유방암에서 Cyclophosphamide , Thiotepa , Carboplatin ( CTCb ) 고용량 복합항암화학요법 후 자가말초혈액 조혈모세포 이식술

민영주 ( Young Joo Min ),서철원 ( Cheol Won Suh ),이제환 ( Je Hwan Lee ),채영란 ( Young Ran Chae ),김신 ( Shin Kim ),배창황 ( Chang Whang Bae ),박진희 ( Jin Hee Park ),최성준 ( Sung Joon Choi ),김태원 ( Tae Won Kim ),윤환중 ( Wha 대한내과학회 1997 대한내과학회지 Vol.53 No.4

Objectives: Recently high dose chemotherapy with autologous peripheral blood stem cell transplantation (APBSCT) has been investigated with the hope of maximizing tumor response and increasing survival. The purpose of this study is to evaluate the effect, feasibility, and toxicity of high-dose cyclophosphamide, thiotepa, and carboplatin (CTCb) with APBSCT in patients with metastatic or high risk primary breast cancer. Methods: Four cases of high-risk primary breast cancer (with more than 10 involved axillary nodes) and three cases of metastatic disease in complete or partial response were enrolled. Peripheral blood stem cells were mobilized by G-CSF plus chemotherapy, and median number of collected mononuclear cells was 5.44×108/㎏(range, 1.95-7.08×108/㎏). High-dose chemotherapy of cyclophosphamide (1,500㎎/㎡/day), thiotepa (125㎎/㎡/day) and carboplatin (200㎎/㎡/day) was administered for 4 days and peripheral blood stem cells were reinfused to the patients 72 hours after the completion of chemotherapy. Results. The median days of recovery for neutrophil (over 500/㎣) and for platelet (over 50,000/㎣) were 10 (range, 8 to 33) and 30 (range, 10 to 40). One patient suffered from seizure attack and grade 3 hepatotoxicity during high dose chemotherapy, There were no treatment-related death. Four patients with high-risk primary breast cancer remained disease-free at 2, 8, 12 and 19 months post-transplant. In one patient with bone metastasis, complete response was induced following APBSCT. All three patients with metastatic disease remained progression-free at 8, 18 and 19 months post-transplant. Conclusion: High-dose chemotherapy and autologous peripheral blood stem cell transplantation was feasible and would be a potentially effective treatment modality in high risk and metastatic breast cancer.

진행성 노인 폐암에 대한 항암요법

민영주 ( Young Joo Min ) 대한내과학회 2014 대한내과학회지 Vol.87 No.5

Lung cancer is not only the most common cancer of the elderly but is also the leading cause of cancer related mortality in Korea. Therefore, the elderly form a large subgroup of patients with advanced lung cancer. Aging is associated with co-morbidities, poor performance status, and impaired organ function. These problems can cause uncertainty when selecting the optimal treatment for advanced lung cancer, and some elderly patients could be undertreated. Patients with non-squamous histology lung cancer, regardless of age or performance status, should be tested for epidermal growth factor receptor (EGFR) mutations; patients with EGFR mutations such as del 19 or L858R are able to receive EGFR tyrosine kinase inhibitors. The treatment options for elderly patients with lung cancer include best supportive care, single agent chemotherapy, platinum-based doublet chemotherapy, and targeted therapy. The optimum therapeutic option for elderly individuals with advanced lung cancer must be selected carefully, taking into account both the risks and benefits. (Korean J Med 2014;87:537-541)

유방의 침윤성 관암종 환자에서 발생한 췌장 전이 1예

노진희 ( Jin-hee Noh ),고수진 ( Su-jin Koh ),최혜정 ( Hye Jeong Choi ),전희정 ( Hee-jeong Jeon ),안재성 ( Jae-sung Ahn ),최윤숙 ( Yunsuk Choi ),민영주 ( Young Joo Min ) 대한내과학회 2017 대한내과학회지 Vol.92 No.3

유방의 췌장 전이는 드물게 발생하는 질환으로 저자들은 유방의 침윤성 관암종으로 진단된 지 13년 후 췌장 전이가 발견된 예를 경험하고 보고하는 바이다. 유방암이 췌장으로 전이되는 경우는 매우 드물지만 주로 장시간이 지난 후 우연히 발견되는 경우가 대부분이므로 장기간의 추적 관찰 후에 발견되는 경우가 많고, 원발성 췌장암과의 감별진단이 필요하다. 또한 전이성 췌장암이 발견되었을 때 질환의 범위와 환자의 전신 상태를 고려하여 수술적 제거의 필요성을 판단해야 하며, 일부의 경우 증상과 질병의 조절에 도움이 될 수 있다. Pancreatic metastases from primary breast cancer are very rare. We report a case of pancreatic metastasis from invasive ductal carcinoma 13 years after the initial diagnosis of breast cancer. When the pancreatic mass was discovered, it was believed to be a primary pancreatic cancer due to the long interval from the initial diagnosis of breast cancer to metastasis. However, it was confirmed as metastatic breast cancer based on the pathology after surgical removal. Follow-up imaging has shown no recurrence. (Korean J Med 2017;92:308-311)

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.

고인슐린형성 저혈당을 보인 성인에서의 Ncsidioblastosis

송영기,이기업,박중열,홍성관,김홍규,한덕종,민영주,이호정,공경업 대한내분비학회 1995 Endocrinology and metabolism Vol.10 No.2

속립성결핵에 의한 골수괴사 1예

박종호,민영주,윤제현,한동하,안종준,이기만,정윤성,이선호,박재후,김성률 대한내과학회 2002 대한내과학회지 Vol.63 No.3

Bone marrow necrosis is most frequently diagnosed at postmortem examination. Antemortem diagnosis is uncommon. However, organized studies using either bone marrow biopsy specimens or autopsy material showed that bone marrow necrosis can be demonstrated in approximately one third of specimens. Bone marrow necrosis has been observed during the course of a wide variety of diseases, most commonly in association with acute and chronic leukemia, carcinoma, malignant lymphoma, infections, and sickle cell disease. We report one case of bone marrow necrosis due to miliary tuberculosis. Although appropriate diagnosis and treatment were performed, the patient expired.

고인슐린혈성 저혈당을 보인 성인에서의 Nesidioblastosis 1 예

송영기,이기업,박중열,홍성관,김기수,김홍규,한덕종,민영주,이호정,공경엽 대한내분비학회 1995 Endocrinology and metabolism Vol.10 No.3

Nesidioblastosis is a primarily childhood disease which is often associated with hyperinsulinemic hypoglycemia. It is very rarely found in adults. Only a few well documented cases are found in the world interature. The authors have recently experienced a case of nesidioblastosis in an adult. A 55-year-old man was admitted due to repeated episodes of reversible loss of consciousness. Hyperinsulinemic hypoglycemia was documented. Under the presumptive diagnosis of insulinoma, localization procedures were done but no definite tumor was found. Only suspicious gradient in insulin concentration was found around the head of pancreas by percutaneous transhepatic portal venous sampling. Exploratory laparotomy was performed and Whipple's operation was done. Seventy percent of proximal pancreas was removed. Histomorphometric study of the resected specimen revealed uneven graded hyperplasia of the islet cells with the most profuse hyperplasia in the head region and progressive decrease in the degree of hyperplasia to the body and tail. The patient remains euglycemia until 6 months after operation since immediate postoperative period and can tolerate 24 hour fasting without any medication(J Kor Soc Endocrinol 10: 273-277, 1995).

확장성 심근병증을 나타낸 가족성 Becker 형 근이영양증 1 예 보고

김재중,박종훈,박성욱,박승정,민영주,이재균,장재원,김유호,임미경,박광재,이상암,이종구 대한내과학회 1997 대한내과학회지 Vol.52 No.5

Dilated cardiomyopaty is a rare occurrence in Hecker muscular dystropy. We report a case of Bec- ken muscular dystrophy in 28 old man who presented with dyspnea, progressive muscle weakness, and dilated cardiomyopathy with severe left ventricular dysfunction which was detected by echocardiograpy. Muscle biopsy demonstrated diffuse degenerated changes consistent with progressive muscular dystropy, His brother has also Becker muscular dystrophy and dilated cardiomyopathy, The patient is on NYHA Class II~III with medical therapy.

총담관 및 주췌관 괄약근 운동성의 동시 측정을 통한 운동 지표 비교

김명환,이성구,서동완,유병무,민영일,박효숙,민영주,정성애,명승재,이미화 대한소화기내시경학회 1996 Clinical Endoscopy Vol.16 No.2

If manometric profiles of sphincter of Oddi(SO) measured from the pancreatic duct and the bild duct are essentially equal, then measurement of manometric profiles from only one duct would be adequate in evaluating SO dysfunction. We report a series of 9 patients whom we evaluate with SO manometry. Cannulation of both the biliary sphincter segment and pancreatic sphincter segment was archived consecutively in one session and we compared the manometric parameters of choledochal sphincter from those of pancreatic sphincter. 1) In 7 out of 9 patients(78%), normal manometric finding of SO were seen in both choledochal and pancreatic sphincters. However, in 2 out of 9 cases(22% ) abnormal manometric findings were noted in only one sphincter segment. Elevation of basal pressure(n = l ) and increased retrograde propagation(n = 1) were found in the pancreatic sphincter segment alone. 2) Tbe mean intraductal pressure in the pancreatic duct was significantly greater(12.6+-5.8mmHg) than that of common bile duct(3.8+-3.3mmHg)(p$lt;0.01). However, basal pressure, amplitude, frequency and propagation sequence in the phasic contraction of SO were not different significantly between choledochal and pancreatic sphincter segment. In conclusion, SO manometry of both the pancreatic and bile duct is needed if complete manometric information is desired. Selective cannulation of common bile duct and pancreatic duct during SO manometry is necessary in order to diagnose segmental 50 dysfunction.

제대혈의 적혈구 제거 방법에 관한 연구 : 제대혈 은행 설립을 위한 기초 연구 Basic Study for the Establishment of Cord Blood Bank

김효정,서철원,김상희,김상위,김성배,김강욱,조화정,민영주,박진희,김암,이인식,이필량,지현숙,서종진,강위창,이정신,김우건 대한조혈모세포이식학회 2000 대한조혈모세포이식학회지 Vol.5 No.1

배경:제대혈에서 적혈구를 제거하는 것은 제대혈 은행의 효율적인 운영 및 제대혈이식시 ABO 부적합 수혈, DMSO 독성 등의 부작용을 해결하기 위한 이상적인 방법이다. 저자들은 동일한 제대혈로 여러가지 적혈구 제거법을 동시에 시행하여, 이들에서 CD34양성 세포의 수득률 및 조혈세포 집락형성능을 비교하여 제대혈 은행 설립의 기반 기술을 확립하고자 하였다. 방법:제왕절개 직후 헤파린 처리된 용기에 제대혈을 채취하였다. 제대혈은 5개의 용기에 분산하여 실온에서 보관하였고 12시간 이내에 적혈구를 분리하였다. 적혈구 제거 방법으로 Ficoll 비중 분리법, gelatin 침전법, 적혈구 용혈법, starch 침전법을 각각의 제대혈에서 시행하였다. 전혈과 적혈구가 제거된 제대혈에서의 세포 생존율, 적혈구 제거율과 단핵구 및 CD34양성 세포의 수득률, 조혈세포 집락형성능을 비교 분석하였다. 결과:18례에서의 평균 제대혈 채취양은 81.3 mL(범위 42~128 mL)이었다. 서로 다른 적혈구 제거법들간에 세포 생존률과 적혈구 제거율은 차이가 없었다. 단핵구 수득률은 3% gelatin침전법(47.7±14.5%)이 다른 적혈구 제거법보다 유의하게 높았다. 3% gelatin침전법은 Ficoll비중 분리법과 Starch침전법에 비해 CD34 양성 세포수가 통계적으로 유의하게 높았다(36.1±5.4×10³/mL, 15.0±3.5×10³/mL, 20.7±4.2×10³/mL). 또한 CFC의 집락수도 3% gelatin침전법에서 Ficoll 비중 분리법과 적혈구 용혈법에 비해 우수한 결과를 보였다(52.0±7.1×10²/mL, 32.8±4.7×10²/mL, 36.8±5.7×10²/mL). 그러나 제대혈 전혈의 CD34 양성 세포수(65.7±11.2×10³/mL) 및 CFC의 집락수(117.8±15.8×10²/mL)를 적혈구 제거법을 이용한 실험군과 비교하였을 때 전혈군에서 높은 것을 알 수 있었다. 결론:3% gelatin 침전법은 다른 적혈구 제거법과 비교해 볼 때 더 우수한 단핵구, CD34 양성 세포 수득률 및 조혈세포 집락형성능을 보였다. 그러나 다른 보고들과는 달리 3% gelatin 침전법은 CD34양성 세포 및 CFC 집락수의 절대값이 제대혈 전혈과 비교하여 의미있게 낮았다. 이러한 결과는 시약의 종류와 실험방법의 차이에 기인하는 것으로 사료되며, 최상의 세포 수득률을 얻기 위하여 적혈구 분리 방법의 표준화를 위한 연구가 진행되어야 할 것으로 생각된다. Background:Efficient volume reduction is important to make a cost-effective umbilical cord blood (UCB) banking system. The aim of this study was to find a method of red cell depletion of UCB without major losses of the hematopoietic progenitor-CD34+ cells. Methods:Eighteen cord blood samples were collected in heparinized bottle immediately after Cesarean section. Five aliquots of each cord blood were stored at room temperature and processed within 12 hours. We used 4 different RBC depletion methods (Ficoll density gradient separation, gelatin sedimentation, red cell lysis, starch sedimentation) and compared the results of viability, RBC reduction rate, mononuclear cell (MNC) recovery rate, CD34+ cells and colony forming unit (CFC).Results: The mean collected cord blood volume was 81.3 mL (range 42~128 mL). There were no differences of viability and RBC reduction rate among groups. MNC recovery rate were significantly higher in gelatin group (47.7±14.5%) than other RBC depletion methods. Gelatin group had significantly higher CD34+ cell count than Ficoll and starch group (36.1±5.4×10³/mL, 15.0±3.5×10³/mL, 20.7±4.2×10³/mL) and higher CFC count than Ficoll and RBC lysis group (52.0±7.1×10²/mL, 32.8±4.7×10²/mL, 36.8±5.7×10²/mL). But the results of CD34+ cell count (65.7±11.2×10³/mL) and CFC count (117.8±15.8×10²/mL) of untreated control group are significantly higher than those of all other treated groups. Conclusion:Umbilical cord blood processed with 3% gelatin sedimentation has higher recovery rate of MNC, CD34+, cell and CFC than other groups. Unlike other reports, the absolute numbers of CD34+ cell and CFC count of 3% gelatin sedimentation method are significantly lower than those of untreated control group. Different laboratory processes with gelatin could be one cause of these differences, a study for standardized laboratory methods should be established to obtain higher recovery rate of hematopoietic cells after RBC depletion.