유방암 치료후에 발생한 속발성 급성 전골수성 백혈병

김용주(Young Joo Kim),문한림(Han Lim Moon),김병욱(Byung Wook Kim),김희열(Hee Yeol Kim),방승호(Seung Ho Bang),안중현(Joong Hyun Ahn),한상국(Sang Kook Han),강진형(Jin Hyung Kang),홍영선(Young Seon Hong),김훈교(Hoon Kyo Kim),이경식(Kyun 대한내과학회 1995 대한내과학회지 Vol.48 No.5

Acute leukemia after chemotherapy and/or radio- therapy for malignant disorder is called secondary acute leukemia(SAL) or therapy related leukemia. Typically, SAL is preceded by a prodrome phase or myelodysplastic syndrome (MDS) resulting in trilineage dysplasia manifested by pancytopenia, associated with cytogenetic abnormalities involving chromosome 5 and 7, and carries a poor prognosis. Although FAB M3 type(acute promyelocytic leukemia) of SAL had been rarely reported, recently there was a report on 16 cases of therapy-related acute promyelocytic leukemia. We hereby report a case of secondary acute promyelocytic leukemia after treatment of advanced breast cancer. A 62-year-old woman was admitted because of pancytopenia, purpura of legs and gingival bleeding. Since six years before admission when she was diagnosed as infiltrating ductal carcinoma of breast with metastases to lung, She had received CMF(cyclophosphamide, methotrexate, 5-fluorouracil) chemotherapy and radiotherapy, and underwent modified radical mastectomy after complete disappearance of pulmonary nodules, She had received further chemotherapy with cumulative doses of chemotherapeutic agents as following; 21g of cyclophosphamide, 410mg of doxorubicin, 21g of 5-fluorouracil, and 600 mg of methotrexate. Radiation doses to chest wall, axilla and supraclavicular area were 2880 to 3400cGy. The examination of bone marrow aspiration and biopsy showed acute promylocytic leukemia(FAR M3). Cytogenetic analysis of peripheral blood demonstrated 46XX[1]/46XX, t(7; 11) (p15; p15) [12]. The patient did not achieved a complete remission despite retinoic acid therapy and intensive chemotherapy with Ara-C and AMSA, and died 10 months after diagnosis of acute promyelocytic leukemia.

Epstein-Barr Virus in Nasal Angiocentric Lymphoma with Malignant Histiocytosis-like Hemophagocytic Syndrome

한지연(Ji Youn Han),김훈교(Hoon Kyo Kim),문한림(Han lim Moon),서은주(Eun Joo Seo),권희정(Hi Jeong Kwon),박연준(Yeon Joon Park),민기옥(Ki Ouk Min),윤세철(Sei Cheol Yoon),김민식(Min Shik Kim),조승호(Seong Ho Cho),김병기(Byung Kee Kim) 대한두경부종양학회 1997 대한두경부 종양학회지 Vol.13 No.1

서론 : 혈구탐식증후근은 고열, 범혈구감소증, 간비장종대, 림프절비대 및 혈액응고장애 등을 동반하는 전신적 질환으로 대부분 면역억제 상태에서 바이러스 및 각종 병원체의 감염에 의해서 유발되고 예후가 불량하다. 조직학적으로 림프세망기관의 조직구의 증가와 혈관탐식현상이 빈번히 관찰되고 이와 같은 현상을 보이는 악성조직구증식증과의 감별이 어렵다. 코의 혈관중심위 림프종은 거의 일정한 Epstein-Barr 바이러스(EBV)양성을 보인다고 보고되고 있고 병의 경과중 혈관탐식증추군이 빈번하게 발생되는데 이는 EBV감염에 의해서 유발된다고 보아지고 있다. 재료 및 방법 : 1985년 1월부터 1995년 12까지 강남성모병원과 성바오로병원에서 코의 혈관중심위 림프종으로 진단 받았던 환자 42명 중 혈구탐식증후근을 동반한 10명을 대상으로 임상양상을 관찰하고, 조직표본에 면역조직화학염색법과 교잡반응을 사용하여 악성세포의 표현형을 살펴보고 EBV와의 관련성을 관찰하였다. 결과 : 10명의 환자 중 5명은 혈관중심위 림프종 진단당시, 3명은 재발시기, 2명은 관해 시기에 혈구탐식증후군을 동반하였다. 모든 환자에서 실시된 치료방법에 상관없이 치명적인 경과를 보였으며 중앙생존기간은 18일(2-44일)이었다. 대상 모두에서 T형세포 표현형과 교잡반응상 EBV양성을 보였으며, EBV는 주로 악성림프종세포에 분포양상을 보였다. 결론 : 혈구탐식증추군은 코의 혈관중심위 림프종의 흔한 합병증으로 불량한 예후를 보인다. 임상적 양상 및 조직학적 검사상 악성 조직구증가증과 유사한 소견을 보여 감별이 어렵고, 치명적 결과를 초래하므로 치료에 어려움을 주고 있다. 코의 혈관중심위 림프종과 밀접한 관계를 보이는 EBV에 의해서 유발된다고 보아지고 있으며 치료의 개선을 위하여 앞으로 병인적연구가 필요하다고 생각된다. Malignant histiocytosis(MH)-like hemophagocytic syndrome(HS) is a fatal complication of nasal angiocentric lymphoma(AL) and difficult to distinguish from MH. Ten of total 42 patients with nasal AL had HS and 9 of them were initially suspected to have MH. Five patients had HS as initial manifestation, 3 at the time of relapse, and 2 during the clinical remission of lymphoma. Four patients were treated by combination chemotherapy(CHOP) and others had only supportive care. Immunohistochemical study and in situ hybridization were performed on the specimen obtained from 10 patients. The median survival of all patients from HS was 18 days(range 2 - 44 days) and all had fatal outcome regardless of the treatment-modality. All cases were positive for UCHL1(CD45RO) and Epstein-Barr virus (EBV) by EBER in situ hybridization. MH-like HS is a fatal complication of nasal AL and has a high association with EBV. Reactivation of EBV may contribute to HS and further investigation of predictive factors and effective treatment of HS should be pursued in future.

복강내 Cisplatin 주입요법에 의한 악성 복수 조절

정진민(Jin Min Chung),문한림(Han Lim Moon),홍영선(Young Seon Hong),박동준(Dong Jun Park),김훈교(Hoon Kyo Kim),이경식(Kyung Shik Lee),김동집(Dong Jip Kim),홍대식(Dae Shik Hong) 대한내과학회 1987 대한내과학회지 Vol.33 No.1

N/A A major problem of cancer chemoterapy is narrow therapeutic index. To overcome this problem, in patients with intraabdominal cancer metastasis, intraperitoneal instillation of cancer chemotherapeutic agent is tried and much higher concentration of chemotherapeutic agent could be exposed to cancer tissue. Sixteen patients with malignant acites with various kinds of cancer, such as stomach caner(9), ovarian cancer(2), hepatocelluar carcinoma(2) and malignacy of unknown origin(4), recieved a total of 23 courses of intraperitoneal cisplatin therapy, After confirmation of normal renal function and adequate hydration, ascites was drained completely. 90 mg/m² B.S.A. of cisplatin suspended in 2 liters of warm saline was in- stilled into the peritoneal cavity. After a single 4-hour dwelling, the solution was again drained as completely as possible. Of 12 evaluable patients, ascites did not recur in 3 patients for 1 month after therapy (complete control). Seven patients showed increased performance status and decreased abdominal girth and body weight (partial control). When ascites recurred, IP therapy was repeated. The toxicities were mild to moderate nausea and vomiting, diarrhea, abdominal pain, high fever and bone marrow suppression. There was no nephrotoxicity and neurotoxicity. We concluded intraperitoneal cisplatin therapy was effective for the control of malignant ascites and tolerable.

Cyclosporin A 의 일차 임파구 혼합배양의 저해작용에 대한 Interleukin - 2 의 역할

민우성(Woo Sung Min),문한림(Han Lim Moon),김호연(Ho Youn Kim),방병기(Byung Kee Bang),이경식(Kyung Shik Lee),김동집(Dong Jip Kim) 대한내과학회 1986 대한내과학회지 Vol.31 No.1

N/A Cyclosporin A (CsA) was found to have remarkable immune suppressive properties without the usual significant myelotoxicity and clinically very useful agent to prevent rejection of organ transplantation or bone marrow transplantation and Graft-versus-Host disease. Recently, the inhibitory effect of CsA on the production of interleukin-2 (IL-2) and on the development of responsiveness to this lymphokine have been implicated as some of the major reasons accounting for CsA mediated immunosuppression. But the exact mode of CsA accounting for its immunosuppressive effects remains unclear. We studied the influence of CsA and exogenous IL-2 on proliferative response in mixed lymphocyte culture. The results were as follows: 1) There is apparent inhibition of proliferative response in M.L.R. by CsA in a dose-dependent manner, optimal concentration is approximately 0.5-1.0ug/ml. 2) The time-course sequential studies indicated that the lymphocyte response was markedly dependent on the time of addition of CsA to the culture. On-going M.L.R., the inhibitory effect of proliferative response by CsA was markedly abolished after 20 hours of the culture.(mean cpm 12,578±1, 445/28, 324±319) 3) On the beginning of the M.L.R., a addition of both CsA and exogenous IL-2 (human, 2.5 u/ml) was found in the no-appreciable immunosuppressive effect. 4) Exogenous human IL-2 abolished the CsA effect on the M.L.R. but mouse IL-2 could not.

국소진행성 두경부암환자에서 5 - Fluorouracil 과 Cisplatin 의 선행항암화학요법과 방사선 치료

김훈교(Hoon Kyo Kim),한지연(Ji Youn Han),강진형(Jin Hyung Kang),송호철(Ho Cheol Song),문한림(Han Lim Moon),홍영선(Young Seon Hong),이경식(Kyung Shik Lee),김동집(Dong Jip Kim),김민식(Min Sik Kim),조승호(Seung Ho Cho),서병도(Byung Do S 대한내과학회 1995 대한내과학회지 Vol.49 No.4

Objectives: The efficacy and problems of sequential induction chemotherapy (IC) using cisplatin and 5 FU, and radiotherapy in locally advanced head and neck cancer patients were analyzed. Methods: Seventy--four locally advanced head and neck cancer patients were treated with a combination of 5-FU 1,000mg/m² lV continuous infusion on days 1 to 5 and cisplatin 100mg/m² IV on day 1 every 3 weeks for 3 cycles and radiotherapy of 6,500 to 7,000cGy in 45 patients to primary site and neck area from 1987 to 1991. The response rate and toxicity of induction chemotherspy, response rate of subsequent radiotherapy and survival data based on response to chemoradiotherapy were evaluated. Results: A 82.9% overall response rate including 30% of complete response was achieved in 70 patients evaluable for response and toxicity of IC. In stage III patients, complete response rate was higher (50.0%). Dose limiting toxicities was oral mucositis, leukopenia, thrombocytopenia, and nephrotoxicity. Additional complete response after subsequent radiotherapy was achieved in 14 of 21(51.9%) partial responders to IC and no better response was seen in non-responders to IC. Survival was followed in 67 patients. Overall survival was 23+months (7-65+) and 1, 2 and 3 year survival were 73.1%, 49.3% and 28.4%, respectively. Survival of complete responders was longer than that of partial responders (30+ and 23+months respectively, p=0.0001). Survival of complete responders after planned radiotherapy was longer than that of partial and non-respondres (31, 14 and 8months, respectively, p=0.0001). Conclusion: Induction chemotherapy with full doses of 5-FU and cisplatin for 3 cycles was very effective to achieve high response in locally advanced head and neck cancer patients without life threatening serious toxicity, and could define the subgroup of possible further responder to subsequent radiotherapy. Longer survival was observed in complete responders to IC and IC-radiotherapy. New therapeutic strategy is required for the patients with poor responders or non responders.

위선암에 병발된 미세맥관 용혈성 빈혈의 2 가지 유형 - 임상특징 , 치료 및 예후 -

양철우(Chul Woo Yang),강혜정(Hae Chung Kang),문한림(Han Lim Moon),박종원(Chong Won Park),김훈교(Hoon Kyo Kim),김호연(Ho Youn Kim),김춘추(Choon Choo Kim),이경식(Kyung Shik Lee),김동집(Dong Jip Kim) 대한내과학회 1989 대한내과학회지 Vol.37 No.6

N/A Microangiopathic hemolytic anemia (MAHA) is char-acterized by schizocytes, intravascular hemolysis and in some instances, thrombocytopenia and coagulation factor deficiencies. Of many cases of cancer related MAHA reported, gastric adenocarcinoma is most frequently related. We found 10 cases of MAHA in gastric adenocarcinoma and analysed their clinical features, therapy and response, and prognosis, and then classified them into two groups. The results are as follows: 1) Cancer related A1AHA could be classified into two groups according to their clinical manifestations: pure MAHA (Group 1:7 cases), and a syndrome of MAHA, renal insufficiency and pulmonary edema (Croup II: 3 cases). 2) Croup I patients showed bane marrow metastasis (Stage IV), no previous chemotherapy (except 2 cases) and consumption coagulopathy in 2 cases. In contrast. Group II patients showed no bone marrow metastasis, but all had previous chemotherapy, especially mitomycin-C, and no evidence of disseminated intravascular coagulation. 3) Therapeutic approaches were directed to reduce tumor burden and immune complexes. In Group I, single or combination chemotherapy reduced the hemolytic event in peripheral blood, but most patients expired due to progression of cancer. In Group II, treatments with plasmapheresis and high dose steroid were tried, but the response was poor and all patients expired due to complications (bleeding, ARDS and uremia) within I month after detection of MAHA.

아구창 치료에 있어 Clotrimazole ( Troches ) 과 Ketoconazole 의 효과

유승규(Seung Kew Yoon),이민상(Min Sang Yi),문한림(Han Lim Moon),홍영선(Yong Seon Hong),김훈교(Hoon Kyo Kim),이경식(Kyung Shik Lee),김동집(Dong Jip Kim) 대한내과학회 1987 대한내과학회지 Vol.34 No.1

N/A A randomized study was performed to compare the effect of clotrimazole troches and ketoconazole in the treatment of oral moniliasis. Eight patients who were treated with clotrimazole troches (10 mg 5 times a day for fourteen days) showed a resolution of symptoms and signs in 1.4 days after treatment initially and 3.0 days after treatment completely. In six cases with ketoconazole therapy (400 mg once a day p.o. for fourteen days), initial and complete clinical response were observed in 1.7 days and 5.0 days after treatment. No side effect was found in patients with clotrimazole troches group, while mild degree of nausea, anorexia and epigastric discomfort were developed in patients with ketoconazole group. These findings suggest clotrimazole troche is as effective as ketoconazole for oral moniliasis and more tolerable than latter.

신경손상이 있던 환자에서의 Cisplatin 에 의한 말초신경병

윤광무(Kwang Moo Yoon),윤선애(Sun Ae Yoon),진종률(Jong Youl Jin),문한림(Han Lim Moon),홍영선(Young Seon Hong),김훈교(Hoon Kyo Kim),이경식(Kyung Shik Lee),김동집(Dong Jip Kim) 대한내과학회 1991 대한내과학회지 Vol.41 No.5

One of the major toxic effects of cisplatin is sensory peripheral neuropathy which is dose-related, but the risk factor is unknown. We experienced cisplatin-induced peripheral neuropathy confined to rhe extermities of previous abnormal neurologic manifestations in 3 patients who had a history of neuropathy. The first case with tonsillar cancer had a recent history of paraplegia by L1 cord compression and recovered completely with radiotherapy. After he received cisplatin 280mg/m², he developed grade I peripheral neuropathy on both lower extremities. Additional cisplatin treatment induced grade III peripheral neuropathy. The second case had a history of right hemiparesis by cerebral infarction 10 years ago. Stage IV laryngeal cancer was diagnosed, and he received cisplatin 80 mg/m². He developed grade I peripheral neuropathy on the right extremities 1,'day after chemotherapy. The third case had a history of paraparesis by tuberculous meningitis 10 years ago. Stage III laryngeal cancer was diagnosed. He developed grade II peripheral neuropathy on both lower extremities 1 day after cisplatin 100 mg/m² treatment, and after a second cycle of chemotherapy grade III peripheral neuropathy developed. The first and second cases recovered completely after discontinuation of cisplation treatment. We can conclude that previous neurologic damage could be a hight-risk factor in the development of cisplatin-induced peripheral neuropathy.

비인강암 환자에서 발생한 경동맥동 과민증후군

윤형규(Hyung Gue Yoon),강진형(Jin Hyung Kang),문한림(Han Lim Moon),채장성(Jang Seong Chae),김훈교(Hoon Kyo Kim),이경식(Kyung Shik Lee),김동집(Dong Jip Kim),이광수(Kwang Soo Lee),윤세철(Sei Chul Yoon),조승호(Seung Ho Cho),서병도(Byung 대한두경부종양학회 1993 대한두경부 종양학회지 Vol.9 No.1

저자들은 극소진행형 비인강암(제 4기, N₄N₂(c)) 환자에서 종양으로 인한 경동맥동 과민증후군과 관련되어 실신이 발생하였으며 방사선치료후 호전된 환자 1예를 경험하였다. The syndrome of carotid sinus hypersensitivity is cardovascular symptom complex including lightheadedness, transient loss of consciousness, perspiration, pallor, weakness of lower extremities, transient hypotension, bradycardia and seizure, which occurs from firing of hyperactive carotid sinus reflex. Most cases are idiopathic, but maliganant tumors involving parapharyngeal space have been occasionally implicated. We present a case of carotid sinus hypersensitivity due to nasopharyngeal carcinoma invading the parapharyngeal space with bilateral cervical lymphnode metastases(stage IV, T₄N₂M(0)). The patient experienced several episodes of severe syncope proceeded by blurring of vision, dizziness and nausea, which were used to occur while he was working in erect position. The tumors were markedly regressed by external radiation therapy with successful resolution of syncope.

CA 125 가 증가하였던 결핵성 복막염 1 예

김상우(Sang Woo Kim),강진형(Jin Hyoung Kang),안유배(Yoo Bae Ahn),송호철(Ho Chul Song),문한림(Han Lim Moon),한상국(Sang Kook Han),홍영선(Young Sun Hong),김훈교(Hoon Kyo Kim),이경식(Kyung Shik Lee),김동집(Dong jip Kim) 대한내과학회 1994 대한내과학회지 Vol.47 No.3

Monoclonal antibody (OC 125) has been developed by hybridization of spleen cell from mice immunized with an epithelial cell line OVCA 433. CA 125 is the antigenic determinant recognized by this monoclonal antibody. CA 125 is considered as a clinically useful tumor marker for monitoring patients with epithelial ovarian cancer. But the specificity of CA 125 is low due to its elevation in other malignancy and benign disease including liver cirrhosis, pelvic inflammatory disease and tubeculous peritonitis. We report a case of tuberculous peritonitis in a 62-year-old woman. Her serum CA 125 level was raised and fell in response to antituberculous therapy.