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      • KCI등재후보

        조혈모세포이식 환자에서 침습성 진균 감염에 대한 이트라코나졸 액과 플루코나졸 시럽의 예방 효과 : 전향적, 무작위, 비교 임상시험

        최수미,이동건,최정현,박선희,엄기성,김유진,김희제,민창기,유진홍,김동욱,이종욱,민우성,신완식,김춘추 대한감염학회 2005 감염과 화학요법 Vol.37 No.2

        목적 : 조혈모세포이식 환자에서 호중구 감소 기간 동안 이트라코나졸 액(ITZS)과 플루코나졸 시럽(FCZS)의 진균 감염에 대한 예방 효과를 전향적으로 비교해 보고자 하였다. 재료 및 방법 : 2001년 8월부터 2002년 6월까지 가톨릭 조혈모세포이식센터에 입원하여 동종 조혈모세포이식을 받은 만 18세 이상의 환자들을 각각 ITZS와 FCZS군으로 무작위 배정하여 침습성 진균 감염 발생과 약제 관련 부작용을 전향적으로 조사하였다. 결과 : ITZS군에 40명, FCZS군에 38명이 배정되었고, FCZS군 환자의 평균 나이가 더 많았다. 시험 약제 평균투여기간은 ITZS군 16.4일, FCZS군 21.9일로 ITZS군이 더 짧았다. 이는 ITZS군에서 소화기 부작용으로 인한 약제 중단이 더 많았기 때문으로 보인다. 시험 약제 투여 후 총 빌리루빈 수치의 유의한 증가가 관찰되었으나, 약제 관련 부작용은 모든 환자에서 가역적이었다. 호중구감소 기간동안 표재성 진균 감염은 두 군에서 모두 발생하지 않았고, 침습성 진균 감염은 ITZS군 5명(12.5%), FCZS군 8명(21.1%)으로 FCZS군에서 많았으나, 통계학적으로 유의하지 않았고, 사망률에도 유의한 차이는 없었다. 결론 : 침습성 진균 감염에 대한 이트라코나졸 액과플루코라졸 시럽의 예방 효과에 유의한 차이는 없었으나, 앞으로 더 많은 환자를 대상으로 잘 짝지어진 대조군 연구가 필요할 것으로 보인다. 부작용 중 간독성과 관련하여 이식시 투여되는 여러 약제들과의 상호작용에 대한 연구도 필요할 것이다. Background : Though fluconazole is widely used for antifungal prophylaxis, it is ineffective against mould infections including Aspergillus species. Itraconazole has a broader spectrum than fluconazole but the capsule form shows erratic bioavailability in neutropenic patients. In this study, we compared itraconazole oral solution (ITZS) with fluconazole syrup (FCZS) for the prevention of invasive fungal infection (IFI) in allogeneic hematopoietic stem cell transplant recipients. Materials and Methods : Adults receiving allogeneic hematopoietic stem cell transplantation (HSCT) from september 2001 to June 2002, were randomly allocated to either the ITZS group or the FCZS group. We prospectively evaluated the safety and efficacy of each drug. Results : Out of 78 patients (40 patients in the ITZS group and 38 patients in the FCZS group) who were eligible for this study, 37 patients completed the course of prophylaxis without any evidence of IFI. The mean duration of prophylaxis was 16.4 days for the ITZS group and 21.9 days for the FCZS group (P<0.006). Drug-related adverse events occurred in 28 patients (70.0%) and 19 patients (50.0%) in the ITZS group and the FCZS group, respectively. Common adverse events of ITZS were nausea, vomiting, and diarrhea. Drug-related reversible hepatotoxicity occurred in 4 patients in the ITZS group. There was a significant elevation of total bilirubin level in the ITZS group. The incidence of suspected IFI occurred in 5 patients (12.5%) who received ITZS, compared with 8 (21.1%) who received FCZS (P=0.372). There were no proven IFIs or superficial (oral/vaginal) fungal infections in both groups. Overall mortality was not different between the two groups (2.5% in the ITZS group versus 5.3% in the FCZS group, P=0.610). Conclusion : ITZS and FCZS showed similar protection against IFI during pre-engraftment period. Poor tolerability due to gastrointestinal troubles of ITZS might limit its success as prophylactic therapy. Well matched controlled study with large number of patients will be required in the future.

      • KCI등재후보

        조혈모세포이식 환자에서 발생한 Cytomegalovirus 질환의 특징 : 일개 대학변원에서 최근 10년간의 경험

        최수미,이동건,박선희,김시현,김유진,민창기,김희제,이석,최정현,유진홍,김동욱,이종욱,민우성,신완식,김춘추 대한감염학회 2009 감염과 화학요법 Vol.41 No.1

        Background : Studies on cytomegalovirus (CMV) diseases in Korean hematopoietic stem cell transplant (HSCT) recipients are lacking and do not reflect the recent trends of advances and changes. Therefore, we tried to analyze the clinical features of CMV diseases in HSCT recipients over the past 10 years at a tertiary university hospital in Korea. Methods : Retrospective review of medical records was done for all adult HSCT patients who received transplant at the Catholic HSCT Center from January 1998 to January 2008. Results : Forty-four cases (2.2%) of CMV diseases were identified. CMV pneumonia was diagnosed in 17 patients, retinitis in 16 patients, enterocolitis in 7 patients, esophagitis 1 patient, gastritis in 1 patient, duodenitis in 1 patient, and hepatitis in 1 patient. The median onset of symptom was 90 days after transplantation. Late CMV diseases accounted for 47.7%. CMV related death varied from 0 to 58.8% according to the involved organ. CMV retinitis was diagnosed relatively later in the course of transplantation mostly in patients who had chronic graft versus host disease (GVHD). On the contrary, CMV enterocolitis mainly occurred in patients who suffered from acute GVHD. The overall concurrent CMV reactivation was documented to be 63.6%: the concurrent CMV reactivation was observed only in 37.5% of patients with retinitis. Conclusions : We observed some differences in the pattern of CMV disease manifestation according to the involved organ and reconfirmed the fact that CMV pneumonia is the most common and fatal disease in HSCT recipients. Additionally, CMV retinitis was not uncommon in HSCT recipients. Since specific marker does not exist in predicting retinitis, regular ocular examination should be done thoroughly, especially in patients with chronic GVHD.

      • KCI등재

        열공형과 비열공형 피질하 혈관성 치매에서 위험인자의 차이에 관한 비교 연구

        배희준,정지향,유경호,나덕렬,김상윤,최경규,양동원,손의주,이상도,김재우,박경원,김응규,이재홍,박미영,한일우,함동석,최문성,하충건,최성혜,이애영,이병철,한설희 대한치매학회 2003 Dementia and Neurocognitive Disorders Vol.2 No.2

        Backgrounds and Objectives: Vascular dementia is a group of dementing disoders arising from various stroke syndrome. Among these. subcortical ischemic vascular dementia (SIVD) is regarded as a relatively distinct clinical entity. However, MRI patterns of SIVD are not homogenous. In some patients, lacunes are dominant, and in others, subcortical white matter changes are. This study was designed to compare risk factor profiles between SIVD with and without multiple lacunes. Methods: We divided 47 subjects (22 males, mean age. 68 years) recruited from VADAPET (Multicenter Trial For Evaluation Of The Changes In the PET Images Of Subcortical Vascular Dementia Patient) study into two groups one with more than 5 lacunes in deep gray matter (lacune group) and the other with 5 or less(non-lacune group) Clinical characteristics and laboratory findings of two groups were compared. Results: Nineteen of 47 patients (40%) belonged to the lacune group. The lacune and non-lacune groups d d not differ in the following variables: age, hypertension, diabetes mellitus, hyperlipidemia heart disease, history of stroke or TIA, history of trauma or major surgery, family history of hypertension stroke, or dementia, age at diagnosis of dementia, body mass index, white blood cell count, ESR, CRP, fibrinogen, hemoglobin A1C, total cholesterol. LDL cholesterol creatinine, proteinuria, glucosuria, and microhematuria. However, male sex, smoking alcohol. hemoglobin, and HDL cholesterol were possibly associated more with lacune group SIVD than with non-lacune group (p<0 1) Multivariate analyses revealed that smoking, hemoglobin, and HDL cholesterol were independent predictors of SIVD with multiple lacunes Conclusion: Our study suggests that SIVD with multiple lacunes may be significantly different in smoking habits hemoglobin, and HDL cholesterol from SIVD without multiple lacunes.

      • 현대패션에 표현된 스트라이프패턴의 이미지 분석

        신주동(Ju Dong Shin) · 김희숙(Hee Sook Kim) · 최종명(Jong Myoung Choi) 충북대학교 생활과학연구소 2008 생활과학연구논총 Vol.12 No.2

        The purpose of this study was to analyze the image of stripe pattern expressed in contemporary fashion. For this research, the fashion magazines, Dong-a TV, Internet sites were used as references. In the middle age, the use of stripe pattern was banned because it was regarded as the pattern of the devil in Europe. But nowadays the stripe pattern plays the role of symbolizing health, youth, and personality. The stripe pattern is being used in various kinds of patterns like alternate stripe, block stripe, candy stripe, chalk stripe, herringbone stripe, hombre stripe, pekin stripe, pin stripe, rope stripe, sports stripe, and stitch stripe. The stripe patterns were expressed by the techniques of weaving, printing, sewing, knitting, and embroidery. The image of stripe pattern appeared during 2006 S/S∼2008 S/S collections could be classified into five images of modern, mannish, elegant, exotic, and sporty image.

      • KCI등재후보

        조혈모세포이식 환자에서 침습성 진균 감염에 대한 Micafungin의 예방 효과 및 안전성

        김시현,이동건,최수미,권재철,박선희,최정현,유진홍,이성은,조병식,김유진,이석,김희제,민창기,조석구,김동욱,이종욱,민우성,박종원 대한감염학회 2010 감염과 화학요법 Vol.42 No.3

        Background: Micafungin, a potent inhibitor of 1,3-β-D-glucan synthase, is a novel antifungal agent of the echinocandin class. In vitro study showed that micafungin was effective against Aspergillus species as well as Candida species, but clinical data on the prophylactic efficacy against invasive fungal infections (IFIs) other than candidiasis are still lacking. Materials and Methods: We identified 60 consecutive adult hematopoietic stem cell transplantation (HSCT) recipients who received at least 3 doses of micafungin during neutropenic period. Micafungin was started as an alternative in patients who were intolerant or had adverse events (AEs) to primary prophylactic antifungal agents. We retrospectively reviewed the medical records and analyzed the efficacy and safety of micafungin for prophylaxis against IFIs. Results: The patients either had autologous (n=9) or allogeneic (n=51: 1 syngeneic, 24 sibling, 26 unrelated donor) HSCT. Itraconazole oral solution (n=58) was the most frequently used first line antifungal agent for prophylaxis and was administered for median 11 days. The most frequent cause of switch to micafungin was vomiting (n=42). The duration of neutropenia and micafungin administration was median 13 and 12 days, respectively. A successful outcome was achieved in 45 (75%) patients. Empirical antifungal therapy was initiated in 13 (22%) patients. There were 2 cases (3.3%) of breakthrough fungal infections which comprised a probable invasive pulmonary aspergillosis and a possible invasive fungal sinusitis. There was no case of invasive candidiasis. A total of 53 (88%) patients experienced at least one AE regardless of causality during micafungin administration. The most frequent AEs were hypokalemia, vomiting, diarrhea, and elevated serum aspartate aminotransferase or alanine aminotransferase. Among the aforementioned AEs, only 1 case of diarrhea could be classified as a probable relation with micafungin when causality was assessed. There was no AEs that caused discontinuation of micafungin. Conclusions: Micafungin seems to be a safe and effective agent for prophylaxis of IFIs including aspergillosis as well as candidiasis in HSCT recipients. However, further large, prospective, and randomized comparative studies are warranted for aspergillosis.

      • 인공효소 8-azaflavin이 기질과의 반응성

        최종정,이용희,이동환 한국공업화학회 2004 응용화학 Vol.8 No.2

        8-azaflavin was synthesized by condensation of 4-amino-3-N-methylamino pyridune and N-methylalloxane. An oxidation-active flavin mimic contributed substantially to flavin chemistry in model systems. One of the ways of exploting oxidation-active flavin mimics could be by introducing electron-withdrawing groups into the isoalloxazine ring thus providing an electron dificient flavin. We report that 8-azaflavin show remarkably high oxidizing activities for the oxidations of N-benzyl-1,4-dihydronicotinamide(BNAH) and nitroalkanes in aqueous solution.

      • 토양미생물을 이용한 하수의 질소제거효율 향상

        최영균,오동익,이종영,손대희 대구대학교 환경기술연구소 2005 미래환경기술 Vol.1 No.2

        The effect of humus soil on biological denitrification was investigated through NUR batch tests. Specific denitrification rate of HMLE(Modified Ludzack Ettinger process combined with Humus soil contactor) and CMLE(Control Modified Ludzack Ettinger process) sludges as well as COD consumed for denitrification could be estimated from the batch tests. Two linear phases of denitrification rate could be observed when acetate was used as a carbon source. However, denitrification behavior was composed of three linear phases when a primary settled municipal wastewater(PW) was used as a carbon source. The specific denitrification rates on SBCOD(slowly biodegradable COD) fraction in raw wastewater were estimated 4.82 and 3.73 mg N/g VSS·hr when HMLE and CMLE sludge was used as a seed sludge. It means that the hydrolysis rate of HMLE sludge on SBCOD fraction was higher than that of CMLE sludge. Actinomycetes, one of the soil microorganisms, was estimated 150,000 actinomycetes/ml in the biomass of HMLE process, which was 10 times higher than that of CMLE process. Actinomycetes was well known for its distinguished hydrolyzing ability on particulate organic matter. Almost of input COD was utilized for denitrification and cell synthesis when HMLE sludge was used as a seed sludge in NUR batch test. While, about 70% of input COD was comsumed when CBNR sludge was used. It means that substrate utilization rate, especially SBCOD utilization rate, of HMLE sludge was higher than that of CMLE sludge.

      • 월출산국립공원 수질특성에 관한 연구

        최형일,김난희,강영주,채희정,김연풍,조도호,설동화 조선대학교 환경공해연구소 2007 環境公害硏究 Vol.20 No.1

        Because mountain streams have narrow widths and steep slopes compared to streams and lakes, hours of immobility are considerably short, and the quality of mountain streams has been greatly influenced by rainfall, land-use, components of the streambed and types of forests. During the summer when heavy rainfall occurs, eroded earth and sand flow into mountain streams and cause temporarily high turbidity. It is also the cause of eutrophication, which is frequently found in downstream. As evaluation standards for the quality of mountain streams were not established in Korea, this quality was evaluated by examining some items based on quality standards for drinkable water and research on the influences of pollution in mountain streams, which showed that these were seldom in downstream water systems. Mountain streams within Wolchulsan National Park flow into a reservoir and when characteristics of mountain streams from forests and rainfall that flow into mountain streams through forest ecosystems were studied, results of measuring its changes are as follows. Monthly changes of pH were low between April and August and higher starting October, and the EC was measured higher in the winter and the spring and tended to be low starting April. The EC on the 19th of May and the 23rd of October and the concentration of floating materials and COD_(Mn) were observed to be higher due to the influence of rainfall on the 19th of May and the 22nd of October, and it was judged that the washing out of dried deposits attached to the water pipe and the leaching of woods were influenced by rainfall. It is considered that real-time monitoring of water quality for a long time and water quality conditions during and after rainfall should be examined for ensuring basic data of water quality and evaluating characteristics and seasonableness of mountain streams, which may be greatly changed by artificial influence in the future.

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