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.

고빌리루빈혈증을 동반한 자가면역성 간염 1례

서영범,김성욱,장재식,강혁주,이중현,윤병구,김욱년,이광헌,이구,유석동,양창헌,이정호,이영현,이창우,서정일 동국대학교 의학연구소 2000 東國醫學 Vol.7 No.-

자가면역성 간염은 대개 만성 경과를 가지며, 혈중 자가면역항체와 혈청 글로불린치의 상승, 그리고 조직학적으로 괴사 염증성 변화를 특징으로 하는 질환으로 아직 정확한 병인이 밝혀져 있지 않은 상태이다. 발병연령은 대개 젊은 영자(15-25세)에서 호발한다. 이 질환은 급성 간염의 임상경과를 보일 수 있으나, 심한 급성 간염이나 전격성 간염으로도 나타날 수 있는데, 이 경우 아주 나쁜 예후를 보인다고 한다. 치료는 자가면역성 간염 임상 경과의 다양성이나 병인, 병리기전의 불확실성에도 불구하고 대개 steroid 치료에 반응하는 것으로 알려져 있으며 대개 80%의 관해율을 나타내며 궁극적으로 간경변으로의 진행을 막을 수 있는 것으로 보인다. 저자들은 58세 남자에서 발생한 급성의 경과를 가지고 심한 황달을 동반한 자가면역성 간염을 경험하였기에 문헌고찰과 함께 보고하는 바이다. Autoimmune hepatitis (AIH) is a chronic necroinflammatory liver disorder of unknown cause associated with circulating autoantibodies and a high serum globulin level. The age of onset of AIH show a peak between the age of 15 and 25 years. AIH can develop and be manifested as acute hepatitis, but severe form of acute hepatitis or fulminant hepatic failure has a poor prognosis. Although AIH is likely to progress from chronic active hepatitis to cirrhosis, steroid therapy can control the disease activity, prolong survival, improve the quality of life , and defer liver transplantation. In the present report we describe a 58-year-old man who admitted because of progressive jaundice and fatigue. He was diagnosed with AIH from laboratory test result showing positivity for antinuclear antibodies, anti-smooth muscle antibodies, and negativity for hepatitis viral markers and from liver biopsy. Steroid therapy, oral administration of prednisolone, was effective in improving the liver function test. Following liver biopsy 6 months after onset shows markedly improved necroinflammatory activity.

고령자 급성 췌장염의 임상적 고찰

이진헌,강진경,박인서,송건훈,정재복,백용한,송시영,서정훈 대한소화기학회 1998 대한소화기학회지 Vol.32 No.3

Background/Aims: Inflammatory diseasas of the pancreas are not uncommon. The advanced age is one of the significant factors in assessing the severity of acute pancreatitis. It has been shown that the biliary tract disease is a more frequent cause of acute pancreatitis in the elderly than in the young. With the increased life span, the elderly are comprising a large proportion of the population. As a result, physicians are more often being faced with acute pancreatitis in the elderly. The purpose af this study was to evaluate clinical features of acute panereatitis in the elderly. Methods: A total of 188 patients with acute pancreatitis were reviewed. We investigated the differences of clinical characteristics between the elderly patients aged over 60 and the young patients aged under 60. Results: The sex distribution showed male preponderance in the young patients (M:F=2.4:1), but was nearly equal in the elderly patients (M:F=1.1:1). The most common cause of acute pancreatitis in the elderly was biliary tract disease (52.5%), while alcohol abuse was the most common cause in the young patients (38.8%), Local complications of acute pancreatitis, such as psuedocyst, necrosis, abscesses were not differently shown between the elderly (16.9%) and the young (20.2%) patients. Systemic complications including acute puhnonary failure occurred more frequently in the elderly patients than the young patients. The mortality rate of the elderly patients (5.1%) was not significantly different from that of the young patients (3.1%). Conclusions: To detect correctable underlying bihary tract diseases the elderly patients with acute pancreatitis should be completely investigated using endoscopic retrograde cholangiopancreatography (ERCP). In addition, the patient should be closely monitored for the development of the systemic complications during the disease process.

고령자 급성 췌장염의 임상적 고찰

백용한,서정훈,송건훈,이진헌,송시영,정재복,강진경,박인서,이수진 大韓消化器病學會 1998 大韓消化器病學會誌 Vol.32 No.3

자기 효능의 개념 분석

서순림,이은남,박송자,양영희,이동숙,최은옥,구미옥,김인자,이인숙,김성재,박영임,이은옥 서울대학교 간호대학 간호과학연구소 1997 간호학 논문집 Vol.11 No.1

Today human needs for health promotion and maintenance are increasing. The nursing progression has a great responsibility for helping clients to practice good health behavior. self efficacy was found to be potent predictor in initiating and maintaining the health-related behavior. Therefore, the concept is important in nursig intervention for change of health behavior. The purpose of this paper was to analyze and clarify the meaning of the concept, self efficacy. This study used Walder & Avant's process of concept analysis. Critical attributes of self efficacy were : 1) positive perception of his won capability; 2) intrapersonal strength; 3) possibility of being learned; 4) individuality; 5) specificity; 6) generalizability. Antecedents of self efficacy consist of those facts that 1) new situation occurs; 2) individuals have needs to change the new situation; 3) there are some required actions in new situation. Consequences occurring as a result of self efficacy consist of those facts that 1) individual initiates the of failure; 5) cope with the situation; 6) controls the situation; 7) the level of self efficacy is enhanced; 8) the level of self-esteem is enhanced.

Tetracaine이 개의 大腦皮質 Na^+-K^+-ATPase의 活性에 미치는 影響

이진영,김광용,서영,서경종,박영순 圓光大學校 基礎自然科學硏究所 1990 基礎科學硏究誌 Vol.9 No.1

본 實驗은 tetracaine이 개의 大腦皮質의 Na^+ - K^+ - ATPase의 活性에 어떻게 影響을 미치는 가를 알아보기 위하여 실시한 것이다. 그 酵素에 대한 tetracatine의 沮害效果와 그 機作은 酵素反應速度論的 分析方法 즉 Dixon-plot, Lineweaver-Burk plot, Arrhenius-plot 등으로 分析하였다. 그 結果는 다음과 같다. 1. Na^+ - K^+ - ATPase는 全 ATPase와 Mg^++ - ATPase의 活性보다 tetracaine에 의하여 더 많은 沮害를 받는다. 2. Tetracaine의 50% 沮害效果는 沮害常數 5㎎/㎖와 동일하였다. 3. Tetracaine은 그 酵素의 Km값을 변화시키지 못하였으나 最高速度(Vmax)는 변화시키기 때문에 tetracaine은 可逆的 非競爭的 沮害劑로 作用한 것 같다. 4. Q_10 값은 tetracaine의 농도가 증가함에 따라 감소되는데 이 값으로 Arrhenius-plot를 作成해 본 結果 切點(transition state)이 나타나지 않으므로 tetracaine은 脂質에는 작용하지 않고 오직 Na^+ - K^+ - ATPase에 작용하는 것 같다. The present experiments were disigned to investigate the effect of tetracaine on the dog brain cortex Na^+ - K^+ - ATPase activity. The inhibitory effects of tetracaine on the enzyme avtivity and its mechanism were analyzed by Dixon plot, Lineweaver-Burk plot, and Arrhenius plot. The results obtained here were as follows : 1. The Na^+ - K^+ - ATPase activity was inhibited more than the total ATPase and Mg^++ - ATPase in the presence of tetracaine. 2. The concentration of 50% inhibition for tetracaine was identical with the inhibition constant (Ki), the Ki value was 5 ㎎/㎖ for tetracaine. 3. In this study tetracaine did not change the Km value (2.5) but decreased the Vmax of the Na^+ - K^+ - ATPase activity, suggesting that tetracaine acts as reversible and noncompetitive inhibitor on the enzyme. 4. Q_10 value and energies of activation (20.1 Kcal/mole) decreased as the concentrations of trtracaine increased and the transition state did not appeared. These results suggest that trtracaine inhibits the enzyme activity by reversible and noncompetitive inhibition.

기종성 신우신염 1례

이재욱,구정태,서정일,양창헌,이정호,이동철,이영현,이활,이경섭 동국대학교 경주대학 1997 東國論集 Vol.16 No.1

기종성 신우신염은 주로 당뇨병환자나 폐쇄성 요로질환을 가진 환자에 발생하며 특징적으로 신실질 및 그 주위조직에 가스를 형성하면서 심한 조직괴사를 일으키는 매우 드문 급성 화농성 신감염으로 사망률이 높은 질환이다. 이 질환은 1989년 Kelly와 MacCallum에 의해 처음 보고된 이래 외국문헌에 약 90례 정도가 보고되어 있으며 국내에는 28례가 보고되어 있다. 수액 및 전해질 보충, 인슐린 투여를 통한 적절한 혈당조절 및 항생제 투여등의 내과적 치료와 절개배농 및 신적출술등의 수술적 치료 방법이 있다. 내과적 치료로 가스의 감소가 없는 경우에는 즉각적인 수술적 치료를 시행하여야하므로 이 가스변화에 대한 추적관찰이 중요하다 하겠다. 본 저자들은 당뇨병환자에서 발생한 기종성 신우신염 1례를 내과적 요법을 치험하였기에 문헌고찰과 함께 보고하고자 한다. Emphysematous pyelonephritis is rare, life-threatening infection of the renal parenchyma and perirenal tisseue. This disease is characterized by the production of intrarenal and perirenal gas and is frequently encountered in patients with diabetes mellitus or urinary obstruction. We experienced a case of emphysematouse pyelonephritis in a 62 years old women with poorly controlled diabetes mellitus who had been managed with medical theraphy. So we report this case with a review of the referenced literatures.

동구북구산 Mesochorinae 아과(별목 : 맵시벌과)의 계통분류학적 연구 1. : Mesochorinae 속의 재고찰 A Review of the Genus Mesochorus

이종욱,최원영,서경인 고려대학교 한국곤충연구소 1997 昆蟲硏究誌 Vol.23 No.1

동구북구산 Mesochorus속을 재고찰한 결과 4미기록종을 포함하여 총 31종을 확인하였다. 따라서 동구북구산 Mesochorus속은 본 연구에서 확인하지 못한 10종을 포함하여 총 41종이 분포하는 것으로 보고된다. 원기재와의 차이점을 추가하여 기록하였고, 채집지, 분포, 숙주목록 등을 정리하였으며, 확인된 31종에 대한 검색표를 작성하였다. 이 중 Lee와 Suh의 M. sp.1은 본 연구에서 신종임이 확인되어 Mesochorus seorakensis로 새로이 명명하였다. 종목록은 아래와 같다. Aa a result of systematic study of the Mesochorinae, a total of 31 species was confirmed in the Eastern palearctic Mesochorus. Among them, four species, M. confus, M. fuscicornis, M. rubranotatus and M. uniformis are new to Eastern palearctic regional fauna. Mesochorus sp. 1 of Lee and Suh (1991) is confirmed as new species and it named to be M. seorakensis. Thus, the Eastern palearctic Masochorus is composed of 41 species including 10 unconfirmed species in this study. Additional descriptions, collection sites, distributions, host lists, keys are provided for the species.

한국인 심부전증 환자 심근에서의 인형 거대 세포 바이러스 감염

이명용,이무용,김영권,한성식,최성준,김효수,이영우,서정돈 단국대학교 1998 論文集 Vol.33 No.-

Objectives: In order to evaluated the prevalence and the site of infection of cytomegalovirus in terminally failing heart, cytomegaloviral DNA was detected in the explanted hearts of transplantation recipients. Methods: DNA extractions were performed from explanted failing hearts(N=22) and normal hearts(N=5) and polymerase cain reactions(PCRs) were done for detection of late gene sequence coding pp150 glycoprotein. The products were confirmed by electrophoresis on the 1% agarose gel. n order to improve the detectability of cytomegaloviral genome, nested PCRs were executed with the primers designed for the original 607 bp products. In situ PCRs also were done with the samples which were confirmed as positive for CMV viral genome by nested PCRs. Results: All patients had IgG anti-cytomegalovirus antibody and did not have IgM anti-cytomegalovirus antibody. Cytomegaloviral genomes in myocardium were detected by polymerase chain reaction. The 607bp products by PCRs were found in both explanted failing heart(3 cases/22. 13.5%) and normal hearts( 1 case/5, 20.0%). In nested PCRs, 186bp products were found in both failing hearts(LV 4/22, LA 3/2, RV 4/22, RA 0/17) and normal hearts(LV 2/5, LA 1/4, RV 2/5, RA 2/5). These was no significant change in positivity of cytomegaloviral DNA genome between failing and normal hearts. Total positivity of cytomegaloviral genome in explanted hearts was 44.4% according to the nested PCR results. The positivity of cytomegaloviral DNA by n situ PCR was 33.3%(4/12), and the site of positive reaction was the nuclei of the myocardial cells. Conclusion: Cytomegalovirus was rarely observed in explanted hearts of terminal heart failure and nested PCR could enhance the sensitivity of cytomegaloviral genome detection. The result of the in situ PCR showed the site of the cytomegaloviral infection was nuclei of the myocardial cells. Cytomegalovirus, however, might have no direct causal relationship in the development of terminal heart failure.

종합검진센터 내원자에서 관상동맥질환 위험요인들의 분포

이충원,이종영,박종원,윤능기,김영조,이현우,이무식,서석권 啓明大學校 醫科大學 1993 계명의대학술지 Vol.12 No.3

1991년3월부터 8월사이에 대구시에 소재한 1개의 대학병원의 종합검진센타에 내원해서 종합검진을 받은 남자 422명(69.9%)과 여자 182명(30.1%)을 대상으로 하여 심헐관계질환의 위험요인들의 전체적인 분포를 보았다. 평균 연령은 남자가 43.3(표준편차, 10.3), 여자가 44.4(표준편차, 10.8)였다. 남자에서 연령에 따라 0.05 수준에서 통계적인 유의성을 보인 위험인자는 혈청 총콜레스테롤(TC). 트리글리세라이드(TC), 고밀도 지단백콜레스테롤(HDL), 저밀도 지단백콜레스테롤(LDL), 수축기혈압, 비체중, A형행동양상이었으며 생활습관으로서는 음주, 흡연, 규칙적인 운동, 우유와 커피섭취, 수면 등이었다. 여자에서는 TC, TG, LDL, 수축기와 확장기혈압, 비체중 그리고 커피섭취와 수면 등이었다. 남자에서 총콜레스테롤의 평균은 181.7mg/dl(표준편차, 32.2), 여자는 182.5mg/이(표준편차, 42.2)였다. 대부분의 위험인자들은 구미의 수준에 미치지 못했으나 남자에서 흡연율이 전체적으로 61.8%로 높으 수준이었으며 특히, 20~29세가 72.9%, 30~39세가 75.2%로서 다른 연령군에 비해 상대적으로 높았다. 여자에서는 전체적으로 6.0%에 지나지 않았다. 확장기혈압 90mmHg 이상을 고혈압자로 정의했을 때의 유병률이 여자 전체대상자에서 24.7%로 높았으며 50-59세는 표본수가 적어서 문제가 되었으나 53.1%였다. 어떤 인구집단내에서 총콜레스테롤의 평균이 200mg/dl 미만이면 고혈압과 흡연의 인구집단의 수준에 관계없이 관상동맥질환(coronary heart disease)의 발생은 드문 것으로 보고가 되고 있으므로 당분간 관상동맥질환 발생률의 급속한 절대적인 증가는 힘드리라 사료된다. 그러나 이러한 결과는 본 연구의 대상자들이 대표성을 지니지 못하며 건강검진센터에 자발적으로 내원한 사람들이므로 해석에 주의를 요한다. Authors examined the distributions of the risk factors for the coronary heart disease in the 422 male (69.9%) and 182 female (30.1%) visitors to the health examination center of a university hospital located in Taegu March to August 1991. Mean age of males was 43.3(standard deviation, SD 10.3) and that of females was 44.4(SD 10.8). Total cholesterol(TC), triglyceride (TG), high-density lipoprotein and low-density lipoprotein cholesterol(LDL), systolic blood pressure, Quetelet index, and Type A Behavior Pattern, and some of life habit variables(alcohol intake, smoking, regular exercise, milk and coffee intake and sleeping) were statistically significant in age groups of the males(P<0.05). In the females, TC, TG and LDL, systolic and diastolic pressure, Quetelet index, coffee intake and sleeping were statistically significant in age groups (P<0.05). Mean of total cholesterol was 181.7㎎/dl(SD,32.2) in males and that of females was 182.5㎎/dl(SD,42.2). Most of the risk factors levels were lower than the Euro-Americans', while smokers were high with 61.8%, especially 72.9% in 20-29 age group and 75.2% in 30-39 age group in males. In females, smokers were just 6.0%. Hypertensives defined by more than 90mmHg diastolic pressure were 24.7% in females, particularly 53.1% in 50-59 age group, but size of the strata was rather small(N=49). In the light of the report that coronary heart disease is uncommon irrespective of population levels of smoking and hypertension, where average total blood cholesterol level in a population is low(<200mg/dl), it is not likely that the absolute increase of the number of the coronary heart disease will increase markedly in the near future. But cautions should be exercised in interpreting the results of this study due to the lack of representativeness and volunteerism. .