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.

신성고혈압 흰쥐에서 측뇌실내 Captopril이 Bradykinin의 중추승압효과에 미치는 영향

정태호,양민준,오승호,전제열,염철호,윤평진 조선대학교 1994 The Medical Journal of Chosun University Vol.19 No.2

Effects of intracerebroventricular captopril on the central pressor response to bradykinin were examined in normotensive and 2-kidney, 1 clip (2KIC) Goldblatt hypertensive rats. The experiment was done under pentobarbital (50 ㎎/㎏. IP) anesthesia. Captopril (1 ㎎)and bradykinin (5 nmol) were administered into the right lateral cerebral ventricle, while arterial blood perssure and heart rate were continuously monitored throughout the experiment. Intracerebroventricular captopril did not affect the blood pressure within 10 minutes in both normotensive and 2KIC hypertensive rats, while it significantly augmented the central pressor response to bradykinin in the hypertensive rats. These observations suggest that an elevation in endogenous kinin levels is without effect on arterial pressure in normotensive and 2KIC hypertensive rats. However, the kallikreinkinin system in the central nervous system plays a role in the regulation of blood pressure, possibly maintaining the hypertension, in 2KIC hypertensive rats.

응급의학과로 내원한 환자중 내원시 예상치 못했던 사망에 대한 고찰

김승렬,김상은,양혁준,정호성,박철완,이 근 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Patients die in the emergency department frequently ; however, there has been little about the incidence and cause of Emergency Department death in the emergency medicine literature. This study was conducted retrospectively to gain insight into the patients who die suddenly and unexpectedly in the Emergency Department(ED). A total of 360 patients were pronounced dead in the ED from 1991 through 1994 in Chung Ang Gil Hospital. Of the 360 patients, 309 (86%) were brought to the ED with cardiopulmonary resuscitation in progress or as do not resuscitation(DNR) patients, leaving 51(14%) patients who met the unexpected death criteria. Of the unexpected deaths, 32(62.7%) patients presented to the ED with either abnormal vital sign (24 of 32) or some alteration in consciousness (18 of 32), or both of them (10 of 56). Medical and surgical causes of death represented 47.1% (24 patients) and 15.6% (8 patients) of the unexpected deaths respectively. Trauma represented 19 (37.3%) of the unexpected deaths, with 14 of these being the result of motor vehicle collision. The yearly incidence of unexpected ED death is presented in numbers of deaths per 10,000 ED visits. In 1991, the incidence was 3.4, and in 1992, 1993 and 1994 those were 2.7, 2.2 and 2.1 respectively.

중심 정맥 삽관법에 의한 동정맥루: 증례 및 문헌 고찰

이 근,원형섭,양기창,박철완,김상일,정호성,이종호 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

A 36-year old woman with end stage renal failure and hypertension was transferred from a university hospital to our emergency department due to a enlarging right cervical mass associated with a palpable thrill and a bruit. Over a 2 month period, she required hemodialysis for severe azotemia at a university hospital in Seoul. 3 days after a difficult attempt at a internal jugular cannulation, she developed a progressive swelling in the right lower cervical area. An arch and primary branch arteriogram revealed a arteriovenous fistula between right innominate artery and internal jugular vein with a large intervening pseudoaneurysm. She underwent vascular surgery within 1 week of injury and subsequent postoperative angiogram showed complete resolution of the fistula. This rare condition is reported with a review of the literature.

장기적 트립토판 결여식이 생쥐의 유해감각예민도에 미치는 영향

서영대,박제민,김명정,전명호,양구범,장세헌,강철중,김정태,김용식 대한생물치료정신의학회 2000 생물치료정신의학 Vol.6 No.1

The depressive patients can be divided into two subgroups by presence and absence of pain symptoms. Those without pain symptoms have blunted pain sensitivity whereas those with pain have normal range of pain sensitivity, and are clinically characterized by anxiety and irritability. The aim of the study is to test if these clinical profiles of the depressives with pain symptoms are related with reduced level of brain serotonin(5-HT). Forty four mice were randomly divided into two groups : one group to be bred with tryptophan free diet and the other with normal control diet, each for 4 weeks. Before the beginning of the breeding period, measured were locomotor activity by open field test, anxiety by elevated plus maze and nociceptive sensitivity by tail flick test, before and after forced swimming(FS). During each FS, duration of immobilization was also measured. The sable sets of measurements were repeated at the end of the breeding period. The brain 5-HT and 5-hydroxyindoleacetic acid(5-HIAA) were measured by high performance liquid chromatography. The results were as follows 1.Four weeks of tryptophan free diet reduced significantly body weight, brain weight, and levels of 5-HT and 5-HIAA in the whole brain. 2.Tryptophan depletion did not influence basal nociceptive sensitivity as measured by tail flick latency before FS. The normal blunting of the pain sensitivity induced by forced swimming was preserved in the tryptophan depleted group. 3.Tryptophan depletion did not influence general locomotor activity in open field. 4.Tryptophan depletion increased significantly time spent on the open arms at the elevated plus maze test done before FS. This anxiolytic-like effect was reduced by FS. 5.Tryptophan depletion did not influence duration of immobilization during FS. From these results, it is suggested that the genesis of the depression with pain symptoms is not medicated by quantitative reduction of brain serotonin

유기용제노출이 직업적 청력손실에 미치는 영향

이지호,고영주,이헌,강정학,유철인,이충렬,김양호 大韓産業醫學會 2000 대한직업환경의학회지 Vol.12 No.4

목적 : 산업 장에서 노출되는 유기용제가 청력역치에 어떠한 영향을 미치는가를 5년 동안의 추적조사를 통하여 파악하고자 하였다. 방 법 : 유기용제와 소음에 동시에 노출된 근로자 43명과 소음노출수준, 연령, 근무경력을 짝짓기 한소음노출군을 대상으로 문진과 이경검사, 소음노출 수준, 유기용제노출수준을 조사하였다. 결과 : 1. 전체 근로자의 각 주파수별 청력역치 변화양상에서 500Hz∼2000Hz에서는 추적기간 동 소음동안 현저한 변화가 없었고, 4000Hz 및 8000Hz에서는 역치가 증가하는 경향을 나타내었다. 2.유기용제와 소음에 동시에 노출된군에서 소음 노출군에 비해 4000Hz 이상에서 청력역치가 높게 나타났으나, 통계적인 유의성은 없었다(p(0.05). 3.반복측정 분산분석 법으로 각 주파수별 평균청력 역치의 연차적 변화에 미치는 영향을 분석한 결과 유기용제 노출은 통계적으로 유의한 영향이 없었으나(p)0.05), 소음노출수준은 250Hz, 2000Hz 및 4000Hz에서, 연령은 250Hz와 500Hz에서 통계학적으로 유의한 영향을 미치는 것으로 나타났다(p(0.05). 4.소음노출군파 동시노출군 각각에서의 청력역치 변화량을 paired t-test로 비교한 결과 250Hz∼4000Hz에서는 통계학적 유의성이 없었으며(p(0.1), 8000Hz에서만 경계치 (p=0.0884)의 유의성을 나타내었다. 5.요인들의 영향을 보정한 상태에서 관찰하기 위해 관찰기간동안의 청력역치변화량을 종속변수로 두고 일반선형모형을 이용하여 주파수별로 관찰한 결과 8000Hz에서만 모델에 통계학적 유의성이 있었으며 (p(0.05), 여기서 소음노출수준이 통계학적으로 유의한 영향을 미치는 것으로 나타났고(p(0.05), 유기용제노출은 경 계수준이 었다(p=0.087). 결론 : 청력에 대한 유기용제의 영향이 소음과 연령에 비해 상대적으로 미미하여 명확한 결론에 이르지는 못하였으나, 다소 영향이 있는 것으로 생각되어 유기용제의 영향에 대한 추가연구가 필요할 것으로 판단된다. 또한 보다 효과적인 근로자들의 청력관리를 위해서는 소음 외 산업 장에서 동시에 노출되는 여러 유해물질들을 고려하여야 할 것이다. Objectives : This study was to evaluate the impacts of simultaneous exposure to noise and mixed solvents on workers'hearing threshold level (HTL) over five-year period. Methods : The study was conducted by interview and annual audiometric test on workers in ship building industry from 1994 to 1998. The cases(workers who exposed to noise and mixed solvent simultaneously) were 43 male workers and controls (workers who exposed to nolle) were selected by matching method with regard to age, sex, carrier, and noise exposure level. To assess the impacts of solvent exposure on hearing threshold level, with considering other factors, general liner model was used. Results : 1. The audiogram of all subjects showed typical sensorineural hearing loss pattern. The mean HTLe were increased at high frequency (4000HB and 8000Hz) for study period. 2. The HTLs of cases were more increased than those of controls at high frequencies (4000Hz and 8000Hz), but there was not statlstical significance. 3. The impact of age on the HTL was statistically significant at 250Hz and 500Hz (p(0.05), and the impact of noise on the HTL was statistically significant at 250Hz, 2000Hz and 4000Hz (p(0.05), but the impact solvent exposure on the HTL was not significant. 4. The changes in HTLs of cases were higher than those of controls at high frequency, there were not statistical significance at 4000Hz, but only at 8000Hz (p=0.087). 5. Statistical analysis of the general linear model implicated that the changes in HTL was impacted by noise exposure bevel significantly (p=0.031) and Impacted by solvent exposure weakly (p=0.087) at 8000Hz. Conclusions : The results of this study suggest that workers who simultaneously exposed to noise and mixed solvent were at risk for more affected HTL than those exposed to noise exposure only, but we could not find definitive evidence. Further detailed studies must be made in large number of workers.

한국인 인슐린비의존형 당뇨병환자에서 엔지오텐신 1-전환효소 유전자의 다형성과 당뇨병성 만성합병증 및 관상동맥질환과의 관계

정민영,천남일,이창훈,조동혁,강호철,정동진,정명호,강정채,박종태,양승원 全南大醫大 2001 전남의대학술지 Vol.37 No.3

2003년 국내 중증급성호흡기증후군 진료 현황 및 문제점 분석

이진수,김은실,정문현,백제중,정선화,안주희,최영화,이선희,고철우,김성범,김민자,박승철,기현균,송재훈,최상호,김양수,이상오,조용균,박영훈,정숙인,김연숙,이흥범,손창희,장성희,정희진,김우주 대한감염학회 2004 감염과 화학요법 Vol.36 No.3

목적 : 2002년 말 중국에서 SARS가 발생한 이후 국내에서도 2003년 10월까지 총 3명의 추정환자, 17명의 의심환자가 보고되었다. 향후 추가적인 SARS의 유행이 우려되는 상황에서, 그간의 SARS 환자 진료에 있어서의 실질적인 준비사항, 진료 현황 등에 대한 조사를 통해 문제점을 파악하여, 향후 더 나은 대비가 될 수 있도록 개선점을 제시하고자 하였다. 재료 및 방법 : SARS로 의심되는 환자를 진료 경험이 있는 병원의료진을 대상으로 2003년 10월에 설문조사를 실시하였다. 설문에는 SARS 환자 진료 시의 실질적인 조치, 진료 현황, 병실, 응급실 및 외래에서의 격리 시설과 준비사항, 보건당국의 관리와 지원에 관한 사항을 포함하였다. 결과 : 대상이 되는 22개 병원 중 17개(17/22, 77.2%) 병원이 설문에 응하였다. SARS 환자를 위한 격리실은 응급실, 외래, 일반병실 및 중환자실에서 각각 9개(9/17, 52.9%), 5개(5/17, 29.4%), 15개(15/16, 93.7%), 4개(4/16, 25%) 병원에서 음압처리가 되어있지 않은 일인실 혹은 다인실이 사용되었고, 1개(1/16, 6.3%) 병원에서만 일반병실에서 음압격리실이 운영되었다. 입원환자의 진찰 시 개인보호구의 착용은 거의 모든 의료기관에서 이루어졌다. 보건당국에서 SARS지정병원의 시설 등을 사전에 확인한 곳은 1곳(1/12, 8.3%)이였고, 14개 병원(14/15, 93.3%)에서는 보건당국에 의뢰한 검사결과를 통하 받지 못하였다. 결론 : 의료기관에서 SARS 환자용 격리실뿐만 아니라 기존의 격리실 설비 등이 미흡하였으며, 특히 중환자실 및 외래의 준비가 더욱 부족하였다. 보건당국의 의료기관에 대한 종합적인 지원이 부족하였고, 병원과의 원활한 연계가 잘 이루어지지 않았다. SARS 만이 아닌 격리를 필요로 하는 질환의 적절한 진료를 위해 향후 병원 시설의 정비와 정부차원에서의 보다 구체적이고 실질적인 대책마련이 필요하다. Background : There was an worldwide outbreak of the Severe Acute Respiratory Syndrome (SARS) originated from China in late 2002. During that period three cases of suspected SARS and 17 cases of probable SARS were reported in Korea. With the concerns about the reemergence of SARS-coV transmission, it is important to be prepared for any possibility. So, this study is aimed to analysis the past measures in managing SARS and propose the amendatory plans to improve the preparedness. Materials & Methods : Questionnaires were collected among clinicians with any experience in managing the probable or suspected SARS cases in Oct. 2003. 17 out of 22 hospitals responded to the questionnaire. The contents in the questionnaire were practical activities, personal equipments, response plans, isolation facilities in emergency centers, outpatient clinics, general wards and intensive care units, and relationship with the public health department. Results : The dedicated isolation rooms in emergency centers, outpatient clinics, general wards, and intensive care units were prepared in 9 (9/17, 52.9%), 5 (5/17, 29.4%), 15 (15/16, 93.7%), and 4 (4/16, 25.0%) hospitals, respectively. Except for one hospital that newly made negative pressure room for SARS, single or multi-bed rooms without airborne infection control were used in all the other hospitals. The personal precaution principles were kept quite well in general wards. Before the designation of SARS hospital by the public health department prior evalution to see if the hospital was suitable for managing SARS was conducted in only 1 (1/12, 8.3%) hospital. The results of laboratory diagnosis were reported back in 1 (1/15, 6.6%) hospital. Conclusions : The isolation facilities which can control airborne infection were almost deficient not only for SARS but also for other respiratory transmissible diseases. For the infection control of transmissible diseases including SARS, more investment is needed on medical facilities and comprehensive support from the public health department required.

Novel Therapeutic Approach for Tibial Nerve Entrapment in Chronic Heel Pain Diagnosed as Plantar Fasciitis: A Case Report

Yang Cheol-Jung,Seong Jeong Won,Kwon Dongrak,Kim Yuntae 대한스포츠의학회 2023 대한스포츠의학회지 Vol.41 No.4

Plantar heel pain is common in sports medicine and orthopedics; it is usually diagnosed as plantar fasciitis. We report the case of a 43-year-old healthy man with chronic pain over the right heel for 5 years. He was diagnosed with plantar fasciitis and received conservative treatment. Surgery was recommended for the intractable pain, which he refused. He had tenderness in the medial calcaneal tubercle region and midportion of soleus muscle near the tendinous arch. At a tibial nerve entrapment point (NEP) over the tender soleus, 4-mL isotonic saline was injected at presentation and 1, 3, and 6 weeks later. The pain improved significantly. He had no adverse effects or aggravation of symptoms at 6 months later. The injection therapy at NEP of the soleus can be considered in chronic unhealed plantar heel pain, including plantar fasciitis, to release the entrapped tibial nerve.

Novel Therapeutic Approach for Extensor Digiti Minimi Tendon Traction in Chronic Ulnar-Sided Wrist Pain Diagnosed as Triangular Fibrocartilage Complex Injury: A Case Report

Yang Cheol-Jung,Seong Jeong Won 대한스포츠의학회 2023 대한스포츠의학회지 Vol.41 No.4

Ulnar-sided wrist pain is common in sports medicine and orthopedics, typically diagnosed as a triangular fibrocartilage complex (TFCC) injury. We present a case study involving a 22-year-old male who has been experiencing chronic left wrist pain for the past 9 months. He was diagnosed with a TFCC injury and received conservative treatment. Surgery was recommended if the pain persisted after 9 months. He exhibited tenderness in the dorsal radioulnar joint region and the proximal one-third portion of the extensor digiti minimi (EDM) muscle. At a tendon traction point (TTP) over the EDM muscle, 4 mL of isotonic saline was injected at presentation, 1 and 3 weeks later. The pain significantly improved, and he did not experience any adverse effects or worsening of his symptoms during the 13-month follow-up. The injection therapy at the TTP of the EDM can be considered in chronic unhealed ulnar-sided wrist pain, including TFCC injury, to release the tightly contracted EDM muscle.