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.

투고논문 : 청천(靑泉) 신유한(申維翰) 한시(漢詩)의 『초사(楚辭)』 수용양상(受用樣相)

최유진 ( Yoo Jin Choi ) 동방한문학회 2007 東方漢文學 Vol.0 No.33

본 논문은 18세기 전반에 활동한 중인층 문인인 靑泉 申維翰(1681~1752)의 의고주의 한시창작의 일환으로서 『楚辭』의 학습과 수용양상을 살피는 것을 목표로 하였다. 신유한은 先秦古文에 대한 애호에서 나아가 그것들의 문학적 가치와 수사적 탁월함의 인식을 기반으로 이를 詩文에 적극적으로 도입하려 하였다. 그는 『詩經』 이후에 정감의 진솔한 표현을 실현하고 계승한 것이 『楚辭』라 하여 그 가치를 인정하였는데, 이는 난초와 佩玉 등에 가탁하여 시인의 울결된 감정을 기탁하고 시적으로 형상화하여 詩道를 완전히 구현한 것이라는 인식에서 비롯된 것이다. 또한 『楚辭』에 쓰인 수사법을 사물에 감정을 가탁하는 수법(實中有虛)과 가설적 수법(虛中有實)로 나누어 분석하고, 시인의 내면에 있는 감정과 의지가 그것을 표상하는 사물과 상황의 설정을 통해 표현되고 있다고 보았다. 한편 신유한 한시의 실제 시작에 있어서 의고주의적 태도가 『楚辭』 등에 나타난 전통적 상징을 수용하면서도 그것이 개인적 상징체계로 변용되는 양상을 고찰하였다. 신유한 한시에 높은 빈도로 등장하며 중요한 의미를 지니는 상징들을 검출하여 분석한 바, 龍과 봉황 등은 주로 자신의 불우한 처지와 관련된 의미를 내포하고 난초, 계수나무 등은 자신의 고결한 인격의 표상으로써 작용하고 있음을 보았다. 아울러 『초사』에 담긴 道家的·遊仙的 사상과 모티브가 그의 한시에 어떠한 양상으로 도입되었는지를 살펴보았는데, 기질적으로 중국 고대 남방문화권과 친연성을 보이면서도 완전히 신선적 사상으로 경도되지 않고 현실참여적인 태도에서 벗어나지 않음을 알 수 있었다. The purpose of this manuscript is to study a receptive aspect and learning of the Chu-Ci as a part of writing of Chinese poetry with pseudo-archaism [擬古主義] by Shin Yoo-Han who was active as a literary man of the middle class in the first half of the 18th century. He intended actively to introduce something to have been based on their value of literature and recognition of a rhetorical excellence as well as loving of Pre-Qin archaic texts[先秦古文] into poetry and prose. Following the Shih-Ching[詩經], he recognized the value of the Chu-Ci as it realized and succeeded a true expression with sentiment. This came from recognition that it made an orchid or a jade commit the care of a poet`s sentiment with a depressed mood what expresses thought or feeling through things, and it embodied a poetic ideal to be of imagery with poetry. Also, it analyzed to divide a rhetorical method which was written in the Chu-Ci into Expression of feeling through things[實中有虛] and Expression of supposition[虛中有實]. It found that the poet`s inner sentiment and will would be expressed through setting of situation and things which symbolized it. On the other hand, in an actual poem writing of his Chinese poetry it considered such aspects that his attitude of pseudo-archaism was diverted it into a personal symbolic system as well as accepting a traditional symbol appeared on the Chu-Ci. This manuscript analyzed the symbols with a significant meaning and a high frequent appearance on his Chinese poetry, so that it found that the dragon and a Chinese phoenix have a meaning related to himself who was in adverse circumstances and the orchid and a cinnamon tree was worked as a representation of himself own noble-mindedness. Besides, it studied that motive and thought of Taoism which was contained within the Chu-Ci was introduced into his poetry with any aspect. Thesis found that he was of a friendly disposition to Southern cultural area in Chinese ancient history, however he did not devote himself to a perfect Taoism and also he did not escape from himself own attitude of participation in reality.

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.

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.

박종홍의 한국불교 이해

최유진 경남대학교 인문과학연구소 2000 人文論叢 Vol.13 No.-

국내 혈액질환 환자에서 침습성 진균 감염의 구제치료로서 Caspofungin의 효과와 안전성

최수미,박선희,이동건,최정현,유진홍,민우성,신완식,김춘추 대한감염학회 2005 감염과 화학요법 Vol.37 No.5

목적 : 본 연구에서는 국내 혈액질환 환자들에서 일차 항진균제를 부작용으로 인해 투여할 수 없거나, 일차 항진균제에 반응이 없는 침습성 진균 감염증의 구제치료로서 caspofungin의 효과와 이상반응에 대한 임상 경험을 소개하고, 예후인자를 분석해 보았다. 재료 및 방법 : Caspofungin은 첫날 70 mg, 이틀째 부터 50 mg을 하루 일회 투여하였고, caspofungin 종료시 그리고 종료 4주 후 반응을 평가하였다. 결과 : 총 55명의 환자가 분석에 포함되었고, 남자 32명, 여자 23명, 평균 나이는 38.2세(16-65세)였다. 기저 질환은 급성 백혈병 33명, 골수이형성 증후군 12명, 만성 백혈병 3명, 기타 7명이었다. 진균 감염은 확진 1명, 가능 5명, 추정 47명, 불확실 2명이었고, 감염 장소는 폐를 침범한 경우가 49명, 파종감염 6명이었다. 전체적으로 41.8% 환자에서 양호한 반응을 보였으며, 치료군, 치료후 기저질환의 상태, 침습성 진균 감염 진단시 호중구 감소증 여부, 스테로이드 등 면역억제제 사용 여부가 유의한 예후인자였다. 약제관련 이상반응은 14.5%에서 관찰되었고, 발열, 피부 발진, 간기능 저하 등으로 나타났다. 이중 4명에서 이상반응과 관련하여 투약을 중지하였고, 약제 중단 후 증상은 모두 호전되었다. Caspofungin 관련 신독성은 관찰되지 않았다. 결론 : Caspofungin은 국내 혈액질환 환자에서 침습성 진균 감염증의 구제치료에 효과적으로 안전하게 사용될 수 있겠다. 최근 여러 항진균제들이 개발되어 임상에 도입되고 있는 바, 항진균 작용 범위, 독성, 약역동학적 특성, 비용-효과면 등을 고려하여 환자별로 직절한 항진균제를 선택하도록 해야 할 것이다. Background : Invasive fungal infection (IFI) is an important cause of morbidity and mortality in patients with hematologic malignancy. Patients with IFI who fail to standard therapy have poor prognoses. We investigated the efficacy and safety of caspofungin (CAS) in Korean adults with hematologic diseases and IFI who did not respond to the conventional antifungal therapy. Materials and Methods : Patients with IFI refractory or intolerant to standard antifungal therapy received CAS 50 mg IV daily after 70 mg loading dose on day 1. Efficacy and safety of CAS were assessed in patients who received more than one dose. Favorable response [complete (CR) or partial (PR)] was defined as significant improvement of all clinical symptoms, signs, and radiologic abnormalities. Results : From Feb. 2004 to Feb. 2005, 55 patients who met the inclusion criteria were enrolled. There were 32 male and 23 female patients with mean age of 38.2 years (range, 16-65). Underlying diseases were acute leukemia (33 cases), myelodysplastic syndrome (12 cases), chronic myelogenous leukemia (3 cases), and other hematologic diseases (7 cases). Thirty-six patients were receiving chemotherapy and 13 patients were under hematopoietic stem cell transplantation (HSCT). The number of proven, probable, possible, and indeterminate IFI cases was 1, 5, 47, and 2, respectively. Conventional amphotericin B, intravenous itraconazole, and liposomal amphotericin B were administered for average of 14.9 days prior to administering CAS. Mean duration of CAS therapy was 12.8 days (range, 1-45). Twenty-three patients (41.8%) showed favorable responses (CR : PR=8 : 15) at the end of CAS therapy. Chemotherapy group, neutropenic state, remitted state of underlying disease, and no steroid therapy were significant prognostic factors for favorable response. Eight (14.5%) patients developed drug-related adverse events such as fever, skin eruption, and hepatic dysfunction which were reversible after discontinuation of CAS. Drug-related nephrotoxicity was not observed. Conclusion : On the basis of our investigation, CAS was effective and safe as a salvage therapy of refractory IFI or as an alternative for patients intolerant to standard antifungal agents.

혈액질환 환자에서 조혈모세포 이식과 화학요법 후의 침습성 진균감염의 분석

유진홍,최정현,이동건,최수미,신완식,김춘추 대한감염학회 2004 감염과 화학요법 Vol.36 No.1

목적 : 조혈모세포 이식이나 화학요법을 받은 혈액질환 환자에서 침습성 진균감염의 양상을 분석하고 예후 인자를 정하기 위하여 이 연구를 실시하였다. 방법 : 2000년 3월부터 2001년 2월까지 가톨릭 조혈모세포이식센터에 입원한 318명의 환자들 중 진균 감염으로 의심되어 항진균제를 투여받은 122명의 환자를 대상으로 후향적 분석을 실시하였다. 결과 : 74명의 환자가 EORTC/MSG 기준에 의해 침습성 진균증으로 판정되었다. 이들 중 6명이 확진이었고, 46명이 추정, 22명이 가능 증례이었다. 가장 많이 침습된 장기는 하부 호흡기이었다(72/74). 사망률은 32.4%이었다. 단변량 분석으로 예후 인자를 도출한 결과 입원 기간, 진단까지 걸린 시일, 그리고 amphotericin B의 총 투여량이 유의한 인자로 나왔다. 그러나 다변량 분석을 시행한 결과 입원 기간만이 독립적으로 유의하게 영향을 미치는 예후 인자로 산출되었다. 결론 : 침습성 진균 감염은 현재도 조혈모세포 이식이나 화학요법 후의 중요한 합병증으로 작용하고 있음을 알 수 있었다. 진균 감염 합병증의 예후에 영향을 미치는 요소로 입원 기간이외에 진단의 신속성과 항진균제의 투여도 유의한지에 대해서는 후속 연구를 통해 재치 규명해야 할 것으로 생각된다. Background : Invasive fungal infections (IFI) are one type of representing total infections in compromised patients. To analyze the characteristics and to determine the prognostic factors of IFI in patients with hematologic diseases undergoing hematopoietic stem cell transplantation (HSCT) and/or chemotherapy. Methods : We retrospectively reviewed consecutive patients (n=122) who received antifungal treatment with the impression of fungal infection complicating post-HSCT or chemotherapy from March-2000 to February-2001. Results : Seventy-four out of 122 registered patients belonged to the IFI on the basis of EORTC/MSG criteria. Six patients were proven IFI, 46 were probable, and 22 were in the category of possible one. The most commonly involved organ was lower respiratory tract (72/74). The mortality was 32.4%. Univariate analysis revealed duration of hospitalization, days to diagnosis of IFI, and total amount of amphotericin B as significant prognostic factors. But multivariate analysis determined only duration of hospitalization from these variables as an independently influencing factor on the prognosis. Conclusion : Invasive fungal infection is still the major threatening complication of HSCT and chemotherapy. Further follow-up and extension of this study is necessary to elucidate more prognostic factors.

관상동맥협착증에 있어서 관상동맥우회술의 치료효과

유영선,박진상,최세영,박창권,이광숙 啓明大學校 醫科大學 1994 계명의대학술지 Vol.13 No.4

Sixty-one patients with coronary artery stenosis underwent coronary artery bypass grafting from February 1986 to September 1993 at the department of Thoracic and Cardiovascular Surgery. There were 41 men and 20 women with a mean age of 54 years(range, 25 to 79 years). History of myocardial infarction was noted in 17 patients(28%). Twenty-eight patients(46%) had single-vessel disease, 24 patients(39%) had double-vessel disease and 9 patients(15%) had triple-vessel disease. The left main disease was in 4 patients(7%). Single aorta-coronary grafts were placed in 37 patients(60%), double or more grafts in 24 patients(40%). An average of 1.4 grafts were performed per patient. Saphenous vein grafts were employed in 49 patients(80%), and the internal mammary grafts, which were anastomosed to left anterior descending artery in 23 patients(38%). The mean bypass time was 135 minutes and cross-clamp time was 45 minutes. Early mortality was 16.4% (10 patients). Perioperative myocardial infarction was the most common complication, followed by atrial arrhythmia, wound infection, bleeding, pneumonia, pneumothorax. The 51 survivors were followed-up for 1 to 72 months, averaging 31 months. Ninety-five percent of the survivors were in New York Heart Association class I or Ⅱ postoperatively. There was one late death. Poor ejection fraction was significantly associated with hospital death(p<0.05).

해안서식 어패류 중 유해중금속 함량에 관한 연구 (Ⅰ)

유영찬,정진일,박유신,이종숙,인상환,최동기,김동우 內務部 國立科學搜査硏究所 2002 國立 科學 搜査 硏究所 年報 Vol.34 No.-