정신분열병 환자의 우울증에서 Paroxetine과 삼환계 항우울제 병용치료

심주철,공보금,박정환,윤영란,신재국,김정익,안동성,김용관,차인준,김영훈 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.4

저자들은 마산동서병원에 입원중인 우울증이 동반된 정신분열증 환자 10명을 대상으로 사용중인 항정신병약물에 paroxetine과 저용량의 삼환계 항우울제를 6주간 병용투여한 후 우울증상에 대한 효과와 치료의 안전성 및 약물상호작용을 알아보았다. Paroxetine은 고정량의 항정신병약물과 삼환계 항우울제에 부가하여 일일 20㎎을 6주간 병용하게 하였으며, 임상상태는 HDRS, HARS, UKU Side Effect Rating Scale등의 평가척도를 사용하여 평가하였다. 또한 약동학적 약물상호작용은 삼환계 항우울제들의 혈장농도를 HPLC로 측정하여 분석하였다. 결과는 다음과 같다. 1) 10명의 전체 대상환자에서의 HDRS 평균점수는 TCA와 paroxetine 병용투여 6주후에 통계적으로 유의하게 감소되었다. 이중 40%의 환자에서는 병용투여 6주후에 HDRS 점수상 50% 이상의 감소를 보여, 일부의 환자들에서는 정신분열병에 동반된 우울증상의 치료에 소량의 삼환계 항우울제와 paroxetine의 병용치료가 효과가 있음을 확인하였다. 2) 두 명의 환자에게서 심각한 약물독성이 발생하였다. 이중 한 명은 삼환계 항우울제의 높은 혈중농도로 인한 항콜린성 위기(anticholinergic crisis) 소견을 보였으며, 다른 한 명은 인지기능 및 의식수준은 명료하였으나 망상과 환각증상이 약화되는 소견을 보였다. 따라서 본 연구에서 시도된 복합적 약물치료의 경우, 삼환계 항우울제의 혈중농도의 측정을 포함한 세심한 임상적 추적이 필요하다고 생각된다. 3) 기저치의 amitriptyline과 그 대사물인 nortriptyline의 농도합. imipramine과 대사물인 desipramine의 농도합은 각각 47.8-226.5ng/㎖. 80.5-395.6ng/㎖였으며 일반적으로 이들 약물들의 단독사용시에 문헌에 보고된 혈중농도를 훨씬 상회하고 있었다. 이는 병용투여된 항정신병 약물 약시 강력한 CYP2D6 효소억제제로서 기저치의 삼환계 항우울제들의 혈장농도를 이미 상당히 증가시켰던 것으로 판단되며, 그러한 결과로 인해 본 연구에서는 paroxetine이 이전의 문헌보고들과는 달리 뚜렷하게 삼환계 항우울제들의 혈장농도를 증가시키지 못하였다. 본 연구는 SSRI와 삼환계 항우울제의 병합 투여가 우울증의 개선 효과를 빠르게 하고, 치료역을 넓히고, 약물상호작용의 결과 paroxetine이 삼환계 항우울제의 혈중농도를 증가시킨다는 기존의 연구결과를 이용하여 정신분열병 우울증상의 치료에 parotextine과 소량의 삼환계 항우울제를 병용하는 방법을 시도해 본 연구이다. 저자들은 이러한 약물치료가 일부의 환자들에게서 효과가 있음을 관찰하였으나, 항정신병약물과 삼환계 항우울제를 병용투여 할 경우는 물론 이에 paroxetine과 같은 선택적 세로토닌 재흡수 억제제를 병용할 경우 복합약물상호작용의 결과로 약물독성의 위험성이 크며 세심한 주의가 필요함을 경험하였다. Depression is well-known to comorbid with several psychiatric disorders. Many schizophrenics also suffer from depression in the course of their illness. Combined therapy of SSRI and tricyclic antidepressants were reported to have benefits in some depressed patients. Paroxetine, a potent CYP2D6 inhibitor, increases the blood levels of tricyclic antidepressant markedly. Using paroxetine, we tried this combined therapy in the treatment of depressive symptoms in 10 chronic schizophrenic inpatients and evaluated its efficacy and drug interactions between paroxetine and tricyclic antidepressants. The following results were obtained : 1) The mean score of Hamilton's Depression Rating Scale(HDRS) was reduced significantly after 6 weeks-trials of this combined therapy for the mild depressive symptoms in 10 chronic schizophrenics. In four patients, 50% or more reductions in the scores of HDRS were noticed at final evaluation. 2) Two among our 10 subjects experienced severe toxic behavioral problems. Anticholinergic crisis with toxic confusion due to high blood levels of tricyclics was found in one patient and the other showed rapid clinical deterioration in his psychotic symptoms such as delusion and hallucination without any consciousness alternation. 3) Baseline plasma levels of tricyclics before adding paroxetine were higher than expected in our chronic schizophrenic subjects maintained with their antipsychotic medications. Several antipsychotics were also known as a potent CYP2D6 inhibitors and to increase the blood levels of tricyclics. Because the blood levels of tricyclics had already increased significantly by the use of antipsychotics, adding paroxetine to antipsychotics and tricyclic antidepressant in our subjects could increase the blood levels of tricyclics not so much as previously reported in the literatures.

Sequential Combination Chemotherapy and Radiotherapy of an Isolated Non-Hodgkin's Lymphoma of the Larynx

Shim, Young Ran,Shin, Sei One,Kim, Sung Kyu,Kim, Myung Se 영남대학교 의과대학 1997 Yeungnam University Journal of Medicine Vol.14 No.2

전신적인 침범없이 후두에만 국한되는 악성 림프종은 매우 드믄 예로서 일반적으로 두경부에만 국한된 방사선 치료로 근치 가능하다. 그러나 때때로 급성 호흡 곤란을 초래하여 응급 기관 절개와 복합 항암제를 투여해야 되는 경우를 간혹 경험하게 된다. 본 증례는 수 개월간 지속되어온 애성과 최근에 갑자기 심해진 호흡 곤란으로 급성 후두염이란 임상 진단명으로 보존적인 치료를 하였으나 증상이 호전되지 않아서 후두조직 검사 결과에서 비 호즈킨 림프종으로 확진되어 6회의 복합 항암제를 투여한 다음 남아있는 병변에 대한 45 Gy의 외부 방사선 치료후 촬영한 전산화 단층 촬영에서 완전 관해를 보였으며 진단후 10개월이 지난 현재 무병 상태를 보이는 환자를 경험하였기에 간단한 문헌 고찰과 함께 보고한다.

뇌 혈관계를 침범한 전신성 홍반성 루푸스 2례

김봉준,이은영,홍영훈,박기도,송영두,이충기,심영란 영남대학교의과대학 1998 Yeungnam University Journal of Medicine Vol.15 No.2

저자들은 최근 루푸스가 뇌 혈관계를 침범하여 신경·정신과적 이상 증상을 보였으며 면역검사, 뇌파검사 및 뇌 자기공명사진에서 중추 신경 루푸스의 소견에 부합되는 양상을 보였고 고용량의 부신피질 호르몬 충격요법에 반응이 좋았던 2례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Systemic lupus erythematosus(SLE) is an autoimmune disease which may affect many different organs and disclose various clinical manifestations. Recently central nervous system(CNS) involvement has been recognized as an increasingly significant contributor to morbidity and mortality of SLE. The clinical manifestations of CNS-lupus are highly variable and range from mild cognitive dysfunction, movement disorder, headache, psychosis to life-threatening stroke and coma. Among the neuropsychiatric disorders encountered in patients with SLE, cerebrovascular disease has been a relatively rare complication. The diagnosis and management of CNS-lupus is difficult because of the lack of useful diagnostic methods. If cerebrovascular involvement is suspected, aggressive treatment such as high dose steroid, immunosuppressive therapy, plasma exchange may be required to reduce high mortality rate. We experienced 2 cases cerebrovascular dis eases occurring in SLE patients which presented with various neuropsychiatric manifestations. They were diagnosed as CNS-lupus by neuropsychiatric symptoms, brain MRI, and EEG, and showed good response to high dose steroid pulse therapy.

Overexpression of PgSQS1 Increases Ginsenoside Production and Negatively Affects Ginseng Growth Rate in Panax ginseng

Shim, Ju-Sun,Lee, Ok-Ran,Kim, Yu-Jin,Lee, Jung-Hye,Kim, Ju-Han,Jung, Dae-Young,In, Jun-Gyo,Lee, Beom-Soo,Yang, Deok-Chun The Korean Society of Ginseng 2010 Journal of Ginseng Research Vol.34 No.2

The medicinal plant Panax ginseng (P. ginseng) contains various phytosterols and bioactive triterpene saponins (ginsenosides). Squalene synthase catalyzes the first committed step in ginsenoside biosynthesis. Transgenic plants of P. ginseng were generated by introducing the squalene synthase gene derived from P. ginseng. Adventitious roots of the transgenic ginseng grew best in B5 medium, and 2 g of inoculum secured an optimal growth rate. Two phytohormones, indolebutyric acid and 1-naphtalene acetic acid, increased root growth and decreased ginsenoside production. Treatment with two selected elicitors, chitosan and jasmonic acid, and a precursor of the isoprenoid pathway, mevalonic acid, enhanced ginsenoside production and retarded ginseng growth rate.

Protective effects of Humulus Japonicus on dopaminergic cell death in Parkinson’s disease

Young-Kyoung Ryu,Kang young,Hye-Yeon Park,Jun Go,Jung-Ran Noh,Yong-Hoon Kim,Jung Hwan Hwang,Dong-Hee Choi,Won-Keun Oh,Chul-Ho Lee,Kyoung-Shim Kim 한국실험동물학회 2016 한국실험동물학회 학술발표대회 논문집 Vol.2016 No.08

회장을 침범한 아니사키스증-2예 보고-

심영란,김동석,이태숙 대한병리학회 1995 Journal of Pathology and Translational Medicine Vol.29 No.1

Clinical Spectrum of Reflux Esophagitis Among 25,536 Koreans Who Underwent a Health Check-up: A Nationwide Multicenter Prospective, Endoscopy-based Study

Shim, Ki-Nam,Hong, Su Jin,Sung, Jae Kyu,Park, Kyung Sik,Kim, Seong-Eun,Park, Hyun-Shin,Kim, Young Sun,Lim, Seon Hee,Kim, Chung Hyeon,Park, Min Jung,Yim, Jeong Yoon,Cho, Kyung Ran,Kim, Donghee,Park, Se Lippincott WilliamsWilkins, Inc. 2009 JOURNAL OF CLINICAL GASTROENTEROLOGY Vol.43 No.7

BACKGROUND: Gastroesophageal reflux is a commonly encountered condition, but detailed data on reflux symptoms in Asian countries are lacking. GOALS: To evaluate the prevalence and to document the clinical spectrum of endoscopic reflux esophagitis (RE). STUDY: A total 25,536 subjects underwent an upper gastrointestinal endoscopic examination as part of a health check, and completed a gastroesophageal reflux questionnaire. Endoscopic findings classified according to the Los Angeles (LA) classification and the data from gastroesophageal reflux questionnaire were analyzed. RESULTS: On the basis of endoscopic findings, 2019 subjects (7.91%) were found to have RE: 5.87% in LA-A; 1.84% in LA-B; 0.18% in LA-C; and 0.02% in LA-D. Heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, cough, and epigastric soreness were found to be associated with RE (P<0.05). Heartburn, acid regurgitation, and epigastric soreness were more frequent in LA-B than in LA-A (P<0.05). Epigastric soreness was most bothersome in LA-A and LA-B, and acid regurgitation was most bothersome in LA-C and LA-D (P<0.01). Heartburn, hoarseness, and globus sensation were more frequent in men with RE, and acid regurgitation was most common in women. CONCLUSIONS: The prevalence of RE was found to be 7.91% in Korea, and the profiles of reflux symptoms were found to depend on grade of RE and sex.

결장암종 및 직장암종에서 p53 유전자 돌연변이의 염기서열

심영란,최준혁,최원희 대한병리학회 1999 Journal of Pathology and Translational Medicine Vol.33 No.6

Association Between Vitamin D Deficiency and Suspected Nonalcoholic Fatty Liver Disease in an Adolescent Population

( Young Hoon Cho ),( Ju Whi Kim ),( Jung Ok Shim ),( Hye Ran Yang ),( Joo Young Chang ),( Jin Soo Moon ),( Jae Sung Ko ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Recent studies have shown that vitamin D deficiency is associated with obesity and metabolic syndrome. The purpose of the study is to examine the relationship between vitamin D deficiency and nonalcoholic fatty liver disease (NAFLD) in adolescents. Methods: Data were obtained from the Korean National Health and Nutrition Examination Survey 2008-2014. A total of 3,878 adolescents were included. Vitamin D deficiency was defined as a 25-hydroxyvitamin D concentration < 20 ng/mL, and suspected NAFLD was defined as a alanine transaminase concentration > 30 U/L. Results: Vitamin D deficiency was noted in 78.9%. Age, body mass indexes, waist circumferences, and blood pressure levels, as well as glucose, cholesterol and triglyceride levels were significantly higher in adolescents with suspected NAFLD than in adolescents without suspected NAFLD, while the mean vitamin D level was significantly lower in adolescents with suspected NAFLD. The multivariate-adjusted odds of suspected NAFLD were higher with increased age, male gender, obesity, and metabolic syndrome. Vitamin D deficiency was at higher risk for suspected NAFLD (odds ratio 1.76, 95% confidence interval 1.05-2.94) after adjustment for age, gender, obesity and metabolic syndrome. Conclusions: Vitamin D deficiency is associated with suspected NAFLD independently of obesity and metabolic syndrome in adolescents.

Gene Promoter Hypermethylation in Tumors and Plasma of Breast Cancer Patients

Young Kyung Bae,Young Ran Shim,Joon Hyuk Choi,Mi Jin Kim,Edward Gabrielson,Soo Jung Lee,Tae Yoon Hwang,Sei One Shin 대한암학회 2005 Cancer Research and Treatment Vol.37 No.4

Purpose: To measure the hypermethylation of four genes in primary tumors and paired plasma samples to determine the feasibility of gene promoter hypermethylation markers for detecting breast cancer in the plasma.Materials and Methods: DNA was extracted from the tumor tissues and peripheral blood plasma of 34 patients with invasive breast cancer, and the samples examined for aberrant hypermethylation in cyclin D2, retinoic acid receptor β (RAR β), twist and high in normal-1 (HIN-1) genes using methylation-specific PCR (MSP), and the results correlated with the clinicopathological parameters.Results: Promoter hypermethylation was detected at high frequency in the primary tumors for cyclin D2 (53%), RAR β (56%), twist (41%) and HIN-1 (77%). Thirty-threeof the 34 (97%) primary tumors displayed promoter hypermethylation in at least one of the genes examined. The corresponding plasma samples showed hyperme thylation of the same genes, although at lower frequencies (6% for cyclin D2, 16% for RAR β, 36% for twist, and 54% for HIN-1). Overall, 22 of the 33 (67%) primary tumors with hypermethylation of at least one of the four genes also had abnormally hypermethylated DNA in their matched plasma samples. No significant relationship was recognized between any of the clinical or pathological parameters (tumor size, axillary lymph node metastasis, stage, or Ki-67 labeling index) with the frequency of hypermethylated DNA in the primary tumor or plasma.Conclusion: The detection of aberrant promoter hypermethylation of cancer-related genes in the plasma may be a useful tool for the detection of breast cancer.