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.

미성숙영구치의 복합항생제 적용에 의한 변색의 처치: 증례보고

박소연,김영재,김정욱,장기택,이상훈,김종철,한세현,현홍근 大韓小兒齒科學會 2012 大韓小兒齒科學會誌 Vol.39 No.1

The concept of revascularization of necrotic pulps regained interest and became an alternative conservative treatment option for young permanent teeth with immature roots. Revascularization of immature teeth with apical periodontitis depends mainly on disinfection of the canal. Since the infection of the root canal system is considered to be polymicrobial, a combination of drugs would be needed to treat the diverse flora. A triple antibiotic mixture of metronidazole, ciprofloxacin, and minocycline was used as an intracanal medicament. However, discoloration was developed after applying the triple antibiotic mixture. It is believed that the marked discoloration is related to the use of minocycline. The aim of this article was to present cases of coronal discoloration after triple antibiotic therapy in immature tooth and was treated with bleaching technique to control coronal discoloration. In conclusion, revascularization by using triple antibiotics promotes a paradigm shift in treating endodontically involved permanent teeth. However, we should understand that triple antibiotics containing minocycline induces tooth discoloration. Further research to prevent coronal discoloration should be investigated and suggested for the safe use of triple antibiotics. 괴사된 미성숙영구치의 치수치료에 있어서 치수의 재혈관화를 통해 치근단 발육 및 치근형성을 지속하려는 개념이 소개됨 으로써 현재 미성숙영구치의 치수치료의 대안으로 제시되고 있다. 이러한 치근단 염증을 가진 미성숙 영구치의 재혈관화를 위해서는 가장 중요한 것이 근관내 감염된 부분을 확실히 제거하는 살균(disinfection)이다. 근관 내 감염은 여러 세균의 복 합작용으로 일어나기 때문에 철저한 살균에 사용되는 약제의 조합은 다양한 범위의 균주를 모두 제거 가능해야한다. Metronidazole(MN), ciprofloxacin(CF), minocycline(MC)의 세 가지 복합항생제가 약제로 사용되고 있으나 이 복합항생 제 적용 후 치관변색을 일으키는 사례가 보고되고 있다. 이러한 치관변색은 항생제의 성분 중 MC에 의한 것으로 여겨지고 있으며, 본 증례에서는 복합항생제 적용에 의해 야기된 치관변색의 증례를 소개하고 이를 표백술로 처치하여 최종 수복한 증 례를 보고하였다. 복합항생제 적용을 통해 미성숙영구치의 치수치료에 새로운 패러다임을 제시한 것은 분명하지만 치관변색 등의 부작용이 있음을 인지하고 치관변색을 사전에 예방하고 최소화하기 위해 다양한 방법이 강구되어야 할 것이다.

身體 微細畸形 및 産科的 合倂症과 精神分裂症의 家族歷

홍경수,주연호,김용식,신철진,강웅구,이중서,정희연,주은정 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.4

저자들은 정신분열병의 일부에서는 태생기 동안 유전 외적인 환경적 요인이 크게 작용할 것이라는 가정 하에 형제 정신분열병 환자군(남 15. 여 7)과 산발성 정신분열병 환자군(남 16, 여 7) 및 정상 대조군(남 16, 여 7)을 대상으로 가족력에 따른 산과적 합병증과 신체 미세 기형을 비교하였다. 산과적 합병증은 Lewis 척도를 이용하여 연구 대상의 어머니와 면담하여 평가하였고 신체미세기형은 Waldrop 척도를 이용하여 측정하였다. 또한 산과적 합병증 및 신체 미세기형과 가족력에에 따라 발병 연령 등의 임상 양상들이 차이를 보이는지 비교함으로써 정신분열병을 좀 더 동질적인 아형으로 나눌 수 있는지를 검토하였다. 1) 형제 환자군, 산발성 환자군 및 정상 대조군의 세균에서 산과적 합병증의 개개의 항목 및 전체 점수의 유의한 차이는 없었다. 신체 미세기형의 경우 입의 미세기 형에서 유의한 차이가 있었으나 그 외에 각 부위별 점수 및 전체 점수에서는 세 군간에 유의한 차이가 없었다. 그러나 대부분의 신체 미세기형 세부 항목 및 전체점수에서 산발성 환자군이 형제 환자군에 비해 높은 신체 미세기형의 점수를 보이는 경향이 있었다. 2) 산과적 합병증의 전체 점수와 신체 미세기형의 전체 점수 사이에 상호 연관성을 찾아볼 수 없었다. 3) 발병연령·정신병리·약물에 대한 반응·병전 기능수준·지연성 운동장애 유무 등의 임상 양상들을 비교하였을때 산발성 환자군과 형제 환자군간에 유의한 차이가 없었다. 4) 산과적 합병증 및 신체 미세기형과 임상 양상들을 비교하였을 때, 형제 환자군에서 분만시간과 회복시 전반적 기능수준간에, 산발성 환자군에서 산과적 합병증의 전체 점수와 발병 연령간에 상관관계가 있었으나 전체적으로 일관된 결과가 도출되지는 못하였다. 위와 같은 결과를 종합하여 볼 때, 산과적 합병증이나 신체 미세기형이 정신분열병의 원인을 밝히는데 유익한 도구가 될 수는 있지만, 가족력 유무에 따라 정신분열병을 보다 동질적인 아형으로 구분하기 힘들다고 생각되었다. In order to test the hypothesis that familial schizophrenics have fewer chances of receiving organic insults during the fetal neural development than sporadic schizophrenics, the authors compared obstetric complications, minor physical anomalies, and other clinical features in sibling schizophrenics, sporadic schizophrenics and controls. Obstetric complications were evaluated by the scale of Lewis, and minor physical anomalies were measured by the Waldrop scale. Sporadic schizophrenics had a significantly higher Waldrop score for mouth than sibling schizophrenics. Although there was some tendency of higher total scores for minor physical anomalies in sporadic schizophrenics, there were no statistically significant differences in obstetric complications and the other minor physical anomalies among three groups. There was no significant correlation between obstetric complications and minor physical anomalies. The clinical features such as age of onset, psychopathology, response to drugs, premorbid functioning, and tardive dyskinesia were not significantly different between sibling and sporadic scizophrenics. In conclusion, while the obstetric complications and minor physical anomalies were suggested to be useful in the search for the cause of schizophrenia, it was difficult to categorize schizophrenics into more homogeneous groups according to family history of schizophrenia using the parameter of obstetric complications and/ or minor physical anomalies.

安東을 中心한 慶北地域의 夏節期 氣溫特性(Ⅰ)

손련규,윤지홍,권성덕,김순철,권태형 安東大學校 安東地域社會開發硏究所 1991 安東開發硏究 Vol.2 No.1

The Andong region that includes Youngju, Bonghwa, Yechon, and Uisung is located in a basin bounded in the northeast and northwest by the Mt. Ranges of Taeback and Soback, and because of the closeness to Andong and Imha dams it has come to experience a large variation in climate. Due to an excessive amount of evaporation of moistures from open surfaces of these dams in the region it has not been possible to avoid heavy fogs, and because of the cooling effect accompanying the evaporation it has come to experience greater variation in temperature. The summer climate of the region may be characterized as follows : 1) The temperatures fall in the eastern coastal region that includes Uljin, Youngduk, and Pohang during the summer when there is a low pressure developed m the southern part of Tonghae following the pattern of high pressure in the north and low pressure in the south induced by the northeastern air current, but the temperatures fall frequently in the interior region that includes Andong, Yougju, Bonghwa, Yechon, Uisung, Sunsan, Kimchon, and Taegu when there is a low pressure region developed there following the pattern of high pressure in the east and low pressure in the west. 2) The temperatures fall equally in both the coastal and interior regions when there is a cold front, spread across east-west line, moving rapidly southward from central region due to a high pressure in the north and a low pressure in the south, and in the interior region the temperatures fall quite rapidly-this trend continues for the next two to three days. 3) The highest temperature during the summer in Kyungbuk region is due to wind effect that may have been resulted from the Foehn-phenomena with the Taeback Mt. Range as boundry. 4) The temperature rises when daily variation is of the pattern of A or B, but the temperature falls when the daily variation is of the pattern C or D. The temperatures fall in the western coast and rise in the interior region when the high pressure region forms a tounge pattern with the axis along the eastern coast. When the axis of the high pressure region is along the western coast, the temperatures rise in both regions, and the amount of rise is comparable, thus creating the pattern E. These five patterns of variation may be considered as the characteristics of the summer weather in the Kyungbuk region.

흰구름버섯(Coriolus hirsutus)에 의한 방향족 염료의 탈색

송연홍,최철민,김창진,신광수 대전대학교 이과대학 기초과학연구소 1997 自然科學 Vol.- No.-

담자균류 백색부후균의 일종인 흰구름버섯(Coriolus hirsutus)을 실험균주로 하여 수종의 난분해성 방향족염료의 분해능을 측정하였다. 사용된 4종류의 염료 중, triphenyl methane 염료인 bromophenol blue가 탈색를 95% 이상으로 가장 잘 탈색되었으며, Congo red와 Poly R-478은 이보다는 낮은 57%, 55% 가 탈색되었다. 그러나, heterocyclic 염료인 methylene blue는 본 균주에 의해 거의 탈색되지 않아TDmau, UV-visible spectrum상에서의 심색성 이동만 관찰되었다. 세포외 laccase와 peroxidase의 활성은 각 염료의 탈색율과 비례하여 나타났으며, 최대 활성 또한 최대 탈색시기에 관찰되었다. 효소의 활성 염색시 모든 연료의 탈색배지에서 공통적인 laccase와 peroxidase의 활성 띠가 관찰되었다. 이러한 결과로 볼 때, 세포의 laccase와 peroxidase가 난분해성 염료의 탈색에 중요한 역할을 할 것으로 판단된다. The white rot fungus Coriolus hirsutus decolorized several recalcitrant dyes. Four different types of dyes, including azo, triphenyl methane, heterocyclic, and polymeric dye, were treated by the mycelial preparation. Tri-phenyl methane dye, bromophenol blue lost over 95% of its color. Congo red and Poly R-478 were decolorized less than bromophenol blue, 57 and 55%, respectively. However, heterocyclic dye, methylene blue was not decolorized significantly and only red shift was observed. Extracellular laccase and peroxidase. activities were appeared maximally in high level of dye decolorization media. In electrophoretic experiments, common active bands of laccase and peroxidase were found in all dye decolorized medium. These results indicated that the culture conditions which yield high levels of laccase and peroxidase activity lead to high levels of dye decolorization, and these two enzymes might be play an important roles in dye decolorization.

백서에서 신 허혈성 손상에 미치는 칼슘 길항제의 효과

문철웅,정종훈,박천국,이승일,배학연,장경식,김만우,정춘해,홍순표,이병래,김호중 朝鮮大學校 附設 醫學硏究所 1993 The Medical Journal of Chosun University Vol.18 No.1

Renal ischemia is one of the most common causes of acute renal failure. Four factors related to the pathogenesis of acute renal failure are vasoconstriction, decreased glomerular filtration rate, tubular back leak of filtrate, and intratubular obstruction. The cellular response to renal ischemic insults include decreased content of adenosine trihosphate, lipid peroxidation induced membrane degradation, alteration in cellular pH, and calcium or phospholipase induced mitochondrial dysfunction. Much attention has been given to the role of increased cellular calcium as a pathogenetic contributor to cell injury during ischemia. Author studied the protective effects of calcium antagonists on cellular injury during renal ischemia in rat. To investigate the protective role of these agents, author measured the amount of malondialdehyde(MDA) and the enzyme activities of free radical scarvengers-superoxide dismutase(SOD), catalase and glutathione peroxidase from non-pretreated group and calcium antagonists pretreated groups in control, ischemia and reflow subgroups. The results were summerized as follows: 1) The amount of MDA in non-pretreated group was higher in the reflow compared with the control(<p<0.01). But, in all pretreated groups, there was no statistically difference in the amount of MDA. 2) The SOD activity in non-pretreated group was lower in both the ischemia and the reflow compared with the control (P<0.05). But, in both verapamil and trifluoperazine-pretreated groups, there was no statistically difference in the SOD activity. 3) Both catalase and glutathione peroxidase activities in non-pretreated group were lower in both the ischemia and the reflow compared with the control (P<0.05). But in all pretreated groups, there was no statically difference in both catalase and glutathione peroxidase activities. These results suggest that free radical mediated ischemic injury by renal artery clamp in rat can be protected by intraperitoneal pretreatment with calcium antagonists. As trifluoperazine has a protective effect in renal ischemia, the calcium activated calmodulin dependent enzyme may play a role in renal ischemic injury.

Wiskott-Aldrich 증후군 환아의 증례보고

이연주,현홍근,장철호,김영재,김정욱,장기택,김종철,한세현,이상훈 대한소아치과학회 2007 大韓小兒齒科學會誌 Vol.34 No.3

황토로부터 합성한 제올라이트에 의한 Cd(Ⅱ) 및 Cu(Ⅱ) 흡착특성

감상규,홍정연,허철구,이민규 한국환경과학회 2003 한국환경과학회지 Vol.12 No.7

Various kinds of zeolites, such as analcime (ANA), cancrinite (CAN), Na-P1 and sodalite octahydrate (SOD) could be synthesized from Hwangto by hydrothermal reaction in a high-pressure vessel. The adsorption characteristics of Cu(Ⅱ) and Cd(Ⅱ) by Hwangto and its synthetic zeolites were investigated using the chemical and electrochemical surface parameters of these adsorbents. The heavy metal adsorptivity among the adsorbents decreased in the following sequences: Na-P1 > SOD > ANA > CAN > Hwangto. This sequence was the same with the values of surface site density (Ns) of these adsorbents and was correlated inversely with the values of pHpzc (pH of the point of zero charge) and the values of Ka2(int) (intrinsic surface deprotonation constant) of the adsorbents for synthetic zeolites, i.e., the adsorbents with higher values of Ns and with lower values of pHpzc and Ka₂(int) for synthetic zeolites showed higher heavy metal adsorptivity. With increasing pH, the heavy metal adsorptivity increased greatly between pHpzc and pH 6 or 7 because of the steep increase of negatively charged sites for synthetic zeolites, but for Hwangto, it increased broadly because of slow increase of negatively charged sites based on its lower surface sites.

고속액체크로마토그래피-가시선/자외선 검출기를 이용한 Di(2-ethylhexyl)phthalate 검출 방법 검증과 일부 한국 성인 남성 혈액 중 DEHP 정량

양윤정,명순철,김세철,홍연표 大韓産業醫學會 2005 대한직업환경의학회지 Vol.17 No.1

목적: 이 연구는 HPLC-UV를 이용한 생체 시료 중 저농도의 DEHP 분석법을 CDER 기준에 따라 검증하고 검증된 분석법으로 일부 한국의 혈장 중의 DEHP를 분석하여 인체 노출 정도를 뒷받침할 수 있는 기초 자료를 제시하고자 한다. 방법: 혈액 내 DEHP 정량을 위한 HPLC-UV 정량 분석법을 CDER의 검증 기준인 검량선 및 직선성과 정밀성, 정확성에 대해 시행하였다. 검증된 분석법으로 울산과 춘천 일부 지역의 근로자 30세 이상 60세 이하의 건강한 남성 255명으로부터 채취한 혈액 내 DEHP를 정량하였다. 결과: 혈액 중 DEHP 정량을 위해 사용된 HPLC-UV는 표준액 0∼150 μg/l 에서 직선성을 나타냈다(r²=0.999). 검량한계는 5.22 μg/l , 정량한계는 15.81 μg/l 이었다. 정밀성과 정확도는 2.5 μg/l DEHP 농도에서 첫째 날을 제외하고는 둘째 날과 셋째 날은 CDER 기준에 적합하였다. 50 μg/l 과 150 μg/l DEHP 농도는 모두 CDER 기준에 적합하였다. 대상자의 98 %가 10 μg/l 이하이었고, 85%는 5 μg/l 이하이었고 왼쪽으로 치우친 분포를 나타냈으며, 최고 농도는 18.9 μg/l 이었다. 대상자의 혈액의 DEHP 농도의 기하평균과 기하표준편차는 0.4±1.5 μg/l 이었다. 결론: 본 연구에 사용된 HPLC-UV를 이용한 혈액 중 DEHP 분석법은 CDER 기준에 따라 검증한 결과 정밀도, 정확도, 검출한계 및 정량한계 등 모든 항목에서 기준에 적합하였다. 일부 한국 성인 남자의 혈액 중 DEHP 농도는 0∼18.9 μg/l 이었으며 왼쪽으로 치우친 분포를 나타냈다. Objectives: This study was conducted to validate a simple, rapid and sensitive reverse-phase high-performance liquid chromatographic method with UV detector (HPLC-UV) and present the plasma level of di(2-ethylhexyl)phthalate (DEHP) in some Korean male workers. Methods: HPLC-UV for quantification of plasma DEHP was validated by the following guideline from the Center for Drug Evaluation and Research (CDER) - calibration/standard curve, precision, accuracy and recovery. Plasma DEHP from 255 healthy Korean male workers aged from 30 to 60 years was analyzed by validated HPLC-UV method. Results: The calibration curve over the range 0∼150 μg/l for the plasma DEHP standard solution showed linearity(r²=0.999). The limit of detection (LOD) and limit of quantification (LOQ) of plasma DEHP were 5.22 μg/l and 15.81 μg/l , respectively. The accuracy and precision for 2.5 μg/l of DEHP were acceptable in CDER guideline on the second and third day but not first day, and those for 50 μg/l and 150 μg/l of DEHP were acceptable on all three days(Ed-confirm this addition). The distribution of plasma DEHP level was skewed to the left and ranged from 0 to 18.9 μg/l. The plasma DEHP level was lower than 10 μg/l for 98 % of subjects and lower than 5 μg/l for 85 %. The geometric mean and standard deviation of plasma DEHP were 0.4±1.5 μg/l. Conclusions: The HPLC-UV method for quantification of plasma DEHP was acceptable by CDER guideline. The plasma DEHP of 255 Korean male workers ranged from 0 to 18.9 μg/l and the distribution was skewed to the left.

일부 사업장 건강증진사업 실태조사 및 요인분석

이경화,이원철,이강숙,홍현숙,송연이 가톨릭대학교 산업의학센터 2000 韓國의 産業醫學 Vol.39 No.2

For the purpose of access the health promotion activities in 138 worksite which had more than 50 workers, we surveyed the questionnaire on May and September 1998. The results of survey were as follows: 1.59 companies(45.1%) were conducting the health promotion activities. Most of them were manufacturing and located Kyung-sang province and had nurses as a health manager. 2.Companies operating the health promotion activities had significant higher degree of satisfaction and usage of welfare facilities than non-operating companies. 3.The level of knowledge for regulations, professional skills, and performance related health promotion was low in all companies. Top manager's interest and will for investment to health promotion was significant lower in non-operating companies. 4.The reasons why the health promotion program was not operated, were low budget, top manager's indifference, lack of information, work overloading, no human resource, an insufficient governmental support in order. 5.The most necessary items for program were education and promotion, budget, and governmental support. Needed personnel were nurses, fitness trainner, and necessary program were health management, exercise, nutrition, and stress counselling. For comparing before and after IMF, amount of budget was decreased. In conclusion, this study suggested that major barriers to conduct health promotion activities were lack of budget, lower interest of top managers, and insufficient professional information, therefore detail health promotion program would be developed and supported by government.