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.

성인 지역사회 폐렴의 원인 미생물에 대한 전향적 다기관 연구 : Legionella, Leptospira, Hantaan virus and Orientia tsutsugamushi

김민자,정희진,손장욱,심희선,박대원,박승철,우준희,강재명,김유겸,신완식,김양리,이환종,김지희 대한감염학회 2001 감염 Vol.33 No.1

Background : Despite rigorous investigations, the etiology of community-acquired pneumonia remains unknown in about 50% of hospitalized patients. The diagnosis of the etiological agent is becoming more challenging and more critical as number of newer pathogens have been recognized in recent years. In the 3-year period prospective study we investigated adult patients with community-acquired pneumonia for Legionella, Leptospira, Hantaan virus and Orientia tsutsugamushi as potential etiologic agents. Methods : A prospective multicenter study was performed from May 1997 to April 2000. A total of 431 patients with community-acquired pneumonia under the inclusion criteria were examined for specific microbial diagnosis; sputum culture and PCR, and serologic teats including indirect immunofluorescence antibody (IFA) test for Legionella, and hemagglutination tests for Leptosoira, Hantaan virus and O. tsutsugamushi. Etiologic diagnosis was determined on the basis of the review of case record forms and specific laboratory diagnostic criteria. Results : During the study period a total of 385 sputum and 283 serum samples were examined. Legionella pneumonia was diagnosed in 2.3% (10/431) of the cases examined : 1.4% cases with PCR-positive (5/367) and 2.1% with positive IFA test (6/283). Leptospirosis and scrub typhus were diagnosed in 0.4% (1/252) and 2.0% (5/252), respectively. All 5 cases with scrub typhus occurred in late fall, and rash or eschar was not found. None of cases was Hantaan virus infection. Conclusion : The results suggest that Legionella, Leptospira, and O. tsutsugamushi should be considered in the etiologic diagnosis and empirical antibiotic therapy of community-acquired pneumonia. (Korean J Infect Dis 32:24∼31, 2001)

아미노산 투여가 중장거리 운동선수의 최대 및 최대하운동시 젖산생성에 미치는 영향

이정수,윤탁영,김문희,이선장,김완조 韓國體育大學校附屬 體育科學硏究所 1992 韓國體育大學校附屬 體育科學硏究所論文集 Vol.11 No.1

The Purpose of the Study was to determine whether the glutamate ingestion prior to exercise would reduce the lactat formation and its clearance in exercising mscle tisue during Submaximal and maximal execise. Six elite distance rummers particapated in this study. The Subjects had a half dose of glutamale(15.6mg .Kg?? ??) at 45min and ingested rest dose at prior to exerise. The test Performed twice. One was Performed in the track and the other was in the Lab. Blood Smples were obtained from catheter which was placed in the antecubital vein (Lab test) and finger tip Samples (Feld test) Unaltered blood lactate was observed in both trials, but, tended to less lactate concentration with glutamate ingestion than that of without glutamate ingestion. The recovery rate of blood lactate was markely rapid with glutamate ingestion in the field test. Unchanged in heart rate was founded in both trials. It many Suggest that, the additional supplement st of glutamate can improve execise performance limiting lactate formation or induce its rapid clearance from the muscle fissue.

國民學校 低學年의 100m 疾走能力 分析硏究

李完熙 春川敎育大學 1982 論文集 Vol.22 No.-

지역특성에 따른 국민학교 육상경기의 지도실태에 관한 분석연구 : 강원도내 국민학교를 중심으로 Centering around the primary schools in Kang Won Do province

이완희 春川敎育大學 1989 論文集 Vol.29 No.-

Conclusion and suggestion : This study as been conducted through the writer's visits to 87 primary schools in Kangwon-do province and through guestionaire on teaching field and track and raising to players from those schools. The schools were divided into 5 groups consisting of 15 schools in urban areas, 13 schools in agricultural areas, 13 schools in mining areas, 19 schools in reaoterural areas, 21 schools in areas adjacent to DMZ. the results of the writer's results of the writer's analysis are : 1. The general results teaching of field events showed more difficulty than that of track events regasdless of areas. 2. The teaching of track events showed difficulty in the order of hurdle races, long distance races, short distance races, middle distance races, and relay races. 3. The teaching of field events showed the most difficulty in high jump events. 4. The problems in teaching field and track events arise grom insuffgicient teaching methods, facilities, and sporting goods. 5. The most necessary facilities and sporting goods in teaching field and track were : 66.67% in high jump, 32.18% in track and straight line track, which are basic. The most serious areas are mining areas, remote rural areas, and areas adjacent to DMZ. 6. The normal operation of field and track events was not available in 89.66% the schools regardless of areas. 7. According to the regional conditions, the problems arise from these factors : in the problems of teaching field and track, urban areas suffer from large classes, agricultural areas from shortage of leaders, and inzmining areas, remote rural areas and areas adjacent to DMZ. 8. 87.36% of field and track umpires and leaders had no experience of participating in workshops. 9. In some schools field and track players were selected through races in schools grounds and teachers recommendations regardless of areas. 10. The responses from the parents of field and track players were generally netgative : urban areas showed 93.33% while mining areas 46.15%. 11. The problams in teaching and raising field and track players arose from these : urban areas suffered from limited ground space because of other events and parents' opposition, agricultural areas from insufficient player resource and budget, miming areas from pollution and freguent pupil transference, and remote rural areas and areas adjacent of DMZ from long cold winter and geavy fall of snow and limited training hours because of short shining hours. There are suggested : Field and track events which are basic and compulsory in physical education become unpopular events, that they are neglected by both pupils and parents. It is suggested that (1) these problems arising from regional conditions he solved immediately, (2) positive public relation be inplemented, (3) development and spread of audio-vidual aids suitable for teaching and developing field and track events he fulfilled, (4) appropriate workshops for in-service teachers he conducted.

호중구 감소성 발열환자에게 경험적으로 투여한 Teicoplanin의 효과

이동건,임동석,최수미,박선희,유진홍,최정현,민우성,신완식,김춘추 대한감염학회 2004 감염과 화학요법 Vol.36 No.2

목적 : 호중구감소성 발열 환자에게 경험적으로 teicoplanin을 투여할 때의 효과를 알아보고자 전향적 연구를 시행하였다. 방법 : 2003년 7월부터 12월까지 가톨릭조혈모세포이식센터에 입원하여 항암치료 혹은 조혈모세포이식을 시행하고 호중구감소성 발열이 있는 환자 중 초기 항균요법에 반응이 없어 경험적 teicoplanin 투여가 필요한 49명을 대상으로 A, B 제조회사에서 제공한 teicoplanin을 무작위로 어느 한 쪽 치료군에 배정하여 투여하였다. 용량은 첫날 400㎎ 부하용량을 정맥내 bolus로 투여하고 매 24시간마다 200㎎ 유지용량을 투여하였다. 결과 : A군 27명, B군 22명이 연구에 참여하였고 대부분의 환자가 신독성이 있는 약제를 병용하고 있었다. A군 8명, B군 7명에서 그람양성균이 동정되었고, teicoplanin에 대한 내성률은 A군 22.2%, B군 28.6%로 유의한 차이는 없었다(P=1.00; 0.61<95%CI<1.95). 미생물학적 확인 감염이 있었던 환자 중 평균 53.3%에서 완치 혹은 개선의 반응이 있었고 양 군간 유의한 차이는 없었다(A군 4명 [50.0%], B군 4명 [57.1%], P=1.00; 0.29<95%CI<2.60). 미생물학적 제거율은 평균 62.5% (A군 55.6%, B군 71.4%)이었고 그 외 미생물학적 효과는 A군에서 제거 후 재발 2명(22.2%), 내성 2명(22.2%)이었고 B군에서 각각 0명(0.0%), 2명(28.6%)이었으며 양 군간 유의한 차이는 없었다(P=0.28). 발열기간(P=0.89), teicoplanin 사용기간(P=0.47) 및 전체적인 사망률(P=1.00; 0.78<95%CI<1.24)도 양 군간 유의한 차이는 없었다. 이상반응 중 신독성은 16.3% (A군 18.5%, B군 13.6%)에서 나타났고 양 군에 차이는 없었으며(P=0.72; 0.39<95%CI<3.51), 신기능 이상과 관련있는 약제를 적어도 2개 이상 병용하고 있었다. 피부발진은 A군에서 1명, B군에서 3명 발생하였다(P=0.31; 0.93<95%CI<1.34). 결론 : 호중구감소성 발열환자에게 teicoplanin을 투여하였을 때 임상적 반응률은 평균 53.3%(A군 50.5%, B군 57.1%), 미생물학적 제거율은 평균 62.5%(A군 55.6%, B군 71.4%)이었고 두 제조회사간 차이가 없었고 이상반응도 양 군간 차이가 없었다. 앞으로 국내 호중구감소증 환자에서의 teicoplanin의 적정 용량, 용법 등을 알기 위한 집단 약동학 등의 연구를 시행할 예정이다. Background : This study was done to elucidate the efficacy of teicoplanin as the empirical treatment for febrile neutropenia. Methods : Patients were randomized to two groups according to pharmaceutical company (company A or B). Total of 49 patients (A, 27; B, 22) with neutropenic fever were studied prospectively for 6 months (Jul. 2003-Dec. 2003). Patients received 400 mg i.v. once, then 200 mg i.v. once daily. Results : Groups were matched for all demographic variables. Most of the patients were concurrently receiving nephrotoxic drugs. Gram positive microorganisms were isolated in 8 patients for A and 7 patients for B. Resistance rate against teicoplanin was 22.2% in A and 28.6% in B (P=1.0; 0.61 < 95% confidence interval [Cl] < 1.95). Among the patients with microbiologically documented infection, clinical cure or improvement was seen in 4 (50%) of 8 patients for A and 4 (57.1%) of 7 patients for B (P=1.00; 0.29 <95%CI <2.60). Bacteriologic efficacy was assessed as follows; elimination in 5 (55.6%), elimination with relapse in 2 (22.2%), resistance in 2 (22.2%) out of 9 gram-positive bacteria for A and 5 (51.4%), 0 (0.0%), 2 (28.6%) out of 7 bacteria for B, respectively (P=Q.28). There were no significant differences in duration of fever, duration of use of teicoplanin, and overall mortality. The incidence of nephrotoxicity and ototoxicity was not significant. Conclusion : For using teicoplanin as the empirical therapy for febrile neutropenia, the rate of clinical, microbiological response, and nephrotoxicity was 53.3%, 62.5%, and 16.3% respectively with no significant differences between the 2 preparations of teicoplanin. Supplementary evaluation on the adequate dose and duration of teicoplanin may be required.

아미노산 투여가 운동중 싸이클선수의 젖산 및 심박수에 미치는 영향

이승국,유병렬,김문희,김완조,이선장 韓國體育大學校附屬 體育科學硏究所 1992 韓國體育大學校附屬 體育科學硏究所論文集 Vol.11 No.1

The purpose of the study was to determine whether a 15.6mg.Kg ??' does of glutamate given one hour prior to incremental exercise test would reduce the lactate formation. Five well trained cyclists served as subjects in this experiment which included a placebo and glutamate trial. The subjects initially work on treadmill 200m/min for 3 minutes and here increased the workload by 20m/min every 3minutes until exhaustion. Blood lactate were collected from finger-tip. Subjects in the glutamate trial showed significantly lower lactate formation during exercise then they did in the placebo trial. In both groups no significant difference was found on heart rate. During the recovery lactate and heart, rate were unaltered in either the glutamate or placebo trials. In summary, glutamate ingestion may reduce lactate formation resultly improvement of performance.

4주간의 쥐뒷다리 고정이 Soleus근섬유 조성에 미친 영향

이선장,김완조,김문희 韓國體育大學校附屬 體育科學硏究所 1992 韓國體育大學校附屬 體育科學硏究所論文集 Vol.11 No.1

The purpose of this study was to examine the effect of immobilization on muscle fiber composition, mass, area and capillarization after 4 - wk of hindlimb suspension. Significant reductions in soleus mass, area and capillary density were occured after 4 wks of hindlimb suspension, Wheres type IIa fiber percentage was significantly increased in the experimental group. The results suggest that hindlimb unweighting induced soleus muscle atropy and these results also demonstrate that muscle fiber atropy not necessarily being associated with a loss in capillary supply.

水泳에서 팔動作과 다리動作이 泳速에 미치는 影響에 關한 硏究

李完熙 春川敎育大學 1991 論文集 Vol.31 No.-

예체능 심화과정 학생들의 기능 변화에 대한 연구

이완섭,김춘선,김정희 춘천교육대학교 예체능교육연구소 1996 예체능교육연구 Vol.1 No.-