• Radiation Oncology Journal
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• v.17 no.4
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• pp.281-286
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• 1999

Purpose : Brain metastases are the most frequent metastatic neurologic complication of systemic cancer. Even if the prognosis of brain metastases is grave, with available treatments, most patients experience effective palliation of neurologic symptoms and meaningful extension of life. We evaluated the clinical features and prognostic factors of the patients who were diagnosed as solid tumors with brain metastasis and received radiotherapy for brain metastases. Materials and Methods: Between January 1987 and January 1998, 71 patients with brain metastases from solid malignancy were included. We reviewed neurologic symptoms and signs of patients and evaluated improvememt of neurologic symptoms and signs. Survival durations after brain metastasis were ana lysed according to several factors such as age, performance status, primary malignancies, the pre-sence of brain metastasis at initial diagnosis of primary tumor, multiplicity of brain metastass, the presence of metastases other than brain, and treatment method. Results: Frequent symptoms associated with brain metastasis were headache (47.9$\%$), motor weakness (40.8$\%$), nausea and vomiting (19.7$\%$) and mental change (19.7%). Palliation of these symptoms was accomplished in 64.9$\%$ of cases. The overall median survival time was 16 weeks and 1- and 2-year survival rates were 15.0$\%$ and 5.1$\%$ respectively. Patients without extracranial metastases (n=27) had longer median survival than patients with extracranial metastases (33 weeks vs 10 weeks, p=0.0018). In patients with single brain metastasis (n=37), the median survival time was longer in patients treated with surgery plus radiotherapy than in patients treated with radiotherapy alone (40 weeks vs 16 weeks, p=0.0438). Conclusion: Patients who has brain metastases only constitute a prognostically favorable group and they may be benefited from radiotherapy and surgery if indicated.

• Radiation Oncology Journal
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• v.14 no.3
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• pp.221-228
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• 1996

Purpose : We tried to evaluate the clinical characteristics, the treatment methods, the results of treatments, and the Patterns of failure in ovarian dysgerminoma retrospectively According to the results we would like to suggest the proper management guideline of stage la ovarian dysgerminoma patients who want to maintain fertility. Materials and Methods : Between 1975 and 1990, 34 patients with ovarian dysgerminoma were treated at the Yonsei University Hospital. The case records of these patients have been reviewed for presenting symptoms, treatment methods, local control and survival following treatment. Excluded from analysis were five patients with mixed ovarian germ cell tumors and gonadoblastomas (46,XY) Treatment results of the twenty nine patients were analysed by each treatment modality. Twenty one patients were treated with surgery and postoperative adjuvant radiotherapy (group 2). The other eight patients were treated with operation alone (group 2). The median age of twenty-nine patients was 23 years with a range of 8 to 39 years. Presenting symptoms were abdominal mass (20) pelvic discomfort or pain (5) et al. Radiotherapy was performed by 10MV LINAC or Co-60 teletherapy unit. The total radiation dose of the whole abdomen was 20-25 Gy/3weeks, 1-1.5 Gy/fraction with a boost to the whole pelvis 10-15 Gy/l-2weeks 1.8-2.0 Gy/fraction. Advanced stage disease (stage II or stage III) patients received prophylactic mediastinal and supraclavicular irradiation to a dose of 16-26 Gy. Median duration of follow-up of living patients was 80 months (range 13-201 months). Results : All of the twenty one patients of group 1 were alive without disease ($100\%$). Among the eight patients who were not treated with radiotherapy (group 2), six patients developed local recurrence. Four Patients referred with recurrent disease were treated with salvage radiotherapy. Three of four patients were salvaged and one Patient who had recurrent intra-abdominal disease died of progressed carcinomatosis at 11 months after salvage radiotherapy. The other two patients with recurrence were salvaged with chemotherapy (1 patient) or re-operation (1 Patient). Twenty eight patients remained alive without disease at last follow up, so the 5 year local control rate and 5 year overall survival rate for all groups were $96.6\%$ (28/29), respectively. Among thirteen patients with stage la unilateral tumors seven patients were treated with postoperative radiotherapy and the other six patients were treated with unilateral salpingo-oophorectomy alone. Five patients who did not received radiotherapy developed local failure but all of the recurrent ovarian dysgerminomas were salvaged with radiotherapy, chemotherapy or re-operation. So all the 13 patients with stage la ovarian dysgerminoma were free of disease from 20-201 months (median 80 months). Conclusion : The authors consider external irradiation to be an effective treatment as a complement to surgery in ovarian dysgerminoma. For those patients with disease presenting in stage la tumors who wish to maintain fertility, unilateral salpingo-oophorectomy alone may be curative and spare ovarian function considering excellent salvage rate of recurrent ovarian dysgerminoma in present study.

• Journal of Hospice and Palliative Care
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• v.18 no.2
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• pp.105-111
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• 2015

Purpose: Fatigue, energy loss, feeling of helplessness, poor appetite, pain besides general weakness are major symptoms presented to terminally ill cancer patients. These symptoms are similar to those that appeared with adrenal insufficiency. Also, for terminally ill cancer patients who are hospitalized for palliative care, opioid agents are prescribed to control moderate to severe pain. We studied the relationship of opioid agents and adrenal insufficiency. Methods: From November 2013 through June 2014, we monitored the serum level of cortisol and dehydroepiandrosterone sulfate (DHEAS, serum) in 55 cancer patients who were over 18 years old and were treated at a hospice center. We also checked the treatment period and dosage of opioid agents. Results: The DHEAS level, treatment period and dosage of opioid agents did not have significant correlation. Correlation between the serum cortisol level and the opioid agent treatment period was not significant either, but the serum cortisol level was positively correlated with the dosage of opioid agents (P value 0.0322). Conclusion: This study did not identify a novel link between treatment period, dosage of opioid agents and adrenal insufficiency. But, the DHEAS level was mostly below the normal level in patients who were treated with opioid agents.

• Journal of Gastric Cancer
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• v.7 no.1
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• pp.16-22
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• 2007

Purpose: The proper reconstruction technique to use after a distal subtotal gastrectomy for a gastric carcinoma, there has been a subject for debated what is the proper reconstruction technique. The aim of this study was to compare the gastricemptying time and the quality of life following both B-I and B-II reconstructions after a distal gastrectomy for a gastric adenocarcinoma. Materials and Methods: We studied 122 patients who had undergone a distal gastrectomy for a gastric adenocarcinoma between June 1999 and July 2002 at our hospital. 51 patients underwent B-I group, and 71 patients underwent B-II group. To evaluate the gastric-emptying time, we analyzed the T1/2 time by means of radionuclide scintigraphy using a gamma camera after ingestion of an $^{99m}Tc$-tin-colloid steamed egg. The nutritional status was measured by the weight change. Postgastrectomy syndrome was evaluated using an abdominal symptoms survey. Dumping syndrome was measured using the Sigstad dumping score. Results: The gastric-emptying time was somewhat delayed in the B-I group after a 6 month period, but there was no difference after 12 months between the two groups. There was less weight loss in the B-I group than in the B-II group (P=0.023). Fewer abdominal symptoms were occurred in the B-I group than in the B-II group. Dumping syndrome occurred less frequently in the B-I group than in the B-II group (P=0.013). Conclusion: In our study, the Billroth I reconstruction led to less weight loss, a better nutritional status, and a better quality of life than the Billroth II reconstruction. We concluded that after a distal subtotal gastrectomy, the Billroth I reconstruction would be considered when the procedure is oncologically suitable.

• Journal of Hospice and Palliative Care
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• v.20 no.3
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• pp.177-187
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• 2017

Purpose: From August 2017, hospice-palliative care (HPC) will be provided to patients with acquired immunodeficiency syndrome (AIDS), chronic obstructive pulmonary disease (COPD), and liver cirrhosis in Korea. To contribute to building a non-cancer (NC) hospice-palliative care model, NC specialists were interviewed regarding the goals, details, and provision methods of the model. Methods: Four physicians specializing in HPC of cancer patients formulated a semi-structured interview with questions extracted from literature review of 85 articles on NC HPC. Eleven NC disease specialists were interviewed, and their answers were analyzed according to the qualitative content analysis process. Results: The interviewees said as follows: It is difficult to define end-stage NC patients. HPC for cancer patients and that for NC patients share similar goals and content. However, emphasis should be placed on alleviating other physical symptoms and emotional care rather than pain control. Timing of the care provision should be when patients are diagnosed as "end stage". Special issues should be considered for each NC disease (e.g., use of anti-retroviral drugs for AIDS patients, oxygen supply for COPD patients suffering from dyspnea, liver transplantation for patients with liver cirrhosis) and education should be provided to healthcare professionals. NC patients tend to negatively perceive HPC, and the government's financial assistance is insufficient. Conclusion: It is necessary to define end-stage NC patients through in-depth discussion to minimize issues that will likely accompany the expansion of care recipients. This requires cooperation between medical staff caring for NC patients and HPC givers for cancer patients.

• Clinical and Experimental Pediatrics
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• v.50 no.8
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• pp.774-780
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• 2007

Purpose : The anthracyclines (AC) are widely used chemotherapeutic agents for pediatric cancers. However, the therapeutic use of these agents is limited by their cardiotoxicity. The aim of the present study was to investigate the usefulness of plasma B-type natriuretic peptide (BNP) levels as a marker for AC-induced cardiotoxicity compared to echocardiography in Korean children with cancer. Methods : Fifty-five pediatric cancer patients who had received chemotherapy including AC were enrolled. The cumulative AC doses, clinical symptoms, and two echocardiography parameters, left ventricular fractional shortening (LVFS) and left ventricular ejection fraction (LVEF), were studied and compared with plasma BNP levels. Results : In 55 patients, plasma BNP levels were measured 115 times and echocardiographies were performed 64 times. The median cumulative dose of AC was $325mg/m^2$ (range 120-600; mean 345) and the median plasma BNP level was 10 pg/mL (range 5-950; mean 31). The cumulative AC doses correlated significantly with the plasma BNP levels (P=0.002). The plasma BNP levels correlated significantly with LVFS (P=0.018) and LVEF (P=0.025). Dilated cardiomyopathies were identified in three patients. LVFS and LVEF decreased and plasma BNP levels increased in a patient with acute dilated cardiomyopathy and in that with symptomatic chronic dilated cardiomyopathy. However, LVFS, LVEF and plasma BNP levels were normal in a patient with asymptomatic chronic dilated cardiomyopathy. Conclusion : The results of this study demonstrated that plasma BNP levels could be used as a marker for AC-induced cardiotoxicity; they showed good correlation with echocardiography findings in pediatric cancer patients. Plasma BNP levels may be used for the detection and management of AC-induced cardiotoxicity in Korean children with cancer.

• Journal of Dairy Science and Biotechnology
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• v.27 no.2
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• pp.55-62
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• 2009

Milk is called an almost complete food in terms of nutrition, especially for the younger generations because it contains a number of nutrients required for growth and development. Lactose intolerance is defined as a malabsorption of lactose in the intestine with some typical symptoms of abdominal pains and bloating, and occurred at 75% of global populations, which hampers milk consumption worldwide. Lacks of milk consumption in the underdeveloped countries frequently lead to many nutrients deficiencies, so that diseases including osteoporosis, hypertension, and colon cancer are more prevalent in the recent days. Lactose in foods needs to be hydrolyzed prior to intestinal absorption. The hydrolytic enzyme responsible for splitting lactose into its monomeric forms, glucose and galactose, is called as lactase or $\beta$-galactosidase. The former is primarily used as blood sugar and energy source and the latter used in glycolipid synthesis of brain tissues in infants. Lactose is clinically diagnosed with the breath hydrogen production test as well as intestinal biopsy. Reportedly, symptoms of lactose intolerance are widely prevalent at 25% of Europeans, 50 to 80% of Hispanics, South Indians, Africans, and Jews, almost 100% of Asians and native Americans. For the adults, phenotype of lactase persistence, which is able to hydrolyse lactose, is more common in the northern Europeans, but in the other area lactase non-persistence or adult-type hypolactasia is dominant. Genetic analysis on human lactase gene continued that lactase persistence was closely related to the err site of 1390 single nucleotide polymorphism from the 5'-end. To alleviate severity of lactose intolerance symptoms, some eating patterns including drinking milk a single cup or less, consumption along with other foods, whole milk rather than skimmed milk, and drink with live yogurt cultures, are highly recommended for the lactose maldigesters. Also, delay of gastric emptying is effective to avoid the symptoms from lactose intolerance. Frequency of lactose intolerance with conventional diagnosis is thought overestimated mainly because the subjects are exposed to too much lactose of 50 g rather than a single serving amount. Thus simple and accurate diagnostic method for lactose intolerance need to be established. It is thought that fermented milk products and low- or free lactose milks help improve currently stagnant milk consumption due to lactose intolerance which contributes to major barrier in milk marketing especially in Asian countries.

• Journal of Korean Medical classics
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• v.13 no.2 s.17
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• pp.107-107
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• 2000

1. Ounyukki(五運六氣) theory was first developed from observation of astronomical phenomena. Natural phenomena were explained and incorporated into the concepts of Yukki(六氣), and Ohaeng(五行, the concept that all matter in the world are comprised of five fundamental elements), during Chon-guk(戰國) and Han(漢) periods. In that period. Kanji(干支, the method to present time with ten and twelve different kinds of symbol's combinations) was used to record Ounyukki(五運六氣). Theoretical study of Un-gi(運氣, the abbreviation of Ounyukki) was almost completed in Un-gichilpyon(運氣七篇) of Naekyong(內經). Un-gi(運氣) theory was further studied and considered to be very important socially, as well as medically, in Tang(唐), Song(宋), Kum(金), and Won(元) periods. Hagan(河間) published various studies based on Un-gi(運氣) theory in Kum won(金元) periods. 2. Hagan(河間) realized the limitation of a remedy method, of Sanghan(傷寒) theory. Therefore, he made an assumption that the prevalence of diseases in his period are closely related to Hwayol(火熱, a fire and a super-heat; two things out of Yukki(六氣)). His new theory was a result of the study on Kyongjon(經典, bibles of the oriental medicine) and the phenomena of nature. 3. Hagan(河間) used a combination of two basic theories of Pimuripsang(比物立象) and Hanhaesungjeron(亢害承制論) to make understood Hwayol(火熱) theory, Pimuripsang(比物立象) theory explains a method to appreciate the essence of things by comparing Sang(象, an expression of how something appears on the outside) and then making another Sang(象) from the comparison. Hanhaesungjeron(亢害承制論) is a theory to emphasize the importance of a balance of Yukki(六氣). It is that, if one of the elements is exceeded, other thing in the other five elements dominate the exceeded thing to control it for the balance between Yukki(六氣). In addition, he articulated P'yobon(標本. inside and outside of a thing) theory to differentiate the disease symptoms. These theories will help to distinguish real and fake symptoms of diseases, on which Hagan(河間) emphasized its importance. 4. Hagan(河間) published a new theory to explain Ounyukki(五運六氣) theory based on the observation of the nature and the experience from medical practice. And he added Chobyonggi(燥病機, course and rule causing disease in dry conditions) to Pyonggishipkujo(病機十九條, nineteen course and rule causing disease), it strengthened Pyonggi(病機, course and rule causing disease) theories. Moreover. he utilized Un-gi (運氣) theory in a real life situation by applying Un-giron(運氣論) to diagnosis like Maekchin(脈診, a method to diagnose by taking the pulse) and to prescription. 5. Modern society is an era in which it is hard to appreciate the principles of the changes due to the various unusual weather. Therefore, it is necessary to make a new paradigm using Un-gi(運氣) theory, like Hagan(河間) did in Kumwon(金元) period. 6. Unusual weather changes and the geriatric diseases such as cancer and diabetes, may have Sang(象) of Hwayol(火熱) theory at the other side. These diseases have been and will create more serious problems in modern society. As a method to solve these problems. it seems to be very important to understand and apply Hagan's(河間) Hawyol(火熱) theory to modern society.

• Journal of Korean Medical classics
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• v.13 no.2 s.17
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• pp.108-145
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• 2000

1. Ounyukki(五運六氣) theory was first developed from observation of astronomical phenomena. Natural phenomena were explained and incorporated into the concepts of Yukki(六氣), and Ohaeng(五行, the concept that all matter in the world are comprised of five fundamental elements), during Chon-guk(戰國) and Han(漢) periods. In that period. Kanji(干支, the method to present time with ten and twelve different kinds of symbol's combinations) was used to record Ounyukki(五運六氣). Theoretical study of Un-gi(運氣, the abbreviation of Ounyukki) was almost completed in Un-gichilpyon(運氣七篇) of Naekyong(內經). Un-gi(運氣) theory was further studied and considered to be very important socially, as well as medically, in Tang(唐), Song(宋), Kum(金), and Won(元) periods. Hagan(河間) published various studies based on Un-gi(運氣) theory in Kum won(金元) periods. 2. Hagan(河間) realized the limitation of a remedy method, of Sanghan(傷寒) theory. Therefore, he made an assumption that the prevalence of diseases in his period are closely related to Hwayol(火熱, a fire and a super-heat; two things out of Yukki(六氣)). His new theory was a result of the study on Kyongjon(經典, bibles of the oriental medicine) and the phenomena of nature. 3. Hagan(河間) used a combination of two basic theories of Pimuripsang(比物立象) and Hanhaesungjeron(亢害承制論) to make understood Hwayol(火熱) theory, Pimuripsang(比物立象) theory explains a method to appreciate the essence of things by comparing Sang(象, an expression of how something appears on the outside) and then making another Sang(象) from the comparison. Hanhaesungjeron(亢害承制論) is a theory to emphasize the importance of a balance of Yukki(六氣). It is that, if one of the elements is exceeded, other thing in the other five elements dominate the exceeded thing to control it for the balance between Yukki(六氣). In addition, he articulated P'yobon(標本. inside and outside of a thing) theory to differentiate the disease symptoms. These theories will help to distinguish real and fake symptoms of diseases, on which Hagan(河間) emphasized its importance. 4. Hagan(河間) published a new theory to explain Ounyukki(五運六氣) theory based on the observation of the nature and the experience from medical practice. And he added Chobyonggi(燥病機, course and rule causing disease in dry conditions) to Pyonggishipkujo(病機十九條, nineteen course and rule causing disease), it strengthened Pyonggi(病機, course and rule causing disease) theories. Moreover. he utilized Un-gi (運氣) theory in a real life situation by applying Un-giron(運氣論) to diagnosis like Maekchin(脈診, a method to diagnose by taking the pulse) and to prescription. 5. Modern society is an era in which it is hard to appreciate the principles of the changes due to the various unusual weather. Therefore, it is necessary to make a new paradigm using Un-gi(運氣) theory, like Hagan(河間) did in Kumwon(金元) period. 6. Unusual weather changes and the geriatric diseases such as cancer and diabetes, may have Sang(象) of Hwayol(火熱) theory at the other side. These diseases have been and will create more serious problems in modern society. As a method to solve these problems. it seems to be very important to understand and apply Hagan's(河間) Hawyol(火熱) theory to modern society.

• The Journal of Internal Korean Medicine
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• v.37 no.3
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• pp.539-547
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• 2016

Myelodysplastic syndrome (MDS) is a typical myeloid malignancy characterized by cell dysplasia in bone marrow. Currently, there is no therapeutic treatment for MDS. The only available therapies either relieve symptoms or prevent the development of acute myeloid leukemia (AML). This study aimed to report the effects of traditional Korean medicine (TKM) on MDS by presenting two case reports. The patient in Case 1 was diagnosed with primary MDS and regularly received acupuncture treatments and herbal medicine. In Case 2, a patient with ovarian cancer was diagnosed with secondary MDS, which resulted from an adverse reaction to chemotherapy. This patient took herbal medicine for four years and was hospitalized three times. In order to have their condition evaluated, both patients underwent regular blood tests. The patient in Case 1, who showed blood transfusion dependency, received only two blood transfusions after TKM treatment, and the person’s health condition was stable as of January 2016 without any signs of AML development. The patient in Case 2 also has stable health condition. TKM treatment effectively treated their MDS symptoms and improved their general health conditions without any adverse effects. It also prevented the rapid development of AML and maximized the effects of conservative therapy.