골수이형성증후군 ( Myelodysplastic syndrome ) 의 임상상에 대한 연구

김노경 ( Noe Kyung Kim ),조한익 ( Han Ik Cho ),이문호 ( Mun Ho Lee ),김병국 ( Byoung Kook Kim ),박석건 ( Seok Gun Park ),이재훈 ( Jae Hoon Lee ),이혁엽 ( Hyok Yop Lee ),박선양 ( Seong Yang Park ),박찬정 ( Chan Jung Park ) 대한내과학회 1985 대한내과학회지 Vol.28 No.6

Incidence and Significance of Multiple Primary Malignant Neoplasms

최은경(Eun Kyung Choi),조문준(Moon June Cho),하성환(Sung Whan Ha),박찬일(Charn Il Park),방영주(Young Ju Bang),김노경(Noe Kyung Kim) 대한방사선종양학회 1986 Radiation Oncology Journal Vol.4 No.2

한 환자에서 두개 이상의 중복암이 발생하는 경우는 매우 드물게 알려져 왔으나 근래에 들어와 치료법의 발달로 환자의 수명이 연장되고 진단법이 발달되면서 그 보고가 증가되고 또한 관심도 높아지고 있는 상태이다. 따라서 이런 중복암을 가진 환자의 특성을 분석함으로써 발생할 수 있는 2차 3차 암의 조기 발견 및 나아가서는 발암 물질과 유전적 요인 등을 찾아 암의 치료 및 예방에 이응 할 수 있겠다. 이에 1978.7~1986.8까지 8년간 서울 대학교 병원에서 중복암으로 진단되어 치료받은 121예를 대상으로 하여 다음과 같은 결과를 얻었다. 전체 발생율은 0.7%이 있으며 이중 2중복암이 119례, 3중복암이 2례 있었다. 동시성은 (6개월 이내) 51례, 속발성은 (6개월 이상) 70례이었으며 속발성의 경우 70%이상에서 3년내에 2차 암이 발생했다. Moertel분류에 의한 mvlticentriz은 11.6%로 다소 낮은 빈도를 보였으며 다른 장기에 발생한 중복암 중에서는 위암과 간암, 위암과 직장암의 빈도가 가장 높았다. To know the three questions about multiple primary cancers: 1) what are the characteristics of persons having multiple parimary cancer? 2) Does the presence of a single primary concer after the susceptability to multiple primary cancers? 3) Does the location of one multiple primary cancer influence the site of others?, we analysed 121 cases of multiple primary malignant neoplasms registered in Seoul National University Hospital during 8 years from July 1978 to August 1986. Of 121 cases, double primary malignant neoplasms were 119 cases and triples were 2 cases. The incidence of multiple primary malignant neoplasms was 0.7%. The metachronous tumor (>6 months) was found in 70 cases and the median time between the first and the second was 32 months. The most commonly associated tumors were stomach and primary liver carcinoma. Cervix and Lung cancer, Stomach and Rectal cancer, Stomach and Esophagus cancer were also commonly associated.

The Result of Radiotherapy in Esophageal Cancer

박찬일,최은경,정웅기,방영주,김노경,Park, Charn-Il,Choi, Eun-Kyung,Chung, Woong-Ki,Bang, Yung-Jue,Kim, Noe-Kyeong The Korean Society for Radiation Oncology 1988 Radiation Oncology Journal Vol.6 No.2

1979년 3월부터 1986년 8월까지 식도의 편평상피암으로 진단되어 서울대학교병원 치료방사선과에서 방사선치료를 받은 177명중 근치적 방사선 치료를 시행한 152명을 대상으로 후향성 분석을 시행하여 다음과 같은 결과를 얻었다. $80\%$이상의 환자에서 관해를 보였으며, 이중 완전관해는 $22\%$, 부분 관해는 $63\%$이었다. 전체 환자의 2년, 5년 생존율은 각각 $22.9\%,\; 13.3\%$이었으며 식도암의 위치, 크기, 병기 그리고 관해 정도에 따라 생존율에 차이가 있었다. 식도 촬영상 5cm 이하$(17\%)$ 또는 식도의 상부 1/3에 종양이 있는 경우$(25.6\%)$에 가장 좋은 5년 생존율을 보였다. 관해 정도에 따른 생존율은 완전관해를 보인 경우의 5년 생존율이 $34.3\%$인 반면 반응이 없던 경우는 $0\%$이었다 During the period between March 1979 and August 1986, 177 patients with carcinoma of the esophagus were treated with radiotherapy in the Department of Therapeutic Radiology, SNUH. Among these, 25 patients who had incomplete treatment were excluded. So a retrospective analysis was undertaken of 152 patients who were treated by curative radiotherapy. More than $80\%$ showed response: Complete remission $(22\%)$, partial remission $(63\%)$ and no response $(15\%)$. The overall two-year and five-year actuarial survival rate were $22.9\%\;and\;13.3\%$ respectively. Prognostic factor was analyzed by its site, size, T stage, and tumor response. Patients with the best five-year survival rate were those who had the tumor no more than 5cm in length $(17\%)$ or confined to the upper third of the esophagus $(20.6\%)$. Complete responders had $34.3\%$ of 5-year actuarial survival, but no responders had $0\%$ of survival.

항인지질증후군의 임상성

이진학(Jin Hak Lee),김노경(Noe Kyeong Kim),김병국(Byoung Kook Kim),양성현(Sung Hyun Yang),신현춘(Hyun Choon Shin),계경채(Kyung Chae Kye),박선양(Seon Yang Park) 대한내과학회 1994 대한내과학회지 Vol.47 No.3

N/A Background: Antiphospholipid syndrome is characterized by arterial or venous thrombosis, recurrent fetal loss, thrombocytopenia, and presence of antiphospholipid antibody. This study was done to know the clinical and serological characteristics of antiphospholipid syndrome in Korea and to evaluate the therapeutic efficacy of prednisolone and antithrombotic agents in antiphospholipid syndrome. Methods: Clinical and laboratory features of 11 patients with antiphospholipid antibodies and histories of spontaneous abortion and thrombosis were studied. Results: Of the 11 patients, 3 were male, and 8 were female, and the ages ranged from 19 to 54 years (median, 30). 3 patients had systemic lupus erythematosus, and the other 8 fulfilled criteia for the primary antiphospholipid syndrome. Initial presentations were deep vein thrombosis in 4 patients, spontaneous abortion in 4, pulmonary embolism in 1, splenic infarct in 1, and stroke in 1. Seven of 11 patents (63.6%) had episodes of venous thrombosis, and in 2 these were accompanied by pulmonary embolism. Arterial occlusions were present in 2 patients. These comprised splenic infarct and right middle cerebral arterial occlusion. Splenic infarct was accompanied by portal vein, splenic vein, and superior mesenteric vein thrombosis. Spontaneous abortion were present in 6 patients with wide range of episodes of fetal loss (range 1-6, median 2.5). Six episodes of spontaneous abortion occurred during the second trimester and 6 during the third. Combined diseases were idiopathic thrombocytopenic purpura, liver chirrosis, iron deficiency anemia, hypertension, and mitral regurgitation. Six patients had both the lupus anticoagulant and anticardiolipin antibodies; 2 had anticardiolipin antibodies alone; and 3 had only the lupus anitcoagulant. Antinuclear antibodies (>1:40) were present in 8 of the 11 patients and anti-ds-DNA (>25 units) in 3. False positive VDRLs were noted in 3 patients, and thrombocytopenia (<150,000/mm) in 6. Two of three pregnancy ended with normal live birth after adminstration of prednisolone and aspirin, and all thrombotic episodes were resolved with prednisolone plus heparine/warfarin or prednisolone plus aspirin or heparine/warfarin alone. Conclusions: The clinical and serological features of the antiphospholipid syndrome in korea were similar to those of previous reports. Prednisolone and antithrombotic agents were effective in these patients, especially in those who had been suffering from spontaneous abortions.

악성종양에서 골수면역신티그라피를 이용한 골수전이의 평가 : 99mTc-MDP 뼈스캔과의 비교

고창순(Chang Soon Koh),김노경(Noe Kyeong Kim),김병국(Byoung Kook Kim),최창운(Chang Woon Choi),정준기(Jun Key Chung),방영주(Yung Jue Bang),이경한(Kyung Han Lee),정홍근(Hong Keun Chung),이명철(Myoung Chul Lee) 대한핵의학회 1994 핵의학 분자영상 Vol.28 No.1

N/A Although bone scan is a highly sensitive test for detecting bone metastasis, its findings are often limited in specificity and cannot be used for assessing the bone marrow. Bone marrow scintigraphy may provide useful information but previous experience with radiolabelled colloid has been disappointing. Recently, 99mTc labeled anti-granulocyte rnonoclonal antibody (anti-NCA-95 MAb) has been introdueed as a new bone marrow imaging agent. To evaluate the usefulness of 99mTc anti-NCA MAb bone marrow scans for detecting skeietal metastasis, bone marrow scans of 44 malignant tumor patients were evaluated and compared with bone scan fmdings. Bone scan showed abnormal lesions in 26(59%) cases, and 18 of these patients also had an abnormal bone marrow scan. Seven of the 8 patients who had normal bone marrow scan despite bone scan lesions were confirmed to be free from metastasis. There was one case with a marrow defect despite normal bone scan but the presence of metastasis was not determined due to loss of follow up. Bone scan demonstrated a total of 64 lesions while bone marrow scan showed 38 lesions. Fifty percent (32/64) of the bone scan lesions had matching marrow defects while the rernaining 50% did not. Most of these non matched lesions were suggested to be nonspecific 1esions such as rib fractures or degenerative change. Meanwhile bone marrow scan was able to detect 6 new lesions not detected by bone scan, but metastasis in each lesion was not confirmed. Bone marrow scan was also helpful in assessing equivocal bone scan lesions to be of metastatic nature in 10 patients by demonstrating a matched marrow defect. Thus 99mTc anti-NCA MAb bone marrow scan can help exclude metastasis in patients with nonspecific bone scan lesions and may be able to detect metastatic lesions not seen with bone scan. It appears useful as a complementary study to bone scan in evaluating malignant tumor patients.

Enzyme - Linked Immunosorbent Assay 를 이용한 Plasminogen Activator Inhibitor - 1 ( PAI - 1 ) 의 측정법 개발과 심부정맥 혈전중 환자에서의 변동에 관한 연구

박선양(Seon Yang Park),계경채(Kyung Chae Kye),김병국(Byoung Kook Kim),김노경(Noe Kyeong Kim),이문호(Moon Ho Lee),이규섭(Kye Sup Lee),박문규(Moon Kye Park),박근조(Keun Jo Park) 대한내과학회 1989 대한내과학회지 Vol.36 No.2

N/A It has been suggested that impaired fibrinolysis plays a role in the development of deep vein thrombosis. The net fibrinolytic activity of blood is dependent on the sum of different types of plasminogen activators (PAs) and plasminogen activator inhibitors (PAIs). Therefore, assessment of each component of the fibrinolytic system is important in order to understand the underlying basis of thrombotic disorders. Certain pathological conditions may exhibit elevated plasma PAI which may inactivate endogenous PA by forming PA-PAI complexes. These enzymatically inactive complexes will not be detected by most functional assays. As PAs released into the circulation are captured within minutes by the excess of PAIs, it is reasonable to assume that PAIs may play an important role in regulating the activity of PAs, and hence the net fibrinolytic activity of the blood. Among the different forms of PAIs, PAI-1 synthesizd and secreted by the endothelial cells and found in the platelets has been suggested to play a major role in the regulation of fibrinolytic activity of the blood. For these reasons, we developed an enzyme-linked immunosorbent assay specific of human PAI-1 and measured its plasma levels in normal Korean subjects and in patients with deep vein thrmbosis. 1) Our ELISA for PAI-l measured both the free PAI-1 and u-PA-PAI-1 complexes. 2) The PAI-1 concentration of our PAI-1 standard, a conditioned medium of cultured human umbilical vein endothelial cells, was 257 ng/ml. 3) The PAI-1 concentrations of EDTA plasma in 16 normal Korean subjects ranged from 0-12,8 ng/ ml (4. 8+ 3.4 ng/ml). 4) The plasma PAI-1 levels in 13 patients with deep vein thrombosis were elevated to 2.8-38.4 ng/ml (16.6+ 9.8 ng/ml). This difference was statistically significant when compared to normal subjects (p<0.001). 5) With a cut-off value of 15.0 ng/ml (up to 3 SD from the mean) for normal plasma PAI-1 concentrations, 6 of the 13 patients (46.2%) with deep vein thrombosis were found to have elevated PAI-1 levels in their plasma, while all the normal subjects had their plasma PAI-1 levels in the normal range.

암환자 응급진료의 현황 및 문제점

허대석,윤영호,정주영,김홍수,김성혜,신상도,김중의,오은경,유철규,방영주,김노경,Heo, Dae-Seog,Yun, Young-Ho,Jeong, Joo-Young,Kim, Hong-Soo,Kim, Sung-Hye,Shin, Sang-Do,Rhee, Joong-Eui,Oh, Eun-Kyung,Yoo, Chul-Gyu,Bang, Yung-Jue,Kim, Noe-K 한국호스피스완화의료학회 1998 한국호스피스.완화의료학회지 Vol.1 No.1

Purpose : Cancer is a common cause for admission to emergency room(ER). Cancer patient present to ER with undiagnosed cancer, acute vague problem of cancer, or treatment related complication. But there is little information on the magnitute of the problems in the Korea. The purposes of our study were to evaluate the appropriateness of care for oncologic emergencies in Korea. Materials and Methods : This study was undertaken of all cancer patients above 15 years old presenting to the Seoul National University Hospital ER, who visited during the period from Oct. 16 to Nov. 15, 1997. ER record was reviewed and ER doctors evaluated patients' reason for visiting ER, appropriateness in patients' utilization of ER, oncology emergency Results : 266 cancer patients(17.4% of total patients) visited ER during this period and 166 cancer patients(62.4%) utilized inappropriately ER. Their average stay is 32.0 hours and 65.8% of them stayed for 6 hours. There were complaints of patients such as pain(44.8%), abdomen distension(9.4%), and dyspnea(7.5%). The most common oncologic emergency in ER during this study were gastrointestinal(34.0%), neurologic(21%), hematologic(8.0%), infectious(7.0%), respiratory(6.0%), and genitourinary(5.0%). Conclusion : For the care of symptoms like pain, most of cancer patients utilize ER inappropriately due to lack of attention from primary health delivery system. For the better care, the palliative medicine should be established in Korea. 목적: 우리나라에서 암환자들이 긴급한 의료문제가 발생한 경우, 어떤 경과를 거쳐 진료를 받고 있는지 자세히 연구된 자료가 없다. 대부분의 1, 2차 의료기관이 암환자진료에 소극적이어서, 사소한 증세조절을 위해서도 3차의료기관의 응급실을 방문해야 하는 등 많은 문제점이 있다. 이에 연구자들은 3차의료기관 응급실을 방문한 암환자들의 적절성여부를 평가하여 암환자의 응급진료상의 문제점을 파악하고자 한다. 방법: 서울대학교 응급실을 방문한 성인암환자들의 응급실방문의 목적, 주증상, 적절성 등을 응급실근무 전공의와 간호사를 통해 조사, 평가하였다. 결과: 1997년 10월 16일부터 11월 15일사이 한달간 서울대학교병원응급실을 방문한 환자중 암환자는 17.4%(266명)를 차지하였다. 이중 응급실이용이 부적절하다고 판단된 환자는 166명(62.4%)이었으며, 이들의 응급실재원 평균시간은 28.7시간이었고, 주증상은 통증이었다. 결론: 통증과 같은 증상조절을 위하여 응급실을 방문하는 암환자의 대부분이 1, 2차의료기관에서도 진료가 가능한 상태로 암환자의 증상조절이 보다 효율적으로 이루어질수 있도록 완화의학 및 의료전달체계의 조속한 확립이 요망된다.

악성종양에서 골수면역신티그라피를 이용한 골수전이의 평가 : $^{99m}Tc$-MDP 뼈스캔과의 비교

이경한,최창운,방영주,정준기,정홍근,이명철,김병국,김노경,고창순,Lee, Kyung-Han,Choi, Chang-Woon,Bang, Yung-Jue,Chung, Jun-Key,Chung, Hong-Keun,Lee, Myoung-Chul,Kim, Byoung-Kook,Kim, Noe-Kyeong,Koh, Chang-Soon 대한핵의학회 1994 핵의학 분자영상 Vol.28 No.1

Although bone scan is a highly sensitive test for detecting bone metastasis, its findings are often limited in specificity and cannot be used for assessing the bone marrow. Bone marrow scintigraphy may provide useful information but previous experience with radiolabelled colloid has been disappointing. Recently, $^{99m}Tc$ labeled anti-granulocyte monoclonal antibody (anti-NCA-95 MAb) has been introduced as a new bone marrow imaging agent. To evaluate the usefulness of $^{99m}Tc$ anti-NCA MAb bone marrow scans for detecting skeletal metastasis, bone marrow scans of 44 malignant tumor patients were evaluated and compared with bone scan findings. Bone scan showed abnormal lesions in 26(59%) cases, and 18 of these patients also had an abnormal bone marrow scan. Seven of the 8 patients who had normal bone marrow scan despite bone scan lesions were confirmed to be free from metastasis. There was one case with a marrow defect despite normal bone scan but the presence of metastasis was not determined due to loss of follow up. Bone scan demonstrated a total of 64 lesions while bone marrow scan showed 38 lesions. Fifty percent (32/64) of the bone scan lesions had matching marrow defects while the remaining 50% did not. Most of these non matched lesions were suggested to be nonspecific lesions such as rib fractures or degenerative change. Meanwhile bone marrow scan was able to detect 6 new lesions not detected by bone scan, bit metastasis in each lesion was not confirmed. Bone marrow scan was also helpful in assessing equivocal bone scan lesions to be of metastatic nature in 10 patients by demonstrating a matched marrow defect. Thus $^{99m}Tc$ anti-NCA MAb bone marrow scan can help exclude metastasis in patients with nonspecific bone scan lesions and may be able to detect metastatic lesions not seen with bone scan. It appears useful as a complementary study to bone scan in evaluating malignant tumor patients.

위암환자에서 99mTc - MDP 스캔에 의한 골전이 평가

최창운,김상은,이동수,여정석,안규리,정준기,이명철,김노경,고창순 ( Chang Woon Choi,Sang Eun Kim,Dong Soo Lee,Jung Seok Lyeo,Cu Rie Ahn,Jung Key Chung,Myung Chul Lee,Noe Kyung Kim,Chang Soon Koh ) 대한핵의학회 1991 핵의학 분자영상 Vol.25 No.2

항암 화학요법에 의한 피부 변화

정진호(Jin Ho Chung),조광현(Kwang Hyun Cho),김노경(Noe Kyung Kim) 대한피부과학회 1987 대한피부과학회지 Vol.25 No.2

A clinical observation of cutaneous complications was made on 200 patients receiving cancer chemotherapy at the Department of Internal Medicine, Seoul National University from January through May, 1986. The results were as follows: 1. Among the 200 patients, 191 case(95. 5%) showed cutaneous complications 2. The cutaneous complications included the following; hyperpigmentation(14l cases, 70. 5%), alopecia(138 cases, 69.4%), nail change(118 cases, 59.0%), muco- sitis(47 cases, 23.5%), dryness of the skin(40 cases, 20.0%), seborrheic dermatitis(24 cases, 12. 2%), increase of seborrheic keratosis(11 cases, 5.6%), folliculitis or acneiform eruptions(9 cases, 4,5%), melasma(6 cases, 3.0%), gynecomastia(3 cases, 1.5%), vessel hardening or dimpling(3 cases, 1.5%), radiation recall(2 cases, 1.0%), hyperhydrosis(2 cases), photosensitivity(1 case, 0.5%), tissue necrosis(1 case), facial flushing(1 case), purpura(1 case) and obesity(1 case), 3 Steps were taken to determine the chemotherapeutic agents causing these cutaneous complications, though in some cases it was difficult in determining exaetlr which chemotherapeutic agent was the cause of the observed cutaneous complication.