독자투고/회신 : 젬시타빈 치료에 실패한 진행 췌장암 환자에서 구제 항암화학요법: 환자 상태에 따른 적극적인 항암치료는 생존 연장을 가져올 수 있다

이재련 ( Jae Lyun Lee ),김용태 ( Yong Tae Kim ) 대한소화기학회 2008 대한소화기학회지 Vol.52 No.1

폐암 환자의 안정시 에너지 소비

이재련 ( Jae Lyun Lee ),김기범 ( Ki Beom Kim ),이학준 ( Hak Jun Lee ),정진홍 ( Jin Hong Jung ),이관호 ( Kwan Ho Lee ),이현우 ( Hyun Woo Lee ) 대한결핵 및 호흡기학회 1997 Tuberculosis and Respiratory Diseases Vol.44 No.5

단전이성 뇌종양의 임상 양상과 예후 인자

이재련(Jae Lyun Lee),신창진(Chang Jin Shin),강희정(Hee Jeong Kang),오현아(Hyun Ah Oh),이구(Gu Lee),최재혁(Jae Hyuk Choi),배성화(Sung Hwa Bae),이경희(Kyung Hee Lee),현명수(Myung Soo Hyun),신세원(Sei One Shin),류헌모(Hyun Mo Ryoo) 대한내과학회 2002 대한내과학회지 Vol.62 No.4

목적 : 전이성 뇌종양은 성인 악성 종양환자의 흔한 합병증이다. 저자 등은 전이성 뇌종양의 임상적인 특징, 치료 효과, 생존에 영향을 미치는 예후 인자를 알아보고자 하였다. 대상 및 방법 : 1991년 1월부터 1997년 12월까지 본원에서 전이성 뇌종양으로 진단 받은 97예의 환자를 대상으로 하여 후향적으로 분석하였다. 결과 : 뇌전이의 원발종양으로는 폐암 (61예, 63%)이 가장 흔하였으며 그 외 원발 불명 전이성 뇌암 (15예, 16%), 위장관암 (13예, 13%), 유방암 (6예, 6%), 신장암 (2예, 2%) 순이었다. 단일성 뇌전이는 44예 (45%)였으며 다발성 뇌전이는 53예 (55%)였다. 치료 유무 및 종류를 고려하지 않을 경우 중앙생존기간은 3개월이었으며 1년 생존율은 8%였다. 생존율에 영향을 미치는 유의한 예후인자로는 진단당시 활동능과 신경손상의 정도 (p< 0.01)였다. 어떠한 치료도 시행하지 않는 군에 비해 스테로이드를 포함한 치료를 시행한 군에서 유의한 생존기간의 증가를 관찰할 수 있었다 (1.1개월 대 3.7개월). 스테로이드 단독 치료에 비해 전뇌 방사선 조사를 추가한 군에서 유의하게 생존기간이 연장되었다 (2.2개월 대 4.8개월). 추가적인 항암화학요법은 유의한 생존기간의 향상을 가져오지는 못하였다. 수술적 절제술을 시행한 군의 중앙생존기간은 8.8개월로 스테로이드와 전뇌 방사선치료만 시행한 군에 비해 유의한 생존기간의 증가를 보였다. 결론 : 전이성 뇌종양 환자에서 전뇌 방사선치료와 스테로이드는 유용한 완화치료 방법이며 진단 당시 활동능과 신경손상의 정도가 중요한 예후 인자로 분석되었다. 후향적인 연구로 인해 결과 해석에 한계가 있으나 수술적 절제 및 항암화학요법이 일부 선택된 환자 치료시 중요한 수단이 될 것으로 사료된다. Background : Brain metastasis is a common complication in cancer patients. We evaluated the clinical characteristics, treatment outcome and prognostic factors for patients with metastatic brain tumor. Methods : The records of 97 patients with metastatic brain tumor during the period from January 1991 to November 1997 were reviewed retrospectively. Results : The most common primary tumor is lung cancer (61 cases, 63%) followed by metastatic cancer unknown primary site (15 cases, 16%), gastrointestinal cancer (13 cases, 13%), breast cancer (6 cases, 6%) and renal cancer (2 cases, 2%). There were 44 patients with a single brain metastasis and 53 patients with multiple brain metastases. The median survival was 3.0 months and one-year survival rate was 8% irrespective of treatment. Favorable prognostic factors which affect survival were ambulatory status (p<0.01) and functional neurologic class 1, 2 (p<0.01). Median survival was 3.7 months for patients with steroid therapy and 1.1 months with no therapy (p<0.01). Median survival was 4.8 months for patients with steroid therapy plus whole brain radiotherapy (WBRT) and 2.2 months with steroid therapy alone (p<0.01). Additional chemotherapy did not appear to affect the survival. The patients treated with surgery had median survival time of 8.8 months compared with 2.5 months for patients treated with steroid therapy plus WBRT (p<0.05). Conclusion : In present study, we confirmed that whole brain irradiation and corticosteroid administration are effective palliative treatment for patients with metastatic brain tumor. Initial performance status and neurological function were identified as important prognostic factors. Although confounded by the limitations of retrospective study, more aggressive treatments including surgery and chemotherapy could be regarded to have a significant role to achieve better treatment outcome in some selected cases.(Korean J Med 62:444-452, 2002)

간경변증 환자에서 간세포암 발생 위험 요인의 분석

이헌주(Heon Ju Lee),이재련(Jae Lyun Lee),이재춘(Jae Chun Lee),이은정(Eun Jung Lee),김기범(Ki Beom Kim),임상우(Sang Woo Lim),이동준(Dong Jun Lee),전경진(Kyeoung Jin Jeon),조영복(Young Bog Cho),도갑석(Gab Suk Doh),서정일(Jeong Ill Suh) 대한내과학회 1995 대한내과학회지 Vol.49 No.1

N/A Objectives: 80-90% of the cases of hepatocellular carcinoma(HCC) are associated with cirrhosis. Hepatitis B virus(HBV) is known as a major etiologic factor of HCC and about 10% of Koreans are HBV carriers. And the prevalence of HCC is high in Korea. Early detection of HCC is important for the better treatment especially in the patients with cirrhosis who usually have the decreased functional hepatic reserve. Risk factors for the hepatocellular carcinoma in the korean patients with cirrhosis were evaluated. Methods: Risk factors for hepatocellular carcinogenisis such as age, sex, ascites, alcohol, HBsAg, anti-HCV, AFP, ICG R(15) and risk score were investigated among the 176 patients with cirrhosis and HCC(group I) and 72 patients with cirrhosis(group II) and compared between the two groups. Results: 1) No age difference was noted between group I and group II. 2) Male to female sex ratio were 5.7: 1 and 2.4: 1 for group I and II in each(p<0.01) and the frequency of HCC among cirrhosis was higher in male than female sex(p<0.01). 3) Both HBsAg and anti-HCV positivity were significantly higher in group I than in group II (p<0.01 and p<0.05 respectively). 4) The frequencies of Child-Pugh A, elevated AFP, elevated ICG R(15) and the frequency of super-high risk patient were higher in group I than in group II(p<0.01). 5) The frequency of alcoholic patients was significantly higher in group II than in group I (p<0.05) but no difference was noted between HBsAg positive group I and group II patients. 6) The frequency of abnormal AST with the level of below 100IU was not significantly different between group I and group II. 7) The frequency of the patients with ascites was higher in group II than in group I (p<0.01). Conclusion: Risk factors for hepatocellular carcinogenesis in korean patients with cirrhosis are male, Child-Pugh A, HBsAg positivity, anti-HCV positivity, absence of ascites, higher AFP, lower ICG R15 and higher platelet count.

위암 환자의 Urokinase Plasminogen Activator Receptor 유전자의 발현양상

김용길,이경희,김민경,이재련,현명수,김상훈,김희선,Kim Yong Gil,Lee Kyung Hee,Kim Min Kyung,Lee Jae Lyun,Hyun Myung Sue,Kim Sang Hun,Kim Hee Sun 대한위암학회 2004 대한위암학회지 Vol.4 No.4

목적: 고형암이 주위조직으로의 침윤과 타장기로의 전이에는 단백분해효소의 활동이 필요하다. Urokinase type plasminogen activator (uPA)는 serine proteinase의 하나로 세포주의 단백분해와 혈관형성에 중요한 물질로서 고형암의 침윤과 전이에 중요한 역할을 한다. uPA는 유방암, 폐암, 방광암, 위암, 직장결장암, 난소암, 및 연조직 육종에서 중요한 예후지표로 알려져 있다. 본 연구에서 저자들은 위암 조직과 정상 점막에서 uPAR유전자의 발현양상에 대해서 조사하고 기존에 알려진 예후인자와의 연관성을 비교 분석하여 향후 중요한 분자학적 치료 target으로의 역할로서의 의의를 살펴보고자 한다. 대상 및 방법: 1997년 5월 이후 위암으로 진단되어 근치적 혹은 고식적 위장절제술을 시행한 위암 환자 35명을 대상으로 하였다. Northern blot analysis와 RT-PCR을 통해 uPAR mRNA의 발현을 확인하였으며, RNA추출을 위한 재료는 위장절제술 직후 종양조직과 동결절편 생검상 종양세포가 없는 것으로 확인된 부위의 정상 위암 조직을 동일 환자로부터 추출하였다. 이들 환자의 육안적 소견, 조직학적 소견, 생존율 등은 내시경과 수술보고서 병리보고서, 병록지 등을 참고하였다. 결과: uPAR mRNA의 expression과 환자의 예후와의 관계를 평가하기 위해서, gene expression과 이미 확립된 clinicopathologic prognostic와의 관계를 비교하였다. 이러한 factor를 중에서 uPAR mRNA expression은 림프절 전이 여부 (P=0.03), TNM stage (P=0.01)와는 일정한 연관성이 있음을 보였으며, 나이나 성별, 종양크기, histologic type, Lauren classification, Ming classification, serosa invasion, vascular invasion, lymphatic vessel invasion, Neural invasion, omental invasion, macroscopic type와는 상관관계를 보이지 않았다. 결론: 종양 세포에서 uPAR를 평가하는 것은 위암의 예후 뿐만 아니라 질병의 재발을 예측하는데 사용될 수 있을 것으로 생각된다. Purpose: Invasion and metastasis in solid tumors require the action of tumor-associated proteases. The serine protease urokinase-type plasminogen (uPA) and receptor (uPAR) appear to have a major function in these processes. Expression of the uPAR is elevated in breast and colon carcinomas, and this is often associated with invasiveness and poor prognosis. The purpose of this study was to determine whether the expression of the uPAR gene correlates with clinico-pathological parameters in human gastric carcinomas. Materials and Methods: We examined the expression of uPAR mRNA by using northern blot analysis and RT-PCR in 35 gastric carcinomas and the surrounding normal mucosa. Macroscopic and histopathological tumor findings and survival rates were obtained from the patient records and from endoscopic, surgical, and pathological reports. Results: The expression of uPAR and was higher in most neoplasms than in the corresponding normal mucosal tissue. uPAR mRNA expression in tumors correlated well with lymph-node metastasis (P<0.02) and tumor stage (P<0.01). The survival rate of patients with tumors displaying high uPAR expression levels was significantly lower (P<0.04) than that of patients without uPAR expression, but IL-8 showed only the tendency of survival difference. Conclusion: These results suggest that uPAR may be an important prognostic factor in human gastric carcinomas.

전이성 경막외 척수 압박증에 대한 임상적 고찰

김민경 ( Min Kyoung Kim ),이재련 ( Jae Lyun Lee ),이상희 ( Sang Hee Lee ),신상준 ( Sang Jun Shin ),김경옥 ( Kyung Ok Kim ),김용길 ( Yong Gil Kim ),이경희 ( Kyung Hee Lee ),현명수 ( Myung Soo Hyun ),배성화 ( Sung Hwa Bae ),류헌모 ( 대한내과학회 2005 대한내과학회지 Vol.68 No.1

전이성 유방외 파제트병에서 나타난 골수괴사와 연관된 혈전성 혈소판감소성 자반증

손종민(Jong Min Sohn),이재련(Jae Lyun Lee),김범준(Bum Jun Kim),송경미(Kyung Mee Song),조영욱(Young-Uk Cho),김은나(Eun Na Kim),홍준혁(Jun Hyuck Hong) 대한비뇨기종양학회 2016 대한비뇨기종양학회지 Vol.14 No.2

As extra-mammary Paget’s disease is rare and usually diagnosed at early stage when it is highly curable with surgical resection, it is much rarer to see patients with recurrent metastatic disease. Thrombotic thrombocytopenic purpura in patients with metastatic solid cancer is also a rare disease and may result from bone marrow metastasis or bone marrow necrosis. For the latter, the majority of cases are not eligible for systemic chemotherapy for rapid disease progression and poor performance status. Herein, authors report a patient with thrombotic thrombocytopenic purpura associated with bone marrow necrosis complicating extra-mammary Paget"s disease who was successfully treated with docetaxel and carboplatin combination chemotherapy.

비전이성 골육종환자에서 술전 Cisplatin, Adriamycin 복합항암화학요법의 효과

오현아 ( Hyun A Oh ),이구 ( Gu Lee ),강희정 ( Hee Jung Kang ),이재련 ( Jae Lyun Lee ),이경희 ( Kyung Hee Lee ),현명수 ( Myung Soo Hyun ),신덕섭 ( Duk Sub Sin ),배성화 ( Sung Hwa Bae ),류헌모 ( Hun Mo Ryoo ) 대한내과학회 2003 대한내과학회지 Vol.65 No.1

목적 : 골육종환자에서 cisplatin과 adriamycin을 사용한 술전 화학요법을 시행하여 반응율 및 생존율을 알아보고자 하였다. 방법 : 골육종 환자 24명 중 보조요법만 시행한 4명의 환자를 제외한 20명의 환자를 대상으로 술전 화학요법과 술후 화학요법을 시행한 14명의 환자군을 A군으로 하고 술후에 화학요법을 시행한 6명의 환자군을 B군으로 하였다. A군 중 12명은 사지구제술을 시행하고 2명은 진행하여 사지절단술을 시행하였고 B군 중 사지외 Background : Adjuvant chemotherapy is the most accepted treatment for localized osteosarcoma. We studied the effectiveness of preoperative cisplatin and adriamycin combination chemotherapy in non-metastatic osteosarcoma. Methods : Twenty four cases of pat

급성 심근경색증 발생 위험인자와 경색관련동맥의 협착정도와의 연관성

김영진(Young Jin Kim),이태일(Tae Il Lee),이재련(Jae Lyun Lee),조인호(In Ho Cho),신동구(Dong Gu Shin),김영조(Young Jo Kim),심봉섭(Bong Seop Sim),이현우(Hyun Woo Le) 대한내과학회 1995 대한내과학회지 Vol.49 No.5

N/A Objectives: The most common cause of myocardial infarction is atherosclerotic lesion of epicardial coronary artery. But coronary blood flow can also be dampered by the arterial emboli, spasm. and this may result in myocardial infarction. To investigate the risk factors of myocardial infarction with normal coronary artery, a study was conducted. Methods: This study was made on 122patients, admitted at Yeungnam University Hospital as their first attack for acute myocardial infarction, from August 1992 to May 1994. The patients undertook angiography with thrombolytic therapy at the earliest possible time. These patients were classified into four groups: group 1-patients with less than 25% stenosis of infarct related artery(IRA); group 2-between 25-50% stenosis of IRA; group 3-between 51-75% stenosis of IRA; group 4-between 76-99% stenosis of IRA. Results: Among 122patients with myocardial infarction, the mean age was 55.4years old and the ratio of male to female was 3.5:1. Group 1patients had a significantly lower mean age(44.6years) than group 3patients(55.8years) and group 4patients (59.1years). Of fifteen patients in group 1, 12 patients developed acute myocardial infarction under 50years of age. In frequency of risk factors of coronary heart disease, 84 of 122cases(68.9%) were smokers. The number of smokers was higher in group 1 (86.7%) than group 3 (58.6%) and group 4 (64%). The frequency of angina prior to myocardial infarction was lower in group 1 (7%) than group 3 (45%) and group 4 (46%). The frequency of multivessel disease was lower in group 1 (13%) than group 3 (31%) and group 4 (50%). There was no significant difference in the frequency of the hypertension, diabetes, dyslipidemia, and obesity among the groups. Conclusion: Acute myocardial infarction with near normal infarct related artery developed at young age compared with those with significant infarct related artery stenosis. The number of smokers was higher and the frequency of previous angina history was lower in the same group.

증례 : Sunitinib 투여로 유발된 혈전성 혈소판 감소성 자반증 1예

김은진 ( Eun Jin Kim ),최윤미 ( Yun Mi Choi ),이신원 ( Sin Won Lee ),하연정 ( Yeon Jung Ha ),이재련 ( Jae Lyun Lee ) 대한내과학회 2013 대한내과학회지 Vol.84 No.2

혈전성 혈소판 감소성 자반증 및 용혈성 요독성 증후군은 다발성 장기 손상 및 미세혈관병증 용혈빈혈을 보이는 급성 질환으로 치료하지 않을 경우 환자의 생명을 위협하는 치명적인 질환이다. 최근 VEGFR-TKI가 혈전성 혈소판 감소성 자반증을 유발할 수 있다는 보고가 나오고 있어, 저자들은 전이성 콩팥세포암종 환자에서 수니티닙을 사용한 뒤, 혈전성 혈소판 감소성 자반증이 발생한 1예를 경험하였기에 이를 보고하는 바이다. Thrombotic thrombocytopenic purpura and hemolytic uremic syndrome (TTP-HUS) is an acute condition with abnormalities of multiple organ systems. It is characterized by microangiopathic hemolytic anemia and thrombocytopenia. Several chemotherapeutic agents have been implicated in causing TTP-HUS. We report a case of TTP-HUS during treatment with sunitinib in a patient with metastatic renal cell carcinoma. A 53-year-old woman visited our hospital for fever and cough. She was diagnosed with sunitinib-induced TTP. Discontinuation of sunitinib and plasmapheresis improved her TTP. When she experienced disease progression after a prolonged period without treatment, sorafenib was tried, resulting in a partial response without recurrence of TTP-HUS. (Korean J Med 2013;84:303-307)