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.

경부에 발생한 낭포성 활액종의 증례보고

이장렬,신인숙,박창서,조정신 大韓口腔顎顔面 放射線學會 1993 Imaging Science in Dentistry Vol.23 No.1

Cystic hygroma is a special form of lymphangioma. It most often occurs in the neck of children. We observed a 14-year-old male whose chief complaint was a abnormal swelling of the right mandibular angle area. The computerized tomography showed the well-defined nonenhancing cystic mass on right submandibular gland areaand anterior triangle of the neck. The histopathologic fidings exhibited the multiloculatedfluid-filled cysts, which are lined a flattened layer of endothelial cells with foci of lymphocytes found lying adjacent to the lining. After evaluation of above findings, the mass was diagnosed as a cystic hygroma in the neck.

한국형 우울장애 약물치료 알고리듬 2006 (Ⅲ) : 정신병적 양상을 동반한 주요우울삽화

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

Objectives : Since the publication of Korean Medication Algorithm Project for Major DepressiveDisorder (KMAP-MD) in 2002, there has been a substantial need for a revision due to rapid progress in the pharmacological management of depressive disorder. We revised KMAP-MD 2002 and developed the Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) 2006. Methods : We developed a questionniare for surveying the opinion of experts on pharmacotherapy of depressive disorder. The questionnaire consisted of 4 parts ; 1) treatment of non-psychotic depressive disorder, 2) treatment of psychotic de-pressive disorder, 3) treatment according to clinical subtypes and drugs choice considering adverse effects, and 4) treatment of depressive disorder in women. The questionnaire was completed by the review committee consisting of 101 experienced Korean psychiatrists. It is composed of 22 questions, and each question includes 54 sub-items. We classified the expert opinionto 3 categories (the first-line, the second-line, or the third-line) by χ²-test. Results : For depressive disorder with psychotic features, most reviewers prefer the combination of antidepressant and atypical antipsychotics. Electroconvulsive therapy and the combination of antidepressant and typical antipsychotics were the second-line treatment. Among antidepressants, venlafaxine was the most preferred, and SSRI and mirtazapine followed. Among atypical antipsychotics, quetiapine, risperidone and olanzapine were the most preferred, in this order. In patients who have no response to the first-line treatment, many reviewers recommended switching to another antidepressant or adding another atypical antipsychotics Conclusion : For severe depressive disorder with psychotic features, the combination of antidepressant and atypical antipsy-chotics was preferred for the first-line treatment. These results suggest that the medication strategies of depressive disorder are rapidly changing and reflects the recent studies and clinical experiences.

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.

백서 척수후근절로부터 슈반세포의 효과적인 체외 배양법

김성민,이종호,김남열,안강민,최원재,최시호,차미주,이주영,황순정,장정원,명훈,최진영,서병무,정필훈,김명진 大韓顎顔面成形再建外科學會 2003 Maxillofacial Plastic Reconstructive Surgery Vol.25 No.4

Schwann cells(SCs), an important component of the peripheral nervous system, intract with nerous to mutually support growth and replication for the peripheral nerve regentation. Recently, ading SCs to the lumen of guidance channel is widely tried to improve regeneration or to make regeneration possible over otherwise irreparable gaps. however, it is not easy to isolate and multiplicate SCs as much as enough to help the axonal regeneration. For the allogeneic SCs source for tubular nerve guidance, we developed a little bit improved technique of harvesting and multiplicating SCs. by culturing dispersed dorsal root ganglia in specially designed medium with growth factors and serial processing, we repeatedlly generate relatively homogenous SC cultures. Our technique was compared with other methods of literature using immunostaining methods such as GFAP, S100, BDNF and the total SC count assessment at different time interval after primary culture.

상악동에 발생한 동석의 증례보고

고지영,김선용,조정신,박창서,신인숙,이장렬,김기덕 大韓口腔顎顔面 放射線學會 1994 Imaging Science in Dentistry Vol.24 No.1

The antrolith is a rare disease in the maxillary sinus. We experienced a 67-year-old female whose chief complaint was intermittent dull pain of clinical, radiological and histological findings, we diagnosed it as antrolith in the left maxillary sinus and obtained results as follows : 1. Three radiopaque substances in the left maxillary sinus was revealed as "Antroliths" 2. These antroliths were movable in the left maxillary antrum and combined with maxillary sinusitis. 3. We supposed it internal origin of nidus in this case.

군위지역 오이 시설 재배지의 토양특성 변화

이동훈,최충렬,김광섭,김평열,서정우,박만 경북대학교 농업과학기술연구소 2006 慶北大農學誌 Vol.24 No.-

군위군 오이재배지역을 정밀토양도를 이용하며 토양특성을 조사하구 군위군 노지 및 시설오이 재배지토양의 물리화학적 특성을 조사하여, 연작과 관행적인 토양관리로 인하여 저하된 토양의 이화학적 특성을 오이재배에 적합한 토양으로 개량하기 위한 기초자료로 이용하고자 토양조사를 실시하였다. 조사지역은 군위군 군위읍 외랑리 오이재배단지로서 주요토양통은 토양토에 나타난 단북통과 신정들이 가장 넓게 분포하였으며, 점토함량은 시설재배지내 토양의 경우 양토이었으며, 시설재배지의 외부 토양의 경우 23.8%로 높게 나타났다. 오이 재배지 토양의 화학적 특성 결과에 대한 오이재배지 토양의 적정범위와비교하여 보면 일반적인 화학적 성질에서 서는 유효인산의 함량이 적정범위보다 높은 것을 알 수 있으며, 치환성 양이온 함량은 시설재배지의 외부토양은 적정범위에 속하나 시설재배지 내부토양은 모두 높은 것으로 나타났으며, 최상부 토양은 매우 높으나 l0cm이하는 깊이에 따라 뚜렷한 차이는 없었다. 오이 재배지 토양 중 중금속 함량은 모두 기준치보다 높게 나타났는데, 구리의 함량이 시설재배지가 노지재배지보다 높게 나타났다. The soils of plastic film houses in which intensive cultivation takes place suffer from the serious problems such as severe salinity and accumulation of heavy metals etc. The objective of this research was to examine the change in soil properties with repeated cucumber cultivation under plastic film house at Gunwi-Gun area. The soils were classified mainly to Danbuk and SinJung series. Clay content is lower in the soils of plastic film house than in the field soil. Available P205 and exchangeable cations were accumulated at the level higher than the optimum range. The content of extractable heavy metals were higher in the soils of plastic film house than in those of the field. For optimum yield, much attention should be paied to the management of soils by the pre-soil survey.

두부에 발생한 신경섬유종증의 증례보고

고지영,김선용,신인숙,박창서,조정신,이장렬,김기덕 大韓口腔顎顔面 放射線學會 1994 Imaging Science in Dentistry Vol.24 No.1

Neurofibromatosis, or Von Recklinghausen's disease is inhereted as an autosomal dominent neurocutaneous systemic disease. It is characterized by multiple Cafe-au-lait spots, generlaized cutaneous neurofibromas. It affects one in 3000 births. We observed the clinical, radiologic and histopathologic findings of 3 cases of neurofibromatosis and obtained following results. 1. All patients had multiple Cafe-au-lait spots and neufibromas. 2. Two patients had radiographic changes of pressive erosion and mesodermal dysplasia. 3. Two patients had plexiform neurofibromas and 1 patient had diffuse neurofibromas. Conclusively, we classified these 3 cases as NF-Ⅰ.

The Effect of pH and Various Cations on the GTP Hydrolysis of Rice Heterotrimeric G-protein α Subunit Expressed in Escherichia Coli

Seo, Hak-Soo,Jeong, Jin-Yong,Nahm, Min-Yeop,Kim, Sam-Woong,Lee, Sang-Yeol,Bahk, Jeong-Dong Korean Society for Biochemistry and Molecular Biol 2003 Journal of biochemistry and molecular biology Vol.36 No.2

Previously, we reported the biochemical properties of RGA1 that is expressed in Escherichia coli (Seo et al., 1997). The activities of RGA1 that hydrolyzes and binds guanine nucleotide were dependent on the $MgCl_2$ concentration. The steady state rate constant ($k_{cat}$) for GTP hydrolysis of RGA1 at 2 mM $MgCl_2$ was $0.0075{\pm}0.0001\;min^{-1}$. Here, we examined the effects of pH and cations on the GTPase activity. The optimum pH at 2 mM $MgCl_2$ was approximately 6.0; whereas, the pH at 2 mM $NH_4Cl$ was approximately 4.0. The result from the cation dependence on the GTPase (guanosine 5'-triphosphatase) activity of RGA1 under the same condition showed that the GTP hydrolysis rate ($k_{cat}=0.0353\;min^{-1}$) under the condition of 2mM $NH_4Cl$ at pH 4.0 was the highest. It corresponded to about 3.24-fold of the $k_{cat}$ value of $0.0109\;min^{-1}$ in the presence of 2 mM $MgCl_2$ at pH 6.0.

몇 가지 신장질환에서 혈청 및 요 Neopterin치 측정의 의의

정수석 ( Jeong Su Seog ),김향 ( Kim Hyang ),윤중원 ( Yun Jung Won ),서정열 ( Seo Jeong Yeol ),정찬희 ( Jeong Chan Hui ),이규백 ( Lee Gyu Baeg ) 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.2

배 경 : Neopterin은 γ-인터페론의 자극하에 주로 단핵세포와 대식세포에서 생성되는 pyrazino-pyrimidine 화합물로서 세포면역이 활성화된 상태를 나타낸다. 세포면역 기전이 매개가 되는 장기이식의 거부반응, 감염질환, 자가면역질환, 종양 및 심부전이나 신부전 등 여러 질환에서 증가하며 진단 및 예후의 지표가 된다고 알려져 있다. 특히 신질환에서 neopterin치 측정이 세포면역의 활성도를 나타내는데 유용하다고 알려져 있으나 전반적인 신질환과 neopterin와의 연관성온 정확히 알려져 있지 않다. 이에 저자들은 신증후군, 만성 신부전 및 말기 신부전으로 유지혈액투석을 받고 있는 신장질환 환자들에서 혈청 및 요 neopterin치를 측정하여 신장질환과 neopterin과의 연관성을 알아보고, neopterin과 다른 임상적인 표지자들과의 상관관계를 알아보아 neopterin치 측정의 임상적 유용성을 평가하고자 하였다. 방 법 : 총 91명 환자 (신장조직검사로 확진된 신증후군 19명, 만성 신부전 8명, 말기 신부전으로 유지혈액투석 중인 환자 64명)에서 혈청 및 요 neopterin치를 radioimmunoaasay 방범으로 측정하였고 임상지표로는 WBC, hemoglobin, hematocrit, BUN, creatinine, total protein, albumin, triglyceride (TG), iron, total iron binding capacity (TIBC) 등을 측정하였다. 결 과 : 혈청 neopterin치는 신증후군, 만성 신부전, 말기 신부전 환자들에서 각각 14.1±30.9, 28.2±19.4, 65,6±25.5 ng/dL로 모두 대조군 1.6±0.3 ng/dL에 비해 증가하였고, 이중 만성 신부전과 말기 신부전 환자에서 통계적으로 의미있게 증가하였다 (p<0.05, p<0.01). 요 neopterin치 또한 신중후군, 만성 신부전, 말기 신부전에서 각각 203.2±349.6, 319.2±107.7, 407.9±256.9 μ㏖ neopterin/㏖ creatinine로 모두 대조군 108.9±57.9 μ㏖ neopterin/㏖ creatinine 보다 각각 증가하였고, 역시 만성 신부전과 말기 신부전에서 통계적으로 의미있게 증가하였다 (p<0.05, p<0.05). 전체 대상군에서 혈청 neopterin치와 임상적 표지자들과의 관계에서 혈청 creatinine과는 양의 상관관계를, triglyceride, TIBC와는 음의 상관관계를 보였고 (각각 p<0.01), 요 neopterin치는 hemoglobin과 음의 상관관계를 보였다 (p<0.05). 결 론 : 신증후군, 만성 신부전, 말기 신부전 등 몇 가지 신장질환 환자들에서 혈청 및 요 neopterin치의 증가와 neopterin치와 몇 가지 임상지표들과의 의미있는 연관성을 통하여 신장 질환 환자에서 neopterin치의 측정이 이들 질환의 활동성 및 예후의 한 지표로 이용될 수 있을 것으로 생각되며 이는 앞으로 보다 많은 수의 연구대상과 지속적인 후향적 연구가 필요할 것으로 생각된다. Background : Neopterin is a pyrazino-pyrimidine compound, produced by human monocytes or macrophages primarily upon stimulation with gamma in terferon. Neopterin is a marker associated with cell mediated immunity. The levels of neopterin in body fluids are elevated in allograft rejection, infections, autoimmune diseases, malignancies, cardiac and renal diseases. We hypothesized that the levels of serum and urine neopterin maybe elevated in some renal disease including nephrotic syndrome (NS), chronic renal failure (CRF) and end stage renal disease (ESRD). Methods : We examnined the serum and urinary neopterin levels in 19 patients with NS underwent renal biopsy, 8 patients with CRF, 64 patients with ESRD undergoing maintenance hemodialysis. Twenty-two healthy controls were enrolled to define the normal range of neopterin levels. Serum and urinary neopterin were measured by radiommunoassay method. We also correlated the levels of serum and urinary neopterin with many clinical parameters such as WBC, hemoglobin, hematocrit, BUN, creatinine, total protein, albumin, triglyceride, iron, total iron binding capacity. Results : The serum neopterin levels elevated in patients with NS (14.1±30.9 ng/mL), CRF (28.2±19.4 ng/mL) and ESRD (68.6±25.5 ng/mL) than control (1.6±0.3 ng/mL). Particularly the patients with CRF and ESRD showed statistically significant elevation (p<0.05, p<0.01). The urine neopterin levels elevated in patients with NS (203.2±349.6 μmol/mol creatinine), CRF (319.2±107.7 μmol/mol creatinine) than control (108.9±57.9 μmol/mol creatinine). Particularly the patients with CRF and ESRD showed statistically significant elevation (p<0.05, p<0.05). The serum neopterin showed significantly positive correlation with serum creatinine levels, inverse correlation with total iron binding capacity and serum triglyceride levels among clinical parameters in all groups (respectively p<0.01). The urine neopterin showed significant inverse correlation with hemoglobin (p<0.05). Conclusion : The serum and urinary neopterin levels elevated in patients with some renal diseases. And also neopterin levels showed clinical correlations with some renal parameters in these patients. We suggest that serum and urinary neopterin levels may be useful marker to predict disease acitivity and prognosis in some renal diseases. They should be confirmed by a prospective study during a long-lasting and in a higher number of patients. (Korean J Nephrol 2004;23(2):241-247)