• The Korean Journal of Pain
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• 제12권2호
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• pp.205-210
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• 1999

Background: Epidural morphine for postoperative pain control has a serious risk of respiratory depression and other side effects such as pruritus, nausea and urinary retention. In recent years, it is known that epidural administration of ketamine potentiates the effect of epidural morphine, and so decrease the side effects of epidural morphine. This study was performed to evaluate the analgesic efficacy of epidurally administered ketamine and whether this epidural administration can decrease the amount of epidural morphine. Methods: Sixty patients scheduled for the elective cesarean section were randomly selected. All patients were given subarachnoid injection of tetracaine 9 mg. Group I received epidural bolus injection of 0.15% bupivacaine 10 ml with morphine 2 mg followed by a continuous infusion of 0.125% bupivacaine 100 ml containing morphine 4 mg after peritoneum closure, and group II received the same method as group I except for the addition of epidural ketamine 30 mg. Analgesic effects were assessed using Numeric Rating Score (NRS) and Prince Henry Score (PHS). Also, the degree of satisfaction and the incidence of the side effects were observed. Results: Analgesic effects were significant in both groups after drug administration. But NRS and PHS were not significantly different between two groups at all times. The incidence of nausea and vomiting was 11 out of 30 in group I and 9 out of 30 in group II and the incidence of itching was 11 out of 30 in group I and 8 out of 30 in group II. Number of patients using additional analgesics were 2 and 1 in group I and II, respectively. Conclusions: Epidural ketamine did not potentiate the analgesic effect of epidural morphine and could not decrease the side effect of epidural morphine.

• Journal of Korean Neurosurgical Society
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• 제29권8호
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• pp.1024-1029
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• 2000

Objectives : With recent improvements in neuroimaging and the development of third and fourth-generation radiosurgical dose-planning soft ware, came a renewed interest in using radiosurgery for the treatment of movement disorders. Radiosurgery involves no opening of the cranium and no incisions, eliminating both the risk of hemorrhage from passing an electrode to the depths of meningitis from operative infection. It is for these reasons stereotactic radiosurgical treatment of movement disorders has value in a small subgroup of patients. The authors report four cases of Parkinson's disease and one case of dystonia that were treated by Gamma knife. Methods : Radiosurgical nucleus ventralis intermedius thalamotomy using the gamma knife unit was performed to make lesion in two Parkinson's disease patients. A radiation dose of 120Gy was delivered to nucleus using a single 4-mm collimator plug pattern following classic anatomical landmarks. Patients were followed for a median of 10.5 months(range 9-12 months). An independent neurological evaluation of tremor, based on the change in the United Parkinson's Disease Rating Scale tremor score(UPDRS), was correlated with a subjective evaluation. Gamma knife ventrolateral(V.O.P) thalamotomy was performed in one case of dystonia. A central dose of 150Gy was delivered and the patient was followed for 18 months. Gamma knife globus pallidus interna pallidotomy was performed in two Parkinson's disease patients. A radiation dose of 130Gy(range 120-140Gy) was delivered. Patients were followed for a median of 13 months(range 9-14 months). Result : Ventrolateral thalamotomy in dystonia produced regained left hand usage in order to be able to use the telephone. Ventralis intermedius thalamotomy produced an excellent improvement of the tremor in one case, mild improvement of the tremor in the other case of Parkinson's disease. A globus pallidus internalis(GPi) pallidotomy produced improvement of rigidity and dyskinesia : one other showed no change. There were no neurological complications. Conclusion : Gamma Knife thalamotomy considered a safe and effective technique for the treatment of tremor in Parkinson's disease. Although the results from Longer follow-up is not available yet, the short-term results seem to be encouraging.

• 정신신체의학
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• 제22권2호
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• pp.87-92
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• 2014

연구목적 본 연구에서는 섬망의 오진과 관련된 임상적 특징 및 임상의를 오진으로 유도할 수 있는 증상적 특징들을 알아보고자 한다. 방 법 일 대학병원에 입원하여 정신과에 협의진료 의뢰된 환자 중, 정신건강의학과 전문의에 의해 섬망으로 진단된 256명을 대상으로 후향적으로 의무기록을 조사하였다. 협진요청서에 명시된 사유를 검토하여, 의뢰의사의 진단이 섬망인 경우 진단일치군으로 섬망이 아닌 경우 진단불일치군으로 구분하였다. 결 과 69명(27%)이 진단불일치군으로, 섬망이 아닌 다른 진단으로 협진이 의뢰되었다. 진단불일치군에서 항정신병약물의 사용, 기질성 정신질환의 과거력이 많았다. Delirium rating scale-Revised-98(DRS-R-98) 중 증상의 변동 항목의 점수가 진단일치군에서 더 높았다. 로지스틱 회귀분석결과 질환의 낮은 심각도, 항정신병약물 사용력, 적은 증상의 변동이 임상의가 섬망 외에 다른 진단을 고려하는 예측인자였다. 결 론 본 연구에서 항정신병약물을 복용중인 경우, 섬망증상의 변동이 적은 경우 오진의 위험이 높았다. 지연된 섬망의 진단과 치료는 환자의 예후에 부정적인 영향을 미칠 수 있으므로 주의 깊은 임상적 관심이 필요하다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제4권1호
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• pp.98-105
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• 1993

주의력결핍과잉운동장애의 병인론에 대한 여러 가설중 알레르기가 그 원인의 하나로 대두되고 있다 주의력결핍장애아동의 21${\sim}$47%에서 알레르기 질환이 보고되고 있으며, 음식 알레르기가 있는 환자의 음식에서 알레르기원을 줄인 결과 82%의 아동이 과잉운동 및 학업문제가 줄었다는 보고가 있어 주의력결핍과잉운동장애의 일부 증상이 알레르기와 어떤 연관관계를 가지고 있음을 시사하고 있다. 또한 알레르기의 생화학적 이론의 하나로써 연구되고 있는 ${\beta}$-아드레날린성 과소반응 및 콜린성 과다반응의 생화학적 불균형의 가설은, 주의력결핍과잉운동장애의 병리중 콜린성 활동의 불균형에 의한 각성의 장애와 연관이 되어 있다 이에 본 연구에서는 알레르기질환이 행동장애를 유발하는지 알아보고자, 알레르기 질환의 진단을 받은 80명의 환아와 알레르기가 없는 정상아동 80명의 일반적 행동 양상을 아동행동조사표(부모형)를 통하여 비교하여 보았다 비교결과 알레르기 환아가 우울척도, 신체화척도, 공격성 척도, 비행행동 척도상 정상아동에 비해 높은 점수를 보였으며, 은둔행동척도는 의의있게 낮게 나타났다 알레르기의 임상요인들중에서 가족력의 유무에 따라 행동양상의 차이가 나타났는데, 알레르기의 가족력이 있는 경우에 총 문제점수 및 외면화행동, 과잉행동, 공격성행동척도 점수가 가족력이 없는 경우에 비해 의의있게 높았다 이러한 결과는 알레르기 환아의 부모가 아동이 문제성을 가지고 있다고 평가함을 의미하며, 알레르기의 유전적 소인과 주의력결핍과잉운동장애의 특성을 가진 행동장애는 유전적요인과 연관될 가능성이 있음을 시사하고 있다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제23권3호
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• pp.134-142
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• 2012

Objectives : Childhood depressive disorder one of the most prevalent chronic health conditions affecting school aged children. The objective of this study was to examine the prevalence and epidemiological characteristics of childhood depressive disorder in Korea. Methods : In this study, a survey was conducted of elementary school children in the Cheonan area from September 2009 to August 2010. A total of 12,084 children were included in the analyses. The primary measure of depression was the 27-item Kovacs' Children's Depression Inventory (CDI), the Korean Dupaul attention-deficit hyperactivity disorder Rating Scales (K-ARS), Autism Spectrum Screening Questionnaire (ASSQ) and Restless Legs Syndrome Questionnaire (RLSQ) were also administered. Results : The prevalence rate of childhood depressive disorder was 3.07%. The mean age was $9.21{\pm}1.81$ years for the control group (5,969 male, 6,054 female) and $9.91{\pm}1.83$ years for the depression group (CDI score${\geq}$22 ; 159 male, 210 female). Age, height, weight, and economic status were similar for the two groups. However, there were statistically significant differences in the distribution of sex. The distribution of school grade also differed between the two groups. Scores for CDI, K-ARS, and ASSQ in the depressive group were higher than those of the control group. Conclusions : This is the first large-scale population-based study to report on the prevalence of childhood depressive disorder in South Korea. Increased rates of childhood depressive disorder, as reported by primary caretakers, might reflect the increasing negative impact of environmental risk factors on neurobehavioral health. Longitudinal study of the prevalence of childhood depressive disorder should be considered for further evaluation.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제20권3호
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• pp.129-139
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• 2009

Objectives : This study evaluated the effectiveness of school-based mental health screening and treatment linkage programs, focusing on attention-deficit hyperactivity disorder (ADHD) and adolescent depression. Methods : All 11,158 children and adolescents aged 8-14 years in Seoul received a school-based mental health screening, consisting of the Korean versions of the ADHD rating scale and the Child Behavior Checklist (CBCL), for ADHD, and the Center for Epidemiological Studies Depression Scale (CES-DS) and the Suicidal Ideation Questionnaire-Junior (SIQ-JR), for depression. The high-risk children's and adolescents' diagnoses were confirmed using the Diagnostic Interview Schedule for Children-IV (DISC-IV). Treatment linkage programs were managed by the Seoul Metropolitan Community Mental Health Center (Program 1), the Seoul Metropolitan Office of Education (Program 2), or the Dongjak District Office of Education (Program 3). We estimated and compared the referral rates of the three programs. Results : Program 1 screened and referred 22.9% of ADHD youths to mental health services, Program 2, 68.8%, and Program 3, 40.0%. Program 1 screened and referred 22.8% of depressed youths to mental health services, Program 2, 53.8%, and Program 3, 88.9%. Key elements for successful screening and referral programs were an effective school/community mental health center/Office of Education network, the parents' financial support and perception of their child's mental health status as being problematic, and the teachers' active engagement. Conclusion : This is the first study investigating the effectiveness of school-based mental health screenings' linkage to treatment for primary and middle school students in Korea. An effective network for community mental health and improvements in parents' and teachers' perceptions regarding mental health are needed for more successful treatment linkage.

• 대한후두음성언어의학회지
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• 제29권1호
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• pp.30-36
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• 2018

Background and Objectives : The effect of palliative injection laryngoplasty in cancer-related unilateral vocal cord paralysis patients on voice and swallowing function is uncertain and there are few previous studies of its suitability, benefits as a palliative treatment option. The purpose of this study is to confirm the objective results of voice and swallowing function after palliative office-based hyaluronic acid injection laryngoplasty in cancer-related unilateral vocal cord paralysis patients. Materials and Method : 36 patients who had unilateral vocal cord paralysis from non-thyroidal, extralaryngeal neoplasms were included in this study. To evaluate the clinical outcome, we analyzed perceptual GRBAS grading, acoustic analysis, aerodynamic study, Electroglottography (EGG), Voice Handicap Index (VHI-30) about voice function and disability rating scale (DRS), gastric tube dependency, aspiration pneumonia about swallowing function and 36-Item Short Form Survey version 2 (SF-36v2) about quality of life. Results : In GRBAS scale, G (p<0.001), R (p=0.004), B (p=0.001), A (p=0.011), and S (p=0.007) showed significant improvement. Jitter, shimmer, speaking fundamental frequency, maximal phonation time, VHI-30, DRS score, gastric tube dependency, aspiration pneumonia, and SF-36v2 were significantly improved after injection (p=0.016, p=0.011, p=0.045, p=0.005, p<0.001, p<0.001 p=0.003, p<0.001, and p<0.001 respectively). Conclusion : From this study we concluded office-based hyaluronic acid injection can be used as a useful palliative treatment option in cancer-related ill patients with unilateral vocal cord paralysis. Palliative hyaluronic acid injection laryngoplasty avoids the need for tube feeding, thus reducing the risk of aspiration pneumonia. These outcomes are accompanied by significant improvement in voice quality.

• 치위생과학회지
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• 제15권4호
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• pp.480-487
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• 2015

본 연구는 2013년 KNHANE 자료를 이용하여 우리나라 성인의 구강건강 상태와 HRQoL 관련성을 EQ5D 구성요소를 중심으로 평가하고자 하였다. 16~64세 성인 3,252명을 최종 분석대상자로 하여 다음과 같은 결론을 얻을 수 있었다. 치아통증과 운동능력, 통증 및 불편은 통계적으로 유의한 관련성을 나타냈고, 저작 불편과 말하기 불편은 EQ5D 구성요소 5가지 모두 통계적으로 유의한 관련성을 나타냈다. 주관적 구강건강 인식은 자기관리, 일상활동, 통증 및 불편, 불안 및 우울과 통계적으로 유의한 관련성을 나타내어 구강건강 상태와 EQ5D 구성요소의 관련성을 확인하였다. 또한 EQ5D 구성요소에 미치는 영향을 통제변수를 보정 후 로지스틱 회귀분석으로 살펴본 결과 치아통증, 저작 불편, 말하기 불편, 주관적 구강건강 인식이 불안 및 우울에 영향을 미치는 것으로 나타났다. 구강건강 증진은 HRQoL을 향상시킬 수 있는 방안이 되므로, 구강건강의 중요성을 인식하고 예방차원의 교육 및 프로그램이 필요하다고 생각된다.

• 한국수자원학회논문집
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• 제47권12호
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• pp.1121-1134
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• 2014

유사발생 잠재성 및 토양침식으로 인한 유사발생 위험성이 높은 것으로 평가된 내성천유역을 대상으로 강우-유출-토양침식-유사이송으로 이어지는 유역단위의 분포형 모형을 구축하였으며 유출과 유사농도 모의 결과에 주요한 영향을 미치는 조도계수 및 투수계수의 민감도 분석을 실시하였다. 모의결과, 내성천유역의 토지 피복이 숲인 지역의 조도계수를 0.4에서 0.45로 변경하여 지표수 유출 유속을 감소시킴으로써 향석 지점에서의 유출곡선에 미치는 영향을 분석하였으나 유출수문곡선의 변화에 영향을 미치지 않는 것으로 나타났으며 평균 유사농도 값과 유사농도의 범위에 있어서도 모의 결과가 근소하게 증가하나 유의한 변화는 없는 것으로 나타났다. 투수계수에 대한 민감도 분석 결과, 투수계수 값을 저감 시킬수록 총 유출량 및 첨두 유출량은 점차 증가하는 것으로 나타났다. 유사농도 모의의 경우에도 투수계수를 저감시킬수록 모든 지점에서 평균 유사농도 및 유량에 따른 유사농도 범위가 증가하였으며, 향석 지점의 경우 투수계수를 50% 저감하였을 때 유사 농도 모의 값이 유량-유사량 관계식에 의해 계산된 값과 가장 근사한 것으로 나타났다.

• 대한암한의학회지
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• 제22권2호
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• pp.1-11
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• 2017

Objectives: Postoperative pain is one of postoperative complications in patients with solid tumor. This systematic review and meta-analysis were aimed to evaluate the efficacy of acupuncture for postoperative pain in solid tumor. Methods: We searched for randomized controlled trials (RCTs) using acupuncture for postoperative pain in adult patients with solid tumor up to September 2016. Acupuncture was defined as manual acupuncture, electroacupuncture and pharmacopuncture. The following databases were searched: PubMed, EMBASE, Cochrane Library, CNKI, CiNii, KoreaMed, Kmbase, KISS, NDSL, KISTI. The results of the studies were meta-analyzed and the risk of bias was assessed. Results: Five studies were included in this review. When acupuncture was compared with usual care, Prince-Henry pain scale score was significantly lower in acupuncture group (MD=-0.44, 95% CI: -0.62 to -0.26, P<0.001, $I^2=87%$) and 10 points pain score (including Numeric Rating Scale and Visual Analog Scale) was lower in acupuncture group but not significantly (MD=-1.00, 95% CI: -2.00 to -0.00, p=0.05). When acupuncture was compared with sham acupuncture, 10 points pain score was significantly lower in acupuncture group (MD=-0.39, 95% CI: -0.65 to -0.14, p=0.002, $I^2=0%$). Any serious adverse events were not reported. Conclusion: This review shows that acupuncture may be considered for postoperative pain in patients with solid tumor without serious adverse events. However, only a few studies were included in this study, further investigation is needed in this area.