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장기이식의 현황 및 추세 : 서울중앙병원 장기이식 프로그램 현황을 중심으로
손광현 울산대학교 의과대학 1994 울산의대학술지 Vol.3 No.1
우리나라의 의료환경속에서 장기이식분야는 1994년 현재까지 동양권에서 비교적 착실하게 그 실적을 진전시켜 왔다고 할 수 있다. 신장이식에 관한 한 특히, 생체신장이식의 경우 국내 33개 이식기관에서 총, 4,233 례(93년말 현재)가 실시되었으며, 말기 신장질환 환자에 대하여, 신투석에 이어 충분히 하나의 치료방법으로 확립된 분야라고 할 수 있다. 각막질환으로 인한 실명환자에 대한 각막이식의 경우는 더욱더 보편화되어 있으며, 백혈병 환자에 대한 골수이식 분야도 많이 진전되어 왔다고 본다. 이제, 우리가 당면한 장기이식의 과제는 개발단계에 있는 이식분야, 특히 간장, 췌장 및 심장이식 분야에서 그리고 아직까지는 초기 단계에 있는 폐장이식 분야에서 미국 및 구라파 여러나라의 장기이식의 이론과 실제를 우리의 것으로 현실화하고 적용하는 문제이다. 우선, 공여자(Donor) 확보를 위해서는 뇌사(Braindeath)가 확립되고 법제화되어 있어야 하나, 현재까지도 진척과정에 놓여있다. 법제화과정은 논리적으로는 의학적 이식술의 진도가 앞서가고 제도는 적절한 시기에 뒷받침되어도 무방하다는 관점이 있다. 즉, 학문적 수준이 높고, 인류와 사회에 대한 의학적 기여가 크게 인정받고 있는 선진 여러나라에서는 이식의 사회적, 윤리적 인식과 기준이 합리적으로 이해되어 있기 때문이다. 우리의 경우에는 현실적으로 장기인식에 관련된 진료비 또는 보험적용 문제라든가, 장기이식의 전문센터(기관)의 육성과 이식학회가 추진중인 장기공여제도 등이 현시점에서 잘 확립되어야 할 과제들이라고 여겨진다. 저자는 최근 2년 간의 서울중앙병원 장기이식의 국제적 동향에 맞추어 앞으로 전개해 나갈 이식의료의 방향을 파악하는데 필요한 기초자료를 삼고자 한다.
미세골절술 후 생체막 덮개가 연골 재생에 미치는 영향 : 고식적인 미세골절술과의 전향적 비교 연구
손광현,김진호,곽규성,박장원,윤경호,민병현,Son, Kwang-Hyun,Kim, Jin-Ho,Kwak, Kyu-Sung,Park, Jang-Won,Yoon, Kyoung Ho,Min, Byoung-Hyun 대한관절경학회 2011 대한관절경학회지 Vol.15 No.2
Purpose: Microfracture has been used as a first-line treatment to repair articular cartilage defects. In this study, a new technique using an extracelluar matrix biomembrane to cover the cartilage lesions after microfracture was evaluated in terms of cartilage repairability and clinical outcome compared with conventional microfracture technique in a prospective randomized trial. Materials and Methods: A total of 53 patients (59 cases) without osteoarthritis who had focal full thickness articular cartilage lesions were randomly assigned in two group. Seventeen patients (17 cases) underwent conventional microfracture procedure (control group) and thirty-six patients (42 cases) received microfracture and placing biomembrane cover (ArtiFilm$^{TM}$) concomitantly (experimental group). Clinical assessment was done through 6 months postoperatively using the subjective International Knee Documentation Committee IKDC questionnaire, and visual analog scale (VAS) for pain and satisfaction. Magnetic resonance imaging (MRI) was performed at 6 months after the operation in all patients. Results: In clinical outcomes, the significant difference was observed between both groups in IKDC, but not in VAS for pain and for satisfaction (final outcomes of IKDC, p=0.001; VAS for pain, p=0.074; VAS for satisfaction, p=0.194). The MRI showed good to complete defect fill (67 to 100%) in 33 patients (78.6%) of experimental group and 4 patients (23.5%) of control group, respectively. In control group, 9 of 17 patients (52.9%) showed poor defect fill (less than 33%), whereas 5 (11.9%) in experimental group (p=0.001). Assessment of peripheral integration revealed no gap formation in 35 patients (83.3%) in experimental group and 6 patients (35.3%) in control group (p=0.001). No serious complications or adverse effects related to the biomembrane were found. Conclusion: Good short-term follow-up clinical results were obtained in the group whose cartilage defects in the knee joint were covered with biomembrane after the microfracture, with the MRI findings confirming the excellent regeneration of the defective cartilage area. This suggests that the surgery to cover the defective area with biomembrane (ArtiFilm$^{TM}$) after the microfracture procedure is a safe, more effective treatment to induce cartilage regeneration.
Herbal Medicine Treatment of Refractory Epilepsy in Tuberous Sclerosis Complex : A Case Report
손광현,이진수,김문주 대한한의학회 2015 대한한의학회지 Vol.36 No.2
Infants with tuberous sclerosis complex (TSC) have a higher chance of experiencing seizures before the age of 1 year; in particular, they commonly accompany infantile spasms. In cases where infantile spasms resulting from TSC are drug-resistant, more severe neuro-developmental and cognitive impairments occur. This particular case dealt with an infant with TSC who continued to experience partial seizures and infantile spasms despite using two different kinds of antiepileptic drugs (AEDs). His spasms ceased on the seventh day of taking modified Yukmijihwang-tang (YMJ), at which point he stopped the use of all AEDs. He became seizure-free after a month of the treatment and modified hypsarrythmia was found to have been resolved in the electroencephalogram test. Until now, the infant has been taking YMJ for 16 months and is maintaining the seizure-free state without side effects. Moreover, his developmental status is continually improving, with a significant progress in language and cognitive-adaptive abilities. Such results suggest that YMJ can serve as an alternative treatment option for refractory epilepsy.
손광현 대한흉부심장혈관외과학회 1987 Journal of Chest Surgery (J Chest Surg) Vol.20 No.1
During the period of 10 years from July, 1976 to July, 1986, 154 cases of primary carcinoma of the lung - by the cell type, stage, operability, and survival rate in the resectable cases - are analyzed at the Dept. of Thoracic Surgery, Paik Hospital in Seoul. The results are as follows: 1] Histopathological types are squamous cell carcinoma 49% [76 cases], adenocarcinoma 25% [39 cases], undifferentiated large cell carcinoma 9% [14 cases], undifferentiated small cell carcinoma 6% [9 cases], bronchioloalveolar carcinoma 4% [6 cases] and adenosquamous carcinoma 3% [4 cases]. 2] Peak incidence is observed in the 4th decade of life [33%], then 5th [29%] and 3rd [21%] respectively. Male to female ratio is 4 to 1. 3] Evidence of inoperability is observed in 64% [99 cases] by clinical staging workup. Thirty six percent [55 cases] were operated. Of these, post-surgical stage I was 5% [3 cases], stage II, 64% [35 cases] and stage III, 31% [17 cases]. Among total 17 cases of stage III, 14 cases were unresectable with evidence of T2N2M0, while 3 cases were resectable. Resectability is 27%, [41 cases] from the total number of 154 cases. And the resectability for the ex 55 cases is 75% [41 cases]. 4] By cell type, highest resectabitity is the squamous cell carcinoma, 49% [20 cases]. Adenocarcinoma is 32% [13 cases] and bronchioloalveolar, 12% [5 cases]. 5] Survival rate is evaluated for 38 cases of 41 resectable stage I, II and III. Overall 5 year survival rate is 24%, 3 year 32% and 10 year 8%. Survival rate in stage II for 5 year is 25%. In squamous cell type for, 5 year is 42%. Authors believe when surgeons continuous effort of early detection is met with patients early visit, 5 year survival rate for the stage I K II resectable patients will improve more effectively. As well, When the efforts are added to combined modality with radiotherapy and chemotherapy for the stage III selected cases of non-small cell carcinoma patients, the enhancement in survival rate is expected.
손광현,김상환,박진,원예연 대한골다공증학회 2010 Osteoporosis and Sarcopenia Vol.8 No.2
목적: 연령에 따른 사람의 근위 대퇴골 골소주의 3차원적미세 구조를 부위별로 조사하는 것이다. 재료 및 방법: 남성 시신으로부터 얻은 27개 대퇴골을 6 구역으로 나누고 각각에서 원통형 시편을 구해 총 162개의 골소주를 얻었다. 미세 컴퓨터 단층 촬영기를 이용하여 영상을 얻어 해면뼈 체적비(BV/TV), 골소주 개수(Tb. N), 골소주 굵기(Tb. Th), 골소주간 거리(Tb. Sp), 구조 모델 지수(SMI), 해면뼈 이방성 정도(DOA)를 분석하였다. 결과: 근위 대퇴골의 서로 다른 부위에 따른 골소주의 미세구조의 변화는 나이에 따라 다르다. 해면뼈 체적비의 유의한 감소와 연령과 관련하여 골소주 굵기의 감소를 보였다. 부위별로 분석한 결과 전자부 상부와 하부 사이에 해면뼈 체적비, 골소주 굵기, 골소주간 거리, 골소주 개수, 구조 모델 지수, 해면뼈 이방성 정도에 유의한 차이를 보였다. 결론: 본 연구에서는 남성 근위 대퇴골의 연령과 관련된 골 소실과 골소주 미세 구조의 변화의 변화가 일정하지 않았다. 연령에 따라 근위 대퇴골의 서로 다른 부위가 골소주의 미세 구조에 있어 많은 차이가 있음을 보여주었다.
肺 惡性腫瘍 : 147例에 對한 臨床的 觀察 An Analysis of 147 Cases
孫光鉉,李南洙,朴東植 인제대학교 1980 仁濟醫學 Vol.1 No.1
폐암은 다른 장기에 발생하는 암의 경우보다도 더욱 조기에 국소임파전이, 종격동의 각종 생체기관에 직접침범하여 상공정맥 증후군, Panccast증후군, 심낭침범, 식도침범, 반회후두신경 또는 횡격막신경 침범등을 일으킬뿐만 아니라 사각임파선전이, 척추, 뇌, 간전이등을 이르키는 치명적질환의 하나로서 구미의 경우 환자의 초진당시 이미 50%가 수술불가능예에속하고 있으며, 저자들의 경우에는 더욱 나뻐서 내원당시 각종검사로 75%가 이미 수술적응이 불가능한 예에 속하였고, 폐암의 Stage Group으로보아 T1, T2병조는 찾어 볼 수 없었고, 외과적 stage II에 해당하는 환자도 표10에서 보는바와 같이 9예에 지나지 않었으며 임상적으로 개흉이 가능하였던 경우에도 개흉결과 stage III에 해당되어 조직검사로 끝나는 경우가 많았다. 1975년 8월부터 1979년 8월까지 폐악성종양 147례를 치험한바 그중 원발성폐암 73례를 주로 분석검토하여 임상적특성, 각종진단술식의 암세포발견율, 조직형의 분포 및 수술가능했던 예에 저한 추월성적은 미흡한대로 검토하였고 이번 분석검토 및 성적을 기초로하여 본병원이 80년대에 맞게되는 폐암환자에 대한 계속적인 도전에 기본재료로 삼고저 한다. During the period of four years from August 1975 to August 1979 one hundred and forty seven cases of lung cancer were seen at Paik Hospital in Seoul, Korea. Among these 147 cases, 104 patients had primary carcinoma of the lung and the remainder were metastatic carcinoma to the lung. Among these 104 primary carcinoma patients, 73 cases were proven histologically as primary carcinoma of the lung(Table 1). The results were as follows. 1.Pathological classifications of the 73 cases of primary carcinima of the lung were as follows; epidermoid carcinoma, 24 cases(32.9%) ; undifferentiated carcinoma, 20 cases(27.4%) : adenocarcinoma, 15 cases(20.5%) : bronchioloalveolar carcinoma, 4 cases(5.5%) and positive cytology, 10cases(13.7%) (Table 2). 2.Primary site of the 43 cases of metastatic carcinoma of the lung were composed of hepatoma(11 cases), stomach cancer(8), choriocarcinoma(7), breast cancer(4), colorectal cancer(4) and the others as seen in Table 3. 3.Age & sex distributions; Peak incidence was observed in the 5th decade of life. Male to female ratio was 2 to 1(Table 4). 4.Predominant bronchopulmonary manifestations were cough with sputum (78%), chest pain (53%) and hemoptysis (27%) Extrapulmonary intrathoracic symptoms such as hoarseness (8%), superior vela cava syndrome(4%) and others were also seen. Metastatic signs including supraclavicular lymphadenopathy (23%) were noted. Non-specific signs were as follows; weight loss (34%), weakness(33%) and anorexia (27%) (Table 5). 5.Characteristic radiographic pictures in the proved primary carcinoma of these series were as follows; atelectasis and or pneumonic consolidation, 43% ; hilar and or perihilar lesions, 38% ; pleural effusion, 27% ; and peripheral lesions, 15% etc(Table 6). 6.Diagnostic reliability by each procedures were shown in Table 7, Sputum cytology was positive in 38%. Bronchofiberscopic brushing and or biopsies were positive histologically and or cytologically in 84% of the patients. Scalene node biopsies informed positive metastatic cancer in 86%. Cytologic examination of the bloody pleural effusion showed positive for malignant cells in 75%. Thoracotomies confirmed the cancer in 100%(Table 7). 7.Evidences of inoperability were observed in 55 patients or 75% of the 73 cases(Table 8). 8.Among those 73 cases, operability was evaluated in 18 patients or 25%. One patient refused operation and 17 patients(23.6%) were explored. In 11 (15%) out of 17 patients, pulmonary resections were performed. Six cases were pneumonectomies and 5 cases were lobectomies or bilobectomies(Table 9). None of T1 lesions or stage I patients in our series were observed. Surgical stagings of the all resectable cases except 2 patients were stage II patients(Table 10). 9.End results or survival of the explored and or resected cases by months were as seen in Table 10.