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FP 항암화학요법환자를 위한 표준진료지침서 및 간호기록지 개발
장선호,조선희,연미자,김매자,임선홍,전현숙,송화선,이지애,엄현정,김은실 성인간호학회 1999 성인간호학회지 Vol.11 No.4
The current patient management system has several limitations. To develop the critical pathway (CP) as a cost-effective method via continuous patient management. we investigated the medical records of 77 patients who underwent FP chemotherapy in Seoul National University Hospital from Feb. 1 to28. 1999. And the pilot study was done to 12 patients admitted to undergo the FP chemotherapy. 1. The vertical contents in the CP consisted of 7 items : assessment, activity, diet, IV therapy, medication, education and evaluation. The duration of the horizontal axis was 6 days from admission to discharge. 2. The medical performance according to the vertical axis in the preliminary CP, consisted of 72, and modified to 74 items in the final form of CP. 3. The nursing record consisted of a vertical axis of 4 items : assessment, IV therapy, medication and education. The duration of the horizontal axis was 6 days from admission to discharge of hospital days.
간세포암 환자의 종양병기 평가에 대한 Up-to-Seven Score의 임상적 유용성
정창호 ( Chang Ho Jung ),서연석 ( Yeon Seok Seo ),이재민 ( Jae Min Lee ),윤석배 ( Seok Bae Yoon ),윤태정 ( Tae Jung Yun ),임선영 ( Sun Young Yim ),안형진 ( Hyonggin An ),엄순호 ( Soon Ho Um ),김창덕 ( Chang Duck Kim ),류호상 ( Ho 대한간암학회 2014 대한간암학회지 Vol.14 No.1
Background/Aims: Up-to-seven criteria was proven to be useful for predicting prognosis after liver transplantation in patients with hepatocellular carcinoma (HCC). The aim of this study was to evaluate that up-to-seven score could be useful method for prediction of prognosis in patients with HCC who did not undergo liver transplantation. Methods: Between January 2006 and December 2008, 216 HCC patients without vascular invasion, lymph node and distant metastasis were analyzed retrospectively. We investigated the prognostic impact of laboratory findings, clinical characteristics, modified UICC T stage, and up-to-seven score in HCC. The survival analyses were performed using Kaplan-Meier Results: Two-hundred sixteen patients with HCC were included. Age was 60.1±11.3 years and 74.5% were male. Chronic hepatitis B was the most common cause of liver disease (60.6%). T stage was T1, T2, and T3 in 36 (16.7%), 118 (54.6%), and 62 (28.7%) patients, respectively. Up-to-even score was 5.5±4.0 and it was <3 (UTS 1), ≥3 and ≤7 (UTS 2), and >7 (UTS 3) in 36 (16.7%), 133 (61.6%), and 47 (21.8%) patients, respectively. The 10 (8.5%) patients of T2 stage were classified into UTS 3 and 25 (40.3%) patients of T3 stage were classified into UTS 2. The prognosis was significantly different in patients with T2 or T3 according to their UTS. Multivariate analysis showed that Child-Pugh score and UTS were significantly associated Conclusions: Up-to-seven score was useful to predict prognosis and to evaluate tumor stage in patients without vascular invasion, lymph node and distant metastasis.
고립성 골 전이를 동반한 식도편평세포암에서 동시 항암화학방사선 요법 후 완전관해를 보인 1례
김선영,서민호,최혁순,김은선,금보라,진윤태,이홍식,엄순호,김창덕,류호상,이우진,전훈재,김예지,Sun Young Kim,Min Ho Seo,Hyuk Soon Choi,Eun Sun Kim,Bora Keum,Yoon Tae Jeen,Hong Sik Lee,Soon Ho Um,Chang Duck Kim,Ho Sang Ryu,Woo Jin Lee,Hoon Jai 대한소화기암연구학회 2013 Journal of digestive cancer reports Vol.1 No.1
There is no established treatment for esophageal carcinoma with metastasis. For the metastatic esophageal squamous cell carcinoma, chemotherapy or best supportive care according to patient's performance status are accepted as an available treatment. We report a case of complete remission after concurrent chemoradiotherapy for esophageal squamous cell carcinoma with metastatic lesion in 5th thoracic vertebrae. A 57-year-old man with ongoing dysphagia and weight loss was admitted to our hospital. On the endoscopic and radiologic imaging evaluation,the patient was diagnosed as a squamous cell carcinoma of esophagus with solitary metastatic lesion in 5th thoracic vertebrae. The patient was treated with combination chemotherapy (5-fluorouracil (5-FU) and cisplatin) and concurrent radiotherapy for two months to relieve dysphagia. Because metastatic lesion in thoracic vertebrae was located near the primary esophageal tumor, the metastatic lesion could be included within the radiation field. After concurrent chemoradiotherapy, consecutive 4 cycles of chemotherapy had been carried out. Primary esophageal tumor with metastatic lymph nodes and metastatic lesion in 5th thoracic vertebrae disappeared on follow up computed tomography (CT) and positron emission tomography-CT (PET-CT). Follow up endoscopic biopsy revealed no remnant malignant cells at previous primary cancer lesion.
Treatment of Intermediate Stage HCC Patient: Impact of Deviation from BCLC Treatment Guidelines
( Sun Young Yim ),( Yoo Ra Lee ),( Han Ah Lee ),( Tae Hyung Kim ),( Hyung Joon Yim ),( Ji Hoon Kim ),( Yeon Seok Seo ),( Soon Ho Um ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: The intermediate stage hepatocellular carcinoma (HCC) comprises a highly heterogenous patient population. Despite the recommendation of transarterial chemoembolization (TACE) as first-line treatment, adherence to the recommended treatment option is low. Four substages (B1-B4) of intermediate HCC based on up-to-seven and Child Pugh Score was proposed by Bolondi et al. and different treatments modalities are recommended according to the stages. We aimed to compare the prognosis of patients who adhere to BCLC guideline impact of substagings in the management of intermediate HCCs. Methods: A retrospective chart review was conducted for 136 patients newly diagnosed with HCC BCLC stage B from year 2004 to 2016. Patients were categorized into three groups: adherent, over-treated and under-treated group based on BCLC guideline and Bolondi substage treatment recommendation. Survival analysis was performed using cox regression to determine the effects of overtreatment in intermediate HCC patients. Results: Among 136 patients, 84.1% were male patient with mean age of 60 years and overall survival was 35 months. Out of 136 patients, 86 patients (63%) adhere to TACE while 44 patients were over-treated (liver transplantation, resection, radioembolization and radiotherapy in addition to TACE) and 6 patients were undertreated (best supportive care) according to BCLC guideline. No patient had systemic therapy as initial treatment. When patients who adhere to TACE were compared to those who were over-treated according BCLC guideline, a higher proportion of patients with greater number of tumors, increased MELD score (≥10), and prolonged INR with lower platelet count were observed in TACE treatment group (all, P<0.05). Factors significantly associated with prolonged survival using multivariate analysis revealed that bolondi substages, over-treatment according to BCLC guideline, baseline AFP level and serum sodium level predictors of survival. Subgroup analysis with those who were treated with TACE only following BCLC guideline revealed that adherence to Bolondi treatment strategy improved survival compared to those who did not adhere to Bolondi treatment (P<0.001). Conclusions: BCLC practice guideline alone is not practiced in real life management of intermediate HCC patients. Our result indicate that overtreatment according to BCLC stage has impact in the prolongation of patient survival and treatment according to Bolondi’s substage could improve survival.
Caveolin-1 Promotes Hepatocarcinogenesis in Cirrhotic Liver
( Sun Young Yim ),( Ji-hyun Shin ),( Yun Seong Jeong ),( Sang-hee Kang ),( Young Nyun Park ),( Yeon Seok Seo ),( Soon Ho Um ),( Ju- Seog Lee ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: Liver cirrhosis is a soil for the development of hepatocellular carcinoma (HCC) and prevention of HCC is urgent. However, biomarkers to predict development of HCC from liver cirrhosis are still lacking. We aimed to discover a biomarker directly from protein analysis and relate it with genomics to validate in a larger cohort. Methods: Forty six patients who had surgical resection for HCC that developed from cirrhotic liver and developed HCC recurrence 3 years after resection were enrolled. HCC that recur less than 3 years was considered as intrahepatic metastasis while those that recur 3 years later was defined as de novo recurrence from liver cirrhosis. Systematic analysis was performed using reverse-phase protein array (RPPA) and microarray data acquired from these patients. Results: Proteomics analysis performed after selecting 20 proteins from 201 proteins with AUROC >70 in predicting late recurrence were able to categorize patients into high (n=20) and low risk (n=26) HCC groups. Caveolin-1 was the dominant protein for this categorization and 298 genes that significantly differed between these 2 groups were derived. This proteome derived late recurrence (PDLC) gene signature well predicted the development of HCC in cohort 1 (n=216) with background of liver cirrhosis. The robustness of this signature was also validated in predicting de novo HCC recurrence in cohort 2 (n=259). PDLC gene signature remained significant in multivariate analysis when compared with clinical variables (HR 1.904, P=0.01) and showed the lowest AIC among previously reported gene signature (186-BROAD gene signature and hepatic injury and regeneration gene signature). in vitro experiment revealed that immortalized liver cell overexpressed with CAV1 showed significantly increased proliferation and soft agar colony formation than the control (P<0.001 and 0.033). Immunohistochemical staining of tissue microarray analysis also supported our findings with increased HCC development in CAV1 positive tissues (P=0.047). Conclusions: Expression of CAV1, a structural protein of caveolae in the plasma membrane appears to be an important predictor of HCC development from liver cirrhosis and our study has provided new insight in considering CAV1 as a biomarker and target for prevention strategy.
( Sun Young Yim ),( Yoo Ra Lee ),( Han Ah Lee ),( Tae Hyung Kim ),( Hyung Joon Yim ),( Ji Hoon Kim ),( Yeon Seok Seo ),( Soon Ho Um ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: Sorafenib is the only standard treatment for advanced hepatocellular carcinoma with (HCC). However, its efficacy is not satisfactory and other treatment options are required. This study investigated the efficacy of chemoembolization and hepatic arterial infusion chemotherapy (HAIC) with or without radiotherapy versus sorafenib alone in patients with portal vein thrombosis (PVT). Methods: This single-center retrospective study involved 105 patients of advanced HCC with portal vein tumor thrombosis (PVT). Enrolled patients had either child-pugh (CP) class A or B liver cirrhosis whom were classified into 3 groups: 1) Sorafenib alone, n=20; 2) Chemoembolization and HAIC, n=26; 3) Chemoembolization and HAIC with radiotherapy, n=59. Sorafenib was initiated with 400mg twice daily and HAIC was based on cisplatin and 5-fluorouracil regimen, performed every 4 weeks. Response of PVT was determined 3 months after completion of treatment and was regarded as responsive when there is at least partial response. Overall survival (OS) was analyzed among the treatment groups and factors associated with mortality were evaluated using multivariate analysis. Results: The median radiation dose, sorafenib treatment duration and chemoembolization sessions were 50 Gy, 40 days, and 4 sessions, respectively. Proportion of patients according to the degree of PVT (main/both vs. first order vs. segmental PV) and bilobar tumor mass involvement did not differ among the three groups of treatment. However, PVT response rate was significantly higher in group 3 (13.5% vs. 6.7% vs. 55%, P=0.014) with lower incidence of solid organ metastasis (60% vs. 23.1% vs. 18.6%, P=0.001) and child pugh class B (70%, 50%, 25.4%%, P=0.001) compared to other groups. In univariate cox analysis, treatment modalities, presence of either lymph node or other organ metastasis, CP class B, decrease in AFP levels were associated with survival. However, multivariate analysis revealed that treatment modalities (group 1 vs. 2, HR, 0.244; 95% CI, 0.06-0.999, P=0.05, group 1 vs. 3, HR, 0.121; 95% CI 0.028-0.51, P=0.004 and group 2 vs. 3, HR 0.495; 95% CI, 0.25-0.98, P=0.044) and decrease in serum AFP level within 2 months of treatment (HR, 1.813; 95% CI, 1.204-2.72; P=0.004) were the only independent factors associated with survival. Median OS was significantly higher in patient treated with radiotherapy (group3, 11.1 months) than group 2 (3.6 months, log rank P<0.001) and group 1 (2 months, P<0.001). Furthermore, median OS survival was still significantly greater in group 2 than group 1, P=0.008. Conclusions: Radiotherapy with chemoembolization and HAIC can be alternative treatment option to sorafenib in patients with advanced HCC and PVT.
The Development of Evidence-Based Guideline for Diagnosis and Management of Headache in Korea
Sun Mi Kim,Young-Hoon Ko,Seoyoung Yoon,Won Sub Kang,Hye-Geum Kim,Hye Youn Park,Cheolmin Shin,Yoo Hyun Um,Soyoung Youn,Jae-Hon Lee,Seung-Ho Jang,Sang Won Jeon,Hong Jun Jeon,Seockhoon Chung,Jae-Won Choi 대한신경정신의학회 2019 PSYCHIATRY INVESTIGATION Vol.16 No.3
Objective: We aimed to develop the clinical guideline for headache by the systematic review and synthesis of existing evidence-based guidelines. The purpose of developing the guideline was to improve the appropriateness of diagnosis and treatment of headache disorder, and consequently, to improve patients’ pain control and quality of life. The guideline broadly covers the differential diagnosis and treatment of tension-type headache, migraine, cluster headache, and medication-overuse headache. Methods: This is a methodological study based on the ADAPTE methodology, including a systematic review of the literature, quality assessment of the guidelines using the Appraisal of Clinical Guidelines for REsearch & Evaluation II (AGREE II) Instrument, as well as an external review using a Delphi technique. The inclusion criteria for systematic search were as follows: topic-relevant, up-to-date guidelines including evidence from within 5 years, evidence-based guidelines, guidelines written in English or Korean, and guidelines issued by academic institutions or government agencies. Results: We selected five guidelines and conducted their quality assessment using the AGREE II Instrument. As a result, one guideline was found to be eligible for adaptation. For 13 key questions, a total of 39 recommendations were proposed with the grading system and revised using the nominal group technique. Conclusion: Recommendations should be applied to actual clinical sites to achieve the ultimate goal of this guideline; therefore, follow-up activities, such as monitoring of guideline usage and assessment of applicability of the recommendations, should be performed in the future. Further assessment of the effectiveness of the guideline in Korea is needed.