조갑 - 슬개골 - 주관절 증후군

김종구 ( Jong Goo Kim ),윤태영 ( Tae Young Yoon ),장승호 ( Seung Ho Chang ) 대한피부과학회 1996 대한피부과학회지 Vol.34 No.3

Nail-patella-elbow syndrome is a relatively rare autosomal dominant disorder characterized by nail and skeletal defects, especially of the patella. The principal manifestations include hypoplastic or absent patellae, dysplastic finger-nails, dislocated radial heads with limited elbow motion, and often iliac horns. A less common but not infrequent manifestations are hereditary nephropathy and hyperpigmentation of the pupillary margin of the iris (Lester iris). A 17-year-old man was presented with abnormalities of both the 1st and 2nd finger-nails since birth. He had triangular lunulae and hypoplastic nail plates. Two months ago, the diagnosis of subluxation of both elbow joints was made as limitation of motion and radiologic findings of both knee joints revealed hypoplastic patellae. Routine laboratory studies were all within normal limits. The patient's father had triangular lunulae and hypoplastic nail plates on both 1st finger-nails. We report a case of nail -patella syndrome with the review of literature. (Kor J Dermatol 1996;34(3): 440-444)

한국형 우울장애 약물치료 알고리듬 2021 (VI) : 비약물학적 생물치료

정종현(Jong-Hyun Jeong),우영섭(Young Sup Woo),박원명(Won-Myong Bahk),왕성민(Sheng-Min Wang),서정석(Jeong Seok Seo),박영민(Young-Min Park),김원(Won Kim),심세훈(Se-Hoon Shim),이정구(Jung Goo Lee),장승호(Seung-Ho Jang),양찬모(Chan-Mo Y 대한신경정신의학회 2021 신경정신의학 Vol.60 No.4

Objectives The Korean Medication Algorithm Project for Depressive Disorder 2021 (KMAP-DD 2021) was made to update new researches and data. This study focused on non-pharmacological biological treatments. Methods Ninety-seven psychiatrists with extensive clinical experience in the non-pharmacological biological treatment of depressive disorder were primary selected and a questionnaire was sent to each of them by mail, 65 of the 97 replied. Results Electroconvulsive therapy (ECT) was recommended as an initial strategy for major depressive disorder, severe depressive disorder with/without psychotic features with urgent suicidal risk, or a severe depressive episode with psychotic features in pregnant patients, for non-responders on pharmacotherapy for a moderate depressive episode, and as a second strategy for non-responders on antidepressant monotherapy or combination therapy combined with physical illness. For pregnant women with a severe episode of major depressive disorder, repetitive transcranial magnetic stimulation (rTMS) was preferred as a first-line strategy, and as a second strategy for non-responders on combined antipsychotic and antidepressant therapy and non-responders with comorbidity and physical illness. Complementary or novel treatment was not recommended as the first-line treatment strategy for depressive disorder, but transcranial direct current stimulation (tDCS), vagus nerve stimulation (VNS), deep brain stimulation (DBS), light therapy, and omega-3 fatty acid nutritional therapy were second-line treatment strategies. Conclusion ECT and rTMS are initial strategies in specific clinical situations. Preferences for complementary or novel treatments such as tDCS, light therapy, and omega-3 fatty acid nutritional therapy have increased gradually, but in practice, their usages are still limited.

Dopamine Gangrene

김종구,장승호,윤태영 ( Jong Goo Kim,Seung Ho Chang,Tae Young Yoon ) 대한피부과학회 1997 대한피부과학회지 Vol.35 No.4

Dopamine, a sympathomimetic agent, is one of the drugs used to improve cardiac output and blood pressure in advanced cardiac life-support in the context of conditions such as shock and heart failure. It is available only for intravenous use. We report a case of dopamine gangrene which has never been reported in Korean medical literature. Four gangrenous lesions developed in both forearms and the left leg of a 72-year-old man during a 7-day infusion of dopamine 3pg per kg per minute as treatment for septic shock, which corresponded to the injection sites. The gangrenous lesions healed up spontaneously leaving scars after administration of dopamine was discontinued. (Kor J Dermatol 1997;35(4): 805 - 808)

비흑색종의 종양과 그 주위 상피 세포에서의 p53 , PCNA , bcl - 2에 대한 면역조직화학 염색 양상

김종구,윤태영,장승호 ( Jong Goo Kim,Tae Young Yoon,Seung Ho Chang ) 대한피부과학회 1997 大韓皮膚科學會誌 Vol.35 No.6

Background: In both normal tissue development and malignant cell growth, the maintenance of cell numbers reflects a balance between cell proliferation and cell death. Excessive growth may result from uncontrolled cellular proliferation or limited cell death. The growth process of squa mous cell carcinorna(SCC) has recently been reported to differ from that of basal cell carcinoma (BCC). Several reports have suggested that the normal-appearing, overlying epidermis might be a proliferative and be a precursor lesion of BCC. SCCs occur in burn scars, chronic ulcers, and chronic sinus but the najority of SCCs are actinic in origin. It. is possible to develop subsequent. skin cancer from the normal-appearing epidermis adjacent to SCC due to chronic sun-exposure. Objective : The purpose of this study was to investigate growth dynamics of non-melanorna skin cancers and characteristics, including the carcinogenic property, of the normal appearing epidermis overlying and acljacent to non rnelanoma skin cancers. Methods : We compared expressions for p53, PCNA, bcl 2, and TGF-a in 21 BCCs and 8 SCCs by irnmunohistochi.mical staining with a labelled strept,avidin biotin complex(LSAB) method. Results . The results were as follows. 1) Expressions for p53 and PCNA within the tumor remarkably increased and the distribution pattern of expression for p53 was not always consistent with that for PCNA. 2) An expression the bcl-2 was increased in half of the BCCs, but not in all of the SCCs. 3) The epidermis overlying the BCC showed increased expressions for p53, PCNA, and TGF-a. 4) The epidermis adjacent to the SCC showed increased expressions for p53, and PCNA in a few of cases. Conclusion : We suggest that a neoplastic transformatiqn in BCC is caused by extended cell survival rather than ini:reased cell proliferation, but in SCC it. is caused by other mechanisms, and that the proliferativ activity in the epiderrnis overlying BCC is different from the normal epidermis and maybe repr'sents carcinogenic activity of the epidermis. (Korean J Dermatol 19()7;35(6): 1110-1120)

Bednar 종양

이홍탁,김종구,장승호,윤태영 ( Hong Tak Lee,Jong Goo Kim,Seung Ho Chang,Tae Young Yoon ) 대한피부과학회 1997 대한피부과학회지 Vol.35 No.3

한국형 우울장애 약물치료 알고리듬 2021 (V) : 안전성, 부작용, 동반 신체질환을 고려한 항우울제 선택 및 치료저항성 우울증의 임상적 정의

정명훈(Myung Hun Jung),이정구(Jung Goo Lee),박원명(Won-Myong Bahk),우영섭(Young Sup Woo),왕성민(Sheng-Min Wang),정종현(Jong-Hyun Jeong),김원(Won Kim),심세훈(Se-Hoon Shim),서정석(Jeong Seok Seo),장승호(Seung-Ho Jang),양찬모(Chan-Mo Y 대한신경정신의학회 2021 신경정신의학 Vol.60 No.4

Objectives To revise Korean Medication Algorithm Project for Depressive Disorder 2017 (KMAPDD 2017) guidelines by revising antidepressant choices based on their safety, adverse effects, comorbid physical illnesses, and the clinical definition of treatment-resistant depression (TRD). Methods A 33-item questionnaire comprised of six parts was developed. A 65-expert consensus (65/97, 67.0%) was obtained on pharmacological treatment strategies regarding antidepressant choice with respect to safety, adverse effects, and comorbid physical illnesses. Multiple response sets were subjected to statistical analysis. Results The results obtained showed that first-line pharmacotherapeutic strategies based on various clinical considerations were as follows: mirtazapine (for patients with increased suicidality, Gastrointestinal discomfort, and insomnia), bupropion (for patients with orthostatic hypotension, history of a safety accident, serotonin syndrome, sedation, sexual dysfunction, and weight gain), and escitalopram (for patients with anticholinergic side effects). For patients exhibiting comorbid conditions, duloxetine was the first line pharmacotherapeutic strategy for chronic pain, escitalopram was the first-line pharmacotherapeutic strategy for diabetes, hypertension, liver disease, Parkinson’s disease, renal disease, epilepsy, and thyroid disease, and sertraline was a first-line pharmacotherapeutic strategy for arrhythmia and cardiovascular disease. Conclusion Pharmacological treatment strategy of KMAP-DD 2021 is similar to that of KMAPDD 2017. Additional study is required to determine antidepressant choices for TRD and cancer patients with depression.

한국형 우울장애 약물치료 알고리듬 2021 (I) : 주요우울삽화의 치료 전략

우영섭(Young Sup Woo),박원명(Won-Myong Bahk),서정석(Jeong Seok Seo),박영민(Young-Min Park),김원(Won Kim),정종현(Jong-Hyun Jeong),심세훈(Se-Hoon Shim),이정구(Jung Goo Lee),장승호(Seung-Ho Jang),왕성민(Sheng-Min Wang),정명훈(Myung Hun 대한신경정신의학회 2021 신경정신의학 Vol.60 No.3

Objectives The Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) is a consensus-based medication guideline. To reflect advances in pharmacotherapy for depressive disorders, we have undertaken a fourth revision of the KMAP-DD. Methods The review committee for the new version of the KMAP-DD (KMAP-DD 2021) included 143 Korean psychiatrists with clinical experience in the field of depressive disorders. Each treatment strategy or treatment option was evaluated with an overall score of nine, and the treatment option was categorized into the three levels of recommendation of primary, secondary, and tertiary. Results The first-line pharmacotherapeutic strategy for mild to moderate major depressive episodes (MDE) was antidepressant (AD) monotherapy. For severe MDE without psychotic features, AD monotherapy or the combination of AD and atypical antipsychotics (AAP) was the first-line strategy. The combination of AD and AAP was recommended as the first-line for the MDE with psychotic features as well. When treatment response to initial AD monotherapy was insufficient, a combination of AAP or another AD was recommended. In the case of unsatisfactory response to initial treatment with an AD and AAP combination, switching to another AAP or adding another AD was recommended. Conclusion Generally, there were no significant changes in the recommendations for MDE management in the KMAP-DD 2021 compared to previous versions. However, it was notable that the preference for the use of AAP and AD with the novel mechanism of action including vortioxetine and agomelatine increased.

한국형 우울장애 약물치료 알고리듬 2021 (II) : 임상 아형

박영민(Young-Min Park),서정석(Jeong Seok Seo),우영섭(Young Sup Woo),박원명(Won-Myong Bahk),김원(Won Kim),정종현(Jong-Hyun Jeong),심세훈(Se-Hoon Shim),이정구(Jung Goo Lee),장승호(Seung-Ho Jang),왕성민(Sheng-Min Wang),정명훈(Myung Hun 대한신경정신의학회 2021 신경정신의학 Vol.60 No.3

Objectives The Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) was developed in 2002 and revised in 2006, 2012, 2017. In 2021, the fifth edition was published. This edition reflected new findings and the latest trends in the areas of pharmacological treatment. The aim of this study is to present strategies and treatment options according to the subtype of depression using data from the KMAP-DD-2021. Methods Ninety-seven psychiatrists with clinical experience in depressive disorder were selected. The questionnaires for KMAP-DD 2021 were sent to participants via mail. KMAP-DD 2021 consists of overall treatment strategies and treatment options under specific circumstances. Each treatment strategy or treatment option was evaluated with an overall score of nine and was divided into the three phases of recommendation that include primary, secondary, and tertiary. Results For persisting depressive disorder, antidepressant monotherapy including selectiveserotonin reuptake inhibitor (SSRI) (escitalopram, fluoxetine, sertraline, paroxetine), serotoninnorepinephrine reuptake inhibitor (SNRI) (desvenlafaxine, venlafaxine, duloxetine, milnacipran), vortioxetine, and mirtazapine, was recommended as first-line medications. For melancholia of major depressive disorder, SSRI, SNRI, vortioxetine, and mirtazapine also were recommended as first-line medications. For mixed features, SSRI, bupropion, mirtazapine, SNRI, except for duloxetine, and milnacipran were recommended as first-line medications. For anxious distress, SSRI, mirtazapine, and SNRI, except milnacipran, were recommended as first-line medications. Conclusion The preferences of antidepressants by experts differed according to the subtype of depression. These findings suggest that experts treat patients with a major depressive disorder after considering the subtype of depression involved.

한국형 우울장애 약물치료 알고리듬 2021 (III) : 소아·청소년

양찬모(Chan-Mo Yang),심세훈(Se-Hoon Shim),박원명(Won-Myong Bahk),우영섭(Young Sup Woo),정종현(Jong-Hyun Jeong),왕성민(Sheng-Min Wang),김원(Won Kim),서정석(Jeong Seok Seo),이정구(Jung Goo Lee),박영민(Young-Min Park),장승호(Seung-Ho J 대한신경정신의학회 2021 신경정신의학 Vol.60 No.3

Objectives The Korean Medication Algorithm Project for Depressive Disorder 2021 (KMAP-DD 2021) was a revision of previous works. The main purpose of the current study was to amend guidelines for the treatment of a major depressive disorder (MDD) for children and adolescents. Methods The survey consisted of 21 questionnaires for children and adolescents. A total of 33 of the 46 experts in child and adolescent psychiatry answered the survey. Results Antidepressant (AD) monotherapy was selected as the 1st line option for MDD with mild to moderate severity. As the 1st line of treatment for MDD severe without psychotic features in children and adolescents, AD monotherapy and AD augmented with atypical antipsychotics (AAP) were recommended. For MDD with psychotic features, AD augmented with AAP was preferred as the 1st line of treatment. Conclusion We developed an algorithm for child and adolescent populations with depressive disorders, more specifically than the KMAP-DD 2017. We expect this algorithm will provide clinicians useful information and help in the treatment of children and adolescents with depressive disorders.

한국형 우울장애 약물치료 알고리듬 2021 (IV) : 여성 및 노인

왕성민(Sheng-Min Wang),박원명(Won-Myong Bahk),우영섭(Young Sup Woo),서정석(Jeong Seok Seo),박영민(Young-Min Park),김원(Won Kim),정종현(Jong-Hyun Jeong),심세훈(Se-Hoon Shim),이정구(Jung Goo Lee),장승호(Seung-Ho Jang),양찬모(Chan-Mo Y 대한신경정신의학회 2021 신경정신의학 Vol.60 No.4

Objectives An expert consensus guideline for the treatment of depressive disorder, the Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD), was first established in 2002 and updated in 2017. To provide an up-to-date treatment guideline, KMAP-DD 2021 was recently completed. This study was undertaken to provide a guideline for the treatment of depressive disorder in a selected population that included females and elderly. Methods The survey conducted consisted of 7 questionnaires for each population, females and elderly, with depressive disorder. A total of 65 of 97 experienced psychiatrists answered the survey. Results For the treatment of premenstrual dysphoric disorder, the selective serotonin reuptake inhibitors, venlafaxine, and desvenlafaxine were recommended as first-line therapies. For major depressive disorder (MDD) during pregnancy, antidepressant (AD) monotherapy was recommended as a first-line therapy for mild to moderate and severe depression, and combined electroconvulsive therapy and AD with atypical antipsychotics (AAP) were recommended as a first-line therapy for severe depression with psychotic features. AD plus AAP was generally recommended for post-partum depression. In elderly with depression, AD monotherapy was recommended as the treatment of choice for mild to moderate episodes, and AD monotherapy and AD plus AAP were recommended as a first-line therapy for severe depression without psychotic features. Lastly, AD plus AAP was chosen as the treatment of choice for psychotic depression. Conclusion Present study provides an updated algorithm for the treatment of females and elderly with depressive disorders. This algorithm provides a practical aid to clinicians for the treatment of females and elderly with MDD.