세로토닌성 항우울제가 백서의 Schedule-Induced Polydipsia에 미치는 영향

이기철,이정호,박중섭,최영민,전성일,정홍경,하준명,정재현 대한생물치료정신의학회 1999 생물치료정신의학 Vol.5 No.2

Object : Schedule-induced polydipsia is considered as an animal model of obsessive-compulsive disorder inrats. The authors evaluated the chronic effects of fluoxetine and clomipramine as serotonergic antidepressants and haloperidol as dopaminergic antagonist on the schedule-induced polydipsia in rat.Methods : Spraque-Dawley rats weighing 200-250gm were individually housed, maintained and allowed free access to water for 1 week. And then the rats were placed on a restricted diet. To induce polydipsia, rats were placed in automatic cage where a pellet dispenser automatically dispensed 90mg pellets on a fixed-time 60 seconds(FT 60s) feeding schedule over 150-minute test session for a day. Water was available at all times during the feeding schedule in automatic cage. After 4 weeks of daily exposure to the FT 60s feeding schedule, experimental rats met a predetermined criterion for polydipsic behavior(greater than 3 times of water per session on average). 4 groups of rats were administered fluoxetine(5mg/kg/i.p.), clomipramine(5mg/kg/i.p.), haloperidol(0.1mg/kg/i.p.), vehicle(1cc/kg/i.p.) for 3 weeks. Rats were tested once a week to access schedule induced polydipsic behavior. The chronic effects of experimental drugs on schedule induced polydipsic behavior were analyzed with repeated analysis of variance and Scheffe test as a post-hoc comparison.In order to measure water consumption in non-polydipsic food-deprived rats, a separate group of rats(N=8) were individually housed and given a single bolus(14.5 gm) of food per day which maintained them at their average body weight.Results and Conclusion : The results were as follows ;1) After 4 weeks of daily feeding procedure with fixed time schedule for 60 seconds per day, the experimental group showed significant differences than the control in the amount of water consumption as compared with their baseline water intakes. At the same periods, there were no differences between the experimental group and the control in body weight. 2) The clomipramine treated group and the fluoxetine treated group showed significant decrease in the amount of water intake as compared with their baseline of polydipsic water intakes for 3 weeks of treatment. However, the haloperidol treated group and the vehicle control group showed no changes of amounts of water intake for 3 weeks of treatment as compared with their baseline of polydipsic water intakes. 3) At 2 weeks of drug treatment, clmipramine treated group(16.88±6.51ml) and the fluoxetine treated group(22.50±10.35ml) showed significantly lower amounts of water intake than the haloperidol treated group (41.25±7.06ml) or vehicle control group(37.50±12.54ml). And also the clomipramine treated group(13.75±5.18ml) and the fluoxetine treated group(18.75±3.54ml) showed significantly lower amounts of water intake than the haloperidol group(35.00±11.65ml) and the vehicle control(34.38±6.78ml) at 3 weeks of drug treatment. Above findings suggest that the fixed time feeding procedure for schedule-induced polydipsia as an animal model of obsessive compulsive disorder was effective to the evaluation of pharmacological challenge study. The author confirmed that schedule-induced polydipsia was successfully decreased for 3 weeks of administration of clomipramine and fluoxetine but there was no response to haloperidol.

기종성 신우신염 1례

이재욱,구정태,서정일,양창헌,이정호,이동철,이영현,이활,이경섭 동국대학교 경주대학 1997 東國論集 Vol.16 No.1

기종성 신우신염은 주로 당뇨병환자나 폐쇄성 요로질환을 가진 환자에 발생하며 특징적으로 신실질 및 그 주위조직에 가스를 형성하면서 심한 조직괴사를 일으키는 매우 드문 급성 화농성 신감염으로 사망률이 높은 질환이다. 이 질환은 1989년 Kelly와 MacCallum에 의해 처음 보고된 이래 외국문헌에 약 90례 정도가 보고되어 있으며 국내에는 28례가 보고되어 있다. 수액 및 전해질 보충, 인슐린 투여를 통한 적절한 혈당조절 및 항생제 투여등의 내과적 치료와 절개배농 및 신적출술등의 수술적 치료 방법이 있다. 내과적 치료로 가스의 감소가 없는 경우에는 즉각적인 수술적 치료를 시행하여야하므로 이 가스변화에 대한 추적관찰이 중요하다 하겠다. 본 저자들은 당뇨병환자에서 발생한 기종성 신우신염 1례를 내과적 요법을 치험하였기에 문헌고찰과 함께 보고하고자 한다. Emphysematous pyelonephritis is rare, life-threatening infection of the renal parenchyma and perirenal tisseue. This disease is characterized by the production of intrarenal and perirenal gas and is frequently encountered in patients with diabetes mellitus or urinary obstruction. We experienced a case of emphysematouse pyelonephritis in a 62 years old women with poorly controlled diabetes mellitus who had been managed with medical theraphy. So we report this case with a review of the referenced literatures.

위의 유암종과 선종의 병발 1례

장재식,강혁주,이중현,서영범,윤병구,김용섭,이구,서정일,양창헌,이창우,김정란,윤환중 東國大學校醫學硏究所 2000 東國醫學 Vol.7 No.-

유암종은 전신에 퍼져 잇는 장크롬친화성 세포에서 기원하는데 위의 유암종은 비교적 드문 질환으로 모든 유암종의 1.9~2.2%에 해당하며 위에 발생하는 종양의 1% 미만에서 보고되고 있다. 유암종은 일반적으로 증상이 비특이적이고 면역조직화학검사에 의해서 진단되기 때문에 과거에는 드물게 발견되었으나 최근 내시경 기기 및 술기의 발전과 검사 빈도의 증가 및 면역조직화학검사의 발달로 진단율이 증가 추세에 있으며, 드물지만 유암종에서 선암과 공존하는 예들이 보고되고 있다. 저자들은 심와부 동통을 주소로 내원한 70세 남자 환자의 상부위장관내시경 검사에서 위체상부의 대만곡에서 0.4×0.4 cm 크기의 중간 함몰을 가진 Yamada 1형의 용종과 함께 전정부의 전벽에서 0.8×0.5 cm 크기의 융기된 점막 소견을 보여 조직학적으로 각각 위유암종 및 위선종임을 확진한 후 내시경적 용종 절제술로 치료한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Carcinoid tumors are arisen from enterochromaffin cells, which are scattered throughout the body. These tumors are composed of variable numbers of cells that contain endocrine granules in their cytoplasm, which can be identified by immunohistochemistry and electron microscopy. Gastric carcinoid tumors are relatively rare tumor, the reported incidence being 1.9~2.2% of all carcinoid tumors and less than 1% of all gastric tumors. Sometimes, composite carcinoid tumors and adenocarcinoma is reported. We experienced a case of the coincidence of carcinoid tumor and adenoma at the other site of the stomach in a 70 year old male patient. Gastrofiberscope showed 0.4×0.4 cm sized Yamada type I polyp with central depression on the greater curvature of the proximal body and 0.8×0.5 cm sized focal slightly elevated mucosa on the anterior wall of the antrum. The endoscopic biopsy specimens revealed carcinoid tumor and tubular adenoma with moderate atypism, respectively. The carcinoid tumor and adenoma were removed by endoscopic polypectomy. According to the follow-up gastrofiberoscopy after 7 month later, both lesions were nearly normal mucosa except whitish atrophic change after polypectomy.

정신분열병 환자들의 自己灣入에 관한 예비 연구

박성봉,김영미,전성일,이기철,김영훈,정영조,이영렬,이정호,최영민 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.6

목 적 : 정 신분열병 환자의 자기만입 정도에 영향을 미치는 인구학적 변인들 및 질병연관 변인들을 규명해 보고자 하였다. 또한. 환자들의 자기만입과 병식 사이의 연관성. 자기만입과 자존심 사이의 연관성을 알아보고자 하였다. 방 법 : 정신과 의사가 병록지와 면담을 통하여 대상 정신분열병 환자들의 인구학적 변인들 및 질병연관 변인들에 관한 자료를 얻고 환자들의 병식 정도를 평가한 후, 환자들로 하여금 자기보고형의 자기만입 척도와 자존심 척도를 시행하게 하였다. 총 111명의 환자가 연구대상으로 선택되었다. 결과: . 1) 여자가 남자보다 유의하게 높은 자기만입 척도 점수를 나타내었다 2) 질병연관 변인들 중 하위집단 사이에 자기만입 척도 점수의 유의한 차이를 보이는 변은 없었다. 3) 자기만입 척도 점수와 병식 점수 사이에 유의한 상관관계가 없었다. 4) 자기만입 척도 점수와 자존심 척도 점수 사이에 유의한 역상관 관계를 보였다. 결 론 : 본 예비 연구의 결과로 보아 정신분열 병 환자의 병식이 부족한 상태에서도 자기만입이 진행될 수 있으며. 자기만입이 심할수록 환자의 자존심이 저하되는 것으로 생각된다. 또한 여자 환자들이 남자 환자들보다 자기만입에 더 취약한 것으로 생각된다. 따라서 정신분열 병 환자의 이해와 치료를 위하여 자기만입에 관한 지속적인 연구가 필요할 것으로 생각된다. objective : This study was conducted to identify demographic variables and illness related variables which may affect the severity of self-engulfment in the patients with schizophrenia. We also studied the relationship between self-engulfment and insight, and the relationship between self-engulfment and self-esteem. Methods : Data on demographic variables and illness related variables for the subjects were gathered from hospital records and clinical interviews by the psychiatrists. Degree of insight for the subjects was assessed through clinical interviews by the psychiatrists. Degree of self-engulfment and self-esteem for the subjects was assessed from the self-engulfment scale and the self-esteem scale respectively. A total of 111 patients with schizophrenia were selected for statistical analysis. Results 1) The females exhibited significantly higher scores than the males on the self-engulfment scale. 2) There was no illness related variable, which exhibited a significant difference among subgroups on the self-engulfment scale. 3) There was no significant correlation between the self-engulfment scores and the insight 4) There was a significantly inverse correlation between the self-engulfment scores and the self-esteem scores. Conclusion : The results of this preliminary study suggest that self-engulfment may develop despite lack of insight and that there was inverse relationship between self-engulfment and self-esteem in the patients with schizophrenia. It also suggests that females are more subject to self-engulfment than males. So, authors suggest that it is valuable to do further studies of self-engulfment in the patients with schizophrenia.

내시경적 점막절제술로 치험한 식도 과립상 세포종 1례

강혁주,김성욱,최석진,이중현,장재식,서영범,윤병구,박건욱,김성자,김용섭,강승완,이구,양창헌,이창우,김욱년,이광헌,서정일 동국대학교 의학연구소 2000 東國醫學 Vol.7 No.-

과립상 세포종은 Schwann 세포 기원으로 생각되며 인체에 비교적 드물게 발생한다. 과립상 세포종은 전신 어느 곳에서나 발견될 수 있으나 주로 혀, 구강, 피부 혹은 유방 등에서 호발하며 드물게 위장관에서 발견된다. 위장관에서는 식도에서 가장 호발하며 다음으로 위, 대장 순이다. 과립상 세포종은 대부분, 특히 위장관에서는 양성이며 소수의 악성 병변이 보고되었다. 이러한 이유와 함께 수술 전의 진단이 어렵기 때문에 과립상 세포종에 대한 근본적인 치료는 현재까지 외과적 절제술이다. 최근에 시도되는 치료방법들로는 내시경적 레이저 치료, 용종절제술, 내시경적 점막 절제술 등이 있다. 저자들은 상부 소화관 내시경검사를 시행하여 식도 과립상 세포종을 진단하고 내시경적 점막 절제술을 시행하여 합병증 없이 퇴원하여 현재 재발없이 경과 관찰중인 1례를 경험하였기에 보고하는 바이다. Granular cell tumors, which occur infrequently, are probably of Schwann cell origin. They can occur almost anywhere in the body but usually affect the tongue, oral cavity, skin, or breasts and are rarely found in the gastrointestinal tracts. The esophagus is the most frequent gastrointestinal site, followed by the stomach and the colon. Granular cell tumors are generally benign, especially in the gastrointestinal tract, some malignant lesions have been reported. For this reason, and also because preoperative diagnosis is difficult, the standard treatment for granular cell tumor has until now been surgical excision. In recent years, other therapeutic methods is endoscopic laser therapy (ELT), polypectiomy, endoscopic mucosal resection (EMR). We report a case of esophageal granular cell tumor which was diagnosed by an endoscopy and managed using an endoscopic mucosal resection without complication.

열사병에 관한 임상적 고찰

이춘일,김정완,길현교,장연복,박정식,박성우,김병태,최문기,고영박,선덕재 대한내과학회 1990 대한내과학회지 Vol.38 No.3

Heat stroke is a medical emergency and the most important environmental heat illness. It is a disease of high fever, dry warm skin without sweating, and mental disturbances. It commonly involves several organs including the liver, kidney, heart, brain, and the coagulation system. Recently, we experienced 10 cases of heat stroke. The clinical findings of those were as follows: 1) At the time of admission, body temperature in all patients were higher than 39.4℃, and especially in 4 cases, higher than 41.4℃ : pulse rates in all patients were more than 140/min: and systolic blood pressure were less than 100 ㎜Hg except in one case. 2) The clinical manifestations were CNS symptoms including 6 cases of coma, variable skin lesions, G-I hemorrhage, muscle swelling with tenderness and oliguria. 3) On blood chemistry, there were markedly decreased levels of protein, albumin and calcium: markedly inceased level of SGOT, SGPT, CPK, LDH, BUN, and creatinine: one case of hypokalemia and two cases of hyperkalemia: and 4 cases of hyperbilirubinemia greater than 2㎎/㎗. 4) Two cases of myoglobinuria, 3 cases of proteinuria nd 1 cases of hematuria were observed. 5) Complications, such as uremia, ventricular tachycardia, D.I.C., pulmonary edema, pleural effusion, jaundice and acute pancreatitis were observed. 6) Four cases out of 10 were died. The causes of death were pulmonary edema, cerebral edema, D.I.C., hepatic failure and cardiac failure.

근막동통증후군의 정신과적 특성

이정호,이기철,최영민,전성일 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.3

본 연구자들은 불안, 우울 및 스트레스가 근막동통증후군과 어떤 관계가 있는지 알아보고자 하였다. 근막동통증후군은 1994년 3월부터 1994년 7월 사이에 통증클리닉을 방문한 환자들중, 근막동통증후군의 임상기준을 만족하는 환자 30명을 대상으로 우울증상(Beck's Depression Inventory)과 불안증상(Spielberger's State-Trait Anxiety Inventory) 및 스트레스지각검사(Global Assessment of Recent Stress)를 시행하고 대조군과 비교하여 다음과 같은 결과를 얻었다. 1) 불안척도인 STAI의 상태불안 및 기질분안에서 신경증대조군, 근막동통증후군, 건강대조군 순으로 각군간에 유의한 차이를 보였다. 2)우울척도인 BDI 전체점수에서 신경증대조군, 근막동통증후군, 건강대조군 순으로 각 군간에 유의한 차이를 보였다. 3) 스트레스 척도인 GARS에서 신경증대조군, 근막동통증후군, 건강대조군 순으로 각군간에 유의한 차이를 보였다. 4) BDI의 요인분석에서, 신체증상 문항집단에서 신경증대조군, 근막동통증후군, 건강대조군 순으로 각군간에 유의한 차이를 보였다. 그러나, 다른 요인에서는 근막동통증후군과 다른 집단간에 차이가 없었다. 이상의 연구결과로 보아, 근막동통증후군 환자들은 건강대조군보다 불안과 우울이 높고, 신체증상에 집착하는 경향을 모이며 일상새활에서도 많은 스트레스를 지각하는 것으로 판단되었으며, 이러한 사실은 이들에대한 정신과적 치료가 필요하다는 것을 보여준다고 사료된다. We investigated the possible association between depression, anxiety, severity of recent stress in patients with myofascial pain, with chronic myofascial pain syndrome. On the initial visit, 30 subjects completed the following psychometric battery : Beck Depression Inventory, Spielberger State-Trait Anxiety Inventory and Global Assessment of Recent Stress. As compared with the neurosis control group and the healthy control group, the results were as follows: 1) The myofascial pain group showed higher scores than the healthy controls but lower than the neurosis controls, in the Spielberger State-Trait Anxiety Inventory. 2) The myofasical pain group showed higher scores than the healthy controls but lower than the neurosis controls, in the total score of Beck Depression Inventory. 3) The myofasical pain group showed higher scores than the healthy controls but lower than the neurosis controls, in the score of Global Assessment of Recent Stress. 4) In the factor analysis of Beck Depression Inventory, the myofascial pain group showed significantly higher scores than the healthy controls but lower than the neurosis control in the somatic symptom subscale. However, there were no significant differences among the myofascial pain group and other control groups in the other sbuscales. These findings suggest that the myofascial pain group is more anxious and depressed and more preoccupied with their somatic symptoms due to their myofascial pain and more stressed in recent periods. The authors propose that the psychiatric management is helpful in intervening with the progression of myofascial pain.

톨루엔 디이소시아네이트 폭로 근로자들의 작업방법에 따른 대사물질의 비교 및 면역능에 관한 연구

이수일,조병만,황인경,이철호,박정래 大韓産業醫學會 1998 대한직업환경의학회지 Vol.10 No.3

Following recent advanced industrialization, the amount of polyurethane to use as thermal insulating materials, upholstery, mattresses and packing materials in automotive and furniture industry is increasing world-widely, and the number of polyurethane-producing worker will be increased. Because the numerous organic solvents are used in polyurethane-producing factory, the workers in this work site is exposed to many organic solvents. Of the organic solvents, Toluene Diisocyanate(TDI) has many hazardous effects to human. The effects of TDI on human are the irritation to respiratory mucosa and gastrointestinal symptoms. Conjunctival irritation, dermal inflammation (redness, pain, vesicular formation) and gastrointestinal symptom(nausea, vomiting. abdominal pain) are reported just after short-term exposure of TDI. TDI is known to give rise to bronchial asthma, as the immune disorder. And because of strongly volatile characteristics of TDI, it is suggested as a more injurious material to human health, especially human immune system, than other organic solvents. Bronchial asthma inducing mechanism of TDI is not clearly known, but on the analogy of TDI induced symptoms and recent studies, early-onset asthma is type I hypersensitivity reaction mediated by immunoglobulin E(IgE), and late-onset asthma is maybe type III hypersensitivity reaction by circulating IgG. And we know that the complicated human immune function is likely to move in such that mechanisms, there are not studies on immune indices evaluating the bronchial asthma-related immune function. The evaluation of change patterns of humoral immunity including IgE and IgG and cellular immunity including T-helper cell. T-suppressor cell and T-cytotoxic cell will be helpful to evaluate exposure degrees and prognosis in TDI exposed workers. Because TDA(toluene diamine) as a biological exposure index of TDI becomes the focus of interest, we know that a study on the correlation between urinary TDA and air TDI and immunological indices will make a contribution to biological effect monitoring indicies. We examined human immunity indicators such as WBC, %Lymph (percentile of Lymphocyte in WBC), %T-cell(percentile of T-lymphocyte in total lymphocyte). CD4, CD8, C3, C4, IgA, IgG, IgM, IgE in peripheral blood to evaluate the health hazard of the TDI-exposed workers. And we examined TDA to evaluate correlation between exposure and effect. Total 90 subjects was selected, 45 workers who worked in the polyurethane-producing factories as an exposed group, and 45 cases who were office workers(10 cases), other blue collors(27 cases), and medical college students(8 cases) as a control group. And the results were as follows; 1. The logarithm of IgE-Log10(IgE)±SD-in peripheral blood of a exposed group was significantly higher than a control group, 2.22 ±0.62 in case group compared with 1.98±0.53 in control group. (p<0.05) 2. IgA and IgM in the polyurethane-producing workers were 261.02±83.12㎎/㎗, 151.97 ±59.64 ㎎/㎗, respectively, and 292.77±100.45, 179.17±100.78 in control group. IgA and IgM was slightly lower in polyurethane-producing group than control.(p>0.05) 3. WBC, %Lymph. %T-cell, C3, C4, CD4, CD8, CD4/CD8 ratio and IgG in case group were 6.391.1 ea/㎖, 37.53 %, 59.54 %, 76.68 ㎎/㎗, 0.76×10(9) ea/L, 0.63×10(9) ea/L, 1.39, and 1606.29 ㎎/㎗, respectively, and 6,974.7 ea/㎖, 35.12 %, 59.64 %, 71.95 ㎎/㎗, 33.94 ㎎/㎗, 0.80×10(9) ea/L, 0.61×10(9) ea/L, 1.39, and 1581.51 ㎎/㎗ in control group. There was no statistical significance between two groups.(p>0.05) 4. In the comparison of each other companies, average of individual urinary TDA in polyurethane paint manufacturing companies is higher than that of polyurethane sponge foaming companies. And, the concentration of 2.6-TDA which is a metabolite of well-vaporized 2.6-TDI is higher than that of 2.4-TDA in the polyurethane sponge foaming companies. But, the concentration of 2.4-TDA which is a metabolite of illvaporized but well skin-absorbed 2.4-TDI is higher in polyurethane paint manufactures. 5. There were no statistical significance in the correlations between individual urinary TDA and immunologic indices.

Clozapine이 백서의 Schedule-Induced Polydipsia에 미치는 영향

이기철,정홍경,이정호,홍승범,최영민,전성일,정재현,하준명 대한생물치료정신의학회 2000 생물치료정신의학 Vol.6 No.2

Object : This study was designed to evaluate the effects of clozapine which is one of most useful atypical antipsychotics in the schedule-induced polydipsic rat which is an animal model of obsessive-compulsive disorder. Methods : Spraque-Dawley rats were placed in automatic cage where a pellet dispenser automatically dispensed 90mg pellets on a fixed-time 60 seconds(FT- 60s) feeding schedule over 150-minute test session for 4 weeks. After 4 weeks of daily exposure to the FT-60s feeding schedule, experimental rats met a predetermined criterion for polydipsic behavior(greater than 3 times of water per session on average). Rats were stratified into clozapine(0.34mg/kg,i.p.), clozapine(14.63mg/kg,i.p.), clomlpramine(5mg/kg,i .p.), and vehicle (1cc/kg,i.p.) group and treated with each drugs for 3 weeks. To identify the non-polydipsic food-deprived rats, a separate group of rats(N=8) were individually housed and given a single bolus(14.5gm) of food per day which maintained them at their average body weight. Results : The results were as follows ; 1)After 4 weeks of scheduled feeding procedure, the experimental group showed significant differences than bolus control in the amount of water consumption as compared with their baseline of water intakes for 4 weeks. At the same periods, there were no differences between the experimental group and bolus control in the borty weight. 2)The clomipramine group, the clozapine 0.34mg group and the clozapine 14.63mg group showed significant decrease in the amount of water intake for at 2nd & 3rd week of drug treatment as compared with their baseline of polydipsic water intakes. But, the vehicle control group showed no changes of amounts of water intake for 3 weeks of treatment as compared with their baseline of polydipsic water intakes. Conclusion : Above findings suggest that the fixed time feeding Procedure for Schedule induced polydipsia as an animal model of obsessive compulsive disorder was effective to the evaluation of pharmacological challenge study. In clinical situation, the authors suggest that atypical antipsychotic drugs which act as serotonin and dopamine receptor antagonist may be helpful to improve the symptoms of the patients with treatment refractory obsessive-compulsive disorder.

절제술로 치료한 요도구 주위 낭종

이정우,서일영,정희종 원광대학교 의과학연구소 2009 圓光醫科學 Vol.24 No.1

요도구 주위 낭종은 드문 선천성 이상으로 대개 무증상이며, 증상이 있을 시 완전절제술이 필요하다. 저자들은 드문 요도구 주위 낭종 2례를 완전 절제술로 치료하였기에 문헌고찰과 함께 보고하는 바이다. Parameatal urethral cyst is a very rare congenital anomaly and very few cases has been reported in the literature. The usual age of presentation is early to late childhood. It is usually asymptomatic in infancy. The usual symptom are spraying or deflection of urinary stream and poor cosmesis. Complete excision of the cyst is required for treatment and prevention of recurrence. We report 2 cases of parameatal urethral cyst in 24-year-old and 38-year-old male.