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윤각원,송익찬,진선아,양영준,박남환,이효진,윤환중,김삼용,조덕연 대한혈액학회 2008 Blood Research Vol.43 No.3
Central nervous system (CNS) myelomatosis, which is the presence of monoclonal plasma cells in the cerebrospinal fluid (CSF), is extremely rare. We report a case of CNS myelomatosis developed in a 45-year-old woman with multiple myeloma in complete response, which was achieved by allogeneic peripheral blood stem cell transplantation using a reduced-intensity conditioning regimen consisting of melphalan, fludarabine, and antithymocyte globulin. Two months after the transplant, she developed a moderate motor and sensory weakness in both lower extremities. Atypical plasma cells were found in the CSF, and immunofixation revealed monoclonal light chain in the CSF. She was given three courses of weekly intra-thecal chemotherapy consisting of methotrexate, cytarabine, and dexamethasone, which cleared the CSF. This case indicates that the allogeneic transplantation could not control CNS myelomatosis, despite successfully treating the bone marrow myeloma. (Korean J Hematol 2008;43:194-197.)
암환자의 통증치료에 대한 $Ultracet^{(R)}$의 유효성과 안전성
이효진,진선아,윤각원,양영준,박남환,천재민,박남숙,윤환중,조덕연,김삼용,Lee, Hyo-Jin,Jin, Sun-Ah,Yun, Gak-Won,Yang, Yung-Joon,Park, Nam-Whan,Chun, Jae-Min,Park, Nam-Sook,Yun, Hwan-Jung,Jo, Deog-Yeon,Kim, Sam-Yong 한국호스피스완화의료학회 2006 한국호스피스.완화의료학회지 Vol.9 No.2
목적: 외래에 내원하는 암환자들을 대상으로 암성통증의 조절에 있어서 $Ultracet^{(R)}$의 효과와 안전성에 대해 알아보고자 하였다. 방법: 암으로 진단을 받고 통증 조절을 목적으로 $Ultracet^{(R)}$을 투여한 61명의 환자를 대상으로 통증조절의 정도와 통증이 환자의 삶의 질에 미치는 영향에 대한 평가를 위해 Korean version of Brief Pain Inventory를 이용하였다. 약물의 안전성은 복용 후 나타나는 부작용 정도에 의하여 평가하였다. 결과: 대상환자의 평균연령은 59.9세였고 성별분포는 남자가 34명, 여자가 27명이었다. 환자의 진단은 폐암, 위암, 육종, 대장암, 췌장암, 자궁 경부암, 두경부암, 그리고 림프종 등의 순이었다. 대상환자에서 가장 심했을 때의 통증 정도는 $Ultracet^{(R)}$을 사용하기 전후에 유의한 감소를 보이지 않았으나($5.18{\pm}1.41\;vs.\;4.82{\pm}1.94$; P=0.113), 가장 약했을 때의 통증 정도($1.2{\pm}1.05\;vs.\;0.87{\pm}1.35$; P=0.038), 환자가 느끼는 통증의 평균 정도($3.65{\pm}1.01\;vs.\;3.13{\pm}1.73$: P=0.022)와 바로 지금 느끼는 통증정도($3.63{\pm}1.25\;vs.\;2.85{\pm}1.94$; P=0.003)는 유의하게 감소되었다. $Ultracet^{(R)}$의 사용으로 인한 부작용은 전반적으로 경미하여 2도의 오심과 구토 각 1예와 1도의 변비, 소양증, 안면 홍조가 각각 1예씩 관찰되었으나 3도나 4도의 독성은 관찰되지 않았다. 결론: $Ultracet^{(R)}$은 외래환경에서 암환자의 통증조절에 있어서 안전하게 사용할 수 있는 비교적 효과적인 약물로 생각된다. Purpose: We aimed to investigate the efficacy and side effects of $Ultracet^{(R)}$ in relieving cancer pain in setting. Methods: Sixty-one cancer patients over 18 years old, who had cancer pain with or without medication, were enrolled. Pain and other variables were evaluated before and after treatment with $Ultracet^{(R)}$ for 2 weeks, using Korean version of Brief Pain Inventory. Results: Of 61 patients with assessable efficacy data, the maximum pain intensity(PI) experienced in a day were $5.18{\pm}1.41\;and\;4.82{\pm}1.94$, before and after treatment with$Ultracet^{(R)}$ respectively (P=0.113). The minimum PI experienced in a day were $1.2{\pm}1.05\;and\;0.87{\pm}1.35$, before and after treatment with $Ultracet^{(R)}$, respectively (P=0.038). The average PI experienced in a day were $3.61{\pm}1.01\;and\;3.15{\pm}1.73$, before and after treatment with $Ultracet^{(R)}$, respectively (P=0.022). The current PI were $3.63{\pm}1.25\;and\;2.85{\pm}1.94$, before and after treatment with $Ultracet^{(R)}$, respectively (P=0.003). Regarding the quality of life, only mood changed for the better in 49 patients who were treated with $Ultracet^{(R)}$ alone ($1.98{\pm}1.73\;and\;1.35{\pm}1.15$, before and after treatment respectively; P=0.046). There were five (8.2%) adverse events associated with $Ultracet^{(R)}$ treatment. Conclusion: $Ultracet^{(R)}$ seems effective and safe in ambulatory patients with cancer pain.
진선아,송익찬,윤각원,양영준,이효진,윤환중,김진만,김삼용,조덕연,백승우 대한혈액학회 2009 Blood Research Vol.44 No.3
Osteosclerotic myeloma is a rare entity, characterized by single or multiple osteosclerotic bone lesions and usually accompanied by a polyneuropathy syndrome (POEMS). Multiple myeloma with osteosclerotic lesions without polyneuropathy is exceedingly rare. We report a case of multiple myeloma associated with multifocal osteosclerotic lesions without any evidence of POEMS. A 48-year-old woman presented with incidentally found osteosclerosis of 8th thoracic vertebra on a plain chest film. Bone survey, CT scan, MR scan, and radioisotope scintigraphy revealed multiple localized osteoclerosis; serum protein immunofixation showed IgG, lambda monoclonal gammopathy. A biopsy of T8 vertebral body disclosed plasma cell myeloma. Given that there was no organ or tissue damage other than multifocal osteosclerosis, the patient was placed on close observation with regular examination. This case indicates that although rare, multiple myeloma should be included in the differential diagnosis of sclerotic bone lesions.
천재민,박남숙,박남환,윤각원,양영준,박상은,윤환중,조덕연,권계철,김삼용 대한혈액학회 2005 Blood Research Vol.40 No.4
배경: 악성빈혈은 위점막의 위축 또는 위 벽세포의 자가면역성 파괴로 인한 내인자의 결여에서 비롯된다. 우리나라에서는 1966년 1예가 보고된 이래 간헐적으로 증례가 보고되어 왔으나 다수의 환자를 대상으로 분석한 자료가 거의 없는 실정이다. 이에 저자들은 최근 10년간 진단된 악성빈혈 환자들의 임상상을 분석하였다. 방법: 1995년부터 2004년까지의 기간 중 충남대학교병원에서 악성빈혈로 진단된 환자 22예의 의무기록을 후향적으로 분석하였다. 결과: 환자 나이는 34~79세였고 중앙치는 66세였다. 증상으로는 빈혈에 의한 증상이 95.5%로 가장 많았고, 위장관 증상이 77.2%, 그리고 신경학적 증상은 50%의 환자에서 각각 관찰되었다. 혈색소 중앙치는 7.0g/dL (3.1~11.8g/dL)였고 절반에서 7g/dL 이하의 심한 빈혈을 보였으며, 평균적혈구용적의 중앙치는 118fL (76~147fL)였다. 혈청 비타민 B12치의 중앙치는 26pg/mL (12~189pg/mL)였다. 항체 검사를 시행한 19예 중 항내인자항체는 15예(78.9%)에서, 항벽세포항체는 8예(42.1%)에서 각각 양성이었다. 21예에서 위내시경검사가 시행되었으며 모든 환자에서 위체부에 중등도 이상의 위축위염 소견이 있었다. 전체 22예 중 5예(22.7%)에서 하시모토갑상선염, 그레이브스병, 백반증 등 다른 자가면역질환이 동반되었다. Hydroxycobalamin으로 치료한 21예 중 재생불량성빈혈이 동반된 2예를 제외한 나머지 19예에서는 빈혈이 소실되었으며 평균적혈구용적도 정상 범위로 회복되었다. 위장관 증상은 모든 환자에서 소실되었으나 신경학적 증상은 일부 환자에서 지속되었다. 악성빈혈로 진단된 경우가 2000년 이전에는 2예에 불과하였으나 그 이후에는 진단 건수가 뚜렷하게 증가하는 추세를 보이고 있다
Large Cell Calcifying Sertoli Cell Tumor of the Testis: A Case Study and Review of the Literature
송대현,이종실,정성묵,박종탁,윤각원,김병권 대한병리학회 2014 Journal of Pathology and Translational Medicine Vol.48 No.1
A 24-year-old man was admitted due to an incidentally detected mass in his left testis, which showed radiopaque calcification on plain X-ray film. Left orchiectomy was performed, and the resected testis contained a well-demarcated, hard mass measuring 1.1 cm. Histological analysis revealed that the tumor was composed of neoplastic cells, fibrotic stroma, and laminated or irregularly shaped calcific bodies. The individual cells had abundant eosinophilic or clear cytoplasm with round nuclei, each of which contained one or two conspicuous nucleoli. They were arranged in cords, trabeculae, clusters, and diffuse sheets. There were several foci of intra-tubular growth patterns, with thickening of the basal lamina. Immunohistochemically, the neoplastic cells were positive for S-100 protein and vimentin, focally positive for inhibin alpha, and negative for cytokeratin, CD10, and Melan-A. In addition to reporting this rare case, we also review the relevant literature regarding large cell calcifying Sertoli cell tumors.
Tumor Necrosis Factor 길항제 치료 실패 후 Methotrexate로 관해 유도와 유지 치료가 가능했던 크론병
최정란 ( Jungran Choi ),윤각원 ( Gak Won Yun ),박유미 ( Yoo Mi Park ),김지현 ( Jie Hyun Kim ),윤영훈 ( Young Hoon Youn ),박효진 ( Hyojin Park ),박재준 ( Jae Jun Park ) 대한소화기학회 2015 대한소화기학회지 Vol.66 No.4
Thanks to the introduction of immumomodulators and biologics, therapeutic approaches in Crohn’s disease have changed significantly during the past decade. Although new biologic therapy has dramatically improved the treatment of Crohn’s disease, a substantial number of patients are refractory to these therapies or lose their initial response. Methotrexate (MTX) is a structural analogue of folic acid that can competitively inhibit the binding of dihydrofolic acid to the enzyme dihydrofolate reductase and has been widely used as immunomodulator in rheumatology area for patients with rheumatoid arthritis and psoriasis. Although MTX has also been shown to be an effective agent for remission induction and maintenance of remission in Crohn’s disease, the use of MTX in Crohn’s disease has not yet been reported in Korea. Herein, we report a case of Crohn’s disease patient who was successfully treated with MTX after treatment failure with thiopurine and anti-tumor necrosis factor. (Korean J Gastroenterol 2015,66:231-236)