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간암세포주를 대상으로 한 체외 복합 항암제 감수성 검사
박인서(In Suh Park),정재복(Jae Bock Chung),김병수(Byung Soo Kim),김주항(Joo Hang Kim),노재경(Jae Kyung Roh),유내춘(Nae Chun Yoo),조재용(Jae Yong Cho),최진혁(Jin Hyuk Choi),임호영(Ho Yeong Lim) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.2
N/A Primary hepatocellular carcinoma(HCC) is one of the most common malignancies in Korea due mainly to high incidence of chronic hepatitis B virus infection. Most of the HCC are inoperable even at first presentation. So chemotherapy could be one of the major therapeutic modalities, but HCC is seldom chemosensitive. This type of chemoresistance is explainesd by high level of expression of multidrug resistance(MDR) gene and p-glycoprotein. We initiated this study to establish the in vitro model of drug selection and combination for HCC. Three human HCC cell lines and five cytotoxic drugs were used. MTT assays for cytotoxicity test were performed with single chemotherapeutic agent and various two drug combinations. Slot blot analysis for measuring the expression levels or MDR1 RNA was performed and demon strated that 2 HCC lines show moderate to high degree of MDRI expression, The ranges of drug concetration which causes 50% inhibition of the cell lines(IC50) are in the clinically achievable concentrations for the 5-fluorouracil in two HCC lines, and adriamycin in one cell line. Two cell lines which showed positive MDRI exression were resistant to adriamycin. But all three cell lines were sensitive to etoposide irrespective of MDR1 expression. In thelinically achievable concentration ranges those we tested, singnificantly improved cytotoxic effects are demonstrated in combinations of etoposide plus cisplatin, and etoposide plus mitomycin-C out of 10 possible two drug combinations. These data indicate the need for in vivo trials with the combination chemotherapy of etoposide plus cisplatin or etoposide plus mitomycin-C for HCC.
위암에서 근치적 절제술 후 전이 림프절 수가 예후에 미치는 영향
임호영,최진혁,김현수,남동기,김효철 아주대학교 의과학연구소 1998 아주의학 Vol.3 No.1
Gastric cancer is the most common cause of cancer death in Korea, and the most important prognostic factor for patients with gastric cancer is the extent of TNM stage. Among TNM staging system, lymph node involvement (N) has been recognized as one of the significant prognostic indicators after curative resection. Recently, nodal stage of new AJCC TNM staging system has changed its emphasis on the location of metastatic lymph nodes to the number of metastatic lymph nodes. Thus, we attempted to analyze the survival difference based on the number of metastatic lymph nodes after curative resection of gastric cancer. Two hundred and forty two patients of curatively resected gastric cancer were retrospectively studied to identify the number of metastatic lymph nodes to influence prognosis. The following results were obtained. The results showed that there was a significant difference in the survival rate between the patients with 0-2 metastatic lymph nodes and those with ≥3 metastatic lymph nodes in adjuvant chemotherapy (FA) group (DFS; 36.7% vs. 23.4%, OS; 38.3% vs. 26.0%). In adjuvant chemoimmunotherapy (FA+poly-AU) group, there was a significant difference in the overall survival between the patients with 0∼2 metastatic lymph nodes and those with ≥ 3 metastatic lymph nodes(70.1% vs. 47.4%). The present report demonstrates the prognostic importance of the number of metastatic lymph nodes in gastric cancer after curative resection and a necessity of further evaluation of current nodal stage.
동종 골수이식 후 만성 이식편대숙주질환과 동반되어 신증후군으로 발현된 IgA 신병증 1예
정철권,김현수,박준성,정성현,조도연,최진혁,남동기,임호영,김명성,신규태,임현이,김효철 대한조혈모세포이식학회 1999 대한조혈모세포이식학회지 Vol.4 No.2
동종 골수이식 후 발생하는 신기능부전은 원인이 다양하여 감별에 어려움이 있다. 만성 GVHD는 흉선의 기능저하에 따른 면역관용의 실패로 발생되는 자가면역현상에 의해 발생되는 것으로 알려져 있으며 드물게 신장을 침범하여 신증후군을 일으키기도 한다. CaA의 용량을 줄이거나 투약중지 후 발생한 만성 GVHD에 동반된 신증후군의 경우 조기에 신조직검사를 시행하여 감별진단하고 CsA의 용량을 증량하거나 재투약하여 좋은 치료 결과를 보일 것으로 기대된다. 저자들은 문헌고찰을 통해 동종 골수이식 후 발생된 신증후군이 유사한 임상양상을 보이며 발생기전에 만성 GVHD와 자가면역현상이 연관되어 있음을 확인하였으며 동종 골수이식 후 신증후군의 임상양상을 보이는 환자에서 병리조직학적으로 lgA 신병증을 진단하고 이러한 lgA 신병증이 발생기전에 만성 GVHD와 자가 면역현상이 연관되어 있을 가능성을 최초로 확인하였으며 CsA를 이용하여 성공적으로 치료한 경험을 하였기에 보고하는 바이다. Renal insufficiency is occasionally encountered in allogeneic bone marrow transplantation and its cause is difficult to ascertain. Chronic graft-versus-host disease (GVHD) related to thymic dysfunction is immune-mediated and involves autoreactivity of T-lymphocytes derived from donor marrow to recipient's major histocompatibility complex(MHC) minor antigens. The clinical mainifestations of chronic GVHD are similar to those of autoimmune disease but kidney involvement is rare. Few cases of nephrotic syndrome with membranous nephropathy or minimal change nephrotic syndrome have been reported to be associated with chronic GVHD in allogeneic bone marrow transplant recipient especially after cyclosporine A(CsA) withdrawal, and these cases have responded well to CsA. Therefore, it is prudent to differentiate the cause of post-transplant renal insufficiency using renal biopsy and to start CsA in a case of nephrotic syndrome associated with chronic GVHD as early as possible. We report a case who had a massive proteinuria during the post-allogeneic marrow transplantation period. The cause of nephrotic syndrome was diagnosed as IgA nephropathy by renal biopsy. The patient was successfully treated with reintroduction of CsA.
급성전골수성백혈병에서 백혈구성분채집술에 이은 치명적인 뇌출혈 2예
오윤정,박소윤,김윤정,한동석,김현수,최진혁,남동기,임호영,김효철,주희재 아주대학교 의과학연구소 1998 아주의학 Vol.3 No.1
The aim of this study is to report 2 cases of acute promyelocytic leukemia who died from intracranial hemorrhage following leukapheresis and to provide proper preventive measures against hemorrhage following leukapheresis. From 1994 to 1997, a total of twenty-six patients with leukemia underwent leukapheresis to control hyperleukocytosis at Ajou University Hospital. Two patients with acute promyelocytic leukemia received all-trans retinoic acid but developed drug-induced hyperleukocytosis. Shortly after leukapheresis, they died from intracranial hemorrhage. The risk factors for fatal hemorrhage are thought to be coexisting disseminated intravascular coagulation(DIC), thrombocytopenia aggravated by leukapheresis, exacerbated coagulopathy related to mechanical trauma through leukapheresis and the excess use of citrate during leukapheresis. To reduce the risk of the bleeding associated with leukapheresis, it is necessary to replace platelet sufficiently before and after leukapheresis and to give calcium to correct coagulopathy induced by excess citrate which is used as anticoagulant as well as the correction of disseminated intravascular coagulation.