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간세포암의 비수술적 치료후 생존율 평가에 의한 UICC 병기의 타당성에 관한 후향적 연구
윤종길(Jong Kil yoon),김현각(Hyun Kag Kim),이창희(Chang Hee Lee),천영국(Young Kug Cheon),김유철(You Cheoul Kim),김창민(Chang Min Kim),홍원선(Weon Seon Hong),이진오(Jhin Oh Lee),강태웅(Tae Woong Kang),최수용(Soo Yong Choi) 대한내과학회 1996 대한내과학회지 Vol.51 No.4
Objectives: The management of hepatocellular carcinoma(HCC) has been frequently complicated due to the variable hepatic dysfunction from underlying chronic liver disease. The validity of UICC staging system based on the anatomical extent of malignant lesion has been questioned because of the poor correlation between stages and clinical outcomes. The purpose of this study is to elucidate the validity of UICC staging system as a prognostic factor and to compare with Child`s classification which represents the functional status of liver. Methods: A total of 831 patients with HCC who received no specific anti-cancer treatment, TACE and/or systemic chemotherapy, between January 1988 and December 1991, were analyzed retrospectively. Factors influencing the prognosis were analyzed by Cox proportional-hazard regression model. Results: Median survival of overall HCC patients was 4 months. There was no significant difference in overall median survival between UICC stage III and IVA; but significant differences between Child A and B, Child B and C were found. UICC staging system for HCC gave less significant clinical value in predicting the survival of HCC patients regardless of the treatment modalities given. In contrast, Child`s classification was better correlated with the survival of HCC patients who received systemic chemotherapy and no specific treatment. In Cox proportional-hazard regression model, Child`s classification was the most influential prognostic factor exceeding the role of UICC system.. Conclusion: UlCC staging system is not a good system for the staging of HCC. We beIieve that the poor correlation between stages and survival originated from the neglect of hepatic dysfunction which is the major prognostic factor in HCC. It is necessary to develop a new staging system which can represent the prognosis better.
최보금(Bo Geum Choi),김종화(Chong Hwa Kim),박지현(Ji Hyun Park),라방주(Bang Joo La),류완희(Wan Hee Yoo),김현각(Hyun Kag Kim),박태선(Tae Sun Park),백홍선(Hong Sun Baek) 대한내과학회 2000 대한내과학회지 Vol.59 No.5
Juvenile rheumatoid arthritis (JRA), an autoimmune disease, was characterized by chronic synovitis and associated with various extra-articular manifestations. Abnormal hematologic findings have been reported in all form of JRA, especially anemia due to chronic disease or iron deficiency. Dysplastic changes were rarely noted in the peripheral blood and bone marrow. We experienced a 15-year-old female patient with pauciarticular JRA who have pancytopenia in peripheral blood and a number of dysplastic changes in bone marrow, and present the case here with brief review of literatures.(Korean J Med 59:587-590, 2000)
강경표 ( Kyung Pyo Kang ),윤경하 ( Kyung Ha Yun ),박주형 ( Ju Hyung Park ),김현각 ( Hyun Kag Kim ),백홍선 ( Hong Sun Baek ) 전북대학교 의과학연구소 2001 全北醫大論文集 Vol.25 No.1
Pendred syndrome is an autosomal recessive disorder characterized by goiter and congenital sensorineural deafness, and positive perchlorate discharge test. The sensorineural deafness is typically associated with a malformation of the inner ear, referred Mondini defect. The incidence of Pendred` syndrome is thought to be more than 7.5 to 10 in 100,000 individuals, and it has been estimated to account for about 10% of the cases with hereditary deafness. The thyroid function is usually normal, but the perchlorate discharge test is positive indicating an impaired iodide organification. In 1996, first reported that Pendred`s syndrome is linked to chromosome 7q22-31.1, and the Pendred`s syndrome gene(PDS gene) was cloned in 1997. The Predicted gene product, pendrin, is a highly hydrophobic, 780 amino-acid protein with 11 transmembrane domains that thought to be a sulfate or anion transporter. We experienced a case of Pendred`s syndrome diagnosed by the triad of congenital deafness, large goiter and positive perchlorate test, and reviewed related literatures.
전이성 또는 재발성 식도암에 대한 Cisplatin , Etoposide 및 5 - Fluorouracil ( PEF ) 복합화학요법의 치료 효과
류백렬(Baek Yeol Ryoo),임영혁(Young Hyuck Im),강윤구(Yoon Koo Kang),정상훈(Sang Hoon Jeong),김현각(Hyun Kag Kim),이창희(Chang Hee Lee),윤종길(Jong Kil Yoon),천영국(Young Kug Cheon),김서운(Seo Woon Kim),김유철(You Cheoul Kim),김창민(C 대한내과학회 1996 대한내과학회지 Vol.51 No.4
Esophageal cancer is widely disseminated in more than 80% of patients at the time of diagnosis and the prognosis of advanced esophageal cancer is dismal with a median survival of 5 to 8 months. Therefore, systemic chemotherapy has assumed an important role in the treatment of these patients. Among various combination chemotherapy regimens, the combination of cisplatin and 5-fluorouracil has been one of the most effective for esophageal cancer because of their synergism. Etoposide, although reported ineffective as a single agent, has been shown to be synergistic with cisplatin in vitro and in vivo. So, we conducted a phase 2 trial to evaluate the effect of a combination of cisplatin, etoposide and 5- FU (PEF) in patients with metastatic or recurrent esophageal cancer. Thirty-four patients with measurable lesion(s) received cisplatin (20㎎/㎡ i.v. Day 1~5), etoposide (100㎎/㎡ i.v. Day 1, 3 & 5) and 5-FU (800㎎/㎡ continuous i.v. for 12 hours, Day 1~5). Of 30 evaluable patients, 1(3.3%) had a complete response and 11(37%) had partial responses. The median duration of response was 29 weeks. The overall median survival was 34 weeks and the survival time in the responders was longer significantly than that of the non-responders. There was no significant prognostic factor influencing the response rate. Among total 135 cycles of chemotherapy, leukopenia was observed in 36% and thrombocytopenia in 4%. There was no treatment-related death. Main non-hematologic toxicities were neurotoxicity (17%), nephrotoxicity (3%), and stomatitis (10%) and diarrhea (10%). All the toxicities were mild and well tolerated. Conclusion: A combination chemotherapy of cisplatin, etoposide and 5-FU (PEF) was effective and well tolerated in patients with metastatic or recurrent esophageal cancer.
국소적으로 진행된 식도암 환자에서 Cisplatin , Etoposide 및 5 - Fluorouracil ( PEF ) 선행화학요법의 효과 ; A Pilot Study
정상훈(Sang Hoon Jeong),임영혁(Young Hyuck Im),강윤구(Yoon Koo Kang),손태용(Tae Yong Son),곽영임(Young Im Kwak),천영국(Young Kug Cheon),김현각(Hyun Kag Kim),류백렬(Baek Yeol Ryoo),김유철(You Cheoul Kim),이춘택(Choon Taek Lee),김창민( 대한내과학회 1996 대한내과학회지 Vol.51 No.4
The prognosis of esophageal cancer is very poor. Even for those with localized disease who are potentially curable, 5-year survival rates are under 20% in almost all series. We conducted a pilot study to evaluate the safety and possibility of efficacy of neoadjuvant chemotherapy followed by surgery in patients with locally advanced esophageal cancer. Two or three cycles of neoadjuvant combination chemotherapy with cisplatin (20㎎/㎡/day i.v., D1-5), etoposide (100㎎/㎡/day i.v., D1,3,5), and 5-fluorouracil (800㎎/㎡/day continuous i.v., D1-5) were planned to be given before surgery. Total 21 patients entered this trial. Three patients were lost to follow-up after 1 cycle of chemotherapy to make eighteen patients evaluable. Thirteen out of eighteen patients (72%) had objective improvement after neoadjuvant chemotherapy and four (22%) had no change and one (6%) had progression. Among 18 evaluable patients, surgery was performed in 11 patients. Surgery could not be done in 7 patients because of patient's refusal (5), progression of disease (1), and development of lung abscess (1). In 13 patients who were candidates for surgery, curative resection was done in 10 patients to make curative resection rate 10/13 (77%). One of eleven patients having surgical resection had no pathologic evidence of tumor (pathologic complete remission 9%). Postoperative complications of wound dehiscence and anastomotic site fistula developed in 2 patients. Three courses of postoperative adjuvant chemotherapy with PEF regimen were administered to 9 patients. The median survival time for all 18 patients was 60 weeks. Toxicities of PEF neoadjuvant chemotherapy were leukopenia, nausea/vomiting and alopecia, but they were mild and reversible. There was no treatment-related deaths. In conclusion, neoadjuvant chemotherapy with PEF regimen were tolerable, safe and possibly effective in locally advanced esophageal cancer. Based on this study, we will perform phase 2 or 3 study to assess the efficacy of PEF neoadjuvant chemotherapy for locally advanced esophageal cancer.
김현각,김종주,김영생 의과학연구소 2000 全北醫大論文集 Vol.24 No.2
It has been reported that NAD induces apototic cell death of T cells through ADP-ribosylation o fCD38 by arginine-specific ADP-ribosyltransferase. In this study, it was investigated whether the T cell lines can be apoptosed by the addition of NAD using EL-4 and CTLL-2 cell lines originated from murine lymphoma and cytotoxic T cell leukemia from mice, respectively. The T cell lines did not show apoptosis, but rather showed proliferation by the treatment or NAD. The reason why the two T cell lines were resistant to the NAD-dependent apoptosis was that CTLL-2 cells and EL-4 cells did not express CD38 and arginine-specific ADP-ribosyltransferase, respectively. In order to examine the mechanism of proliferative effect of NAD, we tested the effect of NAD metabolites on their proliferation. ADP-ribose, ATP and AMP induced proliferation of these cell lines of NAD metabolites on their proliferation. ADP-ribose, ATP and AMP induced proliferation of these cell lines in dose-dependent and time dependent manner. 8-cyclopentyl-1, 3-dipropylxanthine (CPX), an adenosine receptor antagonist, inhibited the NAD- and NAD metabolites-dependent proliferation of the cell lines, suggesting that the proliferative effect of the NAD metabolites may be through the actions of adenosine derived from the NAD metabolites on adenosine receptor. (Key words : EL-4 cell, CTLL-2, NAD, Adenosine receptor)
제2형 당뇨병 환자에서 혈관합병증과 Lipoprotein(a)와의 관계
김현각,박지현,류완희,박태선,백홍선 대한당뇨병학회 2001 임상당뇨병 Vol.2 No.2
연구배경: Lipoprotein(a) [Lp(a)]는 LDL-콜레스테롤과 크기와 지질 구성이 유사하지만 표면에 apo B100와 disulfide 결합을 하고있는 apo(a)라는 당단백을 갖고 있는 것이 특징이다. 이 혈장 성분은 심혈관 질환의 독립적인 위험인자로 알려져 있으며, 최근에 당뇨병이 없는 일반 환자에서 경동맥 죽상동맥경화증과 만성 신장질환과의 관련도 제시되고 있다. 본 연구는 죽상동맥경화증의 고 위험군인 제2형 당뇨병 환자에서 Lp(a)농도를 측정하고, 경동맥 내중막두께와 그 밖의 만성 합병증과의 관계를 알아보고자 하였다. 방법: 대상 환자는 1998년 3월부터 1999맨 12월까지 본원 내분비내과에 내원한 150명의 제2형 당뇨병 환자를 대상으로 하였고 환자의 연령분포는 31세부터 77세까지, C-peptide 평균농도는 1.27pmol/㎖ 이었다. 고해상도 B-mode 초음파기기로 경동맥 내중막두께와 죽전을 측정하였고, two-site sandwich enzyme-linked immunosorbent assay를 이용하여 Lp(a)를 측정하였다. 결과: 혈장 Lp(a) 농도는 경동맥 내중막두께가 두꺼울수록 증가하였고(24.5±17.6, 22.8±20.2, 40.2±37.0 ㎎/㎗ respectively; p=O.003), 죽전이 있는 환자에서 증가되어 있었다(35.4±26.5, 24.8±17.5㎎/㎗, p=0.019). 미세혈관 합병증과의 관계를 보면 망막증이 있는 환자에서 Lp(a)가 증가해 있었고, 정상 단백뇨를 보이는 환자보다 미세 단백뇨와 거대 단백뇨를 보이는 환자에서 Lp(a)가 증가해 있음을 알 수 있었다. 결론: Lp(a)는 제2형 당뇨병 환자에서 경동맥 죽상동맥경화증, 미세혈관 합병증과 관련이 있을 것으로 사료되며 Lp(a)가 당뇨병의 혈관합병증에 미치는 작용을 규명하기 위해서는 전향적 연구가 필요하리라 생각된다. Background: Lipoprotein(a) [Lp(a)] is a plasma particle, similar in size and lipid composition, to LDL, which, in addition to apo B1OO, contains a second glycoprotein, apo(a), which bears a strong resemblance to plasminogen. Many reports have indicated that Lp(a) is an independent risk factor for ischemic heart disease. Furthermore, recent studies have suggested an association between elevated Lp(a) levels and carotid atherosclerosis and chronic renal insufficiency in nondiabetic subjects. Thus we investigated the relationship between Lp (a) level and carotid intima-media thickness (IMT) and the other vascular complications in type 2 diabetes subjects. Method: A total of 150 diabetic patients with type 2 diabetes were examined. The carotid artery IMT and plaque formation were measured by high-resolution ultrasonography. The subjects were divided into tertiles according to IMT values. Serum Lp (a) level was measured by two-side sandwich enzyme-linked immunosorbent assay. Results: Serum Lp (a) increased with increasing IMT (24.5±17.6, 22.8±20.2, 40.2±37.0 ㎎/㎗, respectively; p=0.003) and was higher in subject with carotid artery plaques than without carotid artery plaques (35.4±26.5, 24.8±17.5 ㎎/㎗, p=0.019). Furthermore, serum LP(a) was increased with increasing proteinuria and was higher in subject with retinopathy than without retinopathy. Conclusions : From our study, we suggest that Lp(a) level is associated with carotid atherosclerosis and microvascular diabetic complications in subjects with type 2 diabetes mellitus. Prospective studies will be needed to confirm the effect of Lp(a) an the development of vascular complications in type 2 diabetes.