비호지킨림프종의 임상상과 예후인자

김태원(Tae Won Kim),이정신(Jung Shin Lee),최성준(Sung Jun Choi),최종수(Jong Soo Choi),장대영(Dai Young Zang),이제환(Je Hwan Lee),김성배(Sung Jun Choi),김상위(Sang We Kim),서철원(Cheol Won Suh),이규형(Kyoo Hyung Lee),김우건(Woo Kun Ki 대한내과학회 1997 대한내과학회지 Vol.52 No.2

N/A Objectives: The advent of intense combination chemotherapy has transformed aggressive non-Hod-gkins lymphoma from a disease that was once uniformly fatal to one that is now often curable. Remission rates and survival may be improved by using intensive chemotherapy regimens. However, this more aggressive approach is inevitably associated with increased toxicity, and an accurate pretreament prognostic assessment of patients is required to guide the physician in selecting the most appropriate therapeutic regimen. Many studies have reported prognostic factors of non-Hodgkins lymphoma in western countries, but there are few reports on prognostic factors in Koreans and it is suggested that clinical characteristcs of non-Hodgkins lymphoma in Korea differ from those in western countries. The purpose of this study was to illustrate clinical characteristics, prognostic factors and treatment outcome in non-Hodgkins lymphoma in Korea. Methods: Clinical features of 151patients (age over 15years) with non-Hodgkins lymphoma registered at Asan Medical Center from March 1989 to December 1993 were retrospectively reviewed. Prognostic factors and treatment outcome were evaluated among 121previously untreated patients. Multi variate analysis of potential pretreatment prognostic factors was performed using Coxs proportional hazards model. Results: Of the 151patients evaluated, 55% had diffuse large cell type, while low-grades were encountered in less than 1% of the patients. Extranodal involvement was noted in 76% of the patients. Cental nervous system was the commonest primary extranodal site, followed by stomach. Complete remission was achieved in 73 of 121patients (60%). The median follow-up for 121patients was 24months and the actuarial overall survival was 48% at 3years and 44N at 5years with a median overall survival of 33months. At the median followup of 32months, the actuarial 5year disease-free survival rate among 73patient with complete remission was 65% and median remission duration was not reached. Presence of systemic B symptoms and advanced clinical stages were associated with a low complete remission rate. None turned out to be associated with the remission duration. The Coxs proportional hazards model identified age above 60years, presence of systemic B symptoms and elevated LDH level as significant independent poor prognostic factors influencing overall survival. Conclusion: This study reveals a low prevalence rate of the low-grades lymphoma and a higher propensity of diffuse large cell type. These results suggest that clinical characteristics of non-Hodgkins lymphoma in Korea are different from those in the western countries. Our data also show that certain pretreatment clinical factors can help in predicting survival and in planning treatment.

간세포암종의 자연퇴행

김성배 ( Sung Bae Kim ),강원석 ( Won Seok Kang ),신승환 ( Seung Hwan Shin ),이희승 ( Hee Seung Lee ),이상훈 ( Sang Hoon Lee ),최기홍 ( Gi Hong Choi ),박준용 ( Jun Yong Park ) 대한소화기학회 2015 대한소화기학회지 Vol.65 No.5

We report on a case of a 57-year-old male who underwent a curative resection for hepatocellular carcinoma (HCC) with histological confirmation of a spontaneously necrotized tumor. Initial serum AFP level was 4,778 ng/mL. A 3.7 cm hyperechoic mass in segment 6 of the liver was observed on ultrasonography and dynamic contrast-enhanced liver MRI showed a 3.7×3.1 cm sized HCC. He was scheduled to undergo curative surgical resection under the clinical diagnosis of an early stage HCC (Barcelona Clinic Liver Cancer stage A). Without treatment, the serum AFP level declined rapidly to 50 ng/mL over five weeks. He underwent curative wedge resection of segment 6 of the liver. Histology revealed complete necrosis of the mass rimmed by inflamed fibrous capsule on a background of HBV-related cirrhosis with infiltration of lymphoplasma cells. Exact pathophysiology underlying this event is unknown. Among the proposed mechanisms of spontaneous neoplastic remission of HCC, circulatory disturbance and activation of host immune response offer the most scientific explanation for the complete histologic necrosis of HCC in the resected mass seen in our patient. (Korean J Gastroenterol 2015;65:312-315)

현대도시와 유토피아에 대한 철학적ㆍ정책적 시론

김성배(Kim, Sung-Bae),박삼열(Park, Sam-Yeal),최윤기(Choi, Yoon-Ki),차봉준(Cha, Bong-Jun) 강원대학교 인문과학연구소 2016 인문과학연구 Vol.0 No.48

이미 세계 인구의 반 이상이 도시적 환경에서 삶을 영위하고 있다. 그리고 현재 진행되고 있는 추세를 감안한다면 그 비중은 더욱 높아질 것으로 예견된다. 향후 어떠한 형태의 도시화 경향이 나타나든 한 가지 명확한 것은 우리는 인류 역사상 처음으로 도시사회에 살고 있고, 도시에서의 삶은 이제 피할 수 없는 삶이 되었다는 사실이다. 이러한 현실 앞에서 본 연구자들은 “과연 현대 도시에서 살고 있는 사람들은 행복한가?”라는 질문을 던지게 되었다. 세계적 도시학자 글레이저가 도시의 삶이 우리를 보다 부유하고, 현명하고, 더 많은 녹지를 제공하고, 더 건강하며, 그리고 더 행복하게 만든다고 주장하고 있음에도 불구하고 현대의 도시가 안고 있는 수많은 문제들을 결코 부인할 수 없기 때문이다. 만일 행복하다면 얼마나 행복한지? 도시가 그들을 행복하게 한다면 그러한 행복을 가져오는 요소는 무엇인지? 도시에서의 사람을 더 행복하게 하기 위해서 필요한 것은 무엇인지? 이러한 질문에 대한 답은 우리가 도시에서의 삶을 피할 수 없는 것이라고 한다면 필연적으로 해결해야 하는 의문에 해당할 것이다. 본 연구는 이러한 배경 하에서 현재 도시에서 행복한 삶을 누리기 위해서 무엇을 해야 하는가하는 의문에 대해 답을 구하는 것을 그 목적으로 삼았다. 한편 오늘날의 도시는 그 규모 면에서나 구성 면에서 너무나 방대할 뿐 아니라 복잡다기한 양상을 띠고 있다. 그러므로 어느 한 가지 측면에서 도시문제를 접근하고 진단하기에는 이미 많은 문제점을 내포하고 있는 것이 사실이다. 때문에 본 연구는 현대도시를 유토피아를 향한 관점에서 접근할 필요성을 느낌과 동시에 이를 제학문 간의 융합적 이해를 바탕으로 연구할 필요성을 갖게 되었다. 특히 본 연구가 목적으로 삼고 있는 도시 구성원의 행복한 삶이란 어느 한 가지 요소의 충족만으로는 결코 도달할 수 없는 요원한 지향점이기 때문이다. 그러므로 이는 인문학적․사회학적 관점에서 접근하고 이를 종합하여 새로운 대안을 모색해 나가는 자세가 필요하다. 즉 인문학적 접근을 통해서는 과연 현대도시에서 행복하다는 것이 무엇인가라는 점에 대해 개념적 정의를 내릴 수 있고, 사회과학적 접근을 통해서는 도시민의 행복함에 대해 사회 경제적 관계가 어떠한 영향을 미치는지와 정책적으로 어떠한 노력이 필요한가를 체계적으로 밝혀낼 수 있을 것이다. More than a half of the world population are already living in the urban environment in these days. With current rate of increase for city population, it is very possible prediction that the rate of population in the city will be growing more sharply. Whatever forms the trends of urbanization are, it is going to be very possible case that we, human-beings will largely live in urban environment in the first time of human history and the life of urban area can be inevitable for most people in the future. With this kind of diagnosis, this study asks a question, "Are those who live in the city happy?". Because it is also undeniable that urban life has a lot of realistic questions at the same time even though Glaeser, the renowned urban theorist, argues that urban life provides us with more rich, wise, and green basis, so it makes us more healthy and happier than ever. More specifically, this study explores questions such as "If the urban life provides happiness to us, how much is it?", "What kinds of factors contribute to happiness of urban life?" and "What is more necessity for making those in the city happier if city makes them happy?". The solutions of these questions are very necessity if we should live in the urban environment. That is why the purpose of study is to examine the possible solutions of what we should do for happy life in the urban environment with given contexts. On the other hands, recent city problems have complex aspects in terms of scale as well as structure. This study realizes that it has limitation that approaching to and exploring city problems with the only specific aspect. Therefore, this study suggests that both developing modern city into Utopia and interdisciplinary understandings for related aspects are more helpful to confirming eudiaimonia conditions in the city because it can not be defined a specific condition which satisfies residents" life in the city. Approaching to given context with both humanistic and social scientific perspectives, this study can challenge alternatives to the eudiaimonia conditions for city residents. Firstly, in humanistic approach, this study can define what is happiness in modern city life. Then, in social scientific approach, it can more systematically figure out how much social-economical aspects can affect happiness of city residents and what kind of political efforts will be required for providing eudiaimonia conditions to city residents.

한국인 다발성골수종 환자에서 치료에 대한 반응 및 생존기간에 영향을 미치는 예후인자 분석

송헌호(Hun Ho Song),이제환(Je Hwan Lee),박종범(Jong Beom Park),최성준(Seong Jun Choi),김정균(Jeong Kyoon Kim),김성배(Sung Bae Kim),김상위(Sang We Kim),서철원(Cheol Won Suh),이규형(Kyoo Hyung Lee),이정신(Jung Shin Lee),김우건(Woo Kun 대한내과학회 2000 대한내과학회지 Vol.58 No.1

N/A Background : New therapeutic modalities such as high dose chemotherapy and stem cell support have been tried to prolong the survival period of the patients with multiple myeloma. However, little is known about the criteria for the application of those new therapies. There are only a few reports for the prognostic factors of multiple myeloma in Korea. The purpose of this study is to analyze the prognostic factors affecting chemotherapy response and survival in patients with multiple myeloma. Methods : We retrospectively analysed the clinical records of 122 patients who were newly diagnosed as multiple myeloma by SWOG criteria, between November, 1989 and April, 1997 at Asan Medical Center. Results : 1) The peak incidence was the 7th decade and male to female ratio was 1.3:1. The most common presenting symptom at first diagnosis was bone pain. 2) Initial clinical stage was as followed: stage I in 17.2% , stage II in 16.4% and 66.4% in III. The immunoglobulin classes were IgG in 51.6%, light chain only in 25.4%, IgA in 16.4%, IgD in 4.1%, and non-secretory type in 2.5%. Plasma cell types in bone marrow were classified as plasmablastic type in 45.9%, plasmacytic type in 54.1%. 3) Eighty two patients who recieved chemotherapy more than 3 cycles were evaluable for chemotherapy response. Overall response rate was 69.5%. Factors affecting response to chemotherapy were serum creatinine level, plasma cell type, total plasma cell percentage and plasmablast percentasge of total nucleated cells in bone marrow. 4) For total 122 patients, overall median survival period was 21 months, and estimated 5 year survival rate was 23.5%. Factors affecting survival were serum creatinine, corrected calcium, albumin, β2-microglobulin level, response to chemotherapy, total plasma cell percentage and plasmablast percentage in bone marrow. Conclusion : Bone marrow findings at initial diagnosis are significantly associated with response to chemotherapy and survival duration.(Korean J Med 58:83-90, 2000)

건강한 한국 성인에서의 백혈구와 호중구 감소증

박진희(Jin Hi Park),서철원(Cheol Won Suh),김우건(Woo Kun Kim),이무송(Moo Song Lee),배창황(Chang Hwang Bae),민영주(Young Joo Min),최성준(Seong Jun Choi),김태원(Tae On Kim),장대영(Dae Young Zang),이제환(Je Hwan Lee),김성배(Sung Bae Kim 대한내과학회 1998 대한내과학회지 Vol.54 No.3

N/A Background: It has been well known that normal leukocyte counts in blood can vary depending on age, gender, other environmental factors and ethnic differences. However, the normal white blood ce11 counts in Koreans has not been settled yet. Over past several years, a large number of patients were referred to the Hematology Clinic of Asan Medical Center (AMC) for evaluation of leukopenia, and most of them were found to have no medical problems other than leukocyte counts less than 4.000/mm3. We performed this study on persons who visited Health 3creening Center to analysis of leukopenic patients and also to establish the normal value of white blood cell counts in Korean. Method: We studied 31,307 persons (19,540 men, 11,767 women, aged 15-90), who visited to Health Screening Center of AMC during the period from January through December 1995. We have carried out retrospective analysis of complete medical record of 2,406 patients (838 men, 1,568 women, aged 20-81) who were found to have leukocyte counts less than 4,000/mm3. And we tried to establish the normal values of leukocyte counts and differential counts of 24,079 adults (15,807 men, 8,272 women, aged 19-90), who were assessed to be healthy at Health Screening Center of AMC. Results: 1) Leukopenia (WBC<4,000/mm3) were found in 2,406 subjects (7.7%) among 31,307 persons screened. 2) Among them, 77 subjects (3%) had medical illness; 39 of them had chronic B or C viral hepatitis, 24 of them had iron deficiency anemia, and other diseases were detected in remaining 14 patients. But other hematologic diseases or significant infectious diseases were not detected. Follow-up study of them has indicated no increased incidence of infection or other hematologic diseases. 3) The total white blood cell counts of 24,097 healthy Korean adults were 3,640-9,870/mm (5,900/mm3) in men, and 3,270-8,400/mm3 (5,264/mm3) in women. Neutrophil counts ranged 1,288-6,866mm3 (3,098/mm3) in men, and 1,180-5,985/mm3 (2,816/mm3) in women. Leukocyte counts were significantly lower in female, but no significant variation was found among age groups. Conclusion: Normal range of leukocyte counts and neutrophil counts of healthy Korean adults were lower than those of white populations. Thus, a new normal values of leukocyte and neutrophil counts should be established in Koreans. And many persons with leukocyte counts less than 4,000/mm3 who are otherwise healthy could be normal.

중심정맥 도관 삽입술의 성공률과 합병증 발생 빈도에 대한 전향적 연구

배창황(Chang Hwang Bae),김우건(Woo Kun Kim),박완(Wan Park),박진희(Jin Hee Park),김정균(Jeong Kyun Kim),최성준(Sung Jun Choi),이제환(Je Hwan Lee),김성배(Sung Bae Kim),김상위(Sang We Kim),서철원(Cheol Won Suh),이규형(Kyoo Hyung Lee),이 대한내과학회 1998 대한내과학회지 Vol.55 No.2

N/A Objectives: The reported success rate of central venous catheterization ranged from 84% to 97.5%, and the complication rate from 0.3% to 12%. The most important contributing factor for complications reported by several authors was the physician's experience. We investigated the success and complication rates of central venous catheterization prospectively. We also evaluate the factors that contributed to complications at our institution as part of our quality assurance study. Methods: Four hundred sixty five central venous catheterizations were conducted at the medical intensive care unit and the general ward of the hemato1ogy/ oncology department of Asan Medical Center in Korea, from June to November, 1997. We surveyed the date and place of the procedures, lD numbers, age and sex of the patients, the training level of physicians, the types of catheters, initial puncture sites, success or failure, and complications. We grouped the purpose of procedures into 5categories, such as hemodynamic monitoring, fluid therapy, chemotherapy, total parenteral nutrition, and others, Results: The initial success rate, defined as the initial performer being able to insert the catheter without changing the skin puncture site, was 78.5%. The overall success rate for initial performers, including those who required multiple skin puncture sites, was 82.8%. The total success rate, including changing the performers (up to 4performers), was 96.1%. The overall complication rate was 5.2% including pneumothorax (2.8%), hemothorax (0.2%), subcutaneous hematoma (1.1%), catheter tip malposition (0.9%), and air-embolism (0.2%). There were no differences in the complication rates with regards to the sex and age of the patient, initial puncture sites, the physician's training level between 1st and 2nd year residency, and vein localization. However, the complication rate differed significantly in relation to the number of initial punctures. Patients with 1-3 punctures had a complication rate of 4.3%, while patients with 4 or more punctures had a complication rate of 18.5%. Conclusion: The overall complication rate was 5.2% and pneumothorax occured in 2.8%. We expect that we can decrease the number of complications by taking over the procedure if the initial performer fails on the first or second attempt and by attempting the skin puncture not more than 4times at initial trial.

레트로바이러스벡터를 이용한 제대혈 세포에 유전자이입시 염화칼슘 농도와 싸이토카인의 효과

김성배,김상희,이정신,최성준,김정균,이제환,김상위,서철원,이규형,김우건 대한조혈모세포이식학회 1998 대한조혈모세포이식학회지 Vol.3 No.1

연구배경 : 혈액 세포에 레트로 바이러스를 이용한 유전자 이입시 이입 효율성이 낮은 것이 중요한 장애 요인이 된다. 이를 극복하기 polycation을 첨가해 왔다. 제대혈 단핵세포가 유전자 이입 표적세포로써 적절한지를 알아보고, polycation 첨가방법과 비교하여 유전자 이입시 레트로 바이러스 상층액에 싸이토카인과 염화 칼슘 농도가 유전자 이입에 미치는 영향을 살펴 보고자 하였다. 방법 : 레트로 바이러스 상층액에 일정량의 3가지 싸이토카인(IL-3, IL-6,SCF)과 4가지 종류의 염화 칼슘 농도를 달리하여 첨가한 후 제대혈 단핵세포에 유전자 이입을 하였다. 유전자 이입시킨 제대혈 단핵세포(2×106)를 4개씩 plating 한 후 이중 2개의 well에는 G418(1.0㎎/ml)를 첨가하여 G418 처리한 배지에서 형성된 집락수를 세었다. 동일한 실험을 3회 반복하였다. 결과 : 1) 싸이토카인을 사용하였을때 , IL-3 단독 사용시 보다는 IL-3, IL-6, SCF 혼합 사용시 유전자 이입 효율성이 4.1 배 6.8배 각각 증가되었다. 2) 간질 세포 존재 유무는 유전자 이입 효율성에 직접적인 영향을 주지는 않았다. 3)싸이토카인 첨가유무, 간질세포 조건에 상관없이 염화 칼슘 농도가 증가함에 따라 유전자 주입률이 3.6배 향상되었다. 4) 기존의 polybrene만 처리하였을때 보다 염화칼슘 농도를 올림으로써 유전자 이입에 사용되지 않고 버리는 레트로바이러스가 74%에서 29%로 감소 하였다. 5) 염화칼슘농도가 5mM 초과시에는 methylcellulose 배지에서 colony 수가 감소되었다. 6) G418 처리후 살아남은 colony는 PCR을 통해 Neo® 이 이입되었기 때문임을 확인할 수 있었다. 결론 : 싸이토카인 및 염화칼슘을 처리하여 유전자 이입 효율을 향상시킬수 있었고 생체 외에서 이러한 염화칼슘 침전법을 이용한 유전자 이입은 바닥에 붙어 자라는 세포(anchorage-dependent cell)를 대상으로 할때 더욱 효과적일 것으로 생각하며, 성공적인 유전자 치료에 필수적인 유전자 이입 효율성을 향상시키기 위해 더 많은 연구가 뒷받침 되어야 겠다. Background : Low transduction efficiency has the main obstacle for retroviral mediated gene transfer into hematopoietic cells even with the addition of polycations to enhace transduction. We investigested the feasibility of mononuclear of CaCl₂ added to retroviral supernatant compared to the standard polybrene-enhanced transfection. Methods : Cell free Neo^(R) retroviral supernatant containing 3 cytokines (Ⅱ-3, IL-6, SCF) with 4 different concentrations of CaCl₂ was added to target cells. After gene transfer, the cells(2×10^(6)/ml) were plated in qudriplicate, G418 was added to 2 wells of each set at 1.0 ㎎/ml, measured the percentage of G418 resistant progenitor derived colonies. Results : 1) Use of cytokines or especially combined use of 3 cytokines (IL-3, IL-6, SCF) together increased gene transfer efficiency to 6.8 times as compared to transductions in basal medium. 2) The presence of stromal supports during the transduction of the umbilical cord mononuclear cells did not increase gene transfection efficiency. 3) Transfection efficiency of CBMNCs (cord blood mononuclear cells) could be enhanced to 3.5 times by increment of CaCl₂. 4) Discarded retrovirus with standard polybrene-enhanced method could be reduced from 74% to 29% as the increase of CaCl₂ of the retroviral supernatant. 5) The number of colonies in methycellulose culture constantly reduced above 5mM CaCl₂. 6) Neo^(R) gene transfection in selected colony with G418 was confirmed by DNA-PCR. Conclusion: We conclude that tranduction to umbilical cord blood progenitor cells could be enhanced to 6.8 or 3.6 times with the use of recombinant human growth factors(IL-3, IL-6, SCF) and the increment of CaCl₂ concentration added to retroviral supernatant, but it might be ctyotoxic above 5 mM. Where the use of the calcium coprecipitation method is contemplated in ex vivo gene therapy, anchorage-dependent target cells are more desirable.

제왕절개술의 마취 유도시 사용한 Propofol의 혈중 농도와 신생아의 결과에 대한 연구

김성배,최영석,이인호,허준용,이이옥,공명훈,이미경,김난숙,임상호 대한정맥마취학회 2000 정맥마취 Vol.4 No.3