중증 재생불량성빈혈에서 타인 혹은 HLA 불일치 혈연간 골수이식을 위한 cyclophosphamide와 antithymocyte globulin전처치 요법

이정희,이제환,김신,설미이,이정신,김우건,김상희,지현숙,박찬정,이규형 대한조혈모세포이식학회 2001 대한조혈모세포이식학회지 Vol.6 No.1

배경: Cyclophosphamide와 ATG의 전처치 요법은 HLA가 일치하는 형제간 골수이식에서는 매우 효과적인 것으로 알려져 있으나, 타인 혹은 HLA 불일치 혈연간 골수이식에서는 전처치 요법으로서 불충분한 것으로 보고되었는데, 주요 문제는 착상 부전이었다. 우리나라를 포함하는 극동아시아 지역의 국가들에서 발표되는 보고에 의하면 타인이식을 포함하여 골수이식 후 착상 부전과 이식편대숙주질환의 발생이 서구 국가들로부터의 보고에서보다 적은 것으로 알려져 있다. 저자 등은 6예의 중증 재생불량성빈혈 환자들에서 질병 초기에 Cyclophosphamide와 ATG만을 이용하여 전처치를 한 후에 타인 혹은 HLA 불일치 혈연간 골수이식을 시행하였다. 방법: 1999년 5월부터 2000년 4월까지 서울중앙병원에서 타인 혹은 HLA 불일치 혈연간 골수이식을 시행 받은 성인 중증 재생불량성빈혈 환자들을 대상으로 하였다. 골수이식을 위한 전처치 요법으로 cyclophosphamide (50 mg/kg/d x 4)와 ATG (30 mg/kg/d x 3)를 투여하였는데, 골수이식 전에 ATG에 대하여 과민 반응을 보였던 한 예 (UPN 120)에서는 ATG 대신에 fludarabine (30 mg/m2/d x 3)을 투여하였다. 이식편대숙주질환의 예방을 위하여 cyclosporine과 methotrexate를 투여하였다. 결과: 연구 기간 중에 모두 6예가 타인 혹은 HLA 불일치 혈연간 골수이식을 시행 받았는데, 5예는 타인으로부터 골수를 공여 받았으며, 1예는 HLA의 표현형이 하나의 유전자좌에서 일치하지 않는 형제로부터 골수를 공여 받았다. 타인 골수이식을 받은 5예 중에서 3예의 공여자는 HLA의 표현형이 일치하였으며, 1예는 하나의 유전자좌가 major mismatch였고, 1예는 하나의 유전자좌가 minor mismatch였다. 추적기간의 중앙값은 406일 (범위, 328-643일)인데, 6예 모두에서 착상된 상태를 유지하면서 생존해있다. 2예에서 3도의 급성 이식편대숙주질환과 전신성 만성 이식편대숙주질환이 발생하였다. 결론: Cyclophosphamide와 ATG의 전처치 요법은 재생불량성빈혈의 초기에 타인 혹은 HLA 불일치 혈연간 골수이식을 시행 받은 한국인 환자들에서 충분히 착상을 가져올 수 있는 요법으로 생각된다. 비록 본 연구의 대상 환자 수가 적지만 결과는 매우 고무적이다. HLA가 일치하는 형제가 없는 중증 재생불량성빈혈 환자의 경우에 타인 골수 공여자에 대한 검색을 조기에 시행해야 하며, 타인 혹은 HLA 불일치 혈연간 골수이식을 질병 초기에 적극적으로 고려해야 할 것으로 생각된다. Background: Cyclophosphamide (CY) and ATG regimen was reported to be insufficient for alternative donor BMT in SAA patients due to high incidence of graft rejection. The rates of graft rejection and GVHD after allogeneic BMT including unrelated donor transplants seemed to be lower in reports from Asian countries of Far East. We applied CY/ATG regimen to six patients with early stage of SAA transplanted with marrow from alternative donors other than HLA-identical siblings. Methods: Three patients were transplanted from HLA-phenotypically identical unrelated donors, two from one-locus mismatched unrelated donors, and one from an one-locus mismatched sibling donor. Four patients received no previous therapy for SAA, and two received one course of immunosuppressive therapy with ATG. Preparative regimen was CY (200 mg/kg) plus ATG (90 mg/kg) in all patients except one who had had an anaphylactic reaction to ATG prior to BMT and received fludarabine (90 mg/m2) in place of ATG. Cyclosporine plus methotrexate were given for GVHD prophylaxis. Results: All six patients engrafted and all are alive with durable engraftment at a median follow-up of 406 days (range, 328 to 643). Two patients developed grade III acute GVHD and extensive chronic GVHD. Conclusions: CY/ATG regimen may be sufficient in Korean patients with early stage of SAA transplanted with marrow from alternative donors. Although the number of patients in present study is small, results are encouraging. Stem cell transplantation using alternative donors may be considered at early stage of aplastic anemia.

수입각증후군에 의한 급성 복증 1례

정은욱,지삼룡,이영태,박지훈,김동기,제인수,채두근,박성재,박은택,이연재,이상혁,설상영,정정명 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Afferent loop syndrome is an uncommon complication of a gastrectomy and Billroth Ⅱ reconstruction. It may cause symtoms at any time from the first postoperative day to many years after the gastrectomy. Afferent loop syndrome is characterized by abdominal pain, vomiting and elevation of serum amylase. Thus, it is difficult to differentiate afferent loop syndrome from other cause of acute pancreatitis. However, the history of gastrectomy can be an important clue for diagnosing afferent loop syndrome. We experienced one case of chronic afferent loop syndrome with acute pancreatitis. After appropriate management, the abdominal pain disappeared and serum amylase level decreased. We report this case with a review of relevant literatures.

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.

한국 프로야구 감독의 지도유형과 팀 성적과의 관계

이제홍,김영운,이정훈 순천향대학교 기초과학연구소 2007 순천향자연과학연구 논문집 Vol.13 No.2

To analyze how the leadership of Korean professional baseball coaches influenced the performance of their teams between 1982 and 2002, 11 coaches with above-average length of experience (4.84 years) out of 32 coaches of professional teams were examined and analyzed. The following lists the findings: 1) The teams led by charismatic leaders were mostly showing good performances. 2) The teams led by individually considerate leaders were evenly distributed on ranking, but not many teams had individually considerate leaders. 3) The teams led by intellectually stimulating leaders were evenly distributed on ranking and many teams had intellectually stimulating leaders. 4) Nu teams were led by conditionally rewarding leaders. 5) The teams led by exceptionally managing leaders were generally showing poor performance.

발열을 동반한 호중구감소증에서 Cefepime 단독투여와 Ceftazidime 및 Tobramycin 병합투여의 효능비교

정현욱,채제욱,강미라,양정채,문치숙,기현균,장현하,오원섭,김기현,백경란,이남용,송재훈 대한감염학회 2004 감염과 화학요법 Vol.36 No.6

목적 : 국내에서 발열을 동반한 호중구감소증이 있는 악성 종양환자에게 경험적 항생제로 베타락탐계 항생제와 아미노배당체의 병합요법의 사용이 일반적이다. Cefepime은 광범위 항균 작용을 가지고 있어, 그람 음성균 뿐만 아니라 그람 양성균에 대해서도 우수한 효과를 나타낸다. 재료 및 방법: 발열을 동반한 호중구감소증이 있는 악성 종양환자를 대상으로 무작위, 공개, 비교 연구를 시행하였다. 대상 환자를 무작위로 cefepime 단독요법군과 ceftazidime 및 tobramycin 병합요법군으로 나누어 투여하고 각각의 임상적 효능과 안전성을 비교하였다. 구강및 인후 점막염이 있는 환자에서 분리된 녹색 연쇄알 구균에 대한 항생제 내성 정도를 조사하였다. 결과 : 대상환자 89명 중 CA 투여군이 48예(53.9%), CT 투여군이 41예(46.1%)이었다. 발열의 유형별로 MDI는 18예(20.2%), CDI는 9예(10.1%), UF는 62예(69.7%)로 두 군 간에 차이가 없었다. CA 투여군과 CT 투여군의 임상적 호전률은 시험약 투여 후 2-4일째 각각 91.7%, 85.4% (P=0.31), 치료 종료 시 각각 91.7%, 100% (P=0.15)로 두 군간에 유의한 차이가 없었다. 치료 종료 시 CA 투여군과 CT 투여군의 세균학적 소실률은 모두 100%로 두 군간의 유의한 차이가 없었다(P=0.78). 점막염이 있는 환자로부터 녹색 연쇄알 구균이 분리된 경우는 25예(28.1%)이었으며, 분리된 녹색 연쇄알 구균은 penicillin, ceftriaxone, cefepime, vancomycin에 모두 감수성을 보였다. 약제 관련 이상 반응의 발생 빈도도 두 군간에 유의한 차이가 없었다. 결론 : 발열을 동반한 호중구감소증이 있는 악성 종양환자의 경험적 항생제로서 cefepime 단독요법은 ceftazidime 및 아미노배당체의 병합요법만큼 효과적이고 안전하였다. Background : Broad-spectrum antibiotic therapy has been recommended as an empirical regimen in cancer patients with febrile neutropenia. Cefepime is a fourth generation cephalosporin with good activity against both gram-positive cocci and gram-negative bacilli. Materials and Methods : To compare the efficacy and safety of cefepime alone with ceftazidime plus tobramycin as empirical regimen for adult cancer patients with febrile neutropenia, a randomized, open label, comparative trial was performed. If the patient showed clinical improvent 72 hours, antibiotic could be changed to oral ciprofloxacin. Clinical and microbiological responses were determined at 72 hours and at the end of therapy. To investigate the antimicrobial resistance of viridans streptococci, swab cultures were obtained from throat in all enrolled patients and antimicrobial susceptibility tests were performed by using microdilution method according to the NCCLS. Results : A total of 89 patients were enrolled. Forty-eight patients received cefepime alone (CA), and 41 patients received ceftazidime plus tobramycin (CT). Demographic and baseline clinical characteristics were similar in both groups (P>0.05). The initial clinical success rate at day 2-4 in group CA (91.7%) was similar with that in CT group (85.4%) (P=0.31). At the end of therapy, the final clinical success rate in CA group (91.7%) was similar to that in CT group (100%) (P=0.15). In 18 patients, with microbiologically defined infections, the eradication rate was 100% in both groups. Adverse events including liver dysfunction (21.3%) and renal dysfunction (2.2%), were similar in both groups (P=0.87). Viridans streptococci were isolated from the throat cultures in 25 cases, and all of these strains were susceptible to penicillin (MIC_(90) 0.12 ㎍/mL), cefepime (1 ㎍/mL), and vancomycin (0.12 ㎍/mL). Conclusion : Efficacy and safety of cefepime monotherapy was comparable to the combination of ceftazidime and tobramycin. It could be used as an alternative empirical regimen for treating cancer patients with febrile neutropenia.

PEG 분해균주의 분리와 PEG film의 상용성에 관한 연구

이제혁,정성제,이준열,전억한 경희대학교 부설 식량자원개발연구소 1993 硏究論文集 Vol.14 No.-

PEG를 sole carbon과 energy source로서 이용하는 미생물을 자연계에서 분리하였고, PEG의 분자량이 높아질수록 그 분해 미생물의 수가 감소하는 것을 확인하였다. 또한, liquid culture로서 PEG농도를 감소시키는 미생물을 선별하였고, 분해율은 PEG 8000이 약 18.8%였으며 PEG 10000은 약 25.4%인 것으로 조사되었다. PEG film의 제조를 위해 EMAA 및 EAA와의 상용성을 적외선 분광(IR) 스펙트럼을 사용하여 조사한 결과, EMAA와 EAA의 카르보닐기와 PEG의 에테르기와의 강한 수소결합이 형성으로 blend film제조시 상용성이 있는 것으로 확인되었다. Several strains capable of degrading PEGs(Polyethylene Glycols)were isolated and investigated for their biodgradation ability of PEGs. Microorganisms screened for the biodegradation studies were those grown on the PEG used as a sole carbon and energy source. It was known that the number of microorganisms decreased when grown on the high molecular weight of PEG(e.g. 20,000). A liquid culture was carried out with such microorgaisms and resulted in the decrease in PEG concentration meaning that PEG was degraded in the reactor. The biodegradability was found to be about 18.8% for PEG-8000 and 25.4% for PEG-10000, respectively. For the manufacture of biodegradable PEG film, EMAA/PEG and EAA/PEG blending ability was investigated with IR spectrum and showed that it was possible to produce blending film.

비선형 캐리어 제어 부스트 정류기 특성에 관한 연구

이제환,전기영,조정민,한홍일,한경희 明知大學校 産業技術硏究所 2000 産業技術硏究所論文集 Vol.19 No.-

Average-current mode controlled boost rectifier is most universally used at present, While the method gives high power factor, low harmonics distortion, has drawbacks such as 3-feedback loop, complex component, difficulty of control-circuit design, and high cost. Research for improving these problem has been carried out, and Nonlinear Carrier(NLC) Control method is representative. This control method has easy algorithm for control, and its feedback loop and control components are reduced. In this paper, the control method was evaluated by simulation through Matlab/Simulink, and experimented with 550W boost rectifier. As the result, that can get high power factor above 0.95 and low harmonic distortion was confirmed. Also, a good dynamic response on line and load variation was confirmed.

논에 있어서 포장정보 공간변이의 공간통계학적 해석

이충근,손연규,성제훈,정인규,김상철,박우풍,박원규 한국국제농업개발학회 2002 韓國國際農業開發學會誌 Vol.14 No.2

논에 있어서 정밀농업을 위한 기초자료수집과 분석을 하기 위해서 토양의 특성, 포장면 고저차, 생육상태 그리고 수량에 관한 포장정보를 조사한 결과 아래와 같은 결과를 얻었다. 가. 기본통계값을 살펴보면 유효태 규산의 경우는 한 포장내 14배 이상의 변이차이를 보였으며, 생육정보 중 분얼수는 3배, 수량은 4배 이상의 차이를 보였다. 나. 포장정보의 변이계수를 살펴보면 5.45∼51.3%의 공간변이를 보였다. 토양특성 중에 pH를 제외한 나머지가 10%이상의 공간변이를 보였다. 포장면 고저차는 51.3%, 생육정보는 7.32∼23.2%, 그리고 수량에 있어서도 변이계수가 22.5%를 보였다. 다. 포장정보를 공간통계학을 이용해 해석한 결과, 포장정보의 공간구조 발달여부를 표시하는 Q값이 0.24∼1로서 공간구조가 포장정보에 따라서 발달되어 있었으며, 공간변이의 의존거리를 나타내는 랜지는 8.1∼147.9m를 보였다. 그러나, 실질적인 랜지는 토양특성값이 15∼50m 정도, 생육정보는 15m 전후, 포장면 고저차는 30m 정도, 수량은 8.1m를 보였다. 이것을 기초로 하여 크리깅 방법으로 데이터를 보간하여 지도화 시킨결과, 공간변이를 이해하는데 유용하게 이용될 수 있는 포장정보 지도를 얻을 수 있었다. Soil properties, relief of field surface, growth information, grain yield were investigated in a 1ha paddy field in 2001 to obtain basic field information for precision agriculture. The field information were analyzed to examine their within field variability using descriptive statistical method. Semivariograms and Kriged maps of geostatistical analysis were also adopted to examine their within field spatial dependence. The results obtained were as follows ; 1) Nutrient distribution difference of available SiO_2 was seemed 14 times overs, 3 times overs at tiller number, 4 times overs at grain yield from within a paddy field. 2) Descriptive statistics of field information showed that the coefficient of variation ranged from 5.45∼51.3%. 3) Field information showed a high spatial dependence within a paddy field. The Q values ranged from 0.24∼1, the ranges of spatial dependence were from 8.1∼50m, respectively. 4) Kriged maps enable the visualization and comparison of the spatial variability of field informaton.

수모세포종과 대뇌 원시 신경외배엽 종양의 면역조직화학적 연구

이정일,왕규창,지제근,조병규 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.8

Although it is becoming widely accepted that medulloblastoma and cerebral primitive neuroectodermal tumor(PNET) are identical tumors occuring at different locations, there are some controversies in their origin and pathological classification. As a method of investigating whether the tumors are identical in pathological aspects, immunohistochemical characteristics of medulloblastomas and cerebral PNETs were compared in this study. Also the prognostic significance of the immunohistochemical findings in modulloblastoma patients was analyzed. Clinical features of twenty-seven patients with modulloblastoma and eleven patients with cerebral PNET were reviewed, excluding tumors with significant cellular differentiation such as ependymoblastoma, pineoblastoma and neuroblastoma. The presence of glial fibrillary acidic protein(GFAP), neurofilament(NF), S-100 protein, vimentin synaptophysin, and epithelial membrane antigen (EMA) was examined with immunohistochemical method and the differences of the results between the two tumors were statistically analyzed. The positive rates of NF and synaptophysin were significantly higher in medulloblastomas(p = 0.006 and 0.003, respectively) and so was the positive rate of vimentin in cerebral PNETs(p=0.004). S-100 protein showed a higher positive rate in cerebral PNETs although it was not statistically significant Univariate and multivariate analyses did not show any significant correlation between the duration of survival and the presence of cellular antigens.

진행성 비호지킨 림프종 환자에서 ICE 구제 요법에 의한 조혈모세포 가동화 후 자가 말초혈액 조혈모세포이식

이제중,이병환,김여경,변정래,이일권,박무림,정익주,김형준 대한조혈모세포이식학회 2003 대한조혈모세포이식학회지 Vol.8 No.1

연구배경: 비호지킨 림프종에서 자가 말초혈액 조혈모세포이식술이 폭넓게 이용됨으로 인해서, 높은 치료효과뿐만 아니라 조혈모세포의 가동화 효율이 높은 구제 요법이 요구되었다. 방법: 본 연구에서는 진행성 비호지킨 림프종에서 ICE 요법을 이용하여 조혈모세포를 가동화시킨 후 자가 말초혈액 조혈모세포이식이 시행하였던 환자를 후향적으로 분석하였다. 결과: 대상 환자의 중앙 연령은 38세(범위, 16~61)였으며, ICE 요법은 환자당 4주기(범위, 1~6주기)가 투여되었고, 투여 간격은 중앙값이 24일(범위, 16~36일)이었다. 고위험도 관해군을 제외한 13예의 환자 중 완전반응은 7예(53.8%), 부분반응은 4예(30.8%), 진행성질환은 2예(15.4%)를 보였다. 치료에 따른 3~4등급의 혈액학적 독성은 중성구감소증이 13예(81.3%), 혈소판감소증이 7예(42.8%)에서 관찰되었다. 조혈모세포 채집은 ICE 요법 후 중앙값이 12일(범위, 6~20일)에 시행되었고, 각 ICE 요법당 채집한 단핵구치는 중앙값이 5.75× 10^(8)/체중, CD34^(+) 세포는 중앙값이 1.25× 10^(6)/체중, CFU-GM치는 중앙값이 1.19× 10^(5)/체중이었다. 조혈모세포이식은 11예에서 시행되었고, 중앙 추적기간 401일에 평가한 2년 전체생존율은 70.1±14.7%, 1년 및 2년 무사건생존율은 각각 60.7±15.4%와 32.3±17.1%를 보였다. 결론: ICE 요법은 재발성/불응성 비호지킨 림프종 환자에서 높은 치료 반응률과 만족할 만한 조혈모세포 가동화를 보여 주었지만, 치료에 대한 순응도가 낮아서 투여 간격이 연장되는 문제점을 안고 있어서, 우리나라 환자의 실정에 적합한 구제요법에 대한 연구가 필요할 것으로 생각된다. Background: Due to the extensive application of high-dose chemotherapy with autologous peripheral blood stem cell transplantation (PBSCT), a salvage chemotherapeutic regimen with high response rate as well as effective capacity of PBSC mobilization is needed in non-Hodgkin's lymphoma (NHL). Methods: We analyzed the applicability of ICE (ifosphamide, carboplatin, and etoposide) regimen in NHL patients who underewent autologous PBSCT. Results: The median age was 38 years (range, 16~61 years), the patients received median 4 cycles (range, 1~6 cycles) of ICE regimen, and the median interval between each chemotherapeutic cycle was 24 days (range, 16~36 days). There were 7 (53.8%) complete responses, 4 (30.8%) partial responses, and 2 (15.4%) progressive diseases after ICE regimen. Toxicity included grade 3/4 neutropenia and throm bocytopenia in 13 (81.3%) and 7 (42.8%) patients, respectively. PBSC collection began on median day 12 (range, 6~20 days) after ICE therapy. The median number of mononuclear cells, CD34+ cells, and CFU-GM was 5.75× 10^(8)/kg, 1.25× 10^(6)/kg, and 1.19× 10^(5)/kg, respectively. With a median follow- up of 401 days, the patients who underwent autologous PBSCT had overall survival with 70.1±14.7% at 2 year and event free survival with 60.7±15.4% and 32.3±17.1% at 1 year and 2 years, respectively. Conclusion: ICE chemotherapy is an effective cytoreduction and mobilization regimen in patients with NHL, but profound myelosuppression with delayed recovery might pose difficulties in applying for Korean patients. Further evaluation for appropriate salvage regimens in Korean patients should be needed.