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.

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)

내시경적 점막절제술로 치험한 식도 과립상 세포종 1례

강혁주,김성욱,최석진,이중현,장재식,서영범,윤병구,박건욱,김성자,김용섭,강승완,이구,양창헌,이창우,김욱년,이광헌,서정일 동국대학교 의학연구소 2000 東國醫學 Vol.7 No.-

과립상 세포종은 Schwann 세포 기원으로 생각되며 인체에 비교적 드물게 발생한다. 과립상 세포종은 전신 어느 곳에서나 발견될 수 있으나 주로 혀, 구강, 피부 혹은 유방 등에서 호발하며 드물게 위장관에서 발견된다. 위장관에서는 식도에서 가장 호발하며 다음으로 위, 대장 순이다. 과립상 세포종은 대부분, 특히 위장관에서는 양성이며 소수의 악성 병변이 보고되었다. 이러한 이유와 함께 수술 전의 진단이 어렵기 때문에 과립상 세포종에 대한 근본적인 치료는 현재까지 외과적 절제술이다. 최근에 시도되는 치료방법들로는 내시경적 레이저 치료, 용종절제술, 내시경적 점막 절제술 등이 있다. 저자들은 상부 소화관 내시경검사를 시행하여 식도 과립상 세포종을 진단하고 내시경적 점막 절제술을 시행하여 합병증 없이 퇴원하여 현재 재발없이 경과 관찰중인 1례를 경험하였기에 보고하는 바이다. Granular cell tumors, which occur infrequently, are probably of Schwann cell origin. They can occur almost anywhere in the body but usually affect the tongue, oral cavity, skin, or breasts and are rarely found in the gastrointestinal tracts. The esophagus is the most frequent gastrointestinal site, followed by the stomach and the colon. Granular cell tumors are generally benign, especially in the gastrointestinal tract, some malignant lesions have been reported. For this reason, and also because preoperative diagnosis is difficult, the standard treatment for granular cell tumor has until now been surgical excision. In recent years, other therapeutic methods is endoscopic laser therapy (ELT), polypectiomy, endoscopic mucosal resection (EMR). We report a case of esophageal granular cell tumor which was diagnosed by an endoscopy and managed using an endoscopic mucosal resection without complication.

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.

불응성 자가면역질환에서의 자가조혈모세포이식

민도준,양동원,민창기,김완욱,이상헌,박성환,김동욱,이종욱,조철수,민우성,김범생,김호연,김춘추 대한조혈모세포이식학회 2001 대한조혈모세포이식학회지 Vol.6 No.1

배경: 기존의 치료에 불응하고 예후가 불량한 자가면역질환 환자들에게 최근 고용량 면역억제 및 조혈모 세포이식이 새로운 치료방법으로 대두되고 있다. 저자들은 다발성 경화증(multiple sclerosis, MS) 및 류마티스 관절염(rheumatoid arthritis, RA) 등 2명의 자가면역질환 환자들에서 자가조혈모세포 이식을 시행하였다. 방법: 말초혈액 조혈모세포 가동화를 위하여 cyclophosphamide (4 g/㎡) 및 granulocyte colony stimulating factor (10 g/kg/day)를 투여하였고, CD34+ 세포를 분리·채집 하였다, 이식 전처치로 MS 환자에서 BEAM 및 antihymocyte globulin (ATG) (3.75 mg/kg), RA 환자에서 fludarabine (180 mg/㎡), ATG (10 mg/kg)와 busulfan (8 mg/kg)을 투여하였다. 결과: 호중구 수가 500/㎕ 이상으로 회복되는 기간은 MS 환자에서 9일, RA 환자에서 15일이었다. 혈소판이 20.000/㎕ 이상으로 회복되는 가간은 RA 환자에서 9일 이었고, MS 환자에서는 혈소판 감소증이 발생하지 않았다. 비혈액학적 독성으로 MS 환자에서 WHO 1도의 오심 및 점막염이 관찰되었다. MS 환자는 이식 6개월 후까지 시력감소가 남아있었으나, 이식전에 관찰되던 감각이상 및 운동장애 등의 신경학적 이상 소견은 더 이상 관찰되지 않았다. RA 환자는 이식 1개월 후 관절 증상 및 검사소견의 호전을 보였다. 결론: 불응성 자가면역질환 환자에서 고용량 면역억제 및 조혈모세포이식은 적은 독성으로 높은 치료효과를 기대할수 있으며, 향후 이 시술의 임상적 의의를 규명하기 위하여 전향적이고 장기적인 연구가 필요할 것으로 사료된다. Background: High-dose immunosuppressive therapy followed by autologous hemathpoietic stem cell transplantation (HSCT) has been proposed as a new approach to treat severe, refractory autoimmune diseases. We describe two patients with refractory autoimmune diseases (one multiple sclerosis 〔MS〕and one rheumatoid arthritis〔RA〕) who underwent T-cell-depleted autologous peripheral bleed stem cell transplantation for the first time in Korea. Methods: We mobilized autologous stem cells with cyclophisphamide (4 g/㎡) and granulocyte colony-stimulating factor (10 ㎍/kg/day). Stem cells were enriched ex vivo using CD34-positive immunoselection and reinfused after high-dose chemotherapy with BEAM and antithymocyte globulin (ATG) (3.75 mg/kg) in MS, or fludarabine (180 mg/㎡), ATG (10 mg/kg) and busulfan (8 mg/kg) in RA. Results: The engraftment with an absolute nerutrophil count greater than 500㎕ occurred on day 9 in MS and 15 in RA, respectively. The time to nontransfused platelet count greater than 2.000/㎕ was 9 day in RA. MS patient did not show ant episode of thrombocytopenia. Regimen-related non-hematopoietic toxicity was minimal. For 6 months since HSCT, them patient with MS had been free from previously existed sensory and motor abnormalities except decreased visual acuity. Then patient with RA and only one tender joint and two mildly swollen joints with improvement in laboratory parameters at one month after HSCT. Conclusion: These results underscore the feasibility and potential efficacy of intensive immunosuppression followed by autologous HSCT for treatment of intractable autoimmune diseases. The durability of remission, however, remains to be clarified.

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.

사이클론 내부의 유동특성에 관한 연구

김대욱,윤완중,손현철,박길문 朝鮮大學校 機械技術硏究所 2000 機械技術硏究 Vol.3 No.2

For manufacturing the small-type incinerator with collecting performance of high efficiency, the experimental study was carried out with considering cyclone characteristics, tangential velocity, radial velocity and pressure of the internal cyclone. The model cyclone consisted of slick acryl was made for similarity and data of tangential inflow velocity were acquired by using a vinyl particle as a working fluid. The results obtained from the experimentation are summarized as follows : 1. Tangential velocity of internal cyclone increases as the size of particle become bigger 2. Pressure is maximum value at the wall of cyclone and decreases toward the center of cyclone. 3. The difference of pressure between maximum and minimum value is increased as the size of particle become bigger.

PTT단위를 갖는 액정중합체의 합성 및 블렌드

김원,최유성,이태양,최재곤,홍완해,조병욱 조선대학교 생산기술연구소 2003 生産技術硏究 Vol.25 No.1

This study explores the potential of improving the physical properties of poly(trimethylene terephthalate) (PTT) by inducing thermotropic liquid crystalline polymers. The TLCP was synthesized by polycondensation reaction of terephthaloyl chloride with corresponding diols. The TLCP used was copolymers containing random PTT groups on the polymer backbone. The PTT moieties were used to increse compatibility between the PTT and the TLCP. The TLCP showed the nematic phase above those melting temperature(T_m) The TLCP seems to act as plasticizers and nucleating agents in the matrix polymers Liquid crystalline phase did not reaveal any significant macrophase separation and thermal degradaton under the temperature of processing condition.

실시간 지원시스템의 커널 구현에 관한 연구

방대욱,김완석 계명대학교 산업기술연구소 1991 産業技術硏究所 論文報告集 Vol.14 No.2

본 논문에서는 실시간 처리를 지원하는 커널을 구현하고, 실시간 처리하에서 결정적인 우선순위에 따른 스케줄링기법을 제시한다. 실시간 처리를 지원하는 커널은 다중태스킹 환경을 지원하고, 제시하는 시간 응답성을 보장해 줄 뿐만 아니라 다양한 실시간 응용들에 대하여 잘 정리된 소프트웨어 인터페이스를 제공한다. 이 커널은 구성이 체계적이며 고급언어를 작성되었기 때문에 확장 및 이식이 용이하다. In this paper, we implement the kernel of a dedicated real-time supporing system and present a scheduling mechanism based on the deterministic priority. This kernel supports multitasking environment, guarantees response time and provides well-defined software interface for various real-time applications. Since the system components are structured and most of modules are written in high level language, this system is highly extensible and portable.

국내 조혈모세포이식 환자에서 Human Cytomegalovirus gB 유전형의 분포와 질환과의 연관성 : 예비 보고

최수미,김진희,이동건,박선희,최정현,유진홍,박철민,이종욱,민우성,황응수,신완식,김춘추 대한감염학회 2007 감염과 화학요법 Vol.39 No.2

목적 : 사람 거대세포바이러스(Human cytomegalovirus, 이하 HCMV) glycoprotein B (gB)는 UL55 유전자에 의해 부호화되는 당단백으로, UL55 유전자의 염기서열변화에 따라 4가지 유전형으로 나뉜다. 본 연구에서는 국내 조혈모세포이식 환자들에서 HCMV gB 유전형의 분포와 그 특성을 알아보고, gB 유전형에 따라 특정 HCMV 질환 발생과 연관이 있는지 그 임상적 의미를 분석해 보고자 하였다. 재료 및 방법 : 동종 조혈모세포이식 환자 52명의 혈액검체 94개에 대해, Chou 등이 제시한 방법에 따라, 먼저 UL55 유전자 부위를 nested PCR로 증폭한 후, RsaI과HinfI으로 Restriction fragment length polymorphism(RFLP) 분석을 시행하였다. 결과 : gB type 1은 73.1% (38/52), gB type 2는 13.5%(7/52), gB type 3는 1.9% (1/52), gB type 1과 type 2에 의한 혼합감염은 9.6% (5/52)로 나타났다. gB type 4는 관찰되지 않았다. 1명(1.9%)에서 gB 유전형을 결정할 수 없었는데, RFLP 패턴으로 보아 Trincado 등이 제시한 gB type 7에 해당하는 것으로 생각되었고, 이 새로운 아형에 대해서는 현재 염기서열 분석 중이다. 52명 중 5명(9.6%)에서 HCMV 질환이 발생하였고, 3명에서 HCMV 폐렴, 1명에서 망막염과 위장관염, 나머지 1명에서 망막염이 발생하였다. 5명 중 HCMV 질환과 관련하여 사망한 예는 없었고, 감염된 HCMV는 모두 gB type 1이었다. HCMV gB유전형과 HCMV 질환 발생 사이에 유의한 연관성은 없었고, 단일 주에 의한 감염과 혼합감염에 따른 HCMV 질환발생 사이에도 유의한 연관성은 관찰되지 않았다. 자료 분석 중 gB type 2에 감염되어 있던 환자에서 gB type 1에 재감염 되면서 발열, 간효소 수치 상승 및 pp65 HCMV 항원혈증이 나타난 예가 있었다. 결론 : 연구결과 gB type 1이 아주 우세하고, gB type 4는 검출되지 않았으며, 혼합감염의 빈도가 비교적 낮은 분포를 보였다. 이는 외국의 보고와는 다른 국내 조혈모세포이식 환자에서의 독톡한 감염 양상으로 추정된다. 본 연구에서 HCMV gB 유전형과 질환 발생과의 연관성을 밝힐 수는 없었으나, HCMV 유전형에 대한 연구는 바이러스 감염의 발병기전이나 전파 경로 및 양식과 같은 역학적 연구에 중요한 자료가 될 것이다. 현재 더 많은 수의 조혈모세포이식 환자를 대상으로 연구가 진행 중에 있으며, 앞으로 다른 질환군의 환자나 건강한 잠복 감염자에서의 추가 연구가 필요할 것으로 생각된다. Background : Human cytomegalovirus (HCMV) glycoprotein B (gB) is the major envelope glycoprotein, encoded by the UL55 gene. Based on sequence variation in the UL55 gene, HCMV can be classified into four gB genotypes. Previous studies have suggested an association between HCMV gB genotypes and clinical outcome in the immunocompromised hosts. The goal of this study was to determine the distribution of HCMV gB genotypes and the effect of gB genotype in the developement of HCMV diseases in hematopoietic stem cell transplant (HSCT) recipients in Korea. Materials and Methods : DNA was extracted from 94 blood specimen of 52 allogeneic HSCT recipients with HCMV infection. HCMV gB genotype was determined using polymerase chain reaction to amplify a region of UL55, followed by restriction fragment length polymorphism (RFLP) analysis based on RsaI and HinfI digestion. Results : The distribution of gB types were as follows: gB1, 73.1% (38/52) of patients; gB2, 13.5% (7/52); gB3, 1.9% (1/52) and mixed infection (gB1 and gB2), 9.6% (5/52). While gB4 was not detected, a new genotype (described as gB7 by Trincado et al, 2000) was identified on the basis of their RFLP pattern. During average 708 days’ follow up period, HCMV diseases developed in 5 patients. All of them had gB1 genotype. There was no statistically significant association between the incidence of HCMV diseases and the gB genotypes. Re-infection with gB1 strain was detected in one patient who had been previously infected with gB2. This episode was associated with fever, elevated liver enzyme and positive antigenemia. Conclusion : HCMV gB1 was the dominant genotype and no gB4 was detected in allogeneic HSCT recipients in Korea, which is an unique pattern compared with the previous reports. Although we can not find significant association between the HCMV diseases and the gB genotypes, genotyping of HCMV will serve in the study of pathogenesis and transmission of this virus in transplant patients. Further study is underway with large study population.