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Experience of Advance Directives in a Hospice Center
공봉한,안호정,김현선,하소영,김일규,이정은,박윤정,강이진,김영례,김훈교 대한의학회 2015 Journal of Korean medical science Vol.30 No.2
To protect patient autonomy when confronting death, the importance of advancedirectives (ADs) has recently became an issue and gradually accepted in Korea. However, inreal practice, ADs were not completed by patients but their families in most cases. Toanalyze the current situation of performing ADs, we reviewed medical charts of 214terminal cancer patients admitted to the hospice center from October 2012 to September2013. Seventy-six (35.5%) patients completed ADs. All ADs were completed by patientsthemselves. The most common reason for not completing ADs was poor physical and/ormental condition. As a proxy, the majority of patients preferred their spouses (55.3%). Few patients wanted life sustaining treatment (1.3%), however palliative sedation wasaccepted in 89.5%. The median timing of ADs after admission was three (0-90) days, andduration of survival since ADs was 22 (1-340) days. In conclusion, approximately one thirdof terminal cancer patients completed ADs by themselves. Considering that patient’s poorcondition is the main reason for not completing ADs, earlier discussion regarding ADs isnecessary to enhance patients’ participation.
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공봉한,김동률,허룡,이응구,김주희,한덕재,이원직,오정환 대한상부위장관ㆍ헬리코박터학회 2015 Korean Journal of Helicobacter Upper Gastrointesti Vol.15 No.4
Background/Aims: The natural history of severe erosive reflux disease in Korea remains uncertain. We aimed to evaluate endoscopic follow-up results in subjects with severe reflux esophagitis under routine clinical care. Materials and Methods: A total 61,891 subjects underwent an upper endoscopic examination in the health check-up program from January 2007 to December 2013. We reviewed medical charts of patients who had been diagnosed with severe reflux esophagitis. The severity of reflux esophagitis was determined by the Los Angeles (LA) classification system. Patients underwent at least one follow up endoscopy after diagnosis of severe reflux esophagitis. We classified the patients into two groups; regressed in severity and remained unchanged, according to follow up endoscopic status. Results: Based on endoscopic findings, 5,938 subjects (9.6%) were found to have reflux esopohagitis: 121 subjects (0.2%) in LA-C; 39 subjects (0.06%) in LA-D. Among 31 patients who had endoscopic follow-up, 23 patients (74.2%) showed regression from LA C/D to LA A/B or minimal change disease or normal. The mean follow up duration was 42.2 months in regression group and 53.2 months in no change group. All patients had been treated with proton pump inhibitors (PPIs) on a regular or on-demand basis. Age, sex, smoking, alcohol, exercise, hypertension, diabetes mellitus, dyslipidemia, sliding hiatal hernia, body mass index, waist circumference and duration of PPIs therapy did not significantly influence regression of severe reflux esophagitis. Conclusions: The majority of severe reflux esophagitis patients under routine clinical care showed improvement on endoscopic follow-up.
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트라스투주맙 치료에 반응을 보인 HER2/neu 양성 전이성 타액관 암종 1예
공봉한(Bong Han Kong),이지은(Jieun Lee),최상수(Sang-Su Choi),박진희(Jinhee Park),김연실(Yeon Shil Kim),김민식(Min-Sik Kim),이연수(Youn-Soo Lee):이지연(Ji-Yeon Lee):홍숙희(Sook Hee Hong),강진형(Jin Hyoung Kang) 대한두경부종양학회 2014 대한두경부 종양학회지 Vol.30 No.2
Salivary duct carcinoma(SDC) is rare malignancy, accounting for approximately 1-3% of all malignant sali-vary gland tumors. Systemic chemotherapy has been used for stage IV SDC, but there is no consensus on the stan-dard treatment. SDC is histologically similar to ductal carcinoma of breast and often overexpress HER2/neu, hence HER2/neu targeted therapy could be one of treatment options. A 75-year-old Arabian man was diagnosed as SDC of right parotid gland with extensive metastases. He received oral 5-FU as palliative chemotherapy, but he was intolerable to oral chemotherapy due to severe oral mucositis. Considering immunohistochemical stain of tu-mor tissue showing strong positive for HER2/neu, we decided to administer an anti-HER2/neu antibody, trastu-zumab. Follow-up CT scans before the third dose of trastuzumab demonstrated remarkable regression of multiple metastases as well as primary tumor. This case suggests that HER2/neu targeted therapy may be a potential thera-peutic option for the SDC patient with overexpression of HER2/neu.
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림프종 환자에서 리툭시맙 치료 후에 발생한 저감마글로불린혈증
노현진 ( Hyun Jin Noh ),공봉한 ( Bong Han Gong ),김영신 ( Young Sin Kim ),정윤화 ( Yun Hwa Jung ),우인숙 ( In Sook Woo ),한치화 ( Chi Wha Han ) 대한내과학회 2014 대한내과학회지 Vol.87 No.3
Rituximab, an anti-CD20 monoclonal antibody, is an effective target agent against the B lymphocytes in B-cell lymphoid malignancies and various lymphoproliferative diseases. Moreover, the toxicity of rituximab is less severe than that of conventional cytotoxic agents, which has promoted the widespread application of rituximab in the treatment of B-cell lymphoma. However, depletion of B lymphocytes by rituximab, which leads to secondary hypogammaglobulinemia, can cause deterioration of humoral immunity. Although immune reconstitution after hematopoietic stem cell transplantation is known to prevent prolonged hypogammaglobulinemia, very few cases of long-standing hypogammaglobulinemia have been reported. We report herein a case of prolonged hypogammaglobulinemia after rituximab-containing chemotherapy and splenectomy in a patient with non-Hodgkin`s lymphoma and discuss the clinical significance and pathogenetic mechanism of this phenomenon with a literature review. (Korean J Med 2014;87:357-362)
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비심인성 가슴통증 환자에서 역류성식도염의 유병률 및 임상특징
목지영,권소현,신기원,오선우,한수정,음상훈,강희준,공봉한,황병희,오정환 대한상부위장관ㆍ헬리코박터학회 2016 Korean Journal of Helicobacter Upper Gastrointesti Vol.16 No.2
Background/Aims: Noncardiac chest pain (NCCP) is substernal, squeezing chest pain, unrelated to the cardiac problem. Our study aimed to define the prevalence and clinical characteristics of reflux esophagitis in NCCP patients in Korea. Materials and Methods: We reviewed medical records of patients who visited Department of Cardiology, St. Paul’s Hospital due to chest pain and had normal coronary arteriography and who had received endoscopy within 6 months. Patients diagnosed with peptic ulcer or gastric cancer were excluded. The patients were classified into two groups according to their endoscopic results; the reflux esophagitis group and the control group. Results: Two hundred seventeen NCCP patients were enrolled and 96 patients (44.2%) were diagnosed with reflux esophagitis: 68 patients (31.3%) with minimal change esophagitis; 26 patients (12.0%) with Los Angeles (LA) grade A; 2 patients (0.9%) with LA grade B. There were no patients with severe erosive reflux disease. There were no significantly different characteristics in the reflux esophagitis group and the control group. Conclusions: The prevalence of reflux esophagitis in NCCP patients in Korea was 44.2%. Most patients had mild reflux esophagitis. (Korean J Helicobacter Up Gastrointest Res 2016;16:88-91)
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