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.

慢性胃炎 患者에서의 Aclatonium napadisilate (Aclaton^(�))의 治療效果

尹容範 최신의학사 1986 最新醫學 Vol.29 No.7

광조사 방법에 따른 치과용 심미수복재의 중합수축

윤태호,이용근,임범순,김철위 대한치과기재학회 2000 대한치과재료학회지 Vol.27 No.4

Dental resin composites were introduced commercially in the mid-1960s for the restoration of anterior teeth. Since their advent, resin composites have undergone significant development, which continues to improve the longevity and application of resin composite restorations. Despite the development of new dentin-bonding agents, no system is currently available that completely withstands the formation of contraction gaps at the cementum/dentin-restoration junction, due to the unavoidable polymerization shrinkage of the resin composite during setting, therefore, a major aim of this study was to minimize or control the polymerization shrinkage of composites allowing flow of resin during setting reaction. A thermal dilatometer (DIL 402C, TASC 414/3A Controller, Netzche, Germany) was used to measure and compare conventional continuous cure and pulse cure polymerization shrinkage of seven light curing dental composites and three compomers. For conventional cure, restorative material were polymerized for 2 minutes using VIP (Bisco, U.S.A.) with 400 ㎽/㎠ intensity. After then, further polymerization was allowed for next 12 minutes that total 14 minutes of shrinkage was measured. For pulse cure, material was pre-polymerized irradiating light for 5 seconds with 200 ㎽/㎠ and post-ploymerized 3 minutes later with 400 ㎽/㎠ for 2 minutes. 9 minutes were allowed for further polymerization that total 14 minutes of shrinkage was measured. Polymerization shrinkage ranged from 3.758 ㎛/㎜ (SYC) to 6.897 ㎛/㎜ (P60) for conventional cure and 4.026 ㎛/㎜ (FLT) to 6.996 ㎛/㎜ (SRF) for pulse cure. The highest difference between the two methods was found at EAN (2.713 ㎛/㎜), followed by F20 and CRA which showed significant differences of 2.133, 1.274 ㎛/㎜ respectively (p<0.05). The least difference was found at SYC (0.489 ㎛/㎜). Universal resin composite group showed the highest polymerization shrinkage (6.514±0873 ㎛/㎜), and flowable composite showed the least shrinkage (4.139 ㎛/㎜). Packable composite showed 5.090±1.906 ㎛/㎜, and compomers showed 6.129±2.652 ㎛/㎜.

광원의 종류에 따른 콤포짓트레진의 중합도

윤태호,이용근,임범순,김철위 대한치과기재학회 2001 대한치과재료학회지 Vol.28 No.1

콤포짓트레진의 중합도와 속도는 광원의 종류와 광조사 시간에 따라 영향을 받는다. 현재 할로겐 램프를 중합에 많이 사용하고 있으나 전구의 수명이 짧고, 시간경과에 따라 광선의 출력이 감소하므로 중합도는 낮아져 물성이 감소하고 수복물이 실패할 가능성도 높다. 이를 개선하기 위하여 콤포짓트레진 중합에 사용할 수 있는 LED (blue light emitting diode) 와 플라즈마 아크 기술이 소개되었다. 이 실험에서는 3 종의 광원(할로겐 램프, LED 및 플라즈마 아크) 에서 광조사시간을 달리하여 광에너지의 총량을 변화하는 조건으로 점주도가 서로 다른 3 종의 콤포짓트레진에서 깊이에 따른 중합도를 측정하여 각 광원의 효율성을 상호 비교하였다. 할로겐 램프, LED 및 플라즈마 아크 조사기로 광에너지 총량이 각각 8J/㎤와 16J/㎤ 이 되도록 중합하고 표면에서 1, 2, 3 및 4mm 위치에서 100㎛ 의 두께로 절단하였다. 시편 두께가 50~70㎛ 가 되도록 연마하고 FT-IR 로 표준기선법에 따라 중합직후의 중합도를 측정하였다. 중합방법 및 광조사 부위에서 깊이에 따른 평균 중합도를 계산하여 3 원 분산분석 및 Scheffe 의 방법에 따라 유의수준 0.05 에서 검정하였다. 이 실험에서 다음과 같은 결과를 얻었다. 재료, 깊이 및 광조사 시간 모두 전환율에 유의한 영향을 주었다(p〈0.01). 3 종 광원의 표층에서 1mm 깊이에서의 중합도는 저점도(RVN) 〉중점도(Z25) 〉응축형 콤포짓트레진(SRF) 순이었다(p〈0.05). 3종 광원의 중합도는 유의한 차이를 볼 수 없었다(p〉0.05). 3종의 조사광원 모두에서 광에너지 총량을 2배로 증가한 경우, 중합도는 2mm 깊이까지는 유의한 차이가 없었으나(p〉0.05), 3mm 부터는 광에너지 총량 증가에 따라 유의하게 증가하였다(p〈0.05).

알콜精神病患者에 對한 臨床的 硏究 : 幻覺內容을 中心으로

尹昌範,高診富,嚴龍燮 大韓神經精神醫學會 1976 신경정신의학 Vol.15 No.2

The author studied mainly the hallucinated phenomena of the 15 alcoholic psychotics who were hospitalized in Dept. of Neuro-Psychiatry, of Medical college, Chosun University, from October of 1972 to October of 1975. The following conclusions were obtained from the studies. 1) In general distribution of age, the average of the alcoholic psychotics was 40.5 years, with a range from 35 to 43 years. The range of age is significant, the alcoholic psychotics being a much more homogenous group. The rate of males to females among the alcoholic psychotics was 15 to 0. 2) This report will concern data from a group of 9 patients (60%) who were diagnosed as Delirium tremens and from 4 patients who were diagnosed as having Alcoholic Hallucinosis (25%) without schizophrenia and from 2 Patients (13%) of Korsakoff's psychosis who is less than others. 3) Alcoholic psychosis is the special disease of men in Korean society but not less and it is the most part in the lower class of the educational, socio-cultural level and the lower income class. 4) Their average of drinking capacity of a day is the 2 bottles (which is filled with 2 HOB) of SOJU (spirits) and 2-3 DOI of MAKOULLI, howerever they used not to get some eatables. 5) I found the light tremulousness (80%), insomnia (93%), night-mare or vivid dreams (53%), itching (47%), retching (33%), sweating (13%), seizure (27%) and blurred vision (20%) to be part of the alcoholic withdrawal syndrome. 6) The most frequent incidence was in the formed visual hallucinations (80%), followed by the formed auditory hallucinations (60%) and haptic hallucinations (58%). 7) In the contents of visual hallucinations, the bug, flea and snake are the most part but few seen the case of a rat. The contents of visual hallucinations in western people is the snake and rat which is the most part, such a difference between western and oriental people should be taken into account of the comparative cultural aspects. 8) Alcholic psychotics gave more responses regards as persecutory and every day affairs. 9) Alcoholic psychotics perceived the phenomena externally to any extent. 10) Alcoholic psychotics frequently thought that the hallucination was real at the time of it's appearance but later in the recovery period expressed recgnition of it's unreality and alcoholic psychotics behaved negatively or ambivalently in majority of cases.

정류고환에서 고환하강위치에 따른 M llerian Inhibiting Substance의 발현정도

이충범,이경준,조용현,조대행,윤문수 大韓泌尿器科學會 1998 Korean Journal of Urology Vol.39 No.2

공동주택의 에너지 절약 및 공기환경개선을 위한 열교환기의 성능평가

김범석,정용호,박병윤,손장열 대한건축학회 2003 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.23 No.1

This study was aimed to suggest the appropriate residential heat and moisture recovery ventilation systems(HRVs) in order to maintain an acceptable indoor air quality for the climatic conditions of Korea. This study was developed from experimental data on HRV Performance specifications and HVAC system. Results show that total heat exchangers of rotary type is applied on HVAC system that is possible to conserve energy and improve indoor air quality.

치과용 합금의 부식성에 관한 연구

임범순,이용근,윤숙진,김철위 大韓齒科器材學會 1995 대한치과재료학회지 Vol.22 No.1

Corrosion of dental alloys in the oral cavity can affect the mechanical, esthetic properties and efficiency of metallic restorations, and has great influence upon the local and systemic health of patients. The purpose of this study was to clarify the corrosion behavior of various dental alloys, and to measure the galvanic currents between dissimilar alloys. Fifty-eight kinds of dental casting alloys such as twenty-nine high gold alloys, ten low gold alloys, fourteen silver-palladium alloys, five base metal alloys, and twenty kinds of ceramic alloys such as seventeen noble metal alloys, three base metal alloys, were used as the experimental alloys. Modified Fusayama's artificial saliva titrated to pH 6.7 with phosphoric acid was used as an electrolyte. The specimens were immersed in the modified artificial saliva of 37℃. The rest potentials, anodic polarization curves, corrosion potentials, and galvanic currents were measured by using the potentiostat / galvanostat and zero shunt ammeter. From the experiment, the following results were obtained : 1) The gold based alloys showed the high rest potentials and the low current densities within experimental potential range. 2) The rest potentials and the current densities of the palladium-based alloys were influenced by the content of platinum, palladium, and silver. 3) In the nickel-chromium base alloys, the formations of passivation film were influenced by chromium content. The copper-aluminum alloy showed very high current density which was more than 150 mV . 4) The corrosion potentials of ceramic alloys were lower than those of dental casting alloys, but the trend of anodic polarizations were generally similar to the other alloys. 5) The amount of galvanic current and the polarity in the bimetallic galvanic cell could not be predicted considering only the alloy composition. The galvanic current decreased while the measuring time passed, but flew continuously.

기본 항암 화학요법에 불응 하는 전이성 이행상피 세포암 환자에서 시행한 증량 M-VAC 항암 화학 요법 2례

조용현,권병산,이지열,김세웅,이충범,윤문수 대한화학요법학회 1997 대한화학요법학회지 Vol.15 No.3

1. 목적 전이성 방광 이행 상피 세포암의 경우에 시행될 수 있는 몇가지 전신적 항암 요법 중 M-VAC 병용 투여가 가장 인정받고 있는 항암 요법이긴 하나 일시적 반응 후 재발시 즉 M-VAC 병용투여에 불응하는 경우 증상 완화 요법(palliative therapy) 이외에 다른 치료 방법이 없었다. 저자들은 M-VAC 병용 요법에 불응하는 전이성 방광 이행상피 세포암 환자 2례에서 기존 M-VAC 항암 화학 요법보다 항암제 투여량을 증량한 M-VAC 항암 요법을 시행하였다. 2. 방법 기존 M-VAC 항암 화학요법용량(Methotrexate 30㎎/㎡, Vinblastine 3㎎/㎡, Adriamysin 30㎎/㎡, Cisplatin 70㎎/㎡)보다 항암제 용량을 증량하고(Methotrexate 30㎎/㎡, Vinblastine 4㎎/㎡, Adriamycin 60㎎/㎡, Cisplatin 100㎎/㎡) 이로 인한 골수 저하증을 예방하기 위하여 GM-CSF를 동시에 투여하였다. 3. 결과 증례 1 환자는 중량 항암 화학 요법 1개월 후 추적검사에서 전이된 임파절이 모두 소실된 완전 관해를 보였으며 증례 2 환자는 증량 항암 요법 후 14일째 폐혈증으로 사망하였다. 4. 결론 증량 M-VAC 항암 화학 요법은 아직 시행 기간 및 증례가 많지 않아 완전 관해 기간 및 적절한 항암요법 시행 횟수의 미확립, 항암제 치료 도중의 치사율의 감소등이 문제점으로 지적되고 있으나 기존 M-VAC 항암 요법에 불응하는 전이성 방광이행 상피 세포암 환자에서 우선 고려될 수 있는 치료법으로 사료된다. Background : M-VAC(methotrexate, vinblastine. doxorclbicin, cisplatin) chemotherapy is the most common and effective treatment modality for advanced transitional bladder tumor. However, there is no effective therapy in case of the patients nith bladder tumor refractory to M-VAC chemotherapy. Methods : Two male patients mith metastatic transitional bladder tumors refractory to conventional chemotherapy with methbtrexate, vinblastine, doxorubicim, and cispiatin (M-VAC) were treated with escalate3 dose of M-VAC plus recombinant human granulocyte-macrophage colony stimulating factor (rhGM-CSF). Formula of escalated M-VAC chemotherapy were 30mg/m^(2) of inethotrexate, 4mg/m^(2) of vinblastine. 60rmg/m^(2) of doxorubicm, and 10Omg/m^(2) of cisplatin, and 250mg/m^(2) rhGM-CSF per day administered subcutaneously (SC) for 10 consecutive days. Result : One of the treated patients mas responded with complete remission and the other one m-as dead by sepsis on post-escalated M-VAC chenctherapy 14 days. Coclusion : We believe escalated M-VAC chemotherapy may be one of the effective alternative treatment for patients with metastatic urothelial tumor refractory to conventional M-VAC chemotherapy.

사례기반 추론을 이용한 공정설계

서윤호,고범석,김용태 울산대학교 2002 공학연구논문집 Vol.33 No.1

This paper introduces a method to automate process design using Case Based Reasoning technique. Particularly, the function-behavior-structure model is used to represent a process plan as a case. Specifically, a case retrieval algorithm to use function and behavior, case adaptation knowledge definition by using neural network technique, and a machine selection method are presented.