• Title/Summary/Keyword: 비약물적 치료

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Topical Application of Clonazepam to Burning Mouth Syndrome (구강 작열감 증후군에서 클로나제팜의 국소적 적용)

  • Shim, Young-Joo;Choi, Jong-Hoon;Ahn, Hyung-Joon;Kwon, Jeong-Seung
    • Journal of Oral Medicine and Pain
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    • v.34 no.4
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    • pp.429-433
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    • 2009
  • Burning mouth syndrome (BMS) is defined as burning pain in the tongue or other oral mucous membrane associated with normal sign and laboratory findings at least 4 to 6 months. There are many factors that affect this condition and the pain characters are various among the sufferers, so it is difficult to diagnose exactly and treat properly. The cause of BMS is currently unknown. The etiology is presumed to be that it is related with local, systemic and psychogenic factor. The BMS is related with local factor such as allergic reaction, oral fungal infection(candidiasis), parafunctional oral habits and systemic factors such as diabetes mellitus, hypothyroidism, nutritional deficiencies(vitamin $B_{12}$, folic acid), hyposalivation and psychogenic factor such as depression, anxiety, cancerphobia. So clinicians must be aware of these factors and can give proper treatment options to patients. The management of BMS are pharmacologic management, cognitive behavioral therapy and psychotherapy treatment. Clonazepam, gabapentin, amitriptyline, alpha-lipoic acid and capsaicin are used to manage the BMS. Among these, topical clonazepam is reported that the effect is higher than systemic medication and the complications are rare. This case report is about some cases of the effect of topical clonazepam on BMS.

Implementation of Non-Invasive Pressurized Cerebral Perfusion Platform (가압식 비침습적 대뇌 혈류 증가 장치의 구현)

  • Lee, Jean;Yu, Hyung-gon;Kim, Young-kil
    • Journal of the Korea Institute of Information and Communication Engineering
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    • v.21 no.9
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    • pp.1752-1760
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    • 2017
  • One of the treatments and preventions of strokes such as ischemic stroke is to increase cerebral blood flow. This aims to minimize the size of the stroke by increasing the quantity of blood to the cerebral region circuitously. Several ways to increase cerebral blood flow are a therapy though drugs and through surgery. However these invasive method giving a burden to the patient, the problem of inducing a number of complications were noted. In this thesis, we propose a non-invasive brain flow enhancer to complement the disadvantages of such invasive treatment methods. To compensate for the shortcomings of the existing devices, the patient's blood pressure is accurately measured and the blood pressure is applied to the extremities, thereby increasing blood flow to the femoral region to produce blood clotting treatments. Although somewhat inadequate blood flow increases compared to conventional devices, blood flow can be significantly increased, which can be selectively.

Clinical Significance of MRI Findings During Medical Treatment for Tuberculous Spondylitis (척추염 환자의 약물치료기간 중 추적 검사한 MRI소견 변화의 임상적 중요성)

  • Kim, Dae-Jung;Chung, Tae-Sub;Suh, Sang-Hyun;Kim, Keun-Su;Cho, Yong-Eun;Yoon, Young-Sul;Kim, Sam-Soo
    • Investigative Magnetic Resonance Imaging
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    • v.13 no.2
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    • pp.146-151
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    • 2009
  • Purpose : To evaluate magnetic resonance (MR) imaging features of non-surgically treated tuberculous spondylitis and to evaluate the relationships between these features and clinical outcomes. Materials and Methods : Data from ten patients (male:female=6:4, mean age=45 years) with clinically proven tuberculous spondylitis who were treated nonsurgically over three months were analyzed retrospectively from 2000 to 2007. MRI was performed at least three times for each patient, at baseline, every three or six months, and at the end of treatment. All images were analyzed by two radiologists. Results : The mean follow-up period for the MR examination was 10.1 months (range, 4-17 months). Six patients had clinically complete resolution of tuberculous spondylitis with medication treatment only. Four patients were treated with surgical management alongside medication. All ten patients were divided into two groups by clinical outcome; six patients with complete treatment and four patients with incomplete treatment. In the complete treatment group, follow-up MR findings showed a loss of subligamentous spread of abscesses, decreased size of abscesses, no interval changes in vertebral body heights, and fatty changes in spinal lesions. MR findings in the incomplete treatment group showed bone marrow edema extension to adjacent vertebra, extension of the abscesses, and decreased height of the vertebral bodies. Conclusion : During the nonsurgical management of tuberculous spondylitis, MR imaging may play a role in predicting patient response to antituberculous drug treatment.

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NEW ANTIDEPRESSANTS IN CHILD AND ADOLESCENT PSYCHIATRY (소아청소년정신과영역의 새로운 항우울제)

  • Lee, Soo-Jung
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.14 no.1
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    • pp.12-25
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    • 2003
  • Objectives:As increasing number of new antidepressants have been being introduced in clinical practice, pharmacological understanding has been broadened. These changes mandate new information and theories to be incorporated into the treatment process of children with depressive disorders. In light of newly coming knowledge, this review intended to recapitulate the characteristics of new antidepressants and to consider the pivotal issues to develope guidelines for the treatment of depression in childhood and adolescence. Methods:Searching the Pub-Med online database for the articles with the key words of 'new', 'antidepressants' and 'children' ninety-seven headings of review articles were obtained. The author selected the articles of pertinent subjects in terms of either treatment guideline or psychopharmacology of new antidepressants. When required, articles about the clinical effectiveness of individual antidepressants were separatedly searched. In addition, the safety information of new antidepressants was acquired by browsing the official sites of the United States Food and Drugs Administration and Department of Health and Human Services. Results:1) For the clinical course, treatment phase, and treatment outcome, the reviews or treatment guidelines adopted the information from adult treatment guidelines. 2) Systematic and critical reviews unambiguously concluded that selective serotonin reuptake inhibitors(SSRIs) excelled tricyclic antidepressants( TCAs) for both efficacy and side effect profiles, and were recommend for the first-line choice for the treatment of children with depressive disorders. 3) New antidepressants generally lacked treatment experiences and randomized controlled clinical trials. 4) SSRIs and other new antidepressants, when used together, might result in pharmacokinetic and/or pharmacodynamic drug-to-drug interaction. 5) The difference of the clinical effectiveness of antidepressants between children and adults should be addressed from developmental aspects, which required further evidence. Conclusion:Treatment guidelines for the pharmacological treatment of childhood and adolescence depression could be constructed on the basis of clinical trial findings and practical experiences. Treatment guidelines are to best serve as the frame of reference for a clinician to make reasonable decisions for a particular therapeutic situation. In order to fulfill this role, guidelines should be updated as soon as new research data become available.

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Clinical Observation on Effects and Adverse Effects of Choweseuncheng-tang on Obesity Patients (비만 환자에 대한 조위승청탕의 효과 및 부작용에 관한 임상적 고찰)

  • Seo, Dong-min;Lee, Sang-hoon;Lee, Jae-dong
    • Journal of Acupuncture Research
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    • v.22 no.3
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    • pp.145-153
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    • 2005
  • Objective : This study was designed to investigate the effects and adverse effects of Choweseuncheng-tang on obesity patients Methods : Choweseuncheng-tang was given to 20 obesity patients who have no abnormality of GOT, GPT and past medical history. Additionally, electroacupuncture was performed on Fuchao(腑巢) with 60Hz. We compared body weight, body fat and laboratoy test(GOT, GPT, BUN, Creatinine) between before and after treatment. Blood pressure, heart rate and clinical symptoms were checked to investigate the side effects. Decrease of body weight was checked in accordance with Sasang constitutional type, appetite type, and BMI. Results : 6 patients(BMI 23-24.9), 10 patiets(BMI 25-29.9), and 4 patients(BMI over 30) were showed decrease of body weight. We found body fat was decerased $3.16{\pm}1.25%$. BUN, Creatinine, GOT and GPT were increased within normal range. There were adverse event of autonomic hyperactivity(11 patients), gastrointestinal symptoms(7 patients) and others(3 patients). Conclusions : According to above results, Choweseuncheng-tang could be used effectively, but should be taken cautiously on obese patients.

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Factors Contributing to Treatment Outcome of Functional Constipation in Children (소아 기능성 변비의 치료에 영향을 미치는 인자)

  • Kim, Hyung-Seok;Hong, You-Rha;We, Ju-Hee;Park, Jae-Hong
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.13 no.1
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    • pp.36-43
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    • 2010
  • Purpose: The aim of this study was to evaluate the clinical features and factors contributing to treatment outcome for chronic functional constipation in children. Methods: We analyzed the medical records of patients with constipation, who visited the inpatient or outpatient clinic of the Department of Pediatrics of Pusan National University Hospital, between January 1998 and December 2007. The clinical features, outcomes, and factors affecting the treatment response according to the main drug (lactulose vs. PEG 4000) were analyzed retrospectively. Results: Two hundred forty children (142 males and 98 females) were enrolled in this study. The mean age was 51.2${\pm}$37.9 months. The duration of symptoms was 32.6${\pm}$33.7 months. The accompanying symptoms were as follows: encopresis, 91 (30.4%); abdominal pain, 76 (31.6%); and blood-tinged stool, 37 (15.4%). The treatment response was achieved earlier in females (p<0.001), patients with accompanying symptoms (p<0.05), and patients treated with PEG 4000 (p=0.001). The duration of symptoms (p<0.05) and stool frequency before treatment (p<0.05) were related to a delayed treatment response. Relapse occurred in 7 children, all of whom were treated successfully later. Conclusion: Factors contributing to treatment response are female gender, accompanying symptoms, duration of symptoms, and stool frequency before treatment. PEG 4000 is superior to lactulose in response time and taken into consideration as a primary drug for the treatment of functional constipation of children. Early treatment and sufficient treatment time may also be important factors to achieve an early response and prevent relapse.

Literature Review of Therapeutic Milieu of Psychiatric Patient and Suggestion for Changing Environment of Psychiatric Wards in Korea (치료적 환경에 대한 문헌적 고찰 및 정신과병동 환경변화에 대한 몇가지 제언)

  • Lee, So-Woo
    • Journal of Korean Academy of Nursing
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    • v.6 no.1
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    • pp.80-90
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    • 1976
  • 정신과 영역의 환자를 위해 간호원의 역활을 필요로 한 이래 여러 가지 간호의 개념으로 간호원의 역할이 변화되어오고 있다. 정신과 환자의 안전만이 가장 큰 치료의 중심일 때는 병동열쇠의 위엄에 곁따라 보호관리에만 치중해 왔으며 정신의학에서 약물요법, 전기요법의 치료과정이 생기면서 간호원의 역할 변화 및 지식의 요구를 필요로 하게 되었으며, 환경과 개인의 밀접한 관계를 중시해오면서 치료적 환경속으로 환자의 인간적 치료가 강조되었을 때 의사소통과 대인관계의 인적 환경으로써 또한 간호원의 역활이 중요시 되어왔다. 이런 관점에서 치료적 환경에 대한 정확한 이해는 간호행위과정의 불완전을 제거하며 보다 활발한 정신과 환자간호에 기여하는 일 일 것이다. DR. Bartom은 병실 환경이 비생산적이고 비 치료적일때 성격의 변화는 물론 행동적 특성의 변화까지 가져올 수 있다고 말했다. 즉 무감동적이고, 무조건적 순종이 있으며 솔선하여 행하는 행위가 줄고 장래 계획에 대한 자극이 줄어들고 될대로 되어 가는 상태 그 자체에 머물러 있어 인간의 특징적 의미와 가치를 상실하게 된다는 것이다. 정신과 병실은 잠정적 체류지로 보아야 하겠고 이 체류지에서의 영향이 환자에게 보다 유익하게 끼칠려면 간호원이 지속적으로 치료적 분위기를 유지해야 할 것이다. 치료적 입장으로서의 간호의 활동 초점은 대인관계에서 환자의 의식수준과 자아관련 수준에서의 취급이 무의식 수준에서의 탐구조사보다 바람직하다. 치료적 가치로써 치료적 환경의 이론적 근거를 DR. Sullivan 은 인간의 상호관련 문제에 두고 있다. 즉 상호작용이 존재하는 환경은 어떠한 곳이든 성격에 영향이 있고 이 성격은 대인관계의 복잡성으로부터 결코 떨어질 수 없다는 얘기다. 자아구성 또한 환경의 영향을 받는데 Cumming은 병동환경과 자아구성 재동기간에 밀접성을 시사한바 있다. Visher와 O'sullivan은 정신과적 치료중에서 일상생활에서 경험되어지는 의사소통과 대인관계속에서 학습되어지는 여러 가지가 있기 때문에 매일의 활동획이 치료적 방향으로 계획되어 져야 한다고 말했다. Maxwell Jones 또한 치료적 환경의 유용한 가동은 전 직원의 기여에 있으며 이는 정신건강을 최적으로 올려 줄 것이다. 라고 말했다. 이러한 상황에서 간호원은 의미 없이 환자의 감정 욕구를 깨닫지 못하고 감정지지를 주지 못하며 정서적 긴장을 예방하지 못한 체 환자와의 관계를 유지한다면 현대간호의 개념에서 이탈되어지고 발달되어지지 못한 미숙아 현상이 유지 될 것이다. 보다 바람직한 치료적 환경 유지는 간호로써 환자에게 기여해 주는 일이다. 간호의 역활과 더불어 전문적 태도는 따뜻하고 포용성 있게 그리고 융통성 있게 대함은 물론 간호인 자신의 "자기이용"을 깊이 그리고 치료적으로 이용할 것을 깨달아야 할 것이다. 즉 정신과 병실에서의 간호원 존재 자제가 환자에게 미치는 영향도 고려해야 한다는 것이다. 덧붙여 환자를 위한 일주일 병동 행사표를 Model로 제시하였고 그 안에서의 간호원의 역활을 약술하였다.

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Steroid and enalapril therapy - possible cause of toxic epidermal necrolysis (부신 피질 호르몬제와 안지오텐신 수용체 길항제 사용 후 발생한 독성 표피괴사 증후군)

  • Kim, Dong Wook;Jung, Da Eun;Koo, Ja Wook
    • Clinical and Experimental Pediatrics
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    • v.49 no.3
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    • pp.332-336
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    • 2006
  • Toxic epidermal necrolysis (TEN) is a rare, acute and life-threatening cutaneous drug reaction. TEN is characterized by the sudden onset of extensive necrosis in the epidermis and frequent mucous membrane involvement. The pathogenesis has not yet been elucidated. In addition, no particular treatment for TEN has been established. We report a case of TEN in a 14-year-old-boy, which might have been caused by steroids with enalapril treatment for membranous nephropathy. He recovered after intravenous immunoglobulin therapy.

The pharmacological treatment of patent ductus arteriosus in premature infants with respiratory distress syndrome: oral ibuprofen vs. indomethacin (호흡곤란 증후군 미숙아에서 동맥관 개존증의 약물 치료 : 경구용 ibuprofen과 indomethacin의 비교)

  • Lee, Soo Jin;Kim, Ji Young;Park, Eun Ae;Sohn, Sejung
    • Clinical and Experimental Pediatrics
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    • v.51 no.9
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    • pp.956-963
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    • 2008
  • Purpose : Indomethacin is widely used for the prophylaxis and treatment of patent ductus arteriosus (PDA); however, it is associated with side effects such as renal failure, intraventricular hemorrhage, and gastrointestinal bleeding. Intravenous ibuprofen has been shown to be as effective as indomethacin in prompting PDA closure. If treatment with oral ibuprofen is as effective as indomethacin, it would have the advantages of greater availability, simpler administration, and lower cost. We conducted this study to compare the efficacy and side effects of indomethacin with those of oral ibuprofen, vis-$\grave{a}$-vis on the pharmacological closure of PDA. Methods : As a randomized double-blind study, 34 preterm infants with respiratory distress syndrome and hemodynamically significant PDA were treated with either intravenous indomethacin or oral ibuprofen. Echocardiography was performed by one cardiologist who was blind to the treatment that any given infant received. The rate of ductal closure, the need for additional drug treatment or surgical ligation, clinical outcome, and the side effects of drug treatment were compared. Results : Ductal closure occurred in 16 of 18 patients (88.9%) from the indomethacin group and in 14 of 16 patients (87.5%) from the ibuprofen group (P>0.05). Three patients in the indomethacin group and four in the ibuprofen group required a second drug treatment (P>0.05). Three patients (i.e., one patient in the indomethacin group and two in the ibuprofen group) underwent surgical ligation (P>0.05). Between the two groups, there was no significant difference vis-$\grave{a}$-vis in side effects or clinical outcome. Conclusion : Compared to indomethacin, oral ibuprofen has the advantages of simpler administration and lower cost, while being as effective; in addition, there are no differences between the two drug treatments with regards to side effects or clinical outcomes. Therefore, the widespread use of oral ibuprofen should be considered in treating PDA in preterm infants.

High-resolution MR Imaging of Carotid Atherosclerotic Plaques (경동맥 경화판의 고해상도 자기공명영상)

  • Shin, Won-Seon;Kim, Sung-Mok;Choe, Yeon-Hyeon
    • Investigative Magnetic Resonance Imaging
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    • v.16 no.2
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    • pp.97-102
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    • 2012
  • High-resolution carotid MRI allows visualization of carotid atherosclerotic plaque characteristics. MRI serves as a noninvasive option for the detection of active plaque inflammation and intraplaque hemorrhage. Significant gains in signal-tonoise ratio and contrast-to-noise ratio can be obtained for carotid atheroma imaging at 3T compared with 1.5T. Normalized wall index or wall area on MRI has shown its efficacy in monitoring the response after medical therapy. $T(2)^*$ quantification in carotid plaques before and after the administration of ultrasmall superparamagnetic iron oxide particles shows difference in response to treatment according to drug doses. In conclusion, high-resolution MRI is useful in the diagnosis and monitoring of carotid atherosclerotic plaques prone to transient ischemic attack and stroke.