정신분열증에서 공존하는 신체질환에 대하여

지익성,왕성근,신석철,이선우,황선희,신용재,김정란,배경도 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1

In order to determine the frequency of physical illness in schizophrenia, 107 schizophrenics were assessed with physical exam and routine laboratoy test. The results were as follows 1) Among the total number of 107 schizophrenics, 31 had the physical illness(29%), and among the schizophrenics with physical illness, female outnumbered male at the rate of 17:14. 2) There was no difference between schizophrenics with physical illness and schizophrenics without physical illness in demographic characteristics. 3) Classification of physical illness were disease of skin 7 (22.6%), musculoskeletal system 5(16. 1%), ENT(ear nose throat) 3(9.7%), endocrine system 3(9.7%), circulatory system 2(6.5%), respiratory system 2(6.5%), digestive system 1(3.2%), genitourinary system 1(3.2%), infection 1(3. 2%), eye 1(3.2%) respectively Authors suggest that physical exam and routine laboratory test should be done for all hospitalized psychiatric patients

만발성 근긴장증과 지연성 운동장애가 병발한 만성 정신분열증 환자에서 clozapine 치료 1례

지익성,이선우 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

Tardive dystonia and Tardive dyskinesia have been the most persistent problem of classical antipsychotics because of their potential irreversibility. No effective treatment for them have been found to date. The author report a case of tardive dystonia and tardive dyskinesia in one woman patient with schizophrenia that has successfully responded to clozapine. Treatment with diazepam, lithium, valproate were ineffective in this patient. Thus, clozapine was tried and the effect was markedly improved. The author recommend treatment with clozapine in patient with antipsychoticinduced tardive dystonia or tardive dyskinesia.

Risperidone으로 호전된 Capgras' Syndrome

지익성,배경도,이선우 충남대학교 의과대학 지역사회의학연구소 1996 충남의대잡지 Vol.23 No.2

A case of Capgras' syndrome in a 19-year-old girl who improved on Atypical antipsychotics, Risperideone is described. The patient's delusion of misidentification (She believed that her parents are not truly her parents and even she herself is not she) was treated with Risperidone. She showed significantly improvement. Authors believe Risperidone's antipsychotic effect in the treatment of schizophrenia warrants its consideration in alleviating other delusions of various psychotic disoreders, including the dedusion of doubles.

Clozapine으로 인한 야뇨증에서 Oxybutynin Hydrochloride 사용 3례

지익성,박철범,이선우,왕성근,신석철 大韓神經精神醫學會 2000 신경정신의학 Vol.39 No.5

Clozapine은 치료 저항성 정신분열병의 치료에 있어서의 우수한 효과에도 불구하고, 야뇨증과 같은 환자를 곤란하게 하는 부작용을 유발한다. 야뇨증은 발견 즉시 처리되야 할 부작용 중의 하나이다. 저자들은 oxybutynin hydrochloride가 일일 용량 5∼10mg의 소량으로, 별다른 부작용 없이 빠르게 항 야뇨증 효과가 나타남을 알 수 있었고, clozapine으로 인한 야뇨증 치료의 대안으로 만족할 만한 것이었다. 중심단어:Oxybutinin hydrochloride·Clozapine·야뇨증·정신분열병증. Nocturnal enuresis has been recognized as an adverse effect of clozapine treatment. We re-ported 3 chronic schizophrenic patients who had showed nocturnal enuresis following clozapine treatment. Oxybutynin hydrochloride on clozapine-induced enuresis was very effective in 3 patients. The dose in our patients was 5 to 10mg/day. This medication was well tolerated. It is suggested that oxybutynin hydrochloride is a effective therapeutic option in clozapine-induced nocturnal enuresis. KEY WORDS:Oxbutynin hydrochloride ·Clozapine·Nocturnal enuresis·Schizophrenia.

양극성 기분장애에서 세로토닌 수용체 유전자의 다형성(102T/C)에 관하여

지익성,신석철,왕성근,이선우,신용재,김충수,김상국,최하석,오승용,류택근,이영호 대한생물치료정신의학회 1999 생물치료정신의학 Vol.5 No.2

치료저항 정신분열병환자에서 Clozapine의 효과 및 안전성

지익성,김영희,신석철,왕성근,신윤오,이선우,김정란 충남대학교 의학연구소 2001 충남의대잡지 Vol.28 No.2

In order to assess the efficacy and safety of clozapine, 50 in-patients with treatment-resistanat schizophrenia were evaluated using PANSS(Positive and Negative Symptome Scale for Schizophrenia), CGI(Clinical Global Impression), AMS(Abnormal Involuntary Movement Scale), Adverse Event-Somatic Symptoms, Neurological Rating Scale for EPS before and during treatment. Mean daily dosage of clozapine was 344.15±123.43mg at 12th week. A clinically significant improvement in positive, negative, and general psychopathology was noted as early as week 2 through 12 week. The tolerability of clozapine was generally found to be good. Drowsiness/sleepiness, Hypersalivation, and Constipation were the most common side effects. There was no neutropenia, and 3 patients suffered from seizures. These results suggest that clozapine is worth considering for the treatment-resistant patients

腦室-腹腔間 및 腦室-心房間 側路術의 比較硏究

池善豪 梨花女子大學校 韓國生活科學硏究院 1978 韓國生活科學硏究院 論叢 Vol.21 No.-

著者는 腦室-心房間 側路術과 腦室-腹腔間 側路術의 效果 및 그 合倂症을 比較 檢討하여 水頭症의 外科的 治療에 適用하고자 過去 4年間(1974∼1977) 梨花女子大學校 醫療院 附屬病院 神經外科에 入院되었던 水頭症患者 중 腦室-心房間 혹은 腦室-腹腔間 側路術을 遂行하였던 모든 患者를 對象으로 하여 側路術의 效果 및 그 合倂症을 分析하여 그 意義를 評價하였다. 對象患者 總 40例에 대하여 總 49回의 側路術이 施行된 바, 그 診斷範圍는 閉鎖性 水頭症이 24例(60%)였고, 水頭症의 原因은 頭蓋腔內 腫瘍(40%)이 가장 많았다. (1) 側路術前後의 患者의 狀態를 比較한 바 腦室-心房間 側路術의 效果가 휠씬 優秀하였다. (2) 患者의 死亡率은 腦室-腹腔間側路術이 施行된 患者에서 더욱 높았다. (3) 患者는 腦室-心房 間側路術의 施行後 훨씬 早期에 退院이 可能하였다. (4) 合倂症發生率 및 感染發生率은 腦室-心房間 側路術이 施行된 患者에서 더욱 높았다. (5) 感染이 發生되었던 全例에서 Staphylococcus epidermidis가 原因菌으로 證明 되었다. 腦室-心房間 側路術은 腦室-腹腔間 側路術에 比하여 그 效果가 優秀數하였으나 合倂症 및 感染發生率이 높았다. The author reports an analysis of 40 patients in whom surgical treatment for hydro-cephalus was either a ventriculoperitoneal or ventriculoatrial shunt. A total of 49 shunting procedures were required to control the hydrocephalus in these patients. This report analyzes the experience at the Ewha Womans University Medical Center Hospital over the last 4 years with regard to the effectiveness and complications of these two placements. When the effectiveness of the ventriculoatrial versus the ventriculoperitoneal place-ment was compared, the patients with ventriculoatrial shunts had better postoperative conditions than the patients with ventriculoperitoneal shunts; however, the patients with ventriculoatrial shunts developed higher rate of complications, including infections, than did the patients with ventriculoperitoneal shunts.

外傷性 後頭窩內合倂症의 診斷基準에 關한 硏究

池善豪 梨花女子大學校 韓國生活科學硏究院 1977 韓國生活科學硏究院 論叢 Vol.19 No.-

著者는 外傷에 인한 後頭窩內 合倂症의 臨床的 趨勢를 把握하고 그 診斷基準을 設定하고자 後頭下頭蓋切除術에 의하여 外傷性 後頭窩內合倂症이 確認된 모든 患者를 對象으로 臨床的 特徵을 綿密히 分析하고 그 意義를 評價하였다. (1) 後頭窩內合倂症은 硬膜上血腫(43%), 硬膜下血腫(25%), 硬膜下水囊腫(21%) 및 小腦血腫(11%)이었고 全例에서 後頭部에 局限된 頭皮血腫, 頭皮裂創 및 頭皮挫傷 등의 外傷의 證據를 보였다. (2) 後頭窩內合倂症은 患者의 年齡이 적을수록 發生率이 높았다. (3) 後頭窩內合倂症은 意識障碍(89%), 生徵候의 變化(54%) 및 局在徵候(25%)를 보였다. (4) 後頭窩內合倂症의 全例에서 後頭窩의 骨折이 있었고, 骨折의 樣相은 後頭骨의 半軸前後面像에서 骨折線의 位置와 方向에 따라 5가지 型(Fig. 1)으로 區分되었다. (5) 後頭窩內合倂症의 確認된 出血源은 橫靜脈洞(9例)과 連結靜脈(3例)이었다. (6) 後頭窩內合倂症의 後頭下頭蓋切除術에서 後頭窩內壓의 減少를 위하여 大後頭槽를 切開하였고 그 生存率은 82%였다. 後頭窩內合倂症의 共通所見은 後頭部外傷이 同伴된 後頭窩의 骨折과 意識障碍이며 이를 後頭窩內合倂症의 診斷基準으로 採擇하고자 한다. Traumatic complications located within the posterior fossa continue to escape detection for they are not readily demonstrated by the new diagnostic studies and all too often are not considered until found at autopsy. This study is made to stress the importance of recognition and operability for hemorrhages and fluid accumulations in the posterior fossa as a result of cranial injury. Included in the series are all the cases of clinically significant verified complications in the posterior fissa due to occipital trauma. The various posterior fossa lesions seen at the Ewha Womans University Hospital over a course of 3 years (1974~1976) include the following : (1) epidural hematoma(43%), (2)subdural hematoma(25%), (3)subdural hygroma(21%), and (4) cerebellar hematoma(11%). The diagnostic criteria for recognition of complications in the posterior fossa are as follows : there is evidence of local trauma, such as a scalp hematoma, laceration or contusion to the occiput severe enough to produce a fracture of the occipital bone which may cause unconsciousness.

急性 腦硬膜下血腫의 死亡要因에 關한 硏究

池善豪 梨花女子大學校 韓國生活科學硏究院 1977 韓國生活科學硏究院 論叢 Vol.19 No.-

著者는 急性 腦硬膜下血腫 患者의 死亡率에 미치는 諸要因을 追究하기 위하여 閉鎖性 頭部外傷 患者를 對象으로 하고 頭部外傷 후 72時間 以內에 開頭術을 施行하여 腦硬膜下血腫이 確認된 84例에서 臨床的 分析을 試圖하였으며 患者의 死亡에 影響을 주는 諸要因을 評價하였다. 頭部外傷 患者를 評價하는 重要한 手段으로서 腦動脈撮影術에 의종하였고, 전례의 71%에서 開頭術前에 兩側 腦動脈撮影術을 施行하였다. (1) 急性 腦硬膜下血腫 患者의 全體 死亡率은 52%였다. (2) 急性 腦硬膜下血腫 患者는 開頭術의 時期가 빠를수록 死亡率이 높았다. (3) 急性 腦硬膜下血腫 患者는 41~60歲에서 死亡率이 가장 높았고, 21~40歲에서 生存率이 가장 높았다. (4) 急性 腦硬膜下血腫의 兩側分布率은 29%였고, 兩側分布時의 死亡率은 67%였다. (5) 急性 腦硬膜下血腫 患者의 頭蓋腔內病巢 合倂率은 88%였고, 頭蓋腔內病巢의 合倂時 死亡率은 57%였다. 著者는 經驗을 土臺로 廣範圍한 開頭術을 勸奬하고 있으며 이 術式은 頭蓋骨緣에 가해지는 腦壓迫에 附隨되어 發生되는 靜脈鬱血을 減少시키고 腦浮腫에 인한 腦壓上昇을 減少시키는데 큰 意義가 있을 것으로 생각된다. To investigate the factors responsible for mortality from acute subdural hematoma, clinical analysis and evaluation were performed in a total of 84 cases of acute subdural hematomas. Included in the series are all the cases of surgically verified subdural hematomas which came to craniotomy within 72 hours of injury and occurred as a result of closed head injury. The results are as follows; (1) In an analysis of the relationship of time of surgery to mortality, it is revealed that the mortality rate is 67% for those operated on within 24 hours of injury and 52% for those operated on within 72 hours. (2) In age factor, the striking figures are the highest mortality rate among the patients from 41 to 60 years of age, and the highest survival rate among the patients from 21 to 40 years of age. (3) The incidence of bilateral acute subdural hematoma is 29% of the cases, with a 67% mortality rate.

탄광부 진폐증의 운동지수

조영선,김세곤,문우기,유재인,정치경 가톨릭대학 산업의학 센타 산업의학연구소 1984 韓國의 産業醫學 Vol.23 No.3

Exercise index(EI) was measured on 933 pneumoconiosis patients (865 patients with small rounded opacities and 68 patients with large opacities) and 176 suspected pneumoconiosis patients from Korean anthracitic mines, in order to evaluate the ventilatory impairment of pulmonary function according to the chest radiographic findings of pneumoconiosis. Exercise index was obtained from the maximum breathing capacity (MBC) and the exercise ventilation volume(EV) which were measured by spirometer and two step-test. Classification of pneumoconiosis was based on the international classification of ILO U/C. The results were as follows: 1. The mean value of E1 was significantly increased in pneumoconiosis patients with large opacities(46.0%) than in patients with small rounded opacities(26.5%) and with suspected pneumoconiosis(25.0%). The number of jpatients in substandard EI was 97.1% in patients with large opacities but 49.4% in patients with small rounded opacities and 40.3% in patients with suspected pneumoconiosis. 2. The mean values of EI and the number of patients in substandard EI were markedly increased in pneumoconiosis patients with small rounded opacities and suspected over 50 years of age. However, the number of patients in substandard EI showed no association with age in pneumoconiosis patients with large opacitis. 3. In pneumoconiosis patients with small rounded opacities, the mean values of EI and the number of patients in substandard EI showed significant association with the profusion (category) but no significant association with the type of small rounded opacities. 4. In pneumoconiosis patients with large opacities, the mean values of EI and the number of patients in substandard EI showed no significant difference between patients complicated with and without pulmonary tuberculosis. 5. No significant association of EI and the number of patients in substandard EI with the size of large opacities was observed in pneumoconiosis patients with large opacities, however, the mean values of EI showed increasing tendenccy in category B and C compared to category A.