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.

편측성 하악 과두 과증식으로 인한 안모비대칭의 치험례

김상규,이상한,장현중,우길상,이은진 대한악안면성형재건외과학회 2002 Maxillofacial Plastic Reconstructive Surgery Vol.24 No.1

Condylar hyperplasia is an uncommon malformation of the mandible created by excessive growth of one of the condyles. Condylar hyperplasia is a self-limiting condition, and treatment is determined by the degree of functional difficulty and aesthetic change. Some patients can be treated with unilateral condylectomy, whereas others require unilateral or bilateral mandibular osteotomies. Our method includes a condylectomy to arrest the continued condylar growth or to excise the neoplastic condyle, unilateral vertical ramus osteotomy to allow horizontal rotation of the mandible without significantly altering the temporomandibular articulations, and an arthroplasty by superior repositioning of the stump of the proximal condylar segment into the condylar fossa. Both the facial asymmetry and the occlusion were corrected by rotation of the mandible around the unaffected condyle.

전격성 경과를 취한 만성 호산구성 폐렴 환자 1예

윤호상,진춘조,유광하,이상엽,이수인,정상만,김선두,이순제,이길도,전혜정 건국대학교 의과학연구소 2000 건국의과학학술지 Vol.10 No.-

Chronic eosinophilic pneumonia(CEP) is a rare disease of unknown etiology characterized by chronic infiltration of the lung with eosinophils. It presents with profound systemic symptoms comprising fever, night sweats, weight loss, dyspnea and blood eosinophilia with nonsegmental air-space consolidation confined to the outer third of the lung, the "photographic negative of pulmonary edema". Histopathologic features of chronic eosinophilic pneumonia are intraalveolar and interstitial infiltrations with eosinophils, histiocytes, giant cells, scattered lymphocytes and plasma cells. Glucocorticoid therapy cause prompt resolution of symptoms as well as disappearans of blood eosinophils, elevated serum Ig E levels and the roentgenographic lesions. Infrequent radiographic findings include nodular infiltrates, consolidations, cavitations, atelectasis and pleural effusions. Deaths from CEP although rare, have been reported, but the majorities of CEP have benign courses and do not need a therapy with ventilator. We report a case of chronic eosinophilic pneumonia, which had a sudden course associated with diffuse pneumonic consolidations on the both lung and bilateral pleural effusion.

위절제술 환자의 표준진료지침 개발 및 적용 효과

김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.

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.

높은 지향성을 갖는 Air Line 결합기 설계

길준범,이성원,최영호,박종임,안달,박준석 호서대학교 반도체제조장비국산화연구센터 2000 학술대회 자료집 Vol.2000 No.1

본 논문에서는, 일반적인 스트립 구조의 결합기가 갖는 문제 즉, 높은 온도에서 나쁜 특성을 보이는 문제점을 극복하고자 Air Line Type의 결합기를 구현하였다. 또한 이 결합기는 24dB이상의 지향성을 가지고 있다. 해석을 위해 짝수 모드와 홀수 모드 해석법을 사용하였고, EM-Simulation으로 확인한 특성과 실제 제작된 20dB, 30dB Cellular 대역(800∼900MHz) Air Line 결합기의 결고 특성은 좋은 일치를 보여주고 있다. 또한 최대 장점인 온도 특성은 온도 데이터를 통하여 온도에 강한 특성을 보임을 알 수 있다.

2지역 연계 전력시스템의 뉴로-퍼지제어기 설계

이오걸,이용길,김상효 동의공업대학 2001 論文集 Vol.27 No.1

This paper proposed a optimal scale factors technique of a neuro-fuzzy controller for a load frequency control of two areas power system. The optimal scale factors control technique is optimize from an initial fuzzy logic control rule, and then is learned with an error back propagation learning algorithm of the neuro-fuzzy controller. In application two areas the load frequency control of the power system, it hopes to have response characteristic better than the conventional control technique.

인체 체액내 황색포도상구균의 증식과 철 획득 기전

신성희,이강길,이명희,양남웅,임용,김진호 대한감염학회 2000 감염 Vol.32 No.5

우울증 환자 치료에 있어서 Tianeptine과 Sertraline의 효과와 안전성 비교

이민수,강성민,기백석,연병길,오병훈,이철,채정민,백인호 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.2

연구목적: 주요 우울증의 치료에 있어서 티아넵틴과 써트랄린의 임상적 효과와 안정성을 비교하기 위하여 연구를 시행하였다. 방법: DSM-IV 진단 기준에 의거하여 주요 우울증의 진단기준에 부합되고 17항목 해밀턴 우울척도 점수가 14점 이상인 환자를 대상으로 하였다. 총 40명의 환자를 무작위적 방식에 따라 티아넵틴 치료군과 써트랄린 치료군으로 분류하였다. 선탠된 환자에서 다른 항우울제를 복용하고 있는 경우 7일 이상의 약물 배설기간을 가진 후 티아넵틴과 써트랄린을 각각 6주간 투여하였으며, 기준점, 1주후, 2주 후, 4주 후, 6주 후에 HAM-D, MADRS, 그리고 CGI, COVI 등을 사용하여 평가하였다. 본 연구기간 중 발생된 모든 부작용은 부작용의 발생 및 소실 시기, 심한 정도, 발생 빈도, 관련 조치 및 결과에 대하여 증례기록서에 기록하도록 하였다. 결과: 30명(티아넵틴군 15명 ; 써트랄린군 15명)이 6주간의 연구를 완결하였고 티아넵틴 치료군에서는 1일 37.5mg을 투여하였으며 써트랄린군에서는 1일 평균 64.0±22.5mg을 투여하였다. 본 연구 결과 HAM-D, MADRS, CGI 상에서 두 군 모두에서 치료 1주 후부터 유의한 감소를 나타내었으며 이는 2주 후, 4주 후, 6주 후에도 지속적인 감소를 보였고 두 군간에 항우울 효과의 차이는 없었다. 활력징후, 일반 혈액학, 생화학, 심전도 검사 등에서는 두 군 모두 유의한 변화는 없었다. 티아넵틴과 관련된 부작용으로 흔히 보고한 증상은 오심(33.3%), 복부 불쾌감(26.7%), 구강 건조(20.0%), 두통(13.3%)등 이었고 써트랄린 치료군에서는 구강 건조(53.3%), 두통(46.7%), 오심(33.3%), 그리고 식욕 부진(33.3%)등으로 티아넵틴군에서 보다 적은 발현빈도를 보였다. 결론: 티아넵틴은 우울증의 치료에 있어서 효과적이고, 내약성이 우수한, 안전한 항우울제이다. Objective: This study was designed to evaluate the efficacy and safety of tianeptine and sertraline in the treatment of patients with depression. Method: The study was done on the patients with major depression diagnosed by DSM-IV, who had aHamilton Rating Scale for Depression(HAM-D) score ≥ 14 on the first 17 items of the HAM-D. A total of 40 patients were randomly assigned to tianeptine group and sertraline group. Tianeptine and sertraline were prescribed to each group. 6 weeks of each medication was carried out after 7 days of drug excretion period. Evaluation using 17 item HAM-D, Montgomery and Åsberg Depression Rating Scale(MADRS), Clinical Global Impression Scale (CGI), and Covi Scale was done on the baseline and after 1 week, 2 weeks, 4 weeks, and 6 weeks. Regrding all side effects that had occurred during the period of our study such as their developed/disappeaed time, severitien, incidences, managements and results have been recorded. Results: A total of 30 patients(tianeptine group 15 ; sertraline froup 15) finished the 6 weeks of research. 37.5mg of the daily dose was regularly prescribed to the tianeptine group, the average amount of 64.0±22.5mg of the final daily dose was prescribed to the sertraline group. Total 17 item HAM-D scores, total points of MADRS and CGI showed significant decrease after 1 week in each treatment froup and continous decrease after 2, 4 and 6 weeks ; and no difference was found between tianeptine group and sertaline group in the antidepressant efficacy. Also there were no significant changes in vital sign, CBC, chemistry, and EKG in each treatment group. The common reported side effects of tianeptine were nausea(33.3%), epigastic distress(26.7%), dry mouth(20.0%), headache(13.3%) and those of sertraline were dry mouth (53.3%), headache(46.7%), nausea(33.3%), anorexia(33.3%). Conclusion: According to the results, tianeptine was effective in improvement of depressive symptoms and was well tolerated and safe in patients with depression.

학생 폭력 기사에 대한 내용분석

이상훈,이길홍 중앙대학교 의과대학 의과학연구소 1996 中央醫大誌 Vol.21 No.3

The present study was performed to identify the socio-psychiatric aspects of student violence and to use them as basic material for prevention of adolescent violence. The author analysed adolescent violence cases reported on daily newspaper, Dong-A Ilbo and Chung-Cheong Ilbo, from 1991 to 1995. The total number of cases were 335, including 312 males and 23 females. The cases were devided into three age subgroups by Werkman's classification : early (12-14), middle(15-17), late(18-21). The results of the study were as follows : 1) The cases of adolescent violence were more often in male. The ration of male to female was 13.6 : 1 and the most frequent age population was late group(18-21). The age difference between groups is younger in student group than control group. In student group, the violence incidence was more prevalent in early and middle subgroup in contrast to late subgroup of control group. As concerns occupation and education status, the jobless was the most frequent (36.4%) and among student group, high school adolescents (58.5%) were most common. The most common growth place of violent adolescents was city(42.7%), followed by town(35.2%), Seoul(20.3%). The most premorbid personality of violent adolescents was antisocial personality (35.9%). In psychosocial stressors, the student group was more stressful in school and home, compared with heterosexual confilicts, economic problem in control group. 2) In the analysis of criminal offences, felony(23.3%) was most prevalent, followed by theft(24.2%), violence(20.0%). In student group, violence and theft were more common, but murder and rape were more frequent in control group. In any type of criminal offences. violent behaviors were more often in winter than in any other season, more in weekends than weekdays. And the most vulnerable time of criminal offence in violent adolescents was from 7 PM to 12 PM. Major motivation of crime was economic problem(45.7%). In student group, environmental stressors including home, school and society were more ofter and in control group, pecularity and sexual conflict, economic problem were more prevalent. In terms of accompanied person participating in criminal offence, self crime(46.3%) is most prevalent, followed by peer group(37.0%), peer(15.5%). In the analysis of space condition of crime, the most frequent place was outdoor(38.2%). In student group, school and outdoor were more often, compared with victim's indoor in control group. In the method of offenses, the first(30.1%) was the most common tools and stolen money(30.7%) was most frequent method, followed by forced rape(21.5%), knife or sharp material use(11.9%). 3) The major characterictics of victimized people of violent adolescents were as followed : The cases of victimized people were more often in male(51.3%) and most prevalent age group was more than 22yrs(37.6%). In occupation status, the jobless was most common, followed by student(30.4%), clerk(14.3%), merchant(6.9%), labor(5.7%), housewife(5.4%). The most frequent number of victimized people was one and the degree of awareness between abuser and victim was mostly unknown(71.6%). Victims suffered mostly from mild injury but it was more severe in control group. In response for victims to violent crime, most people requested other's help(89.9%).