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장흥문 ( Heung Moon Chang ) 대한내과학회 2011 대한내과학회지 Vol.80 No.4
The goals of medical treatment for advanced pancreatic neuroendocrine tumor (PNET) are to control hormone-related symptoms and to prolong overall survival. Somatostatin analogues have been used for decreasing the secretion of peptides and relieving symptoms. Recent studies showed that these agents also have an anti-tumor effect and could prolong the survival of patients with advanced PNET. For well-differentiated PNET, streptozocin-based combination chemotherapy has been used for a long time and recent several studies showed survival benefit of targeted agents including angiogenesis inhibitor and mTOR inhibitor. For poorly-differentiated tumors, the number of clinical studies is very limited and the combination of etoposide and cisplatin is widely used. Based on the recent progress in the understanding of tumor biology, newer targeted agents are tested and some of these agents showed promising activity. (Korean J Med 2011;80:393-396)
고형암 환자에서 항암화학요법 후 호중구감소증에 대한 류코업(R) (Filgrastim, rhG-CSF)의 안전성 및 유효성: 그라신(R)과의 다기관 비교 임상시험
이소영 ( So Young Lee ),장흥문 ( Heung Moon Chang ),허대석 ( Dae Seog Heo ),류백렬 ( Baek Yeol Ryoo ),김태원 ( Tae Won Kim ),류민희 ( Min Hee Ryu ),김태유 ( Tae You Kim ),박연희 ( Yeon Hee Park ),이재훈 ( Jae Hoon Lee ),박근칠 ( K 대한내과학회 2005 대한내과학회지 Vol.69 No.1
정상훈 ( Sang Hun Jung ),김희철 ( Hee Cheol Kim ),유창식 ( Chang Sik Yu ),장흥문 ( Heung Moon Chang ),류민희 ( Min Hee Ryu ),이재련 ( Jae Lyun Lee ),김정선 ( Jung Sun Kim ),김진천 ( Jin Cheon Kim ) 대한소화기학회 2006 대한소화기학회지 Vol.48 No.2
목적: 대장의 신경내분비종양은 매우 드물고, 통상적인 대장암에 비해 빠르게 진행하며 예후가 매우 나쁘다. 그러나 발생 빈도가 적어 국내에는 아직까지 보고가 없다. 이번 연구는 후향 분석을 통해 대장의 신경내분비종양의 임상 경과 및 병리 특징을 알고자 하였다. 대상 및 방법: 1997년 6월부터 2004년 12월까지 서울아산병원에서 H&E 및 면역조직화학염색에 의해 조직학적으로 대장의 신경내분비종양으로 진단 받은 13예의 환자를 대상으로 하였으며, 대장의 신경내분비암종 10예와 대장의 샘암종에 신경내분비분화를 포함하는 혼합암종이 3예였다. 카르시노이드 종양은 대상에서 제외되었으며, 환자들의 기록은 후향으로 조사하였다. 결과: 4,512명 중 13예(0.3%)의 환자가 대장의 신경내분비종양으로 진단되었다(신경내분비암종 10예, 혼합암종 3예). 환자 나이의 중앙값은 60세(41-83세)였으며, 남자가 6예, 여자는 7예였다. 종양의 발생부위는 직장 9예, 에스자결장 2예, 그리고 맹장과 횡행결장이 각각 1예였다. 면역조직화학염색을 시행한 신경내분비암종 9예 모두 synaptophysin 양성인 반면, chromogranin A는 3예에서 양성이었다. 6차 AJCC TNM병기에 따라 IIIB 병기 2예, IIIC 병기 3예 그리고 IV 병기가 8예였으며, 대장의 신경내분비암종 환자에서는 10예 중 7예에서 원격전이가 있었다. 신경내분비암종 10예와 혼합암종 3예의 중간생존율은 각각 16.4개월과 30개월이었다. 10예의 신경내분비암종 환자 중 항암치료를 받은 5예의 중간생존율은 III 병기 3예와 IV 병기 2예에서 각각 32개월과 17.5개월이었으나, 항암치료를 받지 않은 5예의 중간생존율은 6.2개월이었다. 혼합암종 3예는 모두 항암치료를 받았으며 중간생존율은 30개월이었다. 결론: 대장의 신경내분비종양의 빈도는 0.3%로 매우 드물다. 지금까지 적은 수의 환자와 빠르게 진행되는 종양의 특성으로 유용한 치료방침이 없었으나, 적극적인 병소의 절제와 etoposide/cisplatin을 이용한 항암치료 및 방사선치료는 환자의 생존율을 향상시킬 수 있을 것으로 기대한다. Background/Aims: Colorectal neuroendocrine carcinoma is a rare neoplasm exhibiting fulminant progression and having poor prognosis. The purpose of this study is to verify the clinicopathologic characteristics of colorectal neuroendocrine carcinoma. Methods: From June 1997 to December 2004 at Asan Medical Center, ten patients were originally identified as colorectal neuroendocrine carcinoma on the basis of H&E and immunohistochemical staining (IHC). Carcinoid tumors were excluded in this study. Medical records of thirteen patients were reviewed retrospectively. Results: Ten patients (0.2%) with colorectal neuroendocrine tumors were identified from 4,512patients with colorectal cancer; ten neuroendocrine carcinomas and three adenocarcinomas with neuroendocrine differentiation. Their median age was 60 (41-83) years. The subjects consisted of six males and seven females. Nine tumors were located in the rectum, two in the sigmoid, and each one in the transverse colon and cecum, respectively. Nine of ten neuroendocrine carcinomas expressed synaptophysin, but chromogranin A were expressed in four. All patients were advanced at the time of diagnosis, with AJCC TNM staging: stage IIIB (n= 2), stage IIIC (n=3), and stage IV (n=8). The median survival for ten neuroendocrine carcinomas and three adenocar-cinomas with neuroendocrine differentiation were 16.4 months and 30 months, respectively. Five patients who received chemotherapy showed median survival of 32 months (stage III) and 17.5 months (stage IV), whereas other five patients without chemotherapy died with a median survival of 6.2 months. Conclusions: Colorectal neuroendocrine tumors are extremely rare showing aggressive behavior biologically, i.e fulminant early distant metastasis. Nevertheless, improved survival may be achieved by aggressive multimodality therapy. (Korean J Gastroenterol 2006;48:97-103)
복부 대동맥류에서 발치 후 발생한 범발성 혈관내 응고증 1 예
안종호 ( Jong Ho Ahn ),이정열 ( Jeong Yeol Lee ),노희종 ( Hee Jong Noh ),주민하 ( Min Ha Joo ),전만조 ( Man Jo Jeon ),윤병인 ( Byung In Yun ),장흥문 ( Heung Moon Chang ) 대한내과학회 2001 대한내과학회지 Vol.61 No.5
N/A Disseminated intravascular coagulation (DIC) is the result of a severe underlying disorder thatinitiates massive activation of the coagulation system. We report an unusual case of 79- year - old man who developed DIC after tooth extraction in abdominal aortic aneurysm. He was referred to our hospital because of persistent bleeding after tooth extraction. Physical examination indicated a pulsating mass in abdomen. Abdominal computerized tomography (CT) scan revealed 70 mm diameter aneurysm of the abdominal aorta, extending from the renal infrahilar level to the common iliac artery, and his coagulation profile showed the features of DIC by revealing thrombocytopenia, hypofibrinogenemia, and increased level of fibrinogen degradation product (FDP). After he had received blood component therapy including fresh frozen plasma and continuous intravenous heparin infusion (4,800 U/day), the bleeding diathesis and coagulopathy improved. He refused to have definitive surgery for the aneurysm. (Korean J Med 61:572- 576, 2001)
H. pylori 제균으로 완전 관해된 위의 고도 MALT 림프종 1예 : a case report
황창연,류민희,강윤구,김태원,장흥문,엄대운,허주령 대한내과학회 2004 대한내과학회지 Vol.66 No.1
위의 저도 MALT 림프종은 H. pylori 제균 후에 60∼90%가 관해를 보이는 것으로 알려져 있으나 고도 MALT 림프종은 H. pylori 제균 만으로는 치료가 부족한 것으로 알려져 있다. 그러나 최근에 위의 고도 MALT 림프종에서도 H. pylori 제균 치료를 통해 관해에 이른 사례들이 보고 되었고, 저자들도 고도 MALT 림프종 환자에서 H. pylori 제균 치료를 통하여 내시경적 및 조직학적 완전 관해에 도달한 증례를 경험하여 이를 보고하는 바이다. Low grade MALT lymphoma of stomach is associated with H. pylori infection in more than 90% of cases, and eradication of H. pylori leads to regression of the low grade MALT lymphoma in 60∼90% of cases. On the contrary, high grade MALT lymphoma is thought to be independent from H. pylori for growth and usually is thought to require antitumor chemotherapy. However, there have been recent reports of high grade MALT lymphoma regressing after H. pylori eradication. We experienced and are reporting a case of high grade MALT lymphoma arising in the background of low grade MALT lymphoma that showed complete regression after H. pylori eradication.
우인숙,김노경,방영주,김원석,장흥문,정흠,정경해,허대석,심영수 대한내과학회 1995 대한내과학회지 Vol.48 No.3
The cancer-associated retinopathy (CAR) is a very rare paraneoplastic syndrome. Most of the cases are associated with the lung cancer, especially small cell lung cancer. The triad of CAR is described as photosensitivity, scotomatous peripheral visual field loss, and attenuated retinal arterial caliver. The pathogenesis is suggested that anti-retinal antibody induced by malignat tumors causes the degeneration of photoreceptors in the retina through the cross reaction. The titer of these antibodies can be used as an index of disease activity and treatment response. The CAR antigen is not clearly determined yet, but 26 kD proteins located in cone and rod photoreceptor cells are considered as that antigen. Consequently, the destructioon of the photoreceptors by immune mechanism results in visual changes even complete blindness. If no treatment is done, the visual loss progresses to complete blindness. Many authors recommanded prednisone as a treatment. This can reduce the antibody titer even to normal range, and stop the disease progress through the immunosuppression. With a brief review of literature, we report a case of cancer-associated retinopathy in 54-year old female patient who has a small cell lung cancer in the stage of limited disease, Her initial symptomes were peritpheral visual loss and sparkling in front of her eys. We treated her with the combination chemotherapy of cisplatin and etoposide (VP-16) and radiation therapy. The gastrointestinal symptom made her stop prednisone medication. The outcome of teatments was complete remission and her visual symptoms were not progressed. We have a good result in this patient. So we report this case.