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.

회귀직선에서 우산형 대립가설에 대한 평행성의 점근 분포무관 검정법

김동희,임동훈 부산대학교 기초과학연구소 1995 부산대학교 기초과학연구소 연구논문집 Vol.15 No.-

우산형 대립가설에 대한 회귀직선의 평행성을 검정하는 점근 분포무관 검정법을 제안하고, 제안된 검정통계량의 점근 분포를 포함한 점근적 성질들을 연구하고자 한다. 기존의 Kim과 Lim(1994)의 검정법과의 비교 연구를 통하여 제안된 검정법이 우수함을 보였다. An asymptotically distribution-free procedure is proposed for paralelism of krefression lines aganist umbrella alternatives. Asympototic properties arediscussed, and comparative results relative to Kim and Lim(1994)'s tests show that our precedure os generally more powerful.

대두단백질 가수분해물의 특성

김동수,양승택,문윤희,류병호,김희숙,염동민,김진목 慶星大學校 1998 論文集 Vol.19 No.1

The present study was conducted to elucidate some characteristics of soy protein hydrolysates. The soy protein was obtained from defatted soy power by the treatment of n-hexan. The hydrolysates of soy protein were prepared from hydrolysis by bromelian and pepsin with the two kinds of samples of precooking for 30 min in steam oven and noncooking, and fractionated through Bio-gel P-4 column chromatography. Fractions of hydrolysates separated on the Bio-gel column chromatography were carried out to SDS-PAG electrophoresis, resulting to show some different bends from 66kD to 14.2kD of molecular weight. In addition, the fractions showed different activities of superoxide dismutase. From these results, it was found that the hydrolysates could be available to use in a lot of food industrial fields as new functional food materials because the hydrolysates had different characteristics in electrophoresis and could increase the activity of superoxide dismutase.

선택적 후근절제술의 수술중 근전도 감시방법과 치료효과

김형일,김연희,김완호,김근수,김동찬 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.10

Selective posterior rhizotomy(SPR) has been known to reduce the spasticity as well as to improve the quality of life in patients with intractable spasticity. Twenty patients underwent SPR under intraoperative electrophysiological monitoring(IOM). Fifty-two percent of sacrolumbar rootlet were cut after electrical stimulation. Eighteen patients(90%) with spastic type of cerebral palsy showed marked reduction of spasticity and functional improvement without any complication. The patients who did not respond to SRP had mixed types of spasticity. IOM facilitate the selection of pathological rootlets regardless of anaesthetic level. intensity of electrical stimulation, and individual variability of responses. It is concluded that careful selection of surgical candidates and of pathological rootlets under IOM are important to reduce the spasticity. thereby to obtain a better outcome.

간질환자의 간질 관련 외상

오동호,박운규,이영주,김희태,김승현,김주한,김명호,신동진 대한신경과학회 1998 대한신경과학회지 Vol.16 No.4

신경섬유종증-제 2형의 진단과 치료 : 16례의 임상경험 Experience of 16 Cases

김정은,백선하,김종수,이상형,오창완,김동규,정희원,김현집,조병규,한대희,최길수 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.12

Neurofibromatosis type 2(NF-2) is a dominantly inherited disorder characterized by the occurrence of bilateral acoustic neurinomas and the frequent association of other central nervous system tumors. We present a retrospective review of 16 patients with NF-2 who were treated at our hospital from 1984 to 1995 in 13 cases, the diagnoses of Nf-2 were based on the criteria developed at the Consensus Development Conference of National Institute of Health in the United States, and in another 3 cases. the criterias of NF-2 were not fully satisfied, but the diagnoses of NF-2 were highly suspected. The average age of the patients was 27.6 years, ranging from 13 years to 56 years. The most common symptom was hearing difficulty : intervals between symptom onset and deafness ranged from 8 months to 6 years(mean : 2.9 years) One family of NF-2 was documented consisting of a sister a brother and their mother. Nine patients underwent operations on unilateral acoustic neurinomas : these were subtotally removed in eight patients and totally in one patient Among these patients five were deaf on the ipsilateral side at surgery. Among the other four patients with useful hearing before surgery, hearing was preserved to preoperative status in two patients. Four patients with diagnoses of meningioma, received operations to relieve mass effect with subtotal removal in two patients and total removal in the other two. Early diagnosis and treatment are the most important in the management planning of patients with NF-2 for reasons of early manifestation and rapid progression of the disease.

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.

설사와 산혈증에 의한 신생아 메트헤모글로빈혈증 2례

김두권,김영진,김기호,고희신,김우택,최성민,이동석,권경배 東國大學校 醫學硏究所 1995 東國醫學 Vol.3 No.-

메트헤모글로빈혈증은 환원 효소계 결핍이나 환원되지 않은 비정상 메트헤모글로빈을 가지는 선천성 질환 및 후천성 산화성 물질이나 약제에 노출될 때 생기게 되나, 신생아에서는 산화성 물질에의 감수성이 높은 동시에 환원효소의 활성이 낮으므로 산화성 물질에의 노출이 없이 설사, 산혈증 및 감염증 등에 의해서 일시적 메트헤모글로빈혈증이 일어날 수 있다. 저자들은 발열과 심한 설사 및 청색증을 주소로 내원한 생후 18일, 생후 19일된 남아 2례에서 메트헤모글로빈 혈증을 경험하였기에 문헌고찰과 함께 보고하는 바이다. Methemoglobinemia is characterized by generalized cyanosis without cardiac and pulmonary diseases. Methemoglobin, yielded by oxidation of hemoglobin iron to the ferric state, is nonfunctional and imparts a chocolate hue to the blood. The blood of normal healthy persons contains methemoglobin, but the intraerythrocytic methemoglobin-reducing system maintains its concentration less than 2% of the total hemoglobin. Methemoglobinemia is caused by the inherited disorders of methemoglobin metabolism and the accidental ingestion of oxidizing agents and infection. Fetal hemoglobin has increased susceptability to oxidation NADH diaphorase activity is reduced to 60% of adult levels in newborn erythrocytes. Acute diarrhea and acidosis further reduce the activity of the enzyme. We experienced two cases of methemoglobinemia due to acute diarrhea and metabolic acidosis who were admitted to the department of pediatrics at Dong-Guk University Hospital. No history of toxin exposure could be elicited. Case 1 concerns a 19-day-old male neonate who had irritability, fever, cyanosis, tachypnea, severe diarrhea, mild metabolic acidosis and grunting without cardiac and pulmonary diseases. On the day of admission, methemoglobin level was 52.3% of the total hemoglobin. After the treatment with methylene blue which was purified by 0.45㎛ of Nalgene syringe filter(Nalge Co.), its level was decreased to 6% of the total hemoglobin, and then it reached a normal level at the 5th day after admission. Case 2 concerns a 18-day-old male neonate who had fever, diarrhea, mild metabolic acidosis and cyanosis around lips without cardiac and pulmonary diseases. At admission, his level of methemoglobin was 25.3% of the total hemoglobin. After twice injection of methylene blue its level was decreased to 4.4% of the total hemoglobin, and then it reached 1.3% of the total hemoglobin at the 7th day after admission. So, we report it with a brief review of relevant literatures.

BaFBr:Eu²+,Na+ 영상판 제작과 특성

김찬중,김성환,이병화,김완,강희동,김도성,서효진,도시홍 경북대학교 센서기술연구소 2002 센서技術學術大會論文集 Vol.13 No.1

알쯔하이머형 치매와 혈관성 치매환자에서의 ALDH2와 APOE 유전자의 다형성에 관한 연구

김동홍,김영돈,이창화,엄기춘,김은식,윤경식,김동희 대한생물치료정신의학회 2002 생물치료정신의학 Vol.8 No.2

연구목적: 본 연구는 국내 치매환자들을 대상으로 치매발병의 위험요소가 될 수있는 ALDH2와 APOE 유전자형이 어떤 양상으로 나타나는지 알아보기 위하여 시행되었다. 방 법: 충남 부여군에 위치한 부여노인병원에 입원중인 65세 이상의 알쯔하이머형 치매와 혈관성 또는 혼재성 치매환자 59명(남:19, 녀:40)을 대상으로 ALDH2와 APOE 유전자형을 제한효소법에 의하여 조사하였고 치매유형에 따른 유전자형과 대립유전자의 빈도를 비교하였다. 결 과: 1) 알쯔하이머형 치매환자군에서 혈관성 또는 혼재성 치매환자군보다 ALDH2*(-/2)유전자형의 빈도가 높았으나 통계학적으로 의미있는 차이는 없었다. 2) 알쯔하이머형 치매화자군에서 혈관성 또는 혼재성 치매환자군보다 APOE*(-/ε4) 유전자형의 빈도가 높았으나 통계학적으로 의미있는 차이는 없었다. 3) APOE*ε4와 ALDH2*2를 알쯔하이머병의 균등한 위험대립유전자로 가정하고 각 유전자형의 대립유전자의 수를 점수화하여 각 치매환자군의 위험유전자 전체점수를 비교한 결과 알쯔하이머형 치매환자군에서 점수가 더 높게 나왔으나 통계학적으로 의미있는 차이는 없었다. 결 론: 알쯔하이머형 치매환자군에서 혈관성 또는 혼재성치매치매환자군보다 ALDH2*2와 APOE*ε4 대립유전자의 빈도가 높게 나왔으나 통계학적으로 의미있는 차이는 없었다. A study on gene polymorphism of ALDH2 and APOE in patients with alzheimer's disease and vascular or mixed dementia. Objective : This study was designed to investigate gene polymorphism of ALDH2 and APOE, reported the risk factor of Alzheimer's disease, in korean dementia patients. Method : 59 Patients(male:19, female:40) with dementia, aged 65 and older in Buyeo geriatric hospital located in Buyeo-gun, chungnam, were finally included in this study. gene polymorphism of ALDH2 and APOE was typed with polymerase chain reaction in patients with Alzheimer's desease and vascular or mixed dementia. Results : 1) There was no difference in allelic frequency of ALDH2 gene polymorphism between patients with Alzheimer's disease and vascular or mixed dementia. 2) There was no difference in allelic frequency of APOE gene polymorphism between patients with Alzheimer's disease and vascular or mixed dementia. 3) Supposing APOE*ε4 and ALDH2*2 were equal risk allele of Alzheimer's disease, the sum of score by counting each risk allele was higher in patients with Alzheimer's disease than vascular mixed dementia, however there was no significant difference. Conclusion : The genotype frequency of ALDH2*(-/2) and APOE*(-/ε4) was higher in patients with Alsheimer's disease than vascular or mixed dementia, however there was no significant difference in allelic frequency of gene polymorphism of ALDH2 and APOE between patients with Alzheimer's disease and vascular or mixed dementia.