정신분열병 환자의 우울증에서 Paroxetine과 삼환계 항우울제 병용치료

심주철,공보금,박정환,윤영란,신재국,김정익,안동성,김용관,차인준,김영훈 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.4

저자들은 마산동서병원에 입원중인 우울증이 동반된 정신분열증 환자 10명을 대상으로 사용중인 항정신병약물에 paroxetine과 저용량의 삼환계 항우울제를 6주간 병용투여한 후 우울증상에 대한 효과와 치료의 안전성 및 약물상호작용을 알아보았다. Paroxetine은 고정량의 항정신병약물과 삼환계 항우울제에 부가하여 일일 20㎎을 6주간 병용하게 하였으며, 임상상태는 HDRS, HARS, UKU Side Effect Rating Scale등의 평가척도를 사용하여 평가하였다. 또한 약동학적 약물상호작용은 삼환계 항우울제들의 혈장농도를 HPLC로 측정하여 분석하였다. 결과는 다음과 같다. 1) 10명의 전체 대상환자에서의 HDRS 평균점수는 TCA와 paroxetine 병용투여 6주후에 통계적으로 유의하게 감소되었다. 이중 40%의 환자에서는 병용투여 6주후에 HDRS 점수상 50% 이상의 감소를 보여, 일부의 환자들에서는 정신분열병에 동반된 우울증상의 치료에 소량의 삼환계 항우울제와 paroxetine의 병용치료가 효과가 있음을 확인하였다. 2) 두 명의 환자에게서 심각한 약물독성이 발생하였다. 이중 한 명은 삼환계 항우울제의 높은 혈중농도로 인한 항콜린성 위기(anticholinergic crisis) 소견을 보였으며, 다른 한 명은 인지기능 및 의식수준은 명료하였으나 망상과 환각증상이 약화되는 소견을 보였다. 따라서 본 연구에서 시도된 복합적 약물치료의 경우, 삼환계 항우울제의 혈중농도의 측정을 포함한 세심한 임상적 추적이 필요하다고 생각된다. 3) 기저치의 amitriptyline과 그 대사물인 nortriptyline의 농도합. imipramine과 대사물인 desipramine의 농도합은 각각 47.8-226.5ng/㎖. 80.5-395.6ng/㎖였으며 일반적으로 이들 약물들의 단독사용시에 문헌에 보고된 혈중농도를 훨씬 상회하고 있었다. 이는 병용투여된 항정신병 약물 약시 강력한 CYP2D6 효소억제제로서 기저치의 삼환계 항우울제들의 혈장농도를 이미 상당히 증가시켰던 것으로 판단되며, 그러한 결과로 인해 본 연구에서는 paroxetine이 이전의 문헌보고들과는 달리 뚜렷하게 삼환계 항우울제들의 혈장농도를 증가시키지 못하였다. 본 연구는 SSRI와 삼환계 항우울제의 병합 투여가 우울증의 개선 효과를 빠르게 하고, 치료역을 넓히고, 약물상호작용의 결과 paroxetine이 삼환계 항우울제의 혈중농도를 증가시킨다는 기존의 연구결과를 이용하여 정신분열병 우울증상의 치료에 parotextine과 소량의 삼환계 항우울제를 병용하는 방법을 시도해 본 연구이다. 저자들은 이러한 약물치료가 일부의 환자들에게서 효과가 있음을 관찰하였으나, 항정신병약물과 삼환계 항우울제를 병용투여 할 경우는 물론 이에 paroxetine과 같은 선택적 세로토닌 재흡수 억제제를 병용할 경우 복합약물상호작용의 결과로 약물독성의 위험성이 크며 세심한 주의가 필요함을 경험하였다. Depression is well-known to comorbid with several psychiatric disorders. Many schizophrenics also suffer from depression in the course of their illness. Combined therapy of SSRI and tricyclic antidepressants were reported to have benefits in some depressed patients. Paroxetine, a potent CYP2D6 inhibitor, increases the blood levels of tricyclic antidepressant markedly. Using paroxetine, we tried this combined therapy in the treatment of depressive symptoms in 10 chronic schizophrenic inpatients and evaluated its efficacy and drug interactions between paroxetine and tricyclic antidepressants. The following results were obtained : 1) The mean score of Hamilton's Depression Rating Scale(HDRS) was reduced significantly after 6 weeks-trials of this combined therapy for the mild depressive symptoms in 10 chronic schizophrenics. In four patients, 50% or more reductions in the scores of HDRS were noticed at final evaluation. 2) Two among our 10 subjects experienced severe toxic behavioral problems. Anticholinergic crisis with toxic confusion due to high blood levels of tricyclics was found in one patient and the other showed rapid clinical deterioration in his psychotic symptoms such as delusion and hallucination without any consciousness alternation. 3) Baseline plasma levels of tricyclics before adding paroxetine were higher than expected in our chronic schizophrenic subjects maintained with their antipsychotic medications. Several antipsychotics were also known as a potent CYP2D6 inhibitors and to increase the blood levels of tricyclics. Because the blood levels of tricyclics had already increased significantly by the use of antipsychotics, adding paroxetine to antipsychotics and tricyclic antidepressant in our subjects could increase the blood levels of tricyclics not so much as previously reported in the literatures.

발레 그랑 쥬떼 동작의 운동학적 분석

심재희,임용규,우병훈 한국학교체육학회 2003 한국학교 체육학회지 Vol.13 No.2

본 연구의 목적은 발레에서 그랑 쥬떼(grand jete´) 동작을 3차원적 동작분석을 통하여 숙련자와 미숙련자 사이의 차이점을 운동학적인 변인으로 규명하는데 있으며, 또한 차이가 나타난 변인에 대한 원인을 분석하여 발레를 지도하는 데 있어서 과학적 자료를 제공하고자 한다. 연구결과에 기초하여 발레 그랑쥬떼 동작은 도약전에는 신체중심을 낮게 하고 오른쪽 발끝의 속도를 빠르게 하여 높은 신체중심으로 체공시간을 길게 하고 양다리를 최대로 신전하여 좌·우 대퇴각은 수직과 수평으로의 더 많은 공간과 힘을 이용하는 것이 효율적인 동작을 수행할 수 있는 결과로 사료된다. The purpose of this study is to analyze the movement of Grand Jete´ through the analysis of 3-dimensional movement, and to find out the difference between experts and the unskilled through kinematical cause. And the purpose is also to provide scientific source by analyzing the cause of its difference when teaching ballet. I come to the condusion below through the kinematical analysis in order to achieve this purpose of the study. 1. The time required means the time needed between each event. It takes the experts 0.361 second from E-3, which is from jumping to reaching the highest point, to E-4, which is a landing point, on the other hand, it takes the unskilled 0.252 second. It takes the longest time to stay in the air between E-3 and E-4. The total required time is 0.694 seconds in case of the experts, and 0.548seconds in case of the unskilled. Concerning the duration of staying in the air, the case of the former is longer than the one of the latter. There is the significant difference between the former and the latter (P<.05). 2. In case of experts, the displacement of the bodily center is 83.44±1.09% in E-3, and in case of the unskilled, 76.44±1.00%. Concerning the height of the bodily center, the case of the former is higher than the one of the latter. There is the significant difference between the former and the latter (P<.01). 3. The speed of the tiptoe to the right side is the top speed between E-3 and E4. The speed of experts in E-2 is 7.69±3.57m/s, and the one of the unskilled in E-2 is 9.51±0.99m/s. The speed of the former is remarkably reduced compared to the one of the latter. There is the significant difference between the former and the latter (P<.01). 4. In the case of the displacement in angle of the right and left ankle joints, temporary reduction of the angle of the experts right ankle in E-2 influences the vertical rise and the horizontal movement. There is the significant difference in E-4 (P<.05). 5. Concerning displacement in angle of the right and left coxae, the experts right coxa angle is 100.58±6.98°, and their left one is 108.92±3.58°. In case of the unskilled, the right coxa angle is 89.66±6.58°, and the left one is 130.33±5.49°. The unskilled need the power and flexibility of the femoral muscle of the left coxa. There is no significant difference between the former and the latter. Based on the result of the study, they should lower the bodily center before jumping and make the speed of the right tiptoe fast when they practice the movement of Grand Jete. And then using high bodily center, they have to prolong the time of staying in the air. Simultaneously, they should stretch both legs so that the right and left femoral ankle can use more space and power vertically and horizontally. Those series of movement can make them practice Grand Jete better.

열전도 개념 습득을 위한 실험 장치의 개발과 적용

심재성,정기주,김용복 공주대학교 사범대학 과학교육연구소 2000 과학교육연구 Vol.31 No.1

금속 막대를 따라 전달되는 열에 의한 온도 변화를 측정할 수 있는 간단한 장치를 제작하고 금속 막대의 한 쪽 끝에 주기적으로 열을 가하면서 막대의 각 지점에서 시간에 따른 온도 분포를 측정하였다. 그 결과 주기 함수적으로 변하는 열파를 확인할 수 있었으며, 이로부터 구산 구리와 알루미늄의 열확산율은 표준 확산율과 비교할 때 6% 정도의 오차 범위 내에서 정확하였다. We make a simple instrument that detects the change of temperature through the metal bar when its end is periodically heated. Using the apparatus, the periodical thermal waves could be determined through the temperature changes by time measured at each point. And the experimental result for the thermal diffusibility of each material could be determined within 6% range of error when comparing with the normal thermal diffusibility of those materials which were calculated by substituting their figures of density and specific heat.

단감에서 Deltamethrin의 안전사용기준 설정을 위한 잔류량 평가

심재한,이강봉,서용택,양광록 全南大學校 農漁村開發硏究所 1990 農業科學技術硏究 Vol.25 No.-

Deltamethrin의 단감 재배기간중 살포횟수 및 처리시기에 따른 잔류수준을 시험하여 다음과 같은 결과를 얻었다. 1. Deltamethrin의 잔류분석 회수율은 단감시료에 대해 0.1ppm과 1.0ppm에서 각각 평균 90.20%, 90.73%를 보였고 검출한계는 0.01ppm이었다. 2. Deltamethrin의 단감에서의 잔류는 Mills 등의 방법으로 분석한 결과 수확 3일전 6회 처리구에서만 0.16ppm으로 잔류 허용기준을 초과하였고 이로 미루어 deltamethrin의 단감중 안전사용은 수확 3일전 5회 이내의 사용으로 추천할 수 있었다. The effects of application number on the persistence of deltamethrin in sweet persimmons was analyzed. Deltamethrin EC(1%) was sprayed on the sweet persimmon trees at regular intervals (400 L/10a, 1,000 times diluted deltamethrin EC was sprayed on 60th, 45th, 30th, 15th, 7th, 3rd days before harvest). The procedure of residue analysis was based on the multiresidue analytical method using a polarized acetonitrile solution as the extracting solvent. Residue of deltamethrin were determined by alternate eluate (acetonitrile, hexane, dichloromethane 1.5 : 48.5 : 50 v/v) from the Florisil column to gas chromatographic analysis (ECD). Residue level of deltamethrin in sweet persimmons were proved to 0.16 ppm when the deltamethrin EC (1%) was sprayed 3 days before harvest. The recoveries were above 90% in spiked sweet persimmon samples, regardless of concentration.

인공 해수분위기에서 저탄소강의 부식특성에 미치는 합금원소 Cr, Co 및 W의 효과

심재주,유승재,최윤석,김정구,유장용 대한금속재료학회 2003 대한금속·재료학회지 Vol.41 No.12

The aqueous corrosion characteristics of 1% Cr-steel alloyed with small amounts of Co and W, in synthetic seawater was studied by using immersion weight-loss tests, electrochemical corrosion tests (potentiodynamic test and electrochemical impedance spectroscopy (EIS) measurements) and analytical techniques. 1% Cr steels containing Co or W from 0.2 to 0.4 wt.% showed higher corrosion resistance than the 1% Cr steel in the immersion and potentiodynamic tests. EIS measurements showed that the Nyquist plot presented one time constant. Furthermore, the Co- and W-bearing steels present higher Rp values than the 1% Cr steel through all the test period. The better corrosion resistance of the Co-and W-bearing steels is attributed to protectiveness of the surface layer. The corrosion products were examined using electron probe microanalysis (EPMA) and X-ray photoelectron spectroscopy (XPS). The results of EPMA indicated that Cr was concentrated in the inner region of the rust layer, while Co and W were distributed all over the rust layer. XPS results showed that Co existed as a trivalent oxide in the rust layer and W in the rust appeared in the form of a WO₄ compound.

유한요소법에 의한 전단변형을 고려한 평판의 해석

沈在守,박재용 慶熙大學校 1988 論文集 Vol.17 No.-

The finite element is formulated in order to analyse linear elastic behavior of plate. The formulation is carried out by considering that the shear deformation is third order instead of on the classical Kirchhoff plate theory ignoring the shear deformation and Mindlin plate theory considering the shear deformation as first order. Thin and thick plate can be analysed by introducing k, the ratio of the shear deformation to the bending deformation on midplane to control the influence of shear stiffness instead of the selective reduced integration technique used generally. The analysed results give good agreement for linear behavior.

보건의료원 설립전후의 의료이용실태

서재붕,이태용,심운택 충남대학교 의과대학 지역사회의학연구소 1990 충남의대잡지 Vol.17 No.1

As the health insurance program was expanded to the rural area Chung-Yang Health Center was transformed to the hospitalized health center in January 1988, in medical facilities. The changes of the medical utilization were expected after the establishment of hospitalized health center. Therefore this study was performed to find the changes of medical utilization. The results were as follows : 1. The utilization rate of male was increased among ages over 50 but that of female among the same age groups was decreased after establishment. All outpatients were increased to 37% after establishment. 2. The highest utilization rate was shown in community health insurance. When adjusted by the enrolled populations, Family planning members had the highest utilization rate. 3. The utilization rate of the people who lived near the health center was higher than that of nay other people, but the rate of those who lived far from the health center was increased after establishment. 4. The most common disease by the Korean Standard Causes of Death Classification was respiratory disease, 37% before the establishment and 29% after the establishment. The next in the disease were digestive disease, musculoskeletal disease and skin disease, much the same as before. 5. The thre major diseases were common cold, arthropathy, gastritis and functional disorder, and those disease are 53% of all disease before the establishment and 47% of all after the establishment. 6. Most frequent disease to visit the health center were diabetes mellitus, hypertension, and chronic liver disease, which need continuously follow up care, and the frequencies of those diseases were the dame as before. 7. The referral rate to other medical facilities was increased from 4.0% to 7.1% after the establishment.

비호지킨림프종 환자에서 발생한 폐 효모균증 1예

장재혁,송치원,심병용,이동건,변재호,정정임,이교영,홍영선,신완식,김춘추,이경식 대한감염학회 2003 감염과 화학요법 Vol.35 No.3

저자들은 비호지킨씨 림프종 환자에서 항암 치료 후 질환의 진행성 병변과 감별을 요했던 우폐 중엽의 단발성 종괴를 흉강경하 생검으로 폐 효모균증을 확진하고 amphotericin B와 fluconazole로 치료한 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Non-Hodgkin's lymphoma is monoclonal expansion of malignant B or T cells. The immunocompromised status in this disease is accompanied by many infections. The cryptococcosis, caused by Cryptococcus neoformans, frequently occurs in leukemia, Hodgkin's disease, sarcoidosis, diabetes mellitus, tuberculosis, and long-term steroid-using patients. Recent increasing incidence of fungal infection could be due to the spread of AIDS and transplantation. We experienced one patient with lung mass in Non-Hodgkin's lymphoma after three cycles of chemotherapy, which could not be discriminated from the newly developed lymphoma mass. Cryptococcus neoformans was isolated from the lung tissue obtained by thoracoscopic biopsy. Herein we report this case with brief review of pertinent literature.

열린교실에서 CAI프로그램의 적용

이재인,심정용 晋州敎育大學校 初等敎育硏究所 1997 初等敎育硏究 Vol.7 No.-

뇌 동맥류 파열환자에서 안구운동 장애 : 증례 보고 Case Report

현용인,강재규,도종웅,정현태,심영기 최신의학사 1991 最新醫學 Vol.34 No.12