase

폐허탈 및 농흉을 유발한 기관지 지방종 1예

이규진,이송주,옥철호,장태원,정만홍,김영옥,박성달 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4

저자들은 객혈을 주소로 내원한 75세 남자 환자에서 기관지내시경 육안 소견상 양성 종양이 의심 되었으나 조직 검사상 지방종을 확진하지 못하였고 악성종양을 배제할 수 없는 상황에서 종괴에 의한 왼쪽 폐의 허탈과 농흉 때문에 수술적 치료를 시행 하였으며, 수술 결과 기관지 지방종에 의한 폐허탈, 농흉 및 기관지 확장증, 이로 인한 객혈이 발생한 예가 있어 보고하는 바이다. Lipoma is a common neoplasm on soft tissues. However, bronchial lipoma is rare benign tumor. Patients with bronchial lipoma might have a malignant potential, and there were case reports of lung cancer accompanied with lipoma. Therefore, it should initially be treated by fibrotic bronchoscopy or surgery. We encountered a 75 year-old male patients with bronchial lipoma, causing hemoptysis.

폐전이암의 외과적 치료성적과 예후인자

조성래,김종인,조성호,변정훈,이해영,박성달,김송명 고신대학교 의학부 2005 高神大學校 醫學部 論文集 Vol.20 No.1

The outcome and Prognostic Factor of Surgically Resected Pulmonary Metastasis. Background: The outcome and prognostic factors of surgically resected pulmonary metastasis were analyzed to improve long term survival. Materials and Methods: The organ and pathology of primary tumor, disease free interval (DFI), laterality, operative procedures, postoperative complications, therapeutic result, and prognostic factor were analyzed in 54 patients with surgically resected pulmonary metastasis at the Department of Thoracic & Cardiovascular Surgery, Kosin Medical College between Jan. 1985 and Dec. 2002. Results: The average age was 46 years old (8 to 70 years, 17 males and 7 females). The primary tumors were comprised of 39 cases of carcinoma(72%), 14 cases of sarcoma(26%), and Wilm's tumor in 1 cases(2%). Among the carcinomas metastasized to the lungs. 10 cases(26%) were breast cancers, 8 cases(20%) were CRCs and renal cell carcinoma in 6 cases(15%). Osteosaroma in 4 cases(29%) was the most common sarcomas. The operative procedures in pulmonary metastasis were 70 cases for 54 patients: 40 cases(57%) in partial resection of lung, 21 cases(30%) in lobectomy, 4 cases(6%) inlobectomy with partial resection of lung, 1 cases(1%) in bilobectomy. 1 case (1%) in bilobectomy with partial resection of lung, 2 cases(3%) in pneumonectomy and 1 cases(1%) in only dissection of mediastinal lymph nodes. The average disease free interval was 26.5 months(1 month to 99 months). The 2-year survival rate (2YSR) was 2%(carcinoma 70%, sarcoma 34%) and carcinoma was higher than sarcoma in 2YSR (p=0.02). Conclusion: The 2YSR of patients with surgically resected pulmonary metastasis was 62%. The 2YSR of patients with carcinoma was higher than sarcoma, but there was no difference between subgroups classified according to sex, laterality, DFI, operative procedure, number, and size of metastatic mass.