• Journal of Veterinary Science
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• 제19권6호
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• pp.827-834
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• 2018

The purpose of this study was to evaluate the clinical and imaging characteristics of canine splenic tumors and to establish guidelines for the presurgical assessment of splenic tumors in dogs. Fifty-seven dogs that underwent total splenectomy for the treatment of splenic tumors were evaluated by examining medical records, hematologic results, diagnostic imaging results, and histopathologic results. The maximum lesion size from ultrasonography was significantly different between malignant and benign tumors (p = 0.002). There was a correlation between tumor margination and type of splenic tumors (p = 0.045). Precontrast lesion attenuation on computed tomography was significantly different between splenic malignant and benign tumors (p = 0.001). The mean ${\pm}$ SD precontrast lesion attenuation of malignant tumors was $40.3{\pm}5.9$ Hounsfield units (HU), and for benign tumors, it was $52.8{\pm}6.8HU$. In conclusion, some variables of the imaging examination could be used to distinguish the type of splenic tumor. Based on the study results, using a diagnostic flowchart would be effective in increasing the survival rate of patients with splenic malignant tumors. In addition, fine needle aspiration or magnetic resonance imaging prior to surgical exploration and histopathologic examination may be useful in achieving a more accurate diagnosis.

• Tuberculosis and Respiratory Diseases
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• 제45권6호
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• pp.1199-1213
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• 1998

연구배경 : 최근 면역기능저하 환자들이 급증하고 있으며 이들에 있어서 새로 발생된 설명이 불가능한 폐침윤은 매우 흔하면서도 환자의 생명을 위협할 수 있는 상황으로 발전할 수 있다. 폐진균증은 이런 임상상에서 폐침윤의 중요한 원인으로 대두되고 있으나 이에 대한 연구가 많지 않아 본 연구를 시행하였다. 방 법 : 1996년 10월부터 1998년 4월까지 삼성서울병원에서 면역기능저하 환자 중 새로운 폐침윤이 있었던 환자로 조직학적으로 폐에서 진균이 증명되었거나 정상적으로 균이 자리지 않는 부위(sterile)에서 시행한 배양검사장 진균이 배양된 환자들을 대상으로 임상적 특정, 방사선학적 소견, 진단적 검사, 치료 및 그 결과에 대해 후향적인 조사를 시행하였다. 결 과 : 총 13명의 환자 (M : F=8 : 5, 연령 중앙값 47세)에서 14예의 폐진균증이 진단되었다. 진단은 asperogillosis가 12예였고 mucormycosis가 2예였다. 혈액암 환자 9명에서 10예, 장기이식 환자에서 4예의 폐진균증이 진단되었다. 3예에서는 진단당시 경험적 amphotericin B를 중앙값 9일(8-21일)간 투여받고 있었다. 혈액암군 10예 중 9예에서 폐침윤 발견당시 백혈구 감소증이 중앙값 16일동안 지속되었으며 발열(9/10), 기침(6/10), 가래(5/10), 호흡곤란(4/10), 흉통 (5/10), 악설음(4/10) 등의 증상과 징후가 흔하게 관찰되었다. 반면에 장기이식환자군에서는 증상 및 징후가 뚜렸하지 않은 경우가 많았다(p<0.05). 단순 흉부촬영상으로 새로운 폐침윤은 단일 혹은 다발성의 결절(6/14)이나 경결(consolidation)(8/14)의 형태로 나타났으며 흉부 단층촬영상에서는 간유리음영(14/14), 흉수(5/14), 동공형성(7/14) 등의 소견이 관찰되었다. 확진한 방법으로는 개흉술이 10예, 비디오 흉강경술이 2예, 경피적침흡인술이 1예, 농양의 농 배양검사가 1예였다. 모든 환자는 amphotericin B(591-2806mg) 투여를 받았으며 1예에서 liposomal amphotericin B, 1예에서 경구 itraconazole로 치료를 부분적으로 시행하였다. Amphotericin B 투여 후 12/14예에서 폐병변의 호전이 관찰되었으며 14예중 4예에서 사망하거나 회복이 불가능한 상태로 퇴원하였다. 결 론 : 혈액암의 치료로 과립구감소증이 있는 환자나 장기이식 환자에서 새로운 폐침윤이 결절이나 경결의 형태로 발현하면, 증상이 미미하거나 경험적 amphotericin B를 투여하고 있더라도 폐진균증을 의심을 해야하며 적극적인 진단과 치료로써 예후를 호전시킬 수 있을 것으로 기대된다.

• Clinical and Experimental Pediatrics
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• 제46권6호
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• pp.566-571
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• 2003

목 적 : 백질뇌병증은 중추신경계 예방 요법을 시행하는 혈액종양 환자들에게는 심각한 합병증의 하나로, 이러한 백질뇌병증을 최소화하기 위해서는 조기 진단과 그에 따른 치료 방법의 변경이 중요하다 하겠다. 이 연구는 소아 혈액종양 환자에서 예방적 중추신경계 치료에 따른 백질뇌병증의 임상 양상 및 치료 방법 변경 후의 예후에 관해 조사하고, 백질뇌병증의 발생을 최소화하기 위한 정기적 두부 자기공명영상 촬영의 의의를 살펴보고자 시행되었다. 방 법 : 1995년 10월부터 2002년 5월까지 경북대학교병원 소아과에서 급성 림프구성 백혈병 및 B세포 림프종으로 진단받고 중추신경계 예방 치료 후 백질뇌병증이 발견된 16명의 환자를 대상으로 병력지와 MRI를 후향적으로 조사하였다. 결 과 : 급성 림프구성 백혈병 환자 15명과 B세포 림프종 환자 1명의 백질뇌병증 진단 시 연령은 중앙값 5년 3개월이었고, 남녀비는 3 : 1이었다. 항암치료 시작 후 백질뇌병증 진단까지 걸린 시간은 2개월에서 17개월이었다. 백질뇌병증 발생 전 투여한 척수강 내 MTX 투여 횟수는 2회에서 15회로 16명에서 모두 시행하였고, 두부 방사선 치료는 10명에서만 시행하였고 용량은 1,800 rads였다. 백질뇌병증 진단 전 경련, 성격 변화, 두통, 정신 이상, 구음 장애, 의식 변화 등의 정신신경학적 증상이 있었던 경우가 10명 있었으며 증상이 없었던 경우가 6명이었다. 백질뇌병증이 진단되었던 16명의 환자 중 4명은 사망하였으며 나머지 12명의 환아 중에서 현재 계속 항암치료 중인 경우가 8명, 항암치료를 종료한 환자가 3명, 그리고 보호자가 원하여 항암치료를 중지한 경우가 1명이었다. 백질뇌병증 진단 후 자기공명영상의 추적관찰을 시행한 경우가 12명, 시기상 아직 시행하지 못한 경우가 4명이었으며 추적관찰을 시행한 경우 중 자기공명영상에서 병변이 호전된 경우가 4명, 지속되는 경우가 6명, 악화된 경우가 2명이었다. 병변이 호전된 4명 중 2명은 병변이 거의 사라져 정상에 가까운 소견을 보였다. 결 론 : 중추신경계 예방 요법으로 사용하는 척수강 내 MTX 주입 요법과 두부 방사선 조사를 비롯하여 정맥으로 투여되는 MTX 또한 백질뇌병증을 유발하며, 이러한 백질뇌병증은 증상없이 발현되는 경우도 많아 병변의 조기발견을 위한 정기적인 자기공명영상의 촬영이 필요하며, 백질뇌병증의 발견 즉시 즉각적인 조치를 취하여 신경학적 기능의 회복을 가능하게 해야 할 것이라고 생각된다.

• Tuberculosis and Respiratory Diseases
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• 제84권4호
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• pp.326-332
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• 2021

Background: The association of invasive tracheobronchial aspergillosis (ITBA) with invasive pulmonary aspergillosis (IPA) is not well established. We aimed to compare clinical characteristics between patients who exhibited ITBA with IPA and those who exhibited isolated ITBA (iITBA). Additionally, the usefulness of serum or bronchial galactomannan (GM) tests in diagnosing ITBA was evaluated. Methods: This retrospective single-center case-control study was conducted over a period of 4 years. Fifteen patients were enrolled after confirming the presence of ITBA using bronchoscopy-guided biopsy (iITBA, 7 vs. ITBA+IPA, 8). Clinical characteristics of patients and results obtained from serum or bronchial GM tests were compared between the two groups. Mortality was assessed using data collected from a 6-month follow-up period. Results: The ITBA+IPA group showed a higher prevalence of hematologic malignancy (75% vs. 14%, p=0.029), a greater number of patients with multiple bronchial ulcers (75% vs. 14%, p=0.029), lower platelet counts (63,000/μL vs. 229,000/μL, p<0.001), and a mortality rate which was significantly higher (63% vs. 0%, p=0.026) than the iITBA group. In the ITBA+IPA group, 57% of patients tested positive according to the serum GM assay, whereas in the iITBA group, all patients tested negative (p=0.070). The bronchial GM level was high in both groups, but there was no significant difference between them. Conclusion: Patients with ITBA+IPA had a greater number of hematologic malignancies with lower platelet counts and a poorer prognosis than patients diagnosed with iITBA. Findings obtained from bronchoscopy and bronchial GM tests were more useful in diagnosing ITBA than the serum GM test results.

• Advances in pediatric surgery
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• 제15권2호
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• pp.103-112
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• 2009

Catheter related and perianal problems are common surgical complications encountered during the treatment of pediatric malignancies. However acute surgical abdominal emergencies are rare. The aim of this study is to review acute surgical abdominal complications that occur during the treatment of childhood malignancies. Out of a total of 1,222 patients who were newly diagnosed with malignant disease, between January 2003 and May 2008, there were 10 patients who required surgery because of acute abdominal emergencies. Their medical records were reviewed retrospectively. Hematologic malignancies were present in 7 patients (4 leukemia, 2 lymphoma, 1 Langerhans cell histiocytosis) and solid tumors in 3 patients (1 adrenocortical carcinoma, 1 desmoplastic small round cell tumor, 1 rhabdomyosarcoma). Seven patients had intestinal obstruction, two had gastrointestinal perforation and one, typhlitis. Intestinal obstructions were treated with resection of the involved segment with (N=2) or without (N=3) enterostomy. Two patients had enterostomy alone when resection could not be performed. Intestinal perforation was treated with primary repair. Typhlitis of the ascending colon was treated with ileostomy. Right hemicolectomy was necessary the next day because of the rapidly progressing sepsis. Three patients are now alive on chemotherapy and one patient was lost to followed-up. Among six patients who died, five died of their original disease progression and one of uncontrolled sepsis after intestinal perforation. Although rare, acute surgical abdominal complications can occur in childhood malignancies. Rapid and accurate diagnosis and appropriate operation are required for effective treatment of the complications.

• 한국임상약학회지
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• 제1권1호
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• pp.31-36
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• 1991

Tobramycin is one of the most frequently selected agents for pharmacokinetic drug monitoring because of its narrow therapeutic index and essential role for the management of serious infections, especially gram-negative infections. Its pharmacokinetic parameters are dependent on race, sex, age, ideal body weight. disease states, and etc. Therefore, to schedule the dosing of tobramycin, the individual pharmacokinetic parameters such as half-life and volume of distribution are needed. However, these pharmacokinetic parameters have never been reported in Koreans. The purposes of this study were to evaluate the volume of distribution of tobramycin in cancer patients who had normal renal function, to compare the mean values of Vd reported in the literature, and to compare the measured half-life with the expected half-life based on ABW, LBW, and IBW, respectively. Venous blood samples were collected just before and thirty minutes after dosing during steady state. Serum tobramycin concentrations were determined by $TD_x$ (fluorescence immunoassay). IBW were measured by the method of Devine: and LBW were measured by the method of Hallynck. Creatinine clearances (CLcr) of the patients were estimated using the Cockcroft and Gault equation. Elimination rate constants (kel) were determined using the Welling and Craig equation. Infusion rate (ko), volume of distribution (Vd), and half-life $(t_{1/2})$ were determined using the Saw chuk and Zaske equation. The volume of distribution Was $27\%$ greater than the Schentag's study (0.26 vs 0.33 l/kg), but the half-life was similar to the Levy's study. The predicted half-lives based on IBW were the closest to actual half-lives (1.85 vs 2.01 hr).

• 디지털융복합연구
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• 제14권1호
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• pp.305-310
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• 2016

최근 초음파검사의 접근이 일반화되면서 한국에서는 갑상선암발생율의 연간변화율이 24.5%로 상승하였다. 이에 고식적 갑상선암의 위험요인인 전리방사선과 요오드식이 이외의 갑상선암의 위험요인을 파악하고자 하였다. 2011년 1월부터 2013년 3월까지 종합검진센타에서 초음파검사 후 미세침흡인검사로 진단된 양성결절 260명과 악성 결절 151명의 여자를 대상으로 나이, 혈액학적 수치, 비만지수, 허리둘레, 폐경여부, 유방결절 유무, 자근근종 유무, 지방간 유무를 비교하였다. 연구 결과 갑상선암 그룹에서 비만인 경우, 유방의 결절과 자궁근종이 있는 경우가 많았으며 갑상선자극호르몬 수치가 양성결절그룹보다 높게 나타났다. 향후 갑상선 및 갑상선암에 영향을 끼치는 요인들을 정립시키기 위한 연구가 지속적으로 필요할 것이다.

• Journal of Oral Medicine and Pain
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• 제25권2호
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• pp.159-165
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• 2000

Subsequent to an allogenic stem cell transplantation(ASCT) on patients with hematologic malignancy(AML, ALL, CML, multiple myeloma, lymphoma etc.), chronic GVHD(graft versus host disease), which is an immunological reaction, occurs. With treatment results from patients who were diagnosed with ALL(acute lymphocytic leukemia), undergone BMT(bone marrow transplantation) and showed oral and skin lesions due to GVHD, treatment of oral manifestations of leukemia and its general management were studied. 90% of patients with chronic GVHD show change in the oral mucosa causing oral manifestations such as leukoplakia, lichenoid change of the oral mucosa, mucosal atrophy, erythema, ulceration and xerostomia. In treating GVHD, extensive systemic immunosuppression cause bacterial, viral, fungal infection that are fatal, and even if the treatment is successful, the patient is already in a severe immunosuppressed state. Therefore, localized target therapy is preferred. In another words, topical application(rinse, cream, ointment etc.) of cyclosporin and steroid in treating oral chronic GVHD is highly recommended, and the use of PUVA(Psoralen Ultraviolet A) and thalidomide is reported to be effective. In treating such diseases, dental treatment to control pain and prevent secondary infection of oral manifestations is very important. To those patients with systemic diseases who show limited effect by general dental treatment, non-invasive treatment such as the dental laser, in addition to the use of drugs, may be necessary to actively treat pain and help the healing process. For greater results, new effective methods are to be developed for treatment.

• Journal of Chest Surgery
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• 제57권2호
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• pp.169-177
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• 2024

Background: Pericardial effusion (PE) is a serious condition in cancer patients, primarily arising from malignant dissemination. Pericardial window formation is a surgical intervention for refractory PE. However, the long-term outcomes and factors associated with postoperative survival remain unclear. Methods: We retrospectively analyzed data from 166 oncology patients who underwent pericardial window formation at Samsung Medical Center between 2011 and 2023. We analyzed survival and PE recurrence regarding surgical approach, cancer type, and cytopathological findings. To identify factors associated with survival, we utilized Cox proportional-hazards regression. Results: All patients had tumors documented in accordance with the American Joint Committee on Cancer staging manual, including lung (61.4%), breast (9.6%), gastrointestinal (9.0%), hematologic (3.6%), and other cancers (16.4%). Surgical approaches included mini-thoracotomy (67.5%) and thoracoscopy (32.5%). Postsurgical cytopathology confirmed malignancy in 94 cases (56.6%). Over a median follow-up duration of 50.0 months, 142 deaths and 16 PE recurrences occurred. The 1-year overall and PE recurrence-free survival rates were 31.4% and 28.6%, respectively. One-year survival rates were significantly higher for thoracoscopy recipients (43.7% vs. 25.6%, p=0.031) and patients with negative cytopathology results (45.1% vs. 20.6%, p<0.001). No significant survival difference was observed between lung cancer and other types (p=0.129). Multivariate analysis identified New York Heart Association class, cancer stage, and cytopathology as independent prognostic factors. Conclusion: This series is the largest to date concerning window formation among cancer patients with PE. Patients' long-term survival after surgery was generally unfavorable. However, cases with negative cytopathology or earlier tumor stage demonstrated comparatively high survival rates.

• Asian Pacific Journal of Cancer Prevention
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• 제16권2호
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• pp.443-449
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• 2015

Background: Myeloproliferative disorders (MPDs) are clonal hematologic malignancies originating at the level of the pluripotent hematopoietic stem cell. Matrix metalloproteases (MMPs) are proteolytic enzymes that contribute to all stages of malignancy progression. Genetic variants in the MMP genes may influence the biological function of these enzymes and change their role in carcinogenesis and progression. To our knowledge, this is the first investigation of associations between the -735 C/T and -1562 C/T polymorphisms in the MMP2 and MMP9 genes, respectively, and the risk of essential thrombocytosis (ET), and polycythemia vera (PV). Materials and Methods: The case-control study included JAK2V617F mutation positive 102 ET and PV patients and 111 controls. Polymorphisms were determined by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and electrophoresis. Results: No statistically significant differences were detected between patient (ET+PV) and control groups regarding genotype distribution for MMP2 gene-735 C/T and MMP9 gene -1562 C/T polymorphisms and C/T allele frequency (p>0.050). Statistically borderline significance was observed between PV and control groups regarding genotype distribution for the MMP9 gene -1562 C/T polymorphism (p=0.050, OR=2.26, 95%Cl=0.99-5.16). Conclusions: Consequently this study supported that CC genotype of MMP9 gene -1562 C/T polymorphism may be related with PV even if with borderline significance.