Multiple myeloma 환자에서 Bortezomib치료 후 발생한 마비성 장폐색증 1례

김준영,이원식,손창학,박성길,진한영,박석주,조영완,정은욱,강명주,박정하,주영돈 인제대학교 2006 仁濟醫學 Vol.27 No.-

Bortezomib is the first clinically available proteasome inhibitor that is clinically effective in the treatment of multiple myeloma. A proteasome inhibitor acts through multiple mechanisms to arrest tumor growth, tumor spread, and angiogenesis. The main adverse effects of bortezomib are gastrointestinal symptoms, cytopenia, fatigue, and peripheral neuropathy. To date, severe paralytic ileus has not been reported as a toxic effect of bortezomib treatment in multiple myeloma. Bortezomib is a novel agent that has only been used clinically for 30 months, so a need exists to further evaluate its toxicity. We report a case of grade Ⅲ (NCI CTCAE v3.0) or grade Ⅳ(SWOG toxicity criteria) paralytic ileus in a 65-year-old man with relapsed multiple myeloma who underwent one cycle of single-agent bortezomib treatment scheduled in a 21-day cycle (1.3 mg/㎥ as a single i.v. bolus on days 1, 4, 8, and 11).

肺吸蟲症 診斷에 있어서 ELISA법의 應用에 관한 硏究

崔銑吉,李駿商,林漢鍾 고려대학교 의과대학 1984 고려대 의대 잡지 Vol.21 No.1

Human paragonimiasis is one of the common trematode diseases and of very important public health problem in Korea. Although many techniques have been deviced for immunological diagnosis of paragonimiasis, they exhibit low sensitivity and specificity. In this study the enzyme-iinked immununosorvent assay (ELISA) was employed in the diagnosis of human paragonimiasis using Paragonimus VBS(veronal buffered saline) antigen, peroxidase conjugated anti-human Ig G and ortho-phenylenediamine as a substrate by micromethod according to technique of Voller et al. (1979) and McLaren et aI. (1978) with minor modifications. Sera tested were categorized into 106 paragonimiasis, 20 clonorchiasis, 12 taeniasis, 10 toxoplasmosis, 10 hymenolepiasis and 10 non-infected human cases. The results obtained are as follows: 1. In the preliminary study optimal dilutions of conjugate, stock antigen and serum were 1/5,000, 1/400 and 1/400 respectively. 2. The O.D. (optical density) values of the ELISA in the sera of paragonimiasis cases using stock antigen and VBS antigen were 1.291±0.731 and 1.466±0.813, respectively, and the mean O.D. values in the sera of paragonimiasis cases using VBS antigen were not significantly different from that of stock antigen in sensitivity. (p<0.001) Results showed a standard sensitivity in the application of the ELISA in the diagnosis of human paragonimiasis using VBS antigen. 3. The mean O.D. values of the ELISA in 106 sera of paragonimiasis cases were 1.243±0.863 and those of other parasite infection groups and non-infected human group were 0.487±0.549 in clonorchiasis, 0.513±0.521 in taeniasis, 0.158±0.235 in hymenolepiasis, 0.222±0.235 in non-infected human group and that in paragonimiasis was significantly higher than those of other groups. 4. Distribution of the O.D. values of the ELISA, 86 (81.1%) out of 106 paragonimiasis sera, 3 out of 52 other parasite infection group sera and none out of 10 non-infected human group showed highter than that of the positive serum of 1.000 at 488nm) O.D. value. In conclusion, results of this study suggest that the ELISA is more applicable and reproducible in the diagnosis of human paragonimiasis than other immunological tests used especially in seroepidemiological study.

서울의 Penicillinase Producing Neisseria gonorrhoeae 발생빈도(1998)

김재홍,김준호,반재용,이정우,황성주,정준규,정성태,강진문,조흔정,홍창의,정혜신,이한승,김이선,이봉길,이종호,선영우,한기덕,윤성필,이성훈,안종성,박석범,문승현,조항래,김형섭,류지호,황재영,박준홍,손상욱 한양대학교 의과대학 2001 한양의대 학술지 Vol.21 No.1

In recent years, gonorrhea has been pandemic and remains one of the most common STDs in the world, especially in developing countries. For the detection of a more effective therapeutic regimen and assessing the prevalence of Penicillinase Producing Neisseria gonorrhoeae(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 menas of the chromogenic cephalosporin method. In 1998, 93 strians of N. genorrhoeae were isolated, among which 60(64.5%) were PPNG. 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 64.5% in 1998.

The Interval Between Initiation of Anti-tuberculosis Treatment in Patients with Culture-positive Pulmonary Tuberculosis and Receipt of Drug-susceptibility Test Results

Joon Sung Joh,Chang Hoon Lee,Ji Eun Lee,Young Kil Park,Gill Han Bai,Eui Chong Kim,Sung Koo Han,Young Soo Shim,Jae Joon Yim 대한의학회 2007 Journal of Korean medical science Vol.22 No.1

이소 유방 조직에서 발생한 유방암

한준길(Joon Kil Han),민진식(Jin Sik Min) 대한외과학회 1982 Annals of Surgical Treatment and Research(ASRT) Vol.24 No.12

유방 및 전흉벽에 발생한 혈전성 천부 정맥염

한준길(Joon Kil Han),민진식(Jin Sik Min) 대한외과학회 1982 Annals of Surgical Treatment and Research(ASRT) Vol.24 No.11

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

Auditory Evoked Potential 을 이용한 마취깊이 감시 경험

길호영,이현화,한태현,홍성준,박훈,채봉수,이규호 대한정맥마취학회 2001 정맥마취 Vol.5 No.3

Evaluation of the depth of anesthesia is essential to the anesthetic management for the patient. The usual clinical markers of anesthetic depth are such as hemodynamic responses, motor signs and sweeting. To date, addition to the commercially available bispectral index and anemon-A monitor, auditory evoked potential monitor for this purpose introduced into the clinical practice recently. Auditory evoked responses are derived from the electoencephalogram in response to auditor stimuli. Especially, amplitude of middle latency auditory evoked potential decreases when the subject is anesthetized and at the same time the latencies of the peaks are prolonged. We report two cases of general anesthesia of which depth of anesthesia monitored by auditory evoked potential index.

Propofol-N_2O-O_2 마취시 PK-SIM 컴퓨터 모의실험을 이용한 상황민감성 반감기와 Propofol 주입시간 및 각성의 비교

길호영,황성미,이승준,김대우,한태형,박영주 대한정맥마취학회 1999 정맥마취 Vol.3 No.2

서론: 최근의 여러 문헌에 의하면 상황민감성 반감기(context-sensitive half-time, CSHT)는 약물을 일정기간 주입한 후 약물농도의 감소를 임상적으로 이용할 수 있는 합리적인 측정밥법으로 제안하고 있다. 이 연구의 목적은 마취로부터의 회복의 유용한 판정방법으로 PK-SIM 컴퓨터 모의실험을 이용하여 상황민감성반감기를 시뮬레이션하고 이를 propofol의 주입기간과 마취로부터의 진정한 회복과 비교하는 것이다. 방법: 정형외고 수술이 예정된 18∼55세 미국마취과학회 신체분류 등급 1 및 2의 95명을 propofol의 주입기간에 따라 다섯 군으로 분류하였다. 1군: 60분 이내, 2군 60분∼120분, 3군: 120분∼180분, 4군: 180분∼240분, 5군 240분∼300분. 마취는 Prys-Robert's의 방법에 따라 유도하고 propofol-nitrous oxide (67%)-oxygen (33%)로 마취유지 하였다. Propofol 주입은 피부봉합 종료시 즉시 중단하였으며 주입시간을 기록하였다. 주입시간, 상황민감성반감기, 마취로부터의 회복시간을 비교하였고 이들 사이의 상관관계를 관찰하였다. 결과: 컴퓨터 시뮬레이션에 의한 효과처 농도는 3.3 ㎍/㎖이었다. 각군의 각성시간은 8.7∼11.8분이었고 상황민감성반감기는 6.4∼9.5분이었다. Propofol 주입기간과 각성사이의 상관계수는 0.95이었고 상황민감성반감기와 각성시간 사이의 상관계수는 0.9 (P<0.05)이었다. 결론: Propofol 주입기간, 각성시간 및 상황민감성 반감기 사이에는 강한 상관관계가 있었다. 따라서 상황민감성반감기는 propofol을 주마취제로 이용한 전심마취의 회복시 마취로부터의 각성의 예견지표로 사용할 수 있을 것으로 사료된다. Background: Several recent studies have suggested that the context-sensitive half-time (CSHT) as a more clinically relevant measure of decreasing drug concentrations after a constant infusion of a given duration. The purpose of this study was to simulate the CSHT using a PK-SIM computer simulation program and compare this with duration of propofol infusion and real awakening time from anesthesia for the evaluation of CSHT as a useful tool of prediction of recovery from anesthesia. Methods: Ninety-five ASA class Ⅰ or Ⅱ adult patients (18~55 yrs) scheduled for orthopedic elective surgery were randomly allocated into 5 groups according to duration of infusion of propofol. Five groups were Group 1: less than 60 min, Group 2: 61~120 min, Group 3: 121~180 min, Group 4: 181~240 min, and Group 5: 241~300 min. Anesthesia was induced and maintained with propofol-nitrous oxide (67%)-oxygen (33%) according to Prys-Roberts' method. Propofol was discontinued immediately after skin closure and duration of infusion was cheked. Duration of infusion, CSHT, and awakening time from anesthesia was compared and evaluated correlations among them using a correlation coefficient. Results: Effect site concentration of propofol derived from computer simulation was 3.3 ㎍/ml. Awakening time for each group was 8.7~11.8 min and CSHT for that was 6.4~9.5 min. The correlation coefficient between duration of infusion of propofol and awakening was r=0.95 and that between CSHT and awakening time was r=0.9(p<0.05). Conclusions: There were strong relationship among duration of infusion of propofol, awakening time and CSHT. It seems that CSHT could be a good predictor of awakening from propofol-based general anesthesia.

적외선 체열활영을 이용한 흡연이 피부온도에 미치는 영향 평가

조길호,지명준,한승상,하태윤,선광진 大韓再活醫學會 1998 Annals of Rehabilitation Medicine Vol.22 No.1