대장과 직장에 발생한 위장관 간질성 종양의 임상 병리학적 분석

최성훈,김서전,최윤정,민병소,김진수,백승혁,김남규,강중구 대한대장항문학회 2009 Annals of Coloproctolgy Vol.25 No.5

Purpose: This study’s aim is to investigate the clinicopathologic characteristics of colorectal gastrointestinal stromal tumors (GISTs) and to evaluate the result of those tumors. Methods: We retrospectively reviewed 22 patients who had been diagnosed with primary colorectal GISTs and who had undergone a surgical resection between October 1996 and July 2008. Results: Colorectal GISTs accounted for 0.28% of all colorectal malignancies and 7.7% of all GISTs. Rectal GISTs (19, 86.4%) were more common than colonic GISTs (3, 13.6%). According to the National Institute of Health’s (NIH) grading system, there were 1 (4.5%) very low, 5 (22.7%) low, 4 (18.2%) intermediate, and 12 (54.6%) high-risk tumors. The disease recurred in 7 patients (1 with intermediate risk and 6 with high risk). Recurrence sites were the liver (42.9%), the peritoneum (71.5%), and the lymph nodes (14.3%). Adjuvant imatinib therapy and/or radiation therapy were done for patients with microscopically positive margins of resection and high risk, of which one experienced a recurrence at 95 months after surgery. The five-year recurrence rates were 0% in the very-low-grade and low-grade groups, 33.3% in the intermediate-grade group, and 37.5% in the high-grade group. The five-year overall survival rates were 100% in the very-low-grade and low-grade groups, 66.7% in the intermediate-grade group, and 62.5% in the high-grade group. Conclusion: Poor prognosis of colorectal GISTs was closely related to the tumor’s histologic grade and size. Integrating surgery, molecular therapy, and radiation therapy might improve outcomes, but further study with more cases is needed. Purpose: This study’s aim is to investigate the clinicopathologic characteristics of colorectal gastrointestinal stromal tumors (GISTs) and to evaluate the result of those tumors. Methods: We retrospectively reviewed 22 patients who had been diagnosed with primary colorectal GISTs and who had undergone a surgical resection between October 1996 and July 2008. Results: Colorectal GISTs accounted for 0.28% of all colorectal malignancies and 7.7% of all GISTs. Rectal GISTs (19, 86.4%) were more common than colonic GISTs (3, 13.6%). According to the National Institute of Health’s (NIH) grading system, there were 1 (4.5%) very low, 5 (22.7%) low, 4 (18.2%) intermediate, and 12 (54.6%) high-risk tumors. The disease recurred in 7 patients (1 with intermediate risk and 6 with high risk). Recurrence sites were the liver (42.9%), the peritoneum (71.5%), and the lymph nodes (14.3%). Adjuvant imatinib therapy and/or radiation therapy were done for patients with microscopically positive margins of resection and high risk, of which one experienced a recurrence at 95 months after surgery. The five-year recurrence rates were 0% in the very-low-grade and low-grade groups, 33.3% in the intermediate-grade group, and 37.5% in the high-grade group. The five-year overall survival rates were 100% in the very-low-grade and low-grade groups, 66.7% in the intermediate-grade group, and 62.5% in the high-grade group. Conclusion: Poor prognosis of colorectal GISTs was closely related to the tumor’s histologic grade and size. Integrating surgery, molecular therapy, and radiation therapy might improve outcomes, but further study with more cases is needed.

대장의 위장관 기질성 종양 : 임상병리학적 고찰

김은규,이호창,이민로,임석병,강성범,박규주,김우호,박재갑 대한대장항문학회 2003 Annals of Coloproctolgy Vol.19 No.5

재발한 위장관 간질성 종양(GISTs) 환자들의 임상양상 분석

나건형(Gun Hyung Na),김영균(Young Kyun Kim),이한홍(Han Hong Lee),지성배(Sung Bae Ji),채병주(Byung Joo Chae),허훈(Hoon Hur),김욱(Wook Kim),전해명(Hae Myung Jeon) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.73 No.4

Purpose: Gastrointestinal stromal tumors (GISTs) are of a mesenchymal origin, and they arise predominantly from the gastrointestinal tract. This study aims to aid the post operative management of GIST patients by analyzing the clinical and immunopathological features of recurrent GISTs. Methods: We enrolled 98 GIST patients who had been operated on for their primary tumor from 1987 to 2001 at the Catholic Medical Center. Among them, 28 patients had clinical and radiological features that were proved to be recurrence, and the patients’ survival rates were compared according to the treatment modalities. Results: When the maximum length of tumor was shorter and the mitotic index lower, then these patients had higher disease free survival rates and lower recurrence rates. The Ki-67 negative group had lower recurrence rates than their Ki-67 positive counterparts. Recurrence was mostly observed as liver metastasis. The mean length of time to recur was 22.96 months. Fifteen patients received additional treatments such as surgery, chemotherapy and radiation therapy, but there was no significant difference in survival rates when they were compared to the 13 patients who did not receive further treatments. Conclusion: Of the patients diagnosed with GIST after surgery, those with worse prognostic factors, i.e. a bigger tumor size and higher mitotic index, require more meticulous surveillance for tumor recurrence, and especially for liver recurrence, which was the most common recurrence site, during the follow up exams. In addition, although there have not been any remarkably effective treatments for the recurrent GIST patients, further researches for new therapy such as STI-571 is mandated.

위장관 기질종양의 10년 수술 성적

이경하(Kyung-Ha Lee),송인상(In-Sang Song),설지영(Ji-Young Sul),김지연(Ji-Yeon Kim),전광식(Kwang-Sik Chun),이상일(Sang-Il Lee),강대영(Dae-Young Kang),최송이(Song-I Choi),노승무(Seung-Moo Noh) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.6

Purpose: Gastrointestinal stromal tumors (GISTs) possess highly variable clinical behaviors and the study thereof is insufficient. There are no standard guidelines for diagnosis and treatment of GISTs, so it is difficult to predict recurrences and conduct appropriate treatments. Throughout the last 10 years of experiences with GIST patients, we have identified the variables predicting recurrences and classified the risk groups by NIH classification, Fletcher risk stratification and UICC TNM stage. Methods: From January 1998 to December 2007, 88 patients with pathologic confirm and surgical resection were diagnosed with GISTs. GISTs were diagnosed when the tumor had characteristic histologic features and confirmed positive by KIT, CD34, or PDGFRA. Results: The size, mitotic index, existence of symptoms, and origins of tumor correlate statistically with recurrence (0.002, <0.001, 0.027, 0.011). The NIH classification, Fletcher risk stratification and UICC TNM stage are correlated with recurrence (0.001, <0.001, <0.001) and 5 year disease free survival, statistically (0.009, <0.001, <0.001). Fifteen patients experienced recurrences. 14 patients were treated with imatinib, and 6 of them showed a response to the treatment. All 4 patients who had R1 resection did not survived due to the progression of the disease. Conclusion: The patients with large, high mitotic index, symptomatic, or extra-gastric tumor require strict surveillance. Also, patients with low risk must be under surveillance due to the possibility of recurrence. It is important to perform R0, en bloc resection. Although the imatinib is the treatment of choice with recurred or metastatic GISTs, the disease is likely to develop resistance, further studies on newly targeted therapy is in need.

Laparoscopic Wedge Resection of GISTs Involving the Second Portion of the Duodenum

Min-Hyung Kim,Kyo-Young Song,Jung-Ho Shim,Chan-Kwon Jung,Seung-Nam Kim,Cho-Hyun Park 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.3

The optimal surgical procedure for treatment of gastrointestinal stromal tumors (GISTs) of the duodenum remains undefined. Therefore, various surgical procedures have been introduced as treatment options for duodenal GISTs. Due to the anatomical complexity, the laparoscopic approach has been considered as a contraindication. Especially for GISTs located at the second portion of the duodenum, a laparoscopic wedge resection is technically difficult to perform. We describe the surgical technique of laparoscopic wedge resection with hand-sewn closure for GISTs that involve the second portion of the duodenum.

소아에서 발생한 위장관 간질 종양 1예

윤경빈,김재영,유재홍,설지영,강대영,Yun, Kyung-Bin,Kim, Jae-Young,Ryu, Jae-Hong,Sul, Ji-Young,Kang, Dae-Young 대한소아소화기영양학회 2007 Pediatric gastroenterology, hepatology & nutrition Vol.10 No.1

저자들은 2년 전부터 식사 후에 주로 나타나는 간헐적인 상복부 복통이 있어오다가 한 차례 흑혈변을 보여인근 병원에서 시행한 혈액검사에서 빈혈을 보여 전원된 10세 여아에서 소아에서는 발생이 드물다고 알려진 위에서 발생한 GIST 1예를 경험하였기에 문헌고찰과 함께 보고한다. Gastrointestinal stromal tumors (GISTs) are the most common primary mesenchymal tumors of the digestive tract. They have been commonly observed in adults but have been rarely described in children. They arise typically from the intestinal wall and rarely in the mesentery, omentum, or retroperitoneum. GISTs originate from the interstitial cell of Cajal and are characterized by overexpression of the receptor tyrosine kinase c-kit. Up to 94% of these tumors express the CD117 on immunohistochemical stain. Surgery is the main modality of treatment for primary resectable GIST. Completely resectable GIST with low risk has excellent prognosis after primary surgical intervention, with over 90% of the 5-year survival. We report a case of 10-year-old girl presenting with an upper gastrointestinal bleeding caused by gastrointestinal stromal tumor.

GISTs에서 증가된 Ki67 Index (>10%)와 p53 단백발현의 예후 인자로서의 유용성

손보성(Bo Sung Sohn),전해명(Hae Myung Jeon),성기영(Gi Young Sung),진형민(Hyung Min Jin),김욱(Wook Kim),박조현(Cho Hyun Park),박승만(Seung Man Park),임근우(Keun Woo Lim),박우배(Woo Bae Park),김승남(Seung Nam Kim),이교영(Kyo Young Lee 대한외과학회 2004 Annals of Surgical Treatment and Research(ASRT) Vol.66 No.2

원불교 교리도에 대한 연구-변천과정의 쟁점을 중심으로

류성태 원광대학교 원불교사상연구원 2018 원불교사상과 종교문화 Vol.75 No.-

What is the Doctrinal Chart in religion and what is the importance of it? In Won Buddhist year 17(1922 C.E.), the Doctrinal Chart was first revealed in the early Won Buddhist scripture. It was an explanatory diagram and provided the convenience of understanding the system of doctrine in Won Buddhism. The Doctrinal Chart has an outline of doctrine so it shows an importance as a diagram, as well as a symbolic character for doctrinal structure. The Doctrinal Chart, which can easily explain the system of doctrines, has been partially changed through four stages: the Doctrinal Chart in Yukdaeyoryŏng(1932), the Doctrinal Chart in Pulgyo chŏngjŏn(1943) before Liberation of Korea, the Doctrinal Chart in Pulgyo chŏngjŏn(1945) after Liberation of Korea, and the Doctrinal Chart in Gyojŏn(1962). The change of the Doctrinal Chart is due to the development of the Won Buddhist order and the systematization of the doctrine. However, the change process of the Doctrinal Chart by the systematization of the doctrine did not go smoothly. This is related to the establishment of the Won Buddhist order and the situation of the state under the Japanese rule. In this sense, there were the issues that have emerged in the process of change: Bagua on behalf of Irwŏnsang on the top of the Doctrinal Chart, 'Two Great Graces' and 'Serve the Country with the Utmost Loyalty’, 'Gists of Gratitude to Grace', imported-Buddhist 'Hwadu' and 'Spreading of Buddhism', and 'Four Essentials' instead of 'Gists of Gratitude to Grace.' The Study focused on defining the meanings of the issues from the change of process of the Doctrinal Chart and identifying the direction of the solution of them. It is necessary to approach from a positive perspective and a critical perspective as a basic principle. A hermeneutical approach to some changes in the Doctrinal Chart is necessary. There are some reflection and suggested solutions during the scriptures councils. Alternatives through improvement will be also necessary. As the history of Won Buddhism will be developed in the future, the re-council of scriptures will continue. This is because the systematization of the doctrine will not cease, and it can be changed and settled in the desirable direction of the doctrine. This is the reason why Won Buddhist study should have a historical perspective and a character for classification of teachings. 종교에서 교리도란 무엇이며, 그 중요성은 어디에 있는가. 원기 17년(1922), 원불교 초기교서에 처음 밝혀진 원불교의 교리도는 ‘도해(圖解)’라는 형식으로 교리의 체계를 이해하는데 그 편의성을 제공해 준다. 교리의 대체(大體)를 드러 내고 있는 교리도는 원불교 교리체계를 한눈으로 볼 수 있는 도해라는 점에서 중요한 역할에 더하여 교강의 상징성을 지니기도 한다. 교리의 체계를 쉽게 요 해할 수 있는 원불교의 교리도는 크게 네 단계를 거치며 부분적으로 변천되어 왔다.『 육대요령』(1932)의 교리도, 해방 전『 불교정전』(1943)의 교리도, 해방 후 『불교정전』(1945)의 교리도,『 교전』(1962)의 교리도로 정착되어 온 것이다. 교리 도가 변천되어 온 이유는 교서결집과 더불어 교리의 체계화가 전개되었기 때 문이다. 그러나 교리의 체계화에 따른 교리도 변천과정은 순탄하지만은 않았 다. 교단창립이 일제하의 시국상황에 관련된 것인데, 변천과정에 나타난 쟁점 사항을 파악해보려는 이유가 여기에 있다. 그것은 상단에 일원상이 아닌「 팔 괘」, 그리고「 양대은」과「 진충보국」,「 보은의 대요」, 원용된 불교의 화두들과 「불교보급」, 보은의 대요를 대체한「 사요」라는 항목들이다. 본 연구에서는 변 천과정의 쟁점으로 부각된 교리도의 항목들에 대한 의미부여 및 해법의 방향은 무엇인가를 파악하는데 초점을 두었다. 이의 방향을 모색하는 기본원리로 서 긍정적인 시각과 비판적 시각에서 접근하였다. 교리도가 변천된 일부 항목 에 대한 해석학적 접근이 필요하며, 몇 차례 교서가 결집되면서 쟁점의 성찰과 더불어 해법이 제시된 경우도 있을 것이며, 아울러 개선을 통한 대안제시도 필 요할 것이다. 앞으로도 교단의 역사가 전개되면서 교서의 재결집은 지속될 것 이다. 교리의 체계화는 멈추지 않을 것이기 때문이며, 이에 따른 교리도의 바 람직한 방향에서 변천, 정착될 수 있으리라 본다. 교학의 연구가 역사적 안목 과 교판적 성격을 띠어야 하는 이유가 이와 관련된다.

원불교 교리도에 대한 연구

유성태(柳聖泰) 원광대학교 원불교사상연구원 2018 원불교사상과 종교문화 Vol.75 No.-

종교에서 교리도란 무엇이며, 그 중요성은 어디에 있는가. 원기 17년(1922), 원불교 초기교서에 처음 밝혀진 원불교의 교리도는 ‘도해(圖解)’라는 형식으로 교리의 체계를 이해하는데 그 편의성을 제공해 준다. 교리의 대체(大體)를 드러내고 있는 교리도는 원불교 교리체계를 한눈으로 볼 수 있는 도해라는 점에서 중요한 역할에 더하여 교강의 상징성을 지니기도 한다. 교리의 체계를 쉽게 요해할 수 있는 원불교의 교리도는 크게 네 단계를 거치며 부분적으로 변천되어 왔다.『육대요령』(1932)의 교리도, 해방 전『불교정전』(1943)의 교리도, 해방 후 『불교정전』(1945)의 교리도,『교전』(1962)의 교리도로 정착되어 온 것이다. 교리도가 변천되어 온 이유는 교서결집과 더불어 교리의 체계화가 전개되었기 때문이다. 그러나 교리의 체계화에 따른 교리도 변천과정은 순탄하지만은 않았다. 교단창립이 일제하의 시국상황에 관련된 것인데, 변천과정에 나타난 쟁점사항을 파악해보려는 이유가 여기에 있다. 그것은 상단에 일원상이 아닌 「팔괘」, 그리고「양대은」과「진충보국」,「보은의 대요」, 원용된 불교의 화두들과「불교보급」, 보은의 대요를 대체한「사요」라는 항목들이다. 본 연구에서는 변천과정의 쟁점으로 부각된 교리도의 항목들에 대한 의미부여 및 해법의 방향은 무엇인가를 파악하는데 초점을 두었다. 이의 방향을 모색하는 기본원리로서 긍정적인 시각과 비판적 시각에서 접근하였다. 교리도가 변천된 일부 항목에 대한 해석학적 접근이 필요하며, 몇 차례 교서가 결집되면서 쟁점의 성찰과 더불어 해법이 제시된 경우도 있을 것이며, 아울러 개선을 통한 대안제시도 필요할 것이다. 앞으로도 교단의 역사가 전개되면서 교서의 재결집은 지속될 것이다. 교리의 체계화는 멈추지 않을 것이기 때문이며, 이에 따른 교리도의 바람직한 방향에서 변천, 정착될 수 있으리라 본다. 교학의 연구가 역사적 안목과 교판적 성격을 띠어야 하는 이유가 이와 관련된다. What is the Doctrinal Chart in religion and what is the importance of it? In Won Buddhist year 17(1922 C.E.), the Doctrinal Chart was first revealed in the early Won Buddhist scripture. It was an explanatory diagram and provided the convenience of understanding the system of doctrine in Won Buddhism. The Doctrinal Chart has an outline of doctrine so it shows an importance as a diagram, as well as a symbolic character for doctrinal structure. The Doctrinal Chart, which can easily explain the system of doctrines, has been partially changed through four stages: the Doctrinal Chart in Yukdaeyoryŏng(1932), the Doctrinal Chart in Pulgyo chŏngjŏn(1943) before Liberation of Korea, the Doctrinal Chart in Pulgyo chŏngjŏn(1945) after Liberation of Korea, and the Doctrinal Chart in Gyojŏn(1962). The change of the Doctrinal Chart is due to the development of the Won Buddhist order and the systematization of the doctrine. However, the change process of the Doctrinal Chart by the systematization of the doctrine did not go smoothly. This is related to the establishment of the Won Buddhist order and the situation of the state under the Japanese rule. In this sense, there were the issues that have emerged in the process of change: Bagua on behalf of Irwŏnsang on the top of the Doctrinal Chart, `Two Great Graces` and `Serve the Country with the Utmost Loyalty’, `Gists of Gratitude to Grace`, imported-Buddhist `Hwadu` and `Spreading of Buddhism`, and `Four Essentials` instead of `Gists of Gratitude to Grace.` The Study focused on defining the meanings of the issues from the change of process of the Doctrinal Chart and identifying the direction of the solution of them. It is necessary to approach from a positive perspective and a critical perspective as a basic principle. A hermeneutical approach to some changes in the Doctrinal Chart is necessary. There are some reflection and suggested solutions during the scriptures councils. Alternatives through improvement will be also necessary. As the history of Won Buddhism will be developed in the future, the re-council of scriptures will continue. This is because the systematization of the doctrine will not cease, and it can be changed and settled in the desirable direction of the doctrine. This is the reason why Won Buddhist study should have a historical perspective and a character for classification of teachings.

위장관의 간질종양에서 예후에 영향을 미치는 인자들에 관한 연구

이우용(Woo-Yong Lee),곽금희(Geumhee Gwag),양근호(Keun-Ho Yang),배병노(Byung-Noe Bae),김기환(Ki-Hwan Kim),한세환(Se-Whan Han),김홍주(Hong-Joo Kim),김영덕(Young-Duk Kim),김홍용(Hong-Yong Kim),임성직(Syung-Jik Lim) 대한외과학회 2005 Annals of Surgical Treatment and Research(ASRT) Vol.69 No.6