치료의 전력이 없는 다발성 골수종에 대한 Vincristine, Doxorubicin 및 Dexamethasone(VAD) 복합화학요법의 효과

김경현,박연희,김성환,김봉석,강윤구,류백렬,최병국,임영혁,김태유 대한내과학회 1999 대한내과학회지 Vol.56 No.1

Objective : The combination of vincristine and doxorubicin by continuous infusion was reported to reduce tumor mass more rapidly than standard regimens, which maybe a result of effect on more slowly proliferating plasma cells. We conducted a phase II study to determine the activity and safety of VAD (vincristine, doxorubicin, dexamethasone) chemotherapy, in which vincristine and doxorubicin are administered as a continuous infusion, for previously untreated multiple myeloma. Methods : VAD chemotherapy (vincristine 0.4 mg/day 24 hour-continuous infusion, days 1∼4; doxorubicin 9 mg/m2/day 24 hour-continuous infusion, days 1∼4; dexamethasone 40 mg/day p.o. days 1∼4) was given to eligible patients every 4 weeks and we assessed response and toxicity of the regimen. Results : Between January 1991 and March 1997, total 25 patients entered this trial and 22 were evaluable. The complete response rate was 14%(3/22) and overall response rate was 59%(13/22, 95% C.I.: 38∼80%). The time to response was 1.0∼6.8(median 2.9) months. Progression free survival was 2∼39+(median 11.5) months and the overall survival was 3+∼42+(median 19.7) months. Toxicities of VAD regimen were leukopenia, infection, stomatitis and neurotoxicity, but there was no treatment-related death. Conclusion : VAD chemotherapy was tolerable, but not more active than the alkylating agent-based chemotherapy as a front-line treatment for the patients with multiple myeloma. But, because of its rapid response and relatively mild myelotoxicity, it could play a role for advanced or highly complicated disease and for remission induction before consolidation with high-dose chemotherapy.

A Case of Composite (Mixed) denocarcinoma-Small Cell Carcinoma of the Stomach

Kim, Nam Don,Park, Yeon Hee,Ki, Seung Seog,Park, Yong Jin,Kim, Heoyng Joon,Ryoo, Baek-Yeol,Kim, Heung Tae,Chung, Jin-Haeng,Yuh, Young Jin 인제대학교 백병원 2003 仁濟醫學 Vol.24 No.1

A composite (mixed) tumor is defined as a glandular-endocrine cell carcinomas characterized by an intricate admixture of both elements in the same lesion. The histogenesis of this tumor is not clear but is considered to be multidirectional differentiation from pluripotential stem cells. The clinical findings are local symptoms due to mass and systemic symptoms due to paraneoplastic syndrome. The prognosis is considered to be very poor because of a high incidence of vasculo-lymphatic invasion and markedly deep infiltration of small cell carcinoma (SCC) of this composite tumor. Treatment has not been established clearly yet, but treatment with regimens specific for SCC of the lung may be used because the biologic and clinical characteristics of gastric SCC are similar to those of SCC of the lung. We encountered a 70-year-old man with pain to the back and both elbows for 20 days on July 22, 2002. Esophagogastroduodenoscopic biopsy revealed a superficially well differentiated adenocarcinoma and a deeply located. poorly differentiated SCC in the same lesion of the stomach, along with multiple bony metastases. We treated the patient with a chemotherapeutic regimen (etoposide and carboplatin) and palliative radiotherapy. The patient complained of sustained abdominal pain and poor oral intake and he died about 5 months later.

뼈에 발생한 악성 림프종 환자의 치료 효과 판정에서 ^(18)F-FDG Positron Emission Tomography의 유용성

김남돈,박연희,기승석,박용진,김형준,류백렬,김흥태,김성은,천기정,최창운,임상무 대한핵의학회 2003 핵의학 분자영상 Vol.37 No.5

원발성골림프종은 매우 드문 질환이기는 하나, 복합항암요법이나 방사선 치료등에 높은 반응율을 보이며, 좋은 예후를 가지는 림프절의 비호지킨 림프종의 일종이다. 그러나, 치료 효과 판정에 있어 골병변의 특이성에 의한 모호한 방사선학적 특징으로 어려움이 있어 왔다. 본 증례는 위와 같은 원발성골림프종 환자에서 PET 스캔을 사용하여 민감하게 완전 반응을 평가할 수 있었던 예로, 앞으로 다른 고식적인 방법과 함께 이 질환의 진단과 치료 평가 있어 유용하게 사용 될 수 있을 것으로 전망할 수 있었다. Purpose: Accurate assessment of the lesion after treatment of patients with bone lymphoma is difficult. In this patient who demonstrated complete remission after chemotherapy, the regions of fluorine-18 fluorodeoxyglucose (^(18)FFDG)PET uptake diminished more rapidly following therapy, indicating a complete response at much earlier stage than did Magnetic Resonance Imaging (MRI) or CT based findings. With the conventional methods, such as MRI and CT. It was difficult to assess whether the residual tumor tissue was viable or not. Decision to complete response is very important in patients with ymphoma to plan the further treatment. We experienced a patient with primary lymphoma of bone who revealed complete response to chemotherapy on ^(18)FFDGPET while CT showed persistent destructive bone lesion. Thus, ^(18)FFDGPET study after therapy may be superior to CT in the evaluation of response to treatment in primary lymphoma of bone.

Panax ginseng as an adjuvant treatment for Alzheimer's disease

Kim, Hyeon-Joong,Jung, Seok-Won,Kim, Seog-Young,Cho, Ik-Hyun,Kim, Hyoung-Chun,Rhim, Hyewhon,Kim, Manho,Nah, Seung-Yeol The Korean Society of Ginseng 2018 Journal of Ginseng Research Vol.42 No.4

Longevity in medicine can be defined as a long life without mental or physical deficits. This can be prevented by Alzheimer's disease (AD). Current conventional AD treatments only alleviate the symptoms without reversing AD progression. Recent studies demonstrated that Panax ginseng extract improves AD symptoms in patients with AD, and the two main components of ginseng might contribute to AD amelioration. Ginsenosides show various AD-related neuroprotective effects. Gintonin is a newly identified ginseng constituent that contains lysophosphatidic acids and attenuates AD-related brain neuropathies. Ginsenosides decrease amyloid ${\beta}$-protein ($A{\beta}$) formation by inhibiting ${\beta}$- and ${\gamma}$-secretase activity or by activating the nonamyloidogenic pathway, inhibit acetylcholinesterase activity and $A{\beta}$-induced neurotoxicity, and decrease $A{\beta}$-induced production of reactive oxygen species and neuro-inflammatory reactions. Oral administration of ginsenosides increases the expression levels of enzymes involved in acetylcholine synthesis in the brain and alleviates $A{\beta}$-induced cholinergic deficits in AD models. Similarly, gintonin inhibits $A{\beta}$-induced neurotoxicity and activates the nonamyloidogenic pathway to reduce $A{\beta}$ formation and to increase acetylcholine and choline acetyltransferase expression in the brain through lysophosphatidic acid receptors. Oral administration of gintonin attenuates brain amyloid plaque deposits, boosting hippocampal cholinergic systems and neurogenesis, thereby ameliorating learning and memory impairments. It also improves cognitive functions in patients with AD. Ginsenosides and gintonin attenuate AD-related neuropathology through multiple routes. This review focuses research demonstrating that ginseng constituents could be a candidate as an adjuvant for AD treatment. However, clinical investigations including efficacy and tolerability analyses may be necessary for the clinical acceptance of ginseng components in combination with conventional AD drugs.

위장관 종양의 진단에서 혈장 Tumor M2-Pyruvate Kinase의 유용성

김창환 ( Kim Chang Hwan ),김진일 ( Kim Jin Il ),박수헌 ( Park Su Heon ),한준열 ( Han Jun Yeol ),김재광 ( Kim Jae Gwang ),한석원 ( Han Seog Won ),정인식 ( Jeong In Sig ),정규원 ( Jeong Gyu Won ),선희식 ( Seon Hui Sig ) 대한소화기학회 2003 대한소화기학회 추계학술대회 Vol.2003 No.-

<목적> Pyruvate kinase (PK)는 당분해에 중요한 역할을 하는 효소로 조직 특이성을 가지는 여러 가지 동종효소(R-PK, L-PK, M1-PK, M2-PK)들이 존재한다. 이들 모든 동종형들은 활성상태에서 동형 사중체(homotetramer)로 존재하나 종양 세포에서는 대부분 이중체(dimeric) M2-PK로 존재하여 Tumor M2-PK로 명명되었다. Tumor M2-PK의 진단적 가치는 신장암, 췌장암, 폐암, 위암, 유방암 등에서

만삭전 조기양막파열 산모의 정맥혈장내 지질과산화, 항산화능 및 항산화 비타민치

김윤하 ( Kim Yun Ha ),안봉환 ( An Bong Hwan ),양성열 ( Yang Seong Yeol ),김철홍 ( Kim Cheol Hong ),조문경 ( Jo Mun Gyeong ),이광수 ( Lee Gwang Su ),김석모 ( Kim Seog Mo ),송태복 ( Song Tae Bog ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.2

목적 : Pfannenstiel incision을 통한 근치자궁절제술 및 골반림프 절제술의 수술을 실시하여 vertical midline incision을 통한 수술과 수술 용의성 및 수술에 따른 제반결과에 대해 비교 분석하고자 한다. 연구 방법 : 2001년 1월부터 2003년 2월까지 만 2년 2개월간 인제대학교 의과대학 부속 부산백병원 산부인과에서 자궁경부암 (Ia₂-IIb)으로 근치자궁절제술 및 골반림프절 절제술을 시행 받은 123명의 환자를 대상으로 임상 및 병리기록을 검토하여 조사하였다. 자료는 환자의 나이, 체질량 지수, 병기, 조직분류, 림프절 수, 수술시간, 예측 실혈양, 수술병리경계의 양성율, 합병증과 재원일수를 포함하여 각 환자의 의무기록을 통하여 전향적으로 수집되었다. 통계분석은 t-test, x²-test, Fisher Exact test를 사용하였고, 유의 수준은 0.05 미만일 때 유의 하다고 판정하였다. 결과 : 근치자궁절제술 및 골반림프절 절제술 시행에 있어 Vertical midline incision으로 시행한 경우는 62 예, Pfannenstiel incision은 61예였다. 두 군간의 연령분포, 체질량 지수, 임상 병기 분포, 조직분류, 제거된 림프절수, 수술 중 평균 실혈량, 병리조직 절개부 양성율, 술 중 혹은 술 후 합병증, 재원일수에는 유의한 차이가 없었고, 평균 수술 시간이 Pfannenstiel incision에서 169분, Vertical midline incision에서 197분으로 (p-value<0.0001) Pfannenstiel incision 군에서 유의 있게 짧은 것으로 나타났다. 결론 : Pfannenstiel incision은 수술에 따른 이환율의 증가 없이 용이하게 시행되었고 Vertical midline incision과 비교 시 유사한 림프절 개수를 획득할 수 있었다. 따라서 이러한 Pfannenstiel incision은 초기 침윤성 자궁경부암의 수술 적치료로 근치자궁절제술 및 골반림프절 절제술 시행에 있어 수술 합병증의 증가나 수술부위 노출의 제약 없이 미용적인 측면에서 뿐만 아니라 수술시간의 단축이란 측면에서도 고려 될 수 있는 절개법이라 사료된다. Objective : Our purpose was to review patients undergoing radical hysterectmy and pelvic lymphadenectomy, comparing Pfannenstiel and Vertical midline incisions for operative feasibility and perioperative outcome. Methods : Between January 2001 and February 2003, 123 patients underwent radical hysterectomy and pelvic lymphadenectomy for cervical cancer at Busan Paik hospital. All procedures were performed by a gynecologic oncologist. Prospectively, all data were collected from review of each patient`s medical record, including age, body mass index (BMI), stage, histology, nodal counts, operative time, estimated blood loss, surgical pathologic margin positivity, complications, and length of hospital stay. Associations between variables were studied using X²test, t-test, and Fisher Exact test. Results : Radical hysterectomy was performed through a Vertical midline (n=62) and Pfannenstiel (n=61) incision. There were no significant differences in age, BMI, stage, histology, nodal counts, estimated blood loss, surgical pathologic margin positivity, complications, and length of hospital stay. But, patients with a Pfannenstiel incision had shorter operative time than those with Vertical midline incision (169 min vs 197 min, P<0.0001). Conclusion : Radical hysterectomy and pelvic lymphadenectomy can be safely performed through a Pfannenstiel incision without increased operative morbidity and equal nodal removal as compared with Vertical midline incision. Pfannenstiel incision may offer the benefits of improved cosmesis and shorter operative time without compromising surgical exposure or increasing the risk of surgical complications.

지속성 외래 복막투석 환자에서 만성 염증 및 감염과 죽상경화증과의 상관성

김현진 ( Kim Hyeon Jin ),김동기 ( Kim Dong Gi ),최훈영 ( Choe Hun Yeong ),김형종 ( Kim Hyeong Jong ),유태현 ( Yu Tae Hyeon ),류동열 ( Lyu Dong Yeol ),김범석 ( Kim Beom Seog ),강신욱 ( Kang Sin Ug ),최규헌 ( Choe Gyu Heon ),이호영 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.3

배경 : 말기신부전 환자에서 심혈관계 질환에 의한 사망의 위험도는 일반인에 비해 10-20배 이상 높은 것으로 보고되고 있으며, 최근 이들 환자들에서 관찰되는 염증 반응이나 감염이 심혈관계 질환에 의한 사망과 어떠한 연관이 있는지에 대한 관심이 집중되고 있다. 본 연구에서는 복막투석 환자를 대상으로 경동맥 내중막 두께와 내중막 면적, 죽상경화반의 유무를 측정하고 만성 염증 및 감염의 지표를 측정하여 투석중인 말기신부전 환자에서 죽상경화증의 진행에 염증 반응 및 감염이 미치는 영향을 알아보고자 하였다. 방법 : 2002년 4월 현재 연세대학교 세브란스병원 신장내과에서 복막투석을 시행받고 있는 환자 중 평균 32개월 전에 경동맥 초음파 검사를 시행한 52명을 대상으로 생화학적 지표 및 CRP, hsCRP, interleukin-6 (IL-6), Chlamydia pneumoniae (C. pneumoniae)에 대한 IgA와 IgG 항체가, ICAM-1, VCAM-1을 측정하였으며, 고해상도초음파를 이용하여 경동맥 내중막 두께, 내중막 면적 및 죽상경화반의 유무를 측정하였다. 결과 : 과거에 경동맥 초음파를 실시한 52명의 환자에서 동일한 방법으로 반복 측정한 경동맥 내중막 두께의 평균값은 유의하게 증가하였으며, 죽상경화반을 보이는 환자의 비율도 의의있게 증가하였다 (p<0.05). 경동맥 내중막 두께의 변화에 따라 진행군과 비진행군으로 나누어 비교하였을 때, log IL-6, C. pneumoniae에 대한 IgA 항체가, ICAM-1은 진행군에서 비진행군보다 유의하게 높았다 (P<0.05). 로지스틱 회귀분석을 시행한 결과 log IL-6, C. pneumoniae에 대한 IgA 항체자가 높은 경우에 경동맥 내중막 두께가 증가하는 위험도가 의의있게 높았으며 HDL 콜레스테롤 또한 경동맥 내중막 두께의 변화에 유의한 독립인자였다. 다중 회귀분석을 시행한 결과 log IL-6와 C. pneumoniae에 대한 IgA 항체가, ICAM-1이 경동맥 내중막 두께에 독립적으로 영향을 미치는 인자였다 (p<0.05). 결론 : 이상의 연구 결과로 지속적인 C. pneumoniae 감염이 여러 염증반응의 단계에 작용하여 죽상경화증을 악화시킴을 알 수 있었다. 향후 더 많은 환자를 대상으로 하여 말기 신부전 환자에서 죽상경화증을 악화시키는 기전에 대한 연구가 필요할 것으로 사료된다. Background : In ESRD patients, the annual mortality rate due to cardiovascular disease (CVD) is 10 to 20 fold higher than that of the general population. Much recent interest have been focused on the association between chronic inflammation and the increased mortality rate due to CVD in ESRD patients. This study was performed to investigate whether the C.pneumoniae infection and inflammation play important roles in the change of the carotid intimamedia thickness (IMT) in ESRD patients. Methods : 5 patients undergoing CAPD were enrolled in the study. We measured IMT by using B-mode ultrasonography. 1L-6, antibody titers to C.pneumoniae, cell-adhesion molecules were assessed by ELISA. Results : Significant increase in carotid IMT (0.71±O.02 to 0.77±0.12 mm, p<0.05), cIM area (19.62±4.21 to 21.82±4.80 mm², p<0.05), prevalence of plaque (36.5% to 57.7%, p<0.05) were observed in 52 patients. `The patients were divided into two groups according to the change in IMT. Progressor for 32 patients who had more than 0.1 mm increase in IMT and nonprogressor for 20 who had lesser than 0.1 mm increase or no changes in IMT. Log IL-6, IgA antibody titers to C. pneumoniae, ICAM-l level were significantly higher in progressors compared to nonprogressors (4.20±5.14 vs. 1.44±0.58pg/mL, 1.14±0.60 vs. 0.77±0.32, 297.42±88.22 vs. 233.93±88.89 ng/mL, p<0.05). Logistic regression analysis showed that elevated log IL-6 and IgA antibody titers to C. pneurnoniae were independent factors adversely affecting change of IMT. Stepwise multiple regression analysis showed that log IL-6, ICAM-1, and IgA antibody titers to C. pneumoniae were independent factors affecting carotid IMT. Conclusion : Our data suggest that inflammation and seropositivity of IgA to C. pneumoniae can be associated with the progression of atherosclerosis in CAPD patients. (Korean J Nephrol 2004;23(3):466-475)

The Impact of Unrecognized Anxiety on Health-related Quality of Life in Patients with Functional Dyspepsia

( Sang Yeol Lee ),( Suck Chei Choi ),( Yong Sung Kim ),( Young Woo Sohn ),( Yong Yeol Oh ),( Geom Seog Seo ),( Tae Hyeon Kim ),( Myung Gyu Choi ),( Yong Ho Nah ) 대한소화관운동학회 2005 대한소화관운동학회 춘계학술대회 Vol.16 No.-

<Objective> Gastroenterologists have been criticized for underrecognizing and undertreating mental health disorders. This criticism assumes patients with recognized disorders and those with unrecognized disorders suffer the same burden of illness. The cur

준설토의 유실율 결정에 관한 연구

김석열 ( Kim Seog Yeol ),김승욱 ( Kim Seung Wook ),노종구 ( Ro Jong Koo ) 한국농공학회 1999 한국농공학회 학술대회초록집 Vol.1999 No.-

Recently, the hydraulic fill method is commonly used in many reclamation projects due to lack of fill materials. The method of hydraulic fill in reclamation is executed by transporting the mixture of water-soil particles into a reclaimed land through dredging pipes, then the dredged soil particles settle down in the water or flow over an out flow weir with the water. The amount of the volume reductions of dredged soil is considered the sum of the overall settlement by desiccation shrinkage and self-weight consolidation and the loss of soil particles now over a weir. In the present study, hydrometer analysis was performed with the soil samples obtained before and after dredging to estimate the amount of soil particles residual at reclaimed area and the loss of soil particles, then it was suggested the method of determining the loss ratio of dredged soils from the test results. The hydrometer analysis of in-situ soil samples showed that the loss ratio of dredged soils is lowest at the nearest point to dredge pipe and the highest al the nearest point to out flow weir.

준설매립지반의 표층처리방안 검토를 위한 모형시험

김석열(Seog-Yeol Kim),노종구(Jong-Koo Ro),이영철(Young-Chul Lee),권수영(Soo-Young Kwon),김승욱(Seung-Wook Kim) 한국지반환경공학회 2002 한국지반환경공학회 학술발표회논문집 Vol.2002 No.-