• 대한두경부종양학회지
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• 제11권1호
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• pp.30-35
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• 1995

Localized non-Hodgkin's lymphomas of head and neck are generally treated with radiation therapy with or without chemotherapy and the results of treatments are favorable, but the recurrences in the primary site or distant sites are a major contributor to failure, We experiened 19 cases of localized non-Hodgkin's lymphomas for 4-year period and retrogradely analized them. We treated patients with Ann Arbor stage I and low grade histology in Working formulation with radiation therapy and patients with Ann Arbor stage II, moderate to high grade histology or extensive tumor size with combination chemotherapy, The complete responses were occurred in 15 of 19 patients (radiation therapy, 5/6 (83.3%); chemotherapy 10/13(76.9%)). 3 relapses were occurred; 2 were in local relapses and 1 was in distant leptomeningeal relapse and the counter-therapeutic modalities were successful in 2 cases. Our results suggest that Ann Arbor stage is significant prognostic factor and appropriate staging with extensive methods is important to improve the results of treatment.

• Investigative Magnetic Resonance Imaging
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• 제19권3호
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• pp.178-185
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• 2015

Purpose: To compare the frequency of posterior globe flattening between two-dimensional T2-weighted imaging (2D T2WI) and three-dimensional (3D T2WI). Materials and Methods: Sixty-nine patients (31 female; mean age, 44.4 years) who had undergone both 5-mm axial T2WI and sagittal 3D 1-mm isovoxel T2WI of the whole brain for evaluation of various diseases (headache [n = 30], large hemorrhage [n = 19], large tumor or leptomeningeal tumor spread [n = 15], large infarct [n = 3], and bacterial meningitis [n = 2]) were used in this study. Two radiologists independently reviewed both sets of images at separate sessions. Axial T2WI and multi-planar imaging of 3D T2WI were visually assessed for the presence of globe flattening. The optic nerve sheath diameter (ONSD) was measured at a location 4 mm posterior to each globe on oblique coronal imaging reformatted from 3D T2WI. Results: There were significantly more globes showing posterior flattening on 3D T2WI (105/138 [76.1%]) than on 2D T2WI (27/138 [19.6%], P = 0.001). Inter-observer agreement was excellent for both 2D T2WI and 3D T2WI (Cohen's kappa = 0.928 and 0.962, respectively). Intra-class correlation coefficient for the ONSD was almost perfect (Cohen's kappa = 0.839). The globes with posterior flattening had significantly larger ONSD than those without on both 2D and 3D T2WI (P < 0.001; $6.14mm{\pm}0.44$ vs. $5.74mm{\pm}0.44$ on 2D T2WI; $5.90mm{\pm}0.47$ vs. $5.56mm{\pm}0.34$ on 3D T2WI). Optic nerve protrusion was significantly more frequent on reformatted 1-mm 3D T2WI than on 5-mm 2D T2WI (8 out of 138 globes on 3D T2WI versus one on 2D T2WI; P = 0.018). Conclusion: Posterior globe flattening is more frequently observed on 3D T2WI than on 2D T2WI in patients suspected of having increased intracranial pressure. The globes with posterior flattening have significantly larger ONSD than those without.

• Tuberculosis and Respiratory Diseases
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• 제62권6호
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• pp.549-553
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• 2007

유육종증은 다발성 비건락성 육아종 형성을 특징으로 하는 원인 미상의 전신 질환으로 주로 폐, 피부, 림프절 등의 장기를 침범하며, 신경계 침범은 상대적으로 드문 것으로 알려져 있다. 저자들은 다른 신경학적 증상 없이 단기 기억장애만을 특징으로 하는 신경유육종증이 병발한 폐유육종증 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Korean Neurosurgical Society
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• 제54권4호
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• pp.329-335
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• 2013

Objective : Brain metastases in primary breast cancer patients are considerable sources of morbidity and mortality. Gamma knife radiosurgery (GKRS) has gained popularity as an up-front therapy in treating such metastases over traditional radiation therapy due to better neurocognitive function preservation. The aim of this study was to clarify the prognostic factors for local tumor control and survival in radiosurgery for brain metastases from primary breast cancer. Methods : From March 2001 to May 2011, 124 women with metastatic brain lesions originating from a primary breast cancer underwent GKRS at a tertiary medical center in Seoul, Korea. All patients had radiosurgery as a primary treatment or salvage therapy. We retrospectively reviewed their clinical outcomes and radiological responses. The end point of this study was the date of patient's death or the last follow-up examination. Results : In total, 106 patients (268 lesions) were available for follow-up imaging. The median follow-up time was 7.5 months. The mean treated tumor volume at the time of GKRS was 6273 $mm^3$ (range, 4.5-27745 mm3) and the median dose delivered to the tumor margin was 22 Gy (range, 20-25 Gy). Local recurrence was assessed in 86 patients (216 lesions) and found to have occurred in 36 patients (83 lesions, 38.6%) with a median time of 6 months (range, 4-16 months). A treated tumor volume >5000 $mm^3$ was significantly correlated with poor local tumor control through a multivariate analysis (hazard risk=7.091, p=0.01). Overall survival was 79.9%, 48.3%, and 15.3% at 6, 12, and 24 months, respectively. The median overall survival was 11 months after GKRS (range, 6 days-113 months). Multivariate analysis showed that the pre-GKRS Karnofsky performance status, leptomeningeal seeding prior to initial GKRS, and multiple metastatic lesions were significant prognostic factors for reduced overall survival (hazard risk=1.94, p=0.001, hazard risk=7.13, p<0.001, and hazard risk=1.46, p=0.046, respectively). Conclusion : GKRS has shown to be an effective and safe treatment modality for treating brain metastases of primary breast cancer. Most metastatic brain lesions initially respond to GKRS, though, many patients have further CNS progression in subsequent periods. Patients with poor Karnofsky performance status and multiple metastatic lesions are at risk of CNS progression and poor survival, and a more frequent and strict surveillance protocol is suggested in such high-risk groups.

• Pediatric Infection and Vaccine
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• 제25권3호
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• pp.113-122
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• 2018

목적: 국내에서 cryopyrin-associated periodic syndrome (CAPS) 환자로 진단된 소아들의 임상 양상을 확인하고자 하였다. 방법: 2000년부터 2015년까지 서울대학교 어린이병원에서 CAPS로 진단받은 9명 소아들의 의무기록을 분석하였다. CAPS의 진단은 처음에는 임상 양상과 병력에 근거하였고 CIAS1 유전자의 돌연변이를 통해 최종 확진하였다. 결과:모든환자는재발하는열및두드러기발진이있었다. 9명의환자중 6명은발진이그리고 4명은발열이출생 1일또는 2일 안에 있었다. 근육통을 보인 환자는 8명이었고, 관절통이 있는 환자는 7명이었다. 이들은 방사선학적 소견 상 골단의 과도한 성장, 골감소증 또는 연골의 과성장과 같은 소견을 보였다. 4명의 환자는 뇌위축, 뇌실 확장 또는 자기공명영상에서 연수막 증대 소견을 보였다. 지적 장애가 1명에서 관찰되었다. 5명의 환자가 결막염, 포도막염, 맥락 망막염, 유두 부종으로 시력에 영향을 받았으며 3명은 진행성 난청을 보였다. 9명 모두에서 초기 C-반응성 단백질과 적혈구 침강속도가 증가되었다. 모든 환자는 CIAS1 유전자의 exon 3에서 돌연변이를 보였다. Anakinra 치료 후 발열과 발진이 사라졌으며 C-반응성 단백질과 적혈구 침강 속도가 호전되었다. 결론: 이 연구는 국내에서 처음으로 CAPS 환자들의 임상 증상을 고찰한 논문으로 향후 새로이 환자들을 진단하는데 유용할 것이다. 또한 환자들의 장기적인 합병증을 예방하기 위해 이른 나이부터 발생하는 반복적인 발열과 발진이 있는 소아에서 조기에 CAPS를 진단하고 치료하는 것이 중요하다.

• Journal of Korean Neurosurgical Society
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• 제64권2호
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• pp.271-281
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• 2021

Objective : Immune checkpoint inhibitors (ICIs) are approved for treating non-small-cell lung cancer (NSCLC); however, the safety and efficacy of combined ICI and Gamma Knife radiosurgery (GKS) treatment remain undefined. In this study, we retrospectively analyzed patients treated with ICIs with or without GKS at our institute to manage patients with brain metastases from NSCLC. Methods : We retrospectively reviewed medical records of patients with brain metastases from NSCLC treated with ICIs between January 2015 and December 2017. Of 134 patients, 77 were assessable for brain responses and categorized into three groups as follows : group A, ICI alone (n=26); group B, ICI with concurrent GKS within 14 days (n=24); and group C, ICI with non-concurrent GKS (n=27). Results : The median follow-up duration after brain metastasis diagnosis was 19.1 months (range, 1-77). At the last follow-up, 53 patients (68.8%) died, 20 were alive, and four were lost to follow-up. The estimated median overall survival (OS) of all patients from the date of brain metastasis diagnosis was 20.0 months (95% confidence interval, 12.5-27.7) (10.0, 22.5, and 42.1 months in groups A, B, and C, respectively). The OS was shorter in group A than in group C (p=0.001). The intracranial disease progression-free survival (p=0.569), local progression-free survival (p=0.457), and complication rates did not significantly differ among the groups. Twelve patients showed leptomeningeal seeding (LMS) during follow-up. The 1-year LMS-free rate in treated with ICI alone group (69.1%) was significantly lower than that in treated with GKS before ICI treatment or within 14 days group (93.2%) (p=0.004). Conclusion : GKS with ICI showed no favorable OS outcome in treating brain metastasis from NSCLC. However, GKS with ICI did not increase the risk of complications. Furthermore, compared with ICI alone, GKS with ICI may be associated with a reduced incidence of LMS. Further understanding of the mechanism, which remains unknown, may help improve the quality of life of patients with brain metastasis.