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공존이환(Comorbidity)이 있는 암환자에서의 항암약물치료
문용화,정희철,Moon Yong-Wha,Jeung Hei-Cheul 대한위암학회 2004 대한위암학회지 Vol.4 No.2
This report attempts to explain the (i) implications of comorbidity for research and practice in the fieldo of oncology, (ii) the approach for dosing of anti-cancer drugs in the presence of comorbidity, as an example of its clinical application, and finally (iii) the dosing guidelines for the anticancer drugs clinically active in gastric cancer in the presence of renal or liver dysfunction. This has resulted from the idea of approaching comorbidity in a systematic way and of integrating it with oncologic decisions. Various methods have been used to assess comorbidity. However, significant work remains to be done to analyze how various diseases combine to influence the oncologic outcome. The main end-point explored so far has been mortality, but a largely open challenge remains to correlate comorbidity with treatment tolerance and functional and quality of life, as well as to integrate it in clinical decision-making. Cancer chemotherapy in comorbidity should be considered as an example of the need for dose optimization in individual patients, and it should be determined by considering the basic principles of the pharmacokinetics and the pharmacodynamics of the agents. This review analyzes the available data on the pharmacokinetics and the toxicities of anti-cancer agents in the comorbidity population.
위절제시 발생한 췌장관 손상의 치료: 췌-십이지장 문합술
김기봉 ( Ki Boong Kim ),오성태 ( Sung Tae Oh ),문용화 ( Yong Wha Moon ) 대한외상학회 1990 大韓外傷學會誌 Vol.3 No.2
Iatrogenic injury of the pancreas may occur in assosiation with a variety of operations or diagnostic studies. We experienced the iatrogenic pancreatic injury during the subtotal gastrectomy and successfully treated with pancreaticoduodenos-tomy without complication. Reviewing the literature and from our experience in this regard, the pancreaticoduodenostomy is not an inappropriate procedure in pancreatic duct injury.
문용화,김지현,강웅철,박병은,고영국,최동훈,유경종 대한내과학회 2004 대한내과학회지 Vol.66 No.3
관동맥우회술을 포함한 심장수술 후에 생기는 급성 장간막경색은 매우 드물지만 치명적인 합병증으로 발생률은 비교적 낮으나 사망률은 매우 높게 보고 되고 있다. 본 증례에서는 55세 여자 환자가 관동맥우회술을 시행받고 수술 후 1일째에 발생한 복부통증에 대해서 장간막경색증을 의심하지 못하고 수술과 연관된 비특이적 증상으로 판단하였으나 그 후 환자의 증상이 악화되면서 상장간막동맥 혈전 색전증에 의한 광범위한 급성 장괴사로 판명되었다. 관독맥우회술 후 상장간막 동맥에 생긴 혈전색전증에 의해 발생한 급성 장간막경색의 증례는 국내에 보고된 바 없고 본 증례를 통해 교육적인 경험을 하였기에 저자들은 문헌고찰과 함께 보고하는 바이다. 심폐우회술을 요하는 심장수술을 받은 환자 중 특히 급성 장간막허혈의 위험인자를 가지고 있는 환자에 대해서는 급성 장간막허혈이 생길 수 있다는 세심한 관찰이 진단이 늦어지지 않게 하는 방법이며 장간막허혈이 의심되면 즉시 적극적인 진단 및 치료적인 접근을 시도해야 하겠다. Acute mesenteric ischemia leading to massive bowel infarction following cardiac surgery particularly coronary artery bypass graft (CABG), is reported to be a very rare but serious life-threatening complication. In this case, a 55-year-old female underwent CABG and complained of abdominal pain on the first postoperative day, which was thought to be nonspecifically related to the operation wound, In the further hospital course, the patient was found to have extensive acute mesenteric infarction due to thromboembolism of superior mesenteric artery. This is a valuable educational case, since only high index of suspicion does not delay making a diagnosis especially in the patients with risk factors of acute mesenteric ischemia after cardiac surgery requiring cardiopulmonary bypass. On suspicion of acute mesenteric ischemia, an aggressive diagnostic and therapeutic approach should be performed immediately.(Korean J Med 66:317-320, 2004)
우심실 자유벽의 거대 우종을 동반한 감염성 심내막염 1예
김진배,오성진,이승철,김원호,문용화,전동운,양주영 대한내과학회 2004 대한내과학회지 Vol.66 No.6
저자 등은 20세 여자 환자로서 10일간의 발열 및 기침을 주소로 내원하여 지역 사회 획득 폐렴으로 진단 후 치료한 후 추적관찰 중 계속하여 재발하는 임상양상을 보여 경식도 심초음파 시행, 심중격 결손 및 우심실 자유벽의 우종을 동반한 감염성 심내막염 진단하에 경험적 항생제 요법으로 성공적으로 치유한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Infective endocarditis is still one of the important fatal diseases especially when it is accompanied with systemic embolic manifestations. So, this is often misdiagnosised because of a variability of systemic embolic manifestations. We experienced a case of infective endocarditis with pulmonic embolic manifestations whose illness was initially diagnosed as recurrent pneumonia. She was a 20-yrs-old girl with ventricular septal defect and treated as community acquired pneumonia. But transesophageal echocardiography revealed a vegetation on right ventricular free wall. Son she was diagnosed as having infective endocarditis and treated effectively with appropriate antibiotic therapy and discharged with improvement of symptoms. This a first case of infective endocarditis with ventricular septal defect who have a vegetation on right ventricular free wall in korea. Therefore, we report this case with brief review of related literatures.