조혈모세포이식 환자에서 침습성 진균 감염에 대한 Micafungin의 예방 효과 및 안전성

김시현,이동건,최수미,권재철,박선희,최정현,유진홍,이성은,조병식,김유진,이석,김희제,민창기,조석구,김동욱,이종욱,민우성,박종원 대한감염학회 2010 감염과 화학요법 Vol.42 No.3

Background: Micafungin, a potent inhibitor of 1,3-β-D-glucan synthase, is a novel antifungal agent of the echinocandin class. In vitro study showed that micafungin was effective against Aspergillus species as well as Candida species, but clinical data on the prophylactic efficacy against invasive fungal infections (IFIs) other than candidiasis are still lacking. Materials and Methods: We identified 60 consecutive adult hematopoietic stem cell transplantation (HSCT) recipients who received at least 3 doses of micafungin during neutropenic period. Micafungin was started as an alternative in patients who were intolerant or had adverse events (AEs) to primary prophylactic antifungal agents. We retrospectively reviewed the medical records and analyzed the efficacy and safety of micafungin for prophylaxis against IFIs. Results: The patients either had autologous (n=9) or allogeneic (n=51: 1 syngeneic, 24 sibling, 26 unrelated donor) HSCT. Itraconazole oral solution (n=58) was the most frequently used first line antifungal agent for prophylaxis and was administered for median 11 days. The most frequent cause of switch to micafungin was vomiting (n=42). The duration of neutropenia and micafungin administration was median 13 and 12 days, respectively. A successful outcome was achieved in 45 (75%) patients. Empirical antifungal therapy was initiated in 13 (22%) patients. There were 2 cases (3.3%) of breakthrough fungal infections which comprised a probable invasive pulmonary aspergillosis and a possible invasive fungal sinusitis. There was no case of invasive candidiasis. A total of 53 (88%) patients experienced at least one AE regardless of causality during micafungin administration. The most frequent AEs were hypokalemia, vomiting, diarrhea, and elevated serum aspartate aminotransferase or alanine aminotransferase. Among the aforementioned AEs, only 1 case of diarrhea could be classified as a probable relation with micafungin when causality was assessed. There was no AEs that caused discontinuation of micafungin. Conclusions: Micafungin seems to be a safe and effective agent for prophylaxis of IFIs including aspergillosis as well as candidiasis in HSCT recipients. However, further large, prospective, and randomized comparative studies are warranted for aspergillosis.

생체모사환경에서 DLC 필름의 부식마모 특성에 미치는 Si 함량의 영향에 관한 연구

김호건,김우중,김정구,박세준,이광렬 대한금속재료학회 2005 대한금속·재료학회지 Vol.43 No.3

In a method to improve resistance to wear, corrosion and mechanical properties of protective coating, DLC coatings have been extensively studied over the past several years due to their unique combination of properties. Especially, Si-DLC coatings have been attracting increasing interest of researchers since they have a great potential for solving some of the major disadvantages of pure DLC coatings. Si-incorporated diamond-like carbon (Si-DLC) coatings ranging from 0 to 2 at.% were deposited on Ti alloy substrate by means of r.f. plasma-assisted chemical vapor deposition (r.f. PACVD) technique, using mixtures of benzene (C_(6)H_(6)) and silane (SiH_(4)) as the reaction gases. Corrosion and wear behavior of DLC coatings was investigated by electrochemical techniques (potentiodynamic polarization test and electrochemical impedance spectroscopy), tribological techchnique(wear test) and surface analyses (atomic force microscopy, scanning electron microscopy and Raman spectroscopy). It was found that DLC coatings with increasing Si content could acquire improved corrosion and wear resistance in the simulated body fluid environment (0.89 wt.% NaCl of pH 7.4 at 37℃). (Received December 6, 2004)

조혈모세포이식 후 발생한 주폐포자층 폐렴에 대한 고찰

주지현,최정현,이동건,백지연,고윤호,이혜정,김세희,신호진,박윤희,박지영,김유진,신완식,김춘추 대한감염학회 2001 감염 Vol.33 No.4

Background : Pneumocytitis cainii pneumonia (PCP) can occur in immunocompromised hosts especially such as AIDS or cancer patients. Although recent research had focused on PCP in AIDS patients, few studies have described the clinical presentations of PCP in recipients of stem cell transplantation (SCT). We evaluated the clinical manifestations of PCP in SCT patients admitted at St. Mary's hospital, Seoul, Korea. Methods : The medical records of 17 PCP patients undergoing SCT between Feb. 1998 and Feb. 2000 were reviewed. The diagnosis of PCP was confirmed through the demonstration of Pneumocytitis cainii via either cytology of brochoalveolar lavage (BAL) or histological technique of lung biopsy. CMV disease and CMV infection were confirmed by BAL culture and antigenemia respectively . Results : Seventeen patients were all recipients of allogeneic SCT and 7 of 17 patients were performed non-sibling SCT. Patients presented with symptoms including brief period (4 ∼23 days) of fever (76%), dyspnea (70%), cough (64%), and signs such as rare(58.8%), Sixteen patients (94%) had been receiving immunosuppressive agent such as cyclosporine A (64%) or Fk506 (35%) without PCP prophylaxis. Eleven patients (64%) were treated with corticosteroid with mean dose of 16 mg/day prednisolone and mean duration of 4.6 months after post-SCT period. Twelve patients were co-infected with CMV. Another co-infected miCroorganisms were Pseudomonas aeruginosa, Mycobacterium tuberculosis, herpes simplex virus, parainfluenza virus, Average duration of treatment with trimethoprim-sulfamethoxazole (TMP/SMX) was 21 ±9 days. Four patients died, and three of them were related with PCP. Conclusion : PCP developed frequently in patients who were taking immunosuppressive drug due to graft versus host disease or were not taking TMP/SMX prophylaxis. High risk patients showing fever, cough, or dyspnea should be considered to take early bronchoscopic intervention for detection of PCP. When treat for PCP, it also be considered to the possibility of coinfection such as CMV. (Korean J Infect Dis 33:273∼279, 2001)

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.

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.

쌍각자궁에서 4회 반복유산 후 만삭 둔위 분만 1예

홍정의,김윤숙,최승도,선우재근,배동한 순천향의학연구소 2008 Journal of Soonchunhyang Medical Science Vol.14 No.2S

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네트워크다이아그램 기법을 이용한 프로토타입 그린빌딩 환경성능 평가프로그램 구축 연구

정근주,김동완,임영빈 대한건축학회 2004 대한건축학회논문집 Vol.20 No.11

The purpose of this study was to analyze the convenience, dearness and effectiveness of the rating system of the GB. This Green Building uses a rating system which includes a network-diagram; Sorensen-network as well as a Sequence-diagram. This study is consisted of a visualized work sheets that were divided into network-diagram, annual energy consumption, air pollution as well as LCC. It has technique of separated rating for the three departments that of the globe environment conservation, health and convenience, construction ability, as well as highest mark such as the object building's performance was which is not considered with non environmental damage level. This program aimed at establishing a weight given to input to default value and needs constant study for this program. Also this study established a inventory database for estimating air pollution quantity.

一部 忠南地域 女大生의 血淸內 重金屬含量과 一部 免疫物質과의 相關關係 調査

金愛貞,呂貞淑,朴秀振,李建純 혜전대학 1999 出版文化硏究所論文集 Vol.1 No.-

This study was performed to investigate the correlations between the status of leucocytes and serum levels of heavy metals in Korean rural 79 young women according to the body mass index. The results were as follows; 1. The mean height, weight, PIBW and BMI were 158.54cm, 55.88Kg, 105.47% and subjects as their BMI increase(p<0.05). 2. The mean values of WBC, neutrophil, lymphocyte, eosinophil, basophil and monocite were 7.25, 4.10, 2.36, 0.10, 0.04 and 0.05 × 10³/mm³, respectively. There was a significant decrease in lymphocyte in subjects as their BMI increase(p<0.05). 3. The mean serum Al, As, Cr, Cu, Mn, Pb and Zn were 33.33, 28.41, 2.90, 95.97, 3.60, 2.31 and 93.65㎕/㎗, respectively. There were no significant differences among anthropometric assessments and serum trace elements. 4. There were no significant differences between the status leucocytes and serum levels of trace elements according to BMI. This study was limited within only blood levels, therefore I hope there will be wider efforts to consider about the dietary intake levels of trace elements for presentation of the connection between dietary intakes of trace elements and status of leucocytes.

한약에 의해 유발된 급성 간질성 신염 2례

김덕윤,박동건,김응석,강영모,양창헌,이정호,이동철,이영현,김정란 동국대학교 경주대학 1996 東國論集 Vol.15 No.-

간질성 신염은 신장의 간질을 선택적으로 침범하는 염증성 질환으로 여러가지 원인에 의해 유발되며, 이 중 약물에 의한 경우는 각종 항생제, 비스테로이드성 진통제, 항경련제, 이뇨제, 면역억제제등에 의한 증례들이 보고되고 있다. 현재 각종 질환-특히 만성질환-의 치료에서 한약이 차지하는 비중이 적지 않으나, 그 각각의 성분들이 유발할 수 있는 부작용들에 대한 연구는 거의 없는 실정이다. 저자들은 관절염 치료를 위해 중국산 한약을 복용한 후 복통, 피로감 및 육안적 혈뇨를 주소로 내원한 두 환자에서, 단백뇨와 신기능 장애를 보여 시행한 신조직 생검상 급성 간질성 신염에 합당한 병리학적 소견을 보이고, 한약 복용 중지 후 급속한 회복을 보여, 한약에 의해 유발된 것으로 사료되는 급성 간질성 신염 2예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Acute interstitial nephritis is a disease characterized by renal interstitial inflammatory cell infiltration and acute renal functional deterioration. This is caused mainly by antibiotics, NSAID and diuretics such as thiazide, but cases induced by herb medication are rare. We experienced two cases of acute interstitial nephritis after treatment with herb medication. One 71-year-old female patient and the other 60-year-old female were admitted to the hospital because of general weakness and gross hematuria. Microscopic hematuria, pyuria, and proteinuria were presented. After definitive diagnosis with a renal biopsy, we noted rapid recovery of renal function by drug withdrawal and steroid therapy. We report these cases with a review of the referenced literatures. Key Words : Herb medication, Acute Interstitial nephritis.

마하피닝 처리에 의한 기계구조용 합금강의 피로균열전파 지연효과

김민건,임복규,박홍기,황중각 강원대학교 산업기술연구소 2006 産業技術硏究 Vol.26 No.B

Mach peening treatment is one of the various kinds of techniques to improve the fatigue properties. The mach peening process gives high-level work hardening and compressive residual stress near the surface layer, improving the fatigue strength. In addition, this treatment reduces slip bands that initiate the fatigue cracks near the surface. During impingement, a plastic indentation surrounded by a plastic zone is formed. Mach peening treatment characteristic is less energy consumption and is an environmental friendly processing methods that is not accompanied by pollution. It is machining process that can prevent fatigue fracture beforehand in structure using already as well as process of production. The test results showed that fatigue crack propagation delay appeared by drilling type 43%, mach peening type 110%.