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증례 : 혈액종양 ; 동종 조혈모세포이식 후 다발성 근염으로 발현된 만성 이식편대숙주반응
이혜원 ( Hye Won Lee ),최희경 ( Hee Kyung Choi ),김수정 ( Soo Jeong Kim ),황도유 ( Doh Yu Hwang ),최준용 ( Jun Yong Choi ),정준원 ( June Won Cheong ),민유홍 ( Yoo Hong Min ) 대한내과학회 2009 대한내과학회지 Vol.76 No.1
동종 조혈모세포이식 후의 합병증으로 드물게 다발성근염으로 만성 이식편대숙주반응이 생길 수 있으며, 경우에 따라 치명적일 수 있으므로 조기 진단이 중요하겠다. 그러나, 임상 양상이 비특이적일 경우 진단이 쉽지 않으며 이식 후 수년 뒤에도 유일한 이식편대숙주반응으로 발현될 수 있어 동종 조혈모세포이식을 받았던 환자를 진료할 때에는 이에 대한 주의가 필요하겠다. Chronic graft-versus-host disease (cGVHD) remains one of the major complications of allogeneic hematopoietic stem cell transplantation. Although cGVHD has various manifestations in almost all organs, cases of cGVHD involving skeletal muscle are rare. We experienced a 26-year-old man with polymyositis with no other concurrent cGVHD after HLA-matched myeloablative transplantation for acute myelogenous leukemia. He had a history of acute and chronic GVHD. The patient complained of fever and myalgia 3 years after transplantation. The serum creatine kinase (CK, 2,223 IU/L) and aldolase (87.6 sigmaU/mL) were elevated. The muscle biopsy and electromyographic findings were consistent with myositis with necrosis. His condition improved dramatically with immunosuppressive therapy. Although muscle involvement, alone, in cGVHD is very rare, early diagnosis and proper treatment are still important. (Korean J Med 76:110-113, 2009)
최현정 ( Hyun Jung Choi ),박용원 ( Yong Won Park ),정준원 ( June Won Cheong ),민유홍 ( You Hong Min ),권자영 ( Ja Yong Kwon ),권한성 ( Han Sung Kwon ),김영한 ( Young Han Kim ),김성훈 ( Sung Hoon Kim ) 대한산부인과학회 2005 Obstetrics & Gynecology Science Vol.48 No.2
The incidence of acute leukemia in pregnancy is estimated to be about 1 per 75000 pregnancies, and the incidence of lymphocytic leukemia is known to be lower than myelocytic leukemia. Pregnancy dose not affect the course of acute leukemia, but thrombocyto
이영주 ( Lee Yeongju ),박장희 ( Park Janghee ),정준원 ( Cheong June-won ),김수정 ( Kim Soo Jeong ),김윤덕 ( Kim Yundeok ) 인하대학교 교육연구소 2017 교육문화연구 Vol.23 No.2
역량중심교육은 학생교육의 질적 강화 및 구체적인 교육효과를 요구하고 있다. 이를 위해서는 적절한 성취수준 설정 및 학생의 도달 여부를 확인하는 준거참조평가(절대평가)가 보다 적절할 것이다. 준거참조평가를 위해서는 준거설정방법을 통해 각 성취수준을 구분하는 분할점수를 산출해야 한다. 기존 준거설정방법들은 대부분 고부담시험에 적용되었으나, 대학의 수업수준에서 이뤄진 연구는 거의 없었다. 본 연구는 준거참조평가를 시행하는 의과대학의 실제 수업에서 활용하는 준거설정방법을 소개하였다. 이를 위해 준거설정방법 중 Modified Angoff 방법과 Modified Ebel 방법을 이용하여 성취수준별 분할점수를 산출했다. 산출결과 Modified Ebel 방법이 Modified Angoff 방법보다 엄격하게 평정되어 분할점수가 높았다. 또한 Modified Ebel 방법은 예상정답률과 실제정답률을 사용했을 때 분할점수에 차이가 있었으며, 실제정답률을 반영하는 것이 보다 현실적이었다. 본 연구는 고부담시험에서 주로 이뤄지는 준거설정을 실제 의과대학에서 사용하는 방법으로 의과대학 성적에 적용해 보았다는데 의의가 있다. 창의성 기반의 역량중심교육을 보다 활성화하려면, 경쟁에 관심을 두는 규준참조평가보다는 협력학습을 가능하게 하는 준거참 조평가가 더욱 강조될 것이고, 이때 다양한 준거설정방법이 수업수준에 적용될 것으로 예측된다. Competency-centered education and the Fourth Industrial Revolution require qualitative strengthening of student education and concrete educational effects. To do this, it is appropriate to establish appropriate levels of achievement and to assess the criterionreferenced evaluation (so-called absolute evaluation). For the criterion-referenced evaluation, the division score between each grade should be calculated through the standard setting method. The existing standard setting methods were carried out in high-stakes examinations, but there were few studies conducted at the class level of universities. This study compares the standard setting method of the medical school which performs the criterion referenced evaluation in the actual class level. Among the standard setting methods, the modified score was calculated using Modified Angoff method and Modified Ebel method. As a result, Modified Ebel method was more strict than Modified Angoff method, and the Modified Ebel method had a higher cutoff score than the Modified Angoff method. It was more realistic to reflect actual difficulty. In this study, it is meaningful to apply the standard setting method, which is mainly used in the high stakes test, to the results of the medical college as a method used in actual medical college. In the future, competency-based evaluation will be more emphasized in order to activate competence-based education and creativity through cooperative learning rather than competition.
손상균 ( Sang Kyun Sohn ),정철원 ( Chul Won Jung ),조덕연 ( Deog Yeon Jo ),정준원 ( June Won Cheong ),대한혈액학회만성골수성백혈병연구회 ( Chronic Myelogenous Leukemia Working Party The Korean Societ ),김대영 ( Dae Young Kim ),이정옥 ( 대한내과학회 2015 대한내과학회지 Vol.88 No.4
Background/Aims: The first edition of the Korean treatment guidelines for chronic myelogenous leukemia (CML) was published in 2006. We intend to update those guidelines to include the use of next-generation tyrosine kinase inhibitors (TKIs). Methods: New guidelines were developed in 2012 based on the results of a survey and a consensus meeting of various Korean experts, the reports of recent clinical studies, and updated guidelines from external study groups. Results: An assessment of risk factors is strongly recommended before treating newly diagnosed chronic phase CML. Imatinib, dasatinib, and nilotinib are reimbursable in Korea as first-line treatments, and the patient`s age, comorbidities, and possible adverse events should be considered in the choice of treatment. Molecular studies are recommended for assessing treatment efficacy instead of invasive cytogenetic response evaluations, and an early response is believed to correlate with a good prognosis. Second-line TKIs can be considered for patients who fail or are intolerant of first-line therapy, pending analysis of ABL tyrosine kinase mutation status. For treating advanced stages, a combination of TKIs with cytotoxic agents and hematopoietic cell transplantation is recommended. The adverse effects of TKI therapy can be managed via dose reduction and supportive care, or switching to an alternate TKI. Conclusions: The use of TKIs has improved the outcome of CML treatment. Treatment-free remission after discontinuing TKIs might be possible in select patients who achieve sufficient response, indicating that curative treatment for CML can be expected in the future.
증례 : 혈액종양 ; 이식초기의 급속한 림프구증식을 동반한 치명적 PTLD 증례
이정연 ( Jung Yeon Lee ),김규리 ( Gyuri Kim ),이은영 ( Eunyoung Lee ),박세희 ( Se Hee Park ),김진석 ( Jin Seok Kim ),정준원 ( June Won Cheong ),민유홍 ( Yoo Hong Min ) 대한내과학회 2015 대한내과학회지 Vol.89 No.2
Post-transplant lymphoproliferative disorder (PTLD) is a spectrum of clinically and morphologically heterogeneous lymphoid proliferations of various clonal compositions that are observed after hematopoietic stem cell transplantation (HSCT) or solid organ transplantation. The majority of PTLD cases are associated with Epstein-Barr virus (EBV) infection, while overt peripheral blood (PB) or bone marrow (BM) involvement in PTLD is uncommon in early lesions. We report a 38-year-old woman with EBV-related PTLD, with BM and PB involvement, who presented with peripheral lymphocytosis as an early lesion 1 month after haploidentical HSCT for Philadelphia chromosome-positive acute lymphoblastic leukemia was performed during first complete remission. Although PB or BM involvement of PTLD after HSCT is uncommon in early lesions, peripheral lymphocytosis can be an initial presenting manifestation of PTLD, as in this case. (Korean J Med 2015,89:243-248)