항정신병약물 사용 중인 정신분열병 환자에서 올란자판으로의 교체 방법에 관한 연구(II) : Comparison of Safety 안전성 비교

안용민,권용실,권준수,민성호,박두병,양문정,소형석,송종호,신윤식,우행원,유범희,이홍석,정한용,한창환,김용식 大韓神經精神醫學會 2002 신경정신의학 Vol.41 No.5

연구목적: 이 다기관 공동임상연구는 사용 중인 항정신병약물을 ’직접 교체 방법’또는 ’시작-감량 교체 방법’중 한 가지 방법으로 올란자핀으로 교체한 후, 안정성 측면에서 두 교체 방법 간의 비교와 교체후의 변화를 관찰하기 위한 것이다. 방법: 국내 13개 병원의 입원 및 외래에 내원한 환자들 중 ICD-10 지단기준으로 정신분열병에 해당되며, 임상적으로 항정신병약물 교체가 필요한 환자를 대상으로 하였다. 두 가지 교체 방법 중 한 가지를 무작위로 피험자에 적용하였으며, ’직접 교체 방법’에 배정된 경우에는 사용중인 항정신병약물을 일시에 중단하고 10㎎의 올란자핀을 바로 투여하였고, ’시작-감량 교체 방법’에 배정된 경우는 10㎎의 올란자핀 투여하고 2주에 걸쳐서 기존 약물을 감량하여 중단하였다. 올란자핀 사용기간은 총 6주이며, 용량은 5∼20㎎ 범위로 제한하였다. 한정성 평가를 위해서 체중, 생명징후, 자발적인 이상반응 복, 실험실 검사 그리고 Simpson-Angus Scale(SAS), Barnes akathisia rating scale(BARS), Abnormal involuntary movement scale(AIMS). Liverpool University neuroleptic side effect rating scale(LUNSERS)등을 이용하였다. 결과: 총 103명의 정신분열병 환자를 대상으로 하였다. 사용한 올란자핀의 용량, 벤조디아제핀의 병용률, 탈락률과 탈락 사유, 자발적인 이상반응 보고, 생명징후, 실험실 검사 그리고 대부분의 부작용 척도 상에서 임상적으로 의미 있는 차이를 두 교체 방법간에 발견하지 못하였다. 다만 AIMS의 감소는 ’직접 교체 방법’군에서 보다 적었고, 항콜린제의 병용률은 ’시작-감량 교체 방법’군에서 보다 많았다. 기저 상태에서 전체 피험자의 SAS와 BARS 점수는 각각 3.5점과 1.8점이었으며 70% 이상의 피험자가 고프로락틴 혈증을 보였다. 올란자핀으로 교체한 후, SAS, BARS, AIMS 점수의 유의한 감소가 있었으며 고프로락틴 혈증을 보인 피험자 분율도 약 30%이하로 감소하였다. 그러나 교체 방법과 상관없이 올란자핀 교체 후 유의한 체중 증가가 있었다. 결론: 이 연구를 통해 교체 방법에 관계없이 비교적 안전하고 용이하게 올란자핀으로 교체 할 수 있음을 알 수 있었다. 그리고 기존 항정신병약물을 올란자핀으로 교체함으로써 일부 부작용들을 줄일 수 있음을 간접적으로 관찰할 수 있었다. 하지만 이 연구는 여러 제한점과 문제점을 지니고 있기 때문에 보다 체계적인 연구를 통해 검정이 필요하리라 생각된다. Objectives: This multicenter clinical trial involving 13 hospital sites compared the safely of switching to olanzapine between ’direct switching method’ and ’start-tapering switching method’. Method: This study included both inpatients and outpatients who fulfilled the criteria for schizophrenia as defined in the ICD-10, and were in need to be appropriate for switching antipsychotics. Subjects were randomly assigned to one of the two switching methods. For ’direct switching method’group, previous antipsychotics were abruptly discontinued and 10㎎ of olanzapine was administered, and previous antipsychotics was gradually tapered for 2 weeks. Olanzapine was used for 6 weeks and the dose was adjusted within the range of 5-20㎎. The safety of switching to olanzapine was measured with vital sings including body weight, adverse events reported spontaneously, laboratory tests, and various scales such as Simpson-Angus Scale(SAS), Barnes Akathisia Rating Scale(BARS). Abnormal Involuntary Movement Scale(AIMS), and Liverpool University Neuroleptic Side Effect Rating Scale(LUNSERS). Results: 103 patients were switched to olanzapine in this study. The comparison between two switching methods did not show any significant difference in the dosage of olanzapine used, the concomitant use of benzodiazepine, the rate and reasons of drop-out, the adverse events, vital signs, laboratory tests, and most scales for measuring side-effects. However, the decrease in AIMS scores was significantly lower in ’direct switching method’ group, and the concomitant use of anticholinergics was comparatively greater in ’start-tapering switching method’ group. At baseline, SAS and BARS scores were 3.5 and 1.8 points respectively, and more than 70% of the subjects showed hyperprolactinemia. After switching to olanzapine, SAS, BARS, and AIMS scores were significantly decreased and the proportion of the patients with hyperprolactinemia was also decreased to less than 30%. However significant weight gain after the treatment of olanzapine was observed regardless of switching method. Conclusion: This study may suggest that switching to olanzapine can be done with relatively high safety regardless of switching methods and olanzapine can significantly decrease some side-effects induced by other antipsychotics.

Prevention of medical malpractice and disputes through analysis of lawsuits related to coronary angiography and intervention

Cheol Won Hyeon,Won Lee,So Yoon Kim,Ji Yong Park,Su Hwan Shin 대한내과학회 2020 The Korean Journal of Internal Medicine Vol.35 No.3

Background/Aims: Possible fatal complications arising from coronary angiography (CAG), percutaneous coronary intervention (PCI), and coronary artery disease itself, are likely to cause medical disputes. Presenting the current status and reasons for judgments given in lawsuits related to CAG/PCI, this study aimed to identify ways to prevent unnecessary disputes and medical malpractice suits related to CAG/PCI through lawsuit analysis. Methods: A total of 13 cases (20 judgments) found in the Supreme Court of Korea’s Written Judgment Management System from 1998 to 2017 were analyzed. Results: Coronary artery injury was the most common causative complication that led to lawsuits (n = 6, 46%). Six cases (46%) were ruled in favor of the plaintiff for violation of duty of care (n = 4) and duty of explanation (n = 2), respectively. Cases that violated duty of care included two errors in intra-procedure device manipulation, one in pre-procedure diagnosis, and one in management of post-procedure complication. Lack of explanation regarding the risk of complications was pointed out in both cases that violated duty of explanation. The average awarded amount for the damages was 114,436,064 Korean won. Conclusions: Physicians need not fear unfair judgments so long as they follow standard of care because the Court consistently looked at the probability, the foreseeability, and the evidence. Therefore, maintaining standard of care is important. Besides, specific, detailed, and comprehensible explanations, including the risk of complications in addition to the necessity of procedures, are important to ensure the patient clearly understands the possible risk of adverse outcomes.

이면성 및 도플러 심초음파도를 이용하여 진단한 선천성 거대 좌회선지-좌심실 관동맥루

진승원,박준철,이영중,유병현,박현옥,김용주,윤호중,김재형,홍순조,최규보,권종범,원용순,박건 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.4

운동훈련이 흰쥐 노화심근에 미치는 영향

박원학(Won-Hark Park),이상선(Sang-Sun Lee),이용덕(Yong-Deok Lee) 대한의생명과학회 1996 Biomedical Science Letters Vol.2 No.1

장기간 반복 주행운동이 흰쥐의 심근에 미치는 효과를 규명하기 위하여 생후 3개월, 10개월 및 20개월된 흰쥐를 운동군과 대조군으로 대별하여 motor driven treadmill을 이용하여 Park등이 사용한 방법에 준해서 5개월만, 주 5일 20분간 운동을 시킨 후 심근의 조직 및 세포학적 변화를 관찰하고 심근 세포 내 미세구조 변화를 입체해석학적으로 비교 분석하였다. 연령 증가에 따라 장기간 반복운동이 흰쥐 심근 미세구조에 미치는 영향은, 8, 15개월의 운동군과 대조군 사이에 뚜렷한 차이를 인정할 수 없으며, 15개월의 운동군에서 대조군에 비하여 변성된 사립체, 리소조옴, 지방적, 공포, 노화색소 등이 증가하는 경향이 있었다. 25개월 운동군은 같은 연령 대조군에 비하여 근원섬유 수축대, 근원섬유 소실, 윤반분리, 세포간질 증식, 핵의 변성, 교원섬유 근섬유내 침입 등 매우 심한 변화를 보였다. 조직상에 나타나는 early lipofusin과 미세구조상에 나타나는 노화색소는 8, 15개월의 운동군과 대조군 사이에 유의한 차이는 없었으며, 25개월 운동군은 같은 연령 대조군에 비하여 유의한 차이로 증가하였다. Glucose-6-phosphatase 활성도 8, 15개월군에서 운동군과 대조군에서 모두 활성이 높았으며 25개월의 대조군과 운동군에서는 모두 활성이 거의 나타나지 않았다. 미세구조 변화를 입체해석학적으로 분석한 결과 8, 15개월의 대조군과 운동군에서 체적 밀도의 모든 항은 양군 사이에 유의한 감소를 나타내었고 근형질세망의 체적밀도는 감소하는 경향을 보였다. 사립체는 대조군에 비하여 유의한 감소를 나타내었고 근형질세망의 체적밀도는 감소하는 경향을 보였다. 사립체와 근원섬유 비는 8개월 운동군에서 유의한 차이는 없지만 대조군에 비하여 높게 나타났으며, 15개월의 운동군과 대조군 사이에서는 차이를 인정할 수 없었다. 그러나 25개월 운동군은 대조군에 비하여 유의한 차이로 감소하였다. 연령증가에 따른 사립체 내막 표면밀도와 사립체수는 대조군과 운동군 사이에는 유의한 변화는 없었다. 본 연구의 성적을 검토한 결과 젊은층(3개월군)과 중령층(10개월군)의 흰쥐에서는 반복된 지구력 운동이 심장에 미치는 역효과를 인정할 수 없었으며 젊은층의 흰쥐에서는 오히려 심장기능 강화를 보이는 경향이 나타났으며, 노화층(20개월군)에서 운동군에서는 스트레스로 작용하여 심장기능의 저하를 초래 하였다고 생각된다. There is considerable current interest in the effect of regular vigorous exercise and in particular endurance-running as a possible measure in improving myocardial function. Some data indicate that the aging heart may actually suffer from vigorous endurance exercise. On the contrary, appropriate exercise in aged animals improves myocardial function and aerobic energy metabolism. So far there is relatively little data to indicate that endurance exercise is in fact beneficial in improving myocardial function or damaging to heart of aged animals. The present investigation aimed to study the possible effect of a long range treadmill training program on the heart in aging rats. Male rats aged 3, 10, and 20 months were divided at random into a control (sedentary) and an exercise group. The training group was exercised for 5 days a week on an automated treadmill for 20minutes at 18m/min over a period of 5 months. The exercise regimen of our experiments did not cause any significant changes in the tissues and ultrastructural as compared with sedentary age-matched control. Tissues and ultrastructures of myocardial cells in trained group aged 8 months are intact and well organized as well as sedentary control group. Age associated tissue and ultrastructural changes of trained group aged 15 months included : an increase in transformed mitochondria, vacuoles, lysosomes, lipid droplets and early lipofuscin. But the trained heart did not show significant difference in tissue and ultrastructural properties from those of sedentary controls. Endurance-trained group aged 25 months showed significant qualitative tissue and ultrastructural difference as compared with age-matched controls. In addition to those found in 25 months control group, focal necrosis, myofibril fraying, hypercontraction band, seperation of intercalated discs, degenerating nucleus and infiltration of collagenous fiber into myocyte were noted in trained 25 months group. The stereological examination of the micrographs disclosed no significant difference in the myofibril, mitochondrion, sarcotubule and interstitium volume density and surface density of mitochondrial cristae and numerical density of mitochondria between trained and control group aged 8 and 15 months. In the trained 25 months group, significant increase in volume density of interstitium, lipofucsin granule were shown as compared to untrained age-matched control. On the other hand, significant decrease in mitochondrion volume density was shown. The myofibril volume density did not differ between trained and control group although trained group showed slight increase. From the data obtained, a reduced mitochondria/myofibrils ratio was found in trained rat heart aged 25 months and there was no difference between trained and control rat aged 15 months. But a slight but not significant increase was found in the trained group aged 8 months as compared with same age control group. Such increase in the ratio in young animals is considered to be of great importance to cardiac pumping and adaptability. Whereas such adaptations don't seem to occur in aged heart muscle. This study proposed that repeated endurance exercise do not cause any significant qualitative and quantitative ultrastructural change of heart muscle in young(3months) and adult(10months) suggesting that the heart is able to adapt to the exercise. On the contrary, the repeated endurance exercise stress may actually induce degenerative changes in the aged heart muscle(20months).

경주국립공원 문화재지정구역의 귀화식물 현황 및 관리방안

윤정원 ( Jung Won Yoon ),신현탁 ( Hyun Tak Shin ),이명훈 ( Myung Hoon Yi ),김기송 ( Gi Song Kim ),성정원 ( Jung Won Sung ),박기환 ( Ki Hwan Park ),이창현 ( Chang Hyun Lee ),김용식 ( Yong Shik Kim ) 한국환경생태학회 2012 한국환경생태학회지 Vol.26 No.4

경주국립공원 문화재지정구역에 분포하는 귀화식물은 총 14과 40속 45종 1변종 등 총 46분류군을 확인하였다. 귀화식물을 유형별로 구별해보면, 생활형은 1년생 초본이 17분류군(37%)으로 가장 많았으며, 다년생 초본이 16분류군 (34.8%), 2년생 초본이 11분류군(23.9%), 목본이 2분류군(4.3%)로 나타났다. 원산지 별로는 유럽이 17분류군(37%)으로 가장 많았으며, 그 다음으로 북아메리카에서 이입된 종이 16분류군(34.8%)으로 나타났다. 또한 귀화도는 3등급이 18분류군(40.9%)으로 가장 높다. 귀화식물 321분류군에 대한 본 연구대상지의 도시화 지수는 14.3%이며, 지구별 도시화 지수는 남산지구가 8.1%로 가장 높다. 경주국립공원은 사적형 공원으로 문화재가 매우 중요하나, 문화재 주변의식재 및 관리 또한 중요하다. 따라서 귀화식물의 경우 장기적인 모니터링과 생태적인 특성을 파악하여 체계적인 관리방안이 요구된다. The naturalized plant species in Gyeongju National Park was summarized as 46taxa including 14 families 40 genus 45 species 1 varieties. Among them, annual herbaceous species was 17taxa (37%) which is grouped as the biggest proportion and 16taxa (34.8%) for perennial herbaceous species and 11taxa (23.9%) for biannual herbaceous species and 2taxa (4.3%) for tree species. European origin was the biggest proportion as 17taxa (37%), and 16% (34.8%) from North America. The degree of naturalization (DoN) was the biggest for Degree III, V as 18taxa (39.1%). Regarding 321 naturalized plant species, the Urbanization Index in the studied area was 14.3%. The Namsam District showed 8.1% which is the highest DoN in the studied districts within the Gyeongju National Park. As the cultural properties is important in the Gyeongju National Park as a representatives for historical sites in Korea, planting and its management in the cultural properties is important tasks. The naturalized plant species in the studied area should be reasonably management.

경주국립공원의 관속식물상

윤정원 ( Jung Won Yoon ),김용식 ( Yong Shik Kim ),신현탁 ( Hyun Tak Shin ),김기송 ( Gi Song Kim ),성정원 ( Jung Won Sung ),이창현 ( Chang Hyeon Lee ),박기환 ( Ki Hwan Park ),이명훈 ( Myung Hoon Yi ) 한국환경생태학회 2013 한국환경생태학회지 Vol.27 No.2

본 연구는 경주국립공원(남산, 토함산, 단석산)의 관속식물상을 밝히고 주요 식물들의 분포를 조사하였다. 2011년 7월부터 2012년 5월까지 총 7회 조사하였다. 조사결과 관속식물은 96과 284속 385속 4아종 41변종 6품종으로 총 436분류군을 확인하였다. 그 중 산림청 지정 희귀식물은 7분류군, 특산식물은 13분류군이다. 식물구계학적 특정식물은 41분류군으로 Ⅴ등급 1분류군, Ⅳ등급 3분류군, Ⅲ등급 9분류군, Ⅱ등급 4분류군,Ⅰ등급 24분류군이다. 한편 귀화식물은 29분류군으로 확인하였으며, 귀화율은 6.65%, 도시화지수는 9.03%이다. 조사된 436분류군의 유용도는 목초용 자원식물이 182분류군(41.7%), 식용 176분류군(40.4%), 약용 147분류군(33.7%), 관상용 52분류군(11.9%), 목재용 18분류군(4.1%), 염료용 16분류군(3.7%), 섬유용 8분류군(1.8%), 공업용 자원식물이 1분류군(0.2%) 그리고 용도가 밝혀지지 않은 식물이 79분류군(18.1%)으로 나타났다. This study was carried out to investigate the vascular flora of Mt. Nam, Mt. Toham, and Mt. Danseok in Gyeongju National Park . The vascular plants were surveyed for 7 times from July 2011 to May 2012. The results were summarized as 436 taxa, 96families, 284 genera, 385 species, 4 subspecies, 41 varieties, and 6 forms. The 13 taxa were categorized as Korean endemic plants species and the other 7 taxa as rare plants species, which categorized by the Korea Forest Service. Based on the Floristic Degrees categorized by the Specific Distribution of Plants Species, one taxa grouped as the Floristic Degree Ⅴ, 3 for Floristic Degree Ⅳ, and 9 for Floristic Degree Ⅲ, 4 for Floristic Degree Ⅱ, and 24 taxa for Floristic Degree I. The naturalized plants were recorded as 29 taxa, and their Naturalization Ratio and Urbanization Index were recorded as 6.65%, and 9.03%, respectively. 436 taxa listed consists of 182 taxa(41.7%) of pasturing plant, 176 taxa(40.4%) of edible plants, 147 taxa(33.7%) of medicinal plants, 52 taxa(11.9%) of ornamental plants, 18 taxa(4.1%) of timber plants, 16 taxa(3.7%) of stain plants, 8 taxa(1.8%) of fiber plants, 1 taxa(0.2%) of industrial plants and 79 taxa(18.1%) of unknown plants.

우심방을 침범한 거대 비호지킨씨 림프종 1예

강상범,진승원,이은경,박용현,최용호,김용주,박준철,김재형,홍순조,최규보,권종범,원용순,박건,이은희 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.4

야뇨증 환아들의 심리사회적 특성에 대한 다기관 연구 : 행동 및 정서 문제를 중심으로

조수철,김재원,신민섭,황준원,한상원,박관현,이상돈,김경도,김건석,서홍진,이유식,정재용,김영균,문두건,남궁미경,한창희,조원열,김영식,배기수,이종국,정우영,신의진 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.6

Objectives : The aim of this study was to examine the behavioral and emotional problems associated with nocturnal enuresis in Korean children. Methods : Three hundred eighteen children with nocturnal enuresis, together with their parents, completed the Child Behavior Checklist (CBCL), Disruptive Behavior Disorder Scale according to DSM-IV (DBDS), Children's Depression Inventory (CDI), State-Trait Anxiety Inventory for Children (STAIC), and Piers-Harris Children's Self-Concept Scale (PHCSC). Ninety-three normal students were selected as the control group. Results : Compared to the normal control group, the mean scores with regard to the withdrawn, social problems, attention problems, delinquent behavior, aggressive behavior, externalizing problems and total problems profiles were significantly higher in the nocturnal enuresis group according to the CBCL results. The nocturnal enuresis group also scored significantly higher in the ADHD and ODD profiles of the DBDS. The nocturnal enuresis group was more depressed and anxious than the control group according to the results of the CDI and STAI. The mean score of the PHCSC was significantly lower in the nocturnal enuresis group when compared to the normal control group. Conclusion : The results of this study suggest that children with nocturnal enuresis in Korea have clinically relevant behavioral and emotional problems. The findings support the link between nocturnal enuresis and psychopathology in Korean children.

부산.경남지역의 일부 고등학교 교사들의 물리치료에 대한 인식도 조사

김지원,박상현,주성희,김용권,안덕현,Kim, JI-Won,Park, Sang-Hyeon,Joo, Sung-Hui,Kim, Yong-Kwon,Ahn, Duck-Hyun 대한물리치료과학회 2003 대한물리치료과학회지 Vol.10 No.2

This study randomly chose 10 humanity high schools, which are located in Busan and KyoungNam province. We then examined the recognition rate of physical therapy among 378 teachers who were and still are working in the schools. 1. The recognition grade of physical therapeutics between men and women was significantly different with results of 80.7% of men and 69.7% of women(p<0.05). In the case of experiencing physical therapy, 83.6% of people said they knew the physical therapeutics and in the case of the opposite side, the result was also significantly different with a result of 67.8%(p<0.05). 2. We ranked the people on how much they knew about the physical therapeutics among men and women. With men, the actual experience of physical therapeutic came before what they heard from other people. In the case of women, what they heard from other people came first and the actual experience of physical therapeutic came after. According to the public information from Inje University, the recognition grade is recorded in the 3rd grade department as 21.5% while in the case of experiencing treatment from a physical therapist, the result was 39.1%. In the other department (the 1st grade department), what men and women heard from mass media was recorded at 17.5% and what they heard from other people, it was recorded at 33.8%(p<0.05). 3. The research about the recognition of academic ability of being a physical therapist was that 55.6% of teachers thought that 3-year-college was the best, which made the results different from the recognition grade of the experience of education(p<0.05). 4. In the recognition grade of physical therapeutics, there were significantly differences from 50.2% of men and 45.2% of women were expecting about 1mil ion won to 1.99million won. In case of 25.2% of people who have experience less than 15years at work, they expected about 2million to 2.99million won. The figures were higher than 10.1% of people who have experiences over 15years. About the recognition grade of physical therapists social level in the future is 48.8% of people who had experienced of physical therapy and 63.8% of people who never had experienced of it said it would be better in the future. From these results, the recognition about physical therapeutics and the view of its social status are optimistic and they know well about the level of academic ability of physical therapists. On the other hand, most teachers don't know exactly about physical therapists work. So we have to inform them aggressively for enhancing the recognition of physical therapy because high school students are well affected by their teachers when they face their future or major in university.

대량의 각혈로 사망한 장티푸스 1예

한상우,유진홍,권순석,김성훈,박지찬,홍은정,최경성,박용완,장준희,안지원,박유경,강지영,박상미,신완식 대한감염학회 2004 감염과 화학요법 Vol.36 No.5

We experienced a 25 year-old male patient with typhoid fever complicated with massive hemoptysis. Pulmonary complication in typhoid fever is very rare and to our knowledge, there has been no report of hemoptysis as a main cause of death with this disease. We herein report a rare case of typhoid fever.