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.

김치유래 젖산균의 균체지방산 분석을 이용한 분류학적 연구

이정숙,정민철,김우식,이근철,김홍중,박찬선,이헌주,주윤정,이근종,안종석,박완,박용하,민태익 한국미생물생명공학회 ( 구 한국산업미생물학회 ) 1996 한국미생물·생명공학회지 Vol.24 No.2

표준균주를 포함한 230여개의 김치유래 젖산균에 대한 균체지방산(FAMEs)을 분석하였다. FAMEs profiles는 Euclidian Distance 17.5에 의해 7개의 Major Cluster와 1개의 Single Cluster로 나뉘어졌다. 이중 A, B, C 및 Cluster는 Leuconostoc속으로 분석되어졌고, F는 Lactobacillus속으로 분석되어졌다. 그리고 E와 G cluster는 두개의 Genus가 혼재되어 나타났으며 보충적인 연구가 필요하다. 앞으로 김치유래 젖산균의 균체지방산 분석결과를 기반으로 한 데이타베이스에 95가지 탄소원을 이용하는 수치분류학적 접근방법 및 Pyrolysis Mass Spectrometry 등의 화학적 분석 방법과 분자친화적 연구를 통한 종합적 분류정보 체계가 갖추어지면 젖산균의 신속, 정확한 동정 및 연구에 활발히 이용되어질 것이다. Two hundreds and thirty lactic acid bacteria, mostly isolated from Kimchi, including type strains were sued for analysis of cellular fatty acids. The 230 test strains were recoverd in 7 major and 1 single clusters defined a Euclidian distance of 17.5. These aggregate taxa were equivalent to the genus Leuconostoc (aggregate group A, B, C and D), and the genera Leuconostoc and Lactobacillus (aggregate group G). It is concluded as evident that FAMEs (Fatty Acid Methyl Esters) profile of cell can be used as a criterion in classification of lactic acid bacterial from kimchi. Additional comparative taxonomic studies need to be carried out on well chosen representative strains to determine the most appropriate methods of value.

Monocyte Chemoattractant Protein-1[MCP1] -2518 유전자 다형성과 주요 우울장애

배치운,이지현,신윤경,김태석,김정진,이창욱,이수정,전태연,이철,백인호 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.4

Object : This study was designed to examine the association between monocyte chemoattractant protein-l (MCPl) -2518poly morphism and major depressive disorder (MDD). Methods : Ninety patients with MDD and 114 healthy controls participated in this study. Genotyping was performed by the polymerase chain reaction-restriction fragment length polymorphism method. Results : Genotype and allele distributions in patients with MDD were significantly different from those of the controls, In particular, subjects with the allele A were found to have an increased risk of MDD. Conclusion : The present study suggests that the MCPl -2518 polymorphism may have a potential role for susceptibility to MDD in the Korean population and thus calls for consecutive studies in order to pile up the data with larger different ethnic background.

위절제술 환자의 표준진료지침 개발 및 적용 효과

김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.

양극성 장애와 Monocyte Chemoattractant Protein-1 유전자 다형성

배치운,김태석,장우영,김정진,이창욱,이수정,전태연,이철,백인호 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.5

Objectives : Several studies suggested that cytokines could be involved in the pathogenesis of mood disorders, while data for bipolar disorder is relatively deficient (BD). BD, Knowned to have a inherited tendency, has been considered to be related with T-helper cell system. This study was designed to investigate the association between polymorphism of monocyte chemoattractant protein-1 (MCP1) gene at promoter-2518 and BD. Methods : Patients with BD (n=92) in accordance with DSM-FV criteria and control subjects (n=114) participated in this study. DNA was extracted from whole blood and the MCP-1 gene promoter region was amplified by polymerase chain reaction-based method. Results : Genotype and allele distributions in patients with BD were not different from those of control subjects (p=0.587 ; p=0.384). Genotype and allele distributions in accordance to presence or absence of suicide attempt (p=0.423), family history (p=0.733) and psychotic feature (p=0.436) were not different between the two groups. Conclusion : Present study suggests that the MCP1 promoter -2518 polymorphism may not affect the susceptibility and clinical diversity of the development of BD.

급성 심근경색 : Gd-DTPA 조영증강 자기공명영상 Gd-DTPA Enhanced Magnetic Resonance Imaging

정경일,김제현,이창호,이영주,김한수,소동문,이영돈,박경주,왕희정,탁승제,이철주,김선용,김옥화,임태환,문창현,최병일,서정호 아주대학교 의과학연구소 1996 아주의학 Vol.1 No.1

This study was undertaken to determine the value of gadolinium dimeglumine (Gd-DTPA) enhanced MRI in the diagnosis of acute myocardial infarction. Seven cats were subjected to 2 hours of left anterior descending coronary arteryocclusion (group 1) and 8 cats to 1 hour of occlusion (group 2). Reperfusion was followed by taking Tl-weighted MR images at 5, 15, 30, 45, 60 minutes after Gd-DTPA (0.2 mmol/kg) injection. Myocardial enhancement patterns were categorized into three zones (central ischemic, peripheral ischemic, and normal) or two zones (ischemic and normal) and the presence of injured myocardium in each zone was confirmed by 2,3,5-triphenyltetrazolium chloride (TTC) staining. Signal intensity (SI) of each zone was evaluated relative to back muscle in regard to its chronological changes and difference among the zones. Group 1 displayed three zones of enhancement in 6 cats whereas 1 cat in group 1 and all in group 2 showed two zones of enhancement. Intermediate SI central zone was compatible but smaller than TTC nonstained area, and determined to be a persistently occlusive injury. High SI peripheral zone in group 1 and high SI ischemic zone in group 2 were stained and determined as reperfused injury although reversibility was not definite. The peak SI, occurring 15 minutes after Gd-DTPA injection, of 2.47±0.48 at peripheral zone was greater than that of 1.66±0.36 at central zone in group 1 and of 1.81±0.41 at ischemic zone in group 2 (p < 0.05). SI of injured myocardium increased more rapidly and decreased more gradually than that of normal myocardium. That the features of SI change with time in injured myocardium was compatible with the results of other studies using different contrast agents. Gd-DTPA enhanced MRI differentiated persistently occlusive injury as central intermediate SI, and reperfused injury as homogenous high SI, with the maximal contrast between the two at 15 minutes after contrast injection, thus indicating the value of Gd-DTPA enhanced MRI in the diagnosis of acute myocardial infarction.

Multi-media and multi-pathway aggregate exposure assessment for polycyclic aromatic hydrocarbons to the inhabitant in Tae-an county after Hebei-spirit oil spill

Kim Chan-Kook(김찬국),Woo-Chul Jeong,Jonil Hur,Pan-Soo Park,Tae-Woo Lee,Hwi-Soo Seol,Jung-hyeon Park,Jong-Heop Lee,Jong-Ho Kim,Byeong-Kyu Kwak,Jong-Hyeon Lee 대한직업환경의학회 2010 대한직업환경의학회 학술대회 논문집 Vol.45 No.-

Mycobacterium fortuitum-chelonei complex 균체항원의 민감성과 특이성

이현우,최철순,정상인,양용태 중앙대학교 의과대학 의과학연구소 1985 中央醫大誌 Vol.10 No.1

Antigenic preparations were made from seven strains of Mycobacterium fortuitum-chelonei complex(MFCC) extracted with phosphate buffered saline(PBS extracts), with 10%, trichloroacetic acid solution (TCA extracts) and with veronal buffered saline solution containing 0.1% Triton X-100(Triton extracts). Serologic reactivities of the antigenic preparations were assayed for immune precipitation by Ouchterlony double diffusion in-gel technique against antisera of rabbits immunized with M. fortuitum TMC 1529 and M. chelonei TMC 1544. Antigenic relationships between Triton extracts of M. fortuitum and M. chelonei were analyzed by two-dimensional immunoelectrophoresis(2D-IE) and fused rocket immunoelectrophoresis(FRIE). The results obtained are summarized as follows: 1. Of antigenic preparations of PBS extracts, TCA extracts and Triton extracts, the Triton extracts and the PBS extracts proved to be active for immune precipitation, but the TCA extracts was inactive. The precipitation reaction of Triton extracts was more sensitive than PBS extracts, and the precipitation reaction of Triton extracts was enhanced by disintegration of cells with sonification, but the cross reaction was also increased. 2.' The Triton extracts of 5 strains of M. fortuitum exhibited 9 common precipitinogens with reference serum against TMC 1529 and one common precipitinogen with reference serum against TMC 1544. but the antigens of TMC 1544 with or without disintegration of cells gave a specific precipitinogen with reference serum against TMC 1544 in addition to a common precipitinogen. 3. Although the electrophoretic patterns of Triton extracts obtained from different strains and species were not demonstrated, 7 strains of the MFCC could be divided into four groups by the relative electrophoretic mobilities(REM) of the antigens with respect to bovine serum albumin(REM value); group Ⅰ(REM =0.18) 2 strains, group Ⅱ(REM = 0.27) 2 strains, group Ⅲ (REM = 0.38) 2 strains and group Ⅳ(REM = 0.49) 1 strain, but the existence of any significant relationship between the REM value and species was not recognized. 4. By means of FRIE, the presence of 3 to 5 common precipitinogens and 1 to 2 species-specific precipitinogens were observed in the Triton extracts of M. fortuitum and M. chelonei. 5. By the use of the reference antisera with a titre of at least 1 : 80 against M. fortuitum TMC 1529 and M. chelonei TMC 1544, the strains of M. fortuitum and M. chelonei could be differentiated by FRIE. In conclusion, this study established that the Triton extracts of the MFCC proved to be active for immune precipitation and contained species-specific procipitinogens, and reproducible amounts of such an antigen for immunodiffusion test could be easily prepared with one plate of heavy cultures.

인체지방기질세포를 통한 척수 손상에 대한 신경학적 회복

이태훈,신철호 남서울대학교 2010 남서울대학교 논문집 Vol.16 No.1-1

중추신경계 질환의 회복은 손실된 세포재생, 손상된 수초대체, 기능적 재연결을 담당하는 척추중추신경계의 제한적 기능으로 인해 저해된다. 중추신경계 질환의 치료방법으로 줄기 세포 이식은 기능적 결함을 감소시킬 수 있는 중요연구 과제로 부상하고 있다. 본 연구에서는 척수 손상된 백서에 인체지방기질세포의 이식을 통한 효과를 검증하는데 목적을 둔다. 척수 손상은 흉수신경 9번째와 10번째에서 혈관용 클립을 통해 유발되었으며 척수 손상후 7일후에 지방기질세포의 이식을 시행하였다. 척수 손상된 동물 모델에 CM-Dil로 염색된 지방기질세포를 이식하게 되면 척수 손상부위에 지방기질세포들이 채워질 것으로 추측된다. 또한 지방 기질세포로 이식한 동물에서 행동측정지침인 BBB 측정값이 높으며 척수 손상 정도가 조직학적으로 감소될 경우 이식한 지방기질세포들이 신경세포나 성상세포로는 분화되지는 않을 경우로 간주될 것이다. 예상한 결과들은 지방으로부터 분리된 기질세포가 신경자극인자들을 분비하거나 손상부위의 조직과 직접적으로 접촉함으로서 기능적, 행동적 향상에 기여한다고 볼 수 있다. 본 연구 결과는 척수 손상 치료에 지방기질세포의 임상적 응용 가능성을 제안한다. 핵심용어 : 중추신경계, 척수 손상, 인체지방기질세포

Heparin이 망내계세포에 미치는 영향에 관한 초미형태학적 연구

이동철,김중길,임정교,손윤경,서인수,손태중 慶北大學校 醫科大學 1991 慶北醫大誌 Vol.32 No.3

저자들은 heparin 투여후 세망내피계의 초미형태학적 변화를 관찰하기 위해 Sprague-Dawley계 숫쥐에 heparin과 endotoxin을 투여한 후 비장을 채취하여 실험에 이용하였다. 실험군은 heparin 전처치군과 heparin 후처치군으로 나누었으며 비교군으로 heparin 단독투여군과 endotoxin 단독투여군을 설정하여 각각을 투약후 비장을 채취하여 광학현미경 및 전자현미경적 검색을 실시하였다. 실험결과를 요약하면 heparin 단독투여군은 대식세포, 형질세포양 림프아구 및 다핵백혈구가 증가되었고, 대식세포의 탐식능도 항진되었다. 그러나 대식세포자체의 소기관 발달은 현저하지 않았다. Endotoxin 단독투여군은 시간이 갈수록 대식세포의 탐식능이 저하되고, 파괴가 증가되어 수가 감소하였다. 미소혈전이 자주 관찰되었으며 기타세포들의 파괴가 관찰되었다. Heparin 전처치 및 후처치군은 공히 endotoxin군에 비해 대식세포 탐식능이 증가되었다. 이상의 성적으로 보아 heparin의 망내세포에 대한 영향은 주로 대식세포의 탐식능과 수의 증가로 생각되며 이는 정상 및 병적상태 모두에서 일어난다고 생각된다. 또한 ET 투여 전후 heparin을 투여한 실험군에서 공히 대식세포 탐식능이 증가되었으므로 이는 ET shock 후 조직손상으로 분비되는 세망내피계 저하물질에 대해 heparin이 길항작용을 할 것으로 생각된다. 또한 heparin의 대식세포 탐식능항진에 대한 효과는 세포의 직접적인 자극이라기 보다는 탐식과정중 특히 oposonization에 효과를 미칠 것으로 생각된다. The authors studied an ultrastructural changes of reticuloendothelial system after administration of heparin. Male Sprague-Dawley rats were examined after administration of heparin and endotoxin. The experimental groups were divided into heparin pretreated groups and heparin posttreated groups. The control groups were divided into heparin-only groups and endotoxin-only groups. Each animals were sacrificed and spleens were extirpated and examined by light and electron microscopy. The results obtained were summarized as follows: Heparin-only groups showed proliferation of macrophages, lymphocytes and neutrophils. The phagocytic activity of marcophage is enhanced. The cytoplamic organellar change is not remarkable except increase of secondary lysosomes. Endotoxin-only groups showed decrease of phagocytic cells. The phagocytic activity is also depressed. Destruction of macrophages and other cells are noted. Microthrombi are frequently seen. Both heparin pretreated and heparin posttreated groups revealed relative enhancement of phagocytic activity compaired to endotoxin-only groups. From the result of the experimental study, it appears that the effect of heparin on the reticuloendothelial system is enhancement of phagocytic activity of macrophages both in the coditions of normal and pathologic one. And it also suggests that heparin may act as an antagonizing factor to the reticuloendothelial depressing agent that may be derived from injured organ of endotoxin shock. And the effect of heparin to the phagocytic activity of macrophage may be related to the process of phagocytosis such as opsonization or to the direct cellular stimulation.