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.

Evaluation of the Efficacy and Safety of DA-9601 versus Its New Formulation, DA-5204, in Patients with Gastritis: Phase III, Randomized, Double-Blind, Non-Inferiority Study

Choi, Yoon Jin,Lee, Dong Ho,Choi, Myung-Gyu,Lee, Sung Joon,Kim, Sung Kook,Song, Geun Am,Rhee, Poong-Lyul,Jung, Hwoon-Yong,Kang, Dae-Hwan,Lee, Yong Chan,Lee, Si Hyung,Choi, Suck Chei,Shim, Ki-Nam,Seol, KOREAN ACADEMY OF MEDICAL SCIENCE 2017 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.32 No.11

<P>This study compared the efficacy of DA-9601 (Dong-A ST Co., Seoul, Korea) and its new formulation, DA-5204 (Dong-A ST Co.), for treating erosive gastritis. This phase III, randomized, multicenter, double-blind, non-inferiority trial randomly assigned 434 patients with endoscopically proven gastric mucosal erosions into two groups: DA-9601 3 times daily or DA-5,204 twice daily for 2 weeks. The final analysis included 421 patients (DA-5204, 209; DA-9601, 212). The primary endpoint (rate of effective gastric erosion healing) and secondary endpoints (cure rate of endoscopic erosion and gastrointestinal [GI] symptom relief) were assessed using endoscopy after the treatment. Drug-related adverse events (AEs), including GI symptoms, were also compared. At week 2, gastric healing rates with DA-5204 and DA-9601 were 42.1% (88/209) and 42.5% (90/212), respectively. The difference between the groups was −0.4% (95% confidence interval, −9.8% to 9.1%), which was above the non-inferiority margin of −14%. The cure rate of gastric erosion in both groups was 37.3%. The improvement rates of GI symptoms with DA-5204 and DA-9601 were 40.4% and 40.8%, respectively. There were no statistically significant differences between the two groups in both secondary endpoints. AEs were reported in 18 (8.4%) patients in the DA-5204 group and 19 (8.8%) in the DA-9601 group. Rates of AE were not different between the two groups. No serious AE or adverse drug reaction (ADR) occurred. These results demonstrate the non-inferiority of DA-5204 compared to DA-9601. DA-5204 is as effective as DA-9601 in the treatment of erosive gastritis. Registered randomized clinical trial at ClinicalTrials.gov (NCT02282670)</P>

각종 난치성 혈액 질환에서의 비혈연간 골수이식

김동욱,한훈,김정아,김희제,민창기,엄현석,최정현,이종욱,한치화,홍영선,최일봉,신완식,민우성,김학기,김춘추,김원일,김동집 대한조혈모세포이식학회 1997 대한조혈모세포이식학회지 Vol.2 No.1

목적: 비혈연간 골수이식은 혈연내에 적절한 골수공여자가 없는 만성골수성백혈병, 고위험군의 급성별혁병, 면역억제치료에 실패한 재생불량성빈혈 및 각종 난치성 조혈모세포질환의 완치를 위한 표준적인 치료방법으로 정착되고 있다. 혈연간 표준적인 동종 이식에 비하여 비혈연간 이식시에는 생착부전, 이식편대숙주반응과 감염이 더 빈번하게 발생하며, 국내에서는 아직까지 체계적인 임상연구결과가 보고된 바 없었다. 이에 본 센터에서는 1995년 10월 이후로 약 20개월간 26예의 비혈연간 골수이식을 시행하였으며 3개월 이상의 추적관찰이 가능하여 이식초기 합병증의 관찰 및 분석이 가능하였던 20예의 환자를 대상으로 이식성적 및 문제점을 보고함으로써 새롭게 확대되고 있는 이 분야의 임상연구 및 진료의 활성화를 꾀하고자 한다. 방법: 각종 혈액 종양질환으로 비혈연간 이식을 시행한 총 26예의 환자중 3개월이상의 추적관찰이 가능하였던 20예를 대상으로 후향적으로 임상경과를 분석한 후 생존 분석을 시행하였고, 환자의 연령, 성별, 질병의 상태, 조식 적합 항원의 일치정도, 이식편대 숙주 반응의 유무와 생존기간과의 상관관계를 살펴보았다. 또한 표준위험군과 고위험군으로 나누어 생존율을 비교하였고 이식과 관계된 생착 부전, 이식편대숙주반응, 감염의 발생과 양상 그리고 그 합병증을 관찰하였다. 결과: 1. 환자와 공여자간에 HLA 불일치가 20예 중 4예에서 있었으며, 생착여부의 확인이 가능했던 17예 중 16예에서 생착이 확인되어 94.1%의 생착율을 보였다. 2. 급성이식편대숙주반응은 62.5%(10/16예)에서 발생하였으며 111도 이상의 급성의 이식편대숙주 반응은 25%(4/16예)에서 발생하였다. 만성이식편대숙주반응은 40%(2/5예)의 환자에서 발생하였으며 이들 모두 국소형으로 중증의 진행형 만성이식편대숙주반응이 관찰된 환자는 없었다. 3. 호흡기 합병증은 10예(50%)에서 발생하였으며 감염성 폐렴을 포함한 호흡기 합병증이 가장 흔한 일차적인 사망 원인이었다. 호흡기 합병증이 발생했던 10예중 6예가 감염에 의한 폐렴이 의심되었고 나머지 4예는 특발성 간질성 폐렴이었다. 4. 8.5개월의 중앙추적기간 중 35%의 생존율을 관찰할 수 있었고, 생존기간은0.5개월에서 15개월 (중앙치:4개월)이었다. 한편 고위험군은 25%(3/12예), 표준위험군은 50%(4/8)의 생존율을 관찰할 수 있었다. 5. 가장 흔한 사망 원인은 감염성 폐렴을 포함한 호흡기 합병증(6예)이었고, 이외의 사망 원인으로는 급성 이식편대숙주반응과 다장기부전이 각각 2예, 생착 부전, 간정맥 폐쇄, 그리고 재발이 각각 1예였다. Unrelated bone marrow transplantation(UBMT) has been increasingly recognized as the standard treatment for cure of chronic myelogenous leukemia, high risk acute leukemia, aplastic failed on immunotherapy, and the variety of refractory hematologic diseases in patients lacking a related donor. However, as compared to HLA identical sibing transplantation, UBMT carries higher incidence of graft failure, graft versus host disease(GVHD), and infection. In our center, 26 patients underwent UMBT between October 1995 and June 1997. The minimum follow-up of 3 months was possible in 20 patients, for whom early complications and clinical outcomes were assessed. The median age of the 20 patients was 24 years. 8 patients had standard risk disease and 12 patients had high risk disease. All patients received various preparative regimens including total body irradiation according to disease and disease status. 19 patients received CsA + short course MTX for GVHD prophylaxis. One patient received marrow that was depleted of T cells ex vivo using avidinbiotin column. The class I loci were typed by serological methods and HLA-A, HLA-B and HLA-DRB1. 3 additional pairs were one minor mismatched at the HLA-B locus. Another one patients was one major mismatched at the DRBI alleles. 17 patients were evaluable for engraftment. Successful enfraftment was confirmed in 16 patients(94.1%). Only one patient who was performed one major DRBI mismatched transplants experienced graft rejection. 16 patients were evaluable for acute GVHD. The overall incidence of acute GVHD developed in 4 patients(25%). Five patients were evaluable for the development of Ⅳ acute GVHD developed in 4 patients (25%). Five patients were evaluanle for the development of chronic GVHD. 2 patients(40%) developed limited chronic GVHD. Respiratory complications including pulmonary infection developed in 10 patients(50%) and these complications were the most common primary cause of death. Of these 10patients, 6 had pneumonia due to fungus(4 patients), pacterial (1 patient), and CMV infection (1 patient) and 4(20%) had idiopathic interstitial pneumonitis and/or adult respiratory distress syndrome. The duration of median follow- up was 8.5 months and 7 of 20 patients(35%) are alive at the time of this analysis with survival duration of 0.5 to 15 months(median survival duration: 4 months). The overall survival was 25% (3/12 patients) in high risk group and 50%(4/8 patients) in standard group. From these results, we can predict that the incidence and severity of GVHD in Korea are lesser than multiracial countries and the long-term survival of patients with standard risk disease can approach that of HLA matched sibling transplants. For the past two years, the performance of UBMT has been rapidly increasing and it will be possible to analyze much larger number of patients soon in Korea. In the future the problems of graft failure, GVHD, and infection due to long lasting immunocompromised status will need to be overcome by continued medical research. In addition, the volunteer donor pool will have to be expanded by the promotion of the national awareness of its need.

P164 : A clinical and statistical study of cutaneous premalignant lesions in Busan city and the eastern Gyeongnam province over 19 years

( Seung Hwan Choi ),( Seung Min Ha ),( Dong Yeob Ko ),( Ki Ho Kim ),( Ki Hoon Song ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.2

Background: Premalignant lesions has recently continuously increased in Koreans. However, there has been little research into the distribution and incidence of cutaneous premalignant lesions in the south-eastern part of korea Objectives: To analyze recent trends in incidence and clinical patterns of cutaneous premalignant lesions in Busan city and the eastern Gyeongnam province Methods: We reviewed 1,292 cases (3,651 lesions) of cutaneous premalignant lesions that include actinic keratosis (AK) and bowen’s disease (BD) at the Department of Dermatology in Dong-A University Hospital Results: The average annual incidence of cutaneous premalignant lesions among total outpatients was 1.82% and has continuously increased from 0.70% to 4.25% over the last 19 years. The most common cutaneous premalignant lesionwas AK (75.85%), followed by BD (24.15%). The mean age of onset was 68.76 years. A major skin cancer was found in 15.79% of patients with cutaneous premalignant lesions, including SCC (11.54%), BCC (6.09%), and malignant melanoma (0.64%). Additionally, 59.13% of the patients had a single lesion, while 40.87% had multiple lesions. Age, occupation-related exposure to ultraviolet radiation, and a past history of skin cancer were higher in the patients with multiple lesions than single lesion Conclusion: The incidence of cutaneous premalignant lesions has gradually increased in Busan city and the eastern Gyeongnam Province, which was relatively higher than incidence in other areas

광선각화증, 보웬병, 편평상피세포암에서 Ki-67, Cyclin A, p53, p16의 발현 양상

이효진 ( Hyo Jin Lee ),신동훈 ( Dong Hoon Shin ),최종수 ( Jong Soo Choi ),김기홍 ( Ki Hong Kim ) 대한피부과학회 2012 대한피부과학회지 Vol.50 No.4

Background: Actinic keratosis (AK) and bowen`s disease (BD) are pre-cancerous diseases, and are regarded as an early squamous cell carcinoma (SCC). AK and BD can be progressed into SCC. In this process, tumor suppressor and cell proliferative proteins may play important roles. Objective: To investigate the differences of expression patterns of the immunohistochemical (IHC) staining and useful markers for differential diagnosis in AK, BD and SCC. Methods: Biopsy had proven 17 cases of AK, 20 cases of BD and 17 cases of SCC, which were all selected. IHC staining for Ki-67 and cyclin-A, as cell proliferative markers, p53 and p16 as tumor suppressor markers, were performed. Labeling index (LI) and distribution pattern of IHC expressions were measured. Results: LI of Ki-67 in AK, BD and SCC were 30.6%, 60.2% and 54.8%, respectively. LI of cyclin-A in AK, BD and SCC were 9.2%, 24.4% and 24.1%, respectively. LI of p53 in AK, BD and SCC were 20.7%, 37.9%, and 39.9%, respectively. LI of p16 in AK, BD and SCC were 10.6%, 38.3% and 39.9%, respectively. Lower 1/3 was the most frequent distribution pattern in AK in all IHC stains, full thickness lower 2/3 were the most frequent distribution pattern in BD and SCC in all IHC stains. Conclusion: LI and distribution pattern of Ki-67, cyclin-A, and p16, as well as the distribution pattern of p53 may be useful markers to differentiate AK from BD and SCC. Higher degree and full-thickness distribution pattern IHC expressions in all stains may be helpful in the diagnosis of BD, rather than AK. (Korean J Dermatol 2012;50(4):290∼298)

관동맥질환에서 저밀도 지단백 입자 크기의 분포

임효영,김인숙,승기배,강동헌,전두수,장기육,박준철,이수영,홍순조,최규보 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.8

슬관절에 히야루론산 주입후 발생한 활막성 연골종증 : 증례 보고

최의성,김용민,김동수,손현철,박경진,조병기,배승환 충북대학교 의과대학 충북대학교 의학연구소 2009 忠北醫大學術誌 Vol.18 No.2

활막성 연골종증은 비교적 드문 양성 종양으로 관절내 활액막 결체조직의 양성 반응성 이형성에 의해 여러 개의 연골성 결절을 형성하고 이것이 관절내로 유리되어 유리체를 형성하는 질환으로 주로 슬관절에 발생한다. 활막성 연골종증의 정확한 발생 기전은 아직 밝혀지지 않았으나 외상, 감염 등이 원인으로 제시되고 있다. 저자들은 슬관절 내 히야루론산 주입후 발생한 슬관절내 활막성 연골종증을 1 례 경험하였으며, 관절경적 제거술을 통해 만족스런 결과를 얻었다. As a relatively rare benign tumor, synovial chondromatosis forms several cartilaginous nodules by the benign reactive metaplasia of synovial connective tissues within joints, which are loosed into the joints and cause a disease forming loose body mainly in knee joint. Accurate mechanism of synovial chondromatosis has not been clarified yet; however, trauma, infections and others have been suggested as its possible causes. The authors of this study experienced an example of a patient with synovial chondromatosis in knee joint occurred after the injection of hyaluronic acid in the joints and had a satisfactory outcome through the arthroscopic resection.

임상학적 적용을 위한 FET형 요소센서의 제조 및 그 특성

최성문,김응수,박동수,김의락,손병기 경북대학교 센서기술연구소 1991 센서技術學術大會論文集 Vol.2 No.1

A FET type micro urea sensor - very proper and promising shapes for in vivo, in situ measurements - had been examined on its compatibilities with clinical analysis. Investigations were performed on the interference of various amino acids, organic metabolites and waste products present in blood, which may cause interference with the sensor output. The results of the measurements of urea-nitrogen in blood plasma measurements was compared with those of conventional spectrophotometric method.

Fusobacterium nucleatum의 테트라사이클린 내성여부를 검사하기 위한 세균배양법과 중합효소연쇄반응법의 비교

최재흥,성진효,국중기,김동기 대한구강보건학회 2003 大韓口腔保健學會誌 Vol.27 No.4

The purposes of this study were to identify the detection and incidence of tetracycline resistance determinant tet(M) by PCR method and to evaluate the availability of PCR method guided for clinical use of antibiotics in dentistry. Subgingival plaque samples were collected from 172 sites of 29 patients. Both original sample and subculturd sample, PCR amplification was used to detect tet(M) in Fusobacterium nucleatum. The percentage of tet(M)-positive subjects and sites in original samples were 100%, 95.9%, respectively. And the percentage of tet(M)-positive subjects and sites in subcultured samples were 17.2%, 3.5%, respectively. In subcultured samples, probing pocket depth and clinical attachment level in tet(M)-positive sites were higher than in negative sites (p<0.05). The sensitivity and specificity of PCR method compared with broth dilution method as a gold standard were 0.91 and 0.86, respectively. The results suggested that tet(M) assay using PCR method was available to detect the tetracycline-resistant F. nucleatum.

아연의 전기화학적 산화ㆍ환원반응에 미치는 전해질 농도의 영향

정순기,최동귀 순천향대학교 산업기술연구소 2007 순천향 산업기술연구소논문집 Vol.13 No.1

.