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.

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 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.

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.

複合組織鋼의 摩擦 熔接部의 疲勞破壞特性에 관한 硏究

吳世旭,姜鎬珉,兪在煥,林東哲 東亞大學校 1988 東亞論叢 Vol.25 No.1

This study has been carried out to investigate the characteristics of fatigue crack of welded zone and heat affected zone of friction welded dual phase steel. The results obtained from the experiments are summarized as follows. Microstructure of welded zone is changed to ferrite and pearlite from ferrite and martensite by wel-ding heat. Micro-vickers hardness of welded zone is higher than that of base metal zone and heat affec-ted zone. Micro-vickers hardness of heat affected zone is lower than that of welded zone and microstructure of heat affected zone is changed to fine martensite and ferrite by heating cycle of welding. Fatigue limits of heat affected zone is a little higher than that of welded zone and base metal zone. There are no difference of fatigue limit of base metal zone and welded zone. Fatigue strength of welded zone is similar to that of base metal zone. At high △K region(△K>19MPa·??), fatigue crack propagation velocity of heat affected zone is slower than that of welded zone and base metal zone, and the difference of fatigue crack propagation velocity is smaller than that of high △K region. The crack occurs to the notch in heat affected zone first, but the final fracture surface is the surface of welded zone. It is abvious that heat affected zone of friction welded dual phase steel superior to welded zone and base metal zone in fatigue strength and resistance of fatigue crack propagation. The above mentioned facts are contrary to theory that heat affected zone of general metals is weaker than welded zone and base metal zone.

광섬유 방사선 센서와 EBT 필름을 이용한 심부선량 백분율 측정 및 비교

조동현,장경원,유욱재,신상훈,이봉수,문주현,박병기 제주대학교 방사선응용과학연구소 2008 방사선응용과학연구소논문집 Vol.22 No.-

In this study, fiber-optic sensor is fabricated to measure PDD of CLINAC. As a scintillating light generated by a high energy X-ray from the medical LINAC is measured using photo diode amp system, It is expected that a high-resolution, real-time fiber-optic dosimeter for medical LINAC can be developed.

Gu¨k 컨버어터에 의한 태양광 발전 시스템에 관한 연구

元忠淵,兪東旭,金學成 成均館大學校 科學技術硏究所 1992 論文集 Vol.42 No.2

The photovoltaic modules have each maximum power point, which depending on the intensity of sunlight, modules temperature and etc. Cu¨k converter is used to obtain the maximum charging power from photovoltaic modules to storage batteries. This paper proposed to a new tracking control method by detecting its current and voltage in photovoltaic power generation system controlled by microprocessor, in order to operate at the maximum power point tracking(MPPT) even if the sunlight and the temperature are validity of proposed MPPT method is verified by the simulations.

X-ray용 고주파 공진형 고전압 발생장치에 관한 연구

김학성,유동욱,김현준,원충연 成均館大學校 科學技術硏究所 1995 論文集 Vol.46 No.1

This paper is concerned with High Frequency, High Voltage Generator for X-ray using zerovoltage soft-switching PWM DC-DC power converter by resonant method, which makes the most of the parastic IBC parameters of high-voltage transformer link, for diagonostic X-ray power generator. The converter circuit basically utilizes phase-shift pulse width modulated series resonant full-bridge PWM DC-DC high-power converter operating at a constant frequency;25kHz. The high-frequency switching operation of the inverter has some effective advantages with consist in the physical reduction in size and weight and lowered acoustic noise. The converter output regulation is digitally controlled using DSP(Digital Signal Processor) for obtaining a fast rising time and adjust output voltage within a wide load range. This converter characteristics are evaluated in terms of computer-aided analytical and experimental results.

Soft Switching 방식을 이용한 Active Clamp Mode Forward Converter 설계

원충연,유동욱,김덕헌,김학성 成均館大學校 科學技術硏究所 1992 論文集 Vol.43 No.2

In recent years, a trend of DC-DC converter is studied mainly quasi resonant converter and multi resonant converter such as resonant type. But by using zero voltage and zero current method, these converter have voltage and current stress in the circuits. So the purpose of this paper is to reduce voltage and current stress, and to increase efficiency (about 5∼10%) rather than above converters. Experimental results show that active clamp mode PWM switching forward converter has minimum switching loss and conducting loss. The test results verify the simulation performance.

방사성 페기물 처리장의 지하수 온도 측정을 위한 광섬유 센서의 제작 및 특성 분석

서정기,유욱재,장경원,조동현,신상훈,이봉수 제주대학교 방사선응용과학연구소 2008 방사선응용과학연구소논문집 Vol.22 No.-

Fiber-optic temperature sensing technology can alternative to classical measurement techniques in nuclear environment, Its advantages allow low cost, a long distance measurement and real-time, In this study, we have measured the optical power of power meter and the output voltage of photodiode according to change temperature of water.