최근 30년간 스포로트리쿰증 임상 병형의 추세에 대한 관찰

임채성,권경술,장호선,정태안,오창근 대한의진균학회 1997 대한의진균학회지 Vol.2 No.1

Background: The clinical types of sporotrichosis are generally classified into four group: lymphocutaneous, fixed cutaneous, and cutaneous disseminated, and hematogenous. Of these, the lymphocutaneous variety is the most frequently encountered pattern, constituting 80% of sporotrichosis patients and the fixed cutaneous sporotrichosis is the next. Potassium iodide (KI) was the most commonly used drug for the treatment of sporotrichosis. Many studies about these clinical findings of sporotrichosis have been reported, but comparative study on the changes in clinical findings has not been reported. Objective: The purpose of this study is to clarify the changes of the clinical findings in sporotrichosis in Korea. Methods: A total of 58 patients with sporotrichosis who had visited the Department of Dermatology, Pusan National University were divided into 2 groups according to the period and then the clinical findings of sporotrichosis were compared. Results: The results of study are summarized as follows: 1. During this period, there were 58 cases of sporotrichosis. In the past period (1967~1979) there were 35 cases of sporotrichosis, and there were 23 cases in the recent period (1980~1997) 2. In the past period, most cases (71.4%) were lymphocutaneous type, however in the recent period, most cases (69.2%) were fixed cutaneous type. 3. The most commonly affected site was right upper extremity in the past period, but face fright upper extremity were the most commonly affected sites in the recent period. 4. In the past period, 2nd and 3rd decades were prevalent age group, but 5th to 7th decades were prevalent age group in the recent period. 5. In the treatment of sporotrichosis, potassium iodide (KI) was the choice of treatment in the past period, however itraconazole is gradually used in the recent period. Conclusion: According to this study, many changes in clinical findings of sporotrichosis were noted, especially in the clinical type. We found that clnical type of sporotrichosis changed from lymphocutaneous type to the fixed cutaneous type with time. And we suggest that further observation would be necessary to define the meaning of these changes.

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

Systemic Sclerosis Sine Scleroderma

김채기 ( Chae Gi Kim ),류헌모 ( Hun Mo Rhoo ),권중구 ( Joong Goo Kwon ),이창형 ( Chang Hyeong Lee ),송용호 ( Yong Ho Song ),최정윤 ( Jung Yoon Choe ) 대한류마티스학회 2000 대한류마티스학회지 Vol.7 No.3

Systemic sclerosis (SSc) is a generalized connective tissue disorder of unknown etiology. Clinically, there is a broad spectrum of disease ranging from widespread severe skin thickening to skin thickening limited to the distal extremities. In rare cases of systemic sclerosis, no cutaneous change only with internal organ involvement has been reported, which is called `systemic sclerosis sine scleroderma (ssSSc)`. We describe a patient with Raynaud`s phenomenon, who showed intestinal pseudoobstruction as a presenting symptom but did not show any skin change. She had also an esophageal motility disorder, but other organ involvement was not evident. Antinuclear antibody was positive. Her obstruction symptoms were improved by decompression by nasogastric tube and pharmaceutical treatment with erythromycin and octreotide.

S-58 : A Case of endoscopic full-thickness resection in gastric high grade dysplasia impossible to do ESD

( Jung Min Chae ),( Jae Young Jang ),( Seok Ho Dong ),( Hyo Jong Kim ),( Byung Ho Kim ),( Young Woon Chang ) 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1

Gastric high grade dysplasia is an important premalignant lesion because of high possibilities of transforming to adenocarcinoma. It is known to be progressed to adenocarcinoma in 60-85% during 4.7 years follow-up period in previous studies. So biopsy-proven high grade dysplasia should be regarded as an early gastric cancer and treated with en bloc resection method like endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). A repeated endoscopic resection is technically difficult, because of the severe ulcerative and fibrotic change. Gastrectomy can`t save stomach and cause several complications like dumping syndrome or vitamin B deficiency. Wedge resection can make a resection larger than expected and cause gastric stenosis or deformity. Ablative therapy could be an alternative to surgical treatment or repeated endoscopic treatment, but with limited role. A 63-year-old man was diagnosed gastric high grade dysplasia at angle four months ago. He had no symptom and no abnormalities in physical examination and laboratory findings. Abdominal CT didn`t show gastric wall thickening and abdominal lymph node enlargement. He treated with ESD but pathologic report showed horizontal margin involvement. We tried ESD again, but the lesion was diffusely edematous and margins were uncertain. Pathologic report of second ESD also showed horizontal margin involvement. Because it isn`t possible to do ESD due to marked fibrosis and unclear margin, we decided to treat him with laparoscopy-assisted endoscopic full-thickness resection (EFTR). EFTR is a recently discovered method to use endoscope to mark margins of the lesion, resect full-thickness around three-fourths circumference and laparoscope to resect full-thickness around the remaining one-fourths circumference and make the lesion closed. The specimen was measuring 4.2×3.0×1.2 cm in size. Because the final pathologic report revealed high grade dysplasia and focal intramucosal cancer sized 0.8×0.7 cm, we conclude that the lesion was completely resected. As you can see in this case, EFTR can be a great alternative treatment in gastric high grade dysplasia impossible to do ESD.

췌장염에 의한 가성낭종내에 생긴 가성동맥류 : 1례 보고

오연희,이채경,김승현,이성우,양창현,이정호,이영현 동국대학교 경주대학 1996 東國論集 Vol.15 No.-

만성 췌장염의 합병증으로 생긴 가성동맥류는 드문질환으로, 반복적으로 다량의 출혈을 일으킬 수 있으며, 치료를 하지 않을 경우 사망율이 높기 때문에, 조기 진단과 치료가 필수적이다. 저자들은 38세 남자 환자에서 췌장염의 합병증으로 생긴 가성낭종내에서 발생한 가성동맥류 1예를 경험하였기에 보고하는 바이다. 가성 동맥류의 색혈류도플러상 낭종내에 양방향 흐름의 와류를 볼 수 있었다. Pancreatic Pseudoaneurysm within Pseudocyst from Pancreatitis: 1 Case Department of Diagnostic Radiology and Internal Medicine, College of Medicine,DongGuk University Yeon Hee OH M.D., Chae Kyeong Lee M.D., Seoung Hyeon Kim M.D., Sung Woo Lee M.D., Chang Heon Yang M.D., Jung Ho Lee M.D., Young Hyun Lee M.D. Pseudoaneurysm from pancreatitis is uncommon, but it can cause recurrent and massive hemorrhage. Because of high morbidity and mortality, early detection and treatment of the pseudoaneurysm is needed. We report a case of pseudoaneurysm within pseudocyst from pancreatitis. Color-flow Doppler sonography shows bidirectional flow and turbulent arterial flow, within anechoic mass.

만성 췌장염에 의한 십이지장 협착 1예

서백종,장기육,박용근,채현석,한석원,이창돈,정인식,차상복,박두호 대한내과학회 1997 대한내과학회지 Vol.53 No.3S

저자들은 만성췌장염환자에서 지속적인 오심과 구토를 주소로 내원하여 십이지장협착으로 진단된 1예를 경험하였기에 보고하는 바이다. Duodenal stenosis resulting from fibroinflammatory process is a rare complication of chronic pancreatitis. The mechanism of duodenal stenosis seems to be related to ischemia and edema caused by persistent inflammation, which results in irreversible change of duodenal wall structure. We experienced a chronic alcoholic male patient with duodenal stenosis who had a history of choledochojejunostomy to relieve distal bile duct stenosis several years ago. He had suffered persistent postprandial nausea and vomiting for several months. Barium study of upper gastrointestinal tract and repeated endoscopy show narrowing lumen of duodenum with coarse nodular surface due to reactive inflammatory change.

정신분열병 및 정신분열형 장애에 대한 올란자핀의 효과와 안전성

안용민,강대엽,권준수,김창윤,김철응,반건호,신영민,이기철,이동우,이중서,조현상,채정호,김용식 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.4

연구목적 : 본 다기관 공동임상연구는 국내 환자를 대상으로 새로운 항정신병약물인 올라자핀의 치료 효과와 안전성을 확인하고자 시행되었다. 방 법 : 1999년 7월부터 2000년 3월까지 국내 10개 병원에 방문한 정신분열병 및 정신분열형 장애 105명을 대상으로 비대조 개방 임상연구를 시행하였다. 중등도 이상의 정신병 증상을 지니거나, 부작용으로 약물교체가 필요한 경우 또는 기분장애 증상의 치료가 필요한 환자를 대상으로 하였다. 2∼7일간의 약물 배설기간 후에 1일 10mg의 올란자핀을 투여하였고, 이후로 3∼7일 간격으로 용량을 조절하여 총 8주간 투여하였다. 치료 효과는 PANSS(Positive and Negative Syndrome Scale), BPRS(Brief Psychiatric Rating Scale), CGI(Clinical Global Impression-Severity), MADRS(Montgomery-Asberg Depression Rating Scale), HAM-A(Hamilton Rating Scale for Anxiety)로 판정하였다. 안전성 평가는 자발적인 이상반응 보고, 활력징후와 혈액 검사 및 SAS(Simpson-Angus Scale), BARS(Barnes Akathisia Rating Scale), AIMS(Abnormal Involuntary Movement Scale)척도를 이용하였다. 결 과 : 105명중에서 85.7%인 90명이 8주간의 치료를 완료하였다. 평균 최빈 용량은 일일 16.1(±4.7)mg이었고, 종료시점에서의 BPRS전체 점수가 기저 상태에 비해 40%이상 감소된 반응군은 69.5%이었다. PANSS의 양성 증후군과 일반정신병리 뿐만 아니라 음성 증후군 소척도에서도 유의한 감소를 보였으며, 이 감소들은 치료 초기부터 나타나서 8주간 지속되었다. 43.8%의 피험자가 중등도 이상의 우울증상을 같이 지니고 있었으며, 올란자핀에 의해 MADRS와 HAM-A가 유의하게 감소하였다. 치료 기간 동안에 활력징후에는 뚜렷한 변화가 없었으나 체중은 8주간 지속적으로 증가하였다. SAS와 AIMS는 감소하였으며, 정좌불능증을 제외한 나머지 추체외로 증상의 발생비율도 낮았다. 임상적인 증상이나 징후를 동반하지 않는 ALT/SGPT의 상승을 보였지만 프로락틴을 포함하는 대부분의 혈액 검사상 뚜렷한 이상 변화는 없었다. 결 론 ; 비록 본 임상연구가 비대조 개방 임상연구로서 많은 제한점을 가지고 있지만, 올란자핀이 기존 약물에 내약성을 보이거나 기분증상을 동반하는 정신병에 치료 효과가 있었다. 그리고 기존 항정신병약물 치료시에 문제가 되었던 추체외로 증상과 고프르로락틴 혈증을 포함하는 대부분의 부작용면에서 안전성을 보여 주었다. Objective : This multicenter clinical trial was carried out to investigate the efficacy and the safety of olanzpine for the treatment of Korean patients. Mothod : 105 patients with schizophrenia and schizophreniform disorder, visited at 10 mental or university hospitals, had received an open and non-comparative treatment with olanzapine for 8 weeks. Patients had psychotic or depressive symptoms with the severity above moderate degree or intolerable side effects to previous antipsychotics. After a wash-out period of 2-7 days, 10mg olanzapine was prescribed initially to all the patients, and then the dosage could be adjusted within the range of 5-20mg/day of olanzapine by 3-7 days. Results : 90(85.7%) of 105 patients completed the 8-weeks trial and the mean modal dose of olanzapine was 16.1(±4.7%)mg/day. At the end of the trial, 73 patients(69.5%) were classified as responder, which was defined as 40% or more improvement in BPRS(Brief Psychiatric Rating Scale) score comparing to baseline. There was a significant reduction in the scores of PANSS(Positive and Negative Syndrome Scale)and subscales including negative symptom scores and CGI. Also weekly analysis showed that the reductions in scores were kept on for the whole period of the trial. 43.8% of all the patients had depressive symptoms at the baseline and total scores of MADRS(Montgomery-Asberg Depression Rating Scale) and HAM-A(Hamilton Rating Scale for Anxiety) were also reduced after the trials. Vital signs revealed no clinically significant changes but continuous weight gain was observed during the treatment with olanzapine. The scores of SAS(Simpson-Angus Scale) and AIMS(Abnormal Involuntary Movement Scale) for assessing the EPS(extrapyramidal symptoms)and tardive dyskinesia respectively were significantly decreased and only a few patients reported EPS as adverse events. Although mild and clinically non-significant of ALT/SGPT was observed, most laboratory parameters including plasma prolactin level showed to significant changes during the trial. Conclusions : Although this trial had many limitations because it was a non-comparative and open study, olanzapine showed high efficacy on the positive, negative and depressive symptoms in schizophrenia and schizophreniform disorder.In addition to that, olanzapine showed a substantially favorable safety profile, such as low incidence of EPS and hyperprolactinemia.

Effects of DK-002, a synthesized (6aS,cis)-9,10-Dimethoxy-7,11b-dihydro-indeno[2,1-c]chromene-3,6a-diol, on platelet activity

Lee, Ki-Seon,Khil, Lee-Yong,Chae, Sang-Ho,Kim, Deukjoon,Lee, Byung-Hoon,Hwang, Gwi-Seo,Moon, Chang-Hyun,Chang, Tong-Shin,Moon, Chang-Kiu 이화여자대학교 약학연구소 2008 藥學硏究論文集 Vol.- No.17

In the present study, the mechanism of antiplatelet activity of DK.-002, a synthesized (6aS,cis)-9.10-Dimethoxy-7,11b-dihydro-indeno|2,1-c ]chroniene-3.6a-diol, was investigated. DK-002 inhibited the thrombin, collagen, and ADP-induced rat platelet aggregation in a concentration- dependent manner, with 1C_(50) values of 120. 27, and 47 μM, respectively. DK-002 also inhibited thrombin-induced dense granule secretion, thromboxane A_(2) synthesis, and [Ca^(2+)], elevation in platelets. DK-002 did not show any significant effect on ADP-induced inhibition of cyclic AMP elevation by prostaglandin E_(1). but DK-002 was confirmed to inhibit ADP-induced [Ca^(2+)] elevation and shape change. DK-002 inhibited 4- bronw-A23187-induced [Ca^(2+)], elevation in the presence of creatine phosphate/creatine phosphokinase (CP/CPK, a ADP scavenging system) and indomethacin (a specific inhibitor of cyclooxygenase). DK-002 also inhibited Ca^(2+) mobilization in thrombin- or 4-bromo-A23187-stimulated platelets through its inhibitory effects on both Ca^(2+) release from intracellular stores and Ca^(2+) influx, in the presence of CP/CPK and indomethacin. Taken together, the present study shows that DK-002 has inhibitory effects on stimulation of platelets, and suggests that its antiplatelet activity might be related to the inhibitory mechanism on Ca^(2+) mobilization in stimulated platelets. ⓒ 2005 Elsevier Inc. All rights reserved.

제왕절개술을 위한 경막외 마취시 술전 투여 수액이 신생아 혈당치에 미치는 영향

이혜원,김선희,신정순,장성호,임혜자,채병국 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.4

It is common for patient undergoing cesarean section under epidural anesthesia to have lower blood pressure because of not only supine hypotension syndrome but vasodilation due to sympathetic blockade. So it is necessary to give large volume of fluid before perfarming epidural anesthesia to prevent hypotension. When we use the dextrose containing fluid for that purpose, newborn baby could have a high blood glucose at delivery and low blood glucose level due to high insulin level after birth. The authors examined the blood glucose level at delivery and two hours after birth following use of 5% dextrose in lactated Ringers solution(HD group, n=24) or lactated Ringers solution (HS group, n=24) for prevention of hypotension during epidural anesthesia for cesarean section. The results were as follows; 1) The total amount of fluid was 789.6±264.2 ml in HD group and 741.1±253.5 ml in HS group. 2) The glucose level of mother at delivery was 300.9±76.3 mg/dl in HD group and 98.7±24.6 mg/dl in HS group and there wastistical significance(p$lt;0.01). 3) In HD group, the glucose level of newborn baby was 212.2±57.2 mg/dl at delivery and 465.±20.3 mg/dl at 2 hours after birth. The change of amount during 2 hours after birth was highly related to the glucose level at birth. Higher level of glucose at birth, larger amount of change during 2 hours after birth. 4) In HS group, the glucose level of newborn baby was 66.8±10.2 mg/dl at birth and 67.0±12.1 mg/dl at 2 hours after birth. There was no significant change.

다양한 골 이식재의 임상 효과에 대한 고찰

이승범,연제영,채경준,정의원,김창성,이용근,조규성,채중규,김종관,최성호,Lee, Seung-Bum,Yon, Je-Young,Chae, Gyung-Joon,Jung, Ui-Won,Kim, Chang-Sung,Lee, Yong-Geun,Cho, Kyoo-Sung,Chai, Jung-Kiu,Kim, Chong-Kwan,Choi, Seong-Ho 대한치주과학회 2007 Journal of Periodontal & Implant Science Vol.37 No.4

Purpose: Various bone graft materials are being used for periodontal tissue regeneration. Th materials are being developed continuously for ideal clinical effects. Therefore, it is necessary to identify the clinical characteristics of each bone graft material through comparing the various bone graft materials statistically and in doing so, proposing a more efficient bone graft material. In this study, the following results were attained through comparing the clinical effects among the bone graft materials, using the statistical method based on the clinical studies published at the department of periodontology of Yonsei hospital. Materials and Method: 6 selected studies of department of Periodontology at Yonsei University Hospital were based on clinical study of bone grafting in intrabony defects. It was compared the clinical parameters among the 6 clinical studies, using the statistical META analysis. Result: When comparing the probing depth reduction, there was a relatively great amount of decease when using the xenograft, Anorganic Bovine Derived Hydroxapatite Bone Matrix/Cell Binding Peptide(ABM/P-15: PepGen $P-15^{(R)}$) and the autogenous bone and absorbable membrane, d, 1-alctide/glycolide copolymer(GC: $Biomesh^{(R)}$). The allogfrafts showed a relatively low decrease in the probing depth and clinical attachment change. It also showed a slight decrease in the bone probing depth. The allografts showed various results according to different bone graft materials. When comparing the ABM/P-15 and bovine bone $powder(BBP^{(R)})$, ABM/P-15 showed a relatively high clinical attachment level and the bovine bone powder showed a relatively high clinical attachment level. The probing depth change and gingival recession change showed a lower value than the mean value between the two bone graft materials. The synthetic bone showed a relatively high decrease in clinical attachment level and periodontal probing depth change. There was a relatively larger amount of gingival recession when using Bioactive Glass(BG) but a relatively low bone regeneration effect was seen. Conclusion: Good restorative results of the periodontal tissue can be attained by applying the various bone graft materials being used today after identifying the accurate clinical effects.