한국문학 개념 규정의 역사적 변천에 관하여

김동식(Kim Dong-shik) 한국현대문학회 2010 한국현대문학연구 Vol.0 No.30

이 글은 한국문학의 개념과 범위에 대한 규정이 역사적으로 어떠한 변화를 겪어왔는가를 살피고자 한다. 이 주제와 관련된 기존 연구는 주로 고전문학의 관점에서 이루어졌다. 그러다보니 근대문학 관련 자료들이 참조의 대상에서 많은 부분 누락되었다. 이 글에서는 근대문학 관련 자료들을 폭넓게 참조하면서 역사적으로 한국문학의 자기규정이 어떠한 방식으로 주제화되었는지를 살폈다. 1910년대 안확과 이광수의 논의들, 1920년대에 있었던 이광수와 경성제대의 대립, 1930년대의 『삼천리』의 설문과 임화의 『신문학사』, 1950년대 초반 정병욱의 한문학=한국문학 논의, 이병기 · 백철의 『국문학전사』와 조윤제의 『한국문학사』, 1970년대 김윤식 · 김현의 『한국문학사』에서 이루어진 근대성 논의, 1980년대 구비문학을 통해서 문학사를 재구성한 조동일의 『한국문학통사』, 그리고 최근에 구체화된 북한문학, 디아스포라 문학, 이중어 문학공간 등에까지 연구의 대상을 확대하였고 역사적 맥락을 재구성했다. 한국문학은 자기규정의 역사 속에서 중층적으로 구성되어왔으며, 그 과정에서 자신의 내부와 외부에 걸쳐 복잡성을 증대시키는 쪽으로 움직여왔다. ‘한국문학이란 무엇인가’라는 물음은 한국문학의 역사적 무의식들을 드러내 보여줄 뿐만 아니라 한국문학에 대한 자기배려의 의지를 생성하는 계기였다. This article inquires how the regulations regarding the concept and the scope of Korean literature historically have been changed. The preceding studies related to this theme have mostly carried out with and from the viewpoint of Korean classical literature so far. Hence the substantial portion of research materials referred to in Korean modern literature has undergone left out. The methods by which the self-definition of Korean literature stipulated and thematized in historic phases are supplied herein with the ample consultations on diverse Korean modern literature references: Ahn Hwak and Lee Kwang-su's opinions in 1910s, Lee Kwang-su's confrontation with Kyoungseong Imperial University in 1920s, a questionnaires of SamCheonli(三千里) in 1930s, Jung Byung-wook's controversial opinions of 'Korean literature written in Chinese(Korean Chinese Literature) equal to Korean literature' in early 1950s, Lee Pyoung-ki & Paek Cheol's The Whole History of Korean Literature(國文學全史) and Cho Youn-je's A History of Korean Literature(韓國文學史), the 1970s' modernity discourses brought up by Kim Yun-sik & Kim Hyun's in their A History of Korean Literature(韓國文學史), Cho Dong-il's The history of Korean Literature(韓國文學通史) which was based on the oral literature studies. Furthermore, North Korean literatures, the diaspora literatures and bilingual literary sphere are engaged herein as well to reshape the historical context within my expanding process of study objects. Korean literature has constituted itself onto the multiplicity of layers in the self-stipulation-wise history and moved toward increasing the complexity both inwards and outwards in the meantime. The question or the quest on ‘What is the Korean Literature?’ has not only uncovered its unconscious, but also served as a momentum to beef up the will to take care itself.

Lidocaine, Thrombin, Epinephrine 의 항균효과

김진우,이동건,전혜선,김승준,김석찬,안중현,김치홍,권순석,김영균,김관형,문화식,신완식,송정섭,박성학 대한감염학회 2005 감염과 화학요법 Vol.37 No.6

목적 : 기관지내시경 검사에서 흔히 사용되는 국소마취제인 lidocaine과 내시경시 지혈목적으로 사용되는 thrombin과 epinephrine이 각종 균주에 미치는 항균효과에 대해 알아보고자 하였다. 재료 및 방법 : 균주는 가톨릭대학교 성모병원에서 2004년 3월부터 2004년 9월까지 임상검체 에서 동정된 S. aureus, S. pneumoniae, K. pneumoniae, P. aeruginosa 각각 42, 42, 42, 43주를 대상으로 하였다. Lidocaine, thrombin, epinephrine 감수성 검사는 National Committee for Clinical Laboratory Standards (NCCLS, 2002)의 기준에 따랐다. 결과 : Lidocaine은 S. aureus, S. pneumoniae, P. aeruginosa에서 MIC_(50), MIC_(90) 모두 20,000 ㎍/mL 이었다. K. pneumoniae는 각각 10,000 ㎍/mL이었다. Thrombin은 S. aureus와 P. aeruginosa에서 MIC50 500 lU/mL 과 MIC_(90) 500 IU/mL 이상이었고, K. pneumoniae에서는 MIC_(50)과 MIC_(90)이 모두 500 lU/mL이상이었으나 S. pneumoniae에서는 MIC_(50)과 MIC_(90)은 125 IU/mL이었다. Epinephrine은 K. pneumoniae, S. pneumoniae에 대한 MIC_(50), MIC_(90)가 모두 >500 ㎍/mL이었고, S. aureus와 P. aeruginosa에 대한 MIC_(50), MIC_(90)가 모두 500 ㎍/mL이었다. 결론 : 기관지 내시경 검사에서 흔히 쓰이는 lidocaine, thrombin, epinephrine 등의 약제들이 호흡기 질환의 흔한 병원균인 S. aureus, S. pneumoniae, K. pneumoniae, P. aeruginosa 균주들에 대해 항균 효과가 있을 수 있어 세균배양검사에 영향을 미칠 수 있겠다. Background : We performed this stody to find out about antimicrobial effect of lidocaine which is commonly used local anesthetic, and thrombin and epinephrine used for hemostasis during bronchoscopic procedures. Materials and Methods : The microorganisms that were cultured from specimens obtained during bronchoscopy were Staphylococcus aureus (n=42), Streptococcus pneumoniae (n=42), Klebsiella pneumoniae (n=42), and Pseudomonas aeruginosa (n=43) collected from St. Mary's Hospital, from March to Sep 2004 were used for susceptibity testing. Susceptibility to lidocaine, thrombin, and epinephrine were tested according to the National Committee for Clinical Laboratory Standards. Result : MIC_(50) and MIC_(90) of lidocaine for S. aureus, S. pneumoniae, P. aeruginosa were all 20,000 ㎍/mL and that for K. pneumoniae were 10,000 ㎍/mL. MIC_(50) and MIC_(90) of thrombin for both S. aureus and P. aeruginosa was 500 IU/mL and above 500 IU/mL, respectively; that for K. pneumoniae were all above 500 IU/mL and for S. pneumoniae they were 125 IU/mL, MIC_(50) and MIC_(90) of epinephrine for K. pneumoniae and S. pneumoniae were above 500 ㎍/mL; that for S. aureus and P. aeruginosa were 500 ㎍/mL. Conclusion : We observed possible antimicrobial effect of lidocaine, thrombin, and epinephrine in vitro against pathogens such as S. aureus, S. pneumoniae, K. pneumoniae, P. aeruginosa, which are common respiratory microorganisms. The use of these agants could affect the result of bacterial culture.

흰쥐 해마박편에서 acetylcholine이 gamma-aminobutyric acid 유리에 미치는 영향에 관한 연구

김익현,김형룡,김관식,정동균 대한구강생물학회 1991 International Journal of Oral Biology Vol.15 No.2

Present study was performed to clarify the effect of acetylcholine on the release of gamma-aminobutyric acid(GABA) employing hippocampal slices. Hippocampal slices (300∼400㎛ thick) were prepared by the method of Kim et al(1988) and pre-equilibrated in Krebs-bicarbonate medium(KBM, pH 7.4) for 1hr at 37℃. Pre-equilibrated slices were incubated in fresh KBM and then potassium(50mM)-containing KBM for 5 min period. Basal and potassium-induced release of GABA were determined from recovered medium by HPLC. After 30min resting period, in the presence of physostigmine(20μM) slices were reincubated in acetylcholine-containing KBM and acetylcholine plus potassium-containing medium consecutively for 5min period each to investigate the effect of acetylcholine on basal or potassium-induced GABA release from hippocampal slices. The observed results were as follows: 1. The release of GABA induced by the first and second 5 min-exposure of 50mM potassium was 107.3±8.2 nmol and 90.6±3.2nmol, respectively. When compared with released amounts of GABA during the corresponding spontaneous periods, these were 4.6 and 4.6-fold increase respectively. 2. Physostigmine(20μM) had no significant effect on the spontaneous release of GABA. 3. Acetylcholine(10-1000μM) increased spontaneous and potassium-induced GABA release in a dose-dependent manner.

한국인 제1형 당뇨병에서 체도 세포질 항체의 양성률 : 항GAD항체, 항ICA512항체, 항phogrin항체의 조합 측정으로의 대체 가능성 Possible Replacement with Combined Measurement of Anti-GAD, Anti-ICA512, and Anti-phogrin Antibodies

김경아,김동준,정재훈,민용기,이문규,김광원,진동규,고경수,김상진,이명식 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.25 No.6

연구배경:최근 당뇨병의 분류를 새로 제정함에 있어 자가항체가 양성이면 임상형에 상관없이 제1형 당뇨병으로 분류하자는 제안이 나옴으로써 자가항체의 중요성은 더욱 커질 것으로 예상된다. 특히 우리나라와 같이 비비만형인 제2형 당뇨병이 많은 나라에서는 당뇨병의 병인 규명에 자가항체가 중요한 위치를 차지할 것으로 사료된다. 자가항체 중에서 전통적으로 측정되어온 췌도 세포질 항체(ICA)는 표준화하기 어렵고 기술적으로 제한점이 많으며 현실적으로도 췌장 공여자가 적은 점 등이 문제로 알려져 있다. ICA의 대응 항원들로는 GAD(glutamic acid decarboxylase), IA­2(islet­associaated antigen­2;ICA512), IA­2β(phogrin)등이 있다. 이러한 대응 항원에 대한 특이적인 자가항체의 측정은 ICA에 비해 표준화되었으며 최근에는 방사면역측정법(radioimmunoassay;RIA)키드까지 등장하여 손쉽고 정확히 이를 측정할 수 있게 되었다. 연구자들은 한국인 제1형 당뇨병에서 측정법이 표준화 되어 있는 항GAD항체 및 항ICA512항체 조합(combimation)의 조합으로 ICA의 측정을 대신할 수 있는지를 조사하였고 더 나아가 항phogrin항체의 조합 측정으로 임상적 유용성이 있는지 보고자 하였다. 방법: ICA는 면역조직화학 염색법을 이용하였다. 항 GAD항체는 상업화 된 키드(RSR??, United Kingdom)를 이용하였다. 항 ICA512항체와 항phogrin항체의 측정은 in vitro transcription&translation한 후 이를 이용해 방사면역 침전법을 이용하였다. 대상 환자로는 전형적 제1형 당뇨병 76명, 지진형 제1형 당뇨병 22명, 제2형 당뇨병 39명이었으며 각 군간의 연령은 각각 22.8±14.0, 37.9±13.9, 45.3±12.3세였다. 결과:1)전형적인 제1형 당뇨병에서는 ICA의 양성률이 30%, RIA조합만의(항GAD항체 또는 항 ICA512항체 또는 항phgrin항체 한가지에라도 양성인 경우)양성률이 57%이었다. 지진형 제1형 당뇨병에서는 각각 18%, 50%이었다. 제2형 당뇨병에서는 각각 7.7%, 5.1%이었다. 2)각 군에서 ICA가 양성인 군에서 RIA조합 양성률을 보면 전형적 제1형 당뇨병에서는 96%, 지진형 제1형 당뇨병에서는 100%에서 양성이었고 제2형 당뇨병에서는 RIA 조합 양성이 없었다. 각 군에서 ICA가 음성인 군에서도 RIA 조합시 전형적 제1형 당뇨병에서는 40%, 지진형 제1형 당뇨병에서는 39%에서 양성이었고, 제2형 당뇨병에서는 5.6%에서 양성이었다. 3)전형적 제1형 당뇨병에서 ICA가 양성인 군(n=23)에서 96%가 RIA조합 양성이었는데 이때 각각의 RIA유형을 보면 항GAD항체 양성이 87%였다. 한편 항 ICA512항체 양성이 48%, 항phogrin항체 양성이 44%이고 항GAD항체 도는 항ICA512항체 양성이 96%를 차지한다. 지진형 제1형 당뇨병에서는 ICA가 양성인 군(n=4)에서는 항 GAD항체 양성이 3명, 항ICA512항체 양성이 1명이었다. 따라서 기존의 ICA를 RIA조합으로 대체할 수 있을 것으로 사료되었는데 이때 항GAD항체와 항ICA512항체의 조합이 도움이 되겠고 항phogrin항체의 추가적인 검사는 일부의 환자에서만 도움이 되리라 사료된다. 4)이환 기간에 따라 ICA와 RIA조합을 비교시 ICA는 차이가 없었으나 RIA조합의 양성률은 지진형 제1형 당뇨병에서 4년 이상의 이환 기간이 지나면 그 이전보다 떨어졌다. 5)발병 연령에 따라 ICA와 RIA조합을 비교시 ICA 양성률이 전형적 제1형 당뇨병에서 15세 이전에 발병한 그룹에서 그 이후에 발병한 그룹보다 유의하게 높았다. 결론:이상의 결과를 요약하면 항GAD항체 및 항ICA512항체 측정의 조합은 ICA보다 민감도가 높아 기존의 ICA를 대체함은 물론 임상적 이용에서 현격한 우월성을 보이며, 성인에서 발병한 비전형적인 당뇨병의 분류에도 도움이 될 것으로 사료되었다. 추가적인 항phogrin항체의 측정은 임상적 유용성이 없었다. Background : Type 1 diabetes includes all forms of autoimmune-mediated and idiopathic beta-cell destruction leading to an absolute insulin deficiency. Evidence of an autoimune pathogenesis was assessed by studying cytoplasmic islet cell antibodies (ICA), antibodies to glutamic acid decarboxylase (GADA), antibodies reacting with an islet tyrosine phosphatase-related molecule referred to as ICA 512 (ICA 512A), or its homologue phogrin (phogrin-A). In comparison with ICA, the best validation to assess the risk of type 1 diabetes, shows that a combination of antibodies to GADA with ICA 512A has the power to detect a majority of ICA and 97 ~ 100% of subjects who progressed to overt diabetes. These findings suggest the possibility of replacing the laborious ICA test in the screening programs to identify subjects at risk of progressing to type 1 diabetes or for classifying the stage of diabetes at the time of diagnosis. Up to now, it is unclear whether these results are applicable to the slowly progressive type 1 diabetes that appears to be more prevalent in Asian than in western countries. The prevalence of combined autoantibody testing (1≥ of GADA, ICA512A, or phogrin-A) was investigated in the patients with type 1 diabetes (typical and slowly progressive) and type 2 diabetes, and compared with that of ICA which is a more laborious and insensitive test. Methods : The ICA assay was performed using immunoenzymatic staining of frozen human (blood group O) pancreatic sections with serial dilutions of serum samples with peroxidase-labeled protein A. For the GADA determination, commercially available GADA radiommunoassay kits utilizing the ^125I-labeled recombinant GAD65 (RSR®, United Kingdom) as an antigen was used. Either ICA512A or phogrin-A were detected by a radioligand-binding assay after in vitro transcription and translation using the clone ICA512bdc or phogrin c DNA. Serum was obtained from 76 patients with type 1 diabetes(mean age 45.3± 12.3 years). Typical and slowly progressive type 1 diabetes patients had the disease for between 4.0±4.6 and 10.1±9.5 years, respectively at the earliest serum sampling. Results: 1) In typicaltype 1 diabetes, 30% of patients tested positive for ICA and 57% for the combined autoantibody test. In type 2 diabetes, 7.7% and 5.1% tested positive, respectively. 2) Ninety-six percent of ICA-positive patients expressed one or more of the 3 auto-antibody specificities in typicaltype 1 diabetes. Among the 53 ICA-negative patients with typicaltype 1 diabetes, 40% had one or more of these auto-antibodies. In the slowly pregressive type 1 diabetes, 100% of the ICA-positive and 39% of the ICA-negative patients expressed one or more of the 3 autoantibody specificities. 3) Of the 23 patients with ICA-positive typical type 1 diabetes patients, 87% had a positive result for GADA, 48% FOR ICA512A, 44% for phogrin-A, and 96% for GADA or ICA512A. Of the 4 patients with ICA-positive slowly progressive type 1 diabetes, three had a positive result for GADA, and 1 for ICA512A. 4) When the prevalence of combined autoantibody testing was analyzed according to the duration of diabetes, the prevalence in patients tested within 4 years after the diagnosis and more than 4 years after the diagnosis was 61% and 52%, respectively in typical type 1 diabetes. Furthermore, that for the ICA was 37% and 21%, respectively. In the slowly progressive type 1 diabetes, the prevalence of combined auto-antibody testing was 88% and 25%, respectively (p<0.05), while that of ICA was 25% and 13%, respectively. 5) In typical type 1 diabetes, ICA were detected more frequently in patients younger than 15 years of age (48%) than in older patients (23%) (p<0.05), while the prevalence of combined auto-antibody testing -was not different according to the onset age(65% vs 53%). Conclusion : Combined autoantibody testing for GADA and ICA512A is more sensitive that ICA in type 1 diabetes. Therefore, it could replace the laborious ICA measurement and may be useful for discriminating the etiology of adult onset a typical diabetes(J Kor Diabetes Asso 25 :430~445, 2001).

흰쥐 해마박편에서 veratrine과 고농도 포타슘자극시 칼슘이온이 gamma-aminobutyric acid 유리에 미치는 영향에 관한 연구 : A role of calcium

강수만,김형룡,김관식,정동균 대한구강생물학회 1991 International Journal of Oral Biology Vol.15 No.2

Present study was performed to clarify the effect of calcium on the release of gamma-aminobutyric acid (GABA) employing hippocampal slices. Hippocampal slices(300-400㎛ thick) were prepared by the method of Kim et al(1988) and pre-equilibrated in Krebs-bicarbonate medium(KBM, pH 7.4) for 1hr at 37℃. In case of veratrine-induced GABA release, pre-equilibrated slices were incubated in fresh KBM and then veratrine (25μM)-containing KBM for 10min period in the presence or absence of 2.5mM Ca^2+. In case of potassium-induced GABA relaese, pre-equilibrated slices were incubated in fresh KBM and then potassium(50mM)-containing KBM for 5min period in the presence or absence of 2.5mM Ca^2+. Basal and veratrine and potassium-induced release of GABA was determined from recovered medium by HPLC. The observed results were as follows: 1. The release of GABA induced by the 10min-exposure of 25μM veratrine and 5min-exposure of 50mM potassium in the presence of 2.5mM Ca^2+ was 228.9±11.2 nmol and 100.1±8.9nmol, respectively. When compared with released amounts of GABA during the corresponding spontaneous periods, these were 6.8 and 4.6-fold increase respectively. 2. The release of GABA induced by the 10min-exposure of 25μM veratrine and 5min-exposure of 50mM potassium in the absence of Ca^2+ was 381.4±30.2 nmol and 55.1±4.1 nmol, respectively. When compared with released amounts of GABA during the corresponding spontaneous periods, these were 11.3 and 2.4-fold increase respectively.

동종 골수이식 후 만성 이식편대숙주반응 환자에서 발생한 폐렴구균에 의한 수막뇌염 1예

신완식,김병욱,유진홍,김동집,김춘추,박종원,이종욱,김동욱,강문원,김양리 대한감염학회 1993 감염 Vol.25 No.3

Graft-versus-host disease (GVHD) is a frequent complication after bone marrow transplantation. Infectious complications are common in GVHD patients due to defect in cell-mediated immunity. A rare case of S. pneumoniae meningoencephalitis occured in a patient with extensive form of chronic GVHD after allogeneic bone marrow transplantation. He was immediately treated with full dosage of ceftriaxone and ampicillin. He suffered from various complications such as sepsis, acute renal failure, atelectasis, and seizure. Despite of aggressive treatment, he died probably due to renal shutdown and massive subacute cerebral infarction of left cerebral hemisphere. This report showed two unusual and rare features. First, the infection site was CNS rather than respiratory system. Second, the causative organism was S. pneumoniae, which is rare cause of CNS infection in immunocompromised patients.

흰쥐 해마박편에서 콜린성 수용체와 glutamate 유리와의 상호관계에 관한 연구

신동인,김형룡,고성희,김관식,정동균 대한구강생물학회 1990 International Journal of Oral Biology Vol.14 No.2

Present study was performed to clarify the effect of cholinergic agents on the release of glutamic acid employing hippocampal slices. Hippocampal slices(300∼400㎛ thick) were prepared by the method of Kim et al.(1988) and pre-equilibrated in Krebs-bicarbonate medium(KBM, pH 7.4) for 1hr at 37℃. Pre-equilibrated slices were incubated in fresh KBM and then potssium(50mM)-containing KBM for 5 min period. Basal and potassium-induced release of GABA and glutamic acid were determined from recovered medium by HPLC. After 30 min resting period, slices were reincubated in cholinergic agents-containing KBM and cholinergic agent plus potassium-containing medium consecutively for 5 min period each to investigate the effect of cholinergic agent on basal or potassium-induced glutamic acid release from hippocampal slices. The observed results were as follows: 1. The release of glutamic acid induced by the first and second 5 min-exposure of 50mM potassium was 139.7±14.05 nmol and 114.5±10.01 nmol, respectively. When compared with released amounts of glutamic acid during the corresponding spontaneous periods, these were 5.3 and 5.6-fold increase respectively. 2. Acetylcholine(10-1000μM) inhibited potassium-induced glutamic acid release in dose-dependent manner. 3. The inhibition of glutamic acid release caused by acetylcholine(1mM) was antagonized by atropine(50μM) but not by mecamylamine(50μM).

1-Arylpyrrole로부터 9-Arylcarbazole의 합성

朴유미,金寅植,李龍均,成大東,金東賢,金倫瑛,鄭大一 東亞大學校附設基礎科學硏究所 1997 基礎科學硏究論文集 Vol.14 No.1

Carbazoles were discovered in anthracene oil of coal tar, and are the parent structure of a number of heterocyclic compounds. Much attention has been paid to carbazole derivatives recently as the materials for semiconductors and photoconductive compounds. Many conventional methods for synthesis of carbazoles were known such as Grabe-Ullmann methods and the Tauber methods. In the course of the investigation for the synthesis of pyrrole derivatives 3. We have found the formation of 9-arylcarbazoles 4 under refluxing glacial acetic acid. Thus we report the results here.

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.

동종 조혈모세포이식 후 발생한 크립토콕쿠스 척추염 1예

고윤호,임동준,이성수,조유경,이동건,최정현,김유진,민창기,김동욱,박정미,김춘추,신완식 대한감염학회 2001 감염 Vol.33 No.4

Skeletal cryptococcosis is an uncommon infection. Cryptococcus is a common cause of meningitis and infects 7∼10% of patients with AIDS. As well as AIDS, the infection may be seen in association with leukemia, lymphoma, Hodgkin's disease, sarcoidosis, tuberculosis and diabetes, also in patients on steroid medication. But there is no case report of skeletal cryptococcosis following allogeneic hematopoietic stem cell transplantation. A 40-year-old woman was admitted to the hospital because of low back pain. She had chronic myelogenous leukemia for 2 years and underwent allogeneic hematopoietic stem cell transplantation 8 months ago. She have been treated with steroid and cyclosporine orally because of chronic graft versus host disease. On examination she was afebrile and had posterior lower lumbar tenderness. But, she had no reduced strength of low extremities. Open biopsy was underwent. Histology demonstrated budding, round-to-oval, refractile yeast-like organisms within debris. The results of a lumbar puncture were unremarkable and cerebrospinal fluid culture failed to grow bacteria and yeast. The patient was treated with amphotericin B (1 gram) and AmBisome□ (2.8 gram) over 6 weeks. Three months after cessation of therapy, the patient was doing well.(Korean J Infect Dis 33:298∼301, 2001)