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( Huapyong Kang ),( Tak Geun Oh ),( Moon Jae Chung ),( Jeong Youp Park ),( Seung Woo Park ),( Si Young Song ),( Jae Bok Chung ),( Seung Min Bang ) 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1
Background: Concurrent chemoradiotherapy (CCRT) is a standard therapeutic option for managing locally advanced pancreatic cancer (LAPC). Although 5-Fluorouracil (5-FU) or gemcitabine are recommended as the reference chemotherapeutic agent for CCRT, the optimal dosage for CCRT is still controversial. Aim: To compare the therapeutic efficacy and tolerability of full-dose gemcitabine based CCRT (FG-CCRT) and low dose 5-FU based CCRT (5FU-CCRT) for LAPC. Methods & Materials: From January 2006 to March 2013, 110 patients with LAPC who received FG-CCRT (n=90) or 5FU-CCRT (n=20) were included for retrospective analysis. FG-CCRT included full-dose weekly gemcitabine monotherapy (1000 mg/m2) or combination therapy with cisplatin (70 mg/m2). 5FU-CCRT treated with radiosensitizing low dose of bolus 5-FU (500mg/m2, weekly) plus leucovorin (20mg/m2). Concurrent radiotherapy targeted the primary tumor with 5 to 10 mm margin without regional lymph node irradiation. One month after completion of CCRT, response evaluation was conducted by computed tomography scan. Results: FG-CCRT had more advanced T-stage at the time of diagnosis (T4-86.7% versus 60.0%; p=0.005). Objective response rate (ORR) and disease control rate (DCR) was significantly higher for FG-CCRT than 5FU-CCRT (ORR-32.6% versus 5%; p=0.013; DCR-79.8% versus 50.0%; p=0.006). Both groups showed similar loco-regional control rate (92.2% versus 85.0%; p=0.362) but distant metastasis rate was higher in 5FU-CCRT (17.8% versus 45.0%; p=0.017). Grade 3 or higher neutropenia (34.4% versus 10%; p=0.031) and thrombocytopenia (21.1% versus 0%; p=0.021) was more frequent in FG-CCRT. The subgroup of FG-CCRT patients who received gemcitabine monotherapy showed no significant differences in toxicity rate compared with 5FU-CCRT (all p>0.05). Conclusion: Full-dose gemcitabine based CCRT seems more effective on initial local and distant control of LAPC than bolus 5-FU based CCRT. With cautious monitoring on hematologic toxicities, FG-CCRT can be tolerably conducted. Considering that distant metastasis is one of treatment failure pattern in CCRT of LAPC, full-dose gemcitabine CCRT should be considered as the first line treatment.
( Eun Hye Kim ),( Huapyong Kang ),( Hyunsoo Chung ),( Jun Chul Park ),( Sang Kil Lee ),( Yong Chan Lee ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: The aim of this study was to assess the effects of Helicobacter pylori status on pepsinogen (PG) concentration for atrophic gastritis and whether gastric atrophy based on the PG test would be improved after H. pylori eradication. Methods: We prospectively enrolled patients who would undergo upper endoscopy for dyspepsia. Clinical data including patient demographics, H. pylori infection status, and initial PGI and PGII concentration were collected. In patients who underwent H. pylori eradication, PGI and PGII concentration was re-checked after 6 months from the eradication. Results: We prospectively enrolled patients who would undergo upper endoscopy for dyspepsia. Clinical data including patient demographics, H. pylori infection status, and initial PGI and PGII concentration were collected. In patients who underwent H. pylori eradication, PGI and PGII concentration was re-checked after 6 months from the eradication. Conclusions: Serum PG concentration was associated with H. pylori infection status. Atrophic gastritis based on the PG test was improved after the H. pylori eradication. Serum PG I/II ratio could be potential biomarkers for H. pylori-infected gastric disease in Korea.
Jo, Jung Hyun,Kang, Huapyong,Lee, Hee Seung,Chung, Moon Jae,Park, Jeong Youp,Bang, Seungmin,Park, Seung Woo,Song, Si Young Elsevier 2019 Hepatobiliary & pancreatic diseases international Vol.18 No.1
<P><B>Abstract</B></P> <P><B>Background</B></P> <P>Sodium meta-arsenite (NaAsO<SUB>2</SUB>, KML001) is a potential oral anticancer agent acting on telomerase and telomere length. This prospective study evaluated its safety, tolerability, and effectiveness as salvage chemotherapy in patients with advanced biliary tract cancer (BTC) resistant to gemcitabine-based chemotherapy.</P> <P><B>Methods</B></P> <P>Forty-four patients (21 women and 23 men) with advanced BTC and failure history of gemcitabine-based chemotherapy, performance status (PS) 0–2, normal cardiac, hepatic, and renal function were enrolled. Daily dose of KML001 (7.5 mg. p.o.) was administered to eligible subjects for 24 weeks divided into six treatment cycles. Response was evaluated bimonthly using CT.</P> <P><B>Results</B></P> <P>After an average of 1.5 months of treatment (range: 0.5–10.0), 3 patients (6.8%) obtained progression-free status, 23 patients (52.3%) had disease progression, and 18 patients (40.9%) dropped out before evaluation. One patient (2.3%) completed six treatment cycles without progression. During the treatment, morphine dosage kept the same or decreased in 20 patients (47.6%). Nine patients (20.5%) experienced grade-3 adverse events (AEs), while no patient experienced grade-4 AEs. The most common AEs were liver enzyme elevation (11/44, 25%) and anemia (10/44, 22.7%). KML001 was discontinued in six patients (13.6%) due to AEs, including liver toxicity (<I>n </I>= 3), QTc prolongation (<I>n </I>= 2), and abdominal pain (<I>n </I>= 1).</P> <P><B>Conclusions</B></P> <P>KML001 did not have enough anticancer effect on patients with advanced BTC resistant to gemcitabine. However, KML001 was safe and well-tolerable in terms of AEs and pain control when used as salvage therapy. Further studies are needed to establish arsenic agents as a reliable treatment option in patients with BTC.</P>
Biliary Obstruction Caused by Non-Hodgkin Lymphoma Involvement: A Case Report
Jae Hyun Lim,Huapyong Kang,Jung Hyun Jo,Hee Seung Lee,Jeong Youp Park,Seungmin Bang,Seung Woo Park,Si Young Song,Moon Jae Chung Korean Society of Gastrointestinal Cancer 2018 Journal of digestive cancer reports Vol.6 No.1
Non-Hodgkin's lymphoma is known to be a rare and unusual cause of biliary obstruction. We report a case of biliary obstruction that a 25-year-old male showed icteric sclera and yellow discoloration of his skin caused by metastasis of non-Hodgkin lymphoma. Initial imaging & endoscopic work-up led us to an impression of either cholangiocarcinoma or IgG4-related disease, yet the pathological results weren't diagnostic. Through our thorough re-examination, we found a 5cm sized round, fixed, non-tender sternal mass, and additional imaging studies were suggestive of lymphoma, which was also consistent with the results of incisional chest wall biopsy. Biliary obstruction by lymphoma was successfully treated by endoscopic plastic stent insertion procedure and chemotherapy. Although it is widely accepted that lymphoma accounts for very few portion of malignant biliary obstruction, due to the fact that lymphoma and cholangiocarcinoma are often indistinguishable, careful diagnostic approach should be done.
내시경역행담췌관조영술로 치료한 성인의 유전성 구상적혈구증에 의한 담도염
박태영 ( Tae Yeong Park ),전제혁 ( Jae Hyuck Jun ),강화평 ( Huapyong Kang ),도영석 ( Young Seok Doh ),장지웅 ( Ji Woong Jang ),백일현 ( Il Hyun Baek ),정성희 ( Sung Hee Jung ) 대한췌장담도학회 2020 대한췌담도학회지 Vol.25 No.2
유전성 구상 적혈구증은 적혈구 골격 형성 장애로 인하여 황달과 빈혈을 유발할 수 있는 질환이다. 국내 영유아 검진 및 국가예방접종사업 등으로 인하여 대부분 성인이 되기 전에 병의 진단 및 치료가 잘 이루어지고 있다. 하지만 빈혈, 비장종대를 동반한 성인 환자에서 간경변증의 증거 없이 간수치 상승이 동반되는 경우는 드물지만 유전성 구상 적혈구증 또한 감별진단에 포함시켜야 하며, 담관결석에 대한 가능성을 염두에 두어야 한다. Hereditary spherocytosis is a disease caused by deficiency of erythrocyte lipid membrane protein. Hereditary spherocytosis shows hemolysis of erythrocyte, and it leads to anemia, jaundice by elevation of indirect bilirubin. Almost of patients are diagnosed in their infancy, and can be cured by splenectomy about their age 6-7. Herein, we report a rare case of 33-year-old male was suffered from gallbladder stone and cholangitis those are thought to be the late complications of hereditary spherocytosis. We performed endoscopic retrograde cholangiopancreaticography to remove common bile duct stones. After he got cholecystectomy and splenectomy, there was no recurrence of choledocholithiasis. This is the first case in Korea who didn’t undergo splenectomy until grown up, shows cholangitis as a late disease manifestation of hereditary spherocytosis.
Cho Jae Hee,Kim Jaihwan,Lee Hee Seung,Ryu Su Jeong,Jang Sung Ill,Kim Eui Joo,Kang Huapyong,Lee Sang Soo,Song Tae Jun,Bang Seungmin 거트앤리버 소화기연관학회협의회 2024 Gut and Liver Vol.18 No.1
Background/Aims: Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) is essential in diagnosing solid pancreatic lesions (SPLs), but without rapid on-site evaluation (ROSE), a repeat EUS-FNA/B is crucial for clarifying an inconclusive diagnosis. We aimed to evaluate factors associated with improved diagnostic performance of repeat EUS-FNA/B for initially inconclusive SPL diagnoses without ROSE. Methods: Of 5,894 patients subjected to EUS-FNA/B, 237 (4.0%) with an initially inconclusive diagnosis of SPLs were retrospectively enrolled from five tertiary medical centers between January 2016 and June 2021. Diagnostic performance and procedural factors of EUS-FNA/B were analyzed. Results: The diagnostic accuracies of first and repeat EUS-FNA/B were 96.2% and 67.6%, respectively. Of 237 patients with an inconclusive diagnosis from initial EUS-FNA/B, 150 were pathologically diagnosed after repeat EUS-FNA/B. In multivariate analysis of repeat EUS-FNA/B, tumor location (body/tail vs head: odds ratio [OR], 3.74; 95% confidence interval [CI], 1.48 to 9.46), number of needle passes (≥4 vs ≤3: OR, 4.80; 95% CI, 1.44 to 15.99), needle type (FNB vs FNA: OR, 3.26; 95% CI, 1.44 to 7.36), needle size (22 gauge vs 19/20 gauge: OR, 2.35; 95% CI, 1.19 to 4.62), and suction method (suction vs others: OR, 5.19; 95% CI, 1.30 to 20.75) were associated with a significantly improved diagnostic performance. Conclusions: Repeat EUS-FNA/B is essential for patients with an inconclusive EUS-FNA/B without ROSE. To improve the diagnostic performance of repeated EUS-FNA/B, it is recommended that 22-gauge FNB needles, ≥4 needle passes, and suction methods are used.