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.

니세틸 정(아세틸 - 엘 - 카르니틴 500mg)에 대한 뉴로세틸 정의 생물학적 동등성

조혜영,오인준,이용복,임동구,문재동,심영순,김은아,정현철 한국약제학회 2001 Journal of Pharmaceutical Investigation Vol.31 No.1

Acetyl-L-carnitine (ALC), an endogenous component of the L-carnitine family, is naturally occurring molecule synthesized from L-carnitine (LC) by carnitine acetyl transferase. ALC has been shown to improve the cognitive performance of patients suffering from dementia of the Alzheimer's type and proposed for treating Alzheimer's disease in pharmacological doses. The purpose of the present study was to evaluate the bioequivalence of two ALC tablets, Nicetile^(TM) (Dong-A pharmaceutical Co., Ltd.) and Neurocetil^(TM) (Kyung-Dong Pharmaceutical Co., Ltd.), according to the guidelines of Korea Food and Drug Administration. Twenty six normal male volunteers, 22.80±2.76 year in age and 63.07±7.98 ㎏ in body weight, were divided into two groups and a randomized 2 × 2 cross-over study was employed. After one tablet containing 500 ㎎ of ALC was orally administered, blood was taken at predetermined time intervals and the concentrations of ALC in serum were determined using HPLC with fluorescence detector. Because of the presence of endogenous ALC, the calibration was performed using dialyzed serum. Pharmacokinetic parameters such as AUC_t, C_(max) and T_(max) were calculated and ANOVA was utilized for the statistical analysis of the parameters. The results showed that the differences in AUC_t, C_(max) and T_(max) between two tablets were 2.72%, -0.65% and -8.42%, respectively, when calculated against the Nicetile^(TM) tablet. The powers (1-β) for AUC_t and C_(max) were 94.87% and 87.17%, respectively. Minimum detectable differences (△) at α=0.05 and 1-β=0.8 were less than 20% (e.g., 15.58% and 19.16% AUC_t and C_(max), respectively). The 90% confidence intervals were within ±20% (e.g., -11.84∼6.41 and -10.57∼11.88 for AUC_t and C_(max), respectively). Two parameters met the criteria of KFDA for bioequivalence, indicating that Neurocetil^(TM) tablet is bioequivalent to Nicetile^(TM) tablet.

거골 경부 골절의 치료

조용만,이영기,리건영,이천동 대한골절학회 1996 대한골절학회지 Vol.9 No.4

The talus has some important anatomic features. Approximately 60% of its surface is cartilage and The talus often has problems with circulation. Talar neck fracture have a high association with ostonecosis and osteoarthritis. Authors have analysed l6 cases of the talar neck fractures treated at Lee-Rha General Hospital from January l990 to December l995 with minimal I year follow up. The results were as follows; 1. In thr l6 cases, there were l4 males and 2 females. the age between 20 and 40 years old was 10 cases(63%). 2. The most common cause of injury was traffic accident(63%), with sudden hyperextension as its mechanism. 3. associated injuries were 4 malleolar fracutres, 3 calcaneous fractures, 3 spine fractures, 3 tiviofibular fractures and 2 femur fractures. 4. According to the Hawkins classification: 3 cases in type I, 4 cases in type I, 5 cases in type l. 4 case in type N fractures were observed. 5. The method of treatment, all 3cases of Hawkins type I fractures were treated by closed reduction and cast immobilization, 3 cases of Hawkins type l and I case of Hawtins type III fracture were treated by closed reduction and internal fixation, other 9 cases were treated by open reduction and internal fixation. 6. Excellent results were observed in 8 cases good in 5 cases, fair in 2 cases . poor in l case with the Hawkins' therapeutic criteria. 7. Complications was observed 3 avascular necrosis, 2 post-traumatic arthritis, 2 ankle stiffness and l skin necrosis. From the above results, authors believe that early anatomical reduction k internal fixation is impotent to get a satisfactory result in de treatment of talar neck fracture.

원위기저 비복동맥 피판술

이동걸,이동훈,이정형,조병채,백봉수 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.3

Reconstruction of soft tissue defect with exposure of the tendons and bone in the lower third of the leg and the heel represents a challenge to plastic surgeons. The sural artery flap is a fasciocutaneous flap supplied by the sural artery that accompanies the sural nerve and connects with a septocutaneous perforator of the peroneal artery via a suprafascial network of vessels. For the coverage of soft tissue defects, we operated on 10 patients using a distally-based sural artery flap. The sites of the soft tissue defect were the lower third of the leg in 7 cases and the heel in 3 cases. The size of flap varied from 3.5x4cm to 12x18cm. Nine of 10 flaps survived completely. One flap in which the sural nerve was preserved showed partial necrosis but healed spontaneously. Two flaps showed slightly venous congestion which disappeared after a few days. The advantages of the sural flap are a reliable blood supply, easy and quick elevation of the flap, preservation of the major artery and minimal donor site morbidity. The disadvantage of the flap is hypoesthesia at the lateral part of the foot. In conclusion, the distally-based sural artery flap can be used safely for soft tissues coverage in the lower third of the leg and the heel.

한국 정신장애의 역학 조사 연구[I] : 각 정신장애의 유병률

조맹제,함봉진,김장규,박강규,정은기,서동우,김선욱,조성진,이준영,홍진표,최용성,박종익,이동우,이기철,배재남,신정호,정인원,박종한,배안,이충경 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.4

Objectives : This study aims to estimate the prevalence of the DSM-IV psychiatric disorders in Korean population using the Korean version of Composite International Diagnostic Interview (K-CIDI). Methods : Subjects were selected by taking multi-stage, cluster samples of 7,867 adult household residents, 18 to 64 years of age, in ten catchment areas. Total 78 trained interviewers administered the K-CIDI to the selected respondents, from June 1 to November30,2001. Results : Total 6,275 respondents completed the interview. Some 33.5% of respondents reported at least one lifetime disorder, 20.6% reported at least one-year disorder, and 16.7% reported at least one-month disorder. The most common lifetime disorders were alcohol abuse/dependence (17.24%), nicotine dependence/withdrawal (11.19%), specific phobia (5.16%), and major de-pressive disorder (4.25%). The lifetime prevalence of substance abuse/dependence (0.25%) and schizophrenia (0.16%) was very low. Nicotine and alcohol use disorder showed very high male/female ratio. Mood disorder and anxiety disorder were more prevalent among female than male. Conclusion : The prevalence of psychiatric disorders was high. In comparison with other studies, remarkable differences in distributions of psychiatric disorders across the areas and times were observed.

니세틸 정(아세틸-엘-카르니틴 500 mg)에 대한 뉴로세틸 정의 생물학적 동등성

조혜영,김은아,정현철,심영순,임동구,오인준,문재동,이용복 전남대학교 약품개발연구소 2001 약품개발연구지 Vol.10 No.-

Acetyl-L-carnitine (ALC), an endogenous component of the L-carnitine family, is naturally occurring molecule synthesized from L-carnitine (LC) by carnitine acetyl transferase. ALC has been shown to improve the cognitive performance of patients suffering from dementia of the Alzheimer's type and proposed for treating Alzheimer's disease in pharmacological doses. The purpose of the present study was to evaluate the bioequivalence of two ALC tablets, Nicetiler^TM (Dong-A pharmaceutical Co., Ltd.) and Neurocetil^TM (Kyung-Dong Pharmaceutical Co., Ltd.), according to the guidelines of Korea Food and Drug Administration. Twenty six normal male volunteers, 22.80±2.76 year in age and 63.07 7.98㎏ in body weight, were divided into two groups and a randomized 2×2 cross-over study was employed. After one tablet containing 500㎎ of ALC was orally administered, blood was taken at predetermined time intervals and the concentrations of ALC in serum were determined using HPLC with fluorescence detector. Because of the presence of endogenous ALC, the calibration was performed using dialyzed serum. Pharmacokinetic parameters such as AUC_t, C_max and T_max were calculated and ANOVA was utilized for the statistical analysis of the parameters. The results showed that the differences in AUC_t, C_max and T_max between two tablets were 2.72%, -0.65% and -8.42%, respectively, when calculated against the Nicetile^TM tablet. The powers (1-β) for AUC_t and C_max were 94.87% and 87.17%, respectively. Minimum detectable differences (Δ) at α=0.05 and 1-β=0.8 were less than 20% (e.g., 15.58% and 19.16% AUC_t and C_max, respectively). The 90% confidence intervals were within ±20% (e.g., -11.84∼6.41 and -10.57∼11.88 for AUC_t and C_max, respectively). Two parameters met the criteria of KFDA for bioequivalence, indicating that Neurocetil^TM tablet is bioequivalent to Nicetile^TM tablet.

한국 주요정신장애의 유병률 및 관련요인 : 2006 전국정신질환역학조사

조맹제,장성만,함봉진,정인원,배안,이영문,안준호,원승희,손정우,홍진표,배재남,이동우,조성진,박종익,이준영,김진영,전홍진,이해우 大韓神經精神醫學會 2009 신경정신의학 Vol.48 No.3

Objectives The aims of this study are to estimate the prevalence of the DSM-IV psychiatric disorders in the Korean population using the Korean version of Composite International Diagnostic Interview (K-CIDI), and to compare those with previous studies. Methods The Korean Epidemiologic Catchment Area study Replication (KECA-R) was Conducted between August 2006 and April 2007. The sampling of the subjects was carried out across 12 catchment areas. A multistage, cluster sampling design was adopted. The target Population included all eligible residents aged 181o 64 years. Face-to-face interviews were conducted with the Korean version of Composite International Diagnostic Interview (K-CIDI) based on the DSM-IV (N=6,510, response rate=81.7%). Results A total of 6,510 participants completed the interview. The lifetime and 12-month prevalence rates for all types of DSM-IV disorders were 30.0% and 17.3%, respectively. Those of Specific disorders were as follows : 1) alcohol use disorder, 16.2% and 5.6% ; 2) nicotine use disorder, 9.0% and 6.0% ; 3) specific phobia, 3.8% and 3.4% ; 4) major depressive disorder, 5.6% and 2.5% ; and 5) generalized anxiety disorder, 1.6% and 0.8%. Data relating to nicotine and alcohol use disorder revealed a very high male/female ratio. Mood disorder and anxiety disorder were more prevalent among females than males. Conclusion The prevalence of psychiatric disorders was high. In comparison with other studies, remarkable differences in the distribution of psychiatric disorders across the country and times were observed.

동씨침을 시술한 안면경련의 치험 3례

김태우,김효은,조명제,강영화,이재동,Kim, Tae-woo,Kim, Hyo-eun,Cho, Myung-je,Kang, Young-hwa,Lee, Jae-dong 대한침구의학회 2003 대한침구의학회지 Vol.20 No.1

Objective : Hemifacial spasm is painless uncommon disorder characterized by involuntary paroxysmal movement of one side of face, In this study, the effect of Dong-Si acupuncture therapy for three patients with hemifacial spasm were evaluated. Methods : We have treated them with acupuncture treatment of Dong-Si acupuncture points(Cheuk-Samni and Cheuk-ha-Samni) and evaluated the effect by Scott's scale, For the first two weeks, it was dine once a day, and after two weeks, the other day. Results : Before therapy, the grades of spasm intensity classified by Scott's description in three cases were 3. And after Dong-Si acupuncture therapy, the grade of one case was 0, and two cases were 1. Conclusion : The Dong-Si acupuncture therapy for hemifacial spasm was effective and will be attempted to the patients with it.

경골과 골절에 대한 수술적 치료

조용만,박명식,강흥식,이건영,이천동,조규철 대한골절학회 1997 대한골절학회지 Vol.10 No.1

The tibial condylar fracture which involves articular surface of the proximal tibia is common in pedestrian injury of the traffic accident and often produces some disability of the knee joint because of the frequent association with ligamentous and meniscal injuries. Methods of treatment in fracture of the tibial condylas has long been a controversial problems. Recently most authors agree that the method of treatment has to be selected in each individual case and anatomical reduction of fracture and early knee motion are recommended but unsatisfactory results has been reported as between 20% and 40%. The authors analyzed 38 cases of the tibial condylar fractures, which were treated at the orthopedic department of the Lee-Rha general Hospital from 1990 to l994, regarding its type. treatment and results. The results of this study were as follows. l. According to Schatzker classification: the most common fracture was type II. 2. According to Blokker's criteria, 28 cases showed satisfactory results( 74% ). 3. Postoperatively, early knee joint exercise like alternatively applling 90( knee flexion and extension splint were very important factors for good results.

수부 주상골 요부의 전위골절에 대한 수술적 치료

조용만,이영기,강흥식,리건영,이천동,오상수 대한골절학회 1997 대한골절학회지 Vol.10 No.1

The authors surveyed the clinical study of 17cases of scaphoid fractures from March 1989 to September 1994 with minimal I year follow up at Department of Orthopedic Surgery, Lee-Rha general Hospital. The following conclusions were obtained through clinical survey. l. Of all l 7 cases, they were l3 males and 4 females; Among the 13 males, 10 cases were aged between 20 and 39 years. forming 56.8% of all. 2. All 17 cases were treated by open reduction. Unions were obtained at average l l.5 weeks in 7 cases treated with Herbert screw fixation and l 2 weeks in l 0 cases treated with K-wire fixation. 3. Two of ten K-wire treated cases resulted in delayed union, one of seven Herbert screw treated cases resulted in delayed union. 4. Unions were obtained at average 20 weeks in 3 cases of delayed union. We concluded that open reduction and K-wire fixation were recomanded for the compatible treatment method of displaced waist fracture of scaphoid.