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박상민,윤명수,김주은,서승표,박진성,임수택,최소침습 척추치료 연구그룹 대한척추외과학회 2023 대한척추외과학회지 Vol.30 No.1
연구계획: 문헌고찰목적: 최소 침습적인 요추 재수술 방법을 소개하고, 기존에 발표된 논문을 분석하고자 한다. 선행 연구문헌의 요약: 최근 척추 수술의 빈도가 증가하면서 요추 재수술의 빈도가 증가하고 있다. 다양한 최소 침습적 기법을 이용한 재수술이 시도되고있으며, 그 중에서도 기존 수술 부위를 피하기 위해 전방 또는 측면 접근과 내시경적 수술 방법을 선호하는 경향이 있다. 대상 및 방법: 관련 연구 고찰결과: 내시경적인 방법으로는 단일공 내시경과 양방향 내시경이 많이 사용되고 있다. 두 가지 수술 모두 요추 재수술에서 사용할 수 있으며 특히 추간판절제술 및 후궁절제술에서 많이 사용된다. 양방향 내시경의 경우에는 후궁절제술 후 재수술로 유합술을 이용하는 경우에도 적용이 가능하다. 원통형 견인기는 주로 최소침습적 경추간공 요추 추체간 유합술 때 많이 사용하고 있으며 후궁절제술 후 재발이나 추간판 탈출증 재탈줄 시 유합술로 변경하는 경우 많이 사용한다. 측방 접근 방법도 사용하는 경우도 많으며 특히 후방의 유착이 심할 것으로 예상되는 경우 많이 사용하고 있다. 결론: 척추 재수술은 척추 의사에게 피할 수 없는 수술이며 이를 해결하기 위한 다양한 수술 방법들이 있다. 고식적인 방법을 통해 수술하는 것이 원칙이지만, 최근 소개된 다양한 최소침습적인 방법들도 환자에게 유용한 치료 방법으로 생각된다.
고혈압 환자에서 하이자(TM) 정의 안정성과 유효성 평가를 위한 Community - based study
HIGH 연구자 그룹(HIGH Study Group) 대한내과학회 2002 대한내과학회지 Vol.62 No.1
N/A Background: This study was designed to evaluate efficacy and safety of losartan/hydro-chlorothiazide combined tablet (Hyzaar?) under usual practice condition. Methods: In HIGH (Hyzaar? In Group of Hypertensive patients) study, patients diagnosed as hypertension were on losartan (50 mg)/hydrochlorothiazide (12.5 mg) combined tablet (Hyzaar?) once daily for more than 8 weeks. Blood pressure was measured at least twice; prior to administering Hyzaar? and 8 weeks after. Blood pressure at week 4 was also measured when possible. Adverse experience was investigated throughout and 14 days following the treatment. Results: A total of 2428 patient s (male : female=4:6, mean age; 57.5±11.3) were assessed. On week 8 of treatment, systolic blood pressure and diastolic blood pressure measured were 135.3±14.7mmHg, 84.4±9.3mmHg, respectively. These denote 23.1mmHg, 12.4mmHg decrease from the baseline levels, respectively. After 8 weeks of treatment, blood pressure in 79% of patients either reached the goal (SBP<140mmHg and DBP<90mmHg) or was under control (reduction of diastolic blood pressure≥10mmHg). Gender, presence of diabetes mellitus, body mass index and comedication of other antihypertensive agents did not affect the degree of blood pressure reduction by Hyzaar? treatment. Decrease of diastolic blood pressure in younger age groups under 40 and 41-49 years-old were significantly greater compared to that of elderly patients over 70 years-old (p<0.05, p <0.01, respectively). Greater decrease of blood pressure (p <0.001) was seen in patients with higher baseline blood pressure. Clinical adverse experience was seen in 26 patients (1.1%) and any specific adverse experience did not exceed 1%. Conclusion: Treatment of losartan (50 mg)/hydrochlorothiazide (12.5 mg) is highly effective in lowering blood pressure with few adverse experience in hypertension patient s.(Korean J Med 62:25-34, 2002)
박상민,박현진,구기형,홍재영,임수택,최소침습 척추치료 연구그룹 대한척추외과학회 2023 대한척추외과학회지 Vol.30 No.1
Study Design: Review article Objectives: To introduce minimally invasive surgical (MIS) techniques and to review previous studies about these techniques. Summary of Literature Review: Recent trends indicate an increase in the use of MIS for spinal fusion. According to reports, MIS reduces postoperative morbidity, with surgical outcomes comparable to those of conventional spine surgery. Furthermore, there are reportedly fewer complications and pain after surgery, resulting in a rapid return to everyday life. Materials and Methods: A review of the relevant articles. Results: MIS techniques, such as biportal endoscopy, the use of a tubular retractor, and the anterior approach, have recently become increasingly popular. Access to the intervertebral disc through the intervertebral foramen is a characteristic shared by biportal endoscopy and the use of a tubular retractor. Numerous investigations have demonstrated that procedures employing a tubular retractor yield clinical and radiographic outcomes comparable to those of conventional open spine surgery. Biportal endoscopy is still undergoing clinical investigations, and its safety and efficacy have not yet been established. Anterior approach fusion is mainly used in patients with mild central canal stenosis; thus, its indications are somewhat limited compared to conventional posterior fusion. However, additional decompression after anterior approach fusion allows both direct and indirect decompression to be obtained. Conclusions: With MIS, patients’ satisfaction after surgery is high due to the small amount of bleeding during surgery and limited damage to surrounding anatomical structures. However, these MIS techniques have narrow indications, and we must accurately understand the disadvantages and limitations of each technique.
박상민,홍재영,박시영,손은석,임수택,최소침습 척추치료 연구그룹 대한척추외과학회 2023 대한척추외과학회지 Vol.30 No.4
Study Design: Review article. Objectives: To introduce the past and present of minimally invasive spine surgery, as well as future developments. Summary of Literature Review: Spine surgery has evolved into a minimally invasive surgical procedure that requires skin incisions that are as small as possible. This has become a topic of interest for both patients and doctors, as it not only solves cosmetic problems by reducing skin incisions, but also reduces postoperative pain and complications by preserving as much normal tissue as possible while reducing blood loss, shortens the recovery period, and facilitates the return to normal life. At the same time, the surgical instruments required for minimally invasive surgery are being actively developed. Materials and Methods: Review of the relevant articles Results: The history of minimally invasive techniques is well described in the evolution of the surgical treatment of lumbar disc herniation. Minimally invasive lumbar discectomy began in the early 20th century, and many advances were made with the development of microscopes and tubular retractors. The development of endoscopes also led to the popularization and use of minimally invasive surgery. Minimally invasive surgery is also used in the thoracic and cervical spine, but many advances remain to be made in the lumbar spine. More recently, technologies such as navigation, robotics, and augmented reality have been developed and are helping to improve the safety of minimally invasive spine surgery. Conclusions: Minimally invasive spine surgery is rapidly evolving with recent technological advances. Advances in technology are expected to compensate for the limitations of minimally invasive surgery, and it is likely to become an alternative to traditional surgery for a variety of spinal diseases.
박상민,서승표,백종민,권기연,장해동,임수택,최소침습 척추치료 연구그룹 대한척추외과학회 2023 대한척추외과학회지 Vol.30 No.3
Study Design: Review article. Objectives: The purpose of this study was to review the perioperative considerations for lumbar fusion surgery. Summary of Literature Review: With an aging population, degenerative lumbar spine diseases are on the rise. The number of patients who have comorbidities and undergo complex lumbar spine surgery is also increasing. There are many points to consider before and after lumbar fusion surgery. Materials and Methods: Review of the relevant articles. Results: In spine surgery, conservative treatment is often considered before surgical treatment because symptoms often improve with conservative treatment. If conservative treatment fails, surgical treatment is then considered. Once the decision to operate has been made, the patient's past medical history is taken, and medical conditions are assessed before surgery. The severity of osteoporosis is also assessed to determine the surgical approach. If severe osteoporosis is present, osteoporosis treatment may be considered first, and if it is very severe, various pedicle screw fixation techniques should be considered. Finally, a multidisciplinary approach to surgery is necessary to ensure rapid recovery. Enhanced recovery after surgery (ERAS) protocols have recently been applied to lumbar fusion surgery. Conclusions: Adequate and appropriate conservative treatment should be implemented before spine surgery. Medical risk factors (diabetes, smoking, osteoporosis, kidney disease, medications, etc.) should be identified and corrected preoperatively. In addition, early patient recovery with perioperative ERAS should be considered, as ERAS protocols may have a positive effect in older patients with a higher frequency of postoperative complications.
한국형 공황장애 약물치료 알고리듬 2008 : 공황장애의 진단, 치료 반응과 관해의 평가
김민숙,유범희,김찬형,윤세창,이상혁,서호석,양종철,한국형 공황장애 약물치료 알고리듬 2008 연구그룹,Kim, Min-Sook,Yu, Bum-Hee,Kim, Chan-Hyung,Yoon, Se-Chang,Lee, Sang-Hyuk,Suh, Ho-Suk,Yang, Jong-Chul 대한불안의학회 2008 대한불안의학회지 Vol.4 No.1
Objective : This article is a part of the Korean Medication Algorithm Project for Panic Disorder, which aims to build consensus regarding the diagnosis, treatment response and achievement of clinical remission for patients with panic disorder in Korea. Methods : The questionnaire used in this article had parts : 1) diagnosis, 2) treatment response, and 3) remission for patients with panic disorder. The questionnaire was completed by each of 54 Korean psychiatrists who had much experience in treating patients with panic disorder. We classified the experts' opinions into 3 categories (first-line, second-line, and third-line) using the ${\chi}^2$-test. Results : Five factors were considered in this research : panic attack, anticipatory anxiety, phobic avoidance, severity of illness, and psychosocial disability. Most reviewers agreed that the presence of a panic attack was the most important factor in the diagnosis of patients with panic disorder. Phobic avoidance was included in the first-line category, whereas the severity of illness and psychosocial disability were included in the second-line category. Most reviewers also agreed that the presence of a panic attack was the most important factor in determining the appropriate treatment response, and it was included in the first-line category along with several other items. To determine remission status, the patients' scores on tests pertaining to the severity of panic attack, anticipatory anxiety, phobic avoidance, severity of illness and psychosocial disability should be less than 3.0-3.3 on a 9-point Likert scale. Conclusion : We suggest useful information for making a diagnosisof panic disorder, determining the appropriate treatment response and identifying remission in panic disorder patients on the basis of the results of a nationwide survey of experts in Korea.
한국형 우울장애 약물치료 알고리듬 2006 (Ⅲ) : 정신병적 양상을 동반한 주요우울삽화
김원,박원명,서정석,민경준,석정호,전덕인,전현태,이상열,송해철,홍진표,한국형 우울장애 약물치료 알고리듬 2006 연구그룹 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.6
Objectives : Since the publication of Korean Medication Algorithm Project for Major DepressiveDisorder (KMAP-MD) in 2002, there has been a substantial need for a revision due to rapid progress in the pharmacological management of depressive disorder. We revised KMAP-MD 2002 and developed the Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) 2006. Methods : We developed a questionniare for surveying the opinion of experts on pharmacotherapy of depressive disorder. The questionnaire consisted of 4 parts ; 1) treatment of non-psychotic depressive disorder, 2) treatment of psychotic de-pressive disorder, 3) treatment according to clinical subtypes and drugs choice considering adverse effects, and 4) treatment of depressive disorder in women. The questionnaire was completed by the review committee consisting of 101 experienced Korean psychiatrists. It is composed of 22 questions, and each question includes 54 sub-items. We classified the expert opinionto 3 categories (the first-line, the second-line, or the third-line) by χ²-test. Results : For depressive disorder with psychotic features, most reviewers prefer the combination of antidepressant and atypical antipsychotics. Electroconvulsive therapy and the combination of antidepressant and typical antipsychotics were the second-line treatment. Among antidepressants, venlafaxine was the most preferred, and SSRI and mirtazapine followed. Among atypical antipsychotics, quetiapine, risperidone and olanzapine were the most preferred, in this order. In patients who have no response to the first-line treatment, many reviewers recommended switching to another antidepressant or adding another atypical antipsychotics Conclusion : For severe depressive disorder with psychotic features, the combination of antidepressant and atypical antipsy-chotics was preferred for the first-line treatment. These results suggest that the medication strategies of depressive disorder are rapidly changing and reflects the recent studies and clinical experiences.
한국형 우울장애 약물치료 알고리듬 2006 (II): 정신병적 양상을 동반하지 않은 주요우울장애의 약물치료
석정호,전덕인,전현태,서정석,김원,송해철,이상열,민경준,박원명,홍진표,한국형 우울장애 약물치료 알고리듬 2006 연구그룹 대한신경정신의학회 2007 신경정신의학 Vol.46 No.5
Objectives:There have been noticeable progresses in the pharmacological management of depressive disorders along with vigorous preclinical and clinical trials of newer antidepressant drugs during the last decade. Since the first development of Korean Medication Algorithm for Major Depressive Disorder (KMAP-MDD) in 2002, there has been a substantial need for the revision of this algorithm. We amended the KMAP-MDD to Korean Medication Algorithm for Depressive Disorders (KMAP-DD) in 2006 and included treatment strategies for other types of depressive disorders. This article is about the treatment of MDD without psychotic features in the KMAP-DD 2006. Methods:Questionnaires were developed by the executive committee for KMAP-DD. The first part of this questionnaire is about the treatment strategies of MDD without psychotic features, minor depressive disorder and dysthymic disorder. Seven questions and 10 sub-items were prepared to investigate the experts’ opinions about treatment of major depressive disorders without psychotic features. The expert review committee composed of 101 experienced Korean psychiatrists was asked to evaluate the medication strategies for various clinical situations of depressive disorders using a 9-point scale. The scale was slightly modified from the format developed by the RAND corporation. We classified the expert opinions into 3 categories (first-line, high second-line and low second-line) by the 95% confidence interval of response score and evaluated the consensus of opinions of Korean experts using χ2-test. Results:For patients with MDD without psychotic features, antidepressant monotherapy was the optimal first-line treatment strategy regardless of the severity of an episode. In case of no or partial response to antidepressant monotherapy for severe episode of MDD, combination treatment with another antidepressant drug or augmentation treatment with triiodothyronine or lithium was considered as the second-line treatment. Meanwhile, for mild-to-moderate episode of MDD without psychotic features, switching to another antidepressant as well as augmentation or combination treatment was also considered as the second-line treatment. Selective serotonin reuptake inhibitors, venlafaxine, and mirtazapine were chosen as the 1st-line antidepressant drugs for MDD without psychotic features in Korea. Conclusion:The initial treatment strategy for patients with major depressive disorder without psychotic features is similar to that of the previous medication algorithm (KMAP-MDD). However, combination treatment with two antidepressant drugs and augmentation treatment strategies were considered at a relatively earlier step in this algorithm than in the previous version of Korean medication algorithm (KMAP-MDD) for the severe episode of major depressive disorder. The recent trials of newer antidepressant drugs and the preference of more active treatment strategy in up-to-date clinical psychiatry fields may have affected these changes in Korea.
서정석,민경준,김원,석정호,박원명,송해철,이상열,전덕인,전현태,홍진표,한국형 우울장애 약물치료 알고리듬 2006 연구그룹 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.5
Objectives : Since the publication of Korean Medication Algorithm Project for Major depressive Disorder (KMAP-MD) in 2002, there has been a substantial need for a revision due to rapid progress in the pharmacological management for depressive disorder. We revised KMAP-MD to Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) in 2006. This paper is one of the following 4 papers consisting of Korean pharmacological algorithm for depressive disorder. Methods : The questionnaire consisted of 4 parts ; initial treatment of 1) non-psychotic depressive disorder, 2) psychotic depressive disorder, 3) treatment strategy for clinical subtypes and drug choice considering adverse effects, and 4) treatment for depressive disorder in women. It was composed of 22 questions, and each question had 54 sub-items. The questionnaire was completed by the review committee consisting of 101 experienced Korean psychiatrists. We classified the expert opinion to 3 categories (the first-line, the second-line, or the third-line). Results : For non-psychotic major depression, regardless ofthe severity of an episode, the antidepressant (AD) monotherapy was the optimal first-line treatment. SSRI, venlafaxine, and mirtazapine were the 1st-line AD. In case of a partial or no response to initial strategy, adding another AD was recommended. For psychotic major depression, combination of an AD and an atypical antipsychotic (AAP) was the treatment of choice. Among AAPs, quetiapine, rispendone, olanzapine were preferred. For non-responder to initial strategy, the next step was adding or changing AD before changing AAP. For women with premenstrual dysphoric syndrome or postpartum depression without psychotic features, AD monotherapty was a preferred strategy while for psychotic postpartum depression, combination of AD and AAP was recommended. Experts recommended various ADs according to adverse effect. Conclusion : These results suggest that the medication strategies for depressive disorder are rapidly changing and reflect the recent studies and clinical experiences.