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.

관상동맥 시술 도중 발생한 좌주간부 관상동맥 박리에 대한 스텐트 삽입 치료의 단장기 임상 결과 : acute and long-term results

이세환,이승환,홍명기,김영학,이철환,한기훈,송종민,강덕현,송재관,김재중,박성욱,박승정 대한내과학회 2004 대한내과학회지 Vol.66 No.6

목적 : 심도자 사용 시술과 관련된 좌주간부 관상동맥박리에 대한 적절한 치료는 아직 확실히 정립되지 않은 상태이다. 이에 본 연구는 좌주간부 관상동맥 박리에 대한 스텐트 삽입술의 단장기 임상결과를 후향적으로 분석하였다. 방법 : 좌주간부 관상동맥 박리에 대한 치료로 즉각적인 스텐트 삽입술을 시행하는 것이 안전하고 효과적인 방법임을 가설하였고, 이러한 즉각적인 스텐트 삽입을 시행한 10명의 환자를 대상으로 단장기적 임상경과를 의무기록 고찰과 전화 면담을 통해서 평가하였다. 결과 : 전체 환자 모두 처음부터 좌주간부 관상동맥에 유의한 협착을 가진 환자는 없었으며, 8명의 환자는 심도자의 조작으로 인한 박리가 발생한 경우였고(진단적 혈관 조영술 중에 3명, 유도 도자 조작 중에 5명), 나머지 2명은 다른 병변에 스텐트 삽입시술을 하는 중에 박리가 발생하였다. 이 10명의 환자에서 모두 즉각적인 스텐트 삽입술이 시행되었고, 4명의 환자에서 시술 도중 혈압 저하로 Intra-aortic Ballon Pump (IABP)를 장착하였다. 모든 환자에서 성공적으로 스텐트가 삽입되었고, 병원내 사망은 1명도 없었다. 6개월 추적 관상동맥 조영술은 8명의 환자에서 시행되었다. 혈관 조영상의 재협착(직경 협착 50% 이상)은 8명 모두에게서 관찰되지 않았으며, 퇴원 후 평균 31±25개월의 추적관찰 결과 주요 심장사건은 1건도 발생하지 않았다. 결론 : 비록 대상 환자가 적은 연구였지만 좌주간부 관상동맥 박리에 대한 스텐트 삽입술은 기술적으로 안전하고 빠르게 시행 할 수 있으며, 훌륭한 단장기적인 치료 효과를 보여준다. Background : The optimal treatment of patients with left main coronary artery (LMCA) dissection during catheter-based procedure remains uncertain. We retrospectively analyzed the acute and long-term results of bail-out stenting for LMCA dissection. Methods : In cases with significant LMCA dissection occurring during catheter-based procedure, prompt stent implantation may be safe and associated with favorable clinical outcome. We evaluated the acute and long-term results of bail-out stenting for LMCA dissection occurring during catheter-bases procedure in 1- patients. Results : Initially, there was significant stenosis of LMCA segment in these patients. Catheter-induced dissection occurred in 8 patients (during diagnostic angiography in 3 patients and guiding catheter manipulation in 5 patients). Two patients suffered dissection in the setting of stent deployment in other vessels. Therefore, bail-out stenting LMCA dissection was performed in a total of 10 patients. In 4 patients, hypotension developed and intra-aortic balloon pump was placed during procedure. Stents were successfully deployed in all patients. There was no in-hospital mortality. Six-month angiographic follow-up was performed in 8 patients. Angiographic restenosis(diameter stenosis 50%) was not observed in all patients at follow-up study. During a mean follow-up of 31±25 months after hospital discharge, there was no major adverse cardiac event (death, myocardial infarction, and target lesion revascularization). Conclusion : Bail-out LMCA stenting is technically feasible, and showed good acute and long-term results in a small series of patients.

동창의 임상 및 병리조직학적 소견과 Ki-67 발현 양상

서기석(Ki Seuk Suh),김상태(Sang Tae Kim),이기욱(Ki Wook Lee) 대한피부과학회 1999 대한피부과학회지 Vol.37 No.9

N/A Background : Pernio or chilblain is an abnormal reaction to damp cold air, resulting in pruritic erythematous swellings on acral skin. The histologic features are subepidermal edema, diffuse fluffy edema of endothelial cell, and superficial or superficial and deep perivascular lymphocytic infiltrates. Many studies with a large sample size have been conducted in western countries, but there were no collective studies of pernio that have been reported in Korea. Objective : The purpose of this study was to clarify the clinical and histopathologic features of pernio in Korea. Methods : We reviewed the clinical and histopathologic findings in ten patients with pernio who visited the Department of Dermatology, Kosin Medical College Gaspel Hospital during the 10 year period from 1988 to 1997. Results : The results were as follows. 1. The age distribution was in the range of 6∼50 year old. The prevalance was heighest in the third and fourth decade. Sex ratio was 1 : 4 (2 males : 8 females). The duration of symptoms ranged from 4 days to 30 years. All patients developed skin lesions on the acral area. Two male patients developed skin lesions on the hand associated with cold exposure and outdoor works. All patient had itching and burning papules and/or plaques, and one had a painful hard nodule. Laboratory studies were all negative and within normal ranges. 2. Histopathologic features revealed subepidermal edema, diffuse fluffy edema of endothelial cell, and superficial or superficial and deep perivascular lymphocytic infiltrates in all specimens. 3. Treatment includes prophylatic measures against cold and nifedipine(calcium channel inhibiting drug). In more severe cases, pentoxifylline might be helpful. Conclusion : Our study suggests that pernio commonly occurs in twenty to forty year old females during fall and winter. Upon exposure to cold temperatures, the acral skin develops pruritic erythematous papules and plaques. If these lesions persisit for a long time or recur, they may progress to vesicle and ulceration and possibly develop vasculitis which does not respond to therapy well. Thus, a thorough understanding of clinical and histopathologic features of pernio is vital in making a diagnosis, a treatment plan and determining the prognosis. (Korean J Dermatol 1999;37(9) : 1254∼1260)

소화불량(消化不良)과 과심상(過心傷)의 상관성(相關性)에 대(對)한 고찰(考察) -스트레스, 기울(氣鬱), 비병증(脾病證)의 평가(評價)를 통(通)해-

김진성,윤상협,류봉하,류기원,이상욱,Kim, Jin-Sung,Yoon, Sang-Hyub,Ryu, Bong-Ha,Ryu, Ki-Won,Lee, Sang-Wook 대한한방내과학회 2004 大韓韓方內科學會誌 Vol.25 No.4

Background & Object : Dyspepsia for which no organic causes are disclosed is referred to as functional dyspepsia. Functional dyspepsia is here studied in connection with a biopsychosocial model. From the aspect of individual response to external environment, in connection with stress response, functional dyspepsia is studied by both the psychology department and the internal medicine departments. The disease is taken as approachable from the aspect of internal injury due to seven emotions and stress as differentiated by Oriental medicine. Materials and Methods : Targeted at 223 patients underwent medical checks and endoscopy at Kangnam Korean Hospital, Kyunghee University. They agreed to join this clinical experiment. Stress response inventory, GARS (global assessment of recent stress scale), GSRS (gastrointestinal symptom rating scale), diagnostic scores for Ki-depression, and Spleen Disease Differentiation of Syndromes were all measured and evaluated. The test group was comprised of functional dyspepsia patients. The control group was comprised of nonsymptomatic chronic gastritis patients who were found to suffer from chronical gastritis in endoscopy and thus could be diagnosed with functional dyspepsia if symptoms would arise, but did not complain of subjective symptoms. Results showed these corelations: Functional dyspepsia patients were found to have more serious Ki-depression compared to nonsymptomatic chronic gastritis patients. The more serious Ki-depression the more serious the dyspepsia symptoms. The higher the stress response inventory the more serious the dyspepsia. Deficiency of spleen Eum, and Deficiency and Sinking of spleen Gi were found to coincide with serious Ki-depression.

횡문근융해증과 급성 신부전 및 범발성 혈관내 응고장애를 동반한 열사병 1예

최대은,박수진,권오경,이한규,이영모,이상주,나기량,이강욱,신영태 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Heat stroke is a life-threatening illness characterized by an elevated core body temperature that rises above 40% and central nervous system dysfunctions that results in delirium, convulsions, or coma. Heat stroke is subdivided into two forms, classic and exertional. Since strenuous exercise is one of the major exacerbating and precipitating factors, the incidence of exertional heat stroke is high among young adult, especially military personnel undergoing military training. Exertional heat stroke commonly causes rhabdomyolysis, lactic acidosis, acute renal failure, shock and pulmonary edema. We report a case of heat stroke with rhabdomyolysis, acute renal failure, disseminated intravascular coagulopathy(DIC) after strenuous exercise. A 18 year old man was admitted to the hospital because of loss of consciousness. He was a wrestler and he had tried to lose 6kg in weight by jogging and strenuous exercise on that summer day with hot temperature. The development of this illness was favoured by much clothes inappropriate for that environmental condition with a purpose to enhance sweating, and by restricted intake of water and food. On admission, the blood pressure was 80/50mmHg, and body temperature was 39.4℃ with stuporous mentality. Laboratory finding were as follows : in complete blood cell count, hemoglobin was 16.7g/dL and platelet count was 158,000/ mm³. In blood chemistry, AST 1061U/L, ALT 201U/L, BUN 30mg/dL, Cr 2.2mg/dL, LDH 941IU/L, CK 696IU/L were resulted. In arterial blood gas analysis, pH 7.39, pCO₂ 30mmHg pO₂ 86mmHg, HCO₃ 18.4mEq/L, O₂ saturation 96.7% were resulted. In urinalysis, specific gravity 1.025, protein 3+, erythrocyte 2+ were resulted. In brain imaging study, brain CT finding was normal. After appropriate treatments with rapid cooling, hydration and supportive care, he improved with alert mental status. On 2nd hospital day, in laboratory result, thrombocytopenia and coagulopathy were appeared and renal insufficiency was aggravated. So he was treated with platelet concentrate and fresh frosen plasma for DIC, and enough hydration for appropriate urine volume preservation. After all, On 22nd hospital day, he fully recovered and discharged. Nowadays, with followed for some duration, he is wellbeing with no complications.

서울의 Penicillinase Producing Neisseria gonorrhoeae 발생빈도(1998)

김재홍,김준호,반재용,이정우,황성주,정준규,정성태,강진문,조흔정,홍창의,정혜신,이한승,김이선,이봉길,이종호,선영우,한기덕,윤성필,이성훈,안종성,박석범,문승현,조항래,김형섭,류지호,황재영,박준홍,손상욱 한양대학교 의과대학 2001 한양의대 학술지 Vol.21 No.1

In recent years, gonorrhea has been pandemic and remains one of the most common STDs in the world, especially in developing countries. For the detection of a more effective therapeutic regimen and assessing the prevalence of Penicillinase Producing Neisseria gonorrhoeae(PPNG), we have been trying to study the patients who have visited the Venereal Disease Clinic of Choong-Ku Public Health Center in Seoul since 1980 by menas of the chromogenic cephalosporin method. In 1998, 93 strians of N. genorrhoeae were isolated, among which 60(64.5%) were PPNG. The prevalence of PPNG in Seoul, which had been decreased to 39% in 1996 after a peak of 74.3% in 1993, is increased to 64.5% in 1998.

The Merchant of Venice에 있어서의 화폐와 인간 관계

李起旭 제주대학교 1986 논문집 Vol.16 No.1

Shakespeare's The Merchant of Venice is one of his most popular plays and rare one reflecting the socio-economic aspects of Elizabethan age's England. This play raises many important problems as to the nature of love and friendship, the relation of man to money, the morality of lending money at interest, the plight of Christian and Jew, parental authority loneliness and the limited value of the civil law. All of these subjects are treated in this play, but few are completely resolved. So that critics are still uncertain about Shakespeare's own attitude to these difficult questions. This thesis is made to define one of these problesms, that is, the relation of man to money. with this subject, we try to show money and human relationship in the transitional society, dealing with main confliect in this play. In doing so, we also try to answer to the problems such as the morality of lending money at interest and Shakesprare's own attitude to these problems. The play opens among the noblemen of Venice. Antonio, Bassanio, and their friends. In this city of glamorous aristocrats money and wealth are crucial elements and yet such affluence has not brought happiness. These young people belong to a privileged leisure class, and yet they complain constantly of boredom and weariness. In desperation, the young men and women of this previleged class attempt to fill in the time with meaningless amusement and festivity. Therefore their previleged society relies on money for its support. To continue their lavish life they should loan money from others. And so they fear the Jewish moneylender who may destroy them. Like all exclusive leisure classes. they have social outcast, Shylock the Jew and conflict with him about money problems. This story has its relation to socio-economic problems of Shakespeare's time. In that time in fact noblemen fell deeply into debt and were forced to take loans from the moneylender. In doing so, they knew that they were in breach of traditional Christian teaching on the subject. Shakespeare echoes a contemporary Elizabethan debate. We must not deduce from the theme of money that Shakespeare was opposed to money or even critical of those who pursued it. After all we can see that Shakespeare was more interested in the differences in people's attitude to money and different uses. Conclusively we are able to be sure that Shakespeare stresses the need for tolerance and forgiveness, that is to say, the ways in which people depend upon one another in the commercial society.

Rieger syndrome : 증례보고 A CASE REPORT

이홍모,김정욱,장기택,이상훈,한세현,김종철 大韓小兒齒科學會 2003 大韓小兒齒科學會誌 Vol.30 No.4

Rieger syndrome은 눈의 전안방 기형과 치아결손을 특징으로 하는 희귀한 유전질환으로 두 개안면 이상과 체성기형을 동반하기도 한다. Rieger syndrome은 상염색체 우선유전(autosomal dominant inheritance)되며, 발생빈도는 약 200,000분의 1이고, Paired-like homeodomain transcription factor2(PITX2)의 변이가 이 질환과 연관이 있는 것으로 보고되고 있다. 본 증례는 Rieger syndrome으로 진단 받은 4세 7개월 된 여아에 대한 것으로, 양안에 다동공증과 후태생환을 보이고, 측모두부계측에서 상악골 열성장이 나타났으며, 상악유측절치와 더불어 다수의 영구치 결손이 방사선 상에서 관찰되었다. 이 증례를 통하여 Rieger syndrome 환아의 구강 및 두 개안면의 소견을 관찰하고, 관련 문헌을 고찰하여 다소의 지견을 얻었기에 보고하는 바이다. Rieger syndrome is a rare, autosomal dominant gentic disorder characterized by malformation of the anterior chamber of the eye(goniodysgenesis) coincident with hypodontia. It may also be accompanied by a spectrum of dental, craniofacial and somatic anomalies. Mutations in paired-like homeodomain transcription factor2(PITX2) are associated with the syndrome, and its frequency in the general population has been estimated to be 1 : 200.000. In the present case, the patient, 4 year 7 month-old female, had posterior embryotoxon and polycoria. The maxilla was retrusive in cephalometric radiography. She had congenital missing on #52, #62 and some tooth germs of permanent tooth were not detected in panoramic radiography. The purpose of this paper is to report the dental and craniofacial findings and review the pertinent literature through this case.

서울대학교치과병원 장애인진료실에서의 치과치료 분석

이현정,김영재,김정욱,장기택,이상훈,김종철,한세현 大韓小兒齒科學會 2009 大韓小兒齒科學會誌 Vol.36 No.2

전신마취하에서의 치과치료는 자발적인 협조가 불가능하거나 전신적인 문제가 있는 경우, 다수의 치료를 한 번에 하고자하는 경우 등에 행해진다. 이 연구는 서울대학교치과병원 장애인진료실에서 외래 전신마취하에 행해진 환자와 치과치료를 분석함으로써 보다 나은 장애인 진료 시스템을 위한 방안 제시에 도움이 되고자 하였다. 2002년 6월 11일부터 2006년 12월 31일까지 장애인진료실에서 치료 받은 432명의 환자들을 대상으로 조사한 결과 15세 이하의 환자가 50.46%로, 소아 및 청소년 환자가 높은 비율을 차지하고 있었다. 진료과는 보존과, 소아치과, 구강외과, 치주과, 보철과 순으로 나타났으며 치료내용을 보면 보존치료와 발치가 주를 이루고 있었다. 또 2회 이상 전신마취를 시행한 환자가 14.1%나 되었다. 본 연구는 장애인 환자를 위한 보다 포괄적인 치과 치료 및 진료과들 간의 긴밀한 협진 체계를 구축하고 필요한 인력과 설비를 보충함으로써 장애인 환자들에게 보다 보존적인 치과치료와 편안한 치료 환경을 제공해야 할 필요성을 제시하고 있다. Seoul National University Dental Hospital opened The Clinic for The Disabled to provide dental treatment under outpatient general anesthesia. 432 patients underwent general anesthesia for dental treatment. The informations such as the pattern of dental treatment, the reasons of general anesthesia, the characteristics of the patients were analyzed. Followings are concluded. 1. The patients below 15 years old made up 50.60%. 2. The reasons for general anesthesia included mental and physical disabilities, systemic disease, dental phobia, and so on. 3. Restorative treatment was the most common procedure with the average of 9.7 teeth treated per one patient. 4. 62(14%) patients underwent general anesthesia for dental treatment more than once. 5. The efforts for better multidisciplinary system to provide more comprehensive and effective dental treatment including periodic recall check, preventive treatment for handicapped patients are necessary.

Sol-gel 공정에 의한 Silica sol의 합성 및 특성

이봉우,최용욱,우기석,박문수,김선일 조선대학교 생산기술연구소 1998 生産技術硏究 Vol.20 No.1

Reaction completion time was investigated to measure OH/CH ratio as reaction time at 25℃. In 50 and 60 minute reaction was completed in 1.0 ratio that was reached equilibrium state. In another method, equilibrium, state was investigated by measuring volume% of C₂H_(5)OH. From 40 to 50 minute. that was reached at 61.6 of volume% After reaction. monomer and tetrasilicate(92%) as main product was discovered and so oligomer(6%). Mean molecular weight (Mw) of sol solution was about 7.000. The beginning point and ending point of hardening was measured through the TGA investigation of reaction material. The hardening of sol solution was complected in 7 minute and viscosity was maximum from 4 to 5 minute and was set at 9 minute.