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이소성 ACTH 생산에 의해 야기된 Cushing 증후군이 동반된 소세포 폐암
곽영임 ( Young Im Kwak ),임영혁 ( Young Hyuck Im ),천영국 ( Young Kug Cheon ),이가희 ( Ka Hee Yi ),남현석 ( Hyeon Seok Nam ),이춘택 ( Choon Taek Lee ),강윤구 ( Yoon Koo Kang ),이진오 ( Jhin Oh Lee ),강태웅 ( Tae Woong Kang ) 대한결핵 및 호흡기학회 1995 Tuberculosis and Respiratory Diseases Vol.42 No.6
이영현(Young Hyun Lee),김용조(Yong Cho Kim),김서운(Seo Woon Kim),임영혁(Young Hyuck Im),김유철(You Cheoul Kim),강윤구(Yoon Koo Kang),김창민(Chang Min Kim),홍원선(Weon Seon Hong),이진오(Jhin Oh Lee),강태웅(Tae Woong Kang),장자준(Ja Ju 대한내과학회 1994 대한내과학회지 Vol.47 No.1
Congenital hepatic fibrosis is a relatively rare disease which is characterized by bile ductular proliferation and prominent fibrosis in the portal area of liver resulting in portal hypertension. The patients usually present with esophageal varix bleeding or repeated episodes of acute cholangitis which both are the major determinants of the long-term prognosis. Congenital hepatic fibrosis is frequently associated with other abnormalities such as polycystic kidney, Caroli`s syndrome, cystic dysplasia of the pancreas, intestinal lymphangiectasia, pulmonary emphysema, hemangioma and cleft palate. We report here a case of congenital hepatic fibrosis associated with nodular nontoxic goiter, which has not been reported previously, pancytopenia due to hypersplenism and polycystic kidney in a 24-year-old female patients
전이성 또는 재발성 식도암에 대한 Cisplatin , Etoposide 및 5 - Fluorouracil ( PEF ) 복합화학요법의 치료 효과
류백렬(Baek Yeol Ryoo),임영혁(Young Hyuck Im),강윤구(Yoon Koo Kang),정상훈(Sang Hoon Jeong),김현각(Hyun Kag Kim),이창희(Chang Hee Lee),윤종길(Jong Kil Yoon),천영국(Young Kug Cheon),김서운(Seo Woon Kim),김유철(You Cheoul Kim),김창민(C 대한내과학회 1996 대한내과학회지 Vol.51 No.4
Esophageal cancer is widely disseminated in more than 80% of patients at the time of diagnosis and the prognosis of advanced esophageal cancer is dismal with a median survival of 5 to 8 months. Therefore, systemic chemotherapy has assumed an important role in the treatment of these patients. Among various combination chemotherapy regimens, the combination of cisplatin and 5-fluorouracil has been one of the most effective for esophageal cancer because of their synergism. Etoposide, although reported ineffective as a single agent, has been shown to be synergistic with cisplatin in vitro and in vivo. So, we conducted a phase 2 trial to evaluate the effect of a combination of cisplatin, etoposide and 5- FU (PEF) in patients with metastatic or recurrent esophageal cancer. Thirty-four patients with measurable lesion(s) received cisplatin (20㎎/㎡ i.v. Day 1~5), etoposide (100㎎/㎡ i.v. Day 1, 3 & 5) and 5-FU (800㎎/㎡ continuous i.v. for 12 hours, Day 1~5). Of 30 evaluable patients, 1(3.3%) had a complete response and 11(37%) had partial responses. The median duration of response was 29 weeks. The overall median survival was 34 weeks and the survival time in the responders was longer significantly than that of the non-responders. There was no significant prognostic factor influencing the response rate. Among total 135 cycles of chemotherapy, leukopenia was observed in 36% and thrombocytopenia in 4%. There was no treatment-related death. Main non-hematologic toxicities were neurotoxicity (17%), nephrotoxicity (3%), and stomatitis (10%) and diarrhea (10%). All the toxicities were mild and well tolerated. Conclusion: A combination chemotherapy of cisplatin, etoposide and 5-FU (PEF) was effective and well tolerated in patients with metastatic or recurrent esophageal cancer.
국소적으로 진행된 식도암 환자에서 Cisplatin , Etoposide 및 5 - Fluorouracil ( PEF ) 선행화학요법의 효과 ; A Pilot Study
정상훈(Sang Hoon Jeong),임영혁(Young Hyuck Im),강윤구(Yoon Koo Kang),손태용(Tae Yong Son),곽영임(Young Im Kwak),천영국(Young Kug Cheon),김현각(Hyun Kag Kim),류백렬(Baek Yeol Ryoo),김유철(You Cheoul Kim),이춘택(Choon Taek Lee),김창민( 대한내과학회 1996 대한내과학회지 Vol.51 No.4
The prognosis of esophageal cancer is very poor. Even for those with localized disease who are potentially curable, 5-year survival rates are under 20% in almost all series. We conducted a pilot study to evaluate the safety and possibility of efficacy of neoadjuvant chemotherapy followed by surgery in patients with locally advanced esophageal cancer. Two or three cycles of neoadjuvant combination chemotherapy with cisplatin (20㎎/㎡/day i.v., D1-5), etoposide (100㎎/㎡/day i.v., D1,3,5), and 5-fluorouracil (800㎎/㎡/day continuous i.v., D1-5) were planned to be given before surgery. Total 21 patients entered this trial. Three patients were lost to follow-up after 1 cycle of chemotherapy to make eighteen patients evaluable. Thirteen out of eighteen patients (72%) had objective improvement after neoadjuvant chemotherapy and four (22%) had no change and one (6%) had progression. Among 18 evaluable patients, surgery was performed in 11 patients. Surgery could not be done in 7 patients because of patient's refusal (5), progression of disease (1), and development of lung abscess (1). In 13 patients who were candidates for surgery, curative resection was done in 10 patients to make curative resection rate 10/13 (77%). One of eleven patients having surgical resection had no pathologic evidence of tumor (pathologic complete remission 9%). Postoperative complications of wound dehiscence and anastomotic site fistula developed in 2 patients. Three courses of postoperative adjuvant chemotherapy with PEF regimen were administered to 9 patients. The median survival time for all 18 patients was 60 weeks. Toxicities of PEF neoadjuvant chemotherapy were leukopenia, nausea/vomiting and alopecia, but they were mild and reversible. There was no treatment-related deaths. In conclusion, neoadjuvant chemotherapy with PEF regimen were tolerable, safe and possibly effective in locally advanced esophageal cancer. Based on this study, we will perform phase 2 or 3 study to assess the efficacy of PEF neoadjuvant chemotherapy for locally advanced esophageal cancer.
Aggressive 비호즈킨 림프종의 예후인자 분석과 고위험군 환자 선별을 위한 International Prognostic Index Model
김경태(Kyung Tae Kim),김태유(Tae You Kim),임영혁(Young Hyuck Im),강윤구(Yoon Koo Kang),이창희(Chang Hee Lee),곽영임(Young Im Kwak),류백렬(Baek Yeol Ryoo),성주병(Ju Byeung Sung),이영우(Young Wo Lee),장은정(Eun Jung Jang),김재학(Jae Ha 대한내과학회 1997 대한내과학회지 Vol.53 No.3
Objective: Although the therapeutic outcome of aggressive non-Hodgkin's lymphoma (NHL) has been considerably improved by the introduction of combination chemotherapy, many patients still fail to achieve complete response(CR) and/or long-term survival. Because the outcome appears to depend on certain prognostic factors, long term prognosis can be predicted by identification of risk group. And also, the patients in high risk group may benefit from new therapeutic modality. In 1993, the international prognostic index model for aggressive NHL as developed far the purpose of predicting outcome and designing of therapeutic trial. Thus, analysis of prognostic factors was performed to identify independent factors for the end points of CR, overall survival, and disease-free survival. Methods : From 1989 to 1994, total 340 patients were treated with combination chemotherapy and/or radiotherapy for NHL in Korea Cancer Center Hospital. Among 340, informations on eleven prognostic factors(sex, age, performance status, Ann Arbor stage, serum LDH level, tumor size, number of extranodal disease sites, bone marrow involvement, presence of B symptom, sex, time to CR, and histologic grade) were avaliable for 273 patients. Among these, 221 patients with aggressive NHL(NCI clinical schema) were eligible for the prognostic factor analysis for the response and survival. Also, 186 patients were eligible to determine whether International Prognostic Index Model could be applicable for Korean NHL. Results: One hundred fifty patients(68%, 95% CI 62-74%) achieved a complete remission, 43 patients (20%) a partial remission. With a median follow-up of 3,5 years, overall 3 year survival rate was 6396, and 3 year DFS for the 150 CRs was 72%. In a univariate analysis for the CR and survival, Ann Arbor stage, number of extranadal disease, performance status, presence of B symptoms, presence of BM involvement, serum LDH level and histologic grade were found to be statistically significant prognostic factors. Among them, by multivariate analysis, number of extranodal disease(RR 0.2, 95% CI 0.1-0.7), B Symptoms (RR 0.4, 95% CI 0.2-0.9), and histologic grade(RR 0.2, 95% CI 0.08-0.7) showed to be independent adverse prognostic factors for CR. For disease-free survival, Ann Arbor stage(RR 2.6, 95% CI 1.1-6.4) was independent risk factor. For overall survival, number of extranodal involvement(RR 2, 95% CI 1.3-4) and histologic grade(RR 2, 95% CI 1.2-3.7) were independently significant prognostic factors. With these 2 independent prognostic factors for survival, we could establish a prognastic index model which could separate the high risk patients. However, the usefulness of this model should be confirmed in a larger patient population. The dose intensity of cyclophosphamide, during initial 3 months of treatment, was significantly associated with CR rate and overall survival(p=0.01 & 0.03, respectively). When International Prognostic Index Model was applied to our patients, patients in the lower risk groups had significantly better outcome than patients in the higher risk groups(3 year survival and RR: 77% & 1 for low risk group, 61% & 1.9 for low-intermediate risk group, 50% & 2.2 for high-intermediate risk group, and 25% & 6 for high risk group). Conclusion: In this study, we confirmed that features other than the Ann Arbor stage were independently associated with CR and survival, and the International Prognostic Index Model would be an useful tool for the selection of high-risk patients who could be benefited from more aggressive chemotherapy.
이지연(Jee Yun Lee),김원석(Won Seog Kim),송서영(Seo Young Song),이순일(Soon Il Lee),박준오(Joon Oh Park),김기현(Ki Hyun Kim),고영혜(Young Hyeh Ko),정철원(Chul Won Jung),임영혁(Young Hyuck Im),강원기(Won Ki Kang),이홍기(Hong Ghi Lee) 대한내과학회 2002 대한내과학회지 Vol.63 No.1
Primary lymphoma of the urinary bladder is a rare non-epithelial bladder tumor accounting for less than 1% of all bladder tumors. Approximately 17 cases of MALT lymphomas of bladder have been reported in the literature. Most reported MALT lymphomas of bladder have a female sexual preponderance with a mean age of 58 years with common presenting symptoms of hematuria, dysuria and urinary frequency. The reported prognosis of MALT lymphoma of the urinary bladder is excellent. We report a case of MALT lymphoma of urinary bladder in a 57-year-old woman patient who presented with a two-year history of persistent dysuria and urinary frequency. An intravenous pyelogram and cystoscopy revealed a 1 cm focal elevated lesion at the base of urinary bladder. The tissue obtained by transurethral resection (TUR) showed plasma cell infiltration consistent with low grade marginal zone B cell lymphoma. The immunohistochemical studies showed an immunoglobulin restriction to lambda light chain while the nested polymerase chain reaction analysis of the tissue showed a monoclonal Ig heavy-chain gene rearrangement. The clinical staging protocol revealed that the tumor was primarily arising from the urinary bladder with no evidence of other site involvements. The patient received radiation therapy of 3060 cGy in 17 fractions.(Korean J Med 63:98-102, 2002)
Klinefelter 증후군에 병발된 원발성 종격동 생식세포종
김용조 ( Yong Jo Kim ),권교선 ( Gyo Seon Kwun ),이영우 ( Young Wo Lee ),김경태 ( Kyung Tae Kim ),박연희 ( Yeon Hee Park ),류백렬 ( Baek Yeol Ryoo ),김태유 ( Tae You Kim ),임영혁 ( Young Hyuck Im ),이춘택 ( Choon Taek Lee ),강윤구 대한결핵 및 호흡기학회 1996 Tuberculosis and Respiratory Diseases Vol.43 No.6
수술이 불가능한 제 III기 비소세포폐암에서 Cisplatin 및 Etoposide(EP)의 화학요법과 방사선요법의 병행요법(2상 임상연구)
허남현,이춘택,김재학,장재진,남승모,박연희,류백렬,김태유,임영혁,강윤구,김미숙,류성렬,이진오,강태웅,Hur, Nam-Hyun,Lee, Choon-Taek,Kim, Jae-Hag,Jang, Jae-Jin,Nam, Seung-Mo,Park, Yeon-Hee,Ryoo, Baek-Yeol,Kim, Tae-You,Im, Young-Hyuck,Kang, Yoon-Ko 대한결핵및호흡기학회 1997 Tuberculosis and Respiratory Diseases Vol.44 No.4
서 론 : 비소세포폐암은 전체 폐암의 약 75%를 차지하고 있으며 조기 발견에 이은 외과적 절제가 유일한 완치방법으로 알려져 있다. 그러나 병기 III기에서는 정립된 치료방법이 없고 여러 종류 및 조합의 치료방법이 시도되고 있다. 이에 연구자들은 수술이 불가능한 병기 IIIA 및 악성흉수를 제외한 병기 IIIB의 과거 치료력이 없는 비소세포폐암 환자에서 cisplatin, etoposide 이용한 복합화학요법을 동시에 시행하여 그의 효과 및 순응성을 조사하였다. 대상 및 방법 : 1995년 10월부터 1996년 12월까지 원자력병원에 입원하여 조직학적으로 비소세포폐암으로 진단된 병기 III기의 환자중 수술이 불가능한 IIIA 및 IIIB의 환자를 대상으로 하였다. 복합화학요법은 cisplatin 30mg/$m^2$/D, etoposide 80mg/$m^2$/D를 방사선요법과 동시에 시작하여 3일간 투여후 4주 간격으로 총 3회 투여하였고, 방사선요법은 5940cGy까지 진행후 치료효과를 평가하였다. 결 과 : 총 대상환자 32명 중 조기종료한 3명을 제외한 29명에서 평가가 가능하였으며, 완전관해는 없었고 부분관해 22명(75.9%), 불변 5명(17.2%), 치료중 진행하였던 경우가 2명(6.9%)으로 전체관해율은 75.9%, 중앙 생존기간 12.1개월, 1년 생존률은 50.6%로 나타났다. 치료에 의한 주된 독성은 백혈구감소로 WHO기준으로 3등급이상이 13명(45%)에서 나타났고 혈소판감소는 3등급이상이 3명(11%)에서 나타났으나 모두 회복되었고, 그밖에 오심과 구토는 대부분의 환자에서 2등급이하이었으며 방사성폐렴은 13명(46%)에서 나타났다. 결 론 : 수술이 불가능한 병기 IIIA 및 악성흉수를 제외한 병기 IIIB기 비소세포폐암환자에서 EP 복합화학요법과 방사선요법을 동시 병행한 치료는 비교적 안전하면서 효과적이었으며, 이에 대한 평가는 방사선요법을 단독으로한 치료와의 3상 연구를 요할 것으로 사료된다. Background : Various combinations of treatment modalities have been reported in stage III non-small cell lung cancer (NSCLC). however, the standard treatment modality has not established yet. Recently, the efficacy of concurrent chemotherapy and radiation therapy has been reported in locally advanced lung cancer. We evaluate the response rate, toxicity, and survival of concurrent chemotherapy with etoposide and cisplatin(EP) and radiation therapy for unresectable stage III NSCLC. Method : Between October 1995 and December 1996, 32 patients with histologically proven unresectable stage III NSCLC without malignant pleural effusion were entered into this study. Twenty-nine patients were eligible for the response, survival, and toxicity analysis. Induction was two cycles of chemotherapy with etoposide and cisplatin plus concurrent chest RT to 4500cGy. Resection was attempted if the clinical response offered surgical resectability. Boost radiation therapy upto 5940cGy and one cycle of EP were performed if the disease were stable or responsive but still unresectable. Results : Of 29 eligible patients, 22(75.9%) showed partial response(PR). The progression free interval was 6.3months(range 1.1 to 19.5months). Surgical resection was performed in one patient. The median survival was 12.1months and one-year survival rate was 50.6%. The major toxicity was leukopenia($\geq$ grade 3, 46%). Thrombocytopenia over grade 3 was found in 11%. Radiation pneumonitis occurred in 13 patients(46%). Conclusion : Concurrent chemotherapy(EP) plus radiotherapy was effective and tolerable in the treatment of unresectable stage III NSCLC.
치료의 전력이 없는 다발성 골수종에 대한 Vincristine , Doxorubicin 및 Dexamethasone ( VAD ) 복합화학요법의 효과
김성환(Seong Whan Kim),류백렬(Baek Yeol Ryoo),김태유(Tae You Kim),임영혁(Young Hyuck Im),박연희(Yeon Hee Park),김봉석(Bong Seog Kim),최병국(Byung Kook Choi),김경현(Kyung Hyun Kim),강윤구(Yoon Koo Kang) 대한내과학회 1999 대한내과학회지 Vol.56 No.1
Objective : The combination of vincristine and doxorubicin by continuous infusion was reported to reduce tumor mass more rapidly than standard regimens, which maybe a result of effect on more slowly proliferating plasma cells. We conducted a phase II study to determine the activity and safety of VAD (vincristine, doxorubicin, dexamethasone) chemotherapy, in which vincristine and doxorubicin are administered as a continuous infusion, for previously untreated multiple myeloma. Methods : VAD chemotherapy (vincristine 0.4 mg/day 24 hour-continuous infusion, days 1∼4; doxorubicin 9 mg/m2/day 24 hour-continuous infusion, days 1∼4; dexamethasone 40 mg/day p.o. days 1∼4) was given to eligible patients every 4 weeks and we assessed response and toxicity of the regimen. Results : Between January 1991 and March 1997, total 25 patients entered this trial and 22 were evaluable. The complete response rate was 14%(3/22) and overall response rate was 59%(13/22, 95% C.I.: 38∼80%). The time to response was 1.0∼6.8(median 2.9) months. Progression free survival was 2∼39+(median 11.5) months and the overall survival was 3+∼42+(median 19.7) months. Toxicities of VAD regimen were leukopenia, infection, stomatitis and neurotoxicity, but there was no treatment-related death. Conclusion : VAD chemotherapy was tolerable, but not more active than the alkylating agent-based chemotherapy as a front-line treatment for the patients with multiple myeloma. But, because of its rapid response and relatively mild myelotoxicity, it could play a role for advanced or highly complicated disease and for remission induction before consolidation with high-dose chemotherapy.
악성 종양 환자에 사용된 중심정맥카테터의 안정성에 대한 임상 연구
김형건(Hyung Gun Kim),손태용(Tae Yong Son),유영진(Young Jin Yuh),이상구(Sang Goo Lee),천은미(Eun Mee Cheon),송재관(Jae Kwan Song),임영혁(Young Hyuck Im),강윤구(Yoon Koo Kang),조재일(Jae Ill Zo),심영목(Young Mog Shim) 대한내과학회 1995 대한내과학회지 Vol.49 No.3
Objectives: As the central venous catheters (CVCs) have been inserted frequent,ly in patients with advanced malignant disease, it becomes necessary to investigate the safety and the complications of the CVCs and to search for the ways to improve them. Methods: The complications related with CVCs and the durations of function of them were analyzed via retrospective review of medical records of 87 patients to whom CVCs were inserted for the treatment of cancer at the departrnent. of internal medicine, Korea Cancer Center Hospital. Results: Acute complications of catheter inser1ion were pneumothorax and pain at the insertion site. Infection, thrombosis and mechanical teraring were the major long term complications. 32(36.8%) catheters were removed by development of complications. Among 87 evaluable cases, CVCs could be maintained with function for 4+to 878+days (median 401 days). There were significantly less infection (40 % vs. 72% ) and longer duration of function(median not. reached vs. 151 days) with Chemoport than with Hickman catheter(p=0.002). Conclusion. CVCs could be inserted and maintained safely for considerahle period of time in patients with advanced malignancy. Further effort should be given to prevent catheter-related complications such as infection and thrombosis and to provide the long term patency.