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증례 : 혈액종양 ; 동종이식으로 치료한 급성 골수성 백혈병 항암 치료 후 골수 무형성증 1예
윤현화 ( Hyun Hwa Yoon ),홍준식 ( Jun Shik Hong ),김수영 ( Su Young Kim ),이동민 ( Dong Min Lee ),박진희 ( Jin Ny Park ),안정열 ( Jeong Yeal Ahn ),이재훈 ( Jae Hoon Lee ) 대한내과학회 2014 대한내과학회지 Vol.86 No.2
급성 골수성 백혈병에서 고용량 항암화학요법 후 발생하는 지속성 골수 무형성증은 높은 이환율과 사망률을 나타낼 수 있는 매우 드문 합병증으로 더욱이 감염까지 동반한 경우는 일반적으로 조혈모세포이식의 금기이나 전문적인 감염 치료를 병행하면서 비골수억제성 전처치로 조혈모세포이식을 적극 고려해야 한다. Persistent bone marrow aplasia after intensive chemotherapy is uncommon, but is one of the fatal complications in patients with acute myeloid leukemia (AML). Although allogeneic hematopoietic stem cell transplantation (HSCT) is considered to be contraindicated for patients who have hematologic diseases with serious infections, such as bacterial septicemia or invasive fungal diseases, combined with prolonged neutropenia due to frequent morbidity and mortality, such risks can be overcome by non-myeloablative conditioning and best supportive care. Here, we report an AML patient with persistent marrow aplasia after induction therapy, treated successfully with reduced-intensity allogeneic HSCT despite severe bacterial and fungal infections. (Korean J Med 2014;86:242-246)
이동민,유승희,윤현화,이강록,엄영실,이기영,김병준,김연순,박레병,김광원,이시훈 대한내분비학회 2014 Endocrinology and metabolism Vol.29 No.2
Background: Multiple endocrine neoplasia type 1 (MEN1) is a rare inherited disorder characterized by the simultaneous occurrence of endocrine tumors in target tissues (mainly the pituitary, endocrine pancreas, and parathyroid glands). MEN1 is caused by mutations in the MEN1 gene, which functions as a tumor suppressor and consists of one untranslated exon and nine exons encoding the menin protein. This condition is usually suspected when we encounter patients diagnosed with tumors in multiple endocrine organs, as mentioned above. Methods: A 65-year-old woman who underwent surgery for a pancreatic tumor (serous cystadenoma) 5 years previously was referred to our hospital due to neurologic symptoms of diplopia and left ptosis. Brain magnetic resonance imaging revealed a 3.4-cm lesion originating from the cavernous sinus wall and extending into the sellar region. It was thought to be a nonfunctioning tumor from the results of the combined pituitary function test. Incidentally, we found that she also had a pancreatic tumor, indicating the necessity of genetic analysis for MEN1. Results: Genomic analysis using peripheral leukocytes revealed a heterozygous c.1621G>A mutation in the MEN1 gene that was previously reported to be either a pathogenic mutation or a simple polymorphism. We pursued a stereotactic approach to the pituitary lesion, and microscopic findings of the tumor revealed it to be an intrasellar cavernous hemangioma, a rare finding in the sellar region and even rarer in relation to oculomotor palsy. The patient recovered well from surgery, but refused further evaluation for the pancreatic lesion. Conclusion: There is great emphasis placed on genetic testing in the diagnosis of MEN1, but herein we report a case where it did not assist in diagnosis, hence, further discussion on the role of genetic testing in this disease is needed. Also, in cases of pituitary tumor with cranial nerve palsy, despite its low prevalence, intrasellar cavernous hemangioma could be suspected.
이유림,허석재,이동현,윤현화,Young Mi Seol,Young Jin Choi,권경아,이수이,오성용,김성현,김효진,권혁찬 한국유방암학회 2011 Journal of breast cancer Vol.14 No.2
Purpose: The role of first-line trastuzumab-based therapy has been firmly established in patients with human epidermal growth factor receptor-2 (HER2) positive metastatic breast cancer. In this trial, we evaluated the efficacy and safety of a vinorelbine and trastuzumab combination chemotherapy in patients who were pretreated with anthracyclines and taxanes. Methods: Thirty-three patients with HER2 overexpressing metastatic breast cancer, all of whom had previously been treated with anthracyclines and taxanes, were included in this study. The patients were treated with 25 mg/m2 of vinorelbine (over a 15-minute infusion) on days 1 and 8 every 3 weeks. Additionally, trastuzumab was administered at an initial dose of 4 mg/kg over 90 minutes, and was subsequently administered at weekly doses of 2 mg/kg (over 30 minutes). Results: The median age of the patients was 53 years (range, 39-72 years). The overall response rate was 30.3% (10 patients; 95% confidence interval [CI], 23-57%). The median time to progression was 6.8 months (95% CI, 5.3-8.2 months). The median overall survival was 12.4 months (95% CI, 10.3-14.6 months). In the 194 cycles of treatment, the incidence rates of grade ≥3 neutropenia and anemia were 7.2% and 1.0%, respectively. Neutropenic fever was detected in three cycles (1.5%). The non-hematological toxicities were not severe: grade 1 or 2 nausea or vomiting was detected in 15.2%, and grade 2 neuropathy was noted in 6.1% of patients. None of the patients experienced any serious cardiac toxicity, and no treatment-related deaths occurred. Conclusion: These results show that a combination chemotherapy consisting of vinorelbine and trastuzumab is useful in patients with HER2-overexpressing metastatic breast cancer who were pretreated with anthracyclines and taxanes, with a favorable toxicity profile.
A Phase II Study of Modified FOLFOX4 for Colorectal Cancer Patients with Peritoneal Carcinomatosis
이동현,오성용,이유림,허석재,윤현화,김성현,이수이,이지현,김영,김효진,권혁찬 대한암학회 2011 Cancer Research and Treatment Vol.43 No.4
Purpose Peritoneal carcinomatosis (PC) of colorectal cancer (CRC) is common and is the second most common cause of death. Clinical studies regarding chemotherapy for CRC with PC have been classically rather limited in scope. We evaluated the efficacy of modified oxaliplatin, leucovorin,and fluorouracil (m-FOLFOX4) regimen for PC of CRC origin. Materials and Methods CRC patients with PC were treated with cycles of oxaliplatin at 85 mg/m^2 on day 1, leucovorin 20mg/m^2 followed by 5-fluorouracil (5-FU) via a 400 mg/m^2 bolus and a 22 hours continuous infusion of 600 mg/m^2 5-FU on days 1-2 at 2-week intervals. Results Forty patients participated in this study. Median age was 55 years. Thirty-two patients (80.0%) received previous operation, and 60.0% of PC occurred synchronously. Thirty-five patients (87.5%)were assessable and exhibited measurable lesions. Two patients (5.7%) demonstrated complete response and five patients (14.3%) showed partial response. The median time to progression was 4.4 months (95% confidence interval, 2.5 to 6.3 months), the median overall survival time was 21.5months (95% confidence interval, 17.2 to 25.7 months). There was no treatment related death. Presence of liver metastasis (p=0.022), performance status (p=0.039), and carcinoembryonic antigen level (p=0.016) were related to the time to progression. Patients with low carcinoembryonic antigen level (37.2 months vs. 15.6 months, p=0.001) or good performance status (22.5 months vs. 6.8 months, p=0.040) showed better overall survival. Conclusion The m-FOLFOX4 regimen was determined to be effective for CRC patients with PC.
A Case of Cardiac Amyloidosis With Diuretic-Refractory Pleural Effusions Treated With Bevacizumab
배숙향,황진연,김우재,윤현화,김정민,남영희,백희경,조용락,박선이,김정환,김성현,박태호,이기남,나서희,김영대 대한심장학회 2010 Korean Circulation Journal Vol.40 No.12
Cardiac amyloidosis describes a clinical disorder caused by infiltration of abnormal insoluble fibrils in the heart, characterized by progressive heart failure and a grave prognosis. Pleural effusion in cardiac amyloidosis may represent a sign of heart failure,but it can also result from pleural infiltration of amyloid, manifested by recurrent large fluid accumulations. Recently,the role of vascular endothelial growth factor (VEGF) has been implicated in the pathogenesis of refractory pleural effusion. We report a case of a 53 year-old female patient with cardiac amyloidosis who presented with recurrent accumulation of large pleural effusions. She was initially treated with high dose loop diuretics, but the pleural effusion persisted, with the daily amount of drainage averaging 1 L/day. Accumulation of pleural fluid did not subside after 3 cycles of melphalan/prednisolone therapy. After the introduction of bevacizumab, an anti-VEGF antibody, the amount of pleural effusion decreased significantly. Efficacy of anti-VEGF therapy for refractory pleural effusions needs to be defined through further studies.
소화기; 악성 림프종 환자에서 항암화학요법 후 발생하는 B형 간염의 재활성화
장승준 ( Seung Jun Jang ),정영걸 ( Young Kul Jung ),백혜림 ( Hae Lim Baek ),윤현화 ( Hyun Hwa Yoon ),신승각 ( Seung Kak Shin ),홍준식 ( Jun Shik Hong ),박진희 ( Jin Ny Park ),권오상 ( Oh Sang Kwon ),김연수 ( Yun Soo Kim ),최덕주 ( 대한내과학회 2013 대한내과학회지 Vol.85 No.6
목적: 악성 림프종 환자에서 항암 치료 후 발생하는 B형간염의 재활성화는 중요한 합병증 중 하나이다. 이러한 B형간염의 재활성화는 항암 치료의 연기 혹은 심각한 간부전을 초래함으로써 결국 악성 림프종 환자의 생존율에 악영향을 준다. B형 간염의 재활성화는 항암 치료 전 검사에서 HBsAg양성인 환자뿐만 아니라 HBsAg 음성인 환자에서도 발생할 수 있다. 실제로 HBsAg이 음성일지라도 과거 B형 간염을 앓았거나 잠재감염 상태인 환자는 anti-HBc 양성 소견을 보인다. 본 연구는 단일 의료센터에서 6년간 항암 치료를 받은196명의 환자를 후향적으로 분석하여 B형 간염의 재활성화 율과 이를 예방하기 위한 방법에 대해 알고자 한다. 방법: 2005년 1월부터 2010년 12월까지 가천대 길병원에서 악성 림프종을 진단받고 항암 치료를 시행받은 196명이 환자들의 검사 결과 및 임상경과 자료를 후향적 분석하였다. 결과: 악성 림프종을 진단받은 총 196명의 환자에 대해항암 치료 전 HBsAg 검사율은 88% (172/196)였으며 11명이 양성이었다. Anti-HBc 검사율은 13% (26/196)에 그쳤으며 HBsAg 음성이면서 Anti-HBc 양성인 환자는 15명이었다. 재활성화는 HBsAg 양성군에서 27.3% (3/11), HBsAg 음성군에서 6.7% (1/15) 발생하였으며 이들은 entecavir 혹은 lamivudine복용 후에 모두 후유증 없이 간기능을 회복하였으며 항암치료를 종료하였다. 결론: HBsAg 양성인 환자뿐만 아니라 과거감염이나 회복된 감염을 의미하는 Anti-HBc 양성인 환자에서도 재활성화는 발생하였다. 따라서 항암 치료 시작 전에 B형 간염 바이러스에 대한 상태를 평가하고 재활성화를 예방하기 위한 적절한 검사와 선제 치료가 필요하다. Background/Aims: Reactivation of hepatitis B virus (HBV) has been reported in HBV surface antigen (HBsAg)-positive patients undergoing chemotherapy, as well as HBsAg-negative patients with antibodies against HBV core antigen (HBcAg) and/or HBsAg (HBsAb). Chemotherapy-including rituximab-has recently been identified as a predictive factor for HBV reactivation in HBsAg- negative patients with malignant lymphoma. The aim of our study was to identify the factors predictive of HBV reactivation after chemotherapy in patients with malignant lymphoma. Methods: We conducted a retrospective analysis of medical records from patients diagnosed with malignant lymphoma at Gachon University Gil Medical Center in City, County from January 2005 to December 2010. We subsequently determined HBsAg, HBsAb and anti-HBc status in the 196 patients treated with chemotherapy. Results: The mean age of the patients was 57.3 ± 14.5 years; 56.3% were male. A total of 172 of 196 (88%) patients in the study population were HBsAg (+) prior to chemotherapy. Three patients (3/11, 27.3%) in the HBsAg (+) group had confirmed HBV reactivation after chemotherapy. In addition, 26 of 196 (13%) patients in the study population tested HBcAg (+) positive prior to chemotherapy. One patient (1/15, 6.7%) in the HBsAg (-)/HBcAb (+) group had confirmed HBV reactivation. In the four patients with HBV reactivation, infection was resolved after treatment with 0.5 mg entecavir or 100 mg lamivudine. Conclusions: Reactivation of HBV after systemic chemotherapy can occur in HBsAg (-) patients. We recommend that malignant lymphoma patients undergoing chemotherapy be screened for HBV infection status, including HBcAg, and followed closely to prevent HBV reactivation. (Korean J Med 2013;85:598-603)
진행 간세포암종 환자에서 소라페닙 치료 후 발생한 간농양증
신승각 ( Seung Kak Shin ),정영걸 ( Young Kul Jung ),윤현화 ( Hyun Hwa Yoon ),권오상 ( Oh Sang Kwon ),김연수 ( Yun Soo Kim ),최덕주 ( Duck Joo Choi ),김주현 ( Ju Hyun Kim ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.1
Hepatocellular carcinoma (HCC) is a critical global health issue and the third most common cause of cancer-related deaths worldwide. The majority of patients who present HCC are already at an advanced stage and their tumors are unresectable. Sorafenib is a multi-kinase inhibitor of the vascular endothelial growth factor pathway and was recently introduced as a therapy for advanced HCC. Furthermore, studies have shown that oral sorafenib has beneficial effects on survival. However, many patients experience diverse side effects, and some of these are severe. Liver abscess development has not been previously documented to be associated with sorafenib administration in HCC. Here, we report the case of a HCC patient that developed a liver abscess while being treated with sorafenib. (Korean J Gastroenterol 2014;63:47-50)