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위 MALT 림프종에서 다발성 림프절 전이로 오인된 동시성 림프절 결핵 1예
김성은,김규종,김도현,송준영,문대성,장리라,유찬희,문원,박무인,박선자,김영옥 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.2
28세 남자가 내시경적 점막절제술을 통해 저등급 위MALT 림프종으로 진단되었다. 병기설정을 위해 18F-FDG PET 검사를 시행하였고 우측 쇄골상부, 우측상/하부 기관주위, AP window 부위에 강한 섭취가 관찰되어 전이성 림프절로 판단하였다. 그러나, 우측 쇄골상부 림프절에서 시행한 절제생검에서 만성육아종성염증소견이 관찰되었고 조직의 결핵 중합효소연쇄반응에서도 양성 반응을 보였다. 2개월간 항결핵제의 사용 후 시행한 추적 컴퓨터단층촬영 검사에서 림프절 크기의 감소를 보여 최종적으로 위 MALT 림프종에서 광범위 림프절 전이로 오인된 동시성 림프절 결핵으로 진단되었다. A 28-year-old man was diagnosed as gastric MALT lymphoma in diagnostic EMR (endoscopic mucosal resection). He subsequently underwent an 18F-FDG PET. 18F-FDG PET showed intense multifocal uptake in right supraclavicular, right upper and lower paratracheal, and AP window areas that was considered radiologically to represent widespread metastatic lymphadenopathy. Excisional biopsy of a supraclavicular lymph node, however, revealed chronic granulomatous lymphadenitis with a positive reaction of Tb-nested PCR. After antituberculosis treatment for 2 months, a follow-up CT scan showed complete resolution of the lesions. Intense 18F-FDG uptake could be due to an infectious process such as synchronous tuberculous lymphadenitis. Therefore, this could mimic a malignant condition such as lymphoma with extensive lymph node metastasis due to a false-positive finding, which may lead to a misdiagnosis.
( Seun Deuk Hwang ),( Jin Ho Lee ),( Jong Hyun Jhee ),( Joon Ho Song ),( Joong Kyung Kim ),( Seoung Woo Lee ) 대한신장학회 2019 Kidney Research and Clinical Practice Vol.38 No.2
Background: Significant increases in the prevalence of obesity have been observed among patients with peritoneal dialysis (PD). The impact of body mass index (BMI) on survival remains unknown in Korean PD patients. Methods: Among data of 80,674 patients on PD acquired from the Insan Memorial ESRD Registry database for the years 1985 to 2014, 6,071 cases were analyzed. Subjects were classified by baseline BMI; < 21.19 kg/m2 (quartile 1, n = 1,518), 21.19 to 23.18 kg/ ㎡ (quartile 2, reference; n = 1,453), 23.19 to 25.71 kg/ ㎡ (quartile 3, n = 1,583), and > 25.71 kg/ ㎡ (quartile 4, n = 1,517). Results: Mean age was 65.8 years, and baseline BMI was 23.57 kg/ ㎡. Numbers of male and diabetic patients were 3,492 (57.5%) and 2,192 (36.1%), respectively. Among 6,071 cases, 2,229 (36.7%) all-cause deaths occurred. As a whole, Kaplan-Meier survival curves according to BMI quartiles was significantly different (P = 0.001). All-cause mortality was significantly higher in quartile 4 than in the reference (hazard ratio [HR] = 1.154, 95% confidence interval [CI], 1.025-1.300; P = 0.018). There was no statistical difference in all-cause mortality among BMI quartiles in diabetic patients on PD. In non-diabetic patients, all-cause mortality of quartiles 1 and 3 was not different from the reference, but the HR was 1.176 times higher in quartile 4 (95% CI, 1.024-1.350; P = 0.022). Conclusion: Baseline BMI > 25.71 kg/ ㎡ seems to be an important risk factor for all-cause mortality in Korean PD patients.
Gemcitabine/cisplatin 항암치료 후 완전관해가 보고된 전이성 췌장암 환자 2례
조중현 ( Jung Hyun Jo ),정문재 ( Moon Jae Chung,),박정엽 ( Jeong Youp Park ),방승민 ( Seun Gmin Bang ),박승우 ( Seung Woo Park ),정재복 ( Jae Bock Chung ),송시영 ( Si Young Song ) 전북대학교 의과학연구소 2013 全北醫大論文集 Vol.37 No.1
Pancreatic ductal adenocarcinoma has a very poor prognosis. Patients with this type of tumor have a median overall survival of 9 months in locally advanced pancreatic cancer and 3-6 months in metastatic disease. However, there have been rare cases of patients with advanced pancreatic cancer who survived unexpectedly longer without curative surgery. We report two cases of metastatic pancreatic cancer in patients who presented complete remission after receiving gemcitabine/cisplatin chemotherapy and survived for about 10 years. The first case is that of a 51-year-old Korean woman who was diagnosed with pancreatic body cancer with invasion of the celiac artery and supraclavicular lymph node metastasis. The patient received gemcitabine/cisplatin systemic chemotherapy and achieved complete remission after the 12th cycle of chemotherapy. At present, the patient has survived for 10 years and 2 months after diagnosis. The second case is that of a 69-year-old Korean woman who was diagnosed with pancreatic head cancer with liver metastasis. The patient received gemcitabine/cisplatin chemotherapy and achieved complete remission after the 6th cycle of chemotherapy. At present, the patient has survived for 9 years and 2 months after diagnosis. Our study is the first case report of patients who achieved long-term survival with complete remission after receiving chemotherapy alone for metastatic pancreatic cancer.
진행성 대장암 환자에서 FOLFOX4 복합화학약물 치료의 실패 후 2차 요법으로 FOLFIRI 복합화학약물 치료의 효과와 안전성
김재현 ( Jae Hyun Kim ),박선자 ( Seun Ja Park ),박무인 ( Moo In Park ),문원 ( Won Moon ),김성은 ( Sung Eun Kim ),구기환 ( Ki Hwan Ku ),송성은 ( Sung Eun Song ),김제훈 ( Je Hun Kim ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.1
Background/Aims: The incidence of colorectal cancer has been increasing every year in Korea. Irinotecan- or oxaliplatin-based regimens including biologic agents are known to be effective in patients with advanced colorectal cancer. But in practice, FOLFOX (combination of oxaliplatin, 5-fluorouracil, and leucovorin) or FOLFIRI (combination of irinotecan, 5-fluorouracil, and leucovorin) regimens without biologic agents are more commonly used in Korea due to of the high costs of biologic agents. The aim of this study was to evaluate the efficacy and toxicity of FOLFIRI following FOLFOX4 in patients with advanced colorectal cancer. Methods: A total of 54 patients with advanced colorectal cancer who were treated between May 2005 and May 2013 with FOLFOX4 as first-line chemotherapy and with FOLFIRI as second-line chemotherapy at Kosin University Gospel Hospital (Busan, Korea) were reviewed retrospectively. Results: A total of 54 patients received second-line FOLFIRI chemotherapy. Five patients (9.3%) had a partial response, 29 patients (53.7%) had a stable disease. The median overall survival was 8.90 months and the median time to progression was 4.33 months. Toxicities were tolerable. Conclusions: In a Korean population, FOLFIRI as second-line chemotherapy is effective and well tolerated in patients with advanced colorectal cancer after failure of FOLFOX4. Although the efficacy of FOLFIRI in this study was lower than that of second-line FOLFIRI with biologic agents, these results can help in the formulation of a treatment strategy for financially troubled patients. (Korean J Gastroenterol 2014;63:18-24)
Impact of pretransplant rituximab induction on highly sensitized kidney recipients
Young Hae Song,Kyu Ha Huh,Yu Seun Kim,Hyung Soon Lee,Myoung Soo Kim,Soo Jin Kim,Hyun Jung Kim,Soon Il Kim,Dong Jin Joo 대한외과학회 2012 Annals of Surgical Treatment and Research(ASRT) Vol.82 No.6
Purpose: Highly sensitized patients with a high level of panel reactive antibody (PRA) experience more episodes of antibody-mediated rejection (AMR) and poorer graft survival than non-sensitized patients. Rituximab is a well-known monoclonal anti-CD20 antibody that causes the depletion of B lymphocytes. The aim of this study was to compare a rituximab-administered and a non-administered group of highly sensitized recipients. Methods: Forty-three kidney recipients with a PRA level of ≥50% were included. Sixteen (group R) received one dose of rituximab at 2 days prior to transplantation and 27 patients (group NR) did not. Results: Patients’ demographics, such as age, sex, dialysis duration, and type of immunosuppressive agent were not different in the two groups. No side effects due to rituximab administration were observed in group R. Class I PRA of group R (75.6 ± 37.7%) was higher than that of group NR (45.7 ± 35.8%, P = 0.013). More acute rejection episodes occurred within 1 year after transplantation in group NR but the difference between the groups was not significant (18.8% in group R vs. 29.6% in group NR, P = 0.631). However, two AMR episodes occurred only in group NR. Renal functions were not different in the two groups. In group R, CD19 and CD20 rapidly decreased 2 days after rituximab infusion. Furthermore, the administration of rituximab was not linked to acute rejection. Conclusion: To confirm the long-term anti-rejection and beneficial effects of rituximab, further studies should be performed with a larger cohort. In conclusion, rituximab administration 2 days prior to transplantation is both effective and safe.
( Jun Young Song ),( Moo In Park ),( Do Hyun Kim ),( Chan Hui Yoo ),( Seun Ja Park ),( Won Moon ),( Hyung Hun Kim ) The Editorial Office of Gut and Liver 2013 Gut and Liver Vol.7 No.3
The aim of this study was to assess changes between primary classification of esophageal motility disease and follow-up classification by high resolution manometry (HRM) and to determine whether previously classified diseases could be recategorized according to the updated Chicago Classification published in 2011. We reviewed individual medical records and HRM findings twice for each of 13 subjects. We analyzed primary and follow-up HRM findings based on the original Chicago Classification. We then reclassified the same HRM findings according to the updated Chicago Classification. This case series revealed the variable course of esophageal motility disorders; some patients experienced improvement, whereas others experienced worsening symptoms. Four cases were reclassified from variant achalasia to peristaltic abnormality, one case from diffuse esophageal spasm to type II achalasia and one case from peristaltic abnormality to variant achalasia. Four unclassified findings were recategorized as variant achalasia. In conclusion, esophageal motility disorders are variable and may not be best conceptualized as an independent group. Original classifications can be recategorized according to the updated Chicago Classification system. More research is needed on this topic. (Gut Liver 2013; 7:377 381)
송성은 ( Sung Eun Song ),박무인 ( Moo In Park ),문원 ( Won Moon ),박선자 ( Seun Ja Park ),김규종 ( Kyu Jong Kim ),김재현 ( Jae Hyun Kim ),김경미 ( Gyung Mi Kim ),김종국 ( Jong Kuk Kim ),심영주 ( Young Joo Sim ),이정민 ( Jung Min 대한소화기기능성질환·운동학회 2009 Journal of Neurogastroenterology and Motility (JNM Vol.15 No.1
Dermatomyositis is a rare autoimmune disorder afflicting an estimated 6-10 million people worldwide that has a distinct clinical entity identified by a characteristic skin rash and inflammatory myopathy. It can be combined with other connective tissue diseases such as systemic sclerosis or systemic lupus erythematosus. In addition to primary disturbances of limb muscle and skin, extramuscular manifestations include dysphagia, cardiac conduction abnormalities, interstitial lung disease or subcutaneous calcifications. Dysphagia occurs in 12%-54% of those with dermatomyositis, manifests gradually over weeks to months rather than in acutely, and is diagnosed with high-resolution esophageal manometry and video-fluoroscopic monitoring during swallowing. We report a case of dermatomyositis presenting initially with acute oropharyngeal dysphagia and review the available swallowing studies and related literature. (Kor J Neurogastroenterol Motil 2009;15:65-69)
다발성 전이를 동반한 대장암의 발견 전에 진단된 식도이완불능증
송준영 ( Jun Young Song ),박무인 ( Moo In Park ),문원 ( Won Moon ),최정민 ( Jung Min Choi ),김도현 ( Do Hyun Kim ),유홍준 ( Hong Jun You ),김규종 ( Kyu Jong Kim ),박선자 ( Seun Ja Park ) 대한소화기기능성질환·운동학회 2008 Journal of Neurogastroenterology and Motility (JNM Vol.14 No.1
Achalasia is characterized by failure of the lower esophageal sphincter to relax normally during swallowing and aperistaltic movement of the esophageal body. The large majority of achalasia is idiopathic, a disorder of unknown etiology with ganglion cell degeneration of esophageal myenteric plexus. Only small proportion of achalasia is secondary induced by malignant tumors. To date, the achalasia in patiet with colon cancer has not been reported. We report a case of achalasia diagnosed before the detection of colon cancer with multiple metastasis.