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        20대 이하 간세포암종의 증례 : 20대 여성에서 임신 중 발견된 간세포암

        최강국 ( Kang Kook Choi ), 홍영주 ( Young Ju Hong ), 최새별 ( Sae Byeol Choi ), 이남준 ( Nam Joon Yi ), 황신 ( Shin Hwang ), 박영년 ( Young Nyun Park ), 최진섭 ( Jin Sub Choi ), 서경석 ( Kyung Suk Suh ), 전재윤 ( Chae Yoon Chon ), 김경식 ) 대한간암연구회 2009 대한간암학회지 Vol.9 No.-

        Hepatocellular carcinoma (HCC) in pregnancy is very rare. The cirrhosis which is present in the majority of patients with HCC induces infertility. The diagnostic methods and treatment modalities in HCC during pregnancy are different from those of usual types of other HCC. A 26-year-old, 32th-gestational-week pregnant female was sent to our hospital because of abnormal liver function test. A 1.5cm sized mass was identified in segment 6 of liver which was compatible to AJCC stage I. She did not have any other medical history except Hepatitis B Virus carrier and the HBs Ag of her mother also was positive. At the 40th gestational week, the female baby was delivered uneventfully. And then she underwent the transarterial chemoembolization (TACE) following the Rt. Hemihepatectomy. Since she underwent a surgical resection, the tumors have been recurred in the remnant liver only. Whenever the tumors were founded, the aggressive surgical approaches were performed including 3 times of hepatic resection with TACE or TACI. She is still alive with good general condition and normal liver function for 9 years since the first diagnosis was made. Therefore an extremely rare case of hepatocellular carcinoma in pregnancy is treated successfully because of aggressive therapies.

      • KCI등재

        T3 담낭암의 임상 양상 분석

        김현구(Hyun Gu Kim), 최새별(Sae Byeol Choi), 박평재(Pyoung Jae Park), 김완배(Wan Bae Kim), 최상용(Sang Yong Choi) 대한종양외과학회 2013 Korean Journal of Clinical Oncology Vol.9 No.2

        Purpose: We investigated clinical characteristics of T3 gallbladder (GB) cancer, and compared the clinicopathological characteristics of the patients according to preoperative diagnosis. We studied the prognostic factors for survival after surgical resection of T3 GB cancer. Methods: Subjects were composed of 51 patients with T3 GB cancers who underwent surgical resection from January 1995 to December 2011. We divided the patients according to the preoperative diagnosis: 17 patients who were diagnosed as benign GB disease at preoperative evaluation, and confirmed GB cancer from pathological result after operation (group 1); and 34 patients who were diagnosed as GB cancer at preoperative work up (group 2). We performed univariate and multivariate analyses of the prognostic factors for survival. Results: Significantly lower proportion of the group 1 patients received liver resection, lymph node dissection, and extrahepatic bile duct resection than group 2 patients. R0 resection was performed in 23.5% of the group 1 and. 67.6% of the group 2 (P=0.007). In the univariate analysis for survival, lymph node dissection and R0 resection were statistically significant prognostic factors. In the multivariate analysis, R0 resection was an independent prognostic factors for survival (hazard ratio, 3.404; P=0.013). Conclusion: Group 1 patients tended to perform less R0 resection than group 2 patients. In the T3 gallbladder cancer, curative resection was the only factor to offer survival benefit. Therefore exact preoperative diagnosis might be important. If GB cancer was diagnosed during or after operation, additional resection to achieve R0 resection should be performed to enhance the survival.

      • 절제술를 시행한 4기 위암 환자의 예후 및 예후 인자

        최새별,홍광대,조재승,김종한,박성수,민병욱,엄준원,송태진,손길수,김종석,목영재,김승주,Choi,,Sae-Byeol,Hong,,Kwang-Dae,Cho,,Jae-Seung,Kim,,Jong-Han,Park,,Sung-Soo,Min,,Byung-Wook,Um,,Jun-Won,Song,,Tae-Jin,Son,,Gil-Soo,Kim,,Chong-Suk,Mok,,Y 대한위암학회 2006 대한위암학회지 Vol.6 No.1

        목적: 4기 위암은 예후가 불량하여 5년 생존율은 10% 이하이며, 진행정도에 따라 임상에서 치료 방침을 선정하는데 어려움이 있다. 이에 절제술을 시행한 4기 위암환자를 대상으로 장기생존군의 특성을 분석하고, 예후인자를 확인하고자 하였다. 대상 및 방법: 1983년 9월부터 2000년 12월까지 고려대학교 의과대학 외과학교실에서 4기 위암으로 절제술을 시행한 383예를 대상으로 하였다. 생존기간 2년을 기준으로 2년 미만 생존한 306예(79.9%)와 2년 이상 생존한 77예 (20.1%)의 두 군으로 나누어 임상병리학적 인자를 비교 분석하였고, 절제술을 시행한 4기 위암환자의 단변량 및 다변량 생존분석을 시행하였다. 결과: 2년 이상 생존군과 2년 미만 생존군에서 종양의 육안형, 원격전이, 림프절 곽청도, 근치도, 조직형이 유의한 차이를 보였다. 절제술을 시행한 4기 위암 환자의 5년 생존율은 5.4%였으며, 단변량 생존분석 결과 종양의 육안형, 원격전이, 림프절 곽청도, 근치도, 조직형이 의미 있는 예후인자였다. 그러나 다변량 생존분석 결과 림프절 곽청도, 근치도, 조직형이 생존율에 영향을 미치는 독립적인 예후인자였다. 결론: 근치적 절제 대상이 되는 4기 위암에서 근치적 절제와 림프절 곽청을 통하여 생존율의 향상을 기대할 수 있다. Purpose: The prognosis of stage IV gastric cancer is poor with the 5-year survival rate still being about 10%. We investigated the prognostic factors of stage IV gastric cancer patients who underwent resection. Materials and Methods: A retrospective study of 383 patients with stage IV gastric cancer who underwent surgery in our department between September 1983 to December 2000 was conducted. We classified the 383 patients into two groups: patients surviving 2 years or more (n=77) and those surviving less than 2 years (n=306). Clinicopathologic differences were analyzed between the two groups. We also performed univariate and multivariate analyses of various clinicopathologic factors concerning survival. Results: Statistically significant clinicopathologic differences between the two groups were observed in regard to macroscopic type, distant metastasis, lymph node dissection, curability, and histology. Curability and histology were significant survival factors in 2-year survival. The 5-year survival rate was 5.4% in stage IV gastric cancer. Significant differences in survival among macroscopic type, distant metastasis, lymph node dissection, curability and histology were observed in the univariate analysis. In the Multivariate analysis, Curability, lymph node dissection, and histology were significantly beneficial factors for survival. Conclusion: Lymph node dissection, curability, and histology were independent prognostic factors in stage IV gastric cancer, and radical treatment is recommended to improve survival.

      • 위에 발생한 위장관 간질성 종양의 임상병리학적 특성과 치료성적

        류제석,이성렬,최새별,박성수,이주한,김승주,김종석,채양석,목영재,Ryu,Je-Seock,Lee,Sung-Ryul,Choi,Sae-Byeol,Park,Sung-Soo,Lee,Ju-Han,Kim,Seung-Joo,Kim,Chong-Suk,Chae,Yang-Seok,Mok,Young-Jae 대한위암학회 2005 대한위암학회지 Vol.5 No.1

        배경: 위장관 간질성 종양(GISTs)은 위장관계에 발생하는 간엽성 종양이다. 위장관 간질성 종양은 면역조직화학 검사에서 c-kit 단백 발현의 양성을 나타내며 그 임상적 경과는 매우 다양하다. 저자들은 위장관 간질성 종양의 임상병리학적 특성을 고찰하고 예후 인자를 평가하기 위하여 후향적 연구를 시행하였다. 대상 및 방법: 본 연구는 고려대학교 의과대학 외과학교실에서 1996년부터 2003년까지 위장관 간질성 종양으로 수술적 절제를 시행한 40명의 환자를 대상으로 하였다. 종양의 크기와 핵분열 정도에 따라 저위험도 집단(23예), 고위험도 집단(17예)으로 분류하였으며 두 군간 임상병리학적 특성, 면역조직화학 검사 결과 및 예후를 비교 분석하였다. 결과: 환자의 평균 연령은 $61.3\pm11.1$세이었으며 남녀비는 1:1,1이었다. 임상병리학적 소견으로는 수술 전 임상 증상이 있었던 경우와 수술 전에 조직학적으로 진단이 되었던 경우, 종양의 크기가 클수록, 핵분열이 많을수록, 종양의 성상이 궤양을 동반하거나 괴사를 보일 때, 고위험군에 포함되는 빈도가 높았다. 단변량 분석 결과, 종양의 크기, 핵분열 정도, 궤양 및 괴사 소견 그리고 내시경적 초음파 이상소견이 통계학적으로 의미가 있는 인자들로 나타났으며, 다변량 분석을 시행한 결과 핵분열 정도가 생존율에 영향을 미치는 독립적인 예후 인자로 나타났다. 관찰 기간 중 8예에서 재발하였으며 STI-571(imatinib mesylate, $Gleeveo^{R}$)을 사용한 4예는 현재까지 생존하고 있으며 사용하지 않은 4예 중 2예는 질환이 진행하는 양상을 나타내었고, 나머지 2P는 사망하였다. 결론: 위에서 기원한 위장관 간질성 종양에서 종양의 크기, 궤양 및 괴사 소견은 생존율에 영향을 주는 임상병리학적 소견이며, 핵분열 정도는 유용한 예후 인자라고 할 수 있다. STI-571은 재발 혹은 전이 환자에 있어 치료 효과를 나타내므로 술후 치료에 적용하는 것이 예후 향상에 기여하리라 생각된다. Purpose: Gastrointestinal stromal tumors (GISTs) are mesenchymal neoplasms of the gastrointestinal tract. GISTs are positive for the expression of c-Kit protein at immunohistochemistry, and their clinical presentations vary. This retrospective study was performed to evaluate the clincopathologic characteristics of GISTs and to define the prognostic factors. Materials and Methods: 40 patients who underwent a complete resection of a GIST during the period $1996\~2003$ at the Department of Surgery, Korea University College of Medicine, were studied. We divided them into low- and high-risk. groups by using tumor size and mitotic count: 23 cases were low risk, and 17 were high risk. Clinicopathologic features, immunohistochemical findings, and prognoses were compared between the low- and the high-risk groups. Results: The mean age of the 40 patients was $61.3\pm11.1$years, and the male-to-female ratio was 1:1.1. There was no significant difference in age and sex between the groups. A comparative analysis revealed tumor size, mitotic count, clinical symptoms, preoperative pathologic diagnosis, ulceration, and necrosis to be variables that had statistically significant differences between the high- and the low-risk groups. In the univariate analysis, tumor size, mitotic count, ulceration, necrosis, and abnormal endoscopic ultrasound findings were associated with disease-free survival, but in the multivariate analysis, mitotic activity was the only independent factor associated with disease-free survival. 8 patients had recurrences during the follow-up period, and four of them were treated with STI-571 (imatinib mesylate, $Gleevec^{(R)}$). The treated patients have survived until now; however, two of non-treated patients died from disease progression. Conclusion: Based on this study, tumor size, ulceration, and necrosis are significant factors affecting survival, and mitotic activity may be a useful prognostic marker. STI-571 may be used in an adjuvant setting because the drug has shown anticancer activity in patients with recurrence or metastasis.

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