Poster Session:PS 0489 ; Nephrology : Increased Risk of Everolimus-Associated Acute Kidney Injury in Cancer Patients with Impaired Kidney Function

( Jung Ho Shin ),( Sung Hae Ha ),( Hye Ryoun Jang ),( Woo Seong Huh ),( Ho Yeong Lim ),( Yoon Goo Kim ),( Dae Joong Kim ),( Ha Young Oh ),( Jung Eun Lee ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Everolimus was recently introduced as a second-line treatment for renal cell carcinoma (RCC) and many other cancers. A few prospective studies have shown that serum creatinine levels are increased in a signifi cant proportion of patients receiving everolimus. We report the incidence, risk factors and clinical signifi cance of AKI associated with everolimus treatment in patients with cancer in the paper. Methods: We analyzed patients who received everolimus for more than 4 weeks as an anti-cancer therapy. AKI is defi ned as a greater than 1.5-fold increase in creatinine levels from baseline levels. Results: AKI developed in 21 (23%) RCC patients and none of the patients (N = 17) with other cancers showed AKI. Fourteen out of 21 were considered to be an everolimus- associated AKI. The incidence of AKI increased progressively as baseline eGFR decreased (10% in subjects with eGFR >90 mL/min/1.73 m2, 17% in with eGFR 60 - 90 mL/min/1.73 m2, 28% in eGFR 30 - 60 mL/min/1.73m2, and 100% in eGFR 15 - 30 mL/min/1.73 m2, P = 0.029 for trend). Baseline eGFR was an independent risk factor for development of everolimus-associated AKI (Hazard ratio per 10 mL/min/1.73 m2 increases, 0.70; P = 0.047). Nine out of 14 patients with everolimus-associated AKI continued with a reduced dose or after a short-term off period. Four out of 14 discontinued the drug because of progression of an underlying malignancy. Only one patient stopped the drug due to AKI. Conclusions: Our study suggests that AKI was a common adverse effect of everolimus treatment, especially in subjects with impaired renal function. However, AKI occurrence did not require discontinuation of the drug, and the treatment decision should be made through a multidisciplinary approach including the assessment of oncological benefi ts of everolimus and other therapeutic options.

증례 : 류마티스 ; 메토트렉세이트와 아자치오프린 투여 후 호전된 피부근염에서의 지방층염

서성례 ( Seong Rye Seo ),임성륜 ( Sung Ryoun Lim ),이성지 ( Sung Ji Lee ),김태종 ( Tae Jong Kim ),박용욱 ( Yong Wook Park ),윤숙정 ( Sook Jung Yun ),이신석 ( Shin Seok Lee ) 대한내과학회 2011 대한내과학회지 Vol.80 No.1

피부근염은 피부와 근육에 침착된 자가 항체와 면역 복합체에 의해 비화농성 염증이 생기는 자가 면역 질환으로 피부 병변은 잘 알려져 있으나 피하지방 병변의 임상양상과 조직학적 소견은 잘 알려져 있지 않다. 1924년 Weber에 의해 피부근염에 동반된 지방층염이 보고된 이래 지금까지 23예의 증례가 보고되어 있다. 저자들은 내원 7년전 피부근염으로 진단되어 외래에서 경과추적을 하고 있던 27세 여자 환자에서 양측 상지와 안면부를 포함한 전흉부에 통증을 동반한 경화성 결절을 발견한 후 피부 조직 생검을 통해 지방층 염으로 진단하였고, 고용량의 프레드니솔론과 메토트렉세이트를 투여함에도 피부 병변의 호전이 없어 아자치오프린을 추가하였고, 이후 호전을 경험하였기에 문헌고찰과 함께 보고하는 바이다. Dermatomyositis is an autoimmune disease wherein autoantibodies and immune complexes cause non-suppurative inflammation in skin and muscle. Although the skin lesions of this disease are well known, the clinical and pathological features of subcutaneous fat lesions remain uncharacterized. Since Weber (1924) reported the development of panniculitis in a patient with dermatomyositis, 23 subsequent cases have been reported. Here, we present the case of a woman who had been diagnosed with dermatomyositis 7 years previously, and presented with diffuse, painful, indurated nodules on her face and upper limbs. A skin biopsy allowed us to diagnose these nodules as panniculitis. The patient was initially treated with high doses of prednisolone and methotrexate. She responded inadequately to these medications, so azathioprine was added to the regimen. The skin lesions subsequently improved and the patient has remained disease-free for 1 year. Here, we present the clinical profile of this patient and review the relevant literature. (Korean J Med 2011;80:122-127)

Poster Exhibition : Antiviral Efficacy and Safety of 48-Week Clevudine Treatment in Patients with Chronic Hepatitis B (초)

Du Young Noh,Tae Jin Seo,Ho Seong Ryu,Sung Ryoun Lim,Hye Kyoung Jeong,Jun Ho Cho,Sung Bum Cho,Young Eun Joo,Hyun Soo Kim,Jong Sun Rew,Sung Kyu Choi 대한간학회 2009 Clinical and Molecular Hepatology(대한간학회지) Vol.15 No.4(S)

Expression of c-FLIP in Gastric Cancer and its Relation to Tumor Cell Proliferation and Apoptosis

( Dae Yeul Ryang ),( Young Eun Joo ),( Kyoung Myeun Chung ),( Sung Ryoun Lim ),( Hye Kyong Jeong ),( Hyung Il Kim ),( Wan Sik Lee ),( Chang Hwan Park ),( Hyun Soo Kim ),( Sung Kyu Choi ),( Jong Sun Re 대한내과학회 2007 The Korean Journal of Internal Medicine Vol.22 No.4

Background: The expression of c-FLIP (cellular Fas-associated death domain-like interleukin-1 β-converting enzyme (FLICE)-inhibitory protein), which is a member of the family of inhibitors of apoptosis, has been associated with tumor development and progression. The aim of this study was to evaluate the expression of c-FLIP in gastric cancer and its correlation with tumor cell proliferation, apoptosis and the clinicopathologic features. Methods: Immunohistochemical staining with anti-c-FLIP antibody was performed in 98 tissue samples obtained from gastric cancer patients who underwent surgical treatment. The apoptotic cells were visualized by terminal deoxynucleotidyl transferase (TdT) mediated deoxyuridine triphosphate (dUTP) nick-end labeling (TUNEL), and the proliferative cells were visualized by staining with Ki-67 antibody. Results: The positive expression of c-FLIP in the gastric cancer tissues was demonstrated in 57.1% of the cases. The expression of c-FLIP was increased in the gastric cancer tissues compared with the matched normal gastric mucosa. The expression of c-FLIP was significantly associated with histologic differentiation (p=0.038). However, there was no association between the c-FLIP expression and the other clinicopathological parameters, including patient survival. The Ki-67 labeling index (KI) for the 98 tumors ranged from 7.6 to 85.0 with a mean KI of 50.4±15.7. The mean KI value of the c-FLIP positive tumors was 54.1±15.3 and this was significantly higher than that of the c-FLIP negative tumors (p=0.005). The apoptotic index (AI) for the 98 tumors ranged from 0.0 to 10.0 with a mean AI of 7.4±2.3. There was no significant difference between the c-FLIP expression and the AI (p=0.347). Conclusions: These results suggest that the c-FLIP expression may be associated with tumor cell proliferation of gastric cancer.

임신부에서 발생한 급성 A형간염의 임상양상과 임신 합병증

류호성 ( Ho Seong Ryu ),박선영 ( Seon Young Park ),임성륜 ( Sung Ryoun Lim ),김형일 ( Hyung Il Kim ),기원주 ( Won Ju Kee ),이금수 ( Geum Soo Lee ),홍건영 ( Gen Young Hong ),조성범 ( Sung Bum Cho ),최성규 ( Sung Kyu Choi ),유종선 ( 대한소화기학회 2010 대한소화기학회지 Vol.56 No.5

Background/Aims: Acute hepatitis A was recently significant increased among women with gestational age in Korea. However, the clinical course and gestational complications have not been fully elucidated in pregnant patients with acute hepatitis A. We evaluated the clinical impact of acute HAV infection in pregnancy. Methods: Twelve pregnant women out of 85 female patients with acute hepatitis A during 6 years were retrospectively reviewed. Results: The median age of the pregnant group was 26.5 years old. The number of patient with acute hepatitis A were 5 cases in the 1st trimester, 3 cases in the 2nd and 4 cases in the 3rd. 4 cases had significant gestational complications. One case experienced the abortion in 1st trimester and one fetal distress was noted in 3rd trimester. The latter case was delivered of a low birth weight infant (2,390 g) caused by premature rupture of membrane in 36 weeks of gestational age. Other two cases experienced premature contraction and they had been required tocolytic treatment. But, all mothers featured full recovery from HAV infection. Except one aborted fetus and one premature birth, Newborn babies were not affected by maternal hepatitis A. Conclusions: Acute HAV infection during pregnancy may be associated with the risk of gestational complications. HAV serology and vaccination for women with gestation age should be considered at high prevalence area of acute hepatitis A. (Korean J Gastroenterol 2010;56:307-313)

다기관 연구를 통한 극소저체중출생아에서 초기 폐표면활성제 투여의 시간에 따른 결과 비교

이나미 ( Na Mi Lee ),이정주 ( Jung Ju Lee ),김천수 ( Chun Soo Kim ),김은령 ( Eun Ryoun Kim ),심재원 ( Jae Won Shim ),임재우 ( Jae Woo Lim ),김민희 ( Min Hee Kim ),박상기 ( Sang Kee Park ),이영아 ( Young Ah Lee ) 대한주산의학회 2012 Perinatology Vol.23 No.2

목적: 미숙아에서 호흡곤란증후군으로 진단 후에 치료하는 것보다 예방적으로 일찍 폐표면활성제를 투여하였을 때 환자들의 예후가 좋다는 것이 많이 보고되고 있다. 저자들은 다기관 연구를 통해 초기 폐표면활성제 투여의 시간과 그에 따른 결과를 비교 분석하였다. 방법: 2004년 1월부터 2005년 12월까지 8개의 병원에서 태어난 출생체중 1,500 g 미만, 재태연령 34주미만의 환아들 중 호흡곤란증후군으로 진단된 환아들 171명을 대상으로 하였다. 우선 폐표면활성제 투여시간을 출생 후 2시간을 기준으로 나누어 군간 비교 분석하였고, 그 다음으로 투여시간을 출생 후 30분을 기준으로 나누어 군간 결과를 비교 분석하였다. 결과: 환아들의 초기 폐표면활성제 투여시간은 평균 140.0±114.3분이었다. 동맥관개존증 발생률, 인공호흡기기간, 입원기간은 출생 후2시간 이내에 폐표면활성제를 투여한 군이2시간이후에 투여한 군에 비해 통계적으로 의미있게 적었다. 30분이내에 폐표면활성제를 투여한 군도 30분이후에 투여한 군에 비해 동맥관개존증 발생률과 인공호흡기간이 의미있게 감소하였다. 결론: 미숙아에서 폐표면활성제는 출생 후 가능한 빠른 시간내에 투여하는 것이 좋다. Purpose: The prophylactic surfactant treatment has been found to improve patient outcomes, compared to the rescue treatment. We performed a multicenter study to determine the relationship between the timing of the initial surfactant treatment and patient outcomes. Methods: One hundred and seventy one neonates, born at eight different centers, from January 1, 2004 to December 31, 2005, were enrolled. The included subjects were gestational age less than 34 weeks, birth weights less than 1500 g and had respiratory distress syndrome (RDS) that received surfactant. First, a group that received surfactant within two hours after birth was compared to a group that received surfactant after two hours. Next, a group that received surfactant within 30 minutes after birth was compared to a group that received surfactant after 30 minutes. Results: The mean time after birth at which the initial surfactant was administered to neonates was 140.0 ± 114.3 minutes. The incidence of patent ductus arteriosus (PDA), duration of ventilatory support and hospital days were significantly reduced in the group that received surfactant within two hours after birth. The incidence of PDA and duration of ventilatory support were significantly reduced in the group that received surfactant within 30 minutes after birth.

최근 10년간 크론병과 장결핵 발생의 변화

정경면 ( Kyoung Myeun Chung ),김현수 ( Hyun Soo Kim ),박선영 ( Seon Young Park ),임성륜 ( Sung Ryoun Lim ),양대열 ( Dae Yeul Ryang ),정혜경 ( Hye Kyong Jeong ),이완식 ( Wan Sik Lee ),박창환 ( Chang Hwan Park ),이재혁 ( Jae Hyuk 대한소화기학회 2008 대한소화기학회지 Vol.52 No.6

목적: 크론병과 장결핵 발생은 지역에 따라 다르고, 같은 지역이라 하더라도 환경 요인에 따라 시기적으로 다른 빈도를 보인다. 이번 연구에서는 크론병과 장결핵의 최근 10년간 발생 변화를 확인하고자 하였다. 대상 및 방법: 1998년 1월부터 2007년 8월까지 전남대학교병원에 입원 및 외래 진료하여 크론병과 장결핵으로 진단 받은 각각 65예(28.2±15.2세, 남자 42예, 여자 23예), 54예(46.2±18.5세, 남자 29예, 여자 25예)를 대상으로 의무 기록을 통하여 임상 증상, 내시경, 병리 소견, 치료에 대해 분석하고 발생 연도별 분포 등을 조사하였다. 결과: 1998년부터 2002년까지 새로 진단된 크론병 환자는 16명(28.6%)이었으며, 2003년부터 2007년 8월까지 새로 진단된 크론병 환자는 40명(71.4%)이었다. 1998년부터 2002년까지 새로 진단된 장결핵 환자는 40명(74.1%)이었고, 2003년부터 2007년 8월까지 새로 진단된 장결핵 환자는 14명(25.9%)이었다. 크론병 및 장결핵의 주요 증상은 복통(89.2%, 77.8%), 설사(70.8%, 35.2%) 등이었다. 내시경 소견에서 종주궤양, 발적, 장관 협착, 가성용종, 조약돌 병변이 크론병에서 장결핵에 비해 유의하게 많았다(p<0.05). 크론병과 장결핵 병리 조직에서 가장 흔한 소견은 궤양(72.3%, 64.8%)과 육아종(29.2%, 42.6%)이었다. 크론병 병변 분포는 소장형이 21.5%, 혼합형이 55.4%, 대장형이 23.1%였다. 장결핵에서는 소장형이 40.7%, 혼합형이 48.1%, 대장형이 11.1%, 결핵 복막염이 동반된 경우는 3.7%였다. 결론: 서구와 같이 크론병 발생이 점점 증가하고 장결핵의 감소 추세이나 추이 관찰이 필요하다. Background/Aims: The incidence of Crohn`s disease (CD) has been steadily increasing in Korea due to westernized life style and widely used imaging studies such as colonoscopy. There were few studies about the status of longterm trend of CD and intestinal tuberculosis (IT). Therefore, we aimed to evaluate the trend of CD and IT in Korea. Methods: We retrospectively reviewed the medical records of newly diagnosed 65 patients with CD and 54 patients with IT at Chonnam National University Hospital between January 1998 and August 2007. Results: Between 1998 and 2002, 16 and 40 patients were newly diagnosed as having CD and IT respectively, but between 2003 and 2007, 39 and 14 patients were newly diagnosed as having CD and IT respectively. CD patients (28.2±15.2 years) were younger than IT (46.2±18.5 years) (p=0.001). The male to female ratio of CD and IT were 2:1 and 1.1:1, respectively. The most common symptom of CD and IT was abdominal pain. Longitudinal ulceration, hyperemia, luminal narrowing, pseudopolyp, and cobble stone appearance were more common in CD than in IT (p<0.05). Conclusions: While the incidence of CD has increased, the incidence of IT has fallen over the last decade.