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.

肝카필라리아症(Hepatic Capillariasis)에 있어서 卵周圍 沈降反應에 관한 實驗的 硏究

金正俊,李駿商,林漢鍾 고려대학교 의과대학 1982 고려대 의대 잡지 Vol.19 No.1

The present study was undertaken to investigate the circumoval precipitation (COP) reaction of Capillaria hepatica. The source of C. hepatica eggs was the deposit of nonembryonated eggs encapsulated in the liver of the house rat. The eggs were embryonated in the incubator at 27℃ to 30℃ for four to five weeks. Rat was infected orally with 2,000 embryonated eggs. Blood collections were made by the cardiac puncture after infection of C. hepatica for 10 to 63 days. Fresh eggs obtained from the liver of the house rat washed three times with distilled water and lyophilized with the freeze dryer. lyophilization was carried out on a temperature of -50℃ and a vacuum of 10^(-4)㎜Hg. The occurrence of circumoval precipitation (COP) reaction was proved by the embryonated eggs of C. hepatica which were incubated in the sera from rats given embryonated eggs of C. hepatica by orally. The result findings were as follows: 1. The precipitations were formed around the mucoid plugs of the embryonated eggs after 24 hours at 37℃ by the sera from infected rats. 2. The average positive rates of COP reaction in different diluting solutions were 46.5% in PBS, 35.5% in Millonig's buffer solution, 20.2% in normal saline and 8.8% in distilled water. 3. Precipitations in COP reaction was noticed even in highly diluted sera up to 1 : 128. The high positive rate of COP reaction in serum with the PBS diluting solution was shown to be over 76% at the dilution of 1 : 16 to 1:32. 4. There were no differences in the positive rates of the COP reaction between the fresh and lyophilized eggs using PBS as a diluting solution. 5. There were no differences in the positive rates of COP reaction using lyophilized embryonated eggs in each serum collected during the 10th to 63rd days after infection of C. hepatica. 6. With the embryonated eggs of C. hepalica precipitations were not produced in the sera from rats infected with Clonorchis sinensis, Metagonimus yokogawai, Paragonimus iloktsuenensis and by the sera from human infected with Ascaris lumbricoides.

물리학 선량법을 이용한 갑상선암의 개인별 최대안전용량 I-131 치료법 개발과 유용성 평가

김정철,윤정한,범희승,제갈영종,송호천,민정준,정환정,김성민,허영준,이명호,박영규,정준기 대한핵의학회 2003 핵의학 분자영상 Vol.37 No.2

목적 : 분화갑상선암 환자에 대한 방사성옥소(I-131) 치료는 재발율과 사망률을 감소시키는 효과적인 치료법이지만, 치료용량을 증가시킴으로써 치료율을 향상시킬 수 있는지에 대해서는 아직 논란이 있다. 본 연구에서는 최대허용선량 치료법의 효용성을 검증하고자 하였다. 대상 및 방법 : 임상적 병기가 제3, 4병기이고, 6개월 이후에 I-131 전신스캔(이하 IWBS)과 혈중 thyroglobulin (이하 Tg), anti-thyroglobulin antibody (이하 ATA), 초음파검사 (이하 US) 및 F-18 FDG PET 등을 통해 치료여부를 확인할 수 있었던 58명(남:여=9:49, 평균연령 50±11세)의 유두상갑상선암 환자를 대상으로 하였다. 이중 11명은 제4병기, 47명은 제3병기였으며, 43명(남:여=4:39), 평균연령 50±11세)은 7.4 GBq 이하의 고식적인 저용량치료법으로 치료하였고, 9.25 GBq 이상의 고용량 치료를 받은 환자는 15명(남:여=5:10, 평균연령 50±12세)으로 고용량군에서 남자가 더 많았으나 연령의 차이는 없었다. 고용량군 환자 모두에서 추적용량의 방사성옥소(평균 77±3 MBq)를 경구 투여한 후 혈중 방사능소실곡선을 통해 최대허용선량(maximum permissible dose, 이하 MPD)을 계산하였으며, 7명에서는 말초혈액림프구의 중기염색체분석법에 의해 생물학적으로 MPD를 계산하였다. 14명에서는 치료용량의 방사성옥소를 투여한 후 혈중 방사능소실곡선을 통해 MPD를 계사하였다. 완전치유(complete response, 이하 CR)는 IWBS에서 병소가 없어지고, 혈중 Tg치가 1 ng/mL 이하로 감소한 경우로 정의하였으며, 부분치유(partial response, 이하 PR)는 IWBS에서 병소가 없어졌더라도 혈중 Tg, ATA치가 높거나, US 또는 PET 검사에서 병소가 남아있는 경우로 정의하였다. 치료후 IWBS에서 병소가 오히려 증가하거나 변함없는 경우는 없었다. 방사성옥소 치료에 의한 부작용은 입원기간 중 타액선이 현저하게 붓고 통증이 있거나, 구토를 심하게 하는 경우, 그리고 퇴원후 1개월째 백혈구수가 20% 이상 감소한 경우로 정의하였다. 결과 : 양 군간에 연속적인 수치변화를 비교하는 경우는 paired t-test를 이용하였으며, 대상군간 치료효과와 부작용의 비교는 chi-square test를 이용하였다. p값 0.05 미만을 통계적으로 유의한 차이로 인정하였다. 고용량군 환자 모두에서 추적용량과 치료용량의 방사성옥소 투여 후 혈액의 피폭선량은 각각 0.012±0.3 Gy, 1.66±25 Gy였으며, 방사성옥소 투여 후 혈액에 전달되는 피폭선량은 추적용량보다 치료용량에서 더 많았고 (1.21: 166 rad, p<0.001), 방사성옥소 1 mCi당 혈액에 전달되는 피폭선량은 차이가 없었다(0.58±0.1 vs. 0.56±0.1 rad/37 MBq, p=0.34). 추적용량 방사성옥소 투여 후 구한 MPD는 평균 13.3±1.9 GBq (9.7 ~ 16 GBq) 이였고, 치료용량 방사성옥소 투여 후 구한 MPD는 평균 13.8±2.1 GBq (10.4 ~ 16.3 GBq)로 유의한 차이가 없었으며 (p=0.20), 두 수치간에는 유의한 상관 관계가 있었다(r=0.8, p<0.0001). 7명의 환자에서 말초혈액림프구 중기염색체 분석법으로 MPD를 측정하였는데 혈액의 피폭선량은 1.78±0.03 G였으며, 같은 환자에서 혈중 방사능소실곡선으로부터 구한 피폭선량은 1.54±0.03 G로 유의하게 낮았으나 (p=0.01), 두 측정치 간에는 유의한 상관관계(r=0.86, p=0.01)가 있었다. 저용량 치료군 43명 중 22명(51.2%)에서 완전치유를 보였고 21명(48.8%)에서는 부분치유를 보인 반면 고용량 치료군 15명 중 12명(80%)에서 완전치유를 보였고 3명(20%)에서만 부분치유를 보여 고용량 치료군에서 유의하게 높은 완전치유를 얻을 수 있었다(p=0.05). 한편 부작용 발생빈도는 저용량 치료군 43명 중 13(30.2%), 고용량 치료군 15명 중 6명(40%)로 양군간에 유의한 차이가 없었다(p=0.46). 임상적인 병기, 연령 및 성별에 따라서는 치유의 차이가 없었다(p>0.05). 결론 : 혈중소실곡선으로부터 MPD를 결정하고 이를 토대로 환자 개개인별로 적절한 선량을 선택하여 치료하는 방법은 부작용을 최소화하면서도 치료효과를 높일 수 있는 매우 유용한 치료법이며, 고위험군 분화갑상선 암 환자에게 가장 적절한 치료법이라고 사료되었다. Purpose: Radioiodine (1-131) therapy is an effective modality to reduce both recurrence and mortality rates in differentiated thyroid cancer. Whether higher doses shows higher therapeutic responses was still debatable. The purpose of this study was to validate curve-fitting (CF) method measuring maximum permissible dose (MPD) by a biological dosimetry using metaphase analysis of peripheral blood lymphocytes. Materials and Methods: Therapeutic effects of MPD was evaluated in 58 patients (49 females and 9 males, mean age 50±11 years) of papillary thyroid cancer. Among them 43 patients were treated with ≤7.4 GBq, while 15 patients with ≥9.25 GBq. The former was defined as low-dose group, and the latter high-dose group. Therapeutic response was defined as complete response when complete disappearance of lesions on follow-up 1-131 scan and undetectable serum thyroglobulin levels were found. Statistical comparison between groups were done using chi-square test. P value less than 0.05 was regarded as statistically significant. Results: MPD measured by CF method using tracer and therapeutic doses were 13.3±1.9 and 13.8±2.1 GBq, respectively (p=0.20). They showed a significant correlation (r=0.8, p<0.0001). Exposed doses to blood measured by CF and biological methods were 1.54±0.03 and 1.78±0.03 Gy (p=0.01). They also showed a significant correlation (r=0.86, p=0.01). High-does group showed a significantly higher rate of complete response (12/15, 80%) as compared to the low-dose group (22/43, 51.2%) (p=0.05). While occurrence of side effects was not different between two groups (40% vs. 30.2%, p=0.46). Conclusion: Measurement of MPD using CF method is reliable, and the high-dose 1-131 therapy using MPD gains significantly higher therapeutic effects as compared with low-dose therapy.

2상2중쵸퍼를 이용한 축전지 충전제어

이정준,함년근,조정민,김동운,한경희 明知大學校 産業技術硏究所 2000 産業技術硏究所論文集 Vol.19 No.-

Recently, increasing of portable, importance of battery has identified. And battery is used for non-utility generation and emergency power for communication power, it has researched for power of electric vehicle. But it is disadvantage that life cycle of battery is decreased by overcharging and overdischarging. In this paper, using two phase with combined step-down chopper, we controlled charging and discharging of battery. It is dereased ripple of current and charging time with continuous current by using two phase with combined step-down chopper. Detecting the full charging voltage and cut-off voltage, it is prohibit overcharging and overdischarging with microprocessor.

어육단백질의 냉동변성에 관한 연구 : Ⅲ. 동결 저장중 방어 보통육과 혈합육 근원섬유 단백질의 단백질 상호작용, 용해도 점도 및 Ca-ATPase활성의 변화 Ⅲ. Changes of Protein-Protein Interaction, Solubility, Viscosity and Ca-ATPase Activity of Myofibrillar Protein from Ordinary and Dark Muscle in Yellowtail during Frozen Storage

김정한,최영준,변재형 國立統營水産專門大學 附設 水産科學硏究所 1989 수산과학연구소보고 Vol.1 No.-

The denaturation mechanism of the protein during freezing of myofibrillar protein extracted from the ordinary and dark muscle of yellowtail (Seriola quinqueradits) were investigated by analyzing the Protein-Protein interaction, Solubility, relative viscosity and Ca-ATPase activity. The rate of protein-protein interaction and inactivation of Ca-ATPase were the first reaction against the frozen storage time. The rate of protein-protein interaction in ordinary myofibrillar protein was 1.14-2.24 times as large as that of dark one, but Ca-ATPase was conversely. A similar relation-ship between ordinary and dark myofibrillar protein was recognized in relative viscosity and solubility, but the extent of decreased relative viscosity was large than solubility. The exposure of hydrophobic residures and protein-protein interaction were significantly related with the freezing denaturation of myofibrillar protein.

성악골 절제후 유리피판술을 이용한 상악재건 3례 보고

박정일,한태근,최준,백세민 大韓成形外科學會 1991 Archives of Plastic Surgery Vol.18 No.1

Malignant tumor of the head and neck can be treated by radical excision of the lesion. But the resultant facial deformity acts as a handicap in the patient's life. The quality of life is as important as the quantity. Therefore reconstruction of these patients is an important field in plastic surgery. We used 3 kinds of flap for reconstruction after maxillectomy. Two cases were late reconstruction with Rectus Abdominis myocutaneous free flap and parascapular free flap respectively. In remaining one case, immediate reconstruction was performed with rib bone graft and Latissimus Dorsi free flap. The results were satisfactory. But we found that ptosis of the flap is problem in all cases.

손상정도계수와 외상치를 이용한 외상환자의 분석

송근정,장문준,김성중,조광현,김인병,최성욱,이한식 대한응급의학회 1993 대한응급의학회지 Vol.4 No.2

Trauma is one of the most common causes of death. Recently, injury severity score(ISS) is widely used to evaluate and classify the patients with multiple injury. Trauma score(TS) was developed as a means of providing rapid accurate assessment of the injured patient. Authors conducted a review of trauma patients who visited the emergency department of YongDong Severance Hospital from September 1992 to August 1993. ISS and TS were collected from comprehensive initial evaluation. The results were as follows : 1) The subjects were 10.2%(2,666 patients) of total 26,202 emergency patients. 2) Male to female ratio was 2.1 : 1. The age distribution was highest under 10 year(24.9%). The mean ISS was 3.5, and the mean ISS increased with ago. 3. Analysis of injury mechanism showed high incidence of traffic accident(35.3%), blunt trauma 25.7%, fall 24.2%, stabbing 10.7%, and others 4.3% in order. 4. The 8.0% of patients were admitted after initial management and their mean Iss was 12.6 mean TS was 15.5. 5. Among admitted traffic accident patients, the mean ISS of passenger T.A., pedestrian T.A. and driver T.A. were 19.0 ±9.9, 14.4 ±10.6, and 11.3 ±7.7 respectively. 6. Among 42 mortality cases, 25 patients were D.O.A. and 17 were expired. The mean ISS of D.O.A. Patients was 30.0; the mean Iss and mean Iss and mean TS of expired patients were 28.3 and 11.8 respectively. 7. The most common cause of death was head trauma(66.7%). 8. By comparing the ISS and TS of admitted and expired patients, mortality occurred above 16 point of ISS. The mortality increased with increasing ISS, but it was influenced by the trauma site and the severity of the particular injury site. Mortality also occurred below 15 point of TS, the mortality increased inversely with TS, and the mortality with TS, and the mortality was high below 13 point (above 40%).

선천성 수정 대혈관 전위증 - 부검1 예 -

황적준,한길로,김윤신,서정욱 大韓法醫學會 1998 대한법의학회지 Vol.22 No.1

The corrected transposition of the great arteries is a rare congenital heart anomaly consisting of the discordant connections of both the atria to ventricles and the ventricles to the great arteries. But its circulation is physiologically corrected and therefore it is compatible with life unless there are associated lesions. Our case was associated with VSD, COA, and PDA. He was slightly cyanotic and irritable. Despite of oxygen supply, his symptoms were not improved and he eventually died in 52 hours after delivery. Medical record revealed severe respiratory and metabolic acidosis.

Multiple myeloma 환자에서 Bortezomib치료 후 발생한 마비성 장폐색증 1례

김준영,이원식,손창학,박성길,진한영,박석주,조영완,정은욱,강명주,박정하,주영돈 인제대학교 2006 仁濟醫學 Vol.27 No.-

Bortezomib is the first clinically available proteasome inhibitor that is clinically effective in the treatment of multiple myeloma. A proteasome inhibitor acts through multiple mechanisms to arrest tumor growth, tumor spread, and angiogenesis. The main adverse effects of bortezomib are gastrointestinal symptoms, cytopenia, fatigue, and peripheral neuropathy. To date, severe paralytic ileus has not been reported as a toxic effect of bortezomib treatment in multiple myeloma. Bortezomib is a novel agent that has only been used clinically for 30 months, so a need exists to further evaluate its toxicity. We report a case of grade Ⅲ (NCI CTCAE v3.0) or grade Ⅳ(SWOG toxicity criteria) paralytic ileus in a 65-year-old man with relapsed multiple myeloma who underwent one cycle of single-agent bortezomib treatment scheduled in a 21-day cycle (1.3 mg/㎥ as a single i.v. bolus on days 1, 4, 8, and 11).

肝吸蟲 感染者에 대한 間接螢光抗體反應(IFAT) 補體結合反應(CFT) 및 ELISA법의 比較 硏究

咸姃希,李駿商,林漢鍾 고려대학교 의과대학 1984 고려대 의대 잡지 Vol.21 No.1

Human colonorchiasis is one of the most common trematode diseases and of very important public health problem in Korea. A number of serological techniques have been applied to the diagnosis of parasitic diseases, and efforts in recent years have been made for the development of new promising serological techniques. In this study the sensitivity and the specificity of the indirect immunofluorescent antibody test(IFAT), the complement fixation test(CFT) and the enzyme-linked immunosorbent assay(ELISA) were investigated with 55 human clonorchiasis sera, 16 sera of other parasitic infections and 9 sera of non-infected human cases. The IFAT was performed using frozen sectioned antigen of adult Clonorchis sinensis, the CFT was performed with ether extracted antigen prepared from adult C.sinensis. The ELISA was performed with Clonorchis veronal buffered saline antigen, peroxidase conjugated antihuman Ig G and ortho-phenylenediamine as a substrate by micro-method. The results obtained were as follows: 1. The positive reactions in 34 (61.8%) out of 55 clonorchiasis sera at a dilution of 1/16 or below and in one (4.0%) out of 25 control sera were detected by the IFAT. 2. The positive reactions in 31 (56.4%) out of 55 clonorchiasis sera at a dilution of 1/8 or below and in 3 (12.0%) out of 25 control sera were detected by the CFT. 3. Fourty-three (78.2%) out of 55 clonorchiasis sera were positive at absorbance 1.000 or below by the ELISA. However, 25 control sera tested by the ELISA were negative. 4. Among the 43 Clonorchis positive sera detected by the ELISA, positive reactions were observed in 33 (76.7%) sera in the IFAT and 30 (69.8%) sera in the CFT. Among the 12 Clonorchis negative sera tested by the ELISA, one gave positive reaction by the IFAT and the CFT. 5. When the results were compared between the IFAT and the CFT using 55 human clonorchiasis sera showed that 50 (90.9%) out of the 55 clonorchiasis sera gave same reactions, and the titers of two immunological techniques were almost corresponding. These findings indicated that the ELISA was the most sensitive and specific in the diagnosis of human clonorchiasis among three serological tests.