의학강좌 : 암 환자에서 발생하는 정맥 혈전색전증의 진단과 치료

방수미 ( Soo Mee Bang ) 대한내과학회 2013 대한내과학회지 Vol.85 No.5

종설 : 비전형적 부위에 발생하는 정맥혈전의 치료

방수미 ( Soo Mee Bang ) 대한내과학회 2014 대한내과학회지 Vol.86 No.1

Venous thrombosis in atypical locations means thrombosis of upper extremity deep vein, cerebral venous sinus, splanchnic vein including portal, hepatic, mesenteric and splenic vein, renal vein, ovarian vein and retinal vein. This thrombosis rarely occurred and could be affected by the involved organ when compared to the incidence and cause of deep vein thrombosis in lower extremity with or without pulmonary embolism. There is a limitation to perform a large-scaled randomized trial for these rare conditions, and several recommendations based on results of small-sized studies and observational registries are available now. Therefore, we need multi-department and international collaboration to test the efficacy and safety of anticoagulation including new oral anticoagulants in the treatment of venous thrombosis in atypical locations. (Korean J Med 2014;86:20-25)

한국인의 유전성 혈전증

김인호(In Ho Kim),박선양(Seon Yang Park),이종태(Jong Tai Lee),방수미(Soo Mee Bang),김효수(Hyo Su Kim),김병국(Byoung Kook Kim),김노경(Noe Kyeong Kim),박성섭(Seong Sub Park),조한익(Han Ik Cho),정해영(Hae Young Jeong),유욱준(Ook Joon Yo 대한내과학회 1996 대한내과학회지 Vol.51 No.6

N/A Objectives: Thromboembolism is a serious medical problem causing considerable morbidity and mortality. Major clinical risk factors for thrombosis included surgery, fracture, malignancy, old age, immobilization and the use of oral contraceptives. In the last several decades, substantial progress has been made in identifying hereditary factors predisposing to thrombosis. The genetic defects known to be associated with thrombophilia are deficiencies of antithrombin 3, protein C, protein S, dysfibrinogenemia and resistance to the anticoagulant action of activated protein C. We have elucidated the characteristics of heriditary thrombophilia of the Korean patients. Methods: The clinical profiles of 48 patients with heriditary thrombophilia (12 cases of our hospital and 36 cases reported previously in Korea) were analyzed. The underlying hemostatic abnormalities about antithrombin 3, Protein C, Protein S, activated protein C, fibriongen were investigated. Family studies of 6 patients of our 12 patients were done. Nucleotide sequences of antithrombin 3 genes of 2 patients were studied. Results: 1) Seven patients (58%) among our 12 patients had thrombotic onset before fifth decades, and 5 patients developed thromboses at their third decades. 2) Pulmonary embolisms were diagnosed in 10 cases (83%) among our 12 cases. Deep vein thromboses of lower extremities were 8 cases (67%) and usually rare site thromboses like a portal vein thrombosis occurred frequently (8 cases, 67%). Arterial thromboses occurred in two cases (17%). Hereditability of 5 families were confirmed by family study. 3) Analysis of 48 cases showed that protein C deficiency (12 cases, 25%) and protein S deficiency (19 cases, 40%) occurred relatively frequently. 4) Neither Resistance to activated protein C nor mutation in the factor V gene was demonstrated in Korean patients with deep vein thrombosis and normal persons. This result suggests that activated protein C resistance may be extremely rare in Korean population. 5) Two new mutations of antithrombin 3 genes were identified in two patients via nucleotide sequencing, and they were named 'AT 3 Seoul' and 'AT 3 Kosung' respectively. Conclusion: We elucidated clinical and laboratory characteristics of hereditary thrombophilia in Korea. Hereditary thrombophilia were not uncommon in Korean patients with deep vein thrombosis, with/without pulmonary embolism. Strong suspicion for hereditary thrombophilia may lead to correct diagnosis and appropriate treatment in these patients.

진행성 비소세포폐암 환자에서 Vinorelbine, Ifosfamide 복합화학요법

조은경(Eun Kyung Cho),홍순홍(Soon Hong Hong),방수미(Soo Mee Bang),이한경(Han Kyung Lee),박정웅(Jeong Woong Park),정성환(Seong Hwan Jeong),남귀현(Gui Hyun Nam),신동복(Dong Bok Shin),이재훈(Jae Hoon Lee) 대한내과학회 2001 대한내과학회지 Vol.60 No.1

N/A Background : Although cisplatin (CDDP)-based chemotherapy is currently considered to be the most active treatment for advanced non-small cell lung cancer (NSCLC), ultimate prognosis still remains poor. More effective cytotoxic agents are needed to improve outcom of these patients. We evaluated the efficacy and safty of combination chemotherapy with vinorelbine and ifosfamide in patients with advanced NSCLC. Methods : Thirty-three chemotherapy-nave patients with stage IIIB or IV NSCLC were treated with vinorelbine 25 mg/m2 on days 1 & 8 and ifosfamide 2 g/m2 on days 1, 2 & 3 with mesna every 3 weeks. Results : Among thirty evaluable patients who received the vinorelbine/ifosfamide combination chemotherapy, nine (30%) partial responses were observed. With median follow-up duration of 80weeks, the median response duration and overall survival durations were 23 weeks and 38 weeks respectively. World Health Organization grade 3 to 4 neutropenia and anemia occured in 5% and 4.3% respectively. Conclusion : Combination chemotherapy with vinorelbine and ifosfamide is an effective treatment for patients with advanced NSCLC with a manageable toxicity.(Korean J Med 60:70-76, 2001)

증례 : 진성다혈구증에 병발된 사구체간질 증식성 사구체 신염 1예

박철희 ( Cheul Hee Park ),정낙소 ( Nak So Chung ),정우경 ( Woo Kyung Chung ),방수미 ( Soo Mee Bang ),이종호 ( Jong Ho Lee ),정재걸 ( Jae Gul Chung ),이준승 ( Joon Seung Lee ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-

진성다혈구증과 동반한 사구체신염의 병발은 매우 드문 것으로 보고되어 있다. 진성다혈구증에 병발한 사구체간질 증식성 사구체신염의 보고가 있었으나 면역형광 현미경 검사가 없어서 IgA 신증을 배제하지 못하였다. 저자들은 단백뇨 및 비장비대를 주소로 내원한 환자에서 면역형광 현미경검사를 포함한 신생검으로 사구체간질 증식성 사구체신염과 세계보건기구 진단 기준에 따른 진성다혈구증으로 진단된 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. There are only a few reports of glomerulonephritis associated with polycythemia vera (PV). These cases include diffuse mesangial proliferative glomerulonephritis (mesPGN), Henoch-Schonlein purpura nephritis, focal segmental glomerulonephritis and IgA nephropathy. In 1983, Plomley et al. reported on 3 cases of mesPGN in patients with PV for the first time. However the possibility that these cases were IgA nephropathy could not be excluded since there was no data of electron microscopic or immnunofluorescent (IF) study. We report a case of idiopathic mesPGN combined with PV. A 46-year-old male was referred to our hospital because of proteinuria and splenomegaly on his routine medical examination. While undergoing investigation for the proteinuria, the patient was found to have a high hemoglobin (22.3 g/dL) and hematocrit (68.8%) levels. At that time, the urinary protein excretion was 3.0 g in 24 hour. We diagnosed the patient as a case of PV by World Health Organization criteria. The renal biopsy revealed focal mesangial proliferation with expansion of the matrix. On IF study, there was no deposition of IgA, IgG and C3 in the mesangium. (Korean J Med 69:S884-S889, 2005)

정상 혈청 엽산 농도에서 발생한 Sulfasalazine에 의한 거대적아구성 빈혈

김정곤 ( Jung Gon Kim ),김태경 ( Tae Kyung Kim ),안정열 ( Jeong Yeal Ahn ),최효진 ( Hyo Jin Choi ),방수미 ( Soo Mee Bang ),백한주 ( Han Joo Baek ) 대한류마티스학회 2005 대한류마티스학회지 Vol.12 No.3

Sulfasalazine produces a varied spectrum of adverse reactions on the hematopoietic system. Sulfasalazine-induced megaloblastic anemia is very rare and a few cases have been reported in patients with inflammatory bowel disease. Most of them show a low serum folate level. The pathogenesis is known as folate deficiency by intestinal folate malabsorption, inhibition of folate enzyme, or hemolysis. We experienced a 43-year old female with Behcet`s disease, who presented with megaloblastic anemia having normal serum folate level after treatement of sulfasalazine (2 g/day for 3 months). Megaloblastic anemia recovered after withdrawal of the drug only.

Tryptase 농도 상승을 동반한 골수증식성 과호산구증가증에서 발생된 만성 호산구성 백혈병

이상표 ( Sang Pyo Lee ),고광일 ( Kwang Il Koh ),박세훈 ( Se Hoon Park ),정성환 ( Sung Hwan Jeong ),안정열 ( Jeong Yeal Ahn ),박중원 ( Jung Won Park ),방수미 ( Soo Mee Bang ) 대한천식알레르기학회 2007 천식 및 알레르기 Vol.27 No.1

A 72-year-old male patient was referred to the hematologic department because of persistent hypereosinophilia, splenomegaly and chronic fatigue; these existed for 3 months. A presumptive diagnosis of a myeloproliferative variant of hypereosinophilic syndrome was made on the basis of anemia, splenomegaly, bone marrow hypercelluarity, increased serum tryptase and vitamine B12. Fip 1 like 1-platelet-driven growth factor receptor alpha fusion gene and platelet-driven growth factor receptor beta gene rearrangement analysis with RT PCR were negative. In initial therapeutic approach with prednisolone, hydroxyurea, and imatinib mesyalte, blood eosniophilia did not improve and transformation into chronic eosinophilic leukemia observed in the peripheral blood smear. In the case herein reported, therapeutic response was not achieved with cytosine arabinoside chemotherapy. (Korean J Asthma Allergy Clin Immunol 2007;27:61-65)

확장기 소세포 폐암에서 Carboplatin, Ifosfamide, Etoposide 복합화학요법의 효과

류희정 ( Hee Juang Ryu ),김영남 ( Young Nam Kim ),경선영 ( Seon Yeong Gyeong ),박세훈 ( Se Hoon Park ),안창혁 ( Chang Hyeok An ),방수미 ( Soo Mee Bang ),이상표 ( Sang Pyo Lee ),이재익 ( Jae Ik Lee ),박정웅 ( Jeong Ung Park ),조은 대한내과학회 2006 대한내과학회지 Vol.70 No.6

목적: 확장기 소세포 폐암의 복합화학요법으로 carboplatin, etoposide, ifosfamide의 치료 효과와 치료 독성을 알아보고자 하였다. 방법: 과거에 치료받은 적이 없는 확장기 소세포 폐암 환자 41명을 대상으로 carboplatin (AUC 6)을 정주하였고, 제1일부터 제3일까지 etoposide (100 mg/m2), ifosfamide (1,200 mg/m2)를 동량의 mesna와 함께 정주하였다. 결과: 전체 41명의 환자들 중 Background: This prospective phase II study assessed the efficacy and toxicity of the combination of carboplatin, ifosfamide and etoposide for previously untreated patients with extensive-disease small cell lung cancer (ED-SCLC). Methods: Patients with ED

대한내과학회가 드리는“안전한 약물 복용 지침”

김수현 ( Su Hyun Kim ),정혜경 ( Hye-kyung Jung ),신인순 ( Ein-soon Shin ),이진서 ( Jin Seo Lee ),류연주 ( Yon Ju Ryu ),홍경섭 ( Kyoung Sup Hong ),방수미 ( Soo Mee Bang ),장윤석 ( Yoon-seok Chang ),김찬규 ( Chan Kyu Kim ),이병완 ( 대한내과학회 2021 대한내과학회지 Vol.96 No.3

목적: 우리나라는 약제를 의사 처방전이 있어야 살 수 있는 전문의약품과 처방전 없이 살 수 있는 일반의약품으로 분류한다. 약제 부작용을 최소화하고 약물 남용을 피하려면 약제에 대한 환자 교육이 중요하다. 노령 인구가 증가함에 따라 다양한 동반 질환을 가진 인구가 증가하여 여러 가지 약물 복용이 증가하고 있어 이로 인한 부작용의 위험도 증가하고 있다. 방법: 대한내과학회 표준진료지침위원회에서 내과 분과별 전문가와 개원의, 진료 지침 개발 방법론 전문가들이 모여 “안전한 약물 복용 지침” 개발 소위원회를 구성하고 개발사업을 진행하였다. 결과: 본 지침의 주요 내용은 1) 안전하고 효과적인 약물복용법, 2) 진통제(아세트아미노펜과 비스테로이드 소염제)의 올바른 사용, 3) 약물 오남용을 막기 위한 안정제와 수면제의 올바른 사용, 4) 여러 가지 약물 복용의 주의사항이다. 결론: 환자와 간병인이 일반적으로 사용되는 진통제, 기분 안정제, 수면제 및 다약제를 포함하여 약물 사용에 대한 일반적인 원칙과 예방 조치를 이해하기 위해 개발된 지침이다. 또한 의사, 간호사 및 의료 종사자가 환자와 간병인을 교육하기 위한 교육 자료로도 사용될 수 있다. Background/Aims: In Korea, medications are available by prescription from a physician, or can be purchased over-the-counter (OTC) without a prescription. Education regarding both prescribed and OTC drugs is important to minimize side effects and avoid drug abuse. The risk of side effects due to polypharmacy is increasing due to the growing number of elderly patients with comorbidities. Methods: There are various clinical guidelines for physicians, but it is difficult for patients and their caregivers to find published guidelines regarding drug use. In this regard, experts from nine subspecialties of internal medicine, geriatric medicine, and guideline development methodology formed a working group to develop guidelines for safe drug use under the Clinical Practice Guidelines Committee of the Korean Association of Internal Medicine. Results: The main contents of this guideline are 1) safe and effective drug administration, 2) the proper use of analgesics (acetaminophen and nonsteroidal anti-inflammatory drugs), 3) the proper use of tranquilizers and sleeping pills to prevent drug abuse, 4) points to be aware of when taking multiple medications. Conclusions: The guidelines were developed for patients and their caregivers to understand the general principles and precautions for drug use, including commonly used painkillers, mood stabilizers, sleeping pills, and polypharmacy. These guidelines could also be used as educational materials for physicians, nurses, and healthcare workers to educate patients and their caregivers. (Korean J Med 2021;96:225-235)

급성 골수성 백혈병에서 AML1 / ETO 융합유전자와 예후

조은경(Eun Kyung Cho),정은경(Eun Kyung Jung),안정렬(Jeong Yeal Ahn),임도윤(Do Yoon Lim),경선영(Sun Young Kyung),주기탁(Ki Tak Ju),방수미(Soo Mee Bang),서일혜(Yiel Hea Seo),신동복(Dong Bok Shin),이재훈(Jae Hoon Lee) 대한내과학회 2001 대한내과학회지 Vol.61 No.6

N/A Background: The t (8;21) (q22;q22), which produces the fusion gene AML1/ETO, is associated with relatively good prognosis and, in particular, with a good response to cytosine arabinoside. Analysis of t (8;21) positive leukemic blasts has shown characteristic morphological and immunological features. We performed this study to investigate the incidence of AML1/ETO rearrangement in adult AML, especially in M2 subtype, to make a comparison of morphologic, immunophenotypic and clinical characteristics between AML1/ETO rearrangement positive and negative group in patient with AML and to analyze the correlation with other biological parameters. Methods: From May 1995 to Sep. 2000, fifty-nine patients with AML including twenty-nine AML-M2 were studied. RNAs were extracted from leukemic cells and reverse transcriptase mediated polymerase chain reaction (RT-PCR) for AML1/ETO fusion transcript was done. Chromosome study, immunophenotypic, and clinical characteristics were analysed and statistical analysis was done. Results: The male to female ratio was 32:27 in AML and 17:12 in AML-M2. The median age was 43 years (range 14-86) in AML and 43 years (range 14-77) in AML-M2. The incidence of AML1/ETO fusion transcripts was 22.0% in AML and 44.8% in AML-M2. The morphologic finding of bone marrow in AML-M2 showed higher incidence of Auer rods, large blast with prominent golgi and abnormal granules in AML1/ETO positive patients. There was no significant difference of immunophenotype. AML patients with AML1/ETO rearrangement had a tendency of higher complete remission rate (81.8% vs 56.6%, p=0.13). The overall survival (median 82.2 weeks vs 34.4 weeks, p=0.02) and progression free survival (median 50.9 weeks vs 20.4 weeks, p=0.02) of AML1/ETO positive group were longer than those of negative group in AML. AML-M2 patients with AML1/ETO rearrangement had also a tendency of longer overall survival and progression free survival, although there was no significant difference between both group (median OS 82.4 weeks vs 15.6 weeks, p=0.07, median PFS 50.9 weeks vs 16.0 weeks, p=0.09). Conclusion: Our data suggest that AML1/ETO rearrangement is detected frequently in AML, especially M2, and is a favorable prognostic factor. Thus, molecular diagnostic approaches should be used routinely to identify patients with this genetic subtype of AML.(Korean J Med 61:650-659, 2001)