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.

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.

투고논문 : 청천(靑泉) 신유한(申維翰) 한시(漢詩)의 『초사(楚辭)』 수용양상(受用樣相)

최유진 ( Yoo Jin Choi ) 동방한문학회 2007 東方漢文學 Vol.0 No.33

본 논문은 18세기 전반에 활동한 중인층 문인인 靑泉 申維翰(1681~1752)의 의고주의 한시창작의 일환으로서 『楚辭』의 학습과 수용양상을 살피는 것을 목표로 하였다. 신유한은 先秦古文에 대한 애호에서 나아가 그것들의 문학적 가치와 수사적 탁월함의 인식을 기반으로 이를 詩文에 적극적으로 도입하려 하였다. 그는 『詩經』 이후에 정감의 진솔한 표현을 실현하고 계승한 것이 『楚辭』라 하여 그 가치를 인정하였는데, 이는 난초와 佩玉 등에 가탁하여 시인의 울결된 감정을 기탁하고 시적으로 형상화하여 詩道를 완전히 구현한 것이라는 인식에서 비롯된 것이다. 또한 『楚辭』에 쓰인 수사법을 사물에 감정을 가탁하는 수법(實中有虛)과 가설적 수법(虛中有實)로 나누어 분석하고, 시인의 내면에 있는 감정과 의지가 그것을 표상하는 사물과 상황의 설정을 통해 표현되고 있다고 보았다. 한편 신유한 한시의 실제 시작에 있어서 의고주의적 태도가 『楚辭』 등에 나타난 전통적 상징을 수용하면서도 그것이 개인적 상징체계로 변용되는 양상을 고찰하였다. 신유한 한시에 높은 빈도로 등장하며 중요한 의미를 지니는 상징들을 검출하여 분석한 바, 龍과 봉황 등은 주로 자신의 불우한 처지와 관련된 의미를 내포하고 난초, 계수나무 등은 자신의 고결한 인격의 표상으로써 작용하고 있음을 보았다. 아울러 『초사』에 담긴 道家的·遊仙的 사상과 모티브가 그의 한시에 어떠한 양상으로 도입되었는지를 살펴보았는데, 기질적으로 중국 고대 남방문화권과 친연성을 보이면서도 완전히 신선적 사상으로 경도되지 않고 현실참여적인 태도에서 벗어나지 않음을 알 수 있었다. The purpose of this manuscript is to study a receptive aspect and learning of the Chu-Ci as a part of writing of Chinese poetry with pseudo-archaism [擬古主義] by Shin Yoo-Han who was active as a literary man of the middle class in the first half of the 18th century. He intended actively to introduce something to have been based on their value of literature and recognition of a rhetorical excellence as well as loving of Pre-Qin archaic texts[先秦古文] into poetry and prose. Following the Shih-Ching[詩經], he recognized the value of the Chu-Ci as it realized and succeeded a true expression with sentiment. This came from recognition that it made an orchid or a jade commit the care of a poet`s sentiment with a depressed mood what expresses thought or feeling through things, and it embodied a poetic ideal to be of imagery with poetry. Also, it analyzed to divide a rhetorical method which was written in the Chu-Ci into Expression of feeling through things[實中有虛] and Expression of supposition[虛中有實]. It found that the poet`s inner sentiment and will would be expressed through setting of situation and things which symbolized it. On the other hand, in an actual poem writing of his Chinese poetry it considered such aspects that his attitude of pseudo-archaism was diverted it into a personal symbolic system as well as accepting a traditional symbol appeared on the Chu-Ci. This manuscript analyzed the symbols with a significant meaning and a high frequent appearance on his Chinese poetry, so that it found that the dragon and a Chinese phoenix have a meaning related to himself who was in adverse circumstances and the orchid and a cinnamon tree was worked as a representation of himself own noble-mindedness. Besides, it studied that motive and thought of Taoism which was contained within the Chu-Ci was introduced into his poetry with any aspect. Thesis found that he was of a friendly disposition to Southern cultural area in Chinese ancient history, however he did not devote himself to a perfect Taoism and also he did not escape from himself own attitude of participation in reality.

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.

고등급 보안 시스템을 위한 IPSec 시스템 기능 명세

유희준,김영미,최진영,서동수,노병규 고려대학교 컴퓨터과학기술연구소 2001 JOURNAL OF COMPUTER SCIENCE & ENGINEERING TECHNOLO Vol.3 No.-

현대 사회는 인터넷 사용자의 증가와 제반 기술의 비약적인 발전으로 사회활동 전반에 대한 인터넷 기반 서비스가 이루어지고 있다. 이런 과정에서 발생한 중요한 문제중의 하나가 불특정 다수가 자유로이 통신을 하기 위해 개발된 인터넷상에서 사용자의 보안을 보장해주는 것이다. 최근에 와서 인터넷상에서 개인 정보유출로 인한 많은 피해가 발생하면서 정보보호에 대한 관심이 더욱 증가하고 있다. 현재 이 문제를 해결하기 위하여 많은 보안 관련 시스템들이 개발되고 있으며, 세계 각 국의 표준 기구에서는 이러한 시스템에 대한 등급을 평가하고 있다. 각 등급을 살펴보면, 시스템 개발 초기부터 정형기법을 이용하여 개발되어진 시스템들이 고등급을 획득하고 있다. 국내에서도 한국정보보호센터(KISA)에서 보안 시스템에 대한 등급을 평가를 수행하면서 정형기법을 이용하여 땅세 검증된 시스템에게 K5이상의 고등급을 부여하고 있다. 이러한 등급을 살펴보면, 시스템의 기능을 정형명세언어를 이용해서 명세하는 부분을 공통적으로 요구하고 있다. 본 논문에서는 높은 보안 등급의 IPSec 관련 시스템을 개발하기 위해서 정형명세언어인 Z를 이용해서 IPSec의 동작을 명세하였다. The modern community is moving across the whole areas based on Internet with the growing Internet users and the great technological development. One of the important things that can be problem in this community is that the Internet should assure secure networking and security mechanism for the many security-ignorant users. Recently, Due to a lot of damages like a personal drain, security concerns is growing very rapidly. Now, many security application system is developing to solve this problem and each of the world standard organizations is evaluating these security application systems. Considering the each levels, we found that system using formal methods from the initial system development process acquired the high-level. In domestic, KISA manages the evaluation of security system and gives the higher than K5 to the system that specified and verified using formal methods. In this all levels, it should be required the system specification part. In this paper, we specified IPSec using formal specification language Z to develope the high-level IPSec system.

滑胎의 治療에 使用된 壽胎丸의 效能에 對한 文獻的 考察

崔眞卿,柳同烈 대전대학교 한의학연구소 2001 혜화의학회지 Vol.10 No.1

The purpose of this research was to investigate the effects of Sutaehwan(壽胎丸) for treatment Abortus habitualis(滑胎). I came to conculsion after considering literatures of every generation on the effects of Sutaehwan and then came to get some conclusion as follows. 1. Sutaehwan(壽胎丸) was designed to prescribe for treatment of Abortus habitualis(滑胎). 2. Sutaehwan(壽胎丸) was made use of Fetal Restlessness(胎動不安) caused by Kidney Deficiency(腎虛). 3. Sutaehwan(壽胎丸) was always used by the origin prescription itself, also used the modified prescription and the additional prescription. 4. Sutaehwan(壽胎丸) is the best quality prescription for treatment Abortus habitualis(滑胎) that due to Deficiency of Liver-Kidney Essence. Sutaehwan(壽胎丸) contains four specific herbs like Dodder Seed(兎絲子), Taxillus Twig(桑寄生), Himalayan Teasel Root(續斷), Donkey-hide Gelatin(阿膠). Dodder Seed(兎絲子) is effective the Tonifying Kidney, the Invigorating yang and the Supplementing Essence. Taxillus Twig(桑寄生) is effective the Nourishing Blood and the Tonifying Kidney. Himalayan Teasel Root(續斷) is effective the Tonifying Liver-Kidney and the Regulation Blood. Donkey-hide Gelatin(阿膠) is effective the Tonifying Liver Blood, the Arresting Bleeding and the Supplementing Kidney Yin Fluid.

박종홍의 한국불교 이해

최유진 경남대학교 인문과학연구소 2000 人文論叢 Vol.13 No.-

관상동맥협착증에 있어서 관상동맥우회술의 치료효과

유영선,박진상,최세영,박창권,이광숙 啓明大學校 醫科大學 1994 계명의대학술지 Vol.13 No.4

Sixty-one patients with coronary artery stenosis underwent coronary artery bypass grafting from February 1986 to September 1993 at the department of Thoracic and Cardiovascular Surgery. There were 41 men and 20 women with a mean age of 54 years(range, 25 to 79 years). History of myocardial infarction was noted in 17 patients(28%). Twenty-eight patients(46%) had single-vessel disease, 24 patients(39%) had double-vessel disease and 9 patients(15%) had triple-vessel disease. The left main disease was in 4 patients(7%). Single aorta-coronary grafts were placed in 37 patients(60%), double or more grafts in 24 patients(40%). An average of 1.4 grafts were performed per patient. Saphenous vein grafts were employed in 49 patients(80%), and the internal mammary grafts, which were anastomosed to left anterior descending artery in 23 patients(38%). The mean bypass time was 135 minutes and cross-clamp time was 45 minutes. Early mortality was 16.4% (10 patients). Perioperative myocardial infarction was the most common complication, followed by atrial arrhythmia, wound infection, bleeding, pneumonia, pneumothorax. The 51 survivors were followed-up for 1 to 72 months, averaging 31 months. Ninety-five percent of the survivors were in New York Heart Association class I or Ⅱ postoperatively. There was one late death. Poor ejection fraction was significantly associated with hospital death(p<0.05).

전방 도달법과 수장부 T자형 금속판 고정을 통한 원위 요골 골절의 치료

최우성,김원유,최동원,신윤학,김진영 대한골절학회 2003 대한골절학회지 Vol.16 No.2

목적 : 원위 요골 골절에 대해 전방 도달법을 이용한 관혈적 정복 및 수장부 T자형 금속판 내고정술의 방사선학적 및 임상적 결과를 분석하여 문헌 고찰과 함께 보고하고자 한다. 대상 및 방법 : 도수 정복이 되지 않았거나, 심한 분쇄 골절로 인해 도수 정복 상태가 유지되지 못했거나, 부적절한 관절면의 정복 등의 이유로 원위 전완부 전방 도달법을 이용한 관혈적 정복 및 수장부 T자형 금속판을 이용한 내고정술을 시행 후 최소 1년 이상 추시 관찰이 가능하였던 19예를 대상으로, 수술 전 후의 방사선학적인 평가와 최종 추시시의 기능적 평가를 Green과 O'Brein의 방법을 이용하여 평가하였다. 결과 : 수술 직후 모든 예에서 관절면의 해부학적 정복을 얻을 수 있었다. 방사선학적 결과에서 요골 관절면의 요골 길이는 수술 전 평균 8.8 ㎜ (±4.8 ㎜)에서 수술 후11 ㎜ (±3 ㎜)로, 요골 경사각은 평균 15˚ (±5.7˚)에서 20˚ (±5˚)로, 전방 경사는 평균 -11˚ (±13˚)에서 7˚ (±4˚)로, 척골 양성 변이는 평균 4 ㎜ (±3 ㎜)에서 0 ㎜ (±1 ㎜)로 향상되었으며, 기능적 결과에 있어서는 우수 9예, 양호 7예, 보통 2예, 불량 1예 이었다. 추시 중 초기 수상이 심하였던 1 예에서는 정복의 소실과 함께 장 무지 굴건의 파열이 초래하였다. 결론 : 원위 요골 골절의 수술적 치료에서 일부 제한된 범위에서만 적응증이 되었던 수장부 금속판 내고정술로 방사선학적 측면과 기능적인 측면에서도 만족할 만한 결과를 얻었으며, 초기 분쇄 골절이 심할 경우에는 정복의 소실을 예방하기 위하여 외고정기를 부수적으로 장착하는 것이 좋을 것으로 생각된다. Purpose : To analyze the radiologic and clinical results of open reduction and volar plating through anterior approach for distal radius fracture. Materials and Methods : We retrospectively analysed that 19 distal radius fracture, which would not be reduced by closed reduction or too comminuted to maintain reduction or articular surface incongruency, were treated by open reduction and volar plating through anterior approach. The results were evaluated by preoperative and immediate postoperative radiographics and clinical results were analysed using Green and O'Brien scoring system at final follow up. Results : All cases achieved anatomical articular surface reduction postoperatively. In terms of radiologic analysis, mean radial length (8.8 ㎜±4.8 ㎜ vs. 11 ㎜±3 ㎜), radial inclination (15˚±5.7˚ vs. 20˚±5˚), volar tilt (-11˚±13˚ vs. 7˚±4˚) and ulnar plus variant (4 ㎜±3 ㎜ vs. 0 ㎜±1 ㎜) were improved. The clinical evaluation revealed 9 excellent cases, 7 good cases, 2 fair cases and I poor case. The reduction loss and flexor pollicis longus rupture was occurred in one patient, who had severely displaced comminute fracture in initial injury. Conclusion : Using volar plating, authors gain good radiologic and clinical results. But, additional external fixation is recommended to prevent further collapse in severly comminuted fractures.

오렌지 껍질로부터 분리된 프라보노이드의 화학요법 감작효과

최철익,변익건,차윤정,김선필,민영돈,유진철,송재경 조선대학교 2001 The Medical Journal of Chosun University Vol.26 No.2

Background and Objectives : The overexpression of P-glycoprotein (Pgp) or multidrug resistanceassociated protein (MRP) confers multidrug resistance (MDR) to cancer cells. MDR cells could be sensitized to anticancer drugs when treated concomitantly with a chemosensitizer. In this study, orange peel have been screened for the development of chemosensitizers reversing MDR. Materials and methods : Expression of Pgp in AML-2/WT and AML-2/D100 were determined using western blot analysis and RT-PCR. Candidates for chemosensitizers were isolated, purified from orange peel using sephadex LH-20 column chromatography and silica-gel column chromatography, whose structure was determined using ^1H-NMR, ^13C-NMR, ^1H-^1H-COSY, 13C-NMR, EI-Mass, IR. Chemosensitizing effect of NP-28 on AML-2/DX100 over expressing Pgp and MRP was determined by the MTT assay. Membrane toxicity was evaluated by the RBC hemolysis test. Antioxidant effects were examined by using a fluorescence probe (2’-7’-dichlorofluorescein diacetate). Results : A potent candidate, NP-28, has a flavonoid nucleus with some methoxy moiety. NP-28 is believed to have high therapeutic index, being non-transportable inhibitor and possibly, of inhibiting other efflux pumps such as MRP and antioxidant effects. NP-28 is also unlikely to be a substrate of Pgp. NP-28 did not increase Pgp levels. Conclusion : NP-28 has a Chemosensitizing effect to reverse Pgp-mediated MDR by increasing the intracellular accumulation of drugs. Furthermore, they do not increase expression of Pgp, which can allow a long term use without the concern about Pgp activation. NP-28 is anticipated as an ideal second-generation flavonoid chemosensitizer and/or possibly other therapeutic agents by further investigation.