Comparison of the Predictive Value of Myelography, Computed Tomography and MRI on the Treadmill Test in Lumbar Spinal Stenosis

문은수,김학선,박진오,신동은,하종원,심동준,곽윤혜,이광일 연세대학교의과대학 2005 Yonsei medical journal Vol.46 No.6

To date, there have been no prospective, objective studies comparing the accuracy of the MRI, myelo-CT and myelography. The purpose of this study is to compare the diagnostic and predictive values of MRIs, myelo-CTs, and myelographies. Myelographies with dynamic motion views, myelo-CTs, MRIs and exercise treadmill tests were performed in 35 cases. The narrowest AP diameter of the dural sac was measured by myelography. At the pathologic level, dural cross-sectional area (D-CSA) was calculated in the MRI and Myelo-CT. The time to the first symptoms (TAF) and the total ambulation time (TAT) were measured during the exercise treadmill test and used as the standard in the comparison of correlation between radiographic parameters and walking capacity. The mean D-CSA by CT was 58.3mm2 and 47.6mm2 by MRI. All radiographic parameters such as AP diameters and D-CSA have no correlation to TAF or TAT (p>0.05). Our data showed no statistically significant differences in the correlation of the patients' walking capacity to the severity of stenosis as assessed by myelography, myelo-CT and MRI.

항정신병약물 장기 사용 정신분열병 환자에서 사용 약물에 따른 혈당 및 지질 대사의 차이

문은수,변원탄,정영인 대한정신약물학회 2006 대한정신약물학회지 Vol.17 No.2

Objective: The development of metabolic disorders including diabetes mellitus and hyperlipidemia has been reported among schizophrenia patients treated with atypical antipsychotic drugs. The role of antipsychotic drugs in the development of this condition has not been proven yet. This study was conducted to investigate whether antipsychotic drugs that often induce weight gain influence glucose and lipid metabolism including insulin resistance and serum leptin level. Methods: The study population consisted of 63 patients (all meeting DSM-IV criteria for schizophrenia), who were divided into 3 treatment groups: haloperidol (N=21), risperidone (N=21), and olanzapine (N=21) monotherapy, and 31 healthy control subjects. Fasting blood samples for glucose, insulin, leptin and lipids were analysed. In addition, insulin resistance (IR) was calculated through the homeostatic model assessment (HOMA) and body mass index (BMI) was also calculated. Results: In patients receiving olanzapine, significant increases in BMI (p<0.01) and lipid profiles including LDL-cholesterol (p<0.05), triglyceride (p<0.01) and leptin levels (p<0.001) were found in comparison with the normal control group. A significantly higher degree of IR, as measured with the HOMA index, was found in patients receiving olanzapine than in patients receiving haloperidol (p<0.01) and risperidone (p<0.05), and in the normal control group (p<0.01). After removal of the impacts of BMI on the degree of HOMA-IR and serum leptin levels, the degree of HOMA-IR (p<0.05) and serum leptin levels (p<0.001) was also higher in patients receiving olanzapine than in the normal control group. Conclusion: The results of this study suggest that olanzapine has more significant influence on metabolic complications than haloperidol and risperidone and the characteristics of antipsychotic drug per se may be involved in the development of metabolic complication as well as weight change. 연구 목적:본 연구의 목적은 항정신병약물을 사용하고 있는 정신분열병 환자에서 사용 약물 간의 BMI와 혈당 및 지질대사의 차이를 알아보고, 이들 대사성 지표와 BMI 간의 관련성을 살펴본 후, 이를 통해 항정신병약물에 의한 대사성 부작용의 발생 기전을 간접적으로 추론항정신약물에 따른 혈당 및 지질 대사의 차이 Korean J Psychopharmacol 2006;17(2):181-187 186 해 보기 위함이다. 방 법:조사 대상은 DSM-Ⅳ 진단기준에 의거하여 정신분열병으로 진단받고 항정신병약물을 장기 투여 받고 있는 환자로서 haloperidol 사용군 21명, risperi -done 사용군 21명, olanzapine 사용군 21명, 그리고 정상대조군 31명으로 구성되어 있다. 공복시 혈당과 각종 지단백지표들을 분석하고, BMI와 homeostatic model assesment(HOMA)에 의한 인슐린 저항성(insulin res-istance, IR)을 계산하여 각 군 간에 차이 유무를 평가하였다. 결 과:BMI는 olanzapine군에서 정상대조군에 비해 유의하게 높았고(p<0.01), haloperidol군과 risperi done군은 정상대조군과 차이가 없었다. HOMA-IR의 값은 olanzapine군이 haloperidol군(p<0.01)과 risperidone군(p<0.05) 및 정상대조군(p<0.01)에 비해 유의하게 높았다. Olanzapine군에서 저밀도 콜레스테롤(p<0.05)과 중성지방(p<0.01) 및 혈중 렙틴 농도(p<0.001)가 정상대조군에 비해 유의하게 높았다. BMI가 HOMA-IR과 혈중 렙틴 농도에 미치는 영향을 배제한 후에도 olanza-pine군에서 HOMA-IR의 값(p<0.05)과 혈중 렙틴 농도(p<0.001)가 정상대조군에 비해 유의하게 높았다.

The Incidence of New Vertebral Compression Fractures in Women after Kyphoplasty and Factors Involved

문은수,김학선,박진오,문성환,이환모,신동은,하정원,안은경,심동준,정준영 연세대학교의과대학 2007 Yonsei medical journal Vol.48 No.4

Purpose: To identify the incidence of new vertebral compression fractures in women after kyphoplasty and to analyze influential factors in these patients. Materials and Methods: One hundred and eleven consecutive female patients with osteoporotic vertebral compression fractures (VCFs) underwent kyphoplasty at 137 levels. These patients were followed for 15.2 months postoperatively. For the survey of new vertebral compression fractures, medical records and x-rays were reviewed, and telephone interviews were conducted with all patients. Results: During that time 20 (18%) patients developed new VCFs. The rate of occurrence of new VCFs in one year was 15.5% using a Kaplan-Meier curve. Body mass index (BMI), symptom duration and kyphoplasty level were the statistically significant factors between the patient groups both with and without new VCFs after kyphoplasty. In the comparison between the adjacent and remote new VCF groups, the adjacent new VCF group showed a larger amount of polymethyl methacrylate (PMMA) use during kyphoplasty (p< 0.05). Before kyphoplasty, 9.9% of the patients had been prescribed medication for osteoporosis, and 93.7% of the patients started or continued medication after kyphoplasty. The development of new VCFs was affected by the number of vertebrae involved in the kyphoplasty. However, the lower incidence rate (15.5%) of new compression fractures might be due to a greater percentage (93.7% in our study) of patients taking anti-osteoporotic medication before and/or after kyphoplasty. Conclusion: When kyphoplasty is planned for the management of patients with osteoporotic VCFs, the application of a small amount of PMMA can be considered in order to lower the risk of new fractures in adjacent vertebrae. The postoperative use of anti- osteoporotic medication is recommended for the prevention of new VCFs.

치과 임플랜트 식립시 관주에 따른 골 천공 기구의 열 발생에 관한 연구

문은수,임헌송,조인호,Moon, Eun-Soo,Lim, Heun-Song,Cho, In-Ho 대한치과보철학회 1999 대한치과보철학회지 Vol.37 No.4

There are a lot of elements affecting the success of implant prosthesis. The quality of surgical procedure is considered as one of the key factors. To avoid the excess heat generation is an important element of successful osseointegration and it can be achieved by using a gentle surgical technique with a sharp instrument in bone drilling. This study was performed to measure and analyze comparatively the heat transmitted to sur-rounding bone at a distance of 0.5mm from the periphery of the drill hole in each drilling stage. The results were as follows. In standard system, the temperature of surrounding bone tissue ranged from $29.2^{\circ}C\;to\;48.3^{\circ}C$ with irrigation and from $34.6^{\circ}C\;to\;84.3^{\circ}C$ without irrigation. And in wide system, the temperature of surrounding bone tissue ranged from $29.5^{\circ}C\;to\;52.5^{\circ}C$ with irrigation and from $34.8^{\circ}C\;to\;87.8^{\circ}C$ without irrigation. And the temperature ranges exceeded the threshold without irrigation, while showing less than the threshold by the cooling effect of irrigation. In comparing standard system with wide system, although there was no significant difference, ${\phi}4.3mm$ pilot and ${\phi}4.3mm$ twist drill of wide system showed high value and wide system showed slightly high elevation of temperature in all depth in fixture installation. In the finite element analysis, the calculated value by the Fourier's cooling law were applied to the bone drilling surface. And through analysis using different irrigation temperatures at $28^{\circ}C,\;15^{\circ}C\;and\;5^{\circ}C$, and according to the time. The result was that the cooling water at least below $15^{\circ}C$ was required to maintain the temperature of surrounding bone less than threshold in bone drilling, the cooling water below $5^{\circ}C$ was required to gain more sufficient cooling effect, and cooling over 5 seconds was needed after bone drilling for sufficient effect.

일반 사병들의 에이즈에 대한 지식, 태도, 건강신념에 관한 연구

문은수,정혜선,최은숙 지역사회간호학회 2004 지역사회간호학회지 Vol.15 No.2

Purpose: This study purposed to investigate the relationship between soldiers' general characteristic and their knowledge, attitude and health-belief about AIDS. Method: This study conducted a survey of 197 soldiers using a structured questionnaire. Data were collected from the 10th to 30th of May 2003. Result: The average age of the participants was 21.6years, 78.2% of them were undergraduates of universities, and by religion the number of Christians was largest. In addition, 81.2% of them had lived with their parents and siblings before they joined the army and most of them were unmarried. Of the subjects, 75.1% finished education about AIDS, 64.5% experienced a sexual intercourse and 6.3% experienced a venereal disease. The participants' knowledge level about AIDS was 14.6 out of 20 points and their attitude about AIDS is 3.96 out of 5 points on the average. Their health-belief about AIDS was 4.0 out of 5 points in "perceived benefits," 2.9 in "perceived barriers," 2.6 in "perceived seriousness" and 2.6 in "perceived sensitivity. Among the subjects' general characteristics, religion was found to be a statistically significant variable for their knowledge level about AIDS. A variable that is statistically significant for the subjects' attitude toward AIDS was families they had lived together before joining the army. Statistically significant variables for the subjects' healthbelief about AIDS were perceived sensitivity and experience in venereal diseases, perceived benefits and AIDS education and perceived barriers and marital status. The subjects' knowledge about AIDS was in a statistically significant correlation with their attitude toward AIDS, and their attitude toward AIDS with perceived benefits. Conclusion: According to the results of this study, those who had had AIDS education appeared to have high attitude and health-belief concerning AIDS. Thus it is necessary to execute AIDS education systematically and continuously in order to have right attitude and high health-belief concerning AIDS.

우울증의 진단 및 평가 지침 개발 : 평가 지침을 중심으로

문은수,사공정규,정성원,성형모,이준엽,구본훈,김양태,신임희,조현주,김대현,김민경,최정식,정인명,김정범 대한신경정신의학회 2014 신경정신의학 Vol.53 No.1

ObjectivesZZThe aim of this study is to develop guideline for evaluation of depression. MethodsZZDevelopment of this guideline was processed according to the ADAPTE manual, which was developed for adaptation of good clinical practice guidelines. Important key questions were determined, and a systematic review of clinical practice guidelines was performed. The contents of guidelines selected by comparison of the methodological quality and currency were evaluated with regard to the applicability and acceptability. Answers to key questions and clinical recommendations were established by peer review. ResultsZZCareful evaluations on the characteristics of depression, including subtype, severity, suicidality, and psychiatric and physical comorbidities were recommended because these factors can have an influence on course and prognosis in treatment of depression. ConclusionZZThe results of this study may contribute to the systematic evaluation of depression, based on clinical importance. However, this guideline did not include systematic reviews regarding useful scales for evaluation of depression. In the future, amendment of this guideline might be needed in order to supplement limitations

정상 한국인 요추 추간판 높이의 방사선학적 계측

문은수,김남현,박진오,박시영,김호중,최우진,한창욱,김학선,이환모,문성환 대한척추외과학회 2007 대한척추외과학회지 Vol.14 No.3

연구계획: 요추 추간판 높이의 방사선학적 계측 연구목적: 정상 한국인의 요추 추간판 높이를 체중 비부하 상태에서 방사선학적 계측을 통해 정상자료에 대한 참고치를 제시하고자 한다. 대상 및 방법: 심각한 허리 통증의 병력이 없고 신체검사상 정상인 20~40세의 남녀 132명을 대상으로 하였다. 체중부하 없이 요추 측면 단순 방사선 사진을 촬영하였고, 컴퓨터 화면상 요추부 추간판의 전방, 중간, 후방 높이를 측정하였다. 이를 남녀 그리고 척추 분절 별로 분석하였다. 단순방사선의 평균 확대 비율은 115%였으며, 추간판 높이는 부위별 확대비율을 적용 보정하였다. 결과: 추간판 높이는 남, 녀 모두에서 Cranio-caudal 양상을 보였다. 남자의 추간판 높이는 전방, 중간, 후방 모두에서 제 4-5요추간 추간판에서 가장 높았다. 여자는 중간과 후방 높이는 요추4-5에서 높았고, 전방 높이는 제 5요추-제 1천추간 추간판에서 가장 높았으나, 제 4-5요추간 및 제 5요추-제 1천추간 전방 추간판 높이 사이에는 통계학적 차이는 없었다(p>0.05). 남, 녀 간 추간판 높이의 차이는 제 1-2요추간 및 제 2-3요추간 추간판의 전방에서만 남자에서 여자보다 높게 나타났고 나머지 부위에서는 차이가 없었다. 남성의 제 1-2요추간 추간판의 후방 높이를 제외한 남,녀 모든 계측부위에서 과체중 환자에서 추간판 높이의 통계학적으로 의미 있는 감소는 나타나지 않았다. 결론: 본 연구를 통해서 정상 한국 남녀에서의 요추 추간판 높이의 정상에 대한 참고치를 제시하는 바이며 이 계측 수치는 척추체간 유합을 위한 기구 제작 및 인공 척추 추간판 치환물의 한국형 모델 제작에 사용될 수 있을 것으로 사료된다.

기분장애 환자의 다중약물치료 시 고려해야 할 대사적 약물상호작용

문은수,장재승,하규섭,하태현 대한정신약물학회 2008 대한정신약물학회지 Vol.19 No.6

Polypharmacy has recently become usual practice in the treatment of patients with mood disorders. In this article, we review the results of recent studies on metabolic drug interactions between anticonvulsants, atypical antipsychotics, and antidepressants. Important drug interactions in clinical practice may be summarized as follows. First, valproate may increase the serum level of carbamazepine and its active metabolite carbamazepine-epoxide, quetiapine, and lamotrigine. In particular, in combined regimens of lamotrigine and valproate, the dose of lamotrigine needs to be downwardly titrated, due to the potential risk of skin lesions. Second, there are numerous carbamazepine- associated interactions that need careful monitoring, because carbamazepine is a well-known inducer of CYP1A2, CYP2C9, and CYP2C19. Thus, in patients receiving carbamazepine, clinically significant decreases in serum levels may be found for drugs metabolized by these enzymes. Third, atypical antipsychotics are primarily metabolized by CYP2D6 and CYP3A4, thereby compromising the use of inhibitors of these enzymes. Fourth, most selective serotonin-reuptake inhibitors (SSRIs) are actually inhibitors of diverse enzyme systems, indicating at least potential problems with increased serum levels. While paroxetine, fluoxetine, and fluvoxamine strongly inhibit CYP enzymes, citalopram, venlafaxine, mirtazapine, and bupropion do so weakly. In conclusion, understanding drug-drug interactions is essential in planning individualized pharmacotherapy with diverse therapeutics. In treating patients with mood disorders, special concern should be paid to combination therapy using valproate, carbamazepine, and some SSRIs. 기분장애 환자의 약물치료 시 항경련제나 비정형 항정 신병약물 및 항우울제들을 서로 병용하는 다중약물치료가 증가하고 있다. 약물상호작용에 대한 이해는 다중약물치 료 시 적정 약물용량의 결정에 있어 중요하다고 볼 수 있 다. 본고에서는 약동학적 약물상호작용 중에서 약물 대 사와 관련된 대사적 약물상호작용을 중심으로 약물대사 효소 및 유도제나 억제제로 작용할 수 있는 약물과 대사 적 약물상호작용에 관한 기존의 연구결과들을 정리하였 다. 대사적 약물상호작용의 연구결과들을 요약해 보면, carbamazepine이 CYP1A2, CYP2C9 및 CYP2C19에 의해 대사되는 약물의 혈중농도를 감소시킬 수 있으며, 항우울제 중에서 fluoxetine, paroxetine, sertraline 및 fluvoxamine은 CYP1A2, CYP2D6 및 CYP2C19에 의 해 대사되는 약물의 혈중농도를 감소시킬 수 있다. 또한 lamotrigine의 경우 valproate에 의해 혈중농도가 증가 할 수 있고, carbamazepine에 의해 혈중농도가 감소할 수 있다. 그리고 비정형 항정신병약물은 억제제나 유도 제로서의 작용이 거의 없으므로 다른 약물의 농도변화에 큰 영향이 없다고 볼 수 있다. 대사적 약물상호작용은 다 중약물치료 시 적정 약물용량 결정에 있어 중요하게 고 려되어야 하며, 향후 약물대사와 관련된 유전자 다형성 에 대한 정보가 보완된다면, 임상진료 시에 실제적인 도 움을 얻을 수 있을 것이다.

청소년기 특발성 척추 측만증과 신경근육성 척추 측만증에서의 골밀도 비교

문은수,문성환,이환모,박진오,신동은,하정원,정민,김학선 대한척추외과학회 2007 대한척추외과학회지 Vol.14 No.1

연구계획: 단면 연구 구목적: 수술적 치료를 시행한 특발성 척추 측만증과 신경근육성 척추 측만증 환자의 골밀도를 비교함으로 골다공증 정도 차이를 알아보고자 한다. 대상 및 방법: 2004년 8월부터 2006년 6월까지 본원에서 척추 측만증에 대하여 수술적 치료를 받은 환자 중 수술 전골다공증 검사를 시행한 환자를 대상으로 하였다. 골다공증 검사는 요추와 대퇴골 근위부에 대하여 DEXA를 시행하여 비교하였다. 요추에 대한 검사 시 측만증에 의한 회전 변형에 의한 오차를 줄이고자 요추 2번을 최대한 중립위로 교정한 후 검사를 시행하였으며, 대퇴골은 양측 근위대퇴골 골밀도의 평균값 비교하였다. 골밀도 결과 비교는 BMD(bone mineral density, g/㎠)와 BMD를 나이, 성별, 인종을 기준으로 변환한 Z값을 이용하였다. 결과: 특발성 척추 측만증군은 25명의 평균 측만각은 48.4도였고, 신경근육성 척추 측만증군은 23명의 평균 측만각은 62.9도였다. 두 군간에 골밀도 비교에서 척추 골밀도의 Z값을 제외한 대퇴골 골밀도 및 Z값과 척추의 골밀도에서는 근육병성 척추 측만증에서 의미있게 낮았으며(p<0.05), 보행이 불가능한 신경근육성 척추 측만증만을 비교하였을 때는 대퇴골 및 척추의 골밀도와 Z값 모두에서 근육병성 척추 측만증에서 의미있게 낮았다(p<0.05). 측만각과 척추 골밀도와 상호관계 분석에서는 두 군 모두에서 의미있는 상관관계는 보이지 않았다. 결론: 신경근육성 척추 측만증에서 특히 보행이 불가능한 환자는 특발성 측만증에 비하여 대퇴골과 척추 모두에서 낮은 골밀도를 보였다. 그러므로 보행이 불가능한 신경근육성 척추 측만증의 수술적 치료 시 골다공증을 고려한 수술적 방법을 택하여야 할 것이다.

심하게 퇴축된 상악 구치부의 임플랜트 시술 및 보철증례

문은수 대한치주과학회 2001 대한치주과학회 학술대회자료집 Vol.2001 No.1