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김우건(Woo Kun Kim),박영환(Young Hwan Park),이규형(Kyoo Hyung Lee),이정신(Jung Shin Lee),박태한(Tae Han Park),안한종(Han Jong Ahn),홍준혁(Jun Hyuk Hong),김청수(Choung Soo Kim) 대한내과학회 1999 대한내과학회지 Vol.57 No.3
Transitional cell carcinoma(TCC) of the bladder is confined to mucosa or submucosa on initial presentation. However, high grade superficial tumors tend to recur and progress to muscle invasive or metastatic diseases. Regardless of radical cystectomy in invasive bladder cancer, a poor prognosis was noted due to local recurrence and distant metastasis in recent studies. In this study, the clinical and pathological factors affecting survival of patients with muscle invasive bladder cancer were analyzed. Methods : A total of 105 patients with histopathologically verified muscle invasive bladder cancer who were admitted to Asan Medical Center between August 1989 and August 1998 were reviewed retrospectively. The clinical manifestations, laboratory findings, and histopathological findings at initial diagnosis were evaluated. Overall survival, disease free survival, and disease specific survival according to many prognostic factors were also analyzed. Results : The factors affecting overall survival of muscle invasive bladder cancer were age, sex, TNM stage, performance status, tumor size, invasion of deep bladder muscle, tumor grade, lymphovascular invasion, and complete resection of tumors. In patients with completely resected bladder cancer by radical cystectomy, tumor size, deep bladder muscle invasion, stage, and lymph node involvement were significant prognostic factors. In patients who had either incomplete resection of bladder cancer or in whom no operation was performed, the survival rate was lower in cases with lymph node involvement or hemoglobin level of less than 10 g/dl. Conclusion : After radical cystectomy, the recurrence rate appeared to be higher in solid tumors with deep bladder muscle invasion and lymphovascular invasion on cystoscopic findings. Overall survival was higher in patients with lower tumor stage, no lymph node involvement, and completely resected bladder cancer. Age and sex had no significant correlation with overall survival. No apparent survival advantage was noted in those patients who received post-operative chemotherapy. However, prospective randomized controlled studies are necessary to evaluate the benefit of adjuvant chemotherapy in muscle invasive bladder cancer. (Korean J Med 57:333-347, 1999)
급성 골수성 백혈병에서 고용량 Cytarabine 을 이용한 공고요법
김도하(Do Ha Kim),이규형(Kyoo Hyung Lee),조재근(Jae Kun Cho),김선희(Seon Hee Kim),이제환(Je Hwan Lee),김성배(Sung Bae Kim),김상위(Sang We Kim),서철원(Chul Won Suh),이정신(Jung Shin Lee),김우건(Woo Kun Kim),김상희(Sang Hee Kim) 대한내과학회 1996 대한내과학회지 Vol.51 No.4
Objectives: This study was designed to evaluate the therapeutic efficacy of postremission therapy utilizing high-dose cytarabine in patients with newly diagnosed acute myelogenous leukemia and to assess the toxicities of the therapy. Acute promyelocytic leukemia (FAB M3) is excluded because it has very unique clinicopathologic characteristics. Methods: Those patients who achieved complete remission had first consolidation therapy with conventional dose cytarabine and daunorubicin but second and third consolidation was done with high-dose cytarabine (cytarabine 1gm/㎡ i.v. over 1 hour every 12 hours daily for 5 days) and daunorubicin. Overall survival and disease free survival were compared with previous conventional dose cytarabine and daunorubicin postremission therapy. Results: 1) Complete remission occurred in 62% (28 of 45 patients) and control group 48% (14 of 29 patients) (p=0.15). 2) The median survival of all 45 patients was not different significantly compared with control group (10 months vs 7 months, p=0.08). 3) The median disease free survival of 21 complete responders receiving at least one course of consolidation was 10 months and there was no significant difference compared with control group 7 months (p=0.47). 4) The toxicity including treatment-related motility, neutropenia duration was similar in both groups. Conclusion: Although our high-dose cytarabine consolidation therapy regimen appeared to have acceptable toxicity, its results did not show the superiority to previous conventional dose cytarabine consolidation regimen.
인슐린 비의존형 당뇨병환자에서 혈관합병증과 Lipoprotein ( a ) 의 관계
김선희(Seon Hee Kim),채희복(Hee Book Chai),박중열(Joong Yeol Park),민원기(Won Ki Min),김우건(Woo Kun Kim),김기수(Ghi Su Kim),이기업(Ki Up Lee) 대한내과학회 1997 대한내과학회지 Vol.52 No.3
Objectives: High serum Lp(a) concentration is associated with a high risk of coronary artery disease(CAD). This study was initiated to determine whether increased Lp(a) levels are associated with diabetic vascular complications in Korean patients with NIDDM. Methods: A total of 183 NDDM patients were studied cross-sectionally for the presence of various vascular complications. Lp(a) levels were measured by 1-step sandwich ELISA method. Results: The patients with overt proteinuria had higher Lp(a) levels than the patients with mormo- albuminuria or microalbuminuria(26.8mg/dl vs 13.8 mg/dl and 17.3mg/dl, p<0.05), The patients with proliferative retinopathy and/or those treated by photocoagulation had higher Lp(a) levels than those without retinopathy or those with background retinopathy(34.1mg/dl vs 13.3mg/dl and 16,9mg/dl, p<0.05), The Lp(a) levels were also higher in the patients with CAD than those without CAD(30.9mg/ dl vs 16.3mg/dl, p<0.05). Multiple logistic regression analysis revealed that high Lp(a) levels were independantly associated with CAD and severe diabetic retinopath3. Conclusion: High Lp(a) levels are associated with CAD and proliferative retinopathy in Korean patients with NIDDM.
중심정맥 도관 삽입술의 성공률과 합병증 발생 빈도에 대한 전향적 연구
배창황(Chang Hwang Bae),김우건(Woo Kun Kim),박완(Wan Park),박진희(Jin Hee Park),김정균(Jeong Kyun Kim),최성준(Sung Jun Choi),이제환(Je Hwan Lee),김성배(Sung Bae Kim),김상위(Sang We Kim),서철원(Cheol Won Suh),이규형(Kyoo Hyung Lee),이 대한내과학회 1998 대한내과학회지 Vol.55 No.2
Objectives: The reported success rate of central venous catheterization ranged from 84% to 97.5%, and the complication rate from 0.3% to 12%. The most important contributing factor for complications reported by several authors was the physician's experience. We investigated the success and complication rates of central venous catheterization prospectively. We also evaluate the factors that contributed to complications at our institution as part of our quality assurance study. Methods: Four hundred sixty five central venous catheterizations were conducted at the medical intensive care unit and the general ward of the hemato1ogy/ oncology department of Asan Medical Center in Korea, from June to November, 1997. We surveyed the date and place of the procedures, lD numbers, age and sex of the patients, the training level of physicians, the types of catheters, initial puncture sites, success or failure, and complications. We grouped the purpose of procedures into 5categories, such as hemodynamic monitoring, fluid therapy, chemotherapy, total parenteral nutrition, and others, Results: The initial success rate, defined as the initial performer being able to insert the catheter without changing the skin puncture site, was 78.5%. The overall success rate for initial performers, including those who required multiple skin puncture sites, was 82.8%. The total success rate, including changing the performers (up to 4performers), was 96.1%. The overall complication rate was 5.2% including pneumothorax (2.8%), hemothorax (0.2%), subcutaneous hematoma (1.1%), catheter tip malposition (0.9%), and air-embolism (0.2%). There were no differences in the complication rates with regards to the sex and age of the patient, initial puncture sites, the physician's training level between 1st and 2nd year residency, and vein localization. However, the complication rate differed significantly in relation to the number of initial punctures. Patients with 1-3 punctures had a complication rate of 4.3%, while patients with 4 or more punctures had a complication rate of 18.5%. Conclusion: The overall complication rate was 5.2% and pneumothorax occured in 2.8%. We expect that we can decrease the number of complications by taking over the procedure if the initial performer fails on the first or second attempt and by attempting the skin puncture not more than 4times at initial trial.
김태원(Tae Won Kim),이정신(Jung Shin Lee),최성준(Sung Jun Choi),최종수(Jong Soo Choi),장대영(Dai Young Zang),이제환(Je Hwan Lee),김성배(Sung Jun Choi),김상위(Sang We Kim),서철원(Cheol Won Suh),이규형(Kyoo Hyung Lee),김우건(Woo Kun Ki 대한내과학회 1997 대한내과학회지 Vol.52 No.2
Objectives: The advent of intense combination chemotherapy has transformed aggressive non-Hod-gkins lymphoma from a disease that was once uniformly fatal to one that is now often curable. Remission rates and survival may be improved by using intensive chemotherapy regimens. However, this more aggressive approach is inevitably associated with increased toxicity, and an accurate pretreament prognostic assessment of patients is required to guide the physician in selecting the most appropriate therapeutic regimen. Many studies have reported prognostic factors of non-Hodgkins lymphoma in western countries, but there are few reports on prognostic factors in Koreans and it is suggested that clinical characteristcs of non-Hodgkins lymphoma in Korea differ from those in western countries. The purpose of this study was to illustrate clinical characteristics, prognostic factors and treatment outcome in non-Hodgkins lymphoma in Korea. Methods: Clinical features of 151patients (age over 15years) with non-Hodgkins lymphoma registered at Asan Medical Center from March 1989 to December 1993 were retrospectively reviewed. Prognostic factors and treatment outcome were evaluated among 121previously untreated patients. Multi variate analysis of potential pretreatment prognostic factors was performed using Coxs proportional hazards model. Results: Of the 151patients evaluated, 55% had diffuse large cell type, while low-grades were encountered in less than 1% of the patients. Extranodal involvement was noted in 76% of the patients. Cental nervous system was the commonest primary extranodal site, followed by stomach. Complete remission was achieved in 73 of 121patients (60%). The median follow-up for 121patients was 24months and the actuarial overall survival was 48% at 3years and 44N at 5years with a median overall survival of 33months. At the median followup of 32months, the actuarial 5year disease-free survival rate among 73patient with complete remission was 65% and median remission duration was not reached. Presence of systemic B symptoms and advanced clinical stages were associated with a low complete remission rate. None turned out to be associated with the remission duration. The Coxs proportional hazards model identified age above 60years, presence of systemic B symptoms and elevated LDH level as significant independent poor prognostic factors influencing overall survival. Conclusion: This study reveals a low prevalence rate of the low-grades lymphoma and a higher propensity of diffuse large cell type. These results suggest that clinical characteristics of non-Hodgkins lymphoma in Korea are different from those in the western countries. Our data also show that certain pretreatment clinical factors can help in predicting survival and in planning treatment.