진행성 악성종양별 맞춤 항암요법의 최신 지견 ; 진행성 유방암의 맞춤 항암요법의 최신 지견

정경해 ( Kyung Hae Jung ) 대한내과학회 2009 대한내과학회지 Vol.77 No.1

유방암은 우리나라 여성에서 두 번째로 흔히 발생하는 암으로 근치적 치료 후 많은 환자에서 재발한다. 전이성 유방암은 비교적 항암요법에 반응이 좋고 중앙 생존기간도 약 2~3년으로 길지만 완치는 어렵다. 현재 임상에서 사용되는 전이성 유방암의 치료에는 호르몬치료, 항HER2 요법 및 항암화학요법이 있는데, 재발한 환자의 임상적 상태와 암의 특성에 따라 각 치료방법에 대한 반응을 예측하고 치료법의 독성을 고려함으로써, 치료의 부작용은 최소화하면서 생존기간을 향상시키고 삶의 질을 향상시킬 수 있다. 호르몬 수용체와 HER2 과발현 여부는 치료에 대한 반응 예측에 가장 중요한 인자로 원발성 유방암은 물론 전이암에서 다시 검사하는 것이 추천된다. 호르몬치료는 부작용이 적어 호르몬 수용체 양성인 환자에서 일차치료로 추천된다. 그간 tamoxifen이 호르몬치료의 근간을 이루었으나, 최근 폐경 후 여성에서 3세대 아로마타제 억제제의 우수성이 입증되면서 더 선호되고 있다. 호르몬치료에 반응한 환자는 다음 호르몬치료에 반응할 확률이 높으며 호르몬치료에 반응하지 않는 환자, 호르몬 수용체 음성인 환자와 급격히 진행하는 전이성 유방암에서는 항암화학요법이 추천된다. Trastuzumab은 전이성 HER2 양성 환자의 일차 치료제로 항암제와 병용하는 것이 표준치료이며, lapatinib은 trastuzumab 치료에 실패한 환자에서 효과가 입증되어 사용되고 있다. In Korea, breast cancer is the second common cancer in women and many patients suffer from metastatic disease after surgery and adjuvant therapy. Metastatic breast cancer is unlikely to be cured, but it is possible to choose therapeutic options according to clinical factors and tumor biology to avoid unnecessary toxicity and improve efficacy. Hormone receptors and HER2 status are the most important predictive factors and should be evaluated in all breast cancers. Hormonal treatment is preferred for initial treatment of hormone receptor positive metastatic breast cancer due to its more favorable side effect profile. Tamoxifen has been the mainstay of hormonal treatment. However, new aromatase inhibitors challenge tamoxifen as the first line therapy in postmenopausal women. Trastuzumab with conventional chemotherapy is the standard of care in patients with strong overexpression of HER2 and lapatinib is active after trastuzumab failure. (Korean J Med 77:26-34, 2009)

노령환자 폐암의 임상적 특징

정경해 ( Kyung Hae Jung ) 대한결핵 및 호흡기학회 1999 Tuberculosis and Respiratory Diseases Vol.47 No.5

모바일 응용프로그램을 이용한 유방암 환자의 삶의 질 측정 초기연구

윤소영,이종원,정경해,김정은,이재호,이건아,안세현,신용욱,Youn, So Young,Lee, Jong Won,Jung, Kyung Hae,Kim, Jeong Eun,Lee, Jae-Ho,Lee, Guna,Ahn, Sei Hyun,Shin, Yong-Wook 대한불안의학회 2013 대한불안의학회지 Vol.9 No.2

Objective : As treatments for breast cancer require long period of time, the patients need continuous monitoring and management of their health related quality of life. The purpose of this preliminary study is to explore the utility of monitoring quality of life using a mobile phone based application, which was developed to enable the patients to report daily quality of life more efficiently. Methods : Department of psychiatry, breast cancer center and U-health team of Asan Medical Center collaborated in developing a mobile application titled 'DugunDugun'. Through the application, patients with breast cancer receiving neo-adjuvant chemotherapy could report on various questions about their daily quality of life. We extracted and explored the daily basis of the data of sleep duration, number of awake, sleep satisfaction, mood and anxiety from nine patients who reported on the questionnaire for more than a month. Results : The longitudinal data collected using our mobile application well represented the characteristics of individual sleep patterns and daily emotional changes. Most of the patients showed high daily variations in the scores of their quality of life while their averaged scores were similar among patients. The patient with highest daily variations in the subjective sleep quality and daily emotional change had highest score corresponding to moderate depression in Beck Depression Inventory (BDI). Conclusion : The results suggest that mobile application could be a useful tool for monitoring and collecting the daily quality of life in the patients with breast cancer. We expect that mobile application could facilitate early detection and proper intervention for the cancer patients at psychological crisis.

폐경기모델 백서 해마에서 식물성 에스트로젠에 의한 뇌-혈액장벽 유전자 occludin 발현의 변화

강한승 ( Han Seung Kang ),정경아 ( Kyung Ah Jung ),강희정 ( Hee Jung Kang ),김다혜 ( Da Hye Kim ),안혜선 ( Hae Sun Ahn ),엄애선 ( Ae Sun Om ),계명찬 ( Myung Chan Gye ) 한국환경생물학회 2006 환경생물 : 환경생물학회지 Vol.24 No.2

청소년기 리듬체조 선수들의 영양소 및 식품 섭취 상태와 영양지식

황세희(Hwang Se-Hee),정경아(Jung Kyung-Ah),김찬(Kim Chan),안해철(Ahn Hae-Chul),장유경(Chang Yoo-Kyung) 韓國營養學會 2004 Journal of Nutrition and Health Vol.37 No.6

직장암의 방사선치료

김대용 ( Dae Yong Kim ),정경해 ( Kyung Hae Jung ) 대한소화기학회 2006 대한소화기학회지 Vol.47 No.4

혈청학적 방법을 이용한 결핵 진단 방법의 효용성

김덕겸,권성연,이석영,박계영,정경해,이춘택,유철규,김영환,한성구,심염수,Kim, Deog-Kyeom,Kwon, Sung-Youn,Lee, Suk-Young,Park, Gye-Young,Jung, Kyung-Hae,Lee, Chun-Taek,Yoo, Churl-Gyoo,Kim, Young-Whan,Han, Sung-Koo,Shim, Yong-Soo 대한결핵및호흡기학회 1999 Tuberculosis and Respiratory Diseases Vol.47 No.5

연구배경: 객담 도말 및 배양 검사나 방사선학적 검사 등의 기존의 결핵 진단 방법은 낮은 민감도와 진단까지 소요되는 기간이 길다는 단점이 있어서 결핵의 조기 진단 및 치료에 제한점이 있었다. 최근에 혈청학적 진단 방법의 하나로 개발된 immunochromatographic assay 기구들이 소개되고, 외국에서 비교적 높은 진단율를 보여, 결핵 유병율이 높은 국내에서 그 유용성을 평가하고, 질병 양상에 따른 차이점을 조사하여, 기존의 결핵 진단 방법들의 문제점을 해결할 수 있는지 알아보고자하였다. 연구방법: 환자군을 폐결핵 환자군(36명), 폐외결핵 환자군(3명) 및 두 가지 모두 이환된 군(22명)으로 나누었으며, 대조군은 과거 결핵 병력이 있는 비활동성 결핵환자(17명), 결핵이외의 폐질환자(16명) 및 폐질환이 없는 심장 환자(14명)를 대상으로 38kDa 항체를 포함한 ICT tuberculosis 또는 BioSign$^{TM}$TB를 이용하여 혈청화적 검사를 시행하였다. 결 과: ICT tuberculosis를 사용한 경우, 환자군 56명 및 대조군 47명에 대하여 64.3%의 민감도 및 91.5%의 특이도를 나타내었으며, 폐결핵만 있는 환자군에서 76.5%의 민감도를 보여, 폐외 결핵만 있는 환자군(33.3%)나 두 가지 모두 이환된 군(47.4%)에 비하여 더 높은 민감도를 나타내었다(p=0.039). BioSign$^{TM}$TB를 이용한 경우, 환자군 43명 및 대조군 43 명에 대하여 74.4%의 민감도 및 95.3%의 특이도를 보였으며, 폐질환이 없는 환자군에서는 100%의 특이도를 나타내었다. 환자군중에서 초발환자 및 과거 폐결핵 병력이 있는 환자군 사이에는 민감도에 차이가 없었으며, 공동성 폐결핵 환자와 비공동성 폐결핵 환자사이에 검사상 민감도 차이는 통계적으로 유의하지 않았다(73.3% vs. 69.6%, p>0.05). 결 론: 혈청학적 방법의 하나인 immunochromatographic assay 기구는 높은 특이도와 양성 예측도를 보여 임상적 유용성이 기대되나, 상대적으로 낮은 민감도와 음성 예측도를 고려할 때, 단독 사용보다는 기존 방법과의 상보적 사용이 결핵진단에 더 도움이 될 것으로 생각된다. Background: Many diagnostic tests have developed to diagnose tuberculosis and other mycobacterial diseases but the diagnosis of tuberculosis relies largely on radiological findings and acid-fast staining of sputum and/or culture. Recently, new serologic diagnostic methods, which are safe and easy to use have been introduced into Korea. In this study, the usefulness of serologic diagnosis for tuberculosis and the disease pattern induced variation of the test were evaluated. Methods: Serological assay was performed upon 108 patients with two test kits, the ICT tuberculosis and the BioSign$^{TM}$TB, which are based upon a rapid immunochromatographic assay technique, capable of being interpreted within 15 minutes. The case groups consisted of 61 patients with active pulmonary tuberculosis(36 patients), extrapulmonary tuberculosis(3 patients), or both(22 patients). Control groups consisted of 47 patients with inactive old pulmonary tuberculosis(17 patients), nontuberculous pulmonary disease(16 patients) and nonpulmonary cardiac disease(14 patients). Results : The diagnostic sensitivity, specificity, positive predictive value(PPV) and negative predictive value(NPV) of the ICT tuberculosis were 64.3%, 91.5%, 90.0% and 68.3% respectively. The diagnostic sensitivity, specificity, PPV and NPV of the BioSign$^{TM}$TB were 76.5%, 95.3%, 94.1 % and 78.8% respectively. Differences in sensitivity were not significant between patients with previous history of tuberculosis or patients without prior history of tuberculosis. The ICT tuberculosis test showed higher sensitivity in pulmonary tuberculosis patients(76.5%) than extrapulmonary tuberculosis patients(33.3%). There was no difference in sensitivity between patients with or without cavitary lesion by chest X-ray. Conclusion: Considering high specificity and PPV, serologic diagnosis using a rapid immunochromatographic assay device is another helpful diagnostic method in the diagnosis of tuberculosis, when combined with previous diagnostic methods such as chest X-ray, microbiologic study but it has limitation in terms of confirming the diagnosis for tuberculosis as the only diagnostic method because of relatively low sensitivity and NPV.

한국의 전문물리치료사제도에 대한 물리치료사와 물리치료학과학생들의 인식도 조사

박혜진 ( Hye Jin Park ),정경옥 ( Kyoung Ok Jung ),경성훈 ( Sung Hun Kyung ),이해정 ( Hae Jung Lee ) 대한물리의학회 2010 대한물리의학회지 Vol.5 No.1

Purpose:The purpose of this study is to know the attitude and beliefs of physical therapists (PTs) and students (Ss) who major in physical therapy about the system of physical therapy specialists in Korea. Methods:Data were collected from 74 clinical physical therapists who work for hospitalsand clinics and 151 physical therapy students who had finished their clinical trainings. A questionnaire was used, and consisted of a general survey part, 4 items on the necessity of the system, 11 items on the operation of the system, and 2 items on the expected effect of the system. The composed items were Korean physical therapists` attitudes towards the system, such as the necessity and the reasons, the standard of qualification, the preferred professional areas, and expected effects of the system. Results:The affirmative response to the items, the necessity of the system of physical therapy specialists, showed 87.9% in physical therapists and 87.5% in students. The responded PTs believed that the system could improve the standard treatment (67.6%) and expanding fields of physical therapy (22.1%). However, students did not quite agree to them with 43.6% and 31.1% responded respectively. The most needed specific areas of physical therapy specialty were the musculoskeletal occupied 95.6% with PTs and 87.2% with students, neurology 95.6% in PTs(students: 92.6), pediatrics 89.1% in PTs(students: 85.8%), geriatrics 75.4% in PTs(students: 73.6%), cardiopulmonary 75.0%in PTs (students: 71.6%). 76.8% of respondents commenced that it could be possible to open a center independently and 94.2% of respondents expected to improve the condition of patients by executing the system of physical therapy specialists. Conclusion:Korean PTs and students believed to improve the patient`s condition and expand areas of physical therapy by execution of the system of physical therapy specialists.

Chaotic 동역학 시스템의 모델 추종 궤환제어에 관한 연구

김정도(Jeong do-Kim),정도영(Do young-Jung),임해진(Hae jin-Lim),정경채(Kyung chae-Jeong) 대한전자공학회 1995 대한전자공학회 학술대회 Vol.1995 No.6

HBV 에 의한 후괴사성 간경화환자들에서 조영 심초음파도를 이용한 폐내 단락에 관한 연구

이재호(Jae Ho Lee),이경미(Kyung Mi Lee),조주희(Joo Hee Zo),이동호(Dong Ho Lee),정경해(Kyung Hae Jung),김원배(Won Bae Kim),이국래(Kook Lae Lee),김철호(Cheol Ho Kim),정희순(Hee Soon Chung) 대한내과학회 1998 대한내과학회지 Vol.54 No.6

N/A Background: Liver cirrhosis is a common disease and mainly postnecrotic by the infection of hepatitis B virus (HBV) in Korea, and arterial hypoxemia is not a rare finding in liver cirrhosis. But there were few studies about hepatopulmonary syndrome which is defined as liver dysfunction, hypoxemia and intrapulmonary vascular dilatation, and one of the causes of arterial hypoxemia. Method: We examined the presence of dyspnea and stigmata of chronic liver disease in 35 patients who were diagnosed as Child class C, liver cirrhosis by HBV and had no evidence of intrinsic cardiopulmonary disease at Seoul Municipal Boramae Hospital (from January 1996 to October 1996). To diagnose hepatopulmonary syndrome, contrast-enhanced echocardiography was done for detecting intrapulmonary shunt in association with pulmonary function test, arterial blood gas analysis, chest roentgenogram and EKG. Result: 1) Twenty nine patients (82.9%) complained of exertional dyspnea, and the six from these patients also complained of resting dyspnea. Tachypnea was observed in 15 patients (42.9%/normal respiration rate defined as 12 to 16 per min), while platypnea was not found. 2) Splenomegaly and ascites were universal findings in all while clubbing of finger and cyanosis were observed in only 1 case (2.9%) and 2 cases (5.7%), respectively, and esophageal varix was found in the thirty two (91.4% / grade I in 9, grade II in 20 and grade III in 3 patients). Spider angioma was observed in the twenty one (70.0% among 30 patients). 3) Seven patients (20.0%) showed mild ventilatory defect of restrictive type since forced vital capacity decreased to 65-79% of predicted value. Diffusing capacity for carbon monoxide decreased below 70% of predicted value in 4 patients (11.4%). In addition, there were small amount of pleural effusion in 5 patients (14.3%) and nonspecific arrhythmia in 3 patients (8.6%). 4) Six cases (17.1%) had intrapulmonary shunt, which showed significantly lower arterial oxygen tension (72.2±15.1 vs 90.2±7.4 mmHg, p<0.05) and increased alveolar- arterial oxygen difference (43.1±16.2 vs 22.4±7.4 mmHg, p<0.05). 5) Only the cyanosis had a significant correlation with intrapulmonary shunt. Conclusion - 1) Intrapulmonary shunt was detected by contrast- enhanced echocardiography in the six from 35 cases of Child class C, liver cirrhosis by HBV 2) But only two patients of six positive intrapulmonary shunt patients showed significant hypoxemia (PaO2<70mmHg). Our results suggest that subclinical hepatopulmonary syrdrome may be exist.