Lung Cancer in the Explanted Lung of the Recipient in Lung Transplantation

Undetected lung cancer in the explanted lungs may significantly complicate the outcome of a patient following lung transplantation. The incidence and survival of undetected primary lung cancer in the explanted lungs have not been studied in a large cohort of patients. We have experienced a 63 year old male with a diagnosis of idiopathic pulmonary fibrosis who underwent bilateral sequential single lung transplantation in whom primary lung cancer was detected in the explanted lung of the recipient. A retrospective review of all radiological imaging study was correlated with the pathology of the explanted lung in order to localize the primary focus of the tumor. The patient was diagnosed as squamous cell carcinoma, stage IIIA (T1N2M0). This patient is currently under the close surveillance, and we recommend computerized tomograms of the chest immediately prior to lung transplantation in order to avoid the incidence of undetected primary lung cancer.ope

해외직구 소비자의 재이용의도에 관한 연구

학위논문 (석사)-- 서울대학교 대학원 생활과학대학 소비자학과, 2017. 8. 김소연.국 문 초 록 해외직구 소비자의 재이용의도에 관한 연구 해외직구는 새로운 유통채널로서 보편적인 소비형태로 자리잡아 가고 있다. 소비자들이 해외직구를 편리하고 안전하게 이용할 수 있는 환경을 마련할 필요하며, 이를 위해 해외직구 소비자의 인식과 이용행동에 대하여 심층적으로 살펴보는 것이 필요하다. 본 연구는 해외직구를 통해 상품 구매한 경험이 있는 소비자를 대상으로 해외직구 재이용의도에 영향을 주는 요인이 무엇인지를 파악하고자 하였다. 이를 위해 첫째, 해외직구 이용행태를 살펴보고, 둘째, 해외직구 소비자의 효용 및 위험지각과 재이용의도 수준을 살펴보고자 하였다. 그리고 해외직구 이용행태에 따라 효용 및 위험 지각과 재이용의도에 차이가 있는지를 알아보고, 소비가치에 따라 재이용의도의 차이가 있는가를 알아보았다. 마지막으로 해외직구 소비자의 소비가치, 효용과 위험지각이 재이용의도에 미치는 영향을 밝혔다. 자료의 분석은 SPSS 22.0 프로그램을 이용하여 빈도분석, t-test, 분산분석, 요인분석, 위계적 회귀분석을 통해 분석하였다. 본 연구의 분석결과 및 결론은 다음과 같다. 첫째, 소비자들이 해외직구 효용에 대하여 모두 3점 이상으로 긍정적으로 평가하고 있었고, 그 중 경제적 효용과 제품 다양성 효용에 대하여 더 긍정적으로 인식하고 있었으며, 쾌락적 효용에 대해서는 상대적으로 낮게 인식하고 있었다. 이는 한국소비자원의 조사결과와 같이 가격 비용 절감은 위해서 해외직구를 이용하는 유인이 가장 큰 것을 시사하였다. 둘째, 소비자가 해외직구 위험 중 교환 및 환불위험이 가장 높게 인식하였으며 그 다음으로는 제품신뢰성 위험, 배송위험, 결제위험의 순으로 나타났다. 해외직구 소비자에게 결제위험은 다른 위험에 비하여는 비교적 낮게 인식되고 있었다. 해외직구 형태가 복잡해지며, 유통단계에 개입해 있는 주체들이 많아지면서 교환/환불에 대한 책임을 지는 주체가 명확하지 않아 소비자들이 이러한 위험을 더욱 높게 지각하는 것으로 생각할 수 있다. 또한 교환 및 환불의 절차가 복잡하고 시간이 너무 오래 걸린다는 점도 문제점으로 지적할 수 있다. 셋째, 해외직구 이용행태에 따라 효용 차이를 살펴본 결과, 해외직구 형태에 따라 제품품질효용에 유의한 차이가 나타났다. 해외 직접구매를 자주 이용하는 집단이 해외 구매대행과 해외 배송대행을 이용하는 집단보다 제품품질효용을 더 높게 지각한 것으로 나타났다. 또한 이용빈도에 따라 편리적 효용 및 쾌락적 효용에 유의한 차이가 있었다. 이용회수가 많을수록 해외직구의 편리적 효용과 쾌락적 효용을 더 높게 지각하였다. 넷째, 해외직구 이용행태에 따라 위험 차이를 살펴본 결과, 지난 1년 동안 해외직구 총 구매금액이 200만원 초과인 집단이 101-200만원인 집단보다 결제위험을 낮게 인식하였다. 또한 해외직구를 월 3회 이상 사용하는 집단이 월 1-2회 사용하는 집단보다 배송 위험을 더 낮게 지각하였으며, 해외직구를 월 1회 미만 이용하는 집단이 월 1-2회 이용하는 집단보다 결제 위험을 낮게 지각하였다. 다섯째, 해외직구 재이용의도가 총 구매금액에 따라 차이가 있었다. 100만원 이상이 50만원 이하보다 재이용의도가 높게 나타났다. 그리고 자율지향에 따른 재이용의도 집단 간 유의한 차이가 나타났다. 자율지향이 높게 추구하는 집단이 재이용의도가 높은 것으로 나타났다. 또한 해외직구 효용에 따라 재이용의도의 차이가 있었으나 위험에 따른 차이가 발견되지 않았다. 여섯째, 위계적 회귀분석을 통해 해외직구 재이용의도에 영향을 미치는 요인을 알아본 결과, 소비가치 중 자율지향과 소속지향, 경제적 효용, 편리적 효용, 제품다양성 효용이 재이용의도에 영향을 영향을 미쳤다. 그러나 해외직구 위험은 재이용의도에 유의한 영향을 미치지 않았다. 이는 소비자들이 해외직구 위험은 높게 인식하면서도 이를 크게 고려하지 않고 해외직구를 이용하고 있는 것으로 해석할 수 있다. 따라서 소비자들은 해외직구를 이용할 때 위험에 대하여 신중히 고려할 필요가 있으며, 해외직구 위험으로 인하여 발생할 수 있는 소비자 문제에 대처할 수 있는 역량이 필요함을 알 수 있었다. 본 연구는 해외직구의 효용 및 위험을 살펴봄으로써 해외직구에서 발생할 수 있는 소비자 문제, 소비자 불편을 해소하고, 소비자가 해외직구를 더 편리하게 이용할 수 있는 환경을 마련하는데 기초자료로 활용될 수 있다는 의의를 가진다. 또한 소비자들이 해외직구 이용을 결정하는데 있어 해외직구의 효용과 위험 요소를 어떻게 활용하고 있는지를 파악하고 소비자 교육 및 마케팅 자료를 제공하였다.제 1 장 서 론 1 제 1 절 문제 제기 1 제 2 절 연구 목적 4 제 2 장 이론적 배경 6 제 1 절 해외직구의 개념 및 현황 6 1. 해외직구의 개념과 유형 6 2. 해외직구의 현황 8 제 2 절 해외직구 이용의도에 영향을 미치는 요인 9 1. 소비가치 9 2. 해외직구 효용 12 3. 해외직구 위험 17 제 3 장 연구문제 및 연구방법 22 제 1 절 연구문제 및 연구모형 22 1. 연구문제 22 2. 연구모형 23 제 2 절 자료수집 및 연구방법 24 3. 자료의 분석방법 37 제 3 절 조사대상자의 특성 37 제 4 장 연구결과 43 제 1 절 소비자가 지각한 해외직구 효용 및 위험 43 1. 해외직구에 대한 효용 및 위험지각 수준 43 2. 해외직구 이용형태에 따른 해외직구 효용 및 위험의 차이 45 제 2 절 해외직구에 대한 재이용의도 50 1. 해외직구에 대한 재이용의도의 수준 50 2. 이용행태에 따른 재이용의도의 차이 51 3. 소비가치에 따른 재이용의도의 차이 52 4. 효용 및 위험지각에 따른 재이용의도의 차이 53 제 3 절 해외직구 재이용의도에 대한 영향요인 분석 56 제 5 장 결론 61 제 1 절 요약 및 결론 61 제 2 절 제언 65 참고 문헌 67 부록 71 ABSTRACT 82Maste

Multi-loculated Pericardial Mesothelioma -A case report-

Primary pericardial mesothelioma is extremely rare and the incidence is low among the mesotheliomas that originate from other parts of the body. The prognosis of the tumor is unfavorable due to its late presentation, difficulties in early diagnosis and complete resection, and the limited treatment options. Herein, we report a case of pericardial mesothelioma. The patient is a 55-year-old woman who presented with chronic cough and dyspnea. During the examination, pericardial effusion was found and pericardial window formation was followed. She visited our hospital because of persistent dyspnea, with right shoulder and chest pain. Four discrete masses were discovered in the chest CT. CT guided-fine needle aspiration biopsy was negative for malignancy. Right exploratory thoracotomy and partial resection of 3⁓3 cm mass abutting pericardium was performed and was histologically diagnosed as malignant mesothelioma, biphasic type. Pericardial mesothelioma is rare, but it should be remembered as an important differential diagnosis in patients with persistent pericardial effusion and symptoms of dyspnea and constrictive pericarditis.ope

A case of multiple endocrine neoplasia type 1 with thymic carcinoid tumor

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant tumor syndrome. Thymic carcinoid tumors in MEN1 are not common and their natural history is little known. But development of thymic carcinoid tumors is important because in 1993, they were identified as a frequent case of death. There has not been a report of case in Korea so far. We encountered a case of thymic carcinoid in MEN1. A 42 year old man was referred presenting with diabetes of 12 years duration. Abnormal findings in his blood chemistry were hypercalcemia and hyperprolactinemia. 99mTc-sestamibi scintigraphy showed parathyroid adenoma and hyperplasia. Sella MRI showed pituitary macroadenoma. Abnormal CT scan demonstrated multiple pancreas islet cell tumors, bilateral adrenal tumor and thymoma. Subtotal parathyroidectomy with thymectomy was perfomed and thymic carcinoid was confirmed. This is the first report of thymic carcinoid with MEN1 in Korea.ope

(The) development of medial lamellar unit in aortic and pulmonary arterial wall of human fetuses.

의과학사업단/석사[한글] 발생 중 동맥의 구조는 다양한 혈역학적 요인에 의하여 변화한다. 인태아 대동맥 벽에서 내측층판단위(medial lamellar unit)의 수는 태아의 발생과 함께 증가하며 대동맥궁에서 복부대동맥 하부로 갈수록 감소함이 보고되었다. 출생 직후 폐동맥은 대동맥과 구조가 별 차이 없지만 출생 후 순환의 변화로 인하여 중간층의 두께가 폐동맥이 대동맥의 0.4 - 0.8배에 불과하게 된다고 알려져 있다. 그러나, 출생 전 태아의 폐동맥에서 내측층판에 대해서는 특별히 연구된 바가 없다. 따라서 이 실험에서는 발생 12 - 28주 사이의 인태아에서 대동맥과 폐동맥의 내측층판단위를 연구하여 다음과 같은 결과를 얻었다. 대동맥과 폐동맥의 층판수는 태아의 성장과 함께 점차 증가하였고 폐동맥이 대동맥의 동맥관 근위부보다 층판수가 많았다(p<0.01). 대동맥에서 동맥관의 위, 아래 즉, 대동맥의 근위부와 원위부 사이의 층판수는 동맥관이 부착하는 부위의 벽보다 반대쪽 벽에 층판수가 많았다. 그러나 근위부와 원위부 사이의 차이는 없었다. 폐동맥에서 좌,우폐동맥은 좌폐동맥이 층판수가 많았으나 통계적 의의는 없었고 16주까지는 두 폐동맥의 층판수가 증가하였으나 그 후에는 뚜렷한 증가는 없었다. 또, 동맥관은 대동맥, 폐동맥과는 다른 구조를 가졌으 며 뚜렷이 층판단위를 측정할 수 없었다. [영문] The structures of the artery are controlled by variable hemodynamic factors during development. It was reported that the number of elastic medial lamellar unit(MLU) increased with age and decreased along its length from arch to lower abdominal aorta. The study on the MLU of the pulmonary artery is rare but it is known that before birth the media of the pulmonary trunk and that of the aorta are of the same thickness. But mean ratio of medial thickness in the pulmonary artery to that in the aorta falls to between 0.4 and 0.8 aged 6 - 24 months. Using human fetuses between 12 to 28 weeks, the following results was obtained. The numbers of MLU of aorta and pulmonary artery were increased with age. The number of MLU in the pulmonary trunk was slightly higher than that of the aorta (p<0.01). The number of MLU of the aortic wall opposite to the ductus arteriosus was higher than that of the same side of the aorta. But, both side of the aorta of ductus arteriosus had no difference in the number of MLU. The left and right pulmonary artery had no differences but MLU increased with age to 16 weeks. After that the increase was minimal. The ductus arteriosus had different structures to the great arteries and MLU was not measureable.ope

The Surgical Outcome of Thoracic Outlet Syndrome

Background: Thoracic outlet syndrome(TOS) is caused by the compression of neurovascular structures that supply to the upper extremities. Only a few reports have been published in Korea, and this study attempts to investigate the clinical aspects and results of the patients who underwent surgical treatment. Material and Method: This study consist of 16 patients who underwent operations for thoracic outlet syndrome from May, 2002 to October, 2004. The surgical indications were confined to patients with: 1) symptom too severe to perform ordinary daily life because of pain, paresthesia, edema of upper extremities, 2) no improvement after proper physical therapy, 3) definite finding of compression confined by radiologic examinations (MRI, angiography, etc), and 4) no other diseases such as cervical intervertebral herniation, myositis, neurologic diseases below the brachial plexus. The surgical approaches were by transaxillary approaches in 12 cases, supraclavicular approaches in 2 cases, and infraciavicular approaches in 2 cases. Result: There were 15 males and one female with an average age of 23.9 years (range:19\∼39). Rib anomalies were observed in four cases (25.0%), but the others had no abnormal ribs. Right lesions were found in eight cases (50.0%), left lesions in five cases (31.3%), and bilateral lesions in three cases (18.7%). The follow-up period was 9\∼26 months and recurrence rate was 12.5% (2/16). Complications were one case of ulnar nerve palsy, one case of persistent pain despite radiologic improvement and three cases of wound dehiscence due to fat necrosis and hematoma. Conclusion: Although the choice of treatment in patients with TOS has been disputed, patients who have no response with proper physical therapies can benefit from the surgical treatment which may help patients to return to normal daily activity in shorter period of time.ope

Sugical Treatment of Ruptured Hemangiopericytoma of the Lung -One case report-

Hemangiopericytoma of the lung is a very rare malignant tumor despite it's high vasculities of the lung, because, this tumor arises from the pericytes enveloping capillaries. A pulmonary hemangiopericytoma was diagnosed in a 63-year-old female who had complained of cough, sputum, and intermittent chest pain for about 8 years. She was admitted to our hospital, because of progressive severe dyspnea on exertion and orthopnea for about 3 months. She was taken explothoracotomy and left pneumonectomy including evacuation of lots of blood clots due to ruptured large tumor and ineffective drainage with closed thoracic tube. She was discharged at post-operative 7 days under very good condition. She has been treated with radiotherapy&chemotherapy since then.ope

The Surgical Treatment of Esophageal Perforation

Background : It is well-known that esophageal perforation (EP) is difficult in diagnosis and has high mortality rate despite proper management. There are disputes in regarding the reatment in cases of delayed diagnosis although in the early diagnosed cases, operation is recommended without arguments. Methods: From April, 2001 to December, 2004, nine patients who were diagnosed as EP in our hospital were analyzed retrospectively about the causes, the interval between the cause and the treatment, and operation methods. Results: There were 8 male and one female with men age of 49.3 years (range: 25-67 years). The causes of EP included perforations following operations of corvical spine in three cases, spontaneous perforation(Boehaave syndrome) in two cases, foreign bodies in two cases, operation of esophageal diverticulum in one case and blunt trauma bytraffic accident in one case. Mean interval between the first treatments and the causes was 11.6 days (range: 2-30 days). The sites of perforation were upper third of esophagus in three cases, middle third in three cases and lower third in three cases. All except two cervical cases presented as mediastinitis or empyema at the time of diagnosis. Primary repair and irrigation had been performed in 7 cases but five cases out of them required more than two procedures. Conclusions : More than one procedure wasrequired in the treatment of EP because of contaminations and infections which had been spread at the time of initial manifestatios, howeverprimary closure and massive irrigation is the best method in order to preserve esophagus unless the remaining esophagus is extensively damaged.ope

Thymic Cyst Causing Tracheal Stenosis : one case report

Thymic cysts are uncommon tumors which usually occur in the neck and mediastinum. It is known to arise from embryonic remnants of the thymopharyngeal duct or from infammation of thymic tissues. Patients with thymic cyst are often asymptomatic and identified after surgical removal and histologic examination. We experienced a 73 year-old man with recently developed dyspnea. During the examination, chest CT showed a 5{times}6cm sized cystic mass causing deviation of the trachea. It was located in between the right thyroid gland and anterior mediastinum. It also caused tracheal narrowing noted by bronchoscopy. Right anterior cervical incision and removal of the mass was performed and a histological diagnosis of thymic cyst was confirmed. The patient was discharged without complication.ope

Analysis of the nuss procedure for pectus excavatum in different age groups

BACKGROUND: The Nuss procedure is a newly developed operative method for minimally invasive repair of pectus excavatum in pediatric patients. However, the surgical indication for this procedure has been extended into adult patients. The aim of this study was to assess the surgical outcome of the Nuss procedure in different age groups and to analyze its feasibility in the adult population. METHODS: From December 1999 to March 2003, 51 patients (40 males and 11 females) with pectus excavatum underwent the Nuss procedure. We classified patients into three groups based on age (pediatric, adolescent, and adult), retrospectively analyzed demographic, intraoperative and postoperative data, and compared outcomes among each group. RESULTS: Mean operation time was 52.0 +/- 22.9 minutes, 80.4 +/- 27.4 minutes, and 127.3 +/- 44.9 minutes in the pediatric, adolescent, and adult groups, respectively (p < 0.001). Postoperative complications occurred in 3 of 27 patients (11.1%) in the pediatric group and in 7 of 12 patients (58.3%) in both the adolescent and adult groups (p = 0.002). Reoperations were performed due to complications in 1 of 27 patients (3.7%) in the pediatric group, 2 of 12 patients (16.6%) in the adolescent group, and 5 of 12 patients (41.7%) in the adult group (p = 0.001). CONCLUSIONS: The Nuss procedure is highly recommended in pediatric patients with pectus excavatum. However, in adults it is necessary to select patients carefully because of the longer operation time and higher incidence of complications associated with the procedure in this population.restrictio