중증 재생불량성빈혈에서 타인 혹은 HLA 불일치 혈연간 골수이식을 위한 cyclophosphamide와 antithymocyte globulin전처치 요법

이정희,이제환,김신,설미이,이정신,김우건,김상희,지현숙,박찬정,이규형 대한조혈모세포이식학회 2001 대한조혈모세포이식학회지 Vol.6 No.1

배경: Cyclophosphamide와 ATG의 전처치 요법은 HLA가 일치하는 형제간 골수이식에서는 매우 효과적인 것으로 알려져 있으나, 타인 혹은 HLA 불일치 혈연간 골수이식에서는 전처치 요법으로서 불충분한 것으로 보고되었는데, 주요 문제는 착상 부전이었다. 우리나라를 포함하는 극동아시아 지역의 국가들에서 발표되는 보고에 의하면 타인이식을 포함하여 골수이식 후 착상 부전과 이식편대숙주질환의 발생이 서구 국가들로부터의 보고에서보다 적은 것으로 알려져 있다. 저자 등은 6예의 중증 재생불량성빈혈 환자들에서 질병 초기에 Cyclophosphamide와 ATG만을 이용하여 전처치를 한 후에 타인 혹은 HLA 불일치 혈연간 골수이식을 시행하였다. 방법: 1999년 5월부터 2000년 4월까지 서울중앙병원에서 타인 혹은 HLA 불일치 혈연간 골수이식을 시행 받은 성인 중증 재생불량성빈혈 환자들을 대상으로 하였다. 골수이식을 위한 전처치 요법으로 cyclophosphamide (50 mg/kg/d x 4)와 ATG (30 mg/kg/d x 3)를 투여하였는데, 골수이식 전에 ATG에 대하여 과민 반응을 보였던 한 예 (UPN 120)에서는 ATG 대신에 fludarabine (30 mg/m2/d x 3)을 투여하였다. 이식편대숙주질환의 예방을 위하여 cyclosporine과 methotrexate를 투여하였다. 결과: 연구 기간 중에 모두 6예가 타인 혹은 HLA 불일치 혈연간 골수이식을 시행 받았는데, 5예는 타인으로부터 골수를 공여 받았으며, 1예는 HLA의 표현형이 하나의 유전자좌에서 일치하지 않는 형제로부터 골수를 공여 받았다. 타인 골수이식을 받은 5예 중에서 3예의 공여자는 HLA의 표현형이 일치하였으며, 1예는 하나의 유전자좌가 major mismatch였고, 1예는 하나의 유전자좌가 minor mismatch였다. 추적기간의 중앙값은 406일 (범위, 328-643일)인데, 6예 모두에서 착상된 상태를 유지하면서 생존해있다. 2예에서 3도의 급성 이식편대숙주질환과 전신성 만성 이식편대숙주질환이 발생하였다. 결론: Cyclophosphamide와 ATG의 전처치 요법은 재생불량성빈혈의 초기에 타인 혹은 HLA 불일치 혈연간 골수이식을 시행 받은 한국인 환자들에서 충분히 착상을 가져올 수 있는 요법으로 생각된다. 비록 본 연구의 대상 환자 수가 적지만 결과는 매우 고무적이다. HLA가 일치하는 형제가 없는 중증 재생불량성빈혈 환자의 경우에 타인 골수 공여자에 대한 검색을 조기에 시행해야 하며, 타인 혹은 HLA 불일치 혈연간 골수이식을 질병 초기에 적극적으로 고려해야 할 것으로 생각된다. Background: Cyclophosphamide (CY) and ATG regimen was reported to be insufficient for alternative donor BMT in SAA patients due to high incidence of graft rejection. The rates of graft rejection and GVHD after allogeneic BMT including unrelated donor transplants seemed to be lower in reports from Asian countries of Far East. We applied CY/ATG regimen to six patients with early stage of SAA transplanted with marrow from alternative donors other than HLA-identical siblings. Methods: Three patients were transplanted from HLA-phenotypically identical unrelated donors, two from one-locus mismatched unrelated donors, and one from an one-locus mismatched sibling donor. Four patients received no previous therapy for SAA, and two received one course of immunosuppressive therapy with ATG. Preparative regimen was CY (200 mg/kg) plus ATG (90 mg/kg) in all patients except one who had had an anaphylactic reaction to ATG prior to BMT and received fludarabine (90 mg/m2) in place of ATG. Cyclosporine plus methotrexate were given for GVHD prophylaxis. Results: All six patients engrafted and all are alive with durable engraftment at a median follow-up of 406 days (range, 328 to 643). Two patients developed grade III acute GVHD and extensive chronic GVHD. Conclusions: CY/ATG regimen may be sufficient in Korean patients with early stage of SAA transplanted with marrow from alternative donors. Although the number of patients in present study is small, results are encouraging. Stem cell transplantation using alternative donors may be considered at early stage of aplastic anemia.

Methicillin내성 포도 구균의 기타 항균제에 대한 감수성

이경수,이제철,설성용 慶北大學校 醫科大學 1991 慶北醫大誌 Vol.32 No.1

A total of 204 strains of Staphylococcus aueus isolates in 1987, 1988, and 1989 were studied for the frequency of methicillin-resistant S. aureus (MRSA) and antimicrobial susceptibility and also were examined for oxacillin screening tst and change of minimal inhibitory concentration (MIC) of methicillin at the various conditions. When S. aureus were incubated on the agar media supplemented with 4% NaCl at 35℃ for 72 hours, 33(16.2%) of 204 strains were resistant to methicillin. In oxacillin screening test, oxacillin resistance was found in 33 (16.2%) of the 204 strains. Compared to the MIC of methicillin, oxacillin screenigng positive strains were not same strains of methicillin resistant S. aureus. Total frequency of MRSA was 24 (11.8%) of 204 strains. The frequencies of MRSA in 1987, 1988, and 1989 were 12 strains (9%), 11 strains (16.9%), and 1 strain(20%), respectively and MRSA increased yearly. All MRSA had multiple antibiotic resistance from 9 to 15 tested antibiotics and resistance to 12 antibiotics was the most predominant. All MRSA were resistant to kanamycin, gentamicin, penicillin and cefoxitin. More than 75% MRSA were resistant to amikacin, cefotaxime, cephalothin, tetracycline, rifampin and erythromycin. All MRSA were susceptible to minocycline, vancomycin and trimethoprim-sulfamethoxazole. More than 75% MRSA strains were susceptible to norfloxacin, ciprofloxacin and doxycycline.

Bochner 방법을 응용한 Shigella의 약제내성 제거

최정현,이제철,설성용 慶北大學校 醫科大學 1991 慶北醫大誌 Vol.32 No.1

To study the optimal curing condition on selective medium described by Bochner et al. and modified medium, six strains of S. flexneri and 2 strains of S. sonnei were tested for minimum inhibitory concentration(MIC) of quinaldic acid and cured resistance pattern. Also, changing patterns of elimination according to incubation temperature were investigated at 37℃ and 42℃. MICs of Shigella on original Bochner medium and modified medium were 50 5o 400㎍/㎖. But MICs of Shigella were above of 400㎍/㎖ on the Bochner's medium excluding tetracycline and sodium phosphate. There were no differences in MIC between at 37℃ and 42℃. On the Bochner's medium, losses of drug resistance were more effective than other medium and cured resistance pattern was partial or total of original resistance, regardless of incubation temperature. Frequencies of curing were low on modified Bochner's medium, but most of cured resistance pattern were total resistance of Shigella. Frequencies of curing at 42℃ were similar to 37℃, but some strains showed resistance loss only at 42℃. MICs of 8 strains of Shigella were above of 400㎍/㎖ and no strains detected resistance loss on the both tryptic soy agar and tryptic soy broth.

만성 C형 간염 환자에서 페그인터페론 알파2a와 리바비린 병합 치료중 발생한 벨마비 1예

김일환,장제혁,유충헌,최규남,고정해,김윤정,서광원,김지현,박성재,박은택,이연재,이상혁,설상영 인제대학교 2008 仁濟醫學 Vol.29 No.-

페그인터페론과 리바비린 병합요법은 만성 C형 간염의 일차 치료법이다. 저자들은 만성 C형 간염 환자에서 페그인터페론 과 리바비린 병합 요법 중에 발생한 벨마비 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. 환자는 5년 전부터 만성 C형 간염을 앓아온 48세 남자이며, PEG-IFN α-2a 135μgm 피하주사 주1회와 하루 1200㎎의 리바비린을 투여하였다. 치료시작 후 9개월째 환자는 오른쪽 안면의 근력약화를 호소하였으며 벨마비로 진단되었다. 페그인터페론과 리바비린 병합요법을 지속하면서 관찰하였다. 환자의 벨마비는 페그인터페론 치료를 중단하지 않았음에도 3개월후 증상이 회복되고 이후 벨마비 재발 없이 현재 경과관찰 중이다. 만성 C형 간염에서 페그인터페론과 리바비린 병합 요법시 벨마비의 발생 가능성을 염두에 두어야 하겠다. A Case of Bell's Palsy Associated with Combination Therapy of Pegylated Interferon Alfa-2a (PEG-IFN) and Ribavirin for Chronic Hepatitis C Virus Infection Pegylated interferon alfa(PEG-IFN α) and ribavirin therapy is the first line treatment for chronic hepatitis C. Mild complications of the therapy are common, but more serious complications are rare. We report here a case of Bell's palsy that occurred in a patient with chronic hepatitis C virus infection during combination therapy of PEG-IFN α-2a and ribavirin. The patient was 49-year-old man with chronic hepatitis C (genotype 1b) for 8 years. He had compensated liver cirrhosis with splenomegaly. Therapy with PEG-IFN α- 2a 135mcg/week and ribavirin 1200mg/day was initiated. After 9 months of the therapy, the patient showed a loss of muscular tone on the right side of his face. A diagnosis of Bell's palsy was made. The Bell's palsy resolved over 3 months despite continuation of the combination therapy.

Expression and Control of Virulence Factors Associated with Adherence of Escherichia coli to HeLa Cells

Je Chul Lee(이제철),Yoo Chul Lee (이유철),Jung Min Kim(김정민),Sang Hwa Lee(이상화),Sung Yong Seol(설성용),Dong Taek Cho(조동택) 大韓微生物學會 1993 大韓微生物學會誌 Vol.28 No.5

Epidemiology of Shigellosis in Korea

Lee, Je-Chul,Jeong, Young-Sook,Oh, Jae-Young,Kang, Hee-Young,Kim, Kwang-Hoon,Kim, Jung-Min,Lee, Yoo-Chul,Cho, Dong-Taek,Seol, Sung-Yong The Korean Society for Microbiology 2006 Journal of Bacteriology and Virology Vol.36 No.2

Shigellosis is an acute diarrheal disease caused by bacteria of the genus Shigella. Following the occurrence of a large outbreak of shigellosis as well as sporadic cases since 1998, shigellosis has been a major health problem in Korea. There have been major changes in epidemiology during the last five decades concerning shigellosis in terms of total incidence of shigellosis, prevalence of certain serogroups, selection of specific clones, and introduction of new Shigella clones. S. dysenteriae was the most prevalent species until the early twentieth century, S. flexneri was the most prevalent until the late 1980s, and S. sonnei has been the most prevalent since 1990. Diverse serotypes of S. dysenteriae (4 serotypes), S. flexneri (8 serotypes), and S. boydii (4 serotypes) were found during the Korean War and many of these Korean endemic Shigella strains circulated in the community until the late 1970s. However, the endemic strains of S. dysenteriae, S. boydii, and S. sonnei disappeared in the late 1980s. A new clone of S. sonnei that was introduced between the late 1980s and the early 1990s was responsible for a large proportion of shigellosis in recent years. S. flexneri serotype 4a was the most frequently found during the Korean War and then the incidence of S. flexneri 2a gradually increased with time. S. flexneri isolates detected from 1991 to 1997 were all serotype 2a. However, the diverse clones of S. flexneri reemerged in Korea since 1999. It has not been determined whether the S. flexneri strains from the 2000s were the descendants of the Korean endemic strains or imported new strains, but the PFGE patterns were different between S. flexneri strains from the 1980s and 2000s. The widespread of new S. sonnei strains and the persistence of S. flexneri strains are responsible for the endemicity of shigellosis in Korea.

Antimicrobial Resistance and Integrons Found in Commensal Escherichia coli Isolates from Healthy Humans

Lee, Je-Chul,Kang, Hee-Young,Oh, Jae-Young,Jeong, Jae-Ho,Kim, Jung-Min,Seol, Sung-Yong,Cho, Dong-Taek,Lee, Yoo-Chul The Korean Society for Microbiology 2006 Journal of Bacteriology and Virology Vol.36 No.3

The emergence and spread of antimicrobial resistance among the pathogenic and commensal Enterobacteriaceae are of great concern worldwide. We characterized the antimicrobial resistance and integrons found in commensal Escherichia coli from healthy humans in the community. Class 1 integrase (intl1) and class 2 integrase (intl2) genes were identified in 22 (13.3%) and 2 (1.2%) of 165 E. coli isolates, respectively. dfrA17-aadA5 and dfrA1-aadA2 were the most common class 1 integrons. The prevalence of each type of class 1 integron among commensal E. coli isolates during $2001{\sim}2003$ was similar to that of clinical E. coli isolates from hospital-acquired infections during $1994{\sim}1999$. The resistant rates of commensal E. coli isolates carrying intl1 to ampicillin, streptomycin, gentamicin, sulfamethoxazole, trimethoprim, chloramphenicol, and tetracycline were significantly higher than those of intl1-negative E. coli isolates (p<0.05). Integrons were directly associated with multidrug resistance in commensal E. coli isolates. It is hypothesized that multidrug-resistant Enterobacteriaceae from hospital-acquired infections are a potential reservoir for integrons associated with resistance genes found in commensal E. coli isolates in the community.

Enhancement of the Ionic Conductivity and Mechanical Strength of Micro-porous Separator by Uni-axial Drawing

Lee Je-An,Seol Wan-Ho,Lee Yong-Min,Park Jung-Ki The Korean Electrochemical Society 2006 한국전기화학회지 Vol.9 No.1

A new porous separator based on poly(vinyl chloride) (PVC)/poly(vinylidene fluoride-co-hexafluoro-propylene) (P(VdF-co-HFP)/poly(methyl methacrylate) (PMMA) was prepared by a phase inversion method. To enhance mechanical property, the membrane was stretched uniaxially at high temperature. Tensile strength and ionic conductivity were measured for various draw ratios. The tensile strength and ionic conductivity were increased with increasing draw ratio. The tensile strength of the separator reached 52MPa after stretching to draw ratio of 5, and the ionic conductivity of the separator was increased from $1.9Xs10^{-4}S/cm\;to\;4.6X10^{-4}S/cm\;at\;25^{\circ}C$. The stretched separator immersed in liquid electrolyte was electrochemically stable up to 4.7 V. The cell based on the stretched separator was maintained at about 99% of the initial discharge capacity after 10th cycle operation at 0.2C rate.

Epidemiology of Shigellosis in Korea

Je Chul Lee,Young Sook Jeong,Jae Young Oh,Hee Young Kang,Kwang Hoon Kim,Jungmin Kim,Yoo Chul Lee,Dong Taek Cho,Sung Yong Seol 대한미생물학회 2006 Journal of Bacteriology and Virology Vol.36 No.2

Antimicrobial Resistance and Integrons Found in Commensal Escherichia coli Isolates from Healthy Humans

Je Chul Lee,Hee Young Kang,Jae Young Oh,Jae Ho Jeong,Jungmin Kim,Sung Yong Seol,Dong Taek Cho,Yoo Chul Lee 대한미생물학회 2006 Journal of Bacteriology and Virology Vol.36 No.3