• Journal of Medicine and Life Science
• /
• 제18권1호
• /
• pp.16-19
• /
• 2021

Cushing's disease (CD) is a rare illness characterized by chronic hypercortisolism secondary to the overproduction of adrenocorticotropic hormone by a pituitary adenoma, which is associated with a high risk of developing serious complications, such as diabetes mellitus, cardiovascular disease, and emotional disorders. Endoscopic transsphenoidal surgery is performed for the treatment of CD, and was initially preferred over other types of treatments. However, the recurrence after pituitary surgery for CD is a common problem after an initial successful surgery. In microadenomas, the remission rates were higher than those of macroadenoma. This patient had a giant tumor that was greater than 4 cm in length on sella magnetic resonance imaging, and panhypopituitarism was detected using a combined pituitary stimulation test. After transsphenoidal surgery, the patient required temporary hormone replacement for a short period of time. After 1 year, he showed a normal cortisol response on the overnight dexamethasone suppression test and low morning cortisol levels. Therefore, we indicated that the patient was cured of giant macroadenoma with panhypopituitarism before surgery, and thus, reported this case.

• 한국임상약학회지
• /
• 제33권4호
• /
• pp.278-289
• /
• 2023

Background: Linezolid has been widely used in the treatment for multidrug-resistant tuberculosis. However, there are limitations to use it such as long treatment, because of related side effects, even adequate treatment period has been needed for remission of multidrug-resistant tuberculosis (MDR-TB). Method: The meta-analysis was performed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. To choose literatures, systematic literature reviews were conducted with databases of PubMed, Web of Science, and EMBASE. Results: Efficacy and safety of Linezolid were determined by 85% (95% CI=79~89%, p<0.05) in the sputum culture conversion and 55% (95% CI=45~64%, p<0.01) in side effects related to linezolid, respectively. In addition, I² was estimated by 72%. In the subgroup analysis, efficacy and safety by dose and region were analyzed. In the subgroup analysis, compared with the linezolid dose in groups greater than 600 mg/day and less than 600 mg/day, this study showed 85% (95% CI 79~90%, p>0.05) in 206 patients and 82% (95% CI 73~89%, p<0.05) in 297 patients, respectively. Also, in the subgroup analysis, adverse effects caused by linezolid occurred more than 50% of treated patients. Conclusion: Therapeutic efficacy of linezolid for MDR-TB patients was confirmed regardless of the initial dose of linezolid, especially for sputum culture conversion and it was recommended that the dose of linezolid has been more effective below 600 mg/day. However, it should be necessary to closely monitored for safety issues since serious side effects possibly occurred by administration of long period treatment.

• 대한두경부종양학회지
• /
• 제16권2호
• /
• pp.172-176
• /
• 2000

Objectives: To improve local control and reduce toxicity, 3-D conformal radiotherapy was used as a boost the primary tumor site following fractionated radiotherapy in patients with nasopharyngeal carcinoma. Materials and Methods: Eight patients with previously untreated nasopharyngeal carcinomas were treated with 3-D conformal radiotherapy following fractionated radiotherapy from September 1998 to April 2000. All patients had biopsy confirmation of disease before radiation therapy. Stages were II in 1, III in 5, and IV in 2. Two patients received cisplatin based chemotherapy in addition to radiation therapy; induction chemotherapy in 1, concurrent chemoradiation in 1. 3-D conformal radiotherapy delivered using 6MV Linac as a boost(range 25.2-28.8Gy, median 25.7Gy) following conventionally fractionated radiotherapy(range 50.4Gy). Average total dose ranged from 75.6-79.2Gy(median 76Gy). Follow-up time was 4-21 months(median 9.6 months). Results: Seven of 8 patients were evaluated radiologically within 3 months after completion of radiation therapy. All 7 patients were seen complete remission. One of 7 patients had distant metastasis after 5 months and local failure after 7 months. The tree interval of local recurrence was ranged from 4 - 21 months(median 10.2 months). One patient without radiological evaluation got complete remission clinically. Treatment related toxicity was grade 1-3 xerostomia, dysphagia, and mucositis. During 3-D conformal radiotherapy, there was no aggravation of any toxicity. Conclusion: Although the number of patients was small and follow-up period was short, 3-D conformal radiotherapy following conventional radiotherapy improved tumor control and dose escalation without increased toxicity. Survival and late toxicity should be evaluated through long term follow-up. In addition, it is necessary to confirm the benefits of 3-D conformal radiotherapy in nasopharyngeal carcinoma with randomized trial.

• Journal of Korean Neurosurgical Society
• /
• 제29권10호
• /
• pp.1316-1321
• /
• 2000

Objectives : The authors analyzed the surgical series of Cushing's disease to evaluate the proper treatment policy and to verify the possible prognostic factors. Material and Methods : Of 50 patients diagnosed as Cushing's disease and operated at Department of Neurosurgery of our institute between 1988 and 1999, 48 patients with available medical records were analyzed retrospectively. Mean follow-up period was 48 months(3 to 109 months). Preoperative diagnosis was made after evaluating the patients with multiple-stage endocrinological studies and 31 selective patients were evaluated with inferior petrosal sinus sampling(IPSS). Magnetic resonance imaging(MRI) and/or high resolution computerized tomography(CT) was done in all patients. A total of 51 transsphenoidal adenomectomy(TSA) were performed including 3 revision for initial surgical failure cases. Remission was decided on the basis of both endocrinological criteria and clinical status. Radiation and/or ketoconazole therapy were applied to failed cases. For the verification of prognostic factors, the authors evaluated the statistical significance of multiple variables over remission rate by chi-square test. Result : Sensitivity of IPSS for central localization was 93.5% which was better than that of MRI(87.5%). But for lateralization, it was 72.4% for IPSS versus MRI 90.5%. Success rate of TSA was 82%(42/51) and recurrence rate was 9%(4/48). When including adjuvant treatments for surgically failed cases, overall success rate was 89.6% and all of 3 reoperated cases(TSA) due to recurrence were successful. Significant complication occurred in 7.8%(4/51) after TSA including hypopituitarism, diabetes insipidus, and visual loss. Non-existence of tumor in MRI and prolonged symptom duration(>3 years) were significant prognostic factors. Conclusion : TSA can be considered as initial treatment for Cushing's disease. In surgically failed cases, multiple treatment modality may improve the overall outcome and repeated TSA for recurrent cases seem to provide similar success.

• Asian Pacific Journal of Cancer Prevention
• /
• 제14권12호
• /
• pp.7569-7576
• /
• 2013

Background: The purpose of this article is to present preliminary results of simultaneous boost irradiation radiotherapy for locally advanced nasopharyngeal carcinoma (NPC). Methods: Fifty-eight patients who underwent simultaneous boost irradiation radiotherapy for NPC in Cancer Center of Sun Yat-sen University between September 2004 and December 2009 were eligible. Acute and late toxicities were scored weekly according to the Radiation Therapy Oncology Group (RTOG) acute and late radiation morbidity scoring schemes. An especial focus was on evidence of post-radiation brain injury. Also quality of life was analysed according to the EORTC (European Organisation for Research and Treatment of Cancer) recommendations. Discrete variables were compared by ${\chi}^2$ test. The Kaplan-Meier method was used to calculate the survival rates and generate survival curves. Results: A total of 58 patients with a mean follow-up time of 36 months completed clinical trials.Fifty-seven patients (98.3) achieved complete remission in the primary sites and cervical lymph nodes, with only one patient (1.7%) showing partial remission.The most frequently observed acute toxicities during the concurrent chemoradiotherapy were mucositis and leucopenia. Four patients (6.9%) had RTOG grade 3 mucositis, whereas four patients (6.9%) had grade 3 leucopenia. No patient had grade 4 acute toxicity. Three (5.17%) of the patients exhibited injury to the brain on routine MRI examination, with a median observation of 32 months (range, 25-42months). All of them were RTOG grade 0. The 3-year overall, regional-free and distant metastasis-free survival rates were 85%, 94% and 91%, respectively. Conclusion: Simultaneous boost irradiation radiotherapy is feasible in patients with locally advanced nasopharyngeal carcinoma. The results showed excellent local control and overall survival, with no significant increase the incidence of radiation brain injury or the extent of damage. A larger population of patients and a longer follow-up period are needed to evaluate ultimate tumor control and late toxicity.

• Clinical and Experimental Pediatrics
• /
• 제60권3호
• /
• pp.86-93
• /
• 2017

Purpose: To evaluate the clinical spectrum of posttransplantation lymphoproliferative disorder (PTLD) after solid organ transplantation (SOT) in children. Methods: We retrospectively reviewed the medical records of 18 patients with PTLD who underwent liver (LT) or kidney transplantation (KT) between January 1995 and December 2014 in Seoul National University Children's Hospital. Results: Eighteen patients (3.9% of pediatric SOTs; LT:KT, 11:7; male to female, 9:9) were diagnosed as having PTLD over the last 2 decades (4.8% for LT and 2.9% for KT). PTLD usually presented with fever or gastrointestinal symptoms in a median period of 7 months after SOT. Eight cases had malignant lesions, and all the patients except one had evidence of Epstein-Barr virus (EBV) involvement, assessed by using in situ hybridization of tumor tissue or EBV viral load quantitation of blood. Remission was achieved in all patients with reduction of immunosuppression and/or rituximab therapy or chemotherapy, although 1 patient had allograft kidney loss and another died from complications of chemotherapy. The first case of PTLD was encountered after the introduction of tacrolimus for pediatric SOT in 2003. The recent increase in PTLD incidence in KT coincided with modification of clinical practice since 2012 to increase the tacrolimus trough level. Conclusion: While the outcome was favorable in that all patients achieved complete remission, some patients still had allograft loss or mortality. To prevent PTLD and improve its outcome, monitoring for EBV infection is essential, which would lead to appropriate modification of immunosuppression and enhanced surveillance for PTLD.

• Childhood Kidney Diseases
• /
• 제7권1호
• /
• pp.1-8
• /
• 2003

목적 : 국소성 분절성 사구체 경화증은 치료에 잘 반응하지 않고, 장기적 예후가 좋지 않은 것으로 알려져 있다. 저자들은 스테로이드 충격 요법 후 괄목할만한 관해율의 향상을 보였으나 다시 스테로이드 저항성을 보이거나 스테로이드 의존성을 보인 환자 4명을 대상으로 혈장반출법, 스테로이드 충격 요법 및 immunoglobulin 병행치료의 효과를 알아보고자 본 연구를 시행하였다. 대상 및 방법 : 1988년 3월부터 2002년 7월까지 국소성 분절성 사구체 경화증이 확진된 환자중 스테로이드 충격 요법을 시행 후 스테로이드 의존성 혹은 저항성을 보였던 4명의 환자를 대상으로 총 8회의 혈장 반출법을 시행하고 후향적 방법으로 치료 효과를 평가하였다. 결과 : 총 4명의 환자 중 남자는 3명, 여자는 1명이었다. 4명의 환자에서 총 8회의 혈장반출법을 시행하여 모두 관해가 왔으며 이중 두 명의 환자에서 두 번씩의 재발이 있어 각각 2회씩의 혈장 반출법을 다시 시행하여 2명 모두 관해가 왔으나 한 명에서는 이후 2회의 재발이 있어 경구 스테로이드를 투여하여 관해를 보였다. 이들 환자들은 발병 이후 현재까지 3명의 환자에서는 10년 이상, 한 명의 환자는 5개월간 추적 관찰중으로 혈중 크레아티닌과 사구체 여과율은 정상을 유지하고 있다. 결론 : 스테로이드 의존성 또는 저항성 국소성 분절성 사구체 경화증 환자를 대상으로 혈장 반출법, 스테로이드 충격 요법 및 immunoglobulin의 병행 치료는 완전 관해를 이루고, 정상 신장 기능을 유지하는데 효과가 있다고 사료된다.

• Journal of Korean Medical Science
• /
• 제33권52호
• /
• pp.346.1-346.11
• /
• 2018

Background: To evaluate the therapeutic benefits of the treat-to-target (T2T) strategy for Asian patients with early rheumatoid arthritis (RA) in Korea. Methods: In a 1-year, multicenter, open-label strategy trial, 346 patients with early RA were recruited from 20 institutions across Korea and stratified into 2 groups, depending on whether they were recruited by rheumatologists who have adopted the T2T strategy (T2T group) or by rheumatologists who provided usual care (non-T2T group). Data regarding demographics, rheumatoid factor titer, anti-cyclic citrullinated peptide antibody titer, disease activity score of 28 joints (DAS28), and Korean Health Assessment Questionnaire (KHAQ) score were obtained at baseline and after 1 year of treatment. In the T2T group, the prescription for disease-modifying antirheumatic drugs was tailored to the predefined treatment target in each patient, namely remission (DAS28 < 2.6) or low disease activity (LDA) ($2.6{\leq}DAS28$ < 3.2). Results: Data were available for 163 T2T patients and 162 non-T2T patients. At the end of the study period, clinical outcomes were better in the T2T group than in the non-T2T group (LDA or remission, 59.5% vs. 35.8%; P < 0.001; remission, 43.6% vs. 19.8%; P < 0.001). Compared with non-T2T, T2T was also associated with higher rate of good European League Against Rheumatism response (63.0% vs. 39.8%; P < 0.001), improved KHAQ scores (-0.38 vs. -0.13; P = 0.008), and higher frequency of follow-up visits (5.0 vs. 2.0 visits/year; P < 0.001). Conclusion: In Asian patients with early RA, T2T improves disease activity and physical function. Setting a pre-defined treatment target in terms of DAS28 is recommended.

• Tuberculosis and Respiratory Diseases
• /
• 제49권3호
• /
• pp.323-331
• /
• 2000

목적 : 소세포 폐암 환자에서 생존율이 향상됨에 따라서 뇌전이의 임상적 중요성이 커지고 있다. PCI 는 뇌전이 빈도를 감소시키며 특히 완전관해된 제한병기 소세포 폐암 환자에서는 생존기간의 연장까지 가져온다는 보고도 있다. 저자들은 완전관해가 된 제한병기 소세포 폐암환자에서 PCI를 시행한 후 뇌전이의 빈도, 생존율 및 임상상을 알아보고자 하였다. 대상 및 방법 : 1989년 3월부터 1999년 9월까지 충남대학교병원에 입원하여 조직학적으로 소세포 폐암으로 확진되고 병기분류상 제한병기로 분류된 후 항암 화학요법 및 방사선치료후 완전관해가 된 환자중 PCI를 시행 받은 42명올 대상으로 후향적분석을 하였다. 항암 화학요법은 초치료로 VPP/CAV교대요법을 6회이상 시행 하였고, 흉부 방사선치료는 동시치료군이 38.1%, 연속치료군이 61.9%였다. 결과 : 대상환자의 88.1%가 남자였고, 중앙연령은 58세였다. 중앙 관찰기간은 18.1개월이었다. 경과 관찰 중에 57.1%에서 전이 또는 재발하였는데, 뇌전이는 14.3%에서 발생하였고, 폐 원발병소에서 재발된 경우가 35.7%로 가장 많았다. 평균 무병생존기간은 1,090일(중앙값 305일), PCI후 뇌전이가 발생하기까지는 평균 2,548일, 뇌전이를 제외한 전이 및 재발되기까지는 평균 1,395일(중앙값 460일)이었다. 생존기간의 중앙값은 21.1개월, 2년생존율은 41.7% 이었다. 전이 및 재발이 발생한 군의 평균 생존기간은 642일(중앙값 489일), 발생하지 않은 군의 평균 생존기간은 2,622일로 유의한 차이가 있었으나, 뇌전이 유무에 따른 생존기간의 차이는 없었다. 사망원인은 원발 병소의 재발 및 전신질환에 의한 사망이 많았고(85.7%), 뇌전이자체에 의한 사망은 14.3%이었다. 결론 : 완전관해가 된 제한병기 소세포 폐암 환자에서 PCI는 뇌전이를 감소시키고 지연시키는 경향이 있었다. 전이 및 재발이 있는 군에서 생존기간이 짧았으나 뇌전이 유무에 따른 생존기간의 차이는 없었고 주된 사망원인이 뇌전이보다는 원발병소의 재발과 전이 및 전산질환에 의한 것이 대부분이어서, 생존율을 높이기위해서는 원발병소의 재발과 전이 및 전신질환에 의한 것이 대부분이어서, 생존율을 높이기 위해서는 원발병소의 재발 및 전이를 감소시킬 수 있는 효과적인 치료방법의 개발 및 전신진환의 적절한 조절이 필요한 것으로 생각된다.

• 대한한방내과학회지
• /
• 제24권2_4호
• /
• pp.967-974
• /
• 2003

Recurrent Aphthous Stomatitis(RAS) is inflammatory ulcerative condition of the oral mucosa. The lesions of RAS are self-limited and persist for 1 to 2 weeks, resolved with or without scarring and recurred after periods of remission. It is known that nicotine may protect oral mucosa from aphthous ulcers by keratinization of the oral mucosa. After quitting smoking, a stroke patient who suffered from RAS, used to relapse into RAS unless he didn't gargle with nicotine extract water. We diagnosed his case as heat in the stomach and treated with Chungwie-San(Qingwei-San). After medication with Chungwie-San, RAS was subsided and he stopped smoking during admission period.