• Korean Journal of Adult Nursing
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• v.18 no.1
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• pp.115-124
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• 2006

Purpose: The purpose of this study was to propose a theoretical model of hope commonly held by the cancer patients just after surgery, under the assumptions that hope of those patients is not only realistic and disease oriented but in dialectical circulation. Method: A theoretical model was generated through 4 steps: exploring a hope structure by synthesizing the relevant hope structures expressed in Kim and Tae's studies, in-depth literature review, examining the meanings of the concepts consisted of the structure in use and their causal relations in logical adequacy, proposing a theoretical structure through synthesizing the causal relations, and diagramming the structure. Results: The proposed theoretical model involves concepts such as Cancer Related Uncertainty (CRU), Efforts to Find out the Possibility of Cure or Recovery (EFPCR), and Hopefulness or Hopelessness. The 'EFPCR' is stipulated as 'Behaviors Related to Looking for Evidences or Cues (BRLEC)' and 'Formation of Cognitive Schema (FCS)'. In the model, Hopefulness is directly influenced by 'CRU in low', which is affected by 'FCS in good' from the result of EFPCR started with 'CRU in increase' while 'CRU with increase' from the result from EFPCR has direct effect on Hopelessness. Conclusion: The theoretical model would be used to enhancing hope of the cancer patients in post-operation.

• Journal of Chest Surgery
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• v.39 no.2 s.259
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• pp.134-139
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• 2006

Background: Complications after surgery for esophageal cancer are various and not rare. Among them, pulmonary complication is well known as one of the most important insults which has negative influence on the postoperative course and results in mortality. So we attempted to analyze the factors which may have relation to postoperative pulmonary complication. Material and Method: The retrospective study was undertaken in 87 patients who underwent curative surgery for esophageal cancer from Jan. 1996 to Aug. 2005. We divided them into two groups, patients with pulmonary complication (group A, n=28), without pulmonary complication (group B, n=59). Statistical analysis was performed with Fisher's exact test. Result: The postoperative pulmonary complication developed in 28 patients ($32\%$). There was no difference between two groups in past medical history, preoperative pulmonary function, surgery time, anastomosis method, pathologic stage, and trial of neoadjuvant therapy. Age and incidence of cervical anastomosis were significantly higher in group A (p=0.001, p=0.023). The rate of routine postoperative ventilator care was significantly higher in group S (p=0.007). Chest tube indwelling time and hospital stay were significantly longer in group A (p=0.011, p=0.001). There were 6 postoperative deaths ($6.8\%$) and 5 deaths were related to pulmonary complication. Pneumonia was the most common cause of death and MRSA (methicillin resistant staphylococcus aureus) was the most common organism in sputum culture. Conclusion: Pulmonary complication after esophageal cancer surgery was the most important cause of death. Pulmonary complication was closely related to patient's age and cervical anastomosis. We think postoperative routine ventilator care is helpful for prevention of pulmonary complications, especially MRSA pneumonia, and reducing mortality.

• Journal of the Korean Society of Radiology
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• v.13 no.4
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• pp.629-635
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• 2019

In term of the factors affecting psychosocial adjustment of breast cancer patients, their quality of life after surgical operation, radiation, and chemotherapy were systematically meta-analyzed. As a result, their qualities of life of the patients that had radiation therapy was the lowest right after the therapy, and gradually increased after the end of the therapy. However, after six months, their quality of life failed to reach the same level before the therapy. They had depression and side effects the most right after the therapy, and somewhat reduced them after the end of the therapy. In case of surgical operation, the more they were educated, the more they had psychosocial adjustment, and the more they had a medical examination and took out an insurance policy, the more they had psychosocial adjustment. In case of chemotherapy, their cognitive function is influenced so that they have impairments in memory, learning, and thinking stages. Since subjective cognitive impairment has a relationship with depression, it is necessary to monitor depression of chemotherapy patients. Given the results of this systematic meta-analysis, when three types of therapies (surgical operation, radiation therapy, and chemotherapy) are applied to patients with breast cancer, it is necessary to recognize their psychosocial adjustment, depression, anxiety, and quality of life in the nursing and radiation therapy fields and thereby to introduce an intervention program for a holistic approach.

• Journal of Chest Surgery
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• v.34 no.2
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• pp.138-147
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• 2001

배경: 폐암발생에 EGF의 자가 분비는 암의 성장과정에 직, 간접적인 영향을 주고 있으며, TNF-$\alpha$는 면역 반응의 급성체로서 폐암의 발생을 억제하고 이미 발생한 폐암종의 치료에도 이용되고 있는 실정이다. 폐암 조직과 혈장에서 epidermal growth factor(EGF)와 tumor necrosis factor-$\alpha$(TNF-$\alpha$)를 면역 방사선 분석법을 이용하여 정량분석 하여 발현 정도를 분석해보고자 하였다. 대상 및 방법: 폐암환자 20례와 양성종양 및 육아종 환자 4례에 대해서 AJCCS에 의한 조직학적 분류와 TNM 분류에 따라 구분하여 절제수술을 받은 환자를 대상으로 수술전 혈액을 채취하고 수술직후 적출한 표본을 암이 없는 건강하다고 판단되는 대조조직과 폐암조직에서 일정량의 조직을 절취하여 액화질소 내에 실험시까지 급속 냉동보관 하였다. 수술후 혈액을 재 채취하여 혈장을 분리하여 냉동고에 검사시까지 보관하였다. EGF의 정량은 Human Epidermal Growth Factor kit(Amersham Phamacia Biotech, England)를 사용하였으며, TNF-$\alpha$ 정량은 TNF-$\alpha$ IRMA kit(Biosouce, Belgium)을 사용하여 IRMA 방법으로 각각 정량분석하여 표현유무를 연구한 결과 다음과 같은 결론을 얻었다. 결과: 1. 대조조직, 양성종양 및 육아종과 폐암 수술전후의 조직과 혈청 모두에서 EGF와 TNF-$\alpha$가 발현되었다. 2. EGF와 TNF-$\alpha$의 농도는 대조조직과 양성종양(0.11$\pm$0.06 ng/ml, 20,3$\pm$9.08 pg/ml)에 비하여 폐암조직(0.13$\pm$0.05 ng/ml, 34.34$\pm$47.74pg/ml)에서 유의하게 높은 농도가 발현되고 있었다. 3. 폐암중 선암조직에서 특히 TNF-$\alpha$(80.92$\pm$104.08 ng/ml)의 발현이 강하게 나타났다. 4. 혈청내의 EGF와 TNF-$\alpha$의 발현되는 양이 조직내의 양보다도 높았다. EGF는 5.7배정도 TNF는 1.3배정도 강하게 표현되었다. 5. 폐암의 조직학적 종류에 따라서 EGF는 거의 차이가 없었으나 TNF-$\alpha$ 정량치에는 차이가 있었다. 6. TNM stage가 진행함에 따라 EGF는 농도가 증가하였고 TNF-$\alpha$는 오히려 감소하는 반대되는 교차현상이 있었다. 7. 수술직후 EGF는 증가하였으나 TNF-$\alpha$는 오히려 감소하였다. 결론: 결론적으로 저자는 암조직과 대조조직간에 EGF와 TNF-$\alpha$의 표현량의 차이가 있음을 관찰하였으며 또한 조직과 혈청사이에도 표현량에 차이가 있으며 조직보다도 오히려 혈청내의 농도가 높다는 사실을 관찰하였다. EFG와 TNF-$\alpha$는 정상조직이나 양성조직과 폐암조직 모두에서 분비작용되는 cytokines으로 세포기능에 따라 다양하게 표현이 되며 계속적인 연구로서 밝혀야만 할 과제라고 판단된다.

• The Korean Journal of Nuclear Medicine Technology
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• v.17 no.2
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• pp.31-36
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• 2013

Purpose: Measure gastric emptying time (GET: Gastric Emptying Time) is a non-invasive and quantitative evaluation methods, mainly by endoscopic or radiological examination confirmed no mechanical obstruction in patients with symptoms of congestion is checked. Such tests are not common gastric emptying time measured esophageal cancer patients (who underwent esophagectomy) patients after surgery for gastric emptying time was measured test. And the period of time for more than one year after the gastric emptying time measurement was performed. By comparing the two kinds of tests in the chest cavity after surgery as the evaluation of gastrointestinal function tests evaluate the usefulness of GET, and will evaluate the characteristics of the image. Materials and Methods: 93 patients who underwent esophagectomy with gastric emptying time measurement of subject tests immediately after surgery and after 1 year or longer were twice. Preparation of the patient before the test is more than 12 hours of overnight fasting is important, in addition to the medicine or to stop smoking, and diabetes insulin injections should be early in the morning is ideal to test. Generally labeled with $^{99m}Tc-DTPA$ resin which is used to make steamed egg, seaweed and fermented milk with a high viscosity after eating, three hours in the standing position was measured. Evaluation of gastric emptying curves on the way intragastric radioactivity level by 50% the time (half-time [T1/2]) was calculated, based on the half-life was divided into three steps: over 180 minutes was defined as delayed gastric emptying, within 180minutes was defined as intermediate gastric emptying and when all the radioisotopes were dumped into the jejunum as soon as swallowed, was defined as rapid gastric emptying. Results: Gastric emptying time of a typical images stomach of antrum and fundus additional images appear stronger over time move on to the small intestine. but esophageal cancer who underwent esophagectomy side of the thoracic cavity showed a strong image. Immediately after surgery, the half-time (T1/2) of rapid gastric emptying appeared to 12.9%, intermediate gastric emptying appeared to 52.7%, delay gastric emptying appeared to 34.4%. After more than a year the results of the half-life after surgery, 67% of rapid gastric emptying to intermediate gastric emptying was changed, 69% of delay gastric emptying to intermediate gastric emptying changed. Intermediate gastric emptying worse in patients rapid gastric emptying and the delay gastric emptying is 24% in the case. Conclusion: Esophagectomy for esophageal cancer who underwent half-time measurement test (T1/2) rapid gastric emptying and delay gastric emptying are the result of the comparison over time, changes were observed intermediate gastric emptying. Mainly seeing of gastric emptying time measurement in the esophagus instead of thoracic cavity to check the evaluation of gastrointestinal function can be useful even means. And segmentation criteria and narrow time interval of checking if more accurate information and analysis of the clinical diagnosis and evaluation seems to be done.

• Korean Journal of Adult Nursing
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• v.15 no.1
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• pp.78-87
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• 2003

Purpose: The purposes of the study were 1) to examine what relationships exist between PTE(perceived treatments effect) and PPS (perceived physical suffering) as the independent variables and hope as the dependent variable and 2) to examine whether PTE and PPS predict hope in cancer patients in their post-operative period within the Stotland's hope theory. Method: The Visual Analog Scale was used for measuring PTE and PPS and the Kim & Lee's Hope Scale which had acceptable reliability and validity was used for measuring hope. The data was collected from 38 hospitalized cancer patients who were in the post-operative period with a convenient sampling method. Result: There was a significant positive relationship between hope and the PTE in the low PTE group. There was a significant negative relationship between hope and the PPS in the low PPS group. There were no significant relationships between hope and the PTE in the high PTE group, and between hope and the PPS in the high PPS group. And the PTE explained hope with 71.2% of the variance in the low PTE group. Conclusion: PTE in the low PTE group and PPS in the low PPS group were identified as the factors to explain hope.

• Investigative Magnetic Resonance Imaging
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• v.18 no.2
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• pp.133-143
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• 2014

Purpose : The aim of this study was to determine the magnetic resonance imaging (MRI) features associated with re-excision due to the presence of a positive margin after breast conserving therapy (BCT) in breast cancer patients. Materials and Methods: We reviewed the records of 286 consecutive breast cancer patients who received BCT between January 2006 and December 2007. Among 246 patients who had undergone BCT, 38 (15.4%) underwent immediate further surgery due to positive margin status. We analyzed the MRI findings using ${\chi}^2$ test, Fisher's exact test and t tests. Multivariate logistic regression was conducted for prediction of re-excision. Results: Tumor size (p < 0.001), lesion multiplicity (p = 0.003), and non-mass-like enhancement (NMLE) type on MRI (p < 0.001) were associated with margin involvement in BCT. On preoperative MRI, larger size (${\geq}5cm$) (odds ratio = 2.96), NMLE (odds ratio = 3.81), and multifocal lesions (odds ratio = 2.54) were positively associated with re-excision. In cases involving NMLE, segmental distribution was associated with a greater likelihood of immediate re-excision. Conclusion: Larger size, multiplicity, and NMLE on MRI are significantly associated with re-excision after BCT in breast cancer patients. For NMLE lesions, the segmental distribution pattern was predictive of re-excision.

• Journal of Chest Surgery
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• v.35 no.4
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• pp.296-302
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• 2002

The classic approach for esophagectomy is via the combined thoracic and abdominal approach. Controversy exists whether patients with esophageal carcinoma are best managed with Ivor-Lewis esophagectomy(ILO) as combined thoracic and abdominal approach or transhiatal esophagectomy(THO). The THO approach is known to be superior with respect to operative time, severity of leak, morbidity/mortality, and length of stay, but may represent an inferior cancer operation as a result of survival disadvantage due to inadequate mediastinal clearance compared with ILO. Accordingly, we reviewed the results of our esophageal resections to compare these outcome parameters for each operative approach. Material and Method: From January 1993 to July 2001, We performed a retrospective review of all esophagectomies performed at Keimyung University Dongsan ·Medical Center; 27 underwent THO, and 45 underwent ILO Result: The two groups were comparable in terms of age, sex, and stage of the disease. Mean tumor length and mean operative time were 3.81cm and 354 minutes for THO versus 5.31cm and 453 minutes for ILO, respectively (p<0.01 and p<0.001). Respiratory complications were 11.1% for THO versus 35.6% for ILO(p<0.05). Hospital mortality was 11.1% for THO versus 22.2% for ILO. There were no significant differences between THO and ILO with respect to other types of complications, amount of blood transfusion, leak and stricture rates, and hospital stay. Overall long-term survival at 5 years was 37%, respectively. Conclustion: There was no significant difference in long-term survival of patients of both operative approach. ILO had significant difference in respiratory complications associated with hospital mortality. Hence, THO is a valid alternative to ILO for well selected patients. And either approach appears to be acceptable depending on the surgeons, preferences and experiences.

• Journal of Chest Surgery
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• v.30 no.9
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• pp.920-926
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• 1997

Remarkable effect of pain relief and prevention of the postoperative Complications after thoracotomy has been achieved by continuous intravenous analgesia. This study was carried out with thirty patients who underwent posterolateral thoraco tony. The patients were divided into three groups: Group I(n= 10), the patients with intermittent intramuscular analgesia(piroxicam 20 mg), Group II(n=10), the patients with continuous epidural analgesia(0.5% bupivacaine 30m1 + normal saline 30 ml + morphine 10 mg), and Group III(n= 10) the patients with controlled intravenous infusion of analgesics(fentanyl 2500 mfg +normal saline 10 ml). The results w re as follows; 1) There were no significant changes of vital signs, between groups. 2) Tidal volume and FVC were significantly improved in the group II and III compared with the group I during the first postoperative day. 3) A significant reduction of immediate post-thoracotomy pain was achieved in the group II and III compared with the group I. 4) The limitation of motion in the operative side was less in the group II and III compared with the group I. 5) A signi(icant reduction of the postoperative analgegics consumption was noticed in group II and III. 6) Significant complications were not occured during follow-up period in all groups.

• Journal of Chest Surgery
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• v.36 no.4
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• pp.267-272
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• 2003

Background: Common treatment modalities for tracheal stenosis include conservative methods such as repeated balloon dilatation, removal of obstructive material through bronchoscopy and T-tube insertion as well as operative treatment methods. Recent advances in surgical approaches through tracheal resection and end-to-end anastomosis have been reported to give better functional and anatomical results. Material and Method: Between March 1990 and July 2002, 41 patients who received tracheal resection and end-to-end anastomosis at Asan Medical Center, University of Ulsan were studied retrospectively. Result: The causes for tracheal resection and end-to-end anastomosis included 26 cases of postintubation stenosis, 10 cases of primary tracheal tumors (3 benign, 7 malignant), 1 case of endobronchial tuberculosis, 2 cases of traumatic rupture, and 2 cases of tracheal invasion of a thyroid cancer, Of the 41 patients who received tracheal resection and reconstruction, 29 received tracheal resection and end-to-end anastomosis, and 12 received laryngotracheal anastomosis with cricoid or thyroid cartilage resection. Four of these patients received supralaryngeal release. The average length of the resected trachea was $3.6{\pm}1.0$cm. Of the 41 patients who received tracheal resection and end-to-end anastomosis, 30 (73.2%) experienced no postoperative complications, and 8 (19.5%) experienced granulation tissue growth and/or minor infections which improved after conservative management. Good or satisfactory results were therefore achieved in 92.7%. Complications included repeated granulation tissue growth in 7, wound infection in 2, anastomotic site dehiscence in 2, restenosis resulting in dyspnea on exertion in 1, and repeated postoperative aspiration requiring retracheostomy in 1. There was no early postoperative mortality. There were 3 cases of hospital death. Conclusion: In cases of proper length of tracheal lesion, excellent results were obtained after tracheal resection and end-to-end anastomosis. But, granulation tissue growth is so serious complication, it is necessary for continuous study and efforts to prevent it.