• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제17권4호
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• pp.209-213
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• 2014

Purpose: Pathologic aerophagia (PA) may lead to bowel perforation or volvulus in mentally retarded patients. The authors investigated the effects of clonazepam on the management of PA in children with severe to profound mental retardation (MR). Methods: This study was undertaken as a retrospective case analysis of 21 PA patients with MR who were followed for over 12 months and diagnosed as having PA. Patients were assigned to two management groups, that is, to a clonazepam randomized open-labeled, treatment group or a reassurance group. The following were recorded and analyzed; age, response, remission rate to clonazepam treatment, and the side effect of clonazepam. It was defined positive response (response+) as being symptom-free for a whole week within 1 month of commencing treatment and remission(+) as being symptom-free for a whole month within 6 months of treatment. Results: The average age of the 21 PA children with MR was 10 years and 13 patients were female. Symptom duration before diagnosis of PA was 7 months. Clinical features of the clonazepam-trial group (n=11) and the reassurance group (n=10) were non-significantly different. Response(+) was achieved by 2 patients (18.2%) in the clonazepamtrial group and by no patient in the reassurance group. Remission(+) was achieved by 6 patients (54.5%) in the clonazepam-trial group and by one patient (10%) in the reassurance group (p=0.040). Conclusion: When PA children with MR with severe bowel distention are considered for surgical treatment to prevent acute abdomen, a trial of clonazepam could be recommended.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제17권1호
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• pp.31-36
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• 2014

Purpose: Infliximab (IFX) is considered safe and effective for the treatment of ulcerative colitis (UC) in both adults and children. The aim of this study was to evaluate the short- and long-term clinical course of IFX in Korean children with UC. Methods: Pediatric patients with UC who had received IFX infusions between November 2007 and May 2013 at Samsung Medical Center were retrospectively investigated. The clinical efficacy of IFX treatment was evaluated at 8 weeks (short term) and 54 weeks (long term) after the initiation of IFX treatment using the Pediatric Ulcerative Colitis Activity Index (PUCAI). The degree of response to IFX treatment was defined as complete response (PUCAI score=0), partial response (decrement of PUCAI score${\geq}20$ points), and non-response (decrement of PUCAI score <20 points). Adverse events associated with IFX treatment were also investigated. Results: Eleven pediatric patients with moderate to severe UC had received IFX. The remission rate after IFX treatment was 46% (5/11) and 82% (9/11) at 8 weeks and 54 weeks after IFX treatment, respectively. All patients who were steroid-dependent before treatment with IFX achieved remission at 54 weeks and were able to stop treatment with corticosteroids, while all steroid-refractory patients failed to achieve remission at 54 weeks after treatment with IFX. Conclusion: Response to IFX treatment after 8 weeks may predict a favorable long-term response to IFX treatment in Korean pediatric UC patients.

• Tuberculosis and Respiratory Diseases
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• 제85권3호
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• pp.227-236
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• 2022

Background: The use of low-dose inhaled corticosteroid-formoterol as reliever monotherapy has recently been recommended in the asthma treatment guidelines. However, the efficacy of this treatment strategy has not yet been determined during the stepping-down period in moderate asthma. This study aimed to evaluate the feasibility of reducing treatment to as-needed budesonide-formoterol (BFM) in moderate asthma with complete remission. Methods: We randomly assigned 31 patients (8 males and 23 females with a mean age of 57.2 years) with complete remission of asthma by inhaled BFM (160/4.5 ㎍) twice daily to receive BFM (160/4.5 ㎍) as needed (16 patients), or budesonide (BUD) (200 ㎍) twice daily (15 patients). The study was an open-label study done for 48 weeks, with the primary outcome as the cumulative percentages of patients with treatment failure (asthma exacerbation or loss of asthma control or lack of satisfaction after using medications) in the two groups. Results: Six patients (42%) using as-needed BFM had treatment failure, as compared with three patients (21.4%) using BUD maintenance (hazards ratio for as-needed BFM, 1.77; 95% confidential interval, 0.44-7.12; p=0.41). The changes in forced expiratory volume in 1 second were -211.3 mL with as-needed BFM versus -97.8 mL with BUD maintenance (difference, 113.5 mL; p=0.75) and the change in fractional exhaled nitric oxide was significantly higher in both groups, at 8.68 parts per billion (ppb) in the as-needed BFM group and 2.5 ppb. in the BUD maintenance group (difference, 6.18 ppb; p=0.049). Conclusion: Compared with BUD maintenance, there were no significant differences in treatment failure rate in patients who received as-needed BFM during the stepping down period in moderate asthma. However, they showed reduced lung function and relapsed airway inflammation. The results are limited by imprecision, and further large RCTs are needed.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제25권6호
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• pp.461-472
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• 2022

Purpose: Golimumab (GLM) is an anti-tumor necrosis factor (TNF)-α antibody preparation known to be less immunogenic than infliximab (IFX) or adalimumab. Few reports on GLM in pediatric patients with ulcerative colitis (UC) are available. This study aimed to review the long-term durability and safety of GLM in a pediatric center. Methods: The medical records of 17 pediatric patients (eight boys and nine girls) who received GLM at the National Center for Child Health and Development were retrospectively reviewed. Results: The median age at GLM initiation was 13.9 (interquartile range 12.0-16.3) years. Fourteen patients had pancolitis, and 11 had severe disease (pediatric ulcerative colitis activity index ≥65). Ten patients were biologic-naive, and 50% achieved corticosteroid-free remission at week 54. Two patients discontinued prior anti-TNF-α agents because of adverse events during remission. Both showed responses to GLM without unfavorable events through week 54. However, the efficacy of GLM in patients who showed primary nonresponse or loss of response to IFX was limited. Four of the five patients showed non-response at week 54. Patients with severe disease had significantly lower corticosteroid-free remission rate at week 54 than those without severe disease. No severe adverse events were observed during the study period. Conclusion: GLM appears to be safe and useful for pediatric patients with UC. Patients with mild to moderate disease who responded to but had some adverse events with prior biologics may be good candidates for GLM. Its safety and low immunogenicity profile serve as favorable options for selected children with UC.

• Journal of Oral Medicine and Pain
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• 제18권1호
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• pp.73-82
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• 1993

To investigate the changes in aerobic and facultative anaerobic oral microflora during remission-induction chemotherapy in patients with acute myeloid leukemia, 10 consecutive patients were studied during a period of 28 days. One day before, during and after the induction therapy, patients were given 10% Betadine solution for mouthrinses after breakfast and kept from eating and drinking. After 3 hours, paraffin-stimulated whole saliva was obtained for 2 minutes and transported to the laboratory. The samples were dispersed and homogenized by use of vortex mixer for 20 seconds. From these samples 10-fold serial dilutions (from 10-1 through 10-3) were prepared. Each dilution of 0.1 ml was plated on duplicate set of one nonselective medium (Blood agar) and four selective media (Sabourauds dextrose agar, Mannitol salt agar, Mac-Conkey agar, SF medium ) using applicator woods. All agar plate were incubated at 37$^{\circ}C$ for 48 hours. The total number of microorganisms was calculated and the percentage distribution of the various microorganisms from each specimen was drawn. 1. The salivary flow rate decreased by 66%, going from 5.38 ml/2min to 1.81 ml/2min over two days during the chemotherapy. 2. The total number of microorganisms in saliva increased by 22%, going from 4.88$\times$105/ml to 6.00$\times$105/ml over two days during the chemotherapy. 3. The salivary flow rate and the total number of microorganisms in saliva were recovered within 28 days after the chemotherapy. 4. The quantitative alteration in oral Enterobacteria, Enterococci, Staphylococci, Cndida during the chemotherapy had no statistical significance. 5. In saliva of the patients with acute myeloid leukemia who ahd intraoral ulcer, Enterobacteria was quantitatively predominent. Our study suggests that chemotherapy-induced transient xerostomia may induce acute oral infection. Consequently, the use of saliva substitute, the removal of intraoral infection source and the consistent oral hygiene care seem to be required to avoid the transmission of potential pathogenes in this group of patients.

• Asian Pacific Journal of Cancer Prevention
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• 제15권16호
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• pp.6823-6827
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• 2014

Objective: This study was conducted to investigate the efficacy of pancreatic drainage for pain relief in advanced pancreatic cancer. Method: Seventy-one patients with pancreatic carcinoma were divided into two groups: dilated and non-dilated pancreatic ducts. All patients underwent endoscopic retrograde cholangiopancreatography (ERCP), endoscopic biliary stenting and pancreatic stenting. Visual Analog Scale (VAS) scores, pain remission rates and survival time were evaluated during follow-up. Results: The post-ERCP VAS score of the dilated group was lower than that of the non-dilated group at 1 and 3 months post-ERCP. There was no difference at 6 months. The pain remission rate in the dilated duct group was significantly higher than that in non-dilated duct group in 1 and 3 months post-ERCP. The median survival times were 8.17 and 8.22 months respectively. Conclusion: Endoscopic pancreatic drainage can relieve pain of advanced pancreatic cancer accompanied by safe dilation of the pancreatic duct.

• Asian Pacific Journal of Cancer Prevention
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• 제16권9호
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• pp.4003-4006
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• 2015

Objecive: To investigate the clinical safety and efficacy of CT-guided $^{125}iodine$ (125I) seed implantation combined with percutaneous intra-tumor injection of chemotherapy emulsion of lobaplatin and lipiodol in treating patients with advanced lung cancer. Materials and Methods: Patients with advanced lung cancer and treated with spiral CT-guided $^{125}I$ seed implantation combined with percutaneous intra-tumor injection of chemotherapy emulsion of lobaplatin and lipiodol were recruited. Results: Of the 36 patients, there were 40 nidi in total. The contrast-enhanced CT evaluation was conducted 60 d after treatment. Response evaluation suggested that 4 patients achieved complete remission (CR), 24 partial remission (PR), 4 stable disease (SD) and 4 progression disease (PD), with a total response rate of 77.8% (28/36). Conclusions: CT-guided $^{125}I$ seed implantation combined with percutaneous intra-tumor injection of chemotherapy emulsion of lobaplatin and lipiodol are safe and effective in treating patients with advanced lung cancer.

• Tuberculosis and Respiratory Diseases
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• 제48권5호
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• pp.740-747
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• 2000

연구배경 : 저자들은 전신병기 소세포 폐암 환자중 VPP/CAV 교대요법을 받은 환자군과 CE요법을 받은 환자군에 대하여 치료반응과 생존기간 그리고 부작용 등을 평가 하여 전신 병기 소세포 폐암 환자의 초치료로 CE요법이 유용한가에 대하여 알아보고자 하였다. 방법 : VPP/CAV교대요법을 받은 환자들은 cisplatin 60mg/$m^2$를 제 1일에 정주하였고 etoposide 100mg/$m^2$를 제 1일에서 제 3일까지 정주한 후, 3주 후에 다시 cyclophosphamide 1000mg/$m^2$, adriamycin 40mg/$m^2$, vincristine 1.4mg/$m^2$를 정주하였고 매 3주마다 반복하였다. CE요법을 받은 환자들은 carboplatin 325mg/$m^2$를 제 1일에 정주하였고, etoposide 100mg/$m^2$를 제 1일에서 제 3일까지 정주하여 매 3주마다 반복하였다. 양군 모두에서 필요한 경우에는 고식척인 방사선 시행하였다. 결과 : 전체 반응률은 61.4% 이었고 중앙 생존기간은 10.8개월이었다. VPP/CAV교대요법군의 경우 반응률은 54.5%, 중앙 생존기간은 9.5개월이었고, CE요법군의 경우 반응률은 68.2%, 중앙 생존기간은 11개월이었으나 양군간에 통계학적인 차이는 없었으며 부작용은 비슷하였으나, CE요법 군에서 빈혈이 더 많았다. 결론 : CE요법은 VPP/CAV교대요법과 동등한 반응률을 보였으며 부작용도 수용할만하여 전신병기 소세포 폐암환자들에서 초치료 약제로 적절한 것으로 판단된다.

• Journal of Korean Neurosurgical Society
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• 제29권6호
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• pp.754-762
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• 2000

Objectives : The surgical results of 80 patients with growth hormone(GH)-producing pituitary adenoma were analyzed retrospectively to evaluate the clinical manifestations and to determine which preoperative factors significantly influenced the surgical outcome. Patients and Methods : The patients consisted of 39 men and 41 women and the age of patients at the time of initial operation ranged from 17 to 67 years(mean age, 40.5 years) Between January 1990 and June 1996, 77 patients underwent transsphenoidal surgery and 3 patients underwent craniotomy for GH-producing pituitary adenoma at our institution. Preoperative administration of octreotide was performed in 18 patients. Surgical control was defined as a postoperative serum basal level of GH less than 5ng/ml. A logistic regression model was used for univariate and multivariate analysis. Probability value of less than 0.05 was considered as statistically significant. Results : The most common presenting symptom was acromegaly, followed by headache, visual disturbance, and fatigability. Visual symptoms were present in 39% of the patients. Diabetes mellitus was associated in 24 patients and hypertension in 12. Preoperative mean basal level of GH was 93.2ng/ml(range 72-500ng/ml) which was closely related with tumor size(p<0.05). Grade II by Hardy's classification was the most common radiological type. Preoperative octreotide treatment significantly reduced the level of GH(p<0.05), but not enough to induce endocrinological remission. One patient died of cerebral infarction after craniotomy. The most common surgical complication was transient diabetes insipidus. The symptom of the earliest improvement after surgery was paresthesia and tightness of the hand and foot, followed by headache and easy fatigability. The preoperative visual symptom was improved in all patients. The patients who had hypertension or DM experienced alleviated symptoms in 67% and 92%, respectively. The overall rate of endocrinological remission was 44%. By multivariate logistic regression analysis, the size of tumor, extrasellar extension, and extent of removal were significant prognostic factors for endocrinologial remission. Conclusion : Early detection of a small tumor without extrasellar extension followed by a complete resection is highly recommended in order to achieve endocrinological cure of GH-producing pituitary adenomas.

• Radiation Oncology Journal
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• 제6권2호
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• pp.227-233
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• 1988

1979년 3월부터 1986년 8월까지 식도의 편평상피암으로 진단되어 서울대학교병원 치료방사선과에서 방사선치료를 받은 177명중 근치적 방사선 치료를 시행한 152명을 대상으로 후향성 분석을 시행하여 다음과 같은 결과를 얻었다. $80\%$이상의 환자에서 관해를 보였으며, 이중 완전관해는 $22\%$, 부분 관해는 $63\%$이었다. 전체 환자의 2년, 5년 생존율은 각각 $22.9\%,\; 13.3\%$이었으며 식도암의 위치, 크기, 병기 그리고 관해 정도에 따라 생존율에 차이가 있었다. 식도 촬영상 5cm 이하$(17\%)$ 또는 식도의 상부 1/3에 종양이 있는 경우$(25.6\%)$에 가장 좋은 5년 생존율을 보였다. 관해 정도에 따른 생존율은 완전관해를 보인 경우의 5년 생존율이 $34.3\%$인 반면 반응이 없던 경우는 $0\%$이었다