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FP 항암화학요법환자를 위한 표준진료지침서 및 간호기록지 개발
장선호,조선희,연미자,김매자,임선홍,전현숙,송화선,이지애,엄현정,김은실 성인간호학회 1999 성인간호학회지 Vol.11 No.4
The current patient management system has several limitations. To develop the critical pathway (CP) as a cost-effective method via continuous patient management. we investigated the medical records of 77 patients who underwent FP chemotherapy in Seoul National University Hospital from Feb. 1 to28. 1999. And the pilot study was done to 12 patients admitted to undergo the FP chemotherapy. 1. The vertical contents in the CP consisted of 7 items : assessment, activity, diet, IV therapy, medication, education and evaluation. The duration of the horizontal axis was 6 days from admission to discharge. 2. The medical performance according to the vertical axis in the preliminary CP, consisted of 72, and modified to 74 items in the final form of CP. 3. The nursing record consisted of a vertical axis of 4 items : assessment, IV therapy, medication and education. The duration of the horizontal axis was 6 days from admission to discharge of hospital days.
간세포암 환자의 종양병기 평가에 대한 Up-to-Seven Score의 임상적 유용성
정창호 ( Chang Ho Jung ),서연석 ( Yeon Seok Seo ),이재민 ( Jae Min Lee ),윤석배 ( Seok Bae Yoon ),윤태정 ( Tae Jung Yun ),임선영 ( Sun Young Yim ),안형진 ( Hyonggin An ),엄순호 ( Soon Ho Um ),김창덕 ( Chang Duck Kim ),류호상 ( Ho 대한간암학회 2014 대한간암학회지 Vol.14 No.1
Background/Aims: Up-to-seven criteria was proven to be useful for predicting prognosis after liver transplantation in patients with hepatocellular carcinoma (HCC). The aim of this study was to evaluate that up-to-seven score could be useful method for prediction of prognosis in patients with HCC who did not undergo liver transplantation. Methods: Between January 2006 and December 2008, 216 HCC patients without vascular invasion, lymph node and distant metastasis were analyzed retrospectively. We investigated the prognostic impact of laboratory findings, clinical characteristics, modified UICC T stage, and up-to-seven score in HCC. The survival analyses were performed using Kaplan-Meier Results: Two-hundred sixteen patients with HCC were included. Age was 60.1±11.3 years and 74.5% were male. Chronic hepatitis B was the most common cause of liver disease (60.6%). T stage was T1, T2, and T3 in 36 (16.7%), 118 (54.6%), and 62 (28.7%) patients, respectively. Up-to-even score was 5.5±4.0 and it was <3 (UTS 1), ≥3 and ≤7 (UTS 2), and >7 (UTS 3) in 36 (16.7%), 133 (61.6%), and 47 (21.8%) patients, respectively. The 10 (8.5%) patients of T2 stage were classified into UTS 3 and 25 (40.3%) patients of T3 stage were classified into UTS 2. The prognosis was significantly different in patients with T2 or T3 according to their UTS. Multivariate analysis showed that Child-Pugh score and UTS were significantly associated Conclusions: Up-to-seven score was useful to predict prognosis and to evaluate tumor stage in patients without vascular invasion, lymph node and distant metastasis.
고립성 골 전이를 동반한 식도편평세포암에서 동시 항암화학방사선 요법 후 완전관해를 보인 1례
김선영,서민호,최혁순,김은선,금보라,진윤태,이홍식,엄순호,김창덕,류호상,이우진,전훈재,김예지,Sun Young Kim,Min Ho Seo,Hyuk Soon Choi,Eun Sun Kim,Bora Keum,Yoon Tae Jeen,Hong Sik Lee,Soon Ho Um,Chang Duck Kim,Ho Sang Ryu,Woo Jin Lee,Hoon Jai 대한소화기암연구학회 2013 Journal of digestive cancer reports Vol.1 No.1
There is no established treatment for esophageal carcinoma with metastasis. For the metastatic esophageal squamous cell carcinoma, chemotherapy or best supportive care according to patient's performance status are accepted as an available treatment. We report a case of complete remission after concurrent chemoradiotherapy for esophageal squamous cell carcinoma with metastatic lesion in 5th thoracic vertebrae. A 57-year-old man with ongoing dysphagia and weight loss was admitted to our hospital. On the endoscopic and radiologic imaging evaluation,the patient was diagnosed as a squamous cell carcinoma of esophagus with solitary metastatic lesion in 5th thoracic vertebrae. The patient was treated with combination chemotherapy (5-fluorouracil (5-FU) and cisplatin) and concurrent radiotherapy for two months to relieve dysphagia. Because metastatic lesion in thoracic vertebrae was located near the primary esophageal tumor, the metastatic lesion could be included within the radiation field. After concurrent chemoradiotherapy, consecutive 4 cycles of chemotherapy had been carried out. Primary esophageal tumor with metastatic lymph nodes and metastatic lesion in 5th thoracic vertebrae disappeared on follow up computed tomography (CT) and positron emission tomography-CT (PET-CT). Follow up endoscopic biopsy revealed no remnant malignant cells at previous primary cancer lesion.
( Sun Young Yim ),( Yeon Seok Seo ),( Soon Ho Um ),( Yoon Tae Jeen ),( Hong Sik Lee ),( Hoon Jai Chun ),( Chang Duck Kim ),( Ho Sang Ryu ),( Yun Ji Park ) 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1
Background/Aim: Serum alpha-fetoprotein (AFP) is widely used as a screening test for the detection of hepatocellular carcinoma (HCC) in patients with high risk group. However, serum AFP level can be elevated without HCC. We aimed to study the role of AFP as screening marker for detecting HCC in different ALT levels. Methods: Our study is based on 395 patients with chronic HBV infection. Diagnostic efficacy of AFP according to the presence of elevated ALT levels was analyzed. Results: The age was 52.7±12.1 years with male predominance 67.8%. HCC were initially diagnosed in 58 patients (14.7%) and serum AFP level was 81,386±28,568.4 ng/mL in these patients. The AUC of AFP for the detection of HCC was 0.911 and sensitivity/specificity of AFP cutoff values of 20, 200 and 400 ng/mL were 79.3%/87.2%, 56.9%/97.0%, and 51.7%/98.5%, respectively. The initial AFP levels for patients without HCC was 42.5±297.0 ng/mL which showed significant correlation with serum ALT levels (Spearman`s correlation coefficient, 0.479; P<0.001). Therefore, changes in AFP level according to the changes in ALT levels were studied. AFP levels at ALT elevation, after normalization, and 3, 6, 9, 12 months thereafter were 90.1±405.0 ng/mL, 9.4±9.5 ng/mL, 5.3±3.8 ng/mL, 3.9±2.3 ng/mL, 3.9±2.4 ng/mL and 3.2±1.5 ng/mL, respectively. AFP level was 2.9±1.7 ng/mL in patients who remained normal ALT level for 1 year. Patients without HCC were followed up for 75.5±37.0 months and HCC were detected in 28 patients. AFP increased significantly from 3.9±1.9 ng/mL to 30.0±45.8 ng/mL when HCC was diagnosed in these patients (P<0.001). AUC was 0.951 in diagnosing HCC and the sensitivity/specificity of AFP cutoff values for 7.7, 10.0 and 15.0 ng/mL were 89.3%/98.6%, 71.4%/99.3% and 39.3%/100%. Conclusion: AFP is a useful screening marker in normal ALT levels especially in the era of antiviral therapy where liver in- flammation can be effectively controlled.
Treatment of Intermediate Stage HCC Patient: Impact of Deviation from BCLC Treatment Guidelines
( Sun Young Yim ),( Yoo Ra Lee ),( Han Ah Lee ),( Tae Hyung Kim ),( Hyung Joon Yim ),( Ji Hoon Kim ),( Yeon Seok Seo ),( Soon Ho Um ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: The intermediate stage hepatocellular carcinoma (HCC) comprises a highly heterogenous patient population. Despite the recommendation of transarterial chemoembolization (TACE) as first-line treatment, adherence to the recommended treatment option is low. Four substages (B1-B4) of intermediate HCC based on up-to-seven and Child Pugh Score was proposed by Bolondi et al. and different treatments modalities are recommended according to the stages. We aimed to compare the prognosis of patients who adhere to BCLC guideline impact of substagings in the management of intermediate HCCs. Methods: A retrospective chart review was conducted for 136 patients newly diagnosed with HCC BCLC stage B from year 2004 to 2016. Patients were categorized into three groups: adherent, over-treated and under-treated group based on BCLC guideline and Bolondi substage treatment recommendation. Survival analysis was performed using cox regression to determine the effects of overtreatment in intermediate HCC patients. Results: Among 136 patients, 84.1% were male patient with mean age of 60 years and overall survival was 35 months. Out of 136 patients, 86 patients (63%) adhere to TACE while 44 patients were over-treated (liver transplantation, resection, radioembolization and radiotherapy in addition to TACE) and 6 patients were undertreated (best supportive care) according to BCLC guideline. No patient had systemic therapy as initial treatment. When patients who adhere to TACE were compared to those who were over-treated according BCLC guideline, a higher proportion of patients with greater number of tumors, increased MELD score (≥10), and prolonged INR with lower platelet count were observed in TACE treatment group (all, P<0.05). Factors significantly associated with prolonged survival using multivariate analysis revealed that bolondi substages, over-treatment according to BCLC guideline, baseline AFP level and serum sodium level predictors of survival. Subgroup analysis with those who were treated with TACE only following BCLC guideline revealed that adherence to Bolondi treatment strategy improved survival compared to those who did not adhere to Bolondi treatment (P<0.001). Conclusions: BCLC practice guideline alone is not practiced in real life management of intermediate HCC patients. Our result indicate that overtreatment according to BCLC stage has impact in the prolongation of patient survival and treatment according to Bolondi’s substage could improve survival.
Biomimetic hydrogel blanket for conserving and recovering intrinsic cell properties
Um Seung-Hoon,서영민,서현선,Lee Kyungwoo,Park Sun Hwa,Jeon Jung Ho,임정연,Ok Myoung-Ryul,김유찬,김현정,천철홍,Han Hyung-Seop,Edwards James R.,김성원,Jeon Hojeong 한국생체재료학회 2023 생체재료학회지 Vol.27 No.00
Cells in the human body experience different growth environments and conditions, such as compressive pressure and oxygen concentrations, depending on the type and location of the tissue. Thus, a culture device that emulates the environment inside the body is required to study cells outside the body.A blanket-type cell culture device (Direct Contact Pressing: DCP) was fabricated with an alginate-based hydrogel. Changes in cell morphology due to DCP pressure were observed using a phase contrast microscope. The changes in the oxygen permeability and pressure according to the hydrogel concentration of DCP were analyzed. To compare the effects of DCP with normal or artificial hypoxic cultures, cells were divided based on the culture technique: normal culture, DCP culture device, and artificial hypoxic environment. Changes in phenotype, genes, and glycosaminoglycan amounts according to each environment were evaluated. Based on this, the mechanism of each culture environment on the intrinsic properties of conserving chondrocytes was suggested.Chondrocytes live under pressure from the surrounding collagen tissue and experience a hypoxic environment because collagen inhibits oxygen permeability. By culturing the chondrocytes in a DCP environment, the capability of DCP to produce a low-oxygen and physical pressure environment was verified. When human primary chondrocytes, which require pressure and a low-oxygen environment during culture to maintain their innate properties, were cultured using the hydrogel blanket, the original shapes and properties of the chondrocytes were maintained. The intrinsic properties could be recovered even in aged cells that had lost their original cell properties.A DCP culture method using a biomimetic hydrogel blanket provides cells with an adjustable physical pressure and a low-oxygen environment. Through this technique, we could maintain the original cellular phenotypes and intrinsic properties of human primary chondrocytes. The results of this study can be applied to other cells that require special pressure and oxygen concentration control to maintain their intrinsic properties. Additionally, this technique has the potential to be applied to the re-differentiation of cells that have lost their original properties.