장기이식 환자에서 발생하는 위장관 합병증

김건민,정대영,김진일 대한소화기내시경학회 2010 Clinical Endoscopy Vol.41 No.2

The gastrointestinal tract is one of the major sites for complications after solid organ and hematopoietic stem cell transplantation, and gastrointestinal complications are the principle cause of morbidity and death. The major gastrointestinal complications after transplantation include mucositis, typhlitis, infectious enterocolitis by virus, bacteria or fungus, pseudomembranous colitis, gastric ulcer, graft- versus-host disease, pneumatosis cystoides intestinalis, thrombotic microangiopathy and post-transplantation lymphoproliferative disease. Symptoms and signs of gastrointestinal complications following transplantation are often non-specific and present with varying severity. Moreover, the suppressed immune state often prohibits invasive studies including endoscopy and blurs the serologic and hematologic results. Therefore, it is hard to reach accurate diagnoses even after thorough investigations. Almost all immunosuppressive drugs can lead to gastrointestinal complications and we need proper strategies to minimize their side effects. On the one hand, we can expect better organ and patient survival through the judicious use of a broad range of immunosuppressive drugs; on the other hand, we should try to not ruin survival through proper precautions and early treatment of gastrointestinal complications following successful transplantation. 장기 이식이나 조혈모세포 이식 후 위장관 합병증은 비교적 흔히 발병하며 삶의 질을 감소시키고, 치명적인 경우가 있어 사망률을 증가시킨다. 조혈모세포 이식 후 면역이 저하되는 과정은 생착 전 단계, 조기 생착 단계, 후기 생착 단계로 분류할 수 있으며 각 단계 별로 빈번히 발생하는 합병증이 있다. 장기 이식 후 흔히 발생하는 위장관 합병증으로는 점막염, 구토, 복통 등이 있고, 또한 설사, 혈변, 맹장염 등이 관찰된다. 이중 중요한 합병증으로는 이식편대숙주병이 가장 많고, 거대세포 바이러스를 비롯한 바이러스 감염, C. difficile에 의한 위막성결장염이 등이 나타날 수 있다. 이외에도 위장관 궤양성 질환, 낭성장기종, 혈전미세혈관병증, 이식후림프세포증식질환 등이 발생할 수 있다. 장기 이식 후 발생하는 위장관 합병증의 증상은 비 특이적이어서 진단이 어려우며 또한 면역 기능이 억제된 상태여서 내시경 등의 적극적인 검사를 하기도 어렵다. 또한 항암제나 항생제 뿐만 아니라 대부분의 면역억제제가 위장관 합병증을 일으키므로 감별 진단을 하여야 한다. 이식 후 정확한 조기 진단 및 조기 치료가 이환율 및 사망률을 낮출 수 있으므로 환자의 증상을 중심으로 내시경 검사와 조직 검사, 혈청학적인 검사, 방사선 검사 등의 적극적인 검사를 이용하여 조기에 진단하는 것이 이식 후 위장관 합병증을 치료 하는 데에 매우 중요하다.

완전 무치악 환자에서 CAD-CAM 기법을 이용한 상악 총의치 및 하악 임플란트 피개의치 수복: 증례 보고

김건민,오경철,김상현,한철관,김지환 大韓齒科補綴學會 2021 대한치과보철학회지 Vol.59 No.4

The CAD-CAM technique is a rapidly developing field in the dental field and is applied to various fields of prosthetic treatment. Among them, the manufacturing of dentures using the milling technique classified as subtractive manufacturing is one of the commercialized digital full denture manufacturing methods. At the same time, it is possible to more efficiently manufacture a metal framework for implant overdenture by selective laser sintering or melting technique classified as an additive manufacturing method. The purpose of this article is to describe the fabrication of CAD-CAM maxillary complete denture and mandibular implant overdenture as well as its features. 컴퓨터 지원 설계 및 제조 기법(CAD-CAM)은 치과 영역에서 급속도로 발전해온 분야로, 다양한 보철 치료 영역에 적용되고 있다. 이 중 절삭형 방식(Subtractive Manufacturing)으로 분류되는 절삭가공 기법을 이용한 의치 제작은 상용화된 디지털 총의치 제작 방식 중 하나이며, 동시에 첨가형 방식(Additive Manufacturing)으로 분류되는 레이저 소결 혹은 용융 기법을 활용하여 피개의치를 위한 금속구조물을 보다 효율적으로 제작할 수 있게 되었다. 본 증례에서는, CAD-CAM을 통해 절삭형 방식으로 제작한 상악 총의치와 3D 금속 프린팅을 이용한 금속구조물과 절삭형 방식으로 제작된 인공치를 접목한 하악 임플란트 피개의치를 제작하였다. 이를 통해 기능적, 심미적으로 적절한 임상적 결과를 얻었으므로 이를 보 고하는 바이다.

A Case of Combined Hepatocellular-Cholangiocarcinoma with Favorable Response to Systemic Chemotherapy

김건민,정희철,김도경,김주훈,윤상현,정은석,신상준 대한암학회 2010 Cancer Research and Treatment Vol.42 No.4

Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare form of primary liver cancer composed of cells with histopathologic features of both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). Because of its low incidence, the information on clinical outcomes of cHCC-CC is very limited and there are no published reports describing non-surgical treatment options for cHCC-CC. We report a case of cHCC-CC exhibiting a favorable response to systemic chemotherapy with doxorubicin and cisplatin. A 62-year-old man who recurred after a right lobectomy for cHCC-CC received sorafenib for palliative systemic therapy, but follow up imaging studies showed disease progression. He received 2nd line chemotherapy with doxorubicin at 60 mg/m2 together with cisplatin at 70 mg/m2. After 2 cycles of chemotherapy, a computed tomography scan of the chest showed markedly decreased size and number of the multiple lung metastases. After completing 8 cycles of 2nd line therapy, we changed the regimen to a fluorouracil (5-FU) mono therapy because of the toxicities associated with doxorubicin and cisplatin. To date, the patient has completed his 15th cycle of 5-FU mono therapy with the disease status remaining stable during 18 months of follow-up.

Cyclosulfamuron과 Pyribenzoxim의 莖葉處理에 따른 논 雜草 防除效果에 관한 硏究

金健敏,金武成,盧泳德 慶熙大學校 1997 論文集 Vol.26 No.-

Experiments were carried out to evaluate weed control performance of Cyclosulfamuron and Pyribenzoxim by foliar application, especially for direct seeded rice. In addition, the combinations of the herbicides and water managements were tested for the improvement of the herbicidal activity. Herbicidal effect of Cyclosulfamuron was excellent for B. tripartita, B, frondosa, fair or fairly good for A. indica, and C. cerotinus, and good for E. crus-galli, L. prostrata, S. juncoides, and A. keisak. Herbicidal effect of Pyribenzoxim was excellent for B. tripartita, B. fonndosa, A. keisak, and A. indica, fairly good for E. crus-galli, L. prostrata and poor for s. juncoides, and C. cerotinus. The foliar treatment of two herbicides were the most effective when irrigated 3 days after treatments. The herbicidal effects became poor when saturated condition was maintained, especially E. crus-galli and S. jucoides. Both Cyclosulfamuron and Pyribenzoxim were very effective for the control of B. tripartita and frondosa even under very low concentrations. But the higher rates of Pyribenzoxim are to be used for the better control of E. crus-galli and L. prostrata. Combination treatments of the two herbicides could extended the weed control spectrum. In addition the combination treatments had some positive effects in controlling L. prostrata, S. juncoides and A. keisak

Meropenem 내성 Ochrobactrum anthropi 균혈증 1예

김건민,진성준,유정선,김창오,최준용,김준명,송영구 대한감염학회 2009 Infection and Chemotherapy Vol.41 No.1

Ochrobactrum anthropi is an oxidase-producing, non-lactose-fermenting, gram-negative bacillus that is frequently isolated from the environment including sinks, baths, soil, and hospital water sources. Recently O. anthropi have been reported as an emerging opportunistic pathogen in immunocompromised patients, particularly in those with indwelling venous catheters. Most O. anthropi were highly resistant to β-lactam antibiotics except carbapenem. We report a case of O. anthropi bacteremia with an unusual pattern of antibiotic resistance compared to previous reports. A 47-year-old woman undergoing camptobell/cisplatin chemotherapy via indwelling venous catheter (chemoport) for stage IV ovarian cancer, had septicemia due to O. anthropi of unknown origin. The isolates were resistant to all β-lactams and meropenem and susceptible to aminoglycoside, ciprofloxacin, and trimethoprim-sulfamethoxazole. She recovered from sepsis with combination treatment with imipenem and ciprofloxacin for 3 weeks.

A Phase II Study to Evaluate the Safety and Efficacy of Pegteograstim in Korean Breast Cancer Patients Receiving Dose-Dense Doxorubicin/Cyclophosphamide

김건민,김주훈,김지흥,조영업,김승일,박세호,박형석,김지예,손주혁 대한암학회 2019 Cancer Research and Treatment Vol.51 No.2

Purpose Dose-dense chemotherapy (DD-CT) is a preferred (neo)adjuvant regimen in early breast cancer (BC). Although the results of reported randomized trials are conflicting, a recent metaanalysis showed improved overall and disease-free survival with DD-CT compared to conventional schedules. However, no DD-CT safety data for Korean BC patients are available. This phase II study was conducted to evaluate the safety and efficacy of pegteograstim in Korean BC patients receiving DD-CT. Materials and Methods Patients with operable (stage I-III), histologically confirmed BC received four cycles of intravenous doxorubicin (60 mg/m2) and cyclophosphamide (600 mg/m2) on day 1 every 2 weeks as neoadjuvant or adjuvant therapy. Pegteograstim (6.0 mg) was administered subcutaneously on day 2 of each cycle. The primary endpoint was the incidence of febrile neutropenia (FN). The secondary endpoints were safety and tolerability. Results Of 63 patients, one (1.6%) developed FN during all cycles of DD-CT. Dose delay was observed in four patients (6.3%) and dose reduction in two (3.2%) during DD-CT. Frequent adverse events (AEs) were nausea, alopecia, generalized muscle weakness, myalgia, mucositis, anorexia, dyspepsia, and diarrhea; most AEs were related to chemotherapy. Grade 3-4 AEs were reported in five of 63 patients (7.9%), and all grade 3 and 4 AEs were related to chemotherapy. Adverse drug reactions possibly linked to pegteograstim were abdominal pain, bone pain, myalgia, generalized muscle weakness, and headache in five of 63 patients (7.9%). Conclusion Dose-dense AC (doxorubicin/cyclophosphamide) chemotherapy with pegteograstim support is a tolerable and safe regimen in Korean early BC patients.

『仁智要錄ㆍ高麗曲』 풀이와 考證 - 古代朝鮮과 中國, 日本, 渤海, 西域과의 音樂文化 交流를 겸하여 論함

김건민,정준갑 한국국악학회 1993 한국음악연구 Vol.21 No.-

인지요록중 고려곡의 해석과 고증(仁智要錄중 高麗曲의 解釋과 考釋) : 兼 古代朝鮮과의 다른 民族과의 音樂文化交流

金建民 중앙대학교 중앙음악연구소 1993 중앙음악연구 Vol.4 No.-

Meropenem 내성 Ochrobactrum anthropi 균혈증 1예

김건민,진성준,유정선,김창오,최준용,김준명,송영구 대한감염학회 2009 감염과 화학요법 Vol.41 No.1

Ochrobactrum anthropi is an oxidase-producing, non-lactose-fermenting, gram-negative bacillus that is frequently isolated from the environment including sinks, baths, soil, and hospital water sources. Recently O. anthropi have been reported as an emerging opportunistic pathogen in immunocompromised patients, Particularly in those with indwelling venous catheters. Most O. anthropi were highly resistant to B-lactam antibiotics except carbapenem. We report a case of O. anthropi bacteremia with an unusual pattern of antibiotic resistance compared to previous reports. A 47-year-o1d woman undergoing camptobell/cisplatin chemotherapy via indwelling venous catheter (chemoport) for stage IV ovarian cancer, had septicemia due to O. anthropi of unknown origin. The isolates were resistant to all B-lactams and meropenem and susceptible to aminoglycoside, ciprofloxacin, and trimethoprim-sulfamethoxazole. She recovered from sepsis with combination treatment with imipenem and ciprofloxacin for 3 weeks.

국내 고유 건강영향 평가를 위한 방사선유발갑상선암 리스크 모델 적용방안

김건민,이승희,김혜진,김석훈 (사)한국방사선산업학회 2019 방사선산업학회지 Vol.13 No.4

As part of various efforts to improve safety since the Fukushima disaster, a level 3 PSAwas enacted as a notice in Korea. For the domestic level 3 PSA, it is essential to formulate theKorean-specific health effect assessment model typically aimed at deriving lifetime risk resultingfrom radiation exposure using cancer incidence model for each cancer site. Of the cancer sites to beevaluated, more attention is required for the thyroid cancer since there is an obvious relationshipbetween the cancer risk and exposure dose. In this study, for the purpose of developing the Koreanmodel for assessing thyroid cancer risk, the following models that were widely used around theworld have been reviewed as the reference; (1) BEIR VII, (2) EPA 2011, (3) Veiga et al. (2016), and (4)Preston et al. (2007). In this review process, the following points were considered: (1) considerationof relationship between time since exposure and thyroid cancer risk, (2) similarity of ethniccharacteristics with the Koreans, and (3) exclusion of medical exposure data. From this point ofview, the Preston et al. (2007) was chosen as the most appropriate reference model. Unlike othermodels, to include both ERR and EAR models in assessing the cancer risk, the weighting factorfor risk transfer must be considered. In this study, it is suggested to use the 0.5 of weighting factorfor each model with reference to the WHO model. However, the cancer risk estimates using thisfactor should be supplemented by the uncertainty analysis. In future, the thyroid cancer risk modelproposed in this study is supposed to be installed as part of the health effect assessment module inthe Korean level 3 PSA code system, and be utilized to estimate the radiation-induced thyroid cancerrisk reflecting ethnic and regional characteristics of the Korean population.