침치료가 폐암 환자의 피로도에 미치는 영향: Pilot Study

현대성 ( Dae Sung Hyun ),김종대 ( Jong Dae Kim ),권효정 ( Hyo Jung Kwon ),정현정 ( Hyun Jung Jung ) 경락경혈학회 2012 Korean Journal of Acupuncture Vol.29 No.4

Objectives: Fatigue is a common and distressing symptom that is a concern for cancer patients. It has a decisive effect on quality of life. The purpose of this study was to examine the feasibility of clinical trial to evaluate of efficacy and safety of acupuncture on cancer related fatigue of lung cancer patients. Methods: Total lung cancer 9 patients complained of fatigue were treated by acupuncture twice a week for four weeks(8 times in total). Evaluation of the severity of fatigue was measured by FSS(Fatigue Severity Score). In visit 1, 10, we checked FSS. For check safety of acupuncture treatment, we did blood test. Results: After 4 weeks of acupuncture treatment, the FSS was significantly decreased from 4.92±1.06 to 3.74±1.37(p=0.008). And the level of hemoglobin was significantly increased from 10.87 g/dl to 12.01 g/dl(p=0.014). No other lab measures indicated any significant differences between before and after acupuncture treatment. Conclusions: This study suggests that acupuncture treatment will be beneficial for lung cancer patients to improve the fatigue severity. And acupuncture treatment is safe method for lung cancer patients. A large-scale study to confirm efficacy and safety of acupuncture is needed.

활동성폐결핵환자에서 말초혈액단핵구의 Th1 및 Th2 cytokine 분비양상

박성학(Sung Hak Park),이상학(Sang Hak Lee),이숙영(Sook Young Lee),문화식(Hwa Sik Moon),현대성(Dae Sung Hyun),신윤(Yoon Shin),최지현(Gee Hyun Choi),여동승(Dong Seung Yoe),김석찬(Suk Chan Kim),송정섭(Jeong Sup Song) 대한내과학회 1999 대한내과학회지 Vol.56 No.4

N/A T cell mediated immunity amlifies macrophage capacities to kill and digest the bacilli through production of interferon-γ (IFN-γ). The secreted cytokines of Th1 and Th2 cells can mutually regulate and inhibit each other's function. Therefore, the fine balance between the secreted cytokines is important for the resulting nature of tuberculosis. In this study, activation marker and cytokine production profiles were compared in patients with active tuberculosis and healthy control, and according to degree of radiographic extent and pleural involvement. Method:Forty-four patients with active pulmonary tuberculosis and 25 normal controls were recruited. We measuerd soluble interleukin-2 receptor(sIL-2R), IFN-r, IL-4 and IL-5 produced from blood mononuclear cells in vitro stimulation with phytohemagglutinin by ELISA. Results:The sIL-2R and IFN-γ from patients with active pulmonary tuberculosis were significantly lower than normal control, while IL-4 and IL-5 were not different between two group. The sIL-2R and IFN-r decreased in proportion to the extent of pulmonary involvement, and the sIL-2R and IFN-r from pulmonary tuberculosis with pleural effusion were significantly lower than those without pleural effusion. Conclusion:At the level of systemic T cells, development of tuberculosis is associated with diminished Th1 but not enhanced Th2 response.

대구 경북지역에서 진단된 노령자 폐암의 임상적 특징과 예후

김현숙 ( Hyun Sook Kim ),현대성 ( Dae Sung Hyun ),김경찬 ( Kyung Chan Kim ),이상채 ( Sang Chae Lee ),정태훈 ( Tae Hoon Jung ),박재용 ( Jae Yong Park ),김창호 ( Chang Ho Kim ),차승익 ( Seung Ick Cha ),이관호 ( Kwan Ho Lee ),정진홍 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.1

연구배경: 폐암은 우리나라 암 사망원인 질환의 가장 높은 비율을 차지하는 질환으로 특히 노령 인구에서 증가하는 추세이다. 그러나 노령의 폐암 환자는 동반된 질환, 노령에 따른 장기 기능의 저하 등의 이유로 적절한 치료를 받지못하는 경우가 많다. 이에 70세 이상의 노령 폐암 환자의 임상적 특징과 치료에 따른 생존기간 등을 알아보고자 한다. 방법: 2005년 1월부터 2005년 12월까지 대구, 경북지역에 소재하고 있는 대학병원 및 종합병원(경북대학병원, 구미 순천향병원, 대구가톨릭대학병원, 대구파티마병원, 동산의료원, 영남대학병원)에서 세포학적 혹은 조직학적으로 원발성 폐암을 진단받은 706명의 환자들을 70세 이상 환자군과 70세 미만 환자군으로 나누어 후향적으로 연구하였다. 결과: 전체 환자 중 70세 이상의 환자는273명(38.7%)이었다. 70세 이상의 환자는 70세 미만보다 호흡곤란의 증상이 많았으며(p<0.001), 만성폐쇄성폐질환의 빈도가 높았고(p<0.001), 활동도가 좋은 경우가 적었다(p<0.001). 비소세포폐암 환자의 중앙생존기간은 70세 미만의 환자와 70세 이상의 환자에서 유의한 차이를 보였지만(962일 vs 298일, p=0.001), 한 가지라도 치료를 받았던 환자들을 대상으로 했을 때는 두 군간에 의미 있는 차이가 없었다(1,109일 vs 708일, p=0.14). 결론: 70세 이상의 비소세포폐암 환자에서 환자의 활동도 등을 고려하여 적극적인 치료를 시행하는 것이 바람직할 것으로 생각된다. Background: Lung cancer is the leading cause of cancer death in South Korea since the year 2000 and it is more common in elderly patients, with a peak incidence at around 70∼80 years of age. However, these elderly patients receive treatment less often than do the younger patients because of organ dysfunction related to their age and their comorbidities, and they show poor tolerance to chemotherapy. The aims of this study were to analyze the clinical characteristics and treatment-related survival of elderly patients with lung cancer. Methods: In this retrospective study, we analyzed the clinical data of 706 lung cancer patients who were diagnosed at hospitals in Daegu and Gyeongsangbukdo from January 2005 to December 2005. We compared the clinical characteristics and outcomes of the patients who were aged 70 years and older (elderly patients) with those clinical characteristics and outcomes of the younger individuals. Results: The median age of the patients was 68 years (from 29 to 93) and the elderly patients were 38.7% (n=273) of all the study``s patients. Squamous cell carcinoma was the most common type of lung cancer in both the elderly and younger patient groups. Elderly patients had more symptoms of dyspnea and chronic obstructive pulmonary disease (COPD) than the younger patients (p<0.001 and p<0.001, respectively). A good performance status (ECOG 0-1) was less common for the elderly patients (p<0.001). The median survival of the non-small cell lung cancer (NSCLC) patients was significantly higher in the younger patient group than in the elderly patient group (962 days vs 298 days, respectively, p=0.001). However, the median survival of the NSCLC patients who received any treatment showed no significant difference between the younger patient group and the elderly patient group (1,109 days vs 708 days, respectively, p=0.14). Conclusion: Our data showed that appropriate treatment for selected elderly patients improved the survival of patients with NSCLC. Therefore, elderly NSCLC patients with a good performance status should be encouraged to receive appropriate treatment.

국소진행성 비소세포폐암 환자에서 weekly paclitaxel을 이용한 화학 방사선 동시요법의 효과

배성화 ( Sung Hwa Bae ),김경찬 ( Kyung Chan Kim ),이선아 ( Sun Ah Lee ),김소연 ( So Yeon Kim ),류헌모 ( Hun Mo Ryoo ),현대성 ( Dae Sung Hyun ),이상채 ( Sang Chae Lee ),예지원 ( Ji Won Yei ),배종엽 ( Jong Yup Bae ),정경재 ( Kyung J 대한내과학회 2005 대한내과학회지 Vol.69 No.4

목적 : 절제 불가능한 국소진행성 비소세포폐암 환자에서 paclitaxel을 이용한 화학 방사선 동시요법의 효과를 조사하기 위해 본 연구를 시행하였다. 방법 : 화학 방사선 동시요법 기간동안 paclitaxel을 매주 60㎎/㎡의 용량으로 1시간 동안 정맥으로 투여하였다. 방사선치료는 일일 1회 1.8Gy 분할량으로 주 5회 조사하였으며, 총 63Gy까지 조사하였다. 동시치료 이후 4주기의 paclitaxel/carboplatin 복합화학요법을 시행하였다. 결과 : 28명의 환자가 등록되었고, 남자가 25명, 여자가 3명이었고, 나이의 중앙값은 60세(범위: 41~73세)였다. 19명의 환자에서 계획된 화학 방사선 동시치료를 마쳤다. 완전관해는 5명, 부분관해는 15명으로 전체 관해율은 71.4%이었고, 7명의 환자에서 3도 이상의 폐렴이 발생하였는데 이 중 3명이 치료 관련 사망하였다. 중앙 생존기간은 17.5개월(95% 신뢰구간 12.5~22.5개월)이었고 무진행 생존기간의 중앙값은 8.0개월(95% 신뢰구간 4.1~11.9개월)이었다. 결론 : 국소진행성 비소세포폐암에서 paclitaxel을 포함한 화학 방사선 동시치료는 효과적이지만 폐의 부작용이 문제가 되며 환자 대상 선택과 추적에 주의를 요한다. Background : Combined modality therapy is standard treatment of unresectable, locally advanced stage III non-small cell lung cancer (NSCLC). However, the optimal chemotherapy regimen and duration of chemotherapy remain a matter of debate. We evaluated the efficacy and feasibility of concurrent chemoradiation therapy (CCRT) in patients with locally advanced NSCLC. Methods : PS 0-2 patients with histologically proven inoperable stage III NSCLC were eligible for this trial. The patients received paclitaxel (60㎎/㎡) on days 1, 8, 15, 22, 29, 36 with a concurrent radiotherapy (5days/week, 1.8Gy/day) starting day 1 with a total dose of 63 Gy. After CCRT, four cycles of consolidation chemotherapy with paclitaxel (140㎎/㎡) and carboplatin (AUC 5) was administered to patients with a partial, complete remission or stable disease. Results : Twenty eight patients with locally advanced NSCLC enrolled in this study. The median age of the patients was 60 years. Of the 28 patients, 19 received scheduled CCRT. Overall response rate was 71.4% including 5 complete responses and 15 partial responses. Grade 3 or 4 pulmonary complication was observed in 7 patients and 3 patients died of pneumonitis. The median overall survival was 17.5 months (95% CI, 12.5-22.5). The median progression free survival was 8.0 months (95% CI, 4.1-11.9). Conclusions : CCRT including paclitaxel in patients with locally advanced NSCLC led to an encouraging response rate and survival, but resulted in high incidence of severe pulmonary complication.(Korean J Med 69:379-386, 2005)

혈액종양 ; 진행성 비소세포폐암의 예후에 있어 FDG-PET의 중요성에 대한 연구

정현영 ( Hyun Young Jung ),장샛별 ( Saet Byul Jang ),정혜련 ( Hye Ryun Jung ),이선아 ( Sun Ah Lee ),배성화 ( Sung Hwa Bae ),현대성 ( Dae Sung Hyun ),이상채 ( Sang Chae Lee ),류헌모 ( Hun Mo Ryoo ) 대한내과학회 2009 대한내과학회지 Vol.77 No.1

목적: 폐암은 우리나라에서 암으로 사망하는 환자 중 가장 많은 부분을 차지하며 최근 지속적으로 증가하는 추세를 보인다. 전체 폐암 중 비소세포폐암은 80~85%를 차지하며, 특히 진행성 비소세포폐암은 예후가 불량하여 1년 생존율은 35%에 불과하다. 비소세포폐암 환자에서 [18F] fluorodeoxyglucose (FDG)를 이용한 양전자방출단층촬영(positron emission tomography, PET)은 다양한 FDG 섭취 정도를 보여준다. 본 연구는 제 IIIb 병기 이상의 진행성 비소세포폐암 환자에서 FDG-PET의 SUV (Standardized Uptake Value) 정도에 따라 이들의 치료 경과 혹은 예후를 예측할 수 있는지를 알아보기 위해 시행하였다. 방법: 제 IIIb, IV 병기인 비소세포폐암을 진단받고 치료 전 FDG-PET을 시행한 59명의 환자들을 대상으로 후향적으로 검토하였다. 각 환자의 PET 영상에서 FDG 섭취 정도를 확인하기 위해 병소 부위에 관심 영역을 설정하여 병소의 SUV를 구하였다. 생존기간(overall survival)과 무진행 생존기간(time to progression)은 Kaplan-Meier법을 이용하여 분석하였고, 생존율의 차이는 log-rank test를 이용하여 분석하였다. 결과: 종양의 FDG 섭취 정도에 따른 차이는 SUV 값을 7로 구분하였을 때 각각의 생존율이 가장 확연하게 차이가 나는 것으로 판단되어 SUV 7의 값으로 구분하여 비교하였다. SUV 7을 기준으로 하여 비교한 FDG 섭취 정도는 생존기간(p=0.02) 및 무진행 생존 기간(p=0.04)에 대해 통계학적으로 의미있는 예후인자로 확인되었고, 이외에 일상생활수행능력(p=0.02)이 생존 기간에 대한 예후인자임을 확인하였다. 결론: 본 연구는 FDG-PET에서 원발암의 SUV가 진행성 비소세포폐암의 예후에 중요한 영향을 미치는 인자가 될 수 있는지 확인하기 위해 시행하였으며, 연구 결과 FDG-PET에서 높은 SUV 섭취 정도를 보이는 진행성 비소세포폐암 환자들에서 생존 기간과 무진행 생존 기간이 더 짧아 나쁜 예후를 보임을 알 수 있었다. 향후 더 오랜 기간 동안 더 많은 환자를 대상으로 분석하여 치료 방침 결정에 도움을 줄 수 있는 예후인자를 확인하는 전향적인 대규모, 다기관 연구가 필요할 것으로 생각된다. Background/Aims: Lung cancer is the leading cause of cancer-related death in Korea. Non-small cell lung cancer (NSCLC) comprises 80~85% of lung cancer. Positron emission tomography with [18F]fluorodeoxyglucose (FDG-PET) shows various levels of FDG uptake for patients with NSCLC. This study determined whether the standardized uptake value (SUV) of FDG uptake by PET is a prognostic factor for advanced NSCLC. Methods: FDG-PET was performed in 59 patients with stage IIIb and IV NSCLC. The SUV was calculated for each patient. Overall survival (OS) and time to progression were calculated using the Kaplan-Meier method and evaluated with the log-rank test. The prognostic significance was assessed using univariate and multivariate analyses. Results: A cutoff of 7 for the SUV gave the best criminative value. In the univariate analysis, performance status (p=0.02) and SUV (p=0.03) were significant predictors of OS. The patients with low SUVs (≤7) had significantly better times to progression than those with high SUVs (>7, p=0.04). A multivariate Cox analysis identified performance status and the SUV as important for the prognosis. Conclusions: These results suggest that SUV is a significant prognostic factor in patients with advanced non-small cell lung cancer. (Korean J Med 77:76-83, 2009)

Platelet-activating Factor에 의한 급성폐손상에서 호중구성 산화성 스트레스에 관여하는 Cytosolic Phospholipase A2 활성도의 변화

권영식 ( Young Shik Kwon ),현대성 ( Dae Sung Hyun ),이영만 ( Young Man Lee ) 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.63 No.6

연구배경: 급성호흡곤란증후군의 병인론에 관여하는 PAF의 역할이 다양하고 중요하므로 본 연구에서는 PAF의 또 다른 작용의 가능성, 즉 cPLA2의 활성화(retrograde activation of cPLA2 by PAF)의 가능성을 검사하고자 하였다. 즉, cPLA2의 활성화에 따른 염증성 지질분자의 생성이 산소기의 생성과정을 증폭시키고 이 때 생성된 PAF가 역으로 cPLA2를 활성화시키는지를 확인하기 위하여 본 연구는 고안되었다. 방법: 흰쥐에서 급성폐손상을 유도하기 위하여 5μg의 PAF를 0.5 ml의 0.25% bovine serum albumin 용액과 혼합한 뒤 기도 내로 직접 분무하거나 0.5 ml의 4.5 mM의 과산화수소를 기도 내로 분무하였다. 대조군의 경우는 0.5 ml의 생리적 식염수를 기도 내로 분무하였다. 5 시간 후에 단백누출지수 측정, 폐장의 MPO 활성도 측정, 폐포세척액 내의 호중구 산정, CINC 측정, NBT 및 cyto-chrome-c 환원검사를 시행하였다. 또한 폐장 및 호중구에서의 cPLA2 활성도의 측정 및 광학현미경과 전자현미경을 이용하여 형태학적 관찰을 시행하였다. 결과: PAF투여 후 단백누출지수, MPO, BAL내의 호중구의 수 및 CINC의 농도가 대조군에 비하여 유의하게 증가하였다. NBT및 cytochrome-c환원검사의 결과 PAF는 호중구의 respiratory burst를 현저히 증가시키고, 분리된 사람의 호중구에서도 산소기의 생성을 현저히 증가시켰다. 동시에 PAF는 분리된 호중구 및 폐장의 cPLA2의 활성도도 증가 시켰다. 폐장 내로 투여한 과산화수소는 폐장의 cPLA2활성도를 대조군에 비하여 현저히 증가시켰다. 결론: cPLA2의 활성화에 따라 생성된 PAF는 호중구의 산소기 생성을 증가시켜 폐장 내의 산화성스트레스를 유발하고 동시에 이때 생성된 산화기는 cPLA2를 활성화시키며 PAF 또한 cPLA2의 활성도를 증가시켜 PAF가 급성호흡 곤란증후군의 병인론에 관여하는 것으로 생각된다. Background: The present investigation was performed in rats and isolated human neutrophils in order to confirm the presumptive role of the positive feedback loop of cytosolic phospholipase A2 (cPLA2) activation by platelet-activating factor (PAF). Methods: The possible formation of the positive feedback loop of the cPLA2 activation and neutrophilic respiratory burst was investigated in vivo and in vitro by measurement of the parameters denoting acute lung injury. In addition, morphological examinations and electron microscopic cytochemistry were performed for the detection of free radicals in the lung. Results: Five hours after intratracheal instillation of PAF (5μg/rat), the lung leak index, lung myeloperoxidase (MPO) activity, the number of neutrophils and the concentration of cytokine-induced neutrophil chemoattractant (CINC) in bronchoalveolar lavage fluid were increased by PAF as compared with those of control rats. The NBT assay and cytochrome-c reduction assay revealed an increased neutrophilic respiratory burst in isolated human neutrophils following exposure to PAF. Lung and neutrophilic cPLA2 activity were increased following PAF exposure and exposure to hydrogen peroxide increased cPLA2 activity in the lung. Histologically, inflammatory findings of the lung were observed after PAF treatment. Remarkably, as determined by CeCl3 cytochemical electron microscopy, increased production of hydrogen peroxide was identified in the lung after PAF treatment. Conclusion: PAF mediates acute oxidative lung injury by the activation of cPLA2, which may provoke the generation of free radicals in neutrophils. (Tuberc Respir Dis 2007;63:497-506)

직무만족도에 따른 임상간호사의 감정노동, 감정부조화, 소진이 이직의도에 미치는 영향

백지윤(Back, Chi-Yun),현대성(Hyun, Dae-Sung),장세진(Chang, Sei-Jin) 한국간호과학회 2017 Journal of Korean Academy of Nursing Vol.47 No.6

간질성 음영의 급격한 악화를 보인 림프관성 폐암종증 1예

정정,장재순,주현중,이상학,여동승,현대성,최영미,김석찬,이숙영,문화식,송정섭,박성학,Jung, Jung,Jang, Jae-Soon,Joo, Hyun-Jung,Lee, Sang-Haak,Yeo, Dong-Seung,Hyun, Dae-Seong,Choi, Young-Mee,Kim, Seok-Chan,Lee, Sook-Young,Moon, Hwa-Sik,Song 대한결핵및호흡기학회 2000 Tuberculosis and Respiratory Diseases Vol.48 No.6

호흡곤란과 마른 기침을 주소로 내원한 52세 여자 환자가 미만성 간질성 폐음영의 급속한 악화소견을 보이며 급성호흡부전으로 진행하여 입원 11일째 사망하였다. 입원 초기에 임상적 진단용 내리는데 어려움이 있었으나 기관지경을 통한 경기관지 폐생검상 선암의 림프관성 폐전이를 확진할 수 있었다. 저자들은 암을 아직 진단받지 않은 상태의 환자에서도 미만성 간질성 폐음영이 진행하는 경우 림프관성 폐암종을 감별진단으로 고려하여야 하며 경기관지 폐생검이 진단에 유용할 수 있을 것으로 생각한다. A 52-year-old woman was presented with 2-week history of increasing dyspnea and dry cough. The chest radiograph revealed bilateral reticular infiltrates. Radiographic infiltrates were rapidly progressed and symptoms from hypoxemia were aggravated. The patient was intubated and bronchoscopy with transbronchial lung biopsies was performed. Biopsies revealed lymphatic vessels plugged by nests of metastatic adenocarcinoma. She died 11 days after admission despite of intensive ventilatory support. We had difficulties in the diagnosis of lymphangitic lung carcinomatosis at initial presentation of her illness because the progression was unusually rapid. Lymphangitic lung carcinomatosis shoud should be included in the differential diagnosis of patients showing rapidly progressive interstitial radiographic findings. Also, transbronchial biopsy may be a useful tool to confirm the diagnosis.

대량 객혈환자에서 기관지 동맥색전술의 효과

여동승 ( Dong Seung Yeo ),이숙영 ( Suk Young Lee ),현대성 ( Dae Seong Hyun ),이상학 ( Sang Haak Lee ),김석찬 ( Seok Chan Kim ),최영미 ( Young Mee Choi ),서지원 ( Ji Won Suhr ),안중현 ( Joong Hyun Ahn ),송소향 ( So Hyang Song ) 대한결핵 및 호흡기학회 1999 Tuberculosis and Respiratory Diseases Vol.46 No.1

간장 ( 肝臟 ) 및 담도 ( 膽道 ) : 고령자에서 간질환의 임상적 고찰

배정동(Jung Dong Bae),최재진(Jae Jin Choi),현대성(Dae Sung Hyun),임달수(Dal Soo Lim),오성윤(Sung Yoon Oh) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.2

N/A Recently, aged patient admitted more frequently due to increased longevity and accessibility to medical center. This report is clinical review of 92 patients who were diagnosed as liver disease at the Department of Internal Medicine, Catholic Hospital from January, 1988 to December, 1990. The following results were obtained. 1) Liver cirrhosis was 67%, hepatoma was 29% type B hepatitis was 4%, and combined liver cirrhosis and hepatoma was 5%. 2) The male to female ratio was 1.5 : 1 in liver cirrhosis and 2 : 1 in hepatoma. 3) HBs antigenemia was 40%; in liver cirrhosis and 29% in hepatoma. 4) 50% of liver cirrhosis patients and 33% of hepatoma patients had history of alcohol drinking. 5) In liver cirrhosis, the symptoms and signs on admission were abdominal pain (45%), hematemesis (16%), and jaundice (14%), and in hepatoma, those were abdominal pain (74%) and weight loss (11%). 6) Overall hospital mortality was 41%. and the cause of death was hematemesis (6 cases) and hepatic encephalopathy (6 cases) in liver cirrhosis, and hepatic failure (15 cases) in hepatoma.