A Case of a Pulmonary Arteriovenous Malformation With Ebstein’s Anomaly

박권오,김창환,임달수,노영무,박종원,전승윤,임승진,조현중,이상호,김성은 대한심장학회 2010 Korean Circulation Journal Vol.40 No.12

A pulmonary arteriovenous malformation (PAVM) is a rare pulmonary vascular anomaly presenting as dyspnea or recurrent epistaxis. Ebstein’s anomaly (EA), a congenital cardiac malformation, is also a rare condition. There have been no reports concerning the co-existence of PAVM with hereditary hemorrhagic telangiectasia (HHT) and EA. A 40-year-old woman was admitted with a 2-month history of increasing dyspnea and several years of recurrent epistaxis. On transthoracic echocardiography, she was diagnosed with EA and agreed to undergo surgical treatment. A chest CT angiography showed a 12-mm serpig-inous vascular structure suspicious for a PAVM and a liver CT suggested HTT. Although it is unclear whether or not a concur-rent PAVM and EA have an embryologic or genetic relationship, we report a case of a PAVM with EA. Further genetic and em-bryonic studies are needed to identify a possible relationship of the two medical conditions.

Safety and Efficacy of Peripherally Inserted Central Catheters in Terminally Ill Cancer Patients: Single Institute Experience

박권오,임형근,홍지연,송헌호 한국호스피스완화의료학회 2014 한국호스피스.완화의료학회지 Vol.17 No.3

Purpose: We investigated the safety and efficacy of peripherally inserted central catheters (PICCs) in terminallyill cancer patients. Methods: A retrospective review was conducted on patients who underwent PICC at thehospice-palliative division of KEPCO (Korea Electric Power Corporation) Medical Center between January 2013and December 2013. All PICCs were inserted by an interventional radiologist. Results: A total of 30 terminallyill cancer patients received the PICC procedure during the study period. Including one patient who had had twoPICC insertions during the period, we analyzed a total of 31 episodes of catheterization and 571 PICC days. Themedian catheter life span was 14.0 days (range, 1∼90 days). In 25 cases, catheters were maintained until theintended time (discharge, transfer, or death), while they were removed prematurely in six other cases (19%;10.5/1000 PICC days). Thus, the catheter maintenance success rate was 81%. Of those six premature PICC removalcases, self-removal due to delirium occurred in four cases (13%; 7.0/1000 PICC days), and catheter-related bloodstream infection and thrombosis were reported in one case, each (3%; 1.8/1000 PICC days). Complication casestotaled eight (26%; 14.1/1000 PICC days). The time to complication development ranged from two to 14 daysand the median was seven days. There was no PICC complication-related death. Conclusion: Consideringcharacteristics of terminally ill cancer patients, such as a poor general condition, vulnerability to trivial damage,and a limited period of survival, PICC could be a safe intravenous procedure.

내시경 풍선확장술로 호전된 거대세포바이러스 대장염 관련 직장협착 1예

박권오,김경호,박종원,이상호,조현정,천승연,박혜원,김학양 대한소화기내시경학회 2010 Clinical Endoscopy Vol.41 No.4

Cytomegalovirus (CMV) colitis is a common opportunistic infection in immunocompromised patients. Affected individuals present with abdominal pain, diarrhea, or hematochezia. Complications of CMV colitis can include massive bleeding, toxic megacolon, bowel perforation and, rarely, colon stricture. A 69-year-old woman who had no specific past history was admitted to the orthopedic department for pelvic bone fracture with right iliac artery rupture caused by a traffic accident. She was successfully managed with emergency transarterial coil embolization. After 2 weeks, she developed hematochezia and recurrent abdominal pain. Colonoscopy showed a huge, deep ulcer in the rectosigmoid colon. Biopsy and immunohistochemical staining revealed giant cells with intracellular inclusion bodies that were positive for CMV antigen. She received antiviral treatment after which her symptoms improved. On follow-up colonoscopy 3 months later, we found a tight luminal narrowing in the rectum. We did a repeat endoscopic balloon dilation in this patient and she experienced improvement. 거대세포바이러스 대장염은 면역기능이 저하된 환자에서 흔히 발생하는 기회 감염이다. 그러나 드물게 면역기능이 정상인 사람에서도 발병한다. 복통, 설사 및 출혈 등의 임상증상을 보이며, 합병증은 대량 출혈, 독성 거대 결장, 장천공 등이 있으나 대장의 협착은 드물다. 69세 여자가 교통사고로 우측 엉덩동맥 파열과 엉덩뼈 골절로 정형외과에 입원하였다. 환자는 응급 혈관조영술 및 코일색전술을 시행받고 호전되었으나, 사고 2주째부터 혈변과 반복적인 복통을 호소하였다. 대장내시경검사에서 직장 주변에 커다란 깊은 궤양을 확인하였고 조직검사와 면역조직염색으로 거대세포바이러스 대장염을 진단하였다. 항바이러스제 치료 후 환자의 증상은 호전되었으나, 3개월 뒤 시행한 대장내시경검사에서 직장 협착이 발견되었다. 환자는 복통과 변비 증상을 호소하여 내시경 풍선확장술을 3회 시행하였고, 이후 증상은 호전되었다.

Efficacy and Safety of Everolimus in Korean Patients with Metastatic Renal Cell Carcinoma Following Treatment Failure with a Vascular Endothelial Growth Factor Receptor-Tyrosine Kinase Inhibitor

박권오,이재련,안진희,이규형,정인갑,송채린,홍범식,홍준혁,안한종 대한암학회 2014 Cancer Research and Treatment Vol.46 No.4

PurposeThe purpose of this study is to assess the efficacy and safety of everolimus in Koreanpatients with metastatic renal cell carcinoma (mRCC) for whom initial treatment with avascular endothelial growth factor receptor-tyrosine kinase inhibitor (VEGFr-TKI) has failed. Materials and MethodsEligible patients with mRCC (any histology) who had progressed on or were intolerant ofVEGFr-TKI therapy received oral everolimus (10 mg dose once daily). Tumor response wasreassessed according to Response Evaluation Criteria in Solid Tumors (RECIST). ResultsThis study included 100 patients with a median follow-up duration of 10.2 months, a medianprogression-free survival (PFS) of 4.2 months (95% confidence interval [CI], 3.4 to 5.0months), and an overall survival of 10.1 months (95% CI, 6.9 to 13.3 months). The mostcommon grade 3 or greater adverse events (AEs) overall were anemia (13%), pneumonitis(9%), hyperglycemia (8%), and stomatitis (6%). While the incidence of pneumonitis wassimilar (26 cases, 26%) to the reported incidence in Western patients, the Koreanpresentations were more severe: 10 patients permanently discontinued everolimus due topneumonitis, including two deaths on treatment. Statistically significant relationships wereestablished between biologic toxicities, hyperglycemia and anemia, and PFS (hyperglycemiavs. non-hyperglycemia: hazard ratio [HR], 0.61; p=0.055 and anemia vs. non-anemia: HR,0.51; p=0.021). ConclusionEverolimus was effective in Korean patients with mRCC who had failed initial VEGFr-TKItherapy. While everolimus was well tolerated in general and the AE incidence of this studywas similar to those of previous reports, severe pneumonitis was common. Hyperglycemiaand anemia showed significant correlation with PFS and thus may be potentially useful asprognostic indicators.

Safety, Efficacy, and Patient Satisfaction with Initial Peripherally Inserted Central Catheters Compared with Usual Intravenous Access in Terminally Ill Cancer Patients: A Randomized Phase II Study

박은주,박권오,김재준,오상보,정기선,오소연,홍윤정,김진혁,장주연,전웅배 대한암학회 2021 Cancer Research and Treatment Vol.53 No.3

Purpose The purpose of this study was to investigate whether routine insertion of peripherally inserted central catheter (PICC) at admission to a hospice-palliative care (HPC) unit is acceptable in terms of safety and efficacy and whether it results in superior patient satisfaction compared to usual intravenous (IV) access.Materials and Methods Terminally ill cancer patients were randomly assigned to two arms: routine PICC access and usual IV access arm. The primary endpoint was IV maintenance success rate, defined as the rate of functional IV maintenance until the intended time (discharge, transfer, or death).Results A total of 66 terminally ill cancer patients were enrolled and randomized to study arms. Among them, 57 patients (routine PICC, 29; usual IV, 28) were analyzed. In the routine PICC arm, mean time to PICC was 0.84 days (range, 0 to 3 days), 27 patients maintained PICC with function until the intended time. In the usual IV arm, 11 patients maintained peripheral IV access until the intended time, and 15 patients underwent PICC insertion. The IV maintenance success rate in the routine PICC arm (27/29, 93.1%) was similar to that in the usual IV arm (26/28, 92.8%, p=0.958). Patient satisfaction at day 5 was better in the routine PICC arm (97%, ‘a little comfort’ or ‘much comfort’) compared with the usual IV arm (21%) (p <0.001). Conclusion Routine PICC insertion in terminally ill cancer patients was comparable in safety and efficacy and resulted in superior satisfaction compared with usual IV access. Thus, routine PICC insertion could be considered at admission to the HPC unit.

요로상피세포암 국내 환자들의 임상 특성, 치료과정, 그리고 시스플라틴 기반 항암치료의 적용

구본진,박권오,김재준,오상보,오소연 대한내과학회 2018 대한내과학회 추계학술대회 Vol.2018 No.1

Efficacy of NEPA and olanzapine for prevention of CINV and rescue in pateints receiving HEC

최은정,박권오 대한내과학회 2021 대한내과학회 추계학술대회 Vol.2021 No.1

Effectiveness of Adding Docetaxel to Androgen Deprivation Therapy for Metastatic Hormone-Sensitive Prostate Cancer in Korean Real-World Practice

이재련,박권오,김진영,박인근,신성훈,이효진 연세대학교의과대학 2023 Yonsei medical journal Vol.64 No.2

Purpose: Evidence in favor of adding docetaxel in treatment of metastatic hormone-sensitive prostate cancer (mHSPC) has led to docetaxel in conjunction with androgen deprivation therapy (ADT) as standard therapy. The aim of this study was to examine the effectiveness of docetaxel with ADT for Korean patients with mHSPC in real-world practice. Materials and Methods: A retrospective cohort study was performed at six Korean hospitals for patients with mHSPC treated with docetaxel plus ADT. Patients were treated every 3 weeks for up to six cycles with 75 mg/m2 of docetaxel. The primary endpoint was time to castration resistant prostate cancer (CRPC). Results: This study included 46 eligible patients from June 2016 to February 2021. Median age was 68.5 years (range, 52–84) and all patients present with de novo M1 with high-volume disease. The median prostate-specific antigen (PSA) level at ADT initiation was 205.4 (7.7–1933) ng/mL, and time from ADT to docetaxel was 2.4 months (0–5.3). All six planned cycles of docetaxel were de livered in 36 patients (78%), 7 patients (15%) discontinued treatment due to adverse events, and 3 patients (7%) discontinued due to progression. At the time of the analysis, CRPC had developed in 34 patients (74%), and the median time to CRPC was 18.0 (95% con fidence interval, 14.1–21.9) months. PSA <0.2 ng/mL was achieved in 11 patients (24%) after 6 months of ADT and in 10 patients (22%) after 12 months. At last follow-up, 35 patients (76%) were alive; the median overall survival was not reached. Conclusion: The effect of docetaxel combined with ADT for Korean patients with mHSPC is comparable with prior results in West ern studies.

건강한 남자에서 Escherichia coli 균혈증으로 발현된 비천공성 급성충수염 1예

임승진,엄중식,박권오,강진구,이진서 대한감염학회 2011 Infection and Chemotherapy Vol.43 No.2

Acute appendicitis is the most frequent cause of acute abdomen. However,bacteremia in patient with acute appendicitis is rare. A 34-year-old male patient presenting with fever and abdominal discomfort for two days showed leukocytosis,elevated C-reactive protein and erythrocyte sedimentation rate. Gram-negative rods were cultured in blood and empirical ceftriaxone was injected intravenously. On abdominal CT, wall enhanced and distended retrocecal appendix was recognized. Appendectomy was performed, which revealed suppurative inflammation without perforation. We report a case of acute appendicitis without perforation associated with Escherichia coli sepsis and atypical clinical manifestations in a healthy male.

S-581 암환자들의 3차병원 응급실 방문 실태; 1개 기관 조사

조현명,오소연,박권오 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1

서론: 암환자들은 다양한 증상들을 경험하게 되는데 암과 직접적 혹은 간접적으로 연관된 증상들을 조절하기 위해 병원을 내원하는 경우가 많다. 보통 암환자들은 새로운 증상이 발생하거나 기존 증상이 급격히 악화될 때 응급실을 방문하게 된다. 그러나 응급실은 생명을 위협할 수 있는 질환들에 대해 급성기 치료를 하는 곳으로 응급이 아닌 증상조절을 위한 응급실 방문은 응급실의 정체와 함께 위급한 환자에 대한 치료를 지연 시킬 수 있다. 또한 응급실 진료는 암 환자와 가족의 불편을 가중시키고 경제적 부담으로 작용한다. 목표: 이 연구는 암환자들이 응급실을 내원하는 이유를 파악하여 불필요한 응급실 방문과 장시간 응급실 체류를 줄일 수 있을지 알아보기 위하여 수행되었다. 방법: 2015년 8월부터 12월 사이에 양산부산대학교 병원 응급실을 방문하여 혈액종양내과로 의뢰된 고형암 환자를 대상으로 후향적 의무기록 조사를 진행하였다. 결과: 조건을 만족하는 환자는 총 107명이었다. 나이의 중앙값은 64세 (29-85)이고 58명이 남성이었다. 암 종류로는 결장직장암(18.7%), 담관암(18.7%), 위암(11.2%) 그리고 폐암 (11.2%) 순으로 많았다. 암환자들이 응급실을 방문하는 5가지 주된 이유는 감염(22.4%), 암성통증(13.4%), 장이나 비뇨기계의 폐쇄(11.2%), 통증 이외 암 관련 증상(10.3%) 그리고 항암 치료로 인한 부작용 (8.4%)이었다. 12명(11.2%)의 환자들이 1차 또는 2차 의료기관에서 암에 대한 검사 및 진단을 위해 3차 기관 진료를 권고 받고 내원하였다. 응급실 퇴실 시 74명(69.2%) 의 환자들이 대기 후 입원 하였으며, 2명(1.8%)이 타 기관으로 전원되었고, 8명(7.4%)은 귀가하였다. 응급실 재원 시간의 중앙값은 27시간(0-141시간), 48시간 이상 체류는 34명(31.8%)이었다. 결론: 암환자들은 대부분 입원이 필요한 증상으로 응급실을 방문한다. 그러나 응급상황이 아닌 경우도 상당부분을 차지한다. 따라서 흔한 통증 및 증상에 대한 대처방법을 암환자에게 미리 충분히 교육 하거나 비상시 문의 가능한 창구가 있다면 응급실 방문 빈도를 줄이고, 환자와 가족의 부담을 줄이는데 도움이 될 수도 있다.