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Yang Hyo-Joon,Kim Young-Il,Ahn Ji Yong,Choi Kee Don,Kim Sang Gyun,Jeon Seong Woo,Kim Jie-Hyun,Shin Sung Kwan,Lee Hyuk,Lee Wan-Sik,Kim Gwang Ha,Park Jae Myung,Shin Woon Geon,Choi Il Ju 거트앤리버 소화기연관학회협의회 2023 Gut and Liver Vol.17 No.4
Background/Aims: The eCura system, a scoring model for stratifying the lymph node metastasis risk after noncurative endoscopic resection for early gastric cancer (EGC), has been internally validated, primarily for differentiated-type EGC. We aimed to externally validate this model for undifferentiated-type EGC. Methods: This multicenter, retrospective cohort study included 634 patients who underwent additional surgery (radical surgery group, n=270) or were followed up without additional treatment (no additional treatment group, n=364) after noncurative endoscopic resection for undifferentiated- type EGC between 2005 and 2015. The lymph node metastasis and survival rates were compared according to the risk categories. Results: For the radical surgery group, the lymph node metastasis rates were 2.6%, 10.9%, and 14.8% for the low-, intermediate-, and high-risk eCura categories, respectively (p for trend=0.003). For the low-, intermediate-, and high-risk categories in the no additional treatment group, the overall survival (92.7%, 68.9%, and 80.0% at 5 years, respectively, p<0.001) and cancer-specific survival rates (99.7%, 94.7%, and 80.0% at 5 years, respectively, p<0.001) differed significantly. In the multivariate analysis, the hazard ratios (95% confidence interval) in the no additional treatment group relative to the radical surgery group were 3.18 (1.41 to 7.17; p=0.005) for overall mortality and 2.60 (0.46 to 14.66; p=0.280) for cancer-specific mortality in the intermediate-tohigh risk category. No such differences were noted in the low-risk category. Conclusions: The eCura system can be applied to undifferentiated-type EGC. Close follow-up without additional treatment might be considered for low-risk patients, while additional surgery is recommended for intermediate- and high-risk patients.
( Jeong Sik Byeon ),( Benjamin Kim ),( Seung Jae Myung ),( Suk Kyun Yang ),( Jin Ho Kim ),( Kee Wook Jung ),( Hyun Suk Song ),( Kee Don Chol ),( Byong Duk Ye ),( Seung Hyun Kwon ),( Mi Young Do ),( So 대한소화기학회 2007 SIDDS Vol.9 No.-
Background/Aims: Although the diagnostic and therapeutic value of double balloon endoscopy (DBE) have been investigated in many studies, the subjective tolerability to DBE has not been assessed. We aimed to evaluate the tolerability to a DBE. Methods: Patients who underwent DBE in Asan Medical Center between March 2005 to March 2007 were eligible in this study. For the comparison of tolerability to DBE with that to EGD and colonoscopy, those who had not undergone EGD nor colonoscopy were excluded. A total of 52 patients were included in this study. Because 7 patients underwent both antegrade and retrograde DBE approach, the total number of DBE procedures analyzed in this study was 59. All procedures were performed under conscious sedation. Tolerability to DBE, EGD, and colonoscopy was assessed through an interview using a standardized questionnaire. Results: A total of 36 patients underwent both antegrade DBE and EGD under conscious sedation. The level of abdominal pain during procedures, the level of post-procedural abdominal discomfort and the proportion of patients with persistent abdominal discomfort till the next morning were higher in antegrade DBE. However, when analyzed in 16 patients who had good quality of sedation, the differences in the level of abdominal pain during procedures and the persistent abdominal discomfort till the next morning disappeared. A total of 23 patients underwent both retrograde DBE and colonoscopy under conscious sedation. Tolerability parameters were not different between retrograde DBE and colonoscopy. Serious complications including hemodynamic instability did not occur during all procedures. Conclusions: Patients tolerate DBE well. DBE can be performed as comfortably as EGD and colonoscopy if the quality of sedation is good enough.
한양천 ( Yang Chun Han ),강명주 ( Myoung Joo Kang ),박정하 ( Jeong Ha Park ),이원석 ( Won Sik Lee ),손창학 ( Chang Hak Sohn ),김찬환 ( Chan Hwan Kim ),주영돈 ( Young Don Joo ) 대한내과학회 2006 대한내과학회지 Vol.71 No.6
위장관에 발생하는 T세포 악성림프종은 발생 빈도가 낮고, 특히 식도에 발생하는 원발성 T세포 악성림프종은 극히 드문 것으로 보고되고 있다. 저자들은 60세 남자로 수 주 간의 연하곤란을 주소로 내원하여 상부위장관 내시경 검사 및 방사선학적 검사상 T세포 악성림프종으로 진단받은 후 복합항암요법을 통해 성공적으로 치료된 예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Gastrointestinal tract (GIT) lymphomas usually originate from B-lymphocytes but rarely from T-lymphocytes. The stomach is the most common site for extranodal GIT lymphoma but the esophagus is a rare site. In addition, a primary esophageal T-cell lymphoma is an uncommon disorder. We encountered a case of a primary esophageal T-cell lymphoma in a 11 60-year-old man, who had swallowing difficulties and multiple ulcers in the upper and lower esophageal mucosa on gastroscopy. Immunohistochemical staining for the biopsy material from the multiple esophageal ulcers tested positive for LCA and CD45RO (pan T-cell marker) and negative for cytokeratin and CD20 reactivity, respectively. No other abnormal lesions were observed on a computed tomography scan of the neck, chest, abdomen and pelvis. After six cycles of combination chemotherapy with cyclophosphamide, adriamycin, vincristin, prednisolone, etoposide and gemcitabine, the multiple esophageal ulcers had completely disappeared suggesting a complete clinical response. We report this case with a review of the relevant literature(Korean J Med 71:694-698. 2006)
Trimethoprim / Sulfamethoxazole ( TMP / SMX ) 을 복용 중인 외래 환자에서 발생하는 경구 칼륨 투여 후 칼륨 대사 장애
최춘식(Chun Sik Choi),유영조(Young Jo Yoo),김태영(Tae Young Kim),민경환(Kyung Hwan Min),한상웅(Sang Woong Han),노광호(Kwang Ho Roh),양성규(Seong Kyu Yang),유준호(Jun Ho Yoo),오석중(Suk Joong Oh),문중돈(Jung Don Mun),김호중(Ho Jung Ki 대한내과학회 1999 대한내과학회지 Vol.57 No.1
N/A TMP/SMX has been shown to cause hyperkalemia in a few outpatients on standard-dose. This prospective study was aimed at investigating other associated factors inducing clinically important hyperkalemia in outpatients on standard-dose of TMP/SMX. Methods : Age-matched diabetic(n=22) and non-diabetic (n=20) patients with UTI on standard dose of TMP/SMX for 5 days were given acute oral intake of 40 mEq of potassium chloride(KCl). Results : Before the intake of TMP/SMX, basal levels of serum potassium(K), serum BUN and creatinine, plasma renin activity(PRA), aldosterone(PA), and transtubular potassium gradient(TTKG) were comparable between diabetic and non-diabetic subjects. Also after TMP/SMX was taken, all parameters didnt reveal any overt changes except a slightly increased serum K but not significantly (from 4.20±0.15 to 4.14±0.21mEq/L in non-diabetics; from 4.13±0.18 to 4.25±0.13mEq/L in diabetics). Following acute oral KCl load, however, the peak increases of serum K changes were significantly higher in diabetics compared to non-diabetics(0.34 0.06 vs 0.62 0.09mEq/L, p<0.01). Furthermore, 8 out of 22 diabetics but none of non-diabetics after acute KCl load developed hyperkalemia(> 5.0 mEq/L). After KCl load, PRA did not show any significant changes, whereas PA was increased simultaneously with the increments of serum K in both diabetic subgroups hyperkalemic(n=8) and normokalemic (n=14) diabetics. But increment was blunted in hyperkalemic diabetic subgroup. TTKG was increased prominently in normokalemic diabetic subgroup(9.20 from 4.50), while it was slightly increased in hyperkalemic diabetic subgroup(4.63 from 3.79mEq/L). There was statistical difference between two subgroups(p < 0.05). In conclusion, Besides the known effect of blocking sodium channels in distal K secreting cells by TMP/SMX, insulinopenia(DM). Hypoaldosteronism with its decreased tubular bioactivity, and increased exogenous K intake in concert could cause clinically overt hyperkalemia on standard-dose of TMP/SMX. When standard- dose of TMP/SMX is administered to patients with deranged K homeostasis, especially to diabetics with hypoaldosteronism, blood K level should be monitored meticulously to avoid hyperkalemia.
( Ki Hyang Kim ),( Young Don Joo ),( Chang Hak Sohn ),( Ho Jin Shin ),( Joo Seop Chung ),( Goon Jae Cho ),( Sung Hoon Shin ),( Yang Soo Kim ),( Won Sik Lee ) 대한내과학회 2009 The Korean Journal of Internal Medicine Vol.24 No.1
Background/Aims: To date, an effective salvage chemotherapy regimen for the treatment of refractory or relapsing non-Hodgkin`s lymphoma (NHL) has not been discovered. This study was conducted to evaluate the efficacy and safety of gemcitabine, etoposide, cisplatin, and dexamethasone in relapsed or refractory NHL patients. Methods: All patients had histologically proven relapsed or refractory NHL. Treatments consisted of gemcitabine 700 mg/m2 by continuous i.v. on days 1 and 8; etoposide 40 mg/m2 by i.v. on days 1-4; cisplatin 60 mg/m2 by i.v. on day 1; or dexamethasone 40 mg by i.v. on days 1-4 (GEPD) every 21 days. The primary end point was the patient response rate following two cycles of treatment. After two cycles, stem cells were harvested using mobilizing regimens (ESHAP or GEPD plus filgrastim), and this was followed by autologous stem cell transplantation or four additional cycles of GEPD. Results: Between January 2005 and January 2006, 20 patients (13 males and 7 females) were enrolled in the study. The median age was 53 (range 16-75) years. The most common histology was diffuse large B-cell lymphoma (n=10). The median follow-up duration was 5.2 (range 1.0-16.0) months. After two cycles, the overall response rate was 50.0% (10/20), including two complete responses and eight partial responses. The doselimiting toxicity was myelosuppression. Grade IV neutropenia and thrombocytopenia occurred in 13 (65.0%) and 6 patients (30.0%), respectively. The median number of CD34-positive cells collected was 6.0 (range, 2.8-11.6)×10(6)/kg. Of the 17 patients<66 years of age, 4 (23.5%) proceeded to autologous stem cell transplantation. Conclusions: GEPD chemotherapy in patients with refractory or relapsed NHL was effective as a salvage therapy and helpful for stem cell harvest followed by autologous transplantation. (Korean J Intern Med 2009;24:37-42)
Castleman's Disease of the Mesentery : A Case Report
Kim, Cheong Yong,Cho, Yang Sik,Min, Young Don,Jung, Yang Soo,Kee, Keun Hong 朝鮮大學校 附設 醫學硏究所 1991 The Medical Journal of Chosun University Vol.16 No.2
52Castleman's disease는 드문 lymphoproliferative disease로써 양성 경과를 취하며, 원인은 확실하지 않지만 아마도 환경 요인에대한 일종의 반응성 과정이라 여겨진다. 발생위치는 주로 종격동이나 드물게는 후복막,장간막,경부 등에도 생길수있으며 조직학적으로 hyaline-vascular 형과 plasma-cell 형, 또한 두 형의 중간형으로 나누어지며 약 90% 는 hyaline-vascular형이라 알려져 있다. 저자들은 52세 여자환자의 장간막에 발생된 plasma-cell 형의 Castleman's disease를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Castleman's disease is rare lymphoproliferative disorder of uncertain cause characterized by a distinctive pttern of hypervascular lymphoid hyperplasia. It was reported first by Castleman at 1956 and has been reported under a variety of headings that reflect various theories of pathogenesis. Most cases occur as mediastinal tumor, although involvement of other anatomic site has been rarely reported. We present a case of Castleman's disease of mesentery of 52-year-old female patient suffering from abdominal discomfort.