• Journal of Oral Medicine and Pain
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• 제37권3호
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• pp.147-154
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• 2012

조혈줄기세포이식은 면역 결핍 질환, 자가 면역 질환, 악성 조혈 종양의 주된 치료법이다. 이종 조혈줄기세포이식의 주요한 합병증은 이식편대 숙주질환이다. 구강 점막 생검은 이식편대 숙주 질환의 확진과 치료계획 수립을 위해 필요하나 영양 결핍과 화학 요법으로 인해 전신상태가 불량한 환자에게 출혈과 균혈증을 일으킨다. 본 논문에서는 레이저를 이용한 최소 침습적 조직생검의 효능을 평가하였다. 모두 3개의 증례가 소개되었고 모든 환자의 의료 기록, 임상 사진, 조직병리학적 결과가 레이저를 이용한 조직생검의 효능을 평가하기 위해 검토되었다. 모든 환자는 생검 후 불편감이 없었고 심각한 합병증이 발생하지 않았다. 생검 조직의 질이 이식편대 숙주 질환을 확진하는 데에 적당했다. 구강 점막의 레이저를 이용한 최소 침습적 생검은 통상의 조직병리학적 생검에 비해 출혈을 일으키지 않아 감염과 균혈증, 술 후 흉터 생성을 줄이므로 이식편대 숙주 질환의 확진에 이로울 것이다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제27권1호
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• pp.87-91
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• 2001

On patients with disorder of hematopoiesis such as leukemia, aplastic anemia, MDS(Myelodisplastic Syndromes), removal of infectious foci prior to the BMT(Bone Marrow Transplantation) is a necessity and what is more, there is no sufficient time to control the infections because the chemotherapy for BMT should be started as soon as possible. And the transfusion should be minimized to prevent the alloimmunization. In those reasons, oral & maxillofacial surgeons are often in need of multiple extractions, and should take into consideration the possibility of complications after multiples extractions such as infection, severe bleeding because those situations can be fatal on patients with disorder of hematopoiesis. We present our experience in multiple extractions on 30 patients with disorder of hematopoiesis referred from Catholic Hematopoiesis Stem Cell transplantation Center at St. Mary's Hospital, The Catholic University of Korea.

• 기본간호학회지
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• 제13권3호
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• pp.437-446
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• 2006

Purpose: This study was done to identify the level of stress, coping, and depression among hemopoietic stem cell transplantation patients who received care in an outpatient center. Method: Data were collected from 81 patients who underwent hemopoietic stem cell transplantation at C University S Hospital between August 2005 and February 2006. Results: Stress and depression were significantly higher following hemopoietic stem cell transplantation in women, and in patients who were worse off financially or who were in bad health. The highest item of stress was 'economic burden for treatment'. There were significantly higher levels of emotion-focused coping among patients who had a spouse and who received motivation from the doctor. The highest item for problem-focused coping was 'try to look at the bright side of life'. The highest items for emotion-focused coping were to 'have faith that treatment will be finished quickly' and 'believe that your situation will improve'. Stress was significantly correlated with depression among these patients. Conclusion: It is necessary to develop nursing interventions to enhance positive coping and to decrease stress and depression among patients who have a hemopoietic stem cell transplantation.

• 종양간호연구
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• 제8권1호
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• pp.40-49
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• 2008

Purpose: This descriptive study was to investigate the quality of life in patients with hematopoietic stem cell transplantation (HSCT) from June 1 to October 13, 2007. Method: The survey was conducted in 6 different university hospitals which located in Seoul and Jeollanam-do province using the Functional Assessment of Cancer Therapy-BMT Scale (FACT-BMT) version 4. We collected a total of 155 questionnaires and analyzed 149 among them. Results: The average score of quality of life was 2.53 out of 5. Physical well being score was highest among sub-domains, followed by emotional well-being, additional concerns, social/family well-being, and functional well-being. Study subjects worried that their conditions would get worse. However study subjects didn't regret having been received HSCT. Age, duration from HSCT, age at diagnosis, income, readmission, HSCT type, educational background, marital status, and the level of activities of daily living were related to quality of life. Conclusions: The findings of this study indicates that the HSCT survivor's quality of life issue is still important and have to be investigated repeatedly in the future. That is necessary for generalizing QOL outcomes for clinical use. We also suggest to develop interventions to improve QOL.

• 대한간호학회지
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• 제44권5호
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• pp.542-551
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• 2014

Purpose: This study was done to examine the incidence of oral mucositis in hematopoietic stem cell transplantation patients and to identify factors influencing oral mucositis and patient outcomes according to severity. Methods: In this retrospective study, data were collected from electronic medical records of 222 patients who had received hematopoietic stem cell transplantation. Oral mucositis was evaluated using WHO's assessment scale. Data were analyzed using Chi-square test, Fisher exact test, Spearman's correlation, Ordinal logistic regression, ANOVA and Kruskal-Wallis test. Results: A total of 69.8% of the patients evaluated developed oral mucositis (grade II and over). As a results of ordinal regression, factors influencing oral mucositis severity were found to be diagnosis, type of transplantation, oxygen inhalation and the number of antiemetics administration before transplantation. The severity of oral mucositis was found to increase the days of hospitalization, days of TPN administration, days of using antibiotics and the number and dosage of analgesics. Conclusion: The results would help predict severity of oral mucositis in hematopoietic stem cell transplantation patients and suggest that provision of appropriate nursing assessment and oral care would improve patient outcomes.

• 생물치료정신의학
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• 제24권3호
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• pp.142-155
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• 2018

Insomnia in patients with hematopoietic stem cell transplantation(HSCT) has been underdiagnosed and undertreated. This study reviewed the frequency, characteristics, physical and psychological effects, and treatments of insomnia in HSCT patients to highlight clinical importance in this specialized population. Furthermore, the authors intended to suggest a model that would conceptualize insomnia in the context of HSCT. In the pre-transplant period, about half of patients with HSCT suffered from sleep disturbance. A substantial number of patients experienced distressing insomnia during the HSCT procedure and recovered to the level of the pre-transplant period. However, sleep disruption could be a chronic symptom in HSCT survivors and could negatively impact quality of control, cancer-related fatigue(CRF), immune function, and psychological distress. The 3P's model(Predisposing, Precipitating, Perpetuating) explains insomnia in cancer population and could be also relevant to HSCT patients with specific consideration of CRF, graft-versus-host diseases, specific properties of hematological disease, and protective isolated milieu. Effective treatment of insomnia in HSCT includes non-pharmacological(e.g., cognitive behavioral therapy, environmental modification) and pharmacological interventions. The decision of pharmacological treatment should be based on the issue of safety due to high risk of potential drug-drug interactions. Screening, treatment, and further research of insomnia in HSCT patients using validated subjective and/or objective measures are warranted.

• 대한유전성대사질환학회지
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• 제24권1호
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• pp.10-16
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• 2024

선천성 당화장애(CDG)는 당화 과정의 결함으로 인해 발생하는 다양한 유전 대사 장애 질환을 포함한다. 당화는 단백질 접힘, 안정성 및 세포 간 신호전달에 필수적인 생화학적 과정이다. CDG는 1980년대에 처음 발견된 이후로 분자생물학과 유전학의 발전에 따라 현재까지 163개의 아형이 발견되었고 트랜스페린 등전점 전기영동이 선별검사로 사용되고 있으며 유전학적 진단기법의 발달로 CDG의 진단이 확연히 늘었으며, 다양한 선천성 당화장애의 결함에 대한 진단 기법이 연구되고 있다. CDG의 치료는 주로 대증요법에 의존하며, 일부 아형에서 단당류, 망간, 우라신, 피리독신 등의 경구 보충요법과 간 이식, 조혈모세포 이식이 사용되고 있으며 약리학적 샤페론, 유전자 치료, 그리고 약물 재배치 연구가 진행되고 있다. CDG 환자들의 진단과 치료에 대한 지속적인 연구와 협력이 필요하다.

• Clinical and Experimental Pediatrics
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• 제52권10호
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• pp.1153-1160
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• 2009

목 적:최근 다양한 치료 방법의 발전과 지지요법의 발달로, 소아 종양/혈액 질환 환자의 생존율이 향상되었으나, 적극적이고 다양한 치료를 하게 되면서 이와 관련된 여러 합병증으로 소아 중환자실에 입실하는 경우 또한 많아졌다. 이에 본 연구에서는 소아 중환자실에 입실한 소아 종양/혈액 질환 환자의 임상양상과 사망률을 살펴보고, 소아 종양/혈액 질환 환자에게 적합한 중증도 측정 체계와 사망률에 영향을 미치는 위험 요인에 대해 알아보고자 했다. 방 법:2005년 9월부터 2008년 7월까지 서울아산병원 소아 중환자실에 입실한 소아 종양/혈액 질환 환자 중 3일 이상 재실한 환자를 대상으로 후향적으로 의무기록을 조사했다. 생존군과 비생존군으로 나누어 나이, 성별, 재실 일수에 대하여 조사했고, 기저 질환과 중환자실 입원 이유, 인공호흡기 적용 여부, 투석 및 승압제 투여 여부, CRP 및 ANC에 따른 사망률을 알아보았다. 또, 생존군과 비생존군의 OSF number, SOFA score, PRISM III score, O-PRISM score를 비교하고, 점수에 따른 사망률을 알아보았다. 결 과:총 88예 중 30예가 사망하여 사망률은 34.1%이었다. 남아가 49예, 여아가 39예이었고, 평균 나이는 $7.0{\pm}5.7$세, 평균 재원일수는 $18.1{\pm}22.2$일로 이었다. 기저 질환은 혈액 질환이 68예(77.3%)로 가장 많았으며, 중환자실 입실 이유는 호흡기능 부전이 35예(39.8%)로 가장 많았고, 패혈쇼크가 19예(21.6%)이었다. CRP는 생존군에서 $9.1{\pm}9.0$, 비생존군에서 $16.4{\pm}11.2$로, 비생존군에서 유의하게 높았고(P<0.01), 비생존군에서 인공호흡기 치료나 투석이 필요했던 경우가 많았으며(P<0.01), 조혈모세포 이식을 받은 군의 사망률이 유의하게 높았다(P<0.05). 중증도 측정 체계 중에서는 initial OSF number, highest OSF number, SOFA score, PRISM III score가 비생존군에서 의미있는 증가를 보였고(P<0.01), 이들을 수용자 작업특성곡선을 사용하여 비교하였을 때, highest OSF number가 곡선하면적 0.845로 가장 높았고, 중환자실 입실 24시간 이내에 측정한 PRSIM III score와 SOFA score의 곡선하면적이 각각 0.723, 0.751로 유의한 결과를 보였다. 총 21예에서 조혈모세포 이식을 받았으며 이들의 O-PRISM score는 비생존군에서 높은 경향을 보였으나, 통계적으로 유의하지는 않았다. 결 론: 본 연구에서 소아 중환자실 입실한 소아 종양/혈액 질환 환자 사망의 위험인자로는 CRP, 인공호흡기 치료, 투석, 조혈모세포 이식이 있었으며, 예후 예측지표로는 highest OSF number, PRISIM III score, SOFA score가 의미 있는 것으로 분석되었다.

• 종양간호연구
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• 제8권1호
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• pp.1-7
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• 2008

Purpose: Peripheral blood stem cell transplantation (PBSCT) has been widely used. The optimal time for collection is a critical factor to obtain proper counts of CD34 cell by peripheral blood stem cell collection (PBSC). The purpose of this study was to identify the factors influencing peripheral blood stem cell collection in order to figure out the more effective timing for PBSC. Method: The subjects of this study were 189 patients undergoing 3 leukapheresis from January 28, 2005 to December 31,2006. Group's characteristics, checkup opinion of pre-peripheral blood on the day of harvest & outcome of PBSC were analyzed and evaluated using SAS statistics program after grouping patients as below; group 1-CD34 cell counts $<2{\times}10^6/kg$ (n=97); group $2-2{\times}10^6/kg$ ${\leq}CD34$ cell counts $<4{\times}10^6/kg$ (n=26); group 3-CD34 cell counts ${\geq}4{\times}10^6/kg$ (n=63). Results: Based on outcome of peripheral blood stem cell according to diagnosis, acute myelocytic leukemia (AML) was 65.5% at Group 1, Lymphoma was 21.7% at Group 2 and multiple myeloma (MM) was 70.8% at Group 3. There were significant differences in CD34 cell counts according to diagnosis (p=0.00004). Type of cytokine mobilization according to diagnosis, Lenograsim was using 62.5% of MM & 38.2% of AML and filgrastim is using 22.0% of AML only. Circular peripheral blood CD34 cell counts prior to harvest was $258.1/{\mu}L$ at Group 3 which was much higher comparing to Group 1 ($10.5/{\mu}L$) and Group 2 ($39.9/{\mu}L$) (p<0.001). TNC counts of collected peripheral blood stem cell was $15.36{\times}10^6/kg$ at Group 3 and it's much higher than Group 2 ($13.16{\times}10^6/kg$) and Group 1 ($12.36{\times}10^6/kg$) (p=0.083). There was no significant difference in MNC counts inbetween 3 groups. Conclusions: Circular peripheral blood CD34+ cell counts prior to harvest was much higher at Group 3 than Group 1 and Group 2. Therefore, the number of CD34+ cells on the day of harvest can be used as an accurate predictor for peripheral blood stem cell.

• Journal of Radiation Protection and Research
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• 제33권3호
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• pp.99-104
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• 2008

암 환자를 대상으로 방사선 치료빈도가 높아짐에 따라 다양한 작용 기전을 바탕으로 한 방사선 방어제 개발에 많은 노력을 경주하고 있다. 본 연구에서는 조혈, 면역세포의 증식과 다양한 싸이토카인의 분비를 증가시킴으로써 방사선 방어효능이 보고된 바 있는 인삼 다당체를 대상으로 화학적 구성성분과 각종 면역활성 지표 및 방사선 방어효능을 확인하고 가장 상관관계가 좋은 인자를 추출해내고자 하였다. 면역학적 활성으로는 임파구 증식능, 대식세포의 산화질소 분비능, AK세포 활성능을 검사하였으며 방사선 방어효과는 endogenous colony-forming unit(e-CFU)로 측정하였다. 인삼으로부터 추출된 다당체의 구성성분 중 galactose함량이 증가할수록 면역증강작용이 우수하였으며 임파구 증식능이 방사선 방어효과와 밀접한 관계가 있는 것으로 나타났다.