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근긴장이상 환자에서 저빈도 반복 경두개자기자극의 효과 1예
김영범,김연희,이강우,장원혁 대한근전도전기진단의학회 2011 대한근전도 전기진단의학회지 Vol.13 No.1
We here reported the suppression of dystonia after the low frequency rTMS in a patient with the pediatric stroke. A 21-year old woman with infarction in the left basal ganglia and corona radiata showed the dystonia on right extremities since 4 years old. The Movement score and the Disability score of Burke-Fahn-Mardsen Dystonia Rating Scale (BFMDRS) was 28.0 and 5. She received a 20 minutes treatment session with 1 Hz rTMS on the left premotor cortex three times per week for 2 weeks. After treatment, the Movement score and the Disability score of BFMDRS scale were improved to 17.5 and 4, respectively. These rTMS effects were maintained for about 2~4 hours after each session. In this case, we observed that lowfrequency rTMS improved specific motor symptom of severe dystonia. We also observed that excessive corticospinal drive could be suppressed by low-frequency rTMS on the premotor cortex.
김영범,박훈,최주열,박성호,이국행,이병철,이명철,최익준 대한이비인후과학회 2013 대한이비인후과학회지 두경부외과학 Vol.56 No.11
Background and Objectives Diffuse sclerosing variant (DSV) is a rare variant of papillary thyroid carcinoma (PTC) and has been adopted as a histologic variant. Due to the limited number of cases and the heterogeneity of the tumor’s clinical behavior, there is no consensus for DSV’s optimal treatment and post-operative follow-up. The purpose of this study is to evaluate the clinical manifestation, recurrence and prognosis of 10 patients with DSV. Subjects and Method We retrospectively reviewed ten consecutive patients in whom DSV was first observed between 2000 and 2012. All patients are presently under active follow-up at Korea Cancer Center Hospital. Patients underwent a total thyroidectomy with central compartment and laterocervical lymph node dissection only when this involvement was documented by pre-surgery ultrasound examination with fine needle aspiration biopsy. Results The mean observation interval was 41.6 months. The ratio of male to female was 1 : 9, and the age of incidence was 34.2±11.4. The average size of mass was measured 2.9±1.9 cm. Upon the diagnosis, eight cases had central and lateral neck lymph nodal metastasis, which was confirmed during the operation. There was no distant metastasis, but one case was confirmed with lung metastasis during the follow-up period. There was no mortality during the follow-up periods in all ten cases. Conclusion DSV of PTC has high risk characteristics of large tumor size, extrathyroidal extension, and multiple lymph nodes metastasis. We may expect comparable outcome with classical PTC by proper surgical treatment and postoperative radioactiveiodine ablation.
CYP2C9 Mutation Affecting the Individual Variability of Warfarin Dose Requirement
김영범,고문주,Dae Gu Lee,황지혜,도종걸 대한재활의학회 2012 Annals of Rehabilitation Medicine Vol.36 No.6
Warfarin is a frequently prescribed anticoagulant in rehabilitation patients. Adverse drug reactions of warfarin were reported as bleeding and cutaneous microvascular thrombosis. Major bleeding, such as intracranial hemorrhage and psoas hematoma, in patients receiving anticoagulation therapy is a rare condition, but sometimes very serious complication that can even be fatal. Patient-specific factors (eg, age, body size, race, concurrent diseases, and medications) explain some of the individual variability in warfarin dose, but genetic factors, which influence warfarin response, explain a significantly higher proportion of the variability in the dose. There are two identified genes that are responsible for the main proportion of the genetic effect: CYP2C9, which codes for the enzyme cytochrome P450 2C9 that metabolizes S-warfarin, and VKORC1, which codes for warfarin’s target, vitamin K epoxide reductase. We report a case of intolerance to warfarin dosing, due to impaired drug metabolism in a patient with CYP2C9*1/*3 and VKORC 1173TT. Fortunately, there are no severe complications.
DYNAMIC WEDGE의 임상 적용 가능성에 관한 고찰
김영범,정세영,황웅구 대한방사선치료학회 1995 大韓放射線治療技術學會誌 Vol.7 No.1
Dynamic wedge system has been introduced to modify the beam profile and to make homogeneous isodose curves in the mass of irregular shape. Before the clinical use of dynamic wedge, several factors such as wedge transmission factor, dose profile, percent depth dose, and wedge angle have to be measured quantitatively. Film dosimetry is used to evaluate these factors in this study. A comparison of the result of the dynamic wedge to physical wedge system is made. A positive result for the application of the dynamic wedge to clinic is derived even though there is a limitation in accuracy of the dosimetry system used. To measure all factors quantitatively, more accurate dosimetry systems are required.