위암으로 전위절제술을 시행한 환자에서의 비타민 B12 결핍성 빈혈

고윤웅(Yun Woong Ko),민진식(Jin Sik Min),서형찬(Hyung Chan Suh),조준식(Joon Sik Cho),이석(Seok Lee),정소영(So Young Chong),유내춘(Nae Choon Yoo),민유홍(Yoo Hong Min),한지숙(Jee Sook Hahn) 대한내과학회 1998 대한내과학회지 Vol.54 No.3

N/A Objectives: We attempt to find out the decremental character of serum vitamin B12 level and features of patients with vitamin B12 deficiency anemia occurring earlier than 4 years after total gastrectomy. Methods: We studied 91 patients who underwent total gastrectomy and select 59 patients who evaluate serum vitamin B12 level within 4 years after total gastrectomy to characterize the features of vitamin B12 deficiency anemia group occurring earlier than 4 years after the operation. Results: 1) In 91 patients, the mean postoperative duration is 31.9(range: 0-135) months and mean serum vitamin B12 level 158.9(total 159 times, range: 20.0-806.2) pg/mL. Correlation equation is y=403.30×e-0.09x +175.93×e-0.02x (r2=0.804). The postoperation duration that serum vitamin B12 level falls below 200pg/mL is 20 months. 2) Among 59 patient, there were 20 cases of vitamin B12 deficiency anemia group(Group I), 21 cases of vitamin B12 deficiency(Group II) and 39 cases of non-vitamin B12 deficiency group(Group III). Preoperation symptom duration in Group I was longer than that in Group II(18.2 vs 9.6 weeks, p<0.01). Group 1 and Group II showed lower serum vitamin B12 level than Group III(126.7 & 96.0pg/mL vs 330.4pg/mL, p<0.01). 3) Eleven cases had associated diseases(9 alcoholics and 2 liver cirrhosis) with vitamin B12 deficiency anemia and these disease had significant influence on the incidence of vitamin B12 deficiency anemia(p<0.01) within 4 years. Among the 30 cases who could measure iron profile, 10 patients had an iron deficiency anemia, There was a higher incidence of vitamin B12 deficiency anemia in iron deficiency anemia group(7/10, 70%) than that in non iron deficiency anemia group(7/20, 35%) but no statistical significance(p=0.12). 4) Although anti-cancer chemotherapy did not have a significant influence on the incidence of vitamin B12 deficiency anemia, vitamin B12 level in anti-cancer chemotherapy group was higher than that in non-chemotherapy group(201.83 vs 127.66pg/mL, p=0.01) at similar mean postoperation duration(27.8 vs 27.7 months, p=0.97). 5) The independent predictor of vitamin B12 deficiency anemia within 4 years were associated disease(p=0.002) and preoperation symptom duration(p=0.004), Conclusion: Red cell indices such as Hb or MCV did not have any clinical significances in predicting the development of vitamin Biz deficiency. To prevent vitamin B12 deficiency anemia and promote better quality of life in total gastrectomized patients with stomach cancer, careful monitoring of serum Vitamin B12 level and replacement therapy should be necessary at least 20 months after operation, especially in patients with associated disease and longer preoperation symptom duration.

복합 항암 화학요법 후 HBsAg 양성 악성림프종환자의 임상경과

구본권(Bon Kwon Ku),한지숙(Jee Sook Hahn),한광협(Kwang Hyub Hahn),이승태(Seung Tae Lee),서형찬(Hyung Chan Suh),권건호(Kun Ho Kwon),이진헌(Jin Hun Lee),민유홍(Yoo Hong Min),고윤웅(Yun Woong Ko) 대한내과학회 1997 대한내과학회지 Vol.52 No.4

N/A Objectives: Infection and replication of the hepatitis B virus are closely related to the host imm- unity. Anticancer chemotherapy decreases the immune response of the host, Especially, glucocorticoid can activate the replication of hepatitis B virus directly. It is well known that hepatitis B virus infection and hepatic complications are more common in patients with hematologic malignancies like malignant lymphoma. We studied the incidence of hepatitis B virus infection and hepatic complications following anti- cancer chemotherapy in patients with malignant lymphoma. Methods: Among 224 cases diagnosed as malignant lymphoma from January 1989 to December 1993 at Yonsei University Medical Center, 77 cases tested for hepatitis B virus serology was studied. Results: 1) Eighteen cases (23%) was HBsAg positive. 2) The results of hepatitis C virus serology in six cases were all negative. 3) Eight (57%) of 14 follow-up cases had hepatic complications, Two patients had fulminant hepatitis, two nonicteric hepatitis and four icteric hepatitis. 4) Interferon-alpha was administered in three cases among the patients with hepatic complications. Loss of HBeAg was observed in one case and loss of HBsAg in another case. Conclusion: Serious hepatic complications can be occurred following anticancer chemotherapy in HBsAg-positive patients with malignant lymphoma. Therefore, we recommend that patients being considered as candidates for anticancer chemotherapy should routinely undergo serologic test for Hepatitis B virus. In addition HBsAg-positive patients with anticancer chemotherapy should be regularly monitored for hepatic injury. And with the careful use of steroid and interferon, prolongation of survival might be searched for these patients.

초기소견으로 미세혈관병성 용혈성 빈혈상을 보인 골수전이성 악성흑색종 1례

서형찬,민유홍,강웅철,이석,정소영,한지숙,고윤웅,양우익 大韓血液學會 1996 大韓血液學會誌 Vol.31 No.3

노령층 급성 골수성 백혈병에서 관해유도요법후 조혈촉진 인자의 효과

이석,민유홍,서형찬,정소영,한지숙,고윤웅 大韓血液學會 1996 大韓血液學會誌 Vol.31 No.3

동종 골수이식후 재발한 급성 골수성 백혈병에서 구제화학요법후 동종 말초혈액조혈모세포 이식 1례

이석,정소영,김성철,서형찬,유내춘,민유홍,한지숙,고윤웅 대한조혈모세포이식학회 1996 대한조혈모세포이식학회지 Vol.1 No.1

Patients who relapse early after allogeneic bone marrow transplantation(BMT) for acute leukemia have little prospect of prolonged survival, as salvage chemotherapy or second transplants are rarely effective. An alternative therapeutic strategy is to provoke a graft-versus-leukemia(GVL) effect by the infusion of PBSC(peripheral blood stem cells) or leukocytes from the original bone marrow donor without attempts at graft-versus-host disease(GVHD) prophylaxis. This approach has been used with some success in patients with chronic myelogenous leukemia to treat relapse after transplant by an adoptive immunotherapy. The role of this approach in patients with acute myelogenous leukemia(AML) has still to be defined. We report a successful case of salvage chemotherapy followed by donor PBSC infusion for the treatment of relapse after allogeneic BMT in AML. The patient was a 16-year-old female with AML-M4 in relapse after allogeneic BMT on day +87. We planned to achieve complete remission(CR) with the two cycles of salvage chemotherapy followed by the infusion of donor PBSC mobilized by granulocyte colony-stimulating factor(G-CSF) at a dose of 10μg/kg/day subcutaneously for 5 days without GVHD prophylaxis. By one leukapheresis, the total mononuclear cells were 10.0×108/kg; the CD34 positive cells were 26.0×106/kg; the CFU-GM were 15.5×105/kg of recipient weight.. No T lymphocyte depletion was carried out on the peripheral blood cells collected and the total T lymphocytes were 7.5×108/kg. The time interval between relapse after allogeneic BMT and PBSC infusion was 63 days. After transplant, the neutrophil count exceeded 0.5×103/㎕ on day 10and the platelet count exceeded 20.0×103/㎕ on day 14. The patient developed skin rashes consistent with clinical grade 1 acute GVHD requiring immunosuppressive therapy on day 10. CR was confirmed with tri-lineage engraftment in bone marrow samples on day 20, and the patient is still in CR without any evidence of GVHD at present(day +150).

NK/T 세포 림프종 환자에서 시행된 비골수제거성 조혈모세포이식

정준원,김진석,장준호,서형찬,이승태,김현옥,양우익,민유홍,한지숙,고윤웅 대한조혈모세포이식학회 2001 대한조혈모세포이식학회지 Vol.6 No.2

저자 등은 맹장, 충수돌기 및 흉막을 침범한 고위험군 NK/T 세포 림프종 환자에서 비골수제거 조혈모세포이식을 시행한 후 이식연관 합병증 없이 무병생존하였기에 보고하는 바이다. NK/T cell lymphoma is a rare type of non-Hodgkin"s lymphomas. It has the histological features of angiocentric lymphoma characterized by prominent angio-invasion by tumor cells, and commonly presents in nasal and paranasal structures. Non-nasal form of NK/T cell lymphoma involves skin, gastrointestinal tract, or liver. With conventional chemotherapy and/or radiotherapy, NK/T cell lymphoma shows poor response rate and seldom results in long term survival. Especially, non-nasal form has more aggressive clinical manifestations and grave outcome than nasal form. We report a case of NK/T cell lymphoma presenting with small bowel perforation and malignant pleural effusion due to lymphoma infiltration, transplanted with allogeneic peripheral blood stem cells from HLA identical sibling donor after fludarabine-based nonmyeloablative chemotherapy. After transplantation, the patient achieved an enduring tri-lineage hematological complete response without any evidence of relapse for 10 months.

급성 전골수성 백혈병에 동반된 Wernicke disease 1 예

이석,민유홍,김현수,한지숙,이상학,유내춘,서형찬,고윤웅,정소영 대한내과학회 1998 대한내과학회지 Vol.54 No.1

Wernicke's disease is a condition produced by thiamine deficiency; more than 90% of the cases are observed in chronic alcoholics. Other less frequent conditions associated with Wernicke disease are gastric disorders, prolonged parenteral nutrition, uremia, hemodialysis, hyperemesis gravidarum, prolonged starvation, and AIDS. We report a 41-year-old female patient of Wernicke disease associated with nausea and prolonged parenteral nutrition after chemotherapy of acute promyelocytic leukemia. She has got thiamine replacement therapy and most symptoms were improved. She was discharged after complete remission of leukemia and recovery of normal diet.

우측 쇄골하 동맥과 흉벽을 침범한 침습성 Aspergillosis 1 예

이석,최병현,민유홍,김성철,한지숙,윤용석,서형찬,고윤웅,유내춘,정소영 대한내과학회 1997 대한내과학회지 Vol.53 No.2

Invasive aspergillosis is an infection that occurs in immunocompromised patients. Its prevalence was increased in the last decade with progression of antineoplastic chemotherapy and immunosuppressive therapy after transplantation. Because it carries a high mortality and morbidity, early diagnosis and aggressive treatment are critical for successful management. In many patients, invasive aspergillosis remains confined to the lung although direct extension to pleural cavity or pericardium has been reported. However great vessel involvement is rare. Therefore we report a case of invasive aspergillosis involving right subclavian artery and chest wall in a patient after chemotherapy for acute lympoblastic leukemia.

원발성 알도스테론증을 보인 거대부신선종 1예

신동환,홍순원,이지현,허갑범,이현철,임승길,송영득,남문석,차봉수,박정수,박재민,서형찬,최영화 대한내분비학회 1996 Endocrinology and metabolism Vol.11 No.3

Primary aldosteronism is a syndrome chracterized by hypokalemic alkalosis and hypertension. Small sized adrenal cortical adenomas have been the major cause of this syndrome in most of the patients. However, if the adrenal mass is larger than 6cm in diameter and with irregular consistency, malignancy is more favored. We experienced a patient who had a giant adrenal adenoma with primary aldosteronism. A 24-year-old female presented with hypertension, hypokalemia, low plasma renin, and high plasrna aldosterone levels, was found to have a 6×5.5×5 cm sized left adrenal tumor by MRI. Her clinical laboratory feature did not revealed any evidence of Cushing's syndrome or pheochromocytoma. Preoperatively adrenal carcinoma presenting pure adrenal aldosteronism was suspected due to large size and heterogenous signal character of the adrenal mass in radiologic study. At operation well encapsulated, round giant adrenal tumor weighing 65gm(4.5×4×4 cm) was removed. There was no evidence of metastasis with return of adrefunction to normal after surgery. Benign adrenal adenoma was confirmed by the gross morphology and the histologic features(J Kor Soc Endocrinol 11:348-354, 1996).