암환자의 통증치료에 대한 $Ultracet^{(R)}$의 유효성과 안전성

이효진,진선아,윤각원,양영준,박남환,천재민,박남숙,윤환중,조덕연,김삼용,Lee, Hyo-Jin,Jin, Sun-Ah,Yun, Gak-Won,Yang, Yung-Joon,Park, Nam-Whan,Chun, Jae-Min,Park, Nam-Sook,Yun, Hwan-Jung,Jo, Deog-Yeon,Kim, Sam-Yong 한국호스피스완화의료학회 2006 한국호스피스.완화의료학회지 Vol.9 No.2

목적: 외래에 내원하는 암환자들을 대상으로 암성통증의 조절에 있어서 $Ultracet^{(R)}$의 효과와 안전성에 대해 알아보고자 하였다. 방법: 암으로 진단을 받고 통증 조절을 목적으로 $Ultracet^{(R)}$을 투여한 61명의 환자를 대상으로 통증조절의 정도와 통증이 환자의 삶의 질에 미치는 영향에 대한 평가를 위해 Korean version of Brief Pain Inventory를 이용하였다. 약물의 안전성은 복용 후 나타나는 부작용 정도에 의하여 평가하였다. 결과: 대상환자의 평균연령은 59.9세였고 성별분포는 남자가 34명, 여자가 27명이었다. 환자의 진단은 폐암, 위암, 육종, 대장암, 췌장암, 자궁 경부암, 두경부암, 그리고 림프종 등의 순이었다. 대상환자에서 가장 심했을 때의 통증 정도는 $Ultracet^{(R)}$을 사용하기 전후에 유의한 감소를 보이지 않았으나($5.18{\pm}1.41\;vs.\;4.82{\pm}1.94$; P=0.113), 가장 약했을 때의 통증 정도($1.2{\pm}1.05\;vs.\;0.87{\pm}1.35$; P=0.038), 환자가 느끼는 통증의 평균 정도($3.65{\pm}1.01\;vs.\;3.13{\pm}1.73$: P=0.022)와 바로 지금 느끼는 통증정도($3.63{\pm}1.25\;vs.\;2.85{\pm}1.94$; P=0.003)는 유의하게 감소되었다. $Ultracet^{(R)}$의 사용으로 인한 부작용은 전반적으로 경미하여 2도의 오심과 구토 각 1예와 1도의 변비, 소양증, 안면 홍조가 각각 1예씩 관찰되었으나 3도나 4도의 독성은 관찰되지 않았다. 결론: $Ultracet^{(R)}$은 외래환경에서 암환자의 통증조절에 있어서 안전하게 사용할 수 있는 비교적 효과적인 약물로 생각된다. Purpose: We aimed to investigate the efficacy and side effects of $Ultracet^{(R)}$ in relieving cancer pain in setting. Methods: Sixty-one cancer patients over 18 years old, who had cancer pain with or without medication, were enrolled. Pain and other variables were evaluated before and after treatment with $Ultracet^{(R)}$ for 2 weeks, using Korean version of Brief Pain Inventory. Results: Of 61 patients with assessable efficacy data, the maximum pain intensity(PI) experienced in a day were $5.18{\pm}1.41\;and\;4.82{\pm}1.94$, before and after treatment with$Ultracet^{(R)}$ respectively (P=0.113). The minimum PI experienced in a day were $1.2{\pm}1.05\;and\;0.87{\pm}1.35$, before and after treatment with $Ultracet^{(R)}$, respectively (P=0.038). The average PI experienced in a day were $3.61{\pm}1.01\;and\;3.15{\pm}1.73$, before and after treatment with $Ultracet^{(R)}$, respectively (P=0.022). The current PI were $3.63{\pm}1.25\;and\;2.85{\pm}1.94$, before and after treatment with $Ultracet^{(R)}$, respectively (P=0.003). Regarding the quality of life, only mood changed for the better in 49 patients who were treated with $Ultracet^{(R)}$ alone ($1.98{\pm}1.73\;and\;1.35{\pm}1.15$, before and after treatment respectively; P=0.046). There were five (8.2%) adverse events associated with $Ultracet^{(R)}$ treatment. Conclusion: $Ultracet^{(R)}$ seems effective and safe in ambulatory patients with cancer pain.

B형간염과 연관된 간세포암종의 근치적 절제술 후 혈관내피성장인자 아형의 발현양성 및 예후와의 관계

문주익 ( Ju Ik Moon ),김종만 ( Jong Man Kim ),정금오 ( Gum Oh Jung ),천재민 ( Jae Min Chun ),최규성 ( Gyu Seong Choi ),박재범 ( Jae Berm Park ),권준혁 ( Choon Hyuck David Kwon ),김성주 ( Sung Joo Kim ),조재원 ( Jae Won Jo ) 대한간학회 2008 Clinical and Molecular Hepatology(대한간학회지) Vol.14 No.2

간세포암 환자의 수술 후 간내 조기 재발에 대한 위험 인자

전은성(Eun Seong Jeon),황윤진(Yun Jin Hwang),김종열(Jong Yeol Kim),천재민(Jae Min Chun),김상걸(Sang Geol Kim),윤영국(Young Kook Yun) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.75 No.1

Purpose: The purpose of this study is to comprehend the prognosis and risk factors for the early recurrence after resection for hepatocellular carcinoma (HCC). Methods: Between 1997 and 2005, 237 patients underwent curative resection for HCC at Kyungpook National University Hospital. The patients were followed up regularly to detect any recurrences of HCC by performing imaging studies and AFP. Early recurrence was defined as recurrence that occurred within one year after resection. The patients were divided into the early recurrence group and the others, which included both patients without recurrence and with recurrence that occurred later than 1 year after resection. The clinicopathologic factors of both group were compared to identify the prognosis and the risk factors by performing univariate and multivariate analyses. Results: Seventy three patients (30.8%, 73/238) had early recurrence after resection and 164 patients (69.2%, 164/238) didn`t have recurrence in the first year. The survival rate was significantly better in the without early recurrence group than that in the early recurrence group (96.3% vs 60.3% and 85.1% vs 23.4%, 62.8% vs 7.3% 1, 3, 5 years). The risk factors for early recurrence in the HCC patients were a tumor size greater than 5 ㎝ (P=0.011; odds ratio=2.304) and vascular invasion (P=<0.001; odds ratio=6.342). Conclusion: Since a large tumor size and vascular invasion are the risk factors for early recurrence, the patients who have these risk factors should be followed up with caution and possible postoperative adjuvant therapeutic trials should be considered.

ICGR15가 10% 이상인 간세포암 환자에서 대량 간절제술에 따른 술후 간부전의 예측인자

이채윤(Chae Yoon Lee),황윤진(Yoon Jin Hwang),천재민(Jae Min Chun),권형준(Hyung Joon Kwon),손준호(Joon Ho Son),김상걸(Sang Gul Kim),윤영국(Yung Kook Yun) 한국간담췌외과학회 2011 한국간담췌외과학회지 Vol.15 No.1

Purpose: Major hepatic resection is sometimes inevitable in patients with impaired liver function. We evaluated risk factors that cause postoperative liver failure after major hepatic resection in patients with over a 10% Indocyanine Green Retention rate at 15 minutes (ICGR15). Methods: From Apr. 2002 to Aug. 2009, 32 patients who had over a 10% rate of ICGR15 underwent major hepatic resection (≥4 Couinaud segments). Among the 32, 9 patients showed postoperative liver failure (less than 50% prothrombine time and/or 5 mg/dl or higher of total bilirubin). This high-risk group was compared to the rest who constituted a low-risk group. Results: Patients with esophageal varix were more common in the high risk group (4 versus 2, p=0.043). Other clinicopathologic features showed no difference between the two groups. We had 2 in-hospital deaths in the high risk group. Conclusion: Great care is needed in patients with esophageal varix and limited liver function during major hepatic resection.

개복 수술로 확인된 외상성 췌장 손상 환자에 대한 임상적 고찰

황보선미 ( Seon Mi Hwang Bo ),권영봉 ( Young Bong Kwon ),윤경진 ( Kyung Jin Yun ),권형준 ( Hyung Jun Kwon ),천재민 ( Jae Min Chun ),김상걸 ( Sang Geol Kim ),박진영 ( Jin Young Park ),황윤진 ( Yun Jin Hwang ),윤영국 ( Young Gook 대한외상학회 2011 大韓外傷學會誌 Vol.24 No.2

Purpose: Althoughpancreas injury is rare in abdominal trauma,it posesa challengeto the surgeon because its clinicalfeaturesare not prominentand the presence of main duct injurycannot be easily identified by imaging studies. Furthermore, severe pancreas injuries require a distal pancreatectomy or a pancreaticoduodnectomy which are associated considerable morbidity and mortality. We reviewed the clinical features of and outcomes for patients with pancreas injury. Methods: For 10 years from Jan. 2001 to Dec. 2010, thirty-four patients were diagnosedas having pancreas injury by using an explo-laparotomy. Patients successfully treated bynon-operative management were excluded. Patients were divided into early (n=18) and delayed surgery groups (n=11) based on an interval of 24hours between injury and surgery. The clinical features of and the outcomes for the patients in both groups were compared. Results: Males were more commonly injured (82.4% vs.17.6%). The mean age was 37.2 years. The injury mechanisms included vehicle accidents (62.9%, 22/34), assaults (20%, 7/34), and falls (11.4%, 3/34)). The head and neck of the pancreas was most commonly injured, followed by the body and the tail (16, 12, and 6 cases). Of the 34 patients, 26 (76.5%) patients had accompanying injuries. Grade 1 and 2 occurred in 14 (5 and 9) patients, and grade 3, 4, and 5 occurred in 20 (16, 3, and 1) patients. The early and delayed surgery groups showed no difference in surgical outcomes. Two patients with grade 3 in the early surgery group died after surgery,one due tomassive hemorrhage and the other due to septic shock. Of the five patients initially managed non-operatively,three developed peripancreatic necrosis and two developed pseudocyst. All five patients were successfully cured by surgery. Conclusion: All cases of pancreas injury in this study involved blunt injury, and accompanying injury to major vessels or the bowel was the major cause of mortality. Surgery delayed for longer than 24 hours after was not associated with adverseoutcomes.

외상 후 지연성으로 발생한 장간막 동정맥루: 증례보고

조자윤 ( Jayun Cho ),정희경 ( Hee Kyung Jung ),김형기 ( Hyung Kee Kim ),임경훈 ( Kyoung Hoon Lim ),천재민 ( Jae Min Chun ),허승 ( Seung Huh ),박진영 ( Jin Young Park ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.3

Introduction: A post-traumatic mesenteric arteriovenous fistula (AVF) is extremely rare. Case Report: A previously healthy 26-year-old male was injured with an abdominal stab wound. Computed tomography (CT) showed liver injury, pancreas injury and a retropancreatic hematoma. We performed the hemostasis of the bleeding due to the liver injury, a distal pancreatectomy with splenectomy and evacuation of the retropancreatic hematoma. On the 5th postoperative day, an abdominal bruit and thrill was detected. CT and angiography showed an AVF between the superior mesenteric artery (SMA) and the inferior mesenteric vein with early enhancement of the portal vein (PV). The point of the AVF was about 4 cm from the SMA`s orifice. After an emergent laparotomy and inframesocolic approach, the isolation of the SMA was performed by dissection and ligation of adjacent mesenteric tissues which was about 6 cm length from the nearby SMA orifice, preserving the major side branches of the SMA, because the exact point of the AVF could not be identified despite the shunt flow in the PV being audible during an intraoperative hand-held Doppler-shift measurement. After that, the shunt flow could not be detected by using an intraoperative hand-held Doppler-shift measuring device. CT two and a half months later showed no AVF. There were no major complications during a 19-month followup period. Conclusion: Early management of a post-traumatic mesenteric AVF is essential to avoid complications such as hemorrhage, congestive heart failure and portal hypertension.

췌장의 신경내분비종양의 임상양상 및 WHO 분류에 따른 예후

이용현(Yong Hyun Lee),손준호(Jun Ho Sohn),윤혁진(Hyuk Jin Yun),권형준(Hyung Jun kwon),천재민(Jae Min Chun),김상미(Sang Mi Kim),김상걸(Sang Geol Kim),황윤진(Yoon Jin Hwang),윤영국(Young Gook Yun) 한국간담췌외과학회 2010 한국간담췌외과학회지 Vol.14 No.3

Purpose: Clinical features of Pancreatic Neuroendocrine Tumors (PETs) vary according to the hormone secreted and to the heredity of the tumors. Malignant PETs are common among nonfunctioning PETs (NFTs) whereas the majority of functioning PETs (FTs) are benign. Our goal was to determine the clinical features and prognosis of PETs stratified by the WHO classification scheme and AJCC-UICC 7TH TNM staging. Methods: We selected for study 30 patients with PETs, including one case of nesidiolastosis, who presented at our clinic between April 1992 and June 2010. Clinicopathological features were studied retrospectively. PETs were classified as benign, uncertain malignant, well differentiated carcinoma, or poorly differentiated carcinomas by the WHO classification. For statistical analysis, Student"s t-test, the Chi-square test, and the Kaplan-Meier method were utilized. Results: Nine cases were FTs and twenty one cases were NFTs. The average size of the FTs was smaller than that of the NFTs (1.71 vs 4.33, p=0.04). The head of the pancreas was most commonly involved (33.3% of FTs; 47.6% of NFTs) but the locations of the tumors were not different. Insulinoma was the most common (66.7%, 6/9) among FTs. The incidence of malignant tumors was 33.3% and 55.0% among, respectively, FTs and NFTs. The 5-year disease-free survival rate of patients with benign PETs (FTs and NFTs), and of patients with functioning well-differentiated carcinomas was 100%. However, the 5-year disease-free survival rates of patients with nonfunctioning well- and poorly-differentiated carcinomas were 66.7% and 0%. Conclusion: Among patients with Pancreatic Neuroendocrine Tumors, malignant tumors are more common among NFTs than FTs. Poorly-differentiated carcinomas have a worse prognosis while all FTs regardless of their WHO classification fail to show any disease recurrence.

5 ㎝ 이하의 간세포암에 대한 제한적 간절제술과 대량간절제술후 결과 및 장기 생존율 비교

김혜진(Hye Jin Kim),황윤진(Yoon Jin Hwang),김종렬(Jong Yeol Kim),권형준(Hyung Jun Kwon),김규성(Gyu Sung Kim),천재민(Jae Min Chun),김상걸(Sang Geol Kim),윤영국(Young Kook Yun) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.1

Purpose: Though major hepatic resections including hemihepatectomy, trisectionectomy, and central bisectionectomy are most commonly employed for small (<5 ㎝) hepatocellular carcinoma (HCC), limited hepatic resection is indicated in some HCC patients with impaired liver function, poor physical condition, or tumors peripherally located. We compared the clinicopathological features and long-term survival between the patients who underwent major resection and limited resection. Methods: From January 1998 to May 2007, 223 patients who underwent hepatic resection for small HCC were enrolled. 123 patients underwent limited resection and 100 patients underwent major resection. Clinocopathologic features, overall, and disease-free survival were compared between both groups. Results: The limited resection group had lower mean serum albumin levels (3.86±0.41 vs. 4.11±3.61, P<0.0001) and higher mean ICG R15 (12.66±0.87 vs. 7.51±4.33, P<0.0001). Patients with esophageal varix and liver cirrhosis were more common in the limited resection group (34.1% and 73.1% versus 9% and 45% respectively). Morbidity and mortality were not different in both groups. Overall 1-, 3-, 5-year survivals in both limited resection and major resection groups were 89.4%, 77.3%, 43.8% and 87.8%, 76.5%, 62.1% respectively (P=0.161) and 1-, 3-, 5-year disease free survivals were 80.2%, 50.2%, 38.6% and 79.9%, 63.2%, 50.4% respectively (P=0.10). Conclusion: Despite indifference of overall and disease-free 5-year survival rates between limited and major resection groups, careful follow up is essential to detect late recurrence in the limited resection group, since limited resection tends to have more frequent recurrence, especially 2 years after surgery.

췌십이지장 손상에서의 응급췌십이지장절제술

박인규 ( In Kyu Park ),황윤진 ( Yoon Jin Hwang ),권형준 ( Hyung Jun Kwon ),윤경진 ( Kyung Jin Yoon ),김상걸 ( Sang Geol Kim ),천재민 ( Jae Min Chun ),박진영 ( Jin Young Park ),윤영국 ( Young Kook Yun ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.4

Purpose: Severe pancreaticoduodenal injuries are relatively uncommon, but may result in high morbidity and mortality, especially when management is not optimal, and determining the appropriate treatment is often difficult. The objective of this study was to review our experience and to evaluate the role of a pancreaticoduodenectomy (PD) in treatment of pancreaticoduodenal injuries. Methods: We performed a retrospective review of 16 patients who underwent an emergency PD at our hospital for severe pancreaticoduodenal injury from 1990 to 2011. Demographic data, clinical manifestations, mechanism and severity of the injury, associated injuries, postoperative complications and outcomes were reviewed. Results: The mean age of the 16 patients was 45±12 years (mean±standard deviation), and 15(93.8%) patients were male. All patients underwent an explorative laparotomy after a diagnosis using abdominal computed tomography. Almost all patients were classified as AAST grade higher than Ⅲ. Thirteen(83.3%) of the 16 patients presented with blunt injuries; none presented with a penetrating injury. Only one(6.3%) patients had a combined major vascular injury. Fifteen patients underwent a standard Whipple`s operation, and 1 patient underwent a pylorus-preserving pancreaticoduodenectomy. Two of the 16 patients required an initial damage-control procedure; then, a PD was performed. The most common associated injured organs were the small bowel mesentery(12, 75%) and the liver(7, 43.8%). Complications were intraabdominal abscess(50%), delayed gastric emptying(37.5%), postoperative pancreatic fistula(31.5%), and postoperative hemorrhage (12.5%). No mortalities occurred after the PD. Conclusion: Although the postoperative morbidity rate is relatively higher, an emergency PD can be perform safely without mortality for severe pancreaticoduodenal injuries. Therefore, an emergency PD should be con-sidered as a life-saving procedure applicable to patients with unreconstructable pancreaticoduodenal injuries, provided that is performed by an experienced hepatobiliary surgeon and the patient is hemodynamically stable. (J Trauma Inj 2012;25:115-121)

동일한 국제예후지표(International Prognostic Index)를 나타내는 미만성 대형 B-세포 림프종에서 Bcl-2와 p16의 임상적 중요성

박상은,박수진,곽승근,박남숙,천재민,윤환중,조덕연,김삼용,김진만 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

In Korea, malignant lymphoma is a common cancer, comprising about 2.7% of all malignant neoplasm. Diffuse large B cell lymphoma is the most common lymphoma, representing about 50% of all Non-Hodgkin's lymphoma. Diffuse large B-cell lymphoma is usually considered as heterogeneous group of neoplasms rather than a single clinicopathological entity. Clinical prognostic systems, including the International Prognostic Index (IPI), although useful to assess overall prognosis, embrace patients with heterogeneous prognoses. But International Prognostic Index scoring system is not sufficiently predict the prognosis. It is likely that the prognostic assessment of patients with diffuse large B-cell lymphomamight be improved by using biological features. Bcl-2 protein and p16 protein expression is recognized as useful biologic markers predicting the prognosis of patients with diffuse large B-cell lymphoma. To determine the clinical significance and prognostic value of bcl-2 and p16 proteins expression patterns, we studied 18 patients with de novo DLBL, whose archival pathology specimen were available for immunohistochemistry studies, atChungnam National University Hospital from September 1992 to December 2000. Archival specimens from each patient were immunostained with respective antibodies for bcl-2, p16. The results are as follows; 1) The median age was 54(rage : 37-69). There were 12 male patients(66.7%) and 6 female patients(33.3%) The 'B' symptom was abscentin all patients. The stages were as follows : Ⅰ, 2 patient(11.1%), Ⅱ, 10 patient(55.6%), Ⅲ, 4patient(22.2%) and Ⅳ, 2patient(11.1%). 3 patients(16.8%) had the elevated LDH level, 14 patients(77.8%) had the normal LDH level and 1 patients(5.6%) was not identified the LDH level. 2 patients(11.1%) had the bulky disease and 16 patients(88.7%) had no bulky diease. The distribution of ECOG status were O, 2 patients(11.1%c), 1, 14patients(77.8%) and 2, 2patients(11.1%). 2) Theimmunohistochemistry results are as follows bcl-2:+,10 patients(55.6%), bcl-2:-, 8patinets(44.4%), p16:+,3 patients(16.7%), p16:-, 15patients(83.3%) 3) After a median follow UP durations of 67 months, the median survival time was 57 months with a rage of 7-100+ months. 5-years overall survival rates was 44% by Kaplan-Meier method. 4) Reduced overall survival was demonstrated in the patients who expressed bcl-2 protein(P=0.0174). 5-year overall survivial rate was 12%(bcl-2 expression) versus 88%(no bcl-2 expression) 5) Among diffuse large B-cell lymphoma patients with IPI score 0-1, reduced overall survival was demonstrated with bcl-2 expression(P=0.023). 5-year overall survival rate was 18%(bcl-2 expression group) versus 100%(no bcl-2 expressiongroup) 6) Median survival durtation of diffuse large B-cell lymphoma patients negative for p16 expression was 57 months whereas p16 postive patients' median survival duration was not reached(P=0.4478). In diffuse large B-cell lymphoma patients with identical IPI scores, bcl-2 expression had additional prognostic value.