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.

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.

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.

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 조혈모세포이식 환자에서 Human Cytomegalovirus gB 유전형의 분포와 질환과의 연관성 : 예비 보고

최수미,김진희,이동건,박선희,최정현,유진홍,박철민,이종욱,민우성,황응수,신완식,김춘추 대한감염학회 2007 감염과 화학요법 Vol.39 No.2

목적 : 사람 거대세포바이러스(Human cytomegalovirus, 이하 HCMV) glycoprotein B (gB)는 UL55 유전자에 의해 부호화되는 당단백으로, UL55 유전자의 염기서열변화에 따라 4가지 유전형으로 나뉜다. 본 연구에서는 국내 조혈모세포이식 환자들에서 HCMV gB 유전형의 분포와 그 특성을 알아보고, gB 유전형에 따라 특정 HCMV 질환 발생과 연관이 있는지 그 임상적 의미를 분석해 보고자 하였다. 재료 및 방법 : 동종 조혈모세포이식 환자 52명의 혈액검체 94개에 대해, Chou 등이 제시한 방법에 따라, 먼저 UL55 유전자 부위를 nested PCR로 증폭한 후, RsaI과HinfI으로 Restriction fragment length polymorphism(RFLP) 분석을 시행하였다. 결과 : gB type 1은 73.1% (38/52), gB type 2는 13.5%(7/52), gB type 3는 1.9% (1/52), gB type 1과 type 2에 의한 혼합감염은 9.6% (5/52)로 나타났다. gB type 4는 관찰되지 않았다. 1명(1.9%)에서 gB 유전형을 결정할 수 없었는데, RFLP 패턴으로 보아 Trincado 등이 제시한 gB type 7에 해당하는 것으로 생각되었고, 이 새로운 아형에 대해서는 현재 염기서열 분석 중이다. 52명 중 5명(9.6%)에서 HCMV 질환이 발생하였고, 3명에서 HCMV 폐렴, 1명에서 망막염과 위장관염, 나머지 1명에서 망막염이 발생하였다. 5명 중 HCMV 질환과 관련하여 사망한 예는 없었고, 감염된 HCMV는 모두 gB type 1이었다. HCMV gB유전형과 HCMV 질환 발생 사이에 유의한 연관성은 없었고, 단일 주에 의한 감염과 혼합감염에 따른 HCMV 질환발생 사이에도 유의한 연관성은 관찰되지 않았다. 자료 분석 중 gB type 2에 감염되어 있던 환자에서 gB type 1에 재감염 되면서 발열, 간효소 수치 상승 및 pp65 HCMV 항원혈증이 나타난 예가 있었다. 결론 : 연구결과 gB type 1이 아주 우세하고, gB type 4는 검출되지 않았으며, 혼합감염의 빈도가 비교적 낮은 분포를 보였다. 이는 외국의 보고와는 다른 국내 조혈모세포이식 환자에서의 독톡한 감염 양상으로 추정된다. 본 연구에서 HCMV gB 유전형과 질환 발생과의 연관성을 밝힐 수는 없었으나, HCMV 유전형에 대한 연구는 바이러스 감염의 발병기전이나 전파 경로 및 양식과 같은 역학적 연구에 중요한 자료가 될 것이다. 현재 더 많은 수의 조혈모세포이식 환자를 대상으로 연구가 진행 중에 있으며, 앞으로 다른 질환군의 환자나 건강한 잠복 감염자에서의 추가 연구가 필요할 것으로 생각된다. Background : Human cytomegalovirus (HCMV) glycoprotein B (gB) is the major envelope glycoprotein, encoded by the UL55 gene. Based on sequence variation in the UL55 gene, HCMV can be classified into four gB genotypes. Previous studies have suggested an association between HCMV gB genotypes and clinical outcome in the immunocompromised hosts. The goal of this study was to determine the distribution of HCMV gB genotypes and the effect of gB genotype in the developement of HCMV diseases in hematopoietic stem cell transplant (HSCT) recipients in Korea. Materials and Methods : DNA was extracted from 94 blood specimen of 52 allogeneic HSCT recipients with HCMV infection. HCMV gB genotype was determined using polymerase chain reaction to amplify a region of UL55, followed by restriction fragment length polymorphism (RFLP) analysis based on RsaI and HinfI digestion. Results : The distribution of gB types were as follows: gB1, 73.1% (38/52) of patients; gB2, 13.5% (7/52); gB3, 1.9% (1/52) and mixed infection (gB1 and gB2), 9.6% (5/52). While gB4 was not detected, a new genotype (described as gB7 by Trincado et al, 2000) was identified on the basis of their RFLP pattern. During average 708 days’ follow up period, HCMV diseases developed in 5 patients. All of them had gB1 genotype. There was no statistically significant association between the incidence of HCMV diseases and the gB genotypes. Re-infection with gB1 strain was detected in one patient who had been previously infected with gB2. This episode was associated with fever, elevated liver enzyme and positive antigenemia. Conclusion : HCMV gB1 was the dominant genotype and no gB4 was detected in allogeneic HSCT recipients in Korea, which is an unique pattern compared with the previous reports. Although we can not find significant association between the HCMV diseases and the gB genotypes, genotyping of HCMV will serve in the study of pathogenesis and transmission of this virus in transplant patients. Further study is underway with large study population.

Hydroxy Propyl Methyl Cellulose의 자연발화에 관한 연구

최재욱,목연수,하동명 한국화재소방학회 2001 한국화재소방학회논문지 Vol.15 No.4

HPM의 자연발화는 일정한 주위온도에서 자연발화의 연구와 Godbret-Greenwald가 고안한 전기로에서 운상상태의 최소발화온도를 구하였으며, 시료를 용기에 충전했을 경우 용기의 크기가 클수록 발화한계온도는 낮아졌으며, 겉보기활성화에너지는 Frank-Kamenetskii의 열발화이론으로부터 계산하였고, 운상상태의 발화온도는 21%의 산소농도하에서 최소발화온도를 구하였으며, 산소농도 변화의 실험결과 산소농도 10%에서 발화되지 않았으며 한계산소농도를 구할 수 있었다. The spontaneous ignition of hydroxypropyl methyl cellulose(HPMC) was investigated at constant ambient temperature in the oven and minimum ignition temperature of dust clouds with Godbret-Creenwald Furnace respectively, In the experiments of the vessel filled with sample, the larger the vessel was the lower the spontaneous ignition temperature and ambient temperature was calculated from the Frank-Kamenetskii thermal ignition theory, The minimum ignition temperature for the dust cloud state was found under 21% oxygen concentration. At the experiment with the change of oxygen concentration, HPMC was not ignite at 10% O2 and so the limiting oxygen concentration was obtained at 10%. Keywords : Spontaneous ignition, Ambient temperature, Minimum ignition temperature Frank-Kamenetskii thermal ignition theory

아크릴로니트릴 제조공정 중 혼합용매를 이용한 아세토니트릴 회수에 관한 연구

최성욱,장윤식,박동원 동아대학교 환경문제연구소 1998 硏究報告 Vol.21 No.2

The phase equilibria of quaternary liquid-liquid extraction system composed acetonitrile- water-o-xylene-ethylacetate mixture was investigated. The purpose of this study is to determine and describe LLE data for the quaternary system containing acetonitrile aqueous solution and solvent at 25℃. We investigated that the selection of the optimum solvent to separate acetonitrile from aqueous solution. The distribution and selectivity- for quaternary system o-xylene(l)-water(2)-acetonitrile(3)-EAc(4) are increased with addition of o-xylene. These experimental tie-line data are also compared with the values predicted by UNIFAC model. It is shown that UNIFAC model is capable of predicting the tie-line in these quaternary systems within an average root mean square deviation of 3.98 mo %.

반복 작업 근로자들에서의 경견완장애에 관한 연구

최재욱,염용태,송동빈,박종태,장성훈,최정애 大韓産業醫學會 1996 대한직업환경의학회지 Vol.8 No.2

본 연구는 근골격계 질환중에서 대표적인 질환인 경견완장애를 대상으로 일부 제조업 및 전화교환수 근로자에서의 경견완장애의 유병실태 파악, 경견완장애의 정확한 분류 및 향후 진단기준의 개발에 필요한 기초적인 자료 수집에 목적을 두었다. 조사대상은 반복동작에 폭로되는 생산직 근로자 98명, 모전화국의 전화교환수 115명을 대상으로 근골격계 증상호소, 이학적 검사 및 신경학적검사와 기타 혈중 효소등의 임상검사 및 악력의 차이 등을 조사하였다. 조사대상 사업장 중 B사업장은 전자부품을 생산하는 사업장으로, 제품 조립라인의 작업형태는 주야 2교대 근무이며, 앉아서 하는 작업과 서서하는 작업이 혼재 되어있다. A사업장은 전화교환작업, 즉 컴퓨터단말기를 취급하는 작업으로 전원 앉아서 하는 작업이며, 주야 2교대 작업이다. 조사대상 집단의 일반적 특성은 다음과 같다. A사업장 근로자의 평균 연령은 37.9세, 평균 근속년수는 17년이며, B사업장은 평균 연령 37.7세, 평균 근속년수 10.4년이었다. A 사업장은 대상 근로자 115명이 전원 여자였으며, B사업장은 대상근로자 98명 중 남자 68(69.4%)명, 여자 30(30.6%)명이었다. 조사 결과는 다음과 같다. 사업장별 자각 증상 호소율은 A 사업장의 경우 경부 85.2%, 견관절 81.7%, 주관절 34.8%, 완관절 73.0%의 순으로 특히 경부 및 견관절, 완관절의 증상 호소율이 높았으며, 반면 B 사업장은 경부 51.2%, 견관절 56.1% 주관절 23.5%, 완관절 31.3%의 순이었다. 근속년수별 자각증상 호소율은 경부와 견관절의 자각증상 호소율이 40%이상으로 주관절 및 완관절의 지각 증상 호소율에 비해서 상대적으로 높았으며, 경부와 완관절은 근속년수가 증가함에 따라 자각증상에 호소율이 통계적으로 유의하게 증가하였다. A 사업장, B 사업장 모두 최소 22.8% 이상의 근로자(증상 경험자중)가 병원이나 약국을 방문하여 치료를 받았다고 응답하였으며, 사업장 간의 차이는 보이지 않았다. 조사 대상자 전원에게 신경학적 검사와 근전도 검사를 포함한 정밀건강진단을 실시하였다. 정밀건강진단 결과 A 사업장은 질병자가 10명(8.6%), 요주의자가 31명(26.9%), 재검자가 2(1.7%)이었으며, B 사업장은 질병자가 16(16.3%), 요주의자가 12명(12.2%), 재검자 2명(2.0%)이었다. 이러한 이상자의 질병별 유형은 긴장성 경부증후군에 해당하는 사람이 46명으로 이 중 질병자는 13명, 요주의자 30명 재검자 3명이었으며, 수근관증후군은 16명으로 질병자 3명, 요주의자 8명, 재검자 5명이었다. 기타 드퀘르뱅씨병은 5명으로 질병자 4명, 요주의자 1명이었으며, 외측상과염 3명, 이두근개건염 3명, 회전근개건염 3명, 내측상과염 2명, 경추디스트증후군이 5명 등이었다. 사업장별로는 A 사업장의 경우 긴장성경부증후군이 11명, 수근관증후군이 8명, 드퀘르뱅씨병 3명, 경추디스크증후군이 1명이었으며, B 사업장은 긴장성경부증후군이 35명, 수근관증후군이 8명, 드퀘르뱅씨병 2명등의 순이었다. 이러한 결과는 A 사업장의 경우 작업 조건이 의자에 앉아서 실시하는 컴퓨터 작업인데 반하여 B 작업장은 대부분 기립작업, 반복 조립으로 이러한 작업조건에 차이에 기인하는 것으로 판단된다. 경견완장애의 이상소견과 관련이 있는 성별, 연령, 빈도 위험도 점수 및 힘 위험도를 독립변수로 설정하여 다단계 로지스틱 회귀분석을 실시하였다. 경견완장애 이상소견에 통계적으로 유의한 영향을 미친 변수는 성별(p=0.0005), 연령(p=0.0093)이었으며, 힘위험도는 p값이 0.0567, 빈도위험도는 0.0983으로 유의하지 않았다. The purpose of this study is to investigate the current status of and to collect the basic informations of musculoskeletal diseases of upper extremities in manufacturing and telecommunication companies. The subjects were 213 workers, consisted of 98 manufacturing workers and 115 telephone operators. The musculoskeletal symptom survey, job safety analysis(JSA), and medical examinations including neurologic and nerve conduction velocity(NCV) test were conducted. All workers were women in company A, while the other composed of 68(69.4%) men and 30(30.6%) women. The results were as follows: 1. The rates of self-reporting symptoms in each company were 85.2% at the neck, 81.7% at the shoulder joint, 73.0% at the wrist joint and 34.8% at the elbow joint in company A, while 56.1% at the shoulder joint, 51.2% at the neck and 23.5% at the elbow joint in company B in order. 2. No relationship was observed between the work duration and symptom rate in company A, but the highest symptom rate was observed at the neck in 10-19 year work duration group, at the shoulder, elbow and wrist joint in 5-9 year work duration group in company B. 3. Over the 22.8% of total workers in this study having symptoms got medical treatment at the medical clinics or drug stores, but there was no statistical difference between both companies. 4. In company A, 16(13.9%) workers were classified as D category, 12(10.4%) workers as C category and 2(1.7%) workers as R category among 115 workers. And D category was 10(10.2%), C category 31(31.6%) and R category 4(4.0%) among 98 workers in company B. D category means disease category needed futher treatment, C category means disease category needed no treatment and R category means recheck category needed futher evaluation. 5. The types of musculoskeletal disorders including D, C, and R category were 46 cases(D 13, C 30, R 3)of tension neck syndrome (TNS), 16 cases(D 3, C 8, R 5) of carpal tunnel syndrome (CTS), 5 cases of De Quervain's disease, 3 cases of lateral epicondylitis, 3 cases of bicipital tendinitis, 3 cases of rotator cuff tendinitis, 2 cases of medical epicondylitis, and 5 cases of cervical disc syndrome. 6. In company A, the total cases of 11 TNS, 8 CTS, 3 De Quervain's disease, 3 lateral epicondylitis, 3 rotator cuff tendinitis and 1 cervical disc syndrome were diagnosed and so were total cases of 35 TNS, 8 CTS and 4 cervical disc syndrome in company B. 7. By stepwise multiple regression analysis with dichotomization of musculoskeletal disease, the following odds ratios were significantly high(p<0.05)-sex(2.707) and age (1.926).

Toluene(1)-water(2)-2-propanol(3)-ethyl acetate(4) 4성분계의 액-액평형

최성욱,정상훈,김영일,이진우,박동원 동아대학교 공과대학부설 생산기술연구소 1998 生産技術硏究所硏究論文集 Vol.3 No.1

We studied on the phase equilibria of quatemary liquid-liquid extraction system composed 2-propanol-water-binary solvent at 25℃. Ethyl acetate(EAc)-toluene was used as binary solvents. Binodal curve, tie-line, distribution and selectivity for quatemary system have been determined in order to investigate the effect of using binary solvent in extracting 2-propanol from aqueous solotion. And this experimental tie-line data was also compared with the values predicted by UNIFAC model. It was shown that UNIFAC model is capable of predicting the tie-line in this quaternary system within an average RMSD of 1.93 mol%.

유방암의 뇌하수체 전이에 의한 양안 시력소실 1 예

최낙원,안명주,김재민,박동우,박용욱 한양대학교 의과대학 2000 한양의대 학술지 Vol.20 No.1

Pituitary gland metastasis is a rare clinical diagnosis, usually made in the setting of known primary systemic cancer with widespread metastasis to other organs. But visual loss as a presenting symptom of metastasis to the pituitary gland is unusal. We report here a case of 45-year-old woman who had been diagnosed as having metastatic breast cancer involving bone and liver 2 years ago, and received high dose chemotherapy with peripheral blood stem cell transplantation, developed sudden bilateral complete visual loss. At initial presentation, the patient had no light perception and no pupillary response to light in both eyes, but without evidence of panhypopituitarism, or diabetes insipidus. Brain MRI showed a large enhanced mass invasion to the cavernous sinus and extension to the suprasella portion without dura or base-of-skull metastasis. Pathologic examination showed metastatic breast cancer. Despite the transsphenoidal decompression surgery of metastatic tumor, the visual loss was not improved.