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.

Clinicopathological role of kidney injury molecule-1 in immunoglobulin A nephropathy

( Yu Ho Lee ),( Yang-gyun Kim ),( Sang-ho Lee ),( Ju-young Moon ),( Kyung-hwan Jeong ),( Tae-won Lee ),( Chun-gyoo Ihm ) 대한신장학회 2014 Kidney Research and Clinical Practice Vol.33 No.3

Background: Urinary kidney injury molecule-1 (KIM-1) is an early and sensitivebiomarker of acute kidney injury, but it is unclear if it is a biomarker of chronicglomerulonephritis. We evaluated whether urinary KIM-1 levels in patients withimmunoglobulin A (IgA) nephropathy can be a marker to reflect clinicopathologicalseverity and predict the prognosis. Methods: We measured urinary KIM-1 levels in 40 patients (15 males; mean age36.6712.9 years) with IgA nephropathy and 10 healthy people (5 males; mean age37.379.6 years) as controls. The correlation of urinary KIM-1 levels with patients’clinical parameters, histological grades, and follow-up data were analyzed using themodified H. S. Lee grading system and tubulointerstitial change scores. Results: Urinary KIM-1 levels were higher in patients with IgA nephropathy thanhealthy controls (P¼0.001). Univariate and multivariate regression analyses showedthat urinary KIM-1 levels had a direct correlation with H. S. Lee grade andtubulointerstitial inflammation (P¼0.004 and P¼0.011, respectively). Conclusion: In patients with IgA nephropathy, urinary KIM-1 has a significantcorrelation with histopathologic severity.

고령 환자에서의 간 절제술

김병철,서거정,김경종,장정환,김성환 조선대학교 2003 The Medical Journal of Chosun University Vol.28 No.1

Hepatic resection for removal of lesion of the liver may be necessary for a wide variety of conditions. Partial hepatectomy for liver disease have become more common This reports describes a review of our experience for hepatic resection and an analysis of potential risk factors affecting the morbidity and the mortality in a hepatectomy methods : Between Jan 1,997 and Mar.2,001, we performed 112 cases of partial hepatectomy and retrospectively analyzed clinicopathological features of the presented. cases Results : The most common disease was intrahepatic duct stone(31.8%). The mean operative time was 324 minutes. The overall In-hospital mortailty an morbidity rates were 6.8%(3/44) and 59%(27/44), respectively, Various posmiddleerative complications developed, including 14 cardiopulmonary complications(53.8%), 8 wound Infections(30.7%), 2 Bile leakage(7%), 1 intraabdominal abscess(3.8%), 1 hepatic failure(38%), 1 posmiddleerative bleeding(3.8%). The old had more cardiopulmonary complications. The significant risk factors for perioperative mortality were high preoperative serum bilirubin level(above 2.0mg/dl), size of resection, massive operative bleeding(above 2,000cc), concomitant diseases, but cirrhosis was not a significant risk factor. Comparison of young age patients, the old had more complications, but it was not significantly Conclusion : Although the old patients had more cardiopulmonary complications but their operative mortality were not much different than younger patients significantly. Hepatic resection can be performed in over 60 years old with acceptable morbidity and mortality rates.

Rifampicin에 의한 것으로 추정되는 위막성 대장염1예

김수현,이은우,정종혁,문승현,김동한,양혁승,오영상,김호동,김도현,박혁,박정환,박경옥,이영직 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.2

Pseudomembranous colitis, caused by altering the normal colonic flora and allowing the multiplication of Clostridium difficile, is an deleterious adverse effect of antibiotics. But it is rarely reported by rifampicin. Rifampicin is one of the first line drug in the treatment of tuberculosis and many patients are exposed to its potential adverse effects. We experienced a patient that had abdominal discomfort and hematochezia due to pseudomembranous colitis after receiving antituberculous medication, and which was probably caused by rifampicin. A 82 years old man was admitted with abdominal discomfort and hematochezia for one week. On the past history he had been diagnosed as endobronchial tuberculosis about 4 months ago. Colonoscopy revealed multiple discrete whitish mucosal lesion on rectosigmoid colon, and histologic findings were consistent with pseudomembranous colitis. The antituberculous agents were discontinued and vancomycin was administered. The patient's symptoms were resolved within several days. There was no recurrence after reinstitution of the antituberculous agents excluding rifampicin. We report here on a case of pseudomembranous colitis probably due to rifampicin.

정상과 갑상선 종양조직에서 사람 IGF-I 유전자의 발현

김성운,장현하,박상미,김덕윤,우정택,양인명,김진우,김영설,김광원,고석환,홍성화,최영길 경희대학교 유전공학연구소 1993 遺傳工學論文集 Vol.5 No.-

Many of the growth-promoting properties of growth hormone(GH) are mediated by insulin-like growth factor-I(IGF-I), a highly conserved circulating 70-amino acid peptide. Recent studies have shown that multiple mechanisms influence IGF-I gene expression, including transcription from two promoters, alternative RNA splicing, and variable polyadenylation. In thyroid tissue, thyroid stimulating hormone(TSH) and IGF-I are the most possible candidates for follicular cell proliferation and hypertrophy. Actually IGF-I had autocrine and paracrine effect for tissue growing. We prepared thyroid tumor tissue mRNAs using single step method for detecting IGF-I levels according to different tissues, i.e., thyroid adenoma or papillary thyroid carcinoma. We used Northern blot analysis for IGF-I mRNA and RNase protection assay (RPA) for IGF-I transcription start sites. For Northern blot, we used whole human IGF-I cDNA as a DNA probe and for RPA, we used IGF-I exon 1 containing noncoding promoter 1 as a riboprobe. We got good RNA bands from Northern blot analysis around 1 kb (IGF-IA) and 7.5 kb (IGF-IB) region. To clarify the amount of both IGF-IA and IB mRNAs, we measured autoradiographied signal of IGF-I mRNAs bands using densitometer. In IGF-IA signals, there's no change among liver and thyroid tissues, but in case of IGF-IB mRNA bands, the signal was markedly increased in thyroid carcinoma tissues than that of normal thyroid tissue (85% vs 14%). In the study of RPA, all thyroid tissues used the same transcription start sites as those of liver's. We concluded that that this different regulation of IGF-I mRNA was originated from tissue specificity. That meant some tissue specific transcription factor/s were related to tissue IGF-I expression.

랫트의 생체내 카드뮴 단독투여 및 카드뮴과 셀레늄 병용투여에 따른 필수원소의 변화

김동현,변정식,조영채,이범식,김광환,김정윤 忠南大學校 環境問題硏究所 1995 環境硏究 Vol.13 No.-

This study was performed to find out the changes of essential elements as Cu, Fe, Zn, and Ca in blood, liver, kidney and testis of rats. The experimental rats were divided into 4 groups that were consisted of control group(groupⅠ), 3.0㎎Cd/kg group(groupⅡ), 3.0㎎Cd +1.0㎎Se/kg group(groupⅢ) and 3.0mgCd+2.5mgSe/kg group(groupⅣ). Each group was intraperitoneal injection with difference dose of cadmium and selenium such as 3.0mgCd/kg, 3.0mgCd+1.0mgSe/kg and 3.0mgCd+2.5mgSe/kg. Rats were killed at the time of 3 day and 28 day, and Cd, Se, Cu, Zn and Ca concentration in several organs were determined by Atomic Absorption Spectrophotometry and inductively Coupled Plasma. Cadmium content in blood, liver, kidney and testis were significantly increased in the Cd alone injection group than Cd mixed with selenium injection groups. But, copper content were not significantly differences in control and each experimental group. Iron content were significantly increased in the Cd alone injection group than others groups. Zinc and calcium content were significantly decreased in the Cd alone injection group than other groups. On the other hand the essential element content in Cd mixed with selenium injection group were almost equaled with those of control group than Cd alone injection group.

유기용제 폭로가 여성 근로자들의 월경에 미치는 영향

김대환,이채관,김휘동,강동묵,문덕환,김정호,손병철,이창희,이채언 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.1

유기용제는 산업장에서 널리 사용되고 있다. 특히 여성근로자들의 폭로기회가 증가하고 있으며 이로 인한 자연유산, 수태능력 감소, 월경이상 등이 보고되고 있다. 따라서 유기용제 폭로가 여성근로자들의 월경에 미치는 영향을 보기 위해 설문조사와 월경주기별 여성생식 호르몬(progesterone, estrogen) 분석을 하였다. 그 결과 폭로군에서 progeterone의 억제효과가 유기용제에 폭로되는 여성근로자들의 다양한 월경이상을 초래할 가능성이 있는 것으로 생각된다. ■ Objectives This study was conducted to evaluate the effects of menstrual function in female workers exposed to organic solvents. ■ Methods Rates of menstrual disorders were studied in 87 female workers with exposure to organic solvents(Cn/Hn-value 0.713) in a factory manufacturing shoes and compared with 83 general female workers who had no exposure to organic solvents, Detailed menstrual and reproductive histories were obtained by personal interview using structured questionnaire, and plasma concentrations of progesterone and estrogen were assayed by radioimmunoassay(RIA). ■ Results The rates for menstrual irregularity, menstrual duration, blood clot in menstrual flow and dysmenorrhea were not significantly different in both groups. Number of using menstrual pad was significantly higher and the plasma level of progesterone during 6-11th day of menstrual cycle was significantly lower in the exposed group compared with non-exposed group(P<0.05). ■ Conclusions It seemed to be suppression effect of organic solvents on the reproductive hormones(progesterone and estrogen) in female workers. But there was no evidence that menstrual disorder was likely to result from exposure to organic solvents, because other behavioral, psychological and work related factors may also affect menstrual function.

췌십이지장절제술 후 결과에 영향을 미치는 인자

정희석,정귀애,장정환,김권천,민영돈,김성환 조선대학교 2003 The Medical Journal of Chosun University Vol.28 No.1

`Background : Pancreatoduodenectomy is a widely used technique in the treatment of periampullary, duodenal and cephalic pancreatic disease. Although many improvements have been made in operative technique and posmiddleerative care, pancreatoduodenectomy remains a technically difficult procedure attended by relatively high morbidity and mortality rates. Materials and methods : The hospital records of 51 patients who underwent pancreatoduodenectomy at the Chosun University Hospital between 1994 and 2001 were reviewed. Clinical data and the following morbidity and mortality were recorded The risk factors were analyzed by a Chi-square test. Results : Fifth decade was the most prevalent ages (43.1%) The mean age was 59 years (ranging from 29 to 78) and the male to female ratio was 26 to 1. The periampullary cancer was the most reason to operation (86%) and injury due to trauma, adenocarcinoma of stomach, colon cancer, chronic pancreatitis in order Posmiddleerative complications were developed in seventeen patients and anastomotic leakage was the most common complication Death within a month after operation was 3 (5.8%) and the one of the cause of death was leakage in two patients, the other cause was intraadbominal bleeding in one patients. The cardiovascular disease, pulomnary problem, diabetes, level of bilirubin were checked preoperatively and showed no statistical difference in the posmiddleerative morbidity. The other factors such as amount of bleeding, operation time were not influencing posmiddleerative complications. The occurrence of leakage in eight cases of drainage tuve inserted into the pancreaticojejunostomy site was not different from no tuve insertion statistically Conclusion: old age of the patients, diabetes mellitus and massive intraoperative hemorrhage are the risk factors influencing the results after pancreatoduodenectomy. Morbidity and mortality after pancreatoduodenctomy can be devreased if a prudent selection of paients is made and the operation is performed by accomplushed surgeon.

질소산화물의 급성 노출로 인한 폐 손상 1례

김정호,김대환,손병철,이창희,김정원,문덕환,이채언,김주인 대한산업의학회 2000 대한직업환경의학회지 Vol.12 No.2

Objectives : Lung injuries due to exposure to nitrogen oxides can occur in various process in industry. We experienced a case of chemical pneumonitis induced by accidental inhalation of nitrogen oxides emitted from the bath in an acid dipping operation. Case : Dyspnea, cough and blood-tinged sputum production, cyanosis, and tachypnea occurred after exposure to oxides of nitrogen. There were bilateral diffuse ground glass opacities in simple chest radiography and high resolutional computed tomography, hypoxemia in arterial blood gas analysis, mixed ventilation defect and reduced diffusion capacity in spirometry. As an oxygen and supportive therapy, after hospitalization, was given, the patient recovered completely from the lung injury on the 8th day after admission. There was no evidence of delayed onset of bronchiolitis obliterance or pulmonary edema in a follow-up for about 6 months. Conclusions : Acid dip operation require more efficient hooding and exhausting system for the prevention of lung injuries caused by inhalation of nitrogen oxides. Also health education for worker need.

장기간 항갑상선제 투여 후 임의 중단 뒤 재복용시 발생한 무과립구증 1 예

김승만;김태영;박수영;배영환;서영경 정은주;김태균;권민정;박정현;이순희 인제대학교 2011 仁濟醫學 Vol.32 No.-

Agranulocytosis, one of the major side effects of antithyroid a gents, probably occurs in less than 0.25% of cases treated with antithyroid agents. It usually occurs within the first several weeks or months after the initiation of therapy, when drug dosage is higher. Most reported cases of agranulocytosis have occurred during the first 3 months of therapy. We describe here a rare case that did not experience the side effect for 6 years of antithyroid agent treatment but presented with agranulocytosis in one month after re-exposure. It suggests that the major side effect such as agranulocytosis can occur in patients who had undergone prior uneventful antithyroid drug therapy.