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.

眼窩粉碎骨折의 診斷과 治療 : 眼科的 合病症을 中心으로 Specifically Concerning the Ocular Complication

李熙哲,姜信益 인제대학교 1985 仁濟醫學 Vol.6 No.2

안와분쇄골절(Orbital Blow-out fracture)의 존재와 그 병태에 관한 최초의 언급은 1889年 Lang氏에 의해서 외상성 안구 함몰(Traumatic Enopthalmos)라고 불리면서였으며 1943年 King氏와 Samuel氏는 外力이 안구를 통하여 안와벽이 전달되어 골절이 유발된다는 작용기전을 설명하였고 1957年 Smith氏와 Regan氏는 그 기전이 外力의 직접 전달이 아니라 안압의 상승에 의한다는 것을 사체 실험으로 증명하였다. 그러나 blow-out fracture時 안구운동장애, 복시, 시력 감퇴, 안구 함몰의 치료에 관한 언급은 1957年 Converse氏와 Smith氏에 의하여 外科的 方法으로 Entrap된 연조직을 release시키고 안와 하벽을 재건하는 술식이 도입되었으며 Blow-out fracture라는 용어를 처음으로 사용하게 되었다. 그후, 진단 방법과 수술 방법이 개선되어 현재에 이르고 있으나 우리의 현실에 있어서는 그 개념의 혼동이 존재하고 있어 많은 환자들이 적절한 치료를 받지 못하고 있는 것이 사실이다. 이에 本人은 1981年 7월부터 1984年 6月 30日까지 本院에 내원한 Mid-facial fracture 89 Case를 주 대상으로 Blow-out fracture時 시신경 조직 손상에 의한 시력의 기능적 이상안모의 심미적 손상의 예방 및 치료에 관한 통일적인 접근법을 모색하고자 한다. Blowout fracture of the orbit was described at first in 1889 by Lang, and surgical correction of the blowout fracture was performed at first in 1957 by Converse. The concept in the diagnosis and treatment of the blowout fractures was reviewed by literatures and specifically the ocular complications in the periorbital bone fractures were studied. The main signs and symptoms of the blow- out fracture of the orbit are enophthalmos, vertical diplopia and ocular motility limitation and the corrective surgery is directed to the disengagement of the entraptted orbital fat and muscles, and reconstruction of the orbital floor with allogenic or autogenic graft materials. We used lyophilized dura(Lyodura) in the reconstruction of the fractured orbital floor, and obtained good results. The cases seen and treated in the Dept.of Oral and Maxillofacial Surgery, Inje Medical College Paik Hospital were reviewed. In 89 midfacial fractures, blow-out fractures were 14 cases (15.7%). Of the 89 midfacial fractures patients 19 patients had notable ocular complications and 7 patients lost their vision due to the global rupture and direct or indirect optic nerve injuries. In the midfacial fractures including the blowout fractures, there was relatively high incidence of ocular and neurological complications, so systematic approach through the team approach including oral surgeon, ophthalmologist and neurosurgeon should be emphasized, and then the patients would have better prognosis.

고등부 유도 지도자의 지도행동 유형분석

이준희,윤익선 龍仁大學校 武道硏究所 1997 武道硏究所誌 Vol.8 No.2

In this assentation I tried to investigate and analyze the actual behaviors of the coaches of the high level male and female team and the behaviors that the players of the team prefer. I came to conclude like the followings through the analysis of 432 Leadership scale for sports from 30 coaches and 432 players in the 30 teams which is constitute of the 20 coaches and 309 players in 20 male high level teams and the 10 coaches and 123 players in 10 female high level teams. 1) The coaches in the male teams are better in efficiency of teaching because the male team coaches are better in the background variables of age, career, and the career of winning the prize. 2) In the assentation on the actual of coach the male team coaches have the strongest disposition of behavior that influence on the advancement of the game, whereas the female team coaches the strongest disposition of democratic behavior. Considering such the differences of leadership behaviors, the coaches of male team have the disposition of emphasis of the task, whereas the coaches of female team emphasis of the relations. 3) In the research of leadership scale among the teams, the male players prefer behavior of training and indicating, positive reward, social support, democratic, and then authority behavior whereas the female players positive reward, social support, democratic, training and indicating and then authority. 4) In the research of preferable behavior, male players prefer the training and indicating, positive reward, social support, and then authority behavior, whereas the female players positive reward, social support, democratic behavior, training and indicating and then authority behavior. The male players were found to prefer such behaviors as influence the advancement of the game power directly, whereas the female players most prefer such behaviors as reward the results of the game. 5) In the comparison of the leadership behaviors that male and female players prefer, the male players have stronger disposition to want training and indications, authorities than female players,, whereas the female players prefer the democratic behaviors, social supports, positive rewards. 6) In the differences of the actual behaviors the players want from the coach, the male players differs in the democratic behaviors most, whereas the female players in the authority behaviors. 7) In the research on the differences of the behaviors the coach actually do and the players expect, ·in the training and indications, the male team players were a little more satisfied than the female team players. ·in the democratic behaviors, the male team players were more unsatisfied. ·in the authority behaviors, the female team players want more authorities from the coaches. ·in the social supports, the female team players were more unsatisfied. ·in the positive rewards, the female team players were more unsatisfied.

소아의 하악 과두 골절의 비외과적 치료 : 증례보고 CASES REPORTS

이정근,박익수,노양호,김동우,김우형,이희철 大韓顎顔面成形再建外科學會 2003 Maxillofacial Plastic Reconstructive Surgery Vol.25 No.1

Of all facial fractures in children, condylar fractures have the greatest propensity to produce a growth disturbance. The pediatric condylar fracture occurs very frequently in the mandible, but this injury is occasionally ignored due to difficulty of diagnosis and no cooperation of patient. The adequate initial diagnosis and active treatment must be performed because delayed and improper treatment lead to possible severe complications such as facial asymmetry, TMJ pain, limiation of motion and deflection, midline deviation of the dental arch. So, the goal of managing condyle fractures in the growing patient is to restore mandibular symmetry, occlusion, function without interfering with future growth. Commonly, fracture teatment aims at restoring function through repositioning and rigid fixation of the bony fragments. However, the generally preferred management of condylar fractures in growing children is nonsurgical. So, we present the clinical and radiographic follow-up results of 4 condylar fractures in pediatric patients whom we managed in conservative and functional method. We can summarize our protocol in management of pediatric condylar fracture as the following: The IMF using acrylic resin splint with circumferential wiring was performed for 1 or 2 weeks. After releasing IMF, the active physical therapy was done with guiding elastic band. Opening deviation was controlled by mannual pressure of surgeon or parents for 2 weeks. When unstable occlusion or functional problem remained, functional appliance after construction bite registration was used for several months.

경동맥 내막 절제술 후 발생한 과관류 증후군 1예

송희정,박광열,정진상,조수진,이순정,허승,김동익,이광호,이병붕 대한신경과학회 1999 대한신경과학회지 Vol.17 No.2

생쥐 안구에서 산화적 손상에 의한 superoxide dismutases와 metallothionein의 나이에 따른 유도의 차이

이홍영,이태범,안춘산,변익건,최석민,권대승,최철희 朝鮮大學校 附設 醫學硏究所 2003 The Medical Journal of Chosun University Vol.28 No.2

The basal levels and inducibility of superoxide dismutases (SODs; Mn-SOD and Cu/Zn-SOD) and metallothionein (MT) was investigated in the eyes of mice with age. Oxidative stress was induced by paraquat, an intracellular superoxide generator, in 1, 4, 8, and 12 months of age and then mRl\As of SODs and MT in the eyes were determined by RT-PCR assay. The basal level of Mn-SOD mRNA increased from 1 month to 8 months but decreased thereafter. Mn-SOD mRNA was induced by paraquat until 4 month but not after 8 months. On the other hand, the basal level of Cu/Zn-SOD mRNA decreased with age. Cu/Zn-SOD mRNA was not induced by paraquat until 4 months. The basal level of MT mRNA declined with age whereas its inducibility by paraquat was intact at all ages. Taken together, the results indicate that SODs and MT are differentially expressed and induced according to the age. It could be also implicated that failure in induction of Mn-SOD with age may be one of causative factors in the aging process whereas induction of Cu/Zn-SOD and MT may be one of important factors in defense against oxidative stress in the eyes. 서론: 최근 노화는 반응성 산소종에 의한 산화적 손상의 축적결과라는 설이 각광을 받고 있다. 노화과정에서 노화와 관련된 질병을 비교적 잘 나타내는 안구를 선정하고, 정상생쥐의 안구에서의 superoxide dismutases (SODs) 와 metallothionein (MT) 의 함량 뿐 아니라 산화성 스트레스를 유발하는 paraquat에 의한 SODs와 MT의 유도능과 나이와의 상호관계를 조사하여 이들의 노화과정에서의 역할을 규명하고자 하였다. 재료 및 방법 : 본 연구에서 1, 4, 8, 12개월된 정상생쥐의 안구에서 반응성 산소종 생성의 초기에 중요한 방어기전인 SODs mRNA와 hydroxy radical (OH·)에 의한 산화적 손상의 마지막 방어기전인 MT mRNA의 함량과 산화성 스트레스를 유발하는 paraquat에 의한 유도능을 역전사 중합효소 연쇄반응 (RT-PCR) 으로 조사하였다. 결과: 정상생쥐의 안구의 노화과정에서 Mn-SOD와 Cu/Zn-SOD, 그리고 MT mRNA의 항정상태 함량을 조사한 결과, Mn-SOD mRNA는 8개월까지는 증가하다가 12개월에서 감소하였으나, Cu/Zn-SOD mRNA는 나이와 함께 감소하였다. 그러나 MT mRNA 는 8개월까지는 감소하다가 12개월에서 약간 증가하였다. 산화성 스트레스를 유발하는 parraquat에 의하여 Mn-SOD mRNA는 1개월과 4개월에서만 유도되었고, Cu/Zn-SOD mRNA는 8개월과 12개월에서만 유도되었으며, MT mRNA는 관찰한 전 기간에서 유도되었다. 결론: 이상의 결과를 종합하면 SODs와 MT는 안구에서 나이에 따라 서로 다르게 발현되고 유도되는 것으로 생각되며, 노화과정에서 Mn-SOD유도의 이상이 노화의 원인이 되는 인자로 작용하고, 반면에 Cu/Zn-SOD와 MT의 정상적인 유도능이 산화적 스트레스에 대하여 방어역할을 하는 것으로 생각된다. 이와 같이 연령이 증가함에 따라 Mn-SOD, Cu-Zn-SOD, 및 MT의 발현과 유도능의 차이가 있게 되고, 그 결과 반응성 산소종에 의한 산화적 손상의 정도의 차이로 노화의 속도가 조절되지 않나 생각된다.

일부 임상간호사들의 직무스트레스와 우울과의 관련성

이미옥,류소연,변익건,박정희 朝鮮大學校 附設 醫學硏究所 2004 The Medical Journal of Chosun University Vol.29 No.2

Objective : This study was performed to identify the relationship between job stress and depression of nurses who work at hospitals in Gwangju city. Methods : The data were collected from October 2 to 22, 2003 using the self-administered questionnaire which was composed demographic characteristics, job-related factors, health-related factors, family-related factors, job stress, self-esteem and Korean Beck's depression inventory. The statistic methods were t-test, analysis of variance (ANOVA), Pearson's correlation analysis and multiple regression analysis. Results : 1. The score of job stress of clinical nurses was 169.23 (24.44) , and depression point was 11.37 (7.71). By the depression criteria, the prevalence of depression were 11.2% in pre-depression, 5.7% in moderate and 4.6% in severe depression. 2. It was found that the characteristics that had a statistically significant relation with depression scores were age, marital status, educational background, career, income, drinking status, satisfaction in living and self-esteem. And job stress was statistically significant positive correlation with depression scores. 3. As a result of multiple regression analysis, the job stress had not a statistically significant relation with depression with controlled other related factors. Conclusion : It is necessary to prepare the program about the control and prevention of depression In clinical nurses. Further study need to identify the relationship between depression and job-related factors in nurses working at the hospitals.

동종 골수이식을 시행받은 환자에서 폐색성 세기관지염에 의하여 발생한 자발성 기종격동과 피하 기종

이병환,이제중,이연경,안재숙,김여경,황호인,박무림,조상희,정익주,김형준 대한조혈모세포이식학회 2002 대한조혈모세포이식학회지 Vol.7 No.2

저자들은 만성골수성백혈병으로 동종 골수이식과 이식편 부전으로 인하여 추가적인 말초혈액 조혈모세포이식을 시행 받은 환자에서 만성 이식편대숙주질환과 그 폐 합병증인 폐색성 세기관지염에 동반된 자발성 기종격동과 피하 기종이 병발한 1예를 경험하였기에 이를 보고하는 바이다. Obstructive lung disorders following after allogeneic bone marrow transplantation (BMT) in association with graft- versus-host disease (GVHD) contribute significant morbidity and mortality. We report a case of a 28-year-old man who developed spontaneous pneumomediatinum and subcutaneous emphysema complicating bronchiolitis obliterans after allogeneic BMT. He received an allogeneic BMT for chronic phase of chronic myeloid leukemia. Five months after BMT, he was boostered by allogeneic peripheral blood stem cells from the same donor due to graft failure. One month after the boostering, chronic GVHD developed and were treated with cyclosporine and steroid. The patients developed spontaneous pneumomediatinum and subcutaneous emphysema secondary to severe bronchiolitis obliterans 4 months after boostering donor cells. The air-leak syndromes were recovered by conservative management, including high-flow oxygen.

하악골 관절 과두돌기 골절의 임상적 연구

이희철,고영규,강신익 大韓顎顔面成形外科學會 1989 Maxillofacial Plastic Reconstructive Surgery Vol.11 No.1

하악골 과두돌기 골절은 하악골에 있어서 자주 일어나는 골절중의 하나이며, 이 부위는 해부학적 구조로 이상적인 Reposition ( )이 통례적으로 불가능 하다고 할 수 있을 정도로 어렵기 때문에 치료방법이 선택적으로 이용된다. 수술후 충분한 악관절기능을 발휘하는데 문제가 있을수도 있기 때문에 (Arthropathia deformans) 치료 계획을 세우는데 있어서는 우선 관절기능이 정상적으로 회복되어져야 하며, 또한 악관절 강직에 따른 안면골의 발육 부전으로 인한 악골기형을 고려하여야 한다는데 치료의 촛점이 두어져야 한다. 본인은 1981년 부터 1987년까지 인제대학부속부산백병원에서 치료한 바 있는 73명을 대상으로 (88골절선) 임상조사와 문헌적 고찰을 통하여 악관절 과두돌기 골절에 대한 치료방법의 선택기준 및 합병증 방지에 그 일익을 하고자 이 연구를 시행하였다. Fractures of the mandibular condyle are among the most frequently occuring facial bone fractures. Anatomical structures around the joint inhibit the ideal reposition of the fragments, so variable treatment modalities have been tried selectivly. There can be functional disturbances postoperatively, and normalization of joint function must be considered primarily in treatment planning. Secondly, the possible joint ankylosis and facial deformity following developmental disturbance of facial skeleton must be considered. The authors reviewed 73 patients treated in Dept. of Oral and Maxillofacial Surgery. Inje College of medicine Pusan Paik Hospital from 1981 to 1987. Also literatures were reviewed, and we obtained some reference points concerning the selection of the treatment modality and prevention of the possible complication.

임천강의 3배체 기름종개속 어류의 출현과 핵형

金益秀,李銀姬 全北大學校 1995 論文集 Vol.39 No.-

It was collected 30 specimens of Cobitis sinensis and 11 specimens of C. sinensis-longicorpus complex from the Imchon River, Hamynag-gun, Kyongsangnam-do, Korea in October, 1994. C. sinensis-longicorpus complex were represented by all females and triploid in karyotypes. The chromosome number of the complex have 73 composing 28 meta-submetacentrics and 45 subtelo-telocentric chromosomes. In this paper, we discussed the systematics of C. sinensis-longicorpus triploid population occuring in this area based on their karyotypes and body color patterns.