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.

身體 微細畸形 및 産科的 合倂症과 精神分裂症의 家族歷

홍경수,주연호,김용식,신철진,강웅구,이중서,정희연,주은정 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.4

저자들은 정신분열병의 일부에서는 태생기 동안 유전 외적인 환경적 요인이 크게 작용할 것이라는 가정 하에 형제 정신분열병 환자군(남 15. 여 7)과 산발성 정신분열병 환자군(남 16, 여 7) 및 정상 대조군(남 16, 여 7)을 대상으로 가족력에 따른 산과적 합병증과 신체 미세 기형을 비교하였다. 산과적 합병증은 Lewis 척도를 이용하여 연구 대상의 어머니와 면담하여 평가하였고 신체미세기형은 Waldrop 척도를 이용하여 측정하였다. 또한 산과적 합병증 및 신체 미세기형과 가족력에에 따라 발병 연령 등의 임상 양상들이 차이를 보이는지 비교함으로써 정신분열병을 좀 더 동질적인 아형으로 나눌 수 있는지를 검토하였다. 1) 형제 환자군, 산발성 환자군 및 정상 대조군의 세균에서 산과적 합병증의 개개의 항목 및 전체 점수의 유의한 차이는 없었다. 신체 미세기형의 경우 입의 미세기 형에서 유의한 차이가 있었으나 그 외에 각 부위별 점수 및 전체 점수에서는 세 군간에 유의한 차이가 없었다. 그러나 대부분의 신체 미세기형 세부 항목 및 전체점수에서 산발성 환자군이 형제 환자군에 비해 높은 신체 미세기형의 점수를 보이는 경향이 있었다. 2) 산과적 합병증의 전체 점수와 신체 미세기형의 전체 점수 사이에 상호 연관성을 찾아볼 수 없었다. 3) 발병연령·정신병리·약물에 대한 반응·병전 기능수준·지연성 운동장애 유무 등의 임상 양상들을 비교하였을때 산발성 환자군과 형제 환자군간에 유의한 차이가 없었다. 4) 산과적 합병증 및 신체 미세기형과 임상 양상들을 비교하였을 때, 형제 환자군에서 분만시간과 회복시 전반적 기능수준간에, 산발성 환자군에서 산과적 합병증의 전체 점수와 발병 연령간에 상관관계가 있었으나 전체적으로 일관된 결과가 도출되지는 못하였다. 위와 같은 결과를 종합하여 볼 때, 산과적 합병증이나 신체 미세기형이 정신분열병의 원인을 밝히는데 유익한 도구가 될 수는 있지만, 가족력 유무에 따라 정신분열병을 보다 동질적인 아형으로 구분하기 힘들다고 생각되었다. In order to test the hypothesis that familial schizophrenics have fewer chances of receiving organic insults during the fetal neural development than sporadic schizophrenics, the authors compared obstetric complications, minor physical anomalies, and other clinical features in sibling schizophrenics, sporadic schizophrenics and controls. Obstetric complications were evaluated by the scale of Lewis, and minor physical anomalies were measured by the Waldrop scale. Sporadic schizophrenics had a significantly higher Waldrop score for mouth than sibling schizophrenics. Although there was some tendency of higher total scores for minor physical anomalies in sporadic schizophrenics, there were no statistically significant differences in obstetric complications and the other minor physical anomalies among three groups. There was no significant correlation between obstetric complications and minor physical anomalies. The clinical features such as age of onset, psychopathology, response to drugs, premorbid functioning, and tardive dyskinesia were not significantly different between sibling and sporadic scizophrenics. In conclusion, while the obstetric complications and minor physical anomalies were suggested to be useful in the search for the cause of schizophrenia, it was difficult to categorize schizophrenics into more homogeneous groups according to family history of schizophrenia using the parameter of obstetric complications and/ or minor physical anomalies.

미성숙영구치의 복합항생제 적용에 의한 변색의 처치: 증례보고

박소연,김영재,김정욱,장기택,이상훈,김종철,한세현,현홍근 大韓小兒齒科學會 2012 大韓小兒齒科學會誌 Vol.39 No.1

The concept of revascularization of necrotic pulps regained interest and became an alternative conservative treatment option for young permanent teeth with immature roots. Revascularization of immature teeth with apical periodontitis depends mainly on disinfection of the canal. Since the infection of the root canal system is considered to be polymicrobial, a combination of drugs would be needed to treat the diverse flora. A triple antibiotic mixture of metronidazole, ciprofloxacin, and minocycline was used as an intracanal medicament. However, discoloration was developed after applying the triple antibiotic mixture. It is believed that the marked discoloration is related to the use of minocycline. The aim of this article was to present cases of coronal discoloration after triple antibiotic therapy in immature tooth and was treated with bleaching technique to control coronal discoloration. In conclusion, revascularization by using triple antibiotics promotes a paradigm shift in treating endodontically involved permanent teeth. However, we should understand that triple antibiotics containing minocycline induces tooth discoloration. Further research to prevent coronal discoloration should be investigated and suggested for the safe use of triple antibiotics. 괴사된 미성숙영구치의 치수치료에 있어서 치수의 재혈관화를 통해 치근단 발육 및 치근형성을 지속하려는 개념이 소개됨 으로써 현재 미성숙영구치의 치수치료의 대안으로 제시되고 있다. 이러한 치근단 염증을 가진 미성숙 영구치의 재혈관화를 위해서는 가장 중요한 것이 근관내 감염된 부분을 확실히 제거하는 살균(disinfection)이다. 근관 내 감염은 여러 세균의 복 합작용으로 일어나기 때문에 철저한 살균에 사용되는 약제의 조합은 다양한 범위의 균주를 모두 제거 가능해야한다. Metronidazole(MN), ciprofloxacin(CF), minocycline(MC)의 세 가지 복합항생제가 약제로 사용되고 있으나 이 복합항생 제 적용 후 치관변색을 일으키는 사례가 보고되고 있다. 이러한 치관변색은 항생제의 성분 중 MC에 의한 것으로 여겨지고 있으며, 본 증례에서는 복합항생제 적용에 의해 야기된 치관변색의 증례를 소개하고 이를 표백술로 처치하여 최종 수복한 증 례를 보고하였다. 복합항생제 적용을 통해 미성숙영구치의 치수치료에 새로운 패러다임을 제시한 것은 분명하지만 치관변색 등의 부작용이 있음을 인지하고 치관변색을 사전에 예방하고 최소화하기 위해 다양한 방법이 강구되어야 할 것이다.

남성 사무직 근로자들의 직무스트레스와 간기능 이상과의 관련성

홍정연,김형렬,이보람,김용규,구정완,박정일 大韓産業醫學會 2009 대한직업환경의학회지 Vol.21 No.2

목적: 사무직 근로자의 직무스트레스와 간기능 이상의 관련성을 파악하고자 하였다. 방법: 근로자 건강검진에 참여한 남성 사무직 근로자 664명을 대상으로 응답자 직접 기입식 건강 검진 문진 및 한국인 직무스트레스 측정도구(Korean Occupational Stress Scale)의 결과와 각 근로자의 간기능 검사결과를 통해 간기능 이상에 영향을 주는 요인에 대해 분석하였다. 결과: 직무요구도 및 전체 직무스트레스 수준이 높은 군에서 간기능 이상률이 증가하였다. 음주 행동과 BMI에 따라 근로자 군을 분류하였을 때, 직무요구도 및 전체 직무스트레스 수준이 높은 군에서 간기능 이상률이 증가 하였다. 불건강 음주를 하는 군과 BMI 25이상 비만자군의 경우 직무스트레스의 수준이 간기능 이상에 중요한 역할을 하는 것으로 나타났다. 결론: 직무요구도 및 전체 직무스트레스 수준이 높은 군에서 간기능 이상과 관련성을 보였다. 따라서 직무스트레스의 조직적 관리 및 접근을 통해 간기능 건강에 기여 할 수 있을 것이다. Objectives: We wanted to investigate the relationship between job stress and liver dysfunction in Korean male white collar workers. Methods: A total of 700 male white collar workers who worked at one electronic institute and who participated in an annual surveillance program were recruited: 664(94.9%) workers were initially recruited and the data for 36 workers was excluded due to poor responses and a past history of liver disease. The questionnaire survey included the participants' general characteristics, the job-related factors, the health-related behaviors and job stress. Job stress was assessed using the Korean Occupational Stress Scale-Short Form (KOSS-SF). We merged the job stress data with the individual liver function results by conducting annual surveillance. Multiple logistic regression analysis with adjusting it for the Confounding variables, including alcohol drinking and the body mass index (BMI), was used to evaluate the relationship between job stress and liver dysfunction. Results: After adjustment for the confounding variables, the proportion of liver dysfunction cases was significantly higher in the groups with a high level of job stress, as assessed by the 'job demands and total score'. After conducting a stratified analysis with considering alcohol drinking and the BMI, the prevalence odds ratio of liver dysfunction was higher in the groups with a high level of job stress, as assessed by the 'job demands and total score'. Conclusions: The results of this study suggest that the level of job stress (and especially that assessed by the job demands and total score) is related to liver dysfunction. Thus, further preventive efforts and studies are needed to reduce job stress and address liver dysfunction.

카드뮴중독의 조기진단을 위한 생물학적 지표탐색 : 요중 Metallothionein 배설량의 의의

홍연표,장임원,박정덕 大韓産業醫學會 1997 대한직업환경의학회지 Vol.9 No.2

Metallothionein(MT) is a low molecular weight protein that is induced as a defence mechanism for cadmium(Cd) toxicity. In present study, urinary MT was determined using a competitive ELISA in Cd-exposed rats. In addition, measured the urinary, blood and renal Cd concentration and the urinary excretion of total protein, β₂-microglobulin(MG) and Nacetyl-β-D-glucosaminidase(NAG) at 1, 3, 7, 14, 28 days after Cd injection in Cd-exposed rats with doses of 0.8 and 1.6㎎ Cd/㎏ body weight, respectively. The urinary, blood and renal Cd were specific for Cd-exposure, that increased in proportional to dose of Cd. The urinary and blood Cd tended to slightly decrease, while renal Cd tended to increase by lapse of time after Cd exposure. This finding indicates that renal Cd is more specific than urinary and blood Cd for Cd exposure. The urinary excretion of MT showed a statistically significant increase in Cd exposed rats(0.8 and 1.6 ㎎ Cd/㎏ body weight). The increase of urinary excretion of MT was more evident at 7, 14, 28 days after Cd exposure than the changes of urinary excretion of total protein, β₂-MG and NAG. The Pearson's correlation coefficients between urinary Cd and urinary MT, β₂-MG, NAG and total protein were 0.4344, 0.3727, 0.3307 and 0.2099, respectively. These findings indicate that the urinary MT is more sensitive and specific than total protein, β₂-MG and nag for Cd exposure. The present results suggest that the urinary MT, using a simple and rapid competitive ELISA, is a valuable index and screening test in epidemiologic study for Cd exposed group.

On the Strengthening Effects Affecting Tensile and Low Cycle Fatigue Properties of Low-Alloyed Seismic/Fire-Resistant Structural Steels

Jung‑Ho Sim,Tae‑Yeong Kim,Jun‑Yeon Kim,Chi‑Won Kim,Jun‑Ho Chung,Joonoh Moon,Chang‑Hoon Lee,Hyun‑Uk Hong 대한금속·재료학회 2022 METALS AND MATERIALS International Vol.28 No.2

In the present study, low carbon ferritic and bainitic steels with different contents of Mo, Ti, and Nb were designed for bothseismic and fire-resistant applications. The microstructure of steels containing 0.3 wt% Mo–0.02 wt% Nb (‘A’ hereinafter)was mainly composed of bainite. By contrast, the microstructure of steels with 0.2 wt% Mo–0.13 wt% Ti (‘B’ hereinafter)consisted of ferrite with a high density of nano-sized (Ti,Mo)-rich MX precipitates. The results showed that the bainiticmicrostructure (‘A’ steel) was quite favorable to high-temperature strength and thermal stability. The yield strength of ‘A’ steelat both room and 600 °C temperatures increased consistently with increasing thermal exposure time (600 °C/200–1000 h),since the precipitation of NbC particles occurred while maintaining bainitic ferrite platelets with a high density of dislocationsduring exposure. In the ‘B’ steel, the formation of nano-sized (Ti,Mo)-rich MX particles was effective to impededislocation movement, leading to excellent plasticity (lower yield ratio) at room temperature. However, their contributionto precipitation hardening was not so much at 600 °C, as compared to the bainitic strengthening. During low cycle fatiguetests at room temperature, the main different feature between the two steels is that the ‘A’ steel showed cyclic softeningwhile cyclic hardening was evident in the ‘B’ steel. The bainitic microstructure showed a better fatigue life due to increasedductility manifested by cyclic softening, by which dislocation cell was developed.

혈액 내 구리, 아연 및 ceruloplasmin 농도에 흡연, 음주 및 신체적 활동이 미치는 영향

홍연표,강은용,신인철,최병선,박정덕,장임원,박진완 大韓産業醫學會 1999 대한직업환경의학회지 Vol.11 No.4

Objectives : To investigate the influence of smoking, alcohol ingestion, and physical activity on copper and zinc in RBC and serum and serum ceruloplasmin, this study was performed in a cross-sectional study in 113 healthy men aged 20 to 40 years who had no symptomatic liver, heart, gastrointestinal, and other chronic diseases. Methods : At the men's entry into the study, blood samples were drawn from each subject and immediately centrifuged for analysis of copper, zinc, iron, ceruloplasmin, total cholesterol, and hematocrit. Each man completed a questionnaire that provided information on smoking, amount of alcohol intake, and physical activity. Partial regression analysis was performed on confounding variables such as age, body mass index, hematocrit, serum cholesterol, and serum iron. Results : In general linear models, adjustment for confounding variables did not show statistical differences, and there was only an increasing tendency in serum copper in heavy smoker(P=0.0678). There was no difference between high physical activity with mild smokers and lower physical with heavy smokers. Conclusions : This study suggested that copper, zinc and ceruloplasmin were not good biomarker for early effect by smoking, alcohol intake and physical activity in young adult. However, selection bias should be considered in evaluation of this result, and a large prospective study will be needed in advance on usefulness of copper, zinc and ceruloplasmin as a marker for risk factors and early change of atherosclerosis.

카드뮴폭로후 혈액과 요중 카드뮴의 변화양상

박정덕,김미정,최병선,홍연표,장임원 大韓産業醫學會 1994 대한직업환경의학회지 Vol.6 No.2

The changes of cadmium(Cd) in plasma, whole blood, erythrocyte and urine in Sprangue-Dawley male rats exposed to intravenous singleinjection of 0.8 ㎎ CdCl₂/kg of body weight were investigated. Blood was taken at 0.5 to 672 hours, and 24 hour-urine was collected by using metabolic cage for the same period. The plasma level of Cd was reached to peak at 0.5 hour after injection and reduced rapidly in 1 hour. The Cd level in blood was the highest in plasma and the lowest in erythrocyte at 0.5 hour after injection. However, in one hour postinjection, the levels of Cd were higher in order of erythrocyte, whole blood and plasma, up to 4 weeks. The changes of urinary volume and creatinine were not significant between Cd-treated and saline-treated groups. However, urinary protein was slightly increased with time in Cd-treated group. Urinary Cd level was higher in Cd treated group than control. These results suggest that the measurement of Cd in erythrocyte and urine is valuable for the biological index to estimate recent Cd exposure.

한국인의 심근 조직내 카드뮴 농도의 참고치

박정덕,임헌방,최병선,권일훈,이상연,강은용,홍연표,장임원 大韓産業醫學會 1999 대한직업환경의학회지 Vol.11 No.1

Cadmium(Cd) is an ubiquitous, toxic and nonessential metal which is controversial about the association with a cardiovascular disease. In this study, we investigated the reference level of Cd in myocardium in Korean general population. The level of Cd and zinc(Zn) concentration in myocardium of 252 cases of "sudden and unexpected death" autopsies (male: 172, female : 60) aged 0 to 87 years was analyzed. The concentration of Cd and Zn was determined with atomic absorption spectrophotometer(Perkin-Elmer Model 5100) by flameless and flame method, respectively. The content of Cd and Zn in myocardium showed the log-normal distribution rather than normal distribution. Geometric mean concentration of Cd was 0.19 ㎍/g wet weight in myocardium. The level of Cd in myocardium was not significantly different between male (0.18㎍/g wet weight) and female (0.22㎍/g wet weight). Geometric mean concentration of Zn in myocardium was 25.25 ㎍/g wet weight. The level of Zn between male (25.13 ㎍/g wet weight) and female (25.57㎍/g wet weight) was not different. The deposit of Cd in myocardium was age-dependent of biphasic pattern, but the Zn level by age was not significantly different. The level of Cd in myocardium was increased to the fifties of age, thereafter a leveling-off was shown. The regression model of Cd deposit in myocardium by age was predicted as the following equation: Log Heart-Cd= -1.2726 + 0.0234 ·Age -0.0002 ·Age². The maximum Cd deposit in myocardium was estimated to be 0.26 ㎍/g wet weight at the age of 58.5 in Korean general population. In addition, the total Cd burden in heart by age was predicted as a following equation: Total Cd burden in Heart= -10.165+2.891 ·Age -0.0258 ·Age². The maximum heart burden of Cd was estimated to be 70.7㎍ at age of 55.4. The positive correlation between Cd and Zn was observed in myocardium. The linear regression equation was Log Heart-Zn = 1.4195+0.0262 ·Log Heart-Cd.

Wiskott-Aldrich 증후군 환아의 증례보고

이연주,현홍근,장철호,김영재,김정욱,장기택,김종철,한세현,이상훈 대한소아치과학회 2007 大韓小兒齒科學會誌 Vol.34 No.3