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.

신경섬유종증-제 2형의 진단과 치료 : 16례의 임상경험 Experience of 16 Cases

김정은,백선하,김종수,이상형,오창완,김동규,정희원,김현집,조병규,한대희,최길수 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.12

Neurofibromatosis type 2(NF-2) is a dominantly inherited disorder characterized by the occurrence of bilateral acoustic neurinomas and the frequent association of other central nervous system tumors. We present a retrospective review of 16 patients with NF-2 who were treated at our hospital from 1984 to 1995 in 13 cases, the diagnoses of Nf-2 were based on the criteria developed at the Consensus Development Conference of National Institute of Health in the United States, and in another 3 cases. the criterias of NF-2 were not fully satisfied, but the diagnoses of NF-2 were highly suspected. The average age of the patients was 27.6 years, ranging from 13 years to 56 years. The most common symptom was hearing difficulty : intervals between symptom onset and deafness ranged from 8 months to 6 years(mean : 2.9 years) One family of NF-2 was documented consisting of a sister a brother and their mother. Nine patients underwent operations on unilateral acoustic neurinomas : these were subtotally removed in eight patients and totally in one patient Among these patients five were deaf on the ipsilateral side at surgery. Among the other four patients with useful hearing before surgery, hearing was preserved to preoperative status in two patients. Four patients with diagnoses of meningioma, received operations to relieve mass effect with subtotal removal in two patients and total removal in the other two. Early diagnosis and treatment are the most important in the management planning of patients with NF-2 for reasons of early manifestation and rapid progression of the disease.

측뇌실내 종괴의 감별진단 및 수술적 치료

김동규,김봉수,이상형,심기범,왕규창,정희원,김현집,조병규,최길수,한대희 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.2

We present a series of 42 patients with the lateral ventricular mass lesions who underwent operative removal between 1979 and 1992 at the Seoul National University Hospital. These lesions included 29 tumors, 10 benign cysts and 3 arteriovenous malformations. There were 20 lesions in the trigone, 14 in the frontal horn, 6 in the body, and 2 in the temporal horn. Together with the age of the patient, the location in the lateral ventricle and the CT or MR patterns, the range of the differential diagnosis of the lesions can be narrowed. The mass were removed by various surgical approaches ; 11 by the middle frontal gyrus, 10 by the superior parieto-occipital, 13 by the middle temporal gyrus, 4 by the anterior transcallosal, 2 by the posterior transcallosal and 3 by the combined approaches. The superior parieto-occipital approach left postoperative morbidities in 64% and other approaches in 20 to 25% of the cases. These morbidities included hemiparesis, hemianopsia, aphasia, memory distubance and seizure. Most hydrocephalus disappeared without the shunting procedure after removal of the lateral ventricular mass. The high frequency of postoperative complications in the superior parieto-occpital approach require meticulous consideration in the selection of this approach.

급성심근경색후 발생한 심실중격결손 2례

김태희,이재호,김애란,허민영,문치숙,정수룡,김대경,김두일,김동수 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.4

Ventricular septal defect remains an infrequent but devastating complication of acute MI. Approximately 1∼3% of cases of acute myocardial infarction are complicated by ventricular septal rupture in the prethrombolytic era and the incidence has decreased to 0.2% with reperfusion therapy. This mechanical complication usually occurs within the first 10 to 14 days when necrotic tissue is most abundant and the collateral coronary circulation is not well developed. This lesion is generally associated with complete coronary obstruction rather than severe stenosis. Rupture of the ventricular septum is a severe mechanical complication of acute myocardial infarction, usually resulting in death unless surgical repair is performed. The bad prognosis of this event within the first 2 weeks indicates the need for early surgical rapair. This complication is more frequent after the first acute myocardial infarction in the elderly and secondary to a transmural myocardial infarction. We report two cases of ventricular septal rupture after acute myocardial infarction.

Kim's Femoral Stem의 임상적 고찰

김영민(Young Min Kim),김희중(Hee Joong Kim),진종수(Jong Soo Jin),문영완(Young Wan Moon) 대한정형외과학회 1991 대한정형외과학회지 Vol.26 No.5

서울의 Penicillinase Producing Neisseria gonorrhoeae 발생빈도(1997)

김재홍,문득곤,김정수,김용준,임동진,박상훈,김희성,이민수,송기훈,김갑형,김형석,성소영,이인섭,김석우,황지환,조창근,김경문,부태성 대한화학요법학회 2000 대한화학요법학회지 Vol.18 No.3

Background : In recent years, gonorrhea has been pandemic and remains one of the most common STDs in the world, especially in developing countries. Objective & Methods : For the detection of a more effective therapeutic regimen and assessing the prevalence of PPNG, we have been trying to study the patients who have visited the Venereal Disease Clinic of Choong-Ku Public Health Center in Seoul since 1980 by means of the chromogenic cephalosporin method. Results : In 1997. 99 strains of N. gonorrhoeae were isolated, among which 45(45.5%) were PPNG. Conclusion : The prevalence of PPNG in Seoul, which had been decreased to 39% in 1996 after a peak of 74.3% in 1993, is increased to 45.5% in 1997.

Microstructure‑Strengthening Interrelationship of an Ultrasonically Treated Hypereutectic Al–Si (A390) Alloy

Soo‑Bae Kim,Young‑Hee Cho,Jae‑Gil Jung,Woon‑Ha Yoon,Young‑Kook Lee,Jung‑Moo Lee 대한금속·재료학회 2018 METALS AND MATERIALS International Vol.24 No.6

Ultrasonic melt treatment (UST) was applied to an A390 hypereutectic Al–Si alloy in a temperature range of 750–800 °Cand its influence on the solidification structure and the consequent increase in strength was investigated. UST at such a hightemperature, which is about 100 °C above the liquidus temperature, had little effect on the grain refinement but enhanced thehomogeneity of the microstructure with the uniform distribution of constituent phases (e.g. primary Si, α-Al and intermetallics)significantly refined. With the microstructural homogeneity, quantitative analysis confirmed that UST was found tosuppress the formation of Cu-bearing phases, i.e., Q-Al5Cu2Mg8Si6, Al2Cuphases that form in the final stage of solidificationwhile notably increasing the average Cu contents in the matrix from 1.29 to 2.06 wt%. A tensile test exhibits an increasein the yield strength of the as-cast alloy from 185 to 208 MPa, which is mainly associated with the solute increment withinthe matrix. The important role of UST in the microstructure evolution during solidification is discussed and the mechanismcovering the microstructure-strengthening interrelationship of the ultrasonically treated A390 alloy is proposed.

ACTH분비 뇌하수체 선종의 진단과 치료결과

김종수,정희원,김현집,조병규,최길수,한대희 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.7

The records of 31 patients diagnosed as having Cushing's disease surgically treated via transs-phenoidal approach at our instituion between March, 1984, and April, 1994, were retrospectively reviewed in order to determine the most ideal method in diagnosing and the treatment outcome of ACTH-producing pituitary adenomas. Preoperative diagnosis was made after evaluating the patients with endocrinological studies including inferior petrosal sinus(IPS) sampling, and high-resolution computerized tomography(CT) and/or high-field magnetic resonance(MR) imaging. The sensitivity of IPS sampling technique used in microadenoma cases was 85.7% and of evaluating with CT and MR imaging, 52.9% and 61.9%, respectively. Of the 31 cases, 22 were microadenomas,6 macroadenomas. 1 hyperplasia, and 2 histopathologically identified as being not a tumor. Microsurgical procedures included 19 selective adenomectomy(SA),7 hemihypo-physectomy(HH), 2 partial adenomectomy(PA), and 3 multiple biopsies(BX). The surgical remission rates of SA group and HH group were 89.5%(17 out of 22) and 71.4 % (5 out of 7), respectively. PA and BX groups showed no remission. Out of 7 patients who underwent radiation therapy after showing no remission postoperatively, 5 demonstrated remission, giving an overall remission rate of 81.1% . It is concluded that IPS sampling and high-field MR imaging(including dynamic MR imaging) procedures are the most ideal methods in evaluating and diagnosing patients with Cushing's disease. Selective adenomectomy via transsphenoidal microsurgery is the most effective treatment modality. but such therapeutic intervention should be used with discretion. The best operative results are obtained in cases in which the margin of the adenoma is clearly visualized grossly, and the frozen bipsy of the resected margin is negative for tumor cells.

Effect of Ultrasonic Melt Treatment on Solidification Microstructure of Al–5Ti–1B Alloy Containing Numerous Inoculant Particles

Soo‑Bae Kim,Jae‑Gil Jung,Young‑Hee Cho,Su‑Hyeon Kim,Kwangjun Euh,Jung‑Moo Lee 대한금속·재료학회 2022 METALS AND MATERIALS International Vol.28 No.7

The effect of ultrasonic melt treatment (UST) on the solidification microstructure of an Al–5Ti–1B alloy containing highvolumefractions of Al3Tiand TiB2particles is investigated for various UST times with different melt holding times. Theas-cast Al–5Ti–1B alloy is composed of TiB2and polygonal Al3Tiparticles (present prior to UST), plate-like Al3Tiparticles,and Al grains (formed during UST and/or solidification). The UST causes a size reduction and homogeneous distributionof the TiB2-agglomerated region containing many submicron-sized TiB2particles pushed to the grain boundaries. The USTslightly decreases the size and improves the distribution of polygonal Al3Tiparticles enriched in the TiB2-agglomeratedregion. Unlike the TiB2and polygonal Al3Tiparticles, which exhibit a minor refining effect, the plate-like Al3Tiparticlesshow a significant refinement with UST application. The UST has a significant effect on the size distribution of Al grains byinducing the formation of medium-sized grains at the expense of small and large grains; however, it only has a slight effecton grain refinement. The degree of microstructure modification increases with increasing UST time but decreases with meltholding time after UST. The mechanisms for the refinement and dispersion of the TiB2and Al3Tiparticles and Al grains arediscussed considering fragmentation, nucleation, and growth behaviors induced by the UST and subsequent solidification.

영상분석 시스템 구현(Ⅰ)

김동욱,한한수,김석경,이중,하영호,김희수 內務部 國立科學搜査硏究所 2001 國立 科學 搜査 硏究所 年報 Vol.33 No.-