각종 난치성 혈액 질환에서의 비혈연간 골수이식

김동욱,한훈,김정아,김희제,민창기,엄현석,최정현,이종욱,한치화,홍영선,최일봉,신완식,민우성,김학기,김춘추,김원일,김동집 대한조혈모세포이식학회 1997 대한조혈모세포이식학회지 Vol.2 No.1

목적: 비혈연간 골수이식은 혈연내에 적절한 골수공여자가 없는 만성골수성백혈병, 고위험군의 급성별혁병, 면역억제치료에 실패한 재생불량성빈혈 및 각종 난치성 조혈모세포질환의 완치를 위한 표준적인 치료방법으로 정착되고 있다. 혈연간 표준적인 동종 이식에 비하여 비혈연간 이식시에는 생착부전, 이식편대숙주반응과 감염이 더 빈번하게 발생하며, 국내에서는 아직까지 체계적인 임상연구결과가 보고된 바 없었다. 이에 본 센터에서는 1995년 10월 이후로 약 20개월간 26예의 비혈연간 골수이식을 시행하였으며 3개월 이상의 추적관찰이 가능하여 이식초기 합병증의 관찰 및 분석이 가능하였던 20예의 환자를 대상으로 이식성적 및 문제점을 보고함으로써 새롭게 확대되고 있는 이 분야의 임상연구 및 진료의 활성화를 꾀하고자 한다. 방법: 각종 혈액 종양질환으로 비혈연간 이식을 시행한 총 26예의 환자중 3개월이상의 추적관찰이 가능하였던 20예를 대상으로 후향적으로 임상경과를 분석한 후 생존 분석을 시행하였고, 환자의 연령, 성별, 질병의 상태, 조식 적합 항원의 일치정도, 이식편대 숙주 반응의 유무와 생존기간과의 상관관계를 살펴보았다. 또한 표준위험군과 고위험군으로 나누어 생존율을 비교하였고 이식과 관계된 생착 부전, 이식편대숙주반응, 감염의 발생과 양상 그리고 그 합병증을 관찰하였다. 결과: 1. 환자와 공여자간에 HLA 불일치가 20예 중 4예에서 있었으며, 생착여부의 확인이 가능했던 17예 중 16예에서 생착이 확인되어 94.1%의 생착율을 보였다. 2. 급성이식편대숙주반응은 62.5%(10/16예)에서 발생하였으며 111도 이상의 급성의 이식편대숙주 반응은 25%(4/16예)에서 발생하였다. 만성이식편대숙주반응은 40%(2/5예)의 환자에서 발생하였으며 이들 모두 국소형으로 중증의 진행형 만성이식편대숙주반응이 관찰된 환자는 없었다. 3. 호흡기 합병증은 10예(50%)에서 발생하였으며 감염성 폐렴을 포함한 호흡기 합병증이 가장 흔한 일차적인 사망 원인이었다. 호흡기 합병증이 발생했던 10예중 6예가 감염에 의한 폐렴이 의심되었고 나머지 4예는 특발성 간질성 폐렴이었다. 4. 8.5개월의 중앙추적기간 중 35%의 생존율을 관찰할 수 있었고, 생존기간은0.5개월에서 15개월 (중앙치:4개월)이었다. 한편 고위험군은 25%(3/12예), 표준위험군은 50%(4/8)의 생존율을 관찰할 수 있었다. 5. 가장 흔한 사망 원인은 감염성 폐렴을 포함한 호흡기 합병증(6예)이었고, 이외의 사망 원인으로는 급성 이식편대숙주반응과 다장기부전이 각각 2예, 생착 부전, 간정맥 폐쇄, 그리고 재발이 각각 1예였다. Unrelated bone marrow transplantation(UBMT) has been increasingly recognized as the standard treatment for cure of chronic myelogenous leukemia, high risk acute leukemia, aplastic failed on immunotherapy, and the variety of refractory hematologic diseases in patients lacking a related donor. However, as compared to HLA identical sibing transplantation, UBMT carries higher incidence of graft failure, graft versus host disease(GVHD), and infection. In our center, 26 patients underwent UMBT between October 1995 and June 1997. The minimum follow-up of 3 months was possible in 20 patients, for whom early complications and clinical outcomes were assessed. The median age of the 20 patients was 24 years. 8 patients had standard risk disease and 12 patients had high risk disease. All patients received various preparative regimens including total body irradiation according to disease and disease status. 19 patients received CsA + short course MTX for GVHD prophylaxis. One patient received marrow that was depleted of T cells ex vivo using avidinbiotin column. The class I loci were typed by serological methods and HLA-A, HLA-B and HLA-DRB1. 3 additional pairs were one minor mismatched at the HLA-B locus. Another one patients was one major mismatched at the DRBI alleles. 17 patients were evaluable for engraftment. Successful enfraftment was confirmed in 16 patients(94.1%). Only one patient who was performed one major DRBI mismatched transplants experienced graft rejection. 16 patients were evaluable for acute GVHD. The overall incidence of acute GVHD developed in 4 patients(25%). Five patients were evaluable for the development of Ⅳ acute GVHD developed in 4 patients (25%). Five patients were evaluanle for the development of chronic GVHD. 2 patients(40%) developed limited chronic GVHD. Respiratory complications including pulmonary infection developed in 10 patients(50%) and these complications were the most common primary cause of death. Of these 10patients, 6 had pneumonia due to fungus(4 patients), pacterial (1 patient), and CMV infection (1 patient) and 4(20%) had idiopathic interstitial pneumonitis and/or adult respiratory distress syndrome. The duration of median follow- up was 8.5 months and 7 of 20 patients(35%) are alive at the time of this analysis with survival duration of 0.5 to 15 months(median survival duration: 4 months). The overall survival was 25% (3/12 patients) in high risk group and 50%(4/8 patients) in standard group. From these results, we can predict that the incidence and severity of GVHD in Korea are lesser than multiracial countries and the long-term survival of patients with standard risk disease can approach that of HLA matched sibling transplants. For the past two years, the performance of UBMT has been rapidly increasing and it will be possible to analyze much larger number of patients soon in Korea. In the future the problems of graft failure, GVHD, and infection due to long lasting immunocompromised status will need to be overcome by continued medical research. In addition, the volunteer donor pool will have to be expanded by the promotion of the national awareness of its need.

Prices, Qualities, and Costly Information in a Search Model of Money

Kim, Young Sik 서울大學校 經濟硏究所 2005 經濟論集 Vol.44 No.3-4

This paper examines the implications of costly information for prices and qualities in a search model of money. Agents can acquire an inspection technology at a cost where incurring a higher cost permits quality to be recognized with higher probability. First, in contrast to the exogenous information structure, the equilibrium without lemons no longer exists. Second, in the constrained equilibrium where uninformed buyers get a zero net surplus from trade, average quality of output increases with the money stock since buyers choose to be better informed as the money stock increases. The price dispersion in terms of the premium for known quality increases with the money stock. As for the effects of inflation, buyers become better informed with inflation, which implies the larger premium for the known quality. In the constrained equilibrium, higher average quality and lower price of known quality with a positive inflation imply higher welfare relative to a zero inflation.

고대산 북서사면(경기도 연천군) 지역의 식물상 및 산림군락 분류에 관한 연구

김남영,김흥식,김영설,김정유,박완근 江原大學校 森林科學硏究所 2004 Journal of Forest Science Vol.20 No.-

2003년 3월부터 10월까지 고대산을 대상으로 식물상과 산림군락을 조사하였다. 관속식물은 94과 299속 481종 1아종 66변종 4품종 1교잡종으로 총 553종류인 것으로 나타났으며, 한국특산식물은 8과 11속 13종 총 13종류, 희귀 및 멸종위기식물은 12과 15속 15속 15종 총 15종류, 귀화식물은 9과 15속 17종 총 17종류로 나타났다. 산림군락은 신갈나무-철쭉군목, 신갈나무-생강나무군단, 갈참나무-신갈나무군락, 굴참나무-신갈나무군락, 당단풍-신갈나무군락으로 전체 1군목, 1군단, 3군락이 분포하는 것으로 나타났다. The study was carried out to investigate the flora and community classification of forest vegetation in Mt. Godae from March to October, 2003. As a result of that, the vascular plants were 94 families, 299 genera, 481 species, 1 subspecies, 66 varieties, 4 formae, 1 hybrid, 553 taxa in all; korean endemic plants were 8 families, 11 genera, 13 species, 13 taxa in all; rare or endangered plants were 12 families, 15 genera, 15 species, 15 taxa in all; naturalized plants were 9 families, 15 genera, 17 species, 17 taxa in all. forest vegetation was classified into 1 order, 1 alliance, 3 communities; Rhododendro - Quercetalia mongolicae (Kim 1990) Lindero - Quercion mongolicae (Kim 1990) A. Fraxinus rhynchophylla - Quercus mongolica Community B. Quercus variabilis - Quercus mongolica Community C. Acer pseudo-sieboldianum - Quercus mongolica Community

Rat의 복강내에 투여한 5-fluorouracil-polyglycolic acid 제형이 장기에 미치는 영향에 관한 연구

강대영,송규상,최정목,노승무,정경수,오정연,김진향,양준묵,최선웅,이진호,조준식,민병무,김용백,김창식,박근성,김승영,김학용,인현빈 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

For more effective intraperitoneal chemotherapy, the authers made 5-fluorouracil-polyglycolic acid composite disks(FU-PGA disks) with 5-fluorouracil and polyglycolic acid, a biodegradable polymer. We inserted the FU-PGA disk into the peritoneal cavites of Sprague-Dawley male rats, the control and three experimental groups; one FU-PGA disk insert group(300mg/kg), two FU-PGA disk insert group(600mg/kg), and three FU-PGA disk insert group(900mg/kg). The control group received a similar number of PGA disk inserts. A pharmacokinetic study was performed to measure the 5-fluorouracil concentration in the peritoneal fluid, blood, and tissues(liver, kidney and heart) at 24 hours, 72hours and 168 hours after insertion of the FU-PGA disk. Light and electron microscopic studies were done. The results were as follows: 1) The number of white blood cells and platelets decreased after FU-PGA insertion. The degree was proportional to the duration and amounts inserted. The change in the number of red blood cells varied slightly. 2) Light microscopically, slight changes were noted at 168 hours in the 3 disk insert group (900mg/kg). Mild fatty change and hepatocyte degeneration around the central veins of the liver were noted, with vacuolar degeneration in the proximal convoluted tubules of the kidney. 3) Electron microscopically,the liver showed focal increases of lipid droplets in the hepatocytes, and irregular nuclear membrane with focal nucleolar segregation of the fibrillar and granular elements. Also the double membranous structure of the hepatocytes and Kupffer cells was widened with bleb formation. The kidney showed wide separation of the nuclear double membrane in the proximal convoluted tubular cells and mesangial cells, with vacuolation and myelin figure formation in the mitochondria of the proximal convoluted tubular cells, at 72 hours and 168 hours in the 2 to 3 FU-PGA insert groups. The heart showed focal loss of cristae,vacuolation and myelin figure formation in the mitochondria of the 2 to 3 FU-PGA insert groups. In conclusion, despite the large amont of FU-PGA inserted, the histopathological changes in the liver, kidney and heart were slight, and consonant with the very low amount of 5-fluorouracil concentrations detected in the liver, kidney and heart. The above results suggest that the FU-PGA composite can serve as a new device for releasing drugs in a controlled manner and easily targeted to intraperitoneal organs. This device can improve the efficacy of intraperitoneal chemotherapy for gastric cancer.

Prednislolne이 골조직에 미치는 영향에 관한 형태학적 연구

송혜정,김무강,김원식,이영호 충남대학교 의과대학 지역사회의학연구소 1988 충남의대잡지 Vol.15 No.1

To study the effects of corticosteroids to the bone tissues, author grouped young(3 weeks affter birth) and adult ICR mouse by dosage, injected intramusculaily prednisolone, a series of corticosteroids, to posterior leg during 6 weeks per day, obtained femurs and tibias, measured the lengths of tibias and femurs. The portions of the distal end of tibial crests were cross-sectioned, general H-E stain was perpormed. The adjacent distal portions of femoral neck were sectioned longitudinally, observed endosteal surface by scanning electron micrscope The results were followings: 1. The adult group injected by large dosage (0.56mg/100g body weight/day) and the young group injected by small dosage(0.14mg/100g body weight/day) from 3 weeks after birth were significantly shorter than the normal group according to statistics. And the adult group injected by small dosage (0.14mg/100g body weight/day) was not different from normal group according to statistics. 2. In the light microscopic sutdy, the adult group injected by large dosage decreased in bone mass of compact bone severely, the adult group injected by small dosage changed a little grade. The young group injected by small dosage from 3 weeks after birth was not severe in bone change, but bone thickness decreased. 3. In the scanning elctron microscopic study, the adult group injected by large dosage and the young group iniected by small dosage from 3 weeks after birth decreased in trabeculae. The trabeculae of the adult group injected by small dosage were decreased slightly. 4. Integrating above all, the changes by prednisolone injection osteoporosis, of young period were more severe than those of adult, too.

중증 외상 환자의 골반골절에서 경피적 혈관 색전술과 Young과 Burgess 분류의 상관관계

차용한 ( Yong Han Cha ),설영훈 ( Young Hoon Sul ),김하용 ( Ha Yong Kim ),최원식 ( Won Sik Choy ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.3

Purpose: Immediate identification of vascular injury requiring embolization in patients with pelvic bone fracture isn’t an easy task. There have been many trials finding indicators of embolization for patients with pelvic bone fracture. Although Young and Burgess classification is useful in decision making of treatment, it is reported to have little value as indicator of embolization in major trauma patients. The aim of this study is to find out Young and burgess classification on predicting vessel injury by analzyng pelvic radiograph taken from major trauma patients with pelvic bone fracture. Methods: Among major trauma patients with injury severity scores (ISS) higher than 15 who visited our emergency room from January 2011 to June 2014, 200 patients were found with pelvic bone fracture in trauma series and thus pelvic CT angiography was taken. Setting aside patients with exclusion criteria, 153 patients were enrolled in this study for analysis of Young and Burgess classification. Results: The most common mechanism of injury was lateral compression in both groups. There was no statistical significant difference in Young and Burgess classification (p=0.397). The obturator artery was the most commonly injured artery in both groups. Six patients had more than one site of bleeding. Conclusion: Prediction of transcatheter angiographic embolization using Young and Burgess classification in severe trauma patients is difficult and requires additional studies. [ J Trauma Inj 2015; 28: 144-148 ]

야뇨증 환아들의 심리사회적 특성에 대한 다기관 연구 : 행동 및 정서 문제를 중심으로

조수철,김재원,신민섭,황준원,한상원,박관현,이상돈,김경도,김건석,서홍진,이유식,정재용,김영균,문두건,남궁미경,한창희,조원열,김영식,배기수,이종국,정우영,신의진 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.6

Objectives : The aim of this study was to examine the behavioral and emotional problems associated with nocturnal enuresis in Korean children. Methods : Three hundred eighteen children with nocturnal enuresis, together with their parents, completed the Child Behavior Checklist (CBCL), Disruptive Behavior Disorder Scale according to DSM-IV (DBDS), Children's Depression Inventory (CDI), State-Trait Anxiety Inventory for Children (STAIC), and Piers-Harris Children's Self-Concept Scale (PHCSC). Ninety-three normal students were selected as the control group. Results : Compared to the normal control group, the mean scores with regard to the withdrawn, social problems, attention problems, delinquent behavior, aggressive behavior, externalizing problems and total problems profiles were significantly higher in the nocturnal enuresis group according to the CBCL results. The nocturnal enuresis group also scored significantly higher in the ADHD and ODD profiles of the DBDS. The nocturnal enuresis group was more depressed and anxious than the control group according to the results of the CDI and STAI. The mean score of the PHCSC was significantly lower in the nocturnal enuresis group when compared to the normal control group. Conclusion : The results of this study suggest that children with nocturnal enuresis in Korea have clinically relevant behavioral and emotional problems. The findings support the link between nocturnal enuresis and psychopathology in Korean children.

영산강 상류일부의 水質汚染에 관한 調査硏究 : 산동교를 중심해서

류일광,이치영,강영식,김관천 광주보건대학 1990 論文集 Vol.15 No.-

Water quality of Young San river was examined for 3 months from April 12, 1989. to Jun 12, 1989. For checking the water quality 4 sampling position were selected. The results we obtained are as follows. 1. The average for Young San river was 6.6∼7.4 of pH, 3.6∼8.7mg/ℓof Dissolved dxygen (DO), 18.67∼33.47mg/ℓof chemical oxygen demand (COD), 47.66∼250mg/ℓ of suspended solid (SS), 37.83∼114.66mg/ℓ of N-hexane abstraction maters, 5.16∼6.63mg/ℓ of BOD. 2. The monthly average for Young San river was 6.5∼7.5 pH,3.5∼10.4mg/ℓ of DO. 15.07∼48.90mg/ℓ COD, 6.2∼10.2 mg/ℓ of BOC, 2∼250mg/ℓ of SS. 2∼124mg/ℓ of N-hexane abstraction mater, in April, 6.2∼7.5 of pH, 3.5∼8.2mg/ℓ of DO, 2.4∼5.7mg/ℓ BOD, 18.21∼32mg/ℓ of COD, 16∼123mg/ℓ of SS, 9.5∼95mg/ℓ of N-hexane abstraction matter, in May 6.9∼7.5 of pH, 3.8∼7.50mg/ℓ of pH, 3.8∼7.50mg/ℓ of DO, 4.0∼5.8mg/ℓ of BOD, 18.23∼of COD, 123∼163mg/ℓ of SS, 102∼125mg/ℓ of N-hexane abstraction matter in Jun. 3. The sampling positions averag for Young San San river was 6.9∼7.5 of pH, 7.5∼10.4mg/ℓ of DO, 15.07∼22.8mg/ℓ of COD, 3.5∼6.2mg/ℓ of BOD, 2∼125mg/ℓ of ss, 2∼102mg/ℓ of N-hexane abstraction matter in posiction 1.7.3∼7.5 of pH, 6.0∼7.5mg/ℓ of DO, 46.25∼52.05mg/ℓ of COD, 2.4∼8.5mg/ℓ of BOD, 58∼123mg/ℓ of SS, 62∼120mg/ℓ of N-hexane abstration matter in position 2. 6.2∼7.3 of pH, of pH, 4.23∼6.7mg/ℓ of DO, 4.9∼7,9mg/ℓ of BOD, 18.23∼36.75mg/ℓ of COD, 89∼152mg/ℓ of SS, 75∼123mg/ℓ of N-hexane abstraction matter, in position 3, 6.5∼7.2 of pH, 4.0∼10.2mg/ℓ of BOD, 3.5∼3.82mg/ℓ of DO, 23.6∼52.32mg/ℓ of COD, 123∼250mg/ℓ of SS, 95∼125mg/ℓ of N-hexane abstraction matter in position 4.

백서의 복강내에 투여한 Mitomycin-C-Polyglycolic acid 제형이 장기에 미치는 영향에 관한 연구

송규상,강대영,최정목,노승무,정경수,오정연,김진향,양준목,최선웅,이진호,조준식,민병무,김용백,김창식,박근성,김승영,김학용,인현빈 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

To evaluate the in-vivo effects of mitomycin-C-polyglycolic acid composite(MMC-PGA) the disk: shaped composite were implanted into the peritoneal cavity of the Sprague-Dawley rats. The pathologic changes were examined at various time points up to 12 weeks. Initially the soft tissue around the inserted disks showed capillary congestion at 3 days. Inflammatory infiltrates with foreign body giant cells appeared from the 2nd week and reached peak response at 6-8 weeks. These reaction diminished prominently at 12 weeks. No specific pathologic change was found in the liver, the kidneys, and the heart. The above results suggest that the MMC-PGA composite can serve as a new device for intraperitoneal chemotherapy of various types of cancers.

위암 환자의 복강내 투여를 위한 Activated Charcoal-Alginate Bead 제형으로부터 Mitomycin C의 용출 거동

이진호,최선웅,서중기,김동민,정경수,오정연,김진향,노승무,민병무,김용백,김창식,박근성,강대영,송규상,양준묵,조준식,정현용,김학용,인현빈 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

Locoregional recurrence is the most common type of recurrence in surgical operation of gastric adenocarcinoma, and peritoneal dissemination is one of the most difficult problems in advanced gastric adenocarcinoma treatment. Because the peritoneal cavity is the most common site of the first recurrence after gastric cancer resection, intraperitoneal chemotherapy seems a logical choice for cancer chemotherapy. In this study, Mitomycin C (MMC)-activated charcoal (CH)-alginate (ALG) beads were prepared by the mixtures of CH particles adsorbed with MMC as an anti-cancer drug and aqueous alginate solution. The alginate is recognized as biodegradable, nontoxic, and biocompatible. The release of MMC from the beads in 0.1 M Tris buffer was stable and continuous until about 1 week. The MMC-CH-ALG beads can be applied in the peritoneal cavity for intraperitoneal chemotherapy since they provide a good adhesiveness on the tissue and controlled release pattern of the drugs.