• Clinics in Shoulder and Elbow
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• 제19권3호
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• pp.163-167
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• 2016

Septic arthritis in neonates is a rare condition. A failure to make an early diagnosis of septic arthritis in neonates may leave a permanent disability as a result of a delayed treatment. Thus, septic arthritis, requires a prompt diagnosis and a timely treatment especially in this subset of patients. In this case report, we describe our treatment protocol for septic arthritis and concurrent osteomyelitis in the right shoulder of a 28-day-old newborn. Using 2.4 mm wrist arthroscopy, we performed an arthroscopic irrigation and drainage, to remove intra-articular debris and inflammatory tissue, and multiple drilling. We report a satisfactory clinical outcome without any postoperative complications or side effects.

• The Korean Journal of Physiology and Pharmacology
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• 제17권2호
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• pp.157-162
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• 2013

Insulin-like growth factor binding proteins (IGFBPs) are important components of insulin growth factor (IGF) signaling pathways. One of the binding proteins, IGFBP-5, enhances the actions of IGF-1, which include the enhanced proliferation of smooth muscle cells. In the present study, we examined the expression and the biological effects of IGFBP-5 in vascular smooth muscle cells (VSMCs) from spontaneously hypertensive rats (SHR) and Wistar Kyoto rats (WKY). The levels of IGFBP-5 mRNA and protein were found to be higher in the VSMC from SHR than in those from WKY. Treatment with recombinant IGFBP-5-stimulated VSMC proliferation in WKY to the levels observed in SHR. In the VSMCs of WKY, incubation with angiotensin (Ang) II or IGF-1 dose dependently increased IGFBP-5 protein levels. Transfection with IGFBP-5 siRNA reduced VSMC proliferation in SHR to the levels exhibited in WKY. In addition, recombinant IGFBP-5 significantly up-regulated ERK1/2 phosphorylation in the VSMCs of WKY as much as those of SHR. Concurrent treatment with the MEK1/2 inhibitors, PD98059 or U0126 completely inhibited recombinant IGFBP-5-induced VSMC proliferation in WKY, while concurrent treatment with the phosphatidylinositol-3 kinase inhibitor, LY294002, had no effect. Furthermore, knockdown with IGFBP-5 siRNA inhibited ERK1/2 phosphorylation in VSMC of SHR. These results suggest that IGFBP-5 plays a role in the regulation of VSMC proliferation via ERK1/2 MAPK signaling in hypertensive rats.

• 한국임상약학회지
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• 제22권3호
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• pp.234-238
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• 2012

Background: Valproic acid is widely used in the treatment of generalized tonic-clonic and partial seizures. The carbapenem class is the most potent and widest spectrum of antimicrobial activity. Concomitant administration of carbapenems and valproic acid has been reported to decrease the serum concentration of valproic acid, which is sometimes associated with seizures. The purpose of this study is to evaluate the changes in valproic acid concentration and half life and the frequency of seizure during concomitant administration of valproic acid and carbapenems. Method: This study was performed retrospectively on total 40 cases with identified valproic acid concentration during concomitant administration of valproic acid and carbapenems at Kangbuk Samsung Hospital from February 1st, 2006 to October 31st, 2011. Patients were classified into 3 groups: ertapenem group (n=14), imipenem group (n=12), meropenem group (n=14). Results: The mean serum concentrations in each group during combined treatment were $9.50{\pm}8.84$, $21.88{\pm}8.17$ and $10.62{\pm}8.67$ mg/L, respectively (p < 0.001). The mean half-lives in each group during concurrent use of valproic acid and carbapenems were $3.18{\pm}0.81$, $4.63{\pm}1.97$ and $2.67{\pm}1.69$ hr, respectively (p < 0.001). The valproic acid serum concentration decreased by 75.5%, 54.1% and 84.1% and the half-life of valporoic acid decreased by 65.6%, 35.7% and 73.5%, respectively. Total cases with seizure were 12(30%) with 5(35.7%) in the ertapenem group, 3 (25.0%) in the imipenem group and 4(28.6%) in the meropenem group (p=0.911). There were no specific factors to influence on seizure development during combined treatment. Conclusion: Concurrent use of carbapenems and valproic acid should be avoided. If concomitant administration is essential, very close serum concentration monitoring and clinical observation are necessary.

• Asian Pacific Journal of Cancer Prevention
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• 제16권9호
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• pp.3827-3833
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• 2015

Background: Positive para-aortic lymph node (PALN) at diagnosis in cervical cancer patients confers an unfavorable prognosis. This study reviewed the outcomes of extended field radiotherapy (EFRT) and concurrent chemotherapy with extended field RT (CCEFRT) in patients with positive PALN at diagnosis. Materials and Methods: Medical records of 407 cervical cancer patients between 1st January 2002 to 31st December 2012 were reviewed. Some 32 cases with positive PALN were identified to have received definitive extended field radiotherapy with or without chemotherapy. Treatment outcomes, clinicopathological factors affecting survival and radiotherapy related acute and late effects were analyzed. Results: Totals of 13 and 19 patients underwent EFRT and CCEFRT respectively during the period of review. The median follow-up was 70 months. The 5-year overall survival (OS) was 40% for patients who underwent CCEFRT as compared to 18% for patients who had EFRT alone, with median survival sof 29 months and 13 months, respectively. The 5-years progression free survival (PFS) for patients who underwent CCEFRT was 32% and 18% for those who had EFRT. Median PFS were 18 months and 12 months, respectively. Overall treatment time (OTT) less than 8 weeks reduced risk of death by 81% (HR=0.19). Acute side effects were documented in 69.7% and 89.5% of patients who underwent EFRT and CCEFRT, respectively. Four patients (12.5%) developed radiotherapy late toxicity and there was no treatment-related death observed. Conclusions: CCEFRT is associated with higher 5-years OS and median OS compared to EFRT and with tolerable level of acute and late toxicities in selected patients with cervical cancer and PALN metastasis.

• Investigative Magnetic Resonance Imaging
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• 제23권4호
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• pp.351-360
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• 2019

Purpose: To investigate noninvasive biomarkers for predicting treatment response in patients with locally advanced HCC who underwent concurrent chemoradiotherapy (CCRTx). Materials and Methods: Thirty patients (55.5 ± 10.2 years old, M:F = 24:6) who underwent CCRTx due to advanced HCC were enrolled. Contrast-enhanced US (CEUS) and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) were obtained before and immediately after CCRTx. The third CEUS was obtained at one month after CCRTx was completed. Response was assessed at three months after CCRTx based on RECIST 1.1. Quantitative imaging biomarkers measured with CEUS and MRI were compared between groups. A cutoff value was calculated with ROC analysis. Overall survival (OS) was compared by the Breslow method. Results: Twenty-five patients were categorized into the non-progression group and five patients were categorized into the progression group. Peak enhancement of the first CEUS before CCRTx (PE1) was significantly lower in the non-progression group (median, 18.6%; IQR, 20.9%) than that in the progression group (median, 59.1%; IQR, 13.5%; P = 0.002). There was no significant difference in other quantitative biomarkers between the two groups. On ROC analysis, with a cutoff value of 42.6% in PE1, the non-progression group was diagnosed with a sensitivity of 90.9% and a specificity of 100%. OS was also significantly longer in patients with PE1 < 42.6% (P = 0.014). Conclusion: Early treatment response and OS could be predicted by PE on CEUS before CCRTx in patients with HCC.

• 대한한의학회지
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• 제42권1호
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• pp.119-128
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• 2021

비소세포성폐암 3기B 진단을 받고, 표준치료인 동시항암방사선치료를 시행했으나 별무효과였던 40대 남자에게, 한양방통합치료를 장기간 집중적으로 시행한 결과, 3개월만에 완전 관해에 도달하고, 5년 생존에 성공함으로써 한양방통합치료의 가능성을 보여 주었기에, 이에 증례를 보고한다.

• Clinical and Experimental Pediatrics
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• 제62권6호
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• pp.235-239
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• 2019

Purpose: In Kawasaki disease (KD) patients, coronary artery complications, incomplete and refractory types occur more frequently in patients with streptococcal or other bacterial/viral infections. Recently, we observed a higher incidence of coronary lesions in KD patients with high anti-streptolysin O (ASO) titer. Therefore, we hypothesized that KD patients diagnosed with concurrent streptococcal infection have poor prognosis, with respect to treatment response and development of coronary artery lesions. Methods: A retrospective review was performed in 723 patients with KD who were admitted to 2 major hospitals between June 2010 and September 2017. Results: Among 723 patients with KD, 11 initially showed an elevated ASO titer (>320 IU/mL) or elevated follow-up ASO titer after treatment. Of these patients, 5 showed no response to the first intravenous immunoglobulin treatment, 3 had abnormalities of the coronary arteries. This is a significantly higher proportion of patients with a high ASO titer (n=3,27.3%) than those with a normal ASO titer (n=53 [7.4%], P=0.047). A severe clinical course was seen in 81.8% of patients in the high ASO group versus 14.5% of patients in the normal ASO group. Conclusion: It is not certain whether acute streptococcal infection may cause KD, but this study revealed that KD with high ASO titers showed higher rates of severe clinical course. It may be helpful to analyze concurrent streptococcal infection in patients with a severe clinical course.

• 대한두경부종양학회지
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• 제38권2호
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• pp.7-13
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• 2022

Human papillomavirus (HPV) is a causative agent for a subset of oropharyngeal cancer (OPC). The current standard of care (SOC) for locally advanced OPC is 70 Gy definitive radiotherapy (RT) concurrent with cisplatin, which entails significant proportions of acute and late grade 3 or higher toxicities. Accordingly, discovery of favorable prognosis of HPV-related OPC has led to enthusiasm to attenuate subspecialties therapy in multidisciplinary treatment. Diverse deintensification strategies were investigated in multiple phase 2 trials with an assumption that attenuated treatments result in comparable oncologic outcome and less toxicities compared with SOC. Several trials on chemotherapy deintensification revealed that concomitant administration of cisplatin is not to be omitted or substituted for cetuximab without compromising progression-free survival or local control. A transoral robotic surgery (TORS) is investigated as alternative local treatment, but TORS plus SOC or mild deintensified adjuvant RT showed similar toxicities and inferior oncologic outcomes compared with SOC definitive RT or moderately deintensified RT. However, it has been reported that TORS plus deintensified 30-36 Gy adjuvant RT results in excellent outcome and less late toxicity compared with SOC adjuvant RT. Several phase 2 trials reported apparently equivalent progression-free survival and local control and similar adverse effects with moderately deintensified 60 Gy RT compared with SOC 70 Gy RT. Further dose reduction below 60 Gy has been investigated using biology-directed approaches, which use response to induction chemotherapy or metabolic images to triage HPV-positive OPC for deintensified RT. In summary, these trials provide valuable insights for future directions. Available evidence consistently showed that moderately deintensified RT is effective and safe for HPV-positive OPC in both definitive and adjuvant settings. Concurrent cisplatin remains an essential component without which progression-free survival is significantly compromised for advanced HPV-positive OPC. A simple incorporation of TORS to SOC may be detrimental for oncologic outcome without anticipated toxicity reduction. Given the lack of level 1 evidence, it is prudent to curb an unjustified deviation from the current SOC and limit any deintensified strategies to clinical trials and adhere to the current SOC.

• 성인간호학회지
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• 제27권2호
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• pp.156-169
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• 2015

Purpose: This study identified the reasons why tuberculosis (TB) patients withhold treatment in a bid to develop a assessment scale to select patients who needs nursing intervention in the early stage and decrease the risk of discontinuation of treatment. Sample: There were two samples. A sample of 191 patients with TB and having primary treatment and a second sample of N who were under re-treatment Methods: The study design included qualitative and quantitative methods. Qualitative data were collected from in-depth interviews of TB patients under re-treatment. The quantitative data were collected from 191 patients with TB under primary treatment. Results: Exploratory factor analysis revealed 11 factors explaining 69.6% of total variance. These factors were categorized into four subgroups. A depression scale was used to establish concurrent validity. The depression scale had a positive relationship (r=54) with the discontinuing of primary treatment. The internal consistency reliability for the four subgroups was over .84. The confidence coefficient was Cronbach's ${\alpha}$ .95. The final scale was a self-reported four Likert scale including 50 items. Conclusion: Reliability and validity was established for the scale and the scale can be used to examine the risk of treatment discontinuation for TB. The scale is an important resource for nursing interventions in identifying and treating high risk clients.

• Radiation Oncology Journal
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• 제17권2호
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• pp.113-119
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• 1999

목적 :국소적으로 진행된 자궁경부암 환자에서 저용량의 Cisplatin을 방사선민감제로 사용하여 방사선치료와 동시 치료하였을 때의 급성독성 평가와 초기 반응을 평가하기 위하여 연구를 시행하였다. 대상 및 방법 : 본 연구는 1996년 12월부터 1999년 1월까지 FIGO Stage IIB-IIIB의 진행된 자궁경부암 환자 38명을 대상으로 하였다. 16명은 자궁경부암의 크기가 4cm이상인 환자들로 방사선 치료와 저용량의 cisplatin을 매일 동시에 치료 하였으며, 나머지 환자에선 방사선 치료 단독으로 치료하였다. 방사선치료는 골반강에 외부 방사선치료로 4500 cGy(3060cGy시행이후 midline block 추가), 자궁옅조직으로 침범이 있는 경우에는 자궁옅조직으로 방사선치료 부위를 줄여 900-1000cGy 추가치료를 시행하였고, 내부치료는 Ir$^{192}$고선량 근접 치료기(micro-Selectron HDR)로 6극회의 강 내조사(point "A"에 3000 to 3500cGy, 500cGy/fx, 2회/week)를 시행하였다. 방사선치료와 저용량의 cisplatin을 동시에 사용한 군에서는 방사선치료 첫날부터 방사선치료 20일째 되는 날까지 저용량의 cisplatin 10mg을 방사선치료 30분 전에 투여하였다. 급성독성의 평가는 expanded common toxicity criteria of the NCI Clinical Trial을 이용하였다. 초기반응의 평가는 방사선치료 종료이후 최소 4주이상의 추적조사가 가능한 사람들을 대상으로 시행되었다. 결과 : 급성독성 평가는 전체 38명에서 평가 가능하였으며, 방사선치료와 저용량의 cisplatin을 병용한 군에서 16명 중 6명(37.5$\%$)에서, 방사선 단독으로 치료한 군에서는 22명중 1명(6.2$\%$)에서 3등급 이상의 백혈구감소를 보였으며, 통계학적으로 의미있는 차이를 보였다 (P=0.030). 3등급 이상의 급성 위장간 독성은 저용량의 cisplatin을 병용한 군에서만 4명이 있었으나, 2-3일의 치료 중단이후 증상이 완화되어서 치료를 계속할 수 있었으며, 치료중 5kg이상의 체중감소는 방사선치료와 저용량의 cisplatin을 병용한 군에서는 16명중 3명(18.7$\%$), 방사선 단독으로 치료한 군에서는 22명중 2명(9.1$\%$)으로 통계학적으로 의미 있는 차이를 보이지 않았다(P=0.63). 초기반응은 추적조사가 4주 이상 가능하였던 34명을 대상으로 하였으며, 저용량의 cisplatin을 병용한 군에서 14명중 11명 (78$\%$), 방사선 단독으로 치료 군에서 20명중 16명(80$\%$)으로 통계학적으로는 의미있는 차이를 보이지 않았다(P=0.126). 결론 :국소 진행된 자궁경부암에 대한 방사선치료와 저용량의 cisplatin 병용요법 치료시 3등급 이상의 백혈구감소가 방사선치료 단독으로 치료시보다 많았으나, 1주 이하의 치료중단 이후 치료를 계속 할 수 있었으며, 4등급 이상의 백혈구감소와 치료에 의한 사망은 없었다. 초기반응에 대한 평가는 저용량의 cisplatin병용 군에서 4cm 이상의 자궁경부암을 가진 환자가 많음에도 불구하고 양 군에서 비슷한 정도의 반응을 보였으므로 진행된 자궁경부암의 치료에서 저용량의 cisplatin을 방사선민감제로 사용하여 치료결과의 향상을 기대할 수 있게 되었다. 따라서 저용량의 clsplatin과 방사선치료를 병용요법하였을 때의 치료효과를 판정하기 위해서는 phase III study가 필요하다.