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.

간세포암과 하대정맥 막성폐쇄의 치료 후 호전된 백혈구파괴혈관염 1예

이준엽 ( Jun Yeob Lee1 ),이주원 ( Ju Won Lee1 ),이진욱 ( Jin Wook Lee ),박현준 ( Hyun Joon Park ),장국환 ( Gook Hwan Jang ),김다정 ( Da Jung Kim ),김선민 ( Sun Min Kim ),한병훈 ( Byung Hoon Han ),정규식 ( Gyoo Sik Jung ),김근태 ( 대한류마티스학회 2015 대한류마티스학회지 Vol.22 No.5

Vasculitis is a heterogeneous group of diseases that destroy blood vessel walls by inflammation. Approximately half of vasculitis cases are idiopathic, but sometimes associated with genetic factors, medicines, chronic infection, autoimmune diseases, and malignancies. Although the mechanism remains unclear, vasculitis secondary to malignancy, also known as paraneoplastic vasculitis, has been reported. It is generally associated with hematologic malignancies rather than solid malignancies and commonly presents as leukocytoclastic vasculitis or polyarteritis nodosa. We experienced a case of leukocytoclastic vasculitis in a patient with hepatocellular carcinoma and membranous obstruction of the inferior vena cava. Here, we report this case with a brief review of literature. (J Rheum Dis 2015;22:322-326)

여호와의 증인 환자에서 산과적 출혈 후 무수혈 치료 2예

김재령,여소진,이해혁,김정식,김태희,남계현,이권해,이임순,박진화,황경호 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Jehovah's Witness comprise a unique obstetric population. Their refusal of blood stems from an interpretation of a literal translation of the Bible, and it is this belief that puts them at an increased risk of morbidity and mortality if hemorrhage occurs. We report two cases of a Jehovah's Witness who bled massively due to obstetric hemorrhage, refused blood transfusion and had profound anemia. The patients were treated with recombinant human erythropoietin, parenteral iron and oxygen. And they were treated on an intensive care unit with intermittent positive pressure ventilation. We reviewed with literature considering the therapy for acutely anemic patients who refuse transfusion to decrease the duration of the most severe anemia.

생체분해성 고분자를 이용한 사시수술용 제형개발 및 효용성에 대한 연구

민병무,김용백,김승영,김창식,박근성,길숙종,조항진,이성복,노승무,송규상,강대영,조준식,양준묵,정경수,최선웅,이진호,김학용,인현빈 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

A new device, muscle clamping system was developed to facilitate exact quatifying technique A strabismus surgery, and reduce the risk of complications. The device is composed of a lower fixing body with three jaws and an upper supporting body. They are used to clip an extraocular muscle and fix it to the sclera with a single bite. Superior rectus recession on 16 rabbit eyes were performed with this new device. Conjunctival injection, muscle adhesion strength, and light microscopic findings were examined at 1, 2, 4 and 8 weeks postoperatively. The Conjunctival injection were minimal, adhesion power ranged from 420 to 600 gram gravity, which is sufficient in withstand the normal pull of human extraocular muscle. In microscopic exam, some Inflammatory cells and fibrosis were found. The new device was technically easy, fast, and accurate, so it may be useful in stabismus surgery.

생체분해성 망막압정을 이용한 망막고정에 대한 실험적 연구

김용백,민병무,김창식,박근성,김승영,길숙종,조항진,이성복,노승무,송규상,강대영,조준식,양준묵,정경수,최선웅,이진호,김학용,인현빈 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

Biodegradable retinal fixation devices obtain mechnical fixation of the retina with desirable chorioretinal scarring and with the potential for local, sustained release of antimetabolites and steroids to inhibit proliferative vitreoretinopathy. We manufactured a biodegradable retinal tack with barb that was designed in order to prevent intrusion from implantation of retinal tacks. This study was carried to evaluate the efficacy for retinal fixation and the capability for sustained release of drugs with a newly designed biodegradable retinal tack Biodegradable retinal tacks were made of polymers of glycolic acids and were designed with barbs in a shape to prevent the disinsertion. Biodegradale retinal tacks are divided into 3 parts, a conical portion that is inserted into the sclera, a cylinder portion that remains in the vitreous, and a neck portion between the pin and the cylinder. The tapered conical end was manufactured to allow easy insertion through the retina and choroid into the sclera. A cylinder portion was manufactured with a tapered angle that fixes firmly into the orifice of 19 gauge spinal needle. A neck portion, 0.4 mm in diameter, was designed to prevent disinsertion from following implantation of retinal tack. The applicator was a 19 gauge spinal needle and its orifice was prepared to 15°angle to accept the tapered cylinder portion of the retinal tack. The retinal tacks, secured in the needles, were passed through the formed vitreous and inserted into the retina, choroid, and sclera and were released by pushing the internal needle, usually within 2-3mm of the medullary ray of the posterior rabbit retina A retinal tack was placed in each of 8 pigmented rabbit eyes. Slit-lamp biomicroscopy, indirect ophthalmoscopy and fundus photography were performed periodically from 1 day to 8 weeks after surgery. Eight eyes were enucleated and studied by light microscopy at 8 weeks. Biomicroscopic evaluation of the animals revealed edemas adjacent to the retinal surfaces immediately after insertion of the biodegradable retinal tacks in all the animals. These edemas disappeared after 1 week. The first noticeable change in the size of retinal tacks was shown after 2weeks. The size of the retinal tacks gradually got smaller, decreasing to about one-half at 4 weeks and about one-third at 8 weeks. All retinal tacks remained in inserted places without any movement for an 8 week period. On light microscopy, epiretinal proliferations were seen to extend into the vitreous cavity. Cellular capsules that lined the inner aspect of the scleral defect caused by tack insertion were found. However the adjacent retina had a normal cytologic appearance and architecture in all specimens. We manufactured a biodegradable retinal tack that is designed to prevent intrusion from implantation of retinal tacks. All biodegradable retinal tacks reduce in size with time, but no retinal tacks extruded from the inserted place. The newly designed biodegradable retinal tack can be used for retinal fixation and may be used as a vehicle for the introduction of pharmacologic agents to prevent the cellular events that promote proliferative vitreoretinopathy.

한의진단명과 진단요건의 표준화 연구 III : 3차년도 연구결과 보고

최선미,양기상,최승훈,박경모,박종현,심범상,김성우,노석선,이인선,정진홍,이진용,김달래,임형호,김윤범,박성식,송태원,김종우,이승기,최윤정,신순식 한국한의학연구원 1997 한국한의학연구원논문집 Vol.3 No.1

The diagnostic requirements were suggested and explained regarding the systems of differentiation of symptoms and signs in the third year study of standardization and unification of the terms and conditions used for diagnosis in oriental medicine. The systems were as follows : - analyzing and differentiating of epidemic febrile disease - analyzing and differentiating in accordance with the Sasang constitution medicine based on four-type recognition - differentiation of disease according to pathological changes of Chong and Ren channels - standards for diagnosis of women's disease - standards for diagnosis of children's disease - standards for diagnosis of motor and sensor disturbance (-muscle. born, joint, etc.) - standards for diagnosis of neuropsychiatric disease - standards for diagnosis of five sense organ disease - standards for diagnosis of external disease The indivisual diagnosis pattern was arranged by the diagnostic requirements in the following order : another name, notion of diagnosis pattern, index of differentiation of symptoms and signs, the main point of diagnosis, analysis of diagnosis pattern, discrimination of diagnosis pattern, prognosis, a way of curing a disease, prescription, herbs in common use, disease appearing the diagnosis pattern, documents. The standards for diagnosis of each disease was arranged by the diagnostic requirements in the following order : another name, notion of disease, the main point of diagnosis, analyzing and differentiating of disease, analysis of disease, discrimination of disease, prognosis, a way of curing and prescription of disease, disease in western medicine appearing the disease in oriental medicine, documents.

고강도 콘크리트(80MPa이상)를 이용한 콘크리트충전강관구조 적용을 위한 기초물성 연구

이장환,강용학,정근호,김진호,정상진,최문식 대한건축학회 2003 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.23 No.2

One of the most important reasons that CFT is used in many conditions is by using that we can achieve the effect, which reduce the section of the member. This research purpose to find the most ideal composition, which is achieved by the investigation in the concrete's property of matter like ability of Slump, Slump Flow, Air content, Bleeding, and Settlement when the high strength of concrete which is over 80MPa is used m the CFT column.

精神分裂病의 5年 追跡調査 : 後向性 硏究 Retrospective Study

李定均,金容植,崔珍淑 大韓神經精神醫學會 1987 신경정신의학 Vol.26 No.4

To explore the possible factors affecting the course of schizophrenia and to clarify some questions on the nature of schizophrenia, a structured retrospective study was carried out to 142 patients (male 74, female 68) discharged from psychiatric department of Seoul National University Hospital during July, 1st 1981 - June, 30th 1982. The study group consisted of 97 patients diagnosed as schizophrenia according to DSM-Ⅲ and 45 controls, who met the following screening criterias, i.e., ⅰ) between the ages of 16 and 65, ⅱ) no evidence of organic, drug related or alcoholdisorder, iii) psychotic symptoms not due to any other mental disorders, such as manic episode, or atypical psychosis, or factitious disorder, etc. The data at index discharge were obtained from clinical records and filled up by one of researchers. Five year follow-up assessment was performed by 4 trained medical students, blind to clinical records, from Jan, 20th through Feb, 28th 1987. Among them 78 patients (male 40, female 38) were able to be traced and successfully interviewed. The average duration of follow-up was 62.2±7.2months(mean±S.D.). To investigate the prognostic significance and specific relations between predictors and outcome variables, 49 predictor variables were chosen from clinical records and 18 outcome variables were selected and grouped by 5-outcome dimensions. Outcome variables were length of rehospitalization during follow-up period, rehospitalization during the last one year, quality of social contact during the last one year, deterioration of work performance during the last one year, severity of psychopathology during the last one year. Results demonstrated some differences between schizophrenia and control groups in clinical records and follow-up assessments. Schizophrenia group definitely showed poorer outcomes than control group. Correlations of individual predictor variables with outcome were calculated, although significant statistically (P<0.05) were modest in their magnitude. Multiple regression analysis of the presenting predictor variables to the outcome dimensions showed correlation .29 -.77, thus explaining statistically about 8-59% of the outcome variance in schziophrenia group. Among them some predictor variables, i.e, work performance during the last one year, social contacts during the last one year, etc, presented high correlations with these outcome variables. Intercorrelations among the 5 outcome dimensions for schizophrenia group were calculated, dimensions correlated each other to a minimal or moderate degrees. Among them social contact correlated highly with individual outcome dimensions.

Glucagon 및 Cycloheximide 投與에 의한 흰쥐 肝細胞 lysosome의 變化에 관한 超微形態學的 硏究

이진식,김익동,배한익,서인수,김중길,곽정식,손태중 慶北大學校 醫科大學 1983 慶北醫大誌 Vol.24 No.2

저자는 체중 30∼35gm 정도의 ICR계 생쥐에 체중 100gm당 100㎍의 glucagon을 그리고 체중 100gm당 0.15mg의 cycloheximide를 각각 단독으로 또 이들을 같이 복강내에 병합 투여하여, 이때 간세포에 일어나는 형태학적 변화와 아울러 lysosome막의 유래의 일단을 알아보기 위한 실험성적을 요약하면 다음과 같다. 광학현미경적으로는 중심정맥 주위의 간세포이 종창과 한국성 지발변화가 나타났었는데, 그 정도는 glucagon 단독투여군과 cycloheximide와 glucagon을 병합투여한 군에서는 다같이 중등도로 일어났었다. 전자현미경적으로는 glucagon 단독투여 군에서는 간세포에 있어서의 lysosome의 현저한 증가, 특히 autophagic vacuole의 증가, 세포핵의 비대 및 핵소체수의 증가, 그리고 kupffer세포의 탐식 작용의 증가등이고 cycloheximide 단독투여군에서는 경한 lysosome의 증가, RER의 확장, 단열, ribosome의 탈락, free ribosome의 증가, Golgi complex의 위축, SER의 감소, mitochondria의 종창 및 공포화와 lipid droplet의 증가 등이다. 그리고 glucagon과 cycloheximide 병합투여군에서는 상기한 두가지 단독투여군의 소견과 여기에 더하여 peroxisome의 증가가 일어났으며, 이들 변화중 특히 autophagic vacuole의 증가는 glucagon 단독투여군보다 좀더 현저한 경향이었다. 이상의 연구성적으로 보아, glucagon은 간세포에 있어서 autophagy를 증가시킬 뿐 아니라, 핵에도 작용하여 그 비대를 일으키며, 이때 cycloheximide를 투여하여 단백합성을 억제하여도 autophagy를 저해하지는 않는다고 믿어진다. 따라서 autophagic vacuole의 한계막은 새롭게 신생된다기 보다는 세포내의 기존의 막, 예를 들면 SER, RER, Golgi막등 막성 성분에서 유래될 가능성이 지금으로서는 더 많은 것으로 생각된다. Glucagon은 autophagic vacuole을 증가시킬 뿐 아니라, cycloheximide를 투여한 후 glucagon을 투여한 경우에는 autophagic vacuole의 증가와 더불어 peroxisome도 증가시킬 것으로 추정된다. In order to investigate the morphologic changes and origin of membrane of lysosomes, the author administered glucagon, 100㎍ per 100gm of body weight, cycloheximide, 0.15㎎ per 100 gm of body weight and both to the healthy male ICR mice intraperitoncally. Each hepatic tissue was observed by light microscope and electron microscope. The results were summarized as follows. Light microscopically, swelling of heaptocytes and focal fatty change appeared around the-central vein. The severity of these changes was mild in the group administered glucagon and was moderate in groups administered cycloheximide alone, both cycloheximide and glucagon. Electron microscopically, in the group administered glucagon, marked increase of lysosomes, particularly autophagic vaculoles, enlargement of nuclei with increase of nuclcoli in thc hepatocytes and increase of phagocytosis in kupffer cells were appeared. In the group administered cycloheximide, slight increase of lysosomes, dilatation and fragmentation of RER, shedding of ribosomes, increase of free ribosomes, atrophy of Golgi complex, decrease of SER, swelling and vacuolizatlon of mitochondria, and increase of lipid droplets occured. In thr group aiministered both cycloheximide and glucagon, above findings in each group and additional increase of peroxisomes appeared. In these changes, increase of autophagic varuoles was more prominent in the group administered glucagon. From the above results, it is believed that glucagon induces enlargement of nuclei as increase of autophagy in the hepatocytes. At this time, in spite of suppression of protein synthesis by administration of cycloheximide, the autophage was not inhibited. Therefore it is more possible that the limiting membrane of autophagic vacuoles originates from preexisting membrane rather than front de novo synthesis. when glucagon was administered after administration of cycloheximide, peroxisomes as well as autophagic vacuoles were increased.

골격형 Ⅲ급 부정교합자의 경추와 수완부 골 성숙도에 관한 연구

이진형,양원식 대한치과교정학회 1990 대한치과교정학회지 Vol.20 No.1

This study was undertaken to investigate the interrelationships between the degrees of skeletal maturity of cervical vertebrae and the hand-and-wrist in skeletal Class Ⅲ malocclusions. In 185 skeletal Class Ⅲ malocclusions (male 62, female 123) having the lateral cephalogram and hand-wrist radiogram which were taken on the same day, 6 skeletal maturity stages of cervical vertebrae were compared with 11 skeletal maturity indicators of the hand-and-wrist. On the basis of findings of this study, the following results were obtained: 1. The stages of cervical vertebral maturity are one of the methods possible to assess the individual maturity. 2. Mean ages of male and female were obtained in each cervical vertebral stage. 3. Cervical vertebral stages 1 and 2 are considered to the accelerative growth phase, cervical vertebral stages 3 and 4 are corresponded to the peak height velocity, and cervical vertebral stages 5 and 6 were observed to occur during the decelerative phase of growth after peak height velocity in both sexes. 4. In cervical vertebral stages 1, 2, 3, 4, and 5, the degrees of skeletal maturity of cervical vertebrae in males were more retarded than females. 5. There was the high correlation between the degrees of skeletal maturity of cervical vertebrae and hand-and-wrist.