• Radiation Oncology Journal
• /
• 제33권2호
• /
• pp.126-133
• /
• 2015

Purpose: To evaluate the outcomes of adjuvant radiotherapy (RT) and to analyze prognostic factors of survival in the International Federation of Gynecology and Obstetrics (FIGO) IB-IIA uterine cervical cancer. Materials and Methods: We retrospectively reviewed the medical records of 148 patients with FIGO IB-IIA uterine cervical cancer who underwent surgery followed by adjuvant RT at the Yonsei Cancer Center between June 1997 and December 2011. Adjuvant radiotherapy was delivered to the whole pelvis or an extended field with or without brachytherapy. Among all patients, 57 (38.5%) received adjuvant chemotherapy either concurrently or sequentially. To analyze prognostic factors, we assessed clinicopathologic variables and metabolic parameters measured on preoperative 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). To evaluate the predictive performance of metabolic parameters, receiver operating characteristic curve analysis was used. Overall survival (OS) and disease-free survival (DFS) were analyzed by the Kaplan-Meier method. Results: The median follow-up period was 63.2 months (range, 2.7 to 206.8 months). Locoregional recurrence alone occurred in 6 patients, while distant metastasis was present in 16 patients, including 2 patients with simultaneous regional failure. The 5-year and 10-year OSs were 87.0% and 85.4%, respectively. The 5-year and 10-year DFSs were 83.8% and 82.5%, respectively. In multivariate analysis, pathologic type and tumor size were shown to be significant prognostic factors associated with both DFS and OS. In subset analysis of 40 patients who underwent preoperative PET/CT, total lesion glycolysis was shown to be the most significant prognostic factor among the clinicopathologic variables and metabolic parameters for DFS. Conclusion: Our results demonstrated that adjuvant RT following hysterectomy effectively improves local control. From the subset analysis of preoperative PET/CT, we can consider that metabolic parameters may hold prognostic significance in early uterine cervical cancer patients. More effective systemic treatments might be needed to reduce distant metastasis in these patients.

• Radiation Oncology Journal
• /
• 제33권2호
• /
• pp.109-116
• /
• 2015

Purpose: To analyze prognostic factors for locoregional recurrence (LRR), distant metastasis (DM), and overall survival (OS) in cervical cancer patients who underwent radical hysterectomy followed by postoperative radiotherapy (PORT) in a single institute. Materials and Methods: Clinicopathologic data of 135 patients with clinical stage IA2 to IIA2 cervical cancer treated with PORT from 2001 to 2012 were reviewed, retrospectively. Postoperative parametrial resection margin (PRM) and vaginal resection margin (VRM) were investigated separately. The median treatment dosage of external beam radiotherapy (EBRT) to the whole pelvis was 50.4 Gy in 1.8 Gy/fraction. High-dose-rate vaginal brachytherapy after EBRT was given to patients with positive or close VRMs. Concurrent platinum-based chemoradiotherapy (CCRT) was administered to 73 patients with positive resection margin, lymph node (LN) metastasis, or direct extension of parametrium. Kaplan-Meier method and log-rank test were used for analyzing LRR, DM, and OS; Cox regression was applied to analyze prognostic factors. Results: The 5-year disease-free survival was 79% and 5-year OS was 91%. In univariate analysis, positive or close PRM, LN metastasis, direct extension of parametrium, lymphovascular invasion, histology of adenocarcinoma, and chemotherapy were related with more DM and poor OS. In multivariate analysis, PRM and LN metastasis remained independent prognostic factors for OS. Conclusion: PORT after radical hysterectomy in uterine cervical cancer showed excellent OS in this study. Positive or close PRM after radical hysterectomy in uterine cervical cancer correlates with poor prognosis even with CCRT. Therefore, additional treatments to improve local control such as radiation boosting need to be considered.

• 한국임상수의학회지
• /
• 제32권5호
• /
• pp.440-444
• /
• 2015

본 케이스는 요독증이 해소되지 않는 말기 만성 신부전 환자에서의 지속적 신대체요법에 관한 보고이다. 본 원에 내원하여 만성신부전으로 진단 내려진 6마리의 환자에서 수액요법과 같은 일반적인 대증요법에 개선이 없었다. 따라서 혈액투석방법을 진행하였다. 평균 57-72%의 요소감소율을 보인 4마리의 환자와 37.3%의 요소감소율을 보인 1마리의 환자견에서 좋은 개선을 보였다. 하지만 6마리의 환자견에서의 93회 혈액투석 동안 체외흐름 폐색, 항응고제 사용에 의한 과도한 출혈등과 같은 부작용이 12회 발생하였다. 따라서 요독증이 개선되지 않는 만성 신부전 환자에서의 지속적 신대체요법은 유용하다 할 수 있으며 혈액투석동안 면밀한 부작용 관찰이 중요하다 여겨진다.

• 대한한의학회지
• /
• 제27권4호
• /
• pp.198-208
• /
• 2006

Background : Ginseng has traditionally been used in oriental countries to recover vital energy from Qi deficiency, and has shown various biomedical effects in the scientific literature. Recent reports suggest that ginseng could regulate blood pressure (BP), but much controversy still remains. Therefore, we intended to assess the anti-hypertensive effect of several ginseng types frequently used in clinics. We also investigated the anti-hypertensive effect on Koreans and Chinese, and by the body type according to Sasang Constitution Medicine (SCM). Methods : The study subjects were recruited from mildly hypertensive patients who exhibited pre-hypertension(120/80 to 139/89 mmHg) and stage I hypertension (140/90 to 159/99 mmHg) in Korea and China. After assigning the subjects into a Korean, a Chinese, a red, and an American ginseng group by randomization, we prescribed ginseng at a dose of 4.5 g per day for 4 weeks. To assess the anti-hypertensive effect, we compared the mean of systolic and diastolic BP between before and after ginseng medication using a 24-hour ambulatory blood pressure monitor (24 hr ABPM. We also monitored adverse effect and laboratory findings to secure the subjects' safety. In addition, all of the subjects in Korea consulted a specialist of Sasang Constitution Medicine to identify their constitutional type. Results : There were 64 subjects treated with Korean ginseng, 58 treated with Chinese ginseng, 33 treated with red ginseng, and 64 treated with American ginseng. Korean, Chinese, and American ginseng all reduced subjects' BP; Korean and Chinese ginseng showed more effect. The secondary analysis on the subjects' nationality revealed that all of the ginseng types showed more significant anti-hypertensive effect in Chinese patients than in Koreans. The third analysis on the constitutional type of SCM showed there was no significant difference in the effectiveness and the safety of ginseng among the constitutional types. Conclusions : We suggest ginseng, especially Panax ginseng without any steaming-drying process, could be useful for mild hypertension. Further, ginseng is safe regardless of subjects' constitutional type or type of ginseng within a dosage of 4.5g per day.

• Childhood Kidney Diseases
• /
• 제10권2호
• /
• pp.109-118
• /
• 2006

Purpose : HUS usually occurs in children after infection with shiga toxin-producing microorganism(D＋HUS). In contrast, non-postdiarrheal(D-) HUS occurs at any age and has a high rate of relapse and a poor prognosis. The clinical presentation of D-HUS is similar to that of thrombotic thrombocytopenic purpura(TTP). Recently severe deficiencies of ADAMTS13 were reported not only in TTP and D- HUS but also in D+ HUS during their acute phase. The purpose of the study is to evaluate the plasma ADAMTS13 activity in D＋ and D-HUS. Methods : Nineteen children with HUS(D＋ HUS 12 and D- HUS 7) were enrolled. The assays of plasma ADAMTS13 activity were performed during the acute stage in the D＋ HUS and at various stages of relapsing courses in the D- HUS patients by multimer assay, based on electrophoresis. Results : The median plasma activity of ADAMTS13 in D＋ HUS and D- HUS were 80.9%(37.8-132.4%) and 53.9%(1.0-94.1%), respectively, which were not statistically significantly different from control(86.4%, 34.2-112.3%)(P>0.05). One boy with D- HUS had severe deficiency of ADAMTS13(1.0%). His platelet count was normalized temporarily by fresh frozen plasma infusion. Conclusion : We have demonstrated that there is no significant difference of the plasma ADAMTS13 activity between D＋ HUS, D- HUS and control. We detected severe deficiency of ADAMTS13 in one boy who presented with relapsing episodes of D- HUS. ADAMTS13 deficiency should be considered in the subgroup of D- HUS especially with early onset and recurrent courses. Plasma therapy can be beneficial in this subgroup.

• 동의생리병리학회지
• /
• 제18권2호
• /
• pp.528-533
• /
• 2004

The immune system acts to protect the host from infectious agents that exist in the environment and from other noxious insults. The immune system has two functional divisions: the innate and the acquired. Both components involve various factors such as cytokines. A number of methodologies exist to assess aspects of immune function. There are large inter-individual variations in many immune functions even among the healthy. Genetics, age, gender, smoking habits, habitual levels of exercise, alcohol consumption, diet, stage in the female menstrual cycle, stress, history of infections and vaccinations, and early life experiences are likely to be important contributors to the observed variation. While it is clear that individuals with immune responses significantly below 'normal' are more susceptible to infectious agents and exhibit increased infectious morbidity and mortality, it is not clear how the variation in immune function among healthy individuals relates to variation in susceptibility to infection. Oriental medicine is an important factor contributing to immune competence. The author investigated the immune enhancement effects of Bojungikkitanggami-bang (BITB). The forced swimming test (FST) has been used as a screening model for new immune enhancement agents. In the present study, the author investigated the effects of BITB on FST and blood biochemical parameters related to fatigue, glucose (Glc); blood urea nitrogen (BUN); lactate dehydrogenase (LDH); creatinine; and total protein (TP). The author found that BITB (1 g/kg) significantly reduced the immobility time in the FST compared to the control. In addition, the contents of Glc, LDH, BUN, TP in the blood serum were increased in BITB (1g/kg)-fed group. Also, the author investigated the effects of BITB on the production of cytokines in human T-cell line, MOLT-4 cells. BITB (1 mg/ml) significantly increased the interferon (IFN)-vproduction compared with media control (about 2.2-fold for IFN-γ) at 24 h. However, BITB has not affect the production of IL-2 and IL-4. In addition, BITB increased the protein expression level of IFN-γ in MOLT-4 cells. Thus, BITB may have therapeutic value in generating or enhancing immune function in a clinical setting.

• 대한예방한의학회지
• /
• 제3권1호
• /
• pp.147-155
• /
• 1999

In order to investigate the effect of circulating blood and extinguishing blood stasis method on acute ischemic stroke treatment, we compared muscle weakness in two groups. Dansamhwanotang was administered to experimental group and the Sopungtang was administered to comparison group. In prospective and consecutive study, 24 patients(male 14, female 10) were admitted to hospital within 6hours(median $4.21{\pm}2.45)$ after stroke attack. All of them were diagnosed computed tomography as acute cerebral infarction. We divided that patients into two groups. The experimental group was 13, took median $4.17{\pm}1.72hrs$ to admission after stroke attack and the comparison group 11, median $4.31{\pm}2.72hrs$ to admission after stroke attack. There was no statistical difference in time consumed from stroke onset to admission(P>0.05). Muscle weakness was measured on admission and 7 days later on AMA(American Medical Association) method. In the experimental group, muscle weakness on admission was $2.23{\pm}0.51$ and $2.79{\pm}0.72$ in upper and lower extremity, respectively. In comparison group, muscle weakness on admission was $2.17{\pm}0.43$ and $2.67{\pm}0.82$ in upper and lower extremity, respectively. There was no difference in muscle weakness(P〈0.05). In 7 days after, muscle weakness was $2.31{\pm}0.35$ in upper extremity and $3.15{\pm}0.12$ in lower extremity in experimental group, and $2.27{\pm}0.74$ in upper extremity and $3.45{\pm}0.48$, lower extremity in comparison group. There was no meaningful improvement statistically in upper extremity(p<0.05) but significant evolution in lower extremity(p<0.05). The muscle weakness comparison between admission time and 7 days later was as follows. Experimental group had improvement at the degree of $0.24{\pm}0.92$, $0.42{\pm}0.82$ in upper and lower extremity, respectively and comparison group, $0.12{\pm}0.82$, $0.27{\pm}0.97$ in same part(p<0.05). So, Dansamhwanotang administered group had more good muscle weakness improvement than Sopungtang administered group(P>0.05). From the above result, I suppose that circulating blood and extinguishing blood stasis method helps recover hemiparesis caused by acute ischemic cerabral disease, in acute stage at least.

• Journal of Chest Surgery
• /
• 제39권5호
• /
• pp.376-381
• /
• 2006

배경: Ki-67 단백질은 세포의 증식활성도를 나타내는 생물표식자로, 비소세포폐암 환자에서 Ki-67 단백질의 증가는 예후에 나쁜 영향을 미치는 것으로 알려져 있다. 이 연구는 비소세포폐암으로 폐절제술을 실시한 환자에서 Ki-67 단백질의 발현정도를 조사하여, 단백질의 발현증가가 환자의 임상적 병리적 양상과 술 후 재발과 생존기간에 미치는 영향을 알아보기 위해 시행되었다. 대상 및 방법: 근치적 폐절제술을 실시한 38명의 비소세포폐암 조직에서 단클론항체 Ki-67로 면역조직화학염색을 실시하여 Ki-67 Labeling Index (LI)를 구하였다. 환자를 Ki-67 증가군$(LI{\ge}20%)$과 Ki-67 비증가군(LI<20%)으로 분류하여, 두 군의 술 전 임상적 병리적 특성, 술 후 생존기간 및 무병생존기간을 비교하였다. 결과: Ki-67 LI는 불균질한 분포를 보였고 평균 LI는 $20.0{\pm}20.1%$였다. Ki-67 증가군과 비증가군 간에나이, 성별, 흡연, TNM 병기, 혈관침윤은 유의한 차이가 없었다. 그러나 증가군은 비증가군에 비해 편평상피암이 많고, 분화도가 나쁘며, 임파침윤이 많았다$(p{\le}0.05)$. 증가군은 중앙 생존기간(47.2 vs. 96.5개월)과 중앙 무병생존기간(18.2 vs. 72.3개월)이 비증가군보다 짧았으나 통계적 유의성은 없었다(각각 p=0.312, p=0.327). 결론: 이상의 연구를 통해 비소세로폐암 환자에서의 Ki-67 단백질 발현증가는 수술 후 환자의 예후에 나쁜 인자로 작용하여 생존기간과 무병생존기간이 짧아지는 경향을 보였으나 통계적 유의성이 부족하여 향후 지속적인 연구가 필요할 것이다.

• Journal of Yeungnam Medical Science
• /
• 제13권1호
• /
• pp.86-96
• /
• 1996

1985년 8월부터 1996년 1월까지 중증 근무력증으로 진단받은 환자 52례에 대한 임상적 고찰을 통하여 다음과 같은 결론을 얻었다. 1. 전체 환자 중 남자가 19례(35.8%), 여자가 33례(64.2%)이었고 11세에서 20세 사이가 12례 (23%)로 가장 높은 빈도를 보였다. 2. 환자의 초기 증상으로는 안검하수, 복시 등의 안구증상이 37례(71.2%)로 가장 많았고 modified Osserman의 분류에 따라서도 가장 증상이 가볍고 약물치료에 잘 반응하는 I군이 36례(69.3%)로 가장 많았다. 3. 환자가 호소하는 중상의 비특이성과 회복과 재발을 거듭하는 질병의 특성으로 인해 발병 이후 진단될 때까지의 시간은 비교적 오래 걸렸고 1년이상 경과하며 진단된 경우도 16례(30.8%)나 되었다. 4. 자가면역질환이 7.6%에서 동반되었는데 갑상선기능 항진증이 2례(3.8%), 인슐린의존형 당뇨 2례(3.8%)였고 종격동 전산화 단층촬영소견에서 흉선의 비대가 의심되었던 환자는 6례(11.5%), 흉선종이 발견되었던 경우는 3례였다. 5. 환자의 치료는 대부분 항콜린에스테라제나 부선피질호르몬을 병용하는 내과적 치료를 하였으며 약물의 치료에 반응이 미비하거나 악화되는 경우 혹은 종격동 전산화 단층촬영 상에서 흉선의 이상 소견이 보인 경우에 2례(3.9%)에서는 흉선절제술이, 1례(1.9%)에서는 혈장여과요법이 추가되었고 흉선절제술과 혈장여과요법이 같이 병합 치료된 경우도 3례(5.9%) 있었다. 6. 전체 환자중 2명에서 자연치유의 경과를 보였으며 이들은 모두 I군이였다. 그리고 흉선절제술과 부신피질 호르몬 투여로 완치된 예가 1례였었다.

• Journal of Yeungnam Medical Science
• /
• 제9권2호
• /
• pp.312-320
• /
• 1992

1986년 4월부터 1992년 3월까지 6년간 영남대학교 의과대학 부속병원 치료방사선과에 내원하여 근치적인 방사선치료를 시행한 후 6개월 이상 추적조사가 가능하였던 31명의 치료성적은 다음과 같다. 대상환자 31명중 남자가 22명으로 여자보다 2.4배 많았으며 30세미만 3명을 제외하면 30대에서 60대까지 고른분포를 보였다. 병리조직학적 분류상 편평세포암이 13명, 미분화세포암이 18명이었다. 임상적병기는 I기 1명, II기 2명, III기 6명, IV기 22명이었다. 31명중 방사선치료만 시행된 경우가 11명, 항암제등과 병합치료를 시행한 경우가 20명이었다. 편평세포암 환자 11명중 6명에서 방사선치료만을 시행하였고 5명에서 병합치료를 시행하였으나, 미분화세포암에서는 18명중 5명은 방사선치료만을 시행하였고 13명은 병합치료를 실시하였다. 치료에 대항 반응은 치료방법에 따른 차이가 없었으나, 방사선치료만 시행한 경우에 편평세포암 6명중 3명이 완전관해를 보인 반면에, 미분화세포암 5명 모두 완전관해를 보여 큰 차이를 보였으나 병합치료에서는 세포형태에 따른 차이가 소실되었다. 치료 후 1년 생존율은 치료방법에 따른 차이가 없었다. 완전관해를 보인 환자 22명중에서 방사선치료만 시행한 8명중 6명에서 재발을 보였으며 그중 3명은 원격전이를 동반하였으나, 병합치료를 시행한 14명중에서 3명만이 재발을 보였으며 그중2명은 원격전이를 보였다. 이상의 결과에서 치료방법에 따른 관해율은 비슷하였으나 치료 후 추적과정에서 발생하는 재발은 방사선치료만 시행한 경우보다 병합치료를 실시한 경우에 현저히 줄어듬을 보여주어 비인강암에 대한병합치료가 국소재발의 감소 및 원격전이의 감소를 통하여 생존율의 향상에도 기여하리라 사료된다.