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.

급성기 뇌지주막하출혈에서 Three-Dimensional Computed Tomographic Angiography (3-D CTA)의 유용성

임동준,이훈갑,김봉룡,정흥섭,정용구,이기찬,서중근 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.12

고등학교 지구과학 실험·실습 요목 비교 분석

정원우,이윤종,기우항,김영호,양승영,강용희,안병호,임성규,윤일희,김중욱,윤성효,강동진 경북대학교 과학교육연구소 1997 科學敎育硏究誌 Vol.21 No.-

The purpose of this study is to investigate the status of the experimental and practical education in high school earth. The present status and reasonable management of the experimental and practical education in high school earth science have been grasped from the questionaires. To do this, eighty eight earth science teachers in Korea are administered questionaires. The frequency of the experimental and practical items in the seven kind of earth science text books were investigated. The problems and the reasonable management for experimental and practical education were proposed in this paper.

음용수 중 유해화학물질에 대한 위해성 평가에 관한 연구 : Ⅱ 비발암성 화학물질을 중심으로

정용,신동천,김종만,박성은,양지연,이자경,황만식,박연신 한국환경독성학회 1995 환경독성보건학회지 Vol.10 No.1

The purpose of this research is to estimate a safe environmental level of human exposure to thresholding acting toxicants in drinking water and recommend the acceptable levels and management plans for maintaining good quality of drinking water and protecting health hazard. This research has been funded as a national project for three years from 1992 to 1995. This study(the second year, 1993-1994) was conducted to monitor 39 species of non-carcinogenic chemicals such as volatile organic compounds(VOCs), polynuclear aromatic hydrocarbons(PAHs), pesticides and heavy metals of drinking water at some area in six cities of Korea, and evaluate health risk due to these chemicals through four main steps (hazard identification, exposure assessment, dose-response assessment and risk characterization) of risk assessment in drinking water. In hazard identification, 39 species of non-carcinogenic chemicals were identified by the US EPA classification system. In the step of exposure assessment, sampling of tap water from the public water supply system had been conducted from 1993 to 1994, and 39 chemicals were analyzed. Indose-response assessment for non-carcinogens, reference doses(RfD) and lifetime health advisories (HAs) of lifetime acceptable levels were calculated. In risk characterization of detected chemicals, the hazard quotients of noncarcinogens were less than one except those of manganese and iron in D city.

만정 뇌경막하혈종에서 술전 CT음영 및 천두폐쇄배액술후 배액량과 재발과의 상관관계에 대한 연구

임동준,박윤관,정용구,김봉룡,정흥섭,이기찬,이훈갑,서중근 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.10

상수의 염소처리시 생성되는 소독부산물 중 Haloacetic acid류의 생성능에 관한 연구 : 일부 상수원수를 대상으로

정용,신동천,임영욱,김준성,박연신 한국환경독성학회 1997 환경독성보건학회지 Vol.12 No.2

The main reason of applying chlorination is to sterilize microbes existing in the drinking water treatment. But chlorination could lead to the formation of disinfection by-products (DBPs) by the reaction of free chlorine with humic substance in the water. Especially the DBPs including trihalomethanes (THMs), haloacetic acids (HAAs), haloacetonitriles (HANs), and haloketones (HKs) exist in the tap water. The US environmental protection agency (US EPA) defines that trihalomethanes, dichloroacetic acid, trichloroacetic acid, and dichloroacetonitrile among DBPs are probable/possible human carcinogens. US EPA suggests maximum contaminant levels (MCLs) for THMs (80 μg/L) and HAAs (60 pg/L) in drinking water. In Korea, THMs in drinking water has been surveyed but DBPs in general has not been studied in drinking water practically. Therefore only THMs have been regulating as criteria compounds since 1990 but neither HAAs nor HANs. Researches on HAAS are yet to be found. HAA formation potentials (HAAFPs) have not been practiced. HAAS depends on the characteristics of water sources by chlorination. In this study, HAAFPs from three distinct sources were investigated by laboratory chlorination experiments. This study was performed to measure the level of HAAS in drinking water in Seoul area. At April 1996, after collecting the raw waters from the three sites with the different properties, the water samples were chlorinated at various conditions (pH 5, 5, pH 7.0 and without pH adjustment) in the state of raw water to have 0.5 mg/L of residual chlorine concentration. And the raw water, treated water, and tap water of water treatment were collected to measure the HAA, concentration. The quantitative analysis of IIAAs was conducted by US EPA methods. After 48 hours of chlorination, The IIAAFPs ranges of measured level of pH 5.5, pH 7. 0, and without pH adjustment were 11.0~48.7ppb, 9.4~60.7ppb, and 4.5~50.0ppb., respectively. HAAFPs was increased with the reaction time. In tap water of households in Seoul, HAAS was measured with the mean value of It. 71 ± 1. 11 ppb. Among the HAAFPs, dichloroacetic acid and trichloroacetic acid as the hazardous compounds are measured at higher value. Based on above results, the health risk assessment of DBPs should be undertaken in urgently for the management process for the standard.

흰쥐 적색핵에서의 Parvalbumin성 신경원의 분포상태와 미세구조

이문용,한동일,천명훈,정진웅 대한해부학회 1994 Anatomy & Cell Biology Vol.27 No.3

수도수중 염소 소독부산물로 인한 건강위해성 평가에 관한 연구 : 서울시 수도수중 Trihalomethanes 및 Haloaceticnitriles을 중심으로

정용,신동천,양지연,박연신,김준성 한국환경독성학회 1997 환경독성보건학회지 Vol.12 No.2

Public concerns about hazardous health effect from the exposure to organic by-products of the chlorination have been increased. There are numerous studies reporting that chlorination of drinking water produces numerous chlorinated organic by -products including THMs, HAAS, HANs. Some of these products are known to be animal carcinogens. The purpose of this study was to estimate health risk of DBPs by chlorinated drinking water ingestion in Seoul based on methodologies that have been developed for conducting risk assessment of complex-chemical-mixture. The drinking water sample was collected seperately at six water treatment plant in Seoul at March, April, 1996. In tap water of households in Seoul, DBPs were measured with the mean value of 36.6 μg/L. Risk assessment processes, which include processes for the estimation of human cancer potency using animal bioassay data and calculation of human exposure, entail uncertainties. In the exposure assessment process, exposure scenarios with various assumptions could affect the exposure amount and excess cancer risk. The reference dose of haloacetonitriles was estimated to be 0.0023 mg/kg/day by applying dibromoacetonitrile NOAEL and uncertainty factor to the mean concentration. In the first case, human excess cancer risk was estimated by the US EPA method used to set the MCL (maximum contaminant level). In the second and third case, the risk was estimated for multi-route exposure with and without adopting Monte-Carlo simulation, respectively. In the second case, exposure input parameters and cancer potencies used probability distributions, and in the third case, those values used point estimates (mean, and maximum or 951!!i) upper-bound value). As a result, while the excess cancer risk estimated by US EPA method considering only direct ingestion tended to be underestimated, the -risk which was estimated by considering multi-route exposure without Monte-Carlo simulation and then using the maximum or 95% upper-bound value as input parameters tended to be overestimated. In risk assessment for Trihalomethanes, considering multi-route exposure with adopting Monte-Carlo analysis seems to provide the most reasonable estimations.

원위 대퇴골의 고립성 골연골종에서 발생한 속발성 연골 육종 1례 보고

정필현,황장수,강석,김용민,오형호,채동주,김종필 동국대학교 경주대학 1996 東國論集 Vol.15 No.-

연골육종은 비교적 서서히 자라며 늦게 전이하는 악성 연골 종양으로 알려져 있다. 골 연골종에서 발생한 속발성 연골육종은 발생빈도는 드물며 타부위로의 전이가 적고 악성도가 낮은 경우가 많아 적합한 수술적 치료로서 좋은 예후를 보이는 것으로 보고되고 있다. 본 동국대학교 정형외과학 교실에서는 우측 대퇴골 원위부 골간단부에 생긴 고립성 골 연골종에서 이차적으로 발생한 연골육종을 치험한 바 문헌고찰과 함께 보고하는 바이다. A case of Secondary Chondrosarcoma Arising from Solitary Osteochondroma of the Distal Femur Department of Orthopaedic Surgery, College of Medicine, DongGuk University Phil Hyun Chung M.D., Jung Su Hwang M.D., Suk Kang M.D., Yang Mln Kim M.D., Hyung Ho Oh M.D., Dong Ju Chae M.D., Jong Pil Kim M.D. Chondrpsarcoma is a malignant cartilage-forming tumor that grows slowly and metastasis of this tumor occurs in late stage. Secondary chondrosarcomas arising from a solitary osteocartilaginous exostosis are rare and those have a better prognosis than other chondrosarcomas, and they rarely metastasize. We present our experience with a case of secondary chondrpsarcoma arising in solitary osteochondroma of distal metaphysis of right femur with clinical details.

급성하벽심근경색에서 전흉부유도 ST절 하강의 의의

정병천,배호상,곽동훈,김영태,배용학,황종현,임현주,류재근,조용근,채성철,전재은,박의현 慶北大學校 醫科大學 1997 慶北醫大誌 Vol.38 No.2

목적 : 급성하벽심근경색증 환자에서 심전도상 흔히 동반되는 전흉부유도 ST절 하강의 의의를 알아보았다. 방법 : 심근경색후 24시간에서 48시간에 얻은 심전도를 기준으로 52명의 급성하벽심근경색증 환자를 전흉부유도에서 ST절의 하강이 있는 군과 없는 군으로 나누었으며 심도자, 관상동맥조영술, 심초음파도 및 방사성 핵종을 이용한 좌심구혈율 측정 등을 시행하였다. 결과 : 1) 좌심실확장기말압은 전흉부유도에서 ST절의 하강이 있는 경우에서 16.9±5.33mmHg로 없는 경우의 11.0±4.02mmHg보다 유의하게 높았다(p<0.05). 그러나 운동량 및 좌심구혈을은 흥부 유도상 ST절의 하강이 있는 경우 7.6±3.0 METs 및 53.9±9.1%로 없는 경우의 9.1±2.7 METs 및 54.6±9.5%보다 낮았으나 통계적 유의성은 없었다(p=0.180, p=0.823). 2) 관상동맥조영술상 전흉부 ST절의 하강이 동반된 군에서는 유의한 좌전하행지나 좌회선지의 협착이 있는 경우가 60.9% 및 57.9%로 ST절의 하강이 없는 군에서의 34.5% 및 7.7%와 비교해 좌관상동맥에 협착이 동반된 경우가 많았다(p=0.050, p=0.001). 3) 관상동맥조영술상 세 혈관질환의 빈도는 흉부유도상 ST절의 하강을 보인 23예에서 10예로 ST절 하강이 없었던 29예중 2예에 비하여 유의하게 많았고(P=0.007), 단 혈관질환의 빈도는 ST절의 하강을 보인 군에서 23예중 5예로 ST절 하강이 없었던 29예중 17예에 비하여 유의하게 적었다(P=0.002). 두 혈관질환의 경우에는 각각 8예와 10예로 양군간에 유의한 차이가 없었다. 4) 흉부유도상 ST절 하강의 빈도는 단 혈관질환 22예 중 5예에서, 두 혈관질환 18예중 8예, 세 혈관질환 12예 중 10예에서 관찰되어 협착이 있는 관상동맥의 수가 많을수록 ST절의 하강이 나타나는 빈도가 많음을 보였다(p=0.00308). 그러나 흉부유도상 나타난 ST절의 하강을 모두 합하여 구한 ST절 하강의 합은 협착이 있는 관상동맥의 수와 통계적인 유의성이 없었다. 5) 심초음파도상 좌심실 하벽의 벽운동은 ST절 하강을 보인 군에서는 akinesia가 83.3%, hypokinesia가 11.1%, 정상 벽운동이 5.6%로, ST절 하강이 없었던 군에서의 dyskinesia가 3.6%, akinesia가 39.3%, hypokinesia가 25.0%, 정상 벽운동이 32.1%와 비교하여 ST절의 하강이 있는 군에서 유의하게 벽운동의 장애가 빈번함을 보였다(p=0.03891). 그러나 좌심실전벽, 측벽 및 중격부위에서는 유의한 벽운동의 차이가 없었다. 결론 : 급성하벽심근경색증 환자의 전흉부유도에서 ST절의 하강이 동반되는 경우 다혈관 질환의 가능성이 높으며 좌심실확장기말압이 상승되었고 운동능력은 감소되어 있었다. 또한 심초음파도상 좌심실하벽의 벽운동장애도 심하였다. 따라서 전흉부 ST절의 하강을 동반한 급성하벽심근경색증 환자는 전흉부유도에 ST절 하강이 없는 경우보다 예후가 불량할 것으로 생각되며, 보다 적극적인 치료가 필요할 것으로 생각된다. The purpose of this study was to determine the significance of precordial ST segment depression appearing during acute inferior myocardial infarction and to assess the correlation of that with angiographic finding. 52 patients were allocated into two groups based on the existence of precordial ST segment depression : 23 patients with ST segment depression and 29 patients without ST segment depression. The extent of coronary artery disease as well as the prevalence of significant stenosis (≥70%) in left anterior descending artery were more frequent in patients showing precordial ST segment depression than in patients not showing them (p=0.050) and the result were similar in cases of left circumplex artery (p=0.001). On echocrdiographic examination of left ventricular (LV) wall motion, it showed more severely decreased inferior LV wall motion in patients showing precordial ST segment depression than in patients not showing them (p=0.03891) even though the other segment of LV wall motion didn't show the statistical difference between both groups. The other cardiac parameters such as LVEDP, exercise amount (METs) and ejection fraction were tend to showing bad profile in patients with precordial ST segment depression. From the above results, we could deduce that patients with precordial ST segment depression have relatively large infarction or concomitant left coronary artery disease, so they need more caution and intensive theraphy.