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Child-Pugh B군인 간세포암 환자에서 sorafenib과 경동맥화학색전술 병합 치료
이종식 ( Jong Sik Lee ),문선영 ( Sun Young Moon ),이경언 ( Kyung Ann Lee ),민재기 ( Jae Ki Min ),전성진 ( Sung Jin Jeon ),김인애 ( In Ae Kim ),이강훈 ( Kang Hoon Lee,),최원혁 ( Won Hyeok Choe ),김정한 ( Jeong Han Kim ),권소영 ( So 대한간암학회 2014 대한간암학회지 Vol.14 No.1
combined with transarterial chemoembolization (TACE) in Child-Pugh (CP) class-B patients with hepatocellular carcinoma (HCC). Methods: A total of 12 CP class-B patients who were initially treated with sorafenib combined with TACE were retrospectively reviewed. At 14 days after the first TACE, patients were continuously treated with sorafenib until unacceptable adverse events (AEs) or diseaseprogression. Consecutive TACEs were also performed, if patients were tolerable. Results: Of 12 patients, 8, 3 and 1 patients had CP-score 7, 8, and 9, respectively. The median overall survival was 85 days. Patients underwent median 2 sessions of TACE (range 1-4) and the median duration of sorafenib was 48days (range, 12-92 days). Three patients refused repeated TACEs and 4 patients required delay of the consecutive TACE due to AEs of sorafenib. Six patients required transient or permanent discontinuation of sorafenib, due to its AEs (grade 1/2 AEs, 2 patients; grade 3/4 AEs, 4 patients). High CP score (score 8/9 vs. 7) was tended to be association with interruption of sorafenib (P=0.061) and requirement of refusal/ delay of consecutive TACE (P=0.081). Conclusions: Sorafenib combined with TACE were frequently interrupted or delayed in CP class-B patients, mostly because of its side effects, even though there were not serious. Our experiences suggest that combination with sorafenib and TACE might interface with each other due to its side effects in CP class-B patients, especially patients with CP score 8/9 liver cirrhosis.
전신홍반루푸스 환자에서 미코페놀레이트모페틸 음독 후 발생한 심실성빈맥
김정훈 ( Jung-hun Kim ),정현지 ( Hyunji Chung ),이경언 ( Kyung-ann Lee ),김해림 ( Hae-rim Kim ),이상헌 ( Sang-heon Lee ) 대한내과학회 2019 대한내과학회지 Vol.94 No.5
MMF의 과량 복용 후 발생한 심혈관계 부작용은 아직까지 보고된 바 없었다. 저자들은 구조적 심장 질환이 없는 SLE 환자에서 34 g의 MMF를 음독 후 발생한 심실성빈맥 1예를 경험하였기에 문헌고찰과 함께 보고한다. Mycophenolate mofetil (MMF) is an immunosuppressive agent used to treat severe lupus, including lupus nephritis. Common adverse effects of MMF include gastrointestinal and hematological manifestations; however, cardiac toxicity in association with MMF has not been reported. We present a 21-year-old woman with lupus nephritis who developed ventricular tachycardia 2 hours after an overdose of MMF (34 g). Ventricular bigeminy was documented 12 hours after the MMF overdose. Transthoracic echocardiography showed no evidence of structural heart disease. The ventricular arrhythmia was successfully treated with potassium replacement, hydration, and cholestyramine. This case suggests that an overdose of MMF can induce ventricular tachycardia, and electrocardiogram monitoring is critical to identify this rare cardiac complication of MMF. (Korean J Med 2019;94:455-458)
Overtube를 이용한 식도정맥류 결찰술 후 발생한 식도천공과 지연성 합병증으로 나타난 종격동염의 치료
김선웅 ( Sun Woong Kim ),이윤정 ( Yoon Jeong Lee ),김수정 ( Soo Jung Kim ),이경언 ( Kyung Ann Lee ),김아란 ( Ah Ran Kim ),박상우 ( Sang Woo Park ),최원혁 ( Won Hyeok Choe ),심찬섭 ( Chan Sup Shim ) 대한소화기학회 2014 대한소화기학회지 Vol.64 No.4
Overtube provides a conduit for the passage of endoscope into the digestive tract. Esophageal perforation with mediastinitis is a rare overtube-related complication. Until now, no reports have been published regarding the esophageal perforation which developed many months after the original procedure using the overtube. A 56-year-old female visited our hospital complaining of chest pain and back pain that began 14 days ago. The patient underwent esophageal variceal ligation using the overtube 12 months earlier. She was diagnosed with esophageal perforation with mediastinitis which extended to intervertebral and epidural space. The cause of this condition was considered to have been related to the use of overtube. Management of delayed perforation remains controversial. Although surgical management might be the preferred mode of treatment, she underwent local N-butyl 2-cyanoacrylate injection therapy and temporary stent therapy with antibiotics due to high operative risk. Herein, we report a case of overtube-related delayed esophageal perforation with mediastinitis that was successfully treated by nonoperative management. (Korean J Gastroenterol 2014;64:224-228)