반복된 출혈을 동반한 상부 위장관 혈관 이형성증 2예

민영일(Young Il Min),이영상(Young Sang Lee),김해련(Hae Ryun Kim),김명환(Myung Hwan Kim),두영철(Young Cheoul Doo),김상위(Sang We Kim),정영화(Young Hwa Joung),이승규(Sung Gyu Lee),박건춘(Kun Choon Park),민병철(Pyung Chul Min),유은실(Eu 대한소화기학회 1990 대한소화기학회지 Vol.22 No.2

We experienced 2 cases of angiodysplasia in duodenal bulb and stomach. The patients had a history of repeated upper gastrointestinal bleeding, and were diagnosed as a angiodysplasia by gastroscopy and angiography. they were treated with surgery due to large lesional involement.

만성폐쇄성 폐질환과 승모판협착증 환자에서의 운동부하 검사

김상위(Sang We Kim),고윤석(Youn Suck Koh),김우성(Woo Sung Kim),김재중(Jae Joong Kim),박성욱(Seong Wook Park),박승정(Seung Jung Park),이종구(Jong Koo Lee),김원동(Won Dong Kim) 대한내과학회 1991 대한내과학회지 Vol.41 No.1

N/A There have been many conflicts concerning the mechanism of exercise limitation in chronic obstructive pulmonary disease (COPD) and mitral stenosis(MS). We performed exercise test with incremental cycle ergometer and measured ventilatory response and heart rate response in 10 normal controls, 10 COPD patients, and 10 MS patients. The results were as follows: (1) COPD and MS patients showed decreased maximal exercise capacity (67±16%, 54±4%, of maximal predicted oxygen uptake) compared with the control group (88±11%). (2) COPD patients showed much higher maximal minute ventilation, lower breathing reserve (100±17% of maximum predicted value, 7±6%), and normal anaerobic threshold (45±7% of maximal predicted oxygen uptake) compared with the MS patients (51±10%, 50±8% and 33±4%) and controls (59±15%, 46±125, and 56±9%), which indicated an exercise limitation due to an abnormality in the respiratory system. (3) The MS patients showed loawer anaerobic threshold, lower maximal minute ventilation, and normal breathing reserve compared with the COPD patients and normal controls, which indicate an exercise limitation due to an abnormality in the cardiovascular system. With the above results, it is thought that an incremental cycle ergometer exercise test is useful in diagnosing the limitation factor of maximal exercise in respiratory and cardiovascular system disease.

식도암 환자에서 악성기관지 - 식도루

김성배(Sung Bae Kim),김상희(Sang Hee Kim),김상위(Sang We Kim),서철원(Cheol Won Suh),이규형(Kyoo Hyung Lee),이정신(Jung Shin Lee),김해련(Hae Ryun Kim),민영일(Young Il Min),송호영(Ho Young Song),최은경(Eun Kyung Choi),이재원(Jae Won Le 대한내과학회 1995 대한내과학회지 Vol.48 No.5

N/A Objectives: Patients with esophageal cancer and a malignant tracheoesophageal fistula(TEF)have an extremely poor prognosis, with or without treatment. However, the presence of a TEF has historically been considered a relative contraindication to radiation therapy. Methods: To determine the appropriate treatmement(use of radiation therapy)for patients with esophageal cancer and malignant TEF, a review was performed of all such cases, obeserved at Asan Medical Center between 1989 and 1993. Results: 1) Six patients with malignant TEF were seen in total 130 esophageal cancer patients, so the incidence was 4.6%. 2) All of the patients were male, had squamous cell histologies. 3) Dysphagia as initial presenting symptom was a chief complaint in all six patients. 4) The number of TEF formation was one in five of six patients, two in the rest. 5) Three TEFs were developed during radiotherapy, two of them stopped radiation therapy, and one patient continued to treat with hyperfractionated radiation and cured. 6) The median survival length was 33(3-60) weeks after initial tumor diagnosis and 16(2-39) weeks after the first TEF occurred. The duration between initial tumor diagnosis and TEF formation was 17.6(0.6-22) weeks. 7) As a pllliative aim, gastrostomy was done in two patients, jejunostomy in one patient, and stent insertion in the other two patients. Associated symptoms with TEF were markedly improved after stent insertion. 8) The cause of death was sepsis as a resulf of aspiration pnenumonia and lung abscess in five of six patients, and advanced esophageal cancer with lung metastasis in the rest. Conclusion: Early detection and proper management were essential in malignant TEF and esophageal cancer. Stent insertion was good palliation. Radiation therapy might be initiated or continued in the presence of a TEF, and eventual resolution of the fistula might occur. Prospective randomized trials are necessary to define the role of radiation treatment, and further attempts to improve the malignt TEF are required.

Hyperfractionated Radiotherapy and Concurrent Chemotherapy for Stage III Unresectable Non Small Cell Lung Cancer : Preliminary Report for Response and Toxicity

최은경,김종훈,장혜술,김상위,서철원,이규형,이정신,김상희,고윤석,김우성,김동순,김원동,송군식,Choi, Eun-Kyung,Kim, Jong-Hoon,Chang, Hye-Sook,Kim, Sang-We,Suh, Cheol-Won,Lee, Kyoo-Hyung,Lee, Jung, Shin,Kim, Sang-Hee,Ko, Youn-Suk,Kim, Woo-Sung The Korean Society for Radiation Oncology 1995 Radiation Oncology Journal Vol.13 No.2

목적 : 절제 불가능한 제 3기 비소세포성 폐암에서 다분할 방사선 치료와 MVP 복합 항암요법의 동시 치료에 의한 종양관해율, 급성부작용, 생존기간에 미치는 효과를 알아보기 위하여 1993년 8월부터 전향성 연구(Prospective study)를 시작하였다. 방법: 본 연구는 제 III기의 비소세포성 폐암중 절제가 불가능한 환자를 대상으로 하여 다분할 방사선치료(120 cGy/fx, BID)를 6,480 cGy 시행하며 동시에 방사선치료 제1일과 28일에 2회의 MVP (Mitomycin C $6mg/m^2,$ Vinblastine $6mg/m^2,$ Cisplatin $60mg/m^2$) 복합 항암 요법을 시행하였다. 1994년 11월까지 등록된 62명의 환자에 대한 분석을 시행하였다. 병기는 IIIa 환자가 6명이고 나머지 56명은 IIIb 환자였으며 이중 흉막액이 있었던 환자는 11명, 쇄골상 임파선 전이가 있었던 환자는 10명으로 대부분의 환자가 IIIb 중에서도 진행된 환자였다. 조직학적 유형은 편평 상피암이 41명으로 $66\%$ 선암도 11명으로 $18\%$를 차지하였다. 결과: 52명의 환자중 끝까지 치료를 마친 환자는 48명으로 이 study의 compliance는 $77\%$이었다. 48명의 환자중 2명은 치료중 치료와 관계된 백혈구 감소로 인한 폐렴으로 사망하였다. 치료의 효과를 판정할 수 있었던 46명의 환자중 완전 관해(CR)는 10명으로 $22\%$의 높은 완전 관해율을 보였다. 부분 관해(PR)는 24명 $(52\%)$ 으로 다분할 방사선 치료와 동시 병행 MVP 항암요법에 의한 부분관해 이상의 관해율은 $74\%$ 이었다. 급성부작용 판정이 가능했던 46명중 가장 빈도가 높은 금성 부작용은 백혈구 감소로 1차 항암요법후 10명이 Grade 3, 4명이 Grade 4의 백혈구 감소를 보였으며 2차 항암요법에는 11명이 Grade 3, 9명이 Grade 4의 백혈구 감소를 보여 치료기간이 3일에서 5일 정도 지연되는 결과를 나타냈고 이중 2명은 폐렴으로 인한 패혈증으로 사망하였다. 치료중 체중감소를 보인 환자는 26명 $(54\%)$ 이었으며 이중 9명에서는 치료전에 비해 $10\%$ 이상의 체중감소를 보였다. 치료 1개월후 찍은 CT상 6명에서는 Grade 1의 방사선 폐렴이 관찰되었고 3명에서는 Grade 2로 Steroid 치료후 호전되었다. 결론: 이상의 결과 다분할 방사선 치료와 MVP 항암요법의 동시 치료가 이전의 항암요법후 다분할 방사선 치료하는 Sequential 방법에 비하여 높은 관해율을 보이고 특히 $22\%$의 높은 완전 관해율이 관찰되어 이 연구를 계속 진행함으로써 더 좋은 결과를 얻을 것으로 생각되며 급성 부작용에 대하여는 입원을 통한 Nutrition support와 G-CSF 등을 이용하여 백혈구 감소를 막을 수 있을 것으로 생각된다. Lung cancer study group at Asan Medical Center has conducted the second prospective study to determine the efficacy and feasibility of MVP chemotherapy with concurrent hyperfractionated radiotherapy for Patients with stage III unresectable non-small cell lung cancer(NSCLC). All eligible Patients with stage III unresectable NSCLC were treated with hyperfractionated radiotherapy(120 cGy/fx BID. 6480 cGy/54fx) and concurrent 2 cycles of MVP(Mitomycin C $6mg/m^2,$ d2 & d29.Vinblastine $6mg/m^2,$ d2 & d29, Cisplatin $60mg/m^2,$ dl & d28) chemotherapy. Between Aug. 1993 and Nov. 1994, 62 patients entered this study; $6(10\%)$ had advanced stage IIIa and $56(90\%)$ had IIIb disease including 11 with pleural effusion and 10 with supraclavicular metastases. Among 62 patients, $48(77\%)$ completed planned therapy. Fourteen patients refused further treatment during chemoradiotherapy. Of 46 patients evaluable for response, $34(74\%)$ showed major response including $10(22\%)$ with complete and $24(52\%)$ with partial responses. Of 48 patients evaluable for toxicity, $13(27\%)$ showed grade IV hematologic toxicity but treatment delay did not exceed 5 days Two patients died of sepsis during chemoradiotherapy. Severe weight loss(more than $10\%)$ occurred in 9 patients$(19\%)$ during treatment. Nine patients$(19\%)$ developed radiation pneumonitis Six of these patients had grade 1 (mild) Pneumonitis with radiographic changes within the treatment fields Three other patients had grade 11 Pneumonitis, but none of these patients had continuous symptoms after steroid treatment. Concurrent chemoradiotherapy for patients with advanced NSCLC was well tolerated with acceptable toxicity and achieved higher response rates than the first study, but rather low compliance $rate(77\%)$ in this study is worrisome. We need to improve nutritional support during treatment and to use G-CSF to improve leukopenia and if necessary. supportive care will be given as in patients, Longer follow-up and larger sample size is needed to observe survival advantage.

진행성 비소세포폐암에서 Navelbine , Ifosfamide , Cisplatin 복합항암화학요법

김태원(Tae Won Kim),김상희(Sang Hee Kim),최성준(Sung Jun Choi),최종수(Jong Soo Choi),김상위(Sang We Kim),최은경(Eun Kyung Choi),서철원(Cheol Won Suh),이정신(Jung Shin Lee),김우성(Woo Sung Kim),김동순(Dong Soon Kim),김원동(Won Dong Ki 대한내과학회 2001 대한내과학회지 Vol.60 No.5

N/A Background : We performed a phase 2 study to determine the activity and toxicity of Navelbine, Ifosfamide, and Cisplatin (NIP) combination in patients with stage IIIB-4 non-small cell lung cancer (NSCLC). Methods : Thirty-two chemotherapy naive patients were enrolled from 2 centers between February 1997 and December 1997. The median age was 57 years (range, 29-71) ; stage IIIB/IV 6/26; male/female 23/9. The regimen consisted of navelbine (25 mg/m2 day 1 and 5), ifosfamide (3 g/m2 day 5 with uroprotective mesna), and cisplatin (80 mg/m2 day 5) every 3 weeks. Results : Twenty-six were evaluable for response and 31 for toxicity. One patient was lost to follow up, one patient refused to continue, and 4 patients could not continue due to poor performance. Total of 120 cycles have been given, with median of 4 cycles per patient (range ; 1-6). Sixteen patients achieved partial response (response rate on an intention-to-treat basis, 50%; 95% C.I:32-68% ). Neutropenia was the most common toxicity. Grade 3-4 neutropenia was observed in 39% of courses ; thrombocytopenia 4% of courses ; anemia 14% of courses. Three patients developed febrile neutropenia; there was no treatment-related death. The median time to progression was 6.9 months and the median overall survival 8.0 months. The probability for 1-year survival was 25%.

근치적 목적의 절제술 후 II , IIIA 기 비소세포폐암의 Mitomycin - C , Vinblastine , Cisplatin ( MVP ) 복합항암화학요법과 방사선요법의 병용 치료

김태원 ( Tae Won Kim ),이정신 ( Jung Shin Lee ),정병학 ( Byung Hak Jung ),윤환중 ( Hwan Jung Yun ),장대영 ( Dae Young Zang ),이제환 ( Je Hwan Lee ),김성배 ( Sung Bae Kim ),김상위 ( Sang We Kim ),서철원 ( Cheol Won Suh ),이규형 ( K 대한내과학회 1998 대한내과학회지 Vol.54 No.5

Objectives: The poor survival rates among patients receiving surgery alone for stages II and III non-small cell lung cancer prompted several trials of adjuvant therapy after resection. We performed a prospective phase II study in patients with stage II-IIIA non-small cell lung cancer after resection to evaluate the feasibility, activity and toxicity of the postoperative sequential MVP chemotherapy and radiotherapy. Methods: Between February 1991 and May 1995, 60 patients with resected stage II, IIIA non-small cell lung cancer received 2 cycles of MVP combination chemotherapy (Mitomycin-C 6 mg/m², Vinblastine 6 mg/m², Cisplatin 60 mg/m) within 3 weeks after surgery, followed by thoracic irradiation (5,040 cGy after complete resection and 900 cGy booster to microscopically positive resection margin at 1.8 Gy per fraction) within 3-4 weeks after chemotherapy. Results: Forty nine men and 11 women with a median age of 60.5 years (range 33-81 years) were included. During the median follow-up period of 828 days (61-2,015 days), 25 patients had developed recurrence. Among the 25 failures, 3 were local relapse only and 20 were distant metastasis only and 2 had both local and distant sites of recurrence. Three-year overall survival and event-free survival were 43% and 37%, respectively. Neutropenia of grade I-II was observed only in 13 patients. Eleven patient showed grade I-II radiation pneumonitis and 32 had grade I-II radiation esophagitis, Conclusion: Postoperative sequential MVP chemotherapy and radiotherapy in resected stage II-IIIA non-small cell lung cancer is well-tolerated and shows interesting activity,

급성 골수성 백혈병에서 고용량 Cytarabine 을 이용한 공고요법

김도하(Do Ha Kim),이규형(Kyoo Hyung Lee),조재근(Jae Kun Cho),김선희(Seon Hee Kim),이제환(Je Hwan Lee),김성배(Sung Bae Kim),김상위(Sang We Kim),서철원(Chul Won Suh),이정신(Jung Shin Lee),김우건(Woo Kun Kim),김상희(Sang Hee Kim) 대한내과학회 1996 대한내과학회지 Vol.51 No.4

N/A Objectives: This study was designed to evaluate the therapeutic efficacy of postremission therapy utilizing high-dose cytarabine in patients with newly diagnosed acute myelogenous leukemia and to assess the toxicities of the therapy. Acute promyelocytic leukemia (FAB M3) is excluded because it has very unique clinicopathologic characteristics. Methods: Those patients who achieved complete remission had first consolidation therapy with conventional dose cytarabine and daunorubicin but second and third consolidation was done with high-dose cytarabine (cytarabine 1gm/㎡ i.v. over 1 hour every 12 hours daily for 5 days) and daunorubicin. Overall survival and disease free survival were compared with previous conventional dose cytarabine and daunorubicin postremission therapy. Results: 1) Complete remission occurred in 62% (28 of 45 patients) and control group 48% (14 of 29 patients) (p=0.15). 2) The median survival of all 45 patients was not different significantly compared with control group (10 months vs 7 months, p=0.08). 3) The median disease free survival of 21 complete responders receiving at least one course of consolidation was 10 months and there was no significant difference compared with control group 7 months (p=0.47). 4) The toxicity including treatment-related motility, neutropenia duration was similar in both groups. Conclusion: Although our high-dose cytarabine consolidation therapy regimen appeared to have acceptable toxicity, its results did not show the superiority to previous conventional dose cytarabine consolidation regimen.

중심정맥 도관 삽입술의 성공률과 합병증 발생 빈도에 대한 전향적 연구

배창황(Chang Hwang Bae),김우건(Woo Kun Kim),박완(Wan Park),박진희(Jin Hee Park),김정균(Jeong Kyun Kim),최성준(Sung Jun Choi),이제환(Je Hwan Lee),김성배(Sung Bae Kim),김상위(Sang We Kim),서철원(Cheol Won Suh),이규형(Kyoo Hyung Lee),이 대한내과학회 1998 대한내과학회지 Vol.55 No.2

N/A Objectives: The reported success rate of central venous catheterization ranged from 84% to 97.5%, and the complication rate from 0.3% to 12%. The most important contributing factor for complications reported by several authors was the physician's experience. We investigated the success and complication rates of central venous catheterization prospectively. We also evaluate the factors that contributed to complications at our institution as part of our quality assurance study. Methods: Four hundred sixty five central venous catheterizations were conducted at the medical intensive care unit and the general ward of the hemato1ogy/ oncology department of Asan Medical Center in Korea, from June to November, 1997. We surveyed the date and place of the procedures, lD numbers, age and sex of the patients, the training level of physicians, the types of catheters, initial puncture sites, success or failure, and complications. We grouped the purpose of procedures into 5categories, such as hemodynamic monitoring, fluid therapy, chemotherapy, total parenteral nutrition, and others, Results: The initial success rate, defined as the initial performer being able to insert the catheter without changing the skin puncture site, was 78.5%. The overall success rate for initial performers, including those who required multiple skin puncture sites, was 82.8%. The total success rate, including changing the performers (up to 4performers), was 96.1%. The overall complication rate was 5.2% including pneumothorax (2.8%), hemothorax (0.2%), subcutaneous hematoma (1.1%), catheter tip malposition (0.9%), and air-embolism (0.2%). There were no differences in the complication rates with regards to the sex and age of the patient, initial puncture sites, the physician's training level between 1st and 2nd year residency, and vein localization. However, the complication rate differed significantly in relation to the number of initial punctures. Patients with 1-3 punctures had a complication rate of 4.3%, while patients with 4 or more punctures had a complication rate of 18.5%. Conclusion: The overall complication rate was 5.2% and pneumothorax occured in 2.8%. We expect that we can decrease the number of complications by taking over the procedure if the initial performer fails on the first or second attempt and by attempting the skin puncture not more than 4times at initial trial.

성인 급성 림프구성 백혈병의 예후 : - 33 예의 환자들을 대상으로 한 분석 -

조유숙(You Sook Cho),이규형(Kyoo Hyung Lee),이제환(Je Hwan Lee),김성배(Sung Bae Kim),김상위(Sang We Kim),서철원(Cheol Won Suh),이정신(Jung Shin Lee),김우건(Woo Kun Kim),김상희(Sang Hee Kim),지현숙(Hyun Sook Chi),박찬정(Chan Jung Park 대한내과학회 1997 대한내과학회지 Vol.52 No.3

N/A Objectives: Rate of complete remission and long-term survival in adult acute lymphoblastic leukemia group has not been as satisfactory as that in childhood ALL. Recently introduction of induction chemotherapy of more intensive combination and various trials of postremission therapy are making improved results better looked forward to. And subtypes of ALL according to the degree of differentiation into T and B cells are identified by using immunologic markers hopefully to work out proper treatment for each subtype. Methods: We analited results of treatment and differences of complete remission rate, remission duration and overall survival as to various immunologic markers and clinicopathologic characteristics in 33adult ALL patients. Results: Eighty five percents of the 27cases that had VPDL chemotherapy achieved complete remission and both overall median survival and mediom duration of remission were 52weeks. No definite prognostic factors were detected influencing complete remission rate, remission duration and overall survival except that patients with serum albumin level higher than 4.0mg/dL showed highter complete remission rate. Although mature B-ALL showed the shortest overall median survival, degree of differenciation of B-cell and other immunologic markers did not influence on complete remission rate, remission duration or overall survival. Conclusion: Further studies are needed to delire the prognostic factors in adult ALL

비호지킨림프종의 임상상과 예후인자

김태원(Tae Won Kim),이정신(Jung Shin Lee),최성준(Sung Jun Choi),최종수(Jong Soo Choi),장대영(Dai Young Zang),이제환(Je Hwan Lee),김성배(Sung Jun Choi),김상위(Sang We Kim),서철원(Cheol Won Suh),이규형(Kyoo Hyung Lee),김우건(Woo Kun Ki 대한내과학회 1997 대한내과학회지 Vol.52 No.2

N/A Objectives: The advent of intense combination chemotherapy has transformed aggressive non-Hod-gkins lymphoma from a disease that was once uniformly fatal to one that is now often curable. Remission rates and survival may be improved by using intensive chemotherapy regimens. However, this more aggressive approach is inevitably associated with increased toxicity, and an accurate pretreament prognostic assessment of patients is required to guide the physician in selecting the most appropriate therapeutic regimen. Many studies have reported prognostic factors of non-Hodgkins lymphoma in western countries, but there are few reports on prognostic factors in Koreans and it is suggested that clinical characteristcs of non-Hodgkins lymphoma in Korea differ from those in western countries. The purpose of this study was to illustrate clinical characteristics, prognostic factors and treatment outcome in non-Hodgkins lymphoma in Korea. Methods: Clinical features of 151patients (age over 15years) with non-Hodgkins lymphoma registered at Asan Medical Center from March 1989 to December 1993 were retrospectively reviewed. Prognostic factors and treatment outcome were evaluated among 121previously untreated patients. Multi variate analysis of potential pretreatment prognostic factors was performed using Coxs proportional hazards model. Results: Of the 151patients evaluated, 55% had diffuse large cell type, while low-grades were encountered in less than 1% of the patients. Extranodal involvement was noted in 76% of the patients. Cental nervous system was the commonest primary extranodal site, followed by stomach. Complete remission was achieved in 73 of 121patients (60%). The median follow-up for 121patients was 24months and the actuarial overall survival was 48% at 3years and 44N at 5years with a median overall survival of 33months. At the median followup of 32months, the actuarial 5year disease-free survival rate among 73patient with complete remission was 65% and median remission duration was not reached. Presence of systemic B symptoms and advanced clinical stages were associated with a low complete remission rate. None turned out to be associated with the remission duration. The Coxs proportional hazards model identified age above 60years, presence of systemic B symptoms and elevated LDH level as significant independent poor prognostic factors influencing overall survival. Conclusion: This study reveals a low prevalence rate of the low-grades lymphoma and a higher propensity of diffuse large cell type. These results suggest that clinical characteristics of non-Hodgkins lymphoma in Korea are different from those in the western countries. Our data also show that certain pretreatment clinical factors can help in predicting survival and in planning treatment.