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Laparoscopic repair of parastomal and incisional hernias with a modified Sugarbaker technique
Duck Hyoun Jeong,Min Geun Park1,George Melich2,Hyuk Hur,Byung Soh Min,Seung Hyuk Baik,Nam Kyu Kim 대한외과학회 2013 Annals of Surgical Treatment and Research(ASRT) Vol.84 No.6
A parastomal hernia is the most common surgical complication following stoma formation. As the field of laparoscopic surgery advances, different laparoscopic approaches to repair of parastomal hernias have been developed. Recently, the Sugarbaker technique has been reported to have lower recurrence rates compared to keyhole techniques. As far as we know, the Sugarbaker technique has not yet been performed in Korea. We herein present a case report of perhaps the first laparoscopic parastomal hernia repair with a modified Sugarbaker technique to be successfully carried out in Korea. A 79-year-old woman, who underwent an abdominoperineal resection for an adenocarcinoma of the rectum 9 years ago, presented with a large parastomal and incisional hernias, and was treated with a laparoscopic repair with a modified Sugarbaker technique. Six months after surgery, follow-up with the patient has shown no evidence of recurrence.
Optimal timing of surgery after neoadjuvant chemoradiation therapy in locally advanced rectal cancer
Duck Hyoun Jeong,Han Beom Lee,Hyuk Hur,Byung Soh Min,Seung Hyuk Baik,Nam Kyu Kim 대한외과학회 2013 Annals of Surgical Treatment and Research(ASRT) Vol.84 No.6
Purpose: The optimal time between neoadjuvant chemoradiotherapy (CRT) and surgery for rectal cancer has been debated. This study evaluated the influence of this interval on oncological outcomes. Methods: We compared postoperative complications, pathological downstaging, disease recurrence, and survival in patients with locally advanced rectal cancer who underwent surgical resection <8 weeks (group A, n = 105) to those who had surgery ≥8 weeks (group B, n = 48) after neoadjuvant CRT. Results: Of 153 patients, 117 (76.5%) were male and 36 (23.5%) were female. Mean age was 57.8 years (range, 28 to 79 years). There was no difference in the rate of sphincter preserving surgery between the two groups (group A, 82.7% vs. group B, 77.6%; P = 0.509). The longer interval group had decreased postoperative complications, although statistical significance was not reached (group A, 28.8% vs. group B, 14.3%; P = 0.068). A total of 111 (group A, 75 [71.4%] and group B, 36 [75%]) patients were downstaged and 26 (group A, 17 [16.2%] and group B, 9 [18%]) achieved pathological complete response (pCR). There was no significant difference in the pCR rate (P = 0.817). The longer interval group experienced significant improvement in the nodal (N) downstaging rate (group A, 46.7% vs. group B, 66.7%; P = 0.024). The local recurrence (P = 0.279), distant recurrence (P = 0.427), disease-free survival (P = 0.967), and overall survival (P = 0.825) rates were not significantly different. Conclusion: It is worth delaying surgical resection for 8 weeks or more after completion of CRT as it is safe and is associated with higher nodal downstaging rates.
한국인 제2형 당뇨병 환자에서 안지오텐신 전환효소 유전자 다형성과 미세알부민뇨 발생
진현정 ( Hyoun Jung Chin ),조용덕 ( Yong Duck Cho ),정경환 ( Kyung Hwan Jeong ),문주영 ( Ju Young Moon ),이상호 ( Sang Ho Lee ),임천규 ( Cheon Gyu Ihm ),이태원 ( Tae Won Lee ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.1
목적: 당뇨병성 신증의 발생의 병태생리학적 기전은 아직까지 명확하지 않지만 고혈당이나 혈압 등의 후천적 요인 외에 유전적 배경이 관여할 것으로 생각되고 있으며 그 중 하나로 안지오텐신 전환효소 유전자 다형성이 많이 연구되어 왔다. 본 연구는 한국인 제2형 당뇨병 환자에서 미세알부민뇨의 발생에 있어 안지오텐신 전환효소 유전자의 관련성을 알아보고 그 외의 영향인자에 대해 알아보고자 하였다. 방법: 경희의료원에서 제2형 당뇨병으로 진단받고 진단시 정상 알부민뇨를 보이는 105명의 환자의 당화 혈색소, 혈청 지질, 혈청 크레아티닌, 소변 검사 및 혈압, 당뇨병성 망막증, 안지오텐신 전환효소 억제제 사용 여부에 대해 10년 간의 경과를 후향 조사하였다. 안지오텐신 전환 효소 유전자 다형성을 알아보기 위해 중합효소 연쇄 반응 (PCR)을 시행하였다. 결과: 21.9%의 환자에서 미세알부민뇨가 발생하였으며 5.5년이 소요되었으며 미세알부민뇨 발생군의 39%에서 평균 10.3년에 현성 단백뇨로 진행되었다. 미세알부민뇨 발생군에서 안지오텐신 전환 효소 유전자 다형성은 D/D 19.5%, D/I 41.5%, I/I 39%, 대조군은 D/D 17.4%, I/D 26.1%, I/I 56.5%으로 통계적 유의성은 없었다. Kaplan-Meyer 생존 곡선에서 미세알부민뇨 발생에 영향인자는 높은 평균 당화 혈색소와 높은 평균 중성지방이 의미 있는 위험 인자이었으나 안지오텐진 전환효소 유전자 다형성은 영향을 미치지 않았으며 Cox 회기분석에서도 확인되었다. 결론: 본 연구의 결과는 한국인 제2형 당뇨병 환자에서 미세단백뇨 발생은 안지오텐신 전환효소 유전자 다형성보다는 평균 당화 혈색소나 평균 혈청 중성지방과 같은 대사성요소가 중요하게 작용함을 시사한다. Purpose: Pathophysiological causes of the development and progression of diabetic nephropathy are not well known, but the angiotensin-converting enzyme (ACE) gene polymorphism has been proposed to be involved in its development. To clarify risk factors for the development of microalbuminuria in Korean type 2 diabetes patients, a retrospective study on the last 10 years was conducted on outpatients with type 2 diabetes. Methods: The impact of insertion/deletion (I/D) genotypes on the progression of diabetic nephropathy in 105 Korean type 2 diabetes patients with normoalbuminuria at diagnosis was investigated by retrospective review of clinical data. Polymorphisms of the ACE gene were examined. Results: During the follow up over the last 10 years, 23 of 105 patients developed Microalbuminuria (21.9%). ACE genotypes were D/D 19.5%, D/I 41.5%, I/I 39% in microalbuminuria group, as compared with D/D 17.4%, I/D 26.1%, I/I 56.5% in normoalbuminuria group. Higher levels of mean HbA1c and mean triglyceride were noted in microalbuminuira group, as compared with those in normoalbuminuria group. Kaplan-Meier survival curve showed that higher HbA1c and higher triglyceride level were significant predictors to the development of Microalbuminuria, but I/D genotype of ACE gene did not affect. Cox regression model also showed that higher HbA1c and triglyceride were independent variables. Conclusion: The control of blood glucose or lipid, rather than the genetic factors such as ACE polymorphism, was considered to be more influential factor on the development of microalbuminuria in Korean patients with type 2 diabetes mellitus.
김정우(Jeong Woo Kim),조진동(Jin Dong Cho),김원균(Won Kyun Kim),민경덕(Kyung Duck Min),황재하(Jae Ha Hwang),이윤수(Youn Soo Lee):박찬홍(Chan Hong Park),권재현(Jay Hyoun Kwon),황종선(Jong Sun Hwang) 대한자원환경지질학회 2003 자원환경지질 Vol.36 No.3
중력이상 및 수치고도모델을 이용하여 한반도 모호면 심도를 추출하였다. 중력이상값은 인공위성고도레이더 관측값을 주로 이용한 전지구 모델을 이용하여 데이터영역 뿐 만 아니라 주파수영역에서도 자료의 균질성을 확보하였다. 모호면 추출은 파동수대비법 및 후리에급수를 이용한 파워스펙트럼분석법을 이용하였다. 전자는 지각균형을 전제로 지형에 의한 중력효과와 후리에어 중력이상을 파동수영역에서 대비하여 모호면의 심도를 계산하는 방법이고 후자는 완전부우계 중력이상으로부터 후리에변환을 이용하여 지하 밀도 변화층의 심도를 계산하는 방법이다. 이 두 모호면은 서로 0.53의 비교적 낮은 상관관계를 갖고 있으며, 이는 모호면 산출의 방법론적인 차이 및 계산성의 오차인 것으로 사료된다. 이렇게 두 가지 독립적인 방법으로 추출된 모호면을 하나로 통합하기 위한 한 방법으로, 두 모호면의 차이를 계산한 후, 이를 최소자승법을 이용, 두 모호면을 보정하였다. 추출된 한반도의 최종 모호면의 평균심도는 32.0km, 표준편차는 2.5km이며, 최소 및 최대 심도는 각 각 20.3, 36.6km 로 나타났다. 이 경우 지형에 의한 중력효과는 파동수대비법에 의해 제거된 결과이나, 한반도의 짖각이 완전한 지각판 내에 놓여 있어서 지각균형설의 가정이 얼마나 타당성이 있는가, 혹은 국부적인 응력장에 의해 한반도의 지각이 과연 얼마나 지지되고 있는가 하는 것에 대한 추가적인 연구가 필요하다. We estimated the Moho depth of Korean Peninsula from gravity anomalies and digital elevation model. The satellite radar altimetry-derived global free-air gravity model was used to ensure the homogeneity in both data and frequency domains of the original data. Two different methods were implemented to calculate the Moho depth; the wavenumber corre-lation analysis (Kim et al., 2000a) and the power spectrum analysis. The former method calculates depth-to-the-Moho by correlating topographic gravity effect with free-air gravity anomaly in the wavenumber domain under the assumption that the study area is not isostatically compensated. The latter one, on the other hand, considers the different density layers (i.e.,Conrad and Moho), using complete Bouguer gravity anomaly in the Frequency domain of the Fourier transform. The corre-lation coefficient of the two Moho model is 0.53, and methodology and numerical error are mainly responsible for any mis-match between the two models. In order to integrate the two independentely-estimated models, we applied least-squares adjustment using the differenced depth. The resultant model has mean and standard deviation Moho depths of 32.0 km and 2.5 km with (min, max) depths of (20.3, 36.6) kms. Although this result does not include any topographic gravity effect, however, the validity of isostasy and the role of local stress field in the study area should be further studied.