주의력 결핍 과잉 행동 환자에서 OROS-Methylphenidate 투여 후 신경심리학적 변화에 대한 개방 연구

국소담(So-Dahm Kook),김주영(Joo-Young Kim),천근아(Keun-Ah Cheon),정경운(Kyungun Jhung),송동호(Dong-Ho Song) 대한소아청소년정신의학회 2013 소아청소년정신의학 Vol.24 No.3

Objectives:Previous studies reported that attention-deficit hyperactivity disorder (ADHD) resulted from a deficit of selective attention and sustained attention. In this study, we assessed the result of methylphenidate-induced changes of the cerebral frontal executive functions in patients with ADHD. Methods:The subjects in this study consisted of 16 ADHD patients whose age ranged from 7 to 12. We used ADHD Diagnostic System (ADS) for the attention improvement, and the Stroop Test for the executive function response to pharmacotherapy with MPH. Results:After pharmacotherapy with methylphenidate for 12 weeks, the study group showed improvement in the clinical aspects through Clinical Global Impression-Severity, ADHD-rating scale and Inattention/Overactivity With Aggression Conner’s Parents Rating Scale. In the ADS test, only in auditory task there was a decrease of both the response time and the standard deviation of the response time significantly. In the Stroop Test, there was a decrease in the word task, color task and color-word task significantly. Conclusion:Our results show that psychostimulant medication improves neuropsychological function, including the cerebral frontal executive function. This study implies that we have to consider the improvement of executive function, as well as attention when evaluating the efficacy of treatment.

중합효소 연쇄반응법 ( Polymerase Chain Reaction ) 을 이용한 Helicobacter pylori 의 검출

이준성(Joon Seong Lee),송동화(Dong Wha Song),박찬욱(Chan Wook Park),이문성(Moon Sung Lee),조성원(Sung Won Cho),심찬섭(Chan Sup Shim),진소영(So Young Jin) 대한내과학회 1995 대한내과학회지 Vol.49 No.3

N/A Objectives: Helicobacter pylri (H. pylori) infection is now known to be the major cause of chronic gastritis, and is strongly associated with peptic ulcer disease and gastric cancer. But no unanimity exists among investigators about which method represents an appropriate gold standard for diagnosing H. pylori infection. Polymerase chain reaction(PCR) has great potential for improving the ability to diagnose infectious diseases caused by fastidious or slow growing bacterias. But its clinical usefulness as a diagnostic tool for H. pylori is uncertain. Methods: We performed endoscopic biopsy of stomach (>3 pieces, at antrum) for the rapid urease test (CLO stain) and PCR in 11 patients with duodenal ulcer, 2 patients with gastric ulcer, 3 patients with combined gastric and duodenal ulcer, 2 patients with gastric cancer, and 12 patients with gastritis. In preliminary study, endoscopic instruments were tested for residual H. pylori using PCR after combined manual and machine-cleaning and ultrasonic washing with disinfection in 5 patients with positive CLO test. Gastric biopsy tissues were digested in proteinase K(F.C.: 500pl/ml) for DNA extraction, and PCR amplification was performed by using 20 base oligonucleotide primers(CAM 2, CAM 4) homologous to a portion of the 1.9-kb fragment. PCR assay amplified a 203 bp product which was analyzed by agarose gel electrophoresis. Results: 1) in preliminary study, H. pylori were detected by PCR in 4 postendoscopic samples of working channels and biopsy forceps of 2 patients, and 1 preendoscopic sample of biopsy forceps, 2) Of the 30 patients, 19(63.3%) were positive for H. pylori by PCR, 17(56.7%) were positive by CLO test and silver staining. 3) The grade of severity of gastritis on H-E stain was well correlated with the grade of H. pylori infection on Warthin-Starrry silver stain(r=0.651, p<0.01). 4) Discordant results between PCR & other diagnostic tools were 3 cases. Repeat PCR tests disclosed the same results. Conclusion: PCR test of H. pylori is the most sensitive and reproducible test and can overcome the disadvantages of other diagnostic techniques showing less sensitivity and specificity, but it must be dealt with caution of instrumental contamination.

Histone Deacetylase 억제제로 유도된 자궁내막암 세포의 세포증식 억제와 세포자멸사 기전연구

임수연 ( Su Yeon Lim ),최준국 ( June Kuk Choi ),신소진 ( So Jin Shin ),권상훈 ( Sang Hoon Kwon ),조치흠 ( Chi Heum Cho ),차순도 ( Soon Do Cha ),송동금 ( Dong Kum Song ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.9

목적: 자궁내막암은 최근 급속한 경제 성장에 따른 생활수준의 향상으로 말미암아 평균 수명이 연장되고 점차 발생 빈도가 증가하고 있는 중요한 부인암의 하나이다. 자궁내막암 환자의 70~80%는 암병기 제 1기에 속하며 생존율이 비교적 양호한 경과를 보이지만 진행암 및 재발암의 경우에는 다른 악성 부인과 종양과 마찬가지로 불량한 예후를 보이며, 진행된 암에서의 치료는 지금까지 적절한 약물치료가 없다. Histone Deacetylase (HDAC) 억제제는 악성화되는 과정에 있는 세포를 복구하는 능력을 가진 새로운 항암치료제이다. 그렇지만 HDACIs의 구체적인 작용기전에 대해서는 아직 명확히 밝혀지고 있지 않다. 그러므로 본 연구자는 천연 물질인 NaB와 합성된 HDAC-I1을 이용하여 자궁내막암 세포주인 Hec 1A 세포주와 정상자궁 내막 세포주인 THESCs 세포에 어떤 영향을 미치는지 알아보고 세포에 미치는 영향을 분석하여 치료에 유용한지를 알아보고자 하였다. 연구 방법: NaB와 HDAC-I1 각각 투여 후 자궁내막암 세포와 정상 자궁 내막세포에서의 세포생존율을 알아보기 위해 MTS분석을 이용하였고, 세포 주기 회로 및 세포자멸사에 관계하는 유전자의 발현을 보기 위해 Western blot analysis를 시행하였다. 세포주기분석은 유세포분석기를 이용하였으며 세포자멸사를 확인하기 위해 DNA fragmentation 방법을 이용하였다. Caspase의 활성도를 확인하기 위해 면역형광 염색을 시행하였다. 결과: 자궁내막암 세포에 NaB와 HDAC-I1을 농도별로 처리하여 24시간 후의 결과에서 농도 및 시간 의존적으로 증식억제의 증가를 보였으나 정상 세포에서는 성장 억제 효과는 보이지 않았다. 세포 주기분석에서 자궁내막암 세포에 투여 시 subG1주기의 지연이 농도가 증가할수록 증가하였으나, 정상 자궁내막 세포에서는 세포주기의 변화가 없었다. 세포자멸사의 증거인 DNA 분절 검사를 시행하여본 결과 자궁내막암 세포가 NaB에 의해 농도가 증가할수록 세포분절현상이 증가되는 것을 확인하였다. p53, p21, p27, FAS와 FAS ligand 단백은 농도가 증가할수록 발현이 증가하였고, CDK2와 cyclin A의 발현 감소를 확인하였으며, 미토콘드리아에서 세포자멸사에 관계하는 Bcl2는 감소하였으나 Bax 단백은 반대로 발현 증가를 보였다. 비활성 형태의 pro-caspase 3과 8 단백질의 양적 감소, caspase 9의 활성과 PARP cleavage의 증가되어 세포자멸사로 유도되는 것을 알았다. caspase 7과 3의 활성도 검사에서도 면역형광으로 활성이 증가하는 것을 관찰하였다. 결론: 이상의 결과를 통해 NaB와 HDAC-I1이 자궁내막암 세포에 내인성과 외인성의 세포자멸사의 경로를 거쳐 세포주기와 세포자멸사에 관련된 유전자들의 발현에 영향을 미침으로써 자궁내막암 세포의 증식을 억제하여 결과적으로 세포자멸사에 이르게 함을 알았으며, 향후 자궁내막암의 치료 약물로서의 가능성을 보인다고 생각된다. Objective: Endometrial cancer is the most common malignant tumor of the female genital tract. Its incidence has increased in recent years, making up 13% of female genital cancers. Nevertheless, the search for agents effective in the treatment of either advanced or recurrent endometrial cancer has been disappointing. Histone deacetylase inhibitors (HDACIs) were recently found to be well-tolerated in patients with hematologic and solid malignancies. HDACIs have been shown to inhibit cancer cell proliferation, stimulate apoptosis, and induce cell cycle arrest. Our purpose was to investigate the antiproliferative effects of the HDACIs (sodium butyrate and HDAC-I1) against endometrial cancer cell line (Hec 1A) and normal endometrial cell line (T-HESCs). Methods: MTS reduction assay was carried out to determine the cell viability. Cell cycle analysis and DNA fragmentation assay was done by fluorescent activated cell sorter analysis. The expression of cell cycle-regulatory and apoptosis-related proteins were evaluated by Western blot. Caspase 3 and 7 activity were measured by immuno-flouorescent staining. Results: Each sodium butyrate and HDAC-I1 induced growth inhibition in a dose and time dependent manner in endometrial cancer cells but did not induce growth inhibition in normal endometrial cells. Treatment with each drugs in endometrial cancer cells increased the percentage of cells in subG1 phase. The expression of p53, p21, p27, FAS, and FAS legand were increased and it was associated with increased p21 and p27 expression in a p53-dependent manner. Activation of caspase-3, 7, 8, 9 and down-regulation of Bcl-2, up-regulation of Bax, with concomitant increase in PARP cleavage, were observed. Conclusion: These results demonstrate that sodium butyrate induced growth inhibition and apoptosis in human endometrial cancer cells rising their possibility applicable against human endometrial cancers.

신경외과적 뇌질환을 지닌 영유아 어머니의 양육 스트레스

주봉림 ( Bong-lim Joo ),심규원 ( Kyu-won Shim ),김동석 ( Dong-seok Kim ),송동호 ( Dong-ho Song ),신의진 ( Yee-jin Shin ),엄소용 ( So-yong Eom ) 한국영유아아동정신건강학회 2010 영유아아동정신건강연구 Vol.3 No.1

본 연구의 목적은 신경외과적 뇌질환을 지닌 영유아 어머니의 양육 스트레스와 정서적인 문제점을 파악하여 이를 경감시켜 주고, 나아가 의료진과 함께 영유아 치료에 적극적인 개입을 할 수 있도록 하는 여건을 만들어 주고자 함이다. 대상에는 신경외과적 뇌질환을 지닌 영유아 65명, 어머니가 포함되어 있으며, Parenting Stress Index(PSI) and Beck Depression Inventory(BDI)를 실시하여 전반적인 정서적 스트레스 수준을 평가하였다. 연구결과, 임상적으로 양육스트레스 수준이 증가되어 있었고 우울감은 경미한 수준으로 증가되어 있었다. 총스트레스 영역을 보면, 과반수 이상이 비정상 범주에 해당하는 스트레스를 경험하는 것으로 나타났으며, 부모영역에 비하여 아동영역과 유능감에서 스트레스가 증가되어 있었다. 특히 수술적 치료를 받은 영유아 어머니는 총 스트레스, 아동영역이 수술적 치료를 받지 않은 영유아 어머니에 비하여 증가되어 있었다. 발달지연 영유아 어머니를 대조군으로 연구한 결과, 발달지연 영유아 어머니가 경험하는 수준만큼 스트레스를 경험하고 있지는 않았다. 다만 기분, 유능감, 애착, 건강, 우울에서 집단 간의 차이가 나타나지 않았고, 유의미한 수준에 이르지 않으나 발달지연 영유아 어머니보다 우울감의 점수가 더 높은 경향을 보였다. 본 연구는 신경외과적 뇌질환을 가진 영유아의 어머니의 양육스트레스가 증가되어 있으며 특히 양육효능성 결여가 두드러지고, 이에 따른 우울감을 주된 문제로 제시하였다. 결과적으로 신경외과적 뇌질환을 가진 영유아의 어머니에게 적극적인 부모교육을 통한 정신과적 개입이 필요하다는 자료를 제시하였다는데 의의가 있다. The study was conducted to examine emotional problems and parenting stress in mothers of infants, who visited the department of pediatric neurosurgery, to reduce them and provide the basis on which comprehensive interventional treatment could be performed to treat the children. For 65 infants who visited the department of pediatric neurosurgery and mothers of 35 mentally retarded infants, Parenting Stress Index (PSI) and Beck Depression Inventory (BDI) were administered and the overall stress level was evaluated. Among mothers of infants who visited the department of neurosurgery, the level of parenting stress was clinically high and depressive symptoms were found to be at the level of a mild severity. In terms of total stress (TS), more than half of the subjects were found to experience stress categorized as an abnormal range. Total stress (TS) and child domain (CD) were higher in mothers of infants who underwent surgical treatments than mothers of infants who were treated conservatively. The scores indicating depressive symptoms among mothers of infants who underwent surgical treatments were found to be relatively high as compared with mothers of developmentally retarded infants although they were not statistically significant. The increased parental distress of mothers with infants having neurosurgical diseases was analyzed and discussed. Particularly, mothers of infants with neurosurgical diseases had a low level of competence and mild depression. The necessity of surgical and comprehensive psychological interventions would be suggested.

성학대를 경험한 소아, 청소년에서 성학대가 외상 후 정신 증상에 미치는 영향

신은영(Eun-Young Shin),천근아(Keun-Ah Cheon),정경운(Kyungun Jhung),송동호(Dong-Ho Song),김소향(So-Hyang Kim) 대한소아청소년정신의학회 2015 소아청소년정신의학 Vol.26 No.1

Objectives:The purpose of this study is to examine the effects of the characteristics of victim and sexual abuse on posttraumatic psychiatric symptoms in children and adolescents with a history of sexual abuse. Methods:A total of 137 children and adolescents were recruited from the Seoul Sunflower Children Center, a nation-funded sexual violence victim protection center, from January 2009 to December 2013. We collected the demographic data of the victims and the Trauma Symptom Checklist for Children (TSCC) from victims. We hypothesized victims’ age, sex, and intelligence quotient, and the characteristics of sexual abuse as the affecting factors of posttraumatic psychiatric symptoms. Descriptive analysis and hierarchical regression analysis were performed for analysis of demographic data, TSCC scores, and psychiatric symptoms. Results:The victims’ age and the characteristics of sexual abuse were significantly related to the traumatic distress of sexual abuse. R-square was 23% for anxiety, 39% for depression, 21% for posttraumatic stress, and 37% for dissociation on TSCC. Conclusion:This study suggests that victims’ age, type, frequency and duration of exposure, and disclosure of sexual abuse are significant affecting factors on posttraumatic psychiatric symptoms in children and adolescents. Exploration of psychiatric symptoms other than posttraumatic symptoms, and relations between pretraumatic and posttraumatic psychiatric symptoms is needed through collection of larger samples.

발달지체 진단에서 CBCL 1.5-5 유아행동평가척도-부모용의 변별력

하은혜(Eun Hye Ha),김서윤(Seo Yun Kim),송동호(Dong-Ho Song),곽은희(Eun Hee Kwak),엄소용(So Yong Eom) 대한소아청소년정신의학회 2011 소아청소년정신의학 Vol.22 No.2

Objectives:The purpose of this study was to verify discriminant validity and the clinical cutoff score of Child Behavior Checklist 1.5-5 in the diagnosis of developmental delayed infants. Methods:The participants were screened by Denver II which includes 156 developmental delayed infants and 288 normal infants. Chi-squared test, t-test, ROC curve analysis, odds ratio analysis were performed on the data. Results:Only 47 items out of 99 items among the CBCL 1.5-5 of total groups, 36 items of boys and 48 items of girls, discriminated developmental delayed infants well. Discriminant validity was confirmed by mean differences on the subscales of Withdrawn, Sleep Problems, Attention Problems, Internalizing Problems, Externalizing Problems, Total Problems, DSM Pervasive Developmental Problems and DSM Attention Deficit/Hyperactivity Problems between the two groups. Additionally, ROC analyses demonstrated that Withdrawn, Attention Problems, Internalizing Problems, Total Behavior Problems and DSM Pervasive Developmental Problems significantly predicted developmental delayed infants compared to normal infants. Also, the clinical cutoff score criteria adopted in the Korean CBCL 1.5-5 for subscales of Withdrawn, Attention Problems, Internalizing Problems, Total Behavior Problems and DSM Pervasive Developmental Problems were shown to be valid. Conclusion:The subscales of Withdrawn, Attention Problems, Internalising Problems, Total Behavior Problems and DSM Pervasive Developmental Problems significantly discriminated in the diagnosis of developmental delayed infants well.

자가면역성 만성 췌장염 17예의 임상상

김규표 ( Kim Gyu Pyo ),김명환 ( Kim Myeong Hwan ),이윤정 ( Lee Yun Jeong ),송문희 ( Song Mun Hui ),박도현 ( Park Do Hyeon ),이상수 ( Lee Sang Su ),서동완 ( Seo Dong Wan ),이성구 ( Lee Seong Gu ),민영일 ( Min Yeong Il ),송동은 ( So 대한소화기학회 2004 대한소화기학회지 Vol.43 No.2

Background/Aims: Autoimmune pancreatitis is a distinctive type of chronic pancreatitis with reversibility. We analyzed the largest number of patients with autoimmune pancreatitis among the studies carried out at a single institution in Korea. Methods: We retrospectively analyzed the clinical, radiologic, laboratory and histologic features in 17 patients who were diagnosed as autoimmune pancreatitis. Results: The patients were predominately elderly men who presented with jaundice or nonspecific gastrointestinal symptoms. In most of the patients, serum pancreatic enzymes were normal or mildly elevated with an accompanying cholestatic biochemical profile. Elevated IgG levels and detection of autoantibodies were observed in 47% (8/17) and 35% (6/17), respectively. Thirteen patients showed histologic findings of lymphoplasmacytic infiltration and fibrosis, and one patient showed predominant infiltration of eosinophils. Fifteen patients revealed radiologic images of diffuse swelling of pancreas and the sclerosing pattern on direct pancreatogram. All of the features improved in response to oral steroid therapy. Two cases showed focal narrowing with upstream duct dilatation and thus, they were diagnosed as focal type. Diabetes mellitus concurred in 13 cases and primary sclerosing cholangitis and Sjoren`s syndrome were present in 1 case, respectively. Conclusions: The recognition of autoimmune pancreatitis allows patients to avoid unnecessary surgery and recover with the administration of oral steroid. (Korean J Gastroenterol 2004; 43:112-119)

한국판 소아 양극성장애 설문지 2.0(Child Bipolar Questionnaire 2.0)의 신뢰도 및 타당도 연구

천근아,신동원,김보라,소윤섭,전진용,송동호 大韓神經精神醫學會 2008 신경정신의학 Vol.47 No.3

Objectives : The Child Bipolar Questionnaire 2.0 (CBQ 2.0) is a rapid screener with a Core Index subscale of symptom dimensions frequently reported in childhood-onset bipolar disorder (BD) and scoring algorithms for DSM-Ⅳ BD, with and without ADHD, and the proposed Narrow, Broad, and Core phenotypes. This report provides preliminary data on the reliability and validity of the CBQ 2.0-Korean version. Methods : Core Index subscale to effectively predict diagnostic classification by structured interview was assessed using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean Version (K-SADS-PL-K). Test-retest and inter-rater reliabilities of the CBQ 2.0 were assessed. Correlation of Korean Child Behavior Checklist (K-CBCL) with CBQ 2.0-Korean version was performed. Results : The CBQ 2.0 screening algorithms performed with a specificity of 66.7% and a sensitivity of 94.7% in classifying subjects with K-SADS-PL-K diagnosis of BD vs. no BD. The Core Index subscale had “good” agreement with K-SADS-PL-K diagnosis (Kappa=0.676) in identifying BD, ADHD-only, and no diagnosis. Conclusion : This preliminary data is from a sample derived from the child and adolescent psychiatric clinics, further validation is needed with community based samples in which childhood-onset BD is rarer and diagnoses more diverse. The CBQ 2.0-Korean version shows potential for rapid and economically feasible identification of possible childhood-onset BD cases as defined by DSM-Ⅳ criteria as well as by alternate disease phenotypes.

에이즈 환자에서 발생한 심장의 비호치킨성림프종 1예

전윤희,김고흔,윤소윤,편욱범,문영철,송동은,최희정 대한감염학회 2010 감염과 화학요법 Vol.42 No.1

AIDS related malignancies have gradually decreased after the introduction of highly active antiretroviral therapy (HAART). Nevertheless, non-Hodgkin’s lymphoma is still a major malignancy in resource limited countries that have difficulty supplying HAART, and same holds true for Korea. We report a case of non-Hodgkin’s lymphoma involving the heart in a Korean AIDS patient, who presented with sudden arrhythmia and superior vena cava syndrome. He was diagnosed with AIDS in 2008, but refused to receive HAART. Immunohistologic findings were compatible diffuse large B cell lymphoma, and futher studies demonstrated involvement of the liver, adrenal gland, heart, and pericardiac space. HAART was initiated and non Hodgkin’s lymphoma was successfully managed with intensive chemotherapy. This is the first cardiac involvement non Hodgkin’s lymphoma in AIDS patients in Korea.

위에 원발한 융모상피암 1예

박찬욱,문철,이동화,이준성,이문성,조성원,심찬섭,진소영,송동화,권강호,홍수진 대한소화기내시경학회 1994 Clinical Endoscopy Vol.14 No.4

Gastational choriocarcinoma is a malignant neoplasm of trophoblast. It may occur after hydatidiform mole, spontaneous abortion, normal pregnancy, and even an ectopic pregnancy. Extragenital choriocarcinoma is a rare tumor which attracts interest because of its controversial pathogenesis. It has been reported to occur within the lung, mediastinum, breast, prostate, thymus, pineal, nose, liver, bladder, and biliary tree, as well as most parts of the gastrointestinal tract. We experienced a case of primary choriocarcinoma of stomach with a metastasis to the liver of a 54-year-old man. So, we present a case with a review of literature.