급성백혈병의 화학요법에서 조혈간세포 보충요법

이규보,배선근,손상균,이재태,이건수,이경혜,서장수 경북대학교 병원 1997 경북대학교병원의학연구소논문집 Vol.1 No.1

1. 목적 급성백혈병의 화학요법에 있어서 관해유도 요법시에 보다 더 강력한 항암화학요법을 시행하고 골수억제의 회복을 위하여 말초혈액에서 채취한 조혈모세포의 투여로 그 효과를 증대시키고자 시도하였다. 2. 방법 관해유도 화학요법후에 골수억제시기로부터 회복단계로서 백혈구감소증이 호전도면서 단핵세포가 증가될 때에 말초혈액에서 조혈간세포(stem cell)로 인정되고 있는 CD34+세포의 함유량이 1% 이상되는 시기를 찾아내고 그 때부터 평균 4차례의 단핵구를 분리채집을 하여 -74。C에 냉동보관하였다가 제2차 화학요법후에 해동시켜서 정맥주입하였다. 3. 결과 대상 급성백혈병환자는 6명에 23회의 조혈간세포를 함유한 단핵구 채집을 시행하였고 유효한 단핵구의 채집은 4례에서 가능하였고 2례에서는 유효한 채집이 못되었다. 채집효율은 39.0-74.5%로서 평균 49.8%였다. 채집 후에 혈액학적 변화는 혈색소의 약간 감소 (평균 1.34g/dl)와 혈소판의 감소 (평균20.25%)를 나타내었다. 해동 단핵구를 투여할시에 일과성인 불쾌감, 기침, 흉부압박감, 호흡곤란 등이 있었다. 4. 결론 자가골수이식에서 자기말초혈액조혈간세포이식으로 관심이 이행되는 현시점에 자가조혈간세포를 채집하여 수혈하는 기술이 확립되는 기초를 이루었다고 본다. 이번 대상들은 재발된 금성백혈병들에 시행하였으나, 향후에는 초발시에 제일차 관해유도 화학요법 과정에 시도해야할 것으로 생각한다. Object: Peripheral blood stem cells(PBSC) were collected after remission induction chemotherapy and reinfused after intensified chemotherapy in order to increase the chemotherapeutic efficacy. Method: Collection of mononuclear cells (MNC) was started when CD34+ cells above 1% and WBC above 1,000/ul with mononuclear cell percentage above 30%, the collection procedures were done 2-6 time in each patient of total 6 cases. The collected MNCs were stored in - 750C and reinfused after thawing in the water bath at 370C Results: Twenty three collection procedures from the 6 cases of acute leukemia had made effective MNC collection in 4 cases and mean collection efficiency was 49.8%(from 39.0% to 74.5%). Hematological changes after the procedure were mean reduction of hemoglobin 1.34g/dl and mean 20.25% of decreased platelet count. There were noticed transient symptoms of discomfort, coughing, chest tightness and dyspnea in association with the infusion of stored cells. Conclusion: The basic process for the peripheral blood stem cell transplantation (PBSCT) was accomplished with this supportive care for the consolidation chemotherapy of acute leukemia. Effective PBSCT would be warrented with more qualified process and high does chemotherapy. (Korean J Blood Transfus 6(2) : 41~47,1995)

림프종 환자에서의 갈륨, TI-201 그리고 Tc-99m MIBI 섭취의 비교

천경아,조인호,원규장,이경희,이형우,현명수,이재태,이규보 영남대학교 의과대학 2002 Yeungnam University Journal of Medicine Vol.19 No.2

Purpose; Ga-67 scintigraphy has been used for the evaluation of tumors, especially lymphoma. Recently, Tl-201 and Tc-99m MIBI were also used to tumor imaging. Tl-201 and Tc-99m MIBI had better physiologic characteristics than Ga-67, so we studied 32 biopsy proven lymphoma patients (male 24, female 8, mean age 46 years) with Ga-67, Tl-201 or Tc-99m MIBI and compared the scan findings. Materials and Methods: Twenty-three of 32 patients were injected 74-111 MBq (2-3 mCi) of Tl-201, before chemotherapy and imaged with dual-headed SPECT (Prism 2000, Picker, USA) at 30 minutes after injection. Delayed images were obtained after 3 hr in 8 patients. Twenty seven of 32 patients were injected 740 MBq (20 mCi) of Tc-99m MIBI and imaged at 30 minutes after injection. 111-185 MBq (3-5 mCi) of Ga-67 was injected in 12 patients and imaged at 48 and 72 hours after injection. Twenty eight patients were diagnosed as non-Hodgkin's lymphoma and others were Hodgkin's lymphoma. Results: Twenty patients were positive on Tl-201 scan and 3 patients showed negative findings. One of these 3 patients, Tc-99m MIBI and Ga-67 scan were positive. Twenty two patients were positive on Tc-99m MIBI scan and 5 patients showed negative findings. One of these 5 patients, Tl-201 was positive and 2 were positive on Ga-67 scan. Ten of 12 patients showed positive findings on Ga-67 scan. The sensitivity of these agents were 83.3%, 87.0% and 81.5% for Ga-67, Tl-201 and Tc-99m MIBI, respectively. The sensitivity was highest in Tl-201 scan, but there were no significant differences among three tests. In this study, there was no significant difference of uptake ratios between early and delayed images of Tl-201. Conclusion: Scintigraphy with Tl-201 and Tc-99m MIBI in lymphoma patients have similar sensitivity with Ga-67.

제2형 당뇨병 환자에서 우연히 발견된 기종성 방광염 1례

박보민,김윤정,이영태,노정현,권수경,김동준,고경수,이병두,임경호,이순희,박정현 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Emphysematous cystitis is an uncommon disease in which bacterias produce gas within the bladder wall and surrounding tissue. Patients with diabetes, neurogenic bladder and chronic urinary tract infection are predisposed to the disease. It is usually caused by E.coli and Klebsiella. Severity of illness ranges from an asymtomatic condition to life threatening cystitis. Succesful management depends on early diagnosis with correction of underlying causes, administration of appropriate antibiotics, establishment of adequate bladder drainage and surgical excision of involved tissue when required. We report a case of 52-year-old woman who did not compain of symtoms of cystitis but epigastric pain, nausea, and vomitting. Emphysematous cystitis was revealed on the abdominal X-ray series incidentally. CT scans of the pelvis showed mottled gas bubble within the bladder. After treatment, the symtoms subsided and plain abdominal film showed no evidence of gas shadow in the pelvic cavity.

자궁경부암에서 혈관 내피 성장인자 ( VEGF ) 및 VEGF Mrna 의 발현에 대한 연구

이선경(Seon Kyung Lee),김승보(Seung Bo Kim),지성길(Sung Gil Chi),염윤석(Yoon Seok Yum),이주희(Ju Hee Lee) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.1

Objective : Angiogenesis, the formation of blood vessels by sprouting from pre-existing ones, is essential for the growth of solid tumors beyond 2~3mm in diameter and for tumor metastasis. Vascular endothelial growth factor (VEGF), is known as vascular permeability factor(VPF) and mediates vascularization and tumor-induced angiogenesis. This study examined the potential of growth, invasion, and metastasis of uterine cervical carcinomas associated with neovascularization. Methods : From January 1996 to December 1999, at the Department of Obstetrics and Gynecology, Kyung-Hee University Hospital, 37 uterine cervical carcinomas and 7 normal cervical tissues were obtained and the samples were immediately frozen and stored at -70℃. Immunohistochemical staining for VEGF was carried out to study VEGF localization, and the levels of VEGF subtype mRNAs were determined by quantitative RT-PCR in specimens. The relation between VEGF subtypes expression of cervical cancers was analysed. Results : The positive staining for VEGF is seen dominantly in the cytoplasm of the cancer cells, and faintly in interstitial cells. The intensity of staining was stronger in squamous carcinomas than in adenocrcinomas, but there was no significant difference (p>0.05). Quantitative RT-PCR analysis demonstrated significantly increased VEGF121/VEGF165 mRNA expression levels (>0.56/>0.72) in 21 (56.8%) and 15 (40.5%) of 37 cervical carcinomas comparing to control groups (mean: 0.28/0.36). There was no obvious relationship between VEGF121/VEGF165 mRNA expression levels and the clinical parameters examined including age, pathology, differentiation, tumor size, lymphovascular space invasion, LN involvement and invasion depth except clinical stage (p<0.05). Conclusions : The overexpression of VEGF mRNA may be an important contributing factor in cervical carcinomas. There is no significant differenece of VEGF mRNAs levels according to clinical parameters, so it seems that the expression of VEGF is involved in the promotion of angiogenesis on cervical cancer and plays an important role in early invasion.

선행 제왕절개 후의 질식 분만시 성공군과 실패군의 비교연구

최현수(Hyun Soo Choi),이상욱(Sang Wook Yi),오영승(Young Seung Oh),진규섭(Kyu seop Jin),이보연(Bo yon Lee),이선경(Seun Kyung Lee),허주엽(Chu Yeop Huh),김승보(Seung Bo Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.10

Objectives: Vaginal birth or trial of labor after previous cesarean section has become one of the most remarkable changes in obstetric practice. The safety and efficacy of a trial of labor and vaginal birth after previous cesarean are well documented. The purpose of this report is to predict the likelihood of vaginal birth in patients undergoing a trial of labor after previous cesarean delivery using factors known at the time of hospital admission. Method: In this retrospective study, 120 women who attempted vaginal birth at Kyung-Hee University Hospital from March 1997 to March 1999. An attempt to identify possible prognostic factors for success of such a trial was made and we evaluated the variables of significant predictive value and the patients' characteristics in the success group and failure group of women who attempted VBAC. Result: 87 cases(72.5%) in 120 cases succeeded in VBAC and 33 cases(27.5%) failed. In this comparative groups in VBAC, there was significant difference in CPD index(cephalopelvic disproportion index) and Bishop score, but no significant difference in gestational age, the estimated fetal weight by sonography and newborn birth weight. Conclusion: In this study, Bishop score and CPD index and age may be useful and valid predictor of success in VBAC and this information could be particularly valuable. The CPD index may prove most important in determining if a vaginal birth should occur after a cesarean section because it can clearly identify some patients who need a repeat cesarean section.

선행 제왕절개술 후 질식 분만: 성공의 예측인자들

동서연 ( Seo Yun Tong ),김여홍 ( Yeo Hong Kim ),최영준 ( Young Jun Choi ),김소라 ( So Ra Kim ),이보연 ( Bo Yon Lee ),이선경 ( Seon Kyung Lee ),허주엽 ( Chu Yeop Huh ),김승보 ( Seong Bo Kim ) 대한주산의학회 2003 Perinatology Vol.14 No.4

목적: 선행제왕절개 후 질식분만을 시도한 산모들 중 성공군과 실패군을 비교하여 성공을 예측할 수 있는 인자를 알아보고자 하였다. 방법: 1997년 3월부터 2003년 2월까지 경희대학교 의과대학 산부인과에서 선행제왕절개 후 질식분만을 위하여 내원한 환자중 질식분만의 금기가 아닌 경우 위험요소 등에 대하여 충분히 상의한 후 분만을 시도한 382명의 환자를 대상으로 하였다. 대상군의 의무기록을 통하여 분만당시 산모의 나이, 분만력, 제태연령, 신생아 몸무게, 입원시 자궁경부 상태 및 Bishop score, 분만의 진행과정, 결과 및 합병증을 조사하여 성공군과 실패군의 차이를 비교분석 하였다. 결과: 292(76.5%)명이 질식분만에 성공하였다. 여러 인자 중 태아의 몸무게(odds ratio, 0.2 ; 95% confidence interval (CI), 0.1-0.4), 입원시 Bishop score(odds ratio, 1.8 ; 95% CI, 1.5-2.1), 질식분만의 과거력(odds ratio, 3.6 ; 95% CI, 1.1-11.6)이 VBAC의 성공과 관련이 있었다. 또한 선행제왕절개시 적응증이 태위이상인 경우에 성공률이 높은 것으로 나타났다(odds ratio, 3.2 ; 95% CI, 1.2~8.6). 입원시 Bishop score로 VBAC의 성공을 예측할 수 있는 지 알아보기 위하여 receiver-operating characteristic curve 분석을 시행하였고, 5점을 cut-off로 하였을 때 47.4%의 민감도와 87.6%의 특이도를 보였다(AUC, 0.765 ; p<0.05). 결론: 출생체중, 질식분만의 과거력, 입원시 Bishop score가 선행제왕절개 후 질식분만을 고려하는 경우 성공의 예측인자로서 유용하게 사용되어 질 수 있을 것이다. Objective: The purpose of this report is to determine the predictable factors for successful vaginal birth after cesarean (VBAC). Methods: In this study, 382 women who attempted VBAC at Kyung-Hee university hospital were included. The medical records of them were reviewed retrospectively. Informations was collected about demographics, medical history, obstetric history, neonatal birth weight, complications, treatment, and outcome of the index pregnancy. Results: The overall success rate was 76.5% (292 cases). Among variables, neonatal birth weight (odds ratio, 0.2; 95% confidence interval, 0.1-0.4), Bishop score at admission (odds ratio, 1.8; 95% confidence interval, 1.5-2.1 ; p<0.05), and history of vaginal delivery (odds ratio, 3.6 ; 95% confidence interval, 1.1-11.6 ; p<0.05) were significant. The Bishop score showed most significant relationship with successful VBAC. The Bishop score 5 at admission had a sensitivity of 47.4% and a specificity of 87.6% in the prediction of successful VBAC. Malpresentation as indications of previous cesarean delivery showed more tendency to succeed than others. Conclusion: Several factors such as birth weight, Bishop score at admission, and history of vaginal delivery may be used to predict the success of VBAC.

집적화된 실리콘 압력센서의 출력전압 보상파라미터 추출 및 그 특성

이보나,김건년,박효덕,신상모,이경탁,김찬,권혁채,이상조,박현주 경북대학교 센서기술연구소 1998 센서技術學術大會論文集 Vol.9 No.1

An integrated silicon pressure sensor has been designed, fabricated and tested. The signal conditioning circuits were designed to include calibration and temperature compensation of output voltage through trimming of diffusion and ion-implanted resistors. Before trimming of resistors, the compensation parameters such as pressure sensitivity, temperature coefficient of pressure sensitivity, temperature coefficient of piezoresistors and pressure sensitivity of piezoresistors were measured. Then offset voltage, span, and temperature coefficients of offset voltage and span were calibrated by trimming of resistors. The measured output voltage met our design specification and simulation value above room temperature. But, the measured output voltage at -30°C deviated from our design specification and simulation value because the offset voltages were found to vary randomly as a function of temperature.

장천공이 발생한 비장티푸스성 D군 살모넬라 장열 1례

이진호,허진국,나종천,김의석,이혜경,신보문,김석호,고행일 대한감염학회 2004 감염과 화학요법 Vol.36 No.4

비장티푸스 살모넬라증에 의한 장열과 장천공은 매우 드물다 저자들은 방어기전의 손상이 없는 건강한 성인에서 비장티푸스성 D군 살모넬라 장열에 동반된 장천공이 발생한 예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. The case of enteric fever and bowel perforation caused by nontyphoidal Salmonella spp. is extremely rare. We report a case of a 28-year-old man who suffered from enteric fever with complicated a small bowel perforation, which is a known complication of S. typhi and S. paratyphi infections. The culprit later proved to be nontyphoidal group D Salmonella spp. in our case.

경피적 중심 정맥 도관의 임상적 적용에 관한 연구

이희경,김영창,이혜경,박보림 순천향의학연구소 1997 Journal of Soonchunhyang Medical Science Vol.3 No.1

신생아실에서의 미숙아 및 선천성 기형의 치료의 발달과 함께 중심 정맥의 필요성이 증가되면서 경피적 중심 정맥 확보인 경피적 정맥 도관(PCVC)을 시행하게 되었으며 현재 널리 이용하계 되었다. 1995년 5월에서부터 1997년 4월까지 본원 신생아실에서 경피적 정맥 도관을 시행받은 78례에 대상으로 후향적으로 성공률의 유무, 도관 유지, 문제점, 합병증등을 알아 보아 향후 치료에 도움을 얻고자 본 연구를 시행하였다. 1. 경피적 정맥 도관을 시행한 78례중 64례(80.8%)에서 시술에 성공하였으며 본 시술만 전담하는 간호사에 의해 시행한 1997년 1월에서 4월까지 성공률은 95.3%였다(p<0.001). 2. 73.1%가 총정맥 영양법을 위해 시행되었고 이중 43.6%가 미숙아로 인한 총정맥 영양법을 위해 본 시술이 필요하였으며 17.9%는 항생제를 포함한 장기간의 약제 사용을 위한 정맥 확보를 위해, 9%에서 고농도의 용액의 사용을 위해 시술되었다. 3. 시술 부위는 주관절 정맥이 59.4%로 가장 많았고 액와 정맥이 35.9%로 많았다. 4. 시술후 도관의 위치는 우심방이 44.9%, 상대 정맥이 12.8%, 액와 정맥이 21.8%, 하대 정맥이 1.3%, 무명정맥이 1.3%로 우심방과 상대 정맥에 위치한 경우와 그이외 말초 부위에 위치한 경우를 비교했을 때 우심방과 상대 정맥에 위치한 경우가 도관의 유지기간이 의의있게 길었다(p<0.001). 5. 도관 제거의 이유는 더 이상 수액 제제가 피료치 않아 계획적으로 제거된 경우가 56.3%, 기계적 폐색등으로 제거된 경우가 21.9%, 도관과 관련된 감염으로 제거된 경우가 3%순이었다. 6. 도관 제거후 배양 검사를 시행한 36례중 9례(25%)에서 균이 배양되었고 staphylococcus epidermidis와 candida albicans가 대부분을 차지하였다. Percutaneous central venous catherization(PCVC) is performed commonly as a vascular access procedure for a various indications in the neonatal intensive care unit (NICU). We evaluated a total of 78 PCVC cases performed in the NICU over 2 years from April, 1995 to April, 1997 in terms of age, success rate, indications, insertion sites, indwelling time and causes of removal of catheters, and associated complications including sepsis retrospectively. The results are described below ; 1. Patient ages and body weights at the time of insertion ranged from 1-120 days (average age, 10.9 days) and from 660-4,100 gm(average weight, 2,119 gm) respectively. 2. The overall success rate of insertions was 80.8%, however, the insertions attempted by highly- trained nurse were successful in 95.3 % from Jan. to April, 1997. 3. The most common indication was total parenteral nutrition (73.1%). 4. The insertion sites were cubital vein(59.4%), axillary vein(35.9%), and external jugular vein(3.1%). 5. The locations of catheter tip were right atrium(44.9%), axillary vein(21.8%), superior vena cava(12.8%), and inferior vena cava(1.3%). 6. The indwelling time ranged from 1-52 days (average, 12.6 days). When the catheter tips were placed in the right atrium or superior vena cava, the catheter was placed in the longer duration compared to those of other sites significantly. 7. The causes of removal of catheter were elective (56.3 %), mechanical obstruction(21.9%) and catheter related infection(3%). 8. The cultures of catheter tip were done after removal in 36 cases, among them cultures were positive in 9 cases(25%) the most common causes were S. epidermidis and Candida albicans.

불소투여 후 배출된 요내 불소농도 변화에 관한 연구

이보경,김종철,김태영 大韓小兒齒科學會 2000 大韓小兒齒科學會誌 Vol.27 No.1

국소적으로 사용된 불소의 일부와 전신적으로 사용된 불소는 체내로 유입되어 유식을 예방하는 효과를 가진다. 그러나 적정 수준이상의 불소가 체내로 유입되면 전신적으로 여러가지 이상을 일으키는 급성, 만성 불소증과 치아불소증을 일으킬 수 있다. 따라서 최대한의 우식예방 효과를 가지며 부작용을 일으키지 않는 적절한 불소량을 아는 것은 매우 중요하다고 할 수 있다. 이러한 불소의 섭취량을 역추적 할 수 있는 가장 일반적인 방법으로는 체외로 배출되는 요내 불소농도를 측정하는 것을 들 수 있다. 따라서 불소투여 후 불소의 체내 잔류시간과 일별 요내 불소농도를 비교하고자, 7명의 성인 남자를 대상으로 서로 다른 용량의 불소보조제- 대조군: 불소를 복용하지 않은 군, 1군; 불소 1mg복용군, 2군 : 불소 2mg 복용군, 3군 : 불소3mg복용군, 4군 : 불소 4mg 복용군-를 복용시킨 후 시간변화에 따른 요내 불소농도를 HMDS를 이용한 확산법과 불소이온전극 (Orion, 96-09, U.S.A)을 사용하여 측정하고 다음과 같은 결과를 얻었다. 1. 대조군 요내 불소농도의 평균값은 0.707PPM, 표준편차는 0.362PPM이었다. 2. 불소투여 후 첫날 요내 불소농도는 4군 (4.076PPM), 3군(2.400PPM).2군 (1.494PPM) 1군(0.362PPM)순으로 높았다. 둘째날부터 1,2,3군에서는 대조군과 비교시 통계적 유의차를 보이지 않았으나 4군에서는 둘째날까지 대조군보다 유의성 있게 높았다.(P<0.05) 3. 투여된 불소량의 증가에 따라 요내 불소농도도 증가되어 유지되었는데, 둘째날까지는 유의성있게 높게 유지되었고 셋째날부터는 대조군과 통계적 유의차를 보이지 않았다. Part of the locally applied, as well as the systemic applied, fluoride is absorbed into the body to aid in the prevention of caries. However, beyond a certain level, systemic distribution of fluoride can cause chronic fluorosis with attending systemic symptoms and dental fluorosis. Thus it is vital to determine the level of fluoride with minimal side effects which will provide optimal caries prevention. A commonly utilized method of regressively determining fluoride intade is to measure the fluoride concentration of excreted urine. Thus, the aim of this study was to determine the clearance time and concentration of fluoride in urine after administration of various doses of fluoride using HMDS-diffusion technique and fluoride ion electrode (Orion, 96-09, U.S.A). Urine samples were collected in 7adult subjects every morning after administration of fluoride supplements such as mo fouoride(control group), 1mg fluoride (group 1), 2mg fluoride(group 2), 3mg fluoride (group 3), 4mg fluoride(group 4). The obtained results were as follows: 1. Mean urinary fluoride concentration of control group was 0.707±0.362ppm) 2. Fluoride levels followed as group 4*4.076ppm), group 3(2.400ppm), group 2(1.494ppm), group 1(1.051ppm) at day 1 after fluoride administration. There were mo statistical differences between the urinary fluoride concentration of group 1,2,3 and control group after day 2, but there was statistical difference between group 4 and control group at day 2 (p<0.05). 3. Urinary fluoride concentration increased and plateaued according to increasing fluoride dosage. The increased concentration remained significantly higher till day 2, but after day 3, there was no significant difference compared to the control.