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.

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.

고등급 보안 시스템을 위한 IPSec 시스템 기능 명세

유희준,김영미,최진영,서동수,노병규 고려대학교 컴퓨터과학기술연구소 2001 JOURNAL OF COMPUTER SCIENCE & ENGINEERING TECHNOLO Vol.3 No.-

현대 사회는 인터넷 사용자의 증가와 제반 기술의 비약적인 발전으로 사회활동 전반에 대한 인터넷 기반 서비스가 이루어지고 있다. 이런 과정에서 발생한 중요한 문제중의 하나가 불특정 다수가 자유로이 통신을 하기 위해 개발된 인터넷상에서 사용자의 보안을 보장해주는 것이다. 최근에 와서 인터넷상에서 개인 정보유출로 인한 많은 피해가 발생하면서 정보보호에 대한 관심이 더욱 증가하고 있다. 현재 이 문제를 해결하기 위하여 많은 보안 관련 시스템들이 개발되고 있으며, 세계 각 국의 표준 기구에서는 이러한 시스템에 대한 등급을 평가하고 있다. 각 등급을 살펴보면, 시스템 개발 초기부터 정형기법을 이용하여 개발되어진 시스템들이 고등급을 획득하고 있다. 국내에서도 한국정보보호센터(KISA)에서 보안 시스템에 대한 등급을 평가를 수행하면서 정형기법을 이용하여 땅세 검증된 시스템에게 K5이상의 고등급을 부여하고 있다. 이러한 등급을 살펴보면, 시스템의 기능을 정형명세언어를 이용해서 명세하는 부분을 공통적으로 요구하고 있다. 본 논문에서는 높은 보안 등급의 IPSec 관련 시스템을 개발하기 위해서 정형명세언어인 Z를 이용해서 IPSec의 동작을 명세하였다. The modern community is moving across the whole areas based on Internet with the growing Internet users and the great technological development. One of the important things that can be problem in this community is that the Internet should assure secure networking and security mechanism for the many security-ignorant users. Recently, Due to a lot of damages like a personal drain, security concerns is growing very rapidly. Now, many security application system is developing to solve this problem and each of the world standard organizations is evaluating these security application systems. Considering the each levels, we found that system using formal methods from the initial system development process acquired the high-level. In domestic, KISA manages the evaluation of security system and gives the higher than K5 to the system that specified and verified using formal methods. In this all levels, it should be required the system specification part. In this paper, we specified IPSec using formal specification language Z to develope the high-level IPSec system.

염기서열특이 - 중합효소연쇄반응법을 이용한 Rh C/c, E/e 혈액형항원 유전자형 검사

서동희,오흥범,황유성,김상인 大韓輸血學會 1999 大韓輸血學會誌 Vol.10 No.1

牛蒡子의 抗알러지 效果에 對한 硏究

兪漢鐵,金聖勳,金東熙 대한본초학회 2001 大韓本草學會誌 Vol.16 No.1

To evaluate the effectiveness of Arctii Fructus(AF) in the treatment of allergy, studies were done experimentally. The results were obtained as follows : 1. Cytotoxicity of AF extract on the mouse lung fibroblast cells was not shown below the level of 100 ㎍/㎖ concentration. 2. In the quantification of IL-1β gene development, the amount was decreased compared to control group, gut which was insignificant. 3. Gene development of IL-4 was suppressed over 70% in the concentration of 100㎍/㎖ and also the of production of IL-4 was decreased significantly in the concentration of 100㎍/㎖ compared to the control group. 4. Gene development of Il-5 was decreased to 60% in the concentration of 100 ㎍/㎖ compared to the control group. 5. Gene development of IL-4 and IL-10 were decreased compared to the control group, but which was not significant. 6. Gene development of TNF-α was suppressed over 60% in the concentration of 10 ㎍/㎖ compared to the control group. 7. The effect of suppression of IgE production was significantly decreased in the concentration of 100㎍/㎖. 8. The effect of suppression of Histamine release was decreased significantly in the concentration of 100 ㎍/㎖. According to the above results, AF has antiallergic effects and suppression of the immune response. Thus it is suggested that aqua extract of AF could be applied to the aqua-acupuncture for suppressing humoral immune response, and further research is recommended.

Ketoprofen 첩포제(Ketotop : )의 경피적용에 따른 혈장농도 및 피부자극의6 검토

임동석,장인진,신상구,유재학,은희철 大韓臨床藥理學會 1994 臨床藥理學會誌 Vol.2 No.1

Cyclosporine과 Ketoconazole의 약물상호작용을 이용한 아토피 피부염 치험 2예

김동원,표형찬,은희철,이유신 大韓臨床藥理學會 1993 臨床藥理學會誌 Vol.1 No.1

인슐린종에 음폐된 신경정신과적 증상 평가

유희정,이성동,김헌수,민병근,박인호 울산대학교 의과대학 1994 울산의대학술지 Vol.3 No.1

The authors experienced a patient with insulinoma presented with neuropsychiatric symptoms. It was demonstrated that Whipple's triad is highly suggestive of the presence of an insulinoma. Therefore physicians and/or psychiatrists, who refer patients with insulinoma to third institution, always have a alertness to neuropsychiatric symptoms of insulinoma and Whipple's triad. This case also illustrated the persistence and cooperation between psychiatric and medical teams including the involvement of a neurologist, endocrinologist, and surgeon for diagnosis and treatment planning of patient with insulinoma.

High Performance Liquid Chromatography를 이용한 Hemoglobin A1C 측정

변동원,서교일,유명희,김극배 순천향의학연구소 1995 Journal of Soonchunhyang Medical Science Vol.1 No.2

Hemoglobin AIc(HbAlc) has been known to be an index of long-term glycemic control (6-8weeks), and offers several practical advantages for screening of diabetes mellitus and evaluation of effects of treatment. Authors introduced to measure and investigate HbAlc levels by high performance liquid chromatoraphy (HPLC ; LDC Milton Roy, USA), with cation exchange column, Mono S HR 5/5 (Pharmacia). The results were as follows; 1. The mean HbAlc level in normal adult control group (n=50) was 4.13±0.25% (Mean±S.D). 2. Within-run precisions of HbAlc levels measured by HPLC were 4.39±0.01% (Mean±S.D.), 1.41(C.V.) in normal control, and 8.95±0.02% (Mean±S.D.), 1.65(C.V.) in intermittently treated diabetic patients, and 11.02±0.01% (Mean±S.D.) 2.93(C.V.) in untreated diabetic patients. 3. Between-run precision of HbAlc levels measured by HPLC were 4.35±0.01% (Mean±S.D.), 2.76(C.V.) in normal control, and 8.98±0.01% (Mean±S.D.), 1.22(C.V.) in intermittently treated diabetic patients, and 10.95±0.15% (Mean±S.D.), 3.51(C.V.) in untreated patients. 4. The peak level of HbAlc was obtained in about 9 minutes and the whole program could be completed within 17 minutes. 5. Blood specimens could be stored for as long as 8 days at 4℃ without changes of HbAlc levels. These results suggest that the measurement of HbAlc by HPLC using cation exchange column is so accurate, simple and rapid that the clinical use is more wider.