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.

심장수술 시 농축적혈구, 자가수혈기 혈액, 체외 순환기 혈액에서의 유리 혈색소 농도 비교

송장호,구승우,백종화,정용보,이정순,최인철 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.5

Background: Intraoperative autotransfusion or residual blood in a cardiopulmonaty bypass (CPB) circuit has been used to reduce the need for an homologous blood transfutsion during cardiac surgery. However, it may contain some free hemoglobin released from damaged cells. The load of blood containing free hemoglobin may cause renal dysfunction. We measured the amount of free hemoglobin in backed blood, cell saver blood and CPB blood to evaluate what is the least hemolytic blood transfused in cardiac surgery. Methods: This study was performed in 20 patients undergoing cardiac surgery. In each patient, the banked blood, intraoperative salvaged blood with a cell saver and CPB residual blood were sampled at the end of the operation. The concentration of free hemoglobin, hemoglobin and platelet counts were measured in these blood samples and percent of hemolysis was calculated (%hemolysis = [free hemoglobin] / .free hemogloben + hemoglobin]) Results: In salvaged blood with a cell saver, CPB residual blood and banked blood, hemoglobin concentrations were 20.1 ± 2.7 g/dl, 8.0 ± 1.1 g/dl, and 22.2 ± 2.7 g/dl, respectively. Free hemoglobin concentrations were 336.6 ± 239.5 mg/dl, 49.2 ± 26.8 mg/dl, and 279.5 ± 167.5 mg/dl respectively. Platelet counts were 26.1 ± 22.2 × 10^3/mm^3, 116.8 ± 56.5 × 10^3/mm^3, and 94.9 ± 43.6 × 10^3/mm^3 respectively. % Hemolysis were 1.6 ± 1.1%, 0.6 ± 0.4%, and 1.2 ± 0.7% respectively. In the comparison between the salvaged blood with a cell saver and CPB residual blood, free hemoglobin concentration, % hemolysis, and platelet counts had positive correlations (r = 0.8, 0.7, and 0.6). Conclusions: In twenty cardiac surgeries, CPB residual blood had a lower free hemoglobin level than the other two blood groups. The platelet counts in CPB residual blood were higher than those in cell saver blood but did not differ from those in banked blood. Therefore, CPB residual blood was the least hemolytic blood among the three blood groups when a transfusion was performed in cardiac surgery. (Korean J Acesthesiol 2002; 43: 588~593)

왜 다양한 항우울제가 필요한가?

윤호경,김용구 大韓神經精神醫學會 2008 신경정신의학 Vol.47 No.1

Depression is a chronic, recurring and potentially life-threatening illness. Depression is a syndrome notable for heterogeneity of its clinical presentation, treatment responsiveness, neurobiology, and genetics. The highly variable compilation of symptoms that is used to define depression, and the highly variable course of the illness and its response to various treatments, indicate that depression subsumes numerous disease states of distinct etiology, and perhaps distinct pathophysiology. Current under-standing ofthe mechanisms of pharmacotherapy for depression is characterized by the emphasis on increasing synaptic avail-ability of serotonin, noradrenaline, and possibly dopamine, while minimizing side effects. This is unfortunate, because less than half of individuals with depression show full remission in response to these mechanisms. While current phannacotherapies target monoaminergic systems, distinct neurobiological underpinnings and other systems are likely involved in the pathogenesis of depression. Recently, several promising hypotheses of depression and antidepressant action have been formulated. These hypotheses are largely based on dsyregulation of neural plasticity, CREB, BDNF, corticotropin-releasing factor, glucocorticoid, hypothalamic-pituitary adrenal axis and cytokines. Based on these new theories and hypotheses of depression, a number of new and novel agents show a considerable promise for refining treatment options for depression. In this article, we provide an overview of the mechanisms of action of currently available antidepressant treatments. We then provide a progress report on some of the most promising current strategies.

May-Thurner Syndrome 환자의 좌측 하지 심부정맥혈전증 : Pigtail 카테터 회전을 이용한 치료의 효용성과 안전성 Lower Extremity Deep Vein Thrombosis of May-Thurner Syndrome

정구용,염차경,이주호,강병철 대한혈관외과학회 2004 Vascular Specialist International Vol.20 No.1

여성 하부요관석환자에서 무마취하 요관경하 배석술

박영호,송윤섭,임용순,김영호,이남규,구자현,서병욱,김민의,전윤수 순천향의학연구소 1999 Journal of Soonchunhyang Medical Science Vol.5 No.2

Although ureteroscopy(URS) has been used widely to remove ureteral calculi, there is an argument against the belief that anesthesia or admission is needed for URS. We evaluated the experience of URS without anesthesia in female patients. From September 1997 to July 1998, URS was performed in 31 female patients without anesthesia. EHL(Electrohydraulic Lithotripsy) was used in 21 patients with impacted or large stone over 5mm. All patients were given oral antibiotics for 3 days and follow-up KUB was taken to confirm successful removal of the stone one week after the procedure. Successful treatment was defined as complete removal of the stone or residual fragments less than 2mm. Overall success rate was 96.7%(30 cases among 31 cases). All but one patient tolerated with analgesia through the entire procedures. There were only minimal complications such as mild flank pain and hematuria. So, we recommend that non-anesthetic ureteroscopic removal of stone as the first choice for treatment of lower ureteral stones in female based on the minimal morbidity, high success rate and low cost.

위암 환자에서 위절제술후 나타나는 담도확장의 임상적 의의: 추적 CT 소견을 중심으로

윤구섭,백승연,이문규,김영환,오용호 울산대학교 의과대학 1993 울산의대학술지 Vol.2 No.1

A retrospective review of consecutive 35 patients'pre and post operative abdominal computed tomography was performed to determine frequency and degree of bile duct dilatation following Billroth Ⅱ operation for stomach cancer and it's clinical significance. Degree of intrahepatic biliary dilatation was classified as mild, moderate, marked according to the extension into central, middle and peripheral zone of liver, respectively. Three specialists on the abdominal image participated in analysis of those findings without prior information of the patients. Intrahepatic biliary dilatation was seen in 22 patients(63%) analysed by at least one radiologist, in 13 patients(37%) by at least two radiologists. Bile duct dilatation on CT was common finding and not necessarily meant tumor recurrence. Vagotomy and afferent loop resulted form Billroth Ⅱ were one of possible causes of bile duct dilatation. This study showed in the cases of bile duct dilatation without clinical and other radiological evidence of recurrence, no further study are needed and only enough to follow up study.

Kimura Disease 치험예보고 : 이하선 종양과의 감별 Pitfalls in Parotid Gland Surgery

류재현,정구용,한호성,최용만 梨花女子大學校 醫科大學 醫科學硏究所 1997 EMJ (Ewha medical journal) Vol.20 No.4

Kimura disease, which was initially described by Kimura et al. in 1948, is a rare entity that occurs primarily in Asian people characterized histopathologically by a lymphofolliculoid granuloma with infiltration of the mass and the surrounding tissue by eosinophils, often with concomitant peripheral blood eosinophilia and elevated serum Ig E. The kimura disease frequentlly involves head and neck region and reraly extrimities. When the disease involvews parotid gland, it is very difficult to differentiate clinically with parotid gland tumor. We have experienced a case of Kimura disease. The lesion was initially diagnosed as a parotid gland due to extensive fibrosis surrounding the mass. So, the mass excision was performed without clear identification of the facial nerve. The Kimura disease usually follows a benign course. But when this disease is confused with parotid gland tumor, there will be a danger of nerve injury due to difficulty in dissection of the extensive fibrotic soft tissue surrounding the parotid gland.

경주지역 여고생의 초경과 체성장간의 관계

김준섭,권오구,박진석,오종수,박정현,박제식,안세한,이용환,서정호,신태섭,최영배,김덕수,이관,박수경 東國大學校醫學硏究所 2002 東國醫學 Vol.9 No.1

본 연구는 경주지역 1개 고등학교 3학년 여고생을 대상으로 초경 시작 전인 초등학교 4학년부터 고등학교 2학년까지의 키, 몸무게, 가슴둘레 수치와 초경 연령을 파악하여 여성의 초경이 빠를수록 체성장 속도의 변화가 있을 것이라는 가설을 기초로 두 요인간의 관련성을 파악하고자 시행되었다. 경주시 1개 여자고등학교 3학년생 총 317명에 대해 ㅊ경 나이, 초경시 심리 상태, 초경이 시작되었을 때의 상담 여부와 상담하였던 사람, 부모 신장과 초경전후의 식사 규칙성, 다이어트 경험, 수면시간, 스트레스, 음주/흡연 여부, 질병력 등에 대한 설문 조사를 시행하였고, 초등학교 4학년부터 고등학교 2학년까지의 키, 몸무게, 가슴둘레에 대한 정보는 건강기록부에서 확보하였다. 상기 대상자 중 건강기록부가 분실된 39명, 초경나이에 대해 응답하지 않았던 29명 및 결석 등으로 조사를 하지 못하였던 42명을 제외한 조사 대상자는 206명으로 선정하였다. 대상자들의 초경연령 평균값(Mean±SD)은 13.0±1.11이었고, 초등학교 4학년부터 고등학교 2학년까지의 초경 이후 신장 성장률은 감소하였으며, 초경연령이 빠른 군이 초등학교 때는 신장에 있어서 우위를 차지하나 고등학교에 오면서 신장은 비슷한 수준이 되었다. 초경후 1-2년 사이에 체중과 흉위의 증가율은 감소하였고, 초경연령이 빠른 군이 초등학교와 고등학교 사이에 체중과 흉위에서 모두 우위를 차지하였다. 본 연구의 결과는, 흔히 이차 성징의 시작 시점 혹은 사춘기의 시작 시점으로 보고있는 초경 연령이 청소년기의 성장과 밀접한 관련성이 있고, 특히 체중과 흉위의 성장 속도와 밀접한 관련성이 있음을 시사한다. To understand the onset of menarche in relation to changes in physical growth that take place during female adolescence, especially the changes in height and weight velocity. The 207 senior in one women high school of Kyongju were investigated in April 3 to 8, 2001. We collected the information, relation in the age at menarche, height & weight of parents, regularity of eating, and obesity diet, duration of sleeping, sickness & stress near age at menarche, by self-recording. The status of height, weight & chest circumference between the 4th grade of primary school and the junior of high school was collected by individual Health Record. The results were followed; The average age at menarche was 12.95±1.11 years old and the most frequent age of menarche is 13 years. After menarche, the velocity of height, weight and chest circumference were decreased. The most rapid group of menarche hold dominant position in height during elementary school. As time passed, they dont hold dominant position in height. The most rapid group of menarche get an advantage in the weight and the girth of chest after elementary school. The height of subjects is directly proportional to the height of their parents. These results suggest that the starting age at menestuation can be closely associated with physical growth and development.

형질전환 제초제저항성 벼 밀양 204호의 농업적 특성

정응기,이기환,원용재,박향미,전남수,최준호,구연충,한창덕,은무영,김태산,남민희 Plant molecular biology and biotechnology research 2005 Plant molecular biology and biotechnology research Vol.2005 No.

This study was conducted to investigated the major characteristics of genetically modified rice of "Milyang 204" originated from Dongjinbyeo compared to a non-transgenic rice varieties Dongjinbyeo and Junambyeo. Basta resistant transgenic rice lines carrying bar gene produced by the Yeongnam Agricultural Research Institute were evaluated for their agronomic characters. The transgenic Japonica rice of "Milyang 204" showed inferior phenotypic traits compared to a non-transgenic rice variety Dongjinbyeo and Junambyeo. On the basis of UPOV (Union Internationale Pour la Protaection des Obtentions Vegetables) and NSMO(National Seed Management Office) the transgenic "Milyang 204" showed difference in some traits out of some agronomic traits, such as leaf color, angle of flag leaf, number of spikelets, culm length, white core and white belly compared to the nontransgenic varieties rice.

초등 교육 발전에 기여하는 교육대학의 현장지도 역할에 관한 연구

김성회 / 이종철 / 전구호 / 정용팔 / 최동준 / 문낙주 공주교육대학교 초등연구원 1977 公州敎大論叢 Vol.13 No.2

.