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이계영 ( Kye Young Lee ), 김희정 ( Hee Joung Kim ), 김순종 ( Sun Jong Kim ), 유광하 ( Gwang Ha Yoo ), 김원동 ( Won Dong Kim ), 오서영 ( Seo Young Oh ), 김완섭 ( Wan Seop Kim ) 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.69 No.4
Background: Recent studies have demonstrated that the epidermal growth factor receptor (EGFR) genotype is the most important predictive marker to EGFR-tyrosine kinase inhibitors (TKIs) and first-line gefitinib treatment will be approved in the near future for use in non-small cell lung cancer (NSCLC) patients with the EGFR mutation. Direct sequencing is known to be the standard for detecting EGFR mutations; however, it has limited sensitivity. Peptide nucleic acids (PNA)-mediated PCR clamping method is a newly introduced method for analyzing EGFR mutations with increased sensitivity and stability. Methods: A total of 71 NSCLC patients were analyzed for EGFR mutations using the PNA-mediated PCR clamping technique. Sixty-nine patients were analyzed for clinicopathologic correlation with EGFR genotype; 2 patients with indeterminate results were excluded. In order to determine EGFR-TKI drug response, 57 patients (42 gefitinib, 15 erlotinib) were included in the analysis. Results: The EGFR mutation rate was 47.8%. Being female, a non-smoker, and having adenocarcinoma were favorable clinicopathologic factors, as expected. However, more than a few smokers (33.3%), male (28.1%), and patients with non-adenocarcinoma (28.6%) had the EGFR mutation. Having a combination of favorable clinicopathologic factors did not increase the EGFR mutation rate significantly. Drug response to EGFR-TKIs showed significant differences depending on the EGFR genotype; ORR was 14.3% for wild type vs 69.0% for mutant type; DCR is 28.6% for wild type vs 96.6% for mutant type. The median EGFR-TKI treatment duration is 7.6 months for mutant type group and 1.4 months for wild type group. Conclusion: EGFR genotype determined using the PNA-mediated PCR clamping method is significantly correlated with the clinical EGFR-TKI responses and PNA-mediated PCR.
이승민 ( Seung Min Lee ), 이정현 ( Jung Hyun Lee ), 황재준 ( Jae Jun Hwang ), 이송암 ( Song Am Lee ), 이정근 ( Jeong Geun Lee ), 김완섭 ( Wan Seop Kim ), 한혜승 ( Hye Seung Han ), 이태훈 ( Tae Hoon Lee ), 유광하 ( Gwang Ha Yoo ), 이계영 ( ) 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.63 No.2
기관 내 사구 종양은 매우 드문 종양이며 일반적인 사구 종양의 증상을 보이지 않다가 크기가 커진 이후에 호흡 곤란이나 객혈, 기침 등의 비특이적인 증상을 보이기 때문에 진단 및 치료가 지연될 수 있다. 따라서 비특이적인 호흡기 증상을 지속적으로 호소하는 환자의 경우 흉부 전산화단층촬영 및 기관지 내시경 등의 적극적인 검사가 필요할 것으로 사료된다. 본 저자들은 호흡 곤란을 주소로 내원한 58세 남자 환자에서 상부 기관 후벽에 발생한 사구 종양 1예를 경험하였기에 이에 대한 문헌 고찰과 함께 보고하는 바이다. A glomus tumor is composed of modified smooth muscle cells that are similar to those of the glomus body. Its occurrence in the trachea is quite rare. To our knowledge, only 20 cases of glomus tumor of the trachea have been reported worldwide and there has been only 1 case in Korea. We report one case of a 58-year-old man with dyspnea who had a glomus tumor in the upper trachea with a review of literatures. The chest CT scan and bronchoscopy demonstrated a 2.5 cm sized lobulated tumor at the posterior wall of the upper trachea. It had an elongated shape with a broad base and with a highly vascularity. A simple resection of 3 levels of the trachearing was with a tumor and end-to-end anastomosis performed. Microscopic and immunohistochemical staining of the tumor revealed the characteristics of a glomus tumor. (Tuberc Respir Dis 2007; 63: 183-187)
이승민 ( Seung Min Lee ), 고순영 ( Soon Young Ko ), 서태호 ( Tae Ho Seo ), 이정현 ( Jung Hyun Lee ), 최승오 ( Seung Oh Choi ), 이정근 ( Jeong Geun Lee ), 김완섭 ( Wan Seop Kim ), 이태훈 ( Tae Hoon Lee ), 유광하 ( Gwang Ha Yoo ), 이계영 ( K) 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.62 No.5
악성 흉막 중피종(Malignant pleural mesothelioma, MPM)은 선암과의 감별이 어렵고 예후가 매우 좋지 않은 드문 암이다. MPM의 치료를 위해 많은 항암제들이 시도되었지만 그 효과는 크지 않았다. 완전 관해는 거의 되지 않으며 부분 관해 역시 1/3 이하의 환자에서 기대할 수 있다. 하지만 최근 한 3상 연구를 보면 cisplatin 단독요법에 비해 pemetrexed/cisplatin 병합 항암화학요법이 반응률과 평균 생존기간을 의미 있게 증가시켰다. 이에 저자들은 1차 항암화학치료에 실패한 MPM 환자에서 pemetrexed/cisplatin 병합화학요법을 시도한 결과 극적인 반응을 보인 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Malignant pleural mesothelioma (MPM) is a rare tumor that is difficult to clearly distinguish from an adenocarcinoma but usually has a poor prognosis. Numerous cytotoxic agents have been used in the primary treatment of MPM with limited success. A complete response is unusual and a partial response occurs in less than one-third of patients. Recently, a phase III trial showed that a combination of pemetrexed with cisplatin resulted in a significantly higher response rate and median survival time than with cisplatin alone. We encountered a case of a dramatic tumor response to pemetrexed/cisplatin combination chemotherapy in patients with MPM, which was resistant to the 1st-line gemcitabine/cisplatin therapy. After six cycles of pemetrexed/cisplatin combination chemotherapy, the tumor volume had decreased dramatically with complete symptom relief. There was no chemotherapy-related toxicity or scheduled violation. The patient is under maintenance chemotherapy with the same regimen. (Tuberc Respir Dis 2007; 62: 432-436)
Crohn's disease is a rare inflammatory bowel disease in Korea which requires a differential diagnosis with intestinal tuberculosis. In the early stages of Crohn's diseaae, the combiation of bowel wall edema and spasm produces intermittent obstructive manifestations, so the usual subjective symptoms were appeared long standing diarrhea, low grade fever and abdominal pain and distension. We recently experienced a case of Crohn's colitis with repeated bowel obstruction in female adult who underwent surgical resection.
Cystic disease of the liver is observed with increasing frequency because of the common use of computed tomography and ultrasonography. Hepatic cyst does not present particular symptoms. However, depending on its size and location, symptoms like abdominal distension, or pressure effects on adjacent organs including bile ducts causing intermittent jaundice could appear. Patients with hepatic cyst usually show no elevation of liver enzyme, bilirubin, or liver function tests. Jaundice usually can occur in the patients when the cyst becomes large enough to cause exrtahepatic blocking of bile duct. We receotly experienced a 57-year old female complaining of generalized pruritus, which was diagnosed as non-parasitic liver cyst with obstructive jaundice. The diagnosis was confirmed by abdominal US, CT, ERCP and operation. Unroofing of hepatic cyst was performed, and 3 months later, she was asyrnptomatic and total bilirubin was normalized. We report this case with a review of the relevant literatures.
Trousseau's syndrome refers to an association of thrombosis with visceral malignancy. The thrombophlebitis is usually recurrent and migratory. An episode of thrombosis may precede clinical recognition of malignancy by weeks or months and in many cases, the underlying malignancy was occult. Patients with a recurrent deep venous thrombophlebitis without a known predisposing factors for hypercoagulable state deserves a consideration for underlying malignancy. We report a patients with lung cancer who initially demonstrates the clinical features of the Trousseau's syndrome.