Comparison of Melanoma Subtypes among Korean Patients by Morphologic Features and Ultraviolet Exposure

( Hong Sun Jang ),( Jee Hung Kim ),( Kyu Hyun Park ),( Jae Seok Lee ),( Jung Min Bae ),( Byung Ho Oh ),( Sun Young Rha ),( Mi Ryung Roh ),( Kee Yang Chung ) 대한피부과학회 2014 Annals of Dermatology Vol.26 No.4

Background: Genetic alterations have been identified in melanomas according to different levels of sun exposure. Whereas the conventional morphology-based classification provides a clue for tumor growth and prognosis, the new classification by genetic alterations offers a basis for targeted therapy. Objective: The purpose of this study is to demonstrate the biological behavior of melanoma subtypes and compare the two classifications in the Korean population. Methods: A retrospective chart review was performed on patients found to have malignant melanoma in Severance Hospital from 2005 to 2012. Age, sex, location of the tumor, histologic subtype, tumor depth, ulceration, lymph node invasion, visceral organ metastasis, and overall survival were evaluated. Results: Of the 206 cases, the most common type was acral melanoma (n=94, 45.6%), followed by nonchronic sun damage-induced melanoma (n=43, 20.9%), and mucosal melanoma (n=40, 19.4%). Twenty-one patients (10.2%) had the chronic sun-damaged type, whereas eight patients (3.9%) had tumors of unknown primary origin. Lentigo maligna melanoma was newly classified as the chronic sun-damaged type, and acral lentiginous melanoma as the acral type. More than half of the superficial spreading melanomas were newly grouped as nonchronic sun-damaged melanomas, whereas nodular melanoma was rather evenly distributed. Conclusion: The distribution of melanomas was largely similar in both the morphology-based and sun exposure-based classifications, and in both classifications, mucosal melanoma had the worst 5-year survival owing to its tumor thickness and advanced stage at the time of diagnosis. (Ann Dermatol 26(4) 485~490, 2014)

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.

보건간호활동으로 추진한 노인건강증진 프로그램

유인영(In-Young Yoo),조정민(Chung0Min Cho),최영숙(Young-Sook Choi),정문희(Moon-Hee Jung),김미혜(Mi-Hye Kim),유광수(Kwang-Soo You),윤숙례(Suk-Rye Yoon),한명화(Myung-Hwa Han),최선하(Sun-Ha Choi),하영(Young Ha),김규성(Kyu-Sung Kim),이현주 한국보건간호학회 1997 韓國保健看護學會誌 Vol.11 No.1

물질남용 치료프로그램 후 재범여부에 대한 예비적 추적조사 연구

김현수,조선미,오은영,임기영,정영기,윤웅장,이영미 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.6

연구목적: 본 연구는 물질사범에게 시행되는 수강명령 프로그램의 효과를 재범률을 중심으로 살펴보고자 한 것이다. 방 법: 이 연구의 대상집단은 보호관찰소에서 의뢰받은 물질남용자집단이다. 이들은 법원으로부터 보호관찰, 수강명령, 치료명령, 사회봉사 등을 부과받았다. 총 104명의 대상자집단을 치료프로그램을 이수한 수강군과 비수강군으로 나누었으며 이들에 대한 재범률을 조사하였다. 결 과: 프로그램을 이수한 수강군이 비수강군에 비해 재범률이 낮았다(p<.05). 또한 단기 수강군과 장기수강군의 재범률의 차이를 조사하였는데 대상자 집단의 수가 적기 때문에 장기 수강군의 효과가 통계적으로 입증되지는 않았다. 결 론: 우리는 물질남용자에 대한 정책이 보다 교육적으로 변화할 것을 본 논문을 통하여 제시하려 하였으며 정부 및 법무부는 물질남용자에게 교육과 치료를 제공해주어야만 한다. Objectives: Using recidivism rate, we investigated the outcome after our substance abuse treatment program had been implemented. Methods: Our target population was substance abuse criminals referred by probational office. They either received the parole and probation order, treatment order or social service order from the court. We divided 104 substance abuse criminals into treatment group and non-treatment group. We examined their recidivism rate. Results: We reached a conclusion that treatment group had lower recidivism rate than non-treatment group(p<.0.5). We examined the effectiveness of short-term and long-term programs. However, no effectivess of long-term program was found because the sabject number was too small. Conclusion: We suggest that the strategies for substance abuse should be changed to more educative ones. The Government and Ministry of Justice must provide education and treatment to the substance abuse criminals.

Hepatocellular Carcinoma in the Elderly: Clinical Characteristics, Outcomes and Treatment Efficacy, Safety in Older than 75 Years

( Ji Ho Seo ),( Sunmin Kim ),( Eunae Cho ),( Chung Hwan Jun ),( Sun Young Park ),( Sung Bum Cho ),( Chang Hwan Park ),( Hyun Soo Kim ),( Sung Kyu Choi ),( Jong Sun Rew ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: The number of elderly patients diagnosed with hepatocellular carcinoma (HCC) has been increasing because the increase in the longevity of the general population. But there is no proper management based on age stratification in elderly patients. We compared clinical characteristics, outcomes and treatment efficacy, safety between oldest-old (aged more than 85 years), middle-old (aged between 80 and 85 years) and young-old (aged between 75 and 80 years) patients with HCC. Methods: We conducted a retrospective cohort study, from January 2010 to December 2016, at Chonnam National University Hospital. A total of 550 elderly patients whose data included demographics, co-morbidity, etiology of liver disease, presence of cirrhosis, staging of HCC, treatment modality and treatment related adverse event were evaluated retrospectively. Also overall survival was assessed in enrolled patient. Results: Fifty one patients (oldest-old; median 87 years old), 153 patients (middle-old; median 82 years old) and 346 patients (young-old; median 77 years old) were diagnosed with HCC. Both oldest- and middle-old patients, compared to young-old patients had significantly lower rate of alcohol-related disease (13.7% vs 20.9% vs 34.1%, P = 0.001). There were no significant difference in underlying sex, body mass index, presence of co-morbidity, hepatitis C-related disease and stage of HCC. The Child-Pugh class (CPT class A 88.9% vs 84.1% vs 83.6%, CPT class B 11.1% vs 15.9% vs 15.0% and CPT class C 0.0% vs 0.0% vs 1.3%, respectively, P = 0.912) and Model for End Stage Liver Disease score (mean MELD score 7.22±3.34 vs 5.88±3.01 vs 5.77±3.14, P = 0.166) were no significant difference between the patients with active treatment. The modified UICC staging (stage I 5.6% vs 17.1% vs 18.6%, stage II 55.6% vs 46.3% vs 47.3%, Stage III 22.2% vs 24.4% vs 24.8%, Stage IV-A 11.1% vs 6.1% vs 4.9% and Stage IV-B 5.6% vs 6.1% vs 4.4%, respectively, P = 0.826) and Barcelona Clinic Liver Cancer staging (stage 0 5.6% vs 9.8% vs 9.3%, stage A 16.7% vs 17.1% vs 22.1%, stage B 27.8% vs 29.3% vs 24.8%, stage C 50.0% vs 43.9% vs 41.2% and stage D 0.0% vs 0.0% vs 2.7%, respectively, P = 0.878) were no significant difference between the patients with active treatment. Furthermore, there were no difference between the age groups in treatment modality (Surgical resection 0.0% vs 3.3% vs 5.2%, P = 0.166; Radiofrequency ablation 2.0% vs 8.5% vs 11.0%, P=0.113; Transcatheter arterial chemoembolization 21.6% vs 34.6% vs 41.6%, P=0.014; Best supportive care 62.7% vs 40.5% vs 29.2%, P < 0.001), adverse event related treatment (P = 0.731) and disease-free survival days (329 .3±309.1 days vs 271.7 ± 414.2 days vs 357.2 ± 511.6 days, P = 0.336). Multivariate analysis showed that age, performance status, CTP class, MELD score, modified UICC staging, presence of portal vein thrombosis and ruptured HCC are risk factors for mortality. Conclusions: Clinician should make an active treatment in elderly patients with HCC not a age but performance status, liver function and disease status of cancer.

서울의 Penicillinase Producing Neisseria gonorrhoeae 발생빈도(1998)

김재홍,김준호,반재용,이정우,황성주,정준규,정성태,강진문,조흔정,홍창의,정혜신,이한승,김이선,이봉길,이종호,선영우,한기덕,윤성필,이성훈,안종성,박석범,문승현,조항래,김형섭,류지호,황재영,박준홍,손상욱 한양대학교 의과대학 2001 한양의대 학술지 Vol.21 No.1

In recent years, gonorrhea has been pandemic and remains one of the most common STDs in the world, especially in developing countries. For the detection of a more effective therapeutic regimen and assessing the prevalence of Penicillinase Producing Neisseria gonorrhoeae(PPNG), we have been trying to study the patients who have visited the Venereal Disease Clinic of Choong-Ku Public Health Center in Seoul since 1980 by menas of the chromogenic cephalosporin method. In 1998, 93 strians of N. genorrhoeae were isolated, among which 60(64.5%) were PPNG. The prevalence of PPNG in Seoul, which had been decreased to 39% in 1996 after a peak of 74.3% in 1993, is increased to 64.5% in 1998.

장간막 림프절염으로 발현된 Kikuchi-Fujimoto병 1예

최원섭,이승순,권진우,이영석,김선영,전선영,김민정,정두련 대한감염학회 2006 감염과 화학요법 Vol.38 No.5

Kikuchi-Fujimoto 병은 주로 경부 림프절을 침범하는 질환이지만, 드물게 회맹부 장간막 림프절을 침범하여, 발열을 동반한 우하복부 통증과 반발압통을 나타내는 장간막 림프절염을 일으킬 수 있다. 급성 충수돌기염과 유사한 양상의 급성 복증을 호소하는 젊은 성인의 경우, 장간막 림프절염 여부를 확인하여야하며, 그럴 경우 Kikuchi-Fujimoto 병을 감별 진단에 포함시켜야 한다. 저자 등이 경험한 장간막 림프절염으로 발현된 성인의 KikuchiFujimoto 병 1예는 국내에서는 최초로 발견된 것이기에 문헌 고찰과 함께 보고하는 바이다. Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis is a benign, rare, self limitimg disease presenting with mainly cervical lymphadenopathy and fever unresponsive to antibiotics or medical treatment. A 28-year old man presented with fever and right lower quadrant abdominal pain. Physical examination showed abdominal tenderness and rebound tenderness mimicking acute appendicitis. Imaging studies showed normal appendix and other abdominal organs except enlarged multiple mesenteric lymph nodes. Symptoms persisted despite antimicrobial therapy. Multiple tender lymph nodes were palpable on bilateral cervical area at the 7th hospital day. The biopsy of the neck node showed large areas of patchy, irregular necrosis with prominent nuclear debris surrounded by T lymphocytes, histiocytes without neutrophils and granuloma, so he was diagnosed as Kikuchi- Fujimoto disease. With conservative management, clinical improvement was observed. We suggest that Kikuchi-Fujimoto disease with mesenteric lymphadenitis should be added to the differential diagnosis of acute abdomen mimicking acute appendicitis in young adults.

백서 뇌에서 전기경련 충격에 의해 발현이 조절되는 새로운 유전자

정선주,박정은,강웅구,구영진,박주배,김용식 大韓神經精神醫學會 2000 신경정신의학 Vol.39 No.5

연구목적: 이 연구는 백서 뇌에서 전기경련 충격(Electroconvulsive shock, ECS)에 의해 발현이 조절되는 새로운 유전자를 검색하고, 발달단게 및 뇌 조직에 따른 발현양상을 관찰하기 위하여 시행되었다. 방법: 생후 7일, 21일된 어린 웅성 백서에 전기경련 충격을 가한 후 mRNS differential display-PCR(DD-PCR) 기법을 시행하여 발현의 차이를 나타내는 유전자를 검색한 후 서열분석을 실시하였다. 생후 7일 및 21일된 백서의 뇌와 성년 백서의 대뇌피질, 해마를 이용한 Northern blot 분석을 시행하여 검색된 유전자의 ECS 처치 후 시간경과에 따른 유전자 발현양상을 관찰하였다. 결과: ECS 처치군과 위충격군간에 발현의 차이를 나타낸 유전자 4개를 검색할 수 있었으며, 이중 ECS에 의해 발현이 증가되는 1개의 유전자를 선정하여 서열분석을 실시한 결과 EST 서열만이 보고된 새로운 유전자임이 밝혀졌다. 이 유전자는 생후 7일된 백서의 뇌에서는 ECS 처치 후 180분에 발현양의 증가가 최고치에 도달하였으나, 생후 21일된 백서의 뇌와 성년백서의 대뇌피질 및 해마에서는 360분 경과시까지 지속적으로 발현 양이 증가하였다. 결론: 이같은 결과는 ECS에 의해 생체 내에서 유전자 발현의 조절이 이루어짐을 시사하며, 향후 이러한 유전자의 세포 내 기능에 관한 연구를 시행함으로써, ECS에 의한 생체의 반응과 치료기전에 대한 이해를 넓힐 수 있을 것으로 기대된다. 중심단어:전기경련 충격·DD-PCR·유전자·백서 뇌. Objectives: This study was performed to identify genes regulated by electroconvulsive shock (ECS) and to observe the pattern of expression of genes according to different developmental stages and brain regions. Method: ECS(130V, 0.5 sec) was given to male Sprague-Dawley rats with age of postnatal day 7 and 21(P7, P21 respectively). After screening genes regulated by ECS with mRNA diffe-rential display-PCR(DD-PCR), we selected one clone among them and observed the induction of this gene after ECS by time-dependent Northern blot analysis of rat brain of P7, P21 and adult rat cortex and hippocampus. Results: By DD-PCR method, we have identified four clones whose expression was regulated by ECS. Among them, one(CP 10-2) was proved to be a new gene by sequencing and BLAST search. Its expression was increased after ECS in P7, P21, and adult rat brain. The expression of CP 10-2 reached peak level at 180 minutes after ECS in P7 rat brain, but was further increased until 360 minutes after ECS in P21 and adult rat brain. Conclusion: In this study, a new gene was identified in rat brain which showed up-regulated expression in response to ECS. Cloning and characterization of this new gene would be helpful to elucidate the effect of ECS in rat brain. KEY WORDS:Electroconvulsive shock·Differential display-PCR·Gene·Rat brain.

Urokinase 뇌실내 주입법을 이용한 중증 뇌실내 혈종의 치료

정영선,김민호,이지영,심기범,홍승관 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.4

The authors applied extraventricular drainage combined with intermittent intraventricular injection of urokinase to 21 patients with intraventricular hematoma and ventricular dilatation. Ten-thousand lU of urokinase was injected every 12 hours for 3 days. Follow-up CT on day 4 after the treatment showed complete disappearance of the hematoma in the 3rd and 4th ventricles and a small residual hematoma in the occipital horns of lateral ventricles in the majority(14 patients) of th8 patients. Obstruction of the drainage catheter did not occur in any case. but transient pleocytosis in CSF study. ventriculitis. and rebleeding complicated 6. 4. and 4 cases. respectively. The duration of extraventricular drainage in the 17 patients without major complications was 3-l7 days. The clinical results on discharge were good recovery in 3. moderate disability in 1, severs disability in 4. vegetative state in 0.and death in 7 cases. The decisive events that were thought to have caused vegetative states or death in the 13patients with poor results were low initial GCS in 7 rebleeding in 4, ventriculitis in 1. pneumonia in 1, and unknown in 1 case. The method of extraventricular drainage combined with intermittent intraventricular injection of urokinase seems useful in removing intraventricular hematomas more rapidly. In regards to various other factors that influence the clinical course of severe intraventricular hematomas. further investigation including prospective studies is necessary to determine whether the intraventricular injection of urokinase significantly improves the final outcomes of those patients with severe intraventricular hematomas.

한국어판 예일 틱 증상 평가척도 : 신뢰도 및 타당도 연구

정선주,이정섭,유태익,구영진,전성일,김봉석,홍강의 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.5

목 적 : 틱 증상의 심한 정도를 평가하기 위한 도구인 예일 틱 증상 평가척도(Yale Global Tic Severity Scale)를 한국판 가정 평가용 설문지 및 임상 평가용 척도로 개발하기 위하여 본 연구를 시행하였다. 방 법 : 예일 틱 증상 평가척도는 뚜렛 장애 및 기타 틱 장애에서 나타나는 운동틱과 음성틱 각각의 증상의 수, 빈도, 심한 정도, 복합성, 방해 정도 및 장해도를 포괄적으로 평가하도록 고안되어져 있다. 틱 증상을 주소로 정신과외래를 방문한 만 4.3세에서 19세까지의 100명의 환아 및 부모들을 대상으로 한국어로 번역한 예일 틱 증상 평가척도의 가정평가용 설문지를 평가전에 완료하도록 한 후, 면담을 통한 임상평가용 척도를 실시하였으며 수렴타당도 및 변별타당도의 검증을 위해 총괄적인 임상 인상척도-뚜렛 증후군, 강박장애, 주의력결립/과잉운동장애(Clinical Global Impression-TS, OCD, ADHD)를 시행하였다. 결 과 : 자료분석결과 내적일치도, 수렴타당도, 변별타당도 및 검사자간 신뢰도 모두 매우 높게 나타났으며 요인분석상 전 항목척도와 장해도는 운동틱과 음성틱에 해당하는 2개의 요인으로 묶여졌다. 결 론 : 본 연구결과 한국판 예일 틱 증상 평가척도의 높은 타당도 및 신뢰도가 입증되었으며 이는 향후 틱 증상의 객관적인 평가 및 정량화를 위해 유용하게 사용되어질 수 있을 것이다. Objectives : This study was carried out to develop the Korean form of Yale Global Tic Severity Scale(YGTSS)-family & clinical rating version. The severity of motor and phonic tics was rated according to five separate dimensions : number, frequency, intensity, complexity, and interference. Methods : The Korean form of YGTSS was applied to 100 children who visited psychiatric outpatient clinic with chief complaints of tic symptom. Together with YGTSS, Clinical Global Impression for Tourette's syndrome(CGI-TS), Obsessive-Compulsive disorder(CGI-OCD), Attention-Deficit/Hyperactivity Disorder(CGI-ADHD) were administered to all subjects for examining convergent and discriminant validities. Results : We could confirm high internal consistency, convergent and discriminant validities and interrater reliability of YGTSS by analysing data from 100 children with tic disorder. In factor analysis, items were clustered to 2 factors which were identical to motor and phonic tic subscales. Conclusion : The results of this study indicate the Korean form of YGSS is a reliable and valid rating scale for rating tic symptom severity. It can be used to evaluate tic symptom objectively and to quantify the tic severity in the studies for tic disorder.