보완대체의학에 대한 간호학과 학생의 주관성 연구

박은영 ( Eun Young Park ),이은남 ( Eun Nam Lee ),강지연 ( Ji Yeon Kang ),주현옥 ( Hyeon Ok Ju ),김삼숙 ( Sam Sook Kim ),최은정 ( Eun Jung Choi ),김학선 ( Hack Sun Kim ) 경희대학교 동서의학연구소 2011 동서간호학연구지 Vol.17 No.1

보완대체의학은 건강증진과 질병예방을 위한 총체적인 접근법의 하나로 환자뿐 아니라 일반인들 사이에서도 이용률이 증가하고 있고, 교육에 있어서도 보완대체요법 관련 교과목을 의학이나 간호학의 정규 교과과정 내에 포함시키는 대학이 늘어남에 따라 미래의 건강관리 제공자인 간호학생들의 보완대체의학에 대한 인식이나 태도를 파악하는 것은 중요하다. 이에 본 연구는 Q방법론을 이용하여 보완대체의학에 대한 간호학생의 반응을 유형화하고 구체적인 특성을 파악하고자 시도되었다. 보완대체의학에 대한 간호학생의 반응은 4개로 유형화되었으며, 각 유형은 실용적 확신형, 견제형, 가치 인정형, 제한적 수용형으로 명명하였다. 각 유형의 명명에서 볼 수 있듯이 간호학생들은 인식에서 약간씩은 차이가 있지만 보완대 체의학에 대해 비교적 긍정적인 태도를 갖고 있는 것으로 나타났다. 이러한 결과는 간호학생들이 보완대체요법에 대해 긍정적인 태도를 보였음을 보고한 Kim (2004), Kim, Erlen, Kim 과 Sok (2006), Uzun과 Tan (2004)의 연구결과와 일치한다고 할 수 있다. 제1유형은 ‘실용적 확신형’으로 보완대체요법의 효과를 단순히 인정하기보다는 실용성에 초점을 맞춘 유형이다. 보완대체요법의 문제점으로 많이 지적되는 것 중의 하나가 사람마다 효과가 다르기 때문에 일률적으로 적용하기 어렵다는 것인데, 제1유형의 대상자들은 이를 오히려 실용적인 측면으로 인식하여, 보완대체요법의 효과는 사람마다 결과가 다르게 나타날 수 있기 때문에 어떤 치료법을 일률적으로 적용하기보다는 자신한테 맞는 보완대체요법을 찾아야 한다고 인식하는 것이다. 또한 제1유형의 대상자들은 보완대체요법에 대해 효과가 없거나 의미 없는 행위이며 의학적 치료를 방해하거나 효과를 믿을 수 없다는 데는 강하게 반대를 했다. 간호학생의 보완요법에 대한 태도를 조사한 Kim (2004)의 연구에서도 보완대체요법이 엉터리 치료법이라는 데에 대해 가장 부정적인 태도를 보임으로써 본 연구결과와 일치한다. 간호학생의 주관성을 조사한 Hwang (2004)의 연구에서는 간호학생의 인식이 세 가지로 유형화되었는데 ‘긍정적 인정형’으로 명명된 사람들은 보완대체요법이 건강의 유지와 증진에 도움이 되며, 면역력을 향상시키고 심리적 지지를 제공하고 몸을 보호하며 안위를 증진시키는 것으로 인식하고, 엉터리 치료법이고 환자의 치유에 방해가 되므로 사용을 피해야 하고 과학적인 근거를 설명할 수 없으므로 신뢰할 수 없다는 데대해서는 강한 반대의 의사를 표함으로써 본 연구에서 ‘실용적 확신형’으로 명명된 대상자들과 유사한 인식양상을 보였다. 본 연구에서의 ‘실용적 확신형’의 사람은 보완대체요법에 대해 쉽게 접근할 수 있고 여러 가지 효과를 한꺼번에 기대할 수 있다는 점에서 좀 더실용적인 면을 강조한 점이 차이라고 할 수 있다. 제2유형은 ‘견제형’으로 보완대체의학의 부작용에 대한 염려와 효과에 대한 정확한 작용기전의 뒷받침을 요구하는 유형으로, Hwang (2004)의 연구에서 보완대체요법은 체계적인 검증 후에 정통적인 치료와 병행해서 사용해야 효과가 있다고 하여 ‘객관적 수용형’으로 명명한 것과 매우 유사하다. 또한 간호사를 대상으로 한Son (2002)의 연구에서 보완대체요법을 현대의학을 보완해주는 치료법으로 고려하면서 과학적인 근거를 확립하는 일이 필요하다고 제시한 것과 일치한다. Ernst (2000)도 보완대체요법을 이용하는 대상자들은 보완대체요법의 안전성과 효율성에 대해서 알고자 하며, 보완대체요법에 대해 건강관리자와 개방적으로 의사소통할 때 안정성이 확립된다고 하여 본 연구의 ‘견제형’ 유형과 유사한 것을 볼 수 있다. ‘견제형’의 사람들은 보완대체요법에 대한 효과가 사람마다 다르게 나타나므로 보완대체요법을 무조건적으로 받아들이기 이전에 임상적인 효율성에 대한 정확한 근거와 과학적인 검증에 관한 많은 연구들이 이루어져야 할 것을 강조한 유형이다. 이러한 견해는 최근 의학이나 간호학 교육에서 근거중심의 행위를 강조하고 있는 것을 반영하는 것이라 할 수 있다. 제3유형은 ‘가치 인정형’으로 보완대체의학에 대해 과학적 신뢰를 갖고 있지는 않지만 보완대체요법의 건강증진에 대한 가치를 인정하는 유형이다. 의사를 대상으로 보완대체요법의 치료 효과에 대한 태도를 분석한 Jang 과 Park (2003)의 연구에서 62.2%는 ‘설명하기는 어렵지만 보완대체요법은 효과가 있다’고 하여 작용기전에 대한 이론적 근거는 부족하지만 치료효과에 대해서는 비교적 긍정적으로 인식하고 있는 것으로 나타나 본 연구 대상자의 ‘가치 인정형’과유사한 태도를 보였다. 또한 초등학교 보건교사를 대상으로 보완대체요법의 문제점에 대한 인식을 조사한 Kim, Kim과 Cho (2007)의 연구에서 40.5%가 ‘과학적인 검증의 부족으로 치료효과가 의심된다’고 지적하였지만 학교보건실무에서 보완대체요법의 적용가능성에 대한 질문에는 72.1%가 ‘가능하다’고 하였으며, 78%가 보완대체요법의 적용이유로 ‘증상완화, 치료보조의 효과’ 때문이라고 답하여 본 연구결과와 유사한 인식을 보였다. 또한 보완대체요법 교과목을 수강한 간호학생들에게 보완대체요법의 치료적 효과에 대해조사한 Kim (2005)의 연구에서도 ‘건강유지증진을 위해 일반 대중들도 보완대체요법을 많이 적용하고 있다’에 대해 5점 만점에 3.7점으로 응답하여 비교적 긍정적 태도를 보였다. 위의 결과들을 종합해 볼 때 보완대체요법이 체계적인 지식체로 인정하기엔 과학적 근거가 부족하지만 신체의 자연 치유력과 면역력을 증가시켜 건강증진에 영향을 미친다는 본 연구의 ‘가치 인정형’과 유사하다고 할 수있다. 제4유형은 ‘제한적 수용형’으로 보완대체의학이 건강증진에 도움이 되고 심리적 안정감을 주는 여러 가지 효과가 있는 반면 부작용이 있을 수 있고 사람마다 효과가 다르게 나타날 수 있으므로 작용기전에 대한 연구도 더 필요하다고 생각하는 유형으로 무조건적으로 수용하기보다는 제한적으로 수용하는 유형이다. 대학생을 대상으로 보완대체요법의 문제점에 대한 인식을 조사한 Gwon 등(2008)의 연구에서 ‘부작용을 예측할 수 없다’가 37.7%로 가장 높았고, 23.2%가 ‘비과학적이다’라고 응답함으로써 자신에게 맞는 보완대체요법을 찾아 효과를 볼 수는 있지만 부작용에 대한 우려, 효과에 대한 객관성 부족 및 작용기전에 대한 체계적 검증의 필요성을 언급한 본 연구에서의 ‘제한적 수용형’ 대상자와 유사한 인식을 보였다. Purpose: The purpose of this study was to grasp the subjectivity of the nursing students toward CAM and put the outcomes into use as basic facts and figures in developing and applying a curriculum associated with CAM. Methods: Q methodology was employed to explore the nursing students` subjectivity from their rank-order statements. For the Q population, individual in-depth interviews and literature research were conducted. Finally, 30 participants completed 40 Q statements. The data were analyzed using the QUANL software package. Results: The current survey that probed into the subjectivity of the nursing students relative to CAM abstracted four categories, namely, practical and convinced type, keep-under-control/wait-and-see type, merit acknowledging type and limitedly accepting type. Conclusion: It is recommended that various educational programs should be developed to shift the awareness of CAM on the part of the nursing students, based on the findings set forth in the current study.

냉동 제대혈 세포의 체외 증폭

김삼용,김철희,배광봉,김현수,박상준,김종숙,윤환중,조덕연 충남대학교 암연구소 1998 癌共同硏究所 硏究誌 Vol.2 No.1

Background : Cord blood(CB), which has no HLA restriction, is an alternative to bone marrow for hematopoietic stem cell transplantation. The use of cord blood, however, is limited by the number of progenitor/stem cells necessary to reconstitute the older child or adult. Therefore, ex vivo expansion of CB could have tremendous impact on diverse clinical settings. We studied the ex vivo expansion of isolated population of CD34_(+) cells from cryopreserved CB cells. Methods : CD34 cells were isolated from cryopreserved CB mononuclear cells. Purified cells were cultured with various combinations of hematopoietic growth factors including erythropoietin(EPO), stem cell factor(SCF), granulocyte-colony-stimulating factor(G-CSF), gra-nulocyte, macrophage-colony-stimulating factor(GM-CSF), interleukin-1β(IL-1β), 1L-3, and IL-6. After 7, 10 or 14 days of culture, the fold increases of colony-forming unit- granu-locyte, macrophage(CFU-GM), burst-forming unit-erythroid(BFU-E), colony-forming unit-mix (CFU-Mix), and high proliferative potential colony-forming cell(HPP-CFC) were evaluated. Results : Ten-day culture with the combination of EPO, SCF, G-CSF, IL-1β, and IL-3 resulted in a median of 60-fold increase of CFU-GM, which was greater than those with the combinations of less than 5 growth factors. The addition of IL-6 or GM-CSF to this combination did not enhance CFU-GM expansion. Ten-day culture was significantly superior to 7-day culture for CFU-GM expansion. Prolongation of culture to 14 days, however, revealed decreased expansion of CFU-GM compared to 10 days. BFU-E and CFU-Mix were expanded to 2~5 folds in 7-day culture with the combination of EPO, SCF, and G-CSF. Further expansion was not achieved in 10-day culture and colonies disappeared in 14-day culture. HPP-CFC was expanded to a median of 7.5 folds in 7-day culture with the combination of EPO, SCF, G-CSF, IL-1β, IL-3, and IL-6. Neither 10-day or 14 day-culture enhanced expansion of HPP-CFU. Conclusion : Cryopreserved cord blood cells maintain ex vivo expansion potential. In our system, 10-day culture with the combination consisting of EPO, SCF, G-CSF, IL-1β, and IL-3 seems to be adequate for hematopoietic progenitor/stem cell expansion from cryopreserved cord blood cells.

항암제 처리한 백혈병 세포주에서의 Apoptosis 발현

김삼용,윤소현,김현수,김종숙,윤환중,김진경,조덕연 충남대학교 암연구소 1998 癌共同硏究所 硏究誌 Vol.2 No.1

The bcl-2 proto-oncogene encodes a 26 kD protein that promotes cell survival by blocking apoptosis. The bax protein is a member of the bcl-2 familly, now known to form heterodimers with the bcl-2 protein. The ratio of bax to bcl-2 is be critical in determining the fate of the cell in response to stimuli that can induce apoptosis. Extract of Pulsatilla Koreana (SB-31) showed promising antitumor activity in vitro with Topo I inhibitory action. In the present study, the relationship between apoptosis and the apoptosis related proteins, bcl-2 and bax were investigated in human leukemic cell lines HL-60, U-937 and CEM-CM3. All anticancer drugs(adriamycin, etoposide, camptothecin, SB-31) induced extensive apoptosis in HL-60, U-937 cells and CEM-CM3 cells. The expression of bcl-2 and bax protein were determined in cell lines by western blotting before and after incubation with anticancer drugs at different time points. 1) In HL-60 or U-937 cell lines, down regulation of bcl-2 and up-regulation of bax were found after incubation with ADR, VP-16 or camptothecin. 2) In HL-60 or U-937 cell lines, no significant change in bcl-2 or bax protein expression resulted after incubation with SB-31. 3) In CEM-CM3 cells, virtually no change was noted in bcl-2/bax expression after incubation with ADR, VP-16, camptothecin or SB-31. It is suggested that different leukemic cell lines use different pathways of apoptosis activation and a given cell may utilize different pathways of apoptosis activation in response to different cytotoxic agents.

대량화학요법을 위한 G-CSF를 이용한 말초조혈모세포의 구동

김삼용,조덕연 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.2

This study probed the effective and economic method for mobilizing the hemopoietic stem cells for the support of high-dose chemotherapy. Eleven trials of Hemopoietic mobilization was performed in 10 patients. A total of 36 leukapheresis was performed(median; 3, range; 2 - 6). Cytotoxic chemotherapy plus G-CSF(300μg/day x 7 days) or G-CSF alone was given to mobilize hemopoietic stem cells. A median of 5.4 x (3.3 - 9.47) x 10 ^8/kg mononuclear cells and 5.1(1.3 - 43) x 10^4/kg GM-CFU was obtained. Nine courses of high-dose chemotherapy was performed in 8 patients. Days with absolute neutrophil count less than 1000/㎣ was 8.5(range ; 3-26) and days with platelet count less than 50.000/㎣ was 14(range; 0-46). Days G-CSF required was 12.5(range ; 9-27) and a median of 100units(range; 10-250) of platelet transfusion was required. Days with antibiotic coverage was 7. 5(0-30) and days of admission was 24(range; 17-51). We can conclude in this study that cyclophosphamide 2g/㎡ and G-CSF 300μg x 7days, or G-CSF for 7 days arc sufficient for the mobilization of hemopoietic stem cells for the high-dose chemotherapy.

치수 치근단 병소의 전구 위험요인으로서의 제 2 형 당뇨의 역할에 관한 소고

김진희,배광식,서덕규,홍성태,이윤,홍삼표,금기연 大韓齒科保存學會 2009 Restorative Dentistry & Endodontics Vol.34 No.3

Diabetes Mellitus (DM) is a syndrome accompanied with the abnormal secretion or function of insulin, a hormone that plays a vital role in controlling the blood glucose level (BGL). Type 1 and 2 DM are most common form and the prevalence of the latter is recently increasing. The aim of this article was to assess whet her Type 2 DM could act as a predisposing risk factor on the pulpo-periapical pathogenesis. Previous literature on the pathologic changes of blood vessels in DM was thoroughly reviewed. Furthermore, a histopathologic analysis of artificially-induced periapical specimens obtained from Type 2 diabetic and DM-resistant rats was compared. Histopathologic results demonstrate that the size of periapical bone destruction was larger and the degree of pulpal inflammation was more severe in diabetic rats, indicating that Type 2 DM itself can be a predisposing risk factor that makes the host more susceptible to pulpal infection. The possible reasons may be that in diabetic state the lumen of pulpal blood vessels are thickened by atheromatous deposits, and microcirculation is hindered. The function of polymorphonuclear leukocyte is also impaired and the migration of immune cells is blocked. leading to increased chance of pulpal infection. Also, lack of collateral circulation of pulpal blood vessels makes the pulp more susceptible to infection. These decrease the regeneration capacity of pulpal cells or tissues, delaying the healing process. Therefore, when restorative treatment is needed in Type 2 DM patients, dentists should minimize irritation to the pulpal tissue under control of BGL. 당뇨(Diabetes Mellitus)란 혈당을 조절하는 인슐린의 분비나 기능에 장애를 야기하는 질환으로 인슐린 의존성 여부에 따라 제 1 형과 제 2 형으로 분류된다. 본 종설은 최근 증가 추세에 있는 제 2 형 당뇨가 치수 치근단 병소의 병인 과정에 전구 위험 요인으로 작용할 수 있는지를 평가 하고자 문헌고찰을 통해 당뇨의 병인 과정에서 특징적으로 나타나는 혈관 합병증에 관해 알아보고, 부가적으로 제 2 형 당뇨 쥐 모델에서 인위적인 치수감염 후 얻은 치근단 조직의 조직병리학적 분석을 시행하였다. 조직학적 관찰 결과 제 2 형 당뇨 쥐에서 대조군에 비해 치수 치근단 병소의 크기가 증가하였고, 치수 염증 반응도 심하게 나타난 것으로 보아 당뇨 자체가 숙주를 감염에 취약한 상태로 만드는 전구 위험요소로 작용하였음을 알 수 있었다. 이러한 이유로는 첫째, 당뇨 시 전반적으로 나타나는 혈관 내 죽상 침착(atheromatous deposits)에 의해 혈관 내벽의 두께가 두꺼워져 미세 순환의 장애는 물론 탐식 세포의 기능 저하, 면역 세포의 혈류 이동이 차단되어 치수 감염 시 쉽게 치근단 병소로 이환될 가능성이 높고, 둘째 치수 혈관에서 특징인 측부 순환(collateral circulation)의 부재에 따른 살균성 다형핵 백혈구의 활동 억제를 포함한 미세 혈관계의 취약성으로 인해 치수 조직의 재생능이 저하되어 추가적인 감염원의 공격에 대한 방어 및 치유 저하를 더욱 심화시키기 때문인 것으로 사료된다. 따라서 제 2 형 당뇨 환자의 수복치료 시 치과의사는 당뇨 조절 하에서 치수 조직의 자극을 최소화하기 위한 세심한 처치가 필요하다.

림프절 종창의 임상적 관찰

김삼용,김현수,김종숙,박상준,최지영,윤환중,조덕연 충남대학교 의과대학 지역사회의학연구소 1995 충남의대잡지 Vol.22 No.2

Objectives : Clinical management of patient with lymphadenopathy requires judicious judgement of clinicians. Careful evaluation of lymph node enlargement by various clinical parameters will help to disclose the etiology of lymph node enlargement. This study was conducted to identify the clinical manifestations and etiology of lymphadenopathy in korean patients. Methods : A total 192 patients with lymph node enlargement were studied retrospectively. All patients who underwent excisional lymph node biopsy during the period from January 1992 to July 1994 were included. The lymph node biopsy and clinical records were reviewed and patient characteristics were analyzed by various clinical parameters. Results : A female predominance was noted in lymphadenopathy of tuberculosis (58.5%), Kikuchi's syndrome (70%). In lymphadenopathy of nonspecific, tuberculosis, kikuchi syndrome, per centage of patients younger than 40 years of age were 84.5%, 75.6%, 100%, respectively. In lymphadenopathy of tuberculosis and metastatic cancer, the duration of lymphadenopathy below 30days were 51.2%, 73.9%, respectively. The two most common etiology of cervical lymphadenopathy were nonspecific lymphadenitis (47.7%) and tuberculous (26.8%). The two most frequent etiology of supraclavicular lymphadenopathy were nonspecific lymphadenitis (46.3%) and metastatic lymphadenopathy (26.8%) and the most common etiology of axillary lymphadenopathy was nonspecific lymphadenopathy (34.5%). The most common frequent of lymph node enlargement with size below 1㎠ was nonspecific lymphadenitis, while above 2.25㎠ it was metastatic lymphadenopathy. Conclusion : Careful evaluation regarding patient age, sex, size of lymph node, consistency, location of lymph node, presence or absence of systemic symptoms should be pursued before performing a biopsy and management.

진행위암에 대한 병합화학요법

김삼용,조덕연 충남대학교 의과대학 지역사회의학연구소 1987 충남의대잡지 Vol.14 No.2

Twenty-three patients with advanced stage metastatic or unresectable gastric cancer were given combination chemotherapy consisting of Fluorouracil, Doxorubicin, and Cisplatin(FAC) or Mitomycin(FAM). 5 patients receiving FAC and 6 patients receiving FAM were evaluable. 3 patients receiving FAC and 3 patients receiving FAM achieved partial response. So, overal response rate was 60% for FAC and 50% for FAM. Median duration of response was 13 weeks for FAC and 20 weeks for FAM. 1 patient receiving FAC and 2 patients receiving FAM who achieved partial response are alive. Median survival was 8 months for FAC and 7 months for FAM. Responders had a longer survival than nonresponder in both regimens. There was no difference in response and median survival between 2 regimens. Toxicities were mainly gastrointesinal and hematologic, but were moderate and well tolerated in both groups. In conclusion, these regimens have substantial effects on advanced or unresectable gastric cancer without severe toxicities.

위암에 대한 복합치료 성적

조덕연,김삼용 충남대학교 의과대학 지역사회의학연구소 1988 충남의대잡지 Vol.15 No.1

Combined radiotherapy(RT, 4500-5400 rad) plus systemic chemotherapy(CT) using FAM regimen(5-FU 600 mg/m²iv days 1, 8, 29, 36, Doxorubicin 30mg/m²iv days 1, 29, MitomycinC 10mg/m²iv day 1) 2-6 cycles were given to 5 patients with high risk resected stomach cancer and 2 patients with advanced stomach cancer. 4 of 5 patients with resected stomach cancer fares well 21 months, 16 months, 12 months and. 6 months after diagnosis without evidence of disease. 1 patient with resected cancer died of stomach outlet obstruction (without tumor recurrence by endoscopy) 19 months after diagnosis. 1 patient with recurrent stomach cancer is alive 9 months after diagnosis but shows porgressive disease. 1 case of advanced stomach cancer died of disease at 7 months. The toxicity from combined RT and CT were moderate. In 7 patients, 2 cases showed grade 2 GI toxicity, 4 cases showed grade 1 GI toxicity. For granulocyte level, there was one grade 1 toxicity, 4 with grade 2 toxicity and one with grade 3 toxicity. For platelet level, 4 cases showed grade 1 toxicity and 2 cases showed grade 2 toxicity. The effect of combined adjuvant therapy in high risk resected stomach cancer must be followed by further observations. For selected patients with locally advanced GI cancer, combined RT and CT might be effective measures, without significant toxicities.

FCL(5-FU, Carboplatin, Leucovorin) 항암 화학요법에서 Gm-CSF의 효과

최지영,김현수,김종숙,박상준,윤환중,조덕연,남상륜,김삼용 忠南大學校 癌共同硏究所 1998 癌共同硏究所 硏究誌 Vol.2 No.1

Background: One of the major side effects of cancer chemotherapy is myelosuppression. Neutropenia and/or thrombocytopenia are dose-limiting factors in chemotherapy. Colony-stimulating factor induces proliferation and functional maturation of hematopoietic progenitor cells. GM-CSF is primarily active on progenitor cells of granulocytic and monocytic lineage. Methods: Fifteen patients with histologically proven malignancy diagnosed at Chungnam National University Hospital from January 1993 to August 1995 were included in this study. We could evaluate the clinical efficacy of GM-CSF in 13 patients undergoing FCL(5-FU, Carboplatin and Leucovorin) chemotherapy; the first cycles involved no GM-CSF while the second cycles involved GM-CSF on day 6 through 15 of chemotherapy. Results: 1) The subjects were fifteen patients in all, there were five patients with head and neck cancer, which was the most common types of maligancy. There were four patients with colon cancer, two patients with stomach cancer, and one patient with breast cancer, gallbladder cancer, cervix cancer and cholangiocarcinoma respectively, two patients, who did not complete two cycles of chemotherapy were excluded. 2) Age distribution was from 38 years to 78 years with a median age of 57. 3) In FCL chemotherapy cycles with GM-CSF, the duration of neutropenia(<500/μL) was 0.5±0.3 day, while FCL chemotherapy cycles without GM-CSF, it was 2.9±0.7 day(P=0.008). 3) There was no significant difference in platelet count between the two chemotherapy cycles(P=0.133). 4) Febrile duration without GM-CSF was 4.9±2.1 day, but with GM-CSF the duration was 1.3±0.7 day, which was significantly different(P=0.003). The duration of antibiotics use with GM-CSF was 1.7±1.2 day and without GM-CSF was 6.8±3.2 day, also significantly different(P=0.002). But hospital stay between the two cycles were not significantly different(P=0.064). Conclusion: GM-CSF was effective in preventing or restoring bone marrow depression after FCL chemotherapy.

췌십이지장절제술 후 발생한 지속적인 구토증과 Wernicke 뇌병증

박우영,김성완,이삼연,신일선,김재민,박기형,양수진,윤진상 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.3

Wernicke encephalopathy is an acute neurologic disorder attributable to thiamine (vitamin B1) deficiency. We report the case of a 61-year-old female patient who presented Wernicke encephalopathy after surgery for pancreatic head cancer. From the ninth postoperative day, she had suffered from nausea and vomiting and had difficulties ingesting food, she was given total parenteral nutrition (TPN), but lacked adequate vitamin (thiamine) supplementation. After 28 days, she developed ataxia, ophthalmoplegia, and mental confusion. The magnetic resonance image showed pathologic changes in the medial thalamus,periaqueductal gray matter, medulla and mamillary bodies. The blood level of thiamine was very low. After intravenous and oral supplementation of thiamine (200 mg/day), consciousness was soon normalized and neurologic symptoms have gradually been improving. Nausea and vomiting disappeared after administration of a low dose of mirtazapine (7.5 mg/day). We emphasize the importance of thiamine supplementation to the patients who suffer from vomiting which hinders them from taking food and who require prolonged TPN.