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Is There the Preventive Effect of COMT-inhibitor on Parkinson’s Disease Associated with Dementia?
이현주,송인욱,김영도,조현지,정성우,양영순 대한치매학회 2012 Dementia and Neurocognitive Disorders Vol.11 No.4
Background: Elevated homocysteine (hcy) levels are associated with dementia, which is a frequent non-motor symptom of Parkinson’s disease (PD). High levels of hcy in PD patients treated with levodopa are thought to result from increased synthesis during the metabolism of levodopa by COMT, and that use of a COMT-inhibitor may reduce hcy levels. In this study, we sought to clarify the effects of COMT-inhibitors on dementia in PD patients. Methods: Thirty-eight PD patients without dementia (PDwoD), 35 PD patients with dementia (PDD), and 48 controls were enrolled in this study. All subjects underwent neuropsychological testing and a neurological examination. The hcy levels were measured in all subjects, and the relationship between hcy levels and dementia was evaluated in two PD groups (those that underwent treatment with levodopa-alone versus treatment with levodopa plus a COMT-inhibitor). Results: Patients in the PDD group showed higher hcy levels than patients in the PDwoD group, though there was no significant difference in the hcy level between PDwoD patients and healthy controls. Regarding the effects of a COMT-inhibitor, there was no correlation between hcy levels in the 2 PD subgroups, indicating that there were no significant effects of the COMT-inhibitor on PDD. In addition, the odds ratio for PDD with the use of a COMT-inhibitor was 0.864 (95% CI=0.342-2.180). Conclusions: These results are in agreement with previous studies in that levodopa treatment in PD patients leads to elevated hcy concentrations. COMT-inhibitors, on the other hand, had no preventive effect on cognitive impairment in PD patients. Background: Elevated homocysteine (hcy) levels are associated with dementia, which is a frequent non-motor symptom of Parkinson’s disease (PD). High levels of hcy in PD patients treated with levodopa are thought to result from increased synthesis during the metabolism of levodopa by COMT, and that use of a COMT-inhibitor may reduce hcy levels. In this study, we sought to clarify the effects of COMT-inhibitors on dementia in PD patients. Methods: Thirty-eight PD patients without dementia (PDwoD), 35 PD patients with dementia (PDD), and 48 controls were enrolled in this study. All subjects underwent neuropsychological testing and a neurological examination. The hcy levels were measured in all subjects, and the relationship between hcy levels and dementia was evaluated in two PD groups (those that underwent treatment with levodopa-alone versus treatment with levodopa plus a COMT-inhibitor). Results: Patients in the PDD group showed higher hcy levels than patients in the PDwoD group, though there was no significant difference in the hcy level between PDwoD patients and healthy controls. Regarding the effects of a COMT-inhibitor, there was no correlation between hcy levels in the 2 PD subgroups, indicating that there were no significant effects of the COMT-inhibitor on PDD. In addition, the odds ratio for PDD with the use of a COMT-inhibitor was 0.864 (95% CI=0.342-2.180). Conclusions: These results are in agreement with previous studies in that levodopa treatment in PD patients leads to elevated hcy concentrations. COMT-inhibitors, on the other hand, had no preventive effect on cognitive impairment in PD patients.
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이현주,민정,황상현,정호주,박지혜,이가영,김원석 대한피부과학회 2014 대한피부과학회지 Vol.52 No.11
34세 남자 환자가 왼쪽 4번째 손톱의 띠모양의 흑색손발톱선조(melanonychia striata)를 주소로 내원하였다. 10개월전 외상력 없이 발생하였고 점차 주변에 사마귀양 병변이 발생하여 손톱진균증 의심 하에 개인의원에서 항진균제 치료를 받았으나, 별다른 호전 없이 병변이 지속되었다(Fig. 1). 국소 마취 하에 손가락 가쪽의 손톱판을 세로로 절개한 후 조직 검사를 시행하였고 표피 내에 편평상피세포와 불규칙한 모양의 세포가 관찰되며 비정상적인 유사 분열을 보이고 있으며 침윤성 성장은 관찰되지 않고 보웬병(Bowen disease)에 합당한 소견을 보였다(Fig. 2). Human papilloma virus (HPV) DNA Chip을 이용하여 고위험군 19종(16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 69, 70, 73형)과 저위험군 13종(6, 11, 32, 34, 40, 42, 43, 44, 54, 55, 62, 81, 83) 등 총 32종의 HPV 유전자형을 동정하는 PCR 검사로 HPV 감염여부를 확인하였으나 음성이었다. 수술적으로 제거한 후 현재 6개월까지 재발소견 없이 경과관찰 중이다. 보웬병은 상피내편평세포암으로 주로 고령에 발생하며 신체 어느 부위에나 발생할 수 있다. 손발톱부위에 발생하는 보웬병은 흔히 사마귀 형태로 나타나며, 홍반, 궤양, 손발톱주위염,손발톱변형이나 세로흑색손발톱의 형태로 다양하게 나타날 수 있다1,2. 세로흑색손발톱의 형태로 나타나는 경우 악성흑색종과 감별이 힘들 수 있으나 보웬병은 대부분이 세로흑색손발톱과 사마귀양 병변이나 손발톱변형이 동반되어 나타난다1. 양성질환과 형태가 유사하고 천천히 진행하며 무증상이어서 진단이 늦어지는 경우가 많으며, 증상이 발생하고 평균적으로 6년 이후에 병원을 내원하는 것으로 알려져 있다1,3. 외상, 만성적인 손발톱주위염, 선천이상각화증(dyskeratosis congenita), 방사선치료와 비소섭취가 손발톱부위 보웬병의 원인으로 생각되며 HPV 감염이 중요한 원인으로 생각된다3. HPV 2, 11, 18, 26, 31, 34, 35, 56, 58, 73에 의해서 발생할 수 있으며 고위험병원성인 HPV 16에 의한 경우가 74%를 차지한다4,5. 본 증례의 경우 외상이나 비소섭취 등의 의심되는 과거력 없이 비교적 젊은 나이에 세로흑색손발톱 형태로 나타났으며 HPV검사도 음성이어서 외상과 HPV 감염이라는 유발요인 이외의 다른 흔하지 않은 원인을 생각해 볼 수 있다. 치료에 반응이 없거나 만성적으로 재발은 보이는 경우 악성종양을 의심하고 조직검사를 시행하는 것이 필요하며 교육적인 증례라 생각하여 문헌 고찰과 함께 보고한다.
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최근 3년간 피부질환으로 응급실에 내원한 환자에 대한 통계학적 고찰(2010∼2012)
이현주 ( Heun Joo Lee ),정호주 ( Ho Joo Jung ),남재희 ( Jae Hui Nam ),박지혜 ( Ji Hye Park ),이가영 ( Ga Young Lee ),김원석 ( Won Serk Kim ) 대한피부과학회 2015 대한피부과학회지 Vol.53 No.1
Background: An increasing number of patients visit the emergency department (ED) for dermatological complaints. However, there is a paucity of data regarding the skin conditions presenting to the ED. Objective: This study aimed to describe the characteristics of skin complaints seen in the ED of a tertiary hospitalin Korea. Methods: We retrospectively reviewed 1,663 new dermatological emergency patients who visited the ED of ourhospital from January 2010 to December 2012. All skin conditions were diagnosed by a dermatologist and not byan emergency medicine specialist. Results: A total of 1,663 patients with skin problem were seen, corresponding to 1.5% of total ED visits. The meanage was 41.8 years and there was a slight female predominance (61.2%). The peak arrival time was between 9 pmand midnight. In terms of visit length, 68.9% of patients stayed less than 2 hours. Patients most commonly presentedwith urticaria/angioedema (53.8%) followed by herpes zoster (14.0%), contact dermatitis (7.2%), drug eruption(6.5%), and cellulitis/erysipelas (4.0%). Urticaria/angioedema patients were most commonly aged 21 to 40 years andherpes zoster patients were most commonly aged 51 to 70 years. Admissions occurred in 8.1% of cases, mostfrequently for herpes zoster. Conclusion: This retrospective study provides insight into the types of cases being evaluated by dermatologists inthe ED of a tertiary hospital. An awareness of these characteristics may assist physicians working in the ED inevaluating patients who present to the ED with skin disease. (Korean J Dermatol 2015;53(1):10∼15)
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발달장애학생의 전환교육에 관한 주요 당사자들의 다각적인 인식 및 요구 분석: 충청북도 지역을 중심으로
이현주 ( Hyunjoo Lee ),김경화 ( Kyeong-hwa Kim ),정지희 ( Jeehee Jeong ) 한국지적장애교육학회(구 한국정신지체아교육학회) 2021 지적장애연구 Vol.23 No.2
본 연구의 목적은 발달장애학생의 전환교육에 관한 특수교사, 가족, 유관기관 실무담당자의 다각적인 인식과 요구를 살펴보는 것이다. 이를 위해 발달장애학생의 전환교육에 대한 주요 당사자들의 견해를 수렴하기 위해 충청북도 지역을 중심으로 선택하여 집단별로 포커스그룹 면담을 실시하였고, 특수교사 10명, 발달장애학생의 가족 13명, 유관기관 실무담당자 8명, 총 31명의 연구참여자가 면담에 참여하였다. 면담내용은 연속적 비교분석법을 사용하여 분석하였다. 연구 결과, 5개의 대주제와 15개의 하위주제를 도출하였다. 대주제는 발달장애학생에게 전환교육이 갖는 의미, 중도 발달장애학생을 위한 전환교육 재조명, 발달장애학생의 요구와 특성에 기초한 전환계획과 지원, 발달장애학생의 전환교육을 위한 가족 연계 및 지원, 지역사회 중심의 전환교육 시스템이며, 각 주제별로 2∼5개의 하위주제가 도출되었다. 본 연구에서는 발달장애에 초점을 두어 이 집단이 가진 성인기 전환에 대한 요구를 다각적인 관점에서 살펴봄으로써 향후 발달장애학생을 위한 전환교육의 질 제고 및 방향성에 대해 논의하면 다음과 같다. 첫째, 중도 발달장애학생을 지원하는 전환교육 모형 및 체제 구축이 이루어져야 한다. 둘째, 발달장애학생의 요구와 특성을 고려한 전환계획의 중요성을 인지하고 실행되어야 한다. 셋째, 발달장애학생의 가족을 지원하는 방안 마련이 필요하다. 넷째, 지역사회를 중심으로 하는 전환교육 시스템 구축되어야 한다. The purpose of this study was to examine the multidimensional perceptions and needs of special education teachers, family members, and staff in transition related organizations regarding transition education for students with developmental disabilities. Focus group interviews were conducted for each group by selecting the Chungcheongbuk-do region in order to collect the opinions of stakeholders’ on the transition education of students, and a total 31 participants participated, including 10 special education teachers, 13 family members, and 8 staff in transition related organizations. The interview contents were analyzed using constant comparative analysis method. As a result, 5 major themes and 15 subthemes were derived. The major themes were the meaning of transition education for students with developmental disabilities, re-examination of transition education for students with severe developmental disabilities, transition planning and supports based on the needs and characteristics of students with developmental disabilities, family connection and support for transition education for students with developmental disabilities, and community-based transition education system. This study focused on developmental disabilities and examined the needs of this group for transition to adulthood from a multidimensional perspective, discussed the improvement of the quality and direction of transition education for students with developmental disabilities in the future. First, a transition education model and system to support students with severe developmental disabilities should be discussed. Second, the importance of transition planning should be acknowledged and implemented in consideration of the needs and characteristics of students with developmental disabilities. Third, a support plan for the families of students with developmental disabilities is necessary. Fourth, a community-based transition education system should be established.
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