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.

임상 증상이 심하지 않은 심낭 삼출 환자의 장기 추적 결과

배장호,김기식,강미숙,남명희,김미정,김민수,김기영,님창욱,김윤년,김권배,정시전,김여희 대한순환기학회 1999 Korean Circulation Journal Vol.29 No.7

베체트병 환자에서 Azathioprine으로 유발된 급성 췌장염 1례

김기향,권민정,김동기,김애란,김윤정,박지훈,이영태,박보민,김동욱 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Although many drug are thought capable of initiating acute pancreatitis, following azathioprine administration represents the 5% incidence by far the highest recorded incidence to date. We report a 35-year-old male who developed acute pancreatitis in the course of treatment with azathioprine for Behcet's disease. He was admitted due to abdominal pain, diarrhea, and fever for 10 days. Serum amylase and lipase levels were 510U/L and 3702U/L respectively. The abdominal CT scan revealed diffuse enlargement of the pancreas. There was no history of alcohol use or gall bladder disease. We considered drugs, especially azathioprine, as the cause of acute pancreatitis. We diagnosed it as acute pancreatitis. The patient was treated conservatively with hydration and analgesics. The symptom subsided within four days. Five days later, azathioprine was resumed. And the patient complained of abdominal pain. The elevated levels of serum amylase and lipase confirmed the recurrence of pancreatitis. His symptom subsided when azathioprine intake the stopped, and the serum amylase and lipase levels returned to normal level within five days.

수출입 컨테이너 장치장 배정을 위한 소프트웨어의 개발

김갑환,김홍배,홍봉희,김기영,배종욱,최진오,김두열,이영기,박영만,박강태,손행대 한국경영과학회 1995 經營 科學 Vol.12 No.3

The Pusan Container Terminal faces a rapid increase in berthing time of container ships as well as in waiting time of external trucks, which is due to an absolute lack of yard space. This research is focused on the development of a decision support system for the planning of the container terminal yard assignment so that the yard space would be utilized most effectively. Efforts should be given to the reasonable assignment of the yard storage and the dynamic adaptation to the ever changing environment. The software introduced here is based o the know-how of the field exports and its framework takes the approach of the hierarchical decision making.

서울의 PPNG 발생 빈도(1991-1992)

김재홍,윤기범,박평원,김영진,전경민,김영태,김중환,곽호,구상완,송민석,유옥,지혜구,김동원,문상은,박영립,정승호,성범진,성순제,엄주용,황정열,이기홍,이주협,전태진 대한화학요법학회 1994 대한화학요법학회지 Vol.12 No.1

The prevalence of PPNG among pretreated gonorrhea cases isolated at the STD clinic of Choong-Ku Public Health Center in Seoul has been studied and reported annually since 1981. In 1991, 123 strains of N.gonorrhoeae were isolated, among which 58(47.1%) were PPNG. In 1992, 98 starains of N.gonorrhoeae were isolated, among which 51(52.0%) were PPNG. In all, 109(49.3%) strains were found to be PPNG among 221 strains isolated between 1991-1992. The prevalence of PPNG in Seoul showed increased tendency till 1989, thereafter, it has been stationary or slightly decreasing.

서울의 Penicillinase Producing Neisseria gonorrhoeae 발생빈도(1998)

김재홍,김준호,반재용,이정우,황성주,정준규,정성태,강진문,조흔정,홍창의,정혜신,이한승,김이선,이봉길,이종호,선영우,한기덕,윤성필,이성훈,안종성,박석범,문승현,조항래,김형섭,류지호,황재영,박준홍,손상욱 한양대학교 의과대학 2001 한양의대 학술지 Vol.21 No.1

In recent years, gonorrhea has been pandemic and remains one of the most common STDs in the world, especially in developing countries. For the detection of a more effective therapeutic regimen and assessing the prevalence of Penicillinase Producing Neisseria gonorrhoeae(PPNG), we have been trying to study the patients who have visited the Venereal Disease Clinic of Choong-Ku Public Health Center in Seoul since 1980 by menas of the chromogenic cephalosporin method. In 1998, 93 strians of N. genorrhoeae were isolated, among which 60(64.5%) were PPNG. The prevalence of PPNG in Seoul, which had been decreased to 39% in 1996 after a peak of 74.3% in 1993, is increased to 64.5% in 1998.

Azithromycin으로 치료한 임신 중 쓰쓰가무시병 1예

김광석,최진욱,서호종,김기훈,박성호,서광섭,고성만,김순혜,김호정 대한감염학회 2001 감염 Vol.33 No.5

We report a case of tsutsugamushi disease in a 26 year-old pregnant woman who was treated with azithromycin. Her gestation period was 27 weeks and she admitted with fever, rash, and eschar on the right shoulder. Currently recommended medications for the treatment of scrub typhus are doxycycline or chloramphenicol. But, these drugs are class D drugs according to the U.S. Food and Drug Administration (FDA) Fetal Risk Summary, so they couldn't be used to treat pregnant women. Recently, a few case reports suggested that azithromycin, a relatively new macrolide antibiotic, was effective and safe for the treatment of scrub typhus in pregnant women. And, there is no evidence that azithromycin causes harmful effects to the developing fetus or to children. On the basis of current in vivo test that confirms the effectiveness of azithromycin, it may be the drug of choice for the treatment of scrub typhus in pregnant women and children. (Korean J Infect Dis 33:380-382, 2001)

수평 매복된 상악 중절치의 교정적 견인 : 증례 보고

김미니,김영재,김정욱,장기택,김종철,한세현,이상훈 大韓小兒齒科學會 2008 大韓小兒齒科學會誌 Vol.35 No.4

본 증례는 수평 변위 매복과 치근 만곡을 가진 상악 중절치를 폐쇄 노출법을 이용한 교정적 견인을 시행하여 영구 전치의 기능과 심미성을 회복하였다. 상악 영구 전치가 수평으로 매복된 경우,가급적 조기에 발견하는 것이 중요하며, 촉진,시진,방사선 사진 등을 이용한 적절한 치료 계획의 수립이 필요하다. 상악 영구 전치의 매복이 조기에 적절히 치료되지 못하면 정중선의 변위,인접치의 이동에 의한 맹출 공간의 감소,치조골 높이의 차이 뿐만 아니라,이로 인한 심미적인 문제를 야기하여 소아 심리 발달에 해로운 영향을 줄 수 있기 때문이다. 매복치의 치료는 매복치의 형태,위치,상태에 따라 다양하나,주기적 관찰 방법,상부 연조직과 경조직을 단순히 제거하여 맹출을 유도하는 방법,외과적 노출 후 매복치를 교정적으로 견인하는 방법,치아 이식술,발치 등을 시행할 수 있다. 이중 이번 증례에서 시행한 매복치의 교정적 견인은 매복치의 치축이 정상 맹출로와 일치되지 않으며,주기적인 관찰 후 더 이상의 맹출이 기대되지 않을 때 시행하는 가장 일반적으로 적용되는 방법으로 매복의 심도,치아의 발육단계,만곡의 부위와 정도,수술방법과 견인방향 등을 고려하여 치료의 예후를 향상 시킬 수 있다. Maxillary central incisor impactions occur infrequently. Their origins include various local causes, such as odontoma, supernumerary teeth, space loss, and disturbances in the eruption path, also trauma and apical follicular cysts. Impacted teeth can cause serious dental and aesthetic difficulties as well as psychological problems especially in anterior regions. Although the impaction of maxillary incisor occurs less frequently than that of the maxillary canine. it is of concern to parents during the early mixed dentition stage because of the uneruption of the tooth. Forced eruption of impacted teeth should be considered in young patients because this technique can lead to suitable results from a periodontal, occlusal, and esthetic perspective at an earlier stage better than with other treatment options. This report presents the surgical and orthodontic treatment of cases with horizontally impacted and dilacerated maxillary central incisors. For each patient. we used the closed eruption method. placed an attachment on the impacted tooth on surgery, and fully closed the flap. Traction was applied immediately. The impacted tooth erupts through the healed tissue in a manner resembling normal eruption.

성장기 아동의 single tooth scissors bite의 교정 치료: 증례 보고

김지인,현홍근,김영재,김정욱,장기택,이상훈,한세현,김종철 大韓小兒齒科學會 2011 大韓小兒齒科學會誌 Vol.38 No.4

A scissors bite in the posterior teeth occurs when the upper teeth are positioned totally buccal to the lower teeth in centric occlusion, either unilaterally or bilaterally. This malocclusion can result from either excessive width of the maxilla or deficient width of the mandible, or sometimes combination of the both. Scissors bite, when left untreated without a proper dental intervention, interferes with the normal mandibular growth leading to a state where consequent disharmony in dental arch width evokes occlusal disturbances. Therefore, early preventive orthodontic treatment is necessary in patients with scissors bite. Scissors bite rarely involves anterior and posterior sites concuttently across the dental arch but usually affect single tooth. Even in the single tooth scissors bite cases, more likely to be met in the clinical fields, immediate dental intervention is indicated because continuous occlusal forces that exacerbate the already adverse axis of the posterior teeth. In this case study, patients with single tooth scissors bite, each 7, 14, 12, and 16 years old, were each treated with criss-cross elastic, fixed appliance, removable appliance, and miniscrews. With the proper selection of appliances appropriate to each specific cases, good treatment outcome can be achieved without resulting any side effects. 중심교합위의 상태에서 편측 혹은 양측으로 상악 구치부의 치아가 하악 구치부의 협측으로 위치한 경우를 scissors bite라 고 한다. 이는 상악의 폭경이 크거나 하악의 폭경이 좁은 경우 발생한다. Scissors bite의 경우 방치하게 되면 하악의 성장이 방해받게 되고 그 결과, 악궁 폭경의 부조화가 심해져 저작 장애를 일으킬 수 있으므로 조기 차단 교정이 반드시 필요하다. 실제 임상에서는 여러 치아의 scissors bite보다 최후방 구치 혹은 그 외 하나의 구치만의 single tooth scissors bite(STSB)을 보이는 경우가 많다. 이러한 STSB의 경우도 방치하게 되면 저작력으로 인하여 구치의 각도가 더욱 악화되므로 즉각적인 치료가 필요하다. 본 증례에서는 STSB를 보이는 7세, 14세, 12세, 16세의 환자에게 각각 criss-cross elastic, 고정성 장치, 가철성 장치, miniscrew를 사용하여 치료한 증례를 보고하였다. 각 환자의 증례에 적합한 장치를 잘 선택하여 사용한다면 치아를 정출시키는 등의 부작용을 야기하지 않고 양호한 결과를 얻을 수 있을 것이다

동창의 임상 및 병리조직학적 소견과 Ki-67 발현 양상

서기석(Ki Seuk Suh),김상태(Sang Tae Kim),이기욱(Ki Wook Lee) 대한피부과학회 1999 대한피부과학회지 Vol.37 No.9

N/A Background : Pernio or chilblain is an abnormal reaction to damp cold air, resulting in pruritic erythematous swellings on acral skin. The histologic features are subepidermal edema, diffuse fluffy edema of endothelial cell, and superficial or superficial and deep perivascular lymphocytic infiltrates. Many studies with a large sample size have been conducted in western countries, but there were no collective studies of pernio that have been reported in Korea. Objective : The purpose of this study was to clarify the clinical and histopathologic features of pernio in Korea. Methods : We reviewed the clinical and histopathologic findings in ten patients with pernio who visited the Department of Dermatology, Kosin Medical College Gaspel Hospital during the 10 year period from 1988 to 1997. Results : The results were as follows. 1. The age distribution was in the range of 6∼50 year old. The prevalance was heighest in the third and fourth decade. Sex ratio was 1 : 4 (2 males : 8 females). The duration of symptoms ranged from 4 days to 30 years. All patients developed skin lesions on the acral area. Two male patients developed skin lesions on the hand associated with cold exposure and outdoor works. All patient had itching and burning papules and/or plaques, and one had a painful hard nodule. Laboratory studies were all negative and within normal ranges. 2. Histopathologic features revealed subepidermal edema, diffuse fluffy edema of endothelial cell, and superficial or superficial and deep perivascular lymphocytic infiltrates in all specimens. 3. Treatment includes prophylatic measures against cold and nifedipine(calcium channel inhibiting drug). In more severe cases, pentoxifylline might be helpful. Conclusion : Our study suggests that pernio commonly occurs in twenty to forty year old females during fall and winter. Upon exposure to cold temperatures, the acral skin develops pruritic erythematous papules and plaques. If these lesions persisit for a long time or recur, they may progress to vesicle and ulceration and possibly develop vasculitis which does not respond to therapy well. Thus, a thorough understanding of clinical and histopathologic features of pernio is vital in making a diagnosis, a treatment plan and determining the prognosis. (Korean J Dermatol 1999;37(9) : 1254∼1260)