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.

국내 혈액질환 환자에서 침습성 아스페르길루스증의 구제치료로서 Voriconazole의 효과와 안전성

권재철,김시현,최수미,최재기,이동건,박선희,최정현,유진홍,신완식 대한감염학회 2010 감염과 화학요법 Vol.42 No.1

Background: Invasive aspergillosis (IA) is associated with significant morbidity and mortality in patients with hematologic malignancies. We investigated the efficacy and safety of voriconazole (VCZ) when used as salvage therapy for IA in Korean adults with hematologic malignancies who had not responded to prior antifungal therapy. Materials and Methods: We retrospectively reviewed data, collected from January 2007 to October 2008, from patients with proven or probable cases of IA. All were probable IA cases, except for one proven case. All cases were refractory or intolerant to antifungal therapy prior to administration of VCZ. Efficacy and safety were assessed in patients treated with VCZ for more than 3 days and for more than one dose, respectively. A favorable response [complete (CR) or partial (PR)] was defined by significant improvement of all clinical symptoms, signs, and radiologic abnormalities. Results: Fifty patients who met the inclusion criteria were enrolled. There were 27 male and 23 female patients with mean age of 44.4 years (range, 15-65 years). Underlying diseases were acute leukemia (35 cases), chronic myelogenous leukemia (4 cases), myelodysplastic syndrome (3 cases), lymphoma (3 cases) and other hematologic diseases (5 cases). Twenty-two patients had received chemotherapy and 13 patients had undergone hematopoietic stem cell transplantation. The lung was the main infection site (94%) followed by the sinus (6%). Amphotericin B deoxycholate alone was the most frequent previous antifungal therapy. The mean duration of antifungal therapy prior to VCZ therapy was 13.9±8.8 days (2-44 days). The median duration of VCZ therapy was 19 days (interquartile range, 49 days). Sixteen patients (32.0%) showed favorable responses (CR:PR=8:8) at the end of VCZ therapy. The numbers of patients with stable disease, progression and death were, 6 (12%), 6 (12%) and 22 (44%) respectively. Most of those with unfavorable responses had relapsed underlying malignancies or refractory graft versus host diseases. Twelve patients developed drug-related adverse events but only one patient stopped VCZ treatment prematurely. Conclusions: VCZ demonstrated an acceptable level of toxicity in patients with hematologic malignancies but further studies are required to prove its efficacy as salvage therapy.

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.

Effect of Myofacial Release and Cryotherapy in Acute Whiplash Injury

Si Eun Park,Joon Hee Lee,Jung San Wang,Yoo Rim Choi,Joo Hyun Park,Ju Hwan Lee,Young Duk Choi,Hyun Sook Hwang,Soon Hee Kim 국제물리치료학회 2014 Journal of International Academy of Physical Ther Vol.5 No.1

The purpose of this study is to provide the case of influence of myofacial release(MFR) and cryotherapy in acute whiplash injury. The subjects were consisted of 3 adults(2 males, 1 female) who had been diagnosed with whiplash injury. The performance period was 1 weeks, 6 times and 1 time is 40min(MFR: 20min, cryotherapy: 20min). We measured neck pain(Visual analogue scale, VAS) and cervical alignment(cervical curvature & line of gravity). All measurements of each subject were measured at pre-treatment and post-treatment. The results are listed below. The neck pain(VAS) index decreased from 7.54cm to 4.11cm. The cervical curvature increased from 23.62°to 29.76°. The line of gravity decreased from 8.03mm to 3.66mm. Based on the results, it can be suggested that both MFR and cryotherapy can be used to neck pain and alignment in acute whiplash injury.

Influences of Chronic Shoulder Pain on Muscle Tone Changes in Trunk Muscles

Hye Mi Jeon,Yoo Rim Choi,Si Eun Park,Ho Jung An,Sang Bin Lee,Wan Suk Choi,Nyeon Jun Kim,Hee Kyoung Kim,Mi Jung Kim,Soon Hee Kim 국제물리치료학회 2013 Journal of International Academy of Physical Ther Vol.4 No.1

The purpose of this study was to examine the influences of chronic shoulder pain on the muscle tone in trunk muscles. The study's subjects were 40 men and women in their 30 to 50s, which were divided into two groups. A chronic shoulder pain group consisted of 20 subjects who had been diagnosed with chronic shoulder pain by doctors, and a painless group consisted of 20 subjects who had experienced no such pain. An analysis was performed using electromyography on the muscle tone in the rectus abdominalis, external oblique, internal oblique, and erector spinae muscles under the same conditions between the two groups. The analysis results were as follows. The chronic shoulder pain group exhibited an overall high level of trunk muscle tone than the painless group, along with a statistically significant difference in the rectus abdominalis(p<.05). Moreover, the chronic shoulder pain group showed differences in the trunk muscle tone depending on the affected side. The chronic left shoulder pain group yielded higher levels of muscle tone in the right-side trunk muscles. In particular, the group revealed statistically significant differences in the rectus abdominalis and internal oblique(p<.05). The chronic right shoulder pain group exhibited higher levels of muscle tone in the left-side trunk muscles with a statistically significant difference in the internal oblique(p<.05). The above results suggested that chronic shoulder pain influences increases in the muscle tone in the trunk muscles on the opposite side to the affected shoulder.

Effects of Therapeutic Ball Exercise and Hippotherapy for Balance Ability in Elderly

Kwon Young Kang,Ji Sung Kim,Yoo Rim Choi,Joon Hee Lee,Joong San Wang,Si Eun Park,Hong Rae Kim,Hee Joon Shin 국제물리치료학회 2012 Journal of International Academy of Physical Ther Vol.3 No.2

This study was conducted to evaluate the effect of the exercise on elderly balance ability by using hippotherapy and therapeutic ball exercise. 10 patients were assigned to the hippotherapy group and they got with 30 minutes of hippotherapy. Another 10 elderly were assigned to the therapeutic ball group and they got with 30 minutes of therapeutic ball exercise. All procedures were repeated 5 times a week for the total of four weeks. To investigate the participants balancing abilities, the Time“ Up & Go”(TUG) and One Leg Stand Test(OLST) were evaluated. The results of study were significant differences between pre-test and post-test of TUG and OLST(p<.05), and there were no significant differences between hippotherapy and therapeutic ball exercise(p>.05). The conclusion showed that both the hippotherapy and the therapeutic ball exercises were effective on elderly balancing ability. Consequently, it would be better to practice therapeutic ball than hippotherapy for elderly exercise because the more economical and there is less restriction of space than the hippotherapy.

Serum Uric Acid as a Predictive Factor for Rotaviral or Noroviral Benign Convulsions with Mild Gastroenteritis

Si Yoon Yoo,Dong Hyun Kim,Yeongseok Lee,Ga Hee Lee,Dong Jun Ha,Young Se Kwon 대한소아신경학회 2020 대한소아신경학회지 Vol.28 No.4

Purpose: This study investigated the relationship between serum uric acid levels and benign convulsions with mild gastroenteritis (CwG) caused by rotavirus and norovirus. Methods: This retrospective study identified 89 patients with CwG at Inha University Hospital from January 1999 to December 2019. We analyzed serum uric acid levels in patients with CwG and in patients with acute gastroenteritis without seizures according to the causative virus. Results: Among the 2,790 patients with rotavirus or norovirus gastroenteritis, 89 patients (3.2%) were diagnosed with CwG. The serum uric acid levels were significantly higher in CwG patients than in acute gastroenteritis patients (8.20±2.34 mg/dL vs. 5.44±2.69 mg/dL, P<0.001). When examined according to the virus type, serum uric acid levels were higher in the CwG group than in the acute gastroenteritis group in patients with rotavirus (8.05±2.48 mg/dL vs. 5.48±2.78 mg/dL) and norovirus (8.43±2.13 mg/dL vs. 5.31±2.36 mg/dL) infections (P<0.001). However, there were no significant differences in uric acid levels between patients with CwG caused by rotavirus and those with CwG caused by norovirus. Conclusion: Patients with CwG, caused either by rotavirus or norovirus, showed significantly higher serum uric acid levels than those with acute gastroenteritis without seizures. Elevated serum uric acid levels could be a useful indicator for diagnosing CwG.

Outcome of surgical resection for invasive pulmonary aspergillosis in patients undergoing chemotherapy or stem cell transplantation (초)

( Si Hyun Kim ),( Su Mi Choi ),( Dong Gun Lee ),( Sun Hee Park ),( Jung Hyun Choi ),( Jin Hong Yoo ),( Wan Shik Shin ) 대한내과학회 2008 대한내과학회지 Vol.75 No.1S

요관석에 대한 정위치 체외충격파쇄석술 시 치료전환 시기

유시택,김병호,김교진,김성진,김원석,성락희,정재용,노충희 大韓泌尿器科學會 2000 Korean Journal of Urology Vol.41 No.2

The Study on Respiratory Function, Spirometric Lung Pattern and Fatigue of Elderly in a Facility

Hee Joon Shin,Ji Sung Kim,Joong San Wang,Yoo Rim Choi,Hong Rae Kim,Si Eun Park,Ho Jung An,Kyung Ok Min 국제물리치료학회 2013 Journal of International Academy of Physical Ther Vol.4 No.1

The purpose of this study was to investigate spirometric lung pattern, respiratory function and degree of fatigue by lung function tests and fatigue tests of 39 elderly people in a care facility aged 65 and over. The respiratory function tests were used to the Spirovit SP-1 and fatigue tests were used modified Piper fatigue scale(mPFS). Regarding the respiratory function, the FVC was 1.41±0.36ℓ, the FVC % predicted was 69.10±14.98%, the FEV1 was 1.02±0.31ℓ, the FEV1 % predicted was 63.27±16.05%, the FEV1/FVC was 72.77±13.40%, and the fatigue score was 5.83±1.09. As for the spirometric lung pattern, 19 patients had a restrictive pattern(48.7%), followed by 11 with a mixed pattern(28.2%), 5 with an obstructive pattern( 12.8%), and 4 with a normal pattern(10.3%). Regarding the respiratory function and fatigue by spirometric lung pattern, the FVC and the FVC % predicted of patients with a normal pattern or an obstructive pattern were greater than other groups at a statistically significant level. As for the FEV1, that of patients with a normal pattern was significantly higher than others, and for the FEV1 % predicted, that of patients with a normal pattern or a restrictive pattern was significantly higher(p<.001). Fatigue score by patients with a normal pattern was significantly less than patients of other patterns(p<.001). Therefore, pulmonary physical therapy is considered necessary to improve respiratory function and fatigue degradation of elderly in a facility.