대장내시경검사의 전처치로서 항콜린제 사용에 관한 연구 : 전향적, 이중맹검법으로

박경남,한동수,이민호,최호순,박준용,손주현,이오영,함준수,전용철,송승찬,기춘석,윤병철,이종희 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.3

Background: Use of antispasmodic medication prior to colonoscopy is controversial but someone believes antispasmodic may improve visualization of colonic mucosa and ease colonoscope insertion. So, we designed a study to assess the effect of premedication with the antispasmodic, hyoscine-N-butyl bromide(Buscopan') on the performance of colonoscopy. Methods: This study was prospective, double blinded, randomized, controlled study, One hundred three consecutive patients were randomized to receive intravenous buscopan lml(n=52) or placebo(n=51) combined with our standard initial medication(me- peridine 50 mg and midazolam 2 mg). Insertion of colonoscopy was timed, and 100 mm visual analogue scales (VAS) were used for asscssing difficulty of procedure, colonic motility, frequency of positional change, frequency of external compression, difficulty of assistance and degree of discomfort experienced by the patients. Results: There were no significant differences of intubation time between buscopan group(mean time, 7.23 min., range 2~15) and placebo group(7.07 min., range 3-25), (p=0.83) and withdrawal time between buscopan group (6.46 min., range 2-22) and placebo group(6.76 min., range 2 25), (p=0.69). Also, there was no significant differences in intubation time between males and females(buscopan; males 7.00 min., females 7.60 min., p=0.34, placebo; males 7.0~5 min., females 7.08 min., p 0.44). The VAS scores checked by endoscopist(p=0.29), assistant(p=0.32) and patient (p=0.15) were not significantly different in both groups. There were no significant differences in intubation time, VAS scores nf endoscopist, assistant, and patients. Conclusion: Premedication with intravenous bu.opan has no advantage on colonoscopy procedure. Use of antispasmodic medication prior to colonoscopy was not considered as recommendable agent.

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.

변형세포와 비변형세포에서 이온형과 Transferrin 결합형 Fe - 59 와 Ga - 67섭취율의 비교

손명희(Myung Hee Sohn),최기철(Ki Chul Choi),이영환(Young Hwan Lee),이상용(Sang Yong Lee),정경호(Gyung Ho Chung),한영민(Young Min Han),김종수(Jong Soo Kim),임창열(Chang Yeol Yim) 대한핵의학회 1996 핵의학 분자영상 Vol.30 No.1

N/A Pathways both mediated by and independent of transferrin(Tf) and the TfR have been described for the accumulation of iron. Although it is not clear whether the same systems take up iron and gallium, these pathways may suggest the contention that uptake of Ga-67 can, in fact, occur by both Tf-independent and Tf-dependent systems and may share with Fe-59 in part the same mechanism for uptake. The predominant system by which uptake of both radiometals occurs may be different in the degree of the transformation af tumor. Transformed(MMSV/3T3) and untransformed(BALB/3T3) cells were incubated with luM of Ga-67-citrate of Fe-59-chloride for 15 min. at 37℃ in either the presence or absence of Tf. After then, the monolayers were washed with HBSS or PBS, and the cells were solubilized in 1% SDS for gamma well counting and protein determinations. There were similarities, as well as differences, in the pattern of uptake of Fe-59 and Ga-67 presented both in ionic from and as bound to Tf. Both radiometals appeared gain to cells in either ionic or Tf-bound forms. Transformed cells appeared to accumulate more radiometal, either Ga-67 or Fe-59 in the presence of Tf than do the their untransforemd counterparts. Conversly the presentation of either radiometal in ionic form resulted in significantly greater accumulation of metal by the untransformed cells than those transformed. The efficiency for uptake of Ga-67 or Fe-59 in the absence of Tf was greater than for uptake of the Ga-Tf or Fe-Tf. However, the magnitude of difference in efficiency of uptake was greater for Fe-59(10-fold) than for Ga-67 (3-fold). Our results Supports the theory that both Tf-independent and Tf-dependent systems for the uptake of Ga-67 both systems operate oppositely between transformed cells and those untransformed, with uptake by the predominating in transformed cells by the Tf-mediated system and in untransformed cells by the Tf-independent. The uptake of Ga-67 by tumor may share with Fe-59 in part the same mechanism.

한국에서 유행한 Cholera균에 대한 Antibiotics sensitivity에 관한 연구

손준용,유재근,김영한,민창홍 國立保健硏究院 1970 국립보건연구원보 Vol.7 No.-

우유와 두유를 혼합한 이유보충음료의 개발

손경희,윤선,이민준,김순영,김용태,장동훈,강석필 연세대학교 생활과학연구소 2001 生活科學論集 Vol.10 No.1

The purpose of this study is to develop an infant supplement composed of cow and soy milk which has acceptable taste and digestability and meets nutritional needs of the infants. Even though soy milk is and excellent source of protein for infants who are allergic to dairy products, its protein quality is still lower than that of regular milk. Therefore in the present study the development of sow-soy milk infant formula was attempted. To make the formula equal amount of cow and soy milk were mixed and supplemented with vitamins and minerals to meet the nutritional standards of breast milk, CODEX and recommended dietary allowances for Korean infants. In animal experimental study, the weight gain rate of weaning rats was highest in the order of 100% milk, cow-soy milk, control, soy milk, commercial soy infant milk group. Feed efficiency ratio(FER) were not significantly different among control, 100% milk and cow-soy milk groups. However, commercialized soy infant milk group showed significantly lower FER than other groups. When the cow-soy milk formula was fed to infant in the age of 5 month to 25 months, it did not show any unsatisfactory results in acceptability and bowel movements of the subjects. Since the cow-soy milk formula has not only all the nutrients for the physical growth of infants but also contains valuable physiological functional ingredients, it is expected to be a good choice of supplements for infants.

매켈게실의 신티그래피 진단

손명희,한영민,김종수,최기철 의과학연구소 1990 全北醫大論文集 Vol.14 No.2

Meckel's diverticulum is one of the most frequent congenital malformations of the gastrointestinal tract in man and found in approximately 1 to 3% of the general population. This remnant of the omphalomesenteric duct gives rise to symptoms of primarily rectal bleeding in the young. The customary radiographic approach to the gastrointestinal bleeder ususally fails to identify this lesion. Most of the symptomatic Meckel's diverticula are lined with ectopic gastric mucosa. Therefore Tc-99m pertechnetate which is concentrated by the gastric mucosa has been found to be useful in localizing these divertecula. The authors described a case of bleeding Meckel's diverticulum whose pathologic diagnosis was expected preoperatively with Tc-99m pertechnetate abdominal scintigraphy and confirmed postoperatively.

6 시그마 기법을 이용한 임상약동학 자문 업무의 효율성 개선 : 신속성과 정확성을 중심으로 Focusing on Speed and Accuracy of CPS

김민영,박효정,박향미,손기호,최경업,박영하 한국병원약사회 2001 병원약사회지 Vol.18 No.2

연구 배경 : 적정한 약물요법을 순발력 있게 시행하기 위해서는 CPS 업무가 신속, 정확하게 수행되는 것이 필수적임에도 불구하고 지금까지 CPS 업무의 신속성, 정확성을 향상시키기 위한 객관적인 업무 표준은 물론 그의 측정까지도 전무한 실정이었다. 이에 수요자인 의사의 측면에서, CPS 자문결과의 신임도에 영향을 미치는 업무의 순발력과 정확성을 향상시키기 위해 CPS 업무의 신속성, 정확성에 영향을 미치는 요인을 파악, 분석하고 이를 향상시킬 수 있는 업무 표준을 개발하는 것을 목표로 6-Sigma 기법을 사용하여 본 연구를 진행하였다. 방 법 : CPS 업무의 신속성 평가를 위해 전체 업무 과정과 부분별 업무 과정에 대한 소요 시간을 측정하였고, 정확한 평가를 위해 예측되는 Cpeak와 실제 측정된 Cpeak를 비교하였다. CPS 업무에 대해 6-Sigma 기법을 사용하여 개선이 필요한 사항을 파악하고 이에 대한 개선활동을 한 후, 개선 활동 전과 후의 CPS 업무의 신속성과 정확성의 σ 수준을 각각 측정하여 이의 향상 정도를 잠재적인 경제적 이익으로 환산하였다. 결 과 : 신속성은 제 1차 자료수집 기간(대조군, 현황 파악 기간) 중 총 소요시간은 평균 930.6±583.2이었으며, 채혈-검체 접수 : 140.4±8705분, 검체접수-약물농도 결과보고: 48.4±23.1분, 결과보고-CPS 보고서 작성 : 741.8±510.6분으로 측정되었다. σ 수준은 총 소요시간의 경우는 0.56σ, 단계별로는 각각 0.45σ, 5.70σ, 0.30σ이었다. 제 2차 자료수집 기간(개선군, 개선활동 평가 기간) 중 총 소요시간은 평균 659.1±344.1분이었고 단계별로는 각각 92±66.2분, 48±28.0분, 518.9±340.7분이 소요되었다. σ 수준은 총 소요시간은 1.75σ이고, 단계별로는 1.32σ, 4.70 σ, 1.10σ로서 총 소요시간과 단계별 소요시간이 1차 자료수집기간에 비해 향상되었다. 정확성 측면에서는, 대조군의 경우, 예측 Cpeak와 실측 Cpeak의 차이는 평균은 0%, 분산 ±27.10%, σ 수준은 -0.56σ이었고 개선군의 평균과 분산 그리고 σ 수준은 각각 0%, ±15.10%, 0.14σ로 향상되었다. CPS 신속성, 정확성 향상으로 인한 경제적 이익은 정확성 측면에서 380만원/년, 신속성 측면에서 1350만원/년으로 총 1730만원/년의 비용절감 효과가 있었다. 결 론 : CPS 업무 흐름에 따라 CPS 효율성에 영향을 미치는 요인을 분석한 결과 CPS 효율성 향상을 위해서는 투약관련 의무 기록의 정확성, 임상병리 검사의 정도관리 향상, 그리고 관련 부서와의 원활한 업무 협조가 가장 중요하였다. The effectiveness of CPS (Clinical Pharmacokinetics Service), one of pharmacist's clinical services, was emphasized by many studies since 1985 it was introduced Korea about. But in the view of clinicians (medical doctors), customers, it's convenience or reliability was not properly evaluated for applying it to patient's care. To improve quality of Clinical Pharmacokinetics Service (CPS), the speed and the accuracy of CPS, the key points of efficiency in CPS, were evaluated by using 6-Sigma method. The speed of CPS was evaluated using total hours it took from blood sampling by a nurse to sending a CPS report to the patient's chart by a clinical pharmacist. Total hours were divided into blood sampling-to-sampling registering, sampling registering-to-C_(peak) result reporting, and C_(peak) result reporting-to-pharmacist's CPS report. The accuracy of CPS was evaluated by the difference between expected C_(peak) and measured C_(peak). Then the speed and the accuracy of CPS were expressed as σ level. After the campaign for improvement by Six Sigma method, the speed was improved by 1.19σ (before and after the campaign; 0.56σand 1.75σ, respectively) and the accuracy was improved by 0.7σ (before and after the campaign, -0.56σand 0.14σ, respectively). Exact recordings of dosing time, drug infusion hours and blood sampling time were shown to have profound effect on the accuracy of CPS. The improvement in the speed and the accuracy of CPS could produce potential financial benefit of U.S.$ 15,300 a year. There have not been studies on evaluating and objectifying as numerical value for the speed and the accuracy of CPS; thus, 6-Sigma method for improving efficiency in manufacturing process was applied to CPS process by expressing as σlevel. The speed and the accuracy of CPS could be improved by tightly controlling many factors related to CPS efficiency.

특발성 과호산구 증후군 환자의 치료 도중 발생한 간혈종 1례

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

Idiopathic hypereosinophilic syndrome is characterized by marked elevation of eosinophil count ( >1,500/㎣) in peripheral blood without explaining etiology. It shows tissue involvement in many organs such as liver, G-I tract, myocar dium, lung, skin, kidney and nerve. Some case of hypereosinophilic syndrome with hepatic involvement have been reported, but not much. We have recently experienced a case with idiopathic hypereosinophilic syndrome of a 40 year old man who presented with RUQ pain. By abdominal CT, ill- defined subcapsular hematoma was detected. Liver biopsy showed eosinophilic infiltration within the portal tract and sinusoid. Drain procedure and corticosteroid adminiiatbrought marked improvement of clinical manifestation, hematologic abnormality and radiologic abnormality.

MPEG-21 표준의 구현을 위한 Testbed 구축

손정화,손현식,조영란,권혁민,김만배 강원대학교 정보통신연구소 2003 정보통신논문지 Vol.7 No.-

1990년대 후반부터 다양한 디지털 통신망을 이용하여 멀티미디어 컨텐츠 서비스가 가능하게 되었다. 하지만, 멀티미디어 컨텐츠의 전달 및 이용을 위한 기반 구조들의 독자적 발전 및 다양한 통합적 관리 체계 시스템으로 인해, 멀티미디어 컨텐츠 표현 방식의 호환성 문제, 혼재하는 네트워크 전달 방식과 단말 방식의 호환성 문제 등의 잠재적인 문제점이 발생한다. 이런 문제의 대안으로 현재 존재하는 기술 및 기반 구조들 사이의 연동을 통한 큰 프레임워크인 MPEG-21이 진행 중이다. 본 논문에서는 현재 표준화 작업이 진행 중인 MPEG-21을 기반으로 하는 Testbed를 제안한다. Testbed는 server, client, DIA(Digital Item Adaptation)의 세 모듈로 구성된다. Server의 역할은 멀티미디어 컨텐츠를 Digital Item(DI)으로 생성하고, client가 DI를 요구할 경우 DIA 모듈을 통해서 변환된 DI를 client에게 제공한다. DIA 모듈은 server에서 동작되며 client로부터 요청된 DI를 분석하고 client로부터 전송된 환경 정보를 이용하여 client 환경에 적합하게 변환된(adapted) DI를 생성하는 것이 주 기능이다. Client는 server에 저장되어 있는 DI를 선택하고 user preference, terminal capability 등의 필요한 정보를 server로 전송한다. Testbed에서는 스포츠 경기의 동영상, 정지 영상, 경기 내용, 역사를 기록한 파일 등의 DI를 이용한다. 표현 언어는 XML이며, HTTP 기반의 Web 환경에서 구동되도록 설계된다.

급성충수돌기염으로 발현된 방선균증 2예

조진원,송진영,김창억,민영훈,최창순,우흥정,현인규,김종현,유기철,채승완,손진희 대한화학요법학회 2001 대한화학요법학회지 Vol.19 No.1

The Actinomyces species are normal flora of oral cavity and upper intestine characterized as gram-positive, non-spore-forming anaerobic or mjcroaerophilic rods. Actinomycosis is a chronic suppurative and granulomatous disease characterized by abscess, sinus, abundant granulation and mass. The appendix is the commonly involved site among abdominal actinomycosis. Abdominal actinomycosis is often difficult to diagnose before operation because of no reliable clinical features and infrequency of the disease. We report two cases of abdominal actinomycosis which were manifested as acute appendicitis. Those were detected Incidentally tv the pathologist after routine appendectomy. Both patients were successfully treated with appendectomy followed by proper antibiotics use.