Safety and Effectiveness of Indwelling Percutaneous Drainage in Hospitalized Terminally Ill Cancer Patients with Recurrent Ascites

Kwonoh Park,Geon Woo Lee,Jae-Joon Kim,Sang-Bo Oh,So Yeon Oh,Eun-Ju Park,Jin Hyeok Kim,Joo Yeon Jang,Ung-Bae Jeon 이화여자대학교 의과학연구소 2020 EMJ (Ewha medical journal) Vol.43 No.2

Objectives: Terminally ill cancer patients in hospice palliative care unit are reluctant to undergo repetitive invasive procedures due to coagulopathies and poor performance or condition, while catheter management such as regular irrigation during hospitalization is easy. The purpose of this study was to investigate the safety and efficacy of indwelling intraperitoneal (IP) catheter in hospitalized terminally ill cancer patients with recurrent ascites. Methods: A retrospective review was conducted in patients who underwent IP catheter at the hospice palliative care unit of Pusan National University Yangsan Hospital between August 2016 and June 2018. All catheters were inserted by interventional radiologists with radiological guidance. The primary end-points were functional IP catheter maintenance rate, which is catheter maintained with patency for drainage until the intended time. Results: A total of 25 terminally ill cancer patients underwent IP catheters placements during the study period. All catheters were successfully inserted without major complications, but one patient had trivial bleeding and one other patient had temporary pain. The median time from admission to catheter insertion was 5 days (range, 1 to 49 days). Twenty-one catheters were maintained with function until the intended time, three cases were maintained without function, and the last one was removed early due to obstruction and pain. Finally, the functional IP maintenance rate was 84% (21/25) and the median functional catheter life span was 15 days (95% confidence interval, 10.8 to 17.2). Conclusion: Our study showed relatively favorable results for IP catheter maintenance and safety in hospitalized terminally ill cancer patients with malignant ascites.

Safety and Efficacy of Peripherally Inserted Central Catheters in Terminally Ill Cancer Patients: Single Institute Experience

Park, Kwonoh,Lim, Hyoung Gun,Hong, Ji Yeon,Song, Hunho Korean Society for Hospice and Palliative Care 2014 한국호스피스.완화의료학회지 Vol.17 No.3

목적: 이 연구는 임종기 암환자들에서 말초삽입중심 정맥카테터(peripherally inserted central catheters, PICC)의 안정성 및 효과에 대해 확인하고자 한다. 방법: 2013년 한 해 동안 한전병원에 호스피스 완화의료를 목적으로 입원한 환자들 중, 말초삽입중심정맥카테터를 시행 받은 환자들을 대상으로 후향적으로 의무 기록 관찰하였다. 모든 말초삽입중심정맥카테터는 중재적 방사선의사에 의해 삽입되었다. 결과: 언급한 기간 동안 30명의 임종기 환자에서 말초 삽입중심정맥카테터가 시행되었고, 그들 중 1명의 환자에서 2회의 삽입이 이뤄져, 전체적으로 31회의 말초삽입중심정맥카테터 삽입 횟수와 571일의 거치기간(PICC days)이 분석되었다. 말초삽입중심정맥카테터 거치기간(PICC days)의 중앙값은 14.0일(범위, 1~90일)이었다. 25예는 계획된 시기(퇴원, 전원, 사망 등)까지 유지하였으나, 6예에서는 여러 이유로 계획된 시기보다 조기에 PICC를 제거하였다(PICC 조기 제거율, 19%; 10.5/1000 PICC days). 따라서, 카테터 유지 성공 비율(catheter maintenance success rate)은 81%였다. PICC 조기 제거 6예 중, 섬망 등에 의한 스스로 제거한 경우가 4예였고(13%; 7.0/1000 PICC days), 카테터 관련 혈액 감염 및 혈전증이 각각 1예씩 있었다(3%; 1.8/1000 PICC days). 조기 PICC 제거를 포함한 총 합병증 발생은 8예에서 있었다(26%; 14.1/1000 PICC days). 합병증 발생까지 기간은 중앙값 7일이었다(기간, 2~14일). 말초삽입중심정맥카테터 관련 합병증에 의한 사망은 없었다. 결론: 좋지 않은 전신 상태, 작은 시술 합병증에도 취약함, 제한된 여명등과 같은 임종기 암환자의 특징을 고려할 때, PICC는 임종기 환자에서 안전한 혈관 접근 방법이 될 수 있다. Purpose: We investigated the safety and efficacy of peripherally inserted central catheters (PICCs) in terminally ill cancer patients. Methods: A retrospective review was conducted on patients who underwent PICC at the hospice-palliative division of KEPCO (Korea Electric Power Corporation) Medical Center between January 2013 and December 2013. All PICCs were inserted by an interventional radiologist. Results: A total of 30 terminally ill cancer patients received the PICC procedure during the study period. Including one patient who had had two PICC insertions during the period, we analyzed a total of 31 episodes of catheterization and 571 PICC days. The median catheter life span was 14.0 days (range, 1~90 days). In 25 cases, catheters were maintained until the intended time (discharge, transfer, or death), while they were removed prematurely in six other cases (19%; 10.5/1000 PICC days). Thus, the catheter maintenance success rate was 81%. Of those six premature PICC removal cases, self-removal due to delirium occurred in four cases (13%; 7.0/1000 PICC days), and catheter-related blood stream infection and thrombosis were reported in one case, each (3%; 1.8/1000 PICC days). Complication cases totaled eight (26%; 14.1/1000 PICC days). The time to complication development ranged from two to 14 days and the median was seven days. There was no PICC complication-related death. Conclusion: Considering characteristics of terminally ill cancer patients, such as a poor general condition, vulnerability to trivial damage, and a limited period of survival, PICC could be a safe intravenous procedure.

p16 immunohistochemistry alone is a better prognosticator in tonsil cancer than human papillomavirus in situ hybridization with or without p16 immunohistochemistry

Park, Kwonoh,Cho, Kyung Ja,Lee, Miji,Yoon, Dok Hyun,Kim, Jiyoun,Kim, Sang Yoon,Nam, Soon Yuhl,Choi, Seung-Ho,Roh, Jonh-Lyel,Han, Myung Woul,Lee, Sang-Wook,Song, Si Yeol,Back, Jeong Hwan,Kim, Sung-Bae Informa Healthcare 2013 Acta oto-laryngologica Vol.133 No.3

<P><I>Conclusions:</I> p16 immunohistochemistry (IHC) status correlated with less exposure to smoking and/or alcohol in Korean patients with locally advanced tonsillar squamous cell carcinoma (TSCC), and was an independent prognostic factor for survival. <I>Objective:</I> TSCC is more likely to be human papillomavirus (HPV)-positive than other head and neck squamous cell carcinoma (HNSCC) subtypes. The objective of this study was to ascertain the HPV status of TSCC in Korean patients and to determine its relationship with clinical parameters and prognosis. <I>Methods:</I> The locally advanced TSCCs of 79 patients who were treated between 2000 and 2008 were tested by p16 IHC and HPV in situ hybridization (ISH) with a tissue microarray. <I>Results:</I> Sixty-three patients (80%) were positive for p16 IHC, while 54 (68%) were positive by HPV ISH. p16 IHC status correlated significantly with lower exposure to smoking and alcohol (<I>p</I> < 0.05) but did not correlate with T and N stage classification, histological differentiation, age, or gender. The p16-positive group had a significantly higher 5-year overall survival rate in comparison with the p16-negative group (78% vs 63%, hazard ratio (HR) = 0.347, 95% CI = 0.14, 95% C<I>p</I> = 0.025). p16 IHC was a favorable independent prognostic factor for overall survival, even after adjustment for age and T stage (HR = 0.283, 95% CI = 0.103, 95% <I>p</I> = 0.015).</P>

Clinical Characteristics, Treatment Delivery, and Cisplatin Eligibility in Korean Patients Initially Diagnosed with Urothelial Carcinoma

Kwonoh Park,Jong Kil Nam,Bon Jin Koo,Hyun Jung Lee,Tae Un Kim,Hwaseong Ryu,Yun Jeong Hong,Seungsoo Lee,Dong Hoon Lee,Sung Woo Park 이화여자대학교 의과학연구소 2021 EMJ (Ewha medical journal) Vol.44 No.3

Objectives: The aim of this study was to examine the clinical presentation, treatment delivery, and cisplatin eligibility of Korean patients with urothelial carcinoma (UC) in a real-world setting. Methods: We performed a retrospective cohort study of patients initially diagnosed with UC from March 2013 to June 2018. Creatinine clearance >60 mL/min and Eastern Cooperative Oncology Group performance status (0–1) were adopted as cisplatin eligibility criteria. Results: This study included 557 eligible patients. Median age was 71.0 years (range, 33–94 years), and males were dominant (80%). Primary tumor sites were: upper genitourinary tract, 18%; bladder, 81%; and urethra, 0.4%. Initial disease status was non-muscle invasive bladder cancer (313, 56%), diffuse infiltrating non-muscle invasive bladder cancer (19, 3%), cTanyN0 upper tract UC (75, 13%), cT2-4N0 bladder UC (82, 15%), TanyN1-3 UC (36, 7%), or initially metastatic UC (32, 6%). At the time of analysis (June 2019), following treatments were delivered to 134 patients with localized UC: radical operation with or without perioperative treatment (89, 67%), definitive chemoradiation (7, 5%), and palliative surgery or supportive care only (36, 28%). In total, 89 patients had metastatic UC, including those with recurrent disease (n=57), and 34 (38%) of the 89 were eligible for cisplatin. Conclusion: Clinical presentations in East Asian UC patients were consistent with those of previous studies in other countries, except for a relatively high incidence of upper genitourinary tract. Our results can serve as a benchmark for further advances and future research for treatments of UC in East Asian patients.

한국임상암학회 전이성 전립선암 치료 지침

박인근 ( Inkeun Park ),강병욱 ( Byung Woog Kang ),고수진 ( Su-jin Koh ),김경하 ( Kyoung Ha Kim ),김세현 ( Se Hyun Kim ),김찬규 ( Chan Kyu Kim ),김호영 ( Ho Young Kim ),박권오 ( Kwonoh Park ),박세훈 ( Se Hoon Park ),오성용 ( Sung Y 대한내과학회 2017 대한내과학회지 Vol.92 No.2

The management of advanced prostate cancer has evolved rapidly. Androgen deprivation therapy, via surgical or medical castration, is the first-line therapy for hormone-naive metastatic prostate cancer. For approximately a decade, docetaxel-based chemotherapy was the only approved agent to show a survival benefit for castration-resistant prostate cancer. However, over the last 5 years, significant advances in the field have led to the approval of several new agents with different mechanisms of action, such as the new androgen pathway inhibitors abiraterone and enzalutamide, a new cytotoxic agent, cabazitaxel, and new bone-seeking agents such as radium-223, which have all been associated with improved quality of life and pain palliation and an increase in survival. However, there has been no Korean treatment guideline for metastatic prostate cancer which is developed based on thorough search for relevant articles, including recently developed agents, and adequate review and assessment of evidences, and thus, a guideline adequate for domestic circumstance is eagerly needed. Experts from the Genitourinary Oncology Committee of the Korea Cancer Study Group developed clinical recommendations for the treatment of metastatic prostate cancer based on 19 key questions. The Korean Association for Clinical Oncology, the Korean Prostate Society, the Korean Urological Oncology Society, and the Korean Society of Pathologists reviewed and endorsed the guidelines. These are the first Korean treatment guidelines developed specifically for metastatic prostate cancer. (Korean J Med 2017;92:124-141)

호스피스완화의료에서 젊은 암 환자의 자녀와의 상담 평가 - 유아기, 아동기, 청소년기로 구분하여

박은주 ( Eun Ju Park ),박권오 ( Kwonoh Park ),오소연 ( So Yeon Oh ) 대한의료커뮤니케이션학회 2019 의료커뮤니케이션 Vol.14 No.1

Background: In this study, consultations with children of young patients with cancer were evaluated by dividing the child’s age into infancy, childhood, and adolescence to ensure the necessity and importance of appropriate intervention, coordination, and communication. Methods: From June 2017 to February 2019, medical records and consultation records were reviewed by selecting suitable cases among patients hospitalized in hospice palliative care unit at a Pusan national university Yangsan hospital. The consultation was conducted on several occasions by nurses, doctors and social workers from the time the patient was hospitalized to the day before death. Results: The cases of consultation were as follows: female patient with stomach cancer with a child in infancy, patient with gastric cancer with a child in childhood, and male patient with rectal cancer with a child in adolescence. Conclusion: It is ideal for parents to initiate communication with their children on their terminal status, so multidisciplinary teams must first support the motivation. In consultations with children, we should first explain the information about the cancer status of the parents, followed by the future clinical course, estimated life expectancy, and changes related to terminal status. Additionally, we must attempt to manage the psychological and emotional concerns of children. This study may support the creation of an atmosphere for in-depth research on family interviews of young patients with cancer in Korea. We think that this will contribute as basic data for some guidelines for communication based on the age of children in consultations with patients with terminal cancer.

Pulmonary Tumor Thrombotic Microangiopathy Associated with Advanced Gastric Cancer Successfully Treated with Chemotherapy

Seung-Hyun Yoo,Kwonoh Park,Ji Yeon Hong,Ji Yeon Kim,Jang Won Park,Yong Won Park,Kyung-Hun Lee,Kyung-So Jeon 이화여자대학교 의과학연구소 2014 EMJ (Ewha medical journal) Vol.37 No.2

Pulmonary tumor thrombotic microangiopathy (PTTM) is an uncommon and fatal malignancy-related pulmonary complication characterized by fibrocellular intimal proliferation of small pulmonary arteries and arterioles. It causes marked pulmonary hypertension, right-side heart failure, and sudden death. Diagnosis of PTTM is extremely difficult while the patient is alive. Here, we report a 44-year-old woman who presented with complaining of progressing dyspnea and pulmonary hypertension but with no history of cancer. She was diagnosed with PTTM caused by advanced gastric cancer ante mortem and was treated effectively with chemotherapy.

Metal Foam DPF의 특성

박만호(Manho Park),이정민(Jeongmin Lee),이의성(Euisung Lee),홍승현(Seunghyun Hong),오권오(Kwonoh Oh),김기호(Kiho Kim),김재권(Jaekwon Kim),송호영(Hoyoung Song) 한국자동차공학회 2009 한국자동차공학회 학술대회 및 전시회 Vol.2009 No.11

In this study, passive type Metal Foam partial DPF characteristics was investigated. 70% target efficiency filter designed by Metal Foam Filter design program, was installed on D6DB(6.6L) engine exhaust line and PM removal efficiency & gas conversion rate by ND-13 mode was evaluated. The Filter has around 70% PM removal efficiency on whole soot loading level. When 7g/L soot loaded on the filter, the differential pressure is 280mbar on ND-13mode 10step air flow. But repeated ND-13mode test, there is no pressure drop gain.

A case of diffuse large B cell lymphoma transformed from a rectal MALT lymphoma

( Saehan Kang ),( Kwonoh Park ) 대한내과학회 2015 대한내과학회 추계학술발표논문집 Vol.2015 No.1

Primary rectal lymphoma is a rare disease among the Gastrointestinal (GI) lymphoma. In particular, DLBCL transformed from Mucosa-Associated Lymphoid Tissue (MALT) lymphoma is often theprimary type of GI lymphoma, mostly in stomach or duodenum, but has never been reported in rectum. Here we report an unusual case in which a 75-year-old male patient visited the hospital due to hematochezia and was diagnosed with DLBCL transformed from MALT lymphoma in the rectum. Multiple nodules around sigmoid colon and rectum, and mass-forming ulcer 5 cm above anal verge were observed using colonoscopy. In histology, Lymphocytic infiltration along with lymphoepithelial lesion was observed at the multiplenodules, which were confirmed as MALT lymphoma, and DLCBL was diagnosed from the tissue of mass-forming ulcer in the rectum. Other staging evaluations, including endoscopic gastroduodenoscopy, Chest computed tomography (CT), abdomino-pelvic CT, PET-CT anda bone marrow examination results confirmed lymphoma distributed around rectum and para-aortic lymph nodes. Finally, the patient was diagnosed as rectal DLBCL transformed from MALT lymphoma as GI-NHL stage II2 and was treated with chemotherapy (R-CHOP) with CD-20 monoclonal antibody (Rituxaimb). Complete remission of multiple lymphadenopathy and mass forming ulcer of the rectum were achieved after 6 cycles of R-CHOP. He has been free from disease for 20 months.

직장 MALT 림프종에서 전환된 B-미만성 대세포 림프종

강새한,박장원,정병욱,송준규,오현식,박권오 이화여자대학교 의과학연구소 2016 EMJ (Ewha medical journal) Vol.39 No.2

Primary rectal lymphoma is a rare disease among the gastrointestinal (GI) lymphoma. In particular, diffuse large B-cell lymphoma (DLBCL) transformed from mucosaassociated lymphoid tissue (MALT) lymphoma is often the primary type of GI lymphoma, mostly in stomach or duodenum, but has never been reported in rectum. Here we report an unusual case in which a 75-year-old male patient diagnosed with DLBCL transformed from MALT lymphoma in the rectum. The patient was diagnosed as rectal DLBCL transformed from MALT lymphoma as Lugano stage II2 and was treated with chemotherapy (R-CHOP) with CD-20 monoclonal antibody (rituxaimb). Complete remission of multiple lymphadenopathy and mass forming ulcer of the rectum was achieved after 6 cycles of R-CHOP. He has been free from disease for 12 months.