• Journal of Korean Neurosurgical Society
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• 제30권9호
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• pp.1144-1149
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• 2001

Schwannomas of the jugular foramen, originating from the glossopharyngeal nerve, vagus and accessory nerve represent approximately 0.17-0.72% of all intracranial tumor, and consists of 1.4-2.9% of all intracranial schwannomas. The clinical presentation of these tumors varies significantly according to originated nerve and it's growth pattern. Magnetic resonance(MR) image and temporal bone computed tomography(CT) scan have a major role for diagnosis of such tumor. The treatment of choice is total resection whenever possible. Generally, suboccipital approach is sufficient for the removal of the tumor, but in case with large size, combination of resection of petrous part of temporal bone with or without transection of sigmoid sinus is may be necessory. We have recently experienced one case of giant jugular foramen schwannoma and postoperative fatal complication in a 34-year-old male who was treated with combined posterior petrous and suboccipital approach with transection of sigmoid sinus

• 대한치과보철학회지
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• 제54권3호
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• pp.280-285
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• 2016

하악골의 결손은 선천적 기형, 외상, 골수염, 종양 절제술 등에 의하여 초래될 수 있는데, 이중 결손부위가 큰 경우는 주로 종양절제술에 의한 결손이다. 악골 결손 부위가 커질수록 저작, 연하, 교합, 발음 등에 큰 지장을 초래하게 되며 심미적으로도 불량하여 일상생활에 많은 불편을 주게 된다. 하악골이 절제된 후 그 자리에 완전히 재생되는 경우는 희박하며 인공적으로 재건해 주어야 한다 일반적으로 자가골 이식을 이용한 재건술을 시행하며, 통상적인 부분의치 혹은 총의치를 시행하거나, 지지할 수 있는 골을 얻은 상태에서 임플란트 고정성 보철, 임플란트 보조 국소의치 혹은 피개의치 등을 시행할 수 있다. 본 증례는 2004년 2월 25일, 편평세포암종 pT1N0M0, stage I로 진단 받고 구강악안면외과에서 동년 3월, 하악 좌측 부위 COMMANDO 수술(combined mandibulectomy and neck dissection operation), 광범위 절제술(wide excision), 하악골 변연절제술(marginal mandibulectomy), 견갑 설골 상부 경부청소술(supraomohyoid neck dissection, SOHND), 시행받은 환자를 하악 좌측 중절치, 하악 좌측 제3대구치 부위에 임플란트 식립하여 임플란트 보조 국소의치로 수복하였고 충분한 피개와 임플란트로의 적절한 교합력 분산을 통해 통상적인 국소의치보다 더 이로운 지지, 유지, 안정을 얻을 수 있었다. 현재까지 경과 관찰 기간은 4년 정도 되었으며, 하악 좌측 제3대구치 부위에는 주위골의 흡수양상이 관찰되어 주기적인 검진이 필요한 상황이다.

• Archives of Reconstructive Microsurgery
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• 제19권2호
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• pp.81-87
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• 2010

In surgical treatment of the malignant melanoma, radical resection and a sentinel lymph node biopsy are essential procedures to eradicate the tumor and to minimize the risk of local recurrence. For the reconstruction of skin defect after tumor resection, a skin graft has been generally performed procedure. However, if tendon or bone is exposed after tumor resection, simple skin graft is not enough for the coverage of the defect and additional procedure is mandatory. In this study, we reviewed the clinical results of 16 patients, who had been diagnosed with malignant melanoma of the limb and underwent surgical resection and reconstruction of the defect with various methods. The sentinel lymph node dissection was performed in all patients combined with radical excision of the tumor. In 11 cases of positive sentinel lymph nodes, further elective lymph node dissections were performed. The mean tumor invasion depth was 4.54 mm (2~10 mm), and AJCC stage II was most common (9 cases). The pedicled flaps were performed in 10 cases for the reconstruction of defects. All flaps were successfully survived without significant complications until the last follow up. In conclusion, a pedicled flap coverage is very useful reconstruction strategy for the soft tissue defects after radical resection of malignant melanoma.

• Journal of Chest Surgery
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• 제52권3호
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• pp.148-154
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• 2019

Background: This study investigated the clinical outcomes of surgical treatment of primary chest wall soft tissue sarcoma (CW-STS). Methods: Thirty-one patients who underwent surgery for CW-STS between 2000 and 2015 were retrospectively reviewed. The disease-free and overall survival rates were estimated using the Kaplan-Meier method, and prognostic factors were analyzed using a Cox proportional hazards model. Results: The median follow-up duration was 65.6 months. The most common histologic type of tumor was malignant fibrous histiocytoma (29%). The resection extended to the soft tissue in 14 patients, while it reached full thickness in 17 patients. Complete resection was achieved in 27 patients (87.1%). There were 5 cases of local recurrence, 3 cases of distant metastasis, and 5 cases of combined recurrence. The 5-year disease-free rate was 49%. Univariate analysis indicated that incomplete resection (p<0.001) and stage (p=0.062) were possible risk factors for recurrence. Multivariate analysis determined that incomplete resection (p=0.013) and stage (p=0.05) were significantly associated with recurrence. The overall 5- and 10-year survival rates were 86.8% and 64.3%, respectively. No prognostic factor for survival was identified. Conclusion: Long-term primary CW-STS surgery outcomes were found to be favorable. Incomplete microscopic resection and stage were risk factors for recurrence.

• 한국간담췌외과학회지
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• 제27권1호
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• pp.28-39
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• 2023

We aimed to compare resection and survival outcomes of neoadjuvant chemoradiotherapy (CRT) and immediate surgery in patients with resectable pancreatic cancer (RPC) or borderline resectable pancreatic cancer (BRPC). In compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards, a systematic review of randomized controlled trials (RCTs) was conducted. Random effects modeling was applied to calculate pooled outcome data. Likelihood of type 1 or 2 errors in the meta-analysis model was assessed by trial sequential analysis. A total of 400 patients from four RCTs were included. When RPC and BRPC were analyzed together, neoadjuvant CRT resulted in a higher R0 resection rate (risk ratio [RR]: 1.55, p = 0.004), longer overall survival (mean difference [MD]: 3.75 years, p = 0.009) but lower overall resection rate (RR: 0.83, p = 0.008) compared with immediate surgery. When RPC and BRPC were analyzed separately, neoadjuvant CRT improved R0 resection rate (RR: 3.72, p = 0.004) and overall survival (MD: 6.64, p = 0.004) of patients with BRPC. However, it did not improve R0 resection rate (RR: 1.18, p = 0.13) or overall survival (MD: 0.94, p = 0.57) of patients with RPC. Neoadjuvant CRT might be beneficial for patients with BRPC, but not for patients with RPC. Nevertheless, the best available evidence does not include contemporary chemotherapy regimens. Patients with RPC and those with BRPC should not be combined in the same cohort in future studies.

• Journal of Gastric Cancer
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• 제7권3호
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• pp.117-123
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• 2007

목적: 주위 장기를 침범한 위암의 수술적 치료는 주위 장기의 합병 절제를 포함한 광범위 확대 위절제술을 하거나, 또는 위공장문합술이나 위절제술을 통한 고식적 수술을 시행하게 된다. 그러나 고식적 수술을 할 경우 정확한 T, N 병기를 알 수 없기 때문에 환자의 예후를 예측하는 것이 적절하지 않다. 본 연구에서는 주위 장기 침윤으로 합병절제를 시행하여 최종적인 TNM 병기 결정이 이루어진 환자들의 예후를 분석하였다. 대상 및 방법: 1983년부터 2002년까지 고려대학교 의과대학 외과학교실에서 위암으로 수술 받은 환자 2,452명 중 수술 중 주위 장기의 직접 침윤이 발견되어 합병 절제를 시행한 102명의 환자를 분석하였다. 결과: 단변량 분석에서 암의 위치, 조직학적 분화도, 위벽 침윤도, 림프절 전이 정도, 원격전이 여부, 병리학적 병기, 근치절제 여부 및 침범한 장기의 개수에 따라 생존율의 차이가 있었으며, 환자의 나이, 성별, 위 절제범위, Borrmann 분류, 암의 크기, 림프절 곽청 범위와 절제 림프절의 개수, 합병 절제한 장기의 종류 및 개수 등은 생존율의 차이를 나타내지 않았다. 다변량 분석에서는 암의 위치, 근치절제 여부, 림프절 전이 정도가 독립적인 예후인자였다. 결론: 위암의 주위 장기로의 직접 침윤이 의심되더라도 실제 T4인 경우는 64.7%이었다. 따라서 주위 장기의 침윤이 의심되더라도 적극적인 절제술로 가능하면 근치 절제술을 하도록 노력하는 것이 정확한 병기 결정을 통한 예후 예측과 생존율의 향상을 위해서 필요하다.

• Journal of Chest Surgery
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• 제9권2호
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• pp.193-197
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• 1976

Pulmonary aspergillosis is a rather uncommon disease as a saprophytic infection, mostly producing significant repeated hemoptysis and frequently combined with chronic debilitating disease or cavitary lung disease such as pulmonary tuberculosis, lung abscess and bronchiectasis. Evaluation of the characteristic symptom, X-ray finding composing intracavitary fungus ball with crescent air patch and immunologic test constitute essential part of diagnosis. Surgical resection is a successful treatment combined with administration of anti-fungal agent to eradicate completely. We present one case of surgically removed pulmonary aspergillosis showing fungus ball, superimposed on underlying pulmonary tuberculosis, with review of the related literatures.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제17권4호
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• pp.257-262
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• 2014

Severe combined immunodeficiency (SCID) is a life-threatening syndrome of recurrent infections and gastro-intestinal alterations due to severe compromise of T cells and B cells. Clinically, most patients present symptoms before the age of 3 months and without intervention SCID usually results in severe infections and death by the age of 2 years. Its association with intestinal anomalies as multiple intestinal atresias (MIA) is rare and worsens the prognosis, resulting lethal. We describe the case of a four year-old boy with SCID-MIA. He presented at birth with meconium peritonitis, multiple ileal atresias and underwent several intestinal resections. A targeted Sanger sequencing revealed a homozygous 4-bp deletion ($c.313{\Delta}TATC$; p.Y105fs) in tetratricopeptide repeat domain 7A (TTC7A). He experienced surgical procedures including resection and stricturoplasty. Despite parenteral nutrition-associated liver disease, the patient is surviving at the time of writing the report. Precocious immune system assessment, scrutiny of TTC7A mutations and prompt surgical procedures are crucial in the management.

• Journal of Digestive Cancer Research
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• 제2권1호
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• pp.32-36
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• 2014

We report a patient with combined hepatocellular-cholangiocarcinoma confined in the common hepatic duct and scirrhous type of hepatocellular carcinoma in the caudate lobe of liver simultaneously. The patient was a 55-yearsold Korean man with hepatitis B virus (HBV) carrier who was referred from a local hospital due to detected liver mass on abdominal computed tomography (CT). He has presented jaundice and weight loss for the previous 3 weeks. Laboratory examination showed AST/ALT elevation and hyperbilirubinemia. HBsAg was positive. The tumor marker study showed elevated AFP and DCP, not CEA and CA 19-9. Abdominal CT disclosed an about 2.1×0.9 cm sized soft tissue density in hilum with both intrahepatic duct (IHD) dilatations and an about 3×2.1 cm sized arterial enhancing lesion at segment 8 of the liver. Patient received 15 cycles of Gemcitabine/Cisplantin chemotherapy from February 27, 2013 to December 31, 2013. Caudate lobectomy of liver, segmental resection of bile duct and Roux-en-Y hepaticojejunostomy was performed on February 10, 2014. The final pathologic report showed double primary liver cancer, combined hepatocellular-cholangiocarcinoma in common hepatic bile duct and scirrhous type of hepatocellular carcinoma in segment 1 of the liver. This is a very unusual case in which combined hepatocellular-cholangiocarcinoma confined in the large bile duct and two rare hepatic cancers coexisted.

• Journal of Chest Surgery
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• 제44권4호
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• pp.311-313
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• 2011

Hemangiomas that arise in cervical esophagus are extremely rare, representing 3.3% of all benign esophageal tumors. Although endoscopic mucosal resection (EMR) and potassium titanyl phosphate/yttrium aluminum garnet (KTP/YAG) laser therapy have been used with success for small tumors, the safety and efficacy in the case of large tumors remains uncertain. We report the successful resection of cervical esophageal hemangioma through a cervical esophagotomy in a patient with thyroid cancer who needed a cervical collar incision.