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.

아시아-태평양 지역의 이주와 트랜스내셔널리즘 해외입양인 내러티브에 나타난 침묵된 이주와 죽음의 이미지〈여행자〉와 〈귀향〉을 중심으로

최유진 ( Yoo Jin Choi ) 국제비교한국학회 2010 비교한국학 Comparative Korean Studies Vol.18 No.3

The objective of this article is to examine the silent migration and the images of death reflected in Korean adoptees` narratives, specifically in the recently released movies, Ounie Lecomte`s A Brand New Life (2009) and Sun-kyoung Ahn`s A Blind River (2009). This study is interdisciplinary in that it combines the historical and social context of international adoption in Korea and Avery F. Gordon`s theoretical meditation on haunting and the appearance of the ghost. The notion of the past that haunts the present can affect inquiry into the economic and political system of Korea which exerted on practices of social disappearance by sending their children out by overseas adoption, the consequence of which comes as the returning of the dead, the ghost of the past or the adopted Koreans from overseas. The history that constituted the silent migration uprooted the children out of their motherland, doffed their Korean?ness, and made them disappear from the birth country. The study is divided into four sections. The first section briefly introduces the history of international adoption in Korea and Gordon`s arguments on the socio-political/socio-cultural significance of the ghost. The second section offers the cinematic representations of an adopted Korean, Jin-hee, in A Brand New Lif-the movie portrays Korea in the 1970s, together with the fragmented pieces of memory of the Korean War, the period where the international adoption first broke out-and it analyzes the images of death through the process of uprootedness from her birth country to her silent migration to France. The third section engages with the issue of birth mothers and the returning of Korean adoptees by presenting the narratives of Sung-chan`s and So-yeon`s one by one, step by step in A Blind River. The movie deals with the period from the mid-1970s to the present, which excavates silent migration and epitomizes the images of death, that continues the circulation of han, the grudge in Korean history.

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.

박종홍의 한국불교 이해

최유진 경남대학교 인문과학연구소 2000 인문논총 Vol.13 No.-

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.

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.-

Starter 및 멸치액젓 첨가가 김치양념 및 겉절이 김치의 품질에 미치는 영향

최택권,박소희,유진현,임호수,조재선,황성연 한국식생활문화학회 2003 한국식생활문화학회지 Vol.18 No.2

양념에 Leu. mesenteroides, Lac plantarum의 젖산균과 멸치액젓 첨가가 김치 양념의 대장균군 제어, 속성촉진여부 및 관능적 특성에 미치는 영향을 조사하였다. Leu. mesenteroides과 젓갈을 첨가한 경우 초기 숙성이 촉진되나 후기 산패는 완만하였으며 Lac. plantarum의 첨가시에는 초기 숙성에는 큰 차이가 없고 후기 산패가 현저하게 진행되었다. 대장균군은 산도 0.80% 이상에서 사멸되었는데 leu. mesenteroides의 경우가 숙성이 촉진되어 보다 신속히 사멸시켰다. 총균수와 젖산균수는 초기에 starter 첨가구는 10^6CFU/mL 정도인데 반해서 starter를 첨가하지 않은 않은 처리구에서 총균수는 10^6CFU/mL , 젖산균수가 10^4CFU/mL 이었고 숙성 후에는 첨가균이 높은 수준을 유지하였다. 하지만 대체적으로 스타터의 첨가가 숙성 및 대장균에 크게 영향을 주지 못하는 경향으로 동일하게 나왔다. 관능적 특성에서는 Leu. mesenteroides 첨가구가 Lac. plantarum의 경우보다 우수하였다. 한편, 시판 겉절이 김치는 산도가 0.09~0.18%, ph 5.46~5.89, 총균수 2.2×10^6~3.1×10^7CFU/mL, 젖산균수는 2.1×10^4~6.6×10^5CFU/mL, 대장균수는 1.8×10^4~7.1×10^5CFU/mL, 염분 1.89%~2.51%으로 스타터 첨가 겉절이에 비해 ph와 염도를 제외한 품질 특성에서 전반적으로 낮은 값을 나타냈다. This study was performed in order to investigate the effect of Leuconostoc mesenteroides, Lactobacillus plantarum and salt fermented anchovy extracts on Kimchi sauce. The sauce was fermented more rapidly by addition of Leu. mesenteroids or salt fermented anchovy extracts on the early fermentation stage than the control, but it was fermented slowly on the late fermentation stage. When L. plantarum was added to the Kimchi on the early fermentation stage, the acidity of Kimchi didn't show a significant difference from the control, but acidity was remarkably increased on the late stage. Coliform group was disappeared when acidity of sauce was higher than 0.8% during fermentation. It was controlled by Leu. mesenteroides but not by L. plantarum. Total count and lactic acid bacterial count of the sauces with starter were 6.30×10^6~1.0×10^7 CFU/mL and 1.04~2.04×10^6 CFU/mL, respectively, but those of the control sauce were 10^6 CFU/mL and 10^4 CFU/mL, respectively. Those count of the sauce with starter were higher than those of the control sauce on the later stage of fermentation. Organoleptic quality of the sauce with Leu. mesenteroides was superior to that with L. plantarum.

Characterization of a Constitutive β-Lactamase from a Pseudomonas aeruginosa

유진홍,허동호,최정현,김양리,신원식,강문원 대한화학요법학회 1996 대한화학요법학회지 Vol.14 No.2

Objective : We analyzed some physicochermical chracteristics of a constitutive β-lactamase from a clinical isolate of a Pseudomonas aeruginosa which resistant to various β-lactams except imipenem and susceptible to aminoglycosides the proportion of its contribution to such resistance profile. Method : 1. Antimicrobial susceptibility test was done by the broth dilution method. 2. In hibition profile was done using EDTA, HgCl₂ and p-chloromercuribenzoate (pCMB). We also measured 50% inhibitory concentration(IC??) using β-lactamase inhibitors, such as clavulanic acid, sulbactam. 3. Kinetics study for substrate profile was performed by spectrophotometric assay using crude extracts and various antimicrobial agents. Relative hydropysis rates were determined. 4. The isoelectric point(pI) was determined by isoelectric focusing. The molecular weight was estimated by SDS-polycrylamide gel electrophoresis. Results : 1. The strain was resistant to ceftriaxone, sulperazon, piperacillin, ceftazidime, and aztreonam, while it was susceptible to gontamicin, tobramycin, amikacin and imipenem. 2. The β-lactamase was not inhibited by EDTA, and pCMB, whereas it was inhibited by HgCI₂. The IC?? of clavulanic acid was over 100μM and that of sulbactam was 22μM. 3. The relative maximal hydrolysis rate was calculated by setting V_(max) for cephaloridine at 100. The enzyme hydrolyzed cephalosporins more rapidly than penicillins. 4. The pI was 9.3 by isoelectric focusing. The molecular weight was estimated to be 40kDa. Conclusion : According to its substrate profile, pI and molecular weight, the β-lactamase from a clinical isolate of P. aeruginosa was a cephalosporinase belonging to group 1 in the Bush-Jacoby-Medeiros classification scheme.

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).