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장폐쇄 증상 있는 절제 불가능한 4기 대장암 환자에서 완화 치료 이후의 장기 성적 비교: 자가팽창금속스텐트 대 수술
유홍열 ( Hong Yeol Yoo ),박지원 ( Ji Won Park ),김병창 ( Byung Chang Kim ),손대경 ( Dae Kyung Sohn ),홍창원 ( Chang Won Hong ),박성찬 ( Sung Chan Park ),최효성 ( Hyo Seong Choi ),오재환 ( Jae Hwan Oh ) 대한임상종양학회 2011 Korean Journal of Clinical Oncology Vol.7 No.2
목적(Purpose): 본 연구의 목적은 장폐쇄 증상이 있는 완전절제가 불가능한 4기 대장암 환자에서 완화 목적의 자가팽창금속스텐트를 시술한 경우와 완화 목적으로 수술을 시행한 경우의 장기 임상 성적을 분석하는 것이다. 대상 및 방법(Methods): 2002년 1월부터 2010년 5월까지, 완화 스텐트 삽입(n = 88)과 완화 수술을 시행한(n = 96)환자들을 대상으로 스텐트 삽입 및 수술의 성공률, 합병증, 재원기간, 합병증 발생까지의 기간, 항암치료까지의 기간, 전체 생존률을 분석하고, 생존률과 관련한 예후인자를 평가하였다. 결과(Results): 스텐트군의 초기 합병증은 수술군보다 낮았으나(26.1% vs 47.9%, P = 0.002), 후기 합병증과 주요 합병증 발생률이 더 많았다(P < 0.05). 또한, 스텐트 시술 후 발생하는 장관련 합병증의 비율은 수술군보다 더 많았다(P = 0.037). 수술군에서의 전체 생존기간 중앙값은 스텐트군보다 더 높았고(15.7개월 vs. 9.1개월), 시술 또는 수술 후 합병증으로 인해 추가로 치료를 받아야 하는 경우도 스텐트군에서 많았다(P <0.001). 결론 (Conclusions): 스텐트 삽입은 상대적으로 덜 침습적이며 빠른 증상 호전을 기대할 수 있다. 그러나, 완화 목적의 스텐트 삽입은 완화 수술 보다 후기 합병증 발생 빈도가 높아 환자의 원발 병소, 증상 정도, 등의 환자 상태를 고려하여 적절한 완화치료를 고려할 필요가 있다. Purpose: The aim of this study was to compare the long-term outcomes and the efficacy between palliative self-expanding metal stent (SEMS) and palliative surgery in unresectable stage IV patients with obstructive symptoms. Methods: Patients with symptomatic unresectable stage IV colorectal cancer who underwent insertion of SEMS (n = 88) or palliative surgery (n = 96) from January 2002 to May 2010 was included in the analysis. The success rates, complications, hospital day, time from treatment procedure to chemotherapy, and the overall survival were compared between the two groups. The independent factors related with overall survival were assessed. Results: Early complication rate in the SEMS group was lower than in the surgery group (26.1% vs 47.9%, P = 0.002). However, the SEMS group had a higher late complication rate and major complication rate than the surgery group. (P < 0.05). The percentage of bowel complications after procedure and additional procedures after complications in the SEMS group were higher than in the surgery group (P = 0.037). The overall survival in the surgery group was higher than in the SEMS group (median 15.7 months vs. 9.1 months), and more patients had to receive additional treatment due to complications in the SEMS group (P< 0.001). Conclusion: SEMS therapy has been considered as relatively simple and less invasive treatment. However, it has more late complications and lower overall survival rates. Therefore, palliative treatment should be applied more carefully considering the site of tumor, symptoms and the status of the patient.
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전이성 대장암 환자에서 Bevacizumab을 사용 후 대장 내시경으로 확인된 허혈성 대장염 1예
이혜인 ( Hye In Lee ),김병창 ( Byung Chang Kim ),김선영 ( Sun Young Kim ),한경수 ( Kyung Su Han ),홍창원 ( Chang Won Hong ),손대경 ( Dae Kyung Sohn ),장희진 ( Hee Jin Chang ) 대한내과학회 2017 대한내과학회지 Vol.92 No.3
베바시주맙은 여러 고형암 치료를 위해서 사용되고 있는 혈관 내피세포 단일클론 항체이다. 베바시주맙은 기존 화학 요법제 보다 낮은 빈도로 부작용을 보이지만, 소화관 천공은 매우 치명적인 부작용이다. 베바시주맙 관련 소화관 천공은 장관내 혈관 구조의 손상과 관련이 있다. 그러나 허혈성 장염은 비특이적으로 증상을 보여서 증상만으로 진단이 어려운 질환이다. 우리는 베바시주맙으로 치료받고 대장 내시경과 병리학적으로 확인된 허혈성 장염으로 진단되었고, 일반적인 지지요법을 통해서 호전된 56세 여자 환자 증례를 보고 합니다. Bevacizumab is a monoclonal antibody against vascular endothelial growth factor widely used to treat several types of solid tumor. Although bevacizumab has fewer adverse effects than conventional chemotherapy agents, several serious events have been reported. Gastrointestinal perforation is an infrequent but potentially fatal side-effect of bevacizumab. The major mechanism of bevacizumab-associated gastrointestinal perforation is damage to the intestinal vasculature. However, preceding ischemic colitis is difficult to diagnose due to its non-specific symptoms. We report a case of a 56-year-old male with bevacizumab-associated ischemic colitis proven by colonoscopy and pathologic findings. The patient`s condition improved after general supportive care including bowel rest, intravenous fluids, and intravenous antibiotics. No similar event has been reported since he resumed chemotherapy without bevacizumab. (Korean J Med 2017;92:312-315)
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홍정표,최선희,김형권,강남욱,강창원,이은아,양윤식,오성욱,박무정,조만종,정연재 대한내과학회 1996 대한내과학회지 Vol.50 No.1
Subacute necrotizing lymphadenitis(SNL) is first described in 1972 by Kikuchi and Fujimoto independently, which has benign clinical course with characteristic histologic features. The etiology is unknown but clinical and histological features suggest an infectious agent, which has not been identified. The resemblance of lymph node lesions to those of systemic lupus erythematosus has suggested an autoimmune process. We report a case of a 24-year-old woman who presented with cervical lymphadenopathy, fever, cough and pulmonary lesion in chest x-ray. The histopathological features of the lymph nodes showed typical findings consistent with SNL and the chest lesion was diagnosed as pulmonary tuberculosis by positive sputum AFB smear.
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김재원,김명남,홍창원,노병인 중앙대학교 의과대학 의과학연구소 1994 中央醫大誌 Vol.19 No.4
The author performed a clinical study of 295 patients with alopecia areata in order to evaluate the clinical manifestations and the effects of treatment with intralesional injection of triamcinolone acetonide suspension and immunotherapy with diphenylcyclopropenone(DPCP) from March, 1992 to February, 1994 at the Department of Dermatology, College of Medicine, Chung Ang University. The results were follows : 1) The age distribution showed a peak incidence in the third decade(38.6%) and average age was 28.6 years. 2) The most common site of predilection was occipital region in both male and female, which were 83 cases(60.2%), 74 cases(59.2%) respectively. 3) The relapse rate was 26.8%. 4) The family histories were contributory in 34 cases(11.5%). 5) Associated diseases with alopecia areata were seborrheic dermatitis, hepatitis, atopic dermatitis, thyroid diseases, vitiligo, hypertensioin, pulmonary diseases, etc. 6) The therapeutic effect in cases of balded area less than 45㎠, treated with intralesional injection of triamcinolone acetonide revealed less effective according to increase the size of balded area. 7) In cases of balded area more than 46㎠, alopecia totalis and alopecia universalis, 18 cases of the 30 cases(60%) treated with intralesional injection of triamcinolone acetonide revealed effective and 24 cases of the 37 cases(64.9%) treated with immunotherapy with DPCP revealed slightly more effective. These findings suggested that alopecia areata was prominantly developed in third decade, and showed good therapeutic effect in cases of balded area less than 5㎠ and relatively good therapeutic effect on the group treated with DPCP than intralesional injection of triamcinolone acetonide in cases of balded area more than 46㎠, alopecia totalis and alopecia universalis.
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