• Korean Journal of Psychosomatic Medicine
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• v.30 no.2
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• pp.165-171
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• 2022

Objectives : This study was conducted to investigate the effect of 1-year administration of second-generation antipsychotics (SGAs) on the platelet activity in patients with schizophrenia through a retrospective review of the medical records. Methods : The mean platelet component (MPC) value was used as an index of the platelet activity. The included subjects (N=24) were the patients who were confirmed to have taken SGAs continuously for one year after the first MPC measurement had been performed. The change of MPC was verified through a paired sample t-test. Results : The result revealed that the mean MPC value was significantly decreased from 26.5±1.4 g/dL to 25.6±1.8 g/dL after 1-year administration of SGAs from the time of the first MPC measurement. Conclusions : This study suggests that 1-year administration of SGAs may be related with increased platelet activity, and that close monitoring for risks such as cerebrovascular/cardiovascular or thromboembolic diseases may be necessary during SGAs treatment in clinical practice.

• Korean Journal of Psychosomatic Medicine
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• v.28 no.1
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• pp.36-41
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• 2020

Objectives : Clozapine has been known to increase the possibility of developing cardio/cerebrovascular diseases, and the platelet activation has been deemed to be related to the occurrence of them. In author's previous study, we observed the increase of platelet activity with short-term clozapine administration. This study was conducted, as a follow-up study, to investigate the effect of clozapine on the platelet activity when administered continuously for long-term period of time of 1 year. Methods : The medical records of the patients with schizophrenia or schizoaffective disorder who were treated with clozapine for 1 year were retrospectively reviewed. The degree of platelet activation was assessed by measuring the mean platelet component. Results : Total of 24 patients were enrolled. 9 of them (37.5%) were male and 15 of them (62.5%) were female. In the Wilcoxon sign-ranks test, no significant change was observed between the mean platelet factor values at the beginning and at the end of one year. Conclusions : No significant changes of mean platelet activity were observed after continued administration of clozapine for 1 year. Considering the author's previous findings that observed a prominent decrease of mean platelet component after short-term clozapine administration, the result of this study suggests the possibility that the activity of the platelet may change depending on the duration of the clozapine administration.

• Korean Journal of Psychosomatic Medicine
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• v.26 no.2
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• pp.188-193
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• 2018

Objectives : Clozapine is a widely prescribed antipsychotic drug for schizophrenia and is known to increase the risk of cardiovascular disease due to its metabolic side effects. However, little is known about the effect of clozapine on the platelet activation, another important factor in the development of cardiovascular disease. In this study, we tried to investigate the effect of clozapine on platelet activity in patients with schizophrenia by comparing the mean platelet component (MPC) values before and after the clozapine administration. Methods : A retrospective review of medical records of patients with schizophrenia, who newly started clozapine treatment from September 1st, 2003 to April 30th, 2007 at the Department of Psychiatry, Konyang University Hospital in Republic of Korea was performed. The final statistical analysis included 14 participants. Bayer ADVIA $120^{(R)}$ system was used to measure MPC. Results : Among the 14 participants, five subjects were males (28.60%), and ten subjects were females (71.40%). The mean age of participants was $37.50{\pm}11.64years$. Average of duration of illness was $91.00{\pm}93.96months$, with the mean dosage of clozapine taken by participants at the time of the last blood test was $337.50{\pm}109.52mg$. The mean MPC measurement before and after receiving clozapine was $26.12{\pm}2.22g/dL$ and $25.14{\pm}2.08g/dL$ respectively. Wilcoxon signed rank test showed that there was a statistically significant decrease in MPC levels after clozapine administration (V=16, p=0.024). Conclusions : Decreased MPC levels after clozapine administration implies that clozapine may increase platelet activation which could have an adverse effect on the occurrence of thromboembolic disease. Our findings also suggest that careful monitoring of the risk factors of cardiovascular diseases, such as platelets activity, is necessary when administering clozapine.

• Tuberculosis and Respiratory Diseases
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• v.53 no.1
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• pp.17-26
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• 2002

Background : The detection and early elimination of the causes for acute respiratory distress syndrome(ARDS) at the initial stage can result in a more favorable prognosis. Miliary tuberculosis as a cause of the ARDS is quite rare. A diagnosis of miliary tuberculosis is difficult due to the diversity of radiological patterns and non-specific clinical finfings, and low sensitivity of sputum examinations for acid-fast bacilli(AFBs). An analysis of the clinical data is the first step in diagnosing these unusual, rare cases. Materials and Methods : In this study the clinical features, laboratory data, radiological findings and diagnostic methods were analyzed in 9 cases with an initial presentation of ARDS due to miliary tuberculosis. The ARDS was defined by the definition of the American-Europian consensus conference 1992. Results : The mean age of the patients was $67{\pm}18$ years (F:M=7:2). The chief complaints were dyspnea(5/9), coughing (3/9) and fever(5/9). On a physical examination, fine or coarse crackles were noted(6/9). The ARDS developed on average 6.7 days after the initial respiratory symptoms. The mean $PaO_2/FiO_2$ of the patients was $133.5{\pm}53.4$, the number of cases with a WBC<5000/$mm^3$ was 4 out of 9 cases. A platelet count<70,000/$mm^3$ was observed in 2 out of 9 cases, and the serum albumin level was $2.6{\pm}0.6$ g/dL. The initial simple chest PA showed ground glass appearances and consolidation in all cases, However, the miliary nodular densities were observed in only 4 out of the 9 cases. HRCT revealed alveolar densities and a consolidation in 5 out of 6 cases, and miliary nodules in 5 out of 6 cases, The diagnosis of tuberculosis was made by a liver biopsy (4/4, 100% sensitivity), a bone marrow biopsy (1/2, 50% sensitivity), and an open lung biopsy (1/1), the sputum AFB was positive in only 2 out of 9 cases. The patient was treated with INH, RFP, EMB, PZA, and steroids. The survival rate was 55.5%. Conclusion : Miliary tuberculosis should be considered as one of the causes for ARDS in areas where there is a high prevalence of tuberculosis. The chief complaints of the patients on admission are dyspnea, fever and coughing without any specific riskfactors. A liver biopsy is particularly useful in ARDS patients with mechanical ventilation to determine the causes of the ARDS if miliary tuberculosis is suspected as being the underlying disease.

• Journal of Chest Surgery
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• v.32 no.10
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• pp.874-882
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• 1999

배경: 체외순환 후의 부종현상 및 이에 따른 여러 장치의 기능 저하를 방지하기 위하여, 최근에 체외 순환 이탈 후 환자의 혈액을 짧은 시간에 관류하여 여과해 주는 변형 초여과법의 사용이 늘고 있다. 이에 대한 긍정적인 임상결과들의 보고도 있으나, 다른 한편 체외 순환 후 염증반응을 포함한 폐손상의 기전에 혈구 성분의 영향이 보고되고 있는 바, 변형 초여과법의 효과, 특히 폐 조직에 대한 영향을 밝혀 보고자 하였다. 대상 및 방법: 몸무게 15에서 22 Kg(평균 16.5$\pm$0.5)의 16 쌍의 잡견을 이용한 정소성 심장이식, 실험에서, 통상적인 인공심폐기 작동군과 인공심폐기 작동 후 변형 초여과 관류를 시행한 군으로 무작위 구분하였다. 변형초여과법은 체외순환 정지 후에 대동맥관에서 나온 혈류를 Roller pump를 거쳐 Amicon Diafilter 초여과 관에 150 mL/m 정도의 속도로 10~15 분 정도 관류시켜 정맥관을 통하여 우심방에 직접 주입하였다. 혈액 채취 및 폐생검은 심폐기 시작 전과 정지 직후, 그리고 변형초여과 시행 군은 초여과 완료 직후에, 대조군은 심폐기 정지 10~15분 후에 각각 시행하였다. 혈류역학 측정요소는 동맥압, 우심방압, 좌심방압 등이었으며, 혈액 검사 항목은 동맥혈 가스분석, 혈색소 농도, 헤마토크릿, 백혈구 수, 혈소판 수, 혈중 단백 성분, 알부민 성분 등이었다. 폐 생검 조직으로는 냉동 건조법을 이용한 수분 함유량을 측정하였고, 광학 및 전자현미경으로 관찰을 하였다. 결과: 변형 초여과 군에서 혈중 혈색소 농도는 수술전 10.3$\pm$1.7 mg/dL, 심폐기 정지 직후 6.3$\pm$1.7 mg/dL, 초여과 직후는 8.3$\pm$2.8 mg/dL의 변화를(p=0.0078, 0.0117), 혈중 총 단백질의 농도 변화는 4.3$\pm$0.9, 3.1$\pm$1.5, 4.1$\pm$1.6 mg/dL, 혈중 알부민의 농도는 1.9$\pm$0.5, 1.4$\pm$0.7, 1.8$\pm$0.8 mg/dL로서, 각각 초여과법의 시행 전후에 유의한 증가를 가져왔고(p=0.0280, 0.0277), 폐조직의 수분 함유량의 변화는 수술전 75.1$\pm$8.6%, 심폐기 정지 직후 82.8$\pm$6.0%, 초여과 직후 77.88%를 보인 반면, 대조군에서는 각각 74.7$\pm$4.9, 82.1$\pm$5.9, 82.3$\pm$5.1%의 변화를 보였다. 미세 구조의 관찰에서, 폐포의 내포세피의 융합 기저막층과 미토콘드리아에서의 부종은 변형 초여과 후에 급격히 감소하였으나, 미토콘드리아내 크리스티의 파괴성 변화와 막성 파괴 성향이 초여과 후에 심화되게 관찰되었고, 세포질 내 소체의 팽창과 공포화 현상도 심폐기 가동 후 발생하여 초여과 후에 더 심화되게 관찰되었다. 세포질 내 소체의 팽창과 공포화 현상도 심폐기 가동 후 발생하여 초여과 후에 더 심화되게 관찰되었다. 폐조직 내의 백혈구는 심폐기 작동 후에 그 수에 있어서 증가하였으며 백혈구의 괴변, 탈과립 정도도 심폐기 작동 후 및 초여과 후에 증가한 소견을 보였다. 결론: 변형 초여과법은 인공 심폐기 후의 혈색소 농도 및 혈중 단백질 농도의 복원에 효과가 있었으며 변형 초여과 관류후 폐의 미세 조직내에서 부종의 급격한 감소 등을 관찰할 수 있었다.