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.

강원도 화천군 수달(Lutra lutra) 서식지의 식생 구조

서형수 ( Hyung Soo Seo ),신영섭 ( Young Seob Shin ),이경은 ( Kyung Eun Lee ),김윤미 ( Yoon Mi Kim ),전미나 ( Mina Jeon ),남택우 ( Taek Woo Nam ),한성용 ( Sung Yong Han ),정연숙 ( Yeonsook Choung ) 한국하천호수학회 2014 생태와 환경 Vol.47 No.special

In order to determine whether vegetation would be one of the factors for the selection of otter home range, vegetation structure and other potential factors were studied in Hwacheon, Korea. Thirteen sites, otter’s activity found and not found, were investigated in North Han River and connected tributary streams of Hwacheon-gun. Three types of vegetation were classified by cluster analysis, which is short grass, tall grass and shrub type. Vegetation zone of each channel is composed of either one type, or mosaic of tall grass and shrub type. Short grass type is common in Lake Paro and upper North Han-river where water level is highly variable throughout a year. Therefore, annual species such as Persicaria nodosa, Fimbristylis dichotomam and Chenopodium ficifolium are the most dominant. Shrub type is common at the downstream sites of Jichon stream and along mainstream of North Han River down Lake Paro. A shrub species, Salix koreensis, is the most common. Tall grass type is dominant occupying the most vegetation zone of the tributary channels. Phragmites japonica is absolutely dominant. Due to its dense cover, a few plant species are co-existed. Otter activity was found in all three vegetation types and no marked activity was found at some sites of tall grass type. There is no difference in species composition and physiognomy between tall grass sites with and without otter activity, while it shows significant difference in fish availability between two groups. Overall we found that home range of otters in the region is along the mainstream and downstream of tributary streams with high fish availability in all vegetation types and in various human activity levels.

IMF와 관련된 스트레스로 신경정신과를 방문한 환자들의 사회정신의학적 특징

한선호,한상우,정한용 순천향의학연구소 1998 Journal of Soonchunhyang Medical Science Vol.4 No.2

Object : The objective of this study was to evaluate how IMF in Korea influenced the Korean in the psycho-social and neuropsychiatric aspects. Method : First, authors compared the number of the patients who had admitted in Seoul Soonchunhyang university hospital and Chun-an Soonchunhyang hospital between the period of January to September 1997(before IMF), and January to September 1998(after TMF). Second, authors evaluated the demographic factors and clinical characteristics of 84 patients who complained psychiatric symptoms induced by IMF related stresses. Results First, the number of stress related patients after IMF was more than before IMF(increased 31%), which suggests that IMF is the stressor of the people enough for psychiatric intervention. Second, IMF plays the role of the various stressors to Koreans (i.e, unemployment, retirement, economic loss, decreased incomes, familial conflicts, change of residence, urge to unemployed, etc) Third, IMF affects not only the urban clerical workers and merchants' employment and economic state but also the rural farmer and stock-farmers' economic state. Conclusion : IMF affects the Koreans' mental health in various aspects. So, it is important and urge to analyze and solve the IMF stresses which affect Koreans' mental health by psychosocial & community health approach.

신호교차로 접근로의 교통특성 분석

우용한,김대웅 嶺南大學校 工業技術硏究所 1997 工業技術硏究所論文集 Vol.25 No.2

Traffic characteristics on the approach of signalized intersection is one of the importance to analyze intersection. The arriving pattern of vehicles and capacity on the intersection are important variations to determine service level. Therefore, this study executed the traffic analysis in 4 intersections. First of all, this study was a collection to behavioural data for each vehicles of 4 intersections to analyze. The items to analyze are the frequency distribution of headway, the relationship between traffic flow and headway, the frequency distribution of approaching speed, the relationship between approaching speed and stopping distance;stopping time. We could realize a traffic condition in Taegu city according to these analysis. Furthermore, it will be used for basic data for developing of simulation model for signal optimization and forecasting the number of queueing vehicles on the approach.

Bio-coal을 첨가하는 AS법에 의한 적조생성 원인물질의 제거특성

한동우,김경동,강용태 東亞大學校 海洋資源硏究所 1998 硏究論文集 Vol.11 No.1

Eutrophication derived from the excess inflow of organics and nutrients into discharge basins results in the mass production of algae, causing other secondary water pollution. Also, toxic alg-ae have been associated with eutrophication in coastal regions and have been implicated in the occrrernce of "red tide" which may lead to paralytic shellfish poisoning. But existing methods that are weak in the performance of from 10 to 20 percent N, P removals have not coped with the water pollution owing to eutrophication. In this study, to researchtreatment characteristics of media in conventional activated sludge system, existng Conventional Activated Sludge system and Media-introduced Activated Sludge system are made a comparative study using a pilot plant in the field. In the performance of Organic matter removal, Media-introduced methid is better than non Medial method, improving BOD average removal 5%, COD 18%, respectively and in nutrients T-N 27% and T-P 12.3%, average. Experiments have it that Media-including methods with shorten HRTs(5 hours) is more satisfactory than Conventional Activated Sludge system with 7 hours.

위 전절제술을 받았던 환자에서 아급성 연합성 변성 1예

한정호,하현욱,이정석,송은향,김우정,김두응,최진영 건국대학교 의과학연구소 2000 건국의과학학술지 Vol.10 No.-

Subacute combined degeneration is a metabolic disorder of the spinal cord caused by vitamin B12 deficiency. A 72-year old man was admitted with weakness and tingling sensation of the bosh upper extremities. 9 years ago, he was diagnosed as having stomach cancer. So total gastrectomy with splenectomy was done at that time. The complete blood cell counts and morphology revealed megaloblastic anemia. Nerve conduction velocity study(NCV), electoromyography(EMG) and somatosensory evoked potentials(SEP) showed diffuse sensorimotor peripheral neuropathy. Magnetic resonance imaging(MRI) showed an increased T2-weighted signal, mild decreased T1-weighted signal, and slight contrast enhancement of the posterior columns of the cord in the cervical and upper thoracic spinal region. He was treated with vitamin B12 supplements and improved gradually. If abnormal sensation and muscle weakness was developed after gastrointestinal surgery, subacute combined degeneration should be considered in the differential diagnosis. We describe MRI findings of a typical case of subacute combined degeneration, which was induced by total gastrectomy.

서사능력의 구조와 기능, 그리고 그 교육에 대한 이론적 탐구

우한용 한국문학교육학회 2004 문학교육학 Vol.13 No.-

The aim of this thesis is to elucidate the structure of narrative power and how it works in the education process of literature. In the course of every day life, they manage their life and make possible world with narratives, it is the main goal of narrative education. The narratives are related with lives by double status, that is narrative act in real life and verbal narration in the texts real or fictional. This doubled status of narrative co-related each other but they are semi-simultaneous. Self and other, same subject divided into two aspects in narrative. In a narrative process, by the time process of cognition, the self realized by the form of 'others'. In this process the subject get the power of interpretation for the narratives. With this fact, it is possible to conclude that the structure of narrative power, it means how to live malung a meaningful life in time process and how to configurate the events in a life time with significant whole structure. For the reader of narrative, the abilities of read out the themes in narrative, it is formed by the facts as follows: 1)person and their relations in the narrative texts 2) holisticity presented by plot structures in the narrative texts 3)linguistic configuration the events and circumstances. The educational function of narrative power, it can be defined with the concept of narrative literacy. They are as follows ; lkomprehensive understanding of the life 2) as a process of self understanding 3) getting the ethical sense. For the getting of narrative power, for the first time it is necessary to understand the main principles of narrative and interpretation of the narrative and critical receiving the result, at last the it is necessary to communicate the narratives and writing (configuration) narratives by themselves. Making their own narratives, they grow up as a meaningful subject in the possible world as well as in the real world.

여성 요도증후군에서 Terazocin의 효과에 대한 연구

우승효,신관희,한광희,정원일,이형래,이상철,김용태,김원재 충북대학교 의학연구소 2000 忠北醫大學術誌 Vol.10 No.2

연구목적: 여성 요도증후군을 보이는 환자에서 교감신경차단제인 terazocin을 복용한 후 치료 효과에 대한 각 증상의 변화와 부작용을 알아보고자 하였다. 대상 및 방법: 1997년부터 1999년까지 충북대학교병원 비뇨기과에 내원한 35명의 여성 중 요검사 및 요배양 검사, 그리고 다른 이학적 검사에서 이상이 없는 요도증후군 환자를 대상으로 간질성방광염 증상점수(ICSS)를 terazocin (3mg/day for 3 months) 투여 전후에 조사하였고, 치료 후 3개월과 1년에 Likert scale 점수를 조사하였다. 결과: ICSS는 비치료군은 18.3±5.9점, 치료군은 16.5±6.8점으로 두군간의 차이는 없는 것으로 나타났다(p=0.52). 치료군은 치료 후 3개월에 시행한 ICSS가 9.9±7.8점으로 치료 전에 비해 현격히 증상이 호전되는 것으로 나타났다(p=0.0001). 특히 3개월에 시행한 Likert scale에서는 주간 및 야간빈뇨, 절박뇨, 배뇨통의 횟수 및 강도, 그리고 전체적인 증상정도에서 40-70% 가량 호전된 것으로 밝혀졌으며 이는 1년 후에도 증상의 호전이 지속되는 것으로 나타났다. 비치료군에서의 1년 후 Likert scale은 6명 중 2명이 전체적인 증상의 호전이 있는 것으로 나타났다. 결론: Terazocin은 환자의 약 70%가량에서 증상의 호전을 가져왔고, 비치료군에서도 환자의 33%가 저절로 증상이 좋아진 것으로 보아 Terazocin은 여성 요도증후군에서 분명히 효과가 있으나 증상이 심할 경우 보조적인 치료로 이용되는 것이 바람직할 것으로 사료된다. Purpose: We performed to assess the effects and complications of terazocin in women with chronic female urethral syndrome. Materials and Methods : Thirty-five women with chronic female urethral syndrome were studied from March 1997 to August 1999. The subjects exhibited normal findings without the pyuria and bacteriuria in urinalysis and urine culture and were invested the interstitial symptom score(ICSS). 29 subjects of them took a terazocin 1-4 mg/day for 3 months. They were reevaluated for the ICSS and Likert scale after 3 months and for Likert scale after 1 year. Results: The ICSS before treatment were showed 18.3±5.9 in the untreated patient group and 16.5±6.8 in the treated patient group, and no statistically difference between both patient groups(p=0.52). In the treated patient group, the ICSS after treatment were showed 9.9±7.8, significant difference between before and after treatment(p=0.0001). The Likert scale was showed at 3 months after treatment that frequency, nocturia, urgency, pain frequency, pain intensity, daily activities, and overall symptoms were improved in 65.5%, 55.2%, 24.1%, 41.4%, 41.4%, 70%, 70%, and 70% of 29 subjects, each other. Overall symptom score assessed at 1 year were showed that 3 subjects was aggravated. In untreated patient group, 2 of 6 was improved in overall symptom score. Conclusion: Terazocin was effective above 70% in the treated group, and symptoms were improved spontaneously in a third of the untreated group. So, we thought that terazocin would be useful as supportive treatment in period of severe symptoms.

신호교차점 접근로의 지체해석에 관한 연구

우용한,김대웅,최용석 嶺南大學校 工業技術硏究所 1998 工業技術硏究所論文集 Vol.26 No.2

This study was a selection circular road of Taegu city and four intersections approach which is located in the suburbs as the subject of study. And then, observed the relation between volume, traffic, speed and distribution of vehicle speed. It was examined the goodness of fit after making a model through the decelerated delay, accelerated delay and stopped delay which are calculated on the basis of the survey data. And also looked into the relation among the approach delay and the stopped delay and vehicles delay of signalized intersection approach which was caused by the traffic congestion. In the comparison of the average stopped delay for the model, KHCM model have an observation values and an approximate value. It was known the fact that the prediction model (1) and (2) that is provided by this study can applied at present. It could use this result to the shortest route search method and the signal system operation, the calculation of the service level at the signalized intersections.

문학교육과 도덕성 발달의 의미망

우한용 한국문학교육학회 2004 문학교육학 Vol.14 No.-

The main goal of this paper is to clarify that the literary education how to improve moral sense of the students. For the improvement of moral sense through literary education, it is useful to accept the hypothesis that every person has two aspects in their mind; holy spirituality and brutality of animal in common. Literature is connected with these two aspects of human being that the scope of functioning is totally wide. Through literature, it is possible to cultivate the moral mind all the life before his death. To accept literature as a life long work and to take efforts to cultivate their life by themselves by literature it is necessary as a primary condition for literary education. Almost all the literature - especially good literature, it is so tightly related to the morality that it is almost impossible to separate them each other. Literature itself, I think, is the ethical practice and the sensibility of literary language is the source of ethics that literary education make sense of the ethicality naturally. Ethical sensibility is pervaded all around the everyone's life, and literary practice introduce the reader to the retrospection of life and it can be transit to the moral practices. Literary practices functions as a reality forces for the reader's moral imagination. For the teaching of morality or elevate the sense of morality, the education in school and out of it must be concentrated . And we must realize that historical consciousness and morality connected so tightly that it is almost impossible to separate them, or to discuss each theme. For the development of moral sense of the student readers we must teach them to get 'the movement and enlightenment' from literature. This paper has a large scale scope for the development of morality in literary education, also the precise speculations on the same theme must be followed.