The impact of blowflies on pig cadaver decomposition on Yeongdo Island, Busan, South Korea

Park Sang‐Hyun,Baek Seung‐Ho,Moon Tae‐Young 한국곤충학회 2021 Entomological Research Vol.51 No.11

The decomposition process is an important factor in forensics, and flies play a crucial role in the decomposition of animals and humans. However, there remains limited information on the effect of flies that attend death scenes. This study assesses the effect of the presence or absence of blowflies on the rate and process of cadaver decomposition in the spring, summer, and autumn from 2016 to 2020 on Yeongdo Island, Busan, South Korea. Nine blowfly species belonging to four genera in two subfamilies were sampled. The blowflies that approached the cadavers differed between seasons, but Chrysomya pinguis (Walker) was the dominant species regardless of the season. Blowfly presence on cadavers significantly affected the duration of the decomposition stage and the pattern of weight loss in nearly all scenarios. With the presence of blowflies, the decomposition rate was four times faster in spring, three times faster in summer, and nine times faster in autumn. These results show that the presence or absence of blowflies is an essential factor in the decomposition process of cadavers. Therefore, it should be taken into account when estimating postmortem intervals in medicolegal forensic entomology.

2003년 국내 중증급성호흡기증후군 진료 현황 및 문제점 분석

이진수,김은실,정문현,백제중,정선화,안주희,최영화,이선희,고철우,김성범,김민자,박승철,기현균,송재훈,최상호,김양수,이상오,조용균,박영훈,정숙인,김연숙,이흥범,손창희,장성희,정희진,김우주 대한감염학회 2004 감염과 화학요법 Vol.36 No.3

목적 : 2002년 말 중국에서 SARS가 발생한 이후 국내에서도 2003년 10월까지 총 3명의 추정환자, 17명의 의심환자가 보고되었다. 향후 추가적인 SARS의 유행이 우려되는 상황에서, 그간의 SARS 환자 진료에 있어서의 실질적인 준비사항, 진료 현황 등에 대한 조사를 통해 문제점을 파악하여, 향후 더 나은 대비가 될 수 있도록 개선점을 제시하고자 하였다. 재료 및 방법 : SARS로 의심되는 환자를 진료 경험이 있는 병원의료진을 대상으로 2003년 10월에 설문조사를 실시하였다. 설문에는 SARS 환자 진료 시의 실질적인 조치, 진료 현황, 병실, 응급실 및 외래에서의 격리 시설과 준비사항, 보건당국의 관리와 지원에 관한 사항을 포함하였다. 결과 : 대상이 되는 22개 병원 중 17개(17/22, 77.2%) 병원이 설문에 응하였다. SARS 환자를 위한 격리실은 응급실, 외래, 일반병실 및 중환자실에서 각각 9개(9/17, 52.9%), 5개(5/17, 29.4%), 15개(15/16, 93.7%), 4개(4/16, 25%) 병원에서 음압처리가 되어있지 않은 일인실 혹은 다인실이 사용되었고, 1개(1/16, 6.3%) 병원에서만 일반병실에서 음압격리실이 운영되었다. 입원환자의 진찰 시 개인보호구의 착용은 거의 모든 의료기관에서 이루어졌다. 보건당국에서 SARS지정병원의 시설 등을 사전에 확인한 곳은 1곳(1/12, 8.3%)이였고, 14개 병원(14/15, 93.3%)에서는 보건당국에 의뢰한 검사결과를 통하 받지 못하였다. 결론 : 의료기관에서 SARS 환자용 격리실뿐만 아니라 기존의 격리실 설비 등이 미흡하였으며, 특히 중환자실 및 외래의 준비가 더욱 부족하였다. 보건당국의 의료기관에 대한 종합적인 지원이 부족하였고, 병원과의 원활한 연계가 잘 이루어지지 않았다. SARS 만이 아닌 격리를 필요로 하는 질환의 적절한 진료를 위해 향후 병원 시설의 정비와 정부차원에서의 보다 구체적이고 실질적인 대책마련이 필요하다. Background : There was an worldwide outbreak of the Severe Acute Respiratory Syndrome (SARS) originated from China in late 2002. During that period three cases of suspected SARS and 17 cases of probable SARS were reported in Korea. With the concerns about the reemergence of SARS-coV transmission, it is important to be prepared for any possibility. So, this study is aimed to analysis the past measures in managing SARS and propose the amendatory plans to improve the preparedness. Materials & Methods : Questionnaires were collected among clinicians with any experience in managing the probable or suspected SARS cases in Oct. 2003. 17 out of 22 hospitals responded to the questionnaire. The contents in the questionnaire were practical activities, personal equipments, response plans, isolation facilities in emergency centers, outpatient clinics, general wards and intensive care units, and relationship with the public health department. Results : The dedicated isolation rooms in emergency centers, outpatient clinics, general wards, and intensive care units were prepared in 9 (9/17, 52.9%), 5 (5/17, 29.4%), 15 (15/16, 93.7%), and 4 (4/16, 25.0%) hospitals, respectively. Except for one hospital that newly made negative pressure room for SARS, single or multi-bed rooms without airborne infection control were used in all the other hospitals. The personal precaution principles were kept quite well in general wards. Before the designation of SARS hospital by the public health department prior evalution to see if the hospital was suitable for managing SARS was conducted in only 1 (1/12, 8.3%) hospital. The results of laboratory diagnosis were reported back in 1 (1/15, 6.6%) hospital. Conclusions : The isolation facilities which can control airborne infection were almost deficient not only for SARS but also for other respiratory transmissible diseases. For the infection control of transmissible diseases including SARS, more investment is needed on medical facilities and comprehensive support from the public health department required.

노화가 인체 중간엽 줄기세포로부터 조골세포로의 증식 및 분화에 미치는 영향

백기현,태현정,오기원,이원영,조정기,권순용,강무일,차봉연,이광우,손호영,강성구,김춘추 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.3

연구배경: 일반적으로 골다공증과 연관된 위험인자로는 연령, 폐경, 약물, 불충분한 칼슘섭취, 만성질환 및 운동부족 등이 있는데, 특히 노화가 진행할수록 골밀도가 감소하는 것은 잘 알려져 있다. 노화와 관련하여 진행되는 골소실은 조골세포 및 전구조골세포의 기능적 결핍에 의한 골형성의 감소가 주요한 요인으로 여겨지고 있다. 그 동안 연령이 조골모 세포의 양과 조골모 세포로부터 성숙조골세포로의 분화 및 증식에 미치는 영향에 대한 일부 보고들이 있었으나 아직 일치된 견해는 없는 형편이다. 방법: 다양한 연령의 사람으로부터 골수를 채취, 중간엽 줄기세포가 포함된 단핵세포를 분리한 후 조골세포로 분화하기 좋은 조건하에서 배양하였다. 대상군은다시 젊은군과 노령군으로 구분하여 다양한 변수를 비교 분석하였다. 일차배양에서는 CFU-F를 계수하여 골수내 중간엽 줄기세포의 수를 추산하였고, 칼슘측정을 통하여 기질의 무기화 정도를 비교하였다. 계대배양후 이차배양에서는 시기별로 알카리성 포스파타제 활성도를 측정하고 오스테오칼신 mRNA의 발현을 관찰하여 젊은군과 노령군 사이의 증식능 차이를 비교하였다. 또한 이차배양 시기별로 MTT 측정을 하여 양군간에 증식능 차이가 있는지 알아보았다. 결과: 1. 일차배양 15일째에 평균 CFU-F의 수는 젊은군에서 유의하게 많았다(젊은군 148.3±28.9, 노령군 54.3±9.1, p=0.02). CFU-F의 평균면적은 젊은군에서 넓은 경향을 보였으나 통계적으로 유의하지는 않았다. 2. 일차배양 17일 경과 후 양군간에 기질 칼슘 침착정도는 유의한 차이를 보이지 않았다(젊은군 103.6±50.6, 노령군: 114.0±56.5, p=NS). 3. 이차배양 10일째에 젊은군에서 알카리성 포스파타제 활성도가 고령군에 비해 유의하게 높았다(젊은군: 935.5±115.0 U/mg, 노령군: 578.4±115.7U/mg,p.0.05). 고령군에서는 시간 경과에 따른 변화가 미약했으며 전반적으로 알카리성 포스파타제의 활성도가 젊은군에 비해 낮았다. 4. 이차배양도중 오스테오칼신 mRNA의 발현은 배양시기별로 젊은군에 비해 고령군에서 더 낮은 경향을 관찰할 수 있었다. 5. 이차배양 10일과 15일에 젊은군에서 노령군보다세포증식이 유의하게 증가된 양상을 보였다(10앓 젊은군 0.73±0.05, 노령군 0.58±0.04, p=0.05, 15일; 젊은군 0.80±0.05, 노령군 0.70±0.03, p=0.05).결론: 이상의 연구에서 저자들은 노령군에서 젊은군보다 골수 내 중간엽줄기세포의 수가 적고, 노령군에서 유래한 전구조골세포의 성숙조골세포로의 증식 및 분화가 젊은군 보다 감소해 있는 것을 관찰할 수 있었다. Background: Osteoblasts originate from osteoprogenitor cells in bone marrow stroma, termed mesenchymal stem cells (MSCs) or bone marrow stromal cells. Each MSC forms colonies (colony forming units-fibroblasts [CFL-Fs]) when cultured ex vivo. There are some reports about the age-related changes of the number and osteogenic potential of osteoprogenitor cells, but any relationship has not been clearly established in humans. In this study, we counted MSCs using CFU-Fs count and examined the proliferative capacity and differentiation potential of osteoprogenitor cells. Finally, we analyzed how these parameters varied with donor age. Methods: Bone marrow was obtained from the iliac crest of young (n=6, 27.2±8.6 years old) and old (n= 10, 57.4k6.7 years old) healthy donors. Mononuclear cells, including MSCs, were isolated and cultured in osteogenic medium. In primary culture, we compared the colony-forming efficiency of MSCs between the two groups and determined the matrix calcification. When primary culture showed near confluence, the cells were subcultured. Alkaline phosphatase activity, osteocalcin expression by RT-PCR and proliferative potential by MTT assay were examined by the time course of secondary culture. Results: At the 15th day of primary culture, the mean number of CFU-Fs was significantly higher in the younger donors (young: 148.3±28.9, old: 54.3±9.1, p=0.02) and the mean size of CFL-Fs was also larger in the younger donors than the older donors. However, matrix calcification was not different between the two groups (young: 103.6±50.6, old: 114.0±56.5, p=NS). In secondary culture, alkaline phosphatase activities were significantly lower in the older donors. The younger donors showed peak alkaline phosphatase activity at day 10, while the older donors didn't showed a remarkable peak (young: 935.5±115.OU/mg, old: 578.4±115.7U/mg, p<0.05). Total cell number as a proliferative index increased progressively during the secondary culture and a significantly greater cell number was noted in the younger donors. Osteocalcin expression was generally upregulated in the younger donors, but this was not statistically significant. Conclusion: Our study shows that the number of osteoprogenitor cells is decreased during aging and that the proliferative capacity and differentiation potential of osteoprogenitor cells seem to be reduced during aging (J Kor SOC Endocrinol 18:296-305, 2003).

혼합유화제 비율에 따른 인계난연제 캡슐의 제조 및 특성 연구

백경현,이준영,홍상현,김중현 한국공업화학회 2004 응용화학 Vol.8 No.1

The microcapsules containing triphenyl phosphate (TPP) flame retardant have been prepared by using the epoxy resin (Novolac Type) with good physical properties and network structure. The reactants including TPP, epoxy resin and mixed surfactants were emulsified to oil in water (O/W) by the phase inversion technology and then conducted on the crosslinking of epoxy resin by In-situ polymerization. The capsule size and size distribution of TPP microcapsules was controlled by mixed surfactant ratio. The thermal property of TPP capsules were measured by the TGA. The morphology and capsule size were also investigated by the SEM respectively. TPP capsules with 1 : 1 of mixed surfactant (F127 : SDBS) ratio were more spherical and uniform than it with others. The TPP capsule size was 12~17㎛ and TGA results shows that TPP capsule efficiency was about 73%.

직장암 절제 수술 후에 발생하는 문합부 누출의 위험 인자

이승현,안병권,배승언 고신대학교 의과대학 2010 고신대학교 의과대학 학술지 Vol.25 No.2

Background: Anastomotic leakages are one of the most serious complications after rectal cancer resection. The aim of this study was to identify the relevant risk factors of anastomotic leakage after low anterior resection for rectal cancer. Methods: We reviewed retrospectively the medical records of 251 patients, who underwent low anterior resection for rectal cancers between January, 2001 and December, 2004. All patients underwent a tumor-specific mesorectal excision. We excluded the patients underwent emergent surgery, protective stoma formation and used pelvic drainage. Results: The mean distance of the tumor from the anal verge was 8.0 cm (3-16 cm). Lower anterior resection was performed in 214 patients and ultra-low anterior resection in 37 patients. Fifteen patients had preoperativechemoradiation for rectal cancer. The anastomotic leakage was identified in 10 patients (4.0%). Seven patients with anastomotic leakage underwent corrective surgery.Other postoperative complications included 5 rectovaginal fistula (2.0%) and 4 intra-abdominal abscess (1.6%). The incidences of anastomotic leakage were significantly different according to preoperative chemoradiation (13.3% vs. 3.4%, p=0.05) and rectal obstruction (33.3% vs. 3.3%, p=0.00). Conclusions: In patients with history of preoperative chemoradiation and rectal obstruction, the careful management for anastomotic leakage is necessary

全蝎 抽出物이 血栓症, 全腦虛血 및 腦細胞毒性에 미치는 影響

백명현,황영근,정지천,강정준,김성훈 동국대학교 한의학연구소 1999 東國韓醫學硏究所論文集 Vol.8 No.1

본 실험은 전갈 추출물이 어혈병태 모델과 KCN으로 유발된 전뇌허혈, 뇌세포독성 등에 미치는 영향을 관찰하였다. 전갈은 Dextran에 의해 유도된 혈전으로 감소된 혈소판수, fibrinogen량, hemocrit치를 유의성 있게 증가시키고. 증가된 prothrombin time을 유의성 있게 단축시켰다. 전갈은 thrombin과 ADP에 의해 유도된 혈소판 응집을 억제하였으나 collagen에 의해 유도된 혈소판 응집에는 저해효과를 나타내지 않았다. 또한 collagen과 epinephrine에 의해 유도된 pulmonary embolism에 대하여 보호 효과를 나타내었다. 전갈은 KCN에 의한 전뇌허혈 유발 실험에서 혼수시간을 유의성 있게 단축시켰고, Amyloid β protein(25-35)에 의해 유도된 PC12 세포의 독성에 대하여 보호효과를 나타내었다. This following is effect of Buthus martensi Karsch (BMK) extract on dextran-thrombus model, KCN-induced coma, cytotoxicity of brain etc. BMK extract significantly increased number of platelet and fibrogen and significantly shortened the prothrombin time as compared with control group treated with dextran. BMK extract didn't affect the changes of hematocrit as compared with control group treated with dextran. BMK extract induced a significant inhibition of human platelet aggregation induced by thrombin and ADP but did not affect human platelet aggregation induced by collagen. BMK extract showed a protective effect on pulmonary thrombosis induced by collagen and epinephrine. BMK extract prolonged the duration of KCN-induced coma and showed a protective effect on cytotoxicity of PC12 cells induced by amyloid β protein(25-35) in a dose dependent manner. These results suggested that BMK extract might be usefully applied for prevention and treatement of thrombosis and brain damage.

신증후출혈열 환자의 역학조사를 위한 혈청학적 분석 및 항원검출

백락주,송기준,김상현,윤재경,김세연,송진원,이용주 대한감염학회 1997 감염 Vol.29 No.5

목 적 : 1991년 한탄바이러스 예방백신접종이 본격적으로 시행된 이후의 신증후출혈열 발생양상 및 한탄바이러스와 서울바이러스에 의한 감염비율에 대한 전반적인 역학조사와 새로운 한탄바이러스종의 존재 가능성을 증명하기 위하여 혈청학적 검사와 환자혈청에서의 한탄바이러스 항원검출을 시도하였다. 방 법 : 1994년 1월부터 1996년 12월까지 3년간 발생한 열성질환 환자중 신증후출혈열, 리케치아증 및 렙토스피라증 등이 의심되어 항체검사를 위해 고려대학교 의과대학 미생물학교실, 바이러스병 연구소에 의뢰된 혈청 8102건을 대상으로, 간접형광항체법, 혈구응집저지반응, 면역효소측정법 및 역전사 중합효소연쇄반응을 이용하여 한탄바이러스 감염에 대한 혈청역학적 연구 및 항원검색을 수행하였다. 결 과 : 간접형광항체법으로 조사한 한탄바이러스에 대한 항체 양성율은 30대 남자에서 가장 높았으며 10월에서 1월사이에 항체 양성 건수가 집중되어 있었다. 신증후출혈열 발생 빈도가 감소하고 있었으며 특히 건조기에 집중되었던 발생양상의 변화가 관찰되었다. 한탄바이러스에 의한 감염이 서울바이러스에 의한 감염보다 3배이상 높게 관찰되었으며 서울바이러스에 의한 감염은 고령층에서 더욱 빈발하였다. 한탄 및 서울 바이러스 이외의 새로운 한탄바이러스에 의한 감염 가능성이 확인되었다. 결 론 : 전반적으로 발생빈도가 감소하였으나 현재에도 우리 나라에서는 매년 수백명의 신증후출혈열 환자가 발생하며 한탄바이러스와 서울바이러스가 주요 원인체이나 새로운 한탄바이러스종의 존재 가능성이 확실하여 이의 규명을 위한 지속적인 연구가 수행되어야 할 것으로 사료된다. Background : Hantaan (HTN) and Seoul (SEO) viruses, harbored by the stripedfield mouse(Apodemus agrarius) and the Norway or common rat(Rattus rattus & Rattus norvegicus) respectively, were known to cause hemorrhagis fever with renal syndrome(HFRS) in Korea. We evaluated the seroepidemiologic patterns of hantaviral infection and detect the hantaviral antigens from patients sera. Methods : total 8,102 HFRS patients' sera were collected from 1994 to 1996, and examined by indirect immunofluorescent antibody technique(IFA), hemagglutination inhibition test(HI), IgM emzyme-linked immunosorbent assay(IgM-ELISA) and nested reverse transcription-polymerase chain reaction(RT-PCR). Results : The seropositive rate against hantaviral antigen was 12.0%(973/8102) with the high incidence rate(68.3%) in the period from October to January, and males in the thirties were mostly affected. HTN viral infections were detected 3.5 and 5.2 times higher than SEO viral infections by HI and RT-PCR, respectively, and patients in the fifties were the mostly affected age-group in SEO viral infections. IgM antibodies were detected in the 717 sera of the 905 IFA positive cases(79.2%), and the antigen detection rate of HTN and SEO viruses was 7.7%(56/724). Interestingly, 40 sera(4.4%), showed higher antibody titers against the puumala(PUU) virus than those against HTN or SEP viruses. Conclusion: The results showed HTN and SEO viruses were the main causative agents of HFRS in Korea, and also suggested the possible presence of PUU-related hantaviral infections.

미용사의 요통 경험에 영향을 미치는 요인

백승룡,남철현,배성욱,김성우,권현숙,이정옥,전연숙 慶山大學校 保健福祉硏究所 2002 保健福祉硏究 Vol.7 No.-

The purpose of this study is to analyze and grasp the actual lumbaginous condition and relevant factors of 1,182 beauty artists of beauty shops in 5 metropolitan cities, small-to-medium cities, and fishing or agrarian villages for 3 months from June 20 to September 25, 2000 through questionnaires. 1) They showed 61.0 percents in her twenties, 66.4 percents of unmarried women from all the female objects, 70 percents in high school graduates as educational background, 52.4 percents in metropolitan city as service place, 25.4 percents in smoking rate, 71.6 percents in drinking rate, 48.1 percents in general bed as condition of bedroom, 17.9 percents in exercising rate, 53.6 percents in 'little eating', 39.6 percents in two or three centimeters of heel, and 89.5 percents in hair as beauty-related professional field. 2) The rate of lumgaginous experience of beauty artists was 83.5 percents. They showed higher rate of 91 percents in the thirties and forties, 92 percents of the married, 93.9 percents in junior college graduates, 97.2 percents in higher economic classes, 88.7 percents in smokers, 85 percents in general bed, 89.3 percents in sleeping on one's face, 85 percents in swimming, 92 percents in stretch, 86.7 percents in 56 to 60 kilograms of weight, 89.7 percents in group O blood, 90.5 percents in experienced women of abortion, 97 percents in heel over 8 centimeters, 58.3 percents in 'feel much fatigue', 93.6 percents in inconvenient chair of beauty shop, and 89.4 percents in a lack of recess than other group. 3) The more women who have been experienced in lumbago, the higher their social treatment(p<0.01), income(p<0.001), working time(p<0.05), job potentiality(p<0.05), inner affinity(p<0.05), and job satisfaction of environment(p<0.001) were. Women who suffered much stress related to job environment(p<0.001), client(p<0.01), and their duty(p<0.01) showed high rate of lumbaginous experience. 4) In degree of lumbago by characteristic, there was the significant difference in age over 50-years-old, unmarried women, college graduates, service of small-medium cities, higher economic classes, smokers or drinkers, hot-floored room, sleeping with ransack, stretch or swimming, group A blood, fat body, experience of abortion, 6 to 7 centimeters of heel, convenient chair of beauty shop, insufficient recess, lumbago continued for one to the three months in comparison of other group. 5) There were variables of posture such as to place materials under one foot(p<0.001), to lay arm on armrest and desk(p<0.001), to pull materials near body while lifting them (p<0.05), to sometimes use anodyne(p<0.01), not to lift also light materials(p<0.001), to be inconvenient in sleeping(p<0.001), to be absent at job for two or three days(p<0.01). The degree of depression(p<0.001), had the significant effect on the degree of lumbago(32.7%). The results are as follows : Beauty artists have faced upon dangerous job environment to cause lumbago. The more the industrial society will be developed, the more their burden of service will be increased. In addition, the occupational stress and posture of beauty artists who showed high job satisfaction and high economical level became major factors which have had an effect on their lumbago. In conclusion, it is desirable for beauty-related organizations and professionals to positively develop program of health education with much concern as well as to lessen stress of beauty artists through education of job posture and rightful life in order to prevent lumbago of those beaut.

조혈모세포이식 후 골성장인자의 변화 및 골대사에 미치는 영향 : Impact on Bone Mineral Metabolism

백기현,오은숙,오기원,이원영,김혜수,권순용,한제호,강무일,차봉연,이광우,손호영,강성구,김춘추 대한내분비학회 2002 Endocrinology and metabolism Vol.17 No.5

연구배경: 각종 장기이식의 시행이 많아지고 이식 후 생존율이 증가함에 따라 이식 후 합병증에 대한 관심 또한 높아지고 있다. 조혈모세포이식 후에도 다양한 내분비적 합병증이 발생할 수 있으며 골격에 대한 합병증도 문제점으로 대두되고 있다. 조혈모세포 이식 후 발생하는 골소실에는 이식 후 초기의 골형성 저하와 골흡수 증가가 중요한 역할을 담당하리라고 추측되는데 이러한 골재형성불일치(biochemical uncoupling)에 골 성장인자들이 미치는 영향에 대해서는 알려진 바가 없다. 본 연구에서는 조혈모세포이식 전, 후로 말초 혈액에서 IGF-I, FGF-2, M-CSF같은 성장인자의 변화를 알아보고, 이들 성장인자의 변화가 조혈모세포이식 후의 골형과 골흡수에 미치는 영향 및 이식 후 발생되는 골량 소실과의 연관성을 확인해 보고자 하였다. 방법: 여러 가지 혈액질환으로 인해 동종 골수이식을 시행 받은 환자들을 전향적으로 관찰하였으며 이식 전 및 이식 후 1주, 2주, 3주, 4주 및 3개월, 6개월 1년에 말초 혈액에서 골교체표지자를 측정하였다. 이식 전 및 이식1년 후에 요추골 및 대퇴골 골밀도를 측정할 수 있었던 36명의 환자들을 대상으로 냉동 보관되어 있던 혈청을 이용하여 IGF-I, FGF-2 및 M-CSF를 시기별로 측정하였으며 이들 성장인자와 골교체표지자의 변화 및 골밀도 변화 사이의 상관관계를 확인하였다. 결과: 골흡수 표지자인 혈청 ICTP는 이식 전에 비해 이식 후 4주까지 점차 의의 있게 증가하다가 이후 6개월까지 더욱 증가한 후 감소하였다. 골형성 표지자인 osteocalcin은 이식 후 3주까지는 점차 감소하다가 이후 증가하여 이식 후 3개월 및 6개월에 기저치보다 통계적으로 유의하게 증가한 후 감소하였다. 혈청 IGF-I과 FGF-2는 각각 이식 후 3주 및 1주까지 의미있게 감소하다가 이후 증가하였으며 혈청 M-CSF는 이식 후 1주째에 기저치에 비해 의미 있게 증가하였다가 이후 기저치로 회복되었다. 이식 1년 후 평균 요추부 골밀도는 5.2% 감소하였고 평균 근위대퇴골 골밀도는 11.6% 감소하였다. 이식 전 및 이식 후 3주에 측정한 IGF-I과 같은 시기에 측정한 오스테오칼신 사이에 유의한 상관관계가 관찰되었으며 이식 후 3주째의 M-CSF와 골흡수표지자인 M-CSF 사이에서 의미 있는 양의 상관관계를 관찰할 수 있었다. 이식 후 3주 및 3개월에 IGF-I이 낮은 환자일수록 이식 1년 후 근위대퇴골에서의 골소실이 많은 것으로 분석되었다. 결론: 조혈모세포이식 후 발생하는 골소실에는 기존에 알려진 기저질환의 영향, 성호르몬의 감소, 면역억제의 투여, 골수기질세포와 조골세포의 손상 및 이식초기 사이토카인의 변화이외에도 골성장인자가 관련이 있음을 확인하였고, 이는 이식 후 발생되는 골량소실에 중요한 역할을 할 것이라고 사료된다. Background: A loss of bone mass is usually detected after a bone marrow transplantation (BMT), especially during the early post-transplant period. We recently reported that enhanced bone resorption following a BMT was related to both the steroid dose and the increase in IL-6. We also suggested damage to the marrow stromal microenvironment, by myoablation, partly explains the impaired bone formation following a BMT. It is well known that some growth factor play important role in bone growth and osteogenesis. However, the pathogenetic role of bone growth factors in post-BMT bone loss is unknown and data on the changes in the growth factors, in accordance with bone turnover markers and bone mineral density (BMD) changes are scarce. We investigated changes in bone growth factors such as IGF-I (Insulin-like growth factor-I), fibroblast growth factor-2 (FGF-2) and Macrophage colony stimulating factor (M-CSF), during the post-BMT period, and assessed whether the growth factor changes influenced the bone turnover and post-BMT bone loss. The present study is the first prospective study to describe the changes in bone growth factors following a BMT. Methods: We prospectively investigated 110 patients undergoing a BMT, and analyzed 36 patients (32.4±1.3 years, 17 men and 19 women) whose BMDs were measured before, and 1 year after, the BMT. The serum biochemical markers of bone turnover were measured before, 1, 2, 3 and 4 weeks, 3 and 6 months, and 1 year, after the BMT. The serum, FGF-2, IGF-I and M-CSF levels were measured before and 1 and 3 weeks, and 3 months after the BMT. The correlation between the changes of growth factors and various bone parameters was analyzed. Results: The mean bone losses in the lumbar spine and total proximal femur, calculated as the percentage change from the baseline to the level at 1 year, were 5.2(p<0.05) and 11.6%(p<0.01), respectively. the serum type I carboxyterminal telopeptide(ICTP), a bone resorption marker, increased progressively until 6 months after the BMT, but thereafter decreased, to the base value after 1 year. Serum osteocalcin, a bone formation marker, decreased progressively, until 3 weeks after the BMT but then increased transiently, and finally returned to the base level at 1 year. The serum IGF-I and FGF-2 also decreased progressively until 3 weeks 1 week after the BMT, respectively, then increased to the base values at 3 months. The serum M-CSF increased briskly at 1 week post-BMT, then decreased to the base level. There were positive correlations between the percentage changes from the baseline proximal femur BMD and the IGF-I levels 3 weeks and 3 months (r=0.52, p<0.01, r=0.41, p<0.05) post BMT. A significant correlation was found between the IGF-I and osteocalcin levels pre-BMT, and 3 weeks after the BMT. Another positive correlation was found between the M-CSF and the ICTP levels at 3 weeks post BMT (r=0.54, p<0.05). Conclusion: In conclusion, there were significant changes in the serum IGF-I, FGF-2 and M-CSF levels in the immediate post-BMT period, which were related to a decrease in bone formation and loss in the proximal femoral BMD during the year following the BMT (J Kor Soc Endocrinol 17:664∼674, 2002).

직장암에서 수술 전 방사선-화학요법 후 발생한 후기 합병증

이승현,이철민,안병권,백승언 고신대학교 의과대학 2011 고신대학교 의과대학 학술지 Vol.26 No.1

OBJECTIVES: To compare the late complications after operations for rectal cancers with and without preoperative chemoradiation. METHODS: From January 2003 to December 2005, 55 patients underwent operation after preoperative chemoradiation for adenocarcinoma of the rectum. All of them received the full scheduled dose of radiation with concurrent chemotherapy. The interval between preoperative chemoradiation and surgery was 4-6 weeks. 47 patients who had tumors below 8 cm from the anal verge were enrolled into the study group (CRT group). During same period, we selected 153 patients who had adenocarcinoma of the rectum below 8cm from the anal verge, underwent surgery alone without postoperative radiotherapy non-CRT group). We compared the early and the late postoperative complications between the CRT group and the non-CRT group. RESULTS: Of the late complications, the incidence of anastomotic stricture was significantly higher in the CRT group (P = 0.018). The incidence of anal stricture was higher in the CRT group (P = 0.164). In the CRT group, 3 cases (17.6%) had failed to preserve the anal function due to moderate or severe anal stricture. Of the 3 cases, protective ileostomy was persistent in 2 cases, colostomy was performed in one case. Otherwise, the late complications of the CRT group were intestinal obstruction in 2 cases (4.3%), lymph edema in 2 cases (4.3%). CONCLUSION: In CRT group, failure of anal function preservation due to anastomotic stricture or anal stricture was more common and serious than non-CRT group. We emphasize the need for careful management for postoperative anal stricture after preoperative chemoradiation.