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)

위암 환자의 개복전 전이판단에 관한 진단법의 비교관찰

허윤(Yoon Huh),조군제(Goon Jae Cho),최석렬(Seok Reyol Choi),이봉춘(Bong Chun Lee),윤중근(Jung Kun Yoon) 대한소화기학회 1985 대한소화기학회지 Vol.17 No.1

N/A The reliability of physical examination, liver scan, abdominal ultrasonography and CT scan in detecting cancer metastasis has been evaluated 49 patients with histologically proven stomach cancer (32 cases was performed CT scan.) who had admitted to Inje medical College, Pusan Paik Hospital from August 1982 to August 1984. Confirmation on laparotomy or peritoneoscopy showed the following results: 1) Thirty two cases out of forty nine were over the age of 41 years (87. 5%). 2) Liver scan, abdominal ultrasonography and CT scan were 71.4% accurate, and 79.6% accurate, and 81.3% accurate, respectively, in detecting liver metastasis. 3) Abdominal ultrasonography and CT scan were 32.7% accurate and 50% accurate in detecting lymph node metasis (p<0.05) 4) Abdominal ultrasonography and CT scan were 85.7% accurate and 84.4% accurate in detecting other organs metastasis. 5) The additional benefit of abdominal ultrasonography when liver scan was in error was an increase in accuracy of 22.4% for liver scan alone. 6) In a composite analysis on hepatic metastasis, the diagnostic accuracy was not improved by combining abdominal ultrasonography and liver scan examination (p>0. 05). 7) Borrmanns type 1V had the highest incidence of TMN classification stage IV (83.3%). Those who had palpable epigastric mass show higher incidence of TMN classification stage IV compared with those who had not (p<0.01).

황달의 감별진단에 있어서 복부초음파검사의 진단적 의의

허윤(Yoon Huh),조군제(Goon Jae Cho),박상희(Sang Hee Park),김장섭(Jang Sup Kim),김시환(Si Hawn Kim),양웅석(Oong Suk Yang) 대한소화기학회 1983 대한소화기학회지 Vol.15 No.1

N/A The authors evaluated the diagnostic accuracy of ultra sonography in the differential diagnosis of jaundice in 63 cases who were confirmed byoperation and other diagnostic methods from Jan. to Aug 1982 at the department of internal rnedicine in Busan National University Hospital. Of 63 cases of jaundice, on ultrasonographic examination biliary obstruction was 36, and non-obstruction of bile duct was 27 according to the degree of bile duct dilatation(common bile duct 6mm, intrahepatic bile duct>4 mm). The sensitivity of ultrasonography in the diagnosis of biliary obstruction was 92% and specificity was 92,%, therefore overall accuracy of ultrasonography in the differential diagnosis of jaundice was 92%. In the detection of the exact caseses of jaundice the diagnostic accuracy of ultrasonography was 54% in obstructive jaundice, 38% in non-obstructive jaundice. So ultrasonographic examination appears to be a simple, reproducible, and high accurable screening method in the differentical diagnesis of jaundice although relatively low valuable in the diagnosis of exact causes of jaundice.

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.

원발성 간암 100 례에 대한 임상적 고찰 (pp.984-992)

문한규 ( Han Kyu Moon ),조군제 ( Goon Jae Cho ),김유철 ( Yoo Chul Kim ),이청 ( Chung Lee ) 대한내과학회 1977 대한내과학회지 Vol.20 No.11

Lamivudine 복용 HIV-1 감염자에게서 내성 돌연변이 검색

조영걸(Young-Keol Cho),성흥섭(Heung-Sub Sung),이희정(Hee-Jung Lee),김유겸(Yoo-Kyum Kim),지현숙(Hyun-Sook Chi),조군제(Goon-Jae Cho),강문원(Moon-Won Kang) 大韓微生物學會 2000 大韓微生物學會誌 Vol.35 No.2

AIDS 환자에서 CD4+ T 세포수 감소에 따른 CMV 감염

조영걸,김유겸,오원일,조군제,Cho, Young-Keol,Kim, Yoo-Kyum,Oh, Won-Il,Cho, Goon-Jae 대한미생물학회 1998 Journal of Bacteriology and Virology Vol.28 No.4

Cytomegalovirus is the most common cause of life-threatening viral infection in HIV-infected patients. This study was done prospectively to investigate the incidence of CMV infection according to the decrease of CD4+ T cell count (CD4+) in Korean AIDS patients. Thirty-nine HIV-infected patients diagnosed before 1994 were followed for regular immunological monitoring. We have used urine shell vial method for the CMV detection from 1994 and have also checked clinical findings. Positive urine culture rate definitely depended on the CD4+ as follows; 45%, 22%, 17%, 11% and 0%, CD4+ <50, 50-100, 100-200, 200-500 and >500, respectively. Except culture positive 2 patients with CD4+ of $200{\sim}300/{\mu}l$, all eight culture positive patients with CD4+ less than $200/{\mu}l$ showed CMV related diseases on or before urine culture. But, we could not get a positive culture for a late AIDS patient with vision loss. With ganciclovir therapy, all culture results were at least negative just after or on late of first 14 days-ganciclovir infusion-course. These data suggest that the incidence of CMV disease in Korean AIDS patients is very high, and early diagnosis and treatment for CMV diseases is required for the prevention of life threatening results.

내시경으로 진단한 식도정맥류의 임상적 검토

양웅석(Oong Sheuck Yang),제영성(Young Sung Jae),허윤(Yoon Huh),조성락(Sung Rag Cho),이정국(Jeong Koog Lee),조군제(Goon Jae Cho) 대한소화기학회 1982 대한소화기학회지 Vol.14 No.1

N/A Sixty-three patients with esophageal varices were selected in whom endoscopic examination was performed at the Busan National University Hospital, September, 1982 and February, 1982 The esophageal varices were classified into three grades from the endoscopical point of point of view in accordance with Sesokos method of classification. A study was done for the relationship between the endoscopical findings of esophageal varices, clinical findings and spleen visualization by 198Au liver scanning. The results obtained were as follow: 1) Among 63 cases with esophageal varices, the grade of esophageal varices was severe in 31.7%, moduate in 39.7%, and mild in 28.6%. 2) In 44 bleeding patients with esophageal varices, there was significant correlation between the grade of esophageal varices and the frequency of upper gastrointestinal bleeding. Severe esophageal varices were associated with a high risk of bleeding. As the cause of upper gastrointestinal bleeding, ruptured esophageal varices (54. 5%) and hemorrhagic gastritis (24.0%) were more frequent. Bleeding source could not be observed in 11 4% of bleeding cases. 3) The grade of esophageal varices had neither significant relationship with abdominal venous dilatation nor with ascites. There was parallel relationship between the grade of esophageal varices and splenomegaly. The larger splenomegaly was, the higher grade of esophageal varices was present. 4) Somewhat correlation was observed between spleen visualization by 198Au liver scanning and the grade of esophageal varices but not statsically significant.

지상발표 : 복수에서의 α-Fetoprotein 과 CEA 의 진단적 의의

유석동(Seuck dong Yo),김무현(Moo Hyun Kim),한상영(Sang Young Han),조군제(Goon Jae Cho),양웅석(Oong Suk Yang),허윤(Yoon Huh) 대한소화기학회 1987 대한소화기학회 추계학술대회 Vol.1987 No.-

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)