한국형 우울장애 약물치료 알고리듬 (Ⅳ) : 우울장애의 아형 및 부작용에 따른 항우울제의 선택과 여성우울장애에서의 치료전략

전현태,이상열,김원,민경준,박원명,서정석,석정호,송해철,전덕인,홍진표,한국형 우울장애 약물치료 알고리듬 2006 연구그룹 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.6

Objectives : In 2002, the Korean Medication Algorithm Project for Major depressive Disorder (KMAP-MD) was published, but there has been a need for a guideline about detailed issues of depressive disorder. We revised KMAP-MDD andreestablished Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) in 2006. Methods : A questionnaire had been developed by the executive committee for KMAP-DD. The review committee consisted of 101 experienced psychiatrists. From the total of 22 questions in the questionnaire, 7 questions were evaluated for these subjects . We classified the expert opinions to 3 categories according to its confidence interval; first, second and third line. Results : SSRI and venlafaxine were the first line antidepressants (AD) for atypical and melancholic depression. For dysthymic disorder and minor depressive disorder, SSRI was recommended as the first line medications. Only AD medications was a preferred initial strategy for treating premenstrual dysphoric disorder, mild to moderate and severe non-psychotic postpartum depression. In severe psychotic postpartum depression, combination therapy of AD and atypical antipsychotics was the treatment of choice. SSRI was preferred when considering sedation, anticholinergic and cardiovascular adverse effects. Also, experts recommended mirtazapine against gastrointestinal adverse effects and bupropion in avoiding sexual dysfunction. Conclusion : These results suggest that clinicians have to consider both clinical situations and drug adverse effects in the choice of antidepressant medications.

CT flouroscopy를 이용한 중재적 시술의 유용성

전혜정,박정희,서보경,박상우,신현준,최영철,한혜승,이창희 건국대학교 의과학연구소 2004 건국의과학학술지 Vol.14 No.-

Conventional CT-guided needle localization has been reported many times, but a few reports of interventional procedures by using multidetector CT scan with CT-fluoroscopy have been described. We presented 36 cases of CT-fluoroscopy guided interventional procedures focusing on the puncture technique. Two cases of small pneumothorax and one case of pulmonary hemorrhage out of 2lcases after lung biopsy, were not needed any treatments We can easily and accurately access to the lesion by using CT-fluoroscopy and unique our marker system.

치커리와 쑥갓의 무균자엽절편체 생산 효율 증진

황현정,전혜정,최근원,김영채 경희대학교식량자원개발연구소 2005 硏究論文集 Vol.24 No.-

치커리와 쑥갓에 있어 식물조직배양이나 형질전환 과정에 필요한 무균 절편체를 얻기 위한 적절한 방법을 제안하기 위해 기내 파종을 위한 소독조건과 배지조성 및 종류에 관한 실험들이 실시되었다. 치커리 'Precole'은 10% NaOCl, 15분간, 'Chiavari'는 5% NaOCl, 15분간이 기내파종 시 발아 및 자엽전개를 촉진시키고 오염발생을 억제하는 조건으로 선발되었다. 쑥갓에서는 발아 및 자엽전개율에 있어 NaOCl 처리 간에 차이는 없었지만 10% NaOCl, 30분간 처리에서 가장 낮은 오염율이 관측되었다. 치커리와 쑥갓의 발아와 자엽전개율 모두 인조토양배지의 사용으로 MS 배지에 비해 현저히 향상 되었다. 비록 육안으로는 오염여부를 관측할 수는 없었지만 이들 인조토양배지에서 자란 쑥갓 묘의 자엽을 MS배지에 치상하여 배양 시에는 오염증상이 나타났으며 이들을 NaOCl 1%로 15분간 소독 후 치상한 결과 오염율을 현저히 낮출 수 있었다. Experiments on the sterilization condition and medium composition and type for in vitro sowing were conducted to suggest a proper way to produce enough aseptic explants for tissue culture or transformation study in chicory and garland chrysanthemum. Fifteen minutes soaking treatment with 10% NaOCl for chicory 'Precole' and 15 minutes with 5% NaOCl for chicory 'Chiavari' were selected as proper sterilization conditions to promote in vitro germination and cotyledon expansion and inhibit the seedling contamination from seed itself. In garland chrysanthemum, there was no significant difference in germination and cotyledon expansion ratio among NaOCl treatments, but the lowest seedling contamination ratio was observed by 30 minutes soaking with 10% NaOCl. Both germination and cotyledon expansion ratio in chicory and garland chrysanthemum were significantly increased by using the artificial soil media in contrast to MS media. Although seedling contamination with the artificial soil media could not be observed with bare eyes, cotyledon explants harvested from the plants grown on the media showed some fungal growth when they were placed onto MS media for further culture. However the percentage of the contamination from these explants was dramatically decreased by 15 minutes sterilization with 1% NaOCl.

한국형 우울장애 약물치료 알고리듬 2006 (Ⅰ)

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.

회맹장 및 대장을 침범한 장 결핵에 있어서 바륨을 이용한 방사선 이중조영촬영 소견에 대한 연구

진용현,전혜정,이용근,강철호,조성범,김윤환,박철민,차상훈,김일영,이혜경 건국대학교 의과학연구소 2002 건국의과학학술지 Vol.12 No.-

To determine the characteristic double contrast barium enema findings of ileo-cecal and colonic tuberculosis and to make differential diagnosis from other bowel inflammatory disease. Sixty-seven patients confirmed as ileo-cecal and/or colonic-tuberculosis in six hospitals were evaluated retrospectively. The diagnosis was proven by endoscopic biopsy, surgery, and clinical follow up. Nine of 67 patients were excluded because radiologic findings were normal though endocopic biopsy examinations resulted in tuberculosis. Histopathological diagnosis were madein 58 cases as follows: endoscopic biopsy(n=29), operation(n=12), follow up examination(n=14), tissue culture(n=1), laparoscopic biopsy(n=2). There were 30 men and 28 females. The mean age were 36 yrs(range:16-67), 34 patients were in the second and third decade. The distribution of lesions, morphological characteristics, mucosal changes, ulcer shape and depth, associated with other tuberculous lesion, multiplicity were retrospectively analyzed in the findngs of double contrast barim enema. The commonest clinical symptoms were abdominal pain(n=35, 60%) and diarrhea(n=18, 31%). The chest radiography revealed association of pulmonary tuberculosis in 39 cases. Tuberculous lesions of other organs except chest were present in five cases. Double contrast barium enema findings showed a thickening and irregularity of intestinal mucosal fold(n=29, 50%), bowel contraction and/or shortening(n=26, 45%). There were small, nodular, superficial ulcers in the case of ulcer depth less than 2 mm in the depth. As many as 39 cases(67%) in this series had two or more lesions in the intestinal tuberculosis. The involved segment revealed symmetrical feature(n=21, 36%). Inflammatory pseudopolypoid lesions were noted in 30 cases(52%). The ileo-cecal region was involved in 38 cases(66%). The ascending colon(n=25, 43%) was the second commonest site with or without contiguous cecal involvement. Lesions in terminal ileum, ileo-cecal valve, transverse colon, descending colon and appendix were seen in 19, 18, 18, 12 and seven cases, respectively. Among 18 cases of ileo-cecal valve lesions, there were incompetency in nine cases(16%) and wide gapping in four cases(7%). In 14 cases, tuberculous enterocolitis was diagnosed by clinical follow-up and double contrast barium enema study. 12 out of 14 cases, the findings of double contrast barium enema of tuberculous enterocolitis were normalized after anti-tuberculous medication. However, two cases showed more aggravated state than before due to inappropriate treatment. Double contrast barium enema plays an important role in the diagnosis of tuberculous enterocolitis, determines the type, site and extent of the involvement and helps in treatment guide by using sequential studies.

원발성 위 소세포암 1례

윤상애,전혜정,함희원,박형석 건국대학교 의과학연구소 1995 건국의과학학술지 Vol.5 No.-

Small cell carcinoma originates from APUD cell of any part of the body. Usually the cases are discovered in the lung, and have poor prognosis. Primary small cell carcinoma of the stomach has been recognized recently, and only three cases have been reported in the Korea. This tumor is morphologically analogous to small cell carcinoma of the lung, and characterized by very aggressive clinical course. We report a case of primary small cell carcinoma of the stomach which had hepatic metastasis. The lesion of the stomach, located in the upper body and cardia, is ulcerated with irregular margin and dirty surface covered with exudates.

자기공명영상에서 신속 FLAIR(Fluid-Attenuated Inversion Recovery) 기법을 이용한 뇌척수액의 흐름메 관한 연구

최영철,전혜정,신현준,박정희 건국대학교 의과학연구소 1999 건국의과학학술지 Vol.9 No.-

The use of MRI to study CSF flow in the brain was mainly by flow void signal on T2WI or hydrodynamic study with phase-contrast cine MRI. Authors pay attention to high signal intensity in CSF passway on fast FLAIR MR image of the brain, usually known as the artifact. The conclusions are as below; 1. The high signal intensity appeared in CSF passway on fast FLAIR MR image of the brain near constantly. 2. The high signal intensity was best visualized on image perpendicular to the CSF flow. 3. The high signal intensity was related to the velocity of the fluid not to the direction of the fluid.

원발성 폐암의 CT상 병기 결정:새로 재정된 TNM 체계와의 비교

신현준,최영칠,전혜정,박정희,김요한,이원진 건국대학교 의과학연구소 1998 건국의과학학술지 Vol.8 No.-

Accurate staging of lung cancer is essential for defining operability, selecting treatment regimens, predicting survival, and reporting comparable end results. Revisions in stage grouping of the TNM subsets in the International System for Staging Lung Cancer have been adopted by the American Joint Committee on Cancer and the Union Internationale le Cancer at 1996. We compared the previous TNM systems with revised stage grouping rules, and tried to applicate the new size-criteria for metastatic lymph nodes in mediastinum. Twenty-two patients were undergone CT stagings by using three different systems of previous, revised, and modified TNM subsets. Ten patients showed different TNM stage by the revised stage grouping rules and seven patients were altered in lymph node stage by the new size-criteria. Recognition of revised stage grouping rules is very important for treatment plan and predicting the correct prognosis.

국소 폐병변에서의 역동적 조용증강 CT의 유용성

신현준,최영철,전혜정,박정희,김요한 건국대학교 의과학연구소 1998 건국의과학학술지 Vol.8 No.-

The blood supply and metabolism of malignant nodules are qualitatively and quantitatively different from those of most benign nodules. We evaluated the efficacy of dynamic CT for differentiation of benign malignant lesions. Thirty-six patients with malignant nodule(n=20), tuberculoma(n=7), and pneumonic consolidation(n=9) were evaluated by thin section dynamic CT. CT numbers of lesion and aorta were measured before enhancement, and 1 minute, and 3 minutes after enhancement. Malignant lesions(maximum, 31.1±10.7 HU) enhanced significantly more than tuberculoma(maximum, 13.5±12.9 HU), but mass/aorta ratios were not so significantly different between malignant lesions(maximum, 0.61±0.27), tuberculoma(maximum, 0.36±0.15), and pneumonic consolidation(maximum,0.49±0.14). Dynamic CT is very useful for differentiation of malignant lesions from tuberculoma.

국내에서 유행하는 HIV의 전파 경로에 따른 Subtype 분포

이주실,남정구,김성순,강춘,최병선,김옥진,박미선,성봉모,서순덕,전수경,변승옥,신영오,조해월 대한감염학회 2001 감염 Vol.33 No.5

Background : Previous data have been reported that subtype B is prevalent in South Korea, but neither the extent nor the proportion of subtypes could be evaluated. This study was designed to analyze the distribution of HIV-1 subtypes, temporal instructions and transmission dynamics between epidemiological groups. Methods : 1,280 Koreans had been diagnosed as HIV seropositive during the period 1985 to 2000. Among them, 134 individuals were selected for this molecular epidemiological study. 134 DNAs were isolated from uncultured or cultured peripheral blood mononuclear cells. V3-V5 (0.7 kb) fragment of HIV-1 env gene was amplified by nested polymerase chain reaction and was sequenced. Results : HIV-1 isolates from thirty-seven homosexuals were all subtype B (100%). On the other hand, 66 isolates from 94 heterosexuals were subtype B (70%) and 28 were non B subtypes (30% : 13 A, 4 C, 2 D, 8 E , 1 G). Only subtype B strains were isolated from 73 males who were infected with HIV inside Korea while 16 B and 20 non B subtype strains were isolated from 36 males who were HIV infected outside of Korea. However, B and non B strains were isolated half and half from females who were infected inside Korea except one. Conclusion : The HIV-1 subtype B strains are prevalent in Korea from the early HIV infection until present in both homo and heterosexuals. Non B strains have been transmitted from men who were infected outside Korea to their spouses and casual partners. So, we need further study to monitor subtype B and non B HIV transmission in epidemiological groups of Korea, (Korean J Infect Dis 33:311∼318, 2001)