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성인의 급성 림프구성 백혈병에서 L - 17 M 복합화학요법의 치료효과 ; 최종 보고
우인숙(In Sook Woo),김정희(Jeong Hee Kim),김재만(Jae Man Kim),김시영(Si Young Kim),윤휘중(Hwi Joong Yoon),조경삼(Kyung Sam Cho) 대한내과학회 1995 대한내과학회지 Vol.48 No.2
N/A Objectives: When treatment schedules for childhood ALL (Acute Lymphocytic Leukemia) were used in adults with ALL, remission rates were lower and disease free survival was inferior. L17M chemotherapy is characterized by intensive chemotherapy regimen calling for 2.5~3 years of treatment that included prophylactic intrathecal methotrexate without cranial irradiation. MSKCC (Memorial Sloan-Kettering Cancer Center) reported complete remission rate 82% and median survival duration 30.7 months in L17M chemotherapy for ALL in adults. Methods: Twenty-six previously untreated patients with acute lymphocytic leukemia were treated with L-17M chemotherapy. L-17M chemotherapy contained multiple drugs including vincristine, prednisolone, adriamycin, cyclophosphamide, daunorubicin, Ara-C, 6-thioguanine, methotrexate, L-asparaginase, dactinomycin, and BCNU which were employed in various combinations, doses and schedules during the induction, consolidation and maintenance phases. Results: Twenty-two out 26 (88%) cases achieved complete remission, median duration of remission was 80 weeks (1+ - 338+ weeks), and median duration of survival was 79 weeks (3 - 340+ weeks). Ten out of 22 (45%) patients relapsed in bone marrow (8 cases) and CNS (2 cases) relapse. Median period of granulocytopeia was 5 days (0 - 31 days) during the induction phase and 8 days (0 - 26 days) in consolidation phase. Nonhematologic toxicities were nausea, vomitig, alopecia, stomatitis, diarrhea, neurotoxicity. Conclusion: L-17M chemotherapy was considered as an effective therapy in adult ALL.
인슐린 비의존성 당뇨병에서 전신골밀도와 체내 총칼슘량 , 체지방량 및 다른 요인과의 관계
우인숙(In Sook Woo),양형인(Hyung In Yang),나정일(Jeong Il Na),황이숙(Yi Sook Hang),이동찬(Dong Chan Lee),김영설(Young Seol Kim),김진우(Jin Woo Kim),김광원(Kwang Won Kim),최영길(Young Kil Choi) 대한내과학회 1991 대한내과학회지 Vol.41 No.4
N/A Some studies suggest that patients with diabetes mellitus have an increased incidence of osteoporosis, but others have disputed it. The mechanisms of reduced bone density in diabetes are unclear but excessive calcium loss in the urine is generally accepted as one of the factors which contribute to bone loss in diabetes. Whole body bone densitometry makes possible to estimate the total body calcium concentration which might be influenced by urinary calcium loss and other humoral factors. To elucidate the possible direct relationship between total body calcium and reduced bone density, we examined the total body calcium, total body fat and the bone mineral density of the lumbar and femur with densitometry (Dual Energy X-ray Absorptiometry) in 93patients with type II diabetes mellitus end 316nondiabetic normal controls, Serum osteocalcin levels also measured by radioimmunoassay in all the patients. The results are summarized as follows: l) The bone mineral density declined with age in both diabetics and the control group but had no significnat differences statistically. 2) Thirty-six patients with diabetes (37.9%) had reduced bone mineral density below one standard deviation (1SD) of the normal controls. 3) The total body calcium concentration correlated highly to the total body bone density. 4) The femur bone density correlated more significantly than the lumbar bone density to the whole body bone density. 5) There were no correlations between the whole body bone density and total body fat or serum osteocalcin levels.
말초성 동맥 질환에 있어서 201TI을 이용한 말초혈관 관류스캔의 유용성
김진우(Jin Woo Kim),김영설(Young Seol Kim),김광원(Kwang Won Kim),최영길(Young Kil Choi),고은미(Eun Mi Koh),김덕윤(Deog Yoon Kim),우인숙(In Sook Woo),나정일(Jung Il Nah) 대한핵의학회 1991 핵의학 분자영상 Vol.25 No.2
N/A Peripheral arterial disease, because of its significant and prolonged morbidity and related mortality is a major medical and surgical problem. Contrast angiograrn remains the essential standard for the anatomic demonstration of disease. It does not, however, provide data suitable for quantification or any evaluation of the microcirculation. For these reasons, radionuclide studies are playing an increasingly important role by not only confirming the diagnosis and offering objective data on the physiologic significance of anatomic lesions, but by offering prognosis of healing and prediction of therapeutic results. In addition, radionuclide procedures offer means t.o safely and repeatedly monitor response to therapy and long term follow up. 1'he object of this study was to evaluate the clinical availability of 'Tl perfusion scan in patients with peripheral arteriai diseases. We performed 'Tl perfusion scans in patients with five Buerger s disease (10 legs), six DM gangrenes (12 legs) and classified three perfusion pattern groups. Finally we compared treatment modalities among each groups and compaired Tl-201 perfusion scan findings with angiographic findings in six patients with Buergers disease. The results were as follows: 1) Seven legs showed increased perfusion in stress image and normal or increased perfusion in resting image (type 1). Six legs showed decreased perfusion in stress image and irnproved in resting image (type II). Of total 13 legs, only 1 leg needed to amputation. 2) Three legs showed decreased perfusion in stress and resting irnage (type III), and subsequently all cases were received surgical amputation. 3) In six Buergers disease patients, there were disagreernents in two patients (2 legs) between 'Tl scan and angiography, in which angiograms were normal but 'Tl scans shawed type II perfusion patterns.
의학강좌 : 개원의를 위한 모범처방 ; 항암제에 의한 말초 신경병증의 최신 지견
우인숙 ( In Sook Woo ) 대한내과학회 2015 대한내과학회지 Vol.88 No.1
Chemotherapy induced peripheral neuropathy (CIPN) could debilitate the quality of life in the patients with cancer. According tothe severity of CIPN, the modification of dosage of chemotherapeutic agents and switch to other drugs can be unavoidable. Platinum such as cisplatin and oxalipatin, vinka alkaloids, bortezomib, and taxane can cause CIPN. The characteristics and severityof CIPN depends on the dosages, duration of exposure of chemotherapeutic agents, comcomittant illness or other drugs affecting onperipheral nervous system and the methods of assessment for CIPN. The symptoms may last for several months or permanentlyeven after quitting chemotherapy. Typically it distributed bilaterally and starts from the distal part of extremities and is presentedprogressively in stocking and glove pattern. Sensory nerve is more involved rather than motor nerve and amplitude of sensorynerve conduction is observed in CIPN. Prevention for CIPN is not effective at present. Tricyclic antidepressant including amitriptylineor nortriptyline and gabapentine have been tried in the practice for the management of CIPN despite of the lack of significantevidence through clinical trials. Recently duloxetine has been reported to decrease pain in the patients with CIPN compared with thepatients with placebo (p = 0.03).
증례 : 혈액종양 ; 고아밀라제혈증을 보인 폐선암 1예
이명현 ( Myung Hyun Lee ),고선영 ( Sun Young Ko ),박건우 ( Kyun Woo Park ),김정훈 ( Jung Hoon Kim ),우인숙 ( In Sook Woo ),한치화 ( Chi Wha Han ),허주연 ( Ju Yeon Heo ) 대한내과학회 2012 대한내과학회지 Vol.82 No.4
Hyperamylasemia in patients with lung cancer is relatively rare, occurring in 1-3% of all cases of the disease. The pathogenesis of hyperamylasemia in solid cancers is not clear. In Korea, no cases of hyperamylasemia have been reported in patients with adenocarcinoma of the lung. Instead, the lung cancers in patients with hyperamylasemia have in most cases been adenocarcinomas. We report a case of a 64-year-old woman with hyperamylasemia that was suspected to have been induced by mucinous adenocarcinoma of the lung. The patient`s amylase isoenzyme pattern was of the salivary type. Systemic chemotherapy normalized her serum amylase levels and produced a partial response in her lung cancer. (Korean J Med 2012;82:507-511)
갑상선 질환의 병태생리를 이해하는 데 있어서 갑상선 스캔의 재평가
김진우(Jin Woo Kim),김영설(Young Seol Kim),김광원(Kwang Won Kim),최영길(Young Kil Choi),고은미(Eun Mi Koh),김덕윤(Deog Yoon Kim),우인숙(In Sook Woo),나정일(Jung Il Nah),김성운(Sung Woon Kim),양인명(In Myung Yang) 대한핵의학회 1991 핵의학 분자영상 Vol.25 No.1
N/A To diagnosis and understand the pathophysiologic status of thyroid disease, not only hormonal measurments but also thyroid scan is believed to have a unique role. Especially in the cases of the change of the thyroid function by thyroiditis, it is emphasized that thyroid scan can be helpful in differentia! diagnosis, Discordant results of thyroid hormone levels and thyroid scan are found in transient hyperthyroidism, or in transient hypothyroidism. We analysed and reevaluated thyroid scan to look at the importance of thyroid scan. The results are summerised as follows: 1) 80%. of hyperthyroid patients had hyperthyroidism increased RAIU with even density, they are compatible with Graves' disease. 2) 2.1% of hyperthyroid patients had normal or decreased RAIU, which are classfied as high iodine turn over genuine hyperthyroidism. 3) 8.5% of hyperthyroid patients had markedly decreased RAIU at both 2 hour and 24 hour, whose patholgic processes are suggested to be heterogenous namely subacute thyroiditis, postpartum thyroiditis, Hashimotos thyroiditis, and pamless thyroiditis. 4) 45% of hypothyroid patients had increased 24hr RAIU, 30% of hypothyroid patients were normal, 25%, decreased In conclusion. thyroid scan should be reevaluated its useful role to asses the pathophysiologic status of thyroid disease. Especially in cases of transient thyrotoxicosis, thyroid scan is essential to diagnose and follow up the disease process.
증례 : 혈액종양 ; 담낭암 환자에서 발생한 비정형성 베르니케 뇌병증 1예
정윤화 ( Yun Hwa Jung ),유현아 ( Hyun Ah Yu ),윤건중 ( Gun Jung Youn ),이자인 ( Ja In Lee ),우인숙 ( In Sook Woo ),한치화 ( Chi Wha Han ) 대한내과학회 2013 대한내과학회지 Vol.84 No.4
담낭암 환자에서 갑작스럽게 발생한 구음장애와 보행실조에 대한 평가를 위해 시행한 뇌자기공명영상에서 치상핵에 국한된 신호강도 변화를 보여 metronidazole 유발성 뇌병증과의 감별이 어려웠으나 thiamine 선제 치료 후 증상과 영상학적 호전을 보여 비정형성 베르니케 뇌병증으로 진단할 수 있었던 증례를 문헌고찰과 함께 보고한다. Wernicke`s encephalopathy (WE) is an acute neuropsychiatric syndrome resulting from thiamine deficiency. Traditionally, diagnosis of WE rests on a clinical symptom triad consisting of ocular signs, altered consciousness, and ataxia. However, the complete triad is only present in a fraction of cases, which means that WE tends to be under-diagnosed, especially in nonalcoholic patients. Brain MRI of WE patients usually shows symmetrical signal intensity alterations in the thalami, mammillary bodies, and periaqueductal area, because of cytotoxic edema in the same region. These typical findings are useful diagnostic leads in WE patients with atypical symptoms. However, atypical findings can occasionally be seen in the vermis of cerebellum and cerebellar nuclei. Notably, alterations of signal intensity in the cerebellar dentate nuclei, which is a typical finding of metronidazole-induced encephalopathy (MIE), need to be distinguished according to medication history and response to thiamine. (Korean J Med 2013;84:602-607)
증례 : 혈액종양 ; 림프종 환자에서 리툭시맙 치료 후에 발생한 저감마글로불린혈증 1예
노현진 ( Hyun Jin Noh ),공봉한 ( Bong Han Gong ),김영신 ( Young Sin Kim ),정윤화 ( Yun Hwa Jung ),우인숙 ( In Sook Woo ),한치화 ( Chi Wha Han ) 대한내과학회 2014 대한내과학회지 Vol.87 No.3
Rituximab, an anti-CD20 monoclonal antibody, is an effective target agent against the B lymphocytes in B-cell lymphoid malignancies and various lymphoproliferative diseases. Moreover, the toxicity of rituximab is less severe than that of conventional cytotoxic agents, which has promoted the widespread application of rituximab in the treatment of B-cell lymphoma. However, depletion of B lymphocytes by rituximab, which leads to secondary hypogammaglobulinemia, can cause deterioration of humoral immunity. Although immune reconstitution after hematopoietic stem cell transplantation is known to prevent prolonged hypogammaglobulinemia, very few cases of long-standing hypogammaglobulinemia have been reported. We report herein a case of prolonged hypogammaglobulinemia after rituximab-containing chemotherapy and splenectomy in a patient with non-Hodgkin`s lymphoma and discuss the clinical significance and pathogenetic mechanism of this phenomenon with a literature review. (Korean J Med 2014;87:357-362)