• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제22권5호
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• pp.417-430
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• 2019

The policies developed for the treatment of Helicobacter pylori infection in adults may not be the most suitable ones to treat children and adolescents. Methods used to treat children and adolescents in Europe and North America may not be appropriate for treating children and adolescents in Korea due to differences in epidemiological characteristics of H. pylori between regions. Moreover, the agreed standard guidelines for the treatment of H. pylori infection in children and adolescents in Korea have not been established yet. In this study, the optimal treatment strategy for H. pylori infection control in children and adolescents in Korea is discussed based on these guidelines, and recent progress on the use and misuse of antimicrobial agents is elaborated. Non-invasive as well as invasive diagnostic test and treatment strategy for H. pylori infection are not recommendable in children aged less than ten years or children with body weight under 35 kg, except in cases of clinically suspected or endoscopically identified peptic ulcers. The uncertainty, whether enough antimicrobial concentrations to eradicate H. pylori can be maintained when administered according to body weight-based dosing, and the costs and adverse effects outweighing the anticipated benefits of treatment make it difficult to decide to eradicate H. pylori in a positive noninvasive diagnostic test in this age group. However, adolescents over ten years of age or with a bodyweight of more than 35 kg can be managed aggressively as adults, because they can tolerate the adult doses of anti-H. pylori therapy. In adolescents, the prevention of future peptic ulcers and gastric cancers is expected after the eradication of H. pylori. Bismuth-based quadruple therapy (bismuth-proton pump inhibitor-amoxicillin/tetracycline-metronidazole) with maximal tolerable doses and optimal dose intervals of 14 days is recommended, because in Korea, the antibiotic susceptibility test for H. pylori is not performed at the initial diagnostic evaluation. If the first-line treatment fails, concomitant therapy plus bismuth can be attempted for 14 days as an empirical rescue therapy. Finally, the salvage therapy, if needed, must be administered after the H. pylori antibiotic susceptibility test.

• 대한골관절종양학회지
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• 제2권1호
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• pp.27-32
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• 1996

Recent advances in imaging techniques, surgery and combination anti-cancer chemotherapy have brought high survival rates in osteosarcoma. To investigate the survival rate, local recurrence and complications in treatment, we analysed 25 osteosarcoma cases who had been treated with preoperative neo-adjuvant chemotherapy, surgery and post operative chemotherapy at Department of Orthopedic Surgery, Catholic University. From May 1988 to April 1995, 42 cases of stage IIB osteosarcoma were admitted in Department of Orthopedic Surgery. Among them, 17 cases who didn't follow our treatment guidance were excluded in this study. The average age were 19 years. There were 21 males and 4 females. The involved sites were 4 humerus, 10 femur, 10 tibia and 1 talus. Eleven cases had received intraarterial cisplatin and intravenous adriamycin chemotherapy, and 7 T-10 protocol and 7 intravenous ifosfamide, ADR, methotrexate, cisplatin. Twenty-three cases were treated with limb salvage surgery, and 2 amputation. The average follow-up was 35 months(3~82). There were 14 cases of continuous disease free, 9 cases of died of disease, 1 case of alive with disease, and 1 case of no evidence of disease at final follow-up. There were three cases of local recurrence at 6,8 and 12 months after operation. The estimated Kaplan-Meier's 5 year survival rates for all, ADR-cisplatin group, T-10 protocol group, and ifosfamide regimen group were 6%, 73%, 44% and 72%, respectively.

• The Korean Journal of Physiology and Pharmacology
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• 제20권6호
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• pp.657-667
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• 2016

Critical limb ischemia (CLI) is one of the most severe forms of peripheral artery diseases, but current treatment strategies do not guarantee complete recovery of vascular blood flow or reduce the risk of mortality. Recently, human bone marrow derived mesenchymal stem cells (MSCs) have been reported to have a paracrine influence on angiogenesis in several ischemic diseases. However, little evidence is available regarding optimal cell doses and injection frequencies. Thus, the authors undertook this study to investigate the effects of cell dose and injection frequency on cell survival and paracrine effects. MSCs were injected at $10^6$ or $10^5$ per injection (high and low doses) either once (single injection) or once in two consecutive weeks (double injection) into ischemic legs. Mice were sacrificed 4 weeks after first injection. Angiogenic effects were confirmed in vitro and in vivo, and M2 macrophage infiltration into ischemic tissues and rates of limb salvage were documented. MSCs were found to induce angiogenesis through a paracrine effect in vitro, and were found to survive in ischemic muscle for up to 4 weeks dependent on cell dose and injection frequency. In addition, double high dose and low dose of MSC injections increased vessel formation, and decreased fibrosis volumes and apoptotic cell numbers, whereas a single high dose did not. Our results showed MSCs protect against ischemic injury in a paracrine manner, and suggest that increasing injection frequency is more important than MSC dosage for the treatment CLI.

• Radiation Oncology Journal
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• 제6권1호
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• pp.23-33
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• 1988

A rerospective review of fifty patients with carcinoma of hypopharynx treated with $RT{\pm}surgery$ was studied for eleven-year period from 1974 to 1984. Of the 50 patients,46 were pyriform sinus in origin, 4 were posterior pharyngeal wall. Eighty-eight percent of patients were locoregionally advanced(stage III, IV) and 78% of patients presented conical lymphadenopathy. 5-year disease-free survival rate of the pyriform sinus ca. was $25.4\%$ in RT alone group, $80\%$ in combined modality group and $30.6\%$ in overall. Local control rate with RT alone in early stage (II) was excellent $(100\%)$, however combined modality appears to be better for local control$(80\%)$ in advanced stage (III, IV) as compared with that of RT alone group $(32\%).$ On basis of this study, RT alone is effective in terms of local control and functional preservation in treatment of early stage of pyriform sinus ca. while surgery can be reserved for salvage purpose when RT fails and combined modality is recommended in patients with locally advanced stage for better local control and survival.

• Asian Pacific Journal of Cancer Prevention
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• 제13권5호
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• pp.2225-2228
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• 2012

Background: We assessed the efficacy and toxicity of ifosfamide and doxorubicin combination chemotherapy (CT) regimen retrospectively in Turkish patients with recurrent or metastatic nasopharyngeal carcinoma (NPC) previously treated with platinum-based chemotherapy. Methods: A total of thirty patients who had received cisplatin based chemotherapy/chemoradiotherapy as a primary treatment received ifosfamide 2500 $mg/m^2$ days 1-3, mesna 2500 $mg/m^2$ days 1-3, doxorubicin 60 mg/m2 day 1 (IMA), repeated every 21 days. Eligible patients had ECOG PS< 2, measurable recurrent or metastatic disease, with adequate renal, hepatic and hematologic functions. Results: Median age was 47 (min-max; 17-60). Twenty six (86.7 %) were male. Median cycles of chemotherapy for each patient were 2 (range:1-6). Twenty patients were evaluable for toxicity and response. No patient achieved complete response, with nine partial responses for a response rate of 30.0% in evaluable patients. Stable disease, and disease progression were observed in five (16.7%) and six (20.0%) patients, respectively. Clinical benefit was 46.7%. Median time to progression was 4.0 months. Six patients had neutropenic fever after IMA regimen and there were one treatment-related death due to tumor lysis syndrome in first cycle of the CT. No cardiotoxicity was observed after CT and treatments were generally well tolerated. Conclusion: Ifosfomide and doxorubicin combination is an effective regimen for patients with recurrent and metastatic NPC. For NPC patients demonstrating failure of cisplatin based regimens, this CT combination may be considered as salvage therapy.

• 대한두경부종양학회지
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• 제15권1호
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• pp.40-45
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• 1999

Objectives: Maxillary cancer is notorious for its poor prognosis because it is usually detected lately and the majority of patients have advanced disease. Especially when the cancer extended to infratemporal fossa or pterygopalatine fossa it is very difficult to remove all the involved structure by conventional maxillectomy. In these cases we have used radical maxillectomy through lateral approach. We tried to figure out the clinical significance of this procedure. Material and Methods: This study retrospectively analyzed 23 patients with squamous cell carcinoma of the maxillary sinus who underwent surgical treatment for cure. Among them 17 patients(group A) were treated with initial surgery and 6 patients(group B) underwent salvage surgery after radiotherpy. Radical maxillectomy was performed in 12 patients and conventional total maxillectomy in 11 patients. Results: In group A, 3 out of 9 total maxillectomy case and none of 8 radical maxillectomy case were recurred. In group B one patient died of postoperative complication and among the other 5 patients only one out of 3 radical maxillectomy was salvaged and 2 total maxillectomy cases were died of intercurrent disease. Conclusion: Wide surgical dissection of pterygopalatine fossa and infratemporal fossa may improve the survival rate in patients with posterior wall invasion of maxillary sinus.

• Journal of Chest Surgery
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• 제5권1호
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• pp.19-24
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• 1972

The recent development of cardiovascular surgery as well as aortoarteriogaphy has been established excellent operative result with great aid of limb-salvage. However, less consideration or less experience still exists on the regard of vascular accident and vascular disease, as well as vascular surgery in Korea. During the last 13 years, we experienced only two cases of aorto-iliac occlusion,acute and chronic, regardless of having had more than 300 cases of mitral valvotomy and gradual increasing tendency of arteriosclerosis and hypertension in Korea. Therefore it is noteworthy to report the cases in order to promote the consideration for vascular surgery. Case 1; 52 year old female who had 20 years history of mitral stenosis with uricular fibrillation and received medical treatment for recent 1 year in the medical department. 10 days before admission, acute saddle emboli developed and 15 days after the onset, embolectomy through both common femoral arteries on the groin and abdominal approach was made. The progression of emboll to the right popliteal bifurcation was found by arteriography on operating table and retrograde flushing with heparin solution by the polyethylene catheter inserted through posterior tibial artery. The operation was successful, but 9 hours after operation sudden death occurred. Considering this case, first, mitral valvotomy already before might prevent peripheral embolizatlon, secondarily, the more early detection and surgery might also prevent the progression of emboli. Thirdly, although preoperative or postoperatlve heparinization is controversial for mitraI stenosis, heparinization might prevent additional emboli to vital organs in this case Cases 2; 66 year old female who had 4 years history of left hip and calf intermittent claudication and has had rest pain, inability to walk and ischemic necrosis on the the left leg since last 3 months prior to admission to the orthopedic department under the suspicion of herniated disc. Absence of pulsation on the groin and aortography evidenced aortoillac occlusion predominantly on the left side. Thromboendarterectomy was made and the operative result was successful with absence of claudication, healing of ulcer and aortographic patency of occlusive site. This chronic occlusion is considered to result from arteriosclerosis in origin with the evidence of moderate hypertension, x-ray evidence of calcified plaque on the aortic knob and operative finding of palpable plaques.

• 대한골관절종양학회지
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• 제8권1호
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• pp.32-37
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• 2002

고등급 표면(high grade surface) 골육종은 골의 표면에서 발생하는 골육종의 희귀한 아형으로, 발생빈도는 전체 골육종의 1%에 못 미친다고 한다. 몇 편의 증례 보고와 연구 논문에서 이 고등급 표면 골육종을 소개하였는데, 국내의 경우 127예의 골육종 중 1예가 고등급 표면 골육종이었음을 기술한 논문이 있으나, 환자 및 진단과 치료에 대한 정보가 포함되어 있지 않았다. 저자들은 66세 여자 환자의 대퇴골 전자하부에서 발생한 고등급 표면 골육종 1예를 진단하고, 수술 전 항암 화학 요법, 광범위 절제술과 사지 구제술 및 수술 후 항암 화학 요법을 시행하였다. 이 종양은 위치만 골 표면에서 발생할 뿐 조직학적으로 전형적인 골수강내 골육종과 같으며, 다른 표면 골육종과는 달리 치료나 예후에 있어 전형적인 골수강 내 골육종과 같기 때문에, 진단과 치료에 있어 방골성 골육종이나 골막성 골육종 등의 표면 골육종과 구별하여야 할 것으로 생각한다.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1993년도 제27차 학술대회 초록집
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• pp.105-105
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• 1993

후두암은 두경부의 악성종양중 가장 흔한 것으로 특히 남자에 많아 한국남자의 악성 종양중 2.3%를 차지하고 있고, 두경부의 다른 악성종양에 비해 생존율이 매우 높다. 저자들은 후두암으로 진단받고 치료받은 환자 121명을 대상으로 치료성적을 분석하여 다음과 같은 결과를 얻었다. 1. 성문암 44%, 성문상부암 41%, 성문하부암 8%, 경성문부암 7% 순이었다. 2. 경부임파절 전이는 T2 stage 19%, T3 stage 47%, T4 stage 69%를 보였다. 전체적인 3년 NED 생존율은 65% 으며 stage I93%, stage II 76%, stage III 63%, stage IV 53%를 보였다. 4. 3년 NED생존율은 성문암이 82%로 성문상부암 58% 보다 더 좋았다. 5. 치료방법에 따른 합병증은 수술단독일경우 보다 수술후 방사선 치료군에서 높고, 방사선 치료실패로 구제수술을 행한 경우는 더욱 높게 나타났다.

• Journal of Trauma and Injury
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• 제34권3호
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• pp.162-169
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• 2021

Purpose: For severe lung injuries or acute respiratory distress syndrome that occurs during critical care due to trauma, extracorporeal membrane oxygenation (ECMO) may be used as a salvage treatment. This study aimed to describe the experiences at a single center with the use of ECMO in trauma patients. Methods: We enrolled a total of 25 trauma patients who were treated with ECMO between January 2015 and December 2019 at a regional trauma center. We analyzed and compared patients' characteristics between survivors and non-survivors through a medical chart review. We also compared the characteristics of patients between direct and indirect lung injury groups. Results: The mean age of the 25 patients was 45.9±19.5 years, and 19 patients (76.0%) were male. The mean Injury Severity Score was 26.1±10.1. Ten patients (40.0%) had an Abbreviated Injury Scale (AIS) 3 score of 4, and six patients (24.0%) had an AIS 3 score of 5. There were 19 cases (76.6%) of direct lung injury. The mortality rate was 60.0% (n=15). Sixteen patients (64.0%) received a loading dose of heparin for the initiation of ECMO. There was no significant difference in heparin use between the survivors and non-survivors (70% in survivors vs. 60% in non-survivors, p=0.691). When comparing the direct and indirect lung injury groups, there were no significant differences in variables other than age and ECMO onset time. Conclusions: If more evidence is gathered, risk factors and indications will be identified and we expect that more trauma patients will receive appropriate treatment with ECMO.