악성 림프종 환자에서 BEAM 고용량화학요법과 자가조혈모세포이식

박진노(Jin No Park),홍영선(Young Seon Hong),송치원(Chee Won Song),조석구(Seok Goo Cho),이종욱(Jong Wook Lee),민우성(Woo Sung Min),김춘추(Chun Choo Kim),이경식(Kyung Shick Lee) 대한내과학회 2001 대한내과학회지 Vol.61 No.3

N/A Background : The long-term survival in patients with non-Hodgkin's lymphoma (NHL) after conventional chemotherapy is about 35% and the rest of the patients tend to have relapse. So, in relapsed or refractory NHL, the outcome of patients undergoing high-dose chemotherapy and autologous peripheral stem cell transplantation (APBSCT) was evaluated, and the main prognostic factors were determined. Methods : 17 patients with relapsed or resistant NHL (5 complete response group, 7 partial response group, 4 primary refractory group, 1 resistant relapse) underwent BEAM (carmustine, etoposide, cytarabine, melphalan) chemotherapy and APBSCT between July 1997 and February 1999. Results : The median follow-up duration was 17 months (range: 4-47). The response rate was 58.3% (complete response 33.3%, partial response 25.0%) in 12 patients in whom complete response group was not included. The 2-year, 3-year overall response rate were 41.2%, 27.5%, respectively. And 2-year progression free survival was 35.3%. The disease status before high-dose chemotherapy was the only significant prognostic factor in determining overall survival (univariate p=.024, multivariate p=.059) and progression free survival (univariate p=.013, multivariate p=.026). Patients with complete response to salvage regimen had better overall survival (p=.021) and progression free survival (p=.008) than patients with refractory response. WBC (≥ 1,000/uL) was recovered at the median 11 days (range; 8-24), and platelet (≥ 50,000/uL) was recovered at the median 18 days (range; 9-44). There was no treatment-related death and no grade 3 and 4 toxicity. Neutropenic infection was in 4 patients (1 Herpes zoster, 1 typhlitis, 1 perianal infection, 1 otitis externa). Conclusion : The pre-transplant disease status was the main prognostic factor. Patients with complete response to salvage regimen had the significant benefit in survival from high-dose chemotherapy and APBSCT, but patients with refractory or resistant relapsed NHL did not have any significant benefit.(Korean J Med 61:255-263, 2001)

초대석 - 가정호스피스 활성화의 걸림돌과 미래 가정호스피스의 필요성

박진노,Park, Jin-No 한국가톨릭호스피스협회 2009 호스피스 Vol.45 No.-

호스피스 수가 제도화를 눈 앞에 두고

박진노,Park, Jin-No 한국가톨릭호스피스협회 2008 호스피스 Vol.41 No.-

감각신경모세포종: 증례 보고와 문헌 고찰

심병용,박진노,한지연,홍영선,김훈교,이경식,김민식,조승호,정수미,이연수,강진형,Shim Byoung-Yong,Park Jin-No,Han Ji-Youn,Hong Young-Sun,Kim Hoon-Kyo,Lee Kyung-Shick,Kim Min-Sik,Cho Seung-Ho,Chung Su-Mi,Lee Youn-Soo,Kang Jin-Hyoung 대한두경부종양학회 2000 대한두경부 종양학회지 Vol.16 No.2

Objectives: Esthesioneuroblastoma is a rare malignant neoplasm that originates from the olfactory sensory cells. This tumor grows from the upper nasal cavity and ethmoid sinus and invades surrounding structures through the cribriform plate into intracranium or orbit in advanced stage. Even though there has been some controversies in determining standard treatment due to rarity of this tumor, the combination treatment of surgery and adjuvant radiation has been recommended for the locally advanced esthesioneuroblastomas. However, the recent clinical experiences of advanced cases showed that combination chemotherapy is highly effective to reduce tumor mass and improve clinical outcomes. Materials and Methods: The authors conducted a retrospective analysis of 6 esthesioneuroblastoma patients who were treated in our hospital from 1986. Results: The age of these patients was between 19 and 86 year-old. Among the 6 cases, 2 were diagnosed at stage B and 4 at stage C, according to Kadish classification. Anti-tumor treatments were performed in 5 patients. One patient refused active treatment and was lost to follow-up. Better survival outcome were observed in 3 patients who were treated with combination chemotherapy alone or combined modality treatment including chemotherapy. Conclusion: Based on our retrospective study, the combined treatment consisting of surgery, radiotherapy, and combination chemotherapy should be used to improve treatment results. And furthermore, innovative clinical approaches such as neoadjuvant chemotherapy, high-dose chemotherapy and autologous peripheral stem cell transplantation, which have been reported to have good therapeutic results, should be considered and applied actively.

위암세포에서 세포유착물질의 발현 및 위암세포의 복막 내피세포에 대한 결합 능에 미치는 retinoicacid의 영향

홍영선,박조현,박진노,이경식,김인철,Hong, Young Seon,Park, Cho Hyun,Park, Jin-No,Lee, Kyung Shik,Kim, In Chul 대한면역학회 2001 Immune Network Vol.1 No.1

Background : Peritoneal metastasis is one of the maj or types of the stomach cancer recurrence and the role of the adhesion molecules is thought to be very much important in this event. Retinoic acid (RA) has been known to induce the growth inhibition and differentiation of various malignancies, and apoptpsis and the change of expression of adhesion molecules have been reported to be involved in the action of RA. Methods : We studied the adhesion abilities of SNU-1, SNU-5, and SNU-6 cells to the peritoneal endothelial cells as well as the expression of the adhesion molecules (CD44, ICAM-1) in Western blot analysis. And also we studied the expression of apoptosis and the change of expression patterns of the various isoforms of CD44 and the change of the adhsion abilities of the cell line cells after RA treatment. Results: CD44 was expressed in SNU-5 and -16, together with an isoform in SNU-16. ICAM-1 was not expressed in any of the cell line cells tested. After the treatment of RA in the concentration range of $1-5{\times}10^{-5}M$ to three stomach cancer cell lines, growth inhibition, apoptosis and the change of expression of the CD44 were noted. After RA treatment, the expression of CD44H was weakly increased in SNU-1, and was markedly increased in SNU-5. In SNU-16, the expression of CD44H was decreased while that of CD44E were markedly increased. The adhesibility of cells to peritoneal cells was increased in relation with the increase of the CD44H expression, which shows the fact that the adhesibility of tumor cells to peritoneal mesothelial cells is mediated by CD44H recognizing hyaluronic acid. Conclusion : RA induces growth inhibition of stomach cancer cell line cells and increase the adhesiblity of stomach cancer cell line cells to peritoneal mesothelium. It is believed that RA decreases the metastatic ability of stomach cancer cells by upregulating the CD44H expression.

표준형 성인 암성 통증 평가 도구(K-CPAT): 설문조사의 신뢰도 및 타당도 평가

최윤선,박진노,이명아,염창환,장세권,이준영,Choi, Youn-Seon,Park, Jin-No,Lee, Myung-Ah,Yeom, Chang-Hwan,Jang, Se-Kwon,Lee, June-Young 한국호스피스완화의료학회 2003 한국호스피스.완화의료학회지 Vol.6 No.2

Pupose : The Korean cancer pain assessment tool (K-CPAT) was developed in 2003 is consisted of questions concerning the pain location, quality of pain, present pain intensity, symptoms associated with pain, and psychosocial/spiritual pain assessments. This study was done to evaluate the reliability and validity of K-CPAT. Methods : A Stratified, proportional-quota, clustered, systematic sampling has been employed. Study population (903 cancer patients) was 1% of the target population (90,252 cancer patients). A total of 314 (34.8%) questionnaires have been collected. Results : Average pain score (5 Likert scale) by cancer type and at-present average pain score (VAS, $0{\sim}10$) were correlated (r=0.56, P<0.0001), and showed a moderate agreement (kappa=0.364). Mean score of satisfaction was 3.8 ($1{\sim}5$). The average time of completion of the questionnaire was 8.9 minutes. Conclusions: The K-CAPT is a reliable and valid instrument for the assessment of Cancer Pain for Korean.

표준활성슬러지 공법과 CNR 공법의 제거효율 비교

김혜진 ( Hye Jin Kim ),권재국 ( Jae Kook Kwon ),피금호 ( Geum Ho Pi ),조은실 ( Eun Sil Jo ),정동섭 ( Dong Sub Jung ),박진노 ( Jin No Park ),변두균 ( Doo Gyoon Byeon ) 한국물환경학회(구 한국수질보전학회) 2011 공동 추계학술발표회 Vol.2011 No.-

호스피스.완화의료 표준교육 프로그램 시범교육의 효과

강진아,유양숙,박진노,김원철,남은정,고수진,이영선,허정식,최성은,김정이,신동욱,Kang, Jin-A,Yoo, Yang-Sook,Park, Jean-No,Kim, Won-Chul,Nam, Eun-Jeoung,Koh, Soo-Jin,Rhee, Young-Sun,Huh, Jung-Sik,Choi, Sung-Eun,Kim, Jung-Lee,Shin, Dong-Wo 한국호스피스완화의료학회 2008 한국호스피스.완화의료학회지 Vol.11 No.4

목적: 호스피스 완화의료 전문인력을 위한 기본단계 교육과정으로 개발된 표준교육 프로그램 시범교육의 결과를 평가하기 위함 방법: 표준교육 프로그램을 개발하기 위하여 미국의 Education in Palliative and End-of-life Care (EPEC)교육을 벤치마킹하여 국내 실정에 맞게 수정 보완하였다. 표준교육 프로그램은 총 19개의 세부 주제로 구성하였으며, 강의와 쌍방향식 강의, 소그룹 토론, 역할극 등의 다양한 교육방법을 적용하도록 설계하였다. 개발한 표준교육 프로그램의 내용과 교육방법의 타당성을 검증하기 위하여 3개 주제를 선택하여 호스피스 고위과정을 수료한 23명을 대상으로 시범교육을 실시하였다. 결과: 표준교육 프로그램 시범교육 대상자들은 피교육자 중심의 교육방법과 현장에서 활용할 수 있는 교육 내용에 대하여 만족하였으며, 강의를 위주로 하는 기존의 교육보다 효과적인 교육이라고 평가하였다. 결론: 표준교육 프로그램 시범교육은 그 효과가 긍정적이었으며 호스피스 완화의료 교육의 표준화와 교육 방법의 발전에 기여할 것으로 기대된다. 앞으로 표준교육 프로그램을 성공적으로 실행하기 위해서는 교육자 (Trainer)를 위한 교육이 실행되어야한다. Purpose: To evaluate the effectiveness of pilot program on standard curriculum of hospice palliative care education; a basic training program for physician, nurse, social worker and clergies at hospice institute. Methods: To develop an educational program, we used the Education in Palliative and End-of-life Care (EPEC) program as a paradigm and modified it to be suited in our situation: The standard curriculum consists of 19 modules, and it is designed to be applied to the teaching methods, including lecture, interactive lecture, small group discussions, and role play. To verify its contents and teaching methods, we implemented a pilot program which consisted of 3 modules, using various teaching methods; trigger video tapes, interactive lecture, small group discussions, and role play. Results: Overwhelming majority were satisfied with the teaching methods and learner-centered methods, and agreed that the contents were clinically relevant to the care of dying patients. They also indicated that their attitudes would likely change as a result of the education. Conclusion: The effects of the pilot program on standard curriculum of hospice and palliative care are very positive and has broader implications for improving hospice palliative care education. For successful implementation of the program, trainers must also be prepared to teach effectively. Also it must be accompanied with train-the trainer program.

재발 및 불응성 비호즈킨 림프종 환자의 치료에서 IVAM ( Ifosfamide , VP-16 , Ara-C , Methotrexate ) 복합화학요법의 치료 효과

송치원(Chi Won Song),박진노(Jin No Park),조석구(Seok Goo Cho),이종욱(Jong Wook Lee),홍영선(Young Seon Hong),민우성(Woo Sung Min),김춘추(Chun Choo Kim),이경식(Kyung Shick Lee) 대한내과학회 2001 대한내과학회지 Vol.61 No.2

N/A Background : Patients with non-Hodgkin's lymphoma who do not respond to first-line chemotherapy or those who relapse after obtaining a complete response have a poor prognosis and are rarely cured with usual salvage chemotherapy. We investigated the treatment responses, toxicities, prognostic factors and mobilization efficacy of peripheral blood stem cells (PBSC) used as salvage chemotherapy. Methods : 55 patients with refractory (36) or relapsed (19) NHL were treated from Novembr 1997 to October 1999 with IVAM (ifosfamide, etoposide, cytarabine, methotrexate) regimen. Each patients was scheduled to receive one to three cycles of chemotherapy. When the leukocyte count reached 5×109/L after chemotherapy, PBSC collection was performed. The treatment was repeated every 4 weeks. Results : The median age was 48 years (range, 19-76). Median 2.1 cycles of chemotherapy were administered. 15 patients (27.3%) achieved complete response and 29 (52.7%) partial response, with an overall response rate of 80.0%. Myelosuppression was the major toxicity, with 98.2% of grade 3, 4 neutropenia and thrombocytopenia, but there was no serious hemorragic event. Neutropenic fever occurred in 25.5% of the patients with one treatment-related death due to sepsis. Non-hematologic toxicity was modest. PBSC was collected in 36 patients for high dose chemotherapy and autologous stem cell transplantation. The median number of mononuclear cells collected was 9.9×108/kg and the median number of CD34(+) cells collected was 11.9×106/kg. After a median follow-up of 13 months (range, 3-26), median progression free survival were 12 months and median overall survival has not been reached yet. 1-year overall survival and progression free survival were 61.9% and 46.1%, respectively. In univariate analyses, unfavorable prognosis was associated with poor performance status (p=0.001), high LDH (p=0.041), stage III,IV (p=0.04), extralymphatic lesion (p=0.027), B sx (p=0.034), bone marrow involvement (p=0.039) and performing high dose chemotherapy (p=0.005). Multivariate analysis showed that performance status(p=0.0042), B sx(p=0.049) was a significant independent risk factors for death. Conclusion : These results suggest that IVAM is an effective salvage chemotherapy for refractory or relapsed NHL and allow effective PBSC collection for high dose chemotherapy and autologous PBSCT.(Korean J Med 61:141-150, 2001)

경막외로 전이된 원발성 간암

정규원(Kyu Won Chung),선희식(Hee Sik Sun),심상인(Sang In Shim),강창석(Chang Suck Kang),박수헌(Soo Heon Park),한혁준(Hyeok Jun Han),노대근(Dae Keun Lo),박진노(Jin No Park),방춘상(Chun Sang Bang),최명규(Myong Gyu Choi) 대한소화기학회 1997 대한소화기학회지 Vol.30 No.1

Hepatocellular carcinoma is one of the most common malignancies reported in ost of the Africa and South-east Asia. As hepatocellular carcinoma metastases well to distant site, half of the cases metastases to distant site at diagnosis. Hepatocellular carcinoma usually spread to regional lymph nodes around porta hepatis via lyphatics and venous metastasis can occur via intrahepatic vein. The usual sites of extrahepatic metastasis are lung, local lymph nodes, adrenal glands and bones, but epidural metastasis is very rare. Although the prognosis of the hepatocellular carcinoma was very poor in the past, the survival time seemed to be prolonged by early diagnosis and improvement of medical therapy. Therefore the importance of metastatic lesion of the hepatocellular carcinoma might be reemphasized. Recently we experienced a case of the hepatocellular carcinoma who developed paraplegia suddenly. MRI revealed ovoid epidural rnass at 6th and 7th dorsal vertebra level posteriorly. After emergency operation, the resected mass was confirmed metaststic hepatocellular carcinoma. (Korean J Gastroenterol 1997;30:119-125)