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.

STI571 (Glivec^(�))에 의하여 빠른 치료 반응을 보인 불응성 Gastrointestinal stromal tumor

윤경원,이제중,김여경,황호인,이병환,조상희,정익주,김형준 全南大醫大 2001 전남의대학술지 Vol.37 No.4

흰쥐에서 부신 적출이 양성 가속도(+Gz) 노출에 의한 위산분비 감소에 미치는 영향

윤신희,김대중,박병옥 공군본부 의무감실 1992 항공의학 Vol.40 No.1-2

흰쥐에서 paraquat독성에 미치는 tumor necrosis factor-α의 영향

차종희,박정수,양성훈,박재윤,이병래 조선대학교 2000 The Medical Journal of Chosun University Vol.25 No.2

Background : The toxicity of paraquat is due to the oxygen-derived radicals formed by the reaction of oxygen with bipyridylium radical cations. Tumor necrosis factor (TNF)-α induces the synthesis of mitochondrial manganese superoxide dismutase (Mn-SOD) and other protective proteins in a variety of tumor cells and these protein contribute to a protect tumor cells from free radical injury. In this study, the effects of TNF-α on paraquat-induced toxicity were investigated in rats. Methods : Experimental animal used was Sprague-Dawley male rat, body weight 150-200g. The paraquat toxicity was determined by survival rate. The SOD, catalse, and glutathione peroxidase(GSHPx) activity were spectrophtomerically determined by Crapo method, Aebi method and Flohe method, respectively. Results : The survival rate of paraquat-intoxicated rats was decreased by subctaneous injection of TNF-α. However, the survival rate of paraquat injected rats were increased by pretreatment of TNF-α, comparing to saline pretreatment. The liver SOD activity was increased significantly by TNF-α treatment, but kidney and lung enzyme was unaltered in TNF-α treated-rats, comparing to normal control rats. The increment of liver SOD activity by TNF-α treatment was dose- and time-dependant SOD activity of kidney and lung of rats were not changed by TNF-α injection. The activities of catalase and glutathione peroxidase and contents of thiobarbituric acid reactive substance(TBARS) in liver were not changed by TNF-α treatment. Conclusion : From these result, TNF-α potentiate paraquat toxicity in rats but TNF-α pretreatment reduce paraquat induced toxicity. Protective effect may be resulted from the increased liver SOD activities by TNF-α.

칼로리량 급여 제한이 OLETF 흰쥐의 콜레스테롤량에 미치는 영향

박재윤,김태형,이병래,차종희 조선대학교 부설 의학연구소 2002 The Medical Journal of Chosun University Vol.27 No.1

본 실험은 식이 제한 급여에 따른 비만형 당뇨병 환자의 체중 및 혈중 지질량의 변화에 대한 연구의 일환으로 사람의 비만형 당뇨병과 유사한 병리소견을 나타내는 OLETF 흰쥐를 이용하여 칼로리 급여량 비 제한군, 칼로리 급여량 20% 제한군과 40% 제한군으로 나누어 12주간 사육한 후 체중과 혈당, 혈액 cholesterol 및 중성지질량을 측정하여 칼로리 급여량제한에 따른 혈액 지질량의 변화를 관찰하였다. 체중은 칼로리 급여량 20% 제한군에서는 체중증가 억제 비율이 LETO와 OLETF흰쥐가 비슷하였고, 칼로리 급여량 40% 제한군에서는 OLETF 흰쥐에서 체중 증가 억제가 더 크게 나타났다. 칼로리 급여량 제한에 의한 혈당량의 저하는 비만형 당뇨쥐인 OLETF 증 흰쥐가 LETO 흰쥐에 비하여 더 크게 나타났다. 칼로리 급여량 제한으로 OLETF 종 흰쥐에서 혈액 중성지질량, 총 콜레스테롤량 및 LDL- 콜레스테롤량이 감소되었고, HDL-콜레스테롤량은 증가되므로, 비만형 당뇨병환자에서 칼로리 제한 식사는 OLETF 종 흰쥐에서와 유사한 혈액 콜레스테롤량의 변화를 유발시켜서 혈관 합병증을 억제할 수 있을 것으로 예상된다. 이상의 실험결과로서 칼로리 급여량 제한에 의한 체중, 혈당, 혈액 총 콜레스테롤량, LDL-콜레스테롤 및 HDL-콜레스테롤량의 변화가 비당뇨 흰쥐보다 당뇨흰쥐에서 더 큰 변화가 있음이 확인되어 칼로리 제한 급여는 당뇨병에서 체중, 혈당, 콜레스테롤량의 조절에 유의한 것으로 생각되고, 칼로리 급여 20% 제한군과 40% 제한군 사이에서 체중, 혈당, 콜레스테롤량의 변화는 칼로리 제한량의 변화에 비하여 적기 때문에 적절한 체중, 혈당, 혈중 지질량의 유지를 위해서는 칼로리 급여량을 적절히 유지하는 것이 중요할 것으로 생각된다. 또한 칼로리 급여 제한에 의한 체중, 혈당, 혈중 중성지질과 콜레스테롤량의 감소는 혈관 합병증 발생이 예방 할 수 있을 것으로 추측되는데, 이에 대해서는 계속적인 연구가 있어야 할 것으로 생각된다. Objective: To determine the effects of caloric restriction on blood cholesterol levels of obese type 2 diabetes, we measured blood glucose and cholesterol level in Otsuka Long Evans Tokushima Fatty(OLETF) rats after caloric restriction. Methods: OLETF rats(obese diabetic rats) and Long Evans Tokushima Otsuka(LETO) rats(nondiabetic control rats) were grouped into 3 groups, control group, 20% caloric restriction(20% CR) group and 40% caloric restriction(40% CR) group, respectively. The blood glucose and cholesterol level in OLETF and LETO rats were determined after 12 weeks caloric restriction. The levels of triglyceride(TG) and cholesterol(total cholesterol, LDL-cholesterol, HDL-cholesterol) in blood of rats were determined by automatic biochemical analyser(Hitachi 747 Japan). Results: Blood glucose level of LETO rats were decreased by 12% on 40% CR compared to control group but the differences of blood glucose levels between control group and 20% CR group was not observed. OLETF rats blood glucose levels were decreased by 20% in 40% CR group and by 15% in 20% CR group. The levels of blood triglyceride in 20% CR and 40% CR groups were decreased by 20%, 15% in LETO rats and by 37%, 32% in OLETF rats respectively. Total cholesterol level was not changed by dietary restriction in LETO rats, but in OLETF rats, total cholesterol levels was decreased significantly by caloric restriction. The HDL-cholesterol levels were increased while LDL-cholesterol levels were decreased by dietary restriction in both LETO and OLETF rats. Conclusion: These results suggested that OLETF rats may be more susceptive to changes of body weight and blood glucose, triglyceride and cholesterol levels than LETO rats by caloric restriction. Reduced LDL-cholesterol and triglyceride levels in diabetes by caloric restriction may have some roles on prevention of diabetic vascular complication.

무균성 수막염 환자에서 분리한 enterovirus의 혈청형 및 계통발생학적 분석

이정희,안병윤,반성환,김상현,김의종 대한임상미샐물학회 2000 Annals of clinical microbiology Vol.3 No.2

녹차 및 결명자 추출물의 교정용 브라켓과 치면 사이의 경계부에서 분리된 mutans streptococci에 대한 항균작용

임성훈,서정순,윤영주,김광원,유소영,김화숙,국중기,이병래,차종희,박재윤 대한치과교정학회 2003 대한치과교정학회지 Vol.33 No.5

본 연구는 치아우식증에 관련된 Mutans streptococci 표준균주 및 임상분리 균주의 성장억제를 유도할 수 있는 천연 생약추출물을 검색하기 위하여 실시되었다. 녹차추출물은 CHMC-2032를 사용하였으며, 결명자 추출물은 50% 에탄올을 이용하여 얻었다. 이들 추출물의 Mutans streptococci 표준균주 및 교정환자들에서 브라켓과 치면 사이의 경계부에서 분리된 각각 10 균주씩의 S. mutans 및 S. sobrinus에 대한 최소성장억제농도를 액체배지 희석법으로 구하였다. 그 결과 CHMC-2032의 S. mutans 및 S. sobrinus의 표준 균주, S. sobrinus의 대부분 임상분리 균주에 대한 최소성장억제농도는 5 mg/ml이었다. 그러나 결명자 추출물에 의한 S. mutans 및 S. sobrinus에 대한 세균 성장억제 효과는 미미하였다. 본 연구 결과 치아우식증의 예방적 측면에서 결명자차보다는 녹차를 마시는 것이 유리하며, CHMC-2032를 이용하여 구강양치용액을 제조하여 사용할 경우 교정환자를 포함하여 대부분의 사람에게서 치아우식증 예방 효과가 있으리고 추정된다. Mutans streptococci is the major causative factor in dental caries. Especially, orthodontic patients with fixed appliance are a risk group for dental caries. Because fixed appliances attached on teeth may change the environment of dental plaque, the enamel decalcification or dental caries around the bracket and band is a major side effect of orthodontic treatment. The aim of this study was to search plant extracts that have antimicrobial effect on mutans streptococci. Seed-extract of Casio tora were prepared with ethanol and CHMC-2032, the leaf-extracts from Camellia sinensis extract, was obtained extract, 2 type strains and 20 clinical isolates of mutans streptococci isolated from the interface between orthodontic brackets and tooth surfaces in the orthodontic patients were used in this study. The minimal inhibitory concentration of CHMC-2032 was 5 mg/ml on the S. mutans KCTC 3065, S. sobrinus KCTC 3088, and 8 clinical isolates of S. sobrinus. However, there was no antibacterial effect of seed-extract of C. tora on mutans streptococci. These data suggest that green tea may be more effective than the tea prepared from C. tora in the prevention of enamel decalcification or dental caries around brackets.

정신분열증 환자에서 대뇌 반구간 정보전달

임두원,이대희,이병윤 大韓神經精神醫學會 1988 신경정신의학 Vol.27 No.6

The author studied on the callosal function of 20 chronic schizophrenic patients who met DSM-Ⅲ criteria and compared the results with those of age, sex matched 20 controls. In this study Cross Retrieval of Small Test Objects, Cross Replication of Hand Postures and Cross Localization of Fingertips, which are known as test that can evaluate interhemispheric transfer of information, were used. The results were as follows: 1) Correct answers in normal control group were 633 out of 640 total questions with 98.9% of correctness, which approximates almost 100%. 2) Number of mean errors in patient group(2.8000±2.262) was higher than that of control group (0.400±0.503) and the difference between the 2 groups was significant (p<0.001). 3) Number of delayed responses in the patient group(3.100±2.789) was also higher than of control group (0.5500±0.887)and the difference between the 2 groups was significant too (p<0.001). 4)Subtype (paranoid vs undifferentiated), family history of mental and/or neurological disease and sex in the patient group made no difference. With the above results the author suggest that chronic schizophrenics suffer from callosal dysfunction and schizophrenic patients (in the case of paranoid and undifferentiated type)are homogeneous in terms of callosal function as far as family history and sex are concerned.

선천성 슬개골 탈구 및 치료 1례 보고

이호승,배병권,윤희석 충북대학교 의학연구소 2001 忠北醫大學術誌 Vol.11 No.1

선천성 슬개골 탈구는 드문 질환으로 수술적 치료 없이는 정복이 불가능하며 다른 선천성 원인에 의한 재발성 슬개골 탈구와 구별되어야 한다. 본 증례는 생후 5개월 된 남아로 좌측 슬관절 신전 장애를 주소로 내원하였으며 이학적 검사상 좌측 슬부의 20도 굴곡구축, 좌측 경골의 외전 및 좌측 족부 모든 족지의 외측편위 등의 소견이 동반되어 있었다.단순 방사선 사진상 특이 소견은 보이지 않았으며 양측 슬부의 초음파검사에서 좌측 슬개골이 대퇴골 외과(lateral condyle)의 외측으로 탈구된 소견을 관찰할 수 있었다. 수술 소견상 슬개골은 슬부 외측으로 탈구되어 있었고 대퇴골 외과는 저형성되었으며 슬개골 외측 지대와 외측 광근의 심한 구축으로 인하여 도수정복이 불가능하였다. 저자들은 선천성 슬개골 탈구 1례에 관하여 슬부의 광범위 외측 유리(release), 대퇴 사두근 중 내측 광근의 전진, 슬개 건 종지부의 내측전이를 이용하여 좋은 수술적 치료 결과를 얻었기에 문헌 고찰과 함께 보고하는 바이다. Congenital dislocation of the patella is a rare condition that can not be reduced without operative treatment.It should be differentiated from recurrent or habitual patella dislocation. We experienced a case of congenital patella dislocation.Five months old male admitted for the extension lag of the knee.Physical examination revealed flexion contracture of the knee, external rotation of the tibia and lateral deviation of the all toes of the ipsilateral foot.Plain knee radiographs revealed no abnormal findings.An ultrasonographic image demonstrated that the patella was dislocated laterally to the lateral femoral condyle.On the operative field, the dislocated cartilaginous patella and lateral femoral condyle seemed to be hypoplastic, and the lateral retinaculum and the vastus lateralis were contracted.Because of tightness of the lateral retinaculum and the vastus lateralis, the dislocated patella failed to be reduced in any efforts of closed manipulation.After the extensive lateral release, the advancement of the vastus medialis and the medial transfer of entire patella tendon, the patella could be relocated within patella groove of the femur. We report a case of congenital patella dislocation that treated by the operative procedure with brief review of literatures

신생아에서 용질배설에 관한 연구

김경범,박재현,최병민,이현희,윤재균 관동대학교 의과학연구소 2000 關東醫大學術誌 Vol.4 No.1

Purpose : Determination of urinary concentration in neonate is mandatory for precise management of fluid and electrolyte requirements. Although measurement of urine specific gravity has been proposed far monitoring fluid requirements, the reliability of specific gravity does not accurately predict urine osmolalities in the neonate period. So specific gravity should be checked by measuring the osmolality. Also the urinary excretion of creatinine has been used for the assessment of hydration state. We present the result of specific gravity, urine osmolality, urine creatinine in a spot urine sample during the first week of life as a reliable reference standard. Methods : Spontaneously-voided urine sample were obtained in 40 full term neonates. Two urine samples were available with a interval of 4 to 7days (A: 1st day, B: 4 - 7days), Urine sample was tested for specific gravity with a strip test. Also urinary osmolality, urinary creatinine, urinary creatinine/osmolality ratio were measured. Results : The mean of specific gravity tested by the strip test was 1.006±0.0040 (A) , 1.005±0.0036 (B). The mean of urine osmolality and creatinine were 177.7 ± 103.0 and 30.9±21.6 (A), 145.7 ±90.3 and 26.4± 17.7 (B). The mean of excretion rate of urine creatinine/osmolality ratio was 18.2 ±8.5 (A), 19.4 ±9.1 (B). There was correlation between urine specific gravity and osmolality in neonate(r=0.833(A), 0.842(B) p<0.001). Urinary creatinine/osmolality levels of the first urine samples were closely correlated with the second samples (r=0.617, p<0.001). Conclusion : Specific gravity of urine was enough to predict the osmolality in neonate. But Specific gravity should be checked by measuring the osmolality of urine. Urine osmolality and creatinine were spread over a wider range and did not used to urinary excretion of solute in neonate. Urinary creatinine/osmolality ratio can be used to standadise the urinary excretion on solute in the first week of life.