두개강내 해면상혈관종의 임상양상 및 수술적 치료의 효용

오창완,정영섭,김동규,백선하,조병규,왕규창,한대희 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.6

폐부종과 심정지가 발생한 페노바비탈 중독환자

오동렬,이운정,박규남,김세경,김영민,이환,유은영,최경호,정시경 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Phenobarbital is a long-acting barbiturate causing generalized depression of neuronal activity in the brain. Its effect is primarily achieved through enhanced GABA-mediated synaptic inhibition. Its use as an antiepileptic agent was first described in 1912. Before the introduction of phenytoin, phenobarbital is used as sedative-hypnotics. It is used for the treatment of epilepsy and status epilepticus. All barbiturates, including phenobarbital, have a high potential for abuse. They were frequently used for suicide attempts in the past, but they have in large part been replaced by benzodiazepines. The onset of symptoms depends on the drug and the route of administration. Mild to moderate barbiturate intoxication resembles ethanol inebriation with slurred speech, ataxia, and lethargy. Severe acute barbiturate intoxication is life threatening. Early deaths are generally cardiovascular-related. Hypotension, shock, pulmonary edema, and cardiac arrest that occurs with large doses are caused by depression of central sympathetic tone and as well as by direct depression of cardiac contractility. The potentially fatal oral dose of phenobarbital is 6-10g. We describe an 23-year-old woman with pulmonary edema, and cardiac arrest ingestion of 18grams of phenobarbital. She was completely recovered by successful cardiopulmonary resuscitation and homoperfusion. We report a case with literature review.

청년에서 발생한 외상성 및 자발성 두개내 동맥 박리에 의한 허혈성 뇌경색

이동국,서상일,김태일,곽규호,도진국,김미숙,오희종 대한신경과학회 1998 대한신경과학회지 Vol.16 No.2

抗精神病藥物에 依한 無顆粒細胞症 治驗 1例

吳東財,申榮宇,張煥一,趙京杉,朴康圭 大韓神經精神醫學會 1985 신경정신의학 Vol.24 No.1

The authors experienced a female schizophrenic patient who revealed severely decreased leucocytes (350/㎣) with the manifestation of high fever, chillness and sore throat after the oral administration of neuroleptics. Agranulocytosis induced with the use of neuroleptic drugs has been well known complication in psychiatric practice although it is quite rare. In this case, following the combined use of neuroleptics (thioridazine halopondol and chlorproonazine), severe decrement of leucocytes (mainly lymphocytes with few neutrophils) was noticed on peripheral blood and marked decrement of erythroid series, especially of myeloid series, with decrement of total cellular elements were confirmed through the biopsy of bone marrow. She did not responded at all to the massive administration of antibiotics, but dramatic improvement was noticed both clinically and in the follow-up biopsy findings of bone marrow after two times trial of leukapheresis.

외과계 감염증에 대한 Sulperazon(Sulbactam/cefoperazone) 및 Cefoperazone의 임상효과 비교연구

박규주,노동영,김상준,권오중,정중기,홍인규 대한화학요법학회 1990 대한화학요법학회지 Vol.8 No.2

Despite recent advances in development of antibiotics and antiseptic techniques, infection still remains to be one of the major problems in the surgical field. Due to development of bacterial resistance to commonly used antibiotics, there is always a need to develop a new antimicrobial agent which would overcome such resistance. Sulperazon (Sulbactam/Cefoperazone) is a combination drug of potent β-lactamase inhigitor, sulbactam, and cefoperazone which has broad antibacterial spectrum, which was developed to combat against β-lactamase producing microorganisms. In an effort to evaluate the efficacy and safety of sulperazone, we have randomly divided 40 patients (12 with perforated appendicitis, 10 with peritionitis, 6 with GB empyema, 6 with periproctal abscess, 3 with wound infection, 1 liver abscess, 1 pancreatic abscess, and 1 acute cholangitis) into 2 groups (20 patients in each group). One group received daily dose of 2 to 3 grams of sulperazon and the other group received daily dose of 2 to 3 grams of cefoperazone. Following results were obtained : 1. Clinical effect of sulperazon was cure in 16 patients (80%), improvement in 3 patients (15%), compaired to cure in 14 patients (70%), improvement in 4 patients (20%) for the cefoperazone group. 2. Using disc diffusion method, sulperazon was sensitive to all of the isolated microorganisms except β-hemolytic streptococci, which was moderately sensitive. Cefoperazone was sensitive to only E. coli, Pseudomonas aeruginosa and Serratia. 3. Microbiological effect of sulperazon was eradication of offending microorganisms in 16 patients (80%), compared to 14 patients (70%) in Cefoperazone group. 4. Overall clinical efficacy of sulperazon was 95%, compared to 80% for cefoperazone. 5. Adverse effects due to sulperazon was nausea and diarrhea which occurred in 1 patient respectively. 2 patients receiving cefoperazone experienced diarrhea. It can be concluded that sulperazon is a safe and effective antibiotic agent which can be used in surgical infection patients.

한국어 판 구조화 임상면담도구 개발 : 신뢰도 연구

한오수,안준호,송선희,조맹제,김장규,배재남,조성진,정범수,서동우,함봉진,이동우,박종익,홍진표 대한신경정신의학회 2000 신경정신의학 Vol.39 No.2

연구목적: 정신장애의 정확한 진단과 평가는 임상에서뿐만 아니라 신뢰성 있는 연구를 위해서도 매우 중요하다. Structured Clinical Interview for DSM-IV(SCID)는 임상전문가들이 사용하는 진단도구로서, 비교적 짧은 시간에 정확한 진단을 내릴 수 있다. 본 연구는 한국어판SCID를 개발하고 그 신뢰도를 평가하기 위해 수행되었다. 방법: 국문학자가 포함된 번역위원회를 통하여 연구용판 SCID를 번역한 후, 정신과 의사 2인과 임상심리학자 1인에게 한국어판SCID 실시방법을 교육시킨 뒤 한국어판SCID를 이용한 면담의 평가자간 신뢰도 (interrater reliability)를 검증하였다. 면담 대상은 1999년 2월에서 3월까지 2개 병원 정신과에 치료중인 환자 90명(남:41명, 여:29명)이었다. 결과: 현재 장애(current disorder) 평가에서 주요 우울장애, 기분부전장애, 정신분열병, 알코올 남용 및 의존, 기타 물질 남용 또는 의존, 여러 불안장애들 및 섭식장애 등과 같은 대부분 장애의 kappa값은 .70이상으로 매우 높았다. 그 이외의 양극성 장애, 망상장애, 광장공포증, 감별 불능 신체화 장애 및 건강염려증의 kappa값도 .69에서 .40사이로 수용할 수 있는 정도였다. 평생 장애(lifetime disorder)에서는 양극성 장애(k=.69)와 감별 불능 신체화장애(k=.59)를 제외한 다른 모든 장애의 kappa값이 .70이상이었다. K-SCID 면담시 Ⅰ축 질환에 대하여 흔하게 다중 진단이 내려졌으며, 평균 진단 수는 1.5∼1.7개로 나타났다. 결론: 한국어판 SCID는 신뢰도가 높은 진단도구로 생각되며, 향후 정신질환의 정확한 진단과 임상연구에 유용하게 사용될 수 있다. Objectives: Accurate diagnosis and assessment for psychiatric disorders is crucial for research, as well as for clinical practice. Structured Clinical Interview for DSM-Ⅳ(SCID-RV) is a less time-consumimg and more accurate structured diagnostic interview form. It can be used by clinical professions and is known for a reliable diagnostic tool. Present study was conducted to develop Korean version of SCID-RV and to test the inter-rater reliability. Methods: The authors have translated original SCID-RV into Korean, and revised in parallel with sociocultural background of Korea. Ninety patients from two psychiatric hospitals, both outpatient and inpatient, were interviewed and rated independently by three raters. Results: The kappa coefficients for most of illnesses, such as major depressive disorder, dysthymia, schizophrenia, alcohol abuse and dependency, anxiety disorder and eating disorder were excellent(>0.70) in the evaluation of current disorders. And the kappa coefficients for bipolar disorder, delusional disorder, agoraphobia, undifferentiated somatoform disorder, and hypochondriasis were acceptable(>0.40) in the evaluation of current disorders. In the evalua-tion of lifetime disorders, the concordant rates of all the diagnoses except bipolar disorder and undifferentiated somatoform disorder were excellent. Lack of hierarchy in DSM-Ⅳ allows for multiple Axis I diagnoses. Mean numbers of Axis I diagnoses per subject assigned by the three raters were 1.5-1.7. Conclusions: Our findings confirm that SCID-RV yields highly reliable diagnoses. SCID-RV is recommended for accurate diagnosis in clinical practice and research on psychiatric disorders.

장시간 불가피한 공복(fasting)후 인체의 내분비 변화 : 삼풍백화점 붕괴 사고후 구조된 3인의 증례 THREE CASES IN COLLAPSE OF SAMPOONG DEPARTMENT STORE

박규남,황주일,박조현,오동렬,이원재,오승택,김세경,김인철 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

The interactions between nutrition and the endocrine system are more intimate and complex that previously thought. Nutrition modulates secretion and activity of many hormones, as part of the stress adaptation process. Fasting, in particular, produces a number of important changes in the endocrine system, with teleological purpose of helping the body tolerate the lack of food ingestion. These changes are therefore beneficial and protective, although at times they may not appear to be that way. The endocrine changes of fasting mediate the metabolic response. We must emphasize that these changes are completely reversible when appropriate nutrition is established. These changes are as followes: 1) decreased insulin and increased glucagon levels, 2) decreased thyroid effect, 3) decreased sympathetic activity, 4) hypothalamic hypogonadism, 5) decreased growth, 6) altered glucocorticoid secretion and metabolism, 7) impaired mineralocorticoid response, 8) decreased ADH secretion and effect. We experienced three cases of involuntary prolonged fasting after collapse of Sampoong department store. They were released from collapsed field after 11(case Ⅰ), 13(case Ⅱ), 17days(case Ⅲ) respectively. In each case, the endocrine changes of plasma levels were as followes: decrease of cortisol in case Ⅰ, increase of GH in case Ⅱ, decrease of free T3, T3, cortisol and increase of reverse T3, insulin in case Ⅲ. Each one did not show the same endocrine changes of plasma levels. But we think these changes of fasting are beneficial in metabolic response of human.

경기지역 소아와 청소년에서의 A형 간염항체 양성률

김동규,김영대,장현오,조종래 인제대학교 2006 仁濟醫學 Vol.27 No.-

Objective : The incidence of hepatitis A virus (HAV) infection in childhood has dramatically declined, and therefore the susceptibility of adult to HAV is increasing in Korea. The purpose of this study is to evaluate the prevalence of anti-HAV IgG in children and adolescents in Gyeonggi Province. Methods : 172 children and adolescents with no history of transfusion of any blood products during recent 1 year were enrolled. They were classified into 3 groups such as; 3~6 years, 10~11 years, and 17~18 years. Positive rates of anti-HAV IgG were determined by chemiluminescence immunoassay. Results : According to age group, the seropositive rates were 0%(0/38), 0%(0/82) and 1.9%(1/52) in 3~6, 11~12, and 17~18 years of age group respectively. Conclusion : Prevalence of Anti-HAV IgG in children and adolescents is nearly zero in our study. We recommend the HAV vaccination for young children.

OK-432(Picibanilⓡ)와 외과적 절제술을 이용한 선천성 림프관종의 치험례

김일규,이성호,오성섭,최진호,오남식,김왕식,임영일,양동환 대한악안면성형재건외과학회 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.3

Lymphangiomas are relatively rare benign tumors of the lymphatic system, characterized by congenital lymphatic malformation such as anastomosis or obstuction of the lymphatic channels. There are most frequently diagnosed in children younger than 3years. In contrast to that of the hemangioma, the sex distribution of the lymphangioma is nearly evenly divided. The head and neck lymphangioma represents about 70∼75% of all lymphangiomas, and they are difficult to manage. Spontaneous regression is rare, and rapid intermittent enlargement occurs secondary to infection or trauma. Enlargement may cause serious sequelae such as airway obstruction, feeding difficulties, and cosmetic problems. Treatments previously used for lymphangiomas include surgical excision and intralesional injection of sclerosants. Problems associated with surgical excision include the risk of cosmetically unacceptable scarring and the risk of damage to surrounding vital stricture and the high risk of incomplete excision. The sclerosants previously used have numerous other local and systemic side effects. This report describes a case that was successfully treated using OK-432 as a new sclerosant drug and secondary surgical excision for congential cavenous lymphangioma extensively enlarged to tongue, mouth floor and submandibular region.

일부 도시지역 노인들의 우울과 일상생활능력에 관련된 요인

박원규,이태용,정용준,오장균,이동배,조영채 충남대학교 의과대학 의학연구소 2002 충남의대잡지 Vol.29 No.1

This study was performed to provide the basic data and related factors available for the assessment of the degree of ADL and depression among older persons, manifesting their physical and psychological status. The subjects included the old people aged more than 65 years old who reside in urban areas. The interviews were delivered to 693 individuals in Taejon metropolitan city during the two-month period from June to July, 2000, and Zung Self-Rating Depression Scale and IADL developed by Older American Resources and Services of Duke medical college, were employed for the assessment of depression and IADL, respectively. The collected data were statistically processed by SPSSWIN(ver 10.0) and led to the following results. The degree of depression among 635 subjects showed that 26.6% had mild depression, 8.2% moderate and 0.6% severe while 64.6% were normal. In terms of IADL, 6.9% had impossible IADL when not aided by others, 37.0% needed some help, 56.0% possible IADL, and the higher depression scores, the significantly higher IADL scores. Based on general characteristics, depression scores were significantly higher in the female group, the older, the lower educated, the ones without cohabitants, without a spouse, without making expenses of living on their own, and IADL scores were lower, meaning the lower capability for performing daily activities, in the male group, the older, the higher educated, the group without a spouse, without making expenses of living on their own. Based on daily activities and psychological characteristics, depression scores were higher in the group who don't go out, who don't have recreational or friendly gatherings, who aren't satisfied with the lives of the past or present, who have a sense of isolation, and who don't have the will to live, and IADL scores were lower in the group who don't go out, who don't have recreational or friendly gatherings, who aren't satisfied with the lives of the past or present, who have a sense of isolation. and who don't have the will to live. Multiple regression analysis revealed that the explanatory variable having effects on depression symptoms included, with the explanatory power of 57.5%, the confidence in life, the degree of education, the subjective index of health, the sense of isolation, the exercise, the degree of IADL, the gender, the level of satisfaction with life, whether they eat breakfast or not, the concern about life, the smoking, the going out, the presence of spouse or not. The explanatory variables having effects, with the explanatory power of 28.9%, on IADL scores included the degree of depression symptoms, the age, the presence of friends or not, the frequency of outgoing, the level of education, the degree of obesity, the confidence in life, the level of satisfaction with life, the drinking or not. The study results showed that the higher depression scores had a tendency to be associated with the decreased capabilities of performing daily activities, and that the factors related to depression and/or IADL, included the confidence in life, the level of education, and the level of satisfaction with life. However, the more detailed and decisive results on the factors related to depression and IADL of the older persons are considered to require continuing efforts and comparisons among a variety of the older population.