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.

금합금의 프라이머 처리가 교정용 브라켓의 접착에 미치는 영향

류동범,권태엽,권용훈,김교한 大韓齒科器材學會 2003 대한치과재료학회지 Vol.30 No.3

The purpose of this study was to compare the bonding strength and the interfacial micromorphology of two surface modification of gold alloys in direct bonding of orthodontic brackets. Flat tab of cast gold alloys (n= 120) were subjected to either of two surface treatments: 1.50㎛ aluminum oxide sandblasting, and 2. sandblasting plus adhesive primer for noble metal. Orthodontic brackets (RMO Co.) were bonded directly with Superbond C&B (Sun Medical Co. Ltd.), or Transbond XT (3M Unitek), or Ortho One (Bisco). All specimens were stored in distilled water at 37℃ for 24 hours, and then the tensile bond strength testing was performed in a Instron test machine. Bond failure sites were classified by a modified Adhesive Remnant Index (ARI) system. The results showed that sandblasting plus adhesive primer for noble metal produced stronger bonds to gold alloy than sandblasting only in all cases (Superbond C&B, Transbond XT, Ortho One). Superbond provided significantly stronger bonds to gold alloy than the others. Bond failure of Superbond to sandblast only and sandblast plus adhesive primer for noble metal to gold alloy occurred at the bracket/adhesives interface, whereas bond failure of the others occurred at the gold/adhesive interface. The clinical implications of these findings are discussed.

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.

Zoledronic acid가 골육종 세포에서 Matrix Metalloproteinase-2와 -14의 발현과 폐전이에 미치는 영향

김용백,김상범,권영호,김재도 KOSIN UNIVERSITY COLLEGE OF MEDICINE 2006 高神大學校 醫學部 論文集 Vol.21 No.1

Purpose : Gelatinase A (MMP-2) and membrane-type metalloproteinase (MT1-MMP, MMP-14) play a critical role in metastasis. It was known that bisphosphonate acts not only to protect bone absorption but also to inhibit tumor invasion and metastasis. The aim of this study is to investigate the inhibition of MMP-2 and 14 in osteosarcoma by zoledronic acid, whether it can prevent lung metastasis in nude mouse. Material and Method : Protein synthesis and mRNA expression of MMP-2 and MMP-14 cultured human MG-63 osteosarcoma and HOS osteosarcoma cell lines with zoledronic acids were measured. In vivo test, it was observed that the inhibitory effect of zoledronic acid on lung metastasis of osteosarcoma with nude mouse model. Result : Zoledronic acid inhibited mRNA expression of MMP-14 and MMP-2 in cultured human MG-63 osteosarcoma and HOS osteosarcoma cell lines. Zoledronic acid decreased the intensity of activated 62KD MMP-2 in human MG-63 osteosarcoma and HOS osteosarcoma cell lines on gelatine zymography. Number of metastatic lung nodule decreased from 9.4 to 1.2 in MG-63 osteosarcoma cell line and from 8 to 1.6 in HOS osteosarcoma cell line with nude mouse model. Conclusion : In vitro, zoledronic acid had an inhibitory effect on the MMP-14 and MMp-2, which also prevents lung metastasis of osteosarcoma in vivo. So, zoledronic acid could be used as one of good chemotherapeutic agents against metastasis of osteosarcoma.

완전 기저 동맥 중복과 동반된 모야모야병(Moyamoya disease) 1예

권준범,양현덕,한범기,이지용,문준식,이성수 대한신경과학회 1999 대한신경과학회지 Vol.17 No.2

20km와 150km의 도로싸이클 주행이 혈중 렙틴, 지질과 호르몬 수준에 미치는 영향

최용어,권봉안,오재근,김범수,조준용,김문희 한국체육대학교 체육과학연구소 2000 韓國體育大學校附屬 體育科學硏究所論文集 Vol.19 No.1

Serum leptin, glucose, lipid profiles (free fatty acid, triglyceride, total cholesterol) were determined in two groups of subjects undergoing long and short strenous cycle race, 8 men who fasted overnight and then pedaled 20km cycle race and 8 men, 150km cycle race, respectively, Blood samples were collected before race, immediately after cessation of race and 2hr, 6hr after the end of race period. Cyclist pedaling 20km cycle race and cyclist pedaling 150km cycle race showed no statistical differences in leptin level. After 6hr of rest, leptin concentrations were gradually decreased but showed no statistical different in both groups. Epinephrine (p〈.01) and norepinephrine (p〈.001) concentration in comparison to pre-race levels were increased significantly. But insulin concentration in comparison to pre-race levels were decreased significantly (p〈.001). Glucose (p〈.01), free fatty acid (p〈.001), cholesterol (p〈.001) and triglyceride (p〈.01) were increased immediately after cessation of race in both groups.

지난 4년간 학회지 "신경정신의학" 심사 평가보고

오병훈,권준수,남궁기,김승현,지익성,김창윤,하규섭,박원명,김성곤,오강섭,김정범,이수정,정한용,이창욱,박용천,이영문,김세주,이병욱 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.5

Four Years Reports of "Journal of Korean Neuropsychiatric Association" during 2001 to 2005 were evaluated by 18 Editorial Board of Korean Neuropsychiatric Association. We investigated the articles to specific fields and rejection rate etc. by different section chiefs. Although several problems concerning review time duration and rejection guideline issues indicated but generally all reviewer processes proved relatively clear and concise criteria. Through these objective and systematic evaluation Processes, "Journal of Korean Neuropsychiatric Association" will develop a good journal.

폐그물 재활용을 위한 폐수처리용 생물막여재 개발 및 적용

한동준,최용범,권영두 도립 강원전문대학 1999 道立 江原專門大學 論文集 Vol.2 No.-

This study was performed to reuse of derelict net. The derelict net would be development and application with the biofilm media using wastewater treatment. The biofilm media of dereliet net can be construct three system of curtain, bar, and modified type. In the wastewater treatment process using the dereliet net media, the organic removal and nitrification rate showed the higher than the process using sun lock media. The derelict net media could be prevent a internal anaerobic condition because of excellent oxygen transportation. Therefore, the dereliet net has the excellent ability with wastewater treatment media. We are known to possible the reuse of derelict net, sufficiently.

수근관 증후군에서의 무증상성 척골신경병증

문준식,이성수,이지용,한범기,권준범,양현덕,이성익 대한신경과학회 1999 대한신경과학회지 Vol.17 No.2

Distinct association between nonsynonymous SNPs of candidate genes and bronchodilatory response to short-acting inhaled B2 agonist according to atopic status

Yong Eun Kwon,Hye Kyung Park,Tae Bum Kim,Eun Sun Shin,Jong Eun Lee,Heung Bum Oh,Yoon Seok Chang,Yoon Keun Kim,Sang Heon Cho,Kyung Up Min,You Young Kim 대한내과학회 2004 대한내과학회 추계학술대회 Vol.2004 No.1