후천성 면역결핍증 환자에서 발생한 주폐포자충 폐렴의 단기 생존율에 관한 예후 인자

정주섭(Chung Joo Seop),조군제(Goon Jae Cho),곽임수(Ihm Soo Kwak),나하연(Ha Yeon Rha) 대한내과학회 1998 대한내과학회지 Vol.54 No.4

N/A Objectives: Pneumocystis carinii pneumonia(PCP) is one of the most common life-threatening opportunistic infections in patients with acquired immunodeficiency syndrome(AIDS). This study reports the clinical characteristics of PCP in the patients with AIDS and prognostic factors for short-term survival of them. Methods: We investigated 43 patients of AIDS to evaluate the frequency of PCP in patients in AIDS by retrospective analysis, and classified the 17 patients with PCP into survivors and non-survivors to compare epidemiology, clinical characteristics and laboratory findings. We also analyzed whether the these findings influenced the short-term survival in patients with PCP that was combined with AIDS. Results: In this retrospective study of 43 patients of AIDS, the frequency of PCP in AIDS patients was relatively high as 17 patients(39%), of whom eight patients(47%) died of PCP. The epidemidologic findings such as age, route of human immunodeficiency virus(HIV) infection and co-existing disease were not significantly different between survivors and non-survivors. Coughing was the most common symptom and bilateral infiltrates of lung was the most common form in the chest X-ray examination. But these clinical features were similar in the both groups. Total lymphocyte count, CD4 cell count, serum albumin level and arterial oxygen tension were decreased and serum LDH was increased in patients with PCP that was the first episode in patients with AIDS. Lymphocyte and CD4 cell count were significantly lower in the non-survivor group (p=.002 and p=.03, respectively), Survivors had higher serum albumin level and arterial oxygen tension than non-survivors (p=.02 and p=.04, respectively). And non-survivors were found to have higher serum LDH level than survivors (p=.02). Conclusion: Lymphocyte and CD4 cell counts, serum albumin and LDH, and arterial oxygen tension may be considered as the prognostic factors for short-term survival of patients with PCP that is combined with AIDS.

국소 진행성 두경부암 환자에서 docetaxel과 cisplatin을 이용한 유도 화학요법

최영진 ( Young Jin Choi ),신호진 ( Ho Jin Shin ),정주섭 ( Joo Seop Chung ),조군제 ( Goon Jae Cho ),이병주 ( Byung Joo Lee ),왕수건 ( Soo Geon Wang ) 대한내과학회 2007 대한내과학회지 Vol.73 No.4

목적: 본 연구는 국소 진행성 두경부 편평세포암에서 docetaxel과 cisplatin 유도 화학요법의 치료 효과와 부작용을 조사하였다. 방법: 2001년 10월부터 2003년 8월까지 부산대학교 병원에서 두경부 편평세포암으로 진단된 국소 진행성병기(AJCC stage III & IV) 환자 44명을 대상으로 하였다. Docetaxel은 제 1일에 70 mg/m2를 5% 포도당 용액에 농도가 0.9 mg/mL 미만으로 희석하여 1시간 동안 정맥 주사하고 cisplatin은 docetaxel 정주 2시간 후 75 mg/m2를 생리 식염수에 희석하여 1시간 동안 정맥 주사하였다. 결과: 대상 환자 44명에 대한 치료 효과는 완전 반응은 20명(45%), 부분 반응은 20명(45%)로 전체 반응율이 90%로 나타났다. 호중구 감소증은 23건에서 관찰되었고 grade 3이 8건, grade 4가 4건에서 관찰되었다. 오심 구토 등이 18건으로 다소 흔한 부작용이었으며 신기능 장애 2건, 설사 4건, 기면 5건, 구내염 6건 등이 있었다. 그리고 림프절 전이가 높을 수록 반응율이 유의한 감소를 보였다. 정중 추적 관찰기간은 15개월(2-51개월)이었고 4년 예측 치료실패시간은 56.3±10.2%이었다. 4년 예측전체 생존율은 87.4±6.9%였다. 결론: 이상의 결과로 docetaxel과 cisplatin의 유도화학요법은 국소 진행성 두경부암에서 높은 반응율과 낮은 부작용으로 유용한 치료법이었다. 환자의 생존율과의 관계를 알기 위해 향후 더 오랜 기간의 추적 조사가 필요하며 docetaxel과 cisplatin 유도 화학요법의 유효성을 검증하기 위해 대규모 무작위 대조군 연구가 필요할 것으로 생각된다. Background: This prospective study was conducted to assess the efficacy and toxicity of induction chemotherapy with docetaxel and cisplatin for patients with previously untreated, locally advanced squamous cell carcinoma of the head and neck (SCCHN). Methods: Forty four patients received 120 courses of treatment with docetaxel (70 mg/m2 in a 1-hour infusion) and cisplatin (75 mg/m2 in a 1-hour infusion), repeated every 3 weeks. Responsive patients (complete response: CR, or partial response: PR) received one more course of chemotherapy before undergoing local radiotherapy. Results: All 44 patients were assessable for response and toxicity analysis. The most common grade 3/4 adverse events were neutropenia, which occurred in 23 patients. Four cases of febrile neutropenia were noted. The overall response rate was 90% (CR 45% & PR 45%). The four year probability of time to treatment failure was 56.3±10.2%. The four year estimated overall survival rates were 87.4±6.9%. Conclusions: Docetaxel and cisplatin induction chemotherapy shows considerable CR, with an acceptable toxicity profile in patients with locally advanced head and neck squamous cell carcinoma.(Korean J Med 73:415-422, 2007)

증례 : 전신성 경화증에서 D-penicillamine 치료 중에 발생한 중증 재생불량성 빈혈 1예

이동원 ( Dong Won Lee ),이선미 ( Sun Mi Lee ),이준희 ( Jun Hee Lee ),신호진 ( Ho Jin Sin ),정주섭 ( Joo Seop Chung ),조군제 ( Goon Jae Cho ),김성일 ( Sung Il Kim ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-

D-penicillamine에 의한 재생불량성 빈혈의 부작용은 비교적 드문 경우로 사망을 초래할 수도 있으며, 국내에서 이에 대해 1예만 보고되어 있다. 저자들은 전신성 경화증을 진단받고 D-penicillamine으로 2년 동안 치료받는 중에 전신적인 허약감과 어지럼증으로 내원한 환자에서 발생한 난치성의 중증 재생불량성 빈혈 1예를 경험하였기에 문헌고찰과 함께 이를 보고하는 바이다. D-penicillamine has been used in treating systemic scleroderma (SSc) to reduce skin thickening and to prevent further involvement of internal organs. Well known side effects include skin rash, changes or loss of taste, nausea and vomiting, hematologic complications such as thrombocytopenia, agranulocytosis, hemolytic anemia, aplastic anemia and autoimmune disease such as Goodpasture`s syndrome, myasthenia gravis, polymyositis, and systemic lupus erythematosis. Aplastic anemia is a rare complication and is usually resolved by discontinuing medication. We experienced a case of D-penicillamine-induced severe aplastic anemia in systemic scleroderma patient and would like to report this case with review of articles. (Korean J Med 69:S970-S973, 2005)

감염 ; 우리나라 사람면역결핍바이러스 감염 환자에서 악성종양 발생 양상

설영미 ( Young Mi Seol ),송무곤 ( Moo Gon Song ),최영진 ( Young Jin Choi ),이선희 ( Sun Hee Lee ),김성일 ( Sung Il Kim ),정주섭 ( Joo Seop Chung ),곽임수 ( Ihm Soo Kwak ),조군제 ( Goon Jae Cho ),이혁 ( Hyuck Lee ),정동식 ( Dong S 대한내과학회 2009 대한내과학회지 Vol.76 No.5

목적: 항HIV 치료의 발전으로 HIV 환자가 장기간 생존하게 되면서 악성종양은 HIV 환자에서 중요한 사망원인으로 대두되고 있다. 본 연구는 국내 HIV 환자에서 암 발생양상을 알아보고 이전에 발표된 국내의 연구들과 비교해봄으로서 우리나라 HIV 환자에서 발생하는 암 발생 특성을 파악하는데 도움이 되는 자료를 제시하고자 하였다. 방법: 1990년 1월부터 2008년까지 6월까지 부산지역 4개 대학 병원(고신대병원, 동아대병원, 부산대병원, 인제대병원)에 내원하였던 HIV 감염 환자들을 대상으로 의무기록을 후향적으로 분석하였다. 결과: 대상 환자 683명 중 27명(4%)에서 악성종양이 발생하였다. 27명 중에서 남자는 25명(93%)이었고, 악성종양 진단 시점 연령의 중앙값(범위) 48세(24~76세)였다. 진단 당시 평균 CD4+ 세포수의 중앙값(범위)은 42/uL (3~399)이었다. 비에이즈 정의 악성종양이 14예(52%), 에이즈 정의 악성종양 13예(48%)였다. 시기별로는 Pre-HAART 기간에는 에이즈 정의 악성종양과 비이에즈 정의 악성종양이 각각 2예씩 발생하였고, HAART 기간에는 비에이즈 정의 악성종양이 12예(52%)로 에이즈 정의 악성종양 11예(48%)가 발생하였다. 에이즈 정의 악성종양 중에서는 비호지킨 림프종(9/13)이 가장 많았고, 카포시육종(4/13)의 순이었다. 비호지킨 림프종 중에서는 미만성 B형 대세포 림프종이 가장 많았으며(5/9) 중추신경계 미만성 B형 대세포 림프종 (3/9), 버킷 림프종 (1/9)의 순이었다. 비에이즈 정의 악성종양 중에서는 위암, 직장암, 간세포암이 가장 많았으며(각각 3/14) 그 외 갑상선암, 편도암, 식도암, 혈관육종, 에크린 땀샘암종(eccrine carcinoma)이 각각 1예로, 위장관 기원 악성종양이 50% (7/14)를 차지하였다. 에이즈 정의 악성종양과 비에이즈 정의악성종양 발생 환자의 사이에는 내원 시점 CD4+ 세포수 중앙값은 각각 18, 114/uL로 비에이즈 정의 악성종양 환자에서 의미있게 높았다(p=0.001). 그 외에 성별, 전파경로, HBsAg 양성, 진단 시점 연령, 사망여부, HIV 감염에서 악성종양 진단까지 및 첫 내원부터 악성종양 진단까지 기간은 양 군 간에 의미있는 차이가 없었다. 결론: 국내 HIV 감염 환자의 악성 종양 발병률은 4%였다. 항HIV 치료에 의한 생존율의 향상에 따른 에이즈 악성종양의 감소와 비에이즈 정의 악성종양의 상대적 증가 양상은 관찰되지 않았다. 가장 흔한 악성종양은 비호지킨 림프종이었으며 비에이즈 악성종양 중에서는 소화기계통의 악성종양과 간암이 흔히 발생하였다. Background/Aims: The prevalence of malignancies associated with human immunodeficiency virus (HIV) is rapidly increasing. The aim of the present study was to identify clinical features associated with malignancies in South Korean patients infected with HIV. Methods: From January 1990 to June 2007, we reviewed an electronic database containing pathological reports obtained from HIV-infected patients and then retrospectively analyzed a total of 27 malignancy cases treated at four different institutions. Results: Among 683 patients infected with HIV, malignant diseases were diagnosed in 27 cases (4.0%). Twenty-five of these patients were male, and the median age was 48 (range; 24-76). At the time of diagnosis, the median CD4+ lymphocyte count was 42/uL (range 3-339). Acquired immune deficiency syndrome (AIDS)-defining malignancies were diagnosed in 13 patients (48%) and non-AIDS-defining malignancies were diagnosed in 14 patients (52%). Two patients each were diagnosed with AIDS-defining and non-AIDS-defining malignancies during the pre-highly active anti-retroviral therapy (HARRT) period. In contrast, 11 patients (48%) and 12 patients (52%) were diagnosed with AIDS-defining and non-AIDS-defining malignancies during the HARRT period, respectively. Among AIDS-defining malignancies, non-Hodgkins lymphoma was the most frequently observed (9/13), followed by Kaposi`s sarcoma (4/13). Among the 9 patients with non-Hodgkins lymphoma, diffuse large B-cell lymphoma was most common (5/9), followed by primary CNS lymphoma (3/9) and Burkitt`s lymphoma (1/9). Gastrointestinal (GI) malignancies [i.e., gastric cancer (3/14), rectal cancer (3/14), and esophageal cancer (1/14)] and hepatocellular carcinoma (3/14) were the most commonly observed among the non-AIDS-defining malignancies. Other observed non-AIDS-defining malignancies were thyroid cancer (1/14), tonsillar cancer (1/14), angiosarcoma (1/14), and eccrine cancer (1/14). Finally, median CD4+ lymphocyte counts at the time of diagnosis were significantly different (18 vs. 114/uL, p=0.001) between AIDS-defining malignancies and non-AIDS-defining malignancies. Conclusions: Malignancies were diagnosed in 4.0% of patients infected with HIV. This study showed similar rates of incidence between AIDS-defining and non-AIDS-defining malignancies. Non-Hodgkins lymphoma was the most frequently observed malignancy, whereas GI malignancies and hepatocellular carcinoma were common among non-AIDS-defining malignancies. (Korean J Med 76:554-563, 2009)

성인 급성 골수성 백혈병의 염색체 이상과 면역 표현형의 임상적 중요성

조군제(Goon Jae Cho),공옥녀(Ok Nyu Kong),정종윤(Jong Yun Cheong),이경우(Kyung Woo Lee),이정현(Jung Hyun Lee),정주섭(Joo Seop Chung),이은엽(Eun Yup Lee) 대한내과학회 2002 대한내과학회지 Vol.62 No.6

목적 : 저자들은 급성 골수성 백혈병에 있어 염색체 이상의 빈도 및 예후와 면역표현형의 임상적 중요성을 알아보고자 본 연구를 시행하였다. 방법 : 1996년 1월부터 2000년 12월까지 부산대학교병원 내과를 방문하여 급성 골수성 백혈병으로 진단 받은 68예를 대상으로 염색체 및 면역표현형 분석과 혈액학적, 임상적 양상을 비교하였다. 이중 47예에서 관해유도 치료를 시행하였으며 염색체 예후군에 따라 치료 성적을 비교하였다. 결과 : 염색체 이상은 핵형의 유형에 따라 t (8;21), t (15;17) 및 inv (16)을 예후양호군 (n=19, 28%), -5, del (5q), -7, der (1;7), 3q 이상 및 3개 이상의 클론성 이상이 갖는 복합성 핵형 (complex karyotype)을 예후불량군 (n=11, 16%), 정상 염색체 및 기타 염색체 이상을 중간위험군 (n=38, 56%)의 세 군으로 구분하였다. 염색체 이상의 빈도는 56% (38/68)였으며 관해유도 치료군에 있어 전체 완전 관해율은 64%였다. 예후양호군, 중간위험군 및 예후불량군의 완전 관해율은 각각 88%, 59% 및 44%였다 (p=0.021). 생존기간의 중앙값은 7개월이었으며 예후불량군 및 중간위험군의 생존기간의 중앙값은 2개월 및 6개월이었다. 예후양호군에서는 생존기간 중앙값에 아직 도달하지 않았다 (p=0.008). 또한 5년 생존율은 38%였으며 예후양호군, 중간위험군 및 예후불량군의 5년 생존율은 각각 68%, 31% 및 9%였다 (p=0.009). CD7, CD14, CD33, CD34 및 terminal deoxynucleotidyl transferase의 표현 여부는 완전 관해율 및 생존율에 통계적으로 의미 있는 차이가 없었다. 다변수 분석에서 연령 및 염색체 이상이 통계적으로 의미가 있었다. 결론 : 급성 골수성 백혈병 환자에 있어 염색체 분석은 치료 성적을 예측하는데 중요하다. 따라서 본 연구와 같은 염색체 결과를 고려하여 치료 방향을 정해야 하겠다. Background : This study was performed to identify the incidence and prognostic significance of chromosomal abnormalities as well as clinical significance of immuno phenotype in patients with acute myelogenous leukemia (AML). Methods : The chromosomal abnormalities, immunophenotype and their hematologic/clinical correlations were studied in 68 patients with de novo AML admitted to Pusan National University Hospital between January 1996 and December 2000. 47 of 68 patients had received induction chemotherapy and we analysed the response of treatment according to the karyotype pattern and immunophenotype. Results : The karyotypic patterns were divided into three groups; favorable (t (8;21), t (15;17) and inv (16); n=19,28%), poor (-5, del (5q), -7, der (1;7), abn (3q) and complex karyotypes; n=11, 16%) and intermediate group (other abnormalities or normal karyotype; n=38, 56%). The incidence of chromosomal abnormalities was 56% (38/68) and overall complete remission (CR) rate of 47 evaluable patients was 64%. The CR rates of favorable, intermediate and poor groups were 88%, 59% and 44%, respectively (p=0.021). The median survival time of all patients was 7 months, those of poor and intermediate groups being 2 months and 6 months. The median survival time of favorable group was not reached (p=0.008). The overall 5 year survival rate was 38% and those of favorable, intermediate and poor groups were 68%, 31% and 9%, respectively (p=0.009). Expression of CD7, CD14, CD33, CD34 and terminal deoxynucleotidyl transferase had no impact on CR rate and overall survival. In multivariate analysis, both age and chromosomal abnormalities influence significantly on prognosis. Conclusion : Cytogenetic study is important in predicting the outcome of patients with AML. And the treatment must be tailored according to the result of cytogenetics such as this study.(Korean J Med 62:608-616, 2002)

균혈증 및 패혈증의 임상 양상 및 예후 인자에 대한 고찰

이수봉(Soo Bong Lee),이우철(Woo Chul Lee),정현철(Hyun Chul Jung),송상헌(Sang Heun Song),이동원(Dong Won Lee),김용범(Yong Bum Kim),정주섭(Joo Seop Chung),곽임수(Ihm Soo Kwak),조군제(Goon Jae Cho),나하연(Ha Youn Rha),장철훈(Chul Hun Ch 대한내과학회 1999 대한내과학회지 Vol.56 No.3

N/A Objectives : In spite of the improvement in therapeutic strategy, the mortality rate from sepsis is still high. The purpose of this study was to examine the clinical characteristics and prognostic factors of sepsis to get help in treatment and estimation of prognosis of sepsis. Methods : We analyzed the clinical and bacteriologic data of 313 admitted patients with bacteremia at Pusan National University Hospital from Jan., 1996 to Dec., 1997 retrospectively and all patients were categorized into 4 groups (bacteremia, sepsis, severe sepsis, septic shock) by the definition from American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference, 1992. Results : 1) Male to female ratio was 1.22 : 1 and mean age was 52 years. 2) The overall mortality rate was 32.3% and the mortality rates of bacteremia, sepsis, severe sepsis and septic shock were 14.9%, 22.8%, 52.0%, and 95.2%, respectively. 3) Underlying diseases predisposing to bacteremia were diabetes mellitus(14.4%), solid cancer (13.1%), hematologic malignancy(10.2%) and liver cirrhosis(9.9%), but the most common was no underlying disease. 4) Among the total 80 species of isolated microorganisms, gram-positive organisms were responsible in 169 cases, gram-negative organisms in 218 cases. E. coli was isolated most frequently, followed by S. aureus, S. epidermidis, K. pneumoniae, Enterococcus spp., Enterobacter spp., Str. viridans group, CNS, P. aeruginosa and S. typhi. 5) Although the source of bacteremia could not be identified in 28.8% of the patients, the others had the primary site of infections ; skin(17.9%), gastrointestinal tract(16.9%), respiratory tract(12.5%), urinary tract(9.9%) and biliary tract(7.3%). 6) The mortality rate in patients with gram-positive bacteremia was 39.4%, with gram-negative bacteremia was 20.9% and with polymicrobial bacteremia was 33.3%. MRSA sepsis showed the highest mortality rate(58.8%), followed by Enterococcus spp.(50.0%), K. pneumoniae (35.0%), P. aeruginosa(27.3%) and E. coli(18.8%). 7) There was significant relation between etiologic organisms of bacteremia and the primary site of infections. 8) Using logistic regression analysis, mortality was predicted by disseminated intravascular coagulation, severity of sepsis and severity of underlying diseases. Conclusion : Sepsis occurred in 16 patients among 1,000 adult admitted patients and overall mortality rate was 32.3%, still high. The mortality rate had positive correlation with the severity of sepsis. Among 16 evaluated risk factors of mortality, mortality was predicted by disseminated intravascular coagulation, severity of sepsis and severity of underlying disease.

우리나라 사람면역결핍바이러스 감염 환자의 톡소포자충 감염

이상현 ( Sang Hyun Lee ),이선희 ( Sun Hee Lee ),차동혁 ( Dong Hyuk Cha ),이수진 ( Su Jin Lee ),곽임수 ( Ihm Soo Kwak ),정주섭 ( Joo Seop Chung ),조군제 ( Goon Jae Cho ),이혁 ( Hyuck Lee ),정동식 ( Dong Sik Jung ),문치숙 ( Chi Soo 대한내과학회 2009 대한내과학회지 Vol.76 No.6

목적: 톡소포자충 뇌염은 사람면역결핍바이러스 환자에서 발생하는 중추신경계 기회감염증의 가장 흔한 원인 중하나이다. 우리나라에서 톡소포자충 뇌염은 HIV 감염 환자에서 발생하는 다른 기회감염증들에 비해 매우 드물게 보고되고 있다. 본 연구는 우리나라 HIV 감염 환자의 톡소포자충 감염의 특성과 현 상황에 대하여 알아보고자 하였다. 방법: 1990년부터 2008년까지 고신대병원, 동아대병원, 부산대병원, 인제대병원의 4개 대학병원에 내원한 HIV 감염환자들을 대상으로 의무기록을 후향적으로 분석하였으며, 톡소포자충 뇌염 발생률과 임상적 특성, 톡소포자충 항체 유병률, 혈청전환율 및 톡소포자충 감염의 위험인자에 대하여 조사하였다. 결과: 총 683명의 HIV 감염 환자가 연구대상에 포함되었다. 남자가 598명(87.6%)이었고, 환자들의 정중 나이는 41세(16~76세)였다. 환자들의 CD4 양성 림프구 수의 중앙값은 221/μL이었으며 49%가 처음 내원 시 에이즈로 진행한 상태였다. 총 683명 중 톡소포자충 뇌염으로 내원한 환자는 6명(0.9%)이었으며, 연구기간 동안 톡소포자충 뇌염의 발생률은 100인년당 0.34명(95% 신뢰구간: 0.17~0.72명)이었다. 6명 모두 남자였으며 톡소포자충 뇌염 진단 당시 정중 나이는 42세(32~48세)였다. 6명 중 4명(50%)은 톡소포자충 뇌염 때문에 처음 병원을 방문하였으며, 이 중 3명은 이때 HIV 감염사실을 처음으로 알게 되었다. 톡소포자충 뇌염 진단시점의 CD4 양성 림프구 수의 중앙값은 44/μL (2~99/μL)로 모두 100μL 미만이었다. 총 683명 중 414명(61%)에서 톡소포자충 항체 검사가 시행되었고, 이 중 35명(8.5%)에서 양성이었다. 처음 시행한 톡소포자충 IgG 항체 검사에서 음성이었던 376명중 95명(25.3%)에서 추적검사가 시행되었다. 총 추적기간은 207.7년이었으며 평균 추적기간은 2.2년(1~6.2년)이었다. 추적기간이 1~2년인 경우가 53명(56%)으로 가장 많았으며, 65%에서 추적기간 동안 폐포자충 예방을 위해서 trimethoprim/sulfamethoxazole을 투여한 적이 있었으며, 투여기간은 1년 미만이 38명(61%)으로 가장 많았고, 평균 투여 기간은 전체추적기간의 32%였다. 추적검사가 시행되었던 95명 중 단지 2명(2.1%)에서만 혈청전환이 있었으며, 추적기간 동안의 혈청전환율은 100인년당 0.96명(95% 신뢰구간: 0.47~3.29명)이었다. 톡소포자충 항체 검사가 시행되었던 414명 중 판정 불가였던 3명을 제외한 411명에 대하여 톡소포자충 감염 위험인자를 분석하였다. 단변량 분석에서는 나이가 많을수록, 결혼을 한 경우, 이성접촉에 의한 감염, 해외 거주력이 있는 경우가 유의한 위험인자로 나타났으나(p<0.05), 다변량 분석에서는 해외 거주력만이 통계학적으로 유의한 위험인자였다. 결론: 우리나라 HIV 감염 환자의 톡소포자충 혈청 유병률은 약 8.5%였으며, 톡소포자충 뇌염의 발생률도 100인년당 0.34명으로 전체 환자의 0.9%에서만 발병하여 혈청 유병률뿐만 아니라 발생률 모두가 다른 국가에 비해서 낮은 수준임을 알 수 있었다. 특히 해외 거주력이 있는 경우에는 톡소포자충 감염의 위험성이 4배 정도 높았다. 또한 톡소포자충에 감염되지 않았던 환자를 약 2년간 추적하는 동안 약 2%에서 새로운 감염이 발생할 수 있음을 알 수 있었다. Background/Aims: Toxoplasmic encephalitis (TE) is one of the most common causes of focal brain lesions, which complicate the course of acquired immunodeficiency syndrome (AIDS). There is wide geographic variation in the prevalence of toxoplasma infection. This study was performed to characterize toxoplasma infection in human immunodeficiency virus (HIV)-infected patients in South Korea. Methods: We retrospectively examined the incidence and clinical characteristics of TE in 683 HIV-infected patients who were enrolled between 1990 and 2008 at four university hospitals in Busan, Korea. We also assessed the seroprevalence of IgG antibodies to Toxoplasma gondii, risk factors for toxoplasma seropositivity, and seroconversion rates during the course of HIV infection. Results: Among 683 HIV-infected patients, six (0.9%) patients were diagnosed with TE. The incidence of TE was 0.34 per 100 person-years (py) during the study period. Of the 414 patients who had undergone serological examinations for Toxoplasma gondii, 35 (8.5%) patients were seropositive. Univariate analysis showed that the risk factors associated with toxoplasma seropositivity included increased age, heterosexual transmission, marriage, and a history of overseas residence (p<0.05). Of these factors, a history of overseas residence was a significant risk factor in a multivariate analysis (p<0.05). A total of 95 patients who were seronegative on their initial screen showed serial toxoplasma IgG antibodies (mean duration of follow-up, 2.1 years). Among these patients, only two (2.1%) acquired IgG antibodies to Toxoplasma gondii during the follow-up period. Conclusions: The seroprevalence of anti-toxoplasma IgG antibodies in HIV-infected patients in Korea was 8.5%. A history of overseas residence was a significant risk factor for toxoplasma seropositivity. The incidence of TE was 0.34/100 py, which is lower than that reported in other countries. Toxoplasma seroconversion was also uncommon (2.1%). (Korean J Med 76:713-721, 2009)

유도화학요법 및 국소 치료 후 원격전이를 보인 국소 진행성 두경부암 환자군의 임상 특징 및 위험인자에 관한 연구

이혜원(Hye Won Lee),백동훈(Dong Hoon Baek),이경남(Kyung Nam Lee),조은정(Eun Jung Cho),김효정(Hyo Jeong Kim),설영미(Young Mi Seol),송무곤(Moo Kon Song),최영진(Young Jin Choi),신호진(Ho Jin Shin),정주섭(Joo Seop Chung),조군제(Goon Jae 대한두경부종양학회 2011 대한두경부 종양학회지 Vol.27 No.2

Backgrounds:Head and neck cancer is one of the most prevalent cancers in the world. It tends to remain lo-calized at the primary site and regional lymph nodes, but if distant metastasis occurs, it has a poor prognosis. This study was performed to evaluate the prevalence of distant metastasis and to determine the risk factor in local-ly advanced head and neck cancer after induction chemotherapy followed locoregional control therapy. Meth-ods:A retrospective review was performed in 420 patients with locally advanced head and neck cancer who treated with induction chemotherapy followed locoregional control therapy from January 2001 to December 2010. Among them, 31 patients who had distant metastasis as first relapse within 2 years after termination of therapy were analyzed for clinical features and the risk factors of distant metastasis. Results : The overall incidence of distant metastasis was 7.3%. The bone, lung, and liver were the most frequent metastatic organs. In univariate analysis, nodal stage, nasopharyngeal cancer, laryngeal cancer, G3/G4 neutropenia during induction chemother-apy, and concurrent chemoradiotherapy were the influencing factors for distant metastasis. In multivariate analy-sis, advanced N stage and nasopharynx were the risk factors of distant metastasis, and grade 3/4 neutropenia during induction chemotherapy was considered to decrease distant metastasis. Conclusion:This study sug-gests that the advanced N stage is the risk factor of distant metastasis and Grade 3/4 neutropenia during induction chemotherapy can be beneficial against distant metastasis in locally advanced head and neck cancer patients treat-ed with induction chemotherapy followed locoregional control therapy.

류마티스관절염에 동반된 만성 골수성 백혈병 환자에서 Imatinib Mesylate 효과 보고 1예

전혜경 ( Hye Kyung Jeon ),박영은 ( Young Eun Park ),김성일 ( Sung Il Kim ),박성후 ( Seong Hu Park ),백승훈 ( Seung Hoon Baek ),이정욱 ( Joung Wook Lee ),하동우 ( Dong Woo Ha ),이혜원 ( Hye Won Lee ),정주섭 ( Joo Seop Chung ),이승 대한류마티스학회 2011 대한류마티스학회지 Vol.18 No.2

Rheumatoid arthritis is associated with an increased risk of hematological malignancy as a result of the RA itself or its treatment. We report here on an unusual case of a 55-year-old female with long-standing rheumatoid arthritis and who was treated with low dose methotrexate and hydrochloroquine. She was diagnosed with chronic myelogenous leukemia that manifested with severe thrombocytosis and basophilia, and this was treated with imatinib mesylate. After 6 months, she achieved a complete cytogenetic response of the CML and a complete resolution of all the RA symptoms without DMARDs.

Taxane계 항암요법 후 재발된 두청부 면평상피세포암에 대한 Capecitiabine과 Cisplatin의 구제 화학요법

정주섭,조군제,신호진,최영진,이선미 부산대학교 병원 암연구소 2007 부산대병원학술지 Vol.- No.21

Purpose: The prospective study was conducted to assess the efficacy and toxicities of the salvage chemotherapy of capecitabine and cisplatin for the patients with recurrent SCCHN (squamous cell carcinoma of head and neck), who could not be treated anymore by surgery or radiation. Subject and Methods: The patients with recurrent SCCHN were eligible if they had treated with previous chemotherapy and radiotherapy. The treatment consisted of cisplatin (75 mg/m² as a 2 hours infusion on day 1) and capecitabine (1000 mg/m² orally twice daily, on day 2-15), repeated every 21 days. Results: Twenty-four patients received total 79 cycles (mean 4 cycles). Overall response rate was 42% with 1 CR (4%) and 9 PR (38%).5 patients were SD (21%) and 9 patients presented PD (38%). The most common grade 3/4 adverse events were neutropenia and anemia, which documented in 5 and 4 patients, respectively. Fatigue was the most frequent non-hematologic side effect that was noted in 11 patients. Treatment-related mortality was absent. Conclusion: Capecitabine plus cisplatin is an effective salvage regimen with an acceptable toxicity profile for the patient with recurrent SCCHN.