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.

난소절제후 Estrogen을 투여한 흰쥐 대동맥에서 Protein Kinase C-α와 Fas 발현의 변화

이왕수,이상엽,안지현,송영빈,김학진,이광재,유재격,김상욱,김태호,김치정,류왕성 중앙대학교 의과대학 의과학연구소 2001 中央醫大誌 Vol.26 No.3

Estrogen is believed to decrease coronary artery disease. Protein kinase C-α(PKCα)appear to be important in signal conduction pathways. Estrogen treatment increases catalytic activity of PKCα,and activation of PKCαcan modulate estrogen receptor levels and responsiveness. And it was reported that activation of PKC can protect cells from apoptosis induced by Fas ligation. But the beneficial effect of estrogen on PKCαwas not clearly demonstrated. The objective of this study was to evaluate the role of PKCαafter ovariectomy and estrogen therapy in rat aorta. The results were summarized as below: 1. The significant pathological changes were not observed in the rat aorta irrelevant to ovariectomy and estrogen therapy. 2. The expression of Fas was decreased in the aorta of estrogen-treated rats than that of ovariectomized rats without estrogen therapy. 3. Increased expression of PKCαwas more marked in the aprta of estrogen-treated rats than that of ovariectomized rat without estrogen therapy. In conclusion,PKCαmay be important in signal conduation pathway on the effect of estrogen. Activation of PKCαby estrogen reduced Fas expression, suggesting that PKCαactivation may play a role in protection against atherasclerosis. Further studies are needed to elucidate the role of PKCαafter estrogen therapy.

한국판 신체변형장애 척도개발을 위한 예비연구

김정란,지익성,신석철 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.4

연구목적 : 본 연구의 목적은 신체변형장애의 진단 및 심한 정도를 평가하는 자기 보고형 검사인 한국판 신체변형 장애 척도(BDDE-SR)를 개발하고 한국 청소년내의 신체 불만족에 대한 자료를 얻고자 하는데 있었다. 방 법 : 한국판 BDDE-SR을 대전 시내 남녀 고등학생 417명을 대상으로 설문을 하였고. 이 중 100명을 선정하여 6주 간격후 재검사를 하였다. 결 과 : 1) 전체 점수에 대한 검사-재검사 신뢰도(Pearson 상관계수)는 0.883(p〈0.001)으로 만족할 만한 신뢰도를 보였으며, 각 문항에 대한 검사-재검사 신뢰도는 통계적으로 유의하였다(Spearman 상광계수 범위:0.159∼0.761). 2) 내적 일치도는 Cronbach's α0.922(p〈0.01)로 높은 신뢰도를 보였다. 3) Varimax 회전에 의한 요인 분석의 결과, 5개의 요인을 추출하였는데, 제1요인은 고통과 당황인자, 제2요인은 자기 의식 및 부정적 평가 인자, 제3요인은 회피인자, 제4요인은 가리기 인자, 그리고 제5요인은 비교 인자였다. 4) 한국 청소년의 신체 불판족에 대한 자료에서, 전체 점수는 여학생 집단에서 52.4±24.8로 남학생집단의 37.7±20.6보다 유의하게 높았다. 남녀 고등학생을 합하여 가장 만족하지 못하는 신체부위는 허리-배(6.8%), 코(6.4%), 다리전체(6.0%), 치아와 눈(각각 5.9%) 순이었다. 결 론 : 이 결과들은 한국판 BDDE-SR이 신체변형장애의 평가를 위한 신뢰할 만한 도구임을 입증하는 것이며, 향후의 연구들에서 신체변형장애 환자군을 대상으로한 임상 자료를 얻고 한국판 BDDE-SR의 타당도 검증이 시행되어야 할 것으로 생각된다. Objective : The purposes of this study were to develop a Korean version of the Body Dysmorphic Disorder Examination-Self Report(BDDE-SR) and to get informations about the body dissatisfaction of the Korean adolescents. Method : A Korean version of the BDDE-SR was applied to 417 Korean high school adolescents. Retest was conducted with 6-week interval in 100 adolescents. Results : 1) Test-retest reliability of the total scores(Pearson's correlation coeffciency) was 0.883(p〈0.001) and test-retest reliabilities of each item also showed high correlation (Spearman's correlation coefficency range : 0.159-0.761). 2) Internal consistency by Cronbach's alpha of 0.922(p〈0.001) was very much high. 3) Five factors were extracted by factor analysis with the Varimax rotation. They were 'the distressing and embarrassment factor','the self-consciousness and negative self-evaluation factor','the avoidance factor','the camouflage factor', and'the comparison factor'. 4) The total score of BDDE-SR of girls was statistically higher(52.4±24.8) than that of boys(37.7±20.6). The most dissatisfied body part was abdomen (6.8%), nose (6.4%), entire leg (6.0%), teeth (5.9%) and eyes (5.9%) in all the subjects. Conclusion : These results indicate that a Korean version of the BDDE-SR is a reliable instrument for the assessment of Body Dysmorphic Disorder (BDD). The authors suggest that future researches should be directed to obtaining clinical of the patients with BDD and should test the validity of a Korean version of the BDDE-SR.

우울증 환자에서 성기능 장애

지익성,김영란,김정란 충남대학교 의학연구소 2001 충남의대잡지 Vol.28 No.2

There are several possible causes of sexual dysfunction in depressed disorder. However, patients will rarely report sexual problem spontaneously. Therefore, it is very difficult to determine a cause of sexual dysfunction in depressive patients, and the differential diagnosis must include primary sexual dysfunction, sexual dysfunction associated with general medical and psychiatric disorder, and sexual dysfunction associated with treatment for psychiatric disorder. Various strategies are recommended to manage antidepressant-induced sexual dysfunction in depression, including waiting, reducing the antidepressant dosage, use of drung holidays, use of adjunctive pharmacotherapy, and switching antidepressant. Use of an antidepressant with a low prevalence of sexual side effects, such as bupropion, nefazodone, and mirtazapine, may be the best way to avoid sexual dysfunction.

편도절제술을 받는 소아에서 수술 후 오심 및 구토에 대한 Propofol과 Ondansetron의 예방적 효과

김영재,구봉근,이정한,이근무,정순호,최영균,신치만 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Objective: To examine the prophylactic effect of ondansetron and propofol against postoperative nausea and vomiting(PONV) in children undergoing tonsill ectomy Methods and Materials: Sixty children(aged 3-11 years) who underwent tonsillectomy received antiemetics (ondansetron group; ondansetron 0.1mg/kg, propofol group; propofol 0.5mg/kg) or not (control group) at the end of surgery. Anesthesia was induced with ketamine(1mg/kgiv) and rocuronium(0.5mg/kg) and maintained by inhalation anesthesia with 2-3vol% sevoflurane in 50% N_(2)O/O_(2). Premedication was given as atropine 0.01mg/kg iv. Ketorolac(1mg/kg) was injected for postoperative analgesia immediate after induction. They were monitored the incidence of PONV at operation room, postanesthetic care unit(PACU) and admission room. Results: No significant differences were observed in the total incidence of PONV among the groups. But ondansetron and propofol group made a difference(p<0.05) in the incidence of PONV at operation room compared with control group. Conclusion: In children undergoing tonsillectomy, ondansetron(0.1mg/kg) and propofol(0.5mg/kg) may have a prophylactic effect against PONV at operation room.

Quartz 자극에 의한 iNOS 발현의 자가조절

김경아,남혜윤,문제혁,정진숙,임영,정치경 大韓産業醫學會 2001 대한직업환경의학회지 Vol.13 No.4

목적 : Rat2 섬유모세포에서 α-quartz에 의해 유도된 NOS의 조절기전을 알아보기 위하여 본 연구가시도 되었다. 방법 : Rat2 세포에 있어서 α-quartz 자극에 의한 NO와 H₂O₂의 분비 및 iNOS의 발현을 관찰하였고, iNOS 억제제인 L-NIL과 H₂O₂ 억제제인Catalase를 전처리하고 마찬가지로 NO와 H₂O₂분비 그리고 iNOS의 단백발현 정도를 western blot-ting을 이용하여 관찰하였다. 결과 : o-quartz는 Rat2 세포에서 iNOS에 의한NO와 H₂O₂의 분비를 유도하였다. L-NIL은 R3t2세포에서 D-quartz에 의한 H₂O₂의 분비와 iNOS발현을 완전히 억제하였다. Catalase로 전처리 하였을 때 o-quartz로 유도된 iNOS에 의하여 생산증가된 H2Oa가 iNOS를 억제하는 autoinhibitorypathway가 차단되어 결과적으로 H₂O₂의 분비와 iNOS의 발현이 증가하였다. 결론 : Rat2 세포에서 α-quartz에 의하여 유도된iNOS는 H₂O₂의 분비를 촉진하고 이 H₂O₂는 iNOS기능을 조절하는 자가조절기전에 중요한 역할을 하는 것으로 생각된다. Objectives : This study was performed in order to investigate the molecular mechanism regulating nitric oxide synthase (NOS) induced by α-quartz in Rat2 fibroblast. Methods : α-quartz-induced nitric Oxide (NO) anti H₂O₂ formation anti α-quarts-induced iNOS protein expression in Rat2 fibroblast were monitored. With iNOS inhibitor (L-N6- (1-iminoethyl) lysine hydrochloride, L-NIL) or antioxidant (catalase), we observed NO and H₂O₂ formation and iNOS protein expression in Rat2 fibroblast stimulated with α-quartz. Results : α-quartz stimulated iNOS-induced NO and H₂O₂ formation in Rat2 fibroblast. L-NIL inhibited H₂O₂ formation and iNOS protein expression by α-quartz in Rat2 fibroblast. Pretreatment with catalase blocked the autoinhibitory pathway of iNOS by iNOS-induced H₂O₂ therefore H₂O₂ and NO production and iNOS protein expression were increased in Rat2 fibrobalst stimulated with α-quartz Conclusion : α-quartz-induced iNOS Stimulated H₂O₂ formation in Rat2 fibroblast. INOS-induced H₂O₂ by α-quartz plays an important role in the autoinhibition pathway for regulating the iNOS function in Rat2 fibroblast

에어컨 냉각 팬용 브러쉬레스 DC 전동기의 역기전력 분석에 대한 연구

조정현,김지현,정정원,황흥식,이치우 경성대학교 공학기술연구소 2012 공학기술연구지 Vol.18 No.-

Compared to conventional dc motors having the combination of commutators and brushes, a brushless DC (BLDC) motor is one of the highly efficient motors due to its electrical commutation without a brush, and this feature allows the BLDC otor to be more suitable for an application requiring no maintenance due to mechanical wear between a commutator and a brush. Also, the BLDC motor has a few benefits over both a dc motor and an induction motor such as high dynamic response, high efficiency, logn life span, and low noise in wide speed-torque region. This paper investigates the variation of voltage induced in phase windings in a BLDC motor in several cases with respect to stack length, steel grade, and coil material. This study is numerically conducted and it is verified from the theoritical point of view by comparing the result of simulation with that of experimental measurement.

전신마취 후 발생한 악성고열증 환자의 치료 경험

이근무,정승환,이정한,정순호,최영균,김영재,신치만,박주열,이영민 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Malignant hyperthermia is the disorder of calcium regulation within skeletal muscle associated predominantly with anesthesia. It is triggered by volatile anesthetics and depolarizing neuromuscular blocking agents. We experienced a case of malignant hyperthermia. 50 years old female patient was transferred to our emergency room that she was developed tachyarrhythmia and high fever. She was taken arthroscopic examination under the general anesthesia with enflurane and succinylcholine. We suspected malignant hyperthermia and promptly treated her with dantrolene sodium. She was developed disseminated intravascular coagulopathy and acute renal failure then we were intensive care to her. She was discharged without sequela. We experienced successful management of malignant hyperthermia.

Rocuronium의 애별투여방법이 모지내전근의 이완에 미치는 영향

최영균,김승수,이원진,조광래,이상은,김영환,임세훈,이정한,이근무,정순호,김영재,신치만 인제대학교 2009 仁濟醫學 Vol.30 No.-

Objective : There are controversies in pnmmg technique of rocuronium whether it can or can't shorten the onset time. We want to compare the effects of two different priming doses and intervals of rocuronium. Materials and Methods : After giving propofol, 50 patients were randomly assigned to 5 groups. Group I received a placebo, followed 3 min later by rocuronium 0.6 mg/kg. Priming doses and intervals of Group II, Ill, N, V were 0.06 rng/kg and 2 min, 0.12 mg/kg and 2 min, 0.06 rug/kg and 3 min, 0.12 mg/kg and 3 min, respectively. Total dose of rocuronium was 0.6mg/kg. Train of four (TOF) count or ratio and 1st twitch height of TOF (T1) were monitored with 15 secondsintervals. TOF ratio of each groups just before bolus injection, duration for TOF count to reach zero and duration for Tl to reach 95% depression after bolus injection were compared. Results : Duration for TOF count to reach zero and duration for Tl to reach 95% depression after bolus injection were decreased in priming groups compared to Group 1 (P < 0.01) In group V, significant depression of TOF ratio just before bolus injection was seen (P < 0.05). Conclusion : Priming technique with rocuronium is effective method to shorten the onset of neuromuscular block. But priming dose of rocuronium itself could cause hypoxia and aspiration in awake patients and should be used carefully. Priming dose of rocuronium 0.06 mg/kg and 2 minutes interval maybe relatively safe method.

노년기에 처음으로 발생한 조증 삽화

신석철,김정란,지익성 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

It has been known that mania in the elderly was a uncommon condition, but the incidence of first admissions for mania tends to increase with advancing age. The etiology of late-onset mania appears to be more heterogeneous, which including identifiable causes, especially brain diseases. The psychopathology of late-onset mania is often attenuated and less severe than in the young. Lithium remains the primary medication in mania in the elderly. However, certain anticonvulsants (valproic acid and carbamazepine) have a number of advantages, including a more tolerable as patients with secondary mania due to neurological and other medical disorders. We report a case of first-episode mania in 73-year old woman, who was treated with valproic acid for 2 weeks to attain stabilizing her symptoms.