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.

우관상동맥 개구부 완전 폐쇄가 동반된 대동맥 판상부 협착증 1례

임상현,김종진,김희열,진승원,전희경,노태호,채장성,김재형,홍순조,최규보,윤정섭,김치경 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.4

中年期婦人에서 흔히 발생하는 婦人科 疾患

金丞兆 대한가정의학회 1984 Korean Journal of Family Medicine Vol.5 No.2

미만성 대형 B-세포 림프종에서의 예후인자에 관한 연구

김삼용,곽승근,박상은,윤환중,조덕연,김진만 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

미만성 대형 B-세포 림프종은 가장 흔한 악성 림프종의 한 종류로서 우리나라에서는 전체 비호지킨 림프종의 50%를 차지한다. 비호지킨 림프종에서 병기는 호지킨병과는 달리 예후 인자로서의 유용성이 적다. 따라서 병기만을 예후 인자로서 평가하는 한계를 극복하기 위해 국제예후지표(International Prognostic Index)가 도입되었다. 특정 환자에서 IPI 점수와 함께 그 환자의 림프종의 생물학적 특성을 분석한다면 예후 예측에서 정확도가 높아질 것이다. 본 연구에서는 미만성 대형 B-세포 림프종에서 국제예후지표의 유용성을 확인하고자 하였으며, 각종 생물학적 지표의 면역화학염색을 통하여 이들을 배세포 중심 아형(germinal center subgroup : 이하 GC양 아형으로 약함)과 활성화 B-세포 아형(post-germinal center subgroup; 이후 pGC양 아형으로 약함)으로 분류하고 이들의 예후 예측에 대한 적절성을 평가하였다. 결과는 다음과 같다. 1. 연령분포는 37세에서 69세로 중앙치는 56세이었으며, 남자는 17예(65.4%), 여자가 9예(34.6%)였다. 병기는 Ⅰ, Ⅱ, Ⅲ, Ⅳ기가 각각 2예(7.7%), 11예 (42.3%), 5예(19.2%), 8예(30.8%)였다. 'B'증상은 5예(19.2%)에서 양성이었다. 진단 당시 혈청 LDH치가 상승한 경우가 11예(42.3%)였고, 거대종양(직경이 10㎝이상)을 갖는 경우가 5예(19.2%)이었다. ECOG 수행등급은 0이 2예(7.7%), 1이 18예(69.2%), 2가 5예(19.2%), 3이 1예(3.8%)이었다. 2. 면역조직화학염색 상 bcl-2의 양성은 17예(65.4%), bcl-6의 양성이 20예(76.9%)이었다. CD10이 양성인 경우가 5예(19.2%)이었다. IRF-4가 양성인 경우는 8예(30.8%)였다. 26명의 환자에서 bcl-6, CD10과 IRF-4를 이용하여 GC양 아형과 pGC양 아형으로 분류 하였는데, GC양 아형은 14예(53.8%)이었고, pGC양 아형은 7예(26.9%), 분류가 되지 않는 경우가 5예(19.3%)이었다. 3. 평균 48개월 동안 추적한 결과 중앙생존기간은 44개월이었고 생존기간은 1~100+개월에 분포하였다. Kaplan-Meier법에 의한 5년 누적 생존률은 32%이었다. 4. 병기, 'B' 증상, 혈청 LDH 농도, ECOG 수행등급, 거대종양유무가 통계학적으로 의미있는 임상적 예후 인자였다. 5. 면연조직화학염색에서는 bcl-2만이 통계학적으로 유의한 예후인자였다. 6. GC양 아형은 pGC양 아형에 비해 생존기간은 좋았으나, 통계학적 유의성은 없었다. 7. 다변량 분석결과 bcl-2 발현과 혈청 LDH치만이 예후에 영향을 미쳤다. Clinical Significanceof Expression of Biomarkers in Patients with Diffuse Large B-cell Lymphoma Diffuse large B-cell lymphoma(DLBL) is the most common type of lymphoma in Korea, representing about 50% of non-Hodgkin's Lymphomas. Although DLBL is usually considered as a specific category, the diversity in clinical presentation, morphology, genetic and molecular alterations strongly suggest that these tumors represent a heterogeneous group of neoplasia rather than a single clinicopathological entity. Clinical prognostic systems, including the International Prognostic Index (IPI), although useful to assess overall prognosis, embraces patients with heterogeneous prognoses. It is likely that the prognostic assessment of patients with DLBL might be improved by using biological features. During the last decade, most studies dealing with the heterogeneity of DLBL have focused on individual protein expression and molecular alterations. The expression of individual antigens related to different stages of B-cell differentiation, including CD10, bcl-6, and IRF-4, may help to define groups of tumors with different clinical and pathological characteristics. To determine the clinical significance and prognostic value of individual biomarker expression and the biomarker expression patterns according to germinal center subgroup or post-germinal center subgroup of DLBL as defined by a relatively small number of single antigens, we studied 26 patients with de novo DLBL, whose archival pathology specimen were available for immunohistochemistry studies, atChungnam National University Hospital from September 1992 to December 2000. Archival specimens from each patient were immunostained with respective antibodies for CD10, bcl-6, IRF-4, bcl-2 antigens. Two immunophenotyping profiles were distinguished according to the pattern of differentiation; germinal center(GC;CD10/Bcl-6+/IRF-4-) subgroup or postgerminal center (pGC ; CD10/bcl-6/IRF4+) subgroup. The results are as follows; 1) Baseline characteristics of patients were ; median age of patients was 56(range ; 37-69). 17 patients(65.4%) were male. 5 patients(l9.2%) had 'B' symptoms. Stages were as follows ; stage Ⅰ2 patients(7.7%), stage Ⅱ 11 patients(42.3%), stage Ⅲ 5 patients(l9.2%), stage Ⅳ 8 patients(30.8%). 11 patients (42.3%) had elevated LDH levels. 25 patients(96.2%) had ECOG performance grade 0-Ⅱ and 1 patient had grade Ⅲ. 5 patients(l9.2%) bad bulky disease. 2) The results of immunohistochemical study were as follows ; positive bcl-2 staining in 17 patients(65.4%), positive bcl-6 in 20 patients(76.1%), positive CD10 in 5 patients(l9.2%), positive IRF-4 staining in 8 patients (30.8%). 3) After a median follow up duration of 48 months, the median survival duration was 44 months with a range of survival of 1-100+ months. 5-year overall survival rate was 32% by Kaplan-Meier method. 4) The clinical factors affecting survival were elevated serum LDH level, B symptoms, bulky disease, stage at diagnosis and ECOG performance status 5) Among the biomarkers, only bcl-2 expression affected survival of DLBL patients 6) The germinal center like subgroup had superior survival than post-germinal center like subgroup but had no statistical significance. 7) Multivariate analysis showed that bcl-2 and serum LDH level had siginificance on survival Conclusion In addition to the known clinical prognostic factors, immunohistochemically defined characteristics such as bcl-2 expressionin DLBL is important and subgroups(germinal center or post-germinal center subgroup) of DLBL may have importance in predicting prognosis of DLBL patients

부산시 가로수 현황과 토양환경개선에 관한 연구

김석규,박승범,남정칠,김승환,강영조 동아대학교 건설기술연구소 1999 硏究報告 Vol.23 No.2

The purpose of this study is to analyze the correlation between soil hardness, soil acidity, and the vitality of street trees. This data was investigatived in 40 areas on 10 main street routes of Pusan; Chungang-ro, Naktong-ro, Suyeong-ro, Taejong-ro, Konghang-ro, Kudeok-ro, Kumjeong-ro, Mandeok-ro, Kaya-ro, Chungjang-ro. The findings are as follows : 1. The average soil hardness where tree grates have been built was shown to be 22.23㎜. In the absence of tree grates, the average soil hardness was 24.60㎜. These figures do not exceed the accepted parameters for acceptable soil hardness when rearing trees (22∼25㎜). However, soil hardness was measured higher in areas where tree grates were absent. Consequently, tree grates are necessary. 2. Soil acidity was measured as satisfactory(pH 5.5), mediocre(pH 5.5∼5.0), inferior(pH 5.0∼4.5), very inferior(pH 4.5). No areas were measured as satisfactory soil acidity. Four areas were measured as mediocre(10%), 19 areas as inferior(47.5%), and 17 areas as very inferior (42.5%). This indicates a requirement to improve soil acidity as about 90% of the investigatived areas were measured as either inferior or very inferior. 3. The following is an analysis of correlation between soil hardness, soil acidity and the vitality of the Ginkgo biloba ; The Ginkgo biloba was found to have a positive correlation was measured with the diagram (R²). In conclusion, the results of the analysis show a strong influence of soil hardness and soil acidity upon the vitality of Street Tree.

비만과 정상체중 여고생의 영양섭취 비교 연구

조현숙,김세종,최승욱,백영호 釜山大學校 附設 體育科學硏究所 2005 體育科學硏究所 論文集 Vol.21 No.2

The purpose of this study was to compare the obese and the normal weight girls in high school on the level of the recommended dietary allowances for the Koreans based on total energy intake, the ratio of 3nutrients intake, micro-nutrients intake, daily dietary intake and the ratio of 4nutrients intake by animality and vegetability. The results of this study are as follows:...............

麗水시 交通 隘路區間 交叉路의 信號體系 改善에 關한 硏究

김승혁,조길환 여수대학교 1997 論文集 Vol.11 No.2

The survey of traffic amount for the analysis of the traffic problems was done throughout Yosu's main principal streets and cross roads. Traffic amount was counted during peak time. The traffic amount was analyzed with HCM's service level analysis. The result tells that the traffics in Dongmoonro street, influx and efflux point of Hanjae Tunnel, and the street in front of Beach Hotel are very disorder. The traffics on Jungangro street, Mipyengro street, Kwangmuro street are quite delayed. As the result, most of street will be much confused unless there will be no construction of new road or improvement of traffic control applications. Also, the service level of the cross road is used by TRANSYT-7F model, so we analyzed the density of each cross road and a time lag by HCM method. I used these models to assume the maximum service of each crossing road.

부인과 영역의 오진(誤診)

김승조 大韓法醫學會 1991 대한법의학회지 Vol.15 No.2

The type of misdiagnosis in gynecological diseases can characteristically derived from various sorts of technical and analogic errors dealing with various informations from menstrual disorders, infertility, abnormal vaginal bleeding, infections, neoplasms, pregnancy related disorders, congenital anomalies, pelvic pains, and psychosomatic diseases, it is important that misdiagnoses are not less often be fatal in gynecological than in other patients. It's because the diseases themselves are mostly related with hemorrhage, septic infection and pregnancy related immune deficiency. Recently, there have appeared so many mordern untrafashionable medical instruments which can dramatically reduce the misdiagnoses such as ultrasonography, and MRI etc. and otherwise physicochemical methods. In our neighborhood, however, we can see so many occasions with negative aspects of medical environment including misdiagnoses, medical accidents and medicolegal conflicts. As a fundamental reason, negligence to develop abilities that human can achieve in the power of attention and concentration to reduce errors can easily be considered. Another important thing for medical doctors to make misdiagnosis is failure in maintaining a good para-medical human relationship, the rapport and the cooreariton with the patients. Furthermore, indirect influences deriver from so many unreasonable political and medicososcial environments such as restricting medical insurance systems which can cause down regulation of the quality of medical treatment must be corrected or abolished, and , on the other hand, establishment of national political and socioenvironmental atmosphere to secure the adequate treatment will also be important to reduce misdiagnosis.

일방향응고 초내열합금 CM186LC의 크리프 및 저주기피로 균열생성

趙昌龍,金豆炫,崔承柱,徐晟文,李在鉉 창원대학교 공작기계기술연구센터 1999 연구업적집 Vol.1 No.1

The second generation DS alloy CM186LC has comparable creep-rupture life to first generation single crystal alloys CMSX-2 and CMSX-3 in the as-cast and double aged condition. In the assembly of nozzle guide vanes, Ds components are joined into pairs by brazing. In order to study mechanical behavior of the material at the same condition as production, DS bars were subjected to brazing simulated treatments. Compared with standard treatment a small drop in creep-rupture life was observed but the degree of fall in life was not serious. Creep cracks initiated at the transverse components of the grain boundaries, which were normal to the applied stress direction. Every crack was associated with the v-v' eutectic phase at grain boundaries v-v' eutectic was not only located at grain boundaries but also in the interdendritic regions. It also acted as crack initiation site during creep. Low cycle fatigue tests were conducted under fully reversed trapezoidal strain wave at a frequency of 0.25Hz. The depth of the LCF cracks at the surface was comparable to that of the secondary dendrite arms from the surf-ace of the specimen. Cracks initiated at all of the interdendritic regions exposed at the surface, especially at the v-v' eutectic phase. LCF crack initiation and propagation are therefore proposed to be microstructally dependent.

애견 추모 공원 계획안

김도경,조용철,김승현 경희대학교 디자인연구원 2004 예술· 디자인학연구 Vol.7 No.1

This paper is master plan for pet memorial space lacking of social-understanding and legislation. Therefore instances of domestic and foreign country and investigation of laws are studied, also memorial space of human is studied for pet-memorial space is not to be planned as a cremation ground and crypt. Also, research on pet related business has a connection with this plan. As problem of reasonableness of business, this paper is planned pet memorial space with other pet business. But according to domestic social-condition is advanced, pet memorial park of large scale will be constructed.