조혈모세포이식 환자에서의 기계 환기의 위험 인자 : Assessment of Risk Factors

안중경,이홍기,황정혜,박세훈,이효락,송서영,이순일,박준오,김기현,김원석,정철원,임영혁,강원기,박근칠 대한조혈모세포이식학회 2002 대한조혈모세포이식학회지 Vol.7 No.1

연구배경: 조혈모세포이식을 시행한 환자에서 집중 치료 시 예후가 매우 나쁜 것으로 알려져 있고, 기계 환기는 강력한 사망 예측 인자로서 보고되고 있다. 그러나 현재까지 이식 환자에서 기계 환기의 위험 인자를 밝힌 연구는 매우 드물다. 따라서 기계 환기를 시행한 조혈모세포이식 환자의 임상적 특징을 살펴보고 기계 환기에 대한 위험 인자를 알아보고자 하였다. 방법: 삼성서울병원에서 조혈모세포이식을 시행한 환자 중 기계 환기를 시행한 23명과 기계 환기를 시행하지 않은 142명을 대상으로 후향적 연구를 시행하였다. 기계 환기에 대한 위험 인자의 여부에 관해서는 chi-square 또는 Fisher's exact 검정을 시행하였으며 기계 환기에 대한 각 위험 인자의 영향에 관해서는 다중로지스틱 회귀분석을 시행하였다. 결과: 기계 환기를 시행한 23명의 환자 중 30일째 생존자는 1명이었고 6개월째 생존율은 0%였다. 생존자와 사망자 모두에서 다기관 기능부전이 관찰되었으며, APACHE II 점수와 SAPS II 점수에 의한 예측 사망률은 각각 56%, 59%였다. 조혈모세포이식 후 기계 환기의 위험 인자로는 선행 질환이 혈액질환, 부분불일치 동종이식, 간정맥폐색성질환, 이식 전 질병 상태가 재발하였거나 약물에 반응하지 않는 경우였다. 다중로지스틱 회귀분석 결과 기계 환기의 위험 인자로 통계적으로 유의한 차이를 나타낸 것은 단지 부분불일치 동종이식을 시행한 경우였다. 결론: 현재까지 조혈모세포이식 환자에서 집중 치료의 역할에 대해서는 확실히 정립되어 있지는 않으며, 이식 환자에서 기계 환기는 강력한 사망 예측 인자이다. 따라서, 조혈모세포이식을 시행한 환자에서 기계 환기의 위험 인자와 불량한 예후 인자를 고려하여 기계 환기 여부에 대한 신중한 결정을 내려야 한다. Background: Respiratory failure requiring mechanical ventilation is a frequent, critical complication of hematopoietic stem cell transplantation (HSCT). Patients who require mechanical ventilatory support after HSCT generally have a very poor prognosis. Mechanical ventilation in HSCT recipients is a strong predictive factor of mortality. The objectives of this study are to describe clinical characteristics of HSCT recipients undergoing mechanical ventilation and to identify the risk factors for mechanical ventilatory support after HSCT. Methods: We performed a retrospective chart review of all patients >15 yrs old who received HSCT at Samsung Medical Center and subsequently required mechanical ventilatory support between 1996 and 2001. Results: Thirty-day mortality rate in HSCT recipients undergoing mechanical ventilation was 95.6%. The mean predictive mortality rates of APAHCE II score and SAPS II score were 56% and 59%, respectively. Reasons for mechanical ventila-tion were sepsis (47.8%) followed by fungal infection (13%) and diffuse alveolar hemorrhage (8.7%). Univariate analysis identified relapsed or refractory diseases at HSCT, hematologic disease, hepatic venoocclusive disease and allogeneic or HLA-mismatched transplant as significant risk factors for mechanical ventilation. On multivariate logistic regression analysis, only allogeneic mismatched transplant remained significant. Conclusion: Overall outcome of HSCT recipients undergoing mechanical ventilation is very poor. Therefore, the risk factors and the poor prognostic factors for mechanical ventilation should be taken into account in making further treatment decision for HSCT recipients requiring mechanical ventilation.

당뇨병환자에서 게이트심장혈액풀신티그라피를 이용한 심기능 평가

윤상임,송치운,이진홍,안미애,성기양,송민호,이강욱,신영태,김영건,노흥규 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

Major cardiovascular complications of diabetes are coronary atherosclerosis, diabetic dilated cardiomyopathy, autonomic neuropathy and those are major causes of morbidity and mortality in diabetic patients. Gated blood pool heart scan is noninvasive and useful method for evaluation of functional status of heart in diabetics. We evaluated 52 patients with diabetes and divided 3 groups. Group 1 were 11 patients without proteinuria or with proteinuria less than 550mng during 24 hours. Group 2 were 9 patients with proteinuria more than 550mg during 24 hours and group 3 were 32 patients with endstage renal diasese due to diabetes. We performed 99mTc-HSA cardiac gated blood pool scan and used left ventricular ejection fraction(LVEF), peak ejection rate(PEF) to indices of LV systolic function and peak filling rate(PER) to index of LV diastolic function. The results were follows : 1) LVEF, PER were significantly lower in diabetics with ESRD than diabetics without ESRD, but there were no significant difference between normal controls and diabetics without ESRD 2) PFR was significantly lower in diabetics than normal controls, but there were no significant differences in diabetics with or without nephropathy. 3) There were negative correlation between PER, PFR and duration of diabetes. On the basis of results, PFR is a LV functional index of GBPS which can disclose early change of LV dysfunction in patients with diabetes.

Ehrlich 암세포에 대한 Acriflavine-Guanosine 복합제 (AG60)의 항암효과 -광학현미경적, 자기방사법적 및 전자현미경적 연구-

안의태,고정식,김형진,김상건,이경영,강종구,유보림,정영신,홍은경,한영복 대한해부학회 1999 Anatomy & Cell Biology Vol.32 No.2

학교보건교육 수행실태 및 영향요인분석

김영임,안지영 韓國學校保健學會 1999 韓國學校保健學會誌 Vol.12 No.1

The objectives of this study are to explain the performance patterns of health education and related factors in elementary middle, and high schools in Korea. The survey data were collected by questionnaires from June to September in 1998. the number of subjects were 294 school nurses. The SAS-pc program was used for statistical analyses such as percent distribution, a x²-test, a Spearman correlation est. and logistic regression analysis. The major results were as follows: 1. The performance rates of health education by elementary, middle and high schools was higher than before. But the education time was not as sufficient as desired. 2. Planning and practice far health education in elementary and middle schools were high. The preparation of the instruction for health education in elementary school was especially strong. 3. The need survey for health education was low'-'32-46%. The performance rates of health education increased yearly in elementary school. 4. The reference data were insufficient fur health education; In other words, it was difficult for' a systematic education. 5. Usually lecture and other methods were used. 10-15% used only the lecture method. 6. The content of heath education was life style in the lower levels of elementary school, Drinking, smoking, drug use etc. were concentrated on in middle and high school. 7 The education evaluation and application was activated in elementary school, otherwise, was low in high school. 8. School nurses and school performance in health education were influenced significatly by planning of health education and the instruction of heath education in elementary school. In the case of planning, the budget was a significant variable; in the case of instruction, the number of school class was significant. In conclusion, these findings suggest that a developed health education curriculum be performed gearly in order to create a systematic school health education. Also, it is necessary to activate an evaluation to system measure behavioral changes. It is expected that the improvement of school health education be accomplished through the systematic support of schools by government in the physical, economi, and psychological areas.

학교보건교육에서의 매체활용실태 및 영향요인 분석

박은옥,안지영,정혜선,김영임,박정영 韓國學校保健學會 1999 韓國學校保健學會誌 Vol.12 No.2

The objectives of this study are to explain the use of media materials in school health education with other related factors in elementary, middle, and high schools in Korea. The data were collected by questionnaires from June to September in 1988. The number of subjects were 294 school nurses. The PC-SAS program was used for statistical analysis such as percent distribution, chi-squared test, spearman correlation test, and logistic regression. The use of media materials in health education has become extremely common. Unfortunately, much of the early materials were of poor production quality, reflected low levels of interest, and generally did little to enhance health education programming. A recent trend in media materials is a move away from the fact filled production to a more affective, process-oriented approach. There is an obvious need for health educators to use high-quality, polished productions in order to counteract the same levels of quality used by commercial agencies that often promote "unhealthy" lifestyles. Health educators need to be aware of the advantages and disadvantages of the various forms of media. Selecting media materials should be based on more than cost, availability, and personal preference. Selection should be based on the goal of achieving behavioral objectives formulated before the review process begins. The decision to use no media materials rather than something of dubious quality will usually be the right decision. Poor-quality, outdated, or boring materials will usually have a detrimental effect on the presentation. Media materials should be viewed as vehicles to enhance learning, not products that will stand in isolation. Process of materials is an essential part of the educational process. The major results were as follows:1. The elementary schools used the materials more frequently. But the production rate of media materials was not enough. The budget was too small for a wide use of media materials in school health education. These findings suggest that all schools have to increase the budget of health education programs. 2. Computers offer an incredibly diverse set of possibilities for use in health education, ranging from complicated statistical analysis to elementary-school-level health education games. But the use rate of this material was not high. The development of related software is essential. 3. In this study, the most effective materials were films in elementary school and videotapes in middle and high school. Film tends to be a more emotive medium than videotape. The difficulties of media selection involved the small amount of extant educational materials. Media selection is a multifaceted process and should be based on a combination of sound principles. 4. The review of material use following student levels showed that the more the contents were various, the more the use rate was high. 5. Health education videotapes and overhead projectors proved the most plentiful and widest media tools. The information depicted was more likely to be current. As a means to display both text and graphic information, this instructional medium has proven to be both effective and enduring. 6. An analysis of how effective the quality of school nurse and school use of media materials shows a result that is not complete)p=0.1113). But, the budget of health education is a significant variable. The increase of the budget therefore is essential to effective use of media materials. From these results it is recommended that various media materials be developed and be wide used.

질편모충 항원분석을 위한 단백빌 용출방법의 비교

권장연,임영희,임미혜,류재숙,안명희,민득영 한양대학교 의과대학 1998 한양의대 학술지 Vol.18 No.2

The purification methods such as bead-beater destruction, trichloroacetic acid(TCA) precipitation and 3-[(3-cholamidopropyl) dimethylammonio]-1-propane sulfonate(CHAPS) solubilization of Trichomonas vaginalis antigens on sodium dodecyl sulfate-polyacrylamide gel electrophoresis(SDS-PAGE) and enzyme-linked immunoelectrotransfer blotting (EITB) were evaluated. Total TCA-precipitated proteins and CHAPS-solubilized extract of T. vaginalis possessed common protein bands whose molecular weights were at 28 kDa, 35 kDa, 40 kDa, 50 kDa, 60 kDa, 100 kDa, 120 kDa, 130 kDa, and 160 kDa, and bead-beater treated trichomonal proteins represented some different spectrum of protein bands from TCA- or CHAPS-treated ones in that they didn't show high M.W. protein bands(〉100 kDa) on SDS-PAGE. But similar antigenic bands with the molecular weights of 60 kDa, 110 kDa, 120 kDa and 140 kDa by EITB were identified in TCA-, CHAPS- and bead-beater treated proteins. In conclusion, TCA-precipitation and CHAPS-solubilization were more stable methods to analyse trichomonal proteins than extraction with bead-beater, and the result will be useful for antigen analysis of Trichomonas vaginalis to elucidate a mechanism of pathogenesis in host-parasite relationship.

자가 말초혈액 조혈모세포 이식술의 임상적용

김혁,안명주,오석중,이영열,김인순,정태준,최일영,오미란,임호준,이항,김신규 한양대학교 의과대학 1999 한양의대 학술지 Vol.19 No.1

Responses to chemotherapy correlate with the increased dose of chemotherapeutic agents in some cancers, e.g. breast cancer, Ewing's sarcoma, Hodgkin's disease(HD) and non-Hodgkin's lymphoma(NHL), then for the improvement of the chemotherapy responsiveness, high-dose chemotherapy(HDCT) was proposed. But, it's application was limited due to complications, especially bone marrow suppression. HDCT and succeeding autologous peripheral blood stem cell transplantation(APBSCT) was introduced to overcome this problem. This study was designed to determine the clinical pictures including clinical parameters and the responsiveness of HDCT followed by APBSCT in Hanyang University Hospital. Ten patients were enrolled. They were 8 adults (3 breast cancers, 3 multiple myelomas, 1 HD, 1 NHL) and 2 children (1 acute myelogenous leukemia (AML), 1 neuroblastoma). Mobilization chemocherapy(MCT) followed by Granulocyte Colony Stimulating Factor(G-CSF) was administered to mobilize stem cells from bone marrow to peripheral blood. The stem cells were collected by using CS-3000 and cryopreserved at -196℃ with programmed controlled rate freezer as the mixture with 10% dimethyl sulfoxide(DMSO). HDCT was administered and cryopreserved peripheral stem cells were infused on day 0 as planned. Patients' mean age was 41 years old. After induction chemotherapy three patients achieved complete response and 5 partial response. The median time for bone marrow recovery after MCT was 11.5 days for neutrophil(〉500/㎣) and 4.8 days for platelet(〉20,000/㎣). There were three cases of neutropenic fever and one case of gingivitis. After HDCT with APBSCT, one patient was converted partial response to complete response, and one patient achieved complete response after HDCT without induction chemotherapy. The median time for bone marrow recovery was 12.7 days for neutrophil(〉500/㎣) and 14.7 days for platelet(〉20,000/㎣). Eight patients developed neutropenic fever and required systemic antibiotics. Transfusion was required 1.6 pints for packed red cell and 23.4 pints for platelet concentrates. Toxicity consisted mainly of vomiting, diarrhea, and mucositis which were mild. HDCT with APBSCT can be performed safely with minimal complications. For the evaluation of the exact role of HDCT with APBSCT in malignant diseases, further studies are required as a large scale of patients and lung-term follow up.

항암제 AG60이 흰생쥐 위점막 상피세포의 DNA합성에 미치는 영향 : 자기방사법적연구

박경호,안의태,고정식,하상선,한영복,정영신,홍은경,유보림,김상건,이경영,강종구 대한해부학회 1999 Anatomy & Cell Biology Vol.32 No.1

각종 소화성질환에서의 Campylobacter Pylori의 검출에 관하여

허정욱,강영우,박준호,박승국,하경임,김재룡,안성훈,박선우 啓明大學校 醫科大學 1988 계명의대학술지 Vol.7 No.2

Peptic disorders are among the most common maladies in korea as the world. In most cases their etiologies not be established and their pathophysioolgy remain obscure. Although the persence of fastric bacteria has been logn established, recently campylobacter pylori seems to be etiologic agent of peptic disorders. Campylobacter pylori is visualized in most cases of peptic disorders and not visualized after treatment of bctericidal agents, bismuth compound or metronidazole. We had a following results for identification of campylocacter pylori in stomach and duodenal mcuosa via endoscipc biopsy. 1. We studied 54 patients who had dyspeptic symptoms, 29 males. 2. Most patients are in 5th decades, next in 3rd and 6th in order. 3. Ptients were composed of 27 peptic ulcer, 22 gastitis and 5 gastric carcinoma. 4. Campylobacter pylori was identified in 69% of total patients, peptic ulcer 63%, gastritis 77%, stomach carcinoma leastly.

SM45C의 레이저 표면경화특성

신호준,유영태,안동규,임기건 한국공작기계학회 2005 한국공작기계학회 춘계학술대회논문집 Vol.2005 No.-

Laser surface hardening is an effective technique used to improve the tribological properties and also to increase the service life of automobile components such as camshafts, crankshatfs, lorry brake drums and gears. High power CO₂ lasers and Nd:YAG lasers are employed for localized hardening of materials and hence are of potential application in the automobile industries. The heat is conducted rapidly into the bulk of the specimen causing self quenching to occur and the formation of martensitic structure. In this investigation, the microstructure features occurring in Nd:YAG laser hardening SM45C steel are discussed with the use of optical microscopic and scanning electron microscopic analysis. Moreover, This paper describes the optimism of the processing parameters for maximum hardened depth of SM45C steel specimens of 3mm thickness by using CW Nd:YAG laser. Travel speed was varied from 0.6m/min to 1.0m/min. The maximum hardness and case depth fo SM45C steel are 780Hv and 0.4mm by laser hardening.