Case Reports : Two Cases of Systemic Capillary Leak Syndrome that were Treated with Pentastarch

Young Seok Lee,Sun Young Kim,Chin Woo Kwon,Hae Geun Song,Young Kyung Lee,Hyo Jung Kim,Dae Young Zang 대한내과학회 2007 The Korean Journal of Internal Medicine Vol.22 No.2

Systemic capillary leak syndrome (SCLS) is a condition that`s caused by the shift of fluid and protein from the intravascular space to the interstitial space as a result of repetitive episodes of capillary hyperpermeability. The pathogenesis of SCLS is still unclear, but there`s recently been a report showing this syndrome in association with monoclonal gammopathy. This syndrome can be a fatal disease because cardiovascular collapse can occur in the initial capillary leak phase. Although theophylline, diuretics, terbutaline, steroids, calcium antagonist, Ginkgo biloba extracts and plasmapheresis have been suggested as medication, none of them have been proven to be effective. Considering that this disease is self-limiting, conservative treatment in the acute phase is believed to be very important. Because hypoalbuminemia is very a common manifestation of SCLS, Pentastarch, which has a higher molecular weight than albumin, could be efficient to prevent cardiovascular collapse. We used 10% Pentastarch during the acute SCLS attacks of 2 patients and the patients both showed a dramatic response. Pentastarch may be helpful to treat SCLS in its initial capillary leak phase by the elevating blood pressure, and this might contribute to somewhat decreasing the acute mortality of SCLS.

Phase I/II trial with docetaxel and S-1 for patients with advanced or recurrent gastric cancer with consideration to age

Zang, Dae Young,Yang, Dae Hyun,Lee, Hae Wan,Hwang, Se Won,Song, Hun Ho,Jung, Joo Young,Kwon, Jung Hye,Kim, Hyo Jung,Kim, Jung Han,Park, Sa Rah,Kim, Min-Jeong,Jang, Kyung Mi,Park, Choong Kee,Kim, Jong Springer-Verlag 2009 Cancer chemotherapy and pharmacology Vol.63 No.3

Practical Application of Target Therapy in Gastric Cancer Field (Herceptin & Cyramza)

Dae Young Zang 대한외과학회 2018 대한외과학회 학술대회 초록집 Vol.2018 No.11

A Case of Completely Resected Advanced Gastric Carcinoma Following Neoadjuvant Chemotherapy with TS-1

Zang, Dae Young,Park, Seong Dong,Park, Keon Uk 동국대학교 의학연구소 2006 東國醫學 Vol.13 No.1

TS-1은 dihydropyrimidine dehydrogenase를 억제하는 새로운 경구용 fluoropyrimidine 약제이다. 몇몇 연구에서 진행성 위암환자에게 TS-1을 이용한 선행 보조 항암요법의 효과적인 항암효과가 발표 되었다. 본 증례는 TS-1을 이용한 4주기의 선행 항암 화학요법 후 완전절제가 가능했던 진행성 위암 환자에 대한 증례이다. 환자는 85세 남자 환자로 췌장과 대동맥 주위 림프절의 전이소견이 있어 진행성 위암 진단을 받았다. TS-1 (80 mg/day)을 경구로 4주간 투약 후 2주간의 휴약을 1주기로 하여 4주기 동안 투약하였다. 투약 중 1도의 설사와 3도의 빈혈 이외의 특별한 부작용은 관찰 되지 않았다. 4주기의 치료 후 시행한 복부 컴퓨터 단층촬영 상 원병변과 위주위 림프절의 전이병변들은 부분반응을 보였으며, 췌장과 대동맥 주의 림프절의 병변은 관찰되지 않았다. 환자는 위전절제술 및 D2 림프절 절제술을 포함하는 치료적 수술을 시행하였고, 병리학적 병기상 T3, N2, P0, CY0, H0, M0 (Stage IIIB)로 확인되었다. 환자는 수술 후 7개월간 재발 없이 생존하고 있다. TS-1, a novel oral anticancer drug is dihydropyrimidine dehydrogenase inhibitory fluoropyrimidine. In some clinical studies, TS-1 has shown effective anti-tumor activity in far advanced gastric cancer patients as neoadjuvant chemotherapy. Here we report our experience with a patient of advanced gastric cancer given 4 cycles of TS-1 as neoadjuvant chemotherapy before complete gastric resection. The patient was an 85-year-old man who was diagnosed with advanced gastric carcinoma that had invaded the pancreas and the paraaortic lymph nodes, before treatment. New oral anticancer drug, TS-1 (80 mg/day) was orally administered for 4 weeks followed by drug-free 2-week period as 1 cycle. Total 4 cycles of TS-1 was administered. No serious drug adverse reaction was observed except for grade 1 diarrhea and grade 3 anemia. After 4 cycles of chemotherapy, follow-up abdominal CT scan showed partial response of primary lesion and regional lymph node metastasis. The lesions in the pancreas tissues and enlarged paraaortic lymph node were not observed. The patient underwent curative surgery, including total gastrectomy and D2 lymph node dissection and the pathologic staging was T3, N2, P0, CY0, H0, M0 (Stage IIIB). The patient has been survived without recurrence for seven months after the surgery.

소세포폐암의 임상경과 및 예후인자

장대영(Dae Young Zang),이정신(Jung Shin Lee),김태원(Tae Won Kim),정병학(Byung Hak Jung),윤환중(Hwan Jung Yun),최종수(Jong Soo Choi),박진희(Jin Hee Park),이동숙(Dong Sook Lee),이제환(Je Hwan Lee),김성배(Sung Bae Kim),김상위(Sang We Ki 대한내과학회 1998 대한내과학회지 Vol.54 No.1

N/A Background: Although small cell lung cancer is a chemosensitive disease, it grows rapidly and relapses frequently. Even with optimum treatment, only small portion of patients have experienced long-term survival. The objective of this study was to describe the clinical characteristics and therapeutic features, and to analyze the prognosis in small cell lung cancer. Methods: We analyzed retrospectively 151 evaluable patients with histologically confirmed small cell lung cancer from August 1989 to June 1995 at our institution. Of 151 patients, 3 had surgery and chemotherapy, 59 had chemotherapy and chest irradiation, and 89 had chemotherapy only. Results: Most patients(82.1%) were men, and the median age was 62 years. Of all patients, 49% had performance status of 0.1 and 59.6% had limited disease. The overall response rate was 67.8% : complete response 23.8%, partial response 44.4%. Complete responses were documented in all of three patients who had surgery and chemotherapy, 49.2% of those who had chemotherapy and radiotherapy, and 4.5% of those who had chemotherapy only. The median follow-up duration was 309 days. The median progression-free survival and overall survival were 256 days and 354 days, respectively: patients who had surgery and chemotherapy were 1631 days and 1631 days, those who had chemotherapy and radiotherapy were 344 days and 450 days, and those who had chemotherapy only were 186 days and 278 days, respectively; complete responders were 580 days and 710 days, partial responders were 231 days and 364 days, non-responders were 132 days and 151 days, respectively. Of 151 patients, 11.3% survived more than two years(long-term survival). Most long-term survivors had limited disease(82.4%) and good performance(76.5%). Long-term survival ocurred in two patients of those who had surgery and chemotherapy, 16.9% of those who had chemotherapy and radiotherapy, and 5.6% of those who had chemotherapy only. Most long-term survivors(70.6%) had complete response. Twenty of 36 complete responders and 8 of 17 long-term survivors had disease relapses or progressions. Patients with limited disease, those with good performance, and those with normal alkaline phosphatase had a significantly higher complete response rate and longer progression-free survival and overall survival than their counterparts. Of pretreatment characteristics, stage and performance status were correlated complete response and survival, independently. Complete response outcome was significant independent variable for survival. Conclusion: The disappointing results in this disease support the need for both new treatment strategies to improve complete response rate and to decrease relapse rate and large-scaled prospective studies to know natural history of long-term survivors.

증례 : 혈액종양 ; 류마티스관절염이 동반된 고전형 카포시육종의 에토포사이드 치료 1예

최난영 ( Nan Young Choi ),박승아 ( Seung Ah Park ),한보람 ( Bo Ram Han ),김호영 ( Ho Young Kim ),민수기 ( Soo Kee Min ),김효정 ( Hyo Jung Kim ),장대영 ( Dae Young Zang ) 대한내과학회 2014 대한내과학회지 Vol.86 No.2

본 저자들은 류마티스관절염을 처음 진단받고 면역저하의 증거가 없으며 HHV-8 음성이며 전신상태가 좋지 않은 고령의 환자에서 전신 피부에 발생한 4병기 고전형 카포시 육종을 진단하였고 지속적인 저용량 경구 에토포사이드 단독요법으로 좋은 임상경과를 얻은 증례가 있어 보고하는 바이다. Kaposi`s sarcoma typically occurs in immunocompromised patients, especially those with acquired immunodeficiency syndrome. Human herpesvirus 8 (HHV-8) and human immunodeficiency virus (HIV) may play important roles in the development of Kaposi`s sarcoma. We report the case of a 75-year-old male who presented with progressive multiple purplish papules and nodules on the skin for 3 months. Social and past medical histories seemed incompatible with an immunesuppressed condition and tests for HIV antibodies and HHV-8 were negative. He was newly diagnosed with rheumatoid arthritis, according to the 2010 ACR-EULAR criteria. Typical findings of Kaposi`s sarcoma were confirmed by biopsy. After treatment with metronomic oral etoposide 25 mg once daily for 9 months, the skin lesions had almost resolved with no serious complication. Thus, we report a rare case of Kaposi`s sarcoma developing in a patient with newly diagnosed rheumatoid arthritis who showed a good response to oral etoposide. (Korean J Med 2014;86:247-252)

A Randomized Phase 2 Trial of Consolidation Chemotherapy After Preoperative Chemoradiation Therapy Versus Chemoradiation Therapy Alone for Locally Advanced Rectal Cancer: KCSG CO 14-03

Kim, Sun Young,Joo, Jungnam,Kim, Tae Won,Hong, Yong Sang,Kim, Jeong Eun,Hwang, In Gyu,Kim, Beom Gyu,Lee, Keun-Wook,Kim, Ji-Won,Oh, Ho-Suk,Ahn, Joong Bae,Zang, Dae Young,Kim, Dae Yong,Oh, Jae Hwan,Baek Elsevier 2018 International journal of radiation oncology, biolo Vol.101 No.4

<P><B>Purpose</B></P> <P>Preoperative chemoradiation therapy (CRT) followed by total mesorectal excision (TME) in locally advanced rectal cancer is the standard of care. To date, the role of consolidation chemotherapy after CRT has rarely been addressed through randomized trials. This study aimed to evaluate the efficacy of CRT followed by consolidation chemotherapy compared with CRT alone.</P> <P><B>Methods and Materials</B></P> <P>This study enrolled patients with adenocarcinoma of the rectum and cT3 or cT4 disease with any N category and no metastasis. In arm A (control arm), we planned CRT (50.4 Gy in 28 fractions) with capecitabine followed by TME. In arm B, 2 cycles of capecitabine and oxaliplatin were administered 1 week after the completion of CRT before TME (capecitabine, 1700 mg/m<SUP>2</SUP> per day from day 1 to 14, and oxaliplatin, 100 mg/m<SUP>2</SUP> on day 1, every 3 weeks). The downstaging rate (the proportion of ypT0 to ypT2 and ypN0M0) was the primary endpoint, which was to be tested with a 1-sided type I error of 15% and with 85% power.</P> <P><B>Results</B></P> <P>From September 2014 to February 2016, 110 patients (56 in arm A and 54 in arm B) were randomized and 108 (55 in arm A and 53 in arm B) started CRT. TME was conducted per protocol in 96 patients (52 in arm A and 44 in arm B). In arms A and B, downstaging was achieved in 21.2% and 36.4% (<I>P</I> = .077), respectively, and the pathologic complete response rate was 5.8% and 13.6% (<I>P</I> = .167), respectively. Grade ≥3 adverse events occurred in 3.6% of patients in arm A and 9.4% of patients in arm B during the preoperative treatment phase and in 1.9% and 9.0%, respectively, during the postoperative recovery phase.</P> <P><B>Conclusions</B></P> <P>Consolidation chemotherapy with 2 cycles of capecitabine and oxaliplatin demonstrated a marginal improvement in the downstaging rate. However, a phase 3 trial of this strategy is discouraged because of the high dropout rate and safety issues.</P>

A randomized trial comparing standard versus high-dose daunorubicin induction in patients with acute myeloid leukemia

Lee, Je-Hwan,Joo, Young-Don,Kim, Hawk,Bae, Sung Hwa,Kim, Min Kyoung,Zang, Dae Young,Lee, Jung-Lim,Lee, Gyeong Won,Lee, Jung-Hee,Park, Jae-Hoo,Kim, Dae-Young,Lee, Won-Sik,Ryoo, Hun Mo,Hyun, Myung Soo,K American Society of Hematology 2011 Blood Vol.118 No.14

<B>Abstract</B><P>We conducted a phase 3 randomized trial comparing 2 different doses of daunorubicin as induction chemotherapy in young adults (60 years of age or younger) with acute myeloid leukemia (AML). Of 383 patients who were analyzed, 189 received standard-dose daunorubicin (SD-DN, 45 mg/m2 per day times 3 days) and 194 received high-dose daunorubicin (HD-DN, 90 mg/m2 per day times 3 days) in addition to cytarabine (200 mg/m2 per day times 7 days) to induce complete remission (CR). The CR rates were 72.0% in the SD-DN arm and 82.5% in the HD-DN arm (P = .014). At a median follow-up of 52.6 months, overall (OS) and event-free (EFS) survival were higher in the HD-DN arm than in the SD-DN arm (OS, 46.8% vs 34.6%, P = .030; EFS, 40.8% vs 28.4%, P = .030). Differences in CR rate and both OS and EFS remained significant after adjusting for other variables (CR, hazard ratio [HR], 1.802, P = .024; OS, HR, 0.739, P = .032; EFS, HR, 0.774, P = .048). The survival benefits of HD-DN therapy were evident principally in patients with intermediate-risk cytogenetic features. The toxicity profiles were similar in the 2 arms. In conclusion, HD-DN improved both the CR rate and survival duration compared with SD-DN in young adults with AML. This study is registered at www.clinicaltrials.gov as #NCT00474006.</P>

Efficacy of Helicobacter pylori eradication for the 1st line treatment of immune thrombocytopenia patients with moderate thrombocytopenia.

Kim, Hawk,Lee, Won-Sik,Lee, Kyoo-Hyung,Bae, Sung Hwa,Kim, Min Kyoung,Joo, Young-Don,Zang, Dae Young,Jo, Jae-Cheol,Lee, Sang Min,Lee, Je-Hwan,Lee, Jung-Hee,Kim, Dae-Young,Ryoo, Hun-Mo,Hyun, Myung Soo,K Springer International 2015 Annals of hematology Vol.94 No.5

<P>The practical usefulness of Helicobacter pylori eradication for immune thrombocytopenia (ITP) patients is still controversial. However, some ITP patients respond to H. pylori eradication. We conducted a multi-center, open label, prospective phase II study to define the efficacy and toxicities of H. pylori eradication as the first line treatment for persistent or chronic ITP patients with moderate thrombocytopenia. Patients with persistent or chronic ITP showing moderate thrombocytopenia (30??10(9)/L??platelet count??70??10(9)/L) and positive C(13)-urea breath test (UBT) were selected. Medication consisted of lansoprazole 30 mg, amoxicillin 1000 mg, and clarithromycin 500 mg orally twice daily for a week. Complete response (CR) rate at 4 weeks, 3 months, 6 months, 12 months, and maximal response was 19.2, 50.0, 50.0, 26.9, and 65.4%, respectively. Overall response rate (ORR) at 4 weeks, 3 months, 6 months, 12 months, and maximal response was 19.2, 57.7, 65.4, 30.8, and 69.2%, respectively. Median maximal platelet count during the first 3 months was 110??10(9)/L (range, 40-274). Median time to CR was 8 weeks (95% CI?=?5.429-10.571). Median time to ORR was 4 weeks (95% CI?=?1.228-6.772). Only per-protocol population was a response predictor for ORR at 3 months (70.0%, p?=?0.054) and maximal ORR (80.0%, p?=?0.051), but not for CR at 3 months (60.0%, p?=?0.160). Therefore, eradication of H. pylori is an effective and durable first line treatment for persistent or chronic ITP with moderate thrombocytopenia with high ORR and rapid onset in this study.</P>

특발성 혈소판증가증에 관한 최신지견

장대영,박성동,박건욱 동국대학교 의학연구소 2006 東國醫學 Vol.13 No.1

최근에 특발성 혈소판증가증의 분자 생물학적 병인에 관한 많은 발전이 이루어 졌다. 특발성 혈소판증가증의 진단은 수 년전에 개발된 방법으로 다른 질환들을 배제함으로써 이루어진다. 특발성 혈소판증가증은 혈전성 및 출혈성 합병증을 증가시키고, 골수 섬유화증이나 급성 골수성 백혈병으로 진행할 수 있다. 혈관성 합병증을 예방하기 위해 사용되는 골수 억제제 치료법은 혈액학적 악성 질환으로서의 진행을 가속화 시키지 않을까하는 우려로 질병의 위험도에 따라 적절한 치료법을 선택하고 있다. 따라서, 저위험 환자군에서 골수 억제제 치료는 추천되지 않으며, 고위험 환자군에서는 하이드록시유리아와 아스피린의 치료가 효과적인 것으로 알려져 있다. 아나글레라이드나 인터페론-알파는 하이드록시유리아에 내성을 가지거나 투약이 불가능한 환자들에게 2차 약제로 고려될 수 있을 것이다. 산모에 있어서는 인터페론-알파가 더 추천된다. Significant progress in our understanding of the molecular pathogenesis of essential thrombocythemia(ET) has recently been achieved. Unfortunately, the diagnosis of ET still relies on a set of exclusion criteria developed years ago, as recent advances have yet to be evaluated for this purpose. The clinical course of ET is characterized by an increased incidence of thrombotic and hemorrhagic complications and an inherent tendency to progress into myelofibrosis or acute myeloid leukemia (AML). There is concern about undesirable effects of cytoreductive therapy given to prevent vascular events, particularly the risk of accelerating the rate of hematologic transformation. Thus, management involves modification of reversible vascular risk factors and further stratification according to the thrombotic risk. Myelosuppressive agents are not recommended in low-risk patients, whereas controlled studies support the therapeutic value of hydroxyurea (HU) plus aspirin in high-risk cases. Anagrelide or interferon-alpha (IFN-alpha) could be considered as second-line therapy in patients refractory or intolerant of HU, IFN-alpha is preferred in pregnant women.