• Journal of Chest Surgery
• /
• 제35권9호
• /
• pp.659-663
• /
• 2002

이 논문은 비소세포폐암으로 새로이 진단 받은 환자에서 수술 전 병기판정에 통상적으로 골 스캔의 유용성에 대하여 연구하였다. 대상 및 방법: 서울대병원에서 2000년 1월부터 12월까지 비소세포 폐암으로 진단 받은 환자 258명을 대상으로 하였다. 수술 전 병기는 과반수에서(132명) 수술이 불가능할 정도로 진행된 상태였다. 골 원격전이의 임상 평가 항목으로 증상, alkaline phosphatase, calcium 등을 채택하였고 모든 환자의 골 스캔 결과를 검토하여, 각각의 민감도, 특이도, 음성 예측률, 양성 예측률을 산출하였다. 최종적인 골 전이의 판단은 일반 X-lay나 MRI 또는 골 생검을 기준으로 하였다. 골 전이만 없다면 수술이 가능한 (“potentially operable”)환자 126명의 임상 경과를 따로 분석하여 수술 대상 환자에서 골 전이에 대한 임상 평가의 중요성을 검토하였다. 결과: 골 전이에 대한 골 스캔의 민감도는 96%, 특이도는 75% 양성 예측률은 44%, 음성 예측률은 99%였고, 골 스캔에 대한 임상 평가의 민감도, 특이도, 양성 예측률, 음성 예측률은 각각 54%, 73%, 54%, 72%였다. 골 전이에 대한 임상 평가의 경우는 80%, 70%, 38%, 94%였다. 골 전이만 배제하면 수술이 가능하였던 “potentially operable”군 환자 126명에서 골 전이에 대한 임상 평가의 음성 예측률은 99%였다. 결론: 폐암 진단 당시 병기 결정에 있어서, 골 전이에 대한 철저한 임상 평가가 필수적이다. 특히 골 전이 외에 다른 수술 불가능 요인이 없는 환자군에서 임상 평가 결과 특이사항이 없을 경우 골 전이의 확률이 매우 낮아, 통상적인 골 스캔 없이도 근치적 수술을 고려할 수 있음을 확인하였다. 그러나 임상 평가 결과 양성인 경우에는 약 30% 이상의 환자에서 골 전이가 발견되므로 골 전이를 발견하기 위한 골 스캔은 물론 다른 여러 가지 진단법을 적극적으로 검토해야 한다.

• Journal of Hospice and Palliative Care
• /
• 제4권2호
• /
• pp.130-136
• /
• 2001

Purpose : It is very important to endow the cancer patients underwent chemotherapy with satisfactory quality of life (QOL). However, little is known about the factors influencing QOL during chemotherapy. Therefore, we designed this study to find out the factors influencing QOL in the cancer patients who underwent chemotherapy. Methods : Ninety-seven cancer patients were studied, prospectively. The patients' characteristics were as follows; median age(range): 48(19{\sim}83) years, male:female; 57:40, PS:0,1/2,3;55/42 patients, diagnosis(number): lymphoma (28), lung cancer (22), gastrointestinal cancer (18), sarcoma (12), breast cancer (12), gynecological cancer (5), Stage: I,II/III.IV;37/60 patients. We used EORTC QLQ-C30 questionnaires to evaluate QOL. EORTC QLQ-C30 scores were performed before the onset of chemotherapy and after the end of 3 cycles of chemotherapy. The correlation of these scores with performance status (PS), diagnosis, disease stage, response to chemotherapy, and regimen related toxicity was evaluated. Results : The responder group (CR, PR) demonstrated marked improvement of social functional and emotional scales to non-responder group (SD,PD) (P=0.024, 0.045). Non-hematologic regimen related toxicity such as mucositis, nausea and vomiting was significantly correlated with pain scale change (P=0.043). Other factors had no notable correlation with QOL changes. Conclusion : Our preliminary study results may suggest as follows. The response to chemotherapy is associated with the change of social functional and emotional scales and the severity of non-hematologic regimen related toxicity is associated with pain scale change.

• 기본간호학회지
• /
• 제7권3호
• /
• pp.415-428
• /
• 2000

The purpose of this study was to identify side effects of the vesicant chemotherapy. The study was designed to be a descriptive survey. The subjects of this study were 88 patients with various types of cancer, primary lung cancer(25.0%), advanced gastric cancer(25.0%), breast cancer(20.5%), etc. The mean age was 44.8 years old(range: 16-68). The questionnaire was completed by nurses of the outpatient unit and chemotherapy ward, and intravenous nurse specialist. The results of the study were as follows: 1) Chemotherapy was administered with a 23G scalp needle and 24G insyte. Injection site was dorsum of hands(64.7%), cephalic vein(19.3%). Successful rate for the first attempt was 88.6%. The first & second cycle chemotherapy was 29.5% each.. Mainly used drugs were Navelbine(34.1%), Adriamycin(20.5%). 2) Venous Problems after chemotherapy were pain(13.6%) incurred by venous, mainly due to the administration of Navelbine; redness at the inravenous site(12.5%) and itching sense 2.3% Non-venous problems were nausea (18.2%), dullness(14.8%), vomiting(8.0%), facial flushing(6.8%), anxiety(5.7%). Subjective discomforts after chemotherapy were generalized arm pain at the injection side(14.8%), dizziness(6.8%), weakness(5.7%) and general bodyache(5.7%). Systemic anaphylactic reaction and extravasation did not occur. 3) Non-venous problem after chemotherapy were nausea, vomiting & anorexia. Frequency of chemotherapy related to side effects were itching, facial flushing, and nausea(p< .05). Day of chemotherapy related to side effects were nausea & vomiting(p< .05). Site of chemotherapy related to side effects were redness(p< .05). Frequency of venipuncture related to side effects were redness(p< .05). Conclusively, cancer chemotherapy patients have had some venous problem. They need appropriate venous access devices for chemotherapy. And other non-venous problem will be managed appropriately. Further research was required to identify the rate of venous complication or side effects of vesicant chemotherapy.

• Journal of Chest Surgery
• /
• 제38권8호
• /
• pp.579-582
• /
• 2005

혼합대세포신경내분비암종은 매우 드문 폐암으로, 조직학적으로 대세포신경내분비암종의 종양세포외에 선암종, 편평세포암종, 거대세포암종 혹은 방추상암종의 구성세포를 포함한다. 저자는 간헐적 흉부 동통을 호소하는 44세 남자환자가 우측 중폐야의폐종양으로 내원하여서 시행한 우측 폐전적 출술과 종격동 림프절 곽청술 후 병리에서 선암종의 요소를 갖는 혼합대세포신경내분비암종이 진단되어 문헌고찰과 함께 보고하는 바이이다.

• Journal of Chest Surgery
• /
• 제34권5호
• /
• pp.426-429
• /
• 2001

Superior sulcus or pancoase tumor refers to any primarty lung cancer locating in thoracic inlet and causing pain in the periscapular region or aim. These originate inperipheral, and involve th extrapulmonary structures more than parenchyma of the lung. We experienced l case of superior sulcus tumor radically resected via anterior transcervical approach, which provide more safe exposure of cervical structures of thoracic inlet than classis posterolateral thoracotomy. Therefore were report this case with review of literature.

• Journal of Chest Surgery
• /
• 제24권8호
• /
• pp.757-764
• /
• 1991

We have observed 360 cases of spontaneous pneumothorax from January 1980 to May 1991 at the department of Thoracic and Cardiovascular Surgery, Chosun University Hospital. Males occupied 266 cases[73.9%] and females 94 cases[26.1%], and its ratio was 2.8: l. The age of patients ranged from neonate[5 days] to 84 years old. The site of pneumothorax was right in 50.3%, left in 43.3% and bilateral in 6.4%a. The clinical symptoms were frequently dyspnea, chest pain and coughing. The associated pulmonary lesions were shown pulmonary tuberculosis in 199 cases[55.3%], bullae in 54, pulmonary emphysema in 31, COPD in 17, pneumonia in 6, lung cancer in 5, paragonimiasis in 5, catamenial pneumothorax in 3 and unknown underlying pathology in 39 cases. The results of surgical management of spontaneous pneumothorax are followings: 288 out of 360 cases[80.0%] were cured by closed thoracotomy, 53 cases[14.8%] were cured by open thoracotomy. Open thoracotomy was the most effective procedure in persistent air leakage, recurrent pneumothorax, visible bleb or bullae on the chest X-ray, associated lesion, bilateral simultaneous pneumothorax, parenchymal incomplete lung expansion and bleeding after closed thoracotomy. The incidence of complication was developed in 10. ado and recurrent rate was seen in 10.6%. There was no operative death.

• Journal of Chest Surgery
• /
• 제22권5호
• /
• pp.800-805
• /
• 1989

The roentgenologic appearance of carcinoma of the lung may vary considerably from case to case. And when it forms cavitary lesion, it is frequently confused with benign lesions and treated conservatively. Twenty-seven patients with cavitary bronchogenic carcinoma were treated in our St. Marys Hospital during the period 1984-1989. There were 24 males and 3 females. They ranged in age from 43 to 76 years. Symptoms of cough, blood-streaked sputum or pleuritic chest pain were present in all patients one month to 6 months before hospital admission and 7 patients among them were delayed in recognition of the malignancy from z month to 3 months. Of 27 malignancies with cavity, 22[81.5 %] were squamous cell ca., 3[11.1%] were large cell ca., and 2[7.4%] were adenoca. And of 22 squamous cell carcinomas, 5 were well differentiated, 13 were moderately and 4 were poorly. All lobes except Rt. middle lobe were involved [RUL 2 cases, RLL 13 cases, LUL 3 cases and LLL 9 cases]. We explored 16 patients and performed 7 lobectomy, 4 bi-lobectomy, 2 pneumonectomy and 3 08zC. Post-operative follow-up examination of the resected 13 patients indicated one and two year survival rates of 69.1 %[9/13 cases] and 37.5%[3/8 cases] respectively, and now 6 survivors whose post-operative periods were from 4 months to 37 months.

• Journal of Oral Medicine and Pain
• /
• 제30권2호
• /
• pp.231-238
• /
• 2005

항암제의 연구는 화학물질에 민감한 암세포를 죽음에 이르게 하는 세포자멸사와 같은 다양한 세포기능에 초점을 맞추어 왔다. 그러나 약물이 유도한 세포의 죽음에 있어서 핵심적인 분자적 기작은 아직 잘 이해되지 않고 있다. Etoposide는 폐암과 고환암에 사용되는 항암제로서, 본 연구는 etoposide가 사람구강편평상피암종세포(OSC9)에도 세포독성효과와 세포자멸사를 일으키는지를 알아보기 위해 실행하였다. 이 실험에서 etoposide는 농도와 시간 의존적으로 OSC9 세포의 생존율를 현저하게 저해시켰다. TUNEL 염색과 Hoechst 염색을 이용한 핵의 형태학적 관찰에서는 etoposide에 의해 핵이 응축되고 분절되었다. p53의 발현은 48 시간에 증가했으며, etoposide 처리로 인해 caspase-3의 활성을 관찰할 수 있었으며, 그 기질에 해당되는 PARP 단백질은 116-kDa과 89-kDa으로 분절되었다. 위의 결과들은 OSC9 세포에서 etoposide가 유도한 세포자멸사는 caspase-3의 활성과 관련됨을 설명하고 있다.

• Journal of Hospice and Palliative Care
• /
• 제17권4호
• /
• pp.207-215
• /
• 2014

암의 다발성 뼈 전이는 폐암, 유방암, 전립선암, 신장암 등 다양한 암에서 흔히 관찰된다. 뼈 전이는 뼈에 발생한 이차적인 암으로 통증, 골절, 그리고 체중을 지지하는 뼈의 불안정성을 유발할 수 있어 신체활동과 삶의 질을 저하시킨다. 뼈 전이 치료 시 병리조직소견, 환자의 전신 상태, 침범 부위, 그리고 환자의 신경학적 소견등 다양한 요인을 고려하여 진통제, 수술, 항암화학요법 그리고 방사선 치료 등을 시행하게 된다. 외부 방사선 치료는 전통적으로 국소 뼈 전이로 인한 통증의 치료에 이용되어왔지만 특히 유방암이나 전립선암의 다발성 골형성 뼈 전이의 경우 $^{89}Sr$, $^{186}Re$, $^{188}Re$, $^{153}Sm$ and $^{117m}Sn$ 등의 방사성동위원소를 이용한 치료가 시행되고 있는데, 약제 투여의 간편함, 낮은 부작용, 방사능 피폭위험에서의 안전성, 높은 치료 반응 등 다양한 장점을 가진 치료로 임상에서의 유용성이 점차 증가되고 있다.

• Journal of Chest Surgery
• /
• 제24권1호
• /
• pp.72-82
• /
• 1991

From May 1978 to Sep. 1990, 106 patients who had been diagnosed as primary lung cancer and operated on at the Department of Thoracic & Cardiovascular Surgery, Han Yang University, were clinically evaluated. 1. The peak incidence of age was 5th decade of life[37.7%] and 6th decade[29.2%]. Male to female ratio was 3.8: l. 2. Most of symptoms were respiratory, which were cough, chest pain, hemoptysis, and asymptomatic cases were 2.9%. 3. Histopathologic classifications were squamous cell carcinoma[53.7%], adenocarcinoma [23.8%], bronchioloalveolar cell carcinoma[6.6%], undifferentiated large cell carcinoma[6.6%], small cell carcinoma[3.8%], adenosquamous carcinoma[3.8%] and others[1.8%]. 4. Methods of operation were pneumonectomy 49.1%[52cases], lobectomy 21%[22cases] bilobectomy[6cases], lobectomy with wedge resection[3cases], exploration 21.9%[23cases], and resectability was 78.3%. 5. Staging classifications were Stage I [22.6%], Stage II [11.3%], Stage IIIa[42.6%], Stage IIIb[21.7%] and Stage lV[1.6%]. Resectability by Stage; Stage I was 100%, II 100%, IIIa 84.4% and IIIb 30.4%. 6. Causes of most of inoperable cases were invasion of mediastinal structures and diffuse chest wall, and others were contralateral lymph node invasion and malignant pleural effusion. 7. Operative mortality was 6.7% which caused by arrhythmia, sepsis, pulmonary edema, and radiation pneumonitis. 8. On the long term follow up of the resectable cases, overall 1 year survival rate was 58.5 %, 2 year 39%, and 5 year 19.5%. Five year survival rate was 40% in Stage I, 25% in Stage II and 11.7% in Stage Illa. As for the method of operation, the higher 5 year survival rate was observed in lobectomies[33.3%] than in pneumonectomies[10.3%].