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.

셀룰라 오토마타 기반의 완전해싱

김한두,허성훈,문종익 인제대학교기초과학연구소 2002 자연과학 Vol.6 No.-

이 논문에서 셀룰라 오토마타를 이용한 완전해싱 방법을 제시하였다. In this paper we investigate the Cellular Automata-based perfect hashing scheme.

노령의 대퇴 전자간 골절 치료에서 압박고 나사못의 안정성 및 유용성

김종오,노권재,윤여헌,고영도,유재두,정준모,방한천,정재학 대한골절학회 2003 대한골절학회지 Vol.16 No.2

목 적: 노령의 대퇴 전자간 골절에서 압박고 나사못의 안정성에 영향을 주는 인자들간의 상관 관계와 골절 양상에 따른 술후 고관절 기능을 평가 및 분석하였다. 대상 및 방법: 압박고 나사를 이용하여 수술적 치료를 시행한 231명의 환자 중 6개월 이상 추시가 가능하였던 60세 이상 84명의 환자들을 대상으로 했다. 방사선적 계측은 압박고 나사못의 활강 길이 및 내반각, 가압 나사 위치, 정복 상태, 원위 골편의 내측 전위를 측정하였으며 술후 기능은 Clawson의 기능 평가표로 하였고 골절 양상에 따라 방사선 계측과 기능 회복과의 상관 관계를 평가하였다. 결 과: 임상 결과는 불안정 골절에서 양호가 10례, 불량이 23례, 안정 골절에서는 양호 40례, 불량이 11례로 안정 골절에서 임상 결과가 좋았고(p<0.001), 압박고 나사 활강은 10 ㎜ 이상일 때 양호가 4례, 불량이 21례, 10 ㎜ 이하에서 양호가 46례, 불량이 13례로 10 ㎜ 이상 활강시에 술후 결과가 불량했다(p<0.001). 다르 방사선적 계측 요인은 결과에 의미있는 차이를 보이지 않았다. 또한, 불안정 골절 중에서 전위 양상 골절의 경우 10㎜ 이상 활강이 12례, 10㎜ 이하 활강이 8례, 분쇄 양상 골절의 경우는 10㎜ 이상이 11례, 10㎜ 이하가 2례로 분쇄 양상의 불안정 골절에서 10㎜ 이상 활강이 의미있게 많았다 (p<0.001). 결 론: 10㎜ 이상의 지연 나사 활강은 고관절 기능 회복 약화를 유발시킬 수 있으며 불안정 골절 분쇄 양상 골절은 이런 지연 나사의 활강이 과도하게 유발될 수 있으므로 불안정 분쇄 양상 골절에서 압박고 나사의 단독 사용은 재고해 보아야 할 것이다. Purpose: To evaluate the relationship between fracture stability and functional results, and analyze the correlation between stability factors and the outcome in intertrochanteric fracture of the elderly. Materials and Methods: Of the 231 patients, 84 patients with age above 60 were able to follow up for minimum 6 months. We measured the sliding length of the lag screw, varus degree, position of lag screw, reduction status and medialization of distal fragment radiologically. The functional outcome of the treatment was evaluated with the Clawson's result classification and we evaluated the correlation between the radiological results of measurement and the functional recovery depending on the Evans fracture classification. Results: There were good results in 40 cases out of 51 stable fractures, and in 10 cases out of 33 unstable fractures (p<0.001). In case of sliding of lag screw more than 10㎜, good results were obtained in 4 cases, and poor in 21. And in case of sliding less than 10㎜, good results were obtained in 46, and poor in 13. (p<0.001).But there was no relationship between other radiologic factors and clinical results. In unstable type, there were 12 cases with lag screw sliding more than 10㎜ and 10 cases with less than 10㎜. In comminuted type, there were 11 cases with lag screw sliding more than 10㎜ and 2 cases with less than 10㎜(p<0.001). Conclusion: The sliding of lag screw more than 10㎜ may result in poor outcome. As in comminuted unstable pattern, sliding of lag screw might be excessive, the use of compression hip screw alone is not good treatment option.

위 전절제술을 받았던 환자에서 아급성 연합성 변성 1예

한정호,하현욱,이정석,송은향,김우정,김두응,최진영 건국대학교 의과학연구소 2000 건국의과학학술지 Vol.10 No.-

Subacute combined degeneration is a metabolic disorder of the spinal cord caused by vitamin B12 deficiency. A 72-year old man was admitted with weakness and tingling sensation of the bosh upper extremities. 9 years ago, he was diagnosed as having stomach cancer. So total gastrectomy with splenectomy was done at that time. The complete blood cell counts and morphology revealed megaloblastic anemia. Nerve conduction velocity study(NCV), electoromyography(EMG) and somatosensory evoked potentials(SEP) showed diffuse sensorimotor peripheral neuropathy. Magnetic resonance imaging(MRI) showed an increased T2-weighted signal, mild decreased T1-weighted signal, and slight contrast enhancement of the posterior columns of the cord in the cervical and upper thoracic spinal region. He was treated with vitamin B12 supplements and improved gradually. If abnormal sensation and muscle weakness was developed after gastrointestinal surgery, subacute combined degeneration should be considered in the differential diagnosis. We describe MRI findings of a typical case of subacute combined degeneration, which was induced by total gastrectomy.

용접강구조 부재의 한냉특성에 따른 파괴거동해석

김두환,한석규,김성훈 서울産業大學校 産業大學院 1997 大學院論文集 Vol.5 No.-

In this paper, low temperature fracture behavior of base metal, HAZ and weldment has been investigated. The effect of residual stress in weld joints on the fracture has been studied. As a result, Charpy impact value was found to decrease with decreasing temperature. Annealed HAZ and weldment have the highest and lowest impact values at 22℃ and -70℃, respectively. The weld joints have larger fracture toughness values than base metal, due to compressive residual stress.

안면골 골절에 관한 임상적 연구

김현수,이상한,장현중,백상흠,차두원 대한악안면성형재건외과학회 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.1

To investigate epidermiologic trend in maxillofacial fractures, We retrospectively studied 934 patients with maxillofacial fractures between 1981∼1987 and 1995∼1999. The results were compared in the previous group (Group A, patients treated between 1981∼1987) with those in the recent group (Group B, 1995∼1999). Also, we studied 516 patient between 1995∼1999 for occupation, associated injuries, treatment and complications. The sex ratio of men to women decreased (5.6 : 1 in Group A vs. 3.5 : 1 in Group B), and the largest age group was 20 to 29 years. There was the highest incidence in September and Fall. The most frequent cause of maxillofacial fracture in both Group A and B was traffic accidents. The distribution of fracture site did not change appreciably, but the frequency of midfacial fracture increased. In the recent group, the largest occupational group was salaried men, and the largest associated injuries of maxillofacial fracture was head and neck injury. Open reduction was used in 91% of the cases, and post-operation complications were infection, neurologic problem, malocclusion, and mouth opening limitation etc. Our results suggest that the clinical features of patients with maxillofacial fractures have changed during the past decade.

데빅병 치료에 사용한 Interferon β-1b의 부작용 1예

김정미,조은경,조정선,최용석,한영수,한정호,김두응,최진영 건국대학교 의과학연구소 2004 건국의과학학술지 Vol.14 No.-

A 63 year-old woman who had diagnosis of multiple sclerosis complaining left hemiparesis and fluctuating decreased visual acuity in her right eye and abnormal findings in pattern shift visual evoked potentials(PSVEPs) and on T2 weighted MR scanning. We treated her subcutaneously with 250μg interferon (3-lb(ITFß -lb) every other day. There were detected pancytopenia, skin rash, and abnormal liver function test seven days after the therapy. In spite of reducing the dose of interferon injection, abnormal laboratory findings were not returned to normal. Dose adjustment of interferon-I3 for body weight or race, may be helpful to reduce the side effects.

흔치않은 대상포진 치험 2예 : 비전형적 부위와 다른 부위로 재발한 예 Unusal Dermatome and Recurs Other Dermatome

김정미,조은경,조정선,최용석,한영수,한정호,김두응,최진영 건국대학교 의과학연구소 2004 건국의과학학술지 Vol.14 No.-

Herpes zoster is well known as an acute, self-limited disease of unilateral sensory dermatome caused by varicella-zoster virus and characterized by grouped vesicular skin eruption and pain over several dermatomes as well as single. This virus usually affects the thoracic dermatome and there are a few reports that this virus involves lower lumbar or sacral area, and recurrent cases. We experienced 2 cases that zoster virus involved L4 or S2 dermatome and left typical skin lesions, of which one was a recurrent case involving different dermatome at an interval of 8 years and the other was a rare case involving sacral dermatome.

공동주택 리모델링 계획기법과 거주자 선호도에 관한 연구 : 주동차원의 시행방안을 중심으로

김미영,장한두,제해성 대한건축학회 2003 대한건축학회논문집 Vol.19 No.11

The purpose of this study is to analyze design alternatives for apartment remodeling, and to find out the applicability of the alternatives to real projects, and to find out residents' preferences and needs on them. This study suggests a direction of remodeling design and hopes to vitalize remodeling projects in Korea. This study categorizes types of remodeling design alternatives after analyzing 28 cases of foreign and domestic remodeling projects. The design alternatives are reviewed to check legal accordance of remodeling project. The survey employed questionnaires and interviews, and was performed at five deteriorated apartments at Gangnamgu, Seoul. The selection of apartments are based upon floor area ratio, period of living and so on. First, the study finds out that the residents prefer additional rooms, extension of existing balconies, and extending rooms to balconies. Second, they want to convert corridor type apartment to staircase type (core type) for efficient use of interior space. Third, the residents at top floors wish not to have public roof gardens and those at ground floor want to install private gardens in front of their units.

노령에서 고관절 골절에 영향을 주는 수상전 요인

김종오,윤여헌,고영도,유재두,정준모,방한천,강규복 대한골절학회 2002 대한골절학회지 Vol.15 No.4

목 적 : 노령에서 고관절골절의 여러 원인적 요인들과 상관관계를 분석, 그 연관성에 대해 알아 보고자 하였다. 대상 및 방법 : 2001년 1월부터 2002년 5월까지 대퇴 고관절 골절로 본원에서 치료받은 환자중 60세 이상이고 골밀도 검사를 시행받은 158례를 대상으로, 수상전 요인을 나이, 성별, 흡연여부, 비만정도, 골절종류, 수상장소, 다른 이환 질환, 골절전 활동도, 골밀도 검사, 수상당시 바닥의 경도, 수상당시 넘어진 방향, 수상에너지에 따라 대퇴 경부골절과 전자간 골절, 전자간 골절중 안정골절과 불안정 골절로 나눠 비교하였다. 결 과 : 80세 이상의 군에서 대퇴 전자간 골절이 대퇴 경부 골절에 비해 의미있게 많이 발생했음을 알 수 잇었으며(p<0.001) 환자의 수상전 활동정도의 비교에서도 활동정도가 낮았던 군에서 대퇴 전자간 골절이 의미있게 많이 발생하였다(p<0.001). 골밀도 검사에 따른 비교에서는 T-score -3.0 이하인 군에서 대퇴 전자간 골절이 많았으며(p<0.005), 수상에너지에 따른 비교에서는 적은 에너지에 의한 골절이 전자간 골절에서 많았다(p<0.05). 대퇴 전자간 골절은 안정 골절과 비안정 골절로 나눈 비교에서는 사회 활동이 어려운 ADL C이하의 군과(p<0.05), 골밀도 T-score -3.0 이하인군에서는 의미있는 차이를 보였다(p<0.001). 결 론 : 노령에서의 고관절 골절 중 80세 이상의 고령에서, 골밀도 T-score -3.0 이하인 경우, 일상생활 활동정도가 낮은 경우에, 비교적 적은 에너지에 의한 충격시에 대퇴 전자간 골절의 발생이 대퇴 경부 골절에 비해 의미있게 많았고 전자간 골절에서 불안정 골절은 사회활동이 적고 골밀도 T-score -3.0 이하인 경우 많음을 알수 있었다. Purpose : We studied the co-relation on the causes of the hip fracture through the analysis of a relevance on the etiological factors as increased incidence according increasing old age. Materials and Methods : Total 158 cases that treated on the hip fracture from 2001 Jan. to 2002 May were studied. The parameters were age, gender, smoking, obesity, type of fracture, place of fracture, other comorbidity, activity of daily living, bone marrow densitometry, hardness of floor, orientation, injury energy. And then, we analysis of difference between femur neck fracture and femur intretrochanter fracture and between stable femur intertrochanter fracture and unstable femur intertrochanter fracture. Results : The incidence of the femoral intertrochanteric fracture was larger significantly than that of the femoral neck fracture in the older then 80(p<0.001). On the comparison of the pre-fractural activity of daily living, the group revealed lower activity had larger incidence of femoral intertrochateric fracture(p<0.001). Also, the femoral intertrochanteric fracture was more larger osteoporosis patient group(p<0.005), and lower energy trauma(p<0.05). In a unstable femoral intertrochanteric fracture, 21 cases(77.7%) of total 27 cases were belong to the group of the activity of daily living scale below C(p<0.05), 24 cases pf 27 cases were belong to the osteoporosis patient who was estimated below -3.0 on T-score(p<0.001). Conclusion : In the hip fracture of the elderly patients, the femoral intertrochanteric fracture is more prevalance ratherthe femoral neck fracture on the cases of older patient more than 80 year-old, lower activity of daily living scale, lower T-score less than -3.0 on BMD, lower energy trauma. Also, in femur intertrochanter fracture, unstable fracture is more common in low daily activity and owteoporosis.