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.

우관상동맥 개구부 완전 폐쇄가 동반된 대동맥 판상부 협착증 1례

임상현,김종진,김희열,진승원,전희경,노태호,채장성,김재형,홍순조,최규보,윤정섭,김치경 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.4

최적설계 기법을 적용한 1톤 운반차용 P.T.O축 및 트랜스미션 개발에 관한 기초연구

김재열,심재기,최승현,정효희,김훈조,오현중,박경섭 한국공작기계학회 2007 한국공작기계학회 추계학술대회논문집 Vol.2007 No.-

Now, power tillers and cultivators which are spread among fruit tree households have usage, low application, and high accident risk. Therefore, the development of multi-purpose work vehicles is needed as an alternative for these problems. Especially, easy usage and the ability to easily change gears when driving and the development of the P.T.O for various tasks such as pruning, water lifting, pest control, application and, mowing are needed. In this research, we will develop a transmission with design on P.T.Oaxle for agricultural work vehicles including multi-purpose vehicles. We aim to develop a 4-wheel drive transmission of synchronous contact type for practical use in fruit tree households which is required to be a large-sized agricultural vehicle. Therefore, we have per performed as follows that are composed of load capacity from 500kg to 1,000kg, safety securing for passengers, and drive securing under bad conditions of the topography slope and swampy land and the rest. For this purpose, we have developed a prototype vehicle through strength analysis of transmission design. we have selected optimal design conditions (Optimal RPM and torque according to some works) on the power transmission with multi-purpose vehicle for various jobs: spraying, manure spreading, mowing, brush wood chopping. If development of the P.T.O containing variable RPM and torque is successful, the following tasks can be possible. Air pruning, air maintenance, water lift, pest control, application, mowing, spraying, and brush wood chopping are possible with this developed P.T.O. Methods and contents for research are followed. Therefore, we have achieved performance-tests through the prototype of the multi-purpose work vehicle and have improved on troubles by the analysis of results of R&D. Also, we provided solutions to problems in mass production in the future.

자발성 뇌교출혈 환자의 예후에 관한 임상 분석

조재영,석종식,민병국,권정택,최덕영,황성남,김영백,박승원 중앙대학교 의과대학 의과학연구소 2002 中央醫大誌 Vol.27 No.1

Patients with spontaneous pontine hemorrhage very often develop setvere disturbances of consciousness,pupilary abnormalities, respiratory and motor. They have high mortality rate. Therefore, I analyzed the correlation between the Glasgow outcome scale(GOS)and clincial manifestations or computed tomographic(CT)findings in 48 patients with spontaneous pontine hemorrhage to clarify factors predicting the prognosis. I examined 48 Patients with spontaneous pontine hemorrhage; 33 males and 15 females, age 54.6±8.99(mean±S.D.;range 39 to 68)brought to our hospital between January 1995 and December 1999, retrospectively. Correlations between the clinical manifestations, CT findings and the GOS was assessed with multivariate regression analysis. The results were as follow: 1) Patients with the pontine hemorrhage were of 8.8% in those with intracerebral hemorrhage. The ratio of male and female was 33 to 15. The incidence of age is eqial to 40,50 and 60. Total mortality was 41.6%. 2) The poor prognostic factor were that; Glasgow coma scale(GCS)3∼8, irregular respiration. pupilary abnormality, quadriplegia, Brain CT typeⅠ(massive), hydrocephalus, extrapontine extension, Intraventricular hemorrhage(IVH). These clinical analysis should be useful in determining the level of care and future resuscitative efforts.

농산 폐기물인 Allium속 뿌리를 이용한 Ni와 Pb 이온 제거

김성조,백승화,김운성,문광현 한국식품영양학회 1998 韓國食品營養學會誌 Vol.11 No.6

농산물의 갈무리시 발생되는 건조한 마늘, 쪽파 및 대파 뿌리 분말을 흡착제로 이용하여 수용액 중 이온 상태로 존재하는 Ni과 Pb의 흡착력을 시료의 입자별, 중금속의 농도별, 용액의 온도별, pH별로 분석하였다. 중금속 이온들은 흡착제의 입자크기가 작을수록 흡착률이 높았고, 그중 마늘뿌리가 Pb에 대해 높은 흡착력을 나타냈다. 수용액중 중금속 농도가 높을수록 중금속들이 흡착되는 양이 증가하였고, 흡착률은 흡착제와 중금속의 종류에 따라 차이가 있었다. 온도의 증가는 쪽파와 대파에서 Ni과 Pb가 감소되었다. 알칼리 조건에서 비교적 흡착이 잘 되는 중금속은 Ni이며, 중성과 산성조건에서는 Pb의 흡착량이 높았다. A batch experiment was conducted to evaluate the removal capacity of welsh onion(Allium fistulosum L.), shallot(Allium ascalonicum L.), garlic(Allium sativum L.) roots as an adsorbent for Ni and Pb in aqueous solution. One gram of the dried Allium root powder was reacted in 100ml of solution containing 10㎎ of each heavy metal and effects of metal concentration, pH, temperature, and size of adsorbent on the removal efficiency were evaluated. The results were as follows : The amount of adsorption of heavy metal ions were higher with the smaller particles size of adsorbent. Garlic root was high adsorption capacity of Pb, especially. The higher concentration of heavy metal solution was, the more amount of adsorption of heavy metals was. The adsorption ratio was differed from a kind of heavy metal. As the temperature increased, the amount of adsorption of Ni and Pb by shallot and welsh onion were decreased. The amount of adsorption of Ni was high under alkali conditions but the amount of adsorption of Pb was high under neutral and acidity condition.

中年期婦人에서 흔히 발생하는 婦人科 疾患

金丞兆 대한가정의학회 1984 Korean Journal of Family Medicine Vol.5 No.2

부인과 영역의 오진(誤診)

김승조 大韓法醫學會 1991 대한법의학회지 Vol.15 No.2

The type of misdiagnosis in gynecological diseases can characteristically derived from various sorts of technical and analogic errors dealing with various informations from menstrual disorders, infertility, abnormal vaginal bleeding, infections, neoplasms, pregnancy related disorders, congenital anomalies, pelvic pains, and psychosomatic diseases, it is important that misdiagnoses are not less often be fatal in gynecological than in other patients. It's because the diseases themselves are mostly related with hemorrhage, septic infection and pregnancy related immune deficiency. Recently, there have appeared so many mordern untrafashionable medical instruments which can dramatically reduce the misdiagnoses such as ultrasonography, and MRI etc. and otherwise physicochemical methods. In our neighborhood, however, we can see so many occasions with negative aspects of medical environment including misdiagnoses, medical accidents and medicolegal conflicts. As a fundamental reason, negligence to develop abilities that human can achieve in the power of attention and concentration to reduce errors can easily be considered. Another important thing for medical doctors to make misdiagnosis is failure in maintaining a good para-medical human relationship, the rapport and the cooreariton with the patients. Furthermore, indirect influences deriver from so many unreasonable political and medicososcial environments such as restricting medical insurance systems which can cause down regulation of the quality of medical treatment must be corrected or abolished, and , on the other hand, establishment of national political and socioenvironmental atmosphere to secure the adequate treatment will also be important to reduce misdiagnosis.

개에서 심실 조율부위 및 조율주기에 따른 혈역학적 변화

김희열,김재형,노태호,김종진,진승원,유기동,이만영,채장성,홍순조,최규보 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.9

Pseudo-Gitelman씨 증후군 1예

김성렬,조영일,이해운,이정연,안해련,송종오,명승운 건국대학교 의과학연구소 2002 건국의과학학술지 Vol.12 No.-

Gitelman's syndrome is a rare disorder with a characteristic set of metabolic abnormalities. These include hypokalemia, metabolic alkalosis, hypocalciuria and hypomagnesemia. The clinical manifestations of Gitelman's syndrome are very similar with those of Bartter's syndrome and diuretic abuse. Gitelman' syndrome and Bartter's syndrome can be distinguished by renal clearance study after administration of furosemide and thiazide, since the primary defect in each of these disorders is an impairment in sodium reabsorption in the distal tubule and loop of Henle, respectively. Pseudo-Bartter's syndrome due to diuretic abuse can be distinguished by history of diuretic use and a positive urine assay for diuretics. We have experienced a case of pseudo-Gitelman's syndrome in 56-year old woman with unexplained hypokalemic metabolic alkalosis, hypocalciuria, and hypomagnesemia. The patient denied ingestion of diuretic medication. The results of renal clearance study using furosemide and thiazide in this case suggested the presence of the primary defect of sodium reabsorption in the distal tubule rather than in the loop of Henle. These clinical and laboratory findings were consistent with those of Gitelman's syndrome. But, this case was confirmed as pseudo-Gitelman's syndrome since diuretics were detected by a urine assay for diuretics. Furosemide and hydrochlorothiazide were contained in the pill that she had been taking due to constipation. Herein, we report the case of pseudo-Gitelman's syndrome by abuse of cathartics containig diuretics presented as Gitelman's syndrome in renal clearance study.

광선각화증, 각화극세포종과 Bowen's병에서 p53과 p21의 표출 양상

조명구,조현득,양승하,김의한 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.2

Background The function of the p53 protein was known to regulate cell proliferation by inhibiting cells entering Sphase. So DNA damaged cell proliferation was inhibited by apoptosis. P21 is a cyclin dependent kinase inhibitor induced by wild type p53, not mutant p53. Thus p21 is thought go mediate the signal of p53 induced by DNA damaged agents to arrest the cell cycle in G1 phase. p53 and p21 were expressed in many malignant tumors, and its role in oncogenesis, tumor progression and prognosis were important. The authors analyzed immunohistochemical expression of mutant p53 and p21 protein in some skin tumors. Method Thirteen cases of actinic keratosis, 7 cases of keratoacanthoma and 8 cases of Bowen's disease were immunohistochemically stained with p53 and p21 monoclonal antibodies. Results; 1. In cases of positive p53 protein and negative p21 protein, the expressed p53 protein was suggested as mutant form. 2. Positive expression of p53 protein and p21 protein in prickle cell layer of actinic keratosis and Bowen's disease was suggesded that the composing cells of prickle cell layer were transformed into the proliferated cell. The p21 protein expression was suggested to be induced by the p53 independent pathway. 3. Negative expression of p53 protein and p21 protein in prickle cell layer of keratoacanthoma was suggested that the composing cells of prickle cell layer were completely mature cells, so the keratoacanthoma had good prognosis.