Higher thoracic radiation dose is beneficial in patients with extensive small cell lung cancer

윤한결,노재명,안용찬,오동렬,표홍렬,김해영 대한방사선종양학회 2019 Radiation Oncology Journal Vol.37 No.3

Purpose: The effectiveness of thoracic radiation therapy (TRT) in extensive-stage small cell lung cancer (ES-SCLC) patients is increasingly reported, but there is no definite consensus on its application. The aim of this study was to identify factors associated with better outcomes of TRT among patients with ES-SCLC, focusing on whether a higher TRT dose could improve treatment outcome. Materials and Methods: The medical records of 85 patients with ES-SCLC who received TRT between January 2008 and June 2017 were retrospectively reviewed. Eligibility criteria were a biological effective dose with α/β = 10 (BED) higher than 30 Gy10 and completion of planned radiotherapy. Results: During a median follow-up of 5.3 months, 68 patients (80.0%) experienced disease progression. In univariate analysis, a BED >50 Gy10 was a significant prognostic factor for overall survival (OS; 40.8% vs. 12.5%, p = 0.006), progression-free survival (PFS; 15.9% vs. 9.6%, p = 0.004), and intrathoracic PFS (IT-PFS; 39.3% vs. 20.5%, p = 0.004) at 1 year. In multivariate analysis, a BED >50 Gy10 remained a significant prognostic factor for OS (hazard ratio [HR] = 0.502; 95% confidence interval [CI], 0.287–0.876; p = 0.015), PFS (HR = 0.453; 95% CI, 0.265–0.773; p = 0.004), and IT-PFS (HR = 0.331; 95% CI, 0.171–0.641; p = 0.001). Response to the last chemotherapy was also associated with better OS in both univariate and multivariate analysis. Conclusion: A TRT dose of BED >50 Gy10 may be beneficial for patients with ES-SCLC. Further studies are needed to select patients who will most benefit from high-dose TRT.

만성B형 간염 환자에서 발생한 A형 간염에 의한 다발성 장기부전 1예

윤한결,김나영,김자선,이기종,연재우,백소야,박영민 대한내과학회 2011 대한내과학회지 Vol.80 No.-

Hepatitis A virus is a major cause of viral hepatitis worldwide. The prevalence of hepatitis A in young adults has recently been increasing in Korea. Hepatitis A infection rarely complicates fulminant hepatitis, acute pancreatitis, and acute renal failure. We experienced a case of multiple organ failure involving fulminant hepatitis, acute pancreatitis, and acute renal failure complicating a hepatitis A superinfection in a chronic hepatitis B patient. The patient was a 38yearold man who presented with febrile sense and myalgia. He was initially alert, but became confused and developed acute renal failure and acute pancreatitis. He received continuous renal replacement therapy and conservative treatment and completely recovered from the multiple organ failure. It is important to consider a variety of potential complications in hepatitis A patients, especially in those with underlying chronic liver disease. (Korean J Med 2011;80:S111-S116) A형 간염 바이러스는 세계적으로 바이러스성 간염의 주요한 원인이다. 최근 우리나라에서는 젊은 성인에서의 A형 간염이 증가하고 있다. A형 간염은 드물게 전격성 간염, 급성 췌장염, 급성 신부전을 일으킨다. 저자들은 만성 B형 간염 환자가 A형 간염 바이러스 중복감염에 의해 전격성 간염, 급성 췌장염, 급성 신부전의 다발성 장기 부전을 보인 증례를 경험하였다. 38세 남자 환자가 열감, 근육통이 있어 내원하였다. 초기에 의식이 명료하였으나 의식이 혼탁해지고 급성 신부전, 급성 췌장염이 발생하였다. 환자는 지속적 신대체 요법과 보존적 치료를 받았으며, 다발성 장기 부전에서 완전히 호전되었다. 특히 기저 간 질환이 있는 환자에서 A형 간염의 여러 합병증에 대한 주의를 기울여야 할 것으로 생각된다.

구강세균 유전자 검사(easy perio test)법을 이용한 치아우식 검사

윤한결(Han Gyeol Yun),박성규(Seong Gyu Park),김진(Jin Kim) 대한치과의료관리학회 2018 대한치과의료관리학회지 Vol.6 No.1

OCR 기술을 활용한 복약 데이터 수집 및 알림 소프트웨어 개발

윤한결(Yun Hangyeol),강희준(Kang HeeJun),권지혁(Kwon Jihyeok),최승혁(Choi SeungHyuk),전정호(Jeon JeongHo),최민규(Choi Minkyoo) 한국정보기술학회 2023 Proceedings of KIIT Conference Vol.2023 No.6

두개강내 동맥류 환자의 신경안과적 분석

윤한결(Han Gyul Yoon),김대현(Dae Hyun Kim) 대한안과학회 2017 대한안과학회지 Vol.58 No.11

목적: 두개강내 동맥류 환자에서 발생한 신경안과 진단 및 임상양상에 대해서 알아보고자 하였다. 대상과 방법: 2008년 4월부터 2016년 12월까지 두개강내 동맥류로 진단 받은 환자 중에서 신경안과 검사가 시행된 환자 33명을 대상 으로 후향적인 분석을 시행하였다. 영상검사 및 신경외과, 신경안과 의무기록을 통해 안과에서 동맥류를 발견한 빈도, 신경안과 진단및 예후, 동맥류의 위치, 동맥류 파열 여부 등을 알아보았고 터슨증후군이 동반된 환자의 신경학적 예후도 조사하였다. 결과: 전체 환자 33명에서 2명만이 안과에서 두개강내 동맥류를 먼저 발견하였고, 대부분의 환자 31명(94%)은 신경외과에서 동맥류를 발견하였다. 신경안과 진단으로는 3번뇌신경마비가 10명(30%)으로 가장 많았고 핵간안근마비, 시야결손, 시신경위축, 6번뇌신경마비, 안구진탕 등이 발생하였다. 동맥류 위치는 전교통동맥이 13예(39%)로 가장 많았고 12예, 후교통동맥 5예 순이었다. 전체 33명 중 10명 에서 터슨증후군이 동반되었고, 최종 관찰 시 6명(60%)에서 인지장애, 보행장애 등의 영구적인 신경학적 장애가 발생하였다. 결론: 두개강내 동맥류 환자에서 가장 많이 발생하는 신경안과 질환은 3번뇌신경마비였다. 신경안과 질환의 예후는 비교적 양호하였 으나, 터슨증후군이 동반된 환자의 신경학적 예후는 좋지 않았다. Purpose: To investigate the neuro-ophthalmic diagnosis and clinical manifestations of intracranial aneurysm. Methods: A retrospective survey of 33 patients who were diagnosed with intracranial aneurysm and underwent neuro-ophthalmic examination from April 2008 to December 2016. Frequency of the first diagnosis of intracranial aneurysm in ophthalmology, neuro-ophthalmic diagnosis, location of intracranial aneurysm, examination of intracranial aneurysm rupture, and neurologic prognosis of Terson’s syndrome patients were analyzed by image examination, neurosurgery, and ophthalmology chart review. Results: Of the 33 patients, most patients (n = 31, 94%) were diagnosed with intracranial aneurysm at the neurosurgical department and only 2 patients were diagnosed initially at the ophthalmology department. Causes and association were: Terson’s syndrome (n = 10, 30%), third cranial nerve palsy (n = 10, 30%), internclear ophthalmoplegia (n = 4, 12%), visual field defect (n = 3, 9%), optic atrophy (n = 3, 9%), sixth cranial nerve palsy (n = 2, 6%), and nystagmus (n = 1, 3%). The location of intracranial aneurysms were: anterior communicating artery (n = 13, 39%), medial communicating artery (n = 12, 36%), and posterior communicating artery (n = 5, 15%). Ten of 33 patients had Terson’s syndrome, and 6 patients (60%) with Terson’s syndrome had a permanent neurological disorder such as agnosia, gait disorder and conduct disorder. Conclusions: Third cranial nerve palsy was the most common neuro-ophthalmic disease in patients presenting with intracranial aneurysm. The neuro-ophthalmic prognoses for those diseases were relatively good, but, if Terson’s syndrome was present, neurological disorders (agnosia, gait disorder, conduct disorder) were more likely to remain after treatment. J Korean Ophthalmol Soc 2017;58(11):1276-1281

전방축농을 동반한 반복적인 헤르페스포도막염 의증 1예

윤한결(Han Gyul Yoon),정진호(Jinho Jeong),김진영(Jin Young Kim,) 대한안과학회 2018 대한안과학회지 Vol.59 No.10

목적: 외상 후 전방축농을 동반한 반복적인 헤르페스포도막염 의증 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 82세 남자 환자가 과거 병력상 좌안의 수지상 각막염으로 헤르페스각막염 진단하 항바이러스제 치료 후 병변이 소실되었다. 그러나 환자는 1년 후에 외상 후 발생한 좌안의 시력저하, 통증, 눈물흘림을 주소로 재내원하였다. 시력은 안전수지, 안압은 27 mmHg였으며, 세극등검사에서 중심부 각막미란, 중증도의 각막 실질부종 및 2 mm의 전방축농이 관찰되었다. 이에 외상에 의해 급격히 진행된 세균성 안내염으로 판단하여 배양검사 및 유리체강 내 항생제주입술을 시행하였다. 또한 병변의 임상 양상 및 과거 헤르페스각막염 치료력을 고려할 때 헤르페스 바이러스 감염도 배제할 수 없어서 항바이러스제 치료를 함께 시행하였다. 배양검사상 균이 검출되지 않았고 증상이 호전되어 2개월간 항바이러스제 치료를 서서히 중단하였다. 그러나 항바이러스제 치료를 중단한 지 5일째에 전방축농을 동반한 재발 소견이 관찰되었으며, 재발성 헤르페스포도막염으로 의심하에 다시 항바이러스제 및 스테로이드 치료를 하였고, 증상 및 시력이 회복되었다. 결론: 외상 후 급격한 전방축농이 발생한 환자에서 세균성 홍채염 및 안내염뿐만 아니라, 바이러스성 전안부 포도막염 또한 감별 진단으로 반드시 고려하여야 한다. Purpose: We report an unusual case of presumptive diagnosis of herpes-induced anterior uveitis with acute hypopyon after trauma. Case summary: A 82-year-old male was diagnosed with herpes keratitis due to dendritic keratitis in the left eye, and the lesion disappeared after antiviral treatment. However, 1 year later, the patient visited again with visual loss, pain, and tearing of the left eye after trauma. At the examination, best-corrected visual acuity was counting fingers and the intraocular pressure was 27 mmHg in the left eye. Slit-lamp examination revealed corneal epithelial erosion, moderate corneal edema, and prominent inflammation with 2 mm high hypopyon in the anterior chamber. We thought that bacterial endophthalmitis had rapidly progressed after trauma, so we performed bacterial cultures and an intravitreal antibiotics injection. Considering the clinical manifestations of lesions and herpes keratitis in the past, we could not exclude herpes virus infection. Cultures were negative and the symptoms improved, so the antiviral treatment was gradually reduced and stopped at 2 months. However, recurrence was observed on day 5 after stopping antiviral therapy. We therefore assumed that recurrent herpes virus caused anterior uveitis, and then, antiviral and steroid therapy was resumed. The patient subsequently showed improvement in his symptoms and recovered his visual acuity. Conclusions: When acute hypopyon is observed in the anterior chamber after trauma, not only bacterial iritis and endophthalmitis but also viral-induced anterior uveitis should be considered in the differential diagnosis.

다중 작업 학습과 Focal Loss를 활용한 혐오 표현 탐지

윤한결(Hangyeol Yoon),양주원(Juwon Yang),최우찬(Woochan Choi),김한휘(Hanhwi Kim) 한국정보과학회 2023 한국정보과학회 학술발표논문집 Vol.2023 No.12

증례 : 소화기 ; 만성B형 간염 환자에서 발생한 A형 간염에 의한 다발성 장기부전 1예

윤한결 ( Han Kyeol Yun ),김나영 ( Nha Young Kim ),김자선 ( Ja Seon Kim ),이기종 ( Ki Jong Lee ),연재우 ( Jae Woo Yeon ),백소야 ( So Ya Paik ),박영민 ( Young Min Park ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2S

A형 간염 바이러스는 세계적으로 바이러스성 간염의 주요한 원인이다. 최근 우리나라에서는 젊은 성인에서의 A형 간염이 증가하고 있다. A형 간염은 드물게 전격성 간염, 급성 췌장염, 급성 신부전을 일으킨다. 저자들은 만성 B형 간염 환자가 A형 간염 바이러스 중복감염에 의해 전격성 간염, 급성 췌장염, 급성 신부전의 다발성 장기 부전을 보인 증례를 경험하였다. 38세 남자 환자가 열감, 근육통이 있어 내원하였다. 초기에 의식이 명료하였으나 의식이 혼탁해 지고 급성 신부전, 급성 췌장염이 발생하였다. 환자는 지속적 신대체 요법과 보존적 치료를 받았으며, 다발성 장기 부전에서 완전히 호전되었다. 특히 기저 간 질환이 있는 환자에서 A형 간염의 여러 합병증에 대한 주의를 기울여야 할 것으로 생각된다. Hepatitis A virus is a major cause of viral hepatitis worldwide. The prevalence of hepatitis A in young adults has recently been increasing in Korea. Hepatitis A infection rarely complicates fulminant hepatitis, acute pancreatitis, and acute renal failure. We experienced a case of multiple organ failure involving fulminant hepatitis, acute pancreatitis, and acute renal failure complicating a hepatitis A superinfection in a chronic hepatitis B patient. The patient was a 38yearold man who presented with febrile sense and myalgia. He was initially alert, but became confused and developed acute renal failure and acute pancreatitis. He received continuous renal replacement therapy and conservative treatment and completely recovered from the multiple organ failure. It is important to consider a variety of potential complications in hepatitis A patients, especially in those with underlying chronic liver disease. (Korean J Med 2011;80:S111-S116)

S-396 Adjuvant endocrine therapy and incidence of fatty liver in postmenopausal women with breast cancer

홍남기,윤한결,서다혜,박세호,김승일,손주혁,이유미 대한내과학회 2016 대한내과학회 추계학술발표논문집 Vol.2016 No.1

Objective: Nonalcoholic fatty liver disease is associated with lipid disorders, insulin resistance, and increased cardiovascular risk. Tamoxifen (TMX) and aromatase inhibitors (AI), well-established adjuvant therapies for hormone receptor-positive breast cancer, are known to be associated with fatty liver. However, there are few data regarding comparison of its effect on long-term incidence of fatty liver. Methods: A total of 5250 patients with breast cancer on adjuvant TMX or AI (anastrozole or letrozole), from July 2005 to January 2015, were enrolled in this retrospective cohort. After excluding those who received both agents, those with fatty liver at baseline, metastatic breast cancer, previous liver disease, and current alcohol intake, TMX and AI group were 1:1 matched using propensity-score. The primary outcome was newly-developed fatty liver diagnosed by annually-performed ultrasonography. Results: Among 316 patients (N=158 for each group, mean age 53.5), 101 newly-developed fatty liver cases were detected in 948.9 person-years. Compared to AI, the incidence rate of fatty liver was significantly higher in TMX (128.2 vs. 90.2 per 1000 person-years, p=0.039) with higher prevalence of moderate to severe grade fatty liver (22/52, 42.3% vs. 2/49, 4.1%; p<0.001). In multivariate Cox model, TMX was associated with greater risk of incident fatty liver compared to AI (HR 1.62, 95% CI 1.06-2.48, p=0.025) independent of body mass index, diabetes, serum triglyceride, and HOMA-IR. Follow-up ultrasonography in subjects with newly developed fatty liver at median 2 years after the first detection showed persistent or worsened grade in about half of cases (45.9% in AI and 58.1% in TMX). During follow-up, decrease in serum total cholesterol was observed in both groups whereas triglyceride level remained high in TMX group compared to AI. Conclusions: TMX had more adverse long-term effect on incidence and progression of fatty liver compared to AI in postmenopausal women with breast cancer.

포스터 전시 발표 : 소화기 ; Epirubicin 과 Cisplatin 의 간동맥 화학요법에 의하여 완전관해가 유도된 폐전이를 동반한 간세포암 환자 증례

김자선,이기종,윤한결,김나영,박상종,박영민 대한내과학회 2008 대한내과학회지 Vol.75 No.1S