진행성 위암환자에 대한 Epirubicin , Cisplatin , 경구 UFT 및 Leucovorin 복합항암화학요법의 효과

김열홍(Yeul Hong Kim),전훈재(Hoon Jai Chun),현진해(Jin Hai Hyun),윤소영(So Young Yoon),서재홍(Jae Hong Seo),최철원(Chul Won Choi),김병수(Byung Soo Kim),목영재(Young Jae Mok),김종석(Chong Suk Kim),김준석(Jun Suk Kim) 대한내과학회 1999 대한내과학회지 Vol.56 No.6

N/A Objective : UFT plus leucovorin treatment had favorable activity and tolerable toxicity in patients with advanced stomach cancer. Recently, high response rates have been reported in patients with advanced stomach cancer with a schedule of epirubicin, cisplatin, and protracted infusion of 5-fluorouracil (5-FU). The advantage of long term oral administration of UFT is that this treatment might be used to mimic protracted infusions of 5-FU. Instead of inconvenience of infusion pump and intravenous catheter for protracted infusion of 5-FU, we administered UFT plus leucovorin in this treatment. Methods : Thirty-seven patients with locally advanced or metastatic stomach cancer received epirubicin, cisplatin, oral UFT plus leucovorin. Epirubicin 50 mg/m2 and cisplatin 60 mg/m2 were administered on day 1 by intravenous injection. UFT 360 mg/m2/day in conjunction with leucovorin administered at 25 mg/m2/day per os in divided daily doses for 21 days followed by a 7-day rest period. Courses were repeated every 4 weeks. The median age of the patients was 55 years with a median World Health Organization (WHO) performance status of 1. Patients received a median of four courses of treatment (range, 2 to 10). Results : Among 37 evaluable patients, two patients achieved complete response, and eighteen had partial responses, for an overall response rate of 54% (95% confidence interval; 39% to 70%). Stable disease was reported in 12 patients (32.5%) and another 5 (13.5%) showed disease progression. The median duration of survival was 10 months (range, 2 to 15+). The main toxicity was nausea/vomiting, leukopenia, diarrhea and oral mucositis. Significant toxicity (WHO grade 3 or 4) included leukopenia in fourteen patients (39.8%), nausea/ vomiting in eleven (29.7%), oral mucositis in five (13.5%), and diarrhea in four (10.8%) patients. Conclusion : We conclude that epirubicin, cisplatin, oral UFT plus leucovorin, a convenient out-patient regimen, has a significant activity in patients with stomach cancer and has tolerable toxicities.

소화성 궤양에 대한 Famotidine 의 임상적 효과

김열홍(Yeul Hong Kim),현진해(Jin Hai Hyun) 대한내과학회 1987 대한내과학회지 Vol.32 No.5

N/A The inhibitary efffect of gastric acid secretion and therapeutic efficacy of famotidine has been studied in peptic ulcer patients with endoscopieally diagnosed 29 cases of gastric ulcer and 26 eases of duodenal ulcer. The effect on gastric acid secretion was studied by measurement of peak acid output and gastric pH before and after the treatment and compare it with the results of the other H, receptor antagonist. Therapeutic efficacy was assessed by endoscopic evaluation of ulcers at 1,3,5,7 and 9 weeks after treatment. The results obtained were summarized as follows, 1) The basal and peak acid output of peptic ulcer patients was much higher than that of normal control group (p<0.01). 2) Ranitidine and famotidine inhibited peak acid output than cimetidine powerfully. 3) Fasting gastric pH levels produced after each treatment were significantly higher than those obtained when no medication was given and famotidine regimen maintained pH above 6.0 more reliable than ranitidine and cimetidine. 4) The cumulative rates of complete healing of gastric ulcer were 44.8% after 5 weeks, 82.8% after 7 weeks, and those of the duodenal ulcer were 88.5% after 5 weeks, 96.2% after 7 weeks. 5) The ulcer healing assessment score of the duodenal ulcer improved more rapidly than that of the gastric ulcer. 6) The improvement of pain score showed that the symptoms were relieved after 3 days of treatment in 76.2%, after 1 week of treatrnent in 83.7% in all cases. 7) There were no significant untoward reactions except 3 cases of mild transaminase elevation in liver function test, 3 cases of constipation and 2 cases of decreased libido. In conclusion famotidine is a potent H, receptor blocker of acid secretion with a long duration of action and famotidine appears to be fairly effective and safe for treatment of patient with peptic ulcer disease.

종설 : 진행성 위암 치료의 최근 동향

김열홍 ( Yeul Hong Kim ) 대한내과학회 2007 대한내과학회지 Vol.73 No.2

Despite its decreasing incidence, gastric cancer is the most common type of cancer in Korea. Surgical resection is the only therapeutic modality capable of cure and improvements in early diagnosis, preoperative assessment, and surgical techniques have increased the number of potentially curative resections over the last 20 years. However, despite of these improvements, survival of advanced gastric cancer has not been improved. Numerous trials of postoperative adjuvant chemotherapy or immunotherapy have been conducted with the hope of improving on the results of surgery alone. However, conclusive evidence of any survival benefit has been lacking. During the past few decades, the principle of combined-multimodality treatment has been developed and applied in practice for various solid tumors, including gastric cancer. This article reviews the current status of the postoperative adjuvant chemoradiatherapy and preoperative chemotherapy with or without radiotherapy in potentially resectable gastric cancer patients including discussion on the application in Korean gastric cancer patients. Issues such as the early assessment of metabolic changes in the tumor by PET was also addressed. Further clinical trials are needed to move towards better consensus and standardization of treatment.(Korean J Med 73:123-130, 2007)

상부소화관 소아내시경 226 예의 임상적 고찰

김열홍(Yeul Hong Kim),현진해(Jin Hai Hyun) 대한내과학회 1986 대한내과학회지 Vol.30 No.6

N/A During a period of 7 years and 10 months from January 1978 to October 1985, we performed upper gastrointestinal endoscopies to 226 pediatric patients under the age of 16. In general upper gastrointestinal endoscopy was performed with diazepam injection parenterally and topical pharyngeal anesthesia and commonly used instruments were GIF type P2 and GIF type P3 (Olympus Co.). Examined patients consisted of 146 boys and 80 girls. Age distribution was as follows; 3 patients between 6 months and 12 months, 14 patients, between 13 months and 5 years, 16 patients between 6 years and 10 years, and 193 patients between 11 years and 16 years. Most common chief complaint was abdominal pain and 30 patients took upper gastrointestinal endoscopy due to melena and hematemesis. Of 119 pathologic cases, 37 had duodenal ulcer, 24 had gastric ulcer, 24 had gastric ulcer, 24had erosive gastritis and 8 had foreign bodies.

액체생검 연구의 개념과 실제

김열홍 ( Yeul-hong Kim ) 대한간학회 2019 임상연구방법론워크숍 Vol.2019 No.1

임상강좌 : 대장의 진행암 - 항암치료가 필요한가?

김열홍 ( Yeul Hong Kim ) 대한내과학회 1999 대한내과학회 추계학술대회 Vol.57 No.-

rhGM-CSF(Leucogen^ⓡ)의 비감염성 상처 치유 효과에 관한 연구

한승규,김병수,김애리,서재홍,최철원,신상원,김열홍,김우경,김준석,Han, Seung Kyu,Kim, Byung Soo,Kim, Aeree,Seo, Jae Hong,Choi, Chul Won,Shin, Sang Won,Kim, Yeul Hong,Kim, Woo Kyung,Kim, Jun Suk 대한면역학회 2001 Immune Network Vol.1 No.1

Background: rhGM-CSF has been shown to enhance the migration and proliferation of endothelial cells and to promote keratinocyte growth. This study was tried to evaluate the effect of rhGM-CSF dressing on the uninfected wounds. Methods: Thirty Sprague-dawley white mice(250-300g) were selected in this study. The number of wound with the diameter of 5 mm, was 3 in left and 3 in right at the symmetric sites, respectively. The site of rhGM-CSF dressing was decided by a randomization. rhGM-CSF($Leucogen^{(R)}$) was diluted in the distilled water($5{\mu}g/mL$). The experimental wound group was dressed by l mL of distilled water mixed with rhGM-CSF and control wound group was dressed by l mL of distilled water. The dressing was done, every 24 hours. The criteria of comparison were the duration of wound healing duration, histologic findings and the bacterial culture of wound sites. Results: The duration of wound healing was $10.3{\pm}1.7days$ in experimental group and $10.2{\pm}2.8days$ in control group, without significant difference. There was no specific difference of histologic findings between both groups. The pathogen was not found, at all. Conclusion: It seems to be that rhGM-CSF has no prominent effect on the uninfected wound healing in the mice without immune suppression.

Behcet 식도 궤양

현진해(Jin Hai Hyun),김열홍(Yeul Hong Kim),송태진(Tae Jin Song),진윤태(Yoon Tae Jeen),박현철(Hyun Chul Park),김재선(Jae Seon Kim),박종재(Jong Jae Park) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.1

Behcet's disease is a multisystem disorder presenting with recurrent oral and genital ulceration as well as uveitis often leading to blindness. While intestinal Behcets disease most commonly affects the ileocecal region, esophageal involvement is v ry uncommon. A 42-year-old male patient was admitted to Haewha hospital because of dysphagia. There was a history of recurrent aphthous stomatitis and genital ulcers. Irregularly marginated ulcer surrounded with hyperermic edematous mucosa was found at mid esophagus in the gastrofiberscopic examination. The pathologic finding was chronic ulcerative inflammation with vasculitis. So he was diagnosed to have Behcet's disease and treated with steroid. We report a case of esophageal Behcet's disease which had been diagnosed by gastrofiberscopy and reviewed literature briefly.

통증 관리에 대한 의사와 간호사의 지식과 태도 비교

이은옥,허대석,김순자,김열홍,윤성수,권인각,조석구,박명희,박정윤,Lee, Eun-Ok,Heo, Dae-Seok,Kim, Soon-Ja,Kim, Yeul-Hong,Yoon, Sung-Soo,Kwon, In-Gak,Cho, Seok-Goo,Park, Myung-Hee,Park, Jung-Yoon 한국호스피스완화의료학회 1999 한국호스피스.완화의료학회지 Vol.2 No.1

목적 : 암환자에게 있어 통증은 삶의 질을 좌우하는 가장 중요한 증상이다. 현재의 통증 치료 방법 즉, 적절한 약물 치료 방사선, 마취, 신경차단 등의 방법으로 97%정도가 통증 조절이 가능함에도 불구하고, 여러 국내외 문헌에서는 암환자의 $60{\sim}70%$가 통증을 호소하고 있음을 보고하고 있다. 이에 이 연구에서는 의료진 측면에서 적절한 통증 치료의 장애가 되는 요인을 찾고, 진통제 및 암환자의 통증에 대한 잘못된 인식과 편견을 파악하여 보다 효과적인 교육프로그램을 개발하는 기초 조사를 마련하고자 한다. 방법 : 1998년 5월 1일부터 5월 31일까지 한달 동안 서울 시내에 있는 네개의 종합병원 내과에서 근무하고 있는 의사와 간호사를 대상으로 통증 관리에 대한 지식과 태도에 관한 도구를 수정한 32개 문항의 설문지를 통해 조사하였다. 설문의 내용은 통증 사정이 6문항, 진통제 투약이 5문항, 진통제 약물 작용이 8문항, 진통제 분류가 11문항, 그리고 진통제 투약 태도 2문항으로 이루어졌다. 결과 : 의사가 99명, 간호사가 152명이 참여하였으며, 전체 정답율은 의사가 71.6%, 간호사가 70.3%였다. 그러나, 그 중 진통제 분류에서는 80% 이상의 정답율을 보였으나 나머지에서는 대부분 $50{\sim}60%$정도의 정답율을 보이면서 통증 관리에 대한 낮은 지식 정도를 보여 주었다. 통증 사정에서는 간호사의 지식이 유의하게 높았으며, 진통제의 약리작용과 진통제 분류에서는 의사의 지식이 유의하게 높았다. 그러나, 전체 통증 관리에 대한 지식과 태도에 있어 의사 평균이 21.40이었으며, 간호사의 평균은 20.87로서 유의한 차이를 보이지 않았다. 결론 : 암환자 통증 관리에 대해 의료진의 지식 정도이 부족함이 나타났고, 이에 대한 적극적인 대안으로 의사와 간호사를 위한 교육프로그램 개발과 교육이 절실히 필요한데 일시적이고 일회적인 교육보다는 지속적이고 장기적이고 자동적으로 운영되는 체계가 필요하다. This survey was designed to evaluate knowledge and attitudes of physicians and nurses toward cancer pain management in South Korea and to compare physicians' knowledge and attitudes with nurses' Ninety-nine physicians and 152 nurses working at four major institutions in South Korea were included for the study. With the 30 items of the knowledge with true and false answers about cancer pain such as pain assessment(6 items), pharmacokinetics of opioids(8 items), analgesics classification(11 items), and drug administration(5 items), total score of knowledge answered by physicians was 21.40, which was not significantly higher than 20.87 answered by nurses. Rates of the correct answer were more than 70% in both physicians and nurses. Physicians were more knowledgeable in pharmacokinetics and analgesics classification than nurses, while nurses higher only in pain assessment than physicians. Since physicians and nurses could not effectively manage the cancer pain because of inappropriate knowledge, it is important to provide intensive education to physicians and nurses about cancer pain management.

혈액종양 : 엉덩허리근의 마비로 발현된 엉덩허리근으로 위암의 전이 1예

김혜숙 ( Hye Sook Kim ),강준혁 ( Jun Hyuk Kang ),이석영 ( Suk Young Lee ),장원진 ( Won Gin Chang ),오상철 ( Sang Cheul Oh ),김열홍 ( Yeul Hong Kim ),김준석 ( Jun Suk Kim ) 대한내과학회 2012 대한내과학회지 Vol.82 No.6

내원 2년 전 위암으로 근치적 위전절제술 및 보조항암치료 후 질환의 재발로 완화 목적의 항암화학치료 중이던 환자가 아래허리와 왼쪽 허벅지의 통증의 증상으로 내원하여 자기공명 영상 및 조직검사를 통해 근육으로 위암전이를 진단하였다. 영상적 검사 및 조직검사를 통한 진단으로 적극적인 국소 치료 및 전신항암치료를 통해 증상 조절을 할 수 있었던 사례를 경험하였기에 문헌고찰과 함께 보고한다. Advanced gastric cancer with skeletal muscle metastasis is a rare occurrence. Here, we report a rare case of gastric carcinoma with psoas muscle metastasis. This patient had advanced gastric carcinoma and complained of inability to extend the left hip joint due to pain. Because magnetic resonance imaging (MRI) revealed an iliopsoas mass showing heterogeneous signal intensity with fluid collection and enhancement around the mass, we speculated that the mass was an intramuscular metastatic tumor from primary gastric carcinoma as well as an intramuscular abscess. Histopathologically, the patient had a metastasis from primary gastric adenocarcinoma. Therefore, the patient was treated with radiotherapy and subsequent chemotherapy.