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.

서울의 Penicillinase Producing Neisseria gonorrhoeae 발생빈도(1997)

김재홍,문득곤,김정수,김용준,임동진,박상훈,김희성,이민수,송기훈,김갑형,김형석,성소영,이인섭,김석우,황지환,조창근,김경문,부태성 대한화학요법학회 2000 대한화학요법학회지 Vol.18 No.3

Background : In recent years, gonorrhea has been pandemic and remains one of the most common STDs in the world, especially in developing countries. Objective & Methods : For the detection of a more effective therapeutic regimen and assessing the prevalence of PPNG, we have been trying to study the patients who have visited the Venereal Disease Clinic of Choong-Ku Public Health Center in Seoul since 1980 by means of the chromogenic cephalosporin method. Results : In 1997. 99 strains of N. gonorrhoeae were isolated, among which 45(45.5%) were PPNG. Conclusion : The prevalence of PPNG in Seoul, which had been decreased to 39% in 1996 after a peak of 74.3% in 1993, is increased to 45.5% in 1997.

Scrub Typhus : 확진된 76예의 임상 소견에 대한 전향적 연구

김동민,김현리,박치영,윤성호,송현제,심수경 대한감염학회 2006 감염과 화학요법 Vol.38 No.4

배경 : Orientia tsutsugamushi에 의한 인체 감염은 혈액과 임파선을 타고 전신에 퍼져 혈관 염을 일으켜, 전신 장기의 침범 소견을 보인다. 그러나 아직 까지 전신장기 침범에 대한 임상 소견 및 검사 결과의 전향적인 추적 관찰에 대한 연구는 거의 없는 실정이다. 재료 및 방법 : 조선대학교병원에 내원한 환자 중 확진법(gold standard)인 간접형광항체법(IFA)으로. 확인된 76명의 환자를 대상으로 내원시 임상 양상 및 검사 결과의 평가 및 치료 후 검사 결과의 변화에 대한 전향적인 연구를 수행하였다. 결과 : 대부분의 환자에서 발열, 갈증, 전신 쇠약감, 두통을 호소하였으며, 특이 할만한 소견으로 현재까지 보고되지 않았지만, 대부분의 환자가 갈증을 심하게 호소한다는 것이다. 3명의 젊은 건강한 환자를 제외한 대부분의 환자에서 이러한 갈증 증상을 호소하였으며, 이러한 갈증은 발열이 호전되어도 지속되었으며, 퇴원 이후에 까지 지속되는 양상을 보였다. 혈액검사상 scrub typhus 초기에 나타날 수 있는 신기능 장애 및 간 기능 장애는 대부분 가역적으로 적절한 항생제 투여 후 모두 정상으로 회복됨을 확인할 수 있었다. 혈액 검사상 CRP, LDH, AST가 대부분의 환자에서 상승하였고, 특히 LDH의 상승이100% 환자에서 관찰된 것은 특이할 만 한데 적절한 치료후 CRP는 신속히 호전을 보이나, LDH는 서서히 호전됨을 확인하였다. DIC 검사상 DIC는 입원환자의 95.5%에서 확인되었으나, 비교적 일부의 환자에서 출혈 및 경색이 초래되는 것으로 생각된다. 결론 : Scrub typhus 초기에 나타 날수 있는 신기능 장애, 간기능 장애 및 DIC는 대부분 가역적으로 적절한 항생제 투여 후 모두 정상으로 회복되며, 이러한 관찰이scrub typhus 환자의 진단 및 임상 경과의 이해에 도움이 되리라 사료된다. Background : Orientia tsutsugamushi spreads to the entire body through the blood and lymphatics, and it induces vasculitis that results in the patients manifesting symptoms of systemic organ involvement. Materials and Methods : We conducted a prospective study to evaluate the clinical manifestations and the change of the laboratory results after instituting treatment for scrub typhus. Results : Most patients presented with fever (100%), malaise (96.1%) and thirst (96.1%). It was remarkable that most patients presented with severe thirst, except for 3 healthy, young patients. This thirst was persistent even after the resolution of fever. The renal and hepatic dysfunction were reversible after the administration of appropriate antibiotics. For the blood testing, it was deteded that the CRP, and LDH were elevated in most patients (95.9% and 100% respectively). DIC could be diagnosed in 95.5% of the patients at the time of admission Conclusion : Most patients presented with fever, malaise and severe thirst, and the renal and hepatic dysfunction were reversible after the administration of appropriate antibiotics. DIC was observed in most of our patients, but hemorrhage and infarction were not present. CRP showed a rapid improvement, nonetheless, the LDH and DIC test results improved slowly.

고속철도 터널출구로부터 방출되는 충격성 소음에 관한 모형실험

김희동,이종수,신현승 安東大學 1995 安東大學 論文集 Vol.17 No.1

As a railway train enters a tunnel at high speed, a compression wave is formed in front of the train and propagates along the tunnel. The compression wave subsequently emerges from the exit of the tunnel and generates a pulse wave, which causes an impulsive noise. In order to clarify the acoustic characteristics of the noises, in the present study experiment was carried out by using the pulse waves emitted from an open end of a shock tube. Various pulse waves were obtained by controlling the compression wave formed in the tube. The results show that as the compression wave formed at tunnel exit becomes strong, the pulse wave emitted propagates with strong directional characteristics forward the axial direction of the tube, and that attenuation of the pulse wave propagating a ground surface can be reasonably predicted by a linear acoustic theory. Furthermore, the impulsive noise at far-field from the tube exit results in a sound level reduction of 6dB with a doubling of the propagating distance.

자기자본 구성요소의 성장성에 대한 시장의 가치평가

金東憲 홍익대학교 경영연구소 2004 경영연구 Vol.29 No.-

Prior research reveals that the accrual component of profitability is less persistent than the cash flow component, and that investors fail to fully appreciate their differing implications for future profitability(Sloan 1996). However, accruals are a component of growth in net operating assets as well as a component of profitability. Just as I can disaggregate profitability into accrual and cash flow from operations, I can disaggregate growth in net operating assets into accruals and growth in long-term net operating assets. I can also disaggregate return on equities(ROE) into return on invested capitals(ROIC) and financial leverage effects. I find that, after controlling for current profitability, both components of growth in net operating assets-accruals and growth in long-term net operating assets-have equivalent association with one-year ahead return on assets. This result is consistent with conservative accounting and diminishing marginal return on investment. I also find that, after controlling for current profitability, financial leverages have positive association with one-year ahead return on equities.

Mo¨nckeberg 중막 석회화로 인해 초기자궁내막암이 진행성 자궁내막암으로 판독되었던 1례

김승만,배철성,김동훈,김정란,이현경,윤혜원 동국대학교 경주대학 1997 東國論集 Vol.16 No.1

Mo¨nckeberg 중막 석회화는 크거나 중간크기의 근육성 동맥(large and medium-sized muscular arteries)의 중막(media)에 노화와 관련되어 퇴행성 과정인 윤상석회화가 특징적으로 나타나는 동맥경화증의 일종으로, 근본적으로 폐쇄성 죽상경화증(occlusive atherosclerosis)과는 다른 과정으로 동맥의 관강(lumen)을 막는 경우는 드물어 상대적으로 임상적 의의는 적거나 거의 없다. 저자들은 Mo¨nckeberg 중막 석회화때문에 초음파 및 컴퓨터 단층촬영에 의한 병기결정에 혼란을 초래하였던 초기 자궁내막암 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. The Mo¨nckeberg medial calcification is aging change rather than disease entity. The Mo¨nckeberg medial calcification involve muscular arteries of limb, head, and genital track and cause fibrosis change associated with hyalinization and fine basophilic staining, suggesting early calcification with little or no clinical significance but is demonstrable on roentgenograms as regular and diffuse radiopaque shadow under intima. We experienced one case of mis-staging of early endometrial cancer due to the Mo¨nckeberg medial calcification therefore, we report this case with a brief review of the literature of the Mo¨nckeberg medial calcification.

5급 복합레진충전된 치아에 있어서의 계면조건과 유지구의 영향에 대한 2차원유한요소법적 연구

김동호,유현미,조병훈 大韓齒科保存學會 1998 Restorative Dentistry & Endodontics Vol.23 No.2

생활체육지도자 양성제도 개선에 관한 연구

김동진,정청희,나영일,조승현 서울대학교 체육연구소 2001 서울大學校 體育硏究所論集 Vol.22 No.1

This study is to investigate the sports for all leader training programs' beginning from now, and see about the problems if have. The objective of this study is to gather the opinion of the experts, and to develop better method of the training program for the Sports for all leader. In this study there were the expert group of 30 people, consist of professors and scholars. The survey and interview were performed on them. To make the expert group were extracted -using simple random sampling- from people who have been in the position of president or vice president of the sports for all leader training institution. The interview and survey on experts group were performed in Delphi Technique. The interview and survey were applied three times before reaching the conclusion. Results obtained from this research are as follow: 1.The first grade should be classified from second and third grade. 2.The qualification of second and third grade should be integrated. 3.The exception of the qualifying examination should be given by the name of the course people took. 4.Technique test and oral test should be up-graded. 5.Training of theory coarse should include technique course. 6.The qualification fee should be charged to the qualifier. 7.The institution of Sports For All Leader should be minimized and it should be operated at all times.

Rifampicin에 의한 것으로 추정되는 위막성 대장염1예

김수현,이은우,정종혁,문승현,김동한,양혁승,오영상,김호동,김도현,박혁,박정환,박경옥,이영직 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.2

Pseudomembranous colitis, caused by altering the normal colonic flora and allowing the multiplication of Clostridium difficile, is an deleterious adverse effect of antibiotics. But it is rarely reported by rifampicin. Rifampicin is one of the first line drug in the treatment of tuberculosis and many patients are exposed to its potential adverse effects. We experienced a patient that had abdominal discomfort and hematochezia due to pseudomembranous colitis after receiving antituberculous medication, and which was probably caused by rifampicin. A 82 years old man was admitted with abdominal discomfort and hematochezia for one week. On the past history he had been diagnosed as endobronchial tuberculosis about 4 months ago. Colonoscopy revealed multiple discrete whitish mucosal lesion on rectosigmoid colon, and histologic findings were consistent with pseudomembranous colitis. The antituberculous agents were discontinued and vancomycin was administered. The patient's symptoms were resolved within several days. There was no recurrence after reinstitution of the antituberculous agents excluding rifampicin. We report here on a case of pseudomembranous colitis probably due to rifampicin.

에이즈 환자의 거대세포바이러스 감염증

김홍빈,박상원,김남중,최희정,신동현,오명돈,김우호,정흠,최강원 대한감염학회 1998 감염 Vol.30 No.4

배 경 : 거대세포바이러스 감염은 인간면역부전바이러스 (Human Immunodeficiency Virus, HIV) 감염자에서 발생하는 가장 중요한 기회감염증의 하나이다. 특히, 국내에서는 95%이상의 국민이 거대세포바이러스의 1차감염을 경험한 상태이므로 에이즈 환자에서 거대세포바이러스 질환의 빈도가 높을 것으로 예상된다. 대상 및 방법 : 1987년 10월부터 1996년 9월까지 서울대학교 병원에서 추적 관찰하였던 128명의 HIV 감염자를 대상으로 하였다. 이들 환자의 의무 기록에서 임상 자료를 얻었다. 거대세포바이러스 망막염은 안과 전문의의 임상적인 소견으로 진단하였으며, 위장관 등 망막이외 부위의 거대세포마이러스 질환은 조직학적으로 확인된 경우에 한하였다. 결 과 : 대상환자 128명의 추적관찰기간은 중앙값이 6(0∼59)개월 이었으며 7명 (5.4%)에서 거대세포바이러스 질환이 발생하였다. 거대세포바이러스 질환은 망막염이 6예, 식도염이 2예, 대장염이 1예, 폐렴 및 부신감염이 1예, 범발성 감염이 1예였다. 거대세포바이러스 질환의 발생빈도는 CD4+ 림프구 수가 적을수록 높았으며, CD4+ 수가 200/㎣미만인 환자 중 15% (6/33)에서 거대세포바이러스 질환이 확인되었다. 11예 중 9예를 ganciclovir로 치료하였으며 이중 7예에서 호전 또는 진행의 억제가 확인되었다. 추적관찰이 가능한 6예 중 3예 (50%)에서 재발하였다. 결 론 : 국내 에이즈 환자에서 거대세포바이러스 질환은 비교적 흔한 기회감염증이다. Background : Cytomegalovirus (CMV) infection is one of the important opportunistic infections in immunocompromised patients. In Korea, seroprevalence of IgG against CMV is over 95%. Therefore, CMV diseases are expected to be a prevalent opportunistic infection in AIDS patients. in Korea. Methods : We reviewed the medical records of 128 patients with HIV infection who visited the Seoul National University Hospital during the period from Nov. 1987 TO Sep. 1996. All the patients were examined by one ophthalmologist and the diagnosis of CMV retinitis were made by funduscopic findings. Other CMV diseases were diagnosed when histopathologic examinations showed the characteristic cytomegalic cells. Results : Median duratior, of follow-up was 8 months. Eleven CMV diseases were found in 7 patients (5.4%): 6 patients ahd retinitis, 2 esophagitis, 1 colitis, 1 pneumonitis, and one patient developed disseminated infection. Fifteen percent (6/33) of the patients whose CD4+ lymphocyte counts were less than 200/㎣ at baseline developed CMV diseases. Out of the 9 cases treated with ganciclovir, 7 improved or were stabilized. No patient received maintenance treatment and 3 had relapsed. Conclusion : CMV diseases are common opportunistic infections in AIDS patients in Korea.