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양미연 ( Mi Yean Yang ),유양선 ( Yang Seon Ryu ),고희자 ( Hee Ja Ko ),박세경 ( Se Kyng Park ),박종숙 ( Jong Sook Park ),박춘식 ( Chun Sik Park ),박재성 ( Jae Sung Park ),백상현 ( Sang Hyen Bak ),고은석 ( Eun Suk Ko ),박정미 ( Jeon 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.69 No.1
Sarcoidosis is a multi-systemic granulomatous disorder of unknown etiology. The characteristic pathological finding is the presence of non-caseating granulomas. The lungs are primarily affected, however other organs may be involved causing various symptoms and ambiguous laboratory findings can be present. There are a few reported cases of sarcoidosis with elevated tumor markers. We describe a 68-year-old woman presenting with sarcoidosis showing elevated serum carcinoembryonic antigen (CEA). The possibility of cancer arising from serum CEA such as gastrointestinal cancer, breast cancer and lung cancer was excluded. A transbronchial lung biopsy demonstrated a non-caseating granuloma without necrosis. As a result prescribed 30 mg prednisolone daily to the patient and serum CEA was decreased after 1 month of treatment. We report a case of pulmonary sarcoidosis with elevated serum CEA.
혈액종양 ; 비편평세포, 비소세포폐암 환자에서 erlotinib, gefitinib 및 pemetrexed의 효과
윤라영 ( La Young Yoon ),양미연 ( Mi Yean Yang ),윤진아 ( Jin A Yun ),김현정 ( Hyun Jung Kim ),김한조 ( Han Jo Kim ),김경하 ( Kyung Ha Kim ),김세형 ( Se Hyung Kim ),이상철 ( Sang Cheol Lee ),김찬규 ( Chan Kyu Kim ),이남수 ( Nam Su 대한내과학회 2010 대한내과학회지 Vol.79 No.4
목적: 본 연구는 비소세포폐암의 2차 이상의 항암 화학 요법에서 EGFR TKIs와 pemetrexed의 임상적인 특징에 따른 치료 성적을 비교함으로써 구제치료의 선택에 도움을 주고자 하였다. 방법: 2002년 2월부터 2009년 8월까지 부천 순천향대학교 병원 혈액종양내과에서 비소세포폐암을 진단받은 환자들 중 편평상피암을 제외한 선암과 대세포암 환자들을 대상으로 하였으며 이들 중 gefitinib이나 erlotinib 및 pemetrexed로 치료받은 환자를 의무기록을 통해 후향적으로 조사하였다. 결과: 총 61명이 연구에 참여하였고 그 중 erlotinib군이 18명, gefitinib군은 18명, pemetrexed군은 25명이었으며 중앙관찰기간은 37개월(7-97개월)이었다. 세 군간에 반응율과 무진행 생존기간에는 의미있는 차이가 없었으며 EGFR TKIs 를 투여받은 환자들 중에서는 여성에서 보다 좋은 반응율은 보였고, erlotinib 을 투여받은 환자들 중 피부발진이 있었던 환자들과 Pemetrexed를 투여 받은 환자들 중 선암으로 진단된 경우에서 무진행 생존기간이 의미있게 길었다. 결론: EGFR TKIs 와 Pemetrexed 는 모두 비편평세포암, 비소세포암 환자에서 2차 이상의 치료로 사용하였을 때 비교적 효과적이었으며 부작용도 적은 것으로 나타났다. 향후 EGKR TKIs 및 pemetrexed군 치료 효과 및 치료 효과에 영향을 미치는 다양한 임상적 예후인자에 대한 보다 많은 대규모 전향적 비교 연구가 필요할 것이다. Background/Aims: This study compared the clinical benefits of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) with pemetrexed to identify the clinical parameters that correlated with response. Methods: A retrospective chart review examined patients who were 1) treated with EGFR TKI or pemetrexed, 2) diagnosed with advanced non-squamous non-small-cell lung cancer, and 3) previously treated with platinum-based chemotherapy in Soonchunhyang Bucheon Hospital. Results: Sixty-one patients (18 erlotinib, 18 gefitinib, 25 pemetrexed) were investigated from February 2002 to August 2009. The median follow-up period was 37 months (7~97 months). Overall, their median age was 63 years, 41 patients were non-smokers, 57 patients had adenocarcinoma, and 55 patients were at stage IV. Twenty-one patients received the study drugs as second-line chemotherapy, and others as third-line or more. No significant differences in the overall response rate (erlotinib 33.3% vs. gefitinib 38.9% vs. pemetrexed 20.0%) and progression-free survival (erlotinib 1.9 months vs. gefitinib 3.0 months vs. pemetrexed 2.9 months) were found among the three groups. Female gender was related to a good response to EGFR TKIs (p=0.047). Skin rash in the erlotinib group (p=0.037) and adenocarcinoma in the pemetrexed group (p=0.02) were related to improved progression-free survival. Few side effects were reported. Conclusions: Both EGFR TKIs and pemetrexed therapy for non-squamous non-small-cell lung cancer were efficient and tolerable after the failure of first-line platinum-based chemotherapy. Further prospective studies are needed to validate the predictive role of the suggested clinical parameters in this study. (Korean J Med 79:394-403, 2010)
심부전 악화로 사망한 대유행 인플루엔자(H1N1 2009) 1예
양미연,박정환,이윤나,임재희,이은정,전민혁,김태형,추은주 대한감염학회 2010 감염과 화학요법 Vol.42 No.2
On April, 2009, pandemic influenza (H1N1 2009) emerged in the United States at first. Clinical outcomes of this infection are reported as ranging from self-limited illness to respiratory failure or death. There were more than 250 deaths due to pandemic influenza until March 2010. Influenza-related deaths occurred in the elderly and in patients with underlying medical conditions. Most of the critically ill patients showed severe hypoxia and acute respiratory distress syndrome and required ventilator care. We experienced a 70-year-old man presenting with pandemic influenza (H1N1 2009) with heart failure. He was treated with antival agents, ventalator and extracorporeal membrane oxygenation. But his heart function was aggravared and resulted in his death.