Comparison of efficacy and safety of milnacipran and fluoxetine in Korean patients with major depression

Lee, Min-Soo,Ham, Byung Joo,Kee, Baik Seok,Kim, Jung‐,Bum,Yeon, Byeong Kil,Oh, Kang‐,Seob,Oh, Byoung Hoon,Lee, Chul,Jung, Han Yong,Chee, Ik‐,Seung,Choe, Byeong Moo,Paik, In Ho Informa UK (Librapharm) 2005 Current medical research and opinion Vol.21 No.9

<P>OBJECT: To compare efficacy and safety of milnacipran and fluoxetine in a population of Korean patients with major depression. RESEARCH DESIGN AND METHODS: The design was a multi-centre, randomised, comparative clinical study. Patients with major depression (DSM-IV diagnostic criteria) scoring over 17 points on the 17-item Hamilton Depression Scale (HAM-D) and over 21 points on the Montgomery-Asberg Depression Rating Scale (MADRS) were recruited and randomised to receive milnacipran (50 mg/day increasing after 1 week to 100 mg/day) or fluoxetine (20 mg/day) for 6 weeks. All previous medication was stopped at least 7 days before entry into the study. Patients were evaluated (HAM-D, MADRS and clinical global impression scale, CGI) at baseline and after 1, 2, 4 and 6 weeks of treatment. All adverse events which developed during the study period were recorded. RESULTS: 70 patients (milnacipran 39; fluoxetine 31) were included in the study. Total score on both HAM-D, MADRS and CGI decreased significantly in both groups after 1 week and continued to decrease throughout the study. There was no significant difference between the two groups for any measurement at any time point. Both antidepressants were well tolerated. In the milnacipran group, 13 patients reported 28 adverse reactions, and in the fluoxetine group 11 patients reported 18 adverse reactions. Two patients discontinued due to adverse events in the milnacipran group and three in the fluoxetine group. There were no clinically significant modifications in vital signs, routine blood laboratory tests, biochemistry or ECG throughout the study. Nausea and headache were the most frequently reported adverse events with milnacipran while digestive disturbances, diarrhoea and insomnia were more common with fluoxetine. CONCLUSION: Milnacipran, like fluoxetine, was found to be effective and well tolerated for the treatment of major depression in this population of depressed Korean patients. Principal limitations of the study were its open design, its small sample size and its relatively short duration.</P>

주요우울증에 대한 Milnacipran의 효과 및 안정성 : Fluoxetine과의 비교

이민수,함병주,기백석,김정범,연병길,오강섭,오병훈,이철,정한용,지익성,최병무,백인호 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.4

Objectives : This 6-week, open label randomized, multicenter study was conducted to evaluate the antidepressant effect and safety of milnacipran and fluoxetine in patients with major depression. Methods : The study was done in patients with major depression diagnosed by DSM-IV who score ≥17 in 17 items Hamilton Rating Scale for Depression (17-item HAM-D) and score ≥25 in Montgomery and Asberg Depression Rating Scale (MADRS). A total of 87 patients were randomized to milnacipran group and fluoxetine group. In cases of the patients taking other antidepressants, 6 weeks of each medication was administered after 7 days of drug excretion period. The evaluation was done using 17 item HAM-D, MADRS, Clinical Global Impression Scale (CGI), and COVI scale after baseline, 1 week, 2 weeks, 4 weeks, and 6 weeks. The side effects that had occurred during the period of our study were put in records by developed/disappeared time, severities, incidences, managements and results. Results : A total of 87 patients were enrolled. 70 (mitnacipran group 39 ; fluoxetine group 31) of them were included for the 6 weeks of research and 17 of them dropped out with in the first week, not due to adverse reactions or deficiency of effects. Total 17 item HAM-D scores, total points of MADRS, and CGI showed significant decrease after 1 week in each treatment group and continued decrease after 2 weeks and 4, 6 weeks. But there was no difference between milnacipran group and fluoxetine group in the antidepressant effect. There were no significant changes in vital sign, CBC, chemistry, and EKG in each treatment group. The commonly reported side elfects of minlacipran were nausea (25.0%), headache (10.7%), vomiting (7.1%),constipation (7.1%), dizziness (7.1%) and those of fluoxetne were GI trouble (11.1%), diarrhea (11.1%), insomnia (11.1%),agitation (5.6%), and dizziness (5.6%). Conclusion : Milnacipran was effective for the improvement of depressive symptoms and was well tolerated and safe in patients with depression.

알루미늄 PEO 코팅의 결정상에 미치는 공정 조건에 대한 연구 I. Unipolar 펄스와 코팅시간

김배연,함재호,이득용,김용남,전민석,김기윤,최지원,김성엽,김광엽,Kim, Bae-Yeon,Ham, Jae-Ho,Lee, Deuk Yong,Kim, Yong-Nam,Jeon, Min-Seok,Kim, Kiyoon,Choi, Ji-Won,Kim, Sung Youp,Kim, Kwang Youp 한국결정성장학회 2014 韓國結晶成長學會誌 Vol.24 No.2

전해질로 $Na_2SiO_3$을 사용하여 A1050 알루미늄 판재를 pulse 폭 $ 2000{\mu}sec$, impulse 420 V, 400 ${\mu}$sec의 unipolar pulse로 플라즈마 전해 산화 코팅(plasma electrolytic oxidation coating)을 하여 산화 피막을 2, 5, 15, 30분에 따라 형성시킨 다음 산화피막을 분석하였다. 표면에 형성된 산화물의 결정상은 ${\alpha}-alumina$와 ${\gamma}-Alumina$로서 시간에 따른 변화는 없었다. 반응 초반에는 ${\gamma}-Alumina$가 많이 생성되었지만 시간이 갈수록 ${\gamma}-Alumina$의 양에는 변화 없이 ${\alpha}-alumina$가 많이 생겨남을 알 수 있었다. 이런 결과는 micro plasma에 의해서 ${\gamma}-Alumina$가 우선 생성되고, 이후 계속되는 micro plasma의 열에 의해서 ${\alpha}-alumina$로의 전이가 일어나기 때문으로 판단된다. Crystallographic phases of Plasma electrolytic oxidized Al alloy, A1050, were investigated. The electrolyte of PEO was $Na_2Si_2O_3$ and KOH. Unipolar pulse, $ 2000{\mu}sec$ with $400{\mu}sec+420V$ impulse, were applied for 2 min, 5 min, 15 min, and 30 min. ${\gamma}-Alumina$, as well as ${\alpha}-alumina$, was main crystal phase. ${\gamma}-Alumina$ was appeared in the beginning, then the amount of ${\alpha}-alumina$ was increased with time, but the amount of ${\gamma}-Alumina$ remained constant without any increasing. So, it is concluded that plasma gas produce ${\gamma}-Alumina$ at the first, and then ${\gamma}-Alumina$ transform ${\alpha}-alumina$ finally. During the transformation, high temperature of micro plasma gives transformation energy.

구미지역 직업성질환 감시체계

김성아,김진석,전혜리,정상재,김상우,이채용,함정오,유재영,최태성,하봉구,조민환,우극현 大韓産業醫學會 2003 대한직업환경의학회지 Vol.15 No.1

목적: 구미지역 내 대학병원이자 특수건강진단·보건관리대행기관의 산업의학전문의, 보건관리대행 간호사, 사업장 간호사를 중심으로 직업성질환감시체계를 구축하여 주요 직업성질환들의 발생현황과 규모를 파악하고자 하였다. 또한 연차적으로 산업, 직업, 업무내용 등에 따른 분포나 원인을 기존 자료원(특수건강진단의 직업병 유소견자와 산재요양승인 되는 직업병자)과 비교하여 분석·기술하고 예방 및 관리를 포함한 보건의료기술개발까지을 포함하는 종합적인 감시체계를 구축하고 운용하고자 하였다. 방법: 구미지역의 산업적 특성에 맞는 직업성질환감시체계를 구축하고 지역 감시체계의 모델을 제시하였다. 6대 감시대상 직업성질환(독성 간염, 직업성천식, 직업성 근골격계질환, 직업성 피부질환, 직업성 암, 수지진동증후군)의 실행적 환례정의, 보고양식 및 보고체계 개발, 분석양식 및 결과 배포 형식을 개발하였으며, 그 유병규모를 파악하고, 감시질환의 분포 및 특성, 관련인자 등을 분석·기술하고자 하였다. 이때, 1년간의 환례분석시 직업병 유소견자 및 직업병 요양자에 대한 자료와 함께 비교 분석하였으며, 노동통계자료를 이용하여 년간 발생률을 추정하였다. 결과: 2001. 1. 1일부터 2002.4.30일까지 총 287건이 보고되었으며, 직업성 근골격계질환 132건(46.0%), 직업성 피부질환 100건(34.8%), 독성간염 34건 (11.8%), 직업성천식 16건 (5.6%), 수지진동증후군 5건 (1.7%) 이었으며 직업성 암은 한건도 보고되지 않았다. 보고경로별로는 보건관리대행에서 33건 (11.5%), 해당 유해인자별로 실시되는 특수검진 외의 각종 건강진단업무 수행 중 발견된 환례에 대한 보고가 206건(71.7%)이었다. 직종별 분류의 결과는 섬유업종사자, 단순노무종사자, 음식업종사자 등이 다수를 차지하였다. 근골격계질환의 경우, 수근관증후군이 42건(33%), 외상과염/내상과염이 39건(30%)로 가장 많았다. 직업성 피부질환은 97건이 접촉성 피부염으로 유기용제류가 59건(59%)으로 가장 많고, 니켈 및 에폭시수지에 의한 알레르기성 접촉성 피부염이 각각 6건과 5건이었다. 독성 간염은 모두 DMF 나 DMAc에 의한 것으로, 근무시작 후부터 간기능이상이 발견되기까지의 근무기간은 대부분이 3개월 이하이며, 1개월 이하인 경우도 10건이나 되었다. 동 기간 중 감시환례에 대해 산재요양 자료와 중복여부를 확인한 결과, 중복되는 것은 하나도 없었다. 특수건강진단에서 직업병유소견자로 판정된 경우는 독성간염에서 3건이 있었으며, 나머지 질환은 중복되는 것은 없었다. 2001도 구미지역의 근로자수와 보고환례건수를 이용하여 연간 발생률을 추정하였다. 근로자 10만 명당 연간 발생률은 상지 근골격계질환은 63.6명, 피부질환 48.2명, 독성 간염 17.9명, 천식 7.7명, 수진진동증후군 2.4명이었다. 참여예상인원은 총 46명이었으며, 실제 참여자수는 21명, 평균참여율은 46%, 실제 참여 1이당 평균 보고건수는 산업의학전문의가 28건으로 가장 많았고, 대행간호사는 45,건, 사업장 간호사는 3.3건이었다. 결론: 지역 감시체계는 기존 통계자료들에서 발견되지 않았던 직업성질환의 발견에 유용한 통계원이며, 특히 지역의 특성과 여건을 고려하여 체계화된 시스템을 구축하여 운용한다면 더 성과가 클 것이다. Objectives: Area-based occupational disease surveillance in Kumi (KODS) was used to collect data on occupational diseases. The data was used to estimate the magnitude of the diseases, to analyze for their characteristics and to find links for their intervention and prevention. Methods: Since January 2001, occupational physicians and nurses in Occupational Health Service (OHS) have reported six major occupational diseases; occuaptional musculoskeletal disorders of the upper extremities (MSDUE), occupational dermatoses, toxic hepatitis, occupational asthma (OA), hand-arm vibration syndrome (HAVS), and occupational cancer. For the respective diseases, a reporting sheet and operational diagnostic criteria were developed by the KODS. An analysis of the KODS data, collected over a certain period, was compared with data from the Korea Labor Workers Corporation (KLWC) and the Specific Health Examination (SHE), and the incidence rates of the diseases estimated. Results: Between Jan 2001 and Apr 2002, 287 cases of the six major occupational disease were reported. Of these, there were 132 (46.0%), 100 (34.8%), 34 (11.8%), 16 (5.6%), and 5 (1.7%), cases of MSDUE, occupational dermatoses, toxic hepatitis, OA, and HAVS, repectively. But, there were no cases of occupational cancer. 33 (11.5%) of the incidence were reported via the OHS, 206 (71.7%) from health checkups, and the other 48(16.8%) from other routes. The synthetic fibers and electronic components manufacturing industries accounted for the greatest number of reported cases. With resport to occupation, the greatest numbers of incidence were reported from the elementary occupations, textile workers, assemblers, and cooks and food services worker, in that order. Of the MSDUE cases, carpal tunnel syndrome and epicondylitis were the two most common diseases. Most of the occupational dermatoses were due to contact dermatitis, with organic solvents (59%), nickel (6%), and epoxy resin (5%) accounting for the majority of these cases. All cases of toxic hepatitis were induced by dimethylformamide or dimethylacetamide, which were reported by a unique monitoring system. During same period, there were no cases claimed by workers to the KLWC, and only three cases from SHE, were identified. Using data from workers' number and surveillance, the annual incidence of MSDUE, dermatoses, hepatitis, OA, and HAVS, per 100,000 workers were 63.6, 48.2, 17.9, 7.7, and 2.4, respectively. Conclusions: These results show that an area-based surveillance system can be very effective for the collection of data on work-related diseases, at least in Kumi.

알루미늄 PEO 코팅의 결정상에 미치는 공정 조건에 대한 연구 II. Bipolar 펄스와 전해액

김배연,함재호,이득용,김용남,전민석,김기윤,최지원,김성엽,김광엽,Kim, Bae-Yeon,Ham, Jae-Ho,Lee, Deuk Yong,Kim, Yong-Nam,Jeon, Min-Seok,Kim, Kiyoon,Choi, Ji-Won,Kim, Sung Youp,Kim, Kwang Youp 한국결정성장학회 2014 한국결정성장학회지 Vol.24 No.2

A1100, A5052, A6061, A6063, A7075 규격의 시판 알루미늄 합금 판재를 $Na_2SiO_3$와 $Na_2P_2O_7$ 전해질에서 pulse폭 $2000{\mu}sec$, + impulse 420 V, $400{\mu}sec$, -impulse $300{\mu}sec$의 bipolar pulse로 플라즈마 전해 산화 코팅(plasma electrolytic oxidation coating)한 산화피막의 결정상을 분석하였다. 표면에 형성된 산화물의 결정상은 ${\alpha}-alumina$, ${\gamma}-alumina$, ${\eta}-alumina$, $Al_{4.95}Si_{1.05}O_{9.52}$, 그리고 $(Al_{0.9}Cr_{0.1})_2O_3$가 관찰되었다. Bipolar pulse에 의해서 전해액의 성분인 Si가 산화피막에 포함되며, 포함된 Si는 결정상을 형성하기도 하지만 유리상을 형성시킨다. 이때 합금의 Mg 성분은 유리상의 양을 증가시킨다. Micro plasma에 의해서 용융된 표면은 유리상이 먼저 형성되고 이후 계속된 micro plasma의 열에 의하여 새로운 결정상으로 전이가 일어나는 과정을 거치며, 이에 따라 기존에 보고된 결정상이외에도 다양한 결정상이 형성될 수 있음을 추측할 수 있다. Crystallographic phases of Plasma electrolytic oxidized Al alloy, A1100, A5052, A6061, A6063, A7075, were investigated. Two types of electrolyte $Na_2Si_2O_3$ and Na2P2O7 were also compared. Bipolar pulse, $2000{\mu}sec$ with $400{\mu}sec+420V$ impulse and $300{\mu}sec$ - impulse were applied for 20 min. ${\alpha}-alumina$, ${\gamma}-alumina$, ${\eta}-alumina$, $Al_{4.95}Si_{1.05}O_{9.52}$, and $(Al_{0.9}Cr_{0.1})_2O_3$ were mainly observed. Si, component of electrolyte, were moved into the PEO layer by bipolar pulse. Glassy phase was also observed at the surface of $Na_2Si_2O_3$ electrolyte treated PEO layer, and increased with the Mg content of Al alloy. It is concluded that at first glassy phase was formed by the micro plasma, and the high temperature of plasma turns glassy phase to several crystalline phases. And we could expect that many other crystalline phase could be formed by PEO process.

동적 신장 신티그래피 검사 시 사용되는 Gates 법과 Modified Gates 법의 사구체 여과율 비교에 관한 고찰

함준철,반영각,박민수,조석원,임한상,김재삼,이창호,Ham, Jun-Cheol,Bahn, Young-Kag,Park, Min-Soo,Cho, Seok-Won,Lim, Han-Sang,Kim, Jae-Sam,Lee, Chang-Ho 대한핵의학기술학회 2012 핵의학 기술 Vol.16 No.1

사구체 여과율은 신기능의 평가 및 신 질환의 조기 발견 및 만성 신 질환 환자의 경과 관찰에 중요한 지표가 된다. 본 연구에서는 동적 신장 신티그래피의 Gates법과 Modified Gates법을 채혈을 이용한 MDRD법 공식을 기준으로 그 차이를 비교, 분석하고자 한다. 2010년 11월부터 2011년 8월까지 본원에 내원하여 신장 신티그래피 검사를 시행한 45명의 환자를 대상으로 시행하였다. 이 중 20명의 환자는 AGUS(Philips Medical System, Cleveland, OH, USA) 장비의 Gates법과 MDRD법(Modification of Diet Renal Disease) 공식에 의한 사구체 여과율 값을 비교하였으며, 20명의 환자는 INFINIA (General Electric Healthcare, Wisconsin, MI, USA) 장비의 Modified Gates법과 MDRD법 공식에 의한 사구체 여과율 값을 비교하였다. 마지막으로 경과 관찰 시 MDRD법 공식에 의한 사구체 여과율 변화가 없는 환자 5명을 대상으로 Gates법과 Modified Gates법을 비교하였다. Gates법과 Modified Gates법 모두 MDRD법 공식에 의한 사구체 여과율 값과 높은 상관 관계를 보였으며($p$<0.01, r=0.903, r=0.867), Gates법의 대응 차 평균은 $2.05{\pm}2.54mL/min/1.73m^2$로 나타났고, Modified Gates법의 대응 차 평균은 $25.2{\pm}3.71mL/min/1.73m^2$로 나타났다. 마지막으로 5명의 환자에서 실시된 Gates법과 Modified Gates법의 비교는 높은 상관 관계를 보였으며($p$<0.05, r=0.949), 대응 차 평균은 $20.4{\pm}8.84mL/min/1.73m^2$ 로 나타났다. Gates법과 Modified Gates법 및 MDRD법 공식에 의한 사구체 여과율 값은 서로 높은 상관 관계를 보였다. 동적 신장 신티그래피 검사 시 사용되는 Gates법과 Modified Gates법의 상관 관계를 인지하고 검사를 진행 한다면, 진단능을 향상시켜 정확한 신기능의 평가가 이루어질 것으로 사료된다. Purpose: Glomerular filtration rate is an important index for assessment of renal function, early discovery of renal disease, and progress observation of chronic renal disease patients. In the present study, the objective is to conduct a comparative analysis of differences between Gates and Modified Gates method in dynamic renal scintigraphy based on MDRD (Modification of Diet Renal Disease) formula using blood collection. Materials and Methods: Renal scintigraphy was performed for 45 patients who visited our hospital between November 2010 and August 2011. For 20 patients of those tested, glomerular filtration rates from Gates method and MDRD formula using AGUS equipment, were compared. For the other 20 patients, glomerular filtration rates from Modified Gates method and MDRD formula using INFINIA equipment. Finally, Gates and Modified Gates method were compared for 5 patients who indicated no change in glomerular filtration rates from MDRD formula during progress observation. Results: Glomerular filtration rates from both Gates and Modified Gates method showed a high correlation with those from MDRD formula ($p$<0.01, r=0.903, r=0.867), with a paired difference mean for Gates method of $2.05{\pm}2.54mL/min/1.73m$, and that for Modified Gates method of $25.2{\pm}3.71mL/min/1.73m$. Finally, the values for Gates method and those for Modified Gates method showed a high correlation for the five patients ($p$<0.05, r=0.949), with a paired difference mean of $20.4{\pm}8.84mL/min/1.73m$. Conclusion: Glomerular filtration rates from Gates method, Modified Gates method and MDRD formula showed mutually high correlations. If the tests are performed with recognition for the correlations between Gates and Modified Gates method used in a dynamic renal scintigraphy, then an accurate assessment of renal function is considered possible with an improved diagnostic ability.

A case of livedo reticularis in a patient after wasp venom intakes

( Min Seok Ham ),( Ji Hyuck Hong ),( Dae Yeon Kim ),( Dong Won Lee ),( Young Chul Kye ),( Hyo Hyun Ahn ),( Soo Hong Seo ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Livedo reticularis refers to various conditions in which there is mottled discolouration of the skin. Livedo reticularis results from disturbance of blood flow to the skin causing low blood flow and reduced oxygen tension to the skin. The usual reactions after an insect sting are mild redness and swelling at the stinging site, and the most serious reaction is anaphylaxis. There have been isolated reports of late-onset reactions, such as vasculitis, neuritis, nephritis and serum sickness, occuring in association with an insect sting. But there are no reports associated with an venom intakes. A 39-years-old male had been visited to ER for headache and reticular patterned rash on upper and lower extremities 7 days after homemade wasp wine intakes. CSF tapping test and Laboratory examinations were within normal limits except C-reactive protein elevated. He was discharged on prescription of aceclofenac(NSAID) and gabapentin. But he re-visited with persistent pain and rash. So he referred to our clinic. Clinically late-onset reaction was suspected that triggered by venom intakes. Treatment was initiated with oral methylprednisolone 24 mg/day. A histopathological study revealed basal hyperpigmentation, focal spongiosis and superficial perivascular lymphocytic infiltration. As the patient improved symptom, steroid was tapered. Herein we report an livedo reticularis patterned late-onset reaction, which was occurred by wasp venom intakes.

A case of kaposi sarcoma presenting as rapidly growing polypoid nodule mimicking eccrine poroma

( Min Seok Ham ),( Jun Hyuk Cho ),( Sung Jin Park ),( Dai Hyun Kim ),( Soo Hong Seo ),( Hyo Hyun Ahn ) 대한피부과학회 2021 대한피부과학회 학술발표대회집 Vol.72 No.2

A rare association and sequential development of pyoderma gangrenosum and livedoid vasculitis

( Min Seok Ham ),( Sung Jin Park ),( Ji Hyuck Hong ),( Dae Yeon Kim ),( Soo Hong Seo ),( Young Chul Kye ),( Hyo Hyun Ahn ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Leg ulcers may be associated with various diseases. But the diseases are clinically and pathologically different. Among them, Pyoderma gangrenosum is a neutrophilic dermatosis that is often diagnosed clinically. It typically manifests as rapidly progressing, well-defined, painful ulcerations with ragged, violaceous, and undermined edges. Otherwise, Livedoid vasculitis is a rare, chronic, recurrent disease lead to local skin ulcer formation. In the acute stage, ulcerations develop with necrotic areas as the result of cutaneous ischemia. Association of the two different disease entities is rare and very few cases have been reported. We report case of 64-year-old female who presented with well-defined multiple ulceration lesions on the both lower leg which diagnosed with pyoderma gangrenosum. After systemic steroid therapy, the lesions improved. Then, the patient presented with asymptomatic crusted ulceration and atrophied blanches on both lower leg 3 years later. In the laboratory test, antiphospholipid antibody and autoantibodies test were negative and histopathological study revealed fibrin thrombi in superficial dermal vessels. Under the diagnosis of livedoid vasculitis, treatment was initiated with oral pentoxifylline and aspirin. Skin lesions improved and there were no sign of recurrence so far. Herein we report a rare case of association and sequential development of pyoderma gangrenosum and livedoid vasculitis.

Treatment of recalcitrant viral warts using a 1064 nm Nd:YAG laser

( Min Seok Ham ),( Ji Hyuck Hong ),( Dae Yeon Kim ),( Dong Won Lee ),( Young Chul Kye ),( Hyo Hyun Ahn ),( Soo Hong Seo ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Viral warts are benign proliferations of epithelial cells caused by infection by human papilloma virus (HPV) types 1, 2, 4 and 57. The best approach to treatment-refractory warts is unclear. There is a variable treatment modalities regarding the therapies of recalcitrant warts, Laser therapy is considered a promising treatment method for recalcitrant warts. Different types of lasers have been used for treatment of warts. long-pulsed Nd:YAG laser is considered a good treatment modality in resistant plantar warts. Objectives: We evaluated the clinical improvement of 13patients with a recalcitrant viral wart who were treated with a long pulsed ND:YAG laser. Methods: We defined recalcitrant warts as those not responding to other treatments and being present for longer than 6months. This study included 13patients with single or multiple recalcitrant viral warts that persisted for more than 6 months. 13patients with 206 recalcitrant plantar warts who were treated by 1064Nd:YAG laser. The diagnosis of plantar warts was made by clinical examination. Results: 3patients (23%) were completely cleared of their warts with long-pulsed Nd:YAG laser. 205 recalcitrant viral warts were decreased to 35 lesions; total clearance rate are 83%. There are no significant adverse effect. Conclusion: Nd:YAG laser emits microwaves with a wavelength of 1064 nm. This is the ideal wavelength to destroy the HPV virus. Long-pulsed Nd:YAG laser for to treat recalcitrant viral wart is safety and efficiency modality.