• Clinical and Experimental Pediatrics
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• 제58권6호
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• pp.206-210
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• 2015

Purpose: The use of a 12-week steroid regimen (long-term therapy, LT) for the first episode of idiopathic nephrotic syndrome (NS) reportedly induces a more sustained remission and lower relapse rate than previous regimens, including an 8-week steroid regimen (short-term therapy, ST). Here, we assessed the potential for selective application of 2 steroid regimens (LT vs. ST) based on the days to remission (early responders [ER] vs. late responders [LR]) for the first idiopathic NS episode in children. Methods: Patients were divided into 4 subgroups (ST+ER, ST+LR, LT+ER, and LT+LR) according to the initial steroid regimen used and rapidity of response; the baseline characteristics, relapse rates, and cumulative percentage of children with sustained remission were then compared among the 4 subgroups. Results: Fifty-four children received ST, and the remaining 45 children received LT. As observed in previous studies, children receiving LT showed significantly lower relapse rates during the first year after the first NS episode than those receiving ST. The ST+ER group showed significantly lower relapse rates during the first one year and two years after the first NS episode than the the ST+LR group, whereas there were no significant differences of the relapse rates and duration to the first relapse between the ST+ER and LT+ER groups. Conclusion: We suggest that the initial steroid regimen in idiopathic NS patients can be shortened according to the duration to remission i.e., LT in patients achieving remission after the first week of steroid therapy, and ST in those achieving remission within the first week of steroid therapy.

• 지역사회간호학회지
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• 제22권4호
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• pp.365-376
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• 2011

Purpose: The purpose of this study was to investigate the patterns of smoking relapse and to identify risk factors related to smoking relapse among those successful in smoking cessation at the smoking cessation clinics of public health centers. Methods: Data were collected from 1,705 six-month quitters and analyzed by the Kaplan-Meier analysis and the Cox proportional hazard model. Results: The rate of smoking relapse was 38.2% in 1 year, 44.4% in 2 years, and 47.8% in 5 years. The vast majority of relapse (62.3%) occurred within the first six months after quitting. The risk factors related to smoking relapse were age (HR 1.964: 95% CI 1.545, to 2.497), nicotine dependence (HR 1.293: 95% CI 1.087 to 1.539), problem drinking (HR 1.497: 95% CI 1.116 to 2.008), behavioral therapy type (HR 1.398: 95% CI 1.193 to 1.638), and nicotine replacement therapy type (HR 1.363: 95% CI 1.077 to 1.724). Conclusion: For reducing smoking relapse, it is necessary to develop a smoking relapse prevention program for the first six months after quitting and to strengthen behavioral therapy in the course of smoking cessations clinics.

• Asian Pacific Journal of Cancer Prevention
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• 제16권9호
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• pp.3861-3866
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• 2015

Background: The aim of this study was to analyze the patterns of relapse and survival outcomes in Northern Thai women with recurrent endometrial cancer (EC). Materials and Methods: Medical records were abstracted from EC patients who underwent primary surgery from 1999 to 2012. Data on clinicopathologic variables, sites of first recurrence, time to relapse of disease, and overall survival (OS) was analyzed. Associations between the clinicopathological variables and the rates of disease recurrence were determined. Results: Among 1,204 reviewed records, 42 eligible patients were identified with recurrent disease. The median age was 55 years and the median follow-up time was 26.0 months. The median times to recurrence (TTR) after completion of the initial treatment in the group of local relapse (LR) and distant/combined sites of recurrence (DCSR) was 6.6 (95% CI=4.6 to 8.6 months) and 16.9 months (95% CI=5.6 to 28.2 months), respectively (p=0.36). The 2-year survival and 3-year survival probability in the group of LR was 54.2% (95% CI=27.2 to 81.3%) and 34.7% (95% CI=9.2 to 60.2%), compared to 50.4% (95% CI=41.1 to 59.7%) and 42.1% (95%CI= 24.1 to 60.1%) for those with DCSR. Distant recurrence was the most frequent pattern of relapse. Overall survival was not significantly different in patients with local relapse when compared to those with DCSR (p=0.69). Conclusions: Patients with recurrence of EC after primary treatment had a worse prognosis and clinical aggressiveness. LR and DCSR occurred most during the first three years. The common sites of relapses were vaginal cuff, pelvis, and lungs. No significant clinicopathological predictor for survival outcomes was identified.

• Clinical and Experimental Pediatrics
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• 제46권9호
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• pp.889-892
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• 2003

목 적 : 신증후군으로 진단 받은 환아에서 신장 조직 검사 없이 진단 당시 임상 소견 및 혈액과 소변 검사 소견만으로 1년내 재발을 예측할 수 있는 위험요인을 알아보고자 본 연구를 실시하였다. 방 법 : 1997년 7월에서 2002년 6월까지 만 5년간 고려대학교 병원 소아신장크리닉을 내원한 환아 중 스테로이드 치료에 반응을 보였던 신증후군 환아 78명을 대상으로 후향적 연구를 시행하였다. 환아는 두 군으로 분류하였는데 I군은 재발이 없거나 스테로이드 치료하여 반응을 보인 환아에서 첫 1년 내에 재발이 2회 이하로 있는 환아였고 II군은 스테로이드 치료하여 반응을 보인 환아에서 첫 1년 내에 재발이 3회 이상 있는 환아로 하였다. 모든 환아에 대해 각각 성별, 나이, 진단 당시 혈청 알부민, 콜레스테롤, 24시간 요단백, 크레아티닌 청소율, 혈뇨 및 고혈압의 유무, 초기 스테로이드에 반응하여 완해되는데 걸린 기간 등을 비교하였다. 결 과 : 78명의 환아 중 남아는 61명(78.2%), 여아는 17명(21.8%)였고 평균 연령은 $5.1{\pm}3.0$세였으며 47명(60.3%)은 I군에 속했고 31명(39.7%)은 II군에 속했다. 성별, 혈청 알부민, 콜레스테롤, 24시간 요단백, 크레아티닌 청소율과 혈뇨 및 고혈압 유무는 두 군에서 유의한 차이를 보이지 않았다. 두 군의 평균 발병연령은 I군에서 $5.1{\pm}3.1$세, II군에서 $4.9{\pm}2.9$세로 II군의 발병연령이 더 낮은 경향을 보였으나 통계적으로 유의한 차이는 없었고 발병 연령을 3세를 기준으로 구분하였을 때 3세 이하의 환아 중 많은 수가 II군에 속했으며 통계적으로도 유의한 차이를 보였다(P<0.05). 또한 초기 스테로이드에 반응하여 완해가 일어나는 시기를 비교했을 때 I군은 $12.9{\pm}0.5$일, II군은 $16.2{\pm}1.1$일로 II군에서 완해되는 시간이 더 오래 걸린 양상을 보였다(P<0.05). 결 론 : 신증후군으로 진단된 환아에서 초기 진단 당시 연령이 3세 이하로 어리거나 초기 스테로이드에 치료에 반응하여 완해 되는데 걸리는 기간이 길수록 나쁜 예후를 보이는 양상을 보였다. 따라서 추후 신증후군 환아 진단시 예후를 예측하는데 도움이 되리라 생각된다.

• 대한기관식도과학회지
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• 제11권1호
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• pp.21-24
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• 2005

Acute lymphocytic leukemia(ALL) is a malignant disease of the bone marrow in which early lymphoid precursors proliferate and replace the normal hematopoietic cells of the marrow. Currently, only $20-30\%$ of adults with ALL are cured with standard chemotherapy regimens. It is very important risk factor whether to failure to achieve complete remission within 4 weeks or not. The relapse of leukemia is usually classified as hematologic and extramedullary relapse, and extramedullary leukemic infiltration is rarely observed in patients with ALL. In October 2004, a 23-year-old man presented with painless enlargement of both parotid glands. He was diagnosed as ALL(L2 subtype) one month ago, and he gained complete remission with induction chemotherapy. Fine needle aspiration cytology and bone marrow biopsy revealed extramedullary and hemtologic remission. To our knowledge this is the first report of extramedullary relapse in the parotid in ALL.

• Radiation Oncology Journal
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• 제33권4호
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• pp.310-319
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• 2015

Purpose: Follicular lymphoma (FL) is an indolent non-Hodgkin's lymphoma that is highly sensitive to radiotherapy (RT). However, the effectiveness of RT has not been well established. We reviewed our experiences to assess the role of RT for FL and analyze treatment results. Materials and Methods: Retrospective analysis was done on 29 patients who received first RT between January 2003 and August 2013. Of 23 early stage (stage I, II) patients, 16 received RT alone, four received chemotherapy followed by RT, two received RT postoperatively, and one received salvage RT for relapse after resection. Six advanced-stage (stage III, IV) patients received RT after chemotherapy: two received consolidation RT, three received salvage RT for residual lesions, and one received RT for progressive sites. Median RT dose was 30.6 Gy (range, 21.6 to 48.6 Gy). Median follow-up duration was 62 months (range, 6 to 141 months). Results: All patients showed complete response in the radiation field. Eight outfield relapses were reported. Seven patients received salvage treatment (three chemotherapy, four RT). Four patients showed excellent responses, especially to RT. Estimated 5-year and 10-year relapse-free survivals were 72% and 60%. In the RT-alone group, 5-year relapse-free survival was 74.5%. All advanced-stage patients were disease-free with 100% 5-year overall survival. Disease-specific death was noted in only one patient; four others died of other unrelated causes. No significant toxicity was reported. Conclusion: RT resulted in excellent treatment outcomes for all FL stages when used as a primary treatment modality for early stage or salvage-treatment modality for advanced-stage disease.

• Journal of Trauma and Injury
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• 제32권2호
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• pp.111-114
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• 2019

Minimal change disease (MCD) in children has a favorable long-term prognosis, and development of end-stage renal disease is very uncommon; less than 5%. In the first case of its kind, we report a 21-year-old female with a history of MCD at the age of 6, who had late relapse subsequent to a motorcycle accident resulting in a de-gloving skin injury and intensive care unit admission. MCD was confirmed by normal light microscopy, podocyte effacement on electron microscopy and absence of any deposits on immunofluorescence 3 weeks after the incident due to critical illness. It is postulated that the skin injury is what caused the relapse of MCD.

• Radiation Oncology Journal
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• 제31권4호
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• pp.222-227
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• 2013

Purpose: This study was performed to evaluate prognostic factors for survival from first relapse (SFFR) in stage I-III breast cancer patients. Materials and Methods: From June 1994 to June 2008, 3,835 patients were treated with surgery plus postoperative radiotherapy and adjuvant chemotherapy for stage I-III breast cancer at Samsung Medical Center. Among them, a total of 224 patients died by June 2009, and 175 deaths were of breast cancer. Retrospective review was performed on medical records of 165 patients who met the inclusion criteria of this study. Univariate and multivariate analysis were done on survivals according to variables, such as age, stage, hormone status of tumor, disease-free interval (DFI), sites of first failure, number of organs involved by recurrent disease (NOR), application of salvage treatments, and existence of brain or liver metastasis (visceral metastasis). Results: Patients' median overall survival time was 38 months (range, 8 to 123 months). Median SFFR was 17 months (range, 5 to 87 months). Ninety percent of deaths occurred within 40 months after first recurrence. The patients with SFFR ${\leq}1$ year had tendency of triple-negativity, shorter DFI (${\leq}2$ years), larger NOR (>3), visceral metastasis for first relapse than the patients with SFFR >1 year. In multivariate analysis, longer DFI (>2 vs. ${\leq}2$ years), absence of visceral metastasis, and application of salvage treatments were statistically significant prognosticators for longer SFFR. Conclusion: The DFI, application of salvage treatments, and visceral metastasis were significant prognostic factors for SFFR in breast cancer patients.

• Clinical and Experimental Pediatrics
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• 제51권1호
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• pp.78-83
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• 2008

목 적 : 골육종은 소아 청소년기에 뼈에 발생하는 가장 흔한 악성종양으로 종양 제거술 및 집중적 항암 화학요법을 시행한 경우에도 약 30-40%에서 재발하는 매우 침습적인 질환이다. 하지만 아직까지 재발한 골육종의 예후 및 예후인자에 대한 연구가 부족한 상태이다. 저자들은 치료 후 재발한 골육종 환아의 치료성적 및 재발 후 생존율에 영향을 주는 요인들을 분석하고자 하였다. 방 법 : 1985년 2월부터 2004년 2월까지 원자력병원에서 골육종으로 치료한 461명의 환아 중 재발한 180명의 의무기록을 후향적으로 조사하였으며 재발 후 생존율과 재발 후 예후인자로 재발병소의 위치, 재발 후 치료 방법, 원발병소의 수술전 화학요법에 대한 병리학적 반응도, 첫 진단 시 전이여부 및 재발기간을 분석하였다. 결 과 : 전체 재발율은 39%였고 재발한 골육종 환아의 5년 및 10년 재발 후 생존율은 각각 13%와 4%였다. 평균 재발기간은 15개월이었다. 재발 후 5년 생존율에 영향을 주는 인자는 재발 부위(폐, 39%; 원발병소, 0%; 폐와 뼈의 재발, 25%; 기타 부위의 재발, 12%), 병소 부위 절제 여부(절제한 경우 38%; 절제하지 않은 경우 11%), 재발기간(1년 이내에 재발한 경우 13%, 1년 이후에 재발한 경우 44%)이었다. 결 론 : 재발된 골육종 환자의 생존율은 높지 않다. 하지만 본 연구에서는 재발된 병변을 적극적으로 치료할 때 생존율이 향상됨을 보여주고 있으며 특히 재발기간이 길고 폐에 재발된 경우에는 수술 및 항암 화학요법과 그 외의 적극적인 치료가 필요하다 하겠다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제26권2호
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• pp.115-131
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• 2000

In the study of craniofacial deformity, it is very important that identifying the factor which can affect the morphology and which is closely related to the morphology, because it can not only improve the comprehension of growth and developmental process but also be applied in growth prediction and treatment modality. Several investigators have already mentioned the characterstics of head posture and airway space in relations to morphologic difference. But it is very meaningful work in clarifying the correlation between morphology, head posture and airway space that observing the change of head posture after morplologic change caused by operation and the change of airway space after same procedure. To investigate above correlation, I selected normal group which is consisted of 43 adults and mandibular prognathism group which is consisted of 47 adults who had been operated by sagittal split ramus osteotomy and were followed up more than 1 year. With their lateral skull radiograghs, reference lines which can evaluate each measuring points and areas without effect of postural change were first determined. And using above reference lines, change of airway space, positional change of tongue and hyoid, change of cranial and cervical angulations were measured. The results obtained from the study were as follows 1. In the change of head posture, the position of tongue and hyoid neighboring to pharynx is more closely related to the reference line of cervical column than to reference line of cranium. 2. After mandibular setback operation, the airway dimension was decreased to 81.6% of preoperative state at 1 month postoperatively and was slightly increased to 89.7% at 1 year postoperatively. 3. Posterior movement of tongue plays important role in decrease of airway dimension and inferior movement of hyoid was closely correlated with posterior movement of tongue. 4. Postoperative anterior movement of mandible, namely, morphologic relapse had correlation with relapse phenomenon of airway dimension. 5. Craniocervical angulation increased postoperatively. Especially in the postoperative early state, there was increased foreward inclination of cervical angulation rather than increase of cranial angulation. But at postoperative 1 year it was observed that cervical inclination was returned to preoperative state and cranial angulation was increased gradually. 6. Increase rate of airway dimension was correlated with the increase of cranial angulation from postoperative 1 month to 1 year. In conclusion, relapse tendency of airway dimension following increase of cranial angulation was found after mandibular setback operation and it is considered that increase of cranial angulation is one of compensatory mechanism in airway maintenance.