만성 두부외상 환자에서 99mTc - HMPAO Brain SPECT의 임상적 유용성

서정호(Jung Ho Suh),김동익(Dong Ik Kim),정태섭(Tae Sub Chung),이종두(Jong Doo Lee),박창윤(Chang Yoon Park),정진일(Jin Ill Chung),김영수(Young Soo Kim) 대한핵의학회 1992 핵의학 분자영상 Vol.26 No.1

N/A Minima1 deterioration of cerebral perfusion or microanatomical changes were undetectable on conventional Brain CT or MRI. So evaluation of focal functional changes of the brain parenchyme is essential in chronic head injury patients, who did not show focal anatomical changes on these radiological studies. However, the patients who had longstanding neurologic sequelae following head injury, there had been no available imaging modalities for evaluating these patients precisely. Therefore we tried to detect the focal functional changes on the brain parenchyme using Tc-99m-HMPAO Brain SPECT on the patients of chronic head injuries. Twenty three patients who had suffered from headache, memory dysfunction, personality change and insomnia lasting more than six months following head injury were included in our cases, which showed no anatomical abnormalities on Brain CT or MRI. At first they underwent psychological test whether the symptoms were organic or not. Also we were able to evaluate the cerebral perfusion changes with Tc-99m-HMPAO Brain SPECT in 22 patients among the 23, which five patients were focal and 17 patients were nonfocally diffuse perfusion changes. Thus we can predict the perfusion changes such as local vascular deterioration or functional defects using Tc-99m-HMPAO Brain SPECT in the patients who had suffered from post-traumatic sequelae, which changes were undetectable on Brain CT or MRI.

강원도지역에서 발생한 발진열과 쯔쯔가무시병

민창홍,장우현,강재승,조수익,최문기,조민기,윤창순,김윤원 대한감염학회 1988 감염 Vol.20 No.2

In Korea, there has been an increasing concern on rickettsiosis as one of most prevailing acute febrile illness, since murine typhus and scrub typhus had not been reported for 2 decades until 1986 and thereafter a few studies were reported on these diseases. A microimmunofluorescence test was used to study antibodies to R. typhi and R. tsutsugamushi in urban and rural inhabitants students, and patiants suspected of leptospirosis or rickettsiosis from 1986 to 1987 in Kangwon-do Korea. 43% of inhabitatnts and 17% of students reacted to R. typhi. Only one inhabitant among inhabitants and students reacted to R. tsutsugamushi. Among 169 patients, 43(25%) reacted to R. typhi, 38(22%) to R. tsutsugamushi and 25(15%) to Leptospira interrogans. Sexual rate(male; female) in murine typhus was 1.7:1, that in scrub typhus was 1:2.2 and that in leptospirosis was 1.5;1. The age ditribution of patients with murine typhus was generally even over 20 years old. But 71% of patients with scrub typhus were over 40 years old. Scrub typhus was most prevailing in female over 40 years old. Murine typhus was relatively more prevailing in Choonchun city than rural area as compared with scrub typhus and leptospirosis. Most of scrub typhus occurred in rural area. Most of each disease occurred between September and November (murine typhus; 93%, scrub typhus; 95%, leptospirosis; 84%) with a peak in October. Scrub typhus considerably occurred not only October(58%) but also November(28%). All patients with scrub typhus were immediately diagnosed by antibody when they visited hospital. 53% of patients with murine typhus were diagnosed when they visited hospital within 7 days after onset of illness, and others were done by second sera obtained 8 days after. The patients in whom IgM was seronegative but antibodies of other class were seropsitive by 20 days after onset of illness, were 14% in murine typhus and 26% in scrub typhus. At least those patients were considered to be infected second. Murine typhus and scrub typhus were suggested to be endemic diseases in Kangwon-do as antibodies of inhabitants and characteristics of patients' sera were considered. By serologic finding of patients with scrub typhus in Kangwon-do, Gilliam was 59'% of etiologic strain of scrub typhus, Karp was 41q% and Kato was none. Most scrub typhus occurred in person to be related to agriculture, but murine typhus was not related to job and occurred more in small city than rural area. Rash was scarcely detected in murine typhus and scrub typhus, and eschar was in 50% of scrub typhus only. Serum transaminase elevated in many patients with scrub typhus and murine typhus. Leukocytosis and abnormal finding in chest X-ray were showed in some patients with scrub typhus but were scarcely in murine typhus.

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

한국산 큰가시고기과 어류의 형태변이와 핵형

김익수,윤창호,이지현 全北大學校 基礎科學硏究所 1991 基礎科學 Vol.14 No.1

우리나라 연안과 담수역에 서식하는 큰가시고기과(Gasterosteidae)어류의 많은 표본은 1988년 3월부터 1989년 6월까지 채집하여 이들의 형태변이와 분류학적 위치에 대하여 검토하였다. 큰가시고기 Gasterosteus aculeatus 6개 조사집단의 체측인판수는 모두 32-35개였고 그 형태는 완판형으로 국내에서는 아직 육봉형이라고 생각되는 저판형이나 반판형은 발견되지 않았다. G. aculeatus의 척추골수, 세파수, 지느러미 기조수 등의 계수형질이나, 두장, 안경 및 등지느러미가시길이의 계측치는 집단간에 뚜렷한 차이가 없었다. 가시고기 Pungitius sinensis와 잔가시고기 P. Kaibarae ssp. 집단의 체측인판수는 모두 31-35개의 완판형이었고, 등지느러미가시 기조수, 척추골수 및 체고비등에 잇어서 2종간에 구별되었지만, 잔가시고기 P. Kaibarae ssp.의 집단에서는 등지느러미가시 기조막에 담회색을 딘 표본(white form)이 출현하였는데 이것은 이들이 서식하는 환경과 관련된 변이라고 본다. 이 2종의 염색체의 수는 모두 2N=42로서 같지만 G. aculeatus의 핵형은 metacentrics이 6개, submetacentrics이 6개 subtelo-acrocentrics이 30개이고, P. sinensis와 P. Kaibarae ssp.는 모두 metacentrics이 4개, submetacentrics이 4개 subtelo-acrocentrics이 34개로 2속 사이에는 서로 달랐다. Three species of Korean sticklebacks family Gasterosteidae were reviewed based on the specimens of several populations for the study of their morphological variations and taxonomical positions. All specimens of Gasterosteus aculeatus observed have a complete row of lateral plates ranging from thirty-two to thirty-five in number. The low-plate morph regarded as landlocked type is virtually absent. And no difference was recognized among six population of G.aculeatus in the meristic characters, i.e. number of vertebrae, gill rakers and fin rays. the Pungitius sinensis and P. Kaibarae ssp. shown local variations have scutes ranging from 31 to 35, but not clinal in the morphometric characters. But P.sinensis was statistically different from P.kaibarae ssp. in some characters such as the number of dorsal spine rays and vertebrae, and body depth, although their ranges overlapped. No significant taxonomic difference was detected between white form and black form in dorsal spinous membrane of P.Kaibarae ssp. Although these three species of Korean sticklebacks have the same diploid chromosome number(2N=42), G. aculeatus is obviously different from the two species of genus Pungitius in their karyotype; G. aculeatus consists of six metacentrics, six submetacentrics, and thirty subtelo-acrocentrics, and both P. sinensis and P. kaibarae ssp. have four metacentrics, six submetacentrics, and thirty-four subtelo-acrocentrics.

적절성 평가지침과 이유목록의 적용 가능성 평가

신영수,김용익,김창엽,김윤,김은경,송윤미,이영성 한국의료QA학회 1994 한국의료질향상학회지 Vol.1 No.1

Background: An appropriate use of hospital beds can improve productivity of hospital significanlly. The authors previous study revealed that approximately one third of Korean hospital bed days and one sixth of admissions were inappropritely used, when it was measured by Appropriateness Evaluation Protocol(AEP) and Delay Tool modified into Korean situation by the authors. This study aims to evaluate applicability of the instruments in a new hospital. More specifically the study aims to measure appropriateness of the instruments used by newly trained nurse reviewers at a new hospital setting. Methods: In order to evaluate applicability of these instruments, agreement rates of the scores recorded by newly trained nurse reviewers with by skilled nurse reviewer and also compared with the scores recorded by physician's implicit decision were assessed. Agreement rates were derived from concurrent application of AEP and Delay Tool to 52 admissions and 104 patient days from internal medicine, pediatrics, and general surgery of one university hospital. Oversall agreement rate, specific nonacute agreement rate, and kappa statistics were used to indicate level of agreement. Results: Overall agreement rates on appropriateness between newly trained nurse reviewers and skilled nurse reviewer were 100% in admission and 98% in bed days. Overall agreement rates on reason for inappropriateness between newly trained nurse reviewers and skilled nurse reviewer were 96% in admission and 91% in bed days. Overall agreement rates between newly trained nurse reviewers and physician reviewer were 86% in admission and 87% in bed days. Conclusion: Results indicated that AEP and Delay Tool were applicable to a new hospital in detecting inappropriate utilization of beds and reasoning of the inappropriateness. Thess instruments could contribute to enhance efficiency of hospital use, through continuous monitoring of level of inappropriate hospital use at national or individual hospital level.

미세 골절 진달을 위한 초음파 C-scan의 활용 가능성

박원근,최민주,이원흠,이윤준,이헌주,강창익,박전홍 제주대학교 공과대학 첨단기술연구소 2001 尖端技術硏究所論文集 Vol.12 No.2

The study examines the medical potential of an ultrasonic C-scanning technique and for diagnosis of the fatigue induced micro-fractures of the bone. In general, it is not easy to detect the micro­fracture by a simple radiological technique. In the study, the micro­fractures were made on the tibia taken from pigs using a three point bending. Comparison was made between the ultrasonic C-scan images (25 MHz) and X-ray images of the bones with the micro-fractures, It was found that the micro-fractures invisible on the X-ray images were observed on the ultrasonic images. It is proposed further in-vitro and in-vivo studies making the ultrasonic C-scan technique clinically useful for the diagnosis of the fatigued induced micro-fractures of the bone which are not possible to detect by the conventional radiological method.

정신장애인 치료에 중요 역할 담당자의 정신질환에 대한 태도조사

김병후,정선욱,강연화,김윤,김창엽,홍진표,한오수,조맹제,김용익 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.5

Objectives : Attitudes of families of mentally ill, health personnels and community leaders to the mentally ill after the development and utilization of the community mental health program and reintegration of the chronically ill patients into society. This study was designed to compare the attitudes toward the mentally ill patient of the persons who have important role in treating the mentally ill and to find the variables influencing the attitudes. Methods : We measured attitudes toward mental illness in psychotic patients' families(N=139), community leaders(N=180) and health personnels(N=324) including mental health personnels before the implementation of community mental health services in Yonchon county and Seodaemun district area. The instrument used to measure attitudes was Opinion about Mental Illness(O. M. I.) scale. Results : 1) Health personnel showed lower Authoritarianism(Factor A) and higher Benevolence(Factor B) scores on the average than community leaders and psychotic patients families. 2) Current residence affect the attitudes in psychotic patients' families, not in community leaders and health personnels. Families in urban area showed lower Authoritarianism(Factor A) and Social Restrictiveness(Factor D) and higher Benevolence(Factor B) scores than in the rural areas. 3) Many patient variables were correlated to the attitudes of families. Duration of illness, number of recurrence, number of admission, age of patient and family burden were positively correlated mainly to Social Restrictiveness(Factor D). 4) Sex and religion of respondents showed no or weak relationship with the factor scores. Conclusions : Education for community leaders and families is required to achieve successful community mental health services. Community support program should be developed for chronic, recurrent and burdensome psychiatric patients in the first place.

한국 성인을 대상으로 한 전산화 Standard Progressive Matrices의 표준화 예비연구

홍경수,이민수,오병훈,하규섭,유한익,이창욱,연병길,김성윤,신민섭,김재진,권준수 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.5

연구목적 : 전산화 Standard Progressive Matrices(SPM) 검사의 한국인 성인 표준자료를 확립함으로써, 간이로 지능을 평가하는 경우에도 보다 정확하게 지능지수를 추정하기 위해서 본 연구를 수행하였다. 방 법 : 18세 이상의 남녀 정상인 자원자 353명을 대상으로 전산화 SPM 검사를 시행하고, 백분율 및 표준점수(T-점수)를 기준으로 하여 표준화 자료를 작성하였다. 전체 대상군을 성별, 연령별로 구분한 후 평균과·분포가 유사한 집단은 군을 합치는 방법을 사용하였다. 한국인 표준자료에 근거하여 추정한 SPM 지능지수와 외국인 표준자료에 근거하여 추정한 SPM 지능지수를 각각 KWAIS 지능지수와 비교함으로써 타당도를 검증하였다. 결 과 : 18∼30세, 31∼40세, 41∼50세, 51세 이상의 연령군으로 구분된 한국 정상 성인의 SPM 표준화 자료를 산출하였다. 본 연구 결과에 의한 표준화 자료를 적용하여 지능지수를 추정하는 것이 현재 사용하고 있는 외국인의 표준화 자료를 이용하는 것보다 KWAIS 지능지수에 더욱 근접한 결과를 보였다. 결 론 : 18세에서 50세까지의 한국인 남녀에게는 간이지능평가도구로서 전산화 SPM 검사의 한국인 표준화 자료를 유용하고 타당하게 적용할 수 있음을 확인하였다. Objectives : We conducted this study to provide standardized data of the computerized Standard Progressive Matrices(SPM) test in Korean adults. Methods : The computerized SPM test was administered to 353 healthy volunteers aged 18 years over. We provided the standardized data(percentile and standardized T-scores) for the groups with similar mean and distribution of SPM scores, which was originally divided by age and sex. The validity of the new standardized data was tested by comparing IQs estimated by SPM and K-WAIS. Results : The standardized SPM data were provided for four age groups : 18 to 30 years, 31 to 40 years, 41 to 50 years, 51 years and over. IQ estimated by this standardized data tends to be closer to IQ by K-WAIS than the IQ estimated by foreign normative data. Conclusion : The standardized data of the computerized SPM were proven to be a useful and valid tool for measuring IQ briefly, compared with the conventional way of measuring IQ.

파킨슨씨병 환자에 있어서 자가부신수질 이식술

정상섭,박상근,오성훈,김선호,윤도흠,박정수,양우익,최인준,안영수,김경환,박창일,김진수,이현철 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.6

Recent experimental studies and clinical cases have suggested that grafting tissue from the adrenal medulla into the brain may alleviate the symptoms of Parkinson's disease. Autologous adrenal medullary grafts into the striatum was performed stereotactically in two patients with Parkinson's disease. Both patients were bedridden preoperatively, but 4 months after the surgery both became ambulatory and one was even capable of returning to his job. Even though the number of cases was small⑵ and the follow-up period was short, this study shows that adrenal medullary transplantation into the striatum may have some beneficial effects in patient with Parkinson's disease. Further experimental and clinical trials are necessary to see whether this procedure will be a recommendable surgical treatment for patients suffering from Parkinson's disease.

일 농촌지역의 우울 증상에 관한 역학연구 -위험요인 및 요인구조분석

하양숙,홍진표,김한규,이군희,한경자,조맹제,김용익,송미순,박성애,김창윤 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.2

연구목적 : 세계적으로 널리 사용되는 우울증 척도인 the Center for Epidemiologic Studies Depression Scale(CES-D)을 이용하여 지역사회 주민의 우울증상의 정도를 평가하고, 우울증상의 위험요인을 분석하고, 한국인에서 우울증상의 요인구조를 알기 위해 본 연구를 실시하였다. 방 법 : 경기도 일 농촌 지역의 30세 이상 주민에 대해 무작위 군집 집락 추출을 실시하였고, 훈련된 면담원들이 가정 방문을 통하여 면접 및 자기보고 검사인 CES-D를 실시하였다. 총 1,315명에서 응답을 하였고 응답율은 59.3%이었다. 결 과 : CES-D에 의한 우울증 점수는 0∼5점이 57%정도를 차지하였고, 평균 점수는 남자 7.8점 여자 9.5점으로 비교적 낮은 편이었다. ANCOVA 분석 결과 비결혼, 저학력, 여성이라는 위험요인은 독립적으로 우울증상을 악화시키는 요인이었으나 연령은 통계적으로 유의하지 않았다. CES-D 결과를 요인분석을 시행한 결과 4가지 요인이 추출되었는데 우울증상 및 신체증상이 한 개의 요인으로, 다른 나라에서 보고되지 않는 정서적 고통이 별도의 요인으로 추출되었다. 결 론 : 국내 역학 조사에서도 외국과 유사한 우울점수 및 위험요인이 확인되었으나 우울증의 요인에서는 특이한 요인이 추출되었다. 한국인에 독특한 우울 반응에 관한 추가 연구가 필요하다. Objectives :The rates, correlates, and factor structure of depressive symptoms in a Korean rural sample were examined using Korean version of the Center for Epidemiologic Studies Depression Scale(CES-D). Methods : Door to door visiting survey was conducted by trained interviewers. A random cluster sample of 1,315 respondents, aged 30 and over completed the CES-D scale along with additional sociodemographic questionnaire. Results : In this sample, mean CES-D score of male and female were 7.8 and 9.5, respectively which were lower than those reported previously. Symptoms of depression were most common among the less educated, non-married and female according to ANCOVA. Age was not a significant risk factor for depressive symptoms. Different factor structures emerged from this sample as compared to other studies using this approach. Somatic symptoms and affective symptoms were combined as one factor and emotional hardship emerged as a separate factor. Conclusion : Symptoms scores and risk factors were similar to the results reported in other countries but unique factor structures were found in this study. Further research is needed about the Korean depressive symptomatology and related areas.