Carotid Endarterectomy after a Completed Storke

Chang, Surk Hyo 인제대학교 1987 仁濟醫學 Vol.8 No.1

경동맥 내막절제술은 Transient ischemic attack의 치료와 stroke의 예방 목적으로 미국 및 유럽의 여러 곳에서 시행하고 있다. 그러나 permanent neurologic dcficit가 있는 환자에서의 cerebral ischemia의 치료에 경동맥의 수술 효과에 대해서는 아직 논란이 많은 실정이다. 저자는 previous stroke가 있던 환자들에게 경동맥 내막절제술을 시행함으로써 recurrent neurologic deficit를 예방할 수 있는지를 같은 기간에 수술을 하지 않은 대조군과 비교하여 추적 조사한 결과 수술군에서 recurrent neurologic deficit의 위험을 경감 시킬 수 있었다. 저자는 경도 내지 중등도의 neurologic deficit가 있는 64명의 stroke가 있었던 환자들에게 32명은 경동맥 내막 절제술을 시행하였고 나머지 32명은 내과적인 치료(Anticoagulant, antiplatelet agent)를 하여 비교하여 보았다. 두 군의 연령, 성별 분포와 다른 질병을 가진 빈도도 비슷하였다. 비수술 요법으로 치료한 환자에서는 추적 기간 동안에 32명 중 7명에서 새로운 neurologic deficit가 있었고 이 중2명이 stroke의 합병증으로 사망하였다. 수술군에서는 수술 후 32명 중 1명에서 새로운 neurologic deficit가 있었으나 stroke에 의한 사망은 없었다. 수술군의 나머지 환자에서는 약 4년 동안 추적 조사한 결과 recurrent neurologic deficit는 나타나지 않았다. 결론적으로 경도 또는 중등도의 neurologic deficit가 있던 stroke환자에서 Carotid endarterectomy를 시행함으로써 recurrent neurologic deficit를 예방 할 수 있다는 결론을 얻었다. The merit of carotid endarterectomy for patients who previously have a sustaind completed stroke remains controversial. Between January 1982 and June 1985, 64 stroke patients with mild to severe permanent neurologic deficits were evaluate. Thirty two patients were managed nonoperatively and 32 operatively. Both cohorts were similar in age and sex distribution, incidence of hypertension (60%), diabetes mellitus (25%), and cardiac disease (38%). In the long-term follow-up (medical cohort average was 32±3.0 months; surgical cohort average,30.6 ± 2.6 months), the overall survival rate was comparable, that is there were five medical deaths and 4 surgical deaths. However, there was a signifiant difference in the development of new neurologic deficits. Seven of the 32 unoperated patients had new neurologic deficits and two patients died at 13,27 months as a result of a recurrent stoke. New neurologic deficits developed in only one of 32 surgical patients and there was no stroke-related death. When the cumulative probability of remaining free from recurrent deficits was examined in the surviving patients at 4 years, all the patients in the operated group remained free from recurrent deficits. These data suggest that stroke patients with fixed mild to moderate neurologic dificits and with carotid lesions may be protected from the recurrent neurologic complication by carotid endarterctomy.

유방암에서 pS2 단백 발현의 임상적 의의

장석효(Surk Hyo Chang),김지억(Ji Uk Kim),왕희정(Hee Jung Wang),오미혜(Mee Hye Oh),서연림(Yeon-Lim Suh),백인욱(In Wook Paik),이혁상(Hyucksang Lee) 대한외과학회 1994 Annals of Surgical Treatment and Research Vol.46 No.5

Bezoar 로 因한 小腸閉鎖症 : 3例 報告 3 Cases Report

張錫孝 최신의학사 1981 最新醫學 Vol.24 No.6

갑상선 결절의 세침흡입 세포조직검사의 유용성

장석효,왕희정 인제대학교 1990 仁濟醫學 Vol.11 No.3

외과적 측면에서 갑상선결적의 세침흡입생검의 유용성과 그 결과에 입각한 치료 방침을 검토하기 위하여 1986년 5월부터 1990년 5월까지 세침흡입생검을 시행한 후 갑상선절제술을 시행한 70례를 비교 분석하였다. Thyroid nodules often present diagnostic difficulties. The task of carcinoma of the thyroid gland is higher for solitary nodule. Aspiration biospsy cytology(ABC) has been considered a highly effective diagnostic tool in evaluating a broad spectrum of palpable and non-palpable thyroid diseases. I reviewed 70 cases of the patient, 3 with thyroid nodule who underwent both, ABC and surgery at the department of surgery, Inje university Paik hospital at Seoul over a period of 5 years from Mar. 1986 to Mar 1990, by comparing of the histologic differences between the ABC findings and the postoperative pathologic report. The results were as followings. 1) In the 22 patients with the ABC diagnosis of adenomatous goiter, the pathologic findings were adenomatous goiter in 18, follicular adenoma in 2, and papillary carcinoma in 27cases. 2) In the 6 patients with the ABC diagnosis of "negative follicular lesion", the pathologic findings were benign follicular lesion in 3, follicular adenocarcinoma in 2, and adenomatous goiter in 1 case. 3) In the 4 patients with the ABC diagnosis of "suspicious follicular lesion", the pathologic findings were follicular adenocarcinoma in 3 and papillary carcinoma in 1case. 4) In the 25 patients with the ABC diagnosis of papillary carcinoma, the pathologic findings were the ABC diagnosis in 21 cases, and the remaining 4 cases were undifferentiated carcinoma, Hurtle cell carcinoma, malignant lymphoma, and thyroiditis 5) In the 31 patients with the ABC diagnosis of "positive" or "suspicious", malignancy, 96.8% of of the cases were confirmed as malignancy with false positive rate of 32%, and in the, 39 patient with the ABC diagnosis of "negative", 79.5% of cases were benign with false negative rate of 16.1%. 6) In this study, the accuracy of the ABC was 814%, the sensitivity was 96.8%, and the specificity was 87.2.

대장암의 시대적 변화

이정호,나양원,서병조,장석효,백인욱,이혁상 大韓消化器病學會 1999 大韓消化器病學會誌 Vol.33 No.1

대장암의 시대적 변화

이정호,나양원,서병조,장석효,백인욱,이혁상 대한소화기학회 1999 대한소화기학회지 Vol.33 No.1

Background/Aims: This study was conducted to evaluate the chronological changes of colorectal cancer in Korea. Methods: A retrospective analysis of 352 cases with colorectal cancer treated in the period from 1988 to 1996 (recent period) was performed and the results were compared with the previously reported study involving 221 cases with colorectal cancer treated in the period from 1975 to 1987 (past period). Results: The proportion of patients over 60 years in the recent period was 46%, which was significantly higher than that in the past period (30%). Dukes' C patients were 40.6% in the recent period. Although Dukes' D patients were lowered by 6.8%, their proportion wa still 21%. The resection rate was raised by 9.6% to reach 87.8% in the recent period and postoperative morbidity and mortality were decreased. Five-year survival rate was 56.0% in the recen period, it is higher than that of the past period (52%). Five-year survival rate was 100% in Dukes A patients, 83.9% in Dukes' B patients, 53.3% in Dukes' C patients and 8.7% in Dukes' D patient (p=0.000). Conclusions: The incidence of colorectal cancer in the aged group has been increasing. The proportion of Dukes' D patients is decreased. Five-year survival rate of the recent period is higher than that of the past period by 4%. (Kor J Gastroenterol 1999;33:51 - 57)

췌두부암의 임상적 고찰

나양원,장석효,박영래,백인욱,이혁상 대한소화기학회 1999 대한소화기학회지 Vol.33 No.5

Background/Aims: Pancreatic head cancer has been characterized by a low resectability and poor survival rate. This study was conducted to examine the resectability and postoperative results of pancreatic head cancer. Methods: A retrospective study was performed for 45 patients with pancreatic head cancer treated at our department from 1988 through 1997. Results: The cancer was prevalent in the 6th and 7th decades (71.1%) of life. The male-to-female ratio was 1.7:1. Ninety-five percent of the patients was in either TNM stage III or IV. Pancreatoduodenectomy was executed in 8 patients (17.8%) without operative mortality or anastomotic leakage. Out of 26 patients who underwent biliary bypass surgery, 24 were subjected to concomitant gastrojejunostomy. Eleven patients (24.4%) received non-operative management. Actuarial survival rates of 1 and 4 years after pan creatoduodenectomy were 75.0% and 45.0%, respectively. The median survival after pancreatoduo denectomy was 27 months, which was significantly longer than those after bypass surgery (8 months or after non-operative treatment (4 months)(p$lt;0.0005). Conclusions: Pancreatoduodenectomy can be safely performed for pancreatic head cancer without operative mortality or major complication. Early detection and the development of more promising adjuvant therapies are required to improve resectability and to prolong survival after resection of pancreatic head cancer.

염산에 의한 부식성 위염에 동반된 고도 이형성증 1예

김한성,박성혜,전영빈,장석효,김용일 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.2

A 80 year-old man ingested hydrochloric acid as suicidal purpose and as a result developed an epigastric fullness and pain. Marked stricture of esophagogastric junction and gastric outlet were found by endoscopic examination after 20 days of admission. A total gastrectomy and Roux-en-Y esophagojejunostomy was performed. Grossly, resected stomach revealed redness and erosion especially over antrum and pylorus. On cross section, a flat elvated lesion measuring 0.7×0.5 cm was incidentally found on high body along lesser curvature. On microscopic examination, the mass consisted of atypical epithelial glands having increased cellularity and round hyperchromatic nuclei without invasive foci. The lesion was diagnosed with ‘epithelial dysplasia, high grade’. Corrosive gastritis and submucosal epithelial heterotopia were found in surrounding mucosa also.

후복막 육종

허태길(Tae Gil Heo),나양원(Yang Won Nah),장석효(Surk Hyo Chang),백인욱(In Wook Paik),이혁상(Hyucksang Lee) 대한외과학회 1998 Annals of Surgical Treatment and Research Vol.54 No.1

총수담관 십이지장 문합술의 원격 성적

백낙환(Nak Whan Paik),이혁상(Hyucksang Lee),백인욱(In Wook Paik),장석효(Surk Hyo Chang),김홍용(Hong-Yong Kim),최성계(Seong-Ge Choi) 대한외과학회 1987 Annals of Surgical Treatment and Research(ASRT) Vol.32 No.3