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.

Prevention of medical malpractice and disputes through analysis of lawsuits related to coronary angiography and intervention

Cheol Won Hyeon,Won Lee,So Yoon Kim,Ji Yong Park,Su Hwan Shin 대한내과학회 2020 The Korean Journal of Internal Medicine Vol.35 No.3

Background/Aims: Possible fatal complications arising from coronary angiography (CAG), percutaneous coronary intervention (PCI), and coronary artery disease itself, are likely to cause medical disputes. Presenting the current status and reasons for judgments given in lawsuits related to CAG/PCI, this study aimed to identify ways to prevent unnecessary disputes and medical malpractice suits related to CAG/PCI through lawsuit analysis. Methods: A total of 13 cases (20 judgments) found in the Supreme Court of Korea’s Written Judgment Management System from 1998 to 2017 were analyzed. Results: Coronary artery injury was the most common causative complication that led to lawsuits (n = 6, 46%). Six cases (46%) were ruled in favor of the plaintiff for violation of duty of care (n = 4) and duty of explanation (n = 2), respectively. Cases that violated duty of care included two errors in intra-procedure device manipulation, one in pre-procedure diagnosis, and one in management of post-procedure complication. Lack of explanation regarding the risk of complications was pointed out in both cases that violated duty of explanation. The average awarded amount for the damages was 114,436,064 Korean won. Conclusions: Physicians need not fear unfair judgments so long as they follow standard of care because the Court consistently looked at the probability, the foreseeability, and the evidence. Therefore, maintaining standard of care is important. Besides, specific, detailed, and comprehensible explanations, including the risk of complications in addition to the necessity of procedures, are important to ensure the patient clearly understands the possible risk of adverse outcomes.

온수배관을 이용한 온실의 난방성능

윤용철(Yong Cheol Yoon),신익수(Yik Soo Shin),김현태(Hyeon Tae Kim),배승범(Seoung Beom Bae),최진식(Jin Sik Choi),서원명(Won Myung Suh) (사)한국생물환경조절학회 2012 생물환경조절학회지 Vol.21 No.2

본 연구는 온실의 난방 에너지 절감을 목적으로 온실 내부에 알루미늄 온수배관을 설치하여 난방효과에 대한 기초자료를 구축하고자 수행되었다. 그 연구결과를 요약하면 다음과 같다. 전체 실험을 포함하여 온실내의 높이별 온도편차는 4.0~7.0℃ 정도의 범위로서 그 차이가 크게 나타났다. 팬코일유니트(FCU)를 작동시킨 경우가 작동시키지 않은 경우에 비해 유출입수의 온도차가 3.3℃ 정도 크고, 소비전력량은 36.2~40.1% 정도 증가하였으며, 시간당 방열량은 44.6~52.0% 정도 증가하는 것으로 나타났다. 실험기간동안 순환유량은 0.48~0.49L · s<SUP>?1</SUP> 정도의 범위에 있었고, 평균유속은 1.53~1.56m · s<SUP>?1</SUP> 정도였다. 유출입수의 평균 온도차는 6.24~11.50℃이었다. 최저 외기온 ?14.0~?0.6℃ 범위에서 설정온도별 방열량은 135,930~307,150㎉ 정도의 범위로서 시간당 9,610~19,630㎉ · h<SUP>?1</SUP> 정도의 범위에 있었다. 이것은 최대난방부하의 약 23~53% 정도의 난방에너지를 공급할 수 있을 것으로 나타났다. 전체 방열량과 소비전력량은 각각 2,548,306㎉ 및 3,075.7㎾h이다. 화석연료인 경유로 난방할 경우, 소요되는 경유의 총 소비량은 281.6L 정도이고 비용은 321,000won인 것으로 나타났다. 농가용 전력요금을 적용하면 전력사용에 대한 총비용은 110,730won 정도로서 경유 소비 비용의 33.5% 정도로 나타났다. 실험구의 온도가 대조구보다 약 8.3~14.6℃ 정도 높게 나타났다. This research was conducted to obtain basic data with regard to the heating performance that would be produced by installing an aluminum hot water pipe inside the greenhouse with the goal of reducing the heating energy in greenhouse. The research results are summarized as follows. The degree of difference in relation to the temperature by height within the greenhouse during the entire experiment was significant - within the range of 4.0~7.0℃. The temperature difference between incoming and outgoing water was about 3.3℃ greater when FCU was activated compared to when it was not activated. Meanwhile, the amount of energy consumed increased about 36.2~40.1%. The amount of pyrexia per hour also increased by 44.6~52.0%. During the experiment period, circulated flux was within the range of 0.48~0.49 L · s<SUP>?1</SUP> while average fluid speed was 1.53~1.56 m · s<SUP>?1</SUP>. The average temperature difference between incoming and outgoing water was 6.24~11.50℃. The amount of heating value by each set temperature within the minimum outdoor temperature range of ?14.0~?0.6℃ was 135,930~307,150 ㎉, and the range was within the 9,610~19,630 ㎉ · h<SUP>?1</SUP> per hour. This demonstrated that about 23~53% heating energy of the maximum heating load could be supplied. Total radiating value and amount of energy consumed were 2,548,306 ㎉ and 3,075.7 ㎾h, respectively. When heating takes place using oil, which is a fossil fuel, the total amount of light oil consumed was 281.6 L while the cost was 321,000 won. When the electricity cost for farms is applied, the total cost was about 110,730 won, which is about 33.5% of the cost required compared to oil consumption. The temperature at in the experiment area was about 8.3~14.6℃ higher compared to that of the control area.

야뇨증 환아들의 심리사회적 특성에 대한 다기관 연구 : 행동 및 정서 문제를 중심으로

조수철,김재원,신민섭,황준원,한상원,박관현,이상돈,김경도,김건석,서홍진,이유식,정재용,김영균,문두건,남궁미경,한창희,조원열,김영식,배기수,이종국,정우영,신의진 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.6

Objectives : The aim of this study was to examine the behavioral and emotional problems associated with nocturnal enuresis in Korean children. Methods : Three hundred eighteen children with nocturnal enuresis, together with their parents, completed the Child Behavior Checklist (CBCL), Disruptive Behavior Disorder Scale according to DSM-IV (DBDS), Children's Depression Inventory (CDI), State-Trait Anxiety Inventory for Children (STAIC), and Piers-Harris Children's Self-Concept Scale (PHCSC). Ninety-three normal students were selected as the control group. Results : Compared to the normal control group, the mean scores with regard to the withdrawn, social problems, attention problems, delinquent behavior, aggressive behavior, externalizing problems and total problems profiles were significantly higher in the nocturnal enuresis group according to the CBCL results. The nocturnal enuresis group also scored significantly higher in the ADHD and ODD profiles of the DBDS. The nocturnal enuresis group was more depressed and anxious than the control group according to the results of the CDI and STAI. The mean score of the PHCSC was significantly lower in the nocturnal enuresis group when compared to the normal control group. Conclusion : The results of this study suggest that children with nocturnal enuresis in Korea have clinically relevant behavioral and emotional problems. The findings support the link between nocturnal enuresis and psychopathology in Korean children.

영구 심박동기 삽입 후에 발생한 우심실 천공 1례

신원용,이승진,진동규 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Myocardial perforation is a rare complication after pacemaker implantation. We experienced the right ventricular perforation during implantation of a transvenous pacing electrode. The patient was 83-year-old woman who had permanent pacemaker(VDD) for 2:1 AV block. After insertion of a permanent pacemaker, she was pale and blood pressure, 80/50mmHg. An echocardiography revealed a moderate pericardial effusion without signs of cardiac tamponade. At serial echocardiography, pericardial effusion was decreased. She was discharged uneventfully.

컴퓨터과학 교육을 중심으로 한 중등 컴퓨팅 교육과정 설계

신상국,권대용,김형신,염용철,유승욱,이원규 한국컴퓨터교육학회 2005 컴퓨터교육학회 논문지 Vol.8 No.3

하수방류수의 자외선 살균을 위한 설계인자 최적화에 관한 연구

신동호,김진현,김정민,고승민,모효원,이용택 한국공업화학회 2004 응용화학 Vol.8 No.2

對아프리카 FDI(해외직접투자)의 현황과 전망

신원용 한국외국어대학교 아프리카연구소 2001 한국아프리카학회지 Vol.13 No.-

Hockey경기 규칙 변경 전·후 경기내용 비교분석 : 남자대학, 일반부 팀을 중심으로 Centering On University Male-Students' and General teams

원영두,신명건,안용덕 조선대학교 스포츠과학연구소 1997 스포츠科學硏究 Vol.8 No.-

This Study is an attempt to compare the games which were played before the Hockey rules were mdidfication with the games after they were mdidfication and to improve competitiveness. In Particular, the 1996’s National Spring Hockey Tournarment, played befor the rules were mdidfication, and 1997 National Spring Hockey Tournarment, which was the first tournarment after the rules were mdidfication, are examined. 1. In the time of attacking, in the regard of attack frequency, the mean of enterning the 25yard point was 45 per game in the 96 tournament and 38.1 per game in the 97 tournament. 2. In the time of attacking, the mean of gaining of fouls with in 25yard point was 10.3 per game in the 96 tournament and 9.6 Per game in the 97 tournament. 3. In the time of attacking, the mean of gaining corner hits was 7.3 Per game in the 96 tournament and 5.2 per game in the 97 tournament. 4. The points made by PCG, PSG and FG were 2.5 per game in the 96 tournament and 3.2 per game in the 97 tournament.

Urapidil, Labetalol의 투여가 기관내 삽관시 심혈관계에 미치는 영향

신용섭,윤석화,손수창,이원형,이정은,황원재,김만수,김영주,김혜자,최세진 충남대학교 의과대학 지역사회의학연구소 1994 충남의대잡지 Vol.21 No.2

We have examined the comparative efficacy of small doses of intravenous urapidil and labetalol in blunting hemodynamic response to endotracheal intubation and surgical incision in 30 patients without cardiovascular diseases. After intravenous urapidil 0.2 mg/kg or labetalol 0.2 mg/kg anesthesia was induced with thiopental 5mg/kg. Endotracheal intubation was facilitated by vecuronium 0.15 mg/kg with priming principle and anesthesia was maintained with enflurane and nitrous oxide in oxygen. Systolic, diastolic and mean arterial pressure and heart rate were measured before administration of the drugs, 5 minute after administration, just prior to endotracheal intubation and 1, 3, 5, 10 minute after intubatin. Also the peak blood pressures and heart rate within 10 minutes after surgical incision were measured. Endotracheal intubation and surgical stimulation were associated with significant increases in blood pressures and heart rate in both urapidil and labetalol group. Comparison of the changes in systolic, diastolic, and mean artrial pressures and heart rate between urapidil and labetalol group showed no significant difference except peak systolic pressure after surgical incision. It is concluded that the pressor response to endotracheal intubation and surgical stimulation are not influenced significantly by urapidil 0.2 mg/kg or labetalol 0.2 mg/kg. However, urapidil and labetalol preloading may be similarly effective in the blunting of the increases in blood pressures with larger doses of the durgs during anesthetic induction.