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불안, 기분장애로 치료 중 보행장애 외에 서동과 강직을 동반한 정상뇌압수두증 증례
장세헌,제영묘,최진혁,배정훈,성상윤,조세훈,김영훈,Jang, Sae Heon,Jae, Young Myo,Choi, Jin Hyuk,Bae, Jung Hoon,Seong, Sang Yoon,Cho, Se Hoon,Kim, Young Hoon 한국정신신체의학회 2015 정신신체의학 Vol.23 No.1
정상뇌압수두증은 보행장애, 요실금 및 치매 등의 전형적인 세 가지 증상 외에도 추체외로 증상과 다양한 신경심리 증상이 동반될 수 있다. 이 사례는 불안과 정동증상으로 치료 중 보행장애와 요실금 증상을 보였던 46세 여자 환자에서 항파킨슨 약물의 사용과 기존 정신과 치료 약물의 중단에도 불구하고 증상의 호전이 없었으나, 뇌 컴퓨터 단층 촬영상 뇌실의 확장 소견이 보였고 시험적 뇌척수액 배액에 의해서 수일 내에 증상들이 극적으로 호전되어 정상뇌압수두증을 감별해야 했던 경우이다. 뚜렷한 대뇌 실질의 위축 소견이 없으나 뇌실이 확장되어 있을 경우 추체외로 증상과 신경심리 증상이 있을 경우 정상뇌압수두증의 전형적 세 가지 증상을 보이지 않는다 하더라도 정상뇌압수두증의 가능성을 고려해서 시험적 뇌척수액 배액 등의 시술이 진단과 치료에 도움이 될 수 있음을 보여주는 사례라고 생각된다. In addition to classical triad such as gait disturbance, urinary incontinence and dementia, parkinsonian extrapyramidal motor signs and neuropsychiatric symptoms can be observed in patients with normal pressure hydrocephalus (NPH). In our case, a 46 year old female patient showed extrapyramidal symptoms such as bradykinesia, rigidity and neuropsychiatric symptoms such as agitation, anxiety, restlessness and regressed behavior beside two(gait disturbance & urinary incontinence) symptoms of three classical triad. It was difficult to diagnose this patient as NPH from the beginning because of her relatively young age and previous psychiatric mediation history for controlling advanced anxiety and affective disorder. Antiparkinsonian agents and discontinuation of psychiatric medications did not work for this patient. Patient's brain computed tomographic finding showed enlarged ventricles. We suspected NPH and did empirical drainage of 30mL CSF. Finally, patient's pyramidal and neuropsychiatric symptoms as well as two of three classical triad of NPH were improved dramatically within several days. It is important to consider NPH as one of the differential diagnosis in patient with parkinsonian symptoms and various neuropsychiatric symptoms who did not respond to usual clinical management especially in case of ventricular enlargement in neuroimaging because of its treatable property by CSF shunt operation.
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박헌종 ( Heon Jong Park ),서경묵 ( Kyung Mook Seo ),강시현 ( Si Hyun Kang ),성상윤 ( Sang Yoon Sung ),김돈규 ( Don Kyu Kim ) 대한스포츠의학회 2008 대한스포츠의학회지 Vol.26 No.1
We conducted a survey of 184 female caddies working in the Seoul area concerning their general characteristics in a season and painful body sites. Their work-related stress factors were classified into 8 categories. 91 persons had leg pain which was related to age, carrier and the physical working environment as a job stress factor. 76 persons had shoulder pain which was related to the body mass index, job burden and past injuries. 50 persons had back pain which was related to job burden, the physical working environment, work demand, work self-regulation and culture. 42 persons had neck pains which was related to past injuries and number of years on the job. 10 persons had arm pain which was related to the average time spent in housework(p<0.05). Our study demonstrated that musculo skeletal pain experienced by caddies is correlated with various work-related stress factors. Therefore, improvement in those factors, safety education, and precautionary measures should be taken for prevention.
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성상윤 외 중앙대학교 의과대학 의학연구소 2004 中央醫大誌 Vol.29 No.1·2
Epidemiological studies suggests an increasing incidence of male infertility. Our understanding of the importance of environmental, genetic and occupational factors on sperm count and fertility is constrained by the extreme variation in sperm count. The relative importance of the various factors and the pathways via which they affect sperm count are discussed. The possible role of other environmental factors commonly supposed to affect sperm count (exposure to pesticides or endocrine disruptors) is discussed, although the evidence for a major influence of such factors is lacking. Intracytoplasmic sperm injection (ICSI) has revolutionized the treatment of male infertility. But futher research into the causes and specific treatment of idiopathic male factor infertility is needed.
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