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침습성 아스페르길수스증 진단을 위항 갈락토만난 항원검사의 유용성 평가
송경호,이신원,장희창,전재현,박완범,박경운,박상원,오명돈,최강원 대한감염학회 2009 감염과 화학요법 Vol.41 No.2
Background : Invasive aspergillosis (IA) is an important cause of morbidity and mortality among immunocompromised patients. However, 1A is difficult to diagnose, especially in the aforementioned patient group. Recently, galactomannan assay (GMA) using enzyme immunoassay has been introduced in Korea. We evaluated its diagnostic usefulness in the diagnosis of 1A and we analyzed the results according to the underlying diseases. Materials and Methods : All patients who underwent GMA during the period from October 2007 to June 2008 were evaluated retrospectively. According to the criteria of European Organization for Research and Treatment of Cancer/Mycoses Study Group, IA was classified into four clinical categories: proven', probable', possible', and 'non' IA. Patients with 'proven' and 'probable' IA were used as the reference standards for IA. GMA was performed using Platelia Aspergillus EIA (Bio-Rad, Hercules, CA, USA). Optical density index ≥0.5 was considered positive. Results : Of the 144 patients who underwent GMA, two patients were classificed as proven' IA and sixteen patients were probable' 1A. Overall sensitivity, specificity, positive predictive value, and negative predictive value of the assay were 50% (95% confidence interval [C195), 26-74%), 88% (C195, 81-93%), 38% (CI95, 19-59%), and 93% (CI95, 86-97%), respectively. Among the 99 patients with underlying hematologic diseases, GMA showed 67% (C195, 35-90%) sensitivity and 89% (C195, 80-94%) specificity, whereas in 45 patients with underlying diseases other than hematologic diseases, sensitivity and specificity of the assay were 17% (CI95, 0-64%) and 87% (CI95, 73-96%), respectively. Conclusions : GMA showed high specificity, irrespective of the patient population. However, sensitivity of GMA was low and the assay was less sensitive in patients with underlying diseases other than hematologic diseases than in patients with hematologic diseases.
술중 전향적 대장세척술과 대장아전절제술을 이용한 폐쇄성 좌측 대장 및 직장암의 일차절제 및 문합술
윤완희,홍기훈,송인상 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.2
The proper surgical management of obstructing left colorectal cancers in an issue of debate. Staged operation including proximal colostomy has generally been accepted as a safe and standard method of management. But staged colonic procedures are associated with significant morbidity and mortality, and many patients, unfit for further surgery, are left with a permanent colostomy. Many other methods such as the use of long intestinal tube, transanastomotic obturation balloon colostomy, intracolonic bypass tube (Coloshield) were developed, but they have failed to gain wide accepance. We have already reported the initial results of intraoperative antegrade colonic irrigation for one-stage operation in obstructing left colorectal cancers. In this investigation, we evaluated the results of prospective trials of primary resection and anastomosis using intraoperative colon irrigation and subtotal colectomy in obstructing loft colon and rectal carcinomas. During recent five years, 19 cases of obstructing left colon and rectal carcinomas which could not received regular colon preparation due to marked abdominal distension were enrolled to this study. There were 12 men and 7 women, and mean age was 61. 14 of the 19 patients which tumors located below mid-descending colon were subjected to primary resection and anastomosis using intraoperative antegrade colonic irrigation, 4 patients which tumors located above the mid-descending colon were treated with subtotal colectomy, and remaining one patient which tumor located upper rectum was performed subtotal coloectomy because of underlying colonic ischemia. There was no mortality and significant postoperative complications such as anastomotic leakage, pelvic abscess of intraabdominal sepsis which seemed to related with anastomotic dehiscence. Therefore, primary resection and anastomosis using intraoperative colonic irrigation of subtotal colectomy depending on tumor locations in cases of obstructing left colon and rectal carcinomas might be useful methods to obtain safe one-stage restorative colorectal resections
위암세포에 의한 종양침윤 림프구의 면역반응 억제기전에 관한 연구
박정규,송규상,서광선,최정목,배진선,장일성,윤완희,노승무,조은경,백태현 大韓免疫學會 1995 大韓免疫學會誌 Vol.17 No.3
Tumor-infiltrating lymphocytes ('1°ILs) interact most closely with tumor cells and thus are more likely to reflect tumor host interactions accurately. But it is unknown whether such T cells are nonspecific inflammatory cells or a subset of specific host immune responses. In this study, there was no clear correlation between the infiltration of T lymphocytes in stomach cancer and the overexpression of c-ErbB-2 or increasing class I MHC expression on tumor cells. A positive correlation was seen between the presence of TILs in the tumor and tumors with diploidy by flow cytometric DNA analysis. The proliferative responses of Ills stimulated with IL-2, anti-CD3 mAb, or both were examined. When compared to normal mucosal-associated lymphoid tissue lymphocytes, the proliferative response of TILs to high dose IL-2 was minimal. A similarly poor response to anti-CD3 mAb plus IL-2 was also observed. The freshly isolated TILs exhibit reduced ability to proliferate in response to IL-2, anti-CD3 mAb or both. The microenvironment of the tumor suppresses the proliferative capacity of the TILs. The mechanism of this suppression remains unknown. It could be mediated by suppressor cells, by soluble substances within the tumor, or both. To examine this question, supernatants of stomach cancer cells (SNSNU-1) were tested for the presence of immunosuppressive factors. Human peripheral blood T-cells and tumor-draining lymph node lymphocytes (TDLNL) were incubated for 3 days with SNSNU-1 and then assessed for proliferative responses to PMA, anti-CD28 mAb, or both and for the inducibility to express IFN- r or IL-4 mRNA to PMA. Peripheral blood T-cells pretreated with SNSNU-1 were unable to proliferate in response to PMA, anti-CD28 mAb or both. SNSNU-1 also produces inhibitory activities of TDLNL proliferative response to PMA or anti-CD28 mAb and PMA (49%, 52%, respectively). In contrast, culture supernatants obtained from HEp-2, K562 or Daudi showed normal proliferative responsiveness of peripheral blood T-cells and TDLNL by PMA, anti-CD28 mAb or both.